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It is not a static set of beliefs or practices; rather it changes and evolves over time. In this sense, spirituality can be thought of developmentally. Consciously or unconsciously, people are drawn to spirituality to discover something of sacred value in their lives, sustain a relationship with the sacred, and, at times, transform their relationship with what they hold sacred Pargament, Theoretical and empirical studies make clear that spirituality is a multi-dimensional construct, holding multiple consequences e.

Glock, ; Idler et al. While some choose to express their spirituality apart from organized religious settings, many people prefer to practice their spirituality within the context of an established religious tradition. Others seek out non-traditional social outlets for their spirituality, such as healing groups, meditation groups, yoga groups, step groups, and most recently online discussion groups. And many people disengage from religious institutions for a period of time only to seek out other like-minded individuals at a later point in time with whom they can share their spiritual interests.

In any case, spirituality always expresses itself in a larger social, cultural, and religious milieu. Both spirituality and religion are dynamic, multi-dimensional, multi-level, and multi-valent processes.

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And both are concerned about issues of tremendous value and significance. In terms of function, religion is directed toward a broader array of significant goals than spirituality. Religion serves the important function of facilitating spirituality itself indeed, it is the spiritual character of its mission that makes religious institutions so distinctive , but religion serves other functions as well, including those that are psychological, social, and physical. In contrast, spirituality focuses on one particular goal or destination, the sacred, however that might be defined by the individual.

With respect to context, religion is more circumscribed than spirituality. In contrast, as noted above, although spirituality can be a vital part of traditional religious life, it can also be embedded in non-traditional contexts. One of the places where the evidence for spiritual care as part of holistic care is fairly strong is in the area of spiritual and religious needs.

The research is consistent in documenting that patients in acute health care settings do have spiritual and religious needs, that religion and spirituality are often central to their coping, and that they generally want those needs attended to in the treatment process. Fitchett, Meyer and Burton documented how often people might need spiritual support.

They interviewed patients admitted to either a general or surgical medical unit in an urban hospital. Patients were asked what religion they were affiliated with, and if they desired one of three spiritual care services: to talk with a chaplain, to have a chaplain pray with them, or to receive the sacrament of communion. Sixty-eight percent of the patients claimed a religious affiliation and seventy-two percent reported that religion was a source of great strength and comfort to them.

Thirty-five percent of the sample requested one or more of the spiritual care services, and those who requested services tended to engage more frequently in religious practices and derive more comfort from religion overall. These findings suggest that while many people derive great comfort and support from religion they do not always ask for spiritual help in the hospital.

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The Christ Chaplain: The Way to a Deeper, More Effective Hospital Ministry

In addition to spiritual needs, people have religious needs. Fifty-eight percent of people with cancer engage in religious practices to help them cope with their illness Alcorn et al. However, little if any progress has been made on building and testing theories and models for the practice of chaplaincy.

This gap may have to do with the fact that most chaplains consider their practice largely a function of their own individuality and thus, not subject to any generalizable theory. It is also essential to note that, while progress with regard to these basic structures has been significant in the recent past, we do not know the proportion of people who work as chaplains who are board certified.

Thus, there is no regulatory or financial business case for the inclusion of professional chaplains in health care settings. These terms are often used interchangeably in the literature leading to confusion. For purposes of clarity, in this reviewchaplaincy care is care provided by a board certified chaplain or by a student in an accredited clinical pastoral education program e.


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All such care is provided by an individual who is mindfully aware of sacred matters that arise during the delivery of chaplaincy care. The issues are understood through beliefs about God, higher powers, and other cultural or religious belief systems -areas of knowledge that chaplains are versed in by virtue of their education and experience.

Thus, spiritual care will be defined as helping the patient maximize their relationship with that which is sacred in the service of their healing. The term, pastoral care,has been historically used within the Christian tradition to refer tocare provided by clergy.

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This care is founded in theology and expressly concerned with a cure of a soul Mills, Pastoral care is more like an intensive discourse between one or more persons seeking guidance in moral or spiritual concerns from the faith leader Mills, Pastoral care is encountered in relationship based on an understood system of shared beliefs, values, and behaviors. Using these definitions, chaplaincy care is the part of spiritual care practiced by chaplains.

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Chaplains focus on their awareness of the sacred, listen and observe how the sacred is experienced by the patient. They are then prepared to move from being mindful and present in that awareness into supporting the sacred for the patient in their coping. The chaplain also brings to the team and the organization skills in spiritually, theologically, and culturally competent care, some of which can be modeled and taught to individuals on the team. The chaplain also provides spiritual care to the members of the organization and acts as a leader in patient-centered holistic care.

While some consensus is emerging conceptually with regard to the above definitions, much of the literature uses the terms interchangeably or without clear distinctions. The definitions above signal a significant shift in the model for delivery of professional health care chaplaincy in the U. Traditionally, chaplaincy in acute health care has been delivered by community clergy who minister exclusively to patients of their faith tradition.

Hospital Chaplain

The major emphasis has been on providing for religious needs and rituals. Thus, care for the spirit has been the exclusive province of the clergy. Further, the chaplain has been focused exclusively on care of the patient and family and not at all on integrated institutional initiatives and communicating with the health care team. The advent of bioethics committees, the concern for patient satisfaction, the awareness of the impact of cultural influences, and, finally, the full advent of patient-centered care broadened the general understanding of spiritual care into a realm that all members of the health care team need to participate in.

The more widespread availability of clinically trained multifaith chaplains has increasingly allowed the chaplain to be more fully integrated as the spiritual care professional on the health care team rather than simply being the community religious professional. While this new model is gaining wide acceptance and provides better congruence with the processes by which health care is currently provided, its efficacy and outcomes remain untested.

Chaplaincy care has historically not been, in general, theory driven. Where theory is used at all, it is generally borrowed from other professions. Many chaplains resist the idea of theory outright, considering it an infringement on the sanctity of their relationships with their patients. Fitchett in press has proposed a system of case analysis for chaplains which could easily and naturally lead inductively to theory in chaplaincy.

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Chaplains begin by being present with a patient, so that the chaplain is open to creating new meaning with the one who suffers Millspaugh, a. To be truly authentic, and have a therapeutic relationship with an individual, four things are required. The first three are: being congruent; being positive and accepting; and being empathic. A fourth characteristic, presence, can arise from those three to enable the therapist to be truly and completely present in the moment with the individual.

Geller and Greenberg studied presence, as suggested to be important for study by Rogers himself in an interview in Baldwin, by asking ten psychotherapists to describe the experience of presence with clients. Their results suggest that there are three domains to be mindful of in therapeutic presence: preparing the situation for experiencing presence; activities that enable the experience of presence; and unconditional positive regard which is the actual experience of presence.

Referring to Geller and Greenberg , Chaplain Kit Hall has developed and uses an evaluation form to help her prepare to offer presence to those she visits Hall, Harvey, Brown, Crawford, and Candlin employed decision analysis to describe the activity that surrounds the preparation for presence, and the depth that happens in the conversation that takes place between the chaplain and patient.


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During the conversation, the chaplain conveys a polite and attentive stance that allows the patient to self-disclose what is troubling her or what is on her mind. This polite stance is known as linguistic politeness, and it is more complicated than everyday politeness.

A chaplain skilled in linguistic politeness knows how to not threaten the conversation partner by speaking inappropriate words. Chaplains converse in a way that allows the patient to speak about great difficulties without losing face. Simply to be passively present at the bedside is no longer enough of a description of this intervention.

Greater detail of the practice of presence and a therapeutic result must be documented to happen with some reliability because of that presence. Clinical pastoral education aims to teach chaplains to become aware of themselves when entering into a relationship with another person, in this case, a patient or family member. There is explicit training in ethical behavior and experiential training in self reflection, reflective listening, and learning through engaging in reality and with other humans Holifield, From the very beginning of the clinical training programs, in the first half of the twentieth century, chaplains have blended clinical technique with theological and psychological theory to optimally meet people where they are in their need.

Despite its long history and wide spread acceptance as the central training model for chaplains, there is limited research on the outcomes of CPE.

The Christ Chaplain: The Way to a Deeper, More Effective Hospital Ministry

In a review of 39 studies Derrickson found that students gain autonomy and self-awareness as a result of participating in CPE.