Comments

1. 

   Reza Zolfagharifard 26 Mar 2023

   I'm delighted to see such a solid and enthusiastic response/support for this project.  I look forward to its approval and implementation, which will be the beginning of a new era in providing holistic care in the NHS.

   1. 

      Karl Carpani 27 Mar 2023

      Thank you Reza!

2. 

   Tomy Adattu 25 Mar 2023

   This is an important research regarding the intervention of chaplaincy  service in to the the real challenge the NHS face.It will provide more opportunity to deal with the patient's   emotional side. I think there are other things that makes the hospital stay long other than the emotional part. The relation between physical, emotional and environmental areas to be considered. A chaplain can deal with the spiritual need of the patient and can help the emotional balancing but there are thing beyond the reach of chaplain hope this also will come under the research.

   fr Tomy Adattu

   1. 

      alfred banya 25 Mar 2023

      Dear Fr Tomy,

      Indeed there are other factors that affect hospital stay which may be outside the emotional or spiritual care domain. Our proposal intends to use our hospital dashboard which provides data on changes in average numbers of discharge. Associated with this dashboard are explanations for  the reasons for those hospitals stays that may have gone beyond the planned duration. Hopefully those explanation may give us an insight in some of the factors.

3. 

   Karl Carpani 23 Mar 2023

   Study Shows Spirituality May Need Bigger Role in Healthcare

   Here is interesting research highlighting a shift in demand for spiritual care in Denmark, measured in four dimensions: religious, existential, generativity, and inner peace.

   Researchers say Denmark is seeing a resurgence of spirituality in more private settings — therefore becoming more "post-secular." This term means there is a shift past secularism, with individuals recognising the importance of religion and spirituality in both private and public settings. Although the Danish population does not appear to be overly spiritual or religiously grounded, 81.9% of respondents reported at least one strong or very strong spiritual need in a month’s span.

   Spiritual needs in Denmark: a population-based cross-sectional survey linked to Danish national registers
   Tobias Anker Stripp, Sonja Wehberg, Arndt Büssing, Harold G. Koenig, Tracy A. Balboni, Tyler J. VanderWeele, et al.

   Open AccessPublished: March 12, 2023DOI:https://doi.org/10.1016/j.lanepe.2023.100602 

   1. 

      Alfred Banya 23 Mar 2023

      The paper states the following which supports what we are proposing in our project “Researchers say documenting the spiritual history and asking relevant questions is a good point of entry in a clinical setting. The University of Southern Denmark team believes spiritual needs conversations from healthcare providers and future research on how to conduct spiritual care interventions is necessary.”

      I like the concept of post secular society although I don’t think Britain is nearing that as yet!

4. 

   Karl Carpani 22 Mar 2023

   Aliya, thank you for bringing a personal narrative to the efficacy of this project.
   We would agree with you that "in healthcare we regularly talk about a whole person approach but spiritual care is so often overlooked in it's importance in health."

   Our "joined up approach of this project with the links to the community" are indeed vital and we will strive "to provide evidence which will help this work expand as well as provide essential care to the patients who directly benefit."

   We have not directly made the l"ink to nature within the hospital context" as you highlight and we would be delighted to hear how you feel this may relate to how this project approaches spiritual care?

5. 

   Aliya Porter 21 Mar 2023

   A much needed project. In healthcare we regularly talk about a whole person approach but spiritual care is so often overlooked in it's importance in health. I know from personal and family experience the importance of healthcare staff recognising faith and spiritual wellbeing as part of care. I also have first hand experience of how spiritual care by healthcare staff can improve wellbeing. The joined up approach of this project with the links to the community are vital and I hope this project is able to provide evidence which will help this work expand as well as provide essential care to the patients who directly benefit.
   I wonder whether considerations to nature have also been considered within the hospital context when it comes to spiritual wellbeing.

   1. 

      Alfred Banya 23 Mar 2023

      Aliya

      Thank you for your very useful comments. Just to add to Karl’s reply, one of the aspects that we try and explore when using the HOPE spiritual care assessment tool is to find out where the patient draws their strength from during challenging times. Some may draw this from the transcendent, others may cite, art, music and indeed nature. The most we can do under such circumstances is liaise with our volunteer service, for example if they have magazines or materials on such. We have a park near on of our sites, which I sometimes see relatives who are able to take their loved ones in a wheelchair use. But as Karl said, we have not explicitly highlighted this in our proposal. Perhaps when we explore groups in the community who are suitable for supporting patients on discharge we can consider groups that provide nature related activities.

6. 

   Alfred Banya 20 Mar 2023

   E

   Thie paper below provides a good critical analysis of some of the evidence we are citing. It also throws light on the methodological challenges of measurement and the need to consider several measurement instruments and approaches when assessing the impact of Chaplaincy interventions. It is certainly something we shall be considering again as we refine our project.:

   Eva Buelens, Laura Dewitte, Jessie Dezutter, Anna Vandenhoeck & Annemie Dillen (2023) The outcomes of healthcare chaplaincy on hospitalized patients. A quasi-experimental study in Belgium, Journal of Spirituality in Mental Health, DOI: 10.1080/19349637.2023.2177239

   1. 

      Karl Carpani 20 Mar 2023

      Alfred

      Thank you for highlighting this paper. It shows that what we are trying to research is something of significance to healthcare, and research that is in need of being done. Although its a challenging area to explore, it is right and good that we try, in the same way that the world of science expends time, resources and energy in doing the seemingly impossible. It is pioneering and the outcomes can only serve to enhance our understanding and practice for the better.

7. 

   Reza Zolfagharifard 17 Mar 2023

   I am happy that "Lifting Spirits and Reducing Hospital Stay" has been selected for the next round.  This means Spiritual/Compassionate Care, as defined (below) by Dr Christina Puchalski, is coming closer to being an everyday reality in our healthcare system.

