Intersections of Compassion, Science, and Spiritual Care in Global Health for Public Health Benefits.

Across the globe, spiritual care is offered by individuals, healthcare chaplains, and humanitarian, social and related spiritual groups on account of zeal, voluntary and paid services. Sometimes, services are provided without understanding the connectivity of compassion, spiritual care, and scientific protocols. There are instances where health professionals and managers disagree with spiritual caregivers or reject spiritual services because of poor service deliveries in conflict with healthcare protocols. Against this background, this article focuses on how spiritual care services can be provided scientifically to improve service delivery. It presents leading questions to link the scientific and compassionate approach to spiritual care. These include-What is science? What is compassion? What is spiritual care? What makes compassion and spiritual care scientific? Are there tenets of compassion in religions? How are compassion, science and spiritual care linked? What are the implications of the intersections for public health and safety? Hopefully, the provided answers may improve the service delivery performance of spiritual caregivers and their collaboration with healthcare professionals, social workers, and related groups.

Factors associated with health personnel-chaplain interactions in the hospital setting: a cross-sectional survey study.

Health personnel may seek chaplain support to discuss stressors related to complex patient cases, difficult team dynamics, and personal issues. In this survey study of 1376 healthcare interprofessional clinicians, participants reported interacting with chaplains most frequently over patient-related stressors in the prior 12 months. Factors associated with chaplain interactions to discuss all three stressors included: reporting chaplains provide spiritual support to health personnel, more years of service, seeking professional help to deal with stressors, and higher levels of secondary traumatic stress. Being a registered nurse (RN) and working in a critical care specialty were associated with increased odds of interactions with a chaplain to discuss patient-related stressors while identifying as Catholic or Protestant was associated with chaplain interactions to discuss team-related and personal stressors. Chaplains should tailor interventions to promote health personnel's spiritual well-being based on patient-related, team-related, and personal stressors. Healthcare institutions which do not employ chaplains should advocate for this resource. Leaders in healthcare settings with chaplains should promote increased staff awareness that chaplains are available to support wellbeing by discussing patient, team, or personal stressors.

Chaplains' reports of integration in community health initiatives: a qualitative study.

Health care and religious organizations have a long history with one another. Chaplains' investments in the health and wellbeing of their local communities have extended beyond the hospital walls for longer than many chaplains may recognize. However, the published evidence suggests these efforts have been limited. Given the history of health care evolution in the United States, the small evidence of cases highlighting chaplains' leadership within community health initiatives, and the pressure for health systems to address the social determinants of health, we sought to explore chaplains' integration in community health and wellness initiatives. This paper presents the results of a qualitative analysis of interviews with chaplains working to promote community health and wellness (n = 10). The identified themes highlight factors at the individual chaplain level, such as how chaplains got involved, characteristics of the chaplains' contexts, and the impact of chaplains' involvement.

Maybe God Doesn't Even Like Miracles That Much.

Reflections from a pediatric chaplain on the irregularity of miracles with help from a Victorian author and an atheist-humanist colleague.

Roles of Chaplains and Clergy in Spiritual Care for African Americans in Hospice: A Pilot Study.

CONTEXT: Spiritual care is recognition of patient and caregiver spiritual/religious needs and attention to those needs. Caregivers of African American hospice patients are more likely to report worse emotional/religious support. Yet, spiritual care delivery and roles of community clergy and chaplains for African American hospice patients are not well understood. OBJECTIVES: Examine who provides spiritual care to African American hospice patients and caregivers. METHODS: Partnering with large, urban/suburban community hospice, we interviewed caregivers of deceased African American hospice patients (n = 12), their clergy (n = 3) and chaplains (n = 5). Using a phenomenological qualitative study design, we coded transcripts and deceased patient chart data and conducted thematic analysis to identify themes. RESULTS: Community clergy and chaplains tend to not interact and provide different aspects of emotional, religious and spiritual support to hospice patients and families. Clergy and chaplains agreed that rapport and openness of the patient were main factors in meeting spiritual care needs. Clergy provided interaction with a trusted person and connection to church, congregational support, religious beliefs/theology, and practices. Chaplains focused on present needs and issues of death and dying. CONCLUSION: Clergy and chaplains have distinct, complementary roles in providing spiritual care to African American hospice patients and families. Both are needed to provide desired spiritual care for African American hospice patients and their caregivers. Robust spiritual care programs need to ensure chaplains have sufficient time to spend with patients and families and incorporate collaboration, handoffs and integrated processes for clergy and chaplains. Research is needed on effectively including clergy in hospice spiritual care delivery.

