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By Austine Duru, MDiv, MA, BCC

In this issue of Vision, in lieu of publishing a research article, we present eight research resources in hopes of assisting readers to sample a broad range of research by chaplains and non-chaplain collaborators. Each research resource is related to our current Vision theme, “Accountable in Acute Care: Examining Standards of Practice.” A link to a safe open access site has been included to aid in further detailed reading.

Meg Orton. “Emerging Best Practice Pastoral Care in the UK, USA and Australia.” Australian Journal of Pastoral Care and Health 2, No. 2 (2008): 1-28. (44 references)
Link: www.pastoraljournal.findaus.com/pdfs/Emerging.pdf

This interesting project by Meg Orton draws on a number of sources to examine the emerging views around best practices in pastoral care across three continents, thus giving the reader a global snapshot of the principles that inform existing standards of care in the countries examined – The United Kingdom, the United States and Australia. This ongoing global project suggests consistent progress in the growth and advancement of professional pastoral practice in healthcare and related fields. Meg Orton observed that in each country there is a movement towards professionalizing pastoral care. Some of the factors cited ring true, yet newer developments, especially in the United States and Australia, call for a revision of this work. Nevertheless, much can be learned by reviewing the cited models and findings. One important lesson to take home is that, in the current global framework, professional chaplaincy cannot survive in isolation in any of these countries. This work invites readers/professional chaplains to continue to add to the available data by contacting the author, through an e-mail address provided to the reader, as things continue to evolve and improve in the professional practices in these countries or elsewhere in the world.

Katherine M. Piderman, Dean V. Marek, Sarah M. Jenkins, Mary E. Johnson, James F. Buryska, Tait D. Shanafelt, Floyd G. O'Bryan, Patrick D. Hansen, Priscilla H. Howick, Heidi L. Durland, Kandace A. Lackore, Laura A. Lovejoy, and Paul S. Mueller. “Predicting Patients’ Expectations of Hospital Chaplains: A Multisite Survey.” Mayo Clinic Proceedings 85, No.11 (2010): 1002-1010. (15 references)
Link: www.ncbi.nlm.nih.gov/pmc/articles/PMC2966363/

In this survey, Katherine M. Piderman and her colleagues set out to identify what patients would expect from chaplains during their stay in the hospital, which patients would most likely seek chaplain visits, and what these patients would consider important elements of a pastoral visit. Some 4,500 medical surgical patients across three hospitals in Minnesota, Arizona and Florida were surveyed by mail. The data were analyzed using multiple tools. The results suggest that medical and surgical patients value chaplain visits during their hospital stay. Patients are more likely to desire chaplain visits because it is a reminder of God’s care and presence. In addition, those patients who are affiliated with religious institutions are more likely to seek chaplain visitation. This study provides some insight into the unique role of professional chaplains who provide care for patients. However, the authors caution against using this survey as a justification for providing pastoral care to every patient without considering patient’s preferences. “These findings can guide institutions in responding to patients’ expectations and implementing best practices in providing spiritual care for their patients…. It cannot be used to overshadow the vital importance of honoring the uniqueness of each person.” Each person, the authors conclude, must be assessed individually, with care and respect. An article by Katherine M. Piderman on this study was published in the March-April 2011 issue of Vision.

Judith R. Ragsdale. Educating Clinical Pastoral Education Supervisors: A Grounded Theory Study of Supervisory Wisdom. Antioch University, 2008: 198 pages. (109 references) Note: this work is the author’s doctoral dissertation. The full text of the electronic version of the dissertation could be accessed at the Ohiolink ETD center:
Link: etd.ohiolink.edu/view.cgi?acc_num=antioch1205193710

In this groundbreaking 198-page work on supervisory education, Judith Ragsdale explores the wisdom and practices of competent CPE supervisors to determine what they are doing right and to develop a theory of CPE supervisory education based on her findings. The author used grounded theory methodology (based on studying experience, what Anton Boisen referred to as the living human document. This theory was developed by Anselm Strauss and Barney Glaser [1967]) to interview 11 CPE supervisors to identify the themes that may emerge. The data for this qualitative study were gathered primarily by interview, each interview lasting about 75-100 minutes. Data were analyzed/coded by a multidisciplinary coding team. Four primary dimensions emerged, including: selecting supervisory education students (SES), helping SES develop supervisory practices, guiding SES toward integration, and blessing SES to develop independently. Supervisory wisdom was the core dimension that weaves all the others together. Continuing education and professional development were seen as significant aspects of the supervisors’ standards of practice that enhance their ministry. The author concludes that the theory of reciprocal wisdom – the wisdom of the CPE process, reflects the best of CPE practices. This work, although lengthy, is a must-read for serious supervisory education students and CPE supervisors. The extensive bibliography offers a wealth of resources for further reading. A shorter, more organized version of this work was also published in the Journal of Pastoral Care and Counseling, Vol. 63, No. 3. 4 (2009).

