Pulse
Body and Soul
As members of the health care team, hospital chaplains tend to the spirit.
By Trout Lowen
When he first began doing chaplaincy work at St. Marys Hospital in Rochester in 1984, Floyd O’Bryan was often called to a patient’s bedside to say a prayer or offer communion. The patient was usually someone from the local Assemblies of God church, where he was the pastor.
Now, as director of Chaplain Services at Mayo Clinic, O’Bryan oversees a staff of 30 that includes members of various Christian denominations as well as two rabbis, a Muslim religious counselor, and a Greek Orthodox priest. All are employed by Mayo to provide a range of spiritual care services to patients and staff of all denominations and religions and even to those with no religious affiliation.
At Mayo, and at hospitals across the country, the role of the chaplain has undergone significant change during the past two decades, even though the core mission has remained essentially the same: to provide spiritual and emotional support to patients, their families, and hospital staff in a time of need.
How much change? Scott McRae, director of Spiritual Care Services at Park Nicollet Methodist Hospital, recently spoke to a group of pastoral care students about the neuroscience of leadership and how understanding the brain can inform the way chaplains educate students, talk with patients, and provide leadership in a hospital setting. “The whole post-modern era has us looking at spirituality through a different lens than we used to when it was primarily a religious lens ... because chaplains are going to be encountering that in the patients that they meet,” he says.
A More Diverse Spiritual Environment
Although religion is prominent in politics these days, Americans are actually becoming less Christian and less religious, according to a recent Trinity College study of American religious identification. And fewer and fewer hospital patients have ties to a local congregation, chaplains say. With the influx of recent immigrants, cultural and spiritual diversity are increasing as well. During the past two decades, Minnesota has seen a significant increase in East Asian, African, and Latino residents.
That diversity is nowhere more apparent than at Children’s Hospitals and Clinics in Minneapolis and St. Paul, says Brian Brooks, manager of chaplaincy services and bereavement coordinator. The patient population is both younger and more ethnically diverse than at other hospitals, and the changing family structure is also more apparent. “What we see today is what society is going to look like in another 20 years,” he says.
Because of that, chaplains have to be able to “meet people wherever they are,” Brooks adds. “I’m ordained Assemblies of God, but I’m not saying you need to do it the Assemblies way. … The religion part isn’t as important as the spiritual journey. What’s important for a chaplain is listening to someone, being willing to just be present rather than having to do any religious rites or rituals.”
Chaplains also serve as a bridge between the patient or family and a hospital staff who may not be familiar with a family’s spiritual traditions, Brooks says, citing the example of a young Laotian boy who was dying in the intensive care unit (ICU). The family’s spiritual tradition was to have an altar and a bowl of water with fresh flowers in the room, but hospital policy said no fresh flowers were allowed in the ICU unless they were wrapped in plastic. Brooks was able to intervene on the family’s behalf and explain to the staff why the flowers were important, comparing them with a Christian Bible.
“It’s really a matter of approaching them humbly, listening, finding out what their religious or spiritual needs are, and then kind of creating the space for that to happen,” he says of working with patients and families with varied beliefs.
New Kid on the Team
In addition to the changing role of religion and spirituality in modern life, the role of the chaplain is evolving within the hospital environment. Chaplains have become much more a part of the health care team, regularly recording their observations about patients’ spiritual and emotional health and providing support for staff and physicians.
They also may serve on hospital ethics committees and help families navigate decisions about treatments and end-of-life care, says Brooks, a past chair of the ethics committee at Children’s. Urban and larger regional hospitals employ chaplains who are often assigned to work with patients on wards, in outpatient clinics for cancer or other diseases, and in home hospice.
When he first began working at St. Marys, O’Bryan says chaplains often kept their own notes on patients, which weren’t part of the medical record. Now, chaplains are expected to chart their observations in the patient’s electronic medical record. He says doctors and nurses want to read chaplains’ impressions, their “spiritual assessment” of the patient. “We would see ourselves back in the ’80s fighting to be at the table for patient care,” O’Bryan recalls. “We don’t have to do that now.”
McRae agrees that there is much less resistance among medical professionals to talking about spirituality. “We’re in a time where there is great openness to integrating currents of medicine, religion, and spirituality,” he says. “I have noticed that physicians and nurses are much more open to the spiritual journey of a patient than they were 10 years ago.”
Even so, patients and hospital staff don’t always understand what chaplains do. And chaplains sometimes find themselves at odds with hospitals’ business models. “Our work is not about healing a patient, so to speak, but is about journeying with that patient,” McRae explains. “That’s hard to quantify or create measures around … yet we work in a culture that is always looking for bottom-line results.”
At Mayo, and around the country, as chaplains have become more integrated into the health care team, demand for their services has grown. “That can stretch the chaplaincy pretty thin at times,” O’Bryan says. However, there remains some lingering discomfort about practices in the past, when some chaplains may have engaged in proselytizing in the name of spiritual care. That’s not part of the modern chaplaincy, chaplains interviewed for this story say.
To dispel patient concerns, McRae says Park Nicollet chaplains often introduce themselves to new patients by saying: “Hello, I’m from spiritual care, and I’m part of your health care team.”
“We want to frame it as a feature of their health care in the same way that a dietitian or physical therapist would,” he explains. “From there, we invite them to talk about how the experience is. Are you getting what you need? Do you have any concerns? Then we try to get them to really reflect on any emotional dynamics, or if it moves into the religious, we’re very capable and able to go there. But we don’t start there because that brings to the fore all of people’s stereotypes about ministers and chaplains, and we don’t want to set that off.”
Certified Professionals
In general, chaplains are better educated and better trained than in the past. Although many are ordained ministers, laypersons also can be commissioned by a denomination or religious organization for the chaplaincy (Catholic nuns and laity can become hospital chaplains, for example). And more students with real-world ministry and counseling experience are pursuing clinical pastoral education (CPE) than in the past.
Regardless of their background, all hospital chaplains must complete a year-long residency in a CPE program accredited by the Association for Clinical Pastoral Education. They must then be board-certified by an organizations such as the Association of Professional Chaplains. To retain certification, they must complete 50 hours of continuing education annually.
Clinical pastoral education is a mix of theology, psychology, and ministry, and it includes classroom education and hands-on ministry in a hospital setting, says McRae, a CPE supervisor and educator. The training is based on an action-reflection model that asks questions such as, How did I meet the needs of the patient? How am I becoming aware of who I am? How does that inform me as to how I do my work? That model has been central to CPE for a long time, he says, but there have been changes such as encouraging students to embrace a broader theological perspective.
Although the classroom training may seem like a long way from deciding what prayer to say with a patient, McRae suggests the distance isn’t as great as it seems. He says the theological discussions build the chaplain’s capacity to encounter patients where they are. “So when we do come to say that prayer, we know that patient and we can say it in a way that is deeply meaningful and possibly transformative. If we can’t make that link, then our teaching is in vain.”
McRae mentions that although chaplains also receive training on clinical issues such as HIPAA regulations, infection control, and ethics, their primary focus remains spiritual, not physical, care. “There’s a line there,” he says. “We need to be informed, and yet we don’t ever want to start thinking like doctors and nurses.”