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					    STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY


                                      Supported by Help the Hospices




                                  Self Assessment Tool


                                            Association of Hospice and
                                             Palliative Care Chaplains

                                           Second Edition AHPCC 2006




Unit Name

                               Name                      Designation     Date
Self Assessment Completed by

Reviewed by
     STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                    SELF ASSESSMENT TOOL


Introduction                                        Using the Self Assessment Tool                   What Kind of audit
This tool has been developed as a practical aid     The self assessment tool has five columns,       The standards were piloted by using two forms
to assess and audit a chaplaincy service by         three of which                                   of audit.
using the Standards for Hospice and Palliative      require completion.                              The AHPCC leaves it to individual units to
Care Chaplaincy. It is acknowledged that the                                                         choose the method of audit felt to be most
tool may need to be adapted where a                 Criteria column                                  effective in evaluating the chaplaincy service.
chaplaincy team is in place and in particular       This column is a duplicate of the chaplaincy
where team members are part-time. The               standards Criteria column                        These audits are offered as a guide.
Association of Hospice and Palliative Care          Self Assessment Question
Chaplains would welcome comments on the             This column poses the audit questions            Internal audit. The chaplain and/or member(s)
self assessment tool and suggestions for ways       Answer                                           of staff complete the form and a line manager,
in which it might be improved for future use. An    This column is for answers to the questions in   clinical audit facilitator (or other person) acts as
electronic version of the self assessment tool in   the                                              reviewer.
Microsoft Word is available from the                Self Assessment Question column
Association of Hospice and Palliative Care          Reviewer comments                                External audit. The chaplain and/or member(s)
Chaplains website:                                  This column allows a reviewer to comment on      of staff complete the form and an external
www.ahpcc.org.uk                                    the                                              person acts as reviewer.
                                                    answers
ASSESSMENTTOOL                                                                                       A sample of the findings of a comparative audit
                                                    Met / Not Met
                                                    This column gives a choice of met or not met,    using the AHPCC 2003 standards is available
                                                    however it may be that you wish to add to this   in full text on-line from the Scottish Journal of
                                                    by                                               Healthcare Chaplaincy:
                                                    including partially met or working towards.      Mitchell, D. and Hibberd, C. (2004) A
                                                                                                     comparative Assessment of Hospice
                                                                                                     Chaplaincy Services. Scottish Journal of
                                                                                                     Healthcare Chaplaincy 7(1), 6-11.
                                                                                                     www.sach.org.uk/journal




                                                                         -1-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL

Standard 1 Access to Chaplaincy Services
Criteria (Standard 1)         Self Assessment Question                       Answer   Reviewer Comments    Met /
                                                                                                          not met
1.1   All patients receive written        Do patients receive written
      information containing details of   information on the chaplaincy
      the chaplaincy service available    service? (give details)
      within the unit.

1.2   The information supplied in the     Does the information :
      information booklet contains an     a. give examples of when to
      explanation of the chaplaincy       contact the chaplain?
      service and when and how
      contact with the chaplain may be    b. explain how to contact the
      obtained .                          chaplain?

1.3   The booklet is supported by Is the booklet supported by
      verbal explanation of access to verbal explanation?(give details)
      the chaplaincy service during
      admission.

1.4   The admission procedure ensures What procedure is in place to
      a check that written information check information is given?
      is given.

1.5   There is a documented protocol      Is there a documented protocol?
      for referral to the chaplaincy
      service. (Note: The referral        Where is it held? (should be an
      procedure/pathway can be a          area accessible to staff e.g.
      verbal system)                      wards, patient notes, local
                                          computer network, local services
                                          manual)



                                                                               -1-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL
Standard 2 Spiritual & Religious Care
Criteria (Standard 2)            Self Assessment Question                         Answer   Reviewer    Met /
                                                                                           Comments   not met
(a) Spiritual

2.a.1 Spiritual needs are assessed and       How do you ensure that patients
      addressed and may include the          and those important to them have
      following:                             had the opportunity for their
    exploring the individual’s sense of     spiritual needs to be assessed and
      meaning and purpose in life.           addressed ? (Describe the process
    exploring attitudes, beliefs, ideas,    and how audited. e.g. audit of
      values and concerns around life        patient information systems(notes
      and death issues.                      or electronic), patient feedback
    affirming life and worth by             etc.)
      encouraging reminiscing of the
      past.
    exploring the individual’s hopes
      and fears regarding the present
      and future for themselves and their
      families/carers.
    exploring the ‘WHY’ questions in
      relation to life, death and
      suffering.

