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Chaplaincy Research: Its Value, Its Quality, and Its Future

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 Chaplaincy Research: Its Value,
Its Quality, and Its Future
Andrew J. Weaver, PhD, MTh
Kevin J. Flannelly, PhD
Chaplain Clarence Liu, MDiv

ABSTRACT. The article is divided into four major sections, the first
of which presents and discusses various reasons given by major
researchers in the field why chaplains should do research. The second
section summarizes findings on the sophistication of research on reli-
gion and health published in (a) medical and other healthcare journals,
and (b) specialty journals on religion and health, chaplaincy, and
pastoral care and counseling. The third section revisits suggestions
that have been made by prominent chaplain researchers to increase
and improve research by chaplains. The last section offers some sug-
gestions for expanding several lines of current research in the future,
including research: (1) to elucidate the nature of spiritual care
chaplains provide to different populations, including patients, families
and staff; (2) to assess the prevalence and intensity of patients’ spiri-
tual needs and the degree to which they are being met; (3) to identify
that subset of patients who are spiritually at risk in terms of having
high needs and slow religious resources; (4) to identify the biological

Andrew J. Weaver, PhD, MTh is the Editor-in-Chief of Journal of Health

Care Chaplaincy.
Kevin J. Flannelly, PhD, is the Associate Director of Research at The
HealthCare Chaplaincy.
Chaplain Clarence Liu, MDiv, is the Director of Patient and Family
Services at Hospice Hawai’i.
Address correspondence to Kevin J. Flannelly, 307 E. 60th Street,
New York, NY 10022; E-mail: [email protected]

Journal of Health Care Chaplaincy, Vol. 14(1) 2008

Available online at http://jhcc.haworthpress.com
# 2008 by The Haworth Press. All rights reserved.
doi: 10.1080/08854720802053788 3
4 JOURNAL OF HEALTH CARE CHAPLAINCY

causal mechanisms by which religion influences health; and (5) to

measure the effectiveness of chaplain interventions.

KEYWORDS. Chaplaincy, pastoral care, research methodology,

spiritual care

INTRODUCTION
Should chaplaincy become more scientific? That was the basic
question posed in a 2002 issue of the Journal of Health Care Chap-
laincy. While several of the contributors to that issue answered with
a resounding ‘‘Yes’’ (e.g., Burton, 2002; Fitchett, 2002; Handzo,
2002), many were ambivalent, and others were opposed to chaplaincy
becoming scientific. Some, such as McCurdy, were concerned that
science was too reductionistic, and that measurement might not
capture and might ‘‘even distort the very nature of pastoral care
itself’’ (McCurdy, 2002, p. 157).
Is chaplaincy becoming more scientific despite such resistance? A
review of all the articles published in the major pastoral counseling
journals from 1980–1989 found that only 5.3% of them were quanti-
tative studies (Gartner et al., 1990). Of the articles published in the
Journal of Pastoral Care—the flagship journal for the various chap-
laincy and clinical pastoral care associations in the United States—
only 4.7% were quantitative studies. We conducted a similar survey
for the years 1990–1999, but we used a more restrictive definition
of what to count as an article and we did not report the results for
individual journals (Flannelly, Liu, et al., 2003). Therefore, we
decided to redo our survey of 1990–1999 for the Journal of Pastoral
Care, using the identical criteria used by Gartner and his colleagues.
Based on new analysis, it appears that the proportion of quantitative
studies more than doubled to 11.9% in the 1990s. Another 4.7% were
qualitative studies, which would generally be excluded under Gartner
et al.’s criteria of what constitutes an empirical study. If we exclude
personal reflections from the base count of articles, as Flannelly,
Liu et al. (2003) did, the percentage of quantitative studies rises to
18.4%. Their findings suggest that chaplaincy is becoming more
scientific.
 Weaver, Flannelly, and Liu 5

