"Powerful Strangers": A Reflection on Spirituality and the Chaplain-Doctor Partnership.

In this piece, Rachel Rim (Chaplain, MDiv) offers a poetic reflection on the nature of spirituality and the unique partnership between chaplains and doctors in the healthcare system, and particularly within the realm of palliative care.

A Quality Improvement Project to Gain Insight Into What Helps Cancer Patients Cope During Outpatient Radiation Therapy Treatments.

Psychosocial support in cancer care has not been researched or published to the degree of physical support. This type of support includes the mental, emotional, social, and spiritual needs of patients and loved ones. This quality improvement project provides insight for those seeking understanding of what exactly helps cancer patients cope during outpatient radiation therapy treatments. The purpose of this project was to learn what practices benefit patient's coping during outpatient external radiation therapy treatments in order to increase attention given to psychosocial support of future cancer patients receiving outpatient external radiation therapy treatments. Insight from this project was used to create a resource handout for Novant Health Cancer Institute to help increase awareness, discussion, and attention to supporting outpatient radiation therapy patients emotionally and spiritually.

Improving access to palliative care clinical pastoral education.

Palliative care is interprofessional care for seriously ill people. Many clergy, religious leaders, and hospice and palliative care chaplains of color and minority religious backgrounds desire clinical palliative care education. This manuscript presents findings from a three-year quality improvement project which included the development of a palliative care specialty ACPE: The Standard for Spiritual Care and Education (ACPE) accredited program at an academic medical center. The program was designed to improve spiritual care provision in palliative care at the institution and to facilitate the participation of clergy and spiritual leaders of color and minority religious groups. Forty-six students participated in 53 400-h clinical pastoral education units. Strategies from medical education literature were employed to address obstacles to CPE participation including a racially and religiously diverse CPE advisory group, financial assistance, flexible learning (e.g. hybrid, asynchronous), and clinical placement agreements at places of employment. Upon completion of the program students provided written feedback, participated in a structured exit interview and completed a survey. Data were reviewed for common themes and results report student perceptions about the strategies utilized.

Chaplaincy, Clergy, Prayer, Cancer and Measuring Religion and Health.

This third issue of JORH for 2023 revisits a number of themes previously highlighted in JORH, along with the addition of two new themes. Since JORH's first special issue on 'Chaplaincy' (JORH, 2022, 61:2), this area of research within JORH has now flourished, with a total of three JORH issues now incorporating the allied health discipline of chaplaincy. Two new article collections in this JORH issue relate to clergy 'faith leaders' and research related to 'prayer.' This issue also revisits the topic of cancer-a recurrent focus within JORH which has, over the past six decades, examined nearly every type of known cancer in the context of religion/spirituality. Finally, JORH collates once again, a number of articles relating to the empirical measurement of religion and health-an increasingly important area of research.

Spiritual Caregiving and Assessments for America's Religious 'Nones': A Chaplaincy Perspective.

One in four American patients now identify as religiously unaffiliated. This study utilizes thematic analysis to deliver qualitative results from in-depth interviews conducted with five chaplains at a premier cancer research institution in Florida to envision what care for their spiritual dimension should look like in practice. It demonstrates why the chaplains interviewed suggested that spiritual caregiving still contributes to their holistic wellbeing, and it suggests how spiritual care and assessments may be provided to so-called religious 'nones'-or those who identify as spiritual but not religious, not religiously affiliated, secular humanist, atheist, agnostic, and so on. We conclude with a novel spirituality assessment for use while serving this patient population.

Addressing spiritual needs in palliative care: proposal for a narrative and interfaith spiritual care intervention for chaplaincy.

Although many recognize the importance of addressing the spiritual domain in palliative care, empirically grounded interventions designed to alleviate spiritual needs for patients in palliative care are remarkably scarce. In this paper we argue that the development of such interventions for chaplains is important in order to improve spiritual care in a (post)secular and religiously plural context. We therefore propose an interfaith chaplain-led spiritual care intervention for home-based palliative care that addresses patients' spiritual needs. The intervention is based on elements of spiritual care interventions that have been investigated among other populations. Three important characteristics of the proposed intervention are (1) life review; (2) materiality, ritual and embodiment; and (3) imagination. The aim of this intervention is to improve palliative patients' spiritual wellbeing. It is anticipated that such a structured intervention could assist in improving spiritual care in palliative care.

