Healthcare chaplaincy is the provision of pastoral care, spiritual care, or chaplaincy services in healthcare settings, such as hospitals, hospices, or home cares. Healthcare chaplains help patients, families, and caregivers draw on their spiritual, religious, and cultural beliefs to help them cope with that they are going through in these medical settings. Chaplains typically have a masters degree and training specific to chaplaincy, sometimes including being board certified.
The role of spirituality in health care has received significant research attention due to its benefits for patients and health care professionals. Integrating spirituality in healthcare can enhance healthcare professionals' ability to communicate effectively with patients and families.Reblin, M. et al. (2014) “Strategies to support spirituality in health care communication,” Journal of Holistic Nursing, 32(4), pp. 269–277. Available at: https://doi.org/10.1177/0898010114531856. It can also have a positive impact on the health and well-being of patients due to its potential to enhance patients' ability to cope with illness and achieve better physical and mental health outcomes.Puchalski, C. M. (2000). The role of spirituality in health care. American Journal of Hospice and Palliative Medicine, 17(3), 165-171. As per 2014, more than 70 medical schools in the United States offer courses on spirituality and medicine. The Association of American Medical Colleges has co-sponsored, with the National Institute for Healthcare Research, four conferences, on curricular development in spirituality and medicine since 1997.
Spiritual assessment Spirituality is defined as "the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred".Puchalski, C., Ferrell, B., Virani, R., Otis-Green, S., Baird, P., Bull, J., Sulmasy, D. (2009). Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. Journal of Palliative Medicine, 12, 885-904. Spirituality in human society can be found in secular and religious contexts. In a secular context, spirituality is the search for meaning and purpose in life, while in a religious context it is an institutionally determined approach to faith.Lanzetta, B. (2010) “SPIRITUALITY,” Alternative Therapies in Health & Medicine, 16(1), pp. 20–25. Available at: https://doi.org/10.4324/9780203647035-19. Understanding spiritual concerns are particularly important when caring for patients at end of life and assisting families through bereavement.Reblin, M. et al. (2014) “Strategies to support spirituality in health care communication,” Journal of Holistic Nursing, 32(4), pp. 269–277. Available at: https://doi.org/10.1177/0898010114531856. Spirituality can provide patients with a path to finding meaning in their life in the face of disease and death.Dalle Ave, A. and Sulmasy, D., 2021. Health Care Professionals’ Spirituality and COVID-19. JAMA, 326(16), p.1577.
The spiritual beliefs of the patients play an integral role in the patient's ability to cope with their sufferings. The hospital's atmosphere is characterised by diverse emotions, and these emotions are influenced by spiritual and cultural beliefs.Gerbino S., Raymer M. (2011). Holding on and letting go: The red thread of adult bereavement. In A. T & O.-G. S. (Eds.), Oxford textbook of palliative social work (pp.319-327). New York, NY: Oxford University Press. Understanding the spirituality of patients allows physicians to know the patient, their ability to cope with the illness and the healing process.Lanzetta, B. (2010) “SPIRITUALITY,” Alternative Therapies in Health & Medicine, 16(1), pp. 20–25. Available at: https://doi.org/10.4324/9780203647035-19. Asking patients questions about the meaning of life, their acceptance of their own or others' failures, and how they experience connectedness with others should have the goal of assessing how satisfied the patient is with the answers to these questions.Potter, Mertie L., and Mary D. Moller. Psychiatric mental health nursing: from suffering to hope. Boston, Pearson, 2016. Patients go through numerous questions during illness and spirituality helps them recognize there is a purpose and power beyond human understanding which allows them to go through painful and catastrophic circumstances with ease.Dalle Ave, A. and Sulmasy, D., 2021. Health Care Professionals’ Spirituality and COVID-19. JAMA, 326(16), p.1577. Encouraging the expression of emotion and grief is identified as the best approach to spiritual communication in a hospital setting as it allows to build strong rapport with the patient and family Ferrell B. R., Baird P. (2012). Deriving meaning and faith in caregiving. Seminars in Oncology Nursing, 28, 256-261. By developing personal relationships with their patients and their families, health professionals can better assess patients' spiritual situation.Wright, L. (2005). Spirituality, Suffering, Illness. Philadelphia, PA: F.A. Davis, p. xviii. Creating a space to express the spiritual beliefs and values of the family is identified to be highly beneficial to encourage meaning-based coping in patients and their families.Reblin, M. et al. (2014) “Strategies to support spirituality in health care communication, ” Journal of Holistic Nursing, 32(4), pp. 269–277. Available at: https://doi.org/10.1177/0898010114531856. There are several ways through which spiritual care can be implemented in hospitals. Five ways to implement spiritual care in health care are discussed here. They are:
