Clinicians Reach Out to Both Chaplains and Ethicists

By Stacey Kusterbeck

Working nights as a chaplain at Providence Sacred Heart Medical Center, Adam Gaines, MSW, MDiv, BCC, often heard nurses express surprise that chaplains were there to support them as well as patients. Approaching the nurses’ station, Gaines recently overheard a nurse trying to decide if she should stay on nights or move to the day shift. “Her colleague suggested she talk with me. Her response was ‘Chaplains are for us, also.’ Yes, we definitely are,” says Gaines. On other occasions, when Gaines was making phone calls to family whose loved ones had died, nurses commented, “Thanks so much — we had to do that at my last job,” and “We didn’t have chaplains where I worked before. Thanks so much for your help.”

Gaines searched for studies on the role chaplains played in supporting nurses and other clinicians but was unable to find any. Gaines and colleagues decided to conduct their own study and surveyed 1,376 clinicians about their interactions with chaplains in the previous 12 months. Patient-related stressors were the most frequent reason for interactions with chaplains.

The researchers also interviewed 50 clinicians to explore qualitatively their experience with chaplains. Most often, caregivers turned to chaplains for help with distress involving patient care, end of life, family support, or futility of care. “In my experience, caregivers nearly always turn to chaplains regarding the moral distress that arises out of difficult ethical situations. The primary implication for ethicists is to recognize the moral distress that occurs around difficult ethical situations and the support chaplains can bring to caregivers,” says Gaines.

Nurses may be uncertain as to whether the case requires an ethics consult, or may be concerned about professional backlash if the situation involves a doctor or other primary provider. “Also, chaplains generally try to round on their units and are therefore known and trusted by the nursing staff — whereas professional ethicists may not be known and seen as frequently,” offers Gaines. In contrast to chaplains’ visibility, not all hospitals have ethicists onsite.

Ethicists can take the opportunity to partner with chaplains when meeting with families or caregivers to listen, explore, and support, advises Gaines. “Any situation that requires an ethics consult carries with it a level of moral distress which a chaplain is well-positioned to be present in for support. Many chaplains have training in ethics both during their Clinical Pastoral Education, and beyond,” says Gaines.

Chaplains often are called to situations where families have different opinions on level of care, when the family is pressing for care which is deemed futile or when there is uncertainty as to who the correct decision-maker is. Ethicists also are involved in those same cases. “It is helpful for chaplains to be aware of the situations ethicists can assist with,” says Gaines. “I have had nurses share their concerns with me, and I have been able to pick up that there is a need for an ethics consult. I have helped nurses place the consults as well.”

The chaplain may not be directly involved in the ethical decision-making, but they can be another set of eyes and ears to help explore what is happening. “Both the chaplain and ethicist are working to relieve suffering. There may be times, also, where the chaplain is a central part of the ethical team. We have at least one chaplain on our team who is an ‘ethics champion,’” notes Gaines.

Many chaplains have enough ethics knowledge to, at a minimum, recognize ethical situations when they arise. “Ethicists may benefit from connecting with and understanding the roles of chaplains in much the same way,” suggests Gaines.

“The chaplain’s role is to support the patient and family, facilitate their goals and wishes, and offer an extra layer of support that may or may not involve faith or spirituality. The role of the chaplain is also to support the bedside caregiver and providers as needed,” says Gary Weisbrich, BCC-PCHAC, manager of spiritual care at Providence St. Patrick Hospital in Missoula, MT.

It is helpful for ethicists and chaplains to be aware of their roles and what they each bring to the table. “Chaplains can be a helpful resource to provide emotional, spiritual, and ethical support for families, caregivers — and ethicists,” says Gaines.

REFERENCE

1. Rangel T, Weisbrich G, Sumner S, et al. Factors associated with health personnel-chaplain interactions in the hospital setting: A cross-sectional survey study. J Health Care Chaplain. 2024; Sep 3:1-15. doi: 10.1080/08854726.2024.2393551. [Online ahead of print].