Communication dynamics in hospice teams: understanding the role of the chaplain in interdisciplinary team collaboration

Interprofessional collaboration in palliative dementia care

Interprofessional collaboration (IPC) is essential for high-quality palliative care (PC) for persons with dementia. The aim of this scoping review was to identify IPC approaches in palliative dementia care and explore the elements constituting these approaches. We performed a search in PubMed, CINAHL, and PsychINFO using the Joanna Briggs Institute Reviewers' manual and PRISMA guidelines, and conducted content analysis of the included articles. In total, 28 articles were included, which described 16 IPC approaches in palliative dementia care. The content analysis revealed three overall elements of these approaches: 1) collaborative themes, 2) collaborative processes, and 3) resources facilitating collaboration. Frequently reported collaborative themes embraced pain management and providing care in the dying phase. These themes were addressed through intertwined collaborative processes including communication, coordination, assessing and monitoring, and reflecting and evaluating. To ensure optimal IPC in palliative dementia care, various resources were required, such as PC knowledge, skills to manage symptoms, skills to communicate with collaborators, and a facilitating environment. In conclusion, the identified IPC approaches in palliative dementia care involve diverse collaborating professionals who mainly manage symptoms, prepare for the dying phase and require material and immaterial resources to enable optimal IPC in palliative dementia care.

Some differences between social work, spiritual care, and psychology: Content variance in end-of-life conversations

OBJECTIVES

Within the multidisciplinary team, there can sometimes be lack of clarity as to the specific different contributions of each of the psycho-social-spiritual professionals: social workers, psychologist, and spiritual caregivers. This study examined the content of their end-of-life conversations with patients.

METHODS

A total of 180 patients with terminal cancer received standard multidisciplinary care, including conversations with a social worker, psychologist, and spiritual caregiver. After each patient's death, these professionals reported using a structured tool which content areas had arisen in their conversations with that patient.

RESULTS

Across all content areas, there were significant differences between social work and spiritual care. The difference between social work and psychology was slightly smaller but still quite large. Psychology and spiritual care were the most similar, though they still significantly differed in half the content areas. The differences persisted even among patients who spoke with more than 1 kind of professional. The 6 content areas examined proved to subdivide into 2 linked groups, where patients speaking about 1 were more likely to speak about the others. One group, "reflective" topics (inner and transpersonal resources, interpersonal relationships, one's past, and end of life), included all those topics which arose more often with spiritual caregivers or psychologists. The second group, "decision-making" topics (medical coping and life changes), was comprised of those topics which arose most commonly with social workers, bridging between the medical and personal aspects of care and helping patients navigate their new physical, psychological, and social worlds.

SIGNIFICANCE OF RESULTS

These findings help shed light on the differences, in practice, between patients' conversations with social workers, psychologists, and spiritual caregivers and the roles these professionals are playing; can aid in formulating individualized care plans; and strengthen the working assumption that all 3 professions contribute in unique, complementary ways to improving patients' and families' well-being.

Racial burdens in the work experiences of state-supported Black chaplains

To understand and improve the experiences of Black chaplains, it is essential to consider how they experience and are integrated into their workplaces. This article draws from interviews with ten Black chaplains in the military and prisons. In light of historic, state-sanctioned, discrimination in these institutions, we ask how these chaplains experience their workplaces racially. All experience racial burdens in the workplace as part of being the first or only Black chaplain or in response to overt racial discrimination. They identify few to no formal workplace efforts to support them as Black chaplains and spoke of resistance to informal efforts that have been tried over the years. State and federal workplaces must recognize the racial burdens Black chaplains' experiences and take action to respond to and support these systemic workplace issues.

What Chaplains Wish Nurses Knew: Findings From an Online Survey

This report presents qualitative data from a larger study that sought to examine chaplain perspectives on collaboration and nurse-provided spiritual care. This cross-sectional, descriptive study used online survey methods to distribute an investigator-designed questionnaire to a convenience sample of members of the Association of Professional Chaplains (N = 298). Findings were generated by written responses to 3 open questions that were thematically analyzed, as well as 1 quantitative item. Over half of these chaplains reported they did experience nurse "gatekeeping" at least occasionally. Themes from qualitative data revealed chaplains perceive nurses: lack understanding about the role and abilities of chaplains, sometimes overstep their role or impede the work of chaplains, and allow personal "baggage" to influence their collaboration with chaplains. Likewise, however, respondents respected nurses and were eager to collaborate. Naming these challenges to nurse-chaplain collaboration allows nurses and chaplains to begin to address them.

