Why We Get Complicated Grief Wrong

I recently switched positions in my company to help manage our bereavement services. Don’t worry – I’m still in the field as a chaplain as well (with a very limited caseload – something I asked for)! I had a great deal of experience working in bereavement in my prior company so this has been a good fit so far.

However this move has brought up something that has always bothered me. That is even though that the staff I work with on a daily basis has years of experience in hospice care we still struggle with measuring and even recognizing complicated grief and bereavement. Continue reading

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Getting Your Foot in the Door: 8 Ways to reduce “declines” for chaplains

the chaplain makes his rounds

One issue that I see frequently coming across chaplain discussion boards is that many have increasing numbers of those declining chaplain support. One poster, a hospice chaplain in Georgia, said her declines went from 10% five years ago to about 35% now.

Many believe that the refusal of spiritual support is due to a decline in religiosity overall in our country and culture. That may be true, but I don’t think it accounts for the majority of declines. Even though the Pew Research Center found a nearly 8 point percentage drop in those professing Christianity between 2007 and 2014, about 70% of Americans still identify as a member of some Christian church or faith group. From my own experience I can say as that I have had many accepting of chaplain support who were atheist or agnostic, or believed in God but did not consider themselves religious.  And no these were not millennials, these were your typical elderly hospice patient. Continue reading

Spiritual Communication Boards for the Critically Ill: Wall Street Journal

This came across the line from the APC and thought it was such a brilliant and simple idea. The text is included below but please access the full article here.

When William Campion was in the intensive-care unit this month after a double lung transplant, he felt nervous and scared and could breathe only with the help of a machine.

Joel Nightingale Berning, a chaplain at Mr. Campion’s hospital, New York-Presbyterian/Columbia University Medical Center, stopped by. He saw that Mr. Campion had a tube in his neck and windpipe, which prevented him from speaking. The chaplain held up a communication board—not the kind used to check a patient’s physical pain and needs, but a “spiritual board” that asks if he or she would like a blessing, a prayer or another religious ministry. The board also lets patients rate their level of spiritual pain on a scale of 0 through 10, from none to “extreme.” Continue reading

When All is Said and Done: Death and “Magic Words”

Your average hospice chaplain. Probably had 3 units of Level II CPE.

Recently I had a family whose mother was on hospice with us. When Isabel* had a sudden decline and became active her family gathered around the bedside and all started to say the things that families and caregivers – including hospice staff – feel that they need to say in order for the dying person to “let go”. They all said that they loved her and that they would be OK. They had out of town family come in and say good-bye in person and on the phone. They told her over and over again that it was OK for her to go. The priest gave last rites. This went on for well over a week.

Needless to say it was rough. The family came and went, said what they needed to say, and still Isabel seemed to hang on. There were a lot of thoughts and questions: “What haven’t we said? Is there someone that hasn’t said goodbye yet? Is she waiting to hear from someone? What are we missing? Why is she still here?

My best response was, “I don’t know.”

Continue reading

The Productive Chaplain

here we see a Chaplain being productive…

If you’re a professional chaplain you have probably heard this phrase: “Let’s talk about your productivity.” For anyone the “productivity” talk is uncomfortable. For chaplains this talk is often more uncomfortable because what we “do” and “produce” can be very hard to grasp. Continue reading

Effective Swearing for Chaplains (and Other Clergy Too!)

***trigger alert: as this is a post about colorful language, be aware that there is colorful language abounding after the jump***

Clergy, sometimes it’s OK to use swear words. That’s the summary. For the full text click below, but language aboundeth herein

Continue reading

Feelings Aren’t Dangerous: A Response to The Gospel Coalition and Gloria Furnam

A while ago an email drifted through my inbox from The Gospel Coalition. Ususally I delete them, mostly because I find most of them to be uninteresting or not that helpful. Thankfully they list the subjects of the email right off, so you can delete them fairly quickly. But this one caught my attention, because one of the articles in the email was called “Moms, Don’t Trust Your Fickle Feelings“.

“OK”, I thought, “don’t rush to judgment – see what they say.”

And I got mad. Continue reading

Amy Kumm-Hanson: The incarnational nature of Chaplaincy

photo: A.Kumm-Hanson, Iceland 2016

From Amy Kumm-Hanson; I thought her words spoke a great deal about the difference between the nature of Chaplaincy and its place in ministry.

Chaplaincy is not a cerebral ministry of long hours spent in a pastor’s study in preparation for preaching. It is holding hands through bed rails and wearing isolation gowns and being willing to literally stand in suffering with God’s beloveds. It is not about translating Hebrew or Greek from ancient texts, but about translating scripture into something now that matters to the mother who is delivering her stillborn child or the son losing his father to cancer.

The theology of the cross is particularly apparent to me in my hospital work. This theology holds that God’s love for all of creation is most clearly seen in the act of dying on the cross.  That God did the most human thing of all, which is to die. The theological conviction that shapes my ministry as a chaplain is that God knows what it is to suffer and to die, and there is no place that God is unwilling to go, even death. This is good news for all of us who feel immersed in suffering, our own or that of others.

Read her whole post here.

Is CPE broken? Reconsidering the “CPE horror story”

anyone having flashbacks to their CPE supervisor’s office?

If you Google “CPE” chances are pretty good that it will start autofilling “horror stories” in the search box. It seems like there are much more stories about bad experiences in CPE than good. Perhaps this is just bias toward the negative, but it certainly does seem to be that CPE is not a good experience for many.

If you follow that search you’ll see why. I read stories about supervisors that destroyed boundaries and exercises designed to tear people down in front of their peers. One person even wrote that “Clinical Pastoral Education is nothing more than a systematic ‘weeding out’ of orthodox seminarians through a process of enforced radical leftist indoctrination.” It’s criticized as being unnecessary, unhelpful, “navel-gazing”, pseudo-psychoanalysis. So why is it still required for those entering ministry? Is there something wrong with the program? Are supervisors adequately trained and supervised themselves? Or are seminarians missing the point of CPE entirely? Continue reading

“Hope can harm dying patients”: F. Perry Wilson on Doctors, Families and Misplaced Hope

Our humanity, as well as our caring nature, often calls us to be sources of strength and encouragement to those who are in crisis. This is true of Doctors, Chaplains, Nurses – in fact the whole hospice team. We hate to be the ones delivering bad news, especially when we feel like the other needs comfort rather than reality when reality most likely is going to be awful.

F. Perry Wilson, MD, MS

Dr. F. Perry Wilson, in a video report on MedPageToday, reports on a recent study concerning what doctors and surrogates believed a terminal ventilator patient’s chances of survival to be. The study found major discrepancies between doctors and families, and while doctors were often more accurate in their assessment that knowledge was rarely transferred to the families in the study. Families were often too optimistic regarding chances of survival. There were several factors involved in this, including religious belief or hope for a miracle, the need to not “give up”, and even magical thinking (“If I circle 50% it might be true”).

The study and analysis reveal how medical clinicians and supporters, including Chaplains and Social Workers, can reframe “hope” to mean hope in a peaceful death rather than hope for a full recovery.

One piece of the puzzle that was not addressed was that this unwarranted optimism could easily be seen as part of the grieving process for families. While education about realistic expectations is certainly necessary and needed, resistance to this advice in favor of “hope” shouldn’t just be written off.  Denial, bargaining and magical thinking are part of the grieving process and may show that they are trying to wrestle with acceptance rather than avoid it.