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Winter 2012 Newsletter

On-Line Newsletter Volume 10, Number 2
Published February 28, 2011

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 Spring-Summer 2012 issue will be published in June.)

 

Table of Contents

  1.   A Message from the ACPE Interim Executive Director
  SPECIAL SECTION: WORKSHOP REPORTS FROM THE ANNUAL ACPE CONFERENCE, FEBRUARY 15-18, 2012
  2.   Teaching Research in CPE Residency Programs
  3.   Self-Assessed Spiritual Skill Changes Reported by CPE Residents and Interns
  4.   Self-Supervision of Work with Students

  5.   Update on Research-Related Activity at the VCU ACPE Center
  6.   Ministry Specialty Projects at St. Luke's Hospital, Bethlehem, PA
  7.   Steve Nolan's Spiritual Care at the End of Life: The Chaplain as a "Hopeful Presence"
  8.   HealthCare Chaplaincy to Award Grants for Growing the Field of Chaplaincy Research in Palliative Care
  9.   "Pastoral Care in Hospitals," A Literature Review from Italian Researchers
10.   Another International Review of Spirituality Instruments
11.   Islamic Approaches to Patient Care, by Ra'ufa Sherry Tuell
12.   Theme Issue of the Journal of Behavioral Medicine

 

1.     A Message from the ACPE Interim Executive Director

[Editor's Note: this message was included in materials distributed to all registrants at the national ACPE conference, February 15-18, 2012, Arlington, VA.]

Greetings to our Research Leaders:

I was recently at a meeting of the member organizations of the Spiritual Care Collaborative as well as other interested organizations for the purpose of considering a project that needs doing together, that cannot be done by any one organization! What would you have chosen? Interestingly enough, on the day of the meeting, an article appeared in the Wall Street Journal on chaplaincy. It was called: “Bigger Roles for Chaplains on Patient Medical Teams,” by Laura Landro.

There was an unusual opportunity that presented itself as we met: the chance to communicate back to the editor of the WSJ our joint appreciation for the article and offer a photo of our organizations’ leadership. Laura responded back to us appreciatively. The story behind this story is our difficulty in truly embracing this opportunity.

An excerpt from the article:

Studies have shown that many transplant patients experience enhanced appreciation for life, re-ordered priorities, increased empathy and higher self-esteem. Yet they also often report lower spiritual well-being. "Negative religious coping" -- feeling angry, unloved or abandoned by God, or doubting one's beliefs -- has been associated with anxiety, depression and poorer social and emotional well-being. [Wall Street Journal, December 6, 2011; Section D3]
We are all eager to live out of the sense that we know the above to be true, yet we often leave the research to other professions. We cannot afford to do that. We must see research as our bread and butter in the world in which we want to serve -- and to keep securing the basis to serve. Thanks for your leadership and faithfulness in bringing the issues to us.

--Deryck Durston, Interim Executive Director, ACPE, 12/22/11

 

 

SPECIAL SECTION: WORKSHOP REPORTS FROM THE ANNUAL ACPE CONFERENCE, FEBRUARY 15-18, 2012, ARLINGTON, VA


2.     Teaching Research in CPE Residency Programs

Over 100 participants attended the workshop, Teaching Research in CPE Residency Programs, led by George Fitchett and Patricia Murphy, from Rush University Medical Center, Chicago, IL; Paul Derrickson, from Milton S. Hershey Medical Center, Hershey, PA; and Alexander Tartaglia and Diane Dodd-McCue, from Virginia Commonwealth University Health System, Richmond, VA. Within the context of Standard 12 of the APC Standards of Practice: namely, "The chaplain practices evidence-based care including ongoing evaluation of new practices and when appropriate, contributes to or conducts research," the presenters addressed three main points. First, they stated the case for research literacy and, as appropriate, for research collaboration and leadership. Second, they reported findings of their recent study of the extent to which ACPE residency programs incorporate research related activities into their curricula. Third, they offered three models for teaching research in CPE. The presentation slides are available for downloading as PowerPoint or PDF files, as well as a handout sheet. The study on the current state of teaching research in CPE will be appearing in an upcoming 2012 issue of The Journal of Pastoral Care and Counseling.

