Pastoral Care - Research Paper Example

? Cancer and Pastoral Care Table of Contents Cancer and Pastoral Care Introduction Young and old, rich or poor, from every ethnic background, cancer victims each fight a unique fight of faith and hope as they often struggle through issues that only a day before they were unaware or merely considered an annoyance. Such annoyances may have been lower back pain, chronic fatigue, weakness, shortness of breath, an inability to focus or think clearly, body aches of various types, or any number of ailments which can have a variety of causes. Cancer can take a significant physical, emotional and financial toll on patients, family members, and loved ones. However, it is also a statistically significant disease. Cancer is the second largest annual killer in the United States, second only to heart disease. This paper posits that pastoral care can identify and address the spiritual and emotional needs of the patient, family members, and loved ones. Background Jann Aldredge Clanton's book Counseling People with Cancer sets a major theological theme as hope, and the pastoral task associated with this is to nurture hope through the use of sacred images and stories. This can be done by hearing what is important to the patient and helping the patient put words to their image of Divinity to find comfort during difficult times.1 Counseling the Sick and Terminally III by Gregg Albers is a practical volume written by a physician from an Evangelical Protestant perspective. He discusses the involvement of the whole person in the healing process and the importance of an integrated emotional and spiritual structure. Albers argues that an individual's spiritual maturity can deeply affect emotional and physical healing abilities and emotional reactions are inseparable from physical symptoms. In his experience, he observed in his practice that there are times when emotional reactions to may become more devastating than physical symptoms.2 Albers introduces a unified theory of grief based upon several clinical models of grief reactions and losses, helping others listen for the initial reaction, the shock, denial, and finally the acceptance: He argues that although Kubler-Ross speaks rightly of the positive aspects of hope and its strengthening effects, the Kubler-Ross model does not personalize the hope that can be found in a personal faith.3 Furthermore, patients often experience loss of control, time, bodily functions, body parts, physical attributes, self-esteem, family positions or roles, and income. The degree of loss depends upon the severity and length of the illness.4 Going beyond the Kubler-Ross model, Albers argues that God can even use these losses to break down psychological defenses. This breaking down of psychological defenses can allow patients to reach out to others for support and build relationships with loved ones. Many studies also demonstrate the value of religious faith at the end of life, and this connection to God or higher power brings strength and helps to sustain individuals living with advanced cancer.5 Some of the more recent work addresses the spiritual needs and resources of the dying patients and their family members. It is helpful to examine a few of these studies. A survey performed by Roberts, Brown, Elkins and Larson at the University of Michigan Medical Center revealed that out of 108 women who described themselves as having some form of fear, 91%feared dependency, 73% feared death, 73 % feared pain and 73% feared loss of control (participants were invited to indicate all fears which applied to them).6 It is interesting to note the primary fear expressed by patients in this study was not fear of death, but fear of being dependent on others for care. Another study was conducted by M.F. Highfield at Veterans Administration West-Los Angeles facility which examined the spiritual health of oncology patients through the eyes of the nursing staff.7 Findings from this study indicated that nurses were often ill-equipped to assess and address the spiritual needs of oncology patients. Other findings indicated that patients do not especially desire their nurse to be their spiritual care provider at this point in their life or disease process. The Highfield study noted that nurses are the primary bedside care providers in home hospice settings, inpatient hospice facilities, or any hospital setting. Therefore, Highfield recommend pastors know the nursing staff and the level of care they provide to patients. This includes the spiritual care which nurses often provide in accordance with the wishes of their patient and the comfort level and spirituality of the individual nurse to provide such care. One case study was the use by the patient of Buddhist background to integrate alternative medicines into her care.8 This study shows the lengths that the medical system is prepared to go, at least this case, with a patient's .articulated desire for spiritual support through the death process. Her spirituality was a factor in how the medical