Healthcare Chaplains Research Articles

Perspectives of board-certified healthcare chaplains on challenges and adaptations in delivery of spiritual care in the COVID-19 era: Findings from an online survey

Background: The COVID-19 pandemic has posed significant challenges for healthcare systems to meet patients’ and families’ complex care needs, including spiritual care needs. Little data are available about spiritual care delivery in light of the pandemic. Aim: This study examined the impact of COVID-19 on spiritual care by healthcare chaplains in the United States. Design: An online survey of 563 board-certified chaplains was conducted from March to July 2020. The survey, designed to identify chaplains’ roles in facilitating conversations about goals of care, included an open-ended question asking how COVID-19 affected chaplaincy practices; 236 chaplains responded. Quantitative data and written qualitative responses were analyzed using descriptive analysis and content analysis, respectively. Setting/participants: Majority of participants were white (88%), female (59%), Protestant (53%), and employed full time (86%). Almost half were working in community hospitals (45%) and designated to one or more special units (48%) including ICU, palliative care, and oncology. Results: Three major themes emerged from chaplains’ qualitative responses: (1) COVID-19—related risk mitigation and operational changes; (2) impact of social distancing guidelines; and (3) increased need for and provision of psychosocial and spiritual support. Conclusions: Chaplains reported that COVID-19 challenges contributed to greater social isolation, and mental health concerns for patients, families, and healthcare staff, and substantially changed the way healthcare chaplains provided spiritual care. With evolving healthcare contexts, developing safer, more creative modes of spiritual care delivery while offering systematic support for chaplains can help meet the increasing psychosocial and spiritual needs of patients, families, and healthcare team members.

“If Only I Could Start All over…” A Case Study of Spiritual Care Provision to a Patient with a Psychiatric Disorder Requesting Physician-Assisted Dying in The Netherlands

In a growing number of countries, legislation permits physicians—under strict conditions—to grant a request for physician-assisted dying (PAD). Legally allowing for the possibility of granting such a request is in accordance with central humanistic values such as respect for autonomy and self-determination. The Netherlands is one of few countries where severe suffering from a psychiatric illness qualifies as a ground for a request for PAD. Central in this article is a case description of spiritual care provision in the Netherlands by a humanist healthcare chaplain to a patient requesting PAD because of psychiatric suffering. We discuss what we may learn from the case description about how spiritual caregivers may support patients who express a wish to die, and about their contribution to the care for patients with a psychiatric disorder who request PAD.

Spezialisierte Care im Horizont des christlichen Heilungsauftrags

Specialised Care in the Horizon of the Christian Call for Healing: Response to Arndt Bialobrzeski and Eberhard Hauschildt This response replies to several considerations which Arndt Bialobrzeski and Eberhard Hauschildt have offered in their nuanced presentation of the book “Klinikseelsorge als spezialisierte Spiritual Care”. After a brief explanation of the main thesis of the book – namely, that healthcare chaplaincy ought to be understood and developed in terms of the Christian call for healing – I proceed to answer these suggestions in three steps. First, it is argued that the first addressees of this call are people who do not belong to the Christian community. Against this background, the Christian ministry in healthcare is from the beginning open to inter- and transreligious encounters. Secondly, it is argued that it is precisely the therapeutic orientation of healthcare chaplains which unites their different denominational and ideological backgrounds. They share the task to advance the professionalisation of spiritual care in a highly specialised healthcare system and underpinning it with empirical research. In a third step, the communicative strategy of “code switching” is presented as competence which enables healthcare chaplains to be instrumental in inter- and transreligious contexts.

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.

Ethics education in clinical pastoral education: prevalence and types

Chaplains frequently serve on ethics committees, as ethics consultants, and as Institutional Review Board (IRB) members in hospitals. However, little is known about how Clinical Pastoral Education (CPE) residents are trained in ethics and whether this training is appropriate or adequate for chaplains' subsequent work in health care settings. We created a survey to canvas 222 CPE residency programs in the United States accredited by the ACPE: The Standard for Spiritual Care (ACPE) to inquire about the prevalence of ethics curricula within residency programs, the educational structure of ethics curricula, and challenges associated with teaching ethics within CPE. We received a total of 84 responses for a 38% response rate. Of these, three-quarters of the programs had a required ethics curriculum, another 10% were in the process of developing one, and 18% had none. There was a great deal of variability in the ethics curricula among the different programs. Developing guidelines for a standardized ethics curriculum could help healthcare chaplains provide more effective service on ethics committees, as ethics consultants, and as IRB members.

Coordinating assessment of spiritual needs: a cross-walk of narrative and psychometric assessment tools used in palliative care

Addressing spiritual needs of patients in healthcare settings improves patient experiences and clinical outcomes; however, non-chaplain providers typically assess spiritual needs differently (quantitative psychometric) than healthcare chaplains (long form narrative) and thus there is little shared language or cross-disciplinary evaluation frameworks across disciplines. This discrepancy impedes the provision of both team-based and patient-centered care. This paper used scoping review methodology to illustrate the overlap between narrative and psychometric assessment tools, comparing four narrative tools against eight psychometric tools. The SpNQ-120 and Brief RCOPE demonstrated consistent domain coverage across the four chaplain narrative tools. This work provides preliminary resources to aid clinicians and researchers in choosing an appropriate tool. Additionally, for those who do not work closely with chaplains, it provides a sense of what domains chaplains prioritize, from their professional and lived experience, in assessing the spiritual life of the patient. This improves interdisciplinary communication, and therefore, patient care.

Scared but Powerful: Healthcare Chaplains’ Emotional Responses and Self-Care Modes during the SARS-Cov-19 Pandemic

Drawing from both the qualitative free-text responses and quantitative responses to an international survey of 1657 chaplains serving during the SARS-Cov-19 pandemic, we explore chaplains' emotional responses to the pandemic and how emotion connects to self-care. This paper reports on the modes of self-care practiced by chaplains, including modes reported as unavailable due to pandemic restrictions. Lastly, we explore how effective spiritual care leadership may mediate chaplain emotions and ultimately chaplain self-care.

Participation in Existential Groups Led by Norwegian Healthcare Chaplains—Relations to Psychological Distress, Crisis of Meaning and Meaningfulness

ABSTRACT Spirituality groups led by healthcare chaplains have been found to aid patients’ recovery processes in US psychiatric units. In Norway, existential groups (EGs) led by healthcare chaplains and co-led by healthcare staff members are offered at psychiatric units; these groups share commonalities with spirituality groups, group psychotherapy, existential therapy and clinical pastoral care, facilitating patients’ reflections regarding existential, spiritual and religious issues. The study aimed to examine associations between patients’ participation and topics discussed in the EGs and their experiences of psychological distress, crisis of meaning and meaningfulness. A cross-sectional design was applied among 157 patients attending EGs led by healthcare chaplains across Norway. Multivariate regression analyses assessed the strength of possible associations, adjusted for relevant demographical variables. Significant association was found between lengthier EG participation and lower levels of psychological distress, while discussion topics concerning religious and spiritual issues were significantly associated with the experience of meaningfulness.

Awareness and Preferences for Health Care Chaplaincy Services Among US Adults.

Health care chaplains intervene on unmet religious/spiritual (R/S) needs in health care settings that are associated with poor outcomes. Little is known about demand for their services. The purpose of this study was to describe population-level awareness and perceptions of health care chaplains and preferences for their services. Data came from a cross-sectional survey of a nationally representative sample of US adults ≥ 18 years of age (n = 1020). Participants were asked about preferences for chaplain services, previous experience and awareness of chaplains, and level of importance on having R/S needs and sources of meaning addressed. Mean age of the sample was 47.6. Although the majority were aware of chaplains (85%), only 15% indicated they had previous experience with one. Adults who were unaware were younger (38 vs 49 years, p < .001), male (P = .007), non-white race/ethnicity (p < .001), and had lower educational attainment (P = .01). Seventy percent reported an interest in having R/S or existential needs met in the context of health care. The majority of the US population say they are aware of chaplains and desire their services, yet few report previous experience with them in health care. More behavioral interventions are needed to better connect patients to chaplains.

