challenge and heart of chaplaincy, The

Health Progress, Jan/Feb 2003 by Sakurai, Michele Le Doux

Recent Decades Have Brought a Host of Changes to the Health Care Chaplain's Role

"I'm no good to anyone!" Andrea's despair was palpable. Her leukemia had returned and the chemotherapy wasn't working. "I'm stuck in this bed," she said. 'I don't do anything. I can't cook or clean my house; I can't even watch my grandchildren. "She fought back her tears.

The chaplain took her hand. "It has been a long haul, hasn't it?"

Andrea nodded. "Look at my arm," she said. "The lymphodema has made it useless. I'm useless."

"Useless? Hmmm. Do you remember when first we met?" the chaplain asked. "It was, what, about three years ago? Remember how your children behaved?"

Andrea rolled her eyes. "Oh, they were awful, weren't they? I was newly diagnosed and my kids were at each other's throats-all six of them, fighting. They were impossible-I even had to throw them out of my room twice."

The chaplain smiled. Yes, I remember. They really had a hard time with your illness. How are your kids doing now?'

"Oh, really well. They are so attentive and supportive. I can't believe how they have come together in this. They are my angels."

"That's quite a change, isn't it? To what do you attribute it? Is there a possibility that it might have to do with how you have handled your illness?"

A broad smile crept over her face as she began to understand. "1 guess I have made a difference, haven't I? My children now know how to . . . Her voice drifted off as she choked back her tears. "Oh chaplain, God has been good to me, hasn't he? My children would have never found a way to get along if it had not been for the last two years. I know that. And now, no matter what happens, they will be okay. I guess I've made a difference after all."

haplains attend to the sacred stories of those confronting change in their lives. Change can be good: the birth of a long-awaited child or perhaps a surgery that enhances a patient's quality of life. More often, change is a life-changing diagnosis or a poor prognosis. As the patient struggles to find some meaning in it, his or her relationship with God, as well as his or her sense of identity and self-worth, come into question. Finding meaning is a dynamic process; as the patient confronts greater challenges, he or she must continually seek ways to re-ground self within the constructs of a higher power, the illness, and significant relationships in his or her life. Finding meaning in these life changes can enhance the patient's quality of life.

In the vignette that began this article, Andrea was grieving significant losses in her life. The chaplain first affirmed the depth of the loss and then provided the questions necessary for Andrea to reframe and reflect on her experience. In the process, Andrea became once again grounded in her sense of worth, in her relationship with God, and in the larger picture of mystery. In essence, Andrea was, through her own story and understanding of God, able to find meaning in this illness at this time.

TRAINING AND CERTIFICATION The chaplain is trained to listen to the patient's story, to "be present to" (as we say) the patient's values, and to reframe the crisis in the context of these values. Being pastorally present requires active, nonjudgmental listening skills that recognize and name the symbols and metaphors found in the sacred stories of others. The chaplain uses these stories to elicit avenues of meaning for the patient or family member. This facilitation can occur only if the chaplain is aware of his or her own issues and the way these issues might affect the ministerial event. This awareness comes through professional training and certification.

In North America, five certifying organizations share common criteria for certification: the National Association of Catholic Chaplains, the National Association of Jewish Chaplains, the Association of Professional Chaplains, the Association for Clinical Pastoral Education, and the Canadian Association for Pastoral Practice and Education. To be certified as a chaplain by one of these organizations requires:

* Graduate theological education or its equivalent

* Ecclesiastical endorsement that reflects the approval for ministry by a faith tradition

* Clinical Pastoral Education (CPE) "equivalent to one year of post graduate training in an accredited program recognized by the constituent organizations"'

* Demonstrated clinical competency, which includes adherence to a code of ethics that protects patients, clients, residents, and their families from proselytization and potential abuse 2

Certification is an assurance to hiring institutions that the chaplain is both theologically and clinically trained and that the sacred stories and dilemmas of the patient will be heard and honored.

THE CHALLENGE OF THE CHAPLAIN'S CHANGING ROLE

The role of the chaplain in health care has changed radically in the past several decades. There was a time in Catholic health care that the bulk of the spiritual support was provided by women religious or priests. These people were committed religious who provided prayer and sacramental support to patients and their families. However, technological change, reduced numbers of clergy, and the expanded ministerial opportunities that Vatican II made available to the laity have contributed to a significant shift in chaplaincy. Chaplains are now expected to have expertise in areas that reflect the increased sophistication of health care today. These areas include risk assessment, crisis intervention, advocacy, cultural and religious diversity, ethics, integration of the patient's story into a larger faith perspective, ritual support, end-of-life issues, and bereavement and grief.