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.     

Health Care Reform: Opportunities for Professional Chaplains to Build Intentional Communities of Learners by Integrating Faith,Science, Quality,and Systems Thinking

SUMMARY

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.     

The Use of Dreams in Spiritual Care

This paper explores the use of dreams in the context of pastoral care. Although many people dream and consider their dreams to hold some significant spiritual meaning, spiritual care providers have been reluctant to incorporate patients' dreams into the therapeutic conversation. Not every dream can be considered insightful, but probing the meaning of some dreams can enhance spiritual care practice. Hill's Cognitive-Experimental Dream Interpretation Model is applied in the current article as a useful framework for exploring dreams, gaining insight about spiritual problems, and developing a therapeutic plan of action. Bulkeley's criteria for dream interpretation were used to furnish safeguards against inappropriate application of dream interpretation to spiritual assessment and interventions.     

Transforming Chaplaincy: The Emergence of a Healthcare Pastoral Care for a Post-Modern World

This article provides a snap shot of the current position and recent developments in chaplaincy in health care settings particularly in England, Scotland, the United States of America and Australia in order to guide the emerging modernization agenda in the Australian context, and to assist the acceleration of the local adoption of best practice in pastoral care. Over all, the picture is one of change. As hospitals develop to meet new performance expectations services that work within the hospital system, such as chaplaincy and pastoral care, must also adapt. Rather than chaplaincy being discarded as marginal during these changes, recent research evidence supports the inclusion of pastoral care in holistic health care. Demographic changes also mean that pastoral care needs to have an emphasis on spiritual support if it is to respond to patients of other faith traditions or with secular beliefs.     

Priorities of Health Care Outcomes for the Elderly

ObjectivesPhysicians are uncertain about what medical services should be provided to older and/or disabled patients. Better understanding of health outcome prioritization among health care providers and recipients may help the process of decision- and policy-making. For this purpose, surveys were conducted on priorities of health care outcomes for the elderly.DesignSurvey research.SettingFour groups of health care providers and four groups of health care recipients.ParticipantsA total of 2512 health care providers and 4277 recipients.MeasurementsQuestionnaires were sent to more than 8000 health care providers and more than 9000 health care recipients: geriatricians, physicians who commonly see older patients or work in long term care facilities, staff members and participants in adult day care, patients in outpatient geriatric clinics, family members of patients with dementia, and community-dwelling older adults. The questionnaire asked the subjects to rank 12 measures of health care outcomes.ResultsThe mean response rate was 49%. All health care provider groups considered “improvement of quality of life” the most important. In contrast, in health care recipient groups, “effective treatment of illness,” “improvement of physical function,” and “reduction of carer burden” were given high priority, whereas “improvement of quality of life” was perceived as less important. All the groups, including health care providers and recipients, ranked “reduction of mortality” the least important, followed by “avoiding institutional care.” Stratification analysis showed that the results did not differ by sex, nursing care level, or the existence of relatives who required nursing care, whereas age slightly influenced the order of high-ranked measures.ConclusionPriorities of health care services and their differences between providers and recipients should be taken into account in the health care of older patients and the design of health care policies and research.     

Connection Versus Disconnection: Examining Culturally Competent Care in the Neonatal Intensive Care Unit

Culturally competent health care is of critical importance; however, it is presented as a frequent challenge in health care settings. This study explored cross-cultural care from the health care provider perspective within two tertiary level Neonatal Intensive Care Units (NICUs). Fifty eight inter-professional health care providers (HCP) participated in focus groups. Participants identified perceived care-related experiences of newly immigrated parents whose infant received care in the NICU as well as health care provider perspectives on delivering that care. Results identified core processes of “connection” and “disconnection,” which appeared to have a substantial bearing on NICU experience and interaction. Connection comprised congruity, synergy, and “fit,” and resulted in an enhanced relationship between the family and HCP. Disconnection, in contrast, entailed a lack of “fit” and in some cases, misunderstanding and/or conflict between the family and a member or members of the health care team. Connection and disconnection occurred at various junctures of NICU care. These junctures reflected interaction between the family and HCP at the bedside and/or at the level of the unit, hospital, or community at large. Implications for practice, policy, and research are discussed.     

