Spirituality, Mental Health, and COVID-19.

This issue of JORH presents a broad range of articles that consider spirituality and spiritual care from various international perspectives. It also looks at a diverse range of articles relating to mental health disorders and addictions. Lastly, this issue considers the aftermath of COVID-19. Readers are also reminded of the European Congress on Religion, Spirituality, and Health (ECRSH) (Salzburg, Austria), as well as the inaugural International Moral Injury and Wellbeing Conference (IMIWC), Brisbane, Australia, 2024.

Pastoral Narrative Disclosure: The Development and Evaluation of an Australian Chaplaincy Intervention Strategy for Addressing Moral Injury.

This paper describes the development and initial chaplaincy user evaluation of 'Pastoral Narrative Disclosure' (PND) as a rehabilitation strategy developed for chaplains to address moral injury among veterans. PND is an empirically informed and integrated intervention comprising eight stages of pastoral counselling, guidance and education that was developed by combining two previously existing therapeutic techniques, namely Litz et al's (2017) 'Adaptive Disclosure' and 'Confessional Practice' (Joob & Kettunen, 2013). The development and results of PND can be categorized into five phases. Phase 1: PND Strategy Formation-based upon extensive international research demonstrating that MI is a complex bio-psycho-social-spiritual syndrome with symptoms sufficiently distinct from post-traumatic stress disorder. The review also provided evidence of the importance of chaplains being involved in moral injury rehabilitation. Phase II: Development and Implementation of 'Moral Injury Skills Training' (MIST)-which involved the majority of available Australian Defence Force (ADF) Chaplains (n = 242/255: 94.9%) completing a basic 'Introduction to Moral Injury' (MIST-1) as well as an 'Introduction to PND' (MIST-2). Phase III: MIST-3-PND-Pilot evaluation-involved a representative chaplaincy cohort (n = 13) undergoing the PND eight-stage strategy to ensure the integrity and quality of PND from a chaplaincy perspective prior to wider implementation. The pilot PND evaluation indicated a favourable satisfaction rating (n = 11/13: 84.6%; M = 4.73/5.0 satisfaction). Phase IV: MIST-3-PND Implementation-involved a larger cohort of ADF Chaplaincy participants (n = 210) completing a revised and finalized PND strategy which was regarded favourably by the majority of ADF Chaplains (n = 201/210: 95.7%; M = 4.73/5.0 satisfaction). Phase V: Summation. In conclusion the positive satisfaction ratings by a significant number of ADF chaplaincy personnel completing MIST-3-PND, provided evidence that chaplains evaluated PND as a suitable counselling, guidance and education strategy, which affirmed its utilisation and justifies further research for using PND to address MI among veterans, that may also prove valuable for other chaplains working in community health and first responder contexts.

"Do you Really Believe that There is Something More?" - The Offer of Transcendental Communication by Pastoral Care Workers in German Hospices and Palliative Care Units: A Qualitative Study.

BACKGROUND: Palliative Care also encompasses the dimension of spiritual pain. Pastoral care workers and chaplains are specialists in the provision of spiritual care. Decreasing religious affiliation and increasing spiritual diversification in modern societies raise the question of the function of pastoral care. AIM: The goal of this study is to answer the question of what pastoral care workers can offer to dying residents in hospices and palliative care units. DESIGN: A qualitative interview study was designed to explore the specific perspective of pastoral care workers in a multidisciplinary environment. The study is based on differentiation theory which is particularly well adjusted to reveal differences in perspectives in so called 'holistic' care settings. The reporting follows the COREQ guidelines. SETTING: Problem centered interviews were conducted at five hospices and two palliative care units. RESULTS: Eight pastoral care workers were interviewed (5 Catholic, 3 Protestant, mean age of 58 years). The analysis of the interviews revealed three major themes: (A) Self-positioning in relation to the organization, (B) Offering conversations to patients and relatives, (C) Performing religious rituals. Minor themes were: mediating conflicts between patients, relatives and staff, sensing moods in silence with patients and organizing workshops for staff. CONCLUSION: In modern hospice care, pastoral care workers routinely address the problem of making death more tangible and of answering the unanswerable question of what comes afterwards. Through this, they support dying residents in hospices and palliative care units in dealing with the inexplicability of death.

The Impact of Faith-Based Pastoral Care in Decreasingly Religious Contexts: The Australian Chaplaincy Advantage in Critical Environments.

