PlainViews

Re: A Challenge for the European Network of Health Care Chaplains Chaplain, Anne M. Vandenhoeck (PlainViews, 11/16/2005, Vol. 2, No. 20)

I note that the European chaplains network defines itself on its web site as relating to one religious tradition, saying. "It is rooted in Christianity, as expressed in European Cultures." This raises questions on which North American chaplains might be able share perspectives.

Chaplaincy grows out of faith, and there certainly is an important role for chaplaincy organizations relating to one religion. To me, this self-definition raises the questions of how or whether the European chaplains see their role as working with/serving patients, families, and potentially chaplains who are Jewish, Muslim, or from other backgrounds.

Rabbi Robert Tabak, PhD
(Board member, National Association of Jewish Chaplains)
Staff Chaplain, Hospital of the University of Pennsylvania
Philadelphia, PA

Thank you for the outstanding article by Chaplain/Professor Vandenhoeck on the struggles and challenges that the European Network of Health Care Chaplaincy faces with the politics of the European Union. I have forwarded this on to the newly formed International Advocacy Committee of APC in hopes that we can be in better and more frequent dialogue with our colleagues overseas.

Chaplain Dick Cathell, BCC
Chair, APC Advocacy Committee

Re: Audio Meditation Review - Radical Prayer (PlainViews, 11/16/2005, Vol. 2, No. 20)

Macky Alston's discussion of "Radical Prayer" reminded me of a quote I treasure and carry in my calendar. Perhaps inspired by "radical prayer," Rabbi Chaim Stern of blessed memory published this in the "Gates of Prayer" on page 215: "May I make of my life an act of reverence - a prayer: the prayer that is its own answer."

Rabbi Sandra Katz
Chaplain,Golden Slipper Uptown Home
Philadelphia, PA

Request for Assistance from Fellow Chaplains

I am working on my Master's thesis and would like to ask for help from my fellow chaplains.

For my thesis, I am looking at the impact of spirituality in end of life decision making. I am building on some work done by a team at our hospital where they surveyed 85 critical care physicians, asking them information about their own spirituality, and then asking them to respond to a series of end of life vignettes, vignettes which presented ethical and moral dilemmas. While their analysis in on-going, there have been some interesting preliminary findings. It is my intention to replicate that work with health care chaplains and clergy.

If you would be willing to complete the survey, please email me at firesmom2003@yahoo.com and I will email you the survey packet, which I would ask you to print and then return, anonymously. The survey should take no more than 15 minutes of your time.

Thank you very much,
Bev Beltramo
Oakwood Hospital and Medical Cente
Dearborn, MI

Family Presence during Resuscitation - a request for information

I am a Staff Chaplain at Providence St. Vincent Medical Center in Portland, Oregon. I am serving on a committee within our facility to look at the impact of family being present during resuscitation efforts for their loved ones.

I am wondering if PlainViews readers have come across any articles regarding this subject and if so, would you kindly forward them (or the citations) on to me via my e-mail: jean.mcquiggin@providence.org.

Thank you,
Chaplain Jean McQuiggin
Providence St. Vincent Medical Center
Portland, Oregon

Re: Book Review –Living Through Pain and the Search for Wholeness, David J. Zucker (PlainViews, 10/19/2005, Vol. 2, No. 18)

Rabbi Dr. David J. Zucker reviewed Living through Pain: Psalms and the Search for Wholeness by Kristen M. Swenson. There's a need for honest criticism in a review, and Rabbi Zucker has certainty made his point about how terribly written this book is. I wouldn't think of ever buying it. However, the style of the review reminds me of a comment from someone in the stands at a college football game. The ball carrier for the other team had been tackled hard... when that fan yelled out, "Hit him again, he's still breathing." There must have been one thing positive in the book the good Rabbi could have commented on. But even if it is as bad as he indicates, his writing style crosses the line into humiliation, which was unnecessary in expressing his opinions.

Wm. Zeckhausen, D.Min.
Diplomate, AAPC
Laconia, New Hampshire

Re: A Chaplain’s Identity and Immigrant Communities, Titus George (PlainViews, 10/19/2005, Vol. 2, No. 18)

Titus George's contextual response to my article shows how a traditional "pastoral identity" is "intimidating" to "relating to the post-colonial, non-Christian immigrant patients from India" in his work in the Bay Area California hospitals. Titus correctly observes that my article does not directly address spiritual care with such an immigrant population.

Remember, my question had to do with "the value of a chaplain rooted in and representative of a faith-based theological tradition when it comes to talking about spirituality." Given what he wrote, it appears that Titus' answer to my question is "not at all." In his clinical case, Titus makes it clear he "was not a representative of Western Christianity." In this context, I have to agree with him. But I cannot tell from this example what value, if any, Titus' own faith perspective plays in assisting his meaningful intervention? And while I would hope every chaplain would be the "curious learner" he describes so beautifully, is it not fair to ask if a social worker or another allied professional have done this? My question, picking up on Harding, is why have a theologically trained chaplain on staff at all?

Also in his article, Titus suggests that I spend too much time on Christian stuff in a way that does not speak to his non-Christian context. Just to be clear: I was of course tracking the North American history of pastoral care, which reveals a Christian background essentially because Christian theologians and pastors were the founding parents of the CPE movement.

What I think Titus' and my article serve to provide are examples of what happens when the context of chaplaincy changes. I was looking at the "I'm spiritual but not religious" phenomenon; he is looking at immigrants recreating "their post-colonial
Indian identity." I am pleased that Titus has shared his experience in an admittedly new context for chaplaincy. It raises significant questions about who the chaplain is.
Christopher De Bono
Director of Spiritual and Volunteer Services,
Mental Health Centre Penetanguishene
Ontario, Canada

I appreciated the reflection of Mr. George. Since coming into chaplaincy from parish ministry 4 years ago, I have often felt the pressure to carry on my work in a manner consistent with the way the other disciplines in health care carry on their work. The problem has and forever will be that the sol does not yield to the same techniques as the body. I have come to believe that listening, connecting, respecting are the central work of chaplaincy. Agenda driven spiritual care often depersonalizes the recipient and leaves them feeling with spiritual care the same way they feel with the lab or the chemo-clinic –just one more body to process. Thank you for your reflection.
Larry Hirst, Steinbach, Manitoba, Canada
Chaplain Specialist in Pastoral Care

I very much appreciated Chaplain George’s reflection on “Pastoral Care”to those from the Indian subcontinent. Although the population of people from the Indian subcontinent is almost nil in Dubuque, Iowa (and most of those here are already highly “westernized”) I found that the process Chaplain George talks about is also applicable to many other populations.

Even though we are a highly Roman Catholic populated community (approximately 60%) and we have almost as many churches as gas stations, we also have a high percentage of persons of no particular church orientation. Some consider themselves “Catholic”because that’s what their parents or grandparents were. Some consider themselves “Protestant”because their parents or grandparents weren’t’Roman Catholic. A few make no pretense and say they don’t have any religion - quickly followed by, “But that doesn’t mean I don’t believe in God.”

I find the same process is needed here as what Chaplain George suggests. It takes time to get to know them and, more importantly letting them get to know me as one who will not judge, as one who is trying to understand their situation, as one who is trying to walk with them through whatever it is they are trying to face. They also learn that I am not there to try to proselytize them or to judge their life-style. If I take time to do that, they will let me minister with them. We walk together through many dark valleys confident in the source of strength and assurance that let’s us face the future only a little afraid.

