By David Lewellen Vision vision W best practices, almost ...Rohr’s newest book,Things Hidden: Scripture As Spirituality. At the same time, Bob O’Gorman revealed Loyola’s newest

By David LewellenVision editor

When Fr. Basil Royston, BCC,arrived at O’ConnorHospital in San Jose eightyears ago, he inherited a narrativesystem of charting pastoral care visits.But he found the format time-consuming. “By the time I had done30 or 40 in a day, I thought that Ishould get a rubber stamp,” he said.“So I thought, why not get [checklist]boxes and check them?”

So Fr. Royston designed a form forcharting with a checkoff list of pastoralinterventions and limited space fornarrative. In the near future, the formwill be easily transmitted into anelectronic format.

Because the Joint Commission nowrequires proof that spiritual care wasprovided, more hospitals now expectthat chaplains will document theirwork in a patient’s medical chart. Butdocumenting a spiritual encounter ismore challenging than noting a pulserate or a dosage of medication.

Across the country, one chaplain ata time, one system at a time, almosteveryone has a different story aboutcharting formats. Some like thenarrative system, some like checklists;

some are electronically formatted;some have efficient paper systems. Butin the absence of a consensus aroundbest practices, almost every institutionis using a system of documentationthat works within their clinical setting.

That may or may not be a problem.Settings and needs vary widely, and atevery institution “the staff developswhat makes sense to them,” said Sr.Colette Hanlon, SC, BCC, thespiritual care coordinator at ProvidenceCare Center in Lenox, MA.

The drawback to a checklist system,Sr. Hanlon said, is that theinterdisciplinary team may not knowchaplain terminology — and there’sprobably not a box to check forsomething as specific andcomprehensible as “the patient isterrified of surgery and had a baddream, and I called the surgeon.”

However, Sr. Hanlon has taughtcharting to CPE students, and alsoeducated other healthcare professionalson what chaplains do, “so they knowwhat a pre-op visit might involve.” Thebest setting for teaching charting, shesaid, is interdisciplinary, where thefocus will not be just on pastoral-carelanguage.

In This Issue:

vision

Karen Pugliese 2

David Lichter 3

Certification Update 4

Newly certified chaplains 5

Seeking, Finding 8

Research Update 10

Volunteer of the Month 11

Lawrence VandeCreek 12

Prayers for Healing 12

Pastoral Care Summit 13

2008 Conference 14

NACC Awards 15

Poem “Solace” 15

Spiritual distress assessment 17

Parent reflects on grief 17

Positions available 18

National Association of Catholic Chaplains

January 2008Vol.18 No. 1

See Charting on page 6

Pastoral care developssolutions to charting

A screenfrom CentralDuPageHospital inWinfield, IL

2 Vision January 2008

By Karen PuglieseNACC Board Chair

On December 1st, in the midst of the city’s first winterstorm, 14 Chicago-area NACC chaplains gatheredwith David Lichter; Dr. Bob Ludwig, director of theInstitute of Pastoral Studies at Loyola University; and Dr.Bob O’Gorman, director of the M.Div. and Master ofPastoral Studies programs at the institute.

We were part of a unique day-long learning opportunitysponsored by Loyola in which best-selling author Fr. RichardRohr led an audience of 630 participants in a powerful andchallenging exploration of Scripture as a path to a spiritualitywhich is grounded, traditional, and yet consistently “counter-intuitive” in its mature form. Over lunch, a diverse group ofchaplains met with our new Executive Director, BobO’Gorman, and Fr. Ludwig, greeted old friends, and madenew collegial acquaintances.

The presentation coincided with the release of RichardRohr’s newest book, Things Hidden: Scripture As Spirituality.At the same time, Bob O’Gorman revealed Loyola’s newestgraduate program, responding to the call to minister in newways within the Church. The school will offer three newfocus areas — healthcare ministries, urban ministry, andministry management and leadership. The curriculum,courses and workshops in this exciting new chaplaincyconcentration were developed in consultation with theNACC and include basic CPE and a CPE residency. Uponcompletion of the degree, students will be ready forcertification. This is a wonderful example of a hoped-foroutcome in our Strategic Plan!

The institute now offers MA degrees in divinity, pastoralstudies, pastoral counseling, spirituality, social justice, andreligious education, as well as advanced graduate certificateprograms in pastoral counseling, spiritual direction, socialjustice and religious education. Dr. O’Gorman told thechaplains attending the gathering that IPS will begin to offerspecific workshops each semester as part of the new track inhealthcare ministries. The workshops will be developed notonly for those preparing for chaplaincy, but also for chaplainsalready in ministry in the Chicago area for their continuingeducation. We were given an opportunity to rank suggestedworkshops with an eye to our own interests and needs, tomodify the topics, suggest additional subject matter, and offerpotential qualified and experienced presenters.

Bob O’Gorman announced that he and Bob Ludwig,along with other educational leaders of graduate schools inpastoral ministry and theological studies, would meet withCatholic Health Association leaders to discuss partnershipopportunities in preparing ministry leaders for education andhealthcare. Our executive director, David Lichter, will alsoparticipate. And as you know (see David Lichter’s article onpage 3), we continue to collaborate closely with Brian

Yanofchick, CHA Senior Vice President of MissionIntegration. We hope you see, as we do, an excitingsynchronicity and a clearly growing momentum for ourStrategic Plan.

Personally, I was deeply moved by the connectionsbetween Fr. Rohr’s reflections and my sense of the NACC’sown spiritual and strategic path. I encourage small groups ofmembers to come together, either in person or in e-mailconversations, to reflect on the depth of wisdom and insightRohr’s book offers. One of his major themes was the notionof “things hidden,” as Jesus said, “since the foundation of theworld.” Rohr offered insight into how humanity comes tosee and understand the Mystery of God revealed in our ownlives, and trust the development of our spiritualconsciousness and inner authority. He suggested that we arerediscovering transformation when we enter more fully intoparabolic and paradoxical thinking.

Fr. Rohr challenged us to engage in “cellular”contemplative prayer, which takes us into the depths of theunconscious and awakens us to what is hidden in our oftendualistic approach to life, even to our life of prayer. Dualistichearts and minds are confounded by mercy, forgiveness,grace, and divine love. As we strive to implement ourStrategic Plan, we need to avoid entrapment in an all-or-nothing mentality that devalues less than perfectachievements. Rohr encouraged us to see with the “thirdeye;” to detach from tightly held ideas, to engage inparadoxical versus oppositional thinking and discover graceshidden in the darkness of our own ignorance, fear, prejudice,blocks, and blind spots and self-protectiveness.

As we step over the threshold of a new year, I amreminded of both the Vision and Action and the PastoralCare Summit, during which we prayerfully sought tobecome more comfortable with uncertainty and more athome dwelling in the Mystery of Possibility. Minds thatcontinually re-process the past and worry about the futureavoid the Gift of the Present Moment, and commit what Fr.Rohr playfully called the capital sin of superficiality. Imaginethe potential energy unleashed by our members committedin prayer and action to what Rohr described as “Life asParticipation” in the transformation of our ownconsciousness and of our association. Imagine the impact onour Church, our world!

Imagine the gifts of wisdom and insight that couldemerge from small groups prayerfully reading and reflectingtogether. Consider taking the initiative to invite colleaguesfrom various traditions to begin the new year by enteringinto a prayerful experience of faithful and graceful livinginto the Mystery and Paradox of Knowing and Unknowing.And let us know what is brought to light, even in the midstof winter’s darkness, from the hidden recesses of your hearts.

Karen Pugliese, MA, BCC, is a chaplain at Central DuPageHospital in Winfield, IL.

New programs, new food for thought offer inspiration

January 2008 Vision 3

visionVision is published 10 times a year by theNational Association of Catholic Chaplains.Its purpose is to connect our members witheach other and with the governance of theAssociation. Vision informs and educatesour membership about issues in pastoral/spiritual care and helps chart directions forthe future of the profession, as well as theAssociation.

IISSSSNN:: 11552277--22337700

Executive EditorDavid A. Lichter, D.Min.

EditorDavid Lewellendlewellen@nacc.org

Graphic DesignerGina Rupcic

The National Association of CatholicChaplains is a professional association forcertified chaplains and clinical pastoral educators who participate in the healingmission of Jesus Christ. We provide standards, certification, education, advocacy, and professional development forour members in service to the Church andsociety.

NNAACCCC NNaattiioonnaall OOffffiiccee5007 S. Howell Avenue Suite 120

Milwaukee, WI 53207-6159(414) 483-4898

Fax: (414) 483-6712info@nacc.orgwww.nacc.org

Executive DirectorDavid A. Lichter, D. Min.dlichter@nacc.org

Director of OperationsKathy Eldridgekeldridge@nacc.org

Director of Education & Professional PracticeSusanne Chawszczewski, Ph.D.schaw@nacc.org

FinancesSue Walkerswalker@nacc.org

Membership/Executive AssistantCindy Bridgescbridges@nacc.org

Special ProjectsPhilip Paradowskipparadowski@nacc.org

By David Lichter, D.Min.Executive Director

Last month, I offered my observationson the first goal of NACC’s strategicplan: to support association memberswith creative educational, spiritual, andcommunication opportunities. As Imentioned, reaching these goals willrequire effective strategy development indialogue with you. I asked for yourcomments on my reflections, and I amgrateful to the many of you who did justthat. I ask you again to respond to thiscolumn.

Considering the value of belonging toan association such as the NACC, onethinks first about the immediate tangiblebenefits, such as Vision. I often weigh thecost benefit of my dues to belong to otherorganizations against those tangiblebenefits, and often come up short. Then Iask, “Is it worth the fees?”

