PlainViews

Rev. SeungJin Kim Yun on why healing moments sometime happen

Cultural Hospitality in a Foreign Land

Last November, my clinical site mentor at North Shore University Hospital, the Rev. Jon Overvold, referred Mr. A, a Korean patient, to me. Mr. A was being treated by the palliative care team under the supervision of Dr. Fred Smith. Mr. A was not open with the medical staff, and he refused to be visited by either a social worker or a chaplain. Nevertheless, Dr. Smith and Rev. Overvold thought that he might have a cultural issue that I could help with.

Mr. A was fifty years old and he came to the U.S. when he was in his twenties. He had suffered from cancer since March, 2005, and the disease had spread throughout his body, including his bones. His siblings and two children lived in California. Only his fiancée stayed at his bedside; she was always there whenever I visited.

Mr. A did not want to see a chaplain at first, but he welcomed me when he saw that I could dialogue with him in Korean. I visited him many times, and each time I prayed with Mr. A and his fiancée. It was an important part of the healing process for them to connect spiritually to God and to each other. On my third visit, we experienced a sacred moment while I was praying for him. After finishing, he told me that he felt like he was in heaven, and he believed that I was an angel who had been sent to him by God. Later, he told me that he had never felt God’s presence before although he used to go to church, but now he really believed in God and His love. After that, he looked like he was comfortable physically, emotionally and spiritually.

Shortly after this encounter, Mr. A’s interactions with the palliative care team members became more effective and easier. He remained much calmer until the next month when he passed away. Dr. Smith told me that after my visits, Mr. A’s attitude totally changed; the difference was night and day. He asked me what had happened between the patient and me.

Why did the healing moment happen between the patient and me?

First, I believe that God was with us when I visited him. Second, since I have come to the United States, I have realized that, though a chaplain and a patient may have different religions, races and cultures, pastoral care still occurs effectively between them. Nevertheless, in Mr. A’s case, he seemed to be more comfortable and was willing to share his feelings with a chaplain from his first culture. Finally, because of the pastoral skills I learned, I was able to walk with him in his suffering, help him to express his own stories and true feelings, and offer him spontaneous prayer, custom made for him each time I visited. Many clergy, though highly educated, are not trained to be with patients in this way.

Of course, it was God who healed the patient’s spirit, not me. I feel humble and thank God for using me as a tool of His work.

SeungJin Kim Yun completed a pastoral residency at The HealthCare Chaplaincy in Manhattan in 2006. She served at North Shore University Hospital in Manhasset as a Chaplain-Resident. Previously, she completed four CPE units at Bellevue Hospital and NYU Hospitals Center. She was ordained by The Presbyterian Church of Korea and has worked as a chaplain at The Yonsei Medical Center in Korea.

Do you have thoughts about professional practice you’d like to share with your colleagues? Send an e-mail info@PlainViews.org.

Editor's note: Because the responses to the two articles about volunteer chaplains are raising some major issues for chaplains, we have chosen to place these comments in the context of Advocacy, since some believe that the number of chaplaincy jobs are affected by the increased use of volunteer chaplains.

I am glad that Chaplain Donovan has continued the discussion on Volunteer Chaplains. The situation in Australia causes me deep concern. Many denominations are not seeing chaplaincy as part of their "Missional" (the in-word) programs. It does not put many more sitting in their pews. Increasingly they are reducing the number of paid chaplains and appointing volunteer chaplains for one or two days a week who are nothing more than denominational visitors. Unfortunately the institutions are putting them into the same basket as chaplains. The new privacy laws do not allow them to see patient’s lists. Some hospitals are legalistically insisting that pastoral visits may be made only to those who request it.

As a consequence, applications for membership to the Australian College of Chaplains, (the equivalent to Board Certification) have dropped considerably. The Registrar reports show a drop in active membership due to retirements, with minimal interest by the volunteers. This type of addition to the Chaplaincy Departments means that fewer chaplains are able to become and be recognized as members of the unit's clinical teams in the hospital.

