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April 2023 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


Desjardins, C. M., Muehlhausen, B. L., Galchutt, P., Tata-Mbeng, B. S. and Fitchett, G. "American health care chaplains' narrative experiences serving during the COVID-19 pandemic: a phenomenological hermeneutical study." Journal of Health Care Chaplaincy 29, no. 2 (April-June 2023): 229-244.

SUMMARY and COMMENT: As the COVID-19 pandemic recedes in the popular consciousness and healthcare settings seek to normalize operations for an endemic presence of the virus, it may be an optimal time for chaplains to reflect on how the crisis emerged to affect our work and lives profoundly. This month's article may be a good aid for such reflection, because it focuses on chaplains' individual experiences described in journals kept from April 2nd to June 30th, 2020, starting just a couple of weeks into the nationwide lockdown in the US. The project was a collaboration between Transforming Chaplaincy and the Ascension Healthcare System, aiming to "gather a very personal perspective about the impact of this huge, global phenomenon" [p. 230, italics added]. One "strength of this study is that most chaplain journalers evidenced being well integrated in their assigned areas and units prior to the beginning of the COVID-19 pandemic," so that their writings "evidence real shifts, changes, and uncertainties in chaplaincy practice as a result of COVID-19 and not exclusively the quotidian struggles of chaplaincy practice and particularly adjustment to new settings" [p. 242].

Thirty chaplains were recruited for the project, using "reputational sampling" [p. 231; note: the term is used without explanation but with the overall implication that participants were chosen by the in-the-know researchers rather than through a snowballing process of one chaplain recommending another who then recommends another, and so on --see Related Items of Interest, §IV, below]. The researchers made an "intentional effort to recruit chaplains from all regions of the United States, representing both urban and rural hospital settings" [p. 231]. "Thirteen of the participants worked in general hospitals; nine of these worked in faith-based hospitals (eight in Ascension hospitals); five participants worked in pediatric hospitals; and three participants worked in other specialty hospitals" [pp. 231-232]. They were asked to write in a journal at least once a week, using a set of four prompts [--see Table 3, p. 233]:

  • Changes this week to your chaplaincy practice in light of Covid-19
  • Challenges you have faced as a chaplain this week while serving during the pandemic
  • Contributions you / your department have made to patients and families, your institution, and beyond
  • Creativity you are discovering in your own chaplaincy practice or that of others, and what is inspiring you during this time

Data were collected from 21 of the participants and analyzed for patterns of concepts that the journals had in common and constituent themes (i.e., "the different ways a pattern manifests itself" [p. 233]). The authors identified 11 patterns and highlight 7 of these, plus two (uncertainty and telechaplaincy) that are "interwoven into discussions on other patterns" [p. 233]. The ostensibly remaining two patterns are never named in the article. The highlighted 7 patterns are:

World of Chaplaincy [pp. 233 and 236] --
"When the pandemic hit in March 2020, chaplains described Heidegger's concept of being 'thrown' into a new world. With no warning, family visitation in hospitals was eliminated or limited. Personal protective equipment (PPE) was limited, resulting in chaplains helping to conserve PPE by not entering rooms with patients who had or were suspected of having COVID-19. This new world was constantly changing as new information was given, procedures shifted, and COVID-19 patient numbers rose. There was a great deal of uncertainty, fear of the unknown, and unpredictability regarding infection surges. ...The term 'essential staff' became loaded, with some chaplains deemed 'essential' by their workplaces and others having to advocate that they too were 'essential.' ...Chaplains were called upon to think of telehealth as the new norm.... In the midst of the constant and changing world of chaplaincy, chaplains responded with profound resiliency, and creativity."

Policies/Procedures/Visitation [pp. 236-237] --
"Stories of patients dying without family members present or visiting only moments before death were common. When less was known about the virus and PPE was in rare supply, many chaplains were not entering patient isolation rooms, unless imminent death was expected. In cases where chaplains were allowed to enter rooms and visit in-person, despite policy awareness, instances of chaplains touching patients emerged and sometimes this touch was initiated by others. One chaplain reported being 'caught off-guard many times as people gave me a squeeze or hug.' ...Some chaplains were put in a place of having to explain or enforce visitation rules, and served as a go-between with families, sometimes holding tablets or telephones to facilitate family visitation...."