I know we need to create moreeducational events related to goal one.However, I would like you to add into thevalue equation our efforts to address goaltwo, to promote the profession of chaplaincy.Fulfilling this goal carries many criticallong-term benefits to your ministry thatare less immediate or countable.

Think about this parallel. You as amember try to weigh the value ofbelonging to an association and todetermine how best to judge its value. Butin turn, the profession of chaplaincy seeksto position itself among other professionsthat are trying to judge the value ofchaplaincy and deciding whether tosupport and invest in it. The sevenobjectives of this goal cover developingpartnerships that will help develop andadvance the value of chaplaincy.

The first objective is: advocate with andeducate the bishops, The Joint Commission,the Catholic Health Association, theAmerican Hospital Association, and CEOs ofhealthcare organizations on the value ofcertified chaplains and clinical pastoraleducators, as well as on their role and needs. Ihad a good meeting with the NACC’sEpiscopal Advisory Board at the

USCCB’s General Assembly inNovember. They were positive about theplan and its direction. Several bishopscame up to me at the end of the meetingto offer their help as needed. I sensegenuine interest and support. BothBishop Calvo, our new Episcopal Liaison,and Bishop Melczek, our former one,again expressed the invaluable ministrychaplains provide.

We greatly appreciate the growingpartnership with CHA, especially throughBrian Yanofchick, Senior Vice Presidentof Mission Integration. With Brian’sleadership and Tom Landry’sgroundwork, we have initiated both thePastoral Care Summit in Omaha (seepage 13) and the more recent survey onpastoral care that was conducted inDecember. CHA is very committed tocollaborate with our chaplains, directors ofpastoral care, and mission integrationleaders to help identify and articulate thevalue of chaplaincy. Then we will be in aposition to further advocate it with theAmerican Hospital Association andCEOs of healthcare organizations. Thesetarget groups were of particularimportance for the Marketing Task Forcegroup that worked in the fall.

The second objective is: work with theSpiritual Care Collaborative, the CatholicHealth Association, and The JointCommission to establish and recognizestandards for Pastoral Care departments andproviders. At the CHA/NACC PastoralCare Summit, this was identified as a keyarea, and we are organizing to address thisneed. However, we don’t want to reinventthe wheel, but build on the best ofexisting standards, and work with theSpiritual Care Collaborative and TheJoint Commission to build a consensusfor standards that can be foundation forfuture programs. We have begun toaddress this objective well.

The third objective is: provideeducational materials for use with collegesand ministry groups to promote chaplaincy asa vocation and profession. Several groups

NACC works to promotevalue of pastoral care

See Pastoral Care on page 4

are converging on this objective. In the fall, both theMarketing and Recruitment Task Forces provided some gooddirection here. Also at the Pastoral Care Summit, a groupoffered strategies for promoting chaplaincy to these educationaland formational entities. We will integrate the efforts of thesetask forces in the coming year. Also, CHA invited us toparticipate in a convening of leaders in higher education to

explore the future leadership needs, and chaplaincywas part of that discussion. We plan to have somesample materials that can be used for these highereducation and ministry groups by Conference2008.

The fourth objective is: promote CPE programsand increase the number of CPE supervisors. At theirNovember board meeting, the NACC board spentsome time discussing this need. Also, I wasgrateful to attend the ACPE National Conventionin October and visit with several CPE supervisors

— some who are certified only with ACPE, and others withdual certification. We need to be in serious dialogue withACPE, which also feels the urgent need for more CPEsupervisors. We are exploring the appropriate partnership withthem to address this objective.

The fifth objective is: Benchmark staffing and wages ofprofessionals with comparable training and experience. A first stepto meeting this objective is getting updated data on staffingand wages within our own profession. As mentioned earlier, we

undertook a survey with CHA in December, and will haveresults in early spring. We are also conducting acompensation survey with the Spiritual Care Collaborative inearly 2008 that will provide us with very helpful data forfurther benchmarking our profession. From this basis we cantake further steps to address this objective.

The sixth objective is: provide resources to assist withdeveloping and sustaining excellent spiritual care services. ThePastoral Care Summit provided an opportunity for many ofyou to encourage collaborative efforts. I want NACCmembers to be able to access such resources on the NACCwebsite. You know better than I the rich resources we alreadyhave among our members. Now it’s a question of gettingmembers to send in their resources, and making sure ourwebsite is very user-friendly. We have a ways to go here, butwe can make this happen!

The seventh objective is: partner with clinical researchfaculties in initiating studies on the value of professional spiritualcare in healthcare settings. Again, at the Pastoral Care Summit,we had some select representation of researchers who haveexperience in this area and want to partner with us. We havesolid potential here also.

Overall, as you can see, the Pastoral Care Summitprovided an invaluable foundation for addressing most of theareas of this goal. We look forward to advancing this workwith those who participated, and many who could notparticipate.

My next Vision article will reflect on goal three: Tostrengthen the NACC’s relationship within the Catholic Church. Ilook forward to a great 2008 with you!


Other

professions

are trying to

judge the value

of chaplaincy

Pastoral CareContinued from page 3

Q. I am interested in applying for certification in 2008.Where can I find the necessary materials?

A. As of now, all of the forms that you will need areavailable online. Go to www.nacc.org and click onCertification to view and download orprint the materials. Beginning this year,we will no longer mail certificationmaterials. (And remember that yourpostmark deadline is Feb. 15.)

The same system now applies tomembers who need to renew theircertification in 2008 or later. All formsare available at our website.

The NACC’s newly revised standards, which you willrefer to frequently in your application, are now also postedat our site under Certification.

Q. I’m a certified member, and I’m interested in being avolunteer interviewer in 2008. What steps should I take?

A. For every round of certification interviews, we needdozens of volunteer interviewers who are NACC-certified

chaplains. There is one round of interviews scheduled for2008, the weekend of Oct. 4-5. To express your interest inparticipating as a certification interviewer in the fall, pleasesend an e-mail to certification@nacc.org. We will respond

to discuss time commitment, training,and other logistics.

Q. Will I have opportunities tolearn more about certification andrenewal of certification at theIndianapolis conference?

A. Yes. We will again offer theworkshops we have offered in previousyears, led by members of the

Certification Commission. There will be four sessions: oneto address your questions about the certification process,one to cover our updated process for renewal ofcertification, and one to discuss supervisors’ certificationand renewal of certification. Additionally this year, we willpresent a session on training to become a certificationinterviewer.

CERTIFICATIONu p d a t e

Chaplaincy & Mental Health

CERTIFICATIONu p d a t e

More certification materials now available online


NACC welcomes newly certified membersCongratulations to the following

NACC members who have beenapproved for chaplain certificationfollowing their interviews in October:

Mr. Pedro J. Acosta Zapata, Greenfield, WIMrs. Linda L. Amato, St. Clair, MIMrs. Maria A. Benoit, Apple Valley, CAMr. Isaac J. Brown, Portland, ORMr. Stanley L. Buglione, Niles, ILBro. Robert E. Campbell, Albuquerque, NMMs. Sherry L. Christ, Adrian, MIRev. Kenneth A. Chukwu, Chatsworth, CASr. Annemarie T. Colapietro, SNJM, Alameda, CARev. Daniel B. Devore, Ponte Vedra Beach, FLSr. Rosa Maria Eubanks, CCV, Hyattsville, MDMr. Isidro Gallegos, Chicago, ILMrs. Carolanne B. Hauck, Lancaster, PARev. Cajetan N. Ihewulezi, St. Louis, MOMrs. Grace Jaworski, East Aurora, NYRev. Luke K. Kalarickal, Tyler, TX

Ms. Lorena M. Klinnert, St. Paul, MNMrs. Laura L. Law, St. Charles, MO

Ms. Ann-Marie Lemire, Eugene, OR

Ms. Mary Jane Lipinski, Marshfield, WI

Ms. Sandra B. Lucas, Waterville, ME

Deacon Victor V. Machiano, McKinney, TX

Rev. Anthony Madu, Uniondale, NY

Rev. Augustine C. Manyama, Portland, OR

Sr. Diane M. McManus, SSJ, Philadelphia, PA

Rev. Elias N. Menuba, Hartford, CT

Mr. Ronald S. Michels, Ripon, WI

Mrs. Debra T. Montelongo, Fairfax Station, VA

Mrs. Karen A. Nehls, Muskego, WI

Rev. Godwin T. Nnamezie, Canon City, CO

Rev. Remigius O. Nwabichie, Bridgeport, CT

Ms. Colleen A. O’Neill, Grand Island, NE

Rev. Charles M. Obinwa, Delphos, OH

Rev. Nelson O. Ogwuegbu, Baltimore, MDRev. Charles U. Okorougo, Lake Charles, LARev. Ejike I. Onyenagubo, Syracuse, NY

Sr. Christiana C. Onyewuche, EHJ, Boston, MARev. Andrew A. Phiri, Oak Park, ILSr. JoAnn Poplar, SSJ-TOSF, Garfield Heights, OHDr. Linda D. Schlafer, Oakland, IAMrs. Dorothy L. Sexton-Nagel, Baiting Hollow, NYDr. Kathleen D. Sweeney, Cumberland, MDMs. Dorothy A. Wilderman, Evansville, INMs. Elizabeth J. Wopat, Onalaska, WISr. Bridget C. Zanin, MSC, Chicago, IL

We also congratulate the followingmembers on their certification:

