The Impact of Professional Spiritual Care
We are pleased to announce that you will now find on our respective websites a link to our new resource for advancing professional chaplaincy. As you know we collaborated in 2001 on the white paper, Professional Chaplaincy: Its Role and Importance in Healthcare. Since then our respective associations, as well as other associations, have published a variety of very helpful resources and research on professional spiritual care.
This current resource, entitled The Impact of Professional Spiritual Care, has been co-authored and co-published by our five associations to provide you the most current expressions of and research on the profession of chaplaincy and spiritual care in the United States and Canada in a very accessible and readable format so that you can utilize the materials for yourself, and for your staffs, associates, and executives to explain and advocate for our profession.
This flip book format, versus a typical pdf format of a white paper, will allow us to continue to update materials as they become relevant, as well as aid you in using them.
We are committed with you to strengthen and advance the profession for the benefit of the care-recipients we serve.
ACPE: The Standard for Spiritual Care & Education, Association of Professional Chaplains,
Canadian Association for Spiritual Care/Association canadienne de soins spirituels,
National Association of Catholic Chaplains, Neshama: Association of Jewish Chaplains
What’s Inside –
To make this publication as easy to use as possible, we have summarized its sections including the key points and take away messages below. These summaries are so that you may quickly find which sections of the publication pertain to your query and verify if it answers your question. The points below are only a glimpse at the depth of information contained in The Impact of Professional Spiritual Care. For the most comprehensive information, please refer to the publication itself.
- Section 1 – Demystifying Spiritual Care
- Section 2 – Professional Chaplains’ Qualifications and Competencies
- Section 3 – Professional Chaplains’ Standards of Practice
- Section 4 – The Evidence for Spiritual Care
Section 1- Demystifying Spiritual Care
What Is Spirituality and What Is a Chaplains’ Role in Spiritual Care?
Because the term chaplain is well known, this publication sometimes uses chaplain and spiritual care practitioner interchangeably to increase understanding. The terms are not truly synonymous, and the term spiritual care practitioner is preferred in Canada. While chaplains are spiritual care practitioners, not all spiritual care practitioners are chaplains.
Professional chaplains are uniquely qualified to provide needed spiritual care that benefits patients and hospitals.
Healthcare cares for the whole person: body, mind, and spirit. The way we experience our spirits is called “spirituality.”
Spirituality’s central aspects are:
The World Health Organization defined the four dimensions of well-being as physical, social, mental, and spiritual health. The spiritual dimension plays a significant role in our health, wellbeing, and quality of life.
Research has demonstrated spirituality’s role in health and health care, making the spirit and spirituality a topic of increasing importance to hospitals, doctors, and other healthcare workers as well collegiate, corporate and corrections institutions.
Spirituality vs. Religion
Spirituality isn’t religion. Religion is “an organized system of beliefs, practices, rituals and symbols” that we use to feel closer to a higher power or concept and to determine our role in our community. (source – see PDF)
All religions express spiritualty, but spirituality is part of our existence whether we participate in religion or not.
Today, more people don’t adhere to a religion or aren’t active in their church or faith community—but they are still likely to believe in a higher power or view themselves as spiritual. When these individuals need spiritual care, it must be personalized to their beliefs and preferences, something professional chaplains are uniquely qualified to do.
Illness and loss cause spiritual distress
Spiritual distress is “a state of suffering related to the impaired ability to experience meaning in life through connections with self, others, the world, or a superior being.” (source – see PDF)
Causes of spiritual distress can include:
- Serious illness
- The serious illness of a loved one
- The death of a loved one
- Serious loss
People in spiritual distress may not know that there is a term to describe their suffering. Professional chaplains are uniquely qualified to detect spiritual distress and offer spiritual care.
How do chaplains benefit hospitals and patients?
Patients want to discuss religious and spiritual concerns while hospitalized, but many never get to. Patients who do address religious and spiritual concerns with a member of their healthcare team are likely to rate their health care at the highest level on four measures of patient satisfaction. This benefits the hospital as a whole.
