Social Work and Spiritual Counseling: Results of One State Audit

Interdisciplinary care is the foundation of hospice service for the terminally ill. This model of care includes a holistic focus on the patient and family, including not only physical and medical management but also psychological and spiritual needs. The importance of social issues is acknowledged and supported through federal and state regulations requiring social work and spiritual counseling services as a part of the hospice care team. State regulatory reports were analyzed to identify compliance issues for social workers and spiritual counselors within hospice programs in a midwestern state. Problems with care planning, assessment, and bereavement services were identified in this process. Deficiencies point to the opportunities for social work educators to improve the training of future hospice social workers and the challenges involved in training spiritual counselors.

A systematic review on chaplains and community-based clergy in three palliative care journals: 1990-1999

A systematic review of all articles appearing between 1990 and 1999 in the American Journal of Hospice and Palliative Care, the Hospice Journal, and the Journal of Palliative Care was conducted. Articles citing at least one reference were categorized as scholarly, included in the study, and divided into either research or nonresearch categories. Scholarly articles were classified as research if they contained clearly defined methods and results sections, even if these headings were not used. Research and nonresearch articles were subdivided into qualitative and quantitative research and general reviews or program descriptions, respectively. All scholarly articles were read to see if they mentioned clergy, including the terms rabbi, priest, minister, pastor, imam, chaplain, or other religious professionals. Of 838 scholarly articles published between 1990 and 1999 in the three journals, 348 (41.5 percent) were research articles, 417 (49.8 percent) were reviews, and 73 (8.7 percent) were program descriptions. Forty-seven (5.6 percent) of all 838 scholarly articles mentioned clergy or chaplains in some way. Clergy and chaplains were more likely to be an integral part of research articles, whereas mention of them in nonresearch articles tended to be incidental (chi-square = 16.8, p < .001). Moreover, quantitative articles were more likely to include clergy as an integral aspect of the article than were qualitative articles (Fischer's exact probability test, p = .088). The results are discussed with respect to the mutual roles hospice chaplains and community-based clergy play in providing spiritual care at the end of life.

The quality of spiritual care--developing a standard

Spiritual care is an important aspect of holistic care. However, it is seldom the subject of audit, or included in quality standards. This article reports on the work of the Trent Hospice Audit Group (THAG) into the development of a quality standard for the assessment, delivery and evaluation of spiritual care. The standard was drafted by a multidisciplinary team and circulated among the THAG user group and other interested specialists, and subsequently revised. Three levels of assessment are defined and the different levels of expertise needed for these assessments identified. Education has been highlighted as a key issue in enabling effective use of the standard package. Although acknowledging possible limitations and the importance of professional judgement, the standard should help provide a consistent approach to assessment, care planning and outcome review of spiritual care.

The revival of death: expression, expertise and governmentality

This paper discusses Walter's (1994) assertion that death in the West has recently undergone a revival. In particular it focuses on his claim that this revival is composed of two different strands: a late modern strand and a postmodern strand. The former, according to Walter, is driven by experts who seek to control death, the latter by ordinary people who seek to express their emotions freely. Describing the history and work of Cruse Bereavement Care, the largest bereavement counselling organization in the UK, we question Walter's distinction. We then problematize Walter's suggestion that the revival of death is caused by general social transformations. In contrast we evoke Rose's (1996) work on 'subjectification' and seek to link recent changes in the management of death and grief to permutations in governmental rationality.

Discrete varieties of care in the clinical pastoral tradition: continuing the dialogue

In the current cultural context, clinically trained ministers, lay and ordained, offer themselves to troubled souls through at least three distinct varieties of assistance: pastoral care, pastoral counseling, and pastoral psychotherapy. This essay delineates three accepted disciplines, emphasizing the importance of ascertaining, and perhaps re-evaluating, the particular needs and desires of persons who are in physical, mental, or spiritual distress. "Pastoral care," "pastoral counseling," and "pastoral psychotherapy" each play an important role in fulfilling the traditional mandate for "the cure of souls."

Informed consent and parish clergy

Pastors are given permission by others to extend care and to practice ministry. This permission may be given in denominational policy, congregational expectations, or individual requests for pastoral care. At the individual level, permission for pastoral care can be understood as analogous to the notion of informed consent in health care ethics. Informed consent is a compound concept involving: (1) the sharing and clarifying of relevant information, and (2) the respect for a person's consent for care or refusal of care. It functions as a guard both against harm and against unwanted beneficence. Because many expectations for pastoral care are not explicitly stated, ministers need to develop sensitivity to hear both requests for help and requests for privacy.

An evaluation of the quantity and quality of empirical research in three pastoral care and counseling journals, 1990-1999: has anything changed?