Supervisory CandidateMs. Theresa Lowther, Buffalo, NY

Associate SupervisorSr. Nancy Beckenhauer, OSU, PepperPike, OH

InterviewersRev. Milton N. Adamson, CSCMr. Bruce C. AguilarDr. Linda M. ArnoldMr. David C. BakerMs. JoAnn Gragnani BossMs. Phyllis A. BowlingMr. Willard J. BraniffSr. Anne K. Breitag, OPRev. Michael E. Burns, SDSSr. Carol E. DeCrane, CSAMrs. Allison S. DeLaneyMr. Michael J. DoyleSr. A. Louise Eggen, OSBSr. Nancy D. Flaig, OSBBro. Daniel J. GallucciSr. Pauline E. Gilmore, FMMSr. Suzanne C. Giro, CSJSr. Mary Ellen Gleason, SCSr. Rose S. Grabowski, SSJ-TOSFSr. Colette Hanlon, SCMs. Jean M. HarringtonMs. Deborah K. HeenSr. Gloria Jean Henchy, CDPSr. Marilyn Herr, OSFSr. Susan M. Holmes, OSB

Dr. Carolyn M. JurkowitzMrs. Kathy J. KaczmarekMrs. Susan M. KangasMr. William H. Korthals, Jr.Rev. Philip G. KrahmanMs. Janice A. LabasMs. Aoife C. LeeMr. James P. LetourneauMs. Martha L. LevenMs. Theresa LowtherMs. Theresa MaikischRev. Dean V. MarekMargaret C. MatacaleMs. Carol MazurekDr. Dennis McCannDeacon William N. MichDr. Anne MurphySr. Mary J. O’Hara, OPRev. Gerald U. OnuohaSr. Ellen Poché, CSJSr. Karen J. Pozniak, SNDdeNMs. Elinor D. QuillMrs. Ellen K. RaddayMr. George P. ReedRev. Basil G. RoystonSr. Maryanne Ruzzo, SCMs. Dorothy M. SandovalMr. Timothy G. SerbanSr. Alice L. Smitherman, OSBMs. Barbara Sorin

Ms. Janice K. StantonSr. Maureen Stocking, OPMr. Michael L. SullivanMiss Mary M. TooleMs. Kathleen A. Vander VeldenDeacon Thomas J. WakenMs. Myra J. WentworthMs. Marilyn Williams

Interview Team EducatorsBro. James F. Adams, FMS, Bayonne, NYMr. Robert J. Barnes, Woodruff, WIMs. Annette Castello, Venice, FLMs. Cathy Connelly, Columbia, SCMs. Camelia L. Hanemann, Milwaukie, ORMs. Judith A. Shemkovitz, Cleveland, OHDr. Jane W. Smith, Columbia, MO

Site CoordinatorsDr. Susanne Chawszczewski, NACC,Milwaukee, WIMrs. Catherine S. Colby, Providence St.Vincent’s Medical Center, Portland, ORMs. Kathleen Eldridge, NACC, Milwaukee, WISr. Mary A. Gallagher, OSF, St. ElizabethMedical Center, Brighton, MAMrs. Angie F. Vorholt-Wilsey, DePaulHospital, Bridgeton, MO

The NACC wishes to thank thefollowing members who made thecertification weekend possible:

Thank you to our volunteers


Different settings — acute care, long-term care, psychiatric, ER, hospice — havedifferent needs. Sr. Hanlon said that herstudents have taken the model she taught toother systems, but “a lot depends on theleadership of your department” as to whatformat is used. Some places, she said, simplyput a sticker on the folder to indicate thatthe chaplain visited or that the patientreceived a sacrament — “and that’s what anurse will look at, at 1 o’clock in themorning.”

At her previous job at The Hospital of St.Raphael in Connecticut, Sr. Hanlon heldquarterly “charting field trips,” for everyonein the pastoral care department to review.She would take 10 charts at random fromeach unit and check the percentage that hadbeen visited by a chaplain and thepercentage that had substantial charting notes. It was achance for the emergency-room chaplain to learn how theob-gyn chaplain worked, and vice versa, and for everyone toshare good or bad examples.

“Charting is about communication in general,” saidGeorge West, director of chaplain services at St. John’sRegional Medical Center in Oxnard, CA, and St. John’sPleasant Valley Hospital in Camarillo, CA. His staff, he said,has learned to chart both for one another and for otherdepartments. Internally, for instance, they might say, “Thepatient is not in touch with her/his mortality,” but to themedical staff they might say, “The patient expects to returnto baseline.”

Fr. Royston said that training the nurses at O’Connor tofill out the spiritual assessment grid has “made a hugedifference in terms of nurse involvement and patientsatisfaction.” Nurses find it helpful to know more of thepatient’s background, he said, and “no other place in thechart are most of those things recorded.”

The “spiritual risk assessment” form at O’Connor askstrained nurses or pastoral visitors (community clergy ortrained volunteers) to identify factors in the patient’sphysical, mental or spiritual condition that could put them atrisk for a crisis. Fr. Royston inputs the results into a databaseand assigns his four full-time chaplains to visit the high-riskpatients. If someone is emotionally unstable, or has anegative diagnosis, or broken family relationships, it’s helpfulfor the chaplain to know in advance

“Pastoral visitors have no business looking at the medicalsection” of a chart, Fr. Royston said, but the professionalchaplains sometimes find it useful background and asupplement to what patients tell them directly.

Space for notes is limited, because “we didn’t want peoplewriting the wrong things,” Fr. Royston said. “We can’t saythat a patient seems depressed. We’re not qualified to makepsychiatric evaluations.” But for major, intense, unusualmeetings, O’Connor Hospital’s chart has a half-page leftopen for notes.

At Mercy Fitzgerald Hospital in Darby, PA, Sr. AngelaFellin, RSM, prefers that her department do the initialspiritual assessments. “99 percent of patients don’t knowwhat a chaplain will do for them,” she said. If a nurse isasking the questions, “it scares them.” But she and her fourpart-time priests manage to see every new admit in keydepartments – ICU, emergency room, cardiac, andpsychiatric.

As the only certified chaplain on staff, Sr. Fellin hastrained the part-time priests to record their work on a paperform adapted to their own purposes. (Mercy Fitzgerald isgoing electronic, but it is not friendly to pastoral care so far:“We have to go through about 10 screens.”)

The form, which is filed directly with a patient’s progressnotes, provides a checklist in which the chaplain can fill in asmany boxes as needed (e.g. “guilty,” “grieving/sad,”“anxious/fearful,” “resistant”) and also a space for comments.

Teaching her coworkers is an ongoing process. “At everydepartment meeting, I go over some aspect of charting,” shesaid. She also sits on a hospital committee that reviewspatient charts and gets a look at the bigger picture.

Interacting with other departments can also be promotedby using their charting system. The pastoral care departmentat Central DuPage Hospital in Winfield, IL adapted thehospital’s McKesson system to include chaplaincy. “We said,What’s the purpose of doing this?” said chaplain Karen

A screen from Mount Carmel Health System in Columbus, OH

ChartingContinued from page 1

Pugliese, BCC, “and it was to work with theinterdisciplinary team.” So chaplains askednurses what was most important to them inthe chaplain’s spiritual assessment of thepatient, and asked themselves what spiritualinformation gleaned by the nurses was mostimportant to them.

Questions were added to the electronicPatient Needs Assessment for nurses to askall their patients if they wish to see achaplain, to receive Catholic Communionand anointing, or to notify their church.Nurse documentation of the responsesgenerates reports for the pastoral caredepartment.

The spiritual care section of the electronicmedical record now has checklists for thechaplain to complete afterward identifyingthe referral source (patient, family, staff orother chaplain), when the initial spiritualassessment was completed by the chaplain,whether the spiritual needs were identifiedand met, and whether there is an ongoing plan of care (forexample, spiritual distress, end-of-life issues, emerging crisis,ethical moral concerns.)

Narrative windows, where the chaplain writes a succinctsummary of the encounter, are not for revealing a patient’sconfidential fears about God, death, or abandonment, but togive a general sense of their state of mind. If, for instance, apatient asks a chaplain to help with life review, it’s a signalthat the person knows he is dying – important informationfor the doctor or nurse.

During the ten years that Michelle Lemiesz, BCC, hasbeen at Mount Carmel Health System in Columbus, OH,spiritual care charting has moved to a medical format, withassessment, plan of care, and outcomes using the HBOCCare Manager system.

Chaplains at Mount Carmel educate and assist patients infilling out advance directive forms and indicate the outcomeof the visit with check-boxes in order to inform the patient-care team that the referral has been completed. The chart canshow which forms the chaplain gave the patient, and whatthe patient’s response was (not interested, thinking about it,consulting with family, etc.)

Mr. West said that St. John’s advance directives arecharted separately and open for all care staff to review. Thetreatment limit/no code status of the patient appears in theMisys system in the same icon that alerts caregivers toallergies — i.e. noting a treatment limit. Advance directivesare a primary responsibility for St. John’s chaplains, as well ascharting family conferences and affirming code status orders.

Mount Carmel’s system allows chaplains, case managers,social workers, and nurses to refer needs and observations toeach other. “It allows each discipline to have a paper trail,”

Ms. Lemiesz said. If, for instance, a patient mentions arecent death in his family, the nurse will refer the patient tochaplaincy for a follow-up assessment. Doctors routinelyorder chaplain visits as part of the patient’s care, andstandard orders of care exist for some diagnoses (stroke,amputation, new diagnosis of cancer). The physician willread the chaplain’s assessment and include them in the planof care for the patient as needed.

Ms. Lemiesz said that 95 percent of the charting done bychaplains will contain at least some narrative, “short andsweet and pertinent.” Any line in the charting system can beclicked to bring up a box to type in comments. When thedocument is saved, it will produce a color code to show it hasbecome a permanent part of the chart.

“It’s important to have a good working relationship with aspecific IT person who understands what chaplains do.” saidMr. West. “Charting is basically a common task for us all,but it is a very complex subject with many opinions andsystems.”


A screen from St. John’s Regional Medical Center in Oxnard, CA

What do you think? We have gathered information from half a dozen

chaplains for this article, but there are nearly 3,000 ofyou in the NACC — and as you know, charting is a fieldwith many approaches and not a great deal of consensus.

We would like to continue this discussion online inthe coming weeks and months. If you have ideas toshare, please e-mail them to dlewellen@nacc.org. Wewill post them on our website and give you updates onnew developments through NACC Now.


By Mary Johnson

Acolor guard, the national anthem, lots of supporters– what had drawn this much attention to twowomen in a swimming pool? We were planning to swim for 24 hours straight, and it

was a good cause: the 2007 Silent No More Swim to raiseawareness about and research funds for ovarian cancer. Buteven so, I got choked up during the national anthem. Irealized that everyone was singing along with therecording and most had their hands over their hearts. Itwas very moving.

Claire Casselman and I had a history of “unusual”swimming events. In 2004 we swam nearly 50 kilometersdown the Missouri River to celebrate my 50th birthday.Now, here we were about to embark on another swimmingodyssey. We aren’t extreme athletes, but we had theadvantage of a compelling cause. We knew we would bemotivated if we kept our focus on the women diagnosed

with ovarian cancer as well as the need forongoing public education about the disease.

Claire had flown in to Rochester, MN, thatmorning from Ann Arbor, where she works asa clinical social worker at the University ofMichigan Comprehensive Cancer Center.People began gathering by the pool about anhour beforehand. They were our friends, ourco-workers, ovarian cancer advocates, curiousonlookers, members of the public who hadread about the event in the local newspaper,

and a sprinkling of surviving spouses.After the Color Guard retired, we jumped into the

water. All of our supplies sat by the edge of the pool:flippers, kickboards, towels, extra goggles, and bottles filledwith a mixture of water and electrolyte replacement.Medical personnel were also there, watching over us,encouraging us to drink and eat on a regular basis, andgiving shoulder massages during our breaks. When Claireand I signaled our readiness, the lifeguard blew a whistleand we started swimming. I was all pumped up onadrenaline. I had to remind myself to relax and slow down.It was important that I get into my “zone.” Mostswimmers can achieve an automatic pilot that allows us tofree our minds. It is possible to actually forget we areswimming. That is where I wanted to go.

Ovarian cancer is a significant health issue in NorthAmerica, with over 25,000 women in the U.S. and 1,200women in Canada diagnosed each year. Unfortunately,approximately 75% of women have advanced disease at the

time of diagnosis. The five-year, disease-free survival ratefor women diagnosed with advanced ovarian cancer is lessthan 20%, according to the Mayo Clinic Guide to Women’sCancers.

One patient advocacy group that raises funds forovarian cancer research is the Minnesota Ovarian CancerAlliance (MOCA). Since its founding in the late 1990s,MOCA has provided substantial grant funding toinstitutions in the state of Minnesota conducting researchin ovarian cancer. In 2003 I was fortunate to receive aMOCA grant for a study titled, “The use of a spiritualintervention to enhance mood states, spiritual well-beingand quality of life in women with recurrent ovariancancer.” I have come to admire the work of MOCA andwas looking for ways to contribute to their mission, sincepart of my clinical focus is women with ovarian and othergynecologic cancers. The marathon swim project seemedlike a great approach to awareness-raising.

So in 2006 I swam a 12-hour marathon by myself. Ijumped in the water at 5 a.m. on a Friday without fanfare.I swam for 50 minutes out of every hour until 5 p.m. Weraised awareness — and almost $1,000 an hour. I felt greatat the conclusion and only slightly fatigued.

With confidence from that experience, I began the 2007swim. My plan was to take it one hour at a time. I hadasked my chaplaincy colleagues to pray that my heartwould be open to God’s grace. This grace had sustained meduring the 2006 swim, making it seem almost easy.

But during the 24-hour marathon, I was showered withdifferent kinds of grace, in ways I might not have thoughtI wanted, but never imagined.

The first several hours of swimming were exhilarating. Ifelt strong and hopeful. I worked to maintain a here-and-now focus, instead of giving in to the temptation ofimagining the finish before I had reached it. Many peoplestopped by the pool to cheer us on. Among them werebreast and gynecologic cancer patients who had come to anannual conference hosted by the Mayo Women’s CancerProgram. They had heard about the swim and showed upat the pool to provide moral support. I knew several ofthem, and their presence was very motivational.

Claire and I planned to swim at the same time, but nottogether. We have different approaches to working out. Iwanted to plan each hour carefully and to execute thatplan, almost like a job. We would both swim for 45minutes and take the last 15 minutes of the hour to get outof the pool, do our self-cares, and refresh before beginningall over again. Replacement swimmers were scheduled tokeep the laps going during our breaks.

During the 24-

hour marathon, I

was showered

with different

kinds of grace

Marathon swim’s unexpected outcome full of grace

Seeking,

Finding

I planned to begin each hour with a vigoroushalf-mile swim and then spend the rest of thetime on a kickboard, moving back and forthusing flutter, scissor, and whip kicks. When usingthe kickboard, I could chat with people whowould walk alongside of the pool. It was a wayfor us to get support and for our many visitors tobecome a part of the total effort.

But I began to have difficulty after about 10hours of swimming. I couldn’t keep up with therequired fluid intake and became dehydrated.One might think that hydration isn’t an issue forswimmers, but a powerful process of dehydrationtakes place with vigorous activity in the water,and the fluid has to be replaced or weakness,light-headedness, nausea and lethargy set in. Itried to recover, pushing fluids and trying to eatbites of high-sugar foods. Despite my efforts, I fellbehind. As I grew weaker, swimming became adaunting challenge and each lap became a majoreffort.

After about 12 hours of swimming I began to havedifficulty keeping fluid or food down. Hypothermia beganto set in as my body struggled to warm itself. The samewater that felt tepid at the start of the swim now felt ice-cold. I battled through the next three hours or so, tryingto keep up with hydration, but I fell farther behind witheach passing hour. At the 15th hour I was taken to theEmergency Department and received several liters ofintravenous fluid.

As my difficulties increased, my need for medicalsupport increased as well. In the middle of the night Ifound myself surrounded by three physicians and twoadvanced practice nurses, none of whom were scheduledto be at the pool at the hour when my need was greatest.When it became all too apparent that I had gone beyondthe point where the situation could be salvaged, theyarranged for my visit to the hospital. One of them, apsychiatrist and a good friend, accompanied me andstayed with me until my treatment was complete. Michael,Sally, Mary, Lanie, Karin, and Jeff were grace.

And during my struggles, Claire quietly kept onswimming. She was a machine. She maintained anamazing focus and successfully completed all 24 hours ofthe marathon. She was able to keep herself fed andwatered properly, and she had an hourly ritual during eachbreak that allowed her to maintain her drive and preparethe next hour. Her body maintained its stamina

throughout and she finished the project for us, to thecheers of the crowd. Claire was also grace.

Later, one of the ovarian cancer survivors handed me acard. In it she had written the following expert advice:“Sometimes things don’t work out as you had planned.Barriers are thrown in your way. So you just learn to acceptthe barriers.” For me, accepting the barriersmade it possible for me to receive the love andcare I so desperately needed. Those words ofencouragement were grace.

When I was being taken to the hospital, anumber of people tried to comfort me aboutnot being able to meet our goal. As wewalked toward the door I suddenly realizedthat the pool had four swimmers at 3 a.m.There were volunteers everywhere. Therewere medical support people by my side, eventhough they were not scheduled to be with usat 3 a.m. I remembered that I had prayed for grace andrealized, at that moment, that I had really been praying tobe able to complete this goal by myself. But grace came inthe form of multiple champions, equally invested in thegoal and generously giving of their time and effort. Thiswasn’t a failure. This was a victory, and I was overcomewith gratitude.

Mary E. Johnson, BCC, is Assistant Professor of Oncology atMayo Clinic College of Medicine and Coordinator of Educationfor Mayo Chaplain Services. johnson.mary3@mayo.edu


Accepting the

barriers made it

possible for me

to receive the

care I needed

Mary Johnson (right) and Claire Casselman get ready for their epicswim to raise money for ovarian cancer research.


By Richard J. Petts

Becoming a parent dramatically changes one’s life. Havinga child may have an especially profound effect on men’slives, leading men to settle down, reevaluate theirpriorities in life, and become more committed to their families(Snarey 1993; Wilcox 2002). However, facing these challengescan be difficult. Many men have no experience in raisingchildren, causing new fathers to search outside sources forparenting support and guidance on how to become a goodfather. One important resource available to new fathers isreligion, and chaplains are in a unique position to help providethe support that new fathers may be looking for.

My research suggests that many men increase theirinvolvement in religion after the birth of a new child (Petts2007). New fathers may turn to religion in order to findmeaning and significance in this life event. Fathers may alsorely on religious institutions for guidance in raising children,and this guidance may be especially important for men who are

having their first child. Because religiousinstitutions and families are interdependent onone another, churches areoften a primary source ofsupport for new parents,and religious leaders shouldcontinue to focus onministries that help newparents to be involved intheir children’s lives.

