Editors: Larry
VandeCreek D.Min. & Laurel Burton Th.D.
Design: ZGroupinc NYC
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients &
Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
This paper describes the role and significance of spiritual
care and is the first joint statement on this subject prepared by the five
largest healthcare chaplaincy organizations in North America representing over
10,000 members. As a consensus paper, it presents the perspectives of these
bodies on the spiritual care they provide for the benefit of individuals,
healthcare organizations and communities. Throughout this paper, the word
spirituality is inclusive of religion; spiritual care includes pastoral care.
Spiritual caregivers in healthcare institutions are often
known as chaplains although they may have different designations in some
settings, i.e. spiritual care providers. The paper contains four sections.
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 care is
provided.
Professional chaplains provide spiritual care. This section
describes their education, skill and certification.
This section delineates the typical activities of
professional chaplains within healthcare settings, focusing on their care of
persons and their participation in healthcare teams.
The materials here describe how professional chaplains
benefit healthcare patients and their families, staff members, employing
organizations, and communities.
The Joint Commission on the Accreditation of Healthcare
Organizations (JCAHO, 1998) in the U.S. states, "Patients have a
fundamental right to considerate care that safeguards their personal dignity
and respects their cultural, psychosocial, and spiritual values." A
Canadian accreditation agency makes similar statements. Such regulations, and
efforts to meet them, flow from the belief that attention to the human spirit,
including mind, heart and soul, contributes to the goals of healthcare
organizations.
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients &
Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
Reflecting on the ancient word spirit, May (1982) writes,
"Spirit implies energy and power." The word spirituality goes further
and describes an awareness of relationships with all creation, an appreciation
of presence and purpose that includes a sense of meaning. Though not true
generations ago, a distinction is frequently made today between spirituality
and religion, the latter focusing on defined structures, rituals and doctrines.
While religion and medicine were virtually inseparable for thousands of years,
the advent of science created a chasm between the two. The term spirituality is
a contemporary bridge that renews this relationship. In this paper, the word
spirituality includes religion; spiritual care is inclusive of pastoral care.
Those who provide spiritual care in healthcare settings are often known as
chaplains, although in some settings they may be described as spiritual care
providers.
Spirituality demonstrates that persons are not merely
physical bodies that require mechanical care. Persons find that their
spirituality helps them maintain health and cope with illnesses, traumas,
losses, and life transitions by integrating body, mind and spirit. When facing
a crisis, persons often turn to their spirituality as a means of coping
(Pargament, 1997). Many believe in its capacity to aid in the recovery from
disease (McNichol, 1996) and 82 percent of Americans believe in the healing
power of personal prayer (Kaplan, 1996), using it or other spiritual practices
during illness.
Persons frequently attend to spiritual concerns within
religious communities through the use of traditional religious practices,
beliefs, and values that reflect the cumulative traditions of their religious
faith. They may pray, read sacred texts, and observe individual or corporate
rituals that are particular to their tradition.
Religious beliefs may encourage or forbid certain behaviors
that impact healthcare. Others focus their spirituality outside traditional
religious communities and practices. All, however, share deep existential needs
and concerns. Many persons both inside and outside traditional religious
structures report profound experiences of transcendence, wonder, awe, joy, and
connection to nature, self, and others as they strive to make their lives
meaningful and to maintain hope when illness strikes. Support for their efforts
is appropriately thought of as spiritual care because their search leads to spiritual
questions such as Why do I exist? Why am I ill? Will I die? and What will
happen to me when I die? Institutions that ignore the spiritual dimension in
their mission statement or daily provision of care increase their risk of
becoming only "biological garages where dysfunctional human parts are
repaired or replaced" (Gibbons & Miller, 1989). Such "prisons of
technical mercy" (Berry, 1994) obscure the integrity and scope of persons.
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients &
Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
Regulatory and accrediting bodies require sensitive attention
to spiritual needs. As the Joint Commission on the Accreditation of Healthcare
Organizations (JCAHO, 1998) makes clear, "Patients have a fundamental
right to considerate care that safeguards their personal dignity and respects
their cultural, psychosocial, and spiritual values." The Canadian Council
on Health Services Accreditation (1999) states, "When developing the
service plan, the team considers the client’s physical, mental, spiritual, and
emotional needs. The team respects the clients’ cultural and religious beliefs
and enables them to carry out their usual cultural or religious practices as
appropriate." In an effort to fulfill such mandates as well as honor their
own values, healthcare institutions create ‘patient rights’ statements in which
they pledge to provide sensitive attention to the dignity, culture, beliefs,
practices, and spiritual needs of all patients, their caregivers, and hospital
personnel. Such attention flows from the belief that care of the body alone
cannot be effective if the mind, heart, and soul are ignored. Healthcare
professionals increasingly recognize that patients want holistic approaches to
their well being. For several years, Harvard cardiologist Herbert Benson has
conducted popular, biannual educational events for healthcare professionals
that explore spirituality and healing in medicine. Following intensive
research, he (1999) wrote, "I am astonished that my scientific studies
have so conclusively shown that our bodies are wired to (be) nourished and
healed by prayer and other exercises of belief." Professional chaplains
respect and respond to patient values and beliefs, encouraging a more holistic
approach to healthcare.
