Tuesday, April 28, 2015
My theology of spiritual care is rooted in my understanding of the doctrine of the Holy Spirit. In John 14:16, Jesus states: ‘And I will ask the Father, and he will give you another Counselor to be with you forever …’ (New International Version) The Greek word translated Counselor is παρακλητον “and it literally means God at hand, One by our side, One that we can call upon in every emergency, One that we call upon, or call to us, One ever within call. In this connection the Holy Spirit is represented to us as the present and all sufficient God.” (The Holy Spirit, pg. 78, A.B. Simpson) The Holy Spirit’s work is seen as “practical efficiency and sufficiency for every occasion and emergency that arises.” (Simpson, p. 78) Simpson’s conclusion that the Parakleet involves Himself in the emergencies of life informs my work as a hospice chaplain in that I am a vessel to bring God at hand and that I am called to the side of a patient. The functions of the Holy Spirit as they apply to my work as a chaplain involve comfort, counsel, and companionship. Comfort: As I understand comfort, it is the absence of feeling alone in the battle against life-limiting illness and suggests there is someone alongside the patient and family as they face the illness. It is a privilege when I am that person that comes to the side of the patient and family. I assist the patient and family by providing spiritual care and by providing comforting rituals or finding religious leaders who will do likewise. Locating a Vietnamese Buddhist monk, a Catholic priest, a Hindu religious leader, or a local pastor are actions I take to bring comfort. Providing effective and timely interventions (active listening, prayer, Scripture reading, to name a few) assists the patient and/or family members to find comfort in their crisis. Often, just showing up and “sitting in the dust” with the patient provides comfort. I hasten to say I recognize the danger that “religious language and practices provide [Chaplains] with a readily available means of escaping the demands of serious dialogue, and retreating into the religious authority role.” (Benner, Strategic Pastoral Counseling, p. 38) Instead, I carefully employ interventions in order to provide comfort measures for the patient. Counsel: My understanding of giving counsel is to explore with the patient the four main issues of life: meaning, forgiveness, relatedness, and hope. (The American Book of Dying, 2005) This approach has opened conversations that proved to be healing. . For instance, I served a father who was estranged from his two adult children. We discussed the forgiveness issue on one visit. He was deeply moved that there was estrangement and took responsibility for his part in the problems they shared. When I came back for the next visit I found him at his kitchen table writing letters to his children. He told me that he wanted two things: forgiveness from his children and pictures of his grand-children. He sent the letters later that day. My next contact with him was at the Emergency Room at the local hospital. When I approached his bed, he looked at me and related that he knew he was dying, but it was OK as he received forgiveness and had the pictures of his grandchildren. Companionship: Accepting each patient as they are forms the basis of companionship. My interaction with a follower of Wicca who felt at ease discussing her religious journey with me is an example of the fact that she sensed I did not come into her home in order to convince her that her belief system was wrong. She contrasted my approach with that of the members of her church when she was a youngster. These persons condemned her father because he didn’t attend church and informed her that he went to hell when he died. The spiritual pain and damage of those words led the patient on a spiritual quest to find a religious system that did not teach that doctrine. She ultimately embraced Wicca because she felt safe in its teachings. I am convinced that a Chaplain’s theology will dictate how that Chaplain provides ministry. What is your theology of ministry? Have you written it down? It would be a good exercise.
