PROFESSIONAL CHAPLAINCY
SECTION I: THE MEANING AND PRACTICE OF SPIRITUAL CARE
SPIRIT IS A NATURAL DIMENSION OF EVERY PERSON
Reflecting on the ancient word spirit, May (1982) writes,
"Spirit implies energy and power." The word spirituality
goes further and describes an awareness of relationships with
all creation, an appreciation of presence and purpose that
includes a sense of meaning. Though not true generations ago,
a distinction is frequently made today between spirituality
and religion, the latter focusing on defined structures, rituals
and doctrines. While religion and medicine were virtually
inseparable for thousands of years, the advent of science
created a chasm between the two. The term spirituality
is a contemporary bridge that renews this relationship. In
this paper, the word spirituality includes religion;
spiritual care is inclusive of pastoral care. Those
who provide spiritual care in healthcare settings are often
known as chaplains, although in some settings they may be
described as spiritual care providers.
Spirituality
demonstrates that persons are not merely physical bodies that
require mechanical care. Persons find that their spirituality
helps them maintain health and cope with illnesses, traumas,
losses, and life transitions by integrating body, mind and
spirit. When facing a crisis, persons often turn to their
spirituality as a means of coping (Pargament, 1997). Many
believe in its capacity to aid in the recovery from disease
(McNichol, 1996) and 82 percent of Americans believe in the
healing power of personal prayer (Kaplan, 1996), using it
or other spiritual practices during illness.
Persons frequently attend to spiritual concerns within religious
communities through the use of traditional religious practices,
beliefs, and values that reflect the cumulative traditions
of their religious faith. They may pray, read sacred texts,
and observe individual or corporate rituals that are particular
to their tradition.
Religious beliefs may encourage or forbid certain behaviors
that impact healthcare. Others focus their spirituality outside
traditional religious communities and practices. All, however,
share deep existential needs and concerns. Many persons both
inside and outside traditional religious structures report
profound experiences of transcendence, wonder, awe, joy, and
connection to nature, self, and others as they strive to make
their lives meaningful and to maintain hope when illness strikes.
Support for their efforts is appropriately thought of as spiritual
care because their search leads to spiritual questions such
as Why do I exist? Why am I ill? Will I die? and What will
happen to me when I die? Institutions that ignore the spiritual
dimension in their mission statement or daily provision of
care increase their risk of becoming only "biological
garages where dysfunctional human parts are repaired or replaced"
(Gibbons & Miller, 1989). Such "prisons of technical
mercy" (Berry, 1994) obscure the integrity and scope
of persons.
SPIRITUAL CARE: ITS RELATIONSHIP
TO HEALTHCARE
1. Healthcare organizations are obligated to respond to
spiritual needs because patients have a right to such services.
Regulatory and accrediting bodies require sensitive attention
to spiritual needs. As the Joint Commission on the Accreditation
of Healthcare Organizations (JCAHO, 1998) makes clear, "Patients
have a fundamental right to considerate care that safeguards
their personal dignity and respects their cultural, psychosocial,
and spiritual values." The Canadian Council on Health
Services Accreditation (1999) states, "When developing
the service plan, the team considers the client’s physical,
mental, spiritual, and emotional needs. The team respects
the clients’ cultural and religious beliefs and enables
them to carry out their usual cultural or religious practices
as appropriate." In an effort to fulfill such mandates
as well as honor their own values, healthcare institutions
create ‘patient rights’ statements in which they
pledge to provide sensitive attention to the dignity, culture,
beliefs, practices, and spiritual needs of all patients, their
caregivers, and hospital personnel. Such attention flows from
the belief that care of the body alone cannot be effective
if the mind, heart, and soul are ignored. Healthcare professionals
increasingly recognize that patients want holistic approaches
to their well being. For several years, Harvard cardiologist
Herbert Benson has conducted popular, biannual educational
events for healthcare professionals that explore spirituality
and healing in medicine. Following intensive research, he
(1999) wrote, "I am astonished that my scientific studies
have so conclusively shown that our bodies are wired to (be)
nourished and healed by prayer and other exercises of belief."
Professional chaplains respect and respond to patient values
and beliefs, encouraging a more holistic approach to healthcare.
2. Fear and loneliness experienced during serious illness
generate spiritual crises that require spiritual care.
While it is a biological event, serious illness frightens
patients and isolates them from their support communities
when they need them most. Losses such as physical and cognitive
capacities, independence, work or family status, and emotional
equilibrium, along with the accompanying grief, can seriously
impact their sense of meaning, purpose, and personal worth.
Professional chaplains address these crises through spiritual
care that emphasizes transcendence and enhances connections
to support communities, thus aiding healing and recovery.
They listen for the impact of medical information on patients
and families, uniquely facilitating an understanding of the
technical language of medical professionals.
3. Spiritual care plays a significant role when cure is
not possible and persons question the meaning of life.
Compassion and comfort become important foci of care when
illness is chronic or incurable. Approaching death can engender
serious spiritual questions that contribute to anxiety, depression,
hopelessness and despair. Professional chaplains bring time-tested
spiritual resources that help patients focus on transcendent
meaning, purpose, and value.
4. Workplace cultures generate or reveal the spiritual
needs of staff members, making spiritual care vital to the
organization.
Mitroff and Denton (1999), in a groundbreaking study of spirituality
in organizations, emphasize that employees do not want to
compartmentalize or fragment their lives and that their search
for meaning, purpose, wholeness, and integration is a constant,
never ending task. Other consultants (Henry & Henry, 1999)
write about the importance of individual and organizational
stories that help healthcare employees cope with their stress.
Such stresses are a concern for organizations that recognize
employees as their most valuable resource. Professional chaplains
are skilled in eliciting stories that "evoke self-understanding
and creativity, and sometimes …bring light to the paths
we travel in life" (Henry & Henry, 1999).
Spiritual care contributes to a healthy organizational culture.
Professional chaplains, moving across disciplinary boundaries,
serve as integral members of healthcare teams as they care
for staff members themselves who experience the stress of
patient care. Chaplains not only help staff members cope,
but empower them to recognize the meaning and value of their
work in new ways.
5. Spiritual care is important in healthcare organizations
when allocation of limited resources leads to moral, ethical
and spiritual concerns.
Difficult ethical dilemmas regularly arise in today’s
highly technological healthcare systems, i.e. decisions to
withdraw aggressive treatment. Unavoidably, such decisions
interact with personal values and beliefs of all involved.
Professional chaplains, who are frequently members of ethics
committees, provide spiritual care to staff members as well
as patients and families affected by these complex issues.
HEALTHCARE SETTINGS FOR SPIRITUAL CARE
Professional chaplains provide spiritual care in a variety
of healthcare settings, including but not limited to the following:
- Acute care
- Long-term care and assisted living
- Rehabilitation
- Mental health
- Outpatient
- Addiction treatment
- Mental retardation and developmental
disability, and
Hospice and palliative care
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