While it is a biological event, serious illness frightens
patients and isolates them from their support communities when they need them
most. Losses such as physical and cognitive capacities, independence, work or
family status, and emotional equilibrium, along with the accompanying grief,
can seriously impact their sense of meaning, purpose, and personal worth.
Professional chaplains address these crises through spiritual care that
emphasizes transcendence and enhances connections to support communities, thus
aiding healing and recovery. They listen for the impact of medical information
on patients and families, uniquely facilitating an understanding of the
technical language of medical professionals.
Compassion and comfort become important foci of care when
illness is chronic or incurable. Approaching death can engender serious
spiritual questions that contribute to anxiety, depression, hopelessness and
despair. Professional chaplains bring time-tested spiritual resources that help
patients focus on transcendent meaning, purpose, and value.
Mitroff and Denton (1999), in a groundbreaking study of
spirituality in organizations, emphasize that employees do not want to
compartmentalize or fragment their lives and that their search for meaning,
purpose, wholeness, and integration is a constant, never ending task. Other
consultants (Henry & Henry, 1999) write about the importance of individual
and organizational stories that help healthcare employees cope with their
stress. Such stresses are a concern for organizations that recognize employees
as their most valuable resource. Professional chaplains are skilled in
eliciting stories that "evoke self-understanding and creativity, and
sometimes …bring light to the paths we travel in life" (Henry & Henry,
1999).
Spiritual care contributes to a healthy organizational
culture. Professional chaplains, moving across disciplinary boundaries, serve
as integral members of healthcare teams as they care for staff members
themselves who experience the stress of patient care. Chaplains not only help
staff members cope, but empower them to recognize the meaning and value of
their work in new ways.
Difficult ethical dilemmas regularly arise in today’s highly
technological healthcare systems, i.e. decisions to withdraw aggressive
treatment. Unavoidably, such decisions interact with personal values and
beliefs of all involved. Professional chaplains, who are frequently members of
ethics committees, provide spiritual care to staff members as well as patients
and families affected by these complex issues.
Professional chaplains provide spiritual care in a variety
of healthcare settings, including but not limited to the following:
Acute care
Long-term care and assisted living
Rehabilitation
Mental health
Outpatient
Addiction treatment
Mental retardation and developmental disability,
and Hospice and palliative care
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients &
Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
A variety of persons may provide patients with basic
spiritual care, including family members, friends, members of their religious
community, and institutional staff members.
Their local clergyperson may also offer spiritual care from their
specific tradition by providing supportive counsel and appropriate rites. The professional chaplain does not displace
local religious leaders, but fills the special requirements involved in intense
medical environments (Gibbons & Miller, 1989). They complement these leaders by joining their respective
resources "to assure that faith continues to have a prominent place among
the healing resources available to all persons" (Mason, 1990). Congregants highly value the spiritual care
provided by their local clergypersons (VandeCreek & Gibson, 1997).
Many religiously active persons do not notify their local
clergy of their hospitalization (Sivan, Fitchett & Burton, 1996; VandeCreek
& Gibson; 1997). Additionally, many
patients do not have a religious community to which they can look during
healthcare crises. In one study, only
42 percent of hospital patients could identify a spiritual counselor to whom
they could turn, and many of them had not talked to their local religious
leader about their situation (Sivan, Fitchett & Burton, 1996). For others, attention from their spiritual
counselor is limited by being in a hospital far from home (VandeCreek &
Cooke, 1996), by patient concerns about privacy or confidentiality, or a fear
that their own religious leader would not understand or be supportive.
Professional chaplains offer spiritual care to all who are
in need and have specialized education to mobilize spiritual resources so that
patients cope more effectively. They
maintain confidentiality and provide a supportive context within which patients
can discuss their concerns. They are
professionally accountable to their religious faith group, their certifying
chaplaincy organization, and the employing institution. Professional chaplains and their certifying
organizations demonstrate a deep commitment and sensitivity to the diverse ethnic
and religious cultures found in North America.
An increasing number of professional chaplains are members of non-white,
non-Christian communities and traditions.
Professional chaplains are theologically and clinically
trained clergy or lay persons whose work reflects:
Sensitivity to multi-cultural and multi-faith
realities
Respect for patients’ spiritual or religious
preferences
Understanding of the impact of illness on
individuals and their caregivers
Knowledge of healthcare organizational structure
and dynamics
Accountability as part of a professional patient
care team
Accountability to their faith groups
In North America, chaplains are certified by at least one of
the national organizations that sponsor this paper and are recognized by the
Joint Commission for Accreditation of Pastoral Services.
