By Austine Duru
Professional chaplaincy is currently experiencing unprecedented transformation, largely driven by the emerging trends associated with rapid changes in healthcare delivery. On the other hand, a renewed interest in the methods of scientific research as a possible tool for understanding and speaking about what chaplains do is also adding to the pressure for chaplains to rethink current chaplaincy practices and protocols.
As chaplains become integral members of the interdisciplinary care team, we must acquire rudimentary knowledge of the language of scientific inquiry as it relates to meaningful interventions in the care of patients. At the 2015 national conference, some workshops addressed research and research literacy. Here are reports on two, for the benefit of our readers who were not able to participate.
A Dummies’ Guide to Reading a Research Article: Reading a Research Article Can Be Fun
Deacon Roger Vandervest and Sr. Pat Murphy (both from Rush University Teaching Hospital, Chicago) sought to give participants a fundamental tool for reading and understanding research materials relevant to the work of chaplains. The duo believe that the real barrier is the limited exposure of chaplains to the complex rules, symbols and specialized terminologies that make research articles seem boring to many. This was confirmed by some of the participants. By the end of this 75-minute workshop, participants learned how to identify the main components of a research article; how to identify the strengths and weaknesses of a research article; and how to critically integrate research findings into chaplaincy practice.
According to the presenters, research justifies what chaplains do, and research can help chaplains become better at what they do. They gave what they described as the GPS of every research article: introduction, methods, results, and discussion. The introduction sets the stage by providing the aims or hypothesis of the research work. The methods tell readers how they set about collecting and analyzing the information. Results tell readers whether the hypothesis or aims are true or not. Finally the discussion explores ways to apply these findings or the implication the research may have for future practice. The presenters illustrate these points with an article by Kate M. Piderman and colleagues, “Predicting Patients’ Expectations of Hospital Chaplains.” Overall, this workshop was helpful for chaplains who wish to read research articles, reflect on the article and draw meaningful information for clinical practice.
Responding to Moral Distress: Applying Research to Our Ministry of Staff.
Marilyn Williams presented a workshop on how research can inform chaplains’ response to moral distress present in staff members.
Williams outlined several precipitating events at the institutional level that exposed staff to moral distress, including reduction in staff, elimination of weekend option for nursing staff, and low staff morale. While this is not exhaustive, it sheds some light on the highly charged environment in which most of the clinical staff operates and indicates that pastoral care leaders must be attentive to these signs of moral distress and staff burnout. Three questions helped Williams focus on the problem: What is moral distress and its characteristics or symptoms? What is the impact of moral distress? What are its causes and how can one prevent or ameliorate it? To answer these questions, Williams turned to existing research literature.
According to Williams, moral distress was first defined in 1984 by Andrew Jameton as the consequence of institutional constraints placed on nurses that prevent them from taking ethically correct actions in the discharge of their duties.
Subsequent work has expanded on the notion of constraints and psychological distress resulting from actions that are against personal ideals and values. Other remarkable work on this subject includes Kelly (1998), McCarthy and Deady (2008), Schluter et al. (2008), Epstein and Hamric (2009), and Corley et al. (1995).
Williams shared a key investigation led by Corley et al. in 1995 in the American Journal of Critical Care which studied 111 members of the Association of Critical Care Nurses. “Three factors most associated with moral distress were aggressive care (unnecessary tests and treatments) at the EOL, lack of honesty with patients/families, and inadequate/incompetent treatment by physicians. Nurses in private hospitals indicated a higher degree of moral distress as well as those not practicing in ICUs. 12% indicated they had left a position due to moral distress.” This study paved the way for further research and the development of the moral distress scale published in 2001 by Corley and her co-investigators.
Williams outlined several relevant researches on moral distress both in the USA and Europe. She highlights one significant article from the perspective of a chaplain, by Michael Guthrie, at the Presbyterian St. Luke’s Medical Center Rocky Mountain Hospital for Children, Denver: “A Healthcare Chaplain’s Pastoral Response to Moral Distress,” Journal of Health Care Chaplaincy, 20:3-15, 2014. Williams concludes her presentation by raising significant questions that might trigger ongoing conversation on the challenges of moral distress among clinical staff and ways chaplains and pastoral care leaders might respond.
Both presentations make the case that research literacy and literature have proven to be valuable tools that can help professional chaplains in their ministry.
Austine Duru, BCC, is director of mission and pastoral care at St. Elizabeth Regional Medical Center & Nebraska Heart Hospital in Lincoln, NE.