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Durham E-Theses Durham E-Theses Ritual, Pastoral Presence, and Character Virtues in Healthcare Chaplaincy: A study of chaplains' support to bereaved parents following the in utero or neonatal death of their baby. NEWITT, MARK,JULIAN How to cite: NEWITT, MARK,JULIAN (2013) Ritual, Pastoral Presence, and Character Virtues in Healthcare Chaplaincy: A study of chaplains' support to bereaved parents following the in utero or neonatal death of their baby., Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/7283/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk 2 Mark Newitt Ritual, Pastoral Presence, and Character Virtues in Healthcare Chaplaincy: A study of chaplains’ support to bereaved parents following the in utero or neonatal death of their baby. Abstract This thesis sets out to understand better how chaplains can support bereaved parents following the death of their baby. Running parallel to this, with increasing demand for evidence-based practice, it aims to evidence the benefit of chaplaincy support and the unique skills of chaplains. The thesis is based on twelve semi-structured interviews with sixteen parents. These were analysed using a form of grounded theory and compared with the findings of related research. I argue that the root of all other spiritual need is the loss of control parents experienced. Alongside this theme I identify a loss of meaning, a loss of self worth, and a desire to do something in response to their loss. Although there is not a one size fits all response, the liturgy and ritual provided by chaplains helped counter spiritual distress. I propose that, alongside the ability to perform liturgy and ritual, chaplains are viewed as having authority in both religious and spiritual matters. As liturgy and ritual was appreciated in conjunction with the presence of the chaplain, I explore a virtue-based approach to chaplaincy and recommend the increased use of shadowing and mentoring. Drawing on Fowler’s Stages of Faith, I describe how some parents found greater religious faith or increased spiritual awareness as a result of their experience. I speculate that, in order to provide the best possible support to parents, chaplains need to exhibit the characteristics of Fowler’s stage 5. Chaplains have a richness of reflection and experience and I appeal to churches to engage more profoundly with them. I also recommend the continued employment of chaplains within hospitals and argue for the narrative voice to be valued in research. Contra to current NICE guidelines, I contend that parents should be offered the opportunity to see and hold their dead baby. Ritual, Pastoral Presence, and Character Virtues in Healthcare Chaplaincy: A study of chaplains’ support to bereaved parents following the in utero or neonatal death of their baby Mark Julian Newitt Doctor of Theology and Ministry Department of Theology and Religion Durham University 2013 Table of Contents Statement of Copyright 7 Acknowledgements 8 1 Introduction 10 1.1 Background Context 10 1.1.1 The increasing need for evidence-based practice 11 1.2 Overview of the Thesis 13 2 The Role and Skills of a Chaplain and How Chaplaincy Might Best be Evidenced 21 2.1 The Role and Skills of a Chaplain 22 2.1.1 Accompanying people through times of transition 22 2.1.2 Attentive listeners 24 2.1.3 Trained in pastoral theology 25 2.1.4 Skilled in handling liturgy and ritual 28 2.1.5 Critical, creative, and reflexive thinkers 30 2.2 Research Investigating Religion, Spirituality and Health 32 2.2.1 An overview of overviews 33 2.2.2 Defining spirituality 34 2.2.3 How should chaplains carry out research? 