Association for Clinical Pastoral Education
(approximately 1000 members)
Association of Professional Chaplains
(approximately 3,700 members)
The Canadian Association for Pastoral Practice and
Education
(approximately 1000 members)
National Association of Catholic Chaplains
(approximately 4000 members)
National Association of Jewish Chaplains
(approximately 400 members)
Whether in the United States or Canada, acquiring and
maintaining certification as a professional chaplain requires:
Graduate theological education or its equivalency
Endorsement by a faith group or a demonstrated
connection to a recognized religious community
Clinical pastoral education equivalent to one year
of postgraduate training in an accredited program recognized by the constituent
organizations
Demonstrated clinical competency
Completing annual continuing education requirements
Adherence to a code of professional ethics for
healthcare chaplains
Professional growth in competencies demonstrated in
peer review
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients & Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
The activities of professional chaplains include diverse
interactions with patients and families, professional staff, volunteers, and
community members. While no one
chaplain can or need perform every function, they can be classified as
follows:
Grief and loss care
Risk screening – identifying individuals whose
religious/spiritual conflicts may compromise recovery or satisfactory
adjustment
Facilitation of spiritual issues related to
organ/tissue donation
Crisis intervention/Critical Incident Stress
Debriefing
Spiritual assessment
Communication with caregivers
Facilitation of staff communication
Conflict resolution among staff members, patients,
and family members
Referral and linkage to internal and external
resources
Assistance with decision making and communication
regarding decedent affairs
Staff support relative to personal crises or work
stress
Institutional support during organizational change
or crisis
Participation in medical rounds and patient care
conferences, offering perspectives on the spiritual status of patients
Participation in interdisciplinary education
Charting spiritual care interventions in medical
charts
Prayer, meditation, and reading of holy texts
Worship and observance of holy days
Blessings and sacraments
Memorial services and funerals
Rituals at the time of birth or other significant
times of life cycle transition
Holiday observances
Assisting patients and families in completing
advance directives
Clarifying value issues with patients, family
members, staff and the organization
Participating in Ethics Committees and
Institutional Review Boards
Consulting with staff and patients about ethical
concerns
Pointing to human value aspects of institutional
policies and behaviors
Conducting in-service education
Interpreting and analyzing multi-faith and
multi-cultural traditions as they impact clinical services
Making presentations concerning spirituality and
health issues
Training of community religious representatives
regarding the institutional procedures for effective visitation
Training and supervising volunteers from religious
communities who can provide spiritual care to the sick
Conducting professional clinical education programs
for seminarians, clergy, and religious leaders
Developing congregational health ministries
Educating students in the healthcare professions
regarding the interface of religion and spirituality with medical care
As advocates or "cultural brokers"
between institutions and patients, family members, and staff
Clarifying and interpreting institutional policies
to patients, community clergy, and religious organizations
Offering patients, family members and staff an
emotionally and spiritually "safe" professional from whom they can seek
counsel or guidance
Representing community issues and concerns to the
organization
Patients increasingly demonstrate interest in
healing from many sources not represented within the traditional healthcare
disciplines. Many of these
complementary healing traditions are grounded in the world’s religious
traditions and chaplains may utilize or make a referral for complementary
therapies such as:
Guided imagery/relaxation training
Meditation
Music therapy
Healing touch
Developing spiritual assessment and spiritual risk
screening tools
Developing tools for benchmarking productivity and
staffing patterns that seek to increase patient and family satisfaction
Conducting interdisciplinary research with
investigators in allied fields, publishing results in medical, psychological,
and chaplaincy journals
Promoting research in spiritual care at national
convention
The work of professional chaplains offers distinct benefits
to the four components of any healthcare delivery system: the patients and their family members, the
professional healthcare staff, the organization itself, and the community
within which it resides. These benefits
are increasingly demonstrated by empirical research studies.
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients &
Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
Six research areas are summarized here that describe the
benefits of attention to the spirituality of patients and family members.
A growing body of research demonstrates the health-related
benefits of religious and spiritual beliefs and practices. A recent meta-analysis of data from 42
published mortality studies involving approximately 126,000 participants
demonstrated that persons who reported frequent religious involvements were
significantly more likely to live longer compared to persons who were involved
infrequently (McCullough, Hoyt, Larson, Koenig & Thoresen, 2000).
In a study of nearly 600 older, severely ill, medical
patients, those who sought a connection with a benevolent God, as well as
support from clergy and faith group members, were less depressed and rated
their quality of life as higher, even after taking into account the severity of
their illness (Koenig, Pargament, & Nielsen, 1998).
In a study of 1,600 cancer patients, the contribution of
patient-reported spiritual well being to quality of life was similar to that
associated with physical well being.
Among patients with significant symptoms such as fatigue and pain, those
with higher levels of spiritual well being had a significantly higher quality
of life (Brady, Peterman, Fitchett, Mo, & Cella, 1999).
CONCLUSION: These and
other studies demonstrate that religious faith and practice impact emotional
and physical well being. Professional
chaplains play an integral role in supporting and strengthening these religious
and spiritual resources.
