The 3 Most Important Needs of a Chaplain in Crisis

When a Chaplain needs help… There are times when a Chaplain needs emotional assistance. The reasons vary from their own grief at the loss of a loved one to burnout. It is essential that the Spiritual Care Manager or whatever your title might be is aware of the resources to give the Chaplain the support he or she needs. Here are the three most important needs of a Chaplain who is in crisis: 1. Your undivided attention and support. In the highly complex world of hospice care the manager must express compassion and understanding. Yes, it is a corporate world and not a religious institution we are working with. Patients need to be seen, compliance is always breathing down our backs, and productivity screams for fulfillment. With all of that said, your Chaplain needs your support. If a PRN Chaplain is not available and it appears the Chaplain will be on PTO for a few days, see the patients yourself. It will be a refreshing change of pace. Your Chaplain will never forget your help. 2. Keep it confidential. The only people that need to know that the Chaplain is engaged in EAP (if that is the route the Chaplain has chosen) is the Benefits Specialist and yourself. The outcome of the EAP is none of our business. Protecting the Chaplain’s privacy is. 3. Stay in contact with the Chaplain when he or she returns to work. An email or phone call of support does a world of good. We all remember the adage an ounce of prevention is worth a pound of cure. That is true when it comes to self-care. Chaplains are the worst at following our own advice. Perhaps an in-service like what follows would help: Christy Matta, M.A., writes with clarity about stress reduction and stress management. Her insights on the 5 Signs of Emotional Exhaustion at Work caught my eye. The work of the hospice Chaplain is heavily emotional. A Chaplain that does not practice self-care is a sitting duck for emotional exhaustion. Chaplains MUST engage in self-care or fall prey to a potentially career ending crash. Matta’s article can be found here: http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=48310&cn=117 Her assertions about emotional exhaustion arrest our attention: o Negative Feelings: Frustration and irritation at work are common when you're emotionally exhausted. Your frustration might be focused on parts of the job, coworkers behavior, or job politics and bureaucracy. o Feeling Pressured and Out of Time: When we're emotionally exhausted we don't have the resources to handle the pressures of the job. You might find yourself feeling pressure to succeed, without time to finish your work or do a good job or without time to plan for your day and proactively deal with work demands. o Negative Thoughts: Our thoughts are closely linked to our feelings. When we're feeling bad, we're also often thinking negative thoughts. Thinking "I'm alone," having overly judgmental thoughts towards your co-workers or the organization or thinking harsh thoughts about yourself are all common signs of emotional exhaustion. Thoughts that "I shouldn't have to deal with this" "this is unfair" or "my coworkers/supervisors/management are incompetent" are judgmental thoughts that might be a sign of emotional exhaustion. o Strained Relationships: Feelings of isolation and negative thoughts about coworkers, supervisors and administrators can leave you with strained relationships at work, adding to feeling isolated and unappreciated. o Counterproductive Work Behaviors: When you're emotionally exhausted, you may feel drained or depleted and find that you are more emotional at work. When you're emotionally exhausted, you may lose the ability or desire to resist temptation. As a result, you may end up acting in ways you otherwise wouldn't. Do you find yourself acting in ways that undermine your colleagues or the company for which you work? Examples might include anything from stealing, or fraudulent behavior to purposeful tardiness and avoiding safety measures. Steps to healthy self-care: 1. Recognize you are in the throes of emotional exhaustion. 2. Talk to someone you trust about it. 3. Make any adjustments you can. 4. Take a few days off. 5. Evaluate how you spend your off hours. 6. Do something that gets your mind off of work. 7. Feed your spirit. 8. Talk to someone you trust. (not a repetition, just an emphasis) 9. Get your body moving. 10. Learn to relax. Most Chaplains don’t know how to do this well at all. Blessings, Chaplain friends. My model for ministry is Jesus Christ. He said to his weary disciples in Mark 6:31, “Then, because so many people were coming and going that they did not even have a chance to eat, he said to them, “Come with me by yourselves to a quiet place and get some rest.” When your work is such that you meet yourself coming and going, it is time to rest and to eat. For the glory of God and the inner healing of man …blessings upon you.

Patients’ expectations of Chaplains: What you need to know.