WHY CHAPLAINS SHOULD DO RESEARCH

O’Connor (2002) offered four reasons why chaplains should do
research. First, since healthcare chaplains function within the culture
of evidence-based medicine, chaplaincy, like other healthcare profes-
sions, must be evidence-based. Second, since science and religion both
seek truth, the two are compatible with one another and share com-
mon concerns, including the physical, mental, and emotional health
of individuals. Professionals in various disciplines are doing research
on these common points of interest in order to integrate spirituality
into their theory and practice of health care. It is natural, therefore,
that chaplains should do research on these areas of commonality too.
Third, chaplains already do research in their practice to the extent
that they utilize clinical evidence from client=patient cases. O’Connor
(2002) is certainly correct in stating that case studies constitute
one level of research on a continuum of research sophistication
(Greenhalgh, 2001; Flannelly et al., 2004). In addition, we agree with
him that the case-study method can be a valuable research tool, but
more methodologically sophisticated research is needed. There is
some evidence that research on chaplaincy and pastoral care is
becoming more methodologically sophisticated (Flannelly, Liu et
al., 2003), as is research on religion and health, in general (Flannelly
et al., 2004; Weaver et al., 2005). We will return to the question of
research sophistication later.
O’Connor’s fourth reason for chaplains to do research is, essen-
tially, that failing to do so will have profound implications for
professional chaplaincy. In his own words: ‘‘The focus of chaplaincy
in caring for the spiritual, soul needs of the sick has proven its worth’’
and ‘‘other health care disciplines are now seeing its worth’’
(O’Connor, 2002, p. 190). However, ‘‘the other health care disciplines
have taken it one step further and have been engaged in doing scien-
tific research on spirituality and health’’ (O’Connor, 2002, p. 190).
This has created a situation in which ‘‘investigators in other disci-
plines have taken over research on spirituality and chaplains are
the followers’’ (O’Connor, 2002, p. 191). Given this situation, ‘‘it is
easy to imagine in the near future when a nurse who specializes in
spirituality will be teaching chaplains on spirituality and health care
using the research in the field’’ (O’Connor, 2002, p. 191). Whether or
not that day will come, surveys of the healthcare literature from
1965–2000 show a dramatic increase in research on spirituality, but
6 JOURNAL OF HEALTH CARE CHAPLAINCY

there continues to be little research about chaplaincy (Weaver, 2003;

Weaver et al., 2006).
The concept of spirituality has long been of interest in nursing
(Flannelly et al., 2002; Weaver et al., 2001) and interest in it appears
to be increasing in social work as well (Modesto et al., 2006).
Although both fields share some common professional goals with
chaplaincy, there is a degree of professional competition among the
fields. This competitiveness appears to be stronger between social
workers and chaplains than nurses and chaplains (Flannelly, Galek,
et al., 2005). Indeed, in many ways nurses are the natural allies of
chaplains. But, do chaplains want to leave it to nurses to define the
spiritual needs of patients (Emblen & Halstead, 1993; Galek et al.,
2005; Flannelly et al., 2006) or what constitutes spiritual care (Babler,
1997; Cavendish et al., 2007; Ross, 2006)?
Fitchett (2002) offers three other reasons for integrating research
into professional chaplaincy. The first is to strengthen the practice
of ministry and improve services to patients. We certainly agree that
the major purpose of research in chaplaincy should be to improve
the spiritual care provided to patients and families by chaplains
and other healthcare professionals. Chaplains should not limit
themselves to research on chaplaincy, however, nor should they
limit themselves to doing to applied research. Chaplains have come
to us with research ideas about such diverse topics as the relation-
ship between religion and depression in the elderly (Springer et al.,
2003), the extent to which religious beliefs influence death anxiety
(Harding et al., 2005), the kinds of psychological problems for
which parishioners seek help from clergy (Moran et al., 2005) and
secondary traumatic stress among chaplains and other clergy after
the September 11th attacks (Roberts et al., 2003; Flannelly,
Roberts et al., 2005).
The second reason Fitchett (2002) suggests chaplains do research is
to increase awareness of what chaplains contribute to the healthcare
team. Just doing research is likely to get the attention of your collea-
gues and administrators. Publishing research definitely gets their
attention and enhances their respect for you and the profession. If
the published study catches the eye of a reporter, the findings may
reach a much wider audience, increasing the visibility of chaplaincy
among the public. The third reason Fitchett gives is to promote inter-
disciplinary relationships. Collaboration with other healthcare
professionals increases a chaplain’s opportunities to do research
 Weaver, Flannelly, and Liu 7

(especially basic research) and, perhaps, to do better research than a

chaplain may have done on his or her own.
Finally, VandeCreek (1992) sees at least three personal and
professional benefits to doing research. The prime benefit, according
to VandeCreek, is that the process itself acquaints a researcher ‘‘with
what others are thinking’’ (VandeCreek, 1992, p. 66), as well as
knowing what others are thinking and doing helps improve one’s
own pastoral care. The second benefit is that ‘‘research work opens
unique doors and creates relationships that would otherwise not be
possible’’ (VandeCreek, 1992, p. 67). This is especially true in large
hospitals in which other healthcare professionals do research.
Chaplains who do research are more likely to be seen as peers by
other healthcare researchers, which raises the status of pastoral care.
‘‘Third, research stimulates creativity,’’ which can be ‘‘an antidote for
the boredom and burnout that accompanies a heavy pastoral care
load’’ (VandeCreek, 1992, p. 67).

