Ethical issues in personality assessment in forensic psychology.

In this article we address several ethical issues of concern for psychologists who are engaged in personality assessment in forensic settings such as for courts or attorneys. The ethical issues reviewed include the role of the psychologist as an expert witness, matters of competence, informed consent, confidentiality, multiple relationships, and special issues related to billing. Emphasis is placed on how psychologists can provide useful information to the courts in a manner consistent with the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct, the Committee on Ethical Guidelines for Forensic Psychologist's Specialty Guidelines for Forensic Psychologists, and the APA's Guidelines for Child Custody Evaluations in Divorce Proceedings. The practical recommendations made in this article are consistent with the APA's Ethical Principles of Psychologists and Code of Conduct.

A 10-year review of research on chaplains and community-based clergy in 3 primary oncology nursing journals: 1990-1999.

A manual examination of 3 primary oncology nursing journals was conducted to identify quantitative studies about chaplains and community-based clergy that were published between 1990 and 1999. This systematic review identified 7 studies involving chaplains and/or clergy dealing with a range of issues. Although the rate at which such studies were published in the oncology nursing literature was relatively low (1 in 123 studies), this rate far exceeds the rate found in a similar review of psychology journals (1 in 600 studies). The nature of the 7 studies and the issues they addressed are discussed and the authors make recommendations for future collaborative efforts.

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.

Risk management and life-threatening patient behaviors.

This article reviews the legal and ethical issues that arise in the treatment of patients who may pose a threat to harm themselves or others. The recent practice of developing empirically validated treatments has not yet been applied to the diagnosis and treatment of patients who present an imminent danger of harm to themselves or others. Instead, psychologists must follow standards that come primarily from court cases or statutes. Although these standards have some degree of commonality across North America, psychologists are encouraged to be informed about local laws and court cases.

How has health care reform affected professional chaplaincy programs and how are department directors responding?

No published studies were identified that describe the impact of health care reform on professional chaplaincy departments in hospital settings. Results from a random sample (N = 370) of department directors indicate that 45 percent report no budgetary consequences, 27 percent have experienced budgetary cutbacks, and 17 percent describe departmental growth. The cutbacks most often involve the loss of staff chaplain positions. Directors also describe past and future strategies for resisting downsizing trends.

The unique benefits of religious support during cardiac bypass surgery.

Compares the self-reports of family members waiting during the cardiac artery grafting surgery of a loved one and explores whether they make distinctions between the contributions of nonreligious and religious support. Results from regression analyses suggests that the use of religious sources of support was associated with both more positive religious and nonreligious psychosocial adjustment scores after the influences of nonreligious support were statistically removed. Notes that among the 13 religious support activities identified, family members reported using prayer most frequently. Concludes that using religious support sources to cope with this surgically related stress is associated with distinct subjective benefits beyond those contributed by nonreligious sources.

Use of alternative therapies among breast cancer outpatients compared with the general population.

CONTEXT: Breast cancer is the second largest cause of cancer death among women in the United States. Given the fear associated with its morbidity and mortality, patients might seek a variety of alternative treatments. No careful description of breast cancer patients' interest in or use of these therapies appears to exist. OBJECTIVE: To create a profile that describes interest in and use of a wide variety of alternative therapies available to breast cancer outpatients; to gather data concerning related issues such as the number of appointments for these therapies, their cost, and reimbursement patterns; and to compare these findings with a published profile of the general public. DESIGN: An interview gauging patients' interest in and use of alternative treatments followed by 2 questionnaires concerning (1) mental adjustment to the cancer experience and (2) personal growth in response to the encounter with cancer. SETTING: Suburban breast cancer clinic in a Midwestern university medical center. PARTICIPANTS: 112 female breast cancer outpatients. MAIN OUTCOME MEASURES: Rankings of interest in and use of alternative treatments by the patients interviewed. RESULTS: The 3 most frequently used alternative therapies were prayer (76%), exercise (38%), and spiritual healing (29%). Comparison with the general public profiles revealed that breast cancer patients more frequently used 17 specific alternative therapies. The largest increases were found in the use of prayer (51% increase), spiritual healing (25% increase), and megavitamins (23% increase). Only chiropractic was used substantially more often among the general population. CONCLUSION: Breast cancer outpatients involved in conventional treatment are more likely to use a wide range of alternative therapies than is the general public. It is likely that the mortality and morbidity associated with breast cancer motivates this increased use.

Professional chaplaincy: an absent profession?

