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The Role of Clergy on the Multidisciplinary ICU Team

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In an effort to better understand the crucial role of clergy on the multidisciplinary intensive care unit (ICU) team, Critical Connections conducted an interview with James E. Willsey, MDiv, BCC, a chaplain at Roger Williams Medical Center in Providence, Rhode Island, USA, for more than 25 years, to shed light on this pertinent topic. His responses are below.

1. Intensive care unit (ICU) medical teams obviously deal with high levels of stress, trauma, and human suffering on a daily basis. How can chaplains help mitigate the toll this takes?

The first thing is just being available to listen to staff as they talk about difficult situations. This could be a sad situation with a patient or even dealing with an angry family member. They might just need to vent or share their feelings in a nonjudgmental setting. Vocalizing sentiments can help them a great deal. It can help them release some of these feelings that are burdening them, to leave these feelings at the hospital when their shift ends. One thing we do here with some regularity is hold debriefing sessions when there is a particularly difficult situation. Staff know they can come to one of these sessions to discuss the stressors and challenges. The articulation of concerns can have a positive therapeutic effect. During these sessions, we also give staff the chance to talk about any regrets, remembrances, and learnings. We do it sequentially in that order. If there is a regret, we have them write it down, the very act of which can help alleviate any affiliated emotional strain. If there is a remembrance, we have them share it aloud. If we’ve learned something from a patient or a medical situation, we acknowledge it. Sharing lessons learned ends things on a positive note.

2. What role do chaplains play in assisting patients and families in the ICU? How can chaplains help them navigate such a painful, traumatic, stressful, and disconcerting event in their lives?​

Well, let’s say the patient is on a ventilator and is unable to speak for themselves. In that instance, we could be the person that learns who that patient is. You know, they are not just the vent in room two. They are a total person. So, we might learn through friends and family that they are a professional whose work life is very important to them and that their favorite hobby is coaching their child’s little league team. We gather a picture of the whole person and then we share that whole person with the attending nurses and doctors. Once staff have a more holistic picture, including, perhaps, a better sense of the patient’s desires and wishes, they may better understand why certain care decisions are being requested. They may better understand why additional care is being requested when the odds of survival are low. In other words, chaplains can act as advocates and help fully flesh out the patient as a human being, which can help guide staff interactions with the patient and their loved ones. This often improves subsequent medical and resource allocation decisions. Additionally, never underestimate the power of a calming presence. Chaplains can be that calming presence in the room. I can remember a specific instance when a patient was not doing well and was going to be undergoing an emergency procedure. I was able to talk to the patient and simply say, “Just take a deep breath. You’ve got a really good team overseeing your procedure. We’ll get you down there, get it taken care of, and bring you back up.” Those words, you could tell, calmed both patient and staff, the latter of which was also feeling great anxiety.

3. How important is it for patients’ spiritual beliefs and practices to be addressed, especially as pertains to end-of-life decisions?

Everybody has their own individual spirituality, whether it’s thematically religious or just spiritual. They have a view of what they want and how far they want to go. Ascertaining information about these deeply held beliefs can give staff a much better sense of how to better guide care decisions. We keep coming back to this: listening is the key. One person’s faith, for instance, may dictate that every medical option should be exhausted before life support is withdrawn. Knowing the patient has this outlook can prove invaluable to medical staff as they chart a course of care. It can reframe everything. Chaplains, of course, are well positioned to gather this pertinent information and relay it to staff. We obviously have a very important role when it comes to helping patients, families, and staff frame the goals of care.

4. What advice would you give to an individual who is considering a career as a hospital chaplain?

Chaplaincy can be very rewarding. If you appreciate listening to stories and growing through being present to people, you might want to explore chaplaincy as a potential career. There is, of course, extensive training to become certified as a chaplain, but if you’re willing to go through all that, it can be very rewarding to help patients use their spiritual resources to cope with the most difficult situations in their lives.