O cuidado em saúde promovido pelas religiões afro-brasileiras / Health care promoted by afro-brazilian religions / El cuidado en salud promovido por las religiones afrobrasileñas

No decorrer da história, sempre foram infindáveis os casos em que os sujeitos recorriam a centros espíritas ou terreiros de religiões de matrizes africanas em decorrência de problemas como doenças, desempregos ou amores mal resolvidos, com o objetivo de saná-los. Por conta disso, este artigo visa apresentar os resultados da pesquisa relacionados ao objetivo de mapear os processos de cuidado em saúde ofertados em três terreiros de umbanda de uma cidade do litoral piauiense. Para isso, utilizamos o referencial da Análise Institucional "no papel". Os participantes foram três líderes de terreiros e os respectivos praticantes/consulentes dos seus estabelecimentos religiosos. Identificamos perspectivas de cuidado que se contrapunham às racionalidades biomédicas, positivistas e cartesianas, e faziam referência ao uso de plantas medicinais, ao recebimento de rezas e passes e à consulta oracular. A partir desses resultados, podemos perceber ser cada vez mais necessário, portanto, que os povos de terreiros protagonizem a construção, implementação e avaliação das políticas públicas que lhe sejam específicas.(AU)

In history, there have always been endless cases of people turning to spiritual centers or terreiros of religions of African matrices due to problems such as illnesses, unemployment, or unresolved love affairs. Therefore, this article aims to present the research results related to the objective of mapping the health care processes offered in three Umbanda terreiros of a city on the Piauí Coast. For this, we use the Institutional Analysis reference "on Paper." The participants were three leaders of terreiros and the respective practitioners/consultants of their religious establishments. We identified perspectives of care that contrasted with biomedical, positivist, and Cartesian rationalities and referred to the use of medicinal plants, the prescript of prayers and passes, and oracular consultation. From these results, we can see that it is increasingly necessary, therefore, that the peoples of the terreiros lead the construction, implementation, and evaluation of public policies that are specific to them.(AU)

A lo largo de la historia, siempre hubo casos en los cuales las personas buscan en los centros espíritas o terreros de religiones africanas la cura para sus problemas, como enfermedades, desempleo o amoríos mal resueltos. Por este motivo, este artículo pretende presentar los resultados de la investigación con el objetivo de mapear los procesos de cuidado en salud ofrecidos en tres terreros de umbanda de una ciudad del litoral de Piauí (Brasil). Para ello, se utiliza el referencial del Análisis Institucional "en el Papel". Los participantes fueron tres líderes de terreros y los respectivos practicantes / consultivos de los establecimientos religiosos que los mismos conducían. Se identificaron perspectivas de cuidado que se contraponían a las racionalidades biomédicas, positivistas y cartesianas, y hacían referencia al uso de plantas medicinales, al recibimiento de rezos y pases y a la consulta oracular. Los resultados permiten concluir que es cada vez más necesario que los pueblos de terreros sean agentes protagónicos de la construcción, implementación y evaluación de las políticas públicas destinadas específicamente para ellos.(AU)

A implicação dos trabalhadores na política de assistência social brasileira / La implicación de los trabajadores en la política brasileña de asistencia social / The implication of workers in the brazilian social assistance policy

RESUMO. Esse artigo analisa a institucionalização da assistência social no Brasil e a implicação dos trabalhadores sociais neste campo. Partimos da narrativa de vida de Maria, que da experiência religiosa parte para a militância nos movimentos sociais e institucionaliza sua prática na ampliação da assistência social do governo de Luiz Inácio Lula da Silva em 2004. Neste contexto de luta e paixões, Maria investe em um saber prático que se torna o ponto de partida para a construção de uma sobreimplicação. Pelo método de narrativas de vida e da análise institucional, o trabalho contempla o campo micropolítico de um percurso biográfico para chegar a aspectos sócio-históricos da constituição da pasta no país e a construção de uma sensibilidade peculiar por parte dos trabalhadores. Essa sensibilidade, construída nas experiências anteriores ao trabalho social e potencializada no encontro com a política institucionalizada, pode adoecer os profissionais e favorecer a precarização da política pública quando alimenta um compromisso pessoal que se nega a enxergar a complexidade do que seja manter a seguridade social com competência e seriedade no país.

