Volume 27 Number 2 • Autumn/Winter 2011 · Volume 27 Number 2 • Autumn/Winter 2011 Rozann Allyn Shackleton 1 PDFEditor’s Voice ( ) 2 Standards of Practice for Professional Chaplains

Volume 27 Number 2 • Autumn/Winter 2011 Rozann Allyn Shackleton

1 Editor’s Voice (PDF)

2 Standards of Practice for Professional Chaplains in Long-term Care: Second Draft of the Consensus Document November 1, 2011 (free access) Responses to this draft of the Standards of Practice (SOP) for Long-term Care are invited through Friday, December 2, 2011 ([email protected]). The revised document will be presented to the APC Board of Directors. keywords: chaplaincy, standards of practice, long-term care

19 Glossary – SOP Long-term Chaplaincy Care (free access) Defines terms used in the Standards of Practice for Professional Chaplains in Long-term Care. keywords: definitions, standards of practice, long-term care

Harold G. Koenig 24 A Physician’s Perspective (PDF) Commentary on the proposed long-term care standards. keywords: commentary, standards of practice, long-term care R. Douglas Spitler 26 An Administrator’s View (PDF) Commentary on the proposed long-term care standards. keywords: commentary, standards of practice, long-term care

Harriet Mowat, Claire Wilson, Geoff Lachlan, William Gray, Alastair Gray, Ellen Faubert, Liz Adams, Stuart Coates, Suzanne Bunniss 27 The Spiritual Care of Older People: The Report of a Group Research Study (PDF) Reprinted from the Scottish Journal of Healthcare Chaplaincy, this article focuses on methods and outcomes of participatory research. It examines the internal and external adaptation required as people age and the chaplain’s role in assisting with this process keywords: health care chaplaincy, participatory research, gerontology, case study

Charles Christie 38 A Poem Is Some Remembering (PDF) This article describes the use of poetic forms of writing, specifically haiku and minute poems, as a model of reflection and self-care. keywords: reflective writing, self-care, poetry

George R. Robie, Coordinator 44 Retired Chaplains’ Writing Project (PDF) This installment features the reflections of four female chaplains, who share stories from their professional chaplaincy journeys. keywords: collegial wisdom, history, chaplaincy

Margaret A. Muncie 44 Weaving a Tapestry Kay Miller 45 The Making of One Chaplain Carolynne Fairweather

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47 APC: Transforming Professional Chaplaincy Sharon F. Peters 48 With Eyes Wide Open

Jerry Gentry 51 Essay – A Nest of Human Connections (PDF) Personal reflection from a hospice chaplain. keywords: reflection, caregiving, empathy

David Hall 53 On Holy Ground – Chosen by Mystery (PDF) Personal reflection from a hospice chaplain. keywords: reflection, caregiving, empathy

Kelly Gregory, Alvin Swindell Hodges, Heidi G. Gessner, Tammy Holland Sullivan 55 Poetry (PDF) Fumes ● The Essence of Reality ● Gratitude ● Not apparent keywords: reflection, chaplaincy, personal experience

Dick Millspaugh 58 Expression of Faith – A Prayer for Chaplains (PDF) keywords: prayer, remembrance, inspiration

59 Media Reviews (free access) Is God Still at the Bedside? The Medical, Ethical and Pastoral Issues of Death and Dying ● Life’s Greatest Teacher: What We Learn from the Sick and Dying ● Domestic Violence: What Every Pastor Needs To Know ● More Glimpses of Heaven ● The First 48 Hours: Spiritual Caregivers as First Responders ● Hospital Preaching as Informed by Bedside Listening: A Homiletical Guide for Preachers, Pastors and Chaplains in Hospital, Hospice, Prison and Nursing Home Ministries

© Chaplaincy Today • Vol. 27 No. 2 • Autumn/Winter 2011

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©Chaplaincy Today • e-Journal of the Association of Professional Chaplains • Volume 27 Number 2 • Autumn/Winter 2011 1 Two continuing education credits (CE) are available on completion of the reading of this issue. Enter CT-27-2.

EDITOR’S VOICE

TWO RECENT PERSONAL INCIDENTS impressed me with the degree to which a limited view influences one’s perception of reality.

I was sitting at my desk when I felt the building shake. Recalling my high school days in California, my first thought was earthquake, but I’m a continent away from the San Andreas fault. A second tremor accompanied by a loud rumble overhead that sounded as though major construction was going on in the unit directly above mine sent me to the living room windows. I saw nothing amiss and was beginning to question my equilibrium, if not my sanity, when my husband returned from lunch and informed me that the courthouse one block to the south, and thus out of my northerly view, had been evacuated because of — an earthquake in Virginia.

A few weeks later as hurricane/tropical storm Irene marched up the east coast, I spent a virtually sleepless night listening to the balcony railing vibrate with roaring winds interspersed with a driving rain, which pelted the windows. Amazingly, by noon the next day the sun was out, and the only effect visible from my vantage point was the muddy color of the swollen Raritan River and its incursion into uninhabited parkland on the far side. Again, beyond my limited sightline but quite obvious from my neighbor’s living room, the river had completely inundated a section of highway, and its waters were moving inexorably toward adjacent low-lying businesses and residences.

As professional chaplains, we are skilled at ministering in situations where circumstances and individuals’ views may be vastly different from ours. I suspect that we are sometimes unprepared for, and perhaps not so comfortable with, views of chaplaincy or of us as representatives of the profession that do not match our own. This issue includes several such windows.

Following the latest draft of the Standards of Procedure for Chaplains in Long-term Care, you’ll find commentaries by two other health care professionals: a physician and a CEO of a long-term care facility. Both reinforce the importance of chaplains in this setting and also bring fresh viewpoints.

In this year’s installment of the Retired Chaplains’ Writing Project, four female chaplains describe their paths to board certification and their subsequent careers. Like the views from my window and that of my neighbor, their experiences are quite different, though in this case, the variable is time.

A different look at the world of research is presented in an article that originally appeared in the Scottish Journal of Healthcare Chaplaincy. Harriet Mowat and colleagues describe their participatory research into the spiritual care of older people.

Charles Christie advocates using short poetic forms as an internal window, a form of self-care that encourages us toward broader and more effective ways of engaging reality. (Disclosure: as you will note, I was a copresenter in the workshop mentioned in this article.)

In the hope that looking through these windows into our profession will expand your view of this world we know as chaplaincy, I invite you into this issue of Chaplaincy Today.

Rozann Allyn Shackleton

MDiv MA BCC

[email protected]


©Chaplaincy Today • e-Journal of the Association of Professional Chaplains • Volume 27 Number 2 • Autumn/Winter 2011 2

Standards of Practice for Professional Chaplains in Long-term Care: Second Draft of the Consensus Document November 1, 2011

In October 2008, the Commission on Quality in Pastoral Services of the Association of Professional Chaplains (APC) convened a work group to draft consensus standards of practice (SOPs) for chaplains in acute care. This was the first step in creating SOPs for chaplains in various settings in order to better communicate the work of chaplaincy and to serve as a basis for establishing best practices. The APC Board accepted the final consensus document for standards of practice for professional chaplains in acute care in January 2010. The APC Quality Commission then began a similar process to develop standards of practice for long-term care. A new work group of chaplains with experience in long-term care was established. The initial draft was published on the APC website in February 2011 and responses invited from the chaplaincy community. This second draft consensus document is followed by invited responses from various perspectives that the work group deemed important to the discussion. If you wish to add your voice, please e-mail the work group by Friday, December 2, 2011. ([email protected]). The work group will consider those responses as well as the ones published in this issue of Chaplaincy Today to create a final consensus document that will be

sent from the Commission on Quality in Pastoral Services to the APC Board of Directors for a decision on how to proceed. The hope is that all cognate partners will affirm or adopt the final consensus document for professional chaplains in long-term care and that it will serve as a model for chaplains in other settings. In this publication, the glossary appears as a separate document to enable the reader to open both and to move easily between them. Glossary words are highlighted on their first appearance.

Standards of Practice for Professional Chaplains in Long-term Care Overview Preamble Chaplaincy care is grounded in initiating, developing and deepening, and bringing to an appropriate close, a mutual and empathic relationship with the resident, family and/or staff. The development of a genuine relationship is at the core of chaplaincy care and underpins, even enables, all the other dimensions of chaplaincy care to occur. It is assumed that all of the standards are addressed within the context of such relationships.1

Section 1: Chaplaincy Care with Resident and Family Standard 1 – Assessment: The chaplain gathers and evaluates relevant data pertinent to the resident’s situation and/or bio-psycho-social-spiritual/religious health.

Standard 2 – Delivery of Care: The chaplain develops and implements a plan of care to promote resident well-being and continuity of care.

The Standards of Practice in Long-term Care Work Group, which developed this draft, includes certified health care chaplains from the Association of Professional Chaplains, Association for Clinical Pastoral Education and National Association of Jewish Chaplains.

Cochairs Mark LaRocca-Pitts Jon Overvold

Leonard Blank Heather Bumstead Dale Carr Scott Cartwright Peter Yuichi Clark John Fureman Robbye Jarrell Donald Koepke Michele Micklewright Margaret Muncie Jackie Ward David Wentroble Josh Zlochower



Standard 3 – Documentation of Care: The chaplain enters information into the resident’s service record or medical record that is relevant to the resident’s medical, psycho-social and spiritual/religious goals of care.

Standard 4 – Teamwork and Collaboration: The chaplain actively and clearly collaborates with the organization’s interdisciplinary care team.

Standard 5 – Ethical Practice: The chaplain will adhere to the Common Code of Ethics, which guides decision-making and professional behavior.

Standard 6 – Confidentiality: The chaplain respects the confidentiality of information from all sources, including the resident, medical record, other team members and family members, and abides by all applicable laws and regulations.

Standard 7 – Respect for Diversity: The chaplain actively models and collaborates with the organization and its interdisciplinary team in respecting and providing culturally competent resident-centered care.

Section 2: Chaplaincy Care for Staff and Organization Standard 8 – Care for Staff: The chaplain provides timely and sensitive chaplaincy care to the organization’s staff via individual and group interactions.

Standard 9 – Care for the Organization: The chaplain provides chaplaincy care to the organization in ways consonant with the organization’s values and mission statement.

Standard 10 – Chaplain as Leader: The chaplain provides leadership in the professional practice setting of long-term care and the profession.

Section 3: Maintaining Good Chaplaincy Care Standard 11 – Continuous Quality Improvement: The chaplain seeks and creates opportunities to enhance the quality of chaplaincy care practice.

Standard 12 – Research: The chaplain practices evidence-based care including ongoing evaluation of new practices and, when appropriate, contributes to or conducts research.

Standard 13 – Knowledge and Continuing Education: The chaplain assumes responsibility for continued professional development, demonstrates a working and up-to-date knowledge of current theory and practices and integrates such information into his/her own practice.

Standards of Practice for Professional Chaplains in Long-term Care Document Introduction Background In 2008, in order to move professional chaplaincy toward standards of practice, the APC Commission on Quality in Pastoral Services brought together leaders in health care chaplaincy to work toward consensus about such standards. The first work group focused on the following:

• Minimal but essential standards of practice. • Standards for board certified chaplains in acute care.

Models in social work and nursing, as well as models in Australian and Canadian chaplaincy, informed this work and provided catalysts for identifying and briefly explicating standards of


practice within health care chaplaincy in acute care. The primary goal of the work group was to reach consensus about what standards of practice were most important at that time and to set those standards in front of the profession for further discussion. These standards were published in Chaplaincy Today 25, no. 2 (Autumn/Winter 2009) and accepted by the Association of Professional Chaplains in 2010. They should be referenced in conjunction with this long-term care document.

Project With the acceptance of the Standards of Practice for Professional Chaplains in Acute Care document, a new goal emerged: development of standards for professional chaplains in long-term care. The acute care model served as a foundation document and provided the catalyst for identifying and briefly explicating standards of practice for chaplaincy care in long-term care. In order to move professional chaplaincy toward standards of practice for long-term care, the APC Commission on Quality in Pastoral Services brought together several leaders in chaplaincy care in long-term care to work toward consensus about such standards. These standards apply to a particular subset of chaplains: chaplains in long-term care. The work group focused on the following:

• Minimal but essential standards of practice. • Standards for board certified chaplains in long-term care.

Distinctions in terminology In order to provide clarity, the following definitions of “standards of practice,” “competency standards,” “scope of practice” and “best practice” are offered.

• Standards of practice are authoritative statements that describe broad responsibilities for which practitioners are accountable, “reflect the values and priorities of the profession” and “provide direction for professional … practice and a framework for the evaluation of practice.”2 They describe a function, action or process that is directed toward the resident to contribute to the shared goal(s) of the resident and organizational care team. For example, a standard of practice may require that there is a process for assessing the spiritual/religious needs of residents.

• Competency standards define what skills and training are required for the provider of care, i.e., the chaplain. For example, competencies will state what the requirements are for the chaplain to have the credentials to do the spiritual/religious assessment.

• Scope of practice refers to the expression of the standard of practice in the chaplain’s individual context. For example, the scope of practice states where, when, and how a chaplain in a particular organization carries out his/her assessments.

• Best practice refers to a technique, method, or process that is more effective at delivering a particular outcome or a better outcome than another technique, method, or process. Best practices are demonstrated by becoming more efficient or more effective. They reflect a means of exceeding the minimal standard of practice. For example, a spiritual/religious assessment best practice will offer a more effective method for chaplains to do their assessments.

Although many terms are defined in the glossary at the end of this document, the following terms need clarification now:

• The term “resident” encompasses the resident and the situation, including family and staff.

• The term “staff,” as in “staff care,” means all staff, volunteers, doctors and students in a long-term care setting.


• Throughout the standards, “chaplain” refers to a professional board certified chaplain serving in a long-term care setting.

• The term “spiritual/religious” recognizes the differences inherent in the two individual concepts but links them in this document.

• The term “long-term care setting” refers to any of the following: o skilled nursing facility o adult day care center o assisted living facility o independent living community o subacute care o dementia care o continuing care retirement community (CCRC), which may include multiple levels of

care, such as independent living, assisted living, skilled nursing care, dementia support care, rehabilitation and subacute care.

Context A number of factors distinguish the long-term care setting from the acute care setting and have a direct influence on the way in which chaplaincy care functions in that setting. For example, long-term care is residential, which implies that these are the communities in which people live. Services offered are based upon the lifestyle preferences of the residents, and the kinds of programs and activities that have meaning to the residents. Depending on their situation, residents may be able to maintain involvement in their existing religious communities. This means the chaplain’s scope of practice may include such things as facilitating a resident’s contact with their existing religious community or providing worship opportunities for residents no longer able to attend their houses of worship. Another factor that distinguishes long-term care from acute care is that not all settings for long-term care are based upon a medical model of care. Some facilities will operate under different licensing requirements and regulations, for example independent living and assisted living. In these settings, care planning and the provision of services may be organized by other models that do not include a medical record but use a “resident service file” instead. Skilled nursing facilities and subacute care facilities are based on the medical model and are regulated by state license and the federal requirements for Medicare/Medicaid reimbursement. The point to emphasize is that depending on the model in use, chaplains will have slightly different roles and responsibilities.

One of the greatest distinguishing factors of the long-term care setting is that the chaplain often provides chaplaincy care to a resident over the course of months or even years. Their relationship may be marked by greater depth and understanding because the resident has been able to share his/her story with the chaplain over time. In addition to the chaplain, other staff and the residents themselves will form long-term relationships in a common community. Hence, an important aspect of the chaplain’s work will be to provide opportunities for the community to mark the transitions of members entering and leaving the community and provide bereavement support as needed. In long-term care, the chaplain’s role as spiritual leader for the whole community of the organization takes on greater importance.

The credentials of the board certified chaplain According to the Common Standards for Professional Chaplaincy, any board certified chaplain will have the following basic qualifications and accountabilities:

• Obtained a bachelor’s degree from a college or university that is appropriately accredited.

• Obtained an appropriately accredited master’s degree in theological studies or its equivalent.

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• Be ordained, commissioned or similarly recognized by an appropriate religious authority according to the standard practice and policy of that authority.

• Completed four units (1,600 hours) of clinical pastoral education (CPE) as accredited by the Association for Clinical Pastoral Education (ACPE), National Association of Catholic Chaplains (NACC) or the Canadian Association for Spiritual Care (CASC/ACSS); one of these units may be an equivalency.

• A minimum of one year full-time chaplaincy experience upon completion of four CPE units.

• Current endorsement by a recognized religious faith group for ministry as a chaplain.

• Demonstrated competency in areas of chaplaincy care, as outlined by the Common Standards for Professional Chaplaincy.3

• Remain accountable to the endorsing faith group, employer and certifying body.

• Affirm and practice chaplaincy according to the Common Code of Ethics.

• Maintain membership in a certifying body by participating in a peer review every five years, documenting at least fifty hours of continuing education each year and providing documentation of endorsement with her/his faith tradition every five years.

Scope of services Chaplains provide a broad and diverse range of services, including the following:

• Assessing and determining plans of care that contribute to the overall care of the residents and that are measurable and documented.

