"From Hurting to Healing" - Pastoral Care at Newark Central

“From Hurting to Healing”

Pastoral Care at Newark Central

Pastoral care is a form of ministry that can be described in three parts:

Presence

Prayer

Practical support

Those three elements sum up most of what is called for when we are asked to provide pastoral care as a church family.

When there is a death, an unexpected diagnosis, an accident, a personal or family crisis, or any other event where people are suddenly jolted out of their usual life activities – or when someone is placed in a situation that takes them out of the everyday round and keeps them there, whether in a hospital, a care facility, or in jail: that’s when we look to provide pastoral care as a church.

For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me.’

Then the righteous will answer him, saying, ‘Lord, when did we see you hungry and feed you, or thirsty and give you drink? And when did we see you a stranger and welcome you, or naked and clothe you? And when did we see you sick or in prison and visit you?’

And the King will answer them, ‘Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.’

~ Matthew 25:35-40 (ESV)

Presence

A ministry of presence sounds like the smallest and most insignificant part of pastoral care, but that could not be further from the truth.

Often, in a time of crisis, when someone is ill or coming out of surgery, or when disturbing news has come into a home, the details of the events and certainly the words spoken are not remembered. But the fact that you were there means everything.

Many times, people think it might be better not to show up and possibly say the wrong thing, and stay away. It can be awkward to stand in the presence of tragedy and tears, and often there will be little you can say or do.

But you can’t go far wrong by saying “I am so very sorry,” and by listening. You may also end up needing to say “I don’t know,” but those words carry more comfort than you might think: especially when they’re followed by more listening.

Presence

A touch, a handshake, a hug can all be important. Reading body language is a form of listening – some people really need a hug, and some people are not wanting contact in a crisis. It is wise to hold yourself back if you’re not certain. An excess of caution will serve you better than too much intrusion into personal space!

You need to ask yourself what you’re comfortable with, and how you can handle standing versus sitting in different contexts. It is almost the only absolute rule in pastoral care: don’t sit on the bed. Hospital beds often have hidden equipment under the sheets, and many are rigged to warnings about the patient that you can trigger. Nursing home beds have some of the same issues, and in all such cases, even in homes – you don’t always know where that foot actually is under the blankets! Don’t sit on the bed.

Presence

After a greeting – and if the person doesn’t know you well, you’ll want to start by saying something like “I’m Jeff Gill from the church, and we wanted to see how you were” – you’ll probably move right into listening!

Sometimes, the atmosphere is different. Whether through weariness or confusion, silence may follow. It’s never out of order to say “I can come back later if that’s better for you.” Sometimes, people are not wanting company, and that should be respected. And sometimes, medications or having just been through a medical round leaves people either disoriented, or just responding VERY slowly.

Patience is a virtue!

If there is a convenient chair, that’s fine, but try to avoid too much furniture moving; also, be aware of how where you sit forces the patient to turn their head or shift their body…or where the light is coming in.

Presence

“How are you?”

That question can take you almost anywhere: go where they are going.

Remember: your job is not to diagnose, not to lay out a treatment plan, not to prescribe!

Monitor your own responses: obviously, you’d prefer not to respond with shock or horror to news, but sympathy is the key.

By the same token: don’t offer certainties you can’t promise. It doesn’t help as much as you think.

Sometimes you have to redirect a conversation, but always ask yourself: am I changing the subject for them, or for me?

Presence

Anyone who has ever visited anyone knows the trickiest part can be leaving.

Sometimes it helps to state early on “I’m just dropping by” or “I’m on my way to…” when you know this might be an issue. It can end up being resaid by the person you’re visiting at just the right time!

A pastor I knew early on told me “Always carry a coat when visiting at the hospital.” I asked why, and was told “Because you keep it over your arm as a signal you’re not staying, and you can start to put it on to show you’re leaving.” I never took that advice, but I’ve had times when I thought “I wish I had a coat” when trying to leave a room for the third time…

Don’t say when you’re coming back unless you know you’re quite certain you will!

Prayer

Prayer is often the last thing in a pastoral call, and it can be a fitting wrap-up of the visit. You are bringing God into the conversation more directly, summing up and offering up what is of concern, what is hoped for, what is feared.

