Professional Quality of Life and Changes in Spirituality Among VHA Chaplains: A Mixed Methods Investigation

A mixed method design was implemented to examine the spirituality and emotional well-being of Veterans Health Administration (VHA) chaplains and how potential changes in spirituality and emotional well-being may affect their professional quality of life. Four distinct categories of changes emerged from the narrative statements of a nationally representative sample of 267 VHA chaplains: (1) positive changes (e.g., increased empathy), (2) negative changes (e.g., dysthymic mood, questioning religious beliefs), (3) combination of positive and negative changes, and (4) no change (e.g., sustenance through spirituality or self-care). Most chaplains reported positive (37%) or no change (30%) in their spirituality and/or emotional well-being. However, quantitative analyses revealed that chaplains who reported negative changes endorsed greater burnout and secondary traumatic stress. Overall, these findings suggest VHA chaplains are predominantly spiritually resilient, but negative changes in the spiritual domain can occur, potentially increasing the risk of adverse changes in professional quality of life.     

Weaving spirituality into organizational life. Suggestions for processes and programs

Recent research has demonstrated a clear link between spirituality and health, but it remains a challenge for many organizations to weave spirituality into organizational life and make it an integral component of clinical care. Three dimensions of spirituality work together in healthcare: spiritual well-being of patients and families, spiritual well-being of workers, and spiritual well-being of the organization. To cultivate these dimensions in the life of healthcare organizations, several strategies may be employed. First, the definition of "spirituality" must be clear. Consider spirituality at the core of providing healthcare, instead of parallel to or part of clinical approaches. Separate spirituality from chaplaincy, since nurturing spiritual values is the responsibility of everyone in the organization. It is important to affirm what people already do spiritually, focus on what they have to offer instead of on deficiencies, and cultivate spirituality individual by individual. Organizational leaders must demonstrate spirituality in their personal and professional lives, and keep the organizational mission to the fore. When working to enhance organizational spirituality, create a vision within the organization of its spirituality and emphasize peer support and collaboration. Programs to help organizations inculcate spirituality include retreats or renewal programs for employees, forums to explore employees' spirituality, inclusion of spiritual issues in training and orientation programs, educational and development programs for working groups, regular review of spiritual well-being, training selected employees as spiritual facilitators, and supporting research on spirituality, health, and healthcare.     

The Utilization of Spirituality in Occupational Therapy: Beliefs,Practices, and Perceived Barriers

Spirituality has become an increasingly important topic in healthcare and specifically in occupational therapy. This study utilized a survey design to examine occupational therapists' current beliefs and practices regarding spirituality, and to identify barriers to the use of spirituality in OT treatment. No statistically significant relationship was found between the use of spirituality and different practice settings or therapists' demographics However the participants' response indicated that the beliefs and practices regarding spirituality in occupational therapy may be changing Therapists reported discussing spiritual issues with clients more frequently than in previous studies. Lack of education or experience in taking a spiritual history was reported as the major barrier impeding the therapists' ability to incorporate spirituality into OT practice.     

Research as a Chaplaincy Intervention

Although widely used, we know very little of the meaning of the word spirituality in secular, non-English speaking societies, and different understandings might lead to misunderstandings and unclear communication. This empirical study compares a theologian and a lay group on their understandings of the term spirituality by analysis of a questionnaire consisting of 115 possible associations of the word spirituality. Analysis compares six understandings of spirituality: 1) positive dimensions in human life and well-being; 2) new Age-ideology; 3) integrated part of established religious life; 4) vague striving, opposed to religion; 5) selfishness; and 6) ordinary inspiration in human activities.

Results show the theologians understand spirituality more as part of established religious life than the lay group, whereas the lay group understands spirituality more as a striving toward something transcendent, vaguely defined. In conclusion, it is suggested never to use the term spirituality without a notion or some keywords framing the meaning of the word in the specific context.     

Adults with cystic fibrosis: spiritual coping with lifelong disease

Abstract

Cystic fibrosis (CF) is a chronic life-shortening disease requiring significant coping. Spiritual belief relates to treatment behaviors. Little is known about spirituality’s role in adults diagnosed as children, nor how it compares with adults diagnosed as adults. Adults over 18?years, diagnosed as children completed a questionnaire; some were randomized to also participate in an interview or daily phone diary to measure adherence. Qualitative analyses of 25 adults are presented. Participants reframed their disease as part of a Divine Plan, in which Divine assistance was conditional upon adherence. Linear regression models of spiritual constructs on airway clearance, nebulized medication, and exercise are presented. Adults diagnosed as children related spirituality to CF in ways both consistent and different from adults diagnosed as adults. Spiritual beliefs were related to adherence determinants and intentions. Increased understanding of the relationship between spirituality and health behaviors is important to providing person-centered care.     

