Spring-Summer 2013 Newsletter
On-Line Newsletter Volume 11, Number 3
Published June 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.
(The Fall 2013 issue will be published in late October.)
Table of Contents
1. Notes of the 2013 Business Meeting of the Research Network
2. "The Organizational Culture of VCUHS Units: An Exploratory Study"
3. Reflection on Research, by Allison Kestenbaum
4. Study of CPE Student Self-Perceptions of Progress on Level 1 Outcomes
5. Interdisciplinary Education Study Involving CPE Students
6. SCIPE Project Update and Workshop
7. Penn's Spirituality Research Symposium on Provider Self-Care
8. BBC Survey Shows Cuts in Chaplaincy at NHS Hospitals
9. Notable Research from 2012 Not Previously Cited on the Research Network Website
1. Notes of the 2013 Business Meeting of the Research Network
The annual meeting of the Network took place on Saturday, May 18, 2013 at 8:30 AM at the Marriott Downtown Hotel, Indianapolis, IN, as part of the ACPE's national conference. Essential financial business was accomplished, and the group then addressed projects and interests.
George Fitchett reported on a Research Task Force originating from the APC and approved by the APC at their Winter/Spring Board meeting. The task force includes Daniel Grossoehme as the chair and Alexander Tartaglia as the official representative from the ACPE (though George Fitchett is part of the group as well). The project is not aimed at developing particular research studies but rather at promoting the teaching of research literacy and helping practicing chaplains develop research literacy --with a goal of seeing chaplaincy become a research-informed profession. The group is currently exploring funding sources.
Diane Dodd McCue spoke about the role of research in interdisciplinary/interprofessional collaborations, in terms of "how chaplain can come to the table"; and in a related vein, Sean Doll O'Mahoney talked about identifying physician researchers with whom chaplains may collaborate, and Paracleta Amrich noted possibilities of work with nurse researchers from her experience especially with Nursing Magnet initiatives. Beth Jackson-Jordan reported on her work on clergy resilience/burnout and on the inclusion of CPE students in process improvement projects (e.g., regarding Advance Directive documentation).
Among other topics: Jack Gleason updated the group on the Spiritual Care Initiative for Professional Excellence (SCIPE) project [see Item #6, below]. Diane Dodd-McCue noted that she has a literature mapping article in press with a library journal, and there was general discussion about chaplaincy journals and concerns for the future of such avenues for publishing in the field, including an announcement at the national ACPE meeting that support for the Journal of Pastoral Care and Counseling would be cut. The group further discussed the Network's website, building membership, and new potential for engaging professional chaplaincy organizations in research.
Special acknowledgement was given to those who had contributed material to our Network Newsletters and other sections of our website over the past year: Shannon Borchert, Paul E. Derrickson, Diane Dodd-McCue, Deryck Durston, George Fitchett, Bill Gaventa, Sharon Ghamari-Tabrizi, Jack Gleason, George Grant, Amy Greene, Gerald Gundersen, John Hartman, Beth Jackson-Jordan, Patricia Murphy, Daniel Nuzum, Stephen Overall, Judith Ragsdale, and Lex Tartaglia.
2. "The Organizational Culture of VCUHS Units: An Exploratory Study"
The CPE program through Virginia Commonwealth University's Department of Patient Counseling provides a strong research emphasis (as is periodically reported through our Newsletters --see, for instance, the Fall 2012 issue). One recent and still unfolding activity involved CPE residents in a quality improvement project using accepted research methodologies. The goal was to identify dimensions of unit organizational culture and chaplain integration. Each resident contributed to developing a shared framework for the study and introduced into their service line. A summary of the cumulative findings is presented in a poster: "The Organizational Culture of VCUHS Units: An Exploratory Study," by Elizabeth Austin, Brian Bower, Michelle Chapman-Campbell, David Hassmer, and Lemuel Sullano; viewable as a PowerPoint slide or PDF. Note, in addition to the results, the sections: What Chaplains Learned Conceptually, What Chaplains Gained From The Process, and What Chaplains Can Incorporate In Their Practice.
The next steps for the residents are to stratify their findings by unit to develop a unit-specific profile, and then, based on that, to generate implications for chaplain practice. The unit profile information will also be compiled into a department resource for faculty and for new interns and residents in hopes it will provide a more informed launch into their clinical assignments. The methodology promotes replication of this project by the department for future updating, as needed. The project has further provided residents with experience with research basics that they can apply in other contexts.
For more information, contact Diane Dodd-McCue at firstname.lastname@example.org.
3. Reflection on Research, by Allison Kestenbaum, UCSF Medical Center
Few chaplains and CPE supervisors are trained or have participated extensively in research. As a newly certified CPE supervisor, I am benefiting from the offerings of the ACPE Research Network. I am also very grateful for the opportunity to be serving as the "lead chaplain researcher" at University of California San Francisco Medical Center for "Spiritual Assessment and Intervention Model (AIM) in Outpatient Palliative Care for Patients with Advanced Cancer." In funding this project, the HealthCare Chaplaincy and The John Templeton Foundation have set out to advance the field of chaplaincy through methods such as pairing chaplains with experienced researchers at their institutions.
At our ACPE center, we offer regular seminars updating our CPE students about the project and its methods. We invite them to sit in on research team meetings and help with research tasks. Here are a few ways that doing research is having a positive impact on my supervision of students:
Research provides a framework for exploring roadblocks and barriers. One of the most important lessons that I have learned so far in being a chaplain researcher is that issues that I previously worried were flaws or insurmountable barriers in pastoral care and supervision can be reframed as inquiries or stimulate hypotheses that can be tested. I am hopeful that I am role modeling this attitude and passing it on to CPE students.
Research allows CPE supervisors to forge relationships with individuals at their institution who can support CPE students. Through our research project, we have forged relationships with physicians and other faculty at our institution who are developing a deep understanding of professional spiritual care. These individuals are making themselves available to CPE students who approach them for advice and guidance about their pastoral specializations.
Research can enrich and add legitimacy to the CPE curriculum. Part of our project focuses on further articulating and refining Spiritual AIM©, Spiritual Assessment and Intervention Model, which has been developed by ACPE Supervisor, Rev. Dr. Michele Shields in over 20 years of practice (manuscript in preparation). Michele and I have observed greater receptivity, comprehension, and application by chaplain trainees who are learning about spiritual assessment. I am able to more clearly articulate the conceptual and theological underpinnings of the model and in teaching it, am better able to articulate how spiritual assessment models differ from psychosocial tools. The research is also yielding a greater evidence base (examples, vignettes, transcripts, qualitative process) that helps chaplain students grasp the material more easily as well as underscore the unique contribution and role of the chaplain as part of the interdisciplinary team.
Our project is yielding rich qualitative and quantitative data. We look forward to keeping this community informed of our analysis and future directions for research that we are pursuing. I personally am excited about the ways that research will continue to enhance my supervision in ways that have not yet been revealed.
4. Study of CPE Student Self-Perceptions of Progress on Level 1 Outcomes
Carl R. Yusavitz, DMin, ACPE Supervisor and Director of Pastoral Services for the Penn Foundation (Sellersville, PA), has been working on research to assess the effect of CPE on Level 1 outcomes. A survey form was developed by rewording nine outcomes as nine self-assessment statements, with a five-point Likert scale for students to rate their competency in meeting each outcome. He has been administering the instrument to all of his Level 1 students during the beginning, middle, and end of their program; and as of this summer he will have data from 51 participants. The study may hold out a model for use in other programs and elsewhere in the ACPE. The next step will be examination of the cumulative data, and Dr. Yusavitz is interesting in partnering with other researchers at this point as he moves toward statistical analysis and publication. Those interesting may contact him at email@example.com.
