A Spoke in the Wheel: Enhancing Chaplaincy Documentation in Interdisciplinary Care Settings

Abstract

Chaplaincy is a spoke in the wheel of interdisciplinary care that uses its disciplines to better the patient’s medical condition. Therefore, chaplains ought to consider how their emotional and spiritual support helps interdisciplinary teams treat patients’ illnesses/injuries. This essay explores how chaplains can contribute more effectively to interdisciplinary care by keeping their patients’ condition in focus throughout their spiritual assessments and using models that are familiar to the medical team.

Keywords

Chaplaincy spiritual care pastoral care charting documentation

Introduction

Pastoral care departments are working hard to provide emotional and spiritual care to patients while maintaining a voice in clinical environments dominated by medical care, particularly in hospital settings (Lewellen, 2018). Chaplaincy documentation, however, may create disconnect between spiritual and medical disciplines if its documentation does not relate patients’ emotional and spiritual needs to their perception of their medical condition. A consequence can be a reduction in holistic care. The assumption of this study is that health care chaplains and other spiritual care providers chart the emotional and spiritual side of patients’ stories. The clinical discipline of pastoral care helps people process through their trauma by helping them identify how they feel and, furthermore, engage their spirituality to begin healing. The chaplain, then, is responsible to interdisciplinary team members (IDTs) to discretely and respectfully share their encounters and discoveries with them. This essay does not provide an exhaustive analysis of current models (see Penng-Keller & Neuhold, 2020) nor seek to establish a universal formula for making a progress note; rather, in this essay, I wish to illuminate the benefits of charting spiritual assessments with the care recipients’ (CR) condition in focus throughout the note and offer ways chaplains can use models familiar to IDTs that can help them utilize spiritual assessments to address the whole person.

Current Methods

Pastoral care departments use a variety of methods and models to document spiritual assessments, outcomes, and recommendations to fit the needs of their healthcare system. Chaplaincy progress notes and spiritual assessments do well to comprise cognitive models that consider CR’s background, emotional and spiritual interventions, outcomes, and recommendations following the visit. Some of the more common models are AIO, FICA, HOPE, Open Invite, ICD-10 codes, etc. (Saguil, 2012; Penng-Keller & Neuhold, 2020; Carey & Cohen, 2014). Other charting methods include the narrative model (Hilsman, 2017) and the flowsheet. My pastoral care department typically uses a combination of narrative and flowsheet in efforts to connect the more concise flowsheet report to the story of the visit.

These models are beneficial and communicate chaplains’ sacred work of emotional and spiritual support to IDT’s. I do not have enough space to review the dynamics of each model and method but of particular interest to this study’s concentration on keeping the CRs’ condition in focus is the HOPE and FICA tools. The E in the HOPE tool stands for the effects of people’s condition on their ability to practice their spirituality while the I of FICA seeks nearly the converse, that is, the importance of people’s beliefs and faith on the way they care for themselves. Both categories invite chaplains to consider how their CRs are spiritually coping with their condition. The H, O, P and the F, C, A of each tool also invites chaplain’s to record pertinent spiritual information including the patient’s faith (O and F), personal spirituality (P), sources of support (C), and pastoral needs to address (A). I am curious, however, to see the yield of these categories when the condition is in focus. For example, “How do CRs’ communities help or hurt their ability to cope with their condition (C)?” or “How can the chaplain help CRs to utilize their spirituality to cope with their condition (A)?”

The nuance is subtle, but the yield in charting with the condition in focus takes spiritual assessments from identifying CRs’ spirituality to identifying it and its effect on how they cope and perceive their condition. The medical team will not only read about what comprises of their CRs’ spirituality but also its impact on the condition which can inform how they treat it. My goal is to assist IDTs with a better understanding of their CRs’ emotions and spirituality so they can more effectively treat their medical conditions.

Vignette

Below, I provide a vignette of a pastoral care visit to distinguish a chart note that has the patient’s medical condition in focus from a note that reproduces salient information of the patient’s emotional and spiritual needs. This vignette will also provide content for the models I discuss in more detail below.

