SACH
Scottish Journal of Healthcare Chaplaincy
Vol 12 No 2 November 2009
Editorial
Chaplains must first plumb the depths of their own souls and experience before they can accompany others to the depths of their own. Robert Mundle
As NHS employees, chaplains are subject to all that is expected of NHS staff and that includes clinical governance. This means that just thinking the needs of patients are being met is not good enough – services are intended to be audited, researched and reviewed continuously. Aldridge et al.
These two comments sit in conscious contradiction in this volume of the journal. Between them lies the tension of modern chaplaincy. How does a professional individual offer the depth of their own soul’s experience while living and working in a highly regulated authority structure? How do chaplains hold on to the depth of the soul when number crunching, verbatim analysing and auditing are all required of their service by the NHS at large? The current issue offers varying answers to these questions, and I hope that might stimulate debate about what it is chaplains offer, what we measure and why, and whether research and the depths of the soul are in harmony or in conflict.
Aldridge et al look at what chaplains actually discuss with patients. They gather first an idea of what it might be and it is no surprise that ‘death and bereavement’ is a hot topic - a hot topic, perhaps, but not as frequently discussed as the team expected. The telling of story is another area which chaplains know from experience is a common theme but to have it recorded and delineated is very useful, and I hope will reinforce the link between story and good chaplaincy. When is a story spiritual? Is all personally told story spiritual? Does non-spiritual or not clearly religious content diminish the value of chaplaincy contacts? Or is there nothing which is not spiritual? Or is non-spiritual content just necessary scene setting? This was a small study and it raises some interesting questions, hopefully it will inspire further work into patient contacts. There is much more that can be done in the future to build on this useful work.
Mundle too raises potentially contentious questions of consent and of religious boundaries. Can chaplaincy, by its nature pluralist and spiritual in emphasis, challenge religious boundaries? Is it part of the nature of human experience to do so? What is the role of the patient’s own request in asking for boundaries to be challenged? Where does boundary challenging become evangelism or proselytising? And there are further questions surely to be answered about the interface between chaplains and faith group leaders, imams, clergy, those who hold the traditions and boundaries of the faiths and also work daily with the challenges that those boundaries meet and absorb.
The boundary between chaplain and faith group leader is viewed from the perspective of co-operation in Cavannagh et al’s work on Trauma and Faith Group Leaders, significantly looking at the level and intensity of experience brought to the door of the minister, priest or belief group leader by those who have suffered traumatic events. Here the boundaries between chaplain and faith group leader are challenged and the similarity of the pastoral and spiritual care work done by both groups is emphasised. Much that chaplains may normally feel is distinctive to their role becomes shared endeavour in this piece.
The shared endeavour could be said to be the theme in both Lumsdaine and Mulligan’s article on Organ Donation and Beth Seymour’s article on nursing students and their own views on spirituality. The co-operation between clinical and spiritual care is rarely straightforward and the interaction between spiritual and physical illness is certainly not direct. Both these pieces bring to the fore the need for individual insight and respect for individual opinion as an underpinning principle of all care, religious, spiritual or clinical.
Readers will also find a new section in the journal entitled ‘Reflective Practice’. Following the practice of some journals to include a ‘Views and Reviews’ section, or to print letters to the editor, the board have decided to create a dedicated section in each issue for views, opinions, and reflective pieces, of 500-1000 words. Those involved in the delivery of Spiritual Care, Religious Care, or Healthcare Chaplaincy are invited to submit short pieces which are grounded in their experience of practice by way of reflection, case study, discussion of current issues or response to previous articles. An invitation to contribute to this section will replace the previous call for letters to the editors.
In order to inaugurate this new section, Tom Gordon writes of the last boundary of life and he reflects on the finality and liberation of death and some common misconceptions of healing and cure, and of suffering, which he has encountered while working as a chaplain. The depths of the human experience are again brought to the surface as a Church of Scotland committee discusses health and healing.
This volume has much within it to stimulate thought and debate. It seems to me that the questions raised, relating to the relationship between research and the active work of pastoral and spiritual care, may be carried forward for some issues to come. As boundaries are breached, and yet also respected, the interaction between chaplaincy and the professional disciplines with which chaplains work ought to produce more research questions for the profession to examine.
