Judith R. Ragsdale

Using Spirituality After an Adult CF Diagnosis: Cognitive Reframing and Adherence Motivation

Chronic illness is a significant stressor; the majority of Americans cope utilizing spirituality. Numerous studies demonstrate links between spiritual coping and health outcomes. The purpose of this study was to determine whether persons diagnosed with cystic fibrosis (CF) as adults use spirituality to cope and influence disease management. Semi-structured interviews were completed and analyzed using grounded theory. Data saturation was reached following twelve interviews (83% female); representing 100% participation of those approached and 48% of eligible adults. Persons with late-life CF diagnoses used spirituality to make meaning, understanding themselves in a collaborative partnership with their pulmonologist and God. Supporting themes were: (a) Gods intervention depended on treatment adherence and (b) spiritual meaning was constructed through positively reframing their experience. The constructed meaning differed from that of adult parents of children with CF. Late-life diagnosed adults focused on personal responsibility for health. Clinical and research implications for chaplains are presented.

Written prayers and religious coping in a paediatric hospital setting

Hospitalised children represent a threatened future to parents. Such stressors call forth peoples coping styles. Some individuals cope religiously or spiritually, and religious coping through prayer may be utilised. A sample of prayers written in a paediatric hospital chapel was coded by styles of religious coping evident within them. Styles associated with coping to gain control of their situation and with coping by seeking comfort from God were present. Seeking to cope for gaining control of a situation was more common than seeking comfort from God during the event. Written prayers did not contain evidence of coping by making meaning. Regression analysis showed that the probability of writing a prayer to gain control decreased over time and a trend towards increasing probability of writing a prayer expressing coping by seeking Gods comfort. Clinical implications are discussed. Future research should include a larger sample and cognitive interviews with prayer writers.

Educating CPE Supervisors: a Grounded Theory Study

This qualitative study was designed to cull the wisdom of CPE supervisors doing especially competent supervisory education and to develop a theory of CPE supervisory education. Grounded theory methodology included interviewing 11 supervisors and coding the data to identify themes. Four primary dimensions emerged along with a reciprocal core dimension, Supervisory Wisdom, which refers to work the supervisors do in terms of their continuing growth and development.

Characterizing the Adequacy, Effectiveness, and Barriers Related to Research Mentorship Among Junior Pediatric Hospitalists and General Pediatricians at a Large Academic Institution

OBJECTIVE The purpose of this qualitative study was to characterize the adequacy, effectiveness, and barriers related to research mentorship among junior pediatric hospitalists and general pediatricians at a large academic institution. METHODS Junior faculty and staff physicians in hospital medicine and general pediatrics at a large academic institution were invited to participate in this qualitative study. In-depth interviews were conducted. Experienced mentors were invited to be interviewed for theoretical sampling. Interviews were conducted and analyzed by using grounded theory methodology. RESULTS Twenty-six (75%) of the eligible physicians, pediatric hospitalists representing 65% of this sample, agreed to be interviewed about their mentoring experiences. Satisfied and dissatisfied participants expressed similar mentoring themes: acquisition of research skills, academic productivity, and career development. Four experienced mentors were interviewed and provided rationale for mentoring clinicians in research. Both groups of participants agreed that institutional support is vital for promoting mentorship. CONCLUSIONS Junior pediatric hospitalists and general pediatricians indicated considerable interest in being mentored to learn to do clinical research. Developing faculty and staff physicians to their utmost potential is critical for advancement in academic medicine. Mentoring clinical physicians seeking to add research skills and academic productivity to their practice merits study as an innovative path to develop clinical investigators. Hospital medicine, as a rapidly developing pediatric specialty, is well-positioned to implement the necessary infrastructure to mentor junior faculty in their academic pursuits, thereby optimizing the potential impact for individuals, families, learners, and institutions.

Mutually engaged supervisory processes: a proposed theory for ACPE supervisory education.

Nineteen newly certified Association for Clinical Pastoral Education (ACPE) Associate Supervisors were interviewed to determine how they learned to do Clinical Pastoral Education (CPE) supervision. Grounded theory was the qualitative research method used in gathering and analyzing data for this IRB approved study. The emerging theory, Mutually Engaged Supervisory Processes, includes nine processes: Discerning Vocation, Feedback, Support, Supervisory Practices and Identity, Theory, Increased Awareness, Shift in Personhood, Offering Presence, and Owning Authority. Member checks confirmed the trustworthiness of the results.

Attention to Spiritual/Religious Concerns in Pediatric Practice: What Clinical Situations? What Educational Preparation?

Chaplaincy Today • Volume 23 Number 2 • Autumn/Winter 2007 Medical practitioners and researchers continue to explore the association between spiritual/religious (SR) concerns and illness and medical care. Koenig et al. summarize over 1600 publications that describe this relationship. In a previous publication, we reported the statistically significant web of associations between the personal/professional characteristics of pediatricians and their attention to SR in clinical practice. In summary, we found that older pediatricians who described themselves as religious and spiritual more frequently talked with patients/families about their SR concerns. These pediatricians reported that their own personal SR was important in their clinical practice and that the SR of patients/families was relevant to the care they provided. This article presents results relative to the following:

Behavioral Outcomes of Supervisory Education in the Association for Clinical Pastoral Education: A Qualitative Research Study:

This study advances the work of developing a theory for educating Clinical Pastoral Education (CPE) Supervisors by describing the behaviors which result from the successful completion of CPE supervisory education. Twenty-eight Association for Clinical Pastoral Education (ACPE) Certification Commissioners were interviewed to identify the behaviors demonstrated by Supervisory Education Students (Candidates) which influenced the decision to certify them at the level of Associate Supervisor. Specific behavioral descriptors are listed for each ACPE supervisory competency

Posttonsillectomy Hemorrhage in a Pediatric Jehovah’s Witness and the Decision to Transfuse:

A 7-year-old male presented for adenotonsillectomy for chronic tonsillitis. The family was Spanish speaking and Jehovah’s Witness, and a specific request to avoid blood transfusions was made. Adenotonsillectomy was performed as an outpatient without event. On postoperative day (POD) 1, the patient presented to the emergency department (ED) with hematemesis. The patient was taken to the operating room (OR) for control of pharyngeal bleeding. Intraoperative blood loss was 400 mL, and he was transferred to the intensive care unit (ICU) intubated. Postoperative hemoglobin was 5.8 g/dL, with normal coagulation profiles. Hematology was consulted, and iron and transexamic acid were started. Discussion was made with the family and the Jehovah’s Witness liaison committee regarding recommendation for transfusion, which the family refused. On POD 2, the patient required an additional OR trip for hemorrhage control with a postoperative hemoglobin of 5.2 g/dL. The patient had another bleeding event on POD 5 and again went to the OR. Hemoglobin was 5.3 g/dL, and after difficulty controlling the hemorrhage, the anesthesiologist and the otolaryngologist jointly decided to administer 3 units of packed red blood cells to the child. The hemorrhage was controlled, and postoperatively, the child had a hemoglobin of 15.9 g/dL with no additional bleeding. The Cincinnati Children’s Hospital Medical Center IRB exempted this case report from review.

Islam, The Holy Qur’an, and Medical Decision-Making: The Experience of Middle Eastern Muslim Families with Children Undergoing Bone Marrow Transplantation in the United States

Some Arabic-speaking Muslim family members of children requiring bone marrow transplantation receive medical care for their children in the United States. Muslim family members’ use of Islam in the course of their child’s bone marrow transplantation was studied using grounded theory, a qualitative research method. Eighteen members of Middle Eastern Muslim families with a total of 13 children receiving bone marrow transplantation were interviewed by an Arabic-speaking healthcare provider. Interviews were coded by an interdisciplinary team. Seven key themes were identified.

Critically Engaging "Mutually Engaged Supervisory Processes" - A Response.

am profoundly grateful to George Fitchett for recognizing the need to collect and organize critical responses to the emerging theory Mutually Engaged Supervisory Processes (MESP). I am also indebted to panelists Mary Altenbaumer, Osofo Kwesi Atta, Sheryl Lyndes Stowman, and Kyle Vlach for their thoughtful critique and for their work, along with Fitchett, to create the article to which I am responding. In the process of receiving critique about MESP, I learned that I did not have a working definition of a completed theory. Grounded theory, the research method I used for this study, draws emerging elements of theory from analysis of experiences of the subject under study; in this case, ACPE supervisory education. Grounded theory produces emerging theory rather than completed theory. I found a model of continuing theory development in the nursing literature. Academic nurses have done considerable work not only in developing theories, but in defining paths for theory development. I chose this definition of a completed theory: “an internally consistent group of relational statements that presents a systematic view about a phenomenon and that is useful for description, explanation, prediction, and prescription” (Walker & Avant, 2011). My plan is to continue working with colleagues to develop a theory for Supervisory CPE that is useful for supervisors of Supervisory Education Students (SESs) and for the SESs themselves. I do not claim to be developing the theory for Supervisory CPE. I suspect any theory that claims to be useful for all cultures and theologies is drawn from the dominant culture. Key elements of the critique of MESP include attention to the inadequacy of the diagram, to personal transformation in supervisory CPE, and to the way theory is addressed in developing SESs. This response addresses those areas of critique as well as the suggestion in the critique article that accepting SESs who are better prepared might shorten the education and certification processes. I agree with the critique that the diagram for MESP is less than useful. Supervisory Education begins with a decision to enter the process, a process we called Discernment. The education journey results in an expanded presence informed by one’s supervisory identity and skills, and in an ability to own one’s supervisory authority while engaging productively and relationally with the authority of others. Several of the processes in between do begin before supervisory education; for instance, no entering SES will be new to the concept of feedback. However, the relationship to feedback will most likely expand and change. No participant in the MESP study reported prior experience presenting video recordings of their work to others for intensive feedback. The emerging theory attempted to describe how the participants in the MESP study experienced the various elements of feedback, but did a poor job explaining how feedback is also inherent in the other processes such as the discernment process, and the process of owning one’s supervisory authority. This is true also for the processes of selfawareness and use of support. Even though these are not new to the SES, they may be I