Staff-Care by Chaplains during COVID-19

The aim of this study was to understand how chaplains delivered spiritual care to staff during the Covid-19 pandemic. The researchers analyzed data collected from an International Survey of Chaplain Activity and Experience during Covid-19 (N = 1657). The findings revealed positive changes that emerged and new practices evolved around the use of technology as useful tools for maintaining contact with staff.

"The Most Effective Experience was a Flexible and Creative Attitude"-Reflections on Those Aspects of Spiritual Care that were Lost, Gained, or Deemed Ineffective during the Pandemic

This paper presents and discusses data from three of the qualitative questions in the international COVID-19 survey: What was the most important aspect of spiritual care that was lost during the pandemic? What was new to you during this pandemic? What are the new ways of delivering spiritual care you have experienced? Of these new experiences, what do you think was the most effective?

"Essential Not Optional": Spiritual Care in Australia during a Pandemic

This paper focuses on the impact of COVID19 in Australia. Three areas were investigated: professionalism, contrasting hospital and aged care services and "business as usual"? Impact was low overall, the timing being pre-second wave impact. Two areas of weakness were highlighted: depleted spiritual care teams due to standing down non-professional staff and uncertainty about the role of Chaplains in the care of other staff. Further study of second wave impact is recommended.

A New Paradigm for Testing Clinical Competence in Chaplaincy Certification

This article describes the rationale, evolution, implementation, and evaluation of a process for testing clinical competence in health care chaplaincy certification. The process developed by the Spiritual Care Association uses Zoom technology, simulated patient actors, and evidence-based behaviors. Evaluation of the process by users has been very positive. The process seems to have acceptable validity, reliability, and usability and should be considered as an alternative to self-report clinical encounters as a test of clinical competence.

Defining the Context for Best Practices: Institutional Setting for Clinical Pastoral Care in Estonia

The current article aims to offer an informational basis for creating an adaptable model of spiritual support provision for Estonian health care institutions. The study addresses Estonian medical staff's knowledge about and attitudes towards spiritual support. The data originate from a quantitative research conducted in 19 Estonian hospitals during 2015-2016. The results show a good will for interdisciplinary co-operation, and pastoral caregiver is expected to be a part of the staff. The fact that spiritual support is not financed by the state budget funds raises the question about explaining the benefits of spiritual support to the hospital's or clinic's management.

Pastoral power in HIV prevention: Converging rationalities of care in Christian and medical practices in Papua New Guinea

In his conceptualisation of pastoral power, Michel Foucault argues that modern healthcare practices derive a specific power technique from pastors of the early Christian church. As experts in a position of authority, pastors practise the care of others through implicitly guiding them towards thoughts and actions that effect self-care, and towards a predefined realm of acceptable conduct, thus having a regulatory effect. This qualitative study of healthcare workers from two Christian faith-based organisations in Papua New Guinea examines the pastoral rationalities of HIV prevention practices which draw together globally circulated modern medical knowledge and Christian teachings in sexual morality for implicit social regulation. Community-based HIV awareness education, voluntary counselling and testing services, mobile outreach, and economic empowerment programs are standardised by promoting behavioural choice and individual responsibility for health. Through pastoral rationalities of care, healthcare practices become part of the social production of negative differences, and condemn those who become ill due to perceived immorality. This emphasis assumes that all individuals are equal in their ability to make behavioural choices, and downplays social inequality and structural drivers of HIV risk that are outside individual control. Given healthcare workers' recognition of the structural drivers of HIV, yet the lack of language and practical strategies to address these issues, political commitment is needed to enhance structural competency among HIV prevention programs and healthcare workers.

