Supporting staff: The role of health care chaplains.

The aim of this study was to describe the range of spiritual care activities in support of clinical colleagues at a subset of U.S. hospitals. A descriptive cross-sectional design using a 76-item Zoom/telephone guided survey containing a subset of staff care questions was employed. Data were provided by directors/managers responsible for spiritual care services at the 2020-2021 U.S. News & World Report top hospitals. Results identified staff support as an important chaplaincy function at both organizational and spiritual care department levels. Staff chaplains at over half of the hospitals spend an estimated 10-30% of their time on staff care, with chaplains in five hospitals spending greater than 30%. The most frequently reported activities were religiously associated, such as blessings and rituals for hospital events. Additionally, chaplains actively support staff during critical events such as patient deaths and through organizational protocols such as code lavender and critical incident debriefings. Chaplain support for staff most commonly grew out of personal relationships or referrals from clinical managers. Future research opportunities in this area include systematic data collection for chaplains' specific staff support activities as well as efforts to investigate the impact of those activities on patient experience.

Chaplain staffing and scope of service: benchmarking spiritual care departments.

The functions of hospital chaplains and the corresponding staffing of spiritual care departments remain persistent and parallel questions within the profession. No consensus exists on services provided by spiritual care departments nor the staffing patterns to meet those expectations. This study describes the key activities and staffing at the 20 U.S. News and World Report Best Hospitals 2020-2021 as well as the connections between services, staffing, and select hospital characteristics such as average daily census. Information about each hospital's chaplaincy department was gathered via a Zoom/telephone assisted survey with its spiritual care manager. Findings reveal that while spiritual care departments are structurally integrated into their organizations and chaplains respond consistently to requests for care, involvement in established organizational protocols varies. Study findings support the notion that staffing levels are a function of chaplain integration into an organization and the activities organizations expect chaplains to fulfill.

Delivering Clinical Pastoral Education (CPE) Remotely: Educators' Views and Perspectives During the COVID-19 Pandemic and Beyond.

Many Clinical Pastoral Education programs pivoted to remote delivery during the COVID-19 pandemic. Our survey explored educators' preparedness, self-efficacy, and views regarding remote Clinical Pastoral Education. Few respondents were either very (14.2%) or not at all (16.5%) prepared. Most were confident facilitating remote learning (69.8%-88.5%), believing remote Clinical Pastoral Education can achieve outcomes equivalent to in-person (59.1%). Six qualitative themes emerged: educator development, educator challenges, remote Clinical Pastoral Education efficacy, remote group dynamics, clinical practice/supervision implications, and benefits and opportunities.

COVID-19 and Clinical Pastoral Education: How ACPE Educators Pivoted Amid the Pandemic.

Clinical Pastoral Education (CPE) programs faced extraordinary challenges during the COVID-19 pandemic. We examined how ACPE-certified educators responded to maintain program delivery. Survey results (n = 210) suggested a substantial and abrupt increase in remote delivery for CPE instruction and supervised clinical practice, primarily driven by those previously fully in-person. Respondents reported abrupt changes impacted 1152 students. Participants rated their utilization and helpfulness of professional, organizational, and technology resources during the pivot and beyond.

Associations Between Patient Health Outcomes and Secure Message Content Exchanged Between Patients and Clinicians: Retrospective Cohort Study.

BACKGROUND: The number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes. OBJECTIVE: To examine associations between patients' and clinicians' message content and changes in patients' health outcomes. METHODS: We applied a taxonomy developed specifically for secure messages to 14,394 patient- and clinic staff-generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 50.94% (n=816) of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic (A1C) levels in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension. RESULTS: Patients who initiated threads had larger declines in A1Cs (P=.01) compared to patients who did not initiate threads. Clinic nonresponse was associated with decreased SBP (ß=-.30; 95% CI -0.56 to -0.04), as were staffs' action responses (ß=-30; 95% CI -0.58 to -0.02). Increased DBP, SBP, and A1C levels were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients' complaints (ß=-4.03; 95% CI -7.94 to -0.12). Deferred information sharing by clinic staff was associated with increased SBP (ß=1.29; 95% CI 0.4 to 2.19). CONCLUSIONS: This is the first research to find associations between message content and patients' health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes.

Charting Our Course: Chaplain Documentation as a Performance Improvement Project.

This article presents the results of a 30-month process improvement initiative examining the spiritual assessment documentation patterns of staff chaplains as well as CPE residents and interns at an academic medical center. Preliminary examination of chaplain documentation patterns led to a multidimensional intervention to address perceived documentation limitations and enhance reliability. The intervention resulted in positive changes in documentation patterns as assessed by an expert panel of experienced chaplains. Results offer opportunities for the use of electronic medical record documentation in training of chaplains.

Chaplain Documentation and the Electronic Medical Record: A Survey of ACPE Residency Programs.

This study explores the extent to which chaplaincy departments at ACPE-accredited residency programs make use of the electronic medical record (EMR) for documentation and training. Survey data solicited from 219 programs with a 45% response rate and interview findings from 11 centers demonstrate a high level of usage of the EMR as well as an expectation that CPE residents document each patient/family encounter. Centers provided considerable initial training, but less ongoing monitoring of chaplain documentation. Centers used multiple sources to develop documentation tools for the EMR. One center was verified as having created the spiritual assessment component of the documentation tool from a peer reviewed published model. Interviews found intermittent use of the student chart notes for educational purposes. One center verified a structured manner of monitoring chart notes as a performance improvement activity. Findings suggested potential for the development of a standard documentation tool for chaplain charting and training.

Organ Donation in the 50+ Age Demographic: Survey Results on Decision Rationale and Information Preferences.

The rate of organ donation by older potential donors is significantly declining even though recent studies show positive clinical outcomes with organs transplanted from older donors. This study examined the 50+ age demographic to identify the rationale for donation decisions, preferred media methods of donation information delivery, and responsiveness to an age-tailored donation message. Results from 579 surveys, 87% from the 50+ age demographic, found respondents prone to self-select themselves as medically ineligible based on current medication and health status, even though they might be medically suitable donors. Their incentive to pursue additional information on donation is limited except when motivated by personal accounts within their families and communities. In addition, even when computer literate, they continue to favor the printed or spoken word for donation information delivery. The results suggest an opportunity for those working with older adults to develop more personalized, localized donation education programs targeting this age demographic.

Education for Professional Chaplains: Should Certification Competencies Shape Curriculum?

The growing importance of professional chaplains in patient-centered care has raised questions about education for professional chaplaincy. One recommendation is that the curricula of Clinical Pastoral Education (CPE) residency programs make use of the chaplaincy certification competencies. To determine the adoption of this recommendation, we surveyed CPE supervisors from 26 recently re-accredited, stipended CPE residency programs. We found the curricula of 38% of these programs had substantive engagement with the certification competencies, 38% only introduced students to the competences, and 23% of the programs made no mention of them. The majority of the supervisors (59%) felt engagement with the competencies should be required while 15% were opposed to such a requirement. Greater engagement with chaplaincy certification competencies is one of several approaches to improvements in chaplaincy education that should be considered to ensure that chaplains have the training needed to function effectively in a complex and changing healthcare environment.

Teaching research in clinical pastoral education: a survey of model practices.

The Association of Professional Chaplains (APC) developed Standards of Practice for Acute and Long-term settings. Standard 12 promotes research-literate chaplains as important for the profession. Since many chaplains receive training in clinical pastoral education (CPE) residency programs, the aim of this study was to identify model practices for the teaching of research in such programs. Using a purposeful sample, this study identified 11 programs that offered "consistent and substantive" education in research. Common features included the existence of a research champion, a culture supportive of research, and the availability of institutional resources. The study identified models and methodologies that CPE programs can adopt.

Mapping the literature of health care chaplaincy.

OBJECTIVE: This study examined citation patterns and indexing coverage from 2008 to 2010 to determine (1) the core literature of health care chaplaincy and (2) the resources providing optimum coverage for the literature. METHODS: Citations from three source journals (2008-2010 inclusive) were collected and analyzed according to the protocol created for the Mapping the Literature of Allied Health Professions Project. An analysis of indexing coverage by five databases was conducted. A secondary analysis of self-citations by source journals was also conducted. RESULTS: The 3 source journals--Chaplaincy Today, the Journal of Health Care Chaplaincy, and the Journal of Pastoral Care and Counseling--ranked as the top 3 journals in Zone 1 and provided the highest number of most frequently cited articles for health care chaplaincy. Additional journals that appeared in this highly productive zone covered the disciplines of medicine, psychology, nursing, and religion, which were also represented in the Zones 2 and 3 journals. None of the databases provided complete coverage for the core journals; however, MEDLINE provided the most comprehensive coverage for journals in Zones 1 and 2, followed by Academic Search Complete, CINAHL, PsycINFO, and ATLA. Self-citations for the source journals ranged from 9% to 16%. CONCLUSIONS: Health care chaplaincy draws from a diverse body of inter-professional literature. Libraries wishing to provide access to journal literature to support health care chaplaincy at their institutions will be best able to do this by subscribing to databases and journals that cover medical, psychological, nursing, and religion- or spirituality-focused disciplines.

Educating chaplains for research literacy: results of a national survey of clinical pastoral education residency programs.

