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Professional Chaplaincy: Its Role and Importance in Healthcare
Abstract
Summary This paper describes the role and significance of spiritual care and is the first joint statement on this subject prepared by the five largest health- care chaplaincy organizations in North America representing over 10,000 members. As a consensus paper, it presents the perspectives of these bod- ies on the spiritual care they provide for the benefit of individuals, health- care organizations and communities. Throughout this paper, the word spirituality is inclusive of religion; spir- itual care includes pastoral care. Spiritual caregivers in healthcare institu- tions are often known as chaplains although they may have different designations in some settings, i.e. spiritual care providers. The paper con- tains four sections. 1. The Meaning and Practice of Spiritual Care This first section describes spirit as a natural dimension of all persons and defines the nature of spiritual care. With the basic premise that attention to spirituality is intrinsic to healthcare, the paper establishes their relationship and outlines the various environments in which it is provided. 2. Who Provides Spiritual Care? Professional chaplains provide spiritual care and this section describes their education, skills and certification. 3. The Functions and Activities of Professional Chaplains This section delineates the typical activities of professional chaplains within healthcare settings, focusing on their care of persons and their participation in healthcare teams. 4. The Benefits of Spiritual Care Provided by Professional Chaplains The materials here describe how professional chaplains benefit health- care patients and their families, staff members, employing organiza- tions, and communities.
... Interdisciplinary care is an essential component of health care, and spiritual care providers or chaplains are an important part of the hospital care team. As such, the discipline of hospital chaplaincy has become a recognized profession with skills acquired through higher education and clinical experience (Cadge, 2019;Cadge et al., 2019;Ho et al., 2018;VandeCreek & Burton, 2001). Chaplains interact with patients and families with diverse medical conditions and prognoses. ...
... Previous research has demonstrated that nurses are apt to contact chaplains in specific situations, such as for patients who are imminently dying (Choi et al., 2015;Kim et al., 2017). However, chaplains are often underutilized or are contacted so late in the hospital stay that they are unable to provide proactive or ongoing spiritual support (Choi et al., 2015;Ho et al., 2018;Timmins & Pujol, 2018;VandeCreek & Burton, 2001;Weinberger-Litman et al., 2010). Several studies have examined nurse perceptions of the role of chaplains. ...
The purpose of this study was to assess the association between nurse religiosity and decision to consult spiritual care services at a hospital in the western USA. An anonymous survey was distributed to assess nurses’ reports of whether they would request spiritual care services across different scenarios. Out of 171 nurses approached to participate in this survey, fifty-one nurses completed the survey and half of respondents considered themselves religious. Compared to non-religious nurses, religious nurses reported greater likelihood to contact a chaplain across a variety of patient and family scenarios, including when a patient has a new diagnosis, is anxious or depressed, or has a challenging family situation.
... To date, multiple studies have documented the challenges chaplains face across diverse domains, including their integration into clinical care teams, challenges working in the setting of stigmatized conditions, struggles to navigate questions of personal identity, and strategies for approaching self-care (VandeCreek & Burton, 2001). In particular, qualitative interview-based strategies have been utilized to understand chaplains' roles in general palliative care (Olsman, 2022), their roles in pediatric palliative care (Fitchett et al., 2012a), their integration into care teams (Lyndes et al., 2012b), their work in carceral settings (Hicks, 2008), their role in managing risk (Hicks, 2012), and their role in addressing distress among other members of clinical teams (Klitzman et al., 2022). ...
The aim of this study was to document the longitudinal experiences of chaplains who served during both the early AIDS (1981–1995) and early COVID-19 (2020–2021) pandemics. A total of 11 hospital chaplains were interviewed across the USA and the United Kingdom. Interviews were analyzed using a Grounded theory approach. Chaplains reported multiple stressors during both pandemics, including barriers to integration into care teams, tensions with home religions institutions, burnout, and challenges arising from the politicization of disease. Despite these challenges, chaplains play a vital role during pandemics. Insights from their experiences can inform future strategies for compassionate crisis response.