This article considers the contribution of faith-based chaplains who provide holistic pastoral and spiritual care within critical environments such as the military, first responders, and hospitals. The contribution of faith-based chaplains can sometimes be taken for granted or not properly understood, particularly in some Western countries which are currently experiencing a decline in religiosity. Following on from a previous paper regarding chaplaincy utilization (Layson et al. 2022), this article presents an alternative argument to the secularist-humanist perspective by noting five ways by which the faith based chaplaincy model provides best practice service and builds a capability advantage for organizations that engage faith-based chaplaincy services. The first section discusses faith-based chaplaincy and organizational holistic care; the second section considers the role of faith-based chaplains-much of which is largely unknown and poorly appreciated; the third section considers the unique capability of faith-based chaplains to provide spiritual and religious care to those of faith and for those of none; the fourth section explores how faith-based chaplains can leverage the positive impact of religious organizations to provide additional low-cost resources for other organizations and their staff; and lastly, the operational advantage of faith-based chaplains on the world stage is considered, particularly in light of culturally and linguistically diverse populations to whom religiosity is increasingly important.

Medical Students' Reflections on Their Experiences in a Trauma Chaplain Shadowing Program.

The importance of spirituality in patient care is well recognized and efforts to develop educational opportunities to improve medical students' competency in spirituality and health are ongoing. In this regard, shadowing of healthcare chaplains has emerged as an experiential approach for providing exposure to and instruction in issues of spirituality in the patient experience and in patient care. Recently published data suggest that a 6-8 hour experience of shadowing a trauma chaplain is effective at introducing first-year medical students to healthcare chaplaincy, difficult spiritual conversations with patients and families, and interprofessional collaboration. As a follow-up to these data, this study provides a qualitative analysis of student reflections written immediately after their shadowing experience with the goal of further characterizing the educational impact of trauma chaplain shadowing. Qualitative analysis of 90 anonymous, student reflections indicated that trauma chaplain shadowing was an experience that provided insights about nature of chaplaincy, enabled opportunities to closely observe the relational skills of chaplains, allowed students to bear witness to suffering, fostered growth toward a professional identity, and facilitated recognition of shortcomings in medical education and clinical medicine. These data therefore provide further evidence of the value of chaplain shadowing in not only enhancing students' understanding of various dimensions of spirituality and medicine but also in promoting their development of a strong physician identity.

Australian Chaplaincy Support of Health Care Staff: Presence, Professional and Relational.

The aim of the research was to explore how health care staff experienced support from hospital chaplains. The context for the study was two acute care hospitals in the South Australian Government's public health system: one paediatric, the other adult. The research utilised semi-structured interviews that were transcribed and analysed and coded using established methodologies for qualitative studies. The results and subsequent analysis revealed two overarching themes which emerged from the narratives of staff members. Support from chaplains was perceived as being (i) part of the hospital institution, (ii) a participant in the overall care team, (iii) as a symbolic presence, and (iv) available in the diverse settings of education, crisis and trauma events and debriefings. Chaplaincy support was experienced in relational and spontaneous care in serendipitous meetings with staff or at a workstation which was experienced as inclusive and respectful.

Grace Notes: feasibility of a manualized intervention to advance spiritual well-being for clients with acquired brain injury.

Spiritual well-being appears to contribute to mental health and adaptation in adults with acquired brain injury (ABI). ABI-related interventions, including those associated with spirituality, must be specifically designed with learning-related impairments in mind. We conducted a feasibility study of a manualized intervention to support spiritual well-being after ABI called Grace Notes. The goal is to provide clients with time tested, easily accessible spiritual practices that help them experience deeper feelings of being in relationship with their Higher Power as they understand it. Findings suggest that Grace Notes can be implemented by both its developer with the context of an interdisciplinary outpatient rehabilitation program and a rehabilitation clinician as a stand-alone group. People with ABI appear to be interested in a spiritually intervention that draws from a variety of spiritual practices and traditions. Further study related to the efficacy of spiritual well-being intervention after ABI is warranted.

The Association of Professional Chaplains: 75 Years of Growth and Excellence.

2021 is the 75th anniversary of the Association of Professional Chaplains. This article celebrates this vibrant history tracing the history of APC and its predecessor organizations through name changes and mergers, recounting their growth toward inclusion and diversity, and illustrating the history of their collaboration ending with a possible new merger with ACPE. Through their commitment to growth and excellency, APC is arguably one of the premier spiritual care organizations in the world.

Cognitive Behavioral-Active Music Pastoral Therapy for Millennials' Academic Anxiety: How & Why?

This study used quasi-experimental design with repeated measures (pre-test, post-test, and follow-up). Based on the post-test and the follow-up comparison, active music therapy was effective in reducing academic anxiety after two weeks of the treatment. Active music therapy which are integrated in CBT group counseling not only can overcome individual problems, but the therapies can also help individuals analyze their own thoughts and behavior.

