Using The Discipline for Integrative Ministry Formation

SUMMARY

One United Methodist Annual Conference has begun a program of ministry formation education for probationary, first-appointment ministers in conjunction with Emory Clergy Care, Atlanta. This program uses an adaptation of The Discipline as an integral part of their ongoing formation education. Participants have learned the basics of planned pastoral care delivery, family and congregational systems thinking and self-supervision. Using The Discipline, they have been effectively adapting it to their local church settings and ministries.     

First Steps: Approaching The Discipline Based,Outcome Oriented Ministry Model

SUMMARY

This article describes how a new staff chaplain is approaching and applying a discipline based, outcome oriented ministry model. He describes his move from being a lone, geriatric chaplain in a long term care facility to becoming a member of a team of staff chaplains in a teaching hospital who have disciplined themselves to an outcome oriented ministry model. The writer gives his perspective on The Discipline, and denotes ways in which his ministry has been impacted. Though the author has been involved with this process for only six months, both he and those in his care are experiencing some of the benefits of making tangible contributions and developing measurable outcomes in ministry.     

Experience with Clinical Pastoral Education in the Context of The Discipline

SUMMARY

This article relates the experience of integrating The Discipline into the process and curriculum of an ACPE accredited clinical pastoral education (CPE) program involving residents and single unit students. It describes supervisor and student concerns as well as the conclusions they reached concerning the integration of The Discipline into The CPE process.     

The Dance with The Discipline

SUMMARY

The author became acquainted with The Discipline only recently and this article describes two pastoral visits in which The Discipline provides guidance for interactive presence. Thus this material represents how the author seeks to grasp and integrate it into her clinical practice in a short time.     

The Discipline for Doing Spiritual Care: Variations on a Theme

SUMMARY

This article describes the writer's introduction to The Discipline and his decision to utilize selected aspects of it in direct care and in an educational milieu. The first section describes adaptation of the Profile (Concepts of Holy, Meaning, Hope, and Community) in the writer's work with addicted persons on a Recovery Center. The second section presents the employment of this Profile as a way to introduce CPE interns to the art of pastoral assessment.     

The Discipline: Its Impact on My Theological Perspective,Pastoral Identity and Practice

SUMMARY

This article is a personal interpretation of how The Discipline has re-formulated the pastoral identity, practice, and theology of a board certified chaplain providing ministry to patients in the heart sciences. His reflections take into account his history as an ordained priest and as a professionally trained chaplain. The article reflects his struggles and theological transformations, demonstrating how a theological base may emerge from the interpretative reflection on The Discipline. The article describes the uneasy internal and external processes that occurred in and around him during that transformation. His story also attests to growth made “from the inside out” as a chaplain within a generative multi-faith department.     

An Adaptation of The Discipline in a Clinical Pastoral Education Program

SUMMARY

The author describes his perspective on providing pastoral care to hospital patients, his search for new ways to understand that ministry, his first contact with The Discipline, and his adaptation of it to the clinical and educational programs at his center. He discusses the need to help clinical pastoral education students to operationalize their ministry and to learn how to identify outcomes that are meaningful to health care decision makers.     

Perceptions of a multidisciplinary team regarding a pediatric rehabilitation modified needs assessment

Background: Efficient service delivery models that optimize processes and human resources are required in the current health care climate. A family-centered care approach is recognized as a model that can improve the effectiveness and efficiency of pediatric rehabilitation. The objective of this study was to explore the perceptions of a multidisciplinary health care team regarding the use of the Préparation au plan d’intervention (PAPI), a modified needs assessment tool designed to facilitate a family-centered care approach among children with cerebral motor deficits (CMD) and their families.

Methods: One focus group was conducted with the multidisciplinary team (n?=?10) of the CMD program at a pediatric rehabilitation center. It was audio recorded and transcribed verbatim for content analysis.

Results: Three overarching themes were identified from the analyzes: (1) a facilitator of open communication, (2) a way to gain the unique sense of the child and family and (3) parents as the experts of their child.

Conclusions: Health care professionals value the use of the PAPI as a way of facilitating a family-centered care plan process, specifically with children with cerebral motor deficits.     

A case study using the Discipline with a clinical team

Health care delivery in hospitals and clinics promotes an interdisciplinary team approach. This article presents the use of The Discipline though the involvements of the chaplain as part of the Infectious Disease team as together they addressed the inherent spirituality of one HIV/AIDS patient. This narrative recounts the unfolding events of the patient's life and describes the use of The Discipline during a very difficult time period for the patient and the staff. The experience can serve as a model for other health care teams who must manage difficult, deteriorating patients.     

