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LOYOLA COLLEGE IN MARYLAND 

—1852— 

The thesis of Gwendolyn Artis Goggins entitled 

The Shifting Role of Healthcare Chaplaincy: 

Meeting the Spiritual Needs of a Trans-Cultural Population 

submitted to the Department of Pastoral Counseling in partial fulfillment 

of the requirements for the Degree of Master of Arts in Spiritual and 

Pastoral Care in the College of Arts and Sciences has been read and 

approved by the Committee: 

Director, M.A. Program in Spiritual and Pastoral Care 

David C. Newton, M.T.S. 

Director of Academic Operations 

Spring 2007 

Date

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The Shifting Role of Healthcare Chaplaincy: 

Meeting the Spiritual Needs of a Trans-Cultural Population 

Gwendolyn Artis Goggins 

B. A. College of Notre Dame of Maryland 

Submitted to the Department of Pastoral Counseling of Loyola College in Maryland 

In Partial Fulfillment of the Requirements for the 

Degree of Masters of Arts in Spiritual and Pastoral Care 

May, 2007

DECDICATION 

Dedicated to 

George Robert Goggins Jr., my beloved husband. 

Thanks for your continued support, love and prayers 

throughout my spiritual and academic journey. 

"My Beloved is mine and I am his ..." Song of Sol. 2:16 

ii

ACKNOWLEDGEMENTS 

I am eternally grateful to each of my professors. Each of you pushed me towards 

excellence, wisdom, and understanding of pastoral presence. I would like to offer special 

thanks to Robin Lynn McMahon, Ph.D. for speaking words of comfort and 

encouragement in my spirit, as I walked a close friend through her end of life process. 

Robin, your Bereavement and Loss Class became a safe place for healing and personal 

growth. To Roch Lapalme, S.J., you are a friend and a good sounding board. Thanks for 

sharing your books and resources on healthcare chaplaincy. 

I especially like to thank, Rev. C. Kevin Gillespie, S. J., Ph.D. for his Godly 

presence in my life. Your drive for excellence in learning cultivated a deep desire in me 

to explore spiritual leaders past and present and to include their teachings in my daily 

walk as a Christian. Your valuable guidance for my thesis kept me on tract, and opened 

the door for exploration of healthcare chaplaincy as a vocation. In addition, I like to give 

special mention to Chaplain Carole Rybicki, at Mercy Medical Center in Baltimore. I am 

forever indebted to you. Your encouragement for self-exploration of my vulnerabilities 

and growing edges strengthened me as a chaplain. Sister Rybicki, you became my 

spiritual director, mentor, and friend. 

I am forever grateful to my youngest brother, David M. Artis, Ph.D. On short 

notice, you responded to my plea for help in editing this thesis. In addition, I would like 

to acknowledge my parents, Mr. & Mrs. Joseph & Nancy Artis for always being 

supportive and loving, as I continue to grow as their child and a child of God. 

iii

ABSTRACT 

This thesis discussed the spiritual and religious interventions of a healthcare chaplain 

who ministers to a multicultural and multi-faith population. The work of Fukuyama and 

Sevig (2004) was used to consider a framework for chaplains to engage in self- 

exploration of other religious beliefs and the spiritual care they offer patients. Gall, et al., 

(2005) was used to consider a transactional model to assess the influence of patient's 

faith tradition, prayer, and spiritual care offered by healthcare chaplains in the coping 

process. This thesis also examined the growing concern that hospitals have in hiring 

professional or generic chaplains to address the swelling multicultural population. Kotva 

(1998) challenged the principle that chaplains have become generic and that patient's 

faith practices neutralize a chaplain's personal beliefs. Through the work of Anderson 

(2004), the thesis explored how cultural diversity in a hospital setting demands that a 

chaplain have specific training and skills. According to Anderson (2004), revised clinical 

training or certification for chaplaincy would include: (1) the capacity to be grounded in 

one's own spirituality, self-awareness. (2) The ability to convey 'Interpathic' empathy 

when dealing with other spiritual experiences, (3) learning multi-spiritual communication 

skill, (4) the ability to identify relational barriers, and (5) having the capacity to respect 

and to learn about multi-spiritual interaction. This study was used as a format for ongoing 

discussions on limitations of chaplaincy to a multicultural healthcare population 

including: (1) the refusal of several faith traditions to ordain female ministers, (2) 

Christian fundamentalists who condemn homosexual chaplains, and (3) patient's biases 

that may reject a chaplain's spiritual care. Finally, Augsburger (1986) concept of 

"Interpathy" was a means of considering how listening needs can extend across cultural 

barriers. 

iv

TABLE OF CONTENTS 

DEDICATION....................................................................................................................ii 

ACKNOWLEDGES..........................................................................................................iii 

ASBRACT.........................................................................................................................iv 

TABLE OF CONTENTS ....................................................................................................v 

CHAPTER I - Introduction .................................................................................................1 

CHAPTER II - History of Chaplaincy ................................................................................6 

Pioneers of Hospital Chaplaincy ...................................................................................7 

Clinical Training Movements and Organizations ........................................................11 

CHAPTER III - The Practice of Spiritual Care............................................................... 13 

Spirituality and Coping Styles ....................................................................................17 

Care of the Soul .........................................................................................................19 

Theology of Pastoral Care ......................................................................................... 23 

The Healing Power of Prayer in Pastoral Care........................................................... 24 

The Presence of God .................................................................................................. 25 

CHAPTER IV - The Diverse Role of Healthcare Chaplaincy .......................................... 30 

Multiculturalism - Many Worldviews........................................................................ 32 

Comparison of Spiritual and Multicultural Values .................................................... 35 

Framework for Multicultural Competency ................................................................. 36 

Spiritual and Multicultural Interpathy ...................................................................... 39 

Danger Zones for Chaplains ...................................................................................... 40 

CHAPTER V - Chaplaincy Training and Competency.................................................... 45 

Clinical Pastoral Education..................................... ...................................................... 

Association of CPE .................................................................................................... 46 

Challenge for Chaplain Associations......................................................................... 50 

Professional and Generic Chaplaincy ........................................................................ 52 

CHAPTER VI - Discussion and Conclusion.................................................................... 55 

Agapeic Intervention .................................................................................................. 55 

Topics for Discussion................................................................................................. 57 

Summary and Conclusion........................................................................................... 58 

REFERENCES................................................................................................................. 62 

v 

Page

CHAPTER I 

Introduction 

Spiritual Role of Healthcare Chaplaincy 1 

"I was sick and you came to visit me," (Matt. 25:36). I was taught during my 

adolescence to care for family members and those who were sick in my extended family. 

As an adult, I realized that the caregiving model that is the base of my ministry of 

caregiving follows the model of Jesus ministry. Jesus showed compassion to those who 

sought healing in body and spirit whom he encountered on his ministerial journey. He 

healed the sick and spoke words of encouragement into the lives. 

Recently, my father was admitted to a large hospital that specializes in heart 

procedures. My mom and I checked Daddy in the day before his procedure for several 

required tests. My father was frightened: he has been through a bypass surgery, a couple 

of other heart procedures and suffers from diabetes. This day started at 6:30 a. m. and did 

not end until after 6:30 p.m. when the last test begun. 

I was sure that a chaplain would visit my father before the onset of the long 

battery of tests. I even reassured my father that a chaplain would pray with him before his 

testing began. From my experiences in hospitals, I thought that it was standard practice 

for patients to receive a chaplain visitation before surgery. I tried not to let my father see 

any disappointment concerning the lack of spiritual visitation. My father was tired and 

weakened from his fast, and he was in tears. When I realized that no one would come to 

pray with us, I slipped into my role as chaplain. I lead my father and family in prayers. 

This simple action seemed to bring comfort and encouragement to all of us by inviting 

God's presence into the room.


I realized the importance of a chaplain's visitation. His or her presence can 

reframe a difficult situation and allow people to see a positive perspective even during 

their crises. I chose healthcare chaplaincy as a topic to explore because I believe that I am 

called to visit and minister to persons who are sick or hospitalized. As an ordained, 

deacon in my church, I regularly minister to hospitalized church members or their 

families. Their expectation of pastoral visitation anticipates words of encouragement, 

comfort from Scripture, and a presence that invites God into their difficult situation. 

When I have prayed for the sick, I have been able to discern a physical change in their 

appearance. They are more relaxed and confident and they realize that they are not alone, 

and the spirit of God is with them. 

My first interaction with hospital chaplaincy occurred during my own hospital 

stay, where I was scheduled for a difficult surgery. I did not have family living close to 

me and I was frightened and felt alone. I remember the chaplain's visitation as being 

comforting and reassuring. The chaplain prayed with me and the heaviness and 

uncertainty that had begun to consume my spirit was lifted. Since that time, I am 

motivated by my own desire to bring a spiritual presence to others who are hospitalized. 

My desire is to bring a spiritual presence to others who are hospitalized. I have a passion 

to minister to those who are sick and need encouragement. 

As I continue to grow in the role of chaplain, my spiritual gifts are being defined. 

I feel that my spirit is being shaped to reflect more of a spiritual presence. After being 

hospitalized for several surgeries, I am able to reach out to patients as a wounded healer, 

one who has faced challenges as a hospital patient.


Since it was the fall semester, there were two major holidays, Thanksgiving and 

Christmas during which time my husband and I traveled out of state to visit family. 

Physically, I had several medical issues attacking my body. In addition to my four 

classes, visiting doctors, along with serving on three ministries at church, and my father's 

health taking a negative turn, I experienced burnout. 

During this time of craziness, my spiritual director was a great help in guiding me 

towards balancing my busy lifestyle. She persuaded me to be dedicated to a committed 

time of prayer. My spiritual director also encouraged me to practice self-care by 

including time for breathing exercises. My circumstances did not change but I was able to 

keep a positive perspective. 

There is a growing demand for chaplains to serve a multi-cultural and multi-faith 

population. Among the factors facing chaplains as they strive to satisfy spiritual needs 

from a multi-faith perspective are (1) ethnicity, (2) refraining one's faith perception, and 

(3) daily stress and burnout. 

Today's chaplains come from diverse ethnicity and religious backgrounds, which 

brings a wealth of cultural tradition and religious rituals to the position. There was a time 

when hospitals seldom hired persons who did not reflect the traditional role of chaplains 

being Christian and white male. Contemporary chaplain comes from a wide variety of 

colors representing many cultures, religious traditions, and whose primarily native tongue 

is not English. This thesis examines possible biases between patient and chaplain from 

different religious and cultural traditions. 

My goal is to research healthcare chaplaincy and examine challenges of meeting 

spiritual needs of multi-faith and trans-cultural population in hospitals.


This thesis will review the emerging paradigm shift from pastoral care visitation to 

professional chaplaincy. The emerging trend is that chaplaincy is becoming more faith- 

base neutral with specialization for specific religious or ethnic population. This questions 

whether chaplains are becoming genetic in their spirituality and are patients religious 

beliefs influencing chaplains convictions. 

I believe that the spiritual presence that chaplains bring to a patient's bedside 

crosses religious and cultural differences and begins the healing process. Healthcare 

chaplaincy augments the inter-pathy healing process for patients crossing 

multiculturalism and multi-faith traditions.

CHAPTER II 

History of Chaplaincy 


The first glimpse of the chaplain's role is in the Old Testament in the book of 

Joshua. The Levite priests were responsible to carry the word of God and to keep his 

presence in the midst of the Jewish people circumstances as they journeyed to the 

Promised Land. "So they may know that I am with you as I was with Moses, tell the 

priests to carry the Ark of the Covenant..." (Josh. 3:7-8). The priests performed 

sacramental ministry and provided spiritual guidance throughout Israel's time in the 

desert. 

