The role of chaplains in end-of -life-care: A coordinated management of meaning approach to interaction

This dissertation explores the communicative nature of the chaplains multiple roles in providing spiritual care at end-of-life (EOL). The philosophy of hospice involves providing care from a holistic perspective that combines biomedical, psychological, and social aspects of the patient's well-being. For EOL patients, holistic care means that an interdisciplinary team (IDT) works together to meet patients' needs. An understudied area of the team involves the communication that chaplains engage in during EOL care processes.;In order to understand how chaplains provide spiritual care for EOL patients, coordinated management of meaning theory was applied. A coordinated management of meaning approach in communication research assumes that communication is a primary social process that involves the coordination of multiple social worlds. Qualitative methods in the form of in-depth interviews and a focus group were used to gather descriptions of chaplains' everyday experiences. Framework analysis provided a basis to organize and make sense of the data in coordinated management of meaning terms. Forty-one chaplains were interviewed in two different rounds of data collection.;Interviews with chaplains about their role in EOL care identified three prominent components: (a) success, (b) resources, and (c) communication patterns. Chaplain interviews indicated that successful coordination and management of meaning led to social constructions of a "good death." Successful chaplaincy was challenging to define and measure, but included themes related to resources and patterns of communication. A good death for chaplains involved the use of formal and communication resources to meet a patient's individual spiritual needs. Patterns of communication emerged regarding a typical day providing spiritual care and themes related to critical moments and facilitating dialogue. Chaplain interviews demonstrate that coordination efforts involve meeting with family members, communicating among team members, and managing intrapersonal reflection. The ability of chaplains to use resources appropriately during patterns of providing spiritual care leads to successful management of meaning and coherent interactions.