An e-Chart Review of Chaplains' Interventions and Outcomes: A Quality Improvement and Documentation Practice Enhancement Project

In Canada, the spiritual care landscape in health care settings is becoming more regulated and standardized documentation is part of this rigorous environment. Staff chaplains at The Ottawa Hospital participated in a Quality Improvement project that aimed to advance patient-centered care through better charting practices. A sample of 104 spiritual-care assessments that had been posted on the patient electronic health record was examined. This chart review focused on chaplains' activities that were reported as interventions as well as chaplain-reported outcomes for the patient. These interventions and outcomes were coded into discreet categories in order to get a better sense of the activities and the impact of their work. The chaplains' electronic charting content and practices were evaluated. Chaplains found that the Quality Improvement process was beneficial as they updated their electronic templates in order to meet the new reporting requirements of the College of Registered Psychotherapists of Ontario.

The Parish Nurse Coordinator

Parish nursing has emerged as a specialized professional nursing practice in the past 10 years. Nursing literature addressing the functions of the parish nurse role in a faith community or congregation has become more prevalent in recent years. However, there is very little literature that examines the role of the parish nurse (PN) in a program leadership position. The purpose of this qualitative descriptive study is to describe the role and functions of the parish nurse coordinator (PNC) charged with leadership of a group of PNs networked together as a PN program. Specifically, this article highlights the demographics of PNCs across the United States, what they value most about being a PNC, and the challenges they experience in this leadership role. Findings are examined in light of their potential for contributing to the growth and development of nursing leadership that incorporates the spiritual dimension.

The Evolution of Research Paradigms in Pastoral/Spiritual Care, Counseling, and Education

This partially autobiographical article is presented as a chapter in the narrative of the evolution of research methodology in the social sciences and the impact that evolution has had on pastoral/spiritual care research as the author has experienced and observed it during the latter part of the 20th century and the early years of the 21st century.

Good Practice Chaplaincy: An Exploratory Study Identifying the Appropriate Skills, Attitudes and Practices for the Selection, Training and Utilisation of Chaplains

This article presents an overview of exploratory research regarding the skills, knowledge, attitudes and practices considered necessary for chaplains to be highly competent in providing holistic care to clients and staff. Utilising a qualitative methodology, two focus groups comprising Salvation Army chaplains and their managers provided data about their expectations of chaplaincy personnel and about the pastoral care interventions undertaken by chaplains. The results indicated that while there were some differences in opinion, nevertheless, in overall terms, there was general agreement between chaplains and their managers about particular personal and professional qualities necessary for chaplains to be considered appropriate and proficient. Evidence was also obtained indicating a need for change with regard to the organisational attitude and culture of The Salvation Army towards chaplaincy. Recommendations are presented concerning (1) the selection criteria for chaplaincy, (2) training and utilisation of chaplains plus (3) issues relating to organizational cultural change necessary to develop a future-ready chaplaincy more suitable for the twenty-first century.

Language and practice changes in Canadian and US specialized pastoral care and counseling: a conversation

On August 20, 2013, Terry Bard, John Carr, and Steve Ivy had a 50-minute conversation about the shift that has been taking place in Canada and the United States in the practice, and the language about that practice, of persons and professional associations that have historic roots in the modern pastoral care and counseling movement. The conversation was digitally recorded, by agreement among the three participants, and is posted on the internet as a stimulus to further conversation.

PATHOS: a quick screening method for assessing sexual addiction

Pastors may understand that sex addiction exists and are frequently faced with people who need non-clinical and clinical services for the addiction. However, the pastoral counselors have no quick reliable method of assessing them. The purpose of this article is to define sexual addiction and provide information about a tool called PATHOS that can be used in clinical and non-clinical settings to identify potential sex addicts.

Ethics in pastoral care and counseling: a contemporary review of updated standards in the field

This article reviews ethical responsibilities that must be considered when engaging in pastoral care, counseling, and psychotherapy. It discusses important contemporary issues counselors will want to contemplate in pursuing a high quality of care in their counseling practices. Examples and case studies are provided. Readers will be able to: Understand the function of ethical standards in the practice of counseling Be able to differentiate between pastoral care, pastoral counseling, and pastoral psychotherapy and their ethical implications Understand the importance of identifying one's limitations in counseling situations and how to proceed under such circumstances. Understand the need for pastoral counselors to attain the necessary credentials for practice in the area of counseling they intend to undertake. Become aware of the legal requirements when engaged in a counseling relationship.

