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Fall 2010 Newsletter
On-Line Newsletter Volume 9, Number 1
Published October 30, 2010
Edited by Chaplain John Ehman, Network Convener
Network members are encouraged to submit articles for upcoming issues.
The Newsletter is published three times a year: Fall, Winter, and Spring-Summer.
(The Winter 2011 issue will be published in late February.)
Table of Contents
- Update on the Current Research Initiative by the ACPE Board and Executive Director
- Important New Survey of Chaplains’ Charting
- Survey of Clinical Members
- Longitudinal Study of God Images in Chronic Pain Patients Planned
- New Study from the Department of Chaplaincy and Pastoral Education at Clarian Health
- Survey of Religion in America -- 1972-2006, from HealthCare Chaplaincy
- Research as Part of "Defining and Advocating for Spiritual Care in the Hospital"
- Two Network Member Articles Now Available Freely Online from Chaplaincy Today
- Special Journal Theme Issue on Spiritual and Religious Issues in Behavior Change
- Southern Medical Association's Spirituality/Medicine Interface Project Website Closes
1. Update on the Current Research Initiative by the ACPE Board and Executive Director
As noted in our Spring-Summer 2010 Newsletter (§1), the ACPE Board has approved a motion that Executive Director Teresa Snorton "...work with interested ACPE Supervisors and Centers and other research experts to design a research initiative for the ACPE." On June 18th, Dr. Snorton e-mailed members of the Research Network as part of a general consultation on how to respond to the Board's motion and especially how to involve members of the organization at large in the initiative. Then on August 20th, a call for specific project ideas went out to all ACPE members through the August 2010 e-News, asking: "What knowledge or information do ACPE members need -- as educators, practitioners, or administrators -- that would be strengthened by empirical data?" and, "Is this an idea/project that you have already formally developed (e.g., have submitted to an IRB, have sought funding for, or have piloted)?" Replies were collected by the Research Network Convener and on September 13th were forwarded to Dr. Snorton, who will next report back to the Board in November and determine the next steps. The continuing development of this initiative will be tracked in our Network Newsletters, including a sample of project proposals.
2. Important New Survey of Chaplains’ Charting
Chaplains' ability to document in medical records is often a significant indicator of their integration into health care institutions' interdisciplinary teams. Moreover, since the enactment in 2003 of the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA), organizations have needed to make a quite intentional decision about chaplains' access to Protected Health Information (PHI). So, what is the overall incidence of "charting" by chaplains in the US?
Rabbi Rafael Goldstein, Director of the Department of Pastoral Care at The Mount Sinai Medical Center in New York has recently conducted a survey of pastoral care departments, focusing on the "Honor Roll" hospitals ranked by US News and World Reports, as well as that magazine's listing of "top hospitals" in Cancer, Heart and Heart Surgery, and Geriatrics. His data show an overwhelming prevalence of chaplains documenting in medical records. Since hospitals routinely tout the US News and World Reports rankings as signifying excellence in health care practice, Rabbi Goldstein's survey indicates a de facto "best practice" for chaplains. This is a very important finding for the field of pastoral care, and one that should be brought to the attention of every heath care institution in the US. It also is pertinent to debates about charting by chaplains' in other countries (Great Britain, for example), where the practice may be more hotly contested.
Rabbi Goldstein's full report of the research is presently being prepared for publication. (News of this publication will be posted on our website, under the General Announcements section of our home page.) For more information, email: rafael.goldstein@mountsinai.org.
3. Survey of Clinical Members
Beginning in March 2010, Chaplain Claudia Meyer invited ACPE Clinical Members to complete an online survey aimed at gaining a snapshot of the demographics of the group, their needs for continuing education, and their involvement in local ACPE centers. Chaplain Meyer is the Clinical Member Representative to the ACPE Board, and this project grew out of discussions by the Board about continuing education and specialty certifications for Clinical Members, as well as a general interest in learning more about who these members are as a group. The survey was conducted using Survey Monkey. Of 411 possible surveys, 138 were completed by the deadline of April 15th, for a 34% response rate. The following results were published originally in the Eastern Region's Summer 2010 Newsletter.
- Clinical Members cited "membership in a professional organization for chaplains" as the primary reason for becoming a Clinical Member, followed by "supporting the educational mission of ACPE," "staying connected to a group of peers," and "participating in continuing education."
- 63% of Clinical Members currently serve as chaplains. Other current positions include clergy, Director or Administrator of Pastoral Care, and educator/Program Director at a university or seminary.
- 63% of Clinical Members currently work in a hospital or health care facility. Other workplaces include hospice, higher education, and "retired."
