Spiritual care is at a critical juncture, poised to make major inroads toward being fully integrated into health care. At the same time, there’s an increasing sense of urgency to take it to the next level—for the benefit of patients, families, and health care institutions.
This was the takeaway at HealthCare Chaplaincy Network’s (HCCN’s) recent 2nd annual international Caring for the Human Spirit Conference in Lake Buena Vista, Fla., which featured some of the world’s most renowned experts in spiritual care.

Spiritual Care A Necessary Ingredient

“As spiritual care and palliative care continue to gain ground on the global health agenda, it’s becoming more and more evident that delivering effective whole-person care must include the domain of spiritual care,” said Rev. Eric Hall, president and chief executive officer of HCCN, a national nonprofit organization focused on spiritual-related clinical care, research, and education.

Christina Puchalski, MD, FACP, founder and director of the George Washington Institute for Spirituality and Health, Washington, D.C., was equally emphatic, stating in her keynote address: “Spirituality should be considered one of the vital signs in the care and treatment of patients.

“People all over the world are hungry for this area,” she said. “They want to incorporate more whole-person care into their health settings, and desperately want the tools to do that.”

Chaplains Should Seize The Moment

Much has changed over the past two decades to get to this point. Big boosts include passage in 2014 of the Palliative Care Resolution by the World Health Assembly, the governing body of the World Health Organization, that cites spiritual care as a vital component of palliative care, an increasing recognition of the critical need for chaplains as members of the interdisciplinary team, and a growing body of work related to the value of spiritual care. The Rev. George Handzo, MA, BCC, CSSBB, HCCN’s director of health services research and quality, urged chaplains and others who support spiritual care to seize the moment. “We need to up our game quickly, emphatically, boldly,” he said.

Eric HallBetty Ferrell, RN, PhD, director and professor of nursing research and education at the City of Hope Medical Center, Duarte, Calif., called it “a very pivotal moment for spiritual care” in the United States and internationally.

“We’re really positioned now to see tremendous advances in incorporating spiritual care,” she said. “The next few years need to be ones of awakening and understanding. We then need to overcome barriers around how do we realistically integrate these great ideas given the restraints in the economics of the health care system.”

At the core of moving spiritual care to the next level is ensuring that chaplains, in taking the spiritual care lead, receive appropriate training, adapt standardized practice, develop research skills, and incorporate evidence that’s being developed into care.

Beyond chaplaincy, also pushing the field forward will be helping other health care professionals understand the field, recommended training for providers in conducting spiritual screening as part of routine patient assessment, more research so that chaplains can be further integrated into interdisciplinary teams, and buy-in of administrators and other providers.

Fact-Finding Missions Needed

When spiritual care feeds the patient experience, staff satisfaction, and overall quality of care, it’s a win-win to the financial bottom line and the human topline.

Proof has been surfacing. While there is much research yet to be unearthed, Handzo provided this synopsis of “Research: What Do We Know”: If spiritual needs are met, outcomes improve, including medical outcomes, costs reduce, and patient satisfaction rises.

Karen Steinhauser, PhD, health scientist, The Center for Health Services Research in Primary Care, VA Medical Center, Durham, N.C., spoke of the progress and gaps.

“There’s been some really powerful, often descriptive, work that has shown that spirituality is vital, particularly to patients and families—vital in terms of being a source of support in coping, to understanding the experience of illness, and to making decisions about care,” Steinhauser said.

 But more must be done in terms of a body of evidence to inform spiritual care. “We need to understand a lot more about the mechanisms that link spirituality with care outcomes,” she added.

The conference offered researchers and clinicians a platform to share progress with a diverse group of attendees, which included chaplains, physicians, nurses, social workers, and other health care professionals from 17 countries.

The integration of spirituality into health care is advancing patient care at City of Hope. Noting the work being done there, Ferrell said, “It really illustrates that spirituality can be included in research and education, and how important it is for chaplains to be equal partners in this interdisciplinary care.”

Not Just The Garnish

Also on the agenda, a team from Mount Sinai Hospital in New York presented research methodology, analysis, and conclusions that demonstrate the positive impact of chaplain visits on patient satisfaction scores.

Similarly, David Cotton, MA, MDiv, manager of pastoral care at Jersey Shore University Medical Center, Neptune City, N.J., spoke of the significance of the Mount Sinai study as well as other research findings that patients would choose prayer, second only to pills, for pain management.

Because the studies address questions on the Hospital Consumer Assessment of Healthcare Providers and Systems and Press Ganey surveys that determine Medicare reimbursement, he said chaplains can prove for the first time that they have a positive financial impact on hospitals.

“That means that in an era of difficult health care financial management, where hospitals are operating on slimmer and slimmer margins, they’re not as likely to look at pastoral care as a place to cut,” Cotton said. “They’re going to realize that pastoral care is not the frills around the edge, not the garnish on the plate. We’re part of the main course of hospital care.”
John Swinton
At Samaritan Institute, Denver, a Spiritually Integrated Therapy curriculum has been developed that extends spiritual care beyond the chaplain. It trains clinicians and administrators to conduct spiritually sensitive conversations with patients, and then, “they make referrals for deeper struggles and questions to those trained in spiritual caregiving,” explained Kelly Arora, PhD, vice president for center resources. “The key message is that we need to continue to push for the full integration of spirituality in all health care professions.”

Palliative Care Holds Key

Palliative care’s embrace of spiritual care helps shine the spotlight on its value. Another plenary speaker, Liliana De Lima, executive director, International Association for Hospice & Palliative Care, Houston, noted that more countries are incorporating palliative care into their agendas as a result of the World Health Assembly resolution.

“The beauty of it is that throughout the resolution there is spiritual care included in palliative care. This will bring spiritual care through the door of palliative care into the health care system.”

Conversations like this about the integration of spiritual care in health care come at a time when a number of research studies show that the majority of Americans say that spirituality, in some form, should be an important consideration in their health care. Yet one study showed that 72 percent of patients said their spiritual needs were minimally or not at all supported by the medical system even though spiritual support was highly associated with quality of life.

Perhaps no one at the conference characterized the import of spiritual care as succinctly as Rev. John Swinton, BD, PhD, RMN, RNMD, a professor in practical theology and pastoral care, University of Aberdeen, Scotland. In concluding remarks at his plenary presentation, he said, “Chaplaincy opens up the soul of health care.”

Carol Steinberg

Carol Steinberg is executive vice president at HealthCare Chaplaincy Network, in New York City. She can be reached at csteinberg@healthcarechaplaincy.org or (212) 644-1111.