Hospital Chaplain Burnout, Depression, and Well-Being during the COVID-19 Pandemic.

Healthcare personnel experienced unprecedented stressors and risk factors for burnout, anxiety, and depression during the COVID-19 pandemic. This may have been particularly true for spiritual health clinicians (SHCs), also referred to as healthcare chaplains. We administered a daily pulse survey that allowed SHCs to self-report burnout, depression, and well-being, administered every weekday for the first year of the pandemic. We used a series of linear regression models to evaluate whether burnout, depression, and well-being were associated with local COVID-19 rates in the chaplains' hospital system (COVID-19 admissions, hospital deaths from COVID-19, and COVID-19 ICU census). We also compared SHC weekly rates with national averages acquired by the U.S. Census Bureau's Household Pulse Survey (HPS) data during the same timeframe. Of the 840 daily entries from 32 SHCs, 90.0% indicated no symptoms of burnout and 97.1% were below the cutoff for depression. There was no statistically significant relationship between any of the COVID-19 predictors and burnout, depression, or well-being. Mean national PHQ-2 scores were consistently higher than our sample's biweekly means. Understanding why SHCs were largely protected against burnout and depression may help in addressing the epidemic of burnout among healthcare providers and for preparedness for future healthcare crises.

Pediatric chaplains iterative process to address religious & spiritual struggle: a qualitative study.

The growing body of literature on religious and spiritual (R/S) struggles consistently highlights its association with various health outcomes in Pediatrics. Chaplains or spiritual care providers, as members of interdisciplinary teams, frequently offer spiritual care to patients and families grappling with R/S struggles. However, there is a paucity of literature demonstrating how chaplains address R/S struggle in their practice. This study aimed to construct a theory describing the process by which pediatric chaplains conceptualize and address it. Employing a constructivist Grounded Theory study design, we sought to comprehend the approaches pediatric chaplains utilize in addressing R/S struggles. Following a semi-structured interview guide, we interviewed twelve Board Certified or Board Certification-eligible chaplains. Findings reveal that chaplains use an iterative three-phase process to address R/S struggles. Thirteen categories emerged, which were further organized into four major themes: Assessing, Processing, Intervening, and Navigating Limitations. A model depicting this iterative process was constructed.

Chaplain interventions and outcomes in outpatient settings: a scoping review.

As chaplaincy is increasingly practiced in outpatient settings, further understanding is needed of what it entails and is accomplishing within this unique context. This scoping review summarizes 42 articles that describe the types of spiritual care interventions and programs offered by chaplains in outpatient settings, and their outcomes. Findings support that chaplaincy is practiced in outpatient settings, especially in palliative care, oncology, and primary care. Interventions are delivered by chaplains as the sole interventionist, and by interdisciplinary teams with chaplain participants. Results show that outpatient chaplain interventions are feasible and acceptable, with positive psychological and spiritual outcomes. More studies with consistent outcome measurements, and structured chaplain interventions are needed to draw further conclusions about the effectiveness of outpatient chaplain interventions.

Spiritual assessment models for palliative care chaplains: a narrative review.

Palliative care chaplains conduct spiritual assessments for those within their care. This narrative review examined the literature concerning existing spiritual assessment models developed or designated for palliative care chaplain use. The literature review was performed using four databases, including a hand search of references due to the variability of keywords used within the spiritual care literature. Five spiritual assessment models were identified. The analysis of the models focused on three areas: (1) Foundational basis, (2) Spiritual needs, and (3) Structural frameworks. Published spiritual assessment models for palliative care chaplain use are variable in how each one was formed, how each tool describes and structures spiritual care needs, and how the models are implemented within their respective contexts. The PC-7 advances the field, especially through its mixed methods approach. Future validation and reliability research is needed as well as investigations concerning which models are taught by chaplain educators and used by palliative care chaplains.

Healthcare chaplains' perspectives on working with culturally diverse patients and families.

OBJECTIVES: Considering the ethnic, racial, and cultural diversity in the U.S., we aim to explore the experiences of healthcare chaplains as they provide culturally sensitive care to diverse patients and their families. METHODS: This is a qualitative study. Individual interviews were conducted with 14 healthcare chaplains recruited from 3 U.S. chaplaincy organizations. RESULTS: Thematic analysis with constant comparison yielded 6 themes in the chaplains' experiences: (1) the diverse roles of chaplains; (2) their high levels of comfort in working with diverse populations, attributed to cultural sensitivity and humility training; (3) cues for trust-building; (4) common topics of diversity, equity, and inclusion discussed; (5) gaps in chaplaincy training; and (6) the importance of collaboration and negotiation with healthcare professionals to accommodate cultural needs. SIGNIFICANCE OF RESULTS: This research highlights the valuable role of chaplains in providing culturally sensitive care and suggests areas for improving chaplaincy training and education to better serve diverse patient populations.