- 67% of Clinical Members are currently required to complete continuing education as a part of their certification or job requirement.
- 37% of Clinical Members also belong to the Association for Professional Chaplains; 41% do not belong to another national professional chaplaincy organization.
- 50% of Clinical Members report having attended either a Regional or a National Conference.
- Of those who have not attended an ACPE conference, "cost of attending" was most frequently cited as the reason, followed by "time required to attend" and "choosing to attend conferences of cognate groups (APC, NACC, NAJC, etc.) instead."
- 79% of Clinical Members indicated that they are likely to participate in ACPE-sponsored continuing education "at a distance" (webinars, DVDs, teleconference, etc.). The 21% who are not likely to participate were vocal about the "impersonal" feel of these offerings and their preference for face-to-face encounters.
- The most popular choices for continuing education topics were: spiritual assessment, end-of-life, ethics, counseling, and PTSD/crisis counseling.
- 82% of Clinical Members live within driving distance (50 miles) of a CPE center.
- Only 29% of Clinical Members currently serve on a Professional Advisory Council for a CPE center.
- 57% of Clinical Members have served as educators or guest lecturers for a CPE center.
- Of those who do not currently serve on a Professional Advisory Council,
- Of those who do not currently serve on a Professional Advisory Council, 46% indicated that they would be willing to serve.
- Of those who have not served as an educator or guest lecturer, 47% indicated that they would be willing to serve.
Based upon this data, Chaplain Meyer identified three priorities for the ACPE's efforts regarding Clinical Members:
- Improve continuing education offerings available and of interest to Clinical Members.
- Work toward greater participation of Clinical Members in ACPE regional and national conferences.
- Encourage greater involvement of Clinical Members in local CPE centers (on Professional Advisory Council or by serving as educators or guest lecturers, for example).
This survey highlights the need for better data on our own organization's membership, as well as the challenge of doing this (as indicted by the 34% response rate). Suggestions of other methodologies for how to capture "who we are" may be sent to the Research Network convener (john.ehman@uphs.upenn.edu).
Chaplain Meyer is on staff at the Albany Medical Center (Albany, NY). She can be contacted at claudialandau@gmail.com.
4. Longitudinal Study of God Images in Chronic Pain Patients Planned
In a communication with the Network Convener, Belgian researcher Jessie Dezutter, PhD, has said that she and associates of the Center for the Psychology of Religion at the Catholic University of Leuven have received funding to begin a three-year longitudinal study of God images for patients with chronic pain. The study will look at changes over time in God images, pain indices and well-being. This follows the publication of her recent article: Dezutter, J., Luyckx, K., Schaap-Jonker, H., Bussing, A., Corveleyn, J. and Hutsebaut, D., "God image and happiness in chronic pain patients: the mediating role of disease interpretation," Pain Medicine 11, no. 5 (May 2010): 765-773. The study analyzed questionnaires from 136 chronic pain patients and found that "a positive God image has an influence on the happiness of CP [chronic pain] patients, both directly and indirectly through the pathway of positive disease interpretation" [p. 771]. Other recent work by Dr. Dezutter regarding religion and chronic pain includes: Dezutter, J., Robertson, L., Luyckx, K., Hutsebaut, D., "Life satisfaction in chronic pain patients," Journal for the Scientific Study of Religion 49, no. 3 (September 2010): 507–516; and Dezutter, J., Luyckx, K., Büssing, A., Hutsebaut, D., "Exploring the link between religious attitudes and subjective well-being in chronic pain patients," International Journal of Psychiatry in Medicine 39, no. 4 (2009), 393-404.
5. New Study from the Department of Chaplaincy and Pastoral Education at Clarian Health
Paul S. Bay and Stephen S. Ivy, from the Department of Chaplaincy and Pastoral Education at Clarian Health, along with statistician Colin L. Terry, have recently published "The effect of spiritual retreat on nurses' spirituality" in Holistic Nursing Practice [vol. 24, no. 3 (May-June 2010): 125-133].
[Abstract:] This study tested whether two 1-day retreats focused on spiritual self-care would positively change nurse participants' spirituality. A total of 199 critical care nurses were accepted into this study; 87 were randomized to receive the retreat intervention. All 199 nurses were tested preretreat, 1 month and 6 months postretreat. Retreat participants demonstrated increased spirituality.
The article offers at the outset a brief but solid overview of the relevant literature and related research and includes a thorough description of methodology (--even a sample agenda from the retreat). This study may be a useful means for pastoral care departments to explore opportunities to work with nursing groups on retreat programs as professional "renewal experiences" [p. 132], and those programs may in turn play into the opportunity for further research in this area. The authors ultimately tie the relevance of such a retreat intervention not only to staff members' personal and professional needs but to the practical issue of staff being better able to address the common patient satisfaction question of whether spiritual, emotional and cultural needs were met during hospitalizations.
