St. Louis, MO—Through staff collaboration and the creation of patient narratives in electronic medical records, spiritual care plans encourage caregivers to remember the human spirit of their patients with cancer, according to Lori McKinley, MDIV, BCC, an ordained chaplain at Mercy Health, a Catholic healthcare ministry serving Ohio and Kentucky.
To address the spiritual needs of their patients, she and her team launched a pilot study entitled “Spiritual Care of Cancer Patients Across the Continuum.” The goal of the study was “providing hospitalized cancer patients, identified as experiencing spiritual and/or emotional distress, with resources that support spiritual coping across the continuum of care,” Ms McKinley said at the Association of Community Cancer Centers 33rd National Oncology Conference.
To implement the program, the team at Mercy Health first researched spiritual care best practices for discharge from acute care to the community, and found that a paucity of research existed on the discharge process. They identified local community resources and opportunities for collaboration, and streamlined the process by which they connected patients to these resources. They then used electronic medical records to classify those patients with cancer who expressed spiritual or emotional distress and the desire for spiritual guidance. Finally, they implemented a small “test of change” in which chaplains began using spiritual care planning in their care of patients.
The Steps to Spiritual Care Planning
Nurses conducted a “distress screen” designed by a psychologist following guidelines from the National Comprehensive Cancer Network. Patients were asked to rate their distress over the past week and on the current day on a scale of 0 to 10. If a patient scored 4 or higher, the nurse asked additional questions concerning practical, physical, emotional, and spiritual concerns that he or she might be experiencing. If deemed necessary, the patient was then referred to spiritual care, where the chaplain developed an appropriate spiritual care plan that nursing and other disciplines used in their documentation.
According to Ms McKinley, these spiritual care plans address an array of patient concerns, including spiritual struggles, emotional distress, life adjustments, and support with decision-making, unresolved conflicts and relationships, sacramental and religious needs, grief, and facing the end of life.
“The patients are connected to appropriate resources in the community, and the chaplain, the social worker, the palliative care specialist, and the physician are all engaged in this spiritual care plan in different ways. The narratives that develop in these charts are done in a very respectful way,” said Ms McKinley.
Care of Patients with Cancer Intensifies
The results of the “test of change,” conducted from November 18 to December 18, 2015, showed that spiritual assessments were completed in 39 of 48 identified patients with cancer. Eleven of those patients received distress screens, but Ms McKinley noted that this test was actually given before the implementation of a distress screening policy at the institution.
“In the 3rd and 4th quarters particularly, our care of cancer patients intensified. We increased our visits with patients, our referrals increased from 6 to 24 between the 2 quarters, and a total of 29 spiritual care plans were initiated,” Ms McKinley reported.
She advocates the use of the distress screen in other patient populations, and hopes that the continued collaboration between electronic medical records and nursing informatics will create more consistent electronic pathways between the outpatient and inpatient settings, as well as more comprehensive discharge plans.
Ms McKinley said the pilot project has allowed for greater multidisciplinary collaboration among the staff, increased spiritual care visibility in the medical record, and created a better understanding of how spiritual care supports patients in distress, all while providing patients with more targeted spiritual and emotional resources.