Responses to Chaplain David Plummer "Struggles
of An Evangelical Chaplain" (PlainViews,
5/19/04, Vol. 1, No. 8)
Having spoken with Rev. David Plummer on the
phone, he is aware of both sympathies and tensions
I have with his position and practice. I suffer
in ways that are hard to express -- taking
form in my understanding and experience of
a huge tension between loving and believing
the truth that only those who are 'in Christ'
are participants in G-d's eternal life, and
abiding in the convictions which David so eloquently
voiced toward authenticity, integrity and ethical
practices of ministry in interfaith settings.
I agree with his concerns about manipulation
and subversion.
Recently I sat at lunch with a resident whose faith group is the Humanistic
Jewish Temple in Detroit Michigan. We discussed the wonderful career of her
now-deceased husband who contributed mightily to the professional Occupational
Therapy community over a lifetime, earning accolades and awards. He was by
report, a wonderful human being. He was also a graduate of my Alma Mater, Heidelberg
College, and we discussed the common ground this gave us with delight and glee.
Yet, my core trust in Jesus had to take no seat at all at this table of discussion,
since to do so would be to throw an offensive 'clinker' into an otherwise delightful
conversation. She would have taken no offense -- rather just would have felt
awkward and embarrassed. For my side, I experienced inward confusion and pain,
not being able to relax into my true self with safety. Perhaps I am missing
something about integration that I should know by now.
This tension within my world is so intense that I am struggling with a decision
-- whether to seek ministry in a more overtly 'evangelical' setting, thus balancing
my commitment to Christ with commitment to authentic ecumenicity in truly equal
powers.
I don't know if this form of suffering is present in or under David's words.
Do these tensions live in him at some level? Being clinically trained, sensitive
to all the ethical issues in play, and also from a charismatic and evangelical
theological and experiential base, I wonder if any of my colleagues experience
tension or pain around these issues? If so, what do you do?
Rev. Steven Heintz, MDiv, MAPC
Chaplain
Longwood at Oakmont
Continuing Care Retirement Community
Verona, Pennsylvania
Thanks for the great article on a delicate
topic. Dave did an excellent job of articulating
his insights and struggles. But, I wanted you
to know, that it has caused me to realize,
that in all of the work of advocacy that APC
is involved in, we have not done near enough,
if any, advocacy (reaching out) with our evangelical
colleagues and friends. I will be giving it
more thought and putting it on the agenda for
our next commission meeting.
Dick Cathell,
Chair for the Commission on Advocacy, APC.
I too deal with the challenges of balancing
evangelism (sharing the good news) and pluralism;
however, I must confess I do not have the apprehension
of being disingenuous or compromising. As the
Senior Chaplain at ATL I work with 37 chaplains
of all denominations and several interfaith.
I feel that if what I believe is revealed to
be erroneous then I need to move to the truth.
If what I believe is the truth then I would
expect the same openness in return. I follow
the teachings of Jesus Christ because I believe
he conveyed a G-d of love and was the moral
exemplar. I find that loving G-d and loving
what G-d loves is not compromising. This is
the good news - that G-d loves all and has
restored our relationship through Christ. If
loving G-d and loving others is proselytizing
– I am guilty. To reject G-d’s love – Jesus’
love – or the love of any follower of this
truth makes no sense. I will love in any case.
Rev. Dr. Chester R. Cook
Executive Director / Senior Chaplain
Interfaith Airport Chaplaincy, Inc
Hartsfield-Jackson Atlanta International Airport
I am a certified chaplain of only 5 years,
and want to thank you so much for your open
article. I am a Catholic lay-woman with a son
who has joined an evangelical, fundamentalist
church. He has said he believes I am part of
a cult (the Catholic Church) and believes I
should be doing nothing less than death bed
conversions. It has certainly been a tension
between us. It pushes me to listen, and to
get better at articulating how I do ministry,
how I show love and respect, how I want to
model the love of Christ.