Hacks… interesting word for 2015. Let me date myself as I inform you or my understanding of that word. When I was a teenager and playing basketball, a player would get ‘hacked’ by a defender when he was shooting the ball. As I grew older, a ‘hack’ was someone who was a novice or outright amateur who thought he knew how to do something (not a term of flattery for sure). And, of course, in our computer age to ‘hack’ means to unlawfully break in to someone’s computer. Now in 2015, a hack is nothing like a foul in basketball, nor something a rank amateur would do, nor is it an illegal attempt to break into a computer, but a ‘hack’ is an ingenious way to do something. With that definition in mind, I want to share with 5 hacks that will propel your chaplaincy to new heights. In fact, every Spiritual Care Manager or Director really hopes you learn these very simple relational hacks. 1. Relate well to your IDT team. When speaking of a joint visit or an event that went particularly well, spread the praise around. Put the spotlight on someone else even though you might have done a great job. Remember, Managers get the word. We get the news of how well something went and we hear about how you relate to your Team. When you put someone else in the spotlight, we hear that. And, it’s always put in these words or at least close to them, “Rich, it was really great when our Chaplain shared with the Team what a great job Nurse Terry did.” It is impressive to leadership when you do that. It doesn’t cost you a thing to do it. 2. Be dependable. When you say you’re going to do something, do it. I am well aware that there are times when a schedule gets blown up and you just can’t. That is the exception. Consistency is the rule. Your Team benefits from your consistency. We hear that, too. Well, actually, what we hear when you’re inconsistent is put in the worst way possible, in disgust. “I just can’t depend on Chaplain. He talks a good game, but hasn’t delivered.” That is not what a Manager wants to hear and will call into question a lot of things (and none of them are good). 3. Focus on outcomes. Isn’t our philosophy of chaplaincy Outcome Oriented Chaplaincy? Nothing will drive a Manager quicker to the brink of apoplexy than to ask a Chaplain how he or she is coming along with that ‘difficult’ patient and be told, “Well, I tried to call, but there was no answer, so I left a message and they haven’t returned my call, yet.” Ok, let’s understand something… it is NOT the patient’s job to call you back. They have no burden of responsibility at this point. Chaplaincy is NOT a reimbursed service. You must find a way to contact that patient. The nurse has found a way. The Social Worker has found a way. And, you? Your attempts do not equate with success. If you can’t contact the patient, then contact the Nurse or Social Worker and make a joint visit. You succeed when you succeed. It’s simple. 4. Make eye contact with the person you are speaking with. Making eye contact is a non-verbal way or saying, “I am interested in what you are saying to me.” It shows maturity. It reveals your heart of compassion. 5. Whatever else you do, smile at your IDT, your patients and family members. You get what you give. If you give a pleasant countenance, you’ll usually get one in return. Even if you don’t, you will make an impact on the person who saw you smile. A smile indicates you are a positive person. People who are at the end-of-life need a smiling face looking at them. That gives them reassurance. Worried people need a smile. Tired people need a smile. Overworked people need a smile. It’s a sad thing to hear that “then Chaplain doesn’t seem very happy. I haven’t seen him smile since he’s been here.” Managers hear about all 5 of the above. Do these simple ‘hacks’ and let me know how your world and your influence on your IDT and your patients and families changes for the better.
Thursday, April 23, 2015
Acceptance and credibility are two aspects of chaplaincy that most Chaplains desire. Our roles are unique as is our calling. These separate us from the rest of the IDT. Having served as a Pastor for 25 years I can attest to the fact that a minister is viewed differently than, say, an engineer or pilot or teacher or any other profession. Yet, we seek acceptance without compromising our belief system. We also desire credibility based upon our professional chaplaincy. We want our observations about patients to have as much credence as any other discipline on the team. With this as a backdrop for today’s discussion, here are 5 ways for the Chaplain to find acceptance and credibility: 1. When you speak use facts, not opinion. When the IDT is meeting and you notice some aspect of the patient discussion is missing or needs clarification, be the one to bring the matter to the group by using fact or clear-cut observation. This action on your part will benefit not only the IDT, but you will be the benefactor of respect. 2. Do not isolate yourself from the IDT. It is an easy thing to do and excuse your isolation based on your ‘busy’-ness. Developing relationships with your IDT is fundamental. You cannot be viewed as being aloof. To not engage with your IDT is disastrous to winning their confidence. Take time to talk with your colleagues and express interest in their lives. 3. When parties are held or breakfasts are planned be one of the first to volunteer your time, your food, or whatever is requested. Your team will take note. Being part of the rest of the IDT will go a long way to your acceptance. 4. There will be those occasions when you will need to do a joint visit with a Team Nurse, Social Worker, Aide, Volunteer Specialist, or Bereavement Counselor. They will be watching you and listening to you to get to know your style of engaging with the patient and/or family. I am assuming you are a highly trained Chaplain who will use this opportunity to model how a professional Chaplain does his/her work with excellence. 5. When there is a tragedy on the IDT, be sure to express compassion to your colleague. On the IDT there will be sad moments when a colleague will lose a loved one to death, or a Team member will go through a divorce, or a son or daughter will end up in some type of trouble. Your presence with a non-judgmental presence and heart of compassion will go a long way to win the friendship and respect of that Team member and the entirety of the Team. Earning acceptance and credibility takes time and cannot be rushed. Don’t try to rush it! Bless you Chaplain Colleagues, yours is a sacred work. Be the person you are to those of your Team.
