Chaplaincy Care in the MICU: Describing the Spiritual Care Provided to MICU Patients and Families at the End of Life

Abstract

Background: Gravely ill patients admitted to the intensive care unit (ICU), and their families experience acute spiritual and existential needs and often require complex decisions about their care. Little is known about what constitutes chaplaincy care for patients or families in ICUs. Chaplains report that participation in medical decision-making is part of their role. Objective: To describe the spiritual care provided to patients and their families in the ICU. Methods: This was a retrospective observational study of spiritual care for patients and families in the medical ICUs (MICUs) at 4 medical centers over a 3-month period. Inclusion criteria were death in the MICU or discharge to palliative care or hospice. Measures included medical, treatment, and spiritual care information (number of visits, length of visit, chaplain categories, and type of spiritual care provided). Results: Of the 254 patients, 197 (78%) received a total of 485 spiritual care visits. Seventy-seven percent of visits included provision of emotional/spiritual support; only 15% included decision-making support such as family meetings or goals-of-care conversations. The proportion receiving spiritual care increased as patients neared death or discharge. Staff chaplains were involved in goals-of-care conversations to a greater extent than student or part-time chaplains ( P < .05). Conclusion: Spiritual care was provided to most patients and/or families at the end of life. Low chaplain involvement in decision-making in the MICU suggests opportunities to improve chaplains’ contributions to ICU care.

What organizational and business models underlie the provision of spiritual care in healthcare organizations? An initial description and analysis

“…Few studies have asked how chaplains are integrated into and aligned with the institutions in which they work. For example, research describes the care chaplains provide in general (Handzo, Flannelly, Kudler, et al, 2008;Handzo, Flannelly, Murphy, et al, 2008) and in specific clinical contexts such as palliative care and the ICU (Jeuland, Fitchett, Schulman-Green, & Kapo, 2017;Labuschagne et al, 2020). Research has also begun to describe the impact of that care on outcomes for patients and families.…”

Comment on: Chaplaincy Care in the MICU: Describing the Spiritual Care Provided to MICU Patients and Families at the End of Life

“…The article by Labuschagne and colleagues, which delved into the role of chaplains in medical intensive care unit (MICU) decision-making, comparing full-time, part-time, and student chaplains, was deeply thought provoking. 1 It brought to light the importance of spiritual care as patients reach the end of their lives, and how families in the MICU call on chaplains to administer religious council when it seems that death is imminent. 1 It left the reader pondering what a spiritual assessment would entail, since nurses were largely the ones recommending chaplain support 1 and, who in the health care system, are prepared to discuss spiritual values with a patient.…”

“…A limitation mentioned in the article by Labuschagne et al is that there was no standardized form of chaplain care. 1 Rather, data were collected from the various notes provided by the chaplains. 1 Additionally, despite having more than 40 spiritual assessment tools available in the United States, chaplains were using their own versions of assessments.…”

“…1 Rather, data were collected from the various notes provided by the chaplains. 1 Additionally, despite having more than 40 spiritual assessment tools available in the United States, chaplains were using their own versions of assessments. 5 Largely, the extensive number of spiritual assessments appears to be due to the different therapeutic models from which health professionals approach spiritual assessments, even when working in the same institution.…”

“…5 Largely, the extensive number of spiritual assessments appears to be due to the different therapeutic models from which health professionals approach spiritual assessments, even when working in the same institution. 5 Further research must be executed in order to deliver a standardized 1 Health Science Department, Utica College, Utica, NY, USA…”