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Palliative Care Education Critical to Chaplains

Guest Editorial by: By Danny Tomlinson

Editor’s Note: This is an article written by the author for his hospital to introduce staff to chaplains and their work.

The chaplain is a professional and participates as an integral component of the multi-disciplinary team within the healthcare or institutional setting.  Not all chaplains are board certified, but all chaplains are expected to provide care at the level of a board certified chaplain. 

A board certified chaplain (BCC) has completed a minimum of a master’s degree in theology or a related discipline, completed a minimum of 12 months of intensive clinical experience called Clinical Pastoral Education (CPE) which is supervised by a person certified by the Association of Clinical Pastoral Education, has completed a minimum of 2000 clinical hours beyond the 12 months of clinical experience, and has written substantial material and been examined by a certification committee in the areas of: The Theory of Pastoral Care, Pastoral Identity and Conduct, Pastoral Competencies, and Professional Competencies. In order to maintain certification, a chaplain must gain 50 hours of continuing education per year, and complete a peer review every five years.

The chaplain has received intensive training in the areas of human development, diverse religious practices, ethics, group and organizational dynamics and behaviors, spiritual, emotional and physical boundaries, dynamics of communication – orally and written, development of the pastoral relationship, appreciation of and respect for diversity, use of spiritual assessments, facilitation of public worship practices in diverse settings, conflict resolution and many other areas of training. 

The chaplain will not seek to coerce any one to come around to the chaplain’s spiritual understanding, but will respect and seek to engage the individual in accordance with his or her own faith practice.

The chaplain has many different functions in the hospital.  Many people associate the chaplain with end-of-life issues, death, or the expectation of a poor Counselor with coupleoutcome, but the chaplain does so much more.  The primary function is to facilitate the recognition of spiritual and emotional paradigms a person uses to cope when encountering various situations in life.

Hospitality is a major function of the chaplain.  As the patient and her family encounter the strange atmosphere of the hospital, they may need assistance in coping with a number of things.  There will be a significant number of people tending to this family unit. 

The pace and order in which the hospital manages its work is unique.  The language used is unique.  Perceptions are different.  What the patient and family see as an emergency, may not be seen as such by the medical team.  Way finding and learning the protocol of the various departments and floors may overwhelm the family.  The chaplain assists in helping these people to negotiate through these new and strange things.

Often in the hospital setting family issues and conflicts can be intensified.  The chaplain is a person who works within that conflict to help achieve reconciliation and cooperation for the benefit of the patient. 

We are a “family focused” hospital.  This means that we take into account, not only the patient, but also the interpersonal environment of the patient’s support system to help ensure an atmosphere which lends itself to healing and health.


Chaplaincy Specialty Certificate in Palliative Care 

The Chaplain’s Function Within the Hospital or Institutional Setting

First Responder: A key role the chaplain fulfills is as a first responder.  This usually takes place in the emergency department, but may take place in the patient room at the time of or shortly following a significant new diagnosis.  In this venue, the chaplain provides comfort, hospitality, orientation, and facilitates communication between the medical team and the family. 

The chaplain does not function as an information gatherer but seeks to assist the family in coping with the tragedy or crisis.  A chaplain works closely with the other disciplines involved to help facilitate the functions of those other disciplines.  Chaplains work closely with the doctors, nurses, child life workers, social workers, environmental services and others to help provide the very best experience possible for the patient and their family.  The chaplain may spend several hours with a family in this situation to make sure they are oriented and comfortable before the chaplain leaves.

Day Surgery: Bringing a family member to the hospital for an outpatient surgery can cause significant emotional and spiritual distress upon each person involved.  Time becomes a stressor as the patient and family hurry to get to the surgery site and then find that they may have to wait an hour to many hours to have the surgery.  They are concerned about getting home and caring for the patient at home.  They are concerned about the possibility of something going wrong during surgery.

The day surgery chaplain offers a friendly contact with the patient and family to assess if they have any emotional or spiritual needs requiring attention.  Many people may not be very religious, but do want to have prayer prior to surgery.  The chaplain affirms the medical team and their abilities.

