Exploring the Perceptions Surrounding Hospital Chaplains in Patient Care and Healing

Abstract

The authors distributed a questionnaire to various hospital staff to explore perceptions surrounding the role of chaplains in patient care and healing through assessing opinions, beliefs, and knowledge. Results revealed a poor understanding of the role of the hospital chaplain in the UK. The authors therefore advocate education programs to increase awareness of the varied role of the hospital chaplain in fulfilling patient spiritual needs to increase referral practices, leading to improved patient outcomes.

Keywords

Chaplain questionnaire healthcare team spirituality

Introduction

Since the 1920s, many chaplains have been clinically trained and are appointed by the National Health Service (NHS) trusts as spiritual care providers to patients, families, and staff. The number of chaplains in each hospital varies depending on hospital and area demographics. With recent studies indicating a substantial growth in chaplaincy-focused programs, this number is expected to rise (Cadge et al., 2020). District and tertiary hospitals also have chaplains representing several health beliefs reflecting patients' needs.

In recent years, a vast expansion has been seen in the understanding of the role of spirituality in relation to health which has become the focus of intense health service involvement (Timmins & Pujol, 2018). Health care professionals are beginning to understand the importance of spiritual needs in the patients’ coping with illness. During a serious illness, the loss of physical and cognitive abilities may also seriously impact the sense of meaning, purpose, and personal worth (Timmins & Pujol, 2018). Hospital chaplains address these crises through spiritual healing by providing supportive spiritual care and by demonstrating an understanding of persons in distress. In recent years, chaplains have also served on hospital ethic committees and helped with issues directly related to patient management (Głusiec, 2022).

While hospital chaplaincy presents an opportunity to be a prophetic voice within a secular institution, chaplains are not seen as a conventional member of the healthcare team (Snowden et al., 2020). The authors therefore aimed to explore the understanding of hospital staff on the important and demanding role of hospital chaplains and their impact on patient well-being.

Methods

With an aim to explore the myths surrounding the role of hospital chaplains in patient care and healing, the authors distributed an anonymous questionnaire (Supplemental File 1) to our hospital staff in a district/tertiary hospital. Recipients of the questionnaire included members of management staff, medical students, nursing staff, junior doctors, and consultants. The survey was distributed via paper form to the departments of various health professionals. The survey was distributed once and the responses were only from those who wished to take part in the survey, giving a 100% response rate. The questionnaire aimed to assess the opinions, beliefs, and knowledge of hospital staff and students regarding the role of hospital chaplains as the authors felt that the services provided by chaplains were undervalued. This survey was approved by the ethics department in the district/tertiary hospital and did not require IRB approval. The raw data was analyzed manually by the authors and results were given in percentages (Quantitative research model) that represent the proportion of staff that answered each question.

Results

Demographical Data

A total of 153 medical staff completed the questionnaire: 50 nurses, 45 junior doctors, 25 management staff, 25 medical students, and 8 consultants. The majority of the medical staff were Christian (57%), followed by No religion (17%), and 11% were Hindu or Muslim. The healthcare group with the largest proportion of Christians were the management staff and nurses (84% and 72%, respectively). Among the groups who claimed No religion, consultants were the majority (38%). Finally, in the group that claimed to be Hindu or Muslim, doctors were found to be the most attributed to these religions (24% and 20%, respectively).

Perceptions on the Role of Chaplains

Thirty four percent of staff claimed they had an average knowledge of the role of chaplains in the hospital with 38% claiming less than average knowledge and 27% with more than average knowledge. Only 3% claimed to have excellent knowledge, whereas 14% claimed that they had no knowledge. A large proportion of medical students and doctors claimed to have below average knowledge (68% and 48%, respectively) and a large proportion of nursing staff, management staff, and consultants claimed to have average knowledge (38%, 44%, 38%, respectively). Nurses claimed the highest proportion of above average knowledge (58%).

Higher proportions of staff who agreed with questions regarding the chaplains’ ability to act as a team player in patient management (63%), provision of consultation to patients (59%), provision of advocacy services (58%), and the importance of chaplains as a team member/need for role to be enhanced (75%) were found across all groups. Higher proportions of staff across all groups however disagreed with questions addressing the high value of pastoral services to patients (65%).

A large majority was also found in questions addressing chaplains’ provision of prayer services, emotional support, and religious services and rituals to patients (90%, 89%, 83%, respectively). However, between the groups, lowest proportions who agreed were found in the doctor group in questions concerning bereavement and prayer services. Lowest proportions were also found in the management staff group on the question addressing emotional support and lowest proportions were identified in the medical student group in the questions addressing provision of religious service. Similarly, with regard to the question concerning whether chaplains meet the average patients’ family/relative's or patient's need for support, most groups answered “yes,” however only the medical student group answered a majority of “no” in both questions.

With regard to the question addressing chaplains’ expectation to visit patients, 59% selected that chaplains are “requested to be seen by the patient (b),” whereas 29% selected “visit patients on their own (a).” The proportion of staff who selected the available answers varied. A higher proportion selected “a” in the consultant group and nursing group, higher proportion selected “b” in the management group and medical student group. A large proportion of doctors selected “a + b.”

Equal responses overall between agreement and disagreement were found in the question that asked whether chaplains provide community outreach to patients (43%). Higher proportions agreed in the medical student and management staff group, whereas the nursing staff, doctor, and consultant group disagreed.

Perceptions on the Training of Chaplains

A large majority of staff selected that chaplains do receive formal religious training (80%). Most groups agreed with this perception with the highest proportion of 87.5% found in the consultant group followed by 84% from the medical student group. Majority of staff also selected that chaplains receive formal training in college (59%) with higher proportions found in the medical student, nursing, management, and consultant group. Only in the doctor group, there was a higher proportion that selected “no.” Eighty-two percent of staff thought chaplains receive formal training to deal with death and bereavement.

General Knowledge/Perceptions of Chaplaincy Service

Answers to the salary of chaplains were primarily divided between “paid” and “voluntary” (52% and 41%, respectively) across all groups. A higher proportion of staff thought chaplains were “paid” in the nursing, management, and consultant groups. However, a higher proportion of staff thought chaplains were “voluntary” in the medical student and doctor group.

Seventy percent of staff thought that chaplains of diverse religious beliefs were available in most hospitals, whereas higher proportions of doctors believed that was not the case compared to the other groups.

Questions addressing whether patients’ faith/religious preference is documented in medical records and whether they should be recorded was not answered by the doctor group in both questions and the consultant group in the latter question. Nevertheless, the majority agreed that it is recorded and that it should be recorded (70% and 81%, respectively). However, higher proportions that said that it is recorded were in the nursing staff and management group, whereas higher proportions that disagreed with the recording of patients’ faith/relief was found in the medical student group and in all of the consultant group. A large proportion of the nursing staff and all of the management staff group agreed that religious preferences should be recorded in the medical documents, but medical students were equally divided between whether documentation should occur or not.

In the question regarding the relationship between spirituality and the immune response, most responded that there was a relationship (49%), however two groups had a higher proportion of staff that disagreed (doctor and consultant group). It must be noted that 69% reported that their own belief did not affect the answers of the questionnaire. The results are represented in Table 1.

Table 1.

Questionnaire results from all healthcare professionals.

