Health care and religious organizations have a long history with one another. Chaplains' investments in the health and wellbeing of their local communities have extended beyond the hospital walls for longer than many chaplains may recognize. However, the published evidence suggests these efforts have been limited. Given the history of health care evolution in the United States, the small evidence of cases highlighting chaplains' leadership within community health initiatives, and the pressure for health systems to address the social determinants of health, we sought to explore chaplains' integration in community health and wellness initiatives. This paper presents the results of a qualitative analysis of interviews with chaplains working to promote community health and wellness (n = 10). The identified themes highlight factors at the individual chaplain level, such as how chaplains got involved, characteristics of the chaplains' contexts, and the impact of chaplains' involvement.

The aim of this study was to describe the range of spiritual care activities in support of clinical colleagues at a subset of U.S. hospitals. A descriptive cross-sectional design using a 76-item Zoom/telephone guided survey containing a subset of staff care questions was employed. Data were provided by directors/managers responsible for spiritual care services at the 2020-2021 U.S. News & World Report top hospitals. Results identified staff support as an important chaplaincy function at both organizational and spiritual care department levels. Staff chaplains at over half of the hospitals spend an estimated 10-30% of their time on staff care, with chaplains in five hospitals spending greater than 30%. The most frequently reported activities were religiously associated, such as blessings and rituals for hospital events. Additionally, chaplains actively support staff during critical events such as patient deaths and through organizational protocols such as code lavender and critical incident debriefings. Chaplain support for staff most commonly grew out of personal relationships or referrals from clinical managers. Future research opportunities in this area include systematic data collection for chaplains' specific staff support activities as well as efforts to investigate the impact of those activities on patient experience.

The functions of hospital chaplains and the corresponding staffing of spiritual care departments remain persistent and parallel questions within the profession. No consensus exists on services provided by spiritual care departments nor the staffing patterns to meet those expectations. This study describes the key activities and staffing at the 20 U.S. News and World Report Best Hospitals 2020-2021 as well as the connections between services, staffing, and select hospital characteristics such as average daily census. Information about each hospital's chaplaincy department was gathered via a Zoom/telephone assisted survey with its spiritual care manager. Findings reveal that while spiritual care departments are structurally integrated into their organizations and chaplains respond consistently to requests for care, involvement in established organizational protocols varies. Study findings support the notion that staffing levels are a function of chaplain integration into an organization and the activities organizations expect chaplains to fulfill.

BackgroundIncreasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available.PurposeThe aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services.MethodologyData were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level.ResultsHospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services.ConclusionThe lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services.Practice ImplicationsChaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.

BACKGROUND:Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available.PURPOSE:The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services.METHODOLOGY:Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level.RESULTS:Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services.CONCLUSION:The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services.PRACTICE IMPLICATIONS:Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.

BACKGROUND:Providers often underestimate the influence of patient religious and spiritual (R&S) needs. The current study sought to determine the influence of R&S beliefs on treatment decision making among patients and providers in the context of cancer care.METHODS:We conducted a systematic review of the literature using web-based search engines and discipline-specific databases. Search terms included a combination of the following Medical Subject Headings and key terms: "cancer,""spirituality,""religion," and "decision making." We used Covidence to screen relevant studies and extracted data into Microsoft Excel.RESULTS:Among 311 screened studies, 32 met inclusion/exclusion criteria. Most studies evaluated the patient perspective (n = 29), while 2 studies evaluated the provider perspective and 1 study examined both. In assessing patient R&S relative to treatment decision making, we thematically characterized articles according to decision-making contexts, including general (n = 11), end-of-life/advance care planning (n = 13), and other: specific (n = 8). Specific contexts included, but were not limited to, clinical trial participation (n = 2) and use of complementary and alternative medicine (n = 4). Within end-of-life/advance care planning, there was a discrepancy regarding how R&S influenced treatment decision making. The influence of R&S on general treatment decision making was both active and passive, with some patients wanting more direct integration of their R&S beliefs in treatment decision making. In contrast, other patients were less aware of indirect R&S influences. Patient perception of the impact of R&S on treatment decision making varied relative to race/ethnicity, being more pronounced among Black patients.CONCLUSION:Most articles focused on R&S relative to treatment decision making at the end of life, even though R&S appeared important across the care continuum. To improve patient-centered cancer care, providers need to be more aware of the impact of R&S on treatment decision making.