   "Spirituality can be an important element in the way patients face chronic illness, suffering, and loss.  We need to address and be attentive to all suffering of our patients, physical, emotional and spiritual.  Doing so is part of the delivery of compassionate care.  I think we can be better and true partners in our patients' living (and in their dying) if we can be compassionate: if we truly listen to their hopes, fears and beliefs and incorporate these into their therapeutic plans."

   Dr Christina Puchalski, professor of Medicine and Health Sciences at George Washington University and the founder and director of the George Washington Institute for Spirituality and Health (GWISH).

    

   1. 

      alfred Joseph Banya 17 Mar 2023

      Reza,

      Once again, thank you for sharing your thoughts, especially the quote from Dr Christina Puchalski who I guess also draws on her vast experience as a palliative care specialist, and how she has perhaps engaged with patients who are faced with existential questions. We may not have definitive answers to such questions, but at least if someone is around to listen and accompany such persons in there search for answers, they might feel comforted during their time of need.

8. 

   Mark Newitt 16 Mar 2023

   I don't have much new to add to what has already been committed on but, alongside echoing others about the importance of such initiatives, a few thoughts picking up on what some others have said:

   1) Iler's study is impossible to replicated as it is not know what interventions were made. It would be important to have good records of interventions made to try and draw any correlations between chaplaincy support and reduced length of stay (or any other positive metric). It would be good to hear the patient voice in relation to how they found any chaplaincy support [It could be argued the chaplain visit was so disliked that people were desperate to be discharged].

   2) I always am slightly worried with tying chaplaincy to reduced stay. There is a good argument that chaplaincy is most needed by those who have a longer stay because either complications or the seriousness of the illness is likely to produce greater spiritual distress that when someone is in and out more quickly.

   3) It is a bit of a semantic point, but HOPE is not an assessment tool, but rather a history taking tool. Tools such as HOPE/FICA have largely been developed by physicians, not those involved in delivering spiritual care, and have increasingly been criticized for a) focusing too much on religion, b) conflating religion/spirituality, c) having no research base and d) being reductionist reducing spirituality to a search for meaning and purpose (and therefore missing a vital experiential aspect).

   4) Running on from the above (and linking to Simon H's comment) Steve Nolan suggests the following 4 areas/questions to explore:

   SELF -  How are you in your self at the moment?

   OTHERS - How’s your illness been affecting your family and those you are close to?

   COMMUNITIES (nature and life) - How much interest do you have in what’s going on in the world around you?

   TRANSCENDENT/THE ULTIMATE - What’s been important to you and how helpful is that at the moment?

   They are not research developed, but rather developed as a result of Steve's reading on assessment and his experience. Interestingly, through structured differently, there is strong overlap with the 4 dimensions  and 5 needs identified within the Spiritual Distress Assessment Tool developed by Monod which does have a research basis:

   Meaning - Need for life balance

   Transcendence - need for connection/beauty

   Values - Need for values acknowledgement and Need to maintain control

   Psychosocial Identity - Need to maintain identity

   5) In relation to thinking about how spiritual care might be continued after discharge you may want to make contact with the chaplaincy team at Barrow in Furness to talk about their project with Anna Chaplaincy.

   1. 

      alfred banya 18 Mar 2023

      Karl,

      I just wanted to add the following publication regarding the value of chaplaincy in ICU setting:

      https://religionnews.com/2023/02/15/chaplains-offer-more-than-prayers-new-study-confirms-impact-on-icu-families

      Thanks

       

   2. 

      alfred banya 18 Mar 2023

      Karl,

      Thanks for adding to my comments. Another important point that occurred to me though is that regarding reasons why patient may stay longer than their estimated discharge time, the dashboard that we have in our hospital not only gives us data on average discharge per week, but where patients have stayed longer than anticipated, it gives reasons why, which could range from not being medically fit for discharge to unavailability of care facilities in the community. We hope that  outside of this, if there are existential issues that patients are facing which impact on their discharge, we may be able to assist in enabling them to overcome these. As I said, this is a Quality Improvement Project premised on testing out ideas, and I hope it is seen in that light.

   3. 

      Karl Carpani 18 Mar 2023

      Dear Mark,

      I just wanted to add to Alfred’s comments.

      Yes, the HOPE tool is a spiritual history taking tool, but it does aid the identification of spiritual care need. Blaber et al (2015) analysed four spiritual history taking tools;  FICA, FAITH, SPIRIT and HOPE. They concluded that, at least in the palliative care setting, the 'HOPE' tool most comprehensively addressed the spirituality themes identified as important within the healthcare literature that they looked at. As we are looking at not just palliative patients, we take the point of considering other tools. The beauty of the Quality Improvement approach is that it gives opportunity to test approaches, refine or discard if better ways are identified. We have used HOPE in our previous Quality Improvement initiative flexibly, as Alfred already pointed out, and it proved effective in helping healthcare staff identify spiritual care needs, but happy to review.

      Regarding listening to the voice of the patient, as we have pointed out in our project proposal, we plan to use patient feedback from: a) patient interview based on the Scottish Patient Reported Outcome Measure instrument. We intend to use this a modified form, perhaps with additional questions b) The Friends and Family Test surveys routinely done in our hospital. These often capture comments as to why patients feel they were satisfied with their care or not.

      Finally, Alfred as already dealt with your observation on Illeret al. This evidence may be limited, but we are looking at this against the fact that spiritual care contribution to positive health outcomes have been comprehensively documented for example by Koenig et. al (2012). Moreover, regarding patient experience generally, study evidence suggests that hospitals with better staff responsiveness to patients’ needs are more likely to have lower re-admission rates for all conditions (Yang et al. 2018) . In addition, higher overall patient satisfaction and satisfaction with discharge planning are known to be associated with lower hospital readmission rates (Boulding et al. 2011).

      Thank you for your very useful comments and observations.

   4. 

      alfred Joseph Banya 17 Mar 2023

      Mark,

      I forgot to mention a point regarding your observation of Iler's study. Moreover his study was with a group of patients with a particular condition (Chronic Obstructive Pulmonary Disease). In the absence of other evidence since this area has not been extensively researched, we beginning with what we have. Indeed it is not possible to replicate Iler's study, but it gives us an indication that there is a possible association between chaplaincy support and reduced hospital stay, at least in certain cases. Thanks once again.