THE STATE OF CURRENT RESEARCH

Before we look at the state of the art in research in chaplaincy and
pastoral care, we will give a brief overview of the research on religion
and health in general. The following discussion does not address
qualitative research. Qualitative research was included in Flannelly
et al.’s (2003) analysis of the field to some extent, but the most thor-
ough assessment of qualitative research in chaplaincy is provided by
O’Connor et al. (2001).
Flannelly et al. (2004) assessed the sophistication of research on
religion and health in four major areas covered in the Handbook of
Religion and Health (Koenig et al., 2001): anxiety, depression, well-
being, and coping with physical disorders. A sample of 283 studies
was selected and evaluated on four criteria: (1) the number of ques-
tions they used to measure religiosity; (2) their research design; (3)
their sampling methodology; and (4) their use of statistical controls.
We will review some of their findings.
Much of the early research on the relationship between religion
and health could hardly be called research ‘‘on religion and health’’
at all. They primarily were epidemiological studies of various diseases
that included some measure of religion for demographic purposes
(Levin & Schiller, 1987). It is not surprising, therefore, that Flannelly
8 JOURNAL OF HEALTH CARE CHAPLAINCY

et al. (2004) found that studies such as these, in which religion was
not a major focus of the study, used less sophisticated measures of
religiosity than those that were designed to examine the association
between religion and health, specifically.
Levin and Schiller say in their historical analysis of the research up
to the mid 1980s: ‘‘Although many epidemiologists continue to
collect some information about subjects’ religious preference, back-
ground, or practice as part of their inquiries, next to nothing has been
accomplished in terms of the refinement of concepts or measures
(Levin & Schiller, 1987, p. 9–10). However, Flannelly et al.’s (2004)
analysis of studies published through the year 2000 found that the
number of questions used to measure religion increased over time,
suggesting the sophistication of the religious measures that research-
ers use has increased over the years.
As mentioned earlier, the various types of research methods or
designs (case studies, cross-sectional surveys, experiments, etc.) can
be thought of as forming a hierarchy. This hierarchy at least partly
reflects the degree to which different designs provide the capacity to
make causal inferences (Greenhalgh, 2001; Flannelly et al., 2004).
Case studies form the lowest rung of the ladder and true experiments
form the top rung. Cross-sectional studies, which include most
survey research, are located just above case studies in terms of their
sophistication. Longitudinal surveys, in which individuals complete
the same questionnaire at two or more points in time, are considered
more sophisticated because being able to track changes over time
is very important for making causal inferences. Flannelly and his
colleagues (2004) found that the research designs of studies on religi-
on and health have become more sophisticated over the years, partly
because of an increase in the number of longitudinal studies.
Flannelly et al. (2004) did not find any improvement in the sampling
procedures used in the field, such as the use of random samples instead
of convenience samples; they did find a significant increase in the use
of statistical controls, however. Statistical control means that charac-
teristics or attributes (i.e. variables) of a sample of people are measured
and analyzed that might not be of interest in and of themselves (such
as age, gender, income, education, etc.), but may confound or obscure
the relationships that one is interested in studying. For example, if one
wanted to look at the relationship between private prayer and
health, one would have to control for age of study participants since
older people are more likely to be religious and they are more
 Weaver, Flannelly, and Liu 9

likely to be ill. One should always try to control for gender, age, other
major demographic characteristics, and any factors that are known to
be associated with either religiosity or health.
How sophisticated is the research published in chaplaincy and
related specialty journals? Flannelly, Liu et al. (2003) tried to answer
this question using a number of different criteria. Most (86.7%) of
the quantitative studies in their 1990–1999 sample from three journals
(Journal of Pastoral Care, Journal of Religion and Health and Pastoral
Psychology) were cross-sectional surveys, so the research is relatively
unsophisticated, at least by medical standards; cross-sectional surveys
are widely used in sociology and other social sciences. However, since
very few studies used statistical controls, the research tends to
unsophisticated by the standards of both medicine and the social
sciences. Ignoring one study that collected data on over 42,000 chap-
lain interventions, and another that examined religious themes in
over 17,000 articles published in medical journals, the sample size
of the survey studies ranged from 4 to over 5,000, with the median
being 160 participants. Sample sizes between 100 and 200 participants
are common in psychology, but larger samples are needed for surveys
when research questions are complicated, and many of the questions
one might ask about chaplaincy and pastoral care are inherently
complicated, especially in healthcare settings.
Flannelly, Liu et al. (2003) also evaluated the research in the field
using a set of criteria that were exactly the same criteria as those used
by Gartner et al. (1990). This allowed them to compare the results of
the two analyses directly, to see if research in the field was more soph-
isticated in 1990–1999 compared to 1980–1989. Table 1 makes that
comparison. Six measures of research sophistication are shown in
the table, which are broken into three categories: internal validity,
external validity, and interpretation.
Internal validity is a concept introduced by Campbell (1957),
which refers to the degree to which one can be confident about
making causal inferences from research conducted in experimental
and quasi-experimental settings. Whether or not a study used a
control group bears directly on this question. Control groups were
very rare in the 1980s and the 1990s because very few studies used
experimental or quasi-experimental designs.
The internal validity of a study also rests on the consistency or
reliability of the measurements made during an experiment. In the
case of mechanical and electronic equipment or instruments, this
10 JOURNAL OF HEALTH CARE CHAPLAINCY