Results from my study also suggestthat attending religious services is linked to

higher levels of father involvement (Petts 2007). Religiousteachings may prepare men for the responsibility of raising achild and help them to find meaning and purpose in this lifeevent. Religious involvement appears to be especially importantfor first-time fathers, who may be more reliant on churches tohelp compensate for their lack of experience in raising a child.In contrast, men who stop attending religious services or attendreligious services less frequently after the birth of a child areless likely to be highly engaged in their children’s lives. Overall,these findings suggest that religious participation may help topromote parent-child interaction and involvement, and perhapsimprove overall family cohesion.

By being available to new parents throughout the time ofpregnancy and childbirth, chaplains have a great opportunity toprovide the religious support that fathers may be looking for.Scholars argue that parenthood may increase one’s desire toturn to religion even if they were not religious prior to having achild (Berman 1968). Therefore, chaplains should strive tomake themselves available and open to providing religiousteaching and guidance to individuals who are making thetransition to parenthood.

Support from chaplains may be especially important forunderprivileged populations. My study was conducted among

urban parents, a population characterized as having high ratesof out-of-wedlock births and relatively low levels of income.These individuals likely do not have access to the same pre-and post-natal resources as wealthier parents, making themmore likely to turn to free sources of support such as religiousinstitutions. Because exposure to religion seems to play animportant role in encouraging parents to become involved intheir children’s lives, it is essential that chaplains extend awillingness to help and support men in these areas who may beseeking out religion for guidance in raising children anddealing with this major life change.

Exposing new parents to religion and encouraging them tobecome involved in a religious community may have aprofound effect on children. High rates of divorce, non-maritalcohabitation, and single parenthood (especially among poorand minority populations) leave many children at adisadvantage because they are not able to receive social andeconomic support from two parents. Since religiousparticipation appears to increase the likelihood that fathersbecome involved in their children’s lives, getting new fathersinvolved in religion from the start may help to counteract some

of the problems facing many Americanfamilies today.

By helping new fathers find meaningand importance in parenthood, chaplainsmay be able to encourage fathers to developstronger family commitments and increasethe likelihood that they provide support totheir children. Research suggests that even

among nonresident fathers, interaction with children increasesthe likelihood that fathers provide vital social and financialsupport to children. Moreover, fathers who are involved earlyon in their children’s lives are more likely to stay involved astheir children get older (Aldous, Mulligan, and Bjarnason1998). Thus, chaplains may be able to (a) indirectly increasethe financial well-being of disadvantaged families by providingreligious guidance and support to new fathers; and (b) increasethe likelihood that fathers remain engaged with their childrenthroughout their lives.

It is important to note, however, that simply identifyingwith a religious denomination may not provide the samebenefits as active religious involvement. Therefore, chaplainsshould not only provide religious support to new fathers, butshould also actively encourage them to get involved in areligious community. Active participation in religious servicesmay provide new fathers with a sense of community and socialsupport, which may increase family commitments. In addition,religious institutions encourage families to attend servicestogether as well as provide programs and resources to aid inchild-rearing. Being immersed in such an environment mayallow new fathers to become more effective parents, which mayultimately improve the well-being of parents, children, andfamilies.

Overall, my research on the influence of religion on new

Religious participation encourages father involvement

Chaplains may be

able to encourage

fathers to develop

stronger family

commitments

ResearchUpdate


fathers has important implications for chaplains. Religiousparticipation is associated with higher levels of fatherinvolvement, and many new fathers increase their religiousinvolvement after the birth of a new child. Chaplains should beaware of the questions and struggles that men may have whenbecoming a new father and make an effort to provide religioussupport to men who are making this transition. Chaplainsshould also encourage new fathers to become active in a religiouscommunity as a way to gain increased religious support as well aslearn about child-rearing practices and ways to pass on religioustraditions to children.

One effective strategy may be to establish partnerships withlocal churches to assist in supporting new fathers. Suchpartnerships may help to ease the transition of shifting from aone-on-one support system between a chaplain and new fatherto a community-based social support system within a religiouscommunity. Perhaps most importantly, increasing fathers’religious involvement may help to improve family stability andcohesion, increasing the likelihood that children are raised bytwo parents (regardless of whether the parents live together).Chaplains may be able to play a primary role in fostering thisreligious involvement because of their accessibility to fathers atthe time of childbirth, and should make themselves available to

new fathers who are searching for religious guidance andsupport.

Richard J. Petts is a PhD. candidate in sociology at The Ohio StateUniversity in Columbus, OH. petts.1@sociology.osu.edu

ReferencesAldous, Joan, Gail Mulligan and Thoroddur Bjarnason.

1998. “Fathering over time: What makes a difference?”Journal of Marriage and Family 60:809-820.

Berman, Louis A. 1968. Jews and Intermarriage. NewYork: Thomas Yoseloff.

Petts, Richard J. 2007. “Religious Participation, ReligiousAffiliation, and Engagement With Children Among FathersExperiencing the Birth of a New Child.” Journal of FamilyIssues 28:1139-1161.

Snarey, John. 1993. How Fathers Care for the NextGeneration: A Four-Decade Study. Cambridge: HarvardUniversity Press.

Wilcox, W. Bradford. 2002. “Religion, Convention, andPaternal Involvement.” Journal of Marriage and Family64:780-792.

Name: Alan E. BowmanWork: Catholic Health Initiatives, Vice

President, Mission Integration.NACC member since: 1985 Volunteer service: Board of

Directors, Standards and Certificationcommissions; regional and nationalconference presenter; conferenceplanning; USCCB/CCA Board aswell as with APC and ACPEroles. Volunteering is always an

opportunity for me to give back to the organizations andmembers who have blessed my ministry.

Book on your nightstand: Thomas Merton: SpiritualMaster edited by Lawrence Cunningham, and The 101Dalmatians by Dodie Smith to read with my daughter.

Book you recommend most often: The Wounded Healerby Henri Nouwen and Good Grief by Granger Westberg

Favorite spiritual resource: Centering prayer and naturehikes

Favorite movie: watching Wild Hogs with family and friendsFavorite retreat spot: Rocky Mountains National ParkFavorite fun self-care activity: Riding a motorcycle in the

Rocky Mountains, enjoying the beauty of God’s creationPersonal mentor or role model: Fr. Jerry Broccolo and

Rev. David MiddletonFamous/historic mentor or role model: Henri NouwenWhy did you become a chaplain? My grandfather and

uncle both died from cancer, and I was searching forunderstanding and desired to learn more about how God

journeys with those who are suffering.Why do you stay with the NACC? NACC is a very

important part of my professional networking. It is where I enjoyopportunities to pray, learn, celebrate, and contribute with otherswho are committed to compassionate and professionalcaregiving.

Why do you volunteer? It truly is in giving that wereceive. When I volunteer with NACC, I not only enjoythe opportunity to share what I have learned with others,I also enjoyed the opportunity to learn with and fromthose who volunteer with me. I have developedrelationships with people who are kindred spirits on thisjourney to open ourselves more fully to God’s presenceand to invite others to join us on the journey.

What volunteer activity has been mostrewarding? Each volunteer activity builds upon priorexperiences and expands my understanding and appreciation forthe healing ministry. Serving on Certification encourages myhope for the future of NACC as I see talented, compassionateand diverse professionals join NACC. Serving on the Boardbroadens my appreciation for the diversity of ministries andservices that NACC comprises. Serving on Standards renews myrespect for professional criteria in preparing those who will servethe ill and suffering. Offering workshops deepens myunderstanding and appreciation for those who are dedicated toeducation and formation. All of the volunteer activities withinNACC facilitate opportunities to build lasting relationships withothers who share a belief and commitment to the healingministry that we offer on behalf of the Church and for the sakeof God’s people.

VOLUNTEEROF THE MONTH

Alan Bowman prays, learns, celebrates with NACC


By Lawrence VandeCreek

Chaplains provide ministry to family members of patients.The family members of those admitted with criticalinjuries or illnesses merit special attention, because theseexperiences leave a lasting impact. But how, exactly, can thatexperience be characterized? If chaplains and parish clergy knewthat, they could more deliberately tailor their care. That was thepurpose of the research article described here.

The author of this study invited family members to providean in-depth description of their feelings and thoughts somemonths after the experience. She taped their descriptions,

beginning the session by saying, “Would youplease describe for me the experience ofhaving your family member admitted to thehospital suddenly during a medical emergencyin as much detail as you can remember?” Shethen simply let the family member talk. Aftertranscribing the interview, she read and rereadthe material until the essence of thatexperience was clear. The author continued tointerview family members of other patientsuntil no new characteristics central to theexperience emerged from the narratives. This

required interviews with a family member of six patients, andeach is briefly described in the article.

What were the results? In general, the “roller-coaster ride”metaphor described the experience. “Participants described greatups and downs, no control over a terrifying experience, and therecognition that they had no choice but to wait until the rideended on its own.” Ten themes emerged from the narratives thatdescribed this ride.

Theme 1: The inability to feel. Shortly after they arrivedat the hospital, participants felt that the experience was unreal.One said, “I was numb” and another stated, “My mind was verymuddled.” This, however, soon ended.

Theme 2: Terrified waiting. Thoughts and feelings soonreturned. Waiting, worrying was all there was to do. One stated,“All I could do was sit there with my thoughts. It was horrible.There was nothing I could do except sit there.”

Theme 3: Understanding the unspoken. The familymembers all understood more than what hospital personnel said

to them. One said, “I could see it. I knew something was wrong.No matter what they said, after I saw the look on their faces,they couldn’t make me feel better.”

Theme 4: Controlled information seeking. Some familymembers wanted no information; others wanted a verycontrolled amount and type of information. One said, “Whenthe doctor started listing all the operations that they had to doand what he was going to have to go though, I was very upset.… I think the details scared me.”

