The ACPE Research Network

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Summer 2017 Newsletter

Volume 15, Number 3
Published June 27, 2017

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, Spring, and Summer.



  1.     The ACPE Research Committee: New Resources and New Foci  --by Steven Ivy
  2.     Strong Interest in Research at 2017 ACPE Conference Workshops
  3.     A Timeline of Research in the ACPE
  4.     Transforming Chaplaincy Announces Second Cohort of Research Fellows
  5.     Research Added to the Common Qualifications and Competencies for Certification for Professional Spiritual Care
  6.     VCU Student Project: "Developing Evidence-Based Practice in Chaplaincy: A Study of Unit and Chaplain-Specific Integration"
  7.     Brief Reports from ACPE Centers:
              - Carolinas HealthCare System NorthEast (Concord, NC)  --by Beth Jackson-Jordan
              - Cedars-Sinai Medical Center (Los Angeles, CA)  --by Pamela Lazor
              - University of Rochester Medical Center (Rochester, NY)  --by Robin Y. Franklin
  8.     The European Research Institute for Chaplains in Healthcare
  9.     Notable Articles from 2016 Not Previously Cited on the Research Network Website


1.   The ACPE Research Committee: New Resources and New Foci --by Steven Ivy, Member, Reorganization Implementation Team (

One of the very promising changes in the reorganization of ACPE governance and administration is the creation of a national Research Committee. Research has always been a focus for some within ACPE as evidenced by local protocols and publications, various regional committees, the Research Network, and The Journal for Pastoral Care and Counseling. But this newly designed effort will bring resources and focus not previously available.

The charge of the Research Committee is: (1) Identify and establish research priorities for ACPE sponsorship and engagement with a horizon of at least three years; (2) Facilitate and collaborate with research focused on the education of CPE Supervisors, providers of spiritual care, and spiritual health educators; (3) Identify and collaborate with formal and informal leaders in research areas of direct interest to ACPE including but not limited to the Joint Research Council and the Transforming Chaplaincy initiatives; (4) Work with FCPE grant processes and ACPE budget processes to fund research that advances the mission of ACPE; establish and maintain processes to evaluate, approve, and monitor progress of FCPE and ACPE funded grants.

From my personal perspective, there are two great opportunities for ACPE focused research that should be grasped immediately. First, we are on the brink of establishing a new certification process. Some formal study of that process and its impact on students and supervisors needs to be quickly planned, funded, and engaged. Second, we are making a rather radical shift in our continuing education and colleagueship process by implementing Communities of Practice. What will be the actual outcomes of this new strategy? I suspect those reading this article can quickly imagine another ten projects that need doing. My belief is that FCPE and ACPE want to provide some funding toward learning about our processes.

Another opportunity for engagement will be identifying persons to participate on this committee. The membership will be built by the Board electing three persons annually over the next three years. If you are interested or know someone who is, please contact the Leadership Development Committee very soon.


2.   Strong Interest in Research at 2017 ACPE Conference Workshops

Workshops focusing on research drew strong attendance this year at the ACPE's national conference in Minneapolis, MN (May 3rd-5th at the Minneapolis Marriott Center). "Teaching Research in CPE" brought 41 people together on Thursday the 3rd to discuss research literacy education initiatives underway or being planned, supported by grants through the Transforming Chaplaincy project. Participants talked about strategies to interest students in research and when to focus on technical aspects of methodology, the advantage of engaging in-house research experts to be partners in teaching and ways to connect and contract with such experts, means for evaluating curricular components, and ideas for dealing with the challenge of adding research to already busy programs. Workshop leaders Lex Tartaglia and George Fitchett also addressed questions from supervisors interested in applying for the second round of curriculum grants, to be awarded this summer. They also spoke about the opportunity of the upcoming online eight-week course, Religion, Spirituality, and Health: An Introduction to Research, being offered at no cost to members of participant organizations through Virginia Commonwealth University and the overwhelming response to openings for the first Chaplaincy Research Summer Institute to be held in July.

The "Teaching Research Literacy in CPE" Workshop

The following day, 35 people attended "Research in CPE: Past, Present and Future," led by George Fitchett and Elizabeth BJ Larson. The program included the following research-based presentations: Judy Ragsdale described the experience with chaplain research fellowships offered at Cincinnati Children's Hospital Medical Center; Karen Hutt highlighted an extended CPE unit in a new out-patient cancer center at the University of Minnesota that included primary research projects; and Lex Tartaglia presented a survey of how ACPE-accredited residency programs make use of the electronic medical record (EMR) for documentation and training [--see: Tartaglia, A., Dodd-McCue, D., Ford, T., Demm, C. and Hassell, A., "Chaplain Documentation and the Electronic Medical Record: A Survey of ACPE Residency Programs," Journal of Health Care Chaplaincy 22, no. 2 (2016): 41-53]. John Ehman also addressed the contributions of the ACPE Research Network and Steve Ivy briefed the group on the new board-level ACPE Research Committee being created as part of the organization's redesign. [Note: More information on that committee will be reported to the Research Network as it develops.] Those attending the workshop recognized the contribution of research in ACPE to date and voiced recommitment to research at this juncture in our work as supervisors and in the organizational vision of ACPE going forward.

Also on Friday the 5th, a dozen members attended a workshop on "Integrating CPE into a Master of Science Degree Program at a Major Research University," led by Lex Tartaglia and Russell Davis, who have achieved such a program integration at Virginia Commonwealth University (Richmond, VA). The group discussed the importance of research literacy in addition to overall curricular development, the benefits and challenges of implementing and maintaining the often complex academic arrangements, and methods to track academic and clinical markers. This workshop highlighted an opportunity for the many CPE programs already based in university medical centers, where research is part and parcel of the institutional culture.

In addition, research played into a workshop by Kenton T. Derstine and Penny Driediger: " 'Start Close In' --Perspectives from Bowen Theory, Transformational Learning Theory and Technology for Building an Integrated CPE Curriculum," with over 40 participating. The session called attention to contemporary research in human functioning and introduced essential concepts of Bowen Theory and their application to a CPE learning process. Bowen Family Systems Theory (BFST) may point toward a variety of research projects in light of, for instance, its hypothesis that the more substantive relationships one has with one's extended family, the more resilient one may be when crisis strikes and the greater one's capacity to engage a wider diversity of people.


