grief in healthcare chaplains: an investigation of the presence of disenfranchised grief

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This article was downloaded by: [Universitat Politècnica de València] On: 27 October 2014, At: 21:48 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Health Care Chaplaincy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/whcc20 Grief in Healthcare Chaplains: An Investigation of the Presence of Disenfranchised Grief Steven Spidell a , AnneMarie Wallace b , Cindy L. Carmack c , Graciela M. Nogueras-González d , Crystal L. Parker d & Scott B. Cantor e a Presbyterian Outreach to Patients , Pearland, Texas, USA b Clinical Chaplaincy Programs, The University of Texas MD Anderson Cancer Center , Houston, Texas, USA c Departments of Behavioral Science and Palliative Care and Rehabilitation Medicine , The University of Texas MD Anderson Cancer Center , Houston, Texas, USA d Department of Biostatistics , The University of Texas MD Anderson Cancer Center , Houston, Texas, USA e Department of Biostatistics, Section of Health Services Research , The University of Texas MD Anderson Cancer Center , Houston, Texas, USA Published online: 29 Apr 2011. To cite this article: Steven Spidell , AnneMarie Wallace , Cindy L. Carmack , Graciela M. Nogueras- González , Crystal L. Parker & Scott B. Cantor (2011) Grief in Healthcare Chaplains: An Investigation of the Presence of Disenfranchised Grief, Journal of Health Care Chaplaincy, 17:1-2, 75-86, DOI: 10.1080/08854726.2011.559859 To link to this article: http://dx.doi.org/10.1080/08854726.2011.559859 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or

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This article was downloaded by: [Universitat Politècnica de València]On: 27 October 2014, At: 21:48Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Health Care ChaplaincyPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/whcc20

Grief in Healthcare Chaplains: AnInvestigation of the Presence ofDisenfranchised GriefSteven Spidell a , AnneMarie Wallace b , Cindy L. Carmack c ,Graciela M. Nogueras-González d , Crystal L. Parker d & Scott B.Cantor ea Presbyterian Outreach to Patients , Pearland, Texas, USAb Clinical Chaplaincy Programs, The University of Texas MD AndersonCancer Center , Houston, Texas, USAc Departments of Behavioral Science and Palliative Care andRehabilitation Medicine , The University of Texas MD AndersonCancer Center , Houston, Texas, USAd Department of Biostatistics , The University of Texas MD AndersonCancer Center , Houston, Texas, USAe Department of Biostatistics, Section of Health Services Research ,The University of Texas MD Anderson Cancer Center , Houston,Texas, USAPublished online: 29 Apr 2011.

To cite this article: Steven Spidell , AnneMarie Wallace , Cindy L. Carmack , Graciela M. Nogueras-González , Crystal L. Parker & Scott B. Cantor (2011) Grief in Healthcare Chaplains: An Investigationof the Presence of Disenfranchised Grief, Journal of Health Care Chaplaincy, 17:1-2, 75-86, DOI:10.1080/08854726.2011.559859

To link to this article: http://dx.doi.org/10.1080/08854726.2011.559859

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or

howsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

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Grief in Healthcare Chaplains: AnInvestigation of the Presence of

Disenfranchised Grief

STEVEN SPIDELLPresbyterian Outreach to Patients, Pearland, Texas, USA

ANNEMARIE WALLACEClinical Chaplaincy Programs, The University of Texas

MD Anderson Cancer Center, Houston, Texas, USA

CINDY L. CARMACKDepartments of Behavioral Science and Palliative Care and Rehabilitation Medicine,

The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

GRACIELA M. NOGUERAS-GONZALEZ and CRYSTAL L. PARKERDepartment of Biostatistics, The University of Texas

MD Anderson Cancer Center, Houston, Texas, USA

SCOTT B. CANTORDepartment of Biostatistics, Section of Health Services Research, The University of

