Chaplain development in Clinical Pastoral Education (CPE) in healthcare settings in England: A mixed methods study.

BACKGROUND: Clinical Pastoral Education (CPE) is the predominant specialised training for healthcare chaplains in several national contexts. CPE is spiritual care education that uses experiential and action-reflection learning methods to train diverse participants. However, CPE is not established for chaplaincy training in England. Currently, chaplaincy education in England lacks standardisation, leading to inequalities in entry into the profession and inconsistent training and career pathways. CPE has the potential to address these issues. We examined changes associated with participating in CPE and participants' perceptions about their learning experience. We sought to evaluate the effectiveness of CPE as a viable chaplaincy education model in healthcare settings in England. METHODS: Convergent mixed methods involved pre-post surveys and focus group sessions to examine the experiences and development of seven chaplains, with diverse experience levels and backgrounds, who participated in the pilot CPE unit in NHS England. We integrated thematic analysis and survey results. RESULTS: We identified four overarching themes: Development pathways, Catalysts for development, Advantages of CPE for chaplaincy education, and Experiences with CPE course structure. Participants developed along various pathways: confidence, reflective practice, emotional intelligence, listening and attending skills, diversity in chaplaincy care, and spiritual assessment. Survey results confirmed several themes, indicating gains in chaplaincy capabilities, emotional intelligence, and counselling self-efficacy. Participants emphasised the advantages and effectiveness of the CPE model. CONCLUSIONS: Quantitative and qualitative findings converged to provide rich evidence that CPE generated personal and professional development, improving chaplaincy practice. General learning pathways moved from personal development, through the interpersonal learning context, and translated into chaplain competency. Participants endorsed CPE, as a robust and effective training model for chaplaincy in the English context, for those entering the profession and experienced chaplains alike. We conceptualised preliminary models for chaplain development and learning pathways in CPE that need validation and refinement by future research.

Chaplain, Can You Carry This Cross for Me? A Reflection on My First Year of CPE-Clinical Pastoral Education.

What is the meaning of sacrament? How can a professional Orthodox Christian lay chaplain participate in sacramental ministry without the grace given by ordination? This piece on Christina Hanegraaff's first year as a Clinical Pastoral Education resident explores this question through reflecting on her experiences of entering into people's suffering and carrying their cross alongside them-a modern-day Simon of Cyrene.

Advancing interprofessional education in communication.

OBJECTIVE: The objective of this training project is to develop and host Interprofessional Communication courses to improve interdisciplinary communication in oncology care. The initial national course was held in a virtual format and included pre- and post-course participant data. The curriculum was developed with support from the National Cancer Institute. METHODS: A virtual two-day course was held to equip nurses, social workers, and chaplains with vital communication skills in oncology practice, so that they could return to their home institutions and teach communication skills to other healthcare professionals, with the intention of making improved communication a quality improvement goal. Fifty-two participants were selected through an application process to attend the virtual course in two-person interprofessional teams (e.g., nurse and chaplain, or social worker and nurse). The Interprofessional Communication Curriculum was based on the National Consensus Project for Quality Palliative Care's eight domains of quality palliative care. The six online modules developed by the investigators were presented in lectures, supplemented by discussion groups, role plays, and other methods of experiential learning. RESULTS: Pre- and post-course results identified areas of communication, which are a priority for improvement by oncology clinicians. Participant goals identified specific strategies to be implemented by participants in their settings. SIGNIFICANCE OF RESULTS: The need for communication training was clearly demonstrated across professions in this national training course. Participants were able to apply course content to their goals for quality improvement in cancer settings.

"We Need to Learn from What we Have Learned!": The Possible Impact of Covid-19 on the Education and Training of Chaplains.

The responses of chaplains providing care in health services during the Covid-19 pandemic showed that they both learned new skills and taught these to others while working in environments made unfamiliar by personal protective equipment and social distancing. This paper discusses the responses of the participants as they relate to education and training as well as suggesting new content and styles of education to meet the needs of chaplains in future similar events.

Study of Shadowing Experiences among Chaplains in the Coleman Palliative Medicine Fellowship.

