Chaplain Certification and Credentialing
Frequently Asked Questions
• How long does the process take?
Every applicant is unique and personal circumstances vary. The length of time from application submission to approval/rejection takes an estimated 4 to 6 months. The timeline is mainly dictated by the candidate’s readiness to take the test and availability to be scheduled for the exam.
• How many types of certification does SCA offer?
SCA offers three types of certification: Advanced Practice Board Certified Chaplain (APBCC, Board Certified Chaplain (BCC), and Credentialed Chaplain (CC). In addition, SCA offers a Spiritual Care Generalist Certificate for candidates interested in becoming spiritual care generalists. In addition, SCA offers one specialty certification in hospice and palliative care (APBCC-HPC).
• What is APBCC?
An Advanced Practice Board Certified Chaplain (APBCC) has demonstrated advanced skills in the provision of and leadership in spiritual and chaplaincy care by successfully completing a standardized test of core knowledge derived from evidence-based quality indicators for spiritual care as well as a simulated patient exam that evaluates competency in direct patient care. APBCC chaplains have been trained and tested in standardized curriculum based on the latest evidence in areas including department management, HIPAA regulations, the assessment, diagnosis and treatment of spiritual distress, cultural competency, advance care directives, patient clinical care, staff support, grief, and bereavement among other essential topics.
• What is the process of Certification or Credentialing like?
If you haven’t already done so, you must first become a member of the Spiritual Care Association.
After carefully reviewing the requirements for the certification you are seeking, begin an online application (please note you must be logged in in order to begin an application).
Submit your application online along with all the required supporting documents. You will receive an email once your application and documents have been reviewed and accepted. At this point, you are “pre-approved” to continue to the next phase.
Next phase: you will need to complete (1) the Standardized Clinical Knowledge Test, and (2) the Simulated Patient Exam through a patient encounter. You will have 6 months to successfully pass both the test and the exam (the 6 months begin from the day you receive notification that your documents have been accepted). You can take the test and exam in any order.
• What is the application fee?
The non-refundable application fee is $300 for APBCC; $300 for BCC (or $150 if you are already BCC with another recognized organization); and $275 for CC.
• How much are the annual maintenance fees?
Advanced Practice Board Certified Chaplains (APBCC), Board Certified Chaplains (BCC) and Credentialed Chaplains (CC) need to pay annual maintenance fees to maintain their APBCC, BCC and CC. The annual maintenance fee is $150. Maintenance fees are due annually every January 1st. You will be invoiced in November of the previous year for the upcoming year. There are no additional fees associated with the APBCC-HPC specialty certification.
Please note: your first invoice will also include a pro-rated amount for the balance of the current calendar year in which you were certified/credentialed. For example, if you are certified or credentialed in August, you will be invoiced for September, October, November, and December of the current year (pro-rated amount of $50, which is 4 months), and the maintenance fee for the following calendar year of $150. In this example, you would be invoiced a total of $200. For subsequent years, you will only be invoiced the annual maintenance fee of $150.
• What are the continuing education requirements (CEs) to maintain Certification or Credentialing?
To maintain Advanced Practice Board Certification (APBCC) status, 30 continuing education hours are required every year. To maintain Board Certified Chaplain (BCC) status, 24 continuing education hours are required every year. To maintain Credentialed Chaplain (CC) status, 12 continuing education hours are required every year. There is no particular format for filing this report. You will get a notice from SCA when fees and CE reports are due. Simply sending a list of activities that have advanced your practice of spiritual care and how many hours you spent on each in the last year will be sufficient.
• Is membership in SCA required?
Yes. Current membership in SCA is required for all three types of certification: APBCC, BCC, and CC.
• Who should I contact if I have questions during the process?
If you have any questions during this process, please contact our Certification Administrators at: email@example.com. If you would like to reach the Director of Certification of the Spiritual Care Association, The Rev. George Handzo, BCC, you can reach him at firstname.lastname@example.org. Questions about fees and payments should be sent to Cindy Melero at email@example.com.
Standardized Clinical Knowledge Test
• In what time period do I have to take the test?
You will have 6 months starting on the day you receive your login credentials to take the test. You will receive your login credentials (and instructions) after your documentation has been accepted. We will notify you via e-mail.
• Is the test timed? How many questions are on the test? What constitutes a passing score?
The APBCC Test has 100 questions. You will have 120 minutes to complete the test. A passing score is 75% or higher.
The BCC Test has 85 questions. You will have 100 minutes to complete the test. A passing score is 75% or higher.
The CC Test is 85 questions. You will have 100 minutes to complete the test. A passing score is 65% or higher.
• What topics are covered in the test?
We have prepared a very thorough overview of what is covered in the test. You can find this information in this document’s Appendix 2: What’s in the Test.
• Do you offer a preparation course for the test? What is the cost?
Yes, SCA offers a preparation course called, Preparation for Standardized Clinical Knowledge Test for Board Certified and Credentialed Chaplains. Please note: it is not a requirement to purchase this course for certification or credentialing.
• What happens if I fail the test?
If you fail the test, you will be allowed to retake the test one more time at no additional cost to you. If you fail the test again, you may retake the test again for a fee of $75. There are no limits to the number of times to retake the test. However, all the re-takes must take place within the 6-month deadline.
• Who gets a copy of my test score?
The test taker and SCA’s certification director are the only two people who receive notification of the test score. Test scores are not shared with anyone else.
• When do I find out if I passed or failed?
Once you have completed the test, your grade will be displayed to you. You will also be notified by an SCA Certification Administrator as to the results of your test. Please note: we are not able to send reports of the test to you.
• What is your Accommodation Policy?
The Spiritual Care Association certification process includes a timed test which requires reading words in English on a computer screen with some speed and an interview online which requires being able to hold a conversation in English via computer. In general, the testing does not require any abilities beyond those normally required by any health care chaplaincy job. Any candidate who believes they need an accommodation to complete this testing should notify SCA no later than one week after they are approved to proceed with testing. This notification must include a description of the reason for the accommodation and documentation from the candidate’s physician of the condition requiring an accommodation. No accommodation will be granted after the candidate has begun the testing process.
• How were the questions and answer options on the test developed?
It is very important to understand that the questions and the answer options are based on the evidence in the field. That is, every correct answer is evidence-based which means it is supported by research, guidelines or expert opinion. This evidence may not conform to the way you have thought or done things or even how your institution does things. Put another way, you should answer each question based on what the evidence says rather than based on what you think is the right answer. Thus, your chances of passing the test will be significantly improved if you make sure you are familiar with the literature we have suggested.
While the questions and answer options on the test have been carefully vetted by subject matter experts in the particular content area, we welcome constructive and specific questions and suggestions about the clarity with which the questions or answers are stated and even smaller issues like grammar and spelling. Note that the questions cannot be considered unless the specific text of the question the concern relates to is stated. These questions should be sent directly to the Director of Credentialing and Certification at firstname.lastname@example.org.
Simulated Patient Exam
• What is the Simulated Patient Exam?
The Simulated Patient Exam is a simulated patient encounter that will be scheduled in advance with the candidate and will be done remotely using a computer application called Zoom (similar to Facetime or Skype). Zoom is a widely used free application that will easily run on any computer. Your computer needs to have a camera. You will also need access to a speaker phone in order to participate (alternatively, if your computer has a microphone, you can use that as well as your audio). The candidate can participate in this exam from any location where he/she can have privacy and quiet.
At the start time for the session, the candidate will be presented with the text of a referral that mimics the kinds of referral a chaplain tends to receive in normal practice. The referral will be for a situation that requires an immediate visit. A couple minutes later, the client, who might be a patient or a caregiver, will join the call, and the chaplain will commence the encounter (visit) as he/she normally would. The client will be played by a professional actor who has thoroughly studied extensive information about the person he/she is portraying. The candidate will have 20 minutes for the encounter. Within 30 minutes of the close of the encounter, the candidate will submit a chart note on the encounter using the criteria on the scoring sheet. The encounter will be scored by the simulated patient and by two or three senior chaplains.
• How do I get scheduled to take the Exam?
After your application and documents have been accepted, you will receive an email from an SCA Certification Administrator with several dates to choose from to be scheduled to take the exam. You must select one of these dates. Failure to select a date within the 6-month period will constitute a failed exam. Likewise, a no-show during your exam date will also constitute a failed exam.
• When do I get notified if I passed/failed the Exam?
Candidates will be notified by email as to whether they pass the exam or not, normally within a couple weeks. Those who do not pass will be automatically sent a copy of the reviewer’s comments. Any candidate who passes the exam and wants a copy of the reviewer’s comments can request them by email.
• What happens if I fail the Exam?
If you fail the Exam, you will be allowed to re-take the exam; however there will be a fee of $100. To re-take the exam, you will also be given up to three dates to choose from. You will have to choose from one of the dates offered. Failure to show-up for a scheduled exam will be considered a failed exam and the re-take fee will apply.
• Does it matter which I do first: the test or the exam?
No. You need to complete both successfully with the 6-month timeline, but it does not matter in which order.
Appendix 1: Simulated Patient Exam
The specific behaviors below are particulars of an overall relational presence, demonstrated clinical acuity, and attitude that scorers will be looking to see the chaplain exhibit. This attitude has been variously called pastoral caring or caring for the human spirit.
The chaplain is expected to exhibit within the visit only those behaviors that are appropriate to the case and avoid behaviors that might be inappropriate to the case.
Does the chaplain exhibit an evident sense of deep caring for the patient or caregiver’s human predicament? Is this attitude clearly therapeutic in the sense of effecting a relationship where the person feels accepted and understood by the chaplain? Does the engagement contribute to the person(s) having a greater sense of comfort, acceptance—even for the unacceptable; connected to self and others, and even a sense of wellness, wisdom and peace? Finally, does the chaplain use his/her clinical acuity in a caring way to move some or all these goals forward?
Note that there are a couple behaviors marked “Mandatory”. This means that, if in the judgment of the reviewers, you do not demonstrate these behaviors, you do not pass the test. Also note that several behaviors marked “APBCC only”. These behaviors will be scored only for APBCC candidates. They do not apply to BCC or CC candidates. Finally, if you are applying for APBCC, the reviewers have the option of not approving you for APBCC but approving you for BCC. They can also approve you for neither.
