By Austine Duru and Marilyn Williams
An urgent trip to the emergency room is often a stressful experience. Besides the obvious stressors — fear of the unknown, pain and frustration, long wait times, and complicated medical procedures — such trips often unleash underlying emotional and spiritual distress. In what might seem like a chaotic environment, the professional chaplain is often a calming presence for patients, families, and the healthcare team. In this article, we explore some of the literature that speaks to the unique roles of professional healthcare chaplains, spirituality, and pastoral care in emergency medicine and trauma care.
In their article “Utilization of Pastoral Care Services for a Screening, Brief Intervention, and Referral-to-Treatment Program at an Urban Level I Trauma Center,” published in the Journal of Emergency Nursing, Tiffany L. Overton and her colleagues write about collaborating with chaplains to help alcohol-dependent patients at JPS Health Networks, Fort Worth, TX. Screening, brief intervention, and referral to treatment (SBIRT) programs have been shown to reduce alcohol-related injuries and have been mandated for use at all designated trauma centers since 2008. This was a unique opportunity to partner with chaplains in a research trial program that used the “CAGE (cut back, annoyed, guilt, and eye-opener) questionnaire and the Alcohol Use Disorders Identification Test (AUDIT)” [page 560]. The authors found two benefits: “First, our chaplains are able to take advantage of a teachable moment by helping patients make connections between drinking and their injuries, if such connections exist. Second, pastoral care providers have the ability to talk about the emotional dynamic behind the drinking (stress, guilt, and so on). Patients inherently trust chaplains, and chaplains are trained to listen and guide our patients” [page 562]. This pilot has several implications for chaplaincy, such as chaplains collaborating as research investigators, primary and advanced chaplaincy skills, reimbursement of chaplaincy services, and chaplaincy training and staffing.
In a recent pilot study, KentuckyOne Jewish Hospital launched an innovative chaplain intervention program that integrated skilled chaplains into the ED. Rabbi Nadia Siritsky, BCC, a social researcher by background and the vice president of Mission for KentuckyOne Jewish Hospital, shared this pilot project at the NACC National Conference in April, 2017, during a workshop titled “Metrics for Spiritual Care: A KentuckyOne Health Intervention.” Current findings suggest that this program has shown significant ways pastoral care can reduce compassion fatigue and burnout while improving patient experience in the emergency department. This study is yet to be published but has implications for spiritual care in emergency medicine, chaplain education, and interdisciplinary collaborations.
In “Rural Emergency Nurses’ Suggestions for Improving End-of-Life Care,” Renea L. Beckstrand, Kelly E. Smith, Karlen E. Luthy, and Janelle E. Macintosh seek to “identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments” [page 214]. A 57-item questionnaire was sent to 53 rural hospitals in four western states, including Alaska. The results yielded four major themes: “providing greater privacy during EOL care for patients and family members, increasing availability of support services, additional staffing, and improved staff and community education” [pages 216-217]. The chaplain or clergy was identified as an important support service and a key partner in the care of the dying patient and their families. This study also raises questions about the well-being of the rural emergency caregivers, quality EOL care, and using volunteer services to meet some of these needs in rural settings.
Another study published in 2015 in the Journal of Emergency Nursing looks at the perceptions of emergency nurses in providing EOL care in the emergency department. This study by Lisa A. Wolf and her associates uses survey data (N=1879) and focus group data (N=17). The quantitative survey shows consistently positive attitudes toward caring for dying patients and their loved ones. An analysis of the transcripts from the focus group, however, reflects concerns and challenges to providing EOL care in the ED. Although overall, emergency nurses were comfortable in providing EOL care, the lack of space, time, and staff made it challenging. This study did not address the availability or role of chaplains in providing EOL care.
Another study looks at the presence of families during resuscitation and/or invasive procedures. This study, by Christine R. Duran, surveyed nurses, respiratory therapists, and physicians. Overall, clinicians had positive attitudes toward family presence. However, they did have concerns about safety, the emotional responses of families, and performance anxiety. Nurses had more favorable attitudes than physicians. Also, patients and families had positive attitudes. This study did not address whether a chaplain was present to provide care to the family during resuscitation or the invasive procedure. In addition, it would be of value to survey chaplains regarding their attitudes about family presence as well as the attitudes of patients and families regarding chaplain availability.
In a pioneering survey of emergency department staff published in 1998, Ann Gill Taylor, and her colleagues set out to investigate the ED staff members’ personal use of complementary therapies and their recommendations to ED patients. The investigators from the Center for the Study of Complementary and Alternative Therapies at the University of Virginia School of Nursing surveyed 10 emergency department staffs across the southeast. The results suggest that the three most frequently used complementary therapies for personal well-being were back rub or massage, music, and prayer or spiritual practices. Also, “back rub or massage and spiritual practices including prayer and group support were most frequently recommended to patients” [pages 496-497]. Since its publication, this study has become a foundational resource for subsequent studies focusing on alternative and complimentary therapies and the growing popularity of such services across the nation. The implications of this survey for chaplaincy and spiritual care services are obvious, especially in emergency medicine and trauma care.
In trauma situations, often the perception of care can affect the post-trauma experience of the patient or family members. Steven C. McCormick and Alice A. Hildebrand set out to investigate this in a study conducted at Maine Medical Center in Portland, ME, titled “A Qualitative Study of Patient and Family Perceptions of Chaplain Presence During Post-Trauma Care,” published in Volume 21 of the Journal of Health Care Chaplaincy. The analysis of 25 interviews draws out three key themes: “the attributes valued in the chaplain’s presence, the elements necessary to form relationship with the chaplain, and the role of the chaplain in helping patients to discover and express meaning in their experiences” [page 65]. The authors conclude, “An understanding of the proposed assessment model can guide chaplain interventions and benefit all members of the clinical care team” [page 60]. The findings and assessment models are both relevant and can serve chaplains working in emergency medicine and other healthcare settings. The study also has broader implications for pastoral visitation and evidence-based chaplaincy care. A link to the full article can be found here.
Austine Duru, BCC, is regional director of mission, ethics, and pastoral care at SSM Health in Madison, WI. Marilyn Williams, BCC, is director of spiritual care at St. Mary’s Health Care System in Athens, GA.