Pastoral Care Staff Research Articles

Measuring the impact of a pastoral care intervention to increase referrals and improve the quality of chaplain documentation in patient records

The complexity of patient care demands that health care teams collaborate effectively. This means that when pastoral care staff engage with patients, they need to communicate their findings to other members of the multidisciplinary team to maximize patient benefits. In 2016, an Australian hospital found that pastoral care staff were able to visit only 30% of admitted patients, and that documentation of pastoral care visits was minimal. This paper describes and measures the impact of a quality improvement education program for pastoral care workers by auditing patient medical records pre- and post-intervention. The intervention did not significantly increase the number of pastoral care visits or referrals. Documentation of pastoral care visits was significantly improved in terms of the detail provided. More work is required to standardize indications for pastoral care referral and templates for pastoral documentation in patient medical records.

Adolescent-Centric Design of an Online Safety Chatbot

ABSTRACT Adolescents encounter numerous online challenges, including privacy breaches, cyberbullying, and online sexual harm, jeopardizing their well-being. Traditional interventions like counseling and educational programs are crucial but face accessibility and resource constraints. However, emerging technologies present new possibilities. Chatbots, known for their versatility in providing support, are gaining traction as a viable solution for adolescent online safety and mental health. This study investigates the potential of chatbots in aiding adolescents affected by online harms by conducting focus groups with students and pastoral care staff. Through thematic analysis, functional requirements for an effective chatbot were developed, revealing their capability to deliver immediate, personalized support, thereby mitigating barriers like cost and stigma associated with seeking professional help. This research underscores the importance of participatory design in crafting interventions that effectively meet adolescents’ mental health needs and combat online harms.

A Most Significant Change evaluation of a new co-designed tool to measure holistic well-being in consumers of community aged care services.

To evaluate a Wellbeing Check-in tool and process for use with BlueCare's home care package (HCP) clients by care and well-being practitioners. The tool had been co-designed with HCP clients and trialled with 15 clients. The Most Significant Change (MSC) methodology was used to gather stories from five practitioners, five HCP staff and seven clients. A workshop with senior staff was held to determine themes and whether the tool met its aims. Out of 22 MSC stories, 18 were judged in scope by workshop participants. Eight themes were then identified. Four themes reflected the content of the narratives (i.e. what was discussed): Isolation and connection; Grief; Faith/explicit spirituality; and Client preference. The other four themes reflected the process (i.e. what the discussions meant to participants): Being there/Meaningful conversations; Impact on significant others; New insight; and Purpose of the check-in. These eight themes largely reflected the aims of the Wellbeing Check-in tool in terms of providing a means to optimise connectedness, well-being and spiritual care in accordance with the client's needs, goals and preferences. Unanticipated findings included its benefits for family members and uncertainty about the aim or value of the tool, which highlighted the need for BlueCare to be clear about the purpose of the tool in promoting it to clients and their informal carers. The Wellbeing Check-in tool was found to be fit for purpose. A tool used flexibly to prompt discussion about well-being can be helpful to clients and pastoral care staff.

Making sense of experience: tools for collaboration with children and young people with social, emotional and mental health needs at points of school transition

ABSTRACTMany teachers, pastoral care staff, counsellors, psychologists and others from related disciplines who support children and young people’s (CYP’s) personal, social and emotional development are concerned by declining well-being and the increased demand for pastoral care and counselling for students with social, emotional and mental health (SEMH) needs. For practitioners to meet these SEMH needs effectively requires both an understanding of them and, more importantly, how CYP themselves make meaning from them. Psychological theories, especially those applicable to exploring experiences that evoke strong emotions, are vital. This paper outlines one such theory-informed approach: a collaborative approach to SEMH assessment at times of school transition. Specifically, it examines a novel use of projective techniques (PTs), where CYP are asked to provide a free-flow response to a stimulus [Content] and then think together with the practitioner about this response [Dialogue]. Reflective accounts of the method are provided to outline how it can support CYP’s engagement in assessment; enhancement of shared insights in formulation and personalisation of interventions. These are critical case study vignettes of using this new approach in applied practice, and there is a priority need for further empirical research. Other limitations and strengths of using PTs are outlined, and implications for future developments provided. Finally, an argument is made that system level transformation may be required if the necessary support for school-based staff to make effective use of these tools is to be realised.

Australian Patient Preferences for Discussing Spiritual Issues in the Hospital Setting: An Exploratory Mixed Methods Study

While there is high patient acceptance for clinical staff discussing issues regarding spirituality with hospital inpatients, it is not clear which staff member patients prefer for these discussions. This unique exploratory study investigated inpatient preferences regarding which staff member should raise the topic of spirituality. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). Pastoral care staff (32.9%) were the preferred staff members with whom to discuss spiritual issues, followed by doctors (22.4%). Qualitative findings indicated that individual characteristics of the staff member are more important than their role.

