Community Clergy Research Articles

Roles of Chaplains and Clergy in Spiritual Care for African Americans in Hospice: A Pilot Study.

Spiritual care is recognition of patient and caregiver spiritual/religious needs and attention to those needs. Caregivers of African American hospice patients are more likely to report worse emotional/religious support. Yet, spiritual care delivery and roles of community clergy and chaplains for African American hospice patients are not well understood. Examine who provides spiritual care to African American hospice patients and caregivers. Partnering with large, urban/suburban community hospice, we interviewed caregivers of deceased African American hospice patients (n = 12), their clergy (n = 3) and chaplains (n = 5). Using a phenomenological qualitative study design, we coded transcripts and deceased patient chart data and conducted thematic analysis to identify themes. Community clergy and chaplains tend to not interact and provide different aspects of emotional, religious and spiritual support to hospice patients and families. Clergy and chaplains agreed that rapport and openness of the patient were main factors in meeting spiritual care needs. Clergy provided interaction with a trusted person and connection to church, congregational support, religious beliefs/theology, and practices. Chaplains focused on present needs and issues of death and dying. Clergy and chaplains have distinct, complementary roles in providing spiritual care to African American hospice patients and families. Both are needed to provide desired spiritual care for African American hospice patients and their caregivers. Robust spiritual care programs need to ensure chaplains have sufficient time to spend with patients and families and incorporate collaboration, handoffs and integrated processes for clergy and chaplains. Research is needed on effectively including clergy in hospice spiritual care delivery.

Mental Health Clinician Community Clergy Collaboration to Address Moral Injury Symptoms: A Feasibility Study.

Moral injury (MI) symptoms (guilt, shame, isolation) can be associated with military experiences. While a degree of overlap is recognized between MI and posttraumatic stress disorder (PTSD) symptoms, MI symptoms do not always respond to evidence-based treatments for PTSD. Mental Health Clinician Community Chaplain Collaboration (MC4) was delivered by community clergy to address MI symptoms through facilitation of forgiveness and community reintegration. Thirteen veterans participated and the results suggested that MC4 was generally feasible and acceptable. However, it is unlikely community clergy time could keep up with demand. Shifting intervention delivery to Department of Veterans Affairs (VA) chaplains will alleviate many barriers experienced in this feasibility study.

We Can Do Better: Why Pastoral Care Visitation to Hospitals is Essential, Especially in Times of Crisis.

From his perspective as a general surgeon, Episcopal priest and Medical Director for High Risk Populations and Outcomes at a large health-care system, the author identifies an unrecognized problem that clergy were banned from visiting parishioners in most hospitals across the country during the height of the Covid-19 pandemic—a situation that persists in many contexts. The author explains why pastoral visitation should be considered essential care—especially at a time of crisis—and encourages hospital administrators across the country to clarify policies to welcome community clergy as essential personnel, but to do so with prudent procedures that mitigate risk to the community and to the visiting clergy. Given the fact that most hospitals in this country were founded by religious organizations and still carry the imprint of that founding in their names, it would be tragic for these very same hospitals to cut patients off from their religious communities precisely at the time they need them most.Electronic supplementary materialThe online version of this article (10.1007/s10943-020-01072-x) contains supplementary material, which is available to authorized users.

Mental Health Clinician and Community Clergy Collaboration to Address Moral Injury in Veterans and the Role of the Veterans Affairs Chaplain

Moral injury in veterans with posttraumatic stress disorder includes symptoms of guilt and shame, and these symptoms are often not responsive to evidence-based mental health treatments. Clergy provide a pathway for relieving the guilt and shame. However, there is a long history of mistrust between clergy and mental health clinicians and not enough Veterans Health Administration chaplains to meet this need. The goal of this study was to gather qualitative interview data from relevant stakeholders regarding whether and how Veterans Affairs (VA) mental health clinicians and community clergy could collaborate to address moral injury issues such as guilt and shame in veterans being treated for posttraumatic stress disorder. The stakeholders for this study were veterans, mental health clinicians, and clergy. Qualitative data were organized into three domains: barriers, facilitators, and intervention suggestions. These data were used to develop a new intervention for moral injury that includes a central role for the Veterans Affairs chaplain.

Training Community Clergy in Serious Illness: Balancing Faith and Medicine.

Community-based clergy are highly engaged in helping seriously ill patients address spiritual concerns at the end of life (EOL). While they desire EOL training, no data exist in guiding how to conceptualize a clergy-training program. The objective of this study was used to identify best practices in an EOL training program for community clergy. As part of the National Clergy Project on End-of-Life Care, the project conducted key informant interviews and focus groups with active clergy in five US states (California, Illinois, Massachusetts, New York, and Texas). A diverse purposive sample of 35 active clergy representing pre-identified racial, educational, theological, and denominational categories hypothesized to be associated with more intensive utilization of medical care at the EOL. We assessed suggested curriculum structure and content for clergy EOL training through interviews and focus groups for the purpose of qualitative analysis. Thematic analysis identified key themes around curriculum structure, curriculum content, and issues of tension. Curriculum structure included ideas for targeting clergy as well as lay congregational leaders and found that clergy were open to combining resources from both religious and health-based institutions. Curriculum content included clergy desires for educational topics such as increasing their medical literacy and reviewing pastoral counseling approaches. Finally, clergy identified challenging barriers to EOL training needing to be openly discussed, including difficulties in collaborating with medical teams, surrounding issues of trust, the role of miracles, and caution of prognostication. Future EOL training is desired and needed for community-based clergy. In partnering together, religious-medical training programs should consider curricula sensitive toward structure, desired content, and perceived clergy tensions.

‘I think you just learnt as you went along’ – community clergy’s experiences of and attitudes towards caring for dying people: A pilot study

Background: Spiritual distress is a factor associated with poor outcomes at the end of life. Timely interventions, assessing and meeting spiritual distress, among patients are contained within nationally agreed guidance. Community clergy are well placed to work alongside healthcare professionals and chaplains to meet spiritual needs. Methods: Qualitative interviews among Christian clergy in two South East London boroughs and a self-completed Death Anxiety Questionnaire. Results: Fourteen clergy were interviewed from six Christian denominations. Participants described their experiences of ordination training and how helpful this had been for their work among Christian communities. Respondents were invited to discuss their knowledge of and involvement with palliative care services. Each interviewee also accounted for their understanding of pastoral care and spiritual care and considered whether any differences existed between these terms and, if so, what they were. Overall, clergy lacked any detailed formal training and had little experience of working with or relating to palliative care providers. Recommendations are made to improve educational opportunities and working relationships. Conclusions: Creating opportunities for clergy and palliative care staff to meet and undertake shared training will enhance the quality and level of care for people dying at home who wish to receive spiritual support. Enabling clergy to develop links with local palliative care centres will enhance confidence for both clergy and staff.

How Community Clergy Provide Spiritual Care: Toward a Conceptual Framework for Clergy End-of-Life Education

ContextCommunity-based clergy are highly engaged in helping terminally ill patients address spiritual concerns at the end of life (EOL). Despite playing a central role in EOL care, clergy report feeling ill-equipped to spiritually support patients in this context. Significant gaps exist in understanding how clergy beliefs and practices influence EOL care. ObjectivesThe objective of this study was to propose a conceptual framework to guide EOL educational programming for community-based clergy. MethodsThis was a qualitative, descriptive study. Clergy from varying spiritual backgrounds, geographical locations in the U.S., and race/ethnicities were recruited and asked about optimal spiritual care provided to patients at the EOL. Interviews were audio taped, transcribed, and analyzed following principles of grounded theory. A final set of themes and subthemes were identified through an iterative process of constant comparison. Participants also completed a survey regarding experiences ministering to the terminally ill. ResultsA total of 35 clergy participated in 14 individual interviews and two focus groups. Primary themes included Patient Struggles at EOL and Clergy Professional Identity in Ministering to the Terminally Ill. Patient Struggles at EOL focused on existential questions, practical concerns, and difficult emotions. Clergy Professional Identity in Ministering to the Terminally Ill was characterized by descriptions of Who Clergy Are (“Being”), What Clergy Do (“Doing”), and What Clergy Believe (“Believing”). “Being” was reflected primarily by manifestations of presence; “Doing” by subthemes of religious activities, spiritual support, meeting practical needs, and mistakes to avoid; “Believing” by subthemes of having a relationship with God, nurturing virtues, and eternal life. Survey results were congruent with interview and focus group findings. ConclusionA conceptual framework informed by clergy perspectives of optimal spiritual care can guide EOL educational programming for clergy.

The Role of the Chaplain in the Interdisciplinary Care of the Rehabilitation Patient.

Chaplains have been utilized for years in acute/tertiary hospitals to meet spiritual needs of patients, their caregivers, and staff. Due to size, nature, and scheduling issues encountered in rehabilitation hospitals, these often do not employ a chaplain, relying on community clergy for religious or emergent needs. This article explores eight roles a chaplain assumes to assist in the total care of the patient and/or support system in conjunction with the rehabilitation nurse and other treatment team members. It also explores the value of the chaplain in ethical situations, as a link to the community and a resource to staff. These eight "roles" come from the author's nineteen years as a chaplain, as well as other resources, where noted. The article gives some suggestions how, in the chaplain's absence, the rehabilitation nurse may help to meet these spiritual needs, concluding with recommendations for the future.

Clergy Views on a Good Versus a Poor Death: Ministry to the Terminally Ill.

Clergy are often important sources of guidance for patients and family members making medical decisions at the end-of-life (EOL). Previous research revealed spiritual support by religious communities led to more aggressive care at the EOL, particularly among minority patients. Understanding this phenomenon is important to help address disparities in EOL care. The study objective was to explore and describe clergy perspectives regarding "good" versus "poor" death within the participant's spiritual tradition. This was a qualitative, descriptive study. Community clergy from various spiritual backgrounds, geographical locations within the United States, and races/ethnicities were recruited. Participants included 35 clergy who participated in one-on-one interviews (N = 14) and two focus groups (N = 21). Semistructured interviews explored clergy viewpoints on factors related to a "good death." Principles of grounded theory were used to identify a final set of themes and subthemes. A good death was characterized by wholeness and certainty and emphasized being in relationship with God. Conversely, a "poor death" was characterized by separation, doubt, and isolation. Clergy identified four primary determinants of good versus poor death: dignity, preparedness, physical suffering, and community. Participants expressed appreciation for contextual factors that affect the death experience; some described a "middle death," or one that integrates both positive and negative elements. Location of death was not viewed as a significant contributing factor. Understanding clergy perspectives regarding quality of death can provide important insights to help improve EOL care, particularly for patients highly engaged with faith communities. These findings can inform initiatives to foster productive relationships between clergy, clinicians, and congregants and reduce health disparities.

Spiritual Interventions and the Impact of a Faith Community Nursing Program

Faith community nursing had its formal beginnings in the Midwestern United States in 1984 when six nurses received financial support from a local hospital to work in churches. Over time, the churches assumed increasing responsibility for the nurses’ salaries. The success of this initiative was associated with the understanding that faith communities are dedicated to keeping people well. The number of programs increased over the past 30 years and now there are thousands of faith community nurses serving populations around the world. Research for this specialty practice has not experienced comparable growth, and is needed to further develop faith community nursing science. This study, based on the Roy Adaptation Model, used a qualitative design to identify spiritual nursing interventions that faith community nurses use in their practice, and to examine the spiritual impact of a faith community nursing program. Data were collected from faith community members, clergy representatives, and faith community nurses with a researcher-developed demographic tool and a six-item open-ended questionnaire that were both mailed to participants (N = 112; n = 52; response rate = 46%) and analyzed through content analysis. A variety of spiritual nursing interventions were identified. Themes related to the spiritual impact included the physical, mental, and spiritual health connection, caring, hope, spiritual support and benefits, and religious concepts.

Facilitating the Provision of Quality Spiritual Care in Palliative Care

In 1948, Dame Cicely Saunders, the founder of the modem hospice movement, established a core principle of palliative care, Total Pain, which is defined as physical, spiritual, psychological, and social suffering. In 2009, a consensus panel (Puchalski, Ferrell, Virani, Otis-Green, Baird, Bull, et al., 2009) was convened to address the important issue of integrating spirituality in palliative care, which led to renewed efforts to focus on spiritual care as a critical component of quality palliative care. This project is a combination of advocacy for the importance of spiritual care, training chaplains, seminarians, community clergy, and healthcare professionals in palliative care, and creating a spiritual care curriculum which can be self-taught or taught to members of transdisciplinary teams.

