Over the last ten years, ‘health care’ chaplaincy within both public and private facilities has become an important field of research.
Indeed, given the post-modern focus upon health and well being, and the emphasis upon medical casemix funding and economic rationalism, the specialist ministry of ‘health care chaplaincy’ has commenced to move to the forefront of chaplaincy research in the United States, Britain, New Zealand and Australia. Through the use of empirical research, quantitative and qualitative, health care chaplaincy has started to seek to improve the quality measures of its pastoral care services so as to demonstrate its efficiency and effectiveness amidst competing professionalism and funding.
Religion, Health and Role of Chaplains
It should be noted at the outset, that while some literature from overseas (Hartung, 1971; Jost & Haase, 1989; Barrows, 1993) and in Australia (Carey, Aroni, Edwards, 1997) has raised criticisms about the services of hospital chaplains, most research has indicated that patients and their families seem very favourable towards the involvement of chaplains (Milne, 1988) and that, for some clinical staff, ‘…the role of the chaplain seems predominantly to be very much accepted and professionally appreciated’ (Carey, 1991; Carey, 1995; Ireland, Carey, et al, 1999).
Recent literature (Carey, 1998), based upon the ‘sacralization of identity’ theory of Emeritus Professor Hans Mol (1976), has suggested that chaplains can be valued within the health care environment because they are considered important in helping patients, who may be in crisis, to use various religious and non-religious ‘mechanisms’, that can assist people to gain a new sense of identity and meaning. This can consequently help to promote positive psycho-social and behavioural outcomes which may ‘…enhance a patient’s own well being and thus (also) assist clinical staff in their work’ (Carey, 1998).
Over 300 clinical staff from the Royal Children’s Hospital (RCH) in Melbourne, including doctors, nurses and allied health professionals, who were involved in the Australian Chaplaincy Utility Research (‘AUS.CUR’: 1992 – 1994), identified several reasons why they valued having resident chaplains. These reasons included that chaplaincy provides assistance with:
(a) teamwork, for example in helping to improve staff time management;
(b) religious and psycho-social support to patients and staff through support in religious faith and connection with church communities;
(c) specialist support to families and staff, particularly at times of death and grieving, and
(d) also providing input in terms of (i) ethical decision making, (ii) being a community link, (iii) providing a non-diagnostic communication role within the hospital and (iv) alleviating emotional discomfort for staff and patients within a complex and sometimes frightening institution (Carey, Aroni, Edwards, 1997).
Further a comprehensive review of all available scientific and clinical pastoral research literature concerning the inter-relationships between religiosity and health indicated that religious factors may benefit the health of patients and assist staff in four main psycho-social ways:
(i) by promoting healthy behaviour; (ii) providing social contact; (iii) encouraging coherent thinking and
(iv) encouraging positive theological understandings (Carey, 1993). This review suggested that:
‘…while the links between religion and health are still tenuous, the links are nevertheless substantial enough to warrant further investigation and significant enough for health care practitioners to encourage a holistic practice that includes the spiritual / religious dimensions of a patient’s / client’s healing needs’ (Carey, 1993).
Chaplaincy Research in the US and UK
Within the United States, one of the earliest and largest single case studies on hospital chaplaincy that gained limited but international attention was titled, ‘Hospital Chaplains: Who needs them?’ based upon the results of the ‘Pastoral Care’ survey (Carey, 1972). This research involved over 200 clinical staff (nurses and doctors) plus patients. The answer to the research title was that both patients and staff valued all the various roles of chaplains as needed within the hospital (ie, sacramental, prayer, teamworker, educator, counsellor, thanotonic and witness role) but the majority particularly favoured the thanotonic role in which the chaplain ministered to the dying. From the 1970’s to the present day, the growth of the ‘Clinical Pastoral Education’ movement within the United States and internationally (including in Australia and New Zealand) has concurrently led to the substantial professionalism of ‘clinical pastoral care’ and a greater utility of health care chaplaincy roles – a development which is still on going today.
Over the last decade the New York based ‘Journal of Health Care Chaplaincy’ (JHCC, Haworth Press) has been the first journal to specifically necessitate the ‘need and appropriateness of measurement and research in chaplaincy’ (McSherry, 1987). VandeCreek’s ‘Health Care Chaplaincy Organization’ has taken this empirical thrust seriously becoming engaged in quantitative and qualitative research much of it being published in the JHCC with an initial focus upon a ‘patient satisfaction instrument’ (VandeCreek, 1997) to more recently upon the national effects of Chaplaincy ‘downsizing’ across the United States (VandeCreek, 1999).
