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Varner-Perez SE, Hoffman SM, Coleman-Phox K, Bhamidipalli S, Monahan PO, Kuppermann M, Tucker Edmonds B. Feasibility and acceptability of chaplain decision coaching on Periviable resuscitation decision quality: A pilot study. PEC INNOVATION 2024; 4:100266. [PMID: 38440389 PMCID: PMC10909622 DOI: 10.1016/j.pecinn.2024.100266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
Objective To pilot test and assess the feasibility and acceptability of chaplain-led decision coaching alongside the GOALS (Getting Optimal Alignment around Life Support) decision support tool to enhance decision-making in threatened periviable delivery. Methods Pregnant people admitted for threatened periviable delivery and their 'important other' (IO) were enrolled. Decisional conflict, acceptability, and knowledge were measured before and after the intervention. Chaplains journaled their impressions of training and coaching encounters. Descriptive analysis and conventional content analysis were completed. Results Eight pregnant people and two IOs participated. Decisional conflict decreased by a mean of 6.7 (SD = 9.4) and knowledge increased by a mean of 1.4 (SD = 1.8). All rated their experience as "good" or "excellent," and the amount of information was "just right." Participants found it "helpful to have someone to talk to" and noted chaplains helped them reach a decision. Chaplains found the intervention a valuable use of their time and skillset. Conclusion This is the first small-scale pilot study to utilize chaplains as decision coaches. Our results suggest that chaplain coaching with a decision support tool is feasible and well-accepted by parents and chaplains. Innovations Our findings recognize chaplains as an underutilized, yet practical resource in value-laden clinical decision-making.
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Affiliation(s)
- Shelley E. Varner-Perez
- Department of Spiritual Care and Chaplaincy, Indiana University Health, Indianapolis, Indiana, USA
| | - Shelley M. Hoffman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kimberly Coleman-Phox
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sruthi Bhamidipalli
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patrick O. Monahan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Brownsyne Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Zwerling B, Hendricks C, Peeler M, Feldstein B, Burke AE, Sufrin CB. "It's different than a doctor saying 'You're making the right choice'": A qualitative study of chaplains' experience caring for patients undergoing abortion in Washington DC, Maryland, and Virginia. Contraception 2024; 135:110434. [PMID: 38508407 DOI: 10.1016/j.contraception.2024.110434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES Health care chaplains are faith providers with theological education, pastoral experience, and clinical training who provide spiritual care to patients, their families, and medical staff. This study sought to characterize chaplains' experiences providing spiritual care for patients experiencing abortion and pregnancy loss and to explore how chaplains gain competency and comfort in providing pastoral care for this patient population. STUDY DESIGN Researchers conducted in-depth, semistructured, qualitative interviews with currently-practicing chaplains recruited via convenience sampling in the Washington DC, Maryland, and Virginia region. We analyzed interviews using directed content analysis and coded using both inductive and deductive coding. RESULTS We interviewed 13 chaplains. The majority were Protestant and identified as Democrats. Participants often personally struggled with the acceptability of abortion but emphasized the importance of spiritual care for this patient population. They recognized that religious stigma regarding abortion prevented referrals to chaplaincy. Though desiring to contribute, chaplains reported little formal education in pregnancy support counseling. They relied on foundational pastoral care skills, like holding space, values clarification, connecting with patients' spirituality, words of comfort, ritualistic memorialization, and resource provision. All desired more training specific to abortion and pregnancy loss in chaplaincy education. CONCLUSIONS Chaplains from varied faith backgrounds have a diverse set of skills to support patients experiencing abortion or pregnancy loss, but feel underutilized and lacking in formal training. Though not all patients require pastoral support, chaplains can be critical members of the care team, particularly for those patients experiencing spiritual distress. IMPLICATIONS Chaplains have a paucity of training in supporting patients experiencing abortion and pregnancy loss. Chaplains want to be involved with patients experiencing abortion but feel excluded by both patients and practitioners. Standardization of pastoral care training is important to ensure adequate spiritual support for patients who desire such services.
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Affiliation(s)
- Blake Zwerling
- Division of Complex Family Planning, Johns Hopkins School of Medicine Department of Gynecology & Obstetrics, Baltimore, MD, United States.
