Abstract
Drawing on James 1:27, Truter and Kotze argue that when confronted with suffering pastors should take a definite ethical stance against disempowering and isolating discourses. Logically then, this must apply to chaplains providing pastoral care in the healthcare context where suffering is endemic.
While the healthcare chaplaincy literature discussed advocacy and challenge as part of the role, little was known about how, when or why chaplains do this in practice. This study investigates the part advocacy plays in the healthcare chaplain role, how chaplains do, and might advocate and challenge to meet the needs of those in the health system who are marginalised, disempowered and isolated. This study bridges the gap between advocacy directives in healthcare chaplain body and institutional guidance and the realities of praxis.
Bhaskarian Critical Realism provided a framework for the examination of the infrastructure and underlying socio-political context of healthcare and chaplain practice within it, enabling a deeper exploration than what can be known empirically. ICHC hospital chaplains were invited to participate. Content analysis of DHB spiritual care policies and chaplaincy body documents enabled triangulation with an online questionnaire (n=53) and participant interviews (n=10). Critical realist analysis of data was used to develop six causal explanatory statements which identified generative mechanisms and explained the findings. The statements highlighted several generative mechanisms that constrain or enable chaplain advocacy and/or challenge.
The findings are unequivocal that advocacy and challenge play a part in the healthcare chaplain role. This is largely at individual level, and mostly reactive. The biggest motivator of advocacy and/or challenge is unmet patient needs and injustice. Some chaplains lacked pastoral frameworks to guide advocacy and had a limited understanding of everyday pastoral and bioethics. Brueggemann’s criticise, energise and transform framework was used to discuss how chaplains might act as agents of challenge.
This study provides a baseline pre-training and guidance interventions. It informs the ‘how to’ in relation to guidelines, training and a pastoral advocacy model. This study adds to the discussion on liminality, its benefits and risks for chaplains. It notes gaps in policy that would benefit from healthcare chaplain involvement in institutional policy development.
The research shows that healthcare chaplains need to advocate for themselves as a profession in order to become more effective advocates for patients, their family/whānau and staff, and to be able to confidently challenge the institution and system. Jesus’ pattern of acknowledging the status quo but refusing to accept it and instead transforming institutions and the system from within provides a helpful model to embrace. Chaplains should not be passive spectators but active participants in this work.