Abstract
Aim:
To explore healthcare chaplains’ experience of providing spiritual support to individuals and families from minority religious and non-religious faiths and to identify key elements of the role.
Background:
Currently, there is limited research uncovering the essential elements of healthcare chaplaincy, specifically with reference to religious and/or spiritual diversity, and as interprofessional collaborators with nurses and midwives in healthcare.
Research design and participants:
Using phenomenology, we interviewed eight healthcare chaplains from a variety of healthcare settings in the Republic of Ireland. Data were analysed using a seven-step framework comprising Moustakas’ (1994) modification of the Van Kaam method of data analysis.
Ethical considerations:
Ethical approval was granted by the university and the principles of informed consent applied.
Findings:
Three main themes emerged: what the chaplain brings; components of ritual, minority faith or no faith; and practising chaplaincy. Subthemes included ‘offering’, ‘awareness and insight’, ‘acceptance and empathy’, ‘skilled companionship’, ‘presence’, ‘a confidant and holder of hope’ and ‘a vital resource’.
Discussion and conclusions:
The healthcare chaplain is a key collaborator in facilitating holistic person-centred care and in supporting healthcare professionals. Chaplaincy services are an essential but largely unrecognised and potentially cost-effective component of interprofessional team working.
Relevance to clinical practice:
This study has illuminated key aspects of the healthcare chaplain’s role as interprofessional collaborator in person-centred care, in navigating diversity and ensuring respect and dignity for the person irrespective of religious or spiritual care needs.
Keywords
Introduction
Interprofessional collaboration is espoused as a consistent feature of healthcare practice 1 ; however, blurring of role boundaries can occur against a context of increasing complexities in healthcare and specialisms and, where staff may be unsure about specific roles within a healthcare team. 2 This is particularly so when the team is ad hoc, or when a variety of healthcare professionals come together to influence care based on the person’s individual needs, or when conditions are uncertain, as distinct from care being necessarily standardised or routine. 1
One dimension of healthcare that may require specialist support is spirituality. Spirituality is understood as a way of making sense of life events, of drawing meaning from life, and of gaining and maintaining value from connectedness. 3 Recognition of spiritual needs as a fundamental right of the person 4 and embedded in the core values of healthcare practice 5,6 is foundational to holistic healthcare. 7
Nurses and midwives need awareness of spiritual needs, specifically, how to assess needs, how to offer spiritual care, and how and where other professional support may be necessary. 8 Omitting spiritual care from healthcare is of ethical concern, as is offering spiritual care that appears coercive or is beyond a practitioner’s competence. 9 Understanding the nurse and midwife’s role in spiritual care is central, but so too is understanding other healthcare workers’ roles in the multi-disciplinary care context.
In this article, we describe the findings of research undertaken with healthcare chaplains to illustrate the unique qualities that healthcare chaplains as team members can bring to person-centred healthcare. To support individuals and families, healthcare workers and healthcare chaplains often work together in unfamiliar ways forging new territory to address a person or family’s unique needs. 10,11 Little published information exists to inform nurses and midwives about the role of the chaplain as partners in healthcare by attending to spiritual and/or religious needs, because much of the established research in Ireland is emic in nature and has been disseminated locally or to smaller audiences. This has contributed to the ambiguity which exists around what is at the heart of healthcare chaplaincy for people of all faiths and none, for multi-disciplinary colleagues and for service users.
To illustrate the gap in evidence, a recent concept analysis to clarify the concept of spirituality in nursing by Murgia et al. 12 concluded that little attention has been paid to religious diversity or to religion in healthcare and that nurses need to have clear awareness of religious pluralism.
