Spring 2005 Newsletter
On-Line Newsletter Volume 3, Number 3
Published May 19, 2005
Edited by Chaplain John Ehman, Network Convener
Network members are encouraged to submit articles for upcoming issues
of the Newsletter, which is published three times a year: Fall, Winter, and Spring.
The Fall 2005 issue is scheduled to be published in October.
Table of Contents
- Network Award Applications/Nominations Due
- Project by the Quality Commission for Pastoral Services
- The Effect of a Chaplain's Presence in the Operating Room
- Issues for Students to Keep in Mind when Reading Pastoral Care Research Studies
- "Ways of Knowing" Handout
- Web Finds
- Spirituality & Health Bibliography
1. Network Award Applications/Nominations Due
Applications and nominations for the 2005 Research Network Awards are due by July 31, 2005. Awards will be presented during the national ACPE conference in Hawaii (October 25th-29th). Awardees will be notified by September 21st.
CPE students completing research projects as part of their residency programs should be encouraged to apply for the Student Award by submitting to the Network Convener a copy of their project write-up with a cover letter addressing briefly the various items contained in the outline of the application criteria on the Awards page. Note that not all of the criteria need to be met but should be considered.
Any ACPE member may nominate another member or for an award. A letter detailing the basis for the nomination should be sent to the Convener. A nomination may be based on the work of a single research project or with regard to a person's cumulative contribution over the years.
2. Project by the Quality Commission for Pastoral Services
[The following notice was sent to the Network from Steven Spidell.]
The Quality Commission for Pastoral Services of the Association of Professional Chaplains is establishing a workgroup to accomplish the following project:
Develop a resource that includes methods to communicate more clearly what is done in the provision of professional spiritual care and that articulates our participation in the spiritual and physical well-being of our patients. The resource will also identify intentional ways by which the membership can continue to highlight and develop beyond clinical training their professional chaplaincy skills that relate to the healing process.
The current project strategy is to link particular chaplaincy practices to studies and resources that demonstrate how chaplaincy contributes to healthcare and to the healing of patients under our care. If you know of articles that demonstrate such effectiveness (from any field or discipline) please pass them on to the workgroup. Your participation in this project would be greatly appreciated. Please contact Steven Spidell at email@example.com.
3. The Effect of a Chaplain's Presence in the Operating Room
While searching the Internet for "Web Finds" for this issue of the Newsletter, I came upon a reference to a 2002 research project by Sr. Eileen S. Shaw, FSPA: "The Effect of a Chaplain's Presence in the Operating Room During Surgery." The research had grown out of the author's CPE experience at Genesis Medical Center (Davenport, IA), where The Rev. Randol G. Batson, Spiritual Care Department Manager, had established a protocol by which chaplains could be present in the Operating Room upon patients' requests. On four occasions during her CPE unit, Sr. Shaw was present for surgeries, and that led her subsequently to formulate the research project, to be carried out at the Genesis Medical Center, as part of a Master of Pastoral Studies program at St. Ambrose University. I located the author (also by an Internet search), and she sent a copy of her project, a partial summary of which I offer here because it shows the creativity of research that can come from our CPE students and because this reader found the participants' responses quite thought provoking.
This IRB-approved study used an original questionnaire to gather data from six patients who requested that a chaplain be part of the OR team. All patients reported using prayer as "part of...every day life" and "in preparation for surgery." None had "used a chaplain as part of the operating team before," but all said that they would "request a chaplain in the operating room again." In response to the question, "What were your reasons for requesting a chaplain?" the participants wrote:
The patients in this sample, therefore, gave strong indication of religiousness and were clearly interested in the resource of a chaplain's presence during their surgeries.
- "Because I believe in God."
- "Helped me through the operation."
- "Comforting to know someone was there praying."
- "I wouldn't be alone."
- "Helped to know a chaplain would be in the room praying for me."
- "Because I believe prayer is helpful."
