A Hospice Take on a Familiar Christmas Story

'Twas the night before Christmas and all through the house no one was stirring but the hospice Chaplain in Grandpa’s room. The family was bowed low by the chimney in prayer, in hopes that God’s intervention would soon be there. The grandchildren were nestled all snug in their beds, with visions of life without Grandpop coursing through their troubled heads. And Mamma with her ‘kerchief, and I in my cap, wished we could settle our brains for a nap. When from the bedroom there arose such a clatter, we sprang from our knees to see what was the matter. The Chaplain sat holding Grandpop’s hand as he said, “Yes, Lord, I am coming home.” I knew in a minute he must be leaving and headed to Heaven. We wept, we hugged, we thanked the Chaplain for her care. Death comes to all, hospice is there.  On Nurse, on Physician, on Social worker, on Home Health Aide, on Chaplain, on IDT, “We care. We love. We serve.”


Thank you, Chaplains, for all you do. Your work is so essential. Have a blessed Christmas celebration. To my Jewish Chaplain friends, May the spirit of Chanukah continue bless

CPE? What's the Big Deal?

From time to time, a Chaplain will have a case that is complex. Complexities come in many forms:  family dynamics, patient internal dynamics, religious issues, conflict, and psycho-social complexities.  Preparation for and experience with theses type of issues are required of the Chaplain. These are key reasons why I am adamant that a hospice Chaplain have a minimum of 3 and hopefully 4 units of Clinical Pastoral Education. CPE prepares a Chaplain for the rigors of hospice chaplaincy. For many hospices one unit of CPE will suffice. In my opinion, that does an injustice to the patients and families. What, then, is CPE? CPE is a hands-on experience that incorporates such matters as pastoral formation and pastoral reflection in order that the Chaplain develops a methodology of ministry that will provide spiritual care to persons of all faiths or no faith. The issue of religious countertransference is often an issue that requires hard work for the Chaplain. CPE is a process. For this reason, there are four units of CPE required as a minimum for a Chaplain to seek Board Certification. Each unit is comprised of 400 hours of supervised study and clinical practice under the guidance of the CPE Supervisor. The end result of CPE is an equipped Chaplain who knows him/herself and has the means to identify those issues of his or her that could jeopardize the pastoral encounters with patients and families. Further, the CPE trained Chaplain possesses the ability to read what Anton Boisen, the founder of CPE, called the "living human document." One of the key reasons I endeavored to attain Board Certification, even though hospices do not require Board Certification or even more than 3 units of CPE, was to develop the skills necessary to benefit the patients and families I would serve. My Board Certification was earned through the Association of Professional Chaplains and the College of Pastoral Supervision and Psychotherapy. At this point, I find it valuable to state in a more detailed fashion what pastoral formation and pastoral reflection include. Pastoral Formation enables the Trainee to articulate an understanding of the pastoral role that is congruent with their pastoral values, basic assumptions, and personhood (312.1); demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self-disclosure, positive use of power and authority, a non-anxious and non-judgmental presence, and clear and responsible boundaries (312.6) Pastoral reflection enable the Trainee to establish collaboration and dialogue with peers, authorities and other professionals (312.7; demonstrate awareness of the Spiritual Care Collaborative Common Standards for Professional Chaplaincy (312.8); demonstrate self-supervision through realistic self-evaluation of pastoral functioning (312.9). Over the course of 1,600 hours of clinical work and classroom supervision, a Chaplain's theory and theology of pastoral care is very well developed. Therefore, based upon the preparation a Board Certified Chaplain has undergone he or she becomes able to work with the complex cases with other members of the care team as a fully participating partner all for the patient's good. In posts to come will be examples of my understanding of pastoral formation and pastoral reflection.

Children and Spiritual Pain at Christmas

Children and Spiritual Pain at Christmas

 

For me this topic hits home.  As I reflect on Christmas when I was a child, the memories are a mixture of pleasant and pain.  When I was 10, my Dad died.  That was the line of demarcation between pleasant and pain, what was and what is, then and now.

 

If any family could have totally messed up grief and mourning it was mine.  I know the adults in the family were well-intentioned, but what a mess it was.  My grief counsel was “brave boys don’t cry” and “you are now the man of the house”.  Being a compliant kid that I was I didn’t cry.  I had no idea how to be the man of the house so I put that one on the back burner.  The fact was that my family had no idea how to handle a sudden death which my father’s death was.  He came home from work with terrible chest pain and died a few days later at the hospital.  There were no warnings of any physical problems, it just happened.  A wise person once said, “The death shapes the grief.”  The shape of our grief was intense at first and then silence.  It just wasn’t discussed.  So, we three kids (my older sisters and me) were left to ourselves.  There’s more to the story, but that is not germane to my point in this article.

 

Should you be suffering the loss of a loved one and you have children, may I gently suggest a few actions to take that might bring a measure of healing to your children’s wounded hearts?

