Providing Pastoral Care for the Elderly in Long Term Care Facilities Without a Chaplain Utilizing Coordinated Congregational Resources

Elderly persons living in long term care facilities are often separated from or have no pastoral care sources. Spiritual care by chaplains was not available in any of the six nursing homes in Wausau, Wisconsin. Twelve Lutheran congregations in the area worked out a plan to provide the necessary pastoral care. The congregations formed a coordinating agency, Greater Wausau Christian Services, Inc. Through the services of one staff person, the director, who enlisted the lay and pastoral resources of the participating congregations, pastoral care was provided. Worship led by the pastors, meaningful visits made by trained and supervised lay people, and the availability of a trained chaplain became a reality for nearly seven hundred residents in the six long term care facilities.     

A Survey of Recent Scholarship on the New Testament and Aging and Suggestions for Future Research

ABSTRACT

This article has a double agenda. In the first section, it identifies and selectively surveys nine areas that have figured prominently in recent scholarship on aging and the elderly in the New Testament. In the second section, it identifies areas for future research. Particularly emphasized is the challenge of exploring the relationship between the New Testament material and the Greco-Roman world. In order to do this, it is necessary to identify attitudes, roles, and practices that surround aging and the elderly in that cultural context. Some resources and questions that may serve as starting points for further research are indicated.     

Being Forgotten: Implications for the Experience of Meaning in Life

ABSTRACT

Two studies investigated the effects of being forgotten on the target of memory. In Study 1, undergraduate women (N = 96) who had completed a lab session two days prior, were randomly assigned to be remembered, forgotten, complimented, or to a control group. In the absence of effects on mood or social self-esteem, being forgotten resulted in lower meaning in life. In Study 2, participants (N = 47) who had completed a group exercise were informed two days later that no one remembered them, that everyone remembered them, or that no one wanted to work with them. Being forgotten led to lower meaning in life than being remembered but did not differ from being excluded. Being forgotten may be considered a type of incipient ostracism that influences meaning in life but not mood or state social self-esteem.     

Job Opportunities/Issues for Health Care Psychologists: The Coming of the Millennium

Job opportunities for psychology for the next decade are being influenced by ongoing shifts in our economic system and resultant general employment practices. As with many burgeoning fields, psychology is experiencing increasing diversification into subspecialities. Professionals in other fields are acquiring supplementary degrees in psychology to heighten their psychological knowledge and professional/organization skills. Thus, psychology is beginning to be viewed, like the MBA, as an important professional degree for many fields, not just mental health or teaching. Training programs are reflecting these diversification trends. Further, as professional applications at the doctoral level expand, there is increasing need for the master's-level technical competence to support the increasing specialities at the doctoral level. These changes represent the creative response of a young and vigorous profession to the challenges of changing market dynamics.     

Agentic and Communal Generative Behavior in Four Areas of Adult Life: Implications for Psychological Well-Being

Fifty mothers and 48 fathers of soon-to-be-independent children were interviewed to determine how agentic and communal generative themes would be reflected in parenting, occupation, volunteer work, and leisure activities. Mothers reported more communal themes (F5, 83 = 2.32, p <.05). Correlations between generativity and well-being resulted in a negative relationship for mothers in parenting communal generative acts (r = –.41, p = .007) and total generative acts (r = –.3, p = .05) as assessed by the interview. Negative correlations also emerged between mothers' well-being and communal generative acts from the Generative Behavior Checklist, (r = –.33, p = .02).     

Issues in Pastoral Care and Counseling for the Fourth Quarter of Life

Issues and risks for pastoral care and counseling from the perspective of old age (here, ages 75 to 100) include identification of old age as a problem and its association with death in a death-denying culture. Two elements are fundamental: existential experiential deficits between the old and their younger caregivers (e.g., age cohort experiences, health status, gender, culture, privilege, etc.); and boundary issues that push the old, and pastoral care, to the edge of experience, where choices must be made between creativity and negativity (e.g., moving to dependent living, disability, etc.). Loss of doing (versus being) as a viable option is a major edge experience. The resulting sense of emptiness carries with it the potential for a sacramental awareness in which absence of doing becomes an outward and visible sign of an inward and spiritual grace.     

Technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.     

A Systems Perspective on the Introduction of Narrative Practice in Human Services Organizations in the Era of Managed Care

General System Theory is used to examine the structure and activity of human services organizations for conditions which support the introduction of selected narrative ideas in a systemic approach to mental health services. The inquiry includes examination of the influence of larger systems (such as managed care companies and regulatory bodies) on such introduction.     