It is appropriate to ask “Would you like me to pray with you?” There are occasions when the answer is no. The reasons are many, but the only respectful response is “that’s fine.” You may pray all the more yourself as you walk away, but never force someone to pray with you.

The usual reply is “Oh, YES.”

Prayer

In a pastoral call, some form of contact in prayer is usual. It is not always possible, but not necessary, either. The medical rule comes to mind from the doctors’ Hippocratic Oath:

“First, do no harm.”

If you cannot hold a hand, you may be able to place one on a shoulder, or gently atop the hand, being careful of IVs and tubes. If there are others present, holding hands is good, a circle is meaningful, but at times someone may not want to join hands – that’s fine. Usually it is.

(If you touch a patient, it is not rude to use hand sanitizer afterwards. In fact, it is appreciated. And recommended. Frankly, touch as little in a hospital room as possible other than holding a hand.)

Prayer

Like any other art, prayer as spoken becomes more fluent and comfortable with practice.

Just do it.

Your own spiritual health is reflected in your spoken prayers. Sometimes, you may find yourself needing to pray out loud when you are feeling ill or ill at ease yourself. It is perfectly appropriate to have some printed, prepared material somewhere that you can put your hands on when that moment comes. And it can come for anyone!

Prayer

As you are getting more accustomed to spoken prayer, there are some tools for supporting your own prayers: one is the acronym “ACTS.”

A  --  adoration

C  --  confession

T  --  thanksgiving

S  --  supplication

The Bible also includes over 200 prayers:

The Lord’s Prayer – Matthew 6:5-15

David’s Prayer for Pardon – Psalm 51

Moses Praying for the People – Exodus 32:9-14

Paul’s Prayer for the Ephesians – Ephesians 1:15-23; 3:14-21

Prayer

We pray for healing, we pray for peace.

When you find yourself referring to God in a prayer – you’re not praying. You’re commenting! (Or preaching, even worse.)

We pray in and with and for God’s will. (Luke 22:39-46)

We can pray for specific requests; we ask, and asking, we trust.

We pray in specific circumstances and places. Grounding our prayers in those details can give our prayer together a lasting resonance. Name the place, the people, speak to what is going on when you can – “Lord, as Jeff fears the MRI so much, we ask for a double measure of peace and calm tomorrow as this test is done.”

Prayer

Often, prayer is the last part of a pastoral care visit. Sometimes, when you’re checking in with someone in pre-op, you may pray first in case the medical team comes for the patient before you’ve done so. In the overwhelming majority of cases, the nurses and/or transportation team will wait, but don’t abuse that kindness!

Sometimes, as you finish, the person visited (patient, resident) or someone else will pick up from where you left off. This is almost always a blessing – be aware that they may or may not “end” but will wait for you as the pastoral care provider to close the group prayer. Don’t worry about it too much: you’ll be able to tell.

Prayer

Therefore, confess your sins to one another and pray for one another,

that you may be healed.

The prayer of a righteous person has great power as it is working.

~ James 5:16 (ESV)

Prayer

You may find yourself in the humbling and overwhelming position of needing to pray a “prayer of release.” When the patient has just died, when all is winding down and it is very clear these are the last few minutes, you may be asked “can you pray with us as we let them go?”

A “prayer of release” is simply a handing over of the person into God’s loving care. It includes an acknowledgment that we, on Earth, find it hard, but in this hour we place our loved one and our trust in Heaven.

If you are asked to do this, let me promise you that you cannot do it wrong. And there is a peace when it is done.

Prayer

When you are leaving the room or bedside in the more usual occasions of concluding a prayer, it is best to ask if it is okay to ask the church to be notified. Sometimes, people are very happy you came, but they do not want the congregation in general notified or asked to pray. It’s important to have clarity on that before you leave.

On departure, let them know that YOU will keep praying for them yourself, regardless of the public or private issues you’ve resolved with them.

And…just do it!

Practical support

Let me be very clear: one of the most effective, powerful, transformative acts of pastoral care this congregation performs is the regular offering of meals following funeral services. To provide “Christian service” as it’s still called by some IS pastoral care, wonderfully so.