Background
Recognising and identifying individuals’ spiritual needs and supporting spiritual care, including referral where relevant, are key competencies of nurses and midwives internationally 8 and are central aspects to respecting the dignity of the person. The healthcare chaplain is recognised as having professional responsibility for addressing service users’ spiritual needs 13 ; however, while nurses and midwives acknowledge the healthcare chaplain as key to providing spiritual support, there is limited understanding of the role of healthcare chaplains and when to refer. 14,15
Lack of certainty about the role of the healthcare chaplains may exist in part because many healthcare providers have little interaction with chaplains or because of the perception that the role of healthcare chaplains is one of religious service provision only. 16 Although religious service provision may have characterised the chaplaincy role historically, the healthcare chaplains’ role has changed to one of spiritual care provider. 17 Healthcare professionals may also perceive that healthcare chaplains provide care from the lens of a single faith, as distinct from the multi-faith service that characterises most of modern chaplaincy. 18 These misperceptions may be influenced by negative public discourse about healthcare chaplaincy as is evident in the United Kingdom and the Republic of Ireland, 16,19,20 or a perception of secularism, based on personal experiences, as distinct from the individual needs of the service user. Without a full understanding of the role, healthcare providers are likely to be hesitant to make necessary referrals. 21,22 Yet, reluctance to recognise and support spiritual needs and to make appropriate referrals to a healthcare chaplain can have a lasting negative effect on individuals and families. 23,24
Understanding the role of chaplains as multi-faith spiritual care providers is particularly important in light of changing perspectives of spirituality and religion. Increasingly, spirituality is viewed as distinct from religion, as individuals may consider themselves spiritual, but not necessarily religious. 3 Spirituality may, however, remain a key component for those who subscribe to religious beliefs, and spiritual distress can arise when religious or spiritual needs are not met. 25 Spiritual care, therefore, applies to those who are religiously diverse and to those who would identify as spiritual, but not religious. 24,26 Within many chaplaincy frameworks, there is an acknowledgement that religious needs may be best met by religious personnel outside the health service. 27 There is also evidence that healthcare chaplains, with their unique experience, skills and education, are well-prepared to deal appropriately with diversity in religious belief 28 and can support multiple faiths and perspectives. 11,29
In the Republic of Ireland, within the current chaplaincy framework, healthcare chaplains are largely from a single faith based on current majority population needs. 16 This appears to work well in the practice of navigating diversity 30 ; however, those from the minority beliefs do not always concur with this view. 31 Beyond small international case study descriptions, 11,19 there is no evidence emerging regarding the role that healthcare chaplains play in the Republic of Ireland when dealing with individuals and families who are not religious or who are from religions outside of the dominant faith traditions. A recent scoping review identified key elements of their role internationally (Table 1) 30 ; however, little information emerged about how healthcare chaplains engage with individuals and families from minority religious and non-religious groups. A steady decline in the catholic faith tradition in Ireland has manifested over the last 30 years, with increased numbers practising other religions and growing numbers, almost 10% in 2016, professing no religion. 31 This movement away from traditional faith values has altered the landscape for the healthcare chaplain attending to service users of all faiths and none.
An outline of chaplains’ skills and requirements emerging from studies on the topic. 30
Given the dearth of research in the Republic of Ireland in the field of healthcare chaplaincy, 30 and concerns about the capacity for this role to be multi-faith, 20,32 it became obvious to us that development of healthcare workers’ understanding of the role of the healthcare chaplain is urgently needed and therefore, the research question was, what are healthcare chaplains’ experience of offering spiritual support to individuals and families, from minority and non-religious groups? This research is timely, given a recent review of chaplaincy services in the Republic of Ireland 33 and how little is known about this topic.
Methods
Research aim
The primary aim of this research was to explore healthcare chaplains’ experience of offering spiritual support to individuals and families from minority religious and non-religious groups, as described by chaplains themselves and using phenomenology. Phenomenology is concerned with meanings and essences of experience, as distinct from measurements and explanations; description of the experience, however, can never really fully grasp the true essence of the phenomenon. 34 We hoped to develop a conceptual understanding of chaplains’ experiences of engaging with service users and to identify what chaplains perceive their role offering spiritual support to individuals and families to be. That is, we hoped to grasp understanding of the role of the chaplain perceived by chaplains themselves, and beyond tasks and description.