3.   A Timeline of Research in the ACPE

As part of the 2017 ACPE Minneapolis conference workshop, "Research in CPE: Past, Present and Future" [--see item #1, above], George Fitchett, Professor and Director of Research for the Department of Religion, Health and Human Values at Rush University Medical Center (Chicago, IL) compiled "A Brief History of Research in CPE." This was shared as a working document, but it presents a quite concise timeline that helps contextualize the story of research in our organization. Handled separately in relation to this history is a timeline covering "Research about CPE & Supervisory Education," highlighting particular studies and initiatives in this area of current interest in the ACPE. For the workshop handout (PDF), click HERE. If ACPE members have comment or suggestions regarding this timeline, please email Network Convener John Ehman at (--communications will be conveyed to Dr. Fitchett).


4.   Transforming Chaplaincy Announces Second Cohort of Research Fellows

The Transforming Chaplaincy Project has announced the second cohort of research fellows, completing the full selection of 16 chaplains to receive the Project's two-year fellowships supported by a grant from the John Templeton Foundation. These individuals will undertake research-focused Master of Science (MS) or Master of Public Health (MPH) degrees in epidemiology, biostatistics, or public health.

  • Marta Dabis, Chaplain, Saint Joseph Mercy Health System (Ann Arbor, MI), to begin an MPH in Health Behaviors and Health Education at the University of Michigan

  • Cate Michelle Desjardins, Chaplain Research Fellow, Cincinnati Children's Hospital Medical Center (Cincinnati, OH), to begin an MPH in Epidemiology at the University of Cincinnati College of Medicine

  • Paul Galchutt, Palliative & Staff Chaplain, University of Minnesota Health (Minneapolis, MN), to begin an MPH in Community Health Promotion at the University of Minnesota

  • Kristin Godlin, Chaplain, Carle Foundation Hospital, and Spiritual Care Minister at Presence Covenant Medical Center (Urbana, IL), to begin an MPH in Health Behavior at the University of Illinois Urbana-Champaign

  • Dirk Labuschagne, Palliative Care Chaplain, John H. Stroger, Jr. Hospital of Cook County (Chicago, IL), to begin an MPH in Epidemiology at the University of Illinois at Chicago

  • Saneta Maiko, Research Chaplain, Indiana University Health (Indianapolis, IN), to begin a MS in Clinical Research at the Indiana University School of Medicine

  • Shelley Varner Perez, Clinical Chaplain, VA Portland Health Care System (Portland, OR), to begin an MPH in Epidemiology at the Oregon Health & Science University and Portland State University

  • Petra Wahnefried, Chaplain Resident, Levine Cancer Institute & Carolinas Healthcare System (Charlotte, NC), to begin an MPH in Health Promotion Education & Behavior at the University of South Carolina
Congratulations to these recipients, who join the first cohort of fellows in research education aimed at advancing chaplaincy.


5.   Research Added to the Common Qualifications and Competencies for Certification for Professional Spiritual Care

As of April 2017, five chaplaincy organizations* have adopted a new common set of qualifications and competencies for certified membership –a revision and emendation of a set of common professional standards originally established in 2004. The document, "Certification for Professional Spiritual Care: Common Qualifications and Competencies" is available from (among other sources) the Association of Professional Chaplains, whose affiliated Board of Chaplaincy Certification, Inc. has produced a Competency Essay Writing Guide which elaborates each of the constituent items. Two new items have been added to the revision: one regarding the facilitation of group processes and one regarding research; the latter being:

Articulate how primary research and research literature inform the profession of chaplaincy and one’s spiritual care practice. [Section 1: Integration of Theory and Practice, item #6]
This is explained in the BCCI Competency Essay Writing Guide as follows:
Spiritual care providers integrate research literacy and may conduct research to ensure that their spiritual care is current and innovative in their practice. Using examples, demonstrate how you are utilizing current research literature in your spiritual care practice and work with interdisciplinary team members. If applicable, what primary research have you participated in and what were the key findings? How are you integrating your findings in your spiritual care practice?
Note that this new set of certification qualifications/competencies is different from the APC’s Standards of Practice for Professional Chaplains, which includes a research standard as well [--see our Fall 2015 Newsletter, news item #7].

* The five chaplaincy organization are: the Association for Clinical Pastoral Education (ACPE), the Association of Professional Chaplains (APC), the Canadian Association for Spiritual Care/Association Canadienne de Soins Spirituel (CASC/ACSS), the National Association of Catholic Chaplains (NACC), and Neshama: Association of Jewish Chaplains (NAJC).


6.   VCU Student Project: "Developing Evidence-Based Practice in Chaplaincy: A Study of Unit and Chaplain-Specific Integration"

For the third year, CPE residents and Master of Science students in Virginia Commonwealth University's Department of Patient Counseling have developed research skills by working together on a quality improvement project. In "Developing Evidence-Based Practice in Chaplaincy: A Study of Unit and Chaplain-Specific Integration," the seven-student group surveyed 150 staff from their assigned patient care units to assess for chaplain engagement, perceived contributions of chaplains to patient care, and both overall and chaplain-specific integration on the units in terms of interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on process. Results, varying by unit, were then used to generate three unique deliverables for each unit studied: an abstract; a poster, and a unit overview. A summary poster (PowerPoint) was also presented during the Department of Patient Counseling's annual Research Day to staff from across the Health System. The project was directed by Dr. Diane Dodd-McCue, DBA, Associate Professor with the Department, who has written an Executive Summary (PDF).

Clara Owens with a project poster, and the student research group (L-R):
Laura Kelly, Neal Green, Diane Dodd-McCue, Clara Owens, Juanita Claiborne, P. Martin Garner, Arouna Stephen, and Heber Aviles Villegas

The group additionally presented to a local chaplains' network and discussed the project at a Virginia Commonwealth University Graduate Research Symposium. This curriculum component to the VCU program has proved quite successful in encouraging chaplain integration patient care units and involving chaplaincy students in the process of research. For more information, contact Dr. Dodd-McCue at

[Editor's Note: Diane Dodd-McCue, along with Lex Tartaglia, have designed and will teach the online eight-week course, Religion, Spirituality, and Health: An Introduction to Research, referenced in Item #2 (above).]


