Healthcare chaplaincy has advanced toward establishing a more universally recognized professional identity. However, the profession lacks a comprehensive definition of what constitutes spiritual care. We conducted a sub-analysis of a larger scoping review of the existing spiritual care literature to further conceptualize spiritual care activities according to published research and from various clinical settings in the United States. This sub-analysis examined 44 articles and identified 388 individual activities which we grouped into 14 spiritual care categories. Most activities focused on patients and/or patients' families. Of the 388 activities, psycho-spiritual activities were the most common (19.6%), followed by spiritual assessment and/or spiritual support activities (16%), spiritual/religious rituals, and services (15.7%), and activities related to staff support and education (11.6%). Findings that a definition of spiritual care, as conceptualized through research articles, establishes interpersonal relationships through which spiritual and religious traditions, practices, beliefs, and values are facilitated to maximize health and wellbeing.
This paper presents findings from a study of medical student reflections on a shadowing experience with hospital chaplains aimed to promote students' understanding of the importance of spirituality in patient care and the role of chaplains on a medical care team. Through a deductive content analysis, we identified key themes providing evidence that this shadowing experience increases student knowledge about spirituality, the role of chaplains, and meets the standards set forth in the National Competencies in Spirituality and Health for Medical Education. Exemplary quotes from student reflections demonstrate how they processed their experience. The student reflections consistently identified the value of the chaplain within health care, the importance of spirituality in patient care, and how this shadowing experience shaped their own Professional Identity Formation.
While guidelines recommend that families of critically ill patients receive emotional support from intensive care unit (ICU) clinicians, few receive it. To address this gap, we designed the Family Perspectives Project, an intervention that utilizes hospital chaplains to enhance the emotional support that ICU teams provide to families. This study's objective was to refine and preliminarily test the feasibility and acceptability of the intervention. The work occurred in two steps. First, we conducted qualitative interviews with stakeholders (n = 12) to refine the proposed intervention and design. Second, we conducted a single-arm feasibility study of the refined intervention in one ICU (9 patient-family dyads) and assessed feasibility and acceptability with validated measures on participant surveys. The intervention was delivered with high fidelity. Chaplains provided emotional support to families and created structured reports about family perspectives that clinicians reviewed. Participants found the intervention feasible and acceptable. A larger pilot randomized trial is warranted.
Paying attention to hope, including its counterparts, is part of spiritual care. In this study, we explored how general practice professionals and chaplains provide care for chronic patients' hope, despair, and hopelessness together. The research was conducted in a home-based care setting in the Netherlands. Based on thematic analysis of semi-structured interviews (N = 22) with chaplains (n = 8), general practitioners and general practice nurses (n = 8), and patients (n = 6), we found that (1) general practice professionals and chaplains collaborated by referring patients and by consultations, although collaboration was not a common practice; (2) health and relationships are important topics to understand hope in chronically ill patients; and (3) key elements in hope related care were listening, acknowledging and asking open-ended questions. We conclude that GP(N)s and chaplains should be willing to understand what hope means for themselves, for each other and for their chronic patients, aiming to provide spiritual care together.
Workplace violence (WPV) is a growing concern within healthcare, yet little attention has been given to its impact on chaplains. The current study examines the prevalence, reporting behaviors, and consequences of WPV among 327 healthcare chaplains across diverse care settings. Approximately 52% of respondents reported experiencing violence within the 30 days preceding the study; however, the vast majority did not report these incidents to their managers, healthcare system administration, or law enforcement. Experiences of WPV were associated with increased turnover intent and higher emotional strain. Results underscore the normalization of violence amongst chaplains as well as the institutional gaps in supporting healthcare workers who experience WPV. The findings highlight an urgent need for targeted interventions, policy development, and further research to enhance chaplain safety and well-being within the healthcare setting.
Burnout and compassion fatigue are prevalent among healthcare professionals, prompting interest in well-being interventions. This study aimed to understand how staff perceive the support of Comfort Corner - a chaplain-led program - on resilience, provision of care, team engagement, and turnover, and to describe the self-care behaviors among Comfort Corner attendees. A sample of convenience included 384 completed surveys. Among the respondents, there were high levels of mental (80%), emotional (77%), and physical (82%) fatigue. Most (59%) continue to practice self-care strategies outside of hospital hours to sustain wellbeing. Nearly all agreed Comfort Corner enhanced self-care knowledge, skills, and attitudes (KSA) (90%), resilience (88%), mood (97%), clarity (90%), and energy (92%). A majority (87%) reported safer care provision and 90% cited better teamwork. Of importance, 23% identified Comfort Corner as a factor in their decision to remain in the hospital. Survey respondents value the support from Comfort Corner. Additional longitudinal studies are needed to understand Comfort Corner's action mechanisms and its indirect effects on patient outcomes.
This study evaluated a country exchange cultural immersion program for Clinical Pastoral Education (CPE) students at Houston Methodist Hospital System (HM). HM has CPE programs with students in both Monterrey, Mexico and Houston, Texas, United States of America (US). Participants included 17 students from Mexico and the United States (US) who were interviewed individually or in small groups regarding their experiences with the program. Students from Mexico were interviewed in Spanish and the US students were interviewed in English. The study received institutional review board approval. All interviews were recorded, transcribed verbatim, with students receiving pseudonyms. The methodology utilized was qualitative interpretative phenomenological analysis (IPA). The research team, composed of three chaplains, one educator and one researcher, coded all interviews twice. Thirteen themes emerged leading to the overall conclusion that the program is very successful at helping chaplain students step out of their comfort zone, grow in compassion, confidence and competence when working with patients, families and staff who represent different cultures and ethnicities than themselves. Themes were matched with Association of Clinical Pastoral Education (ACPE) Level IIA Outcome Indicators demonstrating that the program aids students in meeting several competencies.
Spiritual care providers in health care settings experience high levels of stress, burnout, and compassion fatigue. In this study, we investigated the effects of self-directed activity to address chaplains' fatigue. The study also identified chaplains' preferences for dedicated time, the effects of such an activity, and the contribution of this intervention for well-being and work productivity. Eighteen chaplains participated in the study. Data were collected through a post-intervention survey. Results showed that offering a specific intervention aimed at addressing fatigue and burnout had positive benefits, not only for chaplains but also for the sponsoring organization. When employees feel cared for, they become more productive and willing to accept and work through challenges experienced by the organization such as a pandemic. Investing in self-care and work-based interventions of choice could potentially benefit the organization economically and create a stronger sense of organizational loyalty and connection.
Although chaplaincy is a key part of the Department of Veterans Affairs' (VA) healthcare services, few studies have investigated how classified suicide risk impacts this service utilization. Filling this gap, this study evaluates utilization patterns in a suicide-risk-stratified national sample of VA patients who died by suicide (cases), as well as suicide risk-matched patients (controls) who did not die by suicide in 2017-2018. Given overdispersion and data sparsity, the study used Bayesian Zero-Inflated Negative Binomial regression and evaluated group and risk-tier status associations. Chaplaincy utilization proportionally declined along with suicide risk; high-risk patients received significantly more care than moderate-risk patients, while moderate-risk patients received significantly more care than low-risk patients. Case and control differences were not significant. Findings support broader pattern of higher-risk patients receiving more care in general. Future investigations that include unstructured data could help contextualize case and control differences.
Understanding the characteristics of students entering Clinical Pastoral Education (CPE), including their baseline emotional intelligence (EI) and counseling self-efficacy (CSE), is essential for facilitating their development. This cross-sectional study examines demographic characteristics, EI, and CSE among 274 CPE students across 29 CPE centers nationwide. It also investigates professional and demographic factors that may predict baseline EI and CSE. We found that CSE was most strongly predicted by EI, EI was predicted by related prior work experience, and race was a predictor of both EI and CSE. These findings offer valuable insights for spiritual care education and CPE programs, highlighting the importance of curricula designed to foster emotional intelligence and promote reflective practice. Future research should explore the efficacy of specific instructional strategies and clinical experiences to enhance EI and CSE among spiritual care students, as well as the potential impact on care recipients.