 

3.     Self-Assessed Spiritual Skill Changes Reported by CPE Residents and Interns

This workshop presented Gordon Hilsman’s low-level research on the notion of "spiritual skill" development in initial CPE. Having gathered data from 48 summer students in 12 programs in three ACPE regions, he recorded differences in respondents’ pre and post self-assessments of 103 spiritual skills. Results clustered in four areas: interpersonal, personal, transcendent, and communal. They confirmed many growth areas traditionally expected by supervisors in beginning students. They also showed some surprising other growth areas identified by students regarding non-conventional spiritual skills, defined pragmatically as "proficiencies a given person uses to care for her own human spirit and the spirits of those around her." Four of the supervisors of the 12 programs were Supervisory Candidates, and eight were ACPE supervisors. The data confirmed that experience as a supervisor tends to increase students’ appraisals of their own spiritual skill growth in initial CPE. Hilsman contends that surveying beginning students regarding their appraisal of their own spiritual skill levels before and after the formative clinical learning experience promises benefits in students’ self awareness, relationship development, spiritual conceptualizing and fashioning continuing education goals after CPE is over. An article presenting the project has been submitted to Reflective Practice, an open source internet journal on studying ministry and supervision, for possible publication in May 2012. Hilsman’s contact information is ghilsman@gmail.com, 253-565-4992. He is a recently retired ACPE supervisor and member of the national ACPE Standards committee.

 

4.     Self-Supervision of Work with Students

More than 50 conferees gathered for the “Self-Supervision of Work with Students” workshop led by Jack Gleason, and were given the task of writing supervisory situation summaries that included a section on what would have been more effective. The energy level shot up when participants were then paired to share what they had written and to receive feedback from their partners. Twenty-seven writers allowed their work to be collected for editing into the free, anonymous online Spiritual Care Knowledge Base (available through the Research Network) after writers approve the edits. In so doing, a new category, "CPE Supervisory Issues," will be added to the 24 already there, bringing the collection of actual situations with learnings gained to well over 300. This knowledge base will be used to replicate effective interventions toward evidence-based spiritual care best practices, and thereby help to keep professional spiritual care flourishing in the emerging healthcare pay-for-results paradigm. For more information, contact Jack Gleason at mariejohn50@att.net.

 

 

5.     Update on Research-Related Activity at the VCU ACPE Center --report provided by Diane Dodd McCue

The following are recent developments at the Virginia Commonwealth University Program in Patient Counseling:

  • Angela Duncan received her Doctorate in Health Related Research from Virginia Commonwealth University's School of Allied Health Professions during the December 2011 graduation ceremonies. She becomes the first student to complete her doctorate in the PhD Program's Patient Counseling track. Her dissertation study, "The examination of spiritual and religious coping and well-being and their impact on the health-related quality of life of patients with mechanical circulatory devices," focused on end-stage heart failure patients at Virginia Commonwealth University Medical Center (VCUMC) and the McGuire Woods VA Hospital.

  • Applications for the 2012 PhD Cohort are due in March. Information on the PhD track in Patient Counseling is available from Dr. Diane Dodd-McCue, ddoddmccue@vcu.edu. For a first-hand perspective of this program, contact Dr. Duncan, duncanas@vcu.edu.

  • Chaplain residents Henry Amadeker, Jason Callahan, Marc Fields, Susan Hayes, Louise Mason, Linda Moore, and Joshua Trautmann and Patient Counseling MS student Melvinie Lewis are developing a survey to use in profiling the organization culture of service line units at VCUMC. Understanding the unit culture profiles will help chaplains tailor their pastoral care activities to fit each unit’s unique needs.

  • Two new surveys were developed by VCUMC chaplains using REDcap, an on-line health services-oriented survey system that is the outgrowth of NIH-supported research at Vanderbilt University. In both cases, the use of this electronic survey research tool at VCUMC eliminates paper documentation and allows for on-time, easily retrievable information by chaplains involved in patient and family support. REDCap also allows for development of a database formatted for subsequent research analysis.

    VCUMC Thomas Palliative Care Chaplain Tim Ford developed a bereavement tracking tool that incorporates an assessment of complicated grief. This tool will be used across VCUMC to consolidate and coordinate information on bereavement follow up. The new tool, which is evidence based, was developed in compliance with the new Joint Commission regulations for Palliative Care and in conjunction with the palliative care team’s psychologist and MSW. Over 75 VCUMC staff from different units and clinical specialties will be trained and use this tool, including all chaplain interns and residents.

    Chaplains Nancy Hauser and Sheryl Johnson developed and are implementing an electronic system to consolidate and track information on potential organ donation cases at VCUMC. Nancy is the interim Family Communication Coordinator team leader for potential organ donation cases. Sheryl originally used REDcap last year while completing a residency research project.

  • Palliative care chaplain Tim Ford was a co-author of "Organ donation support after cardiac death from withdrawal of life support in patients with amyotrophic lateral sclerosis," (Smith, et al., 2011) which appeared recently in the Journal of Palliative Medicine. The article reports on case studies at an academic medical center of two men with progressive ALS who underwent withdrawal of artificial life support, rapid cardiac death, and subsequent organ donation.

  • Dr. Diane Dodd-McCue served as a co-author of "Disrupted by disaster: the shared experiences of student CRNAs during Hurricane Katrina," which recently appeared in the Journal of Psychosocial Nursing. The study used mixed methods including focus groups, interviews, and test scores. Other co-authors include Drs. Marjorie Geisz-Everson, Marsha Bennett, and Chuck Biddle.
[For the previous report from the VCU Center, see our Winter 2011 Newsletter, §4.]

 

6.     Ministry Specialty Projects at St. Luke's Hospital, Bethlehem, PA " --report by Sally L. Campbell

For several years at St. Luke’s Hospital (Bethlehem, PA), a level-1 trauma center and community teaching hospital, CPE residents had been asked to work on Ministry Specialty Projects (MSPs) which exposed them to the literature in their chosen clinical area and invited them to create "something to leave behind" for those coming after them regarding innovative pastoral care practice. Residents prepared a paper and then presented it during the 3rd unit to share the results of their reading, interventions in clinical practice, evaluations of their learnings, and recommendations for ongoing work. However, results were uneven in terms of what was learned and how it was presented.

So, since 2010, residents have instead been asked to present their MSP once in February to their peers, supervisors, and staff chaplains, and then again in July to the same group plus invited others: associate chaplains, members of the department advisory group, and other staff who have been mentors or otherwise supportive. In the first session, students share their literature review and plans for designing, implementing, and evaluating clinical intervention(s). Based on the feedback received, they then modified their approach, read additional material, and consult with others, before presenting their completed project. Students have reported more investment in the MSP, more competence in critically reading pastoral care and other research, and the development of more usable material at the conclusion of their work.

As their CPE Supervisor, I have benefited from presentations at ACPE conferences and conversations with members of the Research Network, and I am working with students on how to read literature critically and how to choose an appropriate project. Next steps for our program include the possibility of a multi-year project for residents who stay for a second year and/or staff and students working together on a department performance improvement project.   --SLC

 

7.     Steve Nolan's Spiritual Care at the End of Life: The Chaplain as a "Hopeful Presence"

Last year our Network featured a research article by Chaplain Steve Nolan, PhD (Princess Alice Hospice, Esher, UK): "Hope beyond (redundant) hope: how chaplains work with dying patients" (--see the February 2011 Article-of-the-Month), in which data from interviews with 19 chaplains helped him build a theory of the "chaplain as hopeful presence" for dying patients. Now, Dr. Nolan has developed his work into an engaging book that gives not only a fuller picture of his theory but its roots and application in the practical world of chaplaincy. Spiritual Care at the End of Life: The Chaplain as a "Hopeful Presence" (London and Philadelphia: Jessica Kingsley Publishers, 2012)...

...explores the nature of hope in its different forms at different stages of terminal illness, and asks how chaplains can help dying people to be hopeful even when facing the inevitability of their death. The book identifies key moments in this relationship, from the person’s initial reaction to the chaplain, to the chaplain becoming an accompanying presence and creating the potential to provide comfort, strength and "hope in the present" [--from a description by the publisher]
Filled with case examples, this volume is an evocative and thought-provoking read, suitable for CPE students as well as experienced chaplains, and while the target audience is principally British, an American chaplain should be able to relate to it well.

An appendix details Nolan's qualitative research. His bibliography contains 122 references, and the index is helpfully divided into both subject and author listings. Availability in the US is through Jessica Kingsley Publishers and major book outlets (for example, Amazon).

 

8.     HealthCare Chaplaincy to Award Grants for Growing the Field of Chaplaincy Research in Palliative Care

HealthCare Chaplaincy (New York) will in May 2012 award 6-10 grants ranging up to $250,000 for Growing the Field of Chaplaincy Research in Palliative Care, made possible by the John Templeton Foundation. Projects will develop and explore hypotheses about chaplains’ contributions to palliative care and will support aspiring chaplain-researchers. The call for proposals encouraged studies that would team experienced health, behavioral and social scientists with chaplains to increase their research skills by becoming active participants in the research enterprise. More information is available at www.healthcarechaplaincy.org/templeton-research-project.html.