Health care chaplains and their role on institutional ethics committees: an Australia study

This paper presents the results of the largest Australian pastoral study concerning the perceptions of health care chaplains about their involvement on hospital research ethics committees (also known in some contexts as institutional ethics committees). Survey results from over 300 Australian health care chaplains indicated that nearly 90% of chaplains believed there was merit in chaplains serving on hospital research ethics committees, yet only a minority (22.7%) had ever participated on such committees. Data from in-depth interviews is also presented exploring the reasons for the lack of participation and the varying opinions regarding the role, appropriateness, and value of chaplains on ethics committees. Some implications of this study with respect to chaplaincy, hospital research ethics committees, health care institutions, ecclesiastical institutions, and government responsibilities are discussed.

But What Are We Trying to Prove?

Chaplaincy and Clinical Pastoral Education (CPE) in the health care setting can and should approach their ministries more scientifically, primarily by incorporating the methods and results of quantitative and qualitative research. Such an approach, however, should have a carefully considered rationale. Proponents of a scientific approach should avoid associating their advocacy with dubious notions of health care "reform." They should attend to the perceptions--and fears--that chaplains may have of "science" and research as these affect pastoral care. In particular, fears for professional and programmatic survival should be recognized for their potential to predispose chaplains either favorably or unfavorably toward a scientific approach. Ultimately, chaplains should increase their openness to scientific methods in order to learn more about their ministry and improve their practice, without expecting that the adoption of research methods will be a magical solution to the problems posed by the current environment.

Research or Perish?

The opportunity for sound pastoral care research is not served by the "all or nothing" approach. Professional chaplains whose training includes a thorough orientation to the research process are in a position to speak to the world of science about realities that are beyond physical research, and to the world of theology about realities that should be examined. Cloning, embryonic experimentation, and drug trials in Third World populations are among the areas without the voices of pastoral theologians. Closer to daily practice, research is an invaluable tool in helping chaplains improve their ministry.

Health Care Chaplaincy as a Research-Informed Profession: How We Get There

Health care chaplaincy should become a research-informed profession in the next ten years. This article describes my rationale for this statement and outlines a plan for accomplishing it. This means that all professional health care chaplains will value the contributions that research can make to their ministry and some chaplains will be engaged in research that informs the profession. Becoming a research-informed profession does not mean losing our emphasis on compassion, faith, presence, self-awareness, or any of the other rich resources of our tradition. It does mean supplementing those resources with the information research provides. I conclude that the question that professional health care chaplains face is not whether to become a research-informed profession, but how to get there.

Chaplains and Science

The decision between science and religion is eroding. The changing relationship is associated with the discovery of similarities between science and religion. Chaplains must become more comfortable with science and let it inform our ministry.

An evidence base for a palliative care chaplaincy service in Northern Ireland

Palliative care encompasses spiritual as well as physical, social and psychological aspects. Spiritual care has been identified as a key concern of dying patients. During an audit of the Northern Ireland Hospice chaplaincy service against the national Standards for Hospice and Palliative Care Chaplaincy (2003), 62 patients' spiritual needs along with their interactions with the hospice chaplains were assessed by using a questionnaire survey and reviewing data recorded on their pastoral care notes. Findings suggest that the Standards were useful for assessing and addressing spiritual needs. Access to the chaplaincy service (Standard 1) was partially met and Standard 2's spiritual criteria were fully met. The participants, of whom 92% had a faith in God or a Higher Being, highlighted their top six spiritual needs as: to have the time to think; to have hope; to deal with unresolved issues; to prepare for death; to express true feelings without being judged; to speak of important relationships. The majority of the participants (82%) felt their spiritual needs had been addressed and viewed their interaction with the chaplaincy service positively. Recommendations were made relating to improve communication of chaplaincy services.

