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Whatdo
Chaplains
do?
The role of the Chaplain in meeting
the spiritual needs of patients
Report No.CSHD/MR001 Edition 2
FEBRUARY 2007
REPORT BY
Dr Harriet Mowat
Professor John Swinton
with Clare Guest and Liz Grant
Centre for Spirituality, Health and Disability
The study presented in this report was funded by the Health Planning and Quality Division of the
Scottish Executive Health Department through Section 16 B funding, as part of their support for the
development of spiritual care in the National Health Service in Scotland. The Centre for Spirituality,
Health and Disability at the University of Aberdeen hosted the research which has been led by Dr Harriet
Mowat and Professor John Swinton. The authors wish to thank the Health Planning and Quality Division
of the Scottish Executive for their support and comments prior to the publication of this report.
The authors would like to thank the hospital chaplains for their generous and enthusiastic response to
requests for interviews and information. We are particularly grateful to the chaplains who took part in
the case studies.
Authors
Grantholders and Project Managers
Dr Harriet Mowat is the Director of Mowat Research Limited based in Aberdeen and an honorary senior
lecturer of Aberdeen University.
Professor John Swinton is professor in Practical theology and Pastoral care and the Director of the
Centre for Spirituality, Health and Disability at the University of Aberdeen.
(Dr Mowat and Professor Swinton are the grant holders for the project.)
Research Assistance
Clare Guest was one of two research assistants employed during the project. Ms Guest was based at the
University of Aberdeen and worked on the project during the initial 18 months. Her primary task was to
collect data including interviews and two of the three case studies. We are grateful to Clare for her
comments on the first draft of this report.
Dr Liz Grant was seconded as a research assistant to the project from the Department of Primary Care,
University of Edinburgh. She collected data during the second interviews and conducted one of the case
studies. We are grateful to Dr Grant for her comments on the first draft of the report.
This study is dedicated to Joy Higginson
who had occasion to confront the issues
of spirituality and health.
27.10.48 – 14.12.04
Report No. CSHD/MR001 Edition 2 1
Preamble 5
Executive Summary 7
Aims of the Study 11
The Research Question 13
The Context 15
The Study Design 21
The Findings 23
What do Chaplains do? 29
Conclusions 51
End Word 53
References 55
Report No. CSHD/MR001 Edition 2 3
Contents
Contents
Chaplaincy within the National Health Service in Scotland has been and continues to be an important
dimension of the Service’s drive towards a more holistic perspective on care. There is a general, if often
imprecise, acceptance of the need for chaplaincy and the valued role of the chaplain. However, when one
gets down to issues of the precise needs chaplains are actually expected to fulfil, things become much less
clear. One of the reasons for this lack of clarity and precision is that there has been very little research
done on the nature of chaplaincy in Scotland, its developmental challenges and the crucial question of
precisely what it is that chaplains do.The research that is outlined in this report attempts to address this
issue and offer a perspective on what chaplains do that, we hope, will support the development of
chaplaincy at both practical and strategic levels. There are a number of factors that make this research
particularly opportune.
The national chaplaincy guidelines issued by the Scottish Executive place the onus on the Scottish Health
Service to formally address the spiritual dimensions of care. In so doing, the Scottish Executive have
chosen the existing chaplaincy services within the Health Care Trusts to promote generic spirituality.
Ageneric model of spirituality assumes an understanding of spirituality as a human universal that may
include, but is not defined by any particular religious tradition. Generic spirituality is therefore available
to people of all faiths and none. However, current full-time chaplaincy services are almost exclusively
Christian. This creates an obvious tension between the Christian basis of current chaplaincy services and
the implicit and explicit expectations inherent within the delivery of generic spiritual care. In what way
can a chaplaincy service which has been developed within one particular religious tradition, effectively
meet the generic spiritual needs that policy requires?
Atthe same time, as this report will suggest, chaplaincy is going through a process of significant change,
not least in its current movement towards professionalisation. Chaplaincy is currently seeking to develop
itself as a healthcare profession on a par with other healthcare professions. Health care professions
typically have boundaries, skills and a discrete body of knowledge that distinguishes their services.
Traditionally the boundaries, skills and body of knowledge that underpin the practice of chaplaincy were
drawn from the Christian tradition, and related closely ordination for a Christian ministry. With the
current emphasis on generic, non-denominational spiritual care, chaplains are potentially in a
compromised situation where they will be required to minimise their Christian credentials in order meet
the criteria for a spiritually non partisan service. What then will be the basis for the profession of
chaplaincy? It may be that chaplains have to renegotiate the basis of their professional status in
significant ways, and reflect carefully and honestly on how this may or may not compromise their
integrity as ordained Christian ministers. Indeed the question might be asked whether it is necessary for
chaplains to be ministers within the emerging understanding of spirituality.
Report No. CSHD/MR001 Edition 2 5
Preamble
Preamble
These are serious and challenging dilemmas for hospital chaplains.
There is a pressing need for the development of an evidence base that will provide concrete answers to
these general questions, and to the more specific one of what it is that chaplains actually do.
This report reflects the findings of an eighteen-month study that sought to explore the role and function
of the hospital chaplain within the National Health Service in Scotland. The study was carried out in
2003-2004 and involved all of the full-time hospital chaplains working for the National Health Service in
Scotland.
The report is a descriptive study of the current and evolving role of full-time Scottish Hospital chaplains.
It is intended to act as a supportive and helpful document during the time of transition in which chaplains
find themselves.
This report describes what we will refer to as a process model of chaplaincy. This model emerged from our
engagement with chaplains over a variety of issues. It will suggest that chaplaincy in Scotland is in
transition. The data presented within this report attempts to reflect, and to some extent capture, some
vital insights into the role and function of the hospital chaplain. It is hoped that these insights and
perspectives will enable the significance of chaplaincy for contemporary healthcare practices to be clearly
seen. It is also our hope that the data presented will enable chaplains to reflect critically on their current
practices and move towards the development of a model of professionalisation which is clearly perceived
as relevant within the multi-disciplinary team; but which also enables chaplains to retain their unique
integrity as distinctively spiritual caregivers.
This report is written for a wide audience which includes those who know little about hospital chaplaincy.
In particular the target audience is health care policy makers and hospital managers. We recognise that
many of the hospital chaplains will have considered many of the points raised in this report. We apologise
for stating the obvious to these readers and hope that the commentary will stimulate further discussion.
This first report from the study is intended to lay out the territory on a wide canvas. Subsequent papers
will pick up on particular aspects and may be of more specific interest to groups already knowledgeable
on the subject.
Aseries of seminars arranged through the Chaplaincy Training Unit in Glasgow is planned for 2005.
These are intended to facilitate further discussion about the role of the hospital chaplain in support of
the policy developments that are already underway.
6Report No. CSHD/MR001 Edition 2
What do Chaplains do?
Report No. CSHD/MR001 Edition 2 7
Executive Summary
Aims of the Study
• To build on the existing knowledge around the areas of chaplaincy, spirituality, religion and their relation to the
process of healthcare within the Scottish National Health Service.
• To describe the current role and function of the hospital chaplain.
• To explore the various perceptions of the work of the chaplain held within the health care context.
• To identify what patients perceive as the most beneficial approaches to spiritual care and support.
• To put these findings into the context of the national guidelines on spiritual care and subsequent policy documents
produced by the Health Care Trusts.
Research Question
What do Chaplains do?
The Context of the Study
•Chaplaincy within Scotland is well established and has a strong track record.
•Hospital chaplaincy in Scotland is in transition.
• Chaplains are challenged to prepare for significant changes as older models of chaplaincy give way to models that need
to be developed and shaped to fit the changing spiritual climate within Scotland.
• Spirituality has always been the primary focus within chaplaincy. Traditionally this has been perceived as religious
care carried out by ordained ministers.
• The relationship between spiritual need and health is an increasingly researched topic.1Abody of knowledge is
beginning to emerge that suggests an important link between well being and spiritual comfort and awareness.
Executive Summary
• This indicates the possibility of a strong and credible role for chaplaincy within the healthcare system.
• There is an increasing distinction being drawn between religion or religious care and spirituality or spiritual care.2
This separation poses significant challenges to chaplains.
•The diversity of the spiritual landscape within Scottish culture means that addressing spiritual needs has become a
complex process that involves chaplains having to offer spiritual care to people of all faiths and none.
• The National Health Service in Scotland is undergoing changes particularly with the devolvement of Scottish
Parliament in 1999, which has meant that the Scottish Health Service has taken on a character of its own.
• This character has placed great emphasis on the language of competition, financial accountability, commissioning,
targets and competencies. At one level, chaplaincy and the values and perspectives it stands for are by definition
counter-cultural. Proving the worth of spirituality within such a cluster of priorities is problematic.
• The Executive have also noted the importance of developing and incorporating other underlying “forgotten”
dimensions of the healthcare process, in particular, the importance of spirituality and spiritual care.
• The Scottish Executive has issued guidelines to the Health Care Trusts requiring attention to be paid to the spiritual
within the process of health care.3
• This report addresses this complicated and transitional social and spiritual context, seeking to reflect the
complementarity and tensions encountered by hospital chaplains, in order to develop critical clarity as to how
chaplains do and should function within such a multi-faceted spiritual context.
The Study Design
Forty-four full time Health Care chaplains in Scotland were interviewed twice over a period of eighteen
months. Three case studies supplemented this data by elaborating on themes emerging from the first
interviews and prompting additional themes for the second interviews.
The Findings
The process model focuses on the core tasks of chaplaincy. The data suggest that the core task for chaplaincy
involves an active process of finding people who need spiritual care, identifying the nature of the need and responding
to the need through theological reflection and the sharing of spiritual practices.This core process is achieved in a
variety of ways. These methods of meeting need throw up challenges around the idea of offering a needs led
service. There seem to be some necessary conditions that are required in order to maximise the efficiency of
this core function. Paradoxically these conditions, essential to the core work of chaplaincy, can at the
same time be quite threatening to that work.
The findings indicate that the relevance and validity of chaplaincy within the National Health Service in
Scotland revolves around the key issues of: spiritual plurality, leadership, professionalisation, team-working,
methodology and marketing.These issues and the ways in which chaplains work them out within their caring
practices potentially put the discipline of chaplaincy in a strong and credible position within the 21st
Century health care institution.
8Report No. CSHD/MR001 Edition 2
What do Chaplains do?
Implications for Spiritual Care
The findings have implications not only for the type of spiritual care performed by chaplains, but also for
the spiritual care offered by other professional groups who are similarly caught in the tensions of
establishing territory and claiming generalist skills. We explore this more fully in the final part of the
report. Here it will be helpful to note the following:
• Chaplaincy can become a new kind of profession where the service is driven by individual need rather than established
knowledge.
• Religious care alone does not meet the wider spiritual needs of the non-religious patient. Traditional denominational
or religious models of chaplaincy will not fit into the spiritual plurality of contemporary Scotland.
• Spiritual care includes and may seek to meet religious need.
• Expressed spiritual needs are often couched in existential terms. Chaplains require skills which will enable the
accurate interpretation of these existential expressions.
• If chaplaincy is to hold its own in an evidence-based environment as a competing profession (competing in terms of
resources within the NHS), it needs to have a robust method of enquiry.
• Despite the diversity of understandings surrounding spirituality, the significance of personal faith is, for chaplains,
the basis for chaplaincy.
•One of the primary tasks of the chaplain within the multi-disciplinary team is as the marketer of a spiritual ethos
which has the potential to transform and re-humanise a healthcare system which is often lacking in such aspects.
Report No. CSHD/MR001 Edition 2 9
Executive Summary
The aims of the study were as follows:
• To build on the existing knowledge around the areas of chaplaincy, spirituality, religion and their relation to the
process of healthcare within the Scottish National Health Service.
• To describe the current role and function of the hospital chaplain.
• To explore the various perceptions of the work of the chaplain held within the health care context.
• To identify what patients perceive as the most beneficial approaches to spiritual care and support.
• To put these findings into the context of the national guidelines on spiritual care and subsequent policy documents
produced by the Health Boards across Scotland.
Report No. CSHD/MR001 Edition 2 11
Aims of the Study
Aims of the Study
Report No. CSHD/MR001 Edition 2 13
The research question
What do Chaplains do?
The research question
Achanging spiritual landscape
Increasing interest in spirituality and health
An examination of the spiritual landscape in Scotland throws up some interesting observations. In line
with much of Western Europe4there is a significant decrease in adherence to traditional, formal
institutional religion. The decreasing number of people regularly attending places of worship evidences
this5.However, whilst traditional religion appears to be in decline, there is a corresponding increase in the
number of people expressing the importance of spirituality for their lives and claiming to have spiritual
experiences and beliefs6.Thus spirituality appears to have migrated from the overtly religious towards a
more individualistic and subjective quest that has no necessity of a formal structure, doctrinal beliefs or
an anchoring community of like-minded believers7. People now want to believe in things spiritual, but no
longer wish to belong to traditional religious institutions.8
This broadening understanding of spirituality is reflected in health care settings by the increasing focus
on spirituality within the literature surrounding medicine, nursing, social work and occupational therapy,9
arising interest in complementary and alternative medicine,10 and a developing holistic view of health and
illness within which the role of chaplaincy is rapidly gaining recognition.11
Expanding spirituality from the particular to the universal
In an environment that values highly the role of the ‘specialist’, such a holistic view of health presents
veryparticular challenges to individual professions and to the ways in which multi-disciplinaryteams
function in practice. As medicine and health care advance in knowledge of the micro mechanisms of the
ill body, so the need for greater specialisation increases. In tension with this emphasis is the practical
need expressed by people encountering illness, to be treated as whole persons who require the universal
(overarching meaning) and the particular (the individual self) to be held in critical tension throughout
their experience of illness. Within such a context spirituality becomes of foremost importance
To provide authentic holistic, active, total care requires that attention be given to providing appropriate
services that meet the actual needs of patients and their carers, that is, not simply the needs that health
care professionals may perceive or/and assume, without reference to the wishes, desires and experiences
of patients. The concept of patient focussed care is currently central to Scottish/UK Government health
care policy, which stresses the importance of patient and carer views informing service developments.12 13
There is a good deal of evidence that suggests that patients desire to have their spiritual needs met within
Report No. CSHD/MR001 Edition 2 15
Context
Context
ahealthcare context.14 Developing strategies to meet such expressed needs is therefore very much part of
current governmental approach. Spirituality and spiritual care are not optional extras for “religious
people”.
Religion and health – the known research
In the light of these cultural changes it is not coincidental that spirituality and religion are fast becoming
recognised as a significant part of the healthcare research agenda, even amongst those more inclined
towards the biomedical end of the research community spectrum.15The extensive research work of people
such as Harold Koenig and David Larson in the United States is indicative of the possibility of developing
an evidence base to explore the possibility of there being a positive association between religion,
spirituality and health.16 17 The data from such studies is suggestive of associations between religious and
spiritual observance and well-being. For example, Koenig et al in the Handbook of Religion and Health report
their examination of the relationship between religion and health in about 1200 studies. They rated the
quality of those studies, and on a 1=poor to 10=excellent scale, and found 29 studies which they rated
as 10s and 84 rated as 9s. Their conclusion (in part) was that: “in the vast majority of the cross-sectional studies
and prospective cohort studies we identified, religious beliefs and practices rooted within established religious traditions
were found to be consistently associated with better health and predicted better health over time.”18
Religion and spirituality have been shown to be beneficial on a number of levels and in relation to a wide
variety of conditions. Health benefits include:
• extended life expectancy
•lower blood pressure
• lower rates of death from coronary artery disease
• reduction in myocardial infarction
• increased success in heart transplants
• reduced serum cholesterol levels
• reduced levels of pain in cancer sufferers
• reduced mortality among those who attend church and worship services
• increased longevity among the elderly
• protection against depression and anxiety
• reduced mortality after cardiac surgery19
Whilst there is little research within this area which focuses specifically on chaplaincy, a recent good
example of the potential this area holds is the study by William Iler, et al.20 They report on the effects of
daily visits by a chaplain to patients with COPD (Chronic Obstructive Pulmonary Disease), and compare
their health outcomes with a second group of patients with the same diagnosis, who were not visited.
The study found that, by comparison, the visited group were less anxious at discharge; their length of
stay was significantly less; and their satisfaction with the hospital was significantly higher. One
conclusion that might be drawn is that the support of a chaplain has a demonstrable effect on the
hospitalised patient, certainly with that particular diagnosis. It is of course not certain as to which way
these associations work.
Asimilar evidence base to that being produced within the United States has still to be developed within
the United Kingdom and Europe. It is therefore not possible to draw direct comparisons across cultures.
Nevertheless, the evidence that does exist is helpful in locating some potential benefits spirituality and
religion could offer at a clinical as well as a pastoral level. Whilst that area of research is not a primary
16 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
focus of this report, it does provide some useful background information to the perspectives presented
within the report.
The Scottish context
Patient focus and public involvement
In Scotland, the current and previous Ministers of Health have promoted the philosophy of patient
focused care.
Patient Focus and Public Involvement21 (PFPI) was launched in December 2001 following key commit-
ments within Designed to Care22and Our National Health: a plan for action, a plan for change.23The
Partnership Agreement24 commits the Scottish Executive to addressing the following themes in all its work:
• growing Scotland’s economy
• delivering excellent public services
• supporting stronger, safer communities
• developing a confident, democratic Scotland
In line with these themes, NHS Scotland is committed to equality, excellence and the provision of high
quality health services across Scotland. The leadership for this commitment comes from both the
Minister for Health and Community Care and the Chief Executive of NHS Scotland.
Key to the provision of this culture of continuous improvement in clinical quality is the involvement of
patients, services users, their families and the public in the design, development and delivery of the
services they use. The health plan outlined in the document ‘Our National Health: a plan for action, a
plan for change’ therefore committed NHS Scotland to giving patients a stronger voice and involving
people and communities in the design and delivery of health services.
PFPI developed the Health Plan commitments into a framework for change that covered the entire
breadth and depth of NHS Scotland.
The White Paper, Partnership for Care25 set out a vision of a patient-focused National Health Service
based on a new partnership between patients and staff. Meeting the challenge of Partnership for Care
means ensuring that whatever the individual circumstances of someone’s life, they have access to the
right health services to meet their needs. This includes their spiritual needs.
The NHS Reform (Scotland) Act 2004, now underpins these Partnership for Care commitments and
places specific duties on NHS Boards to involve the public and promote equality of opportunity. The Act
also provides for the establishment of a Scottish Health Council, with a distinctive identity within NHS
Quality Improvement Scotland. These bodies will quality assure NHS Boards’ delivery of their patient
focus and public involvement commitments on behalf of the people of Scotland.
In relation to spiritual care there is clearly a need for some understanding of spirituality among all health
service staff and the increasingly well understood need for a well trained and professional work force of
chaplains, one of whose main tasks is to teach the breadth of spiritual care and its relationship to all areas
of equality and diversity. The focus over the last three years (2000-2004) has been on understanding and
Report No. CSHD/MR001 Edition 2 17
Context
supporting the development of the chaplains’ role and the development of spiritual care policies in every
Health Board area in Scotland.
Chaplaincy and Spiritual Care also needs the confidence of all faith communities however large or small.
Spiritual Care Committees are being established to support these developments. The representation of
people from all faiths and none is a priority.
Spiritual care guidelines
At the same time and in response to the types of changes and developments highlighted earlier, a steering
group was set up to explore what was required in terms of enabling chaplains to provide effective spiritual
care. This group produced a set of guidelines for good practice in chaplaincy. This process resulted in a
Health Department Letter (HDL) to all Health Boards providing guidance on the development of local
policies, which are being steered and developed by hospital chaplains and other staff; two conferences
aimed at senior Trust management; and the setting up of a Chaplaincy Training and Development and
Spiritual Care Co-ordinating Unit. Each Board is developing local spiritual care policies and these are
being implemented by the chaplains, lead managers and widely representative Spiritual Care committees.
Spirited Scotland
The Scottish Executive Health Department has funded an initiative known as Spirited Scotland which
offers a broad perspective on Spirituality and Health in Scotland. It acts as a networking point, hosts a
website and issues a newsletter. In practical terms it has supported the development of confidence
amongst health and social care staff to deal with spiritual issues by offering educational initiatives within
the Trusts. A newly formed Centre for Spirituality, Health and Disability,at the University of Aberdeen,26 is
also pursuing a research and development agenda that promises to make a significant contribution to the
area of spirituality and health care.
It is clear then that, within Scotland, there is an important movement to take healthcare in directions
which meet the types of spiritual need prevalent within contemporary culture.
The nature of chaplaincy
Traditional chaplaincy
One of the main changes for chaplains relates to the movement from being a specifically religious carer, to
adeliverer of spiritual care, which is defined as distinct from care that is solely focused on religion. It will
be helpful to think this through in relation to the development of the definition of the term ‘chaplain’.
The word chaplain,
‘… refers to a clergyperson who has been commissioned by a faith group or an organisation to provide a
pastoral service in an institution, organisation, or governmental entity. Chaplaincy refers to the general
activity performed by a chaplain, which may include crisis ministry, counselling, sacraments, worship,
education, help in ethical decision-making, staff support, clergy contact and community or church co-
ordination.’ 27
18 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
The chaplain, ordained or otherwise, is thus seen, at least traditionally, to be the representative of a
particular faith community who is sent to work within a specific setting. This has certainly been the case
within the development of hospital chaplaincy in Scotland. Historically full-time Scottish Health Care
chaplaincy has been linked exclusively to the Christian Church. More specifically, the vast majority of full-
time hospital chaplains have been ordained into the ministry of Word and Sacrament within the
Presbyterian Church of Scotland. Chaplaincy is thus seen as a particular mode of ministry emanating
primarily from the Protestant churches, the primary intention being to represent the church within a
healthcare context. This full-time presence has been and continues to be supplemented by part-time
denominational ministers and priests who spend time (paid and voluntary), working within the
hospitals, whilst at the same time maintaining responsibilities within their own parishes.
Until relatively recently, full-time chaplains were employed by the church, but paid by the Health Service
Trusts. Within this arrangement, the chaplain was able to maintain his or her status as minister who
worked directly for the church. The Boards, who were the receivers of chaplaincy services, were
responsible for the financial arrangements. Very few hospitals employed their own chaplains directly. This
tension between the church as employer, and the Health Service as the purchaser and user of chaplaincy
services has, arguably, meant that clear lines of communication, authority, accountability and supervision
have been difficult to establish. In an increasingly bureaucratic, competence-based and accountable
environment, this has been recognised by some as a growing anomaly. There is currently a move to
consider direct employment of chaplains by the NHS. Some chaplains have taken up this option and
discussions continue as to whether or not this should become common practice.
Changes in chaplaincy
Within the context outlined thus far, there are some corresponding fundamental shifts taking place in
both (a) practice and the thinking around the nature and function of chaplaincy; and (b) the meaning of
health and well-being. These shifts are taking place within, and in response to the context of the societal
and political changes discussed above. The shifts relate to the theological and philosophical roots of
chaplaincy, as well as to the forms of the care that is offered by chaplaincy under the banner of ‘spiritual
care’. Chaplaincy’s response to these shifts will determine its development as it moves into the
challenging needs-context of 21st Century Scotland.
The traditional denominationally-oriented model of chaplaincy is being challenged, not only at the
bureaucratic level, but also by the spiritual changes highlighted earlier. A redefinition of the spiritual
positioning of chaplaincy has emerged alongside the general movement from narrowly defined religion,
to ‘spirituality’, understood as a diverse human universal. Chaplains now tend to refer to themselves as
‘spiritual carers’ rather than ministers or religious carers. Departments of ‘spiritual care’ are now
emerging within a number of Trusts, indicating a transition from ‘chaplain’ as defined above, to ‘spiritual
carer’. The meaning of this shift for health care chaplaincy will become clearer as the report progresses.
Healthcare chaplains are now required to think about, interpret and act upon considerably wider
definitions of spiritual care than previously assumed. One of the key questions that chaplains have to
tackle is the issue of what Healthcare chaplaincy actually is, in the midst of the changes and transitions
that are shaping Scottish culture and healthcare practices. The data will tell us something of how
chaplains see their current and changing role and how they are practically managing these changing
horizons.
Report No. CSHD/MR001 Edition 2 19
Context
20 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
Report No. CSHD/MR001 Edition 2 21
Preamble
Qualitative research
The study utilises a qualitative study design.28One of the difficulties that confronts the newcomer to
qualitative research methods is the wide and rather vague definitions of ‘method’ that tend to dominate
the literature. Denzin and Lincoln note that,
‘… the open ended nature of the qualitative research project leads to a perpetual resistance against
attempts to impose a single umbrella-like paradigm over the entire project.’ 29
It may be helpful to think of the qualitative method as one way of seeing and discovering.
In essence qualitative methods render the familiar strange. It is a descriptive method that has an inherent
rigour within the data collection, as well as its own internal logic. This ‘way of seeing’ presupposes
certain assumptions about the nature of reality. It suggests that things are going to be more complicated
than they appear at the outset and that common sense understandings of the world and the reality under
scrutiny, will be challenged by the qualitative research eye.
