Spiritual Care: A Guide for Caregivers (5 page)

Jen, the parish nurse from her church, visited weekly, but
Myrtle seemed like a different person in her son's home. The family members were loud and inconsiderate of one another, often
shouting obscenities. The house was thick with cigarette smoke, to
which Myrtle was allergic. Myrtle's room was an unheated back
porch that had been enclosed. The only bathroom to which she
had access contained a toilet and sink but no bathing facilities.
Her eyes were red and watery, and she coughed constantly. Jen
offered to take her to the doctor. On the way, Myrtle poured out
her story of emotional abuse, explaining that her son had tricked her into signing over the house and her bank account to him. Suddenly Myrtle stopped talking, telling Jen she feared reprisal if her
family discovered she was talking. Then she continued, "Why
does God allow this to happen?"

The next step in the assessment process is discovering the meaning behind your observations. Observations can be deceiving.
They need testing. For instance, Carla and Anna, unmarried sisters who lived with their mother, Edna, appeared to care solicitously for Edna when she became chronically ill. Others in the
church openly admired their dedication. However, one day Carla
and Anna were away when Mary, the parish nurse, visited. Mary
commented on how kind the sisters appeared. Edna's face darkened and she replied, "They're mean to me!" Mary probed gently,
asking for more details. "Well, when I don't move fast enough,
sometimes they hit me," Edna explained, slowly raising her sleeve
to reveal a large bruise.

Asking open-ended questions about items surrounding a person may reveal surprises or allow for further discussion. For
example, you could remark, "I see you have a well-used Bible on
your coffee table. Do you have a favorite passage?" One person
may use that as an opportunity to share the comfort a particular
passage has provided, while another may explain that the Bible
belonged to another family member who had used it to judge and
condemn.

Mary Sue, a part-time youth worker in a neighboring church,
frequently referred to her "prayer closet" when I visited, explaining that Jesus commanded us in Matthew 6:6 to go into a closet to
pray. It never occurred to me to ask to see the prayer closet. One
day she offered to show it to me. As she opened the door, the thick smell of incense filled the room. Inside the closet she had placed a
large pillow on the floor facing an altar with candles and a cross -
along with an incense pot, a string of Muslim prayer beads, a
rosary, and statues-of Buddha, Vishnu and an assortment of
unfamiliar idols. Sheepishly she looked at me and said, "I've
always been one to hedge my bets."

After taking a few minutes to regain my composure, I asked
Mary Sue to tell me about the prayer closet. She related a story of
her long spiritual journey and the friendships she had made along
the way. Although raised in a Pentecostal church, she became
embarrassed by her background while she was in college. She
didn't like the restrictions and was eager to see what the "real
world" offered. Whenever she met someone she admired, she
inquired about their spiritual understandings and incorporated
their beliefs and practices into her own, assuming she could
remain a Christian. What she really wanted was spiritual power,
and these other gods seemed to offer it to her. However, recently
she had experienced some frightening encounters in the prayer
closet, and she suspected that God was out to get her.

"Tell me more about these experiences," I prompted. What she
then described did not sound like an encounter with God. I asked
if we could get together the following week for a Bible study. She
agreed, and we began with Genesis 3. She immediately saw herself in the story of Eve's temptation in the Garden of Eden. She
dropped to her knees in tears, confessed her sin and then dumped
all the contents of her prayer closet into the garbage.

No one, including me, had thought to assess the meaning of Mary
Sue's unusual prayer life. It sounded biblical, though a little quirky.
We took it at face value. Yet her prayer closet was a desperate cry for
help, which we ignored. In the meantime, she was influencing her
youth group to explore dangerous spiritual paths, leading them astray.

On the other hand, Cass presented another picture. She moved
into a new home with her boyfriend in our family-oriented community. She did not expect the neighbors to approve of her lifestyle. Appearing cocky and self-assured, she welcomed visitors
eagerly-until any mention of God or church came into the conversation. I assumed the topic was closed. One day after my family and I helped clear the snow from her driveway, she asked what
kind of nursing I did. After I explained that I worked for Nurses
Christian Fellowship, she eyed me knowingly and said, "I knew itl
You remind me of my best friends in nursing school. They were all
born-again Christians-and they are still praying for me." That
was the beginning of a series of approach-avoidance conversations
in which she would bare her soul, then avoid me for months. She
did not become a Christian before she moved away, but I'm sure
the "Hound of Heaven" is still pursuing her.

The moral of the story is this: We cannot assume that what we
observe on the surface is really what is going on in a person's soul.
The most pious church member may be sitting in pyramids or hiding ceramic gods in the closet. The foul-mouthed rebel may be
desperately seeking God. If you are caring for someone as a nurse,
pastor, church visitor or mentor, it might be helpful to work
though a written spiritual assessment guide to clarify spiritual
resources, needs and concerns.