Theme 5: Protecting others. Participants protectedothers, primarily children and the patients, from what they wereexperiencing. One said, “So for the kids, I always tried to bepositive.” Another stated, “I would schedule my cries.”

Theme 6: Isolated and alone. The participants wereaware that they alone were experiencing these intense feelings.One said, “It’s like you are driving along the highway … witheverybody else, and then (someone) tells you to get off at thenext exit, … and now you are all alone on a road by yourself,with no funds, no lights, no nothing.”

Theme 7: The busy mode. Participants sought relief bystaying busy. “I needed to rake, so I raked acorns. I rakedthousands of acorns ... My house gets very clean and my yardgets very acorn-free.”

Theme 8: Fighting the system. Participants recalledstruggling with bills. One said, “Green is the issue, and no oneis colorblind.”

Theme 9: The saturation point. Each participantdescribed the physical and emotional toll of the experience. Onesaid, “I reached the saturation point after about three months,and I started taking medication for anxiety and depression.”

Theme 10: A new normal. Each became aware that therewas no return to the old status quo. One said, “You have toestablish a new normal and you have to live with the fact thatthere is a new normal.”

The author discusses nursing implications of these findings.However, chaplains will have little difficulty in drawingconclusions relevant to their ministry.

Reference: Joyce S. Fontana. 2006. A Sudden, Life-Threatening Medical Crisis: The Family’s Perspective. Advances inNursing Science, 29(3), 222-231.

Larry VandeCreek, BCC, is a retired APC chaplain living in Bozeman,MT. This article originally appeared in the APC News.

Study finds stages of families in medical crisis

In general, the

‘roller-coaster ride’

metaphor

described the

experience

Prayers for Healing

If you know of an association member who is ill and needsprayer, please request permission of the person to submit their name,illness, and city and state, and send the information to the Visioneditor at the national office. You may also send in a prayer requestfor yourself. Names may be reposted if there is a continuing need.

Ellen RaddayArlington, VAHead injury


By David Lichter, D.Min.Executive Director

In the early months of 2007, the NACC and Catholic HealthAssociation, under the leadership of Rev. Tom Landry forNACC and Brian Yanofchick of CHA, began to plan aPastoral Care Summit. The goals were ambitious, but vital tothe profession of pastoral care: to establish a vision,benchmarks, standards, and metrics to measure effectiveness ofpastoral programs with the healthcare industry.

While NACC and CHA co-sponsored the event, AlegentHealth in Omaha was the gracious host when we gatheredOct. 22-24. They also enlisted Right Track services for theDecision Accelerator process with Stu Winby as leader,facilitator and process designer for the Decision AcceleratorProcess.

For those not familiar with Decision Accelerator and theRight Track facility, the process is an intensive collaborativeactivity designed to “accelerate” the group’s thinking, planning,and decision-making. Along with Stu, Christopher Fullertonwas the graphic designer, capturing and synthesizing thecontent with key words, images, phrases, and themes on whitewalls. He was masterful in helping us visualize what we werediscussing and advancing our work. Other support stafftranscribed conversation and photographed whiteboards andour groupings. At the end of the planning, Right Track createda website for the content of the summit. CHA and NACCthen further transcribed the photographed whiteboards.

The invitation list included representatives from seniorleadership in Catholic health systems, including missionintegration executives, experienced practioners (chaplains anddirectors of pastoral care), the Spiritual Care Collaborative,researchers, measurement specialists, graduate programs inministry, and ecclesial leaders. More than 100 invitations weresent out. Our working group was more than 50, but many whocould not participate due to prior commitments want to bepart of the follow-up activity. Those who participated arecommitted to see the process through.

We spent some initial time mapping out past and futureinfluences on the pastoral care environment. Participantsapproached a whiteboard and added their wisdom to map. Thegroup noted several future marks such as: professionalstandards of practice, more accountability, more distancelearning and technology to train supervisors, leadershipcompetencies, ethics expertise, research and publication, andresource sharing.

The group then divided into diverse perspective groups andlooked at various articles to offer us some “best practice”information on the field of pastoral care. Each of us read anarticle or two, then shared the highlights to broaden ourknowledge base.

This all led us to the exercise of envisioning a best practice2017 vision of pastoral care in healthcare. We had to articulatea storyline for a particular publication, whether Health Progress,

Modern Health Care, USA Today, The New York Times, or others.This was an inventive exercise that helped us express wherepastoral care and chaplaincy needed to go. We ended day oneboth tired and enlivened, with an overview, big picture ofpastoral care and chaplaincy. Now we were anxious to getworking on outcomes.

On day two, we self-selected our groups based on ourinterest: educational tracts/credentialing, staffdevelopment/composition, recruitment, metrics, care services,information technology resources, and financial resources. Eachgroup identified the key components of its respective area.Then one person presented the work to the other participantsand sought further insights from them as they migrated fromgroup to group. This added further depth to the work.

The groups were then asked to further refine the results andgenerate both a short-term and long-term (three-to five-yearhorizon) action plan with milestones. On the final morning, wefurther refined and shared the action plans, and created acomprehensive overview.

This was a first-of-its-kind activity for our profession, as wehad representatives from so many systems and hospitals. Do wehave a vision? We have the beginning of a shared vision thatwill need to be further tested and refined in our diversesettings.

Do we have benchmarks? Many diverse benchmarks wereidentified. However, we have follow-up work to summarizeand prioritize them.

Do we have standards? Many systems have standards forpastoral care; some do not. We sensed a commitment onparticipants’ part to share what they have and to work towardsome common standards in collaboration with the SpiritualCare Collaborative, but we do not want to reinvent the wheel.It would be best for all if systems with established standardsmake their work available as a baseline for developing commonstandards.

Do we have metrics to measure effectiveness of pastoralprograms within the healthcare industry? The metrics groupstrove to develop a question that could be used in healthcaresurveys, such as Press Ganey. These groups took the initiativeto self-organize and committed to a series of monthly meetingsto identify these metrics.

So, did we achieve the objectives? I believe every participantwas disappointed that we did not get as far as we hadanticipated. However, everyone left committed to continue theimportant work that was begun. As one participant expressedit, “We can’t do this alone or as isolated systems. We have to dothis together.”

Yes, the steaks are good in Omaha. However, the stakeswere high at this summit, and they remain high. Participantsfrom healthcare systems invested tremendous human andfinancial resources into those days. NACC and CHA arecommitted to see that the objectives of this summit will bemet.

Summit identifies goals for future of pastoral care


By Carey Landry

Who are we called to be as pastoral and certifiedchaplains within the Roman Catholic Church?What are the challenges we face in relating to thewider Church in this day and time? How do we bring ourmany gifts and talents to the service of the whole Church?How do we support each other as NACC members in theongoing issues that we face?

These are some of the questions that the 2008 NACCNational ConferencePlanning Committeehad to work throughduring ourteleconference meetingslast fall. As a first-timeparticipant in an NACCnational conferenceplanning session, Ilistened intently to thosemore experienced. It feltsimilar to my experienceas a pastoral musician —in that role, I have hadto become adept atreflecting on thereadings of a givenSunday, then looking forhymns and songs thatinterpret and enhancethose readings. In muchthe same way, whileissues were being raised,the song “Sing a NewChurch” began to cometo mind, especially the beginning words of the refrain: “Let usbring the gifts that differ, and in splendid varied ways, sing anew Church into being…” It seemed to resonate with thegroup, and, ultimately, we fine-tuned the words into ourConference theme.

Very real challenges confront many of us in our hospitals,prisons and other places of ministry. In the midst of thegraced moments and challenges of our ministry, we recognizenot only the diversity of our own many splendid gifts aschaplains, but that we work amidst remarkable co-workersand within a larger church enriched by diverse roles and gifts.

No three- or four-day conference can solve the majorissues facing us. But we can support each other in “splendidvaried ways,” and that is our hope for the 2008 conference.We want to look at our ministries as both GIFT andCHALLENGE, and nationally known speakers will beaddressing four key questions in our plenary sessions:

Rev. Kenan B. Osborne, OFM, will speak to: How is oursacramental life a gift and foundation to our ministry?

Rev. Richard M. Gula, SS, will address: In light ofCatholic values and ethics, what gifts and responsibilities dowe bring to our ministry that are unique?

Carolyn Osiek, Ph.D., will offer her thoughts on: In lightof our ministry, what does Scripture teach us about ourprophetic calling?

Sr. Jamie T. Phelps, OP, will discuss: Where are we beingchallenged to grow in ourministry?

Again this year, manydifferent workshops will beoffered. Committeemembers have suggested anumber of different topics,such as clinical ethics,mental health, diversity,outcomes, palliative care,end-of-life decisionmaking, mission servicesand pastoral care, pediatriccare, spirituality, basicteaching and presentationskills, promoting andmarketing pastoral care andourselves, to name a few.

One very significantdecision made by thePlanning Committee is tocreate a separate timeduring the 2008Conference for NACCworkshops (e.g.

certification or interviewer training) to leave members free toattend other workshops.

I have been given the responsibility of preparing andleading the music for the 2008 Conference. I am grateful forthis opportunity, as it blends my ministry as a board-certifiedchaplain over the past twelve years and my ministry in musicover the past 40 years. I am looking forward to providing veryjoyful, hope-filled music of the Easter season during ourEucharistic celebrations and prayer services, and quietlyprayerful music when we gather for our Taizé-style healingservice.

Come and join us on April 5 through 8, 2008, in my hometown of Indianapolis, IN. Let us all come together with ourmany different gifts and talents to support one another inministry “in splendid varied ways!”

