Chaplaincy Services Research Articles

“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.

Contributions of the chaplaincy service to the care of terminal patients

This study aims to identify chaplains' understanding in relation to spirituality, and to analyze the chaplaincy's contribution in the care of terminal patients. It is exploratory, qualitative research undertaken with seven hospital chaplains in two public hospitals in João Pessoa in the Brazilian state of Paraíba. The data were collected through semi-structured interviews and were subjected to content analysis. The categories which emerged were: Spirituality in the view of chaplains, and Contributions of the chaplaincy in employing spirituality in the care of the terminal patient. These categories evidenced that the chaplains value the spiritual dimension in their practice, helping the patient to cope with the end-of-life process. It is hoped that this study will provide resources for further investigations, bearing in mind that studies on the chaplaincy and spirituality in the care for the terminal patient remain incipient.

Delivering Chaplaincy Services to Veterans at Increased Risk of Suicide

The present study quantitatively examines the delivery of chaplaincy services to Veterans at increased risk of suicide as well as how chaplains collaborate with other healthcare providers. An on-line survey was distributed to the nationwide network of U.S. Department of Veterans Affairs chaplains, yielding a response rate of 11.91% (N = 118). Most chaplains reported some form of training in suicide prevention, approximately half were involved in safety planning, and the majority reported not engaging in firearm safety counseling. Chaplaincy services were usually delivered through in-person, group, and phone consultations. Respondents were generally satisfied with their collaboration with other healthcare providers, most often collaborating with psychologists, social workers, and counselors. As a descriptive study, the findings serve to inform the delivery of chaplaincy services to at-risk Veterans. Recommendations include expanding service delivery options, developing competency in safety planning and counseling, as well as increasing institutional awareness of chaplaincy services.

Measures of Central Tendency in Chaplaincy, Health Care, and Related Research

The three measures of central tendency are discussed in this article: the mode, the median, and the mean. These measures of central tendency describe data in different and important ways, in relation to the level of measurement (nominal, ordinal, interval, or ratio) used to obtain the data. The results of published research studies, thought experiments, and graphs of frequency and percentage distributions of data are used as examples to demonstrate and explain the similarities and differences among these summary measures of data. The examples include the application of nominal, ordinal, interval, and ratios scales to measure pain, anxiety, chaplaincy services, religious behaviors, and treatment-related preferences, and their respective measures of central tendency. Examples of unimodal and bimodal distributions, and differences in the relative locations of the median and mean in symmetrical and skewed distributions are also presented and discussed.

The Ukrainian Canadian Chaplaincy during World War Two

This paper discusses the creation, development, and significance of the office of Ukrainian chaplaincy in the Canadian military forces during World War II. Seven Ukrainian chaplains—three from the Ukrainian Catholic Church of Canada and four from the Ukrainian Orthodox Church of Canada—served the approximately 32,000–35,000 military personnel. Of these, three chaplains served in England and two in Europe. The work of the chaplains is discussed as is the role of their superiors in Canada and abroad. The paper evaluates the significance of the Ukrainian chaplaincy in the military effort, as well as in the development of the post-WWII Ukrainian Canadian community. Cet article présente la création, le développement et l’importance du bureau de l’aumônerie ukrainienne dans les forces militaires canadiennes pendant la seconde guerre mondiale. Sept aumôniers ukrainiens – appartenant aux Églises ukrainiennes du Canada, dont trois catholiques et quatre orthodoxes – ont œuvré auprès d’environ 32,000–35,000 officiers et soldats. Parmi eux, trois ont servi en Angleterre et deux sur le continent européen. Nous étudions ici le travail de ces aumôniers, ainsi que le rôle de leurs supérieurs au Canada et outremer. Nous y évaluons aussi l’importance du rôle de l’aumônerie ukrainienne dans l’effort militaire, ainsi que dans le développement de la communauté canadienne ukrainienne d’après la seconde guerre mondiale.

A Preliminary Study for Exploring Different Sources of Guilt in a Sample of Veterans Who Sought Chaplaincy Services

Limited research has suggested that experiencing guilt may contribute to the risk of suicidal behavior in some veteran populations. Using data collected by chaplains, this study compared the frequency with which 94 veterans with a history of suicide ideation experienced guilt relative to 670 veterans without a history of ideation. We then compared main sources of guilt reported by ideators and nonideators. Ideators reported experiencing guilt significantly more often than nonideators. No differences were noted for the source of guilt among those who reported frequently experiencing this emotion. Ideators with an infrequent experience of guilt significantly more often named life and the military as the main source of this emotion. Clinicians should be mindful of the need to appropriately assess for and address guilt among veterans at increased risk of suicide. A variety of sources, not limited only to military experiences, may contribute to a veteran’s sense of guilt.

Collaborating across the Departments of Veterans Affairs and Defense to integrate mental health and chaplaincy services.

Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for veterans and service members with mental health needs. Our aim was to evaluate the intersection of chaplain and mental health care practices in VA and DoD in order to determine if improvement is needed, and if so, to develop actionable recommendations as indicated by evaluation findings. A 38-member multidisciplinary task group partnered with researchers in designing, implementing, and interpreting a mixed methods study that included: 1) a quantitative survey of VA and DoD chaplains; and 2) qualitative interviews with mental health providers and chaplains. Quantitative: the survey included all full-time VA chaplains and all active duty military chaplains (n = 2,163 completed of 3,464 invited; 62 % response rate). Qualitative: a total of 291 interviews were conducted with mental health providers and chaplains during site visits to 33 VA and DoD facilities. Quantitative: the online survey assessed intersections between chaplaincy and mental health care and took an average of 37 min to complete. Qualitative: the interviews assessed current integration of mental health and chaplain services and took an average of 1 h to complete. When included on interdisciplinary mental health care teams, chaplains feel understood and valued (82.8-100 % of chaplains indicated this, depending on the team). However, findings from the survey and site visits suggest that integration of services is often lacking and can be improved. Closely coordinating with a multidisciplinary task group in conducting a mixed method evaluation of chaplain-mental health integration in VA and DoD helped to ensure that researchers assessed relevant domains and that findings could be rapidly translated into actionable recommendations.

Spiritual care and kidney disease in NZ: a qualitative study with New Zealand renal specialists.

People with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Research suggests that attending to renal patients' spiritual needs may contribute to an improvement in their quality of life. The aim of this qualitative study was to investigate the provision of spiritual care in New Zealand renal units from the perspective of specialists. The study followed a generic qualitative approach and included semi-structured interviews with specialists recruited from New Zealand's ten renal centres. Five specialist doctors and nine specialist nurses were recruited for interviews. Understandings of spirituality were broad, with most participants having an inclusive understanding. Patients' spiritual needs were generally acknowledged and respected though formal spiritual assessments were not done. Consideration of death was discussed as an often-unexamined need. The dominant position was that the specialists did not provide explicit spiritual care of patients but there was some ad hoc provision offered through pre-dialysis educators, family meetings, Māori liaison staff members and the efforts of individuals. Chaplains were well used in some services. Participants had received no pre and little in-service training or education in spiritual care. Suggestions for improvements included in-service training, better utilization of chaplaincy services and training in advance care planning. Most participants indicated they would attempt to provide some form of spiritual care, either directly or by referring the patient to appropriate services. However, participants generally demonstrated a lack of confidence in addressing a patient's spiritual needs.

Understanding the Role of Chaplains in Veteran Suicide Prevention Efforts

In recent years, identifying ways to mitigate the risk of suicidal behavior in Veteran populations has become a major public health challenge of special significance. This has included identifying support options that can be used by Veterans in times of distress or crisis. For example, Veterans at increased risk of suicide will sometimes voice complaints indicative of a need for spiritual and pastoral care support. At U.S. Department of Veterans Affairs Medical Centers, such support is provided to Veterans by clinical chaplains. This discussion paper aims to present the contextual framework in which chaplaincy services are provided to Veterans at increased risk of suicide, better conceptualize the spiritual and pastoral care needs of at-risk Veterans who request chaplaincy services, and offer practical suggestions for framing the provision of spiritual and pastoral care services.

Characteristics and Outcomes of Ethics Consultations in an Oncologic Intensive Care Unit.

To evaluate the frequency, characteristics, and outcomes of ethics consultations in critically ill patients with cancer. This is a retrospective analysis of all adult patients with cancer who were admitted to the intensive care unit (ICU) of a comprehensive cancer center and had an ethics consultation between September 2007 and December 2011. Demographic and clinical variables were abstracted along with the details and contexts of the ethics consultations. Ethics consultations were obtained on 53 patients (representing 1% of all ICU admissions). The majority (90%) of patients had advanced-stage malignancies, had received oncologic therapies within the past 12 months, and required mechanical ventilation and/or vasopressor therapy for respiratory failure and/or severe sepsis. Two-thirds of the patients lacked decision-making capacity and nearly all had surrogates. The most common reasons for ethics consultations were disagreements between the patients/surrogates and the ICU team regarding end-of-life care. After ethics consultations, the surrogates agreed with the recommendations made by the ICU team on the goals of care in 85% of patients. Moreover, ethics consultations facilitated the provision of palliative medicine and chaplaincy services to several patients who did not have these services offered to them prior to the ethics consultations. Our study showed that ethics consultations were helpful in resolving seemingly irreconcilable differences between the ICU team and the patients' surrogates in the majority of cases. Additionally, these consultations identified the need for an increased provision of palliative care and chaplaincy visits for patients and their surrogates at the end of life.

‘Chaplains for well-being’ in primary care: analysis of the results of a retrospective study

To analyse quantitative changes in patient well-being concurrent with chaplaincy interventions in a retrospective study of a group of Primary Care centres in Sandwell and West Birmingham, United Kingdom. Anecdotal evidence suggests that support from trained Primary Care Chaplains may be particularly useful for those with subclinical mental health issues; it can reduce the tendency to 'medicalise unhappiness' and is a positive response to patients with medically unexplained symptoms. However, to date there has been no published research attempting to quantify their contribution. Data were gathered from a group of Primary Care Centres, which make use of a shared Chaplaincy service. Demographic data and pre-post scores on the Warwick and Edinburgh Mental Wellbeing Scale (WEMWBS) were collected for patients who had attended consultations with a Chaplain. These were subjected to tests of statistical significance to evaluate the possible contribution of chaplaincy to patient well-being along with possible confounding variables. a substantial improvement in WEMWBS scores (mean=9 points, BCa 95% CI [7.23, 10.79], P=0.001) post-intervention. The improvement in scores was highest for those with initially lower levels of well-being. There is therefore evidence that chaplaincy interventions correlate with an improvement of holistic well-being as measured by a WEMWBS score. A prospective study on a larger scale would provide more detailed information on the interaction of possible variables. Further study is also required to evaluate the implications of this result for patient outcomes and GP resources. The efficacy of Primary Care Chaplaincy is under-researched and difficult to measure. This paper represents the first attempt to quantify a measurable improvement in the well-being of patients who are referred to the service.

High Burden of Palliative Needs among Older Intensive Care Unit Survivors Transferred to Post–Acute Care Facilities. A Single-Center Study

Adults with chronic critical illness (tracheostomy after ≥ 10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-acute care facilities. To determine whether older ICU survivors discharged to post-acute care facilities have potentially unmet palliative care needs. We examined electronic records from a 1-year cohort of 228 consecutive adults ≥ 65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality. The median age was 78 years (interquartile range, 71-84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated "comfort care." The 6-month mortality was 40%. Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.

Managing Chaplaincy Service Delivery

Audit, accountability and clinical performance all form what is now understood in the National Health Service (NHS) as Clinical Governance (CG) and it has profound implications for all who work in the NHS including Chaplains. CG is something they will need to comprehend and implement. This paper seeks to describe the service the Chaplaincy provides, our customers are identified, as are the difficulties of assessing whether or not we can/are delivering a quality service. I consider what criteria/performance indicators I would be looking for from an economical, efficient and effective Chaplaincy department. Then as a “customer facing organisation”, I explain some of the difficulties of finding out what our customers think of our service/role and cite examples of surveys from other Trusts.

Spiritual Care in NHSScotland

While welcoming some of the provisions of ‘Spiritual Care in NHSScotland’ he author regards part time chaplains as being ‘conspicuously absent’ from the guidelines, despite the implication that their numbers might increase if more faith communities decide to appoint. Concern is expressed that the lack of attention to the development of part time chaplaincy might seriously undermine what has hitherto been considered to be an important aspect of the chaplaincy service.

Standards and Competencies for Spiritual Care and Chaplaincy in Palliative Care

Spiritual care and chaplaincy have come under considerable focus in recent years in Scotland and especially so within the field of Specialist Palliative Care. A combination of National Guidelines, Clinical Standards, Professional Standards, and a Competency Framework have come together to engender considerable discussion and an impetus for developing a framework for spiritual care, religious care and chaplaincy services and practice. The author reflects on the development of the standards and competencies, their format and integration and considers their impact on chaplaincy & spiritual care services in palliative care in Scotland.

THE INTRODUCTION AND EVALUATION OF A SPIRITUAL ASSESSMENT TOOL IN A PALLIATIVE CARE UNIT

A study was undertaken to determine if individualised, formal spiritual assessment could impact on and optimise patient care within a Palliative Care Unit (PCU). The authors write on the benefits of formal spiritual assessment as undertaken by chaplaincy services. The Spiritual Assessment Tool (SAT) selected, introduced and evaluated for the PCU was the HOPE tool. The authors share the results of research into the effect and benefits that formal spiritual assessment had on members of the PCU's interdisciplinary team. The results highlight a positive impact, of the SAT, upon the various team members. The article explores and expresses the staff's enhanced understanding of the nature and extent of spiritual and religious needs and resources.

From ‘Pastoral Contacts' to ‘Pastoral Interventions'

This research collates statistical results of pastoral care contacts undertaken at the Sheffield Northern General Hospital and the Royal Hallamshire Hospital over a twelve month period. The data was found to provide an important overview of chaplaincy work that can be used for future pastoral care management and developing better data collection and quality assurance measurements. The data was subsequently categorised using the World Health Organization (WHO) Pastoral Intervention (PI) Codings to explore the use of a newly developed universal coding system that might allow national and international data collection and comparison. Overall the data from the Sheffield Teaching Hospitals' pastoral data base was found to be easily transferable to the WHO PI codings. This report of the research offers recommendations for recording chaplaincy activity that at present is unrecorded and by doing so might reflect a more accurate picture of the role and demands of chaplaincy services.

Chaplains working in a hospice palliative care team recount the spiritual challenges at the end-of-life

As part of an on-going review of service provision for Hospice adult patients, six chaplains were interviewed to elicit their views and experiences of meeting spiritual needs within a multidisciplinary palliative care team. Interviews were taped: transcribed and common themes were identified. The chaplains highlighted many positive aspects of their work, recognising their role as one of service to the patients. They emphasised the importance of teamwork, both within the chaplaincy service and throughout the wider palliative care team. Negative aspects of working in palliative care were also identified, such as compassion fatigue. Chaplains need special coping skills and ongoing support in their work. They must recognise and obtain resources for patients from other world faith communities.

Standards for NHS Scotland Chaplaincy Services

A scoping group established by NHS Quality Improvement Scotland and the Healthcare Chaplaincy Training and Development Unit, (HCTDU, now part of NHS Education for Scotland (NES)) was asked to scope awareness and provision of Spiritual Care in NHS Scotland. The group produced a report covering a survey and literature research. Following a seminar May 2005 in which this report was discussed along with some current research, a further group began work on chaplaincy service standards. A consultation conference held on 27 th June 2006 brought much support and many comments on the standards document. Despite some hesitation in trying to measure things spiritual, these standards should be a useful audit tool and an aid for future work on competencies and help development towards national standards or good practice statements on spiritual and religious care in NHS Scotland.

CHAPLAINCY IN THE NHS

This article represents a response to the recent report form the National Secular Society which criticises the money spent on Chaplaincy services in the NHS and which recommends that these services be paid for by churches and faith communities.