Peng-Keller, S. (2024). Healthcare Chaplaincy as Specialised Spiritual Care

This issue of Health and Social Care Chaplaincy (HSCC) carries a broad range of topics. These topics include: the exploration of cognitive science in religion-informed spiritual care, the role of chaplaincy in an interprofessional neuropalliative outpatient team, a taxonomic approach for introducing spiritual care in healthcare settings, a peer-to-peer staff listening service for acute contexts, the indirect effects of prayer on stress and life satisfaction for participants in Alcoholics Anonymous and finally the moral reorientations of healthcare chaplains during the COVID-19 pandemic. There are also several book reviews discussing LGBTQIA inclusive hospice spiritual care, mental health and Christian spirituality, and finally, creating a sacred space for story, reflection and practice in healthcare chaplaincy. The subject matter experts of these diverse topics come from numerous countries, namely, England, Ireland, Germany, Estonia, Netherlands, Poland and the United States. The editorial concludes by noting information about the inaugural Australian and New Zealand Moral Injury Conference (ANZMIC 2026).

Four topic areas are covered in this issue of Health and Social Care Chaplaincy: (i) healthcare chaplaincy, spiritual care and disability, (ii) COVID-19, (iii) deuterocanonical considerations of the “Angel Raphael” and (iv) the artwork of Rembrandt.

Healthcare chaplaincy should focus on the needs of patients. This not only applies to clinical practice, but also to institutional alignments, structural and organizational prerequisites, and public health policies. It is therefore necessary to evaluate whether the delivery of spiritual care corresponds structurally to the needs of the patient population in question. Using a representative population survey (n = 1’011), this study examines the preferences of the population in the Swiss canton of Zurich regarding healthcare chaplaincy. The survey assessed attitudes toward different spiritual care models based on a hypothetical scenario. Nearly half of the population (49.3%) wished the inclusion of spiritual/religious aspects in their healthcare during hospitalization. The most frequently mentioned reasons were the improvement of healthcare. A majority (51.9%) would like to see a healthcare chaplaincy that is part of holistic healthcare and available to anyone, regardless of religious affiliation and personal worldviews.

Spiritual care has the potential to mitigate against "gaps" left when waiting lists (and times) for NHS gender identity clinics (GICs) spiral, and trans people awaiting medical interventions are at increased risk of suicide and self-harm. Healthcare chaplaincy has an explicit role to play, particularly for the sizeable number of trans people with religious faith or who struggle with finding support from faith communities. Spiritual care should be integrated within direct care provided by healthcare professionals, with additional care from specialist chaplains where desirable. Findings from the Modelling Transgender Spiritual Care project point to a need for additional training and resourcing in gender identity care for spiritual carers; a new prioritization of healthcare chaplaincy for gender identity services, which has implications for budgets and commissioning; and increased accountability for fulfilling the statutory requirement for spiritual care in the NHS.

With reference to the experience of the first cohort of students completing the Postgraduate Certificate in Healthcare Chaplaincy delivered by the University of Glasgow, the programme director of healthcare chaplaincy and spiritual care at NHS Education for Scotland, the sponsoring organisation, reflects on the significance of the course for healthcare chaplaincy in Scotland.

Healthcare chaplaincy is working towards recognition as a registered health profession. An accredited programme of professional education is part of that process. The University of Glasgow supported by NHS Education for Scotland have developed a programme of professional education for healthcare chaplains that is integrated into an MSc. (MedSci) in healthcare. This article outlines the commissioning, development and evaluation of a postgraduate certificate in healthcare chaplaincy by students, clinical mentors and experienced healthcare chaplains. It also highlights an innovative approach to practice development in spiritual and religious care in healthcare.

Resources in support of transgender-affirming spiritual care have grown in recent years as attention to transgender experience has gained more mainstream attention. This essay explores resources which provide foundations for transgender spiritual care, spiritual care across the transgender lifespan, health care chaplaincy with transgender patients, and considerations around transgender religiosity, spirituality, and resilience-building. Adjacent fields of study and gaps in the literature are noted, but the suggested resources provide a strong foundation and a representative sample of the patchwork state of the scholarly conversation around transgender-affirming spiritual care at this time. While this review is not exhaustive, it does provide a comprehensive introduction to an emergent field which is increasingly in demand from spiritual care providers in the field.

