Transforming Care: A Christian Vision of Nursing Practice (4 page)

Armed with this information, Janet puts on her gown, gloves, and
mask and enters the room. She greets her charge warmly and is encouraged to note that Ann is lucid today. Janet performs her usual assessment
of a client, using the stethoscope and blood pressure cuff that are reserved
for this room. She takes blood pressure and blood oxygen levels, listens to
heart and lung and bowel sounds, takes radial and pedal pulses, and examines Ann's skin. She asks questions: How are your bowel movements? Any
pain? How would you rate your level of pain? She measures urine output,
and she records all of this information meticulously in the client chart. She
administers medications and prepares a syringe of saline so that she can
flush Ann's heplock. She also turns Ann from one side to the other to prevent bed sores, all the while talking with her about what she might like for
tomorrow's meals.

Before she leaves, Janet asks, as she does with every client, "Is there
anything else I can do for you?" Clients make a variety of requests: Can I
have a drink now or am I still forbidden to take anything by mouth? Do
you know when the doctor will come in? When will they come to take me
down for my test or surgery? Ann's request is simple: she would like to
have her hair combed. Janet searches everywhere for a comb but cannot
find one. She will have to leave the room to get one. This calls for an elaborate ritual. The gown and mask and gloves must be removed while Janet is
still in the room, and her hands must be washed, a 30-second procedure
that Janet performs dozens of times each shift. After she finds the comb,
she must put on a fresh gown and mask and gloves. All of this takes up precious time that acute care nurses, who provide care for multiple clients,
can ill afford. But the client does not know this, and Janet makes it seem
that there is nothing in the world on her mind besides retrieving a comb
for Ann. She carefully arranges Ann's hair, asking her questions about her
children all the while, and then encourages her to eat and drink and rest.

There is nothing terribly out of the ordinary in this nurse-client interaction. Scores of activities are undertaken here that the average acute care
nurse must perform dozens of times each shift. But the individual activities described here are out of the ordinary and only seem normal because
of their context in the hospital (Chambliss 1996, 30-31). Notice what Janet
does. She touches Ann: she touches her chest and back, skin and feet and hair. She listens to Ann: she listens to her voice and heart, lungs and bowels. She watches Ann: she measures her in a variety of ways, injects her with
saline and medications, and washes her. All of these activities would be
odd, inappropriate even, outside of the health care context. They derive
their meaning from that context and from the nurse's self-understanding
of her vocation as health care provider. In short, Janet cares for and attends
to Ann, and she provides this care and attention by employing a range of
skills, competencies, and techniques unique to her role as nurse.

Some of these skills are diagnostic: Is Ann's level of consciousness altered or is she oriented to her surroundings? Is she in discomfort and, if so,
what might be causing that? Some of these skills are interpersonal, and
sometimes the skill and gift of a nurse is simply to be present with a client.
Think of what a gift and task it is to be present with clients as they experience the joy of childbirth, the fear and vulnerability of receiving a cancer
diagnosis, or the confusion and pain of coming to terms with a mental illness. Most of these skills are so natural to the seasoned nurse that they often go unnoticed as skills. Notice, for example, how many steps it takes to
assemble a syringe without contaminating it, and how much background
knowledge about sterile procedure, pharmaceuticals, and human anatomy
is involved in the use of that syringe for the intravenous administration of
medications. Notice also how Janet's hands know what to do almost apart
from her conscious supervision of them. The practice is so integral to her
work as a nurse that it has become part of what it means to be Janet, to be a
person with the skills, interests, and compassion of a nurse. This practice,
like hundreds of others, has become part of her identity as nurse.

The interaction between Janet and Ann described here is perfectly ordinary in the course of an average acute care nurse's shift, but its very ordinariness is an indicator of the complex knot of relationships - personal,
institutional, and systemic - that comprise professional nursing practice.
The interaction is not only ordinary, it is also many other things: morally
good, morally ambiguous, awe-inspiring, frustrating, beautiful in its own
way, and tragic. In this chapter, as we examine how faith structures nursing
practice, we are seeking to tease out some of the strands that make up this
knot of relationships and, in doing so, to discover the theological significance of Christian nursing practice. If faith shapes our character, perspective, and values, then to understand how that shaping takes place we need
to do some thinking about the faith tradition that does the shaping. We
need to tell the story of the faith that will affect so deeply who we are as persons, how we interpret our circumstances, and what principles guide
our action. There are many, many ways of telling this story, and every telling will highlight some features of the tradition and obscure others. Here
we offer just one way of telling the story, hoping that it will illumine some
features of nursing practice and trusting that other tellings will supplement and correct this one.

In this chapter we begin our thinking about Christian nursing by examining some of the theological dimensions of professional nursing practice.
Theology is what happens when people of faith reflect on the meaning and
implications of their faith. It is an exercise that depends upon a prior experience of the power and presence of God. And for Christians, it depends
upon an experience of the power and presence of God as they are met in
the person of Jesus Christ. Consider the everyday way you think and talk
about your faith. Call to mind the images, rhythms, and language of worship that evoke in us a sense of reverence and awe: God is the holy one of
Israel, the good shepherd, a woman who searches for a lost coin, a "mighty
fortress," the one "from whom all blessings flow." These are part of ordinary religious experience. Theology rests on this foundation; it assumes
that human beings naturally possess what the sixteenth-century Protestant
reformer John Calvin called a "sense of the divine," a receptivity to and relationship with the transcendent God (Calvin i96o, 51).

