Reconfiguring the health-promoting hospital: the role of chaplaincy in England.

This paper seeks to explore how hospitals can be reconfigured to adopt more 'health-promoting' approaches and values. Specifically, the paper focuses on the role of hospital chaplaincy and argues that spiritual care should be considered alongside other health domains. Using semi-structured interviews, the aim of the paper is to explore the experiences of patients who accepted (n = 10) and declined (n = 10) hospital chaplaincy services. Data were analysed drawing on principles of interpretative phenomenological analysis (IPA). The findings suggested that participants who accessed chaplaincy services reported using the chaplains for pastoral, religious and spiritual care which contributed positively to their sense of well-being. This included religious rituals and supportive conversations. The majority of these participants had existing links with a faith institution. Participants who declined chaplaincy services reported having personal religious or spiritual beliefs. Other reasons cited, included: that the offer was made close to discharge; they had different support mechanisms; they were unaware of what the chaplaincy service offered. Participants identified a number of skills and attributes they associated with chaplains. They perceived them as being religious but available to all, somebody to talk to who was perceived as impartial with a shared knowledge and understanding. The paper concludes by highlighting the important role of chaplaincy as part of a holistic health-promoting hospital. This has implications not only for the design, delivery and promotion of chaplaincy services but also for health promotion more broadly to consider spiritual needs.

A state health service and funded religious care.

This paper analyses the role chaplaincy plays in providing religious and spiritual care in the UK's National Health Service. The approach considers both the current practice of chaplains and also the wider changes in society around beliefs and public service provision. Amid a small but growing literature about spirituality, health and illness, I shall argue that the role of the chaplain is changing and that such change is creating pressures on the identity and performance of the chaplain as a religiously authorised health worker. I shall question whether either orthodox belief or religious belonging have any significant bearing on the patients' demand for chaplaincy services. Utilising an example of chaplaincy work I shall argue that patient need constitutes the strongest platform for both practice development and an articulated understanding of what chaplains bring to health care. Drawing on a case study the definition and interpretation of spiritual need will be discussed in relation to chaplaincy practice. In conclusion, I shall set out the case for effective research to establish with greater precision the detail of the chaplain's practice within a state-funded health system.

Nursing attitudes towards recording of religious and spiritual data.

Poor recording of patients' religious and spiritual information is known anecdotally and occasionally referred to in publications. Chaplains in particular encounter lack of data entries or errors in records on a routine basis. While novel forms of spiritual assessment have been discussed, the only previously published United Kingdom research on nurses' responses to patients' spiritual needs uses the approach of critical incident analysis. This article reports on the findings of a nurse focus group used to generate issues likely to resonate with staff as to why poor assessment and recording occurs. Apart from clinical factors, nurses cited the intrusiveness of questions about spirituality and the feeling that assessment was 'unnecessary' as major reasons for non-recording. The most significant finding was the correlation between clinical area and the incidence of assessment. Nurses who admitted patients and always asked for religious and spiritual information were three times more likely to work in complex clinical areas. Further training is indicated as most likely to enhance accurate recording. More research is needed to establish whether these findings are matched in practice, and to identify whether the results found in one teaching hospital are equally true for other types of hospital in the UK.