What is the role of spiritual care specialists in teaching generalist spiritual care? The perspectives of pastoral care staff in a large Catholic health and aged care organisation.

The value of spiritual care training for all staff working in health and aged care has been demonstrated. This study investigated how spiritual care specialists (SCSs) perceive their role in delivering spiritual care education to other staff. Fourteen SCSs participated in three online focus groups. Two key themes were identified: First, SCSs build upon existing capacity of staff by: (i) recognising existing strengths and capabilities; (ii) using relevant stories; (iii) using language which makes spiritual care accessible; (iv) making training relevant and practical; (v) tapping into staff vocation or calling; and (vi) building awareness of one’s own spirituality. Second, SCSs assist staff to draw upon SCS expertise by establishing a trusting relationship and developing staff awareness of the SCS role. The SCS’s role in delivering spiritual care education is an important one, and further consideration regarding how to support them in this role is warranted.

The case for trauma-informed behaviour policies

ABSTRACT Current behaviour policies, which focus around reward and deterrent, have only limited long-term effectiveness. They assume that students can exercise self-control and follow rules, when motivated to do so. Students with special educational needs and disabilities typically have many intrinsic challenges to self-regulation, due to executive function difficulties, leading to them having frequent negative experiences of behaviour management practices which compound the challenges they face in schools. When children struggle to follow the rules, their anxiety tends to rise and they may experience many situations during the school day as threatening, leading to the ‘fight, flight or freeze’ response. This escalates behaviour that schools view as challenging. An alternative approach to management of behaviour comes from ‘trauma-informed’ education where all behaviour is seen as a form of communication and an opportunity to develop self-regulation. Pastoral care staff can lead the way to a view of students as on a journey of increased self-insight and self-management that will stand them in good stead throughout their lives.

Understanding the Experience and Needs of School Counsellors When Working with Young People Who Engage in Self-Harm.

Self-harm rates are increasing globally and demand for supporting, treating and managing young people who engage in self-harm often falls to schools. Yet the approach taken by schools varies. This study aimed to explore the experience of school staff managing self-harm, and to obtain their views on the use of guidelines in their work. Twenty-six pastoral care staff from New Zealand were interviewed. Interviews were analyzed and coded using thematic analysis. Three themes emerged: The burden of the role; discrepancies in expectations, training, and experience; and the need for guidelines to support their work. This research, therefore, demonstrated a need for guidelines to support school staff to provide support around decision making and response to self-harm in the school environment.

Patients' and Caregivers' Contested Perspectives on Spiritual Care for Those Affected by Advanced Illnesses: A Qualitative Descriptive Study

ContextSpiritual care refers to practices and rituals addressing spiritual/religious concerns. It supports coping with loss and finding hope, meaning, and peace. Although integral to palliative care, its implementation is challenging. ObjectiveTo understand an Australian cohort of patients' and caregivers' perspectives about experiencing and optimizing spiritual care in the context of advanced illness. MethodsPatients and caregivers of patients with ≤12 month prognosis were recruited from a broader spiritual study via criterion sampling and agreed to opt-in interviews. Participants from an Australian, metropolitan health service received a spiritual care definition and were interviewed. Transcripts were analyzed using qualitative description. Results30 patients (17 male; mean age 70 years) and 10 caregivers (six male; mean age 58.9 years) participated. 27 identified as Christian, and 10 had no religion. Participants described multifaceted and contested beliefs about spirituality. Many queried the tangibility of spirituality, but all valued respectful staff who affirmed personhood, that is, each individual's worth, especially when care exceeded expectations. They also resonated with positive organizational and environmental tones that improved holistic well-being. Participants stressed the importance of the hospital's welcoming context and skilled care, which comforted and reassured. ConclusionAlthough many patients and caregivers did not resonate with the term “spiritual care,” all described how the hospital's hospitality could affirm their values and strengthen coping. The phrase “spiritual care and hospitality” may optimally articulate and guide care in similar, pluralist inpatient palliative care contexts, recognizing that such care encompasses an interplay of generalist and specialist pastoral care staff and organizational and environmental qualities.

Left behind and left out: The impact of the school environment on young people with continence problems.