Wednesday, April 22, 2015
Thank you for reading this blog. I hope these thoughts enlighten your provision of spiritual care to those you are serving. Please contact me with your thoughts and questions. I would be honored to be a part of your spiritual care efforts. firstname.lastname@example.org is my email address.
Tuesday, April 21, 2015
What side of a problem do you usually take? The problem side or the solution side? If you take the problem side, chances are you are a Master of the Obvious. You point out what everyone else knows, there is a problem. If you take the problem side, chances are your personality is more negative than positive. Some folks are born that way, I suppose, but if you’re going to be a difference maker you’re going to have to work on that. If you take the solution side, chances are your focus is on what can be done to change the situation. If you take the solution side, chances are your personality is positive which influences people and circumstances and makes a difference. What does this have to do with chaplaincy? A lot. If you want to have an influence on your IDT, be on the solution side of a problem. Problems arise from time to time. It is easy to join the Fraternity or Sorority of the Negative. Is that really what the IDT needs? When changes are made is being negative what the IDT needs? The fact is your IDT looks to you for leadership. While they may feel and express negativity your lead will help put oil on the troubled waters. Besides the above, isn’t your personal happiness and well-being fostered by a more positive outlook than negative? Our persona and reputation go before us. Bless you, Chaplain Colleagues, yours is a key position that has many facets. May your personality’s facet shine and glimmer like a Tiffany diamond. Maybe the Knot Prayer is for you. It is for me. Dear God, Untie the knots that are in my mind, my heart and my life. Remove the have nots, the can nots, and might nots that find a place in my heart. Release me from the could nots, would nots, and should nots, that obstruct my life. And, most of all, Dear God I ask you to remove from my mind, my heart, and my life, ALL of the "am" nots that I have allowed to hold me back, especially the thought that I am not good enough.
Monday, April 20, 2015
A hospice Chaplain by virtue of the calling is witness to many patient deaths. It is always a tough time for family members. Rarely do I walk away from such a moment untouched. That is why a Chaplain and Bereavement Counselor will pull the IDT members together for a debriefing. We are emotional beings and feel the pain of loss. It’s just the nature of the work. Watching a friend die adds a different dynamic to the pastoral care experience. Many are the reflections that course through the Chaplain’s mind during a visit and afterward. And when death comes, the Chaplain grieves as a friend would grieve. Knowing oneself and one’s reaction to death is part of who we are as Chaplains. Did we go through CPE for nothing? Allowing ourselves to grieve is a key to healthy mourning. No one has ever asked a Chaplain to be a robot with no feelings. It seems to me that from what I am reading about the latest artificial intelligence that robots may actually emote one day. Feeling human pain does not weaken our position as Chaplains. Actually, it strengthens who we are. We do not mourn as those having no hope. We mourn because we will miss our friend and our friend’s great contributions to the community or humanity. Gosh, if you can’t mourn that… So, yes, the Chaplain has permission to grieve the loss of a friend. Please do. You’ll be the better for it. Bless you, Chaplain Colleagues. Yours is a sacred profession. A very challenging sacred profession, indeed.
Thursday, April 9, 2015
Oswald Chambers once stated, “My worth to God in public is what I am in private.” That’s a strong statement that urges us to have a strong and well-centered spiritual life. We cannot do this work of hospice chaplaincy without a deepening spirituality. What are your spiritual development practices? A few years ago I spoke to a denominational leader and one of the questions he asked me (which showed his feelings about chaplains), “Where do you go to church, if you go.” Wow! That was a shocker. I told him where my wife and I went to church and how we were growing and so forth. That satisfied his curiosity, but what a shame that his experience with chaplains led him to believe that most do not worship on a regular basis at a faith community. Frankly, I can’t do without worship, be it corporate worship or private worship. Chaplaincy has the uncanny ability to drain one’s soul. If you don’t get re-filled, you dry up and blow away like dust. A corollary thought has to do with the benefits private and corporate worship have upon our lives. Last time I checked, I wasn’t able to walk on water, which indicates to me that I need God to work in my life and help me deal with the inner me. Francesco Guicciardini dropped a nugget of gold when he reminded us, “To rule self and subdue our passions is the more praiseworthy because so few know how to do it.” If we are to be of use to our patients and their families, we must have our inner man settled. My worth to my colleagues, patients, and their families, let alone my wife, children, and grandchildren is based in large part on my private devotional life. Bless you, Chaplain Colleagues, yours is a sacred work that will have wonderful success as you deepen your soul.