Care workers’ experiences discussing financial issues with families facing end-of-life decisions

Numerous studies have confirmed the presence of financial difficulties for families when a loved one is at the end of life. However, few studies examine the discussions family members have with care workers about financial issues during end of life. The research presented here examines the experiences that care workers have with family members expressing financial concerns and how care workers respond. I conducted in-depth interviews with fifty-eight care workers, defined in this study as clergy, patient advocates, and nurses who had experiences talking with families about financial issues. Transcripts of the interviews served as the data set. I transcribed, coded and analyzed the data. Families talk about financial issues openly, although sometimes guiltily. Some families express difficulties implicitly, and in these cases, care workers often had to piece together information based on other statements and behaviors of the family. Care workers suggest solutions at the interpersonal, organizational, inter-organizational, social, and national levels. Findings also support prior research that it is important for families to have end-of-life discussions before death is imminent so that families may plan accordingly, and offer insights about care workers and their role in making financial discussions easier for families.

Religious/Spiritual Referrals in Hospice and Palliative Care

This study examines the religious/spiritual referral patterns in hospice and palliative care. Religion and death are two highly intersected topics and albeit often discussed together in hospice and palliative care, little is known about how professionals respond to religious/spiritual needs of patients/families/friends and in relation to the chaplaincy team. By means of an in-depth interviewing method, this paper reports on data from 15 hospice and palliative care professionals. Participants were recruited from across five hospice and palliative care organisations, and the data was managed and analysed with the use of NVivo. Largely, participants were keen to refer patients/families/friends to the chaplaincy team, unless the former’s faith or lack thereof did not match the chaplains, in which case referrals to a religious leader in the community were favoured. This shed light to the tendencies to homogenise religious/spiritual beliefs. The paper concludes with some implications for practice and research.

Toward a Practice-Informed Agenda for Hospice Intervention Research: What Are Staff Members' Biggest Challenges?

The translation of evidence-based interventions into routine hospice care is impeded by numerous barriers, including a disconnect between research priorities and clinical care. To inform the development of a more practice-informed agenda for hospice intervention research, our team conducted a qualitative descriptive study, posing the following research questions: 1) How do hospice staff members describe their most significant work-related challenges? and 2) What regulatory changes do hospice staff members report would most improve hospice care? To answer these research questions, we interviewed 22 hospice staff members and then conducted a template analysis of the interview content. In doing so, we identified themes that described challenges in 5 key areas: time, documentation, professional roles, recruitment and retention, and burn-out. In addition, we identified a perceived need among hospice staff members for more regulatory flexibility and clarity. Based on our findings, we conclude that a practice-informed agenda for hospice intervention research includes the development and testing of interventions that increase efficiency, explicitly speak to the humanity of hospice care, and elevate the roles of all members of the interdisciplinary team.

An investigation of the challenges to coordination at the interface of primary and specialized palliative care services in Switzerland: A qualitative interview study

Good coordination of healthcare services is vital for ensuring health cost efficiency and high-quality care for patients. It is especially important in the context of palliative care as services are often highly fragmented due to a combination of diverse professional groups, organizations, and approaches to care. However, the coordination of services in this field is often evaluated as insufficient. Little is known about the challenges to coordination in this sector in Switzerland. The present study addresses this gap in research by investigating the challenges to coordination at the interface of palliative care services in Switzerland. Interviews (n = 24) with 38 healthcare practitioners working in palliative care in four cantons (Basel-City, Lucerne, Ticino, and Vaud) form the basis for this investigation. The selected cantons not only represent French, Italian, and German language regions of Switzerland but also represent diverse rural, urban, and historical contexts. Expert interviews are analyzed using structural content analysis. Three clusters of challenges to coordination were identified in the data: (1) organizational challenges to coordination, which relate to explicit forms of coordination; (2) relational challenges to coordination; and (3) structural challenges to coordination, which relate to implicit forms of coordination. The study reveals a need for better financial support for coordination in palliative care and a stronger focus on interprofessional coordination in educating professionals in palliative care. Future research on how to further foster good team coordination practices between primary and specialized palliative services merits further investigation. Since these findings are indicative of areas for improvement for coordination at the interface of Swiss palliative care services, they are of particular interest for healthcare practitioners, policymakers, and researchers involved in the evolution of coordinative practice.

