Following Jesus in Nursing

Welcome to Following Jesus in Nursing, a podcast for nurses and students produced by InterVarsity's Nurses Christian Fellowship. I'm your host, Lara K. Kiser, and together, we'll be inspired by our guest stories, tackle big questions with experts in the field, and walk together in following Jesus at the intersection of faith and nursing.

Spiritual care isn't just about doing, asking the right questions, eliciting certain responses that allow the patient to hear themselves and to find healing. That is an end goal perhaps, but that can occur also just in the way we are present to them. It's in our being, in the way we convey safety and love, back to love.

In the last episode, Dr. Elizabeth Johnston Taylor defined spiritual care as ways of being and doing that a nurse offers to a patient that promotes their spiritual wellness. Today, you'll hear the rest of my conversation with Beth as she unpacks that definition through stories and wisdom that she's picked up through her research and patient experiences. Listen in.

Well, I would love to hear some stories. I think stories help us really bring these conceptual topics to life. So I'm grateful for the definitions and, you know, some sort of the big picture stuff around spiritual care. But, yeah, let's get into some stories. Could you tell us about some times when you feel like you've integrated spiritual care into your patient work?

Sure. I love stories too. Who doesn't? And I think we actually learn more from them, don't we? Things that we remember later. Well, you know, when I think about spiritual care and a patient's story, I always remember a certain patient I provided care for way back early in my career. Maybe I was 25, 24. And I was on this oncology unit, evening shift. And I'll call this man Mr. Christianson. Mr. Christiansen had renal cancer, was fairly close, I would say he was within the last month of life, and he was on our unit for quite a period of time, and I had been able to provide care for him over several days. So, evidently, there was some rapport. In fact, I'll tell you one way I now realize he we were developing rapport.

I remember chatting with him, and he was he was talking to me. But my mind was on how I needed to still collect all my INOs and get my charting done and ready for report at 11. And I was running late, so I was not listening well. And he stopped me, and he said, Beth, do you understand what I was just saying to you? And I thought, ugh. Caught in the act. What do I do? You know? So I took a deep breath, and I said, Oh, Mr. Christensen, I'm really sorry, but I didn't track. I'm kinda distracted or something to that effect. I was transparent. And he responded, Good, Beth. Because what I just said to you didn't make sense. So, anyway, that was a lesson in and of itself.

But back to, more overt spiritual care, it was this gentleman. And by the way, this was a man who was in a private room. This was a gentleman who actually had had his own company. So, you know, upper social status, you might say, kind of guy.

One evening, out of the blue, he just said to me, Beth, what do you believe happens after we die? And, you know, I was pretty naive back then, but I think my gut told me this is not the time for a Bible study. This is not a time for a sermon. And I gave him a very brief response about what I believed. And, you know, afterwards, not that this made this good spiritual care, but afterwards, he said, yeah. That makes sense. That's what I think I'll believe. Now what that taught me was when one is facing their death without a belief structure that is truly supportive or previously is supportive, but no longer is, That's an important question to resolve. That can create a lot of spiritual angst, I would imagine.

So this is a story where, yes, providing my perspective appears to have been helpful. What I would suggest now for the nurse or including myself is that I was in this position again. I would want to make sure that my self disclosure of my own religious beliefs were not compromising the therapeutic relationship. And that my sharing my beliefs weren't about fulfilling my need, but truly addressing their need. So I think to do that, nowadays, I might follow up with a question like, how's it been living with this question for you? You know?

Or even before launching into my answer, just saying, you know, I hear your question. That's like sounds really important. Tell me more about what's prompting you to ask it now. So questions like that make it not about me disclosing my religiosity so much as about saying, hey. I'm I'm sharing this, but I'm doing it so that I want to facilitate your journey and your following where God is leading you to believe or do. So I think it's important in our conversations that have to do with spirituality and religion to remember to keep the ball in the patient's court. You know? It's not about me. It's about supporting them. It's not a social engagement. It's a therapeutic relationship. honestly,

Yeah. After 12 years of campus ministry, that rings true in ministry too. I mean, any sort of spiritual care role, questions are so powerful. Usually, questions get at what they are really concerned about. Sometimes they don't ask the question they really are looking for an answer to right away. It's sort of, you gotta dig in there. And Jesus did it. I mean, he responded to people all the time in the gospels with a question. And it really helps you enter into the question and not just rely on the other person to answer it. It forces you to wrestle with it too.