Objectives: To explore how and what programs or projects address asset security at the community level as a social determinant of health. Data Sources: To conduct a scoping review following Preferred Reporting Items for Systemic Reviews and Meta analyses guidelines, the databases searched included CINAHL, EconLit, Embase, Pubmed/Medline, and the Sociological Collection of EBSCOhost. Review Methods: Keywords used for article identification were ("asset" AND "community") OR ("asset security" AND "community"). Studies were included if published between 1990 and 2019, written in English, and published in a peer review journal. Reference lists of selected articles were also reviewed for additional articles. Two authors reviewed titles and abstracts separately, then reviewed full-texts for sample selection. Results: After identifying 2,585 articles, researchers refined the final sample to 28 articles. Programs or projects within the sample focused on direct financial interventions or indirect interventions. Direct interventions included financial programs, such as Individual Development Accounts, or ownership opportunities, such as cooperatives or microenterprises. Indirect interventions included those focused on the built environment, such as asset mapping to identify a community's resources, or focused on education, such as those for social workers. Conclusions: Financial programs, ownership opportunities, assessments of the built environment, and targeted education complement one another to influence a community's assets from many angles. Income inequality has evolved from repeated institutionalized practices that inadvertently reinforce that inequality. Published literature emphasizes the local nature of needs and challenges, culturally responsive efforts, and that observing an impact often requires longitudinal efforts.

The Covid-19 pandemic has challenged public health practitioners and clinicians at multiple levels to intentionally consider the impact of social isolation on health outcomes. Many community-based programmes design interventions to address tangible challenges within the social determinants of health, such as asset insecurity or food insecurity, to address health inequities. The growing need to address social isolation within marginalised communities also requires organisations to collaborate and create community partnerships that strengthen their own social integration within the community. The present research reports on the results of a Social Network Analysis (SNA) of community programmes within three southern U.S. cities and their local collaborations to address social isolation. After interviewing representatives of 46 community organisations, it was found that social service organisations that also offer public health services play a central role in community efforts to improve social isolation. The participating organisations primarily collaborate through referrals and information sharing, and report inadequate resources. With a growing recognition that social services and supports play a considerable role in addressing health inequities, this study provides evidence of opportunities for interorganisational collaboration to promote individual and community health.

Hospitalized individuals in the United States with limited English proficiency (LEP) may experience complications when receiving hospital care. Grounded in the ethical principles of chaplaincy and motivated by the desire to address inequitable health service provision, we developed the Cross-Language Chaplaincy Introduction Guidebook. The Guidebook introduces chaplaincy in 20 different languages with the goal of improving chaplain accessibility. We report on the rigorous development of the Guidebook and how to integrate the resource clinically.

Two-thirds of American hospitals have chaplains. This article explores the organizational and business models that underlie how chaplains are integrated into hospitals. Based on interviews with 14 chaplain managers and the 11 healthcare executives to whom they report at 18 hospitals in 9 systems, we identify three central findings. First, there is significant variation in how spiritual care programs are staffed and integrated into their hospitals. Second, executives and chaplain managers see the value of chaplains in terms of their quality of care, reliability and responsivity to emergent patient and staff needs, and clinical training and experience working within a complex environment. Third, few departments rely on empirical data when making decisions about staffing, tending instead to default to the budgetary status quo. These findings provide the basis for a larger more systematic study.

Objective:To estimate the association between weather and COVID-19 fatality rates during US stay-at-home orders.Methods:With a county-level longitudinal design, this study analyzed COVID-19 deaths from public health departments' daily reports and considered exposure as the 18 to 22 day-period before death. Models included state-level social distancing measures, Census Bureau demographics, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2.5 concentrations, and U.V. light index.Results:A 1 degrees F increase in the minimum temperature was associated with 1.9% (95% CI, 0.2% to 3.6%) increase in deaths 20 days later. An ozone concentration increase of 1 ppb (part per billion) decreased daily deaths by 2.0% (95% CI, 0.1% to 3.6%); ozone levels below 38 ppb negatively correlated with deaths.Conclusions:Increased mobility may drive the observed association of minimum daily temperature on COVID-19 deaths.

