Human Development and Pastoral Care in a Postmodern Age: Donald Capps, Erik H. Erikson, and Beyond

This article discusses Donald Capps's use of Erik H. Erikson's life-cycle theory as the basic psychological framework for his theory of pastoral care. Capps was attracted to Erikson's existential-psychological model, his hermeneutic approach, and his religious sensitivity. Capps's thought develops from first exploring biblical foundations for using Eriksonian theory for pastoral care to gradually embracing certain postmodern features. The article concludes with reflections on the usefulness of Erikson's life-cycle theory and Capps's work for contemporary pastoral care.

Improving Spiritual Care in Hospitals in the Netherlands: What Do Health Care Chaplains Involved in an Action-Research Study Report?

Health care chaplains participated in a multicenter trial to explore an implementation strategy for the Dutch multidisciplinary guideline for spiritual care. The intervention was concise spiritual care training for hospital staff of departments where patients in curative and palliative trajectories are treated. Data were collected in semistructured interviews with chaplains who acted as trainers, before and after the intervention. Results based on nine preintervention and eleven post-intervention interviews are presented. During preintervention interviews, chaplains describe the baseline situation of palliative care in Dutch hospitals, barriers, and opportunities for improving spiritual care. In the postintervention interviews, characteristics of the training, effects, and critical success factors were identified. Positive effects such as lowering barriers, increasing health care professionals' competences, and increasing health care chaplains' profile are possible. Chaplain-led, multidisciplinary spiritual care training is a feasible method to start implementation of spiritual care in hospitals, as described in the multidisciplinary guideline.

Training hospital staff on spiritual care in palliative care influences patient-reported outcomes: Results of a quasi-experimental study

BACKGROUND

Spiritual care is reported to be important to palliative patients. There is an increasing need for education in spiritual care.

AIM

To measure the effects of a specific spiritual care training on patients' reports of their perceived care and treatment.

DESIGN

A pragmatic controlled trial conducted between February 2014 and March 2015.

SETTING/PARTICIPANTS

The intervention was a specific spiritual care training implemented by healthcare chaplains to eight multidisciplinary teams in six hospitals on regular wards in which patients resided in both curative and palliative trajectories. In total, 85 patients were included based on the Dutch translation of the Supportive and Palliative Care Indicators Tool. Data were collected in the intervention and control wards pre- and post-training using questionnaires on physical symptoms, spiritual distress, involvement and attitudes (Spiritual Attitude and Involvement List) and on the perceived focus of healthcare professionals on patients' spiritual needs.

RESULTS

All 85 patients had high scores on spiritual themes and involvement. Patients reported that attention to their spiritual needs was very important. We found a significant ( p = 0.008) effect on healthcare professionals' attention to patients' spiritual and existential needs and a significant ( p = 0.020) effect in favour of patients' sleep. No effect on the spiritual distress of patients or their proxies was found.

CONCLUSION

The effects of spiritual care training can be measured using patient-reported outcomes and seemed to indicate a positive effect on the quality of care. Future research should focus on optimizing the spiritual care training to identify the most effective elements and developing strategies to ensure long-term positive effects. This study was registered at the Dutch Trial Register: NTR4559.

Multidisciplinary Training on Spiritual Care for Patients in Palliative Care Trajectories Improves the Attitudes and Competencies of Hospital Medical Staff: Results of a Quasi-Experimental Study

OBJECTIVES

Patients value health-care professionals' attention to their spiritual needs. However, this is undervalued in health-care professionals' education. Additional training is essential for implementation of a national multidisciplinary guideline on spiritual care (SC) in palliative care (PC). Aim of this study is to measure effects of a training program on SC in PC based on the guideline.

METHODS

A pragmatic multicenter trial using a quasi-experimental pretest-posttest design as part of an action research study. Eight multidisciplinary teams in regular wards and 1 team of PC consultants, in 8 Dutch teaching hospitals, received questionnaires before training about perceived barriers for SC, spiritual attitudes and involvement, and SC competencies. The effect on the barriers on SC and SC competencies were measured both 1 and 6 months after the training.

