By Austine Duru, MDiv, MA, BCC
In this issue of Vision, in lieu of publishing a research article, we present eight resources in hopes of assisting readers to sample a broad range of research and research-related topics by chaplains and non-chaplain collaborators. Each resource is related to our current Vision theme. A link to a safe open access site has been included to aid in further detailed reading.
Studnicki, James, Platonova, Elena A., Eiechelberger, Chris N., and Fisher, John W. “Extent and patterns of community collaboration in local health departments: An exploratory survey.” BMC research notes 4, no. 1 (2011): 387. (44. References.)
The new Accountable Care Organization (ACO) framework favors increased collaboration between hospitals and communities. Little is known about the extent to which chaplains and pastoral care departments across the nation collaborate with community leaders to offer a continuum of care beyond the hospital walls. This study by James Studnicki and his colleagues finds that “no existing research has attempted to characterize collaboration, for the defined purpose of setting community health status priorities, between a defined population of local officials and a defined group of alternative partnering organizations.” The study has two important aims: 1) determine the range of collaborative involvement exhibited by a study population of local public health officials, and, 2) characterize the patterns of the selection of organizations/individuals involved with LHDs in the process of setting community health status priorities.
This study was done using an exploratory survey of local health officials in North Carolina to determine their level of involvement with eight possible organizations and individuals they can possibly collaborate with. The results show that the patterns of involvement for specific functions are uniform, even when the range of total involvement remains constant. The findings are significant not only for community leaders involved in shaping public policies, but also for pastoral care departments and/or chaplains who wish to collaborate with others beyond the traditional hospital setting. While this is a good foray into the question of inter-agency/departmental collaboration around community health issues, this study could perhaps benefit from further research.
Fortney, John C., Pyne, Jeffrey M., Edlund, Mark J., Williams, David K., Robinson, Dean E., Mittal, Dinesh, and Henderson, Kathy L. “A randomized trial of telemedicine-based collaborative care for depression.” Journal of General Internal Medicine 22, no. 8 (2007): 1086-1093. (52 references.)
This study by John Fortney and his colleagues emerged out of the premise that evidence-based practices designed for larger urban areas are not necessarily effective in small or rural isolated clinics. This is certainly true for all types of patient populations. However, this study looks at innovative ways to evaluate telemedicine-based collaborative care models designed for small clinics without an on-site psychiatrist. This study drew from 393 random samples of patients with a PHQ9 depression severity score within a small Veteran Administration community-based outpatient clinic who have no psychiatrist on site but were given access to telepsychiatrists. Some of the measures looked at medication adherence, treatment response, remission, health status, health-related quality of life and treatment satisfaction. Results show that the patient population studies point to significant gains in mental health status and health-related quality of life and higher satisfaction within six months and were in remission within 12 months. This study holds significant promise and potential for pastoral care and chaplaincy services, especially in rural and small clinic settings. This novel concept has broader implications for e-chaplaincy as practiced in some settings. Other implications for the future of chaplaincy can also be deduced. This has become necessary as new thinking on the delivery of healthcare is currently under way in the United States and around the world.
Pew Forum on Religion and Public Life, “Religion in Prison: A 50- State Survey of Prison Chaplains.” (14 references.)
This survey done by the Pew Research Center’s Forum on Religion and Public Life takes an unprecedented look into the state of our nation’s prisons from the eyes of professional chaplains and other volunteers who provide spiritual and religious services to prison populations in 50 states. The survey was conducted between September and December 2011. About 1,474 prison chaplains who work in state prisons were identified and contacted for this survey. Seven hundred thirty chaplains returned their completed web or paper questionnaire. The survey is extraordinary in the sense that it’s the closest possible assessment of the religious affiliation of the approximately 1.6 million inmates in the U.S. prison system. The report of the survey was divided into five parts: religious and socio-demographic profile of state prison chaplains; what chaplains do in the course of their work; assessments of religious volunteers; perspectives on the religious lives of inmates, including religious switching and concerns about extremism; and lastly, chaplains’ views on the correctional system. Overall, this survey touches on the significance of chaplain collaboration with correctional officers and facilities across the country to provide meaningful religious and pastoral services to a unique population. It highlights their work as critical in rehabilitation and re-integration into the general population once they have served their terms. This survey also hints at some troubling trends and raises significant questions about certain things that were not addressed, for instance, the lack of chaplains who can meet the needs of minority religions in the prison system. In addition, the extent to which prison chaplains collaborate with one another was not immediately clear from this survey.
Epstein, Andrew S., Volandes, Angelo E., and O’Reilly, Eileen M. “Building on individual, state, and federal initiatives for advance care planning, an integral component of palliative and end-of-life cancer care.” Journal of Oncology Practice 7, no. 6 (2011): 355-359. (30 references)
This interesting article takes on the issue of advance care planning: a topic that has received mixed reviews in the wake of the new healthcare law. Andrew S. Epstein and his team did a fine job of articulating this issue and situate it at the level of broader need for deeper conversation and communication in the disease trajectory as an integral component of the plan of care, especially for patients with life-threatening illnesses. Epstein and team go beyond the current rhetoric and use a case example to drive home the message. The article articulates some of the major barriers to a meaningful conversation around advance care planning. Epstein, also a physician, acknowledges the lack of proactive communication skills among physicians could be reversed with effective training in communication styles. This work remains relevant to pastoral care and chaplaincy. It invites us to seek new ways to partner with physicians and other caregivers in working with patients and families facing advance care planning. I am aware of some palliative care programs that are pioneering the effort to bring “conversation before crisis” to the community and local churches, temples and synagogues, with great success.
McGregor, Margaret, Pare, Dan, Wong, Areta, Cox, Michelle B., and Brasher, Penny. “Correlates of a “do not hospitalize” designation in a sample of frail nursing home residents in Vancouver.” Canadian Family Physician 56, no. 11 (2010): 1158-1164. (18 references)
This research work done by Margaret McGregor and her colleagues extends the conversation on advance care planning, by introducing the reader to the concept of “do not hospitalize.” This study was based in British Columbia and looked at the charts of 369 deceased residents in six extended care facilities between 2001 and 2007. It should be noted that all of these facilities were government funded. The results are quite revealing. This study acknowledges a number of limitations. For one thing, the quality of life outcomes of the residents could not be evaluated since this was a postmortem study. However, it explores the limits of advance care planning and introduces a new concept to this conversation around advance directives in the United States.
Malcolm, Cutchin, Coppola, Susan, Talley, Vibeke, Svihula Judie, Catellier, Diane, and Shank, Kendra. “Feasibility and effects of preventive home visits for at-risk older people: Design of a randomized controlled trial.” BMC Geriatrics 9 (2009).
The blurring of the line between health outcomes and patient satisfaction has driven the discussion of evidence-based care. Malcolm P. Cutchin and his team set out to collect the evidence to support preventive home visits, with its goal being to mitigate functional decline and unwanted relocation, and significantly reduce frequent hospitalization of at-risk older adults. This issue has reappeared in the national discussion as new pressure is exerted on hospitals to reduce readmission rates of their patients. For this randomized controlled pilot trial, 110 older adults who were at risk for functional decline were recruited. An occupational therapy-based program was developed and tried. This article describes a study in progress. This study has a sound logical foundation, but also has significant limitations. It raises legitimate questions, however, about the future of healthcare and chaplaincy.
Wensing, Michel, van der Eijk, Martiin, Koetsenruijter, Jan, Bloem, Bastiaan R., Munneke, Marten, and Faber, Marjan. “Connectedness of healthcare professionals involved in the treatment of patients with Parkinson’s disease: a social networks study.” Implementation Science 6, no. 1 (2011): 67. (22 references)
This study paints an interesting picture of connectedness among healthcare professionals. It appears that the term “connectedness” in this study was treated loosely to represent professional relationships in the course of clinical duties. The study focused primarily on describing and analyzing connectedness in a regional network of health professionals involved in the ambulatory treatment of patients with Parkinson’s disease (PD). One hundred four health professionals who had joined a new network were asked to complete a pre-structures form to report on their professional contacts with others in the network. Results of the study show that those professionals who are affiliated with a hospital, and who have more patients and caseloads, tend to have stronger connectedness with other healthcare professionals. At first, this study may seem irrelevant, but upon further reflection, one could see how connectedness may positively or negatively impact clinical decision-making and coordination of patient care. The perspective of Wensing and his colleagues may have implications for pastoral care and clinical pastoral education. This perspective may trigger useful debate concerning the future relationship of chaplains to the specific sectors of the interdisciplinary team. It also has the potential of helping the chaplain identify staff members who might be at risk of burnout.
Osaba, Maria-Antonia Campo, Del Val, José-Luis, Lapena, Carolina, Laguna, Vicencia, García, Araceli, Lozano, Olga, Martín, Ziortza, et al. “The effectiveness of a health promotion with group intervention by clinical trial. Study protocol.” BMC Public Health 12, no. 1 (2012): 209. (22 references)
Empowering people to achieve their health goals is important for chaplains. There is a complexity in the disease dynamics that is grounded in our human natures. This dynamic is further complicated when one’s behavior and life habits facilitate the onset and progress of the disease process. The authors of this study identified these risk factors of negative life habits and have developed what they call “Health Workshops.” This study evaluates the effectiveness of these health workshops as it relates to certain markers, such as health-related quality of life, diet, physical activity, and elimination of cardiovascular risks. This intervention is designed as an eight-week group session, in which the individual takes full responsibility and ownership of his or her own health and self-care. This proposal is modeled after Virginia Henderson’s 14 components of the holistic person. The changes, if put into practice, would be transformative for the individual. Many of these components are dear to the heart of the chaplain. In the end, it is up to the individual to work toward specific health goals.
Austine Duru is staff chaplain at Franciscan St. Margaret Health in Dyer, IN.
Are you involved in research on a topic related to chaplaincy? Looking for a venue to publish? Vision would be interested in learning about your research effort. Contact Austine Duru at [email protected] or the Vision editor at [email protected].