Abstract
Purpose of Study
The purpose of this case presentation is to provide an example in which a hospital chaplain provided timely, effective spiritual and emotional support to a group of nurses who lost their beloved colleague unexpectedly after childbirth.
Design of Study
This is a case presentation.
Methods Used
This is a case presentation of a work encounter with a highly significant topic.
Findings
This case presentation demonstrates the effectiveness of a hospital chaplain's support for the staff in personal crises. This case presentation uses Hilsman's Spiritual Needs Framework to assess staff needs.
Conclusions
This case presentation highlights the unique opportunities which hospital chaplains have in providing timely, effective spiritual and emotional support to the nursing staff in personal crises, based on their rapport with one another through their shared patient care experience.
Introduction
I have been working as a hospital chaplain since 2018. The COVID-19 pandemic started in the middle of my first year of Clinical Pastoral Education residency in 2019–2020. The COVID-19 Delta variant hit the United States hard with vengeance in 2021. At this time, I was a staff chaplain for another hospital after my CPE training. My hospital asked me to round on the staff intentionally to support the staff. An ICU manager asked me to “walk slowly” to support the nursing staff. One nurse told me that when I checked in with her, it was the best time of her stressful day, because I was the only person at the hospital who showed any interest in her own personal well-being that day. The COVID-19 pandemic trained me to be a hospital chaplain not only to patients but also to staff. Staff care is as important to me as patient care, because I firmly believe that the staff's well-being directly impacts patient care outcomes.
Healthcare workers frequently encounter unexpected deaths of patients. When the death is someone whom they know personally, the impact may be harder on them. I still vividly remember when and where I received the phone call from my brother that my father had passed in South Korea a few hours earlier. I was completely shocked and had to sit down for a while to process what just had happened. This case presentation shows how I, as a hospital chaplain, provided timely spiritual and emotional support to a group of nurses who were shocked by their beloved colleague's tragic death after childbirth. At the time of this case, I worked as a full-time staff chaplain at a 350-bed acute care hospital located in a large city in the southwestern United States. I had been working for the hospital for about a year. I was hired as one of six full-time staff chaplains. I am a Korean American male. I was 49 years old at the time of this case. I am an ordained and endorsed Baptist minister. I am Board Certified with the Association of Professional Chaplains.
Background
Amy (pseudonym) was an African American female nurse, married, in her early 40s at the time of her death. Amy had a natural and gentle smile. She was kind to everyone at work. Everyone I engaged with says Amy was loved by all. Amy was one of the hospital Float Pool nurses. The Float Pool nurses belong to the Nursing Support Team, and they are sent to different units each day, depending on the hospital's staffing situations. It is difficult for them to develop a strong association with any clinical unit. I often worked with Amy for patient care across the hospital. A few weeks before Amy's baby was due, her colleagues organized a baby shower for her. Amy had a full-term pregnancy and gave birth to a healthy baby named Charlie (pseudonym). Amy experienced a serious hemorrhage after delivery. Amy died in another hospital, and no one knew what happened to her medically in detail. I received permission from Amy's family members and my two nurse colleagues—whose conversations with me are attested here—to publish this case presentation anonymously.
Method
I recalled what had happened after a nurse's tragic death after childbirth and how I provided timely, effective spiritual and emotional support to her colleagues. I decided to write this case presentation many months after these events. I did not record any of the two conversations, which I include here. They are not the exact words that were spoken. I reconstructed them as best as I could, based on my own memory, following the format of what is called “Verbatim Pastoral Work Report” in Clinical Pastoral Education. I had many other conversations like them with other nurses. I include these two conversations, only because they were most meaningful to me and I still remember them vividly.
Healthcare chaplains make spiritual assessments of patients after their visits, following the evidence-based practice of health care. I use Hilsman's Spiritual Needs Framework (Hilsman, 2017) as my assessment method. There are no extant published or validated spiritual assessment methods for chaplains to utilize specifically for healthcare colleagues. While Hilsman's Spiritual Needs Framework is not a validated assessment tool, it has been used widely by hospital chaplains since 2017 for their electronic documentation. I reconstructed my spiritual needs assessment retrospectively, based on my memory. I provided spiritual and emotional support to at least 15 nurses who were close to Amy, as I worked with them for patient care and ran into them in the hospital until about 6 months after her death. Hilsman identifies 22 spiritual needs, based on four organizing questions (four axes):
1. “What does this patient[nurse] need from me emotionally right now?” 2. “What has this person lost?” 3. “How does this person uniquely maintain her own human spirit?” 4. “What does this person need that is beyond what I may be able to provide?” (Hilsman, 2017, pp. 104–105).
