First steps: approaching The Discipline based, outcome oriented ministry model

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.     

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.     

A Case Study Using The Discipline with a Clinical Team

SUMMARY

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.     

A Qualitative Study of Patient and Family Perceptions of Chaplain Presence During Post-Trauma Care

Improving the provision of spiritual care to hospitalized patients requires understanding what patients look for from a hospital chaplain, and why. This qualitative study uses grounded theory methodology to analyze data from 25 interviews with adult patients and/or adult family members who received spiritual care in a large tertiary care hospital. Analysis reveals three key themes in chaplaincy care: the attributes valued in the chaplain’s presence, the elements necessary to form relationship with the chaplain, and the role of the chaplain in helping patients to discover and express meaning in their experiences. The authors weave these three themes together into a grounded theory and propose an assessment model that incorporates psychological theory about human motivation, faith development, and the development of autonomy. An understanding of the proposed assessment model can guide chaplain interventions and benefit all members of the clinical care team.     

The Practice of Compassion in Supervision in Residential Treatment Programs for Clients with Severe Mental Illness

ABSTRACT

Clinical supervision for residential care staff is essential and yet has rarely been studied. Drawing from the reflective practice tradition, we interviewed residential care supervisors about their clinical decision-making processes and analyzed the data qualitatively to identify common themes and distill their beliefs and reported practices. We found that supervisors prioritized a compassion-based model of supervision characterized by fostering staff self-care, developing staff's empathy and responsiveness to clients, helping staff with disappointments in their relationships with clients, accurately evaluating client progress, preserving safety, and nurturing teamwork. A supervisor's subjective experience of his caregiving of staff could be explained using a second-level analytic concept we termed a caregiving heuristic—one's beliefs, values, and guidelines for action as a caregiver—of which compassion was, for these supervisors, a foundational element. The supervisors envisioned compassion as a central means by which they could prevent compassion fatigue, develop their staff's caregiving heuristics, and improve job satisfaction and quality of client care.     

Pastoral Care of Problematic Alzheimer's Disease and Dementia Affected Residents in a Long-Term Care Setting

SUMMARY

Pastoral caregivers face many challenges in providing ministry to institutional persons with dementia. This article describes the psychosocial perspective of Bowlby concerning the management of persons with dementia and a pastoral care ministry based on it. Specific pastoral programs and interventions are described. The article contains four case studies and concludes with reflections concerning the chaplain's ministry.     

The Discipline: its impact on my theological perspective, pastoral identity and practice

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.     

Developing chaplain/physician relationships in obstetrics

Effective and comprehensive pastoral care within the obstetrical hospital unit depends on a close working relationship with the entire health care team. This article describes the intentionality, time and energy required to develop these relationships and openness to pastoral ministry. A brief history of obstetrics and pastoral care within this hospital is discussed. Building relationships with obstetricians requires involvement in clinical situations with patients/families, response to ethical issues, and contribution to their continuing medical education. Lastly, the article describes some advantages of a woman chaplain in obstetrics.     

How Has Health Care Reform Affected Professional Chaplaincy Programs and How Are Department Directors Responding?

SUMMARY

No published studies were identified that describe the impact of health care reform on professional chaplaincy departments in hospital settings. Results from a random sample (N = 370) of department directors indicate that 45 percent report no budgetary consequences, 27 percent have experienced budgetary cutbacks, and 17 percent describe departmental growth. The cutbacks most often involve the loss of staff chaplain positions. Directors also describe past and future strategies for resisting downsizing trends.     

Developing Chaplain/Physician Relationships in Obstetrics

Effective and comprehensive pastoral care within the obstetrical hospital unit depends on a close working relationship with the entire health care team. This article describes the intentionality, time and energy required to develop these relationships and openness to pastoral ministry. A brief history of obstetrics and pastoral care within this hospital is discussed. Building relationships with obstetricians requires involvement in clinical situations with patients/families, responses to ethical issues, and contribution to their continuing medical education. Lastly, the article describes some advantages of a woman chaplain in obstetrics.     

The science of caring

A downsizing crisis at Mount Carmel Medical Center, Columbus, OH, forced its Pastoral Care Department to begin thinking in terms of accountability. Trained in an intuitive style of chaplaincy, the staff distrusted a clinical approach to pastoral care. Nonetheless, when they found themselves scrambling to justify their existence, the entire department staff literally withdrew from the hospital for two days to redesign pastoral care. What evolved was a process of "focused care." It represented a radical departure from their traditional assumptions about chaplaincy in that henceforth they would (1) base their ministry on assessment of spiritual need, with primary attention to high-risk patient populations, (2) continue to provide eucharistic ministry through volunteers, but no longer rely on Catholic chaplains to carry out those duties, (3) no longer assume that a chaplain needed to be present at every death or medical crisis, and (4) no longer assume that the impact of a spiritual ministry could not be objectively measured.     

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.     

Commending the Spirit

Drawing on Journal entries, the author describes her ministry to and with a family in the midst of multiple crises, including the accidental death of a child. The process of ministry is described, especially the role of the chaplain at the funeral where a touching ritual was enacted.     

Outpatient Care: The Modern Chaplains' New Impact in Healthcare Reform

SUMMARY

An oncology chaplain details, using The Discipline for Pastoral Care Giving, common themes in the spiritual journeys of stem cell/bone marrow transplantation survivors, and helpful chaplain interventions.     

Relationship Between Chaplain Visits and Patient Satisfaction

This prospective study investigated the relationship between chaplain visits and patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey surveys from 8,978 patients who had been discharged from a tertiary care hospital. Controlling for patients' age, gender, race, ethnicity, language, education, faith, general health status, and medical conditions, chaplain visits increased the willingness of patients to recommend the hospital, as measured by both the HCAHPS survey (regression coefficient = 0.07, p < .05) and the Press Ganey survey (0.11, p < .01). On the Press Ganey survey, patients visited by chaplains were also more likely to endorse that staff met their spiritual needs (0.27, p < .001) and their emotional needs (0.10, p < .05). In terms of overall patient satisfaction, patients visited by a chaplain were more satisfied on both the Press Ganey survey (0.11, p < .01) and on the HCAHPS survey (0.17, p < .05). Chaplains' integration into the healthcare team improves patients' satisfaction with their hospital stay.     

Stroke:

Strokes are one the America's major health problems. While there is progress toward prevention, the health care chaplain must understand the basic mechanics of stroke as a context for theological reflection and ministry. This article outlines the physical dynamics and effects of stroke as well as the stories of ministry to three stroke patients.     

COVID‐19 community assessment hubs in Ireland: A study of staff and patient perceptions of their value

BackgroundCritical care bed capacity per capita in Ireland is among the lowest in Europe. The COVID‐19 pandemic has put additional strain on an over‐stretched healthcare system. COVID‐19 community assessment hubs (CAHs) were established to prevent unnecessary admission to acute hospitals and to reduce infection spread.ObjectiveThe aim of this study was to assess the effectiveness and acceptability of CAHs and identify how the service might be improved or adapted for possible future use.DesignThis was a mixed methods study, incorporating co‐design with clinical stakeholders. Data collection was via an online survey and semistructured telephone interviews with staff and patients conducted between January and May 2021.Setting and participantsThirty‐one patients completed the survey and nine were interviewed. Twenty interviews were conducted with staff.ResultsThe findings suggest that the CAH model was successful in providing a dedicated pathway for assessing patients with COVID‐19 symptoms, whilst mitigating the risk of infection. Patients were particularly positive about the timely, comprehensive and holistic care they received, as well as the accessibility of the clinics and the friendly attitudes of the staff. Staff welcomed the training and clinical protocols which contributed to their feelings of safety and competency in delivering care to this cohort of patients. They also highlighted the benefits of working in a multidisciplinary environment. Both staff and patients felt that the hubs could be repurposed for alternative use, including the treatment of chronic diseases.DiscussionThis study describes staff and patients'' experiences of these hubs. An unexpected outcome of this study is its demonstration of the true value of effective multidisciplinary working, not only for the staff who were deployed to this service but also for the patients in receipt of care in these hubs.ConclusionThis multidisciplinary patient‐centred service may provide a useful model for the delivery of other services currently delivered in hospital settings.Patient or Public ContributionAn earlier phase of this study involved interviews with COVID‐19‐positive patients on a remote monitoring programme. The data informed this phase. Several of the authors had worked in the CAHs and provided valuable input into the design of the staff and patient interviews.     

An adaptation of The Discipline in a clinical pastoral education program. Interview by Larry VandeCreek

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.