Transforming Care: A Christian Vision of Nursing Practice (5 page)

Theology reflects on religious experience, so a theological consideration of
nursing practice must seek the experience of God in that practice. But where
do we encounter God in nursing? As we mentioned earlier, Schleiermacher
describes a religious person as one who seeks God in all things. A sovereign
and creative God is present to us in all of our experiences, if we can learn to
attend to that presence. When we return to the case of Ann, where do we encounter God? We recognize the presence of God, in a very basic sense, in our
recognition that Ann's suffering and weakness are conditions to be ameliorated, not celebrated. In the nurse's double consciousness, the awareness of
the goodness of creation and of its Creator takes priority over the awareness
of tragedy. It is only because of the expectation of goodness and the assumption that the world is well and beautifully made that the recognition of tragedy and the protest of the lament make sense.

The Westminster Catechism, a seventeenth-century tool for Christian
education, captures this sense of the priority of goodness with its deceptively simple first question and answer. It begins by asking, "What is the
chief end of humanity?" Why are we here? The catechism provides an
equally simple answer, one that any child can learn and understand, but
also one that can sustain a lifetime of inquiry. Our purpose is to "glorify
God and enjoy him forever." The purpose of human existence is to glorify
God, to bring delight to the divine, and this is the same as to enjoy God
and bring delight to ourselves. We were meant for happiness, for delight.
And in the context of health care that means that health, the goodness of a
body and mind functioning as they were made to function, is part of the
way the world should be. But how can this be expressed and experienced in
the context of nursing practice?

Enjoyment specifies a kind of affective response to the experience of
divine goodness. An affection is a kind of emotion that does not simply
come and go. It is deeply rooted in the core of our personalities. An affection, then, is like a basic disposition toward God and God's world. Calvin
describes the world as the "theatre of God's glory," and he describes our
human role as that of spectators who take delight in the display of divine
majesty on the stage of creation before us (Lane 2001). In our role as spectators, we discern in the ordering of creation some of the intentions of its
Orderer; we sense in the powers that sustain us and bear down on us the
presence of the Power that creates and sustains the whole. James Gustafson
explains how our affections are formed by our awareness of the creation's
capacity to mediate the presence of its Creator. He describes how our affections are formed in gratitude so that we become thankful people:

As with the sense of dependence, so in the sense of gratitude the goodness provided by the natural world, by cultures and societies, by other
persons, is the glass through which religious persons perceive the
goodness of God. The occasions of thankfulness to others for what
they have done for us are at the same time the occasions for thankfulness to God.... For all the anxieties and struggles of living, we are
grateful to be, to exist. In certain moments of experience we recognize
that we have been loved by others beyond our deserving, we have been
forgiven when we dared not believe it was possible, we have been sustained by the patience of others when they have had sufficient reasons
to reject us, we have benefited from nature and society more than we have contributed to them. We have received more than we have earned
or deserved, and we are thankful. In the religious consciousness these
are experiences that open the possibility of affirming the goodness of
God; they confirm his goodness which we only dimly and in part apprehend. (Gustafson 1975,101-2)

Gustafson goes on to explain that our senses of dependence, gratitude, obligation, remorse, possibility, and direction all originate from our experience of God in creation. Our enjoyment of God, in other words, comes
from our sense of the creation as a place of delight. Our ability to be loving
and thankful people and to know God as the source of love and the one to
whom we owe gratitude rests on our experience of having been loved "beyond our deserving."

The priority of the goodness of the creation and its Creator leads
theologian Herb Richardson to emphasize our experience of rightness and
well-being (Richardson 1967, 57-59). Our thinking begins from a foundation in the rightness of creation. This is particularly clear in the practice of
nursing. When nurses care for the ill, they do so with a vision of what normal human functioning, what good health, looks like. This is because we
have a basic sense of rightness about the world. We observe the structure
of the world and affirm that all of its various parts work together in ways
that are discernibly good. We also, according to Richardson, have a sense of
well-being, an awareness that these structures of the world make for human flourishing, that reality is not fundamentally hostile to the human
good. We were made for this world, not for some spiritual, heavenly realm
to which we can escape after death. We find in this world the proper context for human life and human work.

We see that view of healing in Jesus' ministry. He didn't radically
transform those he healed into something other than what they were made
and intended to be. Christ's miracles of healing were numerous: the man
with leprosy, the centurion's paralyzed and suffering servant, Peter's
mother-in-law afflicted with a fever, those possessed by demons, the
woman with a bleeding disorder, Jairus's dead daughter, the blind, and on
the list goes. The Gospel writer Matthew simply tells us, "Many crowds followed him, and he cured all of them" (Matthew 12:15). In each instance, it
is apparent that Jesus was restoring normal function and good health. Extremities could now bear weight; arms could once again extend and perform a full range of motion; skin was intact; platelets facilitated proper clotting; eyes could see; minds could comprehend the world around them
- in each instance Jesus restored what was intended to be in the goodness
of creation. Jesus' healing ministry affirms that this world is the right and
proper context for human life. We have, then, a sense of rightness and wellbeing about the world, a sense that we fit here. Nurses assume this rightness as they seek to promote, enhance, and restore their clients' sense of
well-being. Nurses attempt, in other words, to conform the is, the current
situation, to the ought. For the Christian nurse, the theological framework
of a creative, loving God provides the background for the recognition and
pursuit of health.

