Monuments of Meaningful Ministry - Jondelle McGheejondelle.weebly.com/uploads/5/3/0/8/53087611/chaplaincy_graduate... · Monuments of Meaningful Ministry 5 In this context Nouwen

Graduate Project:

Master of Science in Chaplaincy Degree

Monuments of Meaningful Ministry

Jondelle D. McGhee, MA, CFLE

Loma Linda University

School of Religion

Spring, 2015


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“Blessed is he who has regard for the weak; the LORD delivers him in times of trouble... The LORD will sustain him on his sickbed and restore him from the bed of illness.” Psalm 41:1,3 Introduction

I stood at the hospital bed of an ailing woman and smiled. Though weak from

surgery she was laughing together with her husband, relishing the repartee between them.

As the man massaged his wife’s feet, he asked her if she knew who I was. Turning to

me, she nodded slightly, indicating that she thought she did. Just to be sure, the man

bellowed in a booming voice, “Honey, she’s a Minister of God!”

What does it mean to carry such a title? As I develop my personal theology and

philosophy of chaplaincy, what fundamentals inform my ministry? The following paper

will discuss the theoretical and practical aspects of chaplaincy that influence me, with

particular emphasis on pastoral care, awareness, conduct, clinical skills, and

professionalism.

Like the building of a great monument, statue, or sculpture, a solid foundation

comes before the detail work can be done. Fashioning an armature or support structure,

an artist begins a masterpiece with a framework, which then is transformed into a graphic

expression of the imagination to evoke emotion, memory, and meaning.

I too begin with a framework; a philosophy of ministry built on the foundation of

Jesus’ lived example, to express my values in the art of spiritual care. Employing a

methodological approach, I endeavor to join in the experience of those who are being

cared for, in order to determine how I may be of help. Drawing from the perspective of

Womanist theologians (Miller-McLemore, and Gill-Austern, 1999), my paradigm of


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theology emerges from those inhabiting the cultural context of ministry (p. 63). This

means that rather than viewing my role of pastor as one who brings a prearranged plan

for ministry (for example the idea that I want each person I care for to have faith as a

result of my visit), I must insert myself into the situation, much like ethnography. To

offer holistic care, I must journey with the individual in their circumstances and suffering

to determine their credible reality and then develop my care plan accordingly.

While there are many positive attributes to Hiltner’s (1958) shepherding model,

which is traditionally viewed as the role of a pastor, I have moved toward Womanist

theologian Jacquelyn Grant’s (1993b) interpretation of Christology. Introducing the idea

of the suffering servant, she writes, “The implication for pastoral theology and care is

that if Jesus Christ is viewed/and or experienced as a co-sufferer by some, the field needs

to reflect theologically on what it means to approach care as one who is suffering with

those who suffer” (p. 59).

Practically, this means that rather than imposing my personal perspective or

panacea for people in my care, I will first ascertain their individual felt needs, values, and

desires. Further, I will not impose my religious beliefs upon them, but encourage

spirituality according to what they hold precious. As Rev. Dr. Martha Jacobs, MDiv,

DMin, BCC so aptly put, “My theology has to be large enough to accept the theology of

those whom I serve, whether they be Christian, Buddhist, Jewish, Muslim, Sikh, Catholic,

Humanist, or Atheist. If I cannot support a patient (or family member or staff person (in

his or her theology, then I cannot serve as a multifaith professional chaplain” (p.11).

Professor of pastoral theology, Father Henri Nouwen (1972) developed a

philosophy, which called ministers to recognize the sufferings of one’s own heart and to


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make that recognition the starting point for service. Coining the term ‘The Wounded

Healer’, Nouwen wrote that the Christian leader is not someone who reveals God to his

people or offers something to those who have nothing. Instead, it is an individual who

helps those who are searching reality as the source of existence.

As a wounded healer, this means that I allow my personal pain to inform my

ministry as well as incorporate my ‘use of self’ to impact how I connect with others.

In the book The Wounded Storyteller by Arthur Frank, a similar principle is

discussed, emphasizing that a minister cannot properly serve others without

acknowledging the personal pain and suffering of one’s own human condition. If

realized, this may become a vital source of healing in the care of souls. Wounded

storytellers make use of their personal pain, illness, and wounds by allowing their stories

a voice. For the pastor who contemplates his or her own life narrative and uses that to

inform ministry, the storyteller gains power to heal and then to help others. This does not

take place by telling patients about one’s own experience of illness, but by understanding

the need to honor patients chaos stories and resist the silence that suffering forces upon a

disenchanted world (Frank, 1995).

Storytelling is an essential component of ministry for the ‘wounded healer’

because it allows the minister to navigate the emotional maelstrom of malady.

Borrowing the metaphor of Judith Zaruches, Frank explains, ‘stories are a way of

drawing maps and finding new destinations’. Like a broken vessel, shipwrecked by the

storm of disease, stories repair damage to the ill person’s sense of where she is in life,

and, where she may be going (p. 54).


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In this context Nouwen (1972) notes that pastoral conversation is not merely a

‘skillful use of conversational techniques to manipulate people into the Kingdom of God’.

Rather it is ‘a deep human encounter in which a man is willing to put his own faith and

doubt, his own hope and despair, his own light and darkness at the disposal of others

who want to find a way through their confusion and touch the solid core of life.’ (p. 39)

For a minister of God, working within the clinical setting, there is great emphasis

placed on healing. Doctors, nurses, therapists, and technicians are working diligently to

restore health and preserve life. Patients who find themselves in crisis often experience a

need for emotional and spiritual wholeness in addition to the physical healing they hope

for. However, healing cannot be prescribed as a salve for the soul from a chaplain

standing at a distance. Nor will alchemy appear by only offering religious rites as a

standard of spiritual care.

In an article entitled ‘The art of listening to hurting people’, Marie Riediger

(1992) describes the transformation of healing that can occur in pained people. She

writes,

A butterfly coming out of its cocoon presents another illustration of what not to

do. The struggle to break open the cocoon prepares the butterfly to develop wings

that will be strong enough to fly. If we assist in opening the cocoon, the butterfly's

wings will be too weak to fly, and it will die. The same is true in the life of a

hurting person. The struggle is a part of their "growing" and "becoming." Growth

and inner healing will take place when we come alongside, supporting and

accompanying the person on his or her painful journey. (Riediger, 1992).

In the example of Christ, who came to earth as one who lived, suffered, and died, fully


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experiencing the plight of humanity, we too may participate in the suffering of others.

Just as Jesus offers restoration to the world, so we are given the privilege of ministering

to those who desire heart healing. Henri Nouwen (1986, p. 97) articulates this

opportunity to use this methodological approach, saying, “Healing is the humble, but,

also, very demanding task of creating and offering a friendly, empty space where

strangers can reflect on their pain and suffering, without fear, and find the confidence

that makes them look for new ways right in the centre of their confusion.”

The Practice of Spiritual Care

Drawing from a Christian tradition and a Seventh-day Adventist upbringing, I

have long loved hearing stories told by Jesus. Chronicled by one of the first documented

doctors who became Christ’s disciple, Luke penned the famous story as told by the great

Master.

Jesus replied with a story: A Jewish man was traveling from Jerusalem down to

Jericho, and he was attacked by bandits. They stripped him of his clothes, beat

him up, and left him half dead beside the road.

By chance a priest came along. But when he saw the man lying there, he crossed

to the other side of the road and passed him by. A Temple assistant walked over

and looked at him lying there, but he also passed by on the other side.

Then a despised Samaritan came along, and when he saw the man, he felt

compassion for him. Going over to him, the Samaritan soothed his wounds with

olive oil and wine and bandaged them. Then he put the man on his own donkey

and took him to an inn, where he took care of him. The next day he handed the


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innkeeper two silver coins, telling him, ‘Take care of this man. If his bill runs

higher than this, I’ll pay you the next time I’m here.’

