Review Article

The Provision of Hospital Chaplaincy in the United States: A National Overview

Authors: Wendy Cadge, PhD, Jeremy Freese, PhD, Nicholas A. Christakis, MD, PhD, MPH

Abstract

Over the past 25 years, the Joint Commission for the Accreditation of Healthcare Organizations has changed its guidelines regarding religious/spiritual care of hospitalized patients to increase attention concerning this aspect of hospital-based care. Little empirical evidence assesses the extent to which hospitals relied on hospital chaplains as care providers during these years. This study investigates (1) the extent of chaplaincy service availability in US hospitals between 1980 and 2003; (2) the predictors of having chaplaincy services in 1993 and 2003; and (3) the change in the magnitude of these predictors between years. This study examines the presence or absence of chaplaincy or pastoral care services in hospitals using the American Hospital Association Annual Survey of Hospitals (ranging from 4,946–6,353 hospitals) in 1980–1985, 1992–1993, and 2002–2003. Between 54% and 64% of hospitals had chaplaincy services between 1980 and 2003, with no systematic trend over this period. In 1993 and 2003, hospital size, location, and church affiliation were central factors influencing the presence of chaplaincy services. Smaller hospitals and those in rural areas were less likely to have chaplaincy services. Church-operated hospitals were much more likely to have chaplaincy services; but between 1993 and 2003, church-operated hospitals were more likely to drop chaplaincy services than to add them. Not-for-profit hospitals were more likely than investor-owned hospitals to add chaplaincy services. Changes to Joint Commission for the Accreditation of Healthcare Organizations policies about the religious/spiritual care of hospitalized patients between 1980 and 2003 seem to have had no discernible effect on the fraction of US hospitals that had chaplaincy services. Rather, characteristics of hospitals, their surroundings, and their religious affiliations influenced whether they provided chaplaincy services to patients.


Key Points


* Between 54% and 64% of hospitals had chaplaincy services between 1980 and 2003, with no systematic trend over this period.


* Smaller hospitals and those in rural areas were less likely to have chaplaincy services.


* Church-operated hospitals were much more likely to have chaplaincy services.


* Between 1993 and 2003, church-operated hospitals were more likely to drop chaplaincy services than to add them.


* Not-for-profit hospitals were more likely than investor-owned hospitals to add chaplaincy services.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Staten P. Spiritual assessment required in all settings. Hosp Peer Rev 2003;28:55–56.
 
2. Weaver AJ, Koenig HK, Flannelly KJ, et al. A review of research on chaplains and community-based clergy in the Journal of the American Medical Association, Lancet, and the New England Journal of Medicine: 1998–2000. J Pastoral Care Counsel 2004;58:343–350.
 
3. Hall C. Head and Heart: The Story of the Clinical Pastoral Education Movement. Journal of Pastoral Care Publications, 1992.
 
4. Holst L. The hospital chaplain between worlds, in Marty ME, Vaux KL (eds): Health/Medicine and the Faith Traditions. Philadelphia, Fortress, 1982, pp 293–309.
 
5. Norwood F. The ambivalent chaplain: negotiating structural and ideological difference on the margins of modern-day hospital medicine. Med Anthropol 2006;25:1–29.
 
6. Lee SJC. In a secular spirit: strategies of clinical pastoral education. Health Care Anal 2002;10:339–356.
 
7. VandeCreek L. Contract Pastoral Care and Education: The Trend of the Future? New York, Haworth Pastoral Press, 1999.
 
8. Flannelly KJ, Weaver AJ, Smith WJ, et al. Psychologists and health care chaplains doing research together. J Psychol 2003;22:327–332.
 
9. VandeCreek L. Professional Chaplaincy: What is Happening to it During Health Care Reform? Binghamton, NY, Haworth Press, 2000.
 
10. Flannelly KJ, Handzo GF, Weaver AJ. Factors affecting healthcare chaplaincy and the provision of pastoral care in the United States. J Pastoral Care Counsel 2004;5:1–2.
 
11. VandeCreek L. How has health care reform affected professional chaplaincy programs and how are department directors responding? in VandeCreek L (ed): Professional Chaplaincy: What Is Happening to It During Health Care Reform? Binghamton, NY, Haworth Press, 2000.
 
12. VandeCreek L, Siegel K, Gorey E, et al. How many chaplains per 100 inpatients? Benchmarks of health care chaplaincy departments. J Pastoral Care Counsel 2001;55:289–301.
 
13. Weaver AJ, Flannelly KJ, Oppenheimer JE. Religion, spirituality, and chaplains in the biomedical literature: 1965–2000. Int J Psychiatry Med 2003;33:155–161.
 
14. Curlin FA, Lawrence RE, Chin MH, et al. Religion, conscience, and controversial clinical practices. N Engl J Med 2007;356:593–600.