Fall 2005 Newsletter
On-Line Newsletter Volume 4, Number 1
Published September 29, 2005
Edited by Chaplain John Ehman, Network Convener
Network members are encouraged to submit articles for upcoming issues
of the Newsletter, which is published three times a year: Fall, Winter, and Spring.
The Winter 2006 issue is scheduled to be posted in January.
Table of Contents
- Bibliographies of Articles on Spirituality and Health
- Incidence of Religion/Spirituality in the Medline Index
- "Responding to John Gleason's Challenge," by Henry Heffernan
- Web Finds: NCCAM and CRISP
- The Journal of Gerontological Social Work's Recent Theme Issues on Spirituality
- Network Meeting in Honolulu HI, October 29th
1. Bibliographies of Articles on Spirituality and Health
In the mid-1990s, this editor became struck by the growing number of articles [--see §2, immediately below] about religion/spirituality appearing in the Medline index, realizing that this was the principal database of literature for all health care professionals. By 1998, I regularly found so many articles of interest that casually keeping track of them no longer seemed adequate, and I began a discipline of checking every week for new entries and compiling a list for my own use. In 1999, I formalized my list in a bibliography of 91 annotated entries, incorporating material from the articles' original abstracts as much as possible in order to guard against a skewed view of the works through excessive-editorializing. The friends with whom I shared this bibliography encouraged me to continue my practice, and so I did. My bibliography of articles published in 2000 contained 116 entries, and in successive years the numbers grew until last year when I noted 253 articles published in 2004.
My purpose in sharing these select bibliographies has been two-fold. First I have wanted to raise awareness among clergy that a great deal of literature is being published on religion/spirituality in a stream of thought among health care professionals that has very little connection to dialogue on the subject within traditional theological and pastoral circles. I have hoped to involve more people--more clergy in particular--in the discussion of spirituality/religion in health care. Second, I have wanted heath care professionals who were interested in the subject of the relation of religion/spirituality and health, especially with an eye toward research, to see in the sheer number of articles already being published that this is no longer the esoteric, dubious, or "tenure-suicide" topic that it once was--that it is indeed a "hot" area of research and writing. I have wanted to encourage more research in the field in general. To these ends, I now offer my bibliographies on line: see the bibliography index on the Hospital of the University of Pennsylvania's Pastoral Care Department web site at www.uphs.upenn.edu/pastoral/resed/bibindex.html.
2. Incidence of Religion/Spirituality in the Medline Index
As noted in §1 (above), the increase in the number of articles listed in the Medline index has been dramatic in recent years. I have compiled three graphs (PDF files) to show the trends in the incidence of articles that consider religion/spirituality.
The first graph is of articles that are indexed with keywords religion/religiosity/religious/religiousness, showing the significant rise in the incidence of these terms. Note that there is an especially sharp rise in the number of articles around 1993, and it is my personal observation that the content of articles also began to shift markedly about this time, so that religion was addressed in a more substantive fashion than previously. I recall speculation in the early 1990s about whether interest in spirituality & health had staying power or was a passing fad, and this graph would seem to demonstrate that interest has been enduring and deepening among health care professionals and researchers.
The second graph tracks the number of articles that are indexed with keywords spiritual/spirituality, showing that while the absolute number of articles using these terms is smaller than those using variations on religion, there has been a sharp rise in the use of the language of spirituality since 1994. Spiritual and spirituality are the ascendant terms in the current literature.
The third graph shows the overall increase and relative use of the two sets of terms--the variations of religion and of spirituality--used in article titles. Unlike the use of keywords, terms that appear in titles indicate a strong degree of explicit focus on the subject. This graph confirms the popularity of the language of spirituality, which occurs in titles now about as much as does the language of religion.
The graphs track crude numbers of times that articles use these terms, but the trend appears to be strong and consistent that religion/spirituality is a well-established topic in the Medline database. Since Medline is the de facto canon and standard for information for health care professionals, trends in the language and concepts represented there should not go unnoticed.
