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Controlled-interview study of "the therapeutic team" in selected hospitals of Southern California evaluated from the standpoint of the Christian Church

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Controlled-interview study of "the therapeutic team" in selected hospitals of Southern California evaluated from the standpoint of the Christian Church

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Content COHTROLLED-JIMTERVIEW STÜDT OP "the therapeotic team" in selected HOSPITALS OP SOUTHERN CALIFORNIA EVALUATED PROM THE STANDPOINT OP THE CHRISTIAN CHURCH by Charles William Teel A Thesis Presented to the FACULTY OP THE GRADUATE SCHOOL UNIVERSITY OP SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OP ARTS (Religion) June 1958 UMl Number: EP65288 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dlssoftatien Publislvng UMl EP65288 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 UNIVERSITY OF SOUTHERN CALIFORNIA G R A D U A TE S C H O O L U N IV E R S IT Y PARK LO S A N G E LE S 7 R 'sot T This thesis, written by ..... CHARLES i Z/ 3 ^ under the guidance of h.ls...Facuity Committee, ^ . | ^ and approved by all its members, has been pre- ^ sented to and accepted by the Faculty of the Graduate School, in partial fulfillment of the requirements for the degree of MASTER OF ARTS JOHN D,..cûam............ Acting jDeaa Faculty Committee TABLE OP CONTENTS CHAPTER PAGE I. INTRODUCTION................... 1 The problem stated ................. 1 The importance of and motive for this study 2 Methodology ••••••••««•••• 3 Organization of the remainder of the study ............................. l \ . II. SEEING THE PATIENT AS A W H O L E ........... 6 III. THE HEALTH T E A M .......................... 15 The administrator.......... 16 The physician....................... . 18 The nurse ................. •••... 23 The dietitian . .................. 2? The medical social worker ........... 29 The psychologist . . . . . . . . . . . 32 The occupational therapist............. 36 The physical therapist ............... 39 IV. THE CHAPLAIN AND RELIGIONS COUNSELING . . I 4 . 3 Resources of the chaplain.......... . 53 Listening............................. 54- Quietness................ 56 Prayer . . . . . . . . . 56 iv CHAPTER PAGE The Bible............................. 59 Religious literature . . . . . 61 V. A SURVEY OP SELECTED HOSPITALS....... 63 The Kings View Homes. .. .. . . . 64> Report on interview with staff members. 65 Patient interviews . . . . . . . . ?2 Loma Linda Sanitarium and Hospital . . . 73 Report on interview with staff members. 74- Patient interviews . . . . . . . . . . 88 The Kaiser Foundation Hospital ..... 100 Report on interview with staff members. 100 Patient interviews ........... 109 VI. EVALUATION, SUMMARY, AND RECOMMENDATIONS. . 119 Evaluation of study..................... 119 Summary ............ 123 Recommendations .......... 126 BIBLIOGRAPHY.................................... 129 APPENDIX A ......................... 133 APPENDIX B ................................ 136 APPENDIX C ......................................... 138 LIST OF TABLES TABLE PAOE I, A Spread Showing the Team Members Now Employed by the Hospitals Studied .... 121 CHAPTER I INTRODUCTION This study points up the needs of ministering to the whole man and how this ministry is best accomplished by the therapeutic team. The therapeutic team may be defined as the professionally trained institutional staff. The team concept, then, is the collaboration, or the working to gether, of this group in the care of the patient in his entirety. I. THE PROBLEM STATED The purpose of this study is to show the trends of modern-day thinking in the field of medical science. Sources have been cited which show the need for the multi- discipline approach and also the need of viewing the patient ”in his totality. The health team consists of persons who have been trained in various fields for the purpose of providing complete care for the patient. The literature and practice tell us that the physician is no longer satisfied with caring only for the body. He recognizes there is an ^Andras Angyal, Foundations for a Science of Person ality (New York: The Commonwealth Fund,“"1941), p."%. — intimate relationship between the mind and the body. liltner^ shows that there have always been those who have argued about the relationship between mind and body. Modern medicine now refers to it as "psychosomatic rela tionships instead of mind-body relationships.*3 The author goes on to state: Modern medicine is rapidly coming to the conclusion that whether an illness is physical or psychic is the wrong question, and that the real question is, #to what extent physical and what extent psychic?* There is no such thing as a purely psychic illness or a purely physical one, but only a living event taking place in a living organism which Is itself alive only by virtue of the fact that in it psychic and somatic are united in a unity.4- Â person is a holistic unit with the capacity of both physiological and psychological functioning. This holistic approach to man bridges the fundamentally artifi cial gap between mind and body. Man is not identified with the body alone II. TEE IMPORTANCE OP AND MOTIVE FOR THIS STUDY Since the whole man is threatened on every side with problems of pain, suffering, illness, death, guilt, and fear, and since in recent years the practice of medicine ^Seward Hiltner, Religion and Health (New York; The Macmillan Company, 194-3) • 3lbld.. p. 66. ^Ibld. ^Angyal, o£. cit., p. 61. 3 has moved into specialized areas, this investigation was instituted to study the team-concept in caring for the whole man. The motive for selecting this topic came from the fact that the investigator is associated with the College of Medical Evangelists and carries the responsibility of overseeing the work of the chaplains of the Loma Linda Sanitarium and Hospital. It was the consensus of the founding fathers of the institution that the spiritual needs of a person will not be cared for adequately if only his medical needs are met. III. METHODOLOGY Books and journals in this field have been studied for the purpose of discovering these trends in present-day thinking. Both the individual and the cooperative roles of the health team members have been discussed in their relationship to the patient as a whole. In addition, a study of selected hospitals in Southern California has been made for the purpose of dis covering the parallel between theory and practice. That is to say, are the books and journals saying one thing and is the practice something different? IV. ORGANIZATION OP THE REMAINDER OP THE STUDY The remainder of the study is organized into five chapters. Chapter II of the study points up the findings from literature concerning the trends in modern-day think ing in the fields of medical science. Chapter III gives a description of the health team members, with their individual and cooperative roles in caring for the patient as a person. Chapter IV deals exclusively with the work of the chaplain as a member of the health team. Resources of the chaplain, such as listening, quietness, prayer, the Bible, and religious literature, are listed and discussed. Chapter V pictures the findings of the three hospitals studied. The following hospitals were included in the study: The Kings View Homes. The Kings View Homes is a psychiatric hospital owned and operated by the Mennonite Church. It deals with the short-term mentally ill patient. This 30-bed hospital, located at Reedly, California, has a distinctive Christian emphasis in treating the mentally ill. The Loma Linda Hospital Sanitarium. This is a church-related general hospital, located on the campus of the College of Medical Evangelists at Loma Linda, California, Since this is a teaching hospital connected with medical ~ 5 and nursing schools, it is of particular interest for this study. The Kaiser Foundation Hospital. This hospital, located at Fontana, California, is an industrial general hospital. By far the majority of its patients are insured by the Kaiser Foundation Health Plan. The writer chose these hospitals because of their differences in order to ascertain the acceptance of the health team approach in varied institutions. Chapter VI, the concluding chapter, lists the evaluation and summary of the study along with specific recommendations• CHAPTER II SEEING THE PATIENT AS A WHOLE The trends In patient care point up the need of caring for the whole person. The physician is increasingly aware of psychosomatic problems. The psychologist has be come concerned about the meaning of behavior along with the observation of behavior. The social worker has seen the necessity of giving attention to the crisis of emotional conflict in families as well as, for example, the crisis of poverty. The counseling and guidance profession has become increasingly aware that a role-conflict regarding vocation or marriage may also be complicated by unconscious motivations. Although the clergyman has always functioned more or less as a consultant on personal concerns, it is only in recent years that he has thought of himself as a counselor in a formal sense.^ The purpose of this study, then, is not to point out the evils of specialization but to show how a group of individuals trained in different professional specialties can take the multi discipline approach and care for the iRoy Miner (ed.), Psychotherapy and Counseling (New York: The New York Academy oi* Science, 1^56), p. 7 whole patient. Thus the patient has the advantage of being studied as a person. It is postulated that the specialists in the various fields need to pool their knowledge of the patient and operate as a team. Granger Westberg,^ Associate Professor of Pastoral Care for the University of Chicago, gives a typical example pointing out this truth. Bill Smith is in the hospital with a severe case of ulcers. The usual mode of treatment is to get him on a good diet and the usual pharmaceuticals, sedatives, and so forth. This is somatic treatment and very necessary. But all the while Bill is still stewing inside. He has read that ulcers are often brought on by an overdose of emotions. He is not sure what this means. No one has taken time to help him understand. His doctor has told him to ”slow down” and "take it easier," and not to worry so much. Someone has suggested it might be a problem of eating wrong foods. But there is just a chance that he is thinking wrong thoughts. The nurse explained to him that his body might be acting as sounding-board for his "inner man" and, much like a railroad crossing light, is flashing the signal "Stop-Look-Listen." There is no question about his being stopped. He is lying on his back; there is no place to go and very Granger Westberg. Nurse, Pastor and Patient (Rock Island, 111.: Augustana Press, 1955)> p.^ 6. ' 8 little to do. He senses that this experience offers him an excellent opportunity for thinking about life and about his faith and its relationship to life. The people who minister to this type of patient must see his many sides. There is little doubt that this patient may have diet problems. There may be organic coi^li cat ions, and he may have distress of an emotional and ^iritual nature. Keen insights of the whole patient are needed. More study and more careful training are needed to see how the needs of the patient may be met better. This present generation has seen medical science emphasize specialization. The total human organism has been broken down and its parts studied intensely. There is now a specialist for practically every organ of the human body. Specialization represents progress, but with progress there is also danger. There is a danger that attention may be focused on the diseased organ to the ex clusion of the sick patient. Plato recognized the pitfalls of this type of medical practice and pointed them out in Charmides: As you ought not to attempt to cure the eyes without the head, or the head without the body, neither ought you to attempt to cure the body without the soul; and this . . . is the reason why the cure of many diseases is unknown to the physician of Hellas, because they are ignorant of the whole, which ought to be studied also; for the part can never be well unless the whole Is well • « * and therefore. If the head and body are to be well, you must begin by curing the soul; that is the first thing.3 To point up this viewpoint Angyal quotes a humorist who said: Scientists have found out that ears are for hearing, the eyes for seeing, the lungs for breathing, the hands for grasping, the feet for walking; they should now take just a little step further and find out what the whole man is for .4 Another writer, a contemporary authority in this area of the needs of the whole man, has written: The belief that the patient should be treated as a whole goes back beyond anything most of us would con sider medicine at all. The witch doctor of our primitive ancestors was both physician and priest. He worked on the patient*s psychic trouble as on his bodily symptoms, for he never knew there was any real difference between them. In fact, the witch doctor*s cures were probably due as much to his treatment of the emotions as to his herbs or bloodletting.5 The minister and the doctor have more in common than they realize. During the days of the Greek civiliza tion the minister and the doctor were one. The Aesculapian temples were really the hospitals of that day and were presided over by priest-physicians who were concerned with treating the whole man. Then came the dawn of scientific Richard P. Young, The Pastor* s Hospital Ministry (Nashville: Broadman Press, 1^543 » P• ^• ^Angyal, o£. cit., p. 24.. %elen Flanders Dunbar, Mind and Body: Psychosomatic Medicine (New York: Random House, T94Y7$■ P* 78. 10 medicine. The two separated for a while. Today there is a new interest in the holistic approach. It is this emphasis on wholeness which is drawing the professions back together again. Each recognizes that it needs the other— or the patient will be only partly cared for.^ In the ministry of Jesus there was teaching, preaching, and healing. He did not treat the individual primarily as a body or as a soul; He ministered to the whole person. The text of His first sermon indicates that the relief of human suffering was a primary purpose of His mission. The Spirit of the Lord is upon me, for He has consecrated me to preach the gospel to the poor. He has sent me to proclaim release for the captives and recovery of sight for the blind, to set free the oppressed.7 Lauterbaeh^ states that Christ's example stands always before us and urges us on. As Jesus was moved to compassion and helpful concern at the sight of the sick and afflicted, so we, his followers, are to have heartfelt compassion for the sick and be ready to serve their spiritual needs. "It is enough for the disciple to be Granger E. Westberg, "The Interrelationship of the Ministry and Medicine," Pastoral Psychology, April, 1957. ^Luke 4.:l8. William A. Lauterbach, Ministering to the Sick (St. Louis: Concordia Publishing Éouse, $ P. 2. 11 like his teacher."9 Or as William James, Professor of Psychology at Harvard University, put it. The constituents of the Me may be divided into three classes, those which make up respectively— the material me; the social me; and the spiritual me.^^ The church went through a stage during which it not only failed to see the need of earing for the whole person but actually opposed progress of medical science. This fact is pointed out in the following paragraph: In A.D, 529 Emperor Justinian, acting upon the advice of church dignitaries, closed the medical schools of Athens and Alexandria. In 1215 Pope Innocent III condemned surgery and all priests who practiced it. In 12i|.6 the dissection of the human body was pronounced sacrilegious, and the study of anatomy was banned.Ü Today, because of the needs of the whole patient, medical science is leading the way in pointing the need of the total approach. The church is obligated to re emphasize its ministry of healing. Young states that the complex society in which we live is producing many sick and confused people whose souls are as much in need of healing as their bodies. He %att. 10:25. ^^William James, Psychology (Hew York: Henry Hold and Company, 1910), p. 177* l^eorge Gordon Dawson, Healing: Pygan and Christian (London: The Society for Promoting Ôiiristlan Knowledge, 1935), PP. 172-174. 12 points up the need for a ministry of healing on the part of the church in the following facts: 1. Two famous medical authorities, Weiss and English, say that one-third of all patients who consult physicians today do not have any definite bodily disease to account for their symptoms. In another third, emotional factors are contributing to the disability produced by organic diseases. 2. Sales of books and magazines directed toward the troubled soul in this land are enormous* Litera ture on the subject of nervousness, tension, guilt, anxiety, frustration, peace, and happiness are gobbled up by readers today in wholesale quanti ties. Peace of Mind by Joshua Liebman led the list of best-sellers in this country for nearly twelve months. This record is indicative of a hunger in society that cannot be denied. 3. There are only about fifty-five hundred practicing psychiatrists in the United States, and most of these are concentrated in Medical centers or large cities. Dr. Douglas Kelley, formerly associate professor of psychiatry at the Bowman Gray School of Medicine in Winston-Salem, North Carolina, said in a speech to the theological students; 'The minister occupies a unique role in society. Be cause of the very nature of his work he is called in when the burdens of the family seem unbearable, thus having opportunity in many instances to uncover psychiatric disease which would otherwise develop into an incurable state. If he is aware of this condition and can recognize early mental disorder, he can render a signal service to the community. Young mentioned further that more and more medical practitioners are eager for the church to help them by ministering to the spiritual needs of their patients. They are recognizing the relationship of body and spirit. He points out that too many people today are being brushed op. cit., p. 6. 13 off by the doctors and not being helped by the church. 1^ In the past the minister and the doctor have more or less gone their separate ways. Very few attempts were made for cooperation. The attitude is now changing. Today the hospital chaplain and doctor in the hospital are finding that cooperation is extremely advantageous. Medical schools are now teaching what is called the "comprehensive approach" to the patient's needs. Young further suggests: This 'comprehensive approach' which is being taught in progressive hospitals today has a tremendous sig nificance for the church and its ministry of healing. The church-related hospital is afforded an opportunity to offer a more distinctively Christian ministry than was conceived of when many of these hospitals were founded. When denominations first became interested in establishing hospitals, these institutions were badly needed by society. Today, however, the govern ment is seeking to provide better medical care for its citizens, and through the medical care commission money has been available for building hospitals throughout the country. Yet even before Congress took this action, many church-related hospitals, like some colleges and universities founded by religious impetus had strayed far afield from the distinctive purpose envisioned by their founding fathers. Today church-related hospitals must make their ministry of healing distinctive in order to justify their existence. Rethinking the purpose of these institutions in present-day society may return them closer to the original ideas promulgated by the founders of these institutions.14 In order that the minister might better see his role in this team relationship with the physician, a 13lbld.. 7. %bid-. PP. 14, 15. clinical training program for ministers has been estab lished. The first plea for such training seems to be found in an interview with Dr. Richard Cabot in the Boston Post of December 27, 1908, entitled "Physician and Minister Must Work Together to Cure the Sick." In it Cabot stated: There ought to be a school where training for such work is given. There is nothing of the sort now to prepare ministers to cope with the subject, and psychology as taught in the colleges is wholly inade quate for this training. In fact it does not cover the branches which would be most useful to the minister in dealing with sick people at all. Therefore the work of helping a patient belongs to others as well as the doctor. It belongs to someone who can doctor his moral as well as his physical ills. A physician specializes on the body, and the minister makes his specialty the human soul. The two should cooperate.15 The comprehensive approach, then, requires the care of man in his totality. One part of man affects the other. Man's entirety calls out for help. One part affects and sympathizes with the other. Thus the team learns to work together. Since the whole of man is ministered to by more than the doctor and the minister, the next chapter will describe the various team members. 15John M. Billinsky, "Clinical Training— A Retro spect ," T ^ Andover Newton Bullet^, XLVI (October, 1953), No. 1, I5T CHAPTER III THE HEALTH TEAM Since we are living in a day of specialization, many intensively trained specialists have learned to work side by side. The health team might be described as the group who contribute to the care of the patient. In this chapter we shall name and discuss the roles of the health team and how the minister fits in as a team member. They are listed as follows: The Hospital Administrator The Physician The Nurse The Dietitian The Social Worker The Psychologist The Occupational Therapist The Physical Therapist The Chaplain This is not an exhaustive list. We might mention other significant persons too. The team will vary from one hospital to another, depending upon size, purpose, and funds. The success in treatment of the patient as a whole will depend upon the cooperation and participation of the 16 entire group. Some space will be given to each member of the team, and an entire chapter will consider the chaplain and religious counseling. The Admini strator The administration is responsible for providing the structure of the health team, clarifying the functions of the various members and facilitating their relation ships in bringing their services to the patients. He with his staff execute policies determined by the governing body of the hospital, by creating regulations, procedures, rights, and obligations, and by making available channels of communication for the health team. Urwick, in his pioneer work. The Elements of Administration, places administration under three headings; a. The basic principle is investigation, research in objectively appraising the situation and determin ing the appropriateness of the institution in fulfilling the policy of the governing body. Thus the administrator maintains in his own mind and in the semi-consciousness of the institution a principle of order, purpose or system. b. The process involved is constant forecasting which attempts to answer the question of how needs can be met by the policy already established. Organi zation arises to execute policy through a chain of command and personal direction. c. The effect of these two first phases is planning, which coordinates and controls the process; channeling the activity of the institution is so complex that a group of administrative officers must be set aside to supervise the many depart ments and numerous workers with impersonal objec tivity. Because the administrator is not 17 personally Involved in any one department, he can view the whole institution with better perspective and consider the functions and needs of the insti tution as a whole Although the administrator is not the head of the health team, he is responsible for the structure of the team, clarifying the functions of the various members, and formulating their relationships in bringing their services to the patient. It is his responsibility to execute policies determined by the governing body of the hospital» by creating regulations, procedures, rights, and obliga tions, and making available channels of communication between members of the health team. Belgum asks the question and gives the answer in a way that points up the role of the administrator: How does this role of the administrator affect other members of the health team, and ultimately the care of the patient? The role of authority in making people conform to regulations is often frustrating. Frustra tion leads to aggression. If morale is low, responsi bility not clearly defined, interdepartmental communi cation slow and sporadic, schedules irregular, and goals in flux, the administrator may be said to be frustrating the members of the staff by poor organiza tion. These members of the health team express aggression and hostility against each other and the patients. @n the other hand, if responsibility is clearly defined, the staff members feel secure in their rights and obligations; if materials are easily available, schedules regular, and communications available, there is likely to be less aggression because there is less ^Lyndall Urwick, The Elements of Administrat ion (New York: Harper and Brothers ïutilsEêrs, 1544) , PZ1E9. 18 frustration. In the latter case, interprofessional cooperation is fostered and the general emotional tone and social atmosphere of the hospital is more conducive to therapy and care of the patients. The administrator has become an integral part of the health team by facilitating its work in each specialized department, by maintaining the cohesiveness of the group, and by directing its efforts toward the goal of caring for the patient In every hospital there must be organizational methods of communicating information pertaining to the goal of the institution and individual responsibility resting upon various members of the institution. Since there will never be total agreement, nor unanimity as to the best methods of achieving these goals, the administra tor makes decisions that are received ambivalently by members of the staff. The administrator plays an important part on the health team. The Physician The role of the physician may well be introduced with the following quotations: The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an in fluence of the strong upon the weak, the righteous upon the wicked, of the wise upon the foolish.— Sir William Osier. There is no disease or disorder which does not in %avid Belgum, Clinical Training for Pastoral Care (Philadelphia: The Westminster ?ress, 19567, pp. 23, %. 19 some degree affect the patient's emotional and mental life, nor Is there any such condition which is not, in its turn, favorably or unfavorably affected by the patient's feelings and thoughts.— Austen P. Riggs. Here is a great group of patients in which it is not the disease but the man or the woman who needs to be treated.— Francis W. Peabody. A good physician is like a good father.— Tamil proverb.3 Medical treatment, then, means treating the whole person. More and more physicians are realizing that disease is to be attacked through the body and mind. Cabot and Dicks^ suggest that man carries into his illness the inter ests, affections, emotions, and conflicts that have governed him hitherto. They raise the blood pressure; they upset the movements of his heart, his stomach, his bowels; they affect the chemistry of his digestion. Physicians understand these relationships better today than they have in the past. One physician stated that before the last World War his practice consisted almost entirely of prescribing medications, setting bones, performing surgery, and earing for emergency cases. After the war his practice took a new turn. He found himself spending more time talking with ^Walter C. Alvarez, Nervousness, Indigestion and Pain (New York: Harper and Brothers fubllskers, 1945), P* v. ^Richard C. Cabot and Russell L. Dicks, The Art of Ministering to the Sick (New York: The Macmillan Co.,M inistering m ^ T r p T i : 20 patients» suggesting certain books to be read, using Scripture therapy, and even praying with patients. Heading up the health team, in both the general and the mental hospitals, the physician must see the patient in his totality— not merely the spiritual side, or the emotional side, or the physical side. The following statements point the new emphasis in the thinking of some clinicians; There Is no such thing as a purely psychic illness or a purely physical one, but only a living event taking place in a living organism which is itself alive only by virtue of the fact that in it psychic and somatic are united in a unity. • • • The question ‘ 'Physical or psychic?” therefore, is in most cases wrongly put and should be replaced by the question; ”To what physical and to what extent psychic?” We can no longer separate either nervous or organic, or functional or organic* If we think in terms of dis turbed function the only adequate concept is that changes take place which are reversible and irrevers-. ible in a series terminating in the gross anatomical.