Simulated Patient Faculty Scoring
|Chaplain introduced him/herself including full name and title and explained the purpose of the visit.|
|Chaplain states chaplain role, clearly, succinctly and without use of jargon. (Mandatory for APBCC)|
|Chaplain used culturally appropriate language.|
|Chaplain demonstrated active listening.|
|Chaplain demonstrated supportive responses.|
|Chaplain uses appropriate non-verbal practices that reflect and mirror the affect of the person including:|
|a. Engaging and maintaining eye contact as is culturally and therapeutically appropriate|
|b. Maintaining appropriate posture|
|c. Using appropriate tone of voice|
|Chaplain exhibits appropriate attire and hygiene|
|Chaplain demonstrates respect for the dignity and worth of the person/caregiver. (Mandatory)|
|Chaplain does not impose his/her doctrinal positions, religious or spiritual beliefs, or practices on the person/caregiver. (Mandatory)|
|Chaplain respects the spiritual/religious/emotional/ physical boundaries of the person/caregiver|
|Chaplain acknowledges spiritual, religious, existential and cultural cues in a non-judgmental manner. (Mandatory)|
|Chaplain assesses as appropriate importance of religion, spirituality, existential, and cultural beliefs and values or lack thereof held by the person/ caregiver.|
|Chaplain assesses as appropriate for spiritual/ religious/existential/cultural needs, hopes and resources or lack thereof|
|Chaplain established a relationship in which the person/caregiver verbalizes their issues and concerns.|
|Chaplain invites expression of genuine emotional quality. (APBCC only)|
|Chaplain invites candor and free expression of values, commitments and meaning, as well as concerns, worries and disappointments. (APBCC only)|
|Chaplain enters into the suffering and distress of the person vs. inviting conversation about the person’s suffering (APBCC only)|
|The chaplain summarizes the visit for the person and lets them know what they can expect from the chaplain or other appropriate interdisciplinary team members (Mandatory for APBCC)|
|The chaplain documents a spiritual/pastoral assessment of the person/caregiver and a spiritual/pastoral care plan including culturally appropriate, evidence-based interventions for both the chaplain and other members of the interdisciplinary team, expected outcomes and any referrals to other members of the interdisciplinary team while holding confidential material not appropriate or necessary to be shared.|
|Note includes analysis of patient dynamics and processes in language useful to the team with reference to social science literature. (APBCC only)|
|In separate note, chaplain is able to critique their own transferences and counter-transferences as reflected in the visit. (APBCC only)|
Patient/Caregiver Feedback Form
|Chaplain introduced him/herself and explained the purpose of the visit.|
|Chaplain used language that I understood.|
|Chaplain used language that was respectful of who I am.|
|Chaplain listened closely to me and paid attention to what I was saying.|
|Chaplain’s responses to me were supportive and helped me talk further about my situation.|
|Chaplain seemed like he/she was really focused on me and my concerns.|
|Chaplain’s tone of voice put me at ease and helped me talk about my concerns.|
|Chaplain treated me with respect.|
|Chaplain accepted my spiritual beliefs and practices and did not try to impose his/her beliefs on me.|
|Chaplain helped me talk about my concerns and fears.|
|After chaplain’s visit, I felt better able to deal with my situation.|
|After chaplain’s visit, I felt less distressed.|
Appendix 2: What’s in the Test?
The following is intended as an overview for persons preparing for the Standardized Clinical Knowledge Test as required for Advanced Practice Board Certification (APBCC), Board Certification (BCC) or Credentialing (CC) by the Spiritual Care Association. This guide can assist you in multiple ways, by providing you with:
- An outline of the topics within the Quality Indicators and Scope of Practice developed in 2016 by international, interdisciplinary panels of experts. These two documents served as the foundation of the evidence-based Standardized Clinical Knowledge Test
- A list of the learning objectives that generate the questions included in the Standardized Clinical Knowledge Test
- A description of areas to be knowledgeable about in preparation for the Standardized Clinical Knowledge Test
- Sample questions to become familiar with the format of the Standardized Clinical Knowledge Test (Note: these are not actual questions from the test) • A list of articles and resources to assist in preparation for the Standardized Clinical Knowledge Test
For many years, chaplains have been allowed and even sometimes encouraged to develop their own style or process. Part of this came from the fact that there was no evidence for best practice in the field. That situation has fortunately changed. SCA and this test are focused, not on what you or I or your institution do or think, but on what the published guidelines, research and expert opinion in the field generally say should be done. This change brings us into alignment with other health care disciplines. As an example, while your institution for very good reasons may emphasize readmission rates their as primary quality metric, that metric is not considered a major driver of health care value and quality nationally. A review of the literature would support that. Likewise, some choices to some questions are close in content. However, all of them are clearly differentiated in the literature. The material in this document gives some direction on literature you should be familiar with before you take the test.
TEST PREPARATION COURSE
The Spiritual Care Association Learning Center has a full course available, Preparation for Standardized Clinical Knowledge Test, which provides more in-depth preparation, articles and resources to assist candidates in preparing for the Standardized Clinical Knowledge Test.
By the end of the course, the learner will be able to:
- Name the learning objectives used in the Standardized Clinical Knowledge Test
- Define evidence-based competency in chaplaincy practice, and provide examples
- Describe each of the Quality Indicators and the knowledge required to demonstrate an understanding of each
- Distinguish the competencies identified in the Scope of Practice, and articulate methods by which to integrate them into one’s professional practice
- Identify additional book and article resources and ways in which to locate them to increase one’s knowledge in preparation for the Standardized Clinical Knowledge Test
While many books can be useful as part of a chaplain’s education, the following are considered to be essential foundational texts that every chaplain should read, have in his or her library, and be able to discuss and integrate into his or her practice. For those desiring to complete the Standardized Clinical Knowledge Test for Board Certification or Credentialing, the texts below are invaluable:
- Making Health Care Whole. Puchalski C and Ferrell B. 2010. Templeton Press. ISBN-10: 159947350X
- Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplain’s Handbook. Roberts, S. Ed. 2012. Skylight Paths Publishing. ISBN-10: 1594733120
- National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care, 4th Edition. Richmond, VA, National Coalition for Hospice and Palliative Care, 2018. https://www.nationalcoalitionpc.org/ncp. (Note: This is a free download)
- Hall, E., Hughes, B., Handzo, G. (2016) Spiritual Care: Why It Matters in Health Care. HealthCare Chaplaincy Network, New York, NY.
- Fitchett, G., White, K., Lyndes, K. (Eds). (2018) Evidence-Based Healthcare Chaplaincy: A Research Reader. Jessica Kingsley Publishers.
STANDARDIZED CLINICAL KNOWLEDGE TEST LEARNING OBJECTIVES
The questions in the Standardized Clinical Knowledge Test are developed from the following learning objectives. A test candidate may wish to focus specifically on those topics for which he or she wants to refresh his or her knowledge base or read more about unfamiliar concepts. (We have marked in red those learning objectives that apply only to Advanced Practice Board Certification – not BCC or CC.)
- Articulate the role of spiritual, religious or existential support, practices, and cultural norms in coping, dying, grief, bereavement, and after death care of the body
- Competently assist other people in correctly completing health care advance directives
- Define and describe effective nonverbal communication practices and skills
- Define and describe effective verbal communication practices and skills
- Define and differentiate the following concepts: grief, mourning, bereavement, anticipatory grief, complicated grief, and disenfranchised grief
- Define appropriate supportive responses to traumatic events so that patients, families and staff can manage the situation and respond appropriately
- Demonstrate an understanding of the discipline’s scope of practice, the competencies required of his or her role and the discipline’s scope of practice
- Demonstrate knowledge and understanding of the differences and methodologies of spiritual screening, spiritual history, and spiritual assessment
- Demonstrate knowledge with one accepted model of spiritual assessment, and apply the model appropriately with patients and families within the required time frame of the setting
- Demonstrate proficient knowledge of the different kinds of health care advance directives and the specific contexts in which each is applicable
- Demonstrate sensitivities to the varied losses persons may experience, such as the loss of a parent, spouse/partner, child or sibling, as well as losses that may be disenfranchised by the larger community
- Demonstrate the capacity for creating strategies for the Health Insurance Portability and Accountability Act (HIPAA) compliance for chaplains & Spiritual/Pastoral Care Departments (Advanced Practice Board Certified Chaplains Only)
- Demonstrate an understanding of grief and bereavement theories and their application, including anticipatory, acute and traumatic grief
- Demonstrate an understanding of the importance of documentation and the requirements of organizational and regulatory guidelines (Advanced Practice Board Certified Chaplains Only)
- Describe the components of multidisciplinary teamwork and the contributions of chaplains
- Describe the current best practices for integrating spiritual care, including the goals of spiritual care, current implementation models, and how they integrate with treatment plans (Advanced Practice Board Certified Chaplains Only)
- Describe the role of the chaplain when ethical situations arise, including assessment, interventions, seeking consults, chaplain’s role on the ethics team, and documentation
- Describe the steps in writing an implementation plan and obtaining buy in from the institutional administration (Advanced Practice Board Certified Chaplains Only)
- Describe the theory, concepts and barriers to continuous quality improvement (CQI) in chaplaincy care, and why CQI is both a necessity and an imperative (Advanced Practice Board Certified Chaplains Only)
- Describe why cultivating leadership is important
- Distinguish between the importance of conducting conversations about health care values and wishes and the completion of health care advance directives
- Effectively articulate the spiritual, religious, cultural, existential, emotional and social needs, resources, and risk factors assessed, as well as identify any needed referrals
- Engage in self-awareness of and the ability to articulate one’s own cultural values, beliefs, assumptions and biases, and be able to set those aside in order to assess for persons’ beliefs and values, and provide interventions to patients and families
- Gain basic knowledge of different cultural groups and common beliefs and practices
- Gain basic knowledge of different religious traditions and common beliefs and practices
- Gain understanding about interventions to respect and demonstrate the ability to create care plans that accurately incorporate the patient’s or surrogate’s stated beliefs, values, culture and preferences without inserting one’s own beliefs
- Identify chaplaincy services that facilitate cultural, religious and spiritual observance by clients, families and staff
- Identify how to secure information on faith tradition directives regarding medical interventions, such as termination of pregnancy; use of certain medications or ingredients; and provision, withholding or withdrawing of life-sustaining treatments
- Identify methods to obtain and employ knowledge on unfamiliar cultures, religious/spiritual beliefs, or existential norms
- Identify methods to provide a calm and calming presence to the interdisciplinary health care team in the midst of crisis and stress
- Identify the issues of emotional and spiritual distress that are experienced by patients facing the end of life, articulate appropriate interventions, and demonstrate their application
- Identify ways in which HIPAA is applied to protect patient privacy
- Recognize and understand the physiological changes that occur during the dying process
- Summarize steps involved in communication to enhance goal clarification
- Understand and articulate the different spiritual, religious and existential beliefs about dying and death, and articulate the appropriate interventions
- Understand and describe the concept and competencies of negotiation when working with patients, families and staff
- Understand effective listening habits and skills, and a systematic method of listening behavior
- Understand the legalities and applications of HIPAA for health care participants/patients
- Understand the ways that grieving is experienced and expressed at varied points within the life cycle
- Understand ways to assess and include in a care plan appropriate spiritual/religious interventions for cross-cultural situations, and include them in documentation in the medical record
To locate articles, many health care settings have libraries available to staff that might include the journals that include these articles, and/or have resources that can locate sources for them. In addition, there are websites to become familiar with in order to do your own literature search for either a specific article or topic. Typing in the name of the article or topic into a web search engine will typically give you several options to find the full article or an abstract.
The following sites may also be helpful to test candidates:
- PubMed Central® (PMC) is a free full-text archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health’s National Library of Medicine (NIH/NLM). To access and save articles, free registration is required
- Medscape is the leading online global destination for physicians and health care professionals worldwide, offering the latest medical news and expert perspectives; essential point-of-care drug and disease information; and relevant professional education. To access articles, free registration is required
- Trip (Turning Research into Practice) searches across multiple internet sites for evidence-based content. It covers key medical journals, Cochrane Systematic reviews, clinical guidelines, and other highly relevant websites to help health professionals find high-quality clinical evidence for clinical practice. As well as research evidence, Trip allows clinicians to search across other content types, including images, videos, patient information, leaflets, educational courses, and news
- The Cochrane Library contains high-quality, independent evidence to inform health care decision-making. It includes reliable evidence from Cochrane systematic reviews and a registry of published clinical trials. The methodology used to create the Cochrane reviews is recognized as the gold standard for developing systematic reviews
- Research Gate was founded in 2008 by two physicians and a computer scientist to facilitate the sharing of articles and information, and engaging in collaboration among professionals. To access articles, free registration is required
- Open Access Online Journals are available from some publishers, including BMJ Open, PLOS Medicine, and Google Scholar
Further preparation for the Standardized Clinical Knowledge Test may also be undertaken by finding courses and in-services with topics that the candidate may not be familiar and desires more study on. Universities offer both in-person and online courses for credit and to audit. In addition, webinars, conferences, and other educational events through health care-related professional associations or other providers may address topics of interest. Full courses are available at the Spiritual Care Association Learning Center for those who may wish to study more in-depth in certain competencies covered by the Standardized Clinical Knowledge Test. Click on each course title listed on the website for a more in-depth description of the course. Each course description in the Learning Center identifies each Quality Indicator foundational to the test that is addressed in the course.
I. Evidence-Based Practice in Health Care
It is essential for test candidates to have basic knowledge of what evidence-based health care is in order to understand the rationale behind evidence-based competency and the standardized clinical knowledge testing process as well as to improve their own chaplaincy practice.
Evidence-based practice (EBP) improves health care quality, reliability, and patient outcomes as well as reduces variations in care and costs. (Melnyk, et al. 2014). The most common definition of EBP is from Dr. David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett D, 1996). It includes the conscientious, explicit and judicious use of current best evidence in making decisions regarding the care of individual patients. (Kang. 2016).
It is the professional responsibility of chaplains to apply the best scientific evidence for designing and implementing spiritual care assessments, interventions and outcomes into the spiritual components of care plans, and integrate the accessible research evidence into their decision making. (Duke University Medical Center Library. 2014).
The evidence-based process which leads to practices decisions is defined by its founders as a process that involves “the integration of best research evidence with clinical expertise and patient values” (Sackett et al. 2000). The evidence, by itself, does not make the decision, but it can help support the patient care process. The EBP process acknowledges the importance of both clinical expertise and client characteristics/values, along with the consideration of the best available evidence when making practice decisions. (Ruben and Parrish. 2011).
- Resource: Understanding Evidence-based Healthcare: A Foundation for Action. U.S. Cochrane Center. This module is designed for the consumer; however, it has a wealth of information that can serve as an introduction to aspects of the EBP process when an individual is a novice.
II. Evidence-Based Practice in Chaplaincy
Evidence-based practice (EBP) has been discussed at various times throughout the history of professional chaplaincy and has occasionally appeared in articles (O’Connor and Meakes. 1998; O’Connor 2002) and documents released by professional chaplaincy organizations (Association of Professional Chaplains. 2009.) However, there was little information about, resources for, or testing to establish how chaplains understood EBP and outcomes into their practice. Some studies indicated that some chaplains were uncertain about how EPB would enhance their practice (O’Connor. 2005), while others were simply resistant to learning about it and/or incorporating it. (Lewis. 2002).
In 2014, Chaplain Researcher George Fitchett and his colleagues undertook a study to examine chaplains’ attitudes and practices with respect to evidence-based chaplaincy care. The study data came from surveys of health care chaplains working in the Department of Veteran Affairs, the Department of Defense, and civilian settings. Chaplains from all three settings strongly endorsed an evidence-based approach to chaplaincy, although, interestingly, “a larger proportion of civilian chaplains were skeptical that chaplaincy care and chaplaincy outcomes could be measured.” Four moderate to major barriers were identified:
- Problems measuring outcomes relevant to chaplaincy
- Problems measuring chaplain care
- No existing evidence-based practice
- Individuality or uniqueness of patients
Fitchett and his colleagues identified several conclusions in their study, the most important of which was that all chaplains, in order to apply EBP “will be required to develop research literacy so they have the ability to critically examine and integrate the results of research into their professional practice” (Fitchett and Grossoehme. 2012). They also concluded that the findings of the study have implications for chaplain training and continuing education.
Reading: Evidence-Based Chaplaincy Care: Attitudes and Practices in Diverse Healthcare Chaplain Samples. Fitchett, Nieuwsma, et.al. 2014.
In 1998, Chaplain John Gleason argued that health care chaplaincy was entering a new paradigm as a “response to individual need” in light of changes in health care, including intentional models for spiritual assessment and attention to outcomes and research. Pay-for-performance (P4P) entered the U.S. health care payment system in 2005, providing financial incentives to hospitals, physicians, and other providers to improve the quality, efficiency, and overall value of care in order to achieve optimal outcomes for patients. Gleason identified strong implications for chaplains, including the need to identify more evidence-based practices. (Gleason. 2012).
In 2005, Gleason initiated An Ideal Intervention Paper project to consolidate the learnings of clinical pastoral education students, which were then collected over a period of seven years. (Gleason. 2013). The goal was to create a knowledge base for effectiveness research in order to identify replicated effective interventions to designate evidence-based best practices in spiritual care, and a pilot effectiveness study of samples was undertaken.
Reading: The Ideal Intervention Project Explained. Sharing Spiritual Care Knowledge for the Good of All. Gleason JJ. 2011. National Association of Catholic Chaplains Conference.
Numerous other chaplains have written articles contributing to the call for evidence-based chaplaincy practice. A test candidate can utilize the literature search information described earlier to find articles to add to one’s knowledge. Examples include:
- Outcomes for Professional Health Care Chaplaincy: An International Call to Action. Handzo G, Cobb M, Sinclair S, et al. 2014. Journal of Health Care Chaplaincy. 20:2. 43-53. DOI:10.1080/08854726.2014.902713
- Health Care Chaplaincy: A Scoping Review of the Evidence 2009–2014. Pesut B, Sinclair S, et al. 2016. Journal of Health Care Chaplaincy. 22(67-84). DOI: 10.1080/08854726.2015.1133185.
III. Quality Indicators and Scope of Practice
In developing the Standardized Clinical Knowledge Test, the foundational documents were the Quality Indicators and Scope of Practice published in 2016, which relate to the most comprehensive evidence-based information that demonstrates the quality and practice of spiritual care. The Quality Indicators and Scope of Practice were developed by two international, multidisciplinary panels of experts in the field that were convened by HealthCare Chaplaincy Network.
Numerous evidence-based professional articles from a variety of disciplines were utilized. This model allows for updates to the standardized knowledge testing, curriculum made available through the Spiritual Care Association Learning Center, and ultimately the Scope of Practice as research continues to identify best practices and evidence for the provision of expert spiritual care to individuals, families and staff.
Test candidates will want to download and become familiar with these three documents.
- What Is Quality Spiritual Care and How Do You Measure It?
- Guidance on Quality Indicators
- Scope of Practice
What Is Quality Spiritual Care in Health Care and How Do You Measure It? provides:
- Indicators of high-quality spiritual care
- The metrics that can measure those indicators
- Suggested evidence-based tools that can reliably qualify those metrics
The Scope of Practice document articulates the scope of practice that chaplains need to effectively and reliably produce quality spiritual care. It follows on the work of the evidence-based Quality Indicators document, establishing what chaplains or spiritual care professionals need to be doing to meet those indicators and establish evidence-based quality care.
The competencies within the Scope of Practice provide specific examples of what a professional chaplain’s knowledge base should be in order to provide the most effective care to meet the Quality Indicators.
IV. Structural Quality Indicators
Structural Indicators refer to the ways in which a health care organization and chaplaincy department ensure a framework is in place and followed in order to provide and promote quality spiritual care for patients/clients, families and staff.
Structural Indicator 1.A.
1.A. Quality Indicator: Certified or credentialed spiritual care professional(s) are provided proportionate to the size and complexity of the unit served and officially recognized as integrated/embedded members of the clinical staff. (Handzo G and Koenig. 2004; Wintz and Handzo 2005)
1.A. Metric: Institutional policy recognizes chaplains as official members of the clinical team.
