Tangible objects Chaplains often gave families various tangible objects that symbolized hope. In five cases, the chaplain gave the parents a prayer shawl; in the other two cases, the chaplain gave the parent a book with a recorder attached to it.

When handing the prayer shawls to a family member, the clergy told the parents that the person who made the blanket had prayed for the child as the blanket was being made. As the observation period progressed, research observers noted that each of the families had either covered the sleeping child with the prayer shawl or the shawl had been placed with the family’s personal belongings in the room.


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The book with the recorder allowed the parent to record his or her own voice reading the story, then if the parent had to leave for the night or was away from the child, a hospital employee could play the book recording and the patient could hear their parent’s voice. On receiving the gift from the chaplain, some parents became emotional and appeared to gain a sense of peace knowing that their child would still be connected to them, even when they were not physically present.

Physical touch Physical interaction was noted to be of high value with the chaplain and the patients’ families. In each of the seven cases, some type of physical touch was noted. The most common form was the chaplain placing a hand on the shoulder of a family member. In one case, a child was admitted to the hospital for nonaccidental trauma. While in the trauma bay of the Emergency Department, the patient’s mother stood over her child crying and kissing his forehead. The maternal grandmother stood on the opposite side of the bed, and the chaplain was behind the mother with a hand on her shoulder. The chaplain asked if the grandmother would like to stand where the chaplain was, by her daughter, but the grandmother declined. The chaplain continued to stand beside the mother, with a tender touch on the mother’s shoulder. In another case, as a baby was being placed on ECMO, the chaplain stood by the watching father with a hand on his shoulder.

In one chaplain’s reflective writing, the physical touch was described as an affirmation to the parent that he or she was not alone. In addition, most of the chaplains seemed to intentionally maintain an eye-level position with the parent. If the parent stood, so did the chaplain. If the parent sat, the chaplains would typically either sit, too, or bend at the waist.

Prayer The chaplains used ritual prayer; however, this was initiated only when family members indicated it was a valued resource for them. When a family member asked for prayer and discussed what they would specifically like prayer for, one chaplain asked if the parent would like to pray or if they wanted the chaplain to lead the prayer. This allowed the family member to have some power and control in a situation in which they typically feel they do not have much control at all. The chaplain assisted in creating a holy space for the patient and family, and then invited the family member to direct the space. Another chaplain, after inquiring what the family would like prayer for, incorporated the parent’s words and phrases into the prayer, as if the chaplain was a mouthpiece for the parent. Of note, in one parent interview, a mother stated, “It was comforting to know that [the chaplain] was praying for me, but we never prayed together.” Another family member said, “[The chaplain’s] prayers were the only thing that enabled me to get through [the crisis].”

DISCUSSION

Chaplains find themselves in an in-between area of the hospital. On one hand, the chaplain is part of the hospital team providing patient care. Although not providing physical medical care, the chaplain does assist in the totality of care for the patient and the family. Chaplains assist explicitly with religious practices and rituals for patients and families, while also acting implicitly as a physical representation of divinity and spirituality. On the other hand, the chaplain advocates for patients and families while they are in the hospital. The chaplain journeys with the patients and families, listening to their story, and helping them articulate meaning during their time of uncertainty. The chaplain is then able to take the family’s understanding back to the medical team, thus assisting with communication and understanding between the two groups.

Although this study used critically ill pediatric patients as the clinical setting, a correlation can be used in the oncology ward. Oncology patients find themselves in the midst of uncertainty, whether it is a recent diagnosis, a time of relapse, or at the end stages of life. A chaplain’s services can be of value to the patient or family during the journey involving cancer. One chaplain from this study stated, “One of my roles is to journey with people—walk with them and provide a caring presence. Sometimes I lead them as I try to anticipate needs and provide information early in a family’s stay.” Because the chaplain is part of the hospital staff, he or she has the ability to anticipate what the future might hold for the patient and can help guide them during this time of their life.

In addition, regardless of whether tangible objects, physical touch, prayer, or other like actions are used, the chaplain, at the end of the day, is a physical representation of the divine. The chaplain is there to offer hope that something greater than the patient is journeying with them, that the patient is not alone, that no matter what happens the patient is being paid attention to, even if the road must travel through the shadow of death. One chaplain described part of her job as the notion of holy listening to the patient and family. “While, yes, it is listening to the patient’s story, including their fears and excitement, it is also listening with intentionality, with an ear toward being that vessel, the conduit of the divine.” And this type of listening is ripe in the oncology ward as patients are imminently dealing with issues of mortality, frailty, and the uncertainty of why this is happening.