The Rev. Verlyn Hemmen remembers the days when a hospital chaplain wore a clerical collar, carried a Bible and visited the bedsides of Minnesotans who were overwhelmingly Catholic and Lutheran.

Today roughly a third of patients are something else, estimates Hemmen, who oversees spiritual care at Twin Cities Allina Hospitals. They're Muslim, Jewish, another faith or nothing at all.

His chaplain closet still holds Bibles and a minister's stole, but there's also a stack of Qur'ans, Muslim prayer rugs, a "singing bowl" for Buddhist meditation, Jewish menorahs, and a soft leather pouch holding tobacco, sage and an eagle feather for American Indian rituals. The hospital chapel below his office — which already has a sign pointing to Mecca — is being remodeled to embrace diverse spiritual practices.

"We've moved away from words like "religion" to "spirituality," said Hemmen. "Now we work more with the spirit or the soul. This population has called us to broaden our approach to people, to meet people where they are at."

More than 520,000 patients checked into Minnesota hospitals last year, carrying religious baggage that wasn't as neatly packed as it used to be. One in four Minnesotans now identify as either unaffiliated with any religion, or not-Christian, according to Pew Research Center, a trend that has dramatically changed the world of chaplains and the spiritual care at Minnesota's hospitals.

A couple of factors are at work. Minnesota's growing immigrant community, which made 50,000 interpreter requests at just two Twin Cities health care systems last year, have injected new religious traditions that require more than a recital of "Our Father." One in five Minnesotans, particularly those younger, have an undefined or no faith, according to Pew Research.

Minnesotans may be particularly open to meditation, guided imagery and other spiritual practices because the state is a national leader in recognizing the mind-body connection in medicine, chaplains say.

Chaplains today are trained to work in interfaith ways, looking for spiritual or emotional connections that go beyond religious creed. Hospitals can, and do, still contact on-call Catholic priests, Protestant ministers or Muslim imams for patients who request that. They're also working to diversify the face of chaplaincy to include Muslims, Jews even nonbelievers.

"It is absolutely in flux," said the Rev. Gary Sartain, north central regional director for the Association of Clinical Pastoral Education, the national training association for chaplains. "We [the ACPE] are in the middle of a major reorganization. ... Should we change the name to Association for Spiritual Education?

"Even to find the terminology is difficult," he said. "How do we communicate to the world who we are and what we do?"

This month, the association is surveying members to solicit new name ideas. It's part of its own soul-searching as it marks its 50th anniversary, including a national conference in Minneapolis in May.

Myo-O Habermas-Scher, a Zen Buddhist priest raised in the Jewish faith, is among 45 staff chaplains serving Fairview Health Services' hospitals and hospice care. The group is mainly Protestant, but includes an imam and chaplains from Jewish, Buddhist and American Indian faith traditions as well as a nonbeliever, said the Rev. B.J. Larson, a Fairview director of spiritual health services.

Their work requires far more than bedside prayers.

Habermas-Scher starts her day reviewing the charts of patients she has visited and checking for other chaplain requests. She makes patient rounds with a health care team.

Sitting in her office, with small Tibetan prayer flags and Buddhist prayer beads strung above her desk, Habermas-Scher explained how she presents herself to patients.

"I explain we are all interfaith chaplains, that we are here to support you in any way," she said.

On a recent afternoon, she visited patient Sue Smith in a quiet corner of the floor lounge. The discussion, they reported later, explored emotional and spiritual issues related to disability and to aging. Habermas-Scher shared insights from the Old Testament as well as Zen teachings.

Smith, raised a Catholic but now less-so, said she appreciated the "neutral" counseling.

"For people who are searching, having an interfaith [approach] broadens things," said Smith, a student counselor at a Twin Cities college. "I like the openness of it."

Across the street, Sharif Mohamed, an imam who is part of the Fairview team, scans hospital admissions. On this day, 29 Muslims have checked into Minneapolis and Burnsville. He acts as cultural interpreter for staff, and emotional and spiritual adviser to members of one of Minnesota's fastest-growing religions.

In fact, Muslims — kneeling on prayer rugs facing Mecca several times a day — now visit hospital chapels more than people of any other faith.

Mohamed wears many hats here, and most recently has been composing a series of "universal prayers." He explains: "When I visit a non-Muslim patient, I want to pray with them but not compromise my own theology."

Most chaplains are still Christian, including Wendy Manuel a resident at Methodist Hospital in St. Louis Park. Here, patients find a menu on the tray next to their beds, listing "Healing Services," including aromatherapy, hand massage, guided imagery, prayer/healing ritual, and more.

Last week Manuel stopped by the room of Marcene Johnson, who requested a hand massage. Manuel took out oil and began gently massaging Johnson's hand, avoiding the IV tube as she rubbed her palms, her fingertips, her veins. Soon Johnson fell into a light sleep. After about 15 minutes, Manuel ended her gentle ritual, as a tear welled in her eyes. "It's like a prayer," she explained softly.

Johnson eventually opened her eyes again. A former evangelical Christian, she said she appreciated spiritual support "without dogma," noting, "They aren't pressuring you to follow their way of thinking."

All Twin Cities hospitals are traversing this shifting religious landscape. "It's been the delicate dance," said the Rev. Tim Nelson, vice president of Spiritual Well-Being at HealthEast Care Systems, which reports 68 languages spoken by patients last year. "Acknowledging our faith-based heritage, while expanding spiritual practices of those around us."

At Bethesda Hospital in St. Paul, a front-desk visitor will pass a nearly life-size statue of Jesus, just feet from the new "meditation room." North Memorial Medical Center holds an ecumenical service on Sundays, a Catholic mass on Wednesdays, and American Indian ceremonies in a grove of pine trees.

Hennepin County Medical Center has a "prayer wall" in its chapel stuffed with tiny paper requests from all faiths, and a CD collection of Benedictine and Hindu chants, New Age, country and gospel music.

The Rev. David Hottinger, manager of the Spiritual Care Department, recalled getting a late-night call for a chaplain — and music. When he arrived with a CD player, the patient wanted to hear Pink Floyd.

"Well, it just so happens I'm a big Pink Floyd fan, too," said Hottinger. "We had a deeply meaningful spiritual conversation, all with Pink Floyd as the entree. If I had come in with a collar and Bible, he would have sent me packing."

Many patients respond to these broader spiritual discussions, said Hottinger.

"Where does your strength come from?" I might ask. "Where do you see hope in your life? How can we help you find peace?"

A growing body of research has shown improved medical outcomes for patients receiving spiritual and emotional support, said Mary Jo Kreitzer, founder of the U's Center for Spirituality and Healing. The commission that accredits hospitals, in fact, requires that spiritual care be part of patient care standards, she said.

"Today it's less [about being] a faith leader, and more about providing spiritual care in the context of health, illness and suffering," said Fairview's Larson. "You have chaplains accompanying patients living with cancer, facilitating spirituality groups for children, designing a ritual for a family with a transplant."

"It's creative and challenging work," she said. "Vital health care depends on it."

Jean Hopfensperger • 612-673-4511