In the course of a pastoral care visit, or as you are leaving, the question can come up from you: “Is there anything I can do to help you?”

The most frequent response is nothing, and that’s often true. How to press the issue if you know or suspect some assistance is needed is a tricky question.

But you will very often hear a simple, practical request. It might be an errand, a small item, or just refilling the water pitcher before you leave. At Newark Central we are blessed to be able to offer the support of the Medical Loan Closet, as well.

Practical support

Whatever it is, don’t say you will do it unless you’re very sure you will be able to follow through on it.

If the request involves others, or is too large a matter for you to handle comfortably, tell them “I will check into that for you.”

If you have not seen it, a great perspective on pastoral care in general, and practical support in particular, is the movie “The Trip to Bountiful.”

Be still, and know that I am God.

~ Psalm 46:10

Silence is possibly the hardest part of pastoral care to master.

This is one way that the over-identification of pastoral care with preachers can present a problem. In fact, every silence is not just waiting for the right word.

Our culture is a noisy one, and it continually adds a soundtrack to everyday life, from elevators to dentist’s offices to our earbuds walking down the street.

For many, turning off the TV does not come easily, and the first act on entering a room is to turn one on.

To affirm and celebrate and be comfortable in silence is, in fact, a very counter-cultural act. It is also central to our Christian faith & practice.

(Mt. 13:53, 15:21, 26:36; John 6:1, Luke 4:1-2)

Body language

How close to stand or sit, when to lean over, even whether you fold your arms or put your hands in your pockets – the truth is, when you are making a visit for the purposes of pastoral care, every action and expression you display are seen in a different light. They are interpreted according to what the person being visited and cared for is hoping for, fearing, or anxious about.

Self-awareness and self-knowledge are so very important in dealing with a pastoral care meeting. Each of us has “hot buttons,” or sensitivities that can vary from person to person. And those can be more sensitive when we are tired or worn down ourselves; we may control our voices, but our bodies can speak volumes.

Be aware of male-female issues, size and physical presence, the shape of the room and arrangement of it, and always the physical limitations of the person being cared for.

Triage – a pastor’s view

ICU / ER / ED

Surgery - pre/post

Hospice – active, in patient

Hospitalization

Newly in care - nursing home, rehab, home

Hospice - ongoing

Ongoing residential rehab

Ongoing nursing home

Ongoing home bound

Visitors

Requests for home visit

Check-ins after absence/questions

General calling

-      scheduled

-      unscheduled

The Gaza Road

Now an angel of the Lord said to Philip, “Rise and go toward the south to the road that goes down from Jerusalem to Gaza.” This is a desert place. And he rose and went. And there was an Ethiopian, a eunuch, a court official of Candace, queen of the Ethiopians, who was in charge of all her treasure. He had come to Jerusalem to worship and was returning, seated in his chariot, and he was reading the prophet Isaiah. And the Spirit said to Philip, “Go over and join this chariot.” So Philip ran to him and heard him reading Isaiah the prophet and asked, “Do you understand what you are reading?” And he said, “How can I, unless someone guides me?” And he invited Philip to come up and sit with him.

Now the passage of the Scripture that he was reading was this:

“Like a sheep he was led to the slaughter and like a lamb before its shearer is silent, so he opens not his mouth.”

   ~ Acts 8:26-32 (ESV)

ICU / ER / ED

In the Intensive Care Unit or the Emergency Room / Department, the first rule is very simple.

Do not touch anything.

This can often include the patient.

You may or may not be able to pray directly with the patient; you are praying through your presence on behalf of the church, you will be praying where you stand.

It is not unusual to stand your entire time in an ICU or ED; be ready for that. If you cannot stand in one place for more than a few minutes, you may want to find someone else to do this pastoral care.

Take your cues from the staff; don’t be offended if they ask you to leave the room for procedures or exams. Do not ask staff to wait until you do something you (or the patient) would like to do, prayer or otherwise.