So I think there's something about it that encourages the other person to take ownership of their spiritual journey with you, you know, kind of inviting you into that journey together. I don't know if that makes sense.

Yes. You know, what you've just said reminds me of what the poet mystic Rilke wrote. And it was something about, by asking the question or living the question, we live into the answer. Something to that effect. And, indeed, often the questions that patients ask us as nurses are impossible to answer. They truly are questions that lead to mystery. They're questions that are unanswerable. And if we were to provide some superficial quick answer to would be to deny the mystery and the depth behind it.

Yeah. That's so good.

If you want one other story? I don't know. Was that enough, or do you wanna another? So although I haven't been directly providing nursing care to patients for the majority of my career, the majority of my career has been doing research. So let me tell you a story about spiritual care while I was doing research. Maybe that's different.

So this actually happened long ago as well. I was in grad school. I was working as a research assistant there at Penn. And my mentor asked me to orient one of the other new doctoral students to the study and how to go about collecting the data for this study. So we were interviewing, trying to trying to collect data from persons who were going to have surgery for colon cancer.

And we would go recruit them to the study just before they had the surgery. And then we would follow up. It's 3 months and 6 months. So I was given the name of a woman who was going to have surgery the next day there at Penn at the Hupp Hospital at the University of Pennsylvania, and I had with me another student to observe. And, I was going through the spiel trying to sell this study funded by the NIH and, how, of course, they would wanna participate as well.

I'm trying to do this ethically, Okay? Non forcibly. And this woman, and she had family members there at the bedside as well. Her response was basically one where she couldn't even talk about the study. She was so anxious about the surgery. And she said to me, I'm really concerned I'm not gonna survive this surgery. And so for her, that was the pressing need. She didn't give a rip about my research study. It was trying to process the huge anxiety she had.

Now I think perhaps Providence had laid this on me, but just not long before that, in some of the reading for school, I'd come across a mention of a study that had documented how people who have premonitions of their death or bad things happening to them during surgery or something like that. Indeed, these things did have a higher likelihood of occurring. So when this woman said that to me, I had that in the back of my mind. And instead of, like, internally dissing her that she was just too anxious, I took it seriously. Thank the Lord.

And so when she expressed all this anxiety and I realized she was not a candidate. she was not gonna sign up for this study, I kinda switched into a different mode. And I just hoped that this other RA wasn't gonna go back and tell my non-religious mentor and PI about this. I didn't know if I was gonna get in trouble or not. But I just felt this woman might appreciate prayer. I don't remember now what hue she gave me, but in a non-coercive way, as the conversation started to come to an end, I asked her something to the effect of, Would a prayer be helpful? And she grabbed my hand, and she said, Yes, please. And I prayed with her in front of all these people.

And, well, incidentally, after that, she said, And what did you need me to sign? So she actually did sign up for the study, and we did collect data after the prayer. Okay. Well so then 3 months later, I go back to collect data, and I discover she is not at home like most patients in the study, but rather she's in the ICU there at the hospital. I went to see if I could collect the 3 months post op data and found that she had, ever since surgery, been comatose. And she did die then before the 6th month. But I don't know. I just have always been so grateful that the Lord put that on my heart, because my sense is that I did do it ethically, and she responded with so much welcome for that prayer. And I did see the anxiety just visibly melt after the prayer.

So I'm grateful for that experience that I could share that with her. And nothing was ever said to me about praying while I collected data. My mentor always seemed to respect me.

I am processing the sort of Disney influence on culture of, oh, this story will have a happy ending. Not that there's nothing happy about it or joyful about it, but, yeah, it's just interesting to make sense of these things in the midst of reality.

