Health care chaplaincy in the Nordic countries: Transformations and perspectives

I: E., Ansen Zeder, P-Y., Brandt & J. Besson,(dir.), Clinique du sensIn this article we present some developmental patterns in the 100 years long history of of health care chaplaincy in the Nordic countries, particularely in Norway. We argue that a shift is gradually taking place from what can be regardes as a religious service model to an existential care model. This can be seen within the context of specialization and professionalization both in health care and chaplaincy, as well on the background of pluralization in society. We point at some challenges for chaplaincy regarding delimitation and the relationships between religious and secular anchoring of chaplaincy, the routines for referrals to chaplains, implementation of chaplaincy and inter-disciplinary work in hospitals, and the need for continuous work on knowledge development and research.publishedVersio

The Challenges Of Dementia Care And The (Un)Making Of Meaning: Analysis Of An Online Forum On Carer Spirituality

Although one writer has called dementia "the theological disease", there has been remarkably little research on how people with dementia and their carers find spiritual meaning and significance in their experience. While there is a significant body of literature examining the role of existing spiritual or religious beliefs and practices in supporting the carer of a person with dementia, there is very little research which offers an insight into the reverse process: how the experience of caring challenges a carer’s sources of spiritual or religious meaning, and what strategies are adopted to resolve the experienced tension between belief and experience. The present study aimed to supplement this incomplete picture by examining the archive of an online forum responding to a request for “thoughts which lend a spiritual perspective to going through dementia”. Interpretative Phenomenal Analysis (IPA) was undertaken on two levels. First, attention was focussed on the forum as an integrated discussion, identifying its recurrent and superordinate themes. The contributions of selected individual participants were then analysed to further examine the way in which their positions were developed. The analysis uncovered the importance which at least some carers of people with dementia attached to spiritual perspectives, as supplying strength for and meaning to the challenges they faced; but also how meaning was undermined by their experience. Few participants identified with traditional religious resources, but attempted to find meaning by reflection on their personal narrative. Six distinct types of response to the initial question were identified. These findings indicate that the wellbeing and resilience of at least some carers may benefit from validation of their spiritual concerns along with sensitive and attentive spiritual support. In this task, a key resource is their reflection on their personal narrative in relation to current challenges

Deacons as conversation partners on existential issues with older people: An empirical study in Norway

Deacons within the Church of Norway constitute a professional group that can encounter older people’s need for existential conversations, but empirical research in this field is scarce. This study aims to explore professional deacons’ perceived competence in the field of older people and existential issues. Three focus group interviews with 18 deacons and an inductive qualitative content analysis were used to answer the inquiry. We introduce the term “approachable deacons” as an analytical innovation. Based on the empirical material and the perspectives from diaconia and the psychology of religion, arguments are made for the societal contribution of the deacon profession. As approachable existential conversation partners, deacons may make an essential contribution to public mental health. We assert that the deacon profession represents a counterculture to society and healthcare, where time is short, older people may feel downgraded, and existential and religious literacy is limited.publishedVersio

Sjelesorg versus konverteringsterapi: Når vi ikke kan eller vil følge konfidenten dit konfidenten peker

Artikkelen har sitt utgangspunkt i to presentasjoner som ble gitt under Sjelesorgsymposiet 23. mai 2022 av oss som skriver denne artikkelen. Temaet var «Kan homoterapi være sjelesorg?»publishedVersio

Embodied meaning-making in the experiences and behaviours of persons with dementia

Background: The aim of the study was to explore and articulate how meaning-making appears and how meaningfulness is experienced in persons with severe dementia. Although there is little knowledge about meaning-making and experience of meaningfulness for this group, this article assumes that persons with dementia are as much in need of meaningfulness in life as any others, and hence, that they are involved in the process of meaning-making. Methods: The study was conducted using a qualitative method with exploratory design. Ten patients with severe dementia at a specialized dementia ward at an old age psychiatric department in hospital were observed through participant observation performed over four months. The field-notes from the observation contained narratives carrying with them a dimension of meaning played out in an everyday setting and thus named Meaning-making dramas. The narratives were analyzed looking for expressions where experiences of meaning-making and meaningfulness could be identified. Results: The narratives demonstrate that persons with severe dementia are involved in processes of meaning-making. The narratives include expressions of meaning-making, and of interactions that include apparent crises of meaning, but also transitions into what may be interpreted as meaningfulness based on experiences of significance, orientation and belonging. The role of the body and the senses has proved significant in these processes. The findings also suggest that experiences of meaning contribute to experience of personhood. Conclusions: The relevance to clinical practice indicates that working from a person-centred approach in dementia care also includes paying attention to the dimension of meaning. This dimension is important both for the person living with dementia and for the people caring for them. Acknowledging meaning as a central human concern, it is crucial to seek understanding and knowledge about the significance of meaning in vulnerable groups such as persons with dementia.Sykehuset Innlandet HF 150332publishedVersio

