Chaplain Visits Research Articles

End of life care in a level IV outborn neonatal intensive care unit.

Describe care surrounding the end of life (EOL) in the neonatal intensive care unit (NICU). Retrospective chart review of 208 infants who died in a level IV referral-only NICU over 5 years. A goals of care (GOC) conversation was documented before the day of death for 63% of infants. 73% died following withdrawal of life-sustaining treatment (WD); 13% died in a code. The median age at death was 17.5 days. 72% were held by a parent at EOL. 94% of families desired formal memory-making. We identified associations with mode of death and parental holding at death, including: WD was associated with palliative care consultation, early GOC conversations, and increased unit-specific length of stay. Holding was associated with chaplain visits, memory-making, and increased home-to-hospital distance. We present a detailed description of EOL care in an outborn NICU, including novel data on parental holding and memory-making.

Relationships Between the Number of Chaplain Visits and Patient Characteristics: A Retrospective Review of aLarge Suburban Midwest Hospital, USA.

It is critical to understand the characteristics of patients who receive spiritual care through chaplain visits. This study evaluated 2373 records from chaplain visits provided to 1315 patients over a three-month period (March-May 2021) at a large suburban teaching hospital, Midwest, USA.Approximately 70% of patients received one chaplain visit. However, data revealed that when patients were admitted emergently, or received visits for reasons related to self-harm or suicidality, the frequency of chaplain visits significantly increased. This study suggests a need for spiritual care services for patients with emergency or mental health conditions. Furthermore, it highlights the need for further training and resources for chaplains to increase clinical competencies in providing specialized spiritual care support to specific patient populations.

Spiritual Care Assessment and Intervention (SCAI) for Adult Outpatients With Advanced Cancer and Caregivers: A Pilot Trial to Assess Feasibility, Acceptability, and Preliminary Effects.

Although religion and spirituality are important to adults with cancer and their family caregivers, few studies have tested spiritual care interventions in the outpatient setting. To determine the feasibility, acceptability, and preliminary effects of chaplain-delivered, semi-structured spiritual care to adult outpatients with advanced cancer and their caregivers. In this pre/post pilot intervention study, board-certified chaplains utilized the Spiritual Care Assessment and Intervention (SCAI) framework during 4 individual sessions. Surveys at baseline and at 1, 6, and 12 weeks post-intervention assessed spiritual well-being, quality of life, depression, anxiety, and religious coping. We enrolled U.S. adult outpatients with or without an eligible family caregiver. Eligible patients were at least 18 years old and at least 2 weeks post-diagnosis of incurable and advanced-stage lung or gastrointestinal (GI) cancer. Of 82 eligible patients, 24 enrolled (29.3%); of 22 eligible caregivers, 18 enrolled (81.8%). Four planned chaplain visits were completed by 87.5% of patients and 77.8% of caregivers. All enrolled participants completed baseline surveys, and more than 75% completed follow-up surveys at 2 of 3 time points. More than 80% of patients and caregivers reported they would recommend the sessions to a friend or family member. Patients' spiritual well-being improved significantly at all timepoints compared to baseline: 1-week post (p < .006), 6-weeks post (p < .001), and 12-weeks post (p < .004). Spiritual care through SCAI is feasible, acceptable, and shows promise in improving spiritual well-being and other important outcomes in advanced-stage cancer patients and family caregivers. Further investigation is warranted.

Patients’ and Loved Ones’ Expectations of Chaplain Services

A study assessing the expectations patients and loved ones have of hospital chaplains was conducted at Ascension St. Vincent Indiana hospitals. In-person interviews were conducted with 452 patients and loved ones during an inpatient stay. The survey instrument was a modified version of a survey developed by Dr. Katherine Piderman of the Mayo Clinic. Participants answered questions regarding demographics, awareness of availability, expectations of visits, reasons for wanting to see a chaplain and gave feedback regarding visits if they had seen a chaplain. Results showed that patients and loved ones value chaplains with 93% saying they wanted a chaplain visit. This study was unique in seeking feedback from loved ones as well as patients. It may be equally important to reach out to loved ones during times of crisis when patients themselves are in surgery or sedated and loved ones are experiencing heightened anxiety.

