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HOW WE DO CHAPLAINCY: A case study of South Australian Chaplains’
Understanding about their way of doing Chaplaincy
Christopher Carl Aiken
Supervised Research Project
Submitted in partial fulfilment of the requirements
for the degree of Master of Ministry
Melbourne College of Divinity June 2009
i
ABSTRACT The motivation for this project came in the context of significant changes in chaplaincy
being initiated by the Heads of Christian Churches Chaplaincy Committee. These
changes have been a source of animated conversation among chaplains. In terms of
chaplaincy there are often articulated differences by chaplains around the chaplaincy
role and practice. However, the various anecdotal discussions and points of view had
not been tested to ascertain how Christian chaplains in the public health environment in
SA understand their role and their practise of ministry.
A specifically designed survey incorporating qualitative and quantitative methods was
used to explore the research question. Thirty seven chaplains returned the
questionnaire. A thematic approach was used to analyse the data and a unique code
developed to describe chaplaincy ministry. The results revealed that while chaplains’
focus is on relationships and centred on patient care, a number also embraced change
and are integrated into the life of the hospital in which they work.
From the results of their project, it is argued that the chaplains scope of practice be
clarified and attention be given by the Heads of Christian Churches Chaplaincy
Committee to the selection of chaplains who can integrate into the life of South
Australian public hospitals. It is also recommended that training be provided to
chaplains to equip them for a more inclusive chaplaincy practice. Furthermore the
continued development of ecumenical chaplaincy teams is endorsed.
ii
ACKNOWLEDGEMENTS
The author wishes to express his appreciation to a number of people who have
provided assistance and direction in the preparation of this research. My thanks
to my supervisor Rev Dr Peter Ryan for his encouragement and guidance and
to Associate Professor Peter Baghust for his insights and assistance in the
statistical analysis of the project. Dr Edith Reddin has been a source of
encouragement and wise counsel around quantitative research. The AHWCA
Research Officer Rev Dr Lindsay Carey has offered helpful and timely
suggestions and acted as my associate supervisor and Mrs Pam Callaghan has
provided editorial assistance.
The approval of the Melbourne College of Divinity and the Children’s Youth and
Women’s Health Service Human Research Ethics Committees is greatly
appreciated. I am indebted to the librarians at the Women’s and Children’s
Hospital Campus for their constant support of my requests and for searches on
a number of data bases.
This project would not have been possible without the generous assistance and
contribution of the thirty seven chaplains who returned the questionnaires. My
wife Mary has been a constant source of encouragement. To each and all of
these special people, my heartfelt thanks.
iii
STATEMENT OF AUTHORSHIP
I affirm that this supervised research project contains no material which has
been accepted for the award of any other degree or diploma in any university or
other institution. To the best of my knowledge, this thesis contains no material
previously published or written by another person, except where due reference
is made in the text of the project.
Christopher Carl Aiken
29 June 2009
iv
ABBREVIATIONS AC Australian Christian
ACC Australian College of Chaplains
ACHI Australian Classification of Health Interventions
AHWCA Australian Health and Welfare Chaplains Association
ALTA American Theological Library Association
ATLAS American Theological Library Association
CA Chaplaincy Australia
CAC Chaplains Advisory Committee
CCAC Civil Chaplaincies Advisory Committee
CINAHL Cumulative Index to Nursing and Allied Health Literature
CPC Chaplaincy Practice Code
CPE Clinical Pastoral Education
CYWHS Children’s Youth and Women’s Health Service
EBMR Evidence Based Medical Reviews
EMBASE Exerpta Medica Database
ETR Ethical, Theological Resource
HC4 Heads of Christian Churches Chaplaincy Committee,
South Australia
HCCG Health Care Chaplaincy Guidelines
HCCVI Health-care Chaplaincy Council, Victoria, Incorporated
HREC Human Research Ethics Committee
IC Inductive Code
ICD-10-AM International Classification of Diseases, Version 10,
Australian Modification
ICN Identify need for chaplaincy
MDC Manage and develop a chaplaincy service
MCD Melbourne College of Divinity
MST Ministry Society and Theology
NA No answer
NHMRC National Health and Medical Research Council
NRO National Research Officer
NSW New South Wales
n Number of respondents (n=)
v
PA Pastoral Assessment
PC Pastoral Care (Allied Health Intervention)
PCE Pastoral Counselling and Education
PEC Patient Ethics Committee
PICs Pastoral Intervention Codes
PM Pastoral Ministry
RW Pastoral Ritual and Worship
SA South Australia
WHO World Health Organisation
vi
LIST OF TABLES
Table 1: Description of Health Care Chaplaincy 6
Guidelines - ‘Key Roles’
Table 2: lCD-10-AM Pastoral Interventions 7
Table 3: Chaplaincy Images and Metaphors 28
Table 4: Comparison of the AHWCA Guidelines and the PICs 39
Table 5: Pooled Responses 42
Table 6: Qualitative Codes 49
Table 7: Important Chaplaincy Ministries 52
Table 8: Role Frustration 55
Table 9: Chaplaincy Changes 58
Table 10: Image or Metaphor 60
Table 11: Biblical Story or Text 62
Table 12: Chaplaincy – Church Differences 63
Table 13: Description of Role – no church background 65
Table 14: Description of Role – church background 67
Table 15: Sources of Personal Support 69
Table 16: Professional Development 71
Table 17: Hospital Chaplaincy Environment 72
Table 18: Hospital Functions 74
Table 19: Ministry Roles – Importance 78
Table 20: Ministry Roles – Involvement 79
Table 21: Ministry Roles – Satisfaction 80
Table 22: Pastoral Assessment – Association 83
Table 23: Pastoral Care – Association 85
Table 24: Pastoral Counselling – Association 88
Table 25: Prayer – Association 90
Table 26: Worship – Association 93
Table 27: Sacraments – Association 96
Table 28: Community-Church Liaison – Association 99
Table 29: Multi-faith Care – Association 102
Table 30: Staff Support – Association 104
Table 31: Witness-Represent Church - Association 107
vii
Table 32: Chaplaincy Teamwork - Association 110
Table 33: Multi-Disciplinary Teamwork - Association 113
Table 34: Administration – Association 116
Table 35: Research – Association 119
Table 36: Teaching-Education – Association 122
Table 37: Ethical Advice – Association 125
Table 38: Professional Development – Association 128
Table 39: Community-Church Liaison – Association 131
Table 40: Advice on Religious Diversity – Association 134
viii
CONTENTS
Abstract i Acknowledgements ii Statement of Authorship iii List of Abbreviations iv List of Tables vi List of Appendices xi
1. CHAPTER ONE: INTRODUCTION
1.1 Context of the Research 1 1.2 Overview of Contents 1 1.3 Conclusion 3
2. CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction 4 2.2 Pastoral Assessment 8 2.3 Pastoral Care 8 2.4 Pastoral Counselling 9 2.5 Prayer 10 2.6 Worship 11 2.7 Sacramental Ministry 12 2.8 Spiritual Care - not specifically Christian 13 2.9 Staff Support 14 2.10 Witness/Represent the Church 16 2.11 Teamwork – Chaplaincy 17 2.12 Team work – Multi-disciplinary 18 2.13 Administration 19 2.14 Research 19 2.15 Teaching and Education 20 2.16 Ethics 20 2.17 Professional Development 21 2.18 Community/Church Liaison 22 2.19 Advice on Religious Diversity 22 2.20 Department, Unit and Ward Meetings 23 2.21 Case Conferences, Multi-Disciplinary Meetings, 24 Ward Rounds 2.22 Bereavement Care 25 2.23 Professional and Personal Roles 25 2.24 Ministry Environment 26 2.25 Chaplaincy Practice 27 2.26 Images and Metaphor 27 2.27 Web Site Search 28 2.28 Summary 29
ix
3. CHAPTER THREE: RESEARCH METHODS
3.1 Introduction 32 3.2 Ethics Approval 32 3.3 Questionnaire 33 3.4 Demographic Information 35 3.5 Qualitative Analysis 36 3.6 Quantitative Analysis 40
4. CHAPTER FOUR: RESULTS
4.1 Introduction 43 4.2 Demographic Responses 43
4.2.1 Gender 43 4.2.2 Age range 43 4.2.3 Length of service in chaplaincy 44 4.2.4 Chaplaincy employment status 44 4.2.5 Formal education in chaplaincy 44 4.2.6 Highest level of education obtained 45 4.2.7 Ordained, Religious Order or Lay status 46
4.2.8 Faith Tradition 46 4.2.9 Membership of professional organisations 46 4.2.10 Hours per week worked 47
4.3 Qualitative Responses 48 4.3.1 Role Importance 50 4.3.2 Role Frustration 53 4.3.3 Chaplaincy Changes 56 4.3.4 Image or Metaphor 59 4.3.5 Biblical Story or Text 61
4.3.6 Chaplaincy – Church Differences 63 4.3.7 Description of Role – no church background 65 4.3.8 Description of Role – church background 66 4.3.9 Summary of Quantitative Analysis 68
4.4 Quantitative Analysis 69 4.4.1 Personal Support 69 4.4.2 Professional Development 71 4.4.3 Environment of Hospital Chaplaincy 72 4.4.4 Hospital Functions 74
4.4.5 Ministry Roles 76 4.4.5.1 Consolidated responses 80
i. Pastoral Assessment 80 ii. Pastoral Care 83 iii. Pastoral Counselling 85 iv. Prayer 88 v. Worship 90 vi. Sacramental Ministry 93
vii Spiritual Care 96 (not specifically Christian)
viii. Multi-faith Care 99 (patients of other faiths)
ix. Staff Support 102 x Witness/Represent Church 105
x
xii. Team work: Chaplaincy 107 xii. Team work: Multi-disciplinary 110 xiii. Administration 113 xiv. Research 116 xv. Teaching/Education 119 xvi. Ethical Advice 122 xvii. Professional Development 125 xviii. Community/Church Liaison 128 xix. Advice on Religious Diversity 131
4.4.6 Summary of Qualitative Analysis 134
5 CHAPTER FIVE: UNDERSTANDING AND PRACTICE OF MINISTRY
5.1 Introduction 136 5.2 Significant Chaplaincy Roles 137 5.3 Roles Chaplains Utilise 140 5.4 Priority of Chaplaincy Ministry 142 5.5 Understanding of Chaplaincy Practice 143 5.6 Practice of Chaplaincy 147 5.7 Summary 149
6 CHAPTER SIX: DISCUSSION AND RECOMMENDATIONS
6.1 Introduction 150 6.2 Summary of Research 150 6.3 Implications for Practice 151 6.4 Recommendations 154
BIBLIOGRAPHY 156 APPENDICIES 164
xi
LIST OF APPENDICIES Appendix 1: Health Care Chaplaincy Guidelines - Key Roles 164 Appendix 2: ICD-10-AM Pastoral Care Interventions 165 Appendix 3: Research Questionnaire 166 Appendix 4: Question 11 – Role Importance 174 Appendix 5: Question 12 – Role Frustration 178 Appendix 6: Question 13 – Chaplaincy Changes 184 Appendix 7: Question 14 – Image or Metaphor 190 Appendix 8: Question 15 - Biblical Story or Text 196 Appendix 9: Question 16 - Church vs Parish 199 Appendix 10: Question 17 – Chaplaincy Description: 206 no church background Appendix 11: Question 18 – Chaplaincy Description: 211 church background Appendix 12: Question 23-25 Data Set 217
1
CHAPTER 1
INTRODUCTION 1.1 Context of the Research Public hospital chaplaincy in South Australia (SA) has undergone significant
change since the mid 1990s at the initiative of the Heads of Christian Churches
Chaplaincy Committee (HC4). At the same time there has been an increasing
expectation from hospital administrations of a professional chaplaincy service.
In response to this HC4 has conducted a number of strategic reviews, initiated
regular performance appraisals for chaplains, articulated competency levels,
developed ecumenical chaplaincy teams, appointed coordinating chaplains and
employed an Executive Officer.
These developments and changes have been a source of animated
conversation among chaplains and the various points of view expressed have
not been tested until now. This research was undertaken to bring clarity to this
discussion with the aim of describing how Christian chaplains understand and
practise their ministry in SA public hospitals. The findings will be shared with
chaplains and HC4 to provide an accurate picture of chaplaincy practice and
enable more effective planning for the future.
1.2 Overview of Contents There are six chapters to this research project, the introduction being Chapter 1.
Chapter 2 contains the literature review and focuses on Australian chaplains’
writing and reflection about their ministry roles. There were 19 possible
chaplaincy roles or ministries identified. These roles included the traditional
2
ministries of the church and, in response to the public hospital environment,
new areas of ministry.
The research methods used in this project are outlined in Chapter 3. A
specially designed questionnaire was developed based on insights gained from
the literature review. Qualitative and quantitative methods were used to gather
information from chaplains about their role. A thematic analysis1 was applied to
the quantitative data and a hybrid of inductive and deductive methods was
employed. A statistical summary was used to report the qualitative analysis.
The research results are contained in Chapter 4 including demographic data,
the analysis of the qualitative information and the quantitative responses. In the
process of thematic labelling a code to describe chaplaincy was developed by
combining two existing codes2 which on their own proved inadequate for a
complete analysis. The development of the Chaplaincy Practice Code3 is an
unexpected outcome of the research.
In Chapter 5 the roles that chaplains considered to be significant, those they
utilised, and the priority that they placed on them are identified. Chaplains’
understanding of their role and scope of practice of is described. The roles that
1 Richard E Boyatzis, Transforming Qualitative Information, Sage, Thousand Oaks, 1998. 2 This was a combination of the Pastoral Intervention Codes and the Australian Health and Welfare Chaplains Association Health Care Chaplaincy Guidelines. The Pastoral Intervention Codes are contained in: National Centre for Classification in Health, Pastoral Intervention Codings, International Classification of Diseases Australian Modification , Sydney University, Sydney, 2002/2005. The Health Care Chaplaincy Guidelines are published as: Ronald Cross, Lindsay B Carey, Noel Allen, Noreen Owens, The Health Care Chaplaincy Guidelines, The Australian Health and Welfare Chaplains Association, Melbourne, Victoria, 2002. These are fully described in chapter two. 3 The development of the Chaplaincy Practice Code is detailed in chapter four.
3
chaplains indicated were important to them and those they derived satisfaction
from were largely relational and person centred.
Chapter 6 summarises the research and the implications for chaplaincy
practice. Issues related to the selection of chaplains, their continued
development and training and having an ability to integrate into the wider life of
the hospital were identified. Recommendations to the HC4 are included and
some possibilities for future research are identified.
1.3 Conclusion The research indicated that there was a clear understanding by chaplains that
their role is relational with an emphasis on patient care. Some were able to
extend their ministry to staff and engage in the wider life of the hospital. A
number of chaplains indicated willingness to initiate change in chaplaincy
practice in particular the adoption of a more inclusive model.
4
CHAPTER 2
LITERATURE REVIEW 2.1 Introduction The literature search was conducted using the minutes and reports of the SA
Heads of Christian Churches Chaplaincy Committee (HC4)4 and the web sites
of public hospital pastoral care departments. Consideration was given to the
Australian Health and Welfare Chaplains’ Association (AHWCA) Health Care
Chaplaincy Guidelines (HCCG),5 the Australian College of Chaplains (ACC)
Handbook6, and the World Health Organisation (WHO) International
Classification of Diseases, Version 10, Australian Modification (IDC-10-AM)
Pastoral Intervention Codes (PIC).7
The AHWCA sponsored journals Australian Christian (AC) and Ministry, Society
and Theology (MST) were searched for articles relating to public hospital
chaplaincy as was the Australasian Theological Literature Index. Databases of
the American Theological Library Association (ALTA) Religion Database, the
ALTA Serials, AustHealth, the Cumulative Index to Nursing and Allied Health
Literature (CINAHL), Evidence Based Medical Reviews (EBMR), Exerpta
Medica Database (EMBASE), Medline, PsychINFO, and the Psychology and
Behavioural Sciences Collection were interrogated for relevant articles using
4 The researcher was given permission by the Heads of Christian Churches Chaplaincy Committee (HC4) to access the records of the committee at its meeting of 26 April 2007. 5 Ronald Cross, Lindsay B Carey, Noel Allen, Noreen Owens, The Health Care Chaplaincy Guidelines, The Australian Health and Welfare Chaplains Association, Melbourne, Victoria, 2002. 6 Australian College of Chaplains, The Australian College of Chaplains Handbook, 2005. 7 National Centre for Classification in Health, Pastoral Intervention Codings, International Classification of Diseases Australian Modification , Sydney University, Sydney, 2002/2005.
5
‘health’, ‘hospital’, ‘chaplain’, ‘hospital chaplaincy’ and ‘pastoral care’ as the
search criteria.
The search focus was on the role of Christian chaplains in the Australian health
care setting. Although there are a large number of articles on various aspects
of chaplaincy, the number that focused on the chaplain’s role was relatively
small. Due to the search engines used, there were a large number of articles
identified from overseas, with few focusing on the role of the chaplain. Those
that did described the same roles that Australian journal articles identified.
Articles with reference to Australian Christian chaplains appeared in a variety of
journals with the most useful being MST and its predecessor AC. The genesis
of these journals and a large part of their contributor base was chaplains. In
exploring their ministry, chaplains often considered not only their practical roles,
but also their function as part of a health-care team and their ministry to the
institution including the way that such a ministry could be organised in terms of
either ecumenical or denominational ministry. A number of writers explored
metaphors and images that illustrate the role and function of chaplains.
The AHWCA HCCG provide an indication of the overall ministry areas, key
roles and competencies expected of chaplains by their Association. The
HCCG8 have been the basis for the application by the AHWCA and the ACC to
have chaplains’ ministry practice recognised in the PIC of the ICD-10-AM.9
8 The HCCG superseded the AHWCA Health Care Chaplaincy Standards which also provided background to the development of the PIC. 9 Australian Classification of Health Interventions, Tabular List, 6th Edition, July 2005: 209, 276, 287, 305.
6
The HCCG were developed to implement a systematic approach to the practice
of health care chaplaincy.10 They outline five general categories of chaplaincy
ministry and list the skills or competencies that are needed to fulfil each role.
The HCCG documents five ‘Key Roles’ identified in Table 1. A description of
the roles is attached at Appendix 1.
Table 1: Health Care Chaplaincy Guidelines - Key Roles
Key Roles11
1. Identify and assess needs for chaplaincy provision. 2. Manage and develop a chaplaincy service. 3. Provide opportunities for worship and religious expression. 4. Provide pastoral care, counselling and spiritual direction. 5. Provide an informed resource on ethical, theological and pastoral matters. The PIC recognise four categories of pastoral interventions and one composite
category. The focus of the PIC is on the interventions that chaplains provide to
patients, their family and or carers. Unlike the HCCG the PIC do not include
non clinical roles such as administration, management and staff support. The
order of the PIC is intentional with a progression beginning with a pastoral
assessment which determines the pastoral interventions that a chaplain will
provide a patient and their carers. The PIC categories in the Australian
Classification of Health Interventions (ACHI) are identified in Table 2 and a fuller
description provided at Appendix 2.
10 Lindsay B Carey, “Health Care Chaplaincy Standards Utility & Satisfaction Evaluation.” Ministry, Society and Theology 16, no.1 (2002): 111. 11 HCCG, 7.
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Table 2: lCD-10-AM Pastoral Intervention Codes
PIC
Pastoral Assessment (lCD code 96186-00)12 Pastoral Ministry (lCD code 96187-00)13 Pastoral Counselling or Education (lCD code 96087-00)14 Pastoral Ritual or Worship (lCD code 96109-01)15 Allied Health Intervention – Pastoral Care (ICD code 955550-12)16 Although they are complementary the HCCG and the PIC address separate
issues. The HCCG provides chaplains and institutions with an overview of
chaplaincy practice and lists the competencies and skills that chaplains bring to
an institution. The PIC focus on chaplains’ patient care and identify the pastoral
interventions that they use.
One of the difficulties in categorising chaplaincy roles is the inter-changeability
of terms and the tendency for them to overlap. Pastoral care can be described
as pastoral ministry while a ritual could be a prayer, or worship or sharing
sacrament. An example may be that a Blessing in the Catholic tradition is an
intentional and possibly sacramental ministry while in some Protestant traditions
it may be seen as a prayer. There is also the complementary nature of terms,
an example being bereavement support, which can be variously identified as a
counselling function, a teaching function, or a role in its own right. This lack of
clarity in definitions makes chaplaincy research problematic.
12 ACHI, 1824 Block: 276. 13 ACHI, 1915 Block: 305. 14 ACHI, 1869 Block: 287. 15 ACHI, 1873 Block: 209. 16 ACHI, 1916 Block: 305.
8
The literature review identified 19 possible chaplaincy roles and insights about
chaplaincy practice. These are now discussed.
2.2 Pastoral Assessment
Pastoral assessment is the first PIC17 category which assumes that an
assessment will form the basis of the ministry that a chaplain offers. The HCCG
18 also anticipates that an assessment will be made to provide ministry
appropriate to the patient’s need. Paver19 notes the need for chaplains to make
a pastoral diagnosis and this theme is articulated by Gibbons20, Carey (et al.)21,
and Carey and Meese.22 It is clear from the literature and from the intent of the
HCCG and the PIC that the conduct of a pastoral assessment is the starting
point for effective chaplaincy ministry.
2.3 Pastoral Care
In both the PIC and the HCCG pastoral care is nominated as a key function of
chaplaincy. In the PIC it is recorded as ‘pastoral ministry’23 and in the HCCG as
a key role.24 Hansen25, Galt26, Willcock27 and Douglas28 indicate that pastoral
17 PIC 96186-00. 18 HCCG, 7. 19 John Paver, “The Role of the Pastoral Care Unit at the Cancer Institute, Melbourne.” The Australian Chaplain, no.2 (1982): 15. 20 Graeme D. Gibbons, “Refocusing Pastoral Care.” Ministry, Society and Theology 3, no.2 (1989): 23. Graeme D. Gibbons, “Pastoral Care Casemix Codings.” Ministry, Society and Theology 10, no.1 (1996): 44, 55, 61. 21 Lindsay B. Carey, Cheryl Holmes and Emil Neven, “Chaplaincy and Pastoral Care Services Pilot Program Process: A Case Study.” Ministry, Society and Theology 18, no.1 (2004): 117. 22 Lindsay B. Carey and Christine Meese, “Do Pastoral Care and Spiritual Services make a Difference?” Ministry, Society and Theology 19, no.1 (2005): 117. 23 PIC 96187-00 24 HCCG, 7. 25 Frank Hansen, “What Makes a Chaplain?” The Australian Chaplain 2, (1981): 24. 26 Alan Galt, “The Chaplain as Visitor – a Theological Basis for a Caring Ministry to People in Crisis.” The Australian Chaplain 2, (1982): 11.
9
care is a core ministry of the hospital chaplain. The Civil Chaplaincies Advisory
Committee (CCAC) of New South Wales (NSW) identifies pastoral care as the
fundamental role of Chaplaincy.29 Douglas30, Hammat31 and Arnot32 note the
chaplains’ role in providing pastoral care to staff as do the HC433 the CCAC34
and the HCCVI.35 A number of writers nominate the ways that pastoral care is
provided with Gibbons36 addressing the ‘pastoral conversation’. Blake37 and
McGurik38 speak of the relational nature of pastoral care. The CCAC39 describe
the chaplain’s role in pastoral care as providing care, healing, sustaining and
guiding.
2.4 Pastoral Counselling
In the PIC40 pastoral counselling is combined with education and as a key role
in the HCCG41. Polkinghorne,42 Douglas,43 Forsyth,44 Carey (et al.)45 and Elliott
27 Peter Willcock, “Some Reflections on Pastoral Care.” Ministry, Society and Theology 3, no.1 (1989): 51. 28 Donald Douglas, ”Role and Accountability for Hospital Chaplains.” Ministry, Society and Theology 3, no.1 (1989): 13. 29 CCAC CHAPLAINCY SUBMISSION, Civil Chaplaincies Advisory Committee, (2002): 11. 30 Moss Arnot, “The Chaplains Role in Staff Support: Incidental or Central?” Ministry, Society and Theology 7, no.1 (1993): 12. 31 Paul Hammat, Pastoral Care Statistics (Microsoft Excel Program), Repatriation General Hospital, South Australia, (2002) Paul Hammat’s electronic document and supporting information has been given to the author. 32 Douglas, 12. 33 HC4, Strategic and Operational Plan 2005-2007: 9. 34 CCAC, 11. 35 Healthcare Chaplaincy Council of Victoria Inc., Capabilities Framework for Pastoral Care and Chaplaincy, (2nd Ed), (2008), 19. 36 Gibbons, “Pastoral Care Casemix Codings”, 53. 37 Philip Blake, “Towards a Biblical Theology of Chaplaincy,” Ministry, Society and Theology 12, no.1 (1998): 28. 38 Jenny McGuirk, “Dancing on the Pin of Mortality: The Challenge of Transplantation.” Ministry, Society and Theology 16, no.2 (2002): 62. 39 CCAC, 11. 40 PIC 96087-00. 41 HCCG, 7.
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and Carey46 identify the chaplains’ counselling role. Arnot47 and Hammat48
note that chaplains also counsel staff. Chaplains’ role in bereavement
counselling and bereavement support is noted by Paver49 and Pavone.50 As
discussed above, bereavement care can be reflected here or as a category in
its own right.
2.5 Prayer
It could be said that praying is one of the visible roles a chaplain fulfils by virtue
of the stance, words and actions that accompany prayer. Providing prayer is
included in the PIC51 and the HCCG52 as a chaplaincy role. The significance of
the prayer role of the chaplain is identified in a number of settings by Hansen,53
Edwards,54 Gault,55 Carey,56 Raj,57 Spring,58 Forsyth,59 Furphy,60 Prentice,61
42 Margaret Polkinghorne, “The Cutting Edge of Chaplaincy.” Ministry, Society and Theology 1, no.1 (1987): 48. 43 Douglas, 12. 44 John Forsyth, “Ernie, The Aboriginal Man on the Intensive Care Ward: A study in ritual.” Ministry, Society and Theology 8, no.2 (1994): 81. 45 Lindsay B. Carey, Rosalie Aroni, and Allen R Edwards, “Medical Ethics and the Role of Hospital Chaplains.” Ministry, Society and Theology 10, no.2 (1996), 71. 46 Hazel Elliott and Lindsay B. Carey, “The Hospital Chaplain’s Role in the Organ Transplant Unit.” Ministry, Society and Theology 10, no.1 (1996): 66. 47 Arnot, 25. 48 Hammat, Pastoral Care Statistics. 49 Paver, 15. 50 Joe Pavone, “Management and Chaplaincy.” Ministry, Society and Theology 1, no.1 (1987): 37. 51 PIC 96109-01. 52 HCCG, 7. 53 Hansen, 24. 54 Allen Edwards, “Congenital Heart Disease and the Family – The Role of the Hospital Chaplain.” The Australian Chaplain 2, (1981): 31. 55 Gault, 13. 56 Lindsay B. Carey, “The Role of Chaplains in the ‘Sacralization of Identity’: An Initial Exploration of a General Theoretical Paradigm for Inter-religious and Cross-cultural Chaplaincy.” Ministry, Society and Theology 15, no.2 (2001): 135. 57 Leslie Raj, “Caring for Parents when their child is dying in the Intensive Care Unit.” Ministry, Society and Theology 8, no.2 (1994): 9.
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Hammat,62 and Gray.63 Barletta and Witteveen64 nominate prayer as a ministry
competency.
2.6 Worship
Like prayer, worship is usually also a public act. In the PIC65 worship is
combined with ritual and identified in the HCCG.66 While there could be debate
around the nuances of and differences between ritual and worship in terms of
chaplaincy ministry it is helpful, as the PICs and HCCG try to do, to combine all
aspects that may be described in such a way. Blessings, Baptisms, Anointing,
Communion, worship services, commemorations, funerals, naming ceremonies
and other rituals are all gathered together in a category that enables chaplaincy
to be described and coded with some accuracy.
In the literature, numerous writers comment on the practice of worship and
associated functions as an important role that the chaplain fulfils or plays
including Gibbons,67 Good68 and the CCAC.69 Cave70 notes that the chaplain’s
58 John Spring, “Prayer in the Clinical Context.” Ministry, Society and Theology 14, no.2 (2000): 115. 59 Forsyth, 78. 60 Jennifer Furphy, “Courage and Hope – A Chaplaincy Experience.” Ministry, Society and Theology 17, no.1&2 (2003): 143. 61 Luke Prentice, ”Theology and Ministry of Hospital Chaplaincy: An Evangelical View.” Ministry, Society and Theology 19, no.2 (2005): 14. 62 Hammat, Pastoral Care Statistics. 63 Geoffrey Gray, “A Hospital Chaplain’s Reflection on his Philosophy of Chaplaincy Integrating an Account and an Evaluation of a ‘Typical’ Week’s Activity.” Ministry, Society and Theology 19, no.2 (2005): 35. 64 John Barletta and Kate Witteveen. The Development of Roles and Education for Pastoral Care Workers in Queensland Health: A Research Report. Brisbane: Queensland Health, (2005): 101. 65 PIC 96109-01. 66 HCCG, 7. 67 James L. Gibbons, “Contemporary Images of Hospital Chaplaincy.” Ministry, Society and Theology 2, no.2 (1988): 20.
12
role includes ministry to the institution. A number of writers including Raj,71
Carey (et al.)72 and Carey and Meese73 also note the role of chaplains in
worship and ritual.
2.7 Sacramental Ministry
The PIC74 and the HCCG75 nominate sacramental ministry as a key chaplaincy
role as do the HC476 and the CCAC.77 This is also noted by Carey78 and
Arnot.79 Generally the writers identify sacraments or communion in this context,
however anointing and blessing are included by Hammat.80 Raj,81 Edwards,82
McFarlin and Carey83 Gray,84 Hansen85 and Gibbons86 all comment on the
chaplain’s role in sacramental ministry.
68 Nan Good, “How can I say Goodbye.” Ministry, Society and Theology 6, no.1 (1992): 57-59. 69 CCAC, 12. 70 Eric Cave. “Since by a man came death.” Ministry, Society and Theology 11, no.1 (1997): 129. 71 Raj, 5. 72 Carey, Holmes and Neven, 50. 73 Carey and Meese, 51. 74 PIC 96109-01 75 HCCG, 7. 76 HC4, Report to Heads of Christian Churches, April 2007, 4. Workshop Notes 5 July2005, 3. 77 CCAC, 12. 78 Lindsay B. Carey, “The Role of Hospital Chaplains: A Research Overview.” Ministry, Society and Theology 9, no.2 (1995): 42. 79 Arnot, 24. 80 Hammat. 81 Raj, 13. 82 Edwards, 32. 83 Phoebe McFarlin and Lindsay B. Carey, “I’m Not Religious…but Please Pray.” Ministry, Society and Theology 18, no.2 (2004): 214. 84 Gray, 27-35. 85 Hansen, 24. 86 James L Gibbons, 18.
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2.8 Spiritual Care - not specifically Christian
Although the PIC and the HCCG have their genesis in the Christian tradition,
both are generic in their description of care. The provisions of care coded by
the PIC do not specify a particular faith practice and are applicable in a multi-
faith setting and for the care of patients who claim to have no faith. The HCCG
envisage a similar context with the requirement of chaplains to respond to
individual pastoral and spiritual needs as well as personal and communal
religious and worship needs.87
In SA public hospitals Christian chaplains increasingly work in an environment
where a range of belief systems are encountered. This is recognised by HC488
in addressing the future of chaplaincy. These include expressions of religion
that include the Christian faith, other traditional faiths and the range of faith and
spiritual expressions evident in the health-care system. Spiritual support to
people of faith traditions other than Christian and an appreciation of cultural
diversity is encouraged by the CCAC89 which is itself a multi-faith committee.
Also evident is an eclectic mix of beliefs, agnostic and atheistic positions, or no
faith experience or expression. Providing care to patients and their carers who
do not have an understanding of the Christian faith was identified by Gepp90
and Barletta and Witteveen.91
87 HCCG, 7. 88 HC4, Strategic and Operational Plan 2005-2007, 3. 89 CCAC, 12, 19. 90 Caroline Gepp, “Pastoral Relationships and the Random Hospital.” Ministry, Society and
Theology 13, no.1 (1999): 17. 91 Barletta and Witteveen, 98, 101.
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The CCAC92 indicates that spiritual guidance and direction are a service
chaplains provide. In defining chaplaincy ministry for chaplains in SA the HC493
in their description of both pastoral care and spiritual care envisage that
chaplains will be working in an arena of spirituality and not only with patients
from a Christian faith. Although outside of the scope of this SRP, it is important
to note that there are chaplains, pastoral carers, and spiritual leaders or guides
of faiths other than Christian serving in South Australian Public hospitals. While
multi-faith care is significant, Kirkwood,94 Corfee and Rao,95 and McFarlin and
Carey96 highlight the care chaplains provide to patients who do not record a
religious preference on admission to hospital.
2.9 Staff Support
The focus of Arnot’s97 article is on the support chaplains’ provide staff
individually and in group settings. Edwards98 includes the role of staff support in
the context of a chaplain who is assigned to specific wards rather than having a
hospital wide role. Francis99 addresses the importance of the staff support role
92 CCAC, 11. 93 HC4, Terms of Reference from the South Australian Heads of Christian Churches, 23 June 2005. HC4 Submission to the SA Health Department Generational Health Review, 2003. The pastoral and spiritual care definitions are included in the role description of all co-ordinating chaplains in South Australia and form the basis of appointment of a placement. 94 Neville Kirkwood, “Pastoral Care and Public Health: A Universal and Professional Vocation.” Ministry, Society and Theology 14, no.1 (2000): 39. 95 Joan Corfee and Mirella Rao, “Sacred Space.” The Summit 28, no.4 (2001): 14. 96 McFarlin and Carey, 219. 97 Arnot, 22, 25. 98 Edwards, 31. 99 Cecillia Francis, “Chaplaincy and Episcopae.” Ministry, Society and Theology 4, no.1 (1990): 8.
15
and Carey (et al.)100 identifies the educational and clinical training support
chaplains provide to staff.
Goode,101 Reddicliffe,102 Cross,103 Hammat,104 and Blake105 all note the role
chaplains have in providing support to staff while Holmes and Carey106 explore
the mechanisms of the religious and psycho-social ways that chaplains fulfil this
role. Given that death, grief and loss are part of a hospital environment and that
staff members are affected by the death of patients, Pavone107 and Holmes and
Carey108 discuss the role of the chaplain in supporting staff during such a time.
Acting as an advocate for staff is identified by Carey and Newell,109 and Carey
(et al.)110 note the chaplain’s role as companions, counsellors and mediators.
Organisationally, the HC4,111 CCAC,112 HCCVI113 and Barletta and
100 Lindsay B Carey, Bruce Rumbould, Christopher Newell and Rosalie Aroni, “Bioethical Issues and Health Care Chaplaincy in Australia.” Scottish Journal of Healthcare Chaplaincy 9, no.1 (2006): 26. 101 Leslie Goode, “To Give Support as we Care” Ministry, Society and Theology 1, no.1 (1987): 56. 102 Ray Reddicliffe, “Chaplaincy Ministry – Present Perspectives and Future Prospects.” Ministry, Society and Theology 5, no.2 (1991): 33. 103 Ron Cross, “The Changing Face of Chaplaincy.” Ministry, Society and Theology 9, no.2 (1995): 8. 104 Hammat, Pastoral Care Statistics. 105 Blake, 35. 106 Cheryl Holmes and Lindsay B. Carey, Pastoral Care and Chaplaincy Provision within Metropolitan Health and Aged Care Services in the State of Victoria, Healthcare Chaplaincy Council of Victoria and the Australian Health & Welfare Chaplains Association Melbourne 2005: 5. 107 Pavone, 35. 108 Holmes and Carey, 5. 109 Lindsay B. Carey and Christopher Newell, “Withdrawal of Life Support and Chaplaincy in Australia.” Critical Care and Resuscitation 9, no.1 (2007): 37. 110 Lindsay B. Carey, Christopher Newell and Bruce Rumbould, “Pain Control and Chaplaincy in Australia.” Journal of Pain and Symptom Management 32, no.6 (2006): 592, 599. 111 HC4, Workshop Notes 5 July 05: 1. Strategic and Operational Plan 2005-2007: 9. 112 CCAC, 11, 14. 113 HCCVI Capabilities Framework, 19.
16
Witteveen114 identify staff support as a major priority for chaplains, such
support ranging from pastoral care and spiritual guidance to providing care
during grief and loss.
2.10 Witness/Represent the Church
Traditionally Christian chaplains have been appointed to their role with the
endorsement of their Church hierarchy and as such are representatives of their
church. Although rituals are applicable to faith groups other than Christian, the
key roles identified in the HCCGs of providing worship and sacraments stand
firmly in the Christian tradition.
Goode115 observes that the chaplain ‘makes God present’ while Polkinghorne116
speaks of the chaplain as ‘servants of God and his church’. The role of
chaplains being a link with the community and a ‘witness’ are noted by Griffin,117
114 Barletta and Witteveen, 98. 115 Nan Good, “The Application of Skills in the Professional Helping Relationship.” The Australian Chaplain 5, (1985): 46. 116 Margaret Polkinghorne, “A Response – Role and Accountability of Hospital Chaplains.” Ministry, Society and Theology 3, no.1 (1989): 16. 117 Graeme M. Griffin, “A Creative Understanding of Stress in a Multi-Disciplined Community.” Ministry, Society and Theology 1, no.2 (1987): 22.
17
Arnot118 and Ireland (et al.).119 Preston,120 Goode,121 Forsyth,122 Francis,123
and Kirkwood124 also identify this representative chaplaincy role.
2.11 Teamwork – Chaplaincy
Chaplaincy teams are envisioned in the HCCG125 and endorsed by Hawkes and
Hallahan126 in reviewing chaplaincy for the HC4. Evans and Miller127 in an
overview of the development of HC4128 described the move to ecumenical
chaplaincy in SA. While recognising the importance of denominational
distinctives, the CCAC129 also notes the need for co-operation between
chaplains. In the development of ward based chaplaincy at the Royal
Children’s Hospital in Melbourne, Edwards130 points out that the key issue is the
level of trust the chaplains have with each other.
118 Arnot, 13. 119 Bede Ireland, Lindsay B. Carey, Ian Baguely, Russell Maurizi, Jenelle Crooks and Meredith Gronlund, “The Westmead Hospital Brain Injury Rehabilitation Unit and Pastoral Care Department Pilot Research Project: A Joint Research Endeavour.” Ministry, Society and Theology 13, no.1 (1999): 57. 120 Noel Preston, “Imagining Chaplaincy.” Ministry, Society and Theology 15, no.2 (2001 ): 39. 121 Nan Good, “The Bible and the Hospital Chaplain.” Ministry, Society and Theology 5, no.2 (1991): 8. 122 Forsyth, 78. 123 Francis, 6. 124 Kirkwood, 39. 125 HCCG, 7. 126 Geraldine Hawkes and Lorna Hallahan, Healthy Chaplaincy in Adelaide’s North West, (24 March 2005): 4. 127 Margaret Evans and Richard Miller, History, Responsibility and Accountability, Heads of Christian Churches Chaplaincy Committee, (November 1991): 2. 128 HC4, Workshop Notes, 5 July 05, 2, 3., and HC4 Strategic and Operational Plan 2005-2007, 3. 129 CCAC, 11. 130 Edwards, 31,32.
18
What is clear from the recent work of Barletta and Witteveen131 and the
discussions between the SA Government and HC4,132 is that governments are
requiring a model along ecumenical if not multi-faith lines as chaplains
encounter and care for patients and their carers who come from a range of faith
perspectives.133
2.12 Team work – Multi-disciplinary
The concept of chaplains working with staff as part of a team is noted in the
HCCG134 and by Pavone135 and Gibbons136 writing in the 1980s. The rationale
for the team at the Royal Children’s Hospital developing ward based chaplaincy
was in part to work more closely with medical and nursing staff.137 This role
continues to be noted in the literature by various authors including Barletta and
Witteveen,138 Harris,139 and Holmes and Carey.140 In the South Australian
context, Hawkes and Hallahan141 note the importance of holistic care with the
chaplain being integrated into the hospital. Aiken142 comments on the chaplain’s
131 Barletta and Witteveen, 101. 132 HC4, Funding discussions have raised this issue. The development of ecumenical co-ordinating chaplains to head teams in hospitals is the result of such discussions included in the HC4 Strategic and Operational Plan 2005-2007. 133 Kirkwood, 39. McFarlin and Carey, 219. 134 HCCG, 7. 135 Pavone, 35. 136 James L. Gibbons, 18. 137 Edwards, 32. 138 Barletta and Witteveen, 101. 139 Joy Harris, “Ten Years After Hours Pastoral Care in Emergency.” Ministry, Society and Theology 17, no.1&2 (2003): 119. 140 Holmes and Carey, 5. 141 Hawkes and Hallahan, 17. 142 Carl Aiken, “Chaplaincy and Health Care in the ADF: The Relationship between Body, Mind and Soul.” ADF Health 9, no.2 (2008): 77.
19
role in case conferences while the CCAC143 identifies the role of being a
channel of communication with staff.
2.13 Administration
The HCCG144 recognise that the chaplain’s role includes areas of ministry that
can variously be seen as administrative, managerial or professional. The role of
chaplains in the administration of chaplaincy services is recognised by the
HC4,145 the HCCVI,146 the CCAC147 and in the HCCG.148 In the daily statistical
report for chaplains at the Repatriation General Hospital in Adelaide, Hammat149
included administration as one of the roles. A wide discussion of administrating
or managing pastoral services was not evident in the literature.
2.14 Research
Research appears to have recently been a low priority for most chaplains. While
the ACC150 has research as a key purpose of its charter few chaplains,
including members of the College intentionally pursue research that is published
in journals. The AHWCA has an honorary Research Officer while the HCCVI’s
Research Officer is part time.
143 CCAC, 10, 12, 14. 144 HCCG, 7. 145 HC4, Strategic and Operational Plan 2005-2007, 4. 146 HCCVI Capabilities Framework, 15. 147 CCAC, 12, 16. 148 HCCG, 7. 149 Hammat, Pastoral Care Statistics. 150 ACC Handbook, 1.
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2.15 Teaching and Education
The PIC151 includes education as a pastoral intervention and the HCCG152
identifies the role. The teaching and education that chaplains provide can
range from issues such as faith instruction and ethical education to cultural
awareness. Hammat,153 Galt,154 Carey (et al.),155 and Gibbons156 note the
chaplains teaching/education role. Elliott and Carey157 and Carey (et al.),158
and Kirkwood159 also comment on this chaplaincy practice.
2.16 Ethics
The provision of ethical advice to research committees and in patient care is
identified as areas of chaplaincy involvement in the PIC,160 the HCCG,161 the
CCAC,162 and HC4.163 Bride, 164 Carey (et al.),165 Gibbons,166 Paver167 and
Pavone168 all comment on chaplains’ involvement in providing ethical advice.
With the advent of patient ethics committees to review and plan patients’
151 PIC 96087-00 152 HCCG, 7. 153 Hammat, Pastoral Care Statistics. 154 Galt, 13. 155 Lindsay B Carey, Rosalie Aroni, Allen R Edwards, Christina L Carey-Sargeant, and Jennifer Boer, “Chaplains and Speech Pathologists: Some Interdisciplinary and Practical Opportunities.” Ministry, Society and Theology 10, no.2 (1997): 136. 156 James L Gibbons, 20. 157 Elliott and Carey, 66. 158 Carey, Aroni, and Edwards, 67,68. 159 Kirkwood, 40. 160 PIC 96087-00 161 HCCG, 7. 162 CCAC, 17. 163 Evans and Miller, 1. 164 Graham Bride, “The Chaplain as Advocate, Reflections from a New Boy.” The Australian Chaplain 2, (1982): 4. James L Gibbons, 20. 165 Carey, Aroni, Gronlund, 135. 166 James L Gibbons, 18. 167 Paver, 14. 168 Pavone, 38.
21
treatment we find chaplains often involved in and sometimes acting as patient
advocates.169
The National Health and Medical Research Council (NHMRC) has a
requirement that a member of a Human Research Ethics Committee (HREC) be
a ‘person who performs a pastoral care role in a community’.170
Complementing their involvement at the institutional level Elliott and Carey171
comment on the role chaplains have in teaching in hospital ethics programs and
providing ethical advice or education to individual staff members. Carey (et
al.)172 also notes that chaplains may be engaged with patients and families in
conversations on ethical issues.
2.17 Professional Development
The HCCG173 consider that an aspect of the chaplain’s role is to identify areas
for personal development. Professional competence and continuing education
and development are promoted by the ACC.174 Surprisingly it is not an issue
that was widely addressed in the literature except in the documents from the
HC4, HCCVI, the CCAC and the expectation of continuing education included in
the competencies developed by Barletta and Witteveen.175
169 CCAC, 12., Graeme D. Gibbons, 44., Paver, 14., Francis, 8., Blake, 33. 170 National Health and Medical Research Council, National Statement on Ethical Conduct in Human Research, Australian Government, Canberra. (2007): 81. 171 Elliott and Carey, 68. 172 Carey, Aroni and Edwards, 71. 173 HCCG, 7. 174 ACC Handbook, 1. 175 Barletta and Witteveen, 98.
22
The HC4176 and the HCCVI177 have developed competency levels and
encouraged continuing education for their chaplains. SA public hospitals are
teaching institutions with links to university medical, nursing and allied health
schools and conduct regular in-house programs of professional development.
Francis178 notes the participation of chaplains in such programs and the
CCAC179 identifies both CPE and studies in theology as components of
professional development.
2.18 Community/Church Liaison
The expectation that chaplains will work co-operatively with religious and
community groups and individuals in providing care is included in the HCCG,180
by the CCAC181 and Barletta and Witteveen.182 The CCAC183 envisages that
representing the Church is a function chaplains fulfil in their role and
Gibbons,184 Hammat185 and Ireland (et al.)186 also identify this role.
2.19 Advice on Religious Diversity
The HC4187 has recognised that chaplains work in a multi-faith environment.
This is also identified in the HCCG.188 The multi-faith nature of the Australian
176 HC4, Terms of Reference, June 2005, and HC4 Competency Standards, November 2006. 177 HCCVI, Capabilities Framework. 178 Francis, 8. 179 CCAC, 18. 180 HCCG, 7. 181 CCAC, 12. 182 Barletta and Witteveen, 98. 183 CCAC, 25. 184 James L Gibbons, 18. 185 Hammat, P. 186 Ireland, Carey, Baguely, Maurizi, Crooks and Gronlund, 57. 187 HC4, Position Description for Executive Officer. Hawkes and Hallahan, Report, 16. 188 HCCG, 7.
23
community is observed by Blake189 and the issue of chaplains offering advice
on religious diversity or being an informed inter-faith resource is mentioned by
Carey (et al.).190 Given the multi-faith and multi-cultural dimension of the
hospital patient population, this is becoming an increasingly important issue and
one in which chaplains could reasonably be expected to offer an informed
assessment. The engagement of chaplains in multi-faith care is encouraged by
the recent work of Davoren.191 The multi-faith CCAC192 identifies the Chaplain’s
role in sitting on hospital cultural diversity committees and providing support to
people of faith traditions other than their own. In this context it is also important
to note the patients who choose to indicate ‘no religion’ as their preference
when they attend hospital,193 or who hold to alternative spiritualities.194
2.20 Department, Unit and Ward Meetings
Co-operation with the extended health-care team and being an informed
resource person in pastoral and spiritual care are chaplaincy roles included in
the HCCG195 the HCCVI Capabilities Framework,196 and by Barletta and
Witteveen.197 Edwards198 describes the placement of a chaplain on a ward
with the intention of integrating them into the health-care team.
189 Blake, 31. 190 Carey, Aroni, Edwards, Carey-Sargeant and Boer, 136. 191 Ronald Davoren, Interfaith Pastoral Care The Role of the Hospital Chaplain, unpublished Masters Research Project, 2006. 192 CCAC, 19. 193 Kirkwood, 39. 194 Aiken, 75. 195 HCCG, 7. 196 HCVVI Capabilities Framework, 27-31. 197 Barletta and Witteveen, 198. 198 Edwards, 31.
24
Pavone199 comments on the chaplain being part of the hospital team as do
Paver200 and Hammat.201 Chaplains’ attendance at case conferences and
inclusion in informal conversations around patient care is identified by Aiken202
as is their role in teams of health care practitioners. The chaplain’s role is
described as focusing on non-diagnostic communication and decision making
and providing input into ethical decision making by Carey (et al.)203 Likewise,
the CCAC204 identifies the chaplain’s role in providing a communication link
between patients and nurses and medical practitioners.
2.21 Case Conferences, Multi-Disciplinary Meetings, Ward Rounds
Case conferences of the practitioners caring for a patient are a regular
occurrence in public hospitals. They are one of the forums where information is
shared, options for treatment discussed, and the welfare of patient and family
are considered. Edwards,205 Paver206 and Barletta and Witteveen207 all explore
the involvement of chaplains in case conferences or similar forums such as
ward rounds. The CCAC,208 Barletta and Witteveen 209 and Ireland (et
al.)210envisage chaplains being involved at various levels of information sharing
about patients’ care including case management meetings, patient rounds and
handover sessions.
199 Pavone, 35. 200 Paver, 16. 201 Hammat. 202 Aiken, 77. 203 Carey, Aroni, Edwards, Carey-Sargeant and Boer, 134. 204 CCAC, 10, 12, 14. 205 Edwards, 32. 206 Paver, 16. 207 Barletta and Witteveen, 99. 208 CCAC, 14. 209 Barletta and Witteveen, 101. 210 Ireland, Carey, Baguely, Maurizi, Crooks and Gronlund, 57.
25
2.22 Bereavement Care
Helping people prepare for death, deal with grief and loss, and crafting rituals to
recognise life have been an important part of the ministry of the church in the
community and of chaplains. The chaplain’s role in bereavement care is
multifaceted and includes working with patients, families and staff in roles that
include pastoral support, pastoral ministry, conducting funerals and liturgies,
and training staff. Carey,211 Paver212 and Elliott and Carey213 identify the
importance of bereavement care and note that this is an area where chaplains
have specialist skills. It is included in the PIC214 and the HCCG.215 Paver216
identifies the chaplain’s role in providing bereavement care. Chaplains’ support
for staff confronting the issues of grief and loss is identified by the CCAC,217
Carey and Meese218 and Elliott and Carey.219
2.23 Professional and Personal Roles
The chaplains’ professional role is recognised in the competencies that have
been developed by the HC4, HCCVI and Barletta and Witteveen.220 A number
of these have already been identified including being part of the health care
team, participating in research, having a teaching role and offering counselling,
advocacy and mediation to staff.
211 Carey, The Role of Hospital Chaplains, 46. 212 Paver, 19., Elliott and Carey, 75. 213 Elliott and Carey, 69. 214 PIC 96187-00 and PIC 96087-00. 215 HCCG, 7. 216 Paver, 14., Holmes and Carey, 5. 217 CCAC, 14, 16. 218 Carey and Meese, 120. 219 Elliott and Carey, 69. 220 HC4, Competencies, November 2006.
26
The role a chaplain plays in the social life of wards and unit social gatherings is
explored by Arnot,221 while Paver222 speaks of the Chaplain being a friend.
Douglas223 reflects on the chaplains’ pastoral care role with staff and Cross224
identifies the chaplain’s role as a ‘team worker’. Arnot225 also explores the
influence chaplains can have through an intentional ministry to staff by sharing
significant life events including weddings, funerals, blessings and baptisms.
2.24 Ministry Environment
The chaplains studied in this research work in a secular public hospital where
they are accountable to both the institution and their denomination. Arnot226
writes of the meeting of two institutions, the hospital and the church.
The dynamics of chaplains from different denominations working together and
their commitment to co-operative ministry was one of the issues identified in the
ecumenical initiative reported by Edwards.227 Barletta and Witteveen228 and
Elliott and Carey229 all note the need for chaplains to be capable of working co-
operatively. This was a key recommendation of the ‘Healthy Chaplaincy
Report’230 and is the direction that the HC4 has taken, resulting in a number of
ecumenical co-ordinating chaplains being appointed to head chaplaincy units in
public hospitals.
221 Arnot, 24. 222 Paver, 14. 223 Douglas, 12. 224 Cross, 11. 225 Arnot, 22. 226 Arnot, 13. 227 Edwards, 32. 228 Barletta and Witteveen, 101. 229 Elliott and Carey, 66. 230 Hawkes and Hallahan, 21, 22.
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2.25 Chaplaincy Practice
The way that chaplains practise their ministry is increasingly dictated by the
hospital environment. Working individually or as part of a co-operative team is
one of the practice issues. The initiative described by Edwards231 was of an
individual chaplain taking responsibility for a ward while Reddicliffe232 noted the
chaplain being integrated as part of the ward team. However, the challenge for
chaplaincy practice is no longer ministry across denominational boundaries, but
engagement with patients of other faiths or no faith.233
The move to an ecumenical model of chaplaincy is in some quarters no longer
an option as hospitals and some governments demand a co-operative model,
not only among Christian chaplains, but in terms of a multi-faith practice.234
2.26 Images and Metaphor
A number of chaplains offered a picture of their ministry by using an image or
metaphor. The images and metaphors are eclectic, drawn from scripture,
theology and life experience. Some are traditional, some creative and others
provocative. It is helpful to consolidate these images and metaphors in a table:
231 Edwards, 31, 32. 232 Reddicliffe, 32. 233 Davoren, 113., Carey and Meese, 119. 234 Harris, 121., Barletta and Witteveen, 98.
28
Table 3: Chaplaincy Images and Metaphors
Image
Author
Shepherd Gault,10. Visitor Gault,10. Lifeboat Crew Gault,10., quoting Clinebell Clown Gault,10., quoting Faber, Preston, 43. Servant/Steward Gault, 10., quoting Brister, Polkinghorne,
16., Reddicliffe, 36. Son/Brother Gault, 10., quoting Brister Ambulance Man Gault, 10., quoting chaplaincy students Coronary Care Team Gault, 10., quoting chaplaincy students Theatre Sister Gault, 10., quoting chaplaincy students Tutor Gault, 10., quoting chaplaincy students Guide Paver, 14., from patients/relatives research Sustainer Paver, 14. Friend Paver, 14., Good, 48. Advocate Paver, 14., Gibbons, G., 44., Preston, 43. Mediator Paver, 14. Spiritual Guide Paver, 14. Prophet Paver, 14., Polkinghorne, 16. Comforter Paver, 14. Expert (on dying and grief) Paver, 14. Symbolic Figure (representing God) Good, 46 Making God Present Good, 46. Priestly Polkinghorne, 16. Undercover Agent Reddicliffe, 36., Preston, 42. Hospitality Tapper, 113., Preston, 43. Guest Preston, 43. Midwife Preston, 43. Journey Preston, 43. Stranger Wegener, 127. Companion Good, 48. Teamworker Cross, 11.
2.27 Web Site Search
The intranet and internet web sites of six SA public hospitals235 were searched
to identify the services provided by chaplains. The search was conducted using
the terms ‘chaplain’, ‘chaplaincy’, ‘pastoral care’ and ‘spiritual care’. Two
hospitals had no chaplaincy presence on their sites.
235 Web sites accessed on 21/4/2007 and 28/10/08 were the Repatriation General Hospital, the Royal Adelaide Hospital, Modbury Public Hospital, the Queen Elizabeth Hospital, Flinders Medical Centre and the Lyell McEwen Hospital.
29
Four hospital sites included chaplaincy and noted that they were part of the
holistic care provided by the hospital.236 Services provided by chaplains
included visiting patients, pastoral care, offering encouragement, human
support and companionship. Listening, guidance, personal counselling, trauma
and bereavement counselling were also noted. In terms of faith support,
worship and religious services were mentioned along with sacramental ministry
which included communion, anointing the sick, reconciliation, baptism, prayer
and spiritual care. Also included were family support and assistance with
funerals and weddings.
2.28 Summary
The scope of the literature review was to consider Australian Christian
chaplains’ reflections on their ministry. The journals AC and its successor,
MST, were the forums in which much of this reflection was recorded. Over the
last decade MST lost much of its chaplaincy focus except for the work of Carey
and his co-authors. It would seem that the vitality shown by chaplains in writing
about their ministry in the 1980s and 1990s has waned until the development of
the electronic Journal of Pastoral Care and Health.237 It would appear from the
articles of the 1980s and 1990s that the chaplains were envisioning and
advocating for a professional approach to chaplaincy.
As has been noted, a number of the chaplaincy roles identified in the literature
review include the traditional roles of pastoral care, provision of sacrament and
worship. The role of multi-faith chaplaincy, pastoral assessment, research and
236 Lyell McEwen Hospital, The Royal Adelaide Hospital, The Queen Elizabeth Hospital and the Repatriation General Hospital. 237 Australian Journal of Pastoral Care and Health available at www.pastoraljournal.org.au.
30
administration receive less attention. At the same time, the descriptions used in
some articles are at times either ambiguous or very general in nature –
teamwork could mean the chaplaincy team, or a multi-disciplinary team.
In this review of the contribution of Australian chaplains in the literature, I have
drawn out the key roles of chaplaincy practice that they identified. Clearly there
are differing points of view in some areas, while in others, different perspectives
around the same theme. The themes and concepts articulated by chaplains
has contributed to the shape of the questionnaire.
The 19 specific chaplaincy roles that will be explored in the questionnaire are:
Pastoral Assessment
Pastoral Care
Pastoral Counselling
Prayer
Worship
Sacramental Ministry
Spiritual Care that is not specifically Christian
Multi-faith Care – patients of other faiths
Staff Support
Witness/Represent the Church
Teamwork – Chaplaincy
Team work – multi-disciplinary
Administration
Research
31
Teaching/Education
Ethics
Professional Development
Community/Church Liaison
Advice on Religious Diversity
Alongside these ministry roles, chaplains’ involvement in department, unit or
ward meetings will be explored along with attendance at case conferences and
multi-disciplinary meetings. The context of chaplaincy ministry will also be
studied, including the extent to which a chaplain is embedded in the fabric of the
hospital, their view of co-operative ministry and their understanding of their
ministry. In the literature review these were identified as ministry environment,
chaplaincy practice, and images and metaphor.
Chapter 3 will describe the research methods used in this project.
32
CHAPTER 3
RESEARCH METHODS
3.1 Introduction The aim of this project is to explore the ways that Christian Chaplains
understand and practise their ministry in the South Australian Public Health
system. This chapter provides details of the research process including data
collection and analysis.
The literature review informed the development of the questionnaire that was
circulated to 50 South Australian public hospital chaplains. Prior to distribution,
expert opinion was sought and the questionnaire was reviewed by the AHWCA
National Research Officer (NRO) and piloted by two chaplains in the private
hospital sector in South Australia.
3.2 Ethics Approval
The National Health and Medical Research Council (NHMRC)238 ethical
guidelines informed the conduct of the research. Approval for the project was
granted by the Human Research Ethics Committees (HREC) of the Melbourne
College of Divinity (MCD) and the Children’s Youth and Women’s Health
Service (CYWHS).
The information sheet and questionnaire was distributed to individual chaplains
through the public hospital Chaplaincy Departments where each chaplain
worked. A reply paid envelope was provided. The information sheet described
238 NHMRC, National Statement.
33
the project and included details of the approval granted by the HRECs239 and
contact information for both the MCD and CYWHS research secretariats.
Protection of participants’ privacy was assured by the questionnaire being
anonymous and the issue of informed consent was satisfied by the voluntary
return of the questionnaire.240
In accordance with the requirements of the MCD HREC, research data was
securely stored in a password protected computer to which only the researcher
had access. Upon completion of the project the data will be
electronically stored at the MCD for seven years.
3.3 Questionnaire
The questionnaire, attached at Appendix 3,241 was uniquely developed from the
insights provided by the literature review and previous research to answer the
research question. The survey comprised twenty five questions and was
distributed to 50 salaried chaplains and volunteer pastoral carers working in the
six major public hospitals in Adelaide. Thirty seven questionnaires were
returned giving a return rate of 74%.
The literature review informed the development of the questionnaire which was
designed to gain a wide appreciation of chaplains’ reflection on their role and
included a combination of qualitative and quantitative questions. This
combination is recognised as providing a comprehensive insight into the subject
239 NHMRC National Statement, 84. 240 NHMRC National Statement, 19. 241 The questionnaire attached at Appendix 1 also contains research data.
34
under investigation.242 Demographic and professional back-ground information
about the chaplains comprised the initial part of the survey, questions 1 to 10.
The qualitative component of the questionnaire was questions 11 to 18 which
provided chaplains the opportunity to respond with comments. The quantitative
component was questions 19 to 25 which included a combination of direct
response questions and Likert scales.
The use of qualitative and quantitative data collection methods required the use
of two methods of analysis. Respondents’ qualitative responses were
transcribed into a Microsoft Word document and tables were used to conduct
the thematic analysis of the responses. The thematic analysis of the qualitative
data was conducted following Boyatzis.243 The quantitative data was entered
into a Microsoft Excel spreadsheet for analysis. Data from questions 23 to 25
was entered into the S-PLUS® 8 Enterprise Developer244 statistics analysis
program for comparison of the responses. The use of a qualitative/quantitative
mixed method provided triangulation that added validity to the research,245 as
does the hybrid approach of using both inductive and deductive codes to
analyse the quantitative data.246
242 John Swinton and Harriet Mowat, Practical Theology and Qualitative Research, SCM Press, London, 2006: 44., Stephen Polgar and Shane A. Thomas, Introduction to Research in the Health Sciences, Churchill Livingstone, Philadelphia, 2008: 10. 243 Richard E Boyatzis, Transforming Qualitative Information, Sage, Thousand Oaks, 1998. 244 S-PLUS® 8 Enterprise Developer, TIBCO Software Inc. 245 Stephen Polgar and Shane A. Thomas, Introduction to Research in the Health Sciences, 5th ed. Philadelphia, Churchill Livingstone, 2008: 137. 246 Boyatzis, 52.
35
3.4 Demographic Information
Demographic questions provided information about the chaplains’ gender, age
range, length of service in chaplaincy, employment status, and education for
chaplaincy. Further information included whether the chaplains were ordained,
from a religious order or lay, their faith tradition, membership of chaplaincy
organisations, and what hours they worked. Information was recorded in
tabulated form and in rank order.
It should be noted that percentages in this report have been rounded in
accordance with normal mathematical rules. Thirty seven surveys were
returned, resulting in one respondent being 2.7%; this was rounded to 3%. In
some cases, the low numbers in some categories, such as the chaplain’s faith
tradition, made a meaningful sub-category statistical comparison difficult.
Due to the descriptive247 nature of the project and the size of the study
population, analysis did not include consideration of the denominational
perspectives of the respondents or whether they worked full-time, part-time or in
a voluntary capacity. Other issues also not considered include insights from the
perspectives of lay or ordained, gender, age or hours worked.
247 W. Lawrence Neuman, Social Research Methods; Qualitative and Quantitative Approaches, 6th ed. Pearson, Boston, 2006: 34., Penny Webb, Chris Bain, Sandy Pirozzo, Essential Epidemiology: An Introduction for Students and Health Professionals, Cambridge University Press, New York, 2005: 119-121., Polgar and Thomas, 19, 292.
36
3.5 Qualitative Analysis
Thematic analysis was used to interpret the qualitative component in this
project.248 The thematic analysis method required the researcher to
systematically identify themes and key patterns within the data after carefully
reading the responses many times to develop familiarity with its contents.249
This process involved the reduction or breaking down of the data into concepts,
categories or themes.250 The themes that emerged from the data were sorted
and coded for further analysis.251 The thematic code was subsequently
checked for reliability in consultation with the supervisor and the NRO of the
AHWCA.
Boyatzis identified three approaches for qualitative analysis, theory driven
(deductive), data driven (inductive)252 and a combination or hybrid253. A hybrid
approach was chosen which had the advantage of providing a triangulation to
enhance the validity of the research.254 The hybrid approach was achieved by
the initial analysis of the data using an inductive approach where themes or
patterns were identified and coded. The researcher combined the HCCG and
PIC to provide a more comprehensive description of chaplaincy than was
possible with each alone. This combination of the two theories into the Clinical
Pastoral Code (CPC) was then applied to the data as the deductive approach.
248 Boyatzis, 3. 249 Matthew B Miles and A. Michael Huberman, An Expanded Sourcebook: Qualitative Data Analysis, 2nd ed. Sage Publications, Thousand Oaks, 1994: 9. 250 John McLeod, Qualitative Research in Counselling and Psychotherapy, Sage, London, 2005: 73., Boyatzis, 4. 251 Boyatzis, 5, 11., Swinton and Mowat, 44. 252 Boyatzis, 44. 253 Boyatzis, 52. 254 Boyatzis, 150.
37
It is important to note that at all times the researcher was actively involved in
identifying the themes or patterns255 and that a specific research question was
being explored.256 It is important to acknowledge that the researcher brought a
theological formation and pastoral perspective to the data. Awareness and
recognition of such a ‘filter’ was important in overcoming the problem of
projection in thematic analysis where the researcher’s ideology can be read into
the data.257 I have attempted to mitigate against this filter by discussion with my
supervisors and other colleagues. Any bias was further reduced by the
inductive analysis results being checked by the deductive analysis.258
The thematic analysis began with reading the data and continued with theme
identification and labelling or coding.259 In the analysis process, key themes or
patterns were identified from the chaplains’ responses. These key themes were
clustered or grouped to provide a clear and concise description that conveyed
the essence260 of the chaplains’ understanding and practice of their role. The
themes were then grouped and a label or code developed. 261 In this process it
was important for the researcher to be rigorous in considering the logic and
plausibility of the grouping and coding used. 262
255 Virginia Braun and Victoria Clarke, “Using Thematic Analysis in Psychology”, Qualitative Research in Psychology, 2006: 80. 256 Braun and Clarke, 84. 257 Boyatzis, 12. 258 Miles and Huberman, 56. 259 Miles and Huberman, 56. 260 Boyatzis, 31, 138., Braun and Clarke, 86. 261 Boyatzis, 4., Miles and Huberman, 51. 262 Miles and Huberman, 256.
38
It is recognised that qualitative analysis is a description of the reality as the
participant sees it, of the phenomenon being considered.263 Throughout the
analysis patterns emerged and differences became evident264 and multiple
meanings identified.265 The richness of the qualitative approach is that while
themes and key patterns are identified, individual ‘voices’266 or alternative
responses can surface and be highlighted. In the qualitative process
significance is not based on the number of responses alone.267
The literature search identified variations between the HCCG and the PICs and
it became evident that a more complete picture of chaplaincy would be provided
if they were combined for the deductive component of the analysis. This
Chaplaincy Practice Code (CPC) was developed by combining the similar
categories of the HCCGs and PICs and identifying the categories that
remained. The use of this combined code of the PICs and the HCCGs allowed
a more complete analysis of the data and enhanced the validity.
The table below outlines how the HCCGs and PICs were combined to provide
the CPC.
263 Ian Dey, Qualitative Data Analysis, Routledge, London, 1993: 177. Swinton and Mowat, 44. 264 Braun and Clarke, 86., Dey, 177. 265 Anthony G. Tuckett, “Applying Thematic Analysis Theory to Practice”, Contemporary Nurse, 2005, 19: 76. 266 Jane F. Gilgun, “‘Grab’ and Good Science”, Qualitative Health Research, 2005, 15, no2: 256., Boyatzis, 30. 267 Boyatzis, 129.
39
Table 4: Pastoral Code: Combination of the AHWCA Guidelines and the PICs
Health Care Chaplaincy Guidelines
lCD Pastoral Interventions
Chaplaincy Practice Code (CPC)
Identify and assess needs for chaplaincy provision (institution)
Identify Chaplaincy Need
(ICN)
Identify and assess needs for chaplaincy provision268 (patient)
Pastoral assessment
Pastoral Assessment (PA)
Manage and develop a chaplaincy service
Manage Develop Chaplaincy
(MDC)
Provide opportunities for worship and religious expression
Pastoral ritual or worship
Ritual Worship
(RW)
Provide pastoral care, counselling and spiritual direction
Pastoral counselling or education Pastoral ministry269
Pastoral Counselling Education
(PCE)
Provide an informed resource on ethical, theological and pastoral matters
Pastoral education Ethical/Educational Theological resource
(ETR) Provide pastoral care
Pastoral ministry Pastoral Ministry (PM)
Allied Health
Intervention (Pastoral Care)270
Pastoral Care (PC)
The development of CPC required an assessment by the researcher regarding
the application of the different terms used to describe a role practised in
different contexts. The main focus of the HCCGs is to describe the work of a
health care Chaplaincy Department while the focus of the PICs is to identify the
ministry of chaplains to patients. In developing the CPC an assessment of the 268 The category ‘Identify and assess needs for Chaplaincy provision’ is included twice as it applies to both an institutional role and a patient centred role. 269 The PIC pastoral ministry code (PM) is included twice as it applies to two of the HCCGs. In the CPC PM is used to code the provision of pastoral care that does not contain pastoral counselling or spiritual direction. 270 The Allied Health Intervention (Pastoral Care) in the PICs is used to identify multiple pastoral interventions in the same visit. As the purpose of this project is to describe the chaplains’ role, this overall code is not used in the analysis.
40
different terms used to describe similar roles or practice was required. For
example, ‘pastoral care’ and ‘pastoral ministry’ were combined for the PM code
while ‘identify and assess needs for chaplaincy provision’ was applied over the
ICN and PA codes. The combination of the HCCG and PIC to provide the CPS
provided a more comprehensive description of the chaplain’s role than they do
alone.
In the literature review additional chaplaincy roles to those included in the
AHWCA Guidelines and the PICs were identified. In the questionnaire,
participants were invited to comment on their role in a variety of ways including
identifying the most important role they fulfil and how they describe that role,
providing the chaplain’s viewpoint or ‘voice’.
3.6 Quantitative Analysis
The literature review identified nineteen chaplaincy ministry acts, roles or
practices. Chaplains were asked to rate the importance of their involvement and
satisfaction with these roles. They were also asked to indicate their involvement
in, and rate their experience of, the professional development opportunities and
hospital functions they attend, their sources of support and the environment of
hospital chaplaincy.
The quantitative data was entered into a Microsoft Excel spreadsheet for
analysis. Data for these questions was summarised and reported using
percentage and rank order collation. Again, it should be noted that percentages
in this report have been rounded for clarity. The summary of the statistics
provided descriptive information about how chaplains understand and practise
41
their ministry or role.271 At times, there were outliers in the statistical summary
that were not representative of the general pattern of responses and these were
discarded.272
Questions 23 to 25 listed nineteen specific chaplaincy roles and sought
responses to what chaplains thought was important, what they were involved in
and what they found satisfying. These responses were entered into the S-
PLUS® 8 Enterprise Developer statistics analysis program and the relationship
between the question responses was compared.273 Comparisons were made
between the responses of importance and involvement, importance and
satisfaction, and involvement and satisfaction.
To enhance the clarity of analysis and provide descriptive information for
analysis, the responses to questions that used a five point Likert scale were
collapsed or pooled either side of the mid-line.274 Questions 19 and 20 used a
three point Likert scale and did not require pooling. The pooled responses for
questions 21 to 25 are;
271 Kathy Eagar, Pamela Garrett and Vivian Lin, Health Planning: Australian Perspectives, Allen and Unwin, Crows Nest, 2001: 135., Barbara Schalk Thomas, Nursing Research, The C.V. Mosby Company, St. Louis, 1990: 153. 272 Geoffrey Keppel, Design and Analysis, Prentice-Hall, Englewood Cliffs, 1982: 392. 273 Keppel, 129. 274 Keppel, 130, 132.
42
Table 5: Pooled Responses for Questions 21 to 25
Question
Responses Pooled as
Question 21 - Ministry Environment
irrelevant not Important
not important
important very important
important
Question 22 - Experience very poor poor
poor
very good good
good
Question 23 - Importance
irrelevant not Important
not important
important very important
important
Question 24 - Involvement occasionally rarely
occasionally
regularly always
regularly
Question 25 - Satisfaction very dissatisfied dissatisfied
dissatisfied
satisfied very satisfied
satisfied
The analysis of chaplains’ responses follows in Chapter 4.
43
CHAPTER 4
RESULTS 4.1 INTRODUCTION The Heads of Christian Churches Chaplaincy Committee (HC4) provided
contact details of 50 Christian public hospital chaplains in South Australia. The
questionnaire was mailed to their hospital address and a return rate of 74%
(n=37) was achieved. The questionnaire was structured to collect demographic
data and qualitative and quantitative responses.
4.2 DEMOGRAPHIC RESPONSES Information regarding the respondent’s gender, age, length of service,
chaplaincy employment status (salaried or volunteer), educational history, and
hours worked was provided. Further information regarding their ordination,
religious or lay status, their faith tradition, and membership of chaplaincy
organisations was also elicited. Due to the number of respondents percentages
have been rounded in accordance with standard mathematical rules as one
respondent is 2.7% of returns.
To provide clarity, this information is presented below in tabulated form.
4.2.1 Gender:
Female 59% (n=22) Male 41% (n=15)
4.2.2 Age range:
51 – 60 43% (n=16) 61 -70 24% (n= 9) 71 + 22% (n=8) 41 – 50 11% (n=4)
44
4.2.3 Length of service in chaplaincy:
1-5 years 32% (n=12) 15 + years 24% (n=9) 6-10 years 22% (n=8) 11-15 years 16% (n=6) Less than 1 year 5% (n=2)
4.2.4 Chaplaincy employment status:
Volunteer 51% (n=19) Part-time – paid 30% (n=11) Full-time - paid 19% (n=7)
4.2.5 Formal education in chaplaincy: Respondents indicated that their formal education for chaplaincy included CPE,
68% (n=25), professional development, 62% (n=23), and other chaplaincy
training, 49% (n=18). There appears to be some confusion in the responses as
to what constitutes education for chaplaincy. Confusion exists due to a lack of
clarity among chaplains about what are appropriate chaplaincy qualifications
and allied disciplines such as counselling having some similarities in their
content and practice. For example, counselling studies which focus on loss and
grief or palliative care have been identified by respondents as both ‘chaplaincy’
and ‘other’ training. Psychology studies were also considered by one
respondent as aligned to chaplaincy yet others consider CPE and pastoral care
study as ‘other’ than chaplaincy training.
45
Chaplaincy Education
Yes ‘n’
No ‘n’
NA ‘n’
CPE
25
8
4
Professional Development* Counselling (including Loss & Grief and Palliative
Care) (n=13) Pastoral Studies/Theology (n=10) Workshop/Conferences (n=7) Mental health (n=2) Personal reading (n=2) Ministry/Chaplaincy supervision (n=2) Psychology degree (n=1)
23 3 11
Other* Counselling Palliative Care (n=7) Mental Health (n=1) Pastoral Care/CPE/ministry training (n=8) Registered Nurse (n=2) Workshop/Conference (n=2) Personal Reading (n=2)
* Note – a number of chaplains had undertaken more than one professional development activity.
18 1 18
4.2.6 Highest level of education obtained: Respondents indicated that in terms of religious or theological education, 49%
(n=18) hold a degree, graduate diploma or masters degree and 22% (n=8) a
diploma or certificate. Twenty two percent (n=8) indicated that they hold no
religious or theological qualifications and 8% (n=3) did not provide a response.
Secular qualifications attained by respondents indicated 49% (n=18) hold a
degree, graduate diploma or masters degree. A diploma or certificate was held
by 8% (n=3) and 8% (n=3) had no secular qualifications. Thirty two percent
(n=12) did not provide a response.
Overall, 41% (n=15) of respondents held both theological and secular
qualifications while 8% (n=3) held no religious or secular qualifications.
46
Qualification
Religious/Theological
‘n’ Secular
‘n’ Degree 10 9 No formal qualification 8 3 Diploma 5 1 Certificate 4 2 Masters 4 5 Graduate Diploma 3 5 Doctorate 0 0 NA 3 12
4.2.7 Ordained, Religious Order or Lay status:
Ordained, Religious Order, Lay
‘n’ %
Lay 18 51% Ordained 16 46% Religious Order 1 3% NA 2 5%
4.2.8 Faith Tradition: The two respondents indicated affiliation with a faith tradition while working in a
role sponsored by another.
Faith Tradition
‘n’ %
Uniting 10 27% Catholic 6 16% Anglican 5 14% Lutheran 5 14% Pentecostal 5 14% Other Christian Tradition (Anglican/Uniting) 2 5% Baptist 1 3% Churches of Christ 1 3% Adventist 1 3% Salvation Army 1 3%
4.2.9 Membership of professional organisations:
Chaplains were asked about which of the four major Australian chaplaincy
organisations they belonged. They were also provided the opportunity to list
and describe other affiliations under the ‘other’ heading. Responses indicate
that 68% (n=25) of the chaplains belonged to a professional organisation, with
47
19% (n=7) chaplains holding membership of more than one organisation. Forty
nine percent (n=18) were members of only one organisation.
The AHWCA was the largest chaplaincy organisation represented with 18
members. The ACC had four members all of whom were also members of the
AHWCA. The CPE association had four members of whom three were
members of the AHWCA with one of these also a member of the ACC. One
chaplain was a member of the CPE association only. The three members of
Chaplaincy Australia (CA) were only members of that organisation.
Membership of Professional Organisations
‘n’ %
Australian Health and Welfare Chaplains Association (AHWCA)
Also Members of ACC (n=4) Also Members of CPE (n=3) Also Members of Other (n=2)
18
49%
Other (please indicate) Pharmacy Society (n=1)
National Council of Priests (n=1) Counselling Association of SA (n=1) Australian Faith Nurses (n=1) Catholic Chaplains Association (n=1)
Also Members of AHWCA (n=2) Also Member of ACC (n=1) with no other affiliation (n=3)
5 14%
Australian College of Chaplains (ACC) All Members of AHWCA
4 11%
Clinical Pastoral Education Association (CPE) Also Members of AHWCA (n=3) Also Member of ACC (n=1) Also Member of CPE only (n=1)
4 11%
Chaplaincy Australia (CA) All 3 members of CA only
3 8%
4.2.10 Hours per week worked by respondents: Respondents were asked about the number of hours worked. Eight Chaplains
worked 40 or more hours per week. In general terms, the hours worked
reflected the number of part-time (n=11) and volunteer (n=19) chaplains in the
survey. Three full-time chaplains reported working a 48 hour week and three a
48
40 hour week. One part-time chaplain reported working 40 hours per week.
The hours worked by part-time chaplains varied from 8 to 40 hours per week
with the majority working 24 hours per week.
Hours worked
Total
‘n’ Volunteers
‘n’ Part-time
‘n’ Full-time
‘n’
%
Less than 8
14
14
38%
8 5 3 2 14% 24 6 6 16% 40 5 1 4 14% 16 3 2 1 8% 48 3 3 8% 32 1 1 3%
4.3 QUALITATIVE RESPONSES The questionnaire provided the opportunity for respondents to provide
qualitative information about their role. Questions explored chaplains’ attitude
to their role including what they believed was important, the roles they were
involved in and those that caused them frustration. The opportunity was also
given for them to consider what changes they would like to make.
Chaplains were also invited to indicate the image or metaphor that they use to
describe their role and any biblical story or text that motivated their ministry.
Observation was invited on the difference between hospital and church or
parish ministry roles. An invitation was also given to provide a description of
their role.
The inductive code developed from the data is in Table 6.
49
Table 6: Qualitative Codes
Inductive Code (IC)
Label
Description
Attend
Attending to patients - receiving from them, discerning patient issues
Engage Interacting with patient – exploring issues with patient, relationship building, responding to patient, relational initiative by chaplain.
Provide Clinical intervention – provide support to/for patient, intentional action (intervention) by chaplain to or for patient, referral.
Ritual Religious/Spiritual observance - recognition of life journey, celebration/worship, spiritual connection and nurture, activities sustaining and supporting faith.
Lead Pastoral/Chaplaincy department - team issues, leadership of pastoral care.
Administration
Administrative tasks, administering pastoral care, accountability, funding issues.
Personal The chaplain’s feelings regarding role, relationships with patients and staff, issues that the chaplain felt uncomfortable dealing with.
Time Time and workload pressures.
Team Team dynamics, working together, training, ecumenical issues.
Church Church polity, disinterested church/clergy.
Facilities Hospital (workplace) environment issues, space, chairs.
Initiative Strategic thinking and planning, development and application of new ideas.
Immediacy The nature of chaplaincy including crisis and trauma, short term patient contact, the intensity of the role.
Structure The setting of the hospital including the clinical focus, team issues, being the patients’ guest.
Relational Personal contact in which a lack of connection, support, or acceptance is experienced.
Same No difference between church and chaplaincy ministry.
It is important to note that in questions 11, 12 and 13, chaplains were afforded
the opportunity to provide three responses to each question. Respondents’ first
50
answer appeared to be the key issue for them with consequent responses
possibly reflecting a process of pastoral care provision by the chaplain.
In the analysis the initial focus was an inductive approach with the development
of codes from the thematic analysis of the responses. Following this analysis a
deductive approach was applied to the data using the CPC creating a hybrid
analysis.
4.3.1 Role Importance This question explored what chaplains consider to be their most important
chaplaincy ministries/roles/actions. Their responses and the coding is attached
at Appendix 4. Codes identified from respondents to question 11 included
Attend, Engage, Provide, Ritual, Lead, and Administration.
Important - First Response The majority of first responses, 62% (n=23), indicated that the themes coded
under the ‘Attend’ label were most important. This category included responses
such as ‘visiting’, ‘listening’, ‘being present’ and ‘conversation’.
The ‘Engage’ label 16% (n=6) included responses with a themes of connection,
‘sharing’ and ‘discernment’. ‘Counselling’, ‘spiritual support’, ‘advocacy’ and
‘encouragement’ were coded ‘Provide’, with 11% (n=4) of responses. ‘Prayer’,
‘ritual’ and ‘sacraments’ were considered by 14% (n=5) of chaplains to be their
most important role. This was coded as ‘Ritual’. The role chaplains have in
providing support to staff was identified by 5% (n=2) of respondents in terms of
‘visiting’ and ‘pastoral care’ and were coded as ‘Attend’ and ‘Provide”.
51
The response, ‘aged care’ is outside the scope of this research. While public
hospitals have a large aged patient population, aged care is a separate area of
chaplaincy. This response was therefore excluded from the coding.
Important - Second Response The second responses indicate the chaplaincy interventions of ‘Ritual’ 30%
(n=11) and ‘Provide’ 27% (n=10) being of next importance to respondents.
‘Lead’ 14% (n=5) indicates that chaplains provide support to other chaplains
and/or patients through the facilitating groups, eg CPE.
Important - Third Response
The third response continued the theme of developing pastoral care with the
responses of ‘Ritual’ 32% (n=12) and ‘Provide’ 22% (n=8) chaplaincy roles.
‘Administration’ 8% (n=3) was identified as an issue with roles of reporting to the
full-time chaplain, involvement in hospital committees and chaplaincy
department administration.
52
Table 7: Important Chaplaincy Ministries
IC CPC
1st
Response ‘n’
2nd Response
‘n’
3rd Response
‘n’
Total ‘n’
Attend
23 8 6 37 PA 40
Ritual
5 11 12 28 RW 29
Provide 4 10 8 22 PM 27 Engage
6 6 4 16 PCE 10
Lead
5 4 9 MDC 10
Administration
3 3
NA
2 2 NA 2
Not Coded Not Coded
1
Totals 38 40 39 117 The responses chaplains provided about what they believed to be important
centred on the care of patients and families and their care as indicated in the
priority of the ‘Attend’ code (n=37). Sustaining and supporting patients’ faith,
‘Ritual” (n=28), was also important as was the chaplain’s pastoral intervention,
‘Provide’ (n=22). A number of chaplains, 16% (n=6), specifically included staff
as recipients of their care. The themes in the responses to this section are
mainly person centred and relational. Leadership and administration are
mentioned as important and are related to training and overseeing the
chaplaincy team or relating to the wider hospital.
The patient care focus indicated is evident in the application of the CPC. The
first three pastoral interventions were assessment, ritual and worship, and
ministry. These correspond with the categories in the codes.
53
4.3.2 Role Frustration
Question 12 invited chaplains to identify the ministries/actions/roles that
frustrated them. The coded responses are attached at Appendix 5. Codes
identified from the responses found that Chaplains’ frustration related mainly to
the quality of their relationships with patients and staff, and the organisation and
structure of chaplaincy departments. A number of respondents did not answer
this question.
The ‘Personal’ code identified chaplains’ frustration around their relationship, or
not, with patients and staff and of not knowing the outcomes for patients.
Responses identified as ‘Team’ reported on the relationships within the
chaplaincy team. The codes of ‘Time, ‘Administration’, ‘Church’ and ‘Facilities’
reflected structural issues either in the chaplaincy teams operation or outside
influences on the chaplain’s role.
Frustration - First Response
The first response indicated that the themes coded under ‘Personal’ (32%
(n=12)) caused chaplains the most frustration. Responses included ‘people not
interested’, ‘not seeing results’, ‘divided families’, and ‘chaplains ignored’.
The ‘Administration’ category 30% (n=11) included responses about the
administrative load and funding issues. ‘Statistics’, ‘administration creep’, ‘not
enough resources’, and ‘lobbying for funding’ were reported as frustrations.
‘Team’ 11% (n=4) identified frustrations associated with the leadership of the
chaplaincy team, a lack of volunteer chaplains, training issues and a desire to
54
work ecumenically. Responses coded as Team were ‘team leadership’, ‘lack of
volunteers to pastorally care’, and ‘seeking to bring about ecumenical structure’.
The pressure of time and workload 8% (n=3) such as ‘patients not available’
and ’24 hour demands’ were coded under the ‘Time’ label. The adequacy of
facilities was also a frustration for chaplains 5% (n=2) and was coded as
‘Facilities’. The lack of space for privacy and spirituality and ‘not having an
adequate chapel’ were coded as Facilities.
Chaplains’ first response could be divided into issues relating to patients, 30%
(n=11) and those that related to administrative issues 57% (n=21), 14% (n=5)
provided no response and one response was unable to be coded.
Frustration - Second Response
Frustrations coded as ‘Personal’ were also the highest second response, 24%
(n=9). Increases were noted in the responses coded ‘Time’ 14% (n=5) and
‘Team’ 14% (n=5). ‘Administration’ 11% (n=4) and ‘Facilities’ 3% (n=1)
remained as issues. Chaplains frustration with a lack of recognition by
churches and an inability to share the Eucharist emerged and was coded as
‘Church’ 8% (n=3).
The pattern noted in the first response that chaplains’ frustrations focused on
relationships with patients and administrative issues were again evident.
Twenty two percent (n=8) of responses related to patients and 46% (n=17)
related to other issues. There was an increase of no response to 32% (n=12).
55
Frustration - Third Response
In the third response ‘Time’ 16% (n=6) increased as a frustration while ‘Church’
8% (n=3), ‘Administration’ 11% (n=4) and ‘Facilities’ 3% (n=1) continued at the
same level as in the second response. Responses in the ‘Personal’ 14% (n=5)
and ‘Team’ 3% (n=1) codes declined. Chaplains not providing a response
increased 49% (n=18) in this round.
Table 8: Role Frustration
IC CPC
1st
Response ‘n’
2nd Response
‘n’
3rd Response
‘n’
Total ‘n’
Personal
12 9 5 26 MDC 41
Administration
11 4 4 19 ICN 27
Time
3 5 6 14 PA 12
Team
4 5 1 10 PM 5
Church
0 3 3 6 ETR 3
Facilities
2 1 1 4 PCE 3
RW 3
Not Coded 1 Not Coded
5
NA
5 12 18 35 NA 35
Totals 37 39 38 114
Chaplains’ responses about their frustrations provide an insight into their
understanding of their role. There were 35 no answers which comprised the
largest response to this question. Responses coded ‘Personal’ (n=26) were
about the chaplains response to rejection by patients or staff. These responses
are indicative of the relational nature of chaplains and complement the
importance they placed on providing care in question 11.
56
‘Administration’ caused chaplains frustration (n=19) while issues of ‘Time’
(n=14) and ‘Team’ (n=10) were evident along with ‘Church’ (n=6) and ‘Facilities’
(n=4). Throughout this question the ‘no answer’ response increased, indicating
that there were some clear and specific frustrations and once named responses
tapered off.
The application of the CPC to question 12 indicated that MDC is the highest
level of frustration, with the codes of ‘Team’, ‘Time’ and ‘Personal’ issues coded
under this item. There is a blending of ‘Team’, ‘Time’ and ‘Facilities’ in the ICN
code. Five responses were unable to be identified using the CPC. Again, the
descriptors used to code this question and the CPC are consistent.
4.3.3 Chaplaincy Changes
In question 13, chaplains were invited to provide comment on how they would
they would like to see chaplaincy change. The coded responses are attached
at Appendix 6. Responses were coded as ‘Team’, ‘Administration’, ‘Personal’,
‘Facilities’, ‘Time’, ‘Church”, ‘Provide’ and ‘Initiative’.
Chaplaincy Changes - First Response
The majority of first responses identifying areas in which chaplains want to see
a change were ‘Team’ 24% (n=9) and ‘Administration’ 24% (n=9).
Responses coded under ‘Team’ contained issues about team leadership
including ‘better supported by team leader’ and ‘value the sense of team a little
higher’. Other responses coded as ‘Team’ focused on ecumenical issues.
57
Eight percent (n=3) wanted an ecumenical team model of chaplaincy and 3%
(n=1) a denominational approach. Also coded as ‘Team’ was the response ‘we
should be there for all, not just Christians’.
Responses coded as ‘Administration’ included ‘better communication’,
‘secretarial support’, and ‘more time funded’. ‘Valued by hospital staff’, and
‘meeting the needs of all people’ were coded as ‘Personal’ 14% (n=5) while
‘opportunity to follow-up initial visit’, ‘more energy by the end of the week’, and
‘more contact with patients’ were coded as ‘Time’ 14% (n=5).
The comment coded as ‘Facilities’ 3% (n=1) was about patient privacy and the
response coded ‘Church’ 3% (n=1) related churches notifying chaplains when
parishioners are hospitalised. Coded as ‘Provide’ 8% (n=3) was the response
‘support to staff members’.
Chaplaincy Changes - Second Response
The second response again indicated ‘Team’ 27% (n=10) and ‘Administration’
22% (n=8) as roles chaplains want to see operate differently. The ‘Personal’
11% (n=4) and ‘Time’ 11% n=4) and ‘Facilities’ 3% (n=1) remained constant
while ‘Church’ 5% (n=2) recorded an increase.
‘Initiative’ 3% (n=1) identified a desire for change with the response ‘opportunity
to put new ideas in place’.
58
Chaplaincy Changes - Third Response
The third response continued the pattern of the first and second responses
around issues of ‘Team’ 19% (n=7), ‘Administration’ 11% (n=4), ‘Time’ 11%
(n=4), ‘Church’ 3% (n=1), ‘Personal’ 3% (n=1) and ‘Initiative’ 3% (n=1).
Table 9: Chaplaincy Changes
IC CPC
1st
Response ‘n’
2nd Response
‘n’
3rd Response
‘n’
Total ‘n’
Team
9 10 7 26 MDC 42
Administration
9 8 4 21 ICN 19
Time
5 4 4 13 PM 4
Personal
5 4 1 10
Church
1 2 1 4
Provide
3 0 0 3 PM 3
Facilities
1 1 0 2
Initiative
0 1 1 2 ICN 2
Not Coded
1
NA
7 15 23 45 NA 45
Totals 37 44 40 121 The main issues chaplains highlighted by respondents for change were in the
areas of ‘Team’ (n=26) and ‘Administration’ (n=21) and ‘Time’ (n=13). Seven
respondents indicated a preference for an ecumenical chaplaincy team with one
preferring a denominational model.
Within this coding there were ‘voices’ that spoke of an integration of chaplaincy
within the hospital, the development of initiatives including specialisation, and
the issues of professional development and job security. There were also
59
responses related to chaplains providing care to staff and to patients who were
not Christian. The issue of funding evident in chaplains’ frustrations in question
12 was also here.
The largest overall response was no answer possibly indicating that a number
of chaplains are satisfied with their current role.
As the CPC was applied to this question it was found that the changes that
chaplains wanted to see in chaplaincy practice were predominantly in the MDC
and ICN categories, which included the integration and initiatives noted above.
One response was not able to be coded using the CPC.
4.3.4 Image or Metaphor
This question explored the pictures chaplains have of their role and offers an
insight into how they describe their involvement in chaplaincy. Images or
metaphors to describe what they do were provided by 86% (n=32) of the
respondents. Fourteen percent (n=5) of respondents did not answer this
question. A number of respondents offered more than one image to describe
their role. The responses and analysis is included in Appendix 7.
Respondents identified images from biblical, pastoral and life sources. Biblical
stories or images identified included the narratives of the sower, the boat in the
storm with Jesus walking on water, and Jesus healing people. Alongside these
were the images of the servant and the shepherd. Pastoral images comprised
metaphors such as ‘accompanying’, ‘being present’, ‘standing or being
alongside’, ‘friendship’ and ‘bringing the Christ light’. ‘Loitering with intent’, ‘an
60
ambulance service’, ‘ear linked to heart’, ‘a host’, and ‘prospector/miner’ were
some of the life images respondents used to describe their role.
Codes identified from responses to question 14 included ‘Attend’, ‘Provide’,
‘Engage’, and ‘Ritual’.
Table 10: Image or Metaphor
IC CPC
Attend
19
PM
23
Provide
16 PA 18
Engage
7 NA 5
Ritual
4 PCE 2
NA
5 RW 4
Images or metaphors coded ‘Attend’ (n=19) included responses such as ‘being
Christ’, ‘being present’, ‘stand alongside’ and ’meeting people where they are’.
The ‘Provide’ (n=16) code responses included ‘offer support’ and ‘hand on to
appropriate provider’. ‘Spiritual companioning’, and ‘building a warm caring
relationship’ were coded ‘Engage’ (n=7), while ‘pray and share’ and ‘pray for
their recovery’ were coded ‘Ritual’ (n=4).
The application of the CPC indicated that the images or metaphors used by
chaplains were predominantly in the ministry and assessment categories.
Again this mirrors the application of the codes as well as offering an insight into
the motivation of chaplains who indicate in Question 11 that the most important
roles are relational.
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4.3.5 Biblical Story or Text
A motivating biblical story or text was provided by 95% (n=35) of the
respondents and 5% (n=2) did not provide an answer. A number of
respondents offered more than one story or text to describe their role. The
responses and analysis is included in Appendix 8.
A number of biblical stories were mentioned by respondents, sometimes texts
were given with a description, at other times a biblical concept was offered.
Stories identified by a number of respondents were the healing ministry of
Jesus including the woman with a haemorrhage275, the woman at the well276,
the Emmaus road277, the Good Samaritan278, Jesus blessing the children279, the
visit to Zaccheaus’ house280, and Jesus accompanying or being with people.
Also mentioned were the words of Jesus about having faith to move
mountains281, Jesus weeping282, the final judgement283 and the parable of the
talents284.
Question 15 responses were coded “Provide’, ‘Ritual’, ‘Engage’, ‘Lead’, and
‘Attend’.
275 Luke 8:43-48 276 John 4:4-26 277 Luke 24:13-35 278 Luke 10:25-37 279 Mark 10:13-16 280 Luke 19:1-10 281 Mark 11:23 282 John 11:35 283 Matthew 25:31-46 284 Matthew 25:14-30
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Table 11: Biblical Story or Text
IC
CPC
Provide
19
PM
28
Ritual
16 RW 16
Engage
15 PCE 11
Lead
6
PA 5
Attend
5
NA
2 NA 2
‘Provide’ (n=23) was used to code the largest category of responses including 2
Corinthians 1:3-11 ‘the God of all comfort’ and Matthew 14:13-21 ‘feeding the
five thousand and healing the sick’. Responses coded ‘Engage’ (n=14) were
‘Jesus companioned others’ and ‘the people Jesus met and spent time with’.
The ‘Attend’ code (n=10) identified responses such as ‘Jesus staying at the
house of Zaccheaus’ and ‘Jesus meeting with, accepting people’. ‘Ritual’ (n=3)
included ‘Jesus love, healing power, importance of prayer’ and the blessing of
the children in Luke 18:15-17 as responses. The ‘Lead’ (n=4) code was applied
to responses that focused on Jesus directing the disciples to ‘go and tell’ in
Matthew 28:18-20 and sending the ‘disciples out in pairs’ in Luke 10:1-2.
There were 54 biblical stories or texts reported with the majority, 45 related to
the ministry of Jesus. Other responses included ‘the whole of Jesus’ life
motivates me’, ‘stories of people being with Jesus’, and ‘the incarnation’.
Again the application of the CPC largely complement the codes with PM
drawing together most of the images and metaphors coded under ‘Provide’ and
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‘Engage’. There remains a care focus, a ‘doing for’ in the images and
metaphors consistent with the relational attitude of the chaplains.
4.3.6 Chaplaincy – Church Differences
Ninety one percent (n=34) of the respondents addressed this question, 3%
(n=1) did not provide a response. Respondents who identified that the hospital
chaplain’s role was the same as the parish minister, priest or lay worker were
8% (n=3) and those who indicated that it is different were 81% (n=30). The
responses and analysis is included in Appendix 9.
The thematic analysis of this question identified responses that were coded
‘Structure’, ‘Immediacy’, ‘Relational’ and ‘Same’.
Table 12: Chaplaincy – Church Differences
IC
CPC
Structure
19
PM
27
Immediacy
14 PA 14
Relational
14 PCE 6
RW
4
Same
3 ICN 3
MDC
1
Un-coded
3 Un-coded 6
N/A
1 NA 1
The difference in role was seen in a variety of ways which included the
immediacy of chaplaincy, the structure of hospital chaplaincy ministry and its
relational nature.
64
Responses coded as ‘Structure’ includes aspects of patient care, clinical focus,
predictability, teamwork, and the hospital’s organisational requirements.
Respondents identified that they were a guest or visitor in the patient’s personal
space. Coded under ‘Structure’ was a sense of being ‘often not in control’, the
hospital’s ‘clinical focus’ and that ‘parish ministry can be more defined and have
predictable events’ and that there is ‘more accountability’ in the hospital. Also
identified were chaplains ‘working as part of a team’, in a ‘secular environment’,
and ‘working ecumenically’. The different nature of administration that hospital
chaplains engage with compared with church ministry was reported, in
particular a difference in administration and meeting requirements.
Issues coded as ‘Immediacy’ included the short term nature of the role,
involvement in crisis, and the intensity of hospital chaplaincy. This was
reflected in responses such as ‘no follow-up outside hospital’, ‘only see people
once’, and ‘working very much in the ‘present moment’’. Responses also coded
“immediacy’ included the crisis and acute setting of the hospital and the
intensity of the chaplaincy role.
While similar to ‘Immediacy’ and ‘Structure’, the ‘Relational’ code identified the
need for chaplains to develop a pastoral relationship in a short time period. The
‘Relational’ code was applied to ‘entering their personal space’ and ‘build a
rapport’ ‘.
The respondents who indicated that the role was the ‘Same’ as church ministry
reported that ‘it is one and the same’ and an ‘extension of the priestly role’.
65
In analysing the question 16 responses with the CPC the responses coded
‘Structure’, ‘Immediacy’ and ‘Relational’ are similar in content to PM and PA.
Despite this agreement, the inductive code emphasises the difference more
clearly than the CPC are able to. Six responses were not able to be coded by
the CPC. Overall, respondents described difference between church ministry
and hospital chaplaincy.
4.3.7 Description of Role – no church background
A description of their ministry was provided by 95% (n=35) of the respondents
with a number offering more than one. Five percent (n=2) did not provide a
response. The responses and analysis is included in Appendix 10.
The codes identified from responses to question 17 were ‘Attend’, ‘Provide’,
‘Engage’, and ‘Ritual’.
Table 13: Description of Role – no church background
IC
CPC
Attend
28
PM
32
Provide
21 PA 18
Engage
20 RW 14
Ritual
15 PCE 9
Un-coded
1 Un-coded 1
N/A
2 NA 2
The majority of responses (n=28) were coded as ‘Attend’ and included
responses such as ‘I visit as a friend and offer a listening ear’, ‘caring for
people’, ‘I have a role of being available to talk’ and ‘provide a friendly, non-
66
judgemental presence for patients’. Responses of ‘offer care and support’,
‘assisting in establishing contacts’ and ‘offer personal and spiritual support’
were coded as ‘Provide’ (n=21). The ‘Engage’ (n=21) was applied to responses
such as ‘have an ear to listen to their stories’, ‘discern what is most important to
them’, and ‘connect where the patient is at’. ‘Offer prayer support, spiritual
guidance and sacramental liturgies’ and ‘praying for the sick’ were coded as
‘Ritual’ (n=15). One response was unable to be coded.
In describing their role respondents indicated that they attend to patients by
listening and being present. Providing support to and engaging with patients
was articulated as was prayer and sacrament. Respondents identified providing
support for hospital staff and patients of no identified faith.
The focus of respondents on relational care is reflected in coding the responses
using the CPC. PM and PA describe most of the responses and the provision
of prayer and sacrament is evident in RW. The comparison of the codes
indicates a consistency in them.
4.3.8 Description of Role – church background
A description of their role that respondents use with people within the church
was provided by 92% (n=34). A number of respondents offered more than one
description for their role while 8% (n=3) did not provide a response. The
responses and further analysis is included in Appendix 11.
Codes identified from the responses to question 18 include ‘Attend’, ‘Provide’,
‘Engage’, and ‘Ritual’.
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Table 14: Description of Role – church background
IC
CPC
Attend
23
PM
31
Provide
21 RW 19
Engage
17 PA 14
Ritual
17 PCE 14
MDC
1
N/A
3 NA 3
‘Attend’ (n=23) was the largest coded response and included ‘I visit people in
hospital’, ‘I journey alongside others’ and ‘provide a friendly presence’.
Responses such as ‘encourage, bring hope’, ‘assist them to find comfort,
support and connectedness’, ‘offer care ... no matter their religious
background/spirituality’, and ‘look after their spiritual needs including connection
with their faith community’ were coded as ‘Provide’ (n=21). The ‘Engage’
(n=17) code contained responses such as ‘hear their story and reflect with
them’, and ‘meeting people where they are in their journey’. ‘Offer to pray’,
‘read the bible and pray’, and ‘offer…prayer and sacraments’ were coded as
‘Ritual’ (n=17)
The responses to this question again indicate that chaplains identify their role in
relational terms. Attending to patients, providing them care and support,
engaging with them, and providing faith support through ritual were main
themes. Support for hospital staff was mentioned in responses to this question
as being part of the chaplain’s role.
68
The application of the CPC to the responses identified the PM, RW, PA and
PCE codes. These codings are again similar in content and emphasis to
‘Attend’, ‘Provide’, ‘Engage’ and ‘Ritual’.
4.3.9 Summary of Quantitative Analysis
What is evident from the analysis is that the emphasis of chaplains’ practice is
person centred and relational. What they consider to be important is visiting
and listening to patients, providing a ministry of care and prayer. Frustrations
that chaplains encounter are largely organisational and structural. Included in
the frustrations are issues related to the chaplaincy team and the support of the
church. A desire for a difference in chaplaincy is largely limited to the
organisational, structural and team issues. Integration into the hospital, taking
initiative, professional development and job security are identified as frustrations
by a few as is the role of staff support.
A variety of images were suggested to ‘picture’ chaplaincy, those that chaplains
used to described their ministry were again relational and person centred.
Within this relational model they offered images that provided care to the other.
When asked to indicate the contrast between parish and hospital ministry the
public hospital environment was described as more immediate in terms of
response to patients and developing relationships with them. At the same time
the structure was one where often a patient was only seen once, while the
internal workings of the hospital were recognised as being different from that of
a parish.
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4.4 QUALITATIVE ANALYSIS
Chaplains were also invited to indicate the sources of their personal support,
professional development and their ministry environment and to nominate the
value that they placed on these in questions 19 to 22. Responses to these
questions were reported with a number count and percentage based on the
number of responses to each question. They are reported in rank order.
Questions 23 to 25 asked respondents to rate the importance of nineteen
chaplaincy roles and indicate their involvement and satisfaction with these roles.
The S-PLUS® 8 Enterprise Developer statistical analysis program was used to
analyse questions 23 to 25.
4.4.1 Personal Support
Table 15: Sources of Personal Support
Sources of Personal Support (non financial)
Received
%
Helpful
%
Not Helpful
%
Not Answered
%
Chaplaincy Colleagues – in the hospital I work in
Yes 95% (n=35)
No 5% (n=2
89%
(n=31)
0
16% (n=6)
Chaplaincy Colleagues – outside the hospital I work in
Yes 76% (n=28) No 24% (n=9)
89% (n=25)
4% (n=1)
30% (n=11)
Fellow Pastors/Ministers/Clergy Yes 68% (n=25) No 32% (n=12)
84% (n=21)
8% (n=2)
39% (n=14)
Hospital staff Yes 59% (n=22) No 41% (n=15)
95% (n=21)
0 43% (n=16)
Spiritual Director Yes 51% (n=19) No 49% (n=18)
84% (n=16)
0 57% (n=21)
Other (please list) Family (8) Friends (7) Church (5) Supervisor/Counsellor (2)
Yes 43% (n=16) No 57% (n=21)
94% (n=15)
0 59% (n=22)
No Support Received
Yes 3% (n=1) 97% (n=36)
70
Respondents indicated that they received most of their support from chaplaincy
colleagues both in the hospital in which they worked, 95% (n=35) and from
other chaplaincy colleagues 76% (n=28). Ministry colleagues were the next
most supportive, 68% (n=25), followed by hospital staff 59% (n=22). Fifty one
percent (n=19) had a spiritual director, while family, friends and church supports
were nominated by 43% (n=16).
Of the respondents receiving personal support, most found it helpful. Of these,
hospital staff were the most helpful 95% (n=21) followed by family and friends,
94% (n=15) and chaplaincy colleagues, 89% (n=31).
71
4.4.2 Professional Development
Table 16: Professional Development Professional Development
Involvement In Value
Yes
%
No
%
No Value
%
Undecided
%
High Value
%
NA
%
Conferences – chaplaincy (n=37)
70% (n=26)
30% (n=11)
15% (n=4)
81% (n=21)
32% (n=12)
Focused reading and reflection
(n=37)
59% (n=22)
41% (n=15)
5% (n=1)
86% (n=19)
46% (n=17)
Conferences – church (n=37)
51% (n=19)
49% (n=18)
5% (n=1)
5% (n=1)
58% (n=11)
49% (n=18)
Personal Supervision (n=37)
32% (n=12)
68% (n=25)
8% (n=1)
92% (n=11)
68% (n=25)
Continuing Education Program
(n=37)
30% (n=11)
70% (n=26)
55% (n=6)
55% (n=6)
68% (n=25)
CPE (n=37)
22% (n=8)
78% (n=29)
1 100% (n=8)
76% (n=28)
Study Groups (n=37)
22% (n=8)
78% (n=29)
13% (n=1)
75% (n=6)
81% (n=30)
Other (please list) Life issues conference Drug and Alcohol rehabilitation training Pastoral care at church CPE Supervisor accreditation Overseas study leave Reading
(n=36)
16% (n=6)
81% (n=30)
83% (n=5)
89% (n=32)
Academic Study (n=37)
14% (n=5)
86% (n=32)
100% (n=5)
86% (n=32)
The respondents indicated that their involvement in professional development
included formal and informal methods such as conferences and focused
reading. The setting for professional development was both individual,
including personal supervision, and groups such as continuing education
programs.
72
While the ranking of responses is by the involvement of respondents in
professional development, it is informative to note the value ranking they placed
on the formats available to them. In the value ranking the order is CPE,
personal supervision, focused reading and reflection, other, chaplaincy
conferences, study groups, church conferences and continuing education
programs. It is noteworthy that the first three in the value ranking focus on
personal development and that the professional development in group settings
is generally ranked as less valuable.
4.4.3 Environment of Hospital Chaplaincy
Table 17: Hospital Chaplaincy Environment
Ministry Environment
Irrelevant/Not Important
Undecided Important/Very Important
Team vs. Individual
Working as a member of the chaplaincy team (n=37)
46% (n=17)
54% n=20)
Working as an individual chaplain
(n=35)
29% (n=8)
3% (n=1) 1
74% (n=26)
Ecumenical vs. Denominational
Ecumenical Chaplaincy (n=36)
8% (n=3)
92% (n=33)
Denominational Chaplaincy
(n=34)
32% (n=11)
9% (n=3) 3
59% (n=20)
Respondents reported that they have a preference for working as an individual
chaplain, 74% (n=26) while at the same time indicating that ecumenical
chaplaincy is also important to them, 92% (n=33). A lower response was
reported for working in a team with 54% (n=20) seeing it as important with an
almost equal number, 46% (n=17) seeing it as not important. The question of
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denominational chaplaincy was also divided in responses with 59% (n=20)
indicating it was important and 32% (n=11) that it was not.
Responses to ‘working as a member of the chaplaincy team’ indicates the
chaplains are divided on this issue. This could also reflect the dissatisfaction
with the chaplaincy team some respondents reported in question 12. It would
appear that the chaplains’ personal ministry and faith tradition are important to
them indicated by the response to ‘working as an individual chaplain’ and
‘denominational chaplaincy’. At the same time, ecumenical chaplaincy is valued
and reflects some of the responses to question 13.
74
4.4.4 Hospital Functions
Table 18: Hospital Functions
Functions Attend Experience
Yes No Very Good/ Good
Indifferent Poor/ Very
Poor285 Departmental/Unit/Ward Meetings
(n=37)
49%
(n=18)
51%
(n=19)
83%
(n=15)
11% (n=2)
6%
(n=1)
Unit social gatherings (n=37)
35% (n=13)
65% (n=24)
85% (n=11)
8% (n=1)
8% (n=1)
Staff In-Service Training/Journal
Clubs (n=37)
32% (n=12)
68% (n=25)
67% (n=8)
33% (n=4)
Other functions (please list)
Chaplains meetings Functions of pastoral care
department Chaplaincy team
Staff Christian care group Other – 5 (n=36)
25% (n=9)
75% (n=27)
89% (n=8)
Case Conferences (n=37)
24% (n=9)
76% (n=28)
89% (n=8)
11% (n=1)
Interdepartmental Meetings
(n=37) 22% (n=8)
78% (n=29)
75% (n=6)
25% (n=2)
Grand Rounds (n=37)
19% (n=7)
81% (n=30)
71% (n=5)
14% (n=1)
14% (n=1)
Research Ethics Committee
(n=37) 14% (n=5)
86% (n=32)
80% (n=4)
20% (n=1)
Patients Ethics Committee (n=37)
14% (n=5)
86% (n=32
This question asked respondents to indicate the various ways that they were
engaged in the wider life of the hospital. The categories are reported in rank
order and responses pooled as noted in the methodology. The only category
that all respondents did not answer was ‘other functions’ which was answered
285 There were no ‘very poor’ responses.
75
by 36 respondents. Respondents were asked about their experience of these
functions to give an indication of their satisfaction with them.
Departmental meetings were attended by 49% (n=18) of respondents of whom
82% (n=15) experienced them as good. Unit social gatherings were attended
by 35% (n=13) with an experience of good by 85% (n=11). A similar number of
respondents attended in-service programs, 32% (n=12) and 67% (n=8) found
them to be good. ‘Other’ functions included chaplains or pastoral care
department meetings with an attendance of 25% (n=9) and 89% (n=8) found the
experience of these meetings good. Case conferences, 24% (n=9) and
Interdepartmental meetings, 22% (n=8) were close in responses and were
experiences as good by 89% (n=8) and 75% (n=6) respectively. Nineteen
percent (n=7) attended grand rounds with a 71% (n=5) experience of good.
Involvement in research and patient ethics was the same with 14% (n=5) and
80% (n=4) found research ethics to be a good experience and 100% (n=5) for
patient ethics. The experience responses for indifferent and poor are noted in
the table while no respondent rated any function as very poor.
It should be noted that not all volunteer or part-time chaplains had the
opportunity to engage in some of these functions. A clear example being the
ethics committees, only one member of these committees is a chaplain, so
despite only five being on the committees that represents a 100%
representation. A similar observation can also be made for interdepartmental
meetings and to a lesser extent the other function categories.
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4.4.5 Ministry Roles
In questions 23 to 25 chaplains were given the opportunity to rate nineteen
ministry tasks or roles using a Likert type scale. Question 23 addressed the
importance of the ministry task, question 24 the level of the chaplains’
involvement in the task and question 25 the chaplains’ satisfaction with these
roles.
The responses to these questions were analysed both on their own and in
comparison with each other using the S-PLUS® 8 Enterprise Developer
statistical analysis program.
As noted in the methodology, due to the descriptive nature of this study and to
gain an overall picture of the respondents’ views it was decided to pool similar
categories either side of the mid-line. Using question 23 as an example,
responses of ‘very important’ and ‘important’ were pooled as ‘important’. The
‘not important’ and ‘irrelevant’ responses were pooled as ‘not important’. The
‘undecided’ category responses and the number of non responses were also
noted. In the methodology it was noted that percentages have been rounded
due to the low numbers and the fact that one respondent of a possible 37 is
2.7%.
As Chaplains did not respond to all of the categories in questions 23 to 25 it
was decided that the analysis would be based on the number of respondents for
that category. Question 23 had 30 responses to the pastoral assessment role,
so 30 became the number that was used to calculate the percentage for
pastoral assessment responses.
77
Tables were constructed to examine relationships between importance,
satisfaction and involvement for each activity. Again, the results will be pooled
to provide a description of chaplains’ attitudes to these issues. While the full
data set is provided at Appendix 12, the analysis concentrates on the major
themes in the importance, satisfaction and involvement categories.
It is noted that in the comparison of the importance, satisfaction and
involvement categories that comment will not be made on some responses that
are on the margin. An example of this is in the Pastoral Assessment category
of Importance compared with Satisfaction where one respondent indicated
satisfaction with pastoral assessment yet deemed it irrelevant. Another
indicated that pastoral assessment was important but undecided regarding
satisfaction.
Tables 19, 20 and 21 contain the responses to the 19 ministry roles surveyed, the analysis follows the tables.
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Table 19: Ministry Roles: Importance
Ministry Act/Task Irrelevant Not
Important
Undecided Important Very Important
Pastoral Assessment 2 1 17 10
Pastoral Care 11 25
Pastoral Counselling 3 19 13
Prayer 1 14 22
Worship 1 1 4 16 12
Sacramental Ministry 1 2 3 18 10
Spiritual Care (not specifically Christian)
2 5 11 17
Multi-faith Care (patients of other faiths)
1 2 6 18 8
Staff Support 2 1 3 13 14
Witness/Represent Church
1 4 4 15 8
Team work – Chaplaincy
2 15 19
Team work – multi-disciplinary
3 1 4 10 15
Administration 3 7 5 17 1
Research 3 7 9 12
Teaching/Education 4 3 6 17 3
Ethical Advice 3 2 4 20 3
Professional Development
1 2 25 6
Community/Church Liaison
1 3 2 22 4
Advice on Religious Diversity
2 5 10 14 1
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Table 20: Ministry Roles: Involvement
Ministry Act/Task Never Rarely
(yearly)
Occasionally
(monthly)
Regularly
(every week)
Always
(every day)
Pastoral Assessment 1 4 3 9 13
Pastoral Care (support) 1 3 17 15
Pastoral Counselling 7 19 7
Prayer 1 15 21
Worship 3 6 4 12 9
Sacramental Ministry 4 3 13 8 6
Spiritual Care (not specifically Christian)
3 4 6 10 11
Multi-faith Care (patients of other faiths)
1 6 15 6 4
Staff Support 6 8 10 8
Witness/Represent Church 1 2 9 13 7
Team work – Chaplaincy 2 6 11 15
Team work – multi-disciplinary 5 6 4 11 5
Administration 7 2 5 10 8
Research 14 9 5 3
Teaching/Education 10 6 10 6
Ethical Advice 7 11 9 4 1
Professional Development 2 7 15 9
Community/Church Liaison 2 7 11 12
Advice on Religious Diversity 6 14 10 1 1
80
Table 21: Ministry Roles: Satisfaction
Ministry Act/Task Very Dissatisfied
Dissatisfied Undecided Satisfied Very Satisfied
Pastoral Assessment 1 3 18 7
Pastoral Care 2 23 12
Pastoral Counselling 1 25 8
Prayer 1 27 9
Worship 1 6 17 7
Sacramental Ministry 1 4 20 5
Spiritual Care (not specifically Christian)
2 7 13 9
Multi-faith Care (patients of other faiths)
2 13 10 5
Staff Support 3 6 19 5
Witness/Represent Church 1 9 22 2
Team work – Chaplaincy 2 6 17 9
Team work – multi-disciplinary
5 11 11 4
Administration 1 5 11 14
Research 6 18 2 1
Teaching/Education 2 10 13 4
Ethical Advice 1 10 15
Professional Development 1 10 19 2
Community/Church Liaison 1 5 8 18 2
Advice on Religious Diversity
3 16 11 1
4.4.5.1 Consolidated Responses i. Pastoral Assessment Analysis of the data indicated that there was an overall positive response to the
conduct of a pastoral assessment in the important, involvement and satisfaction
categories. However, given the order of the PIC and the conduct of a pastoral
assessment as the first chaplaincy intervention it is concerning that 10% see it
as irrelevant and 23% conduct one only occasionally. This is indicated in the
relationship between importance-involvement.
81
There were 30 responses to the question and 7 did not answer. 90% (n=27) of
respondents indicated that compiling a pastoral assessment is very
important/important and 10% (n=3) not important/irrelevant.
Thirty responses 30 were recorded to this question and 7 did not answer. 73%
(n=22) of respondents reported that they always/regularly do a pastoral
assessment and 23% (n=7) that they do so occasionally/rarely. 3% (n=1)
indicated that a pastoral assessment is never done.
82
There were 29 responses to the question and 8 did not answer. 86% (n=25)
indicated that they were very satisfied/satisfied with the pastoral assessment
role and 3% (n=1) dissatisfied/very dissatisfied, and 10% (n=3) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 36 important/satisfaction responses. These responses indicated an
85% (n=23) important and satisfied result with conducting a pastoral
assessment. Three percent (n=1) indicated that pastoral assessment was not
important and they were dissatisfied with it.
Twenty eight Importance/Involvement responses were analysed. There was a
79% (n=22) important and regularly involved response for pastoral assessment
and a 7% (n=2) response in the occasionally involved and not important
category.
The analysis of 24 responses to involvement/satisfaction indicated 83% (n=20)
being regularly involved and satisfied with the pastoral assessment role. Four
percent (n=1) was dissatisfied and occasionally involved.
83
Table 22: Pastoral Assessment - Association
Pastoral Assessment
Association
Importance/Satisfaction (n=36) 85% (n=23) Importance/Involvement (n=28) 79% (n=22) Involvement/Satisfaction (n=24) 83% (n=20)
ii. Pastoral Care
Respondents rated all three categories highly and with a high association in the
relationship between importance, involvement and satisfaction. Pastoral care is
one of the chaplaincy interventions identified in the PIC. It is therefore of
interest that 11% indicated that their involvement was occasional. The
possibilities would appear to be an error in response or that the chaplains were
heavily involved in non-patient roles or were very part-time.
Thirty six responses were made to this question and 1 non responder. 100%
(n=36) of respondents indicated that the pastoral care role is very
important/important.
84
There were 36 responses to the question and 1 non responder. Eighty nine
percent (n=32) of respondents reported that they were always/regularly involved
in pastoral care and 11% (n=4) that they were involved occasionally/rarely.
All 37 respondents answered this question. Ninety five percent (n=35) indicated
that they were very satisfied/satisfied with the pastoral care role, 5% (n=2) were
undecided.
85
Relationship between perceived importance, involvement and
satisfaction.
There were 36 important/satisfaction responses. These indicated that 94%
(n=34) of respondents found pastoral care to be both important and satisfying.
Three percent (n=1) indicated that pastoral care was not important and they
were dissatisfied with it.
Thirty five importance/involvement responses were paired. Eighty nine percent
(n=31) of respondents reported that pastoral care was important and they were
regularly involved and 11% (n=4) that it is important and practiced occasionally.
The involvement/satisfaction analysis of 36 respondents found 86% (n=31)
were regularly involved and satisfied with the pastoral care role. Eleven percent
(n=4) indicated satisfaction with occasional involvement.
Table 23: Pastoral Care - Association
Pastoral Care
Association
Importance/Satisfaction (n=36) 94% (n=34) Importance/Involvement (n=35) 89% (n=31) Involvement/Satisfaction (n=36) 86% (n=31)
iii. Pastoral Counselling Pastoral Counselling is also included in the PIC. The responses indicate a
generally high response to perceptions of importance, involvement and
satisfaction. The 21% response to occasional involvement is likely to be an
indication that counselling is not part of every patient visit, the chaplain is not
comfortable with counselling, or a possible misunderstanding of the meaning or
practice of pastoral counselling. Importance/Satisfaction responses identified a
86
100% association. Associations of importance/involvement and
involvement/satisfaction were high.
There were 35 responses to the question and 2 did not answer. Ninety one
percent (n=32) of respondents indicated that the provision of pastoral
counselling is very important/important and 9% (n=3) were undecided.
Thirty three respondents answered this question and 4 did not. Seventy nine
percent (n=26) of respondents reported that they were always/regularly involved
in pastoral counselling and 21% (n=7) that they are involved only
occasionally/rarely.
87
This question was answered by 34 respondents and there were 3 non
responders. Ninety seven percent (n=33) indicated that they were very
satisfied/satisfied with the pastoral counselling role, 3% (n=1) was undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 30 important/satisfaction responses which indicated 100% (n=30)
found the provision of pastoral counselling to be both important and satisfying.
Thirty two importance/involvement responses were analysed with 78% (n=25)
important and regularly recorded and 16% (n=5) important and occasionally
involved. Three percent (n=1) indicated regular involvement in pastoral
counselling and 3% (n=1) occasional involvement but were undecided on its
importance.
The involvement/satisfaction pairings of 32 respondents indicated 80% (n=26)
were regularly involved and satisfied with the pastoral counselling role. Sixteen
percent (n=5) were satisfied with occasional involvement with the pastoral
counselling role.
88
Table 24: Pastoral Counselling - Association
Pastoral Counselling
Association
Importance/Satisfaction (n=30) 100% (n=30) Importance/Involvement (n=32) 78% (n=25) Involvement/Satisfaction (n=32) 80% (n=26)
iv. Prayer Prayer is a category of Pastoral Ritual and Worship in the PIC. The significance
of the role of prayer to chaplains was indicated by the 97% result in the
importance, involvement and satisfaction categories and is accompanied by
high association between all pairings.
All thirty seven respondents answered this question. Ninety seven percent
(n=36) indicated that Prayer ministry is very important/important and 3% (n=1)
were undecided.
89
Of the 37 responses to the question, 97% (n=36) reported that they were
always/regularly involved in prayer and 3% (n=1) that they are involved
occasionally/rarely.
Again all 37 respondents answered this question. The very satisfied/satisfied
response with the prayer role was 97% (n=36) with 3% (n=1) undecided.
90
Relationship between perceived importance, involvement and
satisfaction.
There were 27 important/satisfaction responses. These responses indicated
that 97% (n=36) found Prayer ministry to be both important and satisfying, 3%
(n=1) were undecided.
Thirty seven importance/involvement responses were recorded. There was a
95% (n=35) important and regularly involved response and 7% (n=2) in the
occasionally involved and not important category.
The involvement/satisfaction analysis of 37 respondents indicated that 95%
(n=35) were regularly involved and satisfied with the prayer role. Three percent
(n=1) indicated satisfaction with occasional involvement in providing prayer and
3% (n=1) were regularly involved but undecided regarding satisfaction.
Table 25: Prayer - Association
Prayer
Association
Importance/Satisfaction (n=37) 97% (n=36) Importance/Involvement (n=37) 95% (n=35) Involvement/Satisfaction (n=37) 95% (n=35)
v. Worship The results for worship raise a number of questions, 82% rated it as important,
yet only 62% reported they were regularly involved. The involvement responses
may indicate a formal view of worship and not include the possibility of a more
intimate event with a patient as indicated in the PIC. It may also indicate that
involvement is lower due to less opportunity for formal worship in the acute
hospital setting. Possibly reflecting this is the 19% of respondents who were
91
undecided regarding their satisfaction,. The association of
importance/involvement and involvement/satisfaction is not high. Worship is a
component of the Pastoral Ritual and Worship category of the PIC.
There were 34 responses and 3 did not answer this question. Eighty two
percent (n=28) of respondents reported that providing worship is very
important/important and 6% (n=2) not important/irrelevant. 12% (n=4) were
undecided.
This question was answered by 34 respondents and 3 did not answer. Sixty
two percent (n=21) of respondents reported that they were always/regularly
92
involved in worship and 20% (n=10) that they were involved occasionally/rarely.
Nine percent (n=3) indicated that they are never involved in worship.
Thirty one respondents answered this question and there were 6 non
respondents. Seventy seven percent (n=24) indicated that they were very
satisfied/satisfied with the provision of worship and 3% (n=1) dissatisfied/very
dissatisfied, while 19% (n=6) of respondents were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 30 important/satisfaction responses. These responses indicated
that 80% (n=24) found the provision of worship to be both important and
satisfying. 13% (n=4) were undecided regarding the importance of and their
satisfaction with worship.
Thirty three (n=33) importance/involvement responses were analysed. Sixty six
percent (n=21) indicated that the provision of worship was important and that
they were regularly involved. Fifteen percent (n=5) indicated that worship was
important and had occasional involvement and 6% (n=2) that this role was not
93
important while having occasionally involvement while12% (n=4) were
undecided.
The involvement/satisfaction pairing of 31 respondents indicated 65% (n=20) as
being regularly involved and satisfied with the provision of worship role.
Thirteen percent (n=4) were satisfied and occasionally involved in worship and
13% (n=4) occasionally involved yet undecided regarding satisfaction.
Table 26: Worship - Association
Worship
Association
Importance/Satisfaction (n=30) 80% (n=24) Importance/Involvement (n=33) 66% (n=21) Involvement/Satisfaction (n=31) 65% (n=20)
vi. Sacramental Ministry The PIC includes the administration of sacraments under Pastoral Ritual and
Worship. The importance, 82% and satisfaction, 83% reported are in contrast
with regular involvement of 41%. This is reflected in a low association of
involvement with satisfaction and importance. Factors that may influence this
result include short hospital stays, the sacramental emphasis of some Christian
faith traditions and not of others and the number of lay respondents.
Sacramental ministry was not a key role for 59% of the respondents.
94
Thirty four 34 responses were recorded to this question and 3 did not answer.
Eighty two percent (n=28) of respondents indicated that sacramental ministry is
very important/important and 9% (n=3) not important/irrelevant with 9% (n=3)
were undecided.
There were 34 responses to the question and 3 non respondents. Forty one
percent (n=14) of respondents reported that they were always/regularly involved
in sacramental ministry and 47% (n=16) that they are involved
occasionally/rarely. Respondents never involved in the provision of
sacramental ministry was12% (n=4).
95
This question was answered by 30 respondents and 7 non respondents. Eighty
three percent (n=25) indicated that they were very satisfied/satisfied with
sacramental ministry and 3% (n=1) dissatisfied/very dissatisfied with 13% (n=4)
were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 29 important/satisfaction responses. These responses indicated
that 72% (n=21) found sacramental ministry to be both important and satisfying.
Three percent (n=1) indicated that sacramental ministry was not important and
were dissatisfied with it while 3% (n=1) was undecided.
Thirty two importance/involvement responses were analysed. There was a 41%
(n=13) important and regularly involved response for the provision of the
sacraments and a further 31% (n=10) indicated that this role was important
while having occasional involvement in practice. Nine percent (n=3) of
respondents identified sacramental ministry as not important with an
involvement ranging from regularly to rarely. Respondents who were
occasionally involved and undecided regarding satisfaction was 6% (n=2).
96
The involvement/satisfaction pairings of (n=30) respondents indicated 43%
(n=13) were regularly involved and satisfied with the sacramental role and 33%
(n=10) occasionally involved and satisfied. 7% (n=2) were undecided
regarding satisfaction while occasionally involved in providing sacramental
ministry, 3% (n=1) regularly involved respondents were dissatisfied with this
aspect of their role.
Table 27: Sacraments - Association
Sacraments Association
Importance/Satisfaction (n=29) 72% (n=21) Importance/Involvement (n=32) 41% (n=13) Involvement/Satisfaction (n=30) 43% (n=13)
vii. Spiritual Care (not specifically Christian) This question was included to address the reality of a secular hospital and to
step outside of a clearly Christian definition of care. Responses indicated that
this was an important aspect of their chaplaincy role but with lower involvement
and satisfaction scores. There was not a high association between chaplains’
perceived importance, involvement and satisfaction.
97
There were 35 responses to the question and 2 non respondents. Eighty
percent (n=28) of respondents indicated that the provision of spiritual care was
very important/important and 6% (n=2) not important/irrelevant and 14% (n=5)
were undecided.
Responses were recorded by 34) chaplains to the question and 3 did not
answer. 62% (n=21) of respondents reported that they were always/regularly
involved in spiritual care and 29% (n=10) that they were involved
occasionally/rarely. Nine percent (n=3) indicated that they were never involved
in the provision of spiritual care.
98
Thirty one responses were recorded for this question and 6 provided no answer.
Seventy one percent (n=22) indicated that they were very satisfied/satisfied with
the provision of spiritual care and 6% (n=2) dissatisfied/very dissatisfied with
23% (n=7) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
Thirty important/satisfaction responses were recorded. These indicated that
67% (n=20) found providing spiritual care to be both important and satisfying.
Twenty percent (n=6) were undecided regarding their satisfaction of whom 10%
(n=3) indicated that it was important. Undecided regarding importance and
satisfaction was 7% (n=2), and 3% (n=1) indicated that the spiritual care role
was not important and were dissatisfied.
The importance/involvement pairing had 31 responses. Sixty one percent
(n=19) indicated that spiritual care was important and they were regularly
involved. A further 23% (n=7) indicated that the spiritual care role was
important while having occasional involvement. Those undecided regarding the
importance of the provision of spiritual care was 6% (n=2) with regular
involvement and 10% (n=2) with occasionally involvement. Three percent (n=1)
identified spiritual care as irrelevant.
The involvement/satisfaction analysis of (n=30) respondents showed 63%
(n=19) were regularly involved and satisfied with the spiritual care role and 7%
(n=2) occasionally involved and satisfied. It was found that 20% (n=6) who
99
were involved in providing spiritual care were undecided regarding their
satisfaction.
Table 28: Spiritual Care – Association
Spiritual Care
Association
Importance/Satisfaction (n=30) 67% (n=20) Importance/Involvement (n=31) 61% (n=19) Involvement/Satisfaction (n=30) 63% (n=19)
viii. Multi-faith Care (patients of other faiths) Chaplains providing care to patients who practice a faith other than Christian is
a relatively new area of practice which is seen as being important by 74%.
Involvement and satisfaction indicate less regular involvement and low
satisfaction. The association between importance, involvement and satisfaction
is low. These responses may be due to the preference of some chaplains to
have a denominational (Christian) specific focus along with the need for an
understanding of multi-faith issues. Added to this may be a need for more
exposure to and experience of providing multi-faith care. There was a strong
undecided response reported, 17% in importance and 43% in satisfaction.
100
This question was answered by 35 respondents with 2 non respondents.
Seventy four percent (n=26) reported that the multi-faith care role was very
important/important and 9% (n=3) as not important/irrelevant with 17% (n=6)
were undecided.
There were 32 responses to the question and 5 did not answer. Thirty one
percent (n=10) of respondents reported that they were always/regularly involved
in providing multi-faith care and 66% (n=21) that they were involved
occasionally/rarely. Respondents never involved in the provision of multi-faith
care was 3% (n=1).
101
Thirty responses to the question were recorded and 7 did not record an answer.
50% (n=15) indicated that they were very satisfied/satisfied with the provision of
multi-faith care and 7% (n=2) dissatisfied/very dissatisfied. Forty three percent
(n=13) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 29 important/satisfaction responses regarding providing multi-faith
care. These responses indicated that 52% (n=15) found this role both important
and satisfying and 21% (n=6) indicated that the multi-faith care role was
important but were undecided regarding their satisfaction. Seventeen percent
(n=5) were undecided regarding importance and satisfaction while 3% (n=1)
indicated that this role was not important and were undecided regarding their
satisfaction.
Thirty importance/involvement responses were analysed. There was a 33%
(n=10) important and regularly involved response and 40% (n=12) of
respondents indicated that multi-faith care provision was important while having
occasional involvement. Respondents who were undecided and occasionally
involved was 20% (n=6).
The involvement/satisfaction pairings of 29 respondents showed 31% (n=9) as
regularly involved and satisfied with the multi-faith care role. Forty one percent
(n=12) were occasionally involved and undecided regarding their satisfaction,
and 7% (n=2) occasionally involved in providing spiritual care were dissatisfied.
102
Table 29: Multi-faith Care - Association
Multi-faith Care
Association
Importance/Satisfaction (n=29) 52% (n=15) Importance/Involvement (n=30) 33% (n=10) Involvement/Satisfaction (n=29) 31% (n=9)
ix. Staff Support While support for staff is rated by chaplains as important by 84% of
respondents, their regular involvement at 55% is low. Some chaplains’ lack of a
positive relationship with staff reported earlier may be reflected here. The
association between the categories of importance, involvement and satisfaction
are low. Again a number of chaplains were undecided regarding importance,
9%, and satisfaction, 18%.
This question attracted 32 responses and 5 non respondents. Eighty four
percent (n=27) of respondents reported that supporting staff was very
important/important and 6% (n=2) not important/irrelevant. Undecided
respondents were 9% (n=3).
103
There were 32 responses to the question and 5 non response. Fifty five
percent (n=18) of respondents reported that they were always/regularly involved
in staff support and 44% (n=14) that they were involved occasionally/rarely.
Thirty three responses to this question were recorded and 4 did not answer.
Seventy three percent (n=24) indicated that they were very satisfied/satisfied
with staff support provision and 9% (n=3) dissatisfied/very dissatisfied. Six
respondents, 18%, were undecided.
104
Relationship between perceived importance, involvement and
satisfaction.
There were 30 important/satisfaction responses. These responses indicated
that 70% (n=21) providing support to staff to be both important and satisfying
and 13% (n=4) indicated that this role was important while undecided regarding
their satisfaction. Three percent (n=1) responded that the staff support role was
irrelevant and were dissatisfied and 7% (n=2) were undecided regarding their
satisfaction and the role’s importance.
Thirty (n=30) importance/involvement responses were paired. There was a
57% (n=17) important and regularly involved response to the provision of staff
support and a further 30% (n=9) indicated that it was important while having
occasional involvement. Seven percent (n=2) while occasionally involved
identified providing support to staff as irrelevant.
The involvement/satisfaction analysis of (n=31) respondents indicated 55%
(n=17) being regularly involved and satisfied with their staff support role.
Sixteen percent (n=5) who were occasionally involved were satisfied with that
involvement. Respondents occasionally involved and undecided with their
satisfaction was 13% (n=4) and 10% (n=3) of respondents occasionally involved
in staff support were dissatisfied.
Table 30: Staff Support - Association
Staff Support
Association
Importance/Satisfaction (n=30) 70% (n=21) Importance/Involvement (n=30) 57% (n=17) Involvement/Satisfaction (n=31) 55% (n=17)
105
x. Witness/Represent Church In the qualitative responses there was a degree of dissatisfaction with the
church. This is possibly reflected here in the indecision around importance,
13%, and satisfaction, 26%. That 16% indicated that this role is irrelevant is
significant. These responses reflect in low associations of importance,
involvement and satisfaction.
There were 32 responses to the question and 5 did not answer. Seventy two
percent (n=23) of respondents indicated that the witnessing and representing
the Church role was very important/important and 16% (n=5) not
important/irrelevant with 13% (n=4) undecided.
106
Thirty two responses were recorded to this question and 5 non respondents.
Sixty three percent (n=20) of respondents reported that they were
always/regularly involved in witnessing and representing the Church and 34%
(n=11) that they were involved occasionally/rarely. Respondents never involved
in this role was 3% (n=1).
This question received 34 responses and 3 did not provide an answer. Seventy
one percent (n=24) of respondents indicated that they were very
satisfied/satisfied with the witnessing or representing the Church role, 3% (n=1)
dissatisfied/very dissatisfied, and 26% (n=9) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 28 important/satisfaction responses of which 64% (n=18) found the
witnessing role to be both important and satisfying while 14% (n=4) indicated
that it was important while undecided regarding their satisfaction. Eleven
percent (n=3) were undecided regarding importance and satisfaction, and 11%
(n=3) indicated that the witnessing and representing the Church role was not
107
important. Seven percent (n=2) were satisfied with this role and 4% (n=1) was
undecided.
Twenty eight importance/involvement responses were paired. There was a
61% (n=17) important and involved response and a further 11% (n=3) indicated
that witnessing and representing the Church was important while having
occasional involvement. Respondents who rated this role as not important
while being occasionally involved was 14% (n=4). Seven percent (n=2) were
occasionally involved yet undecided about this role.
The involvement/satisfaction analysis of 31 respondents indicated 55% (n=17)
as regularly involved and satisfied with the witnessing and representing the
Church role, and 16% (n=5) occasionally involved and satisfied with that
involvement. Twenty six percent (n=8) were undecided regarding their
satisfaction with this chaplaincy role of whom 10% (n=3) were regularly involved
and 16% (n=5) occasionally involved. Respondents occasionally involved in the
witnessing and representing the Church role and satisfied was 3% (n=1).
Table 31: Witness-Represent Church - Association
Witness-Represent Church
Association
Importance/Satisfaction (n=28) 64% (n=18) Importance/Involvement (n=28) 61% (n=17) Involvement/Satisfaction (n=31) 55% (n=17)
xi. Team work: Chaplaincy The responses indicate that chaplains rate the importance of the chaplaincy
team highly at 94%. This is not indicated as clearly in their levels of
involvement and satisfaction which may be due to the dissatisfaction reported
108
previously around team leadership and communication. Another possibility is
that some chaplains may see any contact with colleagues as working with the
team while others could have responded in terms of formal meetings. It is also
possible that these results reflect the experience of one or two teams. Overall
respondents’ high importance rating is not so closely associated with
involvement or satisfaction.
Responses were recorded by 36 respondents to this question with 1 non
responder. Ninety four percent (n=34) of respondents indicated that
involvement in the chaplaincy team was very important/important and 6% (n=2)
as not important/irrelevant.
109
There were 34 responses to the question and 3 did not answer. Seventy six
percent (n=26) of respondents reported that they were always/regularly involved
in the chaplaincy team and 24% (n=8) that they were involved
occasionally/rarely.
This question received 34 responses and 3 did not answer. Seventy six percent
(n=26) of respondents indicated that they were very satisfied/satisfied with the
chaplaincy teamwork role and 6% (n=2) dissatisfied/very dissatisfied while 18%
(n=6) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 33 important/satisfaction responses. These responses indicated
that 76% (n=25) found involvement in the Chaplaincy team to be both important
and satisfying, and 15% (n=5) indicating that it was important while undecided
regarding their satisfaction. Six percent (n=2) indicated that the chaplaincy
teamwork role was important while being dissatisfied with it and 3% (n=1)
indicated that this role was not important and were undecided regarding
satisfaction.
110
Thirty three importance/involvement pairings produced a 75% (n=25) important
and regularly involved response. A further 18% (n=6) with occasional
involvement indicated that chaplaincy teamwork was important. Six percent
(n=2) identified this role as not important and were occasionally involved.
The involvement/satisfaction analysis of 33 respondents indicated 70% (n=23)
were regularly involved and satisfied with the chaplaincy teamwork role and 9%
(n=3) were occasionally involved and satisfied with that involvement.
Respondents involved in the chaplaincy team and dissatisfied was 6% (n=2).
Six percent (n=2) of involved and 9% (n=3) of occasionally involved
respondents were undecided regarding their satisfaction.
Table 32: Chaplaincy Teamwork - Association
Chaplaincy Teamwork
Association
Importance/Satisfaction (n=33) 76% (n=25) Importance/Involvement (n=33) 75% (n=25) Involvement/Satisfaction (n=33) 70% (n=23)
xii. Team work: Multi-disciplinary The importance of multi-disciplinary team work was 76% with an involvement of
52% and 48% satisfaction. A number of chaplains earlier described their
relationship with some staff as not as positive as they would wish. The
importance in these responses is not closely associated with involvement or
satisfaction. Responses identified that 51% were dissatisfied or undecided
regarding satisfaction.
111
There were 33 responses to the question and 4 did not answer. Seventy six
percent (n=25) of respondents indicated that the multi-disciplinary teamwork
role was very important/important, 12% (n=4) not important/irrelevant, and 12%
(n=4) were undecided.
This question had 31 responses and 6 non responses. Fifty two percent (n=16)
of respondents reported that they were always/regularly involved in the multi-
disciplinary teamwork role and 32% (n=10) that they are involved
occasionally/rarely. Respondents that indicated that they were never involved
was16% (n=5).
112
Thirty one responses to the question were recorded and 6 non responses.
Forty eight percent (n=15) indicated that they were very satisfied/satisfied with
the multi-disciplinary teamwork role, 16% (n=5) were dissatisfied/very
dissatisfied, and 35% (n=11) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 29 important/satisfaction responses. These responses indicated
that 45% (n=13) found involvement in the multi-disciplinary team to be both
important and satisfying and 17% (n=5) as important while undecided regarding
satisfaction. Fourteen percent (n=4) indicated that this role was important while
being dissatisfied. Respondents indicating that the multi-disciplinary team role
was not important were 3% (n=1) also undecided regarding their satisfaction
and 3% (n=1) as dissatisfied.
Twenty seven importance/involvement responses were paired. There was a
52% (n=14) important and regularly involved response. Multi-disciplinary
teamwork was recorded by 26% (n=7) of respondents as being important while
having occasional involvement. Seven percent (n=2) of respondents who
113
were occasionally involved indicated it was unimportant and 7% (n=2) who were
never involved rated it as unimportant. A further 7% (n=2) who were never
involved in this activity were undecided about its importance.
The involvement/satisfaction analysis of 29 respondents indicated 38% (n=11)
being regularly involved and satisfied with the multi-disciplinary teamwork role,
and 14% (n=4) who were occasionally involved were satisfied with that
involvement. Regularly involved and dissatisfied respondents was 3% (n=1)
and 14% (n=4) were occasionally involved and dissatisfied. Respondents
undecided regarding their satisfaction were 3% (n=1) involved and 7% (n=2)
occasionally involved. Respondents who were never involved in multi-
disciplinary teams and undecided regarding their satisfaction was 14% (n=4).
Table 33: Multi-Disciplinary Teamwork - Association
Multi-Disciplinary Teamwork
Association
Importance/Satisfaction (n=29) 45% (n=13) Importance/Involvement (n=27) 52% (n=14) Involvement/Satisfaction (n=29) 38% (n=11)
xiii. Administration
Administration has been clearly identified as a cause of frustration for chaplains
and this is reflected in responses here. Chaplains have also indicated that
patient care is their priority both in their qualitative and quantitative responses.
Consistent with this are the scores here with importance, 55%, involvement,
56%, and satisfaction, 45%, being reported. This was reflected in the low
associations detected in the cross tabulation of responses having low
association.
114
Thirty three responses to the question were recorded and 4 non responses.
Fifty five percent (n=18) of respondents indicated that administration was very
important/important, 30% (n=10) not important/irrelevant, and 15% (n=5) were
undecided.
This question had 32 responses and 5 non responses. Fifty six percent (n=18)
of respondents reported that they were always/regularly involved in the
administration role and 22% (n=7) that they are involved occasionally/rarely.
Respondents who indicated that they were never involved in administration was
22% (n=7).
115
There were 31 responses to the question and 6 did not answer. Forty five
percent (n=14) indicated that they were very satisfied/satisfied with the
administration role and 19% (n=6) dissatisfied/very dissatisfied. Undecided
respondents was 35% (n=11).
Relationship between perceived importance, involvement and
satisfaction.
There were 30 important/satisfaction responses. These responses indicated
that for 37% (n=11) the administration role to be both important and satisfying.
Seven percent (n=2) indicated that it was important while being undecided
regarding their satisfaction, and 13% (n=4) saw the administration role as being
important but registered their dissatisfaction with it. Those who indicated that
administration was not important and were undecided regarding satisfaction
were 17% (n=5). A further 7% (n=2) saw administration as not important and
were dissatisfied while 13% (n=4) of respondents were undecided.
Thirty one importance/involvement responses were paired. There was a 37%
(n=12) important and regularly involved response and a further 6% (n=2)
indicated that administration was important with occasional involvement. Ten
116
percent (n=3) identified administration as important although they were never
involved, 13% (n=4) who were regularly involved yet saw it as not important,
and another 10% (n=3) with occasional involvement also saw it as not
important.
The involvement/satisfaction analysis of 30 respondents indicated 37% (n=11)
being regularly involved and satisfied with the administration role and 10% (n=3)
occasionally involved and satisfied with that involvement. Ten percent (n=3)
who were regularly involved in the administration role were dissatisfied. Also
dissatisfied were the 7% (n=2) who were never involved in the administration
role. Respondents undecided regarding their satisfaction were 13% (n=4)
regularly involved, 10% (n=3) occasionally involved, and 10% (n=3) never
involved.
Table 34: Administration - Association
Administration
Association
Importance/Satisfaction (n=30) 37% (n=11) Importance/Involvement (n=31) 37% (n=12) Involvement/Satisfaction (n=30) 37% (n=11)
xiv. Research Given the emphasis on evidence based practice in health and the general
education level of chaplains the responses here are both surprising and
disappointing with 61% indicating that it was not important or were undecided.
The reported level of satisfaction was also low. A reason may be that research
is seen as another administration function. At the same time, 80% of the
chaplains who sit on an HREC indicate that the experience is positive.
Undecided and never involved are high responses here.
117
Thirty one responses to the question were recorded and 6 non responses.
Thirty nine percent (n=12) of respondents reported that research was very
important/important and 32% (n=10) not important/irrelevant and 29% (n=9)
were undecided.
There were 31 responses to the question and 6 did not answer. Ten percent
(n=3) of respondents reported that they were always/regularly involved in
research and 45% (n=14) that they are involved occasionally/rarely.
Respondents who indicated that they were never involved in research was 45%
(n=14).
118
This question had 27responses recorded and 10 non responses. Eleven
percent (n=3) indicated that they were very satisfied/satisfied with research and
22% (n=6) dissatisfied/very dissatisfied while 67% (n=18) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were26 important/satisfaction responses. These responses indicated
that 8% (n=2) of respondents found research to be both important and
satisfying, 19% (n=5) indicated that it was important while undecided regarding
their satisfaction. Eight percent (n=2) indicated that the research role was
important and recorded dissatisfaction with it. Those who saw research as not
important and were undecided regarding their satisfaction was 19% (n=5).
Respondents who rated research as not important and were dissatisfied
was12% (n=3) while 27% (n=7) were undecided regarding importance and
satisfaction.
Twenty nine importance/involvement responses were paired. There was a 7%
(n=2) important and regularly involved response, and a further 21% (n=6)
recorded that research was important while having occasional involvement.
119
Fourteen percent (n=4) identified research as being important while having no
involvement. The respondents who rated research as not important included
7% (n=2) with occasional involvement and 21% (n=6) who were never involved.
The involvement/satisfaction analysis of 26 respondents indicated 12% (n=3) as
regularly involved and satisfied with research. Thirty eight percent (n=10) of
respondents who were occasionally involved in the research role were
undecided regarding their satisfaction and 27% (n=7) who were never involved
also being undecided. Respondents dissatisfied with research was 12% (n=3)
with occasionally involvement and 12% (n=3) never involved.
Table 35: Research - Association
Research
Association
Importance/Satisfaction (n=26) 8% (n=2) Importance/Involvement (n=29) 7% (n=2) Involvement/Satisfaction (n=26) 12% (n=3)
xv. Teaching/Education Providing Pastoral Counselling or Education is one of the chaplaincy roles
identified in the PIC. While 61% of chaplains indicated that it was an important
role, their involvement on a regular basis was only 19% with a satisfaction of
59%. For what is identified in the PIC as a core role, the responses for not
important and undecided along with chaplains’ reported regularity of
involvement raise a concern. This may be due to some chaplains seeing
teaching/education as a formal role as against a conversation with a patient or
family that is educational in nature.
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This question received 33 responses and 4 non responses. Sixty one percent
(n=20) of respondents reported that the teaching/education role was very
important/important and 21% (n=7) as not important/irrelevant and 18% (n=6)
were undecided.
There were 32 responses to the question and 5 did not answer. Nineteen
percent (n=6) of respondents reported that they were always/regularly involved
in the teaching/education role and 50% (n=16) that they are involved
occasionally/rarely. Respondents who indicated that they were never involved
in this role was 31% (n=10).
121
Twenty nine responses to the question were recorded and 8 non responses.
Respondents who indicated that they were very satisfied/satisfied with the
teaching/education role was 59% (n=17). Seven percent (n=2) were
dissatisfied/very dissatisfied and 34% (n=10) of respondents were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 27 important/satisfaction responses. These responses indicated
that 44% (n=12) found the teaching role to be both important and satisfying and
while 15% (n=4) indicating that it was important they were undecided regarding
their satisfaction. The respondents who rated the teaching/education role as
not important included 7% (n=2) who were satisfied, 7% (n=2) who were
dissatisfied and 4% (n=1) who was undecided. Fifteen percent (n=4) of
respondents were undecided on both importance and satisfaction.
Thirty importance/involvement responses were paired. There was a 20% (n=6)
important and regularly involved response, a further 33% (n=10) indicated that
the teaching/education role was important while having occasional involvement.
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Ten percent (n=3) of respondents occasionally involved in the provision of
teaching/education saw it as not important and 13% (n=4) who were never
involved also saw it as not important.
The involvement/satisfaction analysis of 28 respondents showed 18% (n=5)
being regularly involved and satisfied with the teaching/education role, and a
further 25% (n=7) occasionally involved and satisfied. Eleven percent (n=3)
who were rarely involved were also satisfied. Respondents who were involved
in the teaching/education role and undecided regarding their satisfaction was
18% (n=5) and 14% (n=4) who were never involved in this role were also
undecided.
Table 36: Teaching-Education - Association
Teaching-Education
Association
Importance/Satisfaction (n=27) 44% (n=12) Importance/Involvement (n=30) 20% (n=6) Involvement/Satisfaction (n=28) 18% (n=5)
xvi. Ethical Advice The provision of ethical advice was reported by 72% of chaplains to be
important. Respondents indicated that their regular involvement was 16% and
a further 63% reported occasional involvement. However, the responses
indicating that this role is not important and that ethical advice is never provided
are at odds with the PIC for counselling and education. The value placed on
the importance of this role is not associated with involvement or satisfaction.
123
Thirty two responses to this question were recorded and 5 non responses.
Seventy two percent (n=23) of responding chaplains reported that the provision
of ethical advice was very important/important and 16% (n=5) not
important/irrelevant, 14% (n=4) were undecided.
This question received 32 responses 5 non responses. Sixteen percent (n=5)
of respondents reported that they were always/regularly involved in providing
ethical advice and 63% (n=20) that they were involved occasionally/rarely.
Respondents who indicated that they never provide ethical advice was 22%
(n=7).
124
There were 26 responses to the question and 11 did not answer. Fifty eight
percent (n=15) indicated that they were very satisfied/satisfied with the provision
of ethical advice, 4% (n=1) dissatisfied/very dissatisfied, and 38% (n=10)
undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 24 important/satisfaction responses. Fifty percent (n=13) indicated
that the provision of ethical advice was both important and satisfying, 25% (n=6)
were undecided regarding their satisfaction while indicating that it was
important. Respondents who saw the provision of ethical advice as not
important were 8% (n=2) undecided regarding satisfaction and 4% (n=1)
dissatisfied with this role. Respondents undecided on both satisfaction and
importance was 8% (n=2).
Thirty 30 importance/involvement responses were paired. There was a 17%
(n=5) important and regularly involved response, a further 50% (n=15) indicated
that the provision of ethical advice was important while having occasional
involvement. Seven percent (n=2) identified this role as being important while
125
never involved. Respondents reporting the provision of ethical advice as being
not important included 10% (n=3) who were occasionally involved and 7% (n=2)
who indicated that they were never involved.
The involvement/satisfaction analysis of 25 respondents indicated 16% (n=4) as
regularly involved and satisfied with the ethical advice role and 40% (n=10)
occasionally involved were satisfied with that involvement. Those undecided
regarding their satisfaction included 4% (n=1) regularly involved, 20% (n=5)
occasionally involved, and 12% (n=3) never involved. Four percent (n=1) of
respondents who was never involved in the provision of ethical advice was
dissatisfied.
Table 37: Ethical Advice - Association
Ethical Advice
Association
Importance/Satisfaction (n=24) 50% (n=13) Importance/Involvement (n=30) 17% (n=5) Involvement/Satisfaction (n=25) 16% (n=4)
xvii. Professional Development Professional development was seen to be important by 91% of respondents.
However, involvement and satisfaction responses were lower and not a closely
associated with importance. Earlier in the questionnaire respondents indicated
that they accessed a wide range of professional development opportunities.
This may be indicated by 67% reporting occasional involvement. Despite this
the responses indicate that this is a low priority for chaplains.
126
There were 34 responses to the question and 3 did not answer. Ninety one
percent (n=31) of respondents reported that professional development was very
important/important and 3% (n=1) as not important/irrelevant, 6% (n=2) were
undecided.
This question received 33 responses and 4 non responses. Twenty seven
percent (n=9) of respondents reported that they were always/regularly involved
in professional development and 67% (n=22) that they were involved
occasionally/rarely. Six percent (n=2) indicated that they were never involved in
professional development.
127
Thirty two responses to the question were recorded and (n=5) non responses.
Sixty six percent (n=21) indicated that they were very satisfied/satisfied with
their professional development and 3% (n=1) dissatisfied/very dissatisfied, 31%
(n=10) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 31 important/satisfaction responses. These responses indicated
that for 68% (n=21) professional development was both important and
satisfying, and 19% (n=6) that it was important while undecided regarding their
satisfaction. Three percent (n=1) indicated that involvement in of professional
development was important while indicating dissatisfaction with it, and 6% (n=2)
that they were undecided regarding importance and satisfaction.
Thirty two importance/involvement responses were paired. There was a 28%
(n=9) important and regularly involved response, and 59% (n=19) indicated that
professional development was important with occasional involvement. Six
percent (n=2) rated professional development as important while never being
128
involved and 3% (n=1) with occasional involvement indicated that it was not
important.
The involvement/satisfaction analysis of 28 respondents showed 32% (n=9) as
being regularly involved and satisfied with the provision of professional
development, and 32% (n=9) occasionally involved and satisfied with that
involvement. Respondents occasionally involved and undecided regarding their
satisfaction was 29% (n=8), and 4% (n=1) were dissatisfied.
Table 38: Professional Development – Association
Professional Development
Association
Importance/Satisfaction (n=31) 68% (n=21) Importance/Involvement (n=32) 28% (n=9) Involvement/Satisfaction (n=28) 32% (n=9)
xviii. Community/Church Liaison The community or church liaison role is again one that chaplains’ rate as
important but with lower rates of involvement and satisfaction. The involvement
rate may be more positive than may first appear with only 6% of respondents
never involved. There is however a dissatisfaction and undecided response of
42%. In the qualitative component of the questionnaire dissatisfaction was
expressed with churches responses to and support of chaplains. In the analysis
importance is not closely associated with involvement or satisfaction.
129
This question received 32 responses and 5 non responses. Eighty one percent
(n=26) of respondents reported that involvement in community/church liaison
was very important/important, 13% (n=4) not important/irrelevant, and 6% (n=2)
were undecided.
Thirty two responses were recorded to the question and (n=5) non responses.
Thirty eight percent (n=12) of respondents reported that they were
always/regularly involved in the community/church liaison role, 56% (n=18) that
they were occasionally/rarely involved, and 6% (n=2) they were never involved.
130
There were 34 responses to the question and 3 did not answer. Fifty nine
percent (n=20) of respondents indicated that they were very satisfied/satisfied
with the community/church liaison role, 18% (n=6) dissatisfied/very dissatisfied,
and 24% (n=8) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 30 important/satisfaction responses. These indicated that 57%
(n=17) found the community/church liaison role to be both important and
satisfying, 13% (n=4) important and undecided regarding satisfaction, and 10%
(n=3) important and dissatisfied. Respondents indicating that the
community/church liaison role was not important and undecided regarding their
satisfaction was 7% (n=2) and a further 7% (n=2) saw this role as not important
and were dissatisfied. Seven percent (n=2) of respondents were undecided on
both satisfaction and importance of the community/church liaison role.
Twenty nine importance/involvement responses were analysed. A 34% (n=10)
important and regularly involved response was recorded and a further 49%
(n=13) of respondents indicated that community/church liaison was important
131
while having occasional involvement. Seven percent (n=2) identified this role as
important although they were never involved and 10% (n=3) who were
occasionally involved saw it as not important.
The involvement/satisfaction pairing of 32 respondents indicated 38% (n=12) as
being regularly involved and satisfied with the community/church liaison role
and 22% (n=7) occasionally involved were satisfied with that involvement.
Respondents undecided regarding satisfaction were 16% (n=5) occasionally
involved, and 3% (n=1) never involved. 16% (n=5) who were occasionally
involved in this role were dissatisfied and 3% (n=1) who were never involved
also recorded dissatisfaction.
Table 39: Community-Church Liaison – Association
Community-Church Liaison
Association
Importance/Satisfaction (n=30) 57% (n=17) Importance/Involvement (n=29) 34% (n=10) Involvement/Satisfaction (n=32) 38% (n=12)
xix. Advice on Religious Diversity Responses to providing advice on religious diversity are low and a cause for
concern given that the chaplains work in a public hospital environment with a
variety of cultures and religions. The regularity of involvement may be a factor
but this does not explain why 47% of chaplains see this role as important, 22%
as not important and 31% undecided.
This is compounded by responses to satisfaction with 62% being dissatisfied or
undecided. At the same time 81% report involvement in providing advice on
religious diversity at some stage. The responses show little association.
132
Thirty two responses were recorded and 5 non responses. Forty seven percent
(n=15) of respondents reported that the provision of advice on religious diversity
was very important/important and 22% (n=7) not important/irrelevant.
Undecided respondents were 31% (n=10).
There were 32 responses to the question and 5 did not answer. Respondents
who reported that they were always/regularly involved in providing advice on
religious diversity was 6% (n=2) and 75% (n=24) that they were involved
occasionally/rarely. Nineteen percent (n=6) indicated that they never provide
advice on religious diversity.
133
This question received 31 responses and 6 non responses. Thirty nine percent
(n=12) indicated that they were very satisfied/satisfied with the role of providing
advice on religious diversity and 10% (n=3) were dissatisfied/very dissatisfied,
52% (n=16) were undecided.
Relationship between perceived importance, involvement and
satisfaction.
There were 29 important/satisfaction responses. These responses found
providing advice on religious diversity to be both important and satisfying to
28% (n=8), 17% (n=5) important and undecided, and 3% (n=1) important and
dissatisfied. Three percent (n=1) were undecided regarding importance while
satisfied with the role. Respondents undecided on both satisfaction and
importance were 28% (n=8). Those who indicated that the provision of advice
on religious diversity was not important recorded satisfaction levels of 3% (n=1)
satisfied, 3% (n=1) dissatisfied, and 10% (n=3) undecided regarding
satisfaction.
Thirty importance/involvement responses were paired. There was a 7% (n=2)
important and regularly involved response and a further 33% (n=10) indicated
134
that the provision of advice on religious diversity was important while
occasionally involved. Ten percent (n=3) nominated it as important while
having no involvement. Respondents who were undecided regarding the
importance of the provision of this role and occasionally involved was 27%
(n=8). Twelve percent (n=4) who identified this role as not important were
occasionally involved and 7% (n=2) who indicated this role as not important
were never involved.
The involvement/satisfaction analysis of 29 respondents indicated 7% (n=2) as
regularly involved and satisfied with the provision of advice on religious diversity
and 30% (n=9) occasionally involved and satisfied with that involvement. Those
occasionally involved and undecided regarding their satisfaction was 37%
(n=9). Seven percent (n=7) who were occasionally involved in the provision of
advice on religious diversity were dissatisfied. Respondents never involved in
the provision of this role reported levels of satisfaction of 3% (n=1) satisfied,
13% (n=4) undecided, and 3% (n=1) dissatisfied.
Table 40: Advice on Religious Diversity – Association
Advice on Religious Diversity
Association
Importance/Satisfaction (n=29) 28% (n=8) Importance/Involvement (n=30) 7% (n=2) Involvement/Satisfaction (n=30) 7% (n=2)
4.4.6 Summary of Qualitative Analysis Chaplains reported that they received most of their personal support from
chaplaincy colleagues both in the hospital in which they work and those from
other institutions and that this was helpful. Conference attendance and
focussed reading and reflection were the chaplains preferred and most highly
135
valued methods of professional development. Reporting on their ministry
environment chaplains indicated that while their personal ministry and faith
tradition were important to them they also valued ecumenical chaplaincy.
Chaplains’ engagement with the wider hospital was low, their highest
attendance being at department or ward meetings.
Out of the 19 nominated roles chaplains’ attached the most importance to and
reported involvement in and satisfaction with those having a focus on patient
care. Traditional roles such as pastoral care, pastoral counselling, prayer and
worship rated highly while less traditional roles such as multi-faith care and
advice on religious diversity did not. Roles that could be perceived as
administrative were low on satisfaction and involvement and included multi-
disciplinary team work, research, providing ethical advice and teaching and
education.
The importance that chaplains’ placed on the 19 nominated roles was generally
higher than their reported involvement in or satisfaction with them.
136
CHAPTER 5
UNDERSTANDING AND PRACTICE OF CHAPLAINCY
5.1 Introduction The literature review identified nineteen possible chaplaincy ministry acts, roles
or practices. These roles included the traditional ministries of the church such
as pastoral care, prayer and worship as well as ventures into new areas of
ministry such as multi-faith care, research and advice on religious diversity.
The research questionnaire specifically developed for this project was based on
the literature review and was designed to provide insight into how Christian
chaplains in the South Australian public hospital system understand and
practice their ministry. Chaplains were given the opportunity to comment on
and rate aspects of their ministry that demonstrated what roles they utilised, the
roles they considered significant and the priority they attached to them. A
combination of quantitative and qualitative methods was used to help assess
the utilisation, significance and priority of their ministry roles. This allowed
chaplains to contribute insights into their understanding and practice of their role
while at the same time providing the opportunity to validate the responses by
the application of the two methods.
Although there are similarities with and overlap of the categories of the utilised
roles, role priority and role significance and the nuances between each, these
categories nevertheless offer a systematic insight into chaplaincy understanding
and practice. It is important to recognise however that there will more than
likely be a difference between what full-time and part-time salaried chaplains
are able to contribute to the various roles compared with volunteer chaplains
due to time availability and frequency of connectedness with the hospital.
137
5.2 Significant Chaplaincy Roles
The roles that were found to be significant to chaplains were determined by
their responses to the survey questions about their involvement in, the
importance of and satisfaction that they attach to their roles. Additional insight
into their role significance was gained by the value respondents placed on
professional development, co-operative or individual ministry, and their
experience of their involvement in the wider hospital. What was significant to
chaplains however was not limited to the roles they performed and includes
their motivation or religious calling, their perception of the value of their ministry
and their connection with people. This included professional, personal and
practical issues which may have enhanced or hindered their chaplaincy
contribution.
Understanding respondents’ motivation or call to chaplaincy ministry provided
an insight into what chaplains see as significant. Chaplains reported that they
were involved in chaplaincy for one or a combination of four reasons; it is what
God wants them to do, a ministry on behalf of their church, their personal
motivation to care, and to share the gospel.
It was the relational roles, with a focus on patient care that chaplains reported
as important or significant and included visiting, listening, chatting,
conversation, and befriending.
Exploring issues with patients, identifying their concerns and sharing the human
journey also reflected relational roles. Chaplains indicated that they provided
support to patients’ by reminding them of God’s love, and offering spiritual care,
pastoral counsel and by advocacy or referral. Other important patient care roles
138
were praying with patients, providing communion and worship or conducting a
funeral.286 Involvement in the chaplaincy team with co-operative or ecumenical
ministry and receiving support from chaplaincy colleagues in the hospital they
worked in were also identified. When asked to indicate which of the nineteen
nominated chaplaincy roles were important to them, chaplains nominated
pastoral care, pastoral counselling, providing prayer, worship and sacrament,
and staff support as the most important.287 While nominated as important by
some respondents, the provision of multi-faith care and ethical advice were less
highly rated.
Roles that caused chaplains frustration also gave insight into what was
significant for them as these roles kept chaplains from what they consider to be
important. These roles included administration and the related issues of
resourcing, funding, record keeping and limited patient contact. The frustration
of not having enough time for patient contact could be tied in part to the time
spent on administrative functions. Frustration with the functioning of some
chaplaincy teams, communication issues and a desire to focus on training and
team development were also identified.
The relational component of their role was identified as important by chaplains
and is also evident in their frustration when this care was refused by some
patients or staff. Chaplains’ personal frustration can be interpreted in at least
four ways; the chaplains desire to care for patients, a misunderstanding of the
chaplains role by staff and patients, a rejection of the value of chaplaincy or a
286 HCCG,7., Good, ‘How Can I Say Goodbye’, 57-59., ACHI, 1915 Block: 305. 287 HCCVI Capabilities Framework, 19. In respect of staff, Arnot, 22, 25.
139
level of emotional immaturity on behalf of the chaplains. It also raises the
comfortableness of some chaplains engaging with patients of a faith other than
Christian or with no-faith.
Responses to how chaplaincy could be different also identified issues that were
significant to chaplains. These included organisational or structural changes in
the areas of chaplaincy team leadership, professional development, job
security, ecumenical structure and administrative support. Suggested changes
to chaplaincy practice also included intentional pastoral care provision for staff,
a multi-faith chaplaincy approach, and the chaplaincy service being fully
integrated into patient care.288 A desire for chaplains to be strategic in practice
and initiate change within chaplaincy was reported.
Chaplains’ involvement in various functions within the hospital offered insight
into the significance they place on areas that didn’t include patient contact.
These included hospital meetings, training and social gatherings. Although the
involvement of chaplains may at first appear to be low, not all chaplains can be
involved in all of the hospital forums and meetings, a case in point being the
HREC289 or PEC290 with five chaplains reporting that they were on these
committees. Chaplains indicated that their experience of these forums was
generally positive.
288 Kirkwood, 39 re multi-faith care. HCCG, 7., McFarlin and Carey, 219. 289 NHMRC, 81. 290 Carey, Aroni and Gronlund, 135.
140
5.3 Roles Chaplains Utilise
The roles chaplains utilise were identified through the activities they nominated
as important, those in which they were involved and the ministry tasks that gave
them satisfaction or caused frustration.
The structure of the hospital with its clinical focus and a hierarchy that is
predominantly medically oriented is the setting in which chaplains utilise their
understanding of and contribution to organisational functioning. Many public
hospitals are teaching and research institutions. Chaplains’ reported that their
role included teaching and to some extent research.291 They also use an ethical
framework to contribute to ethical discussions surrounding patient care and the
relationships of the various treatment teams.292 In this context chaplains have
identified that it is the relational and patient centred roles complemented by the
application of administrative skills and the ability to work in both chaplaincy and
multi-disciplinary teams that were utilised.293
Respondents reported that the roles utilised in patient care and support
included attending to patients through visiting, listening, and assessing patient
need. Other roles utilised included discerning patient issues, providing pastoral
support, referral to another unit in the hospital, church, or community agency.
Chaplains reported that they provided spiritual care and support to patients by
reminding them of God’s love and the church’s care, and utilised the resources
of prayer, scripture reading, worship or sacrament. Respondents also indicated
291 ACC, 1., James L Gibbons, 20., ACHI, 1869 Block: 287. 292 James L Gibbons, 18., Paver, 14. 293 Pavone, 35., Barletta and Witteveen, 101.
141
that they utilise pastoral counselling and bereavement education skills.294
Some chaplains utilised roles that provided support to people who were not
from the Christian faith and provided advice on religious diversity to hospital
staff.295
Practical and relational skills were utilised in chaplaincy team participation and
leadership, encouraging and training volunteers, supporting each other, and
administration. A large number of chaplains, 95%, reported that they received
personal support from members of the chaplaincy team in the hospital in which
they worked and 76% also received support from chaplaincy colleagues
outside of their own institution. Despite the frustration that some chaplains had
around their relationship with staff, a number also provided and received
support from hospital staff members.
Chaplains reported being active in both formal and informal professional
development opportunities. Attendance at chaplaincy conferences, personal
reading and reflection, participation in CPE and personal supervision were
identified. There was a high level of appreciation by chaplains with regard to
the professional development opportunities that were utilised.296
The predominant roles utilised by chaplains were traditional including pastoral
care, prayer and ritual, pastoral counselling and consideration and advice on
ethical issues. Alongside these traditional patient centred roles are those that
are part of public hospital chaplaincy and different from local parish or church
294 Elliott and Carey, 69., ACHI, 1869 Block: 287. 295 Kirkwood, 39. 296 Barletta and Witteveen, 101., CCAC, 18.
142
ministry. Respondents also indicated involvement in and contribution to their
chaplaincy team, multi-disciplinary team meetings, case conferences, ethics
committees and social functions. Also identified were the roles that chaplains
utilised in providing advice and care in a secular multi-cultural and multi-faith
environment.297 Compliance with hospitals policy is also required of chaplains.
The nineteen chaplaincy roles identified in the literature search were all utilised
by chaplains, some to a greater extent than others.
5.4 Priority of Chaplaincy Ministry
Chaplains’ roles include some that are relational and others that are structural in
nature. The relational roles are person centred, the structural roles focus on
hospital and chaplaincy administration. How chaplains prioritise their roles is
identified in their response to the questions about the role’s importance and
their involvement and satisfaction with them.
Public hospital chaplaincy is practiced in the context of possible crisis and
trauma with short term, often intense patient and family contact which creates
its own priority. Added to this is the requirement of patient care by the provision
pastoral care, counselling and faith support. In describing what is important to
them chaplains indicated that engagement with the patient was a priority and
providing pastoral care, pastoral counselling, prayer, worship and sacrament.
There were also the issues of support within the chaplaincy team and personal
support was received from, and provided by chaplaincy colleagues in the
hospital in which they worked and those outside that facility.
297 Blake, 31., Davoren, 113.
143
The demands of the chaplaincy team, involvement in hospital units,
administration and governance requirements, meetings and involvement in
other areas of hospital life regularly required a chaplains’ attention. The
responses included the strategic issues about what chaplains would want to see
as being different from their current practice such as an ecumenical co-
operative team. In terms of professional development the priority identified by
chaplains included chaplaincy conferences and focused reading and reflection.
The functions of the hospital in which chaplains were involved included
department or ward meetings, in-service training and social gatherings. It is
important to note however that what is a priority for some chaplains may not
necessarily be so for others.
5.5 Understanding of Chaplaincy Practice
Chaplains’ understanding that their role is person centred and relational
seemed to reflect their sense of call and ministry practice. The images and
metaphors chaplains used to describe their role reflected this understanding
and included the images of Jesus being with people during times of difficulty
and his ministry of healing. Responses indicated that providing care by ‘meeting
people where they are’, and ‘being present’ and ‘spiritual companioning’ were
important to chaplains. The unusual image of a miner or prospector suggested
the role required perseverance and commitment.
The biblical stories that chaplains found motivational also had a focus on
providing care, engaging with people and prayer. The stories of Jesus
144
engaging the woman at the well,298 being with Zaccheaus,299 engaging on the
Emmaus road,300 and the blessing of children301 are among those reported.
Prayer and healing stories and the direction to ‘go and do’302 were also offered
as scripture that influenced chaplains’ motivation and shape their practice. The
themes evident in these stories were of Jesus ‘meeting with’ ‘being with’ and
‘doing for’ people. It is this relational motif that most chaplains understand
underpins their ministry. Jesus and his ministry was the model that most
chaplains adopted for their role which they understand as their calling and
which they practiced behalf of God and/or their church.
Most respondents reported that there was a difference between ministry in a
church and that of chaplaincy in a public hospital. The difference was identified
by respondents to be in the context and structure of the hospital. Chaplains
reported that they were a guest or visitor of the patient. Aligned to this was a
recognition of patient privacy issues, the clinical focus of the hospital and the
requirement for accountability which included being part of a chaplaincy team
and contribution to multi-disciplinary units. The immediacy of public hospital
chaplaincy was identified which consisted of one-off visits, little or no follow up,
an emphasis on the present moment and an understanding that a crisis could
present at any time. Three respondents however indicated that church ministry
and hospital chaplaincy were the same.
298 John 4:4-26 299 Luke 19:5 300 Luke 24:13-35 301 Mark 10:13-16 302 Matthew 25:31-46, 28:18-20
145
Chaplains were asked how they would describe what they do to someone with
no church background and to people from within the church. Responses to
both questions were similar and identified that chaplains again understood their
role to be attending to patients, providing care, and offering prayer and
sacraments. Most chaplains indicated that they believed that providing support
to hospital staff members was important and that they did so.
The personal stress associated with hospital chaplaincy and the need for
personal debriefing was identified. Chaplains indicated that their sources of
personal support was predominantly from chaplaincy colleagues both in their
hospital and from other institutions and reported that the support received was
helpful. Hospital staff also provided support to chaplains that chaplains
reported as being helpful. These findings suggest that chaplains understand
that part of their role is to provide and to also receive support from each other.
Sources of support outside of the hospital included spiritual direction, family,
friends and church. More than half of the chaplains had a spiritual director.
Chaplains reported that they appreciate and value their denominational
distinctives while at the same time valuing ecumenical chaplaincy. They were
divided in their opinion when asked to rate team chaplaincy against individual
chaplaincy. When asked about their preference for an ecumenical or
denominational chaplaincy environment, 92% indicated that they favoured an
ecumenical chaplaincy and 59% endorsed denominational chaplaincy. It would
appear that chaplains want to work together while preserving their
denominational distinctives.
146
It has been noted that the public hospitals are also tertiary teaching institutions.
In response to on-going professional development thirty four chaplains indicated
that they were involved in some formal or informal way. Responses indicate
that chaplains place a high value on chaplaincy conferences, focused reading,
personal supervision and CPE. At the time of the survey, thirty percent of
chaplains were involved in a CPE program while sixty eight percent had
completed some CPE in preparation for chaplaincy ministry.303 A number of
chaplains attended in-service training and Grand Rounds in the hospital.
Chaplains were asked to indicate their involvement in the hospital including
professional development forums, functional meetings and social events. Some
chaplains indicated that they attended the hospital in-service training program
and the grand rounds that form part of the hospital’s education and skill
development program. Other hospital functions that chaplains were involved in
included department meetings, case conferences, ethics committees, and unit
social gatherings. Their involvement in both formal and informal professional
development indicates that chaplains understood the importance of on-going
professional development as part of hospital chaplaincy ministry.304 There is an
indication that some chaplains are integrated more than others into the hospital
and that they understand their role goes beyond patient relationships. For
those involved, their experience of these forums was positive.
303 CCAC, 18. 304 HCCVI Capabilities Framework, Barletta and Witteveen, 101.
147
5.6 Practice of Chaplaincy
Chaplains indicated that their practice had a major focus on patients and is
relational in nature, and that the public hospital environment requires an
involvement in a range of other roles including training, administration,
meetings, education and organisational demands. In addition they identified an
environment that has a multi-faith component.
The components of chaplaincy ministry can be variously described as
interventions, skills, tasks or roles depending on the context. The literature
review identified nineteen ministry tasks, some that are patient centred others
which are administrative in nature and those that fall into the category of
providing advice. Chaplains reported that they utilise all of these tasks in their
scope of practice.
The most visible chaplaincy role was patient care involving the roles of listening,
assessment of need, pastoral conversation, education or counselling and the
offer of prayer, sacrament or worship. Chaplains indicated that they were
generally satisfied with their practice of these roles.
Support of hospital staff was included by a number of chaplains as part of their
scope of practice with 55% indicating that they provided care to staff at least
weekly. Witnessing and representing the church was a role that most chaplains
indicated that they do at some time while 63% said that they did so regularly.
Chaplains also reported that they provided spiritual care that is not specifically
Christian in nature and care to people of faiths other than Christian.
148
The less visible roles of chaplaincy practice include involvement in the
chaplaincy team, engagement with other disciplines and participation in
administrative functions. Chaplains indicated that they were involved in the
chaplaincy team with varying degrees of regularity and 41%, indicate
involvement with the chaplaincy team daily. Half of the chaplains reported
involvement with multi-disciplinary teams and 56% indicated that administration
was regularly part of their practice.
Roles that chaplains practiced on a less regular basis included research,
teaching and education and providing advice on ethical issues or religious
diversity. Chaplains’ practice included teaching and education, providing ethical
advice and participation in HRECs and PECs.305 Advice on the religious needs
of patients and staff was provided to staff by chaplains on occasion.
Chaplains practice all of the roles identified in the literature review to a greater
or lesser extent. It is their practice in patient care that they reported as the most
rewarding. Administrative, teaching and personal professional development
were also areas of chaplaincy endeavour. Engagement in hospital functions
both social and professional were recognised by chaplains as part of their
scope of practice. Chaplains also indicated that their practice extended to the
support of hospital staff and the provision of multi-faith care.
305 Carey, Aroni and Gronlund, 135., Paver, 14., NHMEC, 81.
149
5.7 Summary
There was a clear understanding by chaplains that their role was person/patient
centred with an emphasis on the provision of care. Underpinning this was an
understanding that the role included professional development, involvement and
integration into the wider hospital team and a requirement to comply with a
number of administrative and organisational demands. There was a recognition
by chaplains that the structure of a public hospital brings unique demands and
priorities that often require immediate attention.
All of the 19 identified chaplaincy roles were practiced by the chaplains
surveyed however they were done so with varying levels of participation and
satisfaction. A number of chaplains indicated openness to the development
and implementation of new ideas, initiatives in chaplaincy specialisation and
changes in team structure.
150
CHAPTER 6
DISCUSSION AND RECOMMENDATIONS 6.1 Introduction
Public hospital chaplaincy in South Australia has undergone significant change
since the mid 1990s at the initiative of the HC4. At the same time there has
been an increasing expectation from hospital administrations of a professional
chaplaincy service. In response to this HC4 has conducted a number of
strategic reviews, initiated regular performance appraisals for chaplains,
articulated competency levels, developed ecumenical chaplaincy teams,
appointed coordinating chaplains and employed an Executive Officer. These
developments and changes have been a source of animated conversation
among chaplains as has their understanding of their role and practice of
chaplaincy. The anecdotal discussions among chaplains and the various points
of view expressed have not been tested until now. This aim of this research
project was to describe how Christian chaplains understand and practise their
ministry in South Australian public hospitals. Further, the findings will be shared
with chaplains and HC4 and enable more effective planning for the future.
6.2 Summary of Research
The literature search identified nineteen possible ministry acts or roles. These
roles include the traditional ministries of the church such as pastoral care,
prayer and worship as well as ventures into new areas of ministry such as multi-
faith care, research and advice on religious diversity. The 19 ministry roles
were embraced to varying degrees by chaplains.
151
Chaplains indicated that what was most important to them was relational in
content and centred on patient contact and providing ministry to them. This
ministry took for the form of attending to patients, engaging with them and
providing support in various forms including prayer and sacrament. The
descriptions that they used to picture their chaplaincy and the biblical images
that motivated and supported them also had a relational focus. It was not
surprising therefore that the main causes of frustration for chaplains were those
aspects of their role that were administrative or around unsettled relationships
with patients, hospital staff or chaplaincy team members. Other less satisfying
roles for chaplains were those that involved the hospital organisation and
structure of chaplaincy departments.
There was also an indication that there were chaplains who are able to operate
in the complex public hospital environment and not only provide care to patients
but engage with the wider hospital. It would appear that they were able to
embrace and engage in the administrative and governance requirements of the
role and connect with a variety of formal and informal functions.
6.3 Implications for Practice
While a patient care focus was important to the majority of chaplains the
hospitals in which they work also required the issues of governance and the
development of best practice to be addressed. It is in this wider hospital
environment that a number of chaplains identified difficulty. To be more
effective chaplains need the skills to engage in the hospital beyond the bed-
side.
152
Public hospital chaplains work in an environment of possible medical
emergencies and short-term, often intense, ministry. The unsettled nature of
some chaplaincy positions was noted including the need for secure funding and
job security. A major implication is for the continued development of chaplaincy
teams that are well led and resourced.
