Buddhist Healthcare Chaplaincy Group (BHCG) Introduction: A working group has been meeting for the past few years developing a project for Buddhists to make their contribution to Hospital Chaplaincy work and support patients in healthcare settings. Each of the major faiths has been offered the opportunity by the NHS to apply to establish its own faith’s ‘Authorisation Body’. Authorisation is the process whereby a faith community can indicate that individuals are suited to represent their faith community in this work. There is an opportunity for Buddhism to become ‘authorised’ within the next year. Once such arrangements are complete NHS bodies can then deal with designated authorisation bodies direct. Work in Progress Document (Draft 3 – 3rd June 2007) This document is a summary of creative work and discussion that took place at a meeting in London Sunday 18th March 2007 with the following aims: To update groups new to the project on what has happened so far and why this initiative is needed. To gauge assent to the principle of accreditation and competencies developed and administered collectively To develop suggestions for a description of competencies To develop suggestions for a mechanism for accreditation The intention of this working document is to be a focus from which to continue developing these aims. Document Content 1) Structure for competencies – this is the model that the group came up with. It has been simplified from the scheme that came out of the documents somewhat. The more Buddhist aspects are highlighted in green. The other competencies are arguably common to all chaplains. 2) Detail on competencies – which corresponds to the structure. It has been broken down into knowledge, skills and qualities. 3) Accreditation of Chaplains - 4) Issues: This is just a simple list of some of the questions that came up on the day. There could be more we could add here. 5) Involving others and what next: A summary of the actions the involving others subgroup and how we suggested we were going to circulate the write up of the meeting. 6) Role play: Tried and tested ‘role play’ scenarios in case they are useful for training. Being; Understanding of Ability to Knowing Buddhist Awareness, procedures within hospital establish teachings initial mindfulness, including clarity about presence. chaplain’s role relationships Being able to communicate Buddhist teachings Interpersonal skills Practicing together eg meditation Communication Skillful support skills Support network in place for Chaplain Reflective practice Detailed breakdown of elements of competencies (based on collective participatory exercise) Support system Support network in place for chaplain Kalyana Mitra (spiritual friendship) from person in own Sangha (spiritual community) Skills 1, Ability to establish initial relationship Ability to: introduce yourself gather information identify self to staff create a connection with patient 2. Interpersonal skills a) Interpersonal skills - Patient Ability to: Not take over Not project fear into patient’s own circumstances Be in silence with someone Be clear in communication with someone Help patient to reflect on past Judge the appropriateness of physical contact with patient b) Interpersonal skills- Hospital staff Ability to: develop relationships with ward staff Negotiate including making skilful complaints Help arrive at solution without bias 3. Communication skills Ability to: Summarise feelings Communicate in English – spoken and written Listen Ask questions Clarify problem 4. Communication about the Dharma Ability to: Discuss death and suicide when appropriate Give information/advice/doctrinal guidance 5. Practice together Ability to: Lead and practice meditation or other practices when appropriate 6. Skillful support - skills Ability to: Work in wider context with patient’s family etc Clarify situation Elicit issue from reluctant patient Balance sensitivity to patient’s values with clinical needs Knowledge/understanding 1. Understanding of procedures within hospital Knowledge of NHS defined role of chaplain Knowledge of policy of obligation to disclose information discussed with patient Knowledge of how to gain access to clinical notes if needed Knowledge of health and safety procedures including hygiene, restraint Understand of decision making within hospital Knowledge of legal responsibilities of chaplains 2. Dharma knowledge/ Dharma Knowledge Knowledge of perspectives on death from a range of traditions Understanding of different traditions Qualities 1. Being Awareness including self awareness Sensitivity Presence Mindfulness Friendliness At ease with difficult feelings 2. Skillful support - qualities Reliability Accreditation of Chaplains Accreditation by Portfolio Applicants to submit portfolio in following format: - Application form which lists experience, training, skills and knowledge in key areas (approximately six key areas to be identified) - Supplementary materials supporting information given on application form. (this may include written accounts of experience, certificates, photographic or other electronic evidence of prior learning) - A three month learning journal accounting experience of chaplaincy related work in a health related setting (eg work as a chaplaincy volunteer) - Two references; reference one reflecting spiritual experience eg from head of tradition/order/teacher/senior member of group. Reference two reflecting professional experience in healthcare setting eg from senior chaplain, senior health professional, head of training programme if of a different tradition to reference one etc. - CRB checks will be done by healthcare provider in most cases Interview: Initially we would aim to establish a panel to interview potential chaplains. Each panel should be three people from different traditions. This would provide us with valuable learning experience in assessing portfolios and evaluating our assessment methods. Later we might move to other strategies such as sampling. Ongoing Support: - CPD: regular seminars/training days to be offered. In particular these will foster inter-Buddhist discussion. - Supervision as a requirement of ongoing practice - Need to create guidelines, complaints procedures, code of practice etc Portfolio Categories: initial suggestions: 1. Experience/practicum: 3 months placement as hospital visitor or similar evidenced by learning journal, showing ability to reflect on and learn from practice. 