7.   Brief Reports from ACPE Centers

ACPE Accredited Centers are increasingly integrating research into their departmental lives and CPE curriculums, many with the aid of grants from the Transforming Chaplaincy Project. The following are brief reports – part of an ongoing series – from ACPE Certified Educators regarding activities and plans at their sites:

•  From Beth Jackson-Jordan, Carolinas HealthCare System NorthEast (Concord, NC):

Carolinas HealthCare System has been piloting a research literacy curriculum for chaplain residents at two of our component sites -- Carolinas Healthcare NorthEast and Carolinas Medical Center -- with the support of our Transforming Chaplaincy Curriculum Grant. First, we formed an advisory committee of interdisciplinary staff members trained in research to consult with us in planning our curriculum. Several of these persons conducted seminars and served as "research mentors" for our residents. Over the year we held several joint seminars including evidenced based care, introduction to quantitative and qualitative research methods, conducting a literature review and process improvement. Resident projects included completing a research article analysis, completing either a literature review or an annotated bibliography and completing a process improvement project. Our year is culminating with a "Research Symposium" for which we have invited two other North Carolina CPE Centers who received Transforming Chaplaincy grants. The symposium will offer residents a chance to present process improvement projects and we will have a presentation by a chaplain researcher. We are now completing an evaluation process to make improvements to our program as well as working with another CPE center in North Carolina who is interested in replicating our curriculum. We have learned a lot in this process and feel committed to continuing and expanding our focus on research literacy to include the rest of our CPE faculty and staff chaplains.

•  From Pamela Lazor, Cedars-Sinai Medical Center (Los Angeles, CA):

On April 20, 2017 we held a half-day conference with George Fitchett as our guest speaker: "New Frontiers in Spiritual Care Research: Applying and Integrating New Research Findings into Clinical Practice." Ninety people attended, most being CPE educators, CPE students, and chaplains from the Los Angeles area. The conference was very well received, and we have had many requests to make it an annual event -- which we are hoping to do. (We video recorded this conference and will soon be making a link to the presentations generally available to the ACPE.) Also, at the end of May, we completed our first round of implementing our "Research Literacy for Chaplains" curriculum and have learned a great deal in the process. Although students sometimes complained about the "extra" work, they unanimously reported that they had enjoyed it and felt that they had learned valuable skills that had enhanced their clinical practice. In addition, this summer we are piloting the use of relevant research articles to complement our CPE didactic seminars for our summer program. Before each didactic, the students are given pertinent research articles to read before each seminar, and discussion of the articles is included in the speaker's presentation.

•  From Robin Y. Franklin, University of Rochester Medical Center (Rochester, NY):

The University of Rochester Medical Center has used a Transforming Chaplaincy Curriculum Grant to focus on the development of research literacy among the Chaplain Residents. The hope is to help the residents look at ways to incorporate into their practice as chaplains what they find through research articles. The residents offered 25 minute presentations to a hospital-wide audience, using cases from their assigned units and making use of Evidence Based Literature (EBL). In the process, they were surprised to discover significant gaps in the literature regarding the spiritual needs of patients and the most effective ways to meet those needs. We had some of the following suggestions for integrating research into the CPE curriculum: introducing education about using EBL early in the residency, continuing the opportunity for hands-on learning with the medical librarians, establishing a regular Journal Club to be organized by residents, and citing the EBL in verbatim/case study material throughout the year. Profound outcomes of this process were: sharing what they learned with other team members, strengthening interdisciplinary relationships, and giving staff an enriched view of what chaplains do. All of us began the process with dis-ease and anxiety. We ended with excitement regarding the possibilities of what this work could do to improve the spiritual support of patients and to enhance chaplaincy.


8.   European Research Institute for Chaplains in Healthcare

The European Research Institute for Chaplains in Healthcare ( --redirecting to, is an initiative which officially launched June 6, 2017 by the European Network of Healthcare Chaplains (ENHCC) and is hosted by the Academic Centre for Practical Theology (ACPT) in KU Leuven, Belgium. Presentations from the opening event included (see slides):

According to the Mission Statement, ERICH was…
…founded to promote research by chaplains into chaplaincy practice and in doing so to encourage reflection on its theoretical underpinning. ERICH seeks to support such research through education and mentoring with the aim of enhancing spiritual care for patients, their loved ones and healthcare staff.
At start-up, the website contains information on Initiatives and Projects (including, already, research on Specialist Spiritual Care Patient Reported Outcome Measure (PROMs) plus plans to explore of the Economic Value of Chaplaincy) and Research Education (beginning with an ERICH Masterclass on Case Study Methods in Healthcare Chaplaincy Research, led by George Fitchett and Steve Nolan), with site sections yet to be developed regarding Translation into Practice and Theory, Theology and spirituality. Also note: a section of web links titled Making Connections, Broadening Horizons lists the ACPE Research Network.

In addition to its website, ERICH may be followed on Twitter @ERICH_Chaplain


9.   Notable Articles from 2016 Not Previously Cited on the Research Network Website

Our Network regularly highlights quite a number of articles, yet a good many are not cited in the course of a year. The following two dozen have until now not been noted but may be of special interest to chaplains. They are part of an annual annotated bibliography of Medline-indexed articles, available from the Penn Medicine Department of Pastoral Care. (The full 2016 bibliography contains abstracts or descriptions for 203 articles, chosen from the more than 1,100 articles published during the year and categorized in Medline under the subject headings of "Religion and Medicine," "Religion and Psychology," "Religion," "Spirituality," and "Pastoral Care"; plus selected articles from the more than 1,300 in Medline’s In-Process database that were not yet listed on the general Medline database at the time of this bibliography’s completion.)

Abouda, M., Turki, S., Hachicha, A., Yangui, F., Triki, M. and Charfi, M. R. "A spiritual sleepiness scale: the Friday prayer." Tunisie Medicale 94, no. 3 (March 2016): 226-230. [NOTE: Only the abstract is in English; the article itself is in French. Available online at]. [(Abstract:) BACKGROUND: Excessive daytime sleepiness (EDS) affects 5% to 20% of the population and is involved in a large number of traffic accidents. EDS is a major symptom in sleep disorders, especially obstructive sleep apnea syndrome (OSA). The daytime sleepiness is evaluated subjectively using scales and questionnaires based on perception. This study is aimed to build a new questionnaire more suited to our lifestyle and then to compare it to the Epworth sleepiness scales (ESS). METHODS: We administered to 91 adult's patients (76 men and 15 women) consulting for sleep disturbance the ESS and a single subjective question tendency to drowsiness during the Friday prayer. Patients were listed in four groups according to their response to the question "During the past month, have you ever doze or fall asleep during the sermon of the Friday prayer?" by G1 never dozes, G2 low chance of falling asleep, G3 average chance of dozing, G4 high chance of falling asleep. RESULTS: Only 63 patients (58 men and 5 women) responded to both questionnaires. Group 1 included 14 patients with a ESS of 5.5 +/- 1.8, Group 2 included 18 patients with a ESS of 7.3 +/- 1.9, Group 3 included 18 patients with a ESS of 11.05 +/- 2 and Group 4 included 13 patients with a ESS of 14.69 +/- 2.3. The Rho correlation coefficient was high (0.86) and shows a strong correlation between the results of the two questionnaires. CONCLUSION: the answer to the question "During the past month, have you ever doze or fall asleep during the sermon of the Friday prayer?" seems to be an appropriate Sleepiness Scale among Muslim patients.]

Akgul, B. and Karadag, A. "The effect of colostomy and ileostomy on acts of worship in the Islamic faith." Journal of Wound, Ostomy & Continence Nursing 43, no. 4 (July-August 2016): 392-397. [(Abstract:) PURPOSE: The aim of this study was to determine the impact of colostomy and ileostomy on Muslim patients' acts of worship. DESIGN: This was a cross-sectional, descriptive study. SUBJECTS AND SETTING: The research setting was a stoma therapy unit of a 500-bed capacity training and research hospital in Ankara, Turkey. The study sample comprised 150 patients with colostomies (40.7%) or ileostomies (59.3%); their mean age was 51.6 +/- 12.9 (mean +/- standard deviation), more than half (60.7%) were men, and 84.7% were married. METHODS: Participants were queried about specific religious practices following ostomy surgery including those related to salat, fasting, and pilgrimage. Data were collected using forms specifically designed for this study; respondents were interviewed either face-to-face or via telephone. Descriptive statistics were used to characterize the influence of a fecal ostomy on specific religious activities. RESULTS: Participants reported decreasing the frequency of daily and Friday prayers (25.2% and 22.7%, respectively) or stopped practicing these activities all together (12.0% and 14.0%, respectively). Respondents tended to increase the frequency of acts of absolution while reducing acts of fasting. Perceptions of cleanliness, central to performance of salat within the Islamic faith, emerged as a central concern. CONCLUSIONS: Ostomy surgery influences multiple religious acts practiced by Muslims. Awareness of the potential impact of a fecal ostomy on religious acts within the Islamic faith, combined with specialized education about spiritual practices delivered by the WOC nurse or a knowledgeable resource person, is strongly recommended for all persons following ostomy surgery.]

Anandarajah, G., Roseman, J., Lee, D. and Dhandhania, N. "A 10-year longitudinal study of effects of a multifaceted residency spiritual care curriculum: clinical ability, professional formation, end of life, and culture." Journal of Pain & Symptom Management 52, no. 6 (December 2016): 859-872.e1. [(Abstract:) CONTEXT: Although spiritual care (SC) is recognized as important in whole-person medicine, physicians infrequently address patients' spiritual needs, citing lack of training. Although many SC curricula descriptions exist, few studies report effects on physicians. OBJECTIVES: To broadly examine immediate and long-term effects of a required, longitudinal, residency SC curriculum, which emphasized inclusive patient-centered SC, compassion, and spiritual self-care. METHODS: We conducted in-depth individual interviews with 26 physicians (13 intervention; 13 comparison) trained at a 13-13-13 residency. We interviewed intervention physicians three times over 10 years-1) preintervention, as PGY1s, 2) postintervention, as PGY3s, 3) eight-year postintervention, as practicing physicians. We interviewed comparison physicians as PGY3s. Interviews were audio-recorded, transcribed, and analyzed by four researchers. RESULTS: Forty-nine interviews were analyzed. General: Both groups were diverse regarding personal importance of spirituality/religion. All physicians endorsed the value of SC, sharing rich patient stories particularly related to end of life and cultural diversity. Curricular effects: 1) skills/barriers-intervention physicians demonstrated progressive improvements in clinical approach, accompanied by diminishing worries related to SC. PGY3 comparison physicians struggled with SC skills and worries more than PGY3 intervention physicians, 2) physician formation-most physicians described residency as profoundly challenging and transformative. Even after eight years, many intervention physicians noted that reflection on their diverse beliefs and values in safety, coupled with compassion shown to them through this curriculum, had deeply positive effects. High impact training: patient-centered spiritual assessment; chaplain rounds; spiritual self-care workshop/retreats; multicultural SC framework. CONCLUSION: A longitudinal, multifaceted residency SC curriculum can have lasting positive effects on physicians' SC skills and their professional/personal formation.]

Broadhurst, K. and Harrington, A. "A thematic literature review: the importance of providing spiritual care for end-of-life patients who have experienced transcendence phenomena." American Journal of Hospice & Palliative Medicine 33, no. 9 (November 2016): 881-893. [(Abstract:) The purpose of this review was to investigate within the literature the link between transcendent phenomena and peaceful death. The objectives were firstly to acknowledge the importance of such experiences and secondly to provide supportive spiritual care to dying patients. Information surrounding the aforementioned concepts is underreported in the literature. The following 4 key themes emerged: spiritual comfort; peaceful, calm death; spiritual transformation; and unfinished business The review established the importance of transcendence phenomena being accepted as spiritual experiences by health care professionals. Nevertheless, health care professionals were found to struggle with providing spiritual care to patients who have experienced them. Such phenomena are not uncommon and frequently result in peaceful death. Additionally, transcendence experiences of dying patients often provide comfort to the bereaved, assisting them in the grieving process.]

Buttner, M. M., Bormann, J. E., Weingart, K., Andrews, T., Ferguson, M. and Afari, N. "Multi-site evaluation of a complementary, spiritually-based intervention for veterans: the Mantram Repetition Program." Complementary Therapies in Clinical Practice 22 (February 2016): 74-79. [(Abstract:) BACKGROUND: Mental and physical symptoms affect Veterans' quality of life. Despite available conventional treatments, an increasing number of Veterans are seeking complementary approaches to symptom management. Research on the Mantram Repetition Program (MRP), a spiritually-based intervention, has shown significant improvements in psychological distress and spiritual well-being in randomized trials. However, these findings have not been replicated in real-world settings. METHODS: In this naturalistic study, we analyzed outcomes from 273 Veterans who participated in MRP at six sites and explored outcomes based on facilitator training methods. Measures included satisfaction and symptoms of anxiety, depression, and somatization using the Brief Symptom Inventory-18; Functional Assessment of Chronic Illness Therapy-Spiritual Well-being questionnaire; and the Mindfulness Attention Awareness Scale. RESULTS: There were significant improvements in all outcomes (p's < .001) regardless of how facilitators were trained. Patient satisfaction was high. CONCLUSION: The MRP was disseminated successfully yielding improvements in psychological distress, spiritual well-being, and mindfulness.]

Chaves, C. and Park, C. L. "Differential pathways of positive and negative health behavior change in congestive heart failure patients." Journal of Health Psychology 21, no. 8 (August 2016): 1728-1738. [(Abstract:) This longitudinal study applied a stress and coping model to examine the differential pathways of perceived positive and negative health behavior changes. Participants with congestive heart failure completed self-report measures of psychological resources, coping strategies, and perceived behavior changes and were assessed again 6 months later. Patients with higher positive affect and spiritual well-being reported more positive health behavior changes over time, effects mediated by approach coping. Alternatively, patients with lower psychological resources reported more negative behavior changes over time, effects mediated by avoidance coping. The results suggest that different psychological resources are related to different types of coping which, in turn, are associated with perceived positive or negative changes in health behavior over time.]

Clayton-Jones, D. and Haglund, K. "The role of spirituality and religiosity in persons living with sickle cell disease: a review of the literature." Journal of Holistic Nursing 34, no. 4 (December 2016): 351-360. [(Abstract:) PURPOSE: Sickle cell disease (SCD) is a serious debilitating chronic illness, affecting approximately 90,000 Americans and millions globally. Spirituality and religiosity (S/R) may ease the burden faced by persons living with SCD. The purpose of this study was to examine the role of S/R in adolescents and adults living with SCD in the research literature. METHOD: The electronic databases Cumulative Index to Nursing and Allied Health Literature, Health Source Nursing/Academic, ProQuest Health Module, PsycINFO, Medline, PubMed, and the American Theological Library Association were searched from January 1995 to December 2014. FINDINGS: Of the 89 studies retrieved, 11 articles between 2001 and 2013 met the inclusion criteria and were reviewed. Four themes emerged. The themes included (a) S/R as sources of coping, (b) S/R enhance pain management, (c) S/R influence health care utilization, and (d) S/R improve quality of life. DISCUSSION: Use of S/R may be significant in coping with SCD, managing pain, affecting hospitalizations, and affecting quality of life. This review can direct researchers exploring S/R in adolescents and adults living with SCD.]

Exline, J. J., Krause, S. J. and Broer, K. A. "Spiritual struggle among patients seeking treatment for chronic headaches: anger and protest behaviors toward God." Journal of Religion & Health 55, no. 5 (October 2016): 1729-1747. [(Abstract:) This study examined anger and protest behaviors toward God among 80 US adults seeking treatment for chronic headaches (66 women, 14 men; 71 completed treatment). Measures were administered before and after an intensive 3-week outpatient treatment program. At both times, anger and protest toward God correlated with lower pain acceptance, more emotional distress, and greater perceived disability. However, when considered simultaneously, anger predicted sustained distress, whereas protest behaviors (e.g., complaining, questioning, arguing) predicted both reduced distress and an increased sense of meaning. These findings suggest the utility of distinguishing between anger toward God and behaviors suggesting assertiveness toward God.]

Flannelly, K. J., Flannelly, L. T. and Jankowski, K. R. "Studying associations in health care research." Journal of Health Care Chaplaincy 22, no. 3 (July-September 2016): 118-131. [This article was written for chaplain researchers. [Abstract:] This article discusses some of the types of relationships observed in healthcare research and depicts them in graphic form. The article begins by explaining two basic associations observed in chemistry and physics (Boyles' Law and Charles' Law), and illustrates how these associations are similar to curvilinear and linear associations, respectively, found in healthcare. Graphs of curvilinear associations include morbidity curves and survival and mortality curves. Several examples of linear relationships are given and methods of testing linear relationships with interval and ratio data are introduced (i.e., correlation and ordinary least-squares regression). In addition, 2 x 2 contingency tables for testing the association between categorical (or nominal) data are described. Finally, Sir Austin Bradford Hill's eight criteria for assessing causality from research on associations between variables are presented and explained. Three appendices provide interested readers with opportunities to practice interpreting selected curvilinear and linear relationships.]

Gainey, A., Himathongkam, T., Tanaka, H. and Suksom, D. "Effects of Buddhist walking meditation on glycemic control and vascular function in patients with type 2 diabetes." Complementary Therapies in Medicine 26 (June 2016): 92-97. [(Abstract:) OBJECTIVE: To investigate and compare the effects of Buddhist walking meditation and traditional walking on glycemic control and vascular function in patients with type 2 diabetes mellitus. METHODS: Twenty three patients with type 2 diabetes (50-75 years) were randomly allocated into traditional walking exercise (WE; n=11) or Buddhism-based walking meditation exercise (WM; n=12). Both groups performed a 12-week exercise program that consisted of walking on the treadmill at exercise intensity of 50-70% maximum heart rate for 30min/session, 3 times/week. In the WM training program, the participants performed walking on the treadmill while concentrated on foot stepping by voiced "Budd" and "Dha" with each foot step that contacted the floor to practice mindfulness while walking. RESULTS: After 12 weeks, maximal oxygen consumption increased and fasting blood glucose level decreased significantly in both groups (p<0.05). Significant decrease in HbA1c and both systolic and diastolic blood pressure were observed only in the WM group. Flow-mediated dilatation increased significantly (p<0.05) in both exercise groups but arterial stiffness was improved only in the WM group. Blood cortisol level was reduced (p<0.05) only in the WM group. CONCLUSION: Buddhist walking meditation exercise produced a multitude of favorable effects, often superior to traditional walking program, in patients with type 2 diabetes.]