   5. 

      alfred Joseph Banya 17 Mar 2023

      Dear Mark,

      Thank you very much for your useful comments, which we shall take on board as we continue to refine our proposal. We shall consider tools other than HOPE, although the latter is what is presently recommended in our Trust, and we train individuals to use we try to emphasise that the starting point should be broad and not necessarily  begin with religion. I recognise that strictly it is not an assessment tool but can help in screening for spiritual care needs. Regarding reducing hospital stay, if emotional and spiritual support can contribute to this I think its is a positive. Of course, the intention is not to focus on this at the expense of support the spiritual care support that  patients who indeed require to stay longer need. Regarding support in the community, we shall try and look up the project you recommended. Thank you once again.

9. 

   Simon Burton-Jones 16 Mar 2023

   Dear Karl

   Thank you so much for this proposal, which shows imagination and care and allies these with efficient outcomes.  We are accustomed to measuring concrete outcomes in the UK, usually via GDP, and are often at risk of remaindering those which are intangible.  This was at its starkest at the height of the pandemic, when infection rates necessarily took precedence over everything else.  Most people who get ill realise that the emotional impact of dealing with that is one of the very hardest parts of it, but less attention is devoted to that by others, not least in regular intercessions which tend to focus on physical healing.  And then there are the very hard spiritual questions posed by illness of all kinds, and especially serious illness.  Your initiative sits at the heart of what it has meant to offer holistic care, will surely benefit patients and lead to quicker recovery time and reintegration into local communities.  Thank you so much.

   1. 

      alfred banya 18 Mar 2023

      +Simon

      Thank you for your observation. It reminds me of another funding stream which is similar to this and focuses on 'the frail, vulnerable or those who fall through the cracks'. Indeed, we feel those whose emotional and/or spiritual care needs are not responded to do fall through the cracks in terms of holistic care. We hope our project proposal, whether successful or not in gaining funding will have gone a long way to highlighting this.

       

   2. 

      KARL CARPANI 18 Mar 2023

      +Simon, thank you!

      You highlighted how the so called intangible things are often not measured, to which we would want to ask, how do you then apply quality improvement to such things? Effort must be made to try, and to do so with an openness and adaptability that journeys these hard roads less travelled in order to overcome this aversion and discover new things. It was Pablo Picasso who said “ I am always trying to do the things I cannot do in order that I may do them better”.  Spiritual care in the healthcare setting, or any setting for that matter, alongside other holistic approaches, has been a significant contributor to the wellbeing of many, and it deserves a chance to be researched and evidenced alongside other mainstream practices. Quite rightly you have pointed out that “most people who get ill realise that the emotional impact of dealing with that is one of the very hardest parts of it, and that less attention is devoted to that by others”. We seek in this project to give this the attention it deserves and to flag the value that spiritual care brings to healthcare and beyond.

10. 

    George Anibaba 15 Mar 2023

    Incredibly humbling and reassuring to see such a keen interest and insights on an initiative like this. Looking after people's health and wider wellbeing can expose blind spots in the form of partial recognition of 'whole personhood'. Addressing this through a targeted and evidence-based intervention is a great opportunity to build on learning of 'what works' and ultimately spread that learning so more people can benefit from it.

    1. 

       alfred banya 18 Mar 2023

       George

       Thankyou for putting this in terms of addressing 'whole personhood' which I totally agree with. The Spiritual, Social and Psychological are important dimensions of personhood which we hope this project can touch on in helping patients along their recovery.

    2. 

       Karl Carpani 16 Mar 2023

       George thank you, recognition of 'whole personhood' is a wonderful way to put it. Targeted and evidence-based intervention that is studied in this way will, as you quite rightly say, have a broad appeal and spread learning far and wide. The healthcare spiritual care community is an international one, and we enjoy receiving and sharing learning from many different contexts. Being able to contribute to that international platform from a UK based study like this will be good for the NHS and the development of spiritual care in the UK.

11. 

    Neil Coleman 14 Mar 2023

    It would be great to see more expertise given to explore the holistic needs of patients after such a challenging time. The more we can refresh the understanding of what help is required to meet complex needs the more our communities will be supported.

    1. 

       Karl Carpani 14 Mar 2023

       Neil we share your desire for more expertise given to explore the holistic needs of patients, both in light of the challenges globally after Covid 19, and in general.  The holistic needs have been ignored for quite some time by mainstream Healthcare and it is perhaps time that we dig deeper into some of these ancient approaches to test their validity in meeting the demands of our contemporary healthcare system. Our project is both an enquiry and inquiry into the impact of spiritual care on inpatient stay because it looks generally at the  provision of holistic spiritual care and it formally focuses specifically on inpatient stay.

12. 

    Revd Andy Dovey 10 Mar 2023

    This is a key element to the work of the chaplaincy team, which will not only enrich the ministry, but also support the trust in early recovery, freeing beds and provide substaintal cost savings to the trust.

    1. 

       Alfred Banya 13 Mar 2023

       Dear Andy
       Thank you for your comments . Indeed it is an opportunity to test out the impact on freeing beds.

    2. 

       Karl Carpani 10 Mar 2023

       Thank you for linking this to cost savings Andy, its a significant point that we haven't promoted much but certainly relevant.

13. 

    Karl Carpani 10 Mar 2023

    I just had this in an email regarding this project. Its from the Spiritual Care Lead at Croydon University Hospital:

    Being honest it a new one on me, however, I have just sent it to our CQI adviser and advised that I want to start this as well. So thank you so much for linking me in.

14. 

    Revd Jane Winter 9 Mar 2023

    This is a visionary project which will greatly enhance patient support and build interdisciplinary collaboration to the benefit of patient care and well being. It feels like a natural development of the existing excellent chaplaincy support offered to patients whilst developing and innovative approach to whole person care. Good to see this cutting edge work proposed, the outcomes will contribute to future research into patient spiritual care.