Originally, chaplains were Christian men who served as aids to bishops, or as 

personal ministers who cared for the spiritual needs of a nobleman's household. 

Noblemen's castles or residency had at least one chapel attached. The majority of the 

population including noblemen and their families were illiterate and could not read or 

write. Clergy were hired to perform spiritual duties and filled the role as advisor and 

secretary, (Wikipedia, 2007). 

In The Middle Ages, St Martin of Tours (a former solider) was regarded as the 

patron Saint of French Kings. The Church allowed kings to carry St. Martins Cloak into 

battle as a Church relic. A priest, who served as the King's pastor, carried the cloak into 

battle. Capellanus was the title given to the priest who carried the cloak into battle. The 

term chaplain remains tied to warfare and attached to a military (Kovta, 1998). 

With the passage of time, the role of chaplaincy shifted from military assignment 

to hospital chaplaincy. Since 1929, chaplains have clinically trained for their specific 

faith based ministry or a particular facility.


By the 1940s, the role of chaplaincy shifted further with the certification of chaplains for 

specialized responsibilities (Smith, 1990, p.136). In these contemporary times, chaplains 

are classified as ordained clergy, commissioned laypeople, and clinically certified 

professional chaplains. The term pastoral care is often use interchangeable with 

chaplaincy. Contemporary chaplains are either clergy or lay pastors who provide pastoral 

caregiver services in hospital or other facilities. 

Healthcare chaplains are referred to as clergypersons or laypersons who are 

commissioned by a faith group to provide pastoral services in various facilities, including 

hospitals, universities, schools and workplace. Society commonly use the term pastoral 

care to define services provided by laity or ordained ministers and reserve chaplaincy 

duties for pastors, priest or a rabbi. 

Pioneers of Healthcare Chaplaincy 

Chaplain Anton Boisen (1876-1965). In the early 1900s, hospitals hired ministers 

or retired pastors without specific training to provide pastoral visitation. Anton Boisen 

was hired as chaplain at Worcester Mental State Hospital in 1920 after recovering from 

his first psychotic episode. While he was being treated for catatonic schizophrenia, 

Boisen had a breakthrough revelation while hospitalized. During his recovery, he saw a 

clear vision of a relationship between his mental crisis and his religious beliefs. Boisen 

was an ordained pastor. He made a correlation between sin, salvation, and his illness. 

This man of God declared his healing through the compassion of Jesus Christ, whose 

presence he believed, kept his soul during his time of crisis (Leas, 2007). 

breakdowns. 

Boisen was hospitalized several times from 1920 to 1922 with psychotic episodic


At the peak of his own human crisis, Boisen sensed that he was at a turning point towards 

healing, toward reorganization, and toward reconnection to wholeness. Boisen attempted 

to place understanding on his illness and came to an empirical theology of a relationship 

between certain types of schizophrenias and the caring for the soul (Leas, 2007). 

In the winter of 1924, Boisen invited two college students from a local Episcopal 

seminary in Boston to train with him at Worcester State Hospital. The students did not 

remain with him, but became his inspiration for seminarian students' clinical training. In 

the summer of 1925, four students agreed to train with Boisen. Students' schedules 

included: serving as ward attendants, participating in staff meetings, and attending 

evening seminars with Chaplain Boisen or his staff. Helen Flanders Dunbar was one of 

Boisen original students. She later became the Medical Director of the Council for 

Clinical Pastoral Training of Theological Students in New York (Leas, 2007). Boisen 

case study method of collecting patient information by studying the human document 

(patient) and theological reflection is the forerunner of clinical verbatim. Boisen trained 

students to reflect on both psychological and theological condition of patients. 

Richard C. Cabot (868-1939). Cabot a well-known Boston physician is a pioneer 

of medical social work. In 1905, Cabot introduced social work at Massachusetts General 

Hospital (Hemenway, 2007). At age 50, Cabot left the medical field to teach at Harvard 

University. Cabot's goal was to integrate theological students' studies in a medical on the 

job training. Even though Cabot may have disagreed with Boisen theories on mental 

illness and his spirituality, Cabot was a major financial and moral supporter of Chaplain 

Boisen. It was not until Boisen suffered another psychotic break that caused the final split 

between the two men.


In 1925, Cabot joined Boisen at Worcester State Hospital for a summer course of 

clinical training. After working with Boisen, Cabot was convinced that combining 

medicine and pastoral care training would be beneficial to patients. Cabot wrote his Plea 

for Clinical Year in the Course of Theological Study, which became the foundation for 

theological student clinical internship. Cabot teaching philosophy recognized the need for 

seminarian student's clinical training to be similar to that of medical student residency 

(Leas, 2007). 

Cabot interest in the growth of souls produced a new term, growing edges, which 

are jagged, and irregular edges formed as the soul grows new cells (Hemenway, 2007). 

He was one of the early pioneers to train theological students using case histories and 

pastoral education in a personal clinical training. Cabot considered a patient's history as 

clues to their illness and healing. His course on The Essentials of Case Records for 

Teaching Theology Students impressed his student, Anton Boisen. 

Boisen name is coupled with the term living human document (Miller, 2005). 

Boisen believed in the study of the human experience as a means of applying theology to 

patient's illness. Boisen understood his psychotic breaks to be a crisis of faith and healing 

involving God intervention in the midst of his crises. The divisive differences in theology 

between the two men were, Cabot affirmed that mental illness is an expression of 

physiological caused by a chemical imbalance and Boisen teachings and practices leaned 

towards the understanding that mental illness is psychogenic caused by unresolved 

religious experiences, as in a crisis of faith. 

Helen Flanders Dunbar (May 14, 1902-Aug. 1959). Dr. Dunbar was a 

psychiatrist, literary critic and theologian.


Dr. Dunbar earned four graduate degrees in seven years. She became the director of 

Council for The Clinical Training of Theological Students. Her primary interest was 

integration of religion and science (McGovern, 2000). Dr. Dunbar found her niche in 

theoretical for psychosomatic medicine, a holistic and organic approach to healing. When 

the split between Cabot and Boisen occurred, she moved a division of the Council to New 

York. Her goal was to bring clarity to the relationship between psyche and physical 

health. Dr. Dunbar served as chief editor of the Journal of Psychosomatic Medicine from 

1938 to 1947. Dr. Dunbar is one of the pioneers of The American Psychosomatic Society 

(McGovern, 2000). 

Contributors to Clinical Training 

Russell Leslie Dicks (1906 to 1965). Dicks is credited with the development of the 

verbatim, which is used as a teaching tool in clinical education. He wrote down his 

prayers for patients and his detailed discussions with students. Dick's talent of writing 

down meticulous conversations regarding patient's history attracted Cabot's attention. 

Russell Dick's primary theme for pastoral care was more spiritual than clinical. Dicks 

and Cabot guidelines for chaplain's clinical training developed from their book, The Art 

of Visiting the Sick, published in 1936 (Monfalcone, 1990). 

Seward Hiltner. From the 1930s to the 40s, conflict between Council members 

lead to a division among members, this placed Hiltner and Robert Brinkman at opposite 

ends of leadership. Hiltner was Council director from 1935 to 1938. The Hiltner 

Tradition emphasized theological reflection in relationship when studying human 

experiences.


Hiltner and Dunbar clashed on theology as well as daily routine. Their authoritarian 

battles eventually lead to Dr. Dunbar replacing Hiltner as her Executive Secretary. 

Because of conflict, Dr. Dunbar banished Hiltner into the background and hired 

Brinkman as her Administrative Assistant. Dr. Dunbar gave Brinkman more authority 

than Hiltner and he became the ruling voice of the East coast Council. Brinkman 

theology was more aligned with Dr. Dunbar, his emphasis dealt with science and 

psychology. Brinkman ideology and practices exceeded the pastoral care theology that 

was essential to Council teachings. Brinkman authority surpassed other leading voices 

from the Council and its section leaders. He emerged as the authoritative voice of the 

Council until 1967 (Leas, 2007). 

Cabot and Boisen are both recognized for their use of case studies for theology 

students' clinical training. Phillip Guilds is acknowledged as the first to incorporate 

listening and caring skills as integral factors of pastoral care. Rollie Fairbanks, a student 

of Russell Dicks, introduced the wide margin on verbatim. Boisen's name is connected 

with the term living human document (Miller, 2005). Anton Boisen believed in the study 

of the human experiences as a means of applying theology and inserting God in the midst 

of crises (Leas, 2007). 

Clinical Training Movements and Organizations 

Our people have made the mistake of confusing the methods with the objectives. 

As long as we agree on the objectives, we should never fall out with each other 

just because we believe in different methods, tactics, or strategies (Dr. Martin 

Luther King, Jr.). 

The division between the two major powers in Clinical Training created a bitter 

atmosphere between former colleagues.


From 1930 to 1967, there were two powers of authority for pastoral care in a clinical 

training setting, the New York group, led by Dunbar with the support of Boisen and the 

Boston group, consisting of Cabot, Philip Guiles and Russell Dicks (Miller, 2005). Cabot 

wrote that clinical training applies theology to case studies. Boisen believed that hospitals 

were appropriate settings to study theology by using case studies as the primary method. 

Cabot saw mental illness as a manifestation of psychological condition, where as Boisen 

identified mental illness as a function of the psyche used for problem solving with a 

religious connection (Miller, 2005). 

The trio, Boisen, Cabot and Dunbar along with Phillip Guiles formed The Council 

of Theological Students (CCTTS or CCT). Eventually, the trio disbanded because of 

different ideologies and goals. After Boisen suffered another major breakdown, Cabot 

declared Boisen unstable and incapable of training students in a pastoral setting. Cabot 

separated himself from the group. He continued his research and case studies with 

students independently. Along with Russell Dicks and Philip Guiles Cabot formed The 

New England Theological School Committee of Clinical Training, which remained 

closely connected with the seminarian community (Miller, 2005). 

In 1925, The New England Group that included Rev. Dicks, Rev. Guiles, and Dr. 

Cabot along with several laypersons and clergy began training students in general 

hospitals, transitioning from mental wards. In 1944, the New England Group following 

Dr. Cabot direction incorporated as the Institute of Pastoral Care (Leas, 2007). The 

Council voted Cabot out of leadership and Dunbar succeeded him as director of the 

Council. Dunbar moved the Council's headquarter to New York and operated as a 

separate branch of The Council for Clinical Training.

The Role of Chaplaincy in Healthcare 

CHAPTER III 

Spirituality and Healing 


Hospital chaplaincy began in the mid-1920s. The contemporary definition of 

chaplain is one who provides tasks normally performed by clergy. Clinical chaplains 

perform religious rites, rituals, and blessings for patients and staff. Chaplains provide the 

same sacraments and blessings as clergy, but have a different audience and are located 

outside of a church building. A chaplain ministers spiritually to persons who may or may 

not profess a religious belief (Paget & McCormack, 2006). A chaplain's role is also one 

of an intermediary between person and a transcendent. 

In addition, a healthcare chaplain works with a diverse and pluralistic captive 

audience. At some medical facilities, hospital chaplain's schedule includes cold call 

visits, which requires a greater sensitivity to various types of spiritual needs from their 

clients. The chaplain's role is to be amenable and nonjudgmental, but representative of 

the transcendent. Often times, in an emergency, a chaplain is called to minister to patients 

from different faith and ethnic culture (Paget, 2006). Hospital chaplains are held to a 

higher standard of the First Amendment's free exercise clause, which states that the 

chaplain's position will not engage in proselytizing vulnerable patients. 

One equally important role of a healthcare chaplain is to offer spiritual care 

through their presence, communication with patient, family, and hospital staff. Chaplains 

reframe difficult situations with added encouraging words. They also intercede for 

patients and families in negotiating the hospital system, and they give guidance to 

patients in making difficult medical decisions.


