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 Pastoral care in a hospital setting Article Hosted on this site
author- Dr. Simon Harrison
date- March 2001 first published- Langdon Hospital newssheet (UK)


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What is Pastoral care in a hospital Setting?

A ‘Chaplain’ can have many job descriptions- mine includes something like the following: You will be responsible for ensuring the provision of pastoral, spiritual and religious needs of patients and staff.
In this short article, (the first of an occasional series) I will go on a bit about pastoral care, and leave spiritual and religious care to later.

Pastoral care.
There is no easy definition, although it is something to do with ‘looking after a person you have some formal responsibility for’ (unlike a friend) The word pastoral is related to ‘shepherd and sheep’, which sound very politically incorrect in these days of client, service user etc. However incorrect it sounds, it reflects the truth that we have a certain responsibility for patients as people, as we do for our colleagues, especially if we have a management responsibility. Our job is not limited to certain actions, but includes that hard to define thing called ‘care’.

In hospitals, the vast majority of pastoral care is not carried out by chaplains but by nursing staff, irrespective of grade. This said, different levels of authority mean that pastoral care is carried out differently. For example, everyone can show such care by sitting alongside someone when they are anxious or distressed and simply listening without judgement. If we have a greater level of responsibility for the care of a patient however, pastoral care may involve some further action on our part. This is why the pastoral care role of the primary nurse is distinctive. All disciplines have a role in such care, chaplains, consultants, psychologists, O.T’s, etc, although each has a different amount of contact time and different levels of overall responsibility. What makes the primary nurse special is that they have the greatest ‘balance’ of time and responsibility. However frustrated you may be about not having enough quality time to carry out this role, you are still the main person with both time and authority regarding patient care.

A ward manager is in a similar situation with staff on the ward. There are many who’s role involve care and responsibility for ward staff: senior management, Occupational Health, counsellors, personnel, chaplains, clinical supervisors etc. But it seems that the main weight of care will always rest with the person nearest to the situation with sufficient time to listen and authority to effect some change.

So, if all staff ‘do’ pastoral care, and primary nurses and ward mangers have a special place in this work, where does that leave the chaplain (you may well ask). Well, I am clearly not responsible for providing all pastoral care on the ward ( I only visit once a week unless called in), but I am responsible for ensuring that it is provided. This means that there are times when I can and should be providing direct support to patients or staff. This is sometimes because it seems appropriate, say, a patient is not connecting with the nursing team, or a staff member is finding it hard to use line management support. Sometimes there is a need for some sort of ‘advocacy’ role. At other times, I simply add to the overall level of care: by ‘being there’, increasing the range of relationships a patient has, or using the flexibility of my time to respond to personal crises in a way other staff do not always have the privilege of doing. Still, however much direct patient content I have, a key role remains the support of staff who carry the primary pastoral care role, the primary nurses, ward mangers, and all staff responsible for patients and staff members as people working or living in a challenging environment (which of course includes everyone!).

So next time you see me wandering about with a relaxed smile on my face, it is perhaps because I don’t carry a ‘burden’ of pastoral care, but share in the privilege of this responsibility with many others ( i.e.- you). I will waffle on about ‘religious and spiritual’ care next time, and perhaps that will wipe any relaxed smile off my face…(although I am currently preparing a teaching session on ‘the nurses responsibility in spiritual care..’).

Simon Harrison