    1. 

       Karl Carpani 10 Mar 2023

       Jane thank you, its wonderful to have such confidence expressed from you, knowing that you are very in touch with development and formation in the Church of England and Diocese of Rochester, and bring a community based perspective on our project.

       Building interdisciplinary collaboration to the benefit of patient care and well being is a wonderful way to put it and at the heart of what we are trying to achieve, and definitely it is about whole person care, often overlooked in the NHS where there is a strong focus of physical health.

15. 

    Christine Thomas 9 Mar 2023

    The Chaplaincy already give so much support for the well being of patients. This exciting, new project will have such a positive impact on improving patient recovery

    1. 

       Karl Carpani 9 Mar 2023

       We certainly think so Christine and are grateful that there are many more people who agree from many different disciplines, not just chaplaincy.

16. 

    Gulay Pereira 9 Mar 2023

    Length of hospital stay is one of the major issues in NHS. It's really admirable that Chaplaincy is leading on this project. I am always impressed with Chaplaincy's work ethic in Kings particularly here at the PRUH site. I think you have a very healthy perspective on this project and I am looking forward to see the results.

    1. 

       Karl Carpani 9 Mar 2023

       Gulay,

       Thank you for the appreciation of what we do and that you can see the benefit of what we propose in this project.

17. 

    Rev Drew Walker 9 Mar 2023

    I'm looking forward to following this important project and implementing any recommendations that come from the study. This will be a valuable project to follow for all chaplains and hospitals.

    1. 

       Karl Carpani 9 Mar 2023

       Revd Walker, thank you. We are excited that if our bid is successful we will have an opportunity to bring to the wider chaplaincy community both in the UK and internationally, quality learning and evidence for good practice.

        

18. 

    Timothy Mercer 9 Mar 2023

    This is an excellent project which focuses directly on improving emotional support, identifying emotional and spiritual needs on wards, to benefit patients and to ensure that inter-disciplinary care by professionals and appropriate response to relatives and caregivers takes place. The value of addressing people holistically in terms of body, mind, emotions and spirit is not to be underestimated. In diverse communities with a global reach, it is important to recognise inner resources to support recovery. The project relates well to an action learning, reflective practice approach, where tools such as the HOPE Spiritual Care Assessment enable important recording of information, in the patient notes, concerning patient need and associated needs and potential agreed referrals, as well as actioned referrals;  this attention to holistic care is given to both emotional and spiritual care in the moment, with the person on the site where a listening ear and emotional support is available and found to be valuable; this attention to holistic care is also given with a recognition of potential outcomes or similar evidence to discover how inner resources are supported by all concerned, where the focus includes reduction in patient stay, in a complex healthcare provison. One process and communication outcome, which could be valuable is appropriately agreed professionally intelligent referral and received feedback for patient care in the community, in GP practices, health services and charities and through faith and belief communities. For the latter this takes place by requested and agreed pastoral visitation to listen, share conversation, and provide specifically requested support for spiritual, religious and personal practices, which enhance a person's inner life, for instance prayer or mediation or religious ritual. (If the project had been in use I worked as a chaplain the records would have captured information concerning on site spiritual and religious support for a dying patient (during COVID restrictions) and a community pastoral visit to give emotional support and return belongings to relatives, as arranged and requested, where access to the hospital site was constrained). (Comments from a former hospital chaplain and Church of England parish priest using local services, involved briefly with the original quality improvement project on site, before retirement).

    1. 

       Alfred Banya 13 Mar 2023

       Tim

       You rightly point out Action Learning and Reflective Practice as the principles are reflected in the PDSA approach that makes the project so appropriate as a QI undertaking.

    2. 

       Karl Carpani 9 Mar 2023

       Tim,

       What a great comment and very comprehensive!

       Especially how our project will bring value to inter-disciplinary care by professionals giving an appropriate response to relatives and caregivers, the value of addressing people holistically, the global reach, how it relates to action learning, reflective practice, the use of tools such as the HOPE Spiritual Care Assessment.

       You particularly highlighted  the "process and communication outcome, which could be valuable is appropriately agreed professionally intelligent referral and received feedback for patient care in the community, in GP practices, health services and charities and through faith and belief communities". This is an aspect of the project that we feel will develop as we navigate our way ahead.

       You also talked about how you would have gathered data if you had still been in Chaplaincy when this project arose. We are constantly looking at our data gathering, the development of a Taxonomy to articulate consistently our engagements, and also how we analyse this data for quality improvement. We have extensively developed our own data app that is integrated with our Business Intelligence Unit and EPR systems, and we have been hands on with colleagues from GSTT and Bart's NHS Trusts in the development of a new cross Trust software program that will provide good data for ongoing QI for good patient outcomes.

        

19. 

    laura duffell 8 Mar 2023

    I think this is a fantastic opportunity to provide more holistic care to our patients. It is well evidenced that patient outcomes are much better and recovery is faster for those who receive care of the mind, body and soul. Hospitals are still not at a place where each are provided equally to patients, but it's so great to see this changing.

    The chaplains are an integral part of the hospital team, and this will enable them to further develop their vital service improving patient experience and care.

    1. 

       Karl Carpani 9 Mar 2023

       Laura, that's wonderful and encourage that you see what we see in this being an  opportunity to provide more holistic care to our patients. We are hoping to add very specifically to the evidence that patient outcomes are much better and recovery is faster for those who receive care of the mind, body and soul. There is definitely a long way to go for hospitals to be in a place where each are provided equally to patients, and like you we are excited to see this changing.

20. 

    Anju Bhatia 8 Mar 2023

    A very important study and I am so pleased to see the true benefit of spiritual care being evaluated.  I am sure this will further illustrate the multifaceted benefits patients experience, including enhanced recovery and reduced time in hospital whilst receiving spiritual care intervention.

    Wishing this work every success.

    1. 

       Karl Carpani 9 Mar 2023

       Anju, its great to have your support and your understanding of the need for evaluating spiritual care intervention. This project would definitely help develop us here and chaplaincy on the whole if we get the opportunity to roll it out as planned, and with the support of the wider QI community.