The findings indicated that chaplains in public hospitals required a different skill
set to the minister in a local church or parish. The process for selecting
chaplains along with clarification around specific training and educational
requirements needs attention. This would include clarification of what
constitutes qualifications for chaplaincy ministry and the development of a
comprehensive scope of practice description. The findings of this study also
suggest that some chaplains have an insular tendency both within the hospital
and with their churches. An important development is for chaplains to adopt a
holistic and global perceptive including involvement in the ‘life’ of the hospital
and to engage with their denominations and for their churches to engage with
them.
A number of chaplains wanted development of chaplaincy practices that
included intentional professional development, the integration of new ideas and
initiatives which included chaplaincy specialisation and a change of chaplaincy
structure that embraced ecumenical teams. Also specifically identified was the
provision of care to patients who did not claim a faith, those from other faiths
and care for staff. The factors that work against these initiatives include the
busyness of hospital ministry, the denominational model that is currently
practiced by some and the attitude or ability of some chaplains to embrace
153
these changes. These responses are consistent with the changes that HC4 has
continued to implement. To be effective these changes require continued
endorsement from denominational leaders, the willing participation of chaplains
and adequate resourcing.
The study highlighted that of the nineteen areas surveyed, only three had high
association across importance, involvement and satisfaction. These were the
patient care roles of pastoral care, pastoral counselling and prayer. However, it
is problematic that in these key areas some chaplains appear not to be involved
or satisfied. Of particular note with this is the number who indicated that they did
not regularly conduct a pastoral assessment with patients.
While some chaplains were involved and satisfied with the whole range of
chaplaincy roles, the number who were not is a cause for concern. These
ministry areas included staff support, teaching and education, sacramental
ministry, engagement with multi-disciplinary teams, providing ethical advice,
professional development and providing advice on religious diversity. This may
be due to some chaplains having only a denominational focus. The findings
also suggest that chaplains’ involvement in professional development is at their
discretion.
Of significant concern is the number of chaplains who indicated that they were
unsettled by staff or patients who did not embrace their care. Issues of a
confused role identity and adequate personal coping skills are concerns as is
the adequacy of the selection process for chaplains.
154
The PIC proved to be an effective code for describing the chaplain’s role in
providing patient care. A comprehensive description of a chaplaincy
department in a health care setting was provided by the HCCG which also
includes some descriptions of patient care. However, both fall short of offering
an overall description of the chaplain’s role that enable them to be used for an
analysis of chaplaincy practice and to provide accountability in the work-place.
The development of the CPC in this project provides such a tool and is an
initiative that can be easily implemented. Although this project demonstrates its
effectiveness, a larger study to validate the CPC is necessary.
The current study only considered chaplains in South Australian public hospitals
thus limiting generalisation of results. In addition, the small sample size made
an analysis of the differences between salaried and volunteer chaplains, those
who are ordained or lay and between chaplains of different denominations
problematic.
6.4 Recommendations
There are six key recommendations for chaplains and the HC4 from this
research.
• Assess, adapt and validate the CPC for use in South Australian public
hospitals.
• Clarification of what constitutes chaplaincy specific qualifications and
training.
155
• Development of a clear scope of chaplaincy practice and clarification
of the terms of this practice.
• Review the selection process for chaplains in South Australia to
identify individuals who have the ability to engage in the wider
hospital context.
• Identify and address the professional development needs of South
Australian public hospital chaplains particularly in the development of
skills in pastoral assessment, multi-faith care, ethics, staff care and
the provision of advice about faith issues.
• HC4 to continue its policy of developing ecumenical teams headed by
a coordinating chaplain with the ability to relate to hospital
administration.
The findings of this study suggest that future research is required to provide
evidence of the benefits of chaplains’ engagement with patients and staff and
their effectiveness in non-clinical roles. Further study is also needed is to
assess if the results for South Australian public hospital chaplains are reflected
nationally.
156
BIBLIOGRAPHY
Aiken, Carl. “Chaplaincy and Health Care in the ADF: The Relationship between Body, Mind and Soul.” ADF Health 9, no.2 (December 2008): 74-78. Allbrook, David. “Transfiguration: A Change from Doctor to Chaplain.” Ministry 10, no.3 (2000): 25-27. Arnot, Moss. “The Chaplains Role in Staff Support: Incidental or Central?” Ministry, Society and Theology 7, no.1 (1993): 12-25. Australian College of Chaplains, Handbook of the Australian College of Chaplains Incorporated. 2005. Baker, Tony. “Organ Transplantation: That Life Can Go On.” Ministry, (Summer 1991): 20-21. Barletta, John, and Michael Thomsen. “Pastoral Carers in the Hospital Context.” Australian Journal of Primary Health 7, no.2 (2001): 43 – 49. Barletta, John, and Kate Witteveen. The Development of Roles and Education for Pastoral Care workers in Queensland Health: A Research Report. Brisbane: Queensland Health, (2005). Blake, Philip. “Towards a Biblical Theology of Chaplaincy.” Ministry, Society and Theology 12, no.1 (1998): 27-36. Boyatzis, Richard E. Transforming Qualitative Information – ThematicAnalysis and Code Development, Thousand Oaks: Sage, 1998. Braun, Virginia, and Victoria Clarke. “Using Thematic Analysis in Psychology.” Qualitative Research in Psychology 3, (2006): 77-101. Brennan, Michael, and Graeme Gibbons. “Pastoral Care Clinical Codes of Intervention.” Conference paper presented at the Australian Health & Welfare Chaplains Association, National Conference, Wesley College, University of Sydney, February, (2001). Bride, Graham. “The Chaplain as Advocate: Reflections from a New Boy.” The Australian Chaplain 2, (1982): 3-5. Carey, Lindsay B. “Clergy Under the Knife: A Literature Review on Hospital Chaplains.” Ministry: Journal of Continuing Education, (Summer 1991): 7–9. __________ “Religiosity and Health: Review and Synthesis.” New Doctor 60, (1993): 26-32. _________ “The Role of Hospital Chaplains: A Research overview.” Ministry, Society and Theology 9, no.2 (1995): 41–53.
157
________ “The Sacralization of Identity: A Cross-Cultural and Inter-Religious Paradigm for Hospital Chaplaincy.” The Journal of Health Care Chaplaincy, (February 1998): 15-24. ________ “Health care Chaplaincy research: A Need within Aged Care Facilities.” Journal of Family Studies 5, no.2 (1999): 291-296. ________ ed. Chaplaincy in the Clinical Context: Anthology of Published Articles, Volume One, Australian Chaplain Utility Research, Melbourne, (1999). ________ Prayer in the Clinical Context, Order of St. Luke the Physician Memorial Essay Award, Melbourne, (1999). ________ “Clinical Perspectives of the Chaplain’s Prayer Role.” Ministry, Society and Theology 14, no.1 (1999): 45-72. ________ “Health Care Chaplaincy: A Research ‘Snapshot’.” Ministry Journal for Continuing Education 10, no.2 (1999-2000): 28-30. ________ “Hospital Chaplaincy.” Pointers 10, no.2 (2000): 1-4. ________ “The Role of Chaplains in the ‘Sacralization of Identity’: An Initial Exploration of a General Theoretical Paradigm for Inter-religious and Cross-cultural Chaplaincy.” Ministry, Society and Theology 15, no.2 (2001): 133 -145. ________ “Health Care Chaplaincy Standards Utility & Satisfaction Evaluation.” Ministry, Society and Theology 16, no.1 (2002): 111-119. ________ “The Australian Health Care Chaplaincy Guidelines and the World Health Organisation Pastoral Intervention Codings: Some Interim Considerations.” Ministry, Society and Theology 16, no.2 (2002): 72-87.
Carey, Lindsay B., Rosalie Aroni, and Allen R Edwards. “Medical Ethics and the Role of Hospital Chaplains.” Ministry, Society and Theology 10, no.2 (1996): 66-79. Carey, Lindsay B., Rosalie Aroni, Allen R. Edwards, Christina L. Carey-Sargeant, and Jennifer Boer, “Chaplains and Speech Pathologists: Some Interdisciplinary and Practical Opportunities.” Ministry, Society and Theology 11, no.1 (1997): 132-140. Carey, Lindsay B., Rosalie Aroni, and Allen R. Edwards. “Health Policy and Well-being: Hospital Chaplaincy.” in H. Gardner (Ed.), Health Policy in Australia (pp. 190 – 210). Melbourne: Oxford University. (1997). Carey, Lindsay B., Rosalie Aroni, Meredith Gronlund. “Bio-Medical Ethics, Clinical Decision Making and Hospital Chaplaincy in New Zealand: A Research Overview.” Ministry, Society and Theology 12, no.2 (1998): 136-155. Carey, Lindsay B., and Christopher Newell. “Economic Rationalism and the Cost Efficiency of Hospital Chaplaincy: An Australian Study” Journal of Healthcare Chaplaincy 10, no.1 (2000): 37-52.
158
Carey, Lindsay B., and Christopher Newell. “Clinical Pastoral Education and the Value of Empirical Research: Examples from Australian and New Zealand Datum.” Professional Chaplaincy and Clinical Pastoral Education, (2002): 53-65. Carey, Lindsay B., Cheryl Holmes, and Emil Neven. “Chaplaincy and Pastoral Care Services Pilot Program Process: A Case Study.” Ministry, Society and Theology 18, no.1 (2004): 109-126. Carey, Lindsay B., and Christine Meese. “Do Pastoral Care and Spiritual Services Make a Difference?” Ministry, Society and Theology 19, no.1 (2005): 114-128. Carey, Lindsay B., Christopher J Newell, and Bruce Rumbould. “Pain control and Chaplaincy in Australia.” Journal of Pain and Symptom Management 32, no.6 (2006): 589-601. Carey, Lindsay B., Bruce Rumbould, Christopher Newell, and Rosalie Aroni. “Bioethical Issues and Health Care Chaplaincy in Australia.” Scottish Journal of Healthcare Chaplaincy 9, no.1 (2006): 23-30. Carey, Lindsay B., and Christopher Newell. “Withdrawal of Life Support and Chaplaincy in Australia.” Critical Care and Resuscitation 9, no.1 (2007): 34-39. Carey, Lindsay B., and Christopher J Newell. ‘Chaplaincy and Resuscitation.” Resuscitation 75, (2007): 12-22. Cave, Eric. Since by a Man Came Death. Ministry, Society and Theology 11, no.1 (1997): 128-131. Cave, Eric, and Christopher Newell. “An Evaluation of the Effect and Impact of Clinical Pastoral Education in Tasmania.” Ministry, Society and Theology 15, no.2 (2001) 105-132. Civil Chaplaincies Advisory Committee. CCAC CHAPLAINCY SUBMISSION 2002. NSW. Clebsch, William A., and Charles R. Jaekle. Pastoral Care in a Historical Perspective, New Jersey, Jason Aronson, 1975. Clinebell, Howard, Basic Types of Pastoral Care and Counselling, London, SCM, 1984. Corfee, Joan, and Mirella Rao. “Sacred Space.” The Summit 28, no.4 (2001): 14-15.
Cross, Ron. “The Changing Face of Chaplaincy.” Ministry, Society and Theology 9, no.2 (1995): 5-11.
159
Cross, Ron, Lindsay B. Carey, Noel Allen, Noreen Owens. The Health Care Chaplaincy Guidelines, The Australian Health and Welfare Chaplains Association Inc. Melbourne, 2004. Davoren, Ronald P. Interfaith Pastoral Care: The Role of a Hospital Chaplain, Unpublished Masters Research Project, Melbourne College of Divinity, 2007. Dey, Ian. Qualitative Data Analysis, London, Routledge, 1993. Douglas, David. “Role and Accountability for Hospital Chaplains.” Ministry, Society and Theology 3, no.1 (1989): 11-15. Eagar, Kathy, Pamela Garrett and Vivian Lin, Health Planning: Australian Perspectives, Crows Nest, Allen and Unwin, 2001. Edwards, Allen. “Congenital Heart Disease and the Family – The Role of the Hospital Chaplain.” The Australian Chaplain 2, (1981): 31-33. Elliot, Hazel. Hospital Chaplaincy in the Context of Religion in Contemporary Australia, Unpublished PhD thesis, University of Sydney, August 2000 Elliott, Hazel, and Lindsay B. Carey. “The Hospital Chaplain’s Role in the Organ Transplant Unit.” Ministry, Society and Theology 10, no.1 (1996): 66-77. Evans, Meredith, and Richard Miller. History, Responsibility and Accountability, Heads of Christian Churches Chaplaincy Committee, November 1999. Francis, Cecillia. “Chaplaincy and Episcopae.” Ministry, Society and Theology 4, no.1 (1990): 6-10.
Forsyth, John. “Ernie, The Aboriginal Man on the Intensive Care Ward: A Study in Ritual.” Ministry, Society and Theology 8, no.2 (1994): 71-81. Furphy, Jennifer. “Courage and Hope – A Chaplaincy Experience.” Ministry, Society and Theology 17, no.1&2 (2003): 140-145. Galt, Allan. “The Chaplain as Visitor – A Theological Basis for a Caring Ministry to People in Crisis.” The Australian Chaplain 2, (1982): 10-13. Gepp, Caroline. “Pastoral Relationships and the Random Hospital.” Ministry, Society and Theology 13, no.1 (1999): 6-17. Gibbons, James L. “Contemporary Images of Hospital Chaplaincy.” Ministry, Society and Theology 2, no.2 (1988): 12-19. Gibbons, Graeme D. “Refocusing Pastoral Care.” Ministry, Society and Theology 3, no.2 (1989): 20-23. ________ “Pastoral Care Casemix Codings” Ministry, Society and Theology 10, no.1 (1996): 44-65.
160
Gibbons, Graeme, Andrew Retsas, and Jaya Pinikahana. “Describing what Chaplains do in Hospitals.” The Journal of Pastoral Care 53, no.2 (1999): 201-207. Gilgun, Jane F., “‘Grab’ and Good Science: Writing up the Research Results of Qualitative Research.” Qualitative Health Research 15, no.2 (2005): 256-262. Good, Nan. “The Application of Skills in the Professional Helping Relationship.” The Australian Chaplain 5, (1985): 43-49. ________ “The Bible and the Hospital Chaplain.” Ministry, Society and Theology 5, no.2 (1991): 7-12. ________ “How can I say Goodbye.” Ministry, Society and Theology 6, no.1 (1992): 56-59.
________ “Ministry to Outpatients: New Calling in Pastoral Care.” Ministry, Society and Theolog 9, no.2 (1995): 19-21. Goode, Leslie. “To Give Support as we Care” Ministry, Society and Theology 1, no.1 (1987): 55-59. Gray, Geoffrey. “A Hospital Chaplain’s Reflection on his Philosophy of Chaplaincy Integrating an Account and an Evaluation of a ‘Typical’ Week’s Activity.” Ministry, Society and Theology 19, no.2 (2005): 26-39. Griffin, Graeme M. “A Creative Understanding of Stress in a Multi-Disciplined Community.” Ministry, Society and Theology 1, no.2 (1987): 20-25. Hammat, Paul. Pastoral Care Statistics (Microsoft Excel Program), Repatriation General Hospital, South Australia, (2002). Hansen, Frank. “What Makes a Chaplain?” The Australian Chaplain 2, (1981): 23-24. Harris, Joy. “Ten Years After Hours Pastoral Care in Emergency.” Ministry, Society and Theology 17, no.1&2 (2003): 118-125. Hawkes, Geraldine, and Lorna Hallahan. Healthy Chaplaincy in Adelaide’s North West, Final Report to the South Australian Heads of Christian Churches Chaplaincy Committee, 24 March 2005. Heads of Christian Churches Chaplaincy Committee, Terms of Reference, 23 June 2005. ________ Workshop Notes, 5 July 2005 ________ Strategic and Operational Plan 2005 – 2007, 2005. Healthcare Chaplaincy Council of Victoria Inc., Capabilities Framework for Pastoral Care and Chaplaincy, 2nd ed. Melbourne, 2008.
161
Holmes, Cheryl, and Lindsay B. Carey. Pastoral Care and Chaplaincy Provision within Metropolitan Health and Aged Care Services in the State of Victoria. Healthcare Chaplaincy Council of Victoria and the Australian Health & Welfare Chaplains Association. Melbourne: 2005. Ireland, Bede, Lindsay B. Carey, Ian Baguley, Russell Maurizi, Jenelle Crooks, and Meredith Gronlund. “The Westmead Hospital Brain Injury Rehabilitation Unit and Pastoral Care Department Pilot Research Project: A Joint Research Endeavour.” Ministry, Society and Theology 13, no.1 (1999): 46–60. Kenworthy-Toohey, Carmel, and Lindsay B. Carey. “Hospital Chaplaincy to Nurses Suffering Grief and Loss.” Ministry Journal of Continuing Education 5, no.4 (1995): 20-22. Keppel, Geoffrey. Design and Analysis, a Researcher’s Handbook, Prentice-Hall, Englewood Cliffs, 1982. Kirkwood, Neville. “Pastoral care and public health: a universal and professional vocation.” Ministry, Society and Theology 14, no.1 (2000): 37-44. Kingston, Vicky. “My first few months.” The Australian Christian102, no.15 (1999): 16. McFarlin, Phoebe, and Lindsay B. Carey. “I’m Not Religious…but Please Pray.” Ministry, Society and Theology 18, no.2 (2004): 211-225. McGuirk, Jenny. “Dancing on the Pin of Mortality: The Challenge of Transplantation.” Ministry, Society and Theology 16, no.2 (2002): 59-71. McLeod, John. Qualitative Research in Counselling and Psychotherapy, London, Sage, 2005. Miles, Matthew B. and A. Michael Huberman. An Expanded Sourcebook Qualitative Data Analysis, 2nd ed. Thousand Oaks: Sage Publications, 1994. Mulder, Christiaan J., and Lindsay B. Carey. “Our Lady of Consolation Aged Care Services: Results and Critique of a Pilot Pastoral Care Resident’s Survey.” Ministry, Society and Theology 13, no.2 (1999): 22- 35. National Centre for Classification in Health, Pastoral Intervention Codings, International Classification of Diseases Australian Modification, Sydney University, Sydney, 2002/2005. National Health and Medical Research Council, National Statement on Ethical Conduct in Human Research, Australian Government, Canberra, 2007. Newell, Christopher, and Lindsay B. Carey. “Economic Rationalism and the Cost Efficiency of Hospital Chaplaincy: An Australian Study.” Journal of Health Care Chaplaincy 10, no.1 (2000): 37-52.
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Neuman, W. Lawrence, Social Research Methods; Qualitative and Quantitative Approaches, 6th ed. Boston, Pearson, 2006. Paver, John. “The Role of the Pastoral Care Unit at the Cancer Institute, Melbourne.” The Australian Chaplain 2, (1982): 14-25. Pavone, Joe. “Hospitals, Management and Chaplaincy.” Ministry, Society and Theology 1, no.1 (1987): 34-40. Polgar, Stephen and Shane A. Thomas, Introduction to Research in the Health Sciences, 5th ed. Philadelphia, Churchill Livingstone, 2008. Polkinghorne, Margaret. “The Cutting Edge of Chaplaincy.” Ministry, Society and Theology 1, no.1 (1987): 47-50. ________ “A Response – Role and Accountability of Hospital Chaplains.” Ministry, Society and Theology 3, no.1 (1989): 16-18. Pope, Catherine, Sue Ziebland, and Nicholas Mays. “Analysing qualitative data.” British Medical Journal 320(7227), (2000): 114-116.
Prentice, Luke. “Theology and Ministry of Hospital Chaplaincy: An Evangelical View.” Ministry, Society and Theology 19, no.2 (2005): 8-25.
Preston, Noel. “Imagining Chaplaincy.” Ministry, Society and Theology 15, no.2 (2001): 38-46. Raj, Leslie. “Caring for Parents when their Child is Dying in the Intensive Care Unit.” Ministry, Society and Theology 8, no.2 (1994): 5-15. Reddicliffe, Ray. “Chaplaincy Ministry – Present Perspectives and Future Prospects.” Ministry, Society and Theology 5, no.2 (1991): 28-38. Roberts, Harry. “Gladesville Revisited.” Ministry, (Winter 1993): 24-27. Rumbould, Bruce. “Pastoral Care and Spiritual Care.” Ministry, Society and Theology 7, no.1 (1993): 43-51. Ryall, Elizabeth. “Sacrament and Presence.” Ministry, Society and Theology 5, no.1 (1991): 51-57. Silverman, David. Doing Qualitative Research, London, Sage, 2000. Spring, John. “Prayer in the Clinical Context.” Ministry, Society and Theology 14, no.2 (2000): 112-119. Strauss, Anselm and Juliet Corbin. Basics of Qualitative Research, Newbury Park, Sage, 1990. Swinton, John, and Harriet Mowat. Practical Theology and Qualitative Research, London, SCM Press, 2006.
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Tapper, Robin. “The Role of Chaplain.” Ministry, Society and Theology 11, no.1 (1997): 102-114.
Thomas, Barbara Schalk. Nursing Research, an Experiential Approach, The C.V. Mosby Company, St. Louis, 1990. Tuckett, Anthony G. “Applying Thematic Analysis Theory to Practice.” Contemporary Nurse 19, (2005): 75-87. Turabain, Kate. A Manual for Writers of Research Papers, Theses, and Dissertations, The University of Chicago Press, Chicago, 2003. Webb, Penny, Chris Bain, Sandy Pirozzo, Essential Epidemiology: An Introduction for Students and Health Professionals, New York, Cambridge University Press, 2005.
Wegener, Jenni. “Discovering and Singing the Lord’s Song in a Strange Land: Reflections on Being a Hospital Chaplain.” Ministry, Society and Theology 17, no.1&2 (2003): 126-139. Willcock, Peter. “Some Reflections on Pastoral Care.” Ministry, Society and Theology 3, no.1 (1989): 50-52.
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APPENDIX 1
Health Care Chaplaincy Guidelines Key Roles
IDENTIFY AND ASSESS NEEDS FOR CHAPLAINCY PROVISION This category includes gathering information concerning the individual (patient, family and staff) to provide pastoral care to their communal, organizational, spiritual and religious needs. It identifies co-operatively defining a strategy for implementing, monitoring and reviewing the chaplaincy service in the institution. MANAGE AND DEVELOP A CHAPLAINCY SERVICE This category includes managing the financial, material and human resources of a chaplaincy service. Identifying and accessing resources for the development and promotion of the service, the effective operation of the chaplaincy team and the contribution to the health community are included. PROVIDE OPPORTUNITIES FOR WORSHIP AND RELIGIOUS EXPRESSION This category includes support for the individual, the community and the chaplaincy team by providing opportunities for faith expression through physical and religious resources and opportunities for personal and public prayer and worship. PROVIDE PASTORAL CARE, COUNSELLING AND SPIRITUAL DIRECTION This category includes establishing and maintaining relationships that are respectful, supportive and responsive to individual needs - particularly during episodes of psychological, spiritual and emotional distress - by assisting with faith or belief issues, problem solving, decision making and advocacy. It includes the requirement to record pastoral care services. PROVIDE AN INFORMED RESOURCE ON ETHICAL, THEOLOGICAL AND PASTORAL MATTERS This category identifies the provision of ethical, theological and pastoral resources for the benefit of individuals and the wider community. It also includes identifying, designing, and evaluating educational programs for individuals (including chaplains) and groups. The assessment of individual chaplaincy competence is included here.
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APPENDIX 2
ICD-10-AM Pastoral Care Interventions
PASTORAL ASSESSMENT (lCD code 96186-00) Description: An appraisal of the spiritual wellbeing, needs and resources of a person within the context of a pastoral encounter. PASTORAL MINISTRY (lCD code 96187-00) Description: The provision of the primary expression of the service, which may Include: - establishing of relationship / engagement with another, hearing the story, and the enabling of pastoral conversation in which spiritual wellbeing and healing may be nurtured, and companioning persons confronted with profound human issues of death and dying, loss, meaning and aloneness. Predominantly a ‘ministry of presence’. PASTORAL COUNSELLING or EDUCATION (lCD code 96087-00) Description: An expression of Pastoral Care that includes personal or familial counsel, ethical consultation, a facilitative review of one’s spiritual journey and support in matters of religious belief or practice. The intervention expresses a level of service that may include counselling and catechesis for example, and the following elements may be identified - “emotional/spiritual counsel”, “ethical consultation”, “religious counsel/ catechesis”, “spiritual review”, “death and dying” Note: The interventions “Bereavement care/counsel”, and “Crisis care / debriefing”, for example, are not profession-specific to Pastoral Care and are therefore given generic code numbers in lCD-b. When making annotations in the Patient/Resident record therefore, these latter terms may be used by Pastoral Care personnel, but coders will record such activity within the relevant generic codes. PASTORAL RITUAL / WORSHIP (lCD code 96109-01) Description: This intervention contains the pastoral expressions of informal prayer and ritual for individuals or small groups, and the public and more formal expressions of worship, including Eucharist and other services, for faith communities and others. Elements of this intervention may include:- “private prayer and devotion”, bedside “Communion” and “Anointing” services, “Blessing and Naming” services for the stillborn and miscarried, and other “sacrament” and ritual expressions; “public ministry” - “Eucharist/Ministry of the Word”, funerals, memorials, seasonal and occasional services
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APPENDIX 3
CHAPLAINCY QUESITIONAIIRE 1. Gender
Male Female
2. Age
21 -30 31 -40 41 - 50 51 - 60 61 -70 71 +
3. How long have you worked in Chaplaincy?
Less than 1 year 1-5 years 6-10 years 11-15 years 15 + years
4. Which statement best describes your current Chaplaincy employment status?
Full-time - paid Part-time - paid Volunteer
5. Have you received any formal education in chaplaincy?
CPE - (# of quarters)
Professional Development – (please list)
Other - (please list)
6. What is the highest level of education you have obtained?
QUALIFICATION RELIGIOUS/ THEOLOGICAL
SECULAR
No formal qualification Certificate Diploma Degree Graduate Diploma Masters Doctorate
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7. Are you
Ordained Lay Belong to a Religious Order
8. Which faith tradition do you belong to?
Adventist Anglican Catholic Baptist Brethren Churches of Christ Lutheran Pentecostal Religious Order Salvation Army Uniting Other Christian Tradition
9. What professional organisations do you belong to? - Please indicate all groups that you belong to.
CPE Association Australian Health and Welfare Chaplains Association Australian College of Chaplains Chaplaincy Australia Other (please indicate)
10. Approximately how many hours per week would you work?
Less than 8
8 16 24 32 40 48
11. What are the 3 most important chaplaincy ministries/actions/roles that you do?
1._______________________________________________ 2._______________________________________________ 3._______________________________________________
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12. What are the 3 most frustrating chaplaincy ministries/actions/roles that you do?
1._______________________________________________ 2._______________________________________________ 3._______________________________________________
13 If chaplaincy could be different how would you imagine that role to be? What changes would you like to see here? Please name the three things you would most like to change about your
role 1._______________________________________________ 2._______________________________________________ 3._______________________________________________
14 Many chaplains have an image or metaphor to describe what they do. What is the image or metaphor that speaks to you? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 15 Often chaplains have a biblical story or text that motivates their ministry. Which story or text resonates with you? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 16. How do your role and expectations as a hospital chaplain differ from those of a minister/priest/lay worker in the church or parish? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________
17. How do you describe what you do? In lay terms to someone with no church background
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_______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 18. How do you describe what you do? To people within the church _______________________________________________________________
_______________________________________________________________
_______________________________________________________________ 19 If you receive personal support (non-financial) where do you receive that support from? - Is it helpful or not?
Sources of Personal Support
Received FromPlease Circle
Yes or No
Helpful Not Helpful
Chaplaincy Colleagues – in the hospital I work in
Yes - No
Chaplaincy Colleagues – outside the hospital I work in
Yes - No
Fellow Pastors/Ministers/Clergy Yes - No Hospital staff Yes - No Spiritual Director Yes - No Other (please list)
Yes - No
No Support Received Yes
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20 What professional development are you currently involved in. - Please indicate their value to you.
PROFESSIONAL DEVELOPMENT
INVOLVMENT IN VALUE
Please Circle Yes or No
No Value
Undecided High Value
Focussed reading and reflection
Yes - No
CPE Yes - No Academic Study Yes - No Conferences – church Yes - No Conferences – chaplaincy Yes - No Continuing Education Program
Yes - No
Study Groups Yes - No Personal Supervision Yes - No Other (please list)
Yes - No
21. The ministry environment of hospital chaplaincy has changed over the years. Please indicate how important you these issues are in the table below.
Ministry Environment
Irrelevant Not Important
Undecided Important Very Important
Team vs Individual Working as a member of
the chaplaincy team
Working as an individual chaplain
Ecumenical vs Denominational
Ecumenical Chaplaincy
Denominational Chaplaincy
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22. Of these functions in the Hospital, which do you attend/contribute to, and what is your experience of them?
Functions Attend Experience
Please Circle Yes
or No Good Indifferent Poor
Interdepartmental Meetings Yes - No Departmental/Unit/Ward meetings
Yes - No
Case Conferences Yes - No Research Ethics Committee
Yes - No
Patients Ethics Committee Yes - No Grand Rounds Yes - No In-Service Training/Journal Clubs
Yes - No
Unit social gatherings Yes - No Other functions (please list) Yes - No
23. In an ordinary week, how would you rate the importance of these ministry tasks?
Ministry Act/Task Irrelevant Not Important
Undecided Important Very Important
Pastoral Assessment Pastoral Care Pastoral Counsel Prayer Worship Sacramental Ministry Spiritual Care (not specifically Christian)
Multi-faith Care (patients of other faiths)
Staff Support Witness/Represent Church Team work – Chaplaincy Team work – multi-disciplinary Administration Research Teaching/Education Ethical Advice Professional Development Community/Church Liaison Advice on Religious Diversity
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24 In an ordinary week, how would you rate your involvement in these ministry tasks?
Ministry Act/Task Never Rarely (yearly)
Occasionally (monthly)
Regularly (every week)
Always (every day)
Pastoral Assessment Pastoral Care (support) Pastoral Counsel Prayer Worship Sacramental Ministry Spiritual Care (not specifically Christian)
Multi-faith Care (patients of other faiths)
Staff Support Witness/Represent Church Team work – Chaplaincy Team work – multi-disciplinary Administration Research Teaching/Education Ethical Advice Professional Development Community/Church Liaison Advice on Religious Diversity
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25 In an ordinary week, how would you rate your satisfaction with these ministry tasks?
Ministry Act/Task Very Dissatisfied
Dissatisfied Undecided Satisfied Very Satisfied
Pastoral Assessment Pastoral Care Pastoral Counsel Prayer Worship Sacramental Ministry Spiritual Care (not specifically Christian)
Multi-faith Care (patients of other faiths)
Staff Support Witness/Represent Church Team work – Chaplaincy Team work – multi-disciplinary Administration Research Teaching/Education Ethical Advice Professional Development Community/Church Liaison Advice on Religious Diversity
Thank you for completing this survey.
Please return your survey in the envelope provided.
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APPENDIX 4
Question 11 - Role Importance Question 11 - What are the 3 most important chaplaincy ministries/actions/roles that you do? TOTALS - IC Attend 37 Engage 16 Provide 22 Ritual 28 Lead 9 Administration 3 NA 2 Not Coded 1
TOTALS – CPC PA 39 PM 28 PCE 10 PRW 29 MDC 11 NA 2 Not Coded 1
Importance – Round 1
RESPONDENT KEY IDEA IC CPC 1. Turn up Turn up Attend PA 2. Listening Listening Attend PA 3. Listening Listening Attend PA 4. Meeting and sharing with a variety of people
Meeting / sharing Attend Engage
PA PM
5. Be there Be there Attend PA 6. Prayer Prayer Ritual RW 7. Pastoral Visiting Pastoral Visiting Attend PA 8. Praying for the Sick Praying Ritual RW 9. Be with people where they are
Be with people Attend PA
10. Visitation Visitation Attend PA 11. Personal contact with patients – listening
Personal contact / listening
Attend PA
12. Bedside Ministry Bedside Ministry Engage PM 13. Listen Listen Attend PA 14. Aged Care Aged Care Not Coded Not Coded 15. Pray Pray Ritual RW 16. Visit patients Visit Attend PA 17. Pastoral care of those in health crisis and families
Pastoral care Engage PM
18. Pastoral visiting - spiritual care
Pastoral visiting / spiritual care
Engage PA PM
19. Pastoral Care Pastoral Care Provide PM 20. Being with those who are in hospital – listening
Being with / listening Attend PA
21. Visiting Visiting Attend PA 22. Visiting the sick in hospital Visiting Attend PA 23. Prayer and counselling Prayer / counselling Ritual
Provide RW PCE
24. Listening to clients and staff
Listening Attend PA
25. Pastoral Visiting Pastoral Visiting Attend PA 26. Give Holy Communion Give Holy Communion Ritual RW 27. Being a presence in the hospital - visible and intentional
Being a presence Attend PA
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28. Listening to patients/parents
Listening Attend PA
29. Pastoral Care Pastoral Care Provide PM 30. Befriend all - with a smile Befriend Attend PA 31. Hospital Visitation Visitation Attend PA 32. Listening Listening Attend PA 33. Pastoral care to patients families and staff
Pastoral care to patients families and staff
Provide PM
34. Visiting patients, relatives staff and volunteers
Visiting Attend PA
35. Support Support Engage PM 36. Listening Listening Attend PA 37. Support family and patients in the dying process
Support Engage PM
Importance – Round 2
RESPONDENT KEY IDEA IC CPC 1. Spend time with person Spend time Attend PA 2. Understanding/Empathy Understanding/Empathy Engage PA
PM 3. Sharing Sharing Engage PM 4. Sharing prayer Prayer Ritual RW 5. Listen Listen Attend PA 6. Ritual Ritual Ritual RW 7. Pastoral Counselling Pastoral Counselling Provide PCE 8. Pastoral Care Pastoral Care Provide PM 9. Facilitate prayer/sacraments Prayer / Sacraments Ritual RW 10. Counselling Counselling Provide PCE 11. Empathy Empathy Engage PM 12. Trauma Ministry Trauma Ministry Provide PM 13. Encourage Encourage Provide PM 14. Hospital Visitation Visitation Attend PA 15. Listen Listen Attend PA 16. Prepare and debrief volunteer staff
Prepare and debrief volunteer staff
Lead MDC
17. Pastoral care and support of staff
Pastoral care and support of staff
Provide PM
18. Revisiting/follow-up/advocacy/referral/teamwork
Revisiting/follow-up/advocacy/referral/teamwork
Attend Provide
Lead
PA PM
19. Counselling Counselling Provide PCE 20. Reading from scripture as appropriate
Reading from scripture Ritual RW
21. Counselling Counselling Provide PCE 22. Visiting aged, disabled, lonely aged person who desire/wish visits after discharge
Visiting after discharge Attend PM
23. Discussion group with psych. Patients
Discussion group with psych. Patients
Provide PCE
24. Visiting night staff - celebration times and occasionally in-between
Visiting night staff - celebration Attend Ritual
PA RW
25. Supervision and teaching pastoral subjects
Supervision and teaching
Lead MDC
26. Be supportive Be supportive Engage PM 27. Pastoral care to patients families Pastoral care Engage PM
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and staff 28. Prayer / baptising Prayer / baptising Ritual RW 29. Pray Pray Ritual RW 30. Try to be non-judgemental and tolerant, identifying concerns
identifying concerns Engage PA PM
31. Chatting and Praying with patients
Chatting / Praying Attend Ritual
PA RW
32. Parish Nursing Parish Nursing 33. Coordination of various pastoral care responsibilities across the hospital
Coordination of pastoral care
Lead MDC
34. Leadership in Pastoral care department
Leadership in Pastoral care
Lead MDC
35. Prayer Prayer Ritual RW 36. Praying Praying Ritual RW 37. Prepare for funerals with family (& patient)
Prepare for funerals Ritual RW
Importance – Round 3
RESPONDENT KEY IDEA IC CPC 1. Clarify/reframe thoughts and feelings
Clarify/reframe Provide PM
2. Prayer Prayer Ritual RW 3. Praying Praying Ritual RW 4. Hearing other's story Hearing story Attend PA 5. Reflect Reflect Engage PM 6. Bereavement (Funeral) Bereavement Provide
Ritual PCE RW
7. Running groups and workshops Running groups and workshops
Provide PCE
8. NA NA 9. Witness to the love of Jesus in our lives
Witness
Provide RW
10. Study Study Lead MDC 11. Sacramental Sacramental Ritual RW 12. Supporting Staff Supporting Staff Engage PM 13. Be Present Be Present Attend PA 14. Farming contacts Referral Provide PM 15. Support Support Engage PM 16. Confer with colleagues Confer with colleagues Lead MDC 17. Prayer support, both immediate and continuing.
