Perspectives of board-certified healthcare chaplains on challenges and adaptations in delivery of spiritual care in the COVID-19 era: Findings from an online survey.

BACKGROUND: The COVID-19 pandemic has posed significant challenges for healthcare systems to meet patients' and families' complex care needs, including spiritual care needs. Little data are available about spiritual care delivery in light of the pandemic. AIM: This study examined the impact of COVID-19 on spiritual care by healthcare chaplains in the United States. DESIGN: An online survey of 563 board-certified chaplains was conducted from March to July 2020. The survey, designed to identify chaplains' roles in facilitating conversations about goals of care, included an open-ended question asking how COVID-19 affected chaplaincy practices; 236 chaplains responded. Quantitative data and written qualitative responses were analyzed using descriptive analysis and content analysis, respectively. SETTING/PARTICIPANTS: Majority of participants were white (88%), female (59%), Protestant (53%), and employed full time (86%). Almost half were working in community hospitals (45%) and designated to one or more special units (48%) including ICU, palliative care, and oncology. RESULTS: Three major themes emerged from chaplains' qualitative responses: (1) COVID-19-related risk mitigation and operational changes; (2) impact of social distancing guidelines; and (3) increased need for and provision of psychosocial and spiritual support. CONCLUSIONS: Chaplains reported that COVID-19 challenges contributed to greater social isolation, and mental health concerns for patients, families, and healthcare staff, and substantially changed the way healthcare chaplains provided spiritual care. With evolving healthcare contexts, developing safer, more creative modes of spiritual care delivery while offering systematic support for chaplains can help meet the increasing psychosocial and spiritual needs of patients, families, and healthcare team members.

Patients' spiritual concerns and needs and how to address them during advance care planning conversations: Healthcare chaplains' perspectives.

OBJECTIVES: Advance care planning (ACP) conversations require the consideration of deeply held personal values and beliefs and the discussion of uncertainty, fears, and hopes related to current and future personal healthcare. However, empirical data are limited on how such spiritual concerns and needs are supported during ACP. This study explored board-certified healthcare chaplains' perspectives of patients' spiritual needs and support in ACP conversations. METHODS: An online survey of 563 board-certified chaplains was conducted from March to July 2020. The survey included 3 open-ended questions about patients' hopes and fears and about how the chaplains addressed them during ACP conversations. Written qualitative responses provided by 244 of the chaplains were examined with content analysis. RESULTS: The majority of the 244 chaplains were White (83.6%), female (59%), Protestant (63.1%), and designated to one or more special care units (89.8%). Major themes on patients' hopes and fears expressed during ACP were (1) spiritual, religious, and existential questions; (2) suffering, peace, and comfort; (3) focus on the present; (4) hopes and fears for family; and (5) doubt and distrust. Major themes on how chaplains addressed them were (1) active listening to explore and normalize fears, worries, and doubts; (2) conversations to integrate faith, values, and preferences into ACP; and (3) education, empowerment, and advocacy. SIGNIFICANCE OF RESULTS: ACP conversations require deep listening and engagement to address patients' spiritual needs and concerns - an essential dimension of engaging in whole-person care - and should be delivered with an interdisciplinary approach to fulfill the intended purpose of ACP.

Highly Asymmetric Chiral Domain-Wall Velocities in Y-Shaped Junctions.

Recent developments in spin-orbit torques allow for highly efficient current-driven domain wall (DW) motion in nanowires with perpendicular magnetic anisotropy. Here, we show that chiral DWs can be driven into nonequilibrium states that can persist over tens of nanoseconds in Y-shaped magnetic nanowire junctions that have an input and two symmetric outputs. A single DW that is injected into the input splits and travels at very different velocities in the two output branches until it reaches its steady-state velocity. We find that this is due to the disparity between the fast temporal evolution of the spin current derived spin-orbit torque and a much-slower temporal evolution of the DMI-derived torque. Changing the DW polarity inverts the velocity asymmetry in the two output branches, a property that we use to demonstrate the sorting of domains.