^ The same volume gives this further statement; We must avoid the concept that any disease is wholly physical or wholly mental. Rather all disease is both physical and mental and an efficient approach to its control must give correct weight to both factors. At various times the weight of the different factors will vary* In this time of stress, mental factors may be of much greater significance than they are ordi narily. * * . As the result of the teaching of psychosomatic medicine, we, as physicians, are led to examine more %elen Flanders Dunbar, Psychosomatic Diagnosis (Hew York; Harper and Brothers, Ï943)V P* 6. 21 closely the phychical aide of some of our patients with certain diseases, to determine the role played in each particular instance by the mental and emotional factors of each patient concerned, whether or not the existing disorder represents functional visceral ex pressions of a disturbed mind or ego. This information can come only from the patient himself.® These statements again point up the importance of the physician using the team members on his health team. Because of their close association with the patient many times information is gathered and charted that otherwise would be unknown to the physician. These means, however, should not replace the oral communication between the patient and the physician. Many times patients have expressed appreciation of the fact that the doctor took time himself to talk with and listen to the patient. Dr. Brian Bird, Associate Professor of Psychiatry at Western Reserve University, comments on the importance of direct communication: Of all the technical aids which increase the doc tor’s power of cbservation, none comes even close in value to the skillful use of spoken word— the words of the doctor and the words of the patient. Throughout all of medicine, use of words is still the main diagnostic technic, and while in therapy many mechani cal and chemical aids are truly miraculous in their effectiveness, words continue to play a tremendous role. The relationship between doctor and patient, the importance of which is so strongly stressed these days. Sbld., pp. 7» 8. 22 Is directly based upon the talk that goes on between Interpersonal relationships between the physician and patient are important* The talk that takes place be tween them is of such importance that it cannot be over estimated. If the physician, who heads the health team, is a man of strong religious conviction, his manner inspires confidence. Â religious experience is not a substitute for a good practice of medicine; neither can good medicine be practiced if God is left out. In his article "The Man Behind the M. D.,” Dr. Julian Price brings out this important facet: Most physicians I have known are men of high prin ciples. Many of them hold strong religious beliefs; yet for some reason they tend to shy away from ex pressing their convictions except in private conversations with intimate friends. As a result, they are regarded by the public, and by their col leagues, as men idio have good moral character but are lukewarm toward religion itself. Our great need today is for every physician to reaffirm his vows and to let the public know as well as his colleagues know, in clear and unmistakable language, the principles for which he stands and the beliefs that he holds. Only this way may we hope to halt the progress of the spiritual disease that prevails in our profession and our nation. Only this way may we hope to set our feet on the road that leads to spiritual health, o In summary* the physician must recognize his Tsrian Bird, "Talking With Patients," American Practitioner and Digest of Treatment, VI (195^), Ho. 3, 270. Julian P. Price, "The Man Behind the M. D.," The Journal of the American Medical Association, GLVII (19F5)» MÔ. 5* 43Î. 23 complete role. He is the head of the team; he is inter ested in the whole patient. He practices careful medicine; he realizes he is the authoritative figure; he understands the importance of interpersonal relationships; he respects and depends upon the service of the other members of the health team. The Hurae Even in the smallest hospitals, where not all therapies known to modern medicine are available, there are always the physician and the nurse caring for the patient. The nursing profession is concerned with the promotion, maintenance, and recovery of health. It has evolved from the simple care given to loved ones by the primitive mother to an art and a science which challenges every ability and the profound knowledge of any individual motivated to serve, Florence C. Kampf, director of the School of Nursing, and professor of nursing at Michigan State University, East Lansing, Michigan, gives this definition of a nurse: Professional nursing represents that quality of nursing care which meets the individual needs of each person. It includes ministration to physical needs with a high degree of skill in procedures based on the related knowledge; understanding of the sensitivities, drives, desires, and fears of the person and meeting them with reassurance and constructive measures; giving instruction basic to recovery and maintenance of health in words that each patient’s ability and experience make meaningful. It carries the cooperation of all the members of the medical care team, professional as 2k well as auxiliary workers, and serves to integrate ^ these joint efforts to the welfare of other people.? This author points up the fact that the nurse is one member of the health team, not a lone worker serving the patients. She is apart of the group serving the holis tic man. Of all the members of the health team, the nurse is perhaps the most available around the clock. She has a more continuous relationship with the patient than any other member of the health team because she is in and out of the various rooms for an eight-hour stretch, whereas the doctor may see the patient once a day or less, depending on the case. For this reason she often functions on levels and in roles for which she is not officially accredited. If the patient wants to tell an emotionally involved story of home problems at 2:00 A.M. to the night nurse, he does so, not because he does not realize that the social worker could serve in the same capacity of a good listener, but because t^ nurse is available when he is in the mood to talk. A great deal of serious thinking takes place when people are hospitalized. Many times the unanswered ques tion runs through the mind, "Why did this have to happen to me?" Some patients become cynical and blame God for the predicament in which they find themselves. So the task of the nurse is more than ministering to the illness; it is ministering to the person. The nurse knows the need of her patients for physical care, but also she learns much about patients’ economics, family relations, problems re lated to health. The nurse may know of a conflict over ^Florence C. Kempf, The Person as a Nurse (New York: The Macmillan Company, 1957) > pp. 9* 1%TT ^^Belgum, og. cit., p. 25 planned parenthood before the confessor priest or chaplain, and she is able to relate this to other marriage problems and stresses relating to illness* In order to give this service to the patient the nurse must learn how to become a good listener. Granger Westberg points this up in the following paragraph: Some people listen with their ears only. Their minds are a long way off. This kind of listener is not really interested in what the patient is saying, unless it reminds him of something he would like to say. He can hardly wait until the patient pauses for breath so he can get his own life history into it. This is the sort of "listening" so prevalent among visitors the nurse sees in the hospital every after noon. They are not really listening to the deep feelings the patient may be expressing. . . . Most people just hear words. But if the nurse be lieves there are meanings behind every word spoken then she will begin to listen for more than just words. When she has been around sick people a long time, she unconsciously develops the ability to read into the words deeper meanings than are apparent on the surface. When a patient says, "This isn’t a very serious opera tion I’m to go through with is it?" the nurse knows that for him it is much more serious than he would care to let on. He puts it this way because he is trying to talk himself out of being afraid. Here the nurse finds herself in the presence of a fully grown man who ordinarily is quite capable of caring for him self, but who now is in this moment of anxiety, which sometimes borders on panic, is not doing too well at muffling his cry for help. This is really what it is and the nurse recognizes it as such.H It is agreed by writers in the field that the nurse who serves her patient beat will recognize that the patient’s words are heavily freighted with meaning during ^^Westberg, Nurse, Pastor and Patient, p. I7. 26 times of crisis. She listens in a way that allows her to respond to the deeper emotions of the patient. In many of the nursing schools today a great deal is being said about the psychosomatic approach to illness. "Psychosomatic" is a word which particularly inter ests ministers. In Greek classes, it was drilled into them that the word "psyche" really means "spirit," "breath of life," or "soul." A less important meaning of the word is "mind." The word "soma" means "body." The generally accepted meaning is "mind-body" approach to illness. . . . Nurses will find that many people in the fields of psychology and medicine are willing to say that "psyche" has a broader meaning than formerly. The "psychosomatic" is not hyphenated, which points up the fact that any approach to illness ought to take into account that a person can never be split up into two parts— with the doctor taking care of one part and the minister ministering with the spirit. The two are inseparable. Many doctors are stressing that they can not practice good medicine without also being conscious of the patient’s inner needs. Ministers learn from experience that they can never think of people as if they were Just souls— unattached— for Jesus was always alive to the needs of the whole man. The body can never be sick by itself, nor the psyche by itself, because man is one. Spirit means, in fact, the whole man. That is the way we are made and we had better face it.12 The nurse, then, stands in an important position. She is a necessary assistant to the doctor and, whether she realizes it or not, she can be a valuable assistant to the pastor or chaplain. In past years nurses have been in structed against conversations that go beyond simple nursing situations. Nurses were simply automatons who followed the IZibld.. pp. Z$, 26. 27 doctor’s orders and who never spoke unless spoken to re garding insights they may have gained from being close to the patient. The nurse today is recognized more as a contributing member of the health team. Frequently it is the nurse who gives helpful clues to the physician as to how he might best proceed with treatment. The nurse is of great value to the chaplain in discovering deep-seated spiritual problems that might have been missed. When a nurse knows she is a part of a hospital team which demonstrates such concern for its patients, then she tries wherever possible to bring to the atten tion of the minister or other professional helper those patients whom she feels would benefit by their counsel. The nurse can increase her own degree of helpfulness in the field of the total care by attending post graduate courses in related subjects and by reading some of the increasingly good books in the field of religion and health. As she learns what to look for in people, and as she deepens her own understanding of herself in relationship to God and her fellowmen, she will find many more opportunities of this kind of ministry than she ever expected,13 The Dietitian Ho authorities state that members of the health team are used equally by all patients. In the case of tuberculosis, there is frequent association with the x-ray technician. In the case of the diabetic patient, close association exists with the dietitian. The work of the dietitian extends into balanced diets and weight control p. 38. 28 problems. Because many psychological problems are made apparent through eating habits, the importance of the dietitian on the health team becomes clear. 0. Spurgeon English,^ a well known figure in the field of psychosomatic medicine, feels that a more signifi cant place comparable to that accorded to socieûL workers, occupational therapists, and nurses should be given to the dietitian as a member of the health team. English suggests three practical services rendered by the dietitian: 1. Gain information (a social and dietary history) which would be valuable in treating the patient and which the physician rarely has time to col lect «... 2. Under the physician’s direction . . . enter into the therapeutic situation and help to modify faulty attitudes. 3. Give support to a dietary regimen which requires frequent contacts and the presence of a feminine and/or maternal figure and supply a much needed interest in the patient’s welfare. In convales cence, for instance, there is a tendency for all patients to regress to a varying degree to child like feeling, and the "woman" who is interested in what the patient eats can have a great deal to do with the peace of mind as well as the will to get well.15 The foregoing suggestions emphasize the dynamic nature of the role of the dietitian when she is regarded in her proper place on the health team. l^Belgum, o£. cit., pp. 37, 38. ^^0. Spurgeon English, "Psychosomatic Medicine and Dietetics," Journal of the American Dietetic Association, XXVII (1951)“ T “ 29 The following quotation is from Dr. Elda Robb, who is head of the dietetics department and professor in this field at Simmons College in Boston: The role of the dietitian is one of a team. . . . At the Boston Dispensary, both in the diabetic clinic and weight-control class, the dietitian plays an im portant part. Unfortunately, the dietitian often means deprivation of food in reducing and special diets. She receives the hostilities of the patients even if it is the doctor who prescribes the diet. Food means more to the person when he is sick; in the hospital he looks forward to meals, especially if the food is good and the patient fairly well. If the patient realizes that food is an Important factor in his recovery, e.g., in diabetes, then it is a positive relationship. She may be more often with the patient than with the doctor. In the best hospitals she has personal contact with the patient.1® The dietitian is a part of the team working closely with the other team members. She needs to be sensitive to the emotional aspects of food problems. The Medical Social Worker Dr* Richard Cabot, the man who has encouraged ministers to become members of the health team amd who has taken an active part in the setting up of a clinical year in the Massachusetts General Hospital as a part of their theological training, was also a pioneer in bringing the social worker into the hospital and making him a part of the health team. The role of the social worker is non- medical in the sense that he gives no physical treatments. 16 Belgum, cit., pp. 38, 39. 30 Mrs. Ruth Cowin, faculty supervisor of Medical Social Work and teacher of the course "Medical Social Case Work" in the Boston University School of Social Work, states that outside the hospital setting the work of the social worker is nonauthoritative. The cases for the most part are self-referred. Even when a third party, such as employer, pastor, or relative, makes referral, the social worker tries to be sure that there is full willing ness on the part of the client to participate and come for interviews. In the hospital setting, authority is often appropriate. This is true in the case of a child or a delirious or unconscious patient. Different members of the health team use authority in the hospital setting; because of this the patient would not understand non author it at ive roles.17 As the social worker has become integrated into the team and demonstrated her value, clinical services have begun to appreciate the influence and the im portance of emotional, social, and psychological fac tors in the causation of disease and the patient’s response to treatment. Physical and psychological rest are influenced by simple environmental factors of everyday life over which the patient may be worrying and also by complex emotional problems. This is especially appreciated when the staff is aware of the psychosomatic approach to illness.18 Physicians are the primary source of referral to social workers, nurses secondary. Oftentimes chaplains refer patients. Then, too, sometimes the patients p. 31. I8lbld.. p. 32. L 31 themselves request service because they have heard of help received by other patients* The social worker works closely with the doctor* He or she is made aware of the patient’s physical condition and the medical program that is described* Huth Cowin, in Belgum*s book, lists the following services of the social worker: 1« Transportation of patients to outpatient clinics, where patient is unable to arrange such for him self. 2. Anything helping to make medical care effective, such as talking with the patient about how he feels about his condition and treatments prescribed* Reducing anxiety. 3* Discovering allied problems that may relate to patient’s illness or future rehabilitation. I j . . Working with other agencies through referral to bring resources of the community and the needs of the patient together, such as needs for medical appliances, braces, or money, because many people find it very difficult to accept such help. 5* In cases of chronic or terminal care, providing or suggesting resources and implementing such help in details. 6. Study of the patient and family in the diagnostic approach to cases of invalidism where patients ap pear to be overwhelmed by relatively small symptoms. 7. Follow-up of patients in outpatient clinics and later home adjustment, making referral to other appropriate agencies when problem goes beyond the limitation assigned to the social worker of the hospital.19 The patient many times is not aware of the fact that 19lbld.. p. 33. 32 the social worker is a part of the hospital team. The social worker is many times asked by the patient, "Whom do you work for?" or "Are you from the welfare department? " This is due in part by the fact that the services of the social worker are not billed to the patient. More and more, however, hospitals are recognizing the social worker as an important member of the health team. In conclusion, the functions of the social worker may be grouped under four headings: (1) Service to pa tients; (2) teaching of social work students-in-training; (3) research in the field of social work; (if) preventive programs of mental hygiene. The Psychologist. Psychology is misunderstood by many people. In the minds of many it has been associated with all kinds of mysteries, occult studies, such as mind reading, thought transference, mental telepathy, character analysis by the stars, handwriting, or the shape of the face or the head. Although psychology is interested in all human activity, these methods mentioned above are beyond the pale of scientific methods. Psychology is a science; it studies attitudes in a scientific way. Or It may be defined as the scientific study of attitudes of individuals. It is an attempt to discover why we do what we do. 33 20 No one who attempts to depict the spirit of the age in which we live can possibly overlook the im portance of psychological science in the culture of today. It is gradually assuming a commanding influ ence upon the thought forms of western m a n . 2 i Psychology is reaching into industry and community organization and is making its appearance on all fronts. In schools and colleges the demand for training in psy chology has reached unprecedented proportions. In 1951- 1952, a total of 2,328 doctoral degrees were given in humanities and social sciences in America. Over twenty- three per cent were given in psychology. The psychologist plays an important role on the health team, both in and out of the hospital. There are patients who seem not to respond to treatment. A harmless looking cut on the finger does not seem to heal. The physician wonders what is wrong not simply with the finger but with the man’s recuperative powers. Although it is the finger that is sore, the total body must explain the persistence of the injury. On the psychological level, the recuperative powers are no less important. A state of ^^Karl S. Bernhardt, Practical Psychology (New York; McGraw-Hill Book Company, Inc., * P* if. 21 Gordon W. Allport, Becoming (New Haven: Yale Uni versity Press, 1955)* P. 1. 22lbid. 3k mental and emotional health is maintained, not by avoiding every slightest injury, but by recuperating from injury. The emotional shock to the person who is hospital ized or who faces serious surgery or who has been left permanently disabled by an accident is sometimes more than the patient can handle. The recuperative powers are not functioning properly. Here Is where the role of the psychologist fits into the health team. The psychologist does not hold a medical degree. In the hospital setting he works closely with the physician In private practice many of his patients are referred to him by a physician. The work of the clinical psychologist is divided into two parts, testing and counseling or therapy. In medical terms this would be diagnosis and treatment. It is not the purpose of this study to list and describe the many and various tests other than to say that the tests range from vocational tests, an endeavor to find the in terests and abilities of the person, to tests which point out the personality problems of the patient. The steadily increasing interest in the individual and his adjustment is perhaps one of the outstanding phenomena of our times. Psychology is interested in the ^%arry and Bonaro Overstreet, The Mind Alive (New York: W. W. Norton and Company, Inc., \%k) * P. %. 35 dynamic processes through which adjustment is improved. More and more the emphasis is being shifted from diagnosis to therapy, from understanding the individual to interest in the processes through which he may find help. Today the professional worker wants to know how he may become more effective in therapeutic ways in assisting the indi vidual to readjust. Religion has always asked questions. How can I understand the past? How can I have the strength to meet today’s problems? How can I face the future? Psycholo gists have begun to ask some of the same questions. Today the movement is toward merging the insights and aspira tions of religion with the technical knowledge of modern psychology.^ The role of the psychologist in the mental hospital is important. When the health team meets to discuss in dividual patients, the physician looks to the psychologist to report the findings from the various tests, and in addi tion to recommend therapy. Therapy, Carl Rogers^^ says, enables the patient to gain an understanding of himself to a degree which enables him to take positive steps in the light of his own orientation. He begins to have confidence ^Seward Hiltner, Self Understanding (Hew York: Charles Scribner and Sons, p. xii. ^Carl Rogers, Counseling and Psyehotherany Cambridge, Mass.: Houghton MTf f I in Ù ompanyT ï^lf S), p. 18. 36 in himself. Understanding comes as to how he may better handle his own problems and not sidestep them as he has in the past. The Occupational Therapist The place of the occupational therapist on the health team has come to the front during recent wars be cause of the acute problems of rehabilitation. Her ser vices range from the direct physical effect of exercise and muscle-building movements to the psychological value of making articles which demonstrate to the patient himself and to others that he is improving or is at least useful— hence the term "therapy through occupation." To understand the role of the occupational therapist we turn to statements from Marion W. Easton, who is Director of Clinical Training in the Boston School of Occupational Therapy. She is quoted by Belgum: The occupational therapist works directly under the medical supervision of the doctor in carrying out the aim of treatment of the patient. Her function is as broad as the facilities of the hospital and her own ingenuity allow. Mental and physical resources are used to motivate the patient to do his part in his recovery. In this area of treatment, the patient must carry it out, whereas in physical therapy, for example, the treatment is done either for or to the patient. • • • The end product (the article made) is what the patient has his attention focused on, but it is not the main thing. With physical illness, the effects are direct and the therapy prescribed is given to the patient so that he knows what the aim is and why the approach is more indirect. ... The role of the occupational therapist may vary 37 greatly, especially in a mental hospital. It is not always what the therapist chooses, but what the doctor assigns to suit the needs of the patient. So the occupational therapist may be asked to take the part of the mother with one patient and the sister with another. This is indirect psychotherapy. She is channeling the patient’s interests while other members of the health team are looking for the root of his disability or illness. She is considered a person who is interested in helping the patient to help himself .26 According to Miss Easton, the aims of the occupa tional therapist fall under four headings: physical, mental, social-adjustment, and economic. 1. Physical aims necessitate selecting an activity that will improve joint motion, increase muscle strength and work tolerance, and develop co-ordina tion. Here a wide variety of activities are available to suit each individual disability. 2. Mental alms include raising the general morale of the patient so that he may derive the optimum benefit from his hospitalization. An attempt is made to help him adjust to his illness, to allevi ate the mental stress, induce relaxation, or stimulate interest and motivation as is needed in each case. Generally the purpose and aim is to establish as normal a day as possible, which would include work, play, rest, and sleep. Choice of work programs, active and passive recreation depend on the staff and their ingenuity. 3. Social adjustment is broader than the mental aim because it brings into play the forces of inter personal relationships, helping the patient to fit into the social life of the hospital eind subsequently into his own social groups after leaving the hospital. k* Economic aims of occupational therapy seek to make the patient as independent as his capacity will permit, both in the family household and in the economy of the community. For many patients, the ^Belgum, cit., pp. 3k$ 35. 38 test of their own recovery is when they are economicalL^; rehabilitated and able in some degree to turn out use ful work. The activities used to achieve these goals and aims are extremely varied and numerous. Referrals should be specific, but often much is left to the discretion of the occupational therapist. Four general types of activities are used, namely: manual, recreational, prevocational, and educational. 1. Manual activities stimulate the creative interests of the patient in producing a completed article through media of woodworking, metal crafts, leather- work, etc. This is perhaps the most common con ception of occupational therapy. 