2.a.2 Liaise with local resources for        What systems are in place to
      spiritual support and with the         liaise with local resources for
      patient’s    permission      contact   spiritual support? (give details
      relevant groups individuals.           e.g. a directory of contact
        For Example: the Humanist            numbers for local/national
        Society                              organisations is available)




                                                                                   -2-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL
Criteria (Standard 2)                      Self Assessment Question            Answer   Reviewer    Met /
                                                                                        Comments   not met
(b)Religious

2.b.1 Religious needs are assessed and How do you ensure that patients
      addressed                        and those important to them have
                                       had the opportunity for their
                                       religious needs to be assessed and
                                       addressed ? (e.g. audit of patient
                                       information systems(notes or
                                       electronic), patient feedback etc.)

2.b.2 Facilitate  the   provision   of How do you facilitate the
      inclusive worship reflecting the provision of inclusive worship?
      faith groups present within the
      unit.

2.b.3 Facilitate     ceremonies    and How do you facilitate ceremonies
      sacraments for individual and/or and sacraments for individuals?
      groups when requested by patients
      and their carers.                 How do you facilitate ceremonies
                                        and sacraments For groups?

2.b.4 Liaise with local faith groups and   What systems are in place to
      religious leaders and with the       liaise with and refer to faith
      patient’s permission facilitate      groups and religious leaders?
      referrals.                           (give details)

2.b.5 Protect patients from unwanted How are patients protected from
      visits from faith groups / religious unwanted visits from faith groups
      representatives.                     and religious representatives?




                                                                                -3-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL
Criteria (Standard 2)                      Self Assessment Question             Answer   Reviewer    Met /
                                                                                         Comments   not met
(c) Protecting Patients

2.c.1 Protect Patients from unwanted How are patients protected from
      visits from spiritual or religious unwanted visits from spiritual or
      groups or representatives          religious groups or
                                         representatives? (e.g. is there a
                                         protocol for the chaplain/staff
                                         member to contact/inform the
                                         representatives/faith leaders of the
                                         patient’s decision?)




                                                                                 -4-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL

Standard 3 Multidisciplinary Teamworking
Criteria (Standard 3)           Self Assessment Question                         Answer   Reviewer    Met /
                                                                                          Comments   not met

3.1   The     chaplain attends     and Does the chaplain attend
      contributes to multidisciplinary multidisciplinary team meetings?
      team meetings.
                                       Is attendance recorded?

3.2   The chaplain responds to referrals Does the chaplain respond to
      from      members       of     the referrals from the
      multidisciplinary team.            multidisciplinary team?

                                             Is there a timescale for response
                                             to referrals? (Give details)

3.3   The chaplain records relevant Does the chaplain record:
      information, response to referrals,  response to referrals in the
      and interventions, in the patient     patient information system
      notes and in the electronic
      information     systems    (where  interventions in the patient
      available).                           information systems?

                                              Is the recording audited? (give
                                               details)

3.4   In response to recognised patient      Are referrals made to other
      or carer’s needs the chaplain refers   members of the multidisciplinary
      individual patients and their carers   team? (give details)
      to other members of the
      multidisciplinary team.                Are they documented?



                                                                                  -5-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL

Standard 4 Staff Support
Criteria (Standard 4)                    Self Assessment Question            Answer   Reviewer    Met /
                                                                                      Comments   not met

4.1   The chaplain builds working Is there evidence of good working
      relationships with members of relationships? (give details E.g.
      staff and volunteers.         staff/volunteer survey?)

4.2   The chaplain responds to requests Does the chaplain provide
      from members of staff and personal and professional staff
      volunteers for personal and support?
      professional support.
                                        Are incidences (not content) of
                                        support recorded? (e.g. a
                                        diary/log noting time spent and
                                        whether professional or personal.
                                        No name or content need be
                                        recorded to prevent
                                        confidentiality)

4.3   The chaplain responds to requests Does the chaplain provide
      from members of staff and spiritual and religious staff
      volunteers for spiritual and support?
      religious support.
                                        Are incidences (not content) of
                                        support recorded? (e.g. a
                                        diary/log noting time spent and
                                        whether spiritual or religious. No
                                        name or content need be recorded
                                        to prevent confidentiality)




                                                                              -6-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL

Standard 5 Education & Training
Criteria (Standard 5)           Self Assessment Question                         Answer   Reviewer Comments    Met /
                                                                                                              not met

                                             How does the chaplain:
5.1 The chaplain contributes to staff         contribute to staff induction?
      induction, development and
      training within the unit.               contribute to in-service
                                               training?