This is why hospitals need professional chaplains. Chaplains are uniquely qualified to conduct spiritual assessments and develop a spiritual plan of care that is personalized and integrated into the patient’s comprehensive care plan.
Unlike community religious leaders, professional chaplains:
- are specially trained to address spiritual needs in the healthcare setting
- have an exclusive focus on their patients and their role on the healthcare team
- can advocate for their patients’ wishes as part of the healthcare team
- respect diversity and offer care regardless of religion and spiritualty
- do not represent a specific faith tradition or preach religious creeds
- use a nonthreatening approach to create a welcoming, safe environment.
Section 2 – Professional Chaplains’ Qualifications and Competencies
Chaplaincy necessitates special skills and diverse knowledge. To earn board certification, chaplains must demonstrate certain competencies.
Professional chaplaincy as it exists today is the result of chaplaincy groups from different religious backgrounds coming together to affirm and share common core qualifications and competencies.
The common qualifications and competencies were developed and updated by five organizations that certify chaplains:
- ACPE: The Standard for Spiritual Care & Education,
- Association of Professional Chaplains,
- Canadian Association for Spiritual Care/Association canadienne de soins spirituels,
- National Association of Catholic Chaplains,
- Neshama: Association of Jewish Chaplains
These qualifications and competencies:
- Set the baseline for professional chaplains’ practice
- describe who is qualified to provide spiritual care.
Each organization can add competencies in service to their mission, culture, and organizational understanding, but the common qualifications are shared by all.
General Chaplain Qualifications
Professional chaplains undergo rigorous preparation for their profession, requiring a solid foundation of academic accomplishment and personal spiritual development.
Though only chaplains seeking board certification must prove their proficiency in the following competencies, these categories reflect qualities, knowledge, and skills chaplains must possess to excel in their profession.
Chaplain Certification Requirements
For certification, the common qualifications require a bachelor’s degree and a graduate-level theological degree from an institution accredited by the Council for Higher Education Accreditation (CHEA).
Equivalencies can be written as culture differences require, such as to recognize the practice-based pathways of some non-Western spiritual leaders.
Competency Section I: Integration of Theory and Practice
The theories of spiritual care, psychology, social science, ethics, group dynamics, and basic research all apply to spiritual care. Chaplains must have knowledge of these theories and:
- Apply them to spiritual care
- Integrate them into practice.
Competency Section II: Professional Identity and Conduct
Some of this section’s competencies address qualities needed by most professionals; others include chaplains’ abilities to:
- self-reflect, including on their professional strengths and limits
- understand how their practice is affected by their feelings, attitudes, values, and assumptions
- attend to their own well-being and needs
- operate within the profession’s common code of ethics.
Competency Section III: Professional Practice Skills
Within the scope of practice for chaplains are the abilities to engage in relationships, provide effective support, manage crises, and facilitate group process. Additionally, the chaplain is expected to be able to:
- provide spiritual care that respects diversity and differences
- offer appropriate spiritual resources and worship opportunities
- advocate that the interdisciplinary team respect the recipient’s values and beliefs.
Competency Section IV: Organizational Leadership
The chaplain serves the wider organization, often a hospital, by integrating spiritual care into the life and service of the institution.
Chaplains can help the organization navigate change and loss, and help individual staff members with spiritual distress stemming personal issues, workplace concerns, and stresses specific to the setting.
To accomplish this, competencies address:
- integration of spiritual care
- maintaining interdisciplinary relationships
- functioning within the institutional culture
- using business practices
- facilitating ethical decision making
- fostering collaborative relationships with community faith group leaders.
Maintenance of Certification for Board-Certified Chaplains
Chaplaincy is dynamic, and professional chaplains must continue to develop themselves and their practice as new knowledge becomes available and their environment continually change.
To maintain certification, board-certified chaplains must:
- Participate in 50 hours of ongoing education each year
- Adhere to the code of ethics
- Maintain membership in their professional organization
- Be the subject of a peer-review every 5 years
- Demonstrate a good relationship with their faith community.