21. 

    Shivonne Simpson 8 Mar 2023

    Thank you for sharing information about this exciting project.  King's Chaplaincy team work tirelessly  with limited resources to ensure patients spiritual and holistic needs are met, having more support to do this can only have a more positive impact on the patients we serve.

    1. 

       Karl Carpani 9 Mar 2023

       Thank you Shivonne,

       Hearing that from your EDI perspective is great and we are grateful for the partnership we have in supporting EDI in our Trust.

22. 

    Graham Atfield 8 Mar 2023

    I think this is a brilliant project involving the all-important collaborative, multi-disciplinary working. It will show benefits and help to improve staff understanding of what spiritual/emotional care really are and what the benefits can be.

    1. 

       Karl Carpani 8 Mar 2023

        

       Graham,

       Thank you for your comment. I know you have experience extensively of patient engagement and that you see the outcomes. We therefore sing from the same page in terms of the significance of this project in providing vital evidence of what we already know through experience.

23. 

    Rachel Harrington 8 Mar 2023

    Such a brilliant and very worthwhile project. Giving spiritual and/or emotional support to patients is essential for their care and personal well-being. This support will equally help to increase patient discharge rates and free up valuable beds for new admissions. Great potential and a win win!

    1. 

       Karl Carpani 8 Mar 2023

       Rachel,

       Thank you, it will be wonderful to be able explore this as a contributor to shorty stays for patients.

24. 

    Regina Craig 7 Mar 2023

    What a fantastic and worthy project, understanding how important it is to look after the a patients emotional and spiritual needs to improve physical health is so often not understood, assessed or managed.  Enabling and equipping staff to undertake and act on this assessment is vital in how we manage our patients and improve outcomes.

    1. 

       Karl Carpani 7 Mar 2023

       Regina, thank you!

       It's so true that patient's spiritual and emotional needs are not understood, assessed or managed. This came up in a CQC report that highlighted this and sparked our initial Emotional Support project which is the foundation of this further work.  We have a definite focus to enable and equip staff to undertake and act on this assessment and currently run training for various Care Groups  in order to increase referrals to Chaplaincy as specialist practitioners for this and to improve patient outcomes.

25. 

    Karl Carpani 7 Mar 2023

    "This is a really important piece of research".  Thank you Susan!

    You raised the  point about "addressing the boundary between acute and  community settings and the ongoing pastoral & spiritual needs of the patient that require support is also key".  We would completely agree with this and hold this as a significant contributing factor to reducing readmission.  Once we have established the link between spiritual care intervention and reduced hospital stay, we are able to extend this to a community based intervention model that will include co-design with primary care and other community health partners.

26. 

    Karl Carpani 7 Mar 2023

    Thank you and we agree and in our emotional support project we evidenced the change that occurred in the In Patient Survey results resulting from our interventions.

27. 

    Karl Carpani 7 Mar 2023

    Thank you Simon for your very helpful comments.

    A) It would be really interesting to see the mechanics of the 21 day review to see how this might help us in our approach. Is there anything you would be willing to share with us? I can see that the length was not based on maximising benefit, this is however an outcome we would be looking for in our approach. Numbers are indeed difficult and we are applying ourselves to the task of trying to identify data that will evidence this from our existing Business Intelligence Unit analysis and beyond. There is a sense in which this is so new, that we are having to cut a new path and develop the measure as we engage more deeply with the research.

    Our hope is that we can fund a Chaplain on this project as with your review. As you suggest it will include, electronic notes, MDT review , directly with the patient using PROM. This will also need to consider narrative in patient notes.

     

    B) "I was keen not to use FICA or HOPE but we rather  used 3/4 of the research based tool in use at Princess Alice Hospice."  Can you share with us more about this assessment? Our Trust has adopted the HOPE model which is why we are following that path, however we would be interested to see this other assessment method.

28. 

    Ursula Clarke 6 Mar 2023

    Emotional support is integral to healing - fully support this idea

    1. 

       Karl Carpani 8 Mar 2023

       Reply is above. Glitch in the software that has been reported.

29. 

    Susan van Beveren 6 Mar 2023

    This is a really important piece of research and should help build the link between pastoral & spiritual support during the inpatient journey as part of holistic care and improved patient outcomes that help to reduce time in hospital.  I note the other comments and suggestions regarding tools for assessment that can assist the MDT involvement and understanding.  Addressing the boundary between acute and  community settings and the ongoing pastoral & spiritual needs of the patient that require support is also key.  Your project will build some important insights that can be taken into this process.  I am really happy to support this project in any way that is useful.

    1. 

       Karl Carpani 8 Mar 2023

       Reply is above. Glitch in the software that has been reported.

30. 

    Dr Simon Harrison 5 Mar 2023

    I am very happy to engage and support if I can be at all useful.

    2 initial comments.

    A) During Covid19 in our Trust we introduced a 21 day wellbeing review of all patients who had been in 21 days or longer. The length was not based on maximising benefit but the capacity needed to deliver (we would prefer to build a pattern on 7 or 14 day and base the date on research rather than a round number).

    It is carried out by one of the chaplaincy team- and is based on either 1. electronic notes, 2. MDT review or 3. directly with the patient- depending on a number of variables. The outcome is narrated in patient notes.

    This has been very successful but lacks a research framework at present.

    B) I was keen not to use FICA or HOPE but we rather  used 3/4 of the research based tool in use at Princess Alice Hospice.  This has provided a very useful shape to the assessment that communicates well with patients and staff alike. It seems to have a better balance between the emotional/pastoral/spiritual dimensions .

    all the best in what you do, and I said, happy to help if I can.

    Dr. Simon Harrison tssf.

    1. 

       Karl Carpani 8 Mar 2023

       Reply is above. Glitch in the software that has been reported.

31. 

    Anthony Pullen 3 Mar 2023

    Thank you for this interesting and hugely worthwhile project application. I totally agree that a holistic approach to medical care includes spiritual care, specially at EOL.

