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Fall 2013 Newsletter

On-Line Newsletter Volume 12, Number 1
Published October 29, 2013

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.

Table of Contents

  1.   CPE Residency Group Research Project at St. Luke's Hospital (Kansas City, MO)
  2.   New Report on "Spiritual Fitness" by the Rand Corporation
  3.   "Nurses: The Chaplainís Gatekeeper?" --a Reflection by Elizabeth Johnston Taylor
  4.   Margot Hover's "Five Questions I Wish Research Would Address"
  5.   A Message to Chaplains from Joan Beder
  6.   New Journal: Spirituality in Clinical Practice
  7.   Presentations from the 2013 Conference on Interdisciplinary Applications from Spirituality & Health Research

 

1.     CPE Residency Group Research Project at St. Luke's Hospital (Kansas City, MO)

Completing a research project during a CPE residency always presents a logistical challenge, since by the time most students are clear about their topic and hypotheses and obtain the appropriate permissions, precious time is left to gather data, much less draft a report. This was the major subject of discussion at our 2010 Network meeting, when Steve Overall shared a number of finalized projects from his residents at St. Luke's Hospital, Kansas City, MO. Steve (now retired) also offered a brief note of the research component at St. Luke's in our Fall 2012 Newsletter, §4. This past year, the four residents in that program made the unusual decision to combine their efforts and undertake a research project together. For part of the year, they set aside an hour every Friday at 11:00 AM to coordinate their work on "Nursesí Perception of the Role of Chaplain," and the result is a very good example of a measured but substantial contribution to the hospital and possibly beyond. In July, the project was presented to a group of nurses, physicians, and chaplains at St. Luke's and then to the hospital's Nursing Research Council. The co-authors -- Kristin Austin, MDiv; Phyllis Flory, MSM; Tim Maguffee, MDiv; and Judy Sneegas, MDiv -- have continued after the residency to refine their report for publication. The abstract is as follows:

In 2010 an informal survey to examine nursesí perception of the role of chaplain was conducted by the Spiritual Wellness Department at Saint Lukeís Hospital-Plaza in Kansas City, Missouri. This survey was replicated in 2013 in order to further examine and identify areas for growth that will enhance the quality of collaborative patient care. The findings from this study revealed that there is a positive correlation between nursesí familiarity with the role of chaplain and their likelihood to work collaboratively with chaplains.
The report is available online, and, for this reader, what struck me was the clarity of their approach (represented in well organized narrative), plus the thoughtfulness of their methodology (represented in the documentation of a multi-part appendix). Their teamwork strategy may be a model for other programs, though the arc of group dynamics in any residency program may be problematic for such an approach in many programs. For more information about the report itself, contact Kristin Austin at austin.kristin.m@gmail.com.  --JE

 

2.     New Report on "Spiritual Fitness" by the Rand Corporation

The concept of "spiritual fitness" has been developed in recent years within the US military with the goal of supporting soldiers' resilience and well-being. Here, because of First Amendment restrictions, spirituality is not construed in terms of religion but rather core beliefs and values that give a person a sense of meaning and purpose, though obviously for some people such beliefs and values would revolve around religion. Two major articles on this in the health-care literature are: Hufford, D. J., Fritts, M. J. and Rhodes, J. E., "Spiritual fitness," Military Medicine 175, no. 8 (August 2010): 73-87; and Pargament, K. I. and Sweeny, P. J., "Building spiritual fitness in the Army," American Psychologist 66, no. 1 (January 2011): 58-64. Both articles are part of theme issues on the multidimensional construct of fitness and discuss basic definitions and metrics. A note of caution about a possible confusion: this consideration of "spiritual fitness" is distinct from that of a measure called the Spiritual Fitness Assessment, which has an explicitly religious perspective [--see Kassab, V. A. and MacDonald, D. A., "Examination of the psychometric properties of the Spiritual Fitness Assessment," Journal of Religion & Health 50, no. 4 (December 2011): 975-985].