Multidisciplinary staff perspectives on the integration of spiritual care in a new setting: Israel

OBJECTIVE

Integrating spiritual care into multidisciplinary care teams has seen both successful thoughtful collaboration and challenges, including feelings of competition and poor cross-disciplinary understanding. In Israel, where the profession is new, we aimed to examine how spiritual care is perceived by other healthcare professionals learning to integrate spiritual caregivers into their teams.

METHOD

Semi-structured qualitative interviews of 19 professionals (seven physicians, six nurses, three social workers, two psychologists, and one medical secretary) working with spiritual caregivers in three Israeli hospitals, primarily in oncology/hematology. The interviews were transcribed and subjected to thematic analysis.

RESULTS

Respondents' overall experience with adding a spiritual caregiver was strongly positive. Beneficial outcomes described included calmer patients and improved patient-staff relationships. Respondents identified reasons for a referral not limited to the end of life. Respondents distinguished between the role of the spiritual caregiver and those of other professions and, in response to case studies, differentiated when and how each professional should be involved.

CONCLUSION

Despite its relative newness in Israel, spiritual care is well received by a wide variety of professionals at those sites where it has been integrated. Steps to improve collaboration should include improving multidisciplinary communication to broaden the range of situations in which spiritual caregivers and other professionals work together to provide the best possible holistic care.

Care Providers' Integration of Family Requests in End-of-life Communication: Understanding What to Do and Why to Do It

End-of-life situations are fraught with challenges for patients, family members, and individuals working at the patient's bedside. Care workers must address needs of the patient, as well as his or her distressed family members. This article is an inductive investigation of care workers' (nurses, patient advocates, and clergy) experiences with end-of-life discussions when the family asks to "do everything." Participants also noted resistance to hospice in some of these encounters based on pre-existing connotations of hospice held by the family members. The article concludes with a discussion about how identifying end-of-life terms may be transformed to be more accessible for family members.

Handling Challenges Inherent in the Hospice Chaplain Role

With an increasing number of terminal patients in the United States dying in the context of hospice, the role that hospice chaplains play in providing spiritual care for patients and their families is important to examine. The hospice chaplain role requires careful navigation of the development of relationships that may end abruptly, the expectations of hospice organizations, and the needs of both patients and families. The current study uses the concept of competing role dialectics to further our understanding of the challenges chaplains face as they enact this crucial role. Data from 45 current and former hospice chaplains reveal four major role tensions hospice chaplains must develop strategies to handle: fostering relationships versus fostering autonomy, acting as team members versus acting as individuals, serving the family unit as a whole versus serving particular family members, and following the agendas of patients and families versus following one's own agenda.

Reframing, Refocusing, Referring, Reconciling, and Reflecting: Exploring Conflict Resolution Strategies in End-of-Life Situations

Many problems can occur between family members at the end of a patient's life, resulting in conflict that others-the nurses, patient advocates, clergy, and social workers involved in the case-must resolve. This article explores the strategies used by those individuals to resolve conflict. Using grounded practical theory as a theoretical and methodological framework, qualitative interviews (n = 71) revealed how they manage family conflict at the end of life. The management styles include reframing, refocusing, referring, reconciling, and reflecting (the "5 Rs"). These strategies provide a conflict management typology for those who work with families during end-of-life situations.

Nurses' Experiences of Spiritual Communication with Seriously III Children

OBJECTIVE

The goal of this study was to explore nurse experiences in communication with children about spiritual topics in order to develop training in this area.

BACKGROUND

Although spiritual care is essential in pediatric palliative care, few providers receive training about communication with ill children about spirituality.

METHODS

Researchers developed a brief survey to prompt nurses to reflect on pediatric palliative care experiences that included spiritual discussions. Nurses attending training courses voluntarily submitted stories. Qualitative data were thematically analyzed by members of the research team, consisting of two researchers with expertise in palliative care, spirituality, and communication and two expert pediatric palliative care clinicians.

RESULTS

Nurses' spiritual conversations with children revealed that children question God and the reason for their illness, have a desire to talk about the afterlife as a way of understanding their limited lifespan, and to share descriptions of an afterlife, in these cases described as heaven. Nurses conveyed the importance of being present and engaging in spiritual communication with children.

DISCUSSION

Communication training is needed and should prepare providers to respond to a child's spiritual questioning, assist parents when the child initiates discussion about the afterlife, and help parent and child understand the spiritual meaning of their illness. Chaplains serve as spiritual care experts and can help train nurses to screen for spiritual distress, have greater competence in spiritual communication, and to collaborate with chaplains in care. Quality palliative care is incomplete without attention to spiritual care.

