Hospital chaplains minister to patients' spiritual needs

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

The World Health Organization identifies four dimensions of well-being: physical, social, mental and spiritual.

Today I am talking about spiritual care with the Rev. Terry Culbertson. She's a clinical assistant professor who directs spiritual care at Upstate.

Welcome back to "The Informed Patient," Rev. Culbertson.

Rev. Terry Culbertson: Thank you so much, Amber.

Host Amber Smith: Can you start by defining what spiritual care is?

Rev. Terry Culbertson: Yes. I really love this definition by Dr. Christina Puchalski. She is the director of George Washington Institute for Spirituality and Health (in Washington, D.C.), and she says, "Spirituality is that which allows a person to experience transcendent meaning in life."

And it can be expressed in a variety of ways, like a relationship with God. It could be in nature, it could be art, music, could be family, could be community. Whatever beliefs or values give a person a sense of meaning and purpose in life.

Host Amber Smith: A traditional religion.

Rev. Terry Culbertson: Uh-huh, exactly. And it's interesting that the Pew Forum (a research center), does what's called a "changing landscape of religion" analysis every couple years, and what they've discovered in America is this incredible dynamic changing of religious and spiritual practice. Most of us have an amalgamation of both. We might perhaps belong to a faith community, but we might also practice a spiritual practice like yoga or mindfulness.

It's more than a third of the country, they say, now does this. It's definitely increasing in America as things shift and change.

Host Amber Smith: Now, what is a chaplain, then?

Rev. Terry Culbertson: A chaplain is someone who ministers in a specialized setting. That is an incredibly broad definition.

There are a variety of interesting chaplaincies. There's racetrack chaplains, believe it or not. There are cruise ship chaplains. There are airport chaplains. There are nursing home, of course, jail chaplains, hospital chaplains, long-term care, all those kinds of things. So the qualifications to minister in those places varies according to the setting.

Host Amber Smith: So for hospital, is there additional training on top of spiritual care or ministering training that has to do with being in a hospital?

Rev. Terry Culbertson: It's interesting, of all the hospitals in this country, I think they say it's about 65% have chaplains. Hospitals vary also in terms of what they require.

Some of the regulatory agencies, the Centers for Medicare and Medicaid, what's called the Joint Commission, or DNV,they might require something spiritual, but they will not tell the hospital what that looks like. Now, Upstate is different. We are an academic medical center, Level 1 trauma center, and we embrace the highest standard for chaplaincy in hospitals, which is board certification, and there are only three organizations in the country that we recognize: Association for Professional Chaplains, National Association of Catholic Chaplains, National Association of Jewish Chaplains. So the gold standard is, Amber, a high bar indeed, and I could describe the qualifications if you'd like.

Host Amber Smith: I'm curious, does it require some certain training and background or experience?

Rev. Terry Culbertson: Absolutely. One of the biggest things it requires is what's called clinical pastoral education through the Association for Clinical Pastoral Education. So it's a Department of Education-accredited training program.

There's about 300 in the country, and we're the only one in Central New York. It's a big deal. And so we offer this training, what's called units of training, which are 400 hours each. The main experience of these training units is direct encounters with suffering persons, so at the bedside, in the emergency department and traumas, end of life, all those things, and students learn from those encounters, under supervision, with some educational theory and the opportunities to learn the skill. So it's a big, big deal. So you have to have 1,600 hours of this to become board certified, which is a lot.

Host Amber Smith: So this takes some real dedication.

Rev. Terry Culbertson: It sure does, and I've got to say, we have over 160 graduates in our program; we had a reunion this year, 20th year. And people have come from the Southern Tier, they've come from Canada. Some of them work full time, but they're called to this kind of work and come to train alongside of us, and it's very powerful indeed.

Host Amber Smith: So once you are a chaplain, what are the duties of a chaplain in a hospital like Upstate?

Rev. Terry Culbertson: You get everything from -- well, I should say it's like a box of chocolates, right?

Many of our folks, as one enters into clinical training, develop specialties, for example, pediatrics or psychiatry or neurology or cardiology, and they work alongside the interdisciplinary staff because we don't just confine our work to our own discipline, but we are cooperatively multidisciplinary, at the table with the rounds, at the bedside with nurses and physicians, providing holistic care.

So the training: One might develop those specialties, like I mentioned, but we're also more generalist. For example, this morning I had a call about 5 a.m. for a death in the medical intensive care. And we get a lot of those kind of calls. End of life, families need support, very challenging and difficult situations, and organ donation, for example, making health care decisions and looking at the moral issues and the values of that person and that family.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with the Rev. Terry Culbertson, who oversees spiritual care at Upstate.

I know this year's Spiritual Care Week has the theme of "chaplain beyond religious roles." Can you explain what that's about?

Rev. Terry Culbertson: Actually, I think a great example is, this morning I got a request to do an invocation blessing for our new Biobehavioral Health Unit located on the Hutchings campus (near the hospital).

So chaplains, we do direct care at the bedside. We do certainly family care. We do something that might be a little surprising to people; we do a lot of staff support. Staff deal with such hard things, and that's staff in all traditions, like environmental, security, nursing, respiratory, physical therapy. And so one of the great gifts we find is we are an informal sense of support right at the bedside with them and do some supportive care, especially after traumatic situations where there might need some debriefing or some diffusing. But my example of doing a blessing for that building is a great honor and one of the unusual things we do.