1.A. Suggested Tool: Policy review
1.A. Competencies (from Scope of Practice. HCCN.2016)
- The chaplain supports and advocates for the growth and integration of spiritual care within the organization to make spiritual care more accessible to clients, families and staff.
- The chaplain performs an audit of spiritual care needs in the organization and produces a strategic plan to support the inclusion of spiritual care professionals.
- The chaplain is aware of and has a working knowledge of relevant health care policies (national and local), delivery plans, key drivers and levers for change, and understands why this is important for chaplaincy.
- The chaplain is aware of the difference between management and leadership, and why cultivating leadership is significant.
- The chaplain articulates his or her unique professional role as the spiritual care leader to other members of the team.
- The chaplain articulates an understanding of the goals of spiritual care, current models to achieve them, and how they integrate with the treatment plans of the intradisciplinary team.
- The chaplain demonstrates an understanding of the competencies required of his or her role and the discipline’s scope of practice.
- The chaplain utilizes common medical, social and chaplaincy terminology in order to communicate with other members of the team.
- The chaplain utilizes a working knowledge of the key physical, psychological and social issues/principles in spiritual care sufficient to effectively communicate with other team members in a particular clinical setting.
Structural Indicator 1.A. What Do I Need to Know?
Test candidates need to be familiar with the best-practice knowledge and skills needed to advocate within a health care setting. This includes a wide range of issues as indicated in the competencies. A major mistake that many chaplains and their departments make is to plan their department’s program in isolation from other stakeholders within their organizational setting; however, the issues of planning, policies and procedures, regulatory guidelines, being a leader and advocate for spiritual care within the organization, how to work with both management and other members of the intradisiciplinary team, being able to articulate the goals of chaplaincy/spiritual care and how they integrate into treatment plans are essential whether one is a staff chaplain or a department director.
Reading: Intradisciplinary Spiritual Care for Seriously Ill and Dying Patients: A Collaborative Model. (Puchalski C, et. al. 2006)
Structural Indicator 1.A Sample Question
According to Puchalski’s 2006 model for intradisciplinary spiritual care, all professionals on the health care team participate in providing care to the patient. What two critical elements does she include in this model?
- Communication and documentation
- Intrinsic and extrinsic dimensions
- Confidentiality regarding patient concerns and sensitivity to privacy
- Prayer and sharing of the intradisciplinary member’s own beliefs
Correct answer: b. Source: Intradisciplinary Spiritual Care for Seriously Ill and Dying Patients: A Collaborative Model. (Puchalski C, et. al. 2006)
Structural Indicator 1.B.
1.B. Quality Indicator: Dedicated sacred space is available for meditation reflection and ritual. (The National Consensus Project for Quality Palliative Care. 2013)
1.B. Metric: Yes/No
1.B. Suggested Tools: N/A
Structural Indicator 1.B. Competency
The chaplain advocates effectively for the allocation and equipping of dedicated space for meditation, reflection and ritual, taking into account the particular cultural, ethnic and religious needs of the community.
Reading: Sacred Spaces in Public Places: Religious and Spiritual Plurality in Health Care. (Reimer-Kirkham, et al. 2012).
Structural Indicator 1.B. What Do I Need to Know?
Test candidates should understand the important elements to be taken into consideration when designing sacred space within their institutional setting, including steps to be taken to capture the demographics of the patient population cache to ensure representation of cultural, ethnic, religious, spiritual and existential beliefs and values.
Structural Indicator 1.B Sample Question
Sacred spaces within health care institutions need to:
- Reflect the beliefs and values of the organization
- Be open at all times for use by patients, families and staff
- Reflect the religious, spiritual and existential beliefs of the patient population cache and staff
- Provide religious literature for encouragement to those who use the space
Correct answer: c. Source: Sacred Spaces in Public Places: Religious and Spiritual Plurality in Health Care. (Reimer-Kirkham, et al. 2012).
Structural Indicator 1.C.
1 C. Quality Indicator: Information is provided about the availability of spiritual care services. (National Quality Forum. 2006).
1 C. Metric: Percentage of patients who said they were informed that spiritual care was available.
1 C. Suggested Tool: Client satisfaction survey
Structural Indicator 1.C. Competencies
- The chaplain makes information on the range of spiritual care services in the organization available to staff, clients and families, and educates them on how to access those services.
- The chaplain maintains links to local faith communities and belief groups, and makes this information available to staff, clients and families as requested.
- The chaplain identifies and makes available information and resources explaining spiritual needs and services to clients new to the organization.
- The chaplain is able to provide information to clients and families about resources for communicating their care preferences to the medical team and assists in their completion as appropriate.
Structural Indicator 1.C. What Do I Need to Know?
Test candidates will need to have the knowledge required to communicate the availability and description of chaplaincy/spiritual care services within a health care setting, including what elements are important to be aware of and include in planning, execution and evaluation.
Reading: Relationship Between Chaplain Visits and Patient Satisfaction. (Marin D, et al. 2015).
Structural Indicator 1.C. Sample Question
One reason the availability of chaplaincy services is an important element for patients and families to be aware of is because studies demonstrate that:
- Patient outcomes are more positive
- Staff reports less stress
- Patient satisfaction surveys can improve
- Chaplains receive more referrals
Correct answer: c. Source: Relationship Between Chaplain Visits and Patient Satisfaction. (Marin D, et al. 2015).
Structural Indicator 1.D.
1. D. Quality Indicator: Professional education and development programs in spiritual care are developed for all disciplines on the team to improve their provision of generalist spiritual care. (Pulchaski C, Ferrell B, et.al. 2009)
1. D. Metric: All clinical staff receive regular spiritual care training appropriate to their scope of practice and to improve their practice
1. D. Suggested Tools: Lists of programs, number of attendees, and feedback forms
Structural Indicator 1.D. Competencies
- The chaplain, in collaboration with educators from other professions, provides education in the practices and processes involved in spiritual care as provided by each member of the interprofessional team (e.g., for health care: physician, nurse, social worker, physical therapist, pharmacist, quality improvement) and introduces spiritual care. practices/processes into training for the other team professionals.
- The chaplain participates with the interprofessional members of the health care team to modify, innovate and implement practices and processes for the provision, collaboration, communication, education, and quality improvement of spiritual care.
Structural Indicator 1.D. What Do I Need to Know?
Test candidates should have a knowledge of intradisciplinary teams, particularly the importance of the presence and functions of both generalist and specialist spiritual care providers. In addition, candidates should have knowledge of how chaplaincy fits into the intradisiciplinary team structure, communication within teams, and how to articulate the contributions of the chaplain as the spiritual care specialist.
Reading: Collaborating with Chaplains to Meet Spiritual Needs. (Grossoehme D and Jacobson A. 2006).
Structural Indicator 1.D. Sample Question
A key component of an intradisciplinary infrastructure to address patient spiritual needs is for spiritual care generalists to know:
- When and how to refer to the chaplain as the spiritual care specialist
- What hours a chaplain is available
- The patient’s religious affiliation
- Whether the patient wants to see a chaplain
Correct answer: a. Source: Collaborating with Chaplains to Meet Spiritual Needs. (Grossoehme D and Jacobson A. 2006).
Structural Indicator 1.E.
1.E. Quality Indicator: Spiritual care quality measures are reported regularly as part of the organization’s overall quality program and are used to improve practice. (Arthur J. 2011).
1.E. Metric: List of spiritual care quality measures reported
1.E. Suggested Tools: Audit of organizational quality data and improvement initiatives
Structural Indicator 1.E. Competencies
- The chaplain integrates with any organizational quality team and supports the inclusion of relevant spiritual care outcome measures in organizational quality reports.
- The chaplain identifies quality improvement processes, objectives and outcomes in spiritual care.
- The chaplain uses quality improvement data to refine spiritual care programs and services.
- The chaplain is familiar with research processes and practice within spiritual care.
- The chaplain accesses spiritual care journals and other expert sources of research data and best practices to apply to his or her work.
- The chaplain engages in the discussion of research findings with other chaplaincy colleagues and the interdisciplinary team.
Structural Indicator 1.E. What Do I Need to Know?
Test candidates should possess the fundamental knowledge, processes and practices associated with quality improvement projects and the process for conducting research within and about professional chaplaincy.
Reading: An Invitation to Chaplaincy Research: Entering the Process. (HealthCare Chaplaincy Network. 2014.)
Structural Indicator 1.E. Sample Question
“Satisfaction with overall care” is an example of what component in research methodology?
- Independent variable
- Dependent variable
- Control variable
- Staff variable
Correct answer: b. Source: An Invitation to Chaplaincy Research: Entering the Process. (HealthCare Chaplaincy Network. 2014.)
V. Process Quality Indicators
Process indicators refer to actions undertaken by chaplains and the chaplaincy department as the second part of a framework consistently followed to provide and promote quality spiritual care for patients/clients, families and staff.
Process Indicator 2.A.
2. A. Quality Indicator: Specialist spiritual care is made available within a time frame appropriate to the nature of the referral. (Pulchaski C, Ferrell B, et.al. 2009.)
2. A. Metric: 1) Percentage of staff who made referrals to spiritual care and report that the referral was responded to in a timely manner, and 2) Percentage of referrals responded to within chaplaincy services guidelines.
2. A. Suggested Tools: 1) Survey of staff, and 2) Chaplaincy data reports
Process Indicator 2. A. Competency
The chaplain integrates effective and responsive spiritual care into the organization through policies and procedures, use of evidence-based assessment and documentation processes, and education of the interdisciplinary team about spiritual care.
Process Indicator 2. A. What Do I Need to Know?
Test candidates should have knowledge of the theories and evidence that provide effective foundational policies, procedures and processes to establish and integrate chaplaincy care throughout a health care organization.
Reading: Handzo G. The Process of Spiritual/Pastoral Care: A General Theory for Providing Spiritual/Pastoral Care Using Palliative Care as a Paradigm. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012.
Process Indicator 2. A. Sample Question
Chaplaincy protocols are based on:
- Judgment by the chaplain on who needs to be seen
- The level of spiritual distress identified in a spiritual screening
- Specific medical orders or predetermined diagnoses, procedures or transitions
- Availability due to staffing levels of the chaplaincy department
Correct answer: c. Source: Handzo G. The Process of Spiritual/Pastoral Care: A General Theory for Providing Spiritual/Pastoral Care Using Palliative Care as a Paradigm. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012.
