Maybe God Doesn't Even Like Miracles That Much.

Reflections from a pediatric chaplain on the irregularity of miracles with help from a Victorian author and an atheist-humanist colleague.

Self-described religious and spiritual identities of patients receiving gender-affirming surgeries: Implications for chaplaincy practice.

Studies of the U.S. population in general and transgender and gender diverse (TGD) communities specifically suggest that religion and spirituality (R/S) can function in both positive and negative ways, including on health outcomes. Patients recovering from gender-affirming surgeries were asked by chaplains, during the course of spiritual care visits, to describe their R/S identities in their own words. Seventy-five responses were included in the study and were coded. Six themes and 10 sub-themes were identified. The themes were (1) centeredness in self; (2) transcendent belief system; (3) non-religious belief systems; (4) importance of prayer; (5) R/S identity and practice as fixed and consistent; and (6) R/S identity and practice as flexible, contextual, and transforming. The findings broadly reflected national data about R/S belonging, including trends related to the growing share of the population that identifies as atheist, agnostic, or spiritual but not religious; ambivalent relationships with R/S communities due to transphobia; and R/S beliefs and practices as supportive. Implications for chaplaincy practice are discussed, including the need for chaplains to understand both demographic trends and the intersections of R/S and transphobia.

Pediatric chaplains iterative process to address religious & spiritual struggle: a qualitative study.

The growing body of literature on religious and spiritual (R/S) struggles consistently highlights its association with various health outcomes in Pediatrics. Chaplains or spiritual care providers, as members of interdisciplinary teams, frequently offer spiritual care to patients and families grappling with R/S struggles. However, there is a paucity of literature demonstrating how chaplains address R/S struggle in their practice. This study aimed to construct a theory describing the process by which pediatric chaplains conceptualize and address it. Employing a constructivist Grounded Theory study design, we sought to comprehend the approaches pediatric chaplains utilize in addressing R/S struggles. Following a semi-structured interview guide, we interviewed twelve Board Certified or Board Certification-eligible chaplains. Findings reveal that chaplains use an iterative three-phase process to address R/S struggles. Thirteen categories emerged, which were further organized into four major themes: Assessing, Processing, Intervening, and Navigating Limitations. A model depicting this iterative process was constructed.

Chaplain interventions and outcomes in outpatient settings: a scoping review.

As chaplaincy is increasingly practiced in outpatient settings, further understanding is needed of what it entails and is accomplishing within this unique context. This scoping review summarizes 42 articles that describe the types of spiritual care interventions and programs offered by chaplains in outpatient settings, and their outcomes. Findings support that chaplaincy is practiced in outpatient settings, especially in palliative care, oncology, and primary care. Interventions are delivered by chaplains as the sole interventionist, and by interdisciplinary teams with chaplain participants. Results show that outpatient chaplain interventions are feasible and acceptable, with positive psychological and spiritual outcomes. More studies with consistent outcome measurements, and structured chaplain interventions are needed to draw further conclusions about the effectiveness of outpatient chaplain interventions.

Spiritual assessment models for palliative care chaplains: a narrative review.

Palliative care chaplains conduct spiritual assessments for those within their care. This narrative review examined the literature concerning existing spiritual assessment models developed or designated for palliative care chaplain use. The literature review was performed using four databases, including a hand search of references due to the variability of keywords used within the spiritual care literature. Five spiritual assessment models were identified. The analysis of the models focused on three areas: (1) Foundational basis, (2) Spiritual needs, and (3) Structural frameworks. Published spiritual assessment models for palliative care chaplain use are variable in how each one was formed, how each tool describes and structures spiritual care needs, and how the models are implemented within their respective contexts. The PC-7 advances the field, especially through its mixed methods approach. Future validation and reliability research is needed as well as investigations concerning which models are taught by chaplain educators and used by palliative care chaplains.

Mapping spiritual care in small and critical access hospitals in a faith-based US Health system.

Little is known about spiritual care in small hospitals and critical access hospitals (CAHs), essential sources of health care in rural areas of the US. Using interview-administered surveys with spiritual care providers, we examined spiritual care services in 19 facilities, including seven small hospitals, nine CAHs, and three freestanding emergency departments, in one religiously-owned healthcare system. We identified four groups of facilities based on intensity/frequency of chaplain availability. A central finding was the variation in spiritual care services provided in these diverse facilities. Of the 16 hospitals in the sample, 11 of them (69%) offered spiritual care from professional chaplains at least three days per week. Support for staff was an important priority in all the facilities. Needs identified include virtual training and support for the spiritual care providers in these settings. Future research should replicate this study in a representative sample of hospitals that serve the rural US population.

Chaplaincy and outpatient cancer care in a faith-based health system: lessons learned when imbedding two full time chaplain positions in a cancer institute with a faith-based heritage.

There is interest in chaplains devoted to outpatient cancer care, informed by a growing body of research as well as recommendations of accreditors. Simultaneously, a growing share of U.S. healthcare is faith-based and possesses a foundational interest in religious/spiritual (R/S) care due to institutional culture. In that milieu, few articles describe how religious organizational cultures influence the creation and implementation of FTEs intended to meet the evidence-based recommendations of accreditors. This is a lacuna, given that board certified chaplains are measured on their ability to integrate spiritual care into the life and service of their institutions. In response, this article describes the creation and implementation of two chaplain positions devoted to a group of outpatient cancer clinics in a large Catholic healthcare system. This includes lessons learned when navigating R/S aspects of organizational cultures while implementing and executing chaplain practice to meet accreditor recommendations.

A mixed-method evaluation of implementation determinants for chaplain intervention in a hospital setting.

Healthcare chaplains address broad social and emotional dimensions of care within a pluralistic religious landscape. Although the development and evaluation of chaplaincy interventions has advanced the field, little research has investigated factors influencing the implementation of new chaplain interventions. In this mixed-method study, we examined attitudes about evidence-based interventions held by chaplain residents (n = 39) at the outset of an ACPE-accredited residency program in the southeast United States. We also used semi-structured interviews (n = 9) to examine residents' attitudes, beliefs, and decision-making processes after they trained in the delivery of a novel manualized intervention, Compassion-Centered Spiritual Health (CCSH). Most residents reported favorable attitudes toward manualized approaches prior to training. Interviews revealed complex decision-making processes and highlighted personal motivations and challenges to learning and implementing CCSH. Implementation science can reveal factors related to motivation, intention, and training that may be optimized to improve the implementation of healthcare chaplaincy interventions.

Assessing Impact Amongst Chaplains in a University Setting: Phase Two of an Action Research Project.

This article, the result of an Action Research project, describes the process of creating and testing a resource for assessing the contribution of chaplaincy in a British university setting, and the resultant insights and outcomes: organisational and individual learning, changes in chaplains' attitudes to monitoring and evaluation, and a resource which is perceived as having benefits and limitations. This article considers the evaluation process as applied to chaplaincy and offers a model for further testing.

Two Charting Practices Chaplains Should Change.

Hospital chaplains routinely document the spiritual care they provide in patients' medical records, which is a useful and important practice. This article advocates two charting practices chaplains should change to better align our documentation with the beliefs and values of our profession.

Utilizing Poetry as Spiritual Care for Hospital Staff.

This personal reflection emphasizes the potential benefits of poetry for interfaith spiritual and pastoral support of medical professionals. Details are provided for the implementation of several successful practices, including an Intensive Care Unit Poetry Basket, Portable Poetry with Aromatherapy Towelette Hand Blessings, and Presenting Poems to Nurse Practice Council. The references include the poetry used in the spiritual care activities and the author also provided a helpful "Further Resources" section.

Healthcare Chaplaincy for Geriatric Patients: A Quasi-Experimental Study into the Outcomes of Catholic Chaplaincy Interventions in Belgium.

The present non-randomized clinical trial examined the short-term outcomes of one-on-one chaplaincy interventions with 416 geriatric patients in Belgium. Participants were interviewed one or two days before a potential chaplaincy intervention (baseline measurement), and one or two days after a potential intervention (post-measurement). Patients in the non-randomized intervention group received an intervention by the chaplain, while the non-randomized comparison group did not. Patients in the intervention group showed a significant decrease in state anxiety and negative affect, and a significant improvement in levels of hope, positive affect, peace, and Scottish PROM-scores, compared to the comparison group. Levels of meaning in life and faith did not significantly change after the chaplaincy intervention. This study suggests that geriatric patients may benefit from chaplaincy care and recommends the integration of chaplaincy care into the care for older adults.

Assessing Impact Amongst Chaplains in a University Setting: Phase One of an Action Research Project.

This article reports findings from an action research project in which a university chaplaincy team explored the desirability and viability of assessing their impact. It uncovers a complexity in chaplains' understandings about their role and - chief amongst their fears - belief that quantitative measures can be harmful to pastoral and spiritual work. It also reveals a sense of institutional accountability and a desire to engage with processes for determining and articulating chaplaincy's value.

Military Perspectives on the Provision of Spiritual Care in the Australian Defence Force: A Cross-Sectional Study.

A module to explore perspectives on chaplaincy services was included in an online enterprise survey randomly distributed to members of the Australian Defence Force (ADF) during 2021. Up to eight questions were answered by 2783 active military personnel relating to their perception of chaplain activities and the impact of chaplaincy services. Of those military participants answering the question on religious status (n = 1116), a total of 71.6% (n = 799) of respondents identified as non-religious while 28.4% (n = 317) identified as holding a religious affiliation. Approximately 44.2% (n = 1230) of participants had sought support from a chaplain, of which 85.3% (n = 1049) found chaplaincy care to be satisfactory or very satisfactory. While the data suggest there is a lack of clarity around the multiple roles undertaken by chaplaincy, nevertheless respondents were just as likely to prefer chaplains for personal support (24.0%), as they were to seek help from non-chaplaincy personnel such as a non-ADF counsellor (23.2%), their workplace supervisor (23.1%) or a psychologist (21.8%). This evidence affirms that the spiritual care provided by military chaplaincy remains one of several preferred choices and thus a valued part of the holistic care provided by the ADF to support the health and wellbeing of its members.

How does the American public interact with chaplains? Evidence from a national survey.

How does the American public understand the term chaplain? What fraction interact with chaplains and in what settings? What is the content of those interactions and do care recipients find them valuable? We answer these questions with data from a nationally representative survey (N = 1096) conducted in March 2022 and interviews with a subset (N = 50) of survey recipients who interacted with chaplains. We find that people in the United States do not have a consistent understanding of the term chaplain. Based on our definition, at least 18% of Americans have interacted with a chaplain. Among those who interacted with a chaplain as defined in the survey, the majority did so through healthcare organizations. Care recipients include people who were ill and their visitors/caregivers. The most common types of support received were prayer, listening and comfort. Overall, survey respondents found chaplains to be moderately or very valuable.

Healthcare chaplains' conflicting and ambivalent positions regarding meaning in life and worldview.

Western society is increasingly a spiritual society, but not so much a society that draws on clearly delineated religious or worldview pillars anymore. Within healthcare, there's a growing attention to the spiritual dimension of health and the collaborative spiritual care that is needed for person-centered care. This changing religious/worldview and healthcare landscape is influencing healthcare chaplaincy. In this case study in-depth interviews were conducted with a chaplaincy team within a large healthcare organization in The Netherlands. Dialogical Self Theory was used as the theoretical framework in the narrative analysis of these stories. This provided insights into how these chaplains negotiate their professional identity within a changing healthcare landscape. It is concluded that there are multiple and often contradictory and conflicting positions within and between chaplains and that it is a challenge for healthcare chaplains to integrate the "old" and "new" representations of chaplaincy.

"Genuine and fundamentally human": a qualitative study into Dutch humanist chaplains' conceptualizations of empathy.

Empathy has been highlighted as a key concept in chaplaincy care, but its meaning has hardly been explored in depth within this field. This study aims to help develop stronger conceptual clarity by investigating humanist chaplains' conceptualizations of empathy. Data were collected through semi-structured interviews with twenty humanist chaplains working in health care, military, and prisons. A qualitative design was employed to clarify which components and features constitute empathy in humanist chaplaincy care. Empathy emerges as a multidimensional concept that is "fundamentally human." Chaplains distinguish between true and pseudo empathy based on different features including authenticity and concern. This article provides a conceptual model that combines the different components and features of empathy in humanist chaplaincy care and the relationship between them in light of empathy's humanizing quality. It may be used for educational purposes and could function as a conceptual framework for future research efforts.

Navigating challenges in telechaplaincy: A thematic analysis of an international conference.

Telehealth-based care models are being widely adopted by primary care providers and large healthcare institutions. Drawing on data collected at an international conference on the theory and practice of telechaplaincy, this article identifies and discusses how chaplains navigate various telechaplaincy-related challenges. A thematic analysis identified 49 codes and 11 themes at the individual-, organizational- and population levels. Presenters reported facing novel and qualitatively distinct challenges spanning an array of telechaplains' professional activities, including the structure of work routines, the types of interventions used, the ways provider-patient connections are established and experienced, the strategic positioning of chaplains, their role in the model of care, and ultimately, the populations served. It is argued that, though telechaplaincy has gained prominence since the Covid-19 pandemic, the maintenance of professional standards in digital care settings is a systemic challenge related to long-term trends towards outpatient care.

The Effects of Contextual Factors on Hospital Chaplains: A Qualitative Study.

Critical questions arise about how contextual factors affect hospital chaplains. We interviewed 23 chaplains in-depth. Hospitals' religious or other institutional affiliation, geography, and leadership can influence chaplains both explicitly/directly and implicitly/indirectly-for example, in types/amounts of support chaplains receive, scope of chaplains' roles/activities, amounts/types of chaplains' interactions, chaplains' views of their roles and freedom to innovate, and patients', families' and other providers' perceptions/expectations regarding spiritual care. These data have critical implications for research, practice, and education.

Chaplain, Can You Carry This Cross for Me? A Reflection on My First Year of CPE-Clinical Pastoral Education.

What is the meaning of sacrament? How can a professional Orthodox Christian lay chaplain participate in sacramental ministry without the grace given by ordination? This piece on Christina Hanegraaff's first year as a Clinical Pastoral Education resident explores this question through reflecting on her experiences of entering into people's suffering and carrying their cross alongside them-a modern-day Simon of Cyrene.