Providing Pastoral Care Services in a Clinical Setting to Veterans At-Risk of Suicide

The value of enhanced spiritual wellbeing has largely been overlooked as part of suicide prevention efforts in Veterans. The aim of this qualitative study is to examine the clinical pastoral care services provided by VA Chaplains to Veterans at-risk of suicide. This study was conducted using in-depth interviews with five Chaplains affiliated with a medical center located in upstate New York. This study was able to show that some at-risk individuals do actively seek out pastoral care, demonstrating a demand for such services. In conclusion, a pastoral care framework may already exist in some clinical settings, giving at-risk Veterans the opportunity to access spiritual care.     

Issues in Publicly Subsidized Long Term Care Systems and Implications for the Religous Sector

Given the increasing numbers of elderly in need of long term care services and the harsh reality of finite resources, new models are required which define those elderly persons who should remain eligible for publicly subsidized long term care. If, in fact, a method is established for serving only a limited number of older persons, i.e., the truly vulnerable elderly, by way of the public system of long term care, a large constituency of older Americans will be left to exist on the margins. The church as an informal care system may appropriately assume the role of ensuring that the available public funds are used wisely and that service gaps inevitably left bewteen the increasing number of older persons and shrinking public support are bridged. In addition, the church must assist in improving all long term services by contributing to public policy formation.     

Models for Ministry: The Spiritual Needs of the Frail Elderly Living in Long-Term Care Facilities

ABSTRACT

Litte information has been available pertaining to the spirituality of the institutionalized elderly. This paper presents the self-perceived spiritual needs of the elderly living in long-term-care facilities. Additional information is presented indicating the clergy's perceptions of these needs.

Semi-structured interviews were conducted with resident council members from three nursing homes in western North Carolina. The following three domains of spirituality were covered: (1) relationship to God; (2) relationship to church; and (3) relationship to community. Semi-structured interviews were also conducted with these residents' pastors and other clergy members who minister in these three facilities. Data collected from these interviews indicates a variation between the residents' self-perceived spiritual needs and the clergy's perceptions of these needs.

Data analyses suggested a three-step process of the resident's spiritual journey in the nursing home. This process provided a model describing the spiritual journey of the nursing home resident.     

Representing the Good: Pastoral Care in a Secular Age

In ‘a secular age’ (Taylor 2007), pastoral care is no longer exclusively associated with specific religious traditions and communities. Pastoral caregivers who work in secular institutions provide care to religious and nonreligious people alike, and in several Western societies the term pastoral care is used in relation to nonreligious (humanist) care. In secular contexts, the term ‘pastoral care’ is often replaced by the term ‘spiritual care.’ Spiritual care, however, is provided by various professionals, so pastoral caregivers face the challenge of developing adequate and convincing language to explain what is distinctive about their work. In this article, the authors turn to philosophical language in order to develop a conceptual understanding of pastoral care that does not depend on the specific worldview—religious or nonreligious—of either pastoral caregivers or receivers of pastoral care. Using the work of Taylor (1989, 2007) and Murdoch (1970), we explain pastoral care as engaging with people’s attempts to orient in ‘moral space’ and the distinctive quality of pastoral care as ‘representing the Good.’ Murdoch associates ‘the Good’ with a secular idea of transcendence that is both a movement beyond the ego and an engagement with the reality of human vulnerability, suffering, and evil. We argue that pastoral caregivers who ‘represent the Good’ have the task not only of supporting the existential and spiritual processes of individuals but also of promoting dialogue and social justice and of critiquing dehumanizing practices in the organizations in which they work and in society at large.     

Pastoral Care for the Sick in a Post-Secular Age: An Ignatian Perspective

This pastoral-theology-based reflection on hospital chaplaincy,set within the horizon of the pastoral situation of Germanyin the post-secular (!) age, introduces the perspective of aconsolation-oriented ministry, as this was developed by Ignatiusof Loyola. Such a pastoral care for the sick, as integratedinto the basic offices of the church, presents a gradedmodelfor action: while human accompaniment is offered to all, spiritualministry is restricted, but realized in an ecumenically encompassingsense. Spiritual and ritual care for members of other religions,while these members are to be addressed according to the principleslaid down by Vatican II, is severely limited for reasons ofidentity and alterity. In all cases, however, Christianity ispresented as "therapeutic religion".     

Intimate Violence Against Women: Trajectories for Pastoral Care in a New Millennium

This article reviews progress made in the theory and practice of pastoral care and counseling with regard to the issue of intimate violence against women since the 1970’s. It includes a comprehensive survey of sociological, psychological, and pastoral literature, and a summary of research on teaching about domestic violence in mainline Protestant seminaries. Social and theological themes, including gender, power, and social and political context, and the challenges of justice-making are traced historically. The article concludes with new recommendations for churches, pastoral caregivers, counselors, and theologians.     

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.     

Sexual Abuse and the Christian Congregation: The Role of Gender in Pastoral Care for Victims

This study investigated the role of gender in the care for victims of sexual abuse within three Swedish Christian denominations. Questionnaires anchored by vignettes illustrating different abuse situations were answered by 421 clerics. The main findings were that female respondents apprehended the described situations as more likely to occur than male respondents did, and that levels of preparedness to offer pastoral care and belief in the likelihood of the situations to occur were higher when a female was the victim or a male was the perpetrator. Denominational differences were found concerning level of personal discomfort when hearing about the abuse.     

