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May 2018 Article of the Month
 
This month's article selection is highlighted by John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.

 

Murphy, J. N. "The chaplain as the mediator between the patient and the interdisciplinary team in ethical decision making: a chaplaincy case study involving a quadriplegic patient." Health and Social Care Chaplaincy 5, no. 2 (2017): 241-256.

 

SUMMARY and COMMENT: This month's article comes from a special issue of Health and Social Care Chaplaincy [--see Related Items of Interest, §I, below] on Chaplain Case Study Research. Case studies may be a common element of Clinical Pastoral Education, related to verbatim work, but published examples from experienced chaplains who can bring professional discipline to the venture remain relatively scarce. The one at hand is by Chaplain Jeffery N. Murphy, who is at the University of Mississippi Medical Center (Jackson, MS), was the founding president of the Mississippi Chaplains Association, and has been on the Board of the Association for Professional Chaplains, with 27 years of clinical practice. While chaplaincy research has increasingly emphasized quantitative methodology, case studies continue to offer enormously rich material as a ground for subsequent investigation, a resource for education, and a window of insight for other professions to see in-depth what chaplains do.

The case that Murphy presents is that of a patient with a spinal chord injury whom he visited many times over multiple hospitalizations. "Wayne" first came to the hospital in 2015, following a motor vehicle accident, probably from his having fallen asleep at the wheel after a shift at a factory, leaving him quadriplegic. He was 25 years old, single, with parents who were supportive but unable to see him daily because of job commitments and financial limits. He is said to have Baptist church connections but "had never been particularly religious or devout" [p. 242]. He had a history of bipolar disorder. [Since it is the nature of a case study to be replete with details, only certain aspects of the case can be summarized for this article review.]

Murphy was called in on the case by a nurse while the patient was unconscious in the Surgical Intensive Care Unit, according to a hospital protocol "to make a chaplaincy referral for all complete spinal cord injury patients" [p. 343]. So, his initial work was with Wayne's parents, who seemed to have been hoping for a miracle, even though they "realized that 'the miracle' would likely not happen" [p. 344].

During his initial admission Wayne was on my "daily visit" list. His family requested that I offer prayer with Wayne each day. I would also visit with the family members present each day and help them express their concerns, fears and hopes regarding Wayne and his progress and future. Often family was at Wayneís bedside when I visited. [p. 244]
Wayne began to regain consciousness after two weeks, and Murphy notes, "At this time my care shifted from primarily being with Wayne's family to being with Wayne himself" [p. 244]. However, the need for a ventilator created an impediment to communication, and the challenges this created for pastoral work are described [--see p. 245]. When the patient was shortly transferred to an outside specialty care facility, Murphy said "goodbyes" [p. 245] to the patient and his family.

The core aspect of this case study, though, is Murphy's involvement in the patient's return to the hospital over the next year: five times to the Emergency Department and another six times to inpatient units, with each readmission lasting about two weeks. Wayne was able to speak during most of these occasions and shared with Murphy, sometimes tearfully, his anxiety, his struggle to find meaning in his situation, his feelings about death, his questions about "why God didn't allow him to die at the accident scene and why God didn't 'take' him now since he was ready for death" [p. 246], his sense of pain and deprivation, and his frustrations with social interactions and with the discontinuity of his caregiving teams over his multiple hospitalizations. Murphy writes:

My approach was to allow Wayne a "safe place" to express these feelings and his questions. Although I could not provide answers to Wayne's questions, it was my hope that by hearing them I could provide some assurance that God had not abandoned him in his pain, confusion and despair. [p. 246]
However, as Wayne's despair seemed to grow with each hospital visit, Murphy also began to wrestle with how to be helpful to him. But, "[s]ince most of Wayne's caregivers would change from admission to admission, I felt that I must continue my visits whenever he was admitted to the hospital or came to the emergency Department...[because]...I seemed to be the one consistent support person for Wayne at UMMC" [p. 248].

Murphy's consistency as a member of the otherwise largely changing interdisciplinary care teams led to his key involvement in an ethically fraught medical decision-making process, when Wayne considered refusing a new tracheostomy that would once again deprive him of speech. The circumstances led to him to feelings of distrust toward his physicians, refusal to work with his therapists, and combativeness with his nurses. The ethics committee was consulted, but the Nurse Manager specifically asked for Murphy's involvement. The account summarizes Murphy's work to attend to the patient's needs and to facilitate decision-making with him and between him and the care team [--see pp. 249-250], resulting in the patient's eventual agreement to the tracheostomy. The description of the case ends several months later, when Wayne regained the capacity to speak (after the tracheostomy valve could be capped) and with a picture of the patient as more hopeful and upbeat than before. Also, Murphy states, "Wayne seemed to find it meaningful that I was writing a case study about him and mentioned several experiences that he wanted shared and that I have included in this writing" [p. 251].

The study concludes with an assessment of the case, including thoughts on spiritual and emotional issues (i.e., isolation, depression, spiritual despair, and pain), interventions (i.e., encouragement to express feelings and acceptance of feelings and facilitation of discussion, help in the search for meaning, prayer, and consistent relationship and trust building), and outcomes (i.e., assurance of Godís presence, trust, diminished isolation, and resolution of an ethical dilemma, along with an outcome of failure to resolve spiritual distress) [--see pp. 252-254]. Murphy relates that "[t]his case was one of the most frustrating for me in my 27 years of professional chaplaincy ministry," but that "[o]n hindsight...my support of Wayne seemed to be more beneficial than I realized" [p. 254]. He especially observes that "[i]t was noted by the hospital ethics committee and the interdisciplinary team that persistent visits by a single chaplain over time and through multiple admissions became exceedingly valuable" [p. 255].