The Chaplain in the Pediatric ER: A Nurse and Mom's Perspective.

The day after a holiday, our medically complex son, who was acutely ill, needed care at the local children's hospital. Once in the emergency room (ER), he was triaged to a trauma room. Without our knowledge or consent, a chaplain entered the crowded and chaotic room. Although pleasant, the chaplain was not a person who comforted us. Her presence (1) increased our anxiety to panic level, (2) took our attention away from our acutely ill son to worst-case scenarios, (3) made us extremely uncomfortable, and (4) was counterproductive. We strongly feel that the patient/family should be asked if they want a chaplain or other spiritual/support person to enter the room.

Feasibility and acceptability of chaplain decision coaching on Periviable resuscitation decision quality: A pilot study.

Objective: To pilot test and assess the feasibility and acceptability of chaplain-led decision coaching alongside the GOALS (Getting Optimal Alignment around Life Support) decision support tool to enhance decision-making in threatened periviable delivery. Methods: Pregnant people admitted for threatened periviable delivery and their 'important other' (IO) were enrolled. Decisional conflict, acceptability, and knowledge were measured before and after the intervention. Chaplains journaled their impressions of training and coaching encounters. Descriptive analysis and conventional content analysis were completed. Results: Eight pregnant people and two IOs participated. Decisional conflict decreased by a mean of 6.7 (SD = 9.4) and knowledge increased by a mean of 1.4 (SD = 1.8). All rated their experience as "good" or "excellent," and the amount of information was "just right." Participants found it "helpful to have someone to talk to" and noted chaplains helped them reach a decision. Chaplains found the intervention a valuable use of their time and skillset. Conclusion: This is the first small-scale pilot study to utilize chaplains as decision coaches. Our results suggest that chaplain coaching with a decision support tool is feasible and well-accepted by parents and chaplains. Innovations: Our findings recognize chaplains as an underutilized, yet practical resource in value-laden clinical decision-making.

Connecting Families to Bereavement Resources: A Hospital-Based, Bereavement Follow-Up Pilot During First-Wave COVID-19.

Background: Hospitals often lack bereavement programs. Bereaved families often navigate grief support on their own. This problem was complicated by the early COVID-19 pandemic. Objective: Describe a cost neutral pilot to support next of kin (NOK) of deceased patients from our communicable disease response unit (CDRU) and palliative care unit (PCU). Design: Ad hoc pilot leveraging chaplains and a social worker (SW) to call NOK for grief support using a templated guide, referring interested NOK to bereavement support agencies. Setting/Subjects: NOK of patients who died in the CDRU and PCU at a metropolitan, quaternary care, hospital over five months. Results: One hundred eighty-six patients died. Eighty-one NOK were called, 51 calls were considered complete. Fourteen NOK accepted a referral for bereavement support. Conclusions: This cost neutral pilot successfully connected 81 NOK with either a pilot chaplain or SW for bereavement support. Fourteen NOK accepted referral for a community bereavement resource.

Exploring Patients' and Chaplains' Perspectives About a Spiritual Care Program in the Primary Care Setting.

BACKGROUND: Spirituality is an important component of social and cultural identity that influences health-related beliefs, decision-making, and coping behaviors. Despite the importance of addressing spirituality in healthcare, research about its impact is limited, especially in the primary care setting. OBJECTIVE: This study aimed to explore patients' and chaplains' experiences of receiving or providing spiritual care in the primary care setting. METHODS: We conducted an in-depth interview qualitative research study. Participants included patient informants, a chaplain, and chaplains-in-training who participated in a spiritual care program at a primary care clinic. Interviews were transcribed and coded. Conventional qualitative research content analysis was performed. RESULTS: Eleven interviews were conducted - 7 with patient informants, 1 with a chaplain, and 3 with chaplains-in-training. Informants reported that in their experience spiritual care increased trust in their provider, made them feel safe to ask or share anything, improved their satisfaction with care, helped sustain healthy behavior change, and improved coping with chronic illness. Participants specifically attributed these positive experiences to chaplains' ability to respect and attend to patients' spirituality, create a safe space, help patients see the connection between their spirituality and health, and help patients tap into their own spirituality as a healthy means of coping. CONCLUSIONS: Spiritual care, when integrated into the primary care setting, has the potential, according to the report of our informants, to help achieve important health-related objectives, such as increased trust in their providers, sustained healthy behavior change, and happiness in spite of chronic illness. Now, more than ever, when our society is hurting from mistrust of our profession secondary to disinformation and discrimination, spiritual care has an important role to play in our efforts to gain our patients' trust so that we can support their healing.