‘Now which of these three would you say was a neighbor to the man who was

attacked by bandits?’ Jesus asked. The man replied, ‘The one who showed him

mercy.’ Then Jesus said, ‘Yes, now go and do the same.’ (Luke 10:30-37 NLT)

To me, the story of the Good Samaritan is the account of a wounded healer doing the

work of God. Unlike the pious men who passed by without giving aid, it was a man who

had most likely experienced prejudice and pain, having been rejected by Jewish society

for his race and ethnicity, who stopped to care for the suffering victim. Administering

biblical first aid, the Samaritan showed pronounced empathy and genuine compassion for

the bruised and bleeding man on the side of the road. He offered him hospitality and

made sure the man was comfortable. Journeying alongside him, the true neighbor made

sure he was taken to safety, ministering to him by his very presence along the way.

Jesus parable is a poignant one, particularly posed for the pastor dedicated to

clinical ministry. As I articulate the theories that guide my practice of spiritual care, I

find three principles, which may be taken from the narrative, retold by the renowned

raconteur.

♥ First, a minister of God must be compassionate.

♥ Second, a minister of God must exude hospitality.

♥ Third, a minister of God must offer a ministry of presence for the weary or

wounded traveler.


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PLO 1: Theory of Pastoral Care: Articulate theory of pastoral care emphasizing the ministry of presence

Compassion

What is the best way to articulate the practice of spiritual care by a minister of

God in the clinical setting? Based on the story of the Samaritan who saved the day, a

chaplain must be compassionate. Among the countless concepts used to describe

compassionate love, one essayist calls it a "quivering of the heart" deep within ourselves

for the suffering of others, which consequently causes one to move on the other’s behalf

(Brussat and Brussat, 2015). Succinctly stated by Brammer and MacDonald, (1996),

compassion is simply ‘a way of being’. Another definition suggests that it is an

emotional and motivational state, portrayed through feelings of warmth, kindness and

care, coupled with a desire to alleviate any distress and suffering of others (Schantz,

2007). Conceptualized as being a multidimensional developmental process, compassion

is divided into four stages including: (1) the awareness of suffering; (2) an affective

concern for others; (3) a wish to relieve that suffering; and (4) a readiness to relieve that

suffering (Jinpa, 2010).

Regardless of one’s choice of semantics, compassion is a powerful thing. For a

chaplain desiring to support spirituality in suffering people, it is the manifestation of such

love, which will have a profound impact. As famed philosophical revolutionist and

Indian orator Jiddu Krishnamurti (1964) once said, “Love is the most practical thing in

the world. The ambitious seek power, and in their quest are blind to the fact that love is

the greatest power known to man. Great love is great intelligence, because it recognizes

that ultimately love is the only thing that matters.”


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While one of the most essential values for a minister of God, compassion is also a

cornerstone of spiritual teachings for most of the world’s religions. Historian Karen

Armstrong (2006) contended that compassion and empathy were fundamental to

Christianity, Judaism, and Islam. Armstrong wrote, “Central to the Judeo-Christian

tradition is the teaching to “love your neighbor as yourself” (Leviticus 19:18) and to “do

to others what you would have them do to you” (Matthew 7:12). The Jewish value of

tikkun olam (repairing the world) is often interpreted to encompass the repairing of

social bonds and the building of community. Mohammed is quoted as saying, “None of

you really has faith unless he desires for his neighbor what he desires for himself”

(Lutfiyya & Churchill, 1970, p. 58).

Standing at the bedside of man dying from organ failure, or sitting with a child

diagnosed with a rare disease, compassion means that I must open my heart to each

person I meet and allow the gravity of their situation to become personal. As a chaplain,

it becomes my privilege to enter the sacred space where suffering exposes the soul, and

stand beside them, as they find themselves in the malaise, mystery, or mountain of

prodigious pain. It is here where the work of a minister begins. Spiritual care starts with

the state of one’s own heart in order to perform the post of pastoral care. To this end,

Schantz (2007) eloquently encapsulated compassion as:

... Asking us to go where it hurts, to enter into places of pain, to share in

brokenness, fear, confusion, and anguish. Compassion challenges us to cry out

with those in misery, to mourn with those who are lonely, to weep with those in

tears. Compassion requires us to be weak with the weak, vulnerable with the


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vulnerable, and powerless with the powerless. Compassion means full

immersion into the condition of being human. (p. 52)

At this point one might wonder if chaplaincy is really worth it. After all, it isn’t easy to

move toward pain and enter situations where people are hurting (Brussat and Brussat,

2015) all the while being vulnerable yourself. However, I believe that this is the very

place where healing, hope, and happiness can be found. Serving the Lord in such a

vocation means participating in the miraculous, restorative work of God. As an

instrument in the hands of the Great Physician, I may enter the consecrated commission

of the Creator. Inspired by the example of Jesus and the way he interacted with those

who were suffering, I can serve in the footsteps of the Savior through the hallways of the

hospital.

In her book The Ministry of Healing by Ellen G. White, she speaks about Jesus,

and his ministry of restoration saying, “None who came to him went away unhelped.

From Him flowed a stream of healing power, and in body and mind and soul men were

made whole” (1905, pg.11).

Such a motto means putting prejudices away, and seeing people as they really are;

cherished children of the most-high God. Nobel Peace Prize recipient Desmond Tutu, a

man known for his struggle against apartheid in South Africa expressed his beliefs about

love for one another in this way, “Compassion is not just feeling with someone, but

seeking to change the situation. Frequently people think compassion and love are merely

sentimental. No! They are very demanding. If you are going to be compassionate, be

prepared for action!” (Psychology Today, 2005).


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I love the passion with which he speaks and concur with his sentiments. As I see

it, compassion without action is as untenable as a sunrise without morning.

In the medical field, empathy is paramount for patient care (Nadelson, 1993). If

this is true, what do compassion and empathy look like for a chaplain in a clinical

setting? How does one approach the call for action, while not ‘forcing the butterfly from

the cocoon’? Contemplating this conundrum, I turn to Chinese heritage and Buddhist

background to propose a fresh approach to the theory of participating in spiritual care.

Noted by Dr. Andy Maun (2014) after hearing a keynote lecture on ‘The Art of

Doing Nothing’, which was presented by Dr. Iona Heath (2012), the core principles of

Taijiquan ( ), an ancient Chinese martial art (Hong J, & Chen, Z., 2006) commonly

known as Tai Chi, can be applied to professional health care in the therapeutic process.

When using Tai Chi as a form of combat, the intention is to use the alignment of

the body structure to ‘ground the vector of external force in order to reach a turning point,

which opens up the opportunity to change directions in the struggle of competing forces.’

(p. 77–78��a.) That is to say that that an attack can be safely redirected by meeting it with

softness and aligning the body in such a way as to keep contact and follow the other’s

motion in a yin/yang balance until the force of the attack is exhausted and the use of

leverage can overtake the assaulter (Wikipedia, 2015).

As Maun noted, health care professionals can translate the philosophy of

Taijiquan into more effective care of patients. To help them reach turning points, the

professional should align with them through empathy. This, as described in ‘the art of

doing nothing’ lecture means listening, noticing, thinking, waiting, witnessing, and

preventing harm (Maun, 2014).


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For the chaplain, this principle can be integrated into practice too. Rather than

trying to influence a patient in a particular direction by attacking the topic of spirituality

or religion outright, a masterful minister will join alongside the individual by listening,

paying attention to details, and waiting to understand what is important to the person.

Then, with cultivated skill, the chaplain may uncover spiritual themes that will manifest

in meaning for those who are in crisis. Turning points will occur as the chaplain and

patient journey together.

As the professional and patient move together in unified motion, it may be

difficult to observe the subtle maneuvers that the professional is doing to help guide the

patient forward. However, just like Tai Chi martial arts, that will be the mark and

expression of true mastery (Maun, 2014). That is the power of compassion.

In this way, standing side-by-side a sufferer as storm clouds roll overhead, the

response of a chaplain may bring to life the words of William Shakespeare who said

“Love comforteth like sunshine after rain.”

Hospitality

Between 1886 and 1924, one woman became known around the world as a

symbol of freedom. As she welcomed almost 14 million immigrants to the United States,

the 111-foot statue of liberty stood as a monument of inspiration; a reassuring hostess for

newcomers approaching ‘the land of their dreams’ (National Park Service, 2015).