When they were asked to respond on a 10-point Likert scale to questions about their current surgery and the extent to which they felt that "having a chaplain in the operating room was better than prayer alone," all six patients noted 10s with regard to feeling "more hopeful about the outcome," "supported," "more trusting in the surgical team," and "more trusting in God." However, as to whether they felt "more optimistic about...recovery" or "more calm/relaxed," the group broke from the pattern of 10s. Three of the six patients rated the item about feeling "more optimistic about...recovery" an 8, a 7, and a 5; and as to feeling "more calm/relaxed," no patient rated the item a 10, but instead there was one 8, two 7s, one 6, and two 5s. Even for such a small sample size, the shift in responses from 10s on these two items is intriguing. In these latter areas, there appears to have been some desire to qualify the 10-out-of-10 enthusiasm shown in the other four areas.
Participants were also asked to think of the same series of questions in relation to how they thought the chaplain's presence in the OR helped their family members feel, and the only items that scored 10s from everyone were those about feeling "more trusting in the surgical team," and "more trusting in God." Regarding the thought of family members feeling "more hopeful about the outcome," one patient noted a 9; and regarding family members feeling "more supported," two patients noted 8s. Three participants notched down to a rating of 9 the item about family members feeling "more optimistic about...recovery," and the lowest score overall was again given to the item about feeling "more calm/relaxed." (i.e., three 10s, one 9, one 7, and one 6 --though this still created a cumulative score on the item that was higher for family members than for the patients themselves).
While the small sample size here makes problematic any significant research conclusions, the study raised for this reader some interesting ideas. First, patients may want to distinguish between hope and optimism when asked about being affected by a chaplain. These are two closely associated concepts, and the distinction may be useful in future pastoral care research. [For a brief overview of the distinction between hope and optimism, see: Farran, C. J., Herth, K. A. and Popovich, J. M., Hope and Hopelessness: Critical Clinical Constructs (Sage Publications, 1995), esp. pp. 12-15.] Second, patients may recognize a more limited effect of a chaplain on their sense of calm (or, by implication, anxiety) than on feelings around such issues as support and trust. Perhaps patients are more critically-minded--or just less charitable--in their assessment of a chaplain's effectiveness when physiological indicators are involved, like stress reactions. Third, patients may be well able to articulate how their receipt of pastoral care could have separate and particular effects on their loved ones. In the present study, patients tended to see the effect of the chaplain's intervention to be less effective overall for family members than for themselves, except regarding feeling calm/relaxed: patients thought that their receipt of the pastoral "presence" intervention helped their families feel more calm/relaxed than it did the patients themselves (maybe because the physiologically connected indicator of "feeling calm" is this time abstracted from the personal experience of the patient). Finally, this small study points up the need to capture the effect of chaplains' very presence in a health care institution--a value of chaplaincy that is apparent to many but largely undocumented by research. At one point, Sr. Shaw recounts how a surgeon commented to family members after an operation, "When I needed strength, I just looked into [the chaplain's] eyes." Can the power of such anecdotes also find expression through research?
Sr. Shaw's study raises some valuable questions for pastoral care researchers and shows why we in the ACPE should be sharing and discussing student projects. For these reasons alone, the project is worth notice, but it also illustrates a bit of the depth of the experience of a CPE student who was stirred to explore further by research something she discovered to be personally profound about her work as a chaplain. My comments on her project do not give a full sense of Sr. Shaw's work, so for more information about the study, the author may be contacted directly at firstname.lastname@example.org.