Encounters
A day after Amy's death, I ran into Debra (pseudonym), one of Amy's Float Pool nurse colleagues, in the Emergency Department (ED).
D = Debra C = Chaplain
D1: (With a heavy voice) “Chaplain Lee. Did you hear the news?”
C1: “What news are you talking about?”
D2: (With tears in her eyes) “About Amy.”
C2: (With no clue) “What about Amy?”
D3: “She died after giving birth yesterday.”
C3: (Being completely shocked) “What? What are you talking about? I recently saw her in the cafeteria.”
D4: “Me, too. I worked with her two weeks ago. They could not stop her bleeding. She died.”
C4: (Not being able to believe what was spoken) “Wow. I cannot believe this.”
D5: “Me, too. I was very close to her…”
C5: (With tears) “Uh. I am so sorry, Ms. Debra.” (Giving her a big hug, with her permission)
D6: “Thank you. You never know … Wow.”
C6: “Thank you for letting me know. (Pause) She was so kind and wonderful.”
D7: “I don’t know what to say. This is big. Lord, have mercy.”
C7: “Do you know anything about the funeral service?”
D8: “No, I don’t. But I will text you as soon as I hear about it.”
C8: “Thank you. I want to attend it to support her family.”
D9: “Me, too. I will let you know.”
C9: “Thank you so much. I will see you around.”
D10: “Okay, you take care” (sigh)
Ten staff members attended Amy's funeral service and visited her burial site. After people left her burial site, the hospital staff gathered around it and left flowers on the ground. I offered prayer for God's comfort and strength for Amy's family, as the hospital staff requested.
A few days after Amy's funeral service, the Spiritual Care Department facilitated a memorial service for Amy in the hospital chapel. It was fully occupied, with some people standing in the back. Ten of Amy's family members joined us to show appreciation. I shared the Word of Comfort (a short message at the end of our interfaith memorial service), and I read a poem which I wrote for Amy and Charlie.
A few weeks later, I ran into Faith (pseudonym), Amy's Float Pool nurse colleague, at a nurse station.
F = Faith C = Chaplain
C1: “Hi, Faith. How have you been?”
F1: (With a smile) “Hi, Chaplain Lee. I have been doing okay. How about you?”
C2: “Me, too. Thank you for coming to Amy's funeral. It was good to see you there.”
F2: “You are welcome. (Pause and with tears in her eyes) I am still shocked and sad for Amy. I still do not understand what happened to her.”
C3: (Joining Faith in her grief) “I hear you. (Pause) I also cannot believe she is gone. I just saw her a few weeks ago in the cafeteria. She was so excited to become a mom. That was her dream come true.”
F3: “I know. I also worked with her not too long ago, just before her maternity leave.”
C4: “I know you were close. (Pause) I am sorry for your loss, Faith.”
F4: “Thank you. (Pause and with a change of tone) Your poem made everyone cry. (Playfully) You are so mean.”
C5: (With a smile) “I apologize. (Pause) I just did not know what to say. Someone suggested to me that I read a poem. Why not write one instead?”
F5: “I am so glad you did that. You blessed all of us through your poem. You helped us to have closure and start again with hope.”
C6: (Being pleased to hear that) “My pleasure. I am always here for your support. If you need to talk or need prayer, please stop me at any time, okay?”
F6: “Okay, Chaplain Lee. Thank you so much for always being there for us. Barbara (Amy's sister, pseudonym) sent me some pictures of Charlie yesterday. Do you want to see them?”
C7: (With excitement) “Yes, please.”
F7: (Taking her phone out) “Here we go.”
C8: “Wow, he is so cute. He has Amy's eyes. Doesn’t he?”
F8: (Looking at the photo again) “Oh, you are right. He does. He is a cute baby. He is growing fast.”
C9: “Awesome! I am so glad to see that.”
F9: (An incoming call) “Chaplain Lee, it is so nice to talk to you. I will keep you posted.”
C10: “Thank you so much for the update. Have a good day!”
F10: “You too.”
