Spiritual aspects of care for adolescents with cancer

AIMS AND BACKGROUND

Adolescents with cancer have psychosocial issues that need to be adequately addressed. Spirituality is a fundamental aspect of their psychological well-being.

METHODS

A chaplain is a daily presence in the Youth Project ward for adolescents at the Pediatric Oncology Unit of the Istituto Nazionale Tumori, Milan. The chaplain conducts daily visits to the ward and the outpatient clinic/day hospital, holds daily meetings with the psychologists on staff, and attends biweekly meetings with doctors and/or nurses. The cases of patients referred for spiritual assistance between January and December 2012 were analyzed by patient age and reasons for consultation, and were compared with cases referred for psychological consultation.

RESULTS

A psychological consultation was offered to 84% of patients/families, and further support was needed for 23% of children and 45% of teenagers. Spiritual support was provided for 2 children and 20 adolescents (24% of the sample considered).

CONCLUSIONS

Acknowledgment of their spiritual needs helps patients to battle with their disease. The reasons patients and parents ask for spiritual assistance only partially overlap with the motives behind requests to see a psychologist. The care of adolescents with cancer should include catering for their spiritual needs by assuring the constant presence of a chaplain on hospital wards.

Language and practice changes in Canadian and US specialized pastoral care and counseling: a conversation

On August 20, 2013, Terry Bard, John Carr, and Steve Ivy had a 50-minute conversation about the shift that has been taking place in Canada and the United States in the practice, and the language about that practice, of persons and professional associations that have historic roots in the modern pastoral care and counseling movement. The conversation was digitally recorded, by agreement among the three participants, and is posted on the internet as a stimulus to further conversation.

Pastoral counseling in the 21st century: the centrality of community

In this article, I argue that the notion of ecclesia or faith community is a central, existential anthropological premise that can shape how we understand facets of pastoral counseling such as diagnosis, process, and aims. Implicit here is the idea that the distinctiveness of pastoral counseling lies not simply in accountability and authority vis-à-vis community, but in its use of a communitarian anthropology to understand the importance of community for psychosocial development, resiliency, and healing. I argue further that in the 21st century the centrality of the notion of community is, and will continue to be, critical, because of political and economic forces that undermine community, giving rise to psychosocial alienation, depression, etc.

Ethics in pastoral care and counseling: a contemporary review of updated standards in the field

This article reviews ethical responsibilities that must be considered when engaging in pastoral care, counseling, and psychotherapy. It discusses important contemporary issues counselors will want to contemplate in pursuing a high quality of care in their counseling practices. Examples and case studies are provided. Readers will be able to: Understand the function of ethical standards in the practice of counseling Be able to differentiate between pastoral care, pastoral counseling, and pastoral psychotherapy and their ethical implications Understand the importance of identifying one's limitations in counseling situations and how to proceed under such circumstances. Understand the need for pastoral counselors to attain the necessary credentials for practice in the area of counseling they intend to undertake. Become aware of the legal requirements when engaged in a counseling relationship.

Health care chaplains and their role on institutional ethics committees: an Australia study

This paper presents the results of the largest Australian pastoral study concerning the perceptions of health care chaplains about their involvement on hospital research ethics committees (also known in some contexts as institutional ethics committees). Survey results from over 300 Australian health care chaplains indicated that nearly 90% of chaplains believed there was merit in chaplains serving on hospital research ethics committees, yet only a minority (22.7%) had ever participated on such committees. Data from in-depth interviews is also presented exploring the reasons for the lack of participation and the varying opinions regarding the role, appropriateness, and value of chaplains on ethics committees. Some implications of this study with respect to chaplaincy, hospital research ethics committees, health care institutions, ecclesiastical institutions, and government responsibilities are discussed.

'In need of further tuning': using a US patient satisfaction with chaplaincy instrument in a UK multi-faith setting, including the bereaved

Healthcare chaplaincy research seems further advanced in the USA. Here a US patient satisfaction with chaplaincy instrument (PSI-C-R) was used in a London NHS foundation hospital with a multi-faith chaplaincy team and population. A version of the instrument was also generated for the bereaved. PSI-C-R had not been subjected to test-retest to confirm its reliability so this was done at the pilot stage. It proved only partly reliable, but in three separate surveys a cluster of highly rated factors emerged, as in earlier studies: chaplains' prayer, competence, listening skills and spiritual sensitivity. Low-rated factors and qualitative data highlighted areas for improvement. Disappointing response rates arose from patient acuity, ethical concerns about standard follow-up protocols, and the Western Christian origins of the instrument which requires further revision for multi-faith settings, or the design of new instruments.