Part of my authenticity to being ecumenical
is that I AM. I was baptized Catholic, but
never raised in that tradition. I was raised
in the Congregational Church which became the
United Church of Christ. I had a conversion
at 15 and gave my life to Christ at a Billy
Graham Crusade. That has always directed my
life. I married a Catholic man and I was going
to help him “see the light!” Strangely enough,
he never tried to convert me. After me being
a “critical visitor “ to his church for 17
years, life crisis with a child, I found a
new openness in myself and celebrated my journey
of joining the Catholic Church. Later I grew
in my spiritual walk through: Teens Encounter
Christ; Marriage Encounter; Life in the Spirit;
Retreats; three years in a Catholic Charismatic
Community; Catholic Seminary and endorsement
by the National Association of Catholic Chaplains.
My Protestant roots continue to be a vital
part of my ministry and the pluralism you wrote
of is deep in me. I, too, hope people don’t
assume they know me by my title or NACC initials.
One of my patients, a wise and wonderful Christ
centered man, described himself as A UNIVERSAL
CHRISTIAN. Another has told me: “I was a Christian
long before I became denominational.” They
each teach us how we may be authentic and the
ministry spirit within us.
As more chaplains are added to our hospice
staff we want to see the spirit that you were
able to express. I will keep your article to
share with others. Thank you so much for the
challenge.
Chaplain Kathy Brown
Wisconsin Hospice Chaplain
Northwest Wisconsin Home Care
I have to admit that my experience as an evangelical
chaplain working in the healthcare setting
has been somewhat different from that described
by Dave Plummer.
Upon completion of my MDiv at Candler School
of Theology, I enrolled in a CPE program at
Georgia Baptist Medical Center in Atlanta,
Georgia where I completed
nine units of CPE. Subsequently, I joined the staff of that institution and
served for the next 15 years as staff chaplain and clinical site supervisor
for the CPE students. When the hospital was sold in 1988 to a for profit corporation,
I remained as senior chaplain for the next four years. During that period I
had the opportunity to minister to numerous patients, family members and staff
from a variety of backgrounds, ethnic groups, and religious faith traditions.
However, I can not recall an occasion when I felt the need to impose the traditions
and beliefs of my faith group on the individuals to whom I was ministering.
Conversely, I do not recall an instance in which I compromised my religious/spiritual
integrity in words or deeds. In fact, it has been my experience, that people
in crisis are looking for someone who will provide authentic emotional and
spiritual support, regardless of their faith tradition and/or label. Furthermore,
I can recall only a few times when a patient or family member inquired about
my denomination, and usually, it was more out of curiosity than a desire for
a specific denomination.
Currently, I serve as HealthCare Chaplaincy
representative for the chaplaincy department
of the Assemblies of G-d. Currently there are
approximately 90 endorsed AG chaplains serving
in hospitals, nursing homes, hospices, and
mental health facilities throughout the United
States. Each of these chaplains is ordained
and subscribes to the doctrinal beliefs of
our denomination; however, I know of no instance
in the last 15 years when one of our chaplains
was accused of proselytizing or attempting
to impose his/her beliefs while serving as
a chaplain.
Have there been instances off proselytizing
by ministers/persons serving as chaplains?
I’m sure the record will show there has. However,
I also believe the record will show that professionally
trained evangelical chaplains, by and large,
respect the faith traditions of the people
to whom they minister while remaining true
to their distinctive religious beliefs and
practices.
Emanuel Williams
Healthcare Chaplaincy Representative
Chaplaincy Department – Headquarters of the Assemblies of G-d
And a member of the Georgia Society of Healthcare Chaplains
THANK YOU for your words regarding evangelical
chaplains – your sentiments were a breath of
fresh air in a very musty place.
I have had – on more than one occasion – the
misfortune of having a conversation with people
who, on the surface, profess to hold particular
ideals, but soon their true feelings come to
light.
It is a sad commentary when the word of a
chaplain has to be weighted for honesty and
truthfulness. How disappointing that a conversation
with a chaplain should escape integrity and
openness.
I am a chaplain. I am honored to do this work.
