Pastoral Care in Hospitals

Second Edition

Neville A. Kirkwood

• Publisher: Morehouse Publishing
• Year: 2005
• ISBN:
  9780819226365
• Topic: Theology & Religion
• Subtopic: Christian Ministry

Bringing comfort and concern to the bedside of the sick or dying is a challenge for lay people and clergy alike. In this practical guide, Neville Kirkwood shares his wisdom–gleaned from some twenty years of experience as a hospital chaplain–on the art of hospital visitation. This classic handbook is now updated, with an all-new section addressing best practices for hospital chaplains. Pastoral Care in Hospitals, with additional sections addressed to clergy and trained lay pastoral workers, as well as ordinary lay people who simply want to visit their fellow-parishioners, shows visitors ways to make the encounter meaningful and enriching to the patient. Kirkwood guides readers through the minefield of hospital visits–from false heartiness to too much talking–and offers a theology of visitation that can guide both professionals and laity in their ministry. A variety of exercises and a section of prayers for specific circumstances make this a must-have resource for all who work with the sick and dying, and an excellent text for course work.

SECTION 1

For Hospital
Visitors

CHAPTER 1

Off to Hospital

So you are going to visit a patient in hospital? Before you go you should know the reason that prompts you to make the decision to go. The simple question to ask before you make any move is “Why am I going?” That perhaps sounds ridiculous. It is not. The motive for your visit is a gauge against which the value of your visit will be measured. Your reason for visiting will be reflected in your attitude to the patient, and in most cases that attitude will be obvious to the patient. Too often our decision is reached without any thought of how or why the visit is being made.

Too many visitors may have an adverse effect on the progress of a patient in hospital, as well as the nature of the visit. As those who move among patients daily, chaplains and staff frequently hear expressions of relief that a visitor or visitors have at last gone. Patients are sometimes more exhausted and weak on a Monday morning after a weekend of visitors. There are also the occasions when a patient becomes very depressed following the visit of a pastoral person who speaks inappropriately.

After visits by two clergymen to different terminally ill patients, the relatives present at the time of each minister's call requested that those visitors not be allowed near the patient again. On both occasions the reading of the twenty-third Psalm, and in particular the verse that refers to the “valley of the shadow of death,” caused concern and distress. In one it was the spouse who was not able to cope with the reality of the situation.

One must assume that in both cases the visitors went with the purpose of preparing the patient to face death. They had a purpose, a motive and most probably had thought out their agenda for the visit. However, it proved not only ineffective but also harmful.

WHY AM I GOING?

Questionable motives

There will be many surprises if this question is faced honestly. The reasons for hospital visitation will vary and we shall see that many are of dubious character.

Out of duty

As a relative, friend or pastoral care visitor, the reason for going to the hospital springs so often out of a sense of obligation. The fulfillment of that sense of duty hopefully will make the patient happy. Is this a trap we fall into? Are we visiting in order to be released from the guilt of unperformed responsibility? All this has a ring of selfishness about it. It is satisfying our ego. Duty can help fulfill our desire to be needed and our sense of being a martyr for the cause. It promotes the concept, which we desire other people to have of us, of always being busy doing good.

Doing our job helps maintain the reputation and name we are building for ourselves. The greater the inconvenience, the greater the expected acclaim. The duty visit lacks the vital component of pastoral care: spiritual sensitivity.

The mantle's accepted

Appointed as an official hospital visitor the person assumes a certain performance framework. Lay pastoral care workers and clergy frequently fall into this trap.

A parishioner is in hospital so a visit must be made to fly the flag. In doing so, an official church visitor presumes a certain expectation by the church to perform particular functions, such as reading the Bible and praying. As I will show later, these may be inappropriate at that particular stage of the patient's hospitalization.

The mantle that has been assumed is likely to color the method of approaching the bedside. Naturalness and spontaneity are sometimes forsaken in order to fit the role.

Role modeling as a parish visitor often presumes that religion will be raised during the visit. Such a preconception, particularly if you know little about the patient, is as subtle as pushing a bull into a china shop to catch the attention of the proprietor.

To cheer up the patient

It must be remembered that persons under treatment in hospital are not physically well. Their whole person, body, mind and spirit in most cases, is affected by the illness or treatment. This means that they tire easily. Rest and sleep are two of the greatest components of the recuperative process.

A patient was three days out of major surgery. A good friend, a renowned pastoral visitor, came along armed with a small projector and slides of a recent holiday with the intention of providing something of interest to take the patient's mind off the pain. To entertain? To cheer up? The patient was in agony, heightened through the effort of trying to concentrate and not appear rude by nodding off for the much-needed rest. The visit lasted three hours. One wonders how many lengthy entertainment visits were made to other patients who were less understanding.

Out of curiosity or competition

Hospitals and illness hold an unusual fascination for some people. They seem to have an obsession with patients’ symptoms and treatments. For this reason such people are eager to become hospital visitors.

Other folk love to know what is going on in the families of the community. The church calls for prayer for those in hospital. It is a topic for conversation. To have visited the patient in hospital is to have first-hand information and the bearer of such information becomes the center of news—that may be presented as data sincerely conveyed for the purposes of prayer. The visit and the visitor become the source for the church bulletin news flash!

Both these compulsions give rise to visits that are of little value because they are made out of curiosity, to satisfy a personal need: the need to be the center of news or attention, to be thought of as selfless and caring, to be near suffering, pain or even death, or just to be in the know as to what is going on. Such visits seldom bring support, comfort or strength to the patient.

A successful and respected pastoral carer was the envy of another person, who increased visits to a particular patient in order to outdo the first visitor. The patient knew exactly what was going on and when the jealous visitor's calls became a source of anxiety and a burden, she conveyed her feelings to the carer she valued. To spare her the strain of too many visits, and because he detested competition in Christian service, this pastoral worker cut down on his own calls. In this case, the loser was the patient.