Q1 religion	Medical students (%)	Nursing staff (%)	Management staff (%)	Doctors (%)	Consultants (%)	Total (%) 3sf
Christian	48	72	84	30	50	56.9
Hindus	16	2	0	24	12.5	11.1
Muslim	16	6	4	20	0	11.1
Jewish	0	0	0	0	0	0
Sikh	0	0	0	4	0	1.31
Spiritualist	0	2	0	0	0	0.654
Agonists	0	2	8	0	0	1.96
None	20	16	4	22	37.5	17.0
Q2 knowledge
Excellent	0	6	0	4	0	3.27
Good	8	38	8	6	12.5	17.0
Above average	4	20	12	2	12.5	7.19
Average	20	38	44	20	37.5	34.0
Below average	20	6	0	0	25	15.0
Poor	32	2	0	12	0	9.15
No knowledge	16	0	4	36	12.5	14.4
Q3 chaplain role
Highly paid	0	2	0	0	0	0.654
Paid	40	54	80	40	62.5	52.3
Voluntary	60	34	4	56	37.5	40.5
Unaware	0	20	16	4	0	6.54
Q4 visit
a*	16	44	20	0	62.5	28.8
b**	84	42	48	40	25	59.5
a + b	0	10	24	56	0	7.84
Don’t know	0	4	14	4	12.5	3.27
Q5 church training
Yes	84	82	72	78	87.5	80.4
No	16	12	16	20	0	15.0
Don’t know	0	0	12	2	12.5	4.58
Q6 college training
Yes	52	72	72	40	75	59.5
No	48	20	4	54	0	30.7
Don’t know	0	8	24	6	25	9.80
Q7 bereavement training
Yes	84	90	92	64	87.5	81.7
No	16	8	8	30	12.5	15.7
Don’t know	0	2	0	6	0	2.61
Q8 diverse belief
Yes	56	82	92	46	100	69.9
No	44	16	8	52	0	28.8
Don’t know	0	2	0	2	0	1.31
Q9 support
Yes	48	66	60	58	75	60.1
No	52	30	8	38	12.5	31.4
Don’t know	0	4	32	4	12.5	8.50
Q10 family support
Yes	32	58	68	58	50	54.9
No	68	40	8	40	37.5	39.2
Don’t know	0	2	24	2	12.5	5.88
Q11 high value
Yes	24	36	28	14	50	26.8
No	72	54	52	82	50	64.7
Don’t know	4	10	20	4	0	8.50
Q12 team player
Yes	56	68	80	50	75	63.4
No	44	30	16	48	25	35.3
Don’t know	0	2	4	2	0	1.31
Q13 prayer service
Yes	92	92	92	82	100	89.5
No	8	4	0	12	0	5.88
Don’t know	0	4	8	6	0	4.58
Q14 emotional support
Yes	100	88	80	86	100	88.9
No	0	10	8	12	0	7.84
Don’t know	0	2	12	2	0	3.27
Q15 consultation service
Yes	52	62	40	66	87.5	59.5
No	48	32	32	32	0	32.7
Don’t know	0	6	28	2	12.5	7.84
Q16 advocacy service
Yes	56	66	60	46	75	58.2
No	44	28	4	46	12.5	31.4
Don’t know	0	6	36	8	12.5	10.6
Q17 community outreach
Yes	60	42	48	36	25	43.1
No	36	44	16	60	62.5	43.8
Don’t know	4	14	36	4	12.5	13.1
Q18 religious service
Yes	72	90	88	76	100	83.0
No	24	8	0	22	0	13.1
Don’t know	4	2	12	2	0	3.92
Q19 own belief
Yes	28	42	32	40	12.5	30.7
No	72	56	68	56	87.5	68.6
Don’t know	0	2	0	4	0	0.654
Q20 immune response
Yes	50	58	48	40	37.5	49.0
No	2	40	20	58	50	43.1
Don’t know	48	2	32	2	12.5	7.84
Q21 role enhancement
Yes	60	92	80	58	87.5	74.5
No	40	8	8	42	12.5	23.5
Don’t know	0	0	12	0	0	1.96
Q22 preference
Yes	36	92	84		0	70.4
No	60	8	8		100	26.9
Don’t know	4	0	8		0	2.78
Q23 document
Yes	36	94	100			81.0
No	36	6	0			12.0
Don’t know	28	0	0			7.00

sf = significant figures.

*Chaplains expected to visit patients on their own.

**Chaplains have to be requested to be seen by patients.

Discussion

This study has attempted to capture what the hospital staff at one hospital in the UK understand about the role of chaplains. From the results of the survey that was distributed to the staff, this revealed that the staff have little knowledge or understanding of the role of the chaplain and the importance of these roles in patient care and healing. With the immense global impact of the pandemic that created widespread anxiety and fear for many people (Best et al., 2021), this should have been the exact situation where a chaplain may feel at ease, in providing comfort in times of great spiritual need (Best et al., 2020). However, from the research, it has been discovered that the use of the chaplaincy service was diminishing, from chaplains being made redundant to receiving institutional support for increased visibility (Best et al., 2020). This occurrence suggests a range in the understanding of the role of the chaplain and with findings that chaplain respondents also had difficulty understanding their own role prior to the first wave of the pandemic (Best et al., 2021), it is of no surprise that other healthcare professionals are also unclear of the roles. It is on this basis that this study was conducted, to reflect the current understanding of the hospital staff on the roles and impacts of the chaplaincy service in the UK.

