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.

Hospital chaplains' communication with patients: Characteristics, functions and potential benefits.

OBJECTIVE: Hospital chaplains communicate with patients concerning spirituality/religion, but many aspects of their interactions have received little attention. METHODS: Telephone qualitative interviews of ~1 h each were conducted with chaplains and analyzed, drawing on grounded theory. RESULTS: We interviewed 21 U.S. chaplains. Chaplains have relatively unique characteristics, having relatively more time to spend with patients, and less rigid and less medicalized agendas, while gaining respect/trust as religious figures. Chaplains can thus provide several critical beneficial functions - e.g., obtaining key information from patients/families that can help with decision-making and with diagnosis and treatment, and conveying medical providers' points of view to patients/families. Consequently, chaplains can serve as mediators between patients/families and providers; and also overcome staff biases and "labelling" of patients, and pursue or encourage psychological interventions, in part because psychotherapists are often unavailable. CONCLUSION: While past research suggested certain ways how chaplains might benefit hospitals, these professionals can aid these institutions and improve patient care in additional vital, tangible ways. PRACTICAL IMPLICATIONS: Hospital administrators, chaplaincy departments, doctors, nurses and others should more fully recognize, encourage and facilitate these functions. Targeted improvements in practice and education can help achieve these goals. The findings suggest, too, several specific questions for further investigation.

Typologies and Meanings of Prayer Among Patients.

Religion often aids patients, but critical questions arise concerning how patients approach issues regarding prayer. In-depth interviews suggest 12 key patient decisions and aspects of prayer-who prays, to whom (e.g., explicitly to "God" or not), for whom (for self or others), for what (e.g., for symptom reduction), when (regularly or only during crisis), where, what to say (pre-specified language or spontaneous), how consciously planned or not, with what expectations and outcomes, what to call it, and in what social contexts (e.g., how others view one's prayers). These data have implications for future research, clinical practice of physicians, nurses, chaplains, and other allied healthcare providers, and patient education.

Doctor, Will You Pray for Me? Responding to Patients' Religious and Spiritual Concerns.

Religion and spirituality in the United States have been shifting, and physicians are treating patients with increasingly diverse beliefs. Physicians' unfamiliarity with these beliefs poses critical challenges for medical education and practice. Despite efforts to improve medical education in religion/spirituality, most doctors feel their training in these areas is inadequate. This article draws on the author's conversations with providers and patients over several years in various clinical and research contexts in which religious/spiritual issues have arisen. These conversations provided insights into how patients and their families commonly, and often unexpectedly, make religious/spiritual comments to their providers or question their providers about these topics, directly or indirectly. Comments are of at least 9 types that fall within 4 broad domains: (1) perceiving God's role in disease and treatment (in causing disease, affecting treatment outcomes, and knowing disease outcomes), (2) making medical decisions (seeking God's help in making these decisions and determining types/extents of treatment), (3) interacting with providers (ascertaining providers' beliefs, having preferences regarding providers, and requesting prayer with or by providers), and (4) pondering an afterlife. Because of their beliefs or lack of knowledge, doctors face challenges in responding and often do so in 1 of 4 broad ways: (1) not commenting, (2) asking strictly medical questions, (3) referring the patient to a chaplain, or (4) commenting on the patient's remark. Medical education should thus encourage providers to recognize the potential significance of patients' remarks regarding these topics and to be prepared to respond, even if briefly, by developing appropriate responses to each statement type. Becoming aware of potential differences between key aspects of non-Western faiths (e.g., through case vignettes) could be helpful. Further research should examine in greater depth how patients broach these realms, how physicians respond, and how often medical school curricula mention non-Western traditions.

How Infertility Patients and Providers View and Confront Religious and Spiritual Issues.

Questions arise concerning whether and how religion affects infertility treatment decisions. Thirty-seven infertility providers and patients were interviewed. Patients confront religious, spiritual, and metaphysical issues coping with treatment failures and religious opposition from clergy and others. Religion can provide meaning and support, but poses questions and objections that patients may try to avoid or negotiate-e.g., concealing treatment or changing clergy. Differences exist within and between religions. Whether and how much providers discuss these issues with patients varies. These data, the first to examine several key aspects of how infertility providers and patients confront religious/spiritual issues, have important implications for practice, research, guidelines, and education.

Challenges and changes in spirituality among doctors who become patients.

Though spirituality can help patients cope with illness, several studies have suggested that physicians view spirituality differently than do patients. These issues have not been systematically investigated among doctors who become patients, and who may be able to shed critical light on this area. We interviewed fifty doctors from major urban US centers who had become patients due to serious illnesses about their experiences and views relating to religion and spirituality before and after diagnosis, and we explore the range of issues that emerged. These physician-patients revealed continua of forms and contents of spirituality. The forms ranged from being spiritual to start with; to being spiritual, but not thinking of themselves as such; to wanting but being unable to believe. Some continued to doubt and, perhaps relatedly, appeared depressed. The contents of beliefs ranged from established religious traditions, to mixing beliefs, or having non-specific beliefs (e.g., concerning the power of nature). One group of doctors felt wary of organized religion, which could prove an obstacle to belief. Others felt that symptoms could be reduced through prayer. At times, self-assessments of spirituality were difficult to make or inaccurate. Questions surfaced concerning whether and how medical education could best address these issues, and how spirituality may affect clinical work. This study is the first that we know of to examine spirituality among physicians when they become patients. Obstacles to physicians' attentiveness to the potential role of spirituality arose that need to be further explored in medical education and future research. Increased awareness of these areas could potentially have clinical relevance, strengthening doctor-patient relationships and communication, and patient satisfaction.