What did Chaplains do During the Covid Pandemic? An international survey

A survey was designed to learn from chaplain experiences of the impact of the Covid-19 pandemic across the globe. In June 2020, 1657 chaplains responded from 36 countries. They all experienced disruption to their usual practice, and whilst some were viewed as essential employees, most were not. Chaplains themselves were neither clear or unclear about their role before, during and post pandemic. Chaplains lack leadership, and confusion about their role will persist until this changes

How to synthesise original findings back into the literature when the literature has moved on. An Introduction to Concurrent Analysis

BackgroundAll studies need to integrate their findings back in to the literature to explain how the new knowledge changes understanding. This process can be anxiety provoking, especially where the new literature appears to threaten the originality of the study.AimThis paper introduces a method of synthesising relevant literature with primary data MethodConcurrent analysis treats all data as primary data. Findings from a doctoral study of the patient experience of vascular access devices are synthesised with relevant literature to illustrate the technique.ResultsConcurrent Analysis raised new questions that would otherwise have remained unknown. For example, it revealed cultural differences in the way patients react to sub-optimal treatment. Implications for practiceNurse researchers are best placed to influence policy and practice when they can articulate the transferability of their findings. Concurrent Analysis is a practical method of achieving this

A qualitative study on the perceived impact of using an integrated community-based supportive cancer service

Objective‘Improving the Cancer Journey’ (ICJ) is an original, community based, multidisciplinary service offering holistic support to people diagnosed with cancer in Scotland. It is the first service of its kind in the UK. The aim of this qualitative study was to explore the experiences of people who have used this service. MethodTwenty service users were purposively sampled to capture a diverse range of age, sex, cancer types, and deprivation status. Semi-structured interviews explored their experiences of using ICJ. Interviews were transcribed verbatim and thematically analysed.ResultsThirteen females and seven males (mean age 58 years) were interviewed. Three themes were identified: ‘one person, one place’, ‘routes to unexpected support’, and ‘safety net’. ConclusionICJ was perceived to be beneficial because it met the holistic needs of the ICJ service users. By helping people address concerns earlier rather than later, it prevented problems becoming unmanageable. Having an accessible expert to guide and support them through a range of services provided reassurance and created the space to self-manage at a time of distress. These original findings are internationally relevant because there is little evidence on the impact of holistic support services from the patient perspective

Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland

Aims and objectivesThe aim of the study was to explore the impact of implementing an electronic health record system on staff at a Scottish hospice.BackgroundElectronic health records are broadly considered preferable to paper based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice.DesignNaturalistic prospective repeated measures mixed methods approach.MethodData on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, qualitative from Concurrent Analysis of free text comments and focus group. Participants were all 150 employees of a single hospice in Scotland.ResultsBoth system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges:1.Technical issues, with subthemes of accessibility and usability.2.Cultural issues, with sub themes of time, teamwork, care provision and perception of change.ConclusionIt took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless this process of change was found to be consistent with the ‘J curve’ theory of organizational change, and as such is both predictable and manageable for other organizations.Relevance to practiceIt is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity (‘J’ curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically

Patient Reported Outcome Measure of Spiritual Care as Delivered by Chaplains

Chaplains are employed by health organizations around the world to support patients in recognizing and addressing their spiritual needs. There is currently no generalizable measure of the impact of these interventions and so the clinical and strategic worth of chaplaincy is difficult to articulate. This paper introduces the Scottish PROM, an original five-item patient reported outcome measure constructed specifically to address this gap. It describes the validation process from its conceptual grounding in the spiritual care literature through face and content validity cycles. It shows that the Scottish PROM is internally consistent and unidimensional. Responses to the Scottish PROM show strong convergent validity with responses to the Warwick and Edinburgh Mental Well-Being Scale, a generic well-being scale often used as a proxy for spiritual well-being. In summary, the Scottish PROM is fit for purpose. It measures the outcomes of spiritual care as delivered by chaplains in this study. This novel project introduces an essential and original breakthrough; the possibility of generalizable international chaplaincy research

A systematic review on the factors associated with positive experiences in carers of someone with cancer

The aim of this review was to identify the factors associated with positive experiences in non-professional carers of someone with a cancer diagnosis. A systematic search of the following electronic databases was undertaken: Cochrane Library, CINAHL, PsycINFO, SocINDEX and Medline. Literature was searched using terms relating to cancer, caring and positive experiences. Additional records were identified through a manual search of relevant reference lists. The search included studies published in English from 1990- June 2015. Two raters were involved in data extraction, quality appraisal, coding, synthesis, and analysis. Evolutionary concept analysis was used as a guiding framework in order to focus on attributes associated with positive experiences. Fifty two articles were included in this review. Analysis identified four overarching attributes: ‘gender’, ‘personal resources’, ‘finding meaning’ and ‘social context’. Despite the challenges associated with caring this combination of internal and external factors enabled some carers to report positive experiences related to caring. This knowledge may be clinically helpful when designing supportive interventions. Strengths and limitations of these claims are discussed

A J-curve of interprofessional change: co-locating non-health partners in an oncology unit

BackgroundInternationally, clinicians face increased demand, pressure on resources and unmet patient needs. A community social support service was co-located within cancer clinics in Scotland to help meet some of these needs.AimAims were to analyse the impact of the service on clinical staff and to propose an explanatory theory of change.MethodQualitative exploratory design, using thematic analysis of semi-structured interviews with eight nurse specialists and two medical oncologists from lung, breast, head and neck and gastro-intestinal oncology teams in Scotland, UK, in 2018/19.FindingsFour themes captured the process: ‘The Conversation’, ‘a better experience’, ‘freedom to focus’ and ‘working hand in hand’.ConclusionThese four themes together explained the process of effective inter-professional working. This process would have been predicted by the J-Curve literature on diffusion of innovations. Linking J-Curve theory to this successful process provides new understanding that could prove essential for clinical teams who are implementing change within their practice

\u27What’s on your mind?\u27 The only necessary question in spiritual care

Around the world, chaplains provide specialist spiritual care for people with complex healthcare needs. If the nature of chaplain interventions was better understood then multidisciplinary colleagues could both improve their own skills in spiritual care and better understand when to refer people to chaplains. A survey was constructed to establish what aspects of the chaplain/patient relationship were most important for patients in Scotland and Australia. Outcomes were measured with the Scottish Patient Reported Outcome Measure (Scottish PROM©). Results from 610 respondents showed the strongest correlation was between ‘being able to talk about what is on my mind’ and the Scottish PROM (rs(452) = .451, p \u3c .0005). ‘Being able to talk about what is on my mind’ proved more important than being listened to, having faith/beliefs valued, or being understood. Given the importance placed on listening and understanding by clinicians, this original and counterintuitive finding goes some way to explaining the unique role and function of healthcare chaplaincy