Grossoehme, D. H., Szczesniak, R. D., Mrug, S., Dimitriou, S. M., Marshall, A. and McPhail, G. L. "Adolescents' spirituality and cystic fibrosis airway clearance treatment adherence: examining mediators." Journal of Pediatric Psychology 41, no. 9 (October 2016): 1022-1032. [(Abstract:) OBJECTIVE: Adolescent cystic fibrosis (CF) treatment adherence is a significant multidimensional issue. Using the Theory of Reasoned Action (TRA), this study examined the role of spiritual factors in adherence. METHODS: Forty-five 11-19-year-olds diagnosed with CF completed questionnaires concerning psychosocial, spiritual, and adherence-related constructs and Daily Phone Diaries to calculate treatment adherence. Exploratory Factor Analysis identified two spiritual factors used in subsequent analyses. The mediating roles of attitude toward the treatment's value (utility), subjective behavioral norms (the product of perceived behavioral norms and one's motivation to comply with them), self-efficacy for completing the treatments and treatment intentions in the relationship between spiritual factors and treatment adherence were tested with path analysis. RESULTS: Lower 'spiritual struggle' and greater 'engaged spirituality' predicted treatment attitude (utility) and subjective behavioral norms, which, together with self-efficacy, predicted treatment intentions. Finally, treatment intentions predicted airway clearance adherence. CONCLUSIONS: Findings were consistent with the TRA. Engaged spirituality supports pro-adherence determinants and behavior. Spiritual struggle's negative associations with outcomes warrant screening and intervention.]

Hill, T. D., Ellison, C. G., Burdette, A. M., Taylor, J. and Friedman, K. L. "Dimensions of religious involvement and leukocyte telomere length." Social Science & Medicine 163 (August 2016): 168-75. [(Abstract:) Although numerous studies suggest that religious involvement is associated with a wide range of favorable health outcomes, it is unclear whether this general pattern extends to cellular aging. In this paper, we tested whether leukocyte telomere length varies according to several dimensions of religious involvement. We used cross-sectional data from the Nashville Stress and Health Study (2011-2014), a large probability sample of 1252 black and white adults aged 22 to 69 living in Davidson County, TN, USA. Leukocyte telomere length was measured using the monochrome multiplex quantitative polymerase chain reaction method with albumin as the single-copy reference sequence. Dimensions of religious involvement included religiosity, religious support, and religious coping. Our multivariate analyses showed that religiosity (an index of religious attendance, prayer frequency, and religious identity) was positively associated with leukocyte telomere length, even with adjustments for religious support, religious coping, age, gender, race, education, employment status, income, financial strain, stressful life events, marital status, family support, friend support, depressive symptoms, smoking, heavy drinking, and allostatic load. Unlike religiosity, religious support and religious coping were unrelated to leukocyte telomere length across models. Depressive symptoms, smoking, heavy drinking, and allostatic load failed to explain any of the association between religiosity and telomere length. To our knowledge, this is the first population-based study to link religious involvement and cellular aging. Although our data suggest that adults who frequently attend religious services, pray with regularity, and consider themselves to be religious tend to exhibit longer telomeres than those who attend and pray less frequently and do not consider themselves to be religious, additional research is needed to establish the mechanisms underlying this association.]

Iqbal, F., Kujan, O., Bowley, D. M., Keighley, M. R. B. and Vaizey, C. J. "Quality of life after ostomy surgery in Muslim patients: a systematic review of the literature and suggestions for clinical practice." Journal of Wound, Ostomy & Continence Nursing 43, no. 4 (July-August 2016): 385-391. [(Abstract:) PURPOSE: To determine factors that influence health-related quality of life (HRQOL) after ostomy surgery in Muslim patients. METHODS: A systematic literature review of published data was carried out using MeSH terms ("Muslim" OR "Islam") AND ("stoma" OR "ostomy" OR "colostomy" OR "ileostomy") AND "quality of life" AND "outcomes." RESULTS: Twelve studies enrolling 913 subjects were deemed suitable for inclusion in the review. HRQOL was found to be particularly impaired in Muslims; this impairment went beyond that experienced by non-Muslim patients. Factors associated with this difference included psychological factors, social isolation, underreporting of complications, and sexual dysfunction leading to breakdown of marital relations as well as diminished religious practices. CONCLUSION: Muslims requiring ostomies should receive preoperative counseling by surgeons and ostomy nurses. These discussions should also include faith leaders and/or hospital chaplains. Ongoing support after surgery can be extended into the community and encompass family doctors and faith leaders. Additional research exploring HRQOL after surgery in Muslims living in Western societies is indicated.]

Ironson, G., Kremer, H. and Lucette, A. "Relationship between spiritual coping and survival in patients with HIV." Journal of General Internal Medicine 31, no. 9 (September 2016): 1068-1076. [(Abstract:) BACKGROUND: Studies of spirituality in initially healthy people have shown a survival advantage, yet there are fewer research studies in the medically ill, despite the widespread use of spirituality/religiousness to cope with serious physical illness. In addition, many studies have used limited measures such as religious service attendance. OBJECTIVE: We aimed to examine if, independent of medication adherence, the use of spirituality/religiousness to cope with HIV predicts survival over 17 years. DESIGN: This was a longitudinal study, started in 1997. Study materials were administered semi annually. PARTICIPANTS: A diverse sample of 177 HIV patients initially in the mid-stage of disease (150-500 CD4-cells/mm(3); no prior AIDS-defining symptoms) participated in the study. MAIN MEASURES: Participants were administered a battery of psychosocial questionnaires and a blood draw. They completed interviews and essays to assess current stressors. Spiritual coping (overall/strategies) was rated by qualitative content analysis of interviews regarding stress and coping with HIV, and essays. KEY RESULTS: Controlling for medical variables (baseline CD4/viral load) and demographics, Cox regression analyses showed that overall positive spiritual coping significantly predicted greater survival over 17 years (mortality HR= 0.56, p= 0.039). Findings held even after controlling for health behaviors (medication adherence, substance use) and social support. Particular spiritual coping strategies that predicted longer survival included spiritual practices (HR= 0.26, p<0.001), spiritual reframing (HR= 0.27, p= 0.006), overcoming spiritual guilt (HR= 0.24, p<0.001), spiritual gratitude (HR= 0.40, p= 0.002), and spiritual empowerment (HR= 0.52, p= 0.024), indicating that people using these strategies were 2-4 times more likely to survive. CONCLUSIONS: To our knowledge this is the first study showing a prospective relationship of spiritual coping in people who are medically ill with survival over such a long period of time, and also specifically identifies several strategies of spirituality that may be beneficial.]

