Transforming Care: A Christian Vision of Nursing Practice (12 page)

Because nursing is a profession in the fullest sense of the word, it is a practice oriented toward important human goods, and it is a practice that
shapes the lives of its practitioners in important ways. It is a moral practice, carrying within it certain values and encouraging the development of
certain character traits in its practitioners. The identity of nurses is shaped
by the education they receive and by the institutions within which they practice. The identity of nursing is also shaped by assumptions about the
nature of the persons who become nurses and the clients for whom they
care. As we have seen, both the nature of nursing and the identity of persons are shaped and qualified in important ways by the Christian nurse's
faith commitments. This does not mean that the Christian nurse and the
non-Christian nurse disagree about what nursing involves; it means instead that although there is broad agreement about what nursing is, the
Christian nurse comes to that practice shaped by her or his faith and seeing the privileges and responsibilities of that role in terms of the grand
story of God's creating, sustaining, and redeeming activity.

Five elements of personhood:

• image-bearer of God

• physical, mental, social, moral, and
spiritual dimensions

•independent and dependent

• co-author of his or her own story

0 part of a community

The very elements of what
constitute good nursing are
as little understood for the
well as for the sick. The
same laws of health or nursing, for they are in reality
the same, obtain among the
well as among the sick.

FLORENCE NIGHTINGALE

In the same way that Christian faith shapes one's understanding of the
practice of nursing and the meaning of personhood, it also shapes the fundamental orientation nursing has toward
the good of health. It is fairly commonplace to define nursing as a practice oriented toward health. This orientation is a
part of the very earliest history of nursing.
The health in question is not an abstract
idea of health, however, but the health and
well-being of concrete people with whom
the nurse works. And these people live,
work, and sometimes suffer in the midst
of particular environments. Because all of
these concepts are so inescapably interconnected with nursing practice, they are
often called the metaparadigm concepts of nursing. The next chapter examines the two concepts we have not yet discussed - health and environment - from the perspective of an understanding of nursing and
personhood shaped by Christian faith.

The Christian faith shapes nursing practice by shaping the character, perspective, and values of the nurse. In the previous chapter we began a process of reinterpreting the defining concepts of nursing theory. We saw
there how the concepts of nursing and of personhood are understood in
distinctive ways from a Christian perspective. Nursing is not simply a profession; it is a practice whose internal goods such as health and care fit
wonderfully well with a Christian vision of service to God. We argued that
the concept of personhood cannot be understood rightly if we reduce
personhood to autonomy. The resources of the Christian tradition reveal
to us that persons are embodied, vulnerable, and interdependent.

In this chapter we turn to a reinterpretation of the defining concepts
of health and environment. Here our focus is primarily upon how our perspective is shaped by our faith. When we think about how faith qualifies
perspective, we are thinking of how we interpret our circumstances in light
of their religious significance, and we identify this significance in light of
the testimony of Scripture. As we assess the meaning of health and the environment from a Christian perspective, then, certain central biblical
themes frame our discussion. We return again and again in this chapter
and the chapters that follow to ideas such as shalom, "the least of these,"
justice, idolatry, and so forth as we reassess the meaning and significance
of these defining concepts.

Nursing is a practice that is fundamentally oriented toward health. Because health is such a central notion for the definition of nursing as a practice, it plays a central role in every account of what nursing is. Imogene
King, for example, argues that the goal of nursing is "to help individuals and groups attain, maintain, and restore health" (King i98i, 13). But while
health is central to nursing practice, it is not an easy concept to define. The
next section looks in more detail at what health is, the various aspects of it
that make it a complex and difficult notion, and how these aspects are
shaped and qualified by Christian faith.

Rita is the kind of woman who makes others want to be around her. Just
over five feet tall, with short gray hair, and dressed in attractive slacks and
tennis shoes, she heads out on her daily two-mile walk. Before she walks
she stops to say hello to friends who are sitting outside, enjoying the fall
colors at the retirement home. Rita enjoys life and communicates that enjoyment to others. She is 95 years old, and although she is one or two generations older than many others who also live at the retirement home, she
never gives the impression of living in the past. She listens attentively to
her adult grandnieces talk about their lives, and her interest in their activities, made possible by her own zest for life, is unmistakable.

To the external observer, Rita would appear to be an elderly woman in
perfect health. But her life is not without disease. Rita suffers from diverticulitis, an inflammation of the intestine that can result in blockages and
severe abdominal pain. She also has hypertension and type II diabetes. Rita
has been to the hospital three times in the last five years because of her diverticulitis, and each time the surgeons have needed to remove the blocked
and damaged portion of the intestine. The last time she suffered from abdominal pain, she asked friends to help her, and while they were communicating with her doctor concerning her symptoms, she still managed to
eke out a smile, even through the pain. The way she handled the situation
made everyone else in the room feel a little bit less awkward.

When she gets back to her apartment after her walk, Rita meets with
her nurse, James, from the Area Agency on Aging, assigned to help her remain independent and to promote her health. "How have you been feeling
since I saw you last month?" James asks. "And how are those grandnieces?
Still coming by for regular visits?" He waits carefully for Rita to respond
before continuing on to talk about her diet and inquire about any recent
abdominal pain.

