Research and Data

Our Research

Our department is proud to contribute to research being done surrounding chaplaincy and clinical spiritual care. View some of our projects and research articles below!

Caring for Each Other: An Evaluation of a Peer Support Program for Nurses and Health Care Workers

Peer support programs play a critical role in health care organizations by helping nurses and other HCWs manage the physical and emotional aspects of the work and the environment in which care is provided.

Pickett, L., Gosselin, T., Oliver, J., Gross, M. (2025). Caring for Each Other: An Evaluation of a Peer Support Program for Nurses and Health Care Workers. Journal of Nursing Care Quality 40(2):181-186. https://www.nursingcenter.com/journalarticle?Article_ID=7222725.

Evaluating a Clinical Chaplain Pilot Intervention to Facilitate Advance Care Planning in a Primary Care Clinic

Background: While advance care planning (ACP) conversations align an individual’s healthcare options to their goals, primary care physicians (PCPs) often have limited time and training to conduct ACP in clinic. A clinical chaplain’s unique expertise may provide targeted support to help overcome these barriers by assessing the complex dynamics around ACP for patients and providers alike. Objectives: Assess the feasibility and impact of a chaplain pilot intervention to facilitate ACP between PCPs and patients. Design: This pilot quality improvement study was conducted at an urban academic primary care clinic in the Southeastern United States. Participants: Two hundred and six patients at high risk of hospitalization, determined by an institutional algorithm, were assigned to either intervention or control groups. Intervention: For each intervention patient, the chaplain reviewed their chart through a pastoral “empathetic, holistic, and relational framework” to (1) determine patient-specific ACP needs and barriers, and (2) complete targeted next steps to facilitate ACP with the PCP. Main Measures: Feasibility outcomes were measured using the RE-AIM framework. ACP documentation metrics were compared between study arms before and 6 months after intervention. Key Results: The chaplain determined that 75 out of 92 (82%) intervention patients needed additional ACP conversations. Average chart review time was 10 min (range 5–25). The chaplain contacted 62 PCPs and 11 patients, requested 26 appointments, and coordinated 19 interdisciplinary consultations. Compared to controls, intervention patients had a significant increase in ACP notes (35 vs. 2, p = < 0.001), healthcare power of attorney forms (9 vs. 2, p = 0.02), and advance directive forms (6 vs. 0, p = 0.01) after the intervention. Conclusions: A clinical chaplain’s unique training and experience may provide feasible and worthwhile support to help identify patient-specific needs and barriers and facilitate ACP conversations between PCPs and high-risk patients.

Inter-Professional Outpatient Team Publishes on Chaplain ACP Intervention

Dussault, N., Henderson, K.K., et. al. (2024). Evaluating a Clinical Chaplain Pilot Intervention to Facilitate
Advance Care Planning in a Primary Care Clinic. J Gen Intern Med. https://doi.org/10.1007/s11606-025-09527-1 

Project: Untold Stories

Can a story have the power to reinvigorate the practice of medicine? The Stories Project seeks to answer this question through audio narratives and portrait photography co-created with patients of the Duke Outpatient Clinic. Chaplain Katherine Henderson partnered with Dr. Jeffrey Lee (internal medicine-psychiatry resident) and other inter-professional colleagues to bring this narrative medicine project to life.  This collaborative effort seeks to humanize and empower patients while creating opportunities to foster empathy in healthcare workers.

Featured Article: Giving Voice to Patients’ Untold Stories  | Duke University School of Medicine

Conference workshops and presentations: Annual Meeting of the Association of Medicine & Psychiatry (interactive workshop, October 2024); Society of General Internal Medicine (oral presentation, May 2024); North Carolina Psychiatric Association (poster session, March 2024); American College of Physicians, National Conference (poster session, April 2024); American College of Physicians, Regional Conference (awarded best poster, Feb 2024)

Factual Knowledge about Chaplains and Desire for Chaplain Services in an Outpatient Primary Care Clinic

Outpatient chaplaincy is a new specialty in healthcare, with a relative paucity of research studies exploring the need for spiritual care interventions in ambulatory settings. Over the past 3 years, our interdisciplinary team at the Duke Outpatient Clinic has piloted the extension of professional spiritual care into this hospital-based resident teaching clinic offering primary care to underserved populations in Durham, NC. In this article, we report the results of a series of surveys that we conducted at the clinic to assess patients' perceptions of chaplain services, understanding of Chaplains' roles, and desire for chaplain services in specific hypothetical scenarios. As part of this survey, we also asked patients about their personal levels of extrinsic and intrinsic religiosity using the well-validated Duke University Religion Index. Our results indicate which chaplain interventions are most desired among this patient population in relation to patients' self-reported religiosity. We hypothesized that only our more religious patients would strongly desire chaplain support for the majority of scenarios presented. We were surprised to find that a majority of our patients-regardless of their own level of religiosity-express desire for support from an outpatient healthcare chaplain when they need a listening ear, are grieving a loss, or are seeking prayer.