Clinical Pastoral Education (CPE) prepares health care chaplains to address the spiritual and emotional needs of diverse patients and staff by cultivating self-awareness, interpersonal and clinical skills, and resilient compassion. Some health care chaplains engage in structured fellowship activities after CPE to expand and improve their expertise in clinical spiritual care. We conducted a retrospective investigation of recurring consult case reflections from chaplain fellows (n = 10) enrolled in a 2-year Compassion-Centered Spiritual Health (CCSH) fellowship program. We compared the fellows' first and last 10 reflections to identify changes in the fellows' reported activities and in the language that they used to reflect on their attunement during the consults. In the last 10 reflections, fellows attributed patient distress to a wider array of sources and were more likely to report using mindful grounding and cultivating a warmhearted presence with patients. When reflecting on their self-attunement, fellows used fewer discrepancy words (e.g., would) and more positive emotion language in the final 10 reflections. These results suggest that fellows diversified their activities with patients and used less dichotomous thinking to discuss their attunement as they became more experienced. This research provides insight into the cultivation of interpersonal and intrapersonal skills essential for high-quality chaplaincy care.
This study explores the extent to which chaplains employ structured methods in their practice in view of home-based chaplaincy in the Netherlands by conducting a secondary analysis of 40 case studies from the Dutch Case Studies Project (2016-21). Findings indicate that chaplains employ a broad range of interventions, among which two structured methods were identified: The Diamond Model and mindfulness. Both methods support clients in coping with vulnerability and making life decisions using different theoretical and spiritual approaches. It was found that both methods were applied flexibly, reflecting a balance between professional discretion and methodological integrity. Overall, the findings suggest that chaplains aim to integrate interventions, maintaining a balance between structured methods and relational presence, ultimately striving to foster inner peace through varied theoretical and spiritual approaches.
Burnout among healthcare workers has reached unprecedented rates following the COVID pandemic, with few studies looking at measures that might be protective against burnout. Additionally, few studies on how spiritual care interventions impact caregiver wellbeing exist. This study seeks to bridge this gap using a quasi-experimental model to evaluate the effectiveness of Tea for the Soul (TFS), a chaplain-led intervention, on caregivers' experiences of meaning and joy in their work. TFS is an intervention designed to care for healthcare providers (HCP) in their workspace. This study found statistically significant improvement in five meaning measures within the Meaning and Joy in Work (MJW) instrument: (a) My daily work is important, (b) Positive happenings at work give me heightened energy, (c) The work I do serves a greater purpose, (d) My daily work goals are meaningful to me, and (e) My work contributes meaning to my life. Higher chaplain referrals were noted throughout the intervention, indicating increased chaplain utilization by the healthcare team. The results of this study suggest a need to explore chaplain-led interventions, like TFS, and their impact on caregivers' meaning and joy in work as well as to explore interventions that would protect against burnout.
Healthcare chaplaincy should focus on the needs of patients. This not only applies to clinical practice, but also to institutional alignments, structural and organizational prerequisites, and public health policies. It is therefore necessary to evaluate whether the delivery of spiritual care corresponds structurally to the needs of the patient population in question. Using a representative population survey (n = 1'011), this study examines the preferences of the population in the Swiss canton of Zurich regarding healthcare chaplaincy. The survey assessed attitudes toward different spiritual care models based on a hypothetical scenario. Nearly half of the population (49.3%) wished the inclusion of spiritual/religious aspects in their healthcare during hospitalization. The most frequently mentioned reasons were the improvement of healthcare. A majority (51.9%) would like to see a healthcare chaplaincy that is part of holistic healthcare and available to anyone, regardless of religious affiliation and personal worldviews.