Texas MD Anderson Cancer Center, Houston, Texas, USA

We examined how chaplains respond to grief and determined theprevalence of disenfranchised grief (i.e., grief that is not or cannotbe acknowledged or supported by society) in healthcare chaplains.We conducted an online survey of members of the Associationof Professional Chaplains. Of 3131 potential participants, 577(18%) responded to the survey. In response to grief in the work-place, chaplains stated they would have low energy (78%), feelsad or moody (63%), feel like they had no time for themselves(44%), go through the motions (41%), and distance themselves

The authors wish to thank Rebecca Partida and Vicky Cervantes of the Division ofQuantitative Sciences and Walter Pagel of the Department of Scientific Publications foreditorial suggestions.

Address correspondence to Steven Spidell, D.Min., BCC, Executive Director, PresbyterianOutreach to Patients, PCUSA, 1918 Meadow Creek, Pearland, TX 77581, USA. E-mail:[email protected]

Journal of Health Care Chaplaincy, 17:75–86, 2011Copyright # Taylor & Francis Group, LLCISSN: 0885-4726 print=1528-6916 onlineDOI: 10.1080/08854726.2011.559859

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from others (31%). As an indicator of disenfranchised grief, 21%of chaplains felt that their grief was not supported and affirmedin the workplace and 63% listed circumstances of death aboutwhich they felt very uncomfortable hearing or talking about. Theresults suggest that grief, and disenfranchised grief in particular,may be an important concern to address in healthcare chaplaincy.

KEYWORDS chaplaincy, disenfranchised grief, grief, pastoralcare, responses to death

INTRODUCTION

Disenfranchised grief is defined by Doka (2002) as grief that is not acknowl-edged by society, by the healthcare culture, or by individuals. Therefore, dis-enfranchised grief is not confronted therapeutically but rather remainshidden, unrecognized, or unhealed (Papadatou, 2009). Doka’s typologyrecognized four types of disenfranchised grief: (1) the relationship is notrecognized, (2) the loss is not acknowledged, (3) the griever is excluded,and (4) the circumstances around family members’ deaths are deemedsocially unacceptable, for example, suicide, AIDS, or the death of children(Corr, 1988; Doka, 2002).

The concept of disenfranchised grief has been studied in children with afather on death row (Beck & Jones, 2007), the loss of an adolescent romanticrelationship (Kaczmarek & Backlund, 1991), missionary aid workers (Selbyet al., 2009), women who have given up a child for adoption (Aloi, 2009),grandmothers as primary caregivers (Thupayagale-Tshweneagae, 2008),the death of a child with intellectual disabilities (Todd, 2007), science andgenetics (Thachuk, 2007), caring for a child with schizophrenia (Milliken,2001), and background and strategies for counselors (Lenhardt, 1997).Recurring themes in this body of work include the non-recognition of thegrievers’ loss by society, the lack of support, the isolation that the bereavedfeel but cannot express, and the societal unacceptability of the situation inwhich the person died, for example, capital punishment. Such studies havehighlighted the widespread presence of disenfranchised grief. Grievingpeople whose grief is disenfranchised are frequently overlooked andignored.

The aforementioned studies demonstrate the interest in disenfranchisedgrief in various populations. However, in health care, where loss is a dailyevent both for patients and caregivers, disenfranchised grief is an understu-died phenomenon (Papadatou, 2009). Most professional understandings ofstress and grief in the workplace usually refer to burnout or compassionfatigue, rather than grief explicitly. In a quantitative study, Anderson andGaugler (2006) examined the grief experiences of certified nursing assistants

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(CNAs) in nursing homes. The authors found that CNAs felt excluded fromgrieving the loss of their patients despite the depth of the relationship thathad been formed (Anderson & Gaugler, 2006). The failure to acknowledgethe relationships between CNAs and residents, and the denial of death innursing homes, may preclude CNAs from effectively moving through thegrief process.