Data collection and analysis
For this study, three data collection techniques were used, all of which fall within the qualitative research
paradigm. Each set of data was dependent on the previous for guidance. This meant that themes and
codes generated early in the process were then subject to further scrutiny by further data collection. All
the data was recorded by hand rather than tape-recorded. None of the subsequent extracts can be
regarded as direct verbatim quotes. They are part of the research team’s notes. As noted the interpretive
process involved generating themes and subjecting these to further analysis.
Report No. CSHD/MR001 Edition 2 23
The Study Design
The Study Design
Telephone Interviews (1)
Interviews of forty-four full
time health care chaplains in
Scotland.
Use of a four item structure to
guide the interview:
• Personal journey into chaplaincy
– who is the chaplain?
• Typical day of the chaplain
• Working arrangements within
the Trust
• The nature and development
of chaplaincy
Case studies
Observation, interviews and
informal discussions with
chaplains, patients, staff and
family members in three
chaplaincy sites.
Sites were chosen for their
variety and geographical spread.
Sixteen characteristics/
descriptors were identified from
the data and these were given
scores for each chaplaincy site.
Five sites were initially chosen
and three were finally used.
Ethical permission was gained
for the observation case studies.
This took a very long time.
This project was one of the first
to engage in the new system
which involved more paper
work, more screening bodies
and uncertain protocols.
In the end it was practical
to look at three sites and re-
interview. The re-interview was
not in the original protocol but
was indicated by the content
and flow of the research.
Telephone interviews (2)
Second set of interviews with
full time chaplains pursuing
themes derived from telephone
interviews (1) and observational
data.
Themes pursued:
• Leadership
• Professionalisation
• Spiritual needs of patients
• Spiritual needs of chaplains
• Religious and spiritual care
• Spiritual correctness
• Team-working
• Working in institutions
24 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
Confidentiality
None of the chaplains have been identified and neither have the sites of the case studies. Strict
confidentiality has been observed throughout.
A process model of chaplaincy has been developed from this data.
Who are the chaplains?
Basic Characteristics
Table 1 provides a summary of the basic characteristics of the chaplains interviewed.
Gender Average Denomination Years as Previous Qualifications/
chaplain role Training (all ordained)
Total = 44 47.5 33 Church of Scotland 5.35 42/44 had parish BD – 14
3Episcopalian ministry experience Other degrees – 2
1Roman Catholic Other experience Palliative care dip – 6
3Baptist included social Counselling – 7
1Free Church work, teaching, Social work – 3
1 Anglican Bank, industry, PhD – 2
2Methodist personnel, nursing, Masters – 3
working abroad Psychology courses
(bereavement, marriage
guidance, transactional
analysis) – 2
Pastoral studies – 3
Male 48 years 23 Church of Scotland 6 years BD – 7
n=28 (n=24) 1 Episcopalian (n=26) Other degree – 1
(range = 1 Roman Catholic Palliative care – 1
63-38) 1 Baptist Counselling – 5
1Free church Social work – 2
1 Anglican PhD – 1
Master – 2
Psychology – 2
Pastoral studies – 1
Female 47 years 10 Church of Scotland 4.7 years BD – 7
n=16 (n=16) 2 Methodist (n=15) Other degree – 1
(range = 2 Episcopalian Palliative care – 5
62-32) 2 Baptist Counselling – 2
Social work – 1
PhD – 1
Masters – 1
Psychology – 2
Pastoral studies – 2
Report No. CSHD/MR001 Edition 2 25
The Findings
The Findings
26 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
The data clearly indicates the wide-ranging skills and qualifications that chaplains have available. We
might also draw out the following points for reflection:
• The chaplains overwhelmingly belong to the Church of Scotland.
•There are more male chaplains than female.
• The average age is the same between the sexes at 47.
• All but two of the chaplains have had experience of working in a parish.
• Previous work experience is wide ranging and diverse.
• The average length of time people had worked as a full time chaplain was around five years.
• The chaplains had a wide range of qualifications not all of which are directly related to chaplaincy work. However,
courses in counselling bereavement and palliative care were seen as highly relevant. Chaplains had attended day
courses run by SACH and were embarking on or had completed CPE in some cases.
The whole area relating to the formal training of chaplains is currently under review. What this data
confirms is the wide-ranging skills and qualifications available within this group of people.
It has been noted that, at the moment, the majority of chaplains are ministers of the Church of Scotland.
The tensions and complementarities that chaplains highlighted, between the role of the chaplain and the
role of the parish minister help elucidate the nature of chaplaincy. In doing this we will be able to explore
some of the ways that chaplains are beginning to distinguish themselves as professionals with a discrete
mode of ministry that is measurably different from parish ministers.
We recognise that there are chaplains from other denominations and from the Roman Catholic Church
who may not resonate with the idea of ‘parish ministry’. Nevertheless, bearing in mind the historical
roots and contemporary situation of chaplaincy, a comparative exercise such as is presented below would
seem to be appropriate.
Parish ministry and chaplaincy – similarities and differences
In the light of the historical context of chaplaincy, we asked chaplains to describe their role as hospital
chaplains and compare it to other ministry roles they had worked in. All but two of the full-time chaplains
who participated in the study had come from parish ministry. Some had been in the parish for many years.
The chaplains were usually able to make quite clear distinctions between hospital chaplaincy and parish
ministry. On the whole they were very pleased to be in chaplaincy rather than parish ministry.
27 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
Parish
Central figure
‘having to have your finger on the pulse in parish ministry
incase something went pear-shaped’
Int C26, s4.1, p72-75
Understood role
‘Faith community, identity of minister.’
Int C4, s2.4, p16-18
‘Knew you could be isolated in parish ministry but
different kind of isolation … affinity with people, talking
same language, importance of pastoral and spiritual care.
Although people in chaplaincy are supportive, it’s
recognised in parish, you don’t have to work at it.’
Int C17, s4.2, p59
Competitive
‘When he arrived in the parish the local minister phoned
him, wished him well but not that well because if he did
really well it could take people away from his church.’
Int C31, s4.1, p39-41
Agenda
‘Parish ministry is like achieving targets, bums on seats,
like running a business, with falling numbers.’
Int C29, s4.2, p56-57
Meetings
‘More people-centered in chaplaincy. Don’t have building
or finances to worry about. Dealing with people at deeper
level.’
Int C22, s41, p58-59
Chaplaincy
Peripheral figure
‘In Church you may know what is going on but you may
belast person here. Focus is on medical care …’
Int C14, s6.3, p112
Less understood role/isolated
‘In hospital you have to prove yourself more, earn the
respect of people.’
Int C4, s2.4, p16-18
‘In chaplaincy you could be more easily isolated ... Profile
of being a chaplain has to be worked at – can be isolating.’
Int C17, s4.2, p59
Supportive
‘In chaplaincy at beginning there wasn’t week went past
without other chaplains phoning, asking how could they
help.’
Int C31, s4.1, p39-41
Different or no agenda
‘Chaplaincy meets people where they are and better fits
the Gospel picture and ministry of Christ.’
Int H6, s2, p9-11
People
‘More frontline dealing with patients, staff, and families
in time of need.’
Int C2, s4.2, p55
‘More, and deeper conversations here in a week than in a
month in the parish.’
Int C7, s4.3, p59-62
Report No. CSHD/MR001 Edition 2 28
The Findings
29 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
Less able to get away
‘Could have wedding on a Saturday and if that was day
off, half day gone … five phone calls through tea time.’
Int C7, s4.3, p59-62
More control over time
‘To control work as it came in, in a sense, if lots going on,
could go through to study and read some theology books.’
Int C27, s2.2, p14
Longer term contact
‘Parish ministry working in context of longer term
relationships.’
Int C21, s4.1, p40-42
‘See people grow up, marry them, baptize their children.’
Int C1, s6.6, p70-71
More balance
‘In parish, you are obviously working with people in broad
context of home life.’
Int C19, s5.1, p49-50
‘In parish he worked in, buried one child.’
Int C12, s3.12, p66
Church people
‘Not just involved in religious club.’
Int C16, s4.1, p61-62
More office hours
‘Don’t know when had Saturday commitment ... When he
goes home, they phone the switchboard.’
Int C7, s4.3, p59-62
More intense
‘Come in till you go home, constant (at hospital) feeling
like “fire fighting”, responding to need.’
Int C27, s.2.2, p14
‘Time. None of it. In parish ministry time was always a
problem but at least there were elders one could delegate to
(hopefully).’
Int H7, s3.1, p18-20
Shorter term contact
‘Major adjustment in full time chaplaincy, contact much
shorter.’
Int C21, s4.1, p40-42
‘Have to make each encounter count, no second chances.’
Int H2, s5, p37-55
More focus/crisis
‘In hospital, much sharper focus.’
Int C19, s5.1, p49-50
‘Hasn’t a clue now how many child funerals he’s
conducted.’
Int C12, s3.12, p66
Non church people
‘Working in real world, providing service for folk with no
religious faith ... still appreciate and look to chaplain.’
Int C16, s4.1, p61-62
There are some interesting characterisations in this data that may indicate an implicit or overt effort by
chaplains to move away from seeing themselves as parish, church-based ministers, towards a self-
understanding as a distinctive group called “chaplains”. This may well be part of the naturally occurring
process of professionalisation that is well documented in the sociological literature30.Becoming part of a
discrete group (in this case chaplains) requires distinctions such as these to be made, in this case the
unique work of the chaplain as distinct from other forms of ministry. In the light of this it is worth
looking at this table in more detail.
Chaplains are more peripheral than parish ministers
Chaplains said that parish ministers had an identifiable group of people for whom they were responsible:
aparish. They also had a role that was fully legitimised within the context that they ministered. The
chaplains’ perception of the parish minister was that he or she was a central figure within their
community. They also recognised that the boundaries of that community were much narrower than in
previous times and that the authority of the minister was not as strong as previously.
This is an interesting and almost universal distinction found in the data. Yet, the acknowledgement that
parish churches within the Church of Scotland, are called to care for entire communities, both religious
and non-religious, actually suggests a much stronger similarity between the types of people chaplains and
parish ministers are called to serve than there might at first appear to be.
Chaplains are more isolated than parish ministers
Chaplains declared themselves to be isolated within a hospital setting to a greater degree than within the
parish. They were often seen as and felt themselves to be optional extras within a medical setting, with
their perceived place within the healthcare team much less clear or well established than the role of the
parish minister within the parish.
However, as mentioned, the remit of the Church of Scotland parish minister makes them responsible for
every person within the parish boundary. In reality of course, it is only a small number of people who
actually engage with parish ministers. Similarly, the role of the chaplain is, in principle, to care for the
spiritual needs of everyone within the healthcare system. However, in reality, it is a relatively small
number of people with whom chaplains engage. Both chaplains and parish ministers are in different ways
marginalized and over-stretched and for similar reasons: their given task is impossible to fulfil which
leads to a lack of a sense of fulfilment and the achievement of goals.
Chaplains have a different agenda to parish ministers
Chaplains felt they had a different agenda to that of the parish minister. The primary task of the chaplain
was reported as a more general focus on ‘spiritual needs’, a focus which chaplains suggested does not
require overt proclamation of specific religious beliefs. Some chaplains suggested that their work was
agenda-free, and that the nature of their discrete profession could be identified by its agenda-free basis.
The primary task of parish ministers within the Church of Scotland is to proclaim the gospel, administer
the Word and the Sacraments, and to enable people to find a meaningful spiritual home within their
particular congregation. These are primarily religious needs. When one considers the extensive
theological training that chaplains have gone through, it becomes apparent that understanding
themselves as an agenda – free profession is problematic. Social science, philosophy and the discipline of
Report No. CSHD/MR001 Edition 2 30
The Findings
hermeneutics have cast some considerable doubt on the idea that any form of human practice can be
‘agenda-free’. All of us approach any and every situation with a set of assumptions and a world-view
which is shaped by our personal and social histories. Whether implicitly or explicitly, religion is a
powerful shaper of world views; as is humanism, secularism etc. Nevertheless, the distinction made by
the chaplains between chaplaincy and parish ministry over this issue is clear.
It is equally true that the distinction between these two modes of ministry is increasingly unclear; in
theory parish ministers focus on people’s religious needs, and chaplains focus on the spiritual needs.
However in practice, parish ministry involves listening to and reflecting on the religious and spiritual
needs of parishioners (although they may not be articulated in these terms). A good parish minister will
attempt to be inclusive and take care and trouble to listen to the religious and spiritual needs of his/her
parishioners in a similar way to the way that hospital chaplains do. The jobs are perceived as significantly
different, but in practice, the differences are not as great as some chaplains assumed them to be.
Chaplains are less burdened with administrative tasks than parish ministers
Anumber of chaplains applauded the freedom chaplains have from certain administrative and financial
aspects of parish ministry. Chaplaincy was perceived to be liberating and much less bureaucratic.