Perhaps we should be more stringent in our classification of Chaplaincy department members identifying them as Lay Visitors, Lay Pastoral Visitors, Clergy Visitors and Chaplains as set out in my "Pastoral Care in Hospitals". Perhaps then hospitals will be able to identify and cooperate more with the professional chaplains in the department. Professional chaplains must be able to walk tall alongside the professionals of other disciplines in the unit and institution as a whole.

My own involvement as a professional chaplain resulted in being issued with invitations to present papers at three Post-Graduate Medical Conferences with the following titles: "Organ Donations as an Aid to Grief", "Team Work in the Emergency Room" and "Terminal Illness in Teenagers". The first was the result of being summons to the ICU each time life support systems were to be stopped. I sat with the relatives as the Medico spoke to them of the possibility of the donation of their loved one's organs. About 80% denied the request saying that they did not want their family member's body to be mutilated. The doctor left the room. I sat with the relatives and discussed the pros and the cons of donation. Within a short time and without pressure half of those who refused changed their minds.

The ICU Director presented a paper at a National Conference of Intensivists showing how the Chaplain's presence resulted in more than a doubling of the years' donations of organs from the Unit. The present report is that the Chaplain is no longer involved in this process and the donations have dropped.

Churches must be made aware of the value, the practice and the importance of full-time (in one hospital) professional chaplaincy and that part-time volunteers are at best little more than pastoral visitors.

Once again thank you for this opportunity to respond to articles in PlainViews.

Neville A. Kirkwood
Queensland, Australia

The article by Chaplain D W Donovan on A RESPONSE TO VOLUNTEER CHAPLAINCY was excellent. I am aware of an organization that provides hospital/nursing home visitation by lay men and women who refer to themselves as "chaplains." At first, I was shocked, but got over it because they really just do not understand that there is a "difference." I tried to explain, but got nowhere. The organization has been ministering for YEARS. I am grateful that these men and women who take their "gift of visitation" seriously for Jesus' sake. Please thank Chaplain D W Donovan for me.

Louise M. Hutchinson, Chaplain
Fall River, MA

Here’s another thought about the question of using volunteer chaplains. It was suggested that chaplains are “an extension of the church”. While I belong to a church and am endorsed for ministry (ordained) by that church, in my professional role I am the Interfaith Chaplain (emphasis added). There is even some discussion about whether “chaplain”is the best title for one engaged in interfaith spiritual care, since it is rooted so firmly in Christian history. I minister to people of all faith traditions and none, for the experience of illness affects the spiritual health of all people. I operate from a theological conviction that the Creator wills and intends for us to become whole persons –physically, mentally, spiritually, and emotionally. The resources of one’s own and other traditions can assist in that journey to wholeness. Some patients and families will indeed want –and they get –the ministry of the church, through prayer, sacred readings, sacraments and other rites, and connection with their tradition and its representatives. There are a lot of people, though, who do not belong to any organized faith group and do not intend to form this kind of connection. I seek to bring the conviction and hope that healing and wholeness are possible, rather than “the church”in an official sense.

On the other hand, (trained) volunteer pastoral visitors can and should be an extension of their own church to their own members. That kind of support and connection is extremely important in the journey of recovery and navigating the changes that may be happening in the person’s and family’s life.

I’m happy to see Chaplain Donovan’s response to my article. I appreciate that he is approaching this question from a perspective of bringing together spiritual needs and the capacities of the clinically trained chaplain.

I believe that Chaplain Donovan has confused specifics of function with the parameters of practice. These days passing water, etc, are not commonly done by RN’s or LPN/LVN’s. That does not remove them from nursing functions. Professional nurses coordinate these interventions, and determine how they will be delegated. So, while not commonly carried out by RN’s or LPN’s, they remain part of the professional practice of nursing. Nurses have worked hard to express a practice and body of knowledge for nursing. In doing so, they have not repudiated the basics of hands-on care. Instead, they have delegated some of those functions to others who function under supervision. Those activities may be poor use of a professional nurse’s time, but are within professional nursing’s and purview.