“What do patients expect of Chaplains?” This question was posed to me at a volunteer training event. At first, I thought it was a simple question to answer and because I was the speaker fielding questions, I proposed a few simple answers: kindness, respect, listening skills, no preaching, and expertise in matters religious and spiritual. I felt those were too simple, so I did a little exploration. From the Family Satisfaction Surveys in the Deyta reports, I analyzed the Positive Comments to find out more information. The Negative Comments gave no insight. Keep in mind, the family members received the Family Satisfaction Survey within a month of the death of their loved one. Here is a list of descriptors family caregivers used to describe their experience with hospice. The List—You will notice that I pulled together quite a number of descriptors as they were very similar in meaning. 1. By far, the number of times the following words were used were the most frequent: loving, nurturing, kind, respectful, considerate, warm, understanding, great help, gentle, comforting, sensitive, thoughtful, humane, patient, companionship, soothing, sent by God. Without question these attributes of the hospice team were valued far more than any of our expertise or clinical skill. These people had the expectation that we conveyed to them that were important to us, that they mattered. 2. Coming in second place in numbers of times used were these words: great, marvelous, wonderful, awesome, best, super, terrific, outstanding, incredible, exceptional, excellent. All of us like to hear these words said of us, but think about it...these words are filled with affirmation and energy! We met all of their expectations and in the midst of their grief they were able to find the words to express their positive emotions. 3. A very distant third were words used to describe clinical skills: expertise, professional, knowledgeable, skilled, informative. My sense is that it was assumed that the physicians and nurses, social workers, chaplains, home health aides, volunteer specialists, and bereavement counselors were all well trained and could do their jobs. It wasn’t the skills that mattered most it was how they went about using their skills that did. So, how do these positive words inform your hospice chaplaincy? Will you do something differently than you have been as a result? If so, what? What did you gain from this?

What our patients face …

I read a sign that went something like this: “Remember, dealing with death is an everyday thing for us, but for our patients it is their first time.” Do we know what the patient has been through? What is a ‘day-in-the-life-of’ our patient? What have been this patient’s experiences in the healthcare system? What do we really know about this patient? How do the previous questions inform your chaplaincy? I ask because in too many conversations with chaplains I get a queasy feeling that a one size fits all approach to spiritual is being used. That simply won’t cut if for excellence in spiritual care. Please listen carefully to the results of a compelling study conducted by Julia Overturf Johnson, BSN, MA, Daniel P. Sulmasy, OFM, MD, PhD, and Marie T. Nolan, PhD, RN titled, “Patients’ Experiences of Being a Burden on Family in Terminal Illness”, found in The Journal of Hospice and Palliative Nursing. September 2007; 9(5): 264–269. “An under-recognized aspect of care burden at the end of life is how dying persons experience and manage the fear of being a burden on their families. This burden can have emotional, physical, social, and financial aspects. Patients with terminal illnesses face grief and fear not only for their own future but also for their families’ future. These concerns over how their illness will affect their loved ones may influence how they seek care, what decisions they make about their care, and even how they experience dying. The purpose of this study was to further explore the concept of fear of being a burden on family from the perspective of the person in the terminal stage of illness.” My experiences as a field Chaplain attest to the validity of this finding. I recall a nursing home patient with a short while to live shared with me that she would be glad when her life ended so that she would no longer be a burden to her daughter. We explored those feelings a bit. My sense was her statement was not couched in terms of self-pity or depressed mood, but out of a sense of reality. Her daughter’s life was negatively impacted by her illness and the sooner her life could end the better. She was ready to die she said. In another case, the emotions of a husband erupted when he learned that his wife could no longer care for him at home and the option his wife had was to place him in a facility. His worst fears were realized. He was so great a burden that he was “put away.” How do these two episodes in real life inform a Chaplain’s spiritual caregiving? To the patient? To the caregiver? Herein lies another attribute that sets the hospice chaplaincy apart. The hospice chaplain develops a trusting relationship with the patient and family so these fears can find a place in conversation. And, in finding that place they are not diminished, marginalized, or ignored (perhaps a better word would be ‘missed’) by the attentively listening Chaplain. The Chaplain hears the pain, the wounded-ness, the grief the patient is expressing and applies soothing spiritual counsel to the wound. It takes skilled listening, mature understanding, and wise words to assist these persons through their journey of feeling like a burden.