However, the increasing administrative burden now placed on chaplains, as they become a more
recognisable group within the health care setting, appears to be impinging on this freedom. This is
discussed later.
Chaplains’ encounters are more short term than parish ministers
Chaplains thought that they operated in the shorter term than their parish minister counterparts. They
felt that this led to more profound and urgent discussions between chaplains and patients or staff than
had been the case in their roles as parish Ministers. The patient-chaplain encounter could be very brief
indeed. The parish minister’s encounter with people is much more committed and longer term.
Chaplains can escape the ‘role’ more easily than parish ministers
Whilst the chaplains thought their role was more intense, it was also thought to be easier to escape from
than the role of ‘minister.’ Their experience of parish ministry was that they were always “available”. The
chaplains thought that, on balance, they had more time for relationships than the parish minister.
The myth of difference?
In the data, chaplains present themselves as having a distinctive position as clergy, separate from parish
ministry and operating on the axis of spirituality and religion. They are charged with responding to both
religious and spiritual need. Whilst it is clear from the data why they think that their role is quite distinct
from parish ministry, it is not completely clear that this distinction stands up to scrutiny. This “myth of
difference” may be a useful device to establish their own credentials, but the situation is in fact more
complex than some seemed to assume.
31 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
Report No. CSHD/MR001 Edition 2 32
Preamble
33 Report No. CSHD/MR001 Edition 2
Aprocess model of chaplaincy
This model, expressed in diagrammatic form below, is derived from the chaplains’ responses to the two
interviews, combined with analysis of the data collected from the case studies. The model indicates that
the core task of chaplaincy relates to the meeting of spiritual needs as they are defined and expressed by
individuals with whom the chaplain comes into contact. That chaplaincy is needs-led is no great surprise
in itself. The crucial question is whether the implicit institutional definition of spiritual need as generic
and non-denominational is the actual definition used by patients, staff and chaplains. What is therefore
of greater interest in this model is the means by which the core task is pursued. The “how” defines the
task. If we know how spiritual needs are met we can understand how different groups define and
negotiate spiritual need and what competencies are required to do this negotiation.
The task of meeting spiritual needs is facilitated through the process of the chaplain seeking out people
who require their services, identifying the nature of the particular need, and responding to that need
through forms of spiritual practice, some of which are informed by the chaplains’ theological and spiritual
tradition, but others that call for chaplains to expand on and move beyond this core knowledge base.
This process requires certain skills, structures and modes of approach. The mechanism for finding people
who have spiritual needs, as described by the chaplains, range from serendipity (finding something
unexpected and useful while searching for something else entirely) to fixed, formal visiting. The
“antennae” to spot the serendipitous opportunity and the staying power to engage in it are important
chaplaincy skills. The way in which needs that are deemed specifically ‘spiritual’ are identified from this
group of needy individuals, draws on the particular skills of chaplaincy which include spiritual
intelligence,31 emotional intelligence,32 the ability to be with someone in a meaningful way (presencing),
the ability to build meaningful relationships in a short period of time, religious, spiritual, personal and
professional experience and the art of prayerful listening. These are noted by the chaplains as some of
their core skills. For many chaplains the inspiration and power for their work was viewed as coming from
an external source: the Holy Spirit. The Holy Spirit, or the Spirit of God, is of course a vital dimension of
the Christian understanding of the way that God is at work in the world. For chaplains to suggest that
their work is inspired by the Holy Spirit reflects the common acknowledgement that whilst called to meet
the general spiritual needs of patients and staff, the underlying personal motivation for their caring
actions emerges from their own Christian faith. It is this spiritual focus rather than a clinical one, and the
spiritual skills which inhabit it, that offers chaplains a unique place within the healthcare team.
What do Chaplains do?
What do Chaplains do?
Report No. CSHD/MR001 Edition 2 34
Preamble
The core task:
Seeking people who need them
Identifying the nature of the need
Responding to the need through theological and spiritual praxis
HOW?
Seeking people Responding to needIdentifying the nature of needs
Being around
Creative loitering
Apportionment
Prioritising
Rotations
Staff referral
Delegation – proxy
Lists – pre selection
Hierarchy of needs
Grounded own faith
No clinical agenda
Experience
Empathy
Talking and listening
Relationship
Practical tasks
Dependence
Referral onwards
Emotional and
spiritual intelligence
Experience
Listening
Prayer
Holy Spirit
Spiritual antennae
Necessary
Conditions to maximise
corefunctions?
•Spiritual neutrality
•Structural Acceptance
by Health Care Institution
•Leadership
•Professional status
•Teamwork
•Committee work
•Championing Chaplaincy
Challenges
and potential barriers
to core function?
35 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
The Core Tasks – seeking, identifying and responding to need
That the core task of chaplaincy is finding and responding to spiritual need is unsurprising. It is similar
to arguing that the core task of the medical doctor is to identify and treat those who are sick. The
interesting and unique insight lies in the methods, the “how”, as depicted in the model. Again there are
parallels with doctors. The methods of the medical task in helping the sick are in themselves part of the
core task. The methods of chaplains in performing the core tasks to some extent determine the core task.
We will therefore look at how chaplains seek, identify and respond to need.
Below we describe the different circumstances, methods and mechanisms by which chaplains seek
spiritual need.
Seeking Spiritual Need
Spiritual need resides in individuals. In hospitals staff, patients, relatives and friends are all therefore
potential “sites” of spiritual need. Somehow chaplains are required to capture spiritual need as it
fleetingly emerges from individuals.
Acentral part of a typical day relates to what could be called, “need-seeking”. The nature of these needs
is discussed later. Chaplains work on the premise that there are particular spiritual needs within the
patient and staff population, and their role is to uncover such needs. The process of “need-seeking” varies
from hospital to hospital and from chaplain to chaplain and is dependant on a number of variables – the
system by which admission information is distributed, the attitude of the hospital management team to
chaplaincy per se, the attitude of both the ward consultants and the nurse managers, the personality of
the chaplain, the historical role of chaplaincy within particular areas – all of which is filtered to the
chaplains in a variety of forms. This “formal” need-seeking process can then lead into other contacts
developing, literally along the way to the ward. Crucial to this process of need-seeking is the attitude of
staff to chaplaincy. The attitude of staff will, to a greater or lesser extent enable or hinder the role and
function of the chaplain. Other studies on chaplaincy have made similar observations.33
This being so a key chaplaincy skill is the ability of the chaplain to develop strong, meaningful and communicative
relationships with healthcare professionals.Without such relationships chaplains cannot function effectively.
Some teams seem to operate an informal system of prioritising wards and patients. Sudden death or great
trauma tends to be treated as most urgent. Care for mothers and ill children, those who are dying and
children who have died is a very important area for chaplains. Again, such things as baby care and special
baby care units, intensive care and oncology are also seen as chaplaincy priorities. Such allocation and
prioritisation has certain logistical difficulties. For example, the area of oncology is difficult for chaplains
to manage because the patients’ “illness-journey” takes them all over the hospital depending on the
nature of the cancer. For the chaplain to effectively follow this journey requires an awareness by staff of
the significance of chaplaincy, and a willingness to refer patients to the chaplain. This again emphasises
the important chaplaincy task of developing effective communicative relationships.
Chaplains deploy a number of strategies to find and manage spiritual need. Chaplains know where to go
to collect spiritual need. They are conscious of the spiritual needs of the staff and devise strategies to get
to know staff better. Some make a point of lunching in the staff canteen and moving around staff spaces
in the hospital, like the desks on the wards.
Report No. CSHD/MR001 Edition 2 36
What do Chaplains do?
However, the ways in which chaplains create and manage their workloads both as individuals and as
teams varies from context to context. Some chaplaincy teams apportion specific responsibility for
particular areas, thus enabling individual chaplains to build up an area of specialist expertise. In smaller
hospitals the workload is managed in more general ways, with chaplains having mutual responsibility for
visiting all of the wards.
The “endless” nature of chaplaincy
Chaplains are never short of something to do! Even if there are not overt requests for their help, the task
of chaplaincy continues in other forms. Chaplains need only to walk down the corridor and they may be
engaged in a significant encounter. Even an apparently straightforward information-sharing conversation
with a colleague can become a pastoral experience. An example from Site 3 will help make this point.
When a colleague was having a bad day, the chaplain went to chat about something they were both
involved in. The colleague was tearful and spoke with him in depth about personal and professional
issues that were impacting on her life. The chaplain did not think she would have phoned him, if he
hadn’t been there at the time. The reactive nature of this type of chaplaincy is apparent. So also is the
potential for the chaplain to create a huge workload. In Site 1 the chaplaincy was developing good
relationships with the renal unit and the potential for over-extending the chaplains’ abilities to respond
were very real. By being available in this way, not only to colleagues but to all healthcare professionals,
patients and their families, there is a danger that chaplaincy work can become potentially never-ending.
There are issues around chaplains proactively generating work. This raises important pastoral issues in
relation to the health and well-being of chaplains themselves, and the boundaries of their remit within
particular contexts.
In the first set of interviews chaplains were asked to describe their typical day. The typical day was also
reflected on during the case studies. The most striking thing about their responses was that they found
it difficult to offer an account of a standard routinised day. Their descriptions demonstrated the
independent and somewhat reactive nature of their day-to-day activity. The language used to describe the
days reflects this reactive element.
Being around
Tied in with this is the chaplains expressed desire to “be around”. Chaplains view a central aspect of their
task as relating to their availability to people, both staff and patients. Consequently great emphasis is
placed on their being around and getting known. People may not automatically think of phoning the
chaplain, but they will use them if they happen to come across them, or if the chaplain comes onto the ward.
She (chaplain) may go into the ward and they may say glad you’re here, so and so has had a bad time. They
may say they were going to phone … but she didn’t think they would have. This is a kind of referral. ‘What
is a real referral?’ she wondered.
Field Notes Site C
…it’s like the notice in the toilets “now wash your hands” – people may see her and think, oh yes, spiritual
carefor that person.
C9 /1
37 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
The data has suggested that chaplains differ widely in the way they place themselves within the hospital
and make themselves available to staff, patients and relatives. The idea that chaplains simply roam the
hospital looking for work is not quite accurate. Whilst many chaplains do “roam”, and talk about having
periods of time when they are “paddling around” or going to “places where people are” these casual
roamings are usually quite carefully planned. In fact much of the typical day is taken up with pre-
structured visiting, and visiting people who have requested a visit. The serendipity of finding people
“along the way” who want to talk is part of the job but not the whole.
We will now look in more detail at the nature of the needs to which chaplains respond.
Identifying Spiritual Need
Having found spiritual need, chaplains are required to identify the nature of the expressed need before
they offer an authentic and effective response.
Religious or spiritual care needs
Chaplaincy is characterised by both spiritual and religious care giving. The balance of these care-giving
activities has shifted over the years for the reasons outlined earlier in this report. It is the language of the
“new universal spirituality” which provides the common currency for the professional discourse of
chaplaincy. The changes and ongoing transitions within chaplaincy that were described in both sets of
interviews, show the degree to which chaplaincy has taken up this universal spiritual care agenda and
how it has become formalised into the professional identity of chaplains.
One respondent noted that,
Chaplaincy has gone through a paradigm shift. The focus is no longer on religious care but on spiritual care.
Int C5, s2.1, p9
Religion remains significant; however it is now located primarily within the private lives of chaplains
rather than within the public practice of chaplaincy. There was also a general feeling that the,
‘Christian bit is really important. Spirituality is important too, but, mustn’t lose the other bit’.
Int C34, s4, p70-73
These extracts seem to encapsulate something of the complicated and sometimes confused thinking
around the relationship between spiritual care and religious care. There is no doubt that chaplains, and
in particular full time chaplains, are now expected to “deliver” spiritual care. This is fleshed out by one
respondent thus:
Religious care is meeting people’s religious needs, in terms of service and sacraments. Spiritual care, much
more person-centred, relates to what makes you tick, feelings, emotions, big questions, meaning. There is
across over if you are Christian. Religious ritual can be empty, sometimes there is more depth to
spirituality than religious ritual.
Int C29, s3.10, p45
Report No. CSHD/MR001 Edition 2 38
What do Chaplains do?
The comments of this particular chaplain echo the experiences of many people we engaged with:
…spiritual care is acknowledging that the person you are speaking to is a spiritual person, with spiritual
needs, these needs being manifested by first order questions; why is this happening? How am I going to
cope ... Part of that is to understand their search in life, their understanding … What they’ve made of God,
within their own religious context, faith, spiritual aspect ...