David A. Pacholke, Chaplain
The Finley Hospital
Dubuque, Iowa

Re: A Chaplain’s Identity and Immigrant Communities, Titus George and The Times In Between, Rev. George Burn (PlainViews, 10/19/2005, Vol. 2, No. 18)

I want to let PlainViews, George Burn and Rachel K Taber-Hamilton how much I appreciated their respective pieces. I am about to leave my position here in Columbus, Ohio, where I have been the Director of Spiritual Care for 16 years. I have accepted the position of Director of Religious Life for the Council for Jewish Elderly in Chicago. It is a new position, with all of the accompanying challenges and opportunities. Not only am I in an "in between time," but I will also being working with a host of volunteers –so the points that both George and Rachel make resonated deeply with me. Thanks and G-d bless...
Rabbi Cary Kozberg
Columbus, Ohio

Re: Continuing the Discussion on Theology, Rev. Stephen Harding (PlainViews, 8/3/2005, Vol. 2, No. 14)

I concur with Rev. Harding's thoughts, as I've faced them myself in our team meetings. I believe I felt the 'growing sense of frustration' as I listened to others discuss the restlessness of a dying client and felt it had to do with unresolved issues, so send in the social worker, OR prescribe some medication as ativan. Then the children had some anxieties about grandpa dying so send in the bereavement person. I did speak up to say (and I did know the family as I had been visiting them) that there is a spiritual restlessness that occurs as, at times, one seems to struggle between letting go of this life as they move toward the next. At the previous days visit this client had been 'visiting' her mother, sister who had died, but was also waiting for a new grandchild to be born. We had spoken of that restlessness and found prayer and singing hymns helped, along with discussing the families beliefs on life after life, God's will, etc. . As for the children their anxiety had to do with: what happens when grandpa dies, does it hurt to die, and what if grandpa doesn't get to see the new baby.
So we had discussed those issues. And well, in a matter of days, the baby was born, grandpa got to see and hold the baby, and in between times we shared children's books on dying, stories of faith stemming from Sunday School lessons, those scary movies about dying, life and death issues, and all in all it was a rich theological experience.
More and more I find myself saying the family has faith issues vs spiritual issues. It has made a bit of difference. It is a matter of education, again.
I do believe the word spiritual has become as the word love became back in the sixties, almost meaningless as the depth and richness of the definition became lost in overuse.
Rev. Barbara J Lindeman, MS, Mdiv, BCC, FT
Chaplain, ISJ-MHS
Mankato, MN

Re: Proselytizing –A Disturbing Word, Rev. Emanuel Williams (PlainViews, 10/5/2005, Vol. 2, No. 17)

While I appreciate Rev. Williams concern, I am "disturbed" by his acceptance that "Conversely evangelism was defined as the making of an open, honest statement about the Gospel that leaves the hearers entirely free to make up their own minds about it". The power we have as chaplains, especially when dealing with patients and family facing life threatening illness, negates to a large extent the notion of "entirely free to make up their minds etc". We have a tremendous amount of influence on these people! Additionally, as a Jew, I would most certainly experience any reference to the Gospels as proselytizing. Lastly, Rev. Williams writes that the chaplain, "should make an effort to determine what G-d is doing in that particular situation and become a participant in the process". I for one, don't EVER speak for G-d. It keeps things simpler this way.

Rabbi Joel Levinson, BCC
Brookhaven Memorial Hospital, Patchogue, NY
& Good Shepherd Hospice, Port Jefferson Station, NY

Request for Prayers in New Orleans

I am the head of Pastoral Care at Ochsner Clinic Foundation in New Orleans. We are wanting to send an emailed interfaith prayer to our employees each day. I was wondering if I could get some chaplains from around the country to write prayers for us during our time of recovery which we can send to our employees. Prayers can be sent to JnThomas@ochsner.org.

Thank you,
Jennie

Accessing a New Model of Staffing

•Are you looking for objective support or documentation when speaking to your administrator about the need for additional pastoral care staff?
•Could you use helpful guidance in decision making about where and how to allocate chaplaincy time and presence?
•Are you seeking to balance pastoral care staffing in multiple settings?

The pastoral care department at Grant Medical Center and Riverside Methodist Hospital is developing a staffing model which addresses each of the above concerns. This model begins with a comprehensive assessment of unit acuity relative to pastoral care demands. It then provides specific chaplain-to-patient ratios based on the unit acuity. We are now seeking to strengthen and extend this model by benchmarking it nationally. If you would like access to this model as part of our benchmarking process, please contact Orin Newberry: phone number: 614-566-5307 or e-mail: newbero@ohiohealth.com.

Re: More on Harding, Christopher DeBono (PlainViews, 9/21/2005, Vol. 2, No. 16)

Responding to Christopher DeBono's piece on spirituality vs. religion translated into Chaplain vs. other professionals, I would like to make two observations; one is a definition of terms as commonly perceived, the other has to do with titles.

1. Using the NCA's historic and classical definition of spirituality [1]: the affirmation of life in relationship with God, with self, with others and with the environment that nurtures and celebrates wholeness, one concludes that the essence of spirituality is an active awareness of one's powers beyond the physical to maintain relationships and to grow thereby. Now, that's a mouthful!

Religion, however, is a bite-size formulation of an historically and culturally based spirituality and comes in many forms. Religion is the brand version of the generic spirituality. As I put it to patients and others, when you buy oatmeal you can purchase General Mills, Quaker Oats, Trader Joe's .....or generic !
Therefore, there is no discrepancy between the two.

2. The title CHAPLAIN, especially in non-denominational facilities, can be misleading and at times off-putting. Coming from the word CHAPEL, it smacks of "denominational functionary", hence of belonging to a distinct 'brand' of spirituality.

Granted that health-care related spiritual services were originally offered by ordained ministers, "chaplains", that title was by default extended to anyone, clerical or lay who ministered to patients etc.

To the Chaplain's greeting at the patient's door, "Hello, I'm Chaplain Joe or Jane", the patient may ask and want to know "What church are you with", and really wonder quietly "What religion are you peddling?" The chaplain then resorts to all kinds of explanations justifying his/her presence there as a professional on the health team supporting the patient's search for the healing resources of his/her spirituality framed by his/her religion or distinct beliefs.

To the point, I'll relate how an atheist patient was insulted by my presence as "Chaplain" but came to appreciate my presence as a respecter of his spirituality and his life accomplishments that gave meaning to his existence.

Therefore, can we find a more meaningful title for the function of today's health-care related Chaplain?

Lawrence Valentine
NCAA accredited lay Chaplain
Resurrection Retirement Community
Chicago, Ill

[1] The history of the definition can be found at www.ncoa.org/content.cfm?section ID=121. NCA (NCOA) has a constituent body, NCIA (National Interfaith Coalition on Aging) which formulated the definition around 1970/75 through the collaboration of Dr. James Ellor and Dr. Melvan Kimble.

Responding to Melvin Ray who wrote in response to George Handzo and James Stapleford who wrote to TalkBack about Office Space: Profit or Presence, Chaplain Richard Lopez (PlainViews, 8/3/2005, Vol. 2, No. 13)

A number of years ago I entered the offices of one of my colleagues where I happened to be the Director of the Department. He pointed to a newly framed certificate on his wall. The certificate declared that he was now a fully certified Alcoholism Counselor. He was very proud of this accomplishment and I shared his accomplishment with him. I did raise the question with him as to where was his Certificate of Ordination, as it was no where to be seen. A few years later, he came to my office and told me of the profound impact that my question had on him and that he went and looked for his Certificate of Ordination.

It seems to me that this story identifies the tension that we in "secular ministry" have. The tension between the demands of the institutions we are employed by (hospitals, businesses, treatment centers, hospices, etc.) and our personal historic roots –the church that "through the imposition of our hands" authorized us to preach, interpret the scriptures, provide the sacraments and a host of other pastoral services including being a prophet. The medical center where I work does not authorize me to do any of these pastoral offices, the church did that through the Elders and laity that ordained me.

I would agree completely with George Handzo that we are not a bankrupt profession and that we as a profession need proper education and certification. That is the reason that I have dedicated my professional ministry to such pursuits. However, I believe that we need to hold our faith heritage in equal, if not greater, respect. Therein lies the tension that I would hope could be folded into one that can become a banner for all of us.

In direct response to Melvin Ray, Board Certified Chaplain, I was not one of the writers for the White Paper. I am a former Regional Director along with a lot of other "formers". It is true that I have given a lot of my time, energy and love to the leadership of the Association For Clinical Pastoral Education as well as the old College of Chaplains. I have likewise given a lot of my time, energy and love to the United Methodist Church who ordained me. Similarly, I have given a lot of time, energy, and love to the various medical institutions who have provided my financial sustenance.

We in the professional chaplaincy owe a great deal to persons like George Handzo who take their time and energy to provide leadership. Thanks George for providing leadership as the Past President of The Association of Professional Chaplains.

D. James Stapleford, D.Min., MBA
Director of Spiritual Care and Education
Phoebe Putney Memorial Hospital
Albany, GA

Re: Are You Compassioned Out? Rev. Martha R. Jacobs (PlainViews, 9/7/2005, Vol. 2, No. 15)

Martha Jacobs' article is a good reminder of some self-care basics. It reminded me of this quote from the late Chief Justice William Rehnquist, which was printed in our newspaper couple days after his death: "There are dangers that come with successful careers. One can slide almost imperceptibly into a situation where the demands of the job are automatically accorded priority over other, more personal commitments."

Mark Pruitt, M.Div., BCC
Staff Chaplain
Department of Pastoral Care
Centra Health
Lynchburg, VA

I just finished reading Martha Jacobs' article in "Chaplaincy Today" and her comments in PlainViews. Thank you, Martha, for sharing your deepest musings of your soul as you worked toward renewing your soul and spirit. You have given us a guide and an example of what to watch for and what actions to take to make our own journey's back to that "unquiet Soul" that you speak of. Thanks again for letting us hear your soul-work.

Jim Stephens, M.Div. BCC
Senior Staff Chaplain
Providence Alaska Medical Center
Anchorage, AK

Kudos to Martha Jacobs as editor, not only for her article, “Are You Compassioned Out?”but also for the excellent article she penned in APC's Chaplaincy Today, ("The Unquiet Soul," Spring/Summer 2005, 33-36). She shared some thoughts and experiences she had to navigate to revive her own soul in the aftermath of the work she did with and for others following the World Trade Tower destruction in September 2001.

Cordially,
Rabbi David J. Zucker
Chaplain, Shalom Park, Aurora, CO

Re: The Bronze Boot, Rev. Charles Lopez (PlainViews, 9/7/2005, Vol. 2, No. 15)

I just want you to thank Charles Lopez for sharing “Harry”with us. (His own e-mail address was not listed) It makes me wonder how many “Harry’s”there are in the faces of the homeless, the poor, the “biker gang”crowd, the druggies, et.al., et.al. Besides forgiveness the article engenders some soul-searching.

Peace,
David Pacholke, Chaplain
The Finley Hospital
Dubuque, Iowa

I found 3 of the articles very useful and helpful to me. i made a copy of Dr. Hilsman's "Seven Love-Life Spiritual Needs and Hoped-for Outcomes" and plan to share with pastoral care students and volunteer chaplains.

I found Rev. Jacobs "Taking a Close Look at Ourselves" indeed right on the mark for me. I recently minister to the family of a nurse friend who committed suicide and remember how hurtful it was to hear about his death and know the pain he had caused his family and friends as I listened to them and
supported them at his memorial service that I presided at in a local funeral home.

Also Dr. Lopez's article about "the Bronze Boot" was so poignant of an example of how forgiving people can be that we encounter and come to love in our ministries.

I appreciate the quality and variety of PlainViews. Keep up the great work!

Chaplain Jennie Malewski
KU Hospital
Kansas City, KS

A response to the Catholic Church and reiki:

Rev. J.P. Doll would like to hear about the Catholic Church and reiki. He mentions that a " woman religious" (I assume he means a Catholic woman religious) introduced him to the practice. Now, I couldn't recall what reiki was although I've often heard the word. A short Google search and reading two introductory sites about reiki impressed me that it and the whole concept of energy flow and controlling it is rather flaky and not to be incorporated as a "Best Practice". While I applaud the pioneering spirit of Catholic women religious and others to reach out and try to incorporate alternative practices and knowledge, still all that glitters is not gold. Yes, I saw reiki or something like it practiced in the 1970's - along with crystal gazing. No, I don't believe there is much value and I think there there is harm in this and many other so-called alternative healing methods and psychologies. I can imagine that one benefit of reiki is individual attention and encouragement being given to a person seeking healing; something the medical practice in this country sorely lacks. However, couching this in demi-spirituality and it's system of energies is counterproductive in my mind. This reminds me of the story of Naaman the Syrian Army commander who sought for a cure for his leprosy from Elisha the prophet. When told to wash himself and he would be clean Naaman grew angry that Elisha wouldn't appeal to G-d and make incantations for his cure. While I don't doubt Rev. J. P. Doll's desire to be a healer and his (and women religious's) abilities to bring healing, still, wouldn't a technique more understandable to both science and religious tradition be more acceptable and accepted?

John Stangle
Certified Chaplain Advanced Emeritus, NACC

Re: Pastoral Presence: navigating the flow, Rev. Dr. Mark LaRocca-Pitts (PlainViews, 8/17/2005, Vol. 2, No. 14)

Thank you for the challenging words of Chaplain Mark La Rocca-Pitts' article "Pastoral Presence: Navigating the Flow." Pitts takes us on a wonderful and evocative journey as we weave our way between "voice and presence," between doing and being, in our encounters with patients, residents, and clients.

Pitts quotes the 13th Century Sufi mystic Jalaluddin Rumi, whose poetry lends imagery to the work we do on a daily basis. "There is a way between voice and presence/ -where information flows," Rumi writes. Further, "In disciplined silence it opens. / With wandering talk it closes." Pitts offers a concise and convincing interpretation of these words. Well done!

Cordially,
David J. Zucker
Rabbi/Chaplain
Shalom Park
Aurora, CO

Re: Continuing the Discussion on Theology, Rev. Stephen Harding (PlainViews, 8/3/2005, Vol. 2, No. 14)

In regards to Rev. Stephen Harding's articles on this topic, I would like to share a somewhat different view about spirituality, theology and religion, taking a bit of exception to the phrase, "merely spiritual". The common thought about spirituality is that it is limited to the personal experience one has with what they find to be transcendent. While this is true, it is also true that we are all "spiritual," whether we have a
personal apprehension of that or not.

Simply put, spirituality is our common base as human beings. In other words, we are spiritual beings with physical bodies. Some are more aware of their spirituality, while others are less so. In that sense, spirituality is personal. In the other sense, though, spirituality is profoundly a shared experience by all of humanity.

I would think that theology and religion are the more limited experiences of humanity. In that sense, we are "merely theological" when our focus is upon how to explain the trinity, or the unity, of God. Or, we are "merely religious" when our attention is drawn to how we pray and offer rituals toward the end of life.

Theology is the formal language we create to express what we experience at the spiritual level of our being, while religion is the community structure we create to give ritual and meaning to that theological language. Therefore, we can, and most certainly often do, disagree about theological topics and religious practices. But, our one common point is that we are spiritual, in whatever way we approach or avoid that reality about
ourselves.

The chaplain does have theological language and religious community as their background. I agree with Rev. Harding that the chaplain can, should, when invited, share that language and community texture in their care for those who grieve. In fact, chaplains should be able to do so in the skillful manner that allows those who grieve to talk in their own theological language, no matter if it is refined or otherwise. And, our experience with a community of faith should serve as a context for others to utilize their own community, or begin the search for such a resource to support them, should they desire to do so.

Once again, thanks to Rev. Harding for this thoughts on this, as it goes to the heart of much of what we do.

Marilyn Morris, M.Div.
RMH Staff Chaplain
Ohio Health

I'm sorry that I did not respond to the original dialogue presented. However, I am in favor of thinking and discussing theological issues and framing those issues didactically with other clergy. I believe it helps us in our own processing as we assess issues such as being or/and doing.

I am not in favor of clarifying our theological authority with staff. Doctors and nurses may talk in clinical manner and for those of us, who do not fully understand the language they use, has little to do with the authority we carry as pastoral caregivers. Using language that they understand helps us minister to the patients and the staff alike. If we use our language as they use theirs, then the only outcome is more confusion. I believe we need to use language that everyone understands and the authority we do carry will blossom. I find the continuity of visitation helps build relationships with staff and that includes doctors as well as the rest of the staff. Being open, honest and servanthood goes a long way in establishing pastoral authority with the authority within the medical community. Let's keep our language simple so that God's grace in which we represent may be better understood by all.