5. Interdisciplinary Education Study Involving CPE Students
Peter A. Holland, DMin, Director for Clinical Pastoral Education at Avera Health (Sioux Falls, SD), is a co-author of a project on interdisciplinary education that involved 11 CPE students*. The study notes an Institute of Medicine report that "many providers are not trained to work effectively in teams" [p. 381], and so the interventional research here examines the effect of an interdisciplinary seminar on participants' sense of their own discipline, others' disciplines and the idea of teamwork itself. The article gives a great deal of data in five tables that could be quite useful to chaplains contemplating similar investigations. The citation and abstract are as follows:
Schrader, S. L., Brechtelsbauer, D., Heins, J., Holland, P. and Schroeder, P. A.
"Interdisciplinary education in palliative care: impact on attitudes of students in medicine, nursing, pharmacy, social work, and chaplaincy." South Dakota Medicine 65, no. 10 (October 2012): 381-383, 385, 387, 389, 391, 393. [(Abstract:) INTRODUCTION: Interdisciplinary education among health professions has been recommended, and related evaluation can be found in the literature. However questions remain on how effective interdisciplinary education is and what impact it has. The objective of this study was to determine changes in student attitudes and perceptions upon completion of a 5-week interdisciplinary palliative care seminar. METHODS: Pre-test and post-test instruments were administered at three five-week Interdisciplinary Palliative Care Seminars in Sioux Falls, SD during 2009-2010. The central hypotheses were that, at the conclusion of the seminar, students will have greater familiarity with their role in a team and more understanding of the roles of other disciplines in palliative care, and will identify positive contributions to professional practice and patient care using the team approach. Both quantitative and qualitative data were analyzed. RESULTS: Participating students in medicine, nursing, pharmacy, social work, and chaplaincy (N = 88) completed surveys. Quantitative data suggest that interdisciplinary education enhances students' understanding of their discipline and the work of other disciplines. Data show students perceive the team approach as enhancing patient outcomes, goal setting, and communication among colleagues. Qualitative data reinforced the importance of interdisciplinary education while revealing strains among disciplines in hierarchy and valuing. CONCLUSIONS: Playing one's part in the team strengthens students' confidence and comfort in interdisciplinary settings. Yet, the hazard of experiencing the limitations of teamwork in action must be acknowledged for some.]
* While only 11 CPE students participated in this study, the research here is built upon the work of Dr. Holland with students over the previous 10 years, and so the number of CPE students who actually contributed to the overall effort is well over 100.
6. SCIPE Project Update and Workshop
John J. Gleason, DMin, BCC (retired) reported to our Network meeting at the Indianapolis conference an update on his long-standing project: Spiritual Care Initiative for Professional Excellence (SCIPE). His formal report is available as a PDF. Dr. Gleason is currently also offering a one-day workshop related to the project, and he distributed through the conference information table a handout advertising his workshop. Supervisors are encouraged to consider this workshop at their centers and to access the SCIPE Knowledge Base of Spiritual Care Samples hosted on our Network site. Contact: firstname.lastname@example.org.
Also, see Dr. Gleason's latest articles:
Gleason, J. J. "Can chaplains survive and thrive with P4P?" Chaplaincy Today 28, no. 2 (Autumn/Winter 2012): 13-19. [(Abstract:) In the near future, almost all US health care professionalsódoctors, nurses and members of the ancillary disciplines, including chaplainsólikely will be paid based on quality of performance, i.e., pay for performance (P4P), by achieving evidence based, best practice, desired outcomes that have a positive impact on institutional bottom lines. This article describes the context, implications for chaplaincy, progress to date and next steps for professional chaplaincy to survive and thrive with P4P.] [This article is available online.]
Gleason, J. J. "A professional spiritual care knowledge base: boon or bane?" Journal of Health Care Chaplaincy 19, no. 2 (2013): 45-53. [(Abstract:) An Ideal Intervention Paper was initiated in 2005 to consolidate the learnings of clinical pastoral education students. As papers from students, practitioners, and educators were collected over a period of seven years, it became evident that a knowledge base comprised of this work would expedite the professionalization of clinical chaplaincy via provision of second opinions in difficult cases, education of administrators and the public about the nature of chaplaincy work, and baseline data for effectiveness research-to include replication of effective interventions toward designation of evidence based spiritual care best practices. An online 395-sample knowledge base hosted by the Association for Clinical Pastoral Education Research Network was amassed, nearly 40 percent of which is the work of experienced practitioners and educators. A pilot effectiveness study of samples failed to produce meaningful results. As an interim measure a content analysis has provided tentative effectiveness ratings until further research can be done.]
7. Penn's Spirituality Research Symposium on Provider Self-Care
Over 175 people attended the 16th annual symposium, sponsored by the Department of Pastoral Care at the Hospital of the University of Pennsylvania, exploring the theme of provider self-care. Presenters reviewed research in the field and addressed strategies that included insights from mindfulness practice and narrative medicine.
Presentations included: "Caring for Our Spirits as Professionals: Using Narrative and Group Support to Reduce Job Stress, Compassion Fatigue, and Burnout," by Nicole Saint-Louis, DSW, LCSW, Assistant Professor, Human Services, City University of New York; "When Helping Hurts: Healing the Helping Professional's Weary Soul," by Lara Krawchuk, MSW, LCSW, MPH, Lecturer, School of Social Policy and Practice, University of Pennsylvania; "Recognizing and Preventing Vicarious Trauma: A Holistic Perspective," by Christina Jackson, RN, PhD, Professor, Department of Nursing, Eastern University and Associate Editor, Holistic Nursing Practice ; and "Recapturing the Calling: Using Mindfulness to Undo Burnout and Create Meaning in Practice," by Michael J. Baime, MD, Clinical Associate Professor, University of Pennsylvania, and Founder/Director of the Penn Program for Mindfulness. Slides are available on the Pastoral Care website.
TOP: Nicole Saint-Louis; BOTTOM: Christina Jackson and Michael Baime
The event was held at Penn's Center for Advanced Medicine and was co-sponsored this year by the Department of Social Work, making Continuing Education Units for Social Workers available.
8. BBC Survey Shows Cuts in Chaplaincy at NHS Hospitals
A survey by the British Broadcasting Corporation was reported through the BBC News England website on June 26, 2013: "Chaplaincy services cut in 40% of English NHS hospital trusts," pertaining to the period of 2009-2013. The data were gathered from 163 acute care hospitals of the National Health Service trusts of England, through Freedom of Information requests. Analysis showed that "39% of trusts had fewer chaplains in 2013 -- or a lower Whole Time Equivalent (WTE) -- than they did in 2009; 47% of trusts had fewer chaplaincy hours; [and] 25% of trusts increased hours; [with] the net total reduction of hours from 2009 to 2013 was 1,380 - a reduction of 8%" [--from a summary of data available online and for download as a spreadsheet. See also an accompanying article on the BBC site: "A chaplain's story." On a related note (cited in the BBC report), see additionally the document, NHS Chaplaincy: Meeting the religious and spiritual needs of patients and staff. Guidance for managers and those involved in the provision of chaplaincy- spiritual care.