Attitudes on Physician Aid-in-Dying Among Muslim Chaplains: A Qualitative Study (SCI925)

1.List 3 common themes among Muslims chaplains’ attitudes regarding Physician Aid-in-Dying.2.Describe 2 reasons for PAD being considered contrary to Islamic law and belief by Muslim chaplains.3.Recognize how Muslim chaplains define their own clinical practice and duties as it relates to spiritual care in PAD. When facing serious illness, Muslim patients and their families often call upon Muslim chaplains for aid in spiritual coping and medical decision-making in a religious context. As eight states and DC have legalized physician aid-in-dying (PAD), Muslims reflect on how to navigate PAD. However, research describing unique characteristics of spiritual care for Muslim patients is limited. Explore and educate readers about Muslim chaplains' attitudes and approaches to PAD in the context of their religious beliefs. Muslim healthcare chaplains were recruited to participate in semi-structured interviews exploring participants’ views on PAD. Two independent researchers conducted thematic analysis through an iterative process of coding to identify overarching themes, which were further examined to gain an understanding of attitudes towards PAD. Ten North American Muslim chaplains with diverse ethnic backgrounds participated. Five themes were identified:1.Cultural Differences in End-of-Life Experience: Participants qualify suffering with cultural and religious value placed on endurance and patience.2.Contrary to Islamic Law and Belief: The intention of medication causing death, as opposed to the disease, can be interpreted as defiance to God’s decree.3.Dual Identities and Roles: Chaplains recognize the conflict to adhere to religious values while caring for patients where PAD is legal. Some prefer conscientious objection to partaking in PAD and referral to colleagues.4.Duties of Chaplains: Participants emphasized the chaplain’s role to elicit patients’ values with an Islamic view of their decision, while offering support and relief of suffering.5.Autonomy and Accountability Before God: Patients and clinicians have autonomy in their decision-making with informed consent on a spiritual and metaphysical level. Muslim chaplains draw on Islamic principles to form views on PAD. Participants support individual autonomy for patient and clinician while identifying their duty as chaplains to relieve suffering.

Supporting diversity in person-centred care: The role of healthcare chaplains.

To explore healthcare chaplains' experience of providing spiritual support to individuals and families from minority religious and non-religious faiths and to identify key elements of the role. Currently, there is limited research uncovering the essential elements of healthcare chaplaincy, specifically with reference to religious and/or spiritual diversity, and as interprofessional collaborators with nurses and midwives in healthcare. Using phenomenology, we interviewed eight healthcare chaplains from a variety of healthcare settings in the Republic of Ireland. Data were analysed using a seven-step framework comprising Moustakas' (1994) modification of the Van Kaam method of data analysis. Ethical approval was granted by the university and the principles of informed consent applied. Three main themes emerged: what the chaplain brings; components of ritual, minority faith or no faith; and practising chaplaincy. Subthemes included 'offering', 'awareness and insight', 'acceptance and empathy', 'skilled companionship', 'presence', 'a confidant and holder of hope' and 'a vital resource'. The healthcare chaplain is a key collaborator in facilitating holistic person-centred care and in supporting healthcare professionals. Chaplaincy services are an essential but largely unrecognised and potentially cost-effective component of interprofessional team working. This study has illuminated key aspects of the healthcare chaplain's role as interprofessional collaborator in person-centred care, in navigating diversity and ensuring respect and dignity for the person irrespective of religious or spiritual care needs.

The Role and Activities of Board-Certified Chaplains in Advance Care Planning

Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains' organizations in the U.S. The survey data included chaplains' demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.

Maternity Healthcare Chaplains and Perinatal Post-Mortem Support and Understanding in the United Kingdom and Ireland: An Exploratory Study.

Perinatal autopsy rates have declined significantly in recent decades. There is a lack of consensus concerning the potential religious influences for bereaved parents in their decision making process for post-mortem. This online study of British and Irish maternity healthcare chaplains explored their understanding of general and local perinatal post-mortem procedures and their experiences in the support of parents. Participants included Christian, Muslim and non-faith chaplains. No chaplain identified any religious prohibition to perinatal post-mortem. A majority of chaplains reported that they had been asked about post-mortem by parents; only a minority felt adequately prepared. A key recommendation is that following appropriate training chaplains may be well placed to support colleagues and parents during the decision making process.

Chaplain-Physician Interactions From the Chaplain's Perspective: A Mixed Method Analysis.

The value of healthcare chaplains to patient care is increasingly recognized. However, physicians' understandings of the role of pastoral care have been reported to be poor, which have raised concerns about the quality of chaplain-physician interactions and their impact on patient care. These interactions, particularly from the perspective of the chaplain, have not been extensively investigated. An anonymous survey about the interactions of chaplains with physicians was sent to chaplains at a single institution, with subsequent focus group discussions of responding chaplains to obtain additional qualitative data. Quantitative and qualitative data were collected from over 20 chaplains. While chaplains indicated satisfaction regarding their access to physicians, they noted a disconnect between chaplains and physicians, physicians' unfamiliarity with the chaplain role, a sense that physicians do not always appreciate the chaplain role as significant or helpful, and structural barriers to the integration of chaplains into medical care teams. This study provides contemporary data on the nature of chaplain-physician interactions as reported from the perspective of chaplains. Further, these findings highlight opportunities for interventions to enhance the chaplain-physician relationship.

Responding to the “unknown assailant”: A qualitative exploration with Australian health and aged care chaplains on the impact of COVID-19

The global coronavirus pandemic (COVID-19) has brought about physical, psychological and spiritual challenges within health and aged care services across Australia. The aim of this study was to consider the impact of COVID-19 from the perspective of Australian chaplains. Semi-structured interviews were conducted with 17 chaplains. A grounded theory analysis identified three overarching themes: (1) a changing healthcare environment; (2) the impact of the virus; and (3) chaplains responding to the crisis. Increased healthcare restrictions in response to COVID-19 raised levels of fear and anxiety among patients, residents, family members and staff, and generated feelings of isolation and disconnection. Chaplains responded by providing a calm presence, being available, holding out hope, introducing creative ways to provide spiritual care and seeking spiritual nourishment themselves. The value of chaplaincy in health and aged care services is discussed in light of these findings.

Preliminary Evaluation of a Core Knowledge Test for Certification of Health Care Chaplains

This article describes the rationale, evolution, implementation, and evaluation of a process for testing core knowledge in health care chaplaincy certification. The process developed by the Spiritual Care Association uses online testing of evidence-based core knowledge developed with several expert advisory committees. The process seems to have acceptable validity, reliability, feasibility and usability and should be considered as a component to current certification processes for health care chaplains.

Forgiveness facilitation in palliative care: a scoping review.

The objective of this review is to map the nature and extent of forgiveness facilitation intervention implemented and evaluated in palliative care contexts. Spiritual beliefs often include reconciliation and forgiveness, which are critical to patients and families in palliative care. Forgiveness facilitation can represent a valuable response as a multidisciplinary and non-pharmacological intervention to reduce suffering. Studies including palliative care patients aged 18 years or over and assisted by palliative care teams, including all healthcare professionals, chaplains, and volunteers, were included in this review. This scoping review is based on JBI methodology. The search was conducted in June 2017 and updated in December 2018 using international databases and gray literature in English, Spanish, German, Italian, and Portuguese. A total of 23 articles were included in this review. The results suggest a growing interest in forgiveness facilitation in palliative care in different spiritual and religious traditions. Most studies are based on a psychological perspective. Several activities related to the intervention have been identified, but few details or characteristics are described. Social workers, nurses, doctors, and psychologists were most identified as healthcare staff involved in forgiveness facilitation. The outcomes related to the intervention are mental, physical, and relational well-being; quality of life, decision-making and communication; self-esteem and hope; depression, anger, and anxiety; and inner peace. Forgiveness facilitation is critical in palliative care and is grounded in a multidisciplinary approach, but further evidence is needed to inform clinical implementation. These results open new perspectives for research and training on palliative healthcare staff.

Supporting GPs around euthanasia requests from people with dementia: a qualitative analysis of Dutch nominal group meetings.