We also do things like an annual memorial service for all the families of patients that have died here, because we consider those relationships so essential, and that we cared for each other, and we're changed by each other. So that's an annual event that we do as well.

We do educational things, teaching with, for example, respiratory students. We did a simulation reenactment this summer with, the new respiratory students, at a bedside of a simulated manikin while they extubated (disconnected from a ventilator) the manikin. And so that's kind of unusual.

The other thing that was quite remarkable this summer, we have this anatomical gifts program here, where people donate their bodies to science for the medical students, and I was privileged to go out and offer a service over the remains of some of these people out in the community, where we have a burial site. So you never know what you're going to get.

Host Amber Smith: It sounds like your job is different every day.

Yeah. Hour by hour. (chuckles) Well, serious illness or hospitalization can lead to spiritual distress. Are there symptoms? How would you know, or how would the bedside nurse know that someone is in spiritual distress?

Rev. Terry Culbertson: Maybe first thinking, what does that mean? There's a variety of definitions from spiritual injuries, spiritual distress, spiritual pain. But distress implies that whatever you believe or hold most dear, gives you meaning, is not working for you in the context of whatever you're encountering in your life.

So somebody faced with a new diagnosis, say, cancer, who had a belief in a benevolent God that "If I'm faithful enough, I will never have anything go wrong in my life," could experience extreme spiritual distress by wondering: Where is God in this?

There's also spiritual despair. So distress would be "I can't make sense of it, but I'm trying." Well, despair would be what we call a broken ontology, broken meaning of life. And what can come from that brokenness is, in the conversation with a chaplain, is new meaning to emerge. And we do see that happen even at the end of life.

We had one today where hope was expressed that "I'm not going to get better. But I do hope that I'll have a peaceful death. I do hope I'll be reunited with my loved ones." Hope can be transformative, but it might change over time. So that's one symptom, the question of struggle with guilt, struggle with purpose of life, all the things that we hold so dear, our identities, who we are, those are the things that often get challenged with suffering.

Host Amber Smith: Is spiritual care part of the medical record?

Rev. Terry Culbertson: Yes. So we are very grateful to be part of medical documentation, and we do hear providers read our notes. We use a spiritual assessment model where we assess what are the spiritual needs, hopes and resources, because we do not see people as a big bag of needs, but elicit the resources they have within them and then assess what interventions might assist them in, strengthening their spirituality or their practice faith-wise.

And sometimes it can be very simple. Some people just, "I just need, you to come and pray with me." "I need to hold my rosary." "I need a Quran."

But oftentimes it's got more complexity to it, where you have a variety of beliefs in the room. I had one yesterday, an end of life, and the dying person couldn't speak for herself, but her family had a variety of beliefs -- no faith, faith, spirituality related to their nature to how they conceive of God. And to help them gather at the bedside to make their goodbyes was profound.

Host Amber Smith: And so it's your role to bring all of those beliefs together?

Rev. Terry Culbertson: Yes. Or at least to elicit them and to acknowledge them.

Host Amber Smith: So any patient who's hospitalized? What about a patient in the emergency department? Can they request spiritual care as well?

Host Amber Smith: Yes. We really try to round in the emergency. In our clinical pastoral training program. Each intern spends one evening a week in the ED, we call it the ED (emergency department), carrying trauma. And as some of you may know, our emergency room is incredibly busy. People are lining the hallways, people are coming through. There's small things, very big things. There's scared people, angry people. We get called there every single day, for all the traumas. We come down for codes, we come down for strokes, and we come down to provide support and comfort as well, so people know that they're not alone. And sometimes it's that basic, just "Hold my hand and tell me that I'm still here, and I'm still a person of worth." Let me ask you, are there adequate numbers of people who are going into the profession of spiritual care?

Rev. Terry Culbertson: Actually, the number of people going into ministry is shrinking in this country. I think it has to do with the shrinking population as well as the changing landscape of denominationalism.

Those who are Roman Catholic may be aware, obviously, the number of priests in this diocese has considerably lessened. Some traditions are growing some, but I think going into chaplaincy is such a specialized thing in terms of calling.

What we're seeing is more what I would call non-ordained people. We have a number here in our department who are not ordained like I am, but are clinically trained, theologically educated, and provide an incredible service to the patients, and I think that's the cutting edge of chaplaincy.

We have had a few younger people come in. We actually have quite a spectrum. I think our youngest student was 22, and our oldest might have been, like, 79. I actually think it's a great profession for all ages. We bring our wisdom, we bring our life experience. We bring maybe another career that we've learned from the discipline of being responsible, maybe having raised children, which I think is one of the greatest learning opportunities.

We certainly welcome people to inquire, and a lot of times people come alongside of us, and they volunteer for a while and see if this is really what they're meant to do, because it's not for everybody.

Host Amber Smith: But it sounds like you would recommend becoming a chaplain. To some people this might be a good profession.

Rev. Terry Culbertson: Absolutely. The one thing that is different being a chaplain from being, say, a clergyperson or, say, a priest, is we minister to all traditions and no traditions. So we cannot impose our faith or our religion on others. All of us in the department are ordained or endorsed by some tradition. We have to be located somewhere, in our faith walk, but we cannot impose that on others.

So you have to have an open heart and an open soul and, really see what you can learn from someone else.

Host Amber Smith: Well, Rev. Culbertson, thank you so much for making time for this interview.

Rev. Terry Culbertson: Thank you, too.

Host Amber Smith: My guest has been the Rev. Terry Culbertson, director of spiritual care at Upstate. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

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