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November 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


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 is an open access article available freely online through the journal.

SUMMARY and COMMENT: This month's article is a fine example of a chaplain using her professional experience and insight to engage and explore the subject of spirituality with members of allied disciplines. The results fill a gap in the Spirituality & Health literature and suggest some practical guidance regarding support for staff working with trauma. The author holds a PhD in Social Work and is a chaplain researcher with Ascension Health. She previously presented this study at the joint Association of Professional Chaplains and National Association of Catholic Chaplains conference in Anaheim, CA, July 15, 2018. [NOTE: The author has provided a special comment to ACPE Research readers, below.]

"The aim of this study was to expand the understanding of spirituality and vicarious trauma and vicarious growth by examining the lived experiences of frontline health care providers (physicians, nurse practitioners, or physician assistants) dealing with trauma patients" [p. 374]. Interviews were conducted with 36 healthcare professionals (27 physicians, 8 nurse practitioners/physician assistants and 1 RN nurse educator), from a total sample of 46 healthcare professionals contacted at a Level I Trauma Center at St. Vincent's Hospital (Indianapolis, IN) or through the 2018 annual convention of the Eastern Association for the Surgery of Trauma. "Participants at the trauma conference [constituting one third of the sample] expressed the same patterns [of responses] as those from the Midwest trauma hospital, therefore offering no new patterns, which helped ensure data saturation" [p. 375].

Muehlhausen's methodology is well laid out, not only with the guided interview questions being detailed in a table [--see p. 370], but with some background to the study's utilization of hermeneutical phenomenology based on the principles of Martin Heidegger [--see pp. 368-369]. "This [qualitative] methodology seeks to reveal meanings associated with practical knowledge that is left hidden in empirical research approaches" [p. 369]. Interviews lasted 45-75 minutes and were carried out with special attention to privacy. The content was coded by the author alone, but a participant who was a surgeon and researcher with experience in religious studies "provided feedback on patterns and themes to ensure academic rigor" [p. 369]. "Efforts were made to have diverse participants, but the participants were predominantly White and Christian" [p. 375]. Demographics are noted in a table on p. 371.

Four patterns with constituent themes emerged from the data. Among the findings regarding each of these:

1) The World of Trauma
Participants described the world of trauma as "fast-paced and require[ing] members of the trauma team to make quick decisions and rapidly move from one case to the next. There is an expectation that the trauma team members keep moving and do not need or have the luxury to let the work get to them." [p. 369] They also talked about "difficulty shifting from the world of trauma to the world of their families and personal lives" and offered examples of the "cumulative toll" on their family life: "Children may not think Mom or Dad cares because they do not react to blood or even a broken bone," or they may become "hypervigilant about safety," "seeing potential traumatic accidents everywhere." [p. 370]

2) Religious or Spiritual Beliefs as Guiding Their Work
"[A]ll participants talked about their religious or spiritual beliefs as guiding their work with trauma patients. This pattern manifested itself in three key themes: faith in God or higher power; a desire to make a significant difference in the lives of others; and a belief that all persons are sacred." ..."Another strong spiritual theme was a desire to make a significant difference in the lives of others. Participants did not use the language of 'calling,' but they spoke to a sense of being called to care for their fellow human beings as people experienced horrific circumstances." And, participants held that "trauma work attracts professionals who believe all persons deserve exemplary care." [p. 370]

3) The Need for Support Systems
Participants shared the importance of a strong support network, including spouses or significant others with whom they could talk after difficult shifts. "Participants also sought support from clergy, members of a Bible study group, or military chaplains...allow[ing] them to process their experiences...." ..."In addition, participants emphasized the helpfulness of "process[ing] with colleagues on an individual basis, in the moment or immediately following their shift" -- made easy in the moment by the physical proximity of colleagues -- and having the effect of "creating an organizational culture where vicarious trauma is perceived as a normal reaction." [p. 371] By the same token, participants expressed how "difficulties in personal support systems, fall out with friends, divorce, death..." were problematic to their coping. Significantly, "[p]articipants had strong reactions to questions about formal debriefing sessions, including scoffing, rolling their eyes, and shifting their body language." [p. 374]

