Proposals for an accreditation process for Buddhist Healthcare Chaplains

Produced by Buddhist Healthcare Chaplaincy Group, June 2007.

Contacts: Keith Munnings (0121 458 2353) or Roger Green (0174 782 8660)

Introduction

The document is in three sections.

Section 1 answers some key questions about the history of this initiative and the reasons for it.

Section 2 explains the proposals for how prospective chaplains will apply to become authorised.

Section 3 describes the skills and knowledge and qualities that will be looked for and the principles that they will be working within.

Section 1: Questions and answers

Q. Why has the Buddhist Healthcare Chaplaincy Group (BHCG) been set up?

A working group has been meeting for the past few years developing a project for Buddhists to make their contribution to Hospital Chaplaincy work.

Each of the major faiths has been asked by the NHS to seek designation and become 'Authorised'. 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.

Q. What is the role of a Buddhist chaplain?

A chaplain is there to provide spiritual care for patients by which we mean:

• Practice with the patient
• Carrying out religious / spiritual practices where appropriate
• Facilitate the patient's peace of mind at death
• Listening to and validating the experience of the patient
• Helping to create a peaceful space for the patient
• Offering a model of acceptance of what it happening to the patient
• Offering Dharma teaching.

We are also available to hospital staff and the patients' relatives and are able to provide some degree of practical signposting, networking with other agencies involved in the patient's well-being.

Q. Why should our Buddhist school/tradition be involved in this process?

If your tradition wants to contribute your expertise to the development of the Buddhist healthcare chaplaincy, you can contribute by being part of this group's work.

If your tradition feels that members of your Sangha want to be involved in chaplaincy work across different Buddhist groups, then you will need to be part of the accreditation process we are setting up.

If you want to go into a hospital to visit members of your Sangha, of course you can do so without accreditation but it would still be helpful for us to know how to contact you.

Questions and answers a patient might have

Q. If I wanted a particular ritual and wanted someone to come in - would that person have to be accredited?

No. Generally you can invite anyone you wish to visit you to come and perform rituals, though it might be wise to check with ward staff if this could interfere with your medical treatment or cause disturbance to others. Do ask us, or your hospital chaplaincy team, if we can help to facilitate this. Accreditation is necessary for chaplains who wish to be authorised by the hospital and work as part of the chaplaincy team.

Q. If the chaplain is from a particular tradition which is different to the one I am part of, will they come and see me?

Yes, if you would like them to. The chaplain's role is to support you in your own practice. If necessary the chaplain may help you to contact someone from a particular tradition.

Q. If I am not part of any Buddhist Sangha, but just consider myself a Buddhist, could I ask the Buddhist chaplain to see me?

Certainly, and the chaplain would also be very pleased to meet with you if you are not a Buddhist.

Section 2: The Accreditation of Chaplains

Accreditation by Portfolio

Applicants to submit portfolio in following format:

• Application form which lists and documents experience, training, skills and knowledge in key areas (see section three).
• 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 reflective learning journal accounting experience of chaplaincy related work in a health related setting (e.g. work as a chaplaincy volunteer). Guidelines will be given on how to structure this.
• Two references
  Reference one - reflecting spiritual experience e.g. from the head of a tradition/order/teacher/senior member of group.
  Reference two - reflecting professional experience in a healthcare setting e.g. from a senior chaplain, senior health professional, head of a training programme (if they are 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 at least 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

Continuing Professional Development (CPD): regular seminars/training days are to be offered. In particular these will aim to foster inter-Buddhist discussion.

Supervision as a requirement of ongoing practice

There will be a need to create guidelines, complaints procedures, code of practice, interview format etc.

Section 3: The knowledge, skills and qualities of the chaplain

The underlying principles of the chaplains' work are:

1. Non-harm
2. Being grounded in Buddhist practice
3. Not pushing unhelpful views
4. Not being dogmatic about personal views
5. Patient-centred
6. Being aware of and open to the variety of Buddhist traditions
7. Having supportive links with own Buddhist group
8. Developing reflexive practice; awareness of own learning process

Support network in place for chaplain

Each chaplain should be in a supportive relationship with another member of his/her Sangha focused on the chaplaincy work. Each chaplain should be clear about the lines of responsibility and professional boundaries within the hospital.

The list is divided into six skills/knowledge areas and one section on qualities. All these aspects contribute to skilful support (the word skilful in Buddhism has the connotation of "ethical") and the self-reflective learning of the chaplain then affects the development and deepening of their practice.

