By Dan Waters
The family meeting was taking place in a private consultation room just outside the ICU, and the attending physician and I were co-facilitating. The patient was not responsive. Several family members had come to grips with the situation and were prepared to allow nature to take its course with no further interventions. The attending physician clarified the clinical information, and all clinicians were on the same page.
However, one grandson who had been estranged from the patient was extremely vocal about not giving up. As the chaplain, I was able to create a space where the grandson could talk about his guilt and sadness and begin to process emotions. The family offered the young man words of support. The process took longer than one family meeting, but within 24 hours, interventions were stopped, and the patient was moved to the palliative care room and eventually to a local hospice.
This kind of group facilitation is becoming more important in a chaplain’s duties, and the revised competencies reflect that. PPS 9 reads, “Facilitate group processes, such as family meetings, post-trauma, staff debriefing, and support groups.”
Many readers will remember the standards for certification of past years, which did not specifically talk about group facilitation, although Standard 302.5 discussed an understanding of group dynamics. In 2015, the NACC adopted Standard 304.11: “Facilitate group processes, such as family meetings, post trauma, staff debriefing, and support groups, and provide conflict management as needed.” Competency PPS 9 is focused and has been added by our cognate partners. Group work has been a part of CPE programs in the past, but the need for clinical application is growing.
An important starting point is to clearly identify the purpose of the group. This may seem obvious, but a clear understanding of purpose can help the chaplain identify resources, reflect upon chaplaincy skills needed, and assess the dynamics present.
A spirituality group, for instance, may begin with a focus on forgiveness, and resources may include relevant scripture, an object lesson, or a story that will resonate with the participants. Once, when I mentioned the word “spirituality” to the group I facilitated in the dual diagnosis unit, one patient, Don, abruptly stood up and left, saying, “This is NOT what I want to do today!” I had just started again when Don, just as abruptly, came back into the room. Through the course of a story and discussion around healing light from the places where one is most broken, Don began to relax and tell his story: It was the anniversary of his dad’s death seven years earlier. Each of the previous years, Don had spent the day drunk and ended up incarcerated. But by the end of the session, Don proclaimed, “This is NOT what I expected, and this is the best I’ve felt in a LONG time!” I had to admit that this was not what I expected either!
A trauma debriefing in the emergency department might focus on the emotions of a difficult case and include members of a multidisciplinary team that provided care. Recently, I was called on to facilitate a voluntary debriefing session in our community hospital’s Level 3 Emergency Department, which had experienced five pediatric deaths or near-deaths due to abuse in less than a month. Many of the same staff members had provided care in these cases and were overwhelmed with moral distress. The session took place in the ED break room, so that employees would not be far in case they were needed, but the door was closed to provide some privacy and to shut out some of the usual din. Several disciplines were present, and the process began with a recalling of the events. Statements of what each person observed unfolded into statements of the emotions observed and then to reflection on personal emotions; some shared their own spiritual struggles after these events. Each participant voiced healing in the process of deep sharing with colleagues.
In any group setting, a facilitator is challenged to have an awareness of the creative process, cultural differences or traditions, the value of collective wisdom, the need for mutual respect and confidences, and family systems. The facilitator has the task of keeping the group focused on the purpose. A participant in a spirituality group may want to take over with their own personal religious views, or a family member at an ICU meeting may try to focus the discussion on past hurts or a perceived hidden agenda of another family member.
Practical matters in any group may include identifying an appropriate location and setting, respecting time limits, bringing awareness to protocols or HIPPA, or including a co-facilitator.
Setting an agenda will flow from the purpose of the group. A family meeting may start with identification of the patient’s wishes, and resources may include advance directives and doctors, nurses, and other clinicians, as in the opening example. Debriefing of a trauma may begin with a recounting of facts as they are known, allowing space for clinical information but then challenging participants to move into observed emotions and then deeper into personal emotions or spirit.
The facilitator ends the group when appropriate. The end may be set by respecting an agreed-upon time limit, an awareness of the discussion repeating itself beyond need for clarification, an agreement on a plan of care, or a realization that the group has addressed the intended purpose as completely as possible.
Matthew 18:20 says, “For where two or three are gathered together in my name, there am I in the midst of them.” The spirit may take on a skin color different from ours, follow a process that we did not imagine, or bring forth an unanticipated wisdom, but we are challenged to be open to the spirit in each group.
Deacon Dan Waters, BCC, is the Spiritual Care Coordinator and a staff chaplain at Mercy Health St. Charles Hospital in the Toledo, Ohio, area.
