Gela

Gela
He leads me beside still waters

Tuesday, 22 March 2016

Scientific outcomes and pastoral care. They need each other.

David Pettett


Research into healthcare outcomes indicates that when the spiritual needs of patients are met there are further tangible benefits. These benefits include shorter hospital stays, improved pain management and better management of cardiovascular needs. It is not surprising that a recent Deloitte’s report into the economic and social benefits of hospital chaplaincies in New South Wales, Australia showed that for every dollar the New South Wales government spends on subsidising hospital chaplaincies there is close to a seven dollar benefit. That is, given that the New South Wales government spends $2.5 million each year on subsidising chaplaincy services provided by Christian churches and other Faith groups, it would have to spend seven times this amount to achieve the same results if it did not subsidise chaplaincy.

When I was reading some of this research I was excited to see the benefits and outcomes of chaplaincy being measured. But I began to ask myself, “What do they mean by ‘the spiritual needs of the patients’?” What are ‘spiritual needs’? How are spiritual needs defined? When pastoral carers and healthcare professionals speak of ‘spiritual needs’, do they mean the same thing? Are we speaking the same language?

In a similar vein of concern about what is being measured in the pastoral encounter John Swinton asked the question, ‘what actually constitutes acceptable evidence, who decides and why?’[1] While acknowledging the important role of scientific measurement, even in pastoral encounters, Swinton then says, ‘I want to suggest that science, or at least a narrow definition of science, is only one dimension of the professional role of chaplaincy. On its own our current definition of ‘science’ cannot provide an adequate basis for the theory and practice of chaplaincy.’ This is because, on its own, the spiritual ‘outcomes’ of the pastoral encounter cannot be measured. If a pastoral encounter is primarily about relationship, it is only secondary outcomes such as a feeling of wellbeing, which can be measured scientifically in a manner that might satisfy those who are seeking to measure the length of stay in hospital in terms of economic benefit. Swinton further suggests that pastoral ministry has a place in informing scientific outcomes in that it moves beyond empirical measurement to speak of the human condition.

The research on the outcomes of pastoral interventions speaks of things like ‘meaning’, ‘comfort’, ‘hope’ and ‘community’. That is, when a person’s spiritual needs are met they report that they have a greater sense of meaning, comfort, hope and belonging. Spiritual Care Australia defines the value of spirituality as something that increases resilience within a person, helps to positively embrace experiences and outcomes and to celebrate life. The Mayo Clinic Pastoral Care Services defines its work as assisting people in using strengths in coping with their medical condition.

These views seem to place the idea of spirituality within a holistic view of humanity. Within the health care context particularly, a person is viewed as having, not only physical and mental health needs, but also spiritual needs. Within this view of the whole person, just as solutions can be applied to the fixing of a broken leg, or the resolution of an eating disorder, so can solutions and resolutions lead to a person finding meaning, comfort, hope and community. Certainly this is the view in a large body of literature on pastoral care that speaks of the ‘functions of pastoral care’. Kate Bradford has addressed this issue in her earlier post on this site in “Chaplaincy a Ministry not a Function”.

Following on from Kate’s work I want to ask, “If Chaplaincy or pastoral care is not a function but a ministry, how then does it fit into the sphere of public healthcare?” In other words, if the New South Wales government sees the value of subsidising chaplaincy in its public hospitals as achieving better health outcomes and therefore saving money, how does a ministry that does not seek to serve these functions fit into modern health care?

These questions highlight the dichotomy between Christian ministry and the desire in a modern results driven economy to have measurable outcomes. Someone has said, “What cannot be measured has no value.” This statement begs the question about value. In Christian ministry we are not seeking an economic value. It is well and good for government to know that its hospital patients feel better and have better, measurable health outcomes as a result of the ministrations of the chaplains it subsidises. But Christian ministry, which is not a function, has no measurable outcomes, at least in a scientific sense. It does not have an immediate economic value. At its best Christian chaplaincy and pastoral care is an activity where two human beings, the patient and the chaplain, encounter the true human, Jesus.

Government may well want to keep subsidising chaplaincy in its hospitals and prisons because of the measurable positive but secondary outcomes and the economic benefit they bring. Christian denominations, while not denying these tangible benefits and the positive impact they have on society generally, must, never the less, maintain the primary focus of pastoral care as fellowship with the risen Christ. Government must recognise that this ministry is an activity Christian chaplains will focus on. At the same time the Christian chaplain must recognise that in a public institution he or she is there as a guest. They are not ministering to their parishioners, those who come to church of their own free will. In public institutions the chaplain encounters people from every Faith and none, and therefore must show due respect.

As much as the Christian chaplain’s role is to listen with the patient to the Christ who is present, their role in a public institution is not as an evangelist. But as the chaplain listens to the Christ who is present, the patient also, who experiences the listening of the chaplain, will also begin to listen to the Christ. They may or may not respond to this listening but those who do have the opportunity to move into fellowship with Christ, the giver of life. This is no scientific measurable outcome but health managers and other professionals must recognise that this is the real work of pastoral care. When it is done at its best, they may well also see measurable, secondary positive health outcomes.

Chaplaincy and pastoral care in our public institutions must be allowed by government to be chaplaincy and pastoral care. The desire for measurable outcomes must not overtake the real ministry that is happening. If it does, and begins to shape and dictate what a chaplain can and cannot do, it will lose the secondary outcomes government and healthcare professionals are looking for. At the same time chaplaincy must bring its unique contribution to bare on the professional business of healthcare. This will hopefully shape healthcare to be more patient focused than outcome focused. It will remind healthcare professionals that patients are not economic outcomes. It will focus on the human condition and see science and pastoral care working together for the full physical, mental and spiritual health of the patient.




[1] John Swinton. ‘Reclaiming Mystery and Wonder: Towards a narrative based perspective on chaplaincy.’ Journal of Healthcare Chaplaincy. 2002. pp. 223-236

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