6/7/2006 Vol. 3, No. 9

Professional Practice

Dianne Collier on military families in need of support

For Better or For Worse

There is a very popular cartoon by military wife Sophie Patenaude that depicts a couple kneeling before a clergyman as they prepare to exchange wedding vows. The groom handsome in his dress uniform and the beautiful bride in a swirling white gown are looking into each other’s eyes as the clergyman reads the wedding vows “…. for better or for worse.”Just then, the bride whispers to the groom, “Well, how ‘worse’are we talking???”Yes, just how bad will things get?

Today’s military families are dealing with so much more than my generation. The only support we had was what we provided to each other. Our friends became our family, and our family became our friends. However, the old saying “If the military had wanted its troops to have wives they would have issued them one”certainly doesn’t apply today. The establishment recognizes the need to support our military families and is making great strides in providing a variety of networks of support. A key player in the support system is our Chaplains, who work closely with our leaders to help bridge the gap between the needs of the soldiers and the needs of their families—particularly during deployments.

Although many of these wonderful support networks weren’t available to my generation, we didn’t have the worry of today’s spouses who deal with constant deployments, more partners with psychological and medical problems and more children suffering the affects of a father/mother who is away more than he/she is home.

Today’s military spouse certainly deals with much more stress coming at them from several directions, and sadly, many are questioning whether they can continue to deal with all that is asked of them. I can’t count the number of times a military wife has declared, “I don’t know if I can do this anymore….”The number of overseas tours, the death toll, and the amount of training to prepare for these tours, as well as the number of exercises, courses and overtime work commitments, are all taking their toll on our families.

But through all the ups and down of this very challenging lifestyle, there is a very strong sense of pride in our partners, in who they are and what they do. Not only do our partners sacrifice so much for our country, but military spouses as well contribute a great deal and they should receive all the support necessary to change the mindset from “I don’t know if I can”to “I’m in this for the long haul!”

Life has no guarantees, and the military lifestyle is, unfortunately, a challenge that some can’t meet to the end. But, as one military wife stated “Is this life worth it? For me, right now, despite everything, it is. As for the future –only time will tell.”Indeed, the majority of us are looking at the future with a blend of heavy hearts, guarded optimism and fervent hopes as we realize that the quality of our future does not lie solely in our own hands.

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

Advocacy

The Rev. Sue Wintz on understanding the language of quality

By the Numbers

Adams Dudley, an Associate Professor of Medicine and Health Policy at the University of California San Francisco, wrote “There is a need to change today’s approach to health care ‘from more health care’to ‘what is right in health care.’Thus is the foundation of the quality movement within healthcare.

Professional healthcare chaplaincy hasn’t always had to deal so directly with quality issues as we do today. Why, one asks, should we? The health care climate has been changing rapidly over the past 20 years, and it will continue to do so. Report cards, patient satisfaction survey results, and other information is quickly becoming available to the public and will be used by many consumers to choose their health care provider. This change means that these numbers will continue to become the central focus of healthcare organizations.

The profession of chaplaincy is impacted by these changes and must change itself. How we operate as chaplains: how we are trained, certified, and what we offer to the organizations in which we work has also changed dramatically over the past 20 years…and will continue to do so.

It is essential that we understand and utilize the language of today and tomorrow’s healthcare - including that around quality - and incorporate it into our clinical practice, our administration, and our visioning.

Quality health care means doing the right thing at the right time in the right way for the right person having the best possible results. The goals of the national quality movement include:

• Improving clinical outcomes


• Cost-effectiveness


• Teaching consumers how to use quality information and health information


• Guiding consumers to make best decisions for themselves and their families, leading to improved health status and outcomes over time.


• Improving the content, presentation, distribution, and evaluation of information that is presented

There are differences in views about quality. While organizations often focus on clinical and cost issues, consumers focus on service issues. Not surprisingly, it is often because of these differing perceptions that conflicts occur. Both need to be held in balance. Professional chaplains can assist in doing this. However, in order to be most effective and make the best contributions, chaplains need to know and understand the language of quality.

There are a number of quality tools being used, including report cards, performance report systems, accreditation criteria, outcome measures, and patient satisfaction surveys. While the plethora of information can appear overwhelming, there are many tools and resources available for chaplains to utilize to learn more.

One place to start in gaining understanding the importance and impact of the healthcare quality movement is the Institute of Medicine’s report, “Crossing the Quality Chasm”. It is available online at the website of the National Academies Press at www.nap.edu. The report provides a framework and common language for understanding, measuring, and evaluating the quality of medical care.

Other steps chaplains can take:

• Take the time to understand and appreciate what is important to your administrators.