Hospice Core Professions' Views on Interdisciplinary Teams: A Qualitative Investigation

The hospice interdisciplinary team (IDT) has been recognized as an ideal model for interprofessional collaboration. To address the manner in which interdisciplinary practices are perceived by team members, this study explored profession-based similarities and differences in perceptions among the four core hospice IDT members (physicians, nurses, social workers, and spiritual care providers) as well as experiences on the IDT. Semistructured interviews with 20 hospice professionals, 5 from each profession, were completed. Findings suggested that while hospice professions share some perceptions and experiences about hospice team membership, strengths of and barriers to teamwork, and individual members' contribution to the team, significant profession-based differences exist largely in the area of hospice team membership beyond the core members, type of language and descriptions used, perceptions of causes and effects of barriers to teamwork, and understandings of how team effectiveness is evaluated. Changes at the team-based, organizational, policy, and educational levels are needed to further maximize strengths of individual hospice IDT member and team qualities.

Communication Within Hospice Interdisciplinary Teams: A Narrative Review

Hospice care is coordinated through an interdisciplinary team (IDT), which assures that a holistic care plan based on the patient's wishes is implemented. The extent to which an IDT provides quality care may be associated with how effectively they communicate within the team as well as with patients, caregivers, and families. This review seeks to characterize communication strategies among hospice IDT members and to determine how such strategies impact patient care. Although the existing literature sheds some light on communication within hospice IDTs, further research is needed. Inquiry into the communicative process of IDTs in settings other than team meetings, such as during patient visits or informal settings, would provide a more comprehensive representation of how communication influences IDT dynamics and overall team functioning.

Same agency, different teams: perspectives from home and inpatient hospice care

Tremendous growth in hospice over the past 30 years in the United States has increased the number of terminally ill patients dying at home. Recently, however, more hospice patients are dying at inpatient facilities. To understand the varying perceptions about care in the home and inpatient hospice, we conducted semistructured interviews with 24 interdisciplinary team (IDT) members and analyzed the data using the constant comparative method. Core interdisciplinary tasks, including identifying the focus of energy, tailoring family caregiver involvement, acknowledging who is in charge, and knowing both sides differed in the home and inpatient settings. Despite the overarching umbrella of hospice care, home and inpatient hospice settings create different foci for IDT members, burdens and privileges for family caregivers, and control of the care plan. Key differences between home and inpatient hospice processes of care highlight the complexity of patient-centered end-of-life care in the United States.

Piloting a medical student observational experience with hospital-based trauma chaplains

INTRODUCTION

Medical students have typically received relatively modest training in approaches for engaging the concerns of patients and families facing life-threatening situations and terminal illnesses. We propose that medical students would perceive benefits to their communication skills, understanding of the role of the chaplain, and knowledge of emotional and spiritual needs of grieving patients and families after shadowing hospital-based trauma chaplains whose work focuses on emergency department traumas and intensive care units.

METHODS

The authors developed a pilot program in which medical students shadowed a trauma chaplain during an on-call shift in an urban level 1 trauma center. Students subsequently completed an evaluative survey of their experience.

RESULTS

Of 21 participants, 14 (67%) completed the questionnaire. Students observed an average of 1.50 traumas and 3.57 interactions with patients or families. One-third of the students witnessed a death. More than 90% of respondents agreed or strongly agreed that (1) the program provided them with a greater understanding of how to engage patients and families in difficult conversations; (2) they learned about the chaplain's role in the hospital; and (3) the experience was useful for their medical education, careers, and personal development. About two-thirds (9/14) perceived that they learned how to discuss spirituality with patients and families. All recommended the experience be part of the medical school curriculum.

DISCUSSION

Observational experiences with hospital-based trauma chaplains might be an effective nondidactic approach for teaching medical students effective communication with patients and families, collaboration with chaplains, and spirituality in patient care.

Similarities and Differences in Perspectives on Interdisciplinary Collaboration Among Hospice Team Members

This study surveyed 4 core hospice professionals (physicians, nurses, social workers, and chaplains) on their perceived level of interdisciplinary collaboration, the influences of interdisciplinary collaboration, and job satisfaction to determine potential similarities and differences based on profession and various demographic characteristics of the members or member hospices. Analysis found that there are overall no differences based on demographic characteristics. Differences between professions, while few, were largely in the area of perceptions on relationships between members of the hospice team. Specifically, social workers appear to perceive themselves as less connected to the other members of the interdisciplinary team, an area theorized to influence interdisciplinary collaboration. Difference between professions was also found in job satisfaction. Implications for hospice practice and interdisciplinary education are discussed.

