Organ Procurement and Health Care Chaplaincy in Australia

As part of an Australian national project, quantitative data via a survey were retrospectively obtained from 327 Australian health care chaplains (staff and volunteer chaplains) to initially identify chaplaincy participation in various bioethical issues—including organ procurement. Over a third of surveyed staff chaplains (38%) and almost a fifth of volunteer chaplains (19.2%) indicted that they had, in some way, been involved in organ procurement issues with patients and/or their families. Nearly one-fifth of staff chaplains (19%) and 12% of volunteer chaplains had also assisted clinical staff concerning various organ procurement issues. One hundred of the surveyed chaplains volunteered to an interview. Qualitative data were subsequently coded from 42 of the chaplains who had been involved in organ procurement requests. These data were thematically coded using the World Health Organization ‘Pastoral Intervention Codings’ (WHO-PICs). The qualitative data revealed that through a variety of pastoral interventions a number of chaplains (the majority being staff chaplains) were engaged in the critical and sensitive issues of organ procurement. It is argued that while such involvement can help to ensure a holistic and ethically appropriate practice, it is suggested that chaplains could be better utilized not only in the organ procurement process but also for the training of other chaplains and clinicians.     

Prefrontal cognitive ability, intelligence, Big Five personality, and the prediction of advanced academic and workplace performance

Studies 1 and 2 assessed performance on a battery of dorsolateral prefrontal cognitive ability (D-PFCA) tests, personality, psychometric intelligence, and academic performance (AP) in 2 undergraduate samples. In Studies 1 and 2, AP was correlated with D-PFCA (r=.37, p<.01, and r=.33, p<.01, respectively), IQ (r=.24, p<.05, and r=.38, p<.01, respectively), and Conscientiousness (r=.26, p<.05, and r=.37, p<.01, respectively). D-PFCA remained significant in regression analyses controlling for intelligence (or g) and personality. Studies 3 and 4 assessed D-PFCA, personality, and workplace performance among (a) managerial-administrative workers and (b) factory floor workers at a manufacturing company. Prefrontal cognitive ability correlated with supervisor ratings of manager performance at values of r ranging from .42 to .57 (ps<.001), depending on experience, and with factory floor performance at pr=.21 (p=.02), after controlling for experience, age, and education. Conscientiousness correlated with factory floor performance at r=.23.     

Discipline and sex differences in religiosity and spirituality among health care professionals

Significant discipline and sex differences were found among random samples of hospital chaplains, nurses, physicians, and social workers who were asked to rate their religiosity and spirituality. Chaplains were significantly higher and physicians were significantly lower than other disciplines in religiosity. Spirituality was higher than religiosity for all disciplines. Overall, women rated themselves higher on spirituality than men.     

Pastoral care in a trauma center

The pastoral staff of the Mercy Hospital of Pittsburgh, Pennsylvania, is a vital participant in the advanced trauma-care team. The staff of professionally certified chaplains take an active role in ministering to the unique temporal, psychological, and spiritual needs of both patients and patients' families. These professionals serve as hosts, counselors, confidants, and friends to people who have been suddenly thrown into chaos. The pastoral staff at a trauma center also ministers to the emotional and spiritual needs of the various medical and nursing staffs.     

Chaplain–Physician Consultancy: When Chaplains and Doctors Meet in the Clinical Context

This paper summarizes the perspectives of 327 Australian health care chaplains concerning their interaction with physicians within the clinical context. In general terms the findings indicated that nearly 90% of chaplains believed that it was part of their professional role to consult with physicians regarding patient/family issues. Differences of involvement between volunteer and staff chaplains, Catholic and Protestant, male and female chaplains and the type of chaplaincy training are noted, as are the perspectives of chaplaincy informants regarding their role in relation to physicians. Some implications of this study with respect to chaplaincy utility and training are noted.     

