bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Evidence Regarding Chimney Graft Occlusions in the Endovascular Treatment of Pararenal Aortic Pathologies
Authors: Usai Marco V. , Torsello Giovanni , Donas Konstantinos P.
Published: May 2015

Purpose: To review the literature on pararenal endovascular aneurysm repair (EVAR) to determine the frequency and clinical relevance of chimney graft occlusions. Methods: A comprehensive search of the English-language literature abstracted in the Medline and the Cochrane Library databases was performed to identify case series involving pararenal aortic pathologies (degenerative aneurysms, penetrating atherosclerotic ulcers, type Ia endoleaks, and para-anastomotic aneurysms) treated with EVAR and chimney grafts; thoracoabdominal, iliac, or aortic arch chimney graft placements were excluded, as were case reports in which the total number of chimney grafts implanted at the reporting center could not be determined. The literature search identified 83 studies regarding chimneys/snorkels for pararenal pathologies published between January 2007 and March 2014. Of these, 7 studies met the inclusion criteria and were included in the analysis. Results: There were 15 (4.5%) occlusions in the overall 334 renovisceral vessels in which chimney grafts were deployed. The mean time to chimney graft occlusion was 3.5 months (range 1–270 days) over a mean follow-up of 1.4 months (range 9–24). The target arteries were the renal artery (n=12) and the superior mesenteric artery (SMA; n=3). Seven patients were asymptomatic, and no description was given in 5 cases. In the other 3 patients, the symptoms were acute renal failure, intestinal ischemia, and malignant hypertension. The treatment strategy included open conversion and iliorenal bypass (n=1), exploratory laparotomy to revascularize the SMA (n=1), hemodialysis (n=1), placement of bare metal stents (n=4), conservative treatment (n=2), and unknown (n=6). One (6.7%) patient died (an occluded SMA). Two patients with renal chimney occlusion suffered from temporary renal function deterioration. Conclusion: The present analysis identified a low rate of chimney graft occlusions, which appear to occur generally a few months after placement. Involvement of the renal artery had no severe clinical consequences, while occlusion of the SMA can be associated with life-threatening complications. More detailed information regarding occluded chimney grafts will be needed in future publications to help identify the causes.
Endovascular Repair of Aortic Coarctation Pseudoaneurysm Using an Off-Label “Hourglass” Stent-Graft Configuration
Authors: Erben Young , Oderich Gustavo S. , Duncan Audra A.
Published: May 2015

Purpose: To describe an endovascular technique for treating a pseudoaneurysm of the thoracic aorta using an off-label “hourglass” stent-graft configuration. Case Report: A 68-year-old patient with prior open thoracic aorta coarctation repair presented with recurrent coarctation and concurrent enlarging 6-cm bilobed pseudoaneurysm involving the previous anastomosis. There was significant discrepancy in the aortic diameter (measured from wall to wall) proximal to the coarctation (14 mm), at the narrowest segment (8 mm), and distally (23 mm). Endovascular repair included deployment of an inverted iliac limb proximally, followed by an inverted aortic converter distally, giving an “hourglass” configuration. There were no perioperative or stent-graft–related complications at 5-year follow-up. The aneurysm regressed from 61 to 25 mm. Conclusion: The use of inverted stent-grafts can allow tapering and flaring to adapt to discrepant aortic diameters. This technique may be useful in select patients with prior coarctation repair who do not need excessive dilation of the narrow aortic segment.
Use of Indigo Carmine Angiography to Qualitatively Assess Adequate Distal Perfusion After Endovascular Revascularization in Critical Limb Ischemia
Authors: Higashimori Akihiro , Yokoi Yoshiaki
Published: May 2015

Purpose: To report a novel technique to visualize the efficacy of revascularization in critical limb ischemia patients with ischemic foot ulcers. Technique: An 80-year-old man was admitted with nonhealing ulcers on his left second toe and lateral border of the foot owing to in-stent restenosis of the left popliteal artery. After dilation of the popliteal in-stent restenosis, below-the-knee angiography revealed that the anterior tibial artery (ATA) was occluded, the posterior tibial artery was hypoplastic, and the peroneal artery was enlarged, with 2 plantar arteries. To evaluate the foot circulation before performing additional procedures, a 4-F multipurpose catheter was advanced into the peroneal artery, and 5 mL of indigo carmine was injected. Immediately, the patient’s second toe and lateral border ulcers were dyed blue. We concluded that sufficient blood flow had been obtained to the ulcerated area by balloon angioplasty alone, so the procedure was terminated. The ulcers completely healed at 1 month. Conclusion: Indigo carmine angiography provides visual information on foot perfusion, yielding new insights into microcirculation and helping to determine the effectiveness of treatment and procedure endpoint.
Endovascular Aneurysm Sealing for the Treatment of Ruptured Abdominal Aortic Aneurysms
Authors: de Bruin Jorg L. , Brownrigg Jack R. W. , Karthikesalingam Alan , Patterson Benjamin O. , Holt Peter J. E. , Hinchliffe Robert J. , Morgan Robert A. , Loftus Ian M. , Thompson Matthew M.
Published: May 2015