Euract

Background: Continuity of care is widely regarded as an important feature of general practice, but the role of receptionists in influencing continuity has been the subject of little research. Objective: To explore how receptionists might influence access and continuity of care in general practice. Methods: A questionnaire survey of receptionists in practices in Leeds, UK, was conducted. All 119 practices in Leeds were contacted to recruit receptionists via practice managers. A total of 148 receptionists responded from 50 practices. Results: The majority of receptionists (140, 94%) perceived continuity as team continuity. Most (139, 93%) felt it was important for the patient to be seen on the same day by any doctor, rather than the usual doctor. They were less willing to ask patients for more details of a routine problem than an urgent one. The majority (113, 76%) thought that non-attendance was more related to patient issues than to their own behaviour. Organizational factors affected how receptionists offered appointments. Advanced access could impede longitudinal continuity and, indirectly, relational continuity. Having a policy to deal with urgent appointments or routine appointments could facilitate such continuity.

Conclusion: The majority of receptionists perceived continuity as a team response rather than longitudinal. However, if relational continuity is to survive in UK and European general practice, educational and training measures would need to be taken to promote these values to receptionists.     

Relación clínica y problemas éticos en atención primaria,São Paulo,Brasil

ObjectivesMain Objective: to identify ethical problems in primary care according to nurses’ and doctors’ perceptions. Secondary Objective: to know ethical issues of patient-professional relationships in primary care.DesignSynthesis to integrate and reinterpret primary results of qualitative studies.SettingPrimary healthcare centers, Sao Paulo, SP, Brazil.Participants and/or contextIncidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience.MethodsIndividual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results.ResultsPatient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation, and includes feelings and values, with communication skills.ConclusionsEthical problems in primary care are common situations. For quality and humane primary care the relationship should consist of dialogue, trust and cooperation.     

Experiences of hospital-based multidisciplinary team meetings in oncology: An interview study among participating general practitioners

Background: Cancer care has become complex, requiring healthcare professionals to collaborate to provide high-quality care. Multidisciplinary oncological team (MDT) meetings in the hospital have been implemented to coordinate individual cancer patients’ care. General practitioners (GPs) are invited to join, but their participation is minimal.

Objectives: Aim of this study is to explore participating GPs’ perceptions of their current role and to understand their preferences towards effective role execution during MDT meetings.

Methods: In May to June 2014, semi-structured interviews (n?=?16) were conducted involving GPs with MDT experience in Belgium. The analysis was done according to qualitative content analysis principles.

Results: Attendance of an MDT meeting is perceived as part of the GP’s work, especially for complex patient care situations. Interprofessional collaborative relationships and the GP’s perceived benefit to the MDT meeting discussions are important motivators to participate. Enhanced continuity of information flow and optimized organizational time management were practical aspects triggering the GP’s intention to participate. GPs valued the communication with the patient before and after the meeting as an integral part of the MDT dynamics.

Conclusion: GPs perceive attendance of the MDT meeting as an integral part of their job. Suggestions are made to enhance the efficiency of the meetings.     

A Disciplined Approach to Spiritual Care Giving for Adults Living with Cystic Fibrosis

SUMMARY

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.     

A survey of emergency department staff about challenges and recommendations for emergency department care of extended care facility patients

ObjectivesExtended care facility (ECF) patients who transfer to emergency departments (EDs) can pose problems when complicated health problems require extra resources. Higher numbers of older patients are projected to use EDs, so we aimed to identify problems now to implement solutions before they worsen in the future.DesignThis was a prospective survey research study.SettingED in a safety net teaching hospital in the Midwest.ParticipantsED personnel.MeasurementsConfidential, anonymous survey collected views and opinions of ED personnel about problematic issues related to emergency care of ECF residents. The survey targeted communication problems, patient satisfaction concerns, difficult characteristics of patient population, need for education, need for research—and solicited open-ended remarks.ResultsED staff reported concern about flawed communication and poor documentation from the ECF. Based on job title, divergent viewpoints were reported about pharmacological challenges and comfort levels in managing older patients in the ED. Top training priorities were special needs of older adults, detecting abuse in older adults, and specific medical and psychosocial issues associated with older adults. Increased communication among all levels of geriatric care is recommended, especially from extended care facility staff before patient arrival at the ED.ConclusionBecause population projections predict an increasing trend of older adults, health care providers must think ahead and prepare for future medical needs. This survey was an inexpensive and effective way to identify next steps. We plan to use the survey results to initiate collaboration with ED staff, EMS providers, and ECF staff to identify specific actions to improve acute care for elderly patients—for the present and the future.     

Experienced continuity of care in patients at risk for depression in primary care

Background: Existing studies about continuity of care focus on patients with a severe mental illness.

Objectives: Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure.

Methods: Explorative study comparing patients at risk for depression with chronic heart failure patients. Continuity of care was measured using a patient questionnaire and defined as () number of care providers contacted (personal continuity); () collaboration between care providers in general practice (team continuity) (six items, score 1–5); and () collaboration between GPs and care providers outside general practice (cross-boundary continuity) (four items, score 1–5).

Results: Most patients at risk for depression contacted several care providers throughout the care spectrum in the past year. They experienced high team continuity and low cross-boundary continuity. In their general practice, they contacted more different care providers for their illness than heart failure patients did (P < 0.01). Patients at risk for depression experienced a slightly better collaboration between these care providers in their practice: a mean score of 4.3 per item compared to 4.0 for heart failure patients (P = 0.03). The perceived cross-boundary continuity, however, was reversed: a mean score of 3.5 per item for patients at risk for depression, compared to 4.0 for heart failure patients (P = 0.01).

Conclusion: The explorative comparison between patients at risk for depression and heart failure patients shows small differences in experienced continuity of care. This should be analysed further in a more robust study.     

Development and Validation of the Primary Care Team Dynamics Survey

ObjectiveTo develop and validate a survey instrument designed to measure team dynamics in primary care.ConclusionsIt is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes).     

A systematic review of randomised controlled trials evaluating the use of patient-reported outcome measures (PROMs)

Background

Patient-reported outcome measures (PROMs) could play an important role in identifying patients’ needs and goals in clinical encounters, improving communication and decision-making with clinicians, while making care more patient-centred. Comprehensive evidence that PROMS are an effective intervention is lacking in single randomised controlled trials (RCTs).

Methods

A systematic search was performed using controlled vocabulary related to the terms: clinical care setting and patient-reported outcome. English language studies were included if they were a RCT with a PROM as an intervention in a patient population. Included studies were analysed and their methodologic quality was appraised using the Cochrane Risk of Bias tool. The protocol was registered with PROSPERO (CRD42016034182).

Results

Of 4302 articles initially identified, 115 underwent full-text review resulting in 22 studies reporting on 25 comparisons. The majority of included studies were conducted in USA (11), among cancer patients (11), with adult participants only (20). Statistically significant and robust improvements were reported in the pre-specified outcomes of the process of care (2) and health care (3). Additionally, five, eight and three statistically significant but possibly non-robust findings were reported in the process of care, health and patient satisfaction outcomes, respectively.

Conclusions

Overall, studies that compared PROM to standard care either reported a positive effect or were not powered to find pre-specified differences. There is justification for the use of a PROM as part of standard care, but further adequately powered studies on their use in different contexts are necessary for a more comprehensive evidence base.

     

2014—2022年手卫生干预对医院感染例次发病率的影响

目的 观察多模式手卫生干预对手卫生依从性的影响,以及手卫生依从性与医院感染例次发病率之间的关系。方法 2014—2022年,某三甲医院感染控制团队对全院医务人员实施多模式手卫生干预,回顾性分析手卫生监测数据的变化趋势、手卫生依从率与医院感染例次发病率的相关性。结果 病房手卫生用品消耗量呈稳定上升趋势;手卫生依从率从2014年64.98%提高到2022年85.01%(P<0.001),医院感染例次发病率从1.21%下降至0.83%(P<0.05),手卫生依从率与医院感染例次发病率之间存在负相关(r=-0.369,P=0.027)。各季度不同区域及不同岗位的手卫生依从率均有所提高(P<0.001)。各季度5个时刻手卫生依从率中,无菌操作前与接触患者后的手卫生依从率小幅波动;接触患者周围环境后的手卫生依从率呈上升趋势;接触患者前与接触患者体液后的手卫生依从率在2020年之后有所下降(P<0.001)。结论 多模式手卫生干预能提高医务人员的手卫生依从性,提高医务人员手卫生意识有利于降低医院感染例次发病率。     

呼吸危重症精准诊疗体系在抗菌药物应用管理中的价值探索

目的 构建呼吸危重症精准诊疗体系,探索该体系对促进抗菌药物合理使用的价值,从源头上促进呼吸危重症抗菌药物合理使用。 方法 以2012—2021年中南大学湘雅医院呼吸重症监护专科出院病例为研究对象,将抗菌药物科学化管理模式融入呼吸危重症精准诊疗体系,对比该体系实施前后抗菌药物使用情况。 结果 共纳入出院病例2 947例,其中实施前病例1 105例,实施后病例1 842例。出院诊断中涉及感染病例2 643例,占89.7%,其中实施前963例(占87.1%),实施后1 680例(占91.2%)。实施后在感染病例占比增加的情况下,抗菌药物使用率较实施前下降2.9%(97.0% VS 94.2%,P＜0.001);抗菌药物使用强度较实施前下降12.4%(244.4 DDDs VS 214.1 DDDs),特殊使用级抗菌药物使用强度较实施前下降14.4%(131.0 DDDs VS 112.2 DDDs),均由高位波动转为线性下降(P＜0.001)。 结论 呼吸危重症精准诊疗体系有效促进抗菌药物合理、精准使用,临床诊疗团队是该体系的核心,新兴诊疗技术发挥重要作用。