BY: DAVID A. LICHTER, DMin
Within the last few years, there has been additional focus on the chaplain's ministry within Catholic health care. Recently CHA and the National Association of Catholic Chaplains (NACC) paired up to create the Pastoral Care Advisory Committee to focus on specific issues and trends in chaplaincy.
To gain an understanding of how others understand the ministry, the group conducted national surveys in 2012. The surveys targeted executive and clinical staff to determine what Catholic health care executives think about chaplaincy and the spiritual care services being offered, and how clinicians and colleagues view chaplains and spiritual care services that are provided. Using CHA's database of executives and clinicians, the surveys were able to achieve a quality response rate.
The survey asked executives, "How would you describe the purpose and value of spiritual care and professional chaplaincy? And as a decision-maker, what types of information do you want to have regarding the role of chaplain in your decision-making?" The first question was a perception and value question; the second concerned what more they needed to know about chaplains. The committee felt both would be important in understanding executives' assumptions and ideas about chaplaincy services.
There was strong representation (45 percent) of board members and chief executive officers among those surveyed, and they showed a positive understanding of and appreciation for the value of chaplains. Regarding the purpose and value of spiritual care and professional chaplaincy, the responses ranked items in this order of emphasis:
- Providing patient and family support
- Demonstrating Catholic identity/mission
- Treating the whole person
- Providing staff support
In their responses about the chaplain's role, executives linked the value of providing patient and family support as integral to Catholic identity and mission and to treating the whole person.
As one CEO expressed it, a chaplain's job is: "To act in a leadership role in assisting in the development of a culture of respect and dignity for others, and healing for all." A trustee said, "Both a strong presence and wide array of spiritual care services will only enhance our health care mission vision and values." A CFO wrote: "I believe this is an integral part of supporting our mission to provide quality care of the whole patient."
Certainly, viewing spiritual care as essential to Catholic health care is a critical message, and we were delighted to see that executives could articulate this vision. Also, the high number of responses about supporting staff indicates the appreciation that executives have for chaplains and that the spiritual care department is important to staff care.
As to the types of information executives want to have regarding the role of the chaplain in their decision-making, the highest number of responses were for the integral role of spiritual care, especially in tending to the emotional needs of the clients served. Four other responses were grouped closely together:
- Positive influence on patient satisfaction
- Support of staff, especially during critical incidences
- Orientation, education, and integration of staff in meeting spiritual needs
- Essential role of spiritual care in Catholic health care
Again it was helpful to learn that executives want to know more about how chaplains impact patient satisfaction and how they are meeting patient and family emotional needs.
It also was valuable to know how important they view the chaplain's role in preparing staff for their respective roles in meeting spiritual needs, as well as supporting staff in critical times. While how chaplains affect the quality of experience in Catholic health care is a little less emphasized, this might be attributed to leaders not seeing spiritual care services and chaplains as a part of quality initiatives in their facilities.
Clinicians were asked to identify their respective disciplines and to answer four other questions:
- Describe the purpose and value of spiritual care and professional chaplaincy
- When seeking assistance from spiritual care and professional chaplaincy, what are you asking for?
- When would you refer a patient and why?
- What more would you like to know about chaplains?
The majority of those responding were nurses, with the second largest (but much smaller) group being social workers. Many who responded wore several hats.
In response to the question regarding the purpose and value of spiritual care and professional chaplaincy, the four most frequently cited were:
- Patient and family support
- Essential for treatment of the whole person
- Support staff
- Important (with little clarification)
It seemed that clinicians compared similarly with executives who ranked support of patients and their families at the top, grounding this value in a holistic view of the human person. As one physician wrote: "It is at the essential core of the healing process for patients and their families." Or as a nurse expressed it: "We need to recognize that our patients identify themselves as spiritual beings. Respecting that identity requires we provide care commensurate to their identified needs."
However, in contrast to the executives who ranked "part of Catholic mission and identity" as the second highest, clinicians ranked this much lower, only sixth. Given the executives' focus on ensuring that the Catholic mission of the institution is being lived on all levels, it makes sense that they view chaplaincy in this light more than clinicians do.
In response to the question, "When seeking assistance from spiritual care and professional chaplaincy, what are you asking for?" the clinicians' responses came in this order:
- Supportive presence for patients and families
- Prayer/ritual for patients and families
- Supportive presence for staff
- For ethical questions and concerns
Given this group's focus on patient care, it isn't surprising that they named the value of chaplains in terms of patient care and to provide religious support (prayer and ritual) as needed. However, calling upon a chaplain to be a support to staff ranked consistently high. A social worker wrote, "Teaching for staff on how to meet spiritual needs of patients within the work that we do."
Clinicians seemed to view the chaplains as spiritual care resources of religious support and in ethical matters more highly than the executives did. A physical therapist commented: "Help with clarifying needs of patient's from faith backgrounds that we typically do not have experience with Muslim, Hindu, etc." Additional comments focused on specific ways in which that support was provided, for example, aid in end-of-life care.
In response to the question, "When would you refer a patient and why?" several reasons were rated high and grouped close together:
- Patient expresses/evidences emotional or spiritual distress
- Patient expresses need for spiritual or cultural support around faith or beliefs
- Family needs support
- Patient needs support with end-of-life decisions
- Patient receives terminal diagnosis
These responses reflect a healthy understanding as to when to refer to a chaplain. The results seem to indicate that clinicians are more aware of the important role of spiritual care around end-of-life issues than do executives. A nurse noted: "Advance Directives, help with goals of care, or to help clarify a course of treatment/treatment plan."
The final question was "What more would you like to know to better understand the role of professional chaplains?" Across the board, the respondents wanted to understand what chaplains do and how they are trained and certified.
The surveys made clear that chaplains and spiritual care are valued at all levels of the organization. There was little variation between what executives and clinicians reported are the main roles chaplains play, with patient care being at the heart of who chaplains are.
While both groups understand this service in the context of holistic care, executives place the value of spiritual care more strongly in relationship to Catholic identity and mission than do clinicians. Clinicians understand more concretely and specifically when and why a chaplain is needed.
The executives want to know how chaplains' services contribute to patient satisfaction and how they support and educate staff on their role in spiritual care. Clinicians want to know more about the specific roles and responsibilities, training and credentialing of chaplains.
The information from this survey already has been helpful in shaping communication messages for diverse education tools about spiritual care and chaplaincy.
This article was written with the help of the CHA Pastoral Care Committee's communication subcommittee. For more information about the surveys, please visit www.chausa.org/pastoralcare.
DAVID A. LICHTER is executive director of the National Association of Catholic Chaplains, Milwaukee.
Copyright © 2014 by the Catholic Health Association of the United States
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