Patient (P) shares with the chaplain that a physician rudely told her that her heart condition escalated to where regular treatments were no longer effective, there was nothing left they could do, her diet was uncontrolled which would lead to her demise, and her time was limited so she should consider hospice. Chaplain reflected P’s dire situation. P expressed feeling angry at the physician’s delivery and wanting to leave against medical advice. Chaplain allowed P to process her anger towards her physician. She expressed feeling misunderstood and that her strong efforts to get healthy went unnoticed. Then, she shifted her frustration from the doctor to her own dieting efforts. P admitted that she could have done better in some areas of her diet. Chaplain helped P explore her journey with dieting. Afterward, P expressed feeling like she was emotionally stronger now to show better discipline with eating healthier foods. Chaplain reflected P’s ambition and P shared that she did not want to follow the physician’s hospice recommendations because she felt like “there was still a fight left in her.” P proceeded to talk about how meaningful her grandchildren were to her and how important it was for her to “be around” for them. Chaplain helped P explore her relationship with her grandchildren and facilitated storytelling of some meaningful moments she had with them. Afterward, P noted that God had the final say on “when her time was up.”

A progress note that uses pastoral care departmental language and written for other pastoral care providers may read as follows.

Chaplain provided emotional and spiritual care by empathically listening to the patient’s frustrations with the medical team. Chaplain employed active listening to facilitate patient’s story-telling about her journey with heart failure. Chaplain provided compassionate presence when patient shared feelings of anger, fear, and joy. Patient expressed leaning on her faith in God as Timekeeper.

However, a progress note that considers the benefit of IDTs keeps those pastoral elements in mind but uses the patient’s medical condition as a governor or context-setter for communicating the practices and outcomes of the chaplain’s emotional and spiritual support. Please note the emphasis in the following example on the patient’s emotional/spiritual processing in relation to her perception of her health.

Patient processed her journey with a heart condition that she described as ‘admittedly declining.’ Patient expressed feeling angry and disheartened by her encounter with some of the medical team. She shared that she did not feel understood and that her efforts to get healthy were not acknowledged. Patient also shared that she tried hard to eat right but admitted to feeling she ‘could have done more.’ Patient processed physician’s prognosis and expressed feeling incongruent with it. Patient shared that she was not ready for hospice and perceived that ‘there was still a fight left in her’ and wanted to stick around for her grandchildren whom she shared were very meaningful to her and ‘motivation to keep going.’ Patient used hopefulness to cope with her condition and wants to fight for better health and possibly seek additional opinions. Patient expressed using her faith in God to cope with end-of-life; God is Timekeeper and she is not ready to concede her life.

The focus of this progress note is on what the patient processed in relation to how she perceives her condition and care plan. This note assumes the clinical disciplines of empathic listening, active listening, and reflection, and presents their results in a manner that informs IDTs of how the patient perceives her diagnosis/prognosis, enabling them to formulate their care plans for her accordingly. The next physician, for example, could read this note and learn that P does not have the emotional capacity to adhere to the advised care plan and needs extra time or different intervention to process and share her position.

Becoming Bilingual

Whichever model of progress note chaplains choose to use, I would suggest that the language within ought to resonate with IDTs. Robert J.R. Yim (2001) refers to Charles Gerkin’s (1984) The Living Human Document to highlight the isolation that happens when chaplains use clinical theological language when they chart. He notes that Gerkin calls for chaplains to use language that includes, not excludes IDTs. Yim writes, “Just as physicians can use codified, technical medical terms which lay persons do not readily understand, chaplains may unwittingly use theological jargon, God talk or church-speak that are not part of usual physician vocabulary” (p. 50). He asks chaplains to use language that reveals “acute awareness as to who is receiving the communication,” (p. 51) which shows the chaplain’s desire to be understood and further inquired by the care team.

