Pastoral Presence - A Ministry of Care and Hope
Christian ministry to the sick or dying creates and environment from which a patient may draw physical, emotional, and spiritual sustenance. This environment of caring is created by the Holy Spirit and mediated by pastoral presence.
We must first remember that our visit is an offer of presence. The patient may or may not accept this offer. Many variables having nothing to do with our merit as visitors can lead the seriously ill patient to withdraw from our presence. Love compels us to accept both the decision to welcome and the decision to withdraw.
Pastoral presence can be shared with the sick or dying person through prayer, scripture, touch, empathy, and listening.
Prayer at the bedside can be meaningful or mechanical. The difference is determined by the sense of participation experienced by the patient and the visitor. In the case of an unconscious or confused patient, the family members in attendance may become primary participants.
Each patient has a different devotional makeup. Patients with deep spiritual maturity will experience prayer differently from patients who view prayer as a kind of theological magic.
Guidelines for Prayer
Prayer with purpose. Be specific about your petitions for the patient based on what the patient has shared during the visit. Relevance and specificity communicate sincere interest in the patient.
Put the patient in control. When the conditions of the visit create some doubt about the propriety offering prayer, say to the visitor, "I will be praying for you during your illness." If the patient responds positively, ask the question, "Would you like for me to join you in prayer now?" While most patients respond positively, asking the question allows the patient to control the depth of spiritual sharing and set the stage for building trust.
Avoid preaching to the patient with your eyes shut. Do not use prayer to teach, correct, persuade, or challenge.
Avoid praying at such a rapid pace that the patient might infer insincerity. Pausing for a few seconds before beginning the prayer can help to calm and assure.
Avoid trivializing prayer by competing with noisy distractions like a loud television, boisterous visitors of the patient in the next bed, or clanging equipment operated by the medical staff. Allow these tasks and distractions to exit before beginning prayer. The dignity with which we treat the act of prayer sets the tone for the patient’s participation.
Avoid using prayer as means to shorten or conclude the visit. Prayer should happen in natural progression and not as a way to cope with anxiety over the patient’s distress or to control the length of the visit. Patients can sense this impropriety and consequently feel disregarded and manipulated.
Use the patient’s name in prayer. Praying for "this, our brother" or "this, our sister" in the petition will be rightly received as impersonal. When visiting someone unfamiliar, clarify the name and proper pronunciation at the beginning of the visit.
God’s presence is revealed in and mediated through Scripture. Because the Bible speaks directly or indirectly to every need and because patients embody a multitude of needs, it is important to share scripture skillfully and carefully:
Be brief. Seriously ill patients do not have the stamina or power of concentration for a Bible study or lengthy reading.
Commit helpful passages to memory for use in prayer. Some appropriate selections are Isaiah 41:10; Psalm 146:5; John 14:18; Romans 5:3-4; and Revelations 21:4.
Be sensitive to the moment. Some visits will not lead to the readings of scripture or its use in prayer.
Notice the patient’s spiritual or devotional literature as you enter the room. The presence and identity of this material may provide clues concerning the patient’s receptivity.
Read passages of scripture that have been meaningful to the patient in the past. Once the invitation to read scripture has developed during the visit, the visitor may ask the patient for favorite or best-loved passages. Be careful during serious illness not to require more energy and reflection than the patient can generate.
Touching is a powerful nonverbal communication. Because they are sometimes lonely and isolated by their illness, patients need touch to sense genuine concern. A caring, tender touch such as holding a patient’s hand during prayer communicates blessing. Propriety dictates how to touch the patient. Touching the hand or the forearm is appropriate for patients of the opposite gender. Gently touching the patient’s shoulder is an alternative for persons of the same gender.
Mediating Christ’s love entails developing sensitivity to the patient’s experience. While diseases can be diagnosed and verified with ever-increasing precision, the individual patient will have a "private interpretation" of being ill. The attitude, which enables the visitor to grasp these unique interpretations and experiences, is called empathy. Empathy means freeing us to see, understand, and experience life through another’s being.