Carey Landry, BCC, is a chaplain at St. Vincent IndianapolisHospital in Indiana. jclandry@stvincent.org

Conference to look at ministry as gift and challenge

Indianapolis, IN l April 5-8, 2008


Adistinguished member and a distinguished friend ofthe NACC will be honored at our conference inIndianapolis this spring, as the association reinstatesthe practice of annual awards after a seven-year lapse.

Ira Byock, MD, will be honoredwith the Outstanding ColleagueAward, given to a person or groupoutside the NACC who supportsthe NACC or the field of ministry,and Deacon Arthur Metallo hasbeen selected to receive the NACC’sDistinguished Service Award.

Ira Byock is the chair ofpalliative medicine at DartmouthMedical School; director ofpalliative medicine at Dartmouth-

Hitchcock Medical Center; and a professor in thedepartments of anesthesiology and community and familymedicine.

He has been involved in hospice and palliative care sincehis residency in 1978, when he helped found a hospice homecare program for the indigent population of Fresno, CA. Heis a past president (1997) of the American Academy ofHospice and Palliative Medicine. During the 1990s he was aco-founder and principal investigator for the MissoulaDemonstration Project, a community-based organization inMontana dedicated to researching and transforming the end-of-life experience locally, as a demonstration of what ispossible nationally. From 1996 through 2006, he served asDirector for Promoting Excellence in End-of-Life Care, anational grant program of the Robert Wood JohnsonFoundation.

Dr. Byock has authored numerous articles on the ethicsand practice of hospice, palliative and end-of-life care. Hisfirst book, Dying Well, has become a standard in the field. Hehas been an advocate for the voice and rights of dyingpatients and their families. His most recent book, The FourThings That Matter Most, (2004) is published by the FreePress.

Dr. Byock has received the National HospiceOrganization’s Person of the Year (1995), the NationalCoalition of Cancer Survivorship’s Natalie Davis SpingarnWriters Award (2000), and the American College of CHESTPhysicians Roger Bone Memorial Lecture Award (2003). Hehas appeared on numerous national television and radioprograms, including NPR’s All Things Considered and FreshAir, ABC’s Nightline, CBS’s 60 Minutes, and PBS’s The NewsHour.

Deacon Art Metallo recently retired from ResurrectionHealth Care in Chicago, where over 100 chaplains and CPEinterns and residents throughout the system considered himtheir servant leader. Besides chaplains, he ably related tovolunteers, staff, administrators, patients, CPE residents andinterns, clergy, and bishops.

Deacon Metallo was born inChicago and holds degrees fromMundelein College and LoyolaUniversity. While working as asupervisor for Jewel Food Stores, hewas ordained to the diaconate in1974, and shortly afterward becamea chaplain at St. Francis Hospital inEvanston, IL. FollowingResurrection Health Care’s purchaseof St. Francis, Deacon Metallo

became director of spiritual services in 1998.In managing chaplains of various denominations and

faiths, he showed respect for diversity and ecumenism, whileat the same time modeling the Catholic values. Because of hisencouragement, manychaplains became certified bythe NACC and/or the APC.He initiated and developed theRHC system-wide CPEprogram.

Art also developed asystem-wide spiritual servicesoperational policy manual forstaff and helped to integrateand standardize spiritualservices in all venues: acutecare, long-term care, retirementcommunities, behavioralhealth, home health andhospice care in a system thatministers to over 105,000 acutecare patients, 265,000emergency room patients,4,600 nursing home residents,and 1,400 retirementcommunity residents each year.Art justified chaplain FTEs byapplying mission standards aswell as metrics. He made surethe chaplains were part of theleadership team at each facility.His passion for the missionshowed itself in his concern forproviding the spiritualcomponent of healthcare.

Deacon Metallo retiredfrom Resurrection last fall. Helives in Chicago and inChandler, AZ, and has threechildren and six (soon to beseven) grandchildren.

Art Metallo, Ira Byock to be honored at conference

Solace

By Deborah GordonCooper

And still,the world goes on being beautiful…the trees, the water andthe skyoffering solace,whether we see or not.

Just now, the cloudsbehind the black limbsof the mountain ashcatch fire in the last lightof the day.

Hope ringsin the delicate throatof a single bird,singing the sun down,whether we’re listeningor not.

Even as we sleepthe gracious moontraces the sky,keeping the night-watch…soft spill of lightacross the bed.

Deborah Gordon Cooper,BCC, is a chaplain emeritain Duluth, MN.

Ira Byock, MD

Deacon Art Metallo


By Michele Le Doux Sakurai

“The patient is a pastor and has lots of support; hewon’t be needing a chaplain.” Karen, an experiencednurse, was reporting her observations to me; Pastor Smithhad had visits from family members, church members,and clergy friends throughout the day. I trusted Karen’sclinical skills and her intuition; Pastor Smith became alow priority for my visits that evening. It was a busy shift,and I gave no thought to him until his wife stopped mein the hall: “You’re the chaplain, aren’t you? Please, couldyou stop by to see my husband? But wait until all hisvisitors are gone.”

I saw him at 9 p.m., and he welcomed me. “I am soglad you came by; I really need to talk to someone. Yousee, I have two small children, and my treatment isn’tgoing well. I don’t believe I will survive this cancer, and I

am struggling with where God is. I know myfamily and friends are trying to beencouraging as they talk about God’s healingpresence, but that is not what I am feeling.This is so hard for me. I thought I had faith,but now, I just don’t know. … I’m a pastor,and to speak of such doubts could underminethe faith of my community. I don’t darespeak of such things even to my clergyfriends. I don’t know where to turn.”

Pastor Smith’s dilemma isn’t unique; thisis actually just what chaplains are trained to handle. Afterfour or more units of CPE, we develop the skills torecognize spiritual distress. A chaplain visiting with thispatient, while friends and family were present, mighthave recognized a disconnect between the faithsentiments of friends and the response of Pastor Smith(for instance, lack of verbal response, eye contact,engagement, or nonverbal responses that would haveindicated his spiritual distress). To see such a disconnectnot only takes training, but it also requires time. Even iftrained, most nurses do not have the luxury of time at thebedside for such assessment. Many nurses, and otherinterdisciplinary team members, find spiritual assessmentto be outside their expertise. Providing team memberswith examples of spiritual distress is one way to helpthem to more easily recognize when this is a problem forpatients or their families.

Perhaps the most familiar indicator of spiritual distresscomes in the form of a WHY question, “Why is thishappening to me?” or “Why does God let this happen?” Apatient or family member asking “Why” generally islooking less for an answer and more for someone to heartheir pain and suffering. To be present in this manner

requires time with no interruptions and the discipline tohear the anguish without needing to fix the dilemma.

When the “Why” question is not adequatelyaddressed, a feeling of alienation from God/HigherPower can result. Such alienation can exhibit as anger, “Iwant nothing to do with God,” or “I can’t believe in a Godwho would let this happen!” or “I’m too angry to pray.”Alienation can also be experience through a sense ofguilt: “Am I being punished?” “Some things God can’tforgive.”

For some patients, the religious authorities have notadequately addressed issues of crisis. Such examplesinclude, “My pastor says if I had enough faith, I wouldn’t bein this mess.” “The pastor says I am paralyzed because ofsomething wrong I did early in life.” “My husband says if Idivorce him, I will go to hell.” “My pastor says my wife isdying because I haven’t saved enough souls for Jesus.”

In our social context, extended families are no longerthe norm. People move more, and connection withchurch can become fragmented. Examples of suchfragmentation include: “I got sick and was moved into fostercare; I haven’t been to church or seen my pastor for a longtime.” “My pastor of 18 years has retired, and I just don’tcare for the new one.” “It’s been so long; I don’t know how topray anymore.”

Often times crisis can trigger unresolved issues: “Thisis the third family member to die this year,” or “I thought Iwas over my dad’s death, but it’s all coming back.” Crisis canalso cause unresolved conflicts to surface, “I’m estrangedfrom my family; I have no one;” (son to dying father) “ Youdid this to yourself; it serves you right!” “My daughter livesout of state, but I don’t want to bother her;” “My father can’tdie without accepting Jesus as his Savior.”

In the clinical setting, religion can become a barrier toa plan of care. For instance, patients who refuse painmedication because “I need to suffer to get to heaven.” Orsometimes patients or family members use religiousreasoning to continue heroics when heroics are futile: “Iknow my mother wouldn’t want to live like this, but in goodconscience, I can’t just let her go,” or “I believe in miracles.”

In essence, spiritual distress can be manifested in avariety of ways; as anger, fear, confusion, grief, anxiety,depression, despair, desperation, or religiousentrenchment. The questions or statements need not bereligious in nature. “Is it a sin to want to die?” soundsreligious, while “I’m tired of living” does not. Yet bothreflect deeply spiritual issues of despair. Helping staff tolisten on a deeper level can increase their appreciation ofspiritual care’s complexity, as well as of chaplains’distinctive skills, and hopefully increase referrals tochaplains.

Chaplains help the team assess spiritual distress

Provide team

members with

examples of

spiritual distress


Ultimately, we as chaplains are the ones who must educatestaff regarding what competent spiritual care entails. All spiritualcare requires a sensitivity to professional and personalboundaries. One of a chaplain’s roles is to articulate to staff whatthese boundaries entail, while at the same time honoring the

gifts that staff members bring to the bedside - for indeed,spiritual care is a shared ministry.

Michele Le Doux Sakurai, D.Min., BCC, is Trinity Health System’s

2007-08 mission fellow in Boise, ID. MICHSAKU@sarmc.org

Even when interdisciplinary team members are skilledand feel comfortable addressing the spiritual distress of theirpatients, in some situations a referral to a chaplain will becritical. They include:

• When the patient’s question/story begins to feeloverwhelming to the staff member.