A content analysis of 60 articles from six health care journal issues devoted to the topic of spirituality suggest that interdisciplinary health care authors neglect professional chaplaincy when they discuss spirituality. Notes that possible reasons for this neglect include the continuing negative fall-out from the historic religion-science conflicts, the perception that both religion and clergy are irrelevant, and the belief that interdisciplinary professionals themselves can improve their patient services by giving attention to spirituality without the involvement of chaplains. Discusses the results and possible implications for professional chaplaincy and for health care.

The vigil: religion and the search for control in the hospital waiting room.

This study examined how religion is involved in achieving a sense of personal control in a situation that evokes feelings of distress and vulnerability. One hundred and fifty family members, waiting in the hospital while their relative underwent coronary artery bypass surgery, completed a survey about their methods of coping, event-specific outcomes, and adjustment (depression and anxiety). As predicted, religious methods of coping designed to achieve control predicted outcomes and adjustment beyond the effects of non-religious coping measures and traditional general measures of religiousness. A collaborative approach to religious coping, in which the individual shares the responsibility for coping with God, was particularly associated with better outcomes. However, the religious coping measures were also associated with higher self-reported levels of depression and anxiety. Exploratory path analyses suggested that anxiety and depression may be stressors in themselves, eliciting religious coping responses which, in turn, lead to specific outcomes. These findings underscore the practical and empirical value of a closer, more detailed analysis of the roles of religion in coping with uncontrollable life stressors.

Collaboration between nurses and chaplains for spiritual caregiving.

OBJECTIVES: To discuss three ambiguities that may accompany nurse-chaplain collaboration in providing spiritual care: confusion about the meaning of "spiritual" and related terms, spiritual assessment and the referral process, and the role of clergy. DATA SOURCES: Review and research articles related to nursing and pastoral care, and documented standards. CONCLUSION: Effective nurse-chaplain collaboration is necessary (especially considering current health care system changes) to provide adequate spiritual care. Additionally, the increased involvement of both nurses and chaplains in ethical issues is likely to make nurse-chaplain collaboration increasingly important. IMPLICATIONS FOR NURSING PRACTICE: Nurses must collaborate with chaplains and relate to clergy to provide spiritual care for cancer patients and families. Knowledge of assessment differences between nurses and chaplains, terminology, and role of clergy will enhance this collaboration.

Religious support from parish clergy for hospitalized parishioners: availability, evaluation, implications.

Reports the results of interviews with a random sample (N = 500) of hospital patients responding to the following questions: What percentage of hospital patients consider themselves part of a church or synagogue? How many patients identify a specific parish clergy or some other source who could provide them pastoral support? How many patients received pastoral support during hospitalization from clergy or some other person, and by visit or phone call (excluding hospital chaplains)? How do hospital patients evaluate the helpfulness of these pastoral visits? Discusses the results of the survey, implications for pastoral caregivers, and suggests future research possibilities.

Barriers that predict resistance to completing a living will.

We sought to identify perceived barriers and benefits to completing living wills for 176 medical outpatients or their family members, using a questionnaire based on the Health Belief Model. The regression equation of the patient data identified two items that functioned as significant barriers: "I am not very interested in a living will because I believe that I will live a lot longer," and "Completing a living will now is difficult because I would likely change my mind about how I want to be managed during terminal illness." No variables remained in the equation when family member data were analyzed. We conclude that a major barrier to the completion of living wills (and perhaps advance directives generally) is that they connote personal death. Implications are explored.

Variables that predict interest in and the completion of living wills.

Observes that although chaplains and congregational pastors frequently advocate the completion of advance directives, including living wills, the research reports that only 5 to 15% of the general population have completed the instrument. Asks, Why have so few completed it? Reports on research which suggests that age is the only statistical predictor of whether a person possesses a completed living will when measured against social and personality variables, including levels of social support, fear of dying, religiousity, self-esteem, and trust in physicians. Concludes that it is likely that age is a proxy variable which represents changes in attitudes, beliefs, and thoughts which tend to occur as persons grow older.

Using INSPIRIT to conduct spiritual assessments.

Notes that pastoral caregivers are increasingly interested in spiritual assessment of patients. Reports results when the Index of Core Spiritual Experiences (INSPIRIT) is used for assessment with medical and surgical outpatients as well as patient family members (N = 371). Reports subscales within the instrument, mean scores, and notes that 80% of all respondents reported at least one experience which they regarded as spiritual.