snyder j2014 fp
TRANSCRIPT
Prayer in Emergent Healthcare Settings:
Forming and Casting a Vision for Involving Prayer in Patient Care
Rev. Kris Leland Snyder
PT814 – January Term 2014
Rev. Dr. Sharon L. Lewis
April 1, 2014
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Prayer in the intensive care unit can be an ellusive often departmentalized
endeavor in most public hospitals. Considering that this task is even challenged in non-
for-profit hospitals the question of prayer, who enables and empowers the family and
paitent in this task, and how to best ethical practice prayer in the emergent healthcare
situation brings much challenge to chaplains, heatlhcare workers, nurses, and parish
pastors.
Ideally the task of answering if prayer has a place and can advance a movement of
God either for health or mercy begins with addressing the spiritual concerns patients and
families present with. Patients and families can at times have niave experiences in prayer
further complicated by tinges of fundementalist theology which idealize the
conceptualization of a God who answers all prayers - at least in the way we would
expectantly hope.
Hospital chaplains stand in a place and time of guidance and present a climate of
correction. As we struggle to grasp God's will and ultimate plan be it for our medical
needs let alone spiritual needs chaplains assist to identify key areas of strength when
concerning faith, how to evoke and assist this faith to speak into the doubt and times of ill
health, and how to move the family forward with a sense of hope and empowerment
vocaized by their acceptance and believing in a God who hears and answers all prayer.
From a Judeo-Christian perspective the practice of prayer is well documented and
supported as a means to bring about the presence of God, the hope of an eventual
outcome, and the reality that God remains active in the lives of His chosen people. Given
the level of anxiety often present in emergent care situations prayer brings about a sense
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of calm, the affirmation that God is truly dwelling in the uncertainty of the situation, and
the availability mortal man has to call on a God revealed in the Holy Scriptures.
Protestant Christians value the access to prayer as articulated in the work, “The
Lutheran Difference”. “The devil wants to drive us away from God and His kingdom. In
the Sixth Petition of the Lord’s Prayer, we pray for God’s protection from temptation. In
the Seventh Petition, we acknowledge that God does protect and deliver us from evil.”
(Pfotenhauer 2010, 346) Through prayer and in particular the official prayers taught in
the catechism of the Lutheran Church we have direct access to God. Even in times of
grave trouble the comforting words of the Lord’s Prayer lead us to believe in God’s
divine and good will for us whatever the outcome may be.
Luther in his Large Catechism gives further instruction to pastors when educating
the laity of the church on prayer. “Besides this, we should be moved and drawn to
prayer. For in addition to this commandment and promise, God expects us and He
himself arranges the words and form of prayer for us.” (Pfotenhauer 2010, 352) To
advocate and assist in the prayerful conversation with God becomes the responsibility of
the parish pastor primarily but in such absence or in the emergent care need of the patient
the hospital chaplain or spiritual care worker becomes the voice of one walking alongside
of the sick and dying.
Reformed theologians have advocated and pressed clergy to be concerned about
the practice of prayer - a task entrusted to the church to the benefit of the faithful. “The
blessings entrusted to the church. Whom God has entrusted with His spiritual and
heavenly blessings, in order that they might ordinarily be imparted there, must not be
regarded as useless and unnecessary to seek. And God has entrusted them to the church –
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namely, the Word, the Sacraments, the Keys of the Kingdom of heaven, the power to
loose and bind – in order that these spiritual gifts may be imparted to [to man] there.”
(Calov 2012, 135) Many such tasks are given to the church such as the preaching of the
Word, the right administration of the sacraments, and additionally for the sake of this
examination, the proper instruction and application of prayer as a useful means to attain
communication with God.
Scripture points to the importance of prayer and its ability to transcend difficult
situations. “14 if my people, who are called by my name, will humble themselves and
pray and seek my face and turn from their wicked ways, then will I hear from heaven and
will forgive their sin and will heal their land. 15 Now my eyes will be open and my ears
attentive to the prayers offered in this place.” (2 Chronicles 7:14-15) As demonstrated
continually through the witness of the Hebrew scripture the connection between God’s
people and prayer cannot be denied. By its very nature prayer becomes an open channel
for God’s children to uplift concerns to a God who is ever present in the realities of
trouble.
