Spiritual and Pastoral Care in the Veterans Health Administration

Spiritual and pastoral care must be available to Veterans as part of the health care provided at medical centers, clinics, domiciliary, and other VA facilities. The type and extent of spiritual and pastoral care provided must be commensurate with the needs, desires, and voluntary consent of the individual Veteran. Veterans Integrated Service Network (VISN) Directors and facility Directors are responsible for ensuring that patients’ health care needs are met. Clinical chaplains, as the subject matter experts in spiritual and pastoral care, must be employed at each medical center to develop and implement a program which:

  • Ensures every patient’s constitutional right to free exercise of religion
  • Provides opportunities for religious worship, sacramental ministry, pastoral care and counseling
  • Protects all Veterans from proselytization (the imposition of religious beliefs or activities) from any source while in VHA facilities

Each Veteran’s needs and desires, or lack thereof, for spiritual and pastoral care must be screened as part of a complete evaluation of the individual’s health care needs. When a more in depth spiritual assessment is indicated, a clinical chaplain is the subject matter expert authorized to conduct the spiritual assessment and provide appropriate spiritual and pastoral care as desired by the patient. Chaplains collaborate with health care providers in providing of holistic care throughout a full spectrum of interventions and services as appropriate to an individual’s needs and desires, including:

  • Conducting worship services
  • Providing pastoral care for individual patients
  • Providing pastoral counseling with individuals and immediate family members in crisis
  • Facilitating spirituality and therapeutic groups
  • Conducting funerals and memorial services as authorized
  • Coordinating spiritual care for VA patients in all inpatient and outpatient treatment settings 

Policy
It is VHA policy that spiritual and pastoral care must be integrated into the comprehensive health care package made available to Veterans. VHA prohibits proselytization and does not promote, favor, or prefer any particular religion or faith group, nor does it promote, favor, or prefer religion over non-religion.
 
VA Chaplain Staff Responsibilities Health Care Facility Directors, or their designees, are responsible for ensuring that:

  • Spiritual and pastoral care commensurate with the needs, desires, and voluntary consent of the Veteran patient is provided as part of VHA health care
  • Veterans in VHA facilities are provided with opportunities for religious worship, in accordance with their needs and desires, in appropriate settings
  • Chaplains are employed as the designated subject matter experts for spiritual and pastoral care
  • Chaplains are included as members of the professional interdisciplinary teams available to provide holistic care to Veteran patients. 

Director, Chaplain Service is responsible for:

  • Developing policies for the provision of spiritual and pastoral care
  • Advising the Chief Patient Care Services Officer and field officials regarding policies and procedures for the provision of spiritual and pastoral care
  • Ensuring there is appropriate training and career development opportunities for VHA chaplains and other health care providers pertaining to the provision of spiritual and pastoral care
  • Ensuring there is on-going evaluation of the effectiveness of spiritual and pastoral care in VHA facilities using site visits and other means
  • Recruiting and evaluating applicants for VA Chaplaincies to promote a diverse, high quality workforce
  • Maintaining liaisons with religious organizations, professional organizations, the Department of Defense, and other stakeholders to develop and support spiritual and pastoral therapeutic relationships that contribute to accomplishing VHA’s mission

Definitions
Spiritual and Pastoral Care
- VHA spiritual and pastoral care is a total program of assessment and care, administered and overseen by chaplains utilizing the full spectrum of interventions, which include:

  • Identify patients’ religious and spiritual needs and desires
  • Address spiritual injuries
  • Enhance the patient's spiritual health.

Patient - A patient is an individual who is eligible for VHA care.
 
Chaplain - A VA chaplain is an individual meeting the qualification requirements of VA Handbook 5005, Part II, appendix F1, who provides spiritual, pastoral care and counseling in VA.
 
Clinical Chaplain - A clinical chaplain is an individual who meets all VA qualification requirements for Chaplain, and whose spiritual and pastoral care and counseling is characterized by:

  • In-depth assessment, evaluation, and treatment of patients
  • A high degree of integration into the total care and treatment program of a health care facility
  • Close working relationships with staff members of other professional health care disciplines 

Religion - Religion refers to all types of worship, sacrament, ceremonies, prayer, meditation, traditional observances, etc., by which individuals carry out their religious beliefs or through which they maintain or enhance their relationship with the focus of their religion. This includes wearing religiously significant clothing or jewelry, dietary customs, carrying or displaying religious artifacts, symbols, pictures, or scripture.
 
Spiritual - “Spiritual” has to do with that which is related to the “Spirit of Life.” Spirituality may be used in a general sense to refer to that which gives meaning and purpose in life, or the term may be used more specifically to refer to the practice of a philosophy, religion, or way of living. The word “Spiritual” is derived from the old Latin word “spiritus.” The English words “inspire,” meaning to breathe in, and “expire” meaning to breathe out, come from the same Latin root. The concept of breathing captures the meaning of the word “spiritual” in relation to that which is or is not “life giving;” therefore, spirituality may positively or negatively affect one’s overall health and quality of life.
 
Pastoral - The term “Pastoral” is an adjective derived from the image of the shepherd and is used to describe a relationship characterized by expressions of compassionate care, including spiritual counseling, guidance, consolation, empathetic listening, and encouragement.
 
Describing care as pastoral may refer to the motivation or attitude of the caregiver. In VA, pastoral care refers to care provided by a chaplain, professionally educated and endorsed by a particular faith tradition to provide such care.
 
Holistic Care - "Holistic care" is whole-person care tailored for the individual patient's needs and requests; it emphasizes the balance of the physical, environmental, mental, emotional, social, and spiritual aspects of human experience.
 
More>> Spiritual and Pastoral Care in the Veterans Health Administration Directive 
 
What VA Chaplains Do
The primary roles for VA hospital chaplains are to:

  • Ensure t