Prayer Ritual RW
18. Rituals - prayer, communion, worship
Rituals Ritual RW
19. Prayer Prayer Ritual RW 20. Praying with and for God's suffering people
Praying Ritual RW
21. Praying with hospital patients Praying Ritual RW 22. Taking Holy Communion, under my Pastor's supervision, to fold in hospital and home
Holy Communion Ritual RW
23. Encouraging volunteers Encouraging volunteers Lead MDC 24. Visiting each of my wards daily Visiting Attend PA 25. Pastoral Administration Administration Administration MDC
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26. Friendly Friendly Attend PA 27. Working with and being seen as a chaplaincy team
Working with chaplaincy team
Lead MDC
28. Funerals / bereavement counselling
Funerals / bereavement counselling
Ritual Provide
RW PCE
29. Counsel Counsel Provide PCE 30. Provide spiritual nurture a vital part of holistic care
spiritual nurture
Provide PM
31. NA NA 32. Reporting back to full time chaplain
Reporting back to full time chaplain
Administration MDC
33. Worship and sacramental ministry-
Worship and sacramental ministry-
Ritual RW
34. Participate in hospital committees to influence and network with staff
hospital committees
Administration MDC
35. Listening Listening Attend PA 36. Supporting Supporting Engage PM 37. Visitation of patients on site Visitation Attend PA
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APPENDIX 5
Question 12 – Role Frustration Question 12 – What are the 3 most frustrating chaplaincy ministries/actions/roles that you do? TOTAL – IC NA 35 Personal 26 Administration 19 Time 14 Team 10 Church 6 Facilities 4 Not Coded 1
TOTALS - CPC MDC 41 NA 35 ICN 27 PA 12 PM 5 ETR 3 PCE 3 RW 3 Not Coded 5
Roles Frustrating – Round 1
RESPONDENT
KEY IDEA IC CPC
1. Search for people I can't find
Search for people Time ICN
2. NA
NA
3. Trying to talk to people who are not interested in Christian things.
people not interested
Personal PA
4. Lack of Privacy in wards
Privacy Facilities PA
5. People not talking
People not talking
Personal PA
6. Administration
Administration Administration
MDC
7. Management - dealing with hospital funding
Management - funding
Administration
MDC ICN
8. NA
NA
9. Nil + comment…I can't think of any. My work is a gift to me. I try to be a gift to the people. I meet I do not want to appear busy or frustrated it would get in the way of my work.
NA
10. Administration
Administration Administration MDC
11. Team leadership
Team leadership Team MDC
12. Seeking to bring about ecumenical structure
Bring about ecumenical structure
Team ICN MDC
13. Limited opportunities to visit
Limited opportunities to visit
Time ICN MDC
14. Funding Funding Administration MDC
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15. NA
NA
16. try to work ecumenically and denominationally
Work ecumenically and denominationally
Team MDC
17. Visiting people (communicative age) who are indifferent or uncommunicative
People indifferent or uncommunicative
Personal PA
18. Statistics of patients visited for hospital
Statistics of patients Administration MDC ICN
19. Mediate between family members for patient.
Mediate Personal PM PCE
20. Attending to the patient in crisis - not knowing what their ongoing situation is
Attending to patient in crisis - not knowing their situation
Personal PA
21. Time!
Time MDC
22. Visiting patients in the psych ward. When a sick person refuses a visit, declaring himself atheist
Refused visit - atheist
Personal PA
23. Statistics
Statistics Administration MDC
24. Staff ignoring me
Staff ignoring me Personal
25. Administration
Administration Administration MDC
26. None
NA
27. Administration
Administration Administration MDC
28. Not having an adequate chapel
No adequate chapel Facilities ICN MDC
29. Not accepted by Muslim Community
Not accepted by Muslim Community
Personal ETR
30. Lack of volunteers to pastorally care
Lack of volunteers Team MDC
31. People's opposition to my presence as chaplain
Opposition to my presence
Personal ICN ETR
32. Being sure where 'overt' prayer is wanted especially in a ward setting
Where 'overt' prayer is wanted
Personal RW
33. Dealing with funding issues
Dealing with funding Administration MDC ICN
34. Collecting statistics
Statistics Administration MDC ICN
35. Not seeing the end result
Not seeing the end result
Personal
36. Dealing with divided families
Divided families Personal PM
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Roles Frustrating - Round 2
RESPONDENT
KEY IDEA IC CPC
1. Listen endlessly to conversations that seem to have little meaning
Conversations with little meaning
Personal PA
2. NA
NA
3. NA
NA
4. Lack of chairs
Lack of chairs Facilities
5. people being unable to talk
People unable to talk Personal PA ICN
6. Counselling
Counselling Personal PCE
7. Not enough resources to do things as well as I would like
Not enough resources Administration MDC
8. NA
NA
9. NA
NA
10. NA
NA
11. Obtaining suitably trained/skilled volunteer staff
Trained volunteers Team ICN MDC
12. lack of mutual accountability across Pastoral care department
Lack of accountability Team MDC ICN
13. Inability to solve personal problems of patients/parents
Inability to solve personal problems
Personal PCE
14. Recognition by Churches
Recognition by Churches Church MDC
15. NA
NA
16. Meet 24 hour demands of patients and staff
24 hour demands Time ICN MDC
17. Not 'seeing' results and wondering what your doing going back
Not ‘seeing’ results Personal PA ICN
18. inability to give Catholic patients communion personally
Inability to give Catholic communion
Church Team
RW
19. Liaise and communicate with some doctors.
Liaise and communicate with some doctors.
Personal ETR ICN
20. Hearing stories of the frustrations caused by 'Christianity claiming' people.
Frustrations caused by Christians
Church PM
21. Patients not available
Patients not available Time ICN
22. When such a person uses God’s name used in vain Personal
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God's name in vain 23. NA
NA
24. Taking notes
Taking notes Administration MDC
25. Trying to develop team approach with denominational personnel who are resistant to same or do not view it as being of a high priority.
Develop team approach - Personnel resistant to change
Team
MDC ETR
26. NA
NA
27. Workload - the need for more chaplains
Workload - need for more chaplains
Time ICN MDC
28. NA
NA
29. NA
NA
30. Training and funding issues
Training and funding Administration Team
ICN MDC
31. Lack of time on Sundays when inviting to chapel (specific to Sunday teams)
Lack of time Time RW
32. Not really frustrated otherwise as the role is minimal
NA
33. Third parties involving themselves in the care of another
Third party involvement Personal ICN ETR
34. See the names of all the people I don't ever get to see
People I don't see Time ICN MDC
35. NA
NA
36. Liaison with some hospital staff
Liaison some hospital staff
Personal ICN MDC
37. Treasurer for Professional group SANTACPE
Treasurer for Professional group
Administration MDC
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Roles Frustrating – Round 3
RESPONSE KEY IDEA IC CPC 1. NA
NA
2. NA
NA
3. NA
NA
4. Finding suitable times to connect with some parents - if doctors arrive chaplains are ignored often.
Suitable times to connect – Chaplains ignored.
Time Personal
MDC
5. Grieving families
Grief Personal PCE
6. NA
NA
7. Dealing with bureaucrats who have no understanding of chaplaincy and no compassion for chaplaincy.
Dealing with bureaucrats
Administration MDC ICN
8. NA
NA
9. NA
NA
10. NA
NA
11. Local Clergy support
Local Clergy support Church MDC
12. Administration takes up too much time
Administration time Administration MDC
13. Rarely opportunity for follow-up visit.
Opportunity for follow-up Time PM
14. Obtaining referrals to those in hospitals
Obtaining referrals Church ICN
15. NA
NA
16. Carry the workload in an 'unequal' situation.
Workload in an 'unequal' situation.
Time Team
MDC ICN ETR
17. Trying to care professionally when there are ethical/moral questions around the situation which are personally challenging.
Professional care – Ethical/moral questions
Personal ETR
18. Not enough hours to do work required
Not enough hours Time ICN MDC
19. Multiple hospital hopping
Hospital hopping Time MDC
20. Being able to follow up a patient as they move on. (similar to 1 knowing two that it is God's business not mine. I am but God's servant)
Being able to follow up Time
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21. NA
NA
22. People blame GOD for al the ills of mankind. (I am thankful that CPE helped me realise that I cannot change a person's attitude and convert him to faith. Only GOD can do that! I am their to shepherd those who already belong to God.
People blame GOD Personal PA
23. NA
NA
24. NA
NA
25. NA
NA
26. Expectations of church - and being abandoned by church organisation
Expectations of church – Abandoned by Church
Church
27. NA
NA
28. NA
NA
29. NA
NA
30. Peoples lack of purpose and meaning in life.
Peoples lack of purpose and meaning in life.
Personal PA PM ICN
31. NA
NA
32. NA
NA
33. Administration creep - more and more time required doing paper work
Administration creep Administration MDC
34. NA
NA
35. NA
NA
36. Access (parking etc)
Access Facilities MDC
37. Lobbying for sufficient funding for on-going chaplaincy
Lobbying for funding Administration MDC
184
APPENDIX 6
Question 13 – Chaplaincy Changes Question 13 - If your chaplaincy ministry could be different how would you imagine that role to be?
What changes would you like to see here? Please name the three things you would most like to change
about your role. TOTALS - IC NA 45 Team 26 Personal 10 Time 13 Admin 21 Church 3 Provide 3 Facilities 2
TOTALS - CPC NA 45 MDC 42 ICN 18 PM 2 PC 2
If your Ministry could be different - Round 1
RESPONDENT KEY IDEA IC CPC
1. Value the sense of 'team' a little higher
Value the team Team MDC
2. NA
3. To be better supported by the team leader
Support by team Team MDC
4. For the chaplains to be more valued by hospital staff as vital for patient health.
Valued by hospital staff Vital for patient health
Personal MDC ICN
5. NA
6. Meeting the needs of all people
Meet needs of people Personal ICN
7. More time and resources as a team to provide high quality visiting and pastoral support to patients and staff.
Time and resources (team) – Pastoral support to patients and staff
Time Administration
Provide
MDC ICN PM
8. To be able to follow up after hospital
Follow-up Personal
9. I work in a denomination Model I would prefer ecumenical we should be there for all not just Christians
Ecumenical structure - For all
Team
MDC
10. Working in Denominational Cadre instead of ecumenical
Denominational focus Team MDC
185
11. To have a fully committed chaplaincy team
Committed team Team MDC
12. To move from denominational to fully integrated ecumenical structure
Ecumenical structure Team MDC
13. The opportunity to 'follow up' initial visit.
Follow up visit Time PM
14. Like churches to notify me when parishioners go to hospital or get sick
Churches notify Church MDC
15. None
NA
16. Better 'team' sharing
Team sharing Team MDC
17. A greater sense of job security.
Job security Administration MDC ICN
18. Reduced patient number per chaplain
Patient-chaplain ratio Administration MDC ICN
19. Stationed at one hospital
One hospital Administration MDC ICN
20. Better communication within the department.
Better communication Administration
MDC
21. NA
22. At 70 yeas of age, I'm more into LIVING my faith, than wishing for uncertain changes!
NA
23. The role needs considerably more time
More time Time MDC
24. More energy by end of week!
More energy Time MDC
25. Have administrative/secretarial support
Administrative/Secretarial support
Administration
MDC ICN
26. NA
27. secretarial support staff
Secretarial support Administration
MDC ICN
28. None
NA
29. Being a support to staff members
Support to staff Provide PM
30. Greater support network
Support network Personal
31. More support from staff chaplain
Support from staff chaplain
Team MDC
32. work ecumenically in 'pastoral care team'
Ecumenical team Team MDC
33. More contact with patients
More contact with patients
Time MDC
34. More time funded
More funding Administration MDC ICN
186
35. I'd like more time to get to know the staff
Know the staff Provide PM
36. More privacy with patients
Privacy with patients Facilities
37. A settled certainty future for chaplaincy and self (adequate funding)
Settled future - funding Personal Administration
MDC
If your Ministry could be different 2
RESPONDENT KEY IDEA
IC CPC
1. NA
2. NA
3. NA
4. NA
5. NA
6. More training of Pastoral Care Workers
Training of Pastoral workers
Team MDC
7. Time and resources for spirituality initiatives in hospital
Time and resources. Initiatives.
Time Administration
MDC ICN
8. NA
9. NA
10. NA
11. To have more chaplains on team
More chaplains Administration MDC ICN
12. Greater integration in life of hospital
Integration into hospital
Team MDC ICN
13. NA
14. Like to be notified of deaths.
Communication (notification)
Administration MDC
15. NA
16. Better co-ordination of role in hospital.
Better co-ordination Team Administration
MDC
17. A clearer sense of belonging in the hospital.
Sense of belonging Personal MDC ICN
18. Inclusive communion with Catholics
Communion with Catholics
Church Team
MDC
19. Pastoral care secretary to contact me re patients in hospital desiring visitation and support. At the moment I have to check every day to see
Secretary to contact (communication)
Administration
MDC
187
personnel in wards. 20. (better communication) through the hospital
Communication Administration MDC
21. NA
22. NA
23. NA
24. More understanding/support by churches
Support by church Church MDC
25. A more ecumenical approach to chaplaincy.
Ecumenical approach Team MDC
26. NA
27. more integrated into life of hospital
Integration into hospital
Team MDC ICN
28. NA
29. Meet up with more chaplains (teamwork)
Meet with chaplains Team MDC
30. Opportunity to put new ideas in place
New ideas Team ICN
31. P.D. provided at no cost (Professional Development?)
Free professional development
Administration Team
MDC ICN
32. Changes in me! This extending role
Personal changes. Role
Personal
33. More coordination contact to develop volunteers & visiting chaplains
Develop volunteers and visiting chaplains
Administration Time Team
MDC
34. Ward based rather than denominational chaplaincy
Ward chaplaincy Team MDC
35. I'd love to know how patients got on
Follow-up information Personal ICN
36. More time with patients
More time Time MDC ICN
37. Greater energy/vitality to continue ward visits consistently
Energy and vitality Personal Time
MDC
188
If your Ministry could be different – Round 3
RESPONDENT KEY IDEA IC CPC 1. NA
2. NA
3. NA
4. NA
5. NA
6. A secretary for administration
Secretary Administration
MDC ICN
7. More time and resources for professional development
Time. Resources for professional development.
Time Administration
MDC ICN
8. NA
9. NA
10. NA
11. Holistic Ecumenical model
Holistic model Team MDC
12. Greater focus on gifts (i.e. specialisation) rather than 'jack of all trades'
Specialization Team MDC ICN
13. NA
14. Wish some funding was available.
Funding available Administration MDC ICN
15. NA
16. NA
17. A greater sense of being valued by the church and ability to relate to parishes their role in supporting this ministry.
Valued by church Church MDC
18. Time to be included in ward meetings/case conferences
Time. Included in meetings.
Time Team
MDC ICN
19. Shepherd imagery. Tree in the various seasons of nature.
NA
20. I worked ecumenically for a time, being chaplain in charge of 2 wards. The opportunity this allowed to become known to and by the staff on all levels patients and families was beneficial.
Chaplain on wards. Known by staff and patients.
Team
MDC ICN
21. NA
189
22. NA
23. NA
24. NA
25. Larger team of trained volunteers.
Team of trained volunteers
Team
MDC ICN
26. NA
27. more time for reflection and strategic planning
Time for reflection. Strategic planning.
Time MDC ICN
28. NA
29. NA
30. Provide more comprehensive chaplaincy outreach.
Comprehensive chaplaincy
Time MDC ICN
31. NA
32. NA
33. Better funding - stability
Funding stability Administration MDC ICN
34. A revitalised (younger) pastoral visitor team
Revitalised team Team MDC
35. I'd like more contact with other chaplains
Contact with Chaplains Personal Team
MDC
36. NA
37. NA
190
APPENDIX 7
Question 14 – Image or Metaphor
Q14 - Some chaplains have an image or metaphor to describe what they do. What is the image or metaphor that you use to describe what you do? TOTALS - IC Attend 18 Provide 17 Engage 11 NA 5 Ritual 4
TOTALS – CPC PM 23 PA 18 NA 5 RW 4 PCE 2
# RESPONDENT Image or
Metaphor
Key idea IC CPC
1 Being Christ in the presence of another. 'Christ' implies a totally seamless incarnation; i.e. God completely hidden in me so that despite all my humanity and weakness ironically God is seen and experienced.
Being Christ in the presence of another
Being Christ Attend PA
2 NA NA
3 I am like the sower who sows the seed of the gospel (sometimes) but never sees the result.
Sower
Sower Engage Provide
PM
4 I see it as offering to accompany the other on what is often a difficult and challenging stage of their life's journey. To be a spiritual friend.
offering to accompany the other a spiritual friend
Accompany Spiritual Friend
Engage PM
5 Be Christ to all Be Christ to all
Be Christ Attend PA
6 Serving or Servant. We are here in this position to meet the needs of all people no matter what status in life their background. As we are to represent Jesus at the bedside as well as to the staff.
a. Serving or Servant b. represent Jesus
Serve Represent
Provide PM
7 Spiritual Companioning. Being present and available
a. Spiritual Companioning
Spiritual Companion
Attend Engage
PA PM
191
throughout the hospital community in such a way that others feel like they have a kind/compassionate and wise friend who is interested in their well being
. b. Being present c. kind/compassionate and wise friend d. interested
Compassion Friend
8 We deal with people who go to a Pentecostal church, NORMALLY they are born again Christians so I talk about Jesus the healer. I pray for their recovery after XXXXXX. If they have cancer I tell them how to trust God for healing and to have an image in their minds of being made well.
a. I talk about Jesus the healer. b. I pray for their recover c. I tell them how to trust God for healing
Talk Pray Tell
Ritual Provide
PCE RW
9 I stand alongside/journey with people in friendship and support and as a representative of the Christian community I feel called to this ministry.
a. I stand alongside/journey with friendship and support b. representative of the Christian community ministry
Alongside Journey Representative
Attend Provide
PA PM
10 Ear linked to brain and heart Ear linked to brain and heart
Ear Heart
Attend PA
11 Jesus in the boat with his disciples in the storm
Jesus in the boat with his disciples in the storm
In the Storm Attend PA
12 One who walks the walk with others to offer support and mutuality and to offer the love of God in doing so.
One who walks the walk
offer support and mutuality
offer the love of God
Walk the walk (integrity) Support Offer
Attend Provide
PA PM
13 NA NA
14 shepherd Shepherd
Shepherd Provide PM
15 To be myself in loving, caring and supporting patients in their time of need. It’s
To be myself in loving, caring and
Love Care Support
Attend Engage
PA PM
192
amazing how God goes before me and prepares the way with common denominators of interests or events that can be a spring board onto openness and honesty with each other
supporting
16 NA NA
17 My image is of one who comes beside others in their time of vulnerability, to befriend, support, and whether overtly or covertly, to bring the 'Christ light' into their darkness
a. one who comes beside b. befriend, support c. bring the 'Christ light'
Beside Friend/support bring
Attend Provide
PA PM
18 Invite people to come to the well of God's love and drink the life giving water that Jesus showed us is there abundantly for all to drink
Invite people to come to the well of God's love
Invite God’s Love
Provide PM
19 Shepherd imagery. Tree in the various seasons of nature.
a. Shepherd imagery. b. Tree in the various seasons of nature
Shepherd Seasons
Provide PM
20 If any; then similar to the ambulance service where we pick up the person in crisis and then hand them on to the appropriate provider.
a. ambulance service b. hand them on to the appropriate provider
Ambulance Hand on
Provide PM
21 Pastoral care. Relating to those patients I share time with building a warm, caring relationship.
a. Pastoral care. b. building a warm, caring relationship
Pastoral Relationship
Provide Engage
PA PM
22 To walk alongside the suffering, hurting person, just as Jesus walked with the two disciples to Emmaus. Jesus LISTENED and then responded, explained as necessary, helped them recall relevant Scripture, and taught them of God's love and showed it in his life and ministry
a. walk alongside b. LISTENED c. responded, explained , helped d. taught them of God's love
Alongside Listen Respond Taught
Attend Provide
PA PCE
23 None - I just do what I do None
193
24 Like the neighbour 'popping
in' each day
neighbour 'popping in'
Popping in Attend PA
25 The power of blessing - the blessing of a caring, attentive, friendly presence. The blessing of God via prayer and acts of ministry.
a. blessing b. caring, attentive, c. friendly presence. d. prayer e. ministry
Caring Presence Blessing/ Prayer
Attend Ritual
PA RW
26 Promoting God's love for each of us
Promoting God's love
Promoting Provide PM
27 A 'host' as the patients come into this place - hospitality. A fellow traveller
a. 'host' / hospitality. b. A fellow traveller
Hospitality Fellow traveller
Attend Engage
PA PM
28 Because of my age I think of myself as a grandfather figure or at least a great-uncle. Someone whom people (children and adults) can talk to freely and safely and confidentially. I like to think of myself also as the still point of the storm/chaos going on in people's lives and bringing calm to the turmoil
a. grandfather/ great-uncle. b. still point of the storm/chaos c. bringing calm to the turmoil
Grandfather Still point
Engage PM
29 As a chaplain I have a greater opportunity to show the love of Jesus to people because they are open and they have a need. In this environment it is easier to asked them about their level of faith, pray for their needs or tell them about the gospel of Jesus Christ if they show interest
a. show the love of Jesus b. asked them about their level of faith c. pray for their needs d. tell them about the gospel of Jesus
Show Ask Pray Tell
Provide Ritual
PM RW
30 Meeting people where they are. Taking our faith beyond the church walls. Do our best and let God do the rest
a. Meeting people where they are. b. faith beyond the church walls. c. Do our best
Meeting Faith
Attend PA PM
31 Bringing a cool drink to Bringing a cool Cool drink Provide PM
194
someone who is very thirsty drink to someone who is very thirsty
to thirsty
32 Walk alongside'. Meeting people where they are in their journey, unless people are 'exploring' especially in palliative care its too hard/late for 'change'. Hopefully, being a positive calm presence. Friendship, warmth.
a. Walk alongside'. b. Meeting people where they are c. positive calm presence. d. Friendship, warmth
Alongside Meet Presence Friendship
Attend Engage
PA PM
33 Loitering with intent - ministry of presence and relationship. Companion on the journey. Not an expert but a fellow traveller learning from the other and vice versa. Inclusive model open to the other's perspective.
a. Loitering with intent b. ministry of presence and relationship. c. Companion on the journey. d. a fellow traveller learning from the other
Intent Presence/ relationship Companion Fellow traveller
Attend Engage
PA PM
34 The image of friend. I go to be a friend to those I meet - and to offer support in whatever their journey is through the hospital. Friendship is a relationship that is chosen by the participants (not imposed or by birth) and is of equals (there is no hierarchy in friendship).
a. friend b. offer support c. Friendship is a relationship
Friend Support
Attend Engage
PA PM
35 NA NA
36 Coming alongside as a brother - to listen and support - to pray and share sense of the Lord - to love and stay a while.
a. Coming alongside as a brother b. listen and support c. pray and share d. love and stay a while.
Alongside Listen/support Pray Love
Attend Provide Ritual
PA PM RW
37 I seek to find the 'golden ball' in the patients (and other
a. God's presence
God’s Presence
Engage PM
195
people) I meet. (or perhaps the golden flame). In any event it is the source and root of that person’s spirituality (regardless of church/faith affiliation or participation) - goodness. God's presence This is what I seek and this is what I also bring with myself. The image of a prospector/miner searching for precious minerals. Another related image is a flame or glowing coals/embers within my chest, around my heart, that leads to a 'shield volcano' (Hawaii) of slow moving upwelling of lava from deep and it builds up to a basalt, wide volcanic mountain
b. image of a prospector/miner searching for precious minerals
Searching for precious minerals
196
APPENDIX 8
Question 15 – Biblical Story or Text Q15 - Some chaplains have a biblical story or text that motivates their ministry. Which biblical story or text motivates you? TOTALS – IC Provide 19 Ritual 16 Engage 15 Lead 6 Attend 5 NA 2
TOTALS - CPC PM 28 RW 16 PCE 11 PA 5 NA 2
# RESPONDENT
KEY IDEA IC CPC
1 Jesus staying at the house of Zaccheaus for lunch. Luke 19:5
Visit Attend PA
2 2 Corinthians 1:3-11 The God of All Comfort
Comfort Provide PM
3 In Matthew 25:31ff final judgement, those who visited the sick, who were in fact visiting Him!
Visit Minister to
Provide PM
4 a. Jesus meeting with, accepting people just as they are, acknowledging them and caring for them, valuing them b. Woman with haemorrhage, Luke 8:43-48 c. Zaccheaus, Luke 19:5 d. healing the blind, lame, deaf, e. responding to being anointed with expensive perfume by the woman in Simeon's house Mark 14v3 (Simon the Leper’s House)
Accepting Caring Healing Visiting Healing
Engage Ritual
PM RW
5 NA
6 Matt 14:13-21 feeding the five thousand and healing the sick
Feeding Healing
Provide Ritual
PM RW
7 a. stories of people being with Jesus b. Jesus companioned others
Being companion
Attend Engage
PA PM
8 a. Matthew 14:14 Jesus Healed all. b. 1 Peter 2:24 By his stripes we are Healed. c. Mark 11:23 Moving the mountain
Healing Healing or Forgiveness miracle
Ritual RW
9 I am motivated by my own story. The whole of Jesus life motivates me. Its simplicity, authenticity and solidarity with the marginalised. call to follow ;promise of resurrection and eternity
Follow Eternity with Jesus (simplicity, authenticity, solidarity)
Engage PM
10 Psalm 139:8-9 , you are there
God with us Attend PA
11 a. The woman at the well - John's Gospel, Truth telling Engage PM
197
John 4:4-26 b. road to Emmaus Luke 24:13-35
Journey Ritual PCE RW
12 John 11:35 Jesus' empathy and willingness to walk in the shoes of others John 11:35 (New International Version) 35 Jesus wept
Empathy Compassion
Attend Engage
PA PM
13 parable of the talents Matthew 25:14-30
Using gifts Engage PM
14 Good Samaritan Luke 10:25-37
Acceptance Minister to
Provide PM
15 "This is my commandment that you love others even as I have loved you". John 13:35
love Engage Lead
PM PCE
16 road to Emmaus story with all its implications. Luke 24:13-35
Journey Engage Ritual
PM PCE RW
17 words of Jesus read from Isaiah -'I come to bring good news to the poor bind up the broken hearted…' Luke 4:18-19
Good news Healing
Engage Ritual
PM RW
18 a. woman of Samaria - John 4:4-26 b. Prodigal Son - Luke 15. c. Crucifixion - Luke 23v32-43. d. Resurrection - Mark 16v1-8
Truth telling Forgiveness Gift life
Engage Provide Ritual
PM PCE RW
19 a. Jairus daughter and Mark 5:21-24, 35-43 b. woman with bleeding for 12 years. , Luke 8:43-48
Resurrection Gift of life (Return to community)
Provide Ritual
PM RW
20 Jesus love for all people particularly those in need. "suffer the children to come to me Luke 18:16
Acceptance Blessing
Engage Ritual
PM RW
21 Jesus love, healing power, importance of prayer.
Love Healing Prayer
Provide Ritual
PM RW
22 a. The Good Samaritan; Luke 10:25-37
b. John 3:16; Jesus command to make disciples of all people; c. the Feeding of the 5000 Matt 14:13-21 d. 'A new commandment I give you, that you LOVE one another' John 13:35
Acceptance Good News Feeding Love
Provide Lead
PM PCE
23 2 Cor 5:21
made him who had no sin to be sin for us, so that in him we might become the righteousness of God.
Gift of life Provide PM
24 The people Jesus met and spent time with - 'invisible people' on the fringe!
Acceptance Attend Engage
PA PM
25 a. Sower Mark 4:1-9 b. Good Samaritan Luke 10:25-37 c. Suffering servant of Isaiah - using our own wounding as a pastoral service. Isaiah 52,
Acceptance Healing Journey
Provide Engage Ritual
PM PCE RW
198
53 d. Emmaus road journey. Luke 24:13-35
26 Jesus sent his disciples out in pairs Luke 10:1-24
Sent out Lead PCE
27 a. Barnabas encouraging Mark. Acts 15:36-40 b. Luke 4 and Jesus claiming his mission - 'releasing captives' Luke 4:18-19
Acceptance Release captives
Provide Lead
PM PCE
28 a. Jesus blessing the children. Mark 10:13-16 b. Romans Ch 8 (see Q 18) No condemnation for those who are in Christ Jesus
Blessing Acceptance
Ritual Provide
RW PM
29 a. the love of Jesus to others and lead them to him. 'Scripture' Mark 16:20 b. preached everywhere ; signs and miracles
Love of Jesus Preaching Miracles
Engage Provide Ritual
PM RW
30 a. Good Samaritan Luke 10:25-37 b. Paralytic – Matthew 9:1-6 c. Great command Matthew 28 'go and tell" (he is risen v6, the ‘gospel’ v19?)
Acceptance Healing Go tell
Provide Ritual Lead
PM RW PCE
31 Matthew 25:35 When we give a thirsty person a drink we do it 'unto Him'
Give a drink Provide PM
32 I come that you may have life and have it more abundantly. John 10:10
Abundant life Provide PM
33 2 Corinthians 4:16-18 Look not to the things that are seen but to the things that are unseen for they are eternal.
Deeper meanings Provide PCE
34 The incarnation. the person and life of Jesus is expressed the life and love of God
God’s love Provide PM
35 NA
36 Jesus spending time with the leper – Matthew 26:6 (Simon the lepers house) Mark 1:40-42 Luke 17:11-19 (10 lepers)
Acceptance Healing
Ritual Provide
RW PM
37 a. Moses and the burning bush - Exodus 3:1-6. b. Luke 4:16-32 'The spirit of the Lord is upon you because he has anointed you … to bring good news to the poor he has sent you
Holy presence Release Open to all
Engage Ritual Lead
PM RW PCE
199
APPENDIX 9
Question 16 – Chaplain vs Parish
Question 16 - How does your role and expectations as a hospital chaplain differ from those of a minister/priest/lay worker in the church or parish? TOTALS – IC Same Structure Immediate Relational Un-coded 2 NA 1
TOTALS - CPC PM 26 PA 17 PCE 6 RW 4 ICN 3 MDC 2 NA 1 Un-coded 5
RESPONDENT KEY IDEA IC CPC
For me it is one and the same, except that the context is different. Both roles require being 'fair dinkum', genuine, not making assumptions about the person's faith.
- same Same Un-coded
No follow-up outside hospital so often don't know how people are doing. Little or no information as to type of illness or other background information. Working very much in 'present moment'
- No follow-up. - Little or no information illness background - Working very much in 'present moment'
Immediate PA
Parish ministry can be more defined and have predictable events. Hospital visiting is an un-requested (usually) invitation of person's time and space by a stranger from 'the Church'!!! It takes time and effort to build a rapport with the patient and skill to steer the conversation. Parish ministry is more often true Pastoral Care where hospital visiting is not so in the true Biblical sense but is often Evangelistic in nature.
- Parish defined predictable - Hospital visiting- invitation of person - time and effort to build a rapport - skill to steer the conversation - Parish true Pastoral Care - hospital often Evangelistic
Structure Relational
PA PM PCE
200
I meet with people who have faith
and those who have none and all stages in between. They don't usually come to me, I go to them. I often meet people who are stressed, traumatised, fearful, frustrated… Offering time, acceptance of them just as they are, being mindful of entering their personal space, giving encouragement, understanding and support is vital. I always try to see them as who people, much more than just a patient with a particular illness.
- people who have faith and those who have none - don't come to me, I go to them - people who are stressed, traumatised, fearful, frustrated - Offering time, acceptance - entering their personal space
Immediate Relational Structure
PM PA
We are guests/visitors in hospital. We are often not in control. We are reactors in many ways not always proactive.
- guests/visitors in hospital - often not in control - reactors, not always proactive.
Structure Immediate
PA PM
Hospital chaplains are an extension of the priestly role we are here where it all happens as we have a clear knowledge of hospital process.
- Hospital chaplains, extension of the priestly role
Same PM RW
Normally the role is focused indirect pastoral care of people. Parish ministry is primarily focused on organisation day to day management. Chaplaincy is a clinical focus. Parish ministry as a sole practitioner is management focused.
- (Hospital?) focused indirect pastoral care - Parish, focused on organisation day to day management - Chaplaincy is a clinical focus - Parish, sole practitioner - management focused
Structure PM
We may only see people once. We get no follow on information about them.
- may only see people once, no follow on
Immediate PM
I don't really know. I am not a minister or priest. Maybe cold be called lay worker as my denomination has some difficulty accepting non ordained chaplains. It is not a problem for me. I work for God and I am just called by my name. Titles are irrelevant in the Kingdom to
I don't really know
Un-coded Un-coded
201
come. NA NA NA
NA
Working as part of a team - then as part of a larger team. More contact with non religious people. More accountability. Able to live in my own home - not a rectory. More separation between work hours and leisure hours. Do not have to attend meetings in the evening.
- part of a team - contact with non religious people. - accountability - separation between work and leisure
Structure ICN
It is much more person to person (less administrative work), much more intense and both spiritually and emotionally demanding, and much more diverse - working in a secular environment.
- more person to person (less administrative work), - more intense - both spiritually and emotionally demanding - more diverse, secular environment.
Relational Immediate Structure
PM
My role in chaplaincy is an important part of my life, but NOT my whole life.
(work-life balance) Un-coded Un-coded
See myself as a temporary contact. More to encourage and console. A listener and facilitator.
- a temporary contact - to encourage and console, listener and facilitator
Immediate Relational
PA PM
As a hospital chaplain I might only see a patient once before they return home to their own environment. They will then be looked after by their own minister, priest, lay worker. My focus is to help and support them in this time of crisis in their lives. To reassure them that Jesus is their comforter and never leaves them or forsakes them. Sometimes there might only be a touch or a quiet prayer said.
- might only see a patient once - help and support them in this time of crisis
Immediate Relational
PM PCE
People in hospital are generally very vulnerable, often in crisis - it's often intense on a daily basis: hence the need for good collegial debriefing which often can't/doesn't happen.
- hospital… are generally very vulnerable, often in crisis - often intense - need for collegial debriefing
Immediate Relational
PA PM MDC
A much broader understanding of ministry as part of the church's
- broader understanding of
Structure PCE ICN
202
mission to all people irrespective of faith/denomination/culture. Less emphasis on getting people to church and more on bringing 'church' to them. A greater sense of being part of a community of care.
ministry - irrespective of faith/denomination/culture - being part of a community of care.
PM
Working ecumenically - there are no pre-suppositions about people's faith. I start from the ground of unknowing with each new person. I am on their ground (not common ground) and they can accept or reject my offer to engage.
- Working ecumenically - no pre-suppositions about people's faith. - on their ground
Structure PA PM
Visit people, support them by listening to their story and situation. Care where possible and invited to.
- Visit people, support them - invited to
Relational PA PM
not much Not much
Same
Un-coded
More personal Personal Relational
PM
As stated at the end of #12, I am not there to Christianize 'a captive audience' (who can't get away from me!!), but to walk with the sick person on whatever his journey will turn out to be: more pain and anxiety, or healing and recovery, and possibly even facing the end of life and whether 'heaven's assures and can be hoped for/looked forward to.
Relational PM
There is a greater proportion of unbelievers and, therefore, a greater need to be sensitive to them while still wanting, hoping, to have some Gospel reflection in their situation.
- unbelievers… need to be sensitive to them - hoping, to have some Gospel reflection
Structure Relational
PM PCE
As a minister visiting a person from my church I did not relate in detail with nursing staff, or read, or write in their case notes.
- relate - with nursing staff
Structure Un-coded
Focus of a hospital chaplain is specifically pastoral while that of a minister in a church is more widely dispersed. As a chaplain I don't have to preach as frequently or lead corporate worship - but I counsel and lead worship more on a one to one basis. I also have far more contact with non church goers and have more opportunities to
- hospital chaplain specifically pastoral - church, more widely dispersed. - hospital - counsel, worship on a one to one basis - more contact with non church goers
Structure Relational
PM PCE RW ICN
203
work at interdisciplinary level than do parish based clergy. Don't have same opportunity as parish clergy to work with people over the longer term.
