Resources for the Chaplain

Spiritual care (SC) in the healthcare setting is no longer an option for organizations attempting to follow best practices in patient (pt) centered care. Studies have consistently shown that patient satisfaction, procedural outcomes, and the patient’s overall wellbeing related to recovery, hope, and meaning are influenced by the patient’s religious and spiritual (R/S) needs being addressed while admitted in a hospital. A patient centered approach in healthcare demands that we offer a means to address both the religious and spiritual part of who patients consider themselves to be. 

But why is SC so highly valued among the healthcare patient population? Addressing the R/S needs of the patient will help them cope with their illness and directly impact how they want to be cared for concerning the medical decisions they make. Harold Koenig, MD, in his book, Spirituality in Patient Care, identifies that an overwhelming majority of patients use religion and spirituality for health reasons and that “…many have spiritual needs that they would like addressed as part of their health care. Being religious or spiritual is part of who many people are—it forms the root of their identity as human beings and gives life meaning and purpose. This is especially true when medical illness threatens life or way of life” (pp. 25-26). 

Researchers have also determined that there is a financial cost for failing to address what some clinicians would consider the ancillary, R/S needs of the patient. So, what does SC in the ICU look like for a patient on ECMO? What can the multi-disciplinary team expect from a professionally board-certified chaplain (BCC) providing SC support for their patient? The next few paragraphs will briefly summarize a response to these questions, attempting to help prepare and educate the ICU ECMO team to better serve the patients under their care. 

First, the patient, family and the ICU team can be confident that when a referral is made for SC support, the role of the BCC will generally be to come alongside the pt/family to be a spiritual friend. He or she will not walk on the unit and into the patient’s room to convert, persuade, or coerce the patient into believing anything. The professionally trained BCC will reinforce what the patient determines to be beneficial from his/her worldview. If the patient is unable to communicate their wishes, the chaplain will, with the permission of the pt/family/healthcare surrogate (HCS), attempt to gather information to fill in the gaps and to provide SC support for the patient/family. 

While various hospital employees participate in the screening and history taking related to the patient’s spiritual and faith background, it is recommended that the professional BCC provide the comprehensive spiritual assessment to address the R/S needs of the patient and its influence upon their healthcare. Contingent upon the specific circumstances of the patient in the ICU and the involvement of family/friends in supporting that patient, the chaplain will conduct a non-judgmental assessment with unconditional positive regard for the patient’s faith and beliefs, the influence of those beliefs and practices related to the patient’s healthcare, R/S community support systems for the patient, and the actions desired by the pt/family regarding the role of the chaplain for SC in the plan of care (POC) for the patient while in the ICU. The comprehensive spiritual assessment utilizes a developing, universal taxonomy of spiritual interventions and outcome-oriented goals to provide for the R/S needs of the patient, while also discovering if there are any R/S beliefs or practices that immediately impact the delivery of care by the ICU team for the patient. The results and updated POC of the BCC’s spiritual assessments will be available in an electronic medical record (EMR) format to the ICU team to facilitate interdisciplinary collaboration, while providing a “whole person” continuity of care to address the needs and desires of the patient. 

Second, once the SC assessment is complete, the BCC will advocate, support, and serve as a liaison, working toward fulfilling the POC established by the ICU ECMO team with the input of the pt/family. This may mean providing for the sacramental or ritual needs contributing to the spiritual well-being of the patient. Sometimes it involves the chaplain, with the permission of the appropriate sources, contacting outside clergy and serving as an advocate/liaison for the patient/family spiritual needs. At other times, such as prior to extubation, during an end-of-life (EOL) procedure, it requires the chaplain to be present, facilitating bedside rituals combined with anticipatory or initial grief support. 

Most commonly, SC support to the pt/family entails the chaplain providing prayer, active listening, a sacred reading, spiritual song, a ministering presence, and offering spiritual counsel. However, it is not uncommon for the professionally trained BCC to be especially skilled in the art of conflict resolution and de-escalation procedures, especially when emotions run high and the pain of uncertain results surface that have not met previous expectations. A large percentage of BCC’s are competent and knowledgeable in helping patient/families complete Advance Healthcare Directives, sign a DNR, and to consider organ and tissue donation when appropriate. They are especially trained to deal with ethical dilemmas creating barriers to completing the aforementioned documents. Some chaplains are also notaries and may assist in the notarization of healthcare documents that the nurse may not feel comfortable signing. BCC’s also educationally reinforce clinical conversations provided by the physician, nurse, or other disciplines to the family, while “running interference” for clinicians when a patient/family member or friend need a listening ear. 

Third, a professionally trained BCC is available to address an often overlooked and neglected part of the healthcare system, spiritual care for the staff. It is what is frequently defined as the “assumed informal and secondary role” of the chaplain. Due to the high acuity level of the ICU patients and the healthcare team’s tireless efforts to serve as a liaison for the families of their patients, the team frequently neglect their own well-being. Compassion fatigue sets in and a variety of other factors begin to inhibit the performance of the staff, invariably leading to staff burnout. For this reason, a chaplain’s responsibility to support staff should no longer be considered secondary, but rather a primary emphasis in the overall care of others. 

The ICU team can anticipate the chaplain creating and providing a welcoming, confidential, safe, and hospitable space for the clinician to receive individual support and affirmation. In Brown-Haithco’s article titled, Spiritual Care of Staff, she identifies other options utilized by chaplains to facilitate support for staff. These may include, but are not limited to, cookie runs to celebrate and honor staff, blessing of the hands, services of remembrance, special services in the chapel, critical incident debriefings, staff support and grief groups, conflict mediation, spiritual care grand rounds, educational in-services, collaborative training, centering and meditation services, ethics grand rounds, creative arts programs and acting as a consultant to the nursing leadership and hospital administration (Professional Spiritual & Pastoral Care, pp. 215-217). 

In summary, professionally trained BCC’s will do well to remember in the midst of an everchanging, uncertain, high-energy, and chaotic environment within the healthcare system, and more specifically the ICU, to keep it simple and stay focused on the responsibility of the chaplain to love God, love people, and to do it on/with purpose. In our present age of religious pluralism it is important to remember what Atticus Finch said in To Kill a Mockingbird, “You never really understand a person, until you consider things from his point of view . . . until you climb into his skin and walk around in it.”

Rev. Franklin D. Reagan, Jr., MDiv, BCC served in local church ministry for twenty-two years and more recently as a healthcare chaplain for the past seventeen years. Ministering in both the hospital and hospice healthcare settings allowed him the opportunity to assist patient’s, families, and staff as a PRN/Staff Chaplain, a Manager, and as a Director in Spiritual Care Departments.