Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, 3083, Australia.
Australian Institute of Ethics and Society, University of Notre Dame, Sydney, Australia.
J Relig Health. 2023 Dec;62(6):4032-4071. doi: 10.1007/s10943-023-01930-4. Epub 2023 Oct 27.
This paper describes the development and initial chaplaincy user evaluation of 'Pastoral Narrative Disclosure' (PND) as a rehabilitation strategy developed for chaplains to address moral injury among veterans. PND is an empirically informed and integrated intervention comprising eight stages of pastoral counselling, guidance and education that was developed by combining two previously existing therapeutic techniques, namely Litz et al's (2017) 'Adaptive Disclosure' and 'Confessional Practice' (Joob & Kettunen, 2013). The development and results of PND can be categorized into five phases. Phase 1: PND Strategy Formation-based upon extensive international research demonstrating that MI is a complex bio-psycho-social-spiritual syndrome with symptoms sufficiently distinct from post-traumatic stress disorder. The review also provided evidence of the importance of chaplains being involved in moral injury rehabilitation. Phase II: Development and Implementation of 'Moral Injury Skills Training' (MIST)-which involved the majority of available Australian Defence Force (ADF) Chaplains (n = 242/255: 94.9%) completing a basic 'Introduction to Moral Injury' (MIST-1) as well as an 'Introduction to PND' (MIST-2). Phase III: MIST-3-PND-Pilot evaluation-involved a representative chaplaincy cohort (n = 13) undergoing the PND eight-stage strategy to ensure the integrity and quality of PND from a chaplaincy perspective prior to wider implementation. The pilot PND evaluation indicated a favourable satisfaction rating (n = 11/13: 84.6%; M = 4.73/5.0 satisfaction). Phase IV: MIST-3-PND Implementation-involved a larger cohort of ADF Chaplaincy participants (n = 210) completing a revised and finalized PND strategy which was regarded favourably by the majority of ADF Chaplains (n = 201/210: 95.7%; M = 4.73/5.0 satisfaction). Phase V: Summation. In conclusion the positive satisfaction ratings by a significant number of ADF chaplaincy personnel completing MIST-3-PND, provided evidence that chaplains evaluated PND as a suitable counselling, guidance and education strategy, which affirmed its utilisation and justifies further research for using PND to address MI among veterans, that may also prove valuable for other chaplains working in community health and first responder contexts.
本文描述了“牧师叙事披露”（Pastoral Narrative Disclosure，PND）的开发和初步牧师用户评估，这是一种为牧师开发的康复策略，用于解决退伍军人中的道德伤害问题。PND 是一种基于经验的综合干预措施，包括八个阶段的牧师咨询、指导和教育，是通过结合两种先前存在的治疗技术开发的，即 Litz 等人（2017 年）的“适应性披露”和“忏悔实践”（Joob 和 Kettunen，2013 年）。PND 的开发和结果可以分为五个阶段。第 1 阶段：PND 策略形成——基于广泛的国际研究，这些研究表明，MI 是一种复杂的生物-心理-社会-精神综合征，其症状与创伤后应激障碍有足够的区别。该综述还提供了证据表明，牧师参与道德伤害康复非常重要。第 2 阶段：“道德伤害技能培训”（Moral Injury Skills Training，MIST）的开发和实施——涉及大多数澳大利亚国防军（Australian Defence Force，ADF）牧师（n=242/255：94.9%）完成了一项基本的“道德伤害简介”（MIST-1）以及一项“PND 简介”（MIST-2）。第 3 阶段：MIST-3-PND-试点评估——涉及一个代表性的牧师群体（n=13），他们经历了 PND 的八个阶段策略，以确保从牧师的角度来看，PND 的完整性和质量，然后再广泛实施。试点 PND 评估表明，满意度评分较高（n=11/13：84.6%；M=4.73/5.0 满意度）。第 4 阶段：MIST-3-PND 实施——涉及更大的 ADF 牧师群体（n=210），他们完成了修订后的最终 PND 策略，大多数 ADF 牧师对此表示满意（n=201/210：95.7%；M=4.73/5.0 满意度）。第 5 阶段：总结。总之，大量 ADF 牧师人员完成 MIST-3-PND 后给出的积极满意度评分表明，牧师评估 PND 是一种合适的咨询、指导和教育策略，这肯定了它的使用，并为使用 PND 来解决退伍军人中的 MI 提供了进一步的研究依据，这也可能对其他在社区卫生和第一反应者环境中工作的牧师有价值。
