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Journal Volume 3 No 2 October 2000 EDITORIAL 'When a baby is so critically ill or so severely damaged that treatment is of questionable value, there are two processes going on: that of determining what should be done, and that of supporting parents through the decision making and the dying'. (McHaffie) As you read this, English law will have considered the case of Siamese twins Jodie and Mary; sharing one heart, both will die if left unseparated. If they are separated surgically, Mary will die, but Jodie's chances of survival will be enhanced. Their parents, devoutly Catholic, argue that matters should be left in God's hands; better to lose both babies than ac-tively to kill one. When does it become unethical to initiate or to con-tinue a procedure which is technically possible? Behind this question lies a depth of human anguish, both professional and personal, which must be at its most acute where the lives of children and babies are concerned. Our first article examines the ways in which the chaplain can best support parents and health professionals through the chaos and agony of losing a child. What form can spiritual care take, under such circumstances? The complexities of spiritual caring are illustrated on the one hand by Hazel McHaffie's finding that 'many parents are grateful when chaplains avoid reference to God', and on the other, by Tom Gordon's account of a daughter's prayer that her dying father might give his life to Jesus. Chameleon like, chaplains become practised at 'tuning in' to what a situation requires of us, yet at the same time we contrive to meet a diversity of human need with-out losing hold of our own spiritual integrity. John Banks makes a case for a like integrity in chaplains' discussions with colleagues on the meaning of spiri-tuality and spiritual care, if what he calls a 'spurious mutuality' is to be avoided. Meanwhile, Dorothy Grosvenor shares with us her experience of and re-flections upon the task of teaching spiritual care to nurses. The extent to which this is possible depends largely on how we define spiritual care in the first place. However defined, the task of spiritual caring is car-ried out in the fast changing environment of health care, and must be re-thought in response to changing patterns. Brian Cowan describes how the balance between the amount of care delivered from inpatient beds and through ambulatory care has altered sig-nificantly, and will do so more in future. Thus 'the services should be redesigned around the patients'. The implication for chaplaincy is that the chaplain's traditional ward round must needs give way to an-other model, and this is the area which Chris Levi-son explores in his article on the same theme. He reminds us that although medical methods may be speeding up, patients still process events at a human pace, and that the chaplain's contribution might help to 'humanise' a system increasingly dedicated to efficiency and speed of throughput. A ministry of brief but significant encounters will demand every bit as much from the chaplain, in terms of listening, empathy, focussed presence and the search for a word in season, as a ministry exercised in a more traditional ward based setting. From a recent multidisciplinary conference explor-ing Spirituality in Healthcare, Noel Brown, in his introduction to the ORERE SOURCE, offers insight into the challenges and developments for chaplaincy in the USA. With these and other
thought provoking contributions we offer you this edition of the Journal,
in the hope that you are stimulated to reflect....and perhaps to respond.
In our comment on 'Post Graduate Chaplaincy Study' we write, What may be imperilled or lost, and what gained, in this new world of chaplaincy? Reference:
CAMPBELL A V (1985) Professional-ism and Pastoral Care. Fortress Press.
Philadelphia. Full Text (PDF Format) |
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CONTENTS SUPPORTING
FAMILIES WHEN TREATMENT IS WITHDRAWN FROM NEONATES: PARENTAL VIEWS ON
THE ROLE OF THE CHAPLAIN Pages 2-7 Recent in-depth interviews with 108 parents for whose babies there was discussion about treatment withholding/withdrawal, have revealed that whilst the decision itself is seen to be in the medical domain, chaplains can provide valuable support and confirmation. Their reassurance about the morality of what is being done and about the trustworthiness of the medical team is appreciated. They can help parents to gain a sense of control, and offer comfort and ongoing recognition of their loss and grief. Where he has known the child and shared the distress of the parents, the chaplain has a strong advantage when it comes to tailoring the christening/blessing and burial/cremation services to suit the family's beliefs and preferences. A powerful source of solace which influences parents' thinking about treatment withdrawal derives from a belief in an afterlife and/or a divine plan. However, many parents are grateful when chaplains avoid references to God. Key Words: Neonatal care, withdrawal of treatment, decision making, support, chaplaincy, qualitative research Hazel E McHaffie is Research Fellow in the Department of Medicine, University of Edinburgh, and Deputy Director of Research in the Institute of Medical Ethics. Full Text (PDF Format) DOES
THE CAUSE OF DEATH INFLENCE HOW PHUSICIANS INFORM PARENTS OF THEIR CHILDREN'S
DEATHS? Pages 8-12 An uncontrolled prospective observational study was conducted to record the interaction of Emergency Department physicians in cases of trauma and possible Sudden Infant Death Syndrome (SIDS) deaths, to determine whether the manner of death influences whether physicians immediately deliver news of a child's death to the parents or whether the physician first asks questions of the parents. Physicians immediately delivered news of the child's death in three-quarters of the cases at our centre. The presence of other professionals appeared to influence physician behaviour. The sample size limits the conclusions to be drawn, but room for improvement is noted. Chaplains are in a position to teach other staff. Key Words: Death, SIDS., Children, Physician Behavior Daniel H. Grossoehme is director of pastoral care, Jeffrey Kempf is Attending Physician, Emergency Medicine Department, at the Children's Hospital Medical Center of Akron, Ohio 44333 USA. Full Text (PDF Format) MIND