Religious coping, although related to non-religious coping,
is distinct and makes unique contributions to the coping process. Religious and non-religious coping are not
functionally redundant (VandeCreek, Pargament, Belavich, Cowell, & Friedel,
1999; Pargament, Cole, VandeCreek, Brant, & Perez, 1999).
A study of older adults found that more than half reported
their religion was the most important resource that helped them cope with
illness (Koenig, Moberg, & Kvale, 1988).
In another study, 44 percent of the patients reported that religion was
the most important factor that helped them cope with their illness or
hospitalization (Koenig, Hover, Bearon, & Travis, 1991).
In a study of women with breast cancer, 88 percent reported
that religion was important to them and 85 percent indicated it helped them
cope (Johnson & Spilka, 1991).
Similarly, 93 percent of women in a study of gynecological cancer
patients reported that religion enhanced their sense of hopefulness (Roberts,
Brown, Elkins, & Larson, 1997).
A study with breast cancer outpatients reported that 76
percent had prayed about their situation as a way to cope with their diagnosis
(VandeCreek, Rogers, & Lester, 1999).
Studies demonstrate that spiritual well being helps persons
moderate the following painful feelings that accompany illness: anxiety (Kaczorowski, 1989), hopelessness
(Mickley, Soeken, & Belcher, 1992; Fehring, Miller, & Shaw, 1997), and
isolation (Feher & Maly, 1999).
Many patients expect chaplains to help them with such distressing
feelings (Hover, Travis, Koenig, & Bearon, 1992).
Paragment (1997) cites many additional studies that
demonstrate the importance of religious and spiritual coping for persons
dealing with illness.
CONCLUSION: Persons turn
to spiritual resources during illness and other painful experiences, finding
them helpful. Professional chaplains
are trained to encourage helpful religious coping processes.
Studies point to the importance of spiritual distress, that
is, un- resolved religious or spiritual conflicts and doubts. This distress is associated with decreased
health, recovery, and adjustment to illness (Berg, Fonss, Reed, &
VandeCreek, 1995; Fitchett, Rybarczyk, DeMarco, & Nicholas, 1999; Fitchett,
1999a; Fitchett, 1999b).
CONCLUSION: Professional
healthcare chaplains play an especially important role in identifying patients
in spiritual distress and helping them resolve their religious or spiritual
problems, thus improving their health and adjustment.
Studies demonstrate that spiritual well being helps persons
moderate the following painful feelings that accompany illness: anxiety (Kaczorowski, 1989), hopelessness
(Mickley, Soeken, & Belcher, 1992; Fehring, Miller, & Shaw, 1997), and
isolation (Feher & Maly, 1999).
Many patients expect chaplains to help them with distressing feelings
(Hover, Travis, Koenig, & Bearon, 1992).
CONCLUSION: Persons turn
to spiritual resources in the presence of painful feelings and
experiences. Professional healthcare
chaplains are trained to help patients and families draw upon their spiritual
and religious resources to cope with these feelings.
Often family members experience similar or more intense
distress than their hospitalized loved ones.
In some studies, patients have indicated that one of the most important
chaplaincy functions is helping their family members with feelings associated
with illness and hospitalization (Carey, 1973; Carey, 1985).
In one study, 56 percent of the families identified religion
as the most important factor in helping them cope with their loved one’s
illness (Koenig, Hover, Bearon, & Travis, 1991).
In another study, family members rated spiritual care from
chaplains more highly than patients (Vandecreek, Thomas, Jessen, Gibbons &
Strasser, 1991).
Compared to those whose spiritual needs were not being met,
caregivers of Alzheimer’s patients who worshiped regularly and who felt their
spiritual needs were being met reported greater well being and decreased stress
(Burgener, 1999).
CONCLUSION: Families
rely on religious and spiritual resources to cope with the high levels of
distress during a loved one’s illness.
A chaplain’s care for family members has a positive impact.
Studies indicate that as many as 70 percent of patients are
aware of one or more spiritual needs related to their illness (Fitchett,
Burton, & Sivan, 1997; Moadel, Morgan, Fatone, Grennan, Carter, Laruffa,
Skummy, & Dutcher, 1999).
Studies of patients in acute care hospitals indicate that
between one third and two thirds of all patients want to receive spiritual care
(Carey, 1985; Fitchett, Meyer, & Burton, 2000).
When chaplains help a patient’s family, the patient is more
likely to choose that institution again for future hospitalization (Gibbons,
Thomas, VandeCreek, & Jessen, 1991).
A large study (VandeCreek & Lyon, 1997) of patient and
family member satisfaction with the activities of chaplains showed that:
– A large majority of patients were highly
satisfied with the spiritual care provided by professional chaplains.
– The satisfaction with chaplaincy services by
family members was even higher than that reported by patients.
– The chaplain’s visits "made the
hospitalization easier" because the visit provided "comfort" and
helped the patient relax.
– The chaplain helped patients "get better
faster" and enhanced their "readiness to return home" because
the visits helped them feel more hopeful.
