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Prayer in Emergent Healthcare Settings: Forming and Casting a Vision Involving Prayer in Patient Care

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Rev. Kris Leland Snyder

PT814 January Term 2014 Rev. Dr. Sharon L. Lewis April 1, 2014

Snyder - 2 Prayer in the intensive care unit can be an illusive and often departmentalized

endeavor in most public hospitals. Considering that this task is even challenged in nonfor-profit hospitals, the question of prayer, which enables and empowers the family and patients in this task, and how to best promote ethical prayer practices in the emergent healthcare situation brings much challenge to chaplains, healthcare workers, nurses, and parish pastors. Ideally the task of answering whether or not 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 nave experiences in prayer which are further complicated by theology that idealizes 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 vocalized 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. It is the hope of an eventual outcome and 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 of

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calm. The affirmation that God is truly present in the uncertainty of any situation, and the availability that 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 Lords Prayer, we pