How Do Healthcare Executives Understand and Make Decisions about Spiritual Care Provision?

OBJECTIVES: This pilot study explores how healthcare leaders understand spiritual care and how that understanding informs staffing and resource decisions. METHODS: This study is based on interviews with 11 healthcare leaders, representing 18 hospitals in 9 systems, conducted between August 2019 and February 2020. RESULTS: Leaders see the value of chaplains in terms of their work supporting staff in tragic situations and during organizational change. They aim to continue to maintain chaplaincy efforts in the midst of challenging economic realities. CONCLUSIONS: Chaplains' interactions with staff alongside patient outcomes are a contributing factor in how resources decisions are made about spiritual care.

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.

Reconciling as a Primary Pastoral Act of Spiritual Care.

Hiltner's shepherding perspective offered a primary reference point for pastoral theologians. This paper examines how the reconciling function of that perspective guides the care proceeding from it for Black persons experiencing medical crises. I analyze connections in the work of Archie Smith with Black persons involved in the healthcare system to show how Black persons draw upon spiritual resources and other resources implicit to the Black community itself in order to reconcile lived experiences with sickness.

Chaplain care in pediatric oncology: Insight for interprofessional collaboration.

BACKGROUND: Although attending to spiritual and religious needs is part of high quality care of pediatric cancer patients, oncology clinicians may not understand the role of the chaplain, resulting in underutilization of resources and failure to fully integrate the chaplain into the clinical team. We provide a description of what the chaplain does in the care of pediatric oncology patients. METHODS: We conducted a qualitative content analysis of chaplain chart notes over a one-year period on the pediatric oncology service at a freestanding children's hospital. Using criteria designed to capture multiple potential factors in chaplain referral, we selected 30 patients for thematic analysis. RESULTS: In 2016, 166 pediatric patients were diagnosed with cancer and received ongoing care at our institution. From the 30 patients selected, 230 chaplain encounters were documented in the medical chart. Three major themes emerged. (1) The chaplains provided a rich description of spiritual and psychosocial aspects of the patient and family's experience; (2) chaplains provided diverse interventions, both religious and secular in nature; and (3) chaplains provided care within a longitudinal relationship. All three themes depend on the empathic listening by a chaplain. CONCLUSIONS: The chaplains' observations about patient and family beliefs, experiences, and emotional/spiritual states have the potential to inform the interdisciplinary care of the patient. Chaplain documentation provides insight into how spiritual care interventions and close relationships may promote patient and family well-being. In future work, we will explore how to give voice to their insights in caring for pediatric oncology patients.

The Chaplain Family Project: Development, Feasibility, and Acceptability of an Intervention to Improve Spiritual Care of Family Surrogates.

In the Intensive Care Unit (ICU), family members experience psychological and spiritual distress as they cope with fear, grief, and medical decisions for patients. The study team developed and pilot tested a semistructured chaplain intervention that included proactive contact and spiritual assessment, interventions, and documentation. An interdisciplinary team developed the intervention, the Spiritual Care Assessment and Intervention (SCAI) Framework. Three chaplains delivered the intervention to surrogates in two ICUs. There were 25 of 73 eligible patient/surrogate dyads enrolled. Surrogates had a mean age of 57.6, were 84% female and 32% African American. The majority (84%) were Protestant. All received at least one chaplain visit and 19 received three visits. All agreed they felt supported by the chaplains, and qualitative comments showed spiritual and emotional support were valued. A semistructured spiritual care intervention for ICU surrogates is feasible and acceptable. Future work is needed to demonstrate the intervention improves outcomes for surrogates and patients.

[Processes of institutionalization of non-Catholic chaplaincy and spiritual aide in public hospitals of Argentina]. / Procesos de institucionalización del servicio de capellanía y la asistencia espiritual no católica para hospitales públicos de Argentina.

This article seeks to reconstruct how the process of institutionalization of a presbytery of non-Catholic chaplains developed as a way to adapt and interact with public institutions in Argentina, particularly health care institutions. For this purpose, qualitative interviews with religious actors trained in bioethics were carried out, in addition to participant observation in training spaces and conferences on health and bioethics and documentary analysis of training material and declarations of religious actors on issues of health and bioethics. In a context of relations of asymmetry between the State and the churches and the pluralization of the religious field, diverse needs for spiritual aide in state institutional spaces arise. It is in such a framework that this organization of chaplains gains institutional status, developing its own ethos in search of recognition, visibility and social legitimacy to offer chaplaincy services in institutions where the only chaplains recognized and funded by the State belong to the Catholic religion.

