Sunday, 14 December 2008

Reading Patients Notes

Simply: don’t.

You’re not entering into a clinical relationship with patients so you don’t need to know anything about what’s wrong with them. Nursing staff will let you know if a person can sit up or eat or drink or walk around and this should be fairly obvious in any case; if in doubt, ask.

The patient has a right to privacy, that is, he doesn’t need everyone knowing the fascinating soap opera of his life. Some people, in the depths of illness, may have done things that they’re now ashamed or confused about and frankly, you don’t need to know about that and they don’t need you to know about that.

Your way of being with a person cannot help but change if you know someone was violent in the past or that they suffered violence, often extreme violence. You’ll know from your own experience what it’s like when someone discovers a part of your past that you’re not comfortable with, there’s a shift, often unconscious, sometimes not, in the power balance. Mentally ill people can be particularly sensitive to the imbalance of power which is part of what makes many people mentally ill in the first place, so be with them as you are and as they are, here in this room at this time.

Are there individual reasons to be aware of a person’s history? Possibly. It’s too much of a generalisation to say never. But the potential for violence isn’t a reason. If the staff feel that you both will be safe with each other, and you feel personally safe then that’s good enough. All chaplains need to use our common sense, intuition and work on our personal development so that we don’t enter into the paradigm of even very severely mentally ill people becoming an automatic threat. Neither do we need to be able to be comfortable with every situation.

The role of a chaplain is to support the person in the here and now. This holds particular power in institutions, no matter how excellent, where routines and policies can often take precedence over the individual, nuanced needs of patients. Most staff will intend to treat everyone as an individual but when 20 people need washing before 10am and feeding between 12 and 1 a rather impersonal flow and routine is inevitable. One important role of the chaplain is to see the patient as something other than a patient: as an individual person with complex and unique ways of being in the world. Sometimes patients need to be reminded of this themselves and this can be achieved by aiming to be truly authentic, truly in relationship with each other, as two human beings rather than a Chaplain visiting a Patient, or an Expert giving something of value to someone in need.

Being a visiting chaplain is to enter a liminal space: you’re not a member of staff but you have a different kind of status to an ordinary visitor. Most hospital staff will be very cautious about telling any religious representative what they may and may not do because there’s uncertainty and fear about overstepping some kind of Equal Opportunity policy. This gives you particular access to vulnerable people. Consider the potential for the abuse of your power if you ever feel the need to read notes or ask about diagnosis or history. Who does it really serve?

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