As a growing body of research connects spiritual and religious beliefs with a person’s physical and mental health, the role of Pastoral Care in the health-care environment – and its impact – is growing. According to an article in the Journal of Pastoral Care and Counseling, “greater satisfaction with chaplain care was associated with greater satisfaction with the overall hospital stay… Many of the patients reported that chaplains helped them to cope, feel more hopeful and find the strength to go on.”
Throughout Penn Medicine, members of Pastoral Care – hospital chaplains (who have both theological training and specialized training in the health-care environment), community clergy, and specially trained volunteers – reach out every day. Whether by helping trauma families cope, providing space and time for staff to grieve a loss, or just being a good listener, they are making a difference.
A Focus on Families
Chaplain Ray Lewis, Jr. coordinates patient care and family management in the Trauma bay with nurse Rhonda Browning, using “Yellow Cards” to organize key information.
Every time a patient is brought to Penn Medicine’s Level 1 Trauma Center at Penn Presbyterian Medical Center – more than 2,600 a year – a staff chaplain is notified and quickly responds, with a focus on helping the victims’ families. This calming presence is essential in the Trauma Center’s high-paced and stressful environment. As a core member of the trauma team, the chaplain coordinates with the trauma nurse and security officer to figure out how to best care for the family.
“We’re working toward the goal of uniting families with their loved ones,” said Ray Lewis, Jr., trauma chaplain. “We’re the connecting piece – the moving piece – of the puzzle.”
Understandably, the families they meet are usually extremely stressed, especially those whose loved ones were victims of gun violence. “They struggle with making meaning amid trauma,” said John Ehman, director of Pastoral Care at PPMC. “We work with them not just pastorally but help them manage their anger, frustration, and fear. People sometimes want to assign blame and the chaplain is often the target.”
Although the trauma bay can be a bevy of activity, chaplains are the ones who keep the big picture in mind – the practicalities, Ehman said. For example, while a patient who has fallen at home may have just a spouse in the waiting room, with a multiple gunshot victim, “you’ve got 40 people who want to know what’s going on,” he said. “We need to figure out who should be given information, who might represent a further threat to the patient – it’s much more complex.”
While trauma chaplains focus on helping family members, supporting – and building relationships with – members of the trauma care team is also a priority. The constant influx of injured patients, especially from shootings, can leave clinicians psychologically and physically drained. Staff reach out to chaplains – maybe only for a brief, quiet conversation during a break in activity – but “active listening works even in short exchanges,” Lewis noted in an article for the National Association of Catholic Chaplains. “If staff members know they can be heard deeply without having to say much, they will probably feel less apprehensive in sharing vulnerabilities.”
PPMC also holds an annual service of remembrance for the families of patients who died from violence. Staff read initials of the deceased while lighting candles. “This is often a profound – and for many a spiritual – event that some have linked to their sense of calling,” Lewis added.
A Needed Pause at LGH
Whether in the ED or on patient care units, losing a patient is never easy, especially during a code blue when members of the resuscitation team at Lancaster General Hospital work tirelessly to bring a patient back from cardiac arrest. Feelings of distress and sadness among staff arise but must be put aside as they return to caring for other patients. To help address these emotional needs and make the transition to “normal” patient care easier, Pastoral Care at LGH created the post-code pause, a brief period of silence to help staff regroup.
At LGH, chaplains are notified of all code blues in the hospital. “Two chaplains respond – one to take care of family members if they’re present, and one for the post-code pause,” said Elizabeth Schultz, MA, BCC, staff chaplain in Critical Care at LGH.
A chaplain starts the pause around the bedside after a code is “called” (that is, the patient is pronounced dead) with a brief reading, honoring the patient (“someone’s loved one, someone’s friend”) and recognizing the team’s efforts “to provide the best care possible.” Then follows a 10 to 15-second period of silence. The chaplain quietly ends the silence, while “assessing and addressing any immediate needs of the staff,” Schultz said.
Although the post-code pause is normally done with only staff, family members present at the code are also invited to be part of this recognition. At one post-code pause, “after the chaplain ended the silence with ‘Thank you, everyone,’ the family also thanked the medical team,” Schultz said. “It was pretty powerful.”
Participating in the post-code pause is voluntary, but based on feedback she’s received since the initiative launched last February, “it’s very meaningful to the staff. The response has been all positive.” It is expected to be a part of the code blue protocol throughout the hospital.
HUP’s annual Service of Remembrance helps provide closure for employees who have lost coworkers over the past year.
Coping with Disenfranchised Grief
Helping staff deal with grief at the workplace is also part of Pastoral Care at HUP – especially what Denise Statham, MTS, administrative chaplain, called “disenfranchised grief.” A coworker dies, but “you see your coworker’s personal items still at the desk the next morning… We’re not a family member or a close childhood friend, but we grieve nonetheless.”
While chaplains often meet with that staff and lead a prayer, they also hold an annual Service of Remembrance that helps provide closure for employees who have lost coworkers over the past year. As a photo of each person who died flashes on a screen, a coworker speaks about his or her colleague, sharing memories.
Statham said that one year, a nurse stood up and said “‘Jane [not her real name] struggled and took her own life. We are here to support each other so that doesn’t happen again.’”
Pastoral Care also holds monthly grief rounds in the MICU to help new young doctors deal with their first death.
“They might be three years out of medical school and never saw a patient die,” said James Browning, director of Pastoral Care at HUP. “What do you do with those feelings? Doctors question whether they did enough to help the patient. We help them deal with their helplessness – it happens all the time.”
In acknowledging this grief, “you feel like you’ve done something no one else will do,” Browning continued. “We hold this space with integrity and dignity. It’s a privilege to be in the sacred space with people who are the most vulnerable and suffering.”
Beyond Staff Chaplains
Longtime Pastoral Care volunteer Clark Dingman spends time with Linda M. Cutler at PAH.
Many hospitals – whether they have staff chaplains or not – rely on local clergy and volunteers in the community to augment the reach of Pastoral Care. At Chester County Hospital, community clergy visit patients on a regular basis, across a spectrum of different faiths, and participate in the hospital’s Pastoral Care Committee.
According to Richard Donze, DO, MPH, senior vice president for Medical Affairs, “we are also working with the hospital’s Patient and Family Advisory Council to establish a more formal and structured pastoral presence utilizing community volunteer chaplains.”
At Pennsylvania Hospital, local parish communities representing a variety of faith traditions, and both extern chaplaincy students and graduates of HUP’s accredited Clinical Pastoral Education program are integral parts of its Pastoral Care team.
“I rely heavily on these volunteers who provide the appropriate care and their helpful and compassionate presence in our times of need and for those who request spiritual support,” said staff chaplain Madeline Dawson, adding that “volunteers receive ongoing training to enhance their skills and to acquire the information that is relevant to the patients, their families, our staff and our community.
Last year, the hospital’s 30 pastoral care volunteers – some of whom have been there for more than 10 years – contributed nearly 3,200 hours of pastoral outreach at PAH. “We are very fortunate to have an amazing team of dedicated and committed people who have faithfully served our communities over the years, both during the week and on weekends,” she said.