Referrals to school psychologists: A national survey

School psychologists serving a national, systematic sample of public elementary and secondary schools were surveyed regarding recent referrals. Most referrals were initiated by school staff members (75% of referrals), and the majority occured initially through formal mechanisms (55% of referrals). Most informal requests for assistance or information eventually became, or were thought likely to become, formal referrals. In 92% of cases, the referral agent's initial communication with the psychologist included some designation of what the pupil was doing or not doing that was viewed as problematic. Poor academic performance was of primary concern in 52% of referrals and social/emotional problems in 31%. More boys were referred than girls, and one-half of referrals from the elementary grades involved pupils in grades K-2. Frequency of referral and reason for referral were not independent of pupil's grade or sex. Reason for referral was independent of time of year (October vs. May) and geographical region.     

Touching Mortality, Touching Strength: Clinical Work with Dying Patients

This paper outlines some of the special stresses that must be shouldered by clinicians—physicians, nurses, chaplains, social workers, pastoral staff, and others—whose work focuses on dying and extremely vulnerable patients. The utility of a theory of generative death anxiety as a framework for interpreting the nature of these special stresses is suggested. Three common burnout reactions are examined. The paper concludes that positive acceptance of personal mortality may help clinicians avoid burnout and lead to better therapeutic practice. This framework for interpreting therapeutic practice demonstrates the integral role spirituality plays in work with this particular patient group.     

A sense of presence and self-reported performance in international teams

Research over the last two decades has explored the relationship between a variety of states of consciousness, performance, and motivation. These have included flow and a sense of presence in face-to-face, online, and virtual environments. This study examined the relationship between presence and flow experienced by 75 male and female participants from several Pacific Rim nations on 4 international teams and their self-reported performance, enjoyment, and motivation associated with team-related tasks. The results indicate that in these task situations, which are relatively novel because of their cultural diversity, self-reported performance correlated more highly with presence (r=.34, df=72, p<.01) than flow (r=.26, df=71, p<.05). Enjoyment and motivation, however, correlated more highly with flow (r =.60, df=71, p<.01 and r=.40, df=71, p<.01, respectively) than presence (r=.26, p<.05 and r=.25, p<.05). These findings suggest the need to explore further the relationship between activity- or task-related states of consciousness, the characteristics of the tasks involved, particularly in terms of their novelty, and the effect on performance and motivation.     

Students' Machiavellianism and motives for communicating with instructors

This study investigated the relationship between scores of college students (N=210, 114 women, 95 men, 1 unidentified; Mage=19.3 yr., SD=2.8) on Machiavellianism and their motives for communicating with their instructors in the classroom. Students' Machiavellianism scores were positively but weakly related to three motives of Functional (r=.22, p<.01), Excuse-making (r=.16, p<.05), and Sycophancy (r=.17, p<.05).     

Pain Control and Chaplaincy in Aotearoa New Zealand

This paper summarizes the results of 100 New Zealand health care chaplains with regard to their involvement in issues concerning pain control within the New Zealand health care context. Both quantitative (via survey) and qualitative methods (in-depth interviewing) were utilized. The findings of this study indicated that approximately 52 % of surveyed hospital chaplains had provided some form of pastoral intervention directly to patients and/or their families dealing with issues concerning pain and that approximately 30 % of hospital chaplains had assisted clinical staff with issues concerning pain. NZ chaplaincy personnel involved in pain-related issues utilized a number of pastoral interventions to assist patients, their families and clinical staff. Differences of involvement between professionally stipended hospital chaplains and their volunteer chaplaincy assistants are noted, as are the perspectives of interviewed chaplains about their pastoral interventions with issues relating to pain. Some implications of this study with respect to chaplaincy utility, training and collaboration with clinical staff are noted, as are comparisons with international findings.     

Abortion and Health Care Chaplaincy in Australia

This paper summarizes the results gained from quantitative and qualitative research involving 327 Australian health care chaplains with regard to their involvement in abortion issues within the health care context. The findings indicate that approximately 20% of surveyed chaplains had provided some form of pastoral intervention to patients and/or their families dealing with issues of abortion and that approximately 10% of chaplains had assisted clinical staff with issues concerning abortion. There was found to be no-statistically significant difference with regard to the number of catholic chaplains compared with protestant chaplains or staff chaplains compared with volunteer chaplains involved in abortion issues. Analysis using the WHO Pastoral Intervention codings highlighted a variety of issues encountered by chaplains and the non-judgmental pastoral care used by chaplains when assisting those dealing with abortion. Some implications of this study with respect to patient and clinical staff support are suggested. Dr. Lindsay Carey, M.App.Sc., Ph.D.: National Research Fellow, Australian Health & Welfare Chaplains Association & Faculty Associate, Palliative Care, School of Public Health, La Trobe University, Melbourne, Australia. Dr. Christopher Newell, AM, Ph.D.: Associate Professor, School of Medicine, University of Tasmania, Hobart, Australia.     