En este artículo nos interesa reconstruir cómo se desarrolla el proceso de institucionalización de un presbiterio de capellanes no católicos para poder adaptarse e interactuar con las instituciones públicas de Argentina, particularmente, las de salud. Para ello, se realizaron entrevistas cualitativas a actores religiosos formados en temas de bioética, observación participante en espacios de formación, congresos y jornadas de bioética y salud y análisis documental de material de estudio y declaraciones de actores religiosos sobre temas de salud y bioética. En un contexto de relaciones de asimetría entre el Estado y las iglesias y pluralización del campo religioso surgen requerimientos de asistencia espiritual diversos en espacios institucionales estatales. En este marco se institucionaliza esta organización de capellanes que desarrolla un ethos propio en búsqueda de reconocimiento, visibilidad y legitimidad social para ofrecer un servicio de capellanía en instituciones donde los únicos capellanes reconocidos y solventados por el Estado pertenecen a la religión católica.

Procesos de institucionalización del servicio de capellanía y la asistencia espiritual no católica para hospitales públicos de Argentina / Processes of institutionalization of non-Catholic chaplaincy and spiritual aide in public hospitals of Argentina

RESUMEN En este artículo nos interesa reconstruir cómo se desarrolla el proceso de institucionalización de un presbiterio de capellanes no católicos para poder adaptarse e interactuar con las instituciones públicas de Argentina, particularmente, las de salud. Para ello, se realizaron entrevistas cualitativas a actores religiosos formados en temas de bioética, observación participante en espacios de formación, congresos y jornadas de bioética y salud y análisis documental de material de estudio y declaraciones de actores religiosos sobre temas de salud y bioética. En un contexto de relaciones de asimetría entre el Estado y las iglesias y pluralización del campo religioso surgen requerimientos de asistencia espiritual diversos en espacios institucionales estatales. En este marco se institucionaliza esta organización de capellanes que desarrolla un ethos propio en búsqueda de reconocimiento, visibilidad y legitimidad social para ofrecer un servicio de capellanía en instituciones donde los únicos capellanes reconocidos y solventados por el Estado pertenecen a la religión católica.

ABSTRACT This article seeks to reconstruct how the process of institutionalization of a presbytery of non-Catholic chaplains developed as a way to adapt and interact with public institutions in Argentina, particularly health care institutions. For this purpose, qualitative interviews with religious actors trained in bioethics were carried out, in addition to participant observation in training spaces and conferences on health and bioethics and documentary analysis of training material and declarations of religious actors on issues of health and bioethics. In a context of relations of asymmetry between the State and the churches and the pluralization of the religious field, diverse needs for spiritual aide in state institutional spaces arise. It is in such a framework that this organization of chaplains gains institutional status, developing its own ethos in search of recognition, visibility and social legitimacy to offer chaplaincy services in institutions where the only chaplains recognized and funded by the State belong to the Catholic religion.

Critical Care Nurses' Experiences With Spiritual Care: The SPIRIT Study.

BACKGROUND: Little is known about the effect of chaplains on critical care nurses who are caring for critically ill patients and their families. OBJECTIVE: To understand nurses' experiences when they make a referral to the Spiritual Care Department for a patient or the family of a patient who is dying or deceased. Specific aims were to explore spiritual care's effect on nurses and how nurses understand the role of spiritual care in practice. METHODS: A qualitative descriptive study using in-person, semistructured interviews in a 21-bed medical-surgical intensive care unit in a teaching hospital. Purposeful sampling identified nurses who had at least 5 years of experience and had cared for at least 5 patients who died on their shift and at least 5 patients for whom they initiated a spiritual care referral. Interviews were digitally recorded and anonymized; conventional content analysis was used to analyze transcripts. Three investigators independently coded 5 transcripts and developed the preliminary coding list. As analysis proceeded, investigators organized codes into categories and themes. RESULTS: A total of 25 nurses were interviewed. The central theme that emerged was presence, described through 3 main categories: the value of having chaplains present in the intensive care unit and their role, nurses' experiences working with chaplains, and nurses' experiences providing spiritual care. CONCLUSION: Nurses considered spiritual care essential to holistic care and valued the support chaplains provide to patients, families, and staff in today's spiritually diverse society.