• Become aware of the changes and challenges impacting healthcare. One way to do this is by browsing on a regular basis some of the national health care leadership journals, for example Modern Healthcare which is also available on the internet. Reading just one journal will be helpful.


• Learn how to benchmark and compare what you are doing in your department with what is being done in others.


• Find out how to do a cost/benefit analysis, how to develop and track quality projects, what patient satisfaction surveys mean, and how to write a business plan.


• Stay current with and utilize new resources and collaborate with your colleagues in professional chaplaincy. In particular, pay attention to the materials being developed by the APC Commission on Quality in Pastoral Services. Get involved within the profession and share what you are learning and developing.

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

Education & Research

The Rev. Seung-Jin Yun on helping Koreans deal with anger

Nothing Can Separate Us from the Love of God

In 1995, the American Psychiatric Association added Hwa-Byung (Anger Syndrome) to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a Korean cultural syndrome. Hwa-Byung is caused by people suppressing their anger. This impacts upon their bodies with symptoms that include: insomnia, fatigue, depression, digestive trouble, lack of appetite, shortness of breath, etc.

Expressing anger is seriously frowned upon by Koreans. Historically, this comes from the influence of Confucianism, which taught Koreans to respect and obey authority without complaint—even if they thought the authority acted unfairly. Korean Christianity also teaches that expressing anger is a sin. This makes it especially challenging for Korean Christians to dare to express anger with God, who holds the highest authority. When a minister visits church members who are suffering, that minister usually demands that the members show faith in God without complaint or anger, but with positive thinking and hope. This is particularly true for women because Confucianism formed Korea into a male-dominated society. As such, obedience and endurance is expected from women by men.

Since introducing Christianity and Western culture, Korean society has been changing, but Confucianism remains influential.

In 1984, when I was seriously ill, I sometimes felt angry with God. As a Korean woman, I could not express my anger openly. One night, I felt that God was looking upon me with merciful eyes and was pleased with me just as I existed. I realized that God loved me, whatever I said or did. God is greater and more merciful than I had thought.

In 1995, I participated in a CPE-like class in Korea. Surprisingly, I was taught that chaplains needed to help patients freely express their feelings, even anger with God. Soon I realized that more Korean Christians were afraid of expressing their anger than I had thought. As a Korean, I too was uncomfortable and sometimes even afraid. In addition, many patients criticized me for having an improper attitude as God’s servant, especially as a woman. Despite this, I shared my personal experience and offered them opportunities to express themselves, even when they were angry.

In 2002, I came to the United States and started my formal CPE training. I learned from my former supervisor, Rev. Paul Steinke, that by using the Psalms I could help patients who seemed to suppress anger find the right words to express their true feelings. I learned from my current supervisor, Rabbi Bonita Taylor, that by using the Lamentations I could express my own feelings more deeply. Then through my own experiences, I could be more empathetic and help patients express their anger.

I believe that there is nothing that can separate me from the love of God: neither death nor life, neither angels nor demons, neither suffering nor our anger (see Romans 8: 37-39). I believe that even though I sometimes complain to—and feel angry with—God due to my suffering, God still loves me as a parent loves a child.

I will continue with more confidence to help all patients—including Korean patients—to express their anger freely when they need to, using my learning and experiences.

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

Spiritual Development

Chaplain Joan Keiser on finding a “high spot”

Flying Above the "Storms of Life"

"Those who wait for the Lord shall renew their strength,
they shall mount up with wings like eagles."
Isaiah 40:31

Our world, our country, indeed my own state have been hit by many “storms”lately. In the spring, we expect and try to anticipate those storms and make plans to prepare and protect ourselves. Many of our communities have tornado warning sirens to alert us to a storm. Others do not and may find themselves in the midst of a storm without warning.

I have read that an eagle knows when a storm is approaching and will fly to some “high spot”and wait for the winds to come. When the storm hits, it sets its wings so that the wind will pick it up and lift it above the storm. While the storm rages below, the eagle is soaring above it.

Wouldn’t it be wonderful if we, like the eagles, could know when a “storm”is approaching our lives? If we could find a way to “set our wings”and let the wind pick us up and enable us to “fly above the storm”?

In 1992, I found myself in the midst of a storm when I was diagnosed with breast cancer. A storm had indeed hit my life.

The “high spot”for me was God. My faith, my family, my church family and my pastor sheltered me, too. When my storm hit, I was able to fly above it with God’s help. I was held gently and rested in His wings.

The eagle does not escape the storm and neither do we. I used the “storm”to lift me higher and closer to God. God enabled me to ride out that storm and provided me with medical knowledge and technology to conquer the disease. It was not an easy journey but God reminded me I did not journey alone. He surrounded me with loving, caring people along the pathway.