Victims' perceptions of social support: what is helpful from whom?

Although research has demonstrated that social interactions influence psychological well-being, little is known about what specific actions victims of stressful life events experience as helpful or unhelpful. Wortman and Dunkel-Schetter (1979) previously suggested that victims frequently experience rejection, withdrawal, and communication problems with those close to them. To address these issues, 55 cancer patients were interviewed concerning the specific actions they found to be helpful or unhelpful from several potential support providers: spouse, other family members, friends, acquaintances, others with cancer, physicians, and nurses. The data indicated that the Wortman and Dunkel-Schetter victimization model applied better to interactions with friends and acquaintances than to interactions with close family members. In addition, support was found to be partially dependent on the source: Particular actions were perceived to be helpful from some but not other network members. Implications for theory and research on social support are discussed.     

Clinical staff’s attributions about diabetes: Scale-development and staff vs. patient comparisons

Clinical staff’s attributions about diabetes management were measured using newly developed scales. Eighty-five physicians and nurses provided data to investigate the psychometric properties of the scales and to examine the patterns of attributions made. Alpha coefficients for the 7 six-item scales were satisfactory, ranging from .51 to .73. A comparison between attributions for positive and negative outcomes of diabetes management produced examples of self-serving bias. Comparisons were made with data from 286 insulin-dependent diabetes patients. Staff tended to rate patients as having less personal control over positive outcomes (t=2.94;df=338;p<.01) and tended to emphasize chance to a greater extent than did the patients (t=?4.32;df=338;p<.001). There was a tendency for staff to rate negative outcomes as being more foreseeable by the patients than the patients did themselves (t=?3.11;df=346;p<.01). Both patients and staff demonstrated bias towards dispositional attributions. The implications of between and within group differences in attribution patterns are discussed.     

Compassion fatigue and burnout among Rabbis working as chaplains

Compassion Fatigue, Compassion Satisfaction, and Burnout were studied in a convenience sample of 66 male and female Rabbis who work as chaplains and attended the annual conference of the National Association of Jewish Chaplains (NAJC) in 2002. Although Compassion Fatigue and Burnout were low among the survey participants, both measures were significantly higher among the women in the sample. Compassion Fatigue was also higher among chaplains who were divorced, and it increased with the number of hours per week the chaplains spent working with trauma victims or their families (r = .25, p<.05). Hierarchical multiple regression was performed to determine the influence of six professional and five personal variables on each of the three dependent variables. Four professional variables accounted for 19.5% of the variation and three personal variables accounted for 20.3% of the variation in Compassion Fatigue. Attempts to predict Burnout and Compassion Satisfaction were far less successful. Burnout was predicted by only two variables (i.e. age and years as a Rabbi), which accounted for just 18.4% of the variance in Burnout scores. Age was the only variable found to have a significant effect on Compassion Satisfaction, and its effect was positive. The implications of the findings are discussed.     

The deChristianization of Christian hospital chaplaincy: some bioethics reflections on professionalization, ecumenization, and secularization.

The traditional roles of Christian chaplains in aiding patients, physicians, nurses, and hospital administrators in repentance, right belief, right worship, and right conduct are challenged by the contemporary professionalization of chaplaincy guided by post-Christian norms located in a public space structured by three defining postulates: the non-divinity of Christ, robust ecumenism, and the irrelevance of God's existence. The norms of this emerging post-Christian profession of chaplaincy make interventions with patients, physicians, nurses, and hospital administrators in defense of specifically Christian bioethical norms and goals unprofessional, because the chaplain is now directed as a professional to support health care services held to standards articulated within a secular morality. These changes are exemplar of the profound recasting of the dominant moral culture with wide-ranging implications for bioethics.     