9. Notable Research from 2012 Not Previously Cited on the Research Network Website
Our site Network highlights a fair number of studies in the course of a year, but many good articles are not featured. The following 32 articles have until now not been cited on our site but may yet be of special interest to chaplains. They are taken from an annual annotated bibliography of 325 Medline-indexed articles, available from the Penn Medicine Department of Pastoral Care.
Ai, A. L., Wink, P. and Shearer, M. [University of Washington, Seattle]. "Fatigue of survivors following cardiac surgery: positive influences of preoperative prayer coping." British Journal of Health Psychology 17, no. 4 (Nov 2012): 724-742. [(Abstract:) OBJECTIVES: Fatigue symptoms are common among individuals suffering from cardiac diseases, but few studies have explored longitudinally protective factors in this population. This study examined the effect of preoperative factors, especially the use of prayer for coping, on long-term postoperative fatigue symptoms as one aspect of lack of vitality in middle-aged and older patients who survived cardiac surgery. METHOD: The analyses capitalized on demographics, faith factors, mental health, and on medical comorbidities previously collected via two-wave preoperative interviews and standardized information from the Society of Thoracic Surgeons' national database. The current participants completed a mailed survey 30 months after surgery. Two hierarchical regressions were performed to evaluate the extent to which religious factors predicted mental and physical fatigue, respectively, after controlling for key demographics, medical indices, and mental health. RESULTS: Preoperative prayer coping, but not other religious factors, predicted less mental fatigue at the 30-month follow-up, after controlling for key demographics, medical comorbidities, cardiac function (previous cardiovascular intervention, congestive heart failure, left ventricular ejection fraction, New York Heart Association Classification), mental health (depression, anxiety), and protectors (optimism, hope, social support). Male gender, preoperative anxiety, and reverence in secular context predicted more mental fatigue. Physical fatigue increased with age, medical comorbidities, and preoperative anxiety. Including health control beliefs in the model did not eliminate this effect. CONCLUSIONS: Prayer coping may have independent and positive influences on less fatigue in individuals who survived cardiac surgery. However, future research should investigate mechanisms of this association.]
Alrawi, S., Fetters, M. D., Killawi, A., Hammad, A. and Padela, A. [University of Michigan, Ann Arbor]. "Traditional healing practices among American Muslims: perceptions of community leaders in southeast Michigan." Journal of Immigrant & Minority Health 14, no. 3 (Jun 2012): 489-496. [(Abstract:) Despite growing numbers of American Muslims, little empirical work exists on their use of traditional healing practices. We explored the types of traditional healing practices used by American Muslims in southeast Michigan. Twelve semi-structured interviews with American Muslim community leaders identified through a community-academic steering committee were conducted. Using a framework coding structure, a multidisciplinary investigative team identified themes describing traditional healing practices. Traditional healing practices can be categorized into three domains: Islamic religious text based practices, Islamic worship practices, and folk healing practices. Each domain may further contain therapies such as spiritual healing, medicinal herbs, mind body therapy, and dietary prescriptions. Traditional healing practices are utilized in three capacities of care: primary, secondary, and integrative. Our findings demonstrate that American Muslims actively utilize traditional healing practices. Healthcare practitioners caring for this population should be aware of the potential influence of these practices on health behaviors.]
Ballew, S. H., Hannum, S. M., Gaines, J. M., Marx, K. A. and Parrish, J. M. [University of Maryland, Baltimore]. "The role of spiritual experiences and activities in the relationship between chronic illness and psychological well-being." Journal of Religion & Health 51, no. 4 (Dec 2012): 1386-1396. [(Abstract:) Our research explores the correlates of spiritual experiences over a 2-year period in a sample of older adults (N = 164; mean age 81.9 years) living in a continuing care retirement community. Utilizing responses to the Daily Spiritual Experiences Scale, scores were analyzed for changes over time and for their hypothesized moderating effect in the relationship between chronic illness impact and markers of psychological well-being (as measured by the Geriatric Depression and Life Satisfaction scales). Repeated measures ANOVA indicated a significant decline (P < .01) in the reported spiritual experiences over a 2-year period of time, and t tests showed a significant difference by gender (P < .01) in years 1 and 2, with women reporting higher levels of spiritual experiences than men. Analyses found low spirituality scores associated with low life satisfaction in all years (baseline: r = -.288, P < .01; year 1: r = -.209, P < .05; year 2: r = -.330, P < .001). Only weak associations were detected between low spirituality and the presence of depressive symptoms at baseline (r = .186, P < .05) and year 2 (r = .254, P < .01). Moderation effects of spirituality on the relationship between chronic illness impact and markers of psychological well-being were explored in all years, with a statistically significant effect found only for the presence of depressive symptoms in year 2. Higher impact of chronic illnesses is associated with more depressive symptoms under conditions of low spirituality. Future research may center upon longer-duration evaluation of reliance upon spiritual practices and their impact in care management models.]
Besterman-Dahan, K., Gibbons, S. W., Barnett, S. D. and Hickling, E. J. [James A. Haley Veterans Hospital, Tampa, FL]. "The role of military chaplains in mental health care of the deployed service member." Military Medicine 177, no. 9 (Sep 2012): 1028-1033. [(Abstract:) This research utilized a cross-sectional design secondarily analyzing data from active duty military health care personnel who anonymously completed the "2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel." Sample for this analysis of Operation Iraqi Freedom/Operation Enduring Freedom deployed mental health seeking service members was N = 447. Religiosity/spirituality and psychological distress experienced by active duty military personnel who sought help from military mental health providers (MH), military chaplains (CHC) or both (CHC & MH) were explored and compared. Greater psychosocial distress seen in the CHC & MH group could be a reflection of a successful collaborative model for mental health care that is currently promoted by the military where chaplains are first line providers in an effort to provide services to those in greatest need and ultimately provide them with care from a trained mental health professional. Research and evaluation of chaplain training programs and collaborative models is recommended.]
Biegler, K., Cohen, L., Scott, S., Hitzhusen, K., Parker, P., Gilts, C. D., Canada, A. and Pisters, L. [University of California, Irvine, CA]. "The role of religion and spirituality in psychological distress prior to surgery for urologic cancer." Integrative Cancer Therapies 11, no. 3 (Sep 2012): 212-220. [(Abstract:) The present study examined the associations between religion and spirituality (R/S), presurgical distress, and other psychosocial factors such as engagement coping, avoidant coping, and social support. Participants were 115 men scheduled for surgery for urologic cancer. Before surgery, participants completed scales measuring intrinsic religiosity, organized religious activity, and nonorganized religious activity (IR, ORA, NORA); social support (Medical Outcomes Study Social Support Survey); and distress (Impact of Event Scale [IES], Perceived Stress Scale [PSS], Brief Symptom Inventory-18 [BSI-18], and Profile of Mood States [POMS]). R/S was positively associated with engagement coping. Social support was positively associated with engagement coping and inversely associated with POMS and PSS scores. Engagement coping was positively associated with IES and BSI scores, and avoidant coping was positively associated with all distress measures. R/S moderated the association between engagement coping and IES scores, such that the association between engagement coping and IES was not significant for men with high R/S scores (greater religious belief). R/S moderated the association between social support and distress; the inverse association between social support and PSS and POMS scores was only significant for men who scored high on R/S. This study replicated findings from previous studies suggesting that engagement and avoidant types of coping can lead to increased distress prior to surgery. Although R/S was associated with engagement coping, it was not associated with any of the distress measures. The finding that R/S moderated the associations between engagement coping and distress and social support and distress suggests that the association between R/S, coping style, social support, and adjustment to stressful life situations is not simplistic, and indirect associations should be explored.]