Well, maybe the joyful thing is that as she went to her death, it was with a reminder that love is there. And that God was with her, And the same for the family that were in attendance.

It makes me wonder too, not that everyone who's anxious about surgery, it's not gonna go well, but there's something about that that's like it makes me wonder when people are really, really anxious if they know something is not right.

Not to extrapolate and say, oh, every anxiety means something bad.

But she very clear, she definitely had a premonition that it was not gonna go well for her and that she was not gonna survive.

Wow. Well, thanks for sharing that. And I'd love to hear the flip side, maybe some sticky situations where you've tried to give good spiritual care, and this is kind of vulnerable to ask. So I appreciate you being willing to share about this. But, just times that it hasn't gone so well or you wish you did something differently or you ran up against some barriers, what what did that look like?

Oh, I'm glad you're asking the question. I think it's really important for us to be honest about these experiences as well because if anything, they're even more instructive if we reflect on them. Right? So the first story that comes to my mind is from when I was in clinical pastoral education or chaplaincy training. And in that role as a chaplain intern, I would be asked or expected to go make these cold turkey visits to patients up on a surgical or medical unit. So I remember going to the bedside of one woman who was middle aged perhaps, and I was trying to engage her in conversation. And after a few minutes of trying and feeling like I wasn't being very successful, she literally rolled over in bed and faced the wall instead of me. Oh my goodness.

She was quite blunt in her communication, wouldn't you say? So, from that, I learned, and and this is the continuing, cutting edge learning for me. I have this tendency to want to grill people and to keep asking them questions to draw them out.

And later, when I was reading a textbook on helping psychology about how to communicate with people, one of the points was made that, you know, open questions or, you know, asking a patient any kind of question, you really shouldn't do more than 2 or 3 in a row, because you don't want this to be an interrogation. There are other ways to elicit conversation or, you know, expression from those you're trying to help. You can also just make an observation, just make a statement, make a summarization. And they can respond to that. You know, make an empathic response that just names their feeling. They can respond to that. It doesn't have to be question, question, question, question, question. You are on the witness stand. So, you know, I learned that from this experience.

I think I also learned I have this tendency to wanna go for the core, to go for the jugular, to get the patient to name that inner pain and crisis and inner disharmony and spiritual angst. You know? I want get to it. Allow them to express it. You know? Prick the pustule and let the the pus get released. You know? That's my instinct. That's my go to way of thinking about how I'm gonna help somebody. But, again, like this lady taught me, you've gotta, first of all, create rapport. And maybe even after you've got rapport, it may not be where the patient wants to go. Spiritual care, as my chaplain supervisor told me once, can be a lot of just a cup of cold water. There's a lot of religion in a loaf of bread, he used to say. So they used to even say, you know, just sit with the patient, watch TV with them. Well, nurses can't necessarily do that.

But I think what I'm trying to say is spiritual care isn't just about doing, you know, asking the right questions, eliciting certain responses that allow the patient to hear themselves and to find healing. But that I mean, yeah, that is an end goal perhaps, but that can occur also just in the way we are present to them. It's in our being, in the way we convey safety and love, back to love.

Yeah. Well, it's striking to me that just a few minutes ago, we were talking about the value of asking questions. And now you're, also expanding on, you know, the value of not interrogating patients. And that just really reminds me of how discerning we have to be in caring for people that, you know, there's no one size fits all. There's no thing that works in every situation and every moment, but thank God that we have the Holy Spirit with us to guide us in what is right for each situation, each patient, each moment of their care.

What the listeners don't see is my head going up and down. That is in agreement. Right? So you mentioned the Holy Spirit guiding us, and I truly believe that. I want to make a caveat, however, and this is based on data I've collected over the years.

Sometimes Christian nurses, I sense from data I've received, will argue that they are following the Holy Spirit's prompting when they do what I would consider unethical and unloving, which I would argue is unDhrist like, Which the Spirit couldn't possibly be truly prompting. So I think we, as nurses, it really requires a lot of discernment and sensitivity to the spirit. What is the Spirit truly prompting us to do and to be for this patient? Is it to impose my religiosity on them? Or is my wanting to do that really about me instead?