TABLE 1. Percentage of Studies Meeting Gartner et al.’s

Validity Criteria in the 1980’s and the 1990s, According to
Gartner et al. (1990) and Flannelly et al. (2003)

Criteria Gartner et al. (1990) Flannelly et al. (2003)

1980–1989 (%) 1990–1999 (%)

Internal validity
Reliability 40 34
Control group 4 12
External validity
Sampling method 20 63
Response rate 33 43
Interpretation
Hypotheses stated 25 32
Limitations stated 4 58

Significant differences between the two samples:  p < .05;  p < .01.
Adapted from Flannelly, Liu, Oppenheimer, Weaver, & Larson (2003).
See text for details.

entails their ability to measure something accurately and to do so

consistency. The same issues arise with respect to survey instruments
or scales. Do they measure what they are supposed to measure
reliably and consistently? As used in Table 1, the term reliability
simply refers to whether the authors of a study used a survey instru-
ment whose reliability had been previously documented, and whether
they reported that documentation in their study. As seen in Table 1,
there was no difference in reporting the reliability of the instruments
used in the two samples: 1980–1989 versus 1990–1999.
Campbell (1957) also introduced the concept of external validity,
which refers to the degree to which one can be confident about
generalizing about the general population from the findings of experi-
mental and quasi-experimental research designs. The concept of
external validity can also be extended to surveys and other kinds of
studies. It mainly hinges on the extent to which the sample under
study is representative of the population to which one wants to
generalize a study’s findings. A random sample is considered to be
more likely to be representative of the population from which it is
drawn than a convenience sample, although this is not necessarily
so. Similarly, the higher the percentage of people who agree to partici-
pate in a study when asked to do so (i.e., the response rate), the more
 Weaver, Flannelly, and Liu 11

likely it is that the sample is representative. Sample size is also part of

external validity, but we were not able to make a direct comparison of
sample sized of the studies published in the 1980s and the 1999s.
The measure ‘‘sampling method’’ in the table simply records
whether the sampling method was described, not the sophistication
of the sampling method used. Likewise, the measure ‘‘response rate’’
simply records whether the response rate was reported, not the
quality of the response rate. As seen in Table 1, the reporting of
sampling methods and response rates increased significantly between
the 1980s and the 1990s. Although these two measures are crude, they
indicate the research published in the 1990s was more sophisticated
that that published in the 1980s, or at least that there was greater
awareness of the standards of sound research in the 1990s. Gartner
et al. (1990) and Flannelly, Liu et al. (2003) used another measure
of external validity, which did not change over time and is not shown
in Table 1. That was the use of repeated measures designs, which was
7% and 8%, respectively, in the 1980s and 1990s.
The last category in Table 1 relates to a researcher’s sophistication
in interpreting his or her results. The last two measures in Table 1
(under Interpretation) record whether researchers stated and tested
explicit hypotheses and whether they discussed the limitations of
the methodology they used. Specifying a hypothesis indicates that
the author designed the study with a specific rationale in mind, and
that the results can be interpreted in light of the hypothesis being
testing. The last measure indicates that the author realizes there are
methodological problems or issues in any study and they limit one’s
interpretation of findings. Both measures increased over time and the
increase in the latter was statistically significant.
A similar comparison of research published in four gerontology
journals in the 1980s and 1990s allows us to put some of the
Flannelly, Liu et al. (2003) results in a broader context. Three of
the journals examined in that study were medical journals and one
was a sociology journal. The sophistication of research on religion
and health in all four journals improved between 1985–1990 and
1997–2002, in terms of reporting the reliability of instruments, report-
ing response rates, and specifying hypotheses. The percentages of
studies that did so were higher in the gerontology journals, however,
than in the journals represented in Table 1. Compared to the journals
in Table 1, 64% of the studies published in the four gerontology
journals during 1997–2002 reported the reliability of scales they
12 JOURNAL OF HEALTH CARE CHAPLAINCY