A visit to a patient in hospital must be offered in deepest sincerity and with a genuine desire to provide positive pastoral care. Curiosity and competition are evils that have no place in the context of hospital care.

CHAPTER 2

Visiting the Patient

QUESTIONS VISITORS NEED TO
ASK THEMSELVES

Does the patient need a visit?

One hospital I know has a very strict protocol concerning visitors to patients in intensive care. Only members of the immediate family and only one member of the clergy associated with the patient's church are allowed to the bedside. The chaplain of the intensive care unit has the responsibility to verify the identity of that priest, minister or rabbi. This policy had to be brought in because a patient from a family well known in religious circles had numbers of clergy popping in and causing confusion.

The wisdom of your visit at a particular time has to be considered in the light of the best interests of the patient. One patient may be too weak to see you and may need all the rest possible. Another patient may have sufficient people offering pastoral care. Remember, visitors may often unnecessarily tire and exhaust patients. At the height of the crisis you may encroach on the privacy that the family and patient require.

If your visit coincides with a patient's grief and hostility against God, your presence may increase that hostility. Your words and pious offer of prayer may do irrevocable damage, closing off all future opportunities for pastoral care. It may be the last straw that results in a total and final rejection of God. You must ask yourself seriously, “Does the patient need my visit just now or at any time?” The timing of a visit before or after surgery demands your consideration. Visits, unless there are special reasons, should be avoided until a few days after surgery. Sometimes a presurgery visit assuring prayerful support is appreciated, but at other times it may not bring any comfort. Many deeply religious and active members in the church have said that they have not told their minister or priest about hospitalization because other parishioners might then overwhelm their quiet. A private person may desire to share such an anxious time with the family only.

Would my visit be appropriate? Do your homework. Do not take it for granted.

Am I the appropriate pastoral person?

A patient had been transferred from a country hospital to the city by air ambulance. The patient's minister had contacted me, giving details of the family's journey and expected time of arrival by road. In the meantime, an aunt's city minister of another denomination appeared in the intensive care unit and gave an entirely different version of the family's movements to the nurses. That threw the staff into confusion. The fact was that the aunt's minister had it wrong. This type of situation can arise when inappropriate visits are made by pastoral visitors.

The city minister had not ascertained all the facts. While he must be commended for responding to the call, he failed to find out whether the patient had church connections, what they were, what the immediate family wished. He did not seek out the chaplains at the hospital for possible assistance, advice and information on the patient. It turned out that he was not the appropriate person to be involved at that time.

Even when someone is a member of the local parish, she or he may not be the ideal person to provide the most significant contribution. One church elder has a real commitment to the care and support of many people both within and without the church. Her contribution is valuable as an elder. She has a strong personality, is a good organizer, and knows what a person needs. When it comes to hospital visitation, however, patients are often overwhelmed by her presence. Her kindly nature wants to mother and organize both patient and family. Sometimes that is good but not always.

Know your own strengths and weaknesses as a pastoral person. Endeavor to know and understand whether your gifts can be used with this case or whether an approach would be considered an unhelpful intrusion.

A willingness to accept that we cannot minister to all people is a major criterion for a good pastoral care person. With that principle established, it should be an automatic self-posed question: “Am I the most appropriate one to make this visit to this person or family?”

THE VISIT IS TO THE PATIENT

Having decided that you should make the visit, the next factor to concentrate upon is that the visit is to the patient and for the patient.

It is a truism that hospital patients are a captive audience. They are confined to bed. They have no means of escaping from visitors. Evangelical concern for the spiritual welfare of the patient often places expectations upon the carer to say the magical words that will produce a desired spiritual decision. This can translate into pressure on a “trapped” patient.

Every chaplain is called numerous times a year with “Will you visit Mr. X?…He is in your hospital seriously ill. I don't know whether he is a practicing Christian or not. Would you visit him and lead him to the Lord?”

It is such a common request. The chaplain usually replies, “I will see what the situation is and will act appropriately.” More often than not, the raising of religious issues would have provoked strong negative reactions in the patient.

On one occasion I was asked to see a terminally ill retired postmaster on the terms just outlined. His two sisters were present. The whole conversation centered around his far-from-religious activities. It was one of his few lucid days. His sisters were taking advantage of it and were also receiving much comfort. It would have been most inadvisable to press eternal issues. After weeks of confusion and irrationality, he was reveling in reminiscing with his sisters. It was a memorable, comforting and happy time for all present—the last time they were to have communication with him in conversation.

Patients are very vulnerable to their spiritual needs at such times and are susceptible to any suggestions. Coercion, manipulation and, occasionally, dishonest methods are used by pastoral visitors to obtain decisions and promises about which the patient has little understanding. Often patients are in a state of mind that is not receptive to theological pronouncements on spiritual matters.

Some so-called deathbed conversions are assents to pressure tactics. Affirmations are sometimes made to relieve the pressure and make the pastoral visitor happy. Patients have admitted “anything to shut them up.” That is not pastoral care. A caring relationship is not built this way. The many who have come into a deeper and closer relationship with God through the bedside ministry have usually done so after bridges have been built.

If the aim of your visit is to build a caring relationship, then your visit must be to and for the patient. You are wholly concerned with the easing of his or her burden in the Spirit of Jesus. (See chapter 10, “Jesus—A Theological Model.”)

MAKE IT COMFORTABLE

For any relationship...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Foreword
• Prologue
• Introduction to the Second Edition
• Introduction
• Section 1—For Hospital Visitors
• Section 2—For Lay Pastoral Workers
• Section 3—For Clergy Visiting Hospitals
• Section 4—For the Hospital Chaplain
• Epilogue
• Bibliography