In the same way, the fact that some interventions might fall within our professional purview does not require that only we provide them. I may –sometimes I must –delegate or refer out a spiritual intervention. That does not suggest that those interventions have ceased to be within our professional expertise. I cannot provide all the spiritual care that happens in my hospital. I can, however, oversee a program to reach throughout the hospital. I can educate staff in addressing spiritual needs. I can collaborate with local faith communities for specific needs. I “assess needs and determine interventions,”and am uniquely trained for that. However, I can delegate some activities of spiritual support to properly supervised students or trained volunteers.

We are certainly integral to the health care team. We are integral, but we are not “medical”practitioners, or “nursing”or “pharmacy”practitioners. We are those on the team with expertise in spiritual care; and, indeed, spiritual care is why they want us there. Thus, I continue to see the definitive context for our work as ministry, as spiritual work.

Administrators do want those who “cook the best vegetables.”To follow that metaphor, we need to be clear that we are trained as chefs. To feed more people, it is poor use of our professional time to mop floors when we need to be at the fresh market. Our professional training prepares us to implement a broader vision of spiritual care for our institutions. Appropriate leadership of students and volunteers can be part of that implementation. It extends our ministries, rather than diluting or diminishing them. Providing caring presence and information about spiritual care are within our professional purview, but don’t always require our highest expertise. To delegate those functions does not make them less our responsibility, or make us less chaplains; but it can mean more patients have access to compassionate spiritual care.

What do you do when you are serving as a chaplain to a family that exhibits complicated family dynamics that are remarkably similar to those of your family of origin, and you feel yourself being drawn into their conflicts? How do you best get distance, clarity and professional consultation? Which way should you turn if you are a CPE supervisor whose students are relentlessly working out their authority issues, and you are the chosen target?

My answer to both of these questions, and to many others of similar kind, is to receive a consultation with a peer supervision group.

I’ve been working closely with a group of supervisory peers, and receiving ongoing consultation, since I was first certified as a CPE supervisor and was happily kicked out of the supervisory training nest. This small group of CPE supervisors has remained remarkably stable in membership, and over the years we have developed a deep knowledge of one another’s strengths and learning edges. We have also been through numerous life changes and struggles with one another. This group knows me well enough to challenge me when I’m blinded by my own counter-transferences. They have pointed out my foibles and inconsistencies at critical moments in my supervisory and professional life.

These interventions have often been the keys to helping me unlock new understandings and to making good supervisory choices and interventions. My peer group has also supported and encouraged me to make best use of my gifts for my ministry. They have provided support out of their care for me, and their knowledge and experience of who I am.

As a group, we have dedicated ourselves to providing clear feedback to one another and we have committed ourselves to working with the intricacies and challenges within our own group dynamics with honesty and openness. This isn’t always easy or pleasant, but it is always profitable for us as individuals and as a group. We also challenge one another intellectually and share new resources that can lead to exciting new learnings for all of us. The challenges and support of this group has been invaluable over the years as my roles as a supervisor have shifted and changed.

I share my story to encourage all in ministry, chaplaincy and clinical pastoral education to develop and make good use of a peer consultation group. As chaplains and supervisors, much of our clinical training took place in the small group context, in which peer feedback was one of the central learning components. But why should the many benefits of peer group supervision be experienced only during the short period of time when we are CPE students?

One of the objectives of CPE 309.10 is “to develop students’abilities to use both individual and group supervision for personal and professional growth, including the capacity to evaluate one’s ministry.” ACPE Outcome 311.3 is to "initiate peer group and supervisory consultation and receive critique about one’s ministry practice”and, outcome 311.4, to “risk offering appropriate and timely critique.”These all speak to the value our professions put on ongoing peer consultation. These outcomes are also excellent goals for those continuing to develop as pastoral care givers, and suggest how growth in ministry is supported by honing the skills of giving and receiving clear feedback and support in a peer group context.

