The Functions and Services

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The Functions and Services of the Department of
Pastoral Care University of Pennsylvania
Health System 1/27/10
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Case 1
A physician calls a chaplain for Ms. Clark, a
68-year-old woman with a recurrence of cancer who
has just said, I dont understand why this is
happening to me I dont think I can take it
anymore. The chaplain visits and listens
carefully to the patient as she tells of her
struggle with cancer, the recent loss of her
mother, her feelings of being overwhelmed, and
her life of faith. Honoring her story, the
chaplain follows the patients lead in thinking
about how her life of faith speaks to the meaning
of the present crisis. As Ms. Clark identifies
ways that her beliefs and spiritual resources
help her to cope, she begins to discern her
course ahead with some hope and peace.
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Overview

• The Department of Pastoral Care provides
  spiritual and religious support in a
  non-sectarian, inter-faith model for patients,
  family and staff. Chaplains do not proselytize.
• Staff chaplains
• Full and part-time Clinical Pastoral Education
  students
• Fellows
• Residents
• Interns
• Externs
• Adjunct Chaplains
• Volunteer Pastoral Visitors
• continued ?

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Overview (continued)

• At the Hospital of the University of
  Pennsylvania, a chaplain is available 24/7 for
  requests and referrals. Chaplains are assigned to
  each in-patient unit as members of the
  multi-disciplinary team
• At Penn Presbyterian Medical Center, Pennsylvania
  Hospital, Penn Medicine at Rittenhouse, and
  Wissahickon Hospice, chaplains are on staff.
• Chaplains document their visits in the patients
  medical records at each of these facilities.

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Spiritual, Psychosocial, and Cultural Values and
Needs
The Joint Commission on Accreditation of Health
Care Organizations has stated
Patients have a fundamental right to considerate
care that safeguards their personal dignity and
respects their cultural, psychosocial, and
spiritual values. These values often influence
patients perception of care and
illness. Understanding and respecting these
values guide the provider in meeting the
patients care needs and preferences.
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• The Diversity of
• Spiritual Values and
• Religious Expression
• People may express their spiritual search for
  meaning and purpose through an integrated system
  of religious beliefs and practices.
• In the Philadelphia area, there over 3500
  different religious congregations representing
  over 100 different faith traditions. Chaplains
  are prepared to serve people regardless of their
  affiliation.
• Association of Religion Data Archives, 2000
• People may also express their spiritual search
  for meaning and purpose non-religiously.

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Two Definitions of Spirituality

• 1. While many people use the words spirituality
  and religion interchangeably, they are in fact
  very different. Spirituality can be defined as a
  complex and multidimensional part of the human
  experienceour inner belief system. It helps
  individuals to search for the meaning and purpose
  of life, and it helps them experience hope, love,
  inner peace, comfort, and support.

• from "Evaluating Your Spiritual Assessment
  Process," Joint Commission The Source
  Publication of the Joint Commission on
  Accreditation of Healthcare Organizations 3, no.
  2 (February 2005) 6-7.

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• 2. Spirituality is the aspect of humanity that
  refers to the way individuals seek and express
  meaning and purpose and the way they experience
  their connectedness to the moment, to self, to
  others, to nature, and to the significant or
  sacred.

• Puchalski, C., et al., Improving the Quality of
  Spiritual Care as a Dimension of Palliative Care
  The Report of the Census Conference, Journal of
  Palliative Medicine 12, no. 10 (October 2009)
  885-904

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Spiritual, Psychosocial, and Cultural Values and
Needs

• 93 of Americans believe in God or a higher
  power.
• 89 report affiliation with a religious
  organization
• 90 of hospitalized patients rely on religion to
  cope.

Harold Koenig, MD, 2001 The Handbook of Religion
and Health Faith and Mental Health and
Spirituality in Patient Care
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Case 2
Mr. Wilson, a 32-year-old man with Cystic
Fibrosis, suffers an episode of acute breathing
difficulty. He fears that he may die and asks to
receive the Sacrament of the Sick from a Roman
Catholic priest. A chaplain, who is Baptist,
responds and makes contact with a priest from the
local Catholic church. The chaplain sits with the
patient until the priest arrives. She holds the
patients hand, provides a non-anxious and caring
presence, offers prayers appropriate for this
interfaith situation, and helps the patient
express his thoughts and feelings with his
limited ability to talk. The patients panic
subsides, and he begins breathing somewhat
better.
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Four-fold Mission The mission of the
Department of Pastoral Care is to contribute a
religious/spiritual dimension to the patient
care, research, and education missions of UPHS
through 1) Pastoral care for patients,
families, and staff. 2) Pastoral Education
and other value-based education offered to
clergy, qualified lay persons, and interested
hospital personnel and volunteers. 3)
Spirituality Research programs undertaken in an
interdisciplinary context. 4)
Partnerships developed with the surrounding
interfaith community to strengthen the
wholeness and well- being of our community.
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• Department Mission Element 1
• Pastoral Care for Patients, Families, and Staff
• UPHS chaplains provide over 30,000 pastoral care
• contacts per year.
• Chaplains offer
• supportive pastoral conversation
• consultation on treatment decisions, ethical
  dilemmas,
• and matters of religious/cultural diversity.
• religious resources
• prayer
• sacred texts
• connections to those who would provide
  sacraments

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• Department Mission Element 2
• Pastoral Education and Other Value-Based
  Education
• Accredited Clinical Pastoral Education programs
  provide experiential learning for clergy,
  seminary students and qualified lay persons.
• UPHS CPE offers a variety of programs in units
  of 400-hours each. Over 25 students are involved
  each year earning a total of more than 12,000
  educational hours.
• Training for Volunteer Pastoral Visitors, for
  local denominational groups, and for Penn Med
  students reaches a wide range of our hospital and
  community colleagues annually.