In addition to their gifts of service, a healthcare chaplain is required to have 

specific and specialized training plus an endorsement by their faith denomination. 

Hospital chaplains are generalists and usually are assigned to a particular floor or they 

may specialize in a specific area of medical services. Hospital staff includes several 

levels of chaplaincy: staff chaplain (full time), CPE intern trainees, or part-time, pro re 

nata, (PRN) positions that are contracted as needed (on-call) (Paget, 2006, p. 48). A part- 

time chaplain requires a minimum of 1 CPE unit (400 hours) of clinical training. CPE 

interns receive training as a year-long residency or 1 unit of CPE. Most chaplain intern 

receives training at a hospital setting while others serve in community location, e.g., 

police department, church, and counseling centers (Paget, 2006). 

Spirituality and Coping Styles 

In times of difficulties, most patients turn to their faith or religious traditions 

when confronted with serious or life threatening illness. Gall and colleagues developed a 

spiritual conceptual model to analyze the affect of spirituality in coping with illness. This 

spiritual transactional model is multi-faith and multidimensional. It is a spiritual model 

that has God or a transcendent as the key factor in the religious coping process. This 

spirituality framework is subjective, rational, trans-active, and process oriented system 

that functions primarily as an individual's reconnection to his or her religious belief 

tradition and rituals (Gall. et al., 2005). 

As a result, multidimensional spirituality operates on several levels of stress and 

coping skills. It functions primarily on a human factor and secondarily as an appraisal of 

God's attributions, coping behavior, and meaning making. A person's spiritual beliefs 

guide his or her interpretation, understanding, and reactions to illness and healing.


Spiritual appraisal assesses and gives meaning to stressors. Spirituality and religion can 

function at the same level of understanding to find meaning out of a situational crisis. 

Augsburger, one of the leading researchers in the field of spirituality and 

religiosity links the process of religious coping behavior with finding meaning and 

understanding. Recent studies list spiritual appraisal, attributions, and attachment to a 

God as key motivating factors in religious coping (Gall, et al., 2005). The transactional 

model of spiritual coping conceptualized as cognitive reappraisal or refraining of 

stressors helps individuals to find meaning in their circumstances and adapt to the coping 

process. Failure to find meaning can bring on doubt or a spiritual crisis and can lead to 

physical inactivity and depression. Finding meaning and making sense of the situation 

can promote the healing process and encourage a positive attitude. 

In fact, spirituality is a complex, multifaceted, construct that is reveal in human 

behavior, beliefs, and experiences (see Miller & Therese, 1999). Spirituality is also 

multidimensional and operates on several levels of stress. Spirituality exists on levels of 

personal factors (your beliefs), primary and secondary appraisals, and recognized coping 

behavior patterns (prayer), coping resources, which includes family and faith community 

(connection with God) (Gall, et al., 2005). 

In this spiritual framework, individual beliefs are the bases for personal 

interpretation, understanding, and reaction to life stressors. Individual doctrine 

encourages people to find meaning in the midst of their crisis. A strong belief system 

supports patients in maintaining an active attitude through the coping process, and 

strengthens their response to stress. Spiritual appraisals and coping behaviors operate as 

intervening factors in dealing with stress.


As a result, patients sometimes ascribe their health crisis to God's will. Trying to 

make meaning out of a negative situation can reduce initial levels of stress. Sometimes, 

individuals blame themselves, fate, luck, others, God, or the devil as the cause of their 

crisis. Spiritual causal attribution can induce positive refraining of a negative, as 

individuals try to make sense of the situation. Attributions can also preserve a person's 

belief in a just world, helping patients to maintain a sense of personal control in crisis 

(Gall, et al., 2005). There are individuals who assign the causation of 9/11 terrorist attack 

to the devil, some blame God, but all experienced a higher level of Post Trauma Stress 

Disorder (PTSD). 

Moreover, religious denomination and personal beliefs intertwine with an 

individual's faith community to provide social support that influences a person coping 

with stressors. Patients with solid religious beliefs are shown to be physically healthier, 

which reduces their level of illness. Most Christian denominations discourage the use of 

alcohol, drugs, and smoking cigarettes, which presents a healthier body. Hospital studies 

report that persons with strong spiritual and religious beliefs have less anxiety and stress, 

lower depression, and a greater ability to collaborate in making medical decisions (Gall, 

et al., 2005, p. 91). 

In addition, extrinsic and intrinsic religion orientations play an important role in 

patient's ability to cope with stressors. Extrinsic behavior serves the individual for his 

own sake. It is a form of religious belief that provides comfort and safety to the patient. 

Extrinsic behavior assumes guilt based on external stressor with a perception that the 

patient is in able to cope with life threatening situations.


Intrinsic behavior is an internalized understanding of who God is through faith. 

Intrinsic religion orientation demonstrates a positive role in the healing process and is an 

indicator of lowering the intensity of depression in the healing process. Patients with 

higher levels of intrinsic religiosity rely on their deonomination's resources, and resulting 

in more control over their situation. Patients with positive intrinsic behavior appear to 

have an optimistic role in their healing process. 

Gall and colleague (2005) indicate several coping styles in spiritual physical healing: 

A self-direction style indicates that the patient takes on active role that is 

independent of God. (2) In a deferring style, the patient takes on a passive role 

and waits for God to resolve their healthcare crisis. (3) A surrender style which 

signifies release of personal control over to God, and (4) collaborative style 

involves engaging God in a mutual sharing in their healing process (Gall, et al, 

2005). 

In fact, the collaborative style among patient, hospital staff, and God appears to 

have a positive influence on healing. A collaborative relationship provides the patient 

with a sense of empowerment in a challenging or life threatening situation. By sharing 

control of their healing with God, patients understand that they are still included in the 

decision making process. According to Narin & Merluzzi (2003), a deferring- 

collaborative style is more important than social support to the psychosocial adjustment 

to patients with life threatening illness (Gall, et al., 2005). 

Spirituality and Coping Skills 

Spiritual coping is multidimensional and ranges from negative to positive 

problem-solving strategies. Spiritual coping behaviors are categorized as organized or 

private religious behaviors or spiritual traditions, and nontraditional spiritual practices 

(Gall, et al., 2005).


Organized religious behaviors involve patients in a formal public religious institution and 

include practices like attending worship service and praying. There is some literature that 

indicates that persons, who regularly attend church service and prays, often continue to 

pray during their post surgery period. Private, nontraditional, and informal religious 

activities are similar to organizational behaviors, which include prayer, studying 

Scripture, and watching religious programs (Gall, et al., 2005). 

Nontraditional religious practices express an individual's spirituality that is 

different from traditional religious actions. Benson and Borysenko's (1994) research 

indicates that incorporating relaxation techniques with spirituality is a critical factor in 

the healing process. Patients who use devotional material and spiritual meditation 

experience less anger, anxiety, and tension. 

Spiritual coping behavior is a normal response to stress and physical illness. 

Several studies indicate a positive connection to spiritual coping. There is also a negative 

side that comes with having religious dissatisfaction, which produces psychological 

distress and lowers life contentment. Timing is essential in spiritual coping. Depending 

on when individuals pray or plead for healing, one can determine their satisfaction with 

the response from their transcendent being. 

Spiritual correlations link a sense of sacred connections to nature and all living 

things. Interviews from Appalachian women report a sense of groundedness through their 

interaction with nature (Gall, et al., 2005, p. 94). Studies also indicate that interaction 

with nature may reduce levels of stress. Patients have commented that being in nature 

gives them a sense of hope.

Caring for Souls 


The traditional term for pastoral care is cura animarum. The Latin word cura's 

primary meaning is care in reference to healing. Anima, the Latin translation of the word 

comes from the Hebrew word nephesh (breath), as when God breathed life into Adam, 

(Gen. 2:7) (Meiburg, 1990, p. 122). The word anima in Greek translates as psyche or 

soul. The word anima refers to the soul and is interpreted in many ways. In the New 

Testament, soul represents the essence of man with emphasis on a transcendent or a 

higher being. The ancient term for cure of souls comes from the role model of Jesus, as 

one who meets human pain with compassion, grace and forgiveness. 

Meiburg defines the care of souls in three ways: 

In its broadest sense, for priests the act of ministry includes preaching, visitation, and 

organizing parish life. The ultimate goal for priests is salvation and perfecting a person's 

soul. In the Roman Catholic tradition, a curate was one who receives the cure of souls by 

appointment to the office of parish pastor or assistant pastor. (2) In its narrow sense, care 

of souls is more of the traditional pastoral care (Seelsorge), which is closely link to the 

Lutheran Reformation Movement and its pastoral theology. Luther reverted to the New 

Testament idea of mutual correction and encouragement, believing that all believers 

should care for each other. McNeil defines Seelsorge as care of all for the souls of all 

(McNeil, 1951). (3) Clebsch and Jackie (1975) define care of souls as helping acts done 

by representative of a religious community. The goal of care for souls is to guide, direct 

towards healing and to reconcile persons in distress (Meiburg, 1990, p. 122). 

Similarly, Thomas Moore author of Care of Soul maintains that the primary cause 

of illness is the neglect of the soul. Moore explains that the neglected soul does not 

disappear: it manifests itself as obsession, addictions, violence, and loss of meaning of 

life. The care of the soul touches the deepest and most intimate dimensions of being 

human and having a desire for a relationship with God (Anderson, 2001). In fact, 

Anderson describes the soul as a reflection of the bio-social-spiritual unity of the person.


The soul cannot live without the body and human beings are embodied souls and soul- 

filled bodies. The integration of both soul and body creates who we are (Anderson, 

2001). 

Pastoral Care and Seelsorge 

Seelsorge is the ancient tradition of pastoral care that not only cares for the body 

but also provides spiritual care for the soul (salvation). There is a paradigm shift from 

soul care to contemporary pastoral care, which adds psychotherapy to a patient's care. 

One consistent feature of pastoral care throughout history is its focus on persons in 

trouble or patients in crisis. Contemporary pastoral care has shifted from its historical 

connection with a faith-based community to individual beliefs in a transcendent. The 

term spiritual care is replacing pastoral care in most medical facilities (Anderson, 2001). 

Hospitals are renaming or considering renaming their Pastoral Care Department to 

Spiritual Care Department. 

Over recent years, one of the most significant modifications to the term pastoral 

care is the silence concerning the reference to soul. The terminology of soul is out of 

vogue in pastoral theology because of the fear of returning to the old body and soul 

dualisms, and because of the psychological paradigm. Pastoral care emphasizes the 

human story rather than the presence of God in the human experience. Revisiting 

Seelsorge and incorporating the ancient term into modern society help individuals and 

communities to integrate human and divine stories that enhance their spiritual life 

(Anderson, 2001, p. 34). 

Recently, The Association for Clinical Pastoral Education, Inc. (ACPE) began 

replacing pastoral care with spiritual care in its mission statement (Anderson, 2001).


The last line of the mission statement is we promote the integration of personal history, 

faith tradition and the behavioral sciences in the practice of spiritual care. 

The ACPE gives five reasons for changing their mission statement: 

The work of pastoral care performed by laypersons for which the word pastoral is 

associated with and the shift to clinical care, (2) the work of chaplains is more often for 

pay by the healthcare institution. (3) Since most patients visited by chaplains are not 

practicing Christians or not identified with a Christian community, pastoral care is a form 

of generic spirituality. (4) Spirituality is promoted by health care administrators because 

people who recognize the transcendent in life and pray, recover from illness more 

quickly, and (5) the religious diversity of chaplains requires a more inclusive metaphor 

than pastoral care (Anderson, 2001, p. 35). 

Moreover, modifications to the term pastoral care reflect the status of spirituality 

in a response inside and outside of the traditional Christian ministries. Today's 

spirituality refers to the urgings of the spirit, both human and divine. When people are 

sick, spiritual care brings together the transcendent and the support of a faith community. 

Renaming pastoral care to spiritual care accommodates sociality's demand for spirituality 

that reflects a multicultural healthcare population. The advantage is spiritual care invites 

a holistic approach to illness and treatment. The term spiritual care is more inclusive of a 

multi-faith culture than Seelsorge (Anderson, 2001). 

Spiritual care is consistent in demonstrating the Joint Commission on the 

Accreditation of Healthcare Organization ((JCAH) statement of patient's rights to 

provide considerate care that safeguards a patient's personal dignity and respect for their 

cultural, psychosocial, and spiritual values (Anderson, 2001, p. 35). 

Spirit in Spiritual Care 

When spirituality is used to describe human activity such as care, the reference 

often refers to spirit that is integrated in the body. The contemporary definition of 

spirituality connotes the higher functions of the human life


Spirituality tends to duplicate individualism in today's culture. Seelsorge as a model for 

spiritual care enables a caregiver to honor the sacred worth of each individual and respect 

the diversity of human beliefs, and other cultures. Anderson (2001) describes spiritual 

care as an alternative type of care in a pluralistic society. 

Anderson does not equate pastoral care with the traditions of Seelsorge (care of 

the soul). Contemporary thinking prevails in asserting that anyone can provide spiritual 

care but not pastoral care. The term spiritual is general enough to include all expression 

of spirituality (Anderson, 2001, p. 37). Middle Ages theologian, Martin Luther was one 

of the first to acknowledge that the people of God should care for other persons of God, 

thus shifting away from the idea of the necessity of pastoral or spiritual care being 

provided by ordained clergy. 

Contemporary traditions of care indicate that spiritual care is not limited to 

professionally trained staff of chaplains or ministers. On May 16, 2007, a mentally 

disturbed student killed thirty-two students and professors on Virginia Tech campus. The 

first responders to provide comfort and spiritual care were students and faculty members. 

Students went deep enough past their individual pain and suffering to comfort others of 

diverse ethnicity and religious denominations. "The Father of compassion and the God of 

all comfort, who comforts us in all our troubles, so that we can comfort those in any 

trouble with the comfort we ourselves receives from God" (2Cor. 1:3-4). 

Likewise, Dietrich Bonhoeffer describes spiritual care as God's work with human 

experience being limited in spiritual care. Bonhoeffer further writes that invocation and 

evocation are the focus of care. When persons receive spiritual care, it strengthens them 

and makes them aware of the presence of God in their lives.


He further remarks that pastoral care assists individuals in integrating their human 

experiences with biblical stories, parables, and narratives, which empowers individuals 

for discipleships (Anderson, 2001, p. 38). 

Theology of Pastoral Care 

In the Old Testament, the purpose of pastoral care is to care for the covenant that 

God initiated with man, beginning with care given to Adam and Eve while they were in 

the Garden of Paradise (Gen. 2). The covenant between God and the Jewish people 

continues. God initiated a covenant with his people where he promised to make them a 

great nation. Their response was to answer his call to worship and live in community with 

one another (Switzer, 2000, p. 6). Biblically, the contemporary foundation for pastoral 

care is Matt. 25:35-40, where Jesus teaches how to care for those who are sick, hungry, in 

prison, and homeless. 

Historically, pastoral care refers to the cure (care) of the soul (Mills, 1990, p.836). 

Saint Ignatius of Loyola was an early proponent of parakletic (pastoral care) which 

comes from God to meet, the needs of man. Saint Ignatius goal was to heal the body and 

the soul. Saint Ignatius provided pastoral care through teaching the Gospel 

(martyria),works of charity (diakonia), and serving the sacraments (liturgia) to the sick 

and dying (Sievernich, 2003). 

Generally, pastoral care is a specific illustration of church ministry. Pastors, 

ordained ministry leaders, and lay members of a faith-based community exercise care to 

those in crisis. "Carry each other burden so that you may fulfill the law of Christ" (Gal. 

6:2).


Contemporary pastoral care reflects the changing religious attitudes of today's society. 

The scope of pastoral care is broad and holistic and it embraces all ecclesial care. 

Culturally, pastoral care includes a pluralization of cultural tradition, religious rituals, and 

distinct cultural patterns. 

In addition, pastoral care is linked with spiritual and psychophysical healing. 

Spiritual healing confronts sin and salvation and focuses on the intrapersonal dimension 

of life, which connects us to another person's behavior. Pastoral care in relationship to 

Seelsorge is companioning an individual on his or her journey towards God. Seelsorge or 

soul care is a metaphor for the church ministry of care. The language of soul is a story 

and a paradox to the window to the Holy (Anderson, 2001). 

The Healing Power of Prayer in Pastoral Care 

In pastoral care, prayer is seem as an expression or conversation with God that is 

rooted in most religions. Prayer is an instrument that assists individuals in 

communicating with the transcendent. It is individualistic, personal, and is an affective 

factor in the healing process. In the Christian tradition, prayer is usually coupled with 

reading Scripture verses, listening and speaking to God. It is an invitation from God to 

put his presence in the midst of a negative situation. As Christ is the personification of 

God, the church is the embodiment of Christ. In turn, the church's clergy are 

representative of the manifest function of Christ's healing and visiting the sick (Hulme, 

1990). 

One purpose of prayer in pastoral care is its healing of body, mind, and spirit. 

Another function is supporting a context of meaning in affliction when making sense of 

the situations that makes no sense.


Prayer opens up a safe space for patients to discuss meaning in their situations and to ask 

difficult questions such as, where is God in all this pain. Prayer guides patients to the 

source-center of their identity as children of God. During times of prayer, patients are 

encouraged to be still, comforted, and to feel secure in the knowledge of God's presence. 

"Be still and know that I am God..." (Psa. 46:10). According to Hulme (1990), prayer 

has a calming effect during times of stress. 

Prayer energizes an individual's faith and it is an expression of faith. Prayer in 

pastoral care arises from the need of crisis in the moment during visitation, or medical 

emergencies. Visitation and prayer are means through which the Holy Spirit works. Both 

compliment each other's function and affirm that God exists and cares for individuals 

(Hulme, 1990). Gall and colleagues 2005) noted that elderly patients who regularly attend 

worship had their hypertension fall by 40% compared with patients who attend service 

but fail to pray consistently. Their results were 8% in comparison. 

Common Prayer for Diverse Cliental 

Gall and colleagues (2005) indicate that the type of prayer offered is as important 

as the prayer itself. Asking for direct intercession from God may indicate that there is a 

psychosocial distress and that a poorer routine function after a serious illness is indicated. 

Caregiver to patients, Christians ministering to non-Christians, all are welcome to 

participate in common prayer. Pastoral care more narrowly defines participation in the 

ritual. 

The chaplain must respect patient's religious beliefs and practices. Being attentive 

to patient's faith pervades hospital chaplain's visitation to both Christians and non- 

Christians.


Because Christianity covers a diverse religious population, chaplains need to be mindful 

of the types of prayer that are welcome. The chaplain is expected to attend to spiritual 

needs and faith expressions of others and to preserve their own religious dignity 

(Sievernich, 2003). 

Moreover, prayer is a common denominator among all of the major religions. 

Dossey defines prayer as communication with the absolute and a means to affirm 

religious tolerance (see Dossey, 1998). Religions such as Buddhism do not have 

formalized prayer in their tradition. Their faithful engage in meditation on a specific 

theme or word. Chaplains must be aware of non-practicing Christians, agnostics, or 

atheists, and members of other religion denominations who may not desire or accept 

prayer (Mellon, 2003). Common prayer is inclusive and not exclusive of other religious 

traditions. A chaplain must decide which demands of absolutism their own Christian faith 

presents during visitation with patients. 

There are three fundamental models of prayer listed by Schmidt: exclusive, 

inclusive, and pluralistic: 

The exclusive (separatist) model. Christian Chaplains recognize their faith as the only 

way to salvation and all other religion must consequently be false (Schmidt, K. W., 

1998). Pastoral care within the exclusive model means that caregiver rejects patient's 

faith that is different from their own. The strength of this model is a Christian chaplain 

remains firm in his or her religious identity. 

The inclusive model. This prayer model dismisses other religions as false. The 

inclusive regards other faith traditions as qualitatively inferior to Christianity.


Inclusive models acknowledge that other religions exist and assume that believers are in 

search of God (Schmidt, 1998). The inclusive model allows common prayer between 

different faith traditions. One critical objection to the inclusive model is the use of the 

term Heilsgeschichte (salvation history) which is not common to Hinduism and 

Buddhism. Both of these religions are narrowly described with a Christian perspective 

(see Steinacker, 1997, p. 168). 

The pluralistic model. This prayer model represents a contemporary theological 

interpretation that professes that all faith traditions are comprehended as equal paths to 

salvation. All religions lead to the same goal with different paths to salvation and 

redemption. The pluralistic model recognizes that each religious path is of equal value. 

The claim to absolute right is gone and the belief in relativity voices a call for tolerance. 

For pastoral care, pluralism promotes respect and acknowledgment of the other, equally 

valuable religions (Schmidt, 1998). 

In modern theology, the pluralistic model reflection does not clarify why there is 

tolerance towards other religions and why tolerance towards other religions is the only 

correct way of acceptance. Unconditional tolerance towards other religion takes on an 

exclusivist's appearance of absolutism. Another problem with pluralistic model is that it 

promotes generalization and identifies all religions as paths to salvation. This model does 

not lead to salvation, but acknowledge that paths to salvation exist in all religious faith 

(see Bernhardt, 1994, p. 140). 

The Presence of God 

Generally, prayer is used by chaplains when needed or upon request of patient.


It is a means to invite the presence of God into the midst of pain and suffering and it 

offers hope in the situation. God's presence is often symbolic of people standing around 

the water cooler that sits quietly in place. His presence sits there quietly performing its 

function upon request of the patient or chaplain. God's presence is the gift of grace that 

the chaplain brings to the human experience (Paget, 2006). The presence that he or she 

brings is a reminder that spirituality is a part of the ordinary and extraordinary. The 

caregiver relationship strengthens when a patient does not find him or herself alone in 

times of crisis. 

In fact, chaplains practice the presence of God through prayer rituals, listening, 

the spoken word, Scriptures and acts of service (Paget, 2006). A chaplain walks between 

two worlds with patients. They walk with his or her own human stories and are 

simultaneously theotokos, or bearers of God's presence. The chaplain represents a bridge 

between patients' struggles and God's presence. A chaplain empowers patients 

spiritually, ensure God in their midst, and present hope in the healing process. 

Hope is an important factor that affects the spiritual framework of coping (Gall, et 

al., 2005). Hope is a cognitive construct that consists of personal motivation or goal 

directed and is the underlining feature of patient's perception of their ability to maintain 

personal motivation. The theory of hope reconsiders failure to be a way to successfully 

envision and pursue strategies for supporting a desired goal. Studies have found that 

individuals with high levels of hope are able to maintain their faith in difficult and 

traumatic events (Gal, et al., 2005). Through prayer, faith sustains and enhances health 

and healing.

Ministering in God's Presence 


Ministerial awareness is an event that happens only once and cannot be repeated. 

Being mindful on the moment enables reality that seen through the eye of the heart 

(Mossi, 1995, p. 275). During his earthly ministry Jesus urged his disciples to be attentive 

to the needs of the people who surrounded him, do you have eyes but fail to see, and ears 

but fail to hear (Mk. 8:18). Emmaus challenge each person to examine their pastoral 

quality of daily encounters with God. Often the presence of God is hidden in the bland 

and ordinary. God's presence is found in the unexpected places at unexpected times. 

The Mossi lists six ways to be present in the moment and attentive to the presence of God 

in those we serve (Mossi, 1995, p. 280). 

• Be Aware of each present moment 

• Be aware of location, where am I right now? 

• be aware of the event, conversation, experience now occurring 

• Be aware of your feelings 

• Be aware that God is present in each and every movement 

• Whenever you lose touch with the presence moment, return to step one and begin 

again 

The methodology use in ministering in the present moment is pastoral and rests 

on two major truths. First truth gives recognition of the boundaries that we sanctify and 

redeem. Second truth focuses on God's uncompromising presence now.

Chaplaincy Ministry 

CHAPTER IV 

The Diverse Role of Healthcare Chaplaincy 


The word hospital derives from the Latin word hospalalis, which means guest. 

Early hospitals were outgrowths of guesthouses attached to monasteries in The Middle 

Ages (Kotva, 1998). Hospitals are entrenched in centuries-long tradition of extending 

hospitality to travelers, the sick, the elderly, and the poor. Hospitals are the place where 

most Americans take their first and last breath (Kotva, 1998). Church owned hospitals 

include pastoral care in holistic treatment for its patient's well-being and addresses 

patient's concerns of salvation (Sievernich, 2003). Pastoral care defines the profile of the 

majority of church-owned hospitals. 

Furthermore, chaplains are often referred to as shepherd of a flock. They provide 

spiritual guidance (pastoral ministry) to people in and out of their faith traditions. A 

chaplain offers emotional support, relational reconciliation, and spiritual ministry. These 

attributes represent spiritual caring for the soul (Paget, 2006). Chaplaincy's expression of 

support is seeing in gifts of helping, performing acts of kindness, sitting at a bedside, 

listening attentively to stories or just by being present. The ministry of care centers on 

caregivers having a servant's heart and a compassionate and caring spirit (Paget, 2006). 

Chaplains assume the spirit of the Paracelete, "...and I will pray the Father, and 

He will give you another Helper" (John 14:16). A chaplain is someone who will be your 

advocate, advisor, comforter, and encourager. A chaplain provides encouragement by 

meeting the needs of clients, offering spiritual guidance, promote an atmosphere of trust 

and confidentiality, and find light in dark circumstances (Paget, 2006).


In addition, diatonical pastoral services provided by hospitals include care of 

patient, confirmation of faith, and administration of the sacraments. Also, scriptural 

interpretation shapes and reframes patient's understanding of his or her own life and 

death (Sievernich, 2003). Karl Rahmer provides a theological perspective of pastoral care 

and the mystery of The Trinity. Pastoral care represents God's presence, his love, and 

truth and when combined in celebration of the Eucharist, represents The Trinity 


A Christian chaplain offers pastoral care to patients who are religious or non- 

religious beliefs, regardless of ethnicity or religious affiliation. An example of this is the 

story of the Good Samaritan, who cared for a victim of robbery and violence. The victim 

needed and received help from a Samaritan, a man who was of a different faith, 

nationality, and culture than the victim (Luke, 10:25-27). Charitable acts transcend all 

cultural and religious limits and extend consoling help where and when needed 


Gonxcha Bojorhiu, also known as Mother Theresa, is a contemporary 

representative of a charitable human being, who served persons from a diverse 

background different from her culture. The Christian chaplain has a two-fold relationship 

with respect to non-Christian patients. A chaplain should appreciate others pursuit of 

God, but they must be able to hold on to their own faith convictions. Through spiritual 

discernment, chaplains guide and support other faith traditions and sustain individuals in 

crisis. A goal of healthcare chaplaincy is to enable patients to feel the presence of a 

transcendent spirit when challenge by illness or approaching death (Sievernich, 2003).


However, modern consensus concerning healthcare chaplaincy is geared towards 

professional pastoral care. The discipline is more of a multi-faith referral system in most 

current hospital staffs. No one particular type of chaplain will visit all patients of 

different faith traditions. This model is not an efficient use of hospital chaplains, nor does 

it promote integration of the healthcare team (Handzo, 2006). The standard for the most 

hospitals is to assign chaplains to a specific location and have them visit patients of 

various faith denominations. 

Similarly, Handzo & Koenig (2004) presents what is considered to be a better 

plan which includes: a necessity for spiritual screening and assessment by chaplains, 

evaluation of the importance of patient's religious practices have on the patient's coping 

ability, and to assess the need of immediate pastoral care intervention. 

Multiculturalism - Many Worldviews 

Hospitals typically do not emphasize spirituality because the biomedical model of 

healthcare chaplaincy must be objective and efficient. The United States has at least 2000 

identifiable expressions of religion and spiritual traditions (Fukuyama & Sevig, 2004). A 

chaplain should have basic understanding of cultural and religious diversity. Spiritual and 

religious beliefs embed themselves in culture and find meaning in the context of 

worldviews. Cultural diversity consists of commonalities around developed norms, 

values, family, life-style, and behaviors in response to historical events (Fukuyama, 

2004). 

Consequently, multiculturalism acknowledges that we live in a world that has 

more than one point of view about what is reality.


One definition of multiculturalism is many cultures, many worldviews, many languages, 

and many values that exist and serve many forms of human communities (Fukuyama, 

2004 

In the same way, religious or spiritual diversity refers to the many different 

expressions of faith, beliefs, practices, meaning of spirituality, religion, and the 

transpersonal. Religious pluralism is on the increase in the United States because of 

changing immigration patterns, resulting in growing numbers of Muslims, Latino 

Catholics, and Southeast Asians. There is also diversity between and within religious 

mainstream denominations. The primacy of cultural and religious diversity is the 

hallmark of the New American Spirituality (Fukuyama, 2004). 

The challenge for caregivers is to be comfortable in their own cultural and 

religious identity and to be open to working with others from different cultures and 

religious worldviews. Cultural diversity provides a mirror in which one's beliefs and 

customs presents themselves in contextual relationships to society's norms. Through self- 

reflective process, a greater sense of self becomes the catalyst for personal growth and 

adds clarity to individual values (Fukuyama, 2004). Multicultural training is enhanced by 

attention to spiritual values. Gaining knowledge of diverse worldviews has a two-fold 

purpose, (1) I have a clearer idea of who I am now, because I know who I am not. (2) 

Even though, we are different we are all similar. 

A Meaning of Cultural Diversity 

A definition of culture consists of...commonalties around which people have developed 

values, norms, family life-styles, social roles, and behaviors in response to historical, 

political, economic, and social realities. Everyone has culture and cultural identities, 

which include communication styles, language, and socio-demographic features such as 

race, ethnicity, language, religion, social class, physical abilities, sexual orientation, age, 

nationality, and more. It is easier to be aware of one's own culture through contrast with 

another's culture (Fukuyama & Sevig, 2004, p. 27).


Specifically, there are two important factions to include in multicultural training. 

One is exploration of similarities and differences between cultures, e.g., value systems, 

customs and traditions, and worldviews. Second is an importance attached to achieving 

greater understanding of the concepts of power and privilege. Realizing the effect of 

distributions of economic and social resources to specific groups of people affects how a 

caregiver sees other cultures. The core of multicultural training is to find common 

ground, to accept and respect differences, and to work for changes to unjust social laws. 

Therefore, it is important to recognize the difference between spirituality and 

religious diversity in understanding multiculturalism. Fukuyama defines spirituality as 

adapted from the Association for Spiritual, Ethical, and Religious Values in Counseling 

(ASERVIC), as being the animating force in life, represented by images as breath, wind, 

vigor, and courage (Fukuyama, 2004, p. 29). 

Spirituality encompasses religious, spiritual, and transpersonal connectedness of 

cultures to the transcendent. Spirituality relates personal experience of the transcendent. 

In terms of culture, spirituality is the essence that shapes group identity and customs. 

Religious and spiritual diversity refers to the many different expressions of faith, beliefs, 

practices, and meanings attributed to spirituality and religion. Multiculturalism presents 

the opportunity to unlearn personal biases, confront social injustices, and value social, 

spiritual, and cultural differences. 

Fukuyama specifies comparison between spiritual and multicultural values to 

enrich a caregiver's understanding of the complexities of cultural conflicts and to 

encourage spiritual evolvement in the multicultural learning process.

Table 1. Comparison of Spiritual and Multicultural Values 

Spiritual Values Multicultural Values 

Connectedness with others Cultural similarities 

Compassion and love Cultural differences 


Relationship outside of self Movement from ethnocentrism towards 

cultural pluralism 

Social Justice Dealing with issues of oppression, advocacy 

Faith Flexibility and patience 

Grace, intimacy, creativity Commitment and humor 

Sacredness and mystery Observational skills 

Detachment Bicultural and multicultural skills 

Source: Fukuyama, M. & Sevig, T, Integrating Spirituality into Multicultural Counseling, p. 75, 1999. 

Participating in multicultural training opens the door to interact with other 

cultures, customs, and expands one's spiritual worldview. Interacting with others lessens 

the feeling of separateness, clarifies misunderstandings, and acceptance of other 

spirituality, which softens cultural boundaries (Fukuyama, 2004). Multiculturalism 

presents the opportunity to unlearn personal biases, confront social injustices and value 

social, spiritual, and cultural differences. 

Fukuyama and Sevig developed guidelines to enhance caregiver's skills and 

abilities. The framework for multicultural competency suggests training for those who 

serve a diverse population. These competencies assist caregivers in developing skills and 

understanding of the client's worldview, to increase their awareness of cultural traditions, 

and improve communication skills. The multicultural guidelines encourage caregivers to 

engage in self-exploration of their spiritual beliefs (Fukuyama, 2004, p. 33).

Table 2. Framework for Multicultural Competency 


Personal Awareness (Definitions: awareness of self as a member of social groups and a 

self in a system of oppression) 

• aware of the impact of my social identity group membership on self 

• able to verbalize and act on my awareness of how my social identity group 

• aware of the impact of my interpersonal style on others 

• aware of and able to articulate my values 

• able to recognize areas in which I need to grow 

Knowledge (Definition: information/knowledge) 

• knowledge of multiple groups histories and experiences in this country 

• recognize the history of oppression 

• recognize the importance of histories of various social groups 

• models, conceptual frameworks and terminology 

Skills (Definition: facilitating change in individuals groups, and systems) 

• provide feedback in a direct manner, receive feedback in an open manner 

• recognize group dynamics in a manner that includes multicultural factors 

• address oppressive behavior in a manner that allows others to hear different 

behavioral data 

• able to intervene in groups and ask probing/educational questions 

Passion (Definition: deep personal reason for caring about/doing this work and the 

• ability to articulate this to others 

• ability to communicate compassion and empathy 

• ability to communicate/share strong feelings of anger, fear, love, sorrow, guilt 

• ability to lead with heart and head 

Action (Definition: ability to behave/act in a manner consistent with awareness, 

knowledge, skills, passion) 

• can interrupt oppression 

• can take proactive measures against oppression 

• can identify opportunities for action 

However there is another model to addresses multiculturalism learning process 

begins by attacking the "my way is the right way" and incorporating skills of awareness, 

understanding, acceptance, appreciation, and selectively adopting a biculturalism and 

multicultural approach, (see Hoops, D.S., 1979).


Multiculturalism presents tensions for some chaplains when relating to religion 

and spirituality in healthcare. One of the main issues in dealing with multiculturalism is 

knowing when to travel or leave home (comfort zone). A chaplain should be strong in his 

or her convictions, yet be able to accept a patient's perspective when providing spiritual 

care (Fukuyama, 2004). 

Fukuyama offered constructive elements to consider when assessing personal 

convictions and knowing when to leave home: (1) recognizing and understanding one's 

own personal biases, stereotypes, and preconceptions, (2) having general knowledge of 

other cultural influences of people that you are in contact with, (3) learning cultural 

behaviors that influence patients you serve. (4) Knowing your own cultural influences 

and how they affect your practice as chaplain, and (5) being able to name the behaviors 

listed above (Fukuyama, 2004, p. 34). A healthcare chaplain's worldview affects how 

they view patients and their treatment. 

Moreover, cultural complexes are common in the majority of medical facilities in 

today's society. A patient's spiritual practices may be foreign to hospital staff. Chaplains 

should hear the patient's story to understand patient's customs and practices. The 

healthcare chaplain defines this or her role according to their patient's respective culture. 

The Growing Challenges of Pluralism 

The chaplain's training includes being able to adjust personal beliefs and reflect a 

neutral position on spirituality. Pluralism represents the process of creating a society by 

acknowledging, rather than hiding society's deepest cultural differences (Eck, 2006). 

Pluralism and diversity at times can be used interchangeably.


Diversity is created on common bond from plurality, where as pluralism is a person 

engaging in relationship with others from a different faith and culture. 

There are ethnic groups who feel threatened by diversity and will respond with 

demonstrations of intolerance towards foreign cultures, religious practices and rituals. 

There are daily encounters across the United States were groups are confronting each 

other over school districts, zoning and traffic laws that restrict building temples religious 

schools, or mosques. Most persons who feel the impact of the unjust laws are immigrants 

who are Hindu, Buddhist, Muslim, Haitians and Spanish speaking communities. 

Historically, the terms exclusion, assimilation, and pluralism suggest three 

different ways in which Americans work with its widening cultural and religious 

diversity. To those who feel threatened by other cultures, exclusion closes the door to 

those they consider alien or a threat to their culture. Assimilation visualizes America as a 

melting pot, immigration is welcome, but not their culture or traditions (Eck, 2006) 

Pluralist speaks loud and clear, come be yourself and your heritage is welcome and your 

religious traditions is accepted. 

Because of increasing numbers of immigrant's migrating to America, fractures 

along limes of ethnicity and religious diversity are surfacing. Stereotypes and prejudices 

take on old and new forms of discrimination towards Hindu, Buddhist, Muslims, Asians, 

and Spanish speaking persons. Americans also builds bridges with diverse religious 

communities. The Councils of Churches listings now include synagogues, mosques and 

temples as places to worship. Religious groups are joining together in interfaith coalitions 

to serve the poor and at risk population.


Rev. Thiel, CPE Supervisor (2006), examined areas of care that chaplains address 

when attending patients of a different culture. When a healthcare chaplain inquire of 

patient's spiritual and religious themes, responses to four explicit topics including, 

prayer, faith, access to spiritual care, and belief in the transcendent. Meeting the needs of 

a diverse healthcare population starts with diversity in prayer in a hospital setting, adding 

a range of prayer practices that compliment patient and hospital chaplains. 

Spiritual and Multicultural Interpathy 

One who knows one culture knows no culture, participating with 

individuals from a different cultural will either open your spirit of 

acceptance or close doors to expanding your reality. Interacting with 

someone from another culture breaks old stereotype and reframe old 

biases. As society takes on a larger worldview, cultures will encounter 

people from other cultures. Ethnicity, culture, religion, and racial 

backgrounds are a heritage to prize but should not be used to create 

boundaries (Augsburger, 1986). 

In addition, culturally aware caregivers share five characteristics: (1) caregivers 

should be able have a clear vision of their own values and spirituality, (2) they should 

welcome and accept other worldviews, (3) a culturally aware caregiver seeks the source 

of influence on a person's history, (4) culturally aware caregivers are capable of moving 

past teaching theories to become affective humans, and (5) caregivers consider 

themselves as persons that relate to other humans, who are distinct from themselves 

(Augsburger, 1986). These characteristics protect a caregiver and the process from 

becoming oppressive. 

The culturally sensitive chaplain differentiates self from the culture of origin with 

sufficient perception, thinking, feeling, and reflection of freedom to recognize and 

understand changes from an alternate life experiences (Augsburger, 1986, p. 23).


It seems consistent that humans have a natural insensitivity to cultural variations and 

prefer views that were tested in the past. Cross-cultural awareness is more gradual to 

those who remain in monoculture communities. Change comes more quickly when 

individuals encounter other cultures, and interaction happens on a regular basis. 

In order to be an affective cross cultural clinical chaplain with understanding of 

the multiculturalism movement awareness begins within oneself. The chaplain who 

enters a patient's world gain unconscious insight and feelings call sympathy. When, a 

chaplain intentional and actively crosses culturally into a patient's life, it is referred to as 

empathy. There is a third view which is pathos or a feeling way of knowing and it is 

called interpathy (Augsburger, 1986, p. 27). 

In the healing process, sympathy is ineffective. It is an emotional spontaneous 

response by caregivers to patient's pain. The chaplain becomes co-suffer and joins 

patients as co-travelers, together forming one union. A chaplain loses his or her 

perspective when connecting with parallel injuries through projective identification of 

patient's suffering. On the other hand, empathy is caregivers sharing in their client's 

feelings through compassionate active imagination. Empathy is intentionally choosing to 

cross into another person's experience. It is a self-conscious awareness of the patient's 

consciousness. Unlike sympathy, empathy respects the differences of the original culture 

and moves to enhance the boundaries. Through empathy, chaplains share patient's pain, 

but they do not claim the pain (Augsburger, 1986). 

Equally or more important is interpathy empathy in the caring process. Interpathy 

is an intentional cognitive and affective experience of a person's thoughts and feelings.


Interpathic caring requires that chaplains enters into a patient's world of assumptions, 

beliefs systems, values, and temporarily clam them as their own. For instance, the 

chaplain must believe and see as the patient does and share the same feelings based on 

the patient's cultural values. As a result, caregivers seek to learn and consciously accept a 

foreign perspective. According to Augsburger (1996), interpathy is the intellectual 

invasion and the emotional embracing of what is truly other (p.30). Interpathy is actually 

stepping into a patient's shoes and walking in them for a season. It gives an intimate 

perspective of patient's feelings based on sight, traditions, and customs of patient's 

Danger Zones for Chaplains 

Professional chaplains train to minister to population of all faiths or with no faith. 

They are called to provide compassionated care for people in crises. The main task of a 

chaplain is to assess strengths and weakness of a patient's spiritual resources (Paget, 

2006). When religious rituals are required, a chaplain's faith traditions may become an 

issue. The chaplain is always assessing and making decisions about courses of actions 

that are acceptable to the patient, but do no affect their faith traditions. 

When a person assumes the role of chaplain, he or she makes an explicit 

commitment to abide by policies and procedures of the hospital. As a representative of 

their religious faith community and the endorsing body of their denomination, each 

chaplain is accountable to maintain his or her spiritual beliefs and religious practices 

(Paget, 2006). 

With this in mind, chaplains should set boundaries for themselves and their 

clients. The chaplain should use clear, simple, and direct language. There should not be 

any circumstances where a chaplain has to defend his or her faith position.


The fear of rejection and guilt are not reasons for a chaplain to sabotage their boundaries. 

A healthy limitation includes both physical and emotional protection allows both 

chaplain and client to set empowering standards for behavioral and interpersonal 

relationship to develop (Paget, 2006). 

In addition, chaplains are not entitled to talk, counsel, or ask questions. They must 

first ask permission to engage in dialogue with patients. A chaplain must adhere to a strict 

code of confidentiality. Most people engage a healthcare chaplain for good listening, not 

for good replying. During a conversation with a chaplain, he explained that most patients 

are in search of a safe space to share their stories, which frequently express their fears. 

Similarly, chaplains like other medical staff are subject to be infected 

psychologically with secondary stress as a result of reaching out to those in need (Wicks, 

2006). Caregivers who are constantly expose to persons in distress, patients who are 

demanding, individuals who impose guilt feelings, and neglect of self-care will take a toll 

on caregivers. Secondary stress is a result of several factors including changes in patient 

and chaplain relationship, cultural diversion, unrealistic ideals, conflicts with peers, staff, 

and administrators. 

One of the first sign of stress is daily burnout, being mentally fatigued at the end 

of the day. Throughout the year all medical professionals will experience at least a mild 

form of burnout from external stressors of everyday living or daily hassles. The first level 

of burnout is usually short in duration and may occur on occasions. The second level 

symptoms last longer and are harder to eradicate. At the third level, signs and symptoms 

progress to chronic conditions, and develop into physical illness (Wicks, 2006).


Chronic secondary stress also known as burnout or compassion fatigue is the 

acute counterpart of vicarious posttraumatic stress (PTSD) (Wicks, 2006, p. 8). The root 

of burnout has many faces including, cynicism, workaholism, isolation, boredom, 

conflict, arrogance, the savior complex, and the feeling of helplessness (Wicks, 2006). 

In fact, recognizing and acknowledging signs and levels of stress is the beginning 

of managing self-care. Caring for self begins with self-regulation. Personal discipline can 

improve private and professional lifestyle. Naming the negative emotions of the inner self 

addresses unhappy or uncomfortable contacts with patient's sarcasm, anger, and 

dismissive attitudes. To help avoid stress when working with people who are in constant 

distress, there need to be a system in place to protect or improve one's psychological and 

spiritual well-being (Wicks, 2006). 

Moreover, controlling stress when working with patients who are in constant 

distress can be challenging. Dr. Wicks suggests the following guidelines to improve one's 

psychological and spiritual well-being: (1) have an honest prayer life, (2) strive for 

balance in one's schedule, (3) self-nurturance, care for self, (4) engage in healthy 

intimacy with others, (4) confront and deal with negative emotions, and (5) learn how to 

put a positive perspective to failure (Wicks, 1995, p. 250). Similarly, the healthcare 

chaplain and other medical staff suffer with their own brokenness and pain as they reach 

out to serve others who are in crisis (Wicks, 1995). 

Certainly, as Chaplains strived to adapt to fast changing roles and expectations 

from patients there are values and skills that remain constant when meeting the needs of a 

multi-cultural population (McManus, 2006): 

• Theological, foundational knowledge of chaplain's faith traditions 

• Spiritual, understanding of growing spiritual practices of other faith communities


• Ministerial, managing self-care, setting personal boundaries and discerning 

effective interpersonal intervention in crisis situations 

• Reflection and development of a consistent and practical spiritual life 

• Specific awareness of cultural and clinical competence and knowledge of health 

issues, learn medical terms that are applicable work condition 

• Health and social sciences applied to chaplaincy, continuing multi-dimensional 

training and education that is multi-cultural and multi-faith 

Incorporating items from the list above will enable caregivers to penetrate 

relationship barriers like patient's background, economic class, sexual orientation, 

position of power, and gender. These obstacles may create issues that block building trust 

and prevent caregiver from providing affective spiritual care.

The Building Blocks of Chaplaincy 

CHAPTER V 

Chaplaincy Training and Competency 


Hospital facilities utilize at least three different levels of chaplaincy. (1) Full-time 

chaplains provide pastoral services to patients and staff. Full-time hospital chaplains are 

required to have specific educational training, Clinical Pastoral Education (CPE) and a 

Master's of Divinity. (2) Part-time chaplain(s) who offer pastoral services, are also 

required to have a particular training provided by hospital staff or CPE training, and (3) 

volunteer programs which consist of local ministers or lay ministry leaders who are 

trained hospital chaplains (Monfalcone, 1990). 

In addition, most professional chaplains are direct employee hire of healthcare 

institutions. Since 2000, the Joint Commission on Accreditation of Healthcare 

Organizations (JCAHO) requires hospitals to have qualified or professional chaplains. 