An Emotionally Intelligent Chaplain

Emotional Intelligence is a newer term that has absolutely grabbed hold of the human resources world and business world. And, it makes sense as EI or EQ whichever you prefer has a good bit to do with how an employee perceives him/herself as well as others. It is built upon the concept of self-awareness. You, as a Chaplain, ought to be very familiar with the concept of self-awareness since having up to 1,200 or 1,600 hours of supervised clinical training through Clinical Pastoral Education. A lot of CPE is based on self-awareness. Self-discipline and discernment are also key elements of EI. A fun EI test to discover your level of emotional intelligence is found at this site: http://www.queendom.com/tests/access_page/index.htm?idRegTest=3037. I completed it and found that while I had a high level of EI, there was much I could do to grow. This ‘test’ would make a good discussion starter in Chaplain meetings. There are three benefits a Chaplain will gain from improving EI: 1. Emotional Intelligence helps us to “read a room”. How many times have you been in a patient’s hospital, facility, or other room with family and friends in it and the dynamics were both subtle and obvious. What were you learning about those persons surrounding the patient? What did you think was happening with the dynamics? Did this information assist you in relating in a more effective manner with the family? The hospice Chaplain must be keen in this skill. 2. Emotional Intelligence helps the Chaplain to be aware of his or her own emotions and not let them ruin a visit. There will be those times when it would be very easy for the Chaplain to get caught up in an emotional situation and lose effectiveness. As I interviewed a candidate for a position, I noticed that in discussing the loss of his father, he broke down and wept. It was clear his mourning was not complete. This really could get in the way of his work with family members who were in the process of losing their father to death. A Chaplain must be aware of his emotions or risk losing his ability to serve. Now, I am not saying that a Chaplain cannot weep with those who weep. I am saying that transference and projection are not acceptable for the Chaplain. 3. Emotional Intelligence helps the Chaplain understand the emotions of the patient and family/caregiver(s). People need to feel understood. People, at times, exhibit strange emotions. People at end-of-life are allowed to exhibit challenging emotions. If the Chaplain cannot understand the patient or the family caregiver, then an opportunity to assist these folks is lost and their inner peace is at risk. The hospice Chaplain has a lot riding on her connection with the patient or family member. When the Chaplain connects and conveys understanding and shows it with appropriate body language, the patient feels able to unburden a potentially deeply burdened soul. As you can tell, we have barely scratched the surface of this topic. I encourage you to do your own study and exploration of this topic. It is broader and deeper than I imagined. And, Chaplain Friend, bless you as you live out your ministry.

Wanted: Hospice Chaplain

Wanted: Hospice Chaplain Recently, we have interviewed for a number of full time Chaplains. This experience reinforces what I am about to write. There are ways that you will get an interview and ways to interview that will at least get you a second look and even make you a finalist and, further, get you hired. 1. When you respond to a posting for a Chaplain position, be sure to complete the application in as detailed a manner as possible. 2. When you send in a resume, the following are absolute MUSTS:  Choose a format. Word for Windows has several.  Be detailed. Dates and where you worked previously are necessary.  Why you left the position is helpful. We understand if you were to say, “It was not a good fit.”  I prefer a list of at least 3 references.  Since this is hospice chaplaincy, a cover letter that explains your calling to chaplaincy, your experience in chaplaincy, the reason you want to work at a hospice, if you are moving from another venue of chaplaincy to hospice tell us why. If you cannot clearly state a sense of calling, that may be a red flag. 3. Should you be selected for a face to face interview, please follow these guidelines:  Have an ‘elevator’ speech detailing who you are. It should take 3 minutes.  Convey an aptitude for hospice chaplaincy and a calling to it.  When answering questions take a moment to reflect on what you are about to say, then say it. The way you respond to a difficult question will give us some insight into how you will respond to a difficult situation in a hospice pastoral care scenario.  Give real life anecdotes to illustrate your points.  Do NOT ever use racial, ethnic, or gender slurs. That will immediately disqualify you even though the interview may proceed.  Smile … appear relaxed. Again, this will let us know how you will respond in a pastoral care scenario. 4. After the interview, send a “Thank you” email. That will let us know that you have manners and are professional in your business dealings. After all, no one owes you an interview. 5. If you are invited for a second interview, we are looking for even more of a professional manner of response. We are looking for further clarity on issues. It could be that there are one or two matters that are unsettled in our minds and we are looking to you for more information. 6. And, finally, throughout the process we are looking for someone polished, gracious, professional, and skillful. And, if you follow the above, you have a great chance of getting a chaplaincy career position. If you have any questions about resume writing, cover letter writing, or guidance in how to interview, please contact me at rbehers@cshospice.org.