BackgroundEuthanasia has been regulated by law under strict conditions in the Netherlands since 2002. Since then the number of euthanasia cases has constantly increased, and increased exponentially for patients with dementia (PWD). The number of euthanasia requests by such patients is even higher. Recently, an interview study showed that physicians who are confronted with a PWD’s euthanasia request experience problems with communication, pressure from relatives, patients, and society, workload, interpretation of the law, and ethical considerations. Moreover, if honoured, the physician and patient may interpret the right moment for euthanasia differently.AimTo identify ways of supporting GPs confronted with a PWD’s euthanasia request.Design and settingTwo expert nominal group meetings were organised with Dutch care physicians for older people, GPs, legal experts, a healthcare chaplain, a palliative care consultant, and a psychologist.MethodA total of 15 experts participated in the meetings. Both meetings were audio-recorded, transcribed verbatim, and analysed using thematic analysis.ResultsFour themes emerged from the meetings: support provided by healthcare professionals, influencing public opinion, educational activities, and managing time and work pressure. The need for support was considered highest for GPs for all of these themes.ConclusionConsensus was reached with the help of experts on support needs for GPs confronted with euthanasia requests from PWD. A concise and clear explanation of the law is strongly desired. Changing public opinion seems the most challenging and a long-term aim. Communication training for finding the right balance between the physician’s professional responsibility and the patient’s autonomy should be made available, as a short-term aim.

Being There, Virtually Being There, Being Absent : Chaplaincy in Social Care During the COVID-19 Pandemic

The term “being” has featured frequently in publications about the role of&nbsp;chaplains in health and social care. Generally, this has described the physical presence&nbsp;of chaplains among people either during routine pastoral encounters or at critical&nbsp;moments in their lives. The COVID-19 pandemic has led to differentiated practices for&nbsp;chaplains in the UK’s largest charitable care provider for older people. Some chaplains&nbsp;continued to be present in residential care facilities; some provided at-distance support;&nbsp;and some were absent, both physically and virtually. This article begins by discussing&nbsp;the significance of “being” in the context of chaplaincy. It goes on to offer examples of&nbsp;analysis, drawing on chaplaincy experience during the pandemic based on six interviews&nbsp;conducted in the final week of May 2020. From these interviews, an evaluation&nbsp;is made of chaplaincy during the crisis as: being present; virtually being present; and&nbsp;being absent. It is noted that questions about the chaplain’s location in a crisis are not&nbsp;unprecedented. A discussion of pastoral care during the pandemic suggests that presence&nbsp;and in-person encounter remain key aspects of being, and that recent experience&nbsp;has clarified the importance of embodied support for those who are suffering. However,&nbsp;it is also noted that under certain conditions a virtual pastoral encounter has value, can&nbsp;convey impact, and is of consequence.

Feasibility and acceptability of a telephone-based chaplaincy intervention in a large, outpatient oncology center.

PurposeTelechaplaincy (the use of telecommunications and virtual technology to deliver spiritual and religious care by healthcare chaplains or other religious/spiritual leaders) is a relatively novel intervention that has increasingly been used in recent years, and especially during COVID-19. Telephone-based chaplaincy is one mode of telechaplaincy. The purpose of this study was to (1) describe telephone-based chaplaincy interventions delivered as the first point of contact to patients who screen positive for religious/spiritual concern(s) using an electronic data system, and (2) assess the feasibility and acceptability of delivering interventions in an outpatient cancer institute using this methodology.MethodsPatients were screened for religious and spiritual (R/S) concern(s) using an electronic data system. Patients indicating R/S concern(s) were offered a telephone-based chaplaincy intervention and asked to complete a survey assessing acceptability of the intervention. Feasibility and acceptability data were collected.ResultsThirty percent of screened patients indicated R/S concern(s). Telephone-based chaplaincy interventions were offered to 100% of eligible patients, establishing contact with 61% of eligible patients, and offering chaplaincy interventions to 48% of those patients. Survey participants report high acceptability of the offered intervention.ConclusionThis is the first study examining feasibility and acceptability of telephone-based chaplaincy with oncology patients. Telephone-based chaplaincy is feasible and acceptable within an outpatient oncology setting, supporting the promise of this interventional strategy. Further research is needed to refine practices.