 

9.     "Pastoral Care in Hospitals," A Literature Review from Italian Researchers

Researchers from the Pastoral Care Unit of the IRCCS [Istituto Di Ricovero e Cura a Carattere Scientifico] Foundation National Cancer Institute of Milan and the Psychology Section of the Department of Biomolecular Sciences and Biotechnology at the University School of Medicine, Milan, have published, "Pastoral care in hospitals: a literature review," in the Italian journal Tumori [97 (2011): 666-671]. Tullio Proserpio, Claudia Piccinelli and Carlo Alfredo Clerici state at the outset:

Humanizing the medical care afforded by the most advanced public health services implicates integrating the biological, psychological and social aspects of the patient's needs, which also includes the patient’s spiritual and/or religious inclinations and background. Emerging phenomena, such as the increasingly multicultural nature of modern society and the need to base patient care practices on scientific evidence, make it necessary to seek a better understanding of the potential contribution of spiritual care in the hospital setting, particularly in departments and institutions where severe diseases are treated. [p. 666]
They analyzed 98 articles from the health care literature pertaining to "modern hospital chaplains" and conclude:
Improvements are needed on several fronts to professionalize the pastoral care provided in hospitals and modernize the figure of the hospital chaplain. These improvements include better relations between modern chaplains and the hospital organization and scientific world; more focus on a scientific approach to their activities and on evaluating the efficacy of pastoral care activities; greater clarity in the definition of the goals, methods and procedures; the design of protocols and a stance on important ethical issues; respect for the various faiths, different cultures and both religious and nonreligious or secularized customs; greater involvement in the multidisciplinary patient care teams, of which the hospital chaplains are an integral part; stronger integration with public health operators and cooperation with the psychosocial professions; specific training on pastoral care and professional certification of chaplains; and the development of shared ethical codes for the profession. [p. 666, abstract]
While their target audience is Italian, their literature survey draws heavily on US sources. The review provides both an international perspective on chaplaincy and a confirmation of the commonality of many issues in professional chaplaincy across national contexts. The article is available from the journal website.

 

10.   Another International Review of Spirituality Instruments

Our Fall 2011 Newsletter noted four major reviews of spirituality measures [--see vol. 10, no. 1, §6]. To these might added a fifth recent article: Gijsberts, M. J., Echteld. M, A., van der Steen, J. T., Muller, M. T., Otten, R. H., Ribbe, M. W. and Deliens, L., "Spirituality at the end of life: conceptualization of measurable aspects--a systematic review," Journal of Palliative Medicine 14, no. 7 (2011): 852-863; by researchers from the Netherlands and Belgium. From 24 identified spirituality & health instruments, they used 9 to discern measurable aspects of spirituality at the end of life.

Three instruments measured spirituality: the Spiritual Needs Inventory (SNI), the JAREL Spiritual Well-being Scale, and "Are you at peace?" whereas 6 instruments measured quality of life, with a subset of items on spirituality: the Quality of Life at the End of Life Measure (QUAL-E), the Hospice Quality of Life Index, the Missoula Vitas Quality of Life Index, the McGill Quality of Life Questionnaire, the Good Death Inventory, and the Needs Assessment for Advanced Cancer Patients (NA-ACP).
In light of all the instruments, the authors propose a model of spirituality consisting of three interrelated dimensions: Spiritual Well-being (e.g., peace), Spiritual Cognitive Behavioral Context (Spiritual Beliefs, Spiritual Activities, and Spiritual Relationships), and Spiritual Coping. That model itself is worth consideration, but the overall analysis, especially as it is summarized in two tables [pp. 855-856 and 858] may be useful to researchers searching for appropriate instruments. The total list of 24 instruments is as follows:
  • Spiritual Needs Inventory (SNI)
  • JAREL Spiritual Well-being Scale
  • "Are you at peace?"
  • Quality of Life at the End of Life Measure (QUAL-E)
  • Hospice Quality of Life Index (HQLI)
  • Missoula Vitas Quality of Life Index (MVQOLI)
  • McGill Quality of Life Questionnaire (MQOL)
  • Good Death Inventory
  • Needs Assessment for Advanced Cancer Patients (NA-ACP)
  • Spiritual Well-being Scale (SWBS)
  • Spiritual Transcendence Measure (STM)
  • The Functional Assessment of Chronic Illness
  • Therapy-Spiritual Well-being Scale (FACIT-Sp)
  • Skalen zur Erfassung von Lebensqualitat bei Tumorkranken, modified version (SELT-M)
  • Royal Free Interview
  • Spiritual Involvement and Beliefs Scale (SIBS)
  • Fetzer Institute, subscale Brief RCOPE
  • Fetzer Institute, subscale Daily Spiritual Experience Scale
  • Fetzer Institute, subscale Forgiveness, short version
  • Fetzer Institute, subscale Religious Meaning, short version
  • Spiritual Perspective Scale Spiritual Well-being Questionnaire
  • Spiritual Assessment Tool FICA
  • Palliative Care Outcome Scale (POS)
  • The Patient Dignity Inventory (PDI)
Sources for the measures are identified in a bibliography of 67 references.