Rev. Rick Hope
Chaplain, Methodist Specialty and Transplant Hospital
San Antonio, Texas

Re: Responding to George Handzo and James Stapleford who wrote to TalkBack about Office Space: Profit or Presence, Chaplain Richard Lopez (PlainViews, 8/3/2005, Vol. 2, No. 13)

It seems to me there is role confusion among professional health care chaplains. In the context of the issue (interrelationship of pastoral care and profit margin), Mr. Stapleford declares that,”…as a provider of spiritual care, I am a guest in the hospital. …because I receive my authority to do what I do from an authority [my church] outside the medical center. …I try to be a good guest and understand the ‘rules’of the house. One of these rules is the profit margin.”

Mr. Handzo seems to present another facet which reflects the role of a credentialed, professional health care provider who is accountable to a recognized set of Practice Standards (Authority). This is the role of a health care team member practicing clinical interventions, whose education and professional standing is recognized (defined) by an overarching authority such as the JCAHO and Health and Human Services. Quite a contrast to what is usually considered a guest.

It seems to me, this primary identity of who we are and what we do could be interpreted as a “hat-in-hand, tail-between-the-legs, the-church-sent-me”approach. That is a clear message –“this job can be done by nice religious volunteers”–and supports the erroneous identification of “Chaplain”as a community clergy serving in the hospital.

Acknowledging of my own growing identity edges and role challenges, and with due respect to the leadership of Mr. Stapleford (who helped design the White Paper and is an ACPE regional director), I feel the existential impact of seeing chaplaincy as (predominantly) a guest in the health care arena is holding back our profession. I encourage, and join, our profession’s leadership and strategic planning efforts to heed Mr. Handzo’s prophetic words, “The only way we will survive as a profession is to have and adhere to a recognized set of standards for how professional pastoral care givers are credentialed and how they practice. We have to demonstrate as a profession that we do have a ‘best practice’and that we will disavow anyone who doesn’t practice at that level.”

I do not see our status as respected religious house guests. I will plan for vested health care professional ownership recognition.

Melvin Ray, Board Certified Chaplain
Director of Pastoral Care, Hunt Memorial Hospital District
Greenville, Texas

A question about the Catholic Church and reiki:

I am an ordained protestant minister in the Midwest. I have been trained as a reiki (energy work) provider and have incorporated use of reiki in my personal life and in my ministry with others. I was trained by a woman religious, who has trained many others in our community. Our small community hospital has recently opened a cancer center to provide for the care and treatment of cancer patient coming from a wide distance in this rural community. They plan to offer services of complementary therapies and have looked into having reiki available.

There is a strong catholic population in the community. The local priests have spoken out loud, strong and actually in hurtful ways to some about what they see as the “evils”of energy work. They have used their pull and influence with catholic contributors to the new cancer center and have caused the complementary therapy review committee to decide not to offer reiki to persons in our community.

I would like to hear from anyone about your understanding of the use of complementary therapies and the Catholic churches views of the use of them, particularly reiki.
Thank you,
Reverend JP Doll
justjpdoll@yahoo.com

Re: Office Space: Profit or Presence, Chaplain Richard Lopez (PlainViews, 8/3/2005, Vol. 2, No. 13)

Chaplain Richard Lopez’piece raises several myths commonly held by chaplains which are actively holding back our profession from serving patients, families and staff as fully as we might.

Myth #1 The hospital industry is a “desperate industry.”Many hospitals are failing financially and closures will continue to occur. However, the profit margin for the industry overall is rising. The number of hospitals whose bond ratings are being upgraded is rising. In the most recent reporting period, the number of hospitals in the US rose for the first time in years. Hospital construction is a booming business.

Myth #2 Hospitals must make a choice between quality and margin. Smart hospital administrators know and research is increasingly demonstrating a strong positive correlation between good quality care and positive margins. Those who provide better care make more money. The Malcolm Baldrige National Quality Award is the most prestigious quality award in the country. Of the four hospitals that have won it, all have strong margins and strong pastoral care departments.

Myth #3 Pastoral Care cannot contribute to margin. While it is often true that pastoral care does not contribute to a hospital’s margin, that doesn’t mean that we cannot contribute. Staff retention and cost avoidance around adverse events and end of life are prime areas where pastoral care can help the hospital make money. Even raising patient satisfaction can be argued to be a contribution. The problem is that, by buying into this myth, we do not put ourselves in a position to demonstrate our financial worth. We are not on the accountants’radar screens mostly because we have not done the work to put ourselves there.

Myth #4 Raising Standards Makes Pastoral Care Less Attractive. See Myth#2. Good hospital administrators appreciate that quantity without quality is useless. An overarching theme in this health care environment, is a flight to quality. The only way we will survive as a profession is to have and adhere to a recognized set of standards for how professional pastoral care givers are credentialed and how they practice. We have to demonstrate as a profession that we do have such a thing as “best practice”and that we will disavow anyone who doesn’t practice at that level.

As I consult with hospital administrators, what gets their attention is our demonstration of how pastoral care can actively and intentionally contribute to both the institution’s mission and margin. They pay attention when told that we are not just a bunch of nice religious people, but that we have standards and a rigor to our practice. Many hospital administrators want professional pastoral care. All they need from us is to make the case for how it can support the directions the hospital wants to go.

George Handzo, BCC
Associate Vice President, Strategic Development
HealthCare Chaplaincy
New York, NY

Richard Lopez has given us an article that many will add their two cents worth. All of what he says has some truth, but not all truth. Hospitals do have to be concerned with the profit margin if they are going to exist at all. If hospitals didn't exist then the presence of clergy, religious folk, shamans, medicine men etc. would still be required by our society.

I do take a different perspective. While I think that presence is Important, I have spent a lot of my professional career looking for ways to "prove the worth of spiritual care" to the "bean-counters”. I have to recognize that as a provider of spiritual care, I am a guest in the hospital. I am an invited guest, but nonetheless, I am a guest. I am a guest because I receive my authority to do what I do from an authority outside the medical center. As you look around the medical center, everyone there has received their authority to function as the result of being within the medical center's walls. As an ordained clergy, my church provides me my "station charter" to live out my Baptism. Being a guest, I try to be a good guest and understand the "rules" of the house. One of those rules is the profit margin.

The second way that I have tried to be a good guest is to learn the profit margin language. Over 25 years ago now I began to keep statistics on our pastoral visitation. I was able to demonstrate that my "non-revenue" department was "worth the revenue" that was being invested. One year I took the department budget- including the overhead of office space- and demonstrated the cost of each pastoral contact. The CFO was amazed at the small amount that the medical center was expending on "promoting the mission" of the medical center through the Pastoral Care Department. I have done this because I believe that Presence can be measured in terms of "time-value-of-money".

I believe as medical centers continue to fulfill their mission and core values, both presence and profit, will be there for the continuation and extension of healing.

D. James Stapleford, D.Min., MBA
Director of Spiritual Care and Education
Phoebe Putney Memorial Hospital
Albany, GA

Re: Handling Colleague Grief in the Workplace, Chaplain Clair Hochstetler (PlainViews, 7/20/2005, Vol. 2, No. 12)

I appreciate the idea of a formalized approach as Chaplain Hochstetler described. When there is a significant loss event to employees at our hospital, chaplains make themselves available to department managers for staff support. In the last two years, we have been utilized at least three times for staff memorial services or brief words of bereavement support at staff meetings. In one case, a nursing unit was closed by administration forcing nurses to find jobs elsewhere in the institution. Near the closing day of the unit, a nurse and I facilitated a well-received memorial service that dealt with group loss, grief, and forgiveness issues in a closing potluck farewell time. These types of chaplain services, I believe, have the added benefit to fostering an atmosphere of excellent chaplain referrals in general.
Chaplain Phil McGarvey
Carle Foundation Hospital
Urbana, IL

One thing we can do for colleagues in the hospital who are bereaved is to model openness regarding our own grief. My mother died suddenly in March. I have gone to a grief counselor for a series of sessions, read books that help me get in touch with my losses and strengths, and shared with chaplain peers and other hospital staff what this grief has been like. By sharing my thoughts and feelings, laughter and tears, I not only receive their caring, I demonstrate a person's ability to grieve in ways that are fruitful.
Alex Chamberlain, BCC
St. Luke's Regional Medical Center
Boise, ID

Dame Cicely Saunders was the creator of the modern hospice movement. Quoting the St. Christopher Hospice web site (http://www.stchristophers.org.uk/): Dame Cicely Saunders OM, DBE, FRCP, FRCN, died peacefully on Thursday 14 July 2005 at St Christopher’s Hospice in south London, the world-famous hospice that she founded in the 1960s, and the birthplace of the modern hospice movement. Cicely Saunders through her model facility at St. Christopher's Hospice, her writing, and her speaking gifted palliative and hospice care to our side of the Atlantic. Because of Dame Saunders, the expectation and delivery of care with dignity for those in the last stages of life until the last breath became a more normative and common expectation. I was privileged to hear her speak thanks to my teacher Dr. Sam Klagsbrun in the early 1980's. Eventually I was privileged to function in the holy moments between life and death as a hospice chaplains for 6 years. I am very disappointed that many news sources missed marking the death of this great woman, for whom telling her story continues her holy work. I mourn her loss.
Rabbi Leonard Lewy
Milwaukee, Wisconsin

A response to Chaplain Tim Coats comment (see below ):

This is a response to Tim Coats who writes asking if anyone has dealt with the issue of sending out messages via email and getting varied responses.