Wendy Cadge and Julia Bandini (2015) conclude in their study on the evolution of American spiritual assessment that spiritual assessments are formulated largely within the vacuum of a single department which leads to confusion across IDTs regarding the meaning of spirituality. They find that operating in isolation creates a lack of clear inter-disciplinary communication for how IDTs process religion and spirituality into their holistic healthcare. This conclusion exposes the need for spiritual care departments to present discoveries from their assessments in ways that other disciplines can understand. I hear these conclusions as a call for chaplains and other spiritual care workers to become “bilingual,” meaning, to chart with language and structure that benefit both their own pastoral care colleagues and IDTs.

“Bilingual” Language of the Progress Note

Language pertinent to the field of pastoral care such as “empathic listening,” “active listening,” or “spiritual support,” are loaded concepts with meaning that is possibly unfamiliar or unhelpful to IDTs. Such expressions communicate with other chaplains regarding what services were provided, but their usefulness outside of pastoral care can be isolating at times. VandeCreek and Lucas (2001) were pivotal in bringing chaplaincy into an outcome-oriented practice, but as Nadia Siritsky and Ben Miller (2018) illuminate, there is a distinction between languages in pastoral care departments from other interdisciplinary teams. They highlight the medical field’s use of statistics and data with a focus on outcomes. They argue that, “[w]hen chaplains can speak the same language as their colleagues, then they will be able to more fully integrate into patient care and serve effectively and confidently” (p. 17). Gordon Hilsman (2017) writes that chaplain documentation varies depending on the chaplain’s agenda and audience, but even in such variation, he suggests they should utilize the opportunity to use language familiar to IDTs.

Chaplains can inform IDTs of their CRs’ perspectives and emotional/spiritual needs that can, in turn, improve their health condition or benefit their care plan. This is not to say that chaplains should operate as one of their medical colleagues or even appropriate diagnostic language that IDTs use; rather, chaplains ought to consider writing progress notes with language and structure that is familiar and contributive to the way other IDTs care for their patients. If IDTs resonate with statistics, data, and measurable outcomes, then chaplain progress notes might assist them better when centered on CRs’ perception of their medical condition and demonstrate how chaplain interventions contribute to CR’s awareness of and ability to cope with their condition. Chaplains cannot diagnose medical conditions, but they can illuminate areas in CRs’ inner life, emotions, attitudes, spirituality, and experiences that directly affect their ability to cope, adhere, or understand their illness and care plan. IDTs can use these discoveries and outcomes to gauge and monitor how receptive patients are to their medical approach.

“Bilingual” Structure of Progress Note

Chaplains and other spiritual care providers already have an array of helpful models to use for charting especially if the author has the patient’s condition in focus throughout the note. Not every model, however, automatically challenges users to include the context of the condition in their responses. Hilsman (2017) suggests that one way to make the progress note more accommodating to IDTs is to model its structure off the general format used by physicians and nurses. Chaplains can, therefore, present their findings more “bilingual” by charting with a structure that is more familiar to IDTs.

The Medical SOAP Note

Lawrence L. Weed (1968) addressed in his formative article “Medical Records that Guide and Teach,” the need for clinicians to consider the total context of patients’ problems when they document. He observed that management of any one problem requires “a knowledge of at least the presence of all of them” (pp. 593–600). Weed contests that a more systematic approach to documentation can enhance continuity of care by showing progression of treatment that considers the whole context of patients’ problems. A comprehensive and systematic approach can bring consistency in care and allow other IDTs to study, critique, or appropriate its information into their own care. He proposed the systematic SOAP framework—Subjective, Objective, Assessment, Plan—which became widely accepted across interdisciplinary clinical systems. Within this framework, the Subjective field documents what patients experience from their point of view; the Objective field focuses on the clinician’s objective observations of patients’ status and treatments; the Assessment field focuses on review of patients’ progress and current status; and the Plan field focuses on what the clinician intends to provide patients in future visits. These fields establish a cognitive framework that considers the whole medical context. Other studies in healthcare communication utilizing SOAP or other similar cognitive models (i.e. SBAR) statistically demonstrate increases in patient safety (see Raymond & Harrison, 2014), more thorough communication for patient handoff with expedited care (see Shahid & Thomas, 2018), and interdisciplinary collaboration (see Uhm et al., 2019).

