Discovering meaning, purpose and hope through person centred wellbeing and spiritual care: framework

3. Data Collection and Evidence Base

3.0.1 It is good practice for providers of care to evaluate the delivery and impact of spiritual care services in a similar way to other clinical disciplines and to report on this in their annual report and quality accounts.

3.0.2 This framework looks to strengthen and deepen research and evidence into the impact of spiritual care interventions across all settings and services (with an initial focus on building on current work within in-patient and primary care settings). It envisages that robust mechanisms of data capture are in place in all care settings. It looks to develop the theory that underpins the practice of spiritual care and to continue and expand Scotland’s excellent contribution to the international field of evidence-based practice in spiritual care.

3.0.3 Quantitative measures (e.g. numbers of referrals, types of interactions, response times and outcomes) have a part to play and should be collected and reported alongside qualitative information on user experience. Feedback on spiritual care services should be sought from all service users, carers, and staff. Together, they help assess the impact of the service and guide its development^[40]. Health and Care providers should also consider all possible areas of feedback such as Care Opinion^[41] and including questions about the service in patient and staff surveys (e.g. iMatter).

3.1 Research and the Scottish Spiritual Care Patient Reported Outcome Measure (PROM)

3.1.1 The Scottish Spiritual Care Patient Reported Outcome Measure (PROM)^[42] is the only evidence-based and validated tool in the world for measuring the effectiveness of spiritual care. It was developed by NES in partnership with Edinburgh Napier University and is now being used globally. Scotland can be rightly proud for producing this. The PROM was designed to help capture the last part of the spiritual care process, the outcome.

Recommendation 17: The Scottish Spiritual Care Professional Leads Group should ensure that spiritual care teams complete the Scottish Spiritual Care PROM as a routine screening, outcome and feedback measure.

3.2 National Minimum Data Set

3.2.1 Currently there is no reporting mechanism agreed nationally to gather information on what Spiritual Care Teams are providing, who is providing it, to whom and how much. It is vital that we can record interventions, their relevance, value, and importance.

3.2.2 The National Minimum Data Set project was designed to capture transferable elements of the whole process of spiritual care, from referral (who needs spiritual care?) through screening (who is best placed to provide spiritual care?) and intervention (what happened?), to outcome (what difference did the intervention make?).

3.2.3 Systematically gathering data fits within a research-based improvement culture. Pastoral activities undertaken by spiritual care staff need to be recorded in a transferable manner to review and evaluate current practice. Generalisable data would also help in terms of resourcing areas effectively.

3.2.4 There is a need to support research and evaluation and to this end these aspects of practice should be a core aspect of the work undertaken by spiritual care teams.

3.2.5 The National Minimum Data Set is designed to support:

• a reduction in variation with a ‘Once for Scotland’ approach;
• the use of common language to improve mutual understanding;
• a focus on intentionality moving from a narrative of ‘just being there’ to one that speaks of the professional interventions already taking place;
• enabling the valid collation and comparison of referral statistics across spiritual care services nationally;
• the building up of consistent longitudinal data that can be used for research purposes, via an annual return; and
• the provision of data against which training can be developed.

3.2.6 The first version of the National Minimum Data Set was developed in collaboration with representatives from the spiritual care workforce in 2022.

Recommendation 18: The Scottish Spiritual Care Professional Leads Group in partnership with stakeholders should pilot a national minimum data set using a PDSA (Plan, Do, Study Act) model of quality improvement, and use the findings from this to develop and support a permanent national model for data gathering.

3.3 Information Governance

3.3.1 Skilled record keeping is an essential part of professional practice. It enables other professionals to be aware of the interventions and involvement of members of the healthcare team caring for the person. It supports continuity and safety of care^[43].

There are inconsistencies around recording information in relation to spiritual care in patient records. The “Access to Health Records Act 1990” states that a health record is a record which has been made by or on behalf of a health professional in connection with the care of an individual^[44].

3.3.2 Registered Chaplains as healthcare professionals and employees (governed by the Healthcare Support Worker Code of Conduct)^[45] are responsible for any health records which they create or use as defined in law (Public Records (Scotland) Act 1937)^[46].

3.3.3 Registered Chaplains have a duty to maintain clear and accurate records relevant to their practice within care plans and the context of wider multi-disciplinary care planning activity. This supports safe and effective care through evidencing practice and decisions, enabling continuity of care and ensuring cohesion of spiritual care delivery across different professions^[47].

Recommendation 19: Health and social care providers should ensure spiritual care staff are aware of their professional and legal responsibilities to maintain clear and accurate records.