By Kathleen Kaskel and Patricia Moyle Wright
Few things can affect a person’s total well-being more than dealing with pain. It’s hard to focus on any conversation with visitors, or even with a sensitive, compassionate chaplain. Pain can be visible in restless movement, squinted closing eyes, quiet moaning, wincing across the face, protective guarding of body parts, withdrawal to touch, or even pulling away sheets that annoy.
Within the human person lies an integrated totality. Particularly when dealing with long-suffering or life-limiting illness, our emotional, psychological, spiritual and social/communal well-being or dis-ease will contribute to perceptions of pain. We gain insight into our complicated human nature and how this can factor into pain management by considering how family estrangement, guilt from participation in war, isolation or abusive relationships, fear of mortality and death, religious struggle (e.g. “God won’t give me more that I can handle”) — all play a part in managing pain. Repetitive triggers of misery (like vomiting, itchiness, intolerance to variance of temperature, air hunger, inability to swallow) or intractable physical pain all destroy the peace of both patient and family.
What can a chaplain do to alleviate this type of suffering? If the person can answer, ask if they have pain and report your findings to the nurse. If the person cannot answer, notify the nurse that during your visit, the person displayed whatever signs of pain you observed, and then remain with the patient until the issue is addressed.
Waiting for relief from pain causes profound suffering for patients and those around them. Chaplains and other healthcare professionals can suffer deep moral distress when witnessing suffering in the clinical setting. And, since pain management interventions often fall within the purview of nurses and doctors, the chaplain may sometimes feel helpless.
Yet there are ways a chaplain can advocate for a patient who is suffering. One of the most pressing issues for patients in pain is feeling dismissed. On three separate occasions, I (Kathleen) experienced dismissal of my reports of severe pain. As I was questioned by skeptical providers, I felt utterly abandoned. In addition to that, watching the silent screams of my mother as she received wound care tore at my soul. As chaplain and daughter, I advocated for improved pain management with the hospice staff. Simply taking a patient’s pain seriously can make a difference.
Chaplains are experts at easing patients’ feelings of abandonment and journeying with each person through illness, suffering, despair, and grief. In addition to validating patients’ emotions, chaplains can support the interdisciplinary team’s pain assessment by inquiring further into any nonpharmacological pain interventions the patient uses and sharing this information with providers. The chaplain can also use reassuring touch, focused listening, prayer, life review, silent synchronous breathing, and music with patients to help alleviate suffering. All of these strategies help chaplains advocate for their patients, facilitating a significant contribution to the total well-being of vulnerable people — and also to families and healthcare staff.
Kathleen Kaskel, BCC, is a staff chaplain at Geisinger Health System in Pennsylvania. Patricia Moyle Wright, PhD, is chair of the Department of Nursing at the University of Scranton in Scranton, PA.
