METHODOLOGY

The study was qualitative in nature; methods included observation, reflection, and interview. A research observer followed each chaplain for 72 hours during which the chaplain worked with a critically ill patient. A total of seven cases were completed. Inclusion criteria were English-speaking patients who were admitted to the hospital, specifically the Emergency Department, Pediatric Intensive Care Unit, and the Neonatal Intensive Care Unit. The chaplain themselves wrote an exhaustive case study on what they perceived they did while working with the patient and families, and the observer wrote a case study of what he perceived the chaplains were doing.

Specific attention was given to the context and mood of the encounters, what family members said, what the chaplain said, how it was said, nonverbal communications, and also some of what was not said. After the 72-hour observation period, the observer then interviewed the physicians and nurses who worked with the patient to gain their perspective of what the chaplain did.

All of the reports were presented to an interdisciplinary panel that reviewed each case and discussed the role of the chaplain. The panel consisted of a narrative scholar, a member of the hospital Family Advisory Council, a hospital chaplain from another institution, a palliative care physician, a communications specialist, a pediatric intensive care nurse, and a child psychologist.


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And last, the families of the patients were also interviewed approximately 6 months after the 72-hour observation period to learn their understanding and memories of the chaplain. As a final step, the reports and interviews were subjected to qualitative analysis, and themes within each case and across all of the cases were brought to light.

STUDY FINDINGS

Analysis of the reports and interviews revealed that answers to the question “What do chaplains do?” could be categorized into four main themes: (1) Health care providers are unsure of what chaplains actually do while working with the patient and family. (2) Chaplains regularly give patients and families tangible objects that symbolize hope. (3) Chaplains use physical touch to build trust. (4) When families request prayer, chaplains use this ritual as an invitation into a holy space.

Health care provider uncertainty The physician and nurse interviews revealed they were uncertain about what the chaplain actually did while with the patients and families. Nurses were able to provide more specific details of the interactions with the chaplain; however, physicians rarely interacted with the chaplain. The following samples reflect the physicians’ responses when asked about their perception of the chaplain’s role in the particular case.

I wasn’t in [the room] for a lot of interaction with the chaplain.”

“… I would have to say I actually did not have much interaction with the chaplain. [In fact] I did not have any direct interaction.”

I did not have an opportunity to work with the chaplain in this case.”

When nurses were asked the same question, they stated:

Just kind of being a support for the parents.”

“The chaplain came to the bedside and was very supportive and helpful, answered questions, and let the family know that they were available if the family wanted to talk or needed other resources, whether that be something more concerning with their specific religion, etc.”

“I think that I’ve seen the chaplain offer support to the parents. The parents have had a lot of shock and upset … and I feel that chaplaincy has been a great part of them getting through the day-to-day challenges.”

Curiously, even though the health care providers were limited in describing the role of the chaplain in the particular case, when asked if they perceived the chaplains as having been helpful in the situation, they all replied in the affirmative.

“The first 24 hours of admission for these babies are very hard for the parents. There is a lot of information coming on. There is uncertainty … so, I think this is really where the chaplain can play a very vital role, by coming in on admission and talking to the parents, visiting with them, and trying to help them put things together … Giving them spiritual support would be very helpful.”


“I think it’s important for chaplaincy to gauge kind of where the parents are at and what kind of support they need or could potentially need in the future.

“For most families, at least in this part of the country, having some sort of spiritual help, guidance, support helps them get through the next however many hours or days that their child survives or doesn’t survive.”