On October 3, 2013, the Rand Corporation posted to its website the latest report on this subject: Yeung, D. and Martin, M. T., Spiritual Fitness and Resilience: A Review of Relevant Constructs, Measures, and Links to Well-Being (Santa Monica, CA: Rand Corporation, 2013), available for download through www.rand.org/pubs/research_reports/RR100. The abstract is as follows:

This report is one of a series designed to support Air Force leaders in promoting resilience among its Airmen, civilian employees, and Air Force families. It examines the relationship between spiritual fitness and resilience, using key constructs found in the scientific literature: a spiritual worldview, personal religious or spiritual practices, support from a spiritual community, and spiritual coping. The literature shows that possessing a sense of meaning and purpose in life is strongly positively related to quality of life and improved health and functioning. The authors find that diverse types of spiritual interventions are linked to improved resilience and well-being. These interventions focus mainly on the individual, but some address the military unit, the family, and the community.
This document draws heavily on the healthcare literature --see especially the measures listed in Table 2.1 [pp. 7-14]. While written specifically for the military context, the report may be informative for all chaplains with regard to the conceptualization and assessment of spirituality in non-religious settings. Civilian chaplains may want to look, for instance, at the four concluding recommendations [pp. 39-41] addressing diversity, evidence-based guidance, alternative approaches to spiritual enhancement, and the possible impact of non-spiritually-specific interventions on spirituality. Also, this material sees spirituality overall in light of resilience, and that quality is implicitly at the heart of a long-standing concern within chaplaincy: namely, the tension between identifying such practical effects of spirituality and taking an approach to spirituality that may be utilitarian. Another aspect of this literature is that it sees the spirituality and resilience of military personnel as closely connected with that of their families. The very brief preface of the Rand report mentions families 13 times and states, "The results of our studies may...help broaden the scope of research on resilience and help Airmen and their families achieve optimal spiritual fitness" [p. iv]. This family emphasis could be a challenge, if not a model, for a more inclusive perspective of family-patient connections in the field of spirituality & health generally.

Research Network members' thoughts on "spiritual fitness" and on the potential of dialogue between civilian and military chaplains on this subject are welcome and will be posted in future Newsletters.

 

3.     "Nurses: The Chaplainís Gatekeeper?" --a Reflection by Elizabeth Johnston Taylor

[Note: Dr. Taylor, PhD, RN, Professor, School of Nursing, Loma Linda University, Loma Linda, CA, is the co-author of our August 2013 Article-of-the-Month, and she offers this reflection to the Network in light of her experience as a nurse, researcher, and CPE alumna.]

Early in my career as a nurse dedicated to learning about how to support patient spiritual well-being, I completed 2 units of Basic CPE. Both units were immensely satisfying and stimulating times for me, personally and professionally. What I learned during CPE now influences what and how I teach nurses about spiritual care. Consequently, I have a special place in my heart for chaplains and want to encourage them to pursue ways of legitimizing their essential role through generating empirical evidence to that end. Health care recipients and providers need you. I will need you when I face a serious illness or tragedy. Please be there!

Whereas I may want to collaborate with chaplains, I recognize that not all nurses do. One of the first studies I did, now 20 years ago, surveyed a stratified, random sampling of oncology nurses about their spiritual care perceptions and practices (N=181). One of the unexpected findings from this survey data was how a large minority of these nurse respondentsí had negative perceptions and experiences with chaplains (Taylor and Amenta, 1994). For example, they wrote of times when a chaplain appeared to have caused emotional distress instead of comfort, drawing this conclusion from seeing a patient teary after the chaplain left. Others mentioned "rudeness" or "non-responsiveness" of chaplains, apparently out of nurses' frustrations from not having a chaplain immediately on-site and at bedside. Although I do not know if the nursesí perceptions of chaplains were misperceptions, I do have evidence that these perceptions led some nurses to become gatekeepers. One outcome of this was that some nurses reported how they called their own clergy or provided the spiritual care themselves because they could not trust the efforts of the chaplain.