Dying With Dignity in America: The Transformational Leadership of Florence Wald

The aims of this study are to examine the constructs of transformational leadership as they played out for one nurse who steered significant change in the care of the dying in the United States and to provide deeper insights into how nursing leaders can design and direct meaningful changes in the delivery of health care in turbulent times. A significant problem was identified in how the terminally ill were treated in this country post World War II. The introduction of hospice care in the United States represented a paradigm shift in how the health care community viewed and treated dying patients. Critical to this transformation was the work of Florence Wald, who organized with community leaders, clergy, and other health care providers to create a vision and synergy around palliative care. She was instrumental in opening the first American hospice in 1971 in Connecticut. Within 15 years, there were more than 1,000 hospices in the United States. A single case study design was chosen for this qualitative research grounded in the theory of transformational leadership (J.M. Burns, 1978). The study used narrative inquiry to conduct an in-depth exploration of Florence Wald's transformational leadership and the perceptions of the group of founders she organized to conceptualize, build, and open the first hospice in the United States. The participants chosen for interview were involved directly in the designing, planning, and beginning of the first American hospice. In addition to the seven in-depth interviews conducted in 2007 in Connecticut, this research examined three groups of documents from The Florence and Henry Wald Archives in the Yale University Library. The findings from both interviews and the Yale Archives showed that Florence Wald based her leadership on the strong values of reverence for life and social justice for all. To direct meaningful change, Florence Wald elevated the consciousness of her hospice team by conducting a 2-year research study on the needs of dying patients to ensure interventions were based on evidence. To encourage a high level of participation, Florence Wald demonstrated a caring component in her leadership with a strong commitment to mentoring. Wald worked to transform the quality of end-of-life care by assessing the readiness for change prior to acting and by working to provide supports for success. Finally, the findings showed that Florence Wald built consensus on vision before executing purposeful change by collaborating with the Founders and asking the hard questions to examine standards of care. Florence Wald provided transformational leadership in creating a value-driven culture of inquiry among the Founders where decision making was evidence-based and significantly improved the quality of palliative care in the United States. Nursing leaders who build upon the shared values to provide direction and promote momentum critical to the change will have more success in reaching strategic outcomes of transformational efforts. Transformational nursing leaders who build consensus on vision before executing purposeful change by collaborating with a wide group of stakeholders will encourage a broader ownership of the change. When nursing leaders work to elevate the consciousness of their work groups to direct meaningful change by developing and sustaining value-driven cultures of inquire, decisions will more directly align with evidence and support successful outcomes.

Connection to Early Church Theologians: Canadian Ethnographic Study on the Similarities and Differences between Prayer and Theological Reflection in Pastoral Care and Counseling

What are the similarities and differences between prayer and theological reflection in the praxis of pastoral care and counseling? This qualitative study is ethnographic in design. A review of the literature is summarized. Researchers interviewed 75 participants in four cultures: (1) chaplains and (2) pastoral counselors in the Canadian Association of Pastoral Practice and Education (CAPPE), (3) community clergy and persons in lay ministry, and (4) students after internship in a theological reflection course. Interviews were audiotaped, transcribed and then coded for themes. Findings include seeing more similarities than differences between prayer and theological reflection. One of the differences is that prayer is more affective and theological reflection is more cognitive. There are also some areas of ambiguity. Discussion includes what ought to be normative or the orthopraxis for prayer and theological reflection in pastoral care and counseling. Limitations and areas for future research are outlined.

A Canadian Qualitative Study on Theological Reflection in Pastoral Care and Counseling

ABSTRACT This qualitative study is ethnographic in design. Two questions guide the study. How important is theological reflection to pastoral identity in pastoral care and counseling? With whom do practitioners converse in terms of theological reflection? A review of the literature is outlined and 75 persons are interviewed that include chaplains, pastoral counselors, community clergy and students. Findings indicate that theological reflection is essential to pastoral identity and that participants converse most with clients and colleagues and least with other professionals. Most theological reflection is done privately. Discussion includes limitations and areas for future research.

Matters of Spirituality at the End of Life in the Pediatric Intensive Care Unit

Our objective with this study was to identify the nature and the role of spirituality from the parents' perspective at the end of life in the PICU and to discern clinical implications. A qualitative study based on parental responses to open-ended questions on anonymous, self-administered questionnaires was conducted at 3 PICUs in Boston, Massachusetts. Fifty-six parents whose children had died in PICUs after the withdrawal of life-sustaining therapies participated. Overall, spiritual/religious themes were included in the responses of 73% (41 of 56) of parents to questions about what had been most helpful to them and what advice they would offer to others at the end of life. Four explicitly spiritual/religious themes emerged: prayer, faith, access to and care from clergy, and belief in the transcendent quality of the parent-child relationship that endures beyond death. Parents also identified several implicitly spiritual/religious themes, including insight and wisdom; reliance on values; and virtues such as hope, trust, and love. Many parents drew on and relied on their spirituality to guide them in end-of-life decision-making, to make meaning of the loss, and to sustain them emotionally. Despite the dominance of technology and medical discourse in the ICU, many parents experienced their child's end of life as a spiritual journey. Staff members, hospital chaplains, and community clergy are encouraged to be explicit in their hospitality to parents' spirituality and religious faith, to foster a culture of acceptance and integration of spiritual perspectives, and to work collaboratively to deliver spiritual care.

Understanding, Integration and Transformation: A Canadian Ethnographic Study on the Goals of Theological Reflection in Pastoral Care and Counselling

Summary/AbstractWhat are the goals of theological reflection in the praxis of pastoral care and counselling in Canada? This qualitative study is ethnographic in design. A review of the literature is presented noting themes especially in the work of Stephen Bevans (2004), Robert Kinast (2000) and Elaine Graham, Heather Walton and Frances Ward (2005). Researchers interviewed 75 participants in four categories: chaplains, pastoral counsellors in the Canadian Association of Pastoral Practice and Education (CAPPE), community clergy, and students after internship in a theological reflection course. Interviews were audiotaped, transcribed and then coded for themes. Understanding and meaning, integration and transformation emerged as the strongest themes. Our discussion includes the topic of what ought to be normative goals for theological reflection, focusing on the question: ‘Could theological reflection be faith seeking understanding, integration, and transformation equally?’

Word about Recent Book: III. Ministerial Studies: Parish Nurses, Health Care Chaplains, and Community Clergy: Navigating the Maze of Professional Relationships

Word about Recent Book: III. Ministerial Studies: Parish Nurses, Health Care Chaplains, and Community Clergy: Navigating the Maze of Professional Relationships

Parish nurses, health care chaplains, and community clergy: navigating the maze of professional relationships

Parish nurses, health care chaplains, and community clergy: navigating the maze of professional relationships

Collaboration Between Clergy and Mental Health Professionals: A Review of Professional Health Care Journals From 1980 Through 1999

Given the frontline role of community clergy in mental health care, this study examined how collaboration with clergy was viewed by mental health and other health professionals outside of the religious community. Searches of health care journals on Medline and PsycINFO yielded 44 articles from non‐religious journals from 1980 through 1999 that specifically addressed collaboration between clergy and mental health professionals. Seven themes were identified through content analysis, including the benefits of collaboration to each profession, the need to increase the clergy's knowledge about mental heath, and the importance of referrals. Discussion about interdisciplinary referrals significantly increased over time, rø (1, N = 44) = .31, p < .05).

Care Teams and Pastoral Professionals: Response to the Health Care Changes of this Decade

Demographic changes already in motion will result in unprecedented population changes in the next four decades and beyond for which we have little time to prepare. In particular, as the population aged 65 and over grows, a significant cohort will manifest health-related needs of older age. Even in families with adequate health insurance, confronted with the chronic illness of loved ones, the need for continuous in-home support, including pastoral care, will become dire. For many families whose situations are complicated by low incomes, under-insurance, and membership of minority populations, pastoral support will tax their congregations beyond present capabilities. Interfaith Care Partners' Care Team model of in-home pastoral support is the most effective means of delivering the pastoral support such families need. It calls for a creative linking of hospital out-patient services with individuals' congregations, and, particularly, of a stronger connection between hospital chaplaincy services and community clergy.