Within Great Britain, while substantial informative material in regard to health care chaplaincy and pastoral care has been published within journals such as the Cambridge based ‘Journal of Health Care Chaplaincy’, (eg., Law, 1998), very little empirical research has been published assessing the actual role of health care chaplains within the UK. However the National Health Service has recently appointed its first post doctoral research fellow with the specific mandate of researching the role of hospital chaplains within public hospitals. This research will more than likely conclude in 2001.
Australia and New Zealand
Within Australia and New Zealand some small case studies have been conducted on the role and work of hospital chaplains. Some basic descriptive research exploring the ‘sources of satisfaction and stress’ among New Zealand (NZ) Hospital chaplains noted that the main source of stress for chaplains was that of ‘carrying a heavy load of too many patients’ (Tisch, 1997). Other research has explored the involvement of NZ chaplaincy personnel in helping patients, families and staff to make bioethical decisions (Carey, Aroni, Gronlund, 1998). This research is still on going. Thus far however there has been no empirical research published in NZ to cross evaluate and assess chaplaincy roles with the type of institution or type of pastoral care to particular patients (eg, aged care patients). The NZ ‘Inter-Church Council on Hospital Chaplaincy’ is currently exploring the possibility of conducting empirical research among its contracted chaplaincy personnel.
The ‘AUS.CUR’ research conducted at the RCH Melbourne (mentioned earlier) explored the role of chaplains similar to that of US ‘Pastoral Care Survey’ (Carey, 1972). The ‘AUS.CUR’ research however included not only nurses and doctors but all allied health professionals totalling some 390 respondents (Carey, Aroni, Edwards, 1997). This research found that the majority of clinical staff affirmed all the roles of hospital chaplains as being appropriate within a medical setting but emphasized that there needed to be extensions to the chaplains’ role in terms:
(i) increasing their public profile beyond the traditional stereotypes, (ii) to assist staff with more productive teamwork,
(iii) to have a greater input on ethics committees and ethical decision making,
(iv) to be more forthright in personal presentation and
(v) to increase the number of chaplains to patient/staff ratio.
An additional issue arising from data derived from staff indepth interviews, was the need for ‘outpatient chaplaincy’ and home visits by chaplains – thus enabling follow-up pastoral care for recent or early discharged patients. The concept of ‘parish nurses’ and chaplains working together is also currently being explored to consider such a ministry (Van Loon, Carey & Newell, In Press 2000).
Other Australian research has also started to note the important input of chaplains. Preliminary findings from the ‘Liver Transplant And Pastoral Care’ research, conducted within three Australian Hospitals in different states (Queensland, New South Wales and Victoria), suggested that where chaplains are liaising and drawing patients, relatives and staff members together, the patients are more content and are being discharged at a faster rate than otherwise (Elliot & Carey, 1996). This research has not yet been completed. If the findings are fully substantiated the cost saving of having effective chaplaincy and pastoral care services could be very advantageous to all concerned and would clearly help to prove the cost efficiency of hospital chaplaincy (Carey & Newell, 1999).
The Westmead Brain Injury Rehabilitation Unit and Pastoral Care Department pilot research (Ireland, Carey, et al, 1999) which surveyed patients, relatives and visitors over a 12 month period indicated that ‘irrespective of gender, age, category status, or religious belief the majority of respondents believed the chaplaincy services provided were ‘very good’ or ‘good’ (96.3%)’. Also pilot research conducted at the ‘OLOC’ Aged Care Facility in New South Wales, likewise suggests that the majority of patients were very affirming of the provision of pastoral care services (Mulder & Carey, 1999). However, as indicated by such pilot research, there is a long way for health care chaplaincy research to progress in terms of research protocols, method, construction and testing of measurable instruments both descriptive and experimental.
Currently a national research project is being conducted under the auspices of the School of Public Health, La Trobe University, on the involvement of chaplains in bioethical decision making. This descriptive research, involving over 400 chaplains across Australia and New Zealand, will explore issues affecting both acute patients and aged care personnel such as the ‘withdrawal of life support’ (WLS), ‘not for resuscitation’ or ‘do not resuscitate orders’ (NFR / DNR) and ‘euthanasia’. The project is due for completion in 2000 or 2001. Like other chaplaincy research, progress is hampered by a lack of funding.
Future Health Care Chaplaincy Research
It has only been possible in this brief article to present a ‘snapshot’ of health care chaplaincy research known to the author. In general, and in comparison to other areas of research, very little empirical research has been undertaken within Australia upon health care chaplaincy. This is a research area sorely lacking which the government, health care institutions and, in particular, the church need to address.