Section 3 – Professional Chaplains’ Standards of Practice
Professional Chaplains’ Standards of Practice
Chaplains master a comprehensive set of practices to provide quality care and improve their organizations. Professional chaplains provide quality care for patients, their fellow employees, and the hospital and organization itself. Through all of this work, standards of practice (SOPs) guide professional chaplains.
What is the role of chaplains in health care?
Seven SOPs guide the professional chaplain’s practice as it relates to the care recipient. In a hospital or health care setting, this often is a patient.
- Needs and Spiritual Assessment
The chaplain conducts an assessment to gather and evaluate relevant information regarding the care recipient’s spiritual, religious, emotional, and relational or social needs and resources. To provide effective care, care recipients’ needs and organization resources must be assessed and reassessed, plans of care modified accordingly, and care prioritized for those whose needs appear to outweigh their resources.
- Delivery of Care
Developing and implementing a plan of care promotes the well-being of the care recipient. Delivered in collaboration with the recipient and other care providers, the plan includes interventions to achieve goals identified during the assessment.
- Documentation of Care
The chaplain documents the care provided in the appropriate recording structure, using information relevant to the care recipient’s wellbeing. Documentation contributes to the best possible holistic care.
- Teamwork and Collaboration
Chaplains collaborate, within their scope of practice, with other care providers to promote the wellbeing of the care recipient.
- Professional Ethics in Practice
The chaplain ensures ethical practice and adheres to the code of ethics required by the chaplain’s professional setting to guide decision making and professional behavior.
The chaplain respects the confidentiality of information from all sources, including the care recipient, the organization, and other care providers in accordance with laws, regulations, and rules.
- Respect for Diversity
Through practice and education, the chaplain assists other members of the care team in incorporating issues of diversity into the care recipient’s plan of care, and models and collaborates with other care providers in respecting and providing sensitive care to people of diverse abilities, beliefs, cultures, and identities.
What is the role of a chaplain in an organization?
When it comes to providing chaplaincy care for the organization and its employees, the professional chaplain adheres to three SOPs.
- Care for Their Colleagues
The professional chaplain provides effective care to the organization’s employees and affiliates through a wide range of chaplaincy services. One-on-one care includes supportive conversations and formal counseling. Chaplains can create public worship opportunities, as appropriate, for staff that wants to take part. Other interventions include care designed to manage stress, whether the cause of the stress is personal, professional, or traumatic.
- Care for the Organization
The professional chaplain provides care to the organization in ways that are consistent with the organization’s values and mission statement. In keeping with the organization’s values and diversity, chaplains can highlight spiritual components of the hospital’s mission, create sacred spaces for patients and employees, and set up observances connected to the hospitals’ values (such as events for National Organ/Tissue Donor Awareness Day or the National Day of Prayer).
- Spiritual, Religious, and Cultural Leadership
Chaplains are leaders within their work setting on issues related to spiritual, religious, and cultural care and observance, and in their profession, advancing chaplaincy by providing education, supporting colleagues, and participating in their certifying organization and community faith organizations.
How does a chaplain provide quality care?
The final group of SOPs focuses on ensuring the professional chaplain provides quality, competent, and effective care.
- Continuous Quality Improvement
Professional chaplains seek and create opportunities to enhance their quality of care. Chaplains contribute to their organizations’ quality initiatives and identify processes to review and improve with the support of the organization’s quality department.
Keeping up to date with current research is integral to professional functioning and in keeping with the chaplain’s area of expertise. Chaplains stay informed on relevant developments in evidence-based and best practices by reading and reflecting on current research and professional practice.
- Continuing Education
Professional chaplains seek knowledge and participate in continuing education. To be considered for certification, chaplains must have both a bachelor’s degree and a graduate-level theological degree from an accredited institution. Once certified, chaplains must participate in a minimum of 50 hours of continuing education each year.
- Use of Technology
Technology enhances chaplains’ delivery of care and advances the work of the profession.
- Business Acumen
Professional chaplains value and utilize business principles and practices and compliance with regulatory requirements. This includes understanding and supporting the organization’s mission. For a chaplain in a leadership role, necessary skills may include budgeting, compliance, talent acquisition and management, and strategic planning.
