Just in Time! Pastoral Prayers in Public Places (Just in Time! (Abingdon Press))

Only 2 left in stock more on the way. Ten Questions Every Pastor Fears: Answers Included Feb 01, Only 20 left in stock - order soon. Pastoral Prayers in Public Places Apr 01, Only 1 left in stock - order soon. Life in the Fish Bowl: Provide feedback about this page. There's a problem loading this menu right now. Get fast, free shipping with Amazon Prime. Get to Know Us. English Choose a language for shopping. Amazon Music Stream millions of songs. The letter to the Romans, in part, prepares them and gives reasons for his visit. First, Paul was a Hellenistic Jew with a Pharisaic background see Gamaliel , integral to his identity: His concern for his people is one part of the dialogue and runs throughout the letter.

The most probable ancient account of the beginning of Christianity in Rome is given by a 4th-century writer known as Ambrosiaster: It is established that there were Jews living in Rome in the times of the Apostles , and that those Jews who had believed [in Christ] passed on to the Romans the tradition that they ought to profess Christ but keep the law [Torah] One ought not to condemn the Romans, but to praise their faith, because without seeing any signs or miracles and without seeing any of the apostles, they nevertheless accepted faith in Christ, although according to a Jewish rite.

The occasion of writing the epistle: Paul had made acquaintance with all circumstances of the Christians at Rome At this time, the Jews made up a substantial number in Rome, and their synagogues , frequented by many, enabled the Gentiles to become acquainted with the story of Jesus of Nazareth. Consequently, churches composed of both Jews and Gentiles were formed at Rome. According to Irenaeus , a 2nd-century Church Father , the church at Rome was founded directly by the apostles Peter and Paul.

Many of the brethren went out to meet Paul on his approach to Rome. There is evidence that Christians were then in Rome in considerable numbers and probably had more than one place of meeting. Note the large number of names in Romans Verse 5 mentions a church that met in the house of Aquila and Priscilla. Verses 14 and 15 each mention groupings of believers and saints. Jews were expelled from Rome because of disturbances around AD 49 by the edict of Claudius. Fitzmyer argues that with the return of the Jews to Rome in 54 new conflict arose between the Gentile Christians and the Jewish Christians who had formerly been expelled.

Scholars often have difficulty assessing whether Romans is a letter or an epistle , a relevant distinction in form-critical analysis:. A letter is something non-literary, a means of communication between persons who are separated from each other. Confidential and personal in nature, it is intended only for the person or persons to whom it is addressed, and not at all for the public or any kind of publicity An Epistle is an artistic literary form, just like the dialogue, the oration, or the drama.

It has nothing in common with the letter except its form: The contents of the epistle are intended for publicity—they aim at interesting "the public. Joseph Fitzmyer argues, from evidence put forth by Stirewalt, that the style of Romans is an "essay-letter. There are also many "noteworthy elements" missing from Romans that are included in other areas of the Pauline corpus. Baur in when he suggested "this letter had to be interpreted according to the historical circumstances in which Paul wrote it.

Paul sometimes uses a style of writing common in his time called a "diatribe". He appears to be responding to a "heckler" probably an imaginary one based on Paul's encounters with real objections in his previous preaching , and the letter is structured as a series of arguments. In the flow of the letter, Paul shifts his arguments, sometimes addressing the Jewish members of the church, sometimes the Gentile membership and sometimes the church as a whole.

To review the current scholarly viewpoints on the purpose of Romans, along with a bibliography, see Dictionary of Paul and His Letters. In his prologue to his translation of the book of Romans, which was largely taken from the prologue of German Reformer Martin Luther , Tyndale writes that:. The sum and whole cause of the writings of this epistle, is, to prove that a man is justified by faith only: And to bring a man to the understanding and feeling that faith only justifieth, Paul proveth that the whole nature of man is so poisoned and so corrupt, yea and so dead concerning godly living or godly thinking, that it is impossible for her to keep the law in the sight of God.

This essay-letter composed by Paul was written to a specific audience at a specific time; to understand it, the situations of both Paul and the recipients must be understood. The introduction [Rom 1: He introduces his apostleship here and introductory notes about the gospel he wishes to preach to the church at Rome. Jesus' human line stems from David. Paul's goal is that the Gentiles would also hear the gospel. He commends the Romans for their faith. These two verses form a backdrop for the rest of the book. First, we note that Paul is unashamed of his love for this gospel that he preaches about Jesus Christ.

He also notes that he is speaking to the "Jew first. We are hard-pressed to find an answer to such a question without knowing more about the audience in question. Paul may have used the "Jew first" approach to counter such a view. Paul now begins into the main thrust of his letter.

Join Kobo & start eReading today

He begins by suggesting that humans have taken up ungodliness and wickedness for which there will be wrath from God. Paul draws heavily here from the Wisdom of Solomon. Several scholars believe the passage is a non-Pauline interpolation. On the traditional Protestant interpretation, Paul here calls out Jews who are condemning others for not following the law when they themselves are also not following the law.

Stowers writes, "There is absolutely no justification for reading 2: That popular interpretation depends upon anachronistically reading later Christian characterizations of Jews as 'hypocritical Pharisees '". Paul says that a righteousness from God has made itself known apart from the law, to which the law and prophets testify, and this righteousness from God comes through faith in Jesus to all who believe.

In chapters five through eight, Paul argues that believers can be assured of their hope in salvation , having been freed from the bondage of sin. Paul teaches that through faith , [3: In chapters 9—11 Paul addresses the faithfulness of God to the Israelites , where he says that God has been faithful to his promise. Paul hopes that all Israelites will come to realize the truth [9: In Romans 9—11 Paul talks about how the nation of Israel has been cast away, and the conditions under which Israel will be God's chosen nation again: From chapter 12 through the first part of chapter 15, Paul outlines how the Gospel transforms believers and the behaviour that results from such a transformation.

This transformation is described as a "renewing of your mind" Paul goes on to describe how believers should live. Christians are no longer under the law, that is, no longer bound by the law of Moses, [39] but under the grace of God, see Law and grace. We do not need to live under the law because to the extent our minds have been renewed, we will know "almost instinctively" what God wants of us. The law then provides an "objective standard" for judging progress in the "lifelong process" of our mind's renewal.

Fitchett and Gray found that CPE students showed positive change in counseling resources, facilitative relations and non-judgmental acceptance. These improvements were greater for students with no prior CPE experience and for students with fewer years of professional ministry.

This research needs to be replicated and more investigation is needed into the role of skills developed in CPE, the use of these skills in chaplaincy delivery, and the impact of these skills on patient outcomes. There are a few examples of endeavors to establish chaplaincy best practice. Pruyser proposed an example of ministry practice informed by diagnostic classifications. VandeCreek and Lucas edited a volume devoted to outcome-oriented chaplaincy, a method of focusing chaplaincy practice beyond the core of pastoral presence and relationship to include assessment and measurement of patient outcomes.

Research directly investigating the implementation of this approach and its impact of in chaplaincy is greatly needed. In addition to standards of practice for chaplains, the standards for specific kinds of patient care are increasingly requiring that spiritual care needs be met. Hospital standards set forth in by The Joint Commission JC , which accredits most US hospitals, require hospitals to address the spiritual needs of patients Joint Commission, The standards for palliative care from the National Quality Forum specify the inclusion of spiritual care in the delivery of palliative care, but do not specifically include chaplaincy National Quality Forum, The National Comprehensive Cancer Network NCCN guidelines for practice in adult cancer pain specify evaluations of patient spiritual and religious considerations.

The guidelines for palliative care mention chaplains as a part of the interdisciplinary team, and the guidelines for distress management require the inclusion of a certified chaplain experienced in psychosocial aspects of cancer NCCN, There are a number of published descriptions of what chaplains do. These descriptions are helpful in describing the scope and breadth of chaplaincy practice including ministry to families, working with the bereaved, use of various interventions, and use of religious rituals and prayer.

However, many of these studies are restricted to a few hospitals e. New York Chaplaincy Study or particular practice settings like oncology or neonatology. Further, while it is clear that some chaplains do each of these practices, it is not clear how widespread any of them are. Finally, while there is increasing evidence describing what chaplains do, there is virtually no evidence for how well they do it and what results ensue.

With quality being such a central issue in modern health care, this is a serious gap in our knowledge. What Do Chaplains Do? Chaplains address patient issues and concerns such as existential questions, spiritual pain and the sacred. They are able to work with religious patients as well as the increasing number of patients without a specific religious identity Newport, b. Chaplains engage patients and help them reframe their situation to reduce suffering.

Chaplains begin with a focus on the patient and the current situation, and assess all factors that could be potentially contributing to stress and suffering. They propose a plan to address the spiritual suffering, help the person immediately, and then follow-up with a plan to ensure benefits.

This conceptualization again suggests how the role of chaplains is changing. In the past, the chaplain could truly have no agenda because they were not seen as contributing to the general plan of care. As this presumption disappears, chaplains increasingly are seeing themselves and being seen as professionals with a definite agenda- to promote spiritual healing.

To promote spiritual healing, many chaplains conduct a spiritual assessment and create a spiritual care plan which is not to be confused with a spiritual screening. Fitchett and Canada have helpfully differentiated spiritual screening, spiritual history, and spiritual assessment. Screening is a few simple questions asked by any health care personnel that identify a person in serious spiritual crisis and who needs immediate referral to a chaplain.

Spiritual history taking requires more time and more questions to identify specific religious needs and resources of the patient. The assessment requires the training of the professional chaplains and should only be done by someone with that training. The chaplain should assess the degree to which the patient may be experiencing issues of purpose and meaning, loss of any of the many aspects of self control, or spiritual pain and suffering Millspaugh, a.

There is currently no research to determine how often chaplains actually do a formal spiritual assessment vs. Nor is there extensive research on the content of assessments. There is no research on the relationships between assessment content, interventions, and outcomes. VandeCreek and Lucas proposed a system that includes all three, but there does not seem to be any research on whether the components wind up being related in any way.

As electronic medical records become universal, it may well be that chaplains will be automatically called upon to assess and help specific patients as part of the hospital protocol which will require specific assessment methods LaRocca-Pitts, Again, this lack of predictability and consistency is likely to be an issue in any research on chaplaincy care.

Interestingly, a new perspective on what chaplaincy care might offer comes from the research of a psychiatrist, Harvey Chochinov, who developed Dignity Therapy DT; Chochinov, In most instances, these transcripts will be left for family or loved ones, and form part of a personal legacy that the patient will have actively participated in creating. The intervention was well tolerated, even in the sickest patients. The sessions averaged 55 minutes range: Notably, protocol burden was not an issue for patients, perhaps because they only spoke to issues important to them.

Potentially adverse events, such as revealing a hurtful reality insensitively, occurred but were all sufficiently well managed that none reported negative consequences. Staff responses to the trial have been uniformly, overwhelmingly positive. Practitioners felt it was a viable treatment option, especially in circumstances of existential distress. A phase 3 trial of DT has been completed Harvey Chochinov, personal communication. This personal report from Dr. Differences were not detected on depression, anxiety and grief scales.

Randomly selected cases were also captured and are being subjected to qualitative analysis studies; preliminary data indicate high levels of appreciation expressed differently from features captured on available scales. For instance, one woman, hearing from her dying father for the first time that he loved her, expressed its value as priceless. Possible explanations for the dramatically positive personal report and the null findings for psychiatric conditions are several; a prominent possibility is that the intervention is primarily spiritual.

If so, possibly DT would be most suitably administered by chaplains. Current studies are evaluating the impact of DT on settledness and peacefulness regarding life-sustaining-care and terminal care decisions. Thirteen percent of respondents never referred to clergy or pastoral care providers. While this study is informative, it does not specifically ask about chaplains, nor is there a way to determine the rate of actual referral. There is some evidence of physicians having a positive attitude in general toward chaplains.

Flannelly, Handzo, Weaver and Smith surveyed hospital administrators and asked them how important they felt chaplains were for the following listed activities: Chaplains were judged to be important for all of the listed roles with end-of-life care and emotional support being the most highly valued. Hospital administrators with chaplaincy care departments suggested additional roles for chaplains not on the list, such as drug counseling and teaching multicultural sensitivity, community liaison and outreach, crisis counseling and debriefing for staff, grief and bereavement counseling, advanced directives education, participating on a palliative care team, and handling organ and tissue donation requests.

Galek, Flannelly, Koenig and Fogg surveyed a national sample of directors of medical, nursing, social services and chaplaincy care departments. Directors of chaplaincy care felt it was more important than the other directors to refer patients to chaplains. Directors in psychiatric hospitals were less likely to refer to chaplains than other directors. These findings suggest that there is a general consensus that chaplains must be doing something to address these needs. In comparison to the study above, a study of chaplain referrals in an acute care community hospital with beds found that patients were more likely to be referred to chaplains than were family members by 3: Staff referred patients to chaplains for many different reasons.

Other reasons included crying, depression, and difficult decision. Problematically these reasons for referrals are not clearly exclusive of one another, for instance pregnancy loss is an event that could also involve crying, depression, or anxiety and require the support and pastoral care of a chaplain.

Only three kinds of referrals hint at what chaplains might be doing: Patients were more likely to be referred for anxiety, depression and pregnancy loss while family members were seen due to death of patient, bereavement, and support and pastoral care. Again it should be noted that these reasons for referral are not exclusive and can be collapsed, into depression and anxiety for patients and death and bereavement for families. Spiritual concerns were indicated only if a patient clearly exhibited spiritual distress or requested religious items. It is entirely possible that emotional reasons for referrals could have been unrecognized spiritual issues, i.

Reasons for referral are also markedly different depending on whether or not the person was asking for a chaplain.

Weinberger-Litman, Muncie, Flannelly and Flannelly studied intent to refer patients or families to chaplains in nurses in one hospital in New York City. Nurses were provided with short statements describing different patient or family situations the nurse might encounter on the job, such as having a family dealing with the death of a patient, the removal of life support from a patient, or emotional discussions with a palliative care patient.

Nurses were asked how likely they were to refer to a chaplain to help in each situation. Nurses were moderately or very likely to refer in situations that dealt with death, grief and negative emotions. The nurses were only slightly likely to refer patients who were upset about quality of care or patients who were being non-compliant in taking medications, two situations that can escalate to crisis situations in which chaplains are often called Johnson, Finally, Galek, et al.

The most common reason for a referral to a chaplain was that the patient requested a visit. Patients and families most often requested the visit to meet religious needs, including prayer and religious ritual needs. The next most frequently stated needs were related to illness or treatment and end-of-life issues, followed by emotional issues, such as depression, distress or anxiety, and pre-operation needs.

When staff referred chaplains to patients, the chaplains most often observed negative affect such as grief, sadness and anxiety. This might be because doctors, nurses, social workers and other staff were more likely to refer a patient to a chaplain for emotional or end-of-life issues. Whereas patients or family members asked for chaplains to visit more often for religious needs or medical issues, and the most common affect reportedly seen by chaplains was gratitude. These surveys on referrals provide for some general impressions on what is expected from chaplains.

Hospital administrators and staff tend to refer patients to chaplains to get them help with emotional issues, end-of-life, and death and dying issues, while patients and families request a chaplain and expect chaplains to help with religious, spiritual, and emotional needs. While this is important initial evidence about what chaplains are hoped or expected to provide, it is not clear what chaplains actually do or how well they do it.

• Mighty Man of Valor:One Man Against the Odds.
• Monument to Murder (DCI Kate Daniels Book 4).
• Temple Worlds: Secret Lies Within (Sequetus Series Book 14)?
• The Fate of Sudan: The Origins and Consequences of a Flawed Peace Process.
• Up Close.

A prayer request could be due to religious, spiritual or social needs of the patient or the particular perceptions of the person making the request e. The list of reported situations to which chaplains are referred and, to some extent the interventions they make, can also be significantly affected by factors unrelated to the unique training and contributions of chaplains. Thus, a hospital with a very robust chaplaincy department but a very weak social work department will likely generate many more referrals to chaplains for emotional issues than a hospital where the situation is reversed.

In some hospitals, chaplains bear primary responsibility for talking to patients about advance directives. In other hospitals, that task falls to patient advocates or social workers. In many hospitals, the referral pattern to chaplains is significantly related to the interests and skills of the particular chaplains on the staff. Finally, the referral categories are often poorly defined and are not standardized across studies. The data for these studies was obtained through chaplain self-report: The form required predetermined information about who they visited, how long they visited and what they did during their visit.

In one study, Handzo et al. Seventeen chaplain activities were listed: It is important to keep in mind that the data reported in this series of studies consisted of self-reports on a predetermined form by chaplains and chaplain students. Furthermore, the form was filled out by individuals with considerable difference in professional abilities and education. The intervention information does not differentiate between interventions done by board certified chaplains or students. It is possible that the methods used by each group were significantly different in delivery and outcome.

There was only a limited glossary to define terms. There was no documented corroboration with patients on the reason for referral or patient needs. In another study in one oncology hospital, chaplain activity varied depending of diagnosis and circumstances of the visit Flannelly, Weaver and Handzo, Scripture reading occurred most often during pre-op visits and faith affirmation and emotional enabling occurred more frequently with family member of patients in respiratory arrest. In addition, type of activity varied depending on the religious tradition of the patient.

These activities changed in priority somewhat during treatment visits. Emotional enabling was the most frequent activity with the chaplain for these latter three groups during treatment. For instance, the ministry to Muslim patients was conducted almost entirely by the Imam Flannelly, Weaver and Handzo, Also, as with prayer, there was significant variability of each activity across chaplains despite the fact that all were CPE trained. Thus, there is great need for additional research to explore whether these differences will be sustained or were an artifact of the one study.

Montonye and Calderone examined chaplain reports of their activities in a bed acute care hospital in Massachusetts. In this study, the chaplains included board certified chaplains, chaplaincy students and Roman Catholic priests.

The staff reported patient needs, chaplain interventions, and patient outcomes over a two year period for each patient seen. The reports were limited to drop-down responses on a computer screen for each category. The choices of chaplain interventions were limited to: Chaplains and visitors made determinations of needs in dialogue with those being helped.

