Provision of chaplaincy services in U.S. hospitals: A strategic conformity perspective.

BACKGROUND: Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available. PURPOSE: The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services. METHODOLOGY: Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level. RESULTS: Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services. CONCLUSION: The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services. PRACTICE IMPLICATIONS: Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.

Improving Professional Spiritual Care to Persons With Limited English Proficiency: The Cross-Language Chaplaincy Introduction Guidebook.

Hospitalized individuals in the United States with limited English proficiency (LEP) may experience complications when receiving hospital care. Grounded in the ethical principles of chaplaincy and motivated by the desire to address inequitable health service provision, we developed the Cross-Language Chaplaincy Introduction Guidebook. The Guidebook introduces chaplaincy in 20 different languages with the goal of improving chaplain accessibility. We report on the rigorous development of the Guidebook and how to integrate the resource clinically.

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.

A social network analysis of interorganisational collaboration: Efforts to improve social connectedness.

The Covid-19 pandemic has challenged public health practitioners and clinicians at multiple levels to intentionally consider the impact of social isolation on health outcomes. Many community-based programmes design interventions to address tangible challenges within the social determinants of health, such as asset insecurity or food insecurity, to address health inequities. The growing need to address social isolation within marginalised communities also requires organisations to collaborate and create community partnerships that strengthen their own social integration within the community. The present research reports on the results of a Social Network Analysis (SNA) of community programmes within three southern U.S. cities and their local collaborations to address social isolation. After interviewing representatives of 46 community organisations, it was found that social service organisations that also offer public health services play a central role in community efforts to improve social isolation. The participating organisations primarily collaborate through referrals and information sharing, and report inadequate resources. With a growing recognition that social services and supports play a considerable role in addressing health inequities, this study provides evidence of opportunities for interorganisational collaboration to promote individual and community health.

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.

Community-Based Asset Security: A Scoping Review.

OBJECTIVES: To explore how and what programs or projects address asset security at the community level as a social determinant of health. DATA SOURCES: To conduct a scoping review following Preferred Reporting Items for Systemic Reviews and Meta-analyses guidelines, the databases searched included CINAHL, EconLit, Embase, Pubmed/Medline, and the Sociological Collection of EBSCOhost. REVIEW METHODS: Keywords used for article identification were ("asset" AND "community") OR ("asset security" AND "community"). Studies were included if published between 1990 and 2019, written in English, and published in a peer-review journal. Reference lists of selected articles were also reviewed for additional articles. Two authors reviewed titles and abstracts separately, then reviewed full-texts for sample selection. RESULTS: After identifying 2,585 articles, researchers refined the final sample to 28 articles. Programs or projects within the sample focused on direct financial interventions or indirect interventions. Direct interventions included financial programs, such as Individual Development Accounts, or ownership opportunities, such as cooperatives or microenterprises. Indirect interventions included those focused on the built environment, such as asset mapping to identify a community's resources, or focused on education, such as those for social workers. CONCLUSIONS: Financial programs, ownership opportunities, assessments of the built environment, and targeted education complement one another to influence a community's assets from many angles. Income inequality has evolved from repeated institutionalized practices that inadvertently reinforce that inequality. Published literature emphasizes the local nature of needs and challenges, culturally responsive efforts, and that observing an impact often requires longitudinal efforts.

Board certification of professional chaplains: a qualitative study of stakeholder perspectives.

Many professional chaplaincy organizations in the United States have board certified healthcare chaplains since the 1920s and documented how they have adapted their process as the profession has grown. In 2019, the Association of Professional Chaplains and the National Association of Catholic Chaplains sought the perspectives of key stakeholders about professional chaplaincy board certification. This study reports the results from 50 semi-structured interviews with certification candidates, certification committee members, and chaplaincy managers in the United States. Participants discussed the preparation of the certification application, the certification interview, the ease and difficulty of certification competencies, and the evolving workforce. This study demonstrated divergent views on many aspects of board certification, but participants predominately respected and valued the process. Chaplains with varying levels of experience discussed how board certification strengthens multidisciplinary respect and collaboration. Participants reported difficulties with competencies that required translating between theory and practice.

The Influence of Patient and Provider Religious and Spiritual Beliefs on Treatment Decision Making in the Cancer Care Context.