Surgery - pre/post

The usual cycle here goes like this:

Patient arrival

Patient goes, alone, back for prep

Family/pastoral care invited back to pre-op*

Patient leaves for surgery

Family/pastoral care wait in waiting area,

      may be a good time to go to cafeteria, etc.

Notice (electronic, video monitor, staff)

Post-op meeting room

Doctor/surgeon arrival, explanation*

More waiting

Family/pastoral care can go to post-op

Patient moved to regular hospital room, or

      Sent home!

*These are points to try to identify & prioritize.

Some families prefer to “wait” alone, others like company & conversation: use judgment!

Hospice – active, in patient

Hospice units are often, to the surprise of those not used to them, very happy places.

That’s okay. In fact, that’s good. Roll with it!

All the rules are different here. It’s the one place in a hospital or care center where you might just sit on the bed.

If you have ANY questions, just ask the staff. The focus and needs on a hospice unit are different than the rest of a facility, and you will feel that quickly.

In a hospice unit, if you pray out loud with a patient and/or the family, you may be asked by a nearby family if you would pray with them. It happens often.

Hospitalization

Always check the room number at visitor information if they’re present (or often there’s a courtesy phone). In today’s hospital, rooms are changed and dismissals come like a flash!

Roommates are less common than they once were; including them with prayers is always fine, but you should probably wait to be asked. Remember, you get to leave, but your patient has to stay with that roommate when you’re gone.

If a meal gets delivered while you’re making a visit, say grace and leave! If they offer you some of their food, don’t…meals are very much part of the treatment plan, and your involvement complicates the picture.

Always be gracious with staff interruptions, even (especially) when they aren’t.

Newly in care - nursing home, rehab, home

Getting a confirmation of a room number can be trickier in many nursing homes. It’s worth checking; be aware that more places are removing names from doors, as well.

Your opportunity and privilege is to help, in some small way, to bless and make “home” a strange new place. The shock and dislocation that can follow arrival in a care facility is very real, and listening to what is missed and what is lost can be heartbreaking. Prayer in the room with that person starts a necessary process of reconciliation with the new surroundings and needs.

You may well pray with them for a return to familiar surroundings. It is well to also weave in some prayerful words about our true home not being on Earth, but in Heaven, and that we all are on a pilgrim’s journey through this life.

Funeral calling hours

When a family first arrives at a funeral home, not having seen the body yet, it can help to have someone present with them for that moment. It can be difficult for some, overwhelming for others. It is a practical matter that you want to watch for people who are about to collapse when near the casket. Pulling up a chair, or calling over another sturdy looking person, along with being ready to steady the one being overcome in the moment, are all possible responses. If someone faints, you are not trying to hold them up as much as you are trying to guide them to the floor, without letting their head hit it.

This doesn’t happen often. Most often, you are a silent presence, responding as asked. You are not under any expectation to comment on the quality of the work by the funeral home, or arrange clothing. Getting water, tissues, or chairs are an act of pastoral care themselves. A family prayer before callers start entering can be helpful, but not with all families.

Give justice to the weak and the fatherless;

maintain the right of the afflicted

and the destitute.

Rescue the weak and the needy;

deliver them from the hand of the wicked.

~ Psalm 82:3-4 (ESV)

Ministering to Persons with Dementia

                                          and their families

(taken from materials presented at Licking Memorial Hospital, Apr. 9, 2015)

Defining Dementia

+ It is not a specific disease, it is a collection of symptoms

+ Caused by a number of disorders affecting the brain

+ Affects memory, problem solving, language skills, reasoning & judgment

+ Can cause personality changes, agitation, delusions, and hallucinations

+ Most forms of dementia are progressive, and life-limiting or terminal

Dementia Myths

+  Dementia only occurs in the elderly

+  Dementia symptoms are a normal sign of aging

+  Relatives of someone with dementia will themselves likely develop dementia

+  Dementia does not lead to a person’s death

Stages of Dementia

+  Early symptoms

- Forgetfulness: Unable to drive a familiar route home

-      Personality changes

+  Moderate disease

-      Needs supervision and assistance

-      Can accomplish some familiar tasks

-      Often has learned to compensate for some cognitive challenges

+  Advanced dementia

-      Needs 24/7 care

-      Becomes incontinent of bowel & bladder

-      Loses weight even if eating well

-      Loses the ability to coordinate swallowing

-      At risk of pneumonia, UTIs, skin wounds

Challenges

+  We live in a hyper-cognitive culture

+  We value independence & self-reliance

+  We are known by what we do &

what we think

+  As a society, we undervalue persons with diminished intellectual capacity

+ Disease progression is slow: 8-10 years

+  Person is aware of declining abilities in the early stages of the illness, as the family slowly loses the person they have known