Boelens, P. A., Reeves, R. R., Replogle, W. H. and Koenig, H. G. [University of Mississippi, Jackson]. "The effect of prayer on depression and anxiety: maintenance of positive influence one year after prayer intervention." International Journal of Psychiatry in Medicine 43, no. 1 (2012): 85-98. [(Abstract:) OBJECTIVE: To investigate whether the effect of direct contact person-to-person prayer on depression, anxiety, and positive emotions is maintained after 1 year. DESIGN, SETTING, AND PARTICIPANTS: One-year follow-up of subjects with depression and anxiety who had undergone prayer intervention consisting of six weekly 1-hour prayer sessions conducted in an office setting. Subjects (44 women) completed Hamilton Rating Scales for Depression and Anxiety, Life Orientation Test, and Daily Spiritual Experiences Scale after finishing a series of six prayer sessions and then again a month later in an initial study. The current study reassessed those subjects with the same measures 1 year later. One-way repeated measures ANOVAs were used to compare findings pre-prayer, immediately following the six prayer sessions, and 1 month and again 1 year following prayer interventions. RESULTS: Evaluations post-prayer at 1 month and 1 year showed significantly less depression and anxiety, more optimism, and greater levels of spiritual experience than did the baseline (pre-prayer) measures (p < 0.01 in all cases). CONCLUSIONS: Subjects maintained significant improvements for a duration of at least 1 year after the final prayer session. Direct person-to-person prayer may be useful as an adjunct to standard medical care for patients with depression and anxiety. Further research in this area is indicated.]
Bormann, J. E., Liu, L., Thorp, S. R. and Lang, A. J. [Center of Excellence for Stress and Mental Health (CESAMH), Veterans Affairs San Diego Healthcare System (VASDHS), CA]. "Spiritual wellbeing mediates PTSD change in veterans with military-related PTSD." International Journal of Behavioral Medicine 19, no. 4 (Dec 2012): 496-502. [(Abstract:) BACKGROUND: A portable practice of repeating a mantram-a sacred word or phrase-has been shown to reduce the severity of posttraumatic stress disorder (PTSD) symptoms in veterans with military trauma. It is thought that the intervention re-directs attention and initiates relaxation to decrease symptom severity, but there may be other mechanisms that may contribute to this improvement. PURPOSE: We tested the hypothesis that increases in existential spiritual wellbeing (ESWB) would mediate reductions in self-reported PTSD symptoms following a group mantram intervention. METHOD: Veterans diagnosed with PTSD from war-related trauma completed 6weeks of case management plus a group mantram intervention (n=66) as part of a randomized trial. Measures included PTSD Checklist (PCL) and Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing. Path analysis was conducted on those who completed treatment to assess ESWB as a possible mediator of change in PCL from baseline to post-treatment. RESULTS: A significant indirect effect, -2.24, 95% CI (-4.17, -1.05) of the mantram intervention on PCL change was found. The path from the mantram intervention to ESWB change was significant and positive (B=4.89, p<0.0001), and the path from ESWB change to PCL change was significant and negative (B=-0.46, p=0.001), thus supporting the hypothesis. CONCLUSIONS: Findings suggest that one contributing mechanism that partially explains how the mantram intervention reduces PTSD symptom severity in veterans may be by increasing levels of ESWB.]
Buck, H. G. and McMillan, S. C. [Pennsylvania State University, University Park]. "A psychometric analysis of the Spiritual Needs Inventory in informal caregivers of patients with cancer in hospice home care." Oncology Nursing Forum 39, no. 4 (Jul 2012): E332-339. [(Abstract:) PURPOSE/OBJECTIVES: To test the validity and reliability of the Spiritual Needs Inventory (SNI) in measuring the spiritual needs of informal caregivers of patients with cancer in hospice home care. DESIGN: A subanalysis of a longitudinal, randomized hospice clinical trial. SETTING: Two hospices in the southwestern United States. SAMPLE: 410 informal caregivers of patients with cancer in hospice home care. METHODS: To test the hypotheses, Pearson and Spearman correlations, principal factor analysis with oblique rotation, and coefficient alpha were conducted. MAIN RESEARCH VARIABLES: Spiritual needs, depression, social support. FINDINGS: The SNI showed a small but significant positive correlation with the social support (p = 0.003). A three-factor solution of the SNI accounted for about 55% of the variability. The first factor captured a traditional religious measure, with the original patient-reported subscales of inspiration, spiritual activities, and religion collapsing into this one factor. The second and third factors were similar to the original patient study. Cronbach alpha for the total scale was 0.88. The factor alphas ranged from 0.68-0.89. CONCLUSIONS: The current study provides early evidence for the validity and reliability of the SNI in informal caregivers of patients with cancer in hospice home care. Additional testing in other populations is recommended. IMPLICATIONS FOR NURSING: Use of the SNI with hospice caregivers could aid nurses in the identification of spiritual needs, enabling the development of plans of individualized, high-quality care.]
Bullock, M., Nadeau, L. and Renaud, J. [McGill University, Montreal, Canada]. "Spirituality and religion in youth suicide attempters' trajectories of mental health service utilization: the year before a suicide attempt." Journal of the Canadian Academy of Child & Adolescent Psychiatry - Journal de l.Acade.mie canadienne de psychiatrie de l.enfant et de l.adolescent 21, no. 3 (Aug 2012): 186-193. [(Abstract:) OBJECTIVE: Youth suicide attempters are high-risk for suicide. Many have untreated mental disorders and are not receiving services. It is crucial to understand potential influences associated with service use. Spirituality/religion are one influence in youths' mental health service trajectories. This study explored youths' experiences of spirituality/religion as it relates to their help-seeking the year before their suicide attempt. METHOD: Fifteen youth (aged 14-18) who made a suicide attempt(s) one to two years prior were consecutively recruited through the Depressive Disorders Program of a psychiatric hospital and interviewed using a mixed-methods design, including an adapted psychological autopsy method. RESULTS: THREE THEMES EMERGED: religious community members acted as a bridge, step, or provider to mental health services; religious/spiritual discourses were encountered within services; and many youths reported changes in spirituality/religious beliefs the year before their suicide attempt. CONCLUSIONS: Spirituality/religion can have a role in these youths' service trajectories. How this confers protection or challenges needs to be clarified. Our findings can inform policies supporting training religious leaders about suicide intervention to foster coordination with mental health services, and service-providers in judiciously approaching spiritual/religious themes in suicide prevention.]
Burkhart, L. and Schmidt, W. [Loyola University Chicago, IL]. "Measuring effectiveness of a spiritual care pedagogy in nursing education." Journal of Professional Nursing 28, no. 5 (Sep-Oct 2012): 315-321. [(Abstract:) Nurses have long recognized the importance of spiritual care in nursing practice as promoting the integration of meaning and purpose in life. More recently, both the American Nurses Association incorporates spiritual care in the Scope and Standards of Nursing Practice and the American Association of Colleges of Nursing has integrated spiritual care in the Essentials of Baccalaureate Education. However, research suggests that nurses do not know how to provide spiritual care. This study developed and tested a spiritual care pedagogy. In phase I, researchers designed a spiritual care educational and reflective program based on the Burkhart/Hogan theory of spiritual care in nursing practice, incorporating face-to-face and on-line components. In phase 2, the effectiveness of this program was measured in a pre-post test, randomized controlled trial with senior nursing students during their capstone clinical immersion course (n=59). Findings revealed a statistically significant increase in students' perceived ability in providing spiritual care, particularly in complex family clinical situations. Findings also indicated a significant increase in the student's use of reflective practices, which students found to help support them during stressful times. This study translates nursing theory and research into a successful pedagogy.]
