Kate Bradford
June 2015
June 2015
Paediatric chaplaincy is not for everyone. It
meets child-patients and families at times of greatest loses and needs.
Nevertheless, for chaplains who have found their vocational home within
Paediatric hospitals, few would swap their difficult privilege for any other
ministry.
Is paediatric hospital chaplaincy different
for any other form of chaplaincy? Are not all chaplains trained to minister to
vulnerable people ─ suffering with loss and various major life issues? The
first and major difference in paediatric chaplaincy is the differing,
contradictory or even competing needs of the child-patient themselves and those
needs of the child-patient’s family.
The UK NHS Chaplaincy Guidelines[1]
highlight two areas that require specialised focus when working with children. The
first area is concerned with the particular spiritual needs of younger people
and children. This requires highly skilled and imaginative care. Related to
this, and of paramount importance, will be ethical and safeguarding
considerations for care in specialist paediatric units. Chaplains working in
such areas will require enhanced training tailored to their context.
The second area of particular consideration
is the concerns families and friends of younger people and children face which
pose particular challenges to faith, belief and spirituality. Chaplains in
paediatric settings will need to be equipped to support those facing these
challenges and will require support and supervision.
Listed below are some ‘distinctives’ around
paediatric chaplaincy:
1.
Children have different
spiritual needs to adults; children and adolescents are at different
development stages: physically, cognitively, emotionally and spiritually
depending on their age and experience of life.
2.
Children have a greater
vulnerability and require greater safeguards around their care.
3.
Paediatric chaplains very often visit parents
and relatives who have been traumatically impacted by serious illness or
disability of their child. In this case chaplains must ask, “Who is the actual
patient?”
4.
Decisions are being made by parents,
guardians, and medical staff on behalf of patients who cannot speak for
themselves.
5.
There is heightened intensity
around childhood illness triggering precipitation of anticipatory losses of
hopes and dreams of the parents, family and wider community.
6.
Childhood illness, disability
and death alter family systems forever, indelibly changing lives of siblings.
7.
When a young life does not
reach its potential, there is a widespread belief that this is not fair and
there are related issues of injustice, blame, guilt and shame.
8.
Our culture perceives serious
childhood illness, disability and death as a ‘reversal of natural order’ and
consequently does not cope well with these situations.
9.
There is a responsibility on
all practitioners to be aware of self and the way in which their actions affect
the plasticity of the family system.
Ministering as a chaplain in a paediatric
environment does require an additional skill set, and not all generally trained
chaplains will be equipped for ministry in a paediatric setting. The US
Pediatric (sic) Chaplains Network has published a list of demonstrated
competencies of a paediatric chaplain. [2]
General competencies for a paediatric
chaplain are knowledge, skills and maturity around self-awareness, theology,
pastoral care, and leadership ability.
Chaplains in a paediatric setting will
often find childhood memories triggered. These may be of the chaplain’s own
childhood illnesses or disability but can also have to do with issues
experienced second hand such as stillbirth, cot death, cancer, neglect, abuse, accidents
or a myriad of other losses of hopes and dreams buried deep in the
subconscious. These are psychological issues of transference, projection and
countertransference that need to be addressed in order to understand whose
needs are really being addressed in the pastoral situation; the child inside
the chaplain, or the child in the hospital bed.
It is important that chaplains demonstrate
emotional and mental stability. This stability is held together with the
ability to relate to and connect with people over a wide range of ages and
varieties of people. The chaplain also needs to display a non-anxious
compassionate and kind presence in stressful situations, while being aware of,
and maintaining clear professional boundaries.
Paediatric illness triggers a cultural
outrage about the unfairness of innocent suffering; a God who could have
prevented it; a notion that the pain of the loss of a child is pain unbearable,
unendurable and to even speak of the possibility is to tempt fate.
A paediatric chaplain needs to have
personally a well-integrated faith and practice that incorporates well-developed
theological perspectives of suffering, prayer, forgiveness, religious faith,
community and hope while remaining respectful of the vulnerability of the
patient and family. In addition to working with positive aspects of faith the
chaplain needs to be able to recognise issues of perceived absence of God,
guilt, shame, blame, punishment, theodicies, and instances of distorted or
destructive religious beliefs and practices. When working with children and adults across a
variety of ages, stages, faith and cultures it is important to have a working
knowledge of stages of faith in order to communicate in the helpful categories,
and to clarity issues around the difference between spirituality and religious
faith systems. There needs to great clarity around the difference between
responding to the patients’ needs and enquiries and proselytization which employs
coercion.
Families are never a theological problem to
be solved. They are complex evolving social systems and these systems function
according to observed trends and patterns and when we apply spiritual
intervention we also tweak the social systems. The maxim ‘to do no harm’
applies in spiritual care too.
A paediatric chaplain needs a good understanding
of Family Systems and an acquaintance with Attachment Theory as well as various
coping styles and grief models. Skills in active, attentive and reflective
listening are equally significant. It is important for the chaplain to have the
ability to differentiate the various needs of people in the system: the child-patient,
parents, family, medical staff and the wider community.
In a paediatric setting compassion, empathy
and kindness need to be accompanied by good leadership ability for time when
advocacy is needed within a family system, the hospital setting, or the wider
community. The chaplain needs to have the ability to develop training resources
for church communities and in-services for the hospital community. Well rounded
chaplaincy includes planning in conducting services of blessings as well as
baptisms, funerals and memorials.
Chaplains care for child-patients and their
families as they search for meaning, belonging and significance in the midst of
illness and hospitalization. The chaplain accompanies families across a vast
terrain of faith, love and hope, moving from immediate horizons out towards
eternal horizons.
[2] These are extensive and can be accessed at http://media.wix.com/ugd/bbe2bd_173f63d2cc994d3fb99895105a2ad943.pdf
These competencies fall into four main categories: A. Self-knowledge and
Personal maturity. B. Knowledge and Skills in Theology. C. Knowledge and Skills
in Pastoral Care. D. Leadership Ability.