A few years ago, I had the privilege of presenting at a conference of chaplains in New Zealand. I asked them to describe how they related to nurses. By this point, I was not surprised to hear that they often experienced challenges with gatekeeping nurses. I was, however, a bit taken aback by how strongly they personally felt the resistance. A rich discussion ensued and effective strategies for minimizing the gatekeeping were identified (e.g., debriefing with a patientís nurse after a visit and educating nurses about the role and process of chaplain visits).

This international perspective (albeit with only two countries sampled) may lend credence to an argument that nurses' gatekeeping with regard to spiritual care has a deeper etiology than many might assume. Sure, maybe nurses encounter a "bad apple" and "throw the baby out with the bathwater." Sure, maybe they donít understand the process and goals of chaplains. But could the resistance lay deeper? Sociologist Sophie Gillat-Ray (2003) posited that nurses need to establish and maintain a boundary around their professional roles that legitimize nursing. The wider the berth, the more needed and legitimate they become. Sociologically, it is possible that nursesí claim to being generalist spiritual care providers competes with chaplainsí efforts to legitimize chaplaincy within the health care system. I would put forward what Larry VandeCreek taught me years ago: in todayís health care climate, there is plenty of room for generalist spiritual care from competent nurses and expert spiritual care from chaplains (Taylor, 2002).

The snippets above illustrate how poor communication and relationships between nurses and chaplains lead not only to a lack of spiritual care, but potentially the delivery of poor, harmful, or unethical spiritual care. Consequently, it is the patient who suffers. As a researcher, I am prompted to ask empirically researchable questions about this phenomenon. How prevalent is this problem? How does nurse gatekeeping manifest? What factors contribute to its development and use? What strategies do chaplains use that minimize gatekeeping? Would nurse education solve the problem? Many of these questions could rather easily be studied by a team of chaplains or nurses. However, what would produce the richest and most applicable findings would likely come from a team of nurse and chaplain researchers. Indeed, such a collaboration would model further how chaplains and nurses can work jointly for beneficial outcomes.

References:
Gilliat-Ray, S. "Nursing, professionalism, and spirituality." Journal of Contemporary Religion 18, no. 3 (2003): 335-349.
Taylor, E. J. Spiritual care: Nursing Theory, Research, and Practice. Upper Saddle River, NJ: Prentice Hall, 2002.
Taylor, E. J. and Amenta, M. O. "Cancer nurses' perspectives on spiritual care: implications for pastoral care." Journal of Pastoral Care 48, no. 3 (Fall 1994): 259-265.

 

4.     Margot Hover's "Five Questions I Wish Research Would Address"

From the Editor: This is the first in a new series for our Newsletter, whereby members of our Network are invited to suggest five practical questions for research that could be valuable for chaplains and/or the ACPE. This is the sort of generative thinking that often takes place informally at chaplaincy gatherings but seldom reaches beyond immediate conversation. Margot Hover, DMin, is an ACPE Supervisor (retired) and NACC Supervisor Emerita, and has long been a leader in research. She lives in Claremont, CA.   --JE

1) Is there any correlation between chaplains who select a particular specialty -- e.g., pediatrics, palliative care -- and their life experience? That might begin with a qualitative study posing the question to a number of chaplains, and extrapolating from that.
2) Does enrollment in an end-of-life toxicity study impact spirituality differently than routine cancer treatments such as radiation or chemotherapy?
3) What are the spiritual issues in caregivers of their patients with memory disorders? I think it would be interesting to stratify this according to the age of the patient.
4) What techniques do chaplains use to create boundaries between their work and the rest of their daily lives?
5) Has discrimination against women in our various ministry settings -- e.g., hospital, hospice, congregation, or community -- changed its shape through recent years? Do male views of women's experience of discrimination differ from women's actual experience? What are the variations related to race and ethnicity? (I'd be interested in talking about the possibilities for a qualitative study design with others for whom this and other variables are intriguing. I may be contacted at maggiehpiper@gmail.com.)