I feel it is an awesome privilege to minister
to people who are perhaps ill, dying or otherwise
afflicted. I believe that, as a chaplain, I
need to reach them where they are….I must go
to their place. The idea of deliberately trying
to bring them to mine is repugnant. As a chaplain,
I am outraged when I see or hear of colleagues
who slither around the halls just waiting to
strike at an unsuspecting victim.
I believe it to be extremely presumptuous
and highly unfair to use subterfuge and subliminal
tactics to promote personal views. Using a
patient’s most vulnerable moments to one’s
own end is shameful.
Before I became a chaplain, I had been hospitalized
off and on over many years. During these hospital
stays, I was often approached and subjected
to unrelenting and unwanted polemics….first
when I said I did not hold Jesus important
in my life and second, when I said I was Jewish.
Those disgraceful shows of intolerance and
false acceptance was the pivotal experience
that led me to become a chaplain. Now, Jewish
patients AND OTHERS can have an opportunity
to meet with a Chaplain who does not have an
agenda and who remembers the reason one became
a chaplain…..my question to them is: Did you
become a chaplain because you truly believe
in chaplaincy – or – did you become a chaplain
as a means to evangelize to unsuspecting patients?
If you chose to become a chaplain because
it gives you access to unsuspecting people
then it is my opinion you are not on any higher
plane that a pedophile who deliberately takes
a coaching job just to be near kids.
Chaplain Laurie Dinerstein-Kurs
Jewish Federation of Mercer, Bucks, Princeton, NJ
A Response to Chaplain Connie Madden’s
Will We be Ready (PlainViews, 5/19/04,
Vol. 1, No. 8)
It will help if Chaplains and ministers look
at PTSD as a spiritual injury. I have worked
with incest and rape victims and combat veterans.
They all have in common what Gary Berg, retired
VA Chaplain, White Cloud VAMC, called spiritual
injury. Spirituality, in this context, is defined
as a set of relationships between self and
others; others including G-d, or a Higher Power,
other people in one's life, the world around
us (nature) and of course our own selves. Any
event or series of events which damage one's
ability to relate to any of these others may
be called a spiritual injury. The symptoms
of spiritual injury are lack of trust, feelings
of betrayal, shame, guilt, grief, loss of meaning
or purpose (foreshortened future) and the grand
protector which helps us not feel hopeless
and vulnerable as all those previous feelings
do - anger or rage.
In working with combat veterans for the past
12 years, I have found that helping them identify
these feelings and validating them has been
helpful. At the Quillen VA Medical Center at
Mountain Home (Johnson City) TN we have a 12
step program for PTSD which helps with this
process. The anger is the most difficult to
deal with, since it is a protective approach
to perceived threat to the self.
I am Vance Davis, retired VA Chaplain and
ACPE Supervisor. Would be willing to share
what we have found works with our veterans.
Contact me at this email address
or my snail mail address PO Box 1057 Mountain Home, TN 37684-1057.
davisvan@preferred.com
Press Ganey TalkBack Responses (PlainViews,
5/19/04, Vol. 1, No. 8)
I am serving solo at a rural hospital with an average Daily Census of 60. My
take on the question is how did "All" the staff respond to your concerns
for your emotional and spiritual well being. As a recent patient at my own
hospital, I discovered that in our situation, the staff is clinically first
rate and accomplish tasks with great wisdom, skill and quality. But I felt
like a task, not a person. I have since talked with the Director of Nursing
and we are working together to create an educational piece for the whole staff
to begin to change the culture of "task orientation." It is a small
step but has the possible impact greater than my trying to make it to see every
patient on every admission. I understand myself as the Director of Pastoral
Care, not the sole provider.
David Monsen, MDiv.
Director of Pastoral Care
Grays Harbor Community Hospital
Aberdeen, WA
Thanks for the recent edition of Plain Views.
I especially appreciated the article by David
Plummer.
I'm writing today with another thought/question
regarding the patient satisfaction surveys
that have generated some discussion among chaplains.
I am wondering how much real meaning can be
drawn from patient satisfaction scores. Is
there any evidence that the surveys have significance
beyond their use for marketing? Do we know
if patients choose a hospital based on patient
satisfaction scores? Do we know if hospitals
lose business when their scores are low?
It seems that auto dealerships have figured
out how to make sure they have high customer
satisfaction scores. When my wife and I bought
a new car a couple of years ago, the salesperson
gave us a survey to complete. He told us that
if we were considering scoring anything less
than a "5" ("excellent")
we should talk to him before we turn in the
customer satisfaction survey and he would do
whatever it takes to make sure we were totally
satisfied. This experience leads to suspicion
about the meaning of the customer satisfaction
reported in the auto dealership's advertisements.
It also leads to cynicism. If the hospitals
used the same model and told all of the patients
to score everything "excellent" we
could report high patient satisfaction scores,
too. I can see where it would be helpful to
solicit feedback from patients and their loved
ones, but I'm wondering if the healthcare industry
has placed too much importance on surveys.
We aren't in the business of selling a product.
A survey might work for a car dealership, but
does it work for hospitals? So I'm back to
my original question -- is there any evidence
that hospitals gain or lose patients based
on these surveys?
Chaplain Russell N Myers, D.Min., BCC
Chaplain, United Hospital
St. Paul, MN
The one question (now two questions -- spiritual
care is still available as an add-on question,
but it is not a part of the standard list)
cannot be a one-department issue. Any institution
that is holding pastoral care responsible for
this question is doing a great injustice. This
is a whole-house issue as reflected in the
question, "Degree to which HOSPITAL STAFF
addressed your emotional (or spiritual) needs." Any
chaplain running themselves to death to do "hey-howdy" visits
will never increase scores. You can do some
scripting for the entire staff -- "do
you have any emotional or spiritual needs that
we need to be aware of," but this cannot
only be pastoral care asking this question.
Here are two great sites to get a handle on
this, from the Press Ganey folks, themselves.
Both are written by the same person. One is
an in-depth study -- a white paper -- on the
emotional and spiritual needs of patients:
http://www.pressganey.com/files/addressing_es_needs.pdf
The other article has some great suggestions on how your individual units,
as well as whole hospital, can improve these scores and why you would want
to: http://www.hospitalconnect.com/hhnmag/jsp/articledisplay.jsp?dcrpath=AHA/PubsNewsArticle/data/040518HHN_Online_Clark&domain=HHNMAG
Both make a strong case for chaplaincy in
addressing spiritual needs.
Chaplain Stephen Pyle
Director of Pastoral Care
Baxter Regional Medical Center
Mountain Home, AR
Regarding Press Ganey: We have been using
it here at Asante Health System in two hospitals,
one is 100 beds, and the other is 300 beds.
There is a dramatic difference in the cultures
of the two hospitals which have impacted the
scores. The smaller hospital has a culture "spiritually
based whole person caring" model, and
they are in the 97th percentile as a hospital.
Our larger hospital has not made that culture
shift and struggles to get out of the 84th
percentile. We are in the process of designing
a spirituality in the workplace program which
we hope will move the whole organization, and
in the long run move our scores. We took that
approach rather than a scripted approach, because
the script does not change us. The script only
changes the perception of the patient. It was
our executive team’s desire that we do more
than just insert a script. This will take longer
for the results to ripen. I have been laying
the ground work for two years. Hopefully, it
will make a long-term impact not only in the
scores, but in who we become as a staff here.
We are only in the drafting and incubation
process. We hope to launch the program around
January 2005.
Joe McMahan
Advance Directives article (PlainViews, 4/21/04, Vol. 1, No. 6)
In Vol. 1, No 8 of PlainViews TalkBack, there
is a letter signed by Rev. Don Haase from Indianapolis,
IN., in response to the Living Wills/Advanced
Directives discussion. His note follows my
previously submitted comments which you published.
