What Does a Chaplain Do?

 This last week I had a friend call to see if he could see me at the chapel of the hospital. I told him my office was elsewhere, and we could meet there. 

I let him into my office, invited him to sit. As we began our conversation the doctor I work with walked by, joined in for a moment, then left. My friend looked at me and said, "I don't think I know what it is you really do." And, "Is this a paid job or are you a volunteer? How many hours are you here?" 

I began to explain that yes, this is a career, not a volunteer job, that I do get paid, that I've had more than 2000 hours of generalized and specialized training, and just as someone would most likely not allow someone who likes blood to draw their blood, rather waiting for a professional, it is the same with chaplaincy. Just because someone likes religion or spirituality, does not make them trained to spend time with patients who have so many needs in time of crisis. 

My friend and I have folklore in common, and he wondered how I had transitioned from teaching folklore and writing at UVU to being a fulltime chaplain. So I shared with him my passions - listening to others talk about their beliefs, their rituals, their traditions, and being a companion to others along this path we call life. And as a chaplain I get that opportunity. 

First - why on earth are there chaplains in the medical field? I thought they were only for the military. 

The best answer I've read in quite some time comes from: 

Sojourn Chaplaincy at San Francisco General Hospital and Trauma Center

Hospital chaplains provide non judgmental spiritual and emotional support for people facing some of the most difficult times in their lives. We are committed to caring for people of all walks, faiths and backgrounds with love and compassion. We are a key part of the whole person care.

And then I had to answer to what was my education like. And I replied, Clinical Pastoral Education, often referred to as CPE, a 40 hour a week program with course work and on-the-ground internship. Along with more training for my specialization in Palliative Care (another time).

This past month I've spent a significant amount of time working on a document that not only shows what a chaplain's role is, but also the similarities and differences between the roles of a chaplain and a social worker. 

And I'll end today's post with that document and the differentiation in just a few words: 

A social worker provides resources, a chaplain provides relationships. Oversimplified, and as you can see below, we both do both. 

Social Worker	Shared Collaboration	Chaplain
Professional Clinical Counselor (Licensed)	While providing similar services, pastoral counselors integrate spirituality, faith, and theology with psychotherapy to help patients and families (pastoralcounseling.org)	Professional Pastoral Counselor (Certified)
Conduct a psychosocial assessment		Conduct a spiritual assessment, as well as assessing spiritual and existential ethical/moral questions which have an impact on end-of-life decisions or treatment options (where do they draw strength, hope; as well as religious practices)
Coordinate with psychiatric staff as needed	Identify emotional concerns: grief/loss, fear, sadness/depression, nervousness/anxiety, anger, guilt/shame, hopelessness, loss of interest; Consult in Interdisciplinary Team for appropriate referral as needed.	Coordinate with members of the team in aligning patient’s values with care plan
Substance use evaluations and interventions	Identify problems associated with substance use, mental health issues, and behavioral issues and coordinate with SW who will find appropriate resources for patient and family	Provide interventions for spiritual and emotional distress and pain: loss of faith, feeling alone, loss of direction, lack of peace, despair, searching for meaning, etc.
Refer to Neuropsych for capacity determination		Refer to SW for substance abuse, mental health, and behavioral issues
Complete comprehensive assessment with patient and caregivers, refer to resources based on assessment, screening patients for transition planning and psychosocial needs	Identify psycho-spiritual variables that contribute to patient’s care; that is patient-centered and family-focused, that respects diversity in all its dimensions/demographics	Identify patient’s values, i.e. relationships, meaning, making, sense of peace and needs in these areas
Provide brief therapy interventions for patients and families that may include support in treatment decisions	Emotionally support patients and families during times of difficulty including grief, loss, burnout, secondary trauma, compassion fatigue, etc.	Provide spiritual care including deeply listening to all languages – body/verbal/emotional, supportive dialogue, pastoral counsel, and supportive presence
Advocate and refer to community resources to include social determinants including housing, finances, mental needs, substance use, safety, medical follow up, dental, health literacy, and transportation, as well as APS, DCFS, and Guardianship Services	Advocate for quality of spiritual care across the service continuum	Liaise with local clergy for religious rituals and sacraments as well as to provide for unmet spiritual needs of patients and families
Counsel for grief and loss as a result of demise, chronic disease, or trauma	Identify relationship concerns: partner, family, caregiver support, isolation, loneliness	Counsel for grief and loss as a result of diagnosis, disease, hospitalization, death. How will this life be celebrated and loss be grieved?
	Provide bereavement support to patients and family; including: Anticipatory grief, ambiguous grief, complicated grief	Mindfully be present and sit with patient, connect patient with self; allow experiences to arise without needing to act on them
POLST preparation shared with clinical team members	Advanced Directive preparation	Coordinate and support Legacy work, i.e. life review, sharing memories, reflection
Lead hospice and end of life family meetings with providers	Develop, lead, and participate in appropriate support groups, follow-up	Provide care to team members and offer suggestions as well as encourage team members to have practices of self-compassion and kindness. Lead reflections that teach care for self and care for others. Educate team on multiplicity of spiritual care practices. Advocate for spiritual care practices in the system.
		Provide education about spiritual care to caregivers. Participate in/facilitate patient care conferences, meetings.
	Demonstrate, and then provide appropriate coping and relaxation techniques to alleviate stress and situational anxiety	Engage in narrative approaches to finding meaning, identifying fears, hopes, conflicts/coping. Share memories and reflect on legacy. Assist family in ways of preserving these memories.
	Document all visits and interactions in a timely fashion using documentation in iCentra, as well as role specific (FICA, HOPE, SIP, SOAP); use secure messaging forums for inter-team communication