6. Survey of Religion in America -- 1972-2006, from HealthCare Chaplaincy
The Spears Research Institute at the HealthCare Chaplaincy (New York) has published a survey of religion in America in recent decades:
Flannelly, K. J., Galek, K., Kytle, J. and Silton, N. R.
"Religion in America --1972-2006: religious affiliation, attendance, and strength of faith." Psychological Reports 106, no. 3 (June 2010): 875-890. [(Abstract:) The present study used data from the General Social Survey, collected between 1972 and 2006 (N = 45,463) to analyze changes over time in three aspects of religion among American adults: religious affiliation, frequency of attending religious services, and strength of faith. The last two measures were analyzed only for survey participants who had a religious affiliation. Ordinary least-squares regression confirmed a significant decrease in religious affiliation over time, after controlling for socio-demographic variables that are known to be associated with religion. A significant decrease in attending religious services was found among those survey participants who were religiously affiliated. As expected, participants who were African American, female, older, and from the South were more religious according to all three measures. No effect of birth-cohort was found for any religious measure. The results are discussed in the context of Stark and Bainbridge's 1996 theory of religion.]
The authors draw upon data from the General Social Survey, which has been noted in our Winter 2006 Newsletter (§4). This is an interesting and useful database for chaplains doing research, with a great deal of information freely available online from the National Opinion Research Center at the University of Chicago.
7. Research as Part of "Defining and Advocating for Spiritual Care in the Hospital"
Larry VandeCreek's recent article on "Defining and advocating for spiritual care in the hospital," in the Journal of Pastoral Care and Counseling; [vol. 64, no. 2 (2010)] makes a case that is largely research-based.
[Abstract:] A definition of spiritual care and attention to the scientific literature can strengthen the advocacy efforts of hospital funded chaplaincy programs. Adapting Pargament’s work, spiritual care is defined here as giving professional attention to the subjective spiritual and religious worlds of patients, worlds comprised of perceptions, assumptions, feelings, and beliefs concerning the relationship of the sacred to their illness, hospitalization, and recovery or possible death. Results from the scientific literature are then presented in response to four advocacy related questions: 1) How do hospital decision makers and chaplains perceive the experience of hospitalization, 2) Does a need for spiritual care exists; is it relevant, 3) Who can best provide spiritual care, and 4) Are chaplain visits helpful? This definition and advocacy material can be useful when decision makers review the funding of spiritual care.
Dr. VandeCreek cites studies throughout, but especially in light of the questions: "Does a need for spiritual care exists; is it relevant?" [pp. 5-6], "Who can best provide spiritual care?" [pp. 6-7], and "Are chaplain visits helpful?" [pp. 7-8]. He includes a bibliography of 46 items.
8. Two Network Member Articles Now Available Freely Online from Chaplaincy Today
Two articles in Chaplaincy Today by Network members from the Virginia Commonwealth University Program in Patient Counseling, Alexander Tartaglia and Diane Dodd-McCue , et al. -- reported in our Spring-Summer Newsletter [vol. 8, no. 3 §3] -- are now available freely online from the journal. See:
Dodd-McCue, D. and Tartaglia, A. "Self-report bias: learning how to live with its diagnosis in chaplaincy research." Chaplaincy Today 26, no. 1 (Spring-Summer 2010): www.professionalchaplains.org/uploadedFiles/pdf/26_1doddmccue.pdf. [(Abstract:) Chaplaincy research is dominated by self-report data collected directly from research subjects or participants. Self-report response bias is the research measurement inaccuracy that originates with the respondent. This article focuses on seven categories of this bias and offers recommendations for acknowledging and addressing this problem. This article focuses on seven categories of self-report bias that may impact chaplaincy research: social desirability, acquiescence, leniency or harshness, critical event or recency, halo effect, extreme response style, and midpoint response style. Although these biases have the potential to impact self-report data, the data themselves are not inherently flawed. This discussion offers recommendations for addressing self-report response bias during the research process. It also suggests that acknowledging and understanding the impact of self-report response bias may result in more rigorous research as well as more creative and informed interpretation of results.]
