Based on prior research, we hypothesized that staff in an outpatient clinic caring for an HIV pat... more Based on prior research, we hypothesized that staff in an outpatient clinic caring for an HIV patient population might rely on religious and spiritual frameworks to cope with the strains of their work and that their responses to a spiritual and religious survey might reflect work-related spiritual distress. Surveys were completed by 78.7% of staff (n = 59). All respondents scored in the "moderate" range for religious and spiritual well-being as well as existential satisfaction with living. The large majority agreed that the religious and spiritual concerns of patients have a place in patient care. Nurses, (88.2% of nurse respondents) viewed assessing the spiritual needs of patients as their responsibility, (p = 0.03). While 82% of HIV clinic respondents privately prayed for patients always, often or sometimes, this did not include physicians. Physicians in this clinic setting appeared to be less spiritual and religious, based on their survey responses, than coworkers and than US physicians in general. The majority of clinic physicians (78%) believed that God does not suffer with the suffering patients, in contrast to the majority of support staff (69%) and nearly half of the nurses, who believed that God does suffer with them, (p = 0.018). Contrary to our expectation, respondents did not report work-related spiritual distress, which may be related to improved therapies that can prolong and improve patients' lives. Survey data revealed, however, a surprising level of engagement in and reliance on spiritual and religious frameworks among nurses and support staff. Whether the absence of measured spiritual distress is linked, in a causal rather than random manner, to spiritual and religious reliance by certain of these health care providers, is unknown.
OBJECTIVE. Our objective with this study was to identify the nature and the role of spirituality ... more OBJECTIVE. Our objective with this study was to identify the nature and the role of spirituality from the parents' perspective at the end of life in the PICU and to discern clinical implications. METHODS. A qualitative study based on parental responses to open-ended questions on anonymous, self-administered questionnaires was conducted at 3 PICUs in Boston, Massachusetts. Fifty-six parents whose children had died in PICUs after the withdrawal of life-sustaining therapies participated. RESULTS. Overall, spiritual/religious themes were included in the responses of 73% (41 of 56) of parents to questions about what had been most helpful to them and what advice they would offer to others at the end of life. Four explicitly spiritual/religious themes emerged: prayer, faith, access to and care from clergy, and belief in the transcendent quality of the parent-child relationship that endures beyond death. Parents also identified several implicitly spiritual/religious themes, including in...
Background: Critical illness is a crisis for the total person, not just for the physical body. Pa... more Background: Critical illness is a crisis for the total person, not just for the physical body. Patients and their loved ones often reflect on spiritual, religious, and existential questions when seriously ill. Surveys have demonstrated that most patients wish physicians would concern themselves with their patients' spiritual and religious needs, thus indicating that this part of their care has been neglected or avoided. With the well-documented desire of patients to have their caregivers include the patient's spiritual values in their health care, and the well-documented reality that caregivers are often hesitant to do so because of lack of training and comfort in this realm, clinical pastoral education for health care providers fills a significant gap in continuing education for caregivers. Objectives: To report on the first 6 yrs of a unique training program in clinical pastoral education adapted for clinicians and its effect on the experience of the health care worker in the intensive care unit. We describe the didactic and reflective process whereby skills of relating to the ultimate concerns of patients and families are acquired and refined. Design and Setting: Clinical pastoral education designed for clergy was adapted for the health care worker committed to developing skills in the diagnosis and management of spiritual distress. Clinician participants (approximately 10-12) meet weekly for 5 months (400 hrs of supervised clinical pastoral care training). The program is designed to incorporate essential elements of pastoral care training, namely experience, reflection, insight, action, and integration. Results: This accredited program has been in continuous operation training clinicians for the past 6 yrs. Fifty-three clinicians have since graduated from the program. Graduates have incorporated clinical pastoral education training into clinical medical practice, research, and/or further training in clinical pastoral education. Outcomes reported by graduates include the following: Clinical practice became infused with new awareness, sensitivity, and language; graduates learned to relate more meaningfully to patients/families of patients and discover a richer relationship with them; spiritual distress was (newly) recognizable in patients, caregivers, and self. Conclusions: This unique clinical pastoral education program provides the clinician with knowledge, language, and understanding to explore and support spiritual and religious issues confronting critically ill patients and their families. We propose that incorporating spiritual care of the patient and family into clinical practice is an important step in addressing the goal of caring for the whole person.