George Fitchett. “Making our Case(s).” Journal of Health Care Chaplaincy 17, Nos. 1-2 (2011): 3-18. (43 references)
Link: www.tandfonline.com/toc/whcc20/17/1-2

In this insightful article, George Fitchett makes the case that healthcare chaplaincy and professional chaplains must remain engaged with research and the production of excellent body of evidence-based qualitative research work, such as case studies. Fitchett acknowledges that case studies, informed by daily chaplain interventions, play a significant role in “training new chaplains and in continuing education for experienced chaplains, not to mention educating health care colleagues and the public about the work of health care chaplains.” This work is an important introduction to qualitative research; it simplifies this process for professional chaplains and also outlines the steps to get case studies published. It is significant to note that the guidelines presented in this work have been adopted and implemented by the editorial board of the Journal of Health Care Chaplaincy as a standard for future case studies in chaplaincy research and practice (see the editorial from the Journal of Health Care Chaplaincy in the link above.) This call for research literacy has become necessary as new thinking on the delivery of healthcare is currently under way in the United States and worldwide. An excerpt of this article was published in the September/October 2010 issue of Vision.

Kevin J. Flannelly, Katherine R. B. Jankowski & George F. Handzo. "Testing the Efficacy of Chaplaincy Care." Journal of Health Care Chaplaincy 17, Nos. 3-4 (2011): 100-125. (131 references)
Link: www.tandfonline.com/doi/abs/10.1080/08854726.2011.616166

This article, funded by a grant from the John Templeton Foundation, gives a detailed review of clinical practice of chaplains as contained in published studies conducted in the United States. It takes a balanced look at the literature on the efficacy of “chaplain interventions,” “patient satisfaction with chaplaincy services,” and “clinical practices of chaplains with patients and family members.” The authors identify three important factors that are likely to shape the future of chaplaincy services based on emerging trends. These include: a) growth in the demand for palliative care services; b) significant rise in the number of individuals who do not fit into any current religious classifications; c) the convergence of electronic documentation, pastoral interventions and spiritual outcomes. To best position chaplaincy to meet these changing demands, the authors recommend that “chaplains generate research-based definitions of spirituality, spiritual care, and chaplaincy practice; and that more research be conducted to describe the unique contributions of chaplains to spiritual care, identify best chaplaincy practices to optimize patient and family health outcomes, and test the efficacy of chaplaincy care.” The extensive bibliography also offers opportunities for further reading on this subject. Also on this subject see, K. Galek, K. J. Flannelly, K. R. Jankowski, & George F. Handzo. “A Methodological Analysis of Chaplaincy Research: 2000-2009.” Journal of Health Care Chaplaincy 17, Nos. 3-4 (2011): 126-145. (64 references) Link: www.tandfonline.com/doi/abs/10.1080/08854726.2011.616167

Shane Sinclair. “Impact of Death and Dying on the Personal Lives of Palliative and Hospice Care Professionals.” Canadian Medical Association Journal 183, No. 2 (2011): 180-187. (35 references)
Link: www.cmaj.ca/content/183/2/180.full

Burnout and Secondary Traumatic Stress (STS) pose significant challenges for chaplains. This study by Shane Sinclair focuses on an important aspect of ministry for chaplains and healthcare professionals who encounter the death of their patients. The author was specific in focusing his ethnographic research on the impact of death and dying on palliative and hospice care professionals, which he identified as a limitation to the scope of the work. The study surveyed 11 specific themes that were organized into three categories of past, present, and future. Early life experience of death was discovered to play a significant role in the career path of participants in the study. “Participants reported that their work provided a unique opportunity for them to discover meaning in life through the lessons of their patients, and an opportunity to incorporate these teachings in their own lives." The conclusions are somewhat tentative. The study comes at the issue from the vantage point of a privileged observer. The study finds that the challenges of end-of-life care pale in comparison to the benefits of gleaning valuable wisdom from the dying experiences of others. “They had the opportunity to incorporate these truths into their everyday lives, integrating end-of-life wisdom from the vantage of foresight, in contrast to the perspective of dying patients looking back on their lives.” While this study sheds some light on this issue, it fails to raise important questions of self-care and disenfranchised grief known to affect healthcare chaplains and other healthcare professionals. The next article discusses some of these issues in detail. This article, nonetheless, makes for interesting reading on the subject.