• Participating in interdisciplinary teamwork and collaboration.

• Providing spiritual/religious resources, e.g., sacred texts, Shabbat candles, music, prayer rugs, rosaries.

• Offering rituals, prayer and sacraments.

• Contributing in ethics, e.g., through a primary chaplaincy relationship, participation on an ethics committee or consultation team, and/or participation on an institutional review board.

• Helping interpret and broker cultures and faith traditions that impact long-term care practice and decisions.

• Educating and consulting with the long-term care staff and the broader community.

• Building relationships with local faith communities and their leaders on behalf of the organization.

• Providing leadership within the organization and within the broader field of chaplaincy.

• Offering care and counsel to residents and staff regarding dynamic issues, e.g., loss/grief, spiritual/religious struggle, as well as strengths, opportunities for change and transformation, ethical decision making, difficult communication or interpersonal dynamic situations.

Accountability This Standards of Practice for Professional Chaplains in Long-term Care is a fluid document that will change as health care chaplaincy continues to mature and as situations change. It is a project of the APC Commission on Quality in Pastoral Services, which is responsible for the work and to which

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this work group is accountable. This work group is largely composed of board certified chaplains from APC but also includes those with (nonrepresentative) ties to the Association for Clinical Pastoral Education (ACPE), and the National Association of Jewish Chaplains (NAJC). Thus, although brought together by an APC commission, this work group seeks to contribute to the wider profession of chaplaincy and is not writing for any particular organization. Participants in the work group included Leonard Blank, Heather Bumstead, Dale Carr, Scott Cartwright, Peter Yuichi Clark, John Fureman, Robbye Jarrell, Donald Koepke, Mark LaRocca-Pitts, Michele Micklewright, Margaret Muncie, Jon Overvold, Jackie Ward, David Wentroble and Josh Zlochower.

Preamble Chaplaincy care is grounded in initiating, developing and deepening, and bringing to an appropriate close, a mutual and empathic relationship with the resident, family and/or staff. The development of a genuine relationship is at the core of chaplaincy care and underpins, even enables, all the other dimensions of chaplaincy care to occur. It is assumed that all of the standards are addressed within the context of such relationships.4

Section 1: Chaplaincy Care with Resident and Family Standard 1: Assessment Assessment: The chaplain gathers and evaluates relevant data pertinent to the resident’s situation and/or bio-psycho-social-spiritual/religious health.

Interpretation Assessment is a fundamental process of chaplaincy practice. Provision of effective care requires that chaplains assess and reassess resident needs and modify plans of care accordingly. A chaplaincy assessment in health care settings involves relevant biomedical, psycho-social and spiritual/religious factors, including the needs, hopes and resources of the individual resident and/or family.

A comprehensive chaplaincy assessment process includes the following: • Gathering and evaluating information about the spiritual/religious, emotional and social

needs, hopes and resources of the resident or the situation.

• Prioritizing care for those whose needs appear to outweigh their resources.

Measurement criteria • Gathers data in an intentional, systematic and ongoing process with the assent of the

resident.

• Involves the resident, family, other health care providers and the resident’s local spiritual/religious community, as appropriate, in the assessment.

• Prioritizes data collection activities based on the resident’s condition or anticipated needs of the resident or situation.

• Uses appropriate assessment techniques and instruments in collecting pertinent data.

• Synthesizes and evaluates available data, information and knowledge relevant to the situation to identify patterns and variances.

• Documents relevant data and plans of care in a retrievable format accessible to the health care delivery team.


Examples • Basic: Demonstrates familiarity with one accepted model for spiritual/religious assessment

and makes use of that model in his/her chaplaincy practice as appropriate.

• Intermediate: Demonstrates familiarity with several published models for spiritual/religious assessment and is competent to select an appropriate model for specific cases within his/her chaplaincy practice.

• Advanced: Demonstrates familiarity with several published models for spiritual/religious assessment and is competent to instruct others in their use.

Standard 2: Delivery of Care The chaplain develops and implements a plan of care to promote resident well-being and continuity of care.

Interpretation The chaplain develops and implements a plan of care, in collaboration with the resident, the resident’s family and other members of the health care team. It includes interventions provided to achieve desired outcomes identified during assessment. Chaplains are competent to adapt practice techniques to best meet the resident’s needs within the health care setting. Care is based on a comprehensive assessment.

Measurement criteria • Involves the resident, family and other health care providers in formulating desired

outcomes, interventions and personalized care plans when possible and appropriate.

• Defines desired outcomes, interventions and plans in terms of the resident and the resident’s values, spiritual/religious practices and beliefs, ethical considerations, environment and/or situation.

• Identifies desired outcomes, interventions and plans to provide direction for continuity of care.

• Conducts a systematic and ongoing evaluation of the outcomes in relation to the interventions prescribed by the plan.

• Modifies desired outcomes, interventions and plans based on changes in the status of the resident or evaluation of the situation.

• Documents desired outcomes, interventions, plans and evaluations in a retrievable format accessible to the health care delivery team.

Examples Independent care and assisted living

• Delivery of care may entail ongoing contact between a resident and his/her existing religious/spiritual community.

• One-to-one contact between the chaplain and the resident for spiritual/religious assessment may assist in accessing religious/spiritual resources inside and outside the residential setting as needed.

• Documentation may or may not be available in these settings; however, the chaplain should use the records that are available.


Skilled nursing facilities • The chaplain provides one-to-one care that includes spiritual/religious assessment,

development of a plan of care and intervention based upon that plan of care.

• The plan of care may include one-to-one visits with the chaplain, communal worship and/or programs with other residents.

• The chaplain also may be a liaison for community clergy to assist in the clergy/resident relationship.

• As a member of the interdisciplinary team, the chaplain ensures that the resident’s spiritual/religious needs are addressed and integrated into the plan of care.

• The chaplain also provides documentation in the resident’s chart.

• The chaplain may be utilized for end-of-life planning, advanced directives and end-of-life care. The chaplain provides support to the resident, family and staff during times of loss. Some facilities may provide some form of aftercare, such as memorial services and support groups.

• The number of tasks the chaplain may be involved in may vary from facility to facility. Subacute care units

• The chaplain provides one-to-one care either by self-initiative or by referral. This may include a spiritual assessment and development of a plan of care.

• The chaplain’s role also may include facilitating worship services, prayer groups, religious and/or spiritual practices as well as helping the resident remain connected to a faith community.

The chaplain may use an outcome-oriented plan of care.5

Standard 3: Documentation of Care The chaplain enters information into the resident’s service record or medical record that is relevant to the resident’s medical, psycho-social and spiritual/religious goals of care.

Interpretation Documentation related to the chaplain’s interaction with the resident, family and/or staff is pertinent to the overall plan of care and therefore accessible to other members of the care team. The format, language and content of a chaplain’s documentation respect the organizational and regulatory guidelines regarding confidentiality while ensuring that the care team is aware of relevant spiritual/religious needs and concerns. In facilities not using a medical model, documentation should include, but is not limited to, the following:

• Spiritual/religious preference.

• Relevant information obtained from spiritual screen.

• Resident’s involvement in spiritual care activities.

• Referrals to chaplain for spiritual assessment and intervention. In facilities using a medical model, documentation should include but is not limited to the following:

• Spiritual/religious preference and desire for or refusal of ongoing chaplaincy care.


• Reason for visit.

• Critical elements of spiritual/religious assessment.

• Resident’s desired care plan outcome.

• Chaplain’s plan of care, relevant to the resident/family goals.

• Indication of referrals made by chaplain on behalf of the resident/family.

• Relevant outcomes resulting from chaplain’s intervention.

Measurement criteria • Documentation is readily accessible to all disciplines.

• Information included reflects assessment and delivery of care as well as appropriate privacy/confidentiality.

Examples Independent and assisted living facilities Information gathered by a spiritual screen may be summarized by the chaplain or his/her designee in the resident service record. This documentation would include the resident’s preferences for particular religious, cultural or spiritual activities. Because resident service records do not have the same confidentiality protection standards as medical records, the chaplain must ensure that the resident’s confidentiality is maintained with respect to personal information. Facilities that use a medical record

• Documentation in the medical record of spiritual/religious screening and assessment.

• Documentation in the medical record indicating resident’s ongoing spiritual/religious and ritual needs and the plan for meeting such needs, e.g., anointing, communion, Shabbat candles, clergy visits.

• Documentation in medical record indicating spiritual/religious struggle issues that affect the plan of care.

• Documentation in medical record indicating the resident’s wish to receive or terminate ongoing chaplaincy care.

• Documentation in medical record indicating chaplain’s participation on interdisciplinary teams affecting resident’s plan of care.

Standard 4: Teamwork and Collaboration The chaplain actively and clearly collaborates with the organization’s interdisciplinary care team.

Interpretation Resident and family chaplaincy care is a complex endeavor that necessitates the chaplain’s effective integration within the wider care team. Such integration requires the chaplain’s commitment to clear, regular communication patterns as well as dedication to collegial, collaborative interaction.

Measurement criteria • Possesses a thorough knowledge of the services represented on the interdisciplinary care

team.

• Remains alert to resident referral opportunities that arise while providing chaplaincy care.


• Maintains candid, professional interpersonal relationships with the interdisciplinary care team members.

• Participates as fully as possible in the organization’s interdisciplinary care team meetings.

• Works collaboratively to implement the interdisciplinary care team’s plan, ensuring that the resident’s wishes and wholeness remain priorities.

• Promptly responds to interdisciplinary care team member referrals.

• Clearly communicates chaplaincy care interventions using the organization’s approved interdisciplinary communication channels.

• Regularly educates staff regarding the role of chaplaincy care.

Examples • Maintains solid interpersonal relationships within the interdisciplinary team.

• Contributes consistently and meaningfully to interdisciplinary meetings, including sharing information derived from skillful assessment.

• Documents chaplaincy interactions using professional language through means readily accessible to other care team members.

Standard 5: Ethical Practice The chaplain will adhere to the Common Code of Ethics, which guides decision making and professional behavior.

Interpretation The chaplain understands the multiple levels of relationships that are established in the process of providing care to the resident, family and staff. This care is frequently provided in a context of cultural, spiritual and theological differences when individuals are often at a vulnerable point in their lives. An understanding of professional boundaries and ethical relationships is of utmost importance.

Measurement criteria • Protects the confidential relationships with those under her/his care.

• Maintains clear boundaries for sexual, spiritual/religious, financial and/or cultural values.

Examples • Respects various theological/religious values and cultural differences.

• Participates in continuing education events with a focus in ethical decision making.

• Understands personal/professional limitations and seeks consultation when needed.

Standard 6: Confidentiality The chaplain respects the confidentiality of information from all sources, including the resident/family, the medical record and other team members and abides by all applicable laws and regulations.

Interpretation An understanding of the resident’s expectations of the chaplain as a religious/spiritual professional and how information shared by the resident/family will be used is important. Knowing and deciding


what information to keep to oneself; what to share with other staff members, state or regulatory agencies; and/or what to publish as clinical vignettes mark the various degrees of confidentiality.

Measurement criteria • Documents only what is appropriate for the care being received.

• Protects privacy when using clinical material for educational activities or published work.

• Understands the ramifications of the laws regarding confidentiality within the state where s/he practices.

• Maintains the confidentiality of anyone who is a subject in a research project and uses appropriate informed consent with such a research project.

Examples • Understands the issues of the “pastoral confession” versus confidentiality by appropriate

state law.

• Clearly communicates what is and is not reportable to authorities when a confidential conversation is desired.

• Understands the ramifications of a decision to keep confidential information that could be at odds with the legal authorities, e.g., sanctuary/deportation issues.

Standard 7: Respect for Diversity The chaplain actively models and collaborates with the organization and its interdisciplinary team in respecting and providing culturally competent resident-centered care.

Interpretation The chaplain’s assessment includes identification of cultural and spiritual/religious issues, beliefs and values of the resident and/or family that may impact the plan of care. Through practice and education, the chaplain assists the interdisciplinary team in incorporating issues of diversity into the resident’s plan of care.

Measurement criteria • Demonstrates a working knowledge and understanding of cultural and spiritual/religious

diversity.

• Defines and incorporates desired outcomes and interventions into the assessment and plan of care, in terms of the culture, spiritual/religious practices and beliefs, ethical considerations, environment and/or situation of the resident/family.

• Identifies and respects spiritual/religious and/or cultural values; assists in identifying and responding to identified needs and boundaries.

Examples • Provides a variety of spiritual/religious resources that reflect the diversity of the population

served, e.g., prayer rugs, beads, sacred texts in translation and/or original languages as appropriate; provides sacred space that allows for varied configurations, e.g., seated, standing, kneeling, and use of symbols.

• Interprets and mediates when a resident’s cultural and/or spiritual practices have an impact on long-term care practice and decisions.

• Functions as a cultural broker for the organization.

• Provides education to interdisciplinary staff in cultural and spiritual/religious diversity.


• Provides education in cultural and spiritual/religious diversity to all members of the residential community as it affects community life.

Section 2: Chaplaincy Care for Staff and Organization Standard 8: Care for Staff The chaplain provides timely and sensitive chaplaincy care to the organization’s staff via individual and group interactions.

Interpretation Though resident/family chaplaincy care is the primary focus of chaplains, the chaplaincy care provided to organizational staff is of critical importance.

Staff care involves a wide range of chaplaincy services for all health care team members within the organization. These services vary in their complexity. At a basic level, this includes one-on-one supportive conversations with staff as well as provision of public worship opportunities. At a more complex level, staff care includes Critical Incident Stress Management (CISM) or Psychological First Aid (PFA) interventions and formal counseling, which require specialized training.

Measurement criteria • Provides supportive conversations with staff.

• Provides chaplaincy care to the organization’s staff through spiritually/religiously inclusive, noncoercive interactions.

• Proactively offers group rituals, particularly after emotionally significant events.

• Refers to and receives referrals from the organization’s employee assistance program, where appropriate.

• Provides timely collaborative peer support activities during and after critical incidents.

Examples • Engages in informal one-on-one support with staff members.

• Celebrates staff accomplishments, e.g., employment anniversaries, job promotions, academic graduations.

• Attends to staff needs through regularly scheduled public opportunities.

• Provides memorial rituals for staff, especially after unexpected deaths.

• Conducts formal one-on-one counseling sessions, group work and critical incident responses; gives attention to grief issues and family/work-related stresses.

• Provides continuing education, training or support related to grief/bereavement, stress, burnout or compassion fatigue.

• Administers rites and sacraments within ecclesiastical authorization as requested by staff.

• Develops programs for spiritual growth of staff, e.g., daily devotions, study of sacred texts, book study, brief retreat models, spiritual direction.


• Provides opportunities for staff to participate in volunteer charitable programs, e.g., Abider Ministry for the Dying, Alzheimer’s Memory Walk, local United Way projects, food pantry support.

Standard 9: Care for the Organization The chaplain provides chaplaincy care to the organization in ways consonant with the organization’s values and mission statement.

Interpretation The chaplain is alert to potential means of expressing the organization’s spiritual aspirations. At the same time, s/he is sensitive to the organization’s cultural and spiritual/religious diversity. While respecting this diversity, the chaplain is creative and proactive in implementing initiatives that honor and champion the spiritual/religious aspects of the organization’s mission.

Measurement criteria • Maintains professional and ongoing interpersonal relationships with organization leaders.

• Plans and implements corporate, spiritually based rituals consistent with the organization’s mission statement and community needs.

• Creates and maintains adequate public sacred spaces in collaboration with organization leaders.

• Supports the design and placement of public religious symbols in ways that are consonant with the organization’s spiritual/religious heritage.

• Assists in leading the organization’s inspirational community observances.

• Offers public relations guidance to highlight sacred components of healing.

• When possible, provides a prophetic voice to create and implement policies that respect the organization’s staff and residents.

Examples • Cultivates personal relationships with organization leaders through regular and intentional

face-to-face interactions.

• Designs and utilizes appropriate public relations materials that highlight spiritual components of the organization’s mission.

• Designs and maintains mission-appropriate sacred spaces or quiet places that meet the spiritual/religious needs of the resident, family and staff.

• Creates and leads corporate spiritual/religious rituals that undergird transcendent aspects of the organization’s mission or community observances.

Standard 10: Chaplain as Leader The chaplain provides leadership in the professional practice setting of long-term care and the profession.

Interpretation The chaplain takes leadership on issues related to spiritual/religious/cultural care and observance. The chaplain also has an obligation to advance the profession of chaplaincy by providing education, supporting colleagues and participating in his/her certifying organization.


Measurement criteria • Serves in key roles in the work setting by participating in or leading committees, councils

and/or administrative teams.

• Contributes to key organizational initiatives that draw on the knowledge and skills of the professional chaplain, such as cultural competence training, customer and staff retention, and communications training.

• Liaises with community religious leaders.

• Mentors colleagues and writes for publication.

• Promotes advancement of the profession through active participation in his/her certifying organization.

• Advocates for a chaplaincy staff size that is aligned with the scope and complexity of the organization as well as the nature of chaplaincy care needs as they relate to the complexity of the medical care needs of the organization.