The basics of building a strong peer consultation group involve consistent membership, clear group guidelines, and the development of group norms that are structured around the practice of ministry and supervision, rather than on therapeutic issues. I have found it beneficial to have group members that have theories and styles of practice that I respect, yet who bring differences that challenge me as well. Flexibility and compatibility are also important. Most important is respect and a common goal of supporting one another’s growth. Receiving and giving ongoing critique and support of one another’s practice of pastoral care and supervision greatly benefits those who receive our care as well as us as caregivers.

Do you have thoughts about education & research you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

Yoga as a form of exercise and meditation—strengthening body, mind and spirit together—really appeals to me. I am not an avid practitioner, nor do I know many poses, but I have been known to cajole my colleagues into joining me for a non-coffee break once in a while.

Three weeks post-Caesarean delivery of a healthy baby boy, I did not have too much time for yoga. Sleep had priority, at least over physical yoga. I found myself practicing a different kind of yoga, though –the existential kind.

As yoga is made up of poses that challenge flexibility and balance to produce strength and wellness, so functions my "existential yoga." My gurus or teachers are my three children, 21-month-old twins and my new baby boy. The twins have been actively teaching me since their birth, but I have become aware of these lessons only as I have had time to reflect while nursing my new one.

Flexibility is key to yoga just as it is to being a working mother. When I am too rigid and controlling, my children remind me I am not the only one with an agenda and my priorities are not shared by everyone else. Getting dressed can happen after a book has been read rather than the other way round.

There are times when routine can be changed and rules can be bent. Soap bubbles can be blown indoors, which actually makes cleaning the kitchen floor easier –the soap’s already there! This lesson on flexibility has translated nicely into my work as a pastoral caregiver. I need to focus on the people I meet and on their needs instead of on my own agenda. Flexibility at home and in the workplace is an important lesson to learn.

Most folks I meet, myself included, need to work on balance in their lives. My practice of existential yoga has reminded me that God has issued three calls in my life, and no one call takes precedence over another: I am called to be a wife to my wonderful husband, I am called to be a mom to my three children, and I am called to be a pastor serving as a hospital chaplain.

Though I may need to shift emphasis from one call to another during the different seasons in my life, there is no hierarchy of call. All of these blessings and responsibilities come from God and must be balanced for my well-being. When I pay attention to my little gurus at home and learn the all-important messages they teach me, I am a better pastor. When my relationship with my husband is nurtured and we are communicating well and enjoying each other, I am a better parent. Exercising the specific gifts and talents God has given me for being a hospital chaplain helps to challenge and fulfill me mentally and socially so I am able to be a better mom and wife when I am at home.

Yoga is a challenging form of exercise. It takes quite a bit of practice to be able to bend oneself into the more difficult poses and then hold them. But with practice, the process becomes easier, less painful and leaves one feeling energized and at peace.

When I am mindful of flexibility and balance and how to utilize the lessons of existential yoga in my life, I too feel more energized and at peace. This does not mean I am never bent out of shape. I am constantly being stretched and challenged, but when the perspective of increasing flexibility and the ability to balance are applied, I find I am all the stronger in the end.

Parts of this article were originally published in the Argus Leader on 2/25/06.

Do you have thoughts about spiritual development you’d like to share with your colleagues? Send an e-mail of any length to info@PlainViews.org.

EthicsWalk addresses spiritual care as an ethical enterprise. It explores why relationships between spiritual care providers and those they serve need protection, and examines what that protection entails. PlainViews invites our readers to share their responses to each EthicsWalk column, which will be published in the following issue.

If you’d like to respond to EthicsWalk, please send a comment of no more than 100 words. You can use the e-form below (click on "hearing from you," link) or submit your commentary to the editors in the body of an e-mail (or as a Microsoft Word attachment) sent to Info@PlainViews.org. Please put the phrase “EthicsWalk” in your subject line.

We look forward to hearing from you.