Process Indicator 2.B.
2.B. Quality Indicator: All clients are offered the opportunity to have a discussion of religious/spiritual concerns. (Williams J, Meltzer D, et al. 2011.)
2.B. Metric: Percentage of clients who say they were offered a discussion of religious/spiritual concerns
2.B. Suggested Tool: Client survey
Process Indicator 2.B. Competencies
- The chaplain supports and advocates for the establishment of timely and documented spiritual screening to discover and refer clients for discussion of religious/spiritual concerns.
- The chaplain provides timely response to all referrals and facilitates discussions of religious/spiritual concerns.
Process Indicator 2.B. What Do I Need to Know?
Test candidates should have knowledge of the theories and evidence that provide effective foundational policies, procedures and processes to establish and integrate chaplaincy care throughout a health care organization.
Reading: Do You Want to See the Chaplain? Ensuring a Patient’s Right to Pastoral Care and Spiritual Services. (Carlson, J. 2002.)
Process Indicator 2.B Sample Question
Spiritual screening should NOT include the question:
- Are you active in a faith community?
- Do you want to see a chaplain?
- Have you experienced a high level of stress regarding your current medical condition?
- Do you have religious, spiritual or cultural practices that we can support you in during your stay?
Correct answer: c. Source: Carlson, J. Do You Want to See the Chaplain? Ensuring a Patient’s Right to Pastoral Care and Spiritual Services. 2002. Vision 12(5).
Process Indicator 2.C.
2. C. Quality Indicator: An assessment of religious, spiritual and existential concerns using a structured instrument is developed and documented, and the information obtained from the assessment is integrated into the overall care plan. (The National Consensus Project for Quality Palliative Care. 2018; Puchalski C, Ferrell B, et.al. 2009.)
2.C. Metric: Percentage of clients assessed using established tools such as FICA (Puchalski C and Romer A. 2000) Hope (Anadarajah G and Hight E. 2001), 7X7 (Fitchett G. 1993), or Outcome Oriented (VandeCreek L and Lucas A. 2001) models with a spiritual care plan as part of the overall plan of care
2.C. Suggested Tool: Chart review
Process Indicator 2.C. Competencies
- The chaplain implements a process to define and give structure to goals of care, interventions, and care plans that can be articulated clearly according to the situation and applied appropriately and is able to modify them based on changes in the status of the client or situation.
- The chaplain demonstrates a working knowledge of the methodologies of spiritual screening, spiritual history, and spiritual assessment that takes into account the diversity of the population served.
- The chaplain uses several published models for spiritual assessment, appropriately choosing and applying the model suitable for each specific situation, client and family.
- The chaplain evaluates and executes new models of spiritual assessment that have been tested for effectiveness.
- The chaplain respects and advocates for the development of plans of care that accurately incorporate the client’s or surrogate’s stated beliefs, values, culture and preferences without inserting the chaplain’s own beliefs.
- The chaplain develops clear, concise and personalized spiritual care plans for clients and families based upon the assessment of spiritual, religious, existential and cultural beliefs, values, needs and practices, and integrates them into the client’s overall care plan.
- The chaplain collaborates effectively with clinicians from other disciplines to create and implement an interdisciplinary treatment plan.
- The chaplain makes follow-up visits to clients as indicated and informs the team of his or her findings.
- The chaplain incorporates spiritual assessment and documentation into the discharge planning/continuity of care plan.
- The chaplain integrates knowledge of specific community-based resources, such as hospice, home health, long-term care, counseling, and grief and bereavement services into discharge and continuity of care plans.
- The chaplain understands the importance of documentation and the requirements of organizational and regulatory guidelines.
- The chaplain implements best practices for chaplaincy documentation, including documenting the spiritual, religious, cultural, existential, emotional and social needs, resources, and risk factors of clients and any needed referrals.
Process Indicator 2.C. What Do I Need to Know?
Test candidates should have not only a broad knowledge of chaplaincy practices as described in the competencies but also be able to demonstrate an understanding of the theory, evidence, and best practices that are central to every component of the provision of chaplaincy/spiritual care.
Reading: Improving the Quality of Spiritual Care as a Dimension of Palliative Care: the Report of the Consensus Conference. (Puchalski C, et al. 2009.)
Process Indicator 2.C. Sample Question
Which of the following is NOT true of spiritual screening?
- It provides a quick determination of whether a person is experiencing a serious spiritual crisis.
- It can be used by health professionals from any and all disciplines who are trained in its use.
- It should be completed on every patient.
- It is the primary tool to be used by a professional chaplain.
Correct answer: d. Source: Puchalski C, et al. Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference. 2009. Journal of Palliative Medicine.
Process Indicator 2.D.
2.D. Quality Indicator: Spiritual, religious and cultural practices are facilitated for clients, the people important to them, and staff. (The National Consensus Project for Quality Palliative Care. 2018).
2.D. Metric: Referrals for spiritual practice
2.D. Suggested Tool: Referral logs, including disposition of referrals
Process Indicator 2.D. Competencies
- The chaplain understands the concepts of cultural competency and inclusion.
- The chaplain can articulate his or her own cultural values, beliefs, assumptions and biases, and has the self-awareness to set those aside in order to provide spiritual care to clients and families from diverse backgrounds.
- The chaplain facilitates, provides and accommodates religious, spiritual and cultural events, rituals, celebrations and opportunities appropriate to the population served.
- The chaplain provides client-centered, family-focused spiritual care that understands and respects diversity in all its dimensions and takes into account cultural and linguistic needs.
- The chaplain integrates into his or her provision of care a basic knowledge of different religious and cultural groups, including common beliefs and practices related to health care.
- The chaplain acquires knowledge of unfamiliar cultures, religious/spiritual beliefs, or existential norms as needed to provide appropriate care.
- The chaplain assesses, documents and includes in care plans appropriate spiritual/religious interventions for cross-cultural situations.
- The chaplain identifies and integrates into care the unique spiritual/religious/cultural beliefs within vulnerable client populations.
- The chaplain creates partnerships with community religious and cultural leaders to enhance the cultural understanding of the care team and ensure effective support to the client/family.
- The chaplain works collaboratively with the care team as a culture broker in identifying, recommending and integrating appropriate diversity concepts, needs and interventions into client/family care plans and organizational programs and policies.
Process Indicator 2.D. What Do I Need to Know?
Test candidates should have knowledge in cultural competence, inclusion, and vulnerable populations; the importance of diverse spiritual, religious, existential and cultural beliefs; assessment tools that explore, respond to, accommodate and document beliefs, values and practices; and the best practices to communicate their importance to other members of the interdisciplinary team.
Reading: Creating and Implementing a Spiritual/Pastoral Care Plan. Roberts S, et. al. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012.
Process Indicator 2.D Sample Question
The most important place for chaplains to include identified issues regarding religious, spiritual and existential practices is:
- The chaplaincy department log book
- A documented spiritual assessment
- Their report to the bedside nurse
- Intradisciplinary team meetings
Correct answer: b. Source: Creating and Implementing a Spiritual/Pastoral Care Plan. Roberts S, et. al. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012.
Process Indicator 2.E.
2.E. Quality Indicator: Families are offered the opportunity to discuss spiritual issues during goals of care conferences. (Ernecoff N, Curlin F, et.al. 2015)
2.E. Metric: Percentage of meeting reports in which it is noted that families are given the opportunity to discuss spiritual issues
2.E. Suggested Tool: Chart audit
Process Indicator 2.E. Competencies
- Within the discipline’s scope of practice, the chaplain leads, guides or participates in goal clarification with clients, families and team.
- The chaplain supports and advocates for clients and families in goal clarification and family meetings.
- The chaplain provides and models a leadership role within the spiritual care team when talking with families who identify significant religious, spiritual, existential and/or cultural issues in regard to care decisions.
- The chaplain has a working knowledge of the ethical and moral challenges that may occur in relation to spiritual care, as well as the ethical principles of respect, justice, non- maleficence and beneficence.
- Within the discipline’s scope of practice, the chaplain participates effectively in the process of ethical decision making, including with the ethics committee as appropriate to the setting, in such a way that theological, spiritual and cultural values are supported.
- The chaplain secures and disseminates to the team information on faith tradition directives regarding the provision, withholding or withdrawing of medical treatments.
- The chaplain understands the benefits and burdens of specific medical interventions in clients with advanced illness, including nutrition and hydration, and the issues involved in physician-assisted death and terminal sedation.
- The chaplain understands the process to determine client decision-making capacity and government regulations regarding those designated to make decisions for the client.
Process Indicator 2.E. What Do I Need to Know?
Test candidates should possess knowledge regarding key spiritual, religious, existential and cultural beliefs, values and practices at the end of life as well as methods by which to identify those components, find resources, provide appropriate interventions, and identify outcomes in collaboration with the patient and family to improve their decision making. In addition, the candidate should have a knowledge of medical ethics, the understanding of various ethical issues from diverse beliefs and values, how ethics committees work in an interdisciplinary manner, and best practices for participating effectively in ethical decision making, family conferences, and interdisciplinary plan of care meetings.
Reading: Health Care Professionals’ Responses to Religious or Spiritual Statements by Surrogate Decision Makers During Goals-of-Care. (Ernecoff N, Curlin F, et.al. 2015).
Process Indicator 2.E Sample Question
Several studies have identified that goals of care conferences typically do not include discussion of religious or spiritual considerations. What major opportunity may health care professionals miss when these discussions are not held?
- Hearing about patient and family end-of-life beliefs
- Knowing what topics health care providers should avoid in conversations
- Understanding how patients and families make medical decisions
- Having information on what religious practices are important to the family
Correct answer: c. Source: Health Care Professionals’ Responses to Religious or Spiritual Statements by Surrogate Decision Makers During Goals-of-Care. (Ernecoff N, Curlin F, et.al. 2015).
Process Indicator 2.F.
2.F. Quality Indicator: Spiritual care is provided in a culturally and linguistically appropriate manner. (The National Consensus Project for Quality Palliative Care. 2013) Clients’ values and beliefs are integrated into plans of care. (Joint Commission Resources. 2010)
2.F. Metric: 1) Percentage of clients who say that they were provided care in a culturally and linguistically appropriate manner, and 2) Percentage of documented plans of care that mention client beliefs and values
2.F. Suggested Tools: Client survey, chart audit
Process Indicator 2.F. Competencies
The competencies for this Indicator are the same as the competencies for Indicator 2.D.
