Health care chaplaincy research: A need within aged care facilities

Lindsay B Carey
Department of Behavioural Health Sciences, La Trobe University, VIC

PP: 291 - 296

Article Text

An Overview

Over the last 10 years, health care chaplaincy, particularly in several western countries, has become an important field of research. As one form of pastoral care the ministry of chaplaincy has always had a broad and long standing role within such organizations as the defence forces (ie, navy, army and air force), large commercial industries (eg, mining, manufacturing), educational institutions (ie, primary, secondary, and tertiary), remote and regional patrol work (land and air service), police and prison institutions and even, at one stage, the Australian Taxation Office. To put it simply, Health Care Chaplaincies (eg, Hospital Chaplains within public and private hospitals) are only one of many pastoral care chaplaincy ministries encouraged by government, church, and community resources.

More recently, however, given the focus upon health and wellbeing, and the emphasis upon medical case-mix funding and economic rationalism, the specialist ministry of Health Care Chaplaincy has begun to move to the forefront of chaplaincy research in the United States, Britain, and Australia. Through the use of empirical quantitative and qualitative research, health care chaplaincy is seeking to improve the quality measures of its pastoral care services. This issue is particularly important, given ageing populations within some western countries and the increasing need for quality pastoral care within all aged care facilities.

Religion, Health, and Role of Chaplains

While some literature from overseas (Barrows 1993; Hartung 1971; Jost & Haase 1989) and in Australia (Carey, Aroni & Edwards 1997) has raised criticisms about the services of hospital chaplains, most research has indicated that patients and their families seem very favourable towards the involvement of chaplains (Milne 1988) and that, for some clinical staff, 'the role of the chaplain seems predominantly to be very much accepted and professionally appreciated' (Carey 1991; 1995).

Recent literature (Carey 1998), based upon the 'sacralization of identity' theory of Emeritus Professor Hans Mol (1976), has suggested that chaplains can be valued within the health care environment because they are considered important in helping patients, who may be in crisis, to use various religious and nonreligious mechanisms that can assist people to gain a new sense of identity and meaning. This can consequently help to promote positive psychosocial and behavioural outcomes which may 'enhance a patient's own wellbeing and thus (also) assist clinical staff in their work' (Carey 1998).

Over 300 clinical staff from the Royal Children's Hospital (RCH) in Melbourne (including doctors, nurses, and allied health), who were involved in the Australian Chaplaincy Utility Research (AUS.CUR 1992-1994), identified several reasons why they valued having resident chaplains. These reasons included that chaplaincy provides assistance with:

1. Teamwork, eg, helping to improve staff time management;
2. Religious and psychosocial support to patients and staff through such mechanisms as 'religion', 'faith', 'God', and 'church';
3. Specialist support to families and staff, particularly at times of death and grieving; and dalso providing input in terms of (i) ethical decision making, (ii) being a community link, (iii) providing a non-diagnostic communication role within the hospital, and (iv) alleviating emotional discomfort for staff and patients within a complex and sometimes frightening institution (Carey, Aroni & Edwards 1997).

Further, a comprehensive review of all available scientific and clinical pastoral research literature concerning the interrelationships between religiosity and health indicated that religious factors may benefit the health of patients and assist staff in four main psychosocial ways:

aby promoting healthy behaviour bproviding social contact cencouraging coherent thinking, and dencouraging positive theological understandings (Carey 1993). This review suggested that:

While the links between religion and health are still tenuous, the links are nevertheless substantial enough to warrant further investigation and significant enough for health care practitioners to encourage a holistic practice that includes the spiritual/religious dimensions of a patient's/clients healing needs. (p.26)

However, regardless of previous literature that may add to the justification of chaplaincy and the use of pastoral resources in general clinical settings, the question needs to be asked whether there is acceptance within aged care facilities concerning the role and task of hospital chaplains. This is important given the unique demands that may exist in specialist facilities.

Chaplaincy Research in the United States

Within the United States, one of the earliest and largest single case studies on hospital chaplaincy that gained limited but international attention was tided Hospital Chaplains: Who Needs Them?, based upon the results of the Pastoral Care survey (Carey 1972). This research involved over 200 clinical staff (nurses and doctors) plus patients. The answer to the research title was that both patients and staff valued all the various roles of chaplains as needed within the hospital (ie, sacramental, prayer, teamworker, educator, counsellor, thanotonic, and witness role), but the majority particularly favoured the thanotonic role. From the 1970s to the present day, the growth of the Clinical Pastoral Education movement within the United States and internationally (including in Australia and New Zealand) has concurrently led to the substantial professionalism of pastoral care and a greater utility of health care chaplaincy roles - a development which is still ongoing today. As noted by Griffin (1997):

Over the centuries the church has refracted intellectual, social, political, medical, spiritual, theological, ecclesial, and many other forms of change in its pastoral care. Our time and our place is in no way exempt. (p.5)

One area in which the various churches involved in chaplaincy have begun to be attentive, through respective chaplaincy and pastoral care associations, is in terms of conducting empirical research so as to develop quality measures of health care chaplaincy. Over the last decade, the New York based Journal of Health Care Chaplaincy (JHCC) has been the first journal to recognise the need and appropriateness of measurement and research in chaplaincy (McSherry 1987). VandeCreek's Health Care Chaplaincy Organization has taken this empirical thrust seriously, becoming engaged in quantitative and qualitative research. Much of this research has been published in the US JHCC, with an initial focus upon a 'patient satisfaction instrument' (VandeCreek 1997); and more recently upon the national effects of chaplaincy 'downsizing' across the United States (VandeCreek 1999). Under VandeCreek's editorial, the US JHCC has published a special edition on the fundamentals for pastoral practice concerning the issue of 'spiritual care for persons with dementia' (VandeCreek (in press)). As part of this edition, articles covered included caring for long-term residents within nursing homes (eg, Knight 1999).