There were some differences in types of interventions engaged in depending on whether the intervention was provided by a CPE student, interfaith chaplain, or Roman Catholic priest. However, patients were assigned to chaplains or priests based on degree of difficulty and chaplain skill sets, so no definitive conclusions about interventions and kind of chaplain can be made.

Visits before a surgery or at the death of a patient incorporated prayer for most patients, and Muslim and Catholic patients received prayer more often than Protestant or Jewish patients. Professional chaplains have a foundational clinical background that should enable them to anticipate a need for prayer and to ask patients what they would like to pray for. In addition to prayer, chaplains, based on their training, develop rituals which are acceptable to people from a variety of spiritual traditions.

Rituals bring communal meaning to chaos. For example, chaplains may develop non-religious ritual services for dying patients. These studies begin to give a picture of what chaplains do, however, they mostly deal with one or a small number of hospitals in roughly the same geographic area, the Midwest to North Atlantic states. Despite the apparently adequate sample sizes, it is still likely that the reported activities were significantly affected by the peculiarities of individual hospitals rehabilitation hospital vs.

It is expected that more research will replicate and expand these findings. As such, they should be intimately involved in treatment decisions.

Chaplains can and often do play a valuable role in bridging this gap. Indeed, Gillman and his colleagues see chaplains as a vital link between family members and the treatment team, especially in critical care situations. Only eight percent of families with an infant in the NICU interacted with a chaplain. Eighty-three percent of chaplain-initiated visits were for non-decedent care for the support of the parents of an extremely ill child. Nurses and physicians reported that, in addition to the above, chaplains helped with the assessment of parental coping, comforted the medical staff, and took part in morally problematic decisions in the NICU.

Although it appears that chaplains saw more family members than patients, the percentages are somewhat inflated due to counting each family member present during a single patient visit. For example, if there were four family members in the room with a patient when a chaplain visited, the patient was counted once, and family contacts were counted as four. Even though the study also measured the frequency of worship services and sacramental functions, and estimated the time spent in each, it did not identify the extent that patients, family, or staff benefitted from these activities.

Neither did the report examine what was done during the visits or identify how often families or patients received follow-up visits. Broccolo and VandeCreek interviewed next-of-kin, asking two open-ended questions that inquired about what the chaplain did or said, and the degree to which the contact with the chaplain was helpful. The descriptions of what the chaplain did fell into five categories: The chaplains in these studies rate such types of activities as being more important than performing religious rituals or services. Administrators who were surveyed shared the same perspective as chaplains about the importance of providing emotional support to family members.

Much of the evidence on ministry to families basically states the obvious e. Again, while we know something about the kinds of situations that chaplains are called to be part of, we continue to know very little about what they do in those situations and what outcomes those interventions produce. A chart of what chaplains do can be found in Appendix One. Section Three —Research on Chaplaincy Outcomes. Research into chaplaincy outcomes falls roughly into two general categories - patient satisfaction studies and outcome studies of actual chaplaincy interventions.

The patient satisfaction studies are generally stronger methodologically than the outcome studies and tend to show that chaplain visits have a positive effect on overall patient satisfaction. However, in general, they do not give any indication of whether the patient benefits from the visits. It is also not clear whether the same results could not have been achieved by professionals from other disciplines or trained volunteers. The outcome studies are very few in number and most have serious methodological shortcomings. Thus, we have included some research from outside the inpatient acute care setting to obtain a broader horizon of chaplaincy research.

In terms of levels of evidence, the research literature does not offer well established findings to date. All studies are in need of targeted and enhanced replication, and most are only suggestive and certainly not conclusive. A table summarizing pertinent studies of patient satisfaction with chaplaincy may be found in Appendix Two, Table 1, and chaplaincy outcome studies can be found in Appendix Two, Table 2. Spiritual care is an important facet of overall health care. Families rated the facilities more positively when spiritual care needs were met. In another study, Astrow, Wexler, Texeira, He and Sulmasy found that patients who did not have their spiritual care needs met were less satisfied with their health care.

Those goals are often influenced by spirituality and religion Phelps et al. Chaplains are the professionals with special training to offer competent spiritual care. Parkum surveyed patients from six hospitals to compare the helpfulness of different nonmedical support services. Approximately two thousand former hospital patients or family members who were surveyed returned the mailed questionnaire. VandeCreek examined visits by clergy and chaplains and the frequency of religious service attendance, both in the hospital and before hospitalization, among other variables, in relation to satisfaction.

Results indicated that older individuals, those with lower education levels, those who attended church before hospitalization, and those who had shorter stays were more likely to rate satisfaction with chaplaincy care higher than those individuals with more education, those who did not attend church, and those who had longer hospital stays. The chaplain was seen by many as a person with spiritual sensitivity and someone who helped people find ways to cope.

Overall satisfaction was correlated with all measures of chaplain activity. Gibbons, Thomas, VandeCreek and Jessen examined the satisfaction with chaplain and spiritual services of over patients who had recently left the hospital. Just under half of the former patients had received a visit from a chaplain, and half of these had also been visited by clergy.

About a third received a visit from a social worker, and a third from a patient representative. It must be noted, however, that ratings of importance and expectations met were on a scale of 1 to 10, and the level of importance for chaplains was 5 and expectations was 6. This study also looked at spiritual needs, such as the need for support and counseling for patient and family, the need for prayer, and need for sacraments. Support and counseling needs being met were associated with recommending the hospital to others and selecting the hospital again.

Meeting prayer and sacramental needs were not related to recommending the hospital to others. Notable limitations of this study were a VandeCreek and Connell further examined, using the same dataset as Gibbons et al. These were all rated around 6 on a scale of 1 to 10, with sacraments for Catholics being rated as 7. There were significant differences between Catholics and Protestants in several of the outcome measures.

As in Gibbons et al. There is no comparison of chaplains with social workers, patient representatives or clergy. The authors conclude that patients were satisfied with the services rendered. Flannelly, Oettinger, Galek, Braun-Storck and Kreger evaluated the impact of chaplaincy services by focusing on the satisfaction with chaplains in a hospital that specialized in orthopedic surgery. Only patients who requested a visit from the chaplain at check-in were visited by a chaplain.

Interventions used by chaplains varied across patients and included praying, listening and providing help to overcome fears. While there is good evidence now that patients like chaplains and that chaplains have a positive effect on patient satisfaction scores, it is not at all clear what chaplains do, or could do better, that patients find helpful or satisfying.

Many of the activities listed in the studies are not clearly defined. Chaplain helpfulness on average was rated between very good and excellent. This highlighted the fact that many family members did not know what to expect from a chaplain. The majority of those who were helped had a lasting positive impression of the chaplain and the help they received. Chaplains have been involved in research both investigating the impact of their ministry on individuals as well as assisting others as part of an interdisciplinary team.

There are a few studies worth mentioning in detail in this section. Chaplains helped deliver spiritual interventions as part of an effort to improve quality of life in advanced cancer patients Rummans et al. Patients were randomly enrolled in either a treatment as usual condition or an intervention condition. While in the hospital and undergoing radiation treatments for advanced cancer the intervention patients received at least five and up to eight minute intervention sessions that included physical therapy, cognitive, emotional, social and spiritual interventions, and minutes of guided relaxation.

Intervention patients also received a page manual with written materials that covered all of the eight manualized sessions. The treatment as usual control group received the same standard of medical care, including meetings with their oncologist and support group resources. At four weeks follow-up, intervention patients were reporting significantly greater quality of life than patients in the control group.

Ratings of spiritual well-being were also significantly higher in the intervention group at four weeks. Notably, the control group decreased in quality of life and spiritual well-being from baseline to week four. By five months follow-up these differences were no longer significant, as the control returned to baseline levels, as did the intervention group. Although the spiritual domain was the domain to show the most improvement it is not possible to document the influence of the chaplain on this process.

The chaplain was part of a comprehensive care team that included three physicians, a social worker, a nurse, a pharmacist, a psychologist, an art therapist, and a volunteer coordinator. The chaplain was responsible for offering spiritual and psychological support. Patients were offered support groups and weekly telephone contacts from medical and pharmacy students.

Unfortunately, it is impossible in this study to estimate the particular contribution of the chaplain, or any individual professionals involved in patient care, to the overall improvement in patient well-being. Even though there is much diversity in setting, population served, and activities engaged in, several studies have attempted to measure the impact of chaplaincy on patient and family outcomes. Baker conducted an intervention study in a church-related continuing care retirement community in an effort to demonstrate the efficacy of pastoral care in treating depression and the negative impacts of changes in life circumstances.

He divided the elderly participants into three groups; individuals taking anti-depressant medication, individuals at-risk for depression and individuals selected after a weekly religious service. Each of these three groups was again divided into two groups; those receiving weekly pastoral visits and those not receiving weekly pastoral visits. There were no limits on the kinds of pastoral care provided to the adults in the pastoral care group.

The pastoral visits lasted about 30 minutes each and continued for 26 weeks. The visits were conducted by four ordained ministers who were serving area congregations, two ministers had a minimum of one unit of clinical pastoral education and two had no clinical training. Religiosity, religious practice, spiritual well-being, self-transcendence, depression and social participation were all measured before the pastoral visits began, after six months of visits, and three months after visits ceased.

Group averages did change in expected ways that suggest a positive impact of pastoral visits. Pastoral visits were associated with higher religious and spiritual well-being scores and lower depression scores at post-test. Compared to the control group, the pastoral visit group had significantly higher religious and spiritual well-being at posttest. However, there were no significant differences between groups at three months follow-up, and in fact, the pastoral visit group had the highest average levels of depression at follow-up compared to the control group.

www.newyorkethnicfood.com: F. Belton Joyner: Books, Biography, Blogs, Audiobooks, Kindle

The results of this study should be considered descriptive in nature, due to the nonstandard reporting of group sizes, means, and statistical results, multiple comparisons made using a t test which increases the chance of identifying a group difference as significant when it is not, and the examination of subgroups not originally identified before the start of the study. The results of this study are suggestive and in need of replication. Each chaplain followed a protocol for each visit. Also at 6 month follow-up, negative religious coping on the RCOPE as seen in statements that reflected feelings of abandonment and questioning of God, was significantly lower in the intervention group compared to the control group.

This is an important finding, given that patients with negative religious coping and struggle are at a higher risk for health complications Fitchett et al. However, the meaningfulness of these differences is to be determined, given that the magnitude of these average differences is quite small- on average no more than the equivalent of one point on a scale that can range from a score of 7 to Additionally, there was no significant difference between the intervention group and control group in level of depression over time, likely due to the fact that the levels of depression of participants in this study were at the low end of the normal range and not in the clinical range.

The other mental health outcomes measured- anxiety, hope, and religious problem solving, showed no differences between the intervention group and control group over time or at any point in time. Thus, while the chaplaincy intervention did not have the expected impact on mental health, the same intervention may yield much different results in patients with more compromising illness manifestations, for whom there would be more room for improvement on psychological measures of well-being and distress.

In a study with patients with a more compromising diagnosis the impact of chaplaincy care was more dramatic.

Reward Yourself

Chaplain visits to patients with chronic obstructive pulmonary disease COPD in an inpatient setting were studied by Iler, Obenshain and Camac They are often admitted to the hospital when the disease flares, and they can remain hospitalized for a considerable length of time, and require substantial hospital resources. Those that agreed to participate were given the Beck Anxiety Scale both at admission and at discharge. Participants were assigned to one of two groups, patients who received daily chaplain visits during the hospital stay and patients who did not.

Chaplain activities were not standardized across patients or visits and lasted approximately 20 minutes. At discharge, patients were also asked about their satisfaction with the hospital and whether they would recommend the hospital to others. Patients who received chaplain visits had significantly lower anxiety, shorter hospital stays, and were more satisfied with the hospital stay than patients who did not receive chaplain visits. While it appears that chaplain visits were responsible for very good outcomes, several limitations to this study should be kept in mind. No causal conclusion can be made regarding chaplaincy care specifically.

It is not possible to know if the effects are specific to chaplaincy care. That said, this is the one study where we believe that the outcomes presented are defensible methodologically and statistically.

About the Author

Studies with Misleading Findings. Other studies exist that are often cited as evidence for the beneficial effects chaplaincy care that prove, upon closer examination, to be documenting no care, or care of another kind. In one study, patients about to undergo orthopedic surgery were provided regular hospital care, emotionally supportive care by a chaplain, or emotionally supportive care and information about the treatment by a chaplain. The outcome measures were degree of anxiety, length of stay and other physiological patient measures Florell, Patients who received either support condition left the hospital sooner, made fewer calls for help to the nurses' station, and had lower anxiety, respiration, heart rate and lower pain medication needs than the patients who received regular hospital care.

There are a number of limitations of this study, including patient assignment to conditions, and most notably the lack of detail on whether the chaplains provided spiritual care or general support and information. It is possible that anyone who gave general support and information could have effected a change, hence the chaplain intervention in the study would not have been unique to chaplaincy care.

The first study is the Florell study cited above. While it is true chaplains were involved and provided care, there is no evidence that what the chaplain did was unique to being a chaplain: In the second study by McSherry , men who were more religious, as affirmed on a questionnaire, were more likely to leave the hospital sooner. This finding has nothing to do with a chaplain providing care, and it is not clear that the chaplain was involved at all with the patients.

The same might be said of the other two patient stories noted in this report. These studies highlight the importance of identifying the unique intervention contribution of the chaplain, the measurement of that intervention, and the specific outcomes that can not be expected from the interventions of others on a health care team. None of the studies that look at referrals or activities reach a high level of evidence for the efficacy of chaplaincy. Most of the studies equated chaplaincy students with board certified chaplains and volunteers.

These studies represent the extent of the outcomes research in chaplaincy care in the United States. There is a fairly uniform finding that patients like chaplains. What they like about them is generally unknown, although there are indications that those who have experienced chaplains find them spiritually sensitive and supportive. There are no clear patient outcomes studies that document the efficacy of the unique aspects of chaplaincy care, as opposed to spiritual care provided by an interdisciplinary team.

The amount and type of outcomes research conducted so far has not yielded well-established findings in any area. Several recent trends in health care will impact on chaplaincy research going into the future. Firstly, increasing attention at a national level is being paid to palliative care. Secondly, health care is becoming more individualized with electronic medical records that are making possible such innovations as medical homes.

Medical homes allow for much of patient care to be provided in the outpatient setting. Thirdly, as noted in the introduction, there has been an increase in the number of Americans who are claiming to be spiritual but not religious, and in those claiming no religious affiliation at all Newport, b. To move the field forward, a rubric of recommended research methods is needed. The health care chaplaincy field needs to develop an evidence base to guide chaplaincy practice. However, a narrow focus on the specific research methods, definitions, or the criteria for what constitutes empirical support for evidence-based treatments for patients seen by chaplains would not be helpful.

This statement does not necessarily preclude any particular type of research method, but it does imply a deliberate engagement with the best methods available to study the questions at hand. It is important to keep in mind that different research designs are better suited to address different types of questions APA, , p.

The APA Task Force on Evidence-Based Practice report lists and briefly describes various types of research designs and how they might contribute to evidence-based practice. For example, the method of clinical observation, such as an individual case study, is a good source of intervention innovation and theory creation.

It is extremely important to realize that even the most well-designed research study has limitations due to the particular research method used. The gold standard of research methods to demonstrate causality, the random-controlled trial, often has not lead to convincing evidence for psychotherapies Kazdin, Knowing that an intervention works in general often does not help much when deciding which intervention to use with a specific patient Kazdin, There are many difficulties with using RCT investigations of interventions and therapies.

To encourage a thoughtful, comprehensive evidence-based approach to health care chaplaincy research some of the major quantitative and qualitative research designs are briefly described and discussed. The various research designs are not described in detail because this has been done in numerous books and articles e. The purpose here is to briefly describe the defining characteristics of the major designs, their strengths and weaknesses, and the types of research questions regarding health care chaplaincy that they are most suitable for investigating.

Summaries of the key characteristics of designs that have the potential for furthering the understanding of health care chaplaincy can be found in Appendix Three, Table 1. Survey designs could also help determine what types of chaplaincy interventions are being used, and what interventions patients and chaplains believe are the most helpful.

Correlational designs could explore the relationships between the types and severity of illnesses and various chaplaincy interventions. They could also be used to explore whether various types of spiritual practices and chaplaincy interventions are related with positive health care processes and outcomes. Single-subject, task analysis, and discovery-oriented research designs Greenberg, , ; Kazdin, ; Pascual-Leone, Greenberg, Pascual-Leone, also have great potential for contributing to the advancement of an evidence base for the health care chaplaincy field.

The work by Greenberg and colleagues clearly discusses the difficulties inherent in trying to measure and document meaningful change in psychotherapy. One method that is useful for documenting change is discovery-oriented research because it begins not with a hypothesis as much as it begins with an open awareness for observing that which is not expected and a willingness to rigorously document the exploration. An examination of the information collected can lead to an identification of patterns of behavior and the change in patterns that may have occurred at a particular time or after a particular event.

Although these designs are more limited in terms of traditional notions of internal and external validity, they are more feasible to carry out in health care settings because they are less intrusive, ethically problematic, costly, and time-consuming. They also are more clinically relevant in that they allow the exploration of research questions that are more meaningful to health care chaplains.

Single-subject designs could prove especially useful for evaluating the effectiveness of interventions used by chaplains in long-term care settings. Chaplains in these settings can use these designs relatively easily to evaluate their own practices. In a single-subject study, the patient serves as his or her own control. If chaplains are willing to invest the relatively small amount of effort needed to administer brief repeated outcome measures to their patients during the course of treatment, they could document the effectiveness of their own work and contribute to the establishment of a large database on the outcomes of health care chaplaincy interventions.

Perhaps this will be most feasible if practicing chaplains collaborate with scholars in academic and research settings. Both chaplains and scholars would benefit from such collaboration, and the database on health care chaplaincy would grow rapidly. Given that few experimental outcome studies have been conducted in the health care chaplaincy field, there is a need for more of them.

Experimental outcome studies are widely regarded as the premier research design, as this design can provide support of a causal relationship between a treatment and an outcome Kazdin, Considerable work is put into the design of the research method to control as much of the extraneous influences on outcomes as possible, so that the effect of a treatment on an outcome can be isolated.