Lindsay B. Carey

Circles of care: should community development redefine the practice of palliative care?

Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. This has mostly been done in the context of a service delivery approach to care whereby services have become increasingly expert in identifying health and social care need and meeting this need with professional services. This model of patient centred care, with the impeccable assessment and treatment of physical, social, psychological and spiritual need, predominantly worked very well for the latter part of the 20th century. Over the last 13 years, however, there have been several international examples of community development approaches to end of life care. The patient centred model of care has limitations when there is a fundamental lack of integrated community policy, development and resourcing. Within this article, we propose a model of care which identifies a person with an illness at the centre of a network which includes inner and outer networks, communities and service delivery organisations. All of these are underpinned by policy development, supporting the overall structure. Adoption of this model would allow individuals, communities, service delivery organisations and policy makers to work together to provide end of life care that enhances value and meaning for people at end of life, both patients and communities alike.

Psychoeducational Support for Parents of Children with Intellectual Disability: An Outcome Study

The pressures frequently encountered by the parents of children with chronic conditions and the concomitant impact on family life have been well‐documented. Family‐focussed interventions have been advocated to address parents’ difficulties. The present evaluation study was undertaken to ascertain long‐term outcomes of the psychoeducational support program, Caring for Parent Caregivers. The aim of the program is to empower the individual and thereby strengthen family resources. Quantitative and qualitative analytical procedures, which included the written evaluations of treatment subjects, were employed to examine program effectiveness. For the fathers and mothers of children with disabilities, psychological health and well‐being was assessed on the General Health Questionnaire, using a pretest and follow‐up control group design. Results showed a statistically significant difference between groups, 12 months after treatment, with program participants displaying less emotional distress than control group su...

Religion, Spirituality and Health Care Treatment Decisions: The Role of Chaplains in the Australian Clinical Context

This paper summarizes the views of Australian health care chaplains concerning their role and involvement in patient/family health care treatment decisions. In general terms the findings indicated that the majority of chaplains surveyed believed that it was part of their pastoral role to help patients and their families make decisions about their health care treatment. Differences in involvement of volunteer and staff chaplains, Catholic and Protestant, male and female chaplains are noted, as are the perspectives of chaplaincy informants regarding their role in relation to health care treatment decisions. Some implications of this study with respect to quality patient centered care, chaplaincy utility, and training are noted.

Chaplain–Physician Consultancy: When Chaplains and Doctors Meet in the Clinical Context

This paper summarizes the perspectives of 327 Australian health care chaplains concerning their interaction with physicians within the clinical context. In general terms the findings indicated that nearly 90% of chaplains believed that it was part of their professional role to consult with physicians regarding patient/family issues. Differences of involvement between volunteer and staff chaplains, Catholic and Protestant, male and female chaplains and the type of chaplaincy training are noted, as are the perspectives of chaplaincy informants regarding their role in relation to physicians. Some implications of this study with respect to chaplaincy utility and training are noted.

Economic Rationalism and the Cost Efficiency of Hospital Chaplaincy: An Australian Study

SUMMARY Health care reform is also occurring in Australia and effects hospital chaplaincy programs. “Economic rationalism” is the philosophic foundation of this effort and its contrast with the values inherit in hospital chaplaincy are highlighted. Selected research results from the Australian system are described and the authors offer a perspective on the cost efficiency of hospital chaplaincy.

Chaplaincy and mental health care in aotearoa New Zealand: an exploratory study.

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.

The Men's Shed: providing biopsychosocial and spiritual support.

Community Men’s Sheds (CMS) have been a unique approach within Australia for addressing and promoting men’s health and well-being issues by providing biopsychosocial support. Given the decline of traditional religious influence, and the contemporary understanding of ‘spirituality’, it can be argued that CMS may also develop and demonstrate characteristics of a communal spirituality. This research aimed to explore the individual and community contribution of CMS in terms of men’s health and well-being and subsequently whether CMS programmes satisfied the contemporary and consensus understanding of spirituality. A qualitative case study was undertaken combining both participant observation over a 6-month period and semi-structured in-depth interviews with 21 men of varying ages and occupations attending a Melbourne suburban CMS (Victoria, Australia). Thematic analysis indicated that the CMS provided a number of health and well-being benefits at individual, family, community and public health levels. These included increased self-esteem and empowerment, respite from families, a sense of belonging in the community and the opportunity to exchange ideas relating to personal, family, communal and public health issues. It is concluded that CMS, through the provision of an appropriate spatial context and organizational activities, encourage intra-personal and inter-personal reflection and interaction that subsequently results in men meaningfully, purposefully and significantly connecting with the moment, to self, to others and to their environment—and thus, CMS not only provides biopsychosocial support but can also deliver spiritual support.

Bioethical Issues and Health Care Chaplaincy in Aotearoa New Zealand

This paper summarizes survey and interview results from a cross-sectional study of New Zealand health care chaplaincy personnel concerning their involvement in multiple bioethical issues encountered by patients, families and clinical staff within the health care context. Some implications of this study concerning health care chaplaincy, ecclesiastical institutions, health care institutions and government responsibilities are discussed and recommendations presented.

Clinical Pastoral Education and the Value of Empirical Research: Examples from Australian and New Zealand Datum

SUMMARY This article argues in favor of clinical pastoral education programs incorporating research methods as part of a standard neo-curriculum for the 21st Century. It suggests that the benefits of such a curriculum would be useful in scientifically validating and evaluating pastoral care practice at a ‘micro,’ ‘meso’ and ‘macro’ level. This argument is supported with the presentation of Australian and New Zealand descriptive statistical datum exploring the involvement of chaplains in patient bioethical decisions, staff bioethical decision-making and the involvement of chaplains on hospital institutional research ethics committees.

Abortion and health care chaplaincy in Australia

This paper summarizes the results gained from quantitative and qualitative research involving 327 Australian health care chaplains with regard to their involvement in abortion issues within the health care context. The findings indicate that approximately 20% of surveyed chaplains had provided some form of pastoral intervention to patients and/or their families dealing with issues of abortion and that approximately 10% of chaplains had assisted clinical staff with issues concerning abortion. There was found to be no-statistically significant difference with regard to the number of catholic chaplains compared with protestant chaplains or staff chaplains compared with volunteer chaplains involved in abortion issues. Analysis using the WHO Pastoral Intervention codings highlighted a variety of issues encountered by chaplains and the non-judgmental pastoral care used by chaplains when assisting those dealing with abortion. Some implications of this study with respect to patient and clinical staff support are suggested.