Browsing by Subject "Institution"

ABSTRACT

Lori Anne Brown

Duke Divinity School, 2015

Primary Advisor: Esther Acolatse

Assistant Professor of the Practice of Pastoral Theology and World Christianity

Secondary Advisor: Dean Sujin Pak

Assistant Research Professor of the History of Christianity; Associate Dean for Academic Programs

The purpose of this thesis is to examine the challenges that Christian chaplains experience to their authority in secular medical institutions and to explore possible recommendations that can help alleviate them. More specifically, by means of a questionnaire this examination intends to explore if these challenges are both or either personal or institutionally related. Therefore, this examination should be a resource that encourages the Christian chaplain to be an informed interlocutor pertaining to the issues of what his or her God-given authority means. Lastly, this thesis will demonstrate why it is essential for chaplains to know, understand, accept, and embrace the God-given authority bestowed upon them to minister effectively and competently in secular medical institutions.

Key Terms

For the purpose of this study, seven terms require annotation. First, the term “Christian chaplains” refers to individuals who have been baptized, profess Jesus Christ as their Lord and Savior, who ascribe to the orthodoxy and orthopraxis of the Christian faith, and who minister in secular medical institutions. Second, the term “secular medical institution” denotes a public, non-religious institution that provides medical care for people. Thirdly, the term “living human document,” which was coined by Anton Boisen, refers to those to whom Christian chaplains minister. This group includes patients, their families and friends, and the chaplain’s colleagues. Fourth, the term “voices of suffering” refers to the patients who share their narratives while seeking pastoral care. Fifth, the term “bearing witness” refers to the belief that as Christians we are called to develop the skills to bear witness in both word and deed to the gospel of Jesus Christ. Sixth, the term “narratives” refers to the personal stories that patients share. The seventh term “holistic care” is a concept in medical practice that upholds and respects all aspects of a person’s needs: physical, emotional, and spiritual.

I employed three methods in this thesis. The first method was exploratory research to review and study literature to support my argument. The second was to use a method of analogy. In this method, the anecdotal evidence was aggregated in correlation with personal related experiences to help Christian chaplains to learn how to minister effectively in the challenging contexts of the secular medical institution. Moreover, this was done in order to examine how the Christian chaplain can learn to walk competently and effectively with authority between the worlds of religion and medicine. Third, I used a confidential questionnaire to gather additional information from seven Christian chaplains who have ministered or are currently ministering in this context to support the argument of this thesis, as well as to offer recommendations that can help alleviate some of the challenges they experience regarding their authority.

The basic conclusion drawn from the examination and methods employed is that Christian chaplains do experience various types of challenges to their authority than can impact their ministry. However, the conclusion demonstrates that as a result to their commitment to the call of chaplaincy, chaplains recognize that irrespective of the challenges they experience to their authority they are called to compassionately and effectively serve the sick and suffering. Moreover, as a result of their commitment to the call of health care chaplaincy, the chaplains have provided their insight that indicates why some of these challenges exist. Lastly, as a result of the questionnaire the participants provide some practical recommendations that can be implemented into CPE programs, which could possibly help alleviate some of types of the challenges they encounter to their pastoral authority.

Background: Cardiovascular diseases form a large part of a growing pandemic of non-communicable diseases afflicting Sub-Saharan Africa(1–3) Heart failure is one of the most debilitating of these diseases. The global 5-year life expectancy of patients afflicted by heart failure is less than 50%(4–6). Cardiac rehabilitation (CR) has been demonstrated to improve functional status, quality of life, and reduce depression in patients with heart failure(7,8). Even though CR is a simple and comparatively low-cost intervention, adherence rates of CR remains poor and are estimated at 20% in the US(9–11). In Western Kenya, CR is non-existent. We sought to establish the feasibility of two different models of cardiac rehabilitation for heart failure in Western Kenya and to identify potential barriers to participation.

Methods: This was a feasibility study using mixed methods to describe characteristics and changes in a cohort of patients with heart failure. Study participants were prospectively recruited and allocated by convenience into an institution based cardiac rehabilitation (IBCR) arm, a home based cardiac rehabilitation (HBCR) arm and an observational arm (OA). At completion of 3 month follow up period, participants were invited to take part in focus group discussions exploring perspectives on heart failure and cardiac rehabilitation. The primary measure of feasibility was the ability of study participants to attain a mean adherence rate of at least 25%, of prescribed rehabilitation sessions.

Results: This study found that cardiac rehabilitation is a feasible intervention for patients with heart failure in Western Kenya with an adherence rate of 46% for institutional based cardiac rehabilitation and an adherence rate of 28% for home based cardiac rehabilitation. All study arms demonstrated significant change in depression screening and quality of life scores. Participants in focus group discussions identified competing interests, distance to the facility and forgetfulness as barriers to cardiac rehabilitation.

Conclusions: Cardiac rehabilitation is a feasible treatment intervention for heart failure in Western Kenya. However, the barriers to delivery of care are similar to barriers in other health systems around the world(12). There is need for further research to evaluate the efficacy of cardiac rehabilitation and development of innovative ways to improve treatment adherence.

This study seeks to determine how the Army institutionally selects its 3 and 4-star officers. The central focus, What patterns are evident in the output of the Army’s 3 and 4-star selection process? has three main findings: 1. The Army has institutional preferences, 2. Multiple paths are possible to the senior leader level, 3. The Army’s most preferred path is operational and command experience. These findings were the result of a comprehensive analysis of a database developed utilizing the standardized resumes of 3 and 4-star generals who have served or retired after 1985. The database, along with the results presented here can help determine if the Army is selecting the right senior leaders and meeting its senior leader development goals. In addition, by understanding the breadth of experience of the Army’s senior leaders, we can identify potential shortcomings in experience or skills required to meet current and future threats. The Army is tasked with defending the nation, we must therefore continually assess how it adapts and evolves with contemporary events and adversaries. The database, while extensive by itself, serves as a starting point for future researchers. The paper’s narrow lens will offer insight into the Army process of selecting senior leaders and provide a follow-on analysis template.