...[T]his case demonstrated that there is value, when possible, to have the same chaplain visit a patient on each of his or her admissions. As in the case of Wayne, a consistent chaplaincy relationship provided a single confidant to be trusted when relationship with the rest of the team was strained. The chaplain, as clergy, becomes a logical person for many patients to explore difficult ethical decisions since many people, to some degree, draw their ethics from their religion or spirituality. This is especially true where a trusting and non-judgmental relationship has already been established with a chaplain. That, again, comes from the most basic of chaplaincy skills -- being "present with" the patient and facilitating honest discussion. In Wayne's case this ongoing, continued relationship proved instrumental in ethical discussion and decision making between the patient and the interdisciplinary team. [p. 255]

This case study suggests a need for further research into the potential value of maximizing single-chaplain consistency for at least some patients. It also demonstrates how a chaplain's work is guided by careful assessment and intervention in faithfulness to a patient in great need, even amid frustrations and tensions. This reader was especially impressed by the author's personal disclosure of struggle in providing care, as when the patient's despair grew and Murphy began to "question if my visits with Wayne were helpful to him" [p. 248]. Murphy is not only analytical regarding the patient but regarding himself, being quite honest and transparent about his own part in the patient-chaplain relationship. Good case studies should leave the reader with more than some "result" or "conclusion" but rather with a wellspring of critically reflective insight to draw from in many ways. The article should help chaplains think about their place on the interdisciplinary team, about the dynamics of triaging patients for pastoral visitation, about pressing through challenging times over longitudinal care, about involvement in healthcare decision-making, and about both realizing cumulative helpfulness and confronting practical limits in the course of pastoral work.

The article's bibliography is very brief.


 

Suggestions for Use of the Article for Student Discussion: 

The article could be used with any level of students at almost any time during a CPE unit. Discussion could begin simply by asking group members to identify themes or points that stood out to them and how this case study differs from the sorts of case presentations they have known among student peers. Can they relate to Chaplain Murphy's work? What do they think of his approach to the pastoral care of this patient, and his intervention in the decision-making process about the second tracheostomy [--see esp. pp. 249-250]? Do they agree with his enumeration of issues, interventions, and outcomes [--see pp. 251-254]? Do they perceive in Chaplain Murphy a model for claiming a place on the interdisciplinary care team? Do the students receive automatic staff referrals for certain events and circumstances at their institution? Does this sound like a practical idea? How do they feel about Chaplain Murphy's admission of frustration and doubt at times in his patient care [--see esp. p. 248], even though he had been practicing for 27 years? If it has not come up in the group, there might be particular consideration the chaplain's intentional turning from focus on the family while the patient was unconscious to focus on the patient when he regained consciousness. Other key areas of the narrative to explore could be the chaplain's response to the patient's feelings about engaging the "outside world," and the challenge of communication (including touch) in this case. Also, the group might react to how the article ends: on a relatively encouraging note but with the story of the patient not drawing to a complete close, as the chaplain's work with the patient presumably continued beyond the writing of the article. If the students were in Chaplain Murphy's place at the point where the article ends, how might they envision their preparation for the patient's next hospitalization? Finally, does this case study lead members of the group to think about possible areas for research?


 

Related Items of Interest:

I.  Other case study articles in the special issue [vol. 5, no. 2 (2017)] of Health and Social Care Chaplaincy on Chaplain Case Study Research (by Table of Contents order):

Fitchett, G. and Steve Nolan, S. "Chaplaincy case study." Health and Social Care Chaplaincy 5, no. 2 (2017): 167-173. [Editorial/introduction to the special issue by the guest editors.]

Schmohl, C. "'You've done very well' ('Das haben Sie sehr schön gemacht'): on courage and presence of mind in spiritual issues." Health and Social Care Chaplaincy 5, no. 2 (2017): 174-193. [(Abstract:) Although it is not unusual to be called ad hoc onto a ward where one is not on regular duty, there are special challenges for the pastoral caregiver. For example, one might not be familiar with the staff or with the medical focus of the unit. This study (on multiple visits over the course of a long day) demonstrates vividly that the reason a chaplain is called may not always match the real need of the patient and/or of the persons who are close to that patient. Questions that seem to have nothing to do with pastoral care may have a spiritual core or may imply suffering from feelings of futility, of spiritual pain and unresolved religious issues that often remain largely ignored in practice, despite the "total pain" concept in palliative care. The courage to address spiritual issues explicitly, for example, by offering a ritual in pastoral care, can be crucial in making positive changes possible.]

Bassett, L. "Space, time and shared humanity: a case study demonstrating a chaplain's role in end-of-life care." Health and Social Care Chaplaincy 5, no. 2 (2017): 194-208. [(Abstract:) Care is often perceived as "doing something"; spiritual care also involves "being with" another person. This case, set in a hospice inpatient unit, highlights a relationship between being and doing, and the role of chaplains within multi-disciplinary teams, in palliative care. During ward round, a patient learned that he was dying. He appeared overwhelmed; he had a young family and much to organize. Following an informal assessment, the chaplain's aim was to offer him time and the opportunity to talk. For both, this became a space of uncertainty and vulnerability. It represented a pivotal point in his care as he regained control. After this encounter, other members of the multidisciplinary team assisted him to do what he needed. He died peacefully. The case demonstrates the value of spiritual care in relationship with the support of physical, psychological and social needs of people at the end of life, and their families.]

Murphy, K. "'I'm being swallowed up by this illness, so much pain deep inside': Claire, a 40 year-old woman with cancer." Health and Social Care Chaplaincy 5, no. 2 (2017): 209-223. [(Abstract:) This case study describes a chaplain's relatively short intervention with a young female patient. Several themes of learning emerged from the encounters. The chaplain worked closely with a member of the multi-disciplinary team throughout her meetings with the patient, which developed a new way of working with the wider team. The study also explores the deeper themes of how the chaplain and other team members survive working with death constantly, as well as giving significant insight into how relevant spiritual care is to the patientís wellbeing as she approached death.]