The Nature and Meaning of the Near-Death Experience for Patients and Critical Care Nurses

This study was designed to develop a conceptual framework for the near-death experience (NDE), reflecting its nature and meaning for the patient and the critical care nurse. The study used naturalistic inquiry to examine the question: What is the nature and meaning of an NDE and how has it influenced the individual's view of the self, the future, and feelings and beliefs about life and death? The NDE Scale (Greyson, 1983) was used with patients and semi-structured interview guides were used with both nurses and patients to explore the NDE from a comprehensive perspective. An NDE was defined as the report of “unusual” recollections associated with a period of unconsciousness during either serious illness or injury, or resuscitation from a cardiac or respiratory arrest. The sample included 12 patients who experienced an NDE and 19 nurses who cared for patients who experienced NDEs. This study highlighted the emotional aspects of the NDE. Patients described how the NDE transformed their lives and nurses reported how their experiences with patients changed them personally and professionally.     

Reprint of: technology and the evolution of clinical methods for stuttering

The World Wide Web (WWW) was 20 years old last year. Enormous amounts of information about stuttering are now available to anyone who can access the Internet. Compared to 20 years ago, people who stutter and their families can now make more informed choices about speech-language interventions, from a distance. Blogs and chat rooms provide opportunities for people who stutter to share their experiences from a distance and to support one another. New technologies are also being adopted into speech-language pathology practice and service delivery. Telehealth is an exciting development as it means that treatment can now be made available to many rural and remotely located people who previously did not have access to it. Possible future technological developments for speech-language pathology practice include Internet based treatments and the use of Virtual Reality. Having speech and CBT treatments for stuttering available on the Internet would greatly increase their accessibility. Second Life also has exciting possibilities for people who stutter.Educational objectives: The reader will (1) explain how people who stutter and their families can get information about stuttering from the World Wide Web, (2) discuss how new technologies have been applied in speech-language pathology practice, and (3) summarize the principles and practice of telehealth delivery of services for people who stutter and their families.     

Ontologies and Worlds in Category Theory: Implications for Neural Systems

We propose category theory, the mathematical theory of structure, as a vehicle for defining ontologies in an unambiguous language with analytical and constructive features. Specifically, we apply categorical logic and model theory, based upon viewing an ontology as a sub-category of a category of theories expressed in a formal logic. In addition to providing mathematical rigor, this approach has several advantages. It allows the incremental analysis of ontologies by basing them in an interconnected hierarchy of theories, with an operation on the hierarchy that expresses the formation of complex theories from simple theories that express first principles. Another operation forms abstractions expressing the shared concepts in an array of theories. The use of categorical model theory makes possible the incremental analysis of possible worlds, or instances, for the theories, and the mapping of instances of a theory to instances of its more abstract parts. We describe the theoretical approach by applying it to the semantics of neural networks.     

Spirituality and Subjective Well-Being: Evidences for a New Domain in the Personal Well-Being Index

Subjective well-being explores the evaluations, both positive and negative, of how people experience their lives. Research in the field inquires how people perceive their well-being in different settings, including different cultures, regions and cities. A large number of different measures have been designed to capture subjective well-being. One of the most used SWB measure is the Personal Well-being Index (PWI), an evaluation of life developed by Cummins et al [(2003). Social Indicators Research, 64, 159–190] which proposes that satisfaction with life consists of seven different life-domains. Theoretical considerations of the contribution of spirituality and religiosity to life satisfaction, from a eudaimonic (from the Greek, it consists of the word "eu" (good or well-being) and the word “daemon” (spirit)) point of view, led to test the contribution of this new domain in the prediction of the Personal Well-being Index (PWI) in Bogotá, Colombia. Empirical results confirm the construct validity and reliability of the scale. The contribution of the new domain—satisfaction with spirituality and religiosity—to PWI was found significant. Based on these results the paper explores conceptually the role of spirituality contributing to satisfaction with life. The finding stresses the importance of interpreting satisfaction with life as a whole from the Aristotelian concept of eudaimonia. New questions for research in this important area are proposed     

Exercise Stage of Change and Self-Efficacy in Primary Care: Implications for Intervention

Multiple chronic diseases are caused or complicated by a sedentary lifestyle. Thus, an important and challenging application of psychology in clinical settings is changing the behavior of sedentary primary care patients. This study focused on exercise stage of change and self-efficacy in a sample of adult family practice patients recruited while waiting for their scheduled physician appointment. Regarding exercise stage of change, 15% of respondents were in the Precontemplation stage, 26% in the Contemplation stage, 50% in the Preparation stage, 7% in the Action stage, and 13% in the Maintenance stage. Mean self-efficacy scores for exercise were significantly higher among respondents in the Action and Maintenance stages of change. These cross-sectional data are consistent with the hypothesis that movement through the exercise stages of change could be encouraged by clinical interventions that increase exercise self-efficacy. The identification of multiple personal opportunities for increasing exercise self-efficacy may be clinically useful in this context. Recommendations for psychologists in primary care settings in their work with physicians are offered.     