Process Indicator 2.F. What Do I Need to Know?
Test candidates should have the knowledge of cultural and linguistically appropriate ways in which to engage persons in discussions of beliefs and values and how to incorporate them into plans of care, including the core knowledge of regulations from government, accrediting and professional organizations that advocate and educate about the importance of these issues.
Reading: Cultural Humility Versus a Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. (Tervalon, et al. 1998).
Process Indicator 2.F. Sample Question
Cultural humility differs from cultural competence in that:
- Competence requires understanding cultural, nutritional and belief systems of patients and communities
- Humility requires a life-long commitment
- Humility includes the development of programs for specific populations
- Competence requires continual self-evaluation
Correct answer: b. Source: Cultural Humility Versus a Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. (Tervalon, et al. 1998).
Process Indicator 2.G.
2.G. Quality Indicator: End of life and bereavement care is provided as appropriate to the population served
2.G. Metric: Care plans for clients approaching end of life include document attention to end-of-life care. A documented plan for bereavement care after all deaths.
2.G. Suggested Tool: Chart audit
Process Indicator 2.G. Competencies
- The chaplain identifies and integrates into care appropriate grief interventions for those at end of life and those who are grieving.
- The chaplain effectively uses culturally appropriate, evidence-based strategies for communicating with clients and families regarding pain and suffering, loss, complicated and anticipatory grief, and life review.
Process Indicator 2.G. What Do I Need to Know?
Test candidates should have the knowledge of current theories of grief and bereavement, including processes and interventions to provide appropriate care to those experiencing it within their own belief and value system.
Reading: Cultural Humility and Compassionate Presence at the End of Life. (Austerlic S. 2009).
Process Indicator 2.G Sample Question
Health care providers, including chaplains, must become knowledgeable of their patients’ and families’ beliefs and values around end of life and bereavement and include them in the plan of care because principles, practices and procedures that are beneficial to one cultural group might be __________ to another.
Correct answer: a. Source: Cultural Humility and Compassionate Presence at the End of Life. (Austerlic S. 2009).
VI. Outcomes Quality Indicators
Outcomes are the desired difference that the chaplain’s contribution to the care of the patient/client, family and/or staff may help bring about. They are an observed and witnessed change in the person’s ability to cope and/or adapt; a measurable “turn-around” point or points. (VandeCreek and Lucas. 2001).
Outcome Indicator 3.A.
Quality Indicator: Clients’ spiritual needs are met. (Balboni, et.al. 2007)
Metric: Client-reported spiritual needs documented before and after spiritual care
Suggested Tools: Spiritual Needs Assessment Inventory for Patients (SNAP) (Sharma R, et al. 2012) and Spiritual Needs Questionnaire (SpNQ) (Bussing A, et al. 2010)
Outcome Indicator 3.B.
Quality Indicator: Spiritual care increases client satisfaction. (Marin et al. 2015)
Metric: Client-reported satisfaction documented before and after spiritual care
Outcome Indicator 3.C.
Quality Indicator: Spiritual care reduces spiritual distress. (Snowdon A, et al. 2013)
Metric: Client-reported spiritual distress documented before and after spiritual care
Suggested Tool: “Are you experiencing spiritual pain right now?” (Mako, C et al. 2006)
Outcome Indicator 3.D.
Quality Indicator: Spiritual interventions increase client’’ sense of peace. (Snowdon A, et al. 2013).
Metric: Client-reported peace measure documented before and after spiritual care
Outcome Indicator 3.E.
Quality Indicator: Spiritual care facilitates meaning-making for clients and family members. (Flannelly K. et al. 2005)
Metric: Client-reported measure of meaning documented before and after spiritual care
Outcome Indicator 3.F.
Quality Indicator: Spiritual care increases spiritual well-being. (Rabow M and Knish S. 2014)
Metric: Client-reported spiritual well-being documented before and after spiritual care
Suggested Tool: Facit-SP (Peterman A, et al. 2002)
3.A.-3.F. Outcomes Indicators Competencies
The competencies listed below were determined to apply to all of the outcomes for Indicators 3.A through 3.F, and, therefore, are listed as a group rather than repeating the same list for each competency.
- The chaplain integrates theories from the behavioral sciences into spiritual care practice.
- The chaplain integrates spiritual, existential and emotional concepts for clients and families in spiritual care, including faith, hope, forgiveness, meaning and remorse.
- The chaplain integrates a thorough knowledge of chaplaincy practice into interventions to support the client’s identified religious, spiritual, existential or cultural beliefs and values.
- The chaplain utilizes evidence-based practices in spiritual care and chaplaincy to improve spiritual care service.
- The chaplain understands and abides by the ethical standards of care giving in general and chaplaincy in particular.
- The chaplain effectively uses best practice in communication, including listening habits and techniques.
- The chaplain effectively and appropriately uses supportive responses with clients who experience traumatic events so that they can manage the situation and respond appropriately.
- The chaplain utilizes evidence-based practices to help clients and families address their fears, as well as distress (spiritual and otherwise) related to chronic, serious, life-limiting illness, and/or end-of-life care.
Outcomes Indictors 3.A.-3.F. What Do I Need to Know?
Test candidates should have knowledge of the definition of outcomes in chaplaincy care, best practices, and processes by which to consistently demonstrate them in their own practice.
Reading: Spiritual Pain Among Patients with Advanced Cancer in Palliative Care. (Mako C, et al. 2006)
Outcome Indicators 3.A.-3.F. Sample Question
Spiritual distress or “spiritual pain” typically falls into three main categories:
- Interpersonal, resilience, and relationship with God
- Intrapsychic, theological and physical
- Resilience, sense of peace, and meaning-making
- Intrapsychic, interpersonal, and the divine
Correct answer: d. Source: Spiritual Pain Among Patients with Advanced Cancer in Palliative Care. (Mako C, et al. 2006)
VII. Helpful Additional Texts
Other books that will be helpful in building a test candidate’s knowledge base, and were drawn upon in the development of the standardized clinical knowledge test, include:
- 1001 Solution Focused Questions. Bannink F. 2010. Norton. ISBN-10: 0393706346
- An Invitation to Chaplaincy Research: Entering the Process. HealthCare Chaplaincy Network. 2014. http://bit.ly/29Nuroz
- Assessing Spiritual Needs: A Guide for Caregivers. Fitchett, G. 1993. Augsburg Fortress. ISBN-10: 078809940X
- Being Mortal: Medicine and What Matters in the End. Gawande A. 2014. Metropolitan Books. ISBN-10: 0805095152
- Communicating in Groups: Applications and Skills. Adams KL, Galanes GJ, and Brilhart JK. 2009. McGraw-Hill. ISBN-10: 0073523860
- Crucial Conversations: Tools for Resolving Broken Promises, Violated Expectations, and Bad Behavior. 2nd Edition. Patterson K and Grenny J. 2005. Gramedia Pustaka Utama. ISBN-10: 0071829318
- Dignity Therapy: Final Words for Final Days. Chochinov H. 2012. Oxford University Press. ISBN-10: 0195176219
- Disenfranchised Grief: New Directions, Challenges, and Strategies for Practice. Doka K. 2002. Research Press. ISBN-10: 0878224270
- Essentials of the U.S. Health Care System. 3rd Ed. 2012.Shi L and Singh D. Jones & Bartlett Learning. ISBN-10: 1284100553
- Family Therapy in Clinical Practice. Bowen M. 1985.: Rowman and Littlefield. ISBN-10: 1568210116
- Grief and Bereavement in Contemporary Society: Bridging Research and Practice. Neimeyer R, Harris D, Winokuer H, and Thorton G, Eds. 2011. Taylor and Frances. ISBN-10: 0415884810
- Grief Counseling and Grief Therapy. 4th Ed. Worden J. 2008.Springer. ISBN-10: 0826101208
- Hardwiring Excellence: Purpose Worthwhile Work Making a Difference. Studer Q. 2003. Fire Starter Publishing. ISBN-10: 0974998605
- Lean Six Sigma for Hospitals: Simple Steps to Fast, Affordable, Flawless Healthcare. Arthur, Jay. 2011 McGraw-Hill. ISBN-10: 0071753257
- Meaning Reconstruction and the Meaning of Loss. Neimeyer RA. 2001. American Psychological Association. ISBN-10: 1557987424
- Nonviolent Communication: A Language of Life: Life-Changing Tools for Healthy Relationships. Puddle Dancer Press. ISBN-10: 189200528X
- Oxford Textbook of Spirituality in Healthcare. Puchalski C and Rumbold B. Eds. 2012. Oxford University Press. ISBN-10: 0198717385
- Paging God; Religion in the Halls of Medicine. Cadge W. 2013. University of Chicago Press. ISBN-10: 0226922111
- Principles of Medical Ethics. 7th Edition. Beauchamp T and Childress J. 2008. Oxford University Press. ISBN-10: 0199924589
- Psychological First Aid: Field Operations Guide. 2nd Ed. National Child Traumatic Stress Network & National Center for Post-Traumatic Stress Disorder. http://bit.ly/2e3ESrR
- Rando T. Treatment of Complicated Mourning. 1993. Research Press. ISBN-10: 0878223290
- Stages of Faith: The Psychology of Human Development and the Quest for Meaning. Fowler JW. 1981. Harper and Row. ISBN-10: 0060628669
- The Art of Helping in the 21st Century. Carkhuff. RR. 2000. Human Resource Development. ISBN-10: 0874255309
- The Discipline for Pastoral Care Giving: Foundations for Outcome Oriented Chaplaincy. VandeCreek L and Lucas A, Eds. 2001. Haworth Press. ISBN-10: 0789013460
- The Health Care Handbook. 2nd Ed. Askins E and Moore N. 2014. Washington University. St. Louis, MO. ISBN-10: 0615650937
- The Minister as Diagnostician: Personal Problems in Pastoral Perspective. Pruyser P. 1976. The Westminster Press. ISBN-10: 0664241239
- The Psychology of Religion and Coping: Theory, Research, Practice. Pargament, K. I. 1997. New York: Guilford Press. ISBN-10: 1572306645
- The Structure of Scientific Revolutions: 50th Anniversary Edition. Kuhn, TS. 2012. University of Chicago Press. ISBN-10: 0226458121
This list of references includes not only the articles and books referenced in the full Spiritual Care Association Learning Center course Preparation for Standardized Clinical Knowledge Test, it also includes additional resources that may be helpful to the test candidate. All references have links to where the reference can be found, either available as full text or requested on the website or the candidate’s medical library if available.
