Hope beyond (redundant) hope: how chaplains work with dying patients.

Using Grounded Theory, this study examines the experience of 19 palliative care chaplains in counselling dying people. Taking a broad-based definition of counselling, and using unstructured individual interviews and group work, the study aimed to understand how palliative care chaplains work with patients at the point when it has been decided to cease active treatment, the point where they risk losing hope and falling into despair. Analysing the data using code-based theory building software, the author identified four organic moments in the chaplain-patient relationship, each moment being a discernable development in the chaplain's being-with the patient: 'evocative presence'; 'accompanying presence'; 'comforting presence'; and 'hopeful presence'. The author represents the four moments as a theory of 'chaplain as hopeful presence', and offers a description of the way in which the quality of presence can facilitate patients to develop 'a hopeful manner' in which hope is reconfigured into an attribute of being. The author concludes (with Levinas) that chaplains and other palliative care staff should be aware that simply being-with an other can, in itself, be hope fostering.