Spiritual Care,Pastoral Care,and Chaplains: Trends in the Health Care Literature

This study analyzes trends in the health care literature based on electronic searches of MEDLINE between the years 1980 and 2006. The search terms used were “spiritual care,” “pastoral care,” and “chaplain.?” The results document an expected surge in the rate of English-language journal articles about spiritual care beginning in the mid 1990s. Although the rate of articles about pastoral care was several times higher than that for spiritual care over much of the study period, there was a steady decline in articles about pastoral care during the past 10 years. These two trends produced a convergence in the rates, so by 2006 the rate of published articles on pastoral care (21.1 per 100,000) was less than twice as high as that on spiritual care (13.3 per 100,000). The rate of articles about chaplains rose moderately but significantly from 9.6 per 100,000 in the years 1980–1982 to 12.2 per 100,000 in the years 2004–2006. Increasing interest in spiritual care was evident in nursing, mental health, and general health care journals, being most pronounced in nursing. Declining interest in pastoral care was also most pronounced in nursing. This article discusses some implications of and responses to these trends.     

Patients' satisfaction with health care chaplaincy and affecting factors: an exploratory study in the German part of Switzerland

Surveying patients' satisfaction with chaplaincy services contributes to improving the quality of health care chaplaincy. Therefore, 679 patients from 32 general hospitals and psychiatric clinics in the German part of Switzerland were surveyed in a cross-sectional design. Seven factors influencing patients' satisfaction with health care chaplaincy were identified. They pertain, on one hand, to the chaplain-patient relationship ("Respect and friendliness," "Empathy," "Negative relationship") and, on the other hand, to the evaluation of chaplains' interventions ("Religious/spiritual interventions," "Religious/spiritual issues," "Clarification, coping and support," "Conflict management and forgiveness"). Whereas the patient-chaplain relationship was significantly associated with the patient's age and religiosity, the apprehension of pastoral intervention was significantly associated with the patient's religiosity and denomination, length of stay, admission to hospital, and the patient's health status. The results suggest that chaplains have to take account of the situational circumstances and personal characteristics of patients in order to optimize their service.     

Quantifying the health benefits of primary care physician supply in the United States.

This analysis addresses the question, Would increasing the number of primary care physicians improve health outcomes in the United States? A search of the PubMed database for articles containing "primary care physician supply" or "primary care supply" in the title, published between 1985 and 2005, identified 17 studies, and 10 met all inclusion criteria. Results were reanalyzed to assess primary care effect size and the predicted effect on health outcomes of a one-unit increase in primary care physicians per 10,000 population. Primary care physician supply was associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year (1980-1995) or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care physician per 10,000 population was associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year.     

Medical care in the last twelve months of life: the relation between age, functional status, and medical care expenditures

Medical care expenditures of a group of decedents during their last year of life suggest that high-technology medical services may be allocated most rationally than is generally assumed. Patients who received intensive hospital and physician services were largely the "young old," aged 65 to 79 years with good functional status, while the frail "older old," aged 80 years and over, received largely supportive care. Total care expenses of the older old were only slightly below those of the most expensive decedents, however, as expenses for nursing home and home health care more than offset lower medical service expenses. Further studies are needed before concluding that the major cause of high costs at teh end of life is the inappropriate use of high-technology care.     

Adherence to care plan in women with abnormal Papanicolaou smears: a review of barriers and interventions

BACKGROUND: Cancer of the cervix is preventable. According to the Surveillance, Epidemiology, and End Results (SEER) Program, invasive cervical cancer incidence is 9.0 and cancer mortality rate is 2.8 per 100,000 persons. Effective prevention includes appropriate use of Papanicolaou smears and adherence to a care plan by the patient. This review will examine the extent of nonadherence, negative outcomes, barriers, and interventions for improved adherence to care. METHODS: Computer searches in MEDLINE for English language articles were conducted from 1968 to 1999 using the key words "colposcopy," "abnormal Papanicolaou smear," "patient compliance," "adherence to care," and "follow-up." RESULTS: Although there is 10% to 40% nonadherence in the studies reviewed, the definition of nonadherence is not standard. Considerable morbidity from cervical cancer was described among nonadherent women. The most common barriers to follow-up were lack of understanding of the purpose of colposcopy, fear of cancer, forgetting appointments, and lack of time, money, or childcare. Emotional consequences of abnormal Papanicolaou smears had considerable impact on follow-up visits. Focused intervention strategies targeted to the study population were most effective in improving adherence. CONCLUSIONS: Nonadherence results from the interplay of emotional, logistic, cultural, or socioeconomic factors. Among the most effective strategies to improve adherence are personalized reminders to patients by their primary physicians and case management dictated by the size, structure, and style of the practice.     

Health promotion for the nursing home patient.

BACKGROUND: The current nursing home population numbers at least 1.5 million and is growing. Although care of the nursing home patient has been emphasized recently, health promotion activities for these patients appear underused. Current recommendations for health promotion are based on expert opinion, because well-controlled studies to support such activities in the elderly are lacking for most practices. METHODS: Using the key words "health promotion" and "preventive health services," cross-referenced with "aged," articles were selected from MEDLINE files from 1979 to the present. Bibliographies of these references were reviewed to select additional references. RESULTS: A review of the literature shows that although health promotion activities are not appropriate for every nursing home patient, many patients live for years in the long-term care facility and can benefit from health promotion. Health promotion activities can be organized around patients' length of stay. Procedures that should be considered include breast cancer screening, Papanicolaou smears for cervical cancer, hearing and vision loss screening, fall prevention assessment, immunizations, screening for dementia and depression, drug evaluation, screening for thyroid disease, and advance directives. CONCLUSIONS: Physicians who practice in nursing homes should consider health promotion for select nursing home patients.     

Tuberculosis notifications in Australia, 2006

The National Notifiable Disease Surveillance System received 1,201 tuberculosis (TB) notifications in 2006, of which 1,142 were new cases and 59 were relapses. The incidence of TB in Australia was 5.8 cases per 100,000 population in 2006 up from 5.3 per 100,000 in 2005, but still below 6 per 100,000 as it has been since 1985. Eighty-five per cent of TB notifications in 2006 were in people born outside Australia. The incidence in people born overseas and Indigenous Australians were 20.7 and 6.6 cases per 100,000 population, respectively. By contrast, the incidence of TB in the non-Indigenous Australian-born population was 0.9 cases per 100,000 population. Household or other close contact was reported as the most common risk factor for TB infection. The number of cases of TB reported in health care workers increased in 2006; these were mostly in health care workers born in TB-endemic countries and there were no reports of TB transmission in Australian health care settings. Outcome data of the 2005 TB cohort indicates that treatment success was attained in more than 95% of cases. Progress towards TB elimination in Australia will rely on continued TB awareness, maintenance of high standards of TB diagnostic and control practices, and promoting regional and global TB control activities.     

Resident smoking in long-term care facilities--policies and ethics.

Objective: To characterize smoking behavior, facility policies related smoking, and administrators'' views of smoking-related problems in Veterans Affairs nursing home care units nationwide. Methods: An anonymous mail survey of long-term care facilities was administered to 106 nursing home supervisors at VA Medical Centers with nursing home care units. The response rate was 82%. Results: Administrators from 106 VA nursing home units reported smoking rates ranging from 5% to 80% of long-term care residents, with an average of 22%. Half of the nursing homes had indoor smoking areas. Frequent complaints from nonsmokers about passive smoke exposure were reported in 23% of the nursing homes. The nursing administrators reported that patient safety was their greatest concern. Seventy- eight percent ranked health effects to the smokers themselves a "major concern," while 70% put health effects to exposed nonsmokers in that category. Smoking in the nursing home was described as a "right" by 59% of respondents and a ¿privilege¿ by 67%. Some individuals reported that smoking was both a right and a privilege. Conclusion: Smoking is relatively common among VA long-term care patients. The promotion of personal autonomy and individual resident rights stressed in the Omnibus Budget Reconciliation Act of 1987 may conflict with administrative concerns about the safety of nursing home smokers and those around them.     

Trends in mesothelioma incidence in Norway 1960-1988

The age and sex related trends in incidence of malignant mesothelioma and trends in notification of mesothelioma to the Labour Inspection between 1960-88 are investigated. For men, the age-adjusted incidence rate increased from 0.4 per 100,000 in the period 1960-69 to 1.4 per 100,000 in the period 1980-88. The number of mesotheliomas notified to the Labour Inspection increased from only 4 in the period 1960-69 to 165 in the period 1980-88. The incidence rate among women was unchanged, about 0.1 per 100,000.     

Age-specific increases in health care costs

BACKGROUND: The escalating costs of health care raise questions about demographic, epidemiological and technological determinants and future projections. The objectives of this work are to describe the age pattern of health care costs, to analyse the age-specific cost changes and to project future health care costs in an ageing population. METHODS: Comprehensive cost-of-illness data for the whole Dutch population in 1988 and 1994 are compared by age and type of care. National data on all hospital admissions, nursing days and clinical interventions for the period 1988-1994 is used to describe trends in hospital care. Population forecasts are used to project the age distribution of future health care costs. RESULTS: The distribution of health care costs per capita depends strongly on age. The growth rate of per capita costs increases by age for acute care but decreases by age for long-term care. Both combined cause an average annual growth rate of 4.6%, nearly constant with age. CONCLUSIONS: Ageing will result in increasing health care demands and costs. Secular trends in acute and long-term care indicate major shifts in costs from younger to older people and from long-term to acute care.     

Annual report on surveillance of adverse events following immunisation in Australia, 2006

This report summarises Australian passive surveillance data for adverse events following immunisation (AEFI) reported to the Adverse Drug Reactions Advisory Committee for 2006, and describes reporting trends over the seven-year period 2000 to 2006. There were 779 AEFI records for vaccines administered in 2006. This is an annual AEFI reporting rate of 3.8 per 100,000 population, the lowest since 2002 and a 10% decrease compared with 2005 (869 AEFI records; 4.3 records per 100,000 population). Dose-based AEFI reporting rates in 2006 were 1.9 per 100,000 doses of influenza vaccine for adults aged > or = 18 years, 19.1 per 100,000 doses of pneumococcal polysaccharide vaccine for those aged > or = 65 years and 12.5 per 100,000 doses of scheduled vaccines for children aged < 7 years. Trend data showed transient increases in reporting of AEFI following the introduction of DTPa-IPV combination vaccines in November 2005 for children aged < 7 years. The majority of the 779 AEFI records for 2006 described non-serious events while 11% (n = 85) described AEFIs defined as serious. There was one report of death temporally associated with receipt of dTpa-IPV and typhoid vaccines in an adult with a history of a chronic medical condition. The most frequently reported individual AEFI was injection site reaction in children following a fourth or fifth dose of acellular pertussis-containing vaccine (70 reports per 100,000 doses). The data confirm the low rate of AEFI reported in Australia and demonstrate the ability of the system to detect and investigate signals such as those associated with changes in immunisation programs.     

Amenable mortality as a performance indicator of Italian health-care services

ABSTRACT: BACKGROUND: Mortality amenable to health-care services ('amenable mortality') has been defined as "premature deaths that should not occur in the presence of timely and effective health care" and as "conditions for which effective clinical interventions exist." We analyzed the regional variability in health-care services using amenable mortality as a performance indicator. Convergent validity was examined against other indicators, such as health expenditure, GDP per capita, life expectancy at birth, disability-free life expectancy at age 15, number of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer and cardiovascular diseases. METHODS: Amenable mortality rate was calculated as the average annual number of deaths in the population aged 0--74 years per 100,000 inhabitants, and it was then stratified by gender and region. Data were drawn from national mortality statistics for the period 2006--08. RESULTS: During the study period (2006--08), the age-standardized death rate (SDR) amenable to health-care services in Italy was 62.6 per 100,000 inhabitants: 66.0 per 100,000 for males and 59.1 per 100,000 for females. Significant regional variations ranged from 54.1 per 100,000 inhabitants in Alto Adige to 76.3 per 100,000 in Campania. Regional variability in SDR was examined separately for male and females. The variability proved to be statistically significant for both males and females (males: Q-test = 638.5, p < 0.001; females: Q-test = 700.1, p < 0.001). However, among men, we found a clear-cut divide in SDR values between Central and Southern Italy; among women, this divide was less pronounced. Amenable mortality was negatively correlated with life expectancy at birth for both genders (male: r = -0.64, p = 0.002; female: r = -0.88, p <0.001) and with disability-free life expectancy at age 15 (male: r = -0.70, p <0.001; female: r = -0.67, p <0.001). Amenable mortality displayed a statistically significant negative relationship with GDP per capita, the quantity of diagnostic and laboratory tests per 1,000 inhabitants, and the prevalence of cancer. CONCLUSIONS: Amenable mortality shows a wide variation across Italian regions and an inverse relationship with life expectancy and GDP per capita, as expected.     

Nursing care needs of the caregiver of persons under palliative care

The purpose was to identify needs for nursing care of caregiver of the person in the terminal stage and nursing interventions, using a systematic review of the literature. A research in EBSCO and ProQuest and sought Full Text scientific articles, published between 1998 and 2008, using the following keywords: "Palliative care", "Family", "Nursing" and "Needs" was made. The method PI[C]OD was used to select 14 items of total 77. The care needs the person in the terminal stage are: communication, relationship of trust and security, recognition and operationalization of desires; preparation for mourning; needs for information, training, involvement in care, emotional needs, spiritual needs and resting needs. It was concluded that the family has different needs that require personal intervention of the nurse, through the establishment of a trust relationship.     

Health care consumer reports: an evaluation of consumer perspectives

There has been a proliferation of health care consumer reports, also known as "consumer guides," "report cards," and "performance reports," which are designed to assist consumers in making more informed health care decisions. While there is evidence that providers use such reports to identify and make changes in practice, thus improving the quality of care, there is little empirical evidence on how consumer guides/report cards are used by consumers. This study fills that gap by surveying 925 patients as they wait for ambulatory care in several clinics in a midwestern city. Findings indicate that consumers are selective in their use of these reports and quickly identify those sections of the report of most interest to them. Report developers should take precautions to ensure such reports are viewed as credible sources of health care information.     

Body, mind, and soul. The parish nurse offers physical, emotional, and spiritual care

Many hospitals see the parish nurse program as a way to bring their mission to the community and collaborate with area parishes. Because people are finding it increasingly difficult to access our nation's complex healthcare system, the parish nurse program is becoming more popular with hospitals, parishes, and the communities they serve. The parish nurse is a resource person--a health educator, a personal health counselor, a volunteer coordinator and support group organizer, a community liaison, and a role model for the relationship between one's faith and health. Parish nurses do not provide invasive treatments. Parish nurse programs that have been most successful have been developed through the hospital's pastoral care department in conjunction with the nursing department. The hospital establishes a steering committee to guide the program's formation. Daily, the faculty, a group made up of a physician and representatives from nursing and from pastoral care, supervise and monitor the parish nurse program.     

School Nursing in the News

This study investigated the image of school nursing in the American press during 1978 and 1980. Content analysis of newspaper articles yielded specific measurements of the extent to which school nursing is visible via the press, the content of messages disseminated to the public about school nursing issues and two year changes in newspaper treatment of this topic. The mean number of articles published per state was 1.43 in 1978 and 6.30 in 1980. The typical school nurse article appeared in a daily newspaper circulated to less than 10,000 readers. Articles published in 1978 were significantly larger than those published in 1980 and were more likely to focus primarily on the school nursing program rather than on teachers, school boards, funding concerns or other issues. The majority of the articles (77%) devoted some space to describing the services provided by school nurses. Nearly 30% of the articles reported problems with funding for school nursing programs and 21% reported threatened or actual loss of funding for services. Although reports of protests against budget cuts by school nurses, teachers, administrators and parents were found, parents were depicted as the only interest group to succeed in efforts to avert the loss of services. Criticism of school nursing services was found in only 2% of the articles. More than 80% of the articles praised school nursing as a vital force for improving the health of American school children. It was concluded that school nursing has not yet attained a position on the public agenda as an important community issue despite the fact that the quality and level of school health services are increasingly threatened in the current budget-cutting climate.     

Health care reform: opportunities for professional chaplains to build intentional communities of learners by integrating faith, science, quality, and systems thinking

Albert Einstein once said, "The significant problems we face cannot be solved at the same level of thinking we were at when we created them" (www.brainyquote.com). Health care reform has brought professional chaplains to a place of chaos-a place that raises many questions about the past, present and future. This chaos presents tremendous opportunities for professional chaplains to increase their capacities in building intentional communities of learners by integrating faith, science, quality and systems thinking. Pastoral care givers must truly understand the pressures from all sides and the new emerging paradigm of integrated health care delivery. Without this understanding, we will not see the opportunities and challenges of integrating pastoral and spiritual care in the emerging structures and systems. The future of chaplaincy largely will depend on the quality of the data, quality of our conversations and our ability to thinking together through dialogue.     

Pastoral care staff participate on treatment team

Clinical department members at Marianjoy Rehabilitation Center identified problems with their staffing conferences, in which they plan patient care. The problems included a deemphasis on social and spiritual aspects and an overemphasis on billing concerns. To correct these difficulties, the hospital adopted the Patient Evaluation Conference System (PECS), adding a pastoral care component. Central to the new system is the addition of pastoral care data from scales that assess patient status in four areas: (1) awareness of spiritual dimension of disability, (2) knowledge of spiritual resources, (3) skill in spiritual self-management, and (4) use of spiritual resources. Pastoral care staff write evaluations in easily understood language so other staff members can understand pastoral care's purpose. They formulate specific short-term objectives in order to delineate the pastoral services needed. Integration with the treatment team has resulted in greater accountability for the pastoral care staff. Patient progress charts now include specific pastoral care goals, and a daily report of pastoral care services is included on patient bills, although no fee is charged. Program evaluation and feedback systems to enable pastoral care staff to make more accurate assessments are planned. The new system has enhanced staff communication, service documentation, discharge planning, and the quality of pastoral care.     

Use and costs of care in retail clinics versus traditional care sites

Retail clinics have generated much interest, promising convenient, lower-cost service for the treatment of minor conditions than conventional care sites can offer. Using health plan claims data, we describe utilization trends, patient mix, and cost per episode of care for the five conditions most frequently treated at a retail clinic chain in the Minneapolis-St. Paul area, as compared with other care settings. Retail clinic use for these conditions is increasing at about 3 percent per year and offers savings of $50-$55 per episode. However, it accounts for only 6 percent of such episodes, and the impact on overall cost and quality remains undetermined.