Exploring Patients' and Chaplains' Perspectives About a Spiritual Care Program in the Primary Care Setting.

BACKGROUND: Spirituality is an important component of social and cultural identity that influences health-related beliefs, decision-making, and coping behaviors. Despite the importance of addressing spirituality in healthcare, research about its impact is limited, especially in the primary care setting. OBJECTIVE: This study aimed to explore patients' and chaplains' experiences of receiving or providing spiritual care in the primary care setting. METHODS: We conducted an in-depth interview qualitative research study. Participants included patient informants, a chaplain, and chaplains-in-training who participated in a spiritual care program at a primary care clinic. Interviews were transcribed and coded. Conventional qualitative research content analysis was performed. RESULTS: Eleven interviews were conducted - 7 with patient informants, 1 with a chaplain, and 3 with chaplains-in-training. Informants reported that in their experience spiritual care increased trust in their provider, made them feel safe to ask or share anything, improved their satisfaction with care, helped sustain healthy behavior change, and improved coping with chronic illness. Participants specifically attributed these positive experiences to chaplains' ability to respect and attend to patients' spirituality, create a safe space, help patients see the connection between their spirituality and health, and help patients tap into their own spirituality as a healthy means of coping. CONCLUSIONS: Spiritual care, when integrated into the primary care setting, has the potential, according to the report of our informants, to help achieve important health-related objectives, such as increased trust in their providers, sustained healthy behavior change, and happiness in spite of chronic illness. Now, more than ever, when our society is hurting from mistrust of our profession secondary to disinformation and discrimination, spiritual care has an important role to play in our efforts to gain our patients' trust so that we can support their healing.

Twice-in-a-Lifetime Pandemics: An Exploratory Qualitative Life-History Analysis of the Longitudinal Experiences of Hospital Chaplains Who Served During Both the Early AIDS (1981-1995) and Early COVID-19 (2020-2021) Pandemics in the USA and United Kingdom.

The aim of this study was to document the longitudinal experiences of chaplains who served during both the early AIDS (1981-1995) and early COVID-19 (2020-2021) pandemics. A total of 11 hospital chaplains were interviewed across the USA and the United Kingdom. Interviews were analyzed using a Grounded theory approach. Chaplains reported multiple stressors during both pandemics, including barriers to integration into care teams, tensions with home religions institutions, burnout, and challenges arising from the politicization of disease. Despite these challenges, chaplains play a vital role during pandemics. Insights from their experiences can inform future strategies for compassionate crisis response.

An Introduction to a Novel Intervention, "This is My Story", to Support Interdisciplinary Medical Teams Delivering Care to Non-Communicative Patients.

This set of three case studies portrays a unique intervention undertaken at The Johns Hopkins Hospital in response to the COVID-19 pandemic with a goal to reduce the impact of absentee visitors during patient care on physicians, nurses, and the patient's loved ones. The intervention, known by the acronym TIMS, "This is My Story", involves a chaplain-initiated telephone call to a loved one, someone who has been identified by the patient as part of their care discussions, of hospitalized patients who have difficulty with communicating to the medical team. The call is recorded then edited for conciseness, and attached to the electronic health record for the entire medical care team to hear. The focus of the chaplain lead conversation with a loved one centers around gathering and presenting information about the patient as a person. Medical team members listen to the edited audio file either on rounds or by utilizing a hyperlink in the electronic health record (EHR). The audio file is two minutes or less in length, as this is the optimal size for comprehension without overburdening the care provider. While conducting the interview, there is an opportunity for chaplains to provide spiritual and emotional support to loved ones and medical staff, contributing substantively to patient care, as is illustrated in the case studies.

Congregational COVID-19 Conversations: Utilization of Medical-Religious Partnerships During the SARS-CoV-2 Pandemic.

Over the last 12-months during the pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the Centers for Disease Control and Prevention (CDC) have issued public health instructions with the hope of mitigating the spread of the virus. Through existing relationships established by an academic hospital, we established weekly community conference calls to disseminate such critical information on the pandemic and allow community leaders to discuss struggles and successes. From these calls, we were able to collaborate in a more intimate manner with faith-based organizations, whereby we emphasized and planned the role they could undertake during the pandemic. Such emphasis was made between our medical institution and various faith-based organizations through meetings titled "Congregational COVID-19 Conversations." Over the past 12-months, we held virtual meetings with 38 faith-based organizations: 15 Christian congregations, 21 Jewish synagogues, and 2 Islamic masjids. We describe in detail in this report a narrative summary of the meetings. From these meetings, we discussed several COVID-19-related themes that included how to have their place of worship disseminate public health messaging, aid in preparing buildings for public worship, and insight into preparing their regions for aid in both COVID-19 testing and for potential SARS-CoV-2 vaccine sites. This medical-religious partnership has proven feasible and valuable during the pandemic and warrants emphasis in that it has the potential to serve a vital role in mitigating COVID-19-related disparities in certain communities, as well as potentially ending the COVID-19 pandemic completely.

Community Calls: Lessons and Insights Gained from a Medical-Religious Community Engagement During the COVID-19 Pandemic.

During the pandemic caused by the severe acute respiratory syndrome coronavirus-2, public health instructions were issued with the hope of curbing the virus' spread. In an effort to assure accordance with these instructions, equitable strategies for at-risk and vulnerable populations and communities are warranted. One such strategy was our community conference calls, implemented to disseminate information on the pandemic and allow community leaders to discuss struggles and successes. Over the first 6 weeks, we held 12 calls, averaging 125 (standard deviation 41) participants. Participants were primarily from congregations and faith-based organizations that had an established relationship with the hospital, but also included school leaders, elected officials, and representatives of housing associations. Issues discussed included reasons for quarantining, mental health, social isolation, health disparities, and ethical concerns regarding hospital resources. Concerns identified by the community leaders as barriers to effective quarantining and adherence to precautions included food access, housing density, and access to screening and testing. Through the calls, ways to solve such challenges were addressed, with novel strategies and resources reaching the community. This medical-religious resource has proven feasible and valuable during the pandemic and warrants discussions on reproducing it for other communities during this and future infectious disease outbreaks.

The Role of the Chaplain as a Patient Navigator and Advocate for Patients in the Intensive Care Unit: One Academic Medical Center's Experience.

Effective communication between intensive care unit (ICU) staff, and patients and their families, can help increase understanding, trust, and goals-of-care decisions. Many strategies focus on enhancing communication by increasing family meetings or adding patient navigators. In our ICU, we implemented both strategies, uniquely appointing a chaplain for the patient navigator role. We then surveyed ICU staff on their perceptions of the chaplain/patient navigator, which yielded several valuable insights. Although all staff supported a strong chaplaincy presence, many had concerns about the dual chaplain/patient navigator role. Based on our mixed results, we encourage further exploration to optimize the chaplain role in the ICU.

Staff Perceptions of Chaplains in a Neurosciences Critical Care Unit.

Hospital chaplains often visit critically ill patients, but neurosciences critical care unit (NCCU) staff beliefs surrounding chaplains have not been characterized. In this study, we used Qualtrics® to survey 70 NCCU healthcare workers about their attitudes toward chaplains in the NCCU. Chaplains were seen positively by staff but were less likely to be viewed as part of the care team by staff with more than five years of NCCU experience. The results of this study will allow chaplaincy programs to target staff education efforts in order to enhance the care provided to patients in critical care settings.

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.

Chaplains on the Medical Team: A Qualitative Analysis of an Interprofessional Curriculum for Internal Medicine Residents and Chaplain Interns.

Improved collaboration between physicians and chaplains has the potential to improve patient experiences. To better understand the benefits and challenges of learning together, the authors conducted several focus groups with participants in an interprofessional curriculum that partnered internal medicine residents with chaplain interns in the clinical setting. The authors derived four major qualitative themes from the transcripts: (1) physician learners became aware of effective communication skills for addressing spirituality. (2) Chaplain interns enhanced the delivery of team-based patient-centered care. (3) Chaplains were seen as a source of emotional support to the medical team. (4) The partnership has three keys to success: adequate introductions for team members, clear expectations for participants, and opportunities for feedback. The themes presented indicate several benefits of pairing physicians and chaplains in the setting of direct patient care and suggest that this is an effective approach to incorporating spirituality in medical training.

Health Promotion in the Community: Impact of Faith-Based Lay Health Educators in Urban Neighborhoods.

Promoting wellness and providing reliable health information in the community present serious challenges. Lay health educators, also known as community health workers, may offer a cost-effective solution to such challenges. This is a retrospective observational study of graduates from the Lay Health Educator Program (LHEP) at Johns Hopkins Bayview Medical Center from 2013 to 2014. Students were enrolled from the surrounding community congregations and from the hospital's accredited clinical pastoral education program. There were 50 events implemented by the lay health educators during the 2014-2015 time period, reaching a total of 2004 individuals. The mean time from date of graduation from the LHEP to implementation of their first health promotional event was 196 ± 76 days. A significant number of lay health educators implemented events within the first year after completing their training. Ongoing monitoring of their community activity and the clinical impact of their efforts should be a priority for future studies.

The Cerulean Bowl.

The Cerulean Bowl is a metaphor for self-care and boundary setting in spiritual care encounters.

The Effect of Chaplain Patient Navigators and Multidisciplinary Family Meetings on Patient Outcomes in the ICU: The Critical Care Collaboration and Communication Project.

OBJECTIVES: To assess the effectiveness of a chaplain patient navigator in improving outcomes and reducing costs in the ICU setting. DESIGN: A randomized controlled trial at a large, urban, academic community hospital in Baltimore, Maryland. SETTING/PATIENTS: All patients admitted to the Johns Hopkins Bayview Medical Center Cardiac and Medical ICUs between March 2015 and December 2015. INTERVENTIONS: Patients in the intervention group were assigned a chaplain patient navigator to facilitate communication, offer support, and setup multidisciplinary family meetings. MEASUREMENTS AND MAIN RESULTS: The primary outcomes were hospital and ICU length of stay. Secondary outcomes included total and ICU charges, 60- and 90-day readmission rates, and the number of palliative care consults. For all outcomes, patients were included in the intention-to-treat analyses only if they remained in the ICU greater than 24 hours. In total, 1,174 were randomly assigned to "usual care" (n = 573) or to the intervention (n = 601). In the intervention group, 44.8% (269/601) had meetings within 24 hours of admission and, of those patients, 32.8% (88/268) took part in the larger multidisciplinary family meeting 2-3 days later. The intervention group had longer mean adjusted hospital length of stay (7.78 vs 8.63 d; p ≤ 0.001) and mean ICU length of stay (3.65 vs 3.87 d; p = 0.029). In addition, they had greater total and ICU charges. There were no differences in other outcomes. Of note, only differences in total and ICU charges remained when controlling for case-mix index, which were greater in the intervention group. CONCLUSIONS: Although the chaplain patient navigator anecdotally enhanced communication, our study found an increase in hospital and ICU length of stay as well as cost. Since other studies have shown benefits in some clinical outcomes, projects focused on patient navigators may learn lessons from our study in order to better prioritize family meetings, gather indicators of communication quality, and identify the optimal patient navigator operational context.

Psychological first aid training for the faith community: a model curriculum.

Traditionally faith communities have served important roles in helping survivors cope in the aftermath of public health disasters. However, the provision of optimally effective crisis intervention services for persons experiencing acute or prolonged emotional trauma following such incidents requires specialized knowledge, skills, and abilities. Supported by a federally-funded grant, several academic health centers and faith-based organizations collaborated to develop a training program in Psychological First Aid (PFA) and disaster ministry for members of the clergy serving urban minorities and Latino immigrants in Baltimore, Maryland. This article describes the one-day training curriculum composed of four content modules: Stress Reactions of Mind-Body-Spirit, Psychological First Aid and Crisis Intervention, Pastoral Care and Disaster Ministry, and Practical Resources and Self Care for the Spiritual Caregiver Detailed descriptions of each module are provided, including its purpose; rationale and background literature; learning objectives; topics and sub-topics; and educational methods, materials and resources. The strengths, weaknesses, and future applications of the training template are discussed from the vantage points of participants' subjective reactions to the training.

The impact of neonatologists' religiosity and spirituality on health care delivery for high-risk neonates.

BACKGROUND: Ethical decision-making regarding life-sustaining therapies (LST) for high-risk neonates can be challenging for both neonatologists and parents. Parents depend on neonatologists to interpret complex information, identify critical opportunities for decision-making, and present options for care. How neonatologists' belief systems affect care delivery for critically ill newborns is unexplored. OBJECTIVE: To characterize the relationship between neonatologists' religiosity or spirituality and the provision of intensive care services for high-risk newborns. METHODS: Neonatologists practicing at an American Academy of Pediatrics Neonatal-Perinatal Training Program were surveyed about their religious/spiritual beliefs, provision of LST for critically ill neonates, and communication with families. RESULTS: Two hundred ninety-eight neonatologists responded to the survey; 66.4% consider themselves very or moderately spiritual, 40.8% very or moderately religious. In response to a hypothetical prenatal consultation for a fetus at 23 1/7 weeks gestation, 96.3% agreed that the physician has a moral obligation to present all options to parents, including the provision of comfort care. More than 95% had no objection to withholding or withdrawing LST, with religion playing almost no part in these decisions. 38% of participants reported no objection to resuscitating an infant with trisomy 13 or 18; 40% of these neonatologists considered themselves very/moderately religious, 60% slightly/not at all religious. Eighty-nine neonatologists reported that their religious beliefs influence their medical practice. These physicians had similar responses as those not influenced by religion. CONCLUSION: For the majority of neonatologists participating in this study, differences in critical care practice cannot be attributed to personal religious or spiritual views.