In the Gospel of St. Matthew Jesus himself points to the importance of prayer
even to provide a format for uplifting our concerns. Our petitions, concerns,
lamentations, and words of praise are heard by a God – and answered according to His
divine purpose and will. 7 "Ask and it will be given to you; seek and you will find;
knock and the door will be opened to you. 8 For everyone who asks receives; he who
seeks finds; and to him who knocks, the door will be opened. (St. Matthew 7:7-8 NIV)
God is relational, approachable, and faithful in answering our petitions uplifted in prayer.
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However wise discernment would teach us that these prayers may not be answered in
ways we would expect or demand.
Later in the New Testament witness we hear from James the brother of Jesus. In
his letter we acknowledge the two fold nature of prayer and Christian service. Pastors,
chaplains, and Christians alike share in the task of uplifting the sick in prayer and
anointing them with the promises offered by God in the Holy Scriptures. “Is any one of
you in trouble? He should pray. Is anyone happy? Let him sing songs of praise. 14 Is any
one of you sick? He should call the elders of the church to pray over him and anoint him
with oil in the name of the Lord. 15 And the prayer offered in faith will make the sick
person well; the Lord will raise him up. If he has sinned, he will be forgiven. 16
Therefore confess your sins to each other and pray for each other so that you may be
healed. The prayer of a righteous man is powerful and effective.” (James 5:13-16 NIV)
Prayer becomes a forward action of the church in its ministry to those in its care. Pastors
and leaders share in the task of training and sending out those who offer prayers with the
sick and the dying bringing the sacred to the bedside of those in emergent care situations
often found in the ICU (intensive care unit) or ER (Emergency Room).
Discovering and casting a vision for prayer in the care of those sick and dying in
emergent care situations becomes a shared task between the healthcare and faith
community. “The linkage between sin, sickness, suffering, and death forms a
background motif for Isaiah in the Servant song of chaps. 52-53…The modern age
greatly resists this linkage. Medical practitioners generally rely on the physiological
staples of drug therapy and surgery.” (Reichenbach 1998, 553) The goal and task of the
hospital chaplain is to engage the conversation between faith and healthcare.
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Additionally to consider the linkages between modern medicine and its limitations, the
necessity of faith in the human experience, and the ability of both disciplines to shape the
patient care experience.
What we gather from the Holy Scriptures is that “healing is at the very heart of
God”. (Lewis 2014) The continuous witness of God’s people through the Hebrew
scriptures and later into the New Testament proclaims a message of an active present God
who brings healing in many and various ways. God by nature sought to bring healing to
His people and continues to do so. The act of prayer and seeking after the heart of God
for this evidenced healing found in scripture continues the human narrative of creation,
redemption, and sanctification as brought forth in the Holy Scriptures.
Leanne Payne in her work, “The Healing Presence”, advocates for prayer as a
pivotal tool for change. “He it is who comes and heals. It is He who befriends the sinner,
releases the captive, and heals the lame in mind and body. (Payne 1995, 144) Prayer
calls forth the presence of an active agent in the lives of the faithful and leads the person
of faith forward with the expectation that God is active, is listening, and will be present
even if the situation, medical outcome, or future seems uncertain and forboding.
Payne later in work speaks of the practice of evoking and inviting God’s presence
as essential task of prayer ministry – and for the work of the hospital chaplain and pastor
the task is ever of importance in an emergent care situation. Prayer becomes the calm in
the midst of a great storm, the reminder that God is speaking into the unknown, and that
the faith that claims us as God’s children is a reality that can be clung to in uncertain
times. “The practice of the Presence, then, is simply the discipline of calling to mind the
truth that God is with us. When we consistently do this, the miracle of seeing by faith is
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given. We begin to see with the eyes of our hearts.” (Payne 1995, 279-280) Faith is
assured, the presence of God is renewed, and the outcome whether unexpected or advised
is easier to withstand given the presence of faith in the healthcare situation.
Chaplains and pastors, nurses and doctors along with other healthcare
professionals become vessels for the work of the almighty. Through active or passive
participation in prayer at the bedside God’s presence is evoked and the work of healing
begins. “We become ministers of God’s healing love and power, therefore, as we learn to
invoke the mighty Presence of our Lord, and as we learn to become the vessels through
which He ministers in our midst.” (Payne 1995, 441-443) Chaplains through their
practice advocate for active participation by medical professionals through prayer when
appropriate and requested by the patient with the patient leading the prayer, the presence
of supportive clergy or religious leaders, and the presence of family if desired in and
through the process of prayer.
Research indicates the importance of faith in the event of an emergent health
event. . “To the average person grappling with life-changing events, the issues become a
bit more straightforward. They may not be able to define religion, but they most likely
know it when they see it and know whether or not if helps them.” (Koenig 2008, 10)
Faith is a means by which patients find hope and cope with the challenges facing them
especially when it comes to emergent healthcare situations. “Healthcare providers need
to review and assess health from a religious/spiritual as well as mental/physical point of
view.” (Koenig 2008, 12) A multidisciplinary approach to healthcare solicits a response
that is attentive to the spiritual care needs of patients and how to engage, protect, and
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guide these resources as a means of providing healing for the patient. Prayer is such a
resource and chaplains along with others can advocate for its use in emergent situations.
The question of the usefulness and effective quality of prayer in emergent care
situations for patients and families becomes an area of concern for those administrating
healthcare objectives and the chaplain/pastor responding to the crisis event. “The
pastoral caregiver is called upon to be a calming presence…The focus turns to mediating
anxiety.” (Rydholm 2002) Chaplains who advance the spiritual care concerns of the
patient and family work to gain trust, build unconditional positive regard, and seek to
bring the sacred and holy into a tense and ever changing situation. “In the tempest of
impending loss, ‘knowing the care receiver’ is crucial. Knowing the family, their history,
coping strengths, emotional trigger points, etc. becomes the needed rudder for steering
through the murky waters of end-of-life-decision-making.” (Rydholm 2002) Building a
relationship that is additionally supported through a prayerful encounter enables the holy
and sacred to speak into a situation that often evokes emotions of loss, regret, fear, and
desperation.
Prayer is often welcomed in the care experience especially when encountering
families in crisis. “Similarly high rates of daily prayer, meditation, and religious study
underscore the importance of religion in coping with cancer.” (American Medical
Association 2009, 1140) Part of the task of spiritual care would be to cultivate a place of
safety for the patient and family. Prayer can accomplish this task well when it attends to
the faith practices of the patient, the cultural foundations that formulate the faith of the
patient, and involve hospital staff that are comfortable and open to such processes. In her
work “Trauma Healing” Carolyn Yoder articulates the practice of grounding people after
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a traumatic event or loss. “A sustaining faith or spiritual practice” can be grounding to a
person or family experiencing an emergent healthcare episode. (Yoder 2005, 51)
Evoking the name of God and inviting his presence into the experience of pain, loss,
regret, illness, and trauma continues the patient centered focus as long as it is sensitive to
the faith experience of that patient and or family.
Prayer further articulates the relationship between God the Creator and human
kind in that from the very beginning it was intended that we be in communion with God,
that God desired and persued a relationship with us, and that regardless of our sinful
condition God has sought and continues to provide a pathway for redemption – most
notably through Jesus Christ. Theologian Karl Barth addressed the complexity that
inheritly defines the relationship between God and man. “Man does not possess the
power to be as man in the same way as God has His power to be as God, nor does he
have the power over his vital functions as God has His power as Creator, Ruler, and
merciful deliverer of His creature.” (Barth 1998, 246) We may not have such means to
bring about our own salvation, have the ability to manipulate a cure and demand a certain
outcome – but through prayer we have the voice to uplift our heartfelt concerns, desires,
and cries to a God who is ever present in both the good and ill times of our lives.
Our source for life, health, and salvation provides all these things out of His
divine Fatherly goodness. “For health, like life in general, is not an eternal but a
temporal and therefore a limited possession. It is entrusted to man, but it does not belong
to him. It is to be affirmed and wiled by man as a gift from God, yet not in itself and
absolutely, but in the manner and compass in which he gives it.” (Barth 1998, 245) This
relational identity furthers the idea that prayer and conversation with God during times of
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crisis and especially in emergent care situations is of great importance for the person of
faith. Life and health as well as salvation are valued gifts endowed from the creator God
– the same God who desires to be in relationship with his creation. To bridge and build
this access is important as patients and families navigate the deep troublesome waters of
sudden illness, cardiac episodes, trauma, and in some cases emergent mental health
situations.
