Defining the Context for Best Practices: Institutional Setting for Clinical Pastoral Care in Estonia.

The current article aims to offer an informational basis for creating an adaptable model of spiritual support provision for Estonian health care institutions. The study addresses Estonian medical staff's knowledge about and attitudes towards spiritual support. The data originate from a quantitative research conducted in 19 Estonian hospitals during 2015-2016. The results show a good will for interdisciplinary co-operation, and pastoral caregiver is expected to be a part of the staff. The fact that spiritual support is not financed by the state budget funds raises the question about explaining the benefits of spiritual support to the hospital's or clinic's management.

Ars Moriendi: Coping with death in the Late Middle Ages.

OBJECTIVE: The Ars moriendi was a book written in the early 15th century with the goal of assisting friars in their work of helping the dying. The aim of our study was to review the current literature on the Ars Moriendi concerning the field of medicine, to analyze the psychological mechanisms for coping with death anxiety within Ars Moriendi, and to explore parallels between the strategies used in the medieval book and in contemporary literature about death and dying. METHOD: A review of literature using Pubmed, EMBASE, JSTOR, Project MUSE, and the New York Public Library was undertaken first. The primary source was then interpreted from a medical/psychological point of view. RESULTS: Seven articles were selected by literature review. These works comment on the importance of the Ars Moriendi in its historical context and explore the possibility of retrieving the principles of the text in contemporary society. The original text of Ars Moriendi, the primary source, presents death as a relief from the sufferings of earthly life and a gateway to eternal glory. According to the author, a good death implied the triumph over five demonic temptations in agonizing people: a lack of faith, despair, impatience, pride and greed. SIGNIFICANCE OF RESULTS: Analyzed from a modern psychiatric perspective, the Ars Moriendi offers descriptions of behavioral manifestations compatible with delirium, mood and anxiety disorders that characterize people with terminal illnesses. Moreover, we also explored parallels between the strategies used to cope with death anxiety in the Late Middle Ages and in contemporary society.

Perspectives of Taiwanese pastoral counselors on the use of scripture and prayer in the counseling process.

Interviews were carried out with 10 Christian pastoral counselors to explore their perspectives on the use of Scripture and prayer in the counseling process. Grounded Theory was utilized. Five main categories including a theological framework of pastoral counseling, counselors' considerations of using Scripture and prayer, preparation for Christian spiritual intervention, implications of spiritual resources, and ethical issues in the pastoral counseling process were generated. The results suggest the theological framework of pastoral counseling is crucial to the use of Scripture and prayer, and the issue of a neutral response should first be clarified for clients. Basic guidelines for ethically using Scripture and prayer for working with Christian clients are proposed for further pastoral counselor training, practice, and research.

The Evolution of Research Paradigms in Pastoral/Spiritual Care, Counseling, and Education.

This partially autobiographical article is presented as a chapter in the narrative of the evolution of research methodology in the social sciences and the impact that evolution has had on pastoral/spiritual care research as the author has experienced and observed it during the latter part of the 20th century and the early years of the 21st century.

Good Practice Chaplaincy: An Exploratory Study Identifying the Appropriate Skills, Attitudes and Practices for the Selection, Training and Utilisation of Chaplains.

This article presents an overview of exploratory research regarding the skills, knowledge, attitudes and practices considered necessary for chaplains to be highly competent in providing holistic care to clients and staff. Utilising a qualitative methodology, two focus groups comprising Salvation Army chaplains and their managers provided data about their expectations of chaplaincy personnel and about the pastoral care interventions undertaken by chaplains. The results indicated that while there were some differences in opinion, nevertheless, in overall terms, there was general agreement between chaplains and their managers about particular personal and professional qualities necessary for chaplains to be considered appropriate and proficient. Evidence was also obtained indicating a need for change with regard to the organisational attitude and culture of The Salvation Army towards chaplaincy. Recommendations are presented concerning (1) the selection criteria for chaplaincy, (2) training and utilisation of chaplains plus (3) issues relating to organizational cultural change necessary to develop a future-ready chaplaincy more suitable for the twenty-first century.

Language and practice changes in Canadian and US specialized pastoral care and counseling: a conversation.

On August 20, 2013, Terry Bard, John Carr, and Steve Ivy had a 50-minute conversation about the shift that has been taking place in Canada and the United States in the practice, and the language about that practice, of persons and professional associations that have historic roots in the modern pastoral care and counseling movement. The conversation was digitally recorded, by agreement among the three participants, and is posted on the internet as a stimulus to further conversation.

Ethics in pastoral care and counseling: a contemporary review of updated standards in the field.

This article reviews ethical responsibilities that must be considered when engaging in pastoral care, counseling, and psychotherapy. It discusses important contemporary issues counselors will want to contemplate in pursuing a high quality of care in their counseling practices. Examples and case studies are provided. Readers will be able to: Understand the function of ethical standards in the practice of counseling Be able to differentiate between pastoral care, pastoral counseling, and pastoral psychotherapy and their ethical implications Understand the importance of identifying one's limitations in counseling situations and how to proceed under such circumstances. Understand the need for pastoral counselors to attain the necessary credentials for practice in the area of counseling they intend to undertake. Become aware of the legal requirements when engaged in a counseling relationship.

PATHOS: a quick screening method for assessing sexual addiction.

Pastors may understand that sex addiction exists and are frequently faced with people who need non-clinical and clinical services for the addiction. However, the pastoral counselors have no quick reliable method of assessing them. The purpose of this article is to define sexual addiction and provide information about a tool called PATHOS that can be used in clinical and non-clinical settings to identify potential sex addicts.

"Essential Not Optional": Spiritual Care in Australia during a Pandemic.

This paper focuses on the impact of COVID19 in Australia. Three areas were investigated: professionalism, contrasting hospital and aged care services and "business as usual"? Impact was low overall, the timing being pre-second wave impact. Two areas of weakness were highlighted: depleted spiritual care teams due to standing down non-professional staff and uncertainty about the role of Chaplains in the care of other staff. Further study of second wave impact is recommended.

"The Most Effective Experience was a Flexible and Creative Attitude"-Reflections on Those Aspects of Spiritual Care that were Lost, Gained, or Deemed Ineffective during the Pandemic.

This paper presents and discusses data from three of the qualitative questions in the international COVID-19 survey: What was the most important aspect of spiritual care that was lost during the pandemic? What was new to you during this pandemic? What are the new ways of delivering spiritual care you have experienced? Of these new experiences, what do you think was the most effective?

Staff-Care by Chaplains during COVID-19.

The aim of this study was to understand how chaplains delivered spiritual care to staff during the Covid-19 pandemic. The researchers analyzed data collected from an International Survey of Chaplain Activity and Experience during Covid-19 (N = 1657). The findings revealed positive changes that emerged and new practices evolved around the use of technology as useful tools for maintaining contact with staff.

Health care chaplains and their role on institutional ethics committees: an Australia study.

This paper presents the results of the largest Australian pastoral study concerning the perceptions of health care chaplains about their involvement on hospital research ethics committees (also known in some contexts as institutional ethics committees). Survey results from over 300 Australian health care chaplains indicated that nearly 90% of chaplains believed there was merit in chaplains serving on hospital research ethics committees, yet only a minority (22.7%) had ever participated on such committees. Data from in-depth interviews is also presented exploring the reasons for the lack of participation and the varying opinions regarding the role, appropriateness, and value of chaplains on ethics committees. Some implications of this study with respect to chaplaincy, hospital research ethics committees, health care institutions, ecclesiastical institutions, and government responsibilities are discussed.

A New Paradigm for Testing Clinical Competence in Chaplaincy Certification.

This article describes the rationale, evolution, implementation, and evaluation of a process for testing clinical competence in health care chaplaincy certification. The process developed by the Spiritual Care Association uses Zoom technology, simulated patient actors, and evidence-based behaviors. Evaluation of the process by users has been very positive. The process seems to have acceptable validity, reliability, and usability and should be considered as an alternative to self-report clinical encounters as a test of clinical competence.

Intrasectoral variation in mission and values: the case of the Catholic health systems.

BACKGROUND: Catholic health systems represent a unique sector of nonprofit health care delivery organizations because they must be accountable to institutional pressures of the Roman Catholic Church, in addition to responsiveness to market pressures. Mission statements and values are purported to be the driving force of Catholic institutional identity. Central to the understanding of the Catholic health care delivery sector is the exploration of variation in mission and values statements across the homogeneous field of organizations. PURPOSES: The purposes of this study were to identify expressed organizational identity variation-in terms of keywords in mission statements and values-of Catholic health systems in the United States by applying a methodology that integrates text and social network analytical techniques. METHODOLOGY: Data were obtained from the Web site of The Catholic Health Association of the United States and the Web sites of 50 Catholic health systems in 2007. Catholic health system mission statements and values were assessed using a cross-sectional study design. Text analysis and social network techniques were employed to identify the most central words in the texts and linkages among mission statement components and values. FINDINGS: This study identifies the components of a common mission statement and the most shared and unique values for a Catholic health system. Even with tremendous similarity, there is also evidence of intrasectoral variation between Catholic health system keywords in mission statements and values. PRACTICE IMPLICATIONS: Management implications include the consideration of word relationships developing and constructing mission and values statements to form the framework for strategic vision and management decision making, to assess potential partnership arrangements based on expressed mission statements and values, and to use in executing due diligence in mergers and partnerships.

Improving Spiritual Care in Hospitals in the Netherlands: What Do Health Care Chaplains Involved in an Action-Research Study Report?

Health care chaplains participated in a multicenter trial to explore an implementation strategy for the Dutch multidisciplinary guideline for spiritual care. The intervention was concise spiritual care training for hospital staff of departments where patients in curative and palliative trajectories are treated. Data were collected in semistructured interviews with chaplains who acted as trainers, before and after the intervention. Results based on nine preintervention and eleven post-intervention interviews are presented. During preintervention interviews, chaplains describe the baseline situation of palliative care in Dutch hospitals, barriers, and opportunities for improving spiritual care. In the postintervention interviews, characteristics of the training, effects, and critical success factors were identified. Positive effects such as lowering barriers, increasing health care professionals' competences, and increasing health care chaplains' profile are possible. Chaplain-led, multidisciplinary spiritual care training is a feasible method to start implementation of spiritual care in hospitals, as described in the multidisciplinary guideline.

An e-Chart Review of Chaplains' Interventions and Outcomes: A Quality Improvement and Documentation Practice Enhancement Project.

In Canada, the spiritual care landscape in health care settings is becoming more regulated and standardized documentation is part of this rigorous environment. Staff chaplains at The Ottawa Hospital participated in a Quality Improvement project that aimed to advance patient-centered care through better charting practices. A sample of 104 spiritual-care assessments that had been posted on the patient electronic health record was examined. This chart review focused on chaplains' activities that were reported as interventions as well as chaplain-reported outcomes for the patient. These interventions and outcomes were coded into discreet categories in order to get a better sense of the activities and the impact of their work. The chaplains' electronic charting content and practices were evaluated. Chaplains found that the Quality Improvement process was beneficial as they updated their electronic templates in order to meet the new reporting requirements of the College of Registered Psychotherapists of Ontario.

Pastoral power in HIV prevention: Converging rationalities of care in Christian and medical practices in Papua New Guinea.

In his conceptualisation of pastoral power, Michel Foucault argues that modern healthcare practices derive a specific power technique from pastors of the early Christian church. As experts in a position of authority, pastors practise the care of others through implicitly guiding them towards thoughts and actions that effect self-care, and towards a predefined realm of acceptable conduct, thus having a regulatory effect. This qualitative study of healthcare workers from two Christian faith-based organisations in Papua New Guinea examines the pastoral rationalities of HIV prevention practices which draw together globally circulated modern medical knowledge and Christian teachings in sexual morality for implicit social regulation. Community-based HIV awareness education, voluntary counselling and testing services, mobile outreach, and economic empowerment programs are standardised by promoting behavioural choice and individual responsibility for health. Through pastoral rationalities of care, healthcare practices become part of the social production of negative differences, and condemn those who become ill due to perceived immorality. This emphasis assumes that all individuals are equal in their ability to make behavioural choices, and downplays social inequality and structural drivers of HIV risk that are outside individual control. Given healthcare workers' recognition of the structural drivers of HIV, yet the lack of language and practical strategies to address these issues, political commitment is needed to enhance structural competency among HIV prevention programs and healthcare workers.

Improving processes of hospital care during the last hours of life.

BACKGROUND: Known for excellence in care in the last days and hours of life, hospice programs can help individuals have a "good death" and lead to higher family satisfaction with quality of care. Our objective was to evaluate the effectiveness of a multicomponent palliative care intervention based on the best practices of home hospice and designed to improve the quality of care provided for patients dying in an acute care inpatient setting. METHODS: This study was a before-after intervention trial conducted between 2001 and 2003. Participants included physician, nursing, and ancillary staff on inpatient services of an urban, tertiary care Veterans Affairs medical center. The palliative care intervention included staff education and support to identify patients who were actively dying and implement care plans guided by a comfort care order set template for the last days or hours of life. Data abstracted from computerized medical records of 203 veterans who died during a 6-month period before (n = 108) and after (n = 95) intervention were used to determine the impact of intervention on symptom documentation and 5 process of care indicators. RESULTS: There was a significant increase in the mean (SD) number of symptoms documented from 1.7 (2.1) to 4.4 (2.7) (P<.001), and the number of care plans increased from 0.4 (0.9) to 2.7 (2.3) (P<.001). Opioid medication availability increased from 57.1% to 83.2% (P<.001), and do-not-resuscitate orders increased from 61.9% to 85.1% (P<.001). There were nonsignificant changes in the proportion of deaths that occurred in intensive care units (P = .17) and in the use of nasogastric tubes (P = .40), and there was a significant increase in the use of restraints (P<.001). CONCLUSION: Our results indicate that end-of-life care improved after the introduction of the palliative care program.