Glenister, D. "'I want to make it right': a 46 year-old woman with end stage renal disease and her Australian Aboriginal partner make significant choices." Health and Social Care Chaplaincy 5, no. 2 (2017): 224-240. [(Abstract:) Our case study subject, "Ruby," is a 46 year-old female suffering from a chronic renal condition, admitted to Royal Melbourne Hospital. As she, along with partner Charlie and daughter Amanda, received care from several members of Pastoral and Spiritual Care Services, as well as the Aboriginal Liaison Officer, we have decided to present a co-written case study, with each participant writing their own view in their own voice. Ruby's care included all the interventions recognized by Spiritual Health Victoria: spiritual assessment, spiritual support, spiritual counselling or guidance and spiritual ritual. This latter intervention became very significant as Ruby declined, receiving palliative care, and included both religious ritual and legacy creation. On paper -- or the hospital electronic database -- Ruby's admission looks like failure, but as this case study reveals, within her physical decline and treatment, there was significant emotional and spiritual healing, leading to a relatively "good death."]

Walton, M. and Körver, J. "Dutch Case Studies Project in chaplaincy care: a description and theoretical explanation of the format and procedures." Health and Social Care Chaplaincy 5, no. 2 (2017): 257-280. [(Abstract:) The recent surge of case studies in chaplaincy care raises challenges on the comparability of case studies and the degree to which they elucidate the relation between theory and practice. The Dutch Case Studies Project (CSP) addresses these and other issues by use of a set format and procedure and by evaluation in research communities of chaplains and academic researchers. We first place CSP in the context of Dutch chaplaincy and its recent history. The question of selection of a case for a case study then leads to a discussion of a number of methodological issues. That moves into an explanation of the following steps in the procedure: description, evaluation and finalization. Issues for further discussion and a conclusion complete the article.]

Van Loenen, G., Körver, J., Walton, M. and De Vries, R. "Case study of 'moral injury': format Dutch Case Studies Project." Health and Social Care Chaplaincy 5, no. 2 (2017): 281-296. [(Abstract:) The case study "Moral Injury" traces care provided by a chaplain in a mental health institution to a former military marksman named "Hans." Hans was in care at a specialized unit for military veterans with traumas. He sought contact with a chaplain "to set things right with God" and wanted the chaplain to perform a ritual to that end. The case study traces the care provided in conversations, in the reading of Psalms and in the construction and performance of a ritual.]

 

II.  The two guest editors of the issue of the Health and Social Care Chaplaincy, from which our Article-of-the-Month is taken, have also published a book:

Fitchett, G. and Nolan, S. "Spiritual Care in Practice: Case Studies in Healthcare Chaplaincy." London/Philadelphia: Jessica Kingsley Publishers, 2015. [(Description:) These diverse case studies make a compelling case for the importance of effective spiritual care in healthcare and provide unprecedented insight into the essential role of the chaplain within the healthcare team. Presented alongside critical reflections and responses from professionals within chaplaincy, psychology, psychiatry and nursing, they provide an honest and detailed look into how healthcare chaplains actually work with the people in their care and reveal the vital role of narrative and imagination in effective transformative practice. From a 16-year-old with a belief that God would enable a miraculous recovery from paralysis, to an African man with a history of psychosis and depression whose cultural belief in witches complicated his treatment, to a dying Jewish man, aggressive and isolated due to his traumatic life experiences, each case includes insight into the patientís needs and chaplainís perspectives, discussion of spiritual assessments and spiritual care interventions, and accounts of significant encounters and dialogues. The nine paediatric, psychiatric and palliative case studies and reflections in this ground-breaking book will enable chaplains to critically reflect on the spiritual care they provide and communicate their work more effectively, help healthcare professionals develop a clearer understanding of the care chaplains deliver, and provide an informed perspective for those who develop policy around spiritual care and need to make the case for chaplaincy services.]

Table of Contents of Fitchett & Nolan's 2015 Spiritual Care in Practice: Case Studies in Healthcare Chaplaincy:

  • Foreword, by Christina M. Puchalski (p. 9)
  • Introduction, by George Fitchett (p. 11)
  • Part 1: Pediatric Case Studies, by Steve Nolan (p. 25)
  • Chapter 1: "'God Tells the Doctors to Pick the Right Medicine' - LeeAnn, a 12-Year-Old Girl with Cystic Fibrosis," by Daniel H. Grossoehme (p. 31)
  • Chapter 2: "'I Can Tell You This, But Not Everyone Understands' - Erica, Mother of a 2-Year-Old Girl with Cancer," by Alice A. Hildebrand (p. 51)
  • Chapter 3: "'Why Did God Do This To Me?' - Angela, a 17-Year-Old Girl with Spinal Injury," by Katherine M. Piderman (p. 69)
  • Chapter 4: "Critical Response to Pediatric Case Studies: a Chaplain's Perspective," by Alister W. Bull (p. 90)
  • Chapter 5: "Critical Response to Pediatric Case Studies: a Psychologist's Perspective," by Sian Cotton (p. 98)
  • Part 2: Psychiatric Case Studies, by Steve Nolan (p. 107)
  • Chapter 6: "'I Am Frightened To Close My Eyes At Night In Case The Witch Comes To Me In My Sleep' - Yesuto, a Nigerian Man in His Early Thirties Troubled by His Belief in Witchcraft," by Rosie Ratcliffe (p. 113)
  • Chapter 7: "'I Tried To Kill Myself. Will God Keep Me Apart From The Person I Love In The Life-After?' - June, a 78-Year-Old Woman Who Attempted Suicide," by Christopher Swift (p. 133)
  • Chapter 8: "'My Family Wants Me To See A Priest. It Can't Hurt, Right?' - Nate, a 20-Year-Old Man and His Sexual Identity," by Angelika A. Zollfrank (p. 154)
  • Chapter 9: "Critical Response to Psychiatric Case Studies: a Chaplain/Psychologist's Perspective," by Graeme D. Gibbons (p. 177)
  • Chapter 10: "Critical Response to Psychiatric Case Studies: a Psychiatrist's Perspective," by Warren Kinghorn (p. 186)
  • Part 3: Palliative Case Studies, by Steve Nolan (p. 195)
  • Chapter 11: "'I Need To Do The Right Thing For Him' - Andrew, a Canadian Veteran at the End of His Life, and His Daughter Lee," by Jim Huth and Wes Roberts (p. 201)
  • Chapter 12: "'What Can You Do For Me?' - David, a Mid-Sixties Jewish Man with Stage IV Pancreatic Cancer," by Nina Redl (p. 223)
  • Chapter 13: "'Tell Her That It's OK To Release Her Spirit' - Maria, a Native American Woman, Grieving the Loss of Her Dying Mother," by Richard C. Weyls (p. 242)
  • Chapter 14: "Critical Response to Palliative Case Studies: a Chaplain's Perspective," by David Mitchell (p. 263)
  • Chapter 15: "Critical Response to Palliative Case Studies: a Nurse's Perspective," by Barbara Pesut (p. 272)
  • Part 4: Ethical Concerns
  • Chapter 16: "Ethical Issues in Case Study Publication," by David B. McCurdy (p. 282)
  • Afterword, by John Swinton (p. 299)

 

III.  The Journal of Health Care Chaplaincy has published a handful of issues featuring case studies and related commentaries. The listing below is in descending chronological order, by issue. Note especially, however, the 2011 article by George Fitchett, "Making our case(s)," which sets out a critical guide for case studies in general. Additional single case study articles from the Journal of Health Care Chaplaincy are listed in Related Items of Interest, §V, below.

VOLUME 22, NUMBER 1 (2016)

Nolan, S. "'He needs to talk!': a chaplain's case Study of nonreligious spiritual care." Journal of Health Care Chaplaincy 22, no. 1 s2016): 1-16. [(Abstract:) Chaplains have always worked with nonreligious people, but it is not always clear what is distinctive about their contribution. This case describes an episode of nonreligious spiritual care in order to explore the value of chaplaincy work with people who regard themselves as nonreligious. This case reports on work with a dying man and his family-wife, daughter, sister, and son-in-law-whose religion is secularized, but whose secularism is touched by the sacred.]

Hess, D. "Myths and systems: a response to "'He Needs to Talk!': A Chaplain's Case Study of Nonreligious Spiritual Care"." Journal of Health Care Chaplaincy 22, no. 1 (2016): 17-27. [(Abstract:) In response to Chaplain Steve Nolan's case study, "He Needs to Talk: A Chaplain's Case Study of Nonreligious Spiritual Care," this article presents two areas for further examination: the concept of the idealized "good death" and Bowen family systems theory as a model of psychospiritual care for the family system. Chaplains are challenged to critically engage the predominant and often romanticized views of the ideal death in order to support patients and their loved ones through difficult deaths such as the one depicted in this case study. Utilizing Bowen's concept of triangles and the family genogram intervention, chaplains are encouraged to provide care encompassing their full scope of practice as psychospiritual caregivers for the entire family system.]

Pesut, B. "Recovering religious voice and imagination: a response to Nolan's case study, 'He needs to talk!'" Journal of Health Care Chaplaincy 22, no. 1 (2016): 28-39. [(Abstract:) In Nolan's case study, "'He Needs to Talk!'": a Chaplain's Response to Nonreligious Spiritual Care," he asks an important question: "What is distinctive about the chaplain's role in working with nonreligious people?" This is a compelling question for chaplains working in a society where individuals are increasingly defining themselves as NOT religious. In this response, I will analyze how our current religious context, in which we feel over-responsible for an existential quest without a language to express our dilemma, creates a unique role for chaplaincy with the nonreligious. I will apply this context to Nolan's case study providing examples of how the care provided can support nonreligious individuals to find language to express their religious dilemmas and to foster a moral imagination that counters over-responsibility. Finally, I will suggest that case studies provide thick qualitative descriptions of care that help to reveal what chaplains do while countering stereotypical and thin accounts of religion.]

VOLUME 19, NUMBER 3 (2013)

Risk, J. L. "Building a new life: a chaplain's theory based case study of chronic illness." Journal of Health Care Chaplaincy 19, no. 3 (2013): 81-98. [(Abstract:) This article presents the case study of spiritual care for a patient suffering from Parkinson's disease who was referred to the chaplain in an out-patient depression research program. The chaplain's interventions were informed by an application of narrative theory, and the article demonstrates how this theory enabled the chaplain to help a patient develop new coping strategies for dealing with chronic disease. Using narrative theory, the chaplain assisted the patient to develop a new sense of identity as a spiritual, contingent self as the disease eroded his physical self and former life. The article includes a description of a patient's spiritual needs, chaplain interventions, and an outcomes measure of those interventions. The author argues that narrative theory provides chaplains with a language to identify and craft the unique intervention that spiritual care has in the life trajectory of this Parkinson's patient and other patients dealing with chronic illnesses.]

Grossoehme, D. H. "Chaplaincy and narrative theory: a response to Risk's case study." Journal of Health Care Chaplaincy 19, no. 3 (2013): 99-111. [(Abstract:) The response of a clinical chaplain to a case study of chaplaincy with an elderly African-American male with Parkinson's disease is presented. The case study offers two novel aspects: first, it explicitly describes interventions by the chaplain, and second, the chaplain's clinical approach was guided throughout by an underlying theory (narrative theory). The case study seeks to shift the paradigm from chaplains as "agenda-less" companions to clinicians with a repertoire of interventions which they should claim. The chaplain's use of narrative theory is examined. Future case studies may draw on narrative theory in chaplaincy with older males with different chronic disease, with women who have Parkinson's, and may seek to develop a theory of chaplaincy from within the profession.]

