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Chaplains offer far more than just a prayer and a handshake
Hospital chaplains a critical part of health care team
The link between a person’s religion or spirituality and physical condition is one that has gained increasing recognition and consideration in health care discussions, and hospital chaplains have been in the thick of the debate.
"Chaplains provide a spiritual dimension to health care," explains J. Vincent Guss Jr., advocacy commissioner for the Association of Professional Chaplains and chaplain for the Alexandria, VA-based Inova Alexandria Hospital. "What we know is that what affects the body affects the mind and spirit. They’re all interrelated, and to treat the whole patient, you have to address each of these [components]."
Hospital chaplains are ministers, priests, rabbis, and imams, but they have received additional training in ministering to patients in the medical arena, including counseling patients and their families in end-of-life settings, when confronted with medical decisions in conflict with their religious or cultural beliefs, or when facing an unexpected or serious health crisis.
"The importance of treating a patient’s spirit is well recognized," says Rabbi Stephen Roberts, associate executive vice president of the New York Board of Rabbis and immediate past president of the National Association of Jewish Chaplains. "One of the things JCAHO [the Joint Commission on Accreditation of Healthcare Organizations] looks for is pastoral care [in accrediting hospitals]."
Roberts says the role of the chaplain is essential in modern medicine, because changes such as the increase in technology, insistence of managed care on limited lengths of stay, and cuts in hospital staff have robbed medicine of much of the human contact doctors and patients once had.
"It doesn’t really do the work of letting the spirit help the body recover, and when the spirit becomes weak, the body doesn’t have the same resources to heal," he says.
Chaplains encounter patients whose conditions are testing their beliefs, their faith in themselves, and sometimes, their trust in their ability to deal with the health issues confronting them.
Serious illness or injury may cause patients to question the meaning or worth of their lives, or to wonder why they have to endure what lies before them. Even when the patient is not in crisis, practical questions can arise over the ethics of procedures such as in vitro fertilization, organ donation, blood transfusions, compliance with "do not resuscitate" orders, ending life support for a loved one, or the surrendering of a newborn for adoption. In many cases, a chaplain will know how various religious bodies view medical procedures, but in any case, a chaplain will first attempt to elicit the patient’s own understanding or belief about the situation or procedure in question.
"A chaplain understands the medical arena, and also understands the patient’s own clergy and community," says Jeffrey Funk, a hospital chaplain and executive director of the Placentia, CA-based Hospital Chaplains’ Ministry of America. "In making health care decisions, moral issues arise, and most chaplains are trained in dealing with the moral dilemmas that are involved in those health care situations."
Guss says that in helping bridge the span between a patient’s physical and spiritual well-being, "we are not talking about just religion, but about their spirituality. People can be spiritual without being religious, and we as chaplains help mobilize spiritual resources people didn’t know they had."
Roberts says many of the patients he encounters aren’t necessarily anxious for his services when they first meet.
"I am always surprised by how many people say, when I walk in, Rabbi, I’m not religious,’ and then we end up spending an hour talking," he relates. "A good chaplain does not preach and teach; a good chaplain is trained to have someone look within and draw upon their own spiritual tools — and we all have them — to help them at that moment. There is almost no one who won’t benefit from a visit from a chaplain."
Patients and families facing a crisis are often less concerned with a chaplain’s own religious affiliation than they are about the spiritual guidance that the chaplain can offer when needed.
"I have been a chaplain for seven years, and in that time I have found that lots of patients don’t care what my faith background is. They just want to know if I can help them through their crisis," says Jabril Rashad, an associate chaplain at Children’s Hospital of the King’s Daughters in Norfolk, VA. Rashad is one of only a handful of Muslim hospital chaplains in the United States.
Rashad says that while his fellow chaplains and many patients he encounters do not share the Islamic faith, the "universal" approach taken by many chaplains and patients has meant he has felt accepted by both groups.
"We share a lot and learn from each other," says Rashad. "When you see God in others, you can see God in yourself."
Sometimes, the chaplain’s role begins with being a communicator between the patient and physician. Funk says it’s not uncommon for patients to initially question whether a physician — for example, a specialist whom a patient has just met — understands what is important to the patient. Likewise, a physician finding resistance on the part of a patient to a particular treatment course might not initially see a spiritual or moral dilemma that a patient is feeling.
Chaplains tell of patients resigning themselves to letting a treatable illness take its course rather than seek a cure because they feel the illness is some sort of punishment for previous wrongful acts in their lives. Or they might assume — sometimes incorrectly — that a controversial method of treatment might violate their religious beliefs. By understanding and communicating the feelings of the patient, both physician and patient can often reach a conclusion that is in the best interest of the patient.
This doesn’t always mean that the patient is convinced to seek the medically recommended treatment, Funk says. Sometimes, religious or cultural beliefs require that a physician accept that a patient won’t be following his or her recommendations for care.
"There is a code of ethics for chaplains that’s a part of our training, and it emphasizes respecting people’s cultures and beliefs, no matter what our own are," says Funk, whose chaplain’s association is based in evangelical Christianity. "There are cultures that hold the belief that the soul is attached to or ingrained in certain parts of the body, so if amputation or removal of that body part or organ is the treatment indicated for their condition, then they are not going to want that surgery, so we have to help everyone involved deal with that. We have to respect the culture as well as the religious or spiritual beliefs."