Role of Micromagnetic States on Spin-Orbit Torque-Switching Schemes.

Three-terminal spintronic memory devices based on the controlled manipulation of the proximate magnetization of a magnetic nanoelement using spin-orbit torques (SOTs) have attracted growing interest recently. These devices are nonvolatile, can operate at high speeds with low error rates, and have essentially infinite endurance, making them promising candidates for high-speed cache memory. Typically, the magnetization and spin polarization in these devices are collinear to one another, leading to a finite incubation time associated with the switching process. While switching can also be achieved when the magnetization easy axis and spin polarization are noncollinear, this requires the application of an external magnetic field for deterministic switching. Here, we demonstrate a novel SOT scheme that exploits non-uniform micromagnetic states to achieve deterministic switching when the spin polarization and magnetic moment axis are noncollinear to one another in the absence of external magnetic field. We also explore the use of a highly efficient SOT generator, oxygen-doped tungsten in the three-terminal device geometry, confirming its -50% spin Hall angle. Lastly, we illustrate how this scheme may potentially be useful for nanomagnetic logic applications.

Giant thermal spin-torque-assisted magnetic tunnel junction switching.

Spin-polarized charge currents induce magnetic tunnel junction (MTJ) switching by virtue of spin-transfer torque (STT). Recently, by taking advantage of the spin-dependent thermoelectric properties of magnetic materials, novel means of generating spin currents from temperature gradients, and their associated thermal-spin torques (TSTs), have been proposed, but so far these TSTs have not been large enough to influence MTJ switching. Here we demonstrate significant TSTs in MTJs by generating large temperature gradients across ultrathin MgO tunnel barriers that considerably affect the switching fields of the MTJ. We attribute the origin of the TST to an asymmetry of the tunneling conductance across the zero-bias voltage of the MTJ. Remarkably, we estimate through magneto-Seebeck voltage measurements that the charge currents that would be generated due to the temperature gradient would give rise to STT that is a thousand times too small to account for the changes in switching fields that we observe.

The Role and Activities of Board-Certified Chaplains in Advance Care Planning.

BACKGROUND: Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. OBJECTIVES: To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. METHODS: A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains' organizations in the U.S. The survey data included chaplains' demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. RESULTS: More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. CONCLUSION: Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.

Hospital Characteristics Affecting HealthCare Chaplaincy and the Provision of Chaplaincy Care in the United States: 2004 vs. 2016.

This study replicates, expands and analyzes a 2004 survey examining six hospital characteristics influencing three measures of chaplain employment in large, small, for-profit and nonprofit hospitals. The relationship between hospital characteristics and hiring Board Certified Chaplains was minor and inconsistent across time. The results indicate that religiously affiliated hospitals employed more full-time chaplains and that chaplain full-time equivalents were inversely related to hospital size in both surveys. The current survey suggests that urban and religiously affiliated hospitals were more likely to hire chaplains. The sampling method proved problematic, precluding meaningful conclusions but the study focus and questions remain important for future investigation based on this pilot effort.

Enhanced spin-orbit torques by oxygen incorporation in tungsten films.

The origin of spin-orbit torques, which are generated by the conversion of charge-to-spin currents in non-magnetic materials, is of considerable debate. One of the most interesting materials is tungsten, for which large spin-orbit torques have been found in thin films that are stabilized in the A15 (ß-phase) structure. Here we report large spin Hall angles of up to approximately -0.5 by incorporating oxygen into tungsten. While the incorporation of oxygen into the tungsten films leads to significant changes in their microstructure and electrical resistivity, the large spin Hall angles measured are found to be remarkably insensitive to the oxygen-doping level (12-44%). The invariance of the spin Hall angle for higher oxygen concentrations with the bulk properties of the films suggests that the spin-orbit torques in this system may originate dominantly from the interface rather than from the interior of the films.