Romesberg (2004) felt that the disenfranchised grief of health profes-sionals put them at risk for experiencing compassion fatigue and burnout.Oncology nurses are reluctant to grieve because of the reaction of thepatient’s family or their peers (Brown & Wood, 2009). In another study,42% of oncologists indicated incidents of emotional exhaustion, depersona-lization, and lack of personal accomplishment (Gandey, 2006).

How grief is experienced is critical for the resilience of the helping pro-fessions. Helsel (2008) wonders if ‘‘those in situations of frequent loss oftenforget to grieve and respond to the loss without even knowing the signs oftheir own grief’’ (p. 338). Without recognition of grief reactions or the poten-tial presence of disenfranchised grief, losses may be transformed into otheremotions such as anger, anxiety, blame, helplessness, and guilt. Reactionscan also take the form of a chronic or delayed grief that can lead to com-passion fatigue or burnout that never seems to come to a satisfactory con-clusion (Clark, n.d.). Other studies have examined compassion fatigue orburnout in other healthcare professionals such as social workers, nurses,and physicians (Arrington, 2008; Lu, 2008; Schulman-Green, 2003).

The first objective of this study was to learn how healthcare chaplainsrespond to grief from a variety of perspectives. Our second objective was todetermine the experiences of disenfranchised grief in healthcare chaplains.

There are many components to healthcare chaplains’ experiences ofgrief and their responses to it. More specifically, we were interested in whatgrief topics (their own or others) they would be uncomfortable hearing ortalking about. We sought information on how chaplains responded emotion-ally to grief, their coping responses, and how they felt and=or acted whengrief ‘‘piled up’’ in their workplaces. We also were interested in how health-care chaplains revitalized themselves from their grief experiences. Wewanted to determine whether the chaplains felt appreciated for their ministryand if their grief was affirmed in the workplace.

The presence of disenfranchised grief as an underlying componentin the grief of chaplains was studied by a qualitative analysis of writtenresponses according to two of Doka’s (2002) criteria—the loss is notacknowledged and the circumstances around deaths are deemed sociallyunacceptable. In addition, we wanted to know about the chaplains’ own sen-sitivity to topics they were uncomfortable hearing or talking about withpatients and also their own losses about which they were uncomfortable.Our underlying assumption was that such topics could be indicative of thepresence of disenfranchised grief in the chaplains.

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METHODS

Survey

The survey was available online beginning April 9, 2009. It was advertisedonce each in two monthly online newsletters that are sent to Associationof Professional Chaplains (APC) members, APC e-News (May 2009) andPlainViews (May 20, 2009). A brief article in both publications invited partici-pation in a survey that concerned the experience of grief and how chaplainsrespond. The survey was closed on June 1, 2009, which was after seven con-secutive days of not receiving any new responses. We used SurveyMonkey.com, a Web-based program for conducting surveys.

Survey Questionnaire

Participants were asked a series of questions related to death and grief thatincluded open-ended and closed-ended components. Other items askedabout the chaplain’s ministry.

Two questions were about death. The first question was: How are youaffected when one of your patients dies? The response options were sad,angry, hurt, accepting, disappointed, relieved, and other. Participants wereinstructed to check two responses that most generally apply. The secondquestion was: Do you do anything special to mark a person’s death? Sevenpossibilities were offered (in addition to ‘‘Other,’’ each having three responsecategories: Always, Sometimes, and Never. The seven possibilities were: (1)Say a personal prayer; (2) Write the name in a book of remembrance; (3)Light a candle; (4) Attend the funeral; (5) Nothing special; (6) Organize amemorial service at the hospital, etc.; and (7) Have your own personal ritual.