Religious and spiritual care has been overlooked by studies evaluating its impact on caregivers of patients admitted to pediatric hospitals. This scoping review examines the literature on the impact of spiritual and religious care on parents or guardians of children admitted to high acuity pediatric hospital units. Utilizing Arksey & O'Malley's framework for conducting scoping reviews, we included studies from within the last ten years written in English or Spanish in pediatric populations that reported role, effects, or impact of religious and spiritual care. Results reveal themes of positive impact of spiritual or religious care on several components of parents/caregivers' in the areas of emotional coping, grief and bereavement, positive parental perception of the impact of chaplains in high acuity settings, and outside spiritual/religious guidance and support during the medical decision-making process. More studies are needed to address the paucity of data on this topic with caregivers of pediatric patients.
Healthcare chaplaincy education in the United States lacks standardized curriculum guidelines, resulting in inconsistent training and preparation for clinical practice. This modified e-Delphi sought consensus on curriculum standards to address this gap. Nineteen experts-including chaplains, clinical pastoral educators, theological faculty, and thought leaders-participated in a three-round process evaluating eight proposed domains covering academic and clinical competencies. Participants rated 78 knowledge and skill competencies and provided qualitative feedback. The panel achieved over 75% agreement on all domains and competencies, with more than half (58%) reaching at least 90% agreement. This study's standards bridge longstanding divides in healthcare chaplaincy education, offering a cohesive framework to strengthen current programs and design new ones aligned with healthcare's specific needs. These curriculum standards present a roadmap for transforming chaplaincy education, ensuring that future chaplains are equipped to meet the spiritual needs of patients, their loved ones, and staff in increasingly complex healthcare environments.n.
Modern society is characterized by pluralism. We examine how chaplaincy encounters pluralism and what this might mean for chaplaincy and chaplaincy education. Religious pluralism impacts both how the profession is organized and how it is practiced. Financial and legislative structures play an important role in creating space for religious pluralism in chaplaincy. This intersects with "professional pluralism" within spiritual care. In many countries, spiritual care is increasingly considered a responsibility of a wide variety of healthcare professionals. This requires interprofessional collaboration in which different understandings of and approaches to spirituality and spiritual care need to be made explicit and negotiated. For chaplaincy and chaplaincy education, this has five important implications: a) developing interfaith competence as a Core Professional Skill; b) building a shared professional identity while honoring diversity; c) mastering interprofessional collaboration; d) addressing structural inequalities and power dynamics; and e) embracing both generic and specialized approaches to spiritual care.
Spirituality in addiction treatment is important to holistic care, yet many chaplains in the Department of Veterans Affairs (VA) frequently encounter these issues without sufficient training. This study assessed current practices and training needs among VA chaplains. Among 151 respondents, many provided addiction care weekly yet endorsed varying levels of comfort and perceived capability. Frequently used interventions included foundational chaplaincy skills (e.g., active listening, grief counseling) alongside occasional change-oriented approaches (e.g., 12-step care, Motivational Interviewing [MI]), and referrals to mental health services. Respondents expressed a desire for training in evidence-based modalities (e.g., MI, Acceptance and Commitment Therapy [ACT], the 12-step model), reporting these would increase comfort and capability. Post-hoc analyses suggested experience with these approaches and ability to refer were related to greater comfort and capability. The study underscores the need for targeted training initiatives and research to optimize the role of VA chaplains in holistic addiction care.
The COVID-19 pandemic impacted healthcare leadership, but much of the academic focus on leadership research has been on public health professionals and policymakers. Less attention has been given to the leadership roles of interfaith hospital chaplains. This study explores how interfaith hospital chaplains enacted leadership throughout the pandemic, focusing on their personal experiences, practices, and challenges. Utilizing Interpretative Phenomenological Analysis (IPA), the study involved in-depth interviews with ten interfaith chaplains from U.S. hospitals, all with at least six months of service during the pandemic. Chaplains demonstrated leadership through relationality, crisis management, and emotional support for patients, staff, and families. Their leadership was often under-recognized yet critical in navigating both the personal and collective trauma induced by the pandemic. The study underscores the evolving role of chaplains as essential healthcare leaders and highlights implications for future research and practice in interfaith chaplaincy leadership.
