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Reaching In and Reaching Out: Hospital Chaplaincy as a Profession. Wendy Cadge Brandeis University

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reaching in and reaching out hospital chaplaincy as a profession

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 [email protected] Please appropriately cite / reference this material.

data collected
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
question for discussion
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
question for discussion5
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
question for discussion6
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
jcaho 2008 standards
“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
recent statistics
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
insights from studies of professions
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
where are chaplains in this process
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?
why do hospitals need chaplains
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?
what do chaplains do that is unique distinctive
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?
research on hospital chaplaincy
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
strategies that do not increase chaplains resources
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
strategies that seem to increase chaplains resources
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
qualities of a professional department
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
concluding thoughts
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
slide18

(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.)

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