Purpose: To assess the feasibility and report preliminary results of ruptured abdominal aortic aneurysm (rAAA) repair with endovascular aneurysm sealing (EVAS), a novel therapeutic alternative whose feasibility has not been established in rAAAs due to the unknown effects of the rupture site on the ability to achieve sealing. Case Report: Between December 2013 and April 2014, 5 patients (median age 71 years, range 57–90; 3 men) with rAAAs were treated with the Nellix EVAS system at a single institution. Median aneurysm diameter was 70 mm (range 67–91). Aneurysm morphology in 4 of the 5 patients was noncompliant with instructions for use (IFU) for both EVAS and standard stent-grafts; the remaining patient was outside the IFU for standard stent-grafts but treated with EVAS under standard IFU for the Nellix system. Median Hardman index was 2 (range 0–3). Two patients died of multiorgan failure after re-laparotomy and intraoperative cardiac arrest, respectively. Among survivors, all devices were patent with no signs of endoleak or failed aneurysm sac sealing at 6 months (median follow-up 9.2 months). Conclusion: EVAS for the management of infrarenal rAAAs appears feasible. The use of EVAS in emergency repairs may broaden the selection criteria of the current endovascular strategy to include patients with more complex aneurysm morphology.
Appearance of the Nellix Endovascular Aneurysm Sealing System on Computed Tomography
Authors: Karthikesalingam Alan , de Bruin Jorg L. , Patel Shaneel R. , Azhar Bilal , Rossi Luca , Morgan Robert A. , Holt Peter J. E. , Loftus Ian M. , Thompson Matthew M.
Published: May 2015

Purpose: To describe the imaging characteristics of the Nellix Endovascular Aneurysm Sealing (EVAS) System on serial computed tomography (CT) surveillance. Methods: Sixty-eight patients undergoing EVAS were enrolled in a surveillance protocol that included CT scans prior to hospital discharge and at 3, 6, and 9 months postoperatively. Images were analyzed for the presence of gas within the endobag, endoleak, and for maximum radiodensity measured in Hounsfield units (HU) within the uppermost, middle, and lowermost regions of each endobag. Results: Gas was seen within the endobags of all 68 EVAS repairs at the first postoperative CT compared with 2 (5.6%) of 36 undergoing the 3-month scan. The endobags appeared radiodense during initial imaging, and the median (interquartile range) radiodensity of the Nellix polymer decreased from 158.3 HU (149.5; 169.5) at the postoperative CT to 81.0 HU (74.0; 88.0) at 3 months, excluding 3 cases in which contrast pre-fill was utilized. Type I endoleak was seen at the periphery of the aneurysm sac or in the cleft between the endobags, with a substantially different appearance to endoleak after endovascular aneurysm repair. Conclusion: The evolution of CT appearances after EVAS was characteristic and predictable. The device endobags were initially radiodense, which may impact the detection of endoleak within 3 months of EVAS. Endoleaks after EVAS were seen in a different anatomical area to endoleaks after conventional stent-graft repair.
In Situ Fenestration Through the Contralateral Iliac Artery to Convert an Aortouni-iliac Into a Bifurcated Endograft
Authors: Coscas Raphaël , Glorion Matthieu , Javerliat Isabelle , Goëau-Brissonniere Olivier , Coggia Marc
Published: May 2015

Purpose: To present a technique of in situ fenestration that allows conversion of an aortouni-iliac endograft into a bifurcated endograft, thereby avoiding crossover femorofemoral bypass and its complications. Technique: Following conventional deployment of an aortouni-iliac endograft, in situ fenestration through the contralateral common iliac artery is performed with a transjugular intrahepatic access set. The fabric hole is enlarged using a cutting balloon and a high-pressure noncompliant balloon. Kissing iliac-covered stents are then positioned at the level of the bifurcation to convert the aortouni-iliac endograft into a bifurcated repair. To date, this technique has been successfully used in 4 patients with satisfactory short-term results. Conclusion: This technique represents another application of endograft in situ fenestration. This strategy provides a bifurcated repair in cases where bifurcated stent-grafts are usually precluded, such as a narrow distal aorta, ruptured abdominal aortic aneurysm, or combined aortoiliac occlusive disease.
Effect of Intraluminal Thrombus Asymmetrical Deposition on Abdominal Aortic Aneurysm Growth Rate
Authors: Metaxa Eleni , Kontopodis Nikolaos , Tzirakis Konstantinos , Ioannou Christos V. , Papaharilaou Yannis
Published: May 2015

