The spiritual care of sick children: reflections from a pilot participation project

The authors are a multi-disciplinary team of chaplains, one with a counselling qualification, and an academic with a research background in spirituality and youth work. A pilot participation project undertaken at Birmingham Children’s Hospital (UK) focused on increasing the understanding of the spiritual needs of sick children and young people and involving children and young people in improving the service and provision of spiritual and religious care to them. Views from children, young people and parents were sought with the intention of developing resources and training that help facilitate the meeting of spiritual and religious needs of children and young people in hospital. Within the wider chaplaincy team are chaplains from the six major world faiths and this project considers spiritual needs of children and young people who perceive themselves as belonging to a faith group or not. Reflections from the pilot include identifying ten principles and practices to inform the spiritual care of sick children and proposing the concept of interpretive spiritual encounters as a tool for spiritual care. The pilot study indicated that being more proactive in offering spiritual care enhanced the quality of service offered by Chaplaincy.     

Promoting the spiritual development of sick children

This paper considers whether there are aspects of spiritual pedagogy specific to the education of children who are sick and asks how these concerns are to be addressed. The context of the enquiry is England and Wales where the promotion of the spiritual development of children is a legislative requirement. The focus of the study is on sick children whose treatment requires extended stay in hospital. Such children have hardly been noticed in the continuing debate about spiritual education. Our enquiry has involved analysing literature published in English in the UK and North America. We have supplemented this analysis with primary data from semi-structured interviews with three hospital schoolteachers, two hospital chaplains and the founder of a hospice for children and a ‘respice’ for young people. We argue that what emerges as important in the spiritual education of the sick child has significant implications for the spiritual education of all children.     

Hospitable Hospitals in a Diverse Society: From Chaplains to Spiritual Care Providers

The chaplain’s role in health care services has changed profoundly within the contexts of managerial and fiscal constraints, and increasingly pluralistic and secularized societies. Drawing from a larger study that examined religious and spiritual plurality in health care, we present findings regarding the contributions of chaplains or spiritual care providers (SCPs) as they are referred to more recently, in Canadian institutional health care contexts. Qualitative analyses of interviews with 14 employed SCPs and 7 volunteers provided insights about legitimizing and crafting the role of SPCs, becoming part of the health care team, and brokering diversity. Implications are discussed in relation to role clarification and policy development for truly hospitable health care.     

A review of research on chaplains and community-based clergy in the Journal of the American Medical Association, Lancet, and the New England Journal of Medicine: 1998-2000

Based on the content analysis of quantitative research appearing in three medical journals, the authors conclude that, despite the shared ideal of providing spiritual care to patients on the part of physicians and chaplains, there is little attention given in these journals demonstrating and promoting this shared perspective. Suggestions for future research that would focus on this common medicine/religion interface and concern are noted.     

Correctional Services and Prison Chaplaincy in Australia: An Exploratory Study

This paper summarizes an exploratory study undertaken to consider the work of Australian chaplaincy personnel ministering to prisoners within correctional facilities. This qualitative research was not concerned with specific correctional institutions per se, but predominantly about the perspectives of chaplains concerning their professional contribution and issues they experienced while trying to provide pastoral care to prisoners. Data from a single-focus group indicated that prison chaplains were striving to fulfill religious and spiritual duties according to national and international standards for the treatment of prisoners. Given various frustrations identified by participants, that either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to prisoners. Implications of this exploratory study relate not only to prison chaplaincy but also to ecclesiastical organizations, correctional facilities, governments and the need of support for further research to be conducted.     

Negotiating Religious Differences: The Strategies of Interfaith Chaplains in Healthcare

Chaplains in healthcare increasingly work in interfaith roles with patients and families from a range of religious and spiritual backgrounds. Some move with ease between their own religious backgrounds and those of the individuals with whom they work. Others encounter tensions as their status as a person of faith comes into conflict with their status as an interfaith chaplain. We explore the two main strategies—neutralizing and code‐switching—chaplains at one large academic medical center use when working with patients and families whose religious and spiritual backgrounds are different from their own. Through training in clinical pastoral education and experiences on the job, chaplains learn to neutralize (use a broad language of spirituality that emphasizes commonalities rather than differences) and to code‐switch (use the languages, rituals, and practices of the people with whom they work). To the extent that the strategies evident here are present among chaplains in a broader range of institutional settings, they suggest a kind of spiritual secularism or broad approach to meaning makings that may be facilitated by interfaith chaplains in a range of settings.     

Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder

An increased awareness of the spiritual aspects of health and illness has recently led to changes in psychiatry residency training as well as hospital accreditation requirements. The spiritual impact of trauma has been an area of particular interest, as trauma evokes certain existential questions and crises. It is estimated that from 5–11% of trauma survivors will go on to develop posttraumatic stress disorder (PTSD). Given the spiritual challenges of the experience of trauma, patients with PTSD could benefit from spiritual assessment and intervention as part of their overall treatment plan, and clergy can be utilized to perform this. The literature exploring the spiritual impact of trauma and the use of clergy in the treatment of trauma survivors is reviewed. The methods used by three chaplains in a residential treatment program for PTSD at one facility are described and discussed. Both the literature and the experiences of the clergy suggest that exploration of trauma-related existential conflicts in patients with PTSD is beneficial. However, there is a notable dearth of controlled scientific studies evaluating the effectiveness of spiritual interventions with this treatment population. The need for controlled studies to verify the usefulness of spiritual assessment and intervention in patients with PTSD is noted, and a more rigorous analysis of how clergy can best serve this treatment population is encouraged.     

Healthcare Chaplains’ Perspectives on Nurse–Chaplain Collaboration: An Online Survey

The collaboration between nurses and chaplains is essential to provide spiritual support in healthcare institutions. Given challenges in collaboration exist between these disciplines, this study sought to further understand the nature of the chaplain–nurse relationship. Data obtained from an online survey of members of the Association of Professional Chaplains (N = 266) provide a quantified and nuanced picture of how chaplains perceive nurse collaboration and provision of spiritual care. This study not only provides evidence that can inform chaplain and nurse practice, but also an instrument for measuring perceptions about collaboration to provide spiritual care.

     

What is spiritual? What is spiritual suffering?

The author offers definitions for "spiritual" and for "spiritual suffering," suggesting that human spiritual needs include Love, Faith, Hope, Virtue, and Beauty. Spiritual suffering is experienced when these needs are unfulfilled. Spiritual care involves assisting in the fulfillment of these needs. He considers the constant movement between spiritual needs and fulfillments, encouraging use of fluid (not static) assessment methods using "spiritual spectra." As a model, this outline of basic spiritual needs may serve as the foundation for many current spiritual assessment tools.     

Health Care Chaplains and their Role on Institutional Ethics Committees: An Australia Study

This paper presents the results of the largest Australian pastoral study concerning the perceptions of health care chaplains about their involvement on hospital research ethics committees (also known in some contexts as institutional ethics committees). Survey results from over 300 Australian health care chaplains indicated that nearly 90% of chaplains believed there was merit in chaplains serving on hospital research ethics committees, yet only a minority (22.7%) had ever participated on such committees. Data from in-depth interviews is also presented exploring the reasons for the lack of participation and the varying opinions regarding the role, appropriateness, and value of chaplains on ethics committees. Some implications of this study with respect to chaplaincy, hospital research ethics committees, health care institutions, ecclesiastical institutions, and government responsibilities are discussed.     

Who needs chaplain's visitation in general hospitals? Assessing patients with psychosocial and religious needs

Owing to the declining length of patients' hospital stay in recent years, chaplains need evidence-based criteria to decide which patients are likely to have the greatest psychosocial and/or religious-spiritual needs. Therefore, the present pilot study aims at sorting out evidence-based criteria to assess patients with lack of coping resources. A total of 610 patients in the German-speaking part of Switzerland were surveyed with regard to their psychosocial health. The results suggest that lack of vitality (including health condition), lack of support and lack of faith (including spiritual struggle) are valid and reliable criteria for chaplains as internal triggers for pastoral visitation.     

Spiritual and religious experiences of adolescent psychiatric inpatients versus healthy peers

One hundred twenty-two adolescent psychiatric inpatients with depressive disorders and 80 healthy peers were administered the INSPIRIT, a measure of core spiritual experiences. Healthy adolescents reported a greater frequency of spiritual experiences and a more positive impact of such experiences on their belief in God than did their inpatient peers. Adolescent inpatients reported higher frequencies of experiencing angels, demons, God or guiding spirits; feeling unity with the earth and other living things; and with near death or life after death as compared to healthy peers. Overall, females reported higher frequency of spiritual experiences and higher impact of the experience on their belief in God than did males. It was concluded that the INSPIRIT is a feasible spiritual assessment tool for adolescent populations and may be used by chaplains as a means for guiding clinical conversations with adolescents.     

Who Pays for Providing Spiritual Care in Healthcare Settings? The Ethical Dilemma of Taxpayers Funding Holistic Healthcare and the First Amendment Requirement for Separation of Church and State

All US governmental, public, and private healthcare facilities and their staff fall under some form of regulatory requirement to provide opportunities for spiritual health assessment and care as a component of holistic healthcare. As often the case with regulations, these facilities face the predicament of funding un-reimbursable care. However, chaplains and nurses who provide most patient spiritual care are paid using funds the facility obtains from patients, private, and public sources. Furthermore, Veteran healthcare services, under the United States Department of Veterans Affairs (VA), are provided with taxpayer funds from local, state, and federal governments. With the recent legal action by the Freedom From Religion Foundation, Inc. (FFRF) against the Veterans Administration, the ethical dilemma surfaces between taxpayers funding holistic healthcare and the first amendment requirement for separation of church and state.     

Developing an adequate "pneumatraumatology": understanding the spiritual impacts of traumatic injury

Psychosocial interventions and systematic theology are primary resources for chaplains and congregational pastors who care for victims of physical trauma. Yet these resources may not be adequate to address the spiritual impacts of trauma. This article proposes a preliminary "pneumatraumatology," drawing on early Christian asceticism and Buddhist mysticism to describe one way of understanding the spiritual impacts of traumatic injury. It also suggests possible responses to these impacts informed by narrative/constructionist perspectives and Breggemann's understanding of the dimensions of spiritual transformation in the Hebrew Bible.     

Moral Injury,Spiritual Care and the Role of Chaplains: An Exploratory Scoping Review of Literature and Resources

This scoping review considered the role of chaplains with regard to ‘moral injury’. Moral injury is gaining increasing notoriety. This is due to greater recognition that trauma (in its various forms) can cause much deeper inflictions and afflictions than just physiological or psychological harm, for there may also be wounds affecting the ‘soul’ that are far more difficult to heal—if at all. As part of a larger research program exploring moral injury, a scoping review of literature and other resources was implemented utilising Arksey and O’Malley’s scoping method (Int J Soc Res Methodol 8(1):19–32, 2005) to focus upon moral injury, spirituality (including religion) and chaplaincy. Of the total number of articles and/or resources noting the term ‘moral injury’ in relation to spiritual/religious issues (n = 482), the results revealed 60 resources that specifically noted moral injury and chaplains (or other similar bestowed title). The majority of these resources were clearly positive about the role (or the potential role) of chaplains with regard to mental health issues and/or moral injury. The World Health Organization International Classification of Diseases: Australian Modification of Health Interventions to the International Statistical Classification of Diseases and related Health problems (10th revision, vol 3—WHO ICD-10-AM, Geneva, 2002), was utilised as a coding framework to classify and identify distinct chaplaincy roles and interventions with regard to assisting people with moral injury. Several recommendations are made concerning moral injury and chaplaincy, most particularly the need for greater research to be conducted.     

Revs and Psychos: Role,Impact and Interaction of Sport Chaplains and Sport Psychologists within English Premiership Soccer

Despite an increased focus on spirituality and athlete well-being in sport (Watson, 2011), there is limited research regarding those who provide support to the athlete in these areas. The aim of this study was to explore the practice of sport psychologists and sport chaplains within professional soccer, and identify potential for working partnerships. By interviewing three psychologists and four chaplains who are employed currently within English Premiership soccer, it was revealed that significant overlap in their roles existed. The psychologists and chaplains identified barriers that restricted support offered to players, which may be addressed by working cooperatively in the future.     

Challenges to preparing and conducting christian worship in nursing homes

This essay explores and details the various challenges that are faced in the design of Christian worship within the nursing home environment. People in this setting have special needs-physical, mental, social, and spiritual. The physical plant itself demands special considerations when preparing for worship. Difficulties are defined and solutions presented for those who would provide intentional and accessible Christian worship that allows for action and response from the community in these settings. Sources include Christian liturgical reference materials and on-site interviews with chaplains and activity directors at three care facilities in southeast Michigan.     

Chaplains' medical approach to psychiatric patients

Chaplains' understanding of people's psychiatric and medical problems may aid them in dealing with people's spiritual problems. However, exploratory interviews and observations of chaplains and inpatients at a VA psychiatric facility indicate that chaplains take a medical model perspective with patients, often attempting to treat patients' psychiatric problems rather than focusing on their reliigious needs. Chaplains avoid one-on-one religious discussions despite the importance of these conversations to patients. Discussed are implications for the utilization of health services and for the formation of treatment teams.This paper is a revised version of a paper presented at the Society for Applied Anthropology meetings held in Lexington, Kentucky, March 1982.     

Referrals to chaplains: The role of religion and spirituality in healthcare settings

Given the increasing importance of understanding how healthcare workers interact with the principal person designated to meet patients’ spiritual needs— the chaplain— the current study provides an inter-disciplinary perspective of the role of chaplains (and spirituality) in patients’ emotional, physical, and spiritual health. The study surveyed a randomly selected national sample of hospital directors in four disciplines: medicine (n?=?278), nursing (n?=?230), social services (n?=?229), and pastoral care (n?=?470). Participants rated the importance of referring patients to chaplains for four different areas: pain/depression, anxiety/anger, treatment issues, and loss/death/meaning. Results revealed significant differences in referral patterns for type of hospital, professional discipline, the hospital's religious affiliation, and self-reported spirituality. Results are discussed in relation to historical views of spirituality and religion within the different disciplines.     

How are health care chaplains helpful to bereaved family members? Telephone survey results

After conducting telephone interviews with 130 next-of-kin whose loved one died, the authors report whether and how chaplains were helpful to these family members. Analysis of their responses indicated that chaplains were helpful in five ways. They provided comfort and support; they helped family members with details before, during, and after death; they acted as surrogate family members until other loved ones arrived; their availability provided a safety net even if contact was limited; and they functioned as a spiritual figure who provided the transition of the patient from earth to heaven. Family members rated the helpfulness of chaplains as midway between very good and excellent.