Chang, B. H., Stein, N. R., Trevino, K., Stewart, M., Hendricks, A. and Skarf, L. M. [VA Boston Healthcare System, MA]. "Spiritual needs and spiritual care for veterans at end of life and their families." American Journal of Hospice & Palliative Medicine 29, no. 8 (Dec 2012): 610-617. [(Abstract:) Spiritual care is an important domain of palliative care programs across the country and in the Veterans Affairs (VA) Healthcare System specifically. This qualitative study assessed the spiritual needs, spiritual care received, and satisfaction with spiritual care of both Veterans at the end of life and their families. Seventeen Veterans and 9 family members participated. They expressed a wide range of spiritual needs, including a wish of Veterans to have a better understanding of traumatic events that occurred during their combat experience. Some Veterans reported military experience enhanced their spirituality. Generally, respondents reported satisfaction with VA spiritual care, but indicated that Veterans may benefit from greater access to VA chaplains and explicit discussion of the impact of their military experience on their spirituality.]
Costello, M., Atinaja-Faller, J. and Hedberg, M. [Simmons College, Boston, MA]. "The use of simulation to instruct students on the provision of spiritual care: a pilot study." Journal of Holistic Nursing 30, no. 4 (Dec 2012): 277-281. [(Abstract:) Providing spiritual care is recognized as a significant aspect of nursing practice. This pilot study was designed to determine if simulation is an effective method for instructing nursing students in the provision of spiritual care. Fifty-two students participated in a simulation exercise that introduced concepts of spiritual care. Simulation was successful in improving students' attitudes toward patient spirituality, assessment of spiritual needs, ability to refer patients to the appropriate spiritual caregivers, and communication skills. Incorporating spiritual care instruction into curricula may prove to be valuable in increasing students' awareness of spiritual care for patients and incorporation of such care into their practice.]
Cotton, S., Grossoehme, D. and McGrady, M. E. [University of Cincinnati College of Medicine, OH]. "Religious coping and the use of prayer in children with sickle cell disease." Pediatric Blood & Cancer 58, no. 2 (February 2012): 244-249. [(Abstract:) While adolescents and adults with sickle cell disease (SCD) have reported using religion to cope with SCD, there is no data examining religious coping in young children with SCD. The purpose of this qualitative study was to: (1) describe the types of religious coping used by children with SCD; (2) describe the content and frequency of prayer used in relation to SCD; and (3) examine how children viewed God/Higher Power in relation to their SCD. PROCEDURE: Children with SCD participated in a semi-structured interview and an art drawing exercise focused on the use of general coping and religious coping. Interviews were coded, organized, and analyzed using a template organizational style of interpretation and NVivo 8.0 qualitative software. RESULTS: Of the 19 participants, the average age was 8.05 years (SD +/-1.81); 11 were female (58%); all (100%) were African-American and 9 (47%) were Protestant. Children used religion to gain control, make meaning, and find comfort. Most children reported praying to get well, to keep from getting sick, and to get out of the hospital. Children described a functional God who made them take their medicine or took them to the hospital and an emotional God who made them happy and comforted them when they were sad or scared. CONCLUSIONS: These children with SCD reported using religion to help cope with the illness. Providers should be aware of the importance of religion to many of these children and integrate religion, as appropriate, into discussions about coping with SCD.]
Dallas, R. H., Wilkins, M. L., Wang, J., Garcia, A. and Lyon, M. E. [St. Jude Children's Research Hospital, Memphis, TN]. "Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle (FACE): design and methods." Contemporary Clinical Trials 33, no. 5 (Sep 2012): 1033-1043. [(Abstract:) As life expectancy increases for adolescents ever diagnosed with AIDS due to treatment advances, the optimum timing of advance care planning is unclear. Left unprepared for end-of-life (EOL) decisions, families may encounter miscommunication and disagreements, resulting in families being charged with neglect, court battles and even legislative intervention. Advanced care planning (ACP) is a valuable tool rarely used with adolescents. The Longitudinal Pediatric Palliative Care: Quality of Life & Spiritual Struggle study is a two-arm, randomized controlled trial assessing the effectiveness of a disease specific FAmily CEntered (FACE) advanced care planning intervention model among adolescents diagnosed with AIDS, aimed at relieving psychological, spiritual, and physical suffering, while maximizing quality of life through facilitated conversations about ACP. Participants will include 130 eligible dyads (adolescent and family decision-maker) from four urban cities in the United States, randomized to either the FACE intervention or a Healthy Living Control. Three 60-minute sessions will be conducted at weekly intervals. The dyads will be assessed at baseline as well as 3-, 6-, 12-, and 18-month post-intervention. The primary outcome measures will be in congruence with EOL treatment preferences, decisional conflict, and quality of communication. The mediating and moderating effects of threat appraisal, HAART adherence, and spiritual struggle on the relationships among FACE and quality of life and hospitalization/dialysis use will also be assessed. This study will be the first longitudinal study of an AIDS-specific model of ACP with adolescents. If successful, this intervention could quickly translate into clinical practice.]
Ford, D. W., Downey, L., Engelberg, R., Back, A. L. and Curtis, J. R. [Medical University of South Carolina, Charleston]. "Discussing religion and spirituality is an advanced communication skill: an exploratory structural equation model of physician trainee self-ratings." Journal of Palliative Medicine 15, no. 1 (Jan 2012): 63-70. [(Abstract:) BACKGROUND: Communication about religious and spiritual issues is fundamental to palliative care, yet little empirical data exist to guide curricula in this area. The goal of this study was to develop an improved understanding of physicians' perspectives on their communication competence about religious and spiritual issues. METHODS: We examined surveys of physician trainees (n=297) enrolled in an ongoing communication skills study at two medical centers in the northwestern and southeastern United States. Our primary outcome was self-assessed competence in discussing religion and spirituality. We used exploratory structural equation modeling (SEM) to develop measurement and full models for acquisition of self-assessed communication competencies. RESULTS: Our measurement SEM identified two latent constructs that we label Basic and Intermediate Competence, composed of five self-assessed communication skills. The Basic Competence construct included overall satisfaction with palliative care skills and with discussing do not resuscitate (DNR) status. The Intermediate Competence construct included responding to inappropriate treatment requests, maintaining hope, and addressing fears about the end-of-life. Our full SEM model found that Basic Competence predicted Intermediate Competence and that Intermediate Competence predicted competence in religious and spiritual discussions. Years of clinical training directly influenced Basic Competence. Increased end-of-life discussions positively influenced Basic Competence and had a complex association with Intermediate Competence. Southeastern trainees perceived more competence in religious and spiritual discussions than northwestern trainees. CONCLUSION: This study suggests that discussion of religious and spiritual issues is a communication skill that trainees consider more advanced than other commonly taught communication skills, such as discussing DNR orders.]