... Recent literature describes various dimensions of chaplains' work including pastoral assessment, counseling, education, and emotional support of patients, families, and clinical staff (Carey, 2012;Carey & Cohen, 2009;Tartaglia et al., 2024;White et al., 2021)). Hospital chaplains receive specific training, beyond that of community clergy, that prepares them to meet the needs of patients across faith traditions (including those who do not ascribe to a specific faith or are agnostic or atheist) and to address the unique spiritual needs of those in the healthcare setting (VandeCreek & Burton, 2001). The chaplain role is perceived as largely positive by patients, families, and healthcare providers (Cunningham et al., 2017) In one study, willingness to recommend a hospital on industry-standard assessments of patient satisfaction were higher in those visited by chaplains (Marin et al., 2015). ...
Asynchronous email interviewing has been increasingly utilized as an electronic method of data collection in qualitative research, because it eliminates the need for costly travel and transcription and allows more time for participants to react with thoughtful, reflective responses. While research indicates that data collected in written form is comparable in content and richness with that collected in-person, via telephone, or through virtual live interactions, there is the risk of participant attrition, loss of trust-building with subjects and missing non-verbal/visual cues for the researcher. The aim of this paper is to demonstrate use of asynchronous email interviewing as applied to a study on expectations and demands of chaplains in hospital settings. Unique in this approach is the inclusion of multiple participant groups over a large geographical area. Data were collected among chaplains, chaplain leaders, nurses, hospital executives, and patients and family members across a multi-state healthcare system. Although enrollment was adequate, 37% of those enrolled did not respond to initial interview emails, and of those who did respond, only 42% responded to follow-up questions. For several participants who did not respond to requests for email interviews, subsequent invitations to participate in live virtual interviews were preferred. Analysis reflected significant differences between groups in the quantity, quality, and richness of data, which may reflect communication patterns and preferences, time restrictions, and subject matter engagement. Based on study findings, it is suggested that similar studies offer options of interview modalities to participants to best meet their preferences and schedules.
Patients at the end of life experience existential suffering regardless of their religious beliefs; thus, spiritual care appropriate for non-religious patients may be required. Nurses often provide spiritual care unrelated to a particular religion or belief system. This chapter illustrates the non-religious spiritual care nurses provide in Japan by providing examples of how non-religious spiritual care has been provided, assessing patients experiencing spiritual pain and the essentials of care. Finally, strategies for spiritual care for non-religious persons aimed at spiritual healing are discussed using case examples.
Professional chaplains have the unique opportunity to provide spiritual care within institutional settings where other types of pastoral care may not exist. Serving within these institutions presents special challenges, including tension between multiple identities and responsibilities. This tension can create conflict within the Christian chaplain, and confusion as to whom they are ultimately beholden. The first section of the article discusses what I see as the five identity-related tensions a professional chaplain may experience serving in an institution. The second section of the article outlines a Christian theology of calling built on the framework of Covenant Theology and God’s reconciling work of grace. This theology of calling orients the professional identity of the Christian chaplains, rooting them in a clear sense of their responsibilities within their institutional setting. Christian chaplains are beholden first to God and to the calling God places on their life. Proper orientation to that calling equips chaplains to reconcile any cognitive dissonance caused by identity-related tensions, thus opening up a richer spiritual dialogue with God as they live out their kingdom-advancing mission.
