Informed consent and decision making
3. Living wills and natural death acts
4. Bereavement and survivorship
5. Coping with illness in the family
6. Faith and wholeness during illness
7. Patient and family concerns during illness
Forming a health care cabinet in the church could provide a central lay focus to bring before the congregation pertinent issues. It would certainly be possible for such a group to address preventive as well as crisis issues.
A central portion of this preparatory phase is for the congregation to understand what the pastor can offer during illness and hospitalization and how the resources of the congregation may be utilized to provide added support. During illness, the pastoral role is experienced in many ways. Clarifying a hierarchy of needs is often part of an initial assessment visit. Much of this is accomplished through listening to what has led to hospitalization and how the experience has been to date. Providing basic support is essential, just being there and caring while at the same time symbolically representing the love of God. The sharing of scripture, communion (if appropriate), and prayer constitutes a sacramental ministry. On other occasions, counseling which refocuses values, assists decision making, affirms relationship is important. The congregation can benefit from discussion of the pastoral role prior to a crisis. It informs them regarding the functions of ministry and aids in removing any sense of awkwardness about the minister's visits.
Each congregation must decide how to organize itself for providing care during a member's illness. This deciding and any subsequent revisions of the plan are best accomplished prior to crisis moments. A health care council can provide scenarios to which any action plan can be theoretically applied in an effort to test out how well an organizational scheme might work. Any plan must contain both spiritual and concrete services. Prayer, for example, is a comforting notion to patients, especially when they know an entire congregation is participating. It is also useful to have persons who know that a prepared meal or mown grass will be a welcome sight. Nor will anything more quickly spoil the good intentions of a caring congregation than a patient-family who receive ten phone calls a day inquiring as to current status. One person can be appointed as the communications link. A similar role can be reserved for another person to serve as “gatekeeper” on bedside visitation. The only thing worse than a perpetually ringing phone is an endless string of visitors, all of whom expect the patient to be glad to see them, as if the event had been planned with the visitors in mind!
A recently hospitalized patient counted the number of persons entering her room each day.1 The daily average was fifty-six. This included staff as well as personal friends. Nevertheless, think of how you would respond to having even two unscheduled visitors to your home on a day when you felt great.
Obviously a careful balance is required, lest the patient feel abandoned or forgotten. Some churches divide members into networks to provide support. This model allows for a rotating coordinator who can delegate responsibilities.
The pastor's preparation is also ongoing. An excellent approach, perhaps the best, is an opportunity to be a part of a Clinical Pastoral Education program.2 If C.P.E. is unavailable to you, there are other ways to grow as a helping person during life crises. A senior minister who is willing to be a mentor, such as was mentioned in the introduction, is one alternative. More formal structures might involve contracting with a chaplain, pastoral counselor, social worker, psychiatric nurse, marriage and family therapist, mental health professional, psychologist, or other persons trained in counseling, to periodically review your interpersonal interactions with parishioners. Special workshops are available, usually for a nominal registration fee, as are books written to enhance understanding from the pastor's perspective. The important thing is to view yourself as being in the process of learning, to have a learning plan, and to enlist the support of your congregation in supporting your efforts, with both time and budget. It is easy to demonstrate that every professional caregiver group has requirements for continuing education.
In addition to preparation, the second aspect of implementing the pastoral role is the act of initiative. In normal parish life, the minister is often needful of opportunities for either anonymity or temporary relief from being “on duty.” The positive side of this constant spotlight is that s/he doesn't have to spend any significant time contesting the role. Entering the hospital, however, is yet another matter. At worst, it is as if all the status and recognition in the parish gets left at the hospital information desk. In the minister's accustomed place stands the physician. Consequently, initiative is called for in a unique way to assume the role as pastor. The responsibility is always there to define who you are, what you are doing, and to be persuasive enough to enlist hospital staff's cooperation. This is not comfortable, although it is a challenge. The inadequate solution is to capitulate to an awkward system in the name of a busy schedule, slip into the patient's room, pray, and then leave. Initiative, however, can lead to a team membership and is to be equated with assertiveness, not aggressive behavior, though it may on occasion feel like the latter. In hospitals where chaplains are employed or where a C.P.E. program exists, some of this ground may have been plowed for you. If not, perhaps the local Ministerial Association can devise a project to improve working relationships between ministers and hospitals.
The provision of pastoral care, the third dimension of role enactment, is the most difficult to discuss. Perhaps the best contribution which a book such as this can make is to frame several crucial issues in providing care. It is not uncommon for ministers to be impressed to the point of intimidation at how concrete and measurable are the tasks performed by most health professionals. In an effort to compensate, I have seen pastors become activists in hospital visitation, expressing anxiety through attempts at humor, taking the patient's dirty laundry home to be washed, or going to the gift shop to purchase a newspaper. These activities generally suggest a lack of clarity in pastoral identity, heightened somewhat by the loss of status and the skilled tasks performed by others. Simply being there as a concerned, caring person does not feel adequate. But it often is.
Few people enter the patient's room with the task of sitting and listening to them. Yet feelings and concerns, values, self-image, and faith issues are a storm inside, needing to be shared. This is the strength of the pastoral role—to be able to sit and listen with understanding. The patient needs to feel blessed by feeling enough worth that someone would be concerned to hear what the illness experience is like. Self-worth that is normally defined by doing or productivity is unavailable to the patient. Discovering worth in simply being is elusive, until you have the experience of being listened to, with its attendant emotions of being accepted and forgiven.
This skill of listening is hard work, because when done well, the ear is informed by good counseling skills, relevant knowledge, and the wisdom of faith. It is a most active process. At the end of the day, however, the minister cannot count incisions, stiches, or medicines prescribed to measure worth. Being clear about the pastoral role is crucial to the enactment of it, particularly during crisis experiences.
Understanding the Organization of the Hospital
The hospital exists in order to provide care for ill persons who cannot be treated on an ambulatory or outpatient basis. A few services, such as the various clinics and departments like radiology, will serve both outpatients and inpatients. Within the institution, one researcher has estimated that over 230 different professional disciplines provide direct or indirect services to patients.3 Some of these disciplines will have personal contact with the patient while others will play a crucial role but never see or even know the patient's name. The physician's diagnosis, for example, was probably confirmed by a lab technologist who also tested for the drug producing the most beneficial response. Yet the patient will not likely know of this person who played such an important role in treatment.