- more opportunities to work at interdisciplinary level - parish clergy work with people over the longer term
Meeting people who are sick - Meeting people who are sick
Immediate PM
The role is clearly pastoral and not evangelistic. Participation as a team member and not as the clergy running the church. Meetings with clear agendas and outcomes.
- hospital - pastoral not evangelistic - team member - Meetings with clear agendas and outcomes
Structure PM MDC
In a parish the parish priest is appointed by the bishop and has the spiritual care of the parishioners of that parish. They know him and he knows them. In the hospital the chaplain has the spiritual care of people whom he does not know beforehand (usually) and how are in a position of acute and temporary need of spiritual care.
- parish priest - spiritual care of the parishioners - hospital the chaplain has the spiritual care of people whom he does not know - acute and temporary need of spiritual care
Immediate Structure
PA PM
In the church environment I meet a lot of people who have a relationship with Jesus, but in a hospital environment I get to help people are away from the Lord. (1) People who have limited knowledge of Jesus. (2) People who are searching for the Lord. (3) People who have come away from the Lord (4) Those that want spiritual comfort and an ear to listen to them.
- church, people who have a relationship with Jesus - hospital, people are away from the Lord
Relational PM PCE
Folk I meet are in crisis due to health issues. A church or parish have people attend by choice. Chaplain meets 'captive' opportunity for witness.
- (hospital) crisis due to health issues - church, people attend by choice - Chaplain meets 'captive' opportunity for witness
Immediate Structure
PA PM
In the church, chaplaincy or pastoral care is appreciated and sought after. At the hospital, most people are not interested in
- church, care is appreciated and sought - hospital, people
Structure Un-coded
204
spiritual (Christian) practices. are not interested in spiritual (Christian) practices.
My main role in the parish is as the Parish Nurse, so sometimes at the RAH I have to show great discipline not to wear my nurses hat!!! As a volunteer chaplain I see my role as an assessor (friendly) and report back to the permanent chaplain.
- role as an assessor (friendly) and report back to the permanent chaplain
Not coded PA
Hospital chaplaincy tends to be more crisis management and care. People in hospital are often at a point of openness to change due to the nature of their crises. Can be growth focused. Change agent role. Parish has much more politics and maintenance of status quo.
- Hospital, crisis management and care - point of openness to change, Can be growth focused. Change agent role - Parish, politics and maintenance of status quo
Immediate PM PA
We deal constantly with people in crisis, who may well be asking question of 'why' and 'why me'. Very regularly called to crisis occasions (eg at bed of someone dying in ICU) with people we've never met before. Continually meeting new people. Visiting is our primary work - not much administration to dilute out the intensity.
- people in crisis - question of 'why' and 'why me' - crisis occasions - Continually meeting new people - Visiting is primary - not much administration - intensity
Immediate Relational Structure
PM PA RW
My role is to help anyone of any faith. To be a support, not just connecting with people from my own faith. A chance to connect with lots of different people I might not ordinarily meet in my day to day routines.
- to help anyone of any faith - To be a support - connect with different people
Structure Relational
PM
Where the church based pastoral care worker has an ongoing ministry, the hospital chaplain offers ministry over a shorter span to the sick who are being confronted with crisis and their own mortality. It is therefore a more intense ministry.
- church worker has an ongoing ministry - hospital chaplain, shorter span to the sick confronted with crisis - a more intense ministry.
Immediate Structure
PM PA
205
A significant difference for me is I 'minister' pastorally to people of all or no faith traditions predominantly. Parishioners are more concerned with their own Christian denomination. In my Catholic tradition this is predominantly liturgical/sacramental ministry
- 'minister' pastorally to people of all or no faith - Parishioners are more concerned with their own Christian denomination
Structure PM RW
206
APPENDIX 10
Chaplaincy Description: no church background
Question 17 – How do you describe what you do? In lay terms to someone with no church background. TOTALS - IC Attend 28 Engage 21 Provide 21 Ritual 16 NA 2 Not Coded 1
TOTALS – CPC PM 32 PA 18 RW 14 PCE 9 NA 2 Not Coded 1
RESPONDENT KEY IDEA IC CPC
I visit people in hospital who have indicated a 'Lutheran' background. I hear their story and reflect with them on how the whole experience is going. I'm especially interested in exploring what the experience 'means' for them - in terms of grief issues, change, joy, disappointment, faith, relationships, the future.
Visit Reflect Explore meaning
Attend Engage
PA PM PCE
Caring for the emotional and spiritual needs of patients
Caring
Attend
PM
On Wednesday mornings I visit the Children's Ward as a Chaplain/Pastoral Visitor. I seek to find out how they are coping with the fact that their child is sick - or the older child how they are coping themselves. Are the staff caring for them and do they have family support? Conversations may be short or long and I meet many interesting people and family situations. Sometimes I get to remind them how much God loves and cares for them.
Visit Find out Enquire Remind/God’ love
Attend Engage Provide
PM PA PCE
I visit as a friend and offer a listening ear, time, encouragement and understanding. I am a Christian but I try to connect where the patient is at. For instance, when someone says they have no faith, don't wast time on me, I might respond with 'we do have a common humanity'. Often a deep conversation ensues because they know they are accepted and not judged.
Visit Listen Connect
Attend Engage
PA PM
Caring for people. Representing God. 'Being Christ".
Care Being
Attend
PM
NO RESPONSE
NA NA NA
I have a role of being available to talk with Being Attend PA
207
people in the hospital. Sometimes when we are sick we are struggling. Sometimes it is good to have someone to talk with and to share our concerns with. I can also pray with people and share the rituals of anointing and communion if they would like these.
(available) Share Pray
Engage Ritual
PM RW
I encourage them all to put their trust in Jesus. If they want me to, I pray for their recovery from the sickness that put them in hospital.
Encourage faith Pray
Provide Ritual
PCE RW
I am a member of the Christian Community. I bring friendship and support to people in the hard places - in sickness, dying and death. I have no agenda and am not selling anything. I am here to witness to God's love in our lives by being the best I can be for them.
Friendship Support Witness
Engage Ritual
PM PCE
NO RESPONSE
NA NA NA
My role is one where I journey alongside others. I listen with intent.
Alongside Listen
Attend
PA PM
I offer personal and spiritual support to people at times of crisis; I seek to 'walk with them' to empathise, and to encourage them to explore their own spiritual understandings; I try to help them discover for themselves aspects of meaning, purpose and identify; it is a great privilege to be 'invited in' by others.
Spiritual support With Encourage Meaning
Provide Attend Engage
PM PA PCE
Explain that you care about their well-being - would like to pay a little visit and talk with them - enquire about their child's progress - re-assure them re the hospital and caring/competent staff and wish them well.
Care Reassure
Attend Provide
PA PM
I visit lonely, sick hurting people. Helping them to find peace and comfort. Assisting in establishing contacts with others who can help in completing their recovery.
Visit Support Contacts
Attend Engage Provide
PM
As a chaplain I visit patients who are sick in hospital who need care and support and someone who will be available to have a ear to listen to their stories. Most times I have the privilege of being able to pray for that sick person or support their family through a difficult time.
Visit Support Listen Pray
Attend Engage Ritual
PM PA RW
Ask what they know or have experienced first. I'm a member of the Pastoral Care Department - a group in the hospital who attempt to listen to patients - and their families - in a effort to support, be with, assist during what's often a difficult or traumatic time. We have a Christian philosophy.
Ask Listen Support
Engage Attend Provide
PA PM
208
Visit people (children, parents, women) in the
hospital. Discern what is most important to them in terms of hopes, fears, needs to help them cope with their present situation. Through compassion, experience, understanding try to reflect God's unconditional love for each person. Offer prayer support, spiritual guidance and sacramental liturgies where appropriate.
Visit Discern Support Compassion God’s love Prayer Sacrament
Attend Engage Provide Ritual
PA PM RW PCE
I provide a friendly, non-judgmental presence for patients, family and staff. I have no other agenda except to show that person my care and concern for them. I listen to them and assist them to find and remember what gives them comfort and spiritual care at this time. I offer prayer, advocating and a revisit if appropriate and God's love for all people
Presence Listen Assist Prayer Advocate
Attend Engage Ritual Provide
PM PA RW
Pastoral Care and hospital chaplain minister to persons spiritual needs.
Care Minister
Provide PM
I be as Christ to them. Show love and respect. If they wish to talk with me I listen with respect. If not I respect that too.
‘presence’ Listen
Attend
PM PA
Sharing a caring time with hospital patients as one person to another in a relaxed way.
Care Provide
PM
When I have volunteered to visit several computer pages of 'nons', I have learnt to come alongside people more openly, in other words to befriend them and let them know they are valued for themselves and to be available if they wanted to talk or ask questions. The 'religious' only comes up as you introduce yourself, and when further questions are asked. The sick person is very likely to state what denomination he has had some slight association with, or openly state his humanist or atheistic views.
‘Presence’ Befriend
Attend Engage
PM
Visiting, encouraging and praying for the sick, chatting with those who are troubled in a way that is mindful of the Gospel and all it implies.
Visit Encourage Pray Support
Attend Engage Ritual Provide
PM RW
I allow them to lead the conversation which may move into religion, and lead to prayer.
Listen Pray
Attend Ritual
PA RW
As a representative of God and His Church I seek to be a companion to those in need and journey with them for that time that they are hospitalised. This involves listening to their story, their concerns and fears -helping them to identify these - being a friend to them, helping them to discern meaning in what’s happening for them. and supporting them by using resources of
Presence Be with Listen Prayer Support Support staff
Attend Engage Ritual Provide
PA PM RW PCE
209
Christian Faith (e.g. prayer, holy communion) as the patient so wishes. I also see my role as supporting and encouraging staff.
Assistant to the Catholic Chaplain
Not Coded
Not Coded
A person who journeys with them during their time in hospital - the team member who looks after their heart and soul, the stuff that is inside that a pill doesn't fix. The person who doesn't prod and poke them.
With them Support
Attend Provide
PM
I make myself known and my position in the hospital. I chat with them and in the process discover their needs. I listen to what they wish to tell me. If they wish I offer to pray with them and ask a blessing on their child or baby. If parents or carers are not present I do the above (usually without the prayer). Often children are engrossed in video games - so interaction is on a briefer level. Often teenagers are keen to have a talk. Also I conduct funerals, baptise those in danger of death and bless those who have died.
Discover needs Listen Pray
Attend Ritual Engage
PA PM RW
I ask how they are and is there anything I can do for them. I encourage them to open up and let me know their fears and worries. I ask if I could pray for them and I show Jesus’ love to them and I explore how much faith they have and share my faith with them if the opportunity arises.
Ask Encourage Pray Share faith
Attend Ritual Provide
PM RW PCE
Be available for people in time of health crisis to offer care and support and spiritual nurture.
Available Support Nurture
Attend Provide
PM
I visit people in the hospital. I chat with them and seek to discover if they have any spiritual needs which I can address. I am there to listen to them and offer warmth and hope. If appropriate, I offer to pray for them.
Visit Discover Listen Pray
Attend Engage Ritual
PM PA RW
Be a friend and show the hand of the church. Friend Church care
Engage Provide
PM
I offer support and care to people in the hospital setting, whether patients, family or staff. I offer care and support to all people no matter their religious background/spirituality. I work in a person centred way that respects and values the person and their beliefs.
Support Person
centred Multi-faith
Engage Provide
PM
210
I visit people in hospital to offer them my
friendship and support in whatever their journey is in hospital.
Visit Friendship Support
Attend Provide
PM
I visit the parents of sick children. I listen to anything they want to tell me, offer support, a friendly shoulder to lean/cry on. Pray with them, if they allow. Put their children on my prayer lists (with permission).
Visit Listen Support/ friendship Pray
Attend Provide Ritual
PM PA RW
On most Thursday afternoons I spend time with certain people in hospital with whom I have a church link. I talk with them as a trusted friend and offer prayer and support.
Be with Pray Support
Attend Engage Provide Ritual
PM RW
I visit people who are ill, even dying, who are often very anxious and in a time of crisis. I have a conversation(s) with them and allow and encourage them to tell me some of their story and their concerns as human beings. And explore (if they are open to it) what gives them meaning in life and in suffering and even dying. That is spirituality in the wide sense - and Christian spirituality too. This applies to families - especially if a member dies or is dying. I prepare/conduct the funeral if asked and conduct other worship services and pray with people - if they desire that too.
Visit Conversation Encourage Meaning Pray Worship
Attend Engage Ritual Provide
PA PM RW PCE
211
APPENDIX 11
Chaplaincy Description: church background
Question 18 – How do you describe what you do to people within the church? TOTALS - IC Attend 23 Engage 17 Provide 21 Ritual 17 NA 3
TOTALS – CPC
PM 31 RW 19 PA14 PCE 14 MDC 1
NA 1
RESPONDENT KEY IDEA IC CPC
Exactly the same as Lay Description - I visit people in hospital who have indicated a 'Lutheran' background. I hear their story and reflect with them on how the whole experience is going. I'm especially interested in exploring what the experience 'means' for them - in terms of grief issues, change, joy, disappointment, faith, relationships, the future.
Visit Listen Reflect Explore Meaning
Attend Engage
PA PM PCE
Caring for the emotional and spiritual needs of patients by bringing God's comfort through prayer and the Word.
Care God’s comfort Pray
Provide Ritual
PM RW
On Wednesday mornings I visit the Children's ward as a Chaplain/Pastoral Visitor. I ask how they are coping with the sickness and disruption and are the staff caring for them well. Sometimes I get to pray with parents, other times just remind them how much God loves and cares for them. Christian families really appreciate the fact that someone from the church comes to share with them in their time of distress.
Visit Pray God’s Love Share
Attend Provide Ritual
PA PM PCE RW
I visit people in hospital and try to share God's love and hope. Even if the patient does not want prayer they appreciate a blessing. Often he time in hospital can be bewildering, overwhelming and scary and it is a relief to have a visit from someone who isn't going to give medication, give an injection etc, but who is there to listen and share whatever it is that is bothering them. I hope to be as Christ to those I meet and also to receive Christ. Many conversations become a sacred moment.
Visit Share Listen Presence
Attend Engage Provide
PA PM PCE RW
212
Being Christ
Presence
Attend
PM
NO ANSWER
NA NA NA
I support patients and staff by listening and providing spiritual support. I companion people in whatever is happening for them.
Support Listen Support
Attend Engage Provide
PA PM
I encourage them all to put their trust in Jesus. If they want me to, I pray for their recovery from the sickness that put them in hospital.
Encourage Trust Jesus Pray
Provide Ritual
PCE RW
I am a lay authorised chaplain. I have had some study and preparation and feel a calling to this work. I have been appointed by my Head of Church. I offer friendship and support, prayer and sacraments to those who are ill or dying. Their families too. Staff at the hospital and visitors. I always have time to listen.
Friendship/support Prayer/Sacrament Listen
Attend Engage Ritual
PA PM RW
NO ANSWER
NA NA NA
My role is one where I journey alongside others. I listen with intent.
Journey Listen
Attend
PA PM
Pray much the same; perhaps to add that for some people this involves prayer, sacramental ministry and spiritual counsel
Prayer Sacrament Ministry Spiritual support
Provide Ritual
PCE RW
I Endeavour to visit and comfort sick children and their parents because it is what I believe God wants me to do - here and how. Often we chaplains are the only 'face of the Church' these people see, so we try to do our work well. Sometimes little children will ask 'what's a chaplain' and the mother always says 'she comes from 'the church''. 'Oh" says the child. It is meaningful to them, although also, they often know so little about it.
Visit/ Comfort Support
Attend Provide
PM
Pray with people, comfort, encourage, bring hope and help them trust God for direction, healing and peace.
Pray Encourage Trust God
Provide Ritual
PM PCE RW
The same as I would to a person who has
no church background. As a chaplain I visit patients who are sick
in hospital who need care and support and someone who will be available to have a ear to listen to their stories. Most times I have the privilege of being
Visit Care and support Listen Pray
Attend Provide Ritual
PA PM RW
213
able to pray for that sick person or support their family through a difficult time.
Ask what they know about chaplaincy or pastoral care first. Along with the above - I work on an ecumenical team in the hospital - we visit patients to support etc. We also offer prayer, opportunities for worship, sacraments etc, and link patients with their faith support group of and when this seems appropriate.
Visit Support Pray Worship/Sacrament
Attend Provide Ritual
PM RW
Much the same! They have little idea. But I would add that I offer this ministry as one of them, on behalf of them and as my contribution to our combined outreach to the community.
Ministry Outreach
Provide
PM
As a hospital chaplain I provide a friendly presence for people of all faiths or none. Spiritual Care is the main purpose of my work and this includes empathically listening to people and assist them of find comfort, support and connectedness. Jesus inclusive ministry is a model for my work and God's Grace and love made known through Jesus is available for all people. I offer prayer, communion and worship and work with other members of my team. I am able to advocate and liaise with other members of the health care team as required.
Presence Spiritual care Listen Support Prayer & Ritual Advocate
Attend Provide Engage Ritual
PA PM PCE RW
NO ANSWER
When they ask; as above. I show love and respect. Listening to those who want to talk, holding the hand of someone suffering where that is appropriate. As Jesus did I constantly pray.
Listen Companion Support Pray
Attend Engage Ritual
PA PM RW
Sharing a caring time with hospital patients as one person to another in a relaxed way.
Care
Attend Engage
PM
That I visit the sick and fearful and dying, and quietly let them know that I am there to LISTEN to any of their concerns, whether short or long, however much time it takes! When non-Christian, I am unable to convert or bring them to faith. But if I sense the slightest shred of faith through family association or earlier baptism and
Visit Listen God’s Love
Attend Engage Provide
PA PM PCE RW
214
membership, I will gently remind them as opportunity arises, of God's love and will, and His promises, through Jesus; life, death, and ministry - especially of GOD's acceptance of us, forgiveness of sins, and life with God in eternity, and then I pray for and with the person. I use Lutheran Laymen's League tracts and cards to leave behind, few refuse them.
As per #17 - Visiting, encouraging and
praying for the sick, chatting with those who are troubled in a way that is mindful of the Gospel and all it implies.
Visit Encourage Pray
Attend Provide Ritual
PM PCE RW
I allow them to lead the conversation. If they want me to read bible or pray with them - I do so.
Listen Prayer/Ritual
Attend Ritual
PA RW
To live in a secular institution as a disciple of Jesus Christ. To scatter the seed of the Kingdom by word, deed, example and care for people. To companion patients, staff as Jesus did the two disciples on the Emmaus Road, attentively listening to them and as they are ready assisting them to discover meaning and hope. To share with those in distress God's peace and blessing. To co-ordinate a team of lay visitors who assist in visiting. To teach others how to be pastoral carers and to supervise them in the care they offer.
Sow Companion Listen Meaning Blessing Presence Teach
Attend Engage Provide
PA PM PCE MDC
Visit the sick
Visit Attend
PM
The team member who looks after their spiritual needs including connection with their faith community, who will pray for them and encourage them.
Spiritual care Pray Encourage
Provide Ritual Engage
PM PR
I don't very often. But if asked I would say the same as above. Also am with people in times of anxiety and/or grief and stay with them in their pain. The definition of compassion is the ability to stay with people in their pain. 'These things those in need value more than gold: their kind word, the gentle look and the patient hearing of their sorrows' (Catherine McCauley - Founder of the Sisters of Mercy)
Visit Compassion Listening
Attend Engage
PM PA
I pray before I go to the hospital and ask the Holy Spirit to guide me and direct me to those people who have a need and are open to hearing the gospel then I do as
Encourage Prayer Witness/Teach
Provide Ritual
PM PCE RW
215
above by offering encouragement, prayer and witnessing the gospel to them if the opportunity arises.
Offer support and spiritual care as a part of holistic healing.
Support Spiritual care
Engage Provide
PM
The same (as #17?) - I visit people in the hospital. I chat with them and seek to discover if they have any spiritual needs which I can address. I am there to listen to them and offer warmth and hope. If appropriate, I offer to pray for them.
Visit Spiritual needs Pray
Attend Engage Ritual
PA PM RW
As per #14 – ‘Walk alongside'. Meeting people where they are in their journey, unless people are 'exploring' especially in palliative care its too hard/late for 'change'. Hopefully, being a positive calm presence. Friendship, warmth.
Visit Presence Explore Friendship
Attend Engage
PM
As above - I offer support and care to people in the hospital setting, whether patients, family or staff. I offer care and support to all people no matter their religious background/spirituality. I work in a person centred way that respects and values the person and their beliefs.
Probably add chaplaincy as a ministry of presence and motivation of Christ's presence in the world,
Support Care Presence
Attend Engage
PM
I visit people in hospital to offer them my friendship and support in whatever their journey is in hospital. If they want something more theological I might say I visit to show them the love of God for them just as Jesus showed us who God is.
Visit Friendship Support God’s Love
Attend Provide
PM PCE
I give pastoral care to the parents of young, sick children. Offering spiritual support, through prayer and any other areas as needed.
Care Spiritual support Prayer
Provide Ritual
PM RW
On most Thursday afternoons I have the privilege of representing Christ through compassionate ministry to the sick. This ministry provides opportunity for deep spiritual sharing as the sick speak openly about their anxieties and hopes.
Represent Christ Spiritual sharing
Engage
PM PCE
I 'minister' to people - patients and families in crisis because of illness or death and dying. People both active in church and all others in need in the hospital across
Care Prayer and Sacrament Encourage
Engage Provide Ritual
PM PCE RW
216
religions - or none. Prayer, the sacraments and worship are part of this ministry. Yet the focus is on being 'pastoral' to all in need, not trying to impose or 'convert' but encouraging them to tell their story and concerns and being open to the goodness and spirituality already there. God who is present in the patient (family/staff) and in myself as chaplain.
God’s Presence
217
APPENDIX 12
Questions 23-25 – Data
[1] "Pastoral Assessment" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 10 17 0 1 2 7 [1] "involvement" Always Regularly Occasionally Rarely Never NA 13 9 3 4 1 7 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 7 18 3 1 0 8 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 3 7 0 0
0 Important 4 9 1 0
0 Undecided 0 0 0 0
0 Not Important 0 0 0 1
0 Irrelevant 0 1 1 0
0 Always Regularly Occasionally Rarely Never Very Important 6 2 2 0 0 Important 7 7 0 1 1 Undecided 0 0 0 0 0 Not Important 0 0 0 1 0 Irrelevant 0 0 0 1 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 5 8 0 0 0 Regularly 1 6 1 0 0 Occasionally 0 3 0 0 0 Rarely 1 0 1 1 0 Never 0 0 0 0 0 [2] "Pastoral Care" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 25 11 0 0 0 1 [1] "involvement" Always Regularly Occasionally Rarely Never NA 15 17 3 1 0 1 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied 12 23 2 0 0 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 10 13 2 0
0 Important 2 9 0 0
0 Undecided 0 0 0 0
0 Not Important 0 0 0 0
0 Irrelevant 0 0 0 0
0 Always Regularly Occasionally Rarely Never Very Important 13 11 0 0 0 Important 2 5 3 1 0 Undecided 0 0 0 0 0 Not Important 0 0 0 0 0 Irrelevant 0 0 0 0 0
218
Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 9 6 0 0 0 Regularly 2 14 1 0 0 Occasionally 1 2 0 0 0 Rarely 0 1 0 0 0 Never 0 0 0 0 0
219
[3] "Counselling" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 13 19 3 0 0 2 [1] "involvement" Always Regularly Occasionally Rarely Never NA 7 19 7 0 0 4 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 8 25 1 0 0 3 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 3 10 0 0
0 Important 5 12 0 0
0 Undecided 0 3 0 0
0 Not Important 0 0 0 0
0 Irrelevant 0 0 0 0
0 Always Regularly Occasionally Rarely Never Very Important 4 7 1 0 0 Important 3 11 4 0 0 Undecided 0 1 1 0 0 Not Important 0 0 0 0 0 Irrelevant 0 0 0 0 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 3 4 0 0 0 Regularly 4 15 0 0 0 Occasionally 1 4 1 0 0 Rarely 0 0 0 0 0 Never 0 0 0 0 0 [4] "Prayer" [1] "importance" Very Important Important Undecided Not Important Irrelevant 22 14 1 0 0 [1] "involvement" Always Regularly Occasionally Rarely Never 21 15 1 0 0 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied 9 27 1 0 0 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 7 15 0 0
0 Important 2 12 0 0
0 Undecided 0 0 1 0
0 Not Important 0 0 0 0
0 Irrelevant 0 0 0 0
0 Always Regularly Occasionally Rarely Never Very Important 14 7 1 0 0 Important 7 7 0 0 0 Undecided 0 1 0 0 0 Not Important 0 0 0 0 0 Irrelevant 0 0 0 0 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 8 13 0 0 0 Regularly 1 13 1 0 0 Occasionally 0 1 0 0 0 Rarely 0 0 0 0 0 Never 0 0 0 0 0
220
[5] "Worship" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 12 16 4 1 1 3 [1] "involvement" Always Regularly Occasionally Rarely Never NA 9 12 4 6 3 3 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 7 17 6 1 0 6 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 5 6 0 0
0 Important 2 11 1 0
0 Undecided 0 0 4 0
0 Not Important 0 0 1 0
0 Irrelevant 0 0 0 0
0 Always Regularly Occasionally Rarely Never Very Important 8 3 0 0 0 Important 1 9 4 1 1 Undecided 0 0 0 2 2 Not Important 0 0 0 1 0 Irrelevant 0 0 0 1 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 6 3 0 0 0 Regularly 1 10 0 0 0 Occasionally 0 3 1 0 0 Rarely 0 1 3 1 0 Never 0 0 2 0 0 [6] "The Sacraments" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 10 18 3 2 1 3 [1] "involvement" Always Regularly Occasionally Rarely Never NA 6 8 13 3 4 3 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 5 20 4 1 0 7 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 3 5 0 0
0 Important 2 11 3 0
0 Undecided 0 2 1 0
0 Not Important 0 1 0 1
0 Irrelevant 0 0 0 0
0 Always Regularly Occasionally Rarely Never Very Important 4 1 3 1 0 Important 2 6 7 1 1 Undecided 0 0 2 0 1 Not Important 0 1 1 0 0 Irrelevant 0 0 0 1 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 3 3 0 0 0 Regularly 2 5 0 1 0 Occasionally 0 10 2 0 0 Rarely 0 1 0 0 0 Never 0 1 2 0 0
221
[7] "Spiritual Care" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 17 11 5 0 2 2 [1] "involvement" Always Regularly Occasionally Rarely Never NA 11 10 6 4 3 3 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 9 13 7 2 0 6 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 7 5 3 0
0 Important 1 7 0 0
0 Undecided 1 1 2 1
0 Not Important 0 0 0 0
0 Irrelevant 0 0 1 1
0 Always Regularly Occasionally Rarely Never Very Important 8 3 3 0 1 Important 1 7 1 2 0 Undecided 2 0 2 1 0 Not Important 0 0 0 0 0 Irrelevant 0 0 0 0 2 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 8 3 0 0 0 Regularly 1 7 1 0 0 Occasionally 0 2 4 0 0 Rarely 0 0 1 1 0 Never 0 0 1 1 0 [8] "Multiple Faiths" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 8 18 6 2 1 2 [1] "involvement" Always Regularly Occasionally Rarely Never NA 4 6 15 6 1 5 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 5 10 13 2 0 7 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 4 1 1 0
0 Important 1 9 5 1
0 Undecided 0 0 5 1
0 Not Important 0 0 1 0
0 Irrelevant 0 0 0 0
0 Always Regularly Occasionally Rarely Never Very Important 3 1 2 0 1 Important 1 5 7 3 0 Undecided 0 0 4 2 0 Not Important 0 0 1 0 0 Irrelevant 0 0 0 1 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 3 1 0 0 0 Regularly 2 3 1 0 0 Occasionally 0 4 10 1 0 Rarely 0 1 2 1 0 Never 0 0 0 0 0
222
[9] "Staff Support" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 14 13 3 0 2 5 [1] "involvement" Always Regularly Occasionally Rarely Never NA 8 10 8 6 0 5 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 5 19 6 3 0 4 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 4 9 1 0
0 Important 1 7 3 1
0 Undecided 0 0 2 1
0 Not Important 0 0 0 0
0 Irrelevant 0 0 0 1
0 Always Regularly Occasionally Rarely Never Very Important 7 4 2 1 0 Important 1 5 5 1 0 Undecided 0 0 0 2 0 Not Important 0 0 0 0 0 Irrelevant 0 0 0 2 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 2 6 0 0 0 Regularly 3 6 1 0 0 Occasionally 0 5 3 0 0 Rarely 0 1 1 3 0 Never 0 0 0 0 0 [10] "Witnessing" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 8 15 4 4 1 5 [1] "involvement" Always Regularly Occasionally Rarely Never NA 7 13 9 2 1 5 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 2 22 9 0 1 3 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 1 6 1 0
0 Important 1 10 3 0
0 Undecided 0 1 3 0
0 Not Important 0 2 1 0
0 Irrelevant 0 0 0 0
1 Always Regularly Occasionally Rarely Never Very Important 3 2 1 0 0 Important 3 9 1 1 0 Undecided 0 0 2 1 0 Not Important 0 0 3 0 1 Irrelevant 0 0 1 0 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 2 5 0 0 0 Regularly 0 10 3 0 0 Occasionally 0 5 3 0 1 Rarely 0 0 2 0 0 Never 0 0 0 0 0
223
[11] "Chaplaincy Teamwork" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 19 15 0 0 2 1 [1] "involvement" Always Regularly Occasionally Rarely Never NA 15 11 6 2 0 3 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 9 17 6 2 0 3 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 8 9 1 0
0 Important 1 7 4 2
0 Undecided 0 0 0 0
0 Not Important 0 0 0 0
0 Irrelevant 0 0 1 0
0 Always Regularly Occasionally Rarely Never Very Important 11 7 0 0 0 Important 4 3 6 0 0 Undecided 0 0 0 0 0 Not Important 0 0 0 0 0 Irrelevant 0 0 0 2 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 7 5 2 1 0 Regularly 2 9 0 0 0 Occasionally 0 3 2 1 0 Rarely 0 0 1 0 0 Never 0 0 0 0 0 [12] "Multidisciplinary Teamwork" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 15 10 4 1 3 4 [1] "involvement" Always Regularly Occasionally Rarely Never NA 5 11 4 6 5 6 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 4 11 11 5 0 6 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 3 6 1 2
0 Important 1 3 4 2
0 Undecided 0 0 4 0
0 Not Important 0 0 1 0
0 Irrelevant 0 0 1 1
0 Always Regularly Occasionally Rarely Never Very Important 3 6 2 2 0 Important 2 3 1 2 1 Undecided 0 1 0 0 2 Not Important 0 0 0 1 0 Irrelevant 0 0 0 1 2 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 3 1 0 1 0 Regularly 0 7 3 0 0 Occasionally 1 3 0 0 0 Rarely 0 0 2 4 0 Never 0 0 4 0 0
224
[13] "Administration" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 1 17 5 7 3 4 [1] "involvement" Always Regularly Occasionally Rarely Never NA 8 10 5 2 7 5 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 0 14 11 5 1 6 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 0 1 0 0
0 Important 0 10 2 4
0 Undecided 0 1 4 0
0 Not Important 0 1 4 1
1 Irrelevant 0 0 1 0
0 Always Regularly Occasionally Rarely Never Very Important 0 1 0 0 0 Important 6 5 2 0 3 Undecided 0 2 1 0 1 Not Important 1 2 1 2 1 Irrelevant 1 0 0 0 2 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 0 4 2 1 1 Regularly 0 7 2 1 0 Occasionally 0 3 1 1 0 Rarely 0 0 2 0 0 Never 0 0 3 2 0 [14] "Research" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 0 12 9 7 3 6 [1] "involvement" Always Regularly Occasionally Rarely Never NA 0 3 5 9 14 6 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 1 2 18 6 0 10 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 0 0 0 0
0 Important 1 1 5 2
0 Undecided 0 1 7 1
0 Not Important 0 0 4 2
0 Irrelevant 0 0 1 1
0 Always Regularly Occasionally Rarely Never Very Important 0 0 0 0 0 Important 0 2 3 3 4 Undecided 0 1 0 4 3 Not Important 0 0 1 2 3 Irrelevant 0 0 0 0 3 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 0 0 0 0 0 Regularly 1 2 0 0 0 Occasionally 0 0 5 0 0 Rarely 0 0 5 3 0 Never 0 0 7 3 0
225
[15] "Teaching" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 3 17 6 3 4 4 [1] "involvement" Always Regularly Occasionally Rarely Never NA 0 6 10 6 10 5 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 4 13 10 2 0 8 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 1 0 1 0
0 Important 3 8 3 0
0 Undecided 0 2 4 0
0 Not Important 0 1 1 1
0 Irrelevant 0 1 0 1
0 Always Regularly Occasionally Rarely Never Very Important 0 2 0 0 0 Important 0 4 8 2 2 Undecided 0 0 0 1 4 Not Important 0 0 1 2 0 Irrelevant 0 0 0 0 4 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 0 0 0 0 0 Regularly 3 2 1 0 0 Occasionally 1 6 3 0 0 Rarely 0 3 1 1 0 Never 0 2 4 1 0 [16] "Ethics Advice" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 3 20 4 2 3 5 [1] "involvement" Always Regularly Occasionally Rarely Never NA 1 4 9 11 7 5 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 0 15 10 1 0 11 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 0 2 1 0
0 Important 0 10 5 0
0 Undecided 0 1 2 0
0 Not Important 0 0 2 0
0 Irrelevant 0 0 0 1
0 Always Regularly Occasionally Rarely Never Very Important 0 1 1 0 1 Important 1 3 7 7 1 Undecided 0 0 0 0 3 Not Important 0 0 0 2 0 Irrelevant 0 0 0 1 2 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 0 1 0 0 0 Regularly 0 3 1 0 0 Occasionally 0 6 2 0 0 Rarely 0 4 3 0 0 Never 0 1 3 1 0
226
[17] "Professional Development" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 6 25 2 1 0 3 [1] "involvement" Always Regularly Occasionally Rarely Never NA 0 9 15 7 2 4 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 2 19 10 1 0 5 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 0 5 1 0
0 Important 2 14 5 1
0 Undecided 0 0 2 0
0 Not Important 0 0 1 0
0 Irrelevant 0 0 0 0
0 Always Regularly Occasionally Rarely Never Very Important 0 4 1 0 1 Important 0 5 13 5 1 Undecided 0 0 0 1 0 Not Important 0 0 1 0 0 Irrelevant 0 0 0 0 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 0 0 0 0 0 Regularly 1 8 0 0 0 Occasionally 1 8 5 1 0 Rarely 0 3 3 0 0 Never 0 0 1 0 0 [18] "Community Church Liaison" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 4 22 2 3 1 5 [1] "involvement" Always Regularly Occasionally Rarely Never NA 0 12 11 7 2 5 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 2 18 8 5 1 3 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 1 2 0 0
0 Important 1 14 4 3
0 Undecided 0 0 2 0
0 Not Important 0 0 2 1
0 Irrelevant 0 0 0 0
1 Always Regularly Occasionally Rarely Never Very Important 0 2 1 0 0 Important 0 8 7 5 2 Undecided 0 0 1 0 0 Not Important 0 0 1 1 0 Irrelevant 0 0 0 1 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 0 0 0 0 0 Regularly 1 11 0 0 0 Occasionally 1 5 3 2 0 Rarely 0 2 2 2 1 Never 0 0 1 1 0
227
[19] "Advice on Religious Diversity" [1] "importance" Very Important Important Undecided Not Important Irrelevant NA 1 14 10 5 2 5 [1] "involvement" Always Regularly Occasionally Rarely Never NA 1 1 10 14 6 5 [1] "satisfaction" Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied NA 1 11 16 3 0 6 Very Satisfied Satisfied Undecided Dissatisfied Very
Dissatisfied Very Important 0 1 0 0
0 Important 1 6 5 1
0 Undecided 0 1 8 1
0 Not Important 0 0 3 1
0 Irrelevant 0 1 0 0
0 Always Regularly Occasionally Rarely Never Very Important 0 0 1 0 0 Important 1 1 5 4 3 Undecided 0 0 2 6 1 Not Important 0 0 0 2 2 Irrelevant 0 0 0 2 0 Very Satisfied Satisfied Undecided Dissatisfied Very Dissatisfied Always 0 1 0 0 0 Regularly 1 0 0 0 0 Occasionally 0 7 2 1 0 Rarely 0 2 9 1 0 Never 0 1 4 1 0