This article summarizes a review of all articles published in Pastoral Psychology, The Journal of Rleigion and Health, and The Journal of Pastoral Care between 1900 and 1999, identifying a total of 737 scholarly articles, of which 165 (22.4%) were research studies. The proportion of research studies, especially quantitative studies, increased significantly between the first and second half of the study period (p < .05). There was a significant positive correlation between compliance with three out of four criteria of internal validity. Three of five criteria of external validity were also positively related to one another. Compared to previous research using identical criteria to assess quantitative studies in the same journals in 1980-1989, the 1990-1999 sample showed improved compliance with respect to specifying the sampling method (p < .001), reporting the response rate (p < .05), and discussing the limitations of research studies (p < .001). However, the overall findings suggest that many researchers in the field do not have a sophisticated knowledge of statistical sampling, statistical analysis, or research design. Several recommendations for increasing the quality of quantitative research are offered.

Disability, spiritual beliefs and the church: the experiences of adults with disabilities and family members

AIMS

This paper reports the findings of a qualitative interpretive study that explored how people with disabilities and family members use their spiritual beliefs to establish meaning for disability, and to respond to the challenges of lived experience with disability. The participants' perceptions of the evangelical Christian church's influence on their spiritual experiences related to disability suggest recommendations for improved integration by the church. Applications are drawn for helping professionals and religious leaders who provide holistic care.

BACKGROUND/RATIONALE

Although there is a well-established literature on coping in families with disabled children, little is known about how people use spiritual beliefs to establish meaning for and respond to life with disability. Even less is known about how people with a particular set of shared spiritual beliefs make meaning for lived experience with disability.

DESIGN/METHODS

The author interviewed 30 persons, comprising two major groups: 13 parents of children with mixed developmental disabilities and nine adults with physical disabilities. Predominantly white, the participants lived in a south-western metropolitan area in the United States of America (USA) in 1998.

FINDINGS

Trial or difficulty contributed to spiritual challenge, the breaking of self, reliance on God, and strengthened faith in God. The participants chose to live with thankfulness and joy despite difficulties common to experience with disability. The participants' spiritual beliefs stabilized their lives, providing meaning for the experience of disability, assistance with coping and other benefits. The participants' recommendations include increased assistance by the church in promoting theological understanding of disability, and religious support using a continuing model of caring.

CONCLUSIONS

Although the study design limits the generalizability of the findings, applications can be drawn for helping professionals and religious leaders who provide holistic care

Ministry for the Good of the Whole

Clinical pastoral education and professional chaplaincy have long struggled with their relationships to various scientific worlds. With others, I affirm that the Emmanuel Movement, which produced unprecedented collaboration between clergy and physicians, died because its leaders failed to grow, to continue collaboration, and to train other physicians. I describe various indicators that suggest an increasing rapport between pastoral care and the sciences.

Addressing spirituality in pediatric hospice and palliative care

Hospice and palliative care principles mandate clinicIans to provide "total" care to patients and their families. Such care incorporates not only physical, emotional, and psychosocial care, but spiritual care as well. Even though considerable attention has been directed to spiritual issues for adult patients in hospice and palliative care, spirituality in pediatric palliative care has been virtually neglected. The need for guidelines to assess spirituality in this population was identified as a priority issue by members of a subcommittee of the Children's International Project on Children's Palliative/Hospice Services, created under the auspices of the National Hospice Organization. Committee members, based on their clinical, research, and personal experiences, identified several aspects relevant to spirituality in general, and to spirituality in pediatric palliative care in particular, and developed guidelines for clinicians in pediatric palliative care. The purpose of this paper is to share the results of this committee's work and, in particular, to present their guidelines for addressing spiritual issues in children and families in pediatric hospice and palliative care.

[Experiences and significance of comfort for the nurse. Part IV]

This last article is consecrated to testimony's analysis of the eleven nurses having living an experience of comfort with an operated person. It completes the previous article. Six tandems of congruent thematics and complementary categories emerge from the data analysis of patients and nurses, leaving to drop a hint of an adequacy between the expectation and the offer. Yet, two isolated categories appear: for the patient "to have a spiritual support" and for the nurse "to consider the socio-sanitary context". The latter allows to enlighten the part of organisational context about opportunities of comfort. Two recommendations for the management of care end this series of publications.

Partners in healing: home care, hospice, and parish nurses

A creative way to support patients in self-care strategies is to work with the parish nurse as a practice partner. This article shares approaches and innovative ideas on how home care and hospice nurses can work effectively with parish nurses.

Canadian supervised pastoral education--affirmations and ethical queries emerging from a two-year study

Presents the findings of the second phase of a research study carried out in the summer of 1999 and commissioned by CAPPE/ACPEP, and The Churches' Council on Theological Education in Canada. Reports the results of a survey of students who completed a basic unit in Supervised Pastoral Education to identity the self-perceived effects of the unit on their pastoral functioning. Notes that the results of both the first and second phase of the research affirm the use of experiential learning and the success of basic SPE in increasing self-awareness.

Becoming multicultural dancers: the pastoral practitioner in a multicultural society

Uses a dance metaphor in describing pastoral practice. Describes multicultural realities of the United States and argues for the multicultural competencies in the practice of ministry. Details three challenges to overcome: 1) unintentional racism, 2) making visible the invisibility of monoculturalism and "Whiteness," and 3) embracing the complexity of multicultural lived realities.