But What Are We Trying to Prove?

Chaplaincy and Clinical Pastoral Education (CPE) in the health care setting can and should approach their ministries more scientifically, primarily by incorporating the methods and results of quantitative and qualitative research. Such an approach, however, should have a carefully considered rationale. Proponents of a scientific approach should avoid associating their advocacy with dubious notions of health care "reform." They should attend to the perceptions--and fears--that chaplains may have of "science" and research as these affect pastoral care. In particular, fears for professional and programmatic survival should be recognized for their potential to predispose chaplains either favorably or unfavorably toward a scientific approach. Ultimately, chaplains should increase their openness to scientific methods in order to learn more about their ministry and improve their practice, without expecting that the adoption of research methods will be a magical solution to the problems posed by the current environment.

Chaplains and Science

The decision between science and religion is eroding. The changing relationship is associated with the discovery of similarities between science and religion. Chaplains must become more comfortable with science and let it inform our ministry.

An evidence base for a palliative care chaplaincy service in Northern Ireland

Palliative care encompasses spiritual as well as physical, social and psychological aspects. Spiritual care has been identified as a key concern of dying patients. During an audit of the Northern Ireland Hospice chaplaincy service against the national Standards for Hospice and Palliative Care Chaplaincy (2003), 62 patients' spiritual needs along with their interactions with the hospice chaplains were assessed by using a questionnaire survey and reviewing data recorded on their pastoral care notes. Findings suggest that the Standards were useful for assessing and addressing spiritual needs. Access to the chaplaincy service (Standard 1) was partially met and Standard 2's spiritual criteria were fully met. The participants, of whom 92% had a faith in God or a Higher Being, highlighted their top six spiritual needs as: to have the time to think; to have hope; to deal with unresolved issues; to prepare for death; to express true feelings without being judged; to speak of important relationships. The majority of the participants (82%) felt their spiritual needs had been addressed and viewed their interaction with the chaplaincy service positively. Recommendations were made relating to improve communication of chaplaincy services.

What Training Should Be Required as an Education Standard for Healthcare and Hospital Chaplains?

This document discusses training for hospital and healthcare chaplains in the light of different UK standards applied by various interested parties. It considers the different standards and concludes that there is no single applied standard for training for National Health Service (NHS) hospital chaplains across the UK. Those models that do exist take differing approaches, with some basing their systems on normatively defined views of what a chaplain needs to be effective on functional (NHS managerial) or interpersonal (clinical pastoral) levels, while others take a more hybrid approach blending these approaches with doctrinal concerns. Equally, there is wide variation across different denominations and employers. This document seeks to identify where there is common ground on domains of competence for chaplaincy training and suggest some progress for training which fits into NHS structures and systems.

The Development, Status, and Future of Healthcare Chaplaincy

This review article provides insight into the evolution of professional healthcare chaplaincy. It identifies key historical developments identifying the training, qualifications, and competencies of chaplains. Consideration is given to both the unique character of the pastoral role in healthcare as well as the contribution of chaplains to the interdisciplinary care of patients and families. The article points to the emerging need for chaplains to pursue research within the clinical context.

Cultural Diversity in Pastoral Care

Fukuyama and Sevig are counseling psychologists who have a particular interest in the integration of spirituality into multicultural counseling and training. In this article the authors address the complexity of integrating religious and cultural diversity and spirituality into chaplaincy care in the context of an increasingly diverse society. By posing a series of questions, the authors systematically clarify definitions and meanings of culture, spirituality, cultural diversity and multiculturalism, multicultural and spiritual competencies in counseling, and ethical considerations. The authors discuss clinical applications in the context of a "spirituality and health movement," and provide suggestions for continuing professional development. The authors support the notion that multicultural engagement is spiritually synergistic, and encourage health care providers to communicate across professional disciplines to broaden and enrich discourse on these topics.