Improving processes of hospital care during the last hours of life

BACKGROUND

Known for excellence in care in the last days and hours of life, hospice programs can help individuals have a "good death" and lead to higher family satisfaction with quality of care. Our objective was to evaluate the effectiveness of a multicomponent palliative care intervention based on the best practices of home hospice and designed to improve the quality of care provided for patients dying in an acute care inpatient setting.

METHODS

This study was a before-after intervention trial conducted between 2001 and 2003. Participants included physician, nursing, and ancillary staff on inpatient services of an urban, tertiary care Veterans Affairs medical center. The palliative care intervention included staff education and support to identify patients who were actively dying and implement care plans guided by a comfort care order set template for the last days or hours of life. Data abstracted from computerized medical records of 203 veterans who died during a 6-month period before (n = 108) and after (n = 95) intervention were used to determine the impact of intervention on symptom documentation and 5 process of care indicators.

RESULTS

There was a significant increase in the mean (SD) number of symptoms documented from 1.7 (2.1) to 4.4 (2.7) (P<.001), and the number of care plans increased from 0.4 (0.9) to 2.7 (2.3) (P<.001). Opioid medication availability increased from 57.1% to 83.2% (P<.001), and do-not-resuscitate orders increased from 61.9% to 85.1% (P<.001). There were nonsignificant changes in the proportion of deaths that occurred in intensive care units (P = .17) and in the use of nasogastric tubes (P = .40), and there was a significant increase in the use of restraints (P<.001).

CONCLUSION

Our results indicate that end-of-life care improved after the introduction of the palliative care program.

The challenge of providing spiritual care

Spirituality is an essential element of holistic nursing and nurses need the knowledge and confidence to address spiritual issues with patients. This paper describes the development of a tool to help with broaching this sensitive aspect of care. It argues that nurses need to examine their own spiritual needs in order to be able to help others.

A competency model for the assessment and delivery of spiritual care

The delivery of spiritual and religious care has received a high profile in national reports, guidelines and standards since the start of the millennium, yet there is, to date, no recognized definition of spirituality or spiritual care nor a validated assessment tool. This article suggests an alternative to the search for a definition and assessment tool, and seeks to set spiritual care in a practical context by offering a model for spiritual assessment and care based on the individual competence of all healthcare professionals to deliver spiritual and religious care. Through the evaluation of a pilot study to familiarize staff with the Spiritual and Religious Care Competencies for Specialist Palliative Care developed by Marie Curie Cancer Care, the authors conclude that competencies are a viable and crucial first step in 'earthing' spiritual care in practice, and evidencing this illusive area of care.

Spirituality in health: the role of spirituality in critical care

Caring for critically ill patients requires that physicians and other health care professionals recognize the potential importance of spirituality in the lives of patients, families, and loved ones and in their own lives. Patients and loved ones undergo tremendous stress and suffering in facing critical illness. Professional caregivers also face similar stress and sadness. Spirituality offers people away to understand suffering and illness. Spiritual beliefs can also impact how people cope with illness. By addressing spiritual issues of patients, loved ones, and ourselves, we can create more holistic and compassionate systems of care.

Cultural Diversity in Pastoral Care

Fukuyama and Sevig are counseling psychologists who have a particular interest in the integration of spirituality into multicultural counseling and training. In this article the authors address the complexity of integrating religious and cultural diversity and spirituality into chaplaincy care in the context of an increasingly diverse society. By posing a series of questions, the authors systematically clarify definitions and meanings of culture, spirituality, cultural diversity and multiculturalism, multicultural and spiritual competencies in counseling, and ethical considerations. The authors discuss clinical applications in the context of a "spirituality and health movement," and provide suggestions for continuing professional development. The authors support the notion that multicultural engagement is spiritually synergistic, and encourage health care providers to communicate across professional disciplines to broaden and enrich discourse on these topics.