 

11.   Islamic Approaches to Patient Care, by Ra'ufa Sherry Tuell

Pastoral care issues regarding Muslim patients is a rich topic, and our Network has featured research in the area (most recently in the March 2011 Article-of-the-Month). While Ra'ufa Sherry Tuell's book, Islamic Approaches to Patient Care: Muslim Beliefs and Healthcare Practices for Caregivers (Batesville, MD: Amana Publications, 2011) is not a report of research, it is insightful reading for any chaplain researcher --or any provider looking to improve clinical care. The author holds a Masters in Islamic Studies and Christian-Muslim Relations, a Graduate Certificate in Islamic Chaplaincy, and she is a CPE graduate of the centers at St. Luke’s Hospital, Kansas City, MO, and St. Francis Hospital, Hartford, CT. Her book carries an endorsement/blurb from ACPE Supervisor John Swift: "The book is filled with practical advice about what to do and what not to do. It provides insight to the bioethical issues unique to Muslim patients." She was encouraged to bring her work specifically to the attention of our Network by ACPE Supervisor Marc Giedinghagen (St. Luke’s, Kansas City).

Topics covered include: abortion, autopsy, female and male circumcision, death and dying, euthanasia, suicide and assisted suicide, fertility regulation, infertility treatment, organ transplantation, and stem cell research. Ten appendices give guidelines regarding burial preparation, welcoming a newborn, and a collection of prayers and expressions, resources, and a glossary of terms [--summary adapted from the book's abstract]. Availability in the US is through Amana Publications and Amazon.

 

12.   Theme Issue of the Journal of Behavioral Medicine

The Journal of Behavioral Medicine published in December 2011 a special theme issue on Spirituality in Behavioral Medicine Research, and a listing of the articles (with abstracts) can be found on our December 2011 Article-of-the-Month page (--see on that page, Related Items of Interest, III) as well as from the journal website. Of special note, however, is the editorial introduction to the issue by David H. Rosmarin, Amy Wachholtz, Amy Ai, in which they offer a concise summary of the state of research in the field.

...[M]ost empirical studies have [up until now] described simple associations between spirituality and health and provided little explanation for how and why these domains may be functionally connected. Further, significant methodological and statistical limitations have plagued this area of study, including, but not limited to, failure to control for salient covariates and multiple comparisons.... Measurement and definition of spiritual variables are also concerns, with many studies utilizing crude, single-item indices of global religious involvement (e.g., How often do you attend church or religious services?), which do not assess for specific aspects or positive and negative dimensions of spirituality.... Consequently, findings have been inconsistent, and functional relationships between spirituality and health, including directions and mechanisms of effect, remain largely unclear.

However, this field of study is now moving beyond its ubiquitous descriptive research designs to inform a nuanced, evidence-based perspective on the relevance of spirituality to health. Advances have included the utilization of experimental methodologies..., longitudinal studies in clinical populations involving biomarkers of illness..., the advent and utilization of psychometrically sound and clinically-relevant measures of spirituality and religion..., theoretical frameworks to explain links between spirituality and health..., and randomized controlled trials of spiritually-integrated psychosocial treatments.... This growing body of research is slowly unraveling the complexity of relationships between physical health and spiritual/religious variables across cognitive, behavioral, affective and interpersonal dimensions.

Methodological advancement in this area of study is long overdue given the importance of spirituality to the general population. In the United States.... ...Is it not incumbent upon the scientific community--regardless of the religious persuasions of its constituents--to study this area of human life in a responsible and methodologically rigorous manner? [pp. 409-410]
A comment: For chaplains, these statements generally reinforce the need for methodological rigor in our own studies, but included here is one particularly important point: namely, that future research should pursue a perspective that is nuanced as well as evidence-based. Since the discipline of chaplaincy tends to focus on the nuances of patient care situations, we might hear in the words of Rosmarin, Wachholtz and Ai an invitation especially to help bring greater nuance to research, to help develop methodology that is sensitive to the rich interplay of spirituality and health that we know in the lives of our patients.   --JE

 

 


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