Levin, J. "Prevalence and religious predictors of healing prayer use in the USA: findings from the Baylor Religion Survey." Journal of Religion & Health 55, no. 4 (August 2016): 1136-1158. [(Abstract:) Using data from the 2010 Baylor Religion Survey (N = 1714), this study investigates the prevalence and religious predictors of healing prayer use among US adults. Indicators include prayed for self (lifetime prevalence = 78.8%), prayed for others (87.4%), asked for prayer (54.1%), laying-on-of-hands (26.1%), and participated in a prayer group (53.0%). Each was regressed onto eight religious measures, and then again controlling for sociodemographic variables and health. While all religious measures had net effects on at least one healing prayer indicator, the one consistent predictor was a four-item scale assessing a loving relationship with God. Higher scores were associated with more frequent healing prayer use according to every measure, after controlling for all other religious variables and covariates.]

Lewis, A., Adams, N., Varelas, P., Greer, D. and Caplan, A. "Organ support after death by neurologic criteria: results of a survey of US neurologists." Neurology 87, no. 8 (August 23, 2016): 827-834. [This is a survey of 938 members of the American Academy of Neurology (AAN) who treat critically ill patients, including 50% who practice in states with accommodation exceptions (states that require religious or moral beliefs to be taken into consideration when declaring death or discontinuing organ support: California, Illinois, New Jersey, New York). The article considers ways that religious dynamics come into play. See esp. Table 2 (p. 830) regarding "Actions respondents would take if a family voiced religious objection after death by neurologic criteria and requested continuation of organ support."]

Maley, C. M., Pagana, N. K., Velenger, C. A. and Humbert, T. K. "Dealing with major life events and transitions: a systematic literature review on and occupational analysis of spirituality." American Journal of Occupational Therapy 70, no. 4 (July-August 2016): 7004260010 [electronic journal article designation, 6pp.]. [(Abstract:) This systematic literature review analyzed the construct of spirituality as perceived by people who have experienced or are experiencing a major life event or transition. The researchers investigated studies that used narrative analysis or a phenomenological methodology related to the topic. Thematic analysis resulted in three major themes: (1) avenues to and through spirituality, (2) the experience of spirituality, and (3) the meaning of spirituality. The results provide insights into the intersection of spirituality, meaning, and occupational engagement as understood by people experiencing a major life event or transition and suggest further research that addresses spirituality in occupational therapy and interdisciplinary intervention.]

McSherry, W., Boughey, A. and Kevern, P. "'Chaplains for Wellbeing' in primary care: a qualitative investigation of their perceived impact for patients' health and wellbeing." Journal of Health Care Chaplaincy 22, no. 4 (Oct-December 2016): 151-170. [(Abstract:) Although Health Chaplaincy services are well-established in hospitals in the United Kingdom and across the world, Primary Care Chaplaincy is still in its infancy and much less extensively developed. This study explored the impact the introduction of a Primary Care "Chaplains for Wellbeing" service had upon patients' experience and perceived health and well-being. Sixteen patients participated in one-one interviews. Transcripts were analyzed using interpretative phenomenological analysis (IPA). Patients reported circumstances that had eroded perceived self-efficacy, self-identity, and security manifesting as existential displacement; summarized under the superordinate theme of "loss." "Loss" originated from a number of sources and was expressed as the loss of hope, self-confidence, self-efficacy, and sense of purpose and meaning. Chaplains used a wide range of strategies enabling patients to rebuild self-confidence and self-esteem. Person-centered, dignified, and responsive care offered in a supportive environment enabled patients to adapt and cope with existential displacement.]

Muse, S., Love, M. and Christensen, K. "Intensive outpatient therapy for clergy burnout: How much difference can a week make?" Journal of Religion & Health 55, no. 1 (February 2016): 147-158. [(Abstract:) A pre-test and post-test quasi-experimental matched pairs design was used to assess the effectiveness of a week-long multi-therapist intensive outpatient intervention process with clergy suffering from depression and burnout. Participants (n = 23) in the "Clergy in Kairos" program of the Pastoral Institute (Muse in J Pastor Care Couns 61(3):183-195, 2007) constituted the experimental variable. Clergy surveyed from United Methodist and Presbyterian denominations (n = 121) provided a control group from which 23 respondents were selected whose pre-test scores in depression and burnout were statistically equivalent to those in the experimental group. The treatment group consisted of clergy from three denominations who self-selected (or in some cases were referred by denominational officials) into the program. At the outset, clergy in both groups reported equivalent levels of conflict, emotional exhaustion, depersonalization, and depression. At the 6-months follow-up, clergy in the experimental group showed significant improvement of depression, emotional exhaustion, and depersonalization scores. By contrast, there was no change in the burnout and depression scores in the control group at 6-months post-test. Findings suggest the usefulness of a week-long multi-therapist intensive outpatient intervention in reducing burnout and depression.]