Int C17, s5.6, p83-86
The shift towards spiritual care and away from solely religious care is evident in the way in which the
nature of chaplaincy has developed between interview one and two. The guidelines issued in the Health
Directive Letter34 have precipitated a further movement into spiritual care. The requirement to set up
spiritual care departments and the possibility of changing the name of the chaplain to ‘spiritual care giver’
has provided a bureaucratic nudge to an increasing trend. This is a very significant departure from the
traditional position of chaplain as Christian minister, and has raised some dilemmas for chaplains who
see themselves first and foremost as Christian ministers. Spiritual ministers tend a much wider
constituency or at least have a broader remit. Others have said that they like the breadth of the guidelines,
their inclusivity and the fact that it is not just a Christian or sacramental agenda, but a wider spiritual
care agenda.
The religious care provided by chaplains is characterised by the delivery of formal services such as
funerals, bible reading, prayer and discussions about God and faith and the administration of the
sacraments such as baptism and the administration of the Eucharist. However the delivery of religious
care in hospitals is sometimes quite different from the way it is carried out in parish settings. What often
occurs is a non-traditional delivery of traditional religious rites and rituals.
Religious care is still an integral and important part of chaplaincy, and appears to involve a reasonable
amount of a chaplain’s time. Some particular groups of people, older people for example, may be the
recipients of more obvious religious care at their request. Religious care may be requested when
chaplains are specifically called out. This is particularly so in maternity and children’s hospitals when
babies may have been still born or are seriously ill. There may be something distinct about the chaplain’s
role as the bearer of religious narratives that despite the spiritual changes in society, people identify with
and continue to value.
Chaplains may also facilitate religious care for individuals by contacting their minister, priest, rabbi,
imam etc, if the patient wishes. Chaplains may also be seen to have knowledge of, or at least be a starting
point for information about religious issues. An example of this in one of the case studies was a chaplain
who was approached by a couple of different staff members about a patient on the ward who was a
Jehovah’s Witness and asked to facilitate appropriate religious support.
The needs-led service culture
The movement towards needs-led services expressed in both health and social care legislation35 and
manifest in Scotland recently in the patient focus public involvement strategy36 constantly runs up against
the difficulties of professional expertise, legal requirements of practice and limited resources. The idea of
needs-led services is often tempered considerably in practice by the reality of the availability of service,
the availability of skill and a realistic knowledge of real needs.37 Chaplaincy is arguably one of the few
roles within the hospital that could truly be needs-led. Its declared central concern is to be needs-led and
patient-centred. There may be a tension here with the other central concern, as ministers of the church,
39 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
to love and to serve God and to enable others to do the same. This task implies the possibility of creating
new needs and perhaps challenging expressed needs, rather than simply responding to declared needs.
Once again, the question is raised as to how far chaplains see themselves as ministers of the church; and
if they do, what kind of theology underpins their needs-led responses?
Ifchaplaincy sees itself as a profession that has no remit other than to meet spiritual need in a way that
is universally meaningful to the needer, must we conclude that spiritual need is anything that the needer
says it is? Are there moral boundaries that define acceptable and unacceptable forms of spirituality? If
there are, does this mean that spiritual need must be interpreted by the spiritual caregiver, and in effect
triaged into different categories?
We have already noted that the chaplains tended to make a distinction between spiritual and religious
forms of need. Some saw spiritual care as ‘a-religious’ in practice. Their work is motivated by their
Christian faith but their practice is not necessarily specifically Christian. This raises some important
issues relating to what it means for a chaplain to be a healthcare professional in the technical sense of this
word. If chaplains perceive themselves to be providing ‘spiritual care’ which is self consciously not linked
to a religious tradition, and which downplays the professional significance of ordination, then clearly
chaplaincy is a job that can be performed by anyone with expertise in ‘spirituality’ broadly defined.
It also raises the question as to what specific expertise chaplains are called to offer. Chaplains, like the
majority of healthcare employees, are employed on the basis of their task specific expertise. The porter is
employed to port, the cleaner to clean and the nurse to nurse. Specialisation is part of modern
industrialisation. Specialisation means that tasks and professional expertise are minutely defined as part
of the value for money trend. These tasks and discrete activities are carried out by people who are deemed
“competent” in that area. Chaplains therefore have to find a specialist area that is identifiable as the
specialist area for chaplains. This is potentially in direct contrast to the idea that spiritual need and
spiritual care is the province of all. A similar debate is going on in nursing. Denominational religious care
is much easier to specialise in than universal spiritual care. The spiritual caregiving chaplain administers
spiritual support to anybody who says they need it in any way that they have defined it. This is an
unsatisfactory way to proceed given the set up of the NHS. It is a challenge for chaplains to both find
their niche and to preserve their free floating eye.
As shown, the data is able to tell us something of the way in which the chaplains “find their work”, that
is, the way they find people with whom to work. It also tells us how the chaplains define the needs of
patients. Together, the following two sections tell us the core task of chaplaincy. They also tell us
something of how spiritual care and religious care are seen as points on a continuum.
What needs do patients present to chaplains?
The data on patient need is drawn from the second set of interviews wherein the question was asked
directly, from the ‘typical day’ data collected in the first set of interviews and from the patient interviews
throughout the three case studies (n=21).
Patients and staff define spiritual need partly in terms of the methods utilised in meeting the need. So,
such things as talking and listening are seen as both ways of identifying need, and modes of responding
to it.
Report No. CSHD/MR001 Edition 2 40
What do Chaplains do?
The patients spoken to assumed that chaplains would speak to anyone and that a major part of the
chaplain’s role was to offer comfort, to talk and to encourage people in times of distress and concern.
She thought that them coming into the wards could encourage other people too – them coming in with cheer.
Int P3 – 2 December 2003
Patients tended to make a fairly clear association between chaplains and religion. Some were clear that
they did not need to see or want to see a chaplain because they were not religious. However they
understood and accepted that other people might want to see a chaplain.
He thought that the chaplain provides the same kinds of services as he does on the outside, folk who need
him, want him, folk who are really ill, can comfort relatives. He said there were also religious services that
you could attend that were non-denominational.
Int CP1 – 24 November
He thought that the chaplain played an essential part for some people ... Those of own faith, people
needing comfort, people to talk to. People may not be fit enough to go to services. He didn’t think the
chaplain would be interested if they were an atheist. Said they were ‘there to do a job’. Part of this was
listening. He thought a lot of people would take heart from this, someone who cares. He said there was a
lot of death on this ward; he thought chaplains would attend to families.
Int CP1, Paragraph 14
She spoke of a minister doing a service for people who may not know who you are or who they are but when
there is a service, there is a reaction, something is touching them inside.
Patient’s expressed spiritual needs seem to fall into four main categories:
• religious and sacramental
• existential
• teleological
• practical
Sometimes all four categories were expressed at once, or one led naturally into another.
Religious/sacramental needs
These needs were specifically identified as they related to an active, practicing faith. Patients wanted to
pray,read from Scripture, take communion, worship, read the liturgy, and/or have the clergyman/
chaplain perform a recognisable religious rite for them or with them. These overtly religiously oriented
spiritual needs are perhaps the easiest to identify and meet. It is interesting to note that these services,
in a sense, belong to the “religious paradigm” of chaplaincy, which continues to exist alongside the
emerging ‘spiritual’ paradigm. Such a continuation and merging of paradigms is very much in line with
the literature which seeks to explore the nature of paradigms and paradigm shifts. It seems that chaplains
are experiencing paradigm tension which is a necessary precursor of paradigm shifts.38
41 Report No. CSHD/MR001 Edition 2
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Existential need
This expression of need comes out of a situation in which the patients find themselves challenged as to
the meaning of their life and/or their illness experience. As people begin to experience themselves
differently through the experience of illness (“I’m not feeling myself today”), so they begin to recognise
and ask questions which otherwise might not be asked.
The chaplain was there at this time of existential crisis and change, to talk and to ponder with the patient
on deep questions of meaning. Patients felt that when in hospital their search for meaning in what was
happening became acute. The chaplain’s task was to work with the patient to help him or her to find that
meaning, even if the person was not religious.
Most of the patients interviewed confirmed the disorientation felt on entering hospital and being ill.
Being ill requires, as we have already noted, a serious adjustment in the mind of the ill person. This is
not always welcome and this adjustment is expressed via a number of different psychological states –
anger, sadness, fear and so on.
He thought that people needed more care after diagnosis and the family too. There’s still a dimension both
psychological/spiritual. He later said that there was more than the psychological dimension, it doesn’t give
strength or comfort, it gives explanation.
Int P3 – 24 November 2003, Paragraph 12
The chaplains are thus seen to have an important role as interpreters and translators of experience, who
seek to help people explain and understand the answers to their existential questions. The importance of
this existential dimension was supported by responses from the chaplains.
Spiritual needs have a transcendent element, an element of existential stuff – who I am, why am I here,
issues of meaning and being; frightening questions that none of us fully examine. Part of our role is to help
people find meaning in what is happening. Spirituality is what the person thinks it is.
Document 2nd Int C36 – 4 March 04, Paragraph 180
Teleological need
By ‘teleology’ we mean a belief that life and/or particular events are perceived as having a purposeful
development toward a meaningful end. This idea suggests that there is evidence of purpose of design in
the universe and within personal experience. Questions of teleology tend to revolve around some concept
of God or transcendent power. Teleological needs were often expressed by deliberate reference to God’s
actions and responsibilities in the world in general, and in the particular experience of patients. The very
presence of the chaplain (at least when understood as the bearer of a religious narrative), often prompts
some form of teleological discussion, partly because both staff and patients assume that that is what the
chaplain is there to do. Examples here are questions such as “Why is God punishing me?” “What have I
done to deserve this?” “Does God love me?”. However, with the movement towards chaplains as spiritual
carers in the more general sense, wherein the religious narratives have less explanatory power, and where
understandings of spirituality do not demand transcendence, it may be that this role as teleological guide
becomes less significant in the work of the chaplain. Alternatively, the teleological role may change in a
way that makes the chaplain a type of “life-coach”, whose primary task is to help patients answer
teleological questions without any reference to the supernatural.
Report No. CSHD/MR001 Edition 2 42
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Practical need
This refers to issues that worry patients as they move from their normal roles into the role of patient.
Here there are practical worries that require some help. These can include looking after children, securing
aperson’s possessions and housing, informing neighbours and family of their current position, getting
help to look after pets, financial safety and so forth.
Ahierarchy of needs?
The chaplains seem to understand spiritual need as being about exploring the questions surrounding the
meaning of life, questions which are triggered by the experience of illness and which confront individuals
and families with questions about meaning which are not always comfortable or welcome.
The implication in the data is that the more serious the illness, the more pressing the spiritual need.
David Mitchell’s39 study suggests that there are three types of need which are prioritised by chaplains:
• baby deaths or grave illness
• cancer deaths – sudden or untimely
• traumatic emergencies where death or utterly life changing events are a possibility
These three situations were most commonly discussed and clearly prioritised by the chaplains in this
study. Whilst chaplains are clearly sensitive to spiritual needs in general, it appears that these “loud
shouts” for spiritual help are heard most acutely by the chaplains.
An extract from the case study material offers some support to this suggestion:
Chaplains believe that all patients have spiritual needs and that at some time or other many patients will
wish to use chaplaincy. Staff saw chaplaincy very much as a service when in need, interventionist, ongoing
supportive until the need subsides. Chaplains would like to be in a position to offer more long-standing
support to those they had contact with but felt unable to do so because of time commitments. When a
patient is distressed, needs a ritual, bereavement, funeral arrangement, needs counselling, or when staff
are low, having family problems, or having just experienced a trauma on ward.
Staff recognise the spiritual needs of patients as a dictum they have learned at college, but less than half
of staff spoken to could actually describe generalised spiritual needs of individual patients, and constantly
merged spiritual with religious need, only seeing specific needs such as a patient’s need to go to church and
to have communion.
Staff indicated that chaplains were there to support staff as well. This was always a reflected support –
other folk may need that sort of thing. Spiritual needs were equated with emotional breakdown,
bereavement crises. Generalised spiritual need, or ongoing spiritual support were not part of the health
care workers’ vocabulary, either for themselves or for their patients. They tended to see spiritual care as a
form of intervention in crises. Chaplains also described their spiritual care services in these terms.
S2, p21
43 Report No. CSHD/MR001 Edition 2
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Chaplains’ own spiritual needs
The importance for the chaplains of meeting their own spiritual needs cannot be overstated. The
following extract is a strong version of what was said by many:
Chaplains are often verbal and conceptual prostitutes selling what they have in the shape and wares that
the client wants ... We need support and integrity. There is a danger, with the rush towards a new
spirituality, that chaplains will be even further forced to become all things to all people, and lose what they
are in themselves.
2/H/DG
One respondent said that “chaplains are carrying the sadness of others” and that this requires support and
debriefing. There is a move to organise supervision for chaplains either within the Trust or outwith, and
some chaplains also take counselling support on a regular basis. However there is as yet no requirement
for this. The experience and use of supervision across the respondents was varied. Some people felt
extremely isolated and vulnerable and others had good support and felt much comfort as a result.