4) The Importance of Coping Mechanisms
The most prominently mentioned coping methods were prayer, physical exercise, and compartmentalization/detachment/depersonalization. "Several respondents mentioned praying prior to a difficult case, during surgery, or afterward to provide compassionate care to difficult patients." [p. 374] While many talked about exercise, especially running, participants also "spoke of caring for their spirits while in the trauma bay by compartmentalizing. They could cope by focusing on protocols, procedures, and viewing the body as a machine that needed repair." [p. 374]

These patterns and themes are illustrated in some detail through a table of primary quotes from participants [--see pp. 371-372]. For this reader, one of the most significant findings was the negative reaction to formal debriefing sessions, with participants preferring opportunities to process experiences individually with trusted others. The author proposes that "[h]aving a chaplain who understands traumatology and is seen as a trusted colleague may be an additional means for individual processing and support" [p. 374], and goes on to say:

Chaplains are trained to conduct spiritual assessments and provide care to persons of all faith traditions and nonfaith. Chaplains with their specialized training and experience are well suited to aid trauma personnel who want spiritual support in processing their personal stressors and making meaning out of their work experiences on an individual basis. Hospitals and medical groups would be wise to have a specialized chaplain designated to support trauma personnel. [p. 375]
Moreover, the support of trauma staff should be made as convenient as possible. "Without the ease of convenience, personnel may not prioritize debriefing, leading to the cumulative negative impact of working with trauma patients" [p. 375].

The article points to a number of avenues for further study, including "research that combines the Maslach Burnout Inventory with instruments measuring spiritual distress" [p. 375]. "At present, no research measures the prevalence of spiritual distress in trauma health care providers. Research is needed that approaches spirituality in terms of underlying global meaning making and its role in coping in the moment as these are two distinct areas of spirituality" [p. 375].

One final observation: some respondents said that "participating in the interview was a valuable means for helping them process thoughts and emotions previously set aside" [p. 374]. This finding raises anew the intriguing question of how chaplains' engagement with individuals through research may itself be experienced by study participants as a helpful intervention, and how interview studies may lend themselves especially to providing this experience. If so, what might this say about the interpersonal qualities and skills that chaplains can bring to research? Would there be any risk that this sort of experience of Spirituality & Health research could complicate responses and results? What kinds of training might optimally sensitize chaplain researchers to such dynamics in the course of conducting studies? [See Related Items of Interest, §IV, below.]

The bibliography of 38 references is quite up-to-date, extending into 2021.

Special Comment to ACPE Research readers from Dr. Beth L. Muehlhausen, PhD, MDiv, BCC, LCSW; Researcher for Spiritual Care and Mission Integration, Ascension, St Louis, MO:

Chaplains are often intimidated by the concept of research for multiple reasons. They may be intimidated by quantitative research that employs statistical analysis. They may be leery of research fearing it may lose the soul of chaplaincy. Chaplains actually conduct research every day without labeling it as such. They conduct research by talking to charge nurses to find out who in their units needs spiritual care. Chaplains often have to triage and prioritize who to visit first. This entails research by asking questions of medical personnel related to which case is most serious, who has support and can wait, and how family members are coping. I find that chaplains who are intimidated by research sell themselves short. Chaplains are trained to listen to personal stories and make sense out of them. This is the same skill a qualitative researcher needs to interview research participants. Qualitative researchers create questions that lead to storytelling. The researcher then analyzes the stories for patterns and themes that are seen throughout all the stories. Quantitative research projects also tell a story. For example, quantitative research tells the story of how many people are impacted by Covid-19. Qualitative research tells the story of individuals impacted by Covid-19. In chaplaincy we need both perspectives, i.e. how many people receive spiritual care and a deep understanding of what happens during a spiritual care encounter. At Ascension we have had over 35 chaplains participate in the Transforming Chaplaincy online "Research Literacy 101" course. Our chaplains speak highly of the course as a means for understanding research and feeling more confident in reading research articles. For chaplains interested in research, I highly recommend partnering with more experienced researchers. Collaboration can be very synergistic and valuable in a multitude of ways. All chaplains need to be research literate. The field of spiritual care research also needs researchers with diverse backgrounds and perspectives to set research agendas that reflect the diversity of the patients, families and staff that chaplains serve. Please be encouraged to be research literate or possibly a future researcher.