Hale-Smith, A., Park, C. L. and Edmondson, D. [University of Connecticut, Storrs]. "Measuring beliefs about suffering: development of the views of suffering scale." Psychological Assessment 24, no. 4 (Dec 2012): 855-866. [(Abstract:) Efforts to measure religion have intensified, and many specific dimensions have been identified. However, although belief is a core dimension of all world religions, little attention has been given to assessment of religious beliefs. In particular, 1 essential set of religious beliefs, those concerning the reasons for human suffering, has remained virtually unexamined despite the potential clinical relevance of these beliefs. To fill the need for a measure of people's beliefs about suffering, we developed the Views of Suffering Scale (VOSS). Analyses identified factors related to traditional Christian teachings, unorthodox theistic beliefs, karma, and randomness. Internal consistency and test-retest reliability for VOSS subscale scores were good (s and rs >= .70). Comparisons to measures of related constructs suggest that the VOSS scores demonstrate good convergent validity. One subscale score was modestly correlated with social desirability related to image management, and 7 were positively correlated to self-deceptive enhancement. These preliminary studies suggest that the VOSS differentiates religious perspectives on suffering among a sample of U.S. university students, though more research is needed to confirm its utility in diverse populations. The VOSS provides a valid way to measure individuals' beliefs about suffering, allowing for inquiry into the factors that lead to various beliefs about suffering and the roles of these beliefs in adjusting to stressful life events.]
Hayward, R. D., Owen, A. D., Koenig, H. G., Steffens, D. C. and Payne, M. E. [University of Michigan, Ann Arbor]. "Longitudinal relationships of religion with posttreatment depression severity in older psychiatric patients: evidence of direct and indirect effects." Depression Research and Treatment (2012): 745970 [electronic journal article designation]. [(Abstract:) Psychiatric patients (age 59+) were assessed before study treatment for major depressive disorder, and again after 3 months. Measures taken before study treatment included facets of religiousness (subjective religiosity, private prayer, worship attendance, and religious media use), social support, and perceived stress. Clinician-rated depression severity was assessed both before and after treatment using the Montgomery-Asberg Depression Rating Scale (MADRS). Structural equation modeling was used to test a path model of direct and indirect effects of religious factors via psychosocial pathways. Subjective religiousness was directly related to worse initial MADRS, but indirectly related to better posttreatment MADRS via the pathway of more private prayer. Worship attendance was directly related to better initial MADRS, and indirectly related to better post-treatment MADRS via pathways of lower stress, more social support, and more private prayer. Private prayer was directly related to better post-treatment MADRS. Religious media use was related to more private prayer, but had no direct relationship with MADRS.]
Hourani, L. L., Williams, J., Forman-Hoffman, V., Lane, M. E., Weimer, B. and Bray, R. M. [Behavioral Health and Criminal Justice Division, RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC]. "Influence of spirituality on depression, posttraumatic stress disorder, and suicidality in active duty military personnel." Depression Research and Treatment (2012): 425463 [electronic journal article designation]. [(Abstract:) Understanding the role of spirituality as a potential coping mechanism for military personnel is important given growing concern about the mental health issues of personnel returning from war. This study seeks to determine the extent to which spirituality is associated with selected mental health problems among active duty military personnel and whether it moderates the relationship between combat exposure/deployment and (a) depression, (b) posttraumatic stress disorder (PTSD), and (c) suicidality in active duty military personnel. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. Over 24,000 randomly selected active duty personnel worldwide completed an anonymous self-report questionnaire. High spirituality had a significant protective effect only for depression symptoms. Medium, as opposed to high or low, levels of spirituality buffered each of the mental health outcomes to some degree. Medium and low spirituality levels predicted depression symptoms but only among those with moderate combat exposure. Medium spirituality levels also predicted PTSD symptoms among those with moderate levels of combat exposure and predicted self-reported suicidal ideation/attempt among those never deployed. These results point to the complex relationship between spirituality and mental health, particularly among military personnel and the need for further research.]
Jahn, D. R., Poindexter, E. K., Graham, R. D. and Cukrowicz, K. C. [Texas Tech University, Lubbock]. "The moderating effect of the negative impact of recent life events on the relation between intrinsic religiosity and death ideation in older adults." Suicide & Life-Threatening Behavior 42, no. 6 (Dec 2012): 589-601. [(Abstract:) Researchers tested the hypothesis that the negative impact of recent life events would moderate the relationship between intrinsic religiosity and death ideation in older adults. Participants (n = 272) completed assessments of death ideation, intrinsic religiosity, and negative impact of recent life events. We confirmed the presence of concurrent moderation and found that older adults with greater negative impact of recent life events and high intrinsic religiosity reported greater death ideation. These relatively surprising findings may be due to reduced fear of death in intrinsically religious older adults, an explanation consistent with previous research.]
Johnstone, B., McCormack, G., Yoon, D. P. and Smith, M. L. [University of Missouri, Columbia]. "Convergent/divergent validity of the brief multidimensional measure of religiousness/spirituality: empirical support for emotional connectedness as a 'spiritual' construct." Journal of Religion & Health 51, no. 2 (Jun 2012): 529-541. [(Abstract:) The objective of this article is to determine the convergent/divergent validity of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS; Fetzer Institute & National Institute on Aging Working Group 1999) subscales by correlating it with the Temperament and Character Inventory (TCI) Self-Transcendence subscales (i.e., Mysticism, Transpersonal Identification, Self-Forgetfulness; Cloninger et al. 1994). The cross-sectional analysis of 97 undergraduate/graduate students from a Midwestern university was made. The results are (1) all five BMMRS spirituality subscales were significantly correlated with the TCI Mysticism scale; (2) two BMMRS scales (i.e., Daily Spiritual Experiences, Values/Beliefs) were significantly correlated with the TCI Transpersonal Identification scales; (3) no BMMRS spiritual subscales were significantly correlated with the TCI Self-Forgetfulness scale; and (4) of the BMMRS religion scales, only the Organizational Religiousness subscale was correlated with any TCI subscale (i.e., Mysticism). The BMMRS appears to have adequate convergent/divergent validity, although the need exists to determine specific dimensions of spirituality. Inspection of the specific items of the BMMRS and TCI spiritual subscales that were most consistently correlated (i.e., BMMRS Daily Spiritual Experiences, Values/Beliefs; TCI Mysticism, Transpersonal Identification) suggests the existence of a distinct spiritual construct that is best conceptualized as the experience of emotional connectedness to the divine, nature, and/or others.]
Karches, K. E., Chung, G. S., Arora, V., Meltzer, D. O. and Curlin, F. A. [Pritzker School of Medicine, University of Chicago, IL]. "Religiosity, spirituality, and end-of-life planning: a single-site survey of medical inpatients." Journal of Pain & Symptom Management 44, no. 6 (Dec 2012): 843-851. [(Abstract:) CONTEXT: Prior studies suggest that terminally ill patients who use religious coping are less likely to have advance directives and more likely to opt for heroic end-of-life measures. Yet, no study to date has examined whether end-of-life practices are associated with measures of religiosity and spirituality. OBJECTIVES: To assess the relationship between general measures of patient religiosity and spirituality and patients' preferences for care at the end of life. METHODS: We examined data from the University of Chicago Hospitalist Study, which gathers sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center. Primary outcomes were whether the patient had an advance directive, a do-not-resuscitate (DNR) order, a durable power of attorney for health care, and an informally designated decision maker. Primary predictors were religious attendance, intrinsic religiosity, and self-rated spirituality. RESULTS: The sample population (n=8308) was predominantly African American (73%) and female (60%). In this population, 1.5% had advance directives and 10.4% had DNR orders. Half (51%) of the patients had specified a decision maker. White patients were more likely than African American patients to have an advance directive (odds ratio [OR] 2.1; 95% CI 1.1-4.0) and a DNR order (OR 1.7; 95% CI 1.0-2.9). Patients reporting high intrinsic religiosity were more likely to have specified a decision maker than those reporting low intrinsic religiosity (OR 1.3; 95% CI 1.1-1.6). The same was true for those with high compared with low spirituality (OR 1.3; 95% CI 1.1-1.5). Religious characteristics were not significantly associated with having an advance directive or DNR order. CONCLUSION: Among general medicine inpatients at an urban academic medical center, those who were highly religious and/or spiritual were more likely to have a designated decision maker to help with end-of-life decisions but did not differ from other patients in their likelihood of having an advance directive or DNR order.]