Spiritual care in the intensive care unit.

The aim of the present paper is to describe the real possibilities of providing spiritual care in intensive care units (ICUs) in Poland. Faced with suffering and death, critically ill patients and their families need asource of comfort and hope. Spiritual care is intended to bring relief to them by responding to their spiritual needs. The literature review indicates the positive effects of providing spiritual care in ICUs. Spiritual care improves the quality of life of patients, satisfaction with medical care and even prevents or alleviates the negative psychological consequences of hospitalization. Moreover, it is beneficial to the ICU personnel, to their motivation, work efficiency, well-being and reduces the risk of burnout. Basic spiritual care that can be provided by any ICU physician on adaily basis is nothing more than the way of behaving towards apatient: seeing an individual who has his/her dignity, history, personality, beliefs, fears and hopes. Whenever disease-associated stress has led to an existential crisis, the ICU staff may request ahospital chaplain's visit. The physician can support the conscious patient by establishing arelationship with him: by showing concern, compassion and solicituide. According to some researchers, each patient admitted to the ICU should be asked questions about spiritual issues. If faith is important to the patient, it is necessary to allow him/her to use religious resources, which requires cooperation with ahospital chaplain. The paper discusses the ways the hospital chaplaincy operates in Poland and worldwide. Furthermore, the education of chaplains abroad and the scope of their tasks and activities are described.

An Analysis of Chaplains' Narrative Chart Notes Describing Spiritual Care Visits with Gender Affirmation Surgical Patients.

The benefit of spiritual care for patients is well described, but little is known about the role of spiritual care in transgender and nonbinary patients recovering from gender affirming surgeries (GASs). A single-center retrospective chart review was performed on patients who underwent GAS in 2017. Demographic information, surgery type, and chaplains' narrative notes were examined. A total of 145 chaplain visits were identified in 103 inpatient stays among 98 patients at the Mount Sinai Center for Transgender Medicine and Surgery in New York. Analysis was performed on narrative notes authored by a single chaplain, which included 132 visits among 78 transfeminine and 11 transmasculine patients. Fifty-four patients (61%) expressed gratitude for the chaplain visit and/or hospital experience overall. Seven patients (8%) described movement between religious denominations over the course of their lives, and 7 (8%) described supportive belief systems. Fifty-seven patients (64%) had a family member or friend present during the perioperative process, 13 (15%) described support systems, and 9 (10%) described supportive practices, activities, and/or coping methods. Twenty-one patients (24%) expressed concerns about current symptoms or the recovery process, and 32 (36%) received a prayer or blessing from the chaplain. Fifty-two patients (58%) consented to a follow-up call. Almost 50% of patients expressed gratitude for the chaplain's visit and more than half consented to a follow-up call from the chaplain, suggesting a chaplain can provide a welcome layer of support to postoperative GAS patients. The authors recommend integrating spiritual care into perioperative care.

Evidence-Based Review and Discussion Points.

Evidence-Based Review and Discussion Points.

A Team-Based Early Action Protocol to Address Ethical Concerns in the Intensive Care Unit.

Ethical conflicts complicate clinical practice and often compromise communication and teamwork among patients, families, and clinicians. As ethical conflicts escalate, patient and family distress and dissatisfaction with care increase and trust in clinicians erodes, reducing care quality and patient safety. To investigate the effectiveness of a proactive, team-based ethics protocol used routinely to discuss ethics-related concerns, goals of care, and additional supports for patients and families. In a pre-post intervention study in 6 intensive care units (ICUs) at 3 academic medical centers, the electronic medical records of 1649 patients representing 1712 ICU admissions were studied. Number and timing of family conferences, code discussions with the patient or surrogate, and ethics consultations; palliative care, social work, and chaplain referrals; and ICU length of stay were measured. Preintervention outcomes were compared with outcomes 3 and 6 months after the intervention via multivariate logistic regression controlled for patient variables. The odds of receiving a family conference and a chaplain visit were significantly higher after the intervention than at baseline. The number of palliative care consultations and code discussions increased slightly at 3 and 6 months. Social work consultations increased only at 6 months. Ethics consultations increased at both postintervention time points. Length of ICU stay did not change. When health care teams were encouraged to communicate routinely about goals of care, more patients received needed support and communication barriers were reduced.

The Priority List: An Evidence-Based Approach to Selecting Patients for Chaplain Visits.

This paper examines three methods chaplains have historically used to identify patients they should see: rounding, referral, and protocol-based systems. Mercy Health is in the initial stages of adopting an expanded protocol-based system known as "the priority list." Central to the idea is the proposal and testing of clinical indicators that patients would benefit from chaplain support. Practical steps are offered for other pastoral departments in the development, implementation, and interpretation of their own lists.

Using the Taxonomy: A Standard Vocabulary of Chaplain Activities

At present, the field of chaplaincy does not have a standardized vocabulary for the activities that chaplains conduct in different institutions and settings. This is a hindrance when making comparisons among various chaplain activities across institutions and drawing conclusions from the data reported. Recently a standardized vocabulary, the Advocate Taxonomy, was developed by a group of chaplains and there was consensus agreement that the taxonomy represented the gamut of chaplain activities. However, to date, no data with adults has been presented to support the conclusions reached by the taxonomy development team. This article is the first effort to examine which taxonomy items are most commonly used in the acute care setting. It further explores the differences in the use of the taxonomy items in different settings (ICU vs. Non-ICU), the type of chaplain visit (Initial vs. Follow-up) and the patient’s discharge status (Expired vs. discharged alive).

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.

Does Quality of End-of-Life Care Differ by Urban-Rural Location? A Comparison of Processes and Family Evaluations of Care in the VA.

Several studies have identified differences in end-of-life (EOL) care between urban and rural areas, yet little is known about potential differences in care processes or family evaluations of care. The purpose of this study was to examine the relationship between rurality of residence and quality of EOL care within the Veterans Affairs health care system. This study was a retrospective, cross-sectional analysis of 126,475 veterans who died from October 2009 through September 2016 in inpatient settings across 151 facilities. Using unadjusted and adjusted logistic regression, we compared quality of EOL care between urban and rural veterans using family evaluations of care and 4 quality of care indicators for receipt of (1) palliative care consult, (2) a chaplain visit, (3) death in an inpatient hospice unit, and (4) bereavement support. Veterans from rural areas had lower odds of dying in an inpatient hospice unit compared to veterans from urban areas, before and after adjustment (large rural OR 0.73, 95% CI: 0.70-0.77; P < .001, small rural OR 0.81, 95% CI: 0.77-0.86; P < .001, isolated rural OR 0.87, 95% CI: 0.81-0.93; P < .001). Differences in comparisons of other quality of care indicators were small and of mixed significance. No significant differences were found in family ratings of care in fully adjusted models. Receipt of some EOL quality indicators differed with urban-rural residence for some comparisons. However, family ratings of care did not. Our findings call for further investigation into unmeasured individual characteristics and facility processes related to rurality.

Hospital Chaplains: Through the Eyes of Parents of Hospitalized Children.

Chaplain services are available in 68% of hospitals, but hospital chaplains are not yet incorporated into routine patient care. To describe how families of hospitalized children view and utilize hospital chaplains. Telephone survey with 40 questions: Likert, yes/no, and short-answer responses. Parents visited by a hospital chaplain during their child's hospitalization in a tertiary care center. Descriptive statistics were used to characterize the sample. Nonparametrics were used to compare religious versus nonreligious parents. Regression was used to identify independent predictors of a chaplain visit positively influencing satisfaction with hospital care. Seventy-four parents were interviewed; most were 25-50 years old, and 75% felt their child was very sick. Children ranged from newborn to adolescence. Forty-two percent of parents requested a chaplain visit; of the 58% with an unsolicited visit, 11% would have preferred giving prior approval. Parents felt that chaplains provided religious and secular services, including family support and comfort, help with decision making, medical terminology, and advocacy. Chaplains helped most parents maintain hope and reduce stress. Seventy-five percent of parents viewed chaplains as a member of the healthcare team; 38% reported that chaplains helped medical personnel understand their preferences for care and communication. Most parents (66%) felt that hospital chaplaincy increased their satisfaction with hospital care. Families play a fundamental role in the recovery of hospitalized children. Parents view hospital chaplains as members of the healthcare team and report that they play an important role in the well-being of the family during childhood hospitalization. Chaplains positively influence satisfaction with hospital care.

Comparison of palliative care for lung cancer patients (pts) at two Veteran Affairs Medical Centers.

e21621 Background: Palliative and end of life care is essential for lung cancer pts. We examined palliative care delivery for lung cancer pts at 2 VA medical centers. Methods: In an IRB approved protocol, we reviewed medical records of matched pts diagnosed with liver or lung cancer between 2006 and 2012 who were seen by palliative care at 2 VA medical centers (S1, S2). Veterans were compared by 1) demographics, 2) palliative interventions, and 3) outcomes: ED visit within 1 month (mo) of death, ED visit within 6 mo of death, and ICU within 30 days of death. Analyses were performed with SAS Studio Version 3.5. Results: We analyzed 69 male pts (29 at S1and 40 at S2), with a mean age of 63 and 66 years respectively. Thirty (43%) pts were Caucasian and 39 (56.5%) African American. Cancer stages were I (1%), Stage II (3%), Stage III0 (29%), Stage IV (58%), and unknown (8%). Median Karnofsky performance status was 60%. By site, differences were seen in DNR/DNI (S1, S2) [ 21 (72%), 12 (30%) p = 0.0007). For palliative care interventions, significant differences were seen in treatments for pain (S1, S2) [17 (59%), 37 (93%) p = 0.0011], constipation (S1, S2) [10 (34%), 35 (88%) p &lt; 0.0001], and dyspnea (S1, S2) [8 (28%), 29 (73%) p = 0.0003], but not for holding goals of care discussions. We observed differences between sites in evaluations by palliative social work (S1, S2) [15 (51%), 39 (98%) p &lt; 0.0001], mental health (S1, S2) [21 (88%), 10 (25%) p &lt; 0.0001], and chaplain visits (S1, S2) [ 19 (66%), 36 (90%) p = 0.0167]. Finally with outcome, there was a difference between consultations by other medical specialties (S1, S2) [ 19 (66%), 39 (98), p = 0.0005] but not for ED visits, admissions, procedures or ICU stays at the end of life . Conclusions: There are site specific differences between VA medical centers and may reflect local practice patterns, Additional sites should be studied.

Race/Ethnicity and End-of-Life Care Among Veterans.

Few studies have examined comprehensively racial/ethnic variations in quality of end-of-life care. Examine end-of-life care quality received by Veterans and their families, comparing racial/ethnic minorities to nonminorities. This is a retrospective, cross-sectional analysis of chart review and survey data. Nearly all deaths in 145 Veterans Affairs Medical Centers nationally (n=94,697) in addition to Bereaved Family Survey (BFS) data (n=51,859) from October 2009 to September 2014. Outcomes included 15 BFS items and 4 indicators of high-quality end-of-life care, including receipt of a palliative care consult, chaplain visit, bereavement contact, and death in hospice/palliative care unit. Veteran race/ethnicity was measured via chart review and defined as non-Hispanic white, non-Hispanic black, Hispanic, or other. In adjusted models, no differences were observed by race/ethnicity in receipt of a palliative care consult or death in a hospice unit. Although black Veterans were less likely than white Veterans to receive a chaplain visit, Hispanic Veterans were more likely than white Veterans to receive a chaplain visit and to receive a bereavement contact. Less favorable outcomes for racial/ethnic minorities were noted on several BFS items. In comparison with family members of white Veterans, families of minority Veterans were less likely to report excellent overall care, and this difference was largest for black Veterans (48% vs. 62%). Bereaved family members of minority Veterans generally rate the quality of end-of-life care less favorably than those of white Veterans. Family perceptions are critical to the evaluation of equity and quality of end-of-life care.

Operationalizing the Measuring What Matters Spirituality Quality Metric in a Population of Hospitalized, Critically Ill Patients and Their Family Members

ContextMeasuring What Matters (MWM) quality indicators support measurement of the percentage of patients who have spiritual discussions, if desired. ObjectivesThe objective of this study was to 1) determine the ease of, and barriers to, prospectively collecting MWM spirituality quality measure data and 2) further explore the importance of spirituality in a seriously ill, hospitalized population of critically ill patients and their family members. MethodsElectronic medical record (EMR) review and cross-sectional survey of intensive care unit (ICU) patients and their family members from October to December 2015. Participants were in four adult ICUs totaling 68 beds at a single academic, urban, tertiary care center which has ICU-assigned chaplains and an in-house, 24-hour, on-call chaplain. ResultsAll patients had a “Spiritual Risk Screen” which included two questions identifying patient religion and whether a chaplain visit was desired. Approximately 2/3 of ICU patients were eligible, and there were 144 respondents (50% female; 57% patient and 43% family member), with the majority being Caucasian or African American (68% and 21%, respectively). Common religious identifications were Christian or no faith tradition (76% and 11%, respectively). Approximately half of patients had an EMR chaplain note although it did not document presence of a “spiritual discussion.” No study patients received palliative care consultation. A majority (85%) noted that spirituality was “important to them” and that prevalence remained high across respondent age, race, faith tradition, or admitting ICU. ConclusionOperationalizing the MWM spirituality quality indicator was challenging as elements of a “spiritual screening” or documentation of a “spiritual discussion” were not clearly documented in the EMR. The high prevalence of spirituality among respondents validates the importance of spirituality as a potential quality metric.

A Novel Picture Guide to Improve Spiritual Care and Reduce Anxiety in Mechanically Ventilated Adults in the Intensive Care Unit.

Hospital chaplains provide spiritual care that helps patients facing serious illness cope with their symptoms and prognosis, yet because mechanically ventilated patients cannot speak, spiritual care of these patients has been limited. To determine the feasibility and measure the effects of chaplain-led picture-guided spiritual care for mechanically ventilated adults in the intensive care unit (ICU). We conducted a quasi-experimental study at a tertiary care hospital between March 2014 and July 2015. Fifty mechanically ventilated adults in medical or surgical ICUs without delirium or dementia received spiritual care by a hospital chaplain using an illustrated communication card to assess their spiritual affiliations, emotions, and needs and were followed until hospital discharge. Feasibility was assessed as the proportion of participants able to identify spiritual affiliations, emotions, and needs using the card. Among the first 25 participants, we performed semistructured interviews with 8 ICU survivors to identify how spiritual care helped them. For the subsequent 25 participants, we measured anxiety (on 100-mm visual analog scales [VAS]) immediately before and after the first chaplain visit, and we performed semistructured interviews with 18 ICU survivors with added measurements of pain and stress (on ±100-mm VAS). The mean (SD) age was 59 (±16) years, median mechanical ventilation days was 19.5 (interquartile range, 7-29 d), and 15 (30%) died in-hospital. Using the card, 50 (100%) identified a spiritual affiliation, 47 (94%) identified one or more emotions, 45 (90%) rated their spiritual pain, and 36 (72%) selected a chaplain intervention. Anxiety after the first visit decreased 31% (mean score change, -20; 95% confidence interval, -33 to -7). Among 28 ICU survivors, 26 (93%) remembered the intervention and underwent semistructured interviews, of whom 81% felt more capable of dealing with their hospitalization and 0% felt worse. The 18 ICU survivors who underwent additional VAS testing during semistructured follow-up interviews reported a 49-point reduction in stress (95% confidence interval, -72 to -24) and no significant change in physical pain that they attributed to picture-guided spiritual care. Chaplain-led picture-guided spiritual care is feasible among mechanically ventilated adults and shows potential for reducing anxiety during and stress after an ICU admission.

“The Patient Is Dying, Please Call the Chaplain”: The Activities of Chaplains in One Medical Center's Intensive Care Units

ContextPatients and families commonly experience spiritual stress during an intensive care unit (ICU) admission. Although most patients report that they want spiritual support, little is known about how these issues are addressed by hospital chaplains. ObjectivesTo describe the prevalence, timing, and nature of hospital chaplain encounters in ICUs. MethodsThis was a retrospective cross-sectional study of adult ICUs at an academic medical center. Measures included days from ICU admission to initial chaplain visit, days from chaplain visit to ICU death or discharge, hospital and ICU lengths of stay, severity of illness at ICU admission and chaplain visit, and chart documentation of chaplain communication with the ICU team. ResultsOf a total of 4169 ICU admissions over six months, 248 (5.9%) patients were seen by chaplains. Of the 246 patients who died in an ICU, 197 (80%) were seen by a chaplain. There was a median of two days from ICU admission to chaplain encounter and a median of one day from chaplain encounter to ICU discharge or death. Chaplains communicated with nurses after 141 encounters (56.9%) but with physicians after only 14 encounters (5.6%); there was no documented communication in 55 encounters (22%). ConclusionIn the ICUs at this tertiary medical center, chaplain visits are uncommon and generally occur just before death among ICU patients. Communication between chaplains and physicians is rare. Chaplaincy service is primarily reserved for dying patients and their family members rather than providing proactive spiritual support. These observations highlight the need to better understand challenges and barriers to optimal chaplain involvement in ICU patient care.

Relationship Between Chaplain Visits and Patient Satisfaction

This prospective study investigated the relationship between chaplain visits and patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey surveys from 8,978 patients who had been discharged from a tertiary care hospital. Controlling for patients' age, gender, race, ethnicity, language, education, faith, general health status, and medical conditions, chaplain visits increased the willingness of patients to recommend the hospital, as measured by both the HCAHPS survey (regression coefficient = 0.07, p < .05) and the Press Ganey survey (0.11, p < .01). On the Press Ganey survey, patients visited by chaplains were also more likely to endorse that staff met their spiritual needs (0.27, p < .001) and their emotional needs (0.10, p < .05). In terms of overall patient satisfaction, patients visited by a chaplain were more satisfied on both the Press Ganey survey (0.11, p < .01) and on the HCAHPS survey (0.17, p < .05). Chaplains' integration into the healthcare team improves patients' satisfaction with their hospital stay.

Family Involvement at the End-of-Life and Receipt of Quality Care

ContextMost patients will lose decision-making capacity at the end of life. Little is known about the quality of care received by patients who have family involved in their care. ObjectivesTo evaluate differences in the receipt of quality end-of-life care for patients who died with and without family involvement. MethodsWe retrospectively reviewed the charts of 34,290 decedents from 146 acute and long-term care Veterans Affairs facilities between 2010 and 2011. Outcomes included: 1) palliative care consult, 2) chaplain visit, and 3) death in an inpatient hospice or palliative care unit. We also assessed “do not resuscitate” (DNR) orders. Family involvement was defined as documented discussions with the health care team in the last month of life. We used logistic regression adjusted for demographics, comorbidity, and clustered by facility. For chaplain visit, hospice or palliative care unit death, and DNR, we additionally adjusted for palliative care consults. ResultsMean (SD) age was 74 (±12) years, 98% were men, and 19% were nonwhite. Most decedents (94.2%) had involved family. Veterans with involved family were more likely to have had a palliative care consult, adjusted odds ratio (AOR) 4.31 (95% CI 3.90–4.76); a chaplain visit, AOR 1.18 (95% CI 1.07–1.31); and a DNR order, AOR 4.59 (95% CI 4.08–5.16) but not more likely to die in a hospice or palliative care unit. ConclusionFamily involvement at the end of life is associated with receipt of palliative care consultation and a chaplain visit and a higher likelihood of a DNR order. Clinicians should support early advance care planning for vulnerable patients who may lack family or friends.