2. Recreational activities include games, sports, programs, movies, singing and dancing, etc., which combine physical, mental, and social aims at the same time. 3. Prevocational activities test the skills, apti tudes, and Interests of the patient to help to readjust him to a realistic level of rehabilita tion and find for himself his place in society. At this point there is close co-operation and referral to vocational guidance resources. Educational activities include helping patients with correspondence courses, typing, and other projects, so that the patient will not feel that time spent in the hospital has been wasted. This phase would be of special importance in persons whose education is interrupted, and the occupationa. therapist’s part would depend partly upon whether there were special teachers on the staff of the hospital* This is an indication of how far the field of occupational therapy has progressed beyond the hooked-rug and woven-basket stage.27 Occupational therapy utilizes volunteer workers. This leaves the therapist free to do specialized work. These volunteers not only are a blessing to the patient 27lbld.. pp. 35, 36. 39 but serve as a valuable link between the hospital and the eommunity at large. The Physical Therapist The physical therapist is an important member of the medical team. Some hospitals have well equipped physi cal therapy departments. Again it is well to remind the reader that the physician is the head of the health team. The physical therapist carries on his work under the orders of the physician. The following information on the physical therapist is taken from a Physical Therapy Bulletin prepared by the American Physical Therapy Association. Physical Therapy is the art and science dealing with prevention, correction and alleviation of disease and injury by employing manual and other physical means and devices according to the prescription of a physi cian. Physical therapy is prescribed by a general practitioner or a specialist in any of the recognized branches of medicine. The Physical Therapist may be defined as a profes sional person who kas acquired special skills and Judgment through an extended period of specialized study and experience which enable him to devote him self to the practice of physical therapy. He serves with other members of the rehabilitation team to aid the ill and handicapped to achieve maximum restoration of physical function. His endeavors are governed by a code of ethics which include the following principles. 1. He supports the basic principle that the profession of physical therapy is devoted to the best welfare of the patient. 2. He practices according to the prescription of a qualified physician, and he recognizes that the diagnosis of the patient’s condition and statements ko regarding the patient’s prognosis are the direct responsibility of the physician. 3. He assumes responsibilities toward his associates by upholding professional ideals, by performing to the best of his ability, by striving constantly to improve his knowledge and proficiency and by refraining from criticism of his coworkers or the physician in charge of the patient. 1 ) . . He considers it unprofessional to solicit patients, to accept gratuities, and obligates himself to report any instance of unethical practice of which he has knowledge, to the proper authorities The physical therapist is trained for and accepts his role on the healing team. He is made conscious of this relationship. As do the other team members, he has his own special field in which he is the specialist. Some of the most common procedures and treatment applications used by physical therapist are: Diathermy and infrared heat; ultraviolet light. Manual testing of individual and group muscle per formance. Special exercises for conditions such as weak muscles, stiff joints, incoordination, posture, and ante- and post-partum care. Hot and cold baths, packs, and pool treatments. Massage. Special electrical currents for determining muscle and nerve response.29 The physical therapist serves the patient in his psychological problems, aiding the patient in adjusting to new conditions. Many physical handicaps have a sudden and 20 "Physical Therapy, a Career of Science and Ser vice," Prepared by the American Physical Therapy Associa tion, 1957, p. 2. 29lbia., p. 3. kl traumatic onset and some patients find it difficult to adjust to physical limitations and dependency. Oftentimes physical therapy is utilized in motivating and teaching the patient at home; teaching the use and care of braces, wheelchairs, crutches, and other prosthetic devices; ad ministering diagnostic muscle and nerve tests to obtain evaluative datai useful to the physician and other rehabili tation members. Since the physical therapist is relatively young on the health team Information regarding the historical de velopment of this team member, quoted from the same physical therapy bulletin, is of interest: Physical therapy is both a new and old branch of the healing arts. The physical agents employed are as old as time Itself. Early Greek and Roman writings referred to the beneficial effects of sun and water. Both exercise and massage were used by the ancient Chinese, Persians, Egyptians and Greeks for their therapeutic effects. The newness of physical therapy is related to the recognition of its contribution to the practice of modern medicine. The profession was established in England late in the nineteenth century and had its beginning in this country shortly after that date. Orthopedic surgeons, particularly in Boston, New York and Philadelphia, trained young women graduates of schools of physical education to care for patients in doctors’ offices and hospitals. In 1916 when a severe epidemic of polio myelitis struck New York and New England, these young women treated the thousands of paralyzed patients. The first physical therapy course at Walter Reed Army Hospital, Washington, D.C., was organized after world war one. . . . During the past ten years the number of physical therapists has increased to approximately 7*800. k2 Physical therapy is an integral part of medical treat ment in most clinical localities, and the field has become widely recognized as an allied medical service. The growth in members is pictured in the following table: Supply of Physical Therapists Year Active Supply 19# 2,000 1947 3,400 1950 4,600 1953 6,300 1956 7.800 (estimated)3° The foregoing study indicates the place the physical therapist fills on the health team and the growing interest in this field. More physical therapists are still needed. According to a report of the Subcommittee on Para-Medical Personnel in Rehabilitation and Care of the Chronically 111, published in January, 1956,3^ the current need is for 13,600 physical therapists. 3°lbld.. p. 6. p, 7, CHAPTER IV THE CHAPLAIN AND RELIGIOUS COUNSELING The role of the chaplain In the care of the patient is relatively new in many hospitals. The psychological study of religious experience and institutions has con tributed to the clergy’s interest in pastoral care and counseling. More and more, religion is seen, not only as of theological and doctrinal significance, but also as it pertains to the personality needs of the individual in the crises of life, which he is unable to endure alone, apart from God. Being hospitalized, to most people, is a traumatic experience. The patient many times needs support during this sudden transition. Assigned to the receiving ward of a state hospital for clinical training, the writer observed some of the emotional problems through which the patient passes. In the general hospital the crisis is intensified by the patient’s anxiety about his diagnosis and treatment, concern about his family and financial burdens, not to men tion the physical discomfort that may attend his entering the hospital. The hospital crisis offers an opportunity for the church can stand by and aid in guiding the patient through a difficult experience. # Psychology of religion has not only concerned it self with abstract theories, but, lately, especially with the practical relations of physical and mental health to religion. Freud had challenged religion by attributing neuroses to the strictures of religious mores, which caused guilt feelings, repression and frustration of libidinal energy that needed expression. But in the last two or three decades, psychology, psychiatry, social work, and mental health movements have turned to religion to inquire if there were pre ventive or therapeutic elements in wholesome religious experience. With the advent of psychosomatic medicine and a new appreciation of the importance of emotions in bodily functioning, it is little wonder that psy chology of religion has entered this fruitful field of investigation. Christianity, viewed psychologically, strives to ^ equip the individual with spiritual resources to meet the stresses of life with faith, hope, and love, and to provide security, purpose, and wholesome interper sonal relations for his life here and now as well as for eternity. Then when failures, sin, tragedy, and conflict come, he can be redeemed from his predica ment through God’s grace by means of repentance, con fession, and forgiveness; he can be healed and accept the realities of life without bitterness or self-pity. Thus the psychological study of religion deepens our understanding of the significance of pastoral care of those sick in body and mind.1 McNeil’s book,2 shows that the pastoral role has always been a chief foundation of the clergyman. The author quotes Dr. Nolan C. Lewis, a psychiatrist, as saying that, from the dawn of recorded history, medicine was associated with religion.3 ^Belgum, 02# cit., pp. 19, 20. 2 John T. McNeil, A History of the Cure of Souls {New York: Harper and Brothers, 195X) • ^Ibld,. p. 319. k5 McNeil points out that the care of persons suffer» ing from disturbed relationships has been the burden of the ministry throughout the history of the church.4 The clinically trained pastor on the health team is a new development. Pastors who have celebrated their twenty-fifth anniversary of their ordination heard little if anything of pastoral counseling in their seminary days. Today many books have been published on the subject and such periodicals as Pastoral Psychology and The Journal of Pastoral Care now appear. Further, affiliation at centers for clinical training of theological students and pastors, such as theCouncil for Clinical Training and the Insti tute of Pastoral Care* and courses in counseling are now being offered by many theological seminaries. A revival of pastoral service comparable to the revival which has been thriving in the field of religious education within the local church is now well under way. The concern is the outcome of two factors: recognition of the fact that interest in the private concerns of people has been slighted and, of late, development of pastoral approval of the scientific approach.^ It is of interest to note the new direction the ^Ibld.. p. 321. %arl Huf Stolz, Pastoral Psyefaology (New York; Abingdon-Cokesbury Press), p. it. i | - 6 theological seminaries are taking in their coarse offering^ Careful research concerning the role of religion in pre vention and cure of mental illnesses points toward the importance of the minister as a prophylactic and thera peutic agent in the lives of people. Dr. Douglas M. Kelley, professor of psychiatry at the Bowman Gray School of Medicine, says: ”We recognize the minister as one of the first lines of defense in the mental hygiene movement.** It is because of these insights that the curriculums of the Southern Baptist Theological Seminary and others have included courses and procedures of both theoretical and clinical work that will equip the outgoing student to serve on the health team.^ For several years the School of Beligion of the University of Southern California (currently the Southern California School of Theology at Claremont, California) has offered clinical courses for the young minister. Under the direction of David D. Eitzen, professor of pastoral counsel ing and diplomate in clinical psychology, this program gives the student the opportunity to learn about his own dynamics by becoming a "patient” himself in group psycho therapy. These group therapy sessions are led by advanced 6 Wayne E. Oates, "The Role of Religion in Psychoses," Religion and Hyaan Behavior, Simon Doniger, editor (Hew York; Association Press, 19514-), pp. 89, 90. kl students in pastoral counseling, who have previously under gone a therapy experience and have had an experience of supervised counseling. Doctor Eitzen supervises the groups by having regular sessions with the leaders.? These courses being offered in the various semi naries and universities give to the clergyman himself a better understanding of his role. The Cabot-Boisen followers would agree that experi ence for clergy must meet three qualifications to be classed as clinical training; (1) the student must work with people, (2) he must keep records of his work, (3) and must do his work under qualified supervision. . • # The student may learn much from books but we are not satisfied until he studies the living record; the human being.® Clergymen have taken various attitudes toward the development of this new psychology or spiritual counseling. Some have opposed it, some have not been aware of it, others have been deeply concerned about the problems presented to them and have attained valuable insights which aid in giving counsel and guidance to people. Harry Emerson Fosdick and Leslie Weatherhead are two of the leading figures who have used the best of modern psychology 7 Paul S. Hersch, "A Study of Criteria for Guiding the Clergyman in His Care and Referral of Parishioners Who Are in Need of Specialized Counseling or Psychotherapy" (unpublished Ph.D. dissertation. School of Religion, The University of Southern California, Los Angeles, 1958), p. 1%. Û ®Russell Dicks, Pastoral Work and Personal Counsel ing (New York; The Macmillan Company, " 145Ï), P. l2. ............ 48 as well as deeper ministry of religion. Dr. Fosdick is commonly known as one of the greatest preachers of his day. He is known as a teacher, author, and lecturer, but perhaps more significant than anything else has been his personal service to perplexed and needy people. Certain hours each week were set aside for this part of his ministry. The work of Dr. Weatherhead in what he calls his "psychological clinic" has been widely heralded by many writers.9 William Edward Hulme, professor at Wartburg College, states that pastoral counseling as such is not new; Although pastoral counseling is new in its form it is not new in its purpose. The care and cure of souls is as old as the church. The German term seelsorge ( soul care) for example, has a history that daies back to the Reformation and even before. In former days the pastor*s counseling was oriented in pastoral theology; today it centers in pastoral psychology. The impetus for the new movement has come more from the laboratories of the psychological sciences than from the scholarship of theologians. It is a psycho logically oriented seelsorge.lv The pastor* s task of helping is not one which he carries out in isolation. He is not the only one concerned with aiding alcoholics, or tuberculosis patients, or psychoneurotics, or persons with emotional growing pains. The chaplain or pastor has a part to play in the holistic ^Charles P. Kemp, Physicians of the Soul (New York; The Macmillan Company , 1947) > PP• 183^1^1; ^^William E. Hulme, Counseling and Theology (Philadelphia: Muhlenberg Press, l*^5o), pp. l7 57 49 approach to mam and man*a needs. Seward Elltner, associate professor of pastoral theology. Federated Theological Faculty of the University of Chicago, and one who is well » qualified by training and experience in this field, makes this observation: In the first place, all these "sicknesses,” tempo rary or permanent, have psychological or spiritual aspects. Indeed modem medical science has discovered that, directly or indirectly, even many physical dis orders are caused, at least in part, by sick attitudes and sick emotions. If people are sick not only because of germs and falls but also because of short circuits in the emotional hookup, then the pastor, as a repre sentative of ah army of salvation in the realm of the spirit, has to become interested. Besides, there is increasing evidence that some sickness or destructive attitudes involved in sickness can be understood only in a broad time perspective. To put it more simply, people may get sick emotionally, not only because of immediate frustrations, but also because they are troubled about their own meaning and destiny. If this fact does not bring their problems within the pastor* s range of interest and potential capacity to help, then the pastor is no helper at all.H The twofold command of Christ was to preach the gospel and heal the s i c k . 12 a great number in our society are sick with sicknesses ranging from broken arms to de feated creativity. Hiltner suggests these figures: Nearly a fourth of all the men examined for military service during the war were rejected as unfit, and al most half of these because of emotional difficulties. On any one day during the winter at least seven million people in the United States are unable to work, attend llseward Hiltner, Pastoral Counseling (New York: Abingdon-Cokesbury Press, 19441V P* Ï7V l%erk iilk, 15 • 50 school, or pursue their usual activities because of obvious illness, injury or physical impairments. There is a suicide on the average of every twenty- seven minutes. More than a half million people are in mental hospitals at any one time, and more would be there if the therapeutic services were better. There are about three quarters of a million alcohol addicts or chronic alcoholics in the United States, to say nothing of another two million persons who drink so much that scientists class them as excessive drinkers. About 30,000 accidents occur daily. These result in over 1,000,000 deaths and more than 350,000 permanent disabilities a year.13 As medicine gains increasing control over infections and other germ diseases, the number and proportion of people with degenerative types of illness increases. Hiltner calculates that a fifth of the population of the United States is enduring, at any one time, some kind of obvious wastage through handicap, accident, sickness, im prisonment, severe neurosis, and the like.l^ It is for this reason that the church is no longer satisfied merely with spending its time and energy in theological controversies. There are people who are hungering for comfort in sorrow, for freedom from delin quency, and for inward peace. The theological-minded members constitute a minority; the majority of people are burdened with cares, vexations, and obligations,15 13Hiltner, Pastoral Counseling, p. 15. . p. 16. ^^Stolz, og. elt.» p. 19. 51 It Is true that the spiritual worker or counselor on the health team may not deal with the technical aspects of the particular situation, but he will need to deal with people. Dealing with people means dealing with the diffi culty itself, indirectly or directly. It is pertinent to quote here some of the authorities who point out the contributions that religion and the work of the spiritual counselor make for better health. There is no integration which compares with that which comes from religious faith or religious goal, says Dr. Earl D. Bond. I am convinced that the Christian religion is one of the most valuable and potent influences that we possess for producing that harmony and peace of mind . . . needed to bring health and power to a large portion of nervous patients, reports Dr. J. A. Hadfield. Fortunately we are not wholly dependent upon the personal testimony of scientists for our conviction that religion does have a constructive influence for health in the widest and deepest sense. Such quota tions as these, which could be multiplied, perform the service, however, of indicating how we may look for the kind of contribution which religion in practice makes to health. 16 In personal correspondence Everett D. DuVall men tioned to the writer that in his opinion the clergyman holds an important place on the healing team: It may be of interest to you. Vol. 1, page 118, the San Diego County Grand jury letter states that they are of the opinion that the continuous presence of the clergyman at your hospital (Pacific State ^%iltner. Religion and Health, p. 22. 52 Hospital) is an Important factor in safeguarding the welfare of the patient and should he a source of comfort to the patients and relatives.17 DuVall goes on to say that psychotherapy as a part of a positive geriatrics treatment might best be the team assignment of a qualified clergyman. He suggests that the elderly person needs a spiritual element in the essential counseling services. It is significant that the California state hospi tals have placed in their budget a salary which provides a chaplain for each state institution. Although, it is true, the large Los Angeles County Hospital does not pro vide a chaplain as such, it does provide office space and facilities. The chaplain*s salary is paid by the local churches. It is also worthy of notice that in some medical schools religion courses are introduced to the medical and nursing students. In a personal interview, SeSden Marth,^9 who is currently a graduate student at the Southern California School of Theology, Claremont, California, stated to the writer that the administrative board of the ^?Letter from Everett D. DuVall, Former Consultant, Assembly Interim Committee on Social Welfare, California Legislature, April 20, 1958. iBlbld. ^Interview with Selden Martb, gradaat. student at the Southern California School of Theology, Claremont, California, April 22, 1958. 53 Texas Medical Center, located in Houston, Texas, requested the Houston Council of Churches to set up an institution in the Medical Center to provide religious instruction and activity to the students. This is now known as The Insti tute of Religion. It is affiliated with five seminaries in Texas: Presbyterian, Christian, Methodist, Episcopalian, and Baptist. Some of the theological students from the seminary do their clinical work at the Institute of Religior^ and the Texas Medical Center. Granger Westburg, professor of religion and health and associate professor of pastoral care, is carrying on much the same program with medical and nursing students at the University of Chicago. RESOURCES OP THE CHAPLAIN When we think of the physician, we think of the stethoscope; when we think of administrator, we think of the physical plant and the budget ; when we think of the dietitian, we think of food. Just so, when we think of the spiritual worker, immediately certain things come to mind. This does not mean that these resources are the private property of the clergy. Protestantism still stands for the direct relation of man to God, for the priesthood of all believers, and not just the priesthood of the clergy. A surgeon may pray; a psychologist may use a Biblical quotation; a social worker need not be ignorant of the Christian view of the meaning of suffering; a nurse may assist 5k in the administration of the sacraments. But for the most part it is the pastor in whose counseling they can appear as special resources. There are no "hands off" signs on most of them.20 Or again. Not all the resources of the religious worker in ministering to the sick are distinctive resources. That is, not all of them are his peculiar possession. Understanding how to treat the patient as a person is a resource he may share with physician, nurse, or anyone else. The use of listening or quietness are both resources which may be used by others. . . . This point needs emphasis; for many religious workers are inclined to believe that unless the resources they use are distinctive, it is a waste of their time to visit the 111.21 Cabot and Dicks^^ suggest listening, quietness, prayer, the Bible, and the sacraments as resources of the chaplain or pastor. Hiltner^^ adds a fourth, literature. Listening. Since much of the minister’s work con sists of speaking, it is sometimes difficult for him to be a good listener. The people are the listeners while the minister stands before them as the oracle of God. If the Protestant church is to renew its contact and its interest in the care of souls, its ministers must descend from their pulpits and seek out those who are in need. And they must be prepared to listen. Where but in the sickroom does one find those who ^^Èiltner, Pastoral Counseling, p. 189. 21 Hiltner, Religion and Health, pp. 23S, 236. ^^Cabot and Dicks, cit., pp. 189-235. ^%iltner. Pastoral Counseling, p. 210. 55 are "sick and in prison," those who are hungry for companionship, thirsty for affection, afraid, and remorseful? . . . The ability to listen, the courage to face suffering, to hear of loneliness, of boredom, of fears, to take these unto oneself through listening, is like clothes for the naked, shelter for the lost.24 Listening serves two important ends. First, it helps the patient to express. It leads him to form his thoughts. Something new is born in the process. Expres sion creates. Second, besides aiding the patient to better see his problem and in turn accept it, good listen ing enlarges the minister’s understanding of the patient’s feelings. The minister is able to respond to the feelings of the patient, and thus growth takes place. It should be mentioned also that there is a feeling that the patient is accepted when and as the minister listens. Growth takes place when the patient or parishioner feels accepted. The minister’s proper listening builds in the patient more power to meet and to answer the questions which, clearly or obscurely, his illness arouses, questions about the life he has lived, and about the future ahead of him. It has been our experience again and again to listen while the patient described his problems, to be stumped by them and appalled at our own failure, and prudently to keep silence and make no answer till that very silence drew the patient on to say more than he started to say. Soon he begins answering himself better than we could have answered him. Before the end of the visit we have often seen him cheered and enlightened, not by any thing we have said but by our silent interest has led him to discover for himself. And then comes the comic and pathetic farewell, when he thanks us and tells us how much better we have made him feel.25 24cabot and Dicks, cit., p. 190. ^^Ibld.. p. 193. 56 only recently this was demonstrated to the writer. Â wife and young mother came to the office. She poured out her problem. The writer listened. There was no easy solution, no easy answers. When the hour was up, prayer was offered. Just before leaving, the wife said, "Thank you for all the help you have been to me— thanks for listening." Quietness. Spiritual counseling does not always consist of talk. Like music, many times the most beautiful and telling moments are the rests. On one occasion the writer walked down the corridor of a hospital with a husband whose wife had just passed away. There was no talking. This was no time for words. A good rapport had been built during the long illness. Long conversations had taken place, but now death had come and there wasn’t need for much talk. As the two approached the office, the physician on the case approached. "Sorry," he said, placing his hand on the husband’s shoulder. After some time a few words were spoken, then a brief prayer. Later the husband referred to this experience. What made it stand out? Was it the words spoken? No, it was the quiet sharing. Because quietness is a quality of the spirit, it may become a method for its own attainment. Quietness is being quiet, and even more quiet, for always there is a beyond. But quietness is not a moving into the beyond, for quietness is the beyond. Quietness needs 57 no logic, no motion to justify itself, for it stands untouched by the heaping up of mind and matter. In the sickroom quietness may be attained for the patient through the personality of another. Even before one actually enters the sickroom one needs to recognize the difference between quietness and activity. In the very recognition of this difference one begins the stilling of the spirit. When one puts away busi ness and recognizes quietness, one is already becoming quiet. The patient will feel this quietness and will often feel the strength of a growing stillness.26 Cabot and Dickssuggest that the following condi tions seem most favorable to the use of quietness: (1) A satisfactory rapport or working relationship with a patient; (2) a situation where there is considerable stress or tension; (3) the right spiritual condition in the worker. The first condition is a satisfactory rapport, which means simply that the patient likes the worker. He trusts him. He enjoys seeing him. Personality plays an important part. Personality includes knowledge, insight, skill, interest, hope, and devotion. Christianity has its roots in the personality of Jesus. We love the Nazarene, not only because He died for an ideal, albeit an ideal which benefits mankind. We love Him because of the nature He revealed, a nature devoted so profoundly to such an ideal. We love Him because He knew the tendencies of those whom He would help, even as He knew the story of the woman taken in adultery. Yet He did not judge or condemn.28 The second condition is a stress situation. 