David Benner is one of my favorite authors. His book, Care of Souls: Revisioning Christian Nurture and Counsel, is one of his finest works. I came upon a list of challenges that must be confronted by Christians who seek to care for the souls of others. 1. Guard against the erosion of the personal in soul care. 2. Develop an integrated inner core. 3. Continuously renew [your] own inner psycho-spiritual resources. 4. [Don’t] allow professionalism to dilute a sense of Christian vocation. 5. Rediscover the formative and transforming power of story. 6. Recover the uniquely Christian resources of soul care. 7. Avoid sacrificing being on the altar of doing. Mull those over and see where your thoughts lead you. Bless you, Chaplain Colleagues. Yours is a sacred profession.
Tuesday, April 7, 2015
Did you ever play the kids’ game, Keep Away? You know, the game the bigger kids played and stuck a younger kid in the middle and threw the ball just over the younger kid’s head. It was a game of teasing and power. I never liked being the kid in the middle. Adults play a similar game of keep-away. It’s done with knowledge that should be shared. Someone once said, “Knowledge is power.” Yes, that is true. But, while true, knowledge in the hospice environment must be shared. Unfortunately, my experience has been that there are some on an IDT that play that game. They have a tidbit of knowledge that would benefit another Team member, but they keep it to themselves. Poor self-esteem may be a reality to some on an IDT, but self-esteem is never made better by withholding necessary information. This behavior is called Conversational/Relational Violence. Silence or not sharing information is most violent of conversational acts. Other acts of conversational violence include: • Masking—selectively showing our true opinions with sarcasm, sugarcoating, or couching • Avoiding—staying completely away from sensitive subjects • Withdrawing—pulling out of communication altogether • Controlling—coercing other through how we share our views or drive the conversation itself. Cutting others off, overstating our opinions, speaking in the absolute, forcefully changing the subject, or using directive questions to control the conversation (“Don’t you believe that…? You should…) • Labeling—identifying people or ideas as objects that can be dismissed as a category or general stereotype • Attacking—punishing another person by belittling, name-calling, and threatening. So, these issues are what are behind the adult version of keep-away. Not such a nice game. Chaplains cannot and must never start that game or be a part of the game. Bless you, Chaplain Colleagues, yours is a sacred work with many a twist and turn. Be pure, be honest, be transparent.
Monday, April 6, 2015
One of the most challenging circumstances of hospice chaplaincy is that of parallel processing what is happening in your life with what is happening of what happened in the life of your patient. On several occasions, I have been in patients’ homes who were carrying issues and concerns that reflected my own. This has provided an opportunity for self-reflection that has both benefited my patients and propelled my own inner growth. Perhaps an illustration will enlighten the subject… Background: My father died when I was 10. Back in that day the common grief solution was for the boy to not cry as ‘brave boys don’t cry.’ The other ‘counsel’ was ‘you are now the man of the house.’ Both suggestions or commands (depends on how they are stated) are against human nature. It seemed socially acceptable for adult to cry, but not the male child(ren). It took 20 years before I cried over the loss of my father. My feelings about the ‘counsel’ to not cry and so forth used to cause me anger. Now, I just shake my head at the stupidity of that guidance. Chaplaincy impact: There have been several occasions when a patient would share a life review and share the pain of the loss of a parent when he was at a young age. The patient would share how emotional crippled he felt and how abandoned he felt because he, like me, was told brave boys don’t cry and to be the man of the house. I found it interesting to note that the exact words I was told were the exact words the patient was told. It is at this point that I knew I had choice in my patient relationship. I could have gotten drawn into my patient’s spin on things which would have gotten very messy or I could use my own process to benefit the patient, and my patient's process to propel my own. That's parallel process, and it's a powerful tool that benefits everyone when employed judiciously. It is a teacher, a guide and a mentor. I remember learning this term in a series of Clinical Pastoral Education sessions under the tutelage of Dr. D. James Stapleford, my CPE Supervisor. Jim was a great student and guide into truth about the human condition. His teaching on this subject was not lost on me. I use it today to both benefit my patient’s and to set boundaries so I know when to back off and respect the patient and my own emotions. However, I can say with confidence that in this example my own inner person has healed to the point that I honor the father who I had for 10 brief years rather than grieve his loss. And, I have been able to use my process to effect inner healing in the lives of my patients who struggle at this point. Do some study on parallel processing. It will benefit your chaplaincy and perhaps help you understand why you feel the way you do after visiting with a patient whose life events are similar to yours. Bless you Chaplain Colleagues as the work you do is sacred and we all want to keep our efforts pure in ministry.