Pastoral Care and the Medical SOAP Note

Regardless of what cognitive framework is used (SOAP, SBAR, etc.), IDTs use a “Subjective” aspect in their notes; meaning, they record patients’ expressions of how they experience their problems or view their medical situation. This “Subjective” field is precisely where the chaplain’s clinical discipline intersects with other IDTs’ provision of care. The chaplain’s progress note can expound on the “Subjective” field and provide IDTs with progress notes that highlight their patients’ perspectives of their medical condition and how they use their spirituality to cope. Chaplains can illuminate the “S” of other clinicians’ SOAP notes by generating their own spiritual care SOAP note. Since Weed, others have argued for various modifications or alterations to the SOAP framework (see Donnelly & Brauner, 1992; Lenert, 2016). Due to the familiarity of SOAP and its generally wide acceptance, I will engage its framework to explore its cognitive values for pastoral care progress notes.

Establishing “Bilingual” Framework

The SOAP framework guides clinicians to consider the whole context of patients’ problems, demonstrate awareness of their patients’ needs, report on outcomes/results, and project plans for development in patients’ care. I will demonstrate below how the SOAP framework can function similarly for chaplains and other pastoral care providers.

Subjective (Substance of Visit)

The “Subjective” field briefly presents the substance of what CRs processed during the visit and what perceptions patients have regarding their condition. The goal of this field is to provide a snapshot of the transactions between chaplain and patient. The following partitioning of the vignette’s progress note above provides an example of this snapshot: “Chaplain provided emotional and spiritual support to patient who processed her journey with a heart condition that she perceived as ‘admittedly declining.’ Chaplain helped patient process her perceived prognosis. Pt expressed not feeling ready for hospice.”

IDTs can use this field to succinctly see if their approach is working, if their communication is clear, and if their CRs understand and adhere to their care plan. Clinicians who are sensitive to their CR’s experience could read this note and determine better ways to approach this patient and possibly, if the patient’s health allows, offer other treatment plans that accommodate the patient’s goals and ambitions. This part of the note fosters the culture for IDTs to investigate how they can approach their CRs with greater sensitivity to their emotional and spiritual needs as it affects their medical condition.

Objective (Observed Coping Skills)

The “Objective” field presents observed coping skills of CRs that reveal how they use their coping to help or hurt their medical condition. This field considers how the medical, psychological, family systems, psychosocial, racial/ethnic, social, and spiritual dimensions affect how patients and families are using their spirituality to cope with their illness and other concerns in life. Since one’s coping skills impacts one’s spirituality and vice versa, I submit that the chaplain’s visit should consequently reflect coping skills to help CRs become more aware of what they use (positive or negative) to process their healthcare experience. Chaplains can provide their objective observations to IDTs with critical awareness for how to formulate their care plan in a way that accommodates the coping skills of their CRs. The list below concisely names some of the predominate coping skills expressed in P from the vignette above.

Patient uses hopefulness in getting better to cope with her condition

Patient copes by fighting for better health through medical treatment and dieting

Patient uses her faith in God to cope with end-of-life timing

IDTs reading this field may or may not be able to accommodate every coping method their CRs use. A physician for the above patient, for example, may find this patient as coping with hope in a false reality that distracts from productive care planning. On the other hand, the physician can accommodate this patient’s need for hope and reflect that hope in what care planning is available to her at this time.

Assessment (Spiritual)

The “Assessment” field presents a snapshot of how CRs’ illnesses make them feel and how they form or struggle to form meaning and purpose out of them. There are a variety of methods used to formulate this spiritual assessment. Cadge and Bandini (2015) count over 30 spiritual assessment tools from various departments. They expose the trend that each clinical department develops their own assessment tools rather than draw from other disciplines. The upshot to formulating one’s own assessment model is the ability to target specific patient groups that benefit the particular caregiving of the department; however, this freedom comes with limitations. Fitchett (2019) observe three primary limitations in current spiritual assessment models. The first limitation is models’ “one-size-fits-all” approach which is designed to fit multiple clinical contexts but concedes research-informed, condition-specific contexts. The second limitation is models’ focus on the narrative which captures the relational dynamics but often at the expense of measurable outcomes. The third limitation is the lack of standardized evidence-based approaches to clinically assess one’s spirituality. I would add that a fourth limitation in current models is their use of inner-disciplinary language and structures at the exclusion of interdisciplinary communication. Chaplains often present spiritual assessments using the language of their department which IDT’s may struggle to understand or dismiss as irrelevant. A spiritual assessment that considers the benefit of IDTs can highlight key features of CRs’ emotional and spiritual needs that contribute to establishing purpose and meaning from their condition and care planning.

