The domains used to understand receptivity, meaning and belief, available resources, communication needs, and values or conscience concerns.

How is the work documented?

Where findings, interventions, patient response, follow-up, and relevant team communication are recorded.

Who is referred, and what happens next?

Who responds to a positive screen, how quickly the assessment occurs, and how referrals or escalations are closed out.

What outcome is tracked?

A defined measure suited to the service, such as whether the identified need was addressed, the patient’s reported response, or whether the agreed follow-up occurred.

Chaplains Are More Than People Who Pray

Paulette McPherson

6 min read

A chaplain is sometimes understood as someone who comes in, prays with you, and leaves. Prayer can be part of chaplaincy. But if spiritual care were only a prayer, the chart would be a short one.

The impression persists for understandable reasons. Chaplains are often called during the hardest moments of a hospitalization, and a prayer or blessing may be the most visible part of the visit. The less visible work is listening, assessing, identifying what matters to the patient, coordinating support, and documenting what should happen next.

What actually happens in a visit

A clinical spiritual assessment begins with the patient, not with a prepared intervention. The chaplain notices whether the person is ready to talk, listens for sources of meaning and distress, and considers what support the patient can access. The assessment then guides the care provided and what is communicated to the team.

The Practical Chaplain’s PEACE Spiritual Assessment Model organizes this work into five domains: Presence, Exploration, Access, Communication, and Ethical. The Practical Chaplain was founded by Rev. Paulette A. McPherson, MA, MDiv, DMin(c), BCC, a Board Certified Chaplain and Certified Educator Candidate, and the PEACE model was built out of real clinical practice rather than theory. Learn more about the PEACE model.

A chaplain introduces themselves to a patient, establishing a respectful and unhurried encounter

1. Presence: Can this encounter happen now?

The chaplain first establishes the encounter and checks whether the patient can be met in that moment. Presence also requires the chaplain to arrive regulated, unhurried, and non-anxious, rather than bringing a predetermined intervention into the room.

A simple opening is: “I am the chaplain. Is this a good time to sit with you for a few minutes?”

The note can record that the encounter was initiated, the patient’s receptivity, and the presenting emotional state. If the patient declines or is not ready, that matters too. Respecting the answer is part of the care.

2. Exploration: What gives this person meaning?

Exploration concerns the patient’s sources of meaning, identity, belief, and hope, and what the illness may be threatening. The patient may draw on religion, family, personal values, community, or another source of purpose. The chaplain asks without assuming which one applies.

Useful questions include: “What is holding you together right now?” and “Has anything here shaken what you believe?”

The chaplain documents the patient’s stated sources of meaning, relevant belief framework, and any identified spiritual struggle. For example, a patient might describe feeling cut off from the community that usually sustains them. That observation can shape the plan; it is not a cue to assume that a particular ritual or prayer is wanted.

3. Access: Can the patient reach their resources?

A resource can be important and still be out of reach. The patient may want contact with a faith leader, a family member, a familiar ritual, or a personal practice. Illness, visitor restrictions, fatigue, communication barriers, or uncertainty about how to ask may block access.

The chaplain records which resources are present, which are blocked, and what action was taken to restore access. That action might be arranging a call, contacting a requested faith leader, or coordinating with staff around a practice that matters to the patient.

4. Communication: Who needs to know what?

Spiritual needs do not help the care plan if they remain only in the conversation. Communication includes deciding what should reach the family, the clinical team, and the medical record, and noticing where that handoff is failing.

The chaplain may relay a relevant concern to a nurse or provider, recommend a family meeting, document the plan, and close the loop with the people involved. The point is not to share every personal detail. It is to communicate what the team needs to know to support the patient’s care.

A chaplain and patient talk beside a tablet, representing assessment, documentation, and care-team communication

5. Ethical: What values or conscience concerns shape care?

Values-based concerns can affect decisions, consent, and a patient’s willingness to proceed with treatment. A chaplain listens for moral or spiritual conflict without taking over decisions that belong to the patient, family, or clinical team.

Depending on the concern and local policy, the next step may be an ethics consult, palliative care, advance care planning, or escalation to leadership. The chaplain documents the concern and the referral or action taken.

Screening is a flag. Assessment is the follow-through.

Screening and assessment are connected, but they do different jobs. The Practical Chaplain’s distinction is practical: screening identifies that a spiritual concern may exist; assessment interprets the concern, forms a plan, and delivers an intervention.

	Screening	PEACE assessment
Who and when	A nurse, provider, social worker, or intake staff member; usually 1–3 minutes	A Board Certified Chaplain or supervised CPE student; often 15–45 minutes and sometimes several visits
How it works	Fixed question set using tools such as FICA, HOPE, or SPIRIT	Relational and iterative; follows the patient’s responses and changing needs
What it produces	A flag or referral	A documented assessment, plan, intervention, and outcome that can be audited and reported

A screening program without an assessment pathway generates flags that no one acts on. Screening is useful when the organization has a clear process for referral, assessment, intervention, and follow-up. See The Practical Chaplain’s guide to spiritual screening versus assessment.

The clinical contribution, and what the evidence can say

Chaplains contribute a focused assessment of spiritual distress, meaning, coping resources, values, and support needs. They can bring that information into care planning and help patients and families navigate difficult conversations. Research is growing, but it does not support a blanket promise that chaplaincy will reduce length of stay or costs.

A systematic review and meta-analysis of spiritual-care interventions among ICU patients found significant reductions in length of stay and mean arterial pressure, alongside improvements in patient comfort, spiritual well-being, and anxiety. The findings concern varied spiritual-care interventions; they should not be read as proof that a chaplain visit alone causes these outcomes.

A 2025 randomized controlled trial of a compassion-centered spiritual health intervention, published in PLOS One, tested whether that intervention improved outcomes for hospital inpatients. It is one trial in one setting, so it is an encouraging data point rather than evidence that every chaplain encounter produces the same result.

A 2026 quasi-experimental study of healthcare chaplaincy in Belgium looked at both impact and the processes behind it. Because the design was quasi-experimental, its results are best understood as a promising association rather than a definitive causal conclusion.

The evidence also includes results that do not fit a simple success story. A study of chaplain patient navigators and multidisciplinary family meetings in the ICU was associated with longer stays and higher costs. In oncology settings, chaplain visits have also been associated with higher readmission. Sicker patients may be more likely to receive chaplaincy, which can contribute to these associations. Such findings do not show that chaplaincy caused worse outcomes; they do show why patient acuity and referral patterns matter when interpreting data.

There is also a workforce and measurement challenge. A CHA and NACC survey of 748 spiritual care workers and their overseers in U.S. Catholic health ministry, reported in 2026, found that about 40% of respondents used a standardized spiritual distress assessment tool. Thirty-two percent named funding, compensation, and financial sustainability as the profession’s biggest challenge; 21% cited gaps in value, visibility, and administrative understanding (Catholic Health World survey report). A structured assessment and a clear account of what follows can help leaders see the work, but measurement should reflect care, not replace it.

Questions leaders should ask, and answers departments should be ready to give

A chaplain and healthcare professional review a care plan together, illustrating interdisciplinary follow-through

A healthcare leader asks…	A chaplaincy department should be able to explain…
What gets assessed?	The domains used to understand receptivity, meaning and belief, available resources, communication needs, and values or conscience concerns.
How is the work documented?	Where findings, interventions, patient response, follow-up, and relevant team communication are recorded.
Who is referred, and what happens next?	Who responds to a positive screen, how quickly the assessment occurs, and how referrals or escalations are closed out.
What outcome is tracked?	A defined measure suited to the service, such as whether the identified need was addressed, the patient’s reported response, or whether the agreed follow-up occurred.

The department should be able to describe its process in plain language and show how the record supports continuity of care. For chaplains, that is a useful test of practice. For leaders, it is a practical way to understand what the service delivers.

Practical tools for the work

Prayer may be part of a chaplain visit. So may listening, clinical assessment, restoring access to support, communicating with a care team, and helping values become visible in decisions.

The Practical Chaplain offers free resources to support that work: the PEACE Spiritual Assessment Template, PEACE Quick Reference Card, Spiritual Care Progress Note Template, and Spiritual Screening vs. Spiritual Assessment Guide. All of them are free. Departments can also explore PEACE Model implementation and consultation.