A body of evidence is developing that describes harmful effects of religious struggle that includes struggle with the divine (e.g. feeling abandoned or punished by God). We examined the prevalence and correlates of divine struggle among 540 Swiss hospital patients. Some divine struggle was reported by 46 percent of the sample. Unexpected hospital admission and scores on a measure of faith were associated with a greater likelihood of reporting any divine struggle. Higher levels of anxiety and depression were also associated with divine struggle. Screening for divine struggle or other forms of religious struggle will permit, where indicated, appropriate religious assessment and care to mitigate the harmful effects that may accompany religious struggle.

To determine in which situations head nurses refer patients to health care chaplains and to detect significant influential factors, 192 head nurses from 117 health care institutions in the German part of Switzerland were surveyed with regard to situations in which they refer to a chaplain. On average, head nurses refer "often" to a chaplain in their daily work in situations where patients are dying or need religious-spiritual service or support, but they refer only "rarely" to a chaplain in situations where patients or their families express negative feelings or where other psychosocial needs are present. Moreover, the religiosity of head nurses, working in a general acute care hospital and a positive evaluation of the chaplaincy services determine significantly whether a head nurse calls for a chaplain in a particular situation or not. For quality improvement of chaplains' work, health care chaplains have to integrate themselves into the care team. On the contrary, standardized referral processes between chaplains and nurses as well as physicians have to be elaborated to reduce subjective factors (eg, the religiosity of the nurse) from the process of referring.

Identifying patients' expectations of and need for healthcare chaplaincy is important in terms of appropriate intervention. Therefore, a sample of 612 patients from 32 general hospitals and psychiatric clinics in the German part of Switzerland was surveyed about their expectations of chaplaincy service. A principal component factor analysis of participants' ratings found that the survey items fell into three distinct categories. These were the need for (1) emotional support, (2) help to cope with illness/disease, and (3) religious/spiritual assistance. Among the expectations, the need for emotional support was rated most important, followed by help to cope and, lastly, religious/spiritual assistance. Gender, religious denomination, general religiosity, and subjective health status significantly influenced these expectations. The results showed that fulfilling patients' expectations increases their overall satisfaction with, and the importance they accord to the chaplain's visit, as well as their confidence in the chaplain.

In recent years, much research work has been done in the field of religion/spirituality and healthcare. Many chaplains are wary of doing research because they assume it is cumbersome or potentially deleterious to ill patients. The aim of the present pilot study is, therefore, to find out if research on quality improvement of healthcare chaplaincy is emotionally distressing for patients. In connection with a questionnaire about quality improvement proceeding of healthcare chaplaincy, patients were asked subsequently to assess whether the completion of the questionnaire was emotionally distressing for them. A total of 91.89% of the 37 respondents said that the completion of the questionnaire was not or only slightly emotionally distressing for them. Furthermore, analyses for significant differences showed no effect, except for a significant association with the anxiety scale. Findings from this study suggest that participants found no objective reasons not to do research in healthcare chaplaincy.