 

• Kids need words.  I longed for my Mother to talk to me about how she was feeling and what she would say to me in my pain.  That never happened.  Kids need words.
• Kids benefit from rituals.  Light a candle, say a prayer, donate to a hospital that focuses on the illness that your loved died of, go to church/synagogue.
• Kids need routine.  What you’re going through is not part of your daily schedule, but as much as is possible, keep a routine.  Your child will benefit from that.  Believe me, there was no routine in our grief journey.
• Kids do not grieve as adults.  It’s just different for them.  Talking about what happened may come sooner than later, but expect it to come later than sooner. Within a year of my Dad’s death, my Mother had to have gall bladder surgery.  I stayed with my Aunt and Uncle during that time.  I lay awake at night wondering if she would die, too.  Grieving is a tough journey for kids.
• Kids benefit from hospice grief counsel for children.  If you do not know how to help your child with grief, please contact your local hospice.  They will have someone who specializes with children’s grief. 
• One last thing, time will NOT heal this wound.  Your child needs tools to work her way through this process. 

 

I do hope your Christmas is merry.  But, it isn’t and it is because of the loss of a loved one, my heart goes out to you.  If I can help, I am happy to hear you and connect you with someone with a focus on children’s grief.  Blessings for comfort and peace.

How a reputation is lost…

There are a few things a hospice chaplain must hold near and dear to his heart: respect, pastoral care skills, and relational skills.  Respect given and received will keep the chaplain in good stead with the IDT.  Lose it and you find yourself in a hole you dug for yourself.  The one sure way to lose respect of your co-workers is to be the source of rumors.  Rumor-mongering in the workplace is never good.  It creates a toxic environment.  For the Chaplain, of all people, to be the source of rumors is totally incongruous to what a Chaplain is to stand for.  As I researched the concept of rumor mongering in the workplace, I came upon Bull’sEyeCareers.com.  This site’s mission statement caught my eye: “Career advice for those who seek to enhance their lives through meaningful work, professional development and education.”  And, then, came the article titled, “A Bad Workplace Habit to Nip in the Bud this Year.”  Here is a small portion of the article you will find instructive:  “when the rumors get personal and fellow employees begin to discuss other employees or bosses negatively, it is really time to step away. There are toxic people in organizations who would love nothing more than to drag you into their own web as a partner in crime. You know these people. They are always happy to say what they heard or saw and they are not afraid to drop names about who else knows and what someone else said. They are always happy to be the one who lets you in on the “secret” everyone else knows but you. Make no mistake about it, your name will be the first on his/her lips as they share the story with the next willing listener. They may even embellish what you said or didn’t say.
“Here are my five "Be's" for the new year as it relates to workplace rumor mongering:
1. Be careful...about your sources and what you repeat.
2. Be elusive...and avoid being alone with people who always want to snare others into their, "Did you hear about..." trap.
3. Be selective...about what you believe.
4. Be honest...and let people know that you would really prefer to just not talk about other people.
5. Be adept...at changing the conversation.”

I urge my Chaplain Colleagues to guard your reputation as your most valuable possession.  We are reminded in Proverbs 22:1: “A good reputation and respect are worth much more than silver and gold.” (Darby)  What 3 things can you do to enhance your reputation?  What 1 behavior will you not do to prevent your reputation from being soiled?

Stressed?

Stressed? 

It will happen to every Chaplain.  There will come the “evil day” (using the Biblical idea found in the Bible book of Ephesians).  It may involve health, finances, family, or something deeply personal.  The issue I want to address has to do with how the Chaplain handles these types of situations and maintains his or her reputation.  I am not for a moment suggesting or advocating for stoicism or grin and bear it response.  I am advocating for a response to serious stress that will prevent the Chaplain from losing the most valuable possession in all that he or she has …reputation.

I want to suggest 5 Keys to maintaining one’s reputation:

1.      Develop a support system that will be there for such a time as this.  I recall a number of years ago when I was a senior pastor.  It was obvious to me that I made a terrible mistake in moving my family across the state to this new place of service.  The church was in disarray and in no way ready to even think of becoming a witness to the community.  There were factions upon factions.  I called upon the local denominational leader and spoke to him about my assessment of the situation.  He agreed with my assessment and then told me it was much worse.  That was not what I wanted nor needed to hear.  Time proved he was correct.  I then asked him a question that he scoffed at.  I asked if there were a safety net of sorts for such a situation so that I could move from that place.  I learned something of great value from that experience.  The lone ranger style of life and leadership will leave the pastor or Chaplain with no resources at a time of crisis.  I began to build a network of like-minded ministers who I could call or meet to unload the pain I was enduring.  There is almost a syndrome among ministers to go it alone, to be a lone ranger.  Build a network of colleagues who will encourage you and support you.