This article explores the ways in which gendered processes play out through the professionalization of chaplains in healthcare settings. It describes how gender manifests within organizations, how literature addresses the role of gender in professionalization, and considerations for professional chaplaincy. Fifty interviews with U.S. chaplains were analyzed to explore the relationship between the professionalization of chaplaincy and male and female positionality. Although gender theory moves beyond binary conceptualizations of gender, all participants in this study self-identified as male or female and our data were analyzed accordingly. The language and professionalization efforts used by male and female chaplains mirror the gendered cultural expectations associated with these groups. This article notes how the patriarchal structures of both religious and healthcare institutions are inextricably embedded in the chaplaincy profession; thus, female chaplains have found it necessary to challenge these systems from the beginning.

Wearing a facial mask can limit COVID-19 transmission. Measurements of communities' mask use behavior have mostly relied on self-report. This study's objective was to devise a method to measure the prevalence of improper mask use and no mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14-20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The total number of visited public areas was 382 where mask use behavior of 2,080 visitors and 1,510 staff were observed. The average prevalence of mask use among observed visitors was 96%, while the average prevalence of proper use was 86%. In 48% of the public areas, at least one improperly masked visitor was observed and in 17% at least one unmasked visitor was observed. The average prevalence of proper mask use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and improperly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, specifically in food and grocery stores as compared to other retail stores. Also, the majority of the observed unmasked persons were male and middle-aged.

Hospitalized persons want their spiritual needs addressed and discussed by the healthcare team, but medical providers and nurses lack the necessary training. Patients want chaplaincy care, but very few receive it, and little is known about utilization factors. To identify the population characteristics associated with the utilization of chaplaincy services, hospitalization data from March 2012 to July 2017 were analyzed (N = 15,242 patients). Religiously affiliated individuals and those with the most acute health needs were more likely to receive chaplaincy care and received more total care. Patient-centered healthcare models may need to evaluate strategic integration of spiritual care beyond reactive spiritual care provision.

Wearing a facial mask can limit COVID-19 transmission. Measurements of communities’ mask use behavior have mostly relied on self-report. This study’s objective was to devise a method for measuring the prevalence of mask-wearing and proper mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14−20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The average mask use prevalence among observed visitors of the 382 visited public areas was 96%, while the average prevalence of proper use was 86%. In 17% of the public areas, at least one unmasked visitor was among the observed visitors; in 48%, at least one improperly masked visitor was observed. The average mask use among staff was 92%, but unmasked staff were observed in fewer public areas, as an unmasked staff member was observed in 11% of the visited public areas. The average prevalence of proper make use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and incorrectly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, also in food and grocery stores than other retail stores. Also, the majority of the observed unmasked persons were male and middle age adults.

Many professional chaplaincy organizations in the United States have board certified healthcare chaplains since the 1920s and documented how they have adapted their process as the profession has grown. In 2019, the Association of Professional Chaplains and the National Association of Catholic Chaplains sought the perspectives of key stakeholders about professional chaplaincy board certification. This study reports the results from 50 semi-structured interviews with certification candidates, certification committee members, and chaplaincy managers in the United States. Participants discussed the preparation of the certification application, the certification interview, the ease and difficulty of certification competencies, and the evolving workforce. This study demonstrated divergent views on many aspects of board certification, but participants predominately respected and valued the process. Chaplains with varying levels of experience discussed how board certification strengthens multidisciplinary respect and collaboration. Participants reported difficulties with competencies that required translating between theory and practice.

