Healthcare chaplains' conflicting and ambivalent positions regarding meaning in life and worldview.

Western society is increasingly a spiritual society, but not so much a society that draws on clearly delineated religious or worldview pillars anymore. Within healthcare, there's a growing attention to the spiritual dimension of health and the collaborative spiritual care that is needed for person-centered care. This changing religious/worldview and healthcare landscape is influencing healthcare chaplaincy. In this case study in-depth interviews were conducted with a chaplaincy team within a large healthcare organization in The Netherlands. Dialogical Self Theory was used as the theoretical framework in the narrative analysis of these stories. This provided insights into how these chaplains negotiate their professional identity within a changing healthcare landscape. It is concluded that there are multiple and often contradictory and conflicting positions within and between chaplains and that it is a challenge for healthcare chaplains to integrate the "old" and "new" representations of chaplaincy.

From fact to meaning: Care practitioners' hermeneutic competence development in residential care for persons with dementia.

In long-term care for people with dementia, person-centred care (PCC) is widely promoted as an approach that contributes to the well-being of persons in psycho-geriatric care. The goal of PCC is to acknowledge the personhood of residents and to indicate the responsibility of others to ensure the personhood of persons with dementia. In 2016 and 2018, qualitative empirical research was conducted with the purpose to enhance PCC and meaningful care. Five Dutch nursing homes and a total of eight communities of practice participated in the research project 'People and their Stories'. The aim of this project was to strengthen the hermeneutic competence of care practitioners, with a focus on informal everyday interpersonal interactions between residents and care professionals. This article highlights how care professionals, by enhancing their hermeneutical competence, can do justice to the unique personhood of residents in everyday care practice. Three distinguished features for strengthening the hermeneutic competence of care professionals were formulated: respectful curiosity as a prerequisite, being able to differentiate between fact and meaning, and the awareness of own perspectives and assumptions.

"God Hey, Now I've Been Through Something": Moral Resilience of Coordinators in Voluntary Palliative Terminal Care.

Moral distress arises in the dynamic relationship between personal factors and the organizational and political contexts of care work. Whether moral distress actually leads to a reduced well-being of health care workers or a reduced quality of care in the sector depends to a large extent on how moral tensions are dealt with, also called moral resilience, and the protective conditions available. Research about moral distress and moral resilience within the field of health care has concentrated on staff nurses and physicians. Studies into palliative terminal care and/or about the role of coordinating staff are scarce. A study was conducted to gain insight into the moral challenges that coordinators in voluntary palliative terminal care encounter in their ambition to realize good care, how they deal with these challenges, and the individual and organizational characteristics that foster or hamper moral resilience. Interviews were conducted with 20 coordinators and were qualitatively analyzed. The results brought forward 3 moral challenges in working with volunteers and in collaborating with professional care, namely, striving for connection, negotiating autonomy, and struggling with open communication. However, coordinators seemed to face these challenges effectively. In conclusion, the relational narrative strategies used by coordinators to deal with these challenges, in combination with personal and organizational conditions, foster moral resilience.

Enhancing the integration of chaplains within the healthcare team A qualitative analysis of a survey study among healthcare chaplains.

Background: Spiritual well-being is considered an important component of health and is increasingly integrated at all levels of healthcare. Delivering good integrated spiritual care requires coordination between different colleagues in which interprofessional collaboration is crucial. However, this interprofessional collaboration is not always self-evident. What spiritual care entails, is often poorly understood by their healthcare colleagues. Developing a shared professional identity is a crucial component of the shift towards professionalisation in chaplaincy. Objectives: We aim to answer the following research question: how do healthcare chaplains in the Netherlands describe their work and their professional identity in relation to other healthcare professionals? Design and subjects: Analysis of open-ended questions of a survey among healthcare chaplains regarding professional self-understanding in the Netherlands. Results: 107 Dutch chaplains working in a healthcare setting completed the five open-ended questions in the survey. The field of healthcare chaplaincy is changing from an exclusive focus at patients, towards more activities at staff and organisational level such as educating other healthcare professionals and, being involved in ethics and policy making. Conclusions: Our research shows that the professional self-understanding of chaplains entails many leads to foster interprofessional collaboration. At the same time, there are concerns about the professional identity of the chaplain which is not always clear to every healthcare professional. Healthcare teams can benefit from an extensive integration of chaplains in the healthcare team, by including the non-patient-related activities of chaplains, such as staff training, moral deliberation and policy advice.

The development of moral sensitivity of nursing students: A scoping review.

Moral sensitivity is known to be the starting point for moral competence and even is a core concept in the curricula for bachelor's-level nursing students in the Netherlands. While the development of moral sensitivity in nursing is commonly agreed to be important, there is no clear understanding of how to develop moral sensitivity through nursing education and what components of nursing education contribute to moral sensitivity. Studies on educational interventions could build knowledge about what works in developing moral sensitivity and how to achieve this outcome. Therefore, the aim of this study is to explore if and how educational interventions contribute to the development of moral sensitivity in nursing students. A scoping review was conducted. Four electronic databases were searched: CINAHL, PubMed, MEDLINE and SpringerLink. Articles that were not about formal or initial nursing education and that had no link to moral development or moral sensitivity were excluded. After the final selection on educational interventions, 10 articles out of the initial 964 resources were included in the review. Three different but related dimensions of moral sensitivity emerged from the literature: (1) raising moral awareness, (2) providing the ability to frame and name ethical issues and (3) improving moral reasoning ability. Half of the studies used quantitative measures to evaluate the educational intervention, in particular the Moral Sensitivity Questionnaire; the other half used diverse qualitative evaluation methods. None of the studies presented teaching methods that included all three dimensions of moral sensitivity. Moral awareness of self appears to be more loosely connected to the other two dimensions, which raises the question of whether it can be seen as a prerequisite for them. To encompass all dimensions of moral sensitivity, a mix of quantitative and qualitative measures seems most appropriate to study that topic.

Patient autonomy in home care: Nurses' relational practices of responsibility.

BACKGROUND: Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. AIM: To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. RESEARCH DESIGN AND CONTEXT: A case study was conducted in a professional development course ('learning circle') for home care nurses, including participant observations and focus groups. The theoretical notion of 'relational agency' and the moral concept of 'practices of responsibility' were used to conduct a narrative analysis on the nurses' stories about autonomy. PARTICIPANTS: Eight nurses, two coaches and two university lecturers who participated in the learning circle. ETHICAL CONSIDERATIONS: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. FINDINGS: Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients' strengths and collaboration with patients and informal caregivers. DISCUSSION: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. CONCLUSION: The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together.

A Kaleidoscope of Hope: Exploring Experiences of Hope Among Service Users and Informal Carers in Health Care Contexts.

BACKGROUND: There is a large and diverse literature on the concept of hope in health care. This literature covers a broad spectrum of perspectives, from philosophical, conceptual, and theoretical analysis through to attempts at measuring the concept of hope with differing health care users. AIMS: To explore the concept of hope through the secondary analysis of existing data sets, with the intention of understanding hope in the context of person-centeredness. RESEARCH QUESTION: What is the experience of hope among service users and informal carers in different health care contexts? METHOD: Secondary analysis of data derived from three research studies. FINDINGS: We identified four key themes that together illustrate what we describe as a kaleidoscope of hope, reinforcing the view that there is no one presentation of hope and that practitioners must engage authentically with service users to determine the most effective and appropriate intervention strategies. CONCLUSIONS: Hope is not a singular phenomenon, and in the context of person-centered practice there is a need for practitioners to engage authentically with service users and listen carefully to what may bring hope for them.

"Take control or lean back?" Barriers to practicing empowerment in health promotion.

During the past few decades, health promotion has increasingly focused on the empowerment of deprived communities and is shifting from a top-down approach to a participatory practice, aimed at helping people to gain control over their lives and health. Previous research shows that this shift is not without problems. In the Netherlands, an action learning program on empowerment was developed to help health promotion practitioners in this transition. Twenty-four practitioners from different fields of health promotion took part in a 6-month program. Qualitative data were collected from different sources and methods and were analyzed using a thematic analysis. The findings threw light on a core dilemma in health promotion practice and several barriers to bringing empowerment into practice, both on a personal level and in relationship to the community and the wider institutional context. The implications of this study for the empowerment ethos of health promotion and its feasibility within the current West European policy context are discussed.