Recruitment
In phenomenology, immediacy to the experience is very important to fully understand the phenomenon, and this premise guided the inclusion criteria. A gatekeeper from the National Association of Healthcare Chaplains (NAHC) and the Chaplaincy Accreditation Board (CAB) forwarded an invitation letter, participant information leaflet and consent form by email to all chaplains registered with their databases. Prospective participants contacted the interviewer directly if they were interested in taking part in the study. There are approximately 240 healthcare chaplains in Ireland, and 8 healthcare chaplains currently employed in healthcare settings in the Republic of Ireland elected to participate in this study.
Data collection
An interview guide was developed by the research team based on the literature on the topic. Field notes were made after the interviews. The interviewer explained the nature of the research and commitment and offered a minimum of 7 days between receipt of information and participating in the interview. A single interviewer from the research team, a University Assistant Professor and nurse and midwife, skilled in phenomenology, interviewed eight healthcare chaplains from a variety of healthcare settings. Interviews lasted between 45 and 90 min. The interviewer before the study did not know the participants, and none of the participants withdrew once the study began. Interviews took place in a venue of choosing by the participants. Given the small population of healthcare chaplains in the Republic of Ireland, demographic data were not collected as this would be a clear identifier of the participants and potentially compromise the individual’s and the study integrity.
Data analysis
Interviews were taped and transcribed verbatim. Analysis was conducted by two of the research team and involved identifying key emergent themes related to the experiences and practice of engaging with service users from minority religious or non-religious groups, guided by a phenomenological approach. Two researchers were involved in manual data analysis using a seven-step framework comprising Moustakas’ modification of the Van Kaam method. 35 This method of phenomenological data analysis involved organising the transcribed data into individual textural and structural descriptions of invariant constituents (codes) of each experience, developing composite textural descriptions and composite structural descriptions, and finally, a synthesis of textural and structural meanings and essences to represent the group as a whole. 35
Rigour
Each participant received a copy of the findings following three distinct stages of data analysis, when individual (Invariable) constituents (codes) were identified, followed by rich textural descriptions and finally, structural descriptions of their personal interview data. This enabled each participant to confirm via email the accuracy of content in relation to the information that they had provided. This provided confirmability. A clear audit trail was maintained.
Ethical considerations
Ethical approval was granted by the local university ethics committee. We gained approval to circulate invitations to healthcare chaplains from the Chairs or Vice Chairs of the NAHC and CAB. Participating healthcare chaplains gave informed written consent prior to participating in this research. Participants were interviewed in a private room in the university or in a location of their preference. All data were treated as confidential, and pseudonyms were assigned to participants. Given the small number of healthcare chaplains in the Republic of Ireland, researchers ensured no identifying features were revealed within the presentation of the findings.
Findings
Data analysis revealed key concepts emerging under the following themes: ‘what the chaplain brings’; ‘components of ritual, minority faith or no faith’; and ‘practising chaplaincy’. A number of subthemes also emerged.
What the chaplain brings
Participants described their unique contribution of ‘offering’, ‘awareness and insight’, ‘acceptance and empathy’, ‘skilled companionship’, ‘presence’, and ‘a confidant and holder of hope’ for individuals, families and staff, regardless of religion or faith.