Purpose: To determine the relationship between asymmetrical intraluminal thrombus (ILT) deposition in abdominal aortic aneurysm (AAA) and growth rate and to explore its biomechanical perspective. Methods: Thirty-four patients with AAA underwent at least 2 computed tomography scans during surveillance. The volumes of the AAA (VAAA) and thrombus (VILT) and the maximum thrombus thickness (ILTthick) were computed. Thrombus distribution was evaluated by introducing the asymmetrical thrombus deposition index (ATDI), with positive and negative values (–1<ATDI<1) associated with anterior and posterior ILT deposition, respectively. Finite element analysis was applied to estimate wall stress. Aneurysms were divided into high and low growth rate groups based on the cohort’s median growth rate, and the abovementioned parameters were compared between groups. Results: Most AAAs had asymmetrical anterior thrombus deposition. The high and low growth rate groups did not present significant differences in maximum diameter, VAAA, VILT, or maximum ILTthick. However, the high growth rate group had significantly higher ATDI (p=0.02). The ATDI<0 group (posterior ILT distribution) presented a significantly lower median growth rate compared to that of ATDI≥0 group (anterior or symmetrical ILT deposition; p=0.029). The specificity of an ATDI<0 criterion for identifying AAAs with a growth rate below the cohort median was 89%. The ATDI<0 group had a significantly lower posterior maximum wall stress compared with that of the ATDI≥0 group (p=0.03). Overall peak wall stress did not differ between groups. Conclusion: Posterior thrombus deposition in AAAs is associated with significantly lower growth rate and lower posterior maximum wall stress compared with that of AAAs with anterior thrombus deposition and could potentially indicate a lower rupture risk.
Pastoral Counseling as an Echoing Process: A Transformative Therapy Hour
Authors: Anderson Douglas A.
Published: May 2015

The author posits that the essential core of pastoral counseling is an echoing process between client and therapist and between diagnostic listening and restorative responding. He illustrates this process by drawing on the case of a depressed middle-aged client. The therapist's response is described as conveyed through personal presence that is welcoming, participative, courageous, and responsive.
Mighty Prophet/Wounded Healer
Authors: Means J. Jeffrey
Published: May 2015

The concept of wounded healer is revisited from the perspective of a pastoral counselor working in a pastoral counseling center, and this experience is generalized to pastoral caregivers working in other settings. Three types of wounds are reviewed: wounds resulting from the life experience of the caregiver, wounds resulting from listening to and containing the horrendous content and emotionally laden nature of client stories, and wounds brought about by doing our work within an unsupportive culture. Properly dealt with, these wounds offer a foundation of shared life experience connecting us with our clients. Coupled with messages clients bring us about hurtful and destructive aspects of our culture, these wounds also call us to become mighty prophets. In this role, we are urged to move outside our normal practice contexts into the larger community, and to speak out against social forces that hurt and destroy the selves and souls of persons.
Uses of Theories of Depth Psychology in Ordained Ministry and the Institutional Church
Authors: McNish Jill L.
Published: May 2015

Burgeoning understanding of unconscious processes should inform the work of the church and its ministries. Understanding derived from depth psychology can lead to deeper understandings of relationship with God and with one another, of the vicissitudes of spiritual life, of the meaning of ritual and sacraments, and to more profound and relevant scriptural hermeneutics and theological understandings. These claims are illustrated with examples.
Worship with a Twist
Authors: Werner Steve
Published: May 2015

The core values of hospitality, respect, and innovation help to guide and initiate changes in the worship services of a rehabilitation hospital. The Antiphon of the day, special hymnals containing residents choices, and inclusion in the prayers of the day helped achieve these goals. Residents are constantly given choices with the Chaplain ready to keep the service moving smoothly. In these ways the core values are included in all services. Specific resources are listed, and the article is followed by a response from another chaplain with a somewhat different approach.
Depth Oriented Brief Therapy: An Ideal Technique as Hospice Lengths-of-Stay Continue to Shorten
Authors: Thomson Judith E. , Jordan Merle R.
Published: May 2015

The authors note that as hospice patients' lengths-of-stay continue to shorten, psychosocial/spiritual counselors are being challenged to help patients and families process the myriad of issues terminal illness gives rise to. Given this reality, the authors suggest that the Depth Oriented Brief Therapy (DOBT) approach should prove especially useful. The DOBT premise is that if people can be helped to experience the emotional meanings of why they hold on to emotionally painful symptoms then they can abandon their symptoms for healthier ways of being.
Death in a Religious Community
Authors: Dobrin Arthur , Beder Joan
Published: May 2015

Within the experience of all religions, death and loss are a constant of the human condition. Most religions have developed strategies for helping members who are experiencing the pain of loss. Within Ethical Humanism, a non-theistic religion, the reliance on community has been the major source of support and coping for members within each Ethical Society. This article explores the concept of community within Ethical Humanism, developed and articulated through the pastoral role, and applies it to the experiences of two prominent members of the Ethical Society.
If Chaplaincy Understands Health Care Reform, Will it Hurt the Profession Less?
Authors: VandeCreek Larry
Published: May 2015

The author summarizes the work of three authorities who present diverse views concerning health care reform. He suggests that these viewpoints will help chaplaincy more clearly understand clinical and administrative situations and promote creative adjustment to reform efforts.
How Françoise Dolto Links Lacanian Psychoanalysis with the Christian Gospels
Authors: Slattery Maureen
Published: May 2015