2. Buddhist Practice and Knowledge: a) good grounding in one Buddhist tradition supported by reference, with evidence of regular practice and doctrinal knowledge b) knowledge and use of appropriate liturgy and ritual in healthcare settings c) Awareness of a range of Buddhist practices relating to death; ability to offer simple ritual or ceremony at times of death or to accompany a Buddhist of another tradition in performing their chosen practice. Ability to offer other rites of passage / where appropriate refuge ceremonies d) knowledge of different Buddhist traditions sufficient to enable an appropriate initial response to Buddhists of other traditions e) evidence of network of contacts and ability to make referrals where appropriate f) Ability to work in multi-faith team 3. Knowledge of NHS chaplaincy needs: a) Knowledge of NHS organisational practices and settings b) Knowledge of organisational structures within hospital chaplaincy c) Awareness of practical procedures on wards eg avoidance of infection transmission, health and safety issues d) Ability to negotiate complex professional relations within NHS e) Awareness of mental health issues and the impact of mental illness on the chaplain’s role 4. Ability to offer spiritual counselling and support: a) Spiritual facilitation, counselling or listening skills b) Ability to respond at different levels: spiritual, emotional, practical c) Ability to set boundaries and keep confidentiality d) Awareness of specific needs relating to terminal illness, chronic illness, incapacity and life change e) Ability to work with issues of loss and bereavement f) Ability to convey bad news or to accompany those who have just received such news. g) Ability to offer appropriate response to questions of life after death. h) Awareness of issues of difference, culture, disability, age etc 5. Ability to engage in ethical discourse. a) Ability to facilitate ethical exploration without imposing views b) Awareness of issues of medical ethics and breadth of Buddhist positions on matters such end of life, abortion, or organ donation and ability to convey such positions without dogmatism. c) Use of supervision, awareness of lines of responsibility and professional boundaries d) Ability to hear “confession” and respond to feelings of regret or remorse Principles: Non harm Being grounded in Buddhist practice Not pushing unhelpful views Not being dogmatic about personal views Patient centred Being aware of and open to the variety of Buddhist traditions Having links to support, own Buddhist group etc Developing reflexive practice; awareness of own learning process Value of having code of practice as guideline Issues Some issues and questions being discussed: What experience will the chaplain have to have? Eg years of practice, observable volunteering for their Sangha Could there be a development of a code of practice based on the competencies that they chaplain would sign up to. Do we need to clarify definitions – what is a chaplain? What is a hospital visitor, a volunteer? What about when people are not part of a tradition or Sangha? How do we involve a wide range of Sanghas? For example holding awareness raising days? Do chaplains have any rights or entitlement? – eg to be paid for what they do. Strategy for involving others in hospital chaplaincy project The group aim to enable the participation of groups by helping them to know what we are doing, sign up and endorse the process. We have been told by the Multifaith Chaplaincy group that the funding for developing this work in the Buddhist network has to go to one group. The Buddhist working group would be asked to nominate representatives on to the MultiFaith Healthcare Chaplaincy group. The group have already written to hospitals to ascertain where there are Buddhist chaplains of volunteers available and we have received 80 replies. These are Buddhists already visiting hospitals with a remit to provide chaplaincy. Discussion stressed the importance of going to existing Sangha meetings/events and talking to them about the chaplaincy project rather than expecting them to come to meetings we organise. Action points: a joint bid with NBO for funding to pay a worker to outreach to different Sanghas (action: agenda for next meeting) Provide information on training and competencies (Keith) Information gathering from the research to find out which Sanghas are represented (Keith and Roger) Dividing up a communication tree (not relying on email) (Roger, Prasada and Dayasara) Build on Maharvihara link in Birmingham, develop link with Venerable Kassapa and have a meeting there.(Prasada and Keith) Hold small event at Buddhist society. (Keith and Michelle) Next steps Suggested the output from this meeting be circulated to other Sanghas and interested parties. We would circulate a document including: 1. A letter explaining the project and a brief history and rationale of it: 2. The issues arising from the project 3. Competencies 4. Mechanisms for accreditation and authorisation 5. A case study of the US experience (provided by Kate) Suggestions for some Role Plays useful for training I’ve just been told that I’ve got a terminal illness. I might as well top myself now rather than get to a point where I am in constant pain. I don’t want my family to go through that either. Is it wrong from a Buddhist point of view to be thinking about this? I’m self employed as a carpenter. Because of the state of my back, the doctors are saying that I might never be able to do work like that again. I’ve got a mortgage and three children. What am I going to do? I wanted to have my Buddha figure next to my bed but the woman opposite has been making a huge fuss about it – saying its devil worship. What should I do? I nearly died on the operating table and I have been thinking about death a lot. I don’t know anything about Buddhism but I remember seeing one of those films where the person who dies, maybe it was the Dalai Lama or someone, they came back as a different person. I’ve never really understood that – how does it work? Do you believe that? I want to make a confession. I’m really scared of taking any kind of medicine – always have been. So I’ve been hiding the pills the nurse gives me under my tongue and spitting it out when she’s gone. I’ve noticed that the nurse over there has been going round bullying all the patients including me and I think that’s unethical.
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