Giblin, P. "Building a new life: a pastoral counselor's response."Journal of Health Care Chaplaincy 19, no. 3 (2013): 112-119. [(Abstract:) This article is a pastoral counselor's response to a lengthy and unique, theory-driven, chaplain-Parkinson's patient relationship. The author reviews elements of clinical theory, in general, and Narrative Theory, in particular. The chaplain's use of Narrative is affirmed and strengths and limitations of this choice are noted. The benefits of a shared relationship between chaplaincy and pastoral counseling are explored.]

Emery, E. E. "Who am I with Parkinson's disease? A psychologist response to chaplain intervention in the context of identity theory." Journal of Health Care Chaplaincy 19, no. 3 (2013): 120-129. [(Abstract:) Parkinson's disease can rob an individual of their most prized roles, and symptoms of the disease itself can make finding new ways to enact existing roles or developing new roles very challenging. The chaplain's case study is reviewed from the perspective of a clinical geropsychologist through the lens of identity theory. The line between chaplain intervention and psychotherapy is addressed. The patient's significant improvement in depression symptoms over the course of his participation in the BRIGHTEN program and with the chaplain are presented to suggest that chaplain intervention can be a central and effective part of an interdisciplinary treatment approach. The need for utilization of existing measures and development of new measures of chaplain intervention are discussed.]

VOLUME 18, NUMBERS 1-2 (2012)

King, S. D. "Facing fears and counting blessings: a case study of a chaplain's faithful companioning a cancer patient." Journal of Health Care Chaplaincy 18, nos. 1-2 (2012): 3-22. [(Abstract:) This article offers a case study of a long-term chaplaincy care relationship between a woman with recurrent leukemia and an experienced oncology chaplain at a comprehensive cancer center. The case includes an extensive description of the encounters between the patient and the chaplain; a spiritual/religious assessment that includes a spiritual/religious profile and a portrait of the needs, interventions, and outcomes within the case; and a discussion of some key issues in the case, including what aspects regarding the overall care was healing. Although a number of issues were addressed, the author argues that the essence of the care and healing occurred through the faithful companioning of the chaplain. The author articulates an understanding of faithful companioning.]

Schlauch, C. R. "A pastoral theologian's response to the case study." Journal of Health Care Chaplaincy 18, nos. 1-2 (2012): 23-32. [(Abstract:) This response to a case study of a long-term chaplaincy care relationship between a woman with recurrent leukemia and an experienced oncology chaplain at a comprehensive cancer center expresses a clinical attitude formed within three contexts-pastoral psychotherapy, the supervision of psychoanalytically-oriented psychotherapy, and pastoral theology-through which case studies are to be engaged, concurrently, in multiple ways. Illustrating this attitude, the response outlines four distinct "readings" (Ricoeur) of the case study that express different approaches: a personal engagement that a reader can feel; an empathic openness to the plausibility of the chaplain's account; a recognition of the complexity of the report and of the care as constituted of different disciplines and guilds; and an awareness of the difference and distance between a patient's experience and a caregiver's interpretation of a patient's experience.]

Maddox, R. T. "The chaplain as faithful companion: a response to King's case study." Journal of Health Care Chaplaincy 18, nos. 1-2 (2012): 33-42. [(Abstract:) This article is a response to a case study describing the spiritual care provided over an 18-month period by an experienced professional chaplain at a prominent cancer center to a woman undergoing stem cell transplantation following therapy for relapsed leukemia. The author, a professional chaplain at another cancer center, reviews the spiritual assessment, interventions, and outcomes presented by the attending chaplain. The author's comments are organized about the chaplain's characterization of the seven parts of the patient's spiritual profile: courage, meaning, psychological issues, courage and growth in facing spiritual/religious struggle, rituals, community, and authority. The purpose of the response is to engage those inside and outside the discipline of health care chaplaincy in a conversation about the specific aspects of providing spiritual care in health care settings.]

VOLUME 17, NUMBERS 1-2 (2011)

Flannelly, K. J. "Case studies in chaplaincy research and practice." Journal of Health Care Chaplaincy 17, nos. 1-2 (2011): 1-2. [Editorial by the Editor-in-Chief, introducing the special issue, consisting of George Fitchett's guide to case studies, the case study of a woman with cancer, and three subsequent articles regarding that case.]

Fitchett, G. "Making our case(s)." Journal of Health Care Chaplaincy 17, nos. 1-2 (2011): 3-18. [(Abstract:) Health care chaplaincy needs to develop a body of published case studies. Chaplains need these case studies to provide a foundation for further research about the efficacy of chaplainsí spiritual care. Case studies can also play an important role in training new chaplains and in continuing education for experienced chaplains, not to mention educating health care colleagues and the public about the work of health care chaplains. Guidelines for writing case studies are described, herein, as is a project in which three experienced oncology chaplains worked together to write case studies about their work. Steps that chaplains, and professional chaplain organizations, can take to further the writing and publishing of case studies are described.]

Cooper, R. S. "Case study of a chaplain's spiritual care for a patient with advanced metastatic breast cancer." Journal of Health Care Chaplaincy 17, nos. 1-2 (2011): 19-37. [(Abstract:) The case study seeks to describe an oncology chaplain's pastoral relationship with a 64-year-old woman with advanced metastatic breast cancer. The patient's distress was complicated by a history of anxiety and other chronic medical conditions. Approximately 16 pastoral encounters occurred during the last year of the patient's life. The patient, chaplain, and the pastoral conversations are presented as well as a retrospective assessment of them. The chaplain's interventions were appropriate for the patient's spiritual needs, particularly in regard to her fear of death, loneliness, grief that her life was "too short" and estrangement from her inherited faith tradition, with observable benefits for the patient. The oncology chaplain has a distinctive role in the healthcare team as one who can meet the patient at the point of their spiritual need, provide appropriate interventions and, thereby, ameliorate the distress, particularly in regard to death anxiety, peace of mind, and issues of meaning.]