Much conversation has in recent years developed both academically and
theologically on the topic of prayer in the healthcare setting. “Health care chaplains have
the privilege of sharing deeply meaningful experiences with patients/residents on a daily
basis. Prayer and ritual open up opportunities to explore with patients/residents their
understanding of the Divine and their relationships with others.” (Jones 2013, 106) For
patients of faith the ability to evoke tradition, ritual, and meaning into a situation that is
challenging brings hope and new life into the conversation. Prayer and pastoral presence
together work to bring assurance, peace, and the promise that God is present even in
difficult moments when decisions have to be made and death is very present.
Another essential task of prayer involves the process of healing. Healing can
simply be moving from one defined health diagnosis to an eventual outcome. Prayer
involves using the language of faith to evoke possible change. Yet this change or
eventual outcome is to be determined not be us but rather by faith as articulated in the
book of Hebrews. “Communication makes possible the development of an identifiable
Christian group. The Bible provides the language through which communication takes
place in the church.” (Gerkin 1997, 122) The bible demonstrates a pattern of how we are
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to communicate to God be it through the prayers of Abraham, Moses, the prophets, Jesus,
and in the later apostles.
As Gerkin points out the goal or focus of pastoral care in the Christian community
is this, “creating and maintaining a climate of relationship within which all members of
the community are understood and cared for.” (Gerkin 1997, 126) In emergent situations
this is all the more important as persons of faith struggle to find meaning, hope, and
purpose in their suffering. Chaplains become a voice of calm able to communicate the
presence of the Divine in settings were people feel lost, vulnerable, and distant from the
peace that faith brings.
In Henri Nouwen’s classic work “The Wounded Healer” the vocation of pastoral
care provider is called into focus. “The Christian leader is called to help others affirm
this great news, and to make visible in daily events the fact that behind the dirty curtain
of our painful symptoms there is something great to be seen: the face of Him in whose
image we are shaped.” (Nouwen 1972, 44) Through the action of voicing prayer the
chaplain or spiritual care provider begins the conversation with God, the evoking of
emotion and expression to our thoughts, feelings, concerns, and petitions with hopeful
and expectant faith that God will answer according to his will and not ours as suggested
in the Lord’s Prayer.
Speaking specifically to the vocation of hospital chaplain we learn the advent of
prayerful conversations with the Divine become a duty task which cannot be overlooked.
“Chaplaincy is largely a ministry of encouragement and comfort. The chaplain ministers
mostly to the unchurched or those who, by virtue of their circumstances, are at least
temporally separated from their church body.” (Woodward 2011, 146) To encourage and
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comfort especially in times of spiritual and physical distress becomes the vocational
calling of the chaplain. Often time does not permit the patient’s pastor to be present or
other external variables prohibit this from happening. Yet it is then the hospital chaplain
that advocates, prays, and brings into perspective the hopeful real presence of a God who
is present in the very day of trouble.
In moments in which life hangs in the balance prayer should be encouraged by
both the chaplain and staff when deemed that this is part of the patient’s experience/life.
Karl Barth suggests that we should “expect more from God, to let grow within us that
which he will in face cause to grow. We should use all our power to accept what God is
constantly offer us, to wakefully and prayerfully follow what God does.” (Barth, Word
of God and Theology 2011, 435) Accepting what God offers and doing what He does
proclaims the power of his relational presence. God offers an enduring presence that is in
itself healing and liberating to those suffering do to illness and eventual death.
Practical application of prayer ministry in the hospital setting works in several
ways. Chaplains when on call come in to assist staff, families, and patients with critical
care events such as traumas, cardiac events, and terminal causes in which death is
imminent. Prayer functions to give space for the sacred, voicing overall concerns
experienced by those present, and it sets the table for the feast of mercy that God
provides through His abiding and loving presence.
