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Conference on eHealth

“If it’s not documented, it didn’t happen”

Digital change is also having an impact on spiritual care in hospitals, as electronic patient records and eHealth are in common use in many clinics. At a conference about eHealth and spiritual care, the topic on the agenda was the uneasy relationship between digitalization and spiritual care.
Raphael Rauch and David Neuhold
Giving comfort in hospital: Why and for whom should spiritual care documentation practices be developed? What can, should and may be documented and what not?


eHealth is the future development on everyone’s lips in the healthcare sector: How can the electronic storage and processing of patients’ data be improved – thereby optimizing processes of sharing data between family physicians, clinics and laboratories?

For those providing spiritual care in hospitals, eHealth is thus also a currently relevant topic. In palliative care, for example, to properly meet patients’ complex needs a broad team of specialists is required who communicate on an equal level and are on the same page regarding the patients’ care.

Achieving that requires a smooth flow of information – which is happening more and more via electronic means. This is also true for the interdisciplinary area of spiritual care. Effective exchange of information enables patients to get the spiritual care they want – rather than, for example, being asked three times if the hospital chaplain has visited them yet.

Creating solid data foundations

Away from the daily routine of clinical work, eHealth also offers a great opportunity for the professionalization of the discipline. At the conference “Charting Spiritual Care!? Spitalseelsorge und klinische Dokumentation” several points became clear: In addition to facilitating good inter-professional cooperation, keeping records gives practitioners the opportunity to step back and take a critical look at their own actions. Writing up a record is an initial act of reflection that provides a solid base of data – which can be used for further analyses, supervision, training and evaluation. This enables the discipline of spiritual care to show what it can do – and where it needs to improve.

Spiritual care in hospitals should remain a protected and separate space

Around 70 percent of spiritual care practitioners in Switzerland have a positive attitude to the subject of documentation. Nevertheless, the electronic patient file does not enjoy a great reputation. Among other things, doubts are voiced about whether spiritual care ought to be subject to economic and organizational parameters – might not such parameters pose a threat to the unpredictable, incalculable nature of spiritual care? The conference participants responded with a clear “no!” Just as medical confidentiality was maintained when doctors kept electronic patient records, spiritual care would remain a protected, separate space, was the general consensus.

Taking the wishes of patients into account

Keeping records isn’t about writing down the content of the discussion, but rather about the framework of the conversation and the hard facts: Does the patient want spiritual accompaniment and if so, who is involved? How strong are the spiritual needs of the patient and what specific wishes do they have? Do they want to talk to someone, pray and be prayed for, receive the sacrament of the anointing of the sick, or go to a chapel service? At the end of the day, the goal is to improve the patients’ quality of life and to support them in dealing with illness-related challenges. In order to ensure that this dimension does not get forgotten, a kind of spiritual case history is now often taken.

Well-connected in the hospital

Another benefit of eHealth is that it improves connections within hospitals. A normal day in the clinic is often a hectic affair. One of the conference speakers from the USA said that in the US the written record had been king since the 1990s: “If it’s not documented or written down, it didn’t happen.” In some American hospitals spiritual care teams work round the clock with more than 1,500 patients. In such situations documentation is not just helpful for handovers between staff, but also to increase the team’s visibility within the hospital.

Brigitte Tag, professor of law at UZH, gave a presentation about the legal aspects of the topic. Purely from a legal point of view, the obligation to document cases was necessary to ensure patient safety. It was important to always remember the medical goals. If spiritual care was part of the treatment plan, then the obligation to provide documentation would also apply for said care. Insofar as spiritual care contributed to improving quality of life, the same requirements as for other areas of medicine should be taken into consideration. It was necessary to make a legal distinction, however, as to whether the spiritual care providers were an integral part of the clinical setting or not (i.e. autonomous stakeholders not bound by directives).

Treatment/therapy and spiritual care settings should ideally be kept separate. Areas that were unconnected to the medical task were not obliged to keep written records. The conclusion of the conference was that in the medium to long-term, spiritual care in hospitals would not be able to avoid taking part in some form of inter-professional documentation. How the profession can implement and expand such record-keeping for the benefit of patients will be a topic for research and development in the healthcare sector in the coming years.