There is growing evidence that leaders in professional health care chaplaincy recognize the important role of research. The Standards of Practice recently approved by the Association of Professional Chaplains (APC), and especially the standard about research (Standard 12), provide strong evidence that the profession sees research, and research-literate chaplains, as important for its future. The aim of this study was to identify the extent to which Association for Clinical Pastoral Education, Inc (ACPE) accredited clinical pastoral education (CPE) residency programs are preparing their graduates to be the kind of research-literate chaplains described in these Standards. We interviewed CPE supervisors from 26 randomly-selected CPE residency programs. We found 12% of the programs had intentional and substantive research-related curricula, 27% of the programs offered some limited exposure to research, and 62% of the programs provided no education about research. We found also that supervisors often defined "research education" in terms of actually conducting research projects. CPE residency programs potentially play a central role in educating research-literate chaplains. Future research should examine the incentives and barriers that influence the inclusion of research education in CPE residency programs.

Enhancing objectivity in pastoral education: use of standardized patients in video simulation.

Measurement of student learning outcomes in clinical pastoral education has historically been assessed through student self-report instruments and subjective evaluation by CPE supervisors. Valid quantitative measurement is limited. This study utilizes standardized patients and a behavioral interview checklist to measure the impact of an initial summer unit of CPE training. Results demonstrate measurable change in student interview style behavior suggesting that simulation utilizing standardized patients is a valid objective measure of students' behavioral communication styles.

The role of women in the donation consent decision: building on previous research.

BACKGROUND: Recently published findings emphasize the dominant role of women in the donation discussion. With some noteworthy exceptions, the empirical literature on gender and donation, and the role of gender in healthcare decisions as well as donation, is limited. OBJECTIVES: To provide preliminary information needed to begin theoretical or framework development and to initiate more rigorous research on the role of gender in donation discussions. DESIGN: This exploratory study is a descriptive qualitative retrospective study using focus group methodology. SETTING AND PARTICIPANTS: Two focus groups were conducted in 2 major cities in the organ procurement organization's service area. Participants were women who were involved in the donation discussion within the past 5 years; 6 participated in 1 session, 8 in the other. RESULTS: The focus group discussions highlight the role of women in the donation process relative to information needs, information usage, and the ensuring dynamics of the donation discussion. Compared to men, women tend to seek more information and reframe this information for others. Because women are frequently central in family communication networks, they serve as a communication conduit for other family members and may influence others. CONCLUSIONS: Involving key women decision makers in the early stages of the donation discussion and providing information elaboration build on women's central placement and role in family communication network processes. The significance of women's central placement may carry cultural implications, particularly for racial or ethnic groups with strong matriarchal or extended kinship structures.

African American consent and nonconsent cases: are there significant differences?

BACKGROUND: Previous research has examined the differences in organ donation consent rates between African Americans and other racial/ethnic groups. However, there is limited examination of whether differences exist between African American families that consent and those that do not. OBJECTIVE: To examine if there are significant differences between African American families that consent to donation compared to those that do not. METHODS: A random sample of 120 African American potential donor cases from an academic medical center between 1997 and 2004 were included in this study. Variables of interest included next-of-kin relationships, family interactions, knowledge of donor wishes, family initiation of the donation discussion, and satisfaction with the donation process. RESULTS: The data include 32 consent and 88 nonconsent cases. Compared to nonconsent cases, consent cases differed significantly in next-of-kin knowledge of donor wishes, frequent involvement of parents, and infrequent involvement of spouses. Donor wishes were known in 19% of consent cases but in none of the nonconsent cases. A parent was the dominant next-of-kin decision maker in 68% of consent cases, compared to 36% of nonconsent cases. A spouse assumed the dominant role in 29% of nonconsent cases but in only 6% of consent cases. Of these differences, wishes known, parental involvement, and spousal involvement were statistically significant (P = .000, P = .002, and P = .013, respectively). CONCLUSIONS: The results highlight the statistically significant differences between African American consent and nonconsent cases: knowledge of donor wishes and those involved in the donation decision. These results reinforce the importance of programs that encourage African American families to discuss donation with loved ones.

The development, status, and future of healthcare chaplaincy.

This review article provides insight into the evolution of professional healthcare chaplaincy. It identifies key historical developments identifying the training, qualifications, and competencies of chaplains. Consideration is given to both the unique character of the pastoral role in healthcare as well as the contribution of chaplains to the interdisciplinary care of patients and families. The article points to the emerging need for chaplains to pursue research within the clinical context.

Role of "relatedness" in donation discussions with next of kin: an empirical study of the common wisdom.