3. "Responding to John Gleason's Challenge," by Henry Heffernan, Staff Chaplain, Sibley
Hospital, Washington, DC
John Gleason's William Randolph Wycoff Lecture on pastoral research (--see the Winter 2004 Newsletter) stated clearly the moral imperative of all clinical chaplains to involve themselves actively in religious and pastoral research, and challenged CPE supervisors to find ways to inculcate this involvement in research into the "Head and Heart" dialogue of clinical pastoral education:
Like it or not, ready or not, all clinical chaplains have a four-fold moral imperative: to stay abreast of Religious and Pastoral Research findings, to test those findings in the cause of improving our own quality of care, to further examine our practice, and to share what we find. Our professional colleagues from other disciplines have proclaimed that message to us. [ACPE Research Network Newsletter (on line), vol. 2, no. 2, §1]
Supervisors who are members of the Research Network no doubt are already introducing their CPE students to current religious and pastoral research findings in their didactic sessions; and their group discussions offer opportunities for the students to consider how research findings relate to experiences in visiting patients. Gleason's challenge is to go further and introduce CPE students to a systematic examination of their spiritual care practice, and then share in a professional way what is learned through this reflection upon--and examination of--practice.
How can such further steps be actualized in a CPE Unit? What practical ways have supervisors found to introduce into the schedule of CPE student activities some level of systematic examination of professional practice, along with a professional-grade sharing of findings with colleagues? And what are the pragmatic issues that need to be considered in developing practical ways of responding to Gleason's challenge? I offer a few thoughts on these issues.
SOME GENERAL PRAGMATIC ISSUES
Each CPE program has its own pragmatic issues, but there are some general ones that are likely to be present in most, if not all, programs. The first is the issue of time: it takes a while for CPE students to learn to use CPE practices effectively to make progress toward their personal goals and the objectives stated in their contracts with the supervisor. The group discussion practices, the weekly reflections, the verbatims, and the individual sessions with the supervisor are dynamic learning experiences that enable students to make progress towards their stated goals and objectives. Developing rapport and mutual trust among the students in a CPE unit takes time, and the hours dedicated to direct contact with patients are the primary experiential activities that stimulate the dynamic growth of students' personal identities. These interactions with patients drive the other activities in the CPE process, which are designed to help the student perceive and internalize the meaning of the "living documents" encountered in the patients. Therefore, from the pragmatic perspective of the limited time available, any effort devoted to the systematic examination of practice and the professional sharing of the results of this examination should build upon the existing processes of the CPE unit, rather than be separate activities.
Second, the task of sharing what is discovered needs--in order to be effective and professional--to be undertaken in a way that will allow comparability and the systematic accumulation of refined information. In many professional fields, sharing is accomplished through publications in journals and the contribution of data to specialized databases. The format for articles in the professional journals of the medical profession, for instance, is designed to provide the reader with enough information so that the relevance of an article's contents can be quickly assessed. Articles in medical journals typically follow the IMRAD format: Introduction, Methods, Results, and Discussion. Students should appreciate the efficiency of this reporting model: The Introduction section states the objective of the research, and provides background information on the findings of previously published research on the topic. The Methods section describes the research design, with sufficient detail to enable other researchers to design replication studies. The Results section details the findings, often in a fairly raw form. The Discussion section presents the author's interpretation of the results and usually suggests the applicability of the findings and the limits of the research that might be addressed in subsequent research, before offering conclusions based upon initial hypotheses.
For a professional-grade sharing of the results of an examination of pastoral practice in specific cases, an appropriate structure of information is needed along with a format for the description of the interventions with patients that is analogous to professional communications in other disciplines. The Spring 2004 Newsletter offered one model of a structured description of a patient visit.
As one example of a way to introduce systematic practice examination and professional sharing activities into the processes of CPE Units, consider the following, taking a student's verbatim as the starting point:
RESPONSE TO GLEASON'S CHALLENGE
a) Professional Examination of Practice-- The existing CPE processes of writing verbatims, and then discussing these verbatims in a peer group and in sessions with a supervisor, are the first phase of an examination of practice. In order to take full advantage of observations/suggestions from other students and the supervisor, in addition to self reflection on the pastoral intervention, a student might write up a further reflection on the intervention in light of feedback on the verbatim, so as to capture thoughts for improving pastoral practice. This second-phase analysis could be introduced to students as an assignment toward the end of a CPE unit: each student would develop one structured description of an intervention with a patient that would include the student's synthesis of the suggestions received from the other students and the supervisor, and in light of the student's mature reflection on the original encounter with the patient. This structured description would, in essence, present how the student would conduct the intervention if she or he could do it over again. The description of the intervention would therefore represent the student's articulation of a "best practice" in the context of the original encounter with the patient.
b) The Contents and Structure of the Description-- To be of professional usefulness, the structured description of the intervention should contain the information that would enable another chaplain to replicate the intervention in another institution with another patient in circumstances similar to those encountered in the original intervention. It would include patient characteristics/condition and details of the "best practice" of pastoral care involved. The structured description of the intervention with the patient would be designed to describe how another chaplain could plan a sequence of steps for replicating the intervention as a "best practice" for patients with similar needs, and should be sufficient to guide a chaplain or intern in another setting to conduct the model intervention.