Sharing atrocity stories in hospice: A study of niceness message strategies in interdisciplinary team meetings

The telling of atrocity stories offers therapeutic benefits to healthcare providers. Transcripts of hospice interdisciplinary team (IDT) meetings were used to analyze strategies for telling atrocity stories in the performance of symbiotic niceness through criticism. Symbiotic niceness draws upon niceness messages to establish reciprocal niceness by others in order to facilitate emotional labor. In IDT meetings the two predominant strategy types used were indirect and direct criticism. Nurses and medical directors engaged in niceness message strategies mostly about patients and other healthcare professionals. The study concludes that hospice IDT meetings are a venue for team members to communicate symbiotic niceness through emotional labor.

Hospitable hospitals in a diverse society: from chaplains to spiritual care providers

The chaplain's role in health care services has changed profoundly within the contexts of managerial and fiscal constraints, and increasingly pluralistic and secularized societies. Drawing from a larger study that examined religious and spiritual plurality in health care, we present findings regarding the contributions of chaplains or spiritual care providers (SCPs) as they are referred to more recently, in Canadian institutional health care contexts. Qualitative analyses of interviews with 14 employed SCPs and 7 volunteers provided insights about legitimizing and crafting the role of SPCs, becoming part of the health care team, and brokering diversity. Implications are discussed in relation to role clarification and policy development for truly hospitable health care.

Challenges and achievements in the development of spiritual-care training and implementation in Israel

In recent years, pioneering spiritual-care training programs and services have been developed in Israel. This paper examines the implementation of the training programs and the challenge of integrating program graduates in the healthcare services. The information was collected through in-depth interviews with 12 students and graduates and the directors of the three training programs. All the interviews were transcribed in full and analyzed using qualitative study methods. The interviewees emphasized the importance of practical experience, although many of them encountered some degree of antagonism during their training or placement. Continuation of personal counseling and supervision after the conclusion of the program is also essential. Some were worried that they would not find work or were concerned about negotiations with potential employers. Evidently, the implementation of spiritual-care education must continue apace and careful consideration be given to optimizing its acceptance by the establishment.

Interdisciplinary Collaboration: The Voices of Hospice Medical Directors

The value of interdisciplinary collaboration is a significant aspect of the palliative care philosophy, as identified by the founder of the modern hospice movement Cecily Saunders. The purpose of this descriptive study was to explore the experiences of hospice medical directors within this collaborative context. Open-ended interviews with 17 hospice medical directors were done and their responses were thematically analyzed. These narratives present a very positive collaborative experience by these medical directors in their hospice settings. Assisting medical directors to find time and financial opportunities for professional development and support within their role was found to be an opportunity to further improve collaboration.

Interdisciplinary collaboration in hospice team meetings

Hospice and palliative care teams provide interdisciplinary care to seriously-ill and terminally-ill patients and their families. Care teams are comprised of medical and non-medical disciplines and include volunteers and lay workers in healthcare. The authors explored the perception of collaboration among hospice team members and actual collaborative communication practices in team meetings. The data set consisted of videotaped team meetings, some of which included caregiver participation, and team member completion of a survey. Findings revealed that the team's reflection on process was most likely to occur in team meetings, however least likely to occur when caregivers were present. Although team members had a high perception of interdependence and flexibility of roles, this was less likely to be enacted in team meetings with and without the presence of caregivers. Caregiver participation in team meetings had a positive impact on collaborative communication and the potential benefit of caregiver inclusion in team meetings is explored.

An interdisciplinary team communication framework and its application to healthcare 'e-teams' systems design

BACKGROUND

There are few studies that examine the processes that interdisciplinary teams engage in and how we can design health information systems (HIS) to support those team processes. This was an exploratory study with two purposes: (1) To develop a framework for interdisciplinary team communication based on structures, processes and outcomes that were identified as having occurred during weekly team meetings. (2) To use the framework to guide 'e-teams' HIS design to support interdisciplinary team meeting communication.

METHODS

An ethnographic approach was used to collect data on two interdisciplinary teams. Qualitative content analysis was used to analyze the data according to structures, processes and outcomes.

RESULTS

We present details for team meta-concepts of structures, processes and outcomes and the concepts and sub concepts within each meta-concept. We also provide an exploratory framework for interdisciplinary team communication and describe how the framework can guide HIS design to support 'e-teams'.

CONCLUSION

The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non-linear fashion. Electronic data support, process facilitation and team video conferencing are three HIS tools that can enhance team function.