For discussion, I would suggest:
1) What do students find appealing or intimidating about spiritual care research?
2) How do the skills of a chaplain naturally lend themselves to research?
3) How does research elevate the profession of chaplains?
4) How does research enable chaplains to communicate what we do to our colleagues from other disciplines or executives who do not understand the value of chaplains?


Suggestions for Use of the Article for Student Discussion: 

This is an exceptionally well-presented article that should be usable with any group, though chaplains with direct involvement with trauma teams would find it most applicable. In addition to the broad questions that the author has posed for discussion (--see directly above), discussion could open up the topic of chaplains' sense of the needs of staff for support and how chaplains could be helpful. How might the article inform this topic? What stands out from the findings? Can chaplains identify with some of these needs and some of the complex dynamics involved in receiving support? Can the group relate to the findings about debriefing and how disruptions in one's support network can affect the process of coping in the course of clinical practice? Do people ever feel "thrown" into traumatic situations? Do members of the group find themselves compartmentalizing in the middle of traumatic or otherwise demanding situations? What do they think of the following comment?

Compartmentalizing in the middle of the trauma bay can be a healthy way to focus on the job at hand and care for the patient's physical needs. However, compartmentalizing can accumulate to the point of depersonalization without other coping mechanisms and support systems in place. [p. 375]
In relation to this, how might any healthcare professional seek to guard against the subtle accumulation of stress, and what might this say to chaplains? And, what is the possible role of vicarious growth and vicarious resilience? Overall, the very interview questions used with the study participants [--Table 1, p. 370] could also be posed to the group, especially if at a Trauma Center. This article would present an opportunity to invite a Trauma physician and/or nurse into the conversation with the group. Finally, the group could consider the methodology of the study. The author not only utilizes qualitative methodology but appears to be a champion of it! Was the group able to follow the methodology section about hermeneutical phenomenology? It may be worth reading that section carefully all together. Could this methodology hold promise for exploring the lived experience of chaplains?


Related Items of Interest:

I. Muehlhausen notes that the term "vicarious trauma" is found in the research literature alongside such terms as "secondary trauma," "compassion fatigue," and "burnout," and that "[a]t times these terms are used interchangeably or have different definitions associated with them" [p. 367]. The following are a couple of past Articles-of-the-Month that pertain to this constellation of concepts in and beyond the context of Emergency Room/Trauma physicians and nurses:

Liberman, T., Kozikowski, A., Carney, M., Kline, M., Axelrud, A., Ofer, A., Rossetti, M. and Pekmezaris, R. "Knowledge, attitudes, and interactions with chaplains and nursing staff outcomes: a survey study." Journal of Religion and Health (2020): online ahead of print, 5/22/20. [This investigation into whether chaplaincy interaction is associated with decreased employee stress and increased job satisfaction among nurses analyzed data from purposive sample 51 nurses with routine access to a chaplain through daily rounds. Among the findings was a significant positive relationship between the rated importance of having a chaplain in the hospital to talk to and secondary trauma.] [This article was featured as our June 2020 Article-of-the-Month]

Copeland, D. and Liska, H. "Implementation of a Post-Code Pause: extending post-event debriefing to include silence." Journal of Trauma Nursing 23, no. 2 (March-April 2016): 58-64. [This research was carried out at a Level 1 Trauma Canter and demonstrates the feasibility of a brief intervention developed by nurses and originally led by a chaplain, for hospital staff after a resuscitation/trauma response.] [This article was featured as our May 2016 Article-of-the-Month]


II.  While not a report of research, the following is a very personal recent commentary by a medical student with CPE training, recalling a trauma experience.

McCurry, I. J. "Dear unknown: a letter to a teenage gunshot victim." Journal of Pastoral Care and Counseling 75, no. 1 (March 2021): 74.