Patients and family members I minister to in the neuro-trauma area are in the midst of a storm in their lives. They did not have any warning of a storm approaching. They wonder how they can rise above it. How can they find a “high spot?”

I read a story about an elderly lady who felt like giving up on life. As she prayed, the words of the scripture in Isaiah 40:31 filled her mind but she felt she didn’t have the strength to “fly above the storm.”Then, she heard God say: “Yes, you can. The eagle has two wings and so have you. One is your own will power; the other is help from above . . . now get busy and fly over the storm.”

As Chaplains, we can be a presence and help patients find a “high spot”as they ride the winds of the storms that can bring sickness, tragedy, failure and, perhaps, disappointment.

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

EthicsWalk

EthicsWalk addresses spiritual care as an ethical enterprise. It explores why relationships between spiritual care providers and those they serve need protection, and examines what that protection entails. PlainViews invites our readers to share their responses to each EthicsWalk column, which will be published in the following issue.

If you’d like to respond to EthicsWalk, please send a comment of no more than 100 words. You can use the e-form below (click on "hearing from you," link) or submit your commentary to the editors in the body of an e-mail (or as a Microsoft Word attachment) sent to Info@PlainViews.org. Please put the phrase “EthicsWalk” in your subject line.

We look forward to hearing from you.

Anne Underwood is on a break for the summer. If there is a particular issue that you would like her to write about this coming fall, please send your ideas to: info@plainviews.org.

CaseConference

We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place. Please send any cases that you would like considered for inclusion to: info@plainviews.org

We hope that this new addition will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

CaseConference #8 Resolution

The patient's uncle saw a sign on the bulletin board from the Organ Donor Network letting the hospital know that a donor's organs had been harvested and had helped several people. He approached the chaplain, pointed to the sign, and asked if his nephew's organs could help others. The chaplain told the uncle that it was possible. The uncle went to his sister, the patient's mother, and told her what he had read and suggested to her that her son's death could provide for others so they could continue to live. After initially giving a definitive "no," the mother walked over to the sign and read it for herself, with her other son translating it for her. The son and mother stood talking and crying for quite a while, pointing to the sign every so often. Eventually, the mother changed her mind and agreed to allow her son to be an organ donor. The Organ Donor Network staff came in, discussed the situation with the mother (in her native tongue) and answered all of the questions that she had. She eventually gave permission and her son's organs were harvested.

At the request of the chaplain, the hospital reviewed its policy about who approaches the family, affirmed their initial policy and held several educational sessions for the staff and doctors to clarify the policy. They also invited the staff from the Organ Donor Network to hold further educational sessions.

CaseConference #8

A 23-year old Hispanic male is brought into the ER unconscious. He is diagnosed with an intracranial hemorrhage which is quickly swelling his brain. There is no chance that he will recover. The family is naturally very distraught. The doctors start talking about organ donation. The chaplain, who has been sitting with the family, is asked to "feel them out" and see if they are willing to allow his organs to be harvested once it is determined that he is brain dead. It is the hospital's policy that the only one who should approach the family is someone from the organ donor network or the attending physician. The attending physician does not speak Spanish and feels uncomfortable broaching the subject with the family since they did not want to believe his original diagnosis and prognosis.

What is the chaplain's role in this situation?

Should the chaplain, who is bi-lingual, be the intermediary?

Are there cultural issues that need to be taken into account?

What takes precedence - the doctors' request or the hospital policy?

Please check the archives for comments made about the last CaseConference.

Send your comments about CaseConference to info@PlainViews.org.

Reviews

Sarah Masters reviews the film

Islamic Mysticism: The Sufi Way

Sufism is the mystical branch of Islam, and it is said that while a Muslim prays five times a day, the Sufi prays without ceasing.

This film captures the Sufi quest for deeper meaning in all things, and includes entrancing footage of Whirling Dervishes endlessly circling in search of God. The Sufis spin into altered states of consciousness as they shun what they consider to be the secularization of Islam. Islamic Mysticism: The Sufi Way was filmed close to three decades ago in unspoiled and magnificent Islamic architectural settings. The camera wanders from Morocco to Turkey to India.

Commentary from Professor Huston Smith, renowned scholar of world religions and author of A History of Man, enriches this in-depth look at a gentle religious people who follow a strict regimen of fasting, prayer and study. Sufis are little understood by the West and Chaplains will come away with a greater appreciation for distinct Islamic traditions.

Completed: 1979
Running Time: 30 Minutes
Director/Producer: Elda Hartley

If you are interested in purchasing this film, you can do so at www.hartleyfoundation.org. Just click on “Hartley Classics”on the homepage for more information. The cost of the film series is $19.95 for a VHS.