Chaplaincy Research in Great Britain

Within Great Britain, while substantial informative material in regard to health care chaplaincy has been published (within the Cambridge based Journal of Health Care Chaplaincy, eg, Carey & Newell, in press; Law 1998) very little empirical research has been published measuring the role of health care chaplains. However, the British National Health Service has recently appointed its first postdoctoral research fellow with the specific mandate of researching the role of hospital chaplains within public hospitals. This research will more than likely conclude in 2001. It will be interesting to see whether it will be inclusive of pastoral care and health care chaplains within aged care facilities.

Australia and New Zealand

Within Australia and New Zealand, some small case studies have been conducted on the role and work of hospital chaplains. Some basic descriptive research exploring the sources of satisfaction and stress among New Zealand hospital chaplains noted that the main source of stress for chaplains was that of carrying a heavy load of too many patients (Tisch 1997). Other research has explored the involvement of New Zealand chaplaincy personnel in helping patients, families, and staff to make bioethical decisions (Carey, Aroni & Gronlund 1998). This research is still ongoing. Thus far, however, there has been no empirical research published in New Zealand to cross-evaluate and assess chaplaincy roles with the type of institution or type of pastoral care to particular patients (eg, aged care patients). The New Zealand Inter-Church Council on Hospital Chaplaincy is currently exploring the possibility of conducting empirical research among its contracted chaplaincy personnel.

The AUS.CUR research conducted at the Royal Children's Hospital, Melbourne (mentioned earlier) explored the role of chaplains similar to that of US Pastoral Care Survey (Carey 1972). The AUS.CUR research, however, included not only nurses and doctors, but all allied health professionals totalling some 390 respondents (Carey, Aroni & Edwards 1997). This research found that the majority of clinical staff affirmed all the roles of hospital chaplains as being appropriate within a medical setting, but emphasized that there needed to be extensions to the chaplain's role in terms:

1. Increasing their public profile beyond the traditional stereotypes
2. To assist staff with more productive teamwork
3. To have a greater in-put on ethics committees and ethical decision making
4. To be more forthright in personal presentation; and
5. To increase the number of chaplains to patient/staff ratio.

An additional issue arising from data derived from staff in-depth interviews was the need for outpatient chaplaincy and home visits by chaplains, thus enabling follow-up pastoral care for recent or early discharged patients. This concept may prove beneficial for the elderly, particularly those transferred directly from a hospital to an aged care facility.

Other Australian research has also started to note the important input of chaplains. Preliminary findings from the 'Liver Transplant and Pastoral Care' research, conducted within three Australian Hospitals in different states (Queensland, New South Wales, and Victoria), suggested that where chaplains are liaising and drawing patients, relatives, and staff members together, the patients are more content and are being discharged at a faster rate than otherwise (Elliot & Carey 1996). This research has not yet been completed. If the findings are fully substantiated, the cost saving of having effective chaplaincy and pastoral care services could be very advantageous to all concerned and would clearly help to prove the cost efficiency of hospital chaplaincy (Carey & Newell, in press).

The Westmead Brain Injury Rehabilitation Unit and Pastoral Care Department pilot research (Carey, Ireland, et al, in press) which surveyed patients, relatives, and visitors over a 12 month period, indicated that 'irrespective of gender, age, category status, or religious belief the majority of respondents believed the chaplaincy services provided were 'very good' or 'good' (96.3%)' (p.57). Also, pilot research conducted at the Our Lady of Consolation (OLOC) Aged Care Facility in New South Wales, likewise suggests that the majority of patients were very affirming of the provision of pastoral care services (Carey & Mulder, in press). However, as indicated by such pilot research, there is a long way for health care chaplaincy research to progress in terms of research protocols, method and the construction and testing of measurable instruments both descriptive and experimental.

Currently, a national research project is being conducted under the auspices of the School of Public Health, La Trobe University, on the involvement of chaplains in bioethical decision making. This descriptive research, involving over 400 chaplains across Australia and New Zealand, will explore issues affecting both acute patients and aged care personnel such as the withdrawal of life support (WLS), not for resuscitation (NFR) or do not resuscitate orders (DNR), and euthanasia. The project is due for completion in the year 2000, or possibly 2001. Like other chaplaincy research projects, progress is hampered by a lack of funding.

Future Health Care Chaplaincy Research

It has only been possible in this brief article to present a 'snapshot' of health care chaplaincy research known to the author. Much of the chaplaincy research which has, and is currently being conducted, is generally not empirical and has focused primarily upon acute settings. In general, very little empirical research has been undertaken within Australia (or other countries) upon pastoral care chaplaincy within aged care facilities. This is an area sorely lacking. The government, aged care facilities, and pastoral care departments need to attend to this matter, particularly as 'spirituality' and 'religious faith' can become an emotional issue of great importance to the elderly.

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