| | - Caitlin Hendricks
- Division of Complex Family Planning, Johns Hopkins School of Medicine Department of Gynecology & Obstetrics, Baltimore, MD, United States
| | - Mary Peeler
- Johns Hopkins School of Medicine Department of Gynecology & Obstetrics, Baltimore, MD, United States
| | - Bruce Feldstein
- Stanford Medicine Jewish Chaplaincy Services, a program of Jewish Family and Children's Services, Stanford School of Medicine, Division of Primary Careand Population Health Primary Care and Population Health, Stanford University School of Medicine, Medical School Office Building, Stanford, CA, United States
| | - Anne E Burke
- Division of Complex Family Planning, Johns Hopkins School of Medicine Department of Gynecology & Obstetrics, Baltimore, MD, United States
| | - Carolyn B Sufrin
- Division of Complex Family Planning, Johns Hopkins School of Medicine Department of Gynecology & Obstetrics, Baltimore, MD, United States
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Kelly M, Cai C, Teague P. Twice-in-a-Lifetime Pandemics: An Exploratory Qualitative Life-History Analysis of the Longitudinal Experiences of Hospital Chaplains Who Served During Both the Early AIDS (1981-1995) and Early COVID-19 (2020-2021) Pandemics in the USA and United Kingdom. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02080-x. [PMID: 38949751 DOI: 10.1007/s10943-024-02080-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
The aim of this study was to document the longitudinal experiences of chaplains who served during both the early AIDS (1981-1995) and early COVID-19 (2020-2021) pandemics. A total of 11 hospital chaplains were interviewed across the USA and the United Kingdom. Interviews were analyzed using a Grounded theory approach. Chaplains reported multiple stressors during both pandemics, including barriers to integration into care teams, tensions with home religions institutions, burnout, and challenges arising from the politicization of disease. Despite these challenges, chaplains play a vital role during pandemics. Insights from their experiences can inform future strategies for compassionate crisis response.
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Affiliation(s)
- Matthew Kelly
- Center for Medical Humanities and Social Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Connie Cai
- School of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA.
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Nuzum D, Fitzgerald B, Evans MJ, O'Donoghue K. Maternity Healthcare Chaplains and Perinatal Post-Mortem Support and Understanding in the United Kingdom and Ireland: An Exploratory Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:1924-1936. [PMID: 33415602 DOI: 10.1007/s10943-020-01176-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
Perinatal autopsy rates have declined significantly in recent decades. There is a lack of consensus concerning the potential religious influences for bereaved parents in their decision making process for post-mortem. This online study of British and Irish maternity healthcare chaplains explored their understanding of general and local perinatal post-mortem procedures and their experiences in the support of parents. Participants included Christian, Muslim and non-faith chaplains. No chaplain identified any religious prohibition to perinatal post-mortem. A majority of chaplains reported that they had been asked about post-mortem by parents; only a minority felt adequately prepared. A key recommendation is that following appropriate training chaplains may be well placed to support colleagues and parents during the decision making process.
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Affiliation(s)
- D Nuzum
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - B Fitzgerald
- Department of Histopathology, Cork University Hospital, Wilton, Cork, Ireland
| | - M J Evans
- Department of Pathology, Edinburgh Royal Infirmary, Edinburgh, Scotland
- Honorary Professor, Department of Molecular, Genetic and Population Health Studies, University of Edinburgh, Edinburgh, Scotland
| | - K O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
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Murphy D, Flynn P, Warland J. Stillbirth And Faith: When Belief And Death Collide. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2021; 75:33-39. [PMID: 33843312 DOI: 10.1177/1542305020962421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Mothers who had experienced stillbirth (n = 436) were asked about their "faith base" and whether it was "helpful to their healing." Only 178 (24.5%) indicated their faith base was "helpful;" there was also a wide range of other responses including those who indicated their faith was "lost" following their baby's death. Findings are discussed in terms of what participants found helpful from their pastor and/or church community.
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Affiliation(s)
| | | | - Jane Warland
- Clinical and Health Sciences, University of South Australia, Australia
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Timmins F, Pujol N. The Role of Healthcare Chaplains in Resuscitation: A Rapid Literature Review. JOURNAL OF RELIGION AND HEALTH 2018; 57:1183-1195. [PMID: 29569111 DOI: 10.1007/s10943-018-0604-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Spirituality is becoming of increasing importance in the international healthcare context. While patients' spirituality or faith is often overlooked, there is a growing awareness that understanding, addressing and supporting patients' spiritual and faith needs can influence healthcare outcomes. This review aims to illuminate this role and highlight healthcare chaplains' potential in relation to the provision of pastoral support for families during and after patient resuscitation, and the dearth of interdisciplinary education in this field. A rapid structured review was undertaken using four databases-PubMed, CINAHL, PsycINFO and ATLA. Primary research studies published during the 10-year period 2007-2017 written in English addressing the chaplain's role or perceived role in resuscitation were included. An initial search using key terms yielded 18 relevant citations. This reduced to 11 once duplicates were removed. Ultimately five relevant primary research studies were included in the final analysis. This review found few studies that directly explored the topic. Certainly many view the chaplain as a key member of the resuscitation team, although this role has not been fully explored. Chaplains likely have a key role in supporting families during decisions about 'not for resuscitation' and in supporting families during and after resuscitation procedures. Chaplains are key personnel, already employed in many healthcare organisations, who are in a pivotal position to contribute to future developments of spiritual and pastoral care provision and support. Their role at the end of life, despite well described and supported, has received little empirical support. There is an emerging role for chaplains in healthcare ethics, supporting end-of-life decisions and supporting family witnessed resuscitation where relevant. Their role needs to be more clearly understood by medical staff, and chaplain's input into undergraduate medical education programmes is becoming vital.
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Affiliation(s)
- Fiona Timmins
- School of Nursing and Midwifery Studies, Trinity College Dublin, 24 D'Olier St., Dublin 2, Ireland.