- Anandarajah, G., & Hight, E. (2001). Spirituality and medical practice. American family physician, 63(1), 81-88. PMID:11195773 http://bit.ly/2eSpdxa
- Arthur J. (2011) Lean Six Sigma- Simple Steps to Fast, Affordable, Flawless Healthcare. New York: McGraw-Hill. ISBN-10: 007175325.
- Ashley W. Counseling and Interventions. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012. ISBN-10: 1594733120. http://amzn.to/2f2bZgF
- Askins E and Moore N. The Health Care Handbook. 2nd Ed. 2014. Washington University. St. Louis, MO. ISBN-10: 0615650937. http://amzn.to/2d5LBSe
- Association of Professional Chaplains (APC). Standards of Practice for Professional Chaplains in Acute Care. 2009. http://bit.ly/1Uvhlff
- Austerlic S. Cultural Humility and Compassionate Presence at the End of Life. 2009. Santa Clara University. http://bit.ly/2d9O12n
- Balboni, T. A., Paulk, M. E., Balboni, M. J., Phelps, A. C., Loggers, E. T., Wright, A. A., … & Prigerson, H. G. (2010). Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. Journal of Clinical Oncology, 28(3), 445-452. DOI: 10.1200/JCO.2009.24.8005. http://bit.ly/2esggt8
- Balboni, et al. (2007). Religiousness and Spiritual Support Among Advanced Cancer Patients and Associations with End-of-Life Treatment Preferences and Quality of Life. Journal of Clinical Oncology, 25(5), 555-560. DOI: 10.1200/JCO.2006.07.9046. http://jco.ascopubs.org/content/25/5/555.full
- Berlinger N. Ethics and Care of the Sick. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012. ISBN-10: 1594733120. http://amzn.to/2f2bZgF
- Bredle J, et al. Spiritual Well-Being as a Component of Health-Related Quality of Life: The Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale (FACIT-Sp). 2010. Religions. 2. 77-99. DOI: 10.3390/rel2010077. http://bit.ly/2esIHao
- Brophy E. Improving the Patient Experience One Interaction at a Time. 2012. PlainViews. (9).11. HealthCare Chaplaincy Network. http://www.plainviews.org
- Büssing A (1), Balzat HJ, Heusser P. (2010) Spiritual needs of patients with chronic pain diseases and cancer – validation of the spiritual needs questionnaire. Eur J Med Res. Jun 28;15(6):266-73. DOI: 10.1186/2047-783X-15-6-266. http://bit.ly/2dxBjpA
- Byrne-Martelli S. Advocacy Tips for Chaplains. 2013. PlainViews.10(6). HealthCare Chaplaincy Network. http://www.plainviews.org
- Canada A, Murphy P, Fitchett G, et al. A 3-Factor Model for the FACIT-Sp. 2008 Psycho-Oncology. 17. 908-916. DOI:10.1002/pon.1307. http://bit.ly/2e8bAVc
- Carlson, J. Do You Want to See the Chaplain? Ensuring a Patient’s Right to Pastoral Care and Spiritual Services. 2002. Vision 12(5). http://bit.ly/2es4RXr
- Center for Practical Bioethics. Resources about Ethics Committees: Their Purpose, Creation, and Operation. 2014. http://bit.ly/2epv798
- Chi GC. The Role of Hope in Patients with Cancer. Oncol Nurs Forum. 2007;34. 415–424. 10.1188/07.ONF.415-424. http://bit.ly/2ewkLAQ
- Choi P, Curlin F, Cox C. “The Patient is Dying, Please Call the Chaplain”: The Activities of Chaplains in One Medical Center’s Intensive Care Units.” 2015. J Pain Symptom Manage. 50(4). 501-6. DOI: 10.1016/j.jpainsymman.2015.05.003. http://bit.ly/2etIi4r
- Psychological First Aid: Field Operations Guide. National Child Traumatic Stress Network & National Center for Post-Traumatic Stress Disorder. 19.Psychological First Aid: Field Operations Guide. http://bit.ly/2eORjJD
- Clark P, Drain M, Malone M. Addressing Patients’ Emotional and Spiritual Needs. 2003. Jt Comm J Qual Saf. 29(12). 659-70. PMID:14679869. http://bit.ly/2ee4aBw
- CMS.gov. HCAHPS: Patient’s Perspectives of Care Survey. 2014. Centers for Medicare & Medicaid Services. http://go.cms.gov/2cdIRiF
- Community Tool Box. Chapter 8: Developing a Strategic Plan. 2016. http://bit.ly/2cEtmAS
- Community Tool Box. Chapter 27: Understanding Culture, Social Organization, and Leadership to Enhance Engagement. Lee K. 2016. http://bit.ly/1KAea50
- Corman J. Hospitals Revamp Chapels into Interfaith Meditation Rooms. Religion News Service. Huffington Post. 7/21/2010. http://huff.to/2dIJTrr
- Cramer E and Allen M. Translating Spiritual Care in the Chaplain Profession. 2013. Journal of Pastoral Care and Counseling. 67(1):6. DOI: 10.1177/154230501306700106. http://bit.ly/2dEvj0W
- Cultural Relevance in End-of-Life Care. Kagawa-Singer & Blackhall’s ABCD Cultural Assessment Model. http://bit.ly/2dRAzMV
- Daaleman T, Reed D, et al. Development and Preliminary Testing of the Quality of Spiritual Care Scale. 2014. Journal of Pain and Symptom Management. 47(4). 793-800. DOI: http://dx.doi.org/10.1016/j.jpainsymman.2013.06.004. http://bit.ly/2dSbXp6
- Dasitar J and Odden A. How do I Determine if My Patient has Decision-Making Capacity? 2011. The Hospitalist. August 2011. http://bit.ly/2eAtssh
- Duke University Medical Center Library and the Health Sciences Library, University of North Carolina at Chapel Hill. Introduction to Evidence-Based Practice. 2014. http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036002
- Ehman J. Spiritual Distress in Patients: A Guideline for Health Care Providers. 1998. http://bit.ly/2dXSCnG
- Ernecoff, N, Curlin, F., Buddadhumaruk, P, White, D. Health Care Professionals’ Responses to Religious or Spiritual Statements by Surrogate Decision Makers During Goals-of-Care Discussions. JAMA Intern Med. 2015;175(10):1662-1669. Doi:10.1001/jamainternmed.2015.4124. http://bit.ly/2ecHst1
- Evidence-Based Behavioral-Practice (EBBP). Introduction to Systematic Reviews and Searching for Evidence. http://bit.ly/2d9zbqX
- Farokhzadian J, Nayeri ND, Borhani F, Zare MR. Nurse leaders’ Attitudes, Self-Efficacy and training Needs for Implementing Evidence-Based Practice: Is It Time for a Change toward Safe Care? British Journal of Medicine and Medical Research. 2015. 7(8):662-671. Doi:10.9734/BJMMR/2015/16487. http://bit.ly/2etIAIq
- Fitchett, G. Assessing Spiritual Needs: A Guide for Caregivers. 1993. Augsburg Fortress. ISBN-10: 078809940X. http://amzn.to/2dw4yOj
- Fitchett G. Wondering if it’s Time to Give Up: A Case Example of the 7×7 Model for Spiritual Assessment. 2009. Rush University Medical Center. Chicago, IL. http://bit.ly/2dWzFQk
- Fitchett G and Grossoehnme D. Health Care Chaplaincy as a Research-Informed Profession. In Roberts S (Ed) Professional Spiritual and Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012. SkyLight Paths Publishing. Woodstock, VT. ISBN-10: 1594733120. http://amzn.to/2f2bZgF
- Fitchett G, Nieuwsma J, et al. 2014. Journal of Health Care Chaplaincy. 20 (4). Evidence-Based Chaplaincy Care: Attitudes and Practices in Diverse Healthcare Chaplain Samples. DOI: 10.1080/08854726.2014.949163. http://bit.ly/2d2zAIo
- Fitchett G and Nolan S (Eds). Spiritual Care in Practice: Case Studies in Healthcare Chaplaincy. 2015. Jessica Kingsley Publishers. ISBN-10: 1849059764. http://amzn.to/2ehUHgJ
- Fitchett G and Murphy P. Evidence-Based Spiritual Care for Chaplains: Update and Prospects. 2015. http://bit.ly/2dmTUFA
- Flannelly, K. J., Handzo, G. F., Weaver, A. J., & Smith, W. J. (2005b). A National Survey of Health Care Administrators’ Views on the Importance of Various Chaplain Roles. Journal of Pastoral Care & Counseling, 59(1-2), 87 – 96. PMID:15943148. http://bit.ly/2e9Z8Wh
- Galek K, Vanderwerker L, et al. Topography of Referrals to Chaplains in the Metropolitan Chaplaincy Study. 2009. J Pastoral Care Counsel. 63(1-2). 6:1-13. PMID:20196354. http://bit.ly/2dcsMrQ
- Georgetown University Health Center, National Center for Cultural Competence. Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs. 2004. http://bit.ly/2e7fS1h
- Georgetown University Health Center, National Center for Cultural Competence. Sharing a Legacy of Caring Partnerships Between Health Care and Faith-Based Organizations. 2001. http://bit.ly/2eqJw0g
- Giordano, L. A., Elliott, M. N., Goldstein, E., Lehrman, W. G., & Spencer, P. A. (2009). Development, implementation, and public reporting of the HCAHPS survey. Medical Care Research and Review. DOI:10.1177/1077558709341065. http://bit.ly/2ef5mIK
- Glanz K and Bishop D. The Role of Behavioral Science Theory in Development and Implementation of Public Health Interventions. DOI: 10.1146/annurev.publhealth.012809.103604. 2010 http://bit.ly/2eZ5knq
- Gleason JJ. An Emerging Paradigm in Professional Chaplaincy. 1998. Chaplaincy Today. 14. 9-14. DOI: 10.1080/10999183.1998.10767090. http://bit.ly/2eSr5pu
- Gleason JJ. 2011. The Ideal Intervention Project Explained. Sharing Spiritual Care Knowledge for the Good of All. National Association of Catholic Chaplains Conference. http://bit.ly/2dVs2x6
- Gleason JJ. Can Chaplains Survive and Thrive with P4P? 2012. Chaplaincy Today. 28(2). DOI: 10.1080/10999183.2012.10767457. http://bit.ly/2dZZi2w
- Gleason JJ. A Professional Spiritual Care Knowledge Base: Boon or Bane? 2013. Journal of Health Care Chaplaincy. 19(2). DOI: 10.1080/08854726.2013.763699. http://bit.ly/2eEbeHr
- Gleason JJ. 2015. The Pastoral Caregiver’s Casebook. Volume 1: Ministry in Relationships. ISBN-10: 0817017593. http://amzn.to/2eSr5G3 Volume 2: Ministry in Crises. ISBN-10: 0817017607 http://amzn.to/2eDJeCB Volume 3: Ministry in Health. ISBN-10: 0817017615. http://amzn.to/2f2eOxV Volume 4: Ministry in Specialized Settings. ISBN-10: 0817017623. (Pastoral Caregiver’s Casebook Series). http://amzn.to/2er74F9 Judson Press.