In his famous work The Nature of True Virtue, written in the early
eighteenth century, Jonathan Edwards likewise acknowledges this sense of
rightness and well-being. If one believes that the world is well and beautifully made, he argues, then ethical action does not aim, first and foremost,
to transform the world fundamentally. Rather, we consent to God's ordering of the world. We might call this an ethic of consent. "True virtue most
essentially consists," he explains, "in benevolence to being in general" (Edwards 1991, 3). This doesn't mean that Christians adopt a fatalistic acceptance of whatever happens to occur. It means, instead, that virtue begins
with recognition of the underlying goodness of the whole and aims to
bring parts of that whole back into reconciliation with that goodness.
Christians sometimes become so busy trying to transform the world and
claim it for Christ that we forget that God's declaration in Genesis that "it
is good" means that the world is a hospitable place for us. It means that it
has already been claimed by Christ who, as the Word of God, formed the
creation and is still reforming it.

For the nurse this ethic of consent functions at many levels. It means
that, as Margaret Mohrmann points out, the human body is reliable and
can be trusted. The body needs restoration at times and even occasionally
extreme interventions such as surgery. At the same time, however, we
should not treat its most basic functions as if they were pathological or
fundamentally flawed. Bodies work, much of the time, the way they are
supposed to work, and health care should work with them. An overemphasis on the power of science and new technologies can lead us to believe that
we can improve on nature in a number of ways, from advocating caesarean
sections even when a pregnancy is progressing normally to putting small
children on diets because their bodies are chubby. As we know in retrospect, these are problematic interventions, generated by misunderstand ings of the nature of a healthy body. But they also represent a failure of
trust in the goodness of our bodies, in the goodness of creation, and ultimately in the goodness of its Creator (Mohrmann 1995, i6).

The ethic of consent also means that, insofar as human institutions
participate in the goodness of creation, Christian nurses need not
assume that they will be in conflict
with the institutions in which they
work, even though those institutions may not be explicitly Christian. All creatures experience, at
some level, this sense of rightness
and well-being. There is no one, in
other words, who utterly lacks a
"sense of the divine," and because
of this we should expect that
Christians will find large areas of
common interest with those of
other faith traditions (and even with those who hold to no faith at all!).
Given that these common interests are part of our created nature, we
should also expect them to be evident in our organizational structures.
When institutions are structured to promote physical and psychological
health, when they operate in ways that protect the well-being and dignity
of the clients who use their facilities, then the Christian nurse can participate in them and affirm their goals. These institutions can surely embody
our sinfulness (think, for example, of how racism and sexism take on institutional lives of their own), but they also manifest the fundamental goodness of creation.

The gratitude, enjoyment, rightness, and well-being that are rooted in
the first part of the nurse's double consciousness mean that we are called
to respond to those who evoke gratitude and enjoyment as those who belong to God. Gustafson characterizes the task of theological ethics as one
of seeking to "relate to all things in a manner appropriate to their relations
to God" (Gustafson 1981, 158). If our lives are to be lived for the glory of
God, are to be fitted to the divine purposes, then we must relate to those
around us in ways that acknowledge their role as mediators of the divine.
Our basic posture toward God, which Gustafson characterizes as one of
"reverence, awe, and respect," is reflected in our posture toward God's creatures, for they are tokens of the divine (Gustafson 1981, 201). Though
we must never confuse God and creation, we do seek God in and through
God's creatures.

The goal of organizations that provide health care services is helping
individuals maintain their health, regain it if they have had some disturbance in their health, prevent reoccurrence of illness and disease, if
possible, and learn to cope with
chronic illness or disease.

IMOGENE KING

Nurses find in their colleagues
and clients persons who prompt
them to live in gratitude and delight, who move them to enjoy the
creation and to enjoy and glorify
God through that creation. It is
perhaps easiest to see how nurses
show respect to their clients as
those who belong to God. This respect is everywhere present in
Janet's interaction with Ann. She
greets Ann and speaks with her as
one worthy of her time and energies. Even when Ann is disoriented and incoherent, Janet owes this respect
to her. Likewise, Janet never touches Ann or carries out any kind of intervention without first explaining what she is going to do. No matter how
badly deteriorated her body is and no matter how uncomprehending her
mind, Ann's body and mind must be respected as tokens of the divine.
Janet offers a ministry to Ann that shows the love of God, and this is an entirely appropriate way for the Christian nurse to understand what she or
he does. After all, Christ said, "just as you did it to one of the least of these
who are members of my family, you did it to me" (Matthew 25:40). Ann -
in her current condition - certainly qualifies as one of the least of these.
The simple act of combing Ann's hair is transformed into a theophany, an
experience of the presence of God, when one approaches it as a religious
event. Janet, in other words, can manifest the comforting love of God to
Ann through her interventions.

But we cannot stop there, or we will miss an important aspect of
Christ's words. The one who offers aid to one of the least among us encounters Christ in that "least" person. Jesus' emphasis was not on the
Christ-like character of the one offering food, clothing, or shelter, but on
the Christ-mediating presence of the one receiving care. The God of sovereign beauty is manifest in the bloated, confused person of Ann; she mediates the presence of God to Janet. We are used to thinking of God as manifest in gracious service, but we need to remember that God is seen in the vulnerabilities and neediness of those we are called to serve. If we forget
this important truth, then we not only fail to take in the breathtaking
depth and diversity of divine being, but we also deny the client as an
image-bearer of the God who comes to humanity in the person of Christ,
the suffering servant. Ann's circumstances offer us the opportunity to encounter vividly the suffering Jesus. In her infirmity, we see images of the
beaten, broken, and dying Christ. When the nurse refuses to receive Christ
in the client, then the nurse deprives the client of dignity and deprives herself or himself of an important point of contact with God, a source of renewal and refreshment (Mohrmann 1995, 41).

Perhaps no scriptural theme so well
models the spiritual posture of nursing practice as the Old Testament
depiction of Moses and the burning
bush.... The nurse's spiritual posture [is as one] "standing on holy
ground." ... We will respond to our
patients as we would wish to respond to God in the burning bush.