Participation in Existential Groups Led by Norwegian Healthcare Chaplains-Relations to Psychological Distress, Crisis of Meaning and Meaningfulness

Spirituality groups led by healthcare chaplains have been found to aid patients' recovery processes in US psychiatric units. In Norway, existential groups (EGs) led by healthcare chaplains and co-led by healthcare staff members are offered at psychiatric units; these groups share commonalities with spirituality groups, group psychotherapy, existential therapy and clinical pastoral care, facilitating patients' reflections regarding existential, spiritual and religious issues. The study aimed to examine associations between patients' participation and topics discussed in the EGs and their experiences of psychological distress, crisis of meaning and meaningfulness. A cross-sectional design was applied among 157 patients attending EGs led by healthcare chaplains across Norway. Multivariate regression analyses assessed the strength of possible associations, adjusted for relevant demographical variables. Significant association was found between lengthier EG participation and lower levels of psychological distress, while discussion topics concerning religious and spiritual issues were significantly associated with the experience of meaningfulness

Meaning in Life for Patients With Severe Dementia: A Qualitative Study of Healthcare Professionals' Interpretations

The need for meaning in life is a key aspect of being human, and a central issue in the psychology of religion. Understanding experience of meaning for persons with severe dementia is challenging due to the impairments associated with the illness. Despite these challenges, this article argues that meaning in life is as important for a person with severe dementia as it is for everyone else. This study was conducted in a Norwegian hospital and nursing home context and was part of a research project on meaning in life for persons with severe dementia. The study builds on two other studies which focused on how meaning-making and experience of meaningfulness appeared in patients with severe dementia. By presenting the findings from these two studies for a group of healthcare professionals and introducing them to research on meaning in life, the aim of this study was to explore how healthcare professionals interpret the patients' experience of meaning in life in practise for patients with severe dementia in a hospital and nursing home context, and to highlight its clinical implications. The study was conducted using a qualitative method with exploratory design. The data were collected at a round table conference, a method inspired by a mode of action research called “co-operative inquiry.” Altogether 27 professional healthcarers, from a variety of professions, with high competence in dementia care participated together with six researchers authoring this article. This study revealed that healthcare professionals were constantly dealing with different forms of meaning in their everyday care for people with dementia. The findings also showed clear connexions between understanding of meaning and fundamental aspects of good dementia care. Meaning corresponded well with the principles of person-centred care, and this compatibility allowed the healthcare professionals to associate meaning in life as a perspective into their work without having much prior knowledge or being familiar with the use of this perspective. The study points out that awareness of meaning in life as an integrated perspective in clinical practise will contribute to a broader and enhanced repertoire, and hence to improved dementia care. Facilitating experience of meaning calls for increased resources in personnel and competence in future dementia care.publishedVersio

