By Gary Evans, Medical Writer

Healthcare work takes an emotional toll, sometimes raising agonizing spiritual questions about suffering and death. Religious and spiritual leaders in hospitals can give healthcare workers a safe space to ask unanswerable questions and process frayed emotions.

One such person is Matt Norvell, MDiv, BCC, pediatric chaplain at Johns Hopkins University Hospital in Baltimore. Hospital Employee Health asked Norvell about some of the challenges of this kind of work, which helps healthcare workers regain their emotional and spiritual footing in difficult times.

HEH: How is your program set up? Is it nondenominational?

Norvell: Generally, hospital chaplain programs — and this is certainly true of ours — are intended to be generalized spiritual support. They are certainly nondenominational and they are also intended to provide support for anybody of any faith background or of no faith background. For example, a few years ago we renamed our department from “Pastoral Care” to “Spiritual Care and Chaplaincy.” We are trying to cast the net as wide as possible and broadly define spiritual support.

HEH: Have you had any pushback on that change?

Norvell: As I understand it nationally, many places are kind of backing away from the word “pastoral” because it has some specific Judeo-Christian history to it. People outside of those traditions may feel a little bit like, “that is not for me.”

The term “spiritual,” at least for us, has been more accepted. In my experience, people can get on board with some kind of spirituality — more people have that in common than any particular religion or denomination. From that perspective, it has been fine. My experience with staff is that so much of it is the individual comfort level. People get to opt in or self-select to be a part of this.

HEH: What kind of spiritual and religious issues do healthcare workers come to you with?

Norvell: Certainly, there is the day-to-day patient cases that really affect them.

Not long ago, we had a young child who was in an accident and was almost brain dead, had a very poor prognosis. A couple of nurses came to me. They were very distressed. They were worried [and asked] “What are we doing in the care of this child — are we increasing suffering?” One asked, “How do we know when someone’s soul leaves them?” I don’t know that I had a clear answer for that, but as you can imagine, this kind of stuff goes all across the hospital.

People bring their own personal religious and moral convictions to the job, and those get challenged by particular patient cases. Generally, the people that I end up providing spiritual support for are those who have a regular faith-based or religious practice outside of work. It makes a lot of sense for them to reach out to a chaplain for support.

HEH: What about healthcare workers in crisis who describe themselves as spiritual rather than religious?

Norvell: A sizeable portion of the population are people who consider themselves spiritual but don’t have a particular church or identified religious practice. They may ask even more cosmic questions like, “How could a good God allow something like this to happen? What is my role in supporting this person or this family?”

I spend a lot of time just sitting with folks and allowing them to process some of the big questions that come up in the course of their job. Sometimes I provide a little counsel, advice, and direction, but most of the time it is giving people a safe space to ask the questions they are not necessarily comfortable talking to co-workers or supervisors about. They need somebody a little bit outside of the direct healthcare arena to be able to listen to them and offer some feedback.

HEH: These are profound questions. How do you respond to that? Or do you vary your response according to where you think the person is coming from spiritually?

Norvell: A lot of it is how well I know the person. I talk to them a little bit about their background and their context. Different religions and different Christian denominations come at these questions from different directions. It’s my role and my hope that I can support them in thinking about it from their tradition, as opposed to imposing whatever my personal stance might be.

Once in a while someone will say, “But, really, what do you believe, chaplain?” In that particular case [of the child], I said I don’t know when somebody’s soul shows up and I don’t know when somebody’s soul disappears. In that instance — which is that this kid is never, ever going to have any discernible interaction with the rest of the world — then it’s my hope that their soul has gone, because I would hate to think of them being somehow “caught” there.

Again, we are talking about stuff that we just have no way of knowing. It does provide some support, some sort of cathartic opportunity for a staff member to feel safe enough to ask that question. There is a lot of value in having someone sit with you and say, “This is horrible, and I don’t know the answer to it, either.” Some of it is just normalizing that the questions are valid.

HEH: You mentioned that new residents coming into Hopkins have to set up a personal wellness plan.

Norvell: Right now, everybody is ramping up for new residents to start, so there are a lot of orientations going on around the hospital.

The movement in the last few years has been people talking about personal wellness and self-care. People here are building into the curriculum things about compassion fatigue, personal wholeness, and taking care of your mind, body, and spirit. People are really building this into their residency training programs. To me it’s fantastic. We are finally recognizing that these people are human with human needs and challenges, and we are going to try and support that.

For example, someone may say, “I’m Buddhist and I have this particular practice that is very helpful to me. That is a part of my wellness plan.” So when I talk to them about that, I can support them. Then there are some people who come to me and say, “I have no experience with religion or spirituality, but I need to figure out something that is going to help me stay afloat emotionally.”

I have had to define spirituality for myself as I am supporting other people. My baseline definition is it is that which helps to lift and sustain a person’s spirit. What are the things that depress and defeat that? We look for the resources that can help lift somebody’s spirit. They may be reading a particular strain of fiction or helping somebody be in touch with nature. The goal from my corner is to help people be holistically healthy using their own spiritual and emotional approach. How can they be who they want to be?

HEH: In addition to individual counseling, what spiritual or religious services does your department provide for employees?

Norvell: We as a hospital and a department systemically provide spiritual support through regular worship opportunities. Since we have a priest on staff, we have regular mass here. We have a pretty solid group of Muslims, mainly employees, but all people are welcome. The Judah service is on Friday afternoons.

When people come to us with requests to have some sort of a service, say a funeral for an employee, we do whatever we can to support people. It is just trying to honor and respect all of these people that we work with and all the variety of their backgrounds. People come from 10,000 different places and what is going to work for one may not work for another. So, this is to a certain extent trying to provide sort of a menu of ways to provide spiritual support, and hopefully one of those will connect with what the individual needs.

HEH: This may be more a hospital policy than spiritual guidance, but what about accommodating religious beliefs that may conflict with work practice?

Norvell: Those are accommodated on a hospital policy basis and they work it out with their department. In instances where a person might have a religious objection to providing a procedure or something like that, the hospital has a conscientious objector policy built in. Obviously there are emergency situations, but generally it is designed so the person can say, “I am not comfortable participating in this” in enough time to allow somebody else in that role to step in.