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7/20/2005 Vol. 2, No. 12

Professional Practice
 

Chaplain Clair Hochstetler on caring for your co-workers

Handling Colleague Grief in the Workplace

Many chaplains find themselves coordinating or getting involved with grief and bereavement support, but it is especially challenging when it is you and your colleagues who become the bereaved when a colleague, whose life touched many, has died.

What are “best practices”when a close colleague from the workplace, or a well-known co-worker’s family member, dies? What if a tragedy impacts multiple people in your workplace? If we are grieving, what can we as professional chaplains do with our grief while keeping up an intense schedule? When death and other types of loss (such as divorce or layoff) touch our workplace, the resulting grief is too often unrecognized and unsupported. Chaplains know how to reach out to patients who are grieving, but when we are faced with the sudden death or catastrophic illness of a colleague, who cares for us?

We may easily anticipate that the death of a family member or close friend will precipitate intense grief, but when a colleague dies, either suddenly or after a prolonged illness, many of us are not as prepared for the intense feelings of the loss. In his 1917 paper, Mourning and Melancholia, Freud theorized that the more strongly one identifies with the deceased, the more profound the bereavement, and that the relationship’s intensity affects the bereaved one’s ability to let go of the deceased. Rando, in Dying: Facing the Facts observes that Freud was not the first person to examine the effects of bereavement but that his observation that grief is normal –and that a lost love object is never totally relinquished –is congruent with current thinking today.

The arduous process of relinquishing attachment to a deceased coworker –and moving on without forgetting their gifts –is often a gradual process. If not guided effectively it will most certainly happen in some unstructured way.

In recent years our health system has been utilizing Dr. Wolfelt's book and companion journal, Understanding Your Grief –Ten Essential Touchstones for Finding Hope and Healing Your Heart as a primary resource and discussion guide for a periodic nine-week bereavement support group co-sponsored and promoted by seven area funeral homes and cremation societies. We have a group meeting for an hour, then break up into smaller process groups, according to similar grief issues. Afterwards, two other trained chaplain volunteers, the evening's presenter, and I hang with those individuals or families who want to stay and talk about their own issues privately. We've been doing this for more than four years. I helped to start this community-wide support system, and it is a formula that is really working!

Except for one population: I've noticed that very few bereaved hospital colleagues have had the courage to attend these community-oriented group sessions. If they do come, they sometimes express that they feel “out of place.”I suspect their usual level of professional sensitivity to issues of confidentiality and self-disclosure often constricts their freedom of sharing. Realizing we need to be more intentional, we’ve started offering colleagues a variety of opportunities to process feelings and experience, depending on the nature of the grief: e.g. Critical Incident Stress Management sessions, a colleague-only bereavement group, individual counseling via EAP, to deal more effectively with this natural process.

Recently I came across Dr. Alan Wolfelt's latest book entitled Healing Grief at Work. Dr. Wolfelt seeks to address the questions I raised in my second paragraph in a practical, compassionate style. Topics include: effective ways to channel grief during the workday, support for coworkers who mourn, participation in group memorials, negotiation of appropriate bereavement leave.

I'm interested in hearing how other chaplains work at issues involving grief and bereavement support, especially when it is one's own hospital colleagues who become the bereaved.


Clair Hochstetler has been a professional chaplain for ten years. He currently serves the Goshen (Indiana) Health System (www.goshenhealth.com) as their sole staff chaplain while coordinating the work of two dozen trained chaplain volunteers. Clair tries to maintain “balance”in his life by twisting animal balloons and literally clowning around on his unicycle in the community.

 

Do you have thoughts about professional practice you’d like to share with your colleagues? Send an e-mail info@PlainViews.org.

 

 

Advocacy
   

Chaplain Edward Williamson on an acceptable weekly workload

Census 25 Proposal

I am currently a hospital chaplain, but I am also a PRN hospice chaplain. Hospice chaplaincy is a vocation that engenders respect in some quarters and a rolling of the eyes in others. When I did hospice chaplain work full-time in Colorado, some hospital chaplains wanted to know what I wanted to do when I grew up!

Hospice chaplains are some of the most dedicated ministers in service today! Who else would suffer to be on call 24/7, rain or shine, and expect to give quality ministry at 1:30 AM and receive no pager pay for their efforts? I have renewed wedding vows on the fly at 2 AM and performed family funerals in the wilds of the Sangre de Cristo Mountains. I have seen more death in five years than most ministers experience in their entire career.

