Reaching In and Reaching Out: Hospital Chaplaincy as a Profession

1. Reaching In and Reaching Out: Hospital Chaplaincy as a Profession Wendy Cadge Brandeis University **NOTE: This is a revised version of the slides I presented at the SCC on 2/3/09. I have removed most of the photos to make the file smaller and easier to manage. If you have questions or would like a copy of any of the articles I refer to please email me at wcadge@brandeis.edu. Please appropriately cite / reference this material.

2. Interviews with the director and one staff chaplain at 35 hospitals: the 16 most highly ranked hospitals according to U.S. News and World Report (2004) and all the teaching hospitals in one northeastern state Becoming a part of the chaplaincy department at one hospital – attending meetings and retreats and interviewing the 32 staff chaplains, residents, CPE interns, and volunteers. Interviews with 70 staff who work in one neonatal and one medical intensive care unit. Data Collected

3. Top 10 Names for 2007

4. During the course of your career as a chaplain, what change in healthcare, medicine, or the way hospitals do what they do has had the most influence on your work as a chaplain? Question for Discussion

5. During the course of your career as a chaplain, what change in the spiritual / religious experiences and backgrounds of patients, families and staff has most influenced your work as a chaplain? Question for Discussion

6. How have you tried to adjust to these changes in healthcare and spirituality / religion in America more broadly as you do your work as a chaplain? Question for Discussion

7. “Each patient has the right to have his or her cultural, psychosocial, spiritual and personal values, beliefs and preferences respected.” “The hospital accommodates the right to pastoral and other spiritual services for patients” (Standard R1.2.10) Other regulations pertain to food, education, end-of-life care, etc. (See: http://www.uphs.upenn.edu/pastoral/resed/JCAHOrefs.pdf) JCAHO 2008 Standards

8. 70-85% of Americans regularly pray for good or better health for themselves or a family member 72% believe God can cure people given no chance of survival by medical science 60% of the public and 20% of medical professionals think someone in a persistent vegetative state can be saved by a miracle (Jacobs, Burns, and Jacobs 2008). Recent Statistics

9. Criteria for professions do not create professions Special skills and knowledge set groups apart – especially “abstract” knowledge Groups establish “jurisdictions” or things that are their exclusive responsibility Groups need to be able to communicate to others what their skills, knowledge and jurisdictions are. Insights from Studies of Professions

10. In a wide range of places The creation of the “Common Standards for Professional Chaplaincy” was a big step. Some Chaplaincy Departments have done little to professionalize Other Departments have made efforts to keep up with their changing medical, spiritual and religious contexts Where are chaplains in this process?

11. Moral arguments (it is the right thing to do – generally and in hospitals) There is need / demand from patients, staff, and the Joint Commission. Chaplains influence outcomes that hospitals care about (better faster healing, better coping, more and better understanding between patients/families and medical teams, fewer lawsuits). Why do hospitals need chaplains?

12. Pay attention to the whole person Engage the spiritual dimension as a resource for healing Have no agenda / meet patients where they are Not sure…. What do chaplains do that is unique / distinctive?

13. Tends not to focus on patient and family outcomes Tends to be published in a few journals not read by the broader medical community Rarely demonstrates clearly how chaplains influence patients’ and families’ experiences in hospitals. Research on Hospital Chaplaincy

14. Making CPE the central focus of the department Having large numbers of volunteers Being spread thin across the hospital Trying to get physicians involved with the department Doing research that describes what chaplains do (rather than what influence chaplains have on patients/families) Strategies that do not increase chaplains’ resources

15. Focus on patient/family outcomes Have some fluency in the language of the hospital Figure out and respond to the hospital’s problems Have chaplains become part of protocols Get involved in ethics work Do some PR Team up with others (oncology, CAM) Support staff in consistent predictable ways Work on interdisciplinary research projects **Demonstrate rather than assume your value to the institution….by reaching in and reaching out. Strategies that seem to increase chaplains’ resources

16. Employ “professional” chaplains (who are comfortable working across religious / spiritual traditions and who are familiar with how hospitals operate) Have found ways to have chaplains automatically be apart of protocols, interdisciplinary teams, committees Are known to colleagues in the hospital not just by personal name but by group (chaplains are trusted as individuals but recognized as a group) Are able to communicate to hospital staff, in their language, what they do (and do not do) and how they can help them. This includes not just charting but communicating through charting. Are seen as people who help solve problems Are able to talk about, even if they don’t have the research to show it, what they add / bring to patients / families that is unique. Qualities of a Professional Department

17. Many chaplains are allergic to talk of “outcomes,” self-promotion and PR Some are not interested in becoming more integrated in hospitals – see their value in standing outside Many are unclear about their goals (CPE, patient and family care, something else) The successful strategies listed challenge existing professional hierarchies and raise questions about the future training of chaplains. Concluding Thoughts

18. (Source: Cadge, Wendy, Jeremy Freese, and Nicholas Christakis. 2008. “Hospital Chaplaincy in the United States: A National Overview.” Southern Medical Journal. 101(6):626-630.)