Health care chaplaincy needs to develop a body of published case studies. Chaplains need these case studies to provide a foundation for further research about the efficacy of chaplains' spiritual care. Case studies can also play an important role in training new chaplains and in continuing education for experienced chaplains, not to mention educating health care colleagues and the public about the work of health care chaplains. Guidelines for writing case studies are described, herein, as is a project in which three experienced oncology chaplains worked together to write case studies about their work. Steps that chaplains, and professional chaplain organizations, can take to further the writing and publishing of case studies are described.

This article takes a past, present and future look at healthcare chaplaincy from the perspective of the Roman Catholic(RC) Church in Scotland. It explores the traditions and experiences of chaplaincy in the context of a changing National Health Service(NHS), a multi-faith Scotland, and a changing Roman Catholic community. It offers insight into the future focused on a broad understanding of Spiritual care and chaplaincy. The author concludes with positive advice and encouragement for the RC Church, its bishops, the NHS, and all organisations associated with healthcare chaplaincy.

Spiritual care and chaplaincy have been part of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Distress Management since the first meeting of the panel in 1997, possibly the first time this degree of spiritual care and chaplaincy care integration occurred in cancer care. Since that time, the chaplaincy care section of the guidelines, especially chaplain assessment categories derived from a spiritual care assessment, have provided a major resource for healthcare chaplaincy and have served as a model for integrating chaplaincy into the overall team practice of healthcare. However, this section of the NCCN Guidelines has not been substantially updated since it was originally written. During those 20 years, the practice of healthcare chaplaincy and the research that supports it have grown substantially. In the last year, at the request of the panel, we have updated the chaplaincy care section to fully integrate recently published evidence in spiritual care in healthcare, adding more value to this important set of guidelines. Those updates appear in the 2019 version of the NCCN Guidelines. This article discusses the history of chaplaincy involvement in the NCCN Guidelines for Distress Management and the precedent it set for the integration of chaplaincy in other efforts that followed. Integration of this section of the Guidelines into the spiritual care practice at Memorial Sloan Kettering Cancer Center is presented as an example of how these guidelines can be put into practice to improve patient care. Finally, a summary of the recent research by Drs. Kenneth Pargament and Julie Exline is presented as the foundation for the revised chaplain assessment categories and interventions.

Review question/objective: This review seeks to establish what is best practice in relation to health care chaplaincy. More specifically, the objectives are to identify: • What behaviours and practices by chaplains are effective in facilitating well being in hospitalised patients and their carers? Other associated review questions are: • Is chaplaincy effective in providing spiritual and religious care for patients,families and staff? • What impact does chaplaincy have on patients and staff and familiesthrough the provision of spiritual and religious care? Inclusion criteria: Types of participants: The review will consider studies that include patients, and/or their carers and families and hospital staff who are exposed to chaplaincy services Types of intervention(s)/phenomena of interest: All studies and papers evaluating the effectiveness and impact of chaplaincy services on the experience of chaplaincy services will be considered for inclusion in this review. Types of outcomes: Quantitative: This component of the review will consider studies that include the following outcome measures based on previous studies that have considered the role of the chaplain: • Measures of physical and mental improvement using measurable criteria such as BP, levels of anxiety and depression; • Measures of well being; • Measures of quality of life; and • Measures of complaints reporting. Qualitative: Experiential accounts of patients, their carers, families and hospital staff. Individuals coming to terms with the realities of their ill health/wellbeing/life situations

Chaplaincy care has undergone a significant evolution in recent decades, and the end is not yet in sight. It has not always been a simple task to retain the essence of the profession during these changes. In order to gain insight into the core identity of spiritual care in the healthcare sector, we have analysed the journals of two leading professional associations, focusing on key issues, in order to allow the past to help us gain insight into the future. Our analysis of the Dutch journal Tijdschrift Geestelijke Verzorging (Journal for Spiritual Care) and the Scottish Journal of Healthcare Chaplaincy has shown that, although both journals have converging views on several key issues, there are also significant differences. The observations have resulted in different recommendations for professionals of the two countries. To spiritual care professionals in Scotland, recommendations are made to increase the focus on multicultural spiritual care, while the value of evidence-based practice, and working in accordance with best practice, is brought to the attention of their Dutch colleagues.