King, S. D. "Touched by an angel: a chaplain's response to the case study's key interventions, styles, and themes/outcomes." Journal of Health Care Chaplaincy 17, nos. 1-2 (2011): 38-45. [(Abstract:) This article is a response by a long-term oncology chaplain to a case by another oncology chaplain. The author notes interventions key to the relationship and outcomes, highlights differences in chaplaincy styles, and summarizes significant outcomes that are common in oncology chaplaincy. The purpose of the response is to further demonstrate how chaplains think about and engage patients/families in chaplaincy care as well as to stimulate the reflective process of the readers of the case study.]

Canada, A. L. "A psychologist's response to the case study: application of theory and measurement." Journal of Health Care Chaplaincy 17, nos. 1-2 (2011): 46-54. [(Abstract:) This article represents a psychologist's perspective on the case study of Doris, a middle-aged woman with metastatic breast cancer who is initially referred to Chaplain Rhonda for assistance with death anxiety. In the field of psychology, it has long been accepted that good clinical research is informed by theory. As such, Chaplain Rhonda's intervention with Doris will be examined through the lens of object relations theory. Specifically, we will see how Rhonda's relationship and interaction with Doris improves her image of God and, by doing so, decreases her death anxiety. In psychological research, it is also important to accurately measure the effects or outcomes of clinical interventions. In this light, several suggestions are offered for the measurement of constructs relevant to the case of Doris, namely God image and death anxiety. Finally, a simple case study research design, applying the aforementioned theory and measurement, is provided as a suggested starting point for research on the efficacy of chaplaincy interventions.]

McCurdy, D. B. and Fitchett, G. "Ethical issues in case study publication: 'making our case(s)' ethically." Journal of Health Care Chaplaincy 17, nos. 1-2 (2011): 55-74. [(Abstract:) As chaplains develop richly detailed case studies for publication, ethical questions about case study construction and publication are emerging. Concerns about seeking patients' permission to publish material about them suggest additional questions and raise broad confidentiality and privacy issues. Confidentiality-related practices in health care and psychotherapy provide the most extensive guidance for chaplains, but healthcare chaplaincy has roots in religious and professional traditions with distinct notions of confidentiality that deserve consideration. Single case studies do not appear to be "research" requiring informed consent, yet their publication exposes patients to some risk of harm. Obtaining the patient's/"case study subject's" permission to publish, disguising non-essential information, and allowing the patient to review the case study can mitigate the risks. Striking a balance between protecting patients and providing sufficient detail to make case studies useful is a central ethical challenge of case study publication.]

VOLUME 10, NUMBER 2 (2001) [--NOTE: This issue differs from later ones in that it presents several case studies on a theme of "The Discipline."]

Berger, J. A. "A case study: Linda." Journal of Health Care Chaplaincy 10, nos. 2 (2001): 35-43. [(Abstract:) An oncology chaplain illustrates the Discipline for Pastoral Care Giving by recalling interactions with a breast cancer patient.]

Rodrigues Yim, R. J. "A case study of Jerry: emphasizing team communication through use of the Discipline." Journal of Health Care Chaplaincy 10, nos. 2 (2001): 45-56. [(Abstract:) After the chaplain is well acquainted with The Discipline and has begun to implement it in daily pastoral practice, half of the work is done. The further work concerns how and what to communicate to the care team regarding the chaplain's observations. This article begins by offering a pastoral reflection on the chaplain's identity and pastoral practice within a multi-disciplinary care team. The pastoral reflection highlights key theological assertions used by The Discipline. The author then identifies the particular problems facing care teams and their communication that the chaplain can anticipate when using The Discipline. Thirdly, the author suggests workable, theologically based tools for the resolution of these problems. Lastly, through the case study of "Jerry," the author illustrates both the "how" and "what" components of care team communication using the working elements of The Discipline. The "how" component describes the informal and formal relational processes that have contributed to a working partnership. The case study also illustrates the "what" part of care team communication--the structure and delivery of observable and discernible content to physicians and nurses. These materials can ease the transition towards effective pastoral presence on the interdisciplinary care team regarding patient and family/support partner care.]

Crane, J. R. "A case study using the Discipline with a clinical team." Journal of Health Care Chaplaincy 10, nos. 2 (2001): 57-68. [(Abstract:) Health care delivery in hospitals and clinics promotes an interdisciplinary team approach. This article presents the use of The Discipline though the involvements of the chaplain as part of the Infectious Disease team as together they addressed the inherent spirituality of one HIV/AIDS patient. This narrative recounts the unfolding events of the patient's life and describes the use of The Discipline during a very difficult time period for the patient and the staff. The experience can serve as a model for other health care teams who must manage difficult, deteriorating patients.]

 

IV.  Case study materials relating to Anton Boisen, whose work was seminal to the development of Clinical Pastoral Education, may be found through the website of the Interamerican University of Puerto Rico at www.metro.inter.edu/facultad/esthumanisticos/anton_boisen.asp.

 

V.  Other case studies, in one form or another, and articles incorporating case studies relating to chaplaincy, including some older articles that may be of interest:

Bauman, J. "The role of forgiveness in rehabilitation." Journal of Health Care Chaplaincy 14, no. 2 (2008): 75-82. [(Abstract:) This article proposes that unresolved forgiveness issues may affect rehabilitation patients' motivation to participate in their physical therapy, and that their therapeutic outcomes may benefit from working through a forgiveness process. I also suggest that chaplains have a role in helping patients address their unresolved forgiveness issues and lowered motivation by helping the patients work through a forgiveness process. For patients with conditions caused at least in part by their own behavior, or even by someone else, this article offers a case study of pastoral care provided in light of unresolved forgiveness issues and a working through of a forgiveness process. Also presented is a revised model of a forgiveness process that informs the pastoral care provided in the case study.]