I am concerned that professional chaplains
have accurate information regarding the process
of making requests for organs and tissue in
the context of the story he tells. As he says "the
implications of this are tremendous - for the
medical community, for the young girl and her
family, for the families of others who have
faced similar decisions, and for us as caregivers
who are called upon to minister to people in
those situations.”
This is the type of report that is a Public
Relations nightmare for transplant programs.
Having worked closely with organ recovery agencies
and donor and transplantation public education
concerns over a 25 year period, I would like
to correct some misperceptions which Don Haase's
report may leave. First she is declared "brain
dead" and isn't and then after three months,
when the family is considering moving her to
a long term care facility, you state they were
approached with regard to organ donation. In
view of current standards of care in the donation
and transplant field, I cannot imagine this
sequence of events. Even though you state that
the young lady "was declared brain dead
by some very qualified specialists," I
would offer to you that she was not brain dead
and should have never been declared so. Some
clinicians may have thought she would possibly
progress to brain death, but she didn't. One
of the criteria used to determine brain death
(quite definitive and every recovery agency
insists on it) is the removal of the ventilatory
assist for approximately 3 - 5 minutes, with
observation of whether there is any physical
attempt to draw a breath and with clinical
blood tests to determine the CO2 level in the
blood. When a person is clinically brain dead
they have no neurologically driven effort to
breathe and following removal of the artificial
breathing mechanism (ventilator), their carbon
monoxide level increases and within about an
hour, the body experiences cardiac cessation.
The official, legal time of death is when the
physician declares them brain dead, not cardiac
cessation. This young girl does not meet the
criteria.
I would suggest to you that this was a clinical
error in medical determination and a medical
misdiagnosis. Any patient with a clinical Glasgow
Scale of 5 or less on admission must be referred
for evaluation of potential organ donation
to a Recovery agency. Per Federal Regulation,
this is the only agency that may have an organ
donation conversation with a family once the
clinical condition of brain death has been
determined and declared (and they are very
particular about observing the criteria). They
do this in collaboration with the local caregivers.
At a conference on Brain Death which I attended
several years ago, the speaker reported on
some research that had been done in relationship
to clinical brain death criteria. He reported
that of the staff (both physicians and nurses)
working in Intensive Care and Emergency areas,
where brain death is generally determined and
declared, only 35% actually knew and could
accurately apply the brain death criteria to
a patient.
While it was perhaps an amazing action of
G-d that resulted in her recovery, she was
never clinically or legally dead, in spite
of what the clinicians declared. The only context
in which her family should have ever been approached
with regard to donation of organs would be
as follows: Persons who have been determined
to have an irreversible brain injury (generally
from a stroke or cerebral hemorrhage) are potential
donors only when and if a family makes a decision
to remove all artificial support, believing
that there is no hope of recovery to a meaningful,
sentient life and that the patient will expire
in a fairly short time following removal of
the supports. [This may have been what happened
at the point of her removal from life support
after two months, but your telling of the story
does not make that clear.] At that point a
family might be approached with regard to donation
of organs. However, it can only occur when
all prior arrangements for the donation are
in place and if there is cardiac cessation
within 60 minutes or less following removal
of the artificial supports, in which case the
body is immediately taken to a surgical suite
where the organs, other than the heart, are
removed for transplantation. This is called
a Donation after Cardiac Death (DCD) and is
a fairly recent development in organ recovery
and transplantation. Most hospitals do not
have in place policies or procedures for this
type of a donation. However, as you can see,
while this young girl might have been considered
for donation, she didn't qualify. The clinical
condition you describe might have been called
a vegetative state, but patients are not generally
clinically declared to be in a permanent neurological
vegetative state until after three to six months
without change. These patients are not eligible
organ donors, so once again the patient did
not qualify.
I do think that most neurologists who have
been practicing for any length of time would
consider this case somewhat unusual but not
impossible, since the longer a coma lasts,
the less likely the patient is to make a recovery.
Comas of patients who are severely brain injured
can last for extended periods after which the
patient makes a "guarded" recovery,
as in this case.
The dialogue goes on....
Phil Koster
Fort Collins, Colorado
Re: Press Ganey Surveys
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