Intensive Care Units: Having a family member in the Intensive Care Unit is significant in that the patient’s condition is critical.  Days, weeks, or months may go by while the patient and family seem to be suspended emotionally, spiritually and physically. A chaplain enters the room as a person who will not ask anything of the family, but rather offers to hear their story, concerns, fears, joys, and numerous other feeling they may encounter.

The chaplain helps to remind people of their spiritual strengths, reconnects them to their spiritual heritage, facilitates communication with and hospitality for their own spiritual community, and listens without judgment to their heartaches.  The chaplain will interact with the medical team to ensure a solid understanding of the patient and family dynamics that may impact the reception of care for the patient.

General Medical/Surgical Units: Most parents are quite concerned for their child when they come into the hospital for any reason.  There is also the struggle most people have with being confined to the hospital in a small room and away from their support system. 

The chaplain provides a nonthreatening presence to help patients and families adjust to hospital life.  Once again, the chaplain may help to connect families to their local parish, provide emotional and spiritual support, offer religious texts and devotionals, provide articles of comfort, provide items that may help families to remember and sense the presence of the Holy during their time at hospital. 

Families also have the opportunity to reflect upon the meaning(s) surrounding their hospital stay.  Family dynamics are sometimes magnified with a hospital stay and a chaplain can help families to navigate their way through the stress of having conflict come out into the open.

Staff: The chaplain not only tends to the needs of patient and families, but also keeps an eye out for signs of fatigue and burnout in the staff.  She will interact with the staff regarding their personal emotional and spiritual wellbeing, providing time for decompression or facilitating a debriefing when needed. When an employee comes to work with issues from home weighing them down, a chaplain can help them to refocus on work and offer coping strategies to address the particular issue the staff member has shared.

Chaplains help to educate and train staff in the area of spiritual and emotional resilience.  Getting along with a patient or family that is difficult may have a strong impact on the medical team; the chaplain can help to foster understanding and compassion toward the family.

Chaplains seek to encourage and support the staff through humor, listening, affirmation, education, and interpersonal relationship building.

Community: The chaplain can be a strong advocate for the hospital within the community.  Depending on resources, the chaplain is available to offer presentations at churches and other civic venues. 

The development of relationships with clergy and community leaders may enhance the presence of the hospital and provide venues for impacting community-wide health through seminars and other engagements.

The chaplain will help the patient and family to sort through emotions, cultural norms, personal desires, and community preferences.  The most important aspect of the chaplain’s role is also the most privileged aspect; chaplains are witnesses of a person’s life and value.  A chaplain may be a witness of life when a child is born and many junctures in the life of a patient. 

One of the greatest privileges is to be able to stand or sit at the bedside of a patient and validate her/his life with all the good and not so good that in contained within that life span; to rejoice with the family at the contribution the patient has and is making to the family – past, present and future.  To witness the conclusion of a person’s earthly journey, to be there when they move into the next dimension of existence is and awesome privilege and responsibility.

The chaplain is able to enhance the quality of care for our patients and their families through end-of-life preparation, crisis intervention, family conflict resolution, and many other topics which concern our clients.  Chaplains also influence retention and satisfaction of the employees by offering support, encouragement, and understanding of the culture of healthcare at their specific location.

When the word “chaplain” is used, there may be many images that come to a person’s mind.  Ultimately, the chaplain is a person dedicated to being a co-creator of an environment which promotes the emotional, psychological, physical, and spiritual wellbeing of all with whom she comes in contact.

Danny Tomlinson is a staff chaplain at McLane Children’s Hospital Baylor Scoot & White Healthcare in Temple, Texas. He is a board certified chaplain, a member of the Association of Professional Chaplains, The Pediatric Chaplain Network, and is a certified Thanatologist through the Association of Death Education and Counseling. Tomlinson received his Masters of Divinity through Bethel Seminary is St. Paul, Minnesota.

Tomlinson, Danny.  “I am a Chaplain”.  PlainViews.  Vol. 11 No. 16. September 3, 2014. HealthCare Chaplaincy Network.

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