Yes, Tim, I’ve had a similar response. About five years ago, I began sending messages to acknowledge and honor various religious celebrations throughout the year, or to address different concerns that came up. Among our staff, we have people who are Christian (of many varieties), Jewish, Buddhist, Hindu, Muslim, Native American Spirituality and that’s just the start. But the general perception was that folks were “just Christian.”Because I knew the diversity, but I didn’t exactly know who was what, I started sending out what have come to be known as “Cherie’s blurb’s”–short descriptions of the holiday/holy day or feast, along with a greeting and hope for blessings for the celebrators.

The appreciative comments over the years have been ENORMOUS. People enjoyed learning about other faith traditions. People who are culturally in the minority and aren’t so likely to get a greeting deeply appreciated the acknowledgement of what is valuable to them. People found it meaningful to be able to know more about their co-workers and to be sensitive to their religious beliefs and observances. It has helped increase awareness among staff that our patients (as well as our staff) are not as homogeneous as many had assumed.

But I have had an occasional objection. Sometimes from persons of a particular faith group who think that I should be promoting one particular doctrinal position, rather than sharing many. Once from a person, like your colleague, who just didn’t want any of that spiritual stuff in their email. Over five years, I have had scores of appreciative responses, and five objections.

First I clarified with our administration that what I was doing was okay. And I had rousing approval. General consensus from senior management was that these emails were clearly marked in the subject line, and could easily be deleted quickly by anyone who did not wish to read them. They are educational as well as helpful for those who wish to receive them. They are generally less objectionable than much other “all user”mail that comes out (administration’s opinion, not mine). So I knew that from a “policy and procedure”perspective I was okay.

Second, I responded to each response I got. I expressed appreciation for the response itself and then tactfully and gently expressed understanding that they might not find the emails helpful and might wish to delete them when they saw the subject line and sender. Then I thanked them again for their response. (I think it might have helped that I sincerely believe and expressed that there’s no such thing as a “bad”response, even when they are uncomfortable to receive…) I actually had two of them tell me a couple of years later that they had decided maybe the “blurbs”weren’t so bad –and a third apologized, telling me that they were having a bad day when they had sent their response.

It was hard to get those “negative”responses, because I did not want to offend anyone. But I’m glad I listened to the administration and continued to send out my blurbs. Many people have benefited –and I have learned much in the process.

Blessings,
Cherie Baker, Chaplain/Director
Washington County Hospital
Hagerstown, Maryland

Re: Hospice Spiritual Care Providers....This is for You, Rev. Stephen Rice (PlainViews, 7/6/2005, Vol. 2, No. 11)

I work for a small hospice provider in Grand Rapids, Michigan. Please add my name to your info pieces. All of us can tell war stories about the work done by “chaplain”colleagues. I certainly support all attempts to provide some kind of litmus test for those of us who would like to raise the professional standards for this work. Minimally, M.Div. from accredited seminary and at least one quarter of CPE, preferably more, thought that may take some time. I appreciate your work.
John Kirkman
Spiritual Care Coordinator
Metron Hospice
Grand Rapids, MI

Re: Making the Case for Theology, Rev. Stephen Harding (PlainViews, 6/15/2005, Vol. 2, No. 10)

In response to "Making the Case for Theology"...I agree that there is a theological aspect to the spiritual care of patients, because every person carries an at least implicit theology (understood as reflection on faith) through life. However, I would have to disagree strongly with Rev. Harding's insistence that chaplains bring their individual or denominational theologies strongly to bear on the health care setting. He suggests this as a way of "recovering authority and power" and once again being "perceived as needed expert professionals." His motivation seems praiseworthy; he is concerned about dealing effectively with the sometimes negative and hurtful concepts of God that people bring with them. However, I believe the emphasis should never be on the chaplain's theology, but rather on the faith of the patient. The chaplain, after extended listening and effort at understanding the patient's stance, may find it helpful to suggest some very basic "theological" insights, but going beyond that would, I feel, probably be hurtful and ultimately divisive. We live in a pluralistic world, where, for better or worse, there are about as many theologies as individuals. One can lament this situation, but I can think of no worse place to begin correcting it than the chaplain's workplace. In my view, the institutional influence of the chaplain must be earned through presence, compassion and, where opportune, wise counsel. Where I work, the entire hospital staff is encouraged to minister to the whole person, including the "spiritual." The chaplain, by being regarded as an integral part of the institution's healing strategy, serves as a constant reminder of the importance of the spiritual, if not always the theological.

Richard A. Jiru, Associate Chaplain
Poudre Valley Hospital
Fort Collins, Colorado

I feel that there may be a deeper problem going on here that goes beyond terms of 'theology' or 'spirituality'. What I feel has happened is that due to certain scandals in the Churches, the
Church has lost its credibility. As the Church has lost its credibility, chaplians may be painted with the same brush. I further feel that we all need to come together to make the case for 'spiritual' care in the healthcare setting.

I served overseas as a missionary for several years. There, the local Catholic Church had developed a renewed catechism. The renewal had the various stories contemporized to today. The grandmothers who were outspoken who brought their grand kids to religious ed. one time stopped me, looked me in the eye, and said 'arroz e feijao' (rice and beans). They didn't want us delving deeply into the meaning of the scripture for today. What they wanted was the basics of the faith. Sometimes, I have felt that other disciplines think we only give the basics.

Beyond all of this, I feel that the fact that the two words 'spirituality' and 'spirit' appear 523 times in the Bible is full of meaning. What did it mean then that can teach us now?

Peace,

Thomas J. Rowan
Director of Spiritual Care
Providence Rest Nursing Home
Bronx, NY

Hello at Plainviews.
Thanks for the interesting articles. I am a hospital chaplain who wonders about suggestions, patterns, examples of ministering to a diverse staff. I have for years been sending e-mails of spiritual encouragement, support, comfort, etc. to all-users. Lately, one person has complained that he does not want to be asked to pray about anything or be ministered to. Many, many staff send words of appreciation that the notes have been a big blessing to them. Any suggestions?

Thanks and God bless,
Chaplain Tim Coats
Rapid City Regional Hospital
Rapid City, South Dakota

What is wrong with proselytizing/evangelizing?

In the New York Times of July 12, 2005 there is an article about military chaplains. One upper-level U.S. Air Force chaplain by the name of General Richardson is quoted as saying that he reserved the right to evangelize the unchurched. What! What, one might wonder, is wrong with this? What is wrong with this is that it is wrong-headed. Why is it wrong-headed? It is wrong-headed because it wrongly heads people in the wrong direction. The general reserves to himself and his evangelical minded staff the opportunity to enroll the unchurched (or un-joined?) in his religious agenda. And what is his religious agenda? From my point of view his agenda is a distorted presentation of how to know, love, serve, and honor G-d and neighbor. "But", you might ask, "What do you actually know about what he is saying, doing, and urging". I would answer that I don't exactly know the details of his activities, but I've seen the birds that fly in his flock and that's evidence enough. May the general desist his subtle hints and coercion
of the vulnerable and may religious matters remain personal matters and beyond comment or criticism in the military services.
John P. Stangle
Chaplain Advanced Emeritus, NACC

Re: When I’m Sixty-Four, Rabbi Dr. David Zucker (PlainViews, 6/15/2005, Vol. 2, No. 10)

I just read Rabbi Dr. David J. Zucker's article "When I'm Sixty-Four" and wanted to respond. I'm a seminary student and a massage therapist who is interested in chaplaincy. My field placement beginning in Fall 2005 will be at a palliative care center and hospice as a student chaplain. When they heard of it, the staff at the placement were excited to know that I'm a massage therapist because of this very issue of compassionate touch. My supervisor has made it known that throughout my experience at the center I will have opportunities to integrate my skills as a bodyworker. I believe everyone needs to be touched (especially those who are seen as untouchable) and when to we are positively touched, we heal and thrive.