RESUMEN Analizamos la institucionalización de la Asistencia Social en Brasil y la implicación de los trabajadores sociales en este campo. Para esto, partimos de la narrativa de la vida de María, que a partir de la experiencia religiosa, comienza a ser militante en los movimientos sociales e institucionaliza su práctica en la expansión de la Asistencia Social del gobierno de Luiz Inácio Lula da Silva en 2004. En este contexto de lucha y pasiones, María invierte en conocimiento práctico que se convierte en el punto de partida para la construcción de una sobreimplicación. A través de la metodología de la historia de la vida y el análisis institucional, el trabajo contempla el campo micropolítico de una ruta biográfica para llegar a los aspectos sociohistóricos de la constitución de la pasta en el país y la construcción de una sensibilidad peculiar por parte de los trabajadores. Esta sensibilidad, basada en experiencias previas al trabajo social y mejorada en el encuentro con la política institucionalizada, puede enfermar a los profesionales y favorece la precariedad de las políticas públicas cuando alimenta un compromiso personal que se niega a ver la complejidad de lo que significa mantener la seguridad social con competencia y seriedad en el país.

ABSTRACT. This article analyses the institutionalization of Social Assistance in Brazil and the implication of social workers in this field. For this, we start from Maria's life narrative, which from religious experience, starts to militancy in social movements and institutionalizes its practice in the expansion of Social Assistance. Maria invests in practical knowledge that becomes the beginning for construction of an overimplication. Through theory and institutional analysis, the work contemplates the micropolitical field of a biographical path to reach socio-historical aspects of the constitution of the paste in the country and the building of a peculiar sensitivity on the part of the workers. This sensitivity, built on experiences prior to social work and enhanced in the encounter with institutionalized politics, can make professionals sick and favors the precariousness of public policy when it feeds a personal commitment that refuses to see the complexity of what it means to maintain social security with competence and seriousness in the country.

Competencies for Spiritual Care Professionals Specializing in Palliative and Bereavement Care in Canada: A Mixed-Methods Study Using Qualitative Interviews and Modified Delphi Survey.

The purpose of this project was to update competencies for spiritual care professionals specializing in palliative and bereavement care in Canada. Phase one feedback was obtained from 11 clients: six inpatients with greater than two weeks of life expectancy using interviews and five bereaved family members in a focus group. Results were analyzed for congruence or discordance with draft competencies. In phase two, 22 spiritual care experts reached a consensus on nine competencies using a modified Delphi survey. Two limitations were the small sample size and cultural and religious homogeneity of participants.

Inpatient pediatric chaplain service utilization among children with chronic, non-cancer diseases.

Despite the broad importance of pediatric spiritual care, most research focuses on oncologic and palliative care contexts. We aim to describe the utilization of pediatric chaplain services by children hospitalized for non-cancer chronic illnesses and to identify factors that predict utilization of chaplain services. Among 629 patients with 915 admissions, we found chaplain services were utilized in 5.0% of admissions. Utilization was similar between religiously affiliated patients (7.5%, 95%CI [5.3-10.6%]) and un-affiliated patients (6.4%, [3.6-11.0%]). Christian patients (7.3% [5.1-10.5%]) demonstrated similar utilization as non-Christian patients (7.0% [4.3-11.2%]). Utilization was significantly higher among patients with LOS >2 days (10.8% [7.9-14.6%]), compared to LOS ≤2 (1.7% [0.9-3.1%]). These results may represent an addressable gap in spiritual care, and they highlight an opportunity for pediatric chaplains to play a larger role in the holistic care of hospitalized children with chronic diseases, regardless of religious affiliation.

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.

Effect of Spiritual Care on Anxiety and Fear of Orthopaedic Surgery Patients.

Fear and anxiety can affect surgery outcomes. Spirituality is one of the basic aspects of human beings. This study determined the effect of spiritual care on the fear and anxiety of orthopaedic surgery candidates. A spiritual care programme was implemented for the experimental group. The results showed the spiritual care could reduce the anxiety and fear of orthopaedic surgery candidates. Therefore, nurses should pay more attention to spiritual care and receive the necessary training.

Spiritual Care as Part of an Interprofessional Model for Debriefing on an Oncology Unit.

Health care clinicians who care for seriously ill and dying patients have been known to be at higher risk for burnout and moral distress. When not well supported in their workplace, clinicians may suffer additional adverse outcomes to their overall wellbeing. Self-care is one way to help mitigate these adverse outcomes. The literature has described formalized debriefing not only as a self-care strategy but an intervention to promote healthy team development. The focus of this paper will showcase how social work and spiritual care practitioners in our institution worked collaboratively to support an inpatient oncology unit to address issues related to burnout by providing staff with monthly debriefing sessions intended to enhance self-care and wellness in the workplace.