Although chaplains deal in the currency of spiritual need and distress, many found it hard to articulate
their own spiritual needs. The frequency with which this question was answered by an account of how
they sought support and the nature of that support – friendship, counselling, team days away, religious
services – perhaps reflects both the pressure chaplains feel to always be the strength in the midst of pain.
It may also be indicative of the close connection between need and need-meeting. Admitting to and
dealing with the experience of vulnerability is not easy for any profession, least of all for a profession
whose task is to hold the vulnerability of others.
Chaplains utilised various support mechanisms to provide for their needs. As we have seen, chaplains
identified an overwhelming need to feel grounded and assured in their personal faith. They felt that their
work would be very difficult without a faith-based foundation. They therefore looked for opportunities to
strengthen their faith. This meant trying to put aside time for reading, praying and reflection. It also
meant continuing to look for God’s work in the actions and situations in which they found themselves.
The importance of a place to worship and to be themselves and not the chaplain was also expressed. Some
chaplains worshiped at a local church, others sought their worship through groups, others through
reflection on their connection with nature.
The data suggests that chaplains also found some spiritual sustenance through their encounters with
patients. There was a recognised reciprocity within the dialogues between patients and chaplains.
Iget tremendous satisfaction from what I do ... The very work meets some of my needs as a person.
2/H
They also looked for support from family and many mentioned supportive wives or husbands upon whom
they could depend. The power of the confiding relationship and the experience of love is strongly evident
in the lives of the chaplains.
Ineed to be able to say I love you. Being able to express and understand the gift of love as the most essential
human-divine gift.
2/H
Report No. CSHD/MR001 Edition 2 44
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Some chaplains were part of a local Church in which they were “simply” a parishioner. Others chose
other forms of worship which included walking, engaging in nature, listening to music and personal
prayer time – often a combination of both.
There was also a need to feel that their faith was growing and becoming more solid. This was expressed
often in terms of growing into the Christian virtues of love, peace and faith. Chaplains used such things
as meditation, self reflection and reading spiritual texts to help themselves become and remain spiritually
grounded.
“Being present in the present moment, not over-concerned about the future.” 2/C27
Another condition (suggested by the model) that maximises core functions is the structural acceptance
of the chaplains as part of the mainstream organisation. This implies in turn some kind of understanding
of leadership, professional status, and involvement in working in teams.
Responding to need
The chaplains employ a number of key skills based on their experience and expert knowledge.
Listening
Askill that was mentioned almost universally during the interviews was that of listening.The act of
unconditional, non-judgemental and, most importantly, non-clinical listening provided an opportunity for
patients and staff to express and explore their spiritual selves in ways that are unavailable in many other
professional contexts.
The separation of clinical and non-clinical listening is important. The clinical relationship between doctor
and patient is increasingly based on the idea of partnership.The doctor and patient negotiate the most
beneficial treatment for a successful outcome. The meaning and expectation of ‘outcomes’ is also open
for negotiation. Chaplains, however, are not in partnership with the patient, at least not in the same kind
of way. The patient does not have the same expectations regarding outcomes. The ‘outcome’ of chaplaincy
encounters is much more diffuse than that of the medical encounter. The outcome of developing a
relationship with God or a person’s inner self is much less easy to negotiate, and expectations of outcome
much more diverse.
Use of theological knowledge and expertise
The chaplain assists this process of self-exploration through careful listening and the use of expert and
informed theological knowledge, derived from their specific training and experience. If we understand
theology, loosely, as the theory of God that underpins, guides and shapes Christian ministry and practice,
it becomes obvious why this would be so. It is certainly true that the chaplains used and interpreted their
theological understandings in very diffuse ways. Nevertheless, there were some core understandings of
God, church, and the nature and purpose of ministry that underpinned the majority of the chaplains’
experiences and practices. There was a clear view amongst the chaplains that expertise within the realm
of theology (broadly defined) was of importance, and distinguishable as a particular skill. This of course
raises the question of how chaplaincy might change as the theoretical basis for the profession expands,
and people of other faiths and none become chaplains.
45 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
Helping
Chaplains provided help as part of a ‘good neighbour’ process. As we have seen, the chaplain’s skill base
is broad, with chaplains being able to provide help in a variety of ways that, in many ways, cross
traditional health service boundaries. The act of ‘helping,’ is itself a spiritual process that can be a
precursor for, and a facilitator of, conversations that relate to the fostering of a sense of ‘spiritual
etiquette’ and support. It is also linked to the chaplains’ own spiritual needs and how the meeting of
these needs sustains them in their work. Both of these points are discussed below.
Showing dependence and vulnerability
Chaplains perceived themselves as dependent on others for such things as:
• receiving referrals
• requests for help
• requests for prayers
• gaining access to wards
Chaplains thus find themselves in a different position from, for example, doctors, who have a position of
relative power and independence. Chaplains approach their task from a position of dependence and
vulnerability.
Chaplaincy therefore has to be understood and managed in this reactive, dependant context that creates
aworking environment frequently characterised by vulnerability, pressure and lack of structure. This
being so, what chaplains actually do, their primary tasks, are inextricably bound up with the process
through which they find their primary “work”.
Structuring daily tasks
Nevertheless, whilst the chaplain’s day may be primarily reactive, there are certain identifiable common
daily structures and tasks.
Summary of Range of Tasks
Services and
Prayer sacraments Faith Issues Administration Meetings/committee work
Teaching Talks Work outwith Supervision On call
the hospitals and support
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Of these formal structures, the on-call was highlighted as particularly significant. “On call” (being off
duty, but with the potential to be called in if required), was invariably mentioned. Being on call varies
enormously amongst the chaplains and ranges from those who are rarely on call and rarely called out at
all, to those who are on call all of the time and who are called out frequently. This related to both full-
time and part time chaplains.1
Whether or not a chaplain was called out tended to depend on how tuned in the staff within particular
wards and units were as to the role of the chaplain. Attention to on call was perceived as a significant
dimension of a chaplain’s typical day.
Administration
The chaplain’s day involved varying levels of administrative work. This includes such things as answering
phones, dealing with answerphone messages, writing and answering letters and emails, planning the
logistics of services, training sessions, volunteer assistance and so forth. Some of this is related to clinical
and teaching issues, in particular to the area of bereavement, which is commonly seen as a chaplain’s
special domain. Likewise the growing interest in ‘spiritual needs’ across the disciplines has generated the
beginnings of a teaching agenda for chaplains. There is thus, much non-direct patient work implicit in
this administrative work.
There are some chaplaincy units that have secretarial support while others have none. Some chaplains
have linked offices in a physical unit close to the chapel or quiet room of the hospital; others have
individual offices within formal administration blocks. The administrative and hospital structural work
eats into the time that chaplains have to deal with the types of issues we have highlighted as core to the
role of chaplaincy.
Some chaplains have a structured approach to administration which enables them to allocate specific time
and not go beyond that. Others treat it in a more ad hoc manner. The danger in the latter is that
administration can begin to take precedence over patient contact. The way in which the administrative
dimension is structured and carried out depends on the team structure and number of chaplains in the
team. Either way, it is clear that paper work is seen to be increasing. This was recognised as a potential
and an actual problem for chaplains.
1For example, part-time Roman Catholic priests who worked alongside full-time chaplains were most
commonly called out to administer sacraments; whereas part-time Protestant chaplains were rarely called
out. The Roman Catholic chaplains are denominational chaplains. Denominational and part time
chaplains are a key part of chaplaincy but have not been the focus of this study. The case studies picked
up some information from denominational chaplains, but most of what has been learned has been
through the interviews and contact with whole-time chaplains.
47 Report No. CSHD/MR001 Edition 2
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The necessary conditions for chaplaincy to thrive
We have looked in some detail at the core tasks performed by chaplains and the way in which they carry
them out. We have called this a process model of chaplaincy.
Wenow turn to the conditions by which the chaplains can maximise their effectiveness within these core
tasks. The paradox highlighted by the process model is that the conditions that maximise the practice of
chaplaincy are the same conditions that constrain them in their work. This situation is explored more
fully below.
Spiritual neutrality
Adominant discussion within the spirituality and healthcare debate as it relates to chaplaincy has to do
with the importance of spiritual neutrality.Chaplains believe that spiritual care has to be available to
people of ‘all faiths and none’. The Chaplaincy Guidelines are quite clear on this subject and the
sensitivities surrounding these issues are well recorded.40The majority of full-time chaplains in Scotland
are ordained Christian ministers. We have seen that staff and patients tend to assume the task of
chaplaincy to be the delivery of religious care to support patients. This being so, there is a clear tension
between the chaplain’s vocation and training within religious structures, staff and patients’ implicit and
explicit assumptions, and the political ideal of ‘spiritual neutrality’. Arguably, what we find here is
chaplains developing an implicit form of spiritual correctness which is comparable to the idea of political
correctness. Political correctness has of course been a very useful concept used in the process of
sensitizing our society to the implicit prejudices it shows towards certain groups (women, people of
colour, people with disabilities etc). This prejudice is present in the language we use, the attitudes we
have and the social structures we create which make equality and inclusive citizenship problematic for
these groups. ‘Spiritual correctness’ relates to the chaplain recognising implicit prejudices in the way that
spirituality is understood and acted upon within healthcare practices. It involves the chaplain moving
beyond the boundaries of their own denominational position and beginning to recognise the ways in
which the more general mode of spirituality has been occluded by a focus on religion. In response the
chaplain begins to model anew way of spiritual being and in so doing raise people’s consciousness to a
more inclusive understanding of the significance of spirituality. However, positive as this is in some ways,
negotiating the tensions of the various expectations is complex in practice.
Whilst the chaplains liked being free of the denominational party line, they nonetheless felt that their
faith made a difference to how they worked as chaplains. It gave them a reason for what they were doing;
it gave them support, strength and encouragement. They were reluctant to lose the “Christian bit”. The
general tendency was to believe that God’s role could be implicit in many things without being mentioned
directly.
The Bible was a source of inspiration, comfort and guidance for practice. The ‘road to Emmaus’ was
mentioned several times as a good example of Biblical support for chaplains to model. The chaplains also
spoke about praying, quiet devotions or meditations as part of their routine self-spiritual care. The idea
of being “upheld in prayer” by others supported them during very difficult times. It is worth noting that
these spiritual expressions are personal rather than communal. There is no need for a community of faith.
There are some similarities here to contemporary post-modern individualistic spirituality.41 42
Some chaplains noted that their own faith or their attitude towards faith issues had changed or been
challenged over the years. This may be what leads someone into chaplaincy, and it may also happen
Report No. CSHD/MR001 Edition 2 48
What do Chaplains do?
during his or her time in chaplaincy. This “journey” was highlighted as important within the majority of
the interviews. The chaplains also indicated that that they had theological doubts, uncertainties and
difficulties. They felt that they were becoming less identified with the institution and doctrines of the
church. Chaplains also felt it was important to know their own base and boundaries whilst being open
to others. Their own faith base motivated and determined their ability to be spiritually neutral with
others.
“She does what she does in Christ’s name, but she wouldn’t enter a conversation desperate to mention Jesus.”
2nd Int C11
Having a strong foundation was seen as making a difference to practice.
Faith gives support, strength and encouragement to the chaplains, but it does not necessarily affect the
modes of practice they choose to adopt.
“Gives strength and perspective on suffering, illness, loss; doesn’t believe this is part of God’s ordained
plan, it’s stuff that happens to folk.”
Int C16 S2
“The chaplains’ faith informed their whole attitude, their whole being. God’s role was implicit and present
in encounters with people.”
“Don’t need to use traditional God language or mention God, for God to be present ... it’s more hazy, not
as easily definable but just as authentic.”
1snt int C37
There is no doubt from the data that the majority of chaplains see themselves as Christians with a
fundamental faith, to some extent liberated from the perceived constraints of the parish. Freed in this
way, they see themselves as more able to practice and live the gospel and be more “Christ like” in the
hospital setting. The idea of being “like Christ” for those whom they encounter emerged with some
frequency. Interestingly, the emergence of this ideal poses a tension with the chaplains’ expressed desire
to be ‘needs-led’. It is not clear what chaplains actually mean when they talk about being ‘Christ-like’.
Which dimension of Christ is it that they are seeking to reflect? The preaching Christ, the healing Christ,
the condemning/judging Christ, the angry Christ? Again, the Christ whom chaplains wanted to be like
was very clearly, and usually unequivocally, distinguished from the idea of evangelism and proselytising.
