Lost in Translation: The Chaplain's Role in Health Care

Chaplains often describe their work in health care as "translation" between the world of the patient and the world of hospital medicine. Translators usually work with texts, interpreters with words. However, when chaplains use this metaphor, it describes something other than a discrete task associated with the meaning of words. While medical professionals focus on patients' medical conditions, chaplains seek to read the whole person, asking questions about what people's lives are like outside of the hospital, what they care about most, and where they find joy and support in the world. Chaplains offer a supportive presence that serves to remind patients and caregivers that people are more than just their medical conditions or their current collection of concerns. Some chaplains are skilled at translating patients' experiences and sources of meaning in real time, allowing medical teams to better understand the person they are treating. "Translation" is also defined as metamorphosis. Chaplains provide this sort of translation when they are alone with patients, listening to their deepest concerns, helping them redefine their lives.

Unlike a professional interpreter, who helps patients and clinicians communicate when they do not share a common language, the chaplain is not just a conveyor of the spoken words of others. A patient, family member, nurse, or physician may seek out the chaplain for help in translating a situation: Is the family in denial? Is the team giving up? Is the patient ready to go home, like her husband says, or ready to rest, like she says?

Ironically, chaplains-skilled at mediating between patients and hospital staff-often have no one they can rely on to advocate for them at budget time, no one who can "translate" the tangible benefits chaplains provide to patients, families, and staff into terms hospital administrators can understand.

The Professional Chaplaincy and Health Care Quality Improvement research project was initiated, in part, in response to this dilemma: If chaplains wish to be recognized as a health care profession, they need to be able to describe, to themselves and to others, what constitutes "quality" in their area of patient care. Like other health care professionals, they need to specify how their profession and their day-to-day work in the hospital contribute to the ongoing task of quality improvement in health care. This is no easy task. The work that chaplains do is difficult to measure in conventional QI terms: the precise duties of their job are unspecified, and chaplains often find themselves improvising to meet the needs of patients and caregivers. In this situation, how can chaplains define their role in improving health care? External perceptions of chaplains and chaplaincy also complicate this translational task: is chaplaincy best understood as a specialized form of religious ministry, in-but not of-the health care setting? Or is it truly a health care profession, and if so, what is the nature of the health care service that chaplains provide, and how is it relevant to patients' health care needs and their treatment? Is it, in some way, both of these? Without attention to these broader sociological questions, it is difficult for chaplains to see themselves as a "professionalizing profession," and to make the special nature of their work understood to the administrators who must make decisions about investing in services that have no reimbursement code.

Raymond de Vries and Wendy Cadge, two of the authors of this essay, were invited by project codirector Nancy Berlinger, the third author, to participate in this project as sociologists who would observe, reflect, and offer a series of thinking points about the profession and future of hospital chaplaincy. De Vries comes to the project as a sociologist of bioethics (another occupation struggling with its identity and place in worlds of medicine and science) and with expertise in the sociology of culture and the professions. Cadge is a sociologist of religion who studies, among other things, the formal and informal presence of religion and spirituality in hospitals. The three of us offer our thinking in the spirit of continued conversation and with deep respect...