Rev. Lindsay B. Carey, MAppSc, is the National Research Officer for the Australian Health & Welfare Chaplains Association and Parish Minister of the Yarra Vale Uniting Church Parish, Victoria: Linz.Carey@latrobe.edu.au
References listed at http://vic.uca.org.auHospitalChaplaincyResearch
Barrows, D. (1993) ‘A whole different thing: The Hospital Chaplain – the emergence of the occupation and work of the chaplain’, Unpublished PhD Thesis, University of California.
Carey, L.B., Newell, C. (1999) Economic rationalism and the cost efficiency of hospital chaplaincy in Australia. Journal of Health Care Chaplaincy, Vol. 8. No. 1/2 (In press).
Carey, L.B., Aroni, R.A., Gronlund, M. (1998) ‘Bio-Medical Ethics, clinical decision making and hospital chaplaincy in New Zealand’: A Research Progress Report, Ministry, Society & Theology, (Melbourne), p. 136 – 155.
Carey, L.B. (1998) The sacralization of identity: A cross cultural and inter-religious paradigm for hospital chaplaincy. Journal of Health Care Chaplaincy (Cambridge), February, p. 15 – 24.
Carey, L.B., Aroni, R.A., Edwards, A. (1997) ‘Health Policy and Well Being: Hospital Chaplaincy’, In: Gardner, H. [ed] Health Policy in Australia, Oxford University Press, Melbourne, p. 190 – 210.
Carey, L.B. (1995) The role of hospital Chaplains: A research overview, Ministry, Society & Theology, (Melbourne), November, 9, 2, p. 41 – 53.
Carey, L.B. (1993) ‘Religiosity and health: A review and synthesis’. New Doctor, (Sydney) Summer.
Carey, L.B. (1991) ‘Clergy under the knife: A review of literature on hospital chaplains. Ministry: Journal of Continuing Education, (Sydney), Summer, p. 7-9.
Carey, R. (1972) Hospital Chaplains: Who needs them ? St. Louis, Missouri, The Catholic Hospital Association.
Elliot, H., Carey, L.B. (1996) The hospital chaplain’s role in an organ transplant unit. Ministry, Society and Theology (Melbourne) Vol. 1 No. 1, p. 66 – 77.
Hartung, B.M. (1971) ‘Requests of hospitalised patients for a religious ministry’, Unpublished PhD Thesis, Northwestern University, Illinios.
Ireland, B., Carey, L.B., Baguley, I., Maurizi, R., Crooks, J., Gronlund, M. (1999) The Westmead Hospital Brain Injury Rehabilitation Unit & Pastoral Care Department pilot research project: A joint research endeavour. Ministry, Society & Theology, Vol. 13, No. 1, p. 46 – 61.
Jost, K., Haase, J. (1989) ‘At time of death: Help for the Child’s parents’. Children’s Health Care, 18, 3, p. 146 – 182.
Knight, B. (1999) Assuring professional pastoral care for every nursing home resident. Journal of Health Care Chaplaincy, Vol. 8, No. 1/2, pp. 89 – 108.
Law, M. (1998) The right to die: Euthanasia, Journal of Health Care Chaplaincy, (Cambridge) June 1998.
McSherry, E. (1987) The need and appropriateness of measurement and research in chaplaincy. Journal of Health Care Chaplaincy, Vol. 1 No. 1, pp. 3 – 42).
Milne, J. (1988) ‘Patients and their families reflect on pastoral care in their cancer experience – report of a survey. Cancer Forum, 12, 3, p.115 – 123.
Mol, H. (1976) Identity and the sacred: A sketch for a new social scientific theory of religion. Oxford: Blackwell.
Mulder, C., Carey, L.B. (1999) Our Lady of Consolation Aged Care Services – Results and Critique of a pilot pastoral care residents’ survey. Ministry, Society & Theology, Vol. 13, No. 2 (In press).
Newell, C., Carey, L.B. (1998) The euthanasia debate and hospital chaplaincy in Australia, Journal of Health Care Chaplaincy, Cambridge, June 1998, p. 8 – 16.
Tisch, G. (1997) Sources of satisfaction and stress in Inter-Church Council on Hospital Chaplaincy (I.C.H.C.) Chaplains in public hospitals in New Zealand, Unpublished Dip.Ment.Hlth, Research Project Psychology Department, Otago University, New Zealand.
VandeCreek, L. (1997) Ministry of Hospital Chaplains: Patient Satisfaction, Journal of Health Care Chaplaincy, Vol. 6, No. 2, pp. 1 – 59.
VandeCreek, L. (1999) Chaplaincy Downsizing: A National Survey, Journal of Health Care Chaplaincy, Vol. 9, No. 1 (In press).
VanLoon, A., Carey, L.B., Newell, C. (2000) Parish Nursing and Health Care Chaplaincy, Journal of Health Care Chaplaincy, Vol. 10, No.2 (In press).
By Lindsay B. Carey, M.Appsc.