Indeed one of the difficulties for some of the whole-time chaplains is that they see their part-time
colleagues as much more evangelical and religiously orientated. This stands in tension with the ministry
of Jesus which had a primary focus on bringing people into right relationship with the one and only God
of the Jews.
Chaplains see their work as Christian and Christ like but not an evangelical mission. But where does the
image of Christ come from? In a needs-led culture, it would appear that the content of being “Christ like”
is derived from the particular needs of the individual before them, individuals who have no necessary
knowledge of the Christian tradition. So, the content of being “Christ like” is often determined not by
theology,but by secular humanism as it is communicated to the chaplain in the pastoral encounter.
49 Report No. CSHD/MR001 Edition 2
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This theological point is important in the light of our previous discussion and we highlight it not as a
criticism of chaplains but as a challenge to clarify the real nature of the knowledge base that they work
from, and which underpins their practice and professional ideals.
Leadership
Data collected from the first interviews indicated that chaplains found issues of leadership a difficult and
sometimes uncomfortable territory. The hierarchical model of leadership in the NHS with its line
management system – leaders being those who head up units, manage others – is well established. The
chaplains have, on the whole, no group of staff to lead in the line management sense, nor are they
effectively managed. Chaplains were in very different situations in terms of management support or
supervision either within or outwith the organisation. There were also different needs in terms of support
in the practical, institutional issues as well as the more spiritual issues. They are therefore caught in a no
man’s land in terms of their structural position within the organisation. They are a ‘free floating’ group
of professionals whose position within the formal structures is uncertain. This can be interpreted as
chaplains having no leadership role, or that they have a more itinerant, prophetic leadership role. Both
interpretations are available in the data.
Three key ideas emerged in relation to the concept of leadership.
Some chaplains talked about influence rather than leadership. They saw themselves as having an influence
on the way things are done and in this sense functioned as leaders. Secondly there are those who see
themselves as having a moral or spiritual leadership role and thirdly there are those who see their role as
leadership through relationship.
These positions were influenced by varied ideas about the purpose of leadership. Some felt leadership was
asignificant responsibility, others that it was a management role and nothing to do with chaplaincy. Some
chaplains thought it should be part of the role of the chaplain and should be expressed through training
and teaching staff. There was also a strand of thinking which perceived chaplaincy as a liberation from
leadership. Again some felt that leadership could be important but was hampered by the system and
needed acknowledgement from others. Finally, a further view was that it isn’t appropriate for chaplains
to be seen as leaders because of the stresses this might cause between the different denominations
working as chaplains.
Issues surrounding leadership are central to the current movement towards the professionalisation of
chaplains.
Professionalisation
Linked to the marked ambivalence over issues of leadership is a further ambivalence concerning the
movement towards ‘professionalisation’ and the degree to which chaplains are seen and want to be seen
as health care professionals, and therefore part of the Trust structure. There is a difference between the
sociological idea of the profession and professionalisation which emphasises unique skills which are put
to the service of others. This compares with the understanding of behaving professionally. This implies
good behaviour which includes efficiency and propriety.43
In the literature which explores the nature of a profession, there are certain criteria for defining a group
as ‘professionals’. These would include the following:
Report No. CSHD/MR001 Edition 2 50
What do Chaplains do?
• a full-time occupation distinguishable from being an ‘amateur’ activity
•requiring the completion of some form of higher education
• associated with the mastery of a definable body of knowledge
• having a responsibility to the client
• associated with a form of control, which is not externally imposed but rather is managed through their own
professional bodies, which oversee a range of procedures including:
• Registration
• Accreditation
• Sanctions
• Codes of ethics44
The interviews with chaplains produced some powerful arguments both for and against
professionalisation. The unequivocal ‘yes’ to professionalisation was constructed around a number of key
potential advantages. Professionalisation offered:
• a way of distinguishing chaplaincy from parish ministry
• a way of identifying and formally recognising specific required skills
• an opportunity for discerning and delivering training for core skills
• a way of chaplains gaining respect within the healthcare context (and therefore making work and access easier)
• a way of enabling staff to recognise the role of the chaplain more readily
• the possibility of clearly identifying the role of the chaplain within the healthcare team
• a way of ensuring and legitimising normal access to patient information as part of the clinical team
The ‘no’s’ tended to believe that professionalisation would:
• attract the wrong sort of person to the profession – this type of person being more interested in career, management
and status than the practical work of spiritual caring
•act as a blockage to the chaplain’s perceived independent role: patients particularly value the non professional/non-
aligned status of chaplains
The chaplains responses confirmed that their understanding of their core professional role is to offer
spiritual support and comfort to patients in their time of need, and that this spiritual support can include,
but is not defined by religious support. They also stated that all persons have a spiritual side and therefore
that all people can both experience spiritual need and require (and offer) spiritual support. Nevertheless,
it is clear that it is the chaplain’s capacity to offer religious support that distinguishes them from other
spiritually caring people.
This tension raises some crucial questions: Is spiritual support and relationship something that is
common and available to all, or is it peculiar to those trained to give it? If so, what is the basis of such
training? Is spiritual caring a gift from the Holy Spirit – or a skill that can be encapsulated in a
competency which is potentially available to people of all faiths and none? If it is both, will a hierarchy
of spiritual support and response to need be necessary to manage chaplains? Chaplains would then
become people who can give “specialist” spiritual care, offering religious support through such things as
sacrament and liturgy, skills and expertise which are uniquely theirs to offer through their ordination.
This is a complex suggestion that requires much more reflection than can be given within the boundaries
of this report. Here we simply want to highlight the issues as chaplains raised them with us.
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Teamwork
One of the ways in which chaplaincy is changing is reflected in the increasing numbers of full time
chaplains now working within the healthcare context in Scotland. Chaplains now have usually at least
one other colleague and there are also several part time ministers who are also available. The writing of
current spiritual care policies within the Trusts has thrown up some issues around the nature of the
chaplaincy team. The position of part-time chaplains (that is chaplains who are given sessions to visit the
hospitals by their denomination), in relation to the full-time chaplains is of some importance. Currently
in Scotland there are over 400 part-time and 50 full-time chaplains. Because of the history of chaplaincy,
the part-time chaplains hold a position as part of their church work, and are not direct employees of the
Trusts. They visit on a denominational basis, and are less likely to see their work as part of a team
approach. This can create difficulties for the full time chaplains, although in some areas this works well.
Recently full time chaplains have had to tackle the difficult issues of what it means for one member of
the team to become the “lead chaplain,” and the precise criterion that should be applied in appointing
such a person. Tayside Health Care Trust pre-empted discussion of this by advertising the lead chaplain’s
job as a senior management position. Other Trusts have set up notional positions of lead chaplains.
Sometimes this has been agreed as a rotational post, not dissimilar to the role of Head of Department
within the University system. All of this means that it is unclear both who is leading the team and who
the team is.
Delegation is one of the fundamental tenets of the team. If there is no formal system for the distribution
of work around the team, then there is little point in operating as a team.
Teamwork is the backbone of the NHS and also one of the most difficult activities within it. Multi-
professional teamwork and its complexities is the subject of a great number of research studies. Good
teams are those that have clear goals, are comfortable in their roles and are clear about their own
boundaries, both as a team and as individual team members. Delegation within the team is always a
sensitive issue. Delegation implies leadership and hierarchy and chaplains, who currently have no
hierarchical structure within their profession, find this a difficult area to address. It also implies a
hierarchy of tasks, some of which can be delegated, others which cannot. This brings us back to the idea
of professionalism and a specialist body of knowledge.
Nevertheless, despite the problems, teamwork remains a necessity. The chaplain’s role is too large to
avoid delegation, selection and prioritisation. Effective, working teams can offer support and
encouragement and methods of sharing out the work. However, as we have seen, chaplains are often
attracted to chaplaincy precisely because they do not want to operate within a team.
Alongside the various denominational part-time staff, many chaplaincy teams have an independent team
of volunteers. In some chaplaincy units they are considered part of the team, in others they are clearly
seen as extras. The volunteers visit the wards and invite and assist those who want to go to services.
The use of volunteers varies across the country. Some chaplaincies have an organised and trained group
of volunteers who are very much part of the “team” and integral to the process of chaplaincy. Others have
ad hoc volunteers, who are self selected and less part of the core process. Given the rise in the number
of retired individuals across the Western world in general, and in Scotland in particular, and the strategic
encouragement to formalise volunteerism as part of the PFPI policy initiative, it would seem that this is
an area ripe for development.
Report No. CSHD/MR001 Edition 2 52
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53 Report No. CSHD/MR001 Edition 2
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Chaplains also consider themselves potentially or in rare cases (notably in the hospices) members of the
clinical teams. Currently there seems to be rather an informal system whereby some chaplains assume
roles in clinical teams, usually gatekeepered by personalities who can allow them in as some kind of
special favour.
There are issues of access in these teamwork issues, and this whole area is linked back to the previously
highlighted ways in which chaplains find people to work with. Part of structural acceptance for the
chaplain is to move towards being seen as part of a professional team within the hospital context, which
has direct clinical effect on the patients. This means that the unique place of chaplaincy within the
multidisciplinary team has to be negotiated and argued for as well as being constantly defended. This
takes us back to the central question of this report: What do chaplains do?
Negotiating and championing chaplaincy
In the second set of interviews the chaplains were asked to consider how things had changed since the
introduction of the guidelines, and how the institution in which they worked was reacting to these
changes. There was a wide range of responses to this question. On the one hand the guidelines were seen
as simply confirming work already under way; on the other hand some chaplains reported absolutely no
change. There were reports of less time to see patients now that there were more strategic planning
meetings. The appointment of line managers had heralded the potential for more thoughtful and
appropriate supervision. Sometimes these line managers had been given that role in addition to a number
of others. There was generally agreed to be a flurry of interest in the chaplains and a general recognition
of the importance of the work. There were new spaces, new names for chaplaincy and training plans.
Some areas had reallocated tasks on the basis of geography and/or personal interest and there was a
feeling of more teamwork, or at least of the potential for the development of more team work.
There was general agreement about the constraints on developments that were either empirically
experienced or intuitively understood. These were associated with the nature of the health care
institutions in which the chaplains worked, and were mainly around lack of money and other resources.
This limited the possibility of chaplaincy/spiritual care, physical space and the ability of managers to
develop the service in terms of person power. Staff funding was an issue. One manager was noted to be:
Asking for more nursing staff to feed patients. When looking at finances, do we need another chaplain,
nurses or equipmet?
Site 3 Int 17, p2
How chaplains and spiritual care are perceived and prioritised by staff in the hospital is a crucial issue in
terms of development of the service. The competitive and limited nature of the funding in the health
service inevitably leads to prioritising – balancing the greater need of clinical care with that of spiritual
care. The question of how spiritual care is perceived and prioritised by staff is of great importance in
planning chaplaincy services. Individual staff members who were pro chaplaincy and spiritual care raised
this as an issue. For example, on one of the admission wards in Site 3 there were forms to be completed
that included questions about referral to chaplaincy. The researcher paraphrased a member of staff:
Wedon’t even have time to fill in about people’s eating and drinking etc never mind other aspects. When
patients are acutely ill we want to get them stable ... we do try to go back and do them (fill in the
chaplaincy forms) but then the patients have moved on and the paper work goes with them ... it’s a shame
in terms of the holistic approach.
Site 3 Int S7
This is a typical way of understanding spiritual care. It is commonly seen as an add-on; an additional extra
which could be provided if and when there is some spare resource. It is possible to argue that this is
missing the point. Spiritual care can be seen as fundamental to all types of care, and that its presence or
lack, implicitly or explicitly underpins all relationships between health care providers and patients. The
understanding and awareness of the importance of spiritual care as the glue in the development of
genuinely holistic approaches is largely absent within the culture of Scottish hospitals. This culture tends
to focus on such things as targets, outcomes, throughput and value for money. Whilst there is a language
of patient focus and public involvement, the practice in health care settings tends to be bureaucratically
led. The consciousness-raising and awareness work around the importance of spirituality can depend
largely on personalities, both of the chaplain and of staff.
The role of educator and teacher, and the importance of personal factors in the work of the chaplain’s
building of relationships, is noted by Wilson and Woodward. Woodward notes that the success of the
health care chaplain depends upon personal qualities more than upon the clarity of the role. He concludes
from his survey of ward staff that “it depends upon the man (sic)”. This view was confirmed by the
fieldwork in all the sites. For examples in Site 3 the field notes for a staff interview note:
She says that the chaplain works with patients and staff. She spoke of a colleague getting married and him
also doing funerals. She thought that he was just a lovely person. She spoke of ministers in the past being
held up (in respect) with doctors. She saw him as a friend not a minister.
3/s8
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55 Report No. CSHD/MR001 Edition 2
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Preamble
57 Report No. CSHD/MR001 Edition 2
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Report No. CSHD/MR001 Edition 2 58
In conclusion we would like to highlight some key points for reflection.