In this chapter we have set out a dynamic picture of religious and spiritual care with reference to a growing literature and three brief case studies. We have noted the persistence of needs arising in healthcare not only from those with clear religious affiliations, but increasingly from those whose spirituality is not defi ned by traditional boundaries. The chaplain’s leading role in spiritual care is characterized by a detailed knowledge of personal beliefs and the relationship of these to health and illness. Through the chaplain’s expertise patients are supported during some of the most difficult experiences any of us ever faces. The care that is provided enables the patient to cope and make sense while often engaging a network of support that benefi ts the patient long after discharge. In an era when medicine has excelled in its ability to treat ever smaller and discrete aspects of illness the care provided by the chaplain is essential for keeping the complete person in view. As chaplains work alongside other staff, and transect the organization as a whole, they are embodied reminders of the way in which spirituality is connected to the ancient and sacred tasks of healing and caring for the sick. When critics have drawn attention to the enormous breadth of how the term ‘spirituality’ has been employed in healthcare literature, they have ignored the personal beliefs and experiences, which define us. Since the modern professional chaplain works with the patient’s sense of what is spirituality significant for them, there is indeed a flexibility in the use of the term, which is wholly appropriate. There is no exclusion list of items, which may not, under any circumstances, be considered to be spiritual. Where experiences link us to sacred themes, or become contextualized by broader relationships to creation, human, or divine communities, the description of spirituality is both accurate and meaningful. It follows that the delineation of a spiritual experience for someone is the framing that leads their passage through healthcare to be seen with deeper significance. In hospitals, that framing may be the illness itself, the relationships and beliefs it changes, or the sense of transcendence arising from a more imminent sense of our aging and mortality. Above all else, as sickness can change a person’s fundamental outlook, the process of spiritual support and exploration cannot be an isolated endeavour. All healthcare staff play a part by providing care which recognizes the overall impact of illness on patients, their values, and relationships. The spirituality of care chaplains promote within healthcare recognizes that what may be routine to healthcare workers is not routine to patients. Some patients will enter new and difficult territory, and the need for those who are highly trained and skilled in handling spiritual matters will continue, both as a resource to staff and as direct care to patients.

In recent decades, healthcare chaplaincy in the United Kingdom has had to adapt to the growth of cultural pluralism and the waning of Christian monopolies in the public sphere. It has done this in different ways in Scotland and in England, following their differing patterns of secularization. Typically, chaplaincy in England has responded by embracing diversity, with the emergence of "multi-faith" teams. Scotland, by contrast, has sought to create a neutral space for chaplaincy, with the construction of "generic" teams. This article argues that both these responses to pluralism are problematic, for different reasons. "Multi-faith" chaplaincy risks becoming inequitable, while "generic" chaplaincy puts the integrity of the chaplain under threat. This study offers a "third way" – a way of reconceptualizing the relationship between a chaplain's particular formational identity and the demands of a professional spiritual care service that must give equal access to all. This insight is derived by analogy from the world of counselling and psychotherapy, which has come to terms with professionalization in recent years. Writing from the Scottish context, and in contrast to the generic model, I argue for a recovery of emphasis on the chaplain's formational identity as a necessary resource in being able to offer authentic spiritual care. Part of the process of professionalization could be the retention of an older sense of "professional," which acknowledges the importance of being rooted in the beliefs and commitments a person "professes."

Diversifying the chaplain workforce in hospital spiritual care departments and Clinical Pastoral Education (CPE) programs is essential for meeting the needs of a religiously diverse population in the USA. We interviewed seven total participants, including two Somali Muslim chaplain students and their Muslim and Christian chaplain educators in one CPE program. Participants described their personal journeys and motivations for pursuing careers in healthcare chaplaincy, their impact on hospitalized patients, and the role of expanding perspectives for those with little prior exposure to Somali Muslim faith leaders. Representation and linguistic diversity were viewed as positive attributes despite challenges of racial and religious discrimination. Recommendations include adjusting educational requirements for entry into the field to consider professional equivalencies; engaging community chaplains; and collaborating with local communities. These findings have important implications on creating pathways for spiritual care providers from underrepresented faith traditions to meet local community needs.