While shadowing is a relatively common practice in the education of many health professionals, it is not widely used in chaplaincy education. Findings from our qualitative study of 12 chaplains who participated in the Coleman Palliative Medicine Training Program suggest it may offer benefits for practicing chaplains. In interviews with seven fellows who shadowed more experienced palliative care (PC) chaplains and the five mentors who were shadowed at their work settings, participants reported opportunities for mutual learning, self-reflection, and collegiality. Fellows observed how members of a PC team collaborate and contribute equally to the care of patients. Mentors found shadowing was a rare opportunity to share their chaplaincy practice with colleagues. It helped them to appreciate different aspects of their work settings and to distinguish between PC and generalist chaplaincy. We discuss the challenges participants experienced while shadowing and offer recommendations for incorporating the practice more widely into chaplaincy education.

Quality Improvement of Pastoral Care for Major Depression in the Community of an African American Religious Organization.

Mental illness is a complex personal and social problem. In the African American community, cultural and ethnic stigma concerning mental illness often discourages this population from seeking the help they need. African Americans are more likely to rely on religious coping strategies such as prayer and/or informal trusted community social supports such as a senior pastor, members of a ministerial team who provide pastoral care in their churches, family members, and a limited number of friends. Implementation of a unique church-based initiative for depression/suicidality screening and stigma reduction, and collaborative efforts with community mental health providers, are promising steps toward optimizing diagnosis, treatment, follow-up for depression in African American persons in faith-based organizations. This project attempted to elaborate on and clarify the link between stigma, such as beliefs related to mental illness, and how education could influence and improve pastoral care by ministerial leaders for mental health issues in their congregants.

Potential of technology to improve the availability and use of health information on cancer subjects for clergy from rural communities.

BACKGROUND: Cancer is a leading cause of death around the world and often is a chronic long term disease. This calls for an expanded workforce to include non-traditional health care providers. OBJECTIVE: To determine effectiveness of a cancer information training project with clergy from selected rural Appalachian areas to improve comfort and willingness to work as part of the cancer health care team. METHODS: Clergy were trained in the consumer health database of the National Library of Medicine MedlinePlus.gov. Exercises were required that were done using an iPad tablet with an online curriculum. They were also taught how to do a population health assessment of their particular area and develop a health ministry for their church. RESULTS: Three key elements were confirmed that would enable replication of the pilot: access to medlineplus, programmed learning modules using mobile technology such as iPads, and staff support including librarians and medical staff. With these key elements, the cancer project is potentially replicable with other groups beyond clergy. CONCLUSION: Knowledge about population health, built on new awareness and topical health knowledge, and using new skills to identify relevant information and library resources, could open minds and enhance community support for preventive and medical interventions.

Prevalence of Journal Clubs: A Survey of Clinical Pastoral Education Residencies in the United States.

Journal clubs are an established and effective method of promoting research literacy and evidence-based practice in the medical field. However, their use in clinical pastoral education (CPE) residencies is relatively new and largely unstudied. In 2016 we surveyed 201 ACPE certified educators of CPE residency programs throughout the United States. Eighty-eight certified educators participated in this first-of-its-kind study. Our aim was to determine the prevalence and structure of existing CPE journal clubs and establish baseline data to determine the effectiveness of future programs for increasing research literacy. Seventy-three percent of respondents indicated they did not have a journal club. Journal clubs that do exist tend to meet at least monthly and last one to two hours. Chaplains, certified educators, or chaplain residents lead the majority of journal clubs. Seventy percent of respondents whose programs had journal clubs indicated they were interested to learn more about journal clubs. Journal clubs do not appear to be common in CPE residencies and chaplains may feel unprepared to lead them. CPE journal clubs would likely be strengthened by collaboration with other disciplines and from additional training for CPE certified educators. We offer suggestions to this end as well as areas for further research.

Testing a Religiously Tailored Intervention with Somali American Muslim Women and Somali American Imams to Increase Participation in Breast and Cervical Cancer Screening.

Somali American women have low rates of breast and cervical screening. This research aimed to test the feasibility and impact of religiously tailored workshops involving Somali American Muslim women and male imams to improve intention to undergo breast or cervical cancer screening. Religiously tailored workshops addressing cancer screening (each approximately 3 h in length) were conducted with 30 Somali American women and 11 imams. Pre- and post-test surveys measured attitudes toward screening, screening intention, and workshop experience. The workshops were feasible, and both the women and the imams found the workshops enjoyable as well as informative. The discussions of religiously tailored messages had a positive impact on attitudes toward cancer screening, and, for the women, a positive impact on intention to screen. Religiously tailored messages can be an important community asset for engaging Somali American Muslim women around the value of breast and cervical cancer screening.

