Celebrating Our Chaplains: Rabbi Nadia
Wednesday, November 21, 2018
By Rabbi Nadia Siritsky, Vice President, Mission, Jewish Hospital and Frazier Rehab Institute
Rabbi Nadia Siritsky,
Vice President, Mission,
Jewish Hospital and Frazier Rehab Institute
Jewish Hospital’s Academic Contributions to the Study of the Impact of Chaplaincy Upon Patient Care and Staff Engagement
Jewish Hospital’s Chaplaincy Department has made news across the country, with an innovative study that was conducted to try to measure the impact of spiritual care upon patient experience scores and levels of staff burnout. This research study was recently featured in the Catholic Health Association’s Health Progress and also presented at the National Association of Catholic Chaplains, as well as at Research Louisville.
BACKGROUND OF THE PROBLEM
In 2018, the Joint Commission issued a safety alert related to the importance of attending to "second victims," the health care providers who are most directly involved in attending to a patient's adverse event. The emotional trauma associated with the event can have a lasting effect on the provider, including post-traumatic stress disorder resulting from an experience with medical errors. This dynamic contributes to compassion fatigue, which in turn can lead to further safety errors, as well as affecting job performance, staff retention and patient experience. Nursing researchers pointed out that "understanding the linkages between caring, patient satisfaction with nursing care, and patient satisfaction with the hospital experience is now more important than ever."
There is a profusion of research in the literature on health care professionals such as nurses, who experience burnout and stress from their work. In a 2013 paper, researchers Kathleen Flarity, J. Eric Gentry and Nathan Mesnikoff emphasized the gap in the literature when they declared, "Compassion fatigue is an important and often unrecognized problem that has not been thoroughly explored or quantified in a large group of emergency nurses." The impact that staff burnout can have upon patient experience is even less studied.
The phrase "compassion fatigue," which includes secondary traumatic stress, is a common reference in the literature and describes several challenging contributing social factors. It can be defined as "a secondary traumatic stress reaction that results from helping a person suffering from a traumatic event."
METHODS FOR THE PILOT PROJECT
The research project examined the impact of having a chaplain present in the emergency department, rounding on patients and staff for four hours a day over the course of three months. Prior to this project, chaplains primarily provided pastoral care to inpatient units and intensive care units within the hospital and had minimal interactions with the emergency department.
Participants were required to be full-time emergency department staff (nurses and nurses' aides both participated), and they had to have a reading comprehension above the eighth grade level. There were no personal incentives offered for completing the survey. Procedures of informed consent were observed, and respondents' anonymity was maintained. The study was approved by the Institutional Review Board of KentuckyOne Health as a quality improvement project.
Participants completed a pre-test to measure levels of burnout and compassion fatigue and collaborated with a chaplain for three months. During that time, both staff and patients received pastoral counseling interventions and then took a post-test after the intervention. The study used the Professional Quality of Life Scale, a reliable and valid barometer of levels of compassion satisfaction, burnout and compassion fatigue in employees.
DISCUSSION AND IMPLICATIONS
In short, the study results showed that compassion satisfaction (the opposite of compassion fatigue) went up, levels of burnout went down and symptoms of secondary trauma went down after participants talked with a chaplain. Furthermore, the patient experience score in the emergency department increased by 82% during this same period of time.
While there were several limitations to the study, anecdotally, members of the staff reported immense gratitude for the pastoral support. Initially, staff members were hesitant about the project, stating "I am not religious, why would I need a chaplain?" and "Unless someone dies, I don't understand how this is helpful." But, at the conclusion of the three-month project, staff wrote such comments on the post-test as "Don't take my chaplain away" and "I did not realize how much I needed this support until I got it."
Chaplaincy team members also reported a deepened appreciation for the work that emergency nursing staff performed, as well as an enhanced ability to triage patient care needs by being able to provide improved continuity of pastoral support to patients and families.
After the study concluded, Jewish Hospital created a new chaplaincy position for palliative care needs so that the rest of the chaplaincy team could focus upon staff support as well as patient care throughout the hospital. Staff increasingly began to rely on chaplains to debrief them after adverse events and other forms of secondary trauma. Chaplains created a new workflow process that included regular rounding in the emergency department.
The project's findings were disseminated across KentuckyOne Health, and several other emergency departments within the system — including Flaget Memorial Hospital in Bardstown, Kentucky, and Saint Joseph Mount Sterling in Mount Sterling, Kentucky — implemented the changes. Those hospitals also reported improvement in staff morale and patient experience as a result of increased pastoral care presence in the emergency departments.
The project illustrates the statistically significant impact that chaplains can have on patient care, as well as on staff well-being. Although the trauma involved in serving as an emergency department staff person cannot be avoided, staff compassion satisfaction levels — namely, the meaning that they ascribed to the work that they did — increased, thereby helping to mitigate against the secondary distress that can accompany caring for emergency department patients and their families.
By having a chaplain present to make rounds and debrief staff members after difficult encounters, they were able to integrate their spirituality more comprehensively into their daily work. In addition, the chaplains provided pastoral support to emergency department patients, helping them feel less anxious.
RABBI NADIA SIRITSKY is vice president of mission, KentuckyOne Health, serving Jewish Hospital and Frazier Rehab Institute in Louisville, Kentucky.
CYNTHIA L. CONLEY is assistant professor and director of graduate studies, Spalding University School of Social Work, Louisville, Kentucky.
BEN MILLER is a master's of social work student and research assistant, Spalding University School of Social Work, Louisville, Kentucky and he completed his social work practicum internship at Jewish Hospital.
Special thanks to the following Jewish Hospital chaplains: Kathy Lesch, BCC and Anne Alexandra, BCC.