Photo Credit: Nuttapong Punna

ICU chaplains play a vital role in care teams, offering support in stressful times; however, there are limits to what they can and should do in the hospital.

Hospital chaplains play important roles as members of the ICU team, delivering compassionate service to people during the most difficult and stressful periods possible, particularly near the end of life.

Chaplains of whatever order may aid in the performance of religious rites and traditions among families and patients who may wish them. They may also provide religious guidance, spiritual advice, and support aligned with the patient’s or family’s spiritual and religious beliefs. Occasionally, they may provide spiritual guidance regarding difficult determinations regarding life-support activities. There may be intermediaries between families and care teams, ensuring that information is conveyed sympathetically within the context of the patient’s and family’s ideals. The chaplain may provide families with sympathetic guidance and support and may aid them in arranging memorial services and bereavement counseling.

Less recognized but equally important, the chaplain offers the healthcare team emotional and ethical support during difficult times and decisions, preventing or assuaging moral distress and burnout and offering contemplation and reflection.

The chaplain does not need to belong to any specific religious denomination or tradition but is experienced in serving people of diverse backgrounds, even agnostic or atheistic patients. The dedicated chaplain is usually experienced in working collaboratively with clergy of other religions or denominations so the afflicted patient and family may be best served for their spiritual needs.

Common Misunderstandings

This summary is well-known to most hospital healthcare workers, yet there are misunderstandings regarding the roles of chaplaincy in hospitals, particularly in the ICU. These misunderstandings carry the possibility of causing mistrust among patients or families at the most stressful times.

1. The common presence of the chaplain as the first team member facing family upon ED or ICU admission is confusing and possibly offensive to patients and families and should be avoided.
2. The chaplain’s presence upon first consultation for a critically ill or injured patient is also likely to confuse and offend the family. This situation should be avoided unless specifically requested by the family.
3. It is inappropriate for the chaplain to be charged with the delivery of bad news to the patient or family, particularly the diagnosis of a terminal illness.
4. Although local pastors may be interested in greater adherence to one’s faith, this is not usually the job of the hospital chaplain.
5. Unless requested by the family or patient, the chaplain should not be expected to participate in decisions regarding code status, organ donation questions, or other medical interventions.
6. Generally, clergy should not be involved in preparing or completing advanced directives and other legal documents unless specifically requested.
7. The chaplain should never be inserted into a position wherein patients or families may object to their presence or prefer a different member of the clergy. Particularly with advanced illness and near end-of-life, it is best to always ask families or patients about the patient’s religious or spiritual beliefs and offer the services of the chaplain or other clergy as requested. Usually, asking if the family wants the chaplain to say or lead prayers for the patient is well-accepted; a negative reply should be honored.
8. It should go without saying that chaplains should never be placed in a situation where they are expected to give opinions regarding medical practice or standards of care, just as an intensivist would not be expected to opine on theological matters.

In summary, the chaplain has a vital role in the ICU care team, helping to provide religious and spiritual support during the most stressful times. Understanding the chaplain’s role and potentially perceived inappropriate activities and presence will allow even greater benefits and a more positive experience for our critically ill patients and their families.

Note: The author thanks Rev. Gregory Nicholl, MDiv, BCC, for his advice and counsel.