Offering
The concept of ‘offering’ to others related to offering conversation, and offering hope, or a space to reflect and to be quiet, or seeing another way. My role is to offer and it’s an important word to use, it is to offer the [patients and families] and to staff who work here and to the volunteers, I’d say it’s a spiritual care, or whatever kind of spiritual care needs that they have…(Jack) offering a different type of service. (Jack)
Awareness and insight
The work of the healthcare chaplain was characterised by an attitude of caring for people in need. This need is spiritual but is also relational and emotional. Chaplains highlighted that conversation was used as a medium to express awareness and to convey listening and compassion. The manner in which a person’s need is expressed usually dictated the manner of the response that the chaplain offered, and this response opened a space for healing. The nature of conversation was determined by the person in need; chaplains followed where the individual led. Many conversations provide basic social or human connection…a lot of those conversations will be very short and very superficial. Some will go deeper and will have a more meaningful root and supportive role in it, for the patient or their families, or whoever I’ll have the conversations with. (Sam)
Acceptance and empathy
Spiritual care speaks to the lived experience of caring for another. The human entry point for chaplaincy care is to meet the other ‘where they are at’ at that situation and moment in time: I would offer spiritual care. People will say, well, what is spiritual care in this context? Well, it can be anything that people find within their own lives, what is of comfort, or consolation. Therein, lies somewhere their spirituality, or the meaning, or the, how do I say, the fuel, or the characteristics that make them who they are, you know…and you’ll find that can be very much the part of them that is broken. (Jack) I think you need to be listening in your heart. You need to be listening to what’s being said as well as hearing, or not hearing in your head. You need to be listening to what’s going on, and I think that’s part of the role here as well, that you’re hearing in here (pointing to heart) to what’s going on around you, as opposed to in your head. Because if you’re hearing in your head, you analyse it and you judge it, but if you hear it in your heart, you don’t. (Ann) Working with patients is a very humbling experience because they are at their most vulnerable, they are lying down, they are in the bed, I often think of them, just the pyjamas or sometimes a hospital gown on them, everything is stripped away from them…(Sylvia)
Skilled companion
The healthcare chaplain is a skilled companion at times of crisis: My role is about accompaniment and support, in the context of life-limiting illness for patients and for families. So, it’s about connecting with the points on that journey that patients and families struggle with. It’s about forming relationships with patients or families that are good enough to maintain the trust needed in order to support people with whatever challenges emerge…wherever the stress point is for the individual, whether it’s questioning their belief about themselves, about their God. Whether it’s about working through some relationship issues with the person who is dying, or the impact of the dying of the person on the rest of their lives. That’s my role, as one of accompaniment and support. (Tom)
Presence
Chaplains described healing in being present and available to the person: You know that that gift of presence was just so precious you can’t really put words on it…she wouldn’t really be able to talk. I got into a little habit of saying to her, I’m going to just stay here for a few minutes and I’ll just be nice and quiet beside you. I’d stand beside her bed…just quietly, just in myself, not, no words out loud at all because she needed peace, she needed the quietness, but my sense was that she maybe was glad of the company. I didn’t really know, but it was silent, so if she didn’t want my company, she could just close her eyes and pretend I wasn’t there and after a couple of weeks when she was feeling better, she said to me, you know, I really appreciated you coming to visit me and you were such a calm presence…I didn’t really realise that that was happening for her, but I suppose when the nurse came in, she was doing things and I was ‘being’, it’s back to that. (Elizabeth) You do bring yourself to it, I have no doubt…you go into a room and they know by you that you’re genuinely there for them in this time. And I suppose it’s to give off that there is nobody else so important to me, right now, only you, and I have time. (Ann) So, I went back, and I sat in the seat, in the corner of the room, not too close to her. And my sense really was that you know this woman didn’t need a whole lot of talk. I really, really got into a very deep place myself. She might say something, I might answer, and I might say something…I went back on the following Tuesday, not even sure if she’d still be there. I went to her room…she said, ‘I realised I was so anxious that if you said too much to me I would have actually asked you to leave’. And that was my sense of her, that she was just ready to crack you know. And she said, ‘I thought about it and thought about it…’ and she said you were just so present, she said the word ‘present’, and ‘you were so present to me’. (Mabel)