Crescimento pós-traumático no câncer de mama: centralidade de evento e coping / Post-traumatic growth in breast cancer: event centrality and coping / Crecimiento post-traumático em cáncer de mama: centralidad de evento y coping

Crescimento pós-traumático (CPT) refere-se à mudança positiva em algum aspecto da experiência humana como resultado do enfrentamento de adversidades. Investigou-se a relação entre CPT, estilos de enfrentamento e centralidade de evento. Participaram do estudo 65 mulheres que concluíram os tratamentos recomendados para o câncer de mama. Tratou-se de uma pesquisa quantitativa cujos instrumentos foram respondidos on-line. Identificou-se correlações altas entre CPT e centralidade de evento e moderadas entre CPT e os estilos de enfrentamento: estratégia focada no problema, busca de suporte social e práticas religiosas. A centralidade de evento e as estratégias focadas no problema mostraram-se melhores preditoras de CPT. Os resultados sugerem que quanto maior a adversidade percebida, maior a possibilidade de crescimento, sendo as estratégias de enfrentamento focadas no problema um componente importante para a sua ocorrência. Este estudo apontou a possibilidade de crescimento pessoal relacionado ao enfrentamento do CA de mama e indicou estratégias relevantes para desenvolvê-lo. (AU)

Posttraumatic growth (PTG) refers to a positive change in some aspect of the human experience as a result of coping with adversity. This study investigated the relationship between PTG, coping styles, and event centrality, using a cross-sectional research design. The sample consisted of 65 women who had completed the recommended treatments for breast cancer (BC) and answered an online survey. High correlations were identified between PTG and event centrality, and moderate correlations between PTG and the coping styles 'problem-focused strategy', 'social support seeking', and 'religious practices'. Event centrality and problem-focused coping strategies were the best predictors of PTG. The results suggest that the greater the perceived adversity, the greater the possibility of growth, and that problem-focused coping strategies are important for the occurrence of growth in the context of BC. This study pointed to the possibility of personal growth from coping with BC and indicated effective strategies to develop it. (AU)

El crecimiento postraumático (CPT) se refiere al cambio positivo en algún aspecto de la experiencia humana como resultado del enfrentamiento de adversidades. Se investigó la relación entre CPT, estilos de enfrentamiento y centralidad de eventos. Participaron del estudio 65 mujeres que completaron los tratamientos recomendados para el cáncer de mama. Se trató de una investigación cuantitativa respondida on-line. Se identificaron altas correlaciones entre CPT y centralidad de eventos; y moderadas entre CPT y los estilos de enfrentamiento: estrategia centrada en el problema, búsqueda de apoyo social y prácticas religiosas. La centralidad de eventos y las estrategias centradas en el problema demostraron mejores predictores del CPT. Los resultados sugieren que cuanto mayor es la adversidad percibida, mayor es la posibilidad de crecimiento, siendo las estrategias de afrontamientos centradas en el problema un componente importante para su ocurrencia. Este estudio señaló la posibilidad de crecimiento personal frente a la lucha contra el cáncer de mama. (AU)

Characterizing Pastoral Care Utilization by Cancer Patients.

PURPOSE: To assess the rate of and characterize the utilization of pastoral care (PC) among patients on their cancer treatment trajectory. METHODS: Patients included in the present study were diagnosed with cancer 01/2015-08/2019 at The Ohio State Wexner Medical Center-The James. To determine which patient demographic and clinical factors were independently associated with PC utilization, a multivariable logistic regression was performed. RESULTS: A total of 14,322 patients were included in the study and 5,166 (36.1%) had at least one visit with PC. Cancers such as brain (n = 232, 4.5% vs. n = 159, 1.7%), liver/pancreas (n = 733, 14.2% vs. 686, 7.5%), and lung (n = 1,288 vs. 24.9% vs. n = 1,113, 12.2%) were more commonly noted among patients who utilized PC services (all p < 0.001). Furthermore, compared with patients diagnosed with Stage 1 cancer, patients with more advanced disease stages had higher odds of utilizing PC services (Stage III: OR 2.37, 95% CI 2.07-2.70; Stage IV OR 2.31, 95% CI: 2.04-2.61; both p < 0.05). Interestingly, patients who had a DNR order had a markedly higher odds (OR 4.18, 95%CI 3.76-4.65, p < 0.001) of utilizing PC services. DISCUSSION: One in three patients with cancer utilized PC services. Patients with more severe prognoses and individuals with a DNR order were more likely to utilize PC. The data suggest that PC services are an important resource for many patients and should be integrated into the treatment approach for cancer.