ObjectivesTo explore the impact of the secondary school environment on young people with continence problems.DesignIn‐depth qualitative semi‐structured interviews.MethodsWe interviewed 20 young people aged 11–19 years (11 female and nine male) with continence problems (daytime wetting, bedwetting, and/or soiling). Interviews were conducted by Skype (n = 11) and telephone (n = 9). Transcripts were analysed using inductive thematic analysis.ResultsWe generated five main themes: (1) Boundaries of disclosure: friends and teachers; (2) Social consequences of avoidance and deceit; (3) Strict and oblivious gatekeepers; (4) Intimate actions in public spaces; and (5) Interrupted learning.ConclusionDisclosure of continence problems at school to both friends and teachers was rare, due to the perceived stigma and fears of bullying and social isolation. The lack of disclosure to teachers and other school staff, such as pastoral care staff, creates challenges in how best to support these young people. Young people with continence problems require unrestricted access to private and adequate toilet facilities during the school day. There is a need for inclusive toilet access policies and improved toilet standards in schools. Addressing the challenges faced by young people with continence problems at school could help to remove the barriers to successful self‐management of their symptoms. It is particularly concerning that young people with continence problems are at higher risk of academic underachievement. Increased support at school is needed to enable young people with continence problems to achieve their academic potential. Statement of Contribution What is already known on this subject? Continence problems are among the most common paediatric health problemsSelf‐management of continence problems requires a structured schedule of fluid intake and bladder emptyingInadequate toilet facilities and restricted access make it difficult for young people to manage their incontinence What does this study add? Improvement is needed in teacher understanding of the needs of young people with continence problemsYoung people are reluctant to disclose continence problems due to perceived stigma and fear of social isolationYoung people with continence problems may be at increased risk of academic underachievement

A Machine Learning Approach to Evaluating Illness-Induced Religious Struggle.

Religious or spiritual struggles are clinically important to health care chaplains because they are related to poorer health outcomes, involving both mental and physical health problems. Identifying persons experiencing religious struggle poses a challenge for chaplains. One potentially underappreciated means of triaging chaplaincy effort are prayers written in chapel notebooks. We show that religious struggle can be identified in these notebooks through instances of negative religious coping, such as feeling anger or abandonment toward God. We built a data set of entries in chapel notebooks and classified them as showing religious struggle, or not. We show that natural language processing techniques can be used to automatically classify the entries with respect to whether or not they reflect religious struggle with as much accuracy as humans. The work has potential applications to triaging chapel notebook entries for further attention from pastoral care staff.

"Concerns" about medical students' adverse behaviour and attitude: an audit of practice at Nottingham, with mapping to GMC guidance.

BackgroundThe development and maintenance of students’ professional behaviour and attitude is of increasing importance in medical education. Unprofessional behaviour in doctors has the potential to jeopardise patient safety, compromise working relationships, and cause disruption and distress. The General Medical Council issues guidance to medical schools and students describing the standards that should be attained.Nottingham University medical school introduced a ‘Concerns’ form in 2009, to create a standardised, transparent and defensible means of recording and handling complaints about adverse attitudes or behaviours. This paper reports an audit of the system over the first three years.MethodsThe routinely-held database was enhanced with further detail collected from relevant student records. The data were explored in terms of the types of complaint, students who were reported, the people who reported them, and the actions taken afterwards. The data were also mapped to the current GMC guidance.Results189 valid forms were generated, relating to 143 students. The form was used by a wide variety of people, including clinical and non-clinical teachers, administrators, Hall Wardens, and fellow students. The concerns ranged from infringements of regulations to serious fitness to practise issues. Most were dealt with by faculty or pastoral care staff but some required escalation to formal hearings. The complaints were mapped successfully to GMC documentation, with the highest proportions relating to the GMC categories ‘Good Clinical Care’ and ‘Working with Colleagues’.Male and ethnic minority students appeared to be more likely to have a Concern raised, but this is a tentative conclusion that requires a larger sample. Undergraduate (as opposed to Graduate Entry) students may also be at greater risk.ConclusionsA simple form, freely available, but designed to prevent frivolous or malicious use, has provided valuable data on unprofessional behaviour and the responses elicited. Some parts of the form require improvements, and these are underway to provide more efficient use, audit and review in future.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-196) contains supplementary material, which is available to authorized users.

“A guide to interpreting not just the words but the meaning intended” (A DVD to support interpreters, health care, pastoral and spiritual care staff involved in end of life and organ donation discussions with culturally and linguistically diverse (CALD) families)

“A guide to interpreting not just the words but the meaning intended” (A DVD to support interpreters, health care, pastoral and spiritual care staff involved in end of life and organ donation discussions with culturally and linguistically diverse (CALD) families)

Do-Not-Resuscitate Orders in the Last Days of Life

The purpose of this analysis was to describe the presence and timing of do-not-resuscitate (DNR) orders for imminently dying patients in VA Medical Centers, and to examine factors associated with these processes. Data on DNR orders in the last 7 days of life were abstracted from the medical records of 1,069 veterans who had died in one of six VA hospitals in 2005. Of the 1069 records, 681 (63.7%) had an active DNR order at time of death. Among these, records indicated that the order was written within the last 24 hours for 219 (32.2%), 1-2 days prior to death for 54 (7.9%), 3-7 days prior to death for 256 (37.6%), and > 7 days prior to death for 152 (22.3%). Veterans with a family member present at time of death and those who received pastoral care visits were more likely to have DNR orders. African American veterans and veterans who died unexpectedly were less likely to have DNR orders. Compared with those dying on a general medicine unit, veterans dying in the emergency department or an intensive care unit (ICU) and veterans dying during a procedure or in transit were less likely to have DNR orders. Mental health diagnoses were not associated with presence of a DNR order. Results suggest that the DNR process might be improved by interventions that target ICU settings, facilitate transitions to less intensive locations of care, ensure the involvement and availability of pastoral care staff, and create environments that support the presence of family members.