The Role of Healthcare Chaplains in Resuscitation: A Rapid Literature Review.

Spirituality is becoming of increasing importance in the international healthcare context. While patients' spirituality or faith is often overlooked, there is a growing awareness that understanding, addressing and supporting patients' spiritual and faith needs can influence healthcare outcomes. This review aims to illuminate this role and highlight healthcare chaplains' potential in relation to the provision of pastoral support for families during and after patient resuscitation, and the dearth of interdisciplinary education in this field. A rapid structured review was undertaken using four databases-PubMed, CINAHL, PsycINFO and ATLA. Primary research studies published during the 10-year period 2007-2017 written in English addressing the chaplain's role or perceived role in resuscitation were included. An initial search using key terms yielded 18 relevant citations. This reduced to 11 once duplicates were removed. Ultimately five relevant primary research studies were included in the final analysis. This review found few studies that directly explored the topic. Certainly many view the chaplain as a key member of the resuscitation team, although this role has not been fully explored. Chaplains likely have a key role in supporting families during decisions about 'not for resuscitation' and in supporting families during and after resuscitation procedures. Chaplains are key personnel, already employed in many healthcare organisations, who are in a pivotal position to contribute to future developments of spiritual and pastoral care provision and support. Their role at the end of life, despite well described and supported, has received little empirical support. There is an emerging role for chaplains in healthcare ethics, supporting end-of-life decisions and supporting family witnessed resuscitation where relevant. Their role needs to be more clearly understood by medical staff, and chaplain's input into undergraduate medical education programmes is becoming vital.

Patient Appreciation of Student Chaplain Visits During Their Hospitalization.

Spiritual care is associated with improved health outcomes and higher patient satisfaction. However, chaplains often cover many hospital units and thus may not be able to serve all patients. Involving student chaplains in patient spiritual care may allow for more patients to experience the support of spiritual care. In this study, we surveyed 93 patients hospitalized on general medical units at a tertiary care center who were visited by nine student chaplain summer interns. The results indicated that the majority of patients appreciated student chaplain visits and these encounters may have positively influenced their overall hospital experience. Thus, student chaplains could be a way to extend valuable spiritual care in settings where chaplaincy staff shortages preclude access.

Defining the Context for Best Practices: Institutional Setting for Clinical Pastoral Care in Estonia.

The current article aims to offer an informational basis for creating an adaptable model of spiritual support provision for Estonian health care institutions. The study addresses Estonian medical staff's knowledge about and attitudes towards spiritual support. The data originate from a quantitative research conducted in 19 Estonian hospitals during 2015-2016. The results show a good will for interdisciplinary co-operation, and pastoral caregiver is expected to be a part of the staff. The fact that spiritual support is not financed by the state budget funds raises the question about explaining the benefits of spiritual support to the hospital's or clinic's management.

The Role of the Pastoral Practitioner in Health Outcomes and Wellbeing During Acute Illness: Exploring the Patient Experience of a Pastoral Visit.

The role of the pastoral practitioner is embedded in many health care services and organizations. Despite this, there is little evidence to describe the impact of this role on patient outcomes, in particular how visits by a pastoral practitioner influence patient healing and recovery. This paper describes a small study that explored the patient experience of pastoral practitioner visits in an acute care facility.

Spiritual Care Education and Rural Systems in Swan River.

The provision of spiritual care, and the training of spiritual care providers, must be embedded within the larger systems (economic, social, generational, and environmental) and communities within which clients reside. This study analyzes the results of a systems approach to CPE training that focused on the rural context of Swan River, Manitoba. It addresses the need for new approaches to contextualizing CPE training and for understanding the uniqueness of rural contexts in particular.

Ethics, Politics, and Religion in Public Health Care: A Manifesto for Health Care Chaplains in Canada.

Health care chaplaincy positions in Canada are significantly threatened due to widespread health care cutbacks. Yet the current time also presents a significant opportunity for spiritual care providers. This article argues that religion and spirituality in Canada are undergoing significant changes. The question for Canadian health care chaplains is, then: how well equipped are they to understand these changes in health care settings and to engage them? This article attempts to go part way toward an answer.

What do I do? Developing a taxonomy of chaplaincy activities and interventions for spiritual care in intensive care unit palliative care.