Intentional brief check-ins like this continued for about 6 months with the Float Pool nurses. On Amy's birthday, Barbara invited the nurses to join the Walk for Amy and Awareness for Black Maternity Health. I joined the walk with five staff members. Amy's parents remembered us and thanked us for our support. Barbara showed us the recent pictures of Charlie.
Needs Assessment
I identified four spiritual needs in Axis 1 (emotional support)—(1) “trauma shock”; (2) “need to talk”; (3) “sadness, discouragement, despair”; (4) “empowerment” (Hilsman, 2017, p. 105). First, the Float Pool nurses needed immediate support for the trauma shock after hearing the tragic news. Second, they needed to process their complex emotions verbally. Third, they needed to name their sadness, as they had high hopes for Amy and her family. Fourth, they needed empowerment to cope with their loss and continue their everyday lives and work. Several rituals created opportunities for empowerment including the graveside service, the hospital memorial service and the Walk for Amy.
Care Planning and Interventions
For six months, I intentionally checked in with the Float Pool nurses about their grief over Amy's death. I provided spiritual and emotional support to them whenever I saw them in the hospital. Retrospectively, I planned my care in accordance with the four spiritual needs:
I facilitated “careful listening, empathic reflecting, gentle query, supportive validating, [and] intuitive grasping” (Hilsman, 2017, p. 105). The Walk for Amy happened 6 months after her memorial service. After that, I noticed that they processed with me other life issues, when I checked in with them. I assessed, then, that I no longer needed to inquire about their grief as regularly.
Ethical Considerations
I contacted my hospital's Institutional Review Board, and I was told that I did not need a review for a case presentation. I received permission to publish this case presentation anonymously from Amy's family members and my two nurse colleagues.
Results
After my intentional check-ins with the Float Pool nurses concerning their grief over Amy, I observed that they came to terms with her death and began to hope for Charlie. They all wanted to be his aunties and see him grow. I assessed that my support for the staff helped them to reach the stage of “acceptance” and that of “hope” in Kübler-Ross’ On Death & Dying (
1969
). My spiritual care intervention brought the following outcomes, which Hilsman lists:
1. They engaged in “conversation for initial verbal processing of the event.” 2. They expressed “immediate emotions and needs.” 3. They accepted or requested “prayer with chaplain.” 4. They thanked “the chaplain for stabilizing assistance.” 5. They acknowledged “the realistic scope of the sadness as painful but not overwhelming.” 6. They expressed “appreciation for presence and quiet understanding.” (pp. 215–236)
Debra gave me the following comments:
You are an asset to our facility, and you have always been with the staff, family and other interdisciplinary team members. You always think of others. We are fortunate to have you. You are a good person. You deserve the gold badge [ICARE Award—Service Award] and more.
Faith gave me the following comments:
I am still tearful thinking about Amy until this day. Chaplain Lee's immense emotional support in Amy's death has provided comfort for my coworkers and me.
I am grateful that there is great rapport amongst Chaplain Lee and hospital staff. This relationship made it easier for many of us to express and process our grief in Amy's tragic death. Even after more than one year, Chaplain Lee's continued support by being present at gatherings to remember Amy has provided comfort and encouragement amongst hospital staff and loved ones. This unrelenting kindness is palpable and gives us hope.
Discussion
Shah et al. (2021) report extensive nurse burnout in the United States since the COVID-19 pandemic. Usset et al. (2024) note that healthcare workers (HCWs) are exposed frequently to potentially morally injurious events, which are associated with turnover intentions and burnout. The recent research showed the effectiveness of chaplain support for the staff (Gaines et al., 2023; Liberman et al., 2020; Tartaglia et al., 2024). Colorafi et al. (2025) state, “Findings suggest that HCW frequently experience work-related moral distress and seek relief by interacting with hospital chaplains. Chaplain care … is an easily accessible resource to HCWs. Facilitating chaplain-HCW interactions may be an effective strategy for responding to moral distress and improving healthcare workers’ well-being” (p. 102).