The Search for Spiritual/Cultural Competency in Chaplaincy Practice: Five Steps that Mark the Path

Chaplains who are clinically trained and certified spiritual care professionals can make a unique contribution in today's increasingly pluralistic and global health care context with diverse religious, spiritual and cultural values, beliefs and practices. The author characterizes this contribution as spiritual/cultural competency. A self-defined web of meaning is unique to each person, comprised of a composite of values and beliefs, a fabric woven by way of one's life narrative. The proven approach of clinical learning, with heightened introspective and interpersonal awareness, serves as the chaplain's primary pathway to multi-spiritual/cultural competency, integrated with the exploration of context in a way not prioritized before. Utilizing sources from pastoral theology, anthropology and multicultural counseling, a five-step process of competency assessment is introduced and discussed with the aid of two cases. Knowing one's own spiritual/cultural grounding is the first step in this open-ended search.

In the world but not of the world: going beyond a dilemma

Is the issue addressed in this volume a question like "What time is it?" or a quest-ion like "What is time?" I argue that it is a quest-ion that requires professional chaplaincy to quest for an answer although it will always have blurred edges that lack succinctness, clarity, and certainty. The challenge posed by the quest-ion means that we must transform the dilemma into a higher synthesis that respects the qualitative aspects inherent in the profession.

Addressing patients' emotional and spiritual needs

BACKGROUND

A comprehensive, systematic literature review and original research were conducted to ascertain whether patients' emotional and spiritual needs are important, whether hospitals are effective in addressing these needs, and what strategies should guide improvement.

METHODS

The literature review was conducted in August 2002. Patient satisfaction data were derived from the Press Ganey Associates' 2001 National Inpatient Database; survey data were collected from 1,732,562 patients between January 2001 and December 2001.

RESULTS

Data analysis revealed a strong relationship between the "degree to which staff addressed emotional/spiritual needs" and overall patient satisfaction. Three measures most highly correlated with this measure of emotional/spiritual care were (1) staff response to concerns/complaints, (2) staff effort to include patients in decisions about treatment, and (3) staff sensitivity to the inconvenience that health problems and hospitalization can cause.

DISCUSSION

The emotional and spiritual experience of hospitalization remains a prime opportunity for QI. Suggestions for improvement include the immediate availability of resources, appropriate referrals to chaplains or leaders in the religious community, a team dedicated to evaluating and improving the emotional and spiritual care experience, and standardized elicitation and meeting of emotional and spiritual needs. Survey data suggested a focus on response to concerns/complaints, treatment decision making, and staff sensitivity.

A systematic review on chaplains and community-based clergy in three palliative care journals: 1990-1999

A systematic review of all articles appearing between 1990 and 1999 in the American Journal of Hospice and Palliative Care, the Hospice Journal, and the Journal of Palliative Care was conducted. Articles citing at least one reference were categorized as scholarly, included in the study, and divided into either research or nonresearch categories. Scholarly articles were classified as research if they contained clearly defined methods and results sections, even if these headings were not used. Research and nonresearch articles were subdivided into qualitative and quantitative research and general reviews or program descriptions, respectively. All scholarly articles were read to see if they mentioned clergy, including the terms rabbi, priest, minister, pastor, imam, chaplain, or other religious professionals. Of 838 scholarly articles published between 1990 and 1999 in the three journals, 348 (41.5 percent) were research articles, 417 (49.8 percent) were reviews, and 73 (8.7 percent) were program descriptions. Forty-seven (5.6 percent) of all 838 scholarly articles mentioned clergy or chaplains in some way. Clergy and chaplains were more likely to be an integral part of research articles, whereas mention of them in nonresearch articles tended to be incidental (chi-square = 16.8, p < .001). Moreover, quantitative articles were more likely to include clergy as an integral aspect of the article than were qualitative articles (Fischer's exact probability test, p = .088). The results are discussed with respect to the mutual roles hospice chaplains and community-based clergy play in providing spiritual care at the end of life.

Ministry for the Good of the Whole

Clinical pastoral education and professional chaplaincy have long struggled with their relationships to various scientific worlds. With others, I affirm that the Emmanuel Movement, which produced unprecedented collaboration between clergy and physicians, died because its leaders failed to grow, to continue collaboration, and to train other physicians. I describe various indicators that suggest an increasing rapport between pastoral care and the sciences.