In "Surrogate Health Care Decision Makers," Anne Underwood states "DPAs are not limited to end-of-life issues; they serve whenever a person becomes incompetent at any stage of life by disability or illness." While, in general, the statement is true it is possible for a DPA to be limited. For example, a free booklet written by the ethics committee of my hospital contains the following in its "Power of Attorney for Health Care" in the obligatory warning section: I understand that it (the POA-HC) allows another person to make life and death decisions for me if I am incapable of making such decision. Because of the limitation to life and death decisions written into the document I successfully lobbied for another version to also be available that makes the POA-HC effective for any medical decision. This is shared just to remind us that the safest course for those who need to rely upon an advance directive is READ THE DOCUMENT. Even better would be the document plus a clarifying conversation between the earlier competent patient and the surrogate and other key decision makers, but in the absence of such there remains the caution: READ the document.

Dale Pracht
Director, Spiritual Care Services
Faith Regional Health Services
Nebraska

In response to the comment "A health care guardian must follow any advance health care directives expressed by the patient when she or he had capacity," my understanding is that the health care agent can override the living will to the extent of allowing a temporary trial of some life support intervention to test possible benefits. In many cases, this has involved a slow process of assisting the family to work through their own grief and emotional barriers to following the patient's wishes. So my question would be: Are you saying that if someone challenged the process described above in a court of law the health care agent could be required at that time to follow the patient's wishes? Or are there more general practical implications that I'm missing?

Because both of these comments require more than a brief response, Anne will address them in her article that will be in the next issue.

Rev. Gordon Putnam discusses the value of chaplains’asking clarifying medical questions for patients. [PlainViews, 10/18/06] Similarly, chaplains may be useful in clarifying roles of people functioning as agents for incapacitated patients.[1] Such agents most commonly hold a Durable Power of Attorney (DPA) for Heath Care [2] and often are family members or close friends of the patient. DPA’s are recognized, albeit with variations, in every state, and offer the strongest avenue for patients’health care wishes to be advocated and honored. DPAs are not limited to end-of-life issues; they serve whenever a person becomes incompetent at any stage of life by disability or illness. Wisdom suggests everyone designate a DPA while competent to choose.

When a patient becomes incapacitated (a medical determination) and has not designated a DPA, if dissension arises among relatives and/or with the medical team, a court may be asked to appoint a guardian. Relatives, close friends, or medical personnel make the request. Before acting, the court hears evidence to determine if the patient is competent (a legal determination). If the court determines the patient incompetent, a guardian is appointed. When there are significant property assets, a conservator may be appointed to oversee the estate.[3]

State probate or surrogate codes set standards for incompetency and delineate the responsibilities of guardians and conservators.[4] This discussion uses language of the Uniform Probate Code [5] (UPC) adopted by eighteen states.[6] All states use similar language and concepts.

Guardians have most of the powers and duties that a parent has toward a minor child, although guardians do not provide for patients out of the guardian’s own resources. To the extent possible, the guardian should include the patient in decision- making processes. Guardianship may be limited to health care (or other types of decisions) or may encompass all aspects of the patient’s life. It may be permanent or temporary. If the patient has a small estate and no conservator, the guardian’s authority may include managing the patient’s money and property. [The resources of the patient must never be co-mingled with those of the guardian.]

A health care guardian must follow any advance health care directives expressed by the patient when she or he had capacity. The guardian must consider the patient’s personal values when making decisions on the patient’s behalf. However, the guardian has no greater power to determine course of care than would the patient have if competent.

Appointment of a conservator may be permanent or for a “single transaction”to manage the business/financial/property affairs of a patient. If there is a guardian, the conservator must consider the guardian’s recommendations as to the best interests of the patient, but the final management decisions for which the conservator was appointed belong to the conservator.

If relatives, friends, the medical team or anyone else concerned for the patient believes either the guardian or conservator is acting outside the best interests of the patient, the court can be asked to terminate the guardian or conservator’s appointment.

