Lecture # 006:
Defining Chaplaincy

Once during the week, the students have what is called a "verbatum". During this time, each student has a prepared, written interaction he/she had with a patient during the week. This includes a written dialogue of the conversation, the subjective and objective reactions of the pastor and the subjective and objective needs of the patient. At the end of the dialogue, the pastor writes what he/she learned from the interaction with the patient.

The whole class then participates in a discussion of the verbatum. They may give insights from their own experience or alternative opinions about what happened during the interaction with the patient. This is not a time for criticism, but for teaching one another. This is called the adult education model, that is, students learn from one another information they can use to make their practice better.

The chaplains write in the patients' medical record so that there is a record of spiritual problems and their resolution. This is most often done when there is a medical crisis.

There are different types of visits made by the hospital chaplain. Often, the chaplain visits the wards just to let the patients know that he is available if they want to talk with him. Other patients want and need spiritual help of scripture reading, prayer, and thinking through their physical situation in relationship to God.

It is necessary that the chaplain, if he counsels a patient, know the diagnosis of the patient. Those illnesses associated with heart conditions, advanced cancer diagnosis, and trauma may require immediate care. Often, if the spiritual care is ongoing, the chaplain must consult with the doctor or nurse in charge to assess the patient's physical progress or deterioration on a visit by visit basis.

Question:
1.1 Does this practice follow your practice?
yes / no.

Question:
1.2. What has been your experience in the hospital with patients: are they open to talking about spiritual things?

"MAKING A SPIRITUAL ASSESSMENT" (Written by Susan J. Richardson in Nursing Spectrum, January 22, 2001)

Spirituality encompasses the whole of a person's being. Although many people do not follow a recognized, organized system of beliefs - an established religion - all humans are spiritual beings and uphold certain individual principles. These principles shape their view of themselves, the world, and God or some other higher power. Spiritual principles provide structure and meaning to daily life. Research also shows that spiritual beliefs and practices can have an impact on health and recovery from medical and psychiatric illness. While the terms spirituality and religion are often used interchangeably their meanings are not synonymous. Patients, whether or not they practice any particular religion, have spiritual needs. Pastors need to be able to assess these needs to give wholistic care.

There is science behind spirituality. During the past 25 years, scientists have renewed interest in spirituality and the mind-body connection. In the 1970s and 1980s, a doctor named Herbert Benson pioneered research in the power and biology of belief and positive effects of the practices of prayer and meditation. In 1988, a physician did a study on the effects of remote intercessory prayer on the outcome of persons with coronary diseases. He found that patients who received daily, intercessory prayer suffered from significantly fewer complications during their hospital stays. This was shown by decreased need for ventilary assistance for breathing and fewer antibiotics and diuretics. As recently as 1999, a team of investigators replicated the study with the same results.

Question:
2. Is there someone in your congregation who regularly prays for the sick?
yes / no.

In 1993, researchers studied the outcomes of 700 cardiac patients in a Veterans Hospital. The study lasted for 30 months. Those who received daily visits from the hospital chaplain left the hospital three days earlier than those who saw the chaplain for only a few minutes once during their hospital stay.

Studies done over longer periods of time show that those older people who attend religious services once a week or more tend to live longer than those who are infrequent attenders of services. In a similar study of cardiac patients, the relationship between religious attendance of services and prayer with high blood pressure showed that blood pressure was lower in those who frequently attended religious services. Those who prayed or meditated on the Bible showed significant decreases in blood pressure.

Several other studies demonstrate that religious beliefs or practices can enhance coping with the stresses associated with illness, particularly in an older population.

What are Spiritual Needs?

(1) They are the need for purpose and meaning.
What makes life worth living? What is sacred? Some patients find meaning in the role they have such as mother, father, or some other professional role. A spiritual crisis may occur when physical illness leaves them unable to work or assume the usual role they had in their family or community.

(2) They are the need for love and belonging.
Illness can have a profound effect on a person's relationship to God, their family and themselves. For example, can your patients accept themselves as worthwhile human beings? Has this view of themselves been altered by their current illness or condition? How do they relate to family and friends and members of their religious community? How are they relating to God? What role do they believe that God plays in illness? Is God disinterested? Does God use illness to test or punish? Can God heal? Does God have power over illness? And is God willing to heal?

Acute illness often brings the need for forgiveness or reconciliation in patients. For some, there is a need to accept their own functional limitations that emerge from illness. (We will talk about functional limitations later) For others, there is a need to reconnect with family members or friends. Others need to forgive God for allowing illness or disability to happen. Patients often comment, "I was a good person. What have I done to deserve this?

Even if a person does not believe in spiritual life, the illness that caused his/her hospitalization may be the beginning of understanding about spiritual life. The chaplain is the non-judgmental person who helps the sick discover deeper dimensions of life.

Profiling the Spiritual Dimension

How do you know what the patient thinks spiritually? Be attentive to the patient's verbal and non-verbal communication. One may comment, "I feel so useless since I have been ill" or "Is God punishing me?" Another may make judgmental statements such as, "I just need more faith to recover" and others will say, "My family would be better off without me."

Some patients will seek out a visit from a pastor or ask if they may participate in religious disciplines that are meaningful to them. Others may ask for religious literature.

Even when a patient does not give you information, many think that the clergy should ask them questions, which help them to think about their spiritual lives. There are questions such as:

1. What bothers you most about being sick?
2. Is God important to you?
3. What helps you the most when you feel afraid or need special help?
4. Is prayer important to you?
5. Has being sick made any difference in your feelings about God?
6. Does religious practice help you cope with illness?

