Spirituality and health care

From the moment Sarah Toates, M3, heard a lecture on the importance of spiritual care in the hospital setting, she was interested in learning more and inspired to participate.

The presentation took place in an ethics course during her first year of medical school. The speaker, and her future mentor, was Ven. Kevin Hickey, who currently manages a group of eight chaplains at Corewell Health William Beaumont University Hospital in Royal Oak.

When it came time to choose a topic for her four-year Embark longitudinal research requirement, Toates knew exactly what it would be. (For more on Embark, click here.)

The result of her time and effort is an extensive study recently published in the Journal of Religion and Health, called “Relationships Between the Number of Chaplain Visits and Patient Characteristics: A Retrospective Review of a Large Suburban Midwest Hospital, USA.”

“If we don’t ask patients what role their faith has in their life, then we’re missing an opportunity to understand them,” adds Toates.

“We need to be comfortable asking patients about their spirituality and their religion.”

‘A better process’

Hickey is an instructor at OUWB, where he teaches Medical Humanities & Clinical Bioethics (MHCB) seminars.

He began an internship and residency at Corewell Health’s Royal Oak campus l in 2014, and became a staff member in 2016.

Immediately, Hickey identified a need to better track how spiritual care is delivered in health care settings, citing the biopsychosocial-spiritual model of wellness and medicine that essentially includes spiritual health as part of an individual’s overall health.

“Our documentation model had basically two options: ‘chaplain visited with the patient and chaplain prayed with the patient,’” says Hickey. “There was a real need for a better process that allowed us to provide more robust information for the physicians and nurses.”

Piloting and designing the new process was a six-year-long project.

Additional fields were added to the electronic medical record, allowing chaplains to log details of their patient visits directly into the digital database. There were about 100 different points of data.

“It was a massive amount of statistical information and a goldmine of opportunity,” he says.

Toates gave an example of why having this data accessible is so vital for patient care.

“During my clinical rotations, I am often assigned to see a patient whom I’ve never met and know nothing about,” says Toates. “The first thing that I do is to review their medical record. Historically, there’s good documentation from physical and occupational therapists, social workers, dietitians and other support staff.”

Before the implementation of this procedure, detailed information on the patient’s spiritual history — and what chaplains had discussed with or provided to chaplains — didn’t exist.

‘Spiritual care support’

The study led by Toates evaluated 2,373 records of chaplain visits provided to 1,315 patients over a three-month period from March to May 2021.

The study found that about “70% of patients received one chaplain visit. However, data revealed that when patients were admitted emergently, or received visits for reasons related to self-harm or suicidality, the frequency of chaplain visits significantly increased.”

This suggests a more critical need for spiritual care services for patients with emergency or mental health conditions. It also highlights the need for “further training and resources for chaplains to increase clinical competencies in providing specialized spiritual care support to specific patient populations.”

“Our goal is to share this information…to inspire even more research about how spiritual care is delivered in a health care context, says Hickey.

Patience and empathy

Toates says she’s grateful for the experience, has a deeper understanding of the role that chaplains play on the health care team, and a greater appreciation for the fact that “patients think a lot about ...their faith.”

It’s proved helpful in a clinical setting, too.

“I was working in the ER when a woman arrived with her husband, who was seriously ill,” she says. “His wife had a rosary in her hand. She was standing at the head of the bed and praying while the team of medical professionals cared for her husband.”

Toates asked her about her faith, and if she would be interested in connecting with a chaplain.

“She indicated that she would, so I paged one of the chaplains on call and they spoke with her,” says Toates.

Toates, who has a special interest in hospice and palliative care, says it’s just one example of why it’s important to realize that “often there’s patient cues that we, as hospital staff, have to be able to recognize.”