Investigation of the Arcus Vitae Life Review as a Spiritual Care Intervention at End of Life in Long Term Care: A Phenomenological Hermeneutical Qualitative Research Study by Lucinda Annette Landau A Thesis submitted to the Faculty of Trinity College and the Toronto School of Theology In partial fulfillment of requirements for the degree of Doctor of Ministry awarded by Trinity College and The University of Toronto © Copyright Lucinda Annette Landau 2019 Investigation of the Arcus Vitae Life Review Process as a Spiritual Care Intervention at End of Life in Long Term Care: A Phenomenological Hermeneutical Qualitative Research Study Lucinda Annette Landau Doctor of Ministry Trinity College and the University of Toronto 2019 Abstract This research explores how the Arcus Vitae life review process, and in particular, the milestone question engages meaning-making at End of Life (EOL) via a phenomenological hermeneutical research investigation. The concept of the Arcus Vitae was developed from clinical practice as a kind of curriculum vitae to describe the arc of one’s life. Life review is established in the literature as a meaning-making process and this study investigates how the ‘Arcus Vitae’ life review supports people in identifying central themes which inform how they see themselves over the arc of their life. The Arcus Vitae process is also used as a spiritual care therapeutic intervention through a one-to-one engagement with participants. The study is an attempt to illuminate the meaning of a particular lived experience, one’s milestone life event, through the self-interpretation of personal narratives. Seven selected residents at a Long-Term Care (LTC) facility participated in an initial semi-structured life review interview and a follow-up interview one week later to review their transcribed narratives. After an initial reading of their text, participants engaged in a “thick” description of their personal narratives to extract layers of meaning regarding significant life events (Denzin, 1989b, in Creswell, 2007, p. 194). Support was demonstrated for the initial premise of the research. Follow-up interviews confirmed that fresh insight and new perspectives arose for a preponderance of the seven participants after engaging in the Arcus Vitae life review. An innovative cognitive mapping form was developed which directly involves ii participants in coding their own data for meaning. Cognitive mapping may have future application as an inductive data coding process for phenomenological research. iii Acknowledgements To my parents, Fred and Gladys, thank you for always believing in me and raising me to understand that I can accomplish whatever I set my mind to. I am grateful for the continued love and support from my children, Jasmine and Andrew, as well as my six siblings and their families. I am indebted to Trinity College, TST, and the Anglican Foundation for their generous support of my Doctoral studies; I am proud to have had them as partners in my graduate education. I want to sincerely thank Dr. Pam McCarroll, RP, for her diligence and understanding in helping me craft a better thesis. Dr. Joseph Schner SJ, during his time as Director of the Doctor of Ministry program at the Toronto School of Theology, has been an absolute delight to work with, as well as the many professors and colleagues in the Doctorate of Ministry stream at the Toronto School of Theology. I also offer special thanks to the members of my Ministry Base Group. Their encouragement and insight were a formative influence for me in developing my thesis: Dr. Kevin Brazil, Dr. Jennie Legassie, Carol Sweeney SW, Maureen Tettman SW, Ven. Rev’d Marion Vincett, Gemma Dela Cruz Aguba RPN, and Debra Crispin RP. My many colleagues at St. Joseph’s Healthcare Hamilton, especially in the Spiritual Care Department, have contributed much to my professional formation, and I am appreciative of their ongoing support. I also want to sincerely thank Alyson Takaoka; her involvement as editor for my paper has been invaluable. To the residents and staff of Allendale LTC in Milton and staff at the Regional Municipality of Halton, I owe a tremendous debt of gratitude. Without your generous time and collaboration, this study would not have been possible. Thank you. iv Contents Glossary ............................................................................................................................. vii List of Figures ......................................................................................................................... viii List of Appendices .................................................................................................................... ix Songs of Innocence: On Another’s Sorrow - William Blake (1758 – 1827) .............................x Chapter 1. Introduction .......................................................................................................... 1 1.1. Overview of Study ...................................................................................................... 2 1.2. Ministry Context ......................................................................................................... 3 Spiritual Care Framework ................................................................................................. 4 1.3. Key Terms................................................................................................................... 7 1.4. Literature Review on Spiritual Care at End of Life .................................................... 8 Chapter 2. Research Problem & Arcus Vitae Process ......................................................... 16 2.1. Presentation of the Arcus Vitae Process ................................................................. 17 2.2. Review of Literature on Life Review ....................................................................... 20 2.3. Concept of “Milestone” in Life Review Literature................................................... 28 2.4. Describing the Arcus Vitae Process as a Life Review Intervention.......................... 30 2.5. Summary of Research Problem and Arcus Vitae Process......................................... 32 Chapter 3. Theoretical Frameworks .................................................................................... 34 3.1. Theology of Ministry ................................................................................................ 34 3.2. Biblical Sources & Process Theology....................................................................... 35 Concept of Abundance in the Beatitudes ........................................................................ 36 Wounded Healers ............................................................................................................ 38 Prophetic Witness ........................................................................................................... 40 Process Theology ............................................................................................................ 41 3.3. Progression of Spiritual Care via Practical Theology & Pastoral Theology ............ 48 3.4. Theological Reflection in Spiritual Care .................................................................. 53 3.5. Hermeneutical Research & Praxis Ministry ............................................................. 59 3.6. Influence of St. Luke on Praxis Ministry .................................................................. 64 3.7. Assumptions Operative in the Study......................................................................... 66 3.8. Summary of Theoretical Frameworks....................................................................... 67 Chapter 4. Research Methodology ...................................................................................... 70 v 4.1. Introduction ............................................................................................................... 70 4.2. Research Methodology: Qualitative, Phenomenological, Hermeneutical ................ 72 4.3. Research Parameters for the LTC Setting................................................................. 79 4.4. Rationale & Projected Outcomes .............................................................................. 81 4.5. Research Ethics Protocols & Selection of Participants............................................. 83 4.6. Risks & Limitations .................................................................................................. 86 4.7. Formal Interview Protocol ........................................................................................ 87 4.8. Data Collection Process & Coding ........................................................................... 90 4.9. Summary of Research Methodology ........................................................................ 99 Chapter 5. Discoveries: Data Interpretation ...................................................................... 101 5.1. Introduction ............................................................................................................. 101 5.2. Biographical Data & Analysis ................................................................................ 104 5.3. Follow-up Interviews .............................................................................................. 106 5.4. Arcus Vitae Process: A Helpful Method ................................................................. 107 5.5. Conceptual Mapping: Individual Results & Discussion ........................................