    As a chaplaincy volunteer I hesitate to comment and appreciate this is an early stage; may I humbly offer two comments based on my pre-retirement professional interest in neurodegenerative disease , and refereeing grant applications.

    1. Regarding methodology; Is it possible to be more specific how 'impact' will be tested? i.e. what instrument(s) will be used, and will it/they enable direct comparison with other published data?. Important to both cross assess results and to strengthen and validate outcome.
    2. Comment on neuro-rehab/neurology - it is commented that these patients feel a lower  support than others.  My limited experience on the Ruskin wing shows communication is key, but especially difficult when stroke patients have non/limited speech or mentition. The proposed application here is very pertinent and welcome, and specialist training by the speech and language therapy department would be helpful & beneficial to outcome.

    General comment ; Will the proposed training be open to volunteers as well as medical and spiritual care staff? if not it leaves a hole in the final application as Kings has a dedicated Volunteers' section.

    This prjoject is also valuable for pastoral care in my parish, as different perceptions of spiritual care in relation to recovery are expressed by parishioners who have been discharged home from hospital.

    Thank you for allowing me to comment.  Do hope it gets funded.

    1. 

       alfred banya 4 Mar 2023

       Anthony, thank you for your very in depth observations and questions. Regarding methodology, I would say, based on the emotional support project that we undertook on 10 wards that had been identified as scoring low for proportion of patients who reported that they were emotionally supported (e.g. response to the question Did you find someone to talk to about your worries and fears?), the interventions we delivered were a) Training of nurses on their wards to recognised emotional care needs, confidently screen for spiritual and emotional care needs, and refer appropriately to a chaplain b) Chaplains to respond in timely manner to any such referrals, undertake further assessment and deliver the appropriate emotional or spiritual care. The patient feedback scores improved after these interventions. Feedback from some of the nurses who continue to attended our training indicate that their confidence in talking to patients about their and/or emotional and spiritual needs has increased. In the previous project the impact was measured through survey of the patients and seeing if a change in proportion of those who reported they felt they had been emotionally supported improved and rose above the set threshold of 80%. This survey is no longer available to us. We propose to use the Scottish Patient Reported Outcome Measure (Reference: Austyn Snowden & Iain Telfer (2017) Patient Reported Outcome Measure of Spiritual Care as Delivered by Chaplains, Journal of Health Care Chaplaincy, 23:4, 131-155, DOI: 10.1080/08854726.2017.1279935 ). Regarding impact on patients stay in hospital, this is something we did not consider in our previous project, but wish to do so in the proposed project. Our initial though was to use reduction in proportion of ‘length of hospital stay outliers’ (that is reduction in the proportion of patients who stay in hospital longer than the planned duration) as a measure. Having consulted our Transformation Lead, unfortunately this data is not routinely available. What we have identified as routinely available on the Trust Business Intelligence Unit Dashboard is data for each ward on average numbers of patients discharged daily and weekly, and any changes in these. We are therefore looking into using this as measure of impact. question about comparison with other reported data. At the moment the Friend and Family Test (FFT) data is being used to assess patient experience. We are using the data as ’proxy’ measure of emotional support and therefore planning to target wards that are scoring below the threshold (96 out of 100). We will monitor the changes in FFT scores for each ward following our interventions and see whether the changes correspond with improvement in the Patient Reported Outcome Measure scores, and also changes in average number of patients discharged. We may also triangulate with feedback through in-I depth interviews with admissions officers, matrons and ward managers.

       I take note of your comment about the training to include volunteers , I agree that for  maximum impact, as many as possible, of those who undertake pastoral care role for the patients need to have training so that they can competently support the patients. Spiritual Care Needs Assessment using the HOPE tool is already part of our training for Chaplaincy volunteers, but it does no harm to conduct a refresher training.

       Finally, this is a new approach we plan to test out, hence data on evidence and publications on it are hardly available. This is why the Quality Improvement principle of testing out new interventions through the Plan Do Study Act (PDSA) cycle,  appeals to us.

       Thank you once again.

    2. 

       Karl Carpani 4 Mar 2023

       Anthony, thank you for your great questions! Let me respond in the order in which you raise them:

       Regarding methodology; Firstly I would spell out some key terms that will guide us.

       1. Evidence based. Our task is to find the evidence. To do this we are fortunate to be able to work with multidisciplinary teams. Firstly we are guided by our own Continuous Quality Improvement Team who are scrutinising our work and holding us to account. Secondly we have a Business Intelligence Unit, who provide data analysis for a breadth of hospital based care included specifically around discharge rates, reasons for delay, ward by ward breakdowns of patients who are ready for discharge and delayed. This data highlights for us patients who are known to Chaplaincy, who are delayed in discharge, for whom we can focus our care and measure the impact as shown in the BIU data. (More about this under PROM). Thirdly we have our own reported outcomes that are recorded in our database. This gives an audit trail of engagement that can further highlight effective intervention outcomes. Fourthly PROM (Patient reported outcome measure). What patients themselves say about their care and the impact of our interventions will be vital is providing evidence. This will be gained through a PROM survey of before and after intervention.
       2. Co-designed. We are not working alone on this, in addition to those mentioned above we are including a breadth of stakeholders who have direct input in the development of the project. These will include, Consultants, Dr’s, Nurse Specialists, Matrons, Nurses, Healthcare Assistants, Ward Managers, Trust Management and Executives, Social Work Team, Palliative Care Team, End of Life Lead, Discharge Co-ordinators. All these and others will be a much needed resource for evidence and wisdom and will help us with checks and balances so the we do not stray of target.
       3. In terms of other published data. Most of this is USA based with some in Australia, there is next to nothing in the UK around this particular focus. This is why this project is vitally important, the UK Healthcare context needs to understand the impact of spiritual care interventions within modern day Britain. What we propose has far reaching implications for the NHS and spiritual and holistic care and is desperately needed to evidence effectiveness.

       The combination of evidence and date from all the above, carefully studied and analysed will form the basis of measuring our intervention and its impact on discharge.