Section 4 – The Evidence for Spiritual Care
The Research on Professional Chaplaincy
Studies demonstrate chaplains’ value to patient care and hospitals. Research related to chaplaincy is growing as researchers seek to describe and improve practice and assess the importance and value of spiritual care.
The growing body of evidence, which is highlighted below, proves the need for spiritual care from professional chaplains and demonstrate how chaplains benefit hospitals with chaplaincy programs.
The following are high-level insights from recent research. For a comprehensive report of chaplaincy-related research, see Section 4 “The Evidence for Spiritual Care.”
What do chaplains do?
Chaplains listen to patients and offer emotional support. In keeping with the patient’s preferences, chaplain’s visits include religious or spiritual activities, such as prayer or rituals. In a palliative care setting, they can be called upon to ensure the plan of care is consistent with patient’s values and wishes.
Most visits are initiated by the chaplain, not by the patient’s request or a staff referral, though studies show patients do want these visits. Out of the staff referrals that do initiate visits, most come from nurses.
The patients who most need spiritual care may not ask for it. Studies are being conducted to seek screening tools that would enable nurses and other staff members to quickly identify patients most in need of spiritual care.
What do patients want from chaplains?
- 70% of patients want at least one visit from a chaplain
- 78% want chaplains to remind them of God’s care and presence
- 71% want chaplains to offer support to their family and friends
- 69% want chaplains to be with them during times of particular anxiety or uncertainty
- 62% want chaplains to pray or read scriptures or sacred texts
- 39% want chaplains to counsel them regarding moral or ethical concerns or decisions
What is the importance of spirituality and religion in health care?
Religion and/or spirituality is one of most important resources for people facing serious illness. Half of patients with serious illness may be experiencing religious or spiritual struggle, which can compromise their health and well-being.
Studies that survey patients have found that most with serious illnesses use religious beliefs and practices to cope and that this can lead to better quality of life.
Do patients want to talk about religion and spirituality?
At least half of patients want to discuss their religious or spiritual beliefs or concerns with their physicians or other health professionals, and most want their doctors to ask about spiritual beliefs when a serious illness occurs.
Unfortunately, most doctors do not discuss religious or spiritual beliefs with their patients.
Do all patients have access to spiritual care from professional chaplains?
A small but growing body of evidence finds that the need is not being met due to hospitals not employing chaplains or employing too few.
- 35%–70% of patients welcome or expect a chaplain visit
- Just 54%–65% of United States hospitals employ chaplains
- There are 1.5–2.3 chaplains per 100 patients at hospitals with chaplain services.
Does care from chaplains improve patient satisfaction?
Several studies have consistently found that care from chaplains is associated with higher levels of overall patient/family satisfaction, not just satisfaction related to chaplaincy.
The converse is true, according to additional studies. Patient satisfaction rates suffer when spiritual needs aren’t met. One study’s author suggested “that meeting patients’ spiritual needs increases patient satisfaction and may have positive fiscal consequences” for hospitals.
Does chaplain care affect patient outcomes?
Research on effects of chaplain care is in its early stages, but findings point to its positive effects on psychological distress, quality of life, and spiritual well-being. Studies have found that patients who received visits experienced higher levels of positive religious coping, used less healthcare, improved their spiritual well-being, and reduced their symptoms and anxiety.
What is the role of chaplains in palliative care, hospice care, and end-of life care?
Patients receiving palliative care report spiritual pain, spiritual concern, and spiritual distress—but this suffering often is not addressed without chaplaincy services.
Less than half of palliative care programs have funded chaplain positions, despite the costs of not providing spiritual care.
Patients whose spiritual needs were inadequately supported by the healthcare team had a higher cost of care in the final week of life ($2,100 higher, on average).
How does chaplain care benefit organization staff?
Chaplain care of staff can reduce job stress and improve work-life balance, coping, optimism, and problem solving skills.
- Advocacy Information and Resources
- COVID-19 Resources
- Dealing With Grief: Videos
- Faith Tradition Resources
- The Impact of Professional Spiritual Care
- Legislative Tracker
- Professional Advocacy
- Professional Contacts
- Program Development
- Reading Room