The Search for Spiritual/Cultural Competency in Chaplaincy Practice: Five Steps that Mark the Path

Chaplains who are clinically trained and certified spiritual care professionals can make a unique contribution in today's increasingly pluralistic and global health care context with diverse religious, spiritual and cultural values, beliefs and practices. The author characterizes this contribution as spiritual/cultural competency. A self-defined web of meaning is unique to each person, comprised of a composite of values and beliefs, a fabric woven by way of one's life narrative. The proven approach of clinical learning, with heightened introspective and interpersonal awareness, serves as the chaplain's primary pathway to multi-spiritual/cultural competency, integrated with the exploration of context in a way not prioritized before. Utilizing sources from pastoral theology, anthropology and multicultural counseling, a five-step process of competency assessment is introduced and discussed with the aid of two cases. Knowing one's own spiritual/cultural grounding is the first step in this open-ended search.

Religious maturity in the midst of death and dying

Healthy religious experience is defined by certain qualities of expression. In an effort to explore the concept of mature religious phenomenology, this article includes descriptions of two encounters from personal pastoral experience. The first encounter shows how a person with an unhealthy religious experience faces death. The second encounter describes an expression of mature religious experience in the face of death and how a pastoral caregiver can facilitate its outcome. This is followed by a pastoral theological response.

In the world but not of the world: going beyond a dilemma

Is the issue addressed in this volume a question like "What time is it?" or a quest-ion like "What is time?" I argue that it is a quest-ion that requires professional chaplaincy to quest for an answer although it will always have blurred edges that lack succinctness, clarity, and certainty. The challenge posed by the quest-ion means that we must transform the dilemma into a higher synthesis that respects the qualitative aspects inherent in the profession.

Addressing patients' emotional and spiritual needs

BACKGROUND

A comprehensive, systematic literature review and original research were conducted to ascertain whether patients' emotional and spiritual needs are important, whether hospitals are effective in addressing these needs, and what strategies should guide improvement.

METHODS

The literature review was conducted in August 2002. Patient satisfaction data were derived from the Press Ganey Associates' 2001 National Inpatient Database; survey data were collected from 1,732,562 patients between January 2001 and December 2001.

RESULTS

Data analysis revealed a strong relationship between the "degree to which staff addressed emotional/spiritual needs" and overall patient satisfaction. Three measures most highly correlated with this measure of emotional/spiritual care were (1) staff response to concerns/complaints, (2) staff effort to include patients in decisions about treatment, and (3) staff sensitivity to the inconvenience that health problems and hospitalization can cause.

DISCUSSION

The emotional and spiritual experience of hospitalization remains a prime opportunity for QI. Suggestions for improvement include the immediate availability of resources, appropriate referrals to chaplains or leaders in the religious community, a team dedicated to evaluating and improving the emotional and spiritual care experience, and standardized elicitation and meeting of emotional and spiritual needs. Survey data suggested a focus on response to concerns/complaints, treatment decision making, and staff sensitivity.

Pastoral care in a time of global market capitalism

The author defines pastoral theology as "the study of the micro-world of intrapsychic and interpersonal interactions with the tools of theology and the social sciences for the purpose of support and healing. In a typical class or supervisory session, we analyze the words, voice inflection, pace, and gestures of an intimate conversation between two people, looking for clues to the deep structure of personality and intimate relationships. The hope of such study is that we will see the revelation of God is love and power in action to validate and challenge the theological traditions that give us eyes to see and invite us to see more clearly."

How satisfied are patients with the ministry of chaplains?

The author describes the importance of chaplaincy departments conducting periodic patient satisfaction studies and provides quantitative results from 1440 patients discharged from one of 14 U.S. general hospitals. Patients expressed the most satisfaction in response to the item, "The chaplain seemed to be a person of spiritual sensitivity." The results also suggest the characteristics of patients who appear most responsive to this ministry.