Examples • Serves on organizational committees, e.g., ethics, customer satisfaction, institutional review

board, service-based projects.

• Regularly trains organizational staff on religious/spiritual/cultural issues and communications.

• Presents regularly at the certifying organization’s annual conference and other educational events; writes for professional publications.

Section 3: Maintaining Good Chaplaincy Care Standard 11: Continuous Quality Improvement The chaplain seeks and creates opportunities to enhance the quality of chaplaincy care practice.

Interpretation The chaplain participates in organizational programs for continuous quality improvement that are relevant to chaplaincy care. S/he contributes to the organization’s quality initiatives with other members of the interdisciplinary team. Using current, established quality improvement methodologies and with the support of the organization’s quality department, the chaplain identifies processes in the delivery of chaplaincy care for ongoing review and improvement.

Measurement criteria • Collects relevant data to monitor the quality and effectiveness of chaplaincy care services.

• Develops and implements an annual plan for chaplaincy care quality improvement.

• Participates in the quality improvement program of the organization.

• Participates on interdisciplinary teams to monitor opportunities for quality improvement in the clinical setting.

• Uses the results of quality improvement activities to initiate change in methods of delivering chaplaincy care.


• Regularly reports quality improvement initiatives and outcomes to the organization’s quality improvement program.

Examples • Participates in a quality improvement project that is multidisciplinary. The chaplain is not

responsible for the whole project but contributes alongside other team members.

• Develops an annual chaplaincy department plan for continuous quality improvement. Results are reported to the organization’s quality improvement leadership.

• In large organizations, develops and implements projects across the organization to improve chaplaincy care.

Standard 12: Research The chaplain practices evidence-based care, including ongoing evaluation of new practices and, when appropriate, contributes to or conducts research.

Interpretation Chaplaincy care has long centered on the concept of “presence” and nondirective active listening and on the chaplain’s sense that his/her offerings are effective, which sometimes is based on direct feedback from resident, family or staff. In contrast, other health care disciplines have reviewed their practices and have begun to base these on research evidence. Increasingly, the chaplain is being asked to demonstrate that s/he also practices out of a research base and explicitly makes a contribution to health care. Chaplaincy care is amenable to research in many ways; the chaplain should be sufficiently familiar with existing evidence to present it to health care colleagues from other disciplines. The chaplain needs to read and reflect on new research’s potential to change the practice and to be willing and capable of integrating that which is beneficial to the resident, family and/or staff. If the chaplain has sufficient skills and support, this also means participating in or creating research efforts to improve chaplaincy care.

Measurement criteria • Demonstrates familiarity with published research findings that inform clinical practice by

reading professional journals and other materials.

• Critically evaluates new research for its potential to improve clinical practice and integrates new knowledge into clinical practice.

• Contributes through collaboration with other researchers of various disciplines or, if appropriate, initiates research projects intended to improve clinical practice and publishes the findings.

Examples • Regularly reads research articles in professional journals, e.g., Journal of Pastoral Care &

Counseling, Mental Health, Religion & Culture, New England Journal of Medicine, The Journal of Religious Gerontology, The Journal of Palliative Care Nursing, discusses content with colleagues and considers implications for chaplaincy care.

• Uses published research to educate administrators or other health care professionals on the role, value and/or impact of chaplaincy.

• Creates and executes quality improvement programs and disseminates the findings to the wider community, e.g., outside the chaplain’s own department, whether through the organization’s quality improvement committee or through publication in a chaplaincy or other specialized journal.


• Serves on organization’s Institutional Review Board (IRB).

• Collaborates with researchers in other disciplines or with other chaplains in research projects designed for publication in peer-reviewed journals.

• Functions as either principal or co-investigator in one or more peer-reviewed research studies that are published in peer-reviewed journals and/or presented as an abstract/paper at conferences.

• Serves on an editorial board as peer reviewer for a professional journal.

Standard 13: Knowledge and Continuing Education The chaplain assumes responsibility for continued professional development, demonstrates a working and up-to-date knowledge of current theory and practices, and integrates such information into his/her own practice.

Interpretation The chaplain continues to grow and develop professionally and spiritually/religiously to meet the changing needs of the profession, the needs of those to whom s/he ministers and the organization’s needs.

Measurement criteria Relevant continuing education is accountable as follows:

• Within the Common Standards for Professional Chaplaincy and any applicable organizational, state and/or federal requirements that guide the profession.

• To the function, specialty and/or the strategic initiatives of the organization in which the chaplain is employed.

• To current theory/practice which may be found by reading and reviewing current peer-reviewed literature, e.g., Journal of Pastoral Care and Counseling, advanced medical journals, the Hastings Center Report, Journal of Health Care Chaplaincy, Future Age, The Journal of Religious Gerontology, Generations: Journal of the American Society on Aging, The Hospice Journal: Physical, Psychosocial and Pastoral Care of the Dying, Oates Journal, as well as new research vehicles and books that advance the practice of chaplaincy care.

Examples The chaplain may be guided by the following:

• His/her needs, interests and/or performance evaluation, including professional and personal goals/objectives for the year.

• Workshops and professional conferences on the local, regional and national level that meet standards for continuing education for organizations that adhere to the Common Standards for Professional Chaplaincy.

• Outcomes, reflections and feedback from the five-year maintenance of certification peer review that factor into the chaplain’s professional development plan.

• Areas of growing importance to the field, e.g., quality improvement, research, data collection.

• The need to continually learn and implement self-care practices to bring balance to his/her life through healthy habits, e.g., nutrition, rest, relationships, exercise, spirituality.


1 Adapted from Dan Murphy, an e-mail response to “Standards of practice for professional chaplains in health care settings,” PlainViews 6, no. 2 (February 18, 2009) www.plainviews.org accessed March 26, 2009.

2 American Nurses Association, Nursing: Scope and Standards of Practice (Silver Springs, MD: American Nurses Association, 2004), 77.

3 There are four areas of competency. Theory of Pastoral Care includes theology, psychological/sociological disciplines, group dynamics, ethics and emotional/spiritual dimensions of human development. Identity and Conduct includes respect for the other; appropriate boundaries; self-awareness in respect to one’s strengths and limitations; the impact of one’s attitudes, values and assumptions; self-care; communication skills; professionalism; advocacy; and ethical behavior. Pastoral Practice includes the ability to form deep relationships, provide effective care, manage crises, provide care in grief and loss, utilize spiritual assessments, provide appropriate spiritual/religious resources, provide appropriate public worship and facilitate theological reflection. Professionalism includes the ability to integrate chaplaincy care into the life of the organization, establish and maintain interdisciplinary relationships, understand organizational culture and systems, promote ethical decision making, document chaplaincy work appropriately and form appropriate collaborative relationships with local faith communities and their leaders. See http://www.spiritualcarecollaborative.org/docs/common-standards-professional-chaplaincy.pdf accessed November 17, 2010.

4 Murphy, “Standards of practice.”

5 See Larry VandeCreek and Arthur M. Lucas, eds., The Discipline for Pastoral Care Giving: Foundation for Outcome Oriented Chaplaincy (New York, London, Oxford: The Haworth Pastoral Press, 2001).

http://www.plainviews.org/

http://www.spiritualcarecollaborative.org/docs/common-standards-professional-chaplaincy.pdf


Glossary – SOP Long-term Chaplaincy Care activities of daily living (ADL). Six basic personal care activities: eating, toileting, dressing, bathing, transferring and continence. The ability of someone to perform ADLs may help a professional assess an individual’s self-maintenance. Often ADLs are used as the criteria for payment by government and third party payers. (Working with Seniors: Health, Financial and Social Issues [Society of Senior Advisors, 2005])

acute care setting. Where care is provided to patients with short-term physical and psychological needs. It is usually a hospital but may include ambulatory, emergency, rehabilitation and palliative care settings; distinguished from long-term care or home hospice.

adult day care: Care provided at a community-based center for adults who need assistance or supervision during the day but do not need care around the clock. A primary focus of adult day care is on socialization and activities which are mentally and physically stimulating and may include help with personal care. (Working with Seniors: Health, Financial and Social Issues [Society of Senior Advisors, 2005])

assent. Reflects the resident’s agreement with care rather than authorization.

assisted living facility: Residential housing meant for seniors with physical or cognitive impairments that make it difficult for them to perform an average of two ADLs without assistance. (Working with Seniors: Health, Financial and Social Issues [Society of Senior Advisors, 2005])

board certified chaplain. A chaplain who has met all of the requirements of the Common Standards for Professional Chaplaincy. (See http://www.spiritualcarecollaborative.org/docs/common-standards-professional-chaplaincy.pdf accessed January 14, 2009.)

chaplaincy care. Care provided by a board certified chaplain or by a student in an accredited clinical pastoral education program, e.g., ACPE. Examples of such care include emotional, spiritual, religious, pastoral, ethical and/or existential care. (See Brent Peery, “What’s in a Name?” PlainViews 6, no. 2 [February 18, 2009] www.plainviews.org)

clinical pastoral education. “Interfaith professional education for ministry. It brings theological students and ministers of all faiths (pastors, priests, rabbis, imams and others) into supervised encounter with persons in crisis. Out of an intense involvement with persons in need, and the feedback from peers and teachers, students develop new awareness of themselves as persons and of the needs of those to whom they minister. From theological reflection on specific human situations, they gain a new understanding of ministry. Within the interdisciplinary team process of helping persons, they develop skills in interpersonal and interprofessional relationships.” (http://www.acpe.edu/faq.htm#faq1 accessed January 31, 2009.)

clinical pathways. Clinical pathways are known by a variety of terms, e.g, pathways, clinical protocols, parameters, templates, benchmarks. The term speaks to a continuum of care that identifies structures, caregivers and processes that intervene at critical points to efficiently treat the patient and achieve a defined outcome. Pathways may be developed for medical conditions, specific patient groups or actual services such as chaplaincy care. Clinical pathways are essentially care maps that prescribe treatment for a particular patient. Often, they are used to coordinate care between different health care disciplines and to monitor the costs of care. However, they also are useful in mapping the contributions of a particular discipline to the care team and prescribing that discipline’s “branch” of the overall care tree. Increasingly, if a discipline is not represented on a given care map, it is not included in that patient’s care.

http://www.spiritualcarecollaborative.org/docs/common-standards-professional-chaplaincy.pdf


http://www.acpe.edu/faq.htm#faq1


Common Code of Ethics. Gives expression to the basic values and standards of the profession, guides decision making and professional behavior, provides a mechanism for professional accountability, and informs the public as to what they should expect from professionals. (http://www.spiritualcarecollaborative.org/docs/common-code-ethics.pdf accessed January 14, 2009.)

competency. Possession of required skill, knowledge and/or qualifications.

continuing care retirement community (CCRC): Also known as life care communities, they provide a type of combined health, housing and social care insurance for the older adult. The individual signs a contract and agrees to pay an entrance fee and a monthly service fee in exchange for a living unit, health care and a lifetime of skilled nursing care, as needed. Many individuals age in place in a CCRC. (Working with Seniors: Health, Financial and Social Issues [Society of Senior Advisors, 2005].)

continuous quality improvement. A management philosophy that emphasizes an ongoing effort to improve the effectiveness and efficiency of processes and products. It began in manufacturing and was brought to prominence by the Toyota Production System. It is now almost universally practiced in health care as a way of increasing customer satisfaction and reducing costs. The central goals are to improve efficiency and effectiveness. Examples include Six Sigma, Plan-Do-Check-Act and DMAIC (define, measure, analyze, improve, control) Methodology.

cultural broker. An individual who bridges, links or mediates between groups or persons of different cultural backgrounds for the purpose of reducing conflicts, producing change, or advocating on behalf of a cultural group or person. Cultural brokers also may be medical professionals who draw upon cultural and health science knowledge and skills to negotiate with the patient and health system toward an effective outcome. (Amy Wilson-Stronks, Karen K. Lee, Christina L. Cordero, April L. Kopp and Erica Galvez, One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations [The Joint Commission, 2008], 57 http://www.jointcommission.org/assets/1/6/HLCOneSizeFinal.pdf accessed February 9, 2009.)

culture. “Integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups.” (Amy Wilson-Stronks, Karen K. Lee, Christina L. Cordero, April L. Kopp and Erica Galvez, One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations [The Joint Commission, 2008], 57 http://www.jointcommission.org/assets/1/6/HLCOneSizeFinal.pdf accessed February 9, 2009.)

dementia care. Care specifically for the person with progressive cognitive impairment, e.g., Alzheimer’s disease.

endorsement. An official declaration by a recognized faith community/tradition that a person meets its standards to serve in a specialized ministry setting of chaplaincy, counseling or clinical education.

evaluation. The comparison of a clinical practice—real or potential—against some standard, which could be an identified “best practice”; the current practice or a clinical outcome.

evidence based. The integration of the best research and available clinical evidence with one’s clinical expertise and knowledge of resident/family values in order to facilitate clinical decision making. This normally follows a five-step process consisting of (1) development of a clinical question, (2) a literature search for evidence of efficacy, (3) critical appraisal of article(s), (4) summary of evidence found and (5) development of a care recommendation.

family. Refers to family members, loved ones and/or significant others of the resident.

interdisciplinary. An approach to care that involves two or more disciplines (professions) collaborating to plan, care, treat or provide services to an individual resident and/or family. Examples include social work, nursing, medicine and chaplaincy care.

http://www.spiritualcarecollaborative.org/docs/common-code-ethics.pdf

http://www.jointcommission.org/assets/1/6/HLCOneSizeFinal.pdf

http://www.jointcommission.org/assets/1/6/HLCOneSizeFinal.pdf


independent living: Living accommodations for seniors who are independent and ambulatory but may have minor physical impairments and health problems. These independent accommodations may be in an apartment complex or small patio homes/cottages on small lots. Some communities will have a mix of these buildings. The minimum age requirement for entry into such communities is normally 55. (Working with Seniors: Health, Financial and Social Issues [Society of Senior Advisors, 2005])

intervention. Any act, with or without words, originating in the chaplain’s discipline, which is offered or intended for another’s healing or well-being.

pastoral care. The offer of spiritual presence to people who are in need and/or experiencing pain/suffering. Pastoral care may form part of the care provided by a chaplain. See chaplaincy care.

peer review. A process intended to be a collegial and reflective view of one’s chaplaincy care practice, ministry, service and/or professional development. The review is intended to stimulate personal and professional growth through conference interaction with one’s peers.

plan. A detailed method that identifies needs, lists strategies to meet those needs and sets goals/ objectives. The format of the plan may include narratives, protocols, practice guidelines, interventions, clinical pathways and desired outcomes.

principal investigator. The individual judged by that person’s organization to have the appropriate level of authority and responsibility to direct a project or program, including financial responsibility where appropriate, e.g., funded research projects, and who bears final responsibility for the findings. This individual is normally the senior author of the final report or article when there are multiple investigators.

relevant data. Information pertinent to assessing and providing care; often used in continuous quality improvement.

religion. An organized system of beliefs, practices, rituals and symbols designed to facilitate closeness to the sacred or transcendent, e.g., God, higher power or ultimate truth/reality, and to foster an understanding of one’s relationship and responsibility to others in living together in a community. (Harold G. Koenig, Michael E. McCullough and David B. Larson, Handbook of Religion and Health [New York: Oxford University Press, 2001], 18)

religious. See religion.

research. A systematic investigation, including development, testing and evaluation, designed to contribute to generalizable knowledge. (Adapted from Department of Health and Human Services, Protection of Human Subjects, US Federal Code, Title 46, Subpart D, Section 102 [2005].)

resident. A generic term referring to a patient/resident/client/tenant/participant and/or family unit who receives care, treatment and/or services. Terms may vary depending on type of facility or geographic location.

skilled nursing care: Daily nursing and rehabilitative care that may be performed only by or under the supervision of skilled medical personnel. This care is usually needed 24 hours a day, must be ordered by a physician and must follow a plan of care. Individuals usually receive skilled care in a nursing care facility but also may receive it in locations such as the home under physicians’ orders and licensed medical supervision. (Working with Seniors: Health, Financial and Social Issues [Society of Senior Advisors, 2005])

spirit. As the transcending part of the tripartite human, i.e., body, mind and spirit, enables a person to connect with self, others, time, place, ideas, nature and the divine. Connecting is spiritual, which gives rise to relationships from which a person derives a sense of meaning and purpose. (Mark LaRocca-Pitts, “Spiritual Care Means Spiritual,” PlainViews 6, no. 2 [February 18, 2009], www.plainviews.org)

spiritual. See spirit and spirituality.



spiritual care. Interventions—individual or communal—that facilitate the ability to express the integration of the body, mind and spirit to achieve wholeness, health and a sense of connection to self, others and/or a higher power. (American Nurses Association and Health Ministries Association, Faith Community Nursing: Scope and Standards of Practice [Silver Spring, MD: American Nurses Association] 2005) Spiritual care forms part of the care provided by a chaplain. See chaplaincy care.

