Healthcare Chaplains Responding to Change

Embracing Outcomes or Reaffirming Relationships?


  • Steve Nolan Princess Alice Hospice



Presence, Outcome Oriented Chaplaincy (OOC), relationship, nursing, managerialism, research


The economic constraints reshaping Western healthcare are profoundly changing the reality in which healthcare chaplaincy is practiced. The recent ‘call to action’ issued by an international group of leading chaplains acknowledges the complexity of the emerging context and, on the grounds that current healthcare cost are unsustainable and the requirement to put patient needs at the centre of healthcare, they urge chaplains to adopt the outcomes approach that is the ‘new currency’ of healthcare in industrialized countries, and develop outcomes that are ‘replicable and predictable’. To the extent that the outcomes approach is aimed at improving spiritual care, the call to action is to be welcomed. However, this paper argues that adapting to the new reality ‘replicable and predictable outcomes’ will likely impact chaplaincy values as much as professional practice. The paper argues that this will be at the cost of distorting the values and beliefs that chaplains have held to be important to spiritual care.

Author Biography

Steve Nolan, Princess Alice Hospice

Revd Dr Steve Nolan has been chaplain at Princess Alice Hospice, Esher, since 2004. With research and professional interests in chaplains' case studies, non-religious spiritual care, and spiritual care and psychotherapy (psychospiritual care), he has published peer reviewed articles on the theory and practice of spiritual care. His doctoral research involved the interdisciplinary use of psychoanalytic film theory to examine the construction of religious identity (published as Film, Lacan and the Subject of Religion, Continuum, 2009). He has published research looking at how palliative care chaplains work with people who are dying (Spiritual Care at the End of Life: The Chaplain as a ‘Hopeful Presence’, Jessica Kingsley, 2012), and with Prof Margaret Holloway, a wordbook on spirituality (A to Z of Spirituality (Palgrave 2013). His recent editorial collaboration with Prof George Fitchett is a collection of chaplains' case studies (Spiritual Care in Practice, Jessica Kingsley, 2015). He is a BACP accredited psychotherapist; he has tutored on the MTh in Chaplaincy Studies in the Cardiff Centre for Chaplaincy Studies, and been a member of the European Association for Palliative Care Taskforce on Spiritual Care.


Anandarajah, G., and E. Hight (2001) “Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment”. American Family Physician 63(1): 81-89. Available at: (accessed 12 May 2015).

APC (2009) Standards of Practice for Professional Chaplains in Acute Care. Schaumburg, IL: Association of Professional Chaplains.

Autton, N. (1966a) The Pastoral Care of the Dying (The Library of Pastoral Care). London: SPCK.

—(1966b) The Hospital Ministry (Church’s Ministry Series 6). Westminster: Church Information Office.

—(1968) Pastoral Care in Hospitals (The Library of Pastoral Care). London: SPCK.

Brown-Haithco, R. C. (2012) “Spiritual Care of Staff”. In Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplain’s Handbook, ed. S. B. Roberts. Woodstock, VT: SkyLight Paths, 209–218.

Clarke, J. (2013) Spiritual Care in Everyday Nursing Practice: A New Approach. Basingstoke: Palgrave Macmillan.

Clarkson, P. (2003) The Therapeutic Relationship (2nd edn). London & Philadelphia: Whurr.

Cox, J. G. (1955) A Priest’s Work in Hospital. London: SPCK.

Corsini, R. (1984) Current Psychotherapies. Itasca, IL: FE Peacock.

Davies, C. (2014) “Spirituality, Health Care and Not Feeling Alone”. Caring for the Human Spirit (Summer): 5.

DoH (2012) IAPT Three-year Report: The First Million Patients. London: Department of Health. Available at: (accessed 12 May 2015).

Donovan, D. W. (2012) “Assessments”. In Professional Spiritual and Pastoral Care: A Practical Clergy and Chaplain’s Handbook, ed. S. B. Roberts. Woodstock, VT: SkyLight Paths, 42–60.

ENCHC (2014) Statement – Healthcare Chaplaincy in the Midst of Transition. The European Network of Healthcare Chaplaincy. Available at: (accessed 12 May 2015).

Fitchett, G. (1993) Assessing Spiritual Needs: A Guide for Caregivers. Minneapolis, MN: Augsburg.

Fitchett, G., and D. Grossoehme (2012) “Healthcare Chaplaincy as a Research-Informed Profession”. In Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplain’s Handbook, ed. S. B. Roberts. Woodstock, VT: SkyLight Paths, 387–406.

Gilbert, P., and R. L. Leahy (2007) “Preface”. In The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies, eds P. Gilbert and R. L. Leahy. Hove & New York: Routledge, xi–xiii.

Grit, K., and W. Dolfsma (2002) “The Dynamics of the Dutch Health Care System: A Discourse Analysis”. Review of Social Economy 60(3): 377–401.

Handzo, G. (2012) “The Process of Spiritual/Pastoral Care: A General Theory for Providing Spiritual/Pastoral Care Using Palliative Care as a Paradigm”. In Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplain’s Handbook, ed. S. B. Roberts. Woodstock, VT: SkyLight Paths, 21-41.

Handzo, G. (2013) “Lack of Integration for Chaplaincy is an International Issue”. Available at: (accessed: 12 May 2015).

Handzo, G., M. Cobb, C. Holmes, E. Kelly and S. Sinclair (2014) “Outcomes for Professional Health Care Chaplaincy: An International Call to Action”. Journal of Health Care Chaplaincy 20(2): 43–53.

Heelas, P., and L. Woodhead (2005) The Spiritual Revolution: Why Religion is Giving Way to Spirituality. Oxford: Blackwell.

Lazarus, A. A. (2005) “Multimodal Therapy”. In Handbook of Psychotherapy Integration (2nd edn), eds J. C. Norcross and M. R. Goldfried. Oxford & New York: Oxford University Press, 105–20.

Leader, D. (2009) “Talking Therapy”. The Guardian, Thursday 9 April. Available at: (accessed: 12 May 2015).

—(2010) “Being Mad is One Thing, Going Mad Quite Another”. The Guardian, Thursday 29 July. Available at: (accessed 12 May 2015)

Lucas, A. M. (2001) “Introduction to The Discipline for Pastoral Care Giving”. In The Discipline for Pastoral Care Giving: Foundations for Outcome Orientated Chaplaincy, eds L. VandeCreek and A. M. Lucas. New York and London: Routledge, 1–33.

McSherry, W. (2001) “Spiritual Crisis? Call a Nurse”. In Spirituality in Health Care Contexts, ed. H. Orchard. London: Jessica Kingsley, 107–117.

McSherry, W. (2006) Making Sense of Spirituality in Nursing and Health Care Practice: An Interactive Approach (2nd edn). London: Jessica Kingsley.

Mercadante, L. A. (2014) Belief without Borders: Inside the Minds of the Spiritual but Not Religious. Oxford: Oxford University Press.

NHS Choices (2015) The NHS in England. Available at: (accessed: 12 May 2015).

Nolan, S. (2015) “Making Spiritual Care Visible: The Developing Agenda and Methodologies for Research in Spiritual Care”. In Critical Care: Spirituality Engaging the Crisis in Contemporary Healthcare, eds J. H. Pye, P. Sedgwick, and A. Todd. London: Jessica Kingsley, 146–57.

Paley, J. (2008) “Spirituality and Secularization: Nursing and the Sociology of Religion”. Journal of Clinical Nursing 17(2): 175–86.

Peery, B. (2012) “Outcome Orientated Chaplaincy”. In Professional Spiritual & Pastoral Care: A Practical Clergy and Chaplain’s Handbook, ed. S. B. Roberts. Woodstock, VT: SkyLight Paths, 342–61.

Puchalski, C. M., and A. L. Romer (2000) “Taking a Spiritual History Allows Clinicians to Understand Patients More Fully”. Journal of Palliative Medicine 3(1): 129–37.

Ronaldson, S., ed. (1997) Spirituality: The Heart of Nursing. Melbourne: Ausmed Publications.

Ross, L. A. (1994) “Spiritual Aspects of Nursing”. Journal of Advanced Nursing 19(3): 439–47.

Saunders, C. (1988) “Spiritual Pain”. Journal of Palliative Care 4(3): 29–32.

Smith, W. C. (1979) Faith and Belief. Princeton, NJ: Princeton University Press.

Smith, W. C. (1991) The Meaning and End of Religion. Minneapolis, MN: Fortress.

Swift, C. (2009) Hospital Chaplaincy in the Twenty-first Century: The Crisis of Spiritual Care on the NHS. Farnham and Burlington: Ashgate.

Thase, M. E. (2013) “Comparative Effectiveness of Psychodynamic Psychotherapy and Cognitive-Behavioral Therapy: It’s About Time, and What’s Next?” American Journal of Psychiatry 170(9): 953–56. Available at: (accessed: 12 May 2015).

UKBHC (2009) Standards for Healthcare Chaplaincy Services. Cambridge: UK Board for Healthcare Chaplaincy.

Wilson, M. (1971) The Hospital – A Place of Truth. Birmingham: University of Birmingham Institute for the Study of Worship and Religious Architecture.

Wintz, S. (2014) “Outcome Oriented Chaplaincy is Key to Effective Spiritual Care”. Caring for the Human Spirit (Summer): 20.

Woodward, J. (2001) “Are Health Care Chaplains Professionals?” In Spirituality in Health Care Contexts, ed. H. Orchard. London: Jessica Kingsley, 84–95.

Wright, S., and J. Neuberger (2012) “Why Spirituality is Essential for Nurses”. Nursing Standard 26(40): 19–21.



How to Cite

Nolan, S. (2015). Healthcare Chaplains Responding to Change: Embracing Outcomes or Reaffirming Relationships?. Health and Social Care Chaplaincy, 3(2), 93–109.

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