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April 2021 Article of the Month
by John Ehman, Editor, ACPE Research Article-of-the-Month
and Manager for Pastoral Care, Penn Presbyterian Medical Center, Philadelphia PA


Snowden, A. "What did chaplains do during the Covid pandemic? An international survey." Journal of Pastoral Care and Counseling 75, no. 1 Supplement (April 2021): 6-16.

[Note: This article, along with the entire Supplement, is available freely online from the publisher.]

SUMMARY and COMMENT: Over a year now into the Covid-19 pandemic, the picture of how the global crisis has affected chaplains and the profession of chaplaincy is coming into focus. The present study reports empirical data from an international sample to provide context within which individual chaplains may set their own experience and perspective. It is part of a special supplementary issue of the Journal of Pastoral Care and Counseling that is freely available from the publisher's website, with other articles elaborating upon particular aspects of the survey which Snowden outlines. The study elicited information via an online form in May-June 2020, and so it offers insights only from the first wave of the pandemic, but it is a good source for reflection upon how chaplains have been affected overall. Readers are encouraged to seek out also the companion articles in the journal issue.

The author observes an effect of the pandemic in general: "Person centred care appeared to be temporarily superseded by a utilitarian approach in which the quelling of the virus became the sole aim," and consequently, "[o]ne of the major casualties of this agenda was the spiritual dimension, precisely the dimension represented by chaplains" [p. 7]. "Every chaplain surveyed, regardless of age, gender, religion, or country, experienced a change in the way they worked...," [p. 15] and many chaplains contended with being "seen as little more than an infection risk" [p. 13].

To do their jobs, chaplains had to become creative to militate against any barriers put in their way. This research was designed to capture that creativity as well as other changes to practice whilst still fresh in the mind of participants.

A total of 1657 chaplains took typically 12-15 minutes to complete the survey (given in a box on p. 8). It was "designed to obtain a broad mix of quantitative and qualitative data with the emphasis on encouraging free text responses, but without being too onerous for participants to complete" [p. 7]. Responses came from 36 countries on 6 continents, with the great majority from North America (730), Europe (666), and Australia (202). Most participants were Christian (924 Protestant; 412 Catholic). The article includes 2 tables and 6 figures, detailing demographics and various findings.

Among the results:

  • "Most chaplains worked in the same place during the pandemic as they had done previously" [p. 9], including 780 who usually worked in a hospital.

  • "[I]nteractions with non-Covid-19 patients and staff were in the majority during this period" [p. 9]. Chaplains from North America appeared to have had more contact with Covid-19-positive patients, particularly in the ICU, than did chaplains from Europe or Australia. "On the whole however, response patterns were relatively similar around the world" [p. 9].

  • "[T]here was a substantial switch to using technology to care for all patients, whether Covid-19 or not" [p. 9]. Technology used to connect with patients who had the virus was also utilized with over half of patients without the virus. [See Table 2, p. 11.]

  • "[F]requency of supervision during the pandemic remained reasonably high" in North America, Europe, and Australia [p. 9].

  • "[S]taff other than chaplains doing spiritual care was common around the world" [p. 10]. "More than half of the respondents reported seeing others doing spiritual care, and whilst this was welcomed by most, there was a vocal minority that felt others were encroaching on professional chaplain territory" [p. 14].

  • About a third of respondents felt that they could have been better deployed during the pandemic (especially those from Europe, where 45% of the 288 respondents said so) [--see Table 3, p. 12]. Free-text comments highlighted a desire to have been better deployed to support staff. While a majority said that their organization understood the contribution they could offer to Covid-19 patients, a substantial minority did not. [--See p. 10].

  • Chaplains' own understanding of their role during the pandemic fluctuated somewhat but responses overall did not show a pattern of either clarity or a lack of clarity. "...[S]urprisingly, , the survey showed that chaplains weren't clear about their role before the pandemic either" [p. 15, but see also pp. 10, 12, 13, and 14 (Figure5)].

  • Regarding self-care, "In general, faith, prayer and the support of friends were the most frequently adopted strategies, with hobbies also outranking more formal types of support [e.g., support in therapy]" [p. 10].

  • "[S]ocial distancing had the greatest impact on chaplains around the world, followed by concerns for the dignity of patients" [p. 12].

  • Chaplains indicated that their professional organizations and faith groups tended to offer support through emails and online support groups rather than through personal contact [--see p. 12]. Data showed that "almost 50% Australian chaplains were not affiliated with professional associations, whereas the proportion was closer to 20% for North America and Europe" [p. 15].

The author's Discussion section lights especially on this last point and the potential importance of chaplaincy associations for working chaplains. He finds reason to hold that chaplains belonging to professional associations may simply be better supported, and the lack of association membership may not only be a problem for the support of individual chaplains but "could be a barrier to a healthier future for healthcare chaplaincy" [p. 13].

Snowden notes that the sample size was large and that there were "more similarities than differences between the chaplains surveyed here" [p. 15]. He concludes that "chaplaincy wasn't ready for the pandemic" [p. 15], and while the same might be said for other healthcare disciplines, most chaplains found themselves placed in a category of non-essential staff. Chaplains seemed to have been inclined to blame this status on "lack of senior chaplain leadership" [p. 15, and see also p. 13], though the author comments in closing that "leadership is everyone's business" [p. 15].

This is a mid-level presentation of most of the survey, and it sets the ground for further reading. Other articles in the same issue of the journal dive more deeply into the data and specifically address questions of how the pandemic has brought about functional changes for chaplains [--see especially: Vandenhoeck, A., Holmes, C., Desjardins, C. M. and Verhoef, J., "'The most effective experience was a flexible and creative attitude' --reflections on those aspects of spiritual care that were lost, gained, or deemed ineffective during the pandemic," Journal of Pastoral Care and Counseling 75 no1, supplement (April 2021): 17-23]. Still, the tables and figures here add a lot to the text to sir thinking about the pandemic and chaplaincy.

There are two errors in the text, about which the author has written to the journal regarding correction. The first is in Figure 1, about access to patients during the pandemic. The item, "No, I only had access to family members," is repeated twice, with different data. This is a function of two data streams in the statistics package that should have been combined. As printed, neither of those two sets of data are represented precisely. Nevertheless, the data do indicate that more chaplains said they only had access to family members in Covid cases than in non-Covid cases. Second, the author's characterization on p. 10 of how many respondents felt they could have been better deployed during the pandemic is inaccurate: not a "majority" but rather a substantial minority of chaplains, as shown in Table 3 on p. 12 (with the raw numbers translating into 19.5% from Australia, 44.8% from Europe, and 30% from North America).

The study is obviously about the impact of Covid-19, but as the author points out in the introduction, "The pandemic...inadvertently offered an opportunity to systematically examine how different health systems around the world understood, valued and used their chaplains in a 'spiritual emergency'" [p. 6]. As such, it may also raise questions about differences especially between the communities and cultures of chaplaincy in North America, Europe, and Australia, and the survey clearly helps set the ground for further comparative research in and beyond the present crisis.

Austyn Snowden is Chair in Mental Health at Edinburgh Napier University (UK) and is also on staff with the European Research Institute for Chaplains in Healthcare. He has been instrumental in the development of the Lothian PROM (Patient Reported Outcome Measure), used in chaplaincy research [--for more on this, see especially the Related Items of Interest section of our January 2019 Article-of-the-Month].


Suggestions for Use of the Article for Student Discussion: 

This month's article should be a good entree to the general subject of how the Covid-19 pandemic has and is affecting chaplains and chaplaincy. It also leads directly to the other analyses of the international survey data published in the April 2021 Supplement of the Journal of Pastoral Care [--see Related Items of Interest, §I, below]. Any of those additional articles would make good companion pieces for discussion, but the report by Vandenhoeck, et al., "'The most effective experience was a flexible and creative attitude'...," would perhaps be the most immediate fit. Discussion of the Snowden article could begin with a reminder that the data here come only from the first wave of the pandemic. If any students were not in chaplaincy at that time, they may be reading the article in more of an abstract sense than those who worked through that period. For chaplains with experience prior to 2019, how were concerns for infection control in their previous everyday practice -- since chaplains have long routinely been around dangerous pathogens -- changed once Covid-19 was on the scene? How now does Covid-19 stand in their minds in relation to the management of threats from, tuberculosis, hepatitis, influenza, HIV, clostridium difficile, etc.? Were the infection control constraints imposed upon them by a healthcare institution more or less than their own concerns about infection? Did this change over time? The group could review the major findings in the article and straightforwardly assess whether these seem to reflect their experience. The listing of the survey items on p. 8 could be an easy structure for this discussion. Special attention might be paid to the finding that chaplains began using remote technologies much more often overall. What has the use of technology for remote visitation been like, and how might it portend a larger part of chaplaincy practice in the future? The students could also use the article to discuss how they understand their role in the institution. Is it clear? Was it clear before the pandemic? Snowden makes a case for belonging to a professional chaplaincy association. Are the students currently members or planning on membership in an association? Finally, if the article is not paired with another from the supplementary issue, the session could conclude by going around and asking which other article in the issue most piques their interest (to encourage continued reading).


Related Items of Interest:

I.  The table of contents for the April 2021 (vol. 75, no. 1) Supplement of the Journal of Pastoral Care and Counseling:

Bard, T. R. "COVID-19 and chaplains." P. 3.

Vandenhoeck, A. "The impact of the first wave of the Covid-19 pandemic on chaplaincy in health care: introduction to an international survey." Pp. 4-5.

Vandenhoeck, A., Holmes, C., Desjardins, C. M. and Verhoef, J. "'The most effective experience was a flexible and creative attitude' -- reflections on those aspects of spiritual care that were lost, gained, or deemed ineffective during the pandemic." Pp. 17-23.

Tata, B., Nuzum, D., Murphy, K., Karimi, L. and Cadge, W. "Staff-care by chaplains during COVID-19." Pp. 24-29.

Desjardins, C. M., Bovo, A., Cagna, M., Steegen, M. and Vandenhoeck, A. "Scared but powerful: healthcare chaplains' emotional responses and self-care modes during the SARS-Cov-19 pandemic." Pp. 30-36.

Flynn, E., Tan, H. and Vandenhoeck, A. "'We need to learn from what we have learned!': the possible impact of Covid-19 on the education and training of chaplains." Pp. 37-40.

Tan, H., Holmes, C., Flynn E. and Karimi, L. "'Essential not optional': spiritual care in Australia during a pandemic." Pp. 41-45.

Best, M., Rajaee G., and Vandenhoeck, A. "A long way to go understanding the role of chaplaincy? a critical reflection on the findings of the survey examining chaplaincy responses to Covid-19." Pp. 46-48.

Zollfrank, A. A. "Chaplaincy in a free-standing psychiatric hospital during the COVID-19 pandemic." Pp. 49-52.

Haythorn, T. "Conclusion: what we learned and next steps." Pp. 53-54.


II.  A special issue of Health and Social Care Chaplaincy in 2020 (vol. 8, no. 2) offers research and reflections about how Covid-19 is affecting chaplains and chaplaincy internationally. Among the articles:

Byrne, M. J. and Nuzum, D. R. "Pastoral closeness in physical distancing: the use of technology in pastoral ministry during COVID-19." Health and Social Care Chaplaincy 8, no. 2 (2020): 206-217. [(Abstract:) COVID-19 has posed immense challenges for society in general, and for those who work in healthcare in particular. The impact and burden of pandemic isolation on the emotional and physical welfare of patients and staff is well documented. Healthcare systems have come under unprecedented pressure as a result of the pandemic, alongside the imposition of isolation, visiting restrictions, and public health measures to curb the spread of this virus. For patients in hospital, isolation has been further compounded by the necessary use of personal protective equipment, which is a physical barrier to communication for both patients and healthcare staff. These restrictions have also impacted on how healthcare chaplains provide pastoral care to patients, their loved ones, and to colleagues. is article from the Republic of Ireland shares the experiences of healthcare chaplains in the provision of pastoral care through the use of virtual video-call technology by way of tablets and/or other mobile devices. is new approach has proved to be an innovative way of providing pastoral care while having to remain physically distant. Considering the well documented burden of isolation and the societal reality of quarantine, the use of technology is explored by healthcare chaplains with the aim of maintaining pastoral closeness and care.]

Drummond, D. A. and Carey, L. B. "Chaplaincy and spiritual care response to COVID-19: an Australian case study -- the McKellar Centre." Health and Social Care Chaplaincy 8, no. 2 (2020): 165-179. [(Abstract:) This article will consider a practitioner's experience of the impact of COVID-19 on spiritual care within aged care at the McKellar Centre, Barwon Health, Victoria, Australia. Using Sulmasy's (2002) paradigm, the provision of holistic care will be considered in terms of the physical, psychological, social and spiritual service variations that were necessary in order to continue to provide for the health and wellbeing of the most vulnerable in society -- namely those in aged care. The WHO Spiritual Care Intervention codings (WHO, 2017) will be utilized to specifically explore the provision of spiritual care to assist the elderly requesting or needing religious/pastoral intervention. COVID-19 has radically shaped the environment of the McKellar Centre, however, the needs of elderly aged care residents must continue to be met, and this paper seeks to document how that process has been resolved in light of COVID-19. As pandemics are likely to reoccur, future issues for providing spiritual care from a distance, for the benefit of clients, their families, chaplains and health care organizations, will be noted. It must be acknowledged however, that the pandemic impact within Australia (and indeed much of the Oceania region) has been considerably less to that experienced by other regions of the world. Nevertheless, the preparatory and supportive response of spiritual care undertaken at the McKellar Centre speaks to a local response to an international crisis.]

Harrison, S. and Scarle, J. "How are chaplaincy departments responding amidst the COVID-19 pandemic? A snapshot of UK responses to a questionnaire." Health and Social Care Chaplaincy 8, no. 2 (2020): 143-153. [(Abstract:) This is a brief reflection on how chaplaincy in the United Kingdom is responding "on the ground" to COVID-19. It is based on a short questionnaire responded to by 27 chaplaincy teams, who were providing ministry during COVID-19, in April 2020. It notes significant changes in practice and captures some variation and similarities in chaplaincy experiences. It also highlights emerging concerns with respect to chaplaincy practice that may require additional research in the future. A brief reflection on how Chaplaincy is responding "on the ground" to Covid19, based on short questionnaire responses from 27 Teams in April 2020. Highlights Chaplaincy practice that may need research in the near future.]

Wierstra, I. R., Jacobs, G. and Schuhmann, C. "Present in times of crisis: the impact of COVID-19 on activities, visibility, and recognizability of chaplains in a healthcare organization in the Netherlands." Health and Social Care Chaplaincy 8, no. 2 (2020): 191-205. [(Abstract:) This article addresses the question of how the COVID-19 pandemic has impacted on the activities, visibility, and recognizability of a chaplaincy team in a large healthcare facility in the Netherlands. In the context of a participatory action research project aimed at developing a clear chaplaincy profile in order to increase the visibility and recognizability of chaplains in the organization, the COVID-19 outbreak has had a surprising effect. The chaplains reported an unexpected and sudden increase in their visibility and a strengthening of their profile due to the pandemic. In this article, we explore how the chaplains have responded to the COVID-19 outbreak and reflect on the question of what lessons may be learned from the recent past period regarding visibility and recognizability of chaplaincy in healthcare organizations.]


III.  Telechaplaincy, as it figured into the international survey at the heart of this month's featured article, is addressed in Vandenhoeck, A., Holmes, C., Desjardins, C. M. and Verhoef, J., "'The most effective experience was a flexible and creative attitude' -- reflections on those aspects of spiritual care that were lost, gained, or deemed ineffective during the pandemic," Journal of Pastoral Care and Counseling 75, no. 1 Supplement (April 2021): 17-23. The topic has also been raised in our August 2020 and October 2018 Article-of-the-Month features. In addition, see the (Australian) Spiritual Care Association's "Telehealth Guidelines for Spiritual Care." And, the use of electronic tablets is the focus of Byrne and Nuzum's "Pastoral closeness in physical distancing: the use of technology in pastoral ministry during COVID-19," cited in §II, directly above.


IV.  More about this month's international survey's data, specifically on how chaplains have responded emotionally and engaged in self-care during the pandemic may be found in Desjardins, C. M., Bovo, A., Cagna, M., Steegen, M. and Vandenhoeck, A, "Scared but powerful: healthcare chaplains' emotional responses and self-care modes during the SARS-Cov-19 pandemic," Journal of Pastoral Care and Counseling 75, no. 1 Supplement (April 2021): 30-36. Also, while the phenomenon of Covid-19 is too recent for much research about the personal effects on chaplains to have come to light, previous studies regarding chaplain stress and burnout may be instructive. See especially:

Case, A. D., Keyes, C. L. M., Huffman, K. F., Sittser, K., Wallace, A., Khatiwoda, P., Parnell, H. E. and Proeschold-Bell, R. J. "Attitudes and behaviors that differentiate clergy with positive mental health from those with burnout." Journal of Prevention and Intervention in the Community 48, no. 1 (January-March 2020): 94-112. [(Abstract:) Clergy provide significant support to their congregants, sometimes at a cost to their mental health. Identifying the factors that enable clergy to flourish in the face of such occupational stressors can inform prevention and intervention efforts to support their well-being. In particular, more research is needed on positive mental health and not only mental health problems. We conducted interviews with 52 clergy to understand the behaviors and attitudes associated with positive mental health in this population. Our consensual grounded theory analytic approach yielded five factors that appear to distinguish clergy with better versus worse mental health. They were: (1) being intentional about health; (2) a "participating in God's work" orientation to ministry; (3) boundary-setting; (4) lack of boundaries; and (5) ongoing stressors. These findings point to concrete steps that can be taken by clergy and those who care about them to promote their well-being.] [This was our March 2020 Article-of-the-Month.]

Hotchkiss, J. T. and Lesher, R. "Factors predicting burnout among chaplains: compassion satisfaction, organizational factors, and the mediators of mindful self-care and secondary traumatic stress." Journal of Pastoral Care and Counseling 72, no. 2 (June 2018): 86-98. [(Abstract:) This study predicted Burnout from the self-care practices, compassion satisfaction, secondary traumatic stress, and organizational factors among chaplains who participated from all 50 states (N = 534). A hierarchical regression model indicated that the combined effect of compassion satisfaction, secondary traumatic stress, mindful self-care, demographic, and organizational factors explained 83.2% of the variance in Burnout. Chaplains serving in a hospital were slightly more at risk for Burnout than those in hospice or other settings. Organizational factors that most predicted Burnout were feeling bogged down by the "system" (25.7%) and an overwhelming caseload (19.9%). Each self-care category was a statistically significant protective factor against Burnout risk. The strongest protective factors against Burnout in order of strength were self-compassion and purpose, supportive structure, mindful self-awareness, mindful relaxation, supportive relationships, and physical care. For secondary traumatic stress, supportive structure, mindful self-awareness, and self-compassion and purpose were the strongest protective factors. Chaplains who engaged in multiple and frequent self-care strategies experienced higher professional quality of life and low Burnout risk. In the chaplain's journey toward wellness, a reflective practice of feeling good about doing good and mindful self-care are vital. The significance, implications, and limitations of the study were discussed.] [This was our July 2018 Article-of-the-Month.]

White, K. B., Murphy, P. E., Jeuland, J. and Fitchett, G. "Distress and self-care among chaplains working in palliative care." Palliative & Supportive Care (2019): online ahead of print, February 11, 2019. [(Abstract:) BACKGROUND: The prevalence of burnout and distress among palliative care professionals has received much attention since research suggests it negatively impacts the quality of care. Although limited, research suggests low levels of burnout or distress among healthcare chaplains; however, there has been no research among chaplains working in specific clinical contexts, including palliative care. OBJECTIVE: This study explored the distress, self-care, and debriefing practices of chaplains working in palliative care. METHOD: Exploratory, cross-sectional survey of professional chaplains. Electronic surveys were sent to members of four professional chaplaincy organizations between February and April 2015. Primary measures of interest included Professional Distress, Distress from Theodicy, Informal Self-care, Formal Self-care, and debriefing practices. RESULT: More than 60% of chaplains working in palliative care reported feeling worn out in the past 3 months because of their work as a helper; at least 33% practice Informal Self-care weekly. Bivariate analysis suggested significant associations between Informal Self-care and both Professional Distress and Distress from Theodicy. Multivariate analysis also identified that distress decreased as Informal and Formal Self-care increased. SIGNIFICANCE OF RESULTS: Chaplains working in palliative care appear moderately distressed, possibly more so than chaplains working in other clinical areas. These chaplains also use debriefing, with non-chaplain palliative colleagues, to process clinical experiences. Further research is needed about the role of religious or spiritual beliefs and practices in protecting against stress associated with care for people at the end of life.]. [This was our February 2019 Article-of-the-Month.]


V.  At this year's conference of the St. David's Center for Health Promotion and Disease Prevention Research in Underserved Populations (University of Texas at Austin School of Nursing), held online February 24, 2021 on the topic of Health Promotion in the COVID-19 Era, a poster was presented by Shilpa Rajagopal, Jung Kwak, George Handzo, and Brian P. Hughes regarding "The Impact of Covid-19 on Spiritual Care Delivery across Healthcare Settings." Data from a survey of certified chaplains in the US is outlined according three themes: Risk Mitigation and Operational Challenges, Impact of Social Distancing Guidelines, and Increased Need for and Provision of Psychosocial and Spiritual Support. Chaplain burnout is among the considerations. The poster is available online.


VI.  In April 2020, the London School of Economics conducted 58 interviews with individuals known to have deep community connections in the UK, exploring "what a good death looks like" for people across all faiths and for vulnerable groups. "'A Good Death' During the Covid-19 Pandemic in the UK: A Report of Key Findings and Recommendations" is available online, including a detailed summary about specific religious groups [pp. 10-13]. Regarding chaplaincy, the report found: "Many non-Christian patients don't understand hospital chaplaincy services, and have particular anxieties about cost and personal preferences" [p. 6], and while the authors recommend that "[h]ospitals should maintain Chaplaincy and palliative care services where possible, allowing a select number of clergy from different faith communities to conduct bedside ministry, with adequate PPE" [p. 7], they note especially in light of the needs of Hindu families: "Chaplaincy services could be explained better for non-Christians who are unsure of what these are and how they can be used" [p. 13].


VII.  Isolation and loneliness -- prominent burdens for patients in the Covid-19 pandemic -- are explored in the following articles. The selection here highlights several commentaries addressing spiritual dynamics, plus one older review (by Adad, et al., out of the University of Wisconsin) that points to findings from general research.

Abad, C., Fearday, A. and Safdar, N. "Adverse effects of isolation in hospitalised patients: a systematic review." Journal of Hospital Infection 76, no. 2 (October 2010): 97-102. [The use of transmission precautions such as contact isolation in patients known to be colonised or infected with multidrug-resistant organisms is recommended in healthcare institutions. Although essential for infection control, contact isolation has recently been associated with adverse effects in patients. We undertook a systematic review to determine whether contact isolation leads to psychological or physical problems for patients. Studies were included if (1) hospitalised patients were placed under isolation precautions for an underlying medical indication, and (2) any adverse events related to the isolation were evaluated. We found 16 studies that reported data regarding the impact of isolation on patient mental well-being, patient satisfaction, patient safety or time spent by healthcare workers in direct patient care. The majority showed a negative impact on patient mental well-being and behaviour, including higher scores for depression, anxiety and anger among isolated patients. A few studies also found that healthcare workers spent less time with patients in isolation. Patient satisfaction was adversely affected by isolation if patients were kept uninformed of their healthcare. Patient safety was also negatively affected, leading to an eight-fold increase in adverse events related to supportive care failures. We found that contact isolation may negatively impact several dimensions of patient care. Well-validated tools are necessary to investigate these results further. Large studies examining a number of safety indicators to assess the adverse effects of isolation are needed. Patient education may be an important step to mitigate the adverse psychological effects of isolation and is recommended.] [The article is available freely online from the publisher.]

Dutra, C. C. D. and Rocha, H. S. "Religious support as a contribution to face the effects of social isolation in mental health during the pandemic of COVID-19." Journal of Religion and Health 60, no. 1 (February 2021): 99-111. [Coping with the COVID-19 pandemic has required measures to contain the contagion, including social isolation. However, this and other factors have caused mental health problems, both in patients and health professionals and in family members or asymptomatic population. Religious support can be an ally for this type of confrontation. In the case of the COVID-19 pandemic, spiritual/religious care has been restricted and insufficient. When accessible to patients and frontline professionals, they are offered by virtual means, almost always by recorded media and made available in bulk. This essay argues, based on references in the areas of psychology, psychoneuroimmunology, biosafety, and military, that the face-to-face and personalized relationship between religious leaders, patients, health professionals, family members, and faith communities is as essential as possible for the dignified treatment victims, referral to spiritual needs and resilience of society, in addition to contributing to the improvement of the immune response of all. Practical examples are cited in the areas of military chaplaincy and hospital civilian chaplaincy. The essay also proposes the adoption of protocols already published by WHO and other safety measures such as the use of robotics and the recruitment/training of mass chaplains. In addition to contributing to the improvement of COVID-19 pandemic coping processes, the study also contributes to improving the delivery of spiritual/religious care as an ally to physical and mental, individual, and collective health.]

Galbadage, T., Peterson, B. M., Wang, D. C., Wang, J. S. and Gunasekera, R. S. "Biopsychosocial and spiritual implications of patients with COVID-19 dying in isolation." Frontiers in Psychology (2020): 11:588623 [online journal article designation]. [Critically ill patients with the Coronavirus disease 2019 (COVID-19) are dying in isolation without the comfort of their family or other social support in unprecedented numbers. Recently, healthcare teams at COVID-19 epicenters have been inundated with critically ill patients. Patients isolated for COVID-19 have had no contact with their family or loved ones and may have likely experienced death without closure. This situation highlights concerns about patients' psychological and spiritual well-being with COVID-19 and their families, as they permanently part ways. While palliative care has advanced to adequately address these patients' needs, the COVID-19 pandemic presents several barriers that force healthcare teams to deprioritize these essential aspects of patient care. The severe acute respiratory syndrome (SARS) outbreak in 2003 gave us a glimpse of these challenges as these patients were also isolated in hospitals. Here, we discuss the importance of the biopsychosocial spiritual model in end-of-life care and its implications on patients dying with COVID-19. Furthermore, we outline an integrative approach to address the unique and holistic needs of critically ill patients dying with COVID-19. These include intentional and increased coordination with trained palliative care staff, early and frequent goals of care including discussion of end-of-life plans, broader use of technology to improve connectedness, and shared decision making with patients' families.]

Riggs, A. K. "The COVID-19 context calls for a broader range of healthcare chaplaincy models: an exploratory translational study utilizing evolutionary psychology and social neuroscience loneliness research." Journal of Pastoral Care and Counseling 74, no. 4 (December 2020): 258-264. [(Abstract:) Shifts in chaplain requests from patients and families and lack of engagement by staff in now traditional support forms in the COVID-19 context suggest that new insights and resourcing are needed. This exploratory translational study suggests that the evolutionary psychology of R. I. M. Dunbar and the social neuroscience of J. T. Cacioppo, his collaborators, and successors and their concerns for human loneliness have potential for use in development of effective healthcare chaplaincy practice in the COVID-19 context.]



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