Spiritual Care Collaborative. An international group of professional organizations actively collaborating to advance excellence in professional pastoral and spiritual care, counseling, education and research. Participating organizations include the American Association of Pastoral Counselors, the Association for Clinical Pastoral Education, the Canadian Association for Spiritual Care, the National Association of Catholic Chaplains and the National Association of Jewish Chaplains. (http://www.spiritualcarecollaborative.org/mission.asp accessed February 9, 2009.)

spiritual/religious assessment. An in-depth, ongoing process of active listening to a resident’s story as it unfolds in a relationship with a professional chaplain; summarizing the needs and resources that emerge in that process. The summary includes a spiritual care plan with expected outcomes, which should be communicated to the rest of the treatment team. (See George Fitchett and Andrea L. Canada, “The Role of Religion/Spirituality in Coping with Cancer: Evidence, Assessment, and Intervention,” in Psycho-oncology, 2nd ed., ed. Jimmie C. Holland [New York: Oxford University Press, forthcoming].)

spiritual/religious history. The process of interviewing residents by asking them questions about their lives, in order to come to a better understanding of their needs and resources. These questions usually are asked in the context of a comprehensive examination by the clinician who is primarily responsible for providing direct care or referrals to specialists such as professional chaplains. (See George Fitchett and Andrea L. Canada, “The Role of Religion/Spirituality in Coping with Cancer: Evidence, Assessment, and Intervention,” in Psycho-oncology, 2nd ed., ed. Jimmie C. Holland [New York: Oxford University Press, forthcoming].)

spiritual/religious screening. A quick determination (triage) of whether a person is experiencing a serious spiritual/religious crisis and therefore needs an immediate referral to a professional chaplain. Good models of spiritual/religious screening employ a few, simple questions, which can be asked by any health care professional in the course of an overall screening. (See George Fitchett and Andrea L. Canada, “The Role of Religion/Spirituality in Coping with Cancer: Evidence, Assessment, and Intervention,” in Psycho-oncology, 2nd ed., ed. Jimmie C. Holland [New York: Oxford University Press, forthcoming].)

spiritual/religious struggle. A situation which may develop when individuals are unable to make sense of stressful events in light of their spiritual/religious worldviews. Research has shown that elements of spiritual/religious struggle which have a negative impact on health include various aspects of one’s relationship to God, e.g., feelings of anger, abandonment punishment, as well as questioning God’s love. Spiritual/religious struggle also may arise from the individual’s experiencing hurt/betrayal at the hands of one’s congregation and/or religious authority figures. Additional research is needed to help us develop a comprehensive definition of spiritual/religious struggle. (See G. Fitchett, P. E. Murphy, J. Kim, J. L. Gibbons, J. R. Cameron and J. A. Davis, “Religious struggle: Prevalence, correlates and mental health risks in diabetic, congestive heart failure and oncology patients,” International Journal of Psychiatry in Medicine 34, no. 2 [2004], 179-96; K. I. Pargament, B. W. Smith, H. G. Koenig and L. Perez, “Patterns of positive and negative religious coping with major life stressors” Journal for the Scientific Study of Religion 37 [1998], 710-24; K. I. Pargament, H. G. Koenig, N. Tarakeshwar and J. Hahn, “Religious coping methods as predictors of psychological, physical and spiritual outcomes among medically ill elderly patients: a two-year longitudinal study,” Journal of Health Psychology 9, no. 6 [2004], 713-30.)

spirituality. The personal quest for understanding answers to ultimate questions about life, about meaning, and about one’s relationship to the sacred or transcendent, which may or may not lead to or arise from the development of religious rituals and the formation of community. (Harold G.

http://www.spiritualcarecollaborative.org/mission.asp


Koenig, Michael E. McCullough and David B. Larson, Handbook of Religion and Health [New York: Oxford University Press, 2001], 18)

staff. All people who provide care, treatment and services in the organization, including those receiving pay, volunteers and health profession students.

standard. An authoritative statement by which the chaplaincy profession describes the responsibilities for which its practitioners are accountable. Consequently, standards reflect the values and priorities of the profession. Standards provide direction for professional chaplaincy practice and a framework for the evaluation of practice. Written in measurable terms, standards also define the chaplaincy profession’s accountability to the public and the outcomes for which chaplains are responsible.” (Adapted from American Nurses Association, Nursing: Scope and Standards of Practice (Silver Springs, MD: American Nurses Association, 2004), 77)

subacute care: Comprehensive inpatient care designed for someone who has had an acute illness, injury or exacerbation of a disease process. It is goal-oriented treatment rendered immediately after or instead of acute hospitalization to treat one or more specific, active, complex medical conditions or to administer one or more technically complex treatments in the context of a person's underlying long-term conditions and overall situation. (http://aspe.hhs.gov/daltcp/reports/scltrves.htm accessed November 17, 2010)

http://aspe.hhs.gov/daltcp/reports/scltrves.htm


A Physician’s Perspective Harold G. Koenig

IF THERE IS A SETTING IN WHICH CHAPLAINS ARE NEEDED today, it is long-term care. While research indicates that only 54-64 percent of acute care hospitals in the United States have paid chaplain services, no research at all exists, to my knowledge, on the proportion of US nursing homes that have paid chaplain staff. I’m pretty sure the figure is less than 50 percent, and maybe less than 25 percent. (I’m hoping that religiously affiliated homes aren’t the only ones with chaplains on staff.)

Many people with chronic disabling illnesses end up living the remainder of their lives in some type of long-term care setting. Statistics show that

25 percent of all deaths in the US occur in nursing homes, and the average time to death after nursing home admission is 2.4 years. In 2007, there were 1,368,230 individuals living in 16,995 nursing homes; two-thirds of these were for-profit facilities. If one lives to age 65, there is a 43 percent chance of spending time in a nursing home. The sad thing is that 50 percent of nursing home residents have no close relatives, and 60 percent receive no visitors.

Who is available to meet the spiritual needs of these people during this final stage of life? Community clergy? I doubt it. Who meets the needs of families struggling with issues of guilt and other emotional and spiritual conflicts over having to place a loved one in long-term care? What about the emotional and spiritual needs of the staff, who often are both overworked and underpaid? In North Carolina, the average pay for a certified nursing home aide is $24,000; the poverty level in 2009 was $23,803. No wonder that abuse and theft are rampant in such facilities. Talk about a mission field!

By its mere existence, this standards of practice document acknowledges the importance of chaplains within long-term care and sets standards for the type of care that they should deliver. Not only does it include screening and assessment, it encompasses working with staff to help them recognize the spiritual needs of residents and their families. Further, it calls chaplains to move beyond the institution and collaborate with community clergy to increase their involvement as well as the involvement of members of their congregations. What is really exciting is that these standards describe more than merely holding religious services or providing sacraments. Rather they emphasize one-on-one contact between chaplain and resident for spiritual assessment, spiritual care planning and implementation of a spiritual care plan. Furthermore, they stress one-on-one support for staff as well. In a word, BRAVO!

One major strength is that these standards also describe the benefits for chaplains working in long-term care, including the opportunity to develop long-term relationships with patients, family and staff, which allows for greater depth and understanding of spiritual needs. How different this is from acute care, where short lengths of stay seldom allow such meaningful relationships to develop. The standards also emphasize the role of the chaplain as a spiritual care leader who is an integral part of the health care team and not simply “added on” because it looks good.

Of course, I could not help but be impressed by Standard 12 – Research. This is a significant strength as it roots chaplain activities in evidence-based care, the standard to which all health care professionals are now being held accountable. This standard emphasizes the need for chaplains to learn about and to critically evaluate the research as well as actually contributing to the research base by collaborating with other researchers, serving as either principal or co-investigator on

Harold G. Koenig MD is professor of psychiatry and behavioral sciences and associate professor of medicine at Duke University Medical Center, Durham, NC. He also serves as distinguished adjunct professor at King Abdulaziz University, Jeddah, Saudi Arabia.

[email protected]


research that will be published in peer-reviewed publications and/or presented at conferences. In one word, AWESOME!

I actually don’t see a lot of limitations in the standards of practice with the possible exception of the section on documentation. Documentation is a necessary—albeit evil—part of the work that chaplains do. I hope that this will not result in the same problem that nursing has encountered in which documentation has come to take up a very large part of the nurse’s time, which usually means less one-on-one time with patients. I hope that priority will be given to meeting the needs—both spiritual and emotional—of patients, families and staff, rather than writing about it.

Overall, I’m thrilled to see APC take the stance of emphasizing the importance of chaplains in long-term care and describing the standards they are expected to meet. Now, all that’s needed is to persuade nursing homes to hire chaplains so that these standards may be utilized.


An Administrator’s View R. Douglas Spitler

FIRST, I COMMEND THIS WORK GROUP on the thoroughness of the standards and the intent descriptions developed to define effective chaplaincy support in long-term care settings. It is clear from my reading that the work group has a clear grasp of the nuances of the long-term care chaplaincy function in comparison to acute care chaplaincy.

I particularly appreciate the recognition of the importance of establishing meaningful relationships with residents, family and staff as an essential element for the effective provision of chaplaincy services in a long-term care setting. This brings me to my first point, which is to insure that the ability to establish intimate, trusting relationships is an essential competency which needs to be addressed if not incorporated into the Common Standards for Professional Chaplaincy. (I have not had an opportunity to review this document).

In the section Credentials of the Board Certified Chaplain and in the intent description for Standard 13 – Knowledge and Continuing Education, there is reference to the continuing education requirements to maintain certified status. I am not clear regarding the form of continuing education permitted and if it is permissible to participate in e-learning. If not, I encourage this possibility. In addition, I suggest broadening the range of continuing education to include emerging trends in care delivery practices as well as integration with acute care and medical care, all of which are being impacted through a variety of health care reform initiatives.

Under Scope of Services, it should be noted that many faith-based long-term care organizations provide financial aid to residents who have depleted their financial resources and involve chaplains in providing counsel to residents in need of assistance.

In Standard 1 – Assessment, I suggest incorporating a reference to the assessment being undertaken in a fashion which complies with any applicable regulatory, licensure or accrediting body requirements. In this Standard as well as in Standard 3 – Documentation of Care, plans of care are referenced. Many of us in long-term care are moving to I-plans versus the traditional care plan, which approached care planning from a parental perspective. I-plans are based on the resident’s or the resident representative’s personal perspective and commitment to addressing (or not) a particular need.

My suggestions are relatively minor in nature and reflect the high caliber of work completed by the work group in establishing relevant professional standards for long-term care chaplaincy.

R. Douglas Spitler is president and CEO of Episcopal Retirement Homes Inc., Cincinnati, OH.

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The Spiritual Care of Older People: The Report of a Group Research Study Harriet Mowat • Claire Wilson • Geoff Lachlan • William Gray • Alastair Gray • Ellen Faubert • Liz Adams • Stuart Coates • Suzanne Bunniss

This article focuses on methods and outcomes of a piece of participatory research with the intention of combining an educational experience with the production of useful research. This group approach to research may serve chaplaincy well as the combination of perspectives and skills is greater than the parts. This article shows that reflection and discussion can produce “new horizons.” Authors use the Gadamerian stages of the hermeneutic cycle as headings for the presentation of the data and also identify the findings before showing the workings. This deviates from the

standard presentation of research but allows the research story and the workings to be exposed more helpfully. Conclusions show that adaptation both internally and externally are required in old age and a major task for chaplaincy is to help in the adaptive process through focussing on the underlying meaning to a life’s experience. Reprinted with permission from the Scottish Journal of Healthcare Chaplaincy. Original spellings and form for source citations have been maintained.

THIS PAPER REPORTS A STUDY undertaken as part of an educational programme aimed at developing research method skills in health care chaplaincy. This particular project considered the idea of “gerontological chaplaincy.”

The intention of the educational programme was to offer participants an interactive, customised and flexible experience of doing research. This would enhance their understanding of research methods and develop practical research skills. The intention also was to devise a method of collecting and analysing data about the spiritual care of older people in health care settings, which is appropriate to health care chaplaincy and its core beliefs and principles. This meant that a method needed to be found whereby theological reflection and social science analysis could work together.

This was achieved by working as a collaborative group made up of chaplains, spiritual caregivers and spiritual care researchers. The substance of the fieldwork was to gather naturally occurring case study material of spiritual care work with older people.

We recorded and analysed these case studies as a research group. We identified key themes and generalisable issues using qualitative research techniques of analysis and theological reflection, drawing on the various skills of the group. This paper reports the findings of this study and comments on the process of doing collaborative research.

Background: Gerontological chaplaincy The assumption underlying this research topic was that older people have particular spiritual needs which are distinct from those of others, particularly in times of ill health and death and dying. These needs have been underresearched and underacknowledged in health care chaplaincy practice. As individuals, we are often not receptive to our own ageing, tending to see ageing as something that others do. As a society, we struggle to value ageing, seeing youth as more interesting and enlivening. Health care chaplains are not immune from these cultural sentiments, which influence their practice.

Lead author Harriet Mowat is director of Mowat Research and chair of the National Healthcare Research Committee, 52 Richmondhill Place, Aberdeen AB15 5 EP. This article originally appeared in the Scottish Journal of Healthcare Chaplaincy 13, no. 1 (2010).

www.sach.org.uk/journal/journal.htm

http://www.sach.org.uk/journal/journal.htm


Working out the research question The research team were either working as full- or part-time health care chaplains or spiritual care researchers. In addition, there were three course leaders. The total group of nine collectively had backgrounds in medicine, psychology, learning disability, theology, nursing, sociology, business, accounting, education and engineering. The intention was to reflectively work through the research process in order to identify new ways of working with older people based on empirical evidence. We were trying to combine theological reflection on a situation with empirical observation and analysis. This process combined the ideas of Gadamer (1975) and the hermeneutical circle and the expression of the action research cycle found in Swinton and Mowat (2006). In both cases, the importance of reflection, change and use of research knowledge is highlighted. The work of Gerkin (1989) also influenced our thinking in particular in considering the reflective task and the relationship between the researcher and the researched.

The group was asked to prepare themselves for the discussion by reading a variety of articles given to them in the precourse materials. (Reid 2009, Wolfe 2007, Mowat 2008, Mowat 2007, Sadler and Biggs 2006) Our first two days spent together were dedicated to working out the research question and the method. In terms of the Gadamerian reflective cycle, these two days moved from “preunderstanding” to the experience of “being brought up short.” There were a variety of presentations to stimulate discussion, which included the nature of knowledge, how can we know what we know, the idea of ageing, successful ageing and the link between ageing and the spiritual journey. Each member of the group was asked to write up a known case, somebody who had spiritual needs and for whom they had spiritually cared, and to use the research technique of thick description. The anthropological task of thick description requires a detailed unpacking of the situation so that the nuances and subtleties of the interactions may be understood more fully. (Geertz 1973) Using Gherkin’s ideas we also encouraged the team to incorporate their own reflections and selves into the description and analysis.

Our discussions brought us to the conclusion that it might be difficult, and possibly undesirable, to differentiate older people’s spiritual needs from that of anybody else. The idea that ageing has a particular spiritual imperative and indeed that ageing gives us an opportunity to develop spiritually was critically discussed. The result was that a new perspective was found. Instead of accepting uncritically that there were specific characteristics of spiritual care for older people and that the task was to identify them, a new question was posed: Are there specific characteristics of spiritual care for older people: should older people be seen as having different needs to others?

Method During our group discussions, we refined the method taking into account the practicalities of research being conducted by people with other, full-time jobs. The end result was as follows:

1. Each participant reviewed one book and summarised for the others.

2. Each participant wrote two thick descriptions based on their real life practice. They drew these descriptions from their own experience of working with an older person, often during bereavement or illness.

3. Each participant analysed two of the descriptions, one of their own and one of someone else’s.

4. Two participants carried out consensus group discussions with groups of older people linked to churches.

5. Each participant produced a written piece reflecting on an aspect of the research data.


Literature review At the beginning of a piece of research, it is important to establish what has gone before. Typically, an exhaustive review of the literature will lead naturally into the research question. In reality, people do not have time or the resources to do this kind of work and the available materials now online vastly overwhelm capacity to take in the knowledge.

We asked the participants to read one book reflectively in depth and to write up an account of it as it related to the research question. Each of these books was written by established authors in the field. Some of them were edited books. (Woodward 2008; Killinger 2005; White 2006; Mackinlay, ed., 2008; Mackinlay, ed., 2001; Jewell, ed., 2004)

Our group discussions of this literature showed that preunderstandings had shifted and that participants were experiencing the “being brought up short” referred to by Gadamer (in Osmer 2008). None started with a particular knowledge about ageing. All found issues, ideas and knowledge in these books that made them start to view the world of ageing slightly differently. Building on these insights, we started to formulate a way of analyzing the data by creating themes that came from the literature that linked with the themes that came out of the data.

This literature “voice” revealed four themes as shown in the following table.

Definitions of ageing

Ageing is a spiritual journey, helps you become more true to yourself, is normal, something we all do, involves existential angst.

The relationship between ageing, spirituality and religious faith

Spirituality waxes and wanes with age. Spiritual maturation is possible in old age. We have a crisis in faith as we age. Christian faith may be a matrix/resource for ageing (Woodward). The Church denies age. Is about the relationship with the ultimate.