Confidant and holder of hope
The healthcare chaplain described holding hope on the boundaries between life and death. There is no hope of her ever being any better than she is. That for her family, she just doesn’t understand why they kept her alive and you know, it’s very, very hard to hear that. Yet, I understand that she cannot say that to her family. She can say it to me. I need to be able to hold that without pushing it back to her…I said you have lost hope of a better future, but if it’s okay with you, I’m going to hold hope for you. I’ll be praying for you. She said, don’t pray for me, pray for my family. I said, ‘well if it’s okay, I’ll pray for all of you’. (Elizabeth)
A vital resource
Participants in this research confirm that their chaplaincy roles encompassed empathy and concern for all in the healthcare setting, including staff, and their commitment and motivation to this is reflected: We realised after a few days that my role as a spiritual carer, giver, was in supporting the staff, who were supporting the family. They needed the support more so than we needed to be needed by that particular family. (Jack) Call it [chaplaincy] a resource, you could call it skilled people to call on when there’s a crisis or when there’s intervention needed, or whether support is needed, or whether there’s care needed…it varies from staff who are stressed who come down looking for somebody to sound off or listen to them. It’s as complex and as varied as the building and the people in it because healthcare places are complex…so, you can be a sounding board, you can be a calming presence in the midst of a crisis. I mean, I was involved in a particular situation last week, a security [person] wouldn’t go near it. (David)
Components of ritual, minority faith or no faith
The centrality of ritual, ritual prayer and creating ritual
Incorporating ritual and universal religious symbols has a broad and deep association across cultures and ensures inclusiveness: They’ve told me that they don’t practice, or they don’t go to church, or they don’t go to the Mosque, but we all connect with ritual, you know and that’s been my experience here. (Jack) You ask that person in front of you, what do you want me to do for you right now? Acknowledge that you know the tradition…I know that you do this, and you do that, but what would you like, what would you like for your child right now? (Ann) I asked him did he want any particular rituals, or any prayers and he said I would like one of those crosses, so I’d like to put it in my Dad’s hand, because he carried that cross with him often. This was a man who had no faith in a sense…he wanted the cross, I was able to do that, because we have the resources for that too. (David)
Minority faith or no faith
Persons of minority faith and no faith are supported by a spiritual and caring attitude to relationship and an openness: But I would try to take my cues and also my leads from each family that I would meet. So, you know, we’ll say irrespective, never would I have heard, and I’ve offered spiritual care to at least eight or nine Muslim families since I’ve come here. They have never said they were Muslim. They have never asked me my religion. Their whole trust was that I offer care. I offer pastoral care, people care. (Jack) We’d a beautiful Hindu couple they’d delivered a still born baby…and at the burial they walked around the grave, the mother and father as they chanted, ah it was kind of, it was unbelievable, but to me it was like, this is how we do it, you know. (Mabel) We’re simply coming in to be with them. (Mabel) I’m a chaplain to all faiths and none, but equally, I’m a Christian chaplain. I’m a person of Christian faith. So, I can’t be a Muslim chaplain, but I can be a chaplain to a Muslim. (Sam) People, in the crisis moments, people really don’t care what denomination you are or what faith background you are if you have the skill to care for them. (David)
Caring for persons of no faith
Understanding of the processes of grief and loss is captured despite cultural variation: And when the [Buddhist] lady died, the nurse said is there somebody you’d like us to get? And they said that man that listens to the patients, and when I eventually went up to see them, they knew me through association, and through saying hello. When she died they embraced me and then they asked me would I do the service here in the hospital before the person’s remains went. (David) My understanding is that it is to be available for everyone here in the hospital regardless of denomination, religious denomination, regardless of any barriers, I’m available for people here in the hospital – at a spiritual level, at an emotional level, you know, psychological level, whatever people want to bring, I’m there to listen, to listen deeply to the story that people may bring to me and I suppose, and in that listening, perhaps whatever might unfold, that brings us together to a place that maybe brings healing. That’s it, I think in a nutshell. (Sylvia) I would try to just see the human being there. I would always try. So, for me, even though it’s not a minority faith, engaging with somebody who’s from the catholic background would be different to what I would be used to. I would always just try to see the human being there, not see the label. (Elizabeth)
Caring without prejudice
This chaplain described an open response to others that is without judgement. Goodness is not bound to any particular faith or no faith. Sylvia articulates her perception of the distinction between spirituality and religion. Even the most difficult characters you meet, you know, they’re that way for some reason, something has happened, but I think there is, there is a difference between, yeah, I think the spiritual stuff comes from the inside, the religious stuff comes from what you’ve been taught, I think…(Sylvia)
Sustaining the healthcare chaplain in chaplaincy practice
Personal faith and value system
Combining personal faith and humanistic values of compassion and person-centred care supports the chaplain to care for others: I suppose, one of the things, aspects of my life that we’ll say kind of sustains me, is to pray. You know my own spiritual life because I think that’s vital. (Jack) I think also you know there’s an element here around the kind of work that you have done or are willing to do on yourself when you inhabit a role as chaplain…a lot of it is around reflecting on yourself and your role in the world. (Tom)
Self-care and support
Supportive supervision, from one who is further along life’s path, and reflection on personal experience, is central to working with commitment and creativity: I feel that my own personal journey, there’s been tough times and there’s been difficult times, there’s been joyful times, it’s been all part of mine as well and, and I can celebrate that now. (Sylvia) I couldn’t do the job without [supervision] and it helps me just to, I suppose to let go of the stuff I’m holding on to and to see what’s going on in myself, but also its definitely helping me to deepen the practice…I just feel I couldn’t do the work without that. (Mabel) I think we’re investing our body and soul of care and that’s why getting back to the supervision thing. We need to be careful of that. We have to be very careful; you know I think about obviously minding ourselves in healthcare, because we can burn out very quickly. (Jack)
Discussion
Multi-faith working
This research aimed to explore healthcare chaplains’ experience of providing spiritual support to individuals and families from minority religious and non-religious groups and found a wealth of experience emerging. Healthcare chaplains in this research displayed skills in navigating spiritual and religious diversity among individuals and families. This supports previous in-depth case study approaches detailing how healthcare chaplains navigate and support in complex healthcare situations. 11 A chaplain from one faith can work successfully within a multi-faith approach, 11 and can navigate complex cultural and religious domains by what Pesut et al. 28 refer to as ‘brokering diversity’ (p. 825). It is evident from our research and from these case studies 11 that healthcare chaplains, with their professional experience and education in this field, are best placed to steer the landscape of religious and cultural diversity and to address existential questions that may arise in times of health crisis. 28,41,42 A multi-faith approach requires cultural sensitivity to understand various perspectives. 43 Similarly, the advancement or supportive use of symbols or rituals when relevant 44 requires specific skills, particularly in complex faith/cultural/family circumstances. 11 It is unlikely in modern healthcare that individuals and families have single faith needs; rather, they may value a fusion of cultural, religious and historical traditions and beliefs 11 and the facilitation of these requires a highly skilled practitioner.
Notwithstanding their own religious beliefs, healthcare chaplains in this study described being able to ‘be with’, support, or refer individuals and families with diverse religious or spiritual needs or beliefs. This contrasts with the public rhetoric which renders healthcare chaplaincy in the Republic of Ireland a singularly religious service, 20 providing for a perceived minority and without any deep understanding of the breadth and scope of the healthcare chaplains pastoral care role in complex healthcare environments. Interestingly, in this research, the chaplains’ beliefs, education and training served to inform and develop great personal strength, resilience and resourcefulness that strengthened them to be continuously effective and creative in their role.
The role of the chaplain in healthcare
Healthcare chaplains in this research were available to individuals, families and staff offering a supportive presence and a spirit of hope. This approach is reflected in the literature and is testament to the evolving professional role of the healthcare chaplain. 12,16,45 –47 Chaplains serve as key healthcare workers by providing supportive care, especially in difficult or challenging times, such as end of life. 19 They also have an emerging role in supporting the healthcare team’s ethical decision making and in providing pastoral support to healthcare staff. 48,49 This support for healthcare staff has been identified as implicit to the role of chaplain 16 ; however, recent qualitative findings offer explicit confirmation that healthcare chaplains are providing support to co-workers increasingly. 50 In our research, for example, it emerged that there is a holding and containment that chaplains offer, not solely for the ill or dying person and their families, but for staff also.
Healthcare chaplains foresee an ever-increasing role emerging in healthcare. 50 Their competence, flexibility and availability for pastoral support in challenging and ethically complex situations, such as during family witnessed resuscitation, 48 are also likely to be cost-effective for the health service. Contrary to rhetoric of the excessive cost of healthcare chaplaincy, 19,20 recent Randomized Controlled Trial evidence suggests that this service is likely to be cost saving in terms of its overall contribution to patient care. 51 There are also likely savings on sessional psychologists and other interventions for staff given their (often invisible) contribution to staff support. The role in staff support, although strongly emerging in this research, and a clear role and function in some services internationally (Table 1) is not something that emerges strongly within the literature on the topic. 30
Team working
Early work by McSherry 52 suggested that while spirituality is inherently individual, attending to spirituality needs to be supported by the entire healthcare team inclusively and in a way that acknowledges diversity. There is invisibility to chaplaincy work, 53 possibly due to the nature of the work, limited empirical scrutiny or challenges to applying this approach to therapeutic work. 45 Perceived invisibility may also be a consequence of working seamlessly within a healthcare system and fitting the description of a ‘complimentary’ role 48 (p. 400). Complimentary roles are generally highly valued and also develop and change over time to grow to compliment the system and changing healthcare needs. 54 This is very typical of the healthcare chaplain, whose role is quite varied, constantly developing, but also recognised as valuable by other healthcare providers. 16,55 Ultimately, the goal should be to develop a mutual understanding of roles to improve person-centred care in a meaningful way by illuminating the richness each health service provider can bring. A variety of healthcare professionals may come together to influence care based on the person’s individual needs 1 and it is important that healthcare professionals work together to understand key roles within the team. This study has illuminated some aspects of the healthcare chaplain’s role, that the care of the person, family and co-worker is front and centre.
Relevance to clinical practice
Healthcare chaplaincy is considered a ‘support service’ 56 (p. 34) and a component of Mertens et al.’s 1 (p. 3681) description of a ‘fluid’ team of ‘collaborating professionals’ which, given the increasingly complexity of illness, is likely to be a more widespread approach for the future. In this fluidic environment, enabling professionals to work together in the pursuit of high-quality care can prove challenging. 1 The insights emerging from this research promote awareness of the role of healthcare chaplain in collaborating to achieve person-centred care; this is particularly relevant in situations that are traumatic or emotionally challenging. The support here can be multi-purpose and for the individual and family but may also be for the nurse or midwife, with a view to ameliorating the effects of emotional turmoil common in the workplace.
Conclusion
Chaplains have a key role in provision of healthcare services, because of their specialist clinical knowledge and religious and spiritual understanding. Therefore, gaining an understanding of their distinct role within the interdisciplinary/professional team–based approach to care from an ethical perspective is important. This is particularly as healthcare professionals encounter ever-changing healthcare environments and increased diversity of spiritual and religious needs. Identifying key aspects of healthcare chaplains’ roles could serve to contribute more effectively to inform strategies for effective team working to enhance health service delivery. The findings of this research have identified an initial pathway for greater understanding of the contribution of healthcare chaplain, particularly in relation to managing spiritual and religious diversity in the drive for person-centred healthcare.
Footnotes
Acknowledgements
We would like to extend grateful thanks to the chaplains who took part in this research and shared their experiences with us.
Authors’ note
Sılvia Caldeira is now affiliated with Universidade Catolica Portuguesa, Portugal. Margaret Theresa Naughton is now affiliated with Bon Secours Hospital, Ireland.
Author contributions
Vivienne Brady contributed to study development, data collection, data analysis and data verification, and manuscript writing/editing; Fiona Timmins to study development and manuscript writing/editing; Sílvia Caldeira to study development and manuscript writing/editing; Margaret Theresa Naughton to study development and manuscript writing/editing; Anne McCarthy to data analysis and verification, and manuscript writing/editing; and Barbara Pesut to study development and manuscript writing/editing. All authors agreed the manuscript for submission.
Conflict of interest
The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Margaret Theresa Naughton BA, MA, MPhil and BA (Th) is a healthcare Chaplain in Ireland but was not involved in recruitment, data collection or analysis.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The authors would like to thank the Adelaide Health Foundation, Tallaght Hospital, Dublin, for the financial support of the Healthcare Advancement Fund.
Ethical approval
Ethical approval was granted by the Research and Ethics Commitee of the School of Nursing and Midwifery Trinity College Dublin, 24 D’Olier Street Dublin 2 D02 T283.
Ethics committee reference number
Ref No: COM_01_16/17