DPAs for health care are a regular component of many lawyers’discussions with clients making wills and doing estate planning. Their importance should be stressed in health-care discussions between clergy and congregants –especially hospital chaplains.

[1] The Uniform Probate Code (UPC) defines incapacitated as “any person who is impaired by reason of mental illness, mental deficiency, physical illness or disability, chronic use of drugs, chronic intoxication, or other cause except minority to the extent that he [sic] lacks sufficient understanding or capacity to make or communicate reasonable decisions concerning his [sic] person.”Most states use some form of this definition. Capacity usually is discussed in conjunction with “competency”, the later which is “specific rather than global and depends not only on a person’s abilities but also on how that person’s abilities match the particular decision-making task he or she confronts.”Principles of Biomedical Ethics, Beauchamp and Childress, 2001, p.70.
[2] Also known as Health Care Proxy in some jurisdictions.
[3] The UPC sets forth the following list in order of preference for the appointment of guardians or conservators: 1. The person or organization nominated in writing by the person in need of a guardian or conservator; 2. The spouse; 3. An adult child; 4. A parent; 5. Any relative with whom the person in need…has lived with for more than six months prior to the filing of the petition; 6. A person nominated by someone who is caring for the incapacitated person or paying benefits to him or her.
[4] One must consult the Probate or Surrogacy Statues or Code of the state in which one’s facility is located. A Goggle search of the Uniform Probate Code will reveal most state sources, or call a local lawyer for statutory references.
[5] Uniform Probate Code was approved in 1969 by the National Conference of Commissioners on Uniform State Laws and the House of Delegates of the American Bar Association. The intent was to unify terms and processes among the states. Unification remains illusionary.

We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place. Please send any cases that you would like considered for inclusion to: info@plainviews.org

We hope that this new addition will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

A 94-year-old woman falls and breaks her hip. She is brought to the hospital and refuses surgery to repair her hip. Mrs. S has been an independent woman, who lives by herself, still drives and her ADL (Activities of Daily Living) level is very high. The staff, believing that she does not understand that she could return to her home and have a meaningful life after surgery and rehab, continually try to convince Mrs. S that she should have the surgery. Mrs. S keeps saying that she wants to go to a nursing home, be given adequate pain medication and allowed to die. Her 69-year-old daughter is furious at the staff for trying to "convince" her mother to have the surgery. She meets the chaplain in the hall and tells the chaplain what is going on. The chaplain, a member of the Ethics Committee, wonders if this should be referred to that Committee.

Should the chaplain suggest to the daughter that she ask for an Ethics Consult?

The case described of an active 94 year old who declines hip surgery and asks, apparently, for comfort care raises a few ethical and advocacy issues from a chaplaincy perspective. First, was a family meeting arranged and held with the patient, family, and medical team? This could help discern a) whether or not the patient is truly making an informed decision, and b) whether the family is respecting her wishes or trying to superimpose their own in their apparent reaction to the staff. Surgery is always risky with someone of such an advanced age, but a question I would have is does she (the patient) understand that, barring major complications, such a surgery would most likely enhance her comfort level in the long run?

Second, I would try to meet individually with the patient to assess whether she was, indeed, expressing her own wishes, or whether she felt pressured or coerced in some way by her daughter or other caregivers. If there was any question about her mental acuity or competency, I would suggest that the medical team request a psychiatric consult to assess competency. If she was not deemed mentally competent, then the decision-making for her healthcare would be handled by her durable power of attourney for healthcare, or if none had been named, to her next-of-kin, by default.

Third, before any surgery occurred or even a consult to the ethics committee, I would try to talk to the patient to see if she had discussed her treatment wishes with her daughter and doctors, AND if she had completed an advance directive- and specifically who she had named as her DPOA for healthcare. She may not even want her daughter involved in such decisions, so that would need to be determined before involving the daughter any further.