Effect of Spiritual Care on Chest Tube Removal Anxiety and Pain in Heart Surgery in Muslim Patients (Shia and Sunni).

The process of removal of a chest tube can cause pain and anxiety. Spiritual care can be considered as a component of nursing care, especially in the pain and anxiety relating to such procedures. This study was a randomized clinical trial. Eighty patients completed the study. The findings showed significant differences in anxiety and pain between groups (p = 0.001). Spiritual care reduced anxiety and pain caused by chest tube removal in patients (Shia and Sunni Islam) undergoing heart surgery.

The Role of Palliative Care in Caring for the Families of Patients With COVID-19.

In palliative care, we strive to provide care to the whole patient. When we think about the whole patient, we include the people who are important in our patients' lives. Our New York City-based palliative care team has found that caring for patients' loved ones has proven to be an even more important aspect of the care we have provided during the COVID epidemic. In this article, we describe the multicomponenet interdisciplinary interventions we have implemented to enhance our ability to create a therapeutic alliance with family members and facilitate the provision of goal concordant care to patients with COVID during this extremely difficult time.

Religiosity and quality of life of individuals with Alzheimer's disease and of caregivers: Relationship with clinical aspects / Religiosidade e qualidade de vida do individuos com doença de alzheimer e do cuidador: relações com aspectos clínicos e cognitivos

ABSTRACT There are few studies on the religiosity of people with Alzheimer's disease (PwAD) and caregivers, relation with quality of life (QoL) and clinical aspects. Objective: To assess the religiosity and QoL of 39 PwAD and their caregivers; to compare perceived QoL and religiosity of the PwAD with those of their caregivers; to associate QoL and religiosity with the presence of neuropsychiatric symptoms, and depression with cognitive performance of PwAD. Results: Organizational religiosity was greater in caregivers. The AD patients had poorer perceived QoL than their caregivers. Caregiver religiosity correlated with that of the AD patients. Higher intrinsic religiosity was associated with lower occurrence of neuropsychiatric symptoms. Better caregiver QoL correlated with cognitive performance. Lower occurrence of depression correlated with better QoL of the caregivers and AD patients. Conclusion: The religiosity of caregivers was correlated with that of the AD patients. Better QoL and lower religiosity were observed in caregivers when compared with the AD patients. Caregiver religiosity and QoL were associated with neuropsychiatric and cognitive aspects and depression.

RESUMO São poucos os estudos da religiosidade de indivíduos com doença de Alzheimer (AD) e de cuidadores e as relações com a qualidade de vida (QV) e aspectos clinicos. Objetivo: Relacionar os dados do Duke University Religion Index e da Quality of life in Alzheimer's disease scale de 39 idosos (AD: leve ou moderada) e do cuidador com aspectos clínicos, cognitivos e comportamentais. Resultados: religiosidade organizacional é maior nos cuidadores. Idosos com AD percebem pior QV do que o cuidador. Religiosidade do cuidador correlacionou-se com a dos idosos. Maior religiosidade intrínseca relacionou-se com menor ocorrência de sintomas neuropsiquiátricas. Melhor QV dos cuidadores correlacionou-se com desempenho cognitivo. Menor ocorrência de depressão correlacionou-se a melhor QV dos cuidadores e dos idosos. Conclusão: A religiosidade dos cuidadores relaciona-se com a dos idosos. Melhor QV e menor religiosidade foi observada nos cuidadores quando comparadas a dos idosos. Religiosidade e QV dos cuidadores associam-se com aspectos neuropsiquiátricos, cognitivos e com a ocorrência de depressão.

A New Perspective on Spiritual Care: Collaborative Chaplaincy and Nursing Practice.

Spirituality is a key focus and ethical obligation of nursing practice, but many nurses express uncertainty or discomfort with this aspect of their role. The purpose of this article is to explore the domains of religion, spirituality, and culture as commonly conceptualized by chaplains, as a framework for nurses to provide spiritual care interventions to patients in acute care hospitals. Using anecdotes and illustrations from palliative care practice, this article discusses the enhanced benefits to patients and families when spiritual needs are addressed, with specialty-level chaplain interventions, primary spiritual interventions provided uniquely by nurses, or interventions that require the cooperation of both professions. Lessons learned from the inpatient palliative care team experience can also apply to chaplaincy and nursing care for patients in settings beyond the acute care hospital and in disciplines beyond palliative care.