used, 82% reported response rates, and over 78% tested specific
hypotheses.
Our analyses indicate that the research published in pastoral care
and related specialty journals is relatively unsophisticated by the
standard of other disciplines, but it is improving. While we wish to
encourage this trend, we do not suggest that chaplaincy research
needs to follow the path taken by other disciplines who are investigat-
ing the link between religion and health. The methodology of chap-
laincy research still needs to improve, but there is plenty to learn
by surveying, interviewing and simply observing patients, families
and others in both healthcare and community settings. Indeed, we
have noticed that most of the people who suggest that chaplains
need to conduct experiments on the effectiveness of chaplain inter-
ventions, are not sophisticated about research, they are naı̈ve about
it. Studying processes must necessarily precede studying outcomes,
particularly when the processes and the outcomes are so complex,
and they are linked to many other factors.

SOME SUGGESTIONS FOR INCREASING AND

IMPROVING RESEARCH BY CHAPLAINS
Fitchett (2002) suggests three steps for increasing research in chap-
laincy. The first step may be the hardest, to convince chaplains that
research is valuable for their practice of ministry. This can be
achieved through educating chaplains and CPE students about
research, as is done at The HealthCare Chaplaincy. Fitchett and
his colleagues (2003) reported that chaplains’ negative attitudes about
research could be changed even by a one-day research workshop. At
the start of the workshop, most of the chaplains who attended felt
inadequate and inexperienced or anxious and apprehensive. By the
end of the workshop, however, most chaplains felt more positive
about research itself; some felt it was possible that they could do
research themselves; and others expressed ‘‘cautious excitement’’
about the possibility.
Fitchett’s second step is to increase the research literacy of
chaplains to the level where they understand the basic elements of
research, know where to find relevant high-quality research, and read
at least a few relevant studies per year. The third step is for chaplains
to do research as part of their regular job description.
 Weaver, Flannelly, and Liu 13

VandeCreek (1992) makes several practical suggestions for

conducting research. Start small and do not set your sights too high
on you first try, ‘‘then gradually work into more complicated pro-
jects’’ (VandeCreek, 1992, p. 66). Maybe the second or third project
will be worth publishing or presenting at a conference. If you want to
try to publish it, submit it to ‘‘a journal whose standards match the
sophistication of the project’’ (VandeCreek, 1992, p. 66).
VandeCreek wisely suggests seeking help on a research project
from the very start. If you are not familiar with statistics or research
design it may be hard to believe, but you can collect quantitative data
in a way that makes them impossible to analyze in a meaningful way.
If you have not done quantitative research before, make sure you
seek help from a statistician or an experienced researcher in advance
to plan the design and analyses. If possible, take a college-level
research methods course. VandeCreek also suggests finding research-
minded peers or working with an experienced researcher, and we
totally agree. Flannelly, Weaver, and their colleagues (2003) describe
several examples of their collaboration with chaplains who had their
own ideas about research topics.
VandeCreek’s (1994) Research in Pastoral Care and Counseling
is a very useful for beginning researcher in chaplaincy. It walks
the reader through the research process and covers both qualitative
and quantitative research methods.

SOME SUGGESTIONS FOR FUTURE RESEARCH

It is not for us to say what kinds of research chaplains should
pursue, but there are some current avenues of research that we believe
should be continued and expanded in the future. Naturally, we focus
on those with which we are most familiar. To start, much more
research like the studies reported in this issue of the Journal of Health
Care Chaplaincy need to be done, from which, among other things,
standards of practice might evolve. This research should include
studies of the spiritual care provided by chaplains to patients, families,
and staff. Such studies should also help to better define spiritual care.
Obviously, chaplains should conduct more research on the
relationship between spirituality and health in patients. Most of the
current research is done by nurses, physicians and other healthcare
professionals. More disturbing, perhaps, the major focus of the
14 JOURNAL OF HEALTH CARE CHAPLAINCY

