By Marilyn Williams
Although the Certification Standards and CPE programs address diversity and cultural competency, few research studies or academic articles by chaplains address the delivery of spiritual care to diverse populations. An early exception is a February 2004 article that introduced and demonstrated a five-step process of competency assessment in two clinical cases by Robert G. Anderson, a chaplain with New York Presbyterian Hospital. This article was also included in a book, Ministry in the Spiritual and Cultural Diversity of Health Care, edited by Anderson and Mary A. Fukuyama.
However, many articles on this topic in the nursing, medical, and public health literature could be useful to the healthcare chaplain. One frequently cited source is Dr. Josepha Campinha-Bacote’s Cultural Competence in the Delivery of Healthcare Services Model first described in a January 31, 2003, article in The Online Journal of Issues in Nursing. This model identifies five constructs of cultural competence: cultural awareness (a self-reflection of one’s own biases), cultural knowledge (of other cultures), cultural skill (or assessment regarding the patient’s culture), cultural encounters (personal experiences with patients of different backgrounds), and cultural desire (the process of wanting to be culturally competent). In addition, Campinha-Bacote emphasizes that cultural competence is a process whereby the provider should continually strive to effectively work within the cultural context of each client.
While Campinha-Bacote’s model deals with the cultural competency of individual clinicians, also during 2003 Betancourt et al. published in Public Health Reports a framework and conceptual model based on a literature search that also addressed organizational and structural barriers to cultural competency. They found strong evidence that there is a need for organizational and structural as well as clinical interventions. Their model may be particularly applicable to mission leaders’ efforts to address diversity and cultural competency throughout their healthcare systems.
One practical checklist for looking at clinical, organizational, and structural issues regarding diversity and cultural competency in healthcare settings is included in a Mather Lifeways Orange Paper by Dawn Lehman, Ph.D; Paula Fenza, MA; and Linda Hollinger-Smith, PhD, RN, FAAN, entitled Diversity & Cultural Competency in Health Care Settings available at www.matherlifeways.com. This paper also included a good literature review.
The journal Theological Education based an entire issue in 2013 on a project funded by the Luce Foundation: “Christian Hospitality and Pastoral Practices in a Multi-faith Society,” which could potentially enhance cultural competency models in healthcare, especially for Catholic and other faith-based systems. The project that started in 2010 brought together faculty members, scholar practitioners representing world faiths, and chaplains from hospitals, correctional facilities, and the U.S. military to explore pastoral practices of preaching, teaching, pastoral care, marrying, burying, and others. The project was structured around the three ecclesial families with the Association of Theological Schools: evangelical Protestant, mainline Protestant, and Roman Catholic/Orthodox. As such the first three essays provide each group’s perspective regarding Christian hospitality and pastoral practices.
Adeney, Bidwell, and Walker suggested in one article that in the coming decade, theological education’s primary task may be cultivating a capacity for dialogical heart based on a relational stance toward the Religious Other of receiving hospitality as much as providing it. The dialogical heart involves a capacity to recognize the Imago Dei among believers of other faiths, a trust that God is the agent of conversion and therefore proselytization becomes an unnecessary practice (p.41). In addition, Amos Yong claims that “it is the very nature of the triune God to be a guest in the presence of Others” in suggesting that theological education should require visiting those in other faiths in their sacred space (p.79). Perhaps the quality and experience of healthcare for all cultures and religions would be enhanced if healthcare professionals saw themselves as giving and receiving hospitality. Indeed, the term hospital derives from the root word for hospitality.
A 2016 article that would interest especially chaplains in palliative or hospice care is from a 2015 Spirituality in Healthcare “Sowing the Seeds” conference by Hamilton Inbadas at the University of Glasgow, published in Religions (7(5), 53. Inbadas asserts that most studies regarding spirituality and end-of-life care often represent an individualistic understanding of spirituality. He cites a number of references noting that understandings of and attitudes to death are deeply rooted in cultural, historical and contextual factors. He concludes that “further research is needed to understand how spirituality is shaped by history and culture and maintained through traditions in particular contexts.” Also, this research can inform effective spiritual care at the end of life. Another study related to culture and end-of-life care is one studying the impact of physicians’ religion and ethnicity on ethical decisions. (Journal Medical Ethics. 2010; 36 (11):677-82)
In another very interesting recent study regarding culture and healthcare, Lucchetti et al. studied physicians’ perspectives on the influence of spirituality and religion on health from three different cultures: Brazil, India, and Indonesia. (International Journal of Behavioral Medicine, February 2016, 23:1, pp 63-70) This was a cross-sectional, cross-cultural, multi-center study from 2010 to 2012 of 611 physicians. Lucchetti concluded that ethnicity and culture have an important influence on how spirituality is addressed in medical practice and that these cultural differences must be considered in developing curricula for physicians on how to address spirituality in clinical practice.
Marilyn Williams, BCC, is director of spiritual care at St. Mary’s Health Care System in Athens, GA.