Observing behavior can give you insight into a person's spiritual needs. A patient who is constantly in need of attention may be afraid of being alone or dying alone. A patient who has had all the usual treatments and medicine for pain, but still has pain or worsening pain may be suffering from spiritual distress. Be especially sensitive to those patients who deny feelings of sadness, depression, or anger, yet through non-verbal behavior display these emotions.

How do you know how to help a patient?

In the U.S, we use a simple acronym called SOAPE. By remembering this simple word, you can easily remember how to help a patient.

• S - stands for Subjective, that is, what does the patient say about himself or his thoughts in relation to his spiritual needs?
• O - Objective. This stands for your own observations such as a depressed countenance, lack of personal care about one's self, or anxiety behavior such as disjointed speech and pacing the room.
• A - Assessment. These are the conclusions you make from what the person says and what you see.
• P - Plan. The plan is what you are going to do. Do you need to talk with them about God's love, about punishment in relation to illness, or any number of spiritual problems? Your plan may not reflect problems, but simply visiting the patient to pray with him/her or provide literature and discuss it if time allows.
• E - Evaluation. As you review your notes about this patient and your counseling, did your actions help him or not and if not, why not? What would you do if you had this type of person again?

Question:
3. Briefly describe the meaning of the abbreviation SOAPE.

How do you know if you have helped the patient?

You are able to evaluate your help to the patient by what patients tell you and through your observation. Patients may state that they feel better, they are more at peace, or less anxious than before. Patients may need less medication. Others may cooperate more with therapy plans or other treatments.

There are certain other patients that require more careful assessment. These are:

• Psychiatric patients undergoing mental crisis. Oftentimes, these people need a chaplain as much as those who are physically ill. They need the stability of God and their faith to help them through the difficult situation. We cannot simply dismiss their talk about God. The DIFFERENCE between a person who is undergoing mental stress and trying to rely on faith and the mentally ill person who is truly delusional is that the delusion is often a fixed belief by the mentally ill person that he/she is Christ, or a special messiah, etc. This fixed belief is contrary to what the general population believes about this person. If there is a fixed delusional belief, it is better most often to give supportive care until the person is stable.
  
  
• Those patients who are dying or the parents of a baby who has died. A dying person's last days may be the only time in his life when he/she tries to find meaning out of what has happened in their lives and what will happen to their souls. Questions the chaplain may ask the dying are: Do you believe in God?, How do you picture God?, Do you think God is interested in you?, Do you think God understands the suffering you have had from this illness?, What do you think happens after you die?

Question:
4. What are two categories of patients that require more careful assessment?
(Select the best answer.)
New mothers and stroke patients.
Amputees and food poisoning victims.
Psychiatric patients and patients/family experiencing death.

Dialogue: God's love for Harold.

Harold, 57, is a believer, but has just learned from his doctor that his liver cancer had spread to other vital organs. His case was beyond hope. The chaplain came to visit him in his hospital room after he requested that the nurse call the chaplain.

Harold: It's about time you got here, Chaplain! I asked the nurse to phone you almost an hour ago!

Chaplain: I'm sorry that I couldn't get here any sooner. You seem pretty upset.

Harold: Wouldn't you be upset if you were just told that you are going to die?

Chaplain: I am sure that I would be. What exactly did your doctor tell you?

Harold: Can't you hear? She told me that I am going to die! I'm only 57 years old! She said that my cancer has spread and they can't operate. And she said that I might have only 4-6 months to live. I just don't know what to do. I don't want to die. I'm afraid and I'm angry.

Chaplain: It's natural to be afraid of death. Even Jesus was afraid when He knew He was going to die. But He had to die to forgive our sins. In Baptism, we are joined to His death. And He will be with you at your death, Harold. As for your anger, God understands that too. Jesus called death an enemy, and being angry at an enemy that is threatening us is a normal reaction.

Harold: I didn't know that. I always figured that Christians aren't supposed to be angry or afraid.

Chaplain: Even Christians can become afraid when we contemplate the process of dying and the prospect of leaving the world we know and the people we love. And even Christians become angry when the consequences of our fallen world affect us so that we die. But even in our fear and anger, we can trust that God is with us. By Jesus' death on the cross and His resurrection, we are assured that we also shall live even after our bodies stop working and die.

Harold: So if we believe hard enough, we don't have to be afraid of death because we will go to heaven?

Chaplain: Faith isn't a function of will or effort. It's something in your heart that receives God's promises. The Bible tells us that, "whoever believes in Him will not perish, but will have eternal life." It doesn't say we have to have strong faith in order to be saved. God understands that sometimes our faith is weak as we struggle with suffering and temptation.

Harold: How do I know my faith is strong enough?

Chaplain: I can tell that concerns you greatly. Maybe it would help to focus less on how strong your faith is and more on how strong God's love is for you.

Harold: What do you mean?

Chaplain: God is always faithful to His promises even if our faith wavers. He will continue to love us and keep His promises no matter what.

Harold: No matter what? How about when we are angry with Him?

Chaplain: Like you were when I first came into the room?

Harold: Yes. It is hard for me to go past my anger about all this as well as my anger towards God. Will He still love me and keep His promises even if I am angry with Him?

Chaplain: Yes, He will. God understands that in our weakness we get angry when we are in pain or feel threatened. He won't punish us for our anger. "As a father has compassion on his children, so the Lord had compassion on those who fear Him; for He knows how we are formed, He remembers that we are dust." (Psalm 103:13-14)

Harold: I just don't know how I'm going to deal with this cancer. I know it's going to be really hard. But I guess I'll make it if God is willing to understand all my emotions and help me through death. I suppose I will die from it eventually. But now I see that there is always hope since God keeps His promises.

Chaplain: God promises to stay with you no matter what happens. And no matter how you feel, He will always love you and keep His promises of forgiveness, life, and salvation for you.

Question:
5. My general impression and my comments about this lesson.

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