discussion about spirituality in the medical literature is whether

physicians should address spirituality with patients. We believe
research is needed that will help shift the discussion away from physi-
cians and focus it on patients and their spiritual needs. There is sub-
stantial qualitative research on this topic and scales have been
developed to assess patients’ spiritual needs (Flannelly et al., 2006;
Galek et al., 2005; Peterman et al., 2002), but much more research
needs to be done with various patient populations (cardiology
patients, oncology patients, etc.). This research would not only help
us understand the spiritual needs of patients, but show the pervasive-
ness of patients’ spiritual needs. In a market economy, healthcare
institutions will not supply services for which they perceive there is
little demand. We believe the demand is there, but often goes
unnoticed. Beyond that, further research will be necessary to deter-
mine the extent to which patients’ needs are being met, who is meeting
them, and what are the best ways of meeting them.
Fitchett and his colleagues have been doing very valuable research
on two related concepts: spiritual risk (1999a, 1999b, 2000) and
religious struggle (Fitchett et al., 2004). Religious struggle, which
has been found to be associated with poorer health outcomes among
patients (Pargament et al., 2001), refers to negative religious coping,
such as feeling abandoned or punished by God. Although this sense
of abandonment or punishment is relatively low in the general U.S.
population (5%) it appears to be higher (9–11%) among the few
patient populations in which it has been studied (Fitchett et al.,
2004). Spiritual risk is the term Fitchett and his colleagues have used
to characterize patients whose religious needs are high but their
religious resources are low. Since these patients are less likely to make
self-referrals to the pastoral care department (Fitchett et al., 2000),
screening tools must be developed to help identify them and their
unique needs.
After an extensive review of the literature on religion and health he
conducted for the Metanexus Institute, Hufford (2005) noted in his
analysis of the field that it was dominated by social scientists and
physicians, that it lacked a theological perspective, and that chap-
laincy was glaringly absent. The last point echoes the words of
VandeCreek (1999) that chaplains have little voice in the growing
research field of religion=spirituality and health. For chaplains to
have a voice, we think they should try to get involved in basic as well
as applied research. In recent years, even neuroscientists have entered
 Weaver, Flannelly, and Liu 15

the field, exploring how spirituality is represented in the brain. It

would be worthwhile for chaplains to collaborate in this kind of
research to give it theological grounding. Evidence that spiri-
tual=religious practices and beliefs affect the brain will go a long
way to showing how religion=spirituality can influence health. For
example, Flannelly et al. (2007b) have proposed a theoretical model
of how religious beliefs and other kinds of beliefs can moderate certain
classes of psychiatric symptoms by influencing brain systems involved
in assessing threats in the environment. The goal of such theory and
research is to identify the biological causal mechanisms by which reli-
gion influences health. This research should help to show how cha-
plains help patients and may point to the best kinds of interventions.
The last avenue of research we would like to discuss concerns
measuring the effectiveness of chaplains. No doubt, questions about
chaplains’ effectiveness will be asked in the future whether or not cha-
plains choose to ask them. When addressing this issue, chaplaincy as
a whole should follow VandeCreek’s (1992) advice to new researchers
to start small and have limited expectations. There are a myriad of
possible approaches to this question, and each chaplain may have
his or her perspective about how to pursue it. Flannelly et al.
(2007a), for example, have developed a preliminary scale to measure
the effectiveness of pastoral care with family members of hospitalized
patients. Several other related lines of research are being pursued by
our colleagues at The HealthCare Chaplaincy. Some chaplains have
adapted items from VandeCreek’s (2004) patient satisfaction ques-
tionnaire to explore what chaplain activities are correlated with
patients’ perceptions that their spiritual and=or emotional needs have
been met by the chaplain. Other chaplains have adapted items from
several sources to create their own scales to measure the quality of
their work—one for patients and family members and one for
hospital staff. For clinical and methodological reasons, research on
chaplain effectiveness probably should concentrate on patients who
fall into Fitchett’s category of being at-risk – those whose religious
needs are high and whose religious resources are low.
The most important things to keep in mind when pursing this ques-
tion or any other research question is that there is no one right
approach, or one best approach to studying it. Nor is there a way
of knowing in advance which avenue of research will have the great-
est or most important impact on a field. The clinical research process
does not work well when the questions asked and the methods used to
16 JOURNAL OF HEALTH CARE CHAPLAINCY

answer them are selected by those outside the field, or directed from
the top-down. Clinical research is at its best when the research ideas
are generated by those working on the frontlines. Chaplains must
decide what questions to ask and how to try to answer them. When
doing so, it may be worthwhile to keep in mind that medical journals
do not contain studies about the effectiveness of physicians or
surgeons; they contain studies about the effectiveness of specific
medical treatments and procedures.

ACKNOWLEDGMENTS
The authors gratefully acknowledge the assistance of Research
Librarian Helen P. Tannenbaum and Research Assistant Kathryn
M. Murphy in preparing this article. The preparation of this article
was funded in part by grants to The HealthCare Chaplaincy
from the Henry Luce Foundation, the John Templeton Foundation,
and the Arthur Vining Davis Foundations.