Religious or spiritual need
The separation of religion from spirituality and the strategic emphasis within the health service on the
meeting of generic spiritual needs has opened up unique possibilities and challenges for chaplains. This
emerging division seems to be part of the new terms and conditions for chaplains in the health sector. In
assuming that everyone has spiritual needs, but not everyone has religious needs, the field of spirituality
is opened up, but at the expense of effectively closing, or at least minimising an area of unique chaplaincy
expertise. As things stand at the moment, it is the chaplain’s training that provides them with
distinguishing characteristics that enable them to provide spiritual care which is specifically religious in
orientation. This area of religious expertise stands in tension with their professional expectations which
is to offer generic spiritual care. There is therefore an emerging and fundamental identity crisis. Careful
identification of the exact services that chaplains can provide is a priority.
Chaplaincy as a new profession
It is clear from this study that chaplains desire to be seen as health care professionals. However, as has
been pointed out, there are significant issues that require to be worked through before this can become
ameaningful reality. Chaplaincy is, in significant ways, different from many of the other healthcare
professions. It can be understood as an example of a new (post-modern) profession wherein the expert
and discrete knowledge related to the identity of the profession lies in the method of identifying need
rather than in the act of providing a solution. The new professional uses interpretive and inductive skills
starting from the “data”, in this case the spiritual need as expressed by the unique individual before them.
This is quite different from the more established professions where expert knowledge imposes solutions
upon perceived problems.
The uniqueness of chaplaincy is found in the process of chaplaincy rather than in the particular tasks in
which chaplains participate. In other words, it is the unique configuration of the various tasks of chaplaincy
(listening, talking, seeking need etc), that makes it unique and different, rather than the particularities
of its tasks which are often carried out but configured quite differently within other professions.
Conclusions
Conclusions
However, the strength of chaplaincy – its intuitive, skilled discernment – may also become its greatest
weakness. Set in the context of a health system anxious to delineate role, measure outputs according to
concrete measures, and assess practice on the basis of productivity, chaplains may find themselves
focussing on end results to the detriment of process.The present healthcare system sets out to find and
interpret need in order to reduce or eradicate that need. Within such a milieu, expressed or felt need is
equated with better health. Seeking out and interpreting back this need to the person – the key
role/function of chaplaincy – constantly creates a chasm which health providers anxiously wish to fill.
The better chaplains become at seeking out and discerning need, the greater this chasm grows and the
desire to efficiently close it becomes the more tempting.
Selling spiritual perspectives
Chaplains are working in a context which does not necessarily immediately grasp the relevance of their
work. Unlike a doctor or nurse working within the Health Service, the role of the chaplain is less clear.
In order for the role to evolve to the benefit of staff and patients, in a way that maximises the opportunity
of acknowledging the spiritual dimensions of health and illness, chaplains must embark on a marketing
exercise. In an evidence-based culture, one important way in which they can do this is by developing an
evidence base that will help to confirm and validate their role within the multidisciplinary team.
An evidence base for chaplains
Chaplains could be described as being permanent action researchers.45 46 As we have seen they are bound
up in a cycle of need seeking and need meeting. Fleshing out this cycle with base line research data and
rigorous evaluation would complete an action research process and provide a much needed evidence base
for the practice and development of chaplaincy. The chaplains require to understand and be able to utilise
methods of social research (qualitative and quantitative), that will allow them to gather data and to
demonstrate the value of the service they provide. Within an evidence-based environment which values
such approaches, this is a crucial requirement. If chaplains are to progress and be able to argue for more
resources and a changing developing role, there must be accompanying data that makes the case for
change and development. This means that chaplains must include research methods within their ongoing
training programmes.
59 Report No. CSHD/MR001 Edition 2
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Report No. CSHD/MR001 Edition 2 60
This study has clearly shown the relevance of chaplaincy for contemporary healthcare practices. Chaplains
meet a variety of different needs, many of which are not met by other service providers. Nevertheless, if
they are to be taken seriously as healthcare providers, it is important that chaplains learn to recognise,
and effectively communicate the nature and uniqueness of their role. The question raised by this report
is not whether or not there is a role for chaplains. There clearly is a role and we can show what this role
is. Rather the question is, can chaplains effectively conceptualise and articulate their role in language and within
structures that make sense to other healthcare providers?
Such articulation will require chaplains to engage in crucial and perhaps painful reflection and discussion
about their role as religious and spiritual carers as well as their relationship with the Christian
community. It will require chaplains to lay aside some things that may be dear to them in the hope that
the developing paradigm of chaplaincy will enable them to provide effective spiritual care without
compromising their own spiritual journeys. This will be a difficult, arduous and at times dangerous
process. However, as chaplains seek to give birth to the new model of chaplaincy which is currently
gestating in Scottish healthcare, tackling the painful process of rebirth is crucial. If they follow through
with this process effectively, bravely and creatively, then the movement towards professional legitimacy
will be relatively straight forward. However, if they do not bravely face up to the important issues and
tensions highlighted within this report, then the future of chaplaincy is considerably less clear than
people would want it to be. The challenge is there, as are the resources to meet the challenge. The
question is, will chaplains take up that challenge both individually and corporately?
End Word
End Word
61 Report No. CSHD/MR001 Edition 2
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Report No. CSHD/MR001 Edition 2 62
Preamble
63 Report No. CSHD/MR001 Edition 2
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Report No. CSHD/MR001 Edition 2 64
1Koenig H, McCullough M, Larson D (2001)
Handbook of Religion and Health
New York Oxford University Press
2Culliford L (2002) Spiritual care and psychiatric treatment: an introduction
Advanced Psychiatric Treatment
Jul; 8: 249-258
3Scottish Executive (2002) Health Department Letter 76
Spiritual Care in NHS Scotland
4Davie Grace (1994)
Religion in Britain since 1945: believing without belonging
Oxford: Cambridge, Mass: Blackwell
5Scottish Church Census 2002
http://www.scottishchristian.com/features/0305census01.shtml
6Hay D (1990) Religious Experience Today: Studying the facts
London: Cassell
7Heelas P, Woodhead L, Seel B, Tusting K, Szerszynoki B (2005)
The Spiritual Revolution. Why Religion is Giving Way to Spirituality
Oxford, UK and Malden, USA: Blackwell
8Davie G, ibid
9for example Jessica Kingsley Publishers multidisciplinary series on spirituality and healthcare:
http://www.jkp.com/catalogue/index.php/cat/pastoral
10 Austin JA, Why patients use alternative medicine: results of a national study
Journal of the American Medical Association
1998 May 20; 279(19): 1548-53
11 for example the special edition of the Scottish journal of Healthcare Chaplains focussed on the new
chaplaincy guidelines: http://www.sach.org.uk/journal0602.htm
Footnotes
Footnotes
12 Scottish Executive (2001)
Cancer in Scotland: Action for Change
Scottish Executive, Edinburgh
13Scottish Executive (2003)
Anew Public Involvement Structure for NHS Scotland Patient Focus and Public Involvement
14Murray SA, Kendall M, Boyd K, Worth A, Benton TF (2004)
Exploring the spiritual needs of people dying of lung cancer or heart failure:
a prospective qualitative interview study of patients and their carers.
Palliative Medicine; 18:39-45
15 Fry PS (2000)
Religious involvement, spirituality and personal meaning for life:
Existential predictors of psychological wellbeing in community-residing and institutional care elders
Aging & Mental Health Vol 4(4), Nov (pp.375-387)
16Koenig H et al ibid
17Larson DB, Sawyers JP, McCullough M (1997)
Scientific Research on Spirituality and Health: a consensus report
National Institute for Healthcare research
18 Koenig HG, et al ibid, page 591
19 Larson DB, Sawyers JP, McCullough M (1997)
Scientific Research on Spirituality and Health: a consensus report
National Institute for Healthcare Research
20 Iler William, Obershain Don, Camac Mary (2001)
The impact of daily visits from Chaplains on patients with
chronic obstructive pulmonary disease COPD: a pilot study
Chaplaincy Today Vol 17 # 1 Summer pp.5-11)
21 Scottish Executive 2001 www.scotland.gov.uk/library3/health/pfpi-00.asp
22 Designed to Care, SEHD, 1997 http://www.scotland.gov.uk/library/documents1/care-00.htm
23 Scottish Executive, 2000 http://www.scotland.gov.uk/library3/health/onh-00.asp
24 Scottish Executive, 2003 http://www.scotland.gov.uk/library5/government/pfbs-00.asp
25 Scottish Executive, 2003 www.scotland.gov.uk/library5/health/pfcs-00.asp
26 The Centre for Spirituality, Health and Disability
http://www.abdn.ac.uk/cshad
65 Report No. CSHD/MR001 Edition 2
What do Chaplains do?
27 Smith in Hunter, Rodney J (1990)
Dictionary of Pastoral Care and Counselling
Nashville: Abingdon Press, page 136
28Robson, Colin (2002)
Real World Research
London: Blackwell Publishers Ltd
29Denzin NK and Lincoln Y (2000)
Handbook of Qualitative Research
Second Edition, London: Sage Publications Inc
30 Abbott P and Wallace C (1990)
The Sociology of the Caring Professions
The Falmer Press
31 Vaughn Frances (2002)
‘What is spiritual intelligence?’
Journal of Humanistic Psychology, Vol. 42, No. 2, 16-33
Spiritual intelligence calls for multiple ways of knowing and for the integration of the inner life of
mind and spirit with the outer life of work in the world. It can be cultivated through questing,
inquiry, and practice. Spiritual experiences may also contribute to its development, depending on
the context and means of integration. Spiritual maturity is expressed through wisdom and
compassionate action in the world. Spiritual intelligence is necessary for discernment in making
spiritual choices that contribute to psychological well-being and overall healthy human
development.
32 Emotional intelligence, or EI is the ability to understand your own emotions and those of people
around you. The concept of emotional intelligence, developed by Daniel Goleman, means you have
aself-awareness that enables you to recognise feelings and helps you manage your emotions.
33 For instance Woodward J (1998)
A study of the role of the acute health care chaplain in England Open University and
Orchard H (2000)
Hospital chaplaincy: Modern and Dependable?
Sheffield: Sheffield Academic Press Ltd
34 HDL letter (2002) ibid
35 The NHS and Community Care Act 1990
36 PFPI policy ibid
37 Hudson H (1993)
“Nice idea shame about the reality – needs led services”
Health and Social Care 1: pp.115-123
Report No. CSHD/MR001 Edition 2 66
Preamble
38 Kuhn, Thomas S (1970) [1962]
The Structure of Scientific Revolutions,second enlarged edition
Chicago, IL: The University of Chicago Press
39Mitchell D (1999)
How do whole time health care chaplains in Scotland understand and practice spiritual care?
Scottish Journal of Healthcare chaplaincy Vol.2 No.2
http://www.sach.org.uk/journal/0202p02_mitchell-sneddon.pdf
40 Mitchell D (1999) ibid
41Drane J (1991)
What is the new age saying to the Church
Zondervan Paperback
42 Labanow C (2007)
Maturing beyond the Post-modern Context: Practical Theology in the Local Church Setting
PhD Thesis: University of Aberdeen
43Woodward J (1988)
Are Health Care Chaplains Professionals in Orchard H (ed)
Spirituality in Health Care Contexts
London: Jessica Kingsley Publications
44 http://www2.auckland.ac.nz/cpd/HERDSA/HTML/StaffDev/JOHNSTON.HTM
45 Swinton, J and Mowat, H (2006)
Practical Theology and Qualitative Research
SCM Press, St Albans, England
46 Hockley J, Dewar B, and Watson J (2004)
St Columba’s Hospice Bridges Initiative Project phase 3:
Developing quality end of life care in eight independent nursing homes through the
implementation of an integrated pathway for the last days of life
St Columba’s Hospice
Note
Thanks to Noel Brown – Editor of ORERE SOURCE abstracts service – for pointing us to references 18 and 20.
67 Report No. CSHD/MR001 Edition 2
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Report No. CSHD/MR001 Edition 2 68
Preamble
Notes
69 Report No. CSHD/MR001 Edition 2
Notes
Notes
Report No. CSHD/MR001 Edition 2 70
Preamble
Contacts
Dr Harriet Mowat
Mowat Research Limited
52 Richmondhill Place
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E: harriet.mowat@mowatresearch.co.uk
Professor J. Swinton
Professor in Practical Theology and Pastoral Care
School of Divinity,History and Philosophy
King’s College
University of Aberdeen
ABERDEEN
AB24 3UB
T: 01224273224
E: j.swinton@abdn.ac.uk
F: 01224-273750
Published by Mowat Research Limited
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2nd Edition February 2007
ISBN: 0-9549901-0-2