Krageloh, C. U., Chai, P. P., Shepherd, D. and Billington, R. [University of Technology, North Shore Campus, Auckland, New Zealand]. "How religious coping is used relative to other coping strategies depends on the individual's level of religiosity and spirituality." Journal of Religion & Health 51, no. 4 (Dec 2012): 1137-1151. [(Abstract:) Results from empirical studies on the role of religiosity and spirituality in dealing with stress are frequently at odds, and the present study investigated whether level of religiosity and spirituality is related to the way in which religious coping is used relative to other coping strategies. A sample of 616 university undergraduate students completed the Brief COPE (Carver in Int J Behav Med 4:92-100, 1997) questionnaire and was classified into groups of participants with lower and higher levels of religiosity and spirituality, as measured by the WHOQOL-SRPB (WHOQOL-SRPB Group in Soc Sci Med 62:1486-1497, 2006) instrument. For participants with lower levels, religious coping tended to be associated with maladaptive or avoidant coping strategies, compared to participants with higher levels, where religious coping was more closely related to problem-focused coping, which was also supported by multigroup confirmatory factor analysis. The results of the present study thus illustrate that investigating the role of religious coping requires more complex approaches than attempting to assign it to one higher order factor, such as problem- or emotion-focused coping, and that the variability of findings reported by previous studies on the function of religious coping may partly be due to variability in religiosity and spirituality across samples.]
Krause, N. and Hayward, R. D. [University of Michigan, Ann Arbor]. "Humility, lifetime trauma, and change in religious doubt among older adults." Journal of Religion & Health 51, no. 4 (Dec 2012): 1002-1016. [(Abstract:) Compared to research on the positive or beneficial effects of religion on health, far fewer studies have been designed to examine the potentially negative aspects of religion. The purpose of this study is to examine a potentially negative part of leading a religious life--religious doubt. More specifically, the current study was designed to assess the relationships among humility, exposure to lifetime trauma, and change in religious doubt over time. Two hypotheses were developed to explore the relationships among these constructs. The first hypothesis predicts that greater exposure to traumatic events at any point in the life course will be associated with greater doubts about religion over time. The second hypothesis proposes that the potentially deleterious effects of exposure to lifetime trauma will be buffered or offset for individuals who are more humble. Findings from a nationwide, longitudinal survey of older adults provide support for both hypotheses. This appears to be the first time that the relationship among humility, lifetime trauma, and change in religious doubt has been evaluated empirically.]
Maselko, J., Hayward, R. D., Hanlon, A., Buka, S and. Meador, K. [Duke University, Durham, NC]. "Religious service attendance and major depression: a case of reverse causality?" American Journal of Epidemiology 175, no. 6 (Mar 15, 2012): 576-583. [(Abstract:) Although previous studies have found a protective association between attendance at religious services and depression, the extent to which this association is driven by depressed persons' dropping out of religious activities is not clear. The authors examined whether early onset of a major depressive episode (MDE) predicted a subsequent decrease in religious service attendance. Data came from 3 follow-up studies of the National Collaborative Perinatal Project birth cohort (mean age = 37 years at last follow-up; n = 2,097; 1959-2001). The generalized estimating equations method was used to calculate the impact of an early MDE diagnosis (before age 18 years) on the likelihood of change in level of religious service attendance from childhood to adulthood. Twenty-seven percent of study participants met the criteria for lifetime MDE (n = 567), of whom 31% had their first onset prior to age 18 years. Women with early MDE onset were 1.42 times more likely (95% confidence interval: 1.19, 1.70) than women with adult-onset MDE or no lifetime MDE to stop attending religious services by the time of the first adult follow-up wave. No significant associations were observed among men. These findings suggest that women are more likely to stop attending religious services after onset of depression. Selection out of religious activities could be a significant contributor to previously observed inverse correlations between religious service attendance and psychopathology during adulthood.]
Moss, A. S., Wintering, N., Roggenkamp, H., Khalsa, D. S., Waldman, M. R., Monti, D. and Newberg, A. B. [Jefferson-Myrna Brind Center of Integrative Medicine, Philadelphia, PA]. "Effects of an 8-week meditation program on mood and anxiety in patients with memory loss." Journal of Alternative & Complementary Medicine 18, no. 1 (Jan 2012): 48-53. [(Abstract:) BACKGROUND: This study assesses changes in mood and anxiety in a cohort of subjects with memory loss who participated in an 8-week Kirtan Kriya meditation program. Perceived spirituality also was assessed. Previous reports from this cohort showed changes in cognitive function and cerebral blood flow (CBF). The purpose of this analysis was to assess outcome measures of mood and affect, and also spirituality, and to determine whether or not results correlated with changes in CBF. METHODS: Fifteen (15) subjects (mean age 62+/-7 years) with memory problems were enrolled in an 8-week meditation program. Before and after the 8-week meditation, subjects were given a battery of neuropsychologic tests as well as measures of mood, anxiety, and spirituality. In addition, they underwent single photon emission computed tomography scans before and after the program. A region-of-interest template obtained counts in several brain structures that could also be compared to the results from the affect and spirituality measures. RESULTS: The meditation training program resulted in notable improvement trends in mood, anxiety, tension, and fatigue, with some parameters reaching statistical significance. All major trends correlated with changes in CBF. There were nonsignificant trends in spirituality scores that did not correlate with changes in CBF. CONCLUSIONS: An 8-week, 12 minute a day meditation program in patients with memory loss was associated with positive changes in mood, anxiety, and other neuropsychologic parameters, and these changes correlated with changes in CBF. A larger-scale study is needed to confirm these findings and better elucidate mechanisms of change.]
Mouch, C. A. and Sonnega, A. J. [University of Michigan, Ann Arbor]. "Spirituality and recovery from cardiac surgery: a review." Journal of Religion & Health 51, no. 4 (Dec 2012): 1042-106. [(Abstract:) A large research literature attests to the positive influence of spirituality on a range of health outcomes. Recently, a growing literature links spirituality to improved recovery from cardiac surgery. Cardiac surgery has become an increasingly common procedure in the United States, so these results may provide a promising indication for improved treatment of patients undergoing surgery. To our knowledge, a comprehensive review of the literature in this area does not exist. Therefore, this paper reviews the literature relevant to the influence of spirituality on recovery from cardiac surgery. In addition, it proposes a conceptual model that attempts to explicate relationships among the variables studied in the research on this topic. Finally, it discusses limitations, suggests directions for future research, and discusses implications for the treatment of patients undergoing cardiac surgery.]
Nolan, J. A., McEvoy, J. P., Koenig, H. G., Hooten, E. G., Whetten, K. and Pieper, C. F. [Duke University, Durham, NC]. "Religious coping and quality of life among individuals living with schizophrenia." Psychiatric Services 63, no. 10 (Oct 2012): 1051-1054. [(Abstract:) OBJECTIVE: This study investigated the relationship between positive and negative religious coping and quality of life among outpatients with schizophrenia. METHODS: Interviews were conducted with 63 adults in the southeastern United States. Religious coping was measured by the 14-item RCOPE and quality of life by the World Health Organization Quality of Life-BREF. Data were examined via descriptive bivariate statistics and controlled analyses. Results: Most participants reported participation in private religious or spiritual activities (91%) and participation in public religious services or activities (68%). Positive religious coping was related to the quality-of-life facet of psychological health (r=.28, p=.03). Negative religious coping and quality of life were inversely related (r=-.30, p=.02). Positive religious coping was associated with psychological health in the reduced univariate general linear model (B=.72, p=.03, adjusted R(2)=.08). CONCLUSIONS: Greater awareness of the importance of religion in this population may improve cultural competence in treatment and community support.]
Padela, A. I., Gunter, K., Killawi, A. and Heisler, M. [University of Chicago, IL]. "Religious values and healthcare accommodations: voices from the American Muslim community." Journal of General Internal Medicine 27, no. 6 (Jun 2012): 708-715. [(Abstract:) BACKGROUND: Minority populations receive a lower quality healthcare in part due to the inadequate assessment of, and cultural adaptations to meet, their culturally informed healthcare needs. The seven million American Muslims, while ethnically and racially diverse, share religiously informed healthcare values that influence their expectations of healthcare. There is limited empirical research on this community's preferences for cultural modifications in healthcare delivery. OBJECTIVE: Identify healthcare accommodations requested by American Muslims. METHODS: Using community-based participatory research (CBPR) methods, we partnered with four community organizations in the Greater Detroit area to design and conduct thirteen focus groups at area mosques serving African American, Arab American, and South Asian American Muslims. Qualitative content analysis utilized a framework team-based approach. KEY RESULTS: Participants reported stigmatization within the healthcare system and voiced the need for culturally competent healthcare providers. In addition, they identified three key healthcare accommodations to address Muslim sensitivities: the provision of (1) gender-concordant care, (2) halal food and (3) a neutral prayer space. Gender concordance was requested based on Islamic conceptions of modesty and privacy. Halal food was deemed to be health-promoting and therefore integral to the healing process. Lastly, a neutral prayer space was requested to ensure security and privacy during worship. CONCLUSIONS: This study informs efforts to deliver high-quality healthcare to American Muslims in several ways. We note three specific healthcare accommodations requested by this community and the religious values underlying these requests. Healthcare systems can further cultural sensitivity, engender trust, and improve the healthcare experiences of American Muslims by understanding and then attempting to accommodate these values as much as possible.]
Rogers, D. L., Skidmore, S. T., Montgomery, G. T., Reidhead, M. A. and Reidhead, V. A. [University of Texas-Pan American, Edinburg, TX]. "Spiritual integration predicts self-reported mental and physical health." Journal of Religion & Health 51, no. 4 (Dec 2012): 1188-1201. [(Abstract:) Data from 167 participants were used to establish the psychometric properties of the Reidhead spiritual integration scale, 31-item version (SI-31). Structural equation modeling was used to empirically evaluate influences on perceived health functioning, while accounting for possible confounds. The analyses showed that SI-31 predicted perceived mental and physical health while controlling for life satisfaction, religious variables, mood patterns, depression symptoms, and demographics. The importance of SI as a predictor of health-related outcomes is supported, as is the usefulness of the SI-31 in predicting these outcomes.]
Samuelson, B. T., Fromme, E. K. and Thomas, C. R., Jr. [Oregon Health and Science University School of Medicine, Portland]. "Changes in spirituality and quality of life in patients undergoing radiation therapy." American Journal of Hospice & Palliative Medicine 29, no. 6 (Sep 2012): 449-454. [(Abstract:) PURPOSE: Investigations into the role of spirituality in cancer confirm the association of good spiritual well-being with many positive outcomes. This study aimed to evaluate potential changes in spirituality over the course of radiation therapy (RT). PATIENTS AND MATERIALS: The Functional Assessment of Chronic Illness Therapy-Spiritual questionnaire measuring spiritual well-being and quality of life (QOL) was administered to adult patients undergoing RT. Scores were compared using student t tests and chi-square analysis. RESULTS: Despite statistically significant declines in QOL measures such as physical well-being (P < .001) and overall well-being (P < .001), no significant changes were noted in spirituality for all comers. A significant increase in the Sp-12 spirituality measure (P = .001) was noted in patients with breast cancer, independent of age, gender, and purpose of treatment. Sp-12 scores were positively correlated with overall QOL scores (P < .001).]
Svalina, S. S. and Webb, J. R. [East Tennessee State University, Johnson City]. "Forgiveness and health among people in outpatient physical therapy." Disability & Rehabilitation 34, no. 5 (2012): 383-392. [(Abstract:) PURPOSE: Forgiveness is associated with a variety of health-related outcomes; however much of this work has been in the context of forgiveness of others, direct associations and otherwise healthy samples. This study examined associations involving multiple dimensions of forgiveness, including indirect effects through health behavior, among outpatients receiving physical therapy. METHODS: Participants from southern Appalachia (n = 141) completed cross-sectional self-report measures of forgiveness, lifetime religiousness, health behavior, health status and pain. Mediation analysis was employed to examine the direct and indirect relationships between forgiveness and health. RESULTS: Forgiveness of self was associated with: (i) overall health status, physical health status and current pain in an indirect-only fashion and (ii) mental health status and chronic pain in a direct-only fashion. Feeling forgiven by God was associated with health-related social functioning in a direct-only fashion. Forgiveness of others was not associated with the health-related outcomes. CONCLUSIONS: Forgiveness of self appears to be the most important to health, yet the most difficult to achieve. Religious culture may influence whether feeling forgiven by God is also important. Forgiveness-based intervention may be useful in the context of rehabilitation, in general, and physical therapy, in particular.]
Whitehead, B. R. and Bergeman, C. S. [University of Notre Dame, IN]. "Coping with daily stress: differential role of spiritual experience on daily positive and negative affect." Journals of Gerontology Series B-Psychological Sciences & Social Sciences 67, no. 4 (Jul 2012): 456-459. [(Abstract:) OBJECTIVES: On the global-level, spiritual experiences have been shown to buffer against the negative effects of stress on well-being for older adults, but this global-level analysis may not reflect the day-to-day processes at work. The present project uses a daily paradigm to examine the potential moderating effect of everyday spiritual experience (ESE) on the deleterious impact of a given day's perceived stress (PS) on that day's positive and negative affect (PA/NA). METHOD: Participants were 244 older adults aged 55-80 years who completed daily assessments for up to 56 days. RESULTS: Results partially support the moderating hypothesis: ESE buffered the negative effect of PS on same-day NA but had a positive direct effect on same-day PA. DISCUSSION: These results point to a differential function of ESE-that it serves a coping function for NA but enhances PA directly-in the day-to-day lives of older adults, shedding light on the nuanced role of religiousness and spirituality when it comes to coping with daily stress.]