The requirements of ageing and spirituality

A search for meaning and purpose. Seeing things differently, e.g., only see the stars when it’s dark. A challenge to existing beliefs.

Methods of supplying spiritual support

Talking and listening. Nonanxious presence. Friendship. Time. Memory. Journaling. Faith community as holder of memories. Reminiscence. Anticipation of loss – ritual. Life review.

Prayer. Staff discussion. Friendship. Use of language. Strategies for communication. Playfulness. Compassion and cheer. Sense of belonging. Welcome. Relationships.


The group noted several key analytical points, which formed the basis of the review of the data.

• What is seen as strength in early life may become a weakness in later life.

• The process of ageing requires a process of spiritual support.

• For the current generation of those over seventy, spousal relationships are specifically important and central and arguably different in nature to the next generation spousal relationships.

• Finding meaning is the crucial basis from which the carer and those being cared for can emerge and spiritual care cannot be fulfilled unless that basis is found or recognised.

Armed with these insights and reflections we moved on to the data. The richness of the data is never done justice to in the write up because there are always too much data to include.

The data “voice” – dialogical interplay This stage in the cycle allows the texts to reveal themselves to us. The data voice came from the thick descriptions, the consensus group work, the analysis of these data by individuals and the group discussions. This reflects the view that data are inevitably interpretive. We have tried to show the “workings” of that interpretation. The job of the reader is to consider the interpretation presented here in the light of her/his own preunderstandings in order to continue the hermeneutic process.

These were prepared during the fieldwork period and each participant had access to all the data for the two-day analysis period. One of the research team led the analysis process, which involved deriving themes and substantiating them through the data. This was not a typical analysis process in so far as it was collapsed into two days rather than spread out over a period of time with spaces for reflection. This had the benefit of focussing the discussion, but the disadvantages of not allowing ideas to emerge and ferment.

Summary of the findings Through group discussion, reflection and thematic analysis, we derived a method of spiritual care for older people, which is expressed in the Diagram 1 – A method of spiritual care for older people. (See Attachment A.) This was the “fusion of horizons,‟ which we achieved following our “dialogical interplay.‟ The diagram shows that adaptation was central to ageing as well as possible. This is consistent with the work on “successful” ageing. (Baltes & Baltes, 1990) Adaptation and adaptive capacity depended to some extent on the nature of the ageing journey. The findings showed that in all cases ageing was a journey to be taken seriously and which had a number of common characteristics. There were two kinds of adaptation required. An adaptive attitude referred to the internal work and processes of the individual and the adaptive resources referred to the way in which the outer world was responded to—the external relationships. The task of the spiritual carer, expressed as good practice, is therefore to support the adaptive capacity in both spheres. The major way to do this was by engaging in the search for meaning and adopting the practices listed under methods of supplying spiritual support shown in the literature review summary table above.

The data analysis “journey” – dialogical interplay This framework came at the end of a long and sometimes quite challenging process of trying to make sense of the data. The intention had not necessarily been to come up with a model of good spiritual care but to answer the question about specific spiritual care for older people. The development of the themes expressed in Diagram 2 – The data analysis journey and their configuration as a framework for good spiritual care practice came out of the discussions about the data within the group who were themselves applying prior knowledge and theory to the data. (See Attachment A.)


The ageing journey It quickly became obvious that older people in the case studies were “journeying” and that this journey involved a number of common experiences. Attachment B shows examples of the material from the case studies that support the categories. This table demonstrates the process of moving from the data, to clusters, themes and category and then to the framework described above.

The ageing journey for these cases was helped by adaptive capacity. There seemed to be two components to adaptation that were derived from our data set.

Adaptive attitudes Adaptive attitudes seemed to revolve around concepts which are familiar in discourse around spirituality and successful ageing. Specifically, these included thankfulness

… dear wife was taken from their home and never survived to reach hospital and so was spared needless suffering. He was simply so glad she had passed away quickly and painlessly. (01)

as well as acceptance, peace of mind, maintaining routine/ritual and finding a continued role in life.

He was at ease … and spoke with characteristic ease and grace with a real sense of gladness about his wife’s peaceful painless passing and never referring to what the future held for him. … there was no apprehension or anxiety about his own fate; instead he readily planned his weekly shopping trip when he drove himself to the supermarket. (01)

The internal work of adaptive attitudes was influenced by a number of themes: faith, personal characteristics, finding new purposes, looking forward, retaining/rehearsing memories and addressing the question of meaning. (See Attachment C.)

External relationships The other component part of adaptation was in terms of resources. We described these as external relationships. In our sample, these seemed to be the way in which the case study individuals engaged with and related to their families, nature, spousal relationships, community support and involvement in the church. All these factors seemed important in helping individuals adapt to the ageing process and to give a framework for approaching their spiritual care. (See Attachment D.)

The good practice for the spiritual care of these individuals seemed to be to stimulate an adaptive attitude through addressing the internal and external components of the life. This means encouraging and discussing an adaptive attitude and stimulating and supporting adaptive resources.

Conclusions This experimental study has developed a framework for spiritual care of older people. It draws on empirical data derived from case studies, two focus groups and a multidisciplinary group of researchers, who generated themes through reflection and discussion using the techniques of the reflective cycle. It suggests that those who are serious about supporting older people in their spiritual journeys will focus on both the internal and external resources available to them and encourage an adaptive approach to the ageing process. This is very much in tune with the idea of adaptation, compensation and optimisation which Baltes and Baltes generated. Adaptation is in itself a spiritual task and needs help.


Limitations This was an experimental study, which attempted to use a collaborative approach to a topic and to combine the social science qualitative method with a directly reflective cycle. The data are secondhand in the sense that they come from the researchers’ memories of interactions and situations and thus are highly interpretive. However, if we believe that all data are interpretation, then we have tried to identify and to show our “workings” in order that readers may judge for themselves the value of the emerging framework.

Implications – application to the real world Application to the real world is the final part of the Gadamerian cycle. It is here that we consider the new insights that this work has given us.

Firstly, we will consider the insights about chaplains’ capacity to engage in action research. This project was hard work for everyone and had to be fitted in to busy lives elsewhere. However the time to reflect and think served the chaplains well. The model of collaborative research, in which researchers from different perspectives engage with each other, is very appealing and workable. This strengthens the work and allows its theological aspects to maintain their place alongside the social science drive towards themes and generalisations.

Secondly, we consider that the spiritual work required is at the end of life when bereavement, loss and decline are commonplace. Health care chaplains, whether in the community or in hospital, inevitably encounter such topics with patients, many of whom are elderly. We think that this framework for spiritual care provides a real and helpful structure by which to support older people and to offer practical, spiritual and emotional comfort. It offers a vehicle by which meaning in old age may be sought and found.

In the end, our spiritual journey is just that, ours. However we may walk alongside each other as companions for some of the way. We may gently ask the questions, both practical and philosophical, that need to be asked so that adaptive capacity can be maximised and spiritual lives enhanced and enriched.

References Baltes, P. B. and M. M. Baltes. “Psychological perspectives on successful ageing: The model of selective optimization with compensation.” In P. B. Baltes and M. M. Baltes, eds., Successful Aging: Perspectives from the Behavioural Sciences. Cambridge: The European Science Foundation, University of Cambridge, 1990: 1-34.

Gadamer, H. G. Truth and Method. New York: Continuum, 1975.

Geertz, C. “Thick description: Toward an interpretive theory of culture.” In The Interpretation of Cultures: Selected Essays. New York: Basic Books, 1973: 3-30.

Gerkin, C. V. The Living Human Document: Revisioning Pastoral Counseling in a Hermeneutical Mode. Nashville: Abingdon Press, 1989.

Gleason, J. and F. Heffeman. The Ideal Intervention Project, 2010. http://www.ACPEresearch.net

Jewell, A., ed. Ageing, Spirituality and Well-being. London and New York: Jessica Kingsley Publications, 2004.

Killinger, J. Winter Soulstice : Celebrating the Spirituality of the Wisdom Years. New York: The Cross Road Publishing Company, 2005.

MacKinley E., ed., Ageing, Disability and Spirituality: Addressing the Challenge of Disability in Later Life. London and New York: Jessica Kingsley Publishers, 2008.

MacKinley, E., J. Ellor and S. Pickard. Aging, Spirituality and Pastoral Care: A Multinational Persepective. New York: Haworth Pastoral Press, 2001.

http://www.acperesearch.net/


Mowat, H. “The potential for efficacy of health care chaplaincy and spiritual care provision in the NHS (UK): A scoping review of recent research.” Commissioned by NHS (UK) Yorkshire and the Humber, 2008. Available from www.mowatresearch.co.uk

Mowat, H. “Gerontological chaplaincy: The spiritual needs of older people and staff who work with them.” Scottish Journal of Healthcare Chaplaincy 10, no. 1 (2007).

Osmer, R. Practical Theology and introduction. Grand Rapids, MI and Cambridge, UK: William B. Eerdmans Publishing Company, 2008.

Reid, G. Ageing and Spirituality: Reviewing the State of Current Research. The Selwyn Centre for Ageing and Spirituality, 2009 www.selwyncare.org.nz

Sadler, E. and S Biggs. “Exploring the links between spirituality and ‘successful ageing.’” Journal of Social Work Practice 20, no. 3 (2006): 267-80.

Swinton, J. and H. Mowat. Practical Theology and Qualitative Research. SCM Press Division of Canterbury Press, 2006.

White, G. Talking about Spirituality in Health Care Practice: A Resource for the Multiprofessional Health Care Team. London: Jessica Kingsley, 2006.

Wolfe, D. Jung’s 7 Tasks of Ageing, 2007. www.timegoesby.net/weblog/2007/08/david-wolfe-on-.html

Woodward, J. Valuing Age: Pastoral Ministry with Older People. London: SPCK, 2008.

http://www.mowatresearch.co.uk/

http://www.selwyncare.org.nz/

http://www.timegoesby.net/weblog/2007/08/david-wolfe-on-.html

http://www.timegoesby.net/weblog/2007/08/david-wolfe-on-.html


Attachment A

Diagram 1: A method of spiritual care for older people

Diagram 2: The data analysis journey


Attachment B: Examples of material from the case studies which support the categories in the ageing journey

Raw data extracts Detailed refs available in

data files

Clusters Agreed by

group

Themes Named after

discussing clusters

Category Appears on framework

I think about God and how good he has been to me. I … I liked being in the church doing things for the church. You know that I was an elder and in the guild. I miss the people whom I used to be friendly with at church. … is X still there? (021)

Shrinking horizons

Missing church community

Restrictions to daily living

Narrowing and shrinking of horizons

The ageing journey

M has always been a keen gardener, but as she became less able to tend flower beds, J has progressively planted more of the garden as lawn. (062)

Gradual adjustment to loss

Wobbly balance between independence and dependence

Loss The ageing journey

After much deliberation, she suggested that she would like to go into a residential care home rather than be looked after by one of the family. (031)

Accepting that carers become the cared for

Effect on the carers

Acceptance The ageing journey


Attachment C: Adaptive attitudes


data files

Clusters

Themes

Category

Mr. and Mrs. X chose to retire here from a gregarious life style elsewhere and their own social skills ensured that they were accepted within their own locality as well as the church. … they had a substantial network of friends and this gave them support and encouragement. (011)

Practiced social and emotional mobility

Primary identification of self as family member

Core consistency of self aided by routine

Oblivious to the idea of ageing

Personal characteristics

Internal processes

On recovering (from a stroke) … something had changed. P was wanting to pray and be part of a group, which he had never done before. … we wondered if he would like to go to church, and someone said, “He doesn’t get up any other day before 11.” (051)

Questions about life after death

Strong faith

Constant relationship with God

Prayer brings peace

Faith as progress, means of getting nearer to God

Affirmation of spirituality

Faith as a support in life

The group reflected on the cumulative emotional effect of all his losses, compounded by a sense of grievance arising from medical mishap … the feeling of accumulated and accentuated loss fed into an absence of hope; the collective feeling of “what’s the point.” (04103)

Existential anger

Questioning God and faith

Meaning/finding purpose

Some new activities and relationships became available to S … providing a much needed structure to the week. … he continued regularly attending the church he had gone to as a child and also linked up with a befriender. (052)

Making active, positive choices in facing challenges

Making new connections

Making decisions

Looking forward

He did not mindlessly recall and recite past happenings featuring his late wife but would include her whenever it was appropriate, just as if she were out shopping and not present to contribute to the discussion. (011)

Memories as part of resilience

Memories of church and family

Memories


Attachment D: External relationships


data files

Clusters

Themes

Category

The family (who lived a good distance away) would phone them regularly and visit when able. That worked out at about a monthly visit during the winter, more often in the summer. (062) She maintained her interest in family events, and when her grandson was married, she felt she did not have the confidence to be taken to the wedding, so the wedding came to her. In between the reception and the evening party, the bride and groom accompanied by a variety of bridesmaids went out to visit her. (031)

Family blockage

Geography

Intergenerational relationships

Meaningful and contributory loving family relationships

Connections

Families External relationships

With her dementia, L has an inner self-awareness through memories of long ago, whereas her husband is more aware of the present. L displays a greater sense of contentment and serenity than her husband. (062)

Burdensome loneliness

Duration of relationship

Mutual dependency

Endurance

Love

Spousal relationships

He has good neighbours, who bring his daily paper and use this an opportunity to see that he is up and about. (061)

Belonging to a neighbourhood

Friends

Connections to place and across generations

Community support

She still enjoys going to church but now relies on neighbours to take her there and back if her husband is too stiff to walk. … she is always welcoming to people who visit her. (062)

Connection to active church, engagement with the church community, a sense of belonging. It implied a network of support and a sense of continuing purpose. (Some of the case study subjects actively sought to maintain church involvement.)

Church involvement


A Poem Is Some Remembering Charles Christie BCC

Chaplains often use journaling or free form writing as a way to gain insight into their experiences and/or to relieve stress. This article focuses on short form poetry as a vehicle for self-care. After reviewing the creative process, the author explores two specific forms: haiku/senryu and minute poems and provides examples. It’s morning; there’s lamplight, and the room is still. All night as we slept, memory flowed Onto the brain shore. Memories rise and fall And leave behind a delicate openness to death. Almost a longing to die. That longing Is like rain on canyon ground, only droplets. And the brain is like brown sand, it stretches On and on, and it absorbs the rain. What is a poem? “Oh it is some remembering,” A woman said to me. “Thousands of years ago, When I stood by a grave, a woman handed Me a small bone made red with ochre. “It was a poem about heaven, and I wept so.”

Robert Bly “A Poem Is Some Remembering”1

IN CHAPLAINCY, THE SACRED AND THE ORDINARY OFTEN ARE INTERTWINED. As we prepared a body in advance of the grieving family’s visit to the morgue, a chaplain intern and I engaged in mundane conversation about hospital protocols. What keeps us coming back to work in which the extreme has become a matter of course? What brings us back for another day of the worst day in people’s lives? Without some perspective, we may either miss entirely or literally be run over by the horror, irony, sublimity, humor or holiness of these moments.

Pastoral care that matters asks chaplains to open themselves to experiences and relationships that risk everything they ever believed or knew. Though the topic is writing, William Stafford’s book, You Must Revise Your Life, rings true for chaplaincy as well.2

Revising and reflecting on our experience is a necessary part of self-care and growth as chaplains and persons. Left alone, dramatic experiences may build to fearful internal energies held at bay by stoic denial or dogged belief. Indeed, trauma constitutes an existential threat to one’s internal boundaries and sense of order and place. For the traumatized chaplain, the powerful effect of an experience may lead to isolation and shutting down or to a new, broader, more effective way of engaging reality.

Journaling or free form writing has long been recommended for those who want to gain insight into themselves and relieve stress. The cathartic benefits of writing one’s experience, thoughts and

Charles Christie MDiv BCC serves as staff chaplain at Gwinnett Medical Center, Lawrenceville, GA. He is endorsed by the Cooperative Baptist Fellowshiip.

[email protected]


reactions are obvious and valuable. Taking this form of writing several steps further may enhance one’s self-care, moving from catharsis to reflection to reorganizing or revising one’s world-view.

Writing poetry may serve as a distillation process: taking experience and images from journaling, cooking them down to one image, experience or reaction and putting them into affective language. Ideas, constructs and systematic theologies have little currency within the traumatized psyche. The images, metaphors and experience of poetry are the perfect vehicle for soulful, restorative theological reflection.

Poetry as self-care Chaplain Roz Shackleton, the editor of Chaplaincy Today, knows a thing or two about writing and has used poetry as self-care most of her adult life. Roz says she “makes writing” in the same way others make music or visual art, adding that writing is “a way to get feelings outside myself, to put them down where I can look at them with a greater level of objectivity and begin to make sense of what has happened to me or to what I have witnessed.”

She offers a series of steps to incorporate poetry into a plan of self-care:

• Debrief: Tell your story to a trusted colleague or friend—more than once, if necessary.

• Journal: Record your impressions, feelings and/or facts. This helps move daily experiences to a “safe” place.

• Reflect: Take time to look at the experience from different angles.

• Compose: Accept new images and reflections as they present themselves.

• Refine: Continue to work with the poem and consider short forms as a way of reducing the experience to its essence.

Some years ago—before being called to chaplaincy—Roz experienced the end of a three-decade marriage and used the first four steps to compose a poem months after the divorce was final.

Ash Wednesday

The illness was long and painful. When death came at last, There was no time for a proper burial. Still I could not abandon the body, So I carried its ashes In a clenched fist of anger That nothing could penetrate. Now, in the lengthening light, I feel warmth seep into my bones. My hand opens, Finger by finger, Like the petals of a flower. A fresh breeze scatters The remnants of the past Till but a fragment clings to my palm. I rub my thumb into the residue, Mark my forehead with the cross of memory: Earth to earth – ashes to ashes – dust to dust. I wash my hands with the tears of yesterday And hold them up to dry in the sun. R. Shackleton


While Roz’s poem certainly stands on its own and expresses the sublime experience of loss and healing, refining it into a short form produces ever more poignant reflections. By focusing on the words that seemed to hold the essence of “Ash Wednesday,” Roz made the following list:

ashes clenched fist lengthening light

warmth hand opens

memory dry in the sun

She used these words to distill the longer poem into haiku with these results:

Clenched fist opens to warmth, and memory’s ashes bring enlightenment. R. Shackleton

Warmth seeps through fingers— fist of cold ashes opens to enlightenment. R. Shackleton

The case for short poetry In making a case for short poetry, Robert Bly writes, “a fine, intense poem of seven or eight lines suddenly grows by fifteen, telling us what the emotion means, how it relates to philosophy and what the moral is.”3

As chaplains, we all have some preacher in us and often are guilty of taking a perfectly good image or poem and strangling it by the need to explain. As the rational mind takes over and we begin to describe and tell, perhaps even to pontificate, something in the soul switches off. Though informed, both the self and the reader are no longer inspired.

Experimenting with short forms of poetry forces us to continually narrow and refine the focus. Often we are surprised by the result. It is at this point, when we arrive at an unexpected image or insight that our theological reflection begins.

Chaplain Bob Duvall tells of presenting himself for certification in the former College of Chaplains “at age twenty-seven and twenty-two pages.” Although his presenter commented that “this candidate has either lived a full life or is quite wordy,” Bob was certified in spite of himself and his wordiness. Now at age sixty, Bob finds meaning in working with short poetic forms, noting that the process and practice of writing a poem can be a healing re-membering for a chaplain.

In Bly’s lines, we find ourselves standing in the still room at morning. The night’s dreams wash over us. As readers we travel with him to our own rooms of morning lamplight. We lie on our brain shore as the tide comes in and goes out leaving behind delicate debris of sea change.

Even on this shoreline, there are a few rules. We need to stay with the experience and resist the urge to describe or moralize. This is a kind of free association but always with reference to the original experience without being a slave to detail. Working with form and poetic style may become part of the reflection itself as it urges us to find new words, metaphors and images. We also need to pay attention to several general guidelines:

• Sense – Ideally each line will stand on its own.

• Syntax – If the rules are broken, it should be for good reason and not overdone.

• Rhythm – The poem should “sing.” Recall Bly’s words:

“All night as we slept, memory flowed Onto the brain shore … .”4

As chaplains, we encounter many intense moments as we walk with people through life-changing trauma, chronic/terminal illness and sometimes death. Any of these may make or break, empty or


restore, depending on how we integrate them into the fabric of our being. Some moments are at once saturated with spirit and yet common as socks. These are the sighs, offhand comments and uncalculated acts that suddenly open onto a bright valley long hidden behind brush and fallen rock. Putting all of this, the horrific and humble, into a poem of some remembering may yield health and wholeness for the practicing chaplain. Two particular short forms, haiku and senryu, help us to take full-to-the-brim moments and bring them into sharp focus.

The Japanese form of haiku is elegant in its simplicity. The Haiku Society of America defines it as a “poem in which nature is linked to human nature.”5 Haiku is not only structure but is “about living with intense awareness, about having an openness to the existence around us—a kind of openness that involves seeing, hearing, smelling, tasting and touching.”6 Senryu, which follows the same form but deals with human nature and human relationships, is often humorous. Both haiku and senryu embody an awareness of the world around us and are touchstones of suggestiveness.7

The English form of haiku is composed of three lines with a total of seventeen syllables and is intended to be spoken in a single breath:

Haiku As hawks soar and kee a prescribed walk becomes a pilgrimage.

B. Duvall

5 syllables 7 syllables 5 syllables

Focuses on nature; grew out of walks prescribed for rehabilitation after cardiac surgery.

Senryu

His last words: “Poisoned, boa constrictor sperm.” Tox report pending.

B. Duvall

5 syllables 7 syllables 5 syllables

Focuses on human nature/ relationships. When asked, “Do you feel safe to return home?” the patient replied, “No, my daughter is trying to poison me with boa constrictor sperm.”

While not as ancient and elegant as haiku, minute poems are another form of short poetry the chaplain might use for reflection. Created in the 1960s by Verna Lee Hinegardner, a minute poem has a total of sixty syllables in three stanzas, each of which follows an 8/4/4/4 form. This allows the writer to capture a slice of life and turn it into a story. Minute poems are capitalized and punctuated like prose. Like all poetry, they are intended to “shine a light on a moment of intensity.”8

Minute Poems The ER nurse remembers all the countless dead in twenty years— all but one thing. “I never look at their faces.” Man, woman, child, how, when, where, but never a face. One stolen glance, now they’re faceless just like that boy with a gun who blew his face off.

C. Christie

8 syllables 4 syllables 4 syllables 4 syllables

No shrinking Florence Nightingale— white clad, padding halls, dispensing consolation. Nurse Sarah’s patients called her Sarge, there was no room for sentiment in medicine. When medicine failed, she still held feelings suspect, but Sarah’s friends couldn’t help it.

C. Christie


Poetry as self-care Last March, we (Roz Shackleton, Bob Duvall and I) put our collective notion of writing short poems as self-care and reflection to the test. In a workshop at the 2011 APC Annual Conference, we presented our ideas and then invited the attendees to see if the proof was in the writing.

Following an overview of these poetic forms, we invited Chaplain Dorothy Shelly to share a story from the long-term care facility she serves. We “journaled” together as a group to sort out the details and feelings of an interaction between a mother suffering from Alzheimer’s and her daughter, who shares dinner with her once a week.

We invited participants to work individually or in small groups to compose a haiku or minute poem. The shared results of the individual and group sorting and poetic imagination were amazing. Each group or individual seemed to divine deeper and deeper insights from the story, all expressed in the language of the soul. This one example of a mother/daughter relationship produced a dozen or more beautiful poems, each capturing another facet of the human experience as the story of one woman became the story of us all.

Clarissa Pinkola Estes says this poetic sorting, “is the kind which occurs when we face a dilemma or question, but not much is forthcoming to help us solve it. But leave it alone and come back to it later, and there may be a good answer waiting … where there was nothing before.” The poetic imagination is like the “phenomenon that a question asked before bedtime, with practice, elicits an answer upon awakening.”9

We ended the workshop by inviting participants to compose from their own experiences. Here are a few lines from their “brain shores”:

Written from the workshop experience

Daughter and mother Whose mind has forsaken her Dinner bewildered Skye Murray BCC Pediatric Intensive Care Chaplain Kosair Children’s Hospital, Louisville, KY Written from personal experience

Her Vacant Eyes Your childhood stolen; a secondary victim, my theology

Kristin Moore APC affiliate member Staff Chaplain I

Cincinnati (OH) Children’s Hospital Medical Center Dedicated to my colleagues in residential psychiatry at CCHMC where approximately 90 percent of the youth we serve have a history of trauma and/or abuse. Red Balls, balloons and shoes, Baby boy’s burned head and face, Red, red angry red. Tammy Holland Sullivan APC affiliate member Chaplain Compassionate Care Hospice, Athens, GA


In “How to be a Poet,” Wendell Berry advises the aspiring writer to “make a place to sit down …. Be quiet ….” and finally, “accept what comes from silence.”10 This is how the three of us had experienced writing, a solitary experience like meditation or prayer. The delight of the workshop was that like prayer, writing also may be a corporate experience. Our experience was equal parts poetry reading, prayer and theological reflection. We all benefited from the variety of reflections and insights from a room full of chaplains seeking the sublime in human experience.

1 Robert Bly, Morning Poems (New York, NY: Harper Collins, 1997).

2 William Stafford, You Must Revise Your Life (Ann Arbor, MI: University of Michigan Press, 1986).

3 Robert Bly, ed., The Sea and the Honeycomb, A Book of Tiny Poems, (Boston, MA: Beacon Press, 1971).

4 Bly, Morning Poems.

5 Cor Van Den Heuvel, ed., The Haiku Anthology: Haiku and Senryu in English (New York: W.W. Norton, 1999), xi.

6 Ibid., xi-xii.

7 Ibid., xi.

8 Cathy Smith Bowers, A Book of Minutes, (Oak Ridge, TN: Iris Press, 2004), xi.

9 Clarissa Pinkola Estes, Women Who Run With the Wolves: Myths and stories of the Wild Woman Archetype, (New York, NY: Ballantine Books), 99. 10 Wendell Berry, “How to be a Poet (to remind myself)” in Given: New Poems (Berkley, CA: Counterpoint, 2005).


Retired Chaplains’ Writing Project Ubuntu is a Bantu term meaning “I am what I am because of who we all are.” Thus, it is far more than a word. Ubuntu is a philosophy of life which focuses on allegiances, relationships and responsibilities within community. The insights, stories and experiences shared in this article by four retired female chaplains are examples of how Ubuntu manifests itself within professional chaplaincy. The “real life events” recounted by these women give voice to the reality that transformation is a mutual experience. As professional chaplains, these authors are who and what they are because of faith commitment and the collegial educational process which led them to the Association of Professional Chaplains (APC). Also, let us not forget the other half of the equation: today APC is what it is in part because of the courage of female chaplains who faced early challenges of sexism, inequity and prejudice. Their persistence and that of their contemporary sisters continues to move the profession of chaplaincy forward and to support and encourage all women—and men—who follow in their footsteps.

George R. Robie BCC (retired), Coordinator

Weaving a Tapestry Margaret A. Muncie BCC

STORIES ARE THE BREAD AND BUTTER OF OUR WORK as professional chaplains. In addition to all those that are shared with us by those to whom we minister, the stories of our own personal and professional experience etched on our hearts and minds become the things we carry to sustain us on life’s journey. This accumulated wisdom informs our ministry and becomes a gift to share with the generations of colleagues who will walk paths similar to the ones each of us has trod.

The tapestry of our work, this creation of meaning and value that we who now are “retired” offer, is still in the making. Each day, threads of our experiences—our stories of joys, pains, triumphs and failures—become the fibers that we continue to weave into the fabric of our lives. In this year’s installment of the Retired Chaplains’ Writing Project, three women join me in weaving the threads of their own stories into this creation of shared wisdom. They recall specific points in their journeys and lessons learned along the way, sharing how these experiences have led them to continued meaningful, challenging and rewarding work today.

What is remarkable about these stories? Women were not accorded the status of Fellow in the College of Chaplains, APC's predecessor organization, until the 1970s—less than forty years ago.

I remember my first clinical pastoral education (CPE) experience. Having survived my junior year as the first and only woman to matriculate in the class of 1974 at The General Theological Seminary in New York City, I bravely decided to see the country and chose USC Medical Center in southern California. On a sunny summer morning in 1972, I entered the CPE classroom—again, the lone female. We introduced ourselves, and I vividly recall the response of my supervisor: “Well this will be a learning for both of us. I have never supervised a woman!” It turned out to be a good

The Reverend Margaret A. Muncie MDiv BCC (retired) serves as executive director of Canterbury Counseling Center, Greenville, SC. She is endorsed by the Episcopal Church USA.

[email protected]


experience of learning for each of us and started me on a rich and rewarding professional career in chaplaincy.

Even when I walked across the stage at the annual meeting in 1984 to receive my certificate number 1394 as Fellow in the College, I was joined by very few of women. We still were a distinct minority in professional chaplaincy. Over the years, I have served in acute, long-term care and hospice settings. Now I utilize my skills as part-time executive director for a not-for-profit pastoral counseling service. What a joy to say farewell to a pager!

Like me, the women chaplains whose stories appear on the following pages carry the riches of their unique pastoral experiences into the new territory of retired chaplaincy. Their journeys, both professional and personal, are varied, each of us has witnessed APC expand its diversity to become more inclusive across the gender, race, ethnicity and sexual orientation. This diversity broadens and deepens the scope of pastoral care in ways that were unimaginable forty years ago.

Far from being a minority, women are now leaders in our profession. The College elected Elaine Hickman Lehr BCC as its first woman president in 1993. Mary S. Whetstone BCC (2006-2008) and Susan K. Wintz BCC (2008-2010) are past-presidents of APC. Valerie R. Storms BCC is the current president-elect. Most importantly, each of us—whether long tenured or newly certified—carries the hope that the professionalism and integrity of this noble profession of chaplaincy will continue to grow and to be a source of blessing, comfort and strength to all whom we serve.

The Making of One Chaplain Kay Miller BCC

MY PATH TO CHAPLAINCY has been a bit unusual. For starters my family lived in China for three years when I was a child. As we moved around the world, I also attended schools in Hong Kong, England and France, including a university year. Chaplaincy Effect: I developed a deep-seated multicultural orientation and acceptance of those who may be different from me along with the conviction that I am not to judge others. That’s God’s job!

My time in China was spent in the midst of civil war as the Communists took over the country. I witnessed dozens of people killed by firing squads sweeping their machine guns back and forth. There was no regular trash collection, and I became obsessed with the body of an infant in a nearby trash can. Despite my mother’s warning, “Shh, the baby is sleeping. Don’t awaken her,” I kept running to check on the baby, watching her body decay and succumb to the insects. Recurrent nightmares connected to this incident continued for nearly fifty years. Life was not a safe place. People could not be trusted to protect children. Chaplaincy Effect: In the midst of this horror, I turned to church for refuge.

As an adult, I spent twenty-three years as a computer programmer at IBM, in positions ranging from contract work with NASA on the Apollo moon-landing project to business support programming. Chaplaincy Effect: I recognized that people are more interesting to me than machines and that my desire is to work directly with people. I became especially interested in mind-body-spirit interconnections.

When my son and only child died in an automobile accident at the age of seventeen, my world seemed to come to an end. My grief was so “white hot” that I dropped out of life, wandering the

Kay Miller MDiv BCC (retired) serves as chaplain at the Mason County Detention Center, Maysville, KY. She is endorsed by the Episcopal Church USA.

[email protected]


country with his dog for nearly two years. Finally, my faith provided me both strength and direction, but even though I had been assured that God would make something good out of this tragedy, I was determined that I would never allow anything good to come out of the loss of my son. Chaplaincy Effect: I have a deep connection with those who have experienced devastating loss and at the same time a realization that God really can cause good to rise from ashes even if one is determined to block him.

How did this life experience coalesce around chaplaincy? I was two years away from becoming a doctor when my son died, and initially my debate was whether to return to medical school or to consider hospital chaplaincy. I began by serving as a volunteer hospital chaplain a few hours a week. When that grew to sixty, I decided that I could handle the responsibility!

However, even as I felt drawn to chaplaincy, I was reluctant to enter seminary, afraid that my own broad, nonjudgmental beliefs might be overcome by the view that the narrow Christian path was the only “right” connection with God. I am a devout Episcopalian and draw my strength and comfort from within that belief system. Still, I am not convinced that this is the perfect place for anyone else, and I fully support each person’s individual spiritual journey.

My decision to return to medical school instead was short lived. A serious car wreck tore at my brain and put me in a wheelchair. After years of rehab, I was able to read again and thus to handle graduate school. This time I chose seminary and incorporated five units of clinical pastoral education (CPE). I not only was more confident in the strength of my own spirituality, I also was eager to delve into the mind-body-spirit connection from the spiritual care perspective.

Though at first the requirements seemed onerous and tedious, my respect for the professionalism espoused by APC and the Association for Clinical Pastoral Education (ACPE) blossomed. I have grown to understand the wisdom of each part of the process. APC provided much support and direction, and it was a mighty happy day when I went across the stage to receive board certification.

Professionalism within the field is key! Whenever I observe a well-meaning, but untrained “chaplain” in his/her narrow attempts at spiritual care—which often amounts to proselytizing—I ask myself whether this is spiritual abuse rather than spiritual care.

Four years ago, fate took over again, and this time I listened when I felt called to a new venue: chaplain at the Mason County Detention Center, which previously had no professional spiritual care for its inmates. One by one, they come to a private conference room. Their motivation varies. Some just want to get out of their cells and/or to vent their frustration. Some simply want prayer or wish to use the time for Bible study. Some have profound spiritual issues that they want to work on and may seek to confess and to discover forgiveness. Many profoundly miss their families and especially their children. They often experience grief around changed relationships.