• When a staff member begins to feel “hooked” or wantsto “fix” the spiritual issues.

• When time constraints do not permit the teammember to fully address the spiritual issues.

• When staff (nurse, OT/PT, social worker) must wearthe hat of their profession.

• When the staff member has evidencedanger/frustration with the patient or has judged the patient

(“impossible,” “non-compliant,” “druggy,” “demanding,” etc.)• When the patient’s theology seems alien to the staff

member’s understanding (could be cultural, religious, orpersonal interpretation).

• When a team member thinks s/he knows the answer toa patient’s question of meaning. (Such certainty can bedangerous and give way to religious or secularproselytizing.)

• When the patient’s faith community and the patient’sexperience are in conflict.

• When the patient expresses sense of abandonment byGod, community, or clergy.

• When intuition tells the staff member that somethingis amiss, but it isn’t easily identifiable.

By Nicole Onori Hansen

On behalf of the Pregnancy Loss Support Group, myhusband Jay, son Evan, and I would like to inviteyou to share in this time of remembrance, healing,and hope.

Our journey began unexpectedly almost 14 years ago onFebruary 27, 1994. On that day, our son Gabriel was bornprematurely and died in my arms.

On that day, I wept with profound heartache.On that day, an abysmal grief engulfed my soul.On that day, we became parents, a mother and a father.On that day, our family was created.On that day, I touched life and death.On that day, I asked God, why? There are mothers and fathers here today for whom the

grief of pregnancy loss is as new as it was for me onFebruary 27, 1994. There are others, like myself, whobecame intimate with this loss many years ago. For me, thecrushing grief and anguish eventually became like an oldfriend who slowly drifted away. Yet it was not until I fullysurrendered myself to the throes of its pain and profoundlyexperienced my own humanness through its suffering, thatgrief began to gradually distance itself from me. Once in awhile, I still intentionally choose to visit it, or it

unexpectedly visits me because it is a part of who I am.I still do not understand why. I no longer seek the answer

to that futile question. Instead, I have chosen to embracethe gift of a son who has taught me about the blessings offaith, hope, love, and compassion. It is throughremembering and loving Gabriel that I have found the truemeaning of these blessings and the path toward healingwhich has let me set my grief free. My hope is that, in yourown way and in your own time, you find blessings andmeaning in your journey from grief to healing.

Through miscarriage, infant loss, and stillbirth, grief hasbeen a companion to all of us. Grief — that raw, almostinhumane, unbearable emotion that defies expression hasdrawn us together today as a community. Today, our silentsuffering may be openly expressed, shared, and understoodin the refuge of this safe, accepting community of familyand friends — family and friends who have chosen toaccompany us on our journey through grief toward hope andhealing. We are blessed to have this community and thistime and place to remember.

Nicole Onori Hansen is an occupational therapist, writer, andlife/wellness coach in Rochester, MN. This article is adaptedfrom a reflection given at the annual "Remembering" Service onOct. 28, 2007, sponsored by the Mayo Pregnancy Loss SupportGroup in Rochester.

Parent reflects on living with grief for 14 years

When should the chaplain be called in?

t HOSPITAL CHAPLAINSSan Bernardino, CA – The Diocese of San Bernardino, the10th largest diocese in the US, is seeking highly motivatedCatholic priest chaplains for various hospital sites in sunnySouthern California. Positions are full-time and include agenerous salary and compensation package (salary, paidmedical and automobile insurance, retreat allowance). Somepositions also include very comfortable housing provided bythe Diocese of San Bernardino. Bilingual skills are very muchneeded (English/Spanish). CPE training is highly preferred.Priests must be in good standing with their respectivearch/dioceses and/or religious communities. We are agrowing multicultural diocese based on the vision of hope andhealing for the Catholic people of the Inland Empire. Sendinquiries and resumes to: Rev. Msgr. Gerard M. Lopez,Diocese of San Bernardino, 1201 E. Highland Ave., SanBernardino, CA 92404-4641. Telephone: (909) 475-5123.

t DIRECTOR OF SPIRITUAL CARELos Angeles, CA – In accordance with the mission andphilosophy of the Daughters of Charity, St. Vincent MedicalCenter seeks a Director/Priest to provide living evidence ofChrist’s healing love and ministry to the spiritual, religious andemotional needs of patients, their families, employees, andmedical staff. Provide high quality liturgical services and theadministration of the sacrament. For more information aboutour excellent career opportunity and benefits, please visit ourwebsite at www.stvincentmedicalcenter.com. Please emailyour resume to: sylviacolvin@dochs.org or apply online. EOE.

t CHAPLAINSouth Bend, IN – Saint Joseph Regional Medical Center is afaith-based, Catholic hospital providing inclusive interfaithpastoral care to a wide variety of persons. We have six staffchaplains across three sites and a well-developed ethicscommittee. The department maintains a strong ACPEprogram. South Bend, home of the University of Notre Dame,offers a community atmosphere with advantages of a largercity. We are looking for an individual for our full-time nightposition who has a vision for the opportunities this ministryprovides to staff and patients. We are looking for an individualwho can be flexible in their schedule as we move to a newhospital in two years and develop new services. We need aperson who has a well-developed sense of the role ofprofessional chaplain and can help us move toward a moreoutcome-based pastoral care. M.Div. preferred, master’s inrelated field considered. Four units of CPE (residencypreferred), certification by APC or NACC or eligible within twoyears, and computer proficient. For consideration, pleasesubmit an online application at www.sjmed.com. Pleaseinclude a cover letter, resume and document articulating yourpastoral care philosophy and practice. For more informationcontact Linda DeHahn, Manager, Center for Spiritual Care atdehahnl@sjrmc.com, 574-237-7299.

t DIRECTOR OF CATHOLIC HOSPITALMINISTRIESColumbia, MO – The director is responsible for planning,organizing, coordinating and directing the activities ofColumbia Catholic Hospital Ministries. Columbia Catholic

Hospital Ministries offers spiritually based clinically trainedpastoral care and counseling through sacramental ministryand spiritual/emotional support to the Catholic patients andtheir families in the hospitals in Columbia, MO. M.A. intheology, psychology, counseling, or their equivalent ispreferred. Certification as a chaplain by the NACC, orexperience and eligible for certification by NACC.Commissioned as an extraordinary minister of theEucharist. Knowledge of medical moral theology andethics. At least three years of healthcare experience aschaplain or director. Salary depending on qualifications;negotiable. Send resume to Ron Vessell, Diocese ofJefferson City, PO Box 104900, Jefferson City, MO 65110;telephone (573) 635-9127; fax (573) 635-2286.

t DIRECTOR OF PASTORAL CARESuffern, NY – Good Samaritan Hospital, a member of theBon Secours Charity Health System, is a community-basedCatholic hospital dedicated to caring for the whole person,body, mind, and spirit. We are currently seeking a board-certified Roman Catholic chaplain who, with staff, leads acomprehensive program of pastoral care (sacramental andpastoral) for patients, families, staff and physicians.Qualified candidates must possess a bachelor’s degree intheology or related field; a master’s degree is preferred.CPE certification with two years of clinical pastoralexperience in a healthcare setting is also preferred. Thisposition has the possibility to become a CPE supervisoryopportunity. To be considered for this position, please visitour website and apply online at www.bschs.org/careers.EOE.


Positions Available The future of Positions Available For as long as the NACC has had a publication, it has

included job listings. Our readership is exactly the groupthat healthcare institutions want to reach when they needto hire a chaplain or a pastoral care director, and we’ve beenhappy to help employers and employees find each other.

In recent years, the Internet has become a more andmore important way of looking for jobs and of filling jobs.We responded by adding Positions Available on ourwebsite, essentially duplicating the listings in Vision, and ithas become one of our most-viewed areas.

But as media becomes more electronic, and as jobs areposted and filled more quickly, we have to assess whetherPositions Available is still an efficient use of our ink andpaper. Due to our publication lag time, at least a month,and often more, goes by between the time an employersubmits an ad to us and the time you read it in thenewsletter. The lag time for online posting is usually lessthan a week.

We have not yet made any decisions about the future ofPositions Available, but we would like to hear yourthoughts about the printed version and possiblealternatives. Please write to David Lewellen, NACC, 5007S. Howell Ave. Suite 120, Milwaukee, WI 53207, or e-maildlewellen@nacc.org.

t DIRECTOR OF PASTORAL CAREFreeport, IL – Provena St. Joseph Center seeks a Director ofPastoral Care. The Director is responsible for leadership inplanning, implementing, supervising, and evaluating allpastoral services provided for the residents, their families andthe employees. The Director reflects the organizationalmission of the facility and the Church itself in providing anatmosphere of Christian concern and the dignity of eachperson. CPE or equivalent pastoral training/experience isrequired. Candidates must have a bachelor’s degree intheology or related field and be certified by NACC. Sendresume to: Roberta DeHaven, 659 E. Jefferson St., Freeport,IL 61032, phone (815) 232-6181, fax (815) 232-6143or e-mail t

By David Lewellen Vision vision W best practices, almost ...Rohr’s newest book,Things Hidden: Scripture As Spirituality. At the same time, Bob O’Gorman revealed Loyola’s newest

Documents

Pelumasan Newest

Newest catalogue

Newest Portfolio

Homeostasis Newest

Newest Yoga

Newest tugas

Our newest schedules

Repulsewear.com newest catalog

Library2.0 Newest

Homework3 newest

Newest edition

newest catalog