Carey Lindsay B, Newell Christopher J
Australian Health and Welfare Chaplains Association, and the School of Public Health, La Trobe University, Melbourne, VIC, Australia.
Crit Care Resusc. 2007 Mar;9(1):34-9.
To explore the role of health care chaplains in providing pastoral care to patients, their families and clinical staff considering decisions to withdraw life support.
Quantitative data were obtained retrospectively from a survey of 327 Australian health care chaplains (both staff and volunteer chaplains) to initially identify chaplaincy participation in withdrawal-of-life-support issues. Qualitative data were subsequently obtained by in-depth interview of 100 of the surveyed chaplains and thematically coded using the World Health Organization Pastoral Intervention (WHO-PI) codings to explore chaplains' roles.
Over half the staff chaplains surveyed (57%) and over a quarter of the volunteer chaplains (28%) indicated that they had been involved with patients or their families in withdrawal-of-life-support decisions. Over a third of staff chaplains (37%) and 16% of volunteer chaplains had assisted clinical staff concerning withdrawal-of-life-support issues. The qualitative data revealed that chaplains were involved with patients, their families and clinical staff at all levels of pastoral intervention, including "pastoral assessment", "pastoral ministry", "pastoral counselling and education" and "pastoral ritual and worship". The specific nature of chaplaincy involvement varied considerably depending on the idiosyncratic issues faced by patients, families and clinical staff. These activities indicated that pastoral care could be provided for the support and benefit of patients, their families and clinical staff facing a complex bioethical issue.
Through a variety of pastoral interventions, some chaplains (mostly staff chaplains) were involved in assisting patients, their families and clinical staff concerning withdrawal-of-life-support issues and thus helped ensure an holistic approach within the health care context. Given this involvement and the future potential benefit for patients, families and clinical staff, there is a need to develop continuing education and research on pastoral care and chaplaincy services.
探讨医疗保健牧师在为患者、其家属及临床工作人员提供牧灵关怀方面的作用，这些关怀涉及到关于撤除生命支持的决策。
通过对327名澳大利亚医疗保健牧师（包括在职和志愿牧师）的调查回顾性获取定量数据，以初步确定牧师在撤除生命支持问题上的参与情况。随后，通过对100名被调查牧师进行深入访谈获取定性数据，并使用世界卫生组织牧灵干预（WHO-PI）编码进行主题编码，以探究牧师的角色。
超过半数接受调查的在职牧师（57%）和超过四分之一的志愿牧师（28%）表示，他们曾参与患者或其家属关于撤除生命支持的决策。超过三分之一的在职牧师（37%）和16%的志愿牧师曾就撤除生命支持问题协助临床工作人员。定性数据显示，牧师在牧灵干预的各个层面都与患者、其家属及临床工作人员有接触，包括“牧灵评估”“牧灵事工”“牧灵咨询与教育”以及“牧灵仪式与崇拜”。牧师参与的具体性质因患者、家属及临床工作人员所面临的特殊问题而有很大差异。这些活动表明，可为面临复杂生物伦理问题的患者、其家属及临床工作人员提供牧灵关怀以给予支持并带来益处。
通过各种牧灵干预，一些牧师（主要是在职牧师）参与协助患者、其家属及临床工作人员处理撤除生命支持问题，从而有助于在医疗保健环境中确保采取整体方法。鉴于这种参与以及对患者、家属及临床工作人员未来潜在的益处，有必要开展关于牧灵关怀和牧师服务的继续教育及研究。