team addressed her pain and carried out her wishes during the last days of her life. This study was cited for the purposes of demonstrating the lengths the medical system is prepared to go to support and incorporate the spirituality of the patient into the healing process. One may wonder how a Christian pastor is able to minister to non-Christian patients or family members in good conscience. One way is by examining the story of the "Rich Young Ruler" found Luke 18. A review of this parable of Jesus can help one realize that even after this man had a conversation with Jesus, the young man "went away sorrowfully." Whatever else this story may demonstrate about the love of God, it does show the respect Jesus shows this young man to make his own decisions regarding course of his life, In the author's experience, it is often most effective for the Christian pastor to be with patients and family members, ask questions about their source of life and strength, then join them on their spiritual journey, Presenting the Gospel of Jesus as the Savior can be done incarnationally as patients and their loved ones begin to realize the Love of God incarnate manifested in the presence of the pastor. Definitions of Pastoral Care, Religion, and Spirituality It is prudent for the minister to know that the professions of pastoral care and counseling often go through various crises of identity and shifting definitions. These definitions can be understood as the continuing struggle for the field to define itself in a rapidly changing context of counseling and healthcare and try and keep abreast with culture in general. The terms "religion" and "spirituality" are also usually subjectively defined as the thoughts, feelings and memories these words evoke in people is somewhat different from person to person. However, some specific definitions found in current literature serve as a standard or starting point for the field of pastoral counseling. A discussion of how to define pastoral care is in process. This discussion compares two objectives for those who deliver pastoral care and counseling. One objective for professional development is heightened self-awareness in the minister through training and the counseling process.9 The other objective for professional development in the minister is the development of clinical skills. These seemingly divergent objectives between clinical skills and self-awareness are articulated by John R. DeVelder, Past President of the Governing Council of the College of Pastoral Supervision and Psychotherapy (CPSP) "The Clinical Pastoral movement has from its first days experienced the tension between the objectives of personal transformation on the one hand and skill development on the other. This tension led to the early estrangement between Anton Boisen and Richard Cabot. Boisen tended toward the development of personal transformation and Cabot lead the charge toward professional clergy training."10 Definitions of "religion" and "spirituality" are also shifting. The definition of spirituality has been "confused with religiosity, since the latter is more easily quantifiable and has been simplistically conceived of as the only obvious expression of transcendent meaning-making."11 The readings disclose that religion is usually based around a visible, quantifiable activity such as attending worship services, saying specific prayers, participating in community rituals and partaking of sacraments. One can see others involved in these activities. On the other hand, spirituality is a more general concept involving how one relates to God, self, and others. As an example of how definitions of religion and spirituality intersect, one physician who went through clinical pastoral education wrote about how she personally grew to connect with herself better and in that process became more sensitive to others' self-awareness. There is a polarity between the purpose of heightened self-awareness12 and the development of clinical skills. The physician further describes herself as becoming more sensitive to others' self-awareness and describes the personal vulnerability she felt due to her lack of training she had as a physician to handle' sensitive family issues surrounding the death of patients.13 As she built an argument surrounding her observations, she noted an exclusive religious group who are secure in their religious perspectives. This group does not ask or expect much support from others. They are generally conservative, exclusive, and mind-oriented. She describes this group as difficult to assess their self-awareness, but there appeared to be a certain boundary for connectedness to other and to their selves.14 Pastoral caregivers should understand spirituality in order to help patients to grow in their own spirituality. Patients in palliative care (in the dying process) are open to spiritual growth because many lose all their possessions. Their only possessions are themselves and their relationships with others through their understanding of who they are, not what they do or what they have. If a patient needs support to realize who they are, a care provider can provide this with a respectful attitude, learning about the spirituality of the patient and offering a mutual relationship as one human being to another. Care providers can only provide such a relationship if they have awareness of their own limitations as human beings. This is helpful as a living model of how personal, spiritual growth can benefit from conducting pastoral care, while at the same time not "using" patients in an unethical manner. The Quantification of pastor Effectiveness in Ministry There are two schools of thought on this issue. One school is led by Henry Heffernan, S.J. at the National Institute of Health Clinical Center at Bethesda, Maryland and another school is led by Harold Koenig, a physician and researcher at Duke University Medical Center. The two sides grapple with the question, "How do ministers and pastors know they are adding value and being obedient to the call from God in a given situation?" In the face of clinical research conducted by Koenig and others to draw connections between healing, faith, and spirituality, Henry Heffernan advises that no empirical, scientific data is available even though the adaptation of quantifiable techniques was introduced in 1988.15 Heffernan cautions that pastors should not be hired on the basis of making a quantifiable difference in the healthcare setting because no such evidence exists which justifies paying their salaries.16 In Heffernan's opinion, pastors should be hired by the value they bring to the human, caring dimension of a healthcare team (although this value can be documented as well). Heffernan states healthcare systems have pastors because of a "human ethical obligation" to show in practical supportive ways a basic respect for humanity and religious convictions of the patient and for the integral role of religion and spirituality in the patients' lives. He cautions not to shift the rationale for hospital pastors to a medical claim that the pastor's interventions with patients at the bedside will improve the health outcomes. The medical claim argues there is a measurable cost savings to the institution, but Heffernan argues that the rationale for keeping pastors should be based on the respect for the patient's humanity and personal religious values. Heffernan states one reason for this is that there is virtually no scientifically verifiable empirical evidence that pastors' interactions with patients improve health outcomes. Until scientifically grounded studies develop such evidence, and the methods and findings pass peer review for publication in high quality peer-reviewed journals, then justifying a pastor's position based on improved patient results (i.e.; faster recovery- healings etc.) is on shaky ground because the empirical evidence does not support the claims. Heffernan states pastors should be at the bedside to render comfort and care because of a human, ethical obligation involved rather than medical arguments related to speeding of the healing process or how spirituality and religious practice impact health. Heffernan's view seems to be supported by an objective review of studies which examined links between spiritual and physical health. Researchers examined 43 studies isolating nine hypotheses about the link between religion or spirituality and mortality, morbidity, disability, or recovery from illness. In healthy participants, studies repeatedly showed there is a strong, consistent, prospective, and often graded reduction in the risk of mortality in those who attend worship services regularly. However, their analysis revealed consistent failures to support the hypotheses that religion or spirituality slows the progression of cancer or improves recovery from acute illness but some evidence that religion or spirituality impedes recovery from acute illness. The authors conclude that service attendance protects healthy people against [physical] death and there is a lack of methodologically sound studies in this area.17 Heffernan further argues that medical literature that has been examined by Harold Koenig, Michael McCullough, David Larson, Jeffrey Levin and others does not include consistent data describing the specific religious spiritual services--such as prayer with patients in hospital rooms-rendered by hospital pastors. From the studies that have been found in the medical literature, all of the favorable outcomes--if uniquely attributable to the patient's religious practice--can be attributed to the patient's religious practice prior to entering into the hospital. Therefore, Heffernan concludes whatever improvements in health outcomes these studies may indicate are independent any influence that the hospital's pastors may have had on improving the patient's health status through spiritual services. In the book The Healing Power of Faith: Science Explores Medicine’s Last Great Frontier by Koenig (to which Heffernan refers), the author found that research did not account for other factors in the patient's life but focused on subjective responses from patients concerning their religious practices.18 Religious practices were measured independent of the assistance or direction of clergy or hospital pastors. Also discussing the question of measuring a pastor's effectiveness, Chaplain Joseph Baroody of Baroody Pastoral Counseling struggles not with the empirical evidence presented by Koenig, but with theological problems. He argues that Koenig equates religious activity/beliefs with faith itself.19 According to The Dictionary of Pastoral Care and Counseling "Faith needs to be distinguished from religion and belief or believing".20 Most of the studies which examine religion are based on religious activity and beliefs. Basically, the studies demonstrate that worship service attendance, prayer, and beliefs are associated with improved health. Yet Koenig, Matthews, and Benson make the theological claim that their version of faith not only improves health, it also heals. For example, Koenig has published both an article and a book under the title The Healing Power of Faith. Koenig cites several studies supporting the significance of religion, not faith, in coping with illness. What he calls "faith" is actually worship-service attendance. Standard Practices in Pastoral Care Standard practices in pastoral care are published in many places, but some significant recent works include those edited by Larry VandeCreek. Such volumes are a collection of articles simultaneously published as Journal of Health Care Chaplaincy volumes. One of these articles describes The Discipline for Pastoral Care Giving: Foundations for Outcome Oriented Chaplaincy. "The Discipline" was created when the Pastoral Care team at Barnes-Jewish Hospital (BJH) at Washington University Medical Center in St. Louis, Missouri led by Arthur M. Lucas, identified the need for a method of analyzing and meeting the spiritual needs of patients and family members using the art of pastoral care.21 Through the development of a cumulative learning model, this method developed into what they term "The Discipline." The Discipline is a method to evaluate and improve pastoral care, communicate care more effectively, and to help see patterns in the struggling, coping, and healing of people. This method incorporates many elements of traditional pastoral care and organizes them into a useful, easily remembered framework for clergy to use with oncology patients. This framework provides many places for clergy to help the patient articulate what would be most meaningful to them.22 The Discipline is a sequential method to improve the spiritual and physical needs of patients and their loved ones as they progress through the various stages of diagnosis through treatment to either recovery or death. The Discipline method of pastoral care involves five steps. First, a pastor identifies the needs, hopes and resources of those receiving care - be they patients, family members, staff or others. The focus in this first step is to help those receiving care identify the needs in their life, help them look for hope and analyze resources already used by or available to them. Secondly, the pastor designs a profile from attending to these needs and helping the patient identify their resources for those receiving care. This profile is used by the pastor and includes helping the patient define the holy, find meaning, hope and discover a sense of community in their life. This step is a patient-driven process that serves the pastor as a useful frame around which themes can be gathered around making meaning, finding hope, and building community. The third step is for the pastor to formulate the desired outcomes, which are the impact of the pastors activities on the patient. These outcomes must be sensory-based (seen and heard by the medical team, patient himself, family members and others), communicable, and shared with the person for whom care is provided. A helpful way Lucas encourages pastors to think about outcomes for the patient is for the pastor to answer the questions: "What is our prayer for this patient?" "What do we contribute, and what are the results or the impact of what we do on the patient?" Fourth, a clear and communicable plan is created by the pastor in collaboration with those receiving care which defines responsibilities for the patient, family members, pastoral care team members, and other members of the medical team and also draws upon the resources of the person receiving care. Finally, interventions are designed and executed which incorporate the goals of the patient and the resources of all in a relational, intentional and non-judgmental atmosphere. Another collection of articles entitled Professional Chaplaincy and Clinical Pastoral Education Should Become More Scientific: Yes and No edited by Larry VandeCreek discusses the evolution of the profession of pastoral care.23 In the preface, VandeCreek entertains the question, "What has pastoral care to do with science?" He points out this question is also reflected in Tertullian's question, "What has Jerusalem to do with Athens?" The obvious answer to this rhetorical question is "nothing," but Augustine responded to Terullian’s question saying, “Why do pagans get to their persuasive artillery while Christians stand by tongue-tied and unarmed?"24 The articles respond to the editor's question: "Should chaplaincy become more scientific?"25 Articles are arranged in the book alphabetically by the last names of the authors. Most of the authors supported some level of scientific work among pastors,26 others do not,27 and others offer a historical look at the healing ministry and, in so doing, provide a roadmap for pastors to discern the future of the profession.28 Authors also wrestle with the future of pastoral care and the broader role of the ministry in a healthcare setting.29 VandeCreek makes the point that ministers are uniquely positioned to speak to and help patients and others come to grips with faith issues and at the same time understand-sin a medical sense-what is going on with the patient to be able to walk "in both worlds" with respect. Conclusion Pastoral care identifies and addresses the spiritual and emotional needs of the oncology patient, family members, and loved ones. The evidence surveyed in this paper is representative and provides a context for identifying effective pastoral care techniques to oncology patients. Secondly, definitions of pastoral care, religion and spirituality are reviewed in popular journals. Next, a discussion ensued on the quantification of pastors' effectiveness in ministry to answer the question, "How does the minister know when he or she is being effective?" Arguments were presented for two schools of thought on this issue. Lead by Koenig and others, one school seeks to quantify effectiveness by scientific results. The other school of thought, lead by Heffernan, seeks to appeal to the moral obligations of health care institutions to provide pastoral care. Finally, numerous journal articles pertaining to the standard pastoral care practices are examined and discussed. "The Discipline" model was considered at some length because it incorporates many elements of traditional pastoral care and has many practical applications patients that are particularly useful to those who minister to oncology patients. Bibliography D. Barham, "The Last 48 Hours of Life: A Case Study of Symptom Control for a Patient Taking a Buddhist Approach to Dying," International Journal of Palliative Nursing 9 (2003): 245-51. Gregg R. Albers, Counseling the Sick and Terminally III (Dallas: Word, 1989),5. Harold G. Koenig, The Healing Power of Faith: Science Explores Medicine's Last Great Frontier (New York: Simon & Schuster, 1(99), 21-22. Henry Heffernan, "Religion and Health Research: Interpretation Sends Wrong Message Regarding Need for Hospital Chaplains in Health Care Institutions," Journal of Pastoral Care and Counseling 57 (2003): 79. Hung-Ru Lin, Susan M. Bauer-Wu and Lin H'Bauer, "Psycho-spiritual Well being in Patients with Advanced Cancer: An Integrative Review of the Literature," Journal of Advanced Nursing 44 (Oct 2003): 71. J. W. Fowler "faith and Belief," in The Dictionary of Pastoral Care and Counseling, ed, Rodney J. Hunter (Nashville: Abingdon Press, 1990),394. James A. Roberts, Douglas Brown, Thomas Elkins, and David B. Larson, "Factors Influencing Views of Patients with Gynecologic Cancer About End-of-life Decisions," American Journal of Obstetrics and Gynecology 176 (January - March 1997): 172. Jann Aldredge-Clanton, Counseling People with Cancer (Louisville: John Knox Press, 1998), John R. De'Velder, "Guest Editorial," Journal of Pastoral Care and Counseling 57 (2003): 2. Joseph Baroody, "Religion and Health Research: Theology Interpretations Oversimplified," Journal of Pastoral Care and Counseling; 57 (Spring 2003): 83, 84. Larry VandeCreek, A Research Primer for Pastoral Care and Counseling (New York: Journal for Pastoral Care Publishing Service, 1988),4. Larry VandeCreek, ed, and Arthur M. Lucas, ed., The Discipline for Pastoral Care Giving: Foundations for Outcome Oriented Chaplaincy (Binghamton, NY: Haworth, 2001) co-published simultaneously as Journal of Healthcare Chaplaincy 10 (200 I): 7. Larry VandeCreek, ed., Professional Chaplaincy and Clinical Pastoral Education Should Become More Scientific: Yes and No (Binghamton: Haworth Press, 2002), xiii. Lynda H. Powell, Leila Shahabi, and Car! E. Thorensen. "Religion and Spirituality: Linkages to Spiritual Health." American Psychologist 58 (January 2003), 52. M. F. Highfield, "Spiritual Health of Oncology Patients: Nurse and Patient Perspectives." Cancer Nursing 15 (1992): 1-8. P. McGrath, "Exploring Spirituality Through Research: An Important but Challenging Task," Progress in Palliative Care 7 (1999): 3-9. Y. Tarumi, A. Taube and S. Watanabe, "Clinical Pastoral Education: A Physician's Experience and Reflection on the meaning of Spiritual Care in Palliative Care," Journal of Pastoral Care and Counseling 57 (2003): 28. Read More