36 2.3 Deciding what to Research 39 3 Related Research with Bereaved Parents 41 3.1 National Guidelines and other Related Research 41 3.1.1 The Sands guidelines 41 3.1.2 DIPEx Health Experiences Research 43 3.1.3 The NICE Guidelines 44 3.1.4 Concerns over the NICE guidelines 45 3.1.5 Continuing bonds - models of grief and bereavement 46 3.1.6 Religion, spirituality and grief 49 3.2 Ewan Kelly’s Marking Short Lives 50 3.2.1 Four themes of spiritual need 50 3.2.1 How the co-creation of liturgy and ritual help meet spiritual need 51 3.2.2 Poor expectations of chaplaincy support 53 3.3 Deciding what Interview Questions to Ask 54 3 4 Methodological Considerations 57 4.1 Overall Methodology 57 4.1.1 The pastoral cycle 57 4.1.2 Hermeneutic phenomenology 59 4.2 Study Design 60 4.2.1 Recruitment and participant selection 63 4.2.2 Personal reflexivity, bias and other limitations 67 5. The Spiritual Needs of Bereaved Parents and How Chaplains Help Meet that Need 70 5.1 Demographics 70 5.1.1 Age of participants 71 5.1.2 Level of social deprivation 71 5.1.3 Time factors 73 5.1.4 Nature of baby loss 73 5.1.5 Religious and spiritual belief and practice 74 5.2 The Spiritual Need of Bereaved Parents 77 5.2.1 Loss of control 78 5.2.2 Loss of meaning and loss of self worth 80 5.2.3 Social isolation 81 5.2.4 Desire to do something 84 5.3 Meeting Spiritual Need: The Role of Liturgy and Ritual 84 5.3.1 Giving back control 85 5.3.2 Affirming meaning and purpose 85 5.3.3 Countering a loss of self worth 86 5.3.4 Providing mementos 87 5.3.5 Enabling the desire to do something 88 5.4 Not One Size Fits All: Giving Options or Taking Authoritative Action 90 5.5 Parental Expectations of Chaplaincy Support 94 5.6 Balancing Openness and Authority 95 5.6.1 The chaplain as an authority figure 96 5.6.2 Performative utterances 97 5.6.3 Religious or spiritual authority 98 5.7 Ritual Communitas and Koinonia 101 5.8 Chaplains and intuition 105 5.9 Summary 107 4 6. More than Marking Short Lives: Valuing the Presence of a Chaplain and Faith Development 108 6.1 Chaplaincy Presence 108 6.1.1 Presence as attentive listening 108 6.1.2 The chaplain as a constant and/or consistent presence 110 6.1.3 Presence as comfort and strength 111 6.2 A Relationship of Depth 113 6.2.1 Attachment theory 113 6.2.2 Community theory 115 6.2.3 The need for chaplains to ‘let go’ of parents 116 6.3 Faith Development 117 6.3.1 Religious and spiritual development 118 6.3.2 Stages of faith development 120 6.4 Summary 124 7 Chaplaincy Among the Virtues? 126 7.1 Understanding a Virtue-Based Approach to Chaplaincy 126 7.1.1 Virtue 127 7.1.2 Character 128 7.1.3 Eudaimonia 129 7.2 The Value of a Virtue-Based Approach 129 7.2.1 Character as the driver for action 130 7.2.2 Valuing emotions 131 7.2.3 Emotional labour 133 7.3 Character and Regulative Ideals 134 7.4 Engendering an Encounter with Hope: A Regulative Ideal for Chaplaincy 136 7.4.1 Hope as presence 138 7.4.1 Hope as quest 139 7.5 The Virtues of a Chaplain 140 7.5.1 Attentiveness 141 7.5.2 Openness 141 7.5.3 Probity 142 7.5.4 Practical wisdom 143 7.6 Virtues, Training and Continuing Professional Development 145 7.6.1 Mentoring and shadowing 146 7.6.2 The black box of chaplaincy interventions 147 5 7.7 Summary 147 8. Conclusions and Recommendations 149 8.1 Spiritual Need 149 8.2 Conclusions and Recommendations Pertaining to the Health Service 150 8.2.1 Need for training of healthcare staff due to poor expectations of chaplains. 150 8.2.2 Why chaplains should continue to be employed by the NHS 151 8.2.3 Seeing and holding their baby 152 8.2.4 Evidencing the value of chaplaincy 153 8.3 Conclusions and Recommendations Pertaining to the Church 154 8.4 Conclusions and Recommendations Pertaining to Chaplains 156 8.4.1 Co-creation 156 8.4.2 Paradoxical situations and multiple roles 157 8.4.3 Stages of faith and chaplains 158 8.4.4 Transference 159 8.4.5 Chaplaincy support is the active ingredient 161 8.4.6 Researching the chaplain 163 9 Appendices 165 9.1 Appendix I: Interview Schedule 165 9.2 Appendix II: Demographic Details 166 10 Bibliography 167 10.1 Print Resources 167 10.2 Electronic Resources 178 6 Statement of Copyright The copyright of this thesis rests with the author. No quotation from it should be published without the prior written consent and information derived from it should be acknowledged. 7 Acknowledgements Undertaking a doctorate can be a lonely venture at the best of times, never mind when you are doing it part-time and at a distance from the awarding institution.
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