How many chaplains per 100 inpatients? Benchmarks of health care chaplaincy departments

Reports the results of a questionnaire survey of a sample of chaplaincy departments directors (N = 370) designed to answer the following questions: How many chaplains do various types of hospitals employ per 100 inpatients? What is the relationship between the number of employed chaplains and departmental Clinical Pastoral Education (CPE) programs? How much effort do departments give to outpatient ministry? What percentage of ministry do volunteer chaplains provide? Provides tentative answers to inform the strategic planning processes of chaplains and administrators.

An adaptation of The Discipline in a clinical pastoral education program. Interview by Larry VandeCreek

The author describes his perspective on providing pastoral care to hospital patients, his search for new ways to understand that ministry, his first contact with The Discipline, and his adaptation of it to the clinical and educational programs at his center. He discusses the need to help clinical pastoral education students to operationalize their ministry and to learn how to identify outcomes that are meaningful to health care decision makers.

Racial and gender myths as key factors in pastoral supervision

Explores the various dynamics activated when a black male supervisor and a white female supervisee are part of a Clinical Pastoral Education team. Uses the notion of racial and gender myths as a way to understand such a relationship. Claims that it is exceedingly important to train culture and gender conscious supervisors and that such training can lead to significant racial and gender learnings having implications beyond the CPE context.

Utilizing a JCAHO review in the education of clinical pastoral education CPE residents

Reflects on how a pastoral care department utilized a Joint Commission review in the education of five pastoral care residents enrolled in their third unit of Clinical Pastoral Education in a medical center. Outlines how residents prepared for the review, the learning opportunities for residents and medical staff, the outcomes, and the recommendations.

What five clinical pastoral education residents discovered from a JCAHO review

Discusses the process one pastoral care department and its five residents used to prepare for a JCAHO review and reports the experience, detailing questions asked and chaplains' responses when they sat in on twenty unit reviews.

Vinegar and oil: are the moral/ethical decision processes by professional prison chaplains superior to hospital chaplains?

Reports research with chaplains from the Federal Bureau of Prisons and the Department of Veteran's Affairs concerning the impact a prison setting or a hospital setting may have in meeting the dilemmas often encountered in the areas or moral and ethical decision making.

Bioethics education in a clinical pastoral education program

Notes that contemporary health care delivery and the interface of clinical professionals with patients and families are marked by complexity and pluralism and that within this modern matrix patients, families, professionals, and administrators frequently struggle with difficult ethical issues. Observes that these realities have significant implications for chaplains and for chaplains-in-training, a factor which has received the attention of the Bioethics Committee of the Professional Chaplains Association through its Bioethics Committee and resulting in a set of guidelines for the chaplain's appropriate roles in bioethical issues and for their role on bioethics committees. Describes the establishment of a bioetchics modulate at the Cleveland Clinic Foundation (CCF) in which chaplain residents are enabled to function as professional peers with other healthcare professionals and as competent chaplains with patients and families in bioethical decision making. Reports on the methods and the results of a pilot study based on the model described.

The intellectual foundation of pastoral counseling: a perspective on the future of the profession

Reflects on the intellectual nature of pastoral counseling, compares it with certain aspects of contemporary research in psychiatry and clinical psychology, and offers some observations regarding the uniqueness of pastoral counseling as a profession. Argues that pastoral counseling can offer a truly wholistic view of mental health if (1) its intellectual foundation is developed in theological perspective, (2) continues to integrate its theological dimension with clinical psychology and psychiatry, and (3) evaluates its applied research within the framework of the normative standards of mental health.

Patient rights issues and their implications for pastoral caregivers

Reports on actual results of operationalizing the "spiritual concerns" dimension of the Patient Self-Determination Act in one hospital setting. Opines a variety of implications for hospital chaplains and for Clinical Pastoral Education.

Pediatric pastoral care: a case study

Uses the case of a four-year-old boy to illustrate ways in which psychosocial, religious, and spiritual concepts and notions are translated into actual acts of pastoral and clinical care carried out by a chaplain.

The value of hospital chaplains: patient perspectives

Reports the results of a questionnaire mailed to insurance claimants (N = 2480) recently discharged from a hospital. Analyzes the results and concludes from the data that patients place high value on pastoral services. Suggests that both hospital administrators and chaplains make sure that adequate attention be given to serving patient families, long-stay and repeated admission patients, and to the patients' demonstrated need for frequent visits, particularly in these times of rapid changes in condensing hospital stays.