RESULTS

For nurses (n = 214), 7 of 8 barriers to SC were decreased after 1 month, but only 2 were still after 6 months. For physicians (n = 41), the training had no effect on the barriers to SC. Nurses improved in 4 of 6 competencies after both 1 and 6 months. Physicians improved in 3 of 6 competencies after 1 month but in only 1 competency after 6 months.

SIGNIFICANCE OF RESULTS

Concise SC training programs for clinical teams can effect quality of care, by improving hospital staff competencies and decreasing the barriers they perceive. Differences in the effects of the SC training on nurses and physicians show the need for further research on physicians' educational needs on SC.

The split professional identity of the chaplain as a spiritual caregiver in contemporary Dutch health care: are there implications for the United States?

The professional identity of the chaplain in Dutch health care institutions is in need of a new theoretical underpinning. The continued employment of the "spiritual caregiver," as the professional is called in the Netherlands, may be at stake. In former days, she or he was primarily a religious office holder fulfilling ecclesiastical functions. Against the background of secularization and individualization of religions and worldviews, the spiritual caregiver now turns more and more into an existential counselor, focusing on the search for meaning and life-orientation of all the clients/patients/residents, irrespective of their religion or philosophy of life. This brings along the need for a conceptualization of spiritual care. What is the spiritual caregiver's particular contribution to care and treatment, compared to that of, for instance, psychotherapists and social workers? What are the specific aims, methods, and key images of the profession? This brief communication sketches the specific context in which the Dutch spiritual caregiver has to work and the identity dilemmas he or she faces.

Results of cytologic mass screening in the Federal Republic of Germany

Since July 1971, the national screening program for cancer has provided all women 30 years of age and older in the Federal Republic of Germany with the opportunity of undergoing a medical checkup for uterine and mammary cancer once a year. Within this program, more than 27 million cytologic screenings of cervical smears were carried out by the end of 1976. At the Cytologic Institute of the Bavarian Cancer Society, Munich, 503,870 cytologic screenings in 226,428 women were carried out from 1971 to 1976, and the rate of positive and suspicious cytologic findings declined from 2.6% to 0.9% in that period. Whereas the detection rate of cytologic findings suggestive of invasive carcinoma, carcinoma in situ and severe dysplasia was 0.5% on the first screening, it was 0.16% on the second screening and 0.08% on the third screening. A total of 272 invasive carcinomas of the cervix and 948 carcinomas in situ and severe dysplasias was detected by the examinations and verified histologically. According to the number of women screened per annum, an incidence peak for carcinoma in situ (including severe dysplasias) was observed between 25 and 29 years of age, with a second, lower peak at about 65 years. The curve of invasive carcinoma of the cervix, however, rose continuously to old age. From 1963-66 to 1976, the rate of histologically verified invasive carcinoma of the cervix declined continuously, from 0.36% to 0.03%. At first, the rate of carcinoma in situ and severe dysplasia increased slightly, from 0.44% to 0.5%, but since 1971 it also decreased markedly, reaching 0.16% in 1976. Although similar curves are found in foreign studies, morbidity and mortality from cervical carcinoma has decreased relatively slowly within the total population. The possible reasons for this finding are discussed.

[The effectiveness of cervical cytology screening for cervical cancer (author's transl)]

Cervical cytology screening was performed, between July 1971 and the end of 1976, on 503,870 specimens from 226,428 women. During this period the rate of positive or suspicious findings fell from 2.6% to 0.9%. The number of specimens judged suspicious for invasive carcinoma, carcinoma in situ or with severe dysplasia (among those women who had undergone serial examinations) was 5 per thousand for the first specimen, 2 per thousand for a subsequent second specimen, and 1.6 per thousand for a subsequent third specimen. The screening programme detected (later confirmed histologically) 272 cases of invasive carcinoma and 948 of carcinoma in situ or severe dysplasia. Related to the number of women screended at various ages, the frequency of carcinoma in situ and severe dysplasia had a peak between the 25th and 29th year of life, with a second, lower peak at around the 65th year. For invasive cervical carcinoma the frequency remained high into old age. The proportion of histologically proven cases of invasive carcinoma fell continuously from 1963/66, at 3.6 per thousand, until 1976, at 1.6 per thousand.