Listening is the heartbeat of pastoral visitation and the radar that guides us into the empathic understanding of the patient’s experiences. Intuition alone cannot substitute for listening. Disciplined effort is required to share the meaning of other’s experience. Before visiting the patient, pray for the strength to listen in order that the grace and love of God may be manifest in conversation.
God listens to all of us. We should listen to each other.
Most people believe they listen better than they actually do.
Each patient is unique. Do not assume to know the patient’s values, needs, concerns, and attitudes without careful listening.
Listening involves the whole body. Behaviors that can help patients know our interest in their feelings are called attending behaviors. They include (1) taking a comfortable position that allows us to make easy eye contact; (2) maintaining an alert posture such as leaning slightly forward; (3) maintaining a relaxed demeanor. Avoid standing with arms folded (nonverbal statement suggesting a barrier).
Listening involves all the senses. Observe the patient’s nonverbal clues. Are the patient’s physical behaviors (facial expressions, fidgeting with his hands) congruent with verbal messages? Nonverbal clues are indicative of the patient’s feeling and thinking.
Listening for the tone of voice as well as the content of the patient’s statement.
Resonate with the patient’s communication. Do not be thinking of the next response to the patient while he or she is talking.
Listening is interactive. Communication is completed, and the patient is affirmed when we verbally follow up the patient’s conversation. Respond with restatement of the patient’s statement that seems parallel in meaning. Example:
Patient: "God must be mad at me. I’ve had so many problems with my health, just when I was planning to retire."
Visitor: "After experiencing so much hardship, you’re wondering if God is being fair."
Be alert to the meaning of the patient’s disclosures, rather than the facts. As a rule, do not probe for facts. Allow the patient to reveal what is important by responding to his or her feelings.
Responses the visitor might employ combine a feeling word gleaned from the patient’s message with the context of the feeling. Examples:
"So, you feel frustrated because of this confinement."
"I’m sensing how frustrating this illness has become."
Listening may require more than one visit. Our willingness to listen non-judgmentally over time can free the patient to risk genuine feeling without fear of ridicule or rejection.
Ministry to the Dying
Even though we are ever journeying toward death, the prospect of death becomes a crisis when the patient experiences a terminal diagnosis. Ministry to the dying is the ministry of companionship. The visitor listens empathetically during multiple visits as the patient explores what has and does mean the most to him or her. The visitor attempts to be open to the patient’s intense feeling. The visitor tries to support the patient’s family members by allowing them to share honestly what they are feeling.
Considerations for Ministry to the Dying
Death generally occurs a little at a time. Some patients integrate death into their lives over time while others fiercely deny death. Eventually denial will yield to other powerful feelings. This progression is normal. Allowing and receiving the full expression of feelings is a vital part of ministry to the dying.
Feelings spotlight an inner struggle against emerging losses connected to the following needs: control, personal identity, relationships, and sense of completeness. Don’t give false reassurances or minimize problems. The patient will perceive that he or she cannot be honest about troubling concerns.
Be alert to what is known as "unfinished business." Are there persons to whom the patient wants to be reconciled?
Allow the dying patient as much control as possible. Honor as many choices as possible relating to a wide array of concerns: food, visitors, and spiritual resources. Do not impose opinions when the patient is so vulnerable.
If chosen to listen, allow the patient to "tell his or her story." This is a time of exploring the chapters of the patient’s life and a process that helps the patient accept life for what it has been and what it will be.
There will be times when the visitor will be helpless to comfort the patient and will have to wait with the patient for the promise of Christ: "I will not leave you orphaned; I am coming to you"(John 14:18). Our primary task is being present.
Sharing ourselves with the sick and dying is sharing Christ. Through presence, prayer, scripture, empathy, and listening, we share Christian hope. People who are sick and dying need hope as much as they need medical care. Our presence with them as a servant of Christ and members of his Body brings the gift of hope.