In addition to work-based burnout and moral injury, nurses, like everyone else, go through various personal life crises which need spiritual and emotional support. The Joint Commission on the Accreditation of Healthcare Organizations required spiritual support only for patients (Colorafi et al., 2025). However, chaplains have unique positions and opportunities in supporting the nursing staff, as they already know one another through their shared patient care experience. Chaplains provide timely, effective staff support through their ongoing intentional check-ins with nurses before and after crises. While the Employee Assistance Program offers more professional and in-depth counseling service to the staff, it is not as accessible to the staff as chaplaincy services on site. Also, the staff may be more resistant to it for several reasons, such as that they do not know them in person and it takes extra effort to reach out to them.
Implications for Holistic Nursing Research, Education, and Practice
I call the theoretical framework of my spiritual care, “Pause, Creating a Space for I and Thou.” I base my spiritual care on what Buber calls “the I-You relation” in his classic I and Thou (1970). This broadens the scope of my spiritual care, creating a safe space with those with different personal backgrounds. Buber (1970) contrasts the I-You relation and the I-It relation. What gives life or spirit to a human being is one's ability to have a reciprocal relationship with oneself and someone else. Buber's simple but profound insights lay the theoretical foundation for my spiritual care practice. The Float Pool nurses told me that they appreciated the safe space that I provided to them, and they were touched by my poem for Amy and Charlie, which reminded them of the I and Thou relation between Amy and them.
Medicine and healthcare industry like words like “evidence-based,” “kaizen,” “LEAN,” and “productivity,” which resonate with what Buber (1970) calls “the I-It relation.” Chaplaincy has its innate challenge to justify its existence in healthcare today, precisely because its essence is qualitative rather than quantitative. It is holistic in nature and embodies mind, body, and spirit. This is true also for nursing, as holistic nursing goes beyond scientific quantitative data. Patients are not projects to be done or problems to be fixed. They are human beings who deserve respect, dignity, and care. This applies to healthcare workers themselves too. Holistic nursing can continue to remind us that compassionate and excellent care starts from what Buber (1970) calls “the I-You relation.” One of the implications for this case presentation is that chaplains’ ongoing personal check-ins with nurses, while working together for patient care, strengthen their rapport with them, which turns out to be effective in times of personal crises. There is a saying in Korean for athletes, “practice like a game and play a game like a practice.” Chaplains’ “relational cohesion” with staff in ordinary times proves itself to be a strong resource for extraordinary times (Lawler et al., 2000).
This case presentation shows the need for continuing research on the effectiveness of hospital chaplains’ staff support. Holistic nursing includes the holistic care of nurses themselves in addition to their patient care. Education needs to be given to nurses to reflect on the role of the multidisciplinary team, helping the team members care for one another holistically in addition to their patients. Nurses also need education regarding chaplaincy and spiritual care. Education will help nurses to realize that chaplains value and create opportunities for spiritual and emotional support to all people regardless of faith tradition or no faith.
Conclusion
As “a wounded healer” (Nouwen, 1972), I walked with the Float Pool nurses in their loss and grief after Amy's tragic death. Walking with my nurse colleagues also healed me and helped me accept my loss of a dear colleague. We supported one another together as a community of suffering and hope for Amy. This case presentation provides an example in which I, as a hospital chaplain, provided timely, effective spiritual and emotional support to the nursing staff after their colleague's tragic death. I was able to provide authentic and meaningful support to the nursing staff after the crisis, because of our mutual trust and relationships as colleagues in patient care before the crisis. Hospitals are required to provide spiritual care only to patients. However, only holistically healthy staff can provide holistic care to their patients, and they also need support. This case presentation illustrates that chaplains have unique positions and opportunities in providing timely, effective staff care in times of personal crises. This care presentation also portrays that hospitals can empower chaplains for staff support in addition to patient care. I end now with the poem I wrote for Amy and her son.
I AM SO PROUD OF YOU
Mommy, I am so proud of you.
You cared for many, while I was in your womb.
We walked many steps together.
I want to care for others too.
Mommy, I am so delighted to be yours.
You and I got to spend time everywhere.
You smiled at everyone even in the busy moments.
I want to brighten someone's day too.
Mommy, I am so thankful to you.
You gave up your life to give me life.
A part of you is living through me now.
I am proud to be yours.
Mommy, I am so proud of you.
You lived a short life, but your legacy continues.
Countless people tell me how wonderful and kind you were.
I want to be like you one day.
(Written by the author for Amy's Memorial Service)
Footnotes
Consent for Publication
Permission was received from the deceased nurse's family and the two nurses whose conversation with the chaplain was included.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.