WHAT DO PEOPLE TALK TO CHAPLAINS ABOUT?
Anne Aldridge, Derek J Fraser and Keith Morrison
Abstract:An inpatient stay in an acute hospital setting often causes distress, confusion and in many cases the desire to explore existential issues. For health care chaplains there is no debate about the efficacy of the role they play in these existential explorations however there is an increasing need to provide evidence-based research to verify this. As a profession chaplaincy is well versed in anecdote but it needs to move beyond that to evidence of a more robust kind. This research project was an in-depth review of the dialogues held with thirty-four different adults in an acute hospital over a period of three months in 2007 to determine what people talk to chaplains about. The project involved 12 different chaplains having an encounter with a patient and then writing it up as a verbatim. At the same time a literature search was carried out to determine any other research projects of a similar nature. The texts of the encounters were analysed by two chaplains independently – they determined themes raised in the discussions and manually scored these according to the frequency of their occurrence. Results were then compared and areas of discrepancy discussed. Qualitative software was used to verify the findings. The results showed that conversations appeared to fit into four main topics: spiritual themes; life stories; hospital experiences and emotional expression.
Keywords: chaplaincy, spiritual care, efficacy, verbatim, spiritual conversations, hospital experiences, life stories, emotional language
Pages 3-10
Anne Aldridge is Deputy Lead Chaplain at Cambridge University Hospitals NHS Foundation Trust.
Derek Fraser is Lead Chaplain at Addenbrooke‘s in Cambridge and has been involved in the UK Board of Healthcare Chaplaincy (UKBHC) from its inception.
Keith Morrison is a hospital chaplain whose role is Bereavement Care Follow-up Lead at Cambridge University Hospitals NHS Foundation Trust.
Live Donor Kidney Transplantation and the Place of Chaplaincy in the Donor Advocacy Team
Jen Lumsdaine and Anne Mulligan
Abstract: These two pieces (one from a transplant co-ordinator and one from a chaplain) outline some of the ethical and pastoral issues raised in the increasing field of live donor organ transplantation. These include autonomy, ‘first do no harm’ and the support of families facing these decisions. The articles are based on the work of two members of staff in the Royal Infirmary of Edinburgh.
Keywords: live donor transplant, spiritual care, medical ethics, pastoral care
Pages 11-15
Jen Lumsdaine is the Living Donor Transplant Co-ordinator at the Royal Infirmary of Edinburgh.
Anne Mulligan is Chaplain to the Transplant Unit at the Royal Infirmary of Edinburgh.
Religious Pluralism and the Hospital Chaplain
Robert Mundle
Abstract: Following theologian Raimon Panikkar, I argue that healthcare chaplaincy is authentic in regard to religious pluralism only when it is dialogical. In examples of pastoral problems of sacramental ministry and prayer that challenge the aims of denominational and multi-faith chaplaincy, I show how professional healthcare chaplains may enter into communion with patients in authentic relationships while maintaining a sense of alterity necessary for dialogue and effective ministry. I explore also the role of embodied alterity in the creative tension of intrapersonal relationships. In response to the theological challenge of religious pluralism, I conclude that by experiencing dialogical pluralism in the reflective practice of ministry, healthcare chaplains can offer unique insights to pastoral theology.
Key Words: pluralism; communion; alterity; Panikkar; sacrament; prayer
Pages 16-20
Robert Mundle is Chaplain at the Toronto Rehabilitation Institute in Toronto, Canada, where his position is partially funded and defined by the Catholic Archdiocese of Toronto. He completed a residency in Clinical Pastoral Education at the Hospital of St. Raphael in New Haven, Connecticut, USA, and is professionally certified by the National (USA) Association of Catholic Chaplains. He holds graduate degrees in theology from Yale Divinity School and the University of St. Michael’s College in Toronto where he is currently pursuing doctoral studies in Theological Ethics.
The Hospital Chaplain as Religious Interpreter in Bioethical Dilemmas
Robert Mundle
Abstract: Using a recent example of a highly publicized case in Canada in which a family’s demands for life-sustaining treatment based on religious beliefs were pitted against a physician’s refusal to provide “inappropriate” care, this article critiques the suggestion that chaplains function as “religious interpreters” in bioethics cases that seek to determine the medical validity of religious beliefs. It argues that the chaplain as interpreter of religious beliefs and values requires a full vision of the chaplain’s unique and complex role in healthcare that (1) regards the patient not the chaplain as the “expert,” (2) utilizes a variety of key images of pastoral care, and (3) engages a process of dialogical hermeneutics. It concludes that in its broadest understanding and fullest appreciation beyond judgmental interpretation of facts alone pastoral care provides a helpful resource to healthcare teams and an influential model in the art of ethics consultation that embraces uncertainty to build trust among stakeholders.
Key words: bioethics; religious beliefs; validity; pastoral role; dialogue; ambiguity
Pages 21-28
Robert Mundle is Chaplain at the Toronto Rehabilitation Institute in Toronto, Canada.
Faith group leaders and trauma: the difference that can make the difference?
Paul Cavanagh, Janet Foggie, Alastair Hull and Basel Switzer
Abstract: Traumatic events are very much a part of everyday life; they are neither new nor rare. The care of faith group members suffering from psychological trauma is a significant component of pastoral care and yet little attention has been paid to this complex area. This article details the results of a collaborative study between mental health and faith group leaders and between NHS Tayside and NHS Fife, which examines the role of faith and belief group leaders in working with people who have been subjected to trauma. The first part of this article details questions of interest to chaplains and faith group leaders, such as: the relationship between the faith group leaders and mental health personnel, and what training was available to faith and belief group leaders? Following completion of the study a consultation day was held by the Department of Spiritual Care in NHS Tayside (in November 2008) at which the collated results were presented. The faith group leaders, chaplains and health personnel who were present were able to give their responses to the results of the survey; those responses constitute the second part of this article.
Key Words: trauma, faith and belief group leaders, spiritual and religious care
Pages 29-37
Paul Cavannagh is Consultant Psychiatrist in community rehabilitation, Queen Margaret Hospital, Dunfermline
Janet Foggie has been recently appointed Minister of St Andrew’s Parish Church, Dundee
Alastair M Hull is a Consultant Psychiatrist in Psychotherapy for NHS Tayside and Honorary Senior Clinical Lecturer at the University of Dundee.
Basel Switzer is a Consultant Adult Psychiatrist in the Scottish Borders
What do nursing students understand by spirituality and spiritual care?
Beth Seymour
Abstract: The assumption that nursing students have an understanding about the nature of spiritual care requires examination especially in an environment which expects nurses and other health care staff to provide spiritual care. Unfortunately there is little by way of spiritual education in nursing courses. This article describes a case study of nursing students’ understandings of spirituality and experiences of spiritual education. The focus is on a particular method of data collection from the larger study, the nominal group technique, and discussion surrounds its use, analysis and findings.
Key words: spirituality, spiritual education, spiritual care, case study
Pages 38-46
Beth Seymour is a lecturer at Glasgow Caledonian University specialising in spiritual and emotional health. She directs the Centre for Spiritual and Pastoral Care Studies and runs modules in ethics, arts and humanities and spiritual care.
e-mail - b.seymour@gcal.ac.uk
Advance Care Planning - how does it work in practice?
Alison Rich with Julian Abel
Abstract: : Talking to patients about dying is never easy, so anything that can improve this communication has to be a significant benefit. Recent national developments in the UK have highlighted the importance of choice for patients in both the place they die, and the interventions they would want to have. Such developments are aimed at improving quality of care and empowering patients and include the national NHS End of Life Care Programme (2009) and The Mental Capacity Act (2005). This article examines the evidence behind using Advance Care Planning (ACP) as well as the practical issues of who might be best placed to undertake these discussions and what documentation tools to use. It concludes that care should be individualised and full use made of established professional relationships. Communication needs to be to the highest standard as the risks of causing distress are significant. Full use of the breadth of the multi-disciplinary team can enable full discussion of wishes around spiritual, social as well as medical care.