26ibld., p. 206. 27lbid. 28ibld.. p. 58 Quietness is far better than increasing stress by a repe tition of "What can I do?” or "How do try to relax and go to sleep," Even though the patient does not talk but desires company, one’s presence gives a feeling of confi dence. The very presence of some people is tiring, whereas that of others is restful. Quietness is the difference between the two. grayer. The use of prayer in the sickroom by a second person, the minister, is a method whereby the patient is brought in touch with God. In time of personal crisis many people lose their way religiously and having lost their way, their per sonal crisis deepens, for they have nothing to support them. Most people take their faith for granted and go along fairly well until something happens to them. Then they cannot pray effectively. They cannot pray because they do not really believe in God, or under stand the purpose of prayer. All too often God is thought of as a glorified errand boy, who cometh when we say come and who goeth when we say go.29 The basic question concerning prayer is, "Does it help?" The question so often asked by the patient or the patient’s family is, "If there is a loving God, why doesn’t He do something about this?" Or, "If God loves and if He answers prayer, why does He permit this sickness or death?" grayer will help; but it may not help in the 29 Dicks, cit., p. 66. 59 specific way that often is desired by the supplicant. Prayer is not designed to change the mind of God, for God’s mind does not need to be changed. It is sufficient and creative. Prayer changes our minds. We are strength ened as we come close to His creative mind. The person who prays for health honestly and in humility, assists the health-giving resources already within his body which is God at work. The person who prays for safety is conscious of danger and therefore is more alert and wisely cautious than another.30 It is agreed by Bicks^l and Hiltner32 in this field that certain precautions in prayer should be taken; 1. Prayers for the sick should be short. 2. The voice in prayer should be modulated, easy, and natural. 3. Content of the prayer should have close rela tionship to the present need of the patient. 4* Prayer includes the spiritual needs of patient as well as physical needs. The Bible. The religious worker will use the Bible in counseling. The Bible can be used effectively with the sick, but not wholesale. Perspective, we believe, can be gained through the use of Scripture. Perspective is seeing life steadily and seeing it whole. A philosophy of life we call it. . . .On several occasions I (R.L.D.) have been called at their own request to see patients who were facing surgical operations. . . . In such instances 3°lbld.. p. 69. 31lbld.. p. 71. 3%Htner, Pastoral Counseling, p. 19O, people do not want religion urged or lectured to them. They do not want it in the words of the minister but in terms they have always heard.33 It is in these situations that Psalm 90 may be read. Another beautiful passage of scripture which builds con fidence is Psalm 23. Late one night the writer was called to the hospital to see a patient who was to undergo major surgery, spleen- ectomy, on the following morning. This young wife was five months pregnant. Both she and her husband were afraid she might lose the baby. A brief portion of the Bible read included Romans 8:31. "If God is for us, who is against us." The patient relaxed and went to sleep. The next morning as she was being wheeled to surgery, even when half under sedation, the nurses heard her quoting the text, "If God is for me, who is against me." This is sometimes called Scripture Therapy. There are occasions when a patient would appreciate very much hearing read or quoted a verse of familiar scripture.3^ Oftentimes it is good to suggest that the patient memorize a text of scripture. Religious Literature. Hiltner35 suggests three ways 33cabot and Dicks, og. cit., p. 235. 3^See Appendix A. 35aiitner, Pastoral Counseling, pp. 210, 211. 61 in which religious literature can serve a useful purpose. 1. Specific and discriminating follow-up of the contact. 2. To stimulate religious growth. 3. Informative material. In the chaplain’s office of many hospitals is housed a library from which patients may choose good books. 0ften these books are arranged as a library on wheels. In this way the library is moved from room to room. In addition to books, pamphlets are useful and sometimes more convenient. The pamphlet is lighter and easier for the patient to handle. Too, many patients have asked for the privilege of taking the literature home with them. Small pieces of literature are convenient for this. Belgum points out the necessity of using care in the choice of literature; Religious tracts must be carefully screened and scrutinized because, unfortunately, much of the materi al is inadequate theology and harmful from a mental hygiene point of view. Ho doubt some people feel that when a person is trapped in a hospital bed and con fronted with a serious crisis, the time is ripe for a "decision." Me need to consider the ethical iayplica- tions of the "captive audience" concept in performing our pastoral care for the sick. Chaplains frequently must undo the damage done by careless use of coercive, threatening, and unscriptural devotional literature.36 The same author goes on to explain that there is available a large selection of theologically and psycho logically sound literature. He quotes Chaplain Malcolm B. 36 Belgum, o£. cit., p. 54* Ballinger, of University Hospital, in pointing the seven reasons for such literature being sound aids. 1. It is symbolic of Christian faith. 2. It is tangible, "capable of being touched." 3. It is available when needed by the patient. 4. It may direct the thinking and feeling of the patient when he may be too listless to direct himself. 5. Good devotional literature can answer some questions and help the patient accept his situation and himself. 6. He can share his pamphlet with others, which helps to foster interpersonal relations. 7. It may help the patient verbalize his feelings to the chaplain.37 It should be es^hasized here that the chaplain is a part of the health team. Whatever he does must be for the good of the whole person, in cooperation with the work of other health team members. 3 7 l b l d . CHAPTER V A SURVEY OP SELECTED HOSPITALS This section is concerned with the study of three hospitals. Hospitals of three categories have been chosen— a mental hospital, a general hospital, and an industrial hospital. Observation has given opportunity to see the team at work in the various types of institu tions. In each hospital the various members of the health team have been interviewed. In the interview two definite points have been kept in mind; (1) What members are listed on the health team? (2) How closely are the team members working together in the holistic approach to man’s needs and in what areas is their team participation? It was the goal to see a cross section of patients in each hospital to get from them their reaction to care received at the hospital and whether or not the hospital staff is working simply as individuals or as a therapeutic team. This study was not done at the mental hospital, since the psychiatrist in charge felt that it would be too threatening to the patients to undergo this type of inter view. Hence the patient interview was carried out only in the general and industrial hospitals. The writer feels. however, that this does not detract from the findings of the study. It was evident after interviewing the staff members of the mental hospital, as will be pointed out later in this thesis, that all the personnel were well oriented in the group concept. THE KINGS VIEW HOMES A GHURGH-0JPERAT1D MENTAL HOSPITAL The Kings View Homes,^ located at Reedly, Califor nia, owned and operated by the Mennonite Church, is a non profit psychiatric sanitarium serving short-term patients and offering extended treatment to selected cases. This 30-bed hospital has a distinctive Christian emphasis in treating the mentally ill. Kings View Homes is registered with the American Medical Association and affiliated with the California Hospital Association. The hospital operates under license from the California Department of Mental Hygiene. Kings View Homes admits patients of any creed, race, or color. Admission is open to those with emotional dis turbances. There is a staff of thirty workers. One-third of the staff are professionally trained and the other two-thirds are a highly selected and Chris tian-motivated personnel who are trained for short-term ^See Appendix B. 65 sei*vice. Only highly trained, well qualified doctors are permitted to practice at Kings View Homes. Report on Interview with Staff Members The Administrator. It was refreshing to hear from the administrator a report that was convincing to the writer that he was interested in more than a physical plant, a budget, or rules of operation. These were only necessary tools for the care of patients. It was interest ing to hear that the administrator attended the weekly staff meetings. He was interested in the patient as a whole. He was convinced that a well organized and well defined program made for a contented staff and smooth-run ning program. This in turn makes for better patient care. It was apparent in the interview that he often talked with the other team members outside the regular staff meetings. He was acquainted with the patients and their needs. In cooperation with the doctors and other team mem bers, the doors were never locked; there were no high fences or locked doors. "Seldom," he said, "is the safe locked." He spoke often of the team approach. The Physician. When asked about the team approach and the care of the whole patient, the psychiatrist seemed eager to talk. With enthusiasm he told of the Town Hall Meetings. This was a meeting of the entire working staff which was held each Monday morning from 10:00 to 12:00. 66 Volunteer help was brought In to eare for patients during that period. Each staff member, from the administrator and doctor to the maid and kitchen worker, was expected to be present. Gases were studied and discussed. The physician told how the reports from the maid, the tray girl, the grounds man reported bits of information that would not otherwise have been on the patient’s chart. He told how a certain housekeeper brought certain therapeutic help to many of the patients. "In addition to the Town Hall Meetings each Monday we have three daily discussion groups or group psycho therapy," said the doctor. For this group work the patients were divided into three groups, with staff mem bers joined to the various groups. When asked the reason for the Town Hall Meetings, the doctor responded that these make every worker feel that he has a definite place on the health team. He is more than a peeler of potatoes or a cleaner of floors or a rubber of backs. He is a part of the group that brings physical and spiritual help to those in need. The doctor expressed a desire to find the common ground of religion and health and stated that they were looking for a full-time chaplain. The previous arrange ment for only a part-time chaplain was not satisfactory, for it was impossible for him to attend the Town Hall or staff meetings. This pointed up the doctor’s concern for 67 close teamwork. The Nurse. The nurse who was interviewed was the supervisor of nursing service. She was chosen for two reasons: First, to get her thinking on the importance or the unimportance of the team concept; second, to see how she as the supervisor fits her program into the services of the other team members. When asked about the nursing service to the patients and if she felt the other workers in the institution contributed in the overall care of the patients, her response came immediately. "We have a housekeeper who probably does as much for our guests as any one member of the nursing staff. She not only cleans the rooms, she takes time to listen to the patients’ troubles. She reports to the supervisor any information that would be helpful in caring for the patient. The Town Hall Meetings, the time when all the workers of the institution gather to discuss the patients and patients’ needs, gives opportunity for the nurses to gather information from others. This is placed on a sheet in the patient’s folder." There seemed to be no doubt, in the mind of the director of nursing service as to the advantage of the team plan. Her nurses were not on an island by themselves but were a part of a great team. The Dietitian. For the interview in this area, the 68 writer did not choose to see the dietitian but instead went to the kitchen and talked with the kitchen workers, including those who carried trays to the patients. The first one interviewed was a young woman peeling potatoes. A report of the interview is presented: Interviewer: Worker: Interviewer: Worker: Interviewer: Worker: Interviewer: Worker; Interviewer: Worker: Have you worked long here at Kings View Homes? About six months. Gets pretty monotonous peeling so many potatoes, doesn’t it? Ho, not when you know that so many hungry patients are going to be fed. You mean you’re not peeling potatoes, you are feeding people? That is right. In the kitchen we are made to feel that we play a definite part in the care of patients. Dr. has each one of us attend the weekly staff meetings. We get to know each one of the patients as we listen to the reports of the different workers, You feel, then, that you are a part of the hospital team. Yes, that is why we came herg; my husband and I came here from Canada. He works on the grounds and I work here in the kitchen. They make him feel that he has a part in caring for the patients because he attends the Town Hall Meetings too. Why did you and your husband come here to work? We think God wanted us to come here. This gives us a chance to help people. (She is still peeling potatoes.) There are so many people who need help. This 69 is a way we have of serving God and our church. We only get fifteen dollars a month each and our room and board but we have lots of fun in the dorm. This conversation gives insight into the feeling of the kitchen worker. She was a part of the organization. The other team members gave her this feeling of belonging. Social Worker. Asked his interest in and opinion of the multidiscipline approach in the care of patients, the social worker responded by saying: "In our setup here at the Kings View Homes we find this the only way. Our patients here are for the most part short-stay patients. If the patient comes from a distance, some of the family stay near by. Some of the patients come from shorter dis tances. In either event, often while the patient is being cared for in the institution it is my privilege to work with the members of the family. This means a close working' relationship between my work and the other team members. "At the regular staff meeting or, as we call it, the Town Hall Meetings, I am able to get information that aids me in my work. I would say the team plan works if you work it. The secret of our success here in the multi discipline approach is in the regular weekly meetings where all workers are present and participate in the dis cussion." The social worker went on to say that people from all the department a make ap their health' team. * * Some times,” he said, ”I can do my best work with patients through the other team members* At times my presence with the patients is too threatening, since they know that I am acquainted with and am working with members of the family. I love my work. I see about thirty patients a week. My wife and I prayed that God would direct us to a place where we could serve Him and we feel this is the place!” The Clinical Psychologist. Since the psychologist was away, it was impossible to see him. The writer did, however, talk with the supervisor of nursing service about the psychologist and his work. She explained that he worked very closely with the team. Much of his time was consumed in testing. The results were discussed at the Town Hall Meetings every Monday. In addition to this, he did group therapy and individual counseling. Any informa tion was recorded on the patient#s chart. In a letter to the writer, the administrator of Kings View Homes had the following to say about the role of the psychologist on the team: The psychologist is important in intake, diagnosis and evaluation, and disposition. A large percentage of our outpatients and almost all of our inpatients are given psycholoçicals. The M.M.P.I., the Rorschach, the Wise, and other tests are frequently used. Inter est inventories are also used to a lesser degree. The psychologists on our staff have also been used for psychotherapy, both individual and group. Because 71 we use multiple therapists, involving a larger number of therapists, and because our psychologists have a desire to do therapy, we have used them as therapists. At this time we have only one part-time psycholo gist. The one we had full time is returning to school fof further study. As we get our new building (clinic) and use it, we will have room for two full time psychologists in our program.^ The Therapists. Occupational and play therapy was a part of the program. In this all the workers joined. It was interesting to note that no menial tasks were assigned to the patients. Everything was done to inspire the patient. The entire group of patients, except two who were too ill to go, spent three days camping in the moun tains with nearly all the workers. All the workers men tioned this event to the writer. No doubt the patients would have mentioned it also had the writer been able to see them. This and other events were group participation. The Chaplain. This part of the report points up the feelings at Kings View Homes about the team approach. They had no chaplain. To get the information on this, the writer talked with the psychiatrist. ”We had a chaplain,” he said, ”but it was only on a part-time basis. This was not too bad an arrangement ex cept that it was impossible for him to attend the Town Hall ^Letter from Arthur Jost, Administrator of the Kings View Homes, April 13, 1958. 72 Meetings. Both we and the chaplain felt the services were not too effective since it was impossible for him to share with as and for us to share with him. Now we are all working together endeavoring to carry the spiritual work with the patients.” The following is taken from a letter received at a later date from the administrator: We do not now have a chaplain on our paid staff. As our program develops in the next months we hope to employ one. His functions have been projected as follows: Religious services in the hospital. Consultant to pastors of the Valley who have prob lems and questions about parishioners who appear emotionally ill. Seminars with pastors of the Valley on "Mental Health" and on "Counseling and the Emotionally Dis turbed . " Teaching in our Fresno Seminary (a course on mental health). The chaplain would be a member of the team insofar as his qualifications would permit.3 Patient Interview It was the purpose of the writer to interview patients in the hospitals studied. In this instance, the psychiatrist was not acquainted with the writer and there fore had some reservations as to the wisdom of the pro cedure in this type of institution. It is very possible that patient interview might have been too threatening. This procedure was carried out, however, in the other two hospitals. 'Ibid, 73 THE LOMA LINDA HOSPITAL AND SANITARIUM, A CHURCH-OPERATED GENERAL HOSPITAL The Loma Linda Sanitarium and Hospital^ is a general hospital with a capacity of 165 beds^ ^n^ operated by the Seventh-day Adventist Church. It is a teaching hospital of the College of Medical Evangelists. The College, located on two campuses, Loma Linda and Los Angeles, is an ac credited educational institution for the professions of the health arts and sciences. Its resources include para medical, and two hospitals. The motto of the College is "To make man whole." These are as follows: The Schools The School of Dentistry The School of Medicine The School of Nursing "The School of Dental Hygiene The School of Medical Technology The School of Physical Therapy The School of X-ray Technology The School of Tropical and Preventive Medicine The School of Dietetics The School of Graduate Studies "See Appendix B. The Hospitals The White Memorial Hospital and Clinic The Loma Linda Sanitarium and Hospital The Loma Linda Sanitarium and Hospital, opened in 1905, at present has a capacity of 165 hods, with 60 more rooms to be added in the near future. The writer has interviewed some of the members of the health team and a cross section of the patients in an endeavor to see how well the team concept is being worked. Report on Interview with Staff Members The Administrator. There was a strong feeling on the part of the administrator that the team approach was not being used the most effectively. The administrator is a member of the executive com mittee of staff physicians which meet biweekly. He also meets quarterly with the general staff. The administrator is present for the monthly meetings held by the physicians in their specialized fields, that is, surgery, internal medicine, obstetrics, and so forth. The administrator is chairman of the hospital administrator#s committee, where all the directors of paramedical services meet and the discussion centers about policies and plans that will make for better patient care. The administrator is a member and attends the monthly meeting of all head nurses. The director of nursing service is chairman of this meeting. 75 It is the business of this committee to discuss policies pertaining to patient care, visiting rules and regulations, personnel problems, and problems of the physical plant. The administrator felt that this was a good working com mittee. When asked whether or not the individual patients were discussed, or whether it was a matter of policy per taining to patients, the administrator admitted again, "This, I feel, is one of our weak spots." The administrator had this to say: We need to have here an organization set up where the physician becomes a part of the health team, rather than only the director of patient care. The nursing staff does well in discussing together the problems of each patient, but there is a weakness in the program of not always having the physician present for this discussion. If this is to be accomplished, we must start back in the medical school and nursing school level. It must become a part of the teaching program. The physician must learn in his school days that he is a part of a team. The physician not merely leaving orders for the nurse concerning patient care but the nurse and doctor sharing together. This makes the physician a part of the health team and not simply the director of patient care. To do this there must be regularly scheduled meetings. The physician in charge, with the various members of the healing arts team present, giving free discussion on each case. We are not doing as much at this particular point as we wish we were here in our hospital.5 When asked what contact the administrator or members of the administrative staff have in patient contact, the administrator explained that the manager of patient busi ness took the responsibility of keeping in close contact ^Interview with Clarence Miller, Administrator of Loma Linda Sanitarium and Hospital, March 19# 1958. 76 with the patient and members of the patient's family. Also representing the administrator# the community rela tions officer saw each patient just prior to his dismissal in an endeavor to ascertain the patient's attitude toward the hospital service. The administrator felt that this was a "must" if the hospital is to administer to the patient's needs. In order to make all institutional personnel aware of the need of courtesy, thoughtfulness, and kindness, films are scheduled for them to view. The administration hopes that all workers within the hospital will see regulations and policies simply as guides. That is to say, the patient comes first, and sometimes certain policies need to be set aside in order for the individual patient to receive the best of care. He commented that this takes maturity on the part of workers. The Physician. Since there is no medical super intendent from the hospital# but a president of staffs is chosen periodically# the writer interviewed a physician who had held this elected office. His comments are summed up as follows: A hospital team is composed of individual members. The team will be no stronger than the members; hence if the patient is to be adequately cared for, there must be a personal dedication on the part of each individual. The team will depend upon the individual perspective. If there is to be team spirit there must be first individual spirit. A basketball team wins 77 consistently, not because one star displays unusual ability but because the team members have learned to play together.® The physician's role is one of both a director of patient care and a member of the health team involved in patient care. He expressed a desire to see a program worked out whereby patients with dietary problems could be thrown into close relationship with the dietitian in a sort of occupational therapy program. Or the chronic and tension patient could meet in outdoor clinics working with the gardeners and being taught patio and gardening tech niques. This, too, would be in the field of occupational therapy. The physician felt that the hospital has a long way to go in involving the many team workers in patient care. He felt that the chaplain should be in attendance at all staff meetings, that the chaplain should be often present in the occupational therapy room, that the chaplain and the physician should share with each other patient information. Too many times the physician does not know what the chaplain is doing, and the chaplain does not know what the physician is doing. The physician concluded the interview by saying; If to take care of bodies was my only goal, then I would have been a mortician. As a physician I must be interested in the whole man, his spiritual problems, his emotional problems, and his physical problems. ^Interview with Gordon Thompson, Chief in Internal Medicine, March 11, 1958. 