Becoming their mother: Knowledge,attitudes, and practices of orphanage personnel in Ukraine

Institutional caregiving can have adverse effects on children, yet little is known about the caregivers of institutionalized young children. We surveyed staff in three Ukrainian Baby Homes about their attitudes toward the nature of their work and the needs of the young children in their care. Seventy‐one caregivers completed anonymous, semistructured surveys. Popular reasons for working in Baby Homes included benefits and convenient work shifts, morality, and affection for children. Caregivers reported both favorable aspects of the work (enjoyment of children, professional satisfaction) and work difficulties (conflicts, lack of cooperation, little administrative support). In addition, they noted deficiencies in care: high caregiver–child ratio, frequent care disruptions, and lack of stimulation. Direct caregivers (in‐room “nannies,” educators, and nurses) and other providers (e.g., clinic nurses, physicians, therapists) differed in university‐degree attainment, professional motivation, enjoyment of children, professional satisfaction, and perceptions of self as substitute mother. A number of potential “windows for change” were identified, including recognition of deficiencies in institutional care and possibilities for improvement. Implications for interventions are discussed, including the need to consider lack of staff support, high emotional stress, internal conflicts, beliefs and attitudes about institutionalized children and their biological parents, and differences in staff educational achievement.     

Faith-to-faith at the bedside: theological and ethical issues in ecumenical clinical chaplaincy.

Chaplains who serve in a clinical context often minister to patients representing a wide variety of faiths. In order to offer the best pastoral care possible, the chaplain should first possess a set of personal theological convictions as a foundation for ministry. Second, he or she needs to be sensitive to the beliefs and practices of the patients. Third, it is vital to develop a relationship of acceptance and trust not only with patients under their care, but also with family members and caregivers as well. At times, situations will arise that are purely religious or theological. In a clinical setting, however, the questions and problems that arise more often are both theological and ethical. It is beneficial for the chaplain to be involved in an ethics committee, where the specifics of each case can be discussed, and staff can offer counsel to patients and their families. This study examines issues that chaplains face at the bedside, such as terminal care, life-prolonging treatments, dementia, persistent vegetative state, and euthanasia-assisted suicide. We will discover that those who are involved in clinical pastoral ministry will be called upon to be a comforter, mediator, educator, ethicist, and counselor.     

Caregiver models of self and others, coping, and depression: predictors of depression in children with chronic pain.

In a sample of 59 chronically ill pediatric patients and their maternal caregivers, both child-reported pain and caregiver-reported depression predicted child-reported depression. Results further suggested that the association between pain and depression in children is ameliorated by caregiver coping strategies and that how caregivers cope is a function of their attachment-related representations of the self and others. Caregivers with a negative model of the self were more depressed. and those with a negative model of others were more prone to use avoidant coping strategies, and, in turn, to be more depressed. However, the extent to which caregivers with negative models of self used more avoidant and less approach coping appeared to depend on whether they perceived that others were likely to respond to their needs.     

Impact of patient suffering on caregiver well-being: the case of amyotrophic lateral sclerosis patients and their caregivers

The impact of patient suffering on family caregivers is an understudied but important topic. This study of patients with amyotrophic lateral sclerosis (ALS) and their caregivers examined the associations of two components of patient suffering: patient physical symptoms, and mental distress, as well as the patient's support for the caregiver, with caregiver well-being. The sample consisted of 52 patients with ALS and their caregivers. Patients and caregivers each completed a structured survey assessing multiple domains including demographics, health, and well-being. Specifically, patients rated their own physical symptoms and mental distress. Caregivers rated their own daily affect, and the extent to which they perceived the patient as supportive. Caregivers also reported whether or not they had found any benefit in dealing with the patient's illness. Regression analyses yielded significant associations of patient distress with caregiver negative affect; patient support was associated with greater caregiver positive affect, and patient symptoms and support were associated with greater likelihood of caregiver benefit finding. There was a significant two-way interaction of patient symptoms by support, namely, benefit finding was not only more likely with greater physical suffering and patient support, but it was also the case that caregivers who perceived the care recipient as unsupportive could only find benefit when this person experienced intense physical suffering. Support interventions for ALS patients and their caregivers should devote particular attention to how caregivers may be affected by witnessing their loved one's sufferings, as well as identify and address challenges in support exchanges between caregivers and patients.     

Life review in pastoral counseling: background and efficacy for use with the terminally ill

Research continues to confirm that sharing one's life story through the process of life review enhances psychological well-being and increases life satisfaction. Although researchers have outlined techniques and activities that may be used in life review with older adults, little work has focused on the use of life review methods with terminally ill patients. Additionally, researchers have suggested that life review can take on the form of a spiritual assessment; and that such spiritually oriented life reviews may enhance a sense of meaning and foster reconciliation as one approaches dying. In this article, the authors provide a brief review of the research on and the practice of life review. Further, by merging concepts of life review with systematic theology, they offer a sample instrument--using the example of one faith framework--with which pastoral caregivers can better approach the spiritual needs of patients and facilitate a less traumatic death in the terminally ill.     

Detecting and constructing meaning in life events

Three studies examined the meaning ascribed to events varying in intensity and valence and how meaning detection and construction relate to the experience of meaning in life events. In Study 1, participants were more likely to expect meaning to emerge from major life events particularly if they are negative, while trivial events were expected to be meaningful if they were positive. Study 2 showed that constructed meaning was more likely to occur in response to negative events while detected meaning was more likely to be associated with positive events. Study 3 showed that this ‘match’ between valence and meaning strategy predicted enhanced experience of meaning in those events. These studies suggest that the more subtle experience of meaning detection may provide a way to understand the meaning that emerges from positive events and experiences.     

Developing a Public Hermeneutic for the Future of Theological Education?

Abstract : This article considers whether there is a need to develop a public hermeneutic for theological education. Churches and theological schools are rethinking the programs they are providing and other new ways to enhance their process of leadership formation for ministry. In a dynamically global context, where churches have been “disestablished”—as in Canada—the religious needs of the wider public remain important. I suggest that more attention needs to be given to the public questions of “belonging.” Perhaps a notion of public ministry as active accompaniment of people and communities provides a helpful metaphor or public hermeneutic for theological schools in charting their future.     

Gender,sexual harassment,workplace violence,and risk assessment:: Convergence around psychiatric staff's perceptions of personal safety

This paper reviews literature in sexual harassment, workplace violence, and risk assessment as it relates to staff in psychiatric and forensic work environments. These three areas of research overlap in their applicability to psychiatric staff in that each addresses the understanding and management of types of violence to which many staff, particularly women, are likely to be exposed while working. Employee well-being, encompassing mental and physical health, job satisfaction, and morale, has been shown to be closely tied to organizational productivity and cost. In addition, gender has been shown to be an important factor in perceptions and decision-making, and prior work has suggested that female staff often have qualitatively different experiences in traditional male workplaces such as inpatient and forensic settings. Despite these findings, research to date on psychiatric staff has typically focused only on number of assaults by patients. It has not addressed how staff's gender may impact their perceptions of personal safety and judgments of risk from patients, nor have any empirical studies been performed in naturalistic settings to investigate this issue. Given the high correlation between organizational productivity and employee well-being, it is mutually beneficial to both employers and staff to examine current understanding of how certain staff variables such as gender may influence their feelings of safety and judgments of risk from patients.     

Spiritual Autobiography and Older Adults

Spiritual autobiography groups constitute a form of ministry that can potentially enrich the lives of older adults, their families, and their congregations. Such groups, when competently led, provide participants with an environment in which they can make meaning out of their lives, grieve their losses, and give and receive support. The actions and interactions involved in composing, telling, and hearing life stories are salutary exercises that can increase participants’ experiences of clarity, coherence, and connection to God and to each other. The spiritual wisdom that emerges from such life stories, when shared within congregations, can enhance intergenerational relationships and lead to spiritual growth for members of diverse ages.     

Young Children’s Physiological Reactivity during Memory Recall: Associations with Posttraumatic Stress and Parent Physiological Synchrony

Autonomic reactivity is implicated in stress response and social engagement – both key components of posttraumatic stress disorder (PTSD) – but few studies have examined autonomic reactivity in pediatric samples, and no known studies have examined physiological synchrony among children with PTSD and caregivers. In a sample of 247 young children (94 girls, 153 boys), most (85%) of whom had exposure to trauma and 40% who met criteria for PTSD, we examined children’s patterns of respiratory sinus arrhythmia (RSA) at baseline and in response to a memory recall task, as well as correspondence between parents’ and children’s RSA. Children with PTSD demonstrated significantly higher reactivity than other groups during their recollection of a traumatic memory, but not during other memory tasks. Regarding synchrony, caregivers’ and children’s RSA were more significantly and positively correlated during the trauma recall task among children who had had exposure to a potentially traumatic event but did not meet PTSD criteria, suggesting physiological synchrony may be protective in contexts of trauma. Overall, findings demonstrate physiological reactivity differences among young children with PTSD. While more work is needed to understand the meaning of parent-child physiological synchrony, these data suggest that children’s psychopathology is associated with physiological synchrony processes among young children with exposure to trauma.     