Pages 47-51
Alison Rich and Julian Abel are consultants in Palliative Medicine in Weston-super-Mare. They care for patients in the hospital, hospice and community settings. They have a particular interest in enabling patients to be engaged in planning care and in the process of effectively sharing this information.
Assessment and Documentation of Religion and Spirituality in the Liverpool Care Pathway for the Dying Patient – How Well is it Done?
Claire Tuck
Abstract: Introduction: The Liverpool Care Pathway for the Dying (LCP) provides a standardised evidence-based approach to caring for patients and their relatives in the final days of life (MCPIL, 2009). Goal 6, Section 1 of the LCP assesses religion and spirituality. Methods: A retrospective audit of assessment and documentation of Goal 6, Section 1 of the LCP was carried out between 1.6.08 – 31.8.08. Following discussion with the MCPIL, a standard for 80% compliance was set. Results: Compliance with the 80% standard was not met. 50% of patients and 74% of relatives had their religious/spiritual needs assessed with them. 42% of patients had a religious tradition/spiritual need identified and 42% of patients were offered internal chaplaincy support. Internal discussion suggested Hospice staff were not always comfortable discussing religion/spirituality with patients and their families and that religion was easier to document than spirituality. Conclusions: Ways in which provision of religious/spiritual care to dying patients and their families might be facilitated were discussed internally and recommendations for providing this care were made.
Key words:Religion, Spirituality, Liverpool Care Pathway for the Dying, LCP, Bereavement, Dying
Pages 52-59
Claire Tuck is a Clinical Assistant in Palliative Medicine at Strathcarron Hospice, Stirlingshire.
REFLECTIVE PRACTICE
In this new section of the journal, those involved in the delivery of Spiritual Care, Religious Care, or Healthcare Chaplaincy are invited to share their experience of practice by way of reflection, case study, discussion of current issues or response to previous articles.
Reflections on Aspects of Health, Wholeness, Suffering and Healing
Tom Gordon
Abstract: In 2008, the Church of Scotland set up a working group to examine issues of health and healing in the context of the Church’s ministry and mission. This paper represents a contribution to the ongoing discussions from the perspective of hospice chaplaincy. It calls for a basic understanding of what it means to be healed and to be whole.
Key words: spiritual healing, wholeness, ministry of healing, cure
Pages 60-62
Tom Gordon recently retired as Chaplain to the Mairi Curie Hospice in Edinburgh. The Editorial Board wishes to express its gratitude to Tom for his wise presence and guidance on the Board since its beginning and trust that he has a long, happy and productive time as writer and trainer.
Book Reviews
Pages 63-65
Book ReviewsMeaningful Funerals: Meeting the theological and pastoral challenge in a post-modern era
Ewan Kelly 2008
ISBN 978-1-906286-14-9
Mowbray, London
212 pages
Listening to the Other. A new approach to counselling and listening skills
Caroline Brazier 2009
ISBN 978-1-84694-191-7
O Books (John Hunt Publishing) Winchester UK & Washington USA
266 pages
Personality Disorder: The Definitive Reader
Gwen Adshead & Caroline Jacobs 2009
ISBN 978-184310-640-1
Jessica Kingsley, London.
278 pages.
Recovery from Depression Using the Narrative Approach. A Guide for Doctors, Complementary Therapists and Mental Health Professionals.
Damien Ridge 2009
ISBN 978-184310-575-6
Jessica Kingsley, London.
208 Pages
THE ORERE SOURCE
Abstracts from the Pastoral Care and other Healthcare Journals
Page 66-76
Attribution: The creator of these pastoral abstracts is the Rev. W. Noel Brown, a retired Presbyterian minister, and hospital chaplain-supervisor. He was formerly chairman of the Standards Committee of A.C.P.E. and is a board-certified chaplain of the Association of Professional Chaplains.
The abstracts are held in the database of The Orere Source. It currently contains over 17,500 abstracts from the pastoral care literature and health-care literature which has implications for the continuing education of chaplains. Further information may be obtained from: oreresource@rocketmail.com