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Nuzum D, Meaney S, O’Donoghue K. The impact of stillbirth on bereaved parents: A qualitative study. PLoS One 2018; 13:e0191635. [PMID: 29364937 PMCID: PMC5783401 DOI: 10.1371/journal.pone.0191635] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 12/22/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose To explore the lived experiences and personal impact of stillbirth on bereaved parents. Methods Semi-structured in-depth interviews analysed by Interpretative Phenomenological Analysis (IPA) on a purposive sample of parents of twelve babies born following fetal death at a tertiary university maternity hospital in Ireland with a birth rate of c8,500 per annum and a stillbirth rate of 4.6/1000. Results Stillbirth had a profound and enduring impact on bereaved parents. Four superordinate themes relating to the human impact of stillbirth emerged from the data: maintaining hope, importance of the personhood of the baby, protective care and relationships (personal and professional). Bereaved parents recalled in vivid detail their experiences of care following diagnosis of stillbirth and their subsequent care. The time between diagnosis of a life-limiting anomaly or stillbirth and delivery is highlighted as important for parents as they find meaning in their loss. Conclusions The impact of stillbirth on bereaved parents is immense and how parents are cared for is recalled in precise detail as they revisit their experience. Building on existing literature, these data bring to light the depth of personal experience and impact of stillbirth for parents and provides medical professionals with valuable insights to inform their care of bereaved parents and the importance of clear and sensitive communication.
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Affiliation(s)
- Daniel Nuzum
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- * E-mail:
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Keelin O’Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Nuzum D, Meaney S, O'Donoghue K. The public awareness of stillbirth: an Irish population study. BJOG 2017; 125:246-252. [DOI: 10.1111/1471-0528.14939] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 12/01/2022]
Affiliation(s)
- D Nuzum
- Department of Obstetrics and Gynaecology; Cork University Maternity Hospital; University College Cork; Wilton Cork Ireland
| | - S Meaney
- National Perinatal Epidemiology Centre; Cork University Maternity Hospital; University College Cork; Wilton Cork Ireland
| | - K O'Donoghue
- Department of Obstetrics and Gynaecology; Cork University Maternity Hospital; University College Cork; Wilton Cork Ireland
- Department of Obstetrics and Gynaecology; Irish Centre for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
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Timmins F, Caldeira S, Murphy M, Pujol N, Sheaf G, Weathers E, Whelan J, Flanagan B. The Role of the Healthcare Chaplain: A Literature Review. J Health Care Chaplain 2017. [DOI: 10.1080/08854726.2017.1338048] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fiona Timmins
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Sílvia Caldeira
- Institute of Health Sciences, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Maryanne Murphy
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | | | - Greg Sheaf
- Library of Trinity College Dublin, Dublin, Ireland
| | | | - Jacqueline Whelan
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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Nuzum D, Meaney S, O'Donoghue K. The Spiritual and Theological Challenges of Stillbirth for Bereaved Parents. JOURNAL OF RELIGION AND HEALTH 2017; 56:1081-1095. [PMID: 28154999 DOI: 10.1007/s10943-017-0365-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Stillbirth is recognized as one of the most challenging experiences of bereavement raising significant spiritual and theological questions. Semi-structured qualitative interviews were conducted with bereaved parents cared for in a tertiary maternity hospital to explore the spiritual impact of stillbirth. Data were analysed using interpretative phenomenological analysis. Stillbirth was identified as an immensely challenging spiritual and personal experience with enduring impact for parents. The superordinate themes to emerge were searching for meaning, maintaining hope and questioning core beliefs. Most parents reported that their spiritual needs were not adequately addressed while in hospital. The faith of all parents was challenged with only one parent experiencing a stronger faith following stillbirth. This study reveals the depth of spiritual struggle for parents bereaved following stillbirth with a recommendation that spiritual care is provided as part of comprehensive perinatal bereavement care in the obstetric setting.
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Affiliation(s)
- Daniel Nuzum
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
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Nuzum D, Meaney S, O'Donoghue K. The Place of Faith for Consultant Obstetricians Following Stillbirth: A Qualitative Exploratory Study. JOURNAL OF RELIGION AND HEALTH 2016; 55:1519-1528. [PMID: 26093617 DOI: 10.1007/s10943-015-0077-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Stillbirth remains among the most challenging areas in obstetric practice. The objectives of this study were to explore the impact of stillbirth on the faith of obstetricians. Semi-structured in-depth qualitative interviews were conducted with obstetricians focusing on the impact of stillbirth on their faith. Data were analyzed using interpretative phenomenological analysis. Stillbirth was identified as one of the most difficult experiences, and most consultants were unable to engage with their personal beliefs when dealing with death at work. The major study themes were conflict of personal faith and incongruence between personal faith and professional practice. This study highlights a gap in how obstetricians see their own faith and feeling able to respond to the faith needs of bereaved parents. Participating obstetricians did not demonstrate that spirituality was an integrated part of their professional life.
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Affiliation(s)
- Daniel Nuzum
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
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