III.  Our featured article mentions the concept or "vicarious resilience" [p. 368]. For more on that, see our September 2007 Article-of-the-Month, which has been updated to include relevant articles on vicarious resilience published since 2007.

Hernandez, P., Gangsei, D., Engstrom, D. "Vicarious resilience: a new concept in work with those who survive trauma." Family Process 46, no.2 (June 2007): 229-241. [(Abstract:) This study explores the formulation of a new concept: vicarious resilience. It addresses the question of how psychotherapists who work with survivors of political violence or kidnapping are affected by their clients' stories of resilience. It focuses on the psychotherapists' interpretations of their clients' stories, and how they make sense of the impact that these stories have had on their lives. In semistructured interviews, 12 psychotherapists who work with victims of political violence and kidnapping were interviewed about their perceptions of their clients' overcoming of adversity. A phenomenological analysis of the transcripts was used to describe the themes that speak about the effects of witnessing how clients cope constructively with adversity. These themes are discussed to advance the concept of vicarious resilience and how it can contribute to sustaining and empowering trauma therapists.]


IV.  Our featured study found that some respondents felt that "participating in the interview was a valuable means for helping them process thoughts and emotions previously set aside" [p. 374] The idea that participating in Spirituality & Health studies may itself be a positive and healing experience for subjects came up in our June 2015 Articles-of-the-Month.

Piderman, K. M., Breitkopf, C. R., Jenkins, S. M., Lovejoy, L. A., Dulohery, Y. M., Marek, D. V., Durland, H. L., Head, D. L., Swanson, S. W., Hogg, J. T., Evans, J. L., Jorgenson, S. E., Bunkowski, L. J., Jones, K. L., Euerle, T. T., Kwete, G. M., Miller, K. A., Morris, J. R., Yoder, T. J., Lapid, M. I. and Jatoi, A. "The feasibility and educational value of Hear My Voice, a chaplain-led spiritual life review process for patients with brain cancers and progressive neurologic conditions." Journal of Cancer Education 30, no. 2 (June 2015): 209-212. [(Abstract:) Research continues to establish the importance of spirituality for many persons with medical illnesses. This paper describes a pilot study titled, "Hear My Voice," designed to provide an opportunity for persons with progressive neurologic illnesses, including brain tumors and other neurodegenerative diseases, to review and discuss their spirituality with a board-certified chaplain, and to prepare a spiritual legacy document (SLD). First, we provide background information that underscores the importance of such a project for this patient population that is particularly vulnerable to cognitive impairment and communication difficulties. Second, we provide detailed methodology, including the semi-structured interview format used, the development of the SLD, and an overview of responses from participants and investigators. We also describe the quantitative and qualitative approaches to analysis taken with the aim of developing scientific validation in support of the Hear My Voice project.]

Piderman, K. M., Breitkopf, C. R., Jenkins, S. M., Euerle, T. T., Lovejoy, L. A., Kwete, G. M. and Jatoi, A. "A chaplain-led spiritual life review pilot study for patients with brain cancers and other degenerative neurologic diseases." Rambam Maimonides Medical Journal 6, no. 2 (April 2015): e0015 [electronic journal article designation]. [(Abstract:) OBJECTIVE: This pilot study was designed to describe changes in spiritual well-being (SWB), spiritual coping, and quality of life (QOL) in patients with brain cancer or other neurodegenerative diseases participating in a chaplain-led spiritual life review interview and development of a spiritual legacy document (SLD). METHODS: Eligible participants were enrolled and completed baseline questionnaires. They were interviewed by a board-certified chaplain about spiritual influences, beliefs, practices, values, and spiritual struggles. An SLD was prepared for each participant, and one month follow-up questionnaires were completed. Two cases are summarized, and spiritual development themes are illustrated within a spiritual development framework. RESULTS: A total of 27 patients completed baseline questionnaires and the interview; 24 completed the SLD, and 15 completed the follow-up questionnaire. Increases in SWB, religious coping, and QOL were detected. The majority maintained the highest (best) scores of negative religious coping, demonstrating minimal spiritual struggle. CONCLUSIONS: Despite the challenges of brain cancers and other neurodegenerative diseases, participants demonstrated improvements in SWB, positive religious coping, and QOL. Patient comments indicate that benefit is related to the opportunity to reflect on and integrate spiritual experiences and to preserve them for others. Research with a larger, more diverse sample is needed, as well as clinical applications for those too vulnerable to participate in longitudinal follow-up.]

    The idea has also been addressed directly in the following brief commentary by another chaplain researcher.

Grossoehme, D. H. "Research as a Chaplaincy Intervention." Journal of Health Care Chaplaincy 17, nos. 3-4 (July 2011): 97-99. ["I want to suggest that if the questions we ask during a clinical encounter are 'interventions,' which we believe contribute to another person's wholeness, then questions asked in the context of a research study are also interventions with potentially helpful outcomes. I also want to take a further step and suggest that chaplaincy research is not an activity that takes time away from chaplains' care; research is a form of the care that chaplains provide." (p. 98)]


V.  This month's author is a champion for qualitative research as a very intentional method that can hold benefits not realizable through quantitative methods, and as an approach to which chaplains may bring important skills. For an overview of qualitative research for chaplains, see our August 2014 Article-of-the-Month. (Note, too, that this article also includes the idea of research as a chaplaincy intervention.)

Grossoehme, D. H. "Overview of qualitative research." Journal of Health Care Chaplaincy 20, no. 3 (2014): 109-122. [(Abstract:) Qualitative research methods are a robust tool for chaplaincy research questions. Similar to much of chaplaincy clinical care, qualitative research generally works with written texts, often transcriptions of individual interviews or focus group conversations and seeks to understand the meaning of experience in a study sample. This article describes three common methodologies: ethnography, grounded theory, and phenomenology. Issues to consider relating to the study sample, design, and analysis are discussed. Enhancing the validity of the data, as well reliability and ethical issues in qualitative research are described. Qualitative research is an accessible way for chaplains to contribute new knowledge about the sacred dimension of people's lived experience.]


VI.  Our featured article this month emphasizes Martin Heidegger's phenomenology as the ground for Beth Muehlhausen's methodology [--see pp. 368-369]. Daniel Grossoehme's " Overview of qualitative research," cited above, includes a section on phenomenology and notes Heidegger briefly. There has been much published on such an influential thinker, but chaplains may find following articles out of the nursing literature helpful:

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.]

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.]

    It may also be useful to look at the following examples of research in the chaplaincy literature, specifically citing Heideggerian phenomenology:

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.]

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.]


VII.  Regarding the Maslach Burnout Inventory, see also:

Baugh, J. J., Takayesu, J. K., White. B. A. and Raja, A. S. "Beyond the Maslach burnout inventory: addressing emergency medicine burnout with Maslach's full theory." Journal of the American College of Emergency Physicians 1, no. 5 (October 2020): 1044-1049. [(Abstract:) Burnout, a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job, remains a substantial problem for emergency physicians, leading to decreased quality of care and attrition from the workforce. The majority of prior work on burnout in emergency medicine has focused on individualized solutions, which have demonstrated modest efficacy for ameliorating burnout. However, recent studies suggest that burnout in medicine is primarily caused by workplace factors (eg, unmanageable workloads, unreasonable time pressures) and therefore requires solutions at an organizational level. In her decades of research across industries, Christina Maslach identified 6 domains of organizations that can either promote engagement or lead to burnout. In this article, we apply Maslach's 6 domains to emergency medicine to provide a systematic framework for alleviating burnout and promoting engagement among emergency physicians. By considering the domains of workload, reward, control, fairness, community, and value congruence, emergency medicine leaders can develop and deploy more effective interventions aimed at improving the experience and longevity of physicians across our specialty.] [This article is available online.]


