Let’s add science to healthcare chaplaincy without losing its art

Categories: Care.

You may not know that there is such a thing as a professional healthcare chaplain.

I know, because as a physician, I’ve worked with many, and have seen how the chaplain’s art helps patients, loved ones, and stressed-out staff find meaning and comfort.

I recall the notation that a chaplain wrote in the medical chart after visiting a patient recently diagnosed with cancer: “Engaged the patient in expressing his fears of treatment. Identifying courage he can draw upon from his religious practice of prayer.”

How did this chaplain know what to do? Some of the best chaplains I’ve known cannot describe what it is that they do with words everyone will understand in more or less the same way. Ask them, and they say it’s an art based on training and years of experience.

Even more distressing is the all too often absence of connection between these acts of chaplaincy care and what the doctors and nurses are doing for the patient. How much rich opportunity are we missing to provide better care?

The teams of healthcare professionals in hospitals – physicians, nurses, social workers and others – often include professional chaplains but not always. Professional chaplains are trained and board certified (like the rest of us in health care) to meet the needs of people from any faith or no faith. They help to identify and call on sources of strength to cope with a life changing health situation. Professional chaplains are active listeners. They clarify and address concerns, and facilitate communication between the patient, family, and the healthcare team. They aim to help the care plan integrate the beliefs, values and practices that are important to the patient and family.

Picture this: You’re hospitalized with a life-threatening disease and being visited by busy doctors, nurses, and the people who take you to the testing lab. Noone is intentionally unkind but it’s fairly likely that aside from, “How are you feeling today?” or “Are you in any pain?” nobody is asking you how you feel deep in yourself, whether you are in spiritual pain. But body and spirit are one. They cannot successfully treat one while ignoring the other.

During the era of enthusiasm for all things scientific, the role of spirituality in illness was dismissed as subjective and lacking hard data. Yet we can define spirituality in words. We can feel it. So why does something so powerful have such poor evidence? Have we been measuring the wrong things or the right things in the wrong way? We need to ask what should we be measuring and how.

Why does it matter? If we knew how to assess what a chaplain does for a patient, we could guide chaplains just as we do for physicians. Research has told us that diagnosis A calls for actions B.

We can learn much about the spirit from post-traumatic stress disorder or PTSD. A person’s response to trauma can matter almost as much as the trauma itself, whether it comes from combat, being a victim of a violent crime, or the shock of a natural disaster. Faces of too many patients pass through my mind but one face in particular I have never forgotten. A young man returning from Vietnam to an unwelcoming broken life, described himself as feeling “like a dog”. I asked him for how long and he answered: “Since I was a puppy”. He was trying to make light of his suffering, but our eyes met, I saw his face contort, and we both seemed to know he was in spiritual pain. Was there something that could have helped him more than the medical care for his septic foot I was providing?

We need to know how often people feel spiritually abandoned while in the arms of medical care. We need to know how to measure what matters, when chaplains should be asked to consult, what chaplains should be trained to look for, and how to respond based on the data. HealthCare Chaplaincy researchers have begun to mobilize to capture the science of chaplaincy care.

It’s a sacred task whose time has come.

Dr Linda Emanuel is senior vice president for research and education at HealthCare Chaplaincy in New York and Buehler Professor of Geriatric Medicine and director of the Buehler Center on Aging, Health and Society at Northwestern University, Feinberg School of Medicine.

This article originally appeared on the Washington Post ‘On Faith’ website.

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