       1. Neuro Rehab/Neurology and Communication. I am so grateful that you raise this issue of how patients in neuro rehabilitation feel a lower support than others with the added challenge of communication. We have identified this and are excited to have engaged with a Cambridge based University in undertaking research on this exact issue. We have a student on a PhD Program looking directly at spiritual care in the neuro rehabilitation context and the impact intervention has upon patient outcomes. It will have cross reference with the Lifting Spirits and Reducing Hospital Stay project we are proposing and we look forward to working with the PhD student in this respect. Regarding communication, your suggestion for working with Speech and Language is a good one and we will ensure this is part of the process for spiritual care for neuro rehabilitation.
       2. Will the proposed training be open to volunteers as well as medical and spiritual care staff? Yes, it is vitally important that as one team we all understand what we are trying to evidence and volunteers are crucial to screening and highlighting patients where this project may prove to benefit.

       Finally, you mention how this project is valuable for pastoral care in your parish. I would like to say this project is valuable for all faith and non-faith communities, and the reason I say that is because it will set a path for deeper enquiry into what we do, why we do it and how it benefits those for whom it was intended to support. Rightly you say about those being discharged into your parish care, as mention before we assess the need and the social and cultural context and we refer to the community as is appropriate for the patient and their ongoing care. In addition we can refer to primary care providers and tertiary care providers if the patient would find this to be of benefit.

        

32. 

    alfred Joseph Banya 3 Mar 2023

    Thank you Mariano. The approach to the spiritiual and emotional care assessment is to explore with the patient what is appropriate to them and then proceed to providing that intervention, according to what they feel can benefit them. If meditation is what they choose, we try to facilitate the availability of that. It is a person centred approach we take. the HOPE Spiritual Care Assessment tool helps us explore such needs with the patient. Thanks for your input.

    1. 

       Karl CARPANI 4 Mar 2023

       Community referral is also part of what we do Mario. In applying a deeper spiritual care needs assessment, we also explore the connection a patient has, or does not have with those who can continue to support them in the community. The majority of patients are short stay and as you quite rightly point out, our time with them is limited, however, the professionalism with which spiritual care providers approach screening and assessment is itself holistic and considers the social, cultural dynamics of a person and how those needs can be addressed with continuity.  Of course its important to state that this is person centred and anything we do will be with the expressed permission of a patient.

33. 

    MR Mariano Marcigaglia 3 Mar 2023

    What is or may be missing here is a plan for a concerted effort to teach patients (and staff?) sounds techniques based on mindfulness/heartfulness to enable them to gain some agency in the field of emotions/pain management, Simply relying on a degree of temporary spiritual care for the few days patients are in hospital is not going to deliver lasting benefits, and you may well see them back in hospital before long. Mariano Marcigaglia, Lay Buddhist Chaplain  07477 163671

    1. 

       Karl Carpani 7 Mar 2023

       Mariano
       We do have through our Wellbeing partners opportunities for exactly the things you describe.  These are readily available and subsidised or funded by our Trust.

       We agree that relying on a degree of temporary spiritual care for the few days patients are in hospital is not going to deliver lasting benefits. In this respect when a patient is in agreement we have strong community links and are always able to refer ongoing care. This would also become and second stage in our project where we would strengthen those links to include primary care and other healthcare providers so that they are aware of the ongoing need for emotional, pastoral, spiritual and religious care.

34. 

    Sabrina Bajwah 3 Mar 2023

    This is an excellent project. Upskilling all health professionals in delivering holistic care is urgently needed.

    1. 

       Karl Carpani 7 Mar 2023

       Thank you for acknowledging and recognising this need, we value your support for this project and indeed for building a base for upskilling staff.

35. 

    hazel brady 3 Mar 2023

    The project should also factor in the administration of supporting  the Chaplains in responding to admission referral requests, if not already done so.  That role is often the initial contact with patients, relatives, carers or staff.  It also involves interactions with those that will be distressed, anxious, or in an upset state.  Requiring extensive listening skills, the ability to empathise, enable the appropriate responses and ensure the correct follow-up is completed in a timely manner.

    1. 

       alfred Joseph Banya 3 Mar 2023

       Hazel,

       Thank you for your useful observation. Indeed the chaplaincy administrator's time has been has been factored into the the project budget, recognising exactly the crucial role that the administrator plays as part of a multidisciplinary team.

36. 

    Laura-Jane Smith 3 Mar 2023

    This is a very interesting proposal. Increasingly, as we improve outpatient and same day emergency care, those that are inpatients have complex needs. Many are dealing with loss of function and independence and many are nearing the end of life. It would be great to see spiritual needs being addressed routinely as part of care. I’d be really interested in the outcome of this project.

    1. 

       Karl Carpani 8 Mar 2023

       Yes thank you for acknowledging that those that are inpatients have complex needs. It is our aim to see spiritual needs being addressed routinely as part of care and we actively promote this across the NHS and within our Trust. We provide training to clinical and non clinical staff on screening for emotional and spiritual care needs and are always looking to broaden this to the wider community and NHS.

37. 

    goorge ochola 2 Mar 2023

    The project is considering using the Scottish patient Outcome Measure to assess impact of the spiritual and emotional intervention on the wards it will be targeting.

    1. 

       Alfred Banya 2 Mar 2023

       Yes, we are exploring the possibility of using the Scottish Patient Reported Outcome Measure to assess patient satisfaction with emotional and spiritual support provided.The measure of impact on discharges may have to be based on average discharges per week, although we are looking at other possible measures based on length of stay.

    2. 

       Karl Carpani 2 Mar 2023

       Thank you George, the Scottish PROM (Patient reported outcome measure) is an appropriate tool for gathering data to measure the impact of intervention. It ensures that we get patient engagement and feedback on our co-designed interventions, that patients themselves have a significant role in shaping and assessing.

38. 

    alfred banya 2 Mar 2023

    Reza, thank you for looking at our proposal  and endorsing it from a positive psychology perspective.

39. 