Learning Objectives After completing this course, the reader will be able to: Describe the powerf... more Learning Objectives After completing this course, the reader will be able to: Describe the powerful dynamic of hope for patients with cancer.Discuss the importance of addressing how issues of life and death affect patients, families, and caregivers.List the advantages and limitations of realistic hopefulness.Better care for and communicate with patients and families who face life-threatening illness. Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com
Journal of Continuing Education in the Health Professions
INTRODUCTION Meeting spiritual needs of patients is an important aspect of quality health care, b... more INTRODUCTION Meeting spiritual needs of patients is an important aspect of quality health care, but continuing professional development and training to provide spiritual care remains inadequate. The purpose was to identify participants' learning from simulation-based spiritual generalist workshops and application to practice. METHODS Interdisciplinary participants completed self-report demographic questionnaires before the workshops and questionnaires after workshops that listed open-ended take-home learning. Responses were analyzed using qualitative content analysis. A subgroup was surveyed 3 to 9 months after training to examine whether and how participants had incorporated workshop learning into clinical work. RESULTS Workshop participants 181/211 (85.8%) reported learning in four categories: core values and skills of spiritual generalists, understanding spirituality/religion and its role in health care, interfacing with chaplaincy, and interprofessional teamwork. Of the subsample, 73.5% (25/34) completed surveys 3 to 9 months after training. Of those, 25/25 (100%) reported drawing on what they learned in workshops, and 24/25 (96%) reported making clinical practice changes. DISCUSSION One-day spiritual generalist simulation-based workshops can improve continuing professional development learning experiences to provide generalist level of spiritual care. Workshops offered valuable learning and resulted in applicable clinical skills across professional roles. At 3 to 9 months after training, participants reported improved spiritual screening, recognition of spiritual distress, and referral to chaplaincy.
LGBT elders are an increasing demographic in contemporary healthcare settings. Often overlooked ... more LGBT elders are an increasing demographic in contemporary healthcare settings. Often overlooked in discussions of cultural competency, LGBT elders can benefit from spiritual care offered by chaplains who have developed knowledge, skills, and comfort in this specialty. This article presents components of a CPE curriculum designed to enhance chaplains’ competence in providing spiritual care to LGBT elders.
Provision of spiritual/religious (S/R) care has been associated with improvements in patient care... more Provision of spiritual/religious (S/R) care has been associated with improvements in patient care, patient-provider relationships, and resource utilization. Clinicians identify a lack of training in S/R care as the primary impediment. The purpose of the study was to evaluate the effectiveness of one-day, simulation-based workshops to prepare interprofessional clinicians to function as capable, confident, and ethical spiritual care generalists. Interprofessional practitioners (physicians, nurses, social workers, psychologists, child life specialists) in a quaternary care academic pediatric hospital participated in daylong Spiritual Generalist workshops utilizing professional actors to learn requisite spiritual generalist skills. Participants completed pre- and postworkshop questionnaires on the day of the workshop, and three-month follow-up self-report questionnaires that included 1-5-point Likert scale items focused on 15 spiritual generalist skills. One hundred fifteen interprofess...
Background: Health care providers' lack of education on spiritual care is a significant barrier t... more Background: Health care providers' lack of education on spiritual care is a significant barrier to the integration of spiritual care into health care services. Objective: The study objective was to describe the training program, Clinical Pastoral Education for Healthcare Providers (CPE-HP) and evaluate its impact on providers' spiritual care skills. Methods: Fifty CPE-HP participants completed self-report surveys at baseline and posttraining measuring frequency of and confidence in providing religious/spiritual (R/S) care. Four domains were assessed: (1) ability and (2) frequency of R/S care provision; (3) comfort using religious language; and (4) confidence in providing R/S care. Results: At baseline, participants rated their ability to provide R/S care and comfort with religious language as ''fair.'' In the previous two weeks, they reported approximately two R/S patient conversations, initiated R/S conversations less than twice, and prayed with patients less than once. Posttraining participants' reported ability to provide spiritual care increased by 33% (p < 0.001). Their comfort using religious language improved by 29% (p < 0.001), and frequency of R/S care increased 75% (p < 0.001). Participants reported having 61% more (p < 0.001) R/S conversations and more frequent prayer with patients (95% increase; p < 0.001). Confidence in providing spiritual care improved by 36% overall, by 20% (p < 0.001) with religiously concordant patients, and by 43% (p < 0.001) with religiously discordant patients. Conclusions: This study suggests that CPE-HP is an effective approach for training health care providers in spiritual care. Dissemination of this training may improve integration of spiritual care into health care, thereby strengthening comprehensive patient-centered care.
... DOI: 10.1080/15528030.2011.533353 Mary Martha Thiel a * pages 128-138. ... CPE is often the c... more ... DOI: 10.1080/15528030.2011.533353 Mary Martha Thiel a * pages 128-138. ... CPE is often the context in which those preparing for professional religious leadership actually live into their new identity of being the pastor, the minister, the rabbi, the chaplain. ...
Based on prior research, we hypothesized that staff in an outpatient clinic caring for an HIV pat... more Based on prior research, we hypothesized that staff in an outpatient clinic caring for an HIV patient population might rely on religious and spiritual frameworks to cope with the strains of their work and that their responses to a spiritual and religious survey might reflect work-related spiritual distress. Surveys were completed by 78.7% of staff (n = 59). All respondents scored in the "moderate" range for religious and spiritual well-being as well as existential satisfaction with living. The large majority agreed that the religious and spiritual concerns of patients have a place in patient care. Nurses, (88.2% of nurse respondents) viewed assessing the spiritual needs of patients as their responsibility, (p = 0.03). While 82% of HIV clinic respondents privately prayed for patients always, often or sometimes, this did not include physicians. Physicians in this clinic setting appeared to be less spiritual and religious, based on their survey responses, than coworkers and than US physicians in general. The majority of clinic physicians (78%) believed that God does not suffer with the suffering patients, in contrast to the majority of support staff (69%) and nearly half of the nurses, who believed that God does suffer with them, (p = 0.018). Contrary to our expectation, respondents did not report work-related spiritual distress, which may be related to improved therapies that can prolong and improve patients' lives. Survey data revealed, however, a surprising level of engagement in and reliance on spiritual and religious frameworks among nurses and support staff. Whether the absence of measured spiritual distress is linked, in a causal rather than random manner, to spiritual and religious reliance by certain of these health care providers, is unknown.
OBJECTIVE. Our objective with this study was to identify the nature and the role of spirituality ... more OBJECTIVE. Our objective with this study was to identify the nature and the role of spirituality from the parents' perspective at the end of life in the PICU and to discern clinical implications. METHODS. A qualitative study based on parental responses to open-ended questions on anonymous, self-administered questionnaires was conducted at 3 PICUs in Boston, Massachusetts. Fifty-six parents whose children had died in PICUs after the withdrawal of life-sustaining therapies participated. RESULTS. Overall, spiritual/religious themes were included in the responses of 73% (41 of 56) of parents to questions about what had been most helpful to them and what advice they would offer to others at the end of life. Four explicitly spiritual/religious themes emerged: prayer, faith, access to and care from clergy, and belief in the transcendent quality of the parent-child relationship that endures beyond death. Parents also identified several implicitly spiritual/religious themes, including in...
Background: Critical illness is a crisis for the total person, not just for the physical body. Pa... more Background: Critical illness is a crisis for the total person, not just for the physical body. Patients and their loved ones often reflect on spiritual, religious, and existential questions when seriously ill. Surveys have demonstrated that most patients wish physicians would concern themselves with their patients' spiritual and religious needs, thus indicating that this part of their care has been neglected or avoided. With the well-documented desire of patients to have their caregivers include the patient's spiritual values in their health care, and the well-documented reality that caregivers are often hesitant to do so because of lack of training and comfort in this realm, clinical pastoral education for health care providers fills a significant gap in continuing education for caregivers. Objectives: To report on the first 6 yrs of a unique training program in clinical pastoral education adapted for clinicians and its effect on the experience of the health care worker in the intensive care unit. We describe the didactic and reflective process whereby skills of relating to the ultimate concerns of patients and families are acquired and refined. Design and Setting: Clinical pastoral education designed for clergy was adapted for the health care worker committed to developing skills in the diagnosis and management of spiritual distress. Clinician participants (approximately 10-12) meet weekly for 5 months (400 hrs of supervised clinical pastoral care training). The program is designed to incorporate essential elements of pastoral care training, namely experience, reflection, insight, action, and integration. Results: This accredited program has been in continuous operation training clinicians for the past 6 yrs. Fifty-three clinicians have since graduated from the program. Graduates have incorporated clinical pastoral education training into clinical medical practice, research, and/or further training in clinical pastoral education. Outcomes reported by graduates include the following: Clinical practice became infused with new awareness, sensitivity, and language; graduates learned to relate more meaningfully to patients/families of patients and discover a richer relationship with them; spiritual distress was (newly) recognizable in patients, caregivers, and self. Conclusions: This unique clinical pastoral education program provides the clinician with knowledge, language, and understanding to explore and support spiritual and religious issues confronting critically ill patients and their families. We propose that incorporating spiritual care of the patient and family into clinical practice is an important step in addressing the goal of caring for the whole person.
Learning Objectives After completing this course, the reader will be able to: Describe the powerf... more Learning Objectives After completing this course, the reader will be able to: Describe the powerful dynamic of hope for patients with cancer.Discuss the importance of addressing how issues of life and death affect patients, families, and caregivers.List the advantages and limitations of realistic hopefulness.Better care for and communicate with patients and families who face life-threatening illness. Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com
Journal of Continuing Education in the Health Professions
INTRODUCTION Meeting spiritual needs of patients is an important aspect of quality health care, b... more INTRODUCTION Meeting spiritual needs of patients is an important aspect of quality health care, but continuing professional development and training to provide spiritual care remains inadequate. The purpose was to identify participants' learning from simulation-based spiritual generalist workshops and application to practice. METHODS Interdisciplinary participants completed self-report demographic questionnaires before the workshops and questionnaires after workshops that listed open-ended take-home learning. Responses were analyzed using qualitative content analysis. A subgroup was surveyed 3 to 9 months after training to examine whether and how participants had incorporated workshop learning into clinical work. RESULTS Workshop participants 181/211 (85.8%) reported learning in four categories: core values and skills of spiritual generalists, understanding spirituality/religion and its role in health care, interfacing with chaplaincy, and interprofessional teamwork. Of the subsample, 73.5% (25/34) completed surveys 3 to 9 months after training. Of those, 25/25 (100%) reported drawing on what they learned in workshops, and 24/25 (96%) reported making clinical practice changes. DISCUSSION One-day spiritual generalist simulation-based workshops can improve continuing professional development learning experiences to provide generalist level of spiritual care. Workshops offered valuable learning and resulted in applicable clinical skills across professional roles. At 3 to 9 months after training, participants reported improved spiritual screening, recognition of spiritual distress, and referral to chaplaincy.
LGBT elders are an increasing demographic in contemporary healthcare settings. Often overlooked ... more LGBT elders are an increasing demographic in contemporary healthcare settings. Often overlooked in discussions of cultural competency, LGBT elders can benefit from spiritual care offered by chaplains who have developed knowledge, skills, and comfort in this specialty. This article presents components of a CPE curriculum designed to enhance chaplains’ competence in providing spiritual care to LGBT elders.
Provision of spiritual/religious (S/R) care has been associated with improvements in patient care... more Provision of spiritual/religious (S/R) care has been associated with improvements in patient care, patient-provider relationships, and resource utilization. Clinicians identify a lack of training in S/R care as the primary impediment. The purpose of the study was to evaluate the effectiveness of one-day, simulation-based workshops to prepare interprofessional clinicians to function as capable, confident, and ethical spiritual care generalists. Interprofessional practitioners (physicians, nurses, social workers, psychologists, child life specialists) in a quaternary care academic pediatric hospital participated in daylong Spiritual Generalist workshops utilizing professional actors to learn requisite spiritual generalist skills. Participants completed pre- and postworkshop questionnaires on the day of the workshop, and three-month follow-up self-report questionnaires that included 1-5-point Likert scale items focused on 15 spiritual generalist skills. One hundred fifteen interprofess...
Background: Health care providers' lack of education on spiritual care is a significant barrier t... more Background: Health care providers' lack of education on spiritual care is a significant barrier to the integration of spiritual care into health care services. Objective: The study objective was to describe the training program, Clinical Pastoral Education for Healthcare Providers (CPE-HP) and evaluate its impact on providers' spiritual care skills. Methods: Fifty CPE-HP participants completed self-report surveys at baseline and posttraining measuring frequency of and confidence in providing religious/spiritual (R/S) care. Four domains were assessed: (1) ability and (2) frequency of R/S care provision; (3) comfort using religious language; and (4) confidence in providing R/S care. Results: At baseline, participants rated their ability to provide R/S care and comfort with religious language as ''fair.'' In the previous two weeks, they reported approximately two R/S patient conversations, initiated R/S conversations less than twice, and prayed with patients less than once. Posttraining participants' reported ability to provide spiritual care increased by 33% (p < 0.001). Their comfort using religious language improved by 29% (p < 0.001), and frequency of R/S care increased 75% (p < 0.001). Participants reported having 61% more (p < 0.001) R/S conversations and more frequent prayer with patients (95% increase; p < 0.001). Confidence in providing spiritual care improved by 36% overall, by 20% (p < 0.001) with religiously concordant patients, and by 43% (p < 0.001) with religiously discordant patients. Conclusions: This study suggests that CPE-HP is an effective approach for training health care providers in spiritual care. Dissemination of this training may improve integration of spiritual care into health care, thereby strengthening comprehensive patient-centered care.
... DOI: 10.1080/15528030.2011.533353 Mary Martha Thiel a * pages 128-138. ... CPE is often the c... more ... DOI: 10.1080/15528030.2011.533353 Mary Martha Thiel a * pages 128-138. ... CPE is often the context in which those preparing for professional religious leadership actually live into their new identity of being the pastor, the minister, the rabbi, the chaplain. ...
Uploads
Papers by Mary Thiel