BACKGROUND: Chaplains are increasingly seen as key members of interdisciplinary palliative care teams, yet the specific interventions and hoped for outcomes of their work are poorly understood. This project served to develop a standard terminology inventory for the chaplaincy field, to be called the chaplaincy taxonomy. METHODS: The research team used a mixed methods approach to generate, evaluate and validate items for the taxonomy. We conducted a literature review, retrospective chart review, focus groups, self-observation, experience sampling, concept mapping, and reliability testing. Chaplaincy activities focused primarily on palliative care in an intensive care unit setting in order to capture a broad cross section of chaplaincy activities. RESULTS: Literature and chart review resulted in 438 taxonomy items for testing. Chaplain focus groups generated an additional 100 items and removed 421 items as duplications. Self-Observation, Experience Sampling and Concept Mapping provided validity that the taxonomy items were actual activities that chaplains perform in their spiritual care. Inter-rater reliability for chaplains to identify taxonomy items from vignettes was 0.903. CONCLUSIONS: The 100 item chaplaincy taxonomy provides a strong foundation for a normative inventory of chaplaincy activities and outcomes. A deliberative process is proposed to further expand and refine the taxonomy to create a standard terminological inventory for the field of chaplaincy. A standard terminology could improve the ways inter-disciplinary palliative care teams communicate about chaplaincy activities and outcomes.

Spiritual aspects of care for adolescents with cancer.

AIMS AND BACKGROUND: Adolescents with cancer have psychosocial issues that need to be adequately addressed. Spirituality is a fundamental aspect of their psychological well-being. METHODS: A chaplain is a daily presence in the Youth Project ward for adolescents at the Pediatric Oncology Unit of the Istituto Nazionale Tumori, Milan. The chaplain conducts daily visits to the ward and the outpatient clinic/day hospital, holds daily meetings with the psychologists on staff, and attends biweekly meetings with doctors and/or nurses. The cases of patients referred for spiritual assistance between January and December 2012 were analyzed by patient age and reasons for consultation, and were compared with cases referred for psychological consultation. RESULTS: A psychological consultation was offered to 84% of patients/families, and further support was needed for 23% of children and 45% of teenagers. Spiritual support was provided for 2 children and 20 adolescents (24% of the sample considered). CONCLUSIONS: Acknowledgment of their spiritual needs helps patients to battle with their disease. The reasons patients and parents ask for spiritual assistance only partially overlap with the motives behind requests to see a psychologist. The care of adolescents with cancer should include catering for their spiritual needs by assuring the constant presence of a chaplain on hospital wards.

[Support to spiritual needs in hospital care. Integration perspective in modern hospitals]. / Il supporto ai bisogni spirituali nella cura ospedaliera. Prospettive di integrazione nell'ospedale moderno.

Within the course of medical care in the most advanced health care settings, an increasing attention is being paid to the so-called care humanization. According to this perspective, we try to integrate the usual care pathways with aspects related to the spiritual and religious dimension of all people and their families, as well as the employees themselves. It is clearly important to establish this kind of practices on the basis of scientific evidences. That is the reason why it's a necessity to improve the knowledge about the importance that spiritual assistance can offer within the current health service. The aim of this work is to show the relevance of the integration of spiritual perspectives in the hospital setting according to a multidisciplinary point of view. In this work many data that emerge from the international scientific literature, as well as the definition that is given to the concept of "spirituality" are analyzed; about this definition in fact there is not unanimous consent even today. It is also analyzed the legal situation in force within the European territory according to the different laws and social realities. Finally, the possible organizational practices related to spiritual support are described and the opportunity to specific accreditation pathways and careful training of chaplains able to integrate traditional religious practices with modern spiritual perspectives is discussed.

The emergence of the new chaplaincy: re-defining pastoral care for the postmodern age.

Noting the rapid evolution of pastoral care in American hospitals and culture, the author embraces and explicates the shift toward an inclusive and holistic model of spiritual care that has ramifications for care delivery and clinical education.

Long coats, short coats and no coats: chaplaincy presents to psychiatry at the University of Texas MD Anderson Cancer Center, a report.

When Chaplaincy and Psychiatry examine their own methodologies, do they work to reduce age-old barriers, thereby involving each other to promote holistic patient care? Chaplaincy trains in self-awareness and pastoral care specializing in religion, spirituality, grief and loss; while Psychiatry trains in medicine, neurology, and the behavioral neurosciences. Relationships across disciplines with common interests are vital. Ongoing dialogue between these professions will enhance the shared goals of coping and healing in the communities they serve.