Henderson, K.K., Oliver, J.P., P. Hemming. (2023). Patient Religiosity and Desire for Chaplain Services in an Outpatient Primary Care Clinic. Journal Pastoral Care Counsel 77(2):81-91. https://pubmed.ncbi.nlm.nih.gov/36660791/.

Internal Medicine Resident Barriers to Advance Care Planning in the Primary Care Continuity Clinic

Background: While primary care providers regularly engage in Advance Care Planning (ACP) conversations, it is not well known what challenges resident physicians face to achieving this core competency. Objectives: We aimed to assess resident perceptions of barriers and potential interventions to outpatient ACP. Methods: We distributed an electronic survey to Internal Medicine and Medicine-Psychiatry residents at our institution in 2022. Questions addressed outpatient ACP barriers and potential interventions in several domains: structural issues, personal knowledge, and communication skills. We reported results using descriptive statistics and Wilcoxon rank-sum tests, comparing responses by residency year (interns vs upperyears). Likert-scale responses were dichotomized to a "not at all or slightly" vs "moderate or extreme" barrier or helpful intervention. Results: Of 149 residents, 71 completed the survey (48%). Highest scoring barriers were structural, including 1) lack of clinic time (99%), 2) need to prioritize other medical problems (94%), and 3) lack of patient continuity (62%). Highest scoring interventions included the ability to schedule dedicated ACP visits with themselves (96%) or another clinician (82%). Interns were statistically significantly less confident in their ability to conduct ACP, and more likely to report lack of knowledge (i.e., not understanding ACP, patient prognosis, or how to complete paperwork, P < .05). Conclusions: Residents report significant structural barriers to outpatient ACP, including limitations in time, continuity, and competing medical priorities, that may warrant greater program attention to interventions such as clinic schedules and work-flow. Additional trainings may be most beneficial if targeted to the beginning of intern year.

Dussault, N., Nickolopoulos, E., Henderson, K., Hemming, P., Cho, A., Ma, J. (2023). Internal Medicine Resident Barriers to Advance Care Planning in the Primary Care Continuity Clinic. Am J Hosp Pallit Care 40(11):1205-1211. https://pubmed.ncbi.nlm.nih.gov/36722713/.

Interprofessional Code Blue Simulations to Prepare Family Facilitators and Improve Collaboration Competencies

This learning activity used interprofessional groups of inpatient clinicians and standardized patients in a low-fidelity resuscitation simulation to train family facilitators (FF) to care for families and improve team collaboration competencies. Fifteen simulations were held in a large academic hospital over three months.

Overall, this educational approach was successful in improving interprofessional teamwork skills and increasing Chaplain’s confidence in filling the FF role. Commentary and feedback from the participants suggested that the simulation impacted their clinical practice up to 3 months afterwards. Additionally, we found that the simulation served as a social, team-building activity outside the high-pressure clinical environment, and anecdotally it was well-received as such.

Tennyson, C.D., Oliver, J.P., Jooste, K.R., Myers, J.A. (2023). Interprofessional code blue simulations to prepare family facilitators and improve collaboration competencies. Journal of Interprofessional Education and Practice 32. https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S2405452623000538?scrollTo=%23hl0000795. 

Developing a Decision Pathway for Family Presence During Resuscitation

Background: The standard of care for family presence during resuscitation (FPDR) is evolving, and leading organizations collectively recommend establishing institutional policy for its practice. Although FPDR is supported at this single institution, the process was not standardized.

Methods: An interprofessional group authored a decision pathway to standardize the care of families during inpatient code blue events at one institution. The pathway was reviewed and applied in code blue simulation events to highlight the role of the family facilitator and the importance of interprofessional teamwork skills.

Results: The decision pathway is a patient-centered algorithm that promotes safety and family autonomy. Pathway recommendations are shaped by current literature, expert consensus, and existing institutional regulations. An on-call chaplain responds to all code blue events as the family facilitator and conducts assessments and decision making per the pathway. Clinical considerations include patient prioritization, family safety, sterility, and team consensus. One year after implementation, staff felt that it positively affected patient and family care. The frequency of inpatient FPDR did not increase after implementation.

Conclusion: As a result of the decision pathway implementation, FPDR is consistently a safe and coordinated option for patients' family members.

Tennyson, C.D., Oliver, J.P., Jooste, K.R. (2023). Developing a Decision Pathway for Family Presence During Resuscitation. Dimens Crit Care Nurs 42(3):163-170. https://pubmed.ncbi.nlm.nih.gov/36996362/.

Patient Religiosity and Desire for Chaplain Services in an Outpatient Primary Care Clinic

Outpatient chaplaincy is a new specialty in healthcare, with a relative paucity of research studies exploring the need for spiritual care interventions in ambulatory settings. Over the past 3 years, our interdisciplinary team at the Duke Outpatient Clinic has piloted the extension of professional spiritual care into this hospital-based resident teaching clinic offering primary care to underserved populations in Durham, NC. In this article, we report the results of a series of surveys that we conducted at the clinic to assess patients' perceptions of chaplain services, understanding of Chaplains' roles, and desire for chaplain services in specific hypothetical scenarios. As part of this survey, we also asked patients about their personal levels of extrinsic and intrinsic religiosity using the well-validated Duke University Religion Index. Our results indicate which chaplain interventions are most desired among this patient population in relation to patients' self-reported religiosity. We hypothesized that only our more religious patients would strongly desire chaplain support for the majority of scenarios presented. We were surprised to find that a majority of our patients-regardless of their own level of religiosity-express desire for support from an outpatient healthcare chaplain when they need a listening ear, are grieving a loss, or are seeking prayer.