I've been in the field of massage therapy and bodywork for almost 7 years and have both practiced hands-on care in clinical and non-clinical settings and have taught it to students in three different schools. I spend many sessions with my chronically ill clients (mostly HIV/Aids patients) getting to know them and occasionally they confide in me with "pastoral care" issues (even though I'm not in the position of a chaplain) and provide the healing space for them to be heard and accepted.

For my massage students, I teach a course on chronic illness and death and dying discussing the issues related to body/mind/spirit. The integration of the whole person is so essential. Much of the information I share with them is from direct experience, but other information is related to my research for my MTS thesis I wrote almost 6 years ago entitled: A Holistic Look at the Importance, Healing and Theology of Touch.

My goal in returning to seminary (I have already earned an MTS and now am going back for an M.Div.) is to integrate more fully the spiritual, emotional and physical in my practice of working with others both as a chaplain and a massage therapist.

I'd like to thank Rabbi Zucker for bringing this issue to the surface and would like to encourage everyone working in traditional and "non-traditional" pastoral care settings to appropriately bring touch to everyone they encounter.

A book I can recommend on this subject is: Compassionate Touch: Hands-On Caregiving for the Elderly, the Ill and the Dying by Dawn Nelson, Dawn, M.F.A. Nelson ISBN: 0882681494/

Sincerely,
Rich Kamasinski

I just read David Zucker’s article, "When I'm Sixty-four." This article was very inspirational for me personally, (I am sixty-two), but it also gave me a much deeper response as a chaplain as we do minister to our collective aging population.

Thank you for sharing your gift of writing., . . .meaningful writing. . . . this is one more reminder of the lingering benefits of 2002 (EPIC conference).

Shalom
Floyd O'Bryan
Coordinator of Care
Mayo Clinic Hospitals
Rochester, Minnesota

Re: A Hometown Chaplain, Rev. A. Meigs Ross (PlainViews, 6/15/2005, Vol. 2, No. 10)

I was deeply moved by Rev. Ross' article and am very grateful to her for sharing such a tender way to bless the experience of ministry during a time of trauma. Her method of transforming each scene into a place of hope touched my heart. She has definitely found a way to care for her own spirit in a manner that will enable the wellspring of compassion to flow from her and not be diminished by heaviness of heart. Reading her reflection was an "aha" moment for me; her words have a made a difference.

Chaplain Barbara Wojciak
Birmingham, AL

Today when I read A Hometown Chaplain it made me think how many times I have run out of the house without thinking of the community all around me.

Rev. Pete Martin
Head of Spiritual & Pastoral Care
Barking, Havering & Redbridge Hospitals NHS Trust England

Re: Making the Case for Theology, Rev. Stephen Harding (PlainViews, 6/15/2005, Vol. 2, No. 10)

(Editors Note: We had many very thoughtful responses to this article. Clearly this is a topic that needs to continue to be discussed. All comments received are included in their entirety.)

I certainly could identify with Rev. Harding's experience about people of other disciplines thinking they know how to address a person's spiritual issues. I find upon listening to some of these individuals in my teaching hospital setting at team meetings, they do not have the depth or breadth of expertise to address the spiritual matters that those of us trained theologically do. The majority of the times I have talked with a patient about a theological issue related to God, not a spiritual issue. I will hear, "I feel God is far away." "I think God has abandoned me." "I don't know how to pray to God any more." "Why is God letting this happen to me?"

Most patients want to dialogue about a theological concern or question, not a spiritual issue. It's a G-d thing involving his/her relationship with God, and it's usually a G-d thing for me in my own personal life. Harkening back to my seminary days, 21 years ago, I think of what the mental health chaplain asked us in our action/reflection time after being on the floors with the mentally ill patients, "Where are you theologically with what happened today?" It was never, "Where are you spiritually with what occurred today?" I think chaplains in 2005 still are addressing with patients "Where are you theologically today?"

Rev. Jennie Malewski
Staff Chaplain
KU Hospital
Kansas City, KS

I am in full agreement with Chaplain Harding. One of the main reasons for switching from healthcare to training was for this very reason –spirituality and the lack of theology.

As I now get to train those that are going into ministry and looking for doing chaplaincy, it is a concern that we speak of spirituality and do not advocate theology. We are giving up our GOD ordained authority and as Chaplain Harding has reminded us that we as trained theological professionals can go where no one else can. I look forward to hearing about a return to the theological tradition of chaplaincy.

I look back at the theological reflections that were a mainstay of the verbatim that I did during my CPE training and think of a colleague I now work with. If there is not a problem in the relationship with GOD what are they seeking a chaplain for in the first place?

Blessings
In His Service
Chaplain Dale Buffington
The King’s College and Seminary
Lancaster, Ca

I appreciated the article and question put before us that the patient's concern may be of a theological nature and would like to be included on further discussion in this arena. I think for some, spirituality has become a diluted and trendy catch phrase that assumes spirituality like a child assumes it will be fed.

Prayerfully,
Rev. Barbara Means
ACPE Supervisor
Cabell Huntington Hospital
Huntington, West Virginia

I am writing in response to Chaplain Harding' s wonderful reflection in PlainViews regarding reclaiming in our vocabulary the term "theological." I recall having been introduced to the term “Practical Theology”in my D.Min. work with Dr. John Patton and the idea that the chaplain functions as a practical theologian in the Health Care Setting. What we do in our work with patients at its deepest places is help them find meaning in their experience. This then is the theological task. I share Chaplain Harding's concern about the over use of the term spiritual. I have been tolerant because it seems to respond to the need for sensitivity around diversity concerns, which, by the way, I think is the issue of our century and thankfully has continued to evolve as a focus in ACPE circles as we have launched ourselves in our young adulthood as an interfaith association.

It would seem to me that the term theological and our work as practitioners of theology may be an umbrella term under which the term "spirituality" resides. Questions like, "How does one's spirituality inform her/his understanding of the place of the divine in the experience of illness?" In other words, we know that not all articulations of spirituality are holistic, healthy or productive for individuals. The work of the theologian it seems to me, lies in the fertile field of metaphor, image, and the process of meaning making that speak out of ones spiritual practice. In that vast garden we can nourish healthy spirituality and weed out spirituality that is not healthy. It takes some judgment, an understanding of theological language and the theological task that the healthcare worker is not trained to pursue. As practical theologians, doing theology in the places of disease and suffering, we can contribute to the spiritual care that health care workers offer to patients as well as the spiritual well being of patients, families, staff, all our charges in pastoral ministry in the institutional setting.

I look forward to further dialogue around this issue and my thanks to you for raising it to our attention.

Rev. Dr. Steve Dutton
Manager of Pastoral Services
CPE Supervisor
Wilmington, Delaware

When I read Steven Harding’s article Making the Case for Theology my heart raised a strong “Amen brother!”I have been involved in chaplaincy since 2000. Earlier, I spend 22 years in pastoral ministry serving a number of congregations of the Baptist General Conference of Canada. When I engaged my CPE training (May 2000-May 2001) I struggled a lot to understand the concept of “spirituality”and “spiritual”as they were used by my CPE Supervisors. I struggled to understand why it seemed that chaplains had forsaken their theological roots for what seemed a generic, almost meaningless category called “spirituality.”I did come to appreciate the fact that the word “spirituality”is useful and does allow a chaplain to access discussions with many patients, residents and family members who are put off with religion and its theology for one reason or another. I guess the thing that concerns me and the reason I respond to Rev. Harding’s article is that it seems there has been a baby and bathwater thing happening here. In a desire to widen ones ability to connect with people of many religious traditions or no religious tradition, we seem to have forgotten that for many others, religious tradition and the theologies associated with them, are defining entities in our lives; that much that is experienced in the face of suffering can not be understood without an understanding of the theological framework of the patient, resident or family member that we are serving.

