Case study:

22 February 2012

Meeting people’s spiritual and pastoral needs at the end of life

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Key points

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North Tees & Hartlepool NHS Trust’s palliative care multidisciplinary team has developed a new model to ensure that the spiritual needs of patients on the Liverpool Care Pathway (LCP) are addressed.

Since the project began in July 2009 patients placed on the LCP have been visited by the chaplaincy team as a matter of course. So far the trust’s chaplains have visited over 1,000 patients and this action has been popular with both staff and patients and their families.

Under the LCP it is expected that all the patient’s needs – physical, psychological, emotional and spiritual – should be assessed and met as far as is practical. However, a survey undertaken at North Tees & Hartlepool NHS Trust in 2008 found that in only 4% of patients placed on the LCP (about 40% of the average 1600 deaths a year) was there any documented evidence to suggest anyone had attempted to assess patients’ spiritual needs.

The new model proposes that when a patient is placed on the LCP, the chaplaincy team are informed as a matter of course. One of the chaplains visits the patient and/or carers to ascertain what, if any, spiritual needs there may be and, if required, addresses that need. The chaplain leaves a contact card and makes further visits if requested. The outcome is recorded in the LCP documentation, which is kept on the ward.

Over the course of a seven-month pilot the chaplains visited 223 patients on the LCP – on average 37 each month. Fewer than 8% of those visited declined the support of the chaplain and 63% received more than one visit (1). No complaints were received from patients or carers but there were many compliments. Any misgivings professionals might have had about the involvement of chaplains quickly dissipated. In fact they recognised that the support offered by chaplains was not only beneficial to patients but also to staff.

The model is now firmly rooted in the trust’s practice. In the first two years the chaplaincy team has visited well over 1,000 patients. On average, it sees 45 to 50 patients each month on the LCP. More than 97% of patients on the LCP accept spiritual and pastoral support in those last few hours and days before they die. There is anecdotal evidence that complaints around care at the time of death are declining. Staff feel better supported and they know that dying patients on their wards are receiving regular supportive input. They are also more likely to refer other patients for support and spiritual care than they were previously.

For this model to work effectively certain preconditions have to be met:

1. Support of the palliative care MDT, especially the consultants. The consultant is key and can help make things happen.
2. Support of the trust board. The influence of the consultant is critical to having chaplains accepted as part of the MDT.
3. Support of the staff on the wards. Staff took a little time to be convinced but the successful pilot ensured the model was accepted.
4. Support of the chaplains. Unless everyone is committed to this role in the trust, it would be ineffective. There was some concern that this work would overwhelm the chaplains’ workload but this has not proved to be the case and in fact greatly enriches what they do.

References
1. Pugh E., Smith. S & Salter P. Offering spiritual support to dying patients and their families through a chaplaincy service. Nursing Times. Vol. 106. No. 28. pp.18-20, 2010.

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