Religion and spirituality among bisexual Black men in the USA

Traditionally, religion has been a major source of institutional support and well-being for Black people in the USA. However, when juxtaposed against sexuality, religion's positive effect upon the lives of non-heterosexual individuals is questionable. Research suggests that non-heterosexuals often abandon structured religion for spirituality due to the homonegativity perpetuated through religious institutions. Although studies have examined religion and spirituality among gays and lesbians, few have examined their roles in the lives of bisexuals. In this study, we analyzed qualitative interviews from 28 bisexual Black men who resided in New York City. In addition to church attendance, participants expressed belonging to religious communities through activities such as music ministry. Despite rejection because of their bisexuality, some participants saw other religious individuals as being accepting of them. Others discussed the church as a place where non-heterosexuals interacted, often for meeting sexual partners. Participants evoked beliefs in God in coping with adverse life experiences; some linked faith to family and sexual responsibilities. Drawing upon relevant literature, we discuss the implications of religion and spirituality for the quality of life of bisexual Black men in the USA.     

The association between adolescent spirituality and voluntary sexual activity.

PURPOSE: The purpose of this study was to describe the spectrum of adolescent spirituality and to determine the association between dimensions of spirituality and voluntary sexual activity (VSA) in adolescents. DESIGN: A sample of 141 consecutive youth aged 11-25 years presenting to an urban, hospital-based adolescent medicine clinic completed a 153-item instrument assessing sociodemographics, psychosocial parameters, and eight specific aspects of spirituality including: (1) religious attendance, (2) religious importance, (3) intrinsic and (4) extrinsic religious motivation, (5) belief in God, (6) belief in divine support, (7) existential aspects of spirituality, and (8) spiritual interconnectedness. Adolescents were also asked about VSA. RESULTS: Sixty-one percent of respondents were African-American and 67.4%, female; mean age was 16.0+/-2.4 years. Adolescent religious attendance was equally distributed across the categories from "none" to "weekly or greater" attendance. Over 90% felt religion was somewhat important in their lives. Over 85% reported belief in God. Fifty-six percent of respondents reported a history of VSA. Greater importance of religion (p = 0.035) and higher spiritual interconnectedness with friends (p = 0.033) were inversely associated with VSA. A multiple logistic regression model including age, gender, race, socioeconomic status, and specific denomination of religious faith, importance of religion, and spiritual interconnectedness found that spiritual interconnectedness with friends (OR = 0.92, 95% CI = 0.85, 0.99) and age (OR = 1.75, 95% CI = 1.34, 2.28) were independent predictors of VSA. CONCLUSIONS: Spirituality is a common facet of adolescents' lives. Younger age and higher spiritual interconnectedness, particularly interconnectedness among spiritual friends, are independently associated with a lower likelihood of VSA.     

“We both just trusted and leaned on the Lord”: a qualitative study of religiousness and spirituality among African American breast cancer survivors and their caregivers

Purpose

Most breast cancer (BC) survivorship research focuses on the general population of survivors. Scant research investigates the potentially unique experiences of minorities, especially during and after the difficult transition from primary treatment to post-treatment. This qualitative study explored African American BC survivors’ and caregivers’ quality-of-life in the post-treatment period with a focus on social and spiritual well-being.

Methods

Participants included a convenience sample of African American women with stage I–III BC (N = 23) who completed treatment 6–24 months before enrollment. Primary caregivers (N = 22) included friends, spouses and other family members (21 complete dyads). Participants completed separate semi-structured telephone interviews. Template analysis was used to evaluate themes related to religiousness and spirituality, both across and within dyads.

Results

After treatment, religiousness and spirituality played a major role in both survivors’ and caregivers’ lives by: (1) providing global guidance, (2) guiding illness management efforts and (3) facilitating recovery. Participants described a spiritual connectedness with God and others in their social networks. Dyad members shared the goal of keeping a positive attitude and described positive growth from cancer. Few future concerns were expressed due to the belief that survivors were healed and “done” with cancer. Beyond practical and emotional support, provision of spiritual assistance was common.

Conclusions

Results highlight the principal, positive role of religiousness and spirituality for African American BC survivors and caregivers after treatment. Findings emphasize the need to assess the importance of religious and spiritual beliefs and practices, and if appropriate, to provide resources that promote spiritual well-being.     

Spirituality in HIV-infected Adolescents and Their Families: FAmily CEntered (FACE) Advance Care Planning and Medication Adherence

PurposeTo explore the effect of spirituality and religious beliefs on FAmily CEntered (FACE) Advance Care Planning and medication adherence among human immunodeficiency virus (HIV) positive adolescents and their surrogate decision-makers.MethodsA sample of HIV-positive adolescents (n = 40) and their surrogates, aged ≥21 years, (n = 40), was randomized to an active Healthy Living Control group or the FACE Advance Care Planning intervention, guided by transactional stress and coping theory. Adolescents' spirituality and their belief that HIV is a punishment from God were assessed at baseline and 3 months after the intervention, using the Functional Assessment of Chronic Illness Therapy—Spiritual Well Being Scale, Expanded, Version 4.ResultsControl adolescents increased faith and meaning/purpose more than FACE adolescents (p = .02). At baseline, more behaviorally infected adolescents (16%) believed that HIV was a punishment from God as compared with those who were infected perinatally (8%). Adolescents endorsing that HIV was a punishment scored lower on spirituality (p = .05) and adherence to Highly Active Antiretroviral Therapy (HAART) (p = .04). Surrogates were more spiritual than adolescents (p ≤ .0001).ConclusionProviding family support in a friendly, facilitated environment enhanced spirituality among adolescents. Facilitated family conversations had an especially positive effect on medication adherence and spiritual beliefs among behaviorally infected adolescents.     

Building on the positive in children's lives: a co-participatory study on the social construction of children's sense of agency

This study is grounded on the argument that agentic experiences and their reflection in supportive social contexts are crucial protective elements mediating children's socio-emotional well-being. Drawing on the socio-cultural perspective, we investigate the ways in which agency is manifested in children's social interactions while they reflect upon their self-taken photos of positive events in their lives. The empirical data were collected with primary school children via the ‘children as co-researchers’ methodology, and were examined via a micro-level interaction analysis of video-recorded photo-reflection situations. The results illuminate interactions in which the children are constructing, maintaining and contesting the cultural practices of what it means to have agency in their social settings in and outside school. The study contributes towards a more nuanced understanding of the relationship between co-participatory practices upon positive in children's lives and the promotion of children's sense of agency that engenders their socio-emotional well-being.     

Retaining the meaning of the words religiousness and spirituality: a commentary on the WHOQOL SRPB group's "a cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life" (62: 6, 2005, 1486-1497)

Recent years have seen increasing recognition paid to the relation of religiousness/spirituality (R/S) to health care and research. This has led to the development of more inclusive and trans-culturally validated measurements of R/S. This paper comments on the WHOQOL SRPB Group's "A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life" (62: 6, 2005, 1486-1497), a recently published paper in Social Science & Medicine, and illustrates a possible problem in the measurement of R/S, especially as related to the study of mental health outcomes. Some scales have included questions about psychological well-being, satisfaction, connectedness with others, hopefulness, meaning and purpose in life, or altruistic values as part of their measure of R/S. These questions are really tapping indicators of mental health, and should not be included in the definition of R/S itself. Otherwise, tautology is the result, and it should not be surprising that such measures of R/S (defined by questions tapping mental health) are related to mental health outcomes.     

The Role of Meaning in the Prediction of Psychosocial Well-being of Testicular Cancer Survivors

Summary Stressful life events, such as cancer, may threaten the belief that life is meaningful and this may have a negative effect on well-being. This study aimed at: (1) examining meaning in testicular cancer survivors (TCSs); (2) changes in outlook on life after testicular cancer (TC); (3) the contribution of meaning in the prediction of psychosocial well-being and cancer-related distress. A total of 354 TCSs completed relevant questionnaires. Results showed that: (1) TCSs experience their lives as meaningful; (2) most TCSs (60%) report a more positive outlook on life since TC; (3) meaning is the most important predictor for psychosocial well-being, but its relationship with cancer-related distress is weak. These results indicate that the cancer experience did not (permanently) disrupt the sense of meaning in TCSs. Furthermore, results confirm the idea that a sense of meaning has a positive effect on psychosocial well-being. Meaning appeared to have little effect on cancer-related distress. However, previous research has shown that this relationship may be too complex to unravel with a cross-sectional design. Therefore, it is suggested to further investigate the underlying interacting mechanisms between meaning and cancer-related distress. Presented orally during the 7th world congress of psycho-oncology, August 25–28th, 2004, Kopenhagen, Denmark.     