 

5.     A Message to Chaplains from Joan Beder

[Note: Dr. Beder, LCSW, DSW, Wurzweiler School of Social Work, Yeshiva University, New York, NY, is the co-author of our October 2013 Article-of-the-Month.]

Doing research always has its share of challenges: from conception to design to recruitment, analysis and write up. This process may be made more complex or easier depending on a number of variables including institutional support, easy of finding subjects, etc. In our study, "Professional quality of life and associated factors among VHA chaplains," Dr. Yan and I were very fortunate to have found each other. Our collaboration allowed us to report findings with more depth and insight than if we had only stuck with the "people we know." Dr. Yan is expert in reporting quantitative research and my area of strength is in conducting and reporting qualitative research. In addition, we were fortunate to have had the support of the National Chaplaincy Center and to have had so many VA chaplains willing to spend time taking our survey. As challenging as research can be -- and it is often a test of patience and fortitude -- it is always interesting and can even be fun. I would encourage all chaplains to try it.

 

6.     New Journal: Spirituality in Clinical Practice

The American Psychological Association has announced a new quarterly journal: Spirituality in Clinical Practice, providing "a forum for those engaged in clinical activities to report on -- and dialogue about -- their activities to inform treatment models and future research initiatives" [website].

SCP seeks to initiate research questions through clinical insight and to introduce practice approaches supported or guided by existing research. ...Research articles are highly encouraged on clinical conceptualization or settings, including studies on models, processes, or treatment approaches. [website]
A news item from the APA's Monitor offers an anecdote from the experience of the new co-editor: "During a recent psychotherapy seminar at Columbia University, psychologist Lisa Miller, PhD, watched an Orthodox Jewish student listen to a Baptist neuroscientist explain how prayer increases focus and decreases stress. The student had an 'aha' moment, saying the research helped explain why she felt less clearheaded in the United States than in Israel, where prayer was a bigger part of her life." The piece goes on to quote the other co-editor, Len Sperry, PhD, a psychology professor at Florida Atlantic University: "'We envision this to be a cutting-edge journal,' Sperry says. 'It's going to be a journal that has professional respect and one we think will have broad generalizability.'" [See: Miller, A. "Spirituality in clinical practice. A new journal seeks to meet the demand for spirituality-informed clinical interventions." Monitor 44, no. 9 (October 2013): 73, also available online.]

The table of contents for the introductory issue is available now online. Among the articles: Delaney, H. D., Miller, W. R. and Bisonů, A. M., "Religiosity and spirituality among psychologists: a survey of clinician members of the American Psychological Association" (pp. 95-106), reporting a finding that "psychologists remained far less religious than the clients they serve" but "[t]he vast majority...regarded religion as beneficial (82%) rather than harmful (7%) to mental health" [abstract].

 

7.     Presentations from the 2013 Conference on Interdisciplinary Applications from Spirituality & Health Research

This past July 22nd-26th, Fuller Theological Seminary Graduate School of Psychology (Pasadena, CA), hosted an Emerging Tools for Innovative Providers conference on "Interdisciplinary Applications from Spirituality & Health Research." The event was aimed at healthcare administrators, clergy/chaplains, nurses, physicians, psychologists, and social workers, among others; exploring "how the significant accumulation of spirituality and health research over the last 25+ years translates into useful applications for healthcare and other human services providers" [--from the conference flyer]. Bios of the speakers are available from the conference website, as are the presentation materials. Included are a series of presentations by Harold Koenig giving an overview of research, issues in application, and psychoneuroimmunology; Ken Pargament on "From Research to Practice: Envisioning an Applied Science of Spirituality and Health," Alexis Abernathy on "Understanding Worship and its Potential Associations to Health," and a cautionary critique of religion & health research by Michael King in "Differing Cultural Influences of Spirituality on Health and Mental Health: What Do Research Approaches and Findings in the US and Europe Tell Us?"

 

 


If you have suggestions about the form and/or content of the site, e-mail Chaplain John Ehman (Network Convener) at john.ehman@uphs.upenn.edu .
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