CONCLUSION: Patients and family members are frequently
aware of their spiritual needs during hospitalization, want professional
spiritual attention to those needs, and respond positively when attention is
given—indicating that it influences their recommendation of the hospital to
others.
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients & Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
Healthcare professionals, including physicians and nurses,
sometimes experience stress when working with patients and family members. This stress has increased recently because
economic changes have led to fewer staff members providing care for more
seriously ill patients. Chaplains can
provide sensitive, supportive spiritual care to these patients and their
families for extended time periods, thereby allowing other professionals to
attend to other duties.
Professional chaplains play an important role in helping
staff members cope with personal problems.
Their supportive consultation can enhance morale and decrease staff
burnout, thus reducing employee turnover and the use of sick time. One study reports that 73 percent of
Intensive Care physicians and nurses believe that providing comfort for staff
is an important chaplain role, and 32 percent believe chaplains should be
available to help staff with personal problems (Sharp, 1991).
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients &
Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
The services of professional healthcare chaplains benefit
healthcare organizations in at least nine ways.
1. Chaplains
help healthcare organizations meet patient expectations for competent,
compassionate spiritual care services, thus enhancing the image of healthcare
organizations. In an age of high
technology medicine, brief hospitalizations, and shortened contacts with
physicians and other health professionals, chaplains offer one of the few
opportunities for patients to discuss their personal and spiritual
concerns.
2. Chaplains
who are certified as chaplaincy education supervisors through the national
professional organizations conduct certified programs for religious leaders and
laypersons seeking certification. Since
participants in academic quarter-length programs usually do not receive
stipends, their clinical services are free to the institution. (Students in one-year clinical pastoral
education residencies typically receive a small stipend). Such programs increase the amount of
spiritual care available at low cost to institutions.
3. Chaplains
establish and maintain important relationships with the community clergy.
4. Chaplains
play an important role in mitigating situations of patient/family
dissatisfaction involving risk management and potential litigation. When patients or their caregivers become
angry or threatening, professional chaplains can mediate these intense feelings
in ways that conserve valuable organizational resources. Their presence can serve as a vehicle for
reducing risk and potential litigation.
5. Chaplains
can reduce and prevent spiritual abuse, acting as gatekeepers to protect
patients from unwanted proselytizing.
Codes of professional ethics stipulate that chaplains themselves must
respect the diverse beliefs and practices of patients and families.
6. Chaplains
help patients and family members identify their values regarding end-of-life
treatment choices and communicate this information to other healthcare
staff. Clarifying values and improving communication
can reduce expensive, unwanted care (Daly, 2000).
7. Chaplains
help organizations develop their mission, value, and social justice statements
that promote healing for the body, mind and spirit. Especially for faith-based healthcare organizations, they promote
mission awareness and enhancement.
8. Chaplains
assist healthcare organizations in fulfilling a variety of accreditation
standards, including those associated with patient’s rights for spiritual care
and support.
9. Spiritual
care provided by chaplains is cost efficient.
The only published chaplaincy cost study reported that the services of
professional chaplains range between $2.71 and $6.43 per patient visit
(VandeCreek & Lyon, 1994-1995).
Additionally, approximately three quarters of HMO executives surveyed
reported that if spirituality (expressed through personal prayer, meditation
and other spiritual and religious practices) can have an impact on well being,
then it can helpfully impact cost containment (Yankelovich Partners, Inc.,
1997).
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients &
Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
Healthcare institutions are increasingly sensitive about
their relationship to the community and chaplains make unique contributions by
providing many community services.
These include:
Leadership and participation in community wellness
programs
Leadership of support groups to help members of the
community cope with loss or crisis and live with illness
Leadership and participation in community responses
to crisis and disaster including airline disasters, weather emergencies, and
acts of violence
Participation in a continuum of spiritual care that
emphasizes connections to local clergy and faith groups, home health and
hospice workers
Guidance and support for parish nurse programs and
other congregationally supported programs that enhance the health of community
members
Establishing educational programs for
parish/synagogue volunteers who will engage in lay spiritual visitation and
support for faith group members
Maintaining active relationships with local clergy
associations
Providing community educational seminars on topics
of spirituality, loss and illness, and coping with crisis
CONCLUSIONS: During the turmoil of healthcare
reform, decision makers are constantly searching for ways to provide optimal
patient services within financial constraints.
They seek to retain quality caregivers and maintain positive
relationships within the organization and community. Professional chaplains respond to these concerns in unique ways,
drawing on the historic traditions of spirituality that contribute to the
healing of body, mind, heart, and soul.
Executive Summary ~
TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients &
Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members
Benson, Herbert. (1999). Timeless Healing.
N.Y.: Scribner, p. 305.
Berg, Gary E., Fonss, N., Reed, A. J. &
VandeCreek, L. (1995). The Impact of Religious Faith and Practice on Patients
Suffering From a Major Affective Disorder: A Cost Analysis. Journal of Pastoral Care, 49(4), pp. 359-363.