YOUR LANGUAGE Pages 13-17 This is an extract from a dissertation submitted for the MA in Healthcare Chaplaincy, University of Leeds. The dissertation is a reflection on the current literary interest in spirituality within healthcare. While eager to listen and learn from those several disciplines that contribute to the debate, there is a concern that chaplains do not acquiesce in a 'spurious mutuality'. If chaplains simply accept the current 'post modern vacuousness' about spirituality it could serve to rob the other disciplines of the contribution which chaplaincy is uniquely placed to offer. If our colleagues in healthcare are to reach their desired destination of holistic care, then they deserve the best that chaplaincy can offer in the pre-sent debate on Spirituality. Key Words: Language, listening, neutrality, religious and secular spirituality. Rev John Banks is full-time chaplain to Ailsa Hospital, Ayr Full Text (PDF Format) REFLECTIONS
ON RELIGIOUS DOGMATISM
IN THE CARE OF DYING AND BEREAVED PEOPLE Pages 18-22 Faith and
religious beliefs provide comfort and support for dying people and for
those who are bereaved. In facing death and loss people find solace
in a framework of familiar beliefs and religious practices. However,
when religious thinking is restrictive, or when dogmatism is imposed,
religion can cause fear and distress, thus making the process of dying
and the journey of bereavement more difficult rather than easier. The
author argues that religious and non-religious people should be freed
from concepts and ideas which cause such distress and fear in order
that true feelings are accepted and worked through. Rather than struggling
with this only when the stresses of dying and bereavement are apparent,
such a process should begin in religious thinking and in religious communities,
when people are well, and when religious beliefs and practices can be
shaped to help people face the reality of their own mortality. Rev Tom Gordon is full time chaplain to the Marie Curie Centre, Fairmile, Edinburgh Full Text (PDF Format) REFLECTIONS
ON MENTAL HEALTH CHAPLAINCY Pages 23-27 In the ever evolving NHS change is the one consistent factor. For some change is exciting, for others it's threatening. No community likes to 'lose' its hospital, but what if change could bring a better local service? Brian Cowan reflects on the development of ACADs as a complimentary alternative to the traditional hospital site: a service and buildings redesigned around the patients. Chris Levison reflects on the practical implications the change could have on chaplaincy including: multidisciplinary team-working, spiritual needs, and closer community contacts. These papers were presented at the Chaplaincy Conference at Crieff in May 2000. Brian Cowan is Director of Medical Services, South Glasgow Hospitals University NHS Trust, Glasgow. Rev Chris Levison is chaplain at the Victoria Infirmary, Glasgow. The site of a proposed new ACAD. Full Text (PDF Format) TEACHING
SPIRITUAL CARE TO NURSES Pages 28-33 This paper explores the reason why spiritual care is recommended for nurses by discussing two main pieces of nursing research on spiritual care. This is related to Judaeo-Christian teaching and related issues of gender and the body/mind/spirit split in western culture and the effect of this on bodily care in nursing. If there is a case for teaching spiritual care separate from bodily care the difficult questions are who should teach it and what should be taught which is separate from cultural care as already addressed. Key words: Nursing, spiritual, body, gender, poverty, health Dorothy Grosvenor (Lovett) is a full ime lecturer in health/nursing at Napier University Edinburgh Full Text (PDF Format) MAINTAINING
THE INTEGRITY OF PERSONHOOD IN PALLIATIVE CARE Pages 34-39 The integrity of personhood refers to the wholeness or intactness of the self in all its diverse aspects. Life threatening illness can compromise the intactness of the self in many ways, four of which are examined here ; the resultant suffering can be understood as spiritual pain, since spirituality and the integration of the self are closely connected. The needs of persons faced with the threat of disintegration of the self are examined, and it is suggested that such needs may be best met by carers in four ways :- by Seeing, Listening, Loving , Respecting the Mystery. To do this requires not so much professional expertise as a way of being, a quality of presence which depends upon who we really are, as persons. Key Words: Palliative Care, Personhood, Hope, Spiritual Care, Suffering, Transcendence Rev Georgina Nelson is a whole-time chaplain at St John's Hospital, Livingston. Full Text (PDF Format) POSTGRADUATE
CHAPLAINCY STUDY Pages 40-43 Editorial Comment: In the changing world of Healthcare Chaplaincy there is no doubting the increase in whole time-chaplaincy appointments. Recent discussions with the Scottish Executive show a commitment to chaplaincy training: at least one full-time training officer is not far away. As chaplaincy develops we are moving into a world where appraisal, clinical supervision, and professional development are the norm. In palliative care in particular new chaplains are being appointed on the understanding there will be a commitment (on both parties) to further professional study. The choice of courses for such study is limited, though what is around would seem to be of good quality. Three courses that are available are appraised by recent graduates who give us an insiders view of the courses, the costs, and the commitment involved. MA
in Healthcare Chaplaincy
MSc.(MedSci)
Doctor
of Ministry, FullText (PDF Format) BOOK REVIEWS Pages 44-47 On
the death of a child, 2nd Edition Full Text (PDF Format) |
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THE ORERE SOURCE Abstracts from Pastoral Care and other health Care Journals. Pages 48-54 Rev
W Noel Brown Full Text (PDF Format) |
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