Hospital Handbook. James T. Wagner

wishes privacy with friends and family. Clergy also need to know when to leave, gracefully.

      2. Visiting a stranger. There are occasions when you are asked to see someone with whom you have had no previous contact. By this I mean someone not a member of your church. A church member may ask you to visit a friend, or a hospital staff person may say that someone in the next room needs to see a minister.

      Again, gather data, first from the referral source. A nurse or staff person may be facing a situation he cannot handle alone. The staff person may be the one needing the visit, so pay attention to what is being said here, and offer to support the staff person in her role. A church member may have the same need in calling you to see his friend. Your church member may need support in a frightening time.

      If you visit the patient, determine how much this patient actually wants to see you. Make sure you are not overstepping someone else's pastoral territory. Consider your own time priorities and determine just what kind of commitment you can make to this person. It may be that a brief visit and prayer are all that is needed. If the patient needs more time than you can give, contact those key hospital personnel you met in your orientation tour.

      When a church member asks you to visit a friend, be aware of a phenomenon in certain parts of this country where a member of a church sends her pastor to visit a friend who is a member of another church. I had never experienced this in my own background, and I never quite understood why people asked me to do this until another pastor explained this tradition. It is a kind gesture, sort of like sending flowers, and when the patient, the friend of a friend, has no support system, it can be very meaningful. But it becomes ludicrous when three or four friends send their pastors to a common friend who already has his own pastor.

      If you have time to call in behalf of your own parishioner, find out if you are really needed, pay your respects and inform your parishioner that you have made your visit. It is simply good time management and good pastoral care not to duplicate efforts unnecessarily.

      The final element to consider in looking at all aspects of the hospital visit is the work situation of the doctors and nurses who treat the patient. They are very aware of your role. They appreciate the clergy visit most when the guidelines suggested here are followed. Hospital staff are virtually unanimous in this recommendation that clergy visits not be overlong, that there be some kind of physical touch in a gentle way with the patient, and that a supportive prayer be offered. You should be aware of their work situation.

      Any time a person is hospitalized, the patterns of institutionalization develop. Since the patient has little control over his or her environment everyday elements of life take on monumental importance. Times of meals, medication, and therapy are the major organizers of a patient's day. Patients hang onto any word or gesture which suggests information they seek about their own condition or recovery. When a meal is unpleasant, medication late, or an offhand comment is exaggerated, a patient may become depressed, angered, or confused. It is easy for the hospital visitor to be drawn into the patient's institutionalization syndrome if you are not aware of its characteristics and do not understand the structure and routine of a hospital and its staff.

      Be aware of the necessary routines of nursing. A floor nurse cannot be the private nurse to any given patient. Even medication which is prescribed PRN (or, as the situation requires) has to be grouped for efficiency.

      Sometimes a patient will ask you to call a nurse or will complain to you about the lack of nursing attention received. Always gather data from the nursing station about the situation before you intervene in the nurse-patient relationship. There may be times when you can facilitate better understanding between the patient and nursing staff, but do not ever try to do this prematurely, that is, before you have taken time to fully understand the situation.

      You can be most helpful to the patient if you clearly understand the nursing routine, shift schedules, and nursing plan for this patient. You can interpret these to the patient. In so doing, you may develop a deeper empathy for the role of the nursing staff as well. Use this empathy to be a supportive member of the health care team in the hospital.

      Realize too that there will be times that the nursing staff needs your support. The serious illness, pain, and even death of patients they care for affects their lives deeply. Be sensitive to the times they need help.

      For doctors, time is the key issue. The average internist in private practice, for example, has eight to ten patients in the hospital. The internist is aware that he or she has a coordinating, interpreting role to the patient. The physician will often take a pulse and listen with a stethoscope primarily to make physical contact with the patient. The doctor will reinterpret comments of a surgeon or other specialist and listen to the patient's concerns. Sometimes emergencies will prevent the internist from seeing a patient on a certain day, and this may be upsetting to the patient. Doctors consistently cite the difficulty of finding time to keep up the human contact with the patient while going about professional duties as the key pressure of their job.

      You as clergy can relate to this doctor by understanding just how he or she needs your support. Some doctors welcome a ten minute break over a cup of coffee, just to unwind. Others will tell you they would rather have the extra time with patients and prefer that you not try to make them take a break. Find out from the physicians treating patients you see how you can best support them in their role.

      Your empathy with the situation of the doctor and nurse will enhance your total hospital ministry. You will be trusted by hospital staff. You will be able to communicate the needs and role of the hospital staff to the patient. And when necessary, the hospital staff will listen to your concerns on behalf of the patient.

      Consulting With the Physician

      How will you know when you should consult with the physician about the patient's condition? Generally, you can rely on the family to share with you what has been reported by the physician. If it's comfortable for the family, be there when they meet with the physician, so you can hear what they have been told and be identified to the physician as a significant support person to the family. Contacts with the physician beyond these times should be for specific reasons, such as an agitated family member, organ donations, and preferences regarding extraordinary treatment interventions. You receive your authority in these areas from the family.

      One of the areas in which clergy and patients often feel uncomfortable is getting a second opinion for a medical procedure. A patient or family may fear that this will offend their physician. However, second opinions, especially in serious interventions such as surgery, are becoming routine. Some industries which partially provide workers’ health insurance discount costs to the employee when a second opinion is sought. Health care providers should respect the right of individuals to this type of consultation. Usually it is wise to notify the original physician of this second consultation. Often this physician can facilitate referral to a competent colleague. At the very least, the pastor can alleviate any feelings of guilt or disloyalty the parishioner may have in seeking a second opinion. Such a consultation is a wise and increasingly routine procedure.

      You now have the basic map for orientation to the hospital, making your call or visit, and dealing with some of the special issues of the patient's environment. With this information, it is up to you to develop your own unique style. Pastors who shared data for this chapter each prefer different times to visit. One finds non-visiting hours to his liking. Another sees the mid-afternoon as the time a patient is most free of other procedures. One pastor makes a point of visiting late in the evening the night before surgery, a time when a patient often feels most alone. That same pastor by the way also added, “I never bring the altar flowers.”

      How you use this information is up to you. Now we move on the more specific situations.

      Bibliography

      Biegert, John E. Looking Up While Lying Down. New York: Pilgrim, 1983.

      Clinebell, Howard. Basic Types of Pastoral Counselling. Nashville, Tn.: Abingdon, reissued 1984.

      Nelson, James B. Rediscovering the Person in Medical