Exploring Religion as a Path to Meaning: The Role of "Pastrotherapy" in Supporting Young People's Quest for a Good Life in Nigeria.

This paper examines suicide prevalence among Nigerian youth struggling to find meaning in life. Frustrated by unattainable ideals, they experience despair. The study explores religion's role in providing support for meaning-seeking individuals. Utilizing an explorative approach, the paper highlights how religion can play a role in offering solidarity, morality, and hope as vital resources for creating a meaningful life. It introduces "Pastrotherapy" as a pastoral care approach to addressing existential questions. Findings emphasize the importance of religious communities and leaders in promoting resilience and addressing underlying causes of despair. This study reveals how religious beliefs and practices support Nigerian youth facing existential challenges, shedding light on the intersection of religion, meaning-making, and mental health.

"Powerful Strangers": A Reflection on Spirituality and the Chaplain-Doctor Partnership.

In this piece, Rachel Rim (Chaplain, MDiv) offers a poetic reflection on the nature of spirituality and the unique partnership between chaplains and doctors in the healthcare system, and particularly within the realm of palliative care.

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.

Reflection on the Role of a Hospital Chaplain as a Resource for Ethical Concerns.

As I take a legal approach to religion and spirituality, I reflect on how a chaplain can be beneficial as a resource to ethical concerns with which medical teams and patients/caregivers are confronted. This rather new approach can help medical professionals to understand the scope of a chaplain's work and to distinguish the work of a chaplain from that of clergy in organized religion.

A Quality Improvement Project to Gain Insight Into What Helps Cancer Patients Cope During Outpatient Radiation Therapy Treatments.

Psychosocial support in cancer care has not been researched or published to the degree of physical support. This type of support includes the mental, emotional, social, and spiritual needs of patients and loved ones. This quality improvement project provides insight for those seeking understanding of what exactly helps cancer patients cope during outpatient radiation therapy treatments. The purpose of this project was to learn what practices benefit patient's coping during outpatient external radiation therapy treatments in order to increase attention given to psychosocial support of future cancer patients receiving outpatient external radiation therapy treatments. Insight from this project was used to create a resource handout for Novant Health Cancer Institute to help increase awareness, discussion, and attention to supporting outpatient radiation therapy patients emotionally and spiritually.

Mandatory COVID-19 vaccination for healthcare workers: The experience of chaplains evaluating religious accommodation requests from coworkers.

Mandatory COVID-19 vaccination requirements for healthcare workers in the United States, instituted at the height of the pandemic to protect vulnerable patients and preserve the infrastructure of healthcare, nonetheless met with resistance by some members of the work force. As unprecedented numbers of employees sought religious accommodations, chaplain leaders were recruited by institutional leadership to adjudicate these requests, either alone or as part of a committee. This study reports results of a survey conducted from 6/1/2022 to 7/15/2022 with U.S. healthcare chaplains (n = 76) who were involved in the evaluation of coworker requests for religious exemption to the COVID-19 vaccine anytime during the pandemic until they accessed the survey. Chaplains were recruited online through national chaplaincy and ethics organizations. A mixed methods design facilitates integration of statistically significant associations with chaplains' in-depth reflections on their experience. Surveying the religious experts on the review committee affords a rare look into how the tension between the free exercise of religion in the workplace and the obligation to protect the public played out during the pandemic. The study further addresses a gap in research literature on the experience of chaplains during the pandemic and identifies unique features of moral injury experienced by a subset of healthcare providers. Chaplains largely perceived their involvement as promoting an ethical, informed process of review. Although all chaplains found this role stressful, high levels of meaning were protective against distress. Sources of distress identified included: ethical concern that granting exemptions would lead to the spread of the virus; inconsistencies in the review process; and, repeated exposure to coworkers' misunderstanding and political use of religious teachings. Featuring prominently in comments from chaplains was the difficulty navigating requests in the context of anti-science, anti-vaccine, and politically charged public discourse.