- Gonzalez P, Castaneda S, et al. Spiritual Well-Being and Depressive Symptoms among Cancer Survivors. 2014. Support Care Cancer. 22(9). 2393-2400. DOI: 10.1007/s00520-014-2207-2. http://bit.ly/2dJMpbT
- Grossoehme D, Jacobson A. Collaborating with Chaplains to Meet Spiritual Needs. 2006. Medsurg Nursing. 15(3). PMID 16817296. http://bit.ly/2bnX13E
- Grossoehme DH. Research Methodology Overview of Qualitative Research. Journal of Health Care Chaplaincy. 2014;20(3):109-122. doi:10.1080/08854726.2014.925660. http://bit.ly/2eSpwI6
- Gutierrez N. Cultural Competencies. In Professional & Spiritual and Pastoral Care: A Practical Clergy and Chaplain’s Handbook. 2012. Roberts S. (Ed). ISBN-10: 1594733120. http://amzn.to/2f2bZgF
- Handzo G. Best Practices in Professional Pastoral Care. 2006. Southern Medical Journal. 99(6). DOI: 10.1097/01.smj.0000222481.70129.7d. http://bit.ly/2dTGemS
- Handzo G. The Process of Spiritual/Pastoral Care: A General Theory for Providing Spiritual/Pastoral Care Using Palliative Care as a Paradigm. Chapter 3 in Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012. Skylight Paths Publishing. ISBN-10: 1594733120. http://amzn.to/2f2bZgF
- Handzo G. Of Cooks and Cookbooks: The Chaplain’s Version. 2013. PlainViews. 10(20). HealthCare Chaplaincy Network. http://www.plainviews.org
- Handzo G, Flannelly K, et al. What Do Chaplains Really Do? II. Interventions in the New York Chaplaincy Study. 2008. Journal of Health Care Chaplaincy. 14(1). DOI: 10.1080/08854720802053853. http://bit.ly/2dAlLFg
- Handzo G, Cobb M, Sinclair S, et al. Outcomes for Professional Health Care Chaplaincy: An International Call to Action. 2014. Journal of Health Care Chaplaincy. 20:2. 43-53. DOI:10.1080/08854726.2014.902713. http://bit.ly/2dw7YAp
- Handzo G and Koenig H. Spiritual Care: Whose Job is it Anyway? 2004. Southern Medical Journal. 97(12). 1242-1244. DOI: 10.1097/01.SMJ.0000146490.49723. http://bit.ly/2dXJYT5
- Handzo, G. and Wintz, S. (2013). Documentation and Confidentiality in Chaplaincy Practice. PlainViews, 10(17), 9/18. http://www.plainviews.org
- HealthCare Chaplaincy Network. The Research Evidence of the Positive Impact of Chaplaincy and Spiritual Care: Summary of Key Findings. 2014. http://bit.ly/2e850xW
- HealthCare Chaplaincy Network. An Invitation to Chaplaincy Research: Entering the Process. 2014. http://bit.ly/29Nuroz
- HealthCare Chaplaincy Network. Cultural and Spiritual Sensitivity: A Learning Model for Health Care Professionals. 2009. http://bit.ly/2cyiKmG
- HealthCare Chaplaincy Network. Handbook of Patient’s Spiritual and Cultural Values for Health Care Professionals. 2014. http://bit.ly/2e1BVVR
- Institute of Medicine. Committee on the Health Professions Education Summit. Health Professions Education: A Bridge to Quality. In: Greiner AC, Knebel E, editors. Washington, DC: National Academy Press; 2003. http://bit.ly/2eppTcf
- Institute of Medicine. 2015. Dying in America: Improving quality and honoring individual preferences near the end of life. Washington DC: The National Academies Press. http://bit.ly/29nquJ2
- Jankowski K, Handzo G, Flannelly K. Testing the Efficacy of Chaplaincy Care. 2011. Journal of Health Care Chaplaincy. 17:100-125. DOI: 10.1080/08854726.2011.616166.
- Joint Commission Resources. (2010) Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals http://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf
- Kang H. How to Understand and Conduct Evidence-Based Medicine. 2016. Korean J Anesthesiol. Oct; 69(5). 435-554. DOI:10.4097/kjae.2016.69.5.435. http://bit.ly/2dw9Kld
- Kagawa-Singer, M., & Backhall, L. Negotiating Cross-Cultural Issues at End of Life. 2001. Journal of American Medical Association, 286(3001). PMID:11743841. http://bit.ly/2eo06xX
- Kyriakoulis K, et. al. Educational Strategies for Teaching Evidence-Based Practice to Undergraduate Health Students: Systematic Review. 2016. J Educ Eval Health Prof; 13: 34. DOI: https://doi.org/10.3352/jeehp.2016.13.34. http://bit.ly/2eDIOfC
- Lewis JM. Pastoral Assessment in Hospital Ministry: A Conversational Approach. Chaplaincy Today. 18. 5-23. DOI: 10.1080/10999183.2002.10767203. http://bit.ly/2eEbDcI
- Lysne C and Wachholtz A. Pain, Spirituality, and Meaning Making: What Can We Learn from the Literature? 2011. Religions. 2(1-16). DOI:10.3390/rel2010001. https://binged.it/2efNys6
- Mako C, Galek M, Poppito SR. (2006) Spiritual pain among patients with advanced cancer in palliative care. J Palliat Med. 9(5):1106-1113. DOI: 10.1089/jpm.2006.9.1106 http://bit.ly/2eswgvt
- Management Sciences for Health. The Provider’s Guide to Quality and Culture. 2008. http://bit.ly/2bzrvwI
- Marin DB, Sharma V, Sosunov E, Egorova N, Goldstein R, Handzo G. 2015. The relationship between chaplain visits and patient satisfaction. Journal of Health Care Chaplaincy. 21 (1):14-24. DOI:10.1080/08854726.2014.981417. http://bit.ly/2d566P2
- Marino M. Working with Community Religious Resources. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012. Skypaths Publishing. ISBN-10: 1594733120. http://amzn.to/2f2bZgF
- Massey K, Barnes M, et al. What Do I Do? Developing a Taxonomy of Chaplaincy Activities and Interventions for Spiritual Care in Intensive Care Unit Palliative Care. 2015. BMC Palliative Care. DOI 10.1186/s12904-015-0008-0. http://bit.ly/2dZv7bf
- Massey, K., Fitchett, G., and Roberts, P. (2004). Assessment and Diagnosis in Spiritual Care. In Mauk, K.L. and Schmidt N.K., Eds. Spiritual Care in Nursing Practice. (pp. 209-242) Philadelphia: Lippincott, Williams, and Wilkins. ISBN-10: 0781740967. http://amzn.to/2er3r21
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- Merck Manual. Understanding Medical Terms. http://bit.ly/2edbwIC
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- Mitchell P, Wynia M, et al. Core Principles and Values of Effective Team-Based Health Care. 2012. Institute of Medicine. http://bit.ly/2edbocj
- Monod S, Rochat E, et. al. The Spiritual Distress Assessment Tool: An Instrument to Assess Spiritual Distress in Hospitalized Elderly Persons. 2010. BMC Geriatrics. 10(88). DOI: 10.1186/1471-2318-10-88. http://bit.ly/2exs9eG
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- O’Connor TS. The Search for the Truth: The Case for Evidence-Based Chaplaincy. In VandeCreek L (Ed). Professional Chaplaincy and Clinical Pastoral Education Should Become More Scientific: Yes and No. 2002. 185-194. Haworth Press. Binghamton, NY. ISBN-10: 0789022389. http://amzn.to/2eu22X7
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- O’Connor TS. Book Review: The Pastoral Caregiver’s Casebook, Volume 1 and Volume 2 by Gleason JJ. 2015. Journal of Health Care Chaplaincy. 12(165-167). http://bit.ly/2eslhn0
- Overvold J. Quality Improvement: A Chaplaincy Priority. In Roberts S (Ed). Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplains Handbook. 2012. Skylight Paths Publishing. ISBN-10: 1594733120. http://amzn.to/2f2bZgF
- Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The Many Methods of Religious Coping: Development and Initial Validation of the RCOPE. Journal of Clinical Psychology, 56(4), 519-543. PMID:10775045. https://www.ncbi.nlm.nih.gov/pubmed/10775045
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- Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L. and Cella, D. (2002). Measuring Spiritual Well-Being in People with Cancer: The Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale (FACIT-Sp). Annals of Behavioral Medicine, 24(1), 49-58. PMID: 12008794. http://bit.ly/2emxgzG
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- Puchalski C, Ferrell B, Virani R, Otis-Green S, Baird P, Bull J, Chochinov H, Handzo G, Nelson-Becker H, Prince-Paul M, Pugliese K, Sulmasy D. (2009). Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. Journal of Palliative Medicine. 12(10):885-904. DOI: 10.1089/jpm.2009.0142. http://bit.ly/2d4Pgxw
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