Objectives. To increase the scale and efficacy of health promotion practice, culturally responsive approaches to well-being are needed in both communication and practice innovation. This mixed-methods evaluation sought to identify specific mechanisms used in a promising practice model and offers a potential theoretical framework to support public health programs in integrating culture and social justice into communication and intervention programs. Study Design. Rooted at the intersection of ethnographic and phenomenological worldviews, this mixed-methods, retrospective process evaluation used publicly available empirical and experiential data centered on the arts, science, and social justice to identify critical mechanisms used and incorporate them into an emergent theoretical framework. Method. The retrospective process evaluation used an ethnography-informed approach combined with scientific literature reviews. To integrate adjacent ideas into the emergent theoretical framework, a phenomenologically informed theme development approach was used. Results. The evaluation resulted in a five-step framework, called MOTIF, with the potential to be utilized in diverse situational and geographic contexts. Data that surfaced from related literature reviews revealed adjacent mechanisms from positive psychology, critical consciousness theory, and innovation design that were incorporated into the emergent framework. Conclusion. MOTIF may offer a culturally responsive public health communication and innovation process capable of promoting health equity through the cultivation of relationships between artists, community participants, and public health agencies and researchers who collectively endeavor to craft innovative solutions for population health and well-being.

Objectives This pilot study explores how healthcare leaders understand spiritual care and how that understanding informs staffing and resource decisions. Methods This study is based on interviews with 11 healthcare leaders, representing 18 hospitals in 9 systems, conducted between August 2019 and February 2020. Results Leaders see the value of chaplains in terms of their work supporting staff in tragic situations and during organizational change. They aim to continue to maintain chaplaincy efforts in the midst of challenging economic realities. Conclusions Chaplains' interactions with staff alongside patient outcomes are a contributing factor in how resources decisions are made about spiritual care.

INTRODUCTION:Healthcare providers and systems increasingly utilize telehealth modalities to address barriers and challenges for healthcare delivery. Specialties, such as psychiatry, are testing asynchronous methods for telehealth delivery. The National Quality Forum (NQF) developed a framework with which to assess the quality of telemedicine according to measures and measure concepts within four domains. This review assesses existing asynchronous telepsychiatry (ATP) research according to the telehealth domains established by NQF, evaluates the prevalence and quality of ATP, and identifies the areas in which more research must be conducted.METHODS:A systematic review of ATP methods was conducted according to PRISMA guidelines. Studies were categorized according to NQF telehealth domains and subdomains to further examine study outcomes.RESULTS:The review initially identified 205 studies that were narrowed down to a final sample of 11 articles. Of the final articles, most studies addressed the effectiveness of ATP or users' experience with ATP.DISCUSSION:The initial investigation of published ATP literature suggests promising results. ATP studies suggest that these services improve access to care, can be feasibly implemented by the clinical team, maintain patient/family satisfaction, and potentially reduce the cost of services. The limited sample of published literature necessitates further study of the practice in order to assess ATP according to the quality domains identified by NQF, especially access to care for patients and caregivers, the financial costs incurred by both providers and patients, and barriers to uptake.

Background: Understanding if and how weather patterns influence the transmission of SARS-CoV-2 will impact public health preparedness, as the second year of the COVID-19 pandemic draws near. However, the research on weather and SARS-CoV-2 transmission has yielded mixed results. This study aimed to estimate the association of weather and COVID-19 fatality rates during the period of stay-at-home orders in U.S. counties.Methods: This study utilized a county-level longitudinal design to examine COVID-19 adult deaths from the stay-at-home orders to reopening. COVID-19 deaths came from public health departments' daily reports and considered exposure as the 18 to 22 day-period before death. Further, models included information on state-level social distancing measures, Census Bureau demographic information, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2·5 concentrations, and U.V. light index.Findings: The average minimum daily temperature threshold of 53 to 63 degrees Fahrenheit (°F was positively associated with COVID-19 deaths. A 1°F increase in the average minimum temperature was associated with 1·9% (95% CI, 0·2%−3·6%) increase in deaths about 20 days later. An ozone concentration increase of one ppb (part per billion) decreased daily deaths by 2·0% (95% CI, 0·1%−3·6%). Ozone levels below 38 ppb appeared negatively correlated with deaths.Interpretation: Increased mobility and contacts may drive the observed association of minimum daily temperature on COVID-19 deaths. The effect of ozone may be related to its disinfectant properties, but this requires further confirmation.Funding Statement: No Funding Received.Declaration of Interests: None to declare.