I believe it is time to take a hard look at the workload of most hospice chaplains and bring them in line with more traditional ministries. I have no hard empirical evidence when I make this next statement but I believe that no hospice chaplain should have to minister to more than 25 terminally ill patients at a time!

I believe this because most hospice chaplains do more than visit patients. Many of them are also the volunteer coordinator or the bereavement counselor. When I would come to work on a typical Monday at 8 AM I would first sit down and plan my day. I would make phone calls to my patients and schedule visits. I would do phone assessments with new patients. I was usually ready to visit my first patient by 9 AM.

The whole day would race quickly by. I was fortunate if I could grab a sandwich for lunch. Then I would come back to hospice and try to get a computer terminal to chart my visits. My computer illiterate case manager demanded that we keep paper charts so I had to print out what I had charted so it would be available for audit. Then I had volunteer responsibilities to contend with. My CEO would nudge me out the door every evening when our census was above 30 (and I was not ready to go home).

At the time I was too “dedicated”to admit my stress levels were high and I was burning out. It didn’t help that my hospice had a “hire them fast and fire them when they are finished”philosophy when it came to chaplains in their employ. When I was fired it was a great relief. I had no problem proving wrongful termination in order to collect unemployment benefits.

Looking back over that debacle and speaking to my fellow hospice chaplains, I came to the conclusion that most hospices hire one chaplain in order to meet the government requirement and then they will hire no more chaplains. When they burn them out they replace them.

Many chaplains use imaginative tactics to cope with an impossible workload. One hospice chaplain would visit his patients in nursing homes by having the staff gather them in the cafeteria after the breakfast meal and have “mini-church”with them. He would minister to 10 –15 patients in a one-hour period and leave. He charted the same entry for all those patients and would go on to the next nursing home to repeat the same procedure. His patient load was 75 (which he bragged was no problem) but it would be difficult to say that spiritual care actually occurred. Another would phone his patients all at once and chart them as physical visits, using great imagination to fill in the blanks and visit only patients that were truly end stage. Other chaplains visited patient bi-weekly or once a month depending on their census.

I believe this foolishness needs to end! I know there is a movement to board certify or hire only board certifiable chaplains for hospice ministries. I think this is a worthy idea but along with this learned and experienced chaplains should meet and determine what a standard, acceptable weekly workload is for a hospice chaplain. My vote would be no more than 25 active patients per week per chaplain. This would give chaplains a goal of five patients a day with time to chart the visits at the end of the day.

 


Chaplain Edward Williamson, a Southern Baptist, was born and raised in Jackson, Mississippi and ordained in July of 1987. He has been married to the former Jeanne M. Lazio of San Francisco, California for 17 wonderful years. He got his start in ministry as an Army Chaplain, proudly serving soldiers in Cuba, South Korea, and stateside assignments at Fort Rucker, Fort Carson and Presidio of San Francisco. He is a board certified chaplain with the Association of Professional Chaplains and currently serves as Staff Chaplain to CHRISTUS St. Patrick Hospital in Lake Charles, Louisiana.

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

 

Education & Research
   

 

Chaplain Charles Barley on spirituality and physiology

The Neurobiology of Pastoral Care

A new research hypothesis links emotions to a part of our complex internal biochemical system (or internal communication system) called peptides. Should this prove to be true, it will represent another significant link in understanding the physiological connections between one's spirituality and physiology.

This internal communication system takes place through electrical and biochemical processes in the body and are necessary for any biological functioning to occur. This information system can be understood as functioning through two key parts: a receptor and a ligand. (There are three types of ligands: neurotransmitters, steroids, and peptides, the largest group of ligands). The communication process is very specific in that a receptor will only receive information from one type of ligand. This sharing of information has been described as a lock (receptor - receiver) and key (ligand - transceiver) process. In this process, information is exchanged which leads to changes in such things as mood, behavior, and physiology. While Dr. Candace Pert believes the peptides of emotions are innate ligands, drugs/medications serve as extrinsic ligands also binding to the same receptors innate peptides use. An example of such a process which Pert discovered was the opiate receptor. This receptor receives only intrinsic or "extrinsic peptides". Endorphins serve as natural body opiates while she discovered that drugs cultivated on the other side of the world can also fit this same receptor to relieve pain or take on potential addiction properties in individuals from the opium plant. [1]

The patient's theology or world view, values, priorities, and commitments can be a part of such connections with stress, pain, and suffering. The patient's spirituality involves emotionally laden thoughts, relationships, concepts, metaphors, and activities. The impact of such emotionally laden thoughts can be transferred through the body to the patient’s organs.