Trends in Post-Acute Care Utilization During the COVID-19 Pandemic

ObjectiveTo examine the effect of the COVID-19 pandemic on post-acute care utilization and spending.DesignWe used a large national multipayer claims data set from January 2019 through October 2020 to examine trends in posthospital discharge location and spending.Setting and participantsWe identified and included 975,179 hospital discharges who were aged ≥65 years.MethodsWe summarized postdischarge utilization and spending in each month of the study: (1) the percentage of patients discharged from the hospital to home for self-care and to the 3 common post-acute care locations: home with home health, skilled nursing facility (SNF), and inpatient rehabilitation; (2) the rate of discharge to each location per 100,000 insured members in our cohort; (3) the total amount spent per month in each post-acute care location; and (4) the percentage of spending in each post-acute care location out of the total spending across the 3 post-acute care settings.ResultsThe percentage of patients discharged from the hospital to home or to inpatient rehabilitation did not meaningfully change during the pandemic whereas the percentage discharged to SNF declined from 19% of discharges in 2019 to 14% by October 2020. Total monthly spending declined in each of the 3 post-acute care locations, with the largest relative decline in SNFs of 55%, from an average of $42 million per month in 2019 to $19 million in October 2020. Declines in total monthly spending were smaller in home health (a 41% decline) and inpatient rehabilitation (a 32% decline). As a percentage of all post-acute care spending, spending on SNFs declined from 39% to 31%, whereas the percentage of post-acute care spending on home health and inpatient rehabilitation both increased.Conclusions and ImplicationsChanges in posthospital discharge location of care represent a significant shift in post-acute care utilization, which persisted 9 months into the pandemic. These shifts could have profound implications on the future of post-acute care.     

Assuring Professional Pastoral Care for Every Nursing Home Resident

SUMMARY

Ministry to persons in nursing homes is built on two mandates: “… He has sent me to bring good news to the oppressed, to bind up the brokenhearted, to proclaim liberty to the captives, and release to the prisoners; … to comfort all who mourn …” (Isaiah 61:1–3). The federal government provides the second: “Quality of Life. A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life” (OBRA '87, Guidance to Surveyors in Long Term Care Facilities, Code of Federal Regulations, Health Care Financing Administration, 1995, section 483.15, F240). This article discusses both the religious and the U.S. political history of caring for the old and frail. It concludes by describing political efforts in one state to increase the quality of that care and pastoral efforts to support the nursing assistants in long-term care facilities.     

#68 Is there a true “shift” to the right in the incidence of colorectal cancer?

PURPOSE: A recent “shift” in the incidence of colorectal cancer (CRC) to right-sided colon cancers has been reported. Whether this “shift” resulted from a true increase in the incidence of right colon cancers or decline in left colon cancers is unknown. To disentangle these potential explanations, we examined temporal trends in proportion of right colon, left colon, and rectal cancers as well as incidence rates.METHODS: Using data from the NCI SEER program, proportions and age-adjusted incidence rates were calculated for right colon, left colon, and rectal cancers by race over three-year time periods from 1978–1998. Proportion of cases by age at diagnosis was also calculated.RESULTS: Although the proportion of individuals diagnosed with right colon cancer increased for whites (1978–1980 = 34%;1996–1998 = 40%) and blacks (1978–1980 = 37%;1996–1998 = 44%), the proportions with left colon and rectal cancers decreased. Between 1978–1998, age-adjusted incidence rates of left colon cancer declined in whites (1978–1980 = 16/100,000; 1996–1998 = 13/100,000) and blacks (1978–1980 = 18/100,000;1996–1998 = 12/100,000, while the incidence rates of right colon cancer (1978–1980 = 14/100,000;1996–1998 = 15/100,000) did not change significantly. Age-adjusted incidence rates of rectal cancer remained stable for blacks (10/100,000) and declined for whites (1978–1980 = 15/100,000; 1996–1998 = 12/100,000). Overall, 43% of individuals >60 years diagnosed with CRC had right colon cancer. Smaller proportions were diagnosed with left colon (31%) or rectal cancer (26%). Conversely, among individuals <60 years, 28% had right colon, 34% left colon, and 38% rectal.CONCLUSION: 1) The “shift” to right colon cancer is due to a decline in the incidence of left colon and rectal cancers, while the incidence of right colon cancers remains unchanged. 2) In the elderly, the majority of colon cancers are found in the right colon. This has important implications for choice of screening method used in the elderly.     

Case Study of a Chaplain's Spiritual Care for a Patient with Advanced Metastatic Breast Cancer

The case study seeks to describe an oncology chaplain's pastoral relationship with a 64-year-old woman with advanced metastatic breast cancer. The patient's distress was complicated by a history of anxiety and other chronic medical conditions. Approximately 16 pastoral encounters occurred during the last year of the patient's life. The patient, chaplain, and the pastoral conversations are presented as well as a retrospective assessment of them. The chaplain's interventions were appropriate for the patient's spiritual needs, particularly in regard to her fear of death, loneliness, grief that her life was “too short” and estrangement from her inherited faith tradition, with observable benefits for the patient. The oncology chaplain has a distinctive role in the healthcare team as one who can meet the patient at the point of their spiritual need, provide appropriate interventions and, thereby, ameliorate the distress, particularly in regard to death anxiety, peace of mind, and issues of meaning.     

Suicidal Ideation and Behaviour among Young People Leaving Care: Case-file Survey

Self-harming and suicide amongst adolescents are reported to be increasing in Europe and internationally. For young people in state care, this aspect of mental well-being is of particular concern. The aim of this study was to establish the incidence of suicidal ideation and behaviour amongst young people (age 16–21 years) leaving state care in one health and social care trust in Northern Ireland, and to explore the correlation between this and client risk factors that might inform professional practice. Data were gathered from 164 case files of the total 215 (response rate 76%) in relation to all open cases as of 30 April 2012 extracted by the relevant social workers through the use of a standard data collection tool. Twenty-seven per cent of young people known to the 16+ Teams engaged in self-harm or suicidal behaviour. There was a strong correlation between the number of self-harm incidents and the number of suicide attempts. The risk factors identified were consistent with the research base: “male”, “unemployed”, “alcohol and drug misuse”, “adverse childhood experiences”, “higher number of placement moves” “placement type” and “older age when entering care”. Young people in more isolated placements seemed particularly at risk. The results of this study are of particular relevance to social workers and other professionals working with young people leaving state care.     

军队医院护理骨干心理护理培训需求

目的了解军队医院护理骨干心理护理实践现状及培训需求,为构建系统性心理护理培训方案提供参考。方法采用临床护士心理护理知信行及需求调查问卷、自编心理护理培训需求问卷等对2018年4批次接受任职教育培训的103名军队医院护理骨干调查。结果军队医院护理骨干心理护理知识、行为、态度、需求维度分别得分56.18±12.61分、28.52±2.38分、57.94±12.93分、18.62±1.72分;97.1%的护理骨干希望接受心理学相关培训,83%希望将“护士职业心理健康促进”作为培训内容,89%希望培训中应用案例分析;军队医院护理骨干的心理护理态度、需求、知识得分分别在工作年限、初始学历、工作科室与培训经历上的差异有统计学意义(P<0.05)。结论军队医院护理骨干心理护理知识掌握不足,一定程度阻碍临床心理护理工作的开展,亟需开展心理护理培训;并且应根据军队医院护理骨干对心理护理培训内容及培训方式的需求,侧重于临床实践应用,构建系统性、模块化、参与式培训,以切实提高军队医院护理骨干心理护理水平。     

The Role of the Social Worker in the Adult Critical Care Unit: A Systematic Review of the Literature

Social workers provide care to patients and families in the adult critical care unit. We conducted a systematic review of the literature to more clearly identify the role of the social worker practicing in the intensive care unit. We conducted a comprehensive search of the literature using the Pubmed, Embase, ISI, Scopus, and Social Work Abstracts databases using the terms “intensive care,” “critical care,” and “social work.” Articles were selected for review if they met the following criteria: formal studies or opinion papers whose primary focus was the role or scope of practice of the social worker in the adult critical care unit. Articles were selected and reviewed independently by two social work investigators. Our search retrieved 550 potentially relevant articles. Twelve full-text articles were deemed eligible for abstracting. Three of the articles were studies that examined different aspects of social work practice including implementation of a family assistance program, social work response to anxiety levels of families in critical care and common activities of critical care social workers. Nine articles were primarily opinion pieces. All of the opinion articles described psychosocial support and counseling as a primary role of critical care social work. Other frequently identified roles were crisis intervention, psychosocial assessment, facilitating communication, end-of-life care, and practical assistance. There is little empiric data describing the role of the critical care social worker. Consistent themes from the articles identified include the role of social workers as counseling professionals, facilitators of communication, and resource agents. Further research to identify formal assessment tools and outcome studies of specific counseling techniques will provide important information for best practice guidelines in this area.     

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.     

Visit Patterns for Severe Mental Illness with Implementation of Integrated Care: A Pilot Retrospective Cohort Study

There is increasing interest in models that integrate behavioral health services into primary care. For patients with severe mental illness (SMI), a population with disproportionate morbidity and mortality, little is known about the impact of such models on primary care clinic utilization, and provider panels. We performed a retrospective cohort pilot study examining visit patterns for 1,105 patients with SMI overall, by provider, before, and after the implementation of a primary care behavioral health model which had a ramp up period from May 2006-August 2007. We used 2003–2012 electronic health record data from two clinics of a Federally Qualified Health Center and conducted interrupted time series and chi-square analyses. During the intervention period there was a significant increase in the proportion of visits per month to the clinic for patient with SMI relative to overall visits (0.27; 95% CI 0.22-0.32). After the intervention period, this rate declined (-0.23; -0.19-0.28) but remained above the pre-intervention period. After integration of behavioral health into our primary care clinics, there was a sharp increase in the number of patients with SMI, suggesting patient willingness to explore receiving care under this model. Clinics looking to adopt the model should be mindful of potential changes in patient subpopulations and proactively manage this transition.     

Evaluation of a Chaplain Residency Program and Its Partnership with an In-Patient Palliative Care Team

In 2009 a Consensus Conference of experts in the field of spiritual care and palliative care recommended the inclusion of Board-certified professional chaplains with at least 1,600 hours of clinical pastoral education as members of palliative care teams. This study evaluates a clinical pastoral education residency program’s effectiveness in preparing persons to provide spiritual care for those with serious illness and in increasing the palliative care team members’ understanding of the chaplain as part of the palliative care team. Results showed chaplain residents felt the program prepared them to provide care for those with serious illness. It also showed that chaplain residents and palliative care team members view spirituality as an integral part of palliative care and see the chaplain as the team member to lead that effort. Suggested program improvements include longer palliative care orientation period, more shadowing with palliative care team members, and improved communication between palliative care and the chaplain residents.     

Contract theories and partnership in health care. A philosophical inquiry to the philosophy of John Rawls and Seyla Benhabib

Over the last 20 years, a paternalistic view in health care has been losing ground. The question about less asymmetrical positions in the healthcare professional–patient relationship is, for example, being addressed by the increased emphasis on person‐centred care, promoted in disciplines such as medicine and nursing. Partnership is considered as a key component in person‐centred care. Although the previous studies have addressed the attributes inherent in partnership, there is still potential for further discussion on how the various interpretations of partnership influence their use in healthcare literature. A vague understanding might also affect education and evaluation. As we see it, the philosophical underpinnings of the idea of partnership have not been sufficiently explored and discussed. The study reveals that partnership originates in the term “partener” defined as a relationship between individuals or groups characterized by cooperation and responsibility. Etymologically speaking, partnership is hence bound by a contract, which in this study is discussed in the frame of Rawls’ contract theory, which in turn intersects with Benhabib and her distinction between “the abstract” and “the concrete Other.” Further, the expression “equal partnership,” which often appears in the context of person‐centredness, is explored in relation to the philosophies of Rawls and Benhabib. The opportunity for partnership, as well as the risk of partnership becoming a tempting magnet with a vague and imprecise meaning, is discussed. Without exploration, reflection and discussion of the philosophical underpinnings, partnership carries a substantial risk of becoming an indistinct idea used in health care.     

Rocky Mountain Pastoral Care and Training Associates,Littleton, Colorado

SUMMARY

This article uses a sibling metaphor to outline the relationship between science and spirituality. This metaphor forms the backdrop for exploring several directions in spiritual care research. It argues that science and functional spirituality were born as siblings and need to dance now without either estrangement or incest, intent on measuring the material effects of excellent pastoral care.