BACKGROUND: Providers often underestimate the influence of patient religious and spiritual (R&S) needs. The current study sought to determine the influence of R&S beliefs on treatment decision making among patients and providers in the context of cancer care. METHODS: We conducted a systematic review of the literature using web-based search engines and discipline-specific databases. Search terms included a combination of the following Medical Subject Headings and key terms: "cancer,""spirituality,""religion," and "decision making." We used Covidence to screen relevant studies and extracted data into Microsoft Excel. RESULTS: Among 311 screened studies, 32 met inclusion/exclusion criteria. Most studies evaluated the patient perspective (n = 29), while 2 studies evaluated the provider perspective and 1 study examined both. In assessing patient R&S relative to treatment decision making, we thematically characterized articles according to decision-making contexts, including general (n = 11), end-of-life/advance care planning (n = 13), and other: specific (n = 8). Specific contexts included, but were not limited to, clinical trial participation (n = 2) and use of complementary and alternative medicine (n = 4). Within end-of-life/advance care planning, there was a discrepancy regarding how R&S influenced treatment decision making. The influence of R&S on general treatment decision making was both active and passive, with some patients wanting more direct integration of their R&S beliefs in treatment decision making. In contrast, other patients were less aware of indirect R&S influences. Patient perception of the impact of R&S on treatment decision making varied relative to race/ethnicity, being more pronounced among Black patients. CONCLUSION: Most articles focused on R&S relative to treatment decision making at the end of life, even though R&S appeared important across the care continuum. To improve patient-centered cancer care, providers need to be more aware of the impact of R&S on treatment decision making.

Prevalence of unmasked and improperly masked behavior in indoor public areas during the COVID-19 pandemic: Analysis of a stratified random sample from Louisville, Kentucky.

Wearing a facial mask can limit COVID-19 transmission. Measurements of communities' mask use behavior have mostly relied on self-report. This study's objective was to devise a method to measure the prevalence of improper mask use and no mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14-20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The total number of visited public areas was 382 where mask use behavior of 2,080 visitors and 1,510 staff were observed. The average prevalence of mask use among observed visitors was 96%, while the average prevalence of proper use was 86%. In 48% of the public areas, at least one improperly masked visitor was observed and in 17% at least one unmasked visitor was observed. The average prevalence of proper mask use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and improperly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, specifically in food and grocery stores as compared to other retail stores. Also, the majority of the observed unmasked persons were male and middle-aged.

Weather and COVID-19 Deaths During the Stay-at-Home Order in the United States.

OBJECTIVE: To estimate the association between weather and COVID-19 fatality rates during US stay-at-home orders. METHODS: With a county-level longitudinal design, this study analyzed COVID-19 deaths from public health departments' daily reports and considered exposure as the 18 to 22 day-period before death. Models included state-level social distancing measures, Census Bureau demographics, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2.5 concentrations, and U.V. light index. RESULTS: A 1 °F increase in the minimum temperature was associated with 1.9% (95% CI, 0.2% to 3.6%) increase in deaths 20 days later. An ozone concentration increase of 1 ppb (part per billion) decreased daily deaths by 2.0% (95% CI, 0.1% to 3.6%); ozone levels below 38 ppb negatively correlated with deaths. CONCLUSIONS: Increased mobility may drive the observed association of minimum daily temperature on COVID-19 deaths.

Mapping the healthcare chaplaincy workforce: a baseline description.

Changing U.S. demographics and the growing emphasis on diversity in the healthcare workforce requires professional healthcare chaplains to examine the characteristics of its own workforce. Previous research suggested that chaplains were mainly Caucasian/White and Mainline Protestant. To explore further, this paper presents a baseline sketch of the workforce and identifies important differences among board-certified chaplains (BCCs), certified educators, certified educator candidates (CECs), and clinical pastoral education (CPE) students. Although missing data quickly became the central story of the analysis and thus requires caution in comparison, the preliminary results suggest BCCs and Certified Educators are older and Whiter/more Caucasian than CECs and CPE students. At least one-third of chaplains and Certified Educators identify as Mainline Protestant, but students and CECs reported greater variation in religious affiliation. Chaplains may be similar to users of healthcare and hospitalized persons in terms of gender and race/ethnicity. Recommendations include suggestions for improving the data infrastructure of professional chaplaincy organizations.

Distress and self-care among chaplains working in palliative care.

BACKGROUND: The prevalence of burnout and distress among palliative care professionals has received much attention since research suggests it negatively impacts the quality of care. Although limited, research suggests low levels of burnout or distress among healthcare chaplains; however, there has been no research among chaplains working in specific clinical contexts, including palliative care. OBJECTIVE: This study explored the distress, self-care, and debriefing practices of chaplains working in palliative care. METHOD: Exploratory, cross-sectional survey of professional chaplains. Electronic surveys were sent to members of four professional chaplaincy organizations between February and April 2015. Primary measures of interest included Professional Distress, Distress from Theodicy, Informal Self-care, Formal Self-care, and debriefing practices. RESULT: More than 60% of chaplains working in palliative care reported feeling worn out in the past 3 months because of their work as a helper; at least 33% practice Informal Self-care weekly. Bivariate analysis suggested significant associations between Informal Self-care and both Professional Distress and Distress from Theodicy. Multivariate analysis also identified that distress decreased as Informal and Formal Self-care increased. SIGNIFICANCE OF RESULTS: Chaplains working in palliative care appear moderately distressed, possibly more so than chaplains working in other clinical areas. These chaplains also use debriefing, with non-chaplain palliative colleagues, to process clinical experiences. Further research is needed about the role of religious or spiritual beliefs and practices in protecting against stress associated with care for people at the end of life.