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• Department Mission Element 3
• Spirituality
• Research
• Medical research indicates the importance of
  spirituality to patients experience of illness
  and treatment, to the processes of coping,
  decision-making, and healing, and to physical and
  mental health outcomes.
• Published research by the UPHS Pastoral Care
  department has been widely quoted in medical
  literature.
• The Annual Spirituality Research Symposium has
  attracted multi-disciplinary audiences and
  creative co-sponsors since 1995.
  continued ?

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Department Mission Element 3 Spirituality
Research (continued)

• Chaplains draw on this growing body of research
  literature, in addition to religious scholarship,
  to guide their pastoral care practice.
• Clinical Pastoral Education students have
  monthly seminars to acquaint them with this
  research, and the monthly Penn Spirituality,
  Religion and Health Interest Group addresses
  these topics with inter-disciplinary,
  multi-institution, community-wide participation.

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• Department Mission Element 4
• Community
• Partnership
• Extensive participation in our accredited ACPE
  programs, our Volunteer Pastoral Visitor program,
  and in denominational training programs has built
  a strong alliance between HUP and the local
  religious community.
• Clinical Pastoral Education programming through
  the mentoring program at Sayre High School, and a
  dedicated Trauma Chaplain touch the lives of our
  youth at risk for violent injury.
• continued ?

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Department Mission Element 4Community
Partnership (continued)

• Seminars for clergy and congregations on a
  variety of topics engaged in this community
  network have a major impact on the health of our
  neighborhoods.
• Several denominational groups have established
  teams and protocols to provide care to their
  members when hospitalized at HUP.

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• Pastoral Care with the
• Penn Trauma Service
• Chaplains are designated as the primary liaison
  between the Penn Trauma Team, the trauma patients
  and their families.
• Chaplains respond to all trauma alerts, 24/7,
  establishing contact with families on behalf of
  the team and supporting patients and their
  families and the staff through immediate crisis
  intervention.
• Our Trauma Chaplain then follows all trauma
  patients throughout their admission.

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Case 3 Mr. Dow, a 21-year-old man, is
brought to the emergency department unconscious
after being shot. The chaplain on call, a rabbi,
arrives to find a large and diverse family some
are Pentecostal, some Muslim, but all are very
anxious and upset. The chaplain hears their
questions and concerns, which are primarily for
information about their loved one. He works as a
liaison between the family and the clinical team.
As he develops a relationship with the family,
one person says, Lets all pray. Aware of
religious tensions among family members, the
rabbi leads a moment of silent prayers. When a
physician arrives, the chaplain introduces her,
encouraging a sense of trust.
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• Referrals to
• Pastoral Care
• Chaplains make regular rounds on all in-patient
  units and participate in discharge and other
  patient care rounds.
• When hospitalized, patients are invited to
  identify spiritual needs of meaning and purpose,
  identify their religious affiliation, request
  assistance in meeting religious needs (including
  dietary) or request a chaplain visit.
• continued ?

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• Referrals to
• Pastoral Care
• (continued)
• Staff are encouraged to consider referrals to
• Pastoral Care for spiritual support for
• Patients and families struggling to cope with the
  impact of illness and treatment.
• Patients and families seeking support in facing
  difficult diagnoses and prognoses
• Patients seeking support in making difficult
  treatment and related personal decisions
• Patients, families and staff weighing difficult
  ethical and moral dilemmas
  continued ?

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• Referrals to
• Pastoral Care
• (continued)
• Patient or family requests for resources from
  their particular tradition (e.g. Christian
  sacraments, Sabbath candles, or inspirational
  literature.)
• Patients and families indicating spiritual
  concerns and showing signs of spiritual distress
  such as interruption of religious activities, use
  of explicitly religious language amid suffering,
  raising questions of life meaning, struggling
  with loss and grief, and apparent distress of
  unknown origin.

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Spiritual Distress

• Through serious illness, our core spiritual
  values and beliefs may feel threatened. This may
  be referred to as spiritual distress
• People need not identify themselves as religious
  to experience spiritual distress or benefit from
  time speaking with a chaplain.
• And since spiritual distress creates pain that
  may not respond to medication, it is important to
  recognize that, for both religious people and
  those who are non-religious, it occurs as a
  symptom to be addressed.

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Case 4 A nurse calls Pastoral Care with a
referral for Ms. Lake, a 51-year old woman who
has said that she is not religious but willing to
talk with a chaplain. The patient is distraught
after hearing that she must have her leg
amputated. The chaplain visits and explains
that religion need not be part of their
conversation. They speak of the human experience
of what it may be like to lose part of ones body
affecting self-image and social activity, and the
patient puts this in the perspective of her past
losses and her worries about the future. She
says, I needed to talk this out with someone who
wasnt going to judge or tell me how to feel or
simply assure me that everything will be just
fine. I think I can now make it through the
night.
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Contacting Pastoral Care For patient referrals
and general information contact the Pastoral Care
Department offices HUP (215)
662-2591 Pennsylvania Hospital (215)
829-5993 Presbyterian Medical Center (215)
662-9490 See also UPHS Internet and Intranet
home pages (under the Departments submenu).
Extensive information about Pastoral Care
Services, Programs, and Events as well as
articles and resources regarding spirituality
and diversity, and links to related sites are
available at the Department website at
www.uphs.upenn.edu/pastoral