2.     Watch your emotions.  It is very easy to express emotions that will border on bitterness, but will definitely express anger or rage.  Lay persons will never understand the level of stress you are experiencing as a Chaplain.  The work of chaplaincy is something all to itself.  If you express the depth of your emotions, which probably are valid, but way too strong at the moment, you will leave your colleagues and managers wondering about what really is happening with you.  Of course, you haven’t told them the entire story, so they only hear what they hear and see what they see.  Be very careful at this point.  It is not wise to unpack your emotions with colleagues.  Unpack emotions within your network of close friends, instead.

3.     As you counsel those you visit and provide spiritual support, seek to deepen yourself spiritually.  Use your well-developed spirituality to find inner peace.  Pray, read your Sacred Texts, journal, ponder, meditate, and promise yourself you will keep the emotions between you and God.  If need be, seek counsel from your Pastor, Priest, or other Faith-community Leader.  Getting it out often helps reduce the stress level for a time.

4.     If you choose to speak to someone up the leadership chain, choose your words carefully.  Be careful that you do not come across as assigning blame on them for your plight.  That will not turn out well for you.  It’s not that they are too busy to hear you out, they need to understand what is happening and what it is you would like them to do to help.  Again, I caution, choose your words, your tone of voice and attitude carefully.

5.     When you come through the crisis (as you will) approach any and all you spoke to and assure them that their listening ear was helpful to you.  Exude humility and genuine gratitude.  Be gracious in expressing how much the time they took with you meant to you.  That will go a long way to solidifying your relationships. 

Crises happen.  It’s a fact of life.  Ruining your reputation over the crisis is rarely the first choice of the Chaplain.  Do your best to maintain your poise and dignity.  Tears are fine and understandable.  Emotional outbursts in front of the wrong audience will have lasting negative results.  Bless you as you endure. 

A research-based article on fostering hope in caregivers

A research-based article on fostering hope in caregivers

Caregivers shoulder physical, financial, emotional, and spiritual issues that for most would be back-breaking.  How many of us in hospice chaplaincy haven’t witnessed the exhaustion of the caregiver of an AD/dementia patient? or of the Parkinson patient? or ALS patient?  That is not to exclude the stress and mental, emotional, and spiritual exhaustion caregivers of COPD, cardiac, or cancer patient’s experience.

It is in the purview of the Chaplain to foster hope in the caregiver.  How?  “Previous research conducted by Benzein and Berg [Benzein E, Berg A. The level of and relation between hope, hopelessness and fatigue in patients and family members in palliative care. Palliative Med. 2005;19(3):234–240.] noted that family members of patients in palliative care had significantly lower hope than the patients, indicating that the family members' suffering may be greater than the patients. One reason for the lower level of hope noted by Benzein and Berg was that the needs of family members of patients in palliative care were insufficiently met, especially in regard to information and communication from healthcare professionals. Caregivers in the study by Perreault et al [Perreault A, Fothergill-Bourbonnais F, Fiset V. The experience of family members caring for a dying loved one. Int J Palliat Nurs. 2004;10(3):133–143.] also identified the lack of support from healthcare professional as a factor that negatively affected their caregiving experience. Thus, it was postulated that encouragement and support offered by healthcare professionals can provide family caregivers with the strength, confidence, and comfort necessary to participate in the caregiving process, which can ultimately foster hope and lead to a positive experience for both the family caregivers and their loved one.[Benzein and Berg] Similar findings were noted by family caregivers in the current study, indicating that physical support, informational support, and reassurance offered by healthcare professionals and other supportive individuals were necessary to maintain hope during the caregiving experience.” [The Lived Experience of Hope in Family Caregivers Caring for a Terminally Ill Loved One, Sara S. Revier, RN, ACNS-BC, Sonja J. Meiers, PhD, RN, Kaye A. Herth, PhD, RN, FAAN,Journal of Hospice and Palliative Nursing. 2012;14(6):438-446.] (emphasis mine)

Each Chaplain will have to decide how this information informs their approach to spiritual care, but there are several huge targets at which to aim one’s care: informational support, encouragement, and reassurance.  While it seems that these three arenas of support require a good bit of talking, they also require a good bit of listening.  I can recall listening to the exhausted pleas for help of the daughter of one of the dementia patients as she was at the end of her patience and emotional strength after what seemed to be several sleepless nights.  She needed to be heard more than she needed to be talked to.  I did, however, give the nurse a call to explain some of the issues she was having with her mother and have her provide education on those matters.  The daughter just needed to talk it out.  For this woman, prayer inspired new hope even in her most exhausted moments.  It provided a sacred break in her world.

I am convinced that hospice Chaplains have the background in pastoral care to provide for the needs of caregivers.  Thank you for all you do in your work!

The International Readership of this Blog

I am not sure of the state of chaplaincy across the world, but we have a following that is world-wide. To Chaplains in Australia, Russia, The Ukraine, France, and other countries, please feel free to provide input on how your work is going and how this blog might encourage you.