Prayers can be formal or freely recited from the lips of those praying in there
overall format. “The Lutheran Book of Prayer” is a treasure often used in spiritual care
situations and by pastors alike. “Teach me to believe that your abiding presence will
uphold me hour to hour. Give me peaceful days and restful nights. Bless me with a
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refreshing sleep. Come to me with healing in your wings. Speak to my soul the
comforting promises of Your Word, and keep me steadfast in the faith until the end.
Bless this household, and keep all of us cheerful, hopeful, and content. I ask this of You
who has redeemed me with Your own blood. Amen.” (Lutheran Church Missouri Synod
2006, 230) Formal printed prayers have the time and place as do freely spoken prayers
offered by the chaplain, family, patient, healthcare staff, and or pastor present at the time
of the emergent event.
Prayer also works the ability for soul healing to occur in many ways. Often
patients may present with a physical aliment yet underlining that presenting issue may be
other more pressing psychosocial and spiritual issues that need prayer and the Word of
God. “Soul healing prayer is allowing Jesus, who is not hampered by time, to bring
healing to areas of our emotions. Jesus’ desire is to be the Lord of our past, as well as our
present and our future.” (Lewis, Healing Unhealed Hurts 2014) Because we are more
than physical beings the idea of addressing other hurts such as psychological, social,
emotional, and spiritual wounds at the time of the presenting medical crisis is ideal. The
chaplain acts as an agent of God to bring about the presence of God, the ability to speak
plainly to God about the hurts involved, and seek a prayerful guided method to find
resolution.
Healing can happen and be expected for those who wait on the Lord who renews
strength and walks with those who endure hardships, illness, and moments of uncertainty.
“Yet, we are now seeing a return of the direct experience of God’s healing power in such
striking ways that the living tradition of the church – what the Spirit is helping us to
experience and understand today – is leading us again to a more lively awareness of what
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Jesus did in his healing ministry. If we ourselves see miracles of healing, we no longer
have difficulty in visualizing the healings.” (MacNutt 2001, 136) God’s healing power
can be revealed through prayer as evidenced in the Word and through our experiences
with patients and families. Yet how we choose to define healing is critical in our
approach to soul care, applying the truths of scripture to the realities of a diagnosis, and
the giving space for God to reveal His divine will in the lives of His children.
As we strive to be patient focused in our care endeavors we must acknowledge the
importance of spiritual care, prayer, and the spiritual needs of those seeking care in our
hospitals. “Spiritual or compassionate care involves serving the whole person – the
physical, emotional, social, and spiritual. Such service is inherently a spiritual activity.”
(Puchalski 2001, 352) Because we seek to balance the needs of the patient and serve
them fully addressing spiritual care needs such as prayer, the presence of a chaplain or
their personal pastor, and the availability of sacramental supplies to assist them in finding
healing is important to note as we explore whole person care.
Prayer can additionally be seen as a means of coping for patients and families in
emergent care situations. “Spirituality may be a patient need and may be important in
patient coping.” (Puchalski 2001, 354) It is through prayer that people uplift, voice, and
express their concerns to God. In coping with a medical diagnosis or a traumatic event
chaplains and others in the care situation would be wise to discern the use of prayer and
the patients need to find this available to them.
Also evident in healthcare settings is the use of prayer to assist healthcare workers
in post traumatic event processing. The chaplain becomes a voice of guidance, comfort,
and calm to aid staff in processing a medical event which may prove difficult to deal with
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as a whole. Pastors and chaplains are able to name the event which has brought stress to
the medical team and speak to how God can and will bring peace into the moment. More
clinical processes such as Critical Event Stress Management Debriefing or CISM discuss
the importance of rituals for those directly working with victims of violence, mass
casility, and traumatic unexpected deaths. Staff should become a focus of care and
prayer as chaplain move to bring awareness of the sacred in moments of crisis.
Finally to consider prayer in a clinical setting is to also see the role of prayer in
the New Testament church. “All these with one accord were devoting themselves to
prayer, together with the women and Mary the mother of Jesus, and his brothers.” (Acts
1:14) The devotion to prayer asks us to do so in our daily vocations – to seek God in our
endeavors and know that He answers our prayers. For those in emergent situations
bringing prayer to the bedside links the sacred to the broken and chaotic experiences of
trauma, illness, and possible death. Healing comes not in expectant, demanded, or
probable ways but through the will and action of a God who is real, present, and
trustworthy.
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