Chaplains not only act as occasional intermediaries between caregivers and patients, but also between patients and their families, particularly when end-of-life decisions are being made. A patient refusing lifesaving treatment may need help in gaining the understanding, if not the agreement, of family members, and chaplains are sometimes called on to facilitate in these cases.
The medical field is increasingly relying on chaplains as integral components of the health care team.
"We are receiving more and more recognition from the medical community," Guss says. "Health care used to be based exclusively on the medical model, but spiritual, physical, and psychological [components] all are interrelated, and that is being recognized and incorporated into patient care."
Rashad points out, "In the hospital setting, I consider the mind, body, and soul, and take a holistic approach. The doctors take care of the body, and the chaplains take care of the mind and soul."
The comfort of having a chaplain present can be an important factor in a patient finding his or her emotional and spiritual bearings as he or she deals with a difficult health situation.
"I like to say we are the calm before, during, and after the storm," Rashad says. "Whether it’s to pray with them or to just sit with them as they clench a fist in frustration, we’re there through thick and thin."
Specialized training required
To become a chaplain in any clinical setting requires that the candidate earn a master’s degree in religion or theology, and then to complete additional training in clinical pastoral education at an accredited hospital.
"Also, an open mind and heart are important, and the ability to adjust," says Rashad. "Life is a teacher. You have to experience things that can’t be approached in academia, like dealing with families who have survived or barely survived a major crisis. Staff members commit suicide — nothing can prepare you for that.
"Then there are the miraculous things," Rashad continues. "Diseases, cancers that a person normally couldn’t overcome, and the person has overcome it."
The minimum continuing education is rarely enough to keep abreast of the changes in medicine, Funk says.
"You have to keep up, with all the advances in medicine," he observes. "If you are at a facility that doesn’t practice much in the areas of biotech and genetic manipulation, you might not read and study those areas, but then all of a sudden you realize that this is moving forward fast and you don’t understand it."
A decade ago, says Funk, physician-assisted suicide and other end-of-life issues were the hot ethical topics chaplains were contending with. They have been replaced by new questions arising from scientific advances in cloning and genetic manipulation.
Guss says possibly the greatest challenge for not only chaplains, but also all caregivers, is the mapping of the genome, which he says also is potentially the greatest breakthrough in medical science in this generation.
"The future is in genetic medicine, and our challenge is to learn about it and about the spiritual and emotional issues surrounding it," Guss predicts.
Caring for the caregivers
Chaplains are quick to point out that their role is not merely to serve the patients and their families. Hospital staff, including the clinical staff, frequently draw on the experience of chaplains to help them help their patients.
"Doctors approach a lot of ethical challenges, and they ask our opinion. We talk about that and discuss what will help them out," says Rashad.
Physicians, nurses, or hospital staff who are struggling with a bad patient outcome can come away with more peace of mind, he says, even if there are unanswered questions.
Roberts sees a chaplain as an "ambassador to the whole hospital," there to serve each person who is in the hospital, no matter if that person is a doctor, nurse, administrator, support staff, patient, or family member.
"I won’t forget doctors who just agonize over patients’ decisions," says Funk. "They’re left with an unhappy outcome, so chaplains can provide appropriate support to those on the health care team, as well."
Guss says that chaplains are not the only members of the medical community who can act as spiritual support. Peer groups among nurses and physicians often work to counsel clinical staff through emotionally difficult situations, with chaplains involved to "motivate and educate," he says.
"Hospital staff, from the physicians to the housekeeping staff, have personal problems that we can help put in perspective so that while they’re here [at the hospital], they can stay focused on the job," adds Rashad. "The reality is that not all surgeries go well, and they are left feeling, Well, where do we go from here?’"
Rewards for hospitals and chaplains
A consensus paper written by the five largest health care chaplaincy organizations in North America and published in 2001, Professional Chaplaincy — Its Role and Importance in Health Care,1 reports that the benefits to the hospitals served by professional chaplains are not just intangible, feel-good qualities.
According to the authors of the consensus paper, chaplains assist their institutions in obtaining and maintaining accreditation standards associated with patients’ rights to spiritual care and support. They can reduce a hospital’s exposure to litigation by mitigating situations in which patients and families are dissatisfied, angry, or threatening, and thereby potentially minimize legal costs.
The only published chaplaincy cost study, reported in 1995,2 reported that the services of professional chaplains range from $2.71 to $6.43 per patient visit — a cost that the consensus panel deemed cost-effective to the institutions.
But the true rewards, chaplains say, can’t be measured on paper.
"Chaplains provide the institution’s heart, and the rewards are what keep us doing the work we do," Roberts says. "It’s when you see someone who says they have no ability to cope with what they’re going through; and a week later, they’re on their way out, having used skills they didn’t even know they had."
1. Association for Clinical Pastoral Education, Association of Professional Chaplains, Canadian Association for Pastoral Practice and Education, The National Association of Catholic Chaplains, The National Association of Jewish Chaplains. Professional Chaplaincy — Its Role and Importance in Health Care. VandeCreek L, Burton L, eds. The Healthcare Chaplaincy, 2001. Available on-line at www.healthcarechaplaincy.org.
2. VandeCreek L, Lyon M. The General Hospital Chaplain’s Ministry: Analysis of Productivity, Quality, and Cost (1994/ 1995). The Caregiver Journal 1995; 11:3-13.