CONTEXT: Demographic similarities between support personnel and next of kin are of increasing interest. Studies examining like-race requestors have not produced clear and consistent outcomes. No studies have examined demographic relatedness factors for family support personnel who are not requestors. OBJECTIVES: To examine the degree of "relatedness" between family communication coordinator chaplains and next of kin in cases that resulted in consent for donation. To examine "relatedness" in terms of demographic characteristics between primary hospital family support individuals and next of kin. DESIGN: Retrospective nonexperimental descriptive design spanning 1997 to 2004. MAIN OUTCOME MEASURES: Demographic characteristics including gender, race and ethnicity, age, religion, and contact time. RESULTS: The results fail to support the hypothesis that the degree of "relatedness" between the family communicator and next of kin is associated with positive consent decisions. The findings show that gender is a shared quality in 60% of these cases, and race, age, and religion are even more infrequently shared qualities. The findings also suggest an elevated role of women in the donation discussion. CONCLUSIONS: This study fills the void of empirical research through its use of objective outcome measures. The results fail to support the common wisdom and bring to question the foundation of many programs used to promote organ donation. Additionally, the findings emphasize the need for more rigorous investigations and development of more refined, valid measures for examining factors that may influence the donation discussion.

Workplace discrimination and disfigurement: the national EEOC ADA research project.

Using the Integrated Mission System of the Equal Employment Opportunity Commission, the employment discrimination experience of Americans with disfigurement is documented. Key dimensions of workplace discrimination involving Americans with disfigurement and persons with missing limbs are compared and contrasted. Specifically, the researchers examine demographic characteristics of Charging Parties; the industry designation, location and size of Respondents/employers; the discrimination Issue (i.e., type of adverse action) alleged to occur; and the legal outcome or Resolution of these allegations. Charging Parties with disfigurement who are female or between 30 and 39 years of age are more likely to encounter employment discrimination than their counterparts with missing limbs. Harassment and Non-wage Benefits are the Issues that emerge in higher proportion. Allegations derived from persons with disfigurement are more common in among mid-size employers, those located in the South, or those in Retail or Service industries. Following investigation, allegations derived from persons with disfigurement are less likely to have Merit Resolutions than those brought by Charging Parties with missing limbs.

The impact of protocol on nurses' role stress: a longitudinal perspective.

OBJECTIVE: The study examined the impact of a protocol directed at increasing organ donation on the role stress and work attitudes of critical care nurses involved in potential organ donation cases. The research examined whether the protocol could positively affect nurses' perceptions of role stress, and if so, could the work environment improvements be sustained over time. BACKGROUND: The Family Communication Coordinator (FCC) protocol promotes effective communication during potential organ donation cases using a multidisciplinary team approach. Previous research found it associated with improved donation outcomes and with improved perceptions of role stress by critical care nurses. However, the previous study lacked methodological rigor necessary to determine causality and sustainability over time. METHODS: The study used a quasi-experimental prospective longitudinal design. The sample included critical care nurses who had experience with potential organ donation cases with the protocol. Survey data were collected at 4 points over 2 years. Surveys used previously validated and reliable measures of role stress (role ambiguity, role conflict, role overload) and work attitudes (commitment, satisfaction). Interviews supplemented these data. RESULTS: The nurses' perceptions of role stress associated with potential organ donation cases dramatically dropped after the protocol was implemented. All measures of role stress, particularly role ambiguity and role conflict, showed statistically significant and sustained improvement. Nurses' professional, unit, and hospital commitment and satisfaction reflect an increasingly positive workplace. CONCLUSIONS: The results demonstrate that the FCC protocol positively influenced the workplace through its impact on role stress over the first 2 years following its implementation. The findings suggest that similar protocols may be appropriate in improving the critical care environment by reducing the stress and uncertainty of professionals involved in other end-of-life situations. However, the most striking implication relates to the reality of the workplace: meeting the goals of improved patient care outcomes and those of improving the healthcare work environment are not mutually exclusive and may be mutually essential.

The impact of the Family Communication Coordinator (FCC) Protocol on the role stress of hospital chaplains.

The Family Communication Coordinator (FCC) Protocol was implemented to provide early family intervention and to facilitate effective communications during potential organ donation cases. Previous studies found the Protocol associated with improved donor outcome measures and with reduced role stress for ICU nurses caring for potential donors. The present study examines the impact of the Protocol on the perceived role stress of hospital chaplains serving as FCCs. All hospital chaplains serving as FCCs at an academic teaching hospital were surveyed. Their perceptions of job dimensions, role stress, job satisfaction, and commitment were measured; interviews and secondary data supplemented the surveys. The findings demonstrate that the FCC Protocol is associated with improved role stress, specifically role ambiguity and role conflict, among hospital chaplains serving as FCCs. Additionally, the findings suggest that satisfaction with the Protocol may be associated with experience with the Protocol.