78 Her© the nursing profession, the chaplain's profes sion, and I need to work closely together. We feel that in our hospital we have a long way to go, but we are moving slowly.7 Supervisor of Nursing Service. The supervisor in the interview was careful to point out the plan of organi zation in order to bring to the patient the best of care. She was honest in pointing out the strong places and the weak spots in the nursing service. The writer was in terested in the various committees in which the nursing service was involved; Executive Committee Director of Nursing Service, chairman All supervisors and head nurses Here discussion involves the unit problems and the constant need of improving patient care. Health Education Committee— (meets monthly) Supervisor of Inservice Education, chairman Administrator Director of Nursing Service Physician Chaplain Physical Therapist Outpatient Supervisor Director of Dietary Service 7lbld. 79 Dentist Staff Members from Department of Preventive Medicine, School of Medicine This committee has the responsibility of up-grading personnel, studying ways to provide better patient care as a team, and educating the patient how to cope better with present disease and develop greater insights in pre ventive medicine. In addition to these, there is the Procedure Committee, Policy Committee, Cheer and Get Well Committee, Social Committee, Spiritual Committee. The Director of Nursing Service mentioned that various members of the nursing team serve on the various committees, thus spreading the responsibility. The chaplain is represented on some of these committees. When asked if the director of nursing service was able to make patient contacts, she responded by saying she often does spot visiting, and a great deal of family counseling. When asked if it was her opinion whether or not the hospital was organized in a careful way so that all members of the health team were involved, she replied that she felt there was a definite need of an inter disciplinary committee. On this committee she felt that all disciplines in the field of healing arts should be represented and that this committee should be shared by one of the physicians. It was her opinion that as the "" " 80 cases were studied by this group greater understanding between the team members would be derived. Director of Dietary Service. The response of the director as to her place on the health team and whether or not this church-related general hospital was carrying out a closely related team program is summarized as fol lows: There are regularly scheduled meetings of the dietary service. There was a feeling on the part of the dietitian that a closer working relationship could be main tained by the various paramedical services. The director of dietary service attends the hospital administrator's committee which meets biweekly. There is what is known as grand rounds, which is a weekly meeting attended by the physicians. There, cases are presented and studied. These meetings are not too well attended. Seldom is there any representative from the dietary service. When asked about lines of communication the director of dietary service responded that the physician communi cates his diet prescriptions by contacting direct the office or sending a diet prescription through the Nursing Service. Within the dietary service there are those who make patient contact each day. Special care and direction is given personally by the dietitian to those who are having dietary problems. Otherwise someone from the dietitian's office merely picks up the menu from the 81 patients each day. The dietary staff conduct regularly scheduled staff meetings. It was stated that all the kitchen workers and staff of dietitians meet as a group each morning for morning devotions. When asked by the writer if when at the morning devotions some of the problems of the patients were dis cussed so that the dishwasher, the potato peeler, and every kitchen worker felt that they were involved in, not merely doing routine but in their own way caring for the needs of the people, the dietitian said that this had not been done but felt that this was a suggestion that should be carried through. This, she said, would help each kitchen worker, as well as members on the dietary staff, to become involved in patient care. The writer detected a feeling on the part of the dietitian that the dietitians sensed the need of caring for the whole patient, they felt they were a definite and important part of the hospital team, but it would be well if there were a bit more sharing of mutual information on patients so that they could give them a bit more personal care. Chief Occupational Therapist. The occupational therapist responded to such questions as: Do you feel that the occupational therapist is a definite part of the hospital team? Are you included in various meetings scheduled by the staff? Approximately what per cent of 82 the patients do you work with in occupational therapy? How is your service accepted by the patients and members of the patient's family? Do you think of the work of the occupational therapist as being diversional or functional? To these the occupational therapist responded by saying that there was a feeling that the occupational therapist had a definite place on the health team. It is true the occupational therapist does not see a large per centage of patients, the reason being the short period of the patient's stay. Since there is a trend away from long hospital stay and period of convalescence to that of a brief hospitalization, the occupational therapist does not have many days with the patient. The average patient's stay for the Loma Linda Sanitarium and Hospital last year was three and a half days. In mental institutions or hospitals that are dedicated to the care of long-time patients, the picture is considerably changed. This does not lessen the role of the occupational therapist in the general hospital. About ten per cent of the patients here come to the occupational therapy room or else the project is carried on by the patient from his own bed. No patient becomes involved in any type of occupational therapy with out a prescription from the physician in charge. The physician furnishes this prescription. Regular prescrip tion blanks are filled out by a physician of the Physical Medicine and Rehabilitation Service or the charge nurse. 83 according to the instruction of the physician. The occupational therapist is at the mercy of the physicians, nurses, and other hospital workers for the success of her program. First, the doctor prescribes. Even though the doctor prescribes occupational therapy, some patients feel that they do not care to participate. It is the nurse then who suggests and encourages the patient to take part in the occupational therapy. Polders suggesting various types of occupational therapy are placed on the trays of the patients. There is a feeling that there could be a little closer cooperation between the medical staff and the occupational therapy service. Some of the physicians are not aware of the program that is carried on. Some do not sense the need of involving the patient in this type of program. The writer of this thesis sensed a feeling of a need on the part of the occupational therapist for a regularly scheduled physicians* conference at which the occupational therapist would be present. At the present times these meetings are held only occasionally. It was felt that the occupational therapist could fit into the overall plan better if all the nurses were aware of and convinced of the Importance of the program in occupational therapy. If they could see the need for some patients from the standpoint that occupational therapy would be diversional, this would have a tendency to break the 6 1 ^ boredom that comes from being hospitalized. Nurses also need to understand that to some patients this is a func tional program, it was felt. It would be advantageous for someone from the chaplain's office occasionally |o join patients in the occupational therapy room, work alongside and communicate in an indirect way with the patients who are working on the projects. The writer sensed a desire on the part of the occupational therapist for a little closer relationship with reference to her work and that of other team members. Chief Physical Therapist. The chief physical therapist mentioned that membership on the health education committee put him in close contact with the other para medical services. He is also invited to the weekly pro fessional nurses meeting and the their study is given for the purpose of integrating physical therapy along with nursing care. Often the physical therapist meets with the weekly team captains* meetings. Within the physical therapy service there are regularly scheduled weekly staff meetings. The chief physical therapist is in charge. The physician who is the chief of service in physical medicine and rehabilitation is always present. Various cases are presented along with the demonstration of treatments and exercises. The physical therapist is directly responsible to the physician. The type of treatment prescribed is __ _ written on the chart. The nurse then copies the treatment prescription and passes it on to the physical therapy The chief physical therapist was appreciative of the cooperation of the chaplain's office. The chaplain met with the physical therapists regularly in their staff meetings. The writer sensed a feeling of need on the part of the physical therapist for an inter-disciplinary com mittee where all the professional services would get to gether to discuss the various needs of the patient. The Chaplain. The work of the chaplain fills an important place in the overall care of the patients at the Loma Linda Sanitarium and Hospital. The chaplain's quarters consist of two offices situated next to the lounge From the lounge are conducted devotional periods each morning and each evening. The devotional messages coming from the chaplains are patient-centered. In addition to the two offices and the use of the lounge, there is the control room where is stored the public address equipment used for carrying the devotional messages, music, and other programs to the patients. Each bed is equipped with ear phones. There are three members on the chaplain's staff who spend their full time with patients in the hospital. In addition to this there is one worker who goes out into the 66 homes of former patients. There was a feeling throughout the various disci plines of the hospital that the chaplain plays a very definite part in patient care. The chaplain is named on various committees which give study on policies which would improve patient care. He is a member of the health education committee. It is a part of the work of this committee to choose speakers who will bring health talks to patients at the evening devotional time twice weekly. This ties in a close relationship between the physicians, the nurses, the dietitians, in fact all team members to the chaplain's office, inasmuch as there is a sharing of these talks. Each head nurse has a supply of forms on which it is convenient for the nurse to request the chaplain to see certain patients. Information is given as to some of the backgrounds and needs as to this patient for the informa tion of the chaplain. The chaplain felt there is some weakness in that there are no meetings of the various disciplines scheduled at which patients are discussed. He felt that other mem bers of the team would be able to share with him informa tion that would aid him in his patient care, and in turn he would be able to make some contribution to them. To overcome this weakness, however, the physicians often contact the chaplain's office directly to give information 87 on the patient that would make for better care. The same is true of the nursing service. The chaplain often stops at the desk of a head nurse and she gives him valuable assistance. He mentioned that, although the nurses are conscientious in reminding the patients of the worship schedule and assisting them in reaching the earphones, the nursing care, the hydrotherapy schedule, and the physicians* rounds often interfere with the scheduled period of devo tion. The chaplain also stated that the nurses and other team members often mentioned the availability of good reading from the chaplain's office. When asked what was being done by the chaplain's office in the way of an educational program to bring greater insights to the various team members as to the importance of spiritual therapy, the chaplain replied by saying that each nurse in her training spends one week in the chaplain's office reading the literature in the field, seeing patients with some of the members of the staff, and evaluating by paper the experience there. In addition to this, lectures are given to the medical students pointing up the importance of spiritual therapy. The chaplain's office has plans for a ministerial workshop at which the ministers in the area will join with a group of physicians in the study of a better ministry for the sick. 88 Patient Interviews The writer wants it to be clear that the guide she et^ was not used as a questionnaire but only as a guide. The interviews with the patients were not a formal type of interview in which the patient answered "yes,” "no,” or "sometimes.” It was the Intent on the part of the writer to have the visit informal and free-flowing, hoping to cover at least some of the points in the guide sheet. Patient. Approximately k-S years of age. Nervous ness, resulting in stomach ulcers was his problem. The patient spoke rather fluently of the care he was receiving at the hospital. He mentioned various members of the health team in the conversation and was appreciative of the concern of each one. "I am not a Seventh-day Adventist," he said, "but I do appreciate the Christian atmosphere and the concern over me as a patient that I find in this institution." Patient. Approximately 35 years of age. A profes sor of music from a nearby university, stricken with poliomyelitis and paralyzed from the hips down; a mother of two children. The patient seemed to be well adjusted emotionally &See Appendix C. 69 and was accepting her disease courageously. She felt that it was a problem that she and God would need to work out and appreciated the encouragement she was receiving from the chaplain's office, the nursing staff, her physician, the dietitian, and others. Especially was she appreciative of the evening prayers of the nursing students each night just before going to sleep. In her own words, "It is the wonderful Christian atmosphere of this Christian institu tion that is helping me to face my problems." Patient. Approximately 60 years of age. The patient had been in the hospital only a short time but expressed his feelings of appreciation for the warmth on the part of the admitting staff. He said that the physician in charge seemed to be very thorough and that those working with him were taking a personal interest in him as a patient. Patient. Approximately 6$, hospitalized because of several heart attacks. Left the hospital immediately following my visit. He commented that after nearing recovery he was informed by his physician of his narrow escape from death, and he was extremely appreciative of the physician's care. He mentioned that five years ago he was hospitalized here and had one lung removed and that his wife had died here in the hospital approximately one year later. He felt that the various services had cooperated 9Ô for his recovery. The chaplain dropped in for a few moments each day. The dietitians called regularly. The nursing service was adequate, suid especially did he appreciate the nursing students. He commented that the entire team seemed to be working together in his behalf. Patient. Approximately 50 years of age and former dietitian of this institution, I purposely chose this ease because I felt we might get a different story from one who had been an "insider." I began the interview by saying, "Tell me, do you feel that you are receiving as good care as the patients received when you were here on the staff as dietitian?" Enthusiastically she replied by saying, "Certainly, the meals are tastily prepared and the dietitians have been very kind to me. The nurses have been so kind and attentive, and I know they are all working with my doctor to give me the best care possible. Patient. An obstetrical patient, has a baby boy in the nursery and both doing fine. She was exuberant in her expressions of gratitude for the care that both she and the baby were receiving. The bill was paid, the baby boy had arrived, and there were really stars in her sky. She was happy and loving, and in turn everyone enjoyed caring for her. There was no question in her mind that the whole staff, from the delivery room to the chaplain's office. 9i were sharing with her the joys of new motherhood. Patient. Approximately 55 years of age; in for general checkup for nervousness. The patient spoke of many tests that she received during her stay here and the kindly attitude and the personal interest taken in her by everyone, from the laboratory technicians to her own physician. She spoke of the exactness and thoroughness of the examination, how she was pleased with the combined efforts of those who served her. Patient. Approximately 32 years of age, under the care of a general practitioner and urologist. Near the beginning of the interview he expressed his feelings in this way: "I find that both of my physicians are very thorough. I have been having difficulty with my kidneys and bladder for some time. Various doctors had been unable to locate the difficulty. These two men, after very care ful exeunination, gmd various tests, seemed to have diagnosed my trouble correctly. I have no complaints, and I wish to state that all of those who have to do with my care are really doing a good job." Patient. A man of approximately 50 years of age. He came into the hospital with a skin irritation and was under care of a dermatologist. His reaction is summarized partially in his own words and partially in the language of 92 the writer: "I didn't want to come here," he said. "I lived fifty-two years and have never been in a hospital for amything in my life. I knew something about the rules of this institution, and I wasn't too hepped up with the idea of coming to a place where I could not smoke. But you know, something strange has happened to me, I know that there are places here where one can smoke, but frankly I have never felt that I needed to smoke since coming to this hospital. The care that I have received has been excellent. At first I had a terrible appetite and could not seem to get enough to eat. After I regis tered this complaint, the dietitian came in with each meal and checked with me. I seemed to have overcome this terrible hunger and find the food very tasty. Maybe its because the dietitian has taken such a personal interest in me," He went on to express appreciation for the thought fulness and insights of the management in arranging such a smooth-running program and for the complete cooperation between the healing arts staff, from the janitor on through to the physician and administrator. "If I have to be sick," he concluded, "this place is good enough for me." Patient. A young woman of approximately 25, ex periencing some emotional difficulty, at the present time 93 under the care of an internist and a psychiatrist, had taken some shock therapy and was a bit weepy when I entered the room. To sum up her evaluation of the care received at the hospital: She was extremely appreciative of the interest and care manifested on the part of both the in ternist and the psychiatrist. This patient mentioned the attitude of the maids who came in to clean her room. They were especially kind. Someone from the dietitian's office made daily calls. She referred to the help that she re ceived from the occupational therapist. Her painting materials were close by the bed. "There seems to be such a unity here," she said, "among all of the workers. I feel that they are interested in me as a person. I guess ray difficulty is that I am trying so hard to be perfect and I know I am not making it. My parents are Jehovah's Witnesses, and I guess part of my trouble is that I am trying to put on a form of religion on the outside but am rebelling on the inside. I guess you just have to be yourself, don't you?" She said further that the chaplain had not been calling on her and perhaps it was just as well because she wondered if she hadn't been worrying and thinking too much about religion. She was deeply appreciative of the fact that all the workers had taken a genuine interest in her as a person. 9J+ Patient. This patient, a student nurse and had had some bedside nursing experience. She has been in the hospital fifteen weeks. "I have been in this old hospital for fifteen weeks and I hate it," was the beginning statement coming from the lips of this patient. "At $300 a week how can I ever expect to pay this bill? and I don't think I am getting any better either. The doctor that I have now I cannot talk with. I tell him I want certain medicines but he won't give them to me." "Do you feel," I asked the patient, "that you are receiving the care that you think you should?" She responded by saying, "Well, they certainly don't give" me the care that I gave my patients." We could sum up the remaining part of the interview with these thoughts. The patient frankly was discouraged because of her long illness. She was within three weeks of completing her course work to qualify as a registered nurse. She stated that she would not be able to take her state board examinations because of this illness for some time in the future; and because of this, discouragement was overwhelming. She went on to say that she felt the nurses, the physical therapists, the dietitian, in fact the various members of the health team were doing what they could for her, but there was no understanding attitude on the part of the physician. According to her, the 9g physician had told her he was interested in hearing her story but he was not the slightest bit interested in her prescribing the type of medication she should receive. This approach seemed more than her present emotional state could take. It was evident that because of her present emotional situation it was hard for her to know in her own mind just the type of care she was receiving and how well the medical group were working together. Patient. A sweet little lady of approximately 70. Had been successful in business and at present is well off financially. Over the past several years arthritis had been giving her a great deal of pain so that she had been taking large doses of cortisone. Recently she had under gone surgery at the hospital. At the present time she was not responding too rapidly* Her response was brief but to the point: ”I am receiving loving care here at this hospital. The Christian atmosphere is so delightful. The doctors, nurses, dietitians, in fact the entire staff are trying to give me the best they have. I am so grateful for it." Patient. A woman of approximately k$9 residence in Las Vegas, formerly of Fontana, and a graduate nurse. She had been a patient at this hospital several times previ ously. Before her husband» s death he too had been hospitalized here. A kidney infection had been diagnosed. On entering the room I introduced myself as the chaplain and made known to her that I was preparing a study on the attitudes of patients toward the services rendered in this hospital. The patient very enthusiasti cally participated. "I am a registered nurse and should know something about hospitals. I have been hospitalized in other hospitals, but from now on I will come to Loma Linda. Because of my recommendation many of the people of Las Vegas have come to this institution. I appreciate very much the professional devotion of my doctor. I was his office nurse when he first opened his office in Fontana. From the beginning he brought his patients to this hospital and has told me many times how well pleased he is with the service here. There seems to be such a devotion to the patient as a person. My doctor has called in a consulting physician, one who is a specialist in urology. As a nurse I have gone with patients to many hospitals, and what I appreciate here is that there seems to be a complete harmony and cooperation between the various team members." I asked the patient regarding the dietary services. To this she responded by saying, "Someone from the dietitian# 8 office comes in each day and takes such a personal interest in me. I will confess that the complete veget€u?ian diet is a little different from that which I am 97 used to, but the trays are prepared in such an appetizing way I hardly miss the meat dishes. Many of my friends ask me why I go to the Loma Linda Hospital when you can#t smoke, you can*t have coffee, and they don#t serve meat. I always tell them that if you want coffee you can take your instant coffee with you and if you insist on smoking there are places provided for that. And if your doctor thinks that meat is needed he will prescribe it for you and it will be served. I always tell them that the service far outweighs some of those insignificant things when you are sick or need real care. Everybody here seems to be interested in me as a person." Patient. A man who lives approximately one hundred miles north of Loma Linda. This is the second time he has been in our hospital. He is an asthmatic patient. This difficulty, coupled with a chest cold, was giving him serious difficulty in breathing. The patient is approxi mately ii-5 years of age. "This is ray second visit to your hospital. The physician I had before is no longer here; so I had to take the doctor they assigned to me." I then asked the patient how he felt about his present hospitalization. He replied, "The medicine and treatment that this new doctor has prescribed have helped me very much. I had been doctoring at home for about two 98 weeks, but it seemed as though I continued to grow worse. Within two days after this new doctor had put me on this new treatment I began to gain. I hope to be able to go home tomorrow." There was a slight pause and then the patient con tinued. "I will admit that I have been a little disap pointed in this doctor. He has not come into the room as often as I thought he should. I understand that today he is examining school children. I know that is important, but I still think he should be able to take care of the patients that are his." I responded to his statement by saying, "You feel then that perhaps on this visit you have been a bit neg lected." "I do not want to be critical," he said, "for certainly this doctor has prescribed the very thing that I needed and has brought the desired results. The entire staff here have worked closely with him. The physical therapists, under his direction, have taken a personal interest in me. I feel that it was largely the prescrip tions prescribed by the doctor and the treatments given by the physical therapists that have done so much in bringing about my improvement. I appreciate very much the atmos phere of your entire hospital. It seems to be a dedication on the part of all to serve." 99 Patient. A man approximately 55 years of age. A year and a half ago lung cancer was discovered. At that time one lung was removed. This patient#s attitude toward the care received from the workers at the hospital was expressed as follows: "I owe my life to my doctor and these nurses here at your hospital," said the patient. "All my life I have been a heavy smoker, averaging one pack a day. With only one lung I have a great deal of difficulty breathing, especially when I get a cold in my chest. I called the doctor, he put me in his car, and in eleven minutes we were here at the hospital where I was immediately given oxygen to aid in my breathing. I was so appreciative of the way the doctor and nurses worked together. This is the second time I have been in your hospital. It is so peaceful and quiet here. The entire stsiff seems to be working together for one common goal and that is to help each patient." "Do you feel," I asked the patient, "that there is a harmonious working together of the various workers here in the hospital?" "That is what I mean. The entire staff seemed to take a personal interest in me, and if I ever need hospi talization again I hope I can have the same physician and the same hospital services." 