Healthcare chaplains' conflicting and ambivalent positions regarding meaning in life and worldview.

Western society is increasingly a spiritual society, but not so much a society that draws on clearly delineated religious or worldview pillars anymore. Within healthcare, there's a growing attention to the spiritual dimension of health and the collaborative spiritual care that is needed for person-centered care. This changing religious/worldview and healthcare landscape is influencing healthcare chaplaincy. In this case study in-depth interviews were conducted with a chaplaincy team within a large healthcare organization in The Netherlands. Dialogical Self Theory was used as the theoretical framework in the narrative analysis of these stories. This provided insights into how these chaplains negotiate their professional identity within a changing healthcare landscape. It is concluded that there are multiple and often contradictory and conflicting positions within and between chaplains and that it is a challenge for healthcare chaplains to integrate the "old" and "new" representations of chaplaincy.

The future of chaplaincy in a secularized society: a mixed-methods survey from the Netherlands.

The spiritual care profession in the Netherlands is going through significant changes, including an increasing demand for secular and multi-faith spiritual care, a move towards professionalization and formulating 'best practices', as well as a broadening of the scope of chaplains' activities.In October 2019, 405 Dutch healthcare chaplains completed an online mixed methods survey with open and closed-ended questions about their work situation and professional identity. Quantitative analyses showed that most respondents evaluated current developments in chaplaincy in a positive way. Qualitative findings showed trends towards interconfessional and secular spiritual care, outpatient spiritual care and the emergence of evidence-based chaplaincy. Participants who responded most negatively to those developments criticized evidence-based approaches for measuring the effects of chaplaincy, unstable financing structures, and the encroachment of other professions upon the domain of spiritual care.

Goals of chaplaincy care: a scoping review of Dutch literature.

A substantial number of (mostly health care) chaplaincy articles have emphasized the need for chaplaincy outcome research. In this study, we contribute to formulating intrinsic chaplaincy outcomes by first identifying chaplaincy goals. To this end, we have performed a scoping review of Dutch chaplaincy literature. We have focused on articles, books, and dissertations published between 2014 and 2019. Six distinct goals of chaplaincy were identified, using 86 fragments found in 33 sources: worldview vitality and plausibility, processing life events, deepening spirituality, relational affirmation, well-being, and exercising freedom of religion. Several of these main goals could be subdivided into more specific goals. Future research is needed to examine whether the found goals apply equally within the different types of chaplaincy and to examine their interrelations. In addition, future research should examine how these goals are pursued in practice and how they relate to client needs.

How the Military Context Shapes Spiritual Care Interventions by Military Chaplains.

Spiritual care interventions depend upon the context in which care is provided, its institutional setting and the actors involved. In order to understand the relationship between interventions in spiritual care and the context in which care is provided, we study the spiritual interventions of military chaplains against the background of the armed forces. In our study, we demonstrate that the military context needs its own conceptualization to understand the pastoral practices of military chaplains. This article uses a qualitative comparative methodology and is based upon 13 case studies that have been generated over the course of five years by a team of eight military chaplains within the framework of the Dutch Case Study Project. The analysis results in four concepts that describe the relationship between spiritual care practices and the context of the armed forces in more detail: structuring pastoral availability, positioning within the military environment, existential negotiation of being human and being a soldier and transforming military time. We conclude that the study of spiritual care in context leads to a contextualized understanding of spiritual care practices and stimulates comparison of pastoral care practices across contexts.

Enhancing the integration of chaplains within the healthcare team A qualitative analysis of a survey study among healthcare chaplains.

Background: Spiritual well-being is considered an important component of health and is increasingly integrated at all levels of healthcare. Delivering good integrated spiritual care requires coordination between different colleagues in which interprofessional collaboration is crucial. However, this interprofessional collaboration is not always self-evident. What spiritual care entails, is often poorly understood by their healthcare colleagues. Developing a shared professional identity is a crucial component of the shift towards professionalisation in chaplaincy. Objectives: We aim to answer the following research question: how do healthcare chaplains in the Netherlands describe their work and their professional identity in relation to other healthcare professionals? Design and subjects: Analysis of open-ended questions of a survey among healthcare chaplains regarding professional self-understanding in the Netherlands. Results: 107 Dutch chaplains working in a healthcare setting completed the five open-ended questions in the survey. The field of healthcare chaplaincy is changing from an exclusive focus at patients, towards more activities at staff and organisational level such as educating other healthcare professionals and, being involved in ethics and policy making. Conclusions: Our research shows that the professional self-understanding of chaplains entails many leads to foster interprofessional collaboration. At the same time, there are concerns about the professional identity of the chaplain which is not always clear to every healthcare professional. Healthcare teams can benefit from an extensive integration of chaplains in the healthcare team, by including the non-patient-related activities of chaplains, such as staff training, moral deliberation and policy advice.

Research Priorities for Health Care Chaplaincy in The Netherlands: A Delphi Study Among Dutch Chaplains.

The aim of this study was to identify research priorities for health care chaplaincy in The Netherlands according to practicing chaplains and chaplaincy leaders. To this end, a two-round Delphi study was conducted. The first round in which participants were asked to list at least three research priorities was completed by 249 respondents. Through content analysis, the resulting 811 priorities were merged into 54 research topics in 10 domains. In the second round, 179 respondents ranked these topics on a Likert scale from 1 to 5 (low priority-high priority) from the perspective of the patient/client, the organization, and the profession. Based on the mean score of each topic, five research priorities were identified: (a) to investigate the effect of chaplain care according to the patient/client; (b) to determine the patients'/clients' need(s) for chaplaincy; (c) to investigate the effect of chaplain care on the patient/client; (d) to identify possibilities for chaplaincy practice in outpatient care; and (e) to investigate how to develop a stronger profile for chaplaincy in The Netherlands. These priorities resonate with research on this topic from other countries and indicate directions for future research efforts to improve chaplaincy care.

Can Outcome Research Respect the Integrity of Chaplaincy? A Review of Outcome Studies.

In recent years, some within chaplaincy have advocated for a stronger focus on outcomes, including outcome research, whereas others in the field have questioned an outcome-oriented perspective. In this article, existing outcome studies are reviewed in relation to the ongoing discussion about a process- or outcome-oriented approach to chaplaincy. A central question emerges from this discussion: how can outcome research be designed that respects the integrity of the profession of chaplaincy? A literature search in MEDLINE/Pubmed produced twenty-two chaplaincy outcome studies that met the inclusion criteria. A review of these studies shows that thus far most have focused on secondary chaplaincy outcomes (e.g., satisfaction) using quantitative designs. To respect the integrity of chaplaincy, it is recommended that future studies should also focus on characteristic chaplaincy outcomes, use mixed methods designs, and articulate more clearly how their chosen outcomes, outcome measures, and interventions relate to the work of chaplaincy.

Grief in a biography of losses: Meaning-making in hard drug users' grief narratives on drug-related death.

The focus in grief theories has been increasingly shifting toward questions of meaning. In this study, we draw on the meaning-reconstruction model of grief for studying the unique case of hard drug users who have experienced a drug-related death. The social context of hard drug use, as well as the death and grief circumstances, is problematic and stigmatized. Grief narratives of 10 respondents were analyzed according to the principles of grounded theory. We identified four main themes: (1) the inhibition of emotion by drugs leading to fragmented grief reactions, (2) social exclusion and notions of disenfranchized grief, (3) the acceptance of death, and (4) meaningfulness in a "biography of losses." Connecting these results with the literature on meaning, we find that meaning-making is a multidimensional and layered process, where some layers result in meanings made while others do not. Finally, this study emphasizes the importance of social and emotional aspects of grieving, as well as the ambiguity of the notion of successful meaning-making in relation to grief.

Representing the Good: Pastoral Care in a Secular Age.

In 'a secular age' (Taylor 2007), pastoral care is no longer exclusively associated with specific religious traditions and communities. Pastoral caregivers who work in secular institutions provide care to religious and nonreligious people alike, and in several Western societies the term pastoral care is used in relation to nonreligious (humanist) care. In secular contexts, the term 'pastoral care' is often replaced by the term 'spiritual care.' Spiritual care, however, is provided by various professionals, so pastoral caregivers face the challenge of developing adequate and convincing language to explain what is distinctive about their work. In this article, the authors turn to philosophical language in order to develop a conceptual understanding of pastoral care that does not depend on the specific worldview-religious or nonreligious-of either pastoral caregivers or receivers of pastoral care. Using the work of Taylor (1989, 2007) and Murdoch (1970), we explain pastoral care as engaging with people's attempts to orient in 'moral space' and the distinctive quality of pastoral care as 'representing the Good.' Murdoch associates 'the Good' with a secular idea of transcendence that is both a movement beyond the ego and an engagement with the reality of human vulnerability, suffering, and evil. We argue that pastoral caregivers who 'represent the Good' have the task not only of supporting the existential and spiritual processes of individuals but also of promoting dialogue and social justice and of critiquing dehumanizing practices in the organizations in which they work and in society at large.

"Purely for You": Inmates' Perceptions of Prison Visitation by Volunteers in the Netherlands.

Research suggests that prison visitation by volunteers may significantly reduce the risk of recidivism. Community volunteers offer sustained, prosocial support to inmates which may account for these beneficial effects. However, the question of how inmates themselves evaluate volunteer visitation has hardly been studied. This study explores how inmates of Dutch prisons who receive one-on-one volunteer visits experience and value these visits. To that end, semistructured interviews were conducted with 21 inmates across six penitentiaries. These show that the value of volunteer visitation for inmates has to be understood in terms of a human-to-human encounter. Visits by volunteers provide inmates with rare opportunities to have a confidential conversation, away from the harshness of the usual prison life. Furthermore, inmates perceive volunteer visitation as beneficial beyond the actual visits. Inmates draw hope, strength, or self-respect from the conversations; they see volunteers as role models and develop a more positive view of the future. Two potential obstacles to beneficial volunteer visitation were detected: lack of chemistry between volunteer and inmate and imposition of worldview beliefs by volunteers.