According to these standards, these chaplains must be board certified. The 2005, 

Comprehensive Accreditation Manual for hospitals describes clinical chaplains as 

persons who provide spiritual services professionally, rather than local pastors serving in 

the role of healthcare chaplain. 

Professional chaplains hold a Masters of Divinity degree earned through a 

minimum of 3 yrs. of postgraduate seminary education. A healthcare chaplain must 

prepare for the position by studying theological reflection and practicing pastoral care 

skills, and usually are eventually ordain in their faith denomination.


In order to be a candidate for chaplaincy certification, candidates must complete 1,600 

hrs of CPE studies and 1 additional year of professional chaplaincy experience 

(McClung, Grossoehme & Jacobson, 2006). 

Furthermore, professional chaplains agree to abide by the Common Code of 

Ethics for chaplains and pastoral counselors. Certified chaplains train to minister to all 

cultures, gender, and faith traditions. CPE integrates formal theological learning with 

practical education that allow students to realize a deeper understanding of self and the 

chaplaincy profession. CPE offers supervised medical experiences in a clinical setting. 

The purpose of CPE training is to expose students to real human problems by observing 

their experiences in a clinical setting. Students come face to face with another human 

being who is in crisis. 

Learning Through Clinical Pastoral Education 

The learning process uses a common methodology for CPE training that includes, 

teaching skills and techniques that adhere to by all CPE Supervisors and training sites. In 

a healthcare setting, interns provide pastoral care to patients, their family members, and 

offers chaplaincy services to hospital staff. Interns receive clinical and pastoral 

experiences as they learn by doing. 

Also, the educational setting provides opportunities for interns to build 

relationships with peers and managers. Supervisors encourage interns to focus on their 

learning goals and objectives through reflections. One of the most effective tools in a 

clinical setting is the verbatim. Interns record their visits with patients and discuss their 

experience with peers and supervisor.


The educational setting allows the intern to share his or her recordings in a case 

conference session, seminars, and with supervisors and peers. Through reflection and 

input from their respective supervisors and peers, interns become more aware of their 

experiences with patients and their vulnerabilities. Theological and clinical questions 

raised by interns are answered at case conference sessions. 

Consequently, chaplain interns gain insight through connecting experiences 

through finding unexpected truths about their selves. In the clinical settings, interns 

receive insight through their interaction with patients' illnesses and their responses to 

crisis. Interns learn to listen to patients' histories and discern how to respond to patients 

spiritual needs. The educational setting provides opportunities for interns' didactic 

leanings about their own histories, faith development and through the reflective process, 

gain new insight of themselves as person and caregivers (Cotterell, 1990, p. 137). 

The Beginnings of Clinical Pastoral Education (CPE) 

The pastoral care and theological education movement became a recognizable 

organization on January 21, 1930, at the home of the leader of the movement. Samuel 

Eliot, pastor of the Unitarian Church of Boston. The movement adopted the name The 

Council for Clinical Training of Theological Students. During the 30s and 40s, the 

Council struggled under the authoritarian personalities of its directors. The Council 

separated into two groups, one section that remained in the New England area and the 

second that eventually moved to New York under the leadership of Dr. Helen Flanders 

Dunbar. 

The New England group consisted of Rev. Austin Phillip Guiles, Dr. Richard 

Cabot, Rev. Russell Dicks, and several others doctors and pastors.


The New England group was the first to expand into general hospitals as centers for 

learning. In 1944, a group of theological educators and chaplains incorporated as the 

Institute of Pastoral Care. In 1932, Austin Guiles developed a program at the Institute to 

include clinical pastoral study as part of a student's theological program. 

In addition, the Lutheran Advising Council is the third group that survived the 

jockeying and bickering between council members. The Lutherans began preparing their 

chaplains as clinical chaplains and supervisors in order to maintain their positions of 

hospital chaplaincy. Hospitals shifted from using ministers and lay ministers to hiring 

clinically trained healthcare chaplains. Rev. Frederic Norstad, a supervisor at 

Massachusetts Memorial Hospital, began training Lutheran seminarians for hospital 

chaplaincy in 1949. Lutherans were one of the first denominations to create guidelines for 

their theology students to train in a clinical pastoral program. Several major Lutheran 

bodies came together to form The Lutheran Advisory Council on Pastoral Care. A seed 

was planted for the creation of the Committee of Twelve, which included The Institute 

for Pastoral Care, the Council for Clinical Training, and the Association of Seminary 

Professors in the Practical Field (Leas, 2007). 

In 1957, The Southern Baptist Association of Clinical Pastoral Education 

provided certification for the association's chaplains. The Association of Southern 

Baptists prepared the way for CPE. Their corporate statement came from Southern 

religious traditions. One of their primary goals is to correct theological knowledge and to 

strengthen seminary students' pastoral skills. The Southern Baptist Association affirms 

that pastoral care functions as an integral part of the healing process.


Dr. Wayne Oaks trained workers for a ministry that confirms the relationship between the 

Gospel and the holistic approach for people suffering a crisis of faith (Leas, 2007). 

In October of 1967, after many discussions and much planning, the four ruling 

groups came together and formed the Association for Clinical Pastoral Education, Inc. 

(ACPE). The association mission is to standardize certification for clinical pastoral 

education for supervisors and accreditation of clinical training centers (Leas, 2007). 

Association of Clinical Pastoral Education (ACPE) 

The 1967 ACPE alliance was the result of the merger of The Council for Clinical 

Training of Theological Students, The Institute for Pastoral Care, the Lutheran Advisory 

Council, the Southern Baptist Association for Clinical Pastoral Education, and the 

Institute of Pastoral Care. In 2004, the ACPE and five of the leading organizations, 

Association of Professional Chaplains (APC), which is an inter-faith certifying group. 

The National Association of Catholic Chaplains (NACC), the National Association of 

Jewish Chaplains (NAJC), the American Association of Pastoral Counselors (AAPC), 

and the Canadian Association for Pastoral Practice and Education (CAPPE/ACPEP), 

these six groups combined represent more than 10,000 certified chaplains serving in 

healthcare facilities (Snorton, 2006). 

In fact, the ACPE offers over 6,500 units of training to theology students, 

ministers and clergy, laypersons, and health care professionals, who show interest in 

clinical and theological interaction of spirituality and health. In 2006, the ACPE 

acknowledged in excess of 350 accredited programs throughout the United States. The 

ACPE is a multicultural and multi-faith organization with over 600 certified CPE 

supervisors.


There are 117 theological school members representing 23 faith groups and partners of 

ACPE (Snorton, 2006). Current ACPE language describes CPE as action reflection 

model. 

In 1947, the CPE groups began a peer-review professional journal to address 

standards and training, and designated the United States Department of Education as an 

accrediting organization with the power to certify faculty. By 1967, ACPE, Inc. set the 

minimum components for training standards of every accredited CPE program. 

In 2004, ACPE, along with five of the ruling organizations, adopted a Common Code of 

Ethics and common Standards for Professional Chaplaincy, Pastoral Educators and 

Supervisors (Snorton, 2006, p. 660). 

At present, the exclusiveness of the association membership is expanding to 

include faith traditions that are represented in contemporary healthcare facilities. The 

association boasts a growing number of females, Latinos, and African Americans as 

supervisors. The group welcomes supervisors from the major faith-based communities in 

the United States and international communities. Customarily, chaplains and clinical 

supervisors were white Christian males. Medical facilities supplemented their pastoral 

care unit with candidates from multi-faith and diverse religious traditions, including 

Protestant, Roman Catholicism, Jewish and Islamic, Buddhist and Hindu (Leas, 2007). 

In 1981, The Racial Ethnic Minority (REM) formed to address the needs of minority 

members and to enhance recruitment. 

Challenges for Chaplain Associations 

Because of changes, the inclusion of Roman Catholics in CPE training has 

become an entry point for women (nuns and former nuns) to enroll in CPE.


Female population is growing rapidly in seminaries. Women are distancing themselves 

from familiar roles of earning teaching degrees by receiving Masters of Divinity degrees 

followed by ordination. There is a shift in gender balance among clergy as more females 

than males are candidates for ministry in protestant churches. Similarly, there are 

growing numbers of women in CPE training and Supervisor positions. Along with the 

increased population of women and Catholics, foreign students are one of the most 

explosive growth groups. 

As a result, a new religious landscape is becoming more visible as neighborhoods 

changes, student populations show new face types with different languages. The decision 

is whether healthcare chaplaincy will celebrate diversity or participate in pluralism as 

they serve a multiculturalism population. A chaplain is similar to the majority of people, 

and he or she is more at ease with multiculturalism than interacting with other faith 

communities. It is said, that Sunday is the most segregated day of the week in the United 

States. Americans attend separate but equal worship services but seldom visit another 

faith service. 

With this in mind, another question that confronts a chaplain is how will a person 

pray with a different faith tradition than the chaplain's and what words can a chaplain say 

that will bring God's peace in a time of distress? In truth, working with culturally diverse 

population can add tension to an already tensed atmosphere, when visiting the sick and 

those facing death or life threatening illness. Morally, dealing with a situation that may 

not agree with personal value, relies on the old adage, to do no harm (Fukuyama, 2004). 

In order to resolve these issues, critical thinking is necessary to bring clarity to 

distressful situations.


A chaplain should first observe patients and their agendas. Caregivers should be 

aware of negative emotions, talents, growing edges, have a willingness to face unpleasant 

truth, and to be mindful of their motives. A personal issue to address is what am I willing 

to unlearn that is no longer useful and acceptable. Moreover, can old personal embedded 

spiritual beliefs be refrained with a positive perspective for both chaplain and patient? 

Professional and Generic Chaplaincy 

There are healthcare chaplains and subgroups of (ACPE) with concerns that 

clinical pastoral education (CPE) is depreciating the theological convictions and 

denominational allegiance of pastoral caregivers. The primary role of one chaplain 

meeting the spiritual needs of all patients is in jeopardy. Secular hospitals are the largest 

employers of clinical healthcare chaplains. The role of chaplaincy is shifting from 

attending to the majority of persons who are Judeo-Christians to serving a diverse culture 

and multi-faith population. 

Subsequently, professional approach to healthcare chaplaincy can implicitly or 

explicitly discourage a chaplain from focusing on is or her religious beliefs. When 

interacting with patients, the chaplain is encouraged to project a neutral and objective 

approach to spiritual care. This model presupposes that the chaplain will become generic 

and expound spiritual beliefs not of their choice. The appearance of neutrality is tainted 

with a specific faith perspective being smuggled in as an open-mined and loving 

relationship. 

Some chaplains use their personal faith traditions to advocate God's presence in 

patient's distress. For example, a Catholic patient seeking an abortion after her doctor 

indicates that her baby will be born with serious deformity.


When speaking to the chaplain, whose faith tradition permits abortion after critical 

consideration by all parties, including medical and pastoral counseling, the young woman 

aborted her baby. For this reason, the chaplains' role is to advocate for spiritual values 

and religious beliefs held by a patient even when those values and beliefs are not that of 

the chaplain. At times, situations may require a chaplain to express values and practices 

that contradict his or her beliefs. 

One goal of a healthcare chaplain is to be open-minded to faith traditions that 

might have negativity towards their personal religious traditions. The goal is to find a 

balance between a patient's religious practices and the chaplain's personal faith tradition. 

For instance, clinical chaplain training teaches students not to make comments that reflect 

rigid personal value or prejudices based on their theology (Kotva, 1998). Caregivers, who 

intentionally place their religious beliefs over the patient's beliefs, harm the patient's 

spirit, and violate the atmosphere of trust. The healthcare chaplain is a spiritual covering 

for those who are vulnerable during a time of distress. They are held to a higher standard 

of trust than most professionals. 