Juggling Parent Care and Employment Responsibilities: The Dilemmas of Adult Daughter Caregivers in the Workforce

We review findings from our programmatic research on adult daughters who are simultaneously involved in the roles of employee and care provider to an impaired parent. Two opposing theoretical perspectives on the health effects of occupying these two roles are described, and empirical findings that bear on each perspective are presented. Our review reveals that, consistent with the competing demands perspective, parent care and employment often conflict with one another. Consistent with the energy expansion perspective, however, there is evidence that holding these two roles can be beneficial for the health of adult daughters.     

The Importance of Religious Orientation and Purpose in Life for Dying Well: Evidence from Three Case Studies

ABSTRACT

As older adults approach the end of their lives, it is not uncommon to find a decrease in subjective well-being. However, a number of studies have indicated that elders with an intrinsic rather than extrinsic religious orientation often are able to keep a high level of subjective well-being even if they are close to death. In a previous quantitative study, only intrinsic religiosity was indirectly and positively related to subjective well-being in a sample of 103 relatively healthy older adults and 19 hospice patients (aged 61 +), mediated by shared spiritual activities and purpose in life. Extrinsic religiosity, by contrast, was indirectly and negatively related to subjective well-being. To explore in greater depth how religious orientation might influence subjective well-being at the end of life, we used the method of objective hermeneutics to examine semi-structured qualitative interviews with three older male hospice patients (aged 79, 80, and 98) on religion/spirituality and attitudes about death and dying. Results of the analyses revealed that the intrinsically religious respondent maintained his sense of cosmic purpose in life, which continued to be a source of satisfaction for him, unaffected by his terminal illness. The two extrinsically religious respondents, however, did not find solace in their religion and, hence, were unable to cope with their physical and emotional dependence and vulnerability. The findings suggest that an intrinsic religious orientation is most likely to be related to a cosmic sense of purpose in life, which facilitates subjective well-being even in the face of death.     

台湾地区姑息医学制度的建立及法律实践

姑息治疗在提高晚期癌症患者生活质量、实施临终关怀、给予病人及其家属全面周到的照顾诸方面起着重要作用。在台湾,已为姑息治疗立法并实施了10年,积累了丰富的经验。这项法律本身及其细则、附件等配套文件使姑息治疗更加规范可行。研究规范的姑息治疗及台湾的相关法律可以帮助我们更好的理解姑息治疗的理念,帮助发展大陆同道构建有效实用的...     

Building a Better WarBot: Ethical Issues in the Design of Unmanned Systems for Military Applications

Unmanned systems in military applications will often play a role in determining the success or failure of combat missions and thus in determining who lives and dies in times of war. Designers of UMS must therefore consider ethical, as well as operational, requirements and limits when developing UMS. I group the ethical issues involved in UMS design under two broad headings, Building Safe Systems and Designing for the Law of Armed Conflict, and identify and discuss a number of issues under each of these headings. As well as identifying issues, I offer some analysis of their implications and how they might be addressed.

Effectiveness of an empirically supported treatment for social phobia in the field

This study examined the effectiveness of individual exposure combined with cognitive restructuring for social phobia in a clinical setting as well as the influence of sample restriction criteria on the effect size. Participants were 217 unselected patients with a primary diagnosis of social phobia who were treated by 57 therapists in four outpatient clinics of the Christoph-Dornier-Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy showed highly significant reductions in social phobic fears and avoidance as well as in general anxiety and symptoms of depression. However, patients who dropped out during therapy reported a significantly higher degree of depression. Results did not differ between the four outpatient clinics and are comparable with the average effect-sizes reported by meta-analytic studies of controlled efficacy research, using selected patients. Also, restricting the sample according to the selection criteria often applied in research settings did not result in higher effect sizes for the applied outcome measures. We conclude that individual cognitive behavioural therapy for social phobia can be transported from research settings to the field of mental health.     

Cognitive-behaviour therapy for chronic fatigue syndrome: comparison of outcomes within and outside the confines of a randomised controlled trial

Outcomes for cognitive-behaviour therapy (CBT) in randomised controlled trials (RCTs) have rarely been compared to those in routine clinical practice. Taking the case of CBT for chronic fatigue syndrome (CFS), we evaluated the results of a successful RCT against those of the same treatment given in the same setting as part of routine practice. Fatigue and social adjustment scores were compared for patients who received CBT for CFS as part of a RCT (N=30) and patients who received CBT as part of everyday clinical practice (N=384). The results in the RCT were superior to those in routine clinical practice. Between pre-treatment and 6-month follow-up, the RCT showed a larger reduction in fatigue and greater improvement in social adjustment than those in routine treatment. The changes in fatigue scores were similar for both groups during treatment but were greater in the RCT between post-treatment and follow-up. Potential reasons for the superior results of the RCT include patient selection, therapist factors and the use of a manualised treatment protocol. Practitioners need to pay particular attention to relapse prevention and ensuring adequate follow-up in addition to encouraging patients to continue with cognitive-behavioural strategies once treatment has ended.