At present, there is no consensus among professional chaplains about exactly what information such a structured description should include. In the absence of a professional norm, individual CPE supervisors should determine how the description should be structured and what information it should contain. A template for a structured description of a chaplain's intervention was outlined in the Spring 2004 Newsletter. That suggested structure included:
With the accumulation of structured descriptions of interventions, the most useful template designs should emerge. Initial efforts at structured descriptions will clarify what information is needed for other chaplains to replicate and test proposed "best practice" interventions.
- The purpose of the intervention, based on what is already known about the patient
- The sequence of steps or phases of the intervention
- The cognitive content or information presented by the chaplain to the patient
- The indicators considered to be evidence of a favorable outcome of the visit
c) Professional Sharing of the Examination of Practice-- Students would provide the supervisor with electronic copies of the structured description papers, and these should allow the supervisor not only to build a database of structured descriptions of patient visits but also to exchange them with other supervisors. The exchange of these structured descriptions among CPE programs would work as an effective, if quite basic, professional sharing of the examination of practice. Such an exchange could begin with informal communication of CPE students' structured descriptions among supervisors participating in the ACPE Research Network. As the record of experience grows, more formal arrangements can be developed.
In this particular method for responding to John Gleason's challenge, each CPE student would undertake an assignment to work carefully through the critique and suggestions received on one of her or his verbatims, and then write out the design of an optimal patient intervention. The structured description of the encounter would include the "best practices" synthesized by the student. This assignment for each student would provide an experience in examining her or his pastoral practice in a particular encounter with a patient and in formulating what the student has learned about how best to provide spiritual care for a patient with similar needs. By using a standard format for writing the structured descriptions, students may come to think in terms of a process of accurately presenting pastoral care information in ways that other chaplains can understand and use. As the structured description is shared with other CPE programs in other institutions, students would also be able to experience participation in the larger world of professional chaplaincy.
A PILOT PROGRAM FOR A RESEARCH NETWORK SHARING MODEL
CPE supervisors participating in the ACPE Research Network would be invited to introduce the structured description assignment task outlined above into their next CPE units, or as assignments toward the end of current CPE units.
Electronic copies of students' structured descriptions could be sent to the Convener of the Network. A project manager could then package all the structured descriptions together and send the set of structured descriptions to the supervisors participating in the pilot program.
The supervisors participating in the pilot program, after reviewing the combined set of the structured descriptions, could then discuss improvements to be made in the method as well as refinements to a common format for descriptions.
After a year or two of accumulating structured descriptions from the participating supervisors' CPE programs, the descriptions could be made available as a downloadable document/database from the Network's web site. (The set of abstracts of articles made available in §1 of this Newsletter provides an example of how a fairly large set of descriptions could be shared via the web site.)
As this database grows with the input of additional structured descriptions from subsequent CPE units, research studies could be undertaken based on the material, and the objectives outlined in the Spring 2003 Newsletter could be addressed. The availability of a database of these structured descriptions of chaplains' visits with patients could serve multiple purposes for the members of the Network:
- Agreement could be forged on terminology for specific chaplaincy practices within visits with patients could be developed.
- A database of encounters, described in the same structured way, would enable supervisors to compare practices and identify commonalities.
- Appropriate examples among these structured descriptions could be used in CPE education.
- CPE interns and residents in their second, third, and especially their fourth CPE units could develop studies and papers based on this database's examples of interventions with patients.
[Chaplain Heffernan may be contacted by e-mail at firstname.lastname@example.org]
4. Web Finds: NCCAM and CRISP --NOTE: These sites are no longer operational.
The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, produces an on-line Newsletter, the Winter 2005 (vol. 12, no. 1) issue of which contains a feature article, "Prayer and Spirituality in Health: Ancient Practices, Modern Science."