5.2 The chaplain contributes to the           contribute to the units
      unit/team’s education and training       education and training
      programme for all healthcare             programme? (give details &
      professionals.                           topics taught)
        Topics may include:
        Spiritual and Religious Care
        The Role of the Chaplain
        Loss, Grief, and Bereavement

5.3 The chaplain makes                        Make recommendations for
      recommendations for educational          educational resources (give
      resources. e.g. recommendations          details)
      for the unit’s library.

5.4   The chaplain initiates/contributes      initiate/contribute to research
      to research within the unit, within      within the unit? (give details)
      chaplaincy, and spiritual and
      religious care. (e.g. local research    Initiate/contribute to research
      projects and national projects)          within chaplaincy, spiritual
                                               and religious care? (give
                                               details)



                                                                                  -7-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL
5.5   The chaplain is committed to             The chaplain maintains a
      continuing professional                   record / portfolio of CPD
      development (CPD) and keeps a             activity. (Please give details,
      record / portfolio of activities that     e.g. a summary of areas of
      evidences CPD.                            activity.)

      Activities can include:
            attendance or presentation When required for registration
               at conferences;           The chaplain has achieved the
            formal education (courses    required number of CPD
               attended or taught);       points to maintain registration
            teaching delivered;          as a healthcare chaplain. (Give
            articles and books written   details e.g. the number of
               or reviewed;               points required and achieved.)
            journal club;
            reflective practice, e.g.
               clinical supervision.




                                                                                  -8-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL

Standard 6 Resources
Criteria (Standard 6)                       Self Assessment Question           Answer   Reviewer    Met /
                                                                                        Comments   not met

(a) The chaplain should have:               Does the chaplain:

6.a.1 Access to quiet/private areas for  have access to quiet/private
      confidential support of patients,   areas for confidential support
      carers, staff and volunteers.

6.a.2 Access to a chapel/prayer room for  have access to chapel/prayer
      religious observance of all faiths.  room (please describe)

6.a.3 Access to patient information  have access to the patient
      systems for recording information   information systems?
      and interventions.
                                         record interventions in the
                                          patient information systems?

6.a.4 Sufficient     hours    to enable     How many hours per week does the
      attendance at the multidisciplinary   chaplain work?
      meeting, and meeting the spiritual
      and religious needs of patients,      Does the chaplain attend the
      carers, staff and volunteers.         multidisciplinary team meeting?
                                            (Give details - how often?)

6.a.5 Regular appraisal (at least Does the chaplain have an annual
      annually) to review professional appraisal?
      development and training needs.
      Identified needs to be resourced. Are professional and training needs
                                        identified?



                                                                               -9-
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL
Criteria (Standard 6)                     Self Assessment Question               Answer   Reviewer    Met /
                                                                                          Comments   not met
                                          Are resource implications identified
                                          and agreed?

6.a.6 Receive external       professional Does the chaplain have external
      supervision                         supervision (give details e.g.
                                          clinical supervision every 4-6
                                          weeks)


b) The Chaplain should:

6.b.1 be a member of their professions    Is the chaplain a member of the
       ‘specialist interest group’.       Association of Hospice and
       (currently The Association of      Palliative Care Chaplains?
       Hospice and Palliative Care
       Chaplains)                         Is the membership confirmed?
                                          (The AHPCC issue a letter
                                          confirming receipt of subscription
                                          & membership)

6.b.2 have a recognised status within a   Does the chaplain have a
       mainstream faith community.        recognised status with a mainstream
                                          faith community? (please give
                                          details)




                                                                                 - 10 -
      STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
                     SELF ASSESSMENT TOOL

Standard 7 Chaplaincy to the Unit Institution
Criteria (Standard 7)           Self Assessment Question                 Answer   Reviewer    Met /
                                                                                  Comments   not met

The chaplain responds to:               How does the chaplain respond
                                        to:
7.1   Events in the unit which are  events in the unit? Give
      having an impact on staff and         details/examples)
      require a communal response or
      event.
        For Example:
       Death or illness in a member of
         staff
       Unusual patient or family
         events

7.2   Events external to the unit which  external events? (give
      are having an impact on staff and   details/examples)
      require a communal response or
      event.
        For Example:
       National disasters
       World events
       Remembrance / Anniversaries

7.3   An awareness of matters or events  Matters or events affecting
      affecting the morale or functioning morale or functioning of the
      of the unit which require           unit? (e.g. an advocacy role
      management awareness to resolve.    representing staff or
                                          management concerns without
                                          breaking confidence)



                                                                         - 11 -
STANDARDS FOR HOSPICE AND PALLIATIVE CARE CHAPLAINCY
               SELF ASSESSMENT TOOL




                        - 12 -

				
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