An assessment guide provides a review of the strength and
meaning of a person's religious practices that can open doors to
helping the person establish and maintain a dynamic personal
relationship with God. This is not a time to make judgments or
give instructions; it is simply a time to gather information. You
will then be able to intervene more specifically at the person's level
of faith and understanding. The questions in table 1 may be useful
in gathering enough information to enter the other's religious world as a helping person.' In chapters four through eight we will
look more specifically at what to do with the information gleaned.

In order to accurately assess the spiritual needs of others, we need to
be aware of our own. As we have already determined, spiritual health
is closely tied to our relationships with God and other people. The
following assessment guide is designed to help you examine your
relationship with God in the context of your human relationships.

First, think through the following questions on your own. You
may want to write your answers in a notebook or journal. As you
write, think about the memories these questions stimulate, and
consider areas in your life where you may want to seek guidance
or support in making changes.

The guide is especially helpful when used with a friend or
prayer partner. Find a partner whom you trust. Agree to interview
each other. Allow plenty of time -at least a couple of hours for
each of you. Feel free to follow up on thoughts, feelings and concerns expressed, to stop and pray, or to take a break if the interview becomes too intense. You may be surprised by what you
discover about yourself and about God's work in your life.

1. In one paragraph, how would you describe your childhood?

2. Describe your relationships with your parents and siblings -while
growing up and now.

3. If you are or have been married, describe your relationship with
your spouse or former spouse(s). If you have never been married,
describe the most significant "other" in your life and how that relationship developed.

4. If you are a parent, describe your relationship to your child(ren). If
you do not have children of your own, who are the significant children in
your life? Describe your relationships with them.

5. What were the most significant positive events in your childhood?
adulthood? Why?

6. What were the most significant negative events in your childhood?
adulthood? Why?

7. How did you learn about God?

8. In what ways did you experience God while you were growing up?

9. How would you describe God?

10. What were the crisis points in your relationship with God over
your lifetime? What issues were involved? How did your relationship to
God change?

11. Who was the most significant person in your faith development as
a child? as an adult?

12. If married or formerly married, how has your marriage influenced
your faith in God? If never married, how has your closest friend influenced your faith?

13. Describe your faith community (your church and other fellowship
groups). In what ways has that community nurtured your faith? How
has it hindered your faith?

14. What rituals, disciplines or other religious practices have been
particularly helpful or meaningful to you? (sacraments, worship experiences, devotional habits, spiritual direction and so on).

15. Where do you find the most support in your relationship to God?

16. What kind of spiritual support do you need at this point in your
life? Are you receiving it?

17. Describe a time when you were angry with God. How did you get
through that period?

18. How is God at work in your life right now?

19. In what ways is your faith helpful to you in your daily life?

20. How has your faith influenced the major decisions in your life?

21. How has your relationship with God influenced your care for others?

22. What spiritual resources do you draw upon when you feel overwhelmed?

When you are the interviewer, encourage your friend to tell his or her
story as the questions trigger memories and thoughts. This is your time
to listen, not to add your own comments. On another day, switch roles.

You may also want to use this guide with those in your care. As you
go through the questions, take notice of any clues the other person gives
about spiritual concerns. Ask follow-up questions that enable the person
to tell about his or her personal spiritual journey. After completing the
assessment guide, you will probably want to pray together. Be sure to
leave the door open for more discussion on any of the areas of struggle. If
deep-seated problems become evident in the course of conversation, gently suggest appropriate professional help such as talking with a pastor or
counselor.

Angela was an old friend who just happened to be in town when I was
preparing to teach a class on spiritual care. Since Angela taught
psychiatric/mental health nursing, I decided to ask her advice
about my presentation. She looked at my outline and snorted,
"What is it with you and this supposedly spiritual care? This is
nothing but sneaky evangelism!"

"Haven't you ever had a patient bring up spiritual concerns?" I
asked tentatively.

"Never!" she insisted. "Patients don't expect a nurse to meddle
in their spiritual lives. If they want spiritual care, they'll go to
church."

A large part of Angela's avoidance of spiritual care stemmed
from her rebellion against God. Early in her nursing career she
spent one term as a missionary in Pakistan. Those three difficult
years left her broken and angry. She had been running from God ever since. Her own personal baggage left her unable to hear the
spiritual concerns of others. Her graduate-school experience in
mental health nursing further solidified her sense that spiritual
concerns simply grew out of emotional disturbances -and sometimes caused them.

Angela's reaction to spiritual care came from her own personal
struggles. Many times caregivers miss desperate pleas for spiritual
help simply because the concerns are not obvious. For instance,
Jerry appeared composed and confident before surgery. He never
indicated that faith was particularly important to him. When his
pastor visited, they watched a football game on television together
and joked about the underdog winning. The pastor gave Jerry a
firm handshake before he left and said he would be praying for
him.