4. Issues for Students to Keep in Mind when Reading Pastoral Care Research Studies
Students new to reading pastoral care research articles can approach them quite passively. Supervisors may find it initially helpful to challenge students to keep in mind the following handful of general and basic points as a way of encouraging a more critical engagement with reports of studies.
a) RELIGIOUS LANGUAGE / CONCEPTUAL TERMS USED IN A STUDY MAY BE PROBLEMATIC. - Words and phrases (e.g., "spirit," "prayer," "peace of God," "afterlife") can be complex and ambiguous, especially where religious terms may be predicated upon elaborate theologies from particular traditions. Even if there are formal meanings of religious language within a religious tradition, those meanings might not be accepted by all members of that tradition, much less by people outside of that tradition. Indeed, the field of pastoral care research is still working with basic questions about what language to use, especially in the development of questionnaires.
b) INVESTIGATIVE METHODS CAN DISTORT AS WELL AS ELUCIDATE. - Just as a scientific methodology can be developed to check against human tendencies for misperception, so too can any method itself be a party to a distortion of "reality." For example, a method's categories for organizing information may pigeonhole data in artificial and inappropriate ways. Science strives against such distortions by scrutinizing the validity and reliability of particular methodologies and assessment instruments.
c) A STUDY'S UNDERLYING ASSUMPTIONS MAY HAVE THEOLOGICAL IMPLICATIONS OR FOUNDATIONS. - Pastoral care research is often connected closely to theological positions/assumptions which may envelope a study's conclusions in religious debate. Recent studies of the efficacy of intercessory prayer are good examples. As a result, authors may write with a certain polemical tone, readers may react emotionally as well as intellectually, and theology may figure into discussion and criticism. If a study happens to work within a particular religious conceptual frame, this should be made clear, as it will likely qualify any results; it may also be important for the applicability of the study to pastoral practice.
d) WHAT IS THE GENERALIZABILITY OF RESULTS (FROM ONE PERIOD OF TIME AND CONTEXT)? - How conclusive can be any one study? How generalizable can be any set of findings? Most studies present a single "snapshot" of a group of people at a particular period of time and in a particular situation (e.g., patients in 1985 in a large urban teaching hospital being visited by a chaplain). Good research recognizes its limits and resists grand claims. However, a great value of research rests in what the data seem to suggest, which may then be the subject of further and more focused investigation. Note the difference between a study's reported findings and its "discussion" of those findings--usually separate sections of the write-up.
e) WHAT IS THE PRECISE WORDING OF A STUDY'S HYPOTHESES AND CLAIMS? - When reading research, it is vital to pay attention to the precise wording being used for hypotheses and claims. Language may be used in a very narrow or technical sense, and any confusion here may lead to broad misconceptions of a study's intent and value. The reader, and not merely the researcher, must guard against jumping to conclusions.
5. "Ways of Knowing" Handout
After the Network's workshop at the 2004 ACPE Conference in Portland, ME, some members suggested that the web site make available one of the handouts at that event: a table of "Ways of Knowing" that was designed to accompany a lesson plan introducing CPE students to pastoral care research by discussing epistemological issues. (The lesson plan is presented in the Fall 2003 Newsletter.)
This "Ways of Knowing" handout, is now available on line as an HTML file or a PDF file.
6. Web Finds
Two readers have recently commented on the helpfulness of the Research & Education section of www.plainviews.org. PlainViews is a publication of The HealthCare Chaplaincy (New York) and may be subscribed to as an e-newsletter. Its hallmark is a straightforward and often personal style in presenting news and information of interest to chaplains. The Research & Education section contains an index of back issue topics. Readers may also want to check the section on Conferences, Workshops, and Educational Opportunities for research-related events.
The John Templeton Foundation, which over the past decade has led the drive to incorporate spirituality into medical education (as one of its many initiatives), presents on its web site, www.templeton.org, a good deal of research-related resource information. See especially the Spirituality & Health section and the (more elaborate) Science & Religion section for notes of Templeton programs, conferences, and a variety of helpful links to other sites.
7. Spirituality & Health Bibliography
Every year I compile a select--but still quite extensive--bibliography of Medline-indexed articles pertaining to Spirituality and Health. Only a portion of the articles are reports of research, but all of the articles are research-minded, as a function of the research-based culture of health care. Members wishing to receive by return e-mail a copy of the bibliography of articles published this past year should contact email@example.com. --JE [Added 9/30/05: This bibliography is now available online. See the Fall 2005 Newsletter, §1.]