Medical Director Finalists Share Their Secrets to Success

Medical Director Finalists Share Their Secrets to Success

Quality of education at multidisciplinary case conferences in psychiatry

A large Dublin-based teaching hospital facilitates a weekly Psychiatric Case Presentation meeting, which is relatively unique in medicine and even in psychiatry, in that there is a large variety of attendees from various multidisciplinary groups: consultant psychiatrists, psychiatric trainees, nurses, psychologists and psychoanalytic psychotherapists, occupational therapists, social workers and pastoral care staff. The aim of this audit is to assess the quality of education for members of different disciplines at these meetings, and to highlight the differing learning needs of the attendees. Group-structured assessments and Likert scale questionnaires were used to identify what attendees thought were educational and what needed to be improved. Overall, the case conference is educationally worthwhile but there were several areas of dissatisfaction. Some felt that the case conference was overly medical in its orientation and that there was excessive medical jargon. The seating arrangements were not conducive to group discussion. Consultants and psychiatric trainees felt that the quality of the clinical presentations could be improved. Presentation skills teaching classes and topic-based classes would be useful inclusions. Feedback to the multidisciplinary group on the patients' progress and feedback to the patient is important. Changes were implemented in areas of dissatisfaction, and these changes evaluated. The educational qualities of multidisciplinary Case Conferences need to be constantly evaluated to ensure that the learning needs of the different disciplines who attend are being met.

Supportive Leadership: Improving Organisational Health and Preventing Burnout in Pastoral Care Managers and Staff

AbstractThis study examined the efficacy of an evidence based supportive leadership program to address psychosocial hazards identified in an organisational health review of a pastoral care organisation. Participants were employees and volunteers identified as having supervisory or management roles (N = 24; M = 11, F = 13; Age Range = 24 to 68), including the Senior Leadership Team (SLT; n = 7). The supportive leadership program was implemented over a 12-month period with follow-up over another 12-month period. Organisational health was measured through the use of the Health and Safety Executive Indicator Tool (HSE, 2004b) and qualitative interview data at pre-intervention and at 12- and 24-month follow-up. The results of the HSE Tool were compared over time, utilising the comparison benchmarks provided by the HSE (2004b). Results indicated notable improvements in organisational health within the SLT with reductions in risk status at 24-month follow-up across the domains of Control, Managerial Support, Peer Support, Relationships, Role and Change. Supportive leadership is a key predictor in organisational health and burnout, and importance in improving organisational health across managers.

Trends in Publication of Spirituality/Religiosity Articles in Critical Care Populations

Research on spirituality and religion (S/R) is receiving more attention as healthcare staff recognize the importance of treating the whole person. This is especially pertinent in critical care, where patients and families deal with a multitude of issues. As not all research comes exclusively from theologically educated authors, this study explored publication trends of S/R articles in critical care. Findings indicated medically credentialed professionals, not chaplains and/or pastoral care staff, constituted the majority of authors in S/R articles.

Multiperspektivisch denken und lehren

Chaplains in clinical settings have to prove their competency in questions of clinical bioethics on three levels: in counselling patients and relatives, in cooperating with other professions within the organisational context, and through their engagement in teaching. The essay presents the experience of involvement of health care chaplaincy within the context of a university hospital in counselling patients and teaching med school students. It shows the necessity to focus on ethical competency of pastoral care staff within a multiprofessional context.

From music into silence: an exploration of music‐thanatology vigils at end of life

AbstractRecently Helen Cox recorded a conversation with music‐thanatologist, Peter Roberts (Spirituality & Health International, 2006, Vol. 7, No. 1). This paper describes aspects of the findings from a multi‐method study into the effects of this work on six patients who were inpatients at St John of God Hospital in Geelong. A total of 21 live harp vigils were observed over a period of nine months. A researcher observed and recorded details of each vigil, interviewed patients, relatives, nurses and pastoral care staff, and recorded personal observations. The music‐thanatologist audiotaped reflections after each vigil. This paper describes findings from the perspective of patients. A key finding of this research is that music‐thanatology makes a profound difference to the way that people experience the end‐of‐life journey. The prescriptive live harp music vigils take people beyond the music into a silence that is deeply spiritual and profoundly comforting. Copyright © 2007 John Wiley & Sons, Ltd.