Grief

I recently had the pleasure of hearing David Kessler speak on the topic of grief. David Kessler is one of the world’s foremost experts on healing and loss. His experience with thousands of people on the edge of life and death has taught him the secrets to living a happy and fulfilled life. He is the author of five bestselling books, including the newly released You Can Heal Your Heart: Finding Peace After Breakup, Divorce or Death with Louise Hay. He co-authored two bestsellers with the legendary Elisabeth Kübler-Ross: On Grief and Grieving and Life Lessons. Please be sure to visit Grief.com. That site has a great number of resources hospice Chaplains can use. With that said, there are some general guidelines we as hospice Chaplain need to follow and even encourage our IDT members to follow as well. On David’s site he has two lists: The Best Things to Say to Someone in Grief, and The Worst Things to Say to Someone in Grief. The Best Things to Say to Someone in Grief 1. I am so sorry for your loss. 2. I wish I had the right words, just know I care. 3. I don’t know how you feel, but I am here to help in any way I can. 4. You and your loved one will be in my thoughts and prayers. 5. My favorite memory of your loved one is… 6. I am always just a phone call away 7. Give a hug instead of saying something 8. We all need help at times like this, I am here for you 9. I am usually up early or late, if you need anything 10. Saying nothing, just be with the person The Worst Things to Say to Someone in Grief 1. At least she lived a long life, many people die young 2. He is in a better place 3. She brought this on herself 4. There is a reason for everything 5. Aren’t you over him yet, he has been dead for awhile now 6. You can have another child still 7. She was such a good person God wanted her to be with him 8. I know how you feel 9. She did what she came here to do and it was her time to go 10. Be strong Let’s do our best to connect our pure and good intentions with pastoral care skill in providing care to those grieving and experiencing anticipatory grief. Bless you, Chaplains, for your compassionate work.

Open Letter to CPE Supervisors and Diplomates

It is rare that I have ever written an article like this, but it’s time. What is on my mind has everything to do with the hire-ability and sustainability of your students and trainees. One of the key concepts of Clinical Pastoral Education is self-awareness. Dr. D. James Stapleford was my CPE Supervisor and he did a thorough job on this topic. He introduced the concept in Unit 1, emphasized it more in Unit 2, made a spectacle of it in Unit 3, and completed the process in Unit 4. What I am saying is simple; self-awareness is the coin of Hospice Chaplaincy. If a Chaplain is not applying his education in self-awareness, I can assure you his time working as a Hospice Chaplain will be short. There are several venues a Hospice Chaplain will work in: homes, long-term care facilities, hospice houses, and hospital units. Each has its own unique politic. The self-aware CPE trained Chaplain should be able to read a room, sense what his or her surroundings are saying, recognize the question behind the question, skillfully apply spiritual comfort, and work with the staff at each location. It may not be something you like to hear, but I have observed among a growing number of new Hospice Chaplains that there is a glaring absence of self-awareness. Therefore, I urge you to re-double your efforts to provide extended education on this key element of CPE. That you may know a little about how we operate at Cornerstone Hospice & Palliative Care, Inc.….We require an MDiv or similar Master’s degree, 5 years of experience in a congregational setting or hospice/hospital setting, and 3 Units of CPE. Our expectations of our Chaplains are high. We are happy to hire a new-to-hospice Chaplain and equip them to do great work. While I am aware that each CPE student/trainee comes to the table with their own box of rocks, the impact of their past and liabilities of their personalities must be addressed effectively in CPE. If this offends you, I apologize. If this moves you to address this topic more thoroughly then I am delighted. What is at stake is effective spiritual support for dying patients and their families.