Graven upon the pedestal on which the colossal copper statue stands are the words of

Emma Lazarus whose verse gave voice to the silent lips of Lady Liberty:


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"Give me your tired, your poor,

Your huddled masses yearning to breathe free,

The wretched refuse of your teeming shore.

Send these, the homeless, tempest-tost to me,

I lift my lamp beside the golden door!"

These evocative words welcomed weary travellers who journeyed through raging seas

and futures unknown to a new homeland.

As a minister of God, I want to be a welcoming woman, known for a spirit of

hospitality. Holding tightly to a torch of hope, I must stand ready to offer spiritual

support, emotional care, warm openheartedness, and convivial kindness. Like the

Samaritan story, I should consider the comfort, safety, and tangible needs of each person

I meet, so as not to miss the ministry that takes place in a cup of water for the thirsty or

tissue for the tears that undoubtedly will fall.

As I witness the fear, frustration, grief, and worry of persons who have come to an

unfamiliar setting in hopes of healing, I must offer to the best of my ability the kind of

hospitality that will make them feel as though they are valuable, honored, and precious.

Acknowledging biblical counsel to the importance of having a hospitable spirit,

Romans 12:12-13 reads, ‘Be joyful in hope, patient in affliction, faithful in prayer. Share

with the Lord's people who are in need. Practice hospitality.’

Nouwen (1972) describes the principle of hospitality in these words, “We live in a

desert with many lonely travelers who are looking for a moment of peace, for a fresh

drink and for a sign of encouragement so that they can continue their mysterious search

for freedom” (p.89). He suggests that creating an atmosphere of hospitality means


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sharing a friendly space where another may feel free to come and go, rest and play, talk

or be quiet, eat or fast. It is a peaceful space where an unexpected visitor can feel

welcome, free, safe, and at home. Such hospitality can only be offered by an individual

who first feels comfortable in one’s own house, and then creates an empty space where

an unexpected guest can find his or her own soul.

In my personal life, I have discovered that opening my home, preparing meals for

friends, and creating a space where people can fellowship together while worshipping

God is one of my favorite forms of ministry. I enjoy sharing my gift of hospitality and

feel fulfilled when I can bless others in the process. In my professional life, I want to

provide a similar sense of welcoming as I integrate this standard into the practices of

spiritual care.

Because of my personal background, having been born and raised in a Muslim

country, I am influenced by the cultural heritage of my Muslim aunties and uncles.

Among the traditions of Islam, hospitality is central. Included in the Hadith (book of

Islamic traditions) is found the following statement. “Indeed whoever believes that Allah

is All-Generous, Who provides for His creation and rewards those who are hospitable

towards their guests, should look after his guest” (Anonymous, 2008). Furthermore,

Almighty God states in the Respected Qur’an: “Worship Allah and join none with Him in

worship, and do good to parents, kinsfolk, orphans, the poor, the neighbor who is near of

kin, the neighbour who is a stranger, the companion by your side, the wayfarer (you

meet), and those (slaves) whom your right hands possess” [S:4 V:36].

Based upon religious values and a generous culture, it is evident that hospitality is

important to Muslims. I recently experienced this very magnanimous manner in which


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guests are treated in one of my trips abroad. Though I had only purchased a few gifts

from a tiny shop near the city center of Vellore, India, I had been invited to meet the wife

of the shopkeeper and visit as a special guest in their home. Sipping milky tea and

listening to a ballad, belted at the top of the lungs by their first-born five-year-old son, I

was welcomed with overwhelming warmth. As the wife began painting my hand with

henna in traditional, intricate designs reserved for fancy parties and weddings, I felt both

humbled an honored to be treated by strangers as though I were a queen.

This is the same spirit of hospitality I wish to share with others; to convey an

expression of God’s affection for people through generosity, gentility, and genuine

regard. In the book Creative Hospitality, by Nancy Van Pelt (1995), she writes, “If

hospitality is to be more than striking centerpieces and beautiful homes, we must look at

the spirit of how we minister to others. To really meet the needs of others, we must yield

our talents and abilities to the Holy Spirit, asking his blessing on our efforts. (p. 20)

Ellen G. White writes, “If you have God’s presence and possess earnest, loving

hearts, a humble home…with the welcome of unselfish hospitality, [it] will be to your

family and to the weary traveler a heaven below.” (1923, p. 196)

It has been well documented that social support of high quality enhances

resilience to stress and helps to prevent depression (Ozbay, F., et al 2007). For people

enduring physical pain, illness, or emotional havoc, the encouragement of a welcoming

chaplain can truly be a blessing. However, what about the emotions of the minister? Is it

feasible for a spiritual caregiver to maintain such an open, giving spirit without becoming

emotionally empty themselves?


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In the Biblical story of prophet Elijah and the widow of Zarephath, God instructed

his messenger that a woman would show him hospitality (1 Kings 17:12-24). After a

long journey, he entered the city where he met the stranger and asked for something to

eat. Though she explained that she only has enough food for herself and her son to

partake one more meal before facing starvation, Elijah promised that she could trust that

God would provide for their every need. Miraculously, each day when she went to cook

for the prophet and her son, the jug of oil and jar of flour remained full. Van Pelt (1995)

describes the story, saying, “But in a beautiful and generous manner she offered

hospitality by sharing what she had with this stranger. And how wonderfully God

rewarded her…Imagine what fun the angels must have had filling the containers of oil

and flower when the widow wasn’t looking!” (p. 20)

God has a track record of ‘a never empty barrel’. If he asks his children to serve

him using even the smallest resources, he will multiply and magnify and always provide.

If he is capable of never letting flour and oil run dry, he is capable of keeping hearts ever

full and overflowing. A chaplain need never fear running out of joyful generosity. As

the children’s poem goes, “A gift unshared may fade away, but pass it on and it will

stay.” (Wood and Irish, 1983)

Ministry of Presence

The final theoretical principle from which I sculpt my stance on spiritual care is

both a process and a product. Like a treasure map, which is also treasured, a ‘ministry of

presence’ is the paragon of professional practice.


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As a minister of God, I must offer a ‘ministry of presence’ for the welcome

traveler. This concept implies self-giving. It means being available as well as listening

in a meaningful way. “Presence” implies an awareness of the privilege to be invited into

a person’s life in a very intimate way (Pettigrew, 1990). The heart of pastoral care, it

describes genuine relationship and real meaning (Pembroke, 2002).

The ministry of presence asserts that there is divine power in just showing up and

staying by (Nouwen, 2008). More than that, however, the ministry of presence is “the

offering of sacred space as individuals struggle with sickness”. Dr. Siroj Sorajjakool

(2006), professor of theological studies at Loma Linda University and author of the book

When Sickness Heals, says, a ministry of presence “can bring healing to souls who yearn

for the quality of depth in the midst of suffering itself” (p. 98).

The overarching principle of ‘presence’ is that a chaplain must become fully

involved in the entering the situation or emotion of the one being cared for. Nouwen

(2008) explains that no one can help anyone without risking being hurt, wounded, or even

destroyed in the process. To describe this concept, Nouwen proposes that the great

illusion of leadership is to think that someone who has never been to the desert will know

how to lead another out of it. To further his point, he writes, “Who can save a child from

a burning house without taking the risk of being hurt by the flames? (p. 98)

In her doctoral thesis, Baker (2009) discusses the role of chaplaincy and what it

means to be a ‘minister of presence’. She suggests that such individuals should: (1) act

according to the Bible with no compromises; (2) exhibit care and compassion, (3) be

encouraging in their speech; (4) be available; (5) exude a presence that is above reproach;

(6) reflect upon the practice regularly in order to learn how to do it better; and (7) act as a


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minister rather than as someone from a role of the organization served [police officer,

doctor, etc.]. (p. 113).