Yeah. So it sounds like sometimes we mistake our own ego perhaps for, quote, unquote, the Holy Spirit's prompting. Sometimes we have to be careful about that too in discerning, you know, is this really the Holy Spirit? Is this just something that I want to do?

Yeah. We need to be honest about that.

You put it so well, Lara.

I'm just reflecting back what I'm hearing you say. It's really good.

See? Thank you. And it's evolving, allowing me to talk more.

Well, I'm so glad you made that caveat. That is super important. We have to be sure that it's actually the Holy Spirit. Well, as we're talking about offering spiritual care to other people, to patients, it strikes me as very important that we are spiritually cared for well ourselves. We can't pour out of an empty cup. So I would love to hear some of your own spiritual practices and Scripture that have been helpful to you on this journey. How have you found spiritual care for yourself?

Yeah. Great point. Well, that, I would say, has evolved as I have aged. So, you know, first half of life or more, I would say I was, again, the dutiful religious Christian who always had her devotional time or felt guilty if she didn't. And, of course, another rule I bought was it's best to have that first in the day before you start your other work.

And so indeed, you know, I have always found prayer and Scripture and other inspiring writings to be nurturing, weekly church attendance, being in fellowship, being in a small group. You know, I ticked the boxes. I'm a good girl. However, like I say, the last 5 or so years and this, I now realize, was a dark night experience. Was God nudging me to reevaluate and to grow and see God's self in bigger ways than I had previously narrowly defined?

And so I am now maybe broader in what I read and find as inspiring. I'm also realizing that my text may not always be written. Sometimes it's auditory. Podcasts have truly expanded my understanding of the Christian life. But then also coming to realize that Christ is most fun. Oh, there's there's a statement, I believe, Saint Augustine, made that is something to the effect that God is within us and sometimes we're present. So I think spiritual growth and movement towards greater awareness of God is also indeed paralleling greater awareness of God's inner moving within me. So, yes.

I have a spiritual director who is also a union analyst and a retired minister. I mean, she's an angel, many roles rolled up in one, and I've been enormously grateful for spiritual direction over the last several decades now. Yeah. Just taking a walk. I try to walk every day, and I find that's a time of prayerfulness. It might be also listening to a podcast that I think is gonna be enriching for me spiritually. I also garden a lot, and I find the act of gardening is often prayerful. I mean, what I do as a gardener I'm realizing is metaphorical for what God is doing in my own life. And, yeah. So I guess my I'm increasingly realizing that prayer is not confined to certain words at a certain time in a certain way. But it's in the caring relationship. It's becoming more about prayer without praying without ceasing and understanding that that that means it's not always on my knees. It's in acts of giving and receiving love, etcetera.

Yeah. That's so good. Thank you. Well, any last bits of advice or encouragement that you'd like to offer to nursing students and nurses in their first few years?

I think maybe, and this comes out of some of the recent research I've done, at the end of the pandemic, we measured some spiritual responses to providing care during the pandemic amongst nurses here in Southern California. And we documented that their spiritual and religious struggles were elevated. And while there was some post traumatic growth of a spiritual nature that occurred along with the struggle. So right now, my concern is for supporting nurses so that they can be spiritually well.

And that such struggles, when they occur, can be embraced and seen as pivot points for transformation. So given that, I guess, I think it's helpful maybe if we can think about nursing care as being a two way street. It's not about us just giving, giving, giving, giving, giving. It's also reflecting at the end of the day or during the shift or as we wash our hands: What is it I've just received? What is it I've just learned from this patient? What is it I realize about love that is instinctually deep, deep in me that's causing me to do what I'm doing even when I don't feel like it. And just valuing that and thanking God that that is there, I'd like to think would help the young nurse to be able to ride the rough waves that will come. Yeah. And I guess my experience as a gardener as well, I realized the winter season, the dormant season, important work is happening biologically in the plants.

And same for us as humans. We go through spiritually dormant times. We go through wildernesses. And I guess I just want encourage students to recognize that when that does happen to them, to not be fearful, and to know that actually that may be a grace that they are being given and that God will lead them through the wilderness. As a gardener, I'm doing a lot of pruning, and God does pruning of us.

And so when that pruning happens to choose gratitude for it, I think will make it easier and helpful. And, yeah, just fundamentally to see the goodness, to see God at the core of all of this.

What you're saying is making me think of Luke 15 and the story of the 2 sons and, you know, the end of it. I always wonder what an alternate ending, you know, those choose your own adventure books I had when I was little. I always wonder, like, if I could choose if the older son would be just as excited as the father when the younger son returns. And that's what I am picturing when you're describing some of these things at the end of a hard shift instead of feeling frustrated with all the responsibility or, you know, feeling burdened by the day, which would be very justifiable. I mean, there's so much. I really relate to that older son. I'm like, yeah. He was so dutiful, and how come he didn't get a party? But instead to lean into, you know, looking at the younger son, celebrating with the father, realizing how much we are blessed and how much we get to witness.

And like you said, how much you get to learn from patients and, to take joy in their healing. It's really beautiful.

You know what I said at the very end of my last question ties in with what you just said. I'm with you. I totally relate. Most of my life, I've related to the older son. During the dark night, I related to the prodigal, the first prodigal, should we say. But, yeah, just last week, I finished reading a book by Ann and Barry Ulanov about envy of all things. How often do we read about envy? How often do we actually acknowledge we experience envy? Yeah. And what this book did for me, wow, it made me realize that how, when I envy somebody else actually, it's very difficult to be the envied one. That's a very difficult spot to be in. But the one I feel I relate to the most is that of envy-er just like the older older son. And when we are envying somebody else, we are actually denying the good within us. We are trying to spoil their good, so that we, because we don't see the good in ourselves, we can find, should we say, misery and company. When the antidote and the way God created us is, you know, we're all interconnected. We all have God and goodness within us. So if we can find gratitude for the goodness God has placed within us and then recognize that the goodness of someone else is a gift for me as well as everyone, then that envy can melt away.

Yeah. That's so beautiful. Well, thank you so much, Beth. This has been so good to talk with you today. Thank you for making the time.

Oh, my pleasure. And thank you for your great questions. They helped me to think further as well on the topic. It was great.

Beth shared through stories the importance of attentiveness and discernment, paying attention to patients' verbal and nonverbal cues about what they're feeling, wanting, and wondering, and then discerning well about how to care for them in a way that centers on their spiritual journey and not our own. Beth also did talk about our own spiritual journey and about the attentiveness to what we're receiving and not just to what we're giving. If we look, we'll notice all the gifts God has placed throughout our day. Think for a moment on your last shift.

What's one to two things that you received? Encouragement and support from a coworker? Something you learned or enjoyed about a patient? Often when we turn our attention to the goodness around us and to all that we've received, we can't help but worship and praise God who's given us all we have and see and know. I'll close us today by reading the end of a benediction from a prayer book called Every Moment Holy.

Oh, Lord, you were before all things. You created all things. And in you, all things are held together. There is no corner of creation you will fail to redeem. You are Lord of lords and King of kings. Oh Jesus Christ, our King of everything. Amen.

Hey, thanks for joining us for another inspiring episode of Following Jesus in Nursing. We hope you've been encouraged and equipped in integrating your faith with your nursing practice. Be sure to check out our show notes for info about connecting with Nurses Christian Fellowship as well as links and resources mentioned in today's episode.

Don't forget to check out NCF membership at ncf-jcn.org and use the coupon code following for $10 off. And remember, as you go about your work as a nurse, you are not alone. Jesus is right there with you, guiding your steps and using you to bring healing to those in need. Thanks for listening to Following Jesus in Nursing, and may your faith continue to be a light in the world of health care.