Book Review

Rabbi Dr. David J. Zucker and Rev. T. Patrick Bradley review

Jewish and Catholic Bioethics: An Ecumenical Dialogue

As this volume admits, today the “dominant orientation of bioethics has become secular, nonreligious, or even antireligious”(139). By contrast, this work addresses specific religious traditions, that of (Orthodox) Judaism and Roman Catholicism.

The four major sections to this book are: "Ethics and Philosophy," which is a review of the philosophical writings of Baruch Spinoza; "The Sanctity of Human Life;" "Suffering and the Sufferer;" and "Healing and the Healer." The book begins with an essay on "Issues in Biomedical Ethics: Comparison of Jewish and Christian Perspectives;" and concludes with a chapter, "Epilogue: Religion and Bioethical Discourse." The essays in this volume come out of a conference held in 1996.

Perhaps the most important point for readers, at least from the standpoint of Judaism is that “each of these authors underscores the fact that the Jewish perspective is a highly nuanced one”which has been described as a “form of pluralistic casuistry”so that there is no “strict hierarchical ordering of values that is universally applied”(xiii-xiv). That said, one of the limitations of this book is that it represents primarily (if not exclusively) an Orthodox Jewish view. As one of the authors, Ronald M. Greennotes in his chapter titled “Jewish Teaching on the Sanctity and Quality of Life”, he focuses on the “Orthodox tradition of Jewish religious law, halakhah”even though “most modern Jews do not regard themselves as bound by halakhic norms”(26). To his credit, he does recognize that there are alternative views, and he points in an endnote to the important essay by Louis I. Newman, “Woodchoppers and Respirators: The Problem of Interpretation in Contemporary Jewish Ethics”in Eliot N. Dorff and Louis I. Newman, eds., Contemporary Jewish Ethics and Morality (New York: Oxford UP, 1995). He also quotes the liberal ethicist Mark Washofsky and his essay on “Abortion and the Halakhic Conversation: A Liberal Perspective”in Walter Jacobs and Moshe Zemer, eds., The Fetus and Fertility in Jewish Law: Essays and Responses (Pittsburgh and Tel Aviv: Freehof Institute of Progressive Halakha, 1995).

Certainly it is correct that, as another essayist, Shimon Glick points out in his chapter “The Jewish Approach to Living and Dying,”Jewish ethicists do “ultimately fall back on the classic Jewish sources, no matter how differently they are interpreted –and there is certainly room for various interpretations”(43).

The essayists present a diverse cross section of views on Catholic Bioethics. It is important to remember that the Magisterium (the foundational teachings of Roman Catholicism) does not pretend to pronounce on every detail of moral issues. It does not impose final decisions. The role of the Magisterium is to provide guidance to believers. The final judgment and application of this guidance is left to the faithful and their conscience.

As a hospital chaplain, reviewer T. Patrick Bradley finds this book largely to be esoteric, academic, and theoretical. Nonetheless, the essay by James Keenan does offer practical information for those who are included in end-of-life discussions with families. It points to the United States Conference of Catholic Bishops (USCCB) publication, “Ethical and Religious Directives for Catholic Health Care Services.”In that work, it notes that the guiding principle of patient autonomy requires “the surrogate must be ‘faithful to the patient’s intention.’”Further, it stresses that “the staff must consult the person who is in the position ‘to know best the patient’s wishes’”(92). [Note: though Keenan refers to an earlier version, a 2001 copy of this document is downloadable from the USCCB website, www.USCCB.org, (Church Documents, Bishops Statements, Ethical and Religious . . .)] These are critical points for those of who live in the world where bioethics is not just of hypothetical interest.

The book title suggests that this is a “dialogue”between people knowledgeable in Jewish and Catholic Bioethics. In reality, this volume is really two monologues, not a dialogue in the common understanding of that word. There is neither continuity between the essays, nor a common thread. Rather the editors provide a diversity of topics related in some way to bioethics. This said, as a theoretical introduction to the issues covered –Sanctity of Human Life; Suffering and the Sufferer; and Healing and Healer, the volume is a good contribution to the field.

Jewish and Catholic Bioethics: An Ecumenical Dialogue, Edmund D. Pellegrino and Alan I. Faden, eds., (Washington, DC: Georgetown UP, 1999), 154 pp., including Index.

The Rev. T. Patrick Bradley, MA, LAT [Licensed Addictions Therapist], BCC is the Director of Pastoral Care at United Medical Center in Cheyenne WY. An NACC Board Certified Chaplain, he is also a psychotherapist.

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