    Reza Zolfagharifard 2 Mar 2023

    Evidence shows that people find strength and comfort in their beliefs.  Patients show less psychological distress, respond more positively to their treatment and recover faster when they feel supported emotionally and spiritually (holistically).  On the other hand, patients demonstrate more anxiety, respond poorly to their treatment and suffer longer if they cannot find emotional and spiritual peace and harmony.  Therefore, as an experienced positive psychology practitioner, I wholeheartedly support this project and look forward to seeing it used as an integral part of our health system.

    1. 

       alfred banya 2 Mar 2023

       Reza, thank you for looking at our proposal  and endorsing it from a positive psychology perspective.

40. 

    Steve Thomas 2 Mar 2023

    This is a fantastic project. I am very interested in seeing the emotional and spiritual care of patients funded. I am eager to see improvement in patient care. Patient experience, emotionally and spiritually, makes a difference. There are things that medication and spiritual care can do in partnership. I definitely would like to know more about this.

    1. 

       Karl Carpani 2 Mar 2023

       Steve, thank you! Partnership is how we see it, working with clinical colleagues in delivering holistic care for better and improved patient outcomes is both exciting and an absolute. Co design will be important and embracing participation from all care groups who have an investment in improving discharge will be fundamental!

41. 

    NCS Ephraim 2 Mar 2023

    The golden goal of person centred healthcare delivery is directly addressed by this project.  The test run of this project so far has made such a huge difference in the lives of those who participated. Hence this project deserves all the support it can get because it is really fit for purpose.

    1. 

       Karl Carpani 2 Mar 2023

       Ephraim, you have clearly seen the results of our initial project designed to improve the emotional support offer to patients, and how it has set the foundation for this project as a result of significant quality improvement. This project makes a deeper study of impact on discharge and re admission and as such has wider potential for adding value to the NHS and beyond.

42. 

    Karl Carpani 2 Mar 2023

    Deji you clearly see the need from a perspective of experience. The significance of this to those of faith and a none-faith perspective can not be underestimated. This is especially true where a patient has reached the ceiling of available treatment, and they begin to explore the deeper questions of meaning that spiritual care providers are well versed in addressing from a faith and none-faith perspective. Interventions from skilled spiritual care providers can begin a journey for a patient that brings a positive adjustment to the chaos that they presently experience.

43. 

    Deji Ayorinde 2 Mar 2023

    This is a much-needed next step in strengthening interdisciplinary medical care across the NHS, and see our service provision more on par with other leading providers across the world.

44. 

    Rachel Dowdy 1 Mar 2023

    This sounds like a logical next step . We need evidence from the UK in order to deliver the best solutions in our hospitals. The emotional and spiritual care of patients is so important as a part of their overall care.

    1. 

       alfred Joseph Banya 1 Mar 2023

       I absolutely agree, Rachel. Much of the work published has been US based, although colleagues in Scotland have also done significant work on Patient Reported Outcome Measure. We need to build on all these.

45. 

    John Woodhouse 1 Mar 2023

    This is an excellent project and the team have done a lot of work to include people of all faiths and none.

    1. 

       alfred Joseph Banya 1 Mar 2023

       Thank you John. We are trying to promote an outcome oriented approach which starts with assessing the patients needs and then identifying the emotional or spiritual needs, followed by delivering chaplaincy intervention that is appropriate to the patient, religious or non religious.

46. 

    Biba Stanton 1 Mar 2023

    I'm interested in this idea.  In neurology , we know from MyNeuroSurvey that most patients don't feel their emotional needs are being met - this might be one way to address this gap.

    1. 

       alfred Joseph Banya 1 Mar 2023

       Biba, you raise an important point. Incidentally, one of the areas we are presently looking at and liaising with Anglia Ruskin University through a research student is a reviewing our approach and chaplaincy practice in supporting neuro-rehabilitation patients with a view to developing a model to improve practice. This is in the context of the challenges often encountered in engaging with neurology patients. It is something we shall keep in mind, since whatever approach is used need to be appropriate to the patient.

47. 

    Vincent George 1 Mar 2023

    This is an interesting pathway that has not been adequately explored beyond mere rhetoric. It has much potentials in relation to the positive impact it would bring and help create a path to a holistic care. The NHS has a lot to benefit from it.

    1. 

       Karl Carpani 1 Mar 2023

       Yes this is beyond rhetoric and is evidence based in its approach. It directly investigates the question of spiritual care interventions and the impact this has on a patients well-being and health. It seeks to find evidence that such intervention in improving well-being and health directly reduces the length of stay or likelihood of return to hospital. As you say that has to be a worthwhile investigation that will benefit not only the NHS but would be welcome evidence on an international scale in healthcare.

48. 

    Sampson Dankyi 1 Mar 2023

    This looks SMART and very promising and I can't  wait to see the end product rolled out for effective community healthcare for the entire NHS.

    1. 

       Karl Carpani 1 Mar 2023

       Thank you Sampson, the reference to it being SMART is right, we have worked hard to meet the SMART criteria in our planning and preparation. We are also following CQI processes to ensure proper engagement and management of the project.

49. 

    Rebecca Tulk 1 Mar 2023

    This looks like it has good potential for community engagement beyond the project timeline to get local faith leaders supporting the workload.

    1. 

       Karl Carpani 1 Mar 2023

       Holistic healthcare that truly gives consideration for the whole human person, and is backed by this kind of project that evidences its impact, has to be value added to both patients and to the NHS.

    2. 

       Cheryl Levy 1 Mar 2023

       It is good to see that we are looking holistically at our community of patients.  By understanding and supporting the emotional need to patients  as well as improve their recovery.

    3. 

       Karl Carpani 1 Mar 2023

       Yes this certainly has  far reaching potential to provide insight and understanding on the impact of spiritual and emotional support interventions. The UK is a unique context where we can explore the impact on healthcare outcomes from many faith and none faith perspectives. Currently we depend on research data from other nations, mainly the USA and Australia and the time is ripe for the UK to engage its own contextual study.

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