Navigating nonclinical patient care: A review of chaplaincy

Observational research on the role of a chaplain and how he or she interacts with patients and families is limited. Most studies on the role of chaplains are heavily dependent on self-reports generated by the chaplain and lack direct observation by an independent reviewer applying a researcher’s perspective to the chaplain’s interactions with patients and families. For example, Gibbons and colleagues reported on a project in which chaplains self-reported in a diary the work they performed after providing pastoral care.¹ Flannelly investigated the process of chaplain referrals in 2-week increments over 3 years, but specifically focused on the interventions performed by the chaplains.²

Cadge interviewed both pediatricians and chaplains, wanting to learn how each group saw the role of the chaplain.³ The pediatricians described the chaplain as a member of the interdisciplinary team who provided rituals and support for patients and families, especially in regard to the death experience. The chaplains, however, perceived their role in a broader context not limited just to times of death, but also as assisting in wholeness to the patient and by simply being present with the patient and family. Again, these interventions were self-reported by the chaplains.³

Other studies focused on the role of the chaplain in crisis situations. Of note, Puchalski wrote, “The chaplain seeks only to engage the sufferer and to reframe his/her suffering in the context of life’s incongruities.”⁴ This implies that as a member of the interdisciplinary team, the chaplain has a limited agenda with the patient; in particular, the chaplain allows the patient to guide the relationship and various outcomes. In a similar way, O’Connor describes how chaplains restrict their own theology to allow patients to explore their spirituality as influenced by the present crisis narrative in the hospital.⁵ In particular, Freyer and colleagues studied the work of the interdisciplinary team when working with adolescents who are dying.⁶ Their study suggests the role of the chaplain is to “support the adolescent’s search for spiritual meaning.”⁶

The oncology ward is a ripe location for collaboration between the medical staff who provide care for cancer patients and the chaplain. Blanchard noted that spiritual distress in cancer patients can compromise health outcomes, so they created a two-question screening tool oncology nurses can use when admitting a patient with cancer.⁷ Patients’ answers determine the need for a referral to the chaplain.

Johnson and colleagues discussed the feasibility and benefits of using centering prayer for women with recurrent ovarian cancer.⁸ King investigated oncology physicians’ attitudes toward their patients’ spiritual health.⁹ These researchers discovered that physicians who had an understanding of chaplaincy tended to offer referrals to chaplains more often.

In 2012, a cohort of pediatric chaplains, led by John Lantos, MD; Dane Sommer, DMin, BCC; and Jennifer Hunter, RN, PhD, began to fill a void in chaplain research by designing a study to investigate chaplains working in pediatric crisis situations. The study was funded by the John Templeton Foundation (www.templeton.org), with the grant program managed by HealthCare Chaplaincy Network (www.healthcarechaplaincy.org) and was conducted in a Midwestern, free standing, pediatric hospital. The goal of the study was to answer the following three questions:

• How do chaplains respond to parents who are faced with life-threatening crisis in their child?
• How do chaplains understand and incorporate their theoretical and theological conceptual frameworks into the work that they do?
• What commonalities and differences exist through which chaplains provide assistance to these parents?