The first question about grief was: How do you feel when the griefs atwork begin to pile up? Twelve response choices (in addition to ‘‘Other’’)were listed and participants were instructed to check all that applied. Theresponse choices were: (1) Feel sad or moody; (2) Cry more than is normalfor you; (3) Have low energy; (4) Feel like you don’t have any time for your-self; (5) Changes in sleeping patterns; (6) Changes in eating patterns; (7) Iso-late yourself from friends=family=colleagues; (8) Lose interest in hobbies; (9)Feel angry or resentful towards people; (10) Distance or withdraw from rela-tionships; (11) Engage in self-destructive behavior; and (12) Go through themotions without feeling. Since these items were considered to representnegative coping, they were summed to form a single negative coping score.

The next question was: What do you do to revive yourself? Elevenresponse choices (in addition to ‘‘Other’’) were listed and participants wereinstructed to check the three responses that are most effective. The responsechoices were: (1) Play=watch sports; (2) Read; (3) Watch TV; (4) Go out withfriends; (5) Talk with colleagues; (6) Exercise=workout; (7) See a counselor;

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(8) Go on retreat; (9) Take walks; (10) Listen to music; and (11) Pray, readscripture, meditate.

Two open-ended questions examined aspects of grief that wereuncomfortable to talk about. The first question was: Have you discoveredcertain aspects of grief or grieving that you as a chaplain are very uncomfort-able hearing or talking about (e.g., murder, suicide, tragic accidents, death ofa child, etc.)? Participants were asked to explain their answer more fully. Thesecond question was: Are there losses and griefs of your own that you wouldfeel very uncomfortable talking about?

The last question related to grief was: When you feel grief from thedeaths of patients, do you feel that your grief is affirmed and supported inthe workplace? The response options were simply Yes or No.

Two questions were asked about ministry. The first was: Do you feelappreciated for your ministry? The response options were: Always, Most ofthe time, Some of the time, and Almost never. The last question askedhow long the participant had served as a chaplain. The response categorieswere: Less than 5 years; 5 to 9 years; 10 to 14 years; 15 to 20 years, and Morethan 20 years.

Statistical Analysis

For the quantitative data collected from the closed-ended questions,responses were tabulated and percentages were calculated. Chaplains wereclassified into three groups based on their responses to the question: Doyou feel appreciated for your ministry? Those answered ‘‘Some of the time’’and ‘‘Almost never’’ were collapsed into a single group because only threechaplains answered ‘‘Almost never.’’ Differences in negative religious copingamong the three groups were analyzed by analysis of variance (ANOVA).

To look for the possible presence of disenfranchised grief and itsrelationship to mental well-being, we analyzed the relationship betweennegative religious coping and whether the chaplains’ grief was affirmedand supported in the workplace using a t-test.

Qualitative Analysis

For the qualitative data collected from the two open-ended questions aboutcommunicating about grief, two of the authors (SS, SBC) each classified thewritten responses according to various categories. For the first questionregarding whether the chaplain had discovered certain aspects of grief orgrieving that they were very uncomfortable hearing or talking about, theclassified categories were: (1) None; (2) Death of a child; (3) Suicide; (4)Murder; (5) Tragic accidents; (6) Abuse; (7) Fetal demise; and (8) Death ofa young parent. For the second question regarding losses and griefs of thechaplain that they would feel very uncomfortable talking about, the classified

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categories were: (a) Yes, (b) No, (c) Sometimes, (d) Yes, but discussed onlywith certain people, (e) No, but only with certain people, (f) Depends on thelisteners, and (g) Not applicable. The classified responses were compared. Ifthere was a disagreement about classification, then a discussion between thetwo authors was conducted until agreement was reached.

From the qualitative data collected from the open-ended questions, weidentified those that suggested that the chaplain’s loss was not acknowledgedas defined by Doka (2002) as one of the characterizations of disenfranchisedgrief.

RESULTS

A total of 577 chaplains (18% response rate) responded to the survey. Thedistribution of the length of service for the survey respondents was similarto the distribution of the length of service for all 3131 members of the APC(Fisher’s exact test, p¼ .052).1 For example, for both the survey respondentsand the entire APC membership, about 28% have less than 5 years of serviceand 30% have served at least 15 years.

