A survey of chaplains' roles in pediatric palliative care: integral members of the team.

To date, the field of health care chaplaincy has had little information about how pediatric palliative care (PPC) programs meet the spiritual needs of patients and families. We conducted a qualitative study consisting of surveys of 28 well-established PPC programs in the United States followed by interviews with medical directors and professional chaplains in 8 randomly selected programs among those surveyed. In this report, we describe the PPC chaplain activities, evidence regarding chaplain integration with the PPC team, and physician and chaplain perspectives on the chaplains' contributions. Chaplains described their work in terms of processes such as presence, while physicians emphasized outcomes of chaplains' care such as improved communication. Learning to translate what they do into the language of outcomes will help chaplains improve health care colleagues' understanding of chaplains' contributions to care for PPC patients and their families. In addition, future research should describe the spiritual needs and resources of PPC patients and families and examine the contribution chaplains make to improved outcomes for families and children facing life-limiting illnesses.

The role of professional chaplains on pediatric palliative care teams: perspectives from physicians and chaplains.

CONTEXT: Pediatric palliative care (PPC) specialists recognize spiritual care as integral to the services offered to seriously ill children and their families. Little is known about how PPC programs deliver spiritual care. OBJECTIVE: The goal of this pilot study was to begin to describe the role of professional chaplains in established PPC programs in children's hospitals in the United States. METHODS: In 2009 we surveyed 28 PPC programs to ascertain how spiritual care was provided. Of the 19 programs with staff chaplains who met additional study criteria, we randomly selected eight to study in detail. Based on interviews with the medical director and staff chaplain in these eight programs, we qualitatively delineated chaplains' roles in PPC. RESULTS: Twenty-four of the 28 surveyed programs (86%) reported having a staff chaplain on their clinical team. Among the 8 interviewed programs, there was considerable variation in how chaplains functioned as members of interdisciplinary teams. Despite these variations, physicians and chaplains agreed that chaplains address patients' and families' spiritual suffering, improve family-team communication, and provide rituals valued by patients, families, and staff. CONCLUSIONS: Our survey of these PPC programs found that spiritual care was typically provided by staff chaplains, and our interviews indicated that chaplains appeared to be well-integrated members of these teams. Further research is needed to evaluate how well the spiritual needs of patients, families, and staff are being met, and the organizational factors that support the delivery of spiritual care in children's hospitals.

Chaplains and quality improvement: can we make our case by improving our care?

To date, the field of health care chaplaincy has little information about what constitutes "quality spiritual care. "A qualitative study of four focus groups in New York, Illinois, Arizona, and California was conducted to gather preliminary information about how health care chaplains' experience and understand "quality" and "quality improvement" in spiritual care. The study revealed that many chaplains feel a tension inherent in the task of measuring spiritual care services; how does one evaluate interactions that may seem ineffable? The study also enumerated chaplains' creative efforts, often shaped by institutional contexts and cultures, to address these difficulties in measuring spiritual services. To encourage local efforts to improve the quality of spiritual care and increase chaplains' contributions to improving health care quality, this article focuses on these context-specific projects and ideas. It also makes general recommendations aimed at promoting the development of promising practices for the field.