Rita reports triumphantly that she has been able to get the medica tions she needs through the prescription assistance program he helped her
apply for last month, and they share a laugh over the complexities of government programs while he checks her blood pressure and blood glucose
level. James also takes a quick look in the bathroom to be sure that the
shower bars he brought for Rita last month have been properly installed in
her bathtub. Rita and James work together as a team to help Rita stay as
healthy as possible. But what exactly do we mean by healthy? Since Rita is
not without some disease, can she still be healthy? And how should our
understanding of both aging and the disease process affect how we think
of health in this particular case?

Initially we are tempted to consider Rita healthy because she is physically fit enough to walk two miles each day. When we focus on her diverticulitis, hypertension, and diabetes, however, we are likely to think of her as
chronically unhealthy. This indicates that we need a definition of health
that is nuanced enough to capture various aspects of a person's life. In
many ways Rita is healthy. In spite of her disease she is joyfully connected
to her community and environment in very healthy ways. Human beings
were meant to live with others in relationships of mutuality, hospitality,
and reciprocity, and when we see these relationships we should recognize
that they reflect a healthy life. However, health also involves the proper
functioning of our bodies and minds, and that proper functioning is important for the bodily, mental, and spiritual integrity we need to engage
God's world and God's children in healthful ways. Hence, a concept of
health must be broad enough to include the physical, psychological, social,
and spiritual dimensions of being human, and it must be deep enough to
reveal the integral connection between of all of these.

Sometimes a client's physical need, such as dangerously elevated glucose levels, requires that a nurse focus more heavily on just one aspect of
health. But the nurse must always be cognizant of how all dimensions of
health intersect. When the physical crisis has been handled, the psychological, social, and spiritual aspects of the client's health must still be addressed. Suppose Rita had experienced dangerously high glucose levels, a
condition caused, in this case, by missed insulin injections. When James
inquires, he might discover that there were delays with the prescription
program application process that caused Rita to be without needed medications for a day. The nurse functions as a coordinator of care so that all
aspects of an individual's health can be addressed, and this requires the
nurse to discover the story of someone's life - to ask about why the insu lin injection was missed, to recognize how the need for daily insulin injections affects the client's social calendar or makes her feel depressed because
she will be burdened with a need for pharmaceutical intervention all of her
life. Perhaps Rita had a close friend who had a leg amputated because of
diabetic complications, and this affects her commitment to maintaining
her own treatment schedule. Discovering the client's story can help the
nurse be an effective coordinator of all aspects of his client's health.

The Old Testament word shalom, which can mean many things, is
sometimes translated as "health." Shalom can be defined as a dynamic
state of wholeness, well-being, peace, and completeness that permeates all
areas of life (Plantinga 2002, 15). We can understand it as universal flourishing, wholeness, and delight - a rich state of affairs in which natural
needs are satisfied and natural gifts fruitfully employed, all under the arch
of God's love (Wolterstorff 1983, 69-72). If we define health in terms of this
concept of shalom, or in the terms we developed in Chapter One of
creational goodness, it becomes clear that health is not merely the absence
of sickness or pain. Health in the fullest sense is the complete physical,
mental, and spiritual flourishing that allows us to fulfill our created purposes - and so give glory to our Creator and enjoy the relationships with
our Creator and fellow creatures that are made possible by those purposes.

But while this ideal of full flourishing may be part of our definition of
health, it cannot be the definition we normally work with in the context of
nursing. It sets the standard so high that no one is healthy, and surely our
ordinary use of the term healthy implies that many people, much of the
time, experience health. This does not mean that we need to dismiss the
ideal of full flourishing completely; as Christians, the ideal of all things being made new forms the horizon of our thinking at some level. But in
terms of the ideal of health that functions in the context of nursing practice, we need a much more modest definition.

The concept of shalom as an ideal of health is significant because it
makes clear how health is connected to functionality, to flourishing, and to
a fruitful employment of gifts. If disease, which could be described as an
anatomic, physiologic, or biochemical malfunctioning, interferes with our
ability to perform normal human functions or to employ our talents, then
our health has been compromised. When we think of physical accidents
such as a small cut with a scissors, or surgical procedures such as the removal of the tonsils, we usually don't speak of them as making us unhealthy because they have such a small influence on functioning. But dia betes has a greater health impact because the disease can cause further
physical damage or incapacitate a person if not treated, and it requires the
client to extend a fair amount of effort in coping with the disease; both the
disease's physical damage and the effort to cope with it can negatively affect the ability of the person to flourish. In acknowledging the multidimensional nature of health, we note that insofar as physical diseases, poor
social conditions such as poverty and illiteracy, psychological conditions
such as stress and depression, and conditions of spiritual emptiness interfere with our ability to function and flourish, they affect our health.

The ability of a physical disease such as diverticulitis or diabetes to influence health negatively is well noted. However, the overall health outcome
in these disease situations may not be so negative that we evaluate the person with the disease as unhealthy. Some individuals who have a physical ailment can actually be healthier than those whose bodies are whole and functioning well. In Rita's case, even when she is in the midst of a painful
episode of diverticulitis, she still describes herself as quite healthy, and
James, her nurse, would agree with that description. She understands the
nature of her physical disease, she knows what to expect and how to handle
an episode, and she is at peace with her condition. She works with her nurse
and physician and follows their advice and instructions. She also has the
support of her friends and family to help her function well. When James
compares her total health to other clients at the retirement home, several of
whom are younger and are without chronic or episodic physical disease,
Rita's hope for the future and her delight and involvement in other people's
lives makes her shine as the healthier individual.

Health means capability,
vigour, and freedom. It is
strength for human life.