Getting on with life: positive experiences of living with a spinal cord injury

Currently, the dominant cultural beliefs toward disability are negative, and the existing literature is limited with respect to examining how people are using and/or viewing their disabilities positively. The purpose of this study was to identify how individuals living with a spinal cord injury (SCI) viewed and/or used their disability positively, and what contextual influences facilitated this positive approach. This study was a secondary analysis of qualitative data from a larger study. The findings revealed three levels at which disability was viewed and/or used positively by people with SCI: self, peers, and disability community. In addition, several aspects of the participants' situations were found to facilitate this positive view and/or use of disability: personality, spirituality, support systems, and acceptance of one's disability. The findings reveal that individuals with SCI are viewing and/or using their disabilities positively in many different ways. This study has significant implications for the direction of future research and for health care professionals who need to increase their advocacy and facilitating roles.     

Challenges and changes in spirituality among doctors who become patients

Though spirituality can help patients cope with illness, several studies have suggested that physicians view spirituality differently than do patients. These issues have not been systematically investigated among doctors who become patients, and who may be able to shed critical light on this area. We interviewed fifty doctors from major urban US centers who had become patients due to serious illnesses about their experiences and views relating to religion and spirituality before and after diagnosis, and we explore the range of issues that emerged. These physician-patients revealed continua of forms and contents of spirituality. The forms ranged from being spiritual to start with; to being spiritual, but not thinking of themselves as such; to wanting but being unable to believe. Some continued to doubt and, perhaps relatedly, appeared depressed. The contents of beliefs ranged from established religious traditions, to mixing beliefs, or having non-specific beliefs (e.g., concerning the power of nature). One group of doctors felt wary of organized religion, which could prove an obstacle to belief. Others felt that symptoms could be reduced through prayer. At times, self-assessments of spirituality were difficult to make or inaccurate. Questions surfaced concerning whether and how medical education could best address these issues, and how spirituality may affect clinical work. This study is the first that we know of to examine spirituality among physicians when they become patients. Obstacles to physicians' attentiveness to the potential role of spirituality arose that need to be further explored in medical education and future research. Increased awareness of these areas could potentially have clinical relevance, strengthening doctor-patient relationships and communication, and patient satisfaction.     

Spirituality and effective leadership in healthcare: is there a connection?

Does the level of a leader's spirituality affect his or her effectiveness as a leader? The existence or nonexistence of a link between leadership and spirituality is an emerging issue in the healthcare leadership and management literature. This article defines effective leadership and spirituality and reviews the literature for both healthcare and other organizations in the discussion of this link. It concludes that healthcare leaders who are more developed in terms of their actualized spirituality simultaneously implement the five practices of effective leaders: challenge the process, inspire a shared vision, enable others to act, model the way, and encourage the heart. Moreover, they achieve more positive results for their organizations.     

Successful ageing in an area of deprivation: part 2--a quantitative exploration of the role of personality and beliefs in good health in old age

OBJECTIVES: This paper presents further analysis of a study aimed at examining the determinants of good health and successful ageing in an area of deprivation. In this paper we report findings from the quantitative data related to two of the original eight research questions: (1) To what extent can health in old age be attributed to psychological/personality variables? and (2) What is the role of religious beliefs and 'spirituality' in healthy ageing? STUDY DESIGN: In-depth interview study in which standardized measures of personality and beliefs were administered, along with measures of beliefs devised for the study. METHODS: One hundred matched pairs of healthy and unhealthy 'agers' were interviewed face-to-face. Healthy ageing was assessed in terms of hospital morbidity and self-reported health. The sample comprised 106 males and 94 females (53 male matched pairs and 47 female matched pairs) ranging in age from 70 to 90 years of age with the majority (n=165) falling into the 71-80 age group and the remaining 35 in the 81-90 age group. All study participants were survivors of the Paisley/Renfrew (MIDSPAN) survey, a longitudinal study commenced in 1972 with continuous recording of morbidity and mortality since. Questionnaires assessing extraversion, neuroticism, psychoticism, health locus of control, sense of coherence, optimism, and religiosity were filled in by participants during the interviews. RESULTS: Compared to the unhealthy group, the healthy participants were less neurotic, more likely to endorse an internal locus of control belief and less likely to endorse a powerful others locus of control belief, and to report a greater sense of coherence. The unhealthy group scored higher on the religiosity/spirituality measure devised for this study. CONCLUSIONS: The findings are interesting in that, although they cannot address the issue of cause and effect, the very fact that the personality traits measured in this study were linked to health status in old age, further strengthens the argument that in general practice and hospital settings, an understanding of personality aids practitioners in dealing with patients. Finally, with the growing body of evidence that personality traits have a high degree of heritability, the routine gathering of information on personality traits would aid epidemiologists in their understanding of the determinants of healthy and successful ageing.     

