By Austine Duru
Research has shown that resiliency can be learned and cultivated. A recent publication by Rakesh, G., Pier, K., & Costales, T.L. (2017), “A call for action: Cultivating resilience in healthcare providers,” in the American Journal of Psychiatry Residents’ Journal, explores several aspects of resiliency practices and ways to inspire hope. Hope is a theological language that references, in broad terms, the confidence in God’s ability to improve one’s circumstances. At the heart of this is a desire and conviction that things will get better. This generally leads to a sense of resiliency. The authors define hope as “the ability to adapt successfully in the face of trauma, adversity, tragedy, or significant threat.” This does not come easy for most people, especially those who do not practice any religion, or those whose faith is shaken by life’s adversity. It is common knowledge that healthcare providers have one of the highest rates of burnout, including chaplains, who are often relied on to help address the moral distress of their colleagues, along with the spiritual care of patients and families. The article uses a clinical vignette of “Dr. B,” a third-year internal medicine resident, to illustrate the problems of burnout among healthcare providers and the importance of action to address it. Although this article focuses on physician burnout, its practical ideas will be useful for chaplains who counsel peers and other healthcare professionals in time of crisis.
In times of crisis, chaplains understand the importance of attending to psychosocial and spiritual health. The COVID-19 pandemic is a health crisis unprecedented since the last century. How individuals and organizations respond to its toll will determine how quickly recovery might happen. For insights we turn to Heath, C., Sommerfield, A., & von Ungern‐Sternberg, B. S. (2020), “Resilience strategies to manage psychological distress among healthcare workers during the COVID‐19 pandemic: a narrative review” Anaesthesia, 75(10), 1364-1371. This article reviews available research literature on the impact of the COVID-19 pandemic on frontline workers, including clinicians. It highlights some best practices that are practical, proactive, and holistic in increasing healthcare workers’ resilience. An interesting discovery is that “organizational justice – workplace cultures that ensure fairness, respect and social justice in the workplace” can play a huge role. This article provides valuable just-in-time strategies for leaders to encourage resilience in the workplace during a major crisis. The list of the concerns of healthcare workers is a valuable information for any chaplain involved in staff support, ethics committees, or resilience programs.
Spiritual resilience is an essential antidote to spiritual exhaustion, which is often identified as an occupational hazard for chaplains. Spiritual resilience is therefore the ability to build physical and spiritual endurance in ministry (Torres-Chinea, J. M., 2020), as one adapts to the changes and challenges in one’s ministry that induces debilitating stress. An article by Pandya, S. P. (2019) in Journal of health care chaplaincy, 1-17 offers an interesting tool for chaplains in the form of a meditation smartphone app (M-App), which targets burnout and builds resilience among chaplains. The results of this one-year study piloted in a nursing home show a significant emotional and professional benefit for chaplains who utilized the M-App meditation tool frequently. Chaplains in the study cohort reported “lesser emotional exhaustion and depersonalization as burnout markers and higher personal achievement and resilience as compared to leisure app (L-App) users.” An important takeaway for chaplain leaders is that integrating new tools in the promotion of wellbeing for chaplains is essential for the emotional health of the team.
Practices that integrate body, mind, and spirit have been effective in combating caregiver fatigue and burnout. Integrative interventions have been trending during the worst emotional impacts of the COVID-19 pandemic. A recent study in International Journal of Environmental Research and Public Health 18(5), 2515, by Heeter, C., Allbritton, M., Lehto, R., Miller, P., McDaniel, P., & Paletta, M. (2021), investigates providing yoga-based meditation for healthcare professionals who still toil under the shadow of the pandemic. The results of this survey, which used the Professional Fulfillment Index for burnout and the Multidimensional Assessment of Interoceptive Awareness scales for mind-body integration, “showed that the yoga-based meditation intervention was feasible and acceptable and associated with higher interoceptive awareness. The results point to a role for interoceptive awareness in reducing the risk for burnout.” This is a meaningful article for anyone seeking creative, adaptable, cost-effective, and individually tailored resources for front-line workers experiencing COVID-19 fatigue and needing to strengthen resiliency. This is especially true in situations where religion or faith, for whatever reasons, are not options for strengthening hope.
When hope is in short supply and resources are limited, the ability to imagine a better future becomes an essential ingredient for renewed hope and religious coping. Understanding the mechanism for inspiring hope and mitigating the negative effects of a major health crisis on well-being was the focus of a recent study in The Journal of Positive Psychology, 1-12 by Counted, V., Pargament, K. I., Bechara, A. O., Joynt, S., & Cowden, R. G. (2020), titled Hope and well-being in vulnerable contexts during the COVID-19 pandemic: does religious coping matter? The authors suggest that while hope is essential, sometimes it is not enough. To be effective, hope requires positive religious coping. The study shows that higher levels of well-being are positively correlated with higher levels of religious coping and of hope. This study is insightful because it discusses the importance of introducing mechanisms that promote quicker recovery, especially in resource-challenged institutions or areas with notable social-structural limitations.
A similar study by Mosley, D. V., Neville, H. A., Chavez‐Dueñas, N. Y., Adames, H. Y., Lewis, J. A., & French, B. H. (2020) titled Radical hope in revolting times: Proposing a culturally relevant psychological framework in Social and Personality Psychology Compass, 14(1), e12512 explores the relationship of psychological well-being and the concept of “radical hope” (collective memory, faith, and agency), from the racial and ethnic framework. Four pathways to radical hope include “(a) understanding the history of oppression along with the actions of resistance taken to transform these conditions, (b) embracing ancestral pride, (c) envisioning equitable possibilities, and (d) creating meaning and purpose in life by adopting an orientation to social justice.” Another study that explores the concept of hope and resilience from a family resilience framework was done by Walsh, F. (2020). Loss and resilience in the time of COVID‐19: Meaning making, hope, and transcendence, Family process, 59(3), 898-911. This article highlights some of the benefits of applying the family resilience framework, which draws from shared belief systems and meaning-making, to the experience of a major pandemic.
The idea of a resiliency group program for healthcare staff might appeal to some chaplains. If this is true for you, the following study might be relevant. Park, E. R., Sylvia, L. G., Streck, J. M., Luberto, C. M., Stanton, A. M., Perez, G. K., … & Wilhelm, S. (2021). Launching a resiliency group program to assist frontline clinicians in meeting the challenges of the COVID-19 pandemic: Results of a hospital-based systems trial. General hospital psychiatry, 68, 111.This study focused on learning how facilitated relaxation response techniques, mindfulness, cognitive behavioral therapy might help decrease work-related stress during a pandemic. Across a large health system, this study showed decreased COVID-19-associated distress and improved resilience. The program is adaptable and easy to replicate. The Pre/Post treatment outcomes in Table 1 provide interesting visual summary.
We conclude with a review of a recent international survey that explores the impact of COVID-19 pandemic on chaplains during the first wave of the pandemic. Specifically, the study sought to understand how chaplaincy care has changed and the impact on chaplains, patients, staff, and the organizational culture. Vandenhoeck, A. (2021). The Impact of the First Wave of the Covid-19 Pandemic on Chaplaincy in Health Care: Introduction to an International Survey. Journal of Pastoral Care & Counseling, 75(1_suppl), 4-5. The study was first conceived by The European Research Institute for Chaplains in HealthCare and soon drew the interest of chaplain groups in the US, Australia, Belgium. 1,657 chaplains (including some NACC members) participated in the survey. The survey results shed some light on remarkable ways the pandemic impacted chaplaincy services across the globe, including the challenges around PPEs, furloughs, role confusion, learning gaps, increased responsibilities, staff support, emotional drain, and compassion fatigue. It also confirmed the creativity and resilience of chaplains in adapting to the situation and rising to the challenge. The authors took time to extend their gratitude to all chaplains for their dedication and care during a challenging time and honored those who lost their lives in the process.
Austine Duru, BCC, is vice president of mission with Bon Secours Mercy Health in Ohio.