Whichever spiritual assessment tool one uses (IAO, FICA, HOPE, SOAP, etc.), I suggest that the chaplain relates its data to the CR’s condition and care planning. This type of assessment is pragmatic in that it completes the CR’s hypothetical expression, “My condition says that I am (fill in the blank)” or “My condition makes me feel (fill in the blank).” For example, a patient expresses sadness over his new cancer diagnosis and says, “What have I done to deserve this? I’ve been a pretty good person all my life. I’ve tried to help others when I can.” This patient feels that his ailment is punitive and may complete the hypothetical expressions with, “My cancer diagnosis says that I am forgotten or worthless” or “My cancer makes me feel angry because I do not deserve this, it is not fair.” These expressions cascade into other meanings he might derive about himself.

The spiritual assessment, particularly for a follow-up visit, could also include a note regarding the outcome of the chaplain’s intervention. One hope of a chaplain’s visit is to help CRs attain greater emotional and spiritual awareness of themselves. The outcomes should reflect how the chaplain’s intervention of emotional and spiritual support changes, edifies, or reframes CRs’ perception of their diagnoses, prognoses, or care plans. This field presents the concise spiritual journey of how the chaplain’s visit affected the CRs’ ability to engage their spirituality and better cope with their illness and other concerns in life. Below is a concise presentation of P’s spiritual assessment that comprises of (1) her expression of emotions and feelings, (2) the chaplain’s intervention, and (3) the outcomes/results of the intervention. Please note that the medical condition stays in focus when communicating her emotional/spiritual needs.

Patient expressed feeling angry and disheartened by her encounter with some of the medical team. Chaplain provided service recovery. Patient’s anger deescalated, and she no longer wants to leave against medical advice. Patient also expressed gratitude for being heard and hopefulness towards extending quality of life

Patient expressed feeling shame from her recent prognosis that exposes her dieting shortcomings and the severity of her need to become more disciplined in the way she eats. Chaplain reflected patient’s dieting struggle. Patient expressed interest in a second opinion and exploring dieting solutions that she will observe.

Pt expressed hopefulness in her feeling valued and worth. Chaplain reflected patient’s empowerment from a positive support team. Patient stated that her grandchildren are significantly meaningful and give her purpose and motivation to fight for life. Patient also shared about having value before God whom she understood as Timekeeper and used God as another a source of strength.

IDTs can utilize this field to formulate a critical sense of how their CRs appropriate their care plans into what matters most and how they use it to establish purpose in their lives. This section helps clinicians to see what of their care plan creates meaning and purpose and where they can modify it to make the care plan more accessible or achievable to CRs. Clinicians of P, for example, can learn that they need to reflect her need to pause for a moment and engage her interest in more disciplined dieting. If such a plan is not an option, then they can show sensitivity to her desire to live and provide her with efforts she can pursue to extend a certain quality of life.

Plan (Desired Contributing Outcomes/Recommendations)

The “Plan” field provides the chaplain’s desired contributing outcomes (see VandeCreek and Lucas, 2001) or recommendations based on the CR’s spiritual needs as illuminated by the spiritual assessment. Such recommendations center on how CRs can process, utilize, or improve their spirituality to better cope with their medical condition. Chaplains are not always promised a follow-up visit, particularly in a hospital setting, so this field could contain the chaplain’s recommendations for how CRs can further engage or develop their spirituality to assist their journey with their medical condition. Chaplains can also use this field to offer recommendations to other IDTs regarding how they can engage CRs with sensitivity to their emotional and spiritual needs. Below is a list of recommendations for how chaplains and IDTs ought to proceed with patient P based on the results of the chaplain’s interventions.

Chaplain recommends continuing to help the patient process her desire to get healthier and process areas or relationships in her life that make food choices difficult.

Chaplain recommends further exploration of patient’s ambition towards new dieting.

This field provides a working platform that IDTs can use to learn how their CRs are emotionally and spiritually engaged with their care plan and then gauge how to best move forward. A physician for patient P could read the list of outcomes and formulate how to address the patient’s tension of wanting to extend her quality of life yet needing to realize the limited care plan options available. Furthermore, IDTs would learn that P has an emotional/spiritual trigger that obstructs her ability to employ better dieting that needs consideration.

Adapting “Bilingual’ Framework

I encourage pastoral care teams to formulate a template that employs the theory proposed above in a manner that considers their individual healthcare system’s mission, vision, and values. My healthcare system uses SBAR (Situation, Background, Assessment, Recommendation) and Epic to formulate progress notes (see Parry, 2011). The same principle argued above applies here; chaplains communicate the outcomes of their interventions to help IDTs better understand the emotional/spiritual needs of their patients as they engage their care plan. The Situation field contains what is happening at the present time which is the story/narrative about what CRs processed and their perspective of their medical situation. The Background field identifies the circumstances leading up to CRs’ current situation, which includes observed coping mechanisms that CRs use to manage their condition. The Assessment field is where chaplains provide their spiritual assessment of CRs including their expressed emotions/spirituality, interventions made, and results that highlight meaning produced from their ailment. The Recommendation field presents what could be further processed by the CR or what IDTs and other chaplains could do to utilize the spirituality of their CRs and help them better cope with their condition or engage their care plan. I construct the following template below for my pastoral care department and populate its fields with details from my visits:

Pastoral Care

Situation (What patient processed and patient’s perception of medical condition)

Background (Observed coping skills of patient for medical condition)

Assessment (1) Spirituality/Emotions expressed 2) Intervention 3) Outcome)

Recommendation (Suggested recommendations for follow up visits)

Surveying the Model

The pastoral care department of the hospital in which I serve links with our Palliative Care team (PC) to explore the benefits and growing edges of the chaplain’s SBAR progress note described above. For the past year, we have taken an interdisciplinary perspective on how effective the SBAR note communicates the chaplain’s interventions, presents the visit’s outcomes, and utilizes the chaplain’s assessment of how IDTs and CRs can move forward in their care plan. Our SBAR has since increased our value ratings by our PC due to our note’s centricity on the medical condition of their patients and its presentation/organization of content. I invited PC to survey 25 SBAR notes and 25 traditional narrative-based notes from multiple chaplains to see which format provided them with more helpful information. Our PC reported that out of 25 SBAR notes, 24 communicated pertinent information and out of 25 narrative-based notes, 19 communicated pertinent information. This exercise showed in this situation a twenty percent increase in the likelihood that SBAR charting will help our chaplains communicate CR’s emotional and spiritual needs in a way that benefits our PC’s patient care. Our PC made additional comments regarding the efficacy of our SBAR. They appreciated its organization of information and ease to glean what is important to patients. They also liked how succinctly the SBAR note informs them about better ways to approach patients on the next visit, which more intuitively fulfilled Domain 5.1.7 and 5.2.4 in the National Consensus Project for Quality Palliative Care (2018) Guidelines stating that “[t]he professional chaplain is the spiritual care specialist, conducting the assessment and addressing the spiritual aspects of the care plan” (p. 32).

This survey is a limited exercise that represents only our department’s interaction of SBAR with Palliative Care within our hospital system. Its conclusions, however, provide us impetus to continue using SBAR and assessing its efficacy with other IDTs more rigorously. The validity of our SBAR model or others like it needs more formal validation through testing and studies.