Sadness (79% of respondents), acceptance (76%), and relief (24%) werethe main responses chaplains noted to the death of a patient. The surveyallowed chaplains to identify up to two responses that most applied to them.One of the written responses was: ‘‘Sometimes it is not so clear, but for a longtime I felt a kind of heaviness in my body. I felt that the grief was lodged inmy body but I did not know what to do about it. Now that I do more inten-tional movement, it is better . . .’’ Others described themselves as ‘‘tired,’’‘‘relieved,’’ ‘‘honored,’’ and ‘‘hope-filled.’’ Another chaplain wrote, ‘‘I amthe palliative care chaplain on our service . . . . My anger comes from theravages I see, life’s arbitrary nature and the pain and sorrow of not onlythe patient but their loved ones, caregivers and medical center staff. Mysadness comes from giving my heart in love.’’

Chaplains reported that saying a personal prayer was their mainresponse to mark a person’s death (56% indicating ‘‘always’’ and 43% indicat-ing ‘‘sometimes’’). Other frequent responses included attending the funeral(88%), organizing a memorial service (82%), using their own personal ritual(69%), or doing nothing at all (61%). (Frequencies are the percentage ofthose who checked ‘‘always’’ or ‘‘sometimes.’’) Written responses showedother kinds of behaviors, such as journal writing, writing a novel about someof the patients, praying for the family, or going on to the next patient. Somewrote that they sent a condolence card, spoke to colleagues about the loss,shared the experience with the [chaplain’s] family, or spent time near a river.

When grief begins to pile up in the workplace, chaplains respond with avariety of reactions. Primarily, chaplains reported that they would have lowenergy (78%), feel like they had no time for themselves (44%), go through

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the motions (41%), or distance themselves or withdraw from others (31%). Inthe written responses, some responders wrote that they talked with otherpersons when the grief piled up. Other responders spoke of feeling over-whelmed, feeling numb, or feeling a need for solitude. Comments includedrecognition of ‘‘a weight I am carrying,’’ feeling stuck at work, being stressedto juggle work and family, and becoming fearful of engaging others. Onechaplain wondered, ‘‘Perhaps many times I do not realize the ways in whichmy grief work is affecting me.’’

The primary practices chosen by chaplains to revitalize themselves fromgrief included prayer (61%), talking with colleagues (57%), and reading(42%). Some chaplains wrote that they would sleep more, see a movie, goto a beach or park, go dancing, or be with their family.

We also investigated whether or not the chaplains felt appreciated andwhether or not the chaplains felt that their grief was affirmed in the work-place. While the majority of chaplains responded they felt appreciated fortheir ministry always or most of the time (84.5%), 15.5% reported feelingappreciated only some of the time or almost never. Similarly, the majorityindicated feeling that their grief was supported and affirmed in the workplace(79.1%); however, 20.9% felt that it was not. Individual responses regardingsupport included comments that a chaplain felt much affirmed, understood,and supported by fellow team members, doctors, and nurses. On the otherhand, another chaplain wrote ‘‘as a whole the health care environmentand setting does not always lend itself to a healthy support of grief. As achaplain, I often find myself supporting other staff in their grief. It’s easyto just keep going on and not take time for myself.’’ Other chaplains referredto the demands placed on them, such as ‘‘to be available,’’ ‘‘to be able to han-dle whatever comes up,’’ or to ‘‘not miss a beat when going on to the nextcrisis.’’

We identified several examples of disenfranchised grief as unacknowl-edged loss through the written responses regarding discomfort, when griefpiled up, and affirmation. For example, individual chaplains wrote ‘‘hospitalculture encourages emotionless professional behavior including chaplainstaff,’’ ‘‘death is not talked about in the hospital setting,’’ and ‘‘my colleaguesassumed I am immune to grief’’ (See Table 1).