This study aimed to ascertain the perceptions of chaplains into three parts: the role of the chaplain, the training of the chaplain, and general perceptions/knowledge of the chaplaincy service. It was apparent from the data that the healthcare responses towards the roles and impact of chaplains did not necessarily depend on their religious beliefs. There was a large variation of religious beliefs across the hospital staff but no one religious belief could be attributed to having a greater understanding and knowledge of the chaplaincy service. This is further compounded by a larger majority of responses claiming that their religious beliefs did not affect their choice in the survey.

Questions on the perception of the role of chaplains formed the majority of the survey and the responses were largely heterogeneous. This is supported by a large majority of data from the responses of hospital staff who claimed that they had average to no knowledge of chaplains. The only convincing responses on the role of chaplains were regarding questions on the specific services provided by chaplains (prayer service, emotional support, religious service) suggesting that healthcare professionals are aware of who to turn to when these services are required. This perhaps suggests the importance of developing a professional identity that includes collaboration with other healthcare professionals, including the need to define the specific knowledge and skills of healthcare chaplains (Jacobs et al., 2021; Kruizinga et al., 2016). Redefining the professional identity for healthcare chaplains is thought to be rooted to how important chaplains place value on their worldview and having “spiritual competence” (MacLaren, 2020; Napel-Roos et al., 2021). Despite the present pandemic situation, along with the processes of deinstitutionalization, secularization, and pluralization providing challenges to the chaplains’ professional identity, studies have shown that chaplaincy has the ability to evolve and reinvent itself over time (Nolan and MacLaren, 2021). It therefore seems of extreme importance that the evolution of chaplaincy in response to current environments should be a topic of constant, honest debate.

Generally, the hospital staff had no doubts on the training of chaplains. A large majority of responses were in unison towards the perception that chaplains received church, college, and bereavement training. Medical students and doctors showed the highest variance in response in each of the questions that addressed the training of chaplains. In the case of medical students, this is perhaps because they spend less time in the hospital environment and therefore will have less opportunity meeting, observing, and discussing with a chaplain (Gomez et al., 2020). The same cannot be said for doctors. However, a study revealed that doctors encounter chaplains the least in a tertiary medical center and most of these encounters were due to the deaths of patients admitted to the intensive care unit (Choi et al., 2015). Greater exposure to death was found to be strongly associated with greater work-related stress with one study illustrating that 61% of physicians interviewed reported that their most memorable patient death remains emotionally distressing (Linklater, 2010; Whippen & Canellos, 1991). This may deter doctors from having to deal with death and therefore, like medical students, have less opportunity to learn directly about the roles of the chaplain in these situations.

General knowledge on chaplains was poor due to the wide variance in the responses, particularly concerning the question addressing the compensation of chaplains. The two groups of hospital staff that shared the same response to this question were the medical student and doctor group. Highest variance in answers was also found in these two groups in other general knowledge questions also. This can also be explained by the fewer interactions these two groups have with a chaplain.

Finally, the overall heterogeneity of responses across all questions may perhaps be explained by a strong dichotomy of response concerning whether there is a relationship between spirituality and the patient immune response. Although a slightly larger proportion selected that there is a link, for those who selected that there was no relationship, calling upon chaplains to become part of the multi-disciplinary team in the care of the patient may be a rarer occurrence. However, the role of chaplains as important multidisciplinary team members in the management, especially in the dying adolescent, has been evaluated and exalted (Taylor & Li, 2020; Taylor et al., 2015). In symbiosis with the physician, nurse, psychologist, social worker, and child life specialist, the chaplain was an important member of the multidisciplinary team and was crucial in helping the young person continue to develop personal autonomy, and to experience dignity and personal fulfilment in their limited remaining lives (Cunningham et al., 2017). Despite this evidence, it seems that this relationship is not widely acknowledged, thus ultimately affecting the care of patients. With such variability in the responses however, it is encouraging to see that most healthcare professionals still view chaplains as important team members in hospitals and acknowledge the need for the enhancement of their roles.