Programmatic staff care in an outpatient setting

Traditionally, chaplains have provided care for staff through consultation, informal conversation, grief work, and more formal counsel and ritual. This article discusses four programmatic approaches to staff care created in response to particular assessed needs: "Finding Soul" addresses staff care needs to find meaning and joy in their work and to contribute to the "soul" of the institution. "Existential Expedition" helps staff both deal with their accumulated grief and provide better direct care around existential issues being faced by their patients. "After Book" provides a way for staff to have closure with parents/families and to provide holistic care to families after discharge from the system. "The Labyrinth Program" provides staff with an opportunity to de-stress and to attend to their emotional and spiritual well-being. Focused upon staff care, these programs also secondarily benefit both patients/families and the vision and mission of the institution.     

Caregivers Dependent upon Drivers with Dementia

This paper reports findings of a preliminary study of caregivers dependent upon drivers with dementia. Fifteen caregivers who perceived themselves as dependent upon their partner for transportation and 15 who perceived themselves as independent were surveyed. Dependent caregivers were significantly more likely to rely on the cognitively impaired driver for routine daily activities such as shopping, medical appointments, and visiting family and friends. Only 20% of the dependent caregivers believed that the driver with dementia should decrease or discontinue driving. Dependent caregivers were less likely than independent caregivers to take an active approach in encouraging driving cessation. Compared to the independent caregivers, the dependent caregivers believed that if the patient with dementia could no longer drive, it would significantly affect their quality of life. The authors discuss the issues and problems uniquely associated with the dependent caregiver.     

Which behaviours? Identifying the most common and burdensome behaviour changes in amyotrophic lateral sclerosis

Behaviour change is increasingly recognised as a common feature of amyotrophic lateral sclerosis (ALS), and may be similar to that seen in frontotemporal dementia (FTD). The behaviours most disturbed in ALS, and those that relate most significantly to caregiver burden, however, have not been well established. Forty ALS participants and their caregivers, and 27 age- and gender-matched healthy controls and their relatives, participated in this study. ALS participants were assessed on a disease rating scale, and caregivers and control informants completed the revised version of the Cambridge Behaviour Inventory and a measure of burden. ALS caregivers reported significantly more disturbance than healthy control informants on the functional domains of everyday skills, self-care, and sleep, and in the behavioural domains of mood and motivation. There were no differences between groups in frequency of memory and orientation difficulties, or behaviours characteristic of FTD, such as changes to eating habits or stereotypic and motor behaviour, indicating that the behavioural profile in ALS may differ from FTD. In the ALS group, the domains with the strongest relationship to caregiver burden were everyday skills, motivation and memory, likely because poor motivation, memory dysfunction and difficulties completing activities of daily living require more carer support via direct supervision, prompting or hands on care. Services to support ALS patients and caregivers need to provide targeted interventions for those functional and behavioural changes which are most burdensome in the disease.     

Seeking meaning in late stage dementia

The author uses case studies to illustrate the effectiveness of two techniques which pastoral caregivers may teach to family carers of dementia patients. In the last stages of dementia, it is important to seek meaning and keep in significant contact as long as possible, both for family members as well as for the dementia patients. After a brief literature review, implications for care theory, practice, and policy are reviewed, and a scientific bias is illustrated. These techniques build on the work of C. G. Jung and James Hillman, utilizing metaphor in non-rational uses of language. It is suggested that pastoral caregivers could teach these techniques to families of this population, in the hope of prolonging meaningful connection with their loved one.     

A Survey Report of Nursing Home Ministry and Perceived Needs with Implications for Pastoral Care

ABSTRACT

The last 40 years of growth in the development of pastoral care to the sick appears to have virtually bypassed persons in nursing homes. A study within 13 nursing homes in one city revealed that spiritual ministry within those institutions was generally limited to a series of 9 to 13 worship services per month, attended by approximately 20 percent of the patients/residents. Some patients receive an occasional personal visit by a pastor. The staff perceive that pastoral ministry as good, but inadequate, and expressed their views on that which is needed within their institutions and challenge the clergy with specific suggestions for pastoral care for nursing home patients/residents, their families, and staff.     

A Qualitative Survey of the Attitudes of Catholic Priests Toward Bishops and Ministry Following the Sexual Abuse Revelations of 2002

This study used structured interviews to investigate (1) priest-respondents’ perceptions and attitudes toward bishops since 2002, (2) priest-respondents’ perceptions and attitudes toward their diocese, ministry, and vocation, (3) priest-respondents’ changes in ministerial activities as a result of codes of pastoral conduct, (4) priest-respondents’ personal feelings of competence regarding the codes of pastoral conduct, and (5) priest-respondents’ feelings of support since 2002. Using snowball sampling techniques, 22 Catholic priests were interviewed in 2006 and 2007. These respondent-priests perceived a significant barrier between themselves and bishops. While respondents’ attitudes toward the priesthood and their vocations had not changed, they were less trusting of their bishops. Finally, most had made significant accommodation to the manner in which they minister to parishioners, especially to young people. Respondents indicated that they were less likely to become involved in pastoral counseling, developing social relationships with parishioners, and other non-liturgical activities. Respondents indicated that they were far less likely to engage in pastoral activities that might compromise their future ministry or result in suspicion or an allegation.     

Caregiving for children through conflict and displacement: a pilot study testing the feasibility of delivering and evaluating a light touch parenting intervention for caregivers in the West Bank

A child's adjustment to wartime stress is reliant not only on individual responses and qualities, but very significantly on the availability of support that they may receive from their parent or caregivers and quality of relationships. Strengthening parental support has the potential to be valuable. A pilot two-arm randomised controlled trial investigated the feasibility of delivering and evaluating the “Caring for Children Through Conflict and Displacement” intervention with caregivers in the West Bank. Feasibility to recruit and train non-specialist staff on-the-ground to screen families for eligibility, collect outcome data, deliver the intervention and to recruit and retain families in the study were examined. Research staff and intervention facilitators were successfully appointed in the field, screened participants and delivered the intervention to 120 caregivers, collecting outcome measures pre-and post-delivery. All families completed the outcome measures, with very little missing data. This indicated that the intervention can be delivered feasibly and evaluated with families in this humanitarian context. Preliminary outcome data showed promise that the intervention may have the potential to both improve family functioning and reduce children's problem behaviour. Implications of family-focused initiatives, particularly within a conflict/post-conflict context for the prevention of several negative health and social outcomes directions, are discussed.     

Overprotective Relationships: A Nonsupportive Side of Social Networks

Chronically ill adults who feel overprotected by family members tend to be more depressed. However, little is known about the source of these feelings of overly protective care. In this study, three explanations why family members may be seen by stroke patients as overprotective were tested: (a) a discrepancy between patients and caregivers in judging patient functioning; (b) caregiver protective behaviors, such as restricting the patient because of fear for the patient's safety; and (c) caregivers' negative attitudes toward the patient. Consistent with prior work, patients who felt overprotected were more depressed even when the severity of the stroke was controlled for. Caregivers with negative attitudes toward the patient were most likely to be seen as overprotective by the stroke patient. Ways in which negative, resentful attitudes of caregivers are translated into behaviors that engender feelings of overprotection are discussed.     

Adult attachment to transitional objects and borderline personality disorder

Borderline personality disorder (BPD) is characterized by tumultuous, unstable personal relationships, difficulty being alone, and an inability to self-soothe. This may explain why patients with BPD tend to develop strong attachments to transitional objects such as stuffed animals. Research in hospital settings has linked the use of transitional objects to the presence of BPD. Using a nonclinical community sample (N = 80) we explored the link between attachments to transitional objects and various aspects of personality pathology, as well as to childhood trauma, and parental rearing styles. People who reported intense current attachments to transitional objects were significantly more likely to meet criteria for a BPD diagnosis than those who did not; they also reported more childhood trauma, rated their early caregivers as less supportive, and had more attachment problems as adults. Heavy emotional reliance on transitional objects in adulthood may be an indicator of underlying pathology, particularly BPD.     

Caregiving in the close relationships of cardiac patients: Exchange,power, and attributional perspectives on caregiver resentment

Individuals with a cardiac condition and their spousal caregivers were recruited from cardiac rehabilitation centers and interviewed separately. Based on exchange theory, it was expected that greater caregiver resentment would be associated with feeling underbenefited in the relationship and with an orientation to relationships that did not focus on the needs of the partner (communal), but did focus on “tit-for-tat” reciprocity (exchange). It was also expected that those caregivers who were more likely to get their needs satisfied in the relationship before the cardiac incident would be more resentful at giving care. Finally, based on attributional theory, it was predicted that caregivers who thought that their spouses were not taking responsibility for improving their health would be more resentful. As predicted, more resentful caregivers were those who felt underbenefited, were more exchange oriented, and judged that their partners were not working toward improving their health. In addition, only those with a low communal orientation toward their spouse showed a relationship between feeling underbenefited and resentment. The needs centrality prediction was not supported. The findings illustrate the utility of applying theories developed in the close relationship area to the understanding of caregiving with chronically ill populations.