A Spoke in the Wheel: Enhancing Chaplaincy Documentation in Interdisciplinary Care Settings.

Chaplaincy is a spoke in the wheel of interdisciplinary care that uses its disciplines to better the patient's medical condition. Therefore, chaplains ought to consider how their emotional and spiritual support helps interdisciplinary teams treat patients' illnesses/injuries. This essay explores how chaplains can contribute more effectively to interdisciplinary care by keeping their patients' condition in focus throughout their spiritual assessments and using models that are familiar to the medical team.

No One Is Alone: Remembering God Is Always With Us.

A chaplain was conducting a funeral for a long-time patient who had recently died. While he was the only one present with the body, his thoughts turn to the ways we can feel God close to us, even when we otherwise might feel alone.

Spiritual Care of Inpatients Focusing on Outcomes and the Role of Chaplaincy Services: A Systematic Review.

OBJECTIVE: To identify demographic trends associated with patient utilization and healthcare provider request for spiritual care services and to describe the impact of spiritual care on the quality of life (QoL), spiritual well-being (SWB) and level of satisfaction (SAT) of hospitalized patients. PATIENTS AND METHODS: A systematic search of Ovid MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, was combined with review of relevant bibliographies. A total of 464 titles and abstracts were reviewed. Data were independently extracted by reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data on the effects of spiritual interventions on QoL, SWB and SAT were extracted, along with demographic data reflecting chaplain services. The results of the studies are presented narratively and in a qualitative manner. RESULTS: Observational or experimental studies investigating chaplain utilization demographics (n = 12), patient satisfaction (n = 9) and QoL/SWB (n = 3) were included. Perceived severity of illness, average length of stay and older age were consistently found to be predictors of higher need for spiritual care. Receipt of spiritual care was correlated with increased patient and family satisfaction, independent of clinical outcome. Chaplain interventions were associated with improvement in perceived QoL and SWB. In spite of this, healthcare workers rarely attempt to explore the patient's or family's need for spiritual care, with the majority of chaplaincy consults occurring in the final day of the patient's life, potentially leading to a failure to meet the spiritual needs of non-terminal patients who have spiritual trauma related to their resolving illnesses. CONCLUSION: Attention to the spiritual needs of hospitalized patients is an essential yet often overlooked aspect of patient care. Chaplains serve as spiritual care specialists whose services can enhance the hospital experience, improve patient satisfaction and help to bridge potential gaps between the patient and medical providers.

Pastoral Care in Aged Care Settings: Role and Challenges.

This mixed methods study explored challenges faced by pastoral care workers. A development phase preceded an on-line survey completed by chaplains and pastoral practitioners (n = 40) employed by a major Australian aged care provider. The survey covered the purpose of pastoral care, key tasks and resources, current and future challenges, and participants' responses to challenges. The biggest issue was heavy demand on participants' time, due to insufficient staff and demanding organisational procedures. A commonly mentioned challenge with future implications was increasing resident acuity. Respondents were dedicated and enthusiastic, despite heavy workloads and occasional difficulty working with care staff or management.

Religious Support as a Contribution to Face the Effects of Social Isolation in Mental Health During the Pandemic of COVID-19.

Coping with the COVID-19 pandemic has required measures to contain the contagion, including social isolation. However, this and other factors have caused mental health problems, both in patients and health professionals and in family members or asymptomatic population. Religious support can be an ally for this type of confrontation. In the case of the COVID-19 pandemic, spiritual/religious care has been restricted and insufficient. When accessible to patients and frontline professionals, they are offered by virtual means, almost always by recorded media and made available in bulk. This essay argues, based on references in the areas of psychology, psychoneuroimmunology, biosafety, and military, that the face-to-face and personalized relationship between religious leaders, patients, health professionals, family members, and faith communities is as essential as possible for the dignified treatment victims, referral to spiritual needs and resilience of society, in addition to contributing to the improvement of the immune response of all. Practical examples are cited in the areas of military chaplaincy and hospital civilian chaplaincy. The essay also proposes the adoption of protocols already published by WHO and other safety measures such as the use of robotics and the recruitment/training of mass chaplains. In addition to contributing to the improvement of COVID-19 pandemic coping processes, the study also contributes to improving the delivery of spiritual/religious care as an ally to physical and mental, individual, and collective health.

Music, spirituality and dementia: Exploring joint working between pastoral care professionals and music therapists to improve person-centred care for people with dementia (Innovative Practice).