Conclusion

My hope is that the above survey and the assessment of chaplaincy documentation in this manuscript provides a stimulus for others to explore the effectiveness of documenting with CRs’ condition in focus and with models that are more familiar to IDTs. I experience chaplaincy as a spoke in the wheel among other healthcare disciplines who work together to help patients with their medical conditions, only, chaplains have the unique position of addressing the condition from supporting CRs’ emotional and spiritual needs. The chaplain’s sacred work is with the soul of CRs, where their spirit and body reside (see Hilsman, 2017). I encourage chaplains, therefore, to not only be interested in the emotional/spiritual care of CRs but also remain mindful of the body in their documentation to better assist IDTs in their efforts to bring CRs into better health.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Eric J. Fudge

Eric J. Fudge, PhD, BCC, studied Bible and Theology throughout his education and served in a variety of educational and ecclesiastical ministries. Eric is a chaplain in the pastoral care department of TriHealth's Good Samaritan Hospital in Cincinnati, OH and participates on the faculty of Good Samaritan College of Nursing and Health Science as a professor of Ethics in Nursing.

References

Cadge

Bandini

(2015). The evolution of spiritual assessment tools in healthcare. Society, 52(5), 430–437.

Carey

Cohen

(2014). The utility of the WHO ICD-10-AM pastoral intervention codings within religious, pastoral and spiritual care research. Journal of Religion and Health, 54(5), 1–16.

Donnelly

W. J.

Brauner

D. J.

(1992). Why SOAP is bad for the medical record. Archives of Internal Medicine, 152(3), 481–482.

Fitchett

(2019). Development of PC-7, a quantifiable assessment of spiritual concerns of patients receiving palliative care near the end of life. Journal of Palliative Medicine, 20(20), 1–6.

Gerkin

(1984). The living human document: Re-visioning pastoral counseling in a hermeneutical mode. Abingdon Press.

Hilsman

(2017). Spiritual care in common terms: How chaplains can effectively describe the spiritual needs of patients in medical records. Jessica Kingsley.

Lenert

L. A.

(2016). Toward medical documentation that enhances situational awareness and learning. AMIA Annual Symposium Proceedings Archive of PMC, 2016, 763–771.

Lewellen

(2018). Chaplains work to update meaning of spiritual care. Journal of the Catholic Health Association of the United States, 99(3), 37–40.

National Consensus Project for Quality Palliative Care. (2018). Clinical practice guidelines for quality palliative care (4th ed.). National Coalition for Hospice and Palliative Care.

10.

Parry

(2011). 1000 Lives plus O FYWYDAU: Improving clinical communication using SBAR. Tools for Improvement, 3, 1–24.

11.

Penng-Keller

Neuhold

(2020). Charting spiritual care: The emerging role of chaplaincy records in global health care. Springer.

12.

Raymond

Harrison

M. C.

(2014). The structured communication tool SBAR (situation, background, assessment and recommendation) improves communication in neonatology. South African Medical Journal [Suid-Afrikaanse Tydskrif Vir Geneeskunde], 104(12), 850–852.

13.

Saguil

(2012). The spiritual assessment. American Family Physician, 15(86), 546–550.

14.

Shahid

Thomas

(2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care – A narrative review. Safety in Health, 4(1). https://doi.org/https://doi.org/10.1186/s40886-018-0073-1

15.

Siritsky

Miller

(2018). Measuring pastoral care performance. Journal of the Catholic Health Association of the United States, 99(3), 17–23.

16.

Uhm

J.-Y.

Kim

(2019). Implementation of an SBAR communication program based on experiential learning theory in a pediatric nursing practicum: A quasi-experimental study. Nurse Education Today, 80, 78–84.

17.

VandeCreek

Lucas

A. M.

(2001). The discipline for pastoral care giving: Foundations for outcome oriented chaplaincy. Haworth Pastoral Press.

18.

Weed

L. L.

(1968). Medical records that guide and teach. The New England Journal of Medicine, 278(11), 593–600.

19.

Yim, R. J. R. (2001). A case study of jerry: Emphasizing team communication through use of the discipline. In L. Vande Creek and A. Lucas (Eds.), The Discipline for Pastoral Care Giving: Foundations for Outcome Oriented Chaplaincy (pp. 45–56). The Haworth Pastoral Press.