Qualities

1 The quality of being

1. The ability to understand own limitations and behave accordingly/ appropriately.
2. Awareness including self awareness - especially own fears of death and dying.
3. Sensitivity including empathy, compassion, understanding and care.
4. Mindfulness and presence.
5. Equanimity - especially in difficult circumstances.
6. Friendliness - open, approachable and warm.
7. At ease with difficult feelings and conversational silences.
8. Reliability.
9. Availability.
10. Resourcefulness.
11. Commitment and understanding of need for confidentiality.

Skill/knowledge area 1: Ability to establish initial relationships

The chaplain has the ability to:

1. Introduce themselves to the patient appropriately and gather information appropriately and effectively.
2. Identify themselves to hospital staff and relatives.
3. Create a connection with patient, relatives and staff where appropriate.

Skill/knowledge area 2: Interpersonal skills

1. Awareness of issues of difference, culture, disability, age, sexuality etc.
2. Ability to convey bad news or to accompany those who have just received such news.

A) Interpersonal skills - Patient

The chaplain has the ability to:

1. Understand and respect the autonomy of the patient.
2. Encourage the patient's confidence.
3. Comfort within being in silence with someone.
4. Judge the appropriateness of physical contact with patient.
5. Help patient to reflect on past, present and future.
6. Respond at different levels: spiritual, emotional, practical.
7. Set boundaries and keep confidentiality.

B) Interpersonal skills- Hospital staff

The chaplain has the ability to:

1. Develop relationships with ward staff.
2. Negotiate including making skilful complaints.
3. Help arrive at unbiased solution (e.g. issues around understanding of disturbance of the body before, during and after clinical death).
4. Warm friendly, approachable, and available.

Skill/knowledge area 3: Communication skills

The chaplain has the ability to:

1. Communicate clearly.
2. Summarise feelings.
3. Communicate in English - spoken and written where necessary and to organise translation where appropriate.
4. Listen (to what is being said and what isn't).
5. Ask questions.
6. Facilitate ethical exploration without imposing views.
7. Hear "confession" and respond to feelings of regret or remorse.
8. Balance sensitivity to patient's values with clinical needs.
9. Spiritually facilitate, counsel and/or listen to and hear.
10. Understand the importance of validation of the other's experience, and what affects that.
11. Clarify a problem and understanding of it.

Skill/knowledge area 4: Communication about the Dharma/ Buddhist Practice and Knowledge

The chaplain can demonstrate:

1. Good grounding in one Buddhist tradition, with evidence of regular practice and doctrinal knowledge.
2. Knowledge and use of appropriate liturgy and ritual in healthcare settings.
3. Knowledge of different Buddhist traditions sufficient to enable an appropriate initial response to Buddhists of other traditions.
4. A network of contacts and ability to make referrals where appropriate.
5. Ability to work in multi-faith team.
6. Awareness of issues of medical ethics and breadth of Buddhist positions on matters such as end of life, abortion, or organ donation and ability to convey such positions without dogmatism.
7. Ability to give information/advice/doctrinal guidance.
8. Ability to lead and practice meditation or other practices when appropriate.

Skill/knowledge area 5: Skillful support around death and dying

The chaplain has the ability:

1. To work with issues of loss and bereavement.
2. To offer appropriate response to questions of life after death.
3. To offer simple ritual or ceremony at times of death or to accompany a Buddhist of another tradition in performing their chosen practice.
4. To offer other rites of passage / where appropriate refuge ceremonies.
5. To discuss death and suicide when appropriate.

And has:



6. Knowledge of perspectives on death from a range of traditions.
7. Awareness of a range of Buddhist practices relating to death.
8. Awareness of specific needs relating to terminal illness, chronic illness, incapacity and life change.

Skill/knowledge area 6: Understanding of procedures within hospital and wider support networks

The chaplain has knowledge of:

1. Knowledge of NHS defined role of chaplain.
2. Knowledge of legal responsibilities of chaplains.
3. Knowledge of NHS organisational practices and settings.
4. Knowledge of organisational structures within hospital chaplaincy.
5. Knowledge of policy of obligation to disclose information discussed with patient.
6. Knowledge of how to gain access to clinical notes if needed.
7. Knowledge of health and safety procedures including hygiene, restraint.
8. Work in wider context with patients and their families (bereavement support, social services, financial agencies networking).

Ability to:



9. Understand decision making within hospital.
10. Act as an advocate for the patient within wider structures.
11. Negotiate complex professional relations within NHS.

Awareness of:



12. Mental health issues and the impact of mental illness on the chaplain's role.
13. Specific needs relating to terminal illness (e.g. care plans), incapacity and life change.
14. Practical procedures on wards e.g. avoidance of infection transmission, health and safety issues.

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