100 THE KAISER POHNDATIOH AN INDUSTRIAL GENERAL HOSPITAL The Kaiser Foundation Hospital^ is a beautiful, modern one-story general hospital located in Fontana, California. Eighty-two per cent of the patients cared for at this hospital are covered by the Kaiser Foundation Health Plan. This makes this institution unique. The remaining eighteen per cent are covered by other types of insurances or cover their own expense. The writer was interested in comparing this type of hospital, where such a large majority are covered with a hospital insurance plan, with an institution where the majority are responsible for their own financial arrange ments. That is to say, is the patient care less personal? How well is the team concept accepted in this type of hospital? Report on Interview with Staff Members The Administrator. Both the administrator and the business manager, who seemed to work very closely were interviewed. From the conversation it was evident that business manager and the administrator had insights and were definitely interested in maintaining a close ^See Appendix B. 101 relationship between all team members in the institution. In order to make plain the various roles and responsibili ties of those within the hospital, the administrator held department head meetings biweekly. Those who made up this department head group were as follows: Administrator, chairman Supervisor of outpatient nursing Maintenance engineer Obstetrics Supervisor Operating Room Supervisor Medical Records Librarian Stores and Purchasing Agent Head Housekeeper Director of Nurses Business Manager Assistant Director of Nurses Night Supervisor Recording Secretary The administrator felt that these biweekly meetings were important in that they kept him on a scheduled contact with all departments in the hospital. This, as it was pointed out earlier in this thesis, is the chief task of the administrator. That is, keeping all the departments running smoothly and the workers under the department heads satisfied. In turn, this makes for better patient care. The administrator had concern for the patients* welfare and felt that this careful organization meant for a better working together of the group. The Physician. The chief of staff was interviewed. Inasmuch as this physician had been with the institution for a long period of time, his comments were of special interest. The questions asked were: Do you feel that the workers here at your hospital are in agreement with the concept of ministering to man in his totality? Do you feel that the physician is in charge of patient care, a member of an overall health team, or both? Do you feel that the various disciplines within the hospital are work ing together as a team? Do you have any basis for evaluat* ing the feelings of the patient? The physician jotted these questions down. The following is a summary of his answers: He stated that there is acceptance of the team plan program. In the various group discussions there is an endeavor to keep always at the front the fact that no worker stands alone. There is an endeavor on the part of all disciplines or departments to make the patient feel aware of the fact that we are interested in him as an individual. The physician does not shift his responsibil ity to other Individuals. He further stated that the physician is director of patient care and also a member 103 of the health team. That is to say, he is responsible for the patient; but if he does not work with the team the patient is not receiving the care that he should. As to the team* s cooperation in working together, he stated that there is on the team an excellent group of nurses with whom we discuss the various patients. The physician often discusses with the physical therapist the various types of treatments for the patient. There are approximately forty physicians on the staff. In the section meetings, oftentimes when a patient is being dis cussed, some other member of the healing arts team is called in. The physicians work closely with the dietitians on diet problems. With reference to the situation on the part of the patients, the chief of staff mentioned a grievance com mittee, made up of workers from the steel workers union, clerical workers union, and two or three chosen from the hospital staff. In this method it was felt that they kept close tab on patients* reactions. Director of Nurses. The director of nurses in attempting to make plain the organization of the hospital explained that there were five active units in the hospi tal. Upon being asked how the nursing staff is organized for close cooperation and in turn with reference to their tie-in to the other workers of the hospital, the director iW of nurses presented the following picture: All supervisors meet twice daily in the office of the director of nurses. That is to say, the 11:00 to 7:00 supervisors meet with the JiQQ to 3:00 supervisors at 6:30 A.M. The same procedure is repeated at 2:30 P.M. Immediately following this thirty-minute conference, each supervisor meets with the entire group of registered nurses, licensed vocational nurses, orderlies, and nurse aides, on her unit. The director of nurses pointed out that each super visor* s meeting was taken down on tape and permanent records were made of any discussion held there. This, she said, makes for better patient care and less misunderstandings. If there is a problem regarding housekeeping, the head housekeeper is called in and the problem is discussed with the director of nurses. This same procedure is carried out with other departments where there may develop irregu larities. In order to work with the entire team and to give the best care to the patients, the director or nurses pointed out that in the daily conference with all the nursing staff each supervisor was instructed by the di rector of nurses, on the necessity of personal patient care and the importance of working closely with the physicians, the dietitians, and other team members. The director of nurses pointed out that she held many confer ences with family members of the patients. This she felt 105 was Important. When asked about the religious care of the patients and whether or not she felt that the chaplain had a part on the health team, the director of nurses responded by saying that there was a feeling that this area of our medical services is unorganized. The ministers from the various churches take c^e of the spiritual needs of their own members. It is realized, however, this is sporadic, and many who come to the hospital are not connected with the church in any way. It would be well if at least the critically ill patients could have the assurance that comes with pastoral care. The director of nurses has instructions to notify the priest when there is a critical condition on the part of a Roman Catholic patient. This same request has not come from the protestant ministers. The director of nurses went on to point out that nursing service is not always aware of the desperate feeling that comes over the patient should he have to die alone. It would be advantageous if there could be on call a religious worker to stand by, especially in time of need. That is to say nothing of the religious counseling that could be done with both patients and family. The director of nurses spoke highly of the close cooperation between the nursing service and the other hospital workers. " - - - 106 The Dietitian. The dietitian pointed out that much of the success of the dietary department depended upon the good relationships that existed between their department and the other departments and workers of the institution. The dietitian is always present for the department head meetings. Space on the agenda and time for discussion are available for any problems concerning the dietetic ser vice. When asked about the lines of communication between her department and other departments and the opportunities that came to her to stay close to the other team members, she replied by saying that this is done through the de partment heads meetings, personal contact on the floors with the other team members, by the dietary information on the charts as recorded by the nurses, and often by telephone conversation with the doctor when he gives his dietary prescription direct to the dietitian*s office. The head dietitian pointed out that the delivering of the trays to the patients was done by nursing service, and the acceptance or rejection of the food depended largely upon the attitude and cooperation of nursing ser vice. If the food was not of the patient*s choice, the one who received the complaint reported it back to the supervisor. Either the supervisor explained the reason for this diet to this patient, or she reported to the dietitian*8 office and a visit was made. She went on to suggest that she felt in the hospital to a certain degree 107 there was a team concept euid hoped that more of this could be accomplished. Physical Therapist. The physical therapy depart ment is an active department at the Kaiser Hospital. There is a staff of three regular physical therapists and two physical therapy aides who have been trained there. Last year, however, only ten per cent of the patients were inpatients. By far a majority of those were not hospital ized but continue to come for their physical therapy treatments. When the chief physical therapist was asked her feeling as to whether or not the physical therapist played an important part on the health team, her response was an enthusiastic "yes." When asked if the other team members in their attitude and cooperation accepted the physical therapist as a team member, her response could be summed up as follows: We are completely dependent upon the physician sind nursing profession. Under the law we are permitted to give no treatments without doctors* prescription. Regular prescription blanks are prepared and placed on each physician*s desk. These are filled out by the physician and placed with the patient’s chart. When the patient is sent to our department, this prescription accompanies him. When patients are discussed, the physician calls in not only the nurse but the physical therapist as well. 106 The physicians are very willing to prescribe physical therapy for their patients, but many of them have not been trained in physical medicine and frankly do not know too much about physical therapy. The physical therapist mentioned that often she was called in by the physician and told certain problems of the patient, but the physician was completely dependent upon the therapist as to what type of treatment should be prescribed. There was a feeling on the part of the physical therapist that more training should be given to medical students as to the proper place of physical therapy, that the physical therapist work would never be appreciated nor understood until during the training period the doctor himself became better informed. There was no feeling whatsoever on the part of the chief therapist that the physician or the nurses were not interested in the physical therapy care but that it was a matter of their not being properly in formed as to the place and importance of physical therapy. Mention was made of the emotional problems that often accompany those who need physical therapy. The physical therapist suggested that it was their privilege to work not only with limbs, backs, and other parts of the body but with the emotional and spiritual side of man as well. The chief therapist was very alert and certainly had keen insights as to the value of the entire health team working in close harmony. 109 The Chaplain, The Kaiser Hospital has no chaplain on its staff. From the administrator down, it was evident that they were interested in this type of service and felt that the spiritual side of the patient should not be over looked, The various pastors, priests, and rabbis in the area served their own parishioners. Patient Interviews The same type of interview guide was used bn the following patients as was used in the foregoing study,10 Patient, Approximately 55 years of age. Had been in the hospital for sixty-five days. On the day of his surgery, which lasted seven hours, his wife died of a heart attack. The patient was emotional; hence the inter view moved slowly. Because of the long illness, the patient was now concerned about his finances. He mentioned jthat his insurance had long since run out. The patient was asked if he was being pressed unduly so that worry was retarding his convalescence. He felt that the hospital Ldministration and business manager both were very under- Ltanding, that the physician had been thoughtful and con- Liderate, and that the nurses had taken a personal interest Ln him. He was confident that they were all working to gether for his best good. At the close of the visit the writer asked, because of the emotional tension the patient was under, if he would like to have prayer together. To l^See Appendix C, 110 this he responded In the affirmative, and after the prayer he said everyone had been so kind to him. Patient, Approximately $0 years of age. An ambu lance driver. He had brought many patients to the Kaiser Hospital in Fontana, He said that he never suspected that he would be a patient, however. This was a rewarding interview because of the patient’s close contact with the physical therapy department because of an injury to his right arm. He said the physical therapy department was treating him three times a day. It was his opinion that the therapist, the doctor, and the nurse were all working very closely together in his behalf. Patient, Approximately 35 years of age. It was not until the interview began that it was discovered that this patient worked in the medical records office of the Kaiser Hospital, It was of interest to learn the attitude of this patient from the standpoint of a worker and a patient. She thought that the work of the medical records office was an important part of the overall hospital program and seemed to be happy that she had a part in caring for the inpatients and outpatients of the Kaiser Hospital, She was asked from the standpoint of both patient and worker whether the fact that all patients are insurance patients, jmade the patients seem any less personal to her, or Ill whether, as a patient, she felt that the health team was any less interested in her as a person. Her comment was that from the administrator down there was such a pleasant working relationship that each one regarded his work as a challenge, that they all felt they had a definite part in caring for people, and that now as a patient she could feel that spirit filtrating through the various personnel to her. From where she sat as a worker and from where she was lying as a patient, she felt the cooperation of all workers of the health team was very effective. The best proof of this, she said, "almost one hundred per cent of the patients glory over the care that they receive." Patient. Approximately 70 years of age. Wife was seated in the room with him. Had had twelve blood trans fusions. Felt that now the doctors had discovered his difficulty. Both patient emd wife were very enthusiastic in sipging the praises of the physician, nurse, and dietitian. There was no occasion for this patient to have come in contact with the physical therapist. Patient, Gentleman approximately %5 years of age, Employee of the Kaiser Steel Company, and, as the majority of patients at the hospital, insured by the Kaiser health olan. The patient had been in the hospital approximately ■;wo weeks. The attitude of this patient was of interest since he was covered by this health plan. The patient was 112 effervescent in his response. "I do not know how I could have received better care. The entire working staff seemed to take a personal interest in me. My physician goes to no end to care for my physical needs, and even beyond that he seems interested in me personally. I.:feel that the entire working staff is doing an excellent job here." Patient. Approximately 50 years of age, a publisher who had spent time in various hospitals. This patient was in a position to make some comparisons. He frankly ad mitted that this institution was not quite like the hospi tal in Pomona but was quick to say that the charges were not the same either. He had been a patient at Loma Linda Sanitarium and Hospital, where he felt that there were spiritual aspects of care that were not present at the Kaiser Hospital. He made some mention of the physical plant and mentioned some of the earmarks of an industrial institution as distinguished from a church-related insti tution but was quick to say this in no way cast a reflec tion on the purpose and the work that is being carried on by the Kaiser Foundation Hospital, So far as he could see from his bed, he felt there was complete unity on the part of the staff of workers. They were working together in a team situation. The patient seemed to be extremely appreciative of the efforts put forth by all the workers. 113 Patient, A woman approximately IfO years of age, whose husband has been a partial invalid for the past several years. According to the report from the nursing office this patient was an alcoholic and during her stay had been somewhat of a problem patient. The supervisor was anxious that this patient be interviewed. The patient was found to be cheerful, which was surprising after the report from the nurses* staff. Her chief complaint was not with the nurses or the diet department. She felt that the maids and the other workers were very patient and understanding. She did have some complaint with reference to the physician. She felt that he was in too big a hurry and did not seem to be interested in her or her problems. To quote her exact words: "I appreciate the interest that has been taken in me as a patient by the entire staff of workers with the exception of my doctor, I feel that he could be a bit more understanding," Patient. A woman approximately 35 years of age, had been in the hospital nearly two weeks because of a slipped disc. The patient was very pleasant, easy to talk with, and felt that everyone had been kind to her and was doing everything to make her comfortable. She seemed apprehensive and had a desire to ascertain from the writer information regarding those with similar physical difficulty. To these questions the writer asked if she had lilt discussed the matter with her physician. The writer sensed that because of her apprehensiveness that she had talked with the many workers about it but that she needed reassurance. It was gathered from her visit that she felt the workers were doing everything that could be done to make her stay profitable. Patient, A man approximately k5 years of age. Since his wife was present with him, the visit was short, but the information gained was sufficient to reveal his attitude. The first question was, "How are we treating you?" The patient responded by saying, "If I had a million dollars and was paying every cent to these workers here, they couldn*t treat me any better," The patient*s wife responded by saying "Me are so pleased with the interest the nurses— in fact all the workers— take in my husband. It is so wonderful when one is sick to be placed in such kindly care," Mention was further made of the kindness and con sideration shown on the part of those who cleaned the rooms. There was no question in the patient* s mind of the thoughtfulness and dedication on the part of the many workers• Patient, A woman approximately 50 years of age. As the result of a car accident had been hospitalized approximataLy nine months. Even though the patient had 115 spent a long-drawn-out period of hospitalization, she was of good spirits and in the mood for talking. The patient told how after the accident the doctor stood faithfully by and, with the nurses, through it all had been so kind. Special dietary services were needed because of her injured jawbone. The physical therapists were mentioned because of their friendly, kindly attitude and efficiency. When asked about the spiritual work done within the hospital, the patient responded by saying, "While there is no chaplain here in the hospital, the entire working staff is very cooperative and permitted my minister to come to see me regularly," In her own words the patient said, "My minister has not missed once in his weekly visits here to my room. You do not understand how much it means to a patient who is flat on his back for over so long a period of time to have many people take a personal interest in him," Patient, A woman approximately 65. This patient responded to queries very pleasantly. She did mention, however, that the lady in the room with her would know much more about patient care than she, inasmuch as her roommate had been in the hospital over nine months. The patient commented that she had been there only three days with a fractured limb but surely felt that the nursing staff were gentle, thoughtful, and kind. She said, "Everyone here in the hospital has been so very kind to me." 116 Patient, A woman approximately 55» hospitalized at Kaiser for the seventh time. The patient was enthusiastic about the care that she had received during the various hospitalization periods. She made specific mention that the linen was changed every day. The housekeepers were thoughtful and kept the room tidy and clean. The nurses were cheerful and took a personal interest in her as a patient she said. The patient made specific mention also of the food, reporting that on several occasions when she did not feel well enough to eat, not merely the dietitian but the one who is in charge of the kitchen came to see her and asked if there was something about the food that she did not like. The patient mentioned her physician and how she appreciated his willingness to give her the best of service. She felt that the entire hospital staff was doing everything possible to make her stay a worth-while one. Patient, A woman approximately i | - 5 . The reaction of this patient was much the same as the one above. In addition, however, the picture of the activities of the physical therapist was reported. The physical therapist came with the wheelchair to get this patient for her regu- lar treatment just a few moments after the family had arrived to visit. The patient reported the physical therapist as saying: "We are not going to take you away from your family, for you will want to visit with them. The 117 nurse will notify us when your family leaves; then we will come up and take you down to the physical therapy depart ment," The patient mentioned that this is just another example of the thoughtfulness on the part of the workers and the cooperation of the team members, Patient, A man approximately $0 years of age. An employee at the Kaiser Steel Mill, The patient was ex tremely thankful for the prepaid hospital plan that made it possible for him to be hospitalized without the finan cial worry. The patient mentioned the kindly care that he was receiving during this hospital stay and said that each member of the staff seemed to be conscientious in his task. Patient, A man approximately 65 years of age, diagnosed as having pneumonia. The patient specifically mentioned the speed and accuracy of the hospital personnel upon his being hospitalized. He appreciated the fact that the business office did not cause delay in getting him into the room. The doctor had given the orders, the nurses moved in, and it was only a matter of a few minutes until he was receiving oxygen. The patient felt that without the cooperation of the entire group his needs would not have been met so adequately and quickly. He mentioned his tremendous appetite and the dietitian was checking closely with him to see whether or not his food was sufficient and what he should need. The patient closed the interview by saying, "I feel that I owe my life to and am grateful for the entire working staff," CHAPTER VI EVALUATION, SUMMARY, AND RECOMMENDATIONS It was not the investigator* s original intention to make a comparison of the hospitals studied. Contrariwise, hospitals serving divergent types of patients were purposely chosen to get the picture of the acceptance on the part of the workers of team concept and in turn the response on the part of the patients. This point of view will he main tained in evaluating and summarizing the study. I, EVALUATION OP STUDY As stated at the beginning of this study, it was the purpose, first, to check with the published materials which show both the need and trends toward the multi discipline approach of patient care and the need of seeing the patient as a whole, and, second, to make a survey of three selected hospitals to see how well the plan was being utilized. The investigator feels that this plan was fol lowed and at least partially accomplished. One weakness in the study should be pointed out. It was not possible to interview the patients in the first hospital studied. To have done so may have provided help ful material. On the other hand, it should be stated that 120 the (forking staff at the Kings View Homes were all in volved in the team plan. Each worker was dedicated to his task. Each sensed his own worthiness as a member of the health team and felt that he had a definite part in the patient care. Even though it was not possible to talk with the patients of this particular hospital, seeing and feeling the attitude of the workers, it would be easy to believe that this attitude and understanding on the part of the staff would be reflected markedly in the attitude of the patients. The complete cooperation on the part of the administrators of each hospital has made this study a pleasant one. As previously mentioned, this was not intended to be a comparative study, however, the following chart is presented to show the acceptance of the team concept in the three hospitals studied. It should be stated in fairness to the institutions that future plans include the addition of other members to the current team. Two courses might have been followed in obtaining the information from the patients. There is the question naire method and the personal interview method. The questionnaire method would set up certain cate gories for the patient to check. For a close comparative study, this procedure might have been followed. Even then TABLE I 121 A SPREAD SHOWING THE TEAM MEMBERS NOW EMPLOYED BY THE HOSPITALS STUDIED Kings View Homes Loma Linda Sanitarium & Hospital Kaiser Foundation Hospital Administrator Admini strator Admini strat or Physician Physician Physician Hurse Nurse Nurse Dietitian Dietitian Dietitian Social Worker Occupational Therapist Occupational Therapist Physical Therapist Physical Therapist Psychologist Chaplain ...... .... .......... ................ - 122 the thoroughness would he dependent upon the completeness of the list on which the respondent would check. This method would have been time-saving for the writer. The personal interview method was used for the following reasons: 1. The writer was interested in more than facts; he was interested in feelings. 2. It was possible to ascertain attitudes, which in this study was more important than data. 3. The answers came in part from the expression on the patients* faces as well as other bodily responses. l i - . The patient was not dependent upon certain ques tions and would not have given expression beyond these bounds. 5. Because of the patients* weakened condition, some would not have been able to mark the check list. 6. Each patient soon responded in the personal interview, whereas with a questionnaire there is a chance for minimal returns, thus not getting fair results. 7. Responses for some might have been embarrassing to the patient. In the personal interview these can be avoided. 8. The patient may state in a personal interview feelings that he would hesitate to place on paper. 9. The personal interview gives opportunity to follow small cues and at times read between the lines. 123 10. The patient does not feel that the experience is a one way street experience, but more the give and take. The patients interviewed responded freely and seemed eager to talk. The writer feels that in this area the goal was aci^eved, for feelings were expressed and emotions were much in evidence that would not have come to the surface and that would not have been evidenced on a written ques tionnaire. The same approach was taken with the "health team." In this approach to the team member, feelings were expressed and emotions came into play that told much to the inter viewer that would have been left unsaid in the merely statistical-type study. II. SUMMARY The literature in this field, it was found, upholds the team concept in the field of healing arts. The patient is not merely made up of a body. Since he is a composite individual with a body, a mind, and a spirit, and since one affects the other, it is agreed that the whole man is to be treated. In order to accomplish this there is found a need for the entire team. As to what extent the team approach is being utilized the writer found various opinions and a bit of disagreement between the interviews of the hospital workers and the patients. 12k In the study of the Kings View Homes and interview with the personnel, it was evident that each member of the health team from the kitchen worker to the psychiatrist felt he belonged. Because of the close organization and the regular family meetings, known to them as Town Hall, where the workers met and not only the patients were dis cussed but often appeared before the group, there was patient involvement by each worker. Each one felt his responsibility for the care of the patient. To the worker it became a greater challenge than if he considered himself a grower of vegetables or a peeler of potatoes. The study of the Loma Linda Sanitarium and Hospital revealed a desire on the part of the health team for more unity and possibly an organization of some type that would bring the various team members into closer relationships. There was found a desire on the part of some to see the physician not merely the director of patient care but, in addition, a member of the health team. Herein would be a process of giving and taking. It was felt that the patient would receive better care if the physicians had the other beam members share with them. As the patients were interviewed, they were appre ciative of the care received. There was a common note among them all that every worker was interested in them as a person. From where they lay, the whole team seemed to be working very closely. Patients often spoke of the various 125 disciplines, that is, the excellent dietary service, the chaplain* s visits, the competent care of the physicians, and so forth. Mention was made often by the patients of the efficient care and kindly attitude of the student nurses. The study at the Kaiser Foundation Hospital proved to be an interesting one. The two foregoing hospitals were owned and operated by church groups. The Kaiser Foundation Hospital is a general hospital, serving eighty- two per cent prepaid hospital patients. Because this is more of an industrial hospital serving insurance cases, and for the most part assigned physicians, the writer wondered if there would be any concept of the team approach. The writer was interested to see whether this type of institu tion would give less personal care, and whether or not the patient with prepaid hospital insurance would be more diffi cult to satisfy. The findings were reassuring. The various health team members were interviewed. Devotion to the task was much in evidence. Each team mem ber was enthusiastically happy with his part on the health team. The feeling for the need of the patient as a person was evident. Each worker felt a dedication to the task. The workers felt some need for more and better communica tion between the various disciplines in order to share and make known the needs of the patient. The patients were deeply appreciative of the 126 personalized care they received* Many patients mentioned the various departments and how the workers from the physician to the housekeeper showed kindly interest in them. Should it have been put to a vote the patients would have been near unanimous, showing that the team plan was used successfully there. The personal care was emphasized. III. RECOMMENDATIONS Since much of the literature, as indicated by the footnotes and bibliography, points up the need for the multidiscipline approach and the need for viewing the patient in his totality, and since the various members on the health team sense a need for greater study in this field and are not completely satisfied with the present accomplishments, the writer makes the following recommenda tions: 1. That special courses or a lecture series be set up in the medical schools whereby the physician in training may learn to see himself more than just the director of patient care, but in addition to this, a member of the health team where there is a mutual sharing. 2. That provision be made in the medical school and seminary eurriculums for experiencing teamwork during academic, intern, and residence phases of professional education. 127 3« That a special course or series of lectures be given in all schools where the personnel in the various fields of healing arts are educated, emphasizing the need for and the importance of the team concept# This should be included in the hospital administrator* s educational pro gram# k* That a course in Religion and Health .and Spiritual Counseling be included in the curriculum for those studying in the field of the healing arts# 5* That practicing physicians be encouraged to be come acquainted with the two journals. Pastoral Psychology and Journal of Pastoral Care# In turn, that ministers read certain articles in the medical journals# 6# That family meetings for hospital personnel be held at regularly scheduled periods# At such meetings the hospital administrator would discuss policies which affect the workers and working conditions, the chief of staff would share some of the patient problems involving a larger number of workers in patient care# 7. That each hospital include a small chapel within the physical plant, providing a place with a spiritual climate where the chaplain or patient's pastor can meet with the patient or family to counsel with those facing sorrow and death# 8# That the seminaries for the training of theologi cal students offer courses in Religious Counseling, Religion E N D GUIDE SHEET USED IN INTERVIEWING PATIENTS I* The Team Worker 1# Spiritual Definition - Find God*s eternal purpose for you a# Time b. Your reaction c. Prayer d* Talk with you about God and religion e# Your reaction f* Interested in you as a person g. Sympathetic understanding of you h* Morning and evening worship Zm Mental a# Interest in your personal problems b# Occurrence of problems result of hospitalization c. Finance— handling of your statements d# Comfort e# Service f. Food g# Cooperation of team members h# Future— attitude of family I rector, either for use as such institution, university, college, hospital or agency may see fit, or for use as expressly designated therein.” (California Probate Code, Section 20.) Interestingly, the persons who are taking ad vantage of this legal provision as a means of bene fiting their fellow men are typically persons of good intellectual attainments. A young alumnus of the University of California, Los Angeles, fatally ill of a heart ailment, bequeathed his body to the School of Medicine of his alma mater. A member of a millionaire family in Los Angeles chose to arrange for his body to be assigned to the University of Southern California School of Medicine. A medi cal technologist in the prime of life and in perfect health has bequeathed her body after death to the School of Medicine of the College of Medical Evan gelists. At the present time the School of Medicine of the College of Medical Evangelists faces a greater need for bequeathed bodies than do other medical schools in California. This needs stems from the fact that the Department of Anatomy of the School is lo cated in a rural area and from the fact that the Col lege graduates the largest medical classes of any medical school in the West (an average of 95 stu dents per class). The College will arrange transportation of be queathed bodies from any location in Southern California. It will cover the costs of embalming and transportation in all such cases. A Southern Cali fornia resident who is interested in making such a contribution to medical science should write di rectly to the Chairman of the Department of Anat omy requesting instructions and copies of the state ment of bequest. This statement reads: I hereby state that it is my desire to donate my body after death to the School of Medicine of the College of Medical Evangelists for teach ing purposes, scientific research, and for such purposes as the authorized representatives of the College of Medical Evangelists shall in their sole discretion deem advisable. WITNESS WITNESS NAME ADDRESS DATE The one making a bequest should make this ar rangement known to his close relatives and to the person who will be in charge of his affairs after death. Then at the time of his death the Chairman of the Department of Anatomy may be notified promptly so that the College may send its morti cian to obtain the body. There are some bodies which cannot be used to best advantage for scientific purposes. This in cludes those that have been subjected to autopsy, those mutilated by accident, and, in some cases, those in which death has been from cancer. In cases of doubt, counsel should be obtained from the Chairman of the Department of Anatomy. C J ' f J K h><^oKmation Chairman, Department of Anatomy School of Medicine College of Medical Evangelists Loma Linda, California COLLEGE of MEDICAL EVANGELISTS < ^ ( M a d i e 4 J o - k Sfcience The College of Medical Evangelists, founded in Southern California in 1905, is a center of educa tion for the professions related to health arts and sciences. Bachelor of Science degrees may be earned in nursing, medical technology, and physi cal therapy. Master of Science degrees may be earned in fields of dietetics, nursing, basic medical science, and clinical medicine. Instruction ofjered for doctors’ degrees includes that for Doctor of Medicine, Doctor of Dental Surgery, and Doctor of Philosophy. The instructional facilities of the College, with one campus in a rural area and another campus in urban environment, provide a varied and rich experience for the teaching of the health profes sions. More than 800 students are annually en rolled in the schools of the College: Dentistry, Medicine, Nursing, Medical Technology, Physical Therapy, X-ray Technology, Tropical and Preven tive Medicine, Dietetics, and Graduate Studies. The College medical centers, Loma Linda Sani tarium and Hospital at Loma Linda and White Memorial Hospital and Clinic at Los Angeles, care for 15,000 inpatients and record 170,000 outpa tient visits annually. A coeducational institution operated by the Sev enth-day Adventist Church, the College endeavors to create and provide for students an environment conducive to the infusion of sound moral, ethical, and religious principles in harmony with Christian teachings; the motivation of persistent and contin uing intellectual curiosity; and diligent prepara tion for professional competence and purposeful living in the service of God and humanity. One of tfie greatest assets of our nation is tfte ftealth of its citizens. Mucft responsibility for tlie nation’s bealtft is entrusted to its pftysicians. Each year about 7,000 young physicians are graduated from the eighty-two schools of medicine in our country. This number is barely enough to provide replace ments for the older physicians who have dropped out of the picture. The future health of our nation depends upon the continued adequate education of younger persons. The study of anatomy is a basic course for pro spective doctors. Medical students must have the opportunity to take the body apart, structure by structure. This opportunity is provided in the anat omy laboratories of our schools of medicine. It is here that medical students in groups of four spend many months in studying human bodies. They be come familiar with each bone and muscle. They learn the positions and names of the nerves and discover how these control the muscles and carry the sensations. They follow the paths of the arter ies and veins. In this way they become able, in the course of their later training, to make diagnoses, to follow the progress of diseases, to perform sur gery, to set fractured bones, and to perform repairs after injuries. The availability of human bodies for such study is essential. Even the graduate physician must still have ac cess to human bodies for research and study. It is in the anatomy laboratory that the surgeon designs a new surgical procedure. Once he has devised the procedure and perfected his technique on cadaver material, he can use the method with confidence for the treatment of actual disease in living persons. There is a sincere and growing appreciation throughout the nation for the service the medical profession is rendering. Many an enlightened lay man is asking, “W hat can I do to further the prog ress of medical science and thus contribute to the reduction of early death and to the relief of suffer ing?” Many are finding the answer to this ques tion in the legal provision which is now made by ten states for the bequeathing of bodies after death to medical institutions so that they may be used for the training of physicians and thus for the benefit of humanity. The state of California has pioneered in this re cognition of an important way of perpetuating one’s service to humanity after death. The California law reads: “Every person of sound mind, over the age of 18 years, may dispose of his or her separate property, real and personal, by will. In addition, every such person may by will dispose of the whole or any part of his or her body to a teaching institu tion, university, college. State Director of Public Health, or legally licensed hospital, or to or for the use of any nonprofit blood bank, artery bank, eye bank, or other therapeutic service operated by any agency approved by the Director of Public Health under rules and regulations established by the di- Potient Statistics Num ber of patients a d m itte d 3 4 5 Num ber of patient days ..................... 5 0 ,0 1 5 G eographical distribution of patients; California Fresno C o...................................... 145 Tulare Co...................................... 6 8 Kern C o.......................................... 41 Kings Co........................ 9 Other counties .......................... 4 7 Idaho .................................................. 5 K ansas .............................................. 12 Oregon ............................................... 2 W ashington . ............................... 2 Other States .................................... 11 Foreign Countries ................... 3 ^ Religious distribution of patients: ^ M e n n o n ite s........................................ 6 8 g. Baptist ................................................ 30 ^ Brethren in Christ ........................ 2 ^ C atholic ............................................. 4 3 ^ C ongregational ................................ 9 % M ethodist ........................................... 27 ^ Lutheran ............................................. 13 ^ Presbyterian ...................................... 19 Q Other affiliation ........................... 7 3 % N on -offiliated ................................... 61 I Kings View H om es adm its patients o f any creed, race or color. A dm ission is open to patients with em otional disturbances. The services include day and night care, day care, night care, outpatient treatm ent and foster hom e supervision. Upon exam ination, a sta ff psychiatrist determ ines which treatm ent is feasible. Frequently there is a progression from one type of treatm ent to another. Staff Number of present staff ......... 30 Num ber of days contributed by sta ff on voluntary service basis 2 2 ,6 5 0 Kings View Hom es m aintains a sta ff equal or above the requirem ents of the Am erican Psychiatric A ssociation. A core of approxi m ately one-third of the sta ff is professionally trained and on a long term basis. The other two-thirds ore highly selected, Christian m oti vated personnel who ore trained for short term service on voluntary service or on a minimum allow ance basis- Thus hospitalization is m ods financially feasible for m any persons who could not afford treatm ent in a private hospit al. Only highly trained, well qualified doctors ore perm itted to practice at Kings View Hom es. , Y— to Freeno .M a n n t nç'Avffnu^ % Selma a » # M ûim tain View Avenue \43Z to Bakersfield to /C e x p a n d in g THE PSYCHIATRIC SERVICES KINGS VIEW HOMES Reedley, California Kings View Homes, Reedley, California tngs V iew Homes is a non-profit psychiatric sani- , tarium serving short-term patients and offering extended treatm ent to selected cases. This 50-bed hospital has a distinctive Christian emphasis in treating the m entally ill. K ings V iew Homes is registered w ith the American Medical Association and affiliated w ith the ' California H ospital Association. T he hospital operates under license from the California D epartm ent of Mental H ygiene. . j ; K ings V iew Homes is adm inistered hy the M ennonite Central Com m ittee, the American ' M ennonite agency for relief and other Christian s e r v ic e s w ith headquarters at A kron, Pennsylvania. Through its m ental health section, the M ennonite Central Com m ittee op erates tw o other psychiatric hospitals—Brook Lane Farm, H agerstown, M a r y la n d , and Prairie V iew H ospital, N ew ton , Kansas. A g "I > j 1 , r - ■ T .] ' r /0 'lA > .V J 1 KINGS VIEW HOMES Expansion Program The floor plan shown at the lower left is the proposed clinical and 10-bed acute treat m ent addition. This facility will be built and furnished at a cost of $ 2 4 0 ,0 2 7 . The Hill- Burton grant of $ 8 0 ,0 0 9 is m atched by an equal am ount by the State of California. Pri vate funds in the am ount of $ 8 0 ,0 0 9 m ust be secured by the M ennonite Central Com m ittee. The picture below represents a modern structure which was com pleted in 1951, and has served well in the operation of a 30-bed hospital. To the rear is an occupational ther apy building com pleted in 1954. A m aster plan recom m ended by a special study com m ittee includes a geriatric building, a kitchen-cofeterio, a chapel and additional occupational and recreational therapy build ings. The latter facilities will perm it expan sion of the day care program. A r . / ^ . r a r l l • r n t . t r ! . / = W A L T E R WAGNER & PARTNERS X C H I T I C T S A MD I H C I H I I K ings V iew Homes combines skilled professional services w ith the therapeutic effects of a home-like, Christian atmosphere. # • * of the lifetime of CME h ave been presented briefly. W e hope that you recognize in them the sincere desire of its founders, its trustees, its adm inistrators an d faculties to serve the com m unity of Southern California an d the world by the a d e q u ate training of young m en an d wom en in the healing arts an d sciences. You are a most w elcom e visitor on either cam pus of the College of M edical Evangelists. Loma Linda Cam pus: Loma Linda, California (B etw een R edlands and Colton on US H ighw ay 99) Los A n g eles Cam pus: 1720 Brooklyn A venue Los A n geles 33 California > z o m r» l A « 4 n g • Î C - MEDICAL EVANGE ü iïlv « rsirr of SMstutriem The C ollege of M edical E vangelists is a duly accredited center of education for the professions related to health arts and scien ces. Its com munity of activities and interests comprise its educational units two hospitals, outpatient services, and active alum ni associations. CME had its begin n in g in May, 1905, w hen Seventh-day Ad ventist church representatives purchased the Loma Linda Tourists' Hotel for $38,900. Within w eek s the Loma Linda San itarium and H ospital w a s established, and soon thirty-five em p loyees and the first few students of nursing w ere w elcom ing patients. In 1906, the "C ollege of Evangelists," a s it w a s called, w as organized in connection with the sanitarium and offered an "evangelistic-m edical" course, collegiate subjects, music, and a nurses' course. In 1909, the C ollege of M edical E vangelists w a s chartered under the present nam e, and in 1914 the first class of six m edical students w a s graduated. In 1917, the Ellen G. W hite M emorial H ospital and Clinic, nam ed for a Seventh- d a y Adventist pioneer, w a s estab lish ed in Los A n geles to augm ent the clinical services of the C ollege. During the en su in g years, the follow ing schools w ere or gan ized in the C ollege; 1922, Dietetics (reorganized 1954); 1937, M edical Technology; 1941, Physical Therapy; 1941, X-ray Technology; 1948, Tropical and Preventive M edicine; 1948 co lleg e-lev el School of Nursing; 1953, Dentistry; and 1954, G raduate Studies. From its begin n in gs in the sm all hotel of 1905, CME patient care h as grown to re quire the com plex operation of the two C ollege hospitals, one on each cam pus, y with their com bined cap acity of 500 p a tient beds. Here, and in the C ollege clinics too, faculty-staff physicians, dentists, pharm acists, nurses, dietitians, m edical technologists, physical therapists, x-ray technicians — all of them m em bers of the health team — unite in serving the com munity by providing care of p a tients and instruction of students. The sm all investm ent of 1905, now d e velop ed into total a ssets of $15,500,000, continues to increase. Activation of an expansion budget in recent years has provided a major addition to the White Memorial Hospital on the Los A n geles cam pus and at Loma Linda the Library-Administration Build ing, the School of Dentistry, and rem odeling of b asic scien ce departm ent buildings. Further plans for the Los A n geles cam pus include a library building and im proved facilities for outpatient clinical service and teaching. At Loma Linda, plans include student residence halls, enlargem ent of the hospital, and School of Nursing c la ss rooms and offices. CME's operating budget is $12,000,000, and its 2,000 em p lo y ees receive approxim ately $6,200,000 in w a g e s yearly. E i The enrollment of sev en students of nursing in 1905 has grown to ex ceed 800 undergraduate and graduate students w ho now attend the schools of the Col lege. Bachelor of Scien ce d eg rees m ay be earned in nursing, m edical technol ogy, and ph ysical therapy. Master of Scien ce d egrees m ay be earned in the fields of dietetics, nursing, b a sic m edical scien ces, and clinical m edicine. Doctors' d egrees include Doctor of M edicine, Doctor of Dental Surgery, and Doctor of Philosophy. The m edicine and nursing alum ni associations sponsor refresher courses each spring to inform m em bers on rapid a d v a n ces in the respective fields. The C ollege adm inisters its educational programs to a united student body with a united purpose. During its existen ce CME has conferred degrees on and aw arded certificates to an annual a v era g e of more than a hundred students. CME graduates serve m ankind with dis tinction — in California and in the "uttermost" parts of the world — from Atlanta to Vancouver, A ngola to Tokyo, Australia to Italy — in civil positions, in military capacities, in remote m ission outposts. W herever they are, they strive to reflect the purpose of CME: to work com petently and purposefully in the service of God and hum anity. CME welcom es you. A medical education center located in Loma Linda and Los Angeles, California, CME gives opportunity for education in seven professional areas of the healing arts. It is comprised of three major schools— Medicine, Dentistry, and Nursing, three departmental schools— Medical Technology, Physical T h e r a p y and X-ray Technology, and Schools of Dietetics, Tropical and Preventive Medicine, and Graduate Studies. A general hospital is located on each campus. 0 Life is much the same here as in other institutions of higher learning. It has its traditions such as Student-Faculty Field Day, Friday evening vespers, and A.D.W. Mountain Weekend. Recreation on the volley ball court, in the swimming pool, or in a gam e of tennis helps relax those classroom and laboratory tensions. Initiated by the Seventh-da y Adventist Church in 1905, CME is now in its second half-century of service to Christian youth and to the world. More than 5,000 students have left CME for service in all parts of the world. Financial support from t h e s e alumni has helped build a significant share of the facilities on both campuses. Because it sincerely treasures the opportunity of educating for w orld-w ide Chris tian leadership, the College of Medical Evangelists cordially invites you to participate actively In its religious life. Sabbath school and divine services are conducted each w eek on the campuses. lomaUnifa This is m _ m Ü los Angeles y»ur CM C iom a Linda Campas I 1. D aniells Hall 2. Sw im m ing pool 3 . Tennis courts 4 . A natom y 5. Physiology 6. L ibrary-A dm inistration 7 . Dentistry 8. The M all 9. Burden Hall 10 . STPM 11. Pathology 12. Clinic-PT 1 3 . H ard w are 14. D ru g sto re 15. M arket-P ost OflRo 16. Hill Church 17. Lindsay Hall 18. C ollege Press 19. Laundry 2 0 . Purchasing 2 1 . D airy 2 2 . ARF Shops 2 3 . C afeteria-A ccounting Office 2 4 . School o f N ursing 2 5 . L L Bowl 26 . S anitarium 2 7 . Clinical lab STE¥VA/ir STREBT R e C ENTRAL AVENUE CO |l_M j LLÜI 'A a 0 ® 0 N E W JE R S E Y STREET MICHIGAN avenue Las àngeies Campas I 1. WM Church 2. Parking 3. C om stock Bidn. 4 . WM H ospital 5. Physical re h a b ilita tio n 6. WM Clinic 7. C hildren's clinic 8. Brace shop 9. Laundry 10. Scott H ouse 11. Spanish SDA church 12. Clinical lab 13. P athology 14. Physical re h a b ilitatio n 15. Personnel-A ccounting 16. A dm inistration-S tore 17. Em ployee a p artm e n ts 18. O sier H ouse 19. Tennis courts 20 . L ibrary-Poulson Hall 2 1 . SM A lum ni Office 2 2 . N ursing stu d en ts' resid en ce 23 . Borg Hall V 0 ( 1 ar e o c S . I s r ! i HOW O F T E N has so m eo n e not of our cam p u s a sk e d you: "Why does (or do esn 't) CM E do so and so ? " Of c o u rs e you co uldn't a n s w e r, b e c a u s e the suggestion c o n c e rn e d the D e p a rtm e n t of P hlebotom y, and you w ork in the B o ile r R o o m . Why, you n e v e r even see the P hlebotom y people, except once a y e a r at the annual em ployee picnic. B U T to those n o n -C M E -ite s , the D e p a rtm e n t of P h leb o to m y is n 't som ething s e p a ra te fro m the B o ile r R o o m , the C linical L ab, the c a fe te ria , or the School of D e n tis try . To them , th e re a r e ju s t two big bundles of land, buildings and p e o p le --a n d those two big bundles a r e C M E. When P r o f . M, M o rtim e r D oubledom e scow ls at a v i s ito r, a stu d e n t's p a re n t, or a ty p e w ri te r r e p a i r m an , that p e rs o n feels it is CM E scow ling a t him . When M iss C o u rte o u s R e c e p tio n ist g r e e ts a c a lle r with h e r ple asa n t, ch e e ry , "Good M orning - - May I be of a s s i s t a n c e to y o u ? " the c a lle r thinks: "CM E is ce rta in ly a w a r m and h o spitable o rg an iz atio n . " M e re ly by a s n a r l or a s m ile , a frie n d is lo s t or gained for C M E. If you m e e t the p e rs o n P r o f e s s o r D oubledom e scow led at, he w on't like you. B ut if you m e e t the p a rty M iss R e c e p tio n ist g r e e te d so p le a sa n tly , he w ill c o n s id e r you v e ry nice indeed. l/i/kif? B e c a u s e - - - W hoever you a r e ----- M A D e a a ----- A T elephone O p e r a t o r ----- A N u rse ----- A C a r p e n t e r ----- A R e s e a r c h A s s i s t a n t ----- OR anyone connected with CM E . V O Ü ar e o < 3 I •I f HOW O F T E N has so m e o n e not of our cam pus a sk e d you: "Why does (or d o esn 't) CME do so and so ? " Of c o u rs e you co u ld n 't a n s w e r, b e c a u se the su g g estio n co n c e rn e d the D e p a rtm e n t of P hlebotom y, and you w o rk in the B o ile r R o o m . Why, you n e v e r even see the P h lebotom y people, except once a y e a r at the annual em ployee picnic. B U T to those n o n -C M E -ite s , the D e p a rtm e n t of P h leb o to m y is n 't so m eth in g s e p a ra te f r o m the B o ile r R oom , the C linical L ab, the c a fe te ria , or the School of D e n tistry , To them , th e re a r e ju s t two big bundles of land, buildings and p e o p le --a n d those two big bundles a r e C M E. When P r o f . M. M o rtim e r D oubledom e scow ls at a v i s ito r, a stu d e n t's p a re n t, or a ty p e w ri te r r e p a i r m an, that p e rs o n feels it is CM E scow ling a t him . When M iss C o u rte o u s R e c e p tio n ist g r e e ts a c a lle r with h e r p leasan t, c h e e ry , "Good M orning - - May I be of a s s i s t a n c e to y o u ? " the c a lle r thinks: "CM E is c e rta in ly a w a r m and hospitable o rg an iz atio n . " M e re ly by a s n a rl or a s m ile , a frien d is lo st or gained for CM E. If you m e e t the p e rs o n P r o f e s s o r D oubledom e scow led at, he w on't like you. B ut if you m e e t the p a rty M iss R e c e p tio n ist g re e te d so p le a sa n tly , he will c o n sid e r you v e ry nice indeed. (/i/hif? B e c a u s e - - - W hoever you a r e ----- A D eEüü----- A T elephone O p e r a t o r ----- A N u rs e ----- A C a r p e n t e r ----- A R e s e a r c h A s s i s t a n t ----- OR anyone connected with CME To OUR PA TIENTS AND VISITORS rrr Presented by LOMA LINDA SANITARIUM AND HOSPITAL LOMA L IND A, C A L IF O R N I A /f erf i a W E L C O M E TO LOMA LINDA S AN ITARI UM AND HOSPITAL Welcome to Loma Linda Sanitarium and H os pital. W e hope that your stay here will be a comfortable one and that our services will be of real benefit to you. Our primary objective is to provide, by means of a skilled working staff, the best care possible for the more than 6,500 patients served in the hospital and for those whose visits to our out patient clinics total over 25,000 throughout the year. In conjunction with providing this care, the Loma Linda Sanitarium and Hospital serves as one of the educational facilities of the College of Medical Evangelists. Founded by the Seventh-day Adventist Church in 1905 at Loma Linda, Califor nia, the College is a nonprofit medical education center. It now conducts its instructional and re search units both at the Loma Linda campus and, since 1918, at the Los Angeles campus. Comments or suggestions that you think will help us improve our service to you are welcomed. If this is your first visit, you