大学生主观幸福感和生活事件的关系

目的研究大学生主观幸福感和生活事件的关系,为高校大学生心理健康教育提供依据。方法运用主观幸福感问卷和青少年生活事件量表,对769名大学生进行测试。结果大学生主观幸福感处于中等偏上水平。主观幸福感和生活事件均存在性别差异、年级差异、城乡差异;生活事件分别可以解释总体主观幸福感、生活满意度、正性情感及负性情感变异的5.4%,3.7%,1.3%和17.3%。不喜欢上学、学习负担重、受人歧视冷遇、亲友死亡、与教师关系紧张、考试失败或不理想、受批评或处分、长期远离家人不能团聚、被盗或丢失东西、家庭经济困难、与人打架、家庭施加学习压力等是影响大学生主观幸福感的主要生活事件,可以不同程度地解释总体主观幸福感、生活满意度、正性情感及负性情感变异的14.8%,13.9%,8.4%和30.0%。结论生活事件对大学生主观幸福感有显著影响。     

The place of spirituality in managed care. Attending to spiritual needs can help managed care systems achieve their goals

If managed care leaders are able to achieve their goals of enhancing total well-being within a capitated system of care, they must attend to the broad new societal interest in spiritual perspectives and find ways to integrate them into their structure of care. Imaginative and sensitive members of many professions, particularly those who acknowledge the value of spirituality in their own lives and are convinced of its value in healing, will likely spearhead this integrated movement. Promoting individuals' total well-being necessitates an acknowledgement that everyone has a unique personal spirituality that needs to be addressed at times of crisis, such as illness or hospitalization. Further, attention to the spiritual dimensions of problems that result in high healthcare costs, such as violence, alcoholism, and the fear of death, can help reduce those costs. The process of grief also needs to be addressed in healthcare settings, for professionals as well as patients, to enhance understanding, acceptance, and the quality of care. People recover and retain health through a balanced integration of physical, spiritual, and community aspects of their lives. If professional chaplains who have emphasized crisis and acute care in their ministry styles are to contribute to this integrative healing and its adoption into managed care systems, they may need to explore broader frameworks, holistic concepts of healing processes, motivations for self-care, and a personal holistic balance.     

A disciplined approach to spiritual care giving for adults living with cystic fibrosis

Adults living with cystic fibrosis are less likely than other pulmonary patients to describe themselves as religious, to attend worship services regularly, to use god language, to describe their spiritual life, and in general, to give any obvious, outward indications of their spiritual strength, concerns, and depth. And yet, they have consistently demonstrated in chaplain-patient encounters an awareness of the function and importance of their spirituality in relation to life choices, coping with illness, facing mortality, and expressing life meaning, beliefs, and values. A disciplined approach by chaplains is a key component to engaging these patients so that each person's unique spiritual story unfolds. Results from The Discipline demonstrate how adults with cystic fibrosis are different in their expression and approach to spirituality from other pulmonary patients.     

The Spirituality Index of Well-Being: a new instrument for health-related quality-of-life research

PURPOSE: Despite considerable interest in examining spirituality in health-related quality-of-life studies, there is a paucity of instruments that measure this construct. The objective of this study was to test a valid and reliable measure of spirituality that would be useful in patient populations. METHODS: We conducted a multisite, cross-sectional survey using systematic sampling of adult outpatients at primary care clinic sites in the Kansas City metropolitan area (N = 523). We determined the instrument reliability (Cronbach's alpha, test-retest) and validity (confirmatory factor analysis, convergent and discriminant validation) of the Spirituality Index of Well-Being (SIWB). RESULTS: The SIWB contains 12 items: 6 from a self-efficacy domain and 6 from a life scheme domain. Confirmatory factor analysis found the following fit indices: chi2 (54, n = 508) = 508.35, P < .001; Comparative Fit Index = .98; Tucker-Lewis Index = .97; root mean square error of approximation = .13. The index had the following reliability results: for the self-efficacy subscale, alpha = .86 and test-retest r = 0.77; for the life scheme subscale, alpha = .89 and test-retest r = 0.86; and for the total scale alpha = .91 and test-retest r = 0.79, showing very good reliability. The SIWB had significant and expected correlations with other quality-of-life instruments that measure well-being or spirituality: Zung Depression Scale (r = 0-.42, P < .001), General Well-Being Scale (r = 0.64, P < .001), and Spiritual Well-Being Scale (SWB) (r = 0.62, P < .001). There was a modest correlation between the religious well-being subscale of the SWB and the SIWB (r = 0.35, P < .001). CONCLUSIONS: The Spirituality Index of Well-Being is a valid and reliable instrument that can be used in health-related quality-of-life studies.