Therefore, to be an effective caregiver and guardian of souls, a chaplain should 

not proselytize his or her faith traditions. A healthcare chaplain, who works with patients 

that have different values other than Christianity, should not feel as if their convictions 

are weakened. Several ethical factors to consider when crossing into a multi-faith 

population are: (a) being aware of power and privilege of religious issues of existing and 

newer faith traditions for patients, (b) Being able to accept a worldview that no one 

tradition has the corner on spiritual truth, and (c) embracing a both perspective, "I am a 

strong Christian and I value others' religious experiences" (Fukuyama, 2004, p. 37).


Especially since the healthcare chaplain serves as a resource system for patients or 

their families who are without religious beliefs, it is important that the chaplain is 

respectful of patients' mores. When patients are in life threatening or a spiritual distress, 

the question arises as to whose faith of healing is present. There are concerns that each 

chaplain faces when dealing with situation that relates to death and handling of the body. 

For instance, when a Muslim dies, the body must be immediately washed from top of the 

head to the bottom of their feet. Same gender female-to-female and male-to-male wash 

the body. Normally a family member will prepare the body so that the departed soul can 

be at peace (Schmidt, 1998). 

Each hospital chaplain is expected to have basic training in bioethical principles. 

Some patients and chaplains consider modern healthcare chaplaincy as a means to 

promote general principles of spiritual care that are acceptable to all patients. If not 

careful, a chaplain can become a mouthpiece for the accepted viewpoint or culture of the 

medical facilities. His or her faith traditions and spiritual influence become generic. The 

responsibility of a chaplain is to maintain his or her religious and neutral positions when 

ministering to the religious needs of Christians, non-Christians, and those without any 

faith traditions.

Are There Limitations to Spiritual Care? 

CHAPTER VI 

Discussion and Conclusion 


How far should healthcare chaplains extend themselves when fulfilling their 

moral obligations to provide a dying wish for prayer to those who pray to other gods? 

Hospitals are more representative of a multi-spiritual melting pot. Besides Christian 

patients, there are growing numbers of non-believers, e.g., Muslims are the fastest 

growing population in America (Schmidt, 1998). The foundation of pastoral care is based 

on honesty to God and with the patient. Chaplains are responsible to maintain their 

beliefs before God and patient. 

While this may be true, the Christian chaplain must be careful when praying with 

other faith denominations whose view of God is different. Words spoken in prayer must 

be taken seriously. For example, a Christian chaplain should not intentionally pray the 

Muslim Shadada prayer. Praying the creed bears witness to Mohammed being God's 

prophet. Speaking the Shahada declares that the person is Muslim (Schmidt, 1998). 

Apostle Paul declares, "...that I have become all things to all men so that by all possible 

means I might save some" (I Cor. 9:22). Saint Paul never compromised his faith as he 

worked with Gentiles, Jews, and other faith traditions. 

Agapeic Intervention 

Hospital ministry is symbolic of the extension of Jesus healing ministry to the 

sick. Jesus responded to those who were in need of healing regardless of their gender, 

ethnicity or religious background. Simon mother-in-law was sick with fever, and friends 

told Jesus about her, so he went to her, took her hand and helped her up.


"The fever left her ... that evening after sunset the people brought to Jesus the sick and 

the demon possessed. Jesus healed many who had various diseases" (Mark, 1:29-34). 

Pastoral caregivers are vessels that the Spirit of God flows through to touch 

persons who suffer physically or spiritually. According to Kotva (1998), agapeic 

intervention is an unapologetically Christian notion that seeks God's intervention in the 

healing process through Christ. It is the opposing side of genetic chaplaincy or multi-faith 

chaplaincy. It is a loving and non-coercive approach to care giving. Agapeic intervention 

respects others cultures but does not capitulate to other faith traditions. As healthcare 

facilities strive towards multiculturalism, non-generic chaplains may be limited to 

specific religious medical facilities. 

In addition, hospitals are facing a growing demand to hire professional chaplains 

who specialize in specific areas, such as pediatrics, oncology, trauma, hospice, long-term 

care and multicultural rituals, hospital patients continue to shift away from Christianity. 

This presents various questions to the ruling body of professional chaplaincy on how to 

meet the needs of America's healthcare population. As healthcare chaplaincy evolves, 

requirements to formalize the process for certifying specializations beyond board 

certification presents a need for methodology of skills, which includes training that is 

acceptable to all leading chaplain organizations. 

Because of explosive immigration and business globalization, there are major 

changes to the landscape of the United States. Society is growing into multiculturalism 

with a wealth of newer faith practices. The words E Pluribus Unum, which means out of 

many one is found on each American coin.


It is symbolic of many people coming together as one. According to Eck (2006), religion 

is the unspoken rword, which lies beneath the surface of multiculturalism debates. 

Topics for Further Discussion 

In addition to questions concerning ethnicity, there are concerns that challenge 

pastoral care provided by those within the Christian community. Some faith traditions 

refuse to ordain women as ministers or deacons. Their fundamental belief is built upon 

1 Timothy 2:12, I suffer not a woman to teach, no to usurp authority over the man, but to 

be in silence. At present, women out number men in seminaries and are being ordained as 

ministers and chaplains. Several multicultural faith traditions do not allow females in 

leadership positions at home, work, or in the church. Women from other faith traditions 

are beginning to find small cracks in their customs that allow their voices to be heard and 

to assume normal male roles of their birth country. 

Besides gender issues, sexual orientation is another matter confronting 

professional chaplaincy. The majority of Christian faith traditions do not accept 

homosexuals or gays as part of their religious framework. The lifestyle offends most 

Christian culture because first, it violates the call to abstain from sexual encounters 

outside of the marriage covenant. Secondly, fundamentalist and the moral majority 

segments of Christianity condemn homosexuality as not conforming to the word of God. 

Do you not know that the wicked will not inherit the kingdom of God? Do not be 

deceived. Neither the sexually immoral, nor idolaters nor adulterers nor male 

prostitutes nor homosexual offenders nor swindlers shall inherit the kingdom of 

God (I Cor. 6: 9). 

Also, rejection of females, gays, and lesbians has caused national and 

international divisions among major religious denominations in the United States.


For example, the Episcopal denomination separated into sections over the ordination of a 

gay female and a homosexual bishop. In the District of Columbia, a Catholic priest left 

the church, installed himself as a bishop, married a female, and declared his church to be 

inclusive of all race, gender, and sexual orientation. Members are ordained to serve in 

ministry regardless of their sexuality or martial status. 

As a result, professional chaplain associations are left to confront challenges on 

how to include the changing face of the multicultural, gender and sexual orientation of 

their student bodies, while meeting the spiritual needs of medical facilities. The ACPE is 

splintering into sub-groups to address individual necessities for women and men. African 

Americans and Latinos have formed their own network, and there is a gay and lesbians 

group to address their specific expectations as chaplains. In addition to the sub-groups 

listed, there are groups that specialize in certain faith traditions, for e.g., Jewish chaplain 

group, ordained Muslims, and the largest sub-group is the association of Catholic 

chaplains (Miller, 2005). 

With growth in specialization, clinical chaplains are finding themselves as part of 

a novel aspect of providing spiritual care. As healthcare chaplaincy evolves into a multi- 

faith and multi-cultural profession, patients' biases may cause them to reject a chaplain's 

gift of pastoral care. Patients sometimes cling to their faith traditions and reject customs 

that does not reflect their religious traditions. Male patients may prefer males to pray with 

them and Jehovah Witnesses usually reject other Christian prayers and practices. 

Summary and Conclusion 

Pastoral caregivers are to accompany patients on their spiritual journey in healthcare 

situations.


A chaplain assists patients in finding his or her path to their spiritual healing, rather than 

imposing a solution. When it is beneficial for patients, the chaplain may offer to share his 

or her faith. A beneficial relationship is possible because of the presence that the chaplain 

brings to the situation that closes the gape of separation. 

Although the rate of multiculturalism is rapidly increasing, meeting the spiritual 

needs of the fast changing face of the New America requires a healthcare chaplain to 

engage in new skills including becoming more religiously literate. Few medical facilities 

like Massachusetts General Hospital (MGH) have a range of religious background in 

their pastoral care department. The MGH Hotline publication (January, 1999) list a 

rainbow of languages from English, Spanish, Arabic, and Igbo (African). Faith traditions 

range from Jewish, Roman Catholic, and Muslim. 

Patients facing crises of distress, serious illness or impending death, draw upon 

their religious traditions and their faith community. There are times, when barriers deter 

or slow a chaplain from meeting their patient's spiritual needs. Patients who have 

different social and religious beliefs concerning medical or spiritual care may feel 

isolated and fearful. It is important that healthcare facilities provide patients with an 

advocate who is comfortable crossing into their cultural comfort zone. The hospital 

experience becomes more tolerable for the patient and the healing process is enhanced by 

the chaplain's sensitivity.


Unfortunately, being hospitalized adds a host of concerns for patients, including 

fear of pain and the uncertainty of the healing process, loss of control over routine 

activities and the ultimate fear of dying. Added to these fears, are questions of faith 

issues. Patients often times struggle with questions like where is God, and why is this 

happening to me? With this in mind, a chaplain's presence should bear a holistic 

perspective, which focus on the whole person based on an Incarnational relationship with 

patient and family. 

To most persons, a chaplain represents God and a faith-based community. 

Spiritual care offered by a chaplain adds a human quality to a difficult situation by 

providing words of comfort, hope, prayer and a transcendence presence. A healthcare 

chaplain offers pastoral support, spiritual counseling, they provide sacramental ministry 

(offering communion, blessings), pastoral care for staff, and they are a liaison with the 

local community (Monfalcone, 1990). 

Although, each chaplain association has standardized requirements for clinical 

pastoral education, each group maintains the essence of its original organization. As a 

result, professional chaplains are trained to minister to the needs of patients with a faith 

tradition and to those with no faith. This mission is achieved by their willingness to reach 

the patient at his or her level of spiritual growth. One of the tasks of a chaplain is to 

assess the strengths and weakness of the patient's spirituality. 

In conclusion, as the healthcare chaplain strives to meet the spiritual needs of a 

multicultural and multi-faith healthcare population, it important to have a chaplain who 

can walk across and into their patient's culture to provide pastoral or spiritual care.


It is important for a chaplain working in interfaith communities to be grounded in their 

faith traditions. As Fukuyama (2004) wrote, it is important to know when to travel and 

when to stay in one's own tradition. 

Being able to cognitively and emotionally walk in someone else's culture gives a 

chaplain clarity for a holistic approach to spiritual care. Interpathic feelings extends 

beyond culture and faith to offer grace that draws no lines, refuses limits, and claims 

universal humanity to join patients in their healing process. Interpathic caring gives clues 

to how spiritual care is given and received within the boundaries of multiculturalism. 

However, it is through interpathic presence that a chaplain experiences each patient's 

situation and can encourage his or her coping in a crisis (Augsburger, 1986). 

Consequently, a healthcare chaplain and other pastoral caregivers' perspective 

face challenges at times, as they strive to become a spiritual guide for persons who are 

facing crisis in their lives. Meeting the needs of others may have a chaplain question their 

own uncertainty to their calling and to their faith. The chaplain ministers in tension of 

seeking to find balance between serving God and those that are place in his or her care. 

As caregivers, walking in pluralistic setting demands that a healthcare chaplain is 

confident in their walk of faith, if not, the chaplain may lose their connectedness to their 

God. Professional chaplains are encouraged to take an Emmaus walk on their journey of 

compassionate caring. In Luke 24:3-24, chaplains should invite the Holy Spirit to walk 

with them, guide their path with discernment, and to rest and fellowship with the Spirit of 

God.

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