may wonder about some of our procedures and the reasons for them. W e hope that the following information will answer many of your questions. AS YOU E N T E R . . . Your reservation , , , is made through your pri vate physician, who is a member of the hospital attending staff. Arrangements for the type of ac commodations you desire may be discussed at the Admitting Office by you or by him. If you enter through arrangements made at the clinic, a ward reservation will have been made previously. Room accommodations . . . of the following types are available; Private room, semiprivate room (two beds), and wards. The hospital does not maintain a contagious diseases unit. Your daily room rate . . . includes dietary and general nursing services. Hydrotherapy service is also included for medical patients only. Sepa rate charges are made for such things as operating room, x-ray examina tions, medications, laboratory tests, extra dietary items, private duty nursing, and other special services. Your valuables . . . should be left at home. The hospital does not assume re sponsibility for them or for other personal belongings which may be lost or dam aged. Small items, such as rings or other jewelry, may be deposited in the vault at the Patients’ Business Office. When you enter . .. the hospital, your pre-admission form should have arrived before you, having been given to you by your physician to fill out in full and mail to the hospital. At the admitting office, you are asked to give necessary facts about yourself to assure the accurate hos pital records vital to your care and safety. Forms of consent for surgery or other procedures require your signature at this time also. What you bring . . . is only the mini mum of personal items needed, such as bathrobe, slippers, nightgown or pa jamas if you wish, and toilet articles. TERMS OF P A Y M E N T Terms of payment . . . include a deposit amounting to the hospital estimate of your first week’s statement of charges. So that you will be prepared to pay the amount, the Pa tients’ Business Office staff gladly assists you in deter mining the necessary facts before you are admitted. You can obtain this assistance by mail, telephone, or personal visit. If you are confined for more than a week, you will receive a statement of charges on a weekly basis. State ments are payable upon receipt. Group insurance . . . membership cards should be shown at the time you enter the hospital if you are a member of GROUP INSURANCE Blue Cross or California Physicians’ Service. If you are covered by group insurance plans through your employing organization or union, you should bring a hospital claim form properly completed by your organization. If you are a member of a group insurance plan that issues identifica tion cards, present your card to our insurance office. The hospital vrill accept assignment of benefits on these group insurance policies for direct credit on your account. The terms of contract differ in the many plans used. You will receive a statement, each week and at the time of depar ture, indicating the charges not covered by your insurance contract. Statements are payable upon receipt. Individual insurance . . . assignments of benefits are not accepted by the hospital because of the many varied forms in use and because it is virtually impossible for the hospital insurance office to compute the benefits which each policy will pay. Parking facilities . . . are available for friends and relatives who come to visit you. In addition, the hospital provides garage parking facilities for patients who wish to rent this service. FOR YOUR CARE A N D C O N V E N I E N C E Your doctor . . . t o whom the hospital refers as your “attending physician,” is responsible for your care. You should consult him on all matters of professional service. A number of attending physi cians at the Loma Linda Sanitarium and Hospital are on the teaching faculty of the School of Medi cine of the College of Medical Evangelists. The hospital house staff . . . of interns and resi dent physicians are graduates of approved medical schools. They perform their services under the supervision of your attending physician, heads of hospital services, and the hospital administration. Nursing service . . . is provided ttventy-four hours a day. The nursing staff consists of graduate nurses, students of nursing, licensed vocational nurses, nurse aides, and order lies. Questions or comments you may have about nursing service should be directed to the nursing supervisor on your unit. Private duty nurses . . . are available if this extra service is approved by your attending physician or required by the hospital administration. Arrangements for private duty nursing are made through the Nursing Service Office. In formation is provided regarding the added expense in volved. Food service . . . is supervised by a staff of dietitians. Three types of menus are available: selective, standard, and thera peutic. Unless a therapeutic or standard diet is ordered by your physician, you will have the opportunity of making your own selection for each meal. No meat dishes are prepared or served. The hospital chaplain . . . devotes his full time to the spiritual interests of pa tients. If you would like him or a mem ber of his staff to visit you, or if you wish a minister, priest, or rabbi of your choice to call on you, please make your request to your nursing supervisor. Earphones . . . at the bedside are connected to the hospital radio circuit. Devotional programs are broadcast daily at 8:00 a.m. and 6:30 p.m. Divine services from local churches are broadcast each Saturday morning beginning at 8:30. Special health lectures are also frequently broad cast from the Patients’ Parlor. Mail . . . is delivered every morning except Saturdays and holidays. Nursing personnel are glad to mail outgoing letters for you. Telephone and telegraph . . . service is available. Notary public . . . services are available at the Personnel Office for a nominal charge. Library service . . . is cordially extended you. Operated on a lending-library basis, this service provides current magazines, journals, and books of general interest. Tours of the Hospital . . . and College campus may be arranged by a call to the Community Relations Office. V IS I T I N G ; y Visiting privileges . . . are limited for the pur pose of protecting the patient and speeding his recovery. If visitors come early, they will be asked to remain in the hospital lobby until the scheduled visiting hours. Persons with colds or other infectious diseases are expected to refrain from visiting patients. Medical and surgical units . . . have visiting hours: Daily, 2:00 to 4:00 and 7:00 to 8:00 p.m. Maternity unit . . . has visiting hours : Daily, 3:00 to 4:00 and 7:00 to 8:00 p.m. Children who visit . . . are restricted as to age and the location of the patient. Since the hospital has no facilities for caring for small children who may accompany visitors, it is suggested that other arrangements be made for them. Age regulations pertaining to youthful visitors are as follows: Above 12... may visit medical and surgical units Above 16... may visit maternity unit Smoking . . . is not permitted in the Hospital. Quiet . . . is essential at all times for the best interests of the patients. Equipment . . . should not be adjusted, manipulated, or tampered with by the visitor or patient under any circumstances. The nurse should be called if something needs attention. The patient’s welfare . . . and comfort will be served best if the visitor refrains from sitting or placing articles on the bed. W H E N YOU LEAVE A release form . . . is part of the depar ture procedure. After your physician has dismissed you, the nursing supervisor on your unit will ask for a hospital clearance card. This must be secured from the Pa tients’ Business Office by you or your rel ative before you leave. Departure time. . . is scheduled at 2:00 p.m. Patients who remain after that hour will be charged one-half of their daily room rate. Dismissal time is now 11:00 a. m. P ER SON AL RECORD NAME_ ROOA/L ENTRY DATE_ RELEASE DATE- ATTENDING PHYSICIAN- NURSING SUPERVISOR____ DIETITIAN- MEMORANDA- HOSPITAL A FFI LI A T IO N S The Loma Linda Sanitarium and Hospital . . . . . . is approved by Joint Commission on Accreditation of Hospitals Council on Medical Education and Hospitals of the American Medical Association . . . is a member of American Hospital Association Association of Western Hospitals California Hospital Association Name of Dr.. Room. 8 m T3 D O u COMMENT CARD Date_________________ 195J____ By m erely filling in the blanks on th is card a n d m ailing it you m ay m ake th e s ta y in our hospital ev en m ore en jo y ab le to others. 1. W ere you received courteously a t th e h o sp ital? _____________________________________________ 2. W ere your treatm e n ts given satisfacto rily ?___________________________________________________ 3. W as th e hospital service p rom pt?______________________ Efficient?_____________________________ 4 . W as th e fo o d p a la ta b le ? ___________ H ot?___________A p p earan ce a p p etizin g ? __________________ 5. W ere your su rro u n d in g s c le an ?_____ Futher com m ents: _______________________ Restful a n d quiet?_ P le a sa n t? - S ig n atu re- A d d ress- W e th an k you fo r your helpful com m ents. Loma Linda S anitarium a n d H ospital, Loma Linda, Calif. be Paid ^ P o s ta g e S ta m p % i N ecessary p \ If M ailed In the p ^ U n i t e d S t a t e s ^ B U S I N E S S REPLY CARD First Class Permit No. 16, Loma Linda, California OFFICE OF HOSPITAL ADMINISTRATOR LOMA LINDA SANITARIUM AND HOSPITAL LOMA LINDA, CALIFORNIA X//////77A v/z/'/y/zn V /////7 7 A V7777777A X / / / / / / / / A 7 ///Z ////À V ZZ/Z/JÆ T / / / / / / Z / A iy ///////A 7Z/ZZZ///À VZ//////A ROOM RATES PER DAY Medical Department: Private Room Semi-private Room Ward of three or more beds Surgical Department: Private Room . . . Semi-private Room Three bed ward Obstetrical Department : Semi-private Room Three bed ward . . . N u r s e r y .................................. Nursery after mother leaves Incubator . . . . . . $23.50 $20.00 to $21.00 . . $18.50 $23.50 $20.00 $18.50 $20.00 $18.50 6.00 6.00 6.00 These rates are subject to change without notice. They include room, board, and general nursing care only. The full daily rate is charged for the day the patient is admitted, but there is no charge made for the day of departure, provided the patient vacates the room by 11:00 a.m. No allowance is given for leave of absence taken at the conven ience of the patient. The Business Office is not open for regular business on Saturday. Patients who expect to leave between sunset Friday and sunset Saturday are requested to make financial arrangements with the business office not later than 2:00 p.m. Friday. LOMA LINDA SANITARIUM A N D HOSPITAL Loma Linda, California It ' S I S i s k WÜ are c g. I & I ings V iew Homes is a non-pro jit psychiatric sani tarium serving short-term patients and offering extended treatm ent to selected cases. This 50-hed hospital has a distinctive Christian emphasis in treating the m entally ill. K ings V iew Homes is registered w ith the Am erican Medical Association and affiliated w ith the California H ospital Association. The hospital operates under license from the California D epartm ent of M ental Hygiene. K ings V iew Homes is adm inistered by the M ennonite Central Com m ittee, the American M ennonite agency for relief and other Christian s e r v ic e s w ith headquarters at Akron, Pennsylvania. Through its m ental health section, the M ennonite Central Com m ittee op erates tw o other psychiatric hospitals— Brook Lane Farm, H agerstown, M a r y la n d , and Prairie V iew H ospital, N ew ton, Kansas. In a day or night care arrangement patients are admitted to the hospital for a specified period. During this time the entire services of the hos pital as prescribed by the psychiatrist are avail able to the patient. admission A patient is accepted for hospitalization only by the staff psychiatrists. Appointments can be made with the psychiatrists by calling Kings View Homes, Reed ley 454. services Services include day and night hospital care, day care, night care, out-patient treatment and foster home supervision. Upon examination the staff psychiatrist determines which treatment arrange ment is feasible. Frequently there is a progres sion from one type of treatment to another. Treatment is prescribed by the psychiatrist in charge and carried out under his supervision. Nursing services are available from a trained psychiatric nursing staff. Much of the patient’s time is utilized in individual and group activities which are prescribed upon the basis of the pa tient’ s needs. Group activities include walks, films, games, classes and worship services. Trips to the city library, church, concerts and parks are available to patients who can benefit from such experiences. Out-patients are seen at the hospital by appoint ment. Therapeutic activities, psychotherapy and electro-shock therapy are available on this basis as well as for in-patients. Under this arrange ment the patient may live away from the hospital and frequently continue with his usual activities. Under foster home arrangements, the patient lives with a family selected by the hospital. The patient is under the supervision of the family and the hospital’ s social service department. Patients entering the hospital should generally be furnished with clothing as follows; pajamas, robe, slippers for night dress and treatment; work clothes, shoes and coats for outdoors; dress clothes for church, concerts and visiting. Excessive jew elry should be avoided. Arrival should be be tween 10 a.m. and 12 noon or between 1 and 3 p.m. (when possible). A minimum of two hours should be allowed for admission procedures. Kings V iew Homes combines skilled professional services w ith the therapeutic effects of a hom e-like, Christian atmosphere. When the patient arrives at the hospital the steps are usually as follows: ► r ► ► The psychiatrist makes the examination and discusses fees. The administrator discusses fees and pro- i^ses voluntary admission and agreement forms. The psychiatric social worker takes the so cial history. The psychiatric nurse takes the medical is tory and introduces patient to the ward. The activity director discusses interests, hobbies and activities. fees Kings View Homes fees are quoted upon re quest. Quoted fees include nursing care, occupa tional and recreational therapy, room, board and laundry. Payment of ^150 is required upon ad mission. Subsequent payments are made upon monthly billings. All fees are payable upon dis charge. Professional fees are itemized separately and payable monthly. These fees include treatment of the patient, staff conferences concerning the care of the patient and consultation with the family. Charges for physical examinations, psycholo gical tests, laboratory tests, x-rays and other diag nostic or treatment services which are usually prescribed by the doctors are not included in the quoted fees. Statements for such services are is sued to Kings View Homes and billed on the monthly statement. Kings View Homes will gladly answer any questions regarding these prescribed services. Should there be any questions concerning rates, these should be discussed promptly with the hospital business office and the doctor. visiting hours Visiting hours are from 2 p.m. to 4:30 p.m. on Sunday and Wednesday. Visiting is also per mitted during these hours on holidays. location Kings View Homes is located in Tulare County. The hospital derives its name from the river adjacent to the hospital. I^anning-Avenuv Mormtmn View Avertue irto Bakersfield / t an ^ j^ lo n a tio n " o f Itie ^ PSYCHIATRIC SERVICES of KIHGS V I E W H O W i r i j^^Reedley, California Kings View Homes, Reedley, California Physicians or referring agencies may phone or write the hospital for the following serv ices — Consultation by the staff psychiatrist is of fered in general hospitals and other institu tions by appointment. Diagnostic and evaluation studies are pro vided on inpatient or outpatient basis. Inpatient services are provided for acute short term treatment, also for extended treat ment and rehabilitation. Adolescents and adults, including geriatric patients, may be admitted. Outpatient facilities are available for profes sional family services, including child guid ance and marriage counseling. Family care is a post hospital service where psychiatric supervision follows the patient into a selected family setting. Professional Staff is headed by a staff psy chiatrist who is experienced in the adminis tration of a psychiatric service. Medical problems not in the specialty area of psychiatry will be cared for by the attend ing staff in consultation with or by the re ferring physician. Referral to surgical or acute medical services can be conveniently made in consultation with the referring physician. Staff psychologists and psychiatric social workers are available to work with a team approach in the hospital and outpatient service. Nursing services are available around the clock. Occupational and recreational ther apy and service staff are provided to furnish a broad treatment program. A daily hospital rate covers room, board, routine medications, nursing care, occupa tional and recreational therapy, staff psy chiatric care and psychiatric social worker seiwices for the family. Additional hospital fees are charged for elec tro shock therapy, psychological service, con sultation and special nursing services if pa tient is acutely disturbed. The out patient fee is a weekly rate and cov ers interviews by clinic staff with one or more family members. A rate reduction is available — for limited number of acute inpatients with limited means. Such patients, to be elig ible, must stand to gain significantly from hospitalization. — to selected patients with limited means who have not responded maximally to short term treatment but who would ap pear to benefit from continued hospital treatment. Such a rate adjustment can be made only after 90 days of hospitalization. - t o outpatients who have limited means. Patients can be admitted to the hospital as inpatients by voluntary admission, court commitment or by physician certificate com mitment (Sec. 5750, Welfare and Institu tions Code.) KINGS VIEW HOSPITAL (Formerly Kings View Homes) M N-to Fresno A fa n n i n g-A ven u e 1 2 3 / ' / Reedl%/" r ilma M ou n tain View Avenue to Bakersfield Reedley 454 after July 21 MElrose 8-2505 iW H MlMonfe- I toDinubâ-T^ Rio Vista near Rose Ave. P. O. Box 631 Reedley, California A non-profit Psychiatric Service for the San Joaquin Valley, serving all races and creeds. CONSULTATION DIAGNOSIS and EVALUATION INPATIENT TREATMENT OUTPATIENT SERVICE FAMILY CARE A m mi A priv ate nursery a d ja c e n t to each m aternity room perm its m other a n d b ab y to rem ain to g eth er. The in fan t, resting in a bassinet d ra w e r w hile u n d er the n u rse's care a n d alw ay s in view o f th e m other, can be pulled to the b edside th ro u g h the se p a ra tin g w all. H ospital room s utilizing floor-to-ceiling g lass a n d accessible to la n a is in a g a rd e n setting a ffo rd p a tie n ts beneficial ou td o o r living d uring convalescence. The lan ai also serves a s a visitors' corridor, relieving traffic th ro u g h the hospital. V isitors enter ro o m s from the o u tsid e . O ptim um conveniences a n d au to m atic controls for th e p a tie n t’s com fort include m echanically o p e ra te d b ed a n d electrically o p e ra te d d ra p e s, h ot a n d cold w a te r ta p s, n u rse ’s sig n als, p ip ed oxygen, te le p h o n e a n d a ir conditioning. The Kaiser Foundation Hospital at Fontana is a major new addition to San Bernardino County’s medical facilities, providing the community with a “ Hospital of the Future” incorporating advanced concepts of medical service. The Hospital, costing approximately $750,000 comprises three wings radiating over 14 acres and restricted to single-story construction to harmonize with the surrounding country side. It brings 45 more hospital beds to the area, and offers complete hospital services and facilities on a 24-hour basis. Osdvtessitv oé O<îomk 0 “ Is DESCRIPTIVE MATERIALS Kings View Homes Loma Linda Sanitarium and Hospital Kaiser Foundation Hospital 128 and Health* The Art of Ministering to the Siok* and so forth. In addition to this* the theological student should spend at least three months in clinical training in some hospital. 9. That workshops be conducted by hospitals where ministers and physicians can be brought together for mutual study and mutual understandings. 10. That ministerial associations be encouraged to invite physicians to speak to them occasionally on the cooperative role of the doctor and the minister. 11. That the trained minister in turn be invited to &ive similar lectures to the staff meetings where the physicians are in attendance. 12. That in each hospital the library provide such books and journals as stress the team concept and give direction on how the hospital team can better care for the whole man. BIBLIOGRAPHY A. BOOKS Allport, Gordon W. Becoming. New Haven: Yale University Press, 1955* Alvarez, Walter C. Nervousness, Indigestion and Pain. New York: Harper and Brothers, 1914-J Angyal, Andras. Foundations for a Science of Personality. New York: The dommonwealth ÿuind, Ï9^1. Belgum, David. Clinical Training for Pastoral Care. Philadelphia: The Westminster Press, 19$6. Bernhardt, Karl S. Practical Psychology. New York: McGraw- Hill Book Company, Inc., 1^5. Cabot, Richard C., and Russell L. Dicks. The Art of Ministering to the Sick. New York: The MacmTlTSn Co., — — --------------------- Dawson, George God on. Healing: P^an and Christian. London: The Society tor Promoting Christian Knowledge, 1935. Dicks, Russell L. Pastoral Work and Personal Counseling. New York: The Macmillan Co., T95l. Dunbar, Helen Flanders. Mind and Body: Psychosomatic Medicine. New York: Random Ëouse, 1%?. . Psychosomatic Diagnosis. New York: Harper and Brothers, 19^1^3 * Hiltner, Seward. Pastoral Counseling. New York: Abingdon- Cokesbury Press, 194^. . Religion fiuid Health. New York: The Macmillan Co., -----1^3.------------------------ Eulme, William E. Counseling and Theology. Philadelphia: Muhlenberg Press, 1956. James, William. Psychology. New York: Henry Holt and Co., 1910. Kemp, Charles P. Physicians of the Soul. New York: The Macmillan Co., l9i|-t. 131 Ken^f, Florence C. The Person as a Nurse. New York; The Macmillan Co., 195?• " Lauterbach, William A. Ministering to the Sick. St. Louis: Concordia Publishing Ëouse, 1555T" McNeil, John T. A History of the Cure of Souls. New York: Harper and Brothers, 193T. Miner, Roy (ed.). Psychotherapy and Counseling. New York: The New York Academy of Science, 1^56• Oates, Wayne E. "The Role of Religion in Psychoses.” Religions and Human Behavior. Edited by Simon Doniger. New York: Association Press, 195k* Overstreet, Harry and Bonaro. The Mind Alive. New York: W. W. Norton and Company, Inc., 193^• Rogers, Carl. Counseling and Psychotherapy. Cambridge: Houghton Mifflin doz^any, 1^42. Stolz, Karl Ruf. Pastoral Psychology. New York: Abingdon- Cokesbury Press, l5^0. tJrwick, Lyndall. The Eluents of Administration. New York: Harper and Brothers, Westberg. Granger. Nurse, Pastor and Patient. Rock Island: Augustana Press, 1955. Young, Richard P. The Pastor*s Hospital Ministry. Nashville: Broadman Press, 1954. B. ARTICLES AND PERIODICALS Billinsky, John M. "Clinical Training— A Retrospect." The Andover Newton Bulletin, XLVI (October, 1953), 15. (Quoted from *^A Comparative Study of Richard C. Cabot and Paul E. Johnson," unpublished thesis prepared by Rewell William Beach.) bird, Brian. "Talking With Patients." American Practi- tioner and Digest of Treatment, VI (1955), ^70. English, 0. Spurgeon. "Psychosomatic Medicine and Dietetics." Journal of the American Dietetic Associa tion, XXVII (1551) , 7^-725. 132 "Physical Therapy, A Career of Science and Service," Prepared by the American Physical Therapy Association, New York, 1957* Price, Julian P* "The Man Behind the M.D. Degree," The Journal of the Medical Association, CLVII (1955)t k3k* Westberg. Granger E. "The Interrelationship of the Ministry and Medicine," Pastoral Psychology, April, C. UNPUBLISHED MATERIAL Hersch, Paul S. "A Study of Criteria for Guiding the Clergyman in His Care and Referral of Parishioners Who Are in Need of Specialized Counseling or Psychotherapy." Unpublished Ph.D. dissertation. The University of Southern California, Los Angeles, 1958. D. OTHER SOURCES DuVall, Everett. Letter from Former Consultant, Assembly Interim Committee on Social Welfare, California Legislature, April 20, 1958. Jost, Arthur. Letter from the Administrator of the Kings View Homes, April 13, 1958. Marth, Selden. Personal interview with graduate student at Southern California School of Theology, Claremont, California, April 22, 1958. filler, Clarence. Personal interview with Administrator of Loma Linda Sanitarium and Hospital, March 19, 1958. jThompson, Gordon. Personal interview with Chief in Internal i Medicine, Loma Linda Sanitarium and Hospital, March 11, : 1958. APPENDIX A SCRIPTURE TEXTS These things Have I spoken unto you, that my joy might remain in you, and that your joy might be full.— John 15:11* And he said unto me. My grace is sufficient for thee: for my strength is made perfect in weakness. Most gladly therefore will I rather glory in my infirmities, that the power of Christ may rest upon me.— II Cor. 12:9. Be strong and of a good courage, fear not, nor be afraid of them for the Lord thy God, he it is that doth go with thee; he will not fail thee, nor forsake thee.— Deut. 31:6. These things I have spoken unto you, that in me ye might have peace. In the world ye shall have tribula tion: but be of good cheer; I have overcome the world.— John 16:33. Come unto me, all ye that labor and are heavy laden, and I will give your rest.— Matt. 11:28. Casting all your care upon him; for he careth for you.--I Peter 5:7. Why art thou cast down, 0 my soul? and why art thou disquieted within me? hope thou in God: for I shall yet praise him, who is the health of my countenance, and ray God.— Psalm ^2:11. Cast thy burden upon the Lord, and he shall sustain thee: he shall never suffer the righteous to be moved.— Psalm 55:22. I sought the Lord, and he heard me, and delivered me from all my fears.— Psalm 3k*k* I will both lay me down in peace, and sleep: for thou. Lord, only makest me dwell in safety.— Psalm ^:8. I will lift up mine eyes unto the hills, from whence cometh my help. My help cometh from the Lord, which made heaven and earth. He will not suffer thy foot to be moved: he that keepeth thee will not slumber.— Psalm 121:1-3. 23: 1. 135 The Lord is ray shepherd; I shall not want.— Psalm Peace I leave with you, ray peace I give unto you: not as the world giveth, give I unto you. Let not your heart be troubled, neither let it be afraid.— John l i| . :27. God is our refuge and strength, a very present help in trouble.— Psalm ^6:1. The Lord is my light and my salvation; whom shall I fear? the Lord is the strength of my life; of whom shall I be afraid?— Psalm 27:1. Wait on the Lord: be of good courage, and he shall strengthen thine heart: wait, I say, on the Lord.— Psalm 27:14. Thou wilt keep him in perfect peace, whose mind is stayed on thee: because he trusteth in thee.— Isa. 26:3. APPENDIX B l i + o 3. Physical a* Peelings of progress b. Attitude of family in physical condition c. Care Food Nursing service Chaplain#s schedule

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Creator Teel, Charles William (author)

Core Title Controlled-interview study of "the therapeutic team" in selected hospitals of Southern California evaluated from the standpoint of the Christian Church

School Graduate School

Degree Master of Arts

Degree Program Religion

Degree Conferral Date 1958-06

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag health and environmental sciences,OAI-PMH Harvest,philosophy, religion and theology

Format application/pdf (imt)

Language English

Contributor Digitized by ProQuest (provenance)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c39-369498

Unique identifier UC11313687

Identifier EP65288.pdf (filename),usctheses-c39-369498 (legacy record id)

Legacy Identifier EP65288.pdf

Dmrecord 369498

Document Type Thesis

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Rights Teel, Charles William

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA