February 2023 Article of the Month
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.
SUMMARY and COMMENT: This month's article reports the further development of research by Chaplain Petra J. Sprik and colleagues into telechaplaincy, which we last highlighted for our August 2020 Article-of-the-Month. "The purpose of this study was to describe (1) the use of telechaplaincy in the United States, (2) chaplains' perceptions of strengths and weaknesses and (3) best practices as described by a diverse sample of chaplains with telechaplaincy experience" [p. 42]. This project was carried out prior to the COVID-19 pandemic (with the recruitment of subjects in March-April 2019), but it offers a substantial and helpful baseline for a category of professional practice that has since only increased incidence. [--see pp. 60 and 61].
Surveys were sent out by chaplaincy organizations to their members on behalf of the research team, yielding 781 responses and a final total 699 records for quantitative analysis. In addition, the authors used maximum variation sampling to select 52 people for semi-structured, in-depth interviews, with 35 providing the sample for qualitative examination (when saturation was assessed to have been achieved). The methodology is well described on pp. 42-44, though while the survey items are indicated in a table of responses, the interview guide is not included.
Among the findings:
In 2019, ...47.4% of respondents had practiced telechaplaincy. Practice was not associated with age, gender, race, years of chaplain experience, or professional certification.... ....Chaplains who had not practiced telechaplaincy were more willing to do so if they believed it was able to meet patients' spiritual and emotional needs.... Chaplains currently in rural settings reported the highest proportion of use among community types.... Telehealth mediums other than the telephone (i.e., text, email, video- conference, other) were used more commonly by those practicing in non-healthcare versus healthcare settings.... [pp. 44 and 46]
The authors found a "nuanced picture of inter-related strengths and weaknesses" [p. 60] of telechaplaincy, even involving seemingly overlapping and even contradictory positions. These points are presented in two tables, with illustrative/explanatory quotes. Such strengths and weaknesses may be especially useful for department managers to consider when planning a telechaplaincy initiative, and for staff to keep in mind as they assess their experience.
Regarding BEST PRACTICES, the researchers identified four main themes, and constituent subthemes, from the participants' input. The subthemes are described in paragraph-length in the text [--see pp. 49, 51, 54-60] offering a fair sense of the meaning of each.
1) Program Implementation --
In their Discussion section, the authors take up the issue of bias in two ways. First, they note that telechaplaincy itself is an object of bias, in light of the finding that "a substantial number of people had negative perceptions of telechaplaincy or were not willing to practice" [p. 60]. To counter this, they suggest that chaplaincy managers be proactive in educating staff about the potential benefit to patients, since evidence indicates that "chaplains [are] more likely to practice if they believed that telechaplaincy was effective at meeting recipients' spiritual needs" [p. 60]. Moreover, they advise that chaplains be incorporated into the planning process as "key stakeholders" [p. 60], that any plan avoid making telechaplaincy a sole responsibility but instead mix it with in-person encounters in the practice of individual chaplains, and that theological reasons for bias be addressed. The data revealed that while there could be a theological impetus for telechaplaincy outreach (e.g., being "present" to those who may be disconnected, isolated, or "afraid of talking to a faith representative in-person" [p. 51]), theology could also be a disincentive (e.g., "I have not yet worked all this out in my theological mind about how to be a community of connected humans virtually" [p. 53]). Second, they note how bias may have been a limiting factor in the process of the study. They took steps to limit conformity bias in responses by making the surveys largely anonymous, but selection bias may have played into the identification of the participant sample. The authors call for further research to test and refine the best practices proffered by the 35 chaplains who were interviewed.
The importance of this research lies partly in its identification of chaplains' perceptions of telechaplaincy (which should pave the way for overcoming barriers to practice) but, at least for this reader, its great value is largely in the establishment of a baseline for best practices that could be discussed within the profession and lead toward a consensus, informed by further research. The work proceeds from the recognition that "telechaplaincy has unique components to identify and address" [p. 42], above and beyond all that is required for skillful in-person chaplaincy. By the same token, however, telechaplaicy is an umbrella term for various modalities (e.g., phone but also "text, email, videoconference, other" [p. 46]) which would logically call for some special attention to the particular dynamics of each --hence, the points to "[p]ractice to develop confidence and understanding ...of telehealth modalities" [p. 54] and the need to "[a]ssess which modality to use" [p. 55]. The best practices presented here do not delve into every modality in detail, nor do they take into account the many advances in videoconferencing that have occurred through the COVID-19 pandemic, but they nevertheless set the ground for thinking about how chaplaincy may be modulated according to the means of interaction. Taken one step further, what we learn through examining the different modes of telechaplaincy may help chaplains refine best practices for other interactional circumstances, such as when wearing obstructive Personal Protective Equipment or when caring for a patient who is encumbered by some obstacle to communication.
"This study is novel in that it is the first nation-wide study of telechaplaincy practice within the United States and draws from a large sample of people." [p. 61] As such, it "supports the thoughtful integration of telechaplaincy and its promise for improving spiritual care in various settings." [p. 60]
Suggestions for Use of the Article for Student Discussion:
Chaplains of any level of experience should be able to read and relate to this month's article and, given the increasing role of smartphones and tablets in daily life, it should be of practical interest to everyone in the field of chaplaincy and spiritual care. Discussion could begin with a general sharing about individuals' use of telechaplaincy in all its forms and what the students have found to be advantages and difficulties for them personally. That could be connected to study's findings of strengths and weaknesses in Tables 6 and 7 [pp. 50-51 and 52-53]. Next, what have the students done to adjust their in-person practice to the telechaplaincy context? In what ways do they feel a need for more guidance or training? Has the article challenged them in some specific ways? As a group exercise, the students could enumerate what they believe to be the top things to keep in mind for telechaplaincy --a short list that conveys their sense of priority items. This article offers an unusual opportunity to move from discussion into role-playing. A partition could be set up to role-play a remote patient-chaplain interaction. The group may even want to create an education and/or performance improvement project on the subject. Finally, since the authors make a special note about how a chaplain's theology may be a factor here [--see p. 60, as well as pp. 51 and 53], do the students see telechaplaincy through a specific theological lens?
Related Items of Interest:
I. A number of resources on telechaplaincy were noted in the Items of Related Interest for our August 2020 Article-of-the-Month, but see also some that have appeared since:
II. See also this article on developments in the field:
III. When the COVID-19 pandemic hit in March 2020, the Department of Pastoral Care at the Penn Presbyterian Medical Center (Philadelphia, PA) undertook a project to develop best practices for chaplaincy via telephone. At the time, the only guides known to the department focused on videoconferencing and FaceTime-like apps that seemed still unfamiliar to too many patients and presented a number of technological obstacles (e.g., problems with clear connections and lack of device availability). However, cell phones and landlines were convenient, dependable, and grounded to a good degree in social conventions about their use. The project was brought to fruition by Chaplain Joshua Edgar with a summary guide, and telechaplaincy log sheets were created to track implementation for a performance improvement project. The guide was shared widely through a page of Resources on Telechaplaincy from the Chaplaincy Innovation Lab, and it covers many key points highlighted in our featured article this month.
If you have suggestions about the form and/or content of the site, e-mail Chaplain John Ehman, Article-of-the-Month Editor, at email@example.com