As an acute care nurse working in the ED or ICU, Lisa Ruth-Sahd, DEd, RN, CEN, CCRN, CNE, often saw grieving families she thought could be assisted by the hospital’s chaplain. Often, social workers or counselors were called in, but not chaplains.
“I realized the huge impact chaplains can make as a team collaborator. I did not see them being utilized to their potential,” says Ruth-Sahd, a professor in the Stabler Department of Nursing at York College of Pennsylvania.
Critical care nurses need to incorporate board-certified chaplains’ contributions into the patient plan of care during bedside report, the authors of a recent paper argued.1
“Chaplain involvement provides a holistic dimension to patient care,” says Ruth-Sahd, the paper’s lead author. Ruth-Sahd suggests that chaplains can increase their presence and involvement in the following ways:
• Hold educational sessions to clarify their practice parameters and scope of practice to dispel the misconception that chaplains should be summoned only on matters of life or death;
• Make themselves more visible by participating in rounds instead of waiting to be called by clinicians;
• Post an informative sign at the hospital’s main entrance introducing the chaplain and how he or she can be contacted;
• Support the clinical team during debriefings by identifying what could have been improved from a spiritual perspective.
“Being certain that a chaplain is a member of the ethics committee would also be beneficial,” adds Ruth-Sahd.
Chaplains can help mediate critical clinical decisions. Rabbi Susan Harris, MHL, BCC, the director of chaplaincy at Boston Children’s Hospital, authored a recent paper on this topic.2 One reason chaplains are underutilized is persistent misconceptions on their role. Recently, a department head introduced Harris to another administrator as “the hospital’s clergy.”
“Chaplaincy is not always about religion. In fact, increasingly it’s less about religion,” says Harris.
When chaplains are pigeonholed in this manner, one response is to offer a detailed explanation on their true role. “But that is really annoying to the person who has to listen. Instead, we just have to do our role,” says Harris.
Some physicians struggle with communication skills, especially when it comes to end-of-life care. “But the amount of responsibility they have on them is incredible,” says Harris. “Physicians don’t necessarily understand that the chaplain is there for them, as well.”
Ethicists, clinicians, and chaplains play distinct roles. “But we are all in the business of enhancing communication and serving the needs of the patient and supporting the staff,” says Harris.
Sometimes, chaplains are the only ones who pick up on the fact that the family is misunderstanding what the clinical team is saying. Other times, the family is not explaining themselves in a way that the clinical team can comprehend. “Addressing spiritual and existential distress is important to outcomes — and perceived outcomes,” says Harris.
Sometimes the chaplain is silent the entire time during a family meeting or ethics consult. “But afterward, by virtue of having been there, we are in a much better position to help the family and to continue to enhance communication between both sides,” says Harris.
About a year ago, ethicists at Boston Children’s Hospital started participating on multidisciplinary rounds. Ethicists also check in with the bedside nurses when there are difficult cases. “It is such as wonderful co-support role that we share,” says Harris. “I feel like we are doing different parts of the same job together.”
The number of ethics consults has since decreased. “That is a very good sign because the problems are being dealt with in real time,” says Harris.
Chaplains have always been involved in ethics, and now staff is being informally schooled in ethics as well. “That just raises the level of conversation for everyone,” says Harris.
1. Ruth-Sahd LA, Hauck CB, Sahd-Brown KE. Collaborating with hospital chaplains to meet the spiritual needs of critical care patients. Dimens Crit Care Nurs 2018;37(1):18-25.
2. Harris S. Chaplains’ roles as mediators in critical clinical decisions. AMA J Ethics. 2018; 20(7):670-674.