Rituals [pp. 237-238] --
"Social distancing policies during the pandemic prevented chaplains from providing [ritual] functions in the ways they have been doing for years. It was especially challenging when it came to rituals that would be performed at the end of life. ...Some innovations reported in the chaplains' journals included prayer on the overhead loudspeaker, daily devotional emails to staff, and blessing cards for patients and staff. Chaplains provided communal prayer said in place of individual blessings usually offered during nurses' week with some institutions using hand sanitizer in place of oil to do the Blessing of the Hands ritual. Hospital spaces and rooms were blessed to provide a sense of comfort as patients were moved from one part of the hospital to the other. ...Telehealth became one of the most important mediums for providing rituals such as prayer, funeral/memorial services, praying the Rosary and anointing prayers. Worship services were live streamed into patient rooms."

Staff Care [p. 238] --
"...[M]any chaplains increased the amount of time and energy they gave toward caring for fellow hospital staff. Requests for support came not only from staff but also from leadership asking chaplains to 'round on staff; focus on staff care more than anything else.' There was a significant increase in staff needs as 'stressors related to the pandemic became more prevalent.' As staff needs increased, chaplains quickly became innovative and created novel ways to care for staff. ...Chaplains noted that some staff came to know about chaplain services and the work they do only during the pandemic."

Chaplain Emotional Responses [pp. 238-239] --
"The chaplains' journals revealed that serving during the COVID-19 pandemic was a profound emotional experience requiring significant 'emotional labor' in professional contexts as well as frequent emotional shifts between negative and positive emotion.... The research team identified the following emotional themes under this pattern: anger/frustration, anxiety/fear, grief, guilt, helpful, helpless, hope, hopeless, moral distress, overwhelmed, relief, and thankful. ...This led to the analogy of a 'pressure cooker of emotions' that could reach a boiling point at any moment without warning. ...Some of the salient emotions chaplains wrote about in their journals were grief and helplessness." The journals included significant material on the themes of hope, helplessness, and gratitude.

Coping [pp. 239-240] --
"Under the overarching pattern of 'coping' the theme of meaning-making was consistent across all journals.... Unexpectedly, the process of writing the journal itself became for some chaplain participants an 'act of meaning.' ...Multiple chaplain writers commented on their pride of being a chaplain during this time, and noted they were proud of the creativity they found within themselves and their profession: bringing spiritual comfort and care to patients and families, whether over telephones, Facetime or Zoom, through glass, or face shields." Journalers also expressed "pride at having weathered the pandemic changes so far and general optimism for the future."

Racism [p. 241] --
"The Covid pandemic highlighted racism even before George Floyd's murder," and the journals give examples. However, George Floyd's death highlighted racial issues and tensions, and "[s]everal chaplains wrote in their journals about their own emotional reactions, those of staff and the ways in which patients and loved ones were impacted."

These patterns are also presented in a helpful table [pp. 234-235], which also indicates associated themes and Heideggerian principles, as well as illustrative quotes.

In their Discussion, the authors note that the place of racism in the data was a striking new addition to the research that had been done up to this time on chaplaincy in the pandemic. "Experiencing [racism] Firsthand, the Impact of the Murder of George Floyd, the Racial Disparities of COVID-19, [chaplain] Response to Racism, and [the chaplain] Witnessing Racism, have not been previously identified in research on chaplains and COVID-19" [p. 241]. Other thematic additions of this research are "the shifting of emotions and responses over time" [p. 241]. Nevertheless, the results of the present study also aligned with previous research, like the "high emotionality among chaplains...[,] ...a learning curve around telechaplaincy, a sense of being 'kept out' of rooms and sites, and themes of gratitude" [p. 241].

Among other findings emphasized in the Discussion section:

  • "The journals collected during this project universally expressed chaplains' real fears, sense of 'whiplash' with changing roles, emotional intensity, and made it clear that many chaplains witnessed profound suffering and death as those who came to be known as 'frontline' health workers during the COVID-19 pandemic. Still, some chaplains did not identify as 'front line' health workers, struggled to have access to patients and PPE, and others struggled with their identity as helpers and providers while the language of 'essentiality' was prevalent." [p. 241]

  • "...[P]erhaps the most profound finding in the chaplains' journals was a consistent resiliency, determination to serve their patients and colleagues, and meaning-making of even the most horrific pandemic experiences. Along these lines, one surprising finding to the research team was that 'Hopelessness' was the least common emotion evidenced or reported by chaplains in their journals, while hopefulness appeared in almost every journal collected." [p. 241]

  • "A significant finding of this study was that journaling is a valuable form of collecting research data in chaplaincy and spiritual care, albeit with some challenges, and heretofore has not been given enough focus as a way of collecting data within chaplaincy-related research." [p. 241]

This study collected a significant volume of qualitatively rich data from its participants who were geographically spread across the US. The authors acknowledge that their methodology "only captures a small window of the pandemic" [p. 242] during just the first wave of the crisis --"long before the most significant 'wave' of the pandemic in November/December 2020" [p. 242]. However, in the writing of chaplains during this period, through "moving, shocking, and awe-inspiring" stories [p. 243], the journals are a witness to personal experience that not only speak to the particular crisis of COVID-19 but "may contain transferrable insights into other contexts, pandemic environments, or health care fields" [p. 242]

The authors conclude with the observation that while chaplains exhibited "extraordinary resilience in the face of many mounting and shifting challenges," many chaplains were left "exhausted, and a significant lingering question this research raises relates to how the profession of chaplaincy will respond to the exhaustion and trauma chaplains experienced during the COVID-19 pandemic" [p. 242].

In just the past 15 years, the US has experienced threats from SARS and the H1N1 and H5N1 influenza outbreaks, as well as ebola, with relatively little data captured by chaplains at the time [--see Related Items of Interest, §I, below]. Those, of course, did not turn out to be the catastrophes in the US that they could have been, but work like that of Desjardins and colleagues may be practical models for capturing information that could be critical for our profession. The project by Transforming Chaplaincy and Ascension moved quite quickly to begin collecting important data and might -- above and beyond particular findings -- lay a broad and practical foundation for emergency plans by chaplaincy organizations (and maybe individual healthcare institutions) to mobilize research efforts immediately to collect information from and for the world of chaplaincy. The present study suggests that a plan for journaling could be mobilized efficiently and effectively.

Suggestions for Use of the Article for Student Discussion: 

Use of this article for student discussion may depend upon whether the group has had chaplaincy experience prior to the COVID-19 pandemic and may therefore relate to the sense of change described here. If that is the case, then the group members could compare and contrast their own experiences with the presented findings and possibly even offer some thoughts on how the "first significant wave of the pandemic" addressed in the data stands in relation to what they may know of chaplaincy during subsequent waves. Table 4 [pp. 234-235] could prvide a structure for reflection in this way. But, if the group is new to chaplaincy, discussion could come out of a sense of how chaplaincy practice now holds the ramifications of the pandemic. How are such things as social distancing and visitor restrictions continual stressors in the healthcare context, and how much have innovations like telehealth become a norm for chaplains' interactions? The group may want to consider how COVID-19 accelerated some trends and dynamics that were already present prior to the crisis. The pattern/theme of racism may be a particularly poignant topic for consideration. It is worth noting that the authors explicitly disclaim their use of theory drawn from the work of Martin Heidegger [--see p. 243] and "condemn his views and association with the Nazi party, and antisemitism and racism in all its form" [p. 243]. Do students naturally think of the intellectual roots of concepts and theories that may be applied in research? Finally, the group might discuss their feelings about the potential for more highly disruptive health crises like COVID-19 to arise in the not-so-distant future. What takeaways from the COVID-19 pandemic may help them prepare for healthcare chaplaincy the next time around?


Related Items of Interest:

I.  Our Articles-of-the-Month features have been attentive to the COVID-19 context since March 2020, but see especially:

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. [--This was our April 2021 Article-of-the-Month.]

Taylor, J. B. "A moment in the life of a SARS chaplain." Journal of Pastoral Care and Counseling 57, no. 3 (Fall 2003): 355-356. [--This was our April 2020 Article-of-the-Month.]

Selman, L. E., Chao, D., Sowden, R., Marshall, S., Chamberlain, C. and Koffman, J. "Bereavement support on the frontline of COVID-19: recommendations for hospital clinicians." Journal of Pain and Symptom Management 60, no. 2 (August 2020): e81-e86. [--This was one of two articles selected for our May 2020 Article-of-the-Month feature.]

In addition, our February 2023 Article-of-the-Month dealt with the subject of telechaplaincy, which has become such a key development through the COVID-19 pandemic. See: Sprik, P. J., Janssen Keenan, A., Boselli, D. and Grossoehme, D. H. "Chaplains and telechaplaincy: best practices, strengths, weaknesses --a national study." Journal of Health Care Chaplaincy 29, no. 1 (January-March 2023): 41-63.


II.  This month's article has a bibliography of 18 references, extending up through 2021. The following are articles of interest on chaplaincy and COVID-19 published since then, in addition to those cited directly above --part of a stream of articles now hitting publication.

Bauer, Z., Sherwin, J., Smith, S. and Radowsky, J. "A review of Brooke Army Medical Center Chaplaincy Service During the SARS-COV2 pandemic: implications for service structure and patient needs." Military Medicine 188, nos. 3-4 (2023): e824-e828. [(Abstract:) INTRODUCTION: We aimed to evaluate the effect of the SARS-COV2 pandemic on chaplain utilization at Brooke Army Medical Center. Our hypothesis was that multiple pandemic-related factors led to a care environment with increased mental and spiritual stress for patients and their families, leading to an increased need for adjunct services such as chaplaincy. MATERIALS AND METHODS: This was a single-institution retrospective chart review study that evaluated the records of 10,698 patients admitted between July 1, 2019, and January 31, 2020, or between July 1, 2020, and January 31, 2021. Our primary study outcomes included the number of chaplain consultations, the number of visits per consultation, and the time of visits between the two study cohorts. Secondary outcomes included inpatient mortality and the number of end-of-life visits. We also isolated a subgroup of patients admitted with COVID-19 and compared their outcomes with the two larger cohorts. Statistical analysis included t-test or chi-squared test, based on the variable. This study was reviewed and approved by the Brooke Army Medical Center Institutional Review Board (IRB ID C.2021.010e). RESULTS: Fewer consults were performed during the study period affected by the SARS-COV2 pandemic (4814 vs. 5884, P-value <.01). There were fewer individual visits per consult during the study period affected by the SARS-COV2 pandemic (1.44 vs. 1.64, P-value <.01), which led to fewer overall time spent per consult (37.41 vs. 41.19 minutes, P-value <.01). The 2020 cohort (without COVID-19 cases) demonstrated a higher mortality rate than the 2019 cohort (2.8% vs. 1.9%, P-value <.01). The COVID-19 diagnosis cohort demonstrated a much higher mortality rate compared to other patients in the 2020 cohort (19.3% vs. 2.8%, P-value <.01). We demonstrated the relative need for EOL consults by presenting the ratio of EOL consults to inpatient deaths. This ratio was highest for the COVID-19 diagnosis cohort (0.76) compared to the 2020 cohort (0.50) and the 2019 cohort (0.60). CONCLUSIONS: This study demonstrates that factors related to the SARS-COV2 pandemic resulted in fewer chaplaincy consults in our inpatient setting. We did not find other reports of a change in the rate of chaplaincy consultation, but available reports suggest that many centers have had difficulty balancing the spiritual needs of patients with local exposure guidelines. Although fewer individual chaplain consults occurred during the SARS-COV2 pandemic, our chaplain service innovated by utilizing various phone, video, and web-based platforms to deliver spiritual support to our community. Our study also suggests that the patients most greatly affected by the pandemic have an increased need for spiritual support, especially at the end of life. Future studies in this subject should examine the effect of various types of chaplain services as they relate to the health and well-being of hospitalized patients.]

Captari, L. E., Hydinger, K. R., Sandage, S. J., Choe, E. J., Bronstein, M., Stavros, G., Shim, P., Kintanar, A. R., Cadge, W. and Rambo, S. "Supporting chaplains on the frontlines of the COVID-19 pandemic: a mixed-method practice-based pilot intervention study." Psychological Services 20, no. 1 (February 2023): 6-18. [(Abstract:) During the coronavirus disease 2019 (COVID-19) pandemic, chaplains have played a pivotal role in patient, family member, and staff care. However, little empirical attention has been given to (a) the potential toll of frontline spiritual care on chaplains' mental health and occupational functioning as well as (b) the development of interventions that can help ameliorate these risks and promote resilience. Using a mixed-method practice-based design, we conducted a pilot study (n = 77) to evaluate a novel spiritually integrated support group intervention for chaplains across multiple industries, which consisted of five Zoom-based sessions cofacilitated by psychotherapists. Participants completed pre- and postintervention measures of traumatic stress, burnout, spiritual/moral struggles, flourishing, resilience, and overall experience in the group. Qualitative findings elucidated the salience of peer support, therapeutic group processes, and key intervention components that warrant further study. Quantitative results indicated significant (a) decreases in burnout and spiritual/moral struggles from pre- to postintervention as well as (b) increases in sense of resilience and flourishing. Findings of this pilot study offer preliminary evidence for the use of a spiritually integrated group model to decrease isolation, address moral and spiritual distress, and promote resilience among chaplains.]

Domaradzki, J. "Hospital chaplains facing the pandemic. A qualitative study." Journal of Health Care Chaplaincy 29, no. 1 (January-March 2023): 145-160. [(Abstract:) The article explores hospital chaplains perspective on the impact of the coronavirus pandemic on the provision of spiritual care in Poland. Semi-structured interviews with sixteen hospital chaplains providing spiritual care in hospitals during the COVID-19 pandemic were performed. Six main themes emerged during the interviews: chaplains' experience of the pandemic, chaplaincy during the outbreak, patients' needs, health professionals needs, social stigma and discriminatory behaviours against chaplains, and the importance of spiritual care during the crisis. Results indicate that although the COVID-19 crisis has limited the possibilities of providing spiritual care in hospitals and has changed its nature, it has positively impacted the visibility of hospital chaplaincy. It also underpins the contribution of hospital chaplains to modern healthcare practice and suggests that chaplains role as key healthcare workers should be further recognized and their integration into the healthcare system is required.]

Galchutt, P., Labuschagne, D. and Usset, T. "Patient-family experience at the onset of COVID-19: interviews with ten palliative chaplains." Journal of Palliative Medicine 25, no. 8 (2022): 1222-1227. [(Abstract:) Background: As thousands of patients, often with complex care needs, were hospitalized due to the coronavirus disease 2019 (COVID-19) pandemic, demand for palliative care was magnified. Part of hospitals' palliative care teams, palliative chaplains delivered emotional support while specializing in the religious, spiritual, and the existential aspects of care. With COVID-19 containment measures increasing isolation and disrupting supportive family connections, the emotional and spiritual well-being of the patients and families were unclear. Objectives: Through the unique perspectives and insights of inpatient palliative care chaplains, we sought to qualitatively capture their perceptions and the patient-family experience as the pandemic emerged. Setting/Subjects: This investigation was based in the United States. Design: Individual semistructured telephone interviews (n = 10) were conducted between April 22 and May 6, 2020. Through thematic analysis, analyses progressed through initial coding sessions, refining a codebook, identifying representative quotes, and recognizing themes. Results: Five themes were identified and described through the coding process and recognizing representative quotes: (1) visitor restrictions-patients, (2) visitor restrictions-families, (3) religious struggle, (4) spiritual distress, and (5) decision making. Conclusions: Inpatient palliative care chaplains were active interprofessional partners caring for patients and families as the uncertainty of the pandemic unfolded. The crises of this pandemic magnified chaplain specialization as they attended to emotional, spiritual, and religious suffering and as well as complex decision making with patients and their family members.]

Gaines, A. F., Rangel, T. L., Freedberg, R., Doucette, S., Stengem, D., Timmerman, R., Roney, J., Arenivar, P., Patterson, A., Long, J., Sumner, S., Bock, D., Mendelson, S., Saul, T., West, A., Leavitt, R. E. and Colorafi, K. "Relationships between perceived importance of chaplain presence and health professionals' emotional well-being in the United States." Journal of Religion and Health (2023): online ahead of print, 4/3/23. [(Abstract:) Hospital-based chaplains receive specialized training to provide spiritual support to patients and healthcare staff during difficult health transitions. However, the impact of perceived chaplain importance on healthcare staff's emotional and professional well-being is unclear. Healthcare staff (n = 1471) caring for patients in an acute care setting within a large health system answered demographic and emotional health questions in Research Electronic Data Capture (REDCap). Findings suggest that as perceived levels of chaplain importance increase, burnout may decrease and compassion satisfaction may improve. Chaplain presence in the hospital setting may support healthcare staff emotional and professional well-being following occupational stressors including COVID-19-related surges.] [Recruitment began in February 2022 and ended in April 2022, around the second year anniversary of the pandemic lockdown in the US.]

Kwak, J., Rajagopal, S., Handzo, G., Hughes, B. P. and Lee, M. "Perspectives of board-certified healthcare chaplains on challenges and adaptations in delivery of spiritual care in the COVID-19 era: findings from an online survey." Palliative Medicine 36, no. 1 (January 2022): 105-113. [(Abstract:) BACKGROUND: The COVID-19 pandemic has posed significant challenges for healthcare systems to meet patients' and families' complex care needs, including spiritual care needs. Little data are available about spiritual care delivery in light of the pandemic. AIM: This study examined the impact of COVID-19 on spiritual care by healthcare chaplains in the United States. DESIGN: An online survey of 563 board-certified chaplains was conducted from March to July 2020. The survey, designed to identify chaplains' roles in facilitating conversations about goals of care, included an open-ended question asking how COVID-19 affected chaplaincy practices; 236 chaplains responded. Quantitative data and written qualitative responses were analyzed using descriptive analysis and content analysis, respectively. SETTING/PARTICIPANTS: Majority of participants were white (88%), female (59%), Protestant (53%), and employed full time (86%). Almost half were working in community hospitals (45%) and designated to one or more special units (48%) including ICU, palliative care, and oncology. RESULTS: Three major themes emerged from chaplains' qualitative responses: (1) COVID-19-related risk mitigation and operational changes; (2) impact of social distancing guidelines; and (3) increased need for and provision of psychosocial and spiritual support. CONCLUSIONS: Chaplains reported that COVID-19 challenges contributed to greater social isolation, and mental health concerns for patients, families, and healthcare staff, and substantially changed the way healthcare chaplains provided spiritual care. With evolving healthcare contexts, developing safer, more creative modes of spiritual care delivery while offering systematic support for chaplains can help meet the increasing psychosocial and spiritual needs of patients, families, and healthcare team members.]

Shaw, M., Taylor, C. and Alicea, E. "Documenting chaplain involvement: a pilot project exploring Pastoral Care and the integration of data science in a Central Florida Hospital." Journal of Health Care Chaplaincy 29, no. 1 (January-March 2023): 78-88. [(Abstract:) This paper intends to outline a data integration response to the demands placed on the pastoral care department through the COVID-19 pandemic. Uniquely, these demands accelerated the need to implement documentation of care directed towards staff to complement the data derived from patient visitation. The motivation for this initiative is in part, to provide a complete picture of the care provided by hospital chaplains using an evidence-based approach through the implementation of data science.]

Szilagyi, C., Vandenhoeck, A., Best, M. C., Desjardins, C. M., Drummond, D. A., Fitchett, G., Harrison, S., Haythorn, T., Holmes, C., Muthert, H., Nuzum, D., Verhoef, J. H. A. and Willander, E. "Chaplain leadership during COVID-19: an international expert panel." Journal of Pastoral Care and Counseling 76, no. 1 (March 2022): 56-65. [(Abstract:) Chaplain leadership may have played a pivotal role in shaping chaplains' roles in health care amidst the COVID-19 pandemic. We convened an international expert panel to identify expert perception on key chaplain leadership factors. Six leadership themes of professional confidence, engaging and trust-building with executives, decision-making, innovation and creativity, building integrative and trusting connections with colleagues, and promoting cultural competencies emerged as central to determining chaplains' integration, perceived value, and contributions during the pandemic.]

Tracey, E., Wilson, J., Abshire Saylor, M., Donohue, P., Stakias, A., Garibaldi, B. and Needham, D. "TIMS: a mixed methods evaluation of the impact of a novel chaplain facilitated recorded interview placed in the medical chart for the medical staff in an ICU during the COVID-19 pandemic." Journal of Religion and Health (2023): online ahead of print, 4/4/23. [(Abstract:) The purpose of this study is to examine how a novel intervention known as TIMS, "This is My Story," impacted clinicians caring for patients during the COVID-19 pandemic in the medical intensive care unit (MICU) at the Johns Hopkins Hospital. An eight-question survey was administered to MICU staff on their experience with TIMS files for pre- and post-listening reflections. Qualitative interviews were conducted with 17 staff members who prospectively agreed to participate. A total of 97 pre-listening and 88 post-listening questionnaires were completed. Responses indicated that the audio recording was appropriate to discover more about the patient beyond the immediately observable and useful (98%), "considerably" increased staff empathy for the patient (74%), and thought it would "some" or "considerably" improve subsequent interactions with the patient's loved ones (99%). The qualitative analysis revealed that medical staff found the audio format easy to use and helpful in humanizing patients in their clinical practice. The study demonstrates that TIMS audio files are an important addition to the electronic medical record, enabling clinicians to practice with greater awareness of the patient's context and increased empathy for patients and families.]

Winiger, F. "The changing face of spiritual care: current developments in telechaplaincy." Journal of Health Care Chaplaincy 29, no. 1 (January-March 2023): 114-131. [(Abstract:) In recent years, and particularly since the Covid-19 pandemic, telehealth has been rapidly introduced into U.S. healthcare institutions. While preliminary data and best practices are beginning to emerge, it remains unclear how chaplains are responding to this development in practice. Consequently, professional organizations have tended to lag behind the changing demands of increasingly digital professional environments. This article addresses this gap by presenting three case studies of U.S. healthcare settings where chaplains have become an integral component of telehealth infrastructure: the Mercy system, Ascension Health, and the Veteran's Health Administration of the U.S. Department of Veteran Affairs. Based on interviews with chaplains and directors of chaplaincy departments, it shows how the 'telechaplains' at these institutions have adapted to the introduction of telehealth across the continuum of care, and discusses the legal, economic, practical and theological challenges and hopes reported in each case.]


III.  Chaplains should also note the 2022 book published by Transforming Chaplaincy, edited by Cate Michelle Desjardins and Nina Redl: In Their Own Words: Stories of Chaplains' Courage, Creativity, and Compassion During the Early Pandemic, available online. It gives five very poignant examples from chaplains' journals during COVID-19.


IV.  The term "reputational sampling" is often grouped with "snowball" or "chain referral" sampling, indicating a cascading method that takes advantage of connections between members of a population, though a final study sample may still be subject to purposive steering and filtering by researchers, especially if the researchers are personally well-connected experts within a study population. Sometimes, though, researchers simply turn to an expert or group of experts who have reputational expertise about a study population.

The subject of "snowball sampling" was addressed in our July 2022 Article-of-the-Month, with the following trio of invited commentaries on the subject from the perspective of sociological methodology:

Goodman, L. A. "Comment: On respondent-driven sampling and snowball sampling in hard-to-reach populations and snowball sampling not in hard-to-reach populations." Sociological Methodology 41, no. 1 (August 1, 2011): 347-353.

Heckathorn, D. D. "Comment: Snowball versus respondent-driven sampling." Sociological Methodology 41, no. 1 (August 1, 2011): 355-366. [This article is available online from the National Library of Medicine.]

Handcock, M. S. and Gile, K. J. "Comment: On the concept of snowball sampling." Sociological Methodology 41, no. 1 (August 1, 2011): 367-371. [The text of this article is available online from the National Library of Medicine.]

It is worth noting that the 2017 SAGE Encyclopedia of Communication Research gives an example of research into chaplains as part of its section on Snowball Subject Recruitment, in the larger context of how a snowball approach to recruitment could apply to a purposive form of nonrandom sampling. The example refers to a researcher's interest in chaplains' perspectives on the provision of spiritual care in hospitals for ill patients. Purposefully specifying chaplains in the study sample excludes other spiritual care providers, narrowing the sample, even if still employing a snowball recruitment process. [This is principally an online publication, but see print pages 1614-1616.]


V.  For more on Martin Heidegger's phenomenology, see the following articles out of the nursing literature:

Horrigan-Kelly, M., Millar, M., Dowling, M. "Understanding the key tenets of Heidegger's philosophy for interpretive phenomenological research." International Journal of Qualitative Methods 15, no. 1 (2016): 1-8 [online journal pagination]. [(Abstract:) Martin Heidegger's phenomenology provides methodological guidance for qualitative researchers seeking to explicate the lived experience of study participants. However, most phenomenological researchers apply his philosophy loosely. This is not surprising because Heidegger's phenomenological philosophy is challenging and the influence of his philosophy in shaping the conduct of interpretive phenomenological research is broadly debated. This article presents an exploration of Dasein, a key tenet of Martin Heidegger's interpretive phenomenology and explicates its usefulness for phenomenological research. From this perspective, we present guidance for researchers planning to utilize Heidegger's philosophy underpinning their research.] [This article is available online from the journal.]

McConnell-Henry, T. E., Chapman, Y. B. and Francis, K. L. "Unpacking Heideggerian phenomenology." Southern Online Journal of Nursing Research 9, no. 1 (2009): 1-11 [online journal pagination]. [(Abstract:) This paper illuminates the thinking that underpinned Martin Heidegger's philosophy. Essentially Heidegger purported that we construct our reality from our own experiences and beliefs. For many researchers, however the difficultly in deciphering the complexities of German based language is a frequently cited reason for avoiding Heideggerian phenomenology. As a result this article examines facets of the language used by Heidegger, and furthermore offers discussion and examples to allow researchers to appreciate how this philosophy may translate into a methodological framework to be utilized in contemporary nursing research.] [This article is available online from the journal.]

    It may also be useful to look at the following examples of research in the chaplaincy literature, specifically citing Heideggerian phenomenology. Note, particularly, the 2022 article by Muehlhausen and a number of the same authors from our featured article this month.

Echols, B. L. "Improving spiritual care by chaplains for service members who witness death." Doctor of Ministry Thesis, Seattle University, 2020. Available online. [See esp. pages 22-25.]

Muehlhausen, B. L. "Spirituality and vicarious trauma among trauma clinicians: a qualitative study." Journal of Trauma Nursing 28, no. 6 (November-December 2021): 367-377. [--This was our November 2021 Article-of-the-Month.]

Muehlhausen, B. L., Desjardins, C. M., Chappelle, C., Schwartzman, G., Tata-Mbeng, B. and Fitchett, G. "Managing spiritual care departments during the COVID-19 pandemic: a qualitative study." Journal of Pastoral Care and Counseling 76, no. 4 (December 2022): 294-303. [This qualitative study reports how 20 spiritual care leaders provided leadership in the early months of the COVID-19 pandemic. The patterns and themes that emerged centered around the changing world of chaplaincy, the administrative role of the leader, and the personal story of the leader. Spiritual care leaders demonstrated creativity with the potential to shape chaplaincy in positive ways, expanding the reach of spiritual care.]

Taylor, J. J., Hodgson, J. L., Kolobova, I., Lamson, A. L., Sira, N. and Musick, D. "Exploring the phenomenon of spiritual care between hospital chaplains and hospital based healthcare providers." Journal of Health Care Chaplaincy 21, no. 3 (2015): 91-107. [(Abstract:) Hospital chaplaincy and spiritual care services are important to patients' medical care and well-being; however, little is known about healthcare providers' experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers' personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains' services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities.]


VI.  Our featured study notes the resilience of chaplains during the pandemic. The subject of resilience as a challenge for chaplains during COVID-19 was addressed in a Research Update in the March-April 2021 edition of the National Association of Catholic Chaplains' publication Vision. See "Resiliency practices: evidence-based interventions that inspire hope," by Austine Duru, BCC, vice president of mission with Bon Secours Mercy Health in Ohio --available online from the NACC.



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