Tyler Lee Kruger. "Keys to Resilient Practice in Contemporary Chaplaincy." Lancaster Theological Seminary, 2010: 83 pages. (39 references)
Link: gradworks.umi.com/3416822.pdf

This work by Tyler Kruger offers fresh perspectives on how professional chaplains could remain resilient in the face of overwhelming emotional work demand and provides some helpful suggestions on dealing with burnout and grief as they arise in ministry. Kruger’s study was done as part of his graduate work, where his focus was to learn about resilience and “its key characteristics that enable chaplains to remain healthy, emotionally, spiritually and physically.” Tyler also looked at the main theologies of resilience and what constituted enemies of reliance – what chaplains should watch for in ministry. This study was framed to explore three primary concerns: “1) to learn what stressors reduce the chaplain’s ability to live abundantly? Are there environmental risks or other possible ‘enemies’ of resilience? 2) To find ways of incorporating self-care practices into the daily life of chaplains by identifying habits that prevent them from experiencing physical, emotional and spiritual depletion. 3) To discover ways for restoring chaplains to a place of wholeness, when physical, emotional and spiritual emptiness has occurred.” This study led Tyler to offer three important conclusions that should not be ignored by professional chaplains: “1) Take the Life Stress Test and Quality of Work Satisfaction annually as part of one’s yearly review and evaluation. 2) Develop a simple self-care plan “Living with Resilience Action Plan,” termed L-Wrap, that will assist chaplains in the intentional development of resilience practices/thriving strategies that nurture the body, mind and spirit. 3) Develop and implement group rituals around grief and celebration – and incorporate these into the daily life of the department.” This is a recommended reading for chaplains, students and chaplain educators.

Otto C. Scharmer. “The Blind Spot of Institutional Leadership: How To Create Deep Innovation Through Moving from Egosystem to Ecosystem Awareness.” Paper prepared for: World Economic Forum, Annual Meeting of the New Champions, Tianjin, People's Republic of China, September 2010. (2 references)
Link: www.ottoscharmer.com/docs/articles/2010_DeepInnovation_Tianjin.pdf

Otto Scharmer is a significant voice on the subject of individual, groups, organizational/organizational and systems leadership. This paper, presented at an international conference, is built on years of research in contemporary leadership and thought. Scharmer identifies the “blind spot” present in our current “institutional design and intellectual frames about leadership.” The inherent blind spot, Scharmer believes, lies in the fact that current leaders are seldom aware of the “source level… the inner place or the state of awareness from which leaders and social system operate.” An example of this would be the interior work demanded in Clinical Pastoral Education (CPE) training and the relational qualities of “Leadership from behind that demands deep listening and authentic care” (see Margaret B. Clark, Vision, March/April, 2010.) Scharmer argues that success of any particular leadership model must depend on the degree of awareness of this “source dimension.” This concept was introduced in his “Theory-U” process (Scharmer, 2007), and was deepened in “U.School” (Scharmer, Cunningham, and Kaufer, 2011). As one moves through the “U” process, one learns to connect to one’s inner self through “presencing” (presence+sensing) or the source dimension. Scharmer advocates a radical departure from the existing fragmented framework of leadership training.

He proposed a paradigm shift in our thinking and training of future leaders, which includes: “(1) Close all business schools, schools of public policy, and departments of urban studies – and reopen them in the form of tri-sector leadership schools that bring together students and mid-career executives from all three sectors (business, government, civil society), that teach them in the language and the logic of all three sectors.… Such new leadership schools would equip students with an effective set of listening, management, and reflection tools that help them to be effective social entrepreneurs and change agents in the societal renewal processes. (2) Bring together key younger leaders across institutions in specific and deeply broken ecosystems and give them the process, methods, and tools that help them to see, sense, reinvent, and reshape their system.”

This proposed collaborative model has significant implications for CPE training, healthcare chaplaincy and healthcare administration and management. The references cited in this work are not exhaustive, yet the ideas posed here are innovative and touch on important themes in the training of a professional chaplain. I believe CPE training already gives chaplain leaders a significant edge in this area. As the author concludes, “The transformational leadership must involve all key stakeholders in a journey of profound innovation and renewal.”

Austine Duru, staff chaplain at Franciscan St. Margaret Health in Dyer IN, is a member of the NACC’s Editorial Advisory Panel.

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Involved in research on a topic related to chaplaincy? Looking for a venue to publish? Vision would be interested in learning about your research effort. Contact Austine Duru at gusduru@yahoo.com or Laurie Hansen Cardona at Lcardona@nacc.org.