Limitations

Limitations include a small number of participants in the survey. Larger numbers would give a more accurate picture of results. There were also discrepancies in the size of each group with a larger number of staff in the nurse group compared to the consultant group. This may have affected data analysis as it gives a relatively skewed view of the proportion of staff within each group that answered the questions. Although 69% of all hospital staff did not think that their own beliefs affected selection of answers, this still means that a considerable number of the answers were biased. The confirmation bias was not accounted for in this study and presents as a limitation. Furthermore, it must be noted that the responses in this survey do not fully represent all healthcare chaplains in the UK but as it was conducted in a tertiary hospital, it was hoped that the survey would provide a more accurate picture than at a primary or secondary setting. Finally, there are restrictions in the method of data collection in this study. As the data was distributed and collected in paper form, it was difficult for the researchers to ask follow-up questions, in particular, to ask close-ended questions. This posed limits in ascertaining the reasoning behind selection of answers and thus a less accurate picture of the perceptions of hospital staff towards chaplains. Further qualitative research should use a more in-depth method of inquiry.

Conclusion/Future Research

Religion and spirituality in the context of health care may be an enigma for science but recent studies have demonstrated a biochemical link as well as the high value that patients place on pastoral services. Despite the high value, a large proportion of our cohort (153 medical staff) claimed to have below average to average knowledge of the roles of the chaplain with a significantly higher proportion of medical students and doctors in the below average category. The specific questions regarding the role of chaplain, their training and general knowledge were divided in opinion across the hospital staff. However, the majority agreed that chaplains meet needs for support and counselling for patients, family relatives as well as acting as an important team member. A significant proportion of hospital staff thought chaplains were important members and that their roles should be enhanced which was supported by the fact that most reported that their own beliefs did not affect their answers.

Future research should also continue to examine whether and how religious and spiritual practices are used as complementary rather than as alternative medicine. Healthcare professionals should also explore the beliefs of their patients to provide more holistic care which has been shown to have higher patient satisfaction rates. The authors therefore advocate for the need of educational programs to increase awareness of the various roles of the hospital chaplain. An increased awareness of the varied role of the hospital chaplain as an important member of the healthcare team can result in greater appreciation by other hospital staff and also improve referral practices to the hospital chaplaincy service. The latter would fulfil the gap between the prevalence of patient spiritual needs and the extent to which these are being made, leading to an improved patient outcome (Purvis et al., 2018). The authors also advocate for the continued work on assessing outcomes of the chaplaincy service (e.g., Chaplaincy and its impact on physical health) as well as solidifying the professional identity of chaplaincy, as this shall be important in further clarifying the role of the chaplain.

Supplemental Material

sj-docx-1-pcc-10.1177_15423050221100158 - Supplemental material for Exploring the Perceptions Surrounding Hospital Chaplains in Patient Care and Healing

Supplemental material, sj-docx-1-pcc-10.1177_15423050221100158 for Exploring the Perceptions Surrounding Hospital Chaplains in Patient Care and Healing by Yangmyung Ma, Armaan Riaz, Aitzaz Munir Shaikh, Dujanah Siddique Bhatti, Mohammed Farid and Muhammad Adil Abbas Khan in Journal of Pastoral Care & Counseling

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Yangmyung Ma

Supplemental material

Supplemental material for this article is available online.

Yangmyung Ma is a Foundation Year Doctor who has graduated with an MBBS degree. He is now working at the Royal Stoke University Hospital, part of the University Hospitals North Midlands NHS Trust in the city of Stoke-on-Trent, UK.

Armaan Riaz is a medical student who works at Hull Royal Infirmary, a hospital that is a part of the Hull University Teaching Hospitals NHS Trust, UK.

Aitzaz Munir Shaikh is a medical student at The Aga Khan University Medical College in Karachi, Pakistan.

Dujanah Siddique Bhatti is a Core Trainee in Plastic Surgery who has graduated with an MBBS degree and has passed his MRCS examinations. He currently works at Aberdeen Royal Infirmary which is part of NHS Grampian in Scotland.

Mohammed Farid is a Plastic Surgery Registrar who graduated with an MBBS degree and has since obtained higher qualifications (MRCS, MSc, PGCE). He currently works at Royal Stoke University Hospital, part of the University Hospitals North Midlands NHS Trust in the city of Stoke-on-Trent, UK.

Muhammad Adil Abbas Khan is a Hand fellow in Plastic surgery who has graduated with an MBBS degree and has since obtained higher qualifications (MRCS, MA MedEduc, FRCS (Plast)). He currently works at Pinderfields Hospital, part of the Mid Yorkshire Hospitals NHS Trust in Wakefield, UK.

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