This article introduces to an English-speaking audience of pastoral therapists, the writings of the French Lacanian psychoanalyst, Françoise Dolto (1908–1988) on the links she discovered between the most profound question raised by Lacanian psychoanalysis in its dynamics effects and the questions raised by the Christian Gospels. The author summarizes the main points of Dolto's Lacanian thought and where she departed from Lacan in her interpretation of the unconscious ethic of desire. Using Dolto's three writings on Lacanian psychoanalysis and the Bible, as well as material from her published clinical studies, the author illustrates Dolto's approach to the Bible, the parable of the Good Samaritan, and her application of the dialectical principles of desire in three case studies.
Mental Health Issues among Clergy and Other Religious Professionals: A Review of Research
Authors: Weaver Andrew J. , Larson David B. , Flannelly Kevin J. , Stapleton Carolyn L. , Koenig Harold G.
Published: May 2015

The authors reviewed the literature on mental health issues among clergy and other religious professionals, using electronic searches of databases of medical (Medline), nursing (CINAHL), psychology (PsycINFO), religious (ATLA), and sociological research (Sociofile). The existing research indicates the Protestant clergy report higher levels of occupational stress than Catholic priests, brothers, or sisters. Catholic sisters repeatedly reported the lowest work-related stress, whereas women rabbis reported the highest stress levels in various studies. Occupational stress appears to be a source of family stress among Protestant clergy—a factor which clergy and their spouses believe the denominational leadership should address. High levels of stress also have been found to be associated with sexual misconduct among clergy. The authors make several recommendations based on these and other findings they report in their review.
Pastoral Counseling and Pastoral Care: Is there a Difference?
Authors: O'Connor Thomas St. James
Published: May 2015

The author argues that there is little difference between pastoral counseling and pastoral care. Utilizing an evidence-based and narrative approach, he examines the ideas of a variety of historical and contemporary writers to illustrate this thesis. Along with historical and contemporary writings on the topic, the author includes his own clinical experiences and associations to illustrate his conviction that pastoral counseling and pastoral care are more alike than different.
First Look: What Brings Clergy Candidates into Ministry and What Happens When They Don't Get it
Authors: Perry C. Wayne
Published: May 2015

This article reports on a retrospective examination of all candidates for ordained ministry in Alabama-West Florida Annual Conference of The United Methodist Church from September 1995 to 1998. The results showed, contrary to expectations, that clergy in this annual conference are significantly more likely than the general population to become physically ill when placed under stress. One of the major stressors identified in this study was the likelihood that the clergy persons will not receive the high levels of affirmation and reinforcement they look for. The author presents some conclusions and suggestions both for action to change the predictions and for further research.
Homelessness
Authors: Belgum David
Published: May 2015

The author, acknowledging the reality of homeless persons in most communities, explores the meanings and dynamics of homelessness, and the need to recognize the variety of participants needing to be recognized in appreciating the complexity of this segment of society. He raises the issue of how pastoral caregivers become involved in providing authentic care to this sub-culture and offers examples from his own experiences as a volunteer chaplain in the Salvation Army Corps.
Dragon Talk: Providing Pastoral Care for Chinese Immigrants
Authors: Lai Alan Ka Lun
Published: May 2015

This article describes how cultures and pastoral care education processes can be barriers between the patient, the pastoral caregiver, and the Clinical Pastoral Education (CPE) student. By providing sketches of interviews with Chinese patients, the author tries to explain why the attempt to unveil Chinese patients' feelings and needs through conversation can be a frustrating experience. Moreover, the author argues that the pedagogy of pastoral care education ought to be more culturally sensitive in regard to the diverse cultural backgrounds of both patients and CPE students.
Toward Pastoral Counseling Integration: One Bowen Oriented Approach
Authors: Jensen Carl A.
Published: May 2015

This article explores the use of a Bowen oriented approach that treats the relationship with God as a “real person” interaction, that may involve God's “available next of kin,” and that applies the idea of therapist “I positions” to spiritual-religious material. A case example is drawn upon to illustrate and ground the theoretical materials.
Youthful Visitors and Hospitable Hosts: Exercises in Misunderstanding
Authors: Capps Donald
Published: May 2015

This article explores Gordon W. Allport's account of his visit with Sigmund Freud and Milton J. Nauss's account of his visit with Albert Einstein when they were young men. The analysis focuses on how the visitors' preconceptions of their hosts influenced the conversation; on their hosts' use of humor to spare themselves more painful emotions and their visitors the painful consequences of such emotions; and on the fact that both men's subsequent accounts misunderstand their hosts' attitudes and behaviors, thus indicating that they had not learned as much as they might have learned about themselves from the encounter.
“God, Why Did this Happen to Me?”: Three Perspectives on Theodicy
Authors: Bradshaw Anna , Fitchett George
Published: May 2015

This article closely examines the way three people dealt with the theodicy question. The three study subjects participated in extended interviews about their religious beliefs and activities, past and present. The interviews were summarized and analyzed to identify the person's religious resources, statements about theodicy, and mental well-being. The subjects' comments highlight the unique and diverse ways in which people wrestle with theodicy. They also indicate that dealing with the question can extend over many years. Implications for ministry are discussed.
Life Review in Pastoral Counseling: Background and Efficacy for Use with the Terminally III
Authors: LeFavi Robert G. , Wessels Marcia H.
Published: May 2015

