Hospital Chaplain's Role Is More Complex Today, Expert Says

March 26, 1998

P> COLUMBUS, Ohio -- The growing interest in spirituality and changes brought by managed care are challenging the hospital chaplain’s traditional role in providing spiritual care to patients.

“Traditionally, this has been the job of clergy,” said Larry VandeCreek, assistant director of pastoral care at the Ohio State University Medical Center. But the increasing interest in spirituality over the past decade and a half has led to significant changes in who provides this care.

“As spirituality becomes more popular,” said VandeCreek, “religion is viewed as being more old fashioned, and with it, the clergy.”

That sets the stage for persons like physicians, nurses, and other hospital staff to attend to the spirituality of patients. This is complicated further by the growth and demands of managed care. “Nurses have less and less time,” said VandeCreek. “This makes it less likely that a nurse is going to sit by a patient’s bedside to talk for 15 minutes. Yet, there has been a significant increase in articles addressing spirituality in the nursing literature.”

Many of VandeCreek’s comments appeared in a recent issue of the journal Seminars in Nursing Oncology.

VandeCreek noted that because managed care is reducing the hospital stays for many patients, hospital chaplains may see patients on an emergency or short-term basis only.

Nurses therefore can play a key role in identifying patients who should be seen by a chaplain. But how often this does or doesn’t happen may depend on the nurse. “The importance that a nurse places on spirituality is important here. Some are religiously involved themselves and are sensitive to it; others are not.”

The popularity and personalization of spirituality has also affected the hospital chaplain.

“Today, people feel free to define spirituality and religion in any way they see fit. It lacks consistency.”

Clergy from the community have traditionally held a unique relationship with a hospitalized patient, said VandeCreek.

“I don’t know of any other professional from the community who enters the hospital with a recognized entitlement to see the patient,” said VandeCreek. “They, along with hospital staff, have the right to talk with the patient.”

Community clergy have usually known the patient and family, often for a long time, said VandeCreek, “and there is great respect on the part of the hospital chaplain for community clergy.”

The potential for problems also exists, said VandeCreek. Sometimes the patient or family has concerns they do not wish to discuss with their clergy, and, for a variety of reasons, they may wish to talk with the hospital chaplain instead. Additionally, the state does not regulate the licensing of clergy (as it does physicians). Persons can simply declare themselves clergy, and their lack of training can cause problems.

“From time to time, such clergy may promote physical healing and try to dissuade the patient from scientific medicine. The patient may then develop doubts about his or her medical treatment, which the patient has a right to accept or reject.

“Then the family enters the picture,” he said, “and the result is a complex interaction between the patient, chaplain, nurse, community clergy, family, and physician.

“The problem is that just because someone is interested in spirituality doesn’t mean that they are trained to help patients with spiritual problems,” said VandeCreek.

“One must be able to help the patient with faith problems that are uniquely the patient’s; one should never minimize the patient’s concerns.” Such training is offered in most large hospital pastoral-care departments, he said.
Contact: Larry VandeCreek, (614) 293-8791;
Written by Darrell E. Ward, (614) 292-8456;

Ohio State University

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