For a Christian who takes the Apostle Paul’s words to Timothy at face value, “In fact, everyone who wants to live a godly life will be persecuted,”(2 Tim. 3:12 NIV) I assume that my life will be plagued by the corresponding difficulties that accompany the practice of choosing to live by God’s values and in relationship with God in this world. The persecutions spoken of may be in relation to others who do not share my faith and wish to bring suffering upon me because of my faith, but that is a limited view of persecution. Persecution is also suffering associated with making choices to follow God’s path in life. Suffering like living in the pain of broken relationships and maintaining a willingness to forgive long before the perpetrator experiences any sorrow for the offence committed; or the suffering that accompanies a choice to remain pure sexually in the face of a culture that embraces a reckless and hedonistic attitude towards sexuality; or the suffering that accompanies faithfulness to one’s theological foundations even when colleagues look down on you because your theology is not inclusive (in regards to issues of sexual orientation, in regards to what one believes about what is required to be right with God, etc.).

I work in a community that is heavily flavored by three religious traditions: Mennonite, French Catholic and Ukrainian Catholic and Orthodox (Eastern rite traditions). If I fail to understand the theological framework that people grew up in that taught them how to understand suffering, because I am overly focused on generic spirituality, I will miss these sufferers in my encounters with them and fail to validate, understand, show appropriate compassion for them in their times of need.

Larry Hirst, Chaplain
Specialist in Pastoral Care, CAPPE
Bethesda Hospital and Place
Steinbach, Manitoba

I agree we need to speak out of a Theological frame of reference. To keep this short I will give a brief account of what I am doing as a retired chaplain serving as an Episcopal supply priest.

The congregation had the urge to develop a way to monitor (document) their life in the community after worship and came up with a method. During a coffee hour discussion called The Second Table Gathering more thought was given to this issue. (The First Table is at the Eucharist.) A nurse suggested, and others agreed, to fill out slips of paper each Sunday called shepherd notes. The notes are a record of our ministering to others or being ministered to. We started on Pentecost Sunday. The vestry has agreed to promote this for a year. The notes are placed in the offering plates during the service. Already I can see how relational the congregation is during the week.

The theological language comes from Archbishop William Temple who said 9/10's of our time is out in the community. He called this the Church in public and the Body of Christ out in the world. There is more but suffice the introduction for a very Incarnational mode where story listening has a major focus. The Greek word for listening appears 427 times in the New Testament.

For 25 years I directed a lay ministry group in the hospital called Befrienders. They wrote a short anecdotal record as part of their debriefing before leaving the hospital. From time to time we reviewed the records to study trends and new learnings. This was our Megatrends where what was being written began to change. A number of programs evolved from our reviewing and reflecting. It may be the same with the shepherd notes over the year. We will find where Theological language speaks and connect, phronesis and susnesis.

I already know my homily is enhanced by our mission. I preach again on the Sunday when the Gospel talks about a cup of cold water for these little ones. We had Matthew 9:13 previous about "Go and learn, 'I require mercy not sacrifice.'" Knowing Greek you know the connection between learn and disciple. This is not a resource for many in the health care field.

We definitely need to reclaim our Faith knowledge base and our Theological outcomes.

Shalom,
Marlin Whitmer, APC (ret.)
Crystal Lake
DeWitt, Iowa

I have struggled with the term theology for quite some time and have decided that the term itself is misleading. Theology –a study of G-d. Who has done that? Thus to insert theological instead of spiritual seems to be about identity and loss of status of recognition. I do think that another term could off some clarity, however, theological wouldn't be the term for me. Thank you

Bill Neely
CCRC
Silver Spring, MD

It seems to me that the issue of using the term spirituality vs. the term theology isn't helpful in interdisciplinary functioning. The medical profession has rediscovered spirituality as being very important in today's healthcare. I think it is more important to define spirituality in terms which speak to the issue of chronic suffering which may have spiritual/theological grounds for the sufferer, if not for those who provide care. True, spirituality, has been broadened and misused in so many ways, but the term theology has a lot of baggage as well. Our theologies are what help us divide ourselves into various schools of thought and, if we are not careful, answer questions no one is asking. I appreciate the dilemma of establishing one's place on the team as a chaplain. My choice over the years has been staff education, defining what spirituality has to offer patients in their recovery, and making it clear that as Chaplain this is my area of expertise. That is why we developed spiritual assessments for specific groups of patients; those with addictions, those with PTSD, those at end of life, and those who requested to see a chaplain as part of their hospital care. These assessments helped us understand the spirituality of the patients, and helped us communicate to staff about the spiritual needs of the patients, whatever their religious backgrounds or theological persuasions.

Vance Davis
BCC, Retired
Johnson City, TN

I like the idea of using the theological terminology suggested by Rev. Harding. To me spirituality has become SO WATERED down and inclusive that it no longer has any definition, substance or meaning. It seems that we have run scared of the word religion and have allowed it to be divorced from the vocabulary and have embraced a word that used to mean that a devoted, serious religious person would hold dear. To say that a person was spiritual was an adjective that described they were sincere and devoted to their beliefs. Now spiritual means anything and everything from a higher power to a lack thereof. I don't like the re-defining of the word that our profession has embraced and I believe that because spirituality has no substance, it can be claimed and handled by anyone, chaplain or not. Using the Theological lingo may bring the role back to the chaplain and away from social work or others not specialized in that area. Personally, I do not think religion is a bad word, I think it is a good word that defines, sets understanding and gives a foundation for a person to draw strength from and theological terminology in my mind strengthens that foundation. My feelings are that a person that is deeply spiritual, will have a religious framework to worship from, whether that framework is organized or personalized, religion is not a bad word and maybe we can move to theological as a compromise.

Ned McGrady
Manager of Pastoral Care
Foote Health System
Jackson, Michigan

Rev. Harding makes an excellent case for why in our organization our department is called “Spiritual Care and Religious Services.”It’s a bit long and cumbersome, but it speaks to what we chaplains do as healthcare professionals. When I lead the various in-services on spiritual care in clinical healthcare for our organization, I point out the name of our organization, and I talk at some length about the fact that patients are often addressing the ultimate questions of life while they are with us in the hospital –where did I come from, why am I here, why is this happening, what is the meaning of life, where am I going –and that (1) their reflection on these questions will possibly impact their health outcomes and certainly their experience of their stay, and (2) their reflection on these questions will often happen within some theological framework, even if they can’t name or understand that framework. Many of our patients need not only spiritual care but also religious services from the chaplain, the healthcare professional on the team who has the training and focus required to help them sort out and make meaning within the context of the theological and spiritual framework of their lives.

When the issue of who does spiritual care comes up, the answer for us has been that anyone on the team can give the basics of good spiritual care (reflective listening, compassionate support, etc.) to the degree that the team member is comfortable with the circumstance, maintaining professional distance (i.e. not confusing care with conversion), as time constraints allow and complexity of the patient’s needs allow. Likewise, any member of the team can make a referral for chaplain services when needed. We’ve found that this approach has increased an awareness of spiritual AND theological needs among patients as well as increased referrals to chaplains from all members of the team (especially from physicians).

Finally, it has helped to include religious diversity as a part of our cultural sensitivity awareness as an organization. I am a part of that initiative as well, and we observe a variety of religious holidays and holy days both through educational events and through small celebratory times. This has increased awareness in our patient care conferences, and whichever chaplain is present is expected –by the team –to bring a voice of support for the spiritual/religious concerns of the patient.

I guess my final thought on this is that I would like to see us embrace BOTH concepts, rather than have to choose one or the other. The patients we serve (as well as our colleagues in various disciplines) usually come from a rich diversity of religious heritage and traditions, including some who cannot talk about the theology but who know they have spiritual concerns and resources. I find that it’s crucial to the work I do to be able to integrate the language of theology and spirituality and to claim both as the centerpiece of my professional identity. Most healthcare professionals I work with increasingly respect and welcome that.