CRISP (Computer Retrieval of Information on Scientific Projects) is a National Institutes of Health database that allows searches for research projects and programs funded by the Department of Health and Human Services, and may be accessed at http://crisp.cit.nih.gov. A recent search turned up a number of projects on spirituality: "The Role of Daily Spirituality in the Disease Process," "[Creation of a] Comprehensive Database on Spirituality and Health," "Levels of Spirituality and Treatment Outcomes," "The Efficacy of Distant Healing in Glioblastoma Treatment," and "Spirituality, Religiosity, and Immune Functioning," "Spiritually Guided HIV Prevention for Drug Users," "Long-Term Spiritual Changes in Recovery from Alcoholism." "Religious Commitments and Clinical Engagements," and "Spirituality and Health Factors in Women with Diabetes."
5. The Journal of Gerontological Social Work's Recent Theme Issues on Spirituality
The Journal of Gerontological Social Work recently produced successive theme issues on spirituality. Vol. 45, nos. 1/2 (2005), begins with a basic overview of spirituality research and aging by David O. Moberg [--for more about Moberg himself, see the opening paragraphs of the February 2004 Article-of-the-Month page] and includes several reports of studies, along with commentaries and reviews, continuing into vol. 45, no. 3. The issues, published simultaneously as a book (Religion, Spirituality, and Aging: A Social Work Perspective, edited by Harry R. Moody, PhD, Director of Academic Affairs, AARP) is noteworthy not only for its particular focus on an older adult population but for its social work perspective. Abstracts of the articles are available through the journal web site--see the journal's table of contents pages for vol. 45, nos. 1/2 and no. 3. The articles, in order, are:
For vol 45, nos. 1/2 --
Moberg, D. O., "Research in Spirituality, Religion and Aging," pp. 11-40.
Simmons, H. C., "Religion, Spirituality and Aging for The Aging Themselves," pp. 41-49.
Nelson-Becker, H., "Religion and Coping in Older Adults: A Social Work Perspective," pp. 51-67.
Morano, C. L. and King, D., "Religiosity as a Mediator of Care Giver Well-Being: Does Ethnicity Make a Difference?" pp. 69-84.
Eisenhandler, S. A., "Religion Is the Finding Thing: An Evolving Spirituality in Late Life," pp. 85-103.
Cnaan, R. A., Boddie, S. C. and Kang, J., "Religious Congregations as Social Services Providers for Older Adults," pp. 105-130.
Murdock, V., "Guided by Ethics: Religion and Spirituality in Gerontological Social Work Practice," pp. 131-154.
Koenig, T. L., "Caregivers' Use of Spirituality in Ethical Decision-Making," pp. 155-172.
Richards, M., "Spirituality and Social Work in Long-Term Care," pp. 173-183.
Nowitz, L., "Geriatric Care Management: Spiritual Challenges," pp. 185-201.
Brennan, M., Laditka, S. B. and Cohen, A., "Postcards to God: Exploring Spiritual Expression Among Disabled Older Adults," pp. 203-222.
Address, R. F., "Creating Sacred Scenarios: Opportunities for New Rituals and Sacred Aging," pp. 223-232.
Roth, D. E., "Culture Change in Long-Term Care: Educating the Next Generation," pp. 233-248.
For vol. 45, no. 3 --
Staude, J.-R., "Autobiography as a Spiritual Practice," pp. 249-269.
Harry R Moody, H. R., "Dreams for the Second Half of Life," pp. 271-292.
Seicol, S. R., "A Pastoral Understanding of Positive Aging," pp. 293-300.
Ewing. W. A., "Land of Forgetfulness: Dementia Care as Spiritual Formation," pp. 301-311.
Griffin, R., "Caregiving and Our Inner Elder: Insights from a Spiritual Master," pp. 313-317.
Bianchi, E., "Living with Elder Wisdom," pp. 319-329.
6. Network Meeting in Honolulu HI, October 29th
Our Network meeting, as part of the national ACPE conference in Honolulu, is scheduled for 9:00 AM on Saturday, October 29th. We will discuss the various research projects in our CPE programs, how to encourage wider participation in the Network, and our web site, including the need to develop more education-focused content. Members wishing to add items to the agenda should e-mail email@example.com.