Many chaplains and most chaplaincy programs in the United States–with encouragement from their accrediting organization, the Association for Clinical Pastoral Education (ACPE)--have begun to assume a more proactive stance toward patients, healthcare professionals, and
Some chaplains and chaplaincy programs have begun to engage in activities that have ranged from initiating conversations with and perusing the medical records of patients who have not requested their services to proposing that they be permitted to do “spiritual assessments” on patients–in some instances whether these patients have been explicitly informed and have agreed to this beforehand.
Moreover, many chaplains and chaplaincy programs have begun to assume that chaplains are full-fledged members of the healthcare team, complete with access to patients’ medical records both to gather information and to make notations of their own.
It would appear that such novel activities are being justified by a questionable set of claims and assumptions that includes: (1) the claim that chaplains have a spiritual–as opposed to purely religious–expertise that entitles them to interact with patients and/or significant others (even those who have not requested a chaplain)–presumably without in the least compromising patient autonomy or the confidentiality of the patient/healthcare professional relationship;
(2) the assumption that the terms “spirituality” and “religiosity” mutually entail one another; (3) the claim that the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) mandates “spiritual assessments” (which it does not); (4) the assumption that chaplains are full-fledged members of the healthcare team; and.
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Spirituality, religion, and pain
(5) the claim that chaplains must, therefore, be permitted access to patients and patients’ medical records both to gather information and to make notations of their own. We consider such claims and assumptions disquieting, and suggest that it is high time we revisit the terms “chaplaincy,” “healthcare professional,” and “member of the healthcare team” in reassessing what our professional commitments to respect and protect the bio-psycho-social integrity of patients require.
Understanding the relationships between spirituality and health has become increasingly important in health research, including nursing research.
Very little of the research thus far has focused on spirituality, religion, and pain even though spiritual views have been intertwined with beliefs about pain and suffering throughout history. Spiritual views can have a substantial impact on patients’ understanding of pain and decisions about pain management. The author reviews the research literature on spirituality and pain from a historical perspective.
The analysis is concerned with how spirituality and religion have been used to construct a meaning of pain that shapes appraisal, coping, and pain management.
The clinical implications include respectful communication with patients about spirituality and pain, inclusion of spirituality in education and support programs, integration of spiritual preferences in pain management where feasible and appropriate, consultation with pastoral care teams, and reflection by nurses about spirituality in their own lives. A discussion of research implications is included.