Insights and experiences of chaplain interns and social work interns on palliative care teams.

Interdisciplinary palliative care teams provide critical, comprehensive end-of-life care, although the accumulated literature points toward barriers that impede their effectiveness. The current phenomenological qualitative study presents perceptions of chaplaincy interns (N = 24) and social work interns (N = 23) after a semester-long end-of-life clinical training experience with interdisciplinary palliative care teams. Analysis of the end of semester reflections resulted in seven themes, which are fairly consistent with the literature base. The described experiential learning and reflections in the current study are powerful and can inform how to prepare practitioners for teamwork and compassionate end-of-life care.

VA Interprofessional Fellowship in Palliative Care: 15 Years of Training Excellence.

Since 2002, the Department of Veterans Affairs (VA) has provided a unique training opportunity in palliative care at six VA medical centers. The VA Interprofessional Fellowship in Palliative Care has trained chaplains, nurses, pharmacists, physicians, psychologists, and social workers to provide clinical palliative care and to develop as leaders in the profession. This article describes the program's origin, mission, outcomes, and lessons learned.

Pilot Qualitative Study of Informal Teachers in Interprofessional Collaboration and Practice.

CONTEXT: Nonphysician members of the interprofessional palliative care team often participate in teaching physicians and others in the context of workplace learning due to the interprofessional collaborative nature of the specialty. OBJECTIVES: This pilot study examines the beliefs of the nonphysician members of the interprofessional team about teaching physicians-in-training, the disciplinary training and expertise that informs their teaching, and approaches to teaching in the workplace. METHODS: Semistructured interviews were conducted. All interviews were audio recorded and transcribed verbatim. Initial open coding by two researchers identified the codes, and then the constant comparative method was used to find patterns by axial coding, categories, and themes within the data. RESULTS: Of the 10 health care professionals involved with palliative medical education at one academic medical center, six enrolled in the pilot. Those who participated included chaplains, nurses, a social worker, and a physician assistant. Three major themes were identified from the informal teachers: 1) using professional identity as a foundation for teaching, 2) teaching through experiential learning or debriefing, and 3) teaching to perceived gaps in physician training. CONCLUSION: Nonphysician members of the interprofessional team interacted with physicians-in-training guided by their discipline-based skills and perspectives on patient care. They directed their informal teaching toward perceived educational gaps using reflection and debriefing. Future studies could explore the educational roles of health care professionals across diverse institutions and specialties.

Comparing the Effectiveness of Brief Versus In-Depth Gatekeeper Training on Behavioral Outcomes for Trainees.

BACKGROUND: A common suicide prevention strategy is training gatekeepers to identify at-risk individuals and refer them to services. AIMS: The study aimed to examine whether differences in training outcomes were observed for brief versus in-depth gatekeeper trainings for trainees from varied professional settings while controlling for differences in trainee characteristics and community context. METHOD: Trainees' identification and referral behavior 3 months after gatekeeper training was compared with a sample of respondents matched on individual- and community-level variables using propensity score-based techniques. The value was estimated, in terms of additional identification and associated costs, of adopting in-depth training. RESULTS: A higher proportion of trainees who participated in in-depth trainings from K-12 and community settings identified at-risk youth, and a higher proportion of in-depth trainees from mental health settings referred youth to services compared with participants of brief trainings from the same setting and with similar characteristics. The effect of training type on outcomes varied by professional role and community context. LIMITATIONS: Self-report measures were used to assess outcomes. Similar measures are used in other studies; their validity has not been conclusively established. CONCLUSION: Findings suggest certain individuals may benefit from in-depth training more than others, which favors targeting this intervention to particular gatekeepers.

Integrating Spiritual Care During Interprofessional Simulation for Baccalaureate Nursing Students.

Interprofessional educational experiences for baccalaureate nursing students are essential to prepare them for interprofessional communication and collaborative interprofessional teamwork. The aim of this descriptive qualitative study was to understand the experience of baccalaureate nursing students utilizing the hospital chaplain while caring for a suicidal patient in the emergency department during simulation. The need for interprofessional education is documented in the literature, but there are very few comprehensive, successful projects integrating spiritual care for nurse educators to use as models. This project can serve as a model of a successful interprofessional education initiative involving preprofessional nursing students and chaplain services. Overall, nursing students found the learning experience to be beneficial in preparation for professional practice on a collaborative interprofessional health care team.

