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A New Hospitalist in the House


 

Effective spiritual care interventions require the right person with the right training who understands, for example, that spiritual care is more than intercessory prayer alone.1 No one on the healthcare team knows this better than the clinically trained, board-certified professional chaplain.2 When it comes to understanding the unique role of the professional chaplain on the healthcare team, no metaphor communicates this better to physicians and other healthcare providers than that of “hospitalist.” The “chaplain as hospitalist” differentiates the in-house chaplain’s care from that of other spiritual care providers and thereby sheds light on the problematic nexus of managing the provision of spiritual care in healthcare today.3-6

“Hospitalist” as a metaphor for chaplains communicates well with other healthcare professionals whose preconceived notions of chaplains may be based on parish-based models for pastoral care, or on chaplains as harbingers of death, or on the notion that chaplains only hold hands and pray with patients. As a metaphor, the hospitalist compares with the primary care physician as the chaplain compares to local clergy. That is, among all spiritual care providers, including local parish-based clergy and other healthcare professionals (such as physicians, nurses, and social workers) who might consider spirituality as part of their care, the professional chaplain is the “hospitalist.”

(Figure Above): Chaplain Mark LaRocca-Pitts consults with Sharon Crampton, RN, BSN, in the CVICU at Athens Regional Medical Center.

Like the hospitalist, the clinically trained and board-certified [hospital-based] chaplain is thoroughly and specifically trained in hospital-based interventions. These interventions range from the more traditional listening, prayer, and religious rituals to those interventions that incorporate an awareness of multi-cultural concerns, including ethical decision-making on end-of-life issues, and those that utilize current psychosocial and behavioral models as they relate to illness responses.7

Unlike many local pastors who come from the surrounding communities to visit hospitalized parishioners, the in-house chaplain is available 24/7 for emergent care and for consultations and provides a continuum of spiritual care from admission through discharge. In-house chaplains also understand and can respond to the variety of spiritual stresses that patients and families experience as a result of being hospitalized.

Whereas local faith representatives from the surrounding communities have little to no input in the patient’s overall plan of care, chaplains—as clinical members of the healthcare team—can advocate effectively for the patients’ spiritual, pastoral, and religious needs through interdisciplinary rounds and charting. In addition, as a valued member of the healthcare team, the in-house chaplain provides spiritual support for staff who are affected by the stresses of working in a healthcare environment.8

Like hospitalists, chaplains provide teaching, research, and leadership within the hospital. Finally, many healthcare providers understand spiritual support as a part of their overall care, but do not see themselves as ultimately responsible for such care.9,10 The “chaplain as hospitalist” can communicate to healthcare providers that the chaplain has the skills, abilities, and responsibility to assess and manage this particular aspect of their clinical care.3-6 When it comes to providing overall spiritual care for inpatients within the hospital context, chaplains are exceptional.

Problems encountered by the hospitalist movement are informative for professional chaplaincy. For example, upon admission and discharge, medical care is transferred between the primary care physician and the hospitalist. Patients often dislike this transfer, and the continuum of care may be disrupted.11 Educating patients and families concerning the benefits of hospitalists helps facilitate this transfer of care, and good communication between hospitalists and primary care physicians ensures a continuum of professional care.12

Complete transfer of spiritual care from local pastor to in-house chaplain will most likely never become standard practice, though it already occurs in special circumstances, as when local clergy are unavailable or in an emerging crisis. Yet, the hospitalist metaphor invites us to examine intentionally how spiritual care is shared among hospital-based chaplains and community-based local clergy. Formalizing and communicating a confidential and effective transfer or sharing of spiritual care will be difficult, but the hospitalist movement provides models that will help.

In summary, using “hospitalist” as a metaphor to describe professional chaplains has advantages and disadvantages. Within the context and culture of healthcare it is advantageous in providing a clinically based metaphor readily accessible to healthcare providers that communicates well the chaplain’s unique role and work. Within the context and culture of faith communities, however, its disadvantage rests in suggesting a transfer of spiritual care between providers.

Regardless of this disadvantage, the “chaplain as hospitalist” metaphor highlights a problematic nexus where authorities, responsibilities, and accountabilities overlap in the provision of spiritual care. It also suggests a possible solution: the chaplain as manager, but not sole provider, of spiritual care. Naming and examining this nexus can only enhance the overall provision of spiritual care. TH

Rev. Dr. Mark LaRocca-Pitts is a board-certified staff chaplain at Athens (Ga.) Regional Medical Center and is endorsed by the United Methodist (UM) Church. He also teaches as an adjunct professor in the Religion Department at the University of Georgia and pastors three small rural UM churches. Rev. Dr. LaRocca-Pitts received his MDiv from Harvard Divinity School and his PhD from Harvard University in Near Eastern Languages and Civilizations. He completed his clinical training in chaplaincy at Emory University and Duke University.

References

  1. Benson H, Dusek JA, Sherwood JB, et al. Study of the therapeutic effects of intercessory prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. Am Heart J. 2006 Apr;151(4):934-942.
  2. VandeCreek L, Burton L, eds. Professional chaplaincy: its role and importance in healthcare. J Pastoral Care. 2001 Spring;55(1):81-97.
  3. Handzo G, Koenig HG. Spiritual care: whose job is it anyway? South Med J. 2004 Dec;97(12):1242-1244.
  4. Post SG, Puchalski CM, Larson DB. Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med. 2000 Apr 4;132(7):578-583.
  5. Bessinger D, Kuhne T. Medical spirituality: defining domains and boundaries. South Med J. 2002 Dec;95:1385-1388.
  6. Sloan RP, Bagiella E, VandeCreek L, et al. Should physicians prescribe religious activity? N Engl J Med. 2000 Jun;342(25):1913-1916.7.
  7. LaRocca-Pitts M. Walking the wards as a spiritual specialist. Harvard Divinity Bulletin. 2004;32,3:20,29.
  8. LaRocca-Pitts M. The chaplain’s response to moral distress. Chaplaincy Today. 2004;20,2:23-29
  9. Kristeller JL, Zumbrun CS, Schilling RF. “I would if I could”: how oncologists and oncology nurses address spiritual distress in cancer patients. Psychooncology. 1999 Sep-Oct;8(5):451-458.
  10. Meyer CL. How effective are nurse educators preparing students to provide spiritual care? Nurse Educ. 2003;28:185-190
  11. Pantilat SZ, Alpers A, Wachter RM. A new doctor in the house: ethical issues in hospitalist systems. JAMA. 1999 Jul 14; 282(2):171-174.
  12. Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002 Jan 23-30;287(4):487-494.

Resource

For further information on board-certified chaplains, see the Association of Professional Chaplains at www.professionalchaplains.org.

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