Conversations with a Chaplain: A Chaplain’s Role in Supportive Care

Rev. Isaac Dusenbury is a chaplain at Duke University Hospital. He completed his chaplain residency at Duke University Hospital’s Surgical and Intensive Care Unit and graduated from the Divinity School of Duke University. Here he shares his experiences and learnings as a chaplain.

What is a chaplain?

A chaplain is a religious representative that works for a secular institution. In the context of a hospital, they typically offer spiritual care and support to patients, families, and staff. Some chaplains also engage in research; incorporating evidence-based practices into spiritual care models has become increasingly important in the field of chaplaincy. Chaplains often work closely with other medical professionals and teams, especially hospice and palliative care. Sometimes advocacy is an important aspect of chaplaincy, as in advocating for patient/family needs to the medical team.

Chaplains are required to either have or be working towards a Master of Divinity (MDiv). This is a three-year graduate degree that focuses on the practical study of ministry and theology. Additionally, chaplains must be ordained by their denomination and that process can look quite different depending on the religion. Chaplains can also become board certified through an accrediting body like the Association for Clinical Pastoral Education (ACPE). Most hospitals require board certification for senior staff chaplaincy positions.

Unfortunately, hospitals can be a dehumanizing experience where people are reduced to numbers and healthcare plans. Moreover, doctors and nurses are limited to what extent they can connect with patients and families on emotional levels. More often than not they chose to disassociate as a coping mechanism for the many difficult things they see day-to-day. Chaplains are made distinct by the fact that we can consistently form connections with people and acknowledge their humanity and spirituality in even the most sterile, clinical environments.

How chaplains fit into supportive care

In most hospital systems, chaplains are assigned to a specific unit based on their clinical interests. I am the unit chaplain for the Surgery Intensive Care Unit (SICU). One of my colleagues is the unit chaplain for the Pediatric Intensive Care Unit (PICU). On any given day we can be found rounding and charting on our respective units. We do, however, have opportunities to venture elsewhere. It is common for larger hospitals to offer chaplain services 24/7. After regular business hours, there is usually an “on-call” chaplain who sleeps at the hospital and is available the entire night to visits folks as needed. At Duke Hospital the on-call shift is rotated amongst the chaplains, and we usually average two to three on-calls a month. When a chaplain is on-call, they can be called to go anywhere in the hospital.

Do you have to be religious to speak with a chaplain?

Chaplains are trained and expected to work with people from a variety of backgrounds and traditions, even those individuals who identify as atheist or non-religious. It is my belief that every person is spiritual, regardless of their faith tradition or lack thereof. This belief is key to how I understand the meaning of “spirituality.”

The English word “spirit” is derived from the Latin spiritus and its primary translation is breath.¹ I define spirituality broadly, based on its primary translation as “breath.” Spirituality is not just religious, nor is it bound to a belief in a higher power. Rather, it entails everything that makes us breathe and breathe freely, everything that defines us and identifies us.¹

I once visited an atheist patient with cancer. “I miss my garden so much,” he said, “and I can’t wait to get back to it. I feel as though I’ll finally be able to breathe again once I’m there.” I spent the next thirty minutes or so listening to him passionately talk about ornamental horticulture and hybrid seed production. Spirituality can look different for everyone and sometimes conversation is ministry.

The line between conversion and support

Any kind of evangelizing or proselytizing can be grounds for dismissal in most institutions, even those hospitals that have a religious affiliation. We’re not bible peddlers or pamphlet givers. Chaplains are trained to be self-aware and emotionally intelligent; they’re familiar with leading theories in psychology and behavioral sciences. It is considered to be a foundational understanding for chaplains to know that hospital patients and families are often in a position of vulnerability. For a chaplain to abuse their authority and pressure folks about their religious beliefs in vulnerable situations is both unprofessional and predatory.

Chaplains strive to be non-judgmental in their endeavors. Our goal is to meet people where they are -- to journey alongside them. We seek to build appropriate relationships with those in our care and engage in meaningful conversation. Like other medical professionals, our practice is guided by the concept of beneficence: to do no harm. To walk into a patient’s room, not knowing their background and history, and say, “Did you know Jesus Christ is your Lord and Savior?” is as laughable as it is horrifying to imagine.