Bay, P. and Ivy, S. S. "Chaplaincy research: a case study." Journal of Pastoral Care and Counseling 60, no. 4 (2006): 343-352. [(Abstract:) The authors report the pragmatic elements of conducting an empirical chaplaincy research project. The article offers the step-by-step process of implementing, coordinating, and completing a sound quantitative research project. The authors offer a definitive answer to the question, "Can a staff chaplain integrate providing pastoral care and doing a quantitative research project as principle investigator"?]

Berlinger, N. "Promoting patient safety: implications for pastoral care." Journal of Pastoral Care and Counseling 58, nos. 1-2 (Spring-Summer 2004): 55-61. [(Abstract:) This article provides an overview of current issues in patient safety, the subject of recently-implemented JCAHO standards, with attention to issues of special interest to pastoral care professionals and Clinical Pastoral Education (CPE) students. Case studies of patient safety initiatives in two health care systems are used to illustrate the relationship between institutional core values and the just treatment of injured patients and their families, and to suggest opportunities for chaplains to contribute to patient safety efforts in their institutions. A list of suggested readings and online resources is included.]

Castellani, B. C. "A journey in pastoral care: a case study." Journal of Religion and Health 24, no. 3 (September 1985): 239-245. [(Abstract:) What is pastoral care? Many health professionals are not clear about the role of the chaplain on the health care team. This article addresses the question by using an actual case study to demonstrate how the chaplain interacts with the patient and the value of this interaction to the well-being of the patient. It attempts to define, by example, pastoral care.]

Grossoehme, D. H. "Development of a spiritual screening tool for children and adolescents." Journal of Pastoral Care and Counseling 62, nos. 1-2 (Spring-Summer 2008): 71-85. [(Abstract:) A chaplain's ability to provide care where it is most needed depends upon some method of pastoral triage. Screening for spiritual needs of children and adolescents has been a largely neglected area. A Delphi panel developed elements to be included in a tool to screen 10-18 year olds' spiritual needs and resources. The Delphi panelists were informed of survey results of school-aged children and adolescents' opinions on spiritual issues important to them if they were hospitalized. A case study of the tool's use was conducted with a convenient sample of children and adolescents. Subsequent pilot use of the tool by five pediatric chaplains demonstrated the tool's utility in identifying patients' spiritual issues, ability to serve as a springboard to deeper discussion, and as a basis for initiating discussion of spiritual concerns with other disciplines on the healthcare team. Feedback indicates the potential clinical usefulness of this tool for hospitalized children and adolescents.]

Hahn, K., Radde, J. M. and Fellers, J. E. "Spiritual care: bridging the disciplines in congregational health ministries." Journal of Health Care Chaplaincy 11, no. 2 (2001): 49-60. [(Abstract:) These materials describe the professional, legal, relational, and theological roles of parish nurses, health care chaplains, and community clergy. It illustrates these roles by discussing two case studies of how these professionals can work together. It then provides examples of role violations for each profession and recommends some simple rules that will enable them to work together productively.]

Hover, M., Travis, J. L. 3rd, Koenig, H. G. and Bearon. L. B. "Pastoral research in a hospital setting: a case study." Journal of Pastoral Care 46, no. 3 (1991): 283-290. [(Abstract:) Provides a summary of research procedures and outcome data of a utilization review of the pastoral services of a large university medical center. Notes particularly the value of such a project both in terms of concrete knowledge gained and in terms of serendipitous discoveries leading to further research.] [Erratum appears in the Journal of Pastoral Care 46, no. 4 (Winter 1992): 339; correcting the author's name from Bearson to Bearon.]

Johnson, M. E. "A case study in pastoral counseling." Health Progress 67, no. 4 (May 1986): 38-40. [(Abstract:) When Michael Jones was admitted to the hospital with AIDS, he was quite alone. Always a private person, with few personal friends, he had isolated himself from those around him after his diagnosis. Although Michael had long felt alienated from religion, daily visits from a hospital chaplain proved enjoyable and helpful for him. Their conversations helped Michael to understand the difference between religion and spirituality. He acknowledged his relationship with God and began to realize the connection between relating to God and relating to others. He desired inner healing and the healing of some broken relationships. Through the pastoral visits, Michael not only was given comfort and assurance, but he was helped in his journey toward spiritual reconciliation.]

Kearney, G., Fischer, L. and Groninger, H. "Integrating spiritual care into palliative consultation: a case study in expanded practice." Journal of Religion & Health 56, no. 6 (December 2017): 2308-2316. [(Abstract:) Recognizing and addressing spiritual needs has long been identified as a key component of palliative care (PC). More often than not, the provision of spiritual care involves referral to a hospital chaplain. In this study, we aim to describe the role of a PC chaplain embedded within the interdisciplinary PC team and demonstrate how this palliative chaplain role differs from that of a traditional hospital chaplain. We postulate that integrating spiritual care provision into a PC team may offer a broader spiritual care experience for patients receiving PC and begin to delineate expanded clinical roles for the palliative chaplain.]

Overvold, J. "Case study. Chaplains and confidentiality. Commentary." Hastings Center Report 39, no. 1 (January-February 2009): 13. [This is a brief comment on a (hypothetical?) case involving a confidentiality issue. It is paired with a comment by Martin L. Smith (--see elsewhere in this Related Items of Interest listing).]

Rodriguez, J. "Chaplains' communications with Latino patients: case studies on non-verbal communication." Journal of Pastoral Care 53, no. 3 (1999): 309-317. [(Abstract:) Introduces non-Latino chaplains to aspects of non-verbal communications dynamics one may encounter with some Latino patients. Illustrates through vignettes issues of non-verbal communications. Compares and contrasts classical understandings of professional etiquette to Latino views. Provides specific "insights" into the communication styles among some Latinos. Includes a list of non-verbal messages and their generic interpretations.]

Russell, R. C. "Professional chaplains in comprehensive patient-centered care." Rhode Island Medicine 97, no. 3 (March 3, 2014): 39-42. [(Abstract:) There is growing recognition of the valuable role that professional chaplains provide in the medical setting. Yet, most physicians are unfamiliar with or misinformed about chaplains and how they can be effectively utilized in providing quality patient care. Many physicians also feel unskilled and unprepared to identify or discuss patients' spiritual or religious concerns that arise. Using case studies, this article provides an overview of the training and skills of professional chaplains in a medical setting. Chaplains can be effective partners in assessing and treating patients' needs. They also provide ethical and spiritual support to the medical team. In an increasingly culturally diverse patient population, chaplains can offer a proactive, ongoing response to the needs of diverse patients. When integrated into medical teams, chaplains can bring fresh perspectives to patient care and are a highly skilled professional resource for successfully managing patients' spiritual needs.]

Simmonds, A. L. "The chaplain's role in bioethical decision-making." Healthcare Management Forum 7, no. 4 (1994): 5-17. [(Abstract:) With advances in medical technology, difficult questions of "What should be done?" and "Who should decide?" are a daily occurrence in hospitals. This paper reports the results of a survey of Canadian chaplains with respect to their involvement in bioethical decision-making. The survey suggests that chaplains make a significant contribution to discussion and resolution of bioethical dilemmas. Using a case study, the paper elaborates on the chaplain's role in bioethical decision-making, and indicates how such participation can influence both cost containment and risk management.]

Smith, M. L. "Case study. Chaplains and confidentiality. Commentary." Hastings Center Report 39, no. 1 (January-February 2009): 12-13. [This is a brief comment on a (hypothetical?) case involving a confidentiality issue. It is paired with a comment by Jon Overvold (--see elsewhere in this Related Items of Interest listing).]

Watkins, L. "Should emergency nurses attempt to meet patients' spiritual needs?" Emergency Nurse 22, no. 6 (October 2014): 36-38. [(Abstract:) Research suggests there is a positive correlation between addressing some patients' spiritual needs and the outcomes of their care. This article describes a case study in which a patient with mental health problems who frequently re-attended an emergency department (ED) sought spiritual support from a hospital chaplain. The patient was referred to a charitable organisation that offers spiritual care and her re-attendance at the ED has become less frequent.]

Wentroble, D. P. "Pastoral care of problematic Alzheimer's disease and dementia affected residents in a long-term care setting." Journal of Health Care Chaplaincy 8, nos. 1-2 (1999): 59-76. [(Abstract:) Pastoral caregivers face many challenges in providing ministry to institutional persons with dementia. This article describes the psychosocial perspective of Bowlby concerning the management of persons with dementia and a pastoral care ministry based on it. Specific pastoral programs and interventions are described. The article contains four case studies and concludes with reflections concerning the chaplain's ministry.]

 

VI.  For a larger perspective on the case study as a research method, beyond chaplaincy, see the recent article:

Harrison, H., Birks, M., Franklin, R. and Mills, J. "Case study research: foundations and methodological orientations." Forum Qualitative Sozialforschung / Forum: Qualitative Social Research 18, no. 1 (January 2017): 19 [electronic journal article designation]. [(Abstract:) Over the last forty years, case study research has undergone substantial methodological development. This evolution has resulted in a pragmatic, flexible research approach, capable of providing comprehensive in-depth understanding of a diverse range of issues across a number of disciplines. Change and progress have stemmed from parallel influences of historical transformations in approaches to research and individual researcher's preferences, perspectives, and interpretations of this design. Researchers who have contributed to the development of case study research come from diverse disciplines with different philosophical perspectives, resulting in a variety of definitions and approaches. For the researcher new to using case study, such variety can create a confusing platform for its application. In this article, we explore the evolution of case study research, discuss methodological variations, and summarize key elements with the aim of providing guidance on the available options for researchers wanting to use case study in their work.] [Available freely online from the journal at www.qualitative-research.net/index.php/fqs/article/view/2655/4079.]

 

VII.  The Grossoehme Lab at Cincinnati Children's Hospital Medical Center is "currently conducting a meta-synthesis of the extent published case studies of chaplains' interventions and their outcomes. It is anticipated that this will lead to a conceptual model explaining chaplaincy's mechanism of action, and should generate testable hypotheses for future research." [--from the Grossoehme Lab website (accessed 5/15/18)].

 

VIII.  In 2015, ACPE Educator (retired) John J. Gleason published a four-volume set of thematically organized pastoral intervention accounts and brief critical reflections which he collected from hundreds of chaplains' verbatim submissions between 2006-2012. The Pastoral Caregiverís Casebook series [from Judson Press] explores Ministry in Relationships (vol. 1), Ministry in Crises (vol. 2), Ministry in Health (vol. 3), and Ministry in Specialized Settings (vol. 4), by focusing on chaplains' responses to specific patient issues. The project emerged from an effort to create a Knowledge Base of Spiritual Care Samples, in part through the ACPE Research Network.

 

IX.  [ADDED 8/14/18:] Though not a report of research, the following recent ethics article from the American Medical Association's Journal of Ethics should be of interest regarding chaplains and mediation:

Harris. S. "Chaplains' roles as mediators in critical clinical decisions." AMA Journal of Ethics 20, no. 7 (July 2018): E670-674. [(Abstract:) Chaplains provide spiritual care and support to patients, families, and hospital staff. What may be less familiar is that chaplains also help mediate decisions among patients, family members, and clinical teams. How clinicians, patients, and families formulate and articulate their goals and concerns can be informed either directly or indirectly by religious values. Finding common ground and common language can be helpful for both the medical team and the family. Physicians can use their clinical and social authority to try to ameliorate distress and offer recommendations based on patients' and families' goals and values; conversely, physicians' hesitancy to use their authority in these ways can generate moral distress among patients, families, and caregivers. However, when the medical team engages in conversation with a willingness to be informed by patients' religious worldview, more effective decision making may ensue.] [Available freely online from the journal.]

 

 


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