We found that the chaplains have significant concerns when the grief atwork begins to pile up, based on the count of negative coping behaviors thatrespondents exhibited. Interestingly, 21% reported experiencing 3 negativecoping behaviors, 18% reported experiencing 4, and 31% reported experi-encing 5 or more (see Figure 1).

To explore further who was exhibiting these negative coping behaviors,we examined whether respondents who felt their grief was affirmed=supported at work differed from those who did not. Results showed thatof those chaplains who felt their grief was affirmed in the workplace, 86%exhibited 3 or more negative coping behaviors. For those chaplains who felt

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their grief was not affirmed in the workplace, 91% exhibited 3 or more nega-tive coping behaviors. (Result not statistically significant.) In addition, wefound that 79% of those chaplains whose grief was affirmed and supportedin the workplace exhibited approximately one fewer negative coping beha-vior (4 vs. 5) compared to the 21% of those chaplains who wrote that their

FIGURE 1 Distribution of count of negative coping behaviors to ‘‘when the griefs at workbegin to pile up’’.

TABLE 1 Examples of Disenfranchised Grief as Demonstrated in the Survey Responses

Hospital culture encourages emotionless professional behavior including chaplain staff.My chaplaincy is with parents who are grieving the death of a child. It is unlike the ministriesof other chaplains . . . and can be quite isolating.

Death is not talked about here in my hospital setting.Often there is no time in the workplace to acknowledge the chaplain’s grief.I rarely express my grief in the workplace.My colleagues assume I am immune to grief, even on those occasions when I address it intheir presence.

The chaplain is seen as the support for everyone else. Seldom do others remember that I amgrieving too.

One colleague mentioned that she would rather NOT have to listen to me about many of myfeelings.

I remember one [chaplain] on the staff who left immediately when I started crying assumingI wanted to be alone.

We don’t [grieve] very well in our hospice. I would love to find a way to tend to that need inour staff and within myself.

I generally keep [grief] to myself. Sometimes I do share, and then I am usually affirmed.I feel I am the one supporting other’s grief - including staff.When we are running late in IDA [Interdisciplinary Group], we barely mention the deaths.I notice that other staff have debriefing sessions, but not the chaplains.There is much to do. We move on.

Note. Responses are examples of Doka (2002) criterion, ‘‘the loss is not acknowledged.’’

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grief was not affirmed and supported in the workplace (p< .0025). Thus, thelack of affirmation of grief may lead to problematic or disenfranchised grief.

Further, we explored whether respondents who felt appreciated in theirministry were different than those who did not. Results indicated that higherlevels of perceived appreciation were associated with fewer negative copingbehaviors. Chaplains who were ‘‘always’’ appreciated for their ministryexhibited approximately one fewer negative coping behavior than thosewho were appreciated for their ministry ‘‘most of the time,’’ and approxi-mately two fewer negative coping behaviors than those who were appreci-ated for their ministry some of the time (p< .01; see Table 2).

Sixty-three percent of the responding chaplains identified at least onetopic that they were uncomfortable hearing or talking about. Some of themost frequently listed topics included the death of a child (36% of respon-dents), death by murder (9%), and suicide (10%). We observed that 36%claimed that there were no such issues for them. As far as griefs of theirown that they were uncomfortable talking about, chaplains frequently listedtopics such as family tragedies and personal losses. A total of 65% indicatedthat there were no personal grief issues about which they would feeluncomfortable talking.

DISCUSSION

Chaplains who participated in this survey showed awareness of their per-sonal and professional responses to situations of grief in the workplace.While certain forms of death and loss were difficult for some chaplains to dis-cuss, most felt free to discuss any topic with patients. The use of healthy revi-talizing activities could be seen as an antidote to the low energy, goingthrough the motions, withdrawal, and isolation that comes up when griefat work becomes heavy. The survey also indicates that the majority ofchaplains feel both appreciated and affirmed in their workplaces.