Ny organisering av prestetjenesten ("Prostereformen") - evaluering

I hvilken utstrekning er prostereformens målsettinger nådd, og hvilke faktorer har hatt betydning for realisering eller uteblitt realisering av disse målsettingene? Prestene har ganske gode arbeidsvilkår, men det oppleves å være relativt uavhengig av reformen og dens tiltak. Reformtiltakene ser ut til å ha ulik virkning: Avhengig av hvilket nivå i den kirkelige strukturen en undersøker: på bispedømmenivå og prostenivå er man langt mer positiv enn blant prestene. Avhengig av geografi og demografi: Reformtiltakene fungerer bedre i tettbygde og sentrale områder og de større byene enn på mindre steder og i mer spredtbygde områder. Samtidig var prester i byene mest tilfreds med sin arbeidssituasjon i utgangspunktet; reformen treffer ikke nødvendigvis best der behovet er størst. Reformen har virket bedre med ordninger rettet inn mot individuell oppfølging og utvikling, enn strukturelle og organisatoriske ordninger som skulle gi mer fleksibel arbeidsorganisering, styrke samarbeid, utjevne arbeidsfordeling og ressurser. For eksempel har reformen gitt gode muligheter til kompetanseutvikling, men denne er styrt av prestenes ønske snarere enn prostiets og bispedømmets behov, og den økte kompetansen er i liten grad etterspurt av arbeidsgiver. Det er en opplevelse især på lokalplan av at reformen har sammenfalt med en ressursinnstramning i kirken som det ikke er kompensert for. Det er en tydelig forskjell på hvordan prostene opplever sin ledelsessituasjon innen reformen, og hvordan prestene opplever prostenes ledelse i reformen, for eksempel når det gjelder tidsbruk: prostenes opplevelse av hva de bruker mest tid på (personalledelse og arbeidsfordeling) er ikke det prestene opplever at prostene bruker mest tid på (nemlig samarbeid med kirkeverge/råd og økonomisk+administrative oppgaver). kompetanseheving: prostene vurderer sin egen kompetanseheving gjennom reformen mer positivt enn prestene vurderer den. Hvorvidt reformen har styrket prostens lederrolle avhenger av hvem en spør: bispedømmeledelsen sier ja, og syns dette er positivt; prostene svarer nærmest både ʹ og; prestene svarer ja, men er uenige om hvorvidt dette positivt. Hvordan en forstår «prostens lederrolle» og spenningen mellom pastoral ledelse, personalledelse, og administrativ ledelse: Det er en utbredt oppfatning at det er som administrativ ledelse mer enn som personalledelse at prostens lederrolle er styrket, og at dimensjonen av pastoral ledelse er svekket. Prostens relasjon til de kirkelige rådene og kirkevergene gis moderat til høy viktighet av respondentene, men det er ikke noe i materialet som tyder på at denne dimensjonen er sentral. Prostiet som tjenestedistrikt har muliggjort tjeneste på tvers av soknegrenser, men dette har likevel bare forekommet i begrenset grad. Faktorer kan være : Forestillingen om at båndene mellom «et sokn og dets prest» ikke bør brytes . Geografiske forhold : Prestene opplever ikke at prostiet som tjenestedistrikt har hatt positiv innvirkning på rekrutteringssituasjon. Flertallet mener at prostiet er tjenlig som tjenestedistrikt. Derimot er det ikke noe klart votum verken for eller mot en fremtidig nøkkelrolle for prostiet som ledende organ i kirken

Evaluering av Kirkelig ressurssenter mot vold og seksuelle overgrep

Det er all grunn til å understreke at KRS har gjort en stor innsats for å ivareta sitt diakonale oppdrag når det gjelder forholdet mellom seksuelle overgrep og kristen tro. KRS har opparbeidet spisskompetanse og bidratt til at tematikken er satt på dagsordenen og blitt institusjonalisert gjennom den formaliseringen av ansvarsforhold som har funnet sted. Eksempelvis gjennom at kirkesamfunn og kristne organisasjoner har innarbeidet retningslinjer, og at arbeidsgiversiden og frivillighet er tematisert. Et stort flertall av informantene i denne evalueringen, både utsatte brukere og andre som har tatt i bruk tjenestene fra KRS, uttrykker tilfredshet med de ulike formene for hjelp og støtte de har mottatt. Samtidig viser evalueringen at det også er utfordringer i dette store og komplekse feltet, utfordringer som KRS ikke fullt ut kan løse. Dette kan i hovedsak sies å henge sammen med virksomhetens begrensede størrelse og kompetanse. Disse utfordringene har vi i denne rapporten beskrevet under overskriftene organisasjon, bearbeiding, håndtering og forebygging. På bakgrunn av materialet og analysene og drøftingene i denne rapporten vil vi anbefale at tiltaket KRS opprettholdes, med samme tydelighet og representative tyngde som i dag. De overordnede prioriteringene virker godt begrunnet, slik at det kan anbefales å videreføre virksomheten med de tre virksomhetsområdene bearbeiding, håndtering og forebygging, og med de forskyvningene i retning av forebygging som går frem av rapporten.publishedVersio

Health care chaplaincy in the Nordic countries: Transformations and perspectives

In this article we present some developmental patterns in the 100 years long history of of health care chaplaincy in the Nordic countries, particularely in Norway. We argue that a shift is gradually taking place from what can be regardes as a religious service model to an existential care model. This can be seen within the context of specialization and professionalization both in health care and chaplaincy, as well on the background of pluralization in society. We point at some challenges for chaplaincy regarding delimitation and the relationships between religious and secular anchoring of chaplaincy, the routines for referrals to chaplains, implementation of chaplaincy and inter-disciplinary work in hospitals, and the need for continuous work on knowledge development and research