Fourth- regarding an ethics consultation- whether and at what point the ethics committee was consulted would depend on several factors - such as the organizational policy for consulting the committee, as well as the outcome of other interventions. At our organization, an ethics committee consultation is an option to be explored after other interventions have been attempted. Certainly, the patient, and daughter (if she is recognized as a DPOA), should be made aware of their right to an ethics consultation, and second opinion - both verbally and in writing. These interventions are all integral components of the advocacy side of chaplaincy, as I see it.

Rev. John Olsen, M.Div., B.C.C.
Staff Chaplain
Abington Memorial Hospital
Pastoral Care Department

The chaplain surely must be involved. I have been in a similar situation. Approach the patient in a way that lets her know you are her advocate but that you will be also making sure that all information has been provided to both physician and patient. It could be that the patient simply doesn't want surgery and is willing to live with the pain and discomfort, but I have found that to be rare. Assess if her refusal stems from something deeper than she is presenting to the medical staff. It turns out it my case, that the patient had a bad experience with doctors many years ago at another hospital. She also didn't want to be a
"weight" on her family. Chaplains need to be in on these conversations about fear and dependence. In my case the patient, by not having the surgery, ran the risk of her broken hip bone severing her common femoral artery. The chaplain in my opinion needs to encourage the staff to be patient. Frustration and anger from staff would only lead to less openness from the patient. Being on the Ethics committee myself, I had to make sure that the patient understood the doctors and that the
patient was making her decision based on good info and had every chance to refuse or accept the offer for surgery. I would inform the daughter that as a medical team, our physicians have a responsibility to make doubly sure that the patient is aware of all scenarios if patient refuses surgery and that we would never force surgery on anyone. In my hospital's case we planned family meetings and informed pt and family of risks. She decided to go ahead with the surgery and recovered successfully. It is my belief that she changed her mind because she was listened to and someone heard her fears resulting in her anxiety level subsiding. If the case presented is not soon reconciled one way or the other I would have someone call an ethics consult. I doubt, however, I would present that as an option to the daughter. If I thought there needed to be an ethics consult I would call for one and of course inform the patient and daughter.

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In The Essential Parish Nurse, Deborah Patterson has provided an easy to read and thorough guide for establishing this important ministry/service in a local congregation. The book is adaptable to various religious congregations or spiritual groups. From the Christian perspective, she connects the health ministry of the church with the “calling from Jesus Christ…Parish nursing is one vital way to have an effective health ministry in a faith community.”(Pg. 22)

She is clear that a health ministry (service) be for all. She traces the history of the development of parish nursing from its very beginnings to the work of Dr. Granger Westberg. The parish-nursing program is now grounded in the Scope and Practice of the American Nurses Association and other professional groups. Provided in the book are all of the “essentials”to developing and maintaining parish nursing as part of the ministry/service within a local congregation. Guidance is given for preparing the congregation, recruiting the nurse, roles and functions, clarity of authority and guidance from a health council, and even forms for use within the parish nurse program. A course outline is available for a parish nurse program.

Helpful guidance is given for conceptual as well as practical matters for establishing this ministry/ service. Methods of payment, record keeping, and work with volunteers is also provided. In addition to structure, she also addresses relationships within the leadership of the congregation. This is an important matter for clarity of boundaries of responsibilities and confidentiality.

Connections are made between the content of the program, Scripture, organization theory and theology. There is an integration of healing, health and holiness understood within the life of the congregation and based upon spiritual truths.

The book is a helpful resource for a congregation planning on making a health ministry/service available to those within and outside their congregation. The listing of national related organizations, a well-rounded bibliography, and models of surveys, etc., make this a valuable resource for conceptual and practical guidance.

The helpful addition to the book would have been addressing the parish nurse’s requirement to nourish their own spiritual life so that their relationship with the Divine One remains the vital source of life, compassion and strength for their ministry/service. Forming a parish nurse support group would be an effective way of nurturing their relationships without being competitive with relationships in the local congregation.

The Essential Parish Nurse will make the ministry/service to others truly a gift from God.

Patterson, Deborah L. The Essential Parish Nurse (Cleveland: The Pilgrim Press, 2003) pp.160.

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