TABLE 2 Appreciation for Ministry with Count of Negative Beha-viors in Response to How Chaplains Feel When the ‘‘Griefs at WorkBegin to Pile Up’’

Count of negative behaviorsa

Appreciation for ministryb N Mean SD

Always 99 3.08 2.07Most of the time 387 3.72 2.17Some of the time & Almost never 89 4.83 2.58

Notes: F¼ 3.78, p< .01. SD¼ standard deviation.aQuestion asked: How do you feel when the griefs at work begin to pile up?bQuestion asked: Do you feel appreciated for your ministry?

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Our results suggest that disenfranchised grief is present in healthcarechaplains, as indicated by the written responses to various kinds of loss,behaviors that serve to isolate the chaplains and diminish their opportunitiesfor healthy grieving, and the finding that over 20% of respondents feel thattheir grief is not affirmed or supported at work. When chaplains are over-whelmed by personal and professional losses and do not utilize adaptivebehaviors, their grief tends to become hidden, poorly expressed, and unpro-cessed. These are the chaplains who may be most likely to experience disen-franchised grief. The value of understanding the possible presence ofdisenfranchised grief could shine a light on areas of grieving that, by defi-nition, are not going to be recognized by society in general and by a workculture in particular.

Our survey suggests two indicators that may well reflect the presence ofdisenfranchised grief. One has to dowith the topics that chaplains find difficultto hear or talk about. These are issues that are indeed subject to being avoidedand unprocessed, including suicide, death of a child, and tragic accidents.

The second indicator that suggests the presence of disenfranchised griefhas to do with the potential effects on chaplains’ behavior. Chaplains aretrained to be open and empathic to the situations, crises, and feelings ofothers. That there would be limits and effects to that openness, while notsurprising, indicates points where avoidance and disenfranchised grief mayoccur. Nevertheless, for some, the chaplain’s own grief is often avoided ordiminished, seldom to be processed. Chaplains may become at risk forburnout, or, at worst, vicarious traumatization.

Clark (n.d.) notes that ‘‘a high loss environment requires a balancebetween engagement and detachment, and the balance requires ongoingself-monitoring’’ (‘‘Maintaining Professional Balance,’’ para. 1; cf. Papadatou,2009). Clark (n.d.) also highlights several warning signs in chaplains andothers: decreased sensitivity and inability to do one’s work, cynicism and jad-edness, post-traumatic stress disorder-type reactions, and difficulty maintain-ing hope. Similarly, our study indicates some chaplains may be experiencingseveral negative coping behaviors that may be indicative of negative moodswhen overwhelmed by their own grief. It is important that a follow-up studymore closely assess the symptom clusters of these coping behaviors andmood symptoms in order to determine their clinical significance.

Clearly, colleagues and department managers should have awareness ofthe signs of stress and grief so that there is assistance to restore health andbalance without shame. A heightened awareness of grief on the job andhow easily it becomes disenfranchised should be an important concern tothose who train, manage, and work with chaplains. By training, tempera-ment, and unrealistic self-expectations, some chaplains may be especiallyvulnerable to the stressors caused by disenfranchised grief.

Our results are quite preliminary, but do support the need for furtherstudy of disenfranchised grief in hospital chaplains. Limitations to the current

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study include our use of invalidatedmeasurement tools and a low response rateto the survey. While exploratory, our results indicate a possible relationshipbetween disenfranchised grief and behaviors indicative of a negative mood.The cross-sectional design of this study limits any interpretation of causality;thus, a future longitudinal studymay determine the causal relationship betweenpsychological functioning and disenfranchised grief. In addition, a validatedinstrumentwithmore narrowly defined concepts covering disenfranchised griefcategories, rather than the broad issues we used, would be useful. Furtherstudy of compassion fatigue and burnout with regard to the presence of disen-franchised grief would be useful in awareness and future intervention.

NOTE

1. Data provided by Carol Pape, APC Operations Manager, on June 17, 2009.

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