REFERENCES
Babler, J. E. (1997). A comparison of spiritual care provided by hospice social work-
ers, nurses, and spiritual care professionals. Hospice Journal, 12(4), 15–27.
Burton, L. (2002). Chaplaincy is becoming more scientific. What’s the problem?
Journal of Health Care Chaplaincy, 12(1=2), 43–51.
Campbell, D. T. (1957). Factors relevant to the validity of experiments in social
settings. Psychological Bulletin, 54, 297–312.
Cavendish, R., Edelman, M., Naradovy, L., McPartlan Bajo, M., Perosi, I., &
Lanza, M. (2007, March). Do pastoral care providers recognize nurses as spiritual
care providers? Holistic Nursing Practice, 21(2), 89–98.
Emblen, J. & Halstead, L. (1993). Spiritual needs and interventions: Comparing the
views of patients, nurses, and chaplains. Clinical Nurse Specialist, 7(4), 175–182.
Fitchett, G. (2002). Health Chaplaincy as a research-informed profession: How we
get there. Journal of Health Care Chaplaincy, 12(1=2), 67–72.
Fitchett, G., Bradshaw, A. K., & Gibbons, G. D. (2003). Chaplains and research: I
feel a little excited. Ministry, Society, and Theology, 17(1,2), 90–104.
Fitchett, G. (1999a). Screening for spiritual risk. Chaplaincy Today, 15(1), 2–12.
Fitchett, G. (1999b). Selected resources for screening for spiritual risk. Chaplaincy
Today, 15(1), 13–26.
Fitchett, G., Meyer, P. M., & Burton, L. A. (2000). Spiritual care in the hospital:
Who requests it? Who needs it? Journal of Pastoral Care, 54(2), 173–186.
 Weaver, Flannelly, and Liu 17

Fitchett, G., Murphy, P. E., Kim, J., Gibbons, J. L., Cameron, J. R., & Davis, J. A.
(2004). Religious struggle: Prevalence, correlates, and mental health risks in
diabetic, congestive heart failure, and oncology patients. International Journal of
Psychiatry in Medicine, 34(2), 179–196.
Flannelly, K. J., Ellison, C. G., & Strock, A. L. (2004). Methodologic issues in
research on religion and health. Southern Medical Journal, 97(12), 1231–1241.
Flannelly, L. T., Flannelly, K. F., & Weaver, A. J. (2002). Religious and spiritual
variables in three major oncology nursing journals: 1990–1999. Oncology Nursing
Forum, 29(4), 679–685.
Flannelly, K. J., Galek, K., Bucchino, J., Handzo, G. F., & Tannenbaum, H. P.
(2005). Department directors’ perceptions of the roles and functions of hospital
chaplains: A national survey. Hospital Topics, 83(4), 19–27.
Flannelly, K. J., Galek, K., & Flannelly, L. T. (2006). A test of the factor structure
of the patient spiritual needs assessment scale. Holistic Nursing Practice, 20(4),
187–190.
Flannelly, K. J., Galek, K., Tannenbaum, H. P., & Handzo, G. F. (2007a). A prelimi-
nary proposal for a scale to measure the effectiveness of pastoral care with family
members of hospitalized patients. Journal of Pastoral Care and Counseling, 61(1–2),
19–29.
Flannelly, K. J., Koenig, H. G., Galek, K., & Ellison, C. G. (2007b). Beliefs, mental
health, and evolutionary threat assessment systems in the brain. The Journal of
Nervous and Mental Disease, 195(12), 996–1003.
Flannelly, K. J, Liu, C., Oppenheimer, J. E., Weaver, A. J., & Larson, D. B. (2003).
An evaluation of the quantity and quality of empirical research in three pastoral
care and counseling journals, 1990–1999: Has anything changed? Journal of
Pastoral Care & Counseling, 57(2), 167–178.
Flannelly, K. J., Roberts, S. B., & Weaver, A. J. (2005). Correlates of compassion
fatigue and burnout in chaplains and other clergy who responded to the September
11th Attacks in New York City. Journal of Pastoral Care and Counseling, 59(3),
213–224.
Flannelly, K. J., Weaver, A. J., Smith, W. J., & Handzo, G. F. (2003). Psychologists
and health care chaplains doing research together. Journal of Psychology and
Christianity, 22(4), 327–332.
Galek, K., Flannelly, K. J., Vane, A., & Galek, R. M. (2005). Assessing a patient’s
spiritual needs: A comprehensive instrument. Holistic Nursing Practice, 19(2), 62–69.
Gartner, J., Larson, D. B., & Vachar-Mayberry, C. D. (1990). A systematic review of
the quantity and quality of empirical research published in four pastoral counsel-
ing journals. 1975–1984. Journal of Pastoral Care, 1990, 44(2), 115–123.
Greenhalgh, T. (2001). How to read a paper: the basics of evidence based medicine,
2nd ed. London: BMJ Books.
Handzo, G. F. (2002). Science and ministry: confusion and reality. Journal of Health
Care Chaplaincy, 12(1=2), 73–79.
Harding, S. R., Flannelly, K. J., Weaver, A. J., & Costa, K. G. (2005). The influence
of religion on death anxiety and death acceptance. Mental Health, Religion, and
Culture, 8(4), 253–261.
18 JOURNAL OF HEALTH CARE CHAPLAINCY