Empathic relational communication is a key competency in spiritual care for establishing a trusting pastoral relationship. Ministry with d/Deaf persons requires a deeper level of relational skill, where attentiveness to sign language, non-manual features, visual cues and facial grammar are important for meaningful pastoral relatedness. It is widely recognized that d/Deaf persons experience higher than average healthcare access barriers and associated psychological impacts, and therefore spiritual need. In addition, d/Deaf persons develop a non-auditory approach to emotional expression and communication. The competencies of clinical pastoral education (CPE) provide a natural context to further develop the necessary deeper relational skills for healthcare ministry. This article draws on the lived experiences of a chaplain for the d/Deaf engaged in CPE and a CPE educator, in order to highlight current deficiencies in pastoral care for d/Deaf persons, and to explore and illustrate how relational empathy and spiritual connection can be deepened among d/Deaf persons in healthcare by developing the competencies of CPE.Supplementary resource: video format in American, British and Irish sign languagesView ASL Keith Nolan videoView BSL Ayesha Gavin videoView ISL John Patrick Doherty video
Interfaith spiritual care (ISC) is a non-sectarian and open-ended spiritual therapy ubiquitously performed by healthcare chaplains. However, these carers face uncertainty in navigating the many epistemological and ethical norms involved. A theological framework is needed that guides ISC practitioners in engaging and provisioning the existential, religious, and ritual needs of diverse populations. This paper recaps the author’s doctoral work (Youngblood 2020 Youngblood, Peter Ward. 2020. "Interfaith Chaplaincy and Interreligious Hospitality." PhD diss. The Chinese University of Hong Kong.[Crossref] , [Google Scholar]), proposing a pastoral hospitality that opens our hearts and minds to a wider range of religious truths, even strange and uncomfortable ones. It also critiques a postcolonial notion that carers in non-Western contexts should identify primarily as humble ‘guests’ rather than ‘hosts’. Instead, the author maintains that chaplains should still sometimes imagine themselves as hosts empowering the patient. Ultimately host–guest is a dynamic relationship, not a static role. Imagining one’s pastoral ministry as alternating between the two allows the chaplain to balance humility and empathy with assertiveness and (sometimes) confrontation.
The aim of this study was to describe the range of spiritual care activities in support of clinical colleagues at a subset of U.S. hospitals. A descriptive cross-sectional design using a 76-item Zoom/telephone guided survey containing a subset of staff care questions was employed. Data were provided by directors/managers responsible for spiritual care services at the 2020–2021 U.S. News & World Report top hospitals. Results identified staff support as an important chaplaincy function at both organizational and spiritual care department levels. Staff chaplains at over half of the hospitals spend an estimated 10–30% of their time on staff care, with chaplains in five hospitals spending greater than 30%. The most frequently reported activities were religiously associated, such as blessings and rituals for hospital events. Additionally, chaplains actively support staff during critical events such as patient deaths and through organizational protocols such as code lavender and critical incident debriefings. Chaplain support for staff most commonly grew out of personal relationships or referrals from clinical managers. Future research opportunities in this area include systematic data collection for chaplains’ specific staff support activities as well as efforts to investigate the impact of those activities on patient experience.
The functions of hospital chaplains and the corresponding staffing of spiritual care departments remain persistent and parallel questions within the profession. No consensus exists on services provided by spiritual care departments nor the staffing patterns to meet those expectations. This study describes the key activities and staffing at the 20 U.S. News and World Report Best Hospitals 2020–2021 as well as the connections between services, staffing, and select hospital characteristics such as average daily census. Information about each hospital’s chaplaincy department was gathered via a Zoom/telephone assisted survey with its spiritual care manager. Findings reveal that while spiritual care departments are structurally integrated into their organizations and chaplains respond consistently to requests for care, involvement in established organizational protocols varies. Study findings support the notion that staffing levels are a function of chaplain integration into an organization and the activities organizations expect chaplains to fulfill.
A meta-analysis of data from 42 independent samples examining the association of a measure of religious involvement and all-cause mortality is reported. Religious involvement was significantly associated with lower mortality (odds ratio = 1.29; 95% confidence interval: 1.20–1.39), indicating that people high in religious involvement were more likely to be alive at follow-up than people lower in religious involvement. Although the strength of the religious involvement–mortality association varied as a function of several moderator variables, the association of religious involvement and mortality was robust and on the order of magnitude that has come to be expected for psychosocial factors. Conclusions did not appear to be due to publication bias. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Exploring the theory that anxiety is lower in highly spiritual persons confronting life-threatening illness, this correlational study was conducted with 114 adults who had been diagnosed with cancer. Relationships were measured between spiritual wellbeing and state-trait anxiety, using the Spiritual Well-Being Scale, which distinguishes between the religious and existential dimensions of spirituality, and the State-Trait Anxiety Inventory, which differentiates between transitory and characteristic anxiety. Efforts were made to identify demographic features of the sample which could influence spirituality and anxiety and their interactions. A consistent inverse relationship (p < .001) was found between spiritual wellbeing and state-trait anxiety, regardless of influences of gender, age, marital status, diagnosis, group participation, and length of time since diagnosis. This supports the theory that persons with high levels of spiritual well-being have lower levels of anxiety. Controlled studies now are indicated, with attention to diversity and specificity of ethnic, socioeconomic, and religious backgrounds, as well as cancer type, stage, symptoms, and prognosis. The hospice community is challenged to undertake studies of the spiritual dimension and its healing potential.
Chaplains usually assume that cost containment concerns are a negative influence on their ministry. We argue that they can be a positive opportunity to demonstrate cost efficiency. We describe here a pilot project that gathered data for two months from three university general hospital pastoral care departments concerning the number of pastoral contacts, the time used in these contacts, the quality of pastoral services delivered, and the costs involved. We create a model that integrates these diverse data into a “pastoral care index.” The cost per pastoral care contact ranged from 6.43. Further refinement and use of this model will promote the cause of hospital chaplaincy.
Recent research about religion and health points toward the concept of spiritual risk, being at risk for poor health outcomes as a result of underdeveloped, conflicted, overwhelmed, or negative spirituality. This paper will: 1) describe the development of the concept of spiritual risk, 2) define the concept of spiritual risk, 3) describe the need for screening for spiritual risk, 4) describe how measures to screen for spiritual risk can be developed and tested, and 5) discuss the implications of screening for spiritual risk for the work of chaplains and other health professionals.
This paper describes the experiences of 103 breast cancer patients with home pastors and hospital chaplains. Attention was directed at the activities of clergy, the degree to which religious and nonreligious interactions were satisfying to the women, and how these related to their personal faith orientation. Because of the issues of sexual identity and attractiveness entailed by breast cancer, the role of female clergy was also explored. It is evident that religion is an extremely important resource for the majority of these breast cancer patients, and an intrinsic religious orientation helps one cope with breast cancer.
Earlier research suggested that persons in a community with significant psychiatric disorders seek relief from their clergy as often as from trained mental-health professionals. In this research, contacts with clergy about current hospitalization by matched samples of inpatient psychiatric (N=51) and medical/surgical (N=50) patients were compared, as were responses to structured interviews about the importance of religion, religious affiliation, and participation, spiritual needs, and spiritual well-being. The findings suggest that the two groups were similar in demographics, the degree to which religion was a source of strength and comfort in their lives, and percentages reporting as having a clergy person; the group of hospitalized psychiatric patients was significantly less likely, however, than the sample of medical/surgical patients to have discussed their current hospitalization with their clergy persons. Possible causes for this difference as well as areas of further research are discussed.
An Introduction to the Psychology of Religion and Coping. Part I: A Perspective on Religion. The Sacred and the Search for Significance. Religious Pathways and Religious Destinations. Part II: A Perspective on Coping. An Introduction to the Concept of Coping. The Flow of Coping. Part III: The Religion and Coping Connection. When People Turn to Religion. When They Turn Away. The Many Faces of Religion in Coping. Religion and the Mechanisms of Coping - The Transformation of Significance. Part IV: Evaluative and Practical Implications. Does it Work? Religion and the Outcomes of Coping. When Religion Fails - Problems of Integration in the Process of Coping. Putting Religion into Practice.