Transforming Chaplaincy Requires Transforming Clinical Pastoral Education.

Clinical Pastoral Education (CPE) is a process focused on developing students' personal integration. Outcomes for CPE need to expand to reflect current research in religion and spirituality because religion and spirituality impacts coping, meaning making, decision-making, and health care outcomes. Focusing CPE outcomes on religious/spiritual beliefs and practices used by patients will equip chaplains to provide research-informed spiritual care for families and discipline-specific information for the interdisciplinary team.

Evaluation of a Chaplain Residency Program and Its Partnership with an In-Patient Palliative Care Team.

In 2009 a Consensus Conference of experts in the field of spiritual care and palliative care recommended the inclusion of Board-certified professional chaplains with at least 1,600 hours of clinical pastoral education as members of palliative care teams. This study evaluates a clinical pastoral education residency program's effectiveness in preparing persons to provide spiritual care for those with serious illness and in increasing the palliative care team members' understanding of the chaplain as part of the palliative care team. Results showed chaplain residents felt the program prepared them to provide care for those with serious illness. It also showed that chaplain residents and palliative care team members view spirituality as an integral part of palliative care and see the chaplain as the team member to lead that effort. Suggested program improvements include longer palliative care orientation period, more shadowing with palliative care team members, and improved communication between palliative care and the chaplain residents.

End-of-Life Conversation Game Increases Confidence for Having End-of-Life Conversations for Chaplains-in-Training.

CONTEXT: Discussing end-of-life issues with patients is an essential role for chaplains. Few tools are available to help chaplains-in-training develop end-of-life communication skills. OBJECTIVE: This study aimed to determine whether playing an end-of-life conversation game increases the confidence for chaplain-in-trainings to discuss end-of-life issues with patients. METHODS: We used a convergent mixed methods design. Chaplains-in-training played the end-of-life conversation game twice over 2 weeks. For each game, pre- and postgame questionnaires measured confidence discussing end-of-life issues with patients and emotional affect. Between games, chaplains-in-training discussed end-of-life issues with an inpatient. One week after game 2, chaplains-in-training were individually interviewed. Quantitative data were analyzed using descriptive statistics and Wilcoxon rank-sum t tests. Content analysis identified interview themes. Quantitative and qualitative data sets were then integrated using a joint display. RESULTS: Twenty-three chaplains-in-training (52% female; 87% Caucasian; 70% were in year 1 of training) completed the study. Confidence scores (scale: 15-75; 75 = very confident) increased significantly after each game, increasing by 10.0 points from pregame 1 to postgame 2 ( P < .001). Positive affect subscale scores also increased significantly after each game, and shyness subscale scores decreased significantly after each game. Content analysis found that chaplains-in-training found the game to be a positive, useful experience and reported that playing twice was beneficial (not redundant). CONCLUSION: Mixed methods analysis suggest that an end-of-life conversation game is a useful tool that can increase chaplain-in-trainings' confidence for initiating end-of-life discussions with patients. A larger sample size is needed to confirm these findings.

Reflections for Clinical Pastoral Education Students in Psychiatric Settings.

This article focuses on Donald Capps's books on mental illness. In doing so I highlight three key insights from Capps that I have applied in my own ministry with persons with mental illness in various psychiatric hospitals. These insights, together with my own experience as a chaplain, lead to three practical lessons for clinical pastoral education students in psychiatric settings. I provide some context for my interest in mental illness and my friendship with Capps, as well as some background regarding how Capps's writings on mental illness fit with certain broader themes in his own work as a pastoral theologian. This essay is personal throughout.

An Examination of Personal Health Promotion and Curricular Coverage of Health at US Seminary Schools.

Seminary schools train clergy members, who have significant influence on the health-related environment of their faith-based organizations. The purpose of this study was to examine health promotion in seminary schools, including curriculum coverage of health-related topics. This cross-sectional, mixed methods study used print and online surveys. Seminary schools (n = 57) self-reported approaches to health and health-related curriculum. Most schools emphasized the inclusion of health in clerical practice, and healthy behaviors among students, and covered holistic views of health and self-care issues within their curriculum. This study provides insight into how seminary schools are training future generations of clergy on health-related topics.