Friday, April 3, 2015
Along the journey of hospice chaplaincy a Chaplain discovers nuggets of gold that greatly enhance the pastoral care relationship. I found such nuggets published by the University of California at San Francisco in their article dealing with caring for AIDS patients. You can find it here… http://hivinsite.ucsf.edu/InSite-KB-ref.jsp?page=kb-03-03-05&ref=kb-03-03-05-tb-03&no=3. It is expected of Chaplains to be able to initiate and sustain a conversation. Also, experience indicates that patients desire conversations about other subjects besides religion. A Chaplain must be conversant about sports, world events, local events, taxes, education, child-rearing, family dynamics, and a plethora of other topics. To accomplish this, a Chaplain must be well-read and in tune with his or her world. Generally speaking the following 8 questions are very effective in getting a spiritual care conversation started and moving. Please use these in your next visit and let me know how the conversation turned out. Getting Started "Tell me how things are going for you." "Can you tell me about your understanding of about your illness?" "What is the most difficult part of this illness for you?" "As you think about what lies ahead, what concerns you the most?" "As you look ahead, what do you hope for?" Continuing phrases "Tell me more about that." "Sounds like you're really worried about..." "What do you mean by '__' ('futile,' 'vegetable,' 'hopeless,' 'giving up,' 'everything')?" Bless you Chaplains for yours is a sacred work. May you have wisdom and compassion as you serve the spiritual needs of patients, their families, and your colleagues.
Wednesday, April 1, 2015
It almost sounds silly to even talk about the importance of organizing your work as a Chaplain. But, in this day and time of hyper-vigilance on the part of Palmetto and other accrediting agencies it is an absolute must. First, what tools do you have to help you organize? By now, most all hospices are charting with a computer program. Most programs hospices use have a scheduling piece. Second, how many patients are on your caseload? Third, how many meetings are you required to attend and when are they? Fourth, what is your productivity requirement? Now that you have the basics, you have to put some time into the scheduling piece of your program. 1. Your patients are grouped according to nurses. Each nurse has 15-20 patients on average, so let’s begin at this point. The nurse’s patients on home teams are usually grouped together geographically. This suggests that if you are going to be efficient with your time that you also group your visits geographically. Contact your patients in that geographic area with visits for Monday. Place the name of the patients and the time agreed upon in your scheduling program. Do the same for each nurse on your team. And, keep in mind, the industry standard is for a Chaplain to make on average 4 visits per day. 2. If you are a facilities team Chaplain, then you want to visit patients according to the facilities on your caseload. My experience taught me that when I had 8 patients in a facility that I would drive to the facility, park my car, and spend the day visiting and charting. I would group the facilities with fewer patients geographically and make visits and chart. The benefit of facilities is that you can find a place to do charting. Finish your work by 4:30 and go home. 3. By now, you have thought, “Ok, my world is not as perfect as yours! This is not working for me.” Gotcha! I understand for sure. You will have the occasional emergency that will ruin the best of plans. You take care of the emergency and do one of two things: go back to your home patient plan or visit some of your facility patients and then re-work your plan. Please don’t throw out the baby with the bathwater. Your scheduling program allows you to change who you visit and when. It’s not a set-in-stone thing. Flexibility is a required virtue for hospice Chaplains! Working and re-working your visitation schedule is normal. The most helpful process I followed was to lay out a 2-week plan, and then begin to work it. I knew who needed visits and when to stay in compliance and prioritized accordingly. If, when I called to set an appointment with a patient whose compliance visit was close and they couldn’t see me before that date, I charted that and set an appointment for when they could see me. Diligence, initiative, and determination form a good acrostic: DID. My grandson is learning to talk and when he does something he considers difficult, he yells, “I DID it!” And, you will do likewise when at the end of the month all your patients are in compliance. YOU did it, too! Bless you Chaplain Colleagues. Your work is difficult not only in providing the face to face spiritual care, but organizing your work to meet compliance requirements.