+  Late stages require a great deal of assistance. Caregivers tire, while the person may not be safe living at home

+  Late stages require end-of-life treatment decisions

Pastoral Care for Patients & Families

                                          with Dementia

Learn about the disease – www.alz.org

Learn about the person & their family

      + What are the person’s likes/dislikes?

      + Learn about their childhood,

                        and young adulthood

      + Learn if you can how the person wants

to be cared for as the illness progresses

Check-in with yourself

+ Know your own thoughts & feelings about dementia & persons with cognitive impairments

+ Explore your own thoughts & feelings about death and end-of-life decision making

Supporting the family

+ Listen to stories, fears, & feelings

of grief or anger

Losing a loved one to dementia is having to witness their identity being stolen, a “long goodbye” like few other diseases

+ Diminished inhibitions can cause the family significant embarrassment

+ Facilitate congregational support

-      Help caregivers get time to bank, shop, rest, or just get away occasionally

-      At some point, meals are helpful

-      Encourage caregivers to accept help

+ Be ready to listen to end-of-life decision related questions

Caring for the person with dementia

+ Persons living with dementia are created in God’s image, and are entitled to be treated with full personhood

+ Cognitive impairment ≠ spiritual impairment

+ Persons with advanced dementia are often amazingly spiritual

+ Persons with advanced dementia respond to touch, compassion, and love with feelings and behaviors in very honest, even intuitive ways

+ Persons with dementia live in the moment, & are not so self-conscious: joy, gratitude, anger

+ Generally, the last memories lost are the oldest – childhood & “coming of age”

+ “When they are no longer aware they are no longer aware, they give themselves over – sometimes all too enthusiastically – to the faithful care of others, whether human or divine”

Pastoral care visits to persons with dementia

+ Know the person’s “favorite things”

+ Read scriptures that are particularly familiar, or poetry, or even the newspaper – whatever interests the person

+ Be willing to listen to stories that are repeated

+ Be willing to listen to stories that are repeated

+ Be willing to sit in silence

+ Games, busy boxes, aprons – the tactile

+ Learn the person’s favorite music, & play it, sing it, talk about it: from their “coming of age” era – iPods have been used in remarkable ways

+ Be willing to listen to stories that are repeated

Continue steadfastly in prayer,

being watchful in it with thanksgiving.

At the same time, pray also for us,

that God may open to us a door for the word, to declare the mystery of Christ, on account of which I am in prison - that I may make it clear, which is how I ought to speak.

Walk in wisdom toward outsiders,

making the best use of the time.

Let your speech always be gracious,

seasoned with salt, so that you may know how you ought to answer each person.

~ Colossians 4:2-6 (ESV)

“I know your works.

Behold, I have set before you an open door, which no one is able to shut.

I know that you have but little power,

and yet you have kept my word

and have not denied my name…

Because you have kept my word

about patient endurance,

I will keep you from the hour of trial.”

~ Revelation 3:8-10 (ESV)

Role playing

+ You are a person in the hospital, admitted from the ER after you fainted in a public place, who just got word that you have surgery tomorrow, but would rather not say so.

+ You are not sure of the name of the person who has come to visit you, but are unwilling to admit that; you’re also not sure where you are.

+ You are the spouse of the patient, who is out of the room for testing; you do not attend church, and are not comfortable with religion.

+ You are in the hospital for a fairly minor issue, but are extremely fearful of dying, & dementia.

+ You are very angry with your family for how you believe they have put you in this place, and believe they are stealing your money & property.

+ You are very happy to have a visitor, and very thankful for all God has done for you!