A great big THANK YOU to Rev. Harding for this excellent article!

Blessings in peace and grace,
Rev. Cherie Baker, Director of Spiritual Care and Religious Services
Washington County Hospital/Health System
Hagerstown, Maryland

I would like to point out that the stance that Chaplains need to claim or reclaim authority over theological or spiritual language is a belief-defined theological stance worthy of discussion. I understand clearly the risks of not owning our own area of expertise in the highly competitive realm of patient care. I also understand the risks of owning or attempting to own that territory.

However, I wonder if Chaplains who build into their relationships with other professionals an increasingly broadened ownership of the realm of theology and spirituality might be more likely to increase their value to the system. Actually, I think the professional aspect of Chaplaincy most in service is the one that cultivates in others an attitude of expansive respect for the emerging faith beliefs and experience of others.

This happens via Chaplains because they have training and experience withholding/withdrawing their own faith perspective and projections to the patients situation, creating both the room and the listening environment for the patient's faith to grow into the space created by their circumstance.

Rev. Betsy D. Ritzman L.C.P.C.
831 South Oak Park Avenue
Oak Park, IL

I can relate to the author's concern over the recognition of chaplains' "authority." There is a real danger that authority can be compromised, diminished by sharing it too broadly, i.e., with every other discipline. I don't see this as the issue, however. Unlike authority, expertise cannot be compromised or diminished. I believe that this is where our focus needs to be: in demonstrating that chaplains do indeed have certain expertise, honed over years of training and sensitive practice. While it is true that "anyone can have a conversation about spirituality," it would be the rare person who would be able to have that conversation at a level or depth that a chaplain can. We do not want to start turf wars over who is allowed to talk about spirituality; we want to present ourselves as the individuals most capable and most willing, to broach spiritual topics in a way that allows healing of the spirit. Rather than feeling threatened by the fact that any member of the caring team can be seen as spiritual, take heart from the fact that the team is functioning from a holistic perspective.

Since the author's colleague later acknowledged the chaplain's unique role, there didn't seem to be much of an issue left to address. Actions speak louder than words, so let's not spend energy on a campaign to change terminology. One-on-one conversations, like the one held with the colleague, are a valuable way to clarify issues. Let us continue to do what we do well and be alert to opportunities to educate others when appropriate.

Chaplain Barbara Wojciak
St. Vincent's Hospital
Birmingham, AL

I just read Stephen Harding's article, "Making the Case for Theology." First, let me say that I so welcome the invitation to engage in dialog through this newsletter. Although I have often thought about writing a response to something I have read here, this direct invitation was hard to resist. I am a nurse working in hospice care, and at the same time, taking classes in holistic spirituality at Chestnut Hill College in Philadelphia, hoping to eventually work as a chaplain. I am "crossing over" (or perhaps "merging disciplines"?) because I recognized that I did not have the tools that I wanted to have, for helping others with the spiritual work involved in illness, dying, and loss. I agree that part of the tool kit for offering spiritual care is a firm grasp of theology and theological language, and I have enjoyed the theology classes that I have taken immensely. However, I find that the questions Rev. Harding raises to be full of complexities that I believe will not be best served by the claiming of theological language. Christian theological language can be a barrier to intimate communication between and among people of different faith traditions (as reflected in both our clients and our colleagues). This becomes an even more acute challenge when we are talking with a person who has left a faith tradition, and needs to find a door to reenter the conversation.

I am also a bit uncomfortable with the concern that "we have given away a great deal of our authority and power in a system where anyone can be spiritual or have a conversation about spirituality." Instead of taking a defensive posture, I assume that the very presence of a chaplain at the IDT table is what enables people from other disciplines to initiate a spiritual conversation with their clients. Likewise, having medically trained people at the table allows social workers and chaplains to initiate conversations with clients about the physical/medical aspects of their suffering.

Because I do my job wearing the hat of a nurse, I am particularly sensitive when I hear concerns raised by chaplains regarding issues of "turf." I well know that chaplains sometimes can only enter the situation by invitation of another discipline, usually nursing. On the other hand, my ears perk up when I hear that after obtaining a masters degree in holistic spirituality, I still may not be eligible for certification because I do not plan to become ordained within a faith tradition. Although I do not have a clue how to untangle these turf issues, they concern me greatly.

Finally, because I am Jewish, it is particularly relevant to me to learn a language of spirituality that can be accepted as meaningful to people from a very wide range of religious backgrounds. I'm not so sure that theological language will addresses the needs of my "flock" as well as spiritual language. But I am certainly interested in talking more about it.

Risa Denenberg, RN
Nurse Practitioner
Wissahickon Hospice
Philadelphia, PA

Rev. Harding’s article in Plainviews on using the term "theology" rather than "spiritual" is very thoughtful and interesting. It is important to choose our language carefully and know what our mission is and what
we can offer to patients that others cannot. My only caveat is how would a patient who is an atheist or has no belief in G-d or a creator respond to the term "theological?"

Again, you have asked a good question that merits further discussion.

All the best.
Melech Lensky
Chaplain, Chaplaincy Services
Froedtert Memorial Lutheran Hospital
Milwaukee, WI

I agree with your "wonderings" regarding the overuse of the term "spirituality" and thus debasing the meaning of the term.

I do believe Chaplaincy is in danger of losing it's footing in the healthcare field. It seems to me this is happening on several levels. First, we have not done an adequate job of educating other healthcare
personnel with respect to what it is we do. Far too many still think of us as "grief counselors," or, only as "religious" folk available to address religious and sacramental requests/issues.

Secondly, we are not revenue producing. As the competition for healthcare dollars rise, and, as hospitals trim their budgets in order to compete, chaplaincy services become more vulnerable. The more we are unable to clinically justify our presence, the more vulnerable we become.

Thirdly, in spite of the increase in publications regarding spirituality and health, there still remains a lack of solid scientific evidence that supports both the paradigm shifts that need to occur among doctors and administrators, along with the justification needed to continue to provide chaplaincy services.

These observations lead to my more directed comments about your article, "Making the Case for Theology."

While I agree that Chaplains may be the most qualified to address theological issues and identify theological pain, I believe three things must occur in order to make our case. First, theological themes should be identified. There is a need to come to some agreement as to what these themes may be, then communicate these themes to other healthcare personnel.

Second, research must take place that identifies what impact on patients particular theological experiences have. For instance, can we clearly document the impact of the "need for redemption?" Simply identifying theological issues is not enough.

Lastly, further research must be done that documents outcomes. What is the impact on the patient when certain theological issues are addressed? What is the criteria for measuring "theological" outcomes? Does it truly make a difference in the well-being of patients when these issues are addressed and resolved?

As hospitals change, I believe Chaplaincy services will have to be more diligent in justifying our existence. We will have to make ourselves viable to an industry that increasingly is asked to trim fat, run lean and market more effectively. If we cannot prove we are a meaningful service line Chaplaincy will be pushed to the sideline.

We are not hosts to the patients in our organization; we are guests in their lives. (author unknown)

Chaplain Richard Roberts, Jr.
Staff Chaplain
Genesis Medical Center
Davenport, Iowa

While I appreciate the author's concern, the term "theological" has no meaning (or a very heady meaning in some circles). For those who are not Christian I am not sure that that the term theological is even accurate. I agree that the term spiritual has become over used and unclear in terms of definition. I do not have an answer to this dilemma but felt the need to at least make this much of a comment.

Rev. Robin Y. Franklin
Director Chaplaincy Services
University of Rochester Medical Center
Rochester, New York

I'm not sure that changing the title of what we do to reflect theological care is really necessary. I encourage staff who are aware of their spirituality and use it in their practice to know their limits and when to refer to pastoral care. In a small community hospital, with ok coverage, I realize that other staff can really help us address some of the spiritual needs of others. Perhaps our authority comes when we address the case from a spiritual perspective in the team meeting and name the spiritual dynamics in a case or at least voice our hunches.

Barry J. Morris M. Div. BCC
Director of Pastoral Care
Randolph Hospital
Asheboro, NC