Berry, Wendell. (1994). A Parting. Entries: Poems by Wendell Berry. New York: Pantheon Books, 11.
Brady, Marianne J., Peterman, A. H., Fitchett, G.,
Mo, M., & Cella, D. (1999). A Case for Including Spirituality in Quality of
Life Measurement in Oncology. Psycho-Oncology, 8(5), 417-428.
Burgener, Sandy C. (1999) Predicting Quality of Life
in Caregivers of Alzheimer’s Patients:
The Role of Support from and Involvement with the Religious Community.
Journal of Pastoral Care, 53(4), 433-446.
Canadian Council on Health Services Accreditation.
(1999). Achieving Improved Measurement (AIM) Program. 430-1730 St Laurent Blvd,
Ottawa, Ontario, Canada, K1G 5L1. Sections 13.3 & 14.9.
Carey, Raymond G. (1973). Chaplaincy, Component of
Total Patient Care? Hospitals: Journal
of the American Hospital Association, 47(14), 166-172.
Carey, Raymond D. (1985). Change in Perceived Need,
Value and Role of Hospital Chaplains. In Lawrence E. Holst (Ed.) Hospital Ministry: The Role of the Chaplain Today (New
York: Crossroad Publishing Company),
pp. 28-41.
Daly, G. (2000). Ethics and Economics. Nursing
Economics, 18(4), 194-201.
Feher, S. & Maly, C. (1999). Coping With Breast
Cancer in Later Life: The Role of
Religious Faith. Psycho-Oncology, 8(5), 408-416.
Fehring, Richard J., Miller, J.F., & Shaw, C.
(1997). Spiritual Well-Being, Religiosity, Hope, Depression, and Other Mood
States in Elderly People Coping With Cancer. Oncology Nursing Forum, 24(4),
663-671.
Fitchett, George, Burton, L. A.., & Sivan, A. B.
(1997). The Religious Needs and Resources of Psychiatric In-Patients. Journal
of Nervous and Mental Disease, 185(5) 320-326.
Fitchett, George, Rybarczyk, B. D., DeMarco, G. A.,
& Nicholas, J. J. (1999). The Role of Religion in Medical Rehabilitation
Outcomes: A Longitudinal Study.
Rehabilitation Psychology, 44,(4), 333-353.
Fitchett, George. (1999a). Screening for Spiritual
Risk. Chaplaincy Today, 15(1), 2-12.
Fitchett, George. (1999b). Selected Resources for
Screening for Spiritual Risk. Chaplaincy Today, 15(1), 13-26.
Fitchett, George, Meyer, P. & Burton, L. A.
(2000). Spiritual Care: Who Requests
It? Who Needs It? Journal of Pastoral Care, 54(2), 173-186.
Gibbons, James L. & Miller, S.L. (1989). An
Image of Contemporary Hospital Chaplaincy. Journal of Pastoral Care, 43(4),
355-361.
Gibbons, James L., Thomas, J., VandeCreek, L., &
Jessen A. K. (1991). The Value of Hospital Chaplains: Patient Perspectives. Journal of Pastoral Care, 45(2), 117-125.
Henry, L.G. & Henry, J.D. (1999). Reclaiming
Soul in Health Care. Chicago: Health
Form, Inc. 52.
Hover, Margot, Travis, J. L. III, Koenig, H. G.,
& Bearon, L. B. (1992). Pastoral Research in a Hospital Setting: A Case Study. Journal of Pastoral Care,
46(3), 283-290.
Johnson, Sarah C. & Spilka, B. (1991). Coping
with Breast Cancer: The Roles of Clergy
and Faith. Journal of Religion and Health, 30(1), 21-33.
Joint Commission on Accreditation of Healthcare
Organizations. (1998). CAMH Refreshed Core, January, RI1.
Kaczorowski, Jane M. (1989). Spiritual Well-Being
and Anxiety in Adults Diagnosed with Cancer. The Hospice Journal, 5,(3-4),
105-116.
Kaplan, Marty. (June 24, 1996). Ambushed by
Spirituality. Time Magazine, 62.
Koenig, Harold G., Moberg, D. O., & Kvale, J. N.
(1988). Religious Activities and Attitudes of Older Adults in a Geriatric
Assessment Clinic. Journal of the American Geriatrics Society, 36, 362-374.
Koenig, Harold G., Hover, M., Bearon, L. B., &
Travis, J. L. III. (1991). Religious Perspectives of Doctors, Nurses, Patients,
and Families. Journal of Pastoral Care, 45(3), 254-267.
Koenig, Harold G., Pargament, K. I., & Nielsen,
J. (1998). Religious Coping and Health Status in Medically Ill Hospitalized
Older Adults. Journal of Nervous and Mental Disease, 186(9), 513-521.
Koenig, Harold G. (1999). The Healing Power of Faith
(New York: Simon and Schuster).
Mason, Edna. (1990). The Changing Role of Hospital
Chaplaincy. Reformed Liturgy and Music, 24(3), 127-130.