We engage in theology when we ask questions about this primary religious experience and inquire into our common ways of thinking and talking about what it means to live "under the aspect of eternity." When we ask
about the theological dimensions of nursing practice, we are asking where
God is encountered in that practice, and we are assuming that Christian
nurses are engaged in a religious activity - a ministry, an act of worship
even - as they carry out their professional responsibilities. Ministry is not
a calling reserved for pastors and missionaries. All Christians are called by
God to live out their lives in ministry, and this "calling" in the midst of our
everyday activities is the very meaning of vocation. Because of this, professionalism and ministry are not mutually exclusive. Instead, nursing as a
Christian ministry requires professional preparation. Christian nurses engage in a scientific, evidence-based practice, a practice that is an act of ministry, and a ministry that could not exist without professional education. It is in and through the everyday aspects of our work that we encounter and respond faithfully to the God who has called us to this particular
aspect of ministry.

Friedrich Schleiermacher, a nineteenth-century Calvinist theologian
and a chaplain at the Berlin charity hospital, was thinking about this question of where and how we encounter
God in our workaday lives when he
explained that to be a religious person
is to seek the eternal in all temporal
things and to find in all finite existence the presence of the infinite
(Schleiermacher 1994, 36). The religious person seeks God in and finds
God through every creature, and especially in the relationships between
creatures. When Schleiermacher thought of religious experience, he did
not have in mind primarily the "mountain-top experience," where God is
almost palpably present. He thought instead that for most people, most of
the time, God comes to us in the valleys and plains of life.

What this means for nurses is that when we think about nursing as a
religious activity we should not expect to find the "religious" dimension of
a nurse's work confined to moments of intense and intentional "caring"
interaction with individual clients, nor will it be isolated in dramatic interventions - "miracles" - that preserve a client's life. Rather, if we find God
in and through all of God's creatures, then we should expect to find the
presence of God permeating every aspect of nursing practice, from charting to taking vital signs, from dispensing medications to interacting with
colleagues, from teaching a family about a low sodium diet to conducting a
staff meeting, from preparing syringes to washing one's hands. The God
whose goodness and beauty are everywhere present, whose power and
purposes saturate creation, also permeates the full range of practices engaged in by the Christian nurse.

But goodness and beauty are not all that the nurse - or anyone for
that matter - experiences of the power and purposes of God. We also experience profound brokenness, efforts that are frustrated, goals that are
not attained, relationships that are perverted, and desires that are disordered. Our own frustrations lead us to respond badly or to fail in other ways. We see the effects of people's deeply evil choices that sometimes destroy their own lives and other times destroy the lives of those around
them. We experience God, though it is no longer in vogue to admit it, as
judge, as the one who stands over against all of our plans, and who sees the
ways in which we plan to do what we should not do.

There is a beautiful portion of
the gospel that speaks of consecration and I think it is as pertinent to you in health care as it
is to priests and bishops.

JOHN CARDINAL O'CONNOR

We also experience the God who is sovereignly other as a mystery - a
mystery that is often as frustrating as it is inspiring. We don't understand
why God doesn't intervene or protect those who are damaged by others'
choices. We don't understand why an elderly woman dies in isolation and
loneliness and pain. Nurses bring to their work a religious consciousness
that is always marked by doubleness. On the one hand, we are always aware
of our finitude and of the brokenness of creation. On the other hand, we
are also aware of the goodness of creation and of the God who is "sovereign beauty" (Spohn i98i).

This doubleness lies near the heart of nursing practice. Nurses deal
with clients whose health or lack of health determines their ability to pursue life plans and purposes. When we attend to health and its promotion
we also acknowledge that it can, might, sometimes does, and eventually
will fail or be destroyed. Good health always finds its definition relative to
the possibility of failed health. The nurse works in an arena defined by
finitude and brokenness. At the same time, attending to illness and working to overcome it acknowledges that human persons should be healthy
and that health is the proper state for human lives. Our bodies and minds
should reliably serve the plans and purposes for which we were made. Illness always finds its definition relative to a standard of health that allows
for the pursuit of a good life. The nurse caring for ill people works in an
arena circumscribed by the goodness of creation.

It is not as though the nurse's consciousness toggles back and forth between awareness of the goodness of God and God's creation, on the one
hand, and awareness of the brokenness of creation, on the other; rather,
the work of a nurse always calls for praise and anguish simultaneously. We
give thanks for Ann's life, for the caring community that sustains her and
remembers her before God, for the skilled care that she receives, for the
unique and beautiful individual that she is, for the hope that health care
offers, and for the hope of life eternal. But we also lament because her body
is breaking down, because her once-sharp mind is losing its hold on the
threads of continuity that weave a meaningful narrative out of life's events,
because nurses have too little time for their clients, and because health sci ence and all the efforts of skilled health care professionals cannot always
bring relief, and sometimes cannot even provide comfort.

Awareness that caring for Ann provides the occasion for both
thanksgiving and lament constitutes the doubleness of the nurse's consciousness. It is important to note, however, that both our sense of joy in
the goodness of creation and our anguish at its brokenness grow out of
and respond to our knowledge that God through Christ has redeemed us.
This fact engenders a profound sense of hope even at the dark occasion of
our most painful lament. This hope is more than just unrealistic wishful
thinking because it is built on the foundation of Christ's resurrection,
which assures us that God's grace cannot be defeated even by death itself.
In essence, then, we may have two responses to creation - delight and lament - both of which emerge from our gratitude to God for our redemption, and indeed the redemption of all things, in Christ.

In the remainder of this chapter we explore the theological meaning of
the nurse's religious experience of doubleness and awareness of the presence of God reflected in that doubleness. We begin by focusing on the
nurse's experience of the goodness of God as it is met in and mediated
through the nurse's clients and colleagues. Then we turn to a consideration
of the role of lament in light of the nurse's awareness of human limitations
and of the sometimes tragic character of life.