Treatment for Youth in Short-Term Care Facilities: The Impact of a Comprehensive Behavior Management Intervention

We describe a comprehensive program to train emergency shelter staff in effective methods for dealing with youth who have behavioral and emotional problems; assess the degree to which staff implemented the treatment approach; measure the impact of the intervention on shelter-wide incidents such as out-of-control behavior, runaways, and violence against other youth; and examine pre-post changes in staff experiences at the shelter via anonymous surveys. Overall, the short-term shelter staff indicated adequate implementation of the intervention. The rate of youth incidents at the shelter significantly declined from pre to post assessment. Direct-care staff ratings of their satisfaction with their proficiency in behavior management and teaching youth skills increased significantly from pre to post implementation. These findings suggest that it is feasible to deliver an effective staff-training program to improve the behavior management and social skills of youth residing in short-term care facilities within the child welfare system.     

Effects of the Interaction Between Reaction Component of Personal Need for Structure and Role Perceptions on Employee Attitudes in Long‐Term Care for Elderly People1

This study examined the interaction of reaction component of personal need for structure (reaction to lack of structure, RLS) and role perceptions in predicting job satisfaction, job involvement, affective commitment, and occupational identity among employees working in long‐term care for elderly people. High‐RLS employees experienced more role conflict, had less job satisfaction, and experienced lower levels of occupational identity than did low‐RLS employees. We found individual differences in how problems in roles affected employees' job attitudes. High‐RLS employees experienced lower levels of job satisfaction, job involvement, and affective commitment, irrespective of role‐conflict levels. Low‐RLS employees experienced detrimental job attitudes only if role‐conflict levels were high. Our results suggest that high‐RLS people benefit less from low levels of experienced role conflicts.     

老年社会护理机器人“欺骗”问题的伦理审视

老年社会护理机器人其拟人化特征涉及的欺骗性问题始终存在争议。批评者坚持认为机器的拟人化所带来的一切都是假象从而不断质疑护理机器人的欺骗属性,辩护者认为拟人化特征是促进人机融合的必备要素但却未提供有力的合理性证明。聚焦人机多个主体的协调融合,揭露背后欺骗即是背叛,进而为护理机器人不会也不应该存在欺骗补充了有力的证据,并从完善用户知情同意、加强用户自主权、制造商承担举证责任等方面提出防范“欺骗”风险的路径,为辩护的开展提供新的研究视角和可行出路。

     

The Validity of a Brief Risk Assessment Tool for Predicting Suicidal Behavior in Veterans Utilizing VHA Mental Health Care

Suicide risk among military veterans is an important and ongoing concern. The Veterans Administration (VA) mandates suicide risk screening of all veterans seen for mental health issues, but little is known about the effectiveness of this screening. A retrospective chart review to examine all suicide risk screens at VA San Diego between October and December 2012 (n = 3,365) was conducted to assess whether results were associated with suicidal behavior over the subsequent 12 months. Patients judged to be at increased risk for suicide were 3 to 16 times more likely to attempt suicide and 7 to 25 times more likely to engage in self‐directed violence over the next 12 months compared with others. The screening tool may be a useful addition to clinical practice.     

Evaluation of the Effectiveness and Transportability of Panic Control Treatment in a Private Practice Setting: Acute and Long Term Effects

Effectiveness studies have demonstrated the transportability of panic control treatment (PCT) to a variety of settings. The present study examined the acute and long-term effects of PCT in a private practice setting and explored correlates of treatment outcome. Participants (69% female, mean age = 34.8, SD = 8.8 years) were 100 consecutive private practice referrals who entered treatment for panic disorder. Using intent-to-treat analyses, 72% of patients were panic-free and 44% of patients achieved high end state functioning (HESF) at posttreatment. At 1-year follow-up, 75% of patients were panic-free and 55% of patients achieved HESF. Lower levels of agoraphobic avoidance when accompanied (MI-ACM), less misinterpretation of bodily sensations, and less frequent panic attacks at pretreatment were the strongest predictors of treatment outcome at follow-up. Pre-posttreatment changes in trait anxiety were most strongly associated with treatment response. Results support PCT as an effective, durable treatment and add to the body of evidence supporting the generalizability of PCT from research to real-world service settings.     

Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

Internet-Based Therapy for Mild to Moderate Depression in Swedish Primary Care: Short Term Results from the PRIM-NET Randomized Controlled Trial

Depression presents a serious condition for the individual and a major challenge to health care and society. Internet-based cognitive behavior therapy (ICBT) is a treatment option supported in several trials, but there is as yet a lack of effective studies of ICBT in “real world” primary care settings. We examined whether ICBT differed from treatment-as-usual (TAU) in reducing depressive symptoms after 3 months. TAU comprised of visits to general practitioner, registered nurse, antidepressant drugs, waiting list for, or psychotherapy, or combinations of these alternatives. Patients, aged ≥ 18 years, who tentatively met criteria for mild to moderate depression at 16 primary care centers in the south-western region of Sweden were recruited and then assessed in a diagnostic interview. A total of 90 patients were randomized to either TAU or ICBT. The ICBT treatment included interactive elements online, a workbook, a CD with mindfulness and acceptance exercises, and minimal therapist contact. The treatment period lasted for 12 weeks after which both groups were assessed. The main outcome measure was Beck Depression Inventory-II (BDI-II). Additional measures were Montgomery Åsberg Depression Rating Scale – self rating version (MADRS-S) and Beck Anxiety Inventory (BAI). The analyses revealed no significant difference between the two groups at post treatment, neither on BDI-II, MADRS-S, nor BAI. Twenty patients (56%) in the ICBT treatment completed all seven modules. Our findings suggest that ICBT may be successfully delivered in primary care and that the effectiveness, after 3 months, is at par with TAU.