Hufford, D. (2005). An analysis of the field of spirituality, religion, and health.

www.metanexus.net/tarp (Accessed May 27, 2005).
Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion
and health. New York: Oxford University Press.
Levin, J. S. & Schiller, P. L. (1987). Is there a religious factor in health? Journal of
Religion and Health, 26(1), 9–36.
McCurdy, D. B. (2002). But what are we trying to prove? Journal of Health Care
Chaplaincy, 12(1=2), 151–163.
Modesto, K. F., Weaver, A. J., & Flannelly, K. J. (2006). A systematic review of religi-
ous and spiritual research in social work. Social Work & Christianity, 33(1), 77–89.
Moran, M., Flannelly, K. J., Weaver, A. J., Overvold, J. A., Hess, W., & Wilson,
J. C. (2005). A study of pastoral care, referral, and consultation practices
among clergy in four settings in the New York City area. Pastoral Psychology,
53(3), 255–266.
O’Connor, T. (2002). The search for truth: The case for evidence based chaplaincy.
Journal of Healthcare Chaplaincy, 12(1/2), 185–194.
O’Connor, T. S., Koning, F., Meakes, E., McLarnon-Sinclair, K., Davis, K., & Loy,
V. (2001). Quantity and rigor of qualitative research in four pastoral counseling
journals. Journal of Pastoral Care and Counseling, 55(3), 271–280.
Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2001). Religious
struggle as a predictor of mortality among medically ill elderly patients: A 2-year
longitudinal study. Archives of Internal Medicine, 161(15), 1881–1885.
Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002).
Measuring spiritual well-being in people with cancer: The functional assessment
of chronic illness therapy—Spiritual Well-being Scale (FACIT-Sp). Annals of
Behavioral Medicine, 24(1), 49–58.
Roberts, S. B., Flannelly, K. J., Weaver, A. J., & Figley, C. R. (2003). Compassion
fatigue among chaplains, clergy and other respondents after September 11th. The
Journal of Nervous and Mental Disease, 191(11), 756–758.
Ross, L. (2006). Spiritual care in nursing: an overview of the research to date. Journal
of Clinical Nursing, 15(7), 852–862.
Springer, M. B., Weaver, A. J., Lindenblatt, C., Naditch, B., Newman, A., Siritsky,
N., Flannelly, K. J., & VandeCreek, L. (2003). A study of spirituality, depression,
and loneliness among Jewish seniors residing in New York City. Journal of
Pastoral Care and Counseling, 57(3), 305–318.
VandeCreek, L. (1994). Research in pastoral care and counseling: Quantitative and
Qualitative Approaches. Decatur, GA: Journal of Pastoral Care Publications.
VandeCreek, L. (1999). Professional chaplaincy: an absent profession? Journal of
Pastoral Care, 53(4), 417–432.
VandeCreek, L. (1992). Research in the pastoral care department. In L.A. Burton
(Ed.). Chaplaincy services in contemporary health care. Chicago: College of
Chaplains, Inc., 65–69.
VandeCreek, L. (2004). How satisfied are patients with the ministry of chaplains?’’
Journal of Pastoral Care & Counseling, 58(4), 335–342.
 Weaver, Flannelly, and Liu 19

Weaver, A. J., Flannelly, L. T., & Flannelly, K. J. (2001). A review of research on

religious and spiritual variables in two primary gerontological nursing journals:
1991–1997. Journal of Gerontological Nursing, 27(9), 47–54.
Weaver, A. J., Flannelly, K. J., & Oppenheimer, J. E. (2003). Religion, spirituality,
and chaplains in the biomedical literature: 1965–2000. International Journal of
Psychiatry in Medicine, 33(2), 155–161.
Weaver, A. J., Pargament, K. I., Flannelly, K. J., & Oppenheimer, J. E. (2006).
Trends in the scientific study of religion, spirituality, and health: 1965–2000. Jour-
nal of Religion and Health, 45(2), 208–214.
Weaver, A. J., Flannelly, L. T., Strock, A. L., Krause, N., & Flannelly, K. J. (2005).
The quantity and quality of research on religion and spirituality in four major
gerontology journals between 1985 and 2002. Research on Aging, 27(2), 119–135.

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