While many elements of my early life contributed to my chaplaincy, I also have had much help from above in guiding me along this twisted path. I continue to discover the spiritual aspects imbedded within my sometimes tragic history and to learn how to incorporate those gems into my spiritual identity. Each encounter is fresh, and I am grateful as I continue to grow.


APC: Transforming Professional Chaplaincy Carolynne Fairweather BCC

LAST WEEK, I SPOKE TO A CPE GROUP at the Portland (Oregon) VA Medical Center about becoming board certified chaplains in APC. As I sat next to my former supervisor, the Reverend Dr. Horace Duke BCC ACPE, I was humbled and amazed about how far I had come since he introduced me to APC at the 1998 conference—the year that the organization was birthed from the College of Chaplains and the Association of Mental Health Chaplains.

Chaplain Duke asked me to serve at the registration desk and to acquaint chaplain colleagues from across the country with the Portland area. What a great time we all had! The weather—rare for May—was absolutely perfect. Everyone was excited about the new Association of Professional Chaplains. We had a potlatch salmon dinner, followed by the old time music of the Oregon Trail Band. The plenary speakers were top notch, and the workshops really added to my knowledge of chaplaincy. When it was all over, I missed the camaraderie and stimulation of colleagues, who were on a mission to improve the standards and continuing education for professional chaplains.

A year later, I summoned the courage to begin the certification process. I was working full time and caring for my husband, a former hospice chaplain

who had taken disability retirement two years earlier. When I finally had all the forms filled out, papers written and last endorsement letter in hand, it was deadline day. We raced to the 24-hour post office at the airport to send all forty-six pages by overnight mail!

I have to admit that I was really nervous as I waited until the fall for my certification interview. A friend on the east coast met three committees before passing, and as I knew what a great chaplain he was, I worried that my own gifts and skills wouldn’t be adequate. Happily, my experience was fantastic. Committee members asked pertinent questions about my chaplaincy work; we laughed together, and I felt tears trickling down my cheeks a couple of times.

As I gathered with other BCCs at the 2000 conference in Charlotte, NC, I felt very much at home. My friend, the Reverend Paula Curtis-Burns BCC, said to me, “Now you really have arrived. This is the most important step in your career!” At the time, I wasn’t too sure what she meant. Now I know that belonging to APC has been a launching point both personally and professionally. With the support of the administration at Legacy Meridian Park Medical Center, I began by serving as the State Advocate (2001-02), followed by State Education Chair (2002-06).

In 2004, with the help of the state rep, the Reverend Merv Friberg BCC, I launched Chaplains’ Chatter to publicize continuing education events, local chaplains’ news, meetings, jobs and job transitions. I wrote an editorial for each issue addressing something in my own life that spoke to things we all faced in chaplaincy. Published online three times a year, the Chatter eventually grew to a listserv connecting over 200 chaplains or friends of chaplaincy in the greater Oregon/southwest Washington area: working chaplains, CPE students, retired and nonworking chaplains, local clergy, members of National Association of Catholic Chaplains (NACC) and Hospital Chaplains of America (HCA) and chaplaincy volunteers. One of my special joys was running into chaplains at annual conferences and realizing that we knew of each other through the Chatter. It was so good to put names and faces together! I continued writing the Chatter through my terms as State Rep for Oregon North (2006-2010).

As I grew professionally, so did APC, especially in the area of communications. On September 11, 2001, and throughout the following days, I relied on the work and comfort of my fellow board

The Reverend Dr. Carolynne Fairweather DMin BCC (retired) serves as a volunteer in the Chaplains Office of legacy McMinneville (OR) Hospice. She is endorsed by the Episcopal Church USA.

[email protected]


certified chaplains. Living on the West Coast, I didn’t find out about the attacks on New York and Washington until I was on my way to work about three hours after the fact. I remember trying to bring a sense of calm out of the chaotic concerns of staff, volunteers, patients and their families. It was through the prayer resources posted online, and especially the prayer written by Dick Millspaugh, APC president, that I found what I needed to bring comfort and hope, both at the memorial service on 9/11 and to the eighty plus people who attended on the National Day of Prayer three days later.

When Hurricane Katrina struck, APC communicated needs and prayer requests from BCCs in the hardest hit states. Although I couldn’t leave my work to go to them, my hospital provided gifts, both personal and monetary, to three families of staff at one of the hardest hit hospitals in New Orleans, who had lost everything in the subsequent flooding.

One of the most important things I have noticed about APC’s and my own growth, over the past decade is the appreciation for chaplain candidates with diverse backgrounds who bring new skills, learnings and points of view to professional chaplaincy. APC has challenged certification committees to present qualified applicants from many faith practices and traditions, and has been increasingly hospitable to individuals of varying physical abilities, ethnicities and sexual orientation. As a result, thousands of highly qualified chaplains have added their professional expertise and abilities to the organization and serve as excellent teachers to all of us as we seek to understand the human condition.

This move toward inclusivity places APC in the forefront of the interfaith movement in this country and abroad. Board certified chaplains are leading the way to understanding differences among human beings’ faith practices, gender/identity issues and abilities. I believe that it is this work of chaplains to include all people that will help the world to become a smaller, kinder and closer place for all to live in peace and harmony. It has been—and is—my privilege to belong to such a fine professional organization dedicated to the betterment of chaplaincy for the entire world.

With Eyes Wide Open Sharon F. Peters BCC

THERE IS AN EXPERIENCE IN MY PROFESSIONAL CAREER that I often have recalled. I was sleeping at the hospital as on-call chaplain when my beeper woke me around 3 a.m. I dressed, gathered my badge and Bible and headed to a code blue. En route, I realized that in my rush, I had forgotten to put in my contact lenses. I convinced myself that I would be able to cope without them. The patient died, and for the rest of the night I accompanied relatives into the room to say their goodbyes to the deceased with my poor, uncorrected vision.

Three months later, a nurse called for pastoral support for a patient whose doctor had shared with her that she had an inoperable malignant brain tumor. When I entered the patient’s room, I was jolted by her screams of rejection. “No, no, anyone but you. I never want to see you again. Ever!” I retreated in shock since I had no memory of having seen her before. Another chaplain met with her and later explained her reaction.

She had been the roommate of the patient who had died the night I responded to the code blue without my contacts. Distressed by witnessing

Sharon F. Peters MDiv BCC (retired) serves part-time as chaplain at Fahrney-Keedy Home and Village, Boonsboro, MD, and Meritus Medical Center, Hagerstown, MD, She is endorsed by the Presbyterian Church (USA).

[email protected]


the failed resuscitation efforts, she had motioned repeatedly for me to come to her bedside, and I had acted like I didn’t see her. How could any chaplain be so uncaring!

The reality was that I hadn’t seen her, but her accusations hit me hard. Though I did not have the opportunity to reconcile with this woman before she died, I was able to grapple with my remorse, feelings of failure and need of self-forgiveness in conversation with my peers and CPE supervisor. Though I never spoke again about this incident, I have been guided by it as I supervised others. In the performance of our duties, in the fulfilling of our callings, at times we all make mistakes, and we fail to meet the needs of others. There is pain when we discover this, but there also is grace. If we are to experience true professional growth throughout our careers, such “I was blind but now I see” moments need to occur. With a smile now, I realize this was not the only time of my only seeing dimly what was happening.

When I entered seminary in 1979 with the approval of my presbytery, I was counseled that as a woman, I should be prepared to have a difficult time finding a call to a pastorate upon graduation. I proceeded with eyes open, or so I thought. Juggling marriage, motherhood and a part-time job, I still managed to graduate with honors, to be awarded a fellowship for an urban ministries internship and to become board certified as a chaplain. Clearly, I still was naïve as I expected that these credentials would suffice to ensure a call to hospital chaplaincy or parish ministry. Although forewarned, I was still naïve.

I quickly discovered that chaplain positions required former experience. Parish positions were open but not the minds of most congregations. Although they granted me interviews in order to meet the presbytery’s requirement that a woman be among the top five candidates, it was obvious that these were a charade enacted to comply with affirmative action guidelines. Still, the compromise of my integrity that I felt by participating in this process caught me by surprise.

Ultimately, I accepted the position of executive director at an educational nonprofit with church affiliations in suburban Washington, DC, which served students with emotional disabilities and their families. I was recruited to establish a clinical program with a wholistic philosophy, and my ordaining denomination, the Presbyterian Church (USA), recognized the position as a call to specialized ministry.

For twenty-three years, I supervised professionals including special educators, speech, occupational, art and movement therapists, vocational counselors, social workers, psychologists and psychiatrists, as well as social work interns and psychologists in training. I drew heavily on my chaplaincy training and experience to forge a multidisciplinary team.

Looking back, I realize that I did not fully appreciate how much my training and experience would influence my vision for this organization. The initial challenge was to break down communication barriers and to build mutual respect and collaboration among staff from different disciplines. How could we come together and talk about common concerns and goals? How could we help each other get past distancing professional jargon, attitudes of superiority based on age, gender or experience? How could we find ways as a team—and not simply individuals—to honor confidentiality, to observe boundaries and to adhere to professional ethics by keeping the welfare of our clients uppermost? Answers to these questions varied from year to year depending on the team, but my commitment to seeking them did not.

Having risen to the position of CEO, I retired in 2007 from what had been an immensely rewarding career and moved with my husband to central Maryland. Today I enjoy working part-time, serving a long-term continuing care retirement center and an acute care hospital. It is good to once again have my Bible and badge in hand and to walk the floors at both institutions visiting patients and residents. It is even better to realize that the gender discrimination I faced as a young woman chaplain has lessened.


Patients are at ease and usually welcoming when I walk into their rooms and introduce myself as chaplain. It is not difficult to initiate pastoral conversations. Only infrequently do I hear comments about the fact that I am a woman and to some an attractive woman. In earlier times, my gender and my appearance frequently elicited surprise, uneasiness or rejection—in worse case scenarios, unwanted sexual comments or advances.

When I responded to an invitation to attend a luncheon at the 2011 APC Annual Conference in Dallas, in recognition of the twenty-fifth anniversary of my certification, a memory of how it used to be surfaced with startling clarity. At the grand banquet during the conference where I was welcomed as a new board certified chaplain, my name was called, and I went forward to receive my certificate. When the other recipients returned to their seats, the presenter asked me to remain on stage. Standing there before the large audience in the ballroom, I heard him say, “Now I want you all to take a good look at what our new crop of chaplains looks like. Wouldn’t you have loved to have been her supervisor?” There was applause and ripples of laughter as I returned to my seat hurt and humiliated on an evening when I should have felt proud and affirmed by my colleagues.

Thankfully, none of the “new crop of chaplains” in Dallas was subjected to such blatant sexism. Our society and our profession no longer tolerate it. Granted, it seems that only belatedly have some male colleagues come to see the pain of not embracing the values of inclusivity, diversity and equality espoused by APC. Nevertheless, I believe that organizations, like individuals, sometimes come to their most blessed times of grace when they realize that they were blind but now they see. I also believe that the future is brighter because men and women now work together as equals to fulfill their vision and calling as caregivers and healers.

My hope for all of us in chaplaincy today is that we will be advocates for wholistic care through multidisciplinary teams at the varied institutions where we serve. May we articulate our competencies and roles in advancing the missions of our respective institutions. May we be listeners and leaders, using our training to help others come to moments of truth telling and self-awareness. May we find calm, confident voices to help our colleagues from other disciplines work together for the benefit of those we serve.


ESSAY

A Nest of Human Connections Jerry Gentry

I HAVE BEEN A HOSPICE CHAPLAIN FOR FIVE YEARS. One of my first patients, a woman in her fifties, was dying of cancer. I visited her at home a few times, where she spent most days by herself until her husband came home from work. Eventually, she declined to the point that she couldn’t be alone even for that length of time, so there was talk of her moving to a facility, which saddened her.

Once, while we were talking about this imminent move, she waved her arm in a gesture meant to include many items spread around her house and said, “These things are not just things. They mean something to me.” She slowly rose from her chair, took my arm and gingerly walked through two rooms, telling me about some of the “things” in her house, the stories behind them and what they meant to her. One was a painting that someone special had given to her. One was a memento from a vacation to another country. Each one that she pointed out connected her—in some powerful, emotional way—with another person.

It is true that when a tornado or a fire destroys a house many of the “things” in it can be replaced. Even when they are irreplaceable, such as old family photos, the residents often say, “We hate to lose them, but at least we are all safe.” So in a sense, two opposite thoughts are true: When disaster strikes, the material things are not as important as the human beings, but at the same time, certain possessions are quite valuable—because of the emotional meaning attached to them and to the human relationships they represent.

This has become vividly clear to me as I work in hospice, especially when I visit patients in a facility and notice which possessions they, or their families, have chosen to bring into this limited space. I look around the room for things that may become a topic of conversation as I try to bring pastoral comfort. Those “things” often help me guide patients and families as they reflect on the life that is slipping away. Perhaps there are pictures of reunions, weddings and vacations. In Mrs. B’s room, there are paintings that she herself painted. Her daughter put them on the wall to remain connected to her mother’s younger, healthier, creative self. On Mr. M’s wall is a picture of a train that reminds him of his lifelong career. In someone else’s room, I may see a stuffed animal, a trinket from the Smokey Mountains or a handmade quilt. Each has a story behind it, and each story involves people who are special to the patient in the room.

Years ago, my family helped a Vietnamese refugee family resettle in the United States. The family included a young daughter who, after they had moved to Florida, sent us a little doll that looked a little like Minnie Mouse, but—to tell the truth—was a knock-off, a bit tacky and not particularly attractive. Nevertheless, I kept it in a prominent spot on a bookshelf in our living room for years—not because it was anything great to look at but because whenever I saw it, I thought of the daughter’s big smile and her giggly laugh.

Even things that once upset me can become special. In my house there are marks on the wall and scratches in the furniture made by my daughter. Although I’m a little embarrassed to admit it, I

Jerry Gentry PhD serves as chaplain at Crossroads Hospice, Atlanta, GA. He is endorsed by the Alliance of Baptists.

[email protected]


haven’t painted over the marks or sanded down the scratches, and each time I look at them, I fondly recall that my 12-year-old was once a toddler whom I held so lovingly in my arms.

As you walk through your house, sit on your porch or in your car, as you do anything that brings you within eyesight of your “things,” think about the persons who are connected to you because of them. Let the warm glow of that relationship replenish your soul and your spirit, even if it’s only for a few seconds as you gaze upon it or hold it in your hands.

Think of the “things” that you see and touch as reminders that you are special to someone, that there are people in your life who are sources of great love and support and grace. Your little physical place in the world is a nest of human connections. A weak, slow-walking woman dying on hospice taught me to never forget that.


ON HOLY GROUND

Chosen by Mystery David Hall

MYSTERY HAS PICKED ME. It has pulled me out, strand by strand, into days of surprise, torment and love.

A couple I will call William and Carla had welcomed me into their home several times. He was facing a mean end. Forty-seven years old, he had a tumor on the brain stem and a wife promising to love him to the end. It seemed that only a few days were left to them.

In conversation with Carla one day, the hospice nurse learned that their dream was a trip to the Caribbean, to Carla’s home country. That wasn’t going to happen, not now. “What else,” the nurse asked. “Fifteen years ago this June we would be married,” she said on that cold February day. “We always wanted to recite our wedding vows to each other again. You know, maybe even wear the same clothes and have a few flowers, my daughter and her boyfriend standing there with us. That is what we talked about.”

It is a Wednesday when the hospice nurse calls to outline her plan. Great idea, I thought, except I’ve got forty other patients and anything like this will have to wait till next week. “I tell you what,” I say. “I’ll go by Carla’s on Friday morning and see what she wants to do.”

I run it by a couple of other chaplains. “Do they have any children? If they do, a child could stand in and speak the lines for the patient. I did that once, and it worked out.”

Another chaplain relates how she honored a similar request, and it turned into a green card scam. “Keep it celebratory, not official. That’s my advice.”

Friday morning rolls around. Around ten, the nurse calls. “I saw William yesterday. He’s declining faster than I thought he would.” She rattles off numbers that create a picture of unpleasantness, a dying body already beginning to shut down. Maybe only hours are left.

“It sounds like we should do this sooner rather than later—like right now.” The nurse agrees to call Carla and tell her we’re ready to go. She will meet me at the apartment at eleven, picking up a vase of flowers and a small cake on the way—something to help make this “something.” We have ordered posters, but they won’t arrive until Monday. We will create our own island getaway.

As I drive to the apartment, Psalm 61 pops into my head. I pull over, grabbed my little green Gideon’s Bible and read: “For thou, Oh God, has heard and I will send praise unto Thy name forever that I may daily perform my vows.”

Yes. This is exactly what we are wanting to say.

I call Carla to tell her we’re just about there, and as I pulled into the parking lot, she says in a calm voice, as if it was something she had prepared for a long time, or a bad script from a bad dream, “I think William stopped breathing.”

David Hall MDiv serves as chaplain at Crossroads Hospice, Atlanta, GA. He is an APC affiliate member.

[email protected]


I park and jump out of the car just as the nurse pulls into a nearby spot.

“Carla just told me William stopped breathing.” My sadness is reflected in her face. We run toward the stairwell and around the second landing, I feel the thump in my stomach.

I get to the door first. Carla is spread across the bed and underneath her is the very lifeless form of William. The nurse grabs his wrist. Nothing. She feels his heart. Nothing. Opens his right eye. Still nothing.

She looks at Carla. “No. I’m sorry.”

As Carla shakes from the deepest depths of her soul, the room also shakes, so deeply, so profoundly, and different from any tidal wave or hurricane, that I reach out to hold her.

She is wearing her beautiful gold and black wedding outfit; William has on a gold shirt, representative of her homeland.

After moments of deep thundering wails I hear myself say, “Carla, we can still do this. Do you want to?” “Yes, yes, I do.”

Though it is my voice that reads the groom’s words, the heartful exchange of vows fills the air with sweetness. The eternal love of Carla’s words move into William’s spirit, into his soul. The words from William bounce off the heavens.

Our vows are heard by God as we have performed them, we will, daily. It is a mystery worthy of David’s song.


POETRY

Fumes Kelly Gregory BCC

No longer do I lift my prayers as grateful incense into Your loving presence. They catapult one after another as to the enemy, Reloading in an endless supply of flame – Furiously, vehemently. No longer will I carry the sorrows of others into Your gentle embrace. I pummel them at You like the pitcher’s fast ball in the batter’s cage – Violently, obsessively. No longer can I confidently rest the heavy burdens at Your feet. I pile them in giant mounds as a bulldozer, Tearing into the earth, leaving gaping holes – Desperately, futilely. Until in an exhausted heap, I crumple. I breathe in, Fumes extinguished. And I hear: I hold, I embrace, I accompany. This is enough. I breathe out. This is enough.

The Reverend Kelly Gregory MDiv BCC serves as staff chaplain at Banner Good Samaritan Hospital, Phoenix, AZ. She is endorsed by the Presbyterian Church (USA).

[email protected]



The Essence of Reality Alvin Swindell Hodges BCC

The worship procession was underway. Recorded voices sang “Blessed Assurance” as I invited the patients into the once a week chapel. I noted the curious process of seat selection: Schizophrenics on the perimeter, Bipolars flitting hither and yon, The depressed, with sad eyes, taking first avaliable. The beginning of my service was delayed by Eve who Arose from the perimeter prophetically declaring God’s anger over the treatment of His people By this institution. As the psyche-techs respectfully removed the prophet I felt both resentment and sadness But was eager to finally start the service.

But Eve’s peers interrupted: “Let her stay, she just wants to give her testimony.” “Take her out, she’s ruining the chaplain’s service.” Then a litany of caring: “She’s not a bad person, she once gave me a soda.” “I’ve been where she is,” with the challenge, “Haven’t we all?” I listened in silent awareness of the epiphany. The merged and energized congregation Was effectively caring for itself But, unknowingly, preaching to me. They spoke of acceptance, forgiveness, respect With an insight and dignity that was Untainted by stereotypical thought. An idea intruded, “Could Eve have been prophetic after all?” My status quo was changing, patients were Ministering to each other with a mutuality I had not expected. As I watched the recession of the people A forgotten memory was remembered again. A poster, once proudly displayed in the hospital, had read: “Know Me By My Name Not My Diagnosis.”

Alvin Swindell Hodges MTh BCC serves as lead chaplain at the University of Texas – Harris County Psychiatric Center, Houston, TX. He is endorsed by the United Methodist Church.

[email protected]


Gratitude Heidi G. Gessner BCC

Though darkness gathers, around me like a veil, I praise the over brush which I go under.

I praise the bridge that is my threshold, the portal to the other side, where time becomes kairos, and the line between heaven and earth is thin.

I praise the healing vibration, the steady pulse emanating from the earth that breathes, all truly is well.

I praise the wild geese and their goslings, squawking at me and Harry, my steady golden companion.

I praise the lake and its glass like calm, and rippling currents.

I praise the sunlight dappling the ground, and dancing across the water.

I praise the blanket of trees, heavy with blossoms and moisture.

And I praise the Blue Heron

Solitary, serene, stoic

Majestically perched on the point

Confidently sailing across the pond with her wide wing span.

I lived there two years before I realized the Blue Heron was God.

Heidi G. Gessner MDiv BCC serves as bereavement coordinator and palliative care chaplain at UNC Hospitals, Chapel Hill, NC. She is endorsed by the United Church of Christ.

[email protected]

Tammy Holland Sullivan serves as chaplain at Compassionate Care Hospice, Athens, GA. She is an

APC affiliate member.

[email protected]

Not apparent Tammy Holland Sullivan

Small baby boy, bundle of joy Swaddled tightly Blanket warm and Multihued yarn Gently swaying, softly singing Sweet By and By Waiting for mom Waiting for dad Cradling grief stillborn by time Desire birthed late A childless life Not a parent


EXPRESSION OF FAITH Two months ago, we paused to remember and reflect on that autumn day—ten years past now—that will forever be engraved on our hearts as 9/11. In the aftermath, Dick Millspaugh, who was serving as APC president, wrote the following prayer. It was subsequently printed on a bookmark and distributed to attendees at the 2002 APC Annual Conference. As we approach the end of a year that has seen so many disasters—natural as well as those inflicted by humans—it seems fitting to once again offer his words. – RAS

A Prayer for Chaplains O Holy One When disaster strikes by air, land or sea, Strengthen me. When shock numbs, stuns or overcomes me, Hold me. When the flames of anger threaten me, Calm me. When retaliation seems my only choice, Speak to me of grace. When I would be god to save all, Humble me. Creator of the air, land and sea Strengthen me, that I may calm others. Ground me, that I may be peace for others. Empower me, that I may act where I am. Humble me, that I may know my need is always, always to live in you. Amen. Dick Millspaugh BCC

Dick Millspaugh MDiv BCC is chief, chaplain service in the VA San Diego Healthcare System, San Diego, CA. He is endorsed by the United Methodist Church.

[email protected]


MEDIA REVIEWS

Mardie J. Chapman BCC Media Review Editor

Is God Still at the Bedside? The Medical, Ethical and Pastoral Issues of Death and Dying Abigail Rian Evans (Grand Rapids, MI: William B. Eerdmans Publishing Company, 2011, 484 pages, softcover) This comprehensive work deserves a place on the reference shelf of any chaplain, CPE supervisor, counselor, medical ethics committee member, hospice worker, clergy or faith community nurse. I highly recommend it for training, continuing education and a surprisingly good read. Writing concisely, with clarity and creativity, Evans presents complex definitions of life and death, descriptions of end-of-life choices and tips for healthy bereavement. She draws from fields of medicine, theology, scriptures, philosophy, literature, ethics, psychology, law, history, politics, finances, hospice and community organizing. Her constant theme is connectedness and the importance of networks and partnerships in supporting the dying and the bereaved.

Community approaches are needed to face challenges including current attitudes about death, e.g., “Death is considered un-American because we cannot control it.” (p. 17) She cites a poll that indicates “only 53 to 57 percent had spoken with their spouses, partners or families about their wishes for end-of-life care and only 10 percent had discussed these issues with their primary care physicians.” (p. 59) She notes that death may be feared, welcomed or viewed as punishment. (Chapter 2) And she includes insightful descriptions of Hospice care and the work of faith community nurses in cooperation with clergy. Specific aids for chaplains and counselors include the following:

• A table on religious views of end-of-life choices that summarizes the positions of twenty-seven denominations/faith traditions. (pp. 101-8)

• A description of “religious communities’ attitudes toward organ donation and transplantation.” (pp. 169-77)

• Specifics on how to counsel/support the suffering, including a critique of Kushner’s popular When Bad Things Happen to Good People. (Chapter 7, “When Winter Enters Your Life”)

• Suggestions for encouraging hope and for transforming and transcending suffering. (p. 227) • Suggestions for supporting the bereaved, including asking, “How is God at work here?”

(p. 295), and rather than encouraging the bereaved to “let go,” helping them learn “how to retain the dead person in a healthy way.” (p. 312)

• Examples of effective spiritual care. (Chapter 10, “Clergy at the Bedside”)

In addition, two brief appendices list “some dos and don’ts for caregivers” and “things you can do to help yourself face grief.” (Appendices I, J).

Although her description of the chaplain’s role does not give credit for the profession’s growth and increased training and responsibilities, Evans does cite the value of the chaplain’s wholistic approach.

Chaplaincy Today publishes reviews of books and recorded material that is of interest to spiritual caregivers, including chaplains and pastoral counselors. Address requests for reviews to Mardie J. Chapman MDiv MS BCC ([email protected]) and include a short synopsis.


In addition to high-quality writing, several features contribute to the readability of the book. Controversial subjects are presented in a nonbiased manner with comprehensive descriptions of both sides of the arguments. Each chapter is introduced with an inspiring poem, e.g., John Donne’s “Death Be Not Proud.” There are separate indices of names and subjects.

Reviewed by Mardie J. Chapman MDiv BCC, Chaplain, St. Anthony’s Hospital, St. Petersburg, FL.

Life’s Greatest Teacher: What We Learn from the Sick and Dying Karen Rushen (Traverse City, MI: Spirituality & Health Books, 2011, 151 pages, softcover) Hospice staff and volunteers as well as parishioners who provide care to the dying will find affirmation of their work in Rushen’s book. New CPE students may find this an interesting introduction to the range of scenarios and personalities they will encounter in hospital and hospice work. I will add this book to our hospice library for coworkers and family members’ use. Rushen describes poignant, startling and even humorous encounters gleaned from her twenty-plus years as a chaplain. Many of her stories are powerful and clearly have influenced her personal as well as professional growth. Unfortunately, it is unclear for whom she is writing. These essays first appeared in Spirituality and Health magazine and still read like a compilation of inspirational reflections. For professional chaplains, Rushen’s most important contribution is the attention she focuses on the wealth of stories and wisdom that patients and families entrust to each of us and her ability to apply the lessons learned to her own life and practice.

Reviewed by Astuti Bijlefeld MDiv BCC, Chaplain, St. James Mercy Health, Hornell, NY.

Domestic Violence: What Every Pastor Needs To Know Al Miles (Minneapolis: Fortress Press, 2011, 224 pages softcover) Al Miles, coordinator of the Hospital Ministry Department – Pacific Health Ministry, at Queen’s Medical Center in Honolulu, is concerned because “pastors tend to ignore domestic violence …. It is easy to do nothing.” This volume offers guidelines for responding to such situations. Story after story is shared about the heartbreak, lack of sensitivity and ineptness in responding to this problem in congregations and communities. Miles provides the latest statistics and also notes the impact of the economic downturn. He asserts that clergy need more professional training as many do more harm than good. Miles offers the clergy professional, pastor, chaplain and CPE supervisor practical guidelines for understanding and responding to this increasing problem in our society. Chaplains face victims/survivors on a regular basic rounding through the hospital. This volume of practical guidelines will assist them in knowing what to do and what to say. Miles stresses the importance of setting aside preconceived assumptions and believing victim /survivor stories. The section on myths and assumptions within the parish setting, e.g., the notion that “it does not ‘happen’ in our congregation,” seems particularly insightful and helpful. He explains that when clergy have personal relationships with abusers, they often cannot believe the words, “He attacked me!” Miles explains how to avoid certain types of advice giving that have proved harmful. Also, as safety is a primary goal of any pastoral care treatment plan, proactive collaboration with other community professionals is a must.


Another important section addresses potential conflicts over forgiveness in such situations. Miles offers nuanced definitions of forgiveness, and he explains how to navigate this critical theological issue when assisting a victim/survivor. Each chapter ends with reflection questions that easily could fit into a continuing education series at a local/community or teaching hospital. The director of pastoral care could offer a series of clergy breakfasts or luncheons using each chapter as a central them or topic. This would address one of this author’s greatest concerns: the uninformed clergy professional.

Reviewed by Beverly C. Jessup DMin BCC, CPSP Diplomate – Pastoral Supervision, Clinical Director, Pastoral Care, FirstHealth Moore Regional Hospital, Pinehurst, NC.

More Glimpses of Heaven Trudy Harris (Grand Rapids, MI: Revell, 2010, 204 pages, softcover) This book tells the stories of patients who faced their deaths under the loving care of hospice nurses. Chaplains and nurses who provide care in free standing hospices, hospitals, long-term care facilities and patients’ homes will find these stories both inspirational and informative. Alex, a Navy officer who wanted to die in his best Navy blues and how much this request demanded physically from his family. He said on more than one occasion as he faced his terminal diagnosis: “It will be time to meet my commander soon.” (p.40) Trudy Harris, former hospice nurse, said that Alex reminded her of the centurion who approached Jesus as a man under authority willing to do what Jesus asked of him and how that faith was honored. Sarah, dying from breast cancer, was a believer but had not been baptized by immersion as her church required. She was told by the church brothers and the senior elder that this church requirement could not be met because she was too frail. When the family asked hospice nurse Bonnie Tingley what she thought about baptism, she responded, “In my denomination, baptism into Christ does not depend on the amount of water used.” (p. 94) Sarah and her family asked to see the hospice chaplain, and after a significant discussion, Sarah decided on a “sprinkle baptism.” Several days later she died in peace. Bonnie said that the words of Jesus kept coming back to her as she drove home: “I have baptized you with water; he will baptize you with the Holy Spirit (Mark 1:8). (p. 94) Naomi knew she was dying, but her family would not let her talk about it. It was not until the hospice nurse “explained to them what was happening to their mother” that they were able to share her final journey. (p. 44) The stories are short and may be read individually with time for reflection and evaluation in light of one’s own experiences. For example, what does the naval officer’s dying tell us about how one’s profession may influence the way one chooses to die? What may we learn from Sarah’s experience when hospice staff were asked to share aspects of their faith traditions? What resources are available when church doctrine does not meet the needs of the dying person? What does Naomi’s story reveal about hospice nurses’ intentional intervention at critical moments? As a chaplain who has offered care to the dying and their families and who has personally experienced compassionate and professional care in my own family from hospice staff, I highly recommend this book.

Reviewed by Michael G. Davis DMin BCC (retired), Hernando, MS.


The First 48 Hours: Spiritual Caregivers as First Responders Jennifer F. Cisney and Kevin L. Ellers (Abingdon Press, 2009, 145 pages, softcover) Chaplains in training (CPE students), volunteer chaplains, clergy and church laity may benefit from this introduction to crisis ministry after “critical incidents.” For more experienced chaplains, Cisney and Ellers provide an easy, useful refresher of basic principles of spiritual care to traumatized persons and a good resource for continuing education. Well-organized, the book features two sections at the end of each chapter: “Quick Reference Tips” and “Questions for Discussion.” Chapter 8, “Telling the Story,” was most helpful to me because it provides methods to elicit feelings and help victims after they have found a recommended “safe place” and have reached a point of wanting to talk about their experiences. Cisney and Ellers write from a distinctively Christian perspective. Bible references support suggested interventions, especially regarding the topics of resiliency, suffering, hope and new beginnings. The authors recommend caregivers avoid theological discussions and maintain healthy boundaries between the victim’s beliefs versus the caregiver’s. The book is full of practical advice to provide spiritual support without causing secondary trauma. I work in a Level One trauma center and regularly care for pediatric and adult patients who need pastoral care following critical incidents. This book was a concise refresher, generally well researched and written by people who understand the pitfalls of the critical incident milieu. I recommend it both to those in training and to those who need a good book about the basics of spiritual care as a “first responder.”

Reviewed by George M. Rossi MA MDiv BCC, Clinical Chaplain, Medical University of South Carolina, Charleston, SC.

Hospital Preaching as Informed by Bedside Listening: A Homiletical Guide for Preachers, Pastors and Chaplains in Hospital, Hospice, Prison and Nursing Home Ministries Cajetan N. Ihewulezi (Lanham, MD: University Press of America, Inc., 2011, 94 pages, softcover) Cajetan Ngozika Ihewulezi is a Roman Catholic priest and board certified chaplain (BCC) whose previous publications include Beyond the Color of Skin, Not Created to Come Last and Keep Moving Forward. In this book, he explains how worship leadership in hospitals is enhanced by effective listening to the stories of patients and incorporating them into homilies during worship events. As many BCCs serve as worship leaders, this book may be useful for continuing education and reference. The first part of the book relates vignettes that demonstrate the importance of listening effectively to patients’ spiritual pain. Subsequent chapters focus on the skill or art of listening and building effective rapport with patients. Ihewulezi draws from several authors to support his ideas and provides an extensive bibliography. He suggests ways to establish sufficient trust to hear the full plot of the patients’ stories. Additionally, he undertakes the challenge of incorporating them into homilies while maintaining strict confidentiality. The final chapter focuses on a questionnaire that evaluates the effectiveness of the homilies in chapel worship.

Reviewed by Beverly C. Jessup DMin BCC, CPSP Diplomate – Pastoral Supervision, Clinical Director, Pastoral Care, FirstHealth Moore Regional Hospital, Pinehurst, NC.