Sources of Care for Alcohol and Other Drug Problems: The Role of the African American Church

African Americans experience significant disparities in treatment access, retention, and quality of care for alcohol and drug use (AOD) problems. Religious congregations, often the first point of contact for help with AOD problems, can play an integral role in improving access to treatment. However, little is known about the role of African American churches in addressing AOD problems. We administered a survey to a faith-based collaborative of 169 African American churches in Los Angeles to examine how AOD problems are identified in congregations, the types of support provided, barriers to providing treatment referrals, and factors associated with the provision of treatment referrals. Seventy-one percent of churches reported caring often for individuals with AOD problems. AOD problems came to the attention of congregations most commonly via a concerned family member (55%) and less frequently through individuals with AOD problems directly approaching clergy (30%). In addition to providing spiritual support, a substantial proportion of churches reported linking individuals to AOD services through referrals (62%) and consultation with providers (48%). Barriers to providing treatment referrals included lack of affordable programs (50%), stigma (50%), lack of effective treatments (45%), and insufficient resources or staff (45%). The likelihood of providing treatment referrals was greater among mid-sized versus smaller-size congregations (OR 3.43; p < .05) and among congregations with clergy that had attended seminary (OR 3.93; p < .05). Knowing how to effectively coordinate informal sources of care provided by African American churches with the formal service sector could make a significant impact on AOD treatment disparities.     

What Do Chaplains Contribute to Large Academic Hospitals? The Perspectives of Pediatric Physicians and Chaplains

This article analyzes interviews with pediatric physicians (N = 30) and chaplains (N = 22) who work at the same large academic medical centers (N = 13). We ask how pediatric physicians understand and work with chaplains and how chaplains describe their own work. We find that physicians see chaplains as part of interdisciplinary medical teams where they perform rituals and support patients and families, especially around death. Chaplains agree but frame their contributions in terms of the perspectives related to wholeness, presence, and healing they bring. Chaplains have a broader sense of what they contribute to patient care than do physicians.     

Reducing obstacles to the provision of quality diabetic care

Abstract

High quality diabetic care is seen as influenced by the organisation of care, health care workers' involvement in diabetes-specific areas, co-operation among staff members, the availability of resources, and the competence of medical staff (including both physicians and nurses). In a prospective study we have tested a programme for improvements of the quality of diabetes services which combined organisational development and continuing medical education (CME) measures. The study involved 34 primary health care centres over an 18 month period and was based on the responses to questionnaires answered by 123 general practitioners and 247 registered nurses at the 34 PHCCs.

The combined programme had a considerable influence on inter-group co-operation, staff members' perceptions of resources available, and nurses' involvement in diabetic care (54 versus 30% seeing diabetic patients for regular check-ups).

The results show that, in order to diminish obstacles to high quality care, organisation of care as well as care workers' theoretical knowledge has to be focused.     

A perinatal ethics committee on abortion: process and outcome in thirty-one cases.

The US Supreme Court's June 1992 decision to uphold most of Pennsylvania's law restricting access to abortion confirms that while abortion is still permitted in the US, it is being increasingly regulated. Individual institutions may, however, find ways to permit access to abortion. One hospital formed a mandatory, prospective perinatal ethics committee (PEC) in May 1987 to develop clinical guidelines with which to consider and decide requests by physicians for their patients seeking abortions. The authors obtained the consent of this PEC to study its membership, processes, case outcomes, and clinical decision making. Understanding PEC processes and outcomes may help other institutions to decide whether to institute similar mechanisms. Specifically, the investigators determined the backgrounds and abortion-related beliefs of PEC members and obstetric and gynecology department members, whether the PEC affects the number of abortions performed, how PEC members decide in individual cases, and whether requesting physicians find the PEC helpful. All eleven PEC members and 58 of the 65 medical staff ob/gyn physicians returned background surveys. Study results are presented. Overall, the PEC appeared to function as an affirming regulatory body for second-trimester, medically-indicated terminations and for certain personal choice terminations. Institutional interests were well-served by the PEC and with the assurance of informed consent, the interests of some patients were also well served.