A Longitudinal Retrospective 5-Year Registry Study of the Health Care Chaplains’ Work in Finland: Impact of a Large Health Care Services Reform

Spirituality and spiritual care are essential parts of patients’ well-being and health care. Health care chaplains (HCP) are recognized experts in spiritual issues. The work of chaplains may be subject to cultural and structural changes in the societies. However, very little long-term data are available on the HCPs work or how reforms of health care services influence health care chaplaincy. This study aims to find out how the workloads of HCPs evolved during 2021–2025 and explore the observed differences before and after the 2023 health care reform. The study is based on public registry data of health care chaplains’ actual work from the Evangelical Lutheran Church of Finland before (2021–2022) and after (2023–2025) the implementation of a large national health care services reform. All chaplains are obliged to report their daily activities on a weekly basis anonymously to the registry. Information about hospitals, patients and regional populations was collected from annual national statistics. Data concerning chaplains’ work were grouped into primary categories defined by the context. The total number of chaplains was 103 and 0,04 per 1000 patients on average during the 5 years, mostly located in the capital area. Chaplains’ most prominent tasks were discussions with patients about their health and illness-related issues, life crises and daily life events, while the religious rituals occurred substantially less frequently. The Finnish chaplains met a total of 324,244 persons at different encounters during the years. The number of patients in the age group of 29–64 years increased significantly during the observation period, and the number of conversations about life crises, grieving, death and daily life became more prevalent after the health care reform. It was found that, for the most part, chaplains’ tasks did not change and that they were paid only by the Finnish Lutheran Church. In summary, the Finnish Evangelical Lutheran Church pays the health care chaplaincy for all Finnish hospitals, and the pastoral conversations may reflect the instability of health care services reform in the country.