VIII.  Research that addresses the phenomena of "secondary trauma," "compassion fatigue," and "burnout," among chaplains, and extending beyond the context of caring for trauma patients:

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.] [March 2020 Article-of-the-Month]

Galek, K., Flannelly, K. J., Greene, P. B. and Kudler, T. "Burnout, secondary traumatic stress, and social support." Pastoral Psychology (2011): 60, no. 5 (October 2011): 633-649. [(Abstract:) The current study examines the extent to which selected work-related variables differentially predict burnout and secondary traumatic stress (STS) and the degree to which social support mitigates both of these occupational stress syndromes. Multiple regression performed on responses from 331 professional chaplains found that: (1) the number of years worked in the same employment position was positively associated with burnout but not STS; (2) STS, but not burnout, was positively associated with the number of hours spent per week counseling patients who had had a traumatic experience; and (3) social support was negatively related to burnout and STS. Only specific sources of social support (supervisory support and family support), however, were negatively associated with burnout. Results highlight the need for counselors to be attuned to not only their clients but also to their own inner dynamics in order to mitigate the possible deleterious effects of their work.] [October 2011 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. [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.] [July 2018 Article-of-the-Month.]

Currier, J. M., Drescher, K. D., Nieuwsma, J. A. and McCormick, W. H. "Theodicies and professional quality of life in a nationally representative sample of chaplains in the veterans' health administration." Journal of Prevention and Intervention in the Community 5, no. 4 (October-December 2017): 286-296. [(Abstract:) This study examined the role of theodicies or theological/philosophic attempts to resolve existential dilemmas related to evil and human suffering in chaplains' professional quality of life (ProQOL). A nationally representative sample of 298 VHA chaplains completed the recently developed Views of Suffering Scale (Hale-Smith, Park, & Edmondson, 2012 ) and ProQOL-5 (Stamm, 2010 ). Descriptive results revealed that 20-50% endorsed strong theistic beliefs in a compassionate deity who reciprocally suffers with hurting people, God ultimately being responsible for suffering, and that suffering can provide opportunities for intimate encounters with God and personal growth. Other results indicated that chaplains' beliefs about human suffering were differentially linked with their sense of enjoyment/purpose in working with veterans. These results suggest that theodicies might serve as a pathway to resilience for individuals in spiritual communities and traditions in USA, particularly for clinicians and ministry professionals who are committed to serving the needs of traumatized persons.]

Oliver, R., Hughes, B. and Weiss, G. "A study of the self-reported resilience of APC chaplains." Journal of Pastoral Care and Counseling 72, no. 2 (June 2018): 99-103. [(Abstract:) Approximately 5000 members of the Association of Professional Chaplains were surveyed using the Professional Quality of Life instrument in order to assess levels of Compassion Satisfaction and Compassion Fatigue and its associated subscales, Burnout and Secondary Traumatic Stress; 1299 surveys were completed. The most significant finding of this study is that Board Certified Chaplains have remarkably low scores of Burnout and Secondary Traumatic Stress and significantly high levels of Compassion Satisfaction.]

Yan, G. W. and Beder, J. "Professional quality of life and associated factors among VHA chaplains." Military Medicine 178, no. 6 (June 2013): 638-645. [(Abstract:) Chaplains play a unique role in the Veterans Affairs (VA) health care systems and have numerous responsibilities. Compassion satisfaction (CS), compassion fatigue (CF), and burnout (BO) are three major phenomenons that have been documented in other helping professions, but little is known about VA Chaplains' professional quality of life. This study examines a national sample of VA Chaplains and their professional quality of life along with associated factors. Two-hundred and seventeen VA Chaplains completed an anonymous Internet survey, and regression analyses were conducted to determine which variables affect professional quality of life. On average, participants report high levels of CS and low levels of CF and BO. Gender, perceived support from VA administration, and mental health (MH) integration were significant predictors for CS. MH integration and perceived support significantly affected CF. Age, MH integration, and perceived support affected BO. Significant interaction effects were found for CF and BO. In summary, younger Chaplains and Chaplains who report low levels of collaboration with MH professionals are most likely to develop CF and BO. This supports continued support from the VA for interdisciplinary initiatives and mentorship of younger Chaplains.] [October 2013 Article-of-the-Month.]



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