If a chaplain is truly present with patients and creates a safe space for them to be,

trust becomes possible. Having someone beside you while in the midst of misery and

pain lead right into the middle of the mystery of God (Nouwen, 2008). This can be quite

a joyful thing to witness, not to mention experience. On the other hand, this type of

ministry doesn’t always promote a positive result. For example, many people do not

want to embrace the negative parts of their lives and try to distance themselves from the

authenticity and acceptance of who they really are (Sorajjakool, 2006). Even if a minister

makes space to help them find their own reality, their own internal scripts may prevent

them from exploring certain emotions. For example, their beliefs about God might make

them feel that they cannot question why. Their social culture might prohibit them from

expressing anger, fear, or weakness. Sorajjakool suggests that since internal scripts may

already occupy a large place in a person’s thoughts, it may be “limiting the availability of

the much needed space to process and move on.” Attention to the conflict that may be

happening within that space is very important. Yet, it is the caregiver’s empty self

without words or actions that will have the greatest power. Sorajjakool continues,

“Simple presence can communicate something much more beneficial than careful

selection of words or well-strategized deeds” (p. 95).

Describing the role of a chaplain, Paget and McCormack (2006) write that the

presence of God through the ministry of the chaplain is what brings healing and

wholeness. Because of God’s presence, calm to chaos, comfort in loss, sufficiency in

need, and victory over despair can be experienced through the practice of prayer, rites,


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rituals, listening, the spoken word, the Holy Scriptures and acts of service (p.28). To this

list, I would add the sometimes-silent ministry of presence.

When words fall short, I can put my arms around those who are suffering and

weep with them. When I don’t know what to do, I can use my ministry of presence to

journey along side them so that they do not feel alone. While I may not be able to take

away suffering, I can support them by standing with them in the shadows, holding their

hand. Such is a ministry of presence. As 17th-century French priest St. Vincent de Paul

once said, "If God is the center of your life, no words are necessary. Your mere presence

will touch hearts"(p. 54).

PLO 2: Awareness: Demonstrate awareness of the impact of values

and assumptions in interpersonal relations

Awareness

Another aspect of chaplaincy, which is pivotal to understanding the needs of

patients and offering care with a standard of excellence, is the ability to demonstrate

awareness of the impact of values and assumptions in interpersonal relations.

First, a chaplain must recognize differences existing in human relationships.

For example, dynamics within families can play a leading role in the way people

relate to life, illness, coping, and each other. This belief is supported by Bowen’s

Family Systems Theory, which postulates that the family is an emotional unit. (1988, p.

viii-xi). Within this theory comes the belief that people occupy different functioning

positions within a family, which has a reciprocating effect. That is to say that what

happens to one member of the family will have an impact on the other members within

the group.


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Awareness of who is in the room, who is missing, and family dynamics in general

can be very important for a chaplain. As I enter a room, I immediately begin drawing a

mental genogram to understand family relationships and emotional patterns that may be

useful or necessary to understand in order to provide conscientious care.

One example of how this made a difference occurred while I was working as the

on-call chaplain for Loma Linda Medical Center one Saturday afternoon. Requested to

visit by the grandmother of the patient who was only a few months old, I made my way

to the Pediatric ICU. There I found the teenage mother of the child, curled up like a baby

in her boyfriend’s lap, her own child in the crib at the other side of the room. Suddenly, a

nurse informed me that the grandmother who was just outside the unit, had fallen to the

ground and was weeping hysterically. The boyfriend and I made our way to the woman

and tried to help her into a wheelchair. When I told her I was a chaplain, she clung to me

in great distress and together all three of us huddled together until she was ready to visit

the baby. The dynamics and emotional undercurrents of this family were very

complicated as I discovered that the grandmother was the main caretaker of the baby, the

mother was pregnant with her current boyfriend’s baby though her child in the ICU was

not his. The boyfriend was responsible for the state of the baby, whom the doctors

suspected had been physically abused. The boyfriend’s mother arrived and pushed past

the nurses saying she had a right to be there, even though she was not technically related.

The mother did not want a chaplain bothering her, while the grandmother was asking for

support as she dealt with the possible death of the baby girl and the emotions she felt

toward the person in the room for whom she believed was responsible for the battering of


21

the baby. In a visit like this one, understanding the differences between these

relationships was crucial.

Second, a chaplain must recognize how cultural, religious, gender, and

economic assumptions can affect human relationships. As the United States becomes

a more diverse nation, it is essential for health care systems to respond to the varied

perspectives, values, and behaviors about health and well being of patients. For

minorities in particular, failure to recognize social and cultural differences may have

significant health effects (Abu-Ras, 2011). Pargament (2002) notes the need for

clinicians to assess spiritual influence with particular understanding of religious beliefs

and values, which may be both positive and negative for the patient. Included in the book

World Religions for HealthCare Professionals (edited by Sorajjakool & Carr, 2010),

comes a discussion regarding the treatment of patients by healthcare practitioners.

Chapter authors Gober and Kim write, “there must be some understanding of the

[patient’s] culture and religion, as well as his/her historical context [in order for healing

to take place” (p.28).

As chaplains, it is important to recognize that issues like gender, socioeconomic

status, religion, and culture can make a difference. For example, visiting a Muslim

woman who has just had a baby would be appropriate for a woman chaplain while

potentially improper for a man. A person without health insurance may be more worried

about finances than in the treatments proposed to restore his or her health. Conflict could

arise regarding the need for surgery and the religious belief to not accepting blood

transfusions. The permutations of possibility regarding the challenges that can arise are

endless.


22

Also, if I as a chaplain, first understand my own cultural and social heritage, it

may help me as I interact with others. I am able to connect with people from all around

the world, because I have lived in Pakistan, the Philippines, Russia, Ukraine, Korea,

Papua, Africa, and America. I can connect with people because of my native American

ancestors, my Seventh-day Adventist upbringing, my Islamic influences, my years of

education, my experience knowing what it means to be poor. I can connect because of

my love for music or my dreams of adventure. The list goes on and on. As a spiritual

caregiver, living a diverse life means many opportunities to make connections with others

who come from unique, beautiful backgrounds.

Third, a chaplain must be able to identify assumptions that affect human

relationship. Not only do assumptions create baseless beliefs, criticism, judgment, and

anger, but they create misunderstandings that may influence improper treatment or

reactions to one another. Personally, I have experienced the negative repercussions of

assumptions both as a patient, and as a chaplain.

While trying to get a refill for a prescription of an opioid medication, which had

been authorized by my doctor, I had the misfortune of having to be seen by a different

doctor filling in while my doctor was on vacation. The man I met seemed callused,

narcissistic, and suspicious. He treated me as if I was a drug seeker and directed anger

toward me. Because he didn’t know me, or take the time to really listen without

preconceived ideas, his actions caused me great pain.

Working as a chaplain, a family arrived at the hospital to view their brother who

had died in the Emergency Department the night before. Though instructed not to touch

the body, they began taking pictures of the medical tape on his body. The Vietnamese


23

family, who did not speak English well, became concerned about what had happened to

him in the hospital. They assumed that their brother had been tortured by the doctors,

which they believed was the true cause of his death. The family’s distress was

understandable, even though they were operating on false information.

Another example of a harmful assumption occurs when someone chooses to sign

a DNR (Do Not Resuscitate) because they do not want heroic measures to be taken to

keep them alive. In such a situation, it is easy to mistakenly assume that a person is

suicidal, has given up his or her faith, or feels they no longer want to fight to live.

All three of these scenarios could have been prevented if premature assumptions

had not been made.

PLO 3: Conduct: Respect boundaries in chaplain relationships

Conduct

As with any profession, codes of conduct are crucial to protect and preserve

safety. For a chaplain, the respect of boundaries within relationships is of utmost

importance. As Erikson (1980) expresses, building trust is one of the earliest

developmental task and the foundation on which all others are built. Therefore, it is

imperative that certain boundaries are not crossed if trust is to remain unbroken.

Because of the marked power imbalance between healthcare professionals

and patients, caregivers have a moral obligation to be trustworthy. Additionally,

because a deep sense of intimacy can be created when connecting on a spiritual level, a

chaplain must exercise restraint and calculated care to keep boundaries in place (Astrow,

Puchalski, & Sulmasy, 2001) (Post, Puchalski, & Larson, 2000).


24

Symptoms of unhealthy boundaries may be seen in displaced emotion aimed

toward patients such as attraction, fear, or hurt. Learner (2014) describes anger as a

signal of something else. Managing anger effectively comes by becoming a better self-

expert and developing a clearer “I”. To identify true sources of anger, one may ask

questions such as: “What about this situation makes me angry? What do I think and feel?

Who is responsible for what?

Another symptom of unhealthy boundaries can be seen when a chaplain’s outlook

becomes altered and it begins to interfere with one’s personal life. This may be as an

indication of burnout (De Bellis, 1997) or the toll of helping known as ‘compassion

fatigue’ (Figley, 1995). Additionally, Chaplain’s must be vigilant in putting patient’s

best interests first and making sure to be careful when dual relationships exist. Harmful

boundary violations always occur when dual relationships become exploitive (Zur, 2014).

Unhealthy thinking can also have a negative effect on relationships with

patients. Over-identification, transference, counter-transference, prejudices, and quick

spiritual fixes are just a few of the many potentially harmful thought processes to be

aware of. Transference refers to feelings from the past that a client projects onto the

chaplain counselor. These distortions are often expressed by using old patterns of relating

(Kahn, 1991). Countertransference occurs when the caregiver loses objectivity,

becoming overwhelmed, angry, or grief stricken while hearing a client's story (TIP,

2000).

Healthy thinking and beliefs that lead to proper boundary setting between

chaplains and patients involve an appropriate use of self, the avoidance of role


25

confusion, and keeping ethically centered. Also, approaching ministry from a place

where one does not have an agenda or desire to change the patient is vital.

One of my favorite descriptions of this principle is found in Sorajjakool’s (2006)

book as an excerpt from Waterbuffalo Theology written by Kostuke Koyama entitled

“The Man Wears the Coat”. Considering the story of the north wind and the sun from the

Fables of Aesop, come the value of honoring man’s dignity, complexity, and self-

determination. As the story goes:

The north wind and the sun were arguing about who was stronger. Seeing a man

coming down the road, they decided to settle their dispute by seeing who could

make the man take off his coat first. When the wind blew hard, the man wrapped

his coat closer to himself but the sun shone over the whole earth and the man

became warm and removed the coat himself.

In response Koyama writes, “We cannot and must not approach man by ‘blowing’. It is

an attack upon the dignity of man and it is also an insult upon man’s amazing inner

spiritual quality. Let man come first, then the coat!” (p. 87)

James Ditts, Professor of Pastoral Care and Counseling, Yale Divinity School,

suggests the role of the witness, witnessing the life of others in all its fullness. In Pastoral

Counseling: The Basics, He states, “Fundamentally, the pastoral counselor does not try

to ‘do’ anything and is not struggling to make something happen, to make repairs, or to

make changes. The intent of pastoral counseling is more profound than that. The

pastoral counselor witnesses.”


26

Not only that, but it is imperative that we leave our own baggage at the door when

we enter a patient’s room. Feelings of fear, biases, triggers, and personal pain must be

dealt with ahead of time in order to foster meaningful ministry (Niklas, 1996).

Moving from the theoretical to the practical, I have contemplated the

repertoire of boundary building behaviors from which I operate and am considering

new behaviors that may be needed as I grow in ministry practices.

The first is self-care. When I become stressed, overworked, or exhausted from

chronic loss or grief, self-care will be most important to bring balance back into my life

(Puchalski, ET AL, 2009).

Over-identification may also be an area of weakness for which I may find need of

careful boundaries. Because of recent illness, for which I have undergone significant life

changes due to severe chronic pain, loss of eyesight, and becoming bedridden for nearly

one year, I recognize that I will need to be careful to not over-relate with patients I meet.

I will need to find a way to guard this boundary because like those I meet, I have

experienced such deep pain.

PLO 4: Clinical Skills: demonstrate clinical skills related to the field of chaplaincy

Clinical Skills

Like the old army adage “be all you can be”, a chaplain must rely on an arsenal of

the finest clinical skills with which to utilize in the implementation of day-to-day

dealings of spiritual care. These skills include connecting, listening, assessing, and and

theorizing.


27

Within the ‘basic training’ of ministry proficiencies, a chaplain must first

connect with patients. While this may seem blatantly basic, it can be more complicated

than it seems. I recall a particularly awkward patient encounter where I just couldn’t

seem to connect. Try as I might, nothing seemed to work. I flashed a smile and

introduced myself. I commented on the flowers in a vase beside his bed. I explained

why I was visiting and what our department had to offer. Finally, I asked the man a

question he wanted to answer. “If you didn’t have to be lying in this hospital bed, where

do you wish you could be?” I queried, and the man immediately brightened. Soon we

were imagining the mist of the early morning, sitting in a boat on a quiet lake, catching

fish by the hour.

The gentleman shared with me how meaningful those times had been as he fished

with his sons and later his grandsons. And of course what it meant to be suffering from

ill health that had taken away what he loved to do more than anything else. Connecting

was the key to a meaningful visit. Never would our visit have ended with us imagining

standing on the shore with Jesus, the fisher of men, if we hadn’t first bonded and found a

reason to share.

Second, a chaplain must listen instead of trying to fix things. According to

Roberts (2012), ‘listening is a mindset’ (p.1127). Active listening, effective listening,

compassionate listening, and in-depth listening involve respect and appreciation for the

one who is talking. The key to quality care is in a listening mindset. If a chaplain will

listen carefully, empathetically, with an agenda-free mentality, she will find that patients

will appreciate the care and counsel she offers. The reason for this, as Dr. Emma Justes

(2006) explains is that as people we long to be connected in a way that is not superficial


28

or minimal. When a person has a chance to share their pain of struggle, they feel deep

relief and a sense of connection. Justes writes, “When we are heard, we experience being

“seen” (p.1).

Carl Rogers (1980) expressed the need for listeners to enter “the private

perceptual world of the other and becoming thoroughly at home in it. This involves being

sensitive, moment by moment, to the changing felt needs, which flow in this other person”

(p.142). Effective ministry means knowing the individual needs of the other person,

which can only be learned through listening. Otherwise, as Justes (2006) says, “care

becomes a generalized shot in the dark with no target and no consideration of the

individual to whom care is being offered” (Kindle Edition).

One way to approach listening is to consider elements of a person’s narrative,

sometimes referred to as double listening, with the addition of empathetic positioning.

Story listening can be a powerful tool to reconstruct meaning and discover heart needs

while the listener attends to buried feelings or wounded hearts. In an article written by

Michael Guilfoyle (2015), he suggests that empathetic positioning occurs when the

listener responds to the themes of resistance that the patient is sharing about his or her

story. In addition to hearing what was explicitly said and done, as well as listening for

sub-stories expressed through expressions or actions which point to what is implied, the

chaplain listens for what lies in between them: the ‘set of forces that resist’ problem

saturated accounts. (p.36-49) Because people ‘live multi-storied lives’ (Walther & Carey,

2009, p. 3) guiding questions such as ‘What is implied by the person’s stories and

actions, and yet is not explicitly present in them?’; ‘What are the subjugated meanings

that the problem story relies upon for its expression? How do these connect with stories


29

of preference and how can we bring them forward?’ (Carey et al., 2009, p. 321) could be

asked. For empathetic positioning, the chaplain listens carefully for the ways in which

people exceed the stories that seek to contain them. As this happens, it is crucial that the

listener attends to what a story means to the teller rather than fixating on the degrees of

distortion, especially in relation to “truth”(Hovey, 2006).

Quality listening requires time. Dudhwala (2005), writes, “in a diverse multi-faith

multicultural society such as ours [we need] time: time to ask patients and relatives what

they deem to be important, whether or not in terms of their religious beliefs and time to

help deliver what they ask for no matter how trivial this may seem.” (p.15). Quality

listening also requires tools. Roberts (2012), discusses a large list (see Appendix E)

which includes basic responses such as: 1) Literal Repetition; 2) Reflecting; 3)

Paraphrasing; and 4) Summarizing, as well as facilitating responses, like: 1) Open-ended

Questions; 2) Buffering; 3) Understatement/Euphemism; and 4) Tell-me-more/Minimal

encouragement. These tools, when mixed with genuine interest, compassion, and care,

can help a chaplain listen empathetically. Egan (2010) describes this as the highest form

of listening, which is expressed as the counselor or chaplain puts aside their own

experiencing of reality and senses the patient’s stories as if it were their own (Mearns &

Thorne, 2007, Hackney & Cormier, 2009).

Third, a chaplain must make assessments based on an understanding of

spiritual, psychological, and social dimensions. A number of modalities exist, which

may be utilized for spiritual assessment. In his book, When Sickness Heals, Sorajjakool

(2006) includes Harold Koenig’s method of obtaining a spiritual history, for example: 1)

Is spirituality being employed as a method of coping with illness?; 2) Does the patient


30

have a supportive spiritual community?; 3) Are there spiritual questions that are of

concern to the patient?; and 4) Are there spiritual beliefs that may affect medical care?

(Koenig, 2013).

Following the whole person care model adopted by Loma Linda University

Medical Center, the acronym CLEAR (connect, listen, explore, acknowledge and

respond) helps a chaplain to provide a holistic visit. Data from the SOUL spiritual

history electronic medical record integrated into the Loma Linda University Health plan

documents patients sources of strength, outlook on religion and beliefs, and underlying

life events (Yuen, 2015). Another acronym, which may be useful for assessment is

SKLS (pronounced skills). This tool includes questions such as: What gives you inner

strength and support?; What religion, faith group, or philosophy shapes you most?; What

significant life events do you want us to be aware of as we care for you?; and What

religious practices or beliefs would you like us to consider as we care for you? (See

Appendix A)

Other useful tools may be to integrate counseling theories into the way a chaplain

interacts with patients. For me Family Systems Theory, Relational-Cultural, Narrative,

Art, and Music Therapy are of particular interest as I consider how I may most genuinely

reflect myself and assess and interact with those I have been called to serve (For other

therapy forms see Appendix B).

While assessment methods can be very helpful, there are some with concerns

regarding the potential pitfalls of using a standardized formula. For example Kelly

(2002) writes that there can be danger in allowing an assessment tool to become a “tick a

box” exercise. Kelly asserts, “In an already dehumanizing environment it is important


31

that assessment of an individual’s spiritual needs is done sensitively and at a pace which

enables the individual concerned to feel safe enough to share with the healthcare

professional involved at least part of their life story” (p. 14).

Finally, a list of essential clinical skills would not be complete without

considering how listening is theologically and theoretically informed. In his book

The Jesus Habits (2005) by Jay Dennis, he describes how important listening was and is

to Christ. Dennis writes, “Jesus was the consummate listener. He still is. Imagine all

those prayers he continues to listen to—from people all around the world, 24-7…People

that were speaking to him had his full attention at that moment. He zoned in on that

person. By listening he made people feel they had value” (p. 63).

In earlier discussion, we were reminded of the Good Samaritan as an example of

how we may approach ministry. John 4:7 tells another story of a Samaritan, from which

we can see the Savior’s ministry style. The Bible reads, “When a Samaritan woman

came to draw water, Jesus said to her, “Will you give me a drink?” Dennis (2005)

writes, “Jesus listened with love and care to this woman who had been used and abused

by men. His listening brought her to the point of receiving him personally. The world

will be more open to our sage of the gospel if we will first listen with love to their hurts

(p. 65-66).

From a theoretical reflection, I choose to construct my ministry practices

from an ‘ethnographic’ standpoint. This means that I will allow the skill of ‘presence’

to inform my practice. I will enter into the suffering and wait, witness, listen, and think

before employing interventions and techniques. Like researchers who document stories

while living among the people being studied, I will learn about the needs of individual,


32

listen to their stories, as a means to strengthen hope in mystery and meaning of God’s

compassion and grace. As a pastoral listener, I will participate in God’s healing work as

an extension of his attentive presence. By listening, I will endeavor to strengthen faith

that God is ‘the One who hears every anguished cry’ (Hunsinger, 2006).

PLO 5: Professional: Maintain professional relationship and

encourage ethical decision within the context of care

Professionalism

To achieve excellence in my work as a chaplain, it is essential that I

encourage ethical decision-making and maintain professional relationships within

the context of care.

1. Encourage Ethical Decision-making.

As a healthcare profession, chaplaincy has produced its own set of ethics rules.

The Common Code of Ethics for Chaplains, Pastoral Counselors, Pastoral Educators

and Students was adopted in 2004 by the six organizations in the United States and

Canada with authority to certify professionals and training programs. This code of ethics

sets out principles that inform relationships in professional practice, including

relationships with clients, between supervisors and students, with faith communities, with

other professionals and in the community, with colleagues in providing spiritual care, in

advertising, and in research (Roberts, 2012).

2. Maintain Professional Relationships.

One entity which helps hold hospitals accountable for maintaining patients rights

including cultural, religious, and spiritual concerns is the Joint-Commission. The oldest


33

standard-setting accrediting body in health care, it strives to make hospitals maintain

patient rights. Founded in 1951, it seeks to improve healthcare of the general public.

Because healthcare professionals are entrusted to care for patients as whole persons -

body, mind and spirit, it is important that they maintain integrity by responding to the

unique needs of each patient and their loved ones. To this end, the Commission has

created a ‘Roadmap for Hospitals’, which addresses issues such as advancing effective

communication, cultural competence, and patient/family centered care. The manual

addresses topics like language access, cultural competency, health literacy,

communication barriers, and mobility needs. The document states: "patients have a

fundamental right to considerate care that safeguards their personal dignity and respects

their cultural, psychosocial, and spiritual values" (JCAHO, 1998, 2010).

Chaplains should be very familiar with these documents and be prepared to act in

accordance with the ethical standards set forth within them. Practically, it can be helpful

to create a set of Christian standards of service that most health facilities and businesses

expect of their employees. Niklas (1996) presents a list that can guide a chaplain’s

professional conduct, including:

1. Treat all persons with compassion, care, courtesy, and respect.

2. Respond quickly.

3. Take time to be helpful.

4. Respect the privacy/dignity of others.

5. Always give clear, concise explanations.

6. Practice good listening skills.

7. Maintain an appropriate environment.


34

8. Look the part.

9. Deal with difficult situations effectively.

10. Perform as a member of the team.

Within the culture and mission of the institution, the pastoral role has an

important place. First, as an integral part of the team, chaplains incorporate cross-

cultural competence into spiritual care of patients. Second chaplains shape the culture of

the organization by providing spiritual support for staff. Third, chaplains use their

position of authority to advocate for ethical care, respecting to human rights.

As part of the team, healthcare chaplains can be an invaluable resource in the

provision of holistic care (Barber, 2013). Reverend George Handzo, vice president of

Healthcare Chaplaincy, discussed the need for intentional education, which chaplains

may help to provide. “Many health care providers, although they want to treat their

patients in a culturally and spiritually sensitive manner, often don’t know how.” (Handzo,

2011). Making sure one is serving within a culturally sensitive manner will have a

beneficial effect on both patients and medical personnel.

Next, spiritual care contributes to a healthy organizational culture. Chaplains not

only help staff members cope, but empower them to recognize the meaning and value of

their work in new ways (VandeCreek & Burton, 2001). This means that chaplains must

be aware of high-stress cases that occur on the wards, get to know staff on a first name

basis, and design creative ways of providing spiritual care to busy people in a high-stress

work environment. (See Appendix F)


35

As Chaplains consider the ethical ramifications of their sworn duty, standards of

ethical practice place great bearing on issues of limited access, hidden discrimination, and

inequality of those who may be marginalized. Spiritual leaders can participate in

purposeful advocacy and conscientious support of those in need.

Additionally, recent research, undertaken in Australia supports the argument that

health care chaplains may be able to make an important contribution to ethics

committees. Because chaplains minister beyond their own particular faith traditions,

they develop a tacit knowledge gained from providing pastoral interventions to a

diversity of patients, families, and staff dealing with significant bioethical issues. These

issues might include but are not limited to pain control, abortion, withdrawal of life

support, resuscitation orders, euthanasia, and in vitro-fertilization (Carey et al. 2006a).

Within a multi-disciplinary team of the units assigned, the role of chaplain

can take on different dimensions. The chaplain may work as an advocate, mediator,

counselor, educator, listener, or bridge builder.

As professional Chaplains offer spiritual care, they are particularly positioned to

make a difference among those who may be marginalized. This is the case not only

because Chaplains are theologically and clinically trained, but because of their sensitivity

to multi-cultural and multi-faith realities. Through empathic listening and understanding

the pain of persons in distress, a chaplain may attend the fears, concerns, and worries of

patients. By participating in rounds on the hospital floor and offering spiritual insight

regarding patients to their doctors, a chaplain may be a valuable part of the health-care

team. Additionally, as part of the multidisciplinary team, chaplains work closely between

the patient and the community. They provide bereavement counseling, support for staff,


36

and facilitate communication between patients, families, and staff (Ford & Tartaglia,

2006).

Another critical element of professionalism within the field is understanding

the administrative work flow of the institution. This means that a chaplain would be

familiar with the culture and procedures of the units she is assigned to and understand the

day-to-day functions of the various hospital departments.

Because health care institutions have many parts which must work in cohesion to

provide the best care possible, it is important to understand protocols, be aware of who is

responsible for what, be familiar with people, and make an effort to be an uplifting player

in the team.

An illustration of a chaplain’s need to understand the workflow of the institution

can be seen in the experience I had while training to be a chaplain at Loma Linda

University. When facilitating the ‘viewing’ for a family who had just discovered their

brother had died in the ER, a number of arrangements needed to be made with different

departments. It was necessary to coordinate with the ER to reserve the family room,

arrange with Dispatch to unlock the morgue so the body could be checked as well as

arrange for someone to transport the body to and from the viewing room. Laundry

services had to be visited for fresh linens, and the disposal of dirty bedding after. The

Social Workers department was contacted just in case they needed to be involved. The

nurses’ station was communicated with so the body could be released to our care. Guest

Services was coordinated to help us find the family. Patient Relations was called when

the family became angry about the way they thought their brother died. Administration

was informed, in case the misunderstanding became a lawsuit.


37

Conclusion

What does it mean to carry the title of chaplain, a minister of God? As I have

developed a personal theology and philosophy of chaplaincy as well as discussed the

theoretical and practical aspects that influence me, I am drawn to the description of a

chaplain as described by Henri Nouwen (2008) who wrote, “It indeed seems that the

Christian leader is first of all the artist who can bind together many people by his

courage in giving expression to his most personal concern” (p.74).

As I open my heart to a ministry of presence, it is there that my ministry will be

molded into something special. Reminded by Riediger (1992) the care I offer is not my

own. God goes with me and is already there when I arrive. To me this means that my

ministry of presence is God’s ministry of presence. Beyond the mystery I cannot

understand, it is He who works to heal hearts and minds and extend comfort and care to

his treasured children.

Ellen White (1905, p. 226) writes,

Christ desires to manifest his presence in the sickroom, filling the hearts of

physicians and nurses with the sweetness of his love. If the life of the attendants

upon the sick is such that Christ can go with them to the bedside of the patient,

there will come to him the conviction that the compassionate savior is present,

and this conviction will itself do much for the healing of both the soul and the

body.


38

In the center of the Loma Linda University campus, stands a monument of

meaning for many. First carved out of limestone, the 7’3” high, now bronzed statue of

the Good Samaritan story renders a contemporary interpretation of compassion and

healing extended across barriers of prejudice. Created by sculptor Alan Collins, the

statue is much more than a graphic representation of the parable told by Jesus. It is an

artistic reminder of the philosophy "to make man whole" (Collins, 2014).

As I carry this motto with me, I will continue to cultivate a philosophy of care for

the future. Inspired by the Samaritan stories, I will endeavor to be more compassionate,

hospitable, and present while listening to the sacred narratives of my patients’ suffering.

Learning from the Great Master, it is my solemn prayer that as I answer his call, I

will treat patients and families with dignity, space, and love. When I enter a new room or

shake another hand, I want to be known for my welcoming smile and sincerity of spirit as

I offer compassionate care to each individual as though I were visiting Jesus himself.

In Davidson, N.C., outside a neighborhood church, sits another spiritual sculpture

impacting the community. The statue depicts a vagrant, huddled under a blanket,

sleeping on a park bench. His face is covered, but his bare feet show scars from the

cross; it is a provocative picture of a homeless Jesus who won’t go away. (Burnett, 2014)

(See Appendix G). This monument is a meaningful reminder that when I hold a grieving

mother’s hand, I am holding the hand of God.


39

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Appendix A

CLEAR: The following whole person care model (CLEAR) has five areas. You are expected to engage in all five areas as needed (Connect, Listen, Explore concerns, Acknowledge, Review resources and empower. Question adapted from the LLU Spiritual History for the purposes of the medical student interview

C: Connect • Connect with God

o Pray before entering the room and ask God to guide you • Connect with yourself

o Be aware of your own thoughts/feelings (nervousness, excitement, fear, etc • Connect with the patient:

o Establish eye contact (be present with the patient). Ask yourself, “Am I really here, with this person?” If not, why not? What causes you to distance yourself?

o “What are you famous for?” o What is the patient’s diagnosis? What is the history of the problem?

• Connect with family members/friends who might be in the room • Connect the patient to his/her loved ones

o “It looks as though there are some important people here with you” • Connect with the environment

o “I see you have _____ in your room. Tell me about it.”

L: Listen • Listen to the patient’s story

o “Tell me about your illness” or “What brought you to the hospital?”

• Listen to the patient’s physical story o “When was the last time you felt really healthy?” o “What has it been like for you to deal with this health issue?” o “What is your understanding of your illness?” o “How has your illness affected your lifestyle?” “What has it been like to be in the

hospital?

• Listen to the patient’s emotional story o “Has any part of your illness been scary for you? Has the illness seemed life

threatening?” o “Have you felt any losses as a result of being ill? “What significant life events

(gains or losses) have you experienced that you want us to know about?” (spiritual history question)

o “In what ways has this illness affected your picture of yourself? Your control of your life”

o “How does pain affect you? How do you deal with it?” o “Has your illness brought any feelings of helplessness, hopelessness, anger,

frustration, or sadness?”


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• Listen to the patient’s relational story

o “In what ways do you see yourself as a valuable, worthwhile person?” o “What are you learning about yourself during this experience?” o “Do you need other people around you at this time? What caring people do you

have near you?” o “What is it like to be dependent on other people during your illness?” o “Are you being cared for as you wish? How are your healthcare givers and your

family relating to you and your illness?”

• Listen to the patient’s spiritual and religious story o “Has your illness raised any puzzling questions for you? Are you able to make

any sense out of being ill? o “What gives you inner strength and support?” (spiritual history question) o “What religion, faith group or philosophy shapes you most?” (spiritual

history question) o “What role does your community play in your emotional health and spiritual

growth?” o “What role has your faith community played in your illness?” o “What religious beliefs might affect your healthcare decisions?” o “Are there any religious practices that you would like to continue in the hospital

setting?” o “What is the role of prayer in your life (if a praying person)?” o “How does the future look to you?”

E: Explore concerns • “What are some of your main concerns right now? • “When you think about the story you are telling me, what concerns you most” • “You have identified several stressors. Which one(s) cause you the most stress?” • “When you think about the story you are telling me… (“what have you most

appreciated?” In what ways have you grown? What has brought the greatest challenges?”)

A: Acknowledge • No matter what the story or concern, validate the patient (and the story/concern). You

may not agree with them; it only means that you acknowledge how a person could see things the way he/she sees them

• “I hear you saying that ___________. Am I hearing you correctly?” • “It seems that ________ really causes you stress/fear/guilt” • “Your story is very rich and full of memories” • “You seem to have a lot of support around you right now” • “This must be difficult”

R: Review resources and empower

• Review resources


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o “What resources do you have that might help right now?” o “What gives you inner strength and support?” (repeat of spiritual history

question) o “What religious practices or beliefs are most helpful during this time?

Would you like us to consider them as we care for you?”1 o “When you encounter difficult situations, what helps you most?” “What strengths

do you have that might help you now?” “What could we do to help you during this time?”

o “You mentioned prayer as a resource. Would you like to pray with me or would you rather do that on your own or with something else?”

• Empower o “Your story has been very meaningful to listen to. I have learned a lot from your

experiences” “You have identified some important resources. What will you do from here?”

Appendix B

1 Question adapted from the LLU Spiritual History for the purposes of the medical student interview


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Appendix C:

Adlerian Art Therapy Behaviour Therapy Attachment Therapy Body Based Psychotherapies (Mind Body or Somatic Therapies)

Integrative Body Psychotherapy Sensiormotor Psychotherapy

USA Self-Regulation Therapy Canada Somatic Experiencing USA Affect Regulation Australia Body Psychotherapy Britain Hakomi

Bioenergetic Analysis Therapy Brief Therapy Client Centered Therapy (or Rogerian) Cognitive Analytic Therapy Cognitive Behavioral Therapy Coherence Therapy Dance Therapy Dialectical Behaviour Therapy Drama Therapy Dyadic Developmental Psychotherapy Emotionally Focused Couples Therapy Emotional Freedom Techniques Existential Therapy Eye Movement Desensitizaiton & Reprocessing Therapy Family Therapy Feminist Therapy Focusing Functional Analytic Psychotherapy Gestalt Therapy Group Therapy Humanistic Therapy Humor Therapy Hypnotherapy Interpersonal Psychotherapy Jungian Therapy Marital and Family Systems Therapy Multimodal Therapy

Music Therapy Narrative Therapy Neurofeedback Therapy Neurolinguistic Programming Objects Relations (do not choose both this AND attachment therapy) Pastoral Counseling Play Therapy Positive Psychology Primal Therapy Psychodynamic Psychoanalytic Rational Emotive Therapy Relational-Cultural Therapy Reiki Therapy Reikian Therapy Rolfing Therapy Short-Term Psychodynamic Psychotherapy Solution Focused Therapy Somatic Psychotherapy (see Body-Based above) Systems Therapy (Family Systems Therapy) Transactional Analysis Transpersonal Psychology


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The Art of Doing Almost Nothing: Reaching turning points through alignment.

FIG. 1. Color images available online at www.liebertpub.com/acm

Published in the Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Appendix D


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HOSPITALITY

The welcoming woman and a monument of hope

A newly arrived immigrant family on Ellis Island, gazing across the bay at the Statue of Liberty.

National Park Service, Statue of Liberty NM Appendix E


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Listening & Responding Skills:

The following lists include general principles for foundational listening and responding skills.

Principles for effective listeners: A listener… 1) Encourages the speaker to take initiative; 2) Stays attuned to the present; 3) Stays as objective as possible during conversations. Basic responses include: 1) Literal Repetition; 2) Reflecting; 3) Paraphrasing; 4) Summarizing. Facilitating responses include: 1) Open-ended Questions; 2) Buffering; 3) Understatement/Euphemism; 4) Tell-me-more/Minimal encouragement. Intense interaction responses include: 1) Calling attention; 2) Hovering. Avoid stereotypes: they tend to provide us with negative expectations and we therefore try to avoid communicating with people who are different. (Consciously or unconsciously)

This information has been taken from the following book: Roberts, Stephen. (2012). Professional Spiritual and Pastoral Care: A Practical Clergy

and Chaplain’s Handbook, Skylight Paths Publishing, Woodstock, VT.


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Appendix F:

Supporting Staff

Creative Ideas for Encouragement, Bereavement, & Spiritual Support Staff Support Roles:

1. Help staff find meaning in their work 2. Provide spiritual and emotional support for staff 3. Help staff bring closure with patients 4. Nurture the spirituality of the staff 5. Provide counsel on ethical matters 6. Contribute key information to doctors regarding patient illness stories

Creative Hospital Staff Support Ideas:

1. Annual holiday cookie run 2. Blessing of the hands 3. Services of remembrance 4. Chapel services/Places of worship for various religious traditions 5. Critical incident debriefings 6. Staff support and grief groups 7. Individual support for staff 8. Conflict mediation 9. Spiritual grand rounds 10. Educational in-services 11. Creative arts programs 12. Prayer/devotions over sound system 13. Television/Internet channels with spiritual programming

Lists taken from: Professional Spiritual and Pastoral Care

Roberts, Stephen (2012). Professional Spiritual and Pastoral Care: A Practical Clergy and Chaplain’s Handbook, Skylight Paths Publishing, Woodstock, VT.

Appendix G:


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Statue Of A Homeless Jesus

NPR ONLINE ARTICLE:

A new religious statue in the town of Davidson, N.C., is unlike anything you might see in church. The statue depicts Jesus as a vagrant sleeping on a park bench. St. Alban's Episcopal Church installed the homeless Jesus statue on its property in the middle of an upscale neighborhood filled with well-kept townhomes. Jesus is huddled under a blanket with his face and hands obscured; only the crucifixion wounds on his uncovered feet give him away. The reaction was immediate. Some loved it; some didn't. "One woman from the neighborhood actually called police the first time she drove by," says David Boraks, editor of DavidsonNews.net. "She thought it was an actual homeless person." That's right. Somebody called the cops on Jesus. "Another neighbor, who lives a couple of doors down from the church, wrote us a letter to the editor saying it creeps him out," Boraks added. Some neighbors feel that it's an insulting depiction of the son of God, and that what appears to be a hobo curled up on a bench demeans the neighborhood. The bronze statue was purchased for $22,000 as a memorial for a parishioner, Kate McIntyre, who loved public art. The rector of this liberal, inclusive church is the Rev. David Buck, a 65-year-ol Baptis turned-Episcopalian who seems not at all averse to the controversy, the double takes and the discussion the statue has provoked. "It gives authenticity to our church," he says. "This is a relatively affluent church, to be honest, and we need to be reminded ourselves that our faith expresses itself in active concern for the marginalized of society." The sculpture is intended as a visual translation of the passage in the Book of Matthew, in which Jesus tells his disciples, "As you did it to one of the least of my brothers, you did it to me." Moreover, Buck says, it's a good Bible lesson for those used to seeing Jesus depicted in traditional religious art as the Christ of glory, enthroned in finery. "We believe that that's the kind of life Jesus had," Buck says. "He was, in essence, a homeless person." This lakeside college town north of Charlotte has the first Jesus the Homeless statue on display in the United States. Catholic Charities of Chicago plans to install its statue when the weather warms up. The Archdiocese of Washington, D.C., is said to be interested in one, too. The creator is a Canadian sculptor and devout Catholic named Timothy Schmalz. From his studio in Ontario, Schmalz says he understands that his Jesus the Homeless is provocative. "That's essentially what the sculpture is there to do," he says. "It's meant to challenge people." He says he offered the first casts to St. Michael's Cathedral in Toronto and St. Patrick's Cathedral in New York. Both declined. A spokesman at St. Michael's says appreciation of the statue "was not unanimous," and the church was being restored, so a new work of art was out of the question. That statue found a home in front of the Jesuit School of Theology at the University of Toronto. A spokesperson at St. Patrick's in New York says they liked the homeless Jesus, but their cathedral is also being renovated and they had to turn it down. The most high-profile installation of the bronze Jesus on a park bench will be on the Via della Conciliazione, the avenue leading to St. Peter's Basilica — if the city of Rome approves it. Schmalz traveled to the Vatican last November to present a miniature to the pope himself. "He walked over to the sculpture, and it was just chilling because he touched the knee of the Jesus the Homeless sculpture, and closed his eyes and prayed," Schmalz says. "It was like, that's what he's doing throughout the whole world: Pope Francis is reaching out to the marginalized." Back at St. Alban's in Davidson, the rector reports that the Jesus the Homeless statue has earned more followers than detractors. It is now common, he says, to see people come, sit on the bench, rest their hand on the bronze feet and pray.

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