Matthews, Dale A., McCullough, M. E., Larson, D. B.,
Koenig, H. G., Swyers, J. P., & Milano, M. G. (1998). Religious Commitment
and Health Status: A Review of the
Research and Implications for Family Medicine. Archives of Family Medicine, 7,
118-124.
May, Gerald. (1982). Care of Mind/Care of Spirit.
San Francisco: Harper and Row, 7.
McCullough, Michael, Hoyt, W., Larson, D., Koenig.,
Thoresen, C. (2000). Religious Involvement and Mortality: A Meta-Analytic Review. Health Psychology,
19(3), 211-222.
McNichol, T. (1996). The New Faith in Medicine. USA
Today, April 7, p.4.
Mickley, Jacqueline R., Soeken, K., & Belcher,
A. (1992). Spiritual Well-Being, Religiousness and Hope Among Women with Breast
Cancer. Image: Journal of Nursing
Scholarship, 24(4), 267-272.
Mitroff, Ian & Denton, E. (1999). A Spiritual
Audit of Corporate America: A Hard Look
At Spirituality, Religion, and Values in the Workplace. San Francisco: Jossey-Bass Publishers.
Moadel, Alyson, Morgan, C., Fatone, A., Grennan, J.,
Carter, J., Laruffa, G., Skummy, A., & Dutcher, J. (1999). Seeking Meaning
and Hope: Self-Reported Spiritual and
Existential Needs Among an Ethnically-Diverse Cancer Patient Population.
Psycho-Oncology, 8(5), 378-385.
Pargament, Kenneth. (1997). The Psychology of
Religion and Coping: Theory, Research,
Practice. New York: Guilford
Publications.
Pargament, Kenneth, Cole, B., VandeCreek, L., Brant,
C., & Perex L. (1999). The Vigil:
Relion and the Search for Control in the Hospital Waiting Room. Journal
of Health Psychology, 4(3), 327-341.
Roberts, James A., Brown, D., Elkins, T., &
Larson, D. B. (1997). Factors Influencing Views of Patients with Gynecologic
Cancer About End-of -Life Decisions. American Journal of Obstetrics and
Gynecology, 176, 166-172.
Sharp, Cecil G. (1991). The Use of Chaplaincy in the
Neonatal Intensive Care Unit. Southern Medical Journal, 84(12), 1482-1486.
Sivan, A., Fitchett, G., & Burton, L. (1996).
Hospitalized Psychiatric and Medical Patients and the Clergy. Journal of
Religion and Health, 35(1), 11-19.
VandeCreek, Larry, Thomas, J., Jessen, A., Gibbons,
J., & Strasser, S. (1991). Patient and Family Perceptions of Hospital
Chaplains. Hospital and Health Services Administration, 36(3), 455-467.
VandeCreek, Larry & Lyon, M. (1994/1995). The
General Hospital Chaplain’s Ministry:
Analysis of Productivity, Quality and Cost. The Caregiver Journal,
11(2), 3-13.
VandeCreek, Larry & Cooke, B. (1996). Hospital
Pastoral Care Practices of Parish Clergy. Research in the Social Scientific
Study of Religion, 7, 253-264.
VandeCreek, Larry & Lyon, M. (1997). Ministry of
Hospital Chaplains: Patient
Satisfaction. The Journal of Health Care Chaplaincy, 6(2), 1-61. (Also in book
form: (New York: Haworth Press, 1997).
VandeCreek, Larry & Gibson, S. (1997). Religious
Support from Parish Clergy for Hospitalized Parishioners: Availability, Evaluation, Implications.
Journal of Pastoral Care, 51(4), 403-414.
VandeCreek, Larry, Pargament, K., Belavich, T.,
Cowell, B. & Friedel, L. (1999). The Unique Benefits of Religious Support
During Cardiac Bypass Surgery. Journal of Pastoral Care, 53(1), 19-29.
VandeCreek, Larry, Rogers, E., & Lester, J.
(1999). Use of Alternative Therapies Among Breast Cancer Outpatients Compared
with the General Population. Alternative Therapies, 5(1), 71-76.
Yankelovich Partners, Inc. (1997). Belief and Healing: HMO Professionals and Family Physicians.
Report Prepared for the John Templeton Foundation.