Tartaglia, A., Dodd-McCue, D., Horrocks, B. and Faulkner, K. "Enhancing student engagement and critical thinking during hospital orientation for Level 1 CPE students ." Chaplaincy Today 25, no. 1 (Spring-Summer 2009): www.professionalchaplains.org/uploadedFiles/Publications/CT_free_access/25_1tartaglia.pdf. [(Abstract:) Hospital orientation for a Level 1 CPE unit is challenging due to the volume of information and the requirement to comply with hospital and regulatory policies. In contrast with the case based, experiential focus of CPE, hospital orientation is content-driven. This pilot project revised hospital orientation to align it with the action-reflection method using video scenarios. Effectiveness was evaluated by assessing student knowledge as well as student and faculty perceptions of the delivery method. Pre-test and post-test results found improved student knowledge in each of four areas studied. Students found the scenarios enhanced critical thinking but were more neutral in recommending them over other methodologies. In contrast, faculty and residents strongly recommended scenarios rather than content-only orientation methods.]
9. Special Journal Theme Issue on Spiritual and Religious Issues in Behavior Change
The November 2010 issue of Cognitive and Behavioral Practice [vol. 17, no. 4] is a special theme edition on Spiritual and Religious Issues in Behavior Change. Guest editors David H. Rosmarin and Harold B. Robb, III, along with Kennith I. Pargament, introduce the series of articles:
Spiritual and religious beliefs and practices are commonplace in the general population of North America today. In recognition of this fact, research on the interplay of spirituality, religion, and psychological variables increased substantially over the past 3 decades; a recent PsycInfo search identified over 28,000 scientific contributions to this area. However, the relevance of spirituality and religion to clinical practice remains poorly understood. As a result, many practitioners of empirically supported treatments may be reticent to address spirituality and religion in the course of their work. The intent of this special series is to help demystify this topic with the hope of increasing dissemination of spiritually sensitive, empirically supported treatments. The authors in this series cast some light on this understudied topic by highlighting several salient spiritual and religious issues in behavior change. Moreover, based on case material, the authors illustrate how to assess for and address both adaptive and maladaptive utilizations of spirituality and religion in the practice of cognitive behavior therapy. This introductory paper presents a rationale for why it is important to address this topic, and provides an overview of recent research developments in the creation of spiritually integrated psychosocial treatments. [Abstract, p. 343.]
The research articles that follow are, in order:
Weisman de Mamani, A. G., Tuchman, N. and Duarte, E. A.
"Incorporating religion/spirituality into treatment for serious mental illness." Pp. 348-357
Spangler, D. L. "Heavenly bodies: religious issues in cognitive behavioral treatment of eating disorders." Pp. 358-370.
Karekla, M. and Constantinou, M. "Religious coping and cancer: proposing an acceptance and commitment therapy approach." Pp. 371-381.
Huppert, J. D. and Siev, J. "Treating scrupulosity in religious individuals using cognitive-behavioral therapy." Pp. 382-392.
Masters, K. S. "The role of religion in therapy: time for psychologists to have a little faith?" Pp. 393-400.
10. Southern Medical Association's Spirituality/Medicine Interface Project Website Closes
The Southern Medical Association's Spirituality/Medicine Interface Project website has been taken off line after a significant run of over four-and-a-half years. The project was originally introduced in the December 2005 issue of the Southern Medical Journal, building on what the journal's editor, Ronald C. Hamdy, noted as "a long tradition of publishing manuscripts on the interface between spirituality, religion and medicine" [SMJ 98(12): 1233]. Supported by a grant from the John Templeton Foundation, the initiative involved educational programs for physicians, physicians-in-training, chaplains, social workers and nurses; as well as a special section of articles on a quarterly basis in the organization's journal and, of course, the website offering full-text journal articles, on-line presentations, and an extensive listing of links (including a link to our Research Network). The original grant from the Templeton Foundation concluded in 2008, and the website was unavailable from April to July of that year, while it was being transformed into a static, archival source. The revised site ran for another two years.
The project was a milestone in the study of Spirituality & Medicine, not only because of the wealth of resources that it brought together for easy access, but because it provided a much more extended and intensive focus on the subject from a major medical organization than had previously been the case. (Prior to this, the only medical journal initiatives that systematically emphasized Spirituality & Health issues over time -- apart from those in journals dedicated precisely to the subject -- were perhaps article series on religious/cultural bioethics that ran in the Canadian Medical Association Journal from 2000-2002, or the series on religious traditions and end-of-life care that ran in the British journal, The Lancet, through the summer-fall of 2005.) The Project also stands as another indicator of the importance of the Tempeton Foundation to the development of field of Spirituality & Medicine.
While the Project website no longer exists, a collection of freely available articles on spirituality from the Southern Medical Journal may be found at http://journals.lww.com/smajournalonline/pages/collectiondetails.aspx?TopicalCollectionId=7, and this itself constitutes a fine resource for physicians...and chaplains.
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