This paper presents innovative practice in the area of interdisciplinary collaboration between pastoral care and music therapy professionals to meet the spiritual needs of people with dementia in a hospital environment. Our qualitative research identified the following themes to guide future endeavours in this area: Music has the capacity to facilitate spiritual expression; music therapy contributes to validating the individuality of the person with dementia; collaborative work between music therapy and pastoral care is worthy of further exploration. This study is one of few to address the potential for combining pastoral care and music therapy in the care of people with dementia.

Chaplain-Physician Interactions From the Chaplain's Perspective: A Mixed Method Analysis.

BACKGROUND: The value of healthcare chaplains to patient care is increasingly recognized. However, physicians' understandings of the role of pastoral care have been reported to be poor, which have raised concerns about the quality of chaplain-physician interactions and their impact on patient care. These interactions, particularly from the perspective of the chaplain, have not been extensively investigated. METHODS: An anonymous survey about the interactions of chaplains with physicians was sent to chaplains at a single institution, with subsequent focus group discussions of responding chaplains to obtain additional qualitative data. RESULTS: Quantitative and qualitative data were collected from over 20 chaplains. While chaplains indicated satisfaction regarding their access to physicians, they noted a disconnect between chaplains and physicians, physicians' unfamiliarity with the chaplain role, a sense that physicians do not always appreciate the chaplain role as significant or helpful, and structural barriers to the integration of chaplains into medical care teams. CONCLUSIONS: This study provides contemporary data on the nature of chaplain-physician interactions as reported from the perspective of chaplains. Further, these findings highlight opportunities for interventions to enhance the chaplain-physician relationship.

Doctors Don't Treat Cadavers.

The modern problem caused by the Enlightenment of reducing human beings to cadavers seriously affects the image medical professionals have of their art. The world of the spirit and therefore the place of the spiritual soul should be taken into consideration even in problems of physical healings because the human being is a combination of body and spirit. The teachings of faith can contribute to this. Because of the unique attitude of Christianity to the problem of physical and spiritual healing, Christ is a special model and teacher in this.

"Slowed Down but Not Stopped": A Spiritual Life Review Intervention in Patients with Neurodegenerative Disease.

Spiritual health is important in managing and coping with chronic and debilitating illnesses, such as neurodegenerative diseases. However, few spiritual interventions have addressed this population. This article quantitatively and qualitatively evaluates outcomes of a spiritual life review in neurodegenerative diseases patients. The majority of participants improved or maintained quality of life and spiritual/emotional well-being following the intervention. Spiritual life review may be an important intervention in the comprehensive care of patients with neurodegenerative diseases.

Widening The Gallery Of Biblical Combat Veteran Types With Gideon.

This spiritual-psychological exegesis continues to expand the gallery of biblical combat veteran types by shedding light on a new biblical combat character. Gideon from the Book of Judges was an experienced combat veteran and military commander. The findings include the proposal of a new categorical type of a combat veteran who illustrates both spiritual integrity and resilience. The article engages in conversations of what the findings may mean for pastoral care and their connections to theology.

Medical Students' Experience in a Trauma Chaplain Shadowing Program: A Mixed Method Analysis.

Despite the importance of spirituality to health and patient care, there remains a lack of educational opportunities for medical students to learn about and engage the spiritual needs of patients. Shadowing of hospital chaplains has been employed as a means of providing instruction in spirituality, but published experiences of this pedagogy are limited. This study therefore analyzed an elective, first-year medical student, eight-hour, trauma chaplain shadowing experience, the objectives of which are to increase students' knowledge and understanding of (i) the role of chaplains/pastoral care in patient care; (ii) strategies for engaging patients and/or families in difficult situations; and (iii) approaches for discussing issues of spirituality with patients and families. Aquestionnaire was sent to participants after the experience assessing the value of the experience. Two focus groups provided additional qualitative data. Of the 148 participants over 6 years, 100 completed the questionnaire (68%). Participants on average engaged 1.78 trauma patients or their families and experienced 3.63 overall patient/family interactions during their shadowing. Over 90% of respondents agreed or strongly agreed that the experience provided agreater understanding of the role of the chaplain, and was educationally, professionally, and personally useful. Over 60% of respondents agreed or strongly agreed that the experience improved their understanding of discussing difficult or spiritual topics with patients and families. Nearly all respondents (98%) would recommend asimilar shadowing experience to fellow medical students. Qualitative remarks echoed these findings, revealing themes surrounding the educational benefits, surprise, and awe experienced by participants, and indicating appreciation for the interprofessional aspect of the experience. These data demonstrate that trauma chaplain shadowing may be effective for introducing first-year medical students to healthcare chaplaincy, educating them about the challenges of navigating difficult spiritual conversations with patients and families, and exposing them to interprofessional collaboration.