The following persons were appointed by their organizations
to draft the Paper:
Representing The Association for Clinical Pastoral
Education:
Maxine Glaz, Fraser, CO
Mark Jensen, Winston-Salem, NC
Representing the Association of Professional
Chaplains:
Carl Anderson, Downer Grove, IL
George Fitchett, Chicago, IL
Representing The Canadian Association for Pastoral
Practice and Education:
Tim Frymire, Winnipeg, MB
Phyllis Smyth, Quebec City, QC
Representing The National Association of Catholic
Chaplains:
Steven Ryan, Los Angeles, CA
Michele Sakurai, Beaverton, OR
Representing The National Association of Jewish
Chaplains:
Zahara Davidowitz-Farkas, New York, NY
Seth Bernstein, Worcester, MA
The board members of the five sponsoring organizations
approved the final draft of this Paper on November 9, 2000 at a joint meeting
in Nashville, TN. They are:
Orwoll O. Anderson,
Fall Creek, WI
Charles F. Pieplow, Birmingham, AL
J. Paul Balas, Gettysburg, PA
Lee Ann Nolan Rathbun, Dallas, TX
Verlin E. Barnett, Jr., Akron, OH
Harlan E. Ratmeyer, Albany, NY
Yvonne M. Boudreau, Orange, CA
Cornel G. Rempel, Mount Gretna, PA
James V. Corrigan, San Diego, CA
William D. Russell, Chesterfield, MO
JoAnn M. Garma, New Orleans, LA
Sally A. Schwab, Saint Joseph, MO
James L. Gibbons, Park Ridge, IL
Teresa E. Snorton, Decatur, GA
Theodore E. Hodge, Louisville, KY
D. James Stapleford, Wichita, KS
Janet L. Humphreys, Louisville, KY
Donald A. Stiger, Chicago, IL
Janet T. Labrecque, Minneapolis, MN
Elizabeth Stroop, Chapel Hill, NC
Dan A. McRight, Miami, FL
Henry Douglas Watson, Newport News, VA
Irvin Moore, Jr., Cincinnati, OH
Linda Wilkerson, Dallas, TX
Duane F. Parker, Riverside, RI
Patricia A. Wilson-Robinson, Tacoma, WA
Carl Anderson,
Downers Grove, IL
Paul B. Janke, Sacramento, CA
Judith Blanchard, Portland, ME
Theodore Lindquist, Madison, WI
Robert Kidd, Houston, TX
Stephen L. Mann, Baltimore, MD
Karen Ballard, Greenville, NC
Dick D. Millspaugh, Columbia, MO
Timothy Little, Sacramento, CA
Mary Moore, Marietta, GA
George F. Handzo, New York, NY
Roderick J. Pierce, Houston, TX
Elizabeth Jackson-Jordon, Rockingham, NC
Mary Whetstone-Robinson, Columbus, OH
Josephine Schrader, Schaumburg, IL
Margaret Cobbold,
Toronto, ON
Dale Johnson, Vancouver, BC
Neil Elford, Edmonton, AB
Cynthia M. Morneault, Pierrefonds, QC
Martin Frith, Toronto, ON
Phyllis Smyth, Quebec, QC
Bill James-Abra, Stratford, ON
Joan Bumpus,
Indianapolis, IN
Mary Lou O’Gorman, Nashville, TN
Liam C. Casey, Hartford, CT
Hubert P. Polensky, Ontario, OR
Jane M. Connolly, Astoria, PA
Ellen K. Radday, Arlington, VA
Mary Anne DiVincenzo, Fresno, CA
Farroel A. Richardson, Portland, OR
Joseph J. Driscoll, Milwaukee, WI
Stephen R. Ryan, Los Angeles, CA
Virgine Elking, Kettering, OH
Charlene A. Schaaf, Colorado Springs, CO
Eileen F. Grimaldi, West Seneca, NY
Nancy A. Siekierka, Irving, TX
James H. Kunz, Rochester, MN
Jane Smith, Fulton, MO
Richard M. Leliaert, Riverview, MI
Patricia M. Walsh, San Gabriel, CA
Mitchell Ackerson,
Baltimore, MD
Stephen D. Roberts, New York, NY
Cecille Allman Asekoff, Whippany, NJ
Solomon Schiff, Miami Beach, FL
Sandra Rosenthal Berliner, Melrose Park, PA
Zev Schostak, Commack,NY
Seth L. Bernstein, Worcester, MA
Julie Schwartz, Atlanta, GA
Zahara Davidowitz-Farkas, Norwalk, CT
Sam Seicol, Brookline, MA
Shimon Hirschhorn, Riverdale, NY
Marion Shulevitz, New York, NY
Steven Kaye, Denver, CO
Stephen Shulman, Riverdale, NY
Lowell S. Kronick, New Hyde Park, NY
Barbara J. Speyer, Los Angeles, CA
Tom Liebschutz, Rockville, MD
Bonita E. Taylor, New York, NY
Beverly W. Magidson, Albany, NY
Michael Wolff, Quebec, Canada
Seymour Panitz, Rockville, MD
David J. Zucker, Aurora, CO
Bristol-Myers Squibb has generously provided the financial
support for the research and publication of this paper.
Executive Summary ~ TOP ~
Section I: The Meaning & Practice of Spiritual Care
Spiritual
Care: Relationship to Healthcare—Five
Dimensions
Healthcare Settings
Section II: Who Provides Spiritual Care
Section III: Functions of Professional Chaplains—Nine
Section IV: Benefits of Spiritual Care
A. Benefits for Patients &
Families—Six
B. Benefits for Healthcare Staff
C. Benefits for Healthcare
Organizations—Nine
D.
Benefits for the Community
References ~
Contributors ~
Board
Members