Philippus, A., Mellick, D., O'Neil-Pirozzi, T., Bergquist, T., Guller Bodien, Y., Sander, A. M., Dreer, L. E., Giacino, J. and Novack, T. "Impact of religious attendance on psychosocial outcomes for individuals with traumatic brain injury: a NIDILRR funded TBI Model Systems study." Brain Injury 30, nos. 13-14 (2016): 1605-1611. [(Abstract:) OBJECTIVES: To (1) identify demographic characteristics of individuals with traumatic brain injury (TBI) who attend religious services, (2) understand the relationship between attending religious services and psychosocial outcomes and (3) examine the independent contribution of religious service attendance to psychosocial outcomes while controlling for demographic characteristics, functional status and geographic location at 1, 5 and 10-years post injury. DESIGN: Retrospective, cross-sectional cohort study using secondary data analysis of the TBI Model Systems (TBIMS) National Database (NDB). PARTICIPANTS: TBIMS NDB participants who completed 1, 5 or 10-year follow-up interview with data on religious attendance. A total of 5573 interviews were analyzed. OUTCOME MEASURES: Satisfaction with Life scale (SWLS), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9) and Participation Assessment with Recombined Tools-Objective Social sub-scale. RESULTS: Approximately half of the sample was attending religious services at each time point. Attendance was a significant protective factor for each outcome across all three-time periods. After controlling for demographic characteristics, functional status and geographic makeup, religious attendance contributed a small but significant amount of unique variance in all models except for GAD-7 at years 1 and 10. DISCUSSION: This study highlights the benefits of religious attendance on psychosocial outcomes post-TBI. Implications for rehabilitation are discussed.]

Ronneberg, C. R., Miller, E. A., Dugan, E. and Porell, F. "The protective effects of religiosity on depression: a 2-year prospective study." Gerontologist 56, no. 3 (June 2016): 421-431. [(Abstract:) PURPOSE OF THE STUDY: Approximately 20% of older adults are diagnosed with depression in the United States. Extant research suggests that engagement in religious activity, or religiosity, may serve as a protective factor against depression. This prospective study examines whether religiosity protects against depression and/or aids in recovery. DESIGN AND METHODS: Study data are drawn from the 2006 and 2008 waves of the Health and Retirement Study. The sample consists of 1,992 depressed and 5,740 nondepressed older adults (mean age = 68.12 years), at baseline (2006), for an overall sample size of 7,732. Logistic regressions analyzed the relationship between organizational (service attendance), nonorganizational (private prayer), and intrinsic measures of religiosity and depression onset (in the baseline nondepressed group) and depression recovery (in the baseline depressed group) at follow-up (2008), controlling for other baseline factors. RESULTS: Religiosity was found to both protect against and help individuals recover from depression. Individuals not depressed at baseline remained nondepressed 2 years later if they frequently attended religious services, whereas those depressed at baseline were less likely to be depressed at follow-up if they more frequently engaged in private prayer. IMPLICATIONS: Findings suggest that both organizational and nonorganizational forms of religiosity affect depression outcomes in different circumstances (i.e., onset and recovery, respectively). Important strategies to prevent and relieve depression among older adults may include improving access and transportation to places of worship among those interested in attending services and facilitating discussions about religious activities and beliefs with clinicians.]

Sharma, V., Marin, D. B., Sosunov, E., Ozbay, F., Goldstein, R. and Handzo, G. F. "The differential effects of chaplain interventions on patient satisfaction." Journal of Health Care Chaplaincy 22, no. 3 (July-September 2016): 85-101. [(Abstract:) There is an acute need to define the specific skills that make chaplains integral to the healthcare team. This prospective study attempts to identify those skills that may be specific to chaplains, for whom no other member of the health care team has similar training, and to examine if these skills have a differential effect on patient satisfaction. A total of 59 interventions were identified and grouped into 10 categories by focus groups comprised of chaplains. Subsequently, Principal Component Analysis yielded two independent variables; Component 1 representing the "Religious/Spiritual" dimension, and Component 2 representing the "Psychosocial" dimension of chaplains' work. The two components were used in an OLS regression model to measure patient satisfaction. Interventions that comprise the "Religious/Spiritual" dimension may be considered to be specific skills that chaplains contribute to patient care and these have a slightly stronger correlation with patient satisfaction than the interventions of the "Psychosocial" dimension.]

Tobin, E. T. and Slatcher, R. B. "Religious participation predicts diurnal cortisol profiles 10 years later via lower levels of religious struggle." Health Psychology 35, no. 12 (December 2016): 1356-1363. [(Abstract:) OBJECTIVE: Multiple aspects of religion have been linked with a variety of physical health outcomes; however, rarely have investigators attempted to empirically test the mechanisms through which religiosity impacts health. The links between religious participation, religious coping, and diurnal cortisol patterns over a 10-year period in a national sample of adults in the United States were investigated. METHOD: Participants included 1,470 respondents from the Midlife in the United States (MIDUS) study who provided reports on religious participation, religious coping, and diurnal cortisol. RESULTS: Religious participation predicted steeper ("healthier") cortisol slopes at the 10-year follow-up, controlling for potential confounds. Further, religious struggle (religious coping marked by tension and strain about religious and spiritual issues) mediated the prospective association between religious participation and cortisol slope, such that greater religious attendance predicted lower levels of religious struggle 10 years later, which in turn was linked with a steeper cortisol slope; this effect remained strong when controlling for general emotional coping and social support. Positive religious coping was unrelated to diurnal cortisol patterns. CONCLUSION: These findings identify religious struggle as a mechanism through which religious participation impacts diurnal cortisol levels and suggest that diurnal cortisol is a plausible pathway through which aspects of religion influence long-term physical health.]

Toussaint, L., Kamble, S., Marschall, J. C. and Duggi, D. B. "The effects of brief prayer on the experience of forgiveness: an American and Indian comparison." International Journal of Psychology 51, no. 4 (August 2016): 288-295. [(Abstract:) The present study offers a cross-cultural examination of the effect of prayer on forgiveness. American (n = 51) and Indian (n = 100) participants either prayed for their romantic partner (prayer condition) or described their romantic partner's physical attributes (control condition). Prayers were self-guided and lasted 3 minutes. Pre-test and post-test measures of retaliation were completed. Results showed that participants in the prayer group showed statistically significant decreases in retaliation motives from pre-test to post-test and the magnitude of this change was not different across cultures. Control groups in both cultures showed no change. Because of the religious diversity present in the Indian sample, the robustness of the effect of prayer on forgiveness was tested across Christian, Hindu and Muslim Indians. Religious affiliation did not moderate the effect of prayer on forgiveness in this sample. Results suggest that a brief prayer is capable of producing real change in forgiveness and this change is consistent across American and Indian cultures and across three different religious groups in India. Brief prayer for others that enhances forgiveness may be useful for individuals in close relationships, in certain counseling settings and for people in many different walks of life.]



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