Henderson, K.K., Oliver, J.P., Hemming, P. (2023). Patient Religiosity and Desire for Chaplain Services in an Outpatient Primary Care Clinic. J Pastoral Care Counsel 77(2):81-91. https://pubmed.ncbi.nlm.nih.gov/36660791/.

Patients', Staff, and Providers' Factual Knowledge About Hospital Chaplains and Association with Desire for Chaplain Services

Stavig, A., Bowlby, L.A., Oliver, J.P., Henderson, K.K., Dillard, J., Nickolopoulos, E., Hemming, P. (2021). Patients', Staff, and Providers' Factual Knowledge About Hospital Chaplains and Association with Desire for Chaplain Services. J Gen Intern Med 37(3):697-699. https://pubmed.ncbi.nlm.nih.gov/33483825/.

A Descriptive Study of Chaplains' Code Blue Responses

Background: Family presence during resuscitation is the compassionate practice of allowing a patient's family to witness treatment for cardiac or respiratory arrest (code blue event) when appropriate. Offering family presence during resuscitation as an interprofessional practice is consistent with patient- and family-centered care. In many institutions, the role of family facilitator is not formalized and may be performed by various staff members. At the large academic institution of this study, the family facilitator is a member of the chaplain staff.

Objectives: To examine the frequency of family presence during code blue events and describe the role of chaplains as family facilitators.

Methods: Chaplain staff documented information about their code responses daily from January 2012 through April 2020. They documented their response time, occurrence of patient death, presence of family at the event, and services they provided. A retrospective data review was performed.

Results: Chaplains responded to 1971 code blue pages during this time frame. Family members were present at 53% of code blue events. Chaplains provided multiple services, including crisis support, compassionate presence, spiritual care, bereavement support, staff debriefing, and prayer with and for patients, families, and staff.

Conclusions: Family members are frequently present during code blue events. Chaplains are available to respond to all such events and provide a variety of immediate and longitudinal services to patients, families, and members of the health care team. Their experience in crisis management, spiritual care, and bereavement support makes them ideally suited to serve as family facilitators during resuscitation events.

Tennyson, C.D., Oliver, J.P., Jooste, K.R. (2021). A Descriptive Study of Chaplains’ Code Blue Responses. Am J Crit Care 30(6):419-425. https://pubmed.ncbi.nlm.nih.gov/34719714/.

Hope, Religiosity, and Mental Health in U.S. Veterans and Active Duty Military with PTSD Symptoms

Introduction: Many studies have linked hope with better mental health and lower risk of suicide. This is especially true in those who have experienced severe physical or emotional trauma. Religious involvement is associated with greater hope. We examine here the relationship between hope, religiosity, and mental health in a sample of Veterans and Active Duty Military (ADM) with PTSD symptoms.

Materials and methods: A cross-sectional multi-site study was conducted involving 591 Veterans and ADM from across the United States. Inclusion criteria were having served in a combat theater and the presence of PTSD symptoms. Measures of religiosity, PTSD symptoms, depression, and anxiety were administered, along with a single question assessing the level of hope on a visual analog scale from 1 to 10. Bivariate and multivariate relationships were examined, along with the moderating effects of religiosity on the relationship between hope and symptoms of PTSD, depression, and anxiety.

Results: Hope was inversely related to PTSD, depression, and anxiety symptoms (r = -0.33, -0.56, and -0.40, respectively, all p < 0.0001), but was positively related to religiosity (r = 0.32, p < 0.0001). Religiosity remained significantly related to hope (p < 0.0001) after controlling for demographics, military characteristics, as well as PTSD, depression, and anxiety symptoms, and this relationship was partly but not entirely mediated by social factors (marital status, relationship quality, community involvement). Religiosity did not, however, moderate the strong inverse relationships between hope and PTSD, depression or anxiety symptoms.

Conclusion: Hope is inversely related to PTSD, depression, and anxiety in Veterans and ADM with PTSD symptoms. Although religiosity is positively related to hope, independent of demographic, military, social, and psychological factors, it does not buffer the negative relationships between hope and PTSD, depression, or anxiety. While further research is warranted, particularly longitudinal studies capable of addressing questions about causality, providing support for the existing religious beliefs of current and former military personnel may help to enhance hope and mental health in the setting of severe combat-related trauma.

Koenig, H.G., Youssef, N.A., Smothers, Z., Oliver, J.P., Boucher, N.A., Ames, D., Volk, F., Teng, E.J., Haynes, K. (2020). Hope, Religiosity, and Mental Health in U.S. Veterans and Active Duty Military with PTSD Symptoms. Mil Med 185(1-2):97-104. https://pubmed.ncbi.nlm.nih.gov/31247101/.