Research continues to confirm that sharing one's life story through the process of life review enhances psychological well-being and increases life satisfaction. Although researchers have outlined techniques and activities that may be used in life review with older adults, little work has focused on the use of life review methods with terminally ill patients. Additionally, researchers have suggested that life review can take on the form of a spiritual assessment; and that such spiritually oriented life reviews may enhance a sense of meaning and foster reconciliation as one approaches dying. In this article, the authors provide a brief review of the research on and the practice of life review. Further, by merging concepts of life review with systematic theology, they offer a sample instrument—using the example of one faith framework—with which pastoral caregivers can better approach the spiritual needs of patients and facilitate a less traumatic death in the terminally ill.
Courage in the Development of Self in Women
Authors: Godby Katherine
Published: May 2015

The author discusses the development of self in women, explores the role of courage inherent in this movement, and, employing existentialist notions of courage as authenticity, explicates how these notions may lead to the development of a stronger sense of self. Notes as well that this development of self entails a dangerous complexity and that pastoral care providers will want to aid women in holding together both autonomy and connection.
Spirituality, Depression, and Loneliness among Jewish Seniors Residing in New York City
Authors: Springer Rabbi Mychal B. , Weaver Andrew J. , Linderblatt Rabbi Chaim , Naditch Rabbi Beth , Newman Rabbi Avraham , Siritsky Rabbi Nadia , Flannelly Kevin J. , VandeCreek Larry
Published: May 2015

This article reports the results of research that examined a randomized group of 118 Jewish seniors who were clients of one of three Jewish social service agencies in New York City. They were interviewed by four Clinical Pastoral Education residents at the Jewish Institute for Pastoral Care. During the interview, participants were asked to respond to the questions contained in the Brief Depression Scale, Version 3 of the UCLA Loneliness Scale, and the Index of Core Spiritual Experience—INSPIRIT. A statistically significant positive correlation was found between the depression and loneliness scores, r(116) = .56, p< .001. Spirituality was not correlated with either of these scales. Both depression and loneliness were significantly higher among women, among people who had physical impairments and those who had been victims of Nazi persecution. Depression and loneliness were inversely related to participants' ability to venture out of their house and to their relationship with their families. Having a sense of meaning or purpose in life was also inversely related to depression and loneliness. Spirituality tended to be higher among women, those participants with more years of religious education, and those with physicals impairments, but only the gender effect was statistically significant.
Pastoral Counseling among Chinese Churches: A Canadian Study
Authors: Poon Vincent , Cheng Mona , Chan Vivian C. H.
Published: May 2015

This article reports the results of a survey of Canadian Chinese pastors (N=20) regarding their experiences and attitudes related to pastoral counseling. It identifies common concerns encountered during pastoral counseling, as well as key areas of church concerns. Results of the survey indicate that pastoral counseling may be more important than is currently recognized by Chinese pastors, particularly in key areas of marriage, family life, and general relationship issues. The authors discuss possible implications of the survey relative to training and equipping Chinese pastors to engage more in pastoral counseling as an integral part of their parish ministry.
Homecoming Rituals: Weaving Multicultural Funeral Narratives
Authors: Kwon Soo-Young
Published: May 2015

Using the personal experience of “homecoming” funerary journey from the U.S. to Korea the author of this article probes the cultural construction of familial bond in Korean and biblical ( Genesis) funeral narratives. He highlights the cultural differences between American and Korean funeral traditions—(1) dying at hospital vs. dying at home, (2) embalming vs. sup/yom (washing/binding of the corpse), (3) metal casket vs. wooden coffin, (4) committal vs. banhon (returning of the spirit)—to explore the religious and practical implications of the multicultural grieving process for pastoral care and grief ministry in which death is conceived as returning to the familial, cultural, and spiritual homes.
The Communion of Saints as a Paradigm for Pastoral Counseling: A Revised Look at an Ancient Symbol
Authors: Mayer Suzanne
Published: May 2015

The Christian symbol of the Communion of Saints has stood for centuries as a call to celebrate relationships. From the ancient doctrine of calling out those honored among the faithful for their holiness, the symbol evolved into a more formal ecclesial process involving procedures and miraculous proof. Reaching back to the early roots, the author draws on theologian Elizabeth Johnson's revisioning of saints as “friends and prophets” to explore a paradigm for the pastoral counselor. Such pastoral characteristics as presence, transforming vision, and creative hope are explored for the richness of growth within the counseling relationship for all who enter into it.
Healing the Wounds and the Wounds of Healing: A Journey of the Spirit
Authors: Roberts-Yates D Christine
Published: May 2015

This article is a reflective narrative about the death of a parent told from the perspective of her daughter. It is an experience-based account. This shared journey of mother and child links the familiar realm of the conscious and known self to a realm that is not known in the same way and is not merely the self. It is as if one end is in the midst of life's struggles and crises and the other in another realm; yet the whole works together as a single force. In this way the idea is introduced that the very challenges and trauma of life can be a wound that is a healing of wounds, in so far as it prompts recognition of the realm that is out of sight, though the wound certainly is real enough.
An Analysis of Referrals to Chaplains in a Community Hospital in New York over a Seven Year Period
Authors: Fogg Sarah L. , Flannelly Kevin J. , Weaver Andrew J. , Handzo George F.
Published: May 2015

The study analyzed the pattern of referrals to chaplains in a suburban hospital over a 7-year period. Nurses made more than half of all the referrals to chaplains, with nursing accounting for 81.74% of referrals from staff members other than pastoral care workers and volunteers. Social workers and physicians made 11.74% and 4.08% of referrals, respectively. The number of referrals from social workers ( r= .86, p<.05), nurses ( r= .68, p<.10) and other staff ( r= .69, p<.10) increased across years, with the exception of physicians. Three quarters of referrals were requests for chaplains to visit patients and one quarter were requests to visit with family or friends. A significant difference was found in the percentage of referrals made for patients and family/friends by staff members ( p<.05), with social workers making a higher percentage of referrals for relatives and friends (34.1%), compared to nurses (26.74%) and physicians (27.27%). The most common presenting problems for which patients were referred to chaplains were anxiety, depression, and pregnancy loss. The rate of referrals for patients over the entire study period was 39.04 per 1000 patient stays.
The Modern Mystic: A Spirituality for Health Care Workers
Authors: Bryant Cullene
Published: May 2015

In this essay the author suggests that a deepening of one's spirituality may be the nurture that is required to remain fulfilled when working in the health care professions; and she illustrates this thesis by tracing a young chaplain's deepening spiritual journey in a Clinical Pastoral Education program. As the young aspiring chaplain attempts to minister to Joe, a dying farmer, he embarks on a path that leads to a religious experience. The essay concludes by listing eight criteria or guidelines that may help pastoral caregivers realize that they themselves may be nurtured by meeting the Holy in their caregiving acts.
Challenges to Preparing and Conducting Christian Worship in Nursing Homes
Authors: Hamlen Geraldine G.
Published: May 2015

This essay explores and details the various challenges that are faced in the design of Christian worship within the nursing home environment. People in this setting have special needs-physical, mental, social, and spiritual. The physical plant itself demands special considerations when preparing for worship. Difficulties are defined and solutions presented for those who would provide intentional and accessible Christian worship that allows for action and response from the community in these settings. Sources include Christian liturgical reference materials and on-site interviews with chaplains and activity directors at three care facilities in southeast Michigan.
How Satisfied are Patients with the Ministry of Chaplains?
Authors: VandeCreek Larry
Published: May 2015

The author describes the importance of chaplaincy departments conducting periodic patient satisfaction studies and provides quantitative results from 1440 patients discharged from one of 14 U.S. general hospitals. Patients expressed the most satisfaction in response to the item, “The chaplain seemed to be a person of spiritual sensitivity.” The results also suggest the characteristics of patients who appear most responsive to this ministry.
A Review of Research on Chaplains and Community-Based Clergy in the Journal of the American Medical Association, Lancet, and the New England Journal of Medicine: 1998–2000
Authors: Weaver Andrew J. , Flannelly Kevin J. , Koenig Harold G. , Smith Fred Douglas
Published: May 2015

Based on the content analysis of quantitative research appearing in three medical journals, the authors conclude that, despite the shared ideal of providing spiritual care to patients on the part of physicians and chaplains, there is little attention given in these journals demonstrating and promoting this shared perspective. Suggestions for future research that would focus on this common medicine/religion interface and concern are noted.
Plumbing the Darkness to See the Light: A Book Review Essay
Authors: Steinke Paul D.
Published: May 2015

The author compares the educational theories of Laurent A. Daloz ( Mentor) and Parker J. Palmer ( The Courage to Teach) and how they fit into Clinical Pastoral Education (CPE). He implies as well the questions, “Do the holocaust and September 11, 2001 have anything to teach pastoral educators about the nature of change in education?” and “Is transformation a legitimate goal for pastoral educators or more than students can bear?”
Through the Looking Glass: Women and Ministry Supervision
Authors: Trothen Tracy J.
Published: May 2015

Issues pertaining to women and clinical pastoral supervision are identified and examined in this essay. An in-depth literature review regarding the relationship between gender and supervised pastoral training provides the basis for the identification of the following themes: the relative lack of female supervisors; how and why we ought to talk about gender and ministry supervision; the contextual relevance of systemic marginalization to ministry supervision; the relationship between pastoral care and the “feminine”; the relevance of a panentheistic God to gender and ministry supervision; and, lastly, the relevance of gender to the supervisory relationship. Although the focus is on the ways in which gender dynamics can affect the female supervisee's experience, the author also takes a brief look at how female supervisors might experience the relevance of their gender to the art of supervision.
Communication Strategies to Promote Spiritual Well-Being among People with Dementia
Authors: Ryan Ellen B. , Martin Lori Schindel , Beaman Amanda
Published: May 2015

Declining communication skills in dementia threaten a person's sense of self. Building on enduring capabilities, pastoral visitors can significantly enhance spiritual well-being through the use of individualized, person-centered strategies. This article outlines the primary spiritual needs of older adults with dementia and some general strategies to improve communication based on enduring abilities. Detailed examples illustrate how these personhood-centered strategies can meet spiritual needs by connecting with individuals with dementia through life stories and through helping them to participate in religious life.
A Fairy Tale with a Twist: Pastoral Counseling with Adoptive Families
Authors: Fraser Ryan Noel
Published: May 2015

Adoption counseling often focuses primarily on the enigmatic issues faced by adoptees. Very little attention, however, is pointed in the direction of the adoptive parents and their unique struggles. This article begins by providing some current information on adoption in the United States and ensuing implications for pastoral caregiving. Some of the unique challenges associated with the adoption experience are delineated, primarily focusing on systemic and personal issues faced by many adoptive families. Several practical interventions are suggested for pastoral caregivers working with adoptive families. Finally, the entire adoption experience is framed within a theological perspective offering hope to adoptive parents and adoptees.
A National Survey of Health Care Administrators' Views on the Importance of Various Chaplain Roles
Authors: Flannelly Kevin J. , Weaver Andrew J. , Handzo George F. , Smith Walter J.
Published: May 2015

A random sample of hospital administrators throughout the United States was surveyed about their views on the importance of eleven chaplain roles and functions. The 494 respondents fell into three categories: (1) directors of pastoral care departments (N = 132); (2) administrators of hospitals that have a pastoral care department (N = 180); and (3) administrators of hospitals that do not have a pastoral care department (N = 182). All three groups considered all eleven roles to be relatively important, although administrators of hospitals that do not have a pastoral care department gave lower ratings, overall. Meeting the emotional needs of patients and relatives were seen as chaplains most important roles, whereas performing religious rituals and conducting religious services were seen as least important by all three groups. In all but a few instances, the level of importance that administrators assigned to the various roles were positively related to their ratings of their own religiousness and spirituality ( r's = .11 to .26, p<.05).
Not Well Known, Used Little and Needed: Canadian Chaplains' Experiences of Published Spiritual Assessment Tools
Authors: O'Connor Thomas St. James , Meakes Elizabeth , O'Neill Kathleen , Penner Carol , Van Staalduinen Grace , Davis Katherine
Published: May 2015

What are Canadian chaplains' experiences of published assessment tools? Utilizing a quantitative and qualitative methodology with multiple investigators and theoretical triangulation, this article reports the results of a survey of chaplains in the Canadian Association for Pastoral Practice and Education (CAPPE) and interview results of 15 chaplains in three focus groups. Findings indicated that published spiritual assessment tools are not well know, used little, criticized for being reductionistic and not fitting the clinical situation. Participants noted, however, that spiritual assessment is needed for spiritual care. Thirty percent reported the development of their own tools (not published) and three published tools were mentioned by 50% and more. Discussion, limitations of the research, and suggestions for education, practice, and future research are offered.
Theological Reflections on Violence and Abuse
Authors: Nienhuis Nancy Eileen
Published: May 2015

This article examines the contemporary problem of intimate violence and sexual assault within a larger theoretical and theological context. It does so by tracing two trajectories in theological thinking: first, that suffering is sent from God and requires obedience; and, second, that the roles of men and women are not only specific and hierarchical but must remain so lest society risk moral chaos. It argues that many messages from traditional Christian theology continue to haunt abused women in such a way as to at times facilitate domestic violence. It offers suggestions for transforming common theological interpretations in ways that are empowering for battered women. These recommendations include attempts to emphasize resources within a tradition that may help transform unjust power relations like those in abusive relationships.
The Locus Theologicus of U. S. Hispanic/ Latino/a Theology and Its Implications for Clinical Pastoral Education (CPE) Curriculum Development
Authors: Meza Francis Rivers
Published: May 2015

The author examines the history of theological method based on the term locus theologicus, the refinement of this method by Liberation Theologians and U. S. Hispanic/Latino/a Theologians, and describes one experience of using contextual theology to develop curriculum for Second-Year Clinical Pastoral Education (CPE) Residents.
Correlates of Compassion Fatigue and Burnout in Chaplains and Other Clergy who Responded to the September 11th Attacks in New York City
Authors: Flannelly Kevin J. , Roberts Rabbi Stephen B. , Weaver Andrew J.
Published: May 2015

Participants at a June 2002 conference about the September 11th attacks were tested for compassion fatigue, compassion satisfaction, and burnout. The sample consisted of 343 clergy, including 97 chaplains. A total of 149 (43.4%) of the participants had responded as disaster-relief workers following the September 11th attacks. The number of hours clergy worked with trauma victims each week was directly related to compassion fatigue among responders and non-responders. Compassion fatigue also was positively related to the number of days that responders worked at Ground Zero, while disaster-relief work with the American Red Cross reduced compassion fatigue and burnout. Clinical Pastoral Education tended to decrease compassion fatigue and burnout and increase compassion satisfaction in both responders and non-responders. Burnout was inversely related to age in both groups.
A Study of Religion, Ministry, and Meaning in Caregiving among Health Professionals in an Institutional Setting in New York City
Authors: Overvold Jon A. , Weaver Andrew J. , Flannelly Kevin J. , Koenig Harold G.
Published: May 2015

The clinical staff of a large metropolitan nursing home was surveyed about their religious practices, the degree to which they saw their work as a ministry, and the meaning they obtain from being caregivers. Age, race, gender, education, and various other measures were also taken. As hypothesized, religiosity made a significant positive contribution to participants' belief their work was a ministry to those in need. Multiple regression revealed that African American and older staff scored significantly higher on both dependent variables, whereas Caucasians were significantly less likely to view their work as ministry. Staff who worked with long-term patients derived significantly more meaning from their work, but they were no more likely to see it as ministry. Religiosity appears to enhance the meaning caregivers get from their work, and this may be beneficial to patients. Further research may identify other factors that enhance the meaning caregivers get from their work.
Grief and Critical Care Nursing: Occurrence and Resolution
Authors: Weir Silas M.
Published: May 2015

This article reports on research designed to assess the level of grief and the mechanisms of resolution experienced by critical care nurses as they relate to patient death. This prospective exploratory, descriptive study surveyed Registered Nurses (N=92) assigned to Critical Care Units at the University of Colorado Hospital in Denver, Colorado. Based on the findings, the author offers suggestions for ways to provide grief management education to staff as well as timely grief ministry by chaplains.
The Spirituality of People of Color Living with AIDS in Long-Term Care
Authors: Moran Michael
Published: May 2015

This article describes research results regarding the role of religion/spirituality among the chronically ill that highlights the benefits of religious beliefs and practices on patient health and well being. The author reports results from a questionnaire administered to People of Color living with AIDS who reside in a nursing home. The results suggest a strong spirituality as evidenced in a desire to communicate with God through frequent prayer and the reading of the patient's Holy Book. It includes high levels of hope, feelings of being loved, and attendance at religious services and classes held in the nursing home.
The Impact of the Family Communication Coordinator (FCC) Protocol on the Role Stress of Hospital Chaplains
Authors: Dodd-McCue Diane , Tartaglia Alexander
Published: May 2015

The Family Communication Coordinator (FCC) Protocol was implemented to provide early family intervention and to facilitate effective communications during potential organ donation cases. Previous studies found the Protocol associated with improved donor outcome measures and with reduced role stress for ICU nurses caring for potential donors. The present study examines the impact of the Protocol on the perceived role stress of hospital chaplains serving as FCCs. All hospital chaplains serving as FCCs at an academic teaching hospital were surveyed. Their perceptions of job dimensions, role stress, job satisfaction, and commitment were measured; interviews and secondary data supplemented the surveys. The findings demonstrate that the FCC Protocol is associated with improved role stress, specifically role ambiguity and role conflict, among hospital chaplains serving as FCCs. Additionally, the findings suggest that satisfaction with the Protocol may be associated with experience with the Protocol.
Revisiting Viktor Frankl: His Contributions to the Contemporary Interest in Spirituality and Health Care
Authors: Gojmerac-Leiner Georgia
Published: May 2015

The case is made for location of spirituality to be in the body, and at the same time for the power of the spirit to transcend the body when it is afflicted. The author highlights Viktor Frankl's strongest convictions that one can survive through the shear power of one's spirit. Correspondingly, the promise of resurrection can help a Christian to maintain a vision of life, stay courageous though there may be no hope of tomorrow as we have known it. The author asserts the role of the hospital chaplain in helping the sick person to draw upon his or her spiritual strength to cope with their physical illness or affliction.
African-American Clergy's Perceptions of the Leading Health Problems in Their Communities and Their Role in Supporting Parishioners' Health
Authors: West Donnie W. , Tanamly Susie , Novgrod Judith , Williams Eugene , Bisesi Lorrie , Branch Cheryl A. , Sim Tiffanie
Published: May 2015

This article is a report on a survey of Southern California pastors to learn of their perceptions of the leading health problems in their congregations. Participants (N=41) identified stress, overweight, and obesity as the top three health indicators that effect the health of their congregations. Tobacco use and substance abuse were listed among the top five. From a list of health problems, pastors felt that from the pulpit they could impact parishioners responsible sexual behavior most. Pastors expressed their opinions about the reasons for certain maladies and addictions. The findings indicate room for improvement in building clergy's understanding of the nature of illness and addiction and in empowering them in their role of supporting healthy behaviors in the African-American community.
Hypertension Reduction through Forgiveness Training
Authors: Tibbits Dick , Piramelli Chris , Ellis Greg , Luskin Fred , Lukman Roy
Published: May 2015

The objective of this study was to determine if patients with diagnosed stage-1 hypertension could benefit by a forgiveness training program to achieve measurable reductions in anger expression and blood pressure. Twenty-five participants were randomly divided into wait-listed control and intervention groups. The control group monitored blood pressure while the intervention group participated in an 8-week forgiveness training program. At the end of eight weeks, the wait listed group became an intervention group. Those who received forgiveness training achieved significant reductions in anger expression when compared to the control group. While reductions in blood pressure were not achieved by all the participants, those participants who entered the program with elevated anger expression scores did achieve significant reductions in blood pressure. It is suggested that forgiveness training may be an effective clinical intervention for some hypertensive patients with elevated levels of anger.