Executive Summary: What Do Chaplains Do?

Dr H. Mowat and Professor J. Swinton

Report Number: CSHD/MR001

February 2005
ISBN 0-9549901-0-2

Aims of the Study

• To build on the existing knowledge around the areas of chaplaincy, spirituality, religion and their relation to the process of healthcare within the Scottish National Health Service

• To describe the current role and function of the hospital chaplain

• To explore the various perceptions of the work of the chaplain held within the health care context

• To identify what patients perceive as the most beneficial approaches to spiritual care and support

• To put these findings into the context of the national guidelines on spiritual care and subsequent policy documents produced by the Health Care Trusts

Research Question

What do chaplains do?

The Context of the study

• Chaplaincy within Scotland is well established and has a strong track record
• Hospital chaplaincy in Scotland is in transition
• Chaplains are challenged to prepare for significant changes as older models of chaplaincy give way to models that need to be developed and shaped to fit the changing spiritual climate within Scotland
• Spirituality has always been the primary focus within chaplaincy. Traditionally this has been perceived as religious care carried out by ordained ministers
• The relationship between spiritual need and health is an increasingly researched topic.[i] A body of knowledge is beginning to emerge that suggests an important link between well being and spiritual comfort and awareness
• This indicates the possibility of a strong and credible role for chaplaincy within the healthcare system
• There is an increasing distinction being drawn between religion or religious care and spirituality or spiritual care.[ii] This separation poses significant challenges to chaplains
• The diversity of the spiritual landscape within Scottish culture means that addressing spiritual needs has become a complex process that involves chaplains having to offer spiritual care to people of all faiths and none
• The National Health Service in Scotland is undergoing changes particularly with the devolvement of Scottish Parliament in 1999, which has meant that the Scottish Health Service has taken on a character of its own
• This character has placed great emphasis on the language of competition, financial accountability, commissioning, targets and competencies. At one level, chaplaincy and the values and perspectives it stands for are by definition counter-cultural. Proving the worth of spirituality within such a cluster of priorities is problematic
• The Executive have also noted the importance of developing and incorporating other underlying “forgotten” dimensions of the healthcare process, in particular, the importance of spirituality and spiritual care
• The Scottish Executive has issued guidelines to the Health Care Trusts requiring attention to be paid to the spiritual within the process of health care[iii]
• This report addresses this complicated and transitional social and spiritual context, seeking to reflect the complementarity and tensions encountered by hospital chaplains, in order to develop critical clarity as to how chaplains do and should function within such a multi-faceted spiritual context

The Study Design

Forty-four full time Health Care chaplains in Scotland were interviewed twice over a period of eighteen months. Three case studies supplemented this data by elaborating on themes emerging from the first interviews and prompting additional themes for the second interviews.

The Findings

The process model focuses on the core tasks of chaplaincy. The data suggest that the core task for chaplaincy involves an active process of finding people who need spiritual care, identifying the nature of the need and responding to the need through theological reflection and the sharing of spiritual practices. This core process is achieved in a variety of ways. These methods of meeting need throw up challenges around the idea of offering a needs led service.  There seem to be some necessary conditions that are required in order to maximise the efficiency of this core function. Paradoxically these conditions, essential to the core work of chaplaincy, can at the same time be quite threatening to that work.

The findings indicate that the relevance and validity of chaplaincy within the National Health Service in Scotland revolves around the key issues of: spiritual plurality, leadership, professionalisation, team-working, methodology and marketing . These issues and the ways in which chaplains work them out within their caring practices  potentially put the discipline of chaplaincy in a strong and credible position within the 21 st Century health care institution.

Implications for Spiritual Care

The findings have implications not only for the type of spiritual care performed by chaplains, but also for the spiritual care offered by other professional groups who are similarly caught in the tensions of establishing territory and claiming generalist skills. We explore this more fully in the final part of the report. Here it will be helpful to note the following:

• Chaplaincy can become a new kind of profession where the service is driven by individual need rather than established knowledge.

• Religious care alone does not meet the wider spiritual needs of the non-religious patient. Traditional denominational or religious models of chaplaincy will not fit into the spiritual plurality of contemporary Scotland .

• Spiritual care includes and may seek to meet religious need.

• Expressed spiritual needs are often couched in existential terms. Chaplains require skills which will enable the accurate interpretation of these existential expressions.

If chaplaincy is to hold its own in an evidence-based environment as a competing profession (competing in terms of resources within the NHS), it needs to have a robust method of enquiry.

Despite the diversity of understandings surrounding spirituality, the significance of personal faith is, for chaplains, the basis for chaplaincy.

One of the primary tasks of the chaplain within the multi-disciplinary team is as the marketer of a spiritual ethos which has the potential to transform and re-humanise a healthcare system which is often lacking in such aspects.

[i] Koenig H, McCullough M, Larson D (2001)  Handbook Of Religion And Health Oxford University Press.

[ii] Culliford L (2002)   Spiritual care and psychiatric treatment: an introduction Advanced  Psychiatric  Treatment Jul; 8: 249-258

[iii] Scottish Executive (2002) Health Department Letter 76, Spiritual Care in NHS Scotland.