Assessing the spiritual needs of patients and families: Open-ended questions, observations and assessment tools can be used to assess the spiritual needs of patients and families.The Joint Commission. (2021). Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oak Brook, IL: Author. Some examples of opening questions in a spiritual assessment are as follows:Potter, Mertie L., and Mary D. Moller. Psychiatric mental health nursing: from suffering to hope. Boston, Pearson, 2016. "Do you have a religious preference?" "Are there any spiritual or religious practices that are important to you?" "Would you like for us to contact your clergy member or religious advisor?". Integrating spiritual care into the overall care plan: The spiritual needs of the patients need to be evaluated by the healthcare provider and incorporate into the patient's care plan.Puchalski, C. M., & Romer, A. L. (2000). The role of spirituality in healthcare. The Lancet, 356(9238), 936-939. Access to spiritual resources: Patients and families need to be provided access to spiritual resources including spiritual leaders, chaplains, and religious texts.Koenig, H. G. (2012). Handbook of religion and health. Oxford University Press. Providing patients the opportunity to express their spiritual beliefs and practices: The spiritual beliefs and practices of the patients need to be listened to, respected and incorporated into their care.Fitchett, G. (2002). Measuring spiritual well-being in people with cancer. Cancer Nursing, 25(1), 1-9. Collaborating with spiritual leaders and communities: Support from spiritual leaders and communities can be obtained for better health care and to provide spiritual support to patients and their families.American Hospital Association. (2017). Spirituality and Religion in Healthcare: A Guide for Healthcare Providers. Chicago, IL: Author.
Role of spirituality in illness
The prospect of death may lead a patient to deal with questions related to meaning of life, such as "Why is this happening to me?" or "Is there a God?" The positive effect of meditation, faith, prayer or religious practice on the patient’s reported health and well-being is well established.Beaton LB, Koenig R. Religious cognitions and use of prayer in heallh and illness. 1990:30(2):249-253.Benson H. Stark M, Timeless Healing: The Power and Biology of Belief New York, NY Scribner; 1996. Discussion of the spiritual topic with the patients and families in their grief can enhance information exchange about the preferences, ongoing concerns and strategies to support the patient and their family.Stark D. (2011). Teamwork in palliative care. In Altilio T., Otis-Green S. (Eds.), Oxford textbook of palliative social work (pp. 415-424). New York: Oxford University Press.
Self-care
Li and Shun (2016) focused on self care coping styles in patients with chronic heart failure found that spiritual and religious support affects heart failure patients coping with both physical and psychological self-care.
Applications in health care
There are three main applications for chaplains in healthcare. Firstly, they can help build trust in the medical plan and aid in healthcare decision-making. Sometimes this means discussing how spiritual beliefs align with the care plan, either with the patient or with the patient’s family if the patient is incapacitated. For example, a chaplain may help a family decide whether to sign a DNR. The clinical tool developed by Arthur Kleinman is an effective practical tool to understand the spiritual belief system of a patient, obtain insights about the patient's understanding of their own illness to provide spiritual support for patients.Kleinman A, Benson P (2006) Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It. PLoS Med 3(10): e294. https://doi.org/10.1371/journal.pmed.0030294
Secondly, the application of spirituality in healthcare enable healthcare professionals to provide compassionate and holistic care for patients. Integrating the spiritual dimension in healthcare decision-making is identified to have resulted in better treatment decisions including less aggressive interventions, fewer ICU deaths and greater hospice utilisation.Maldonado, A.J. (2021) Spirituality and health, Primary Care Review. Available at: https://info.primarycare.hms.harvard.edu/review/spirituality-health (Accessed: January 2, 2023). When spirituality is applied in healthcare decision-making, it promotes centralised healing through shared goals of patients and clinicians thereby achieving better health outcomes. The positive effects of the application of spiritual care for patients are better coping for patients and enhanced recovery from illnesses and surgery.Puchalski, C. (2004) “Spirituality in health: The role of spirituality in critical care,”Critical Care Clinics, 20(3), pp. 487–504. Available at: https://doi.org/10.1016/j.ccc.2004.03.007. Despite the positive impact of spirituality on both patients and healthcare professionals, its application in healthcare is still limited. One major challenge in the application of spirituality in healthcare is the diverse spiritual practice and beliefs that are unique to each person.Maldonado, A.J. (2021) Spirituality and health, Primary Care Review. Available at: https://info.primarycare.hms.harvard.edu/review/spirituality-health (Accessed: January 2, 2023).
Thirdly, spirituality can effectively be applied to alleviate burnout symptoms in health care professionals. Healthcare professionals with spiritual and religious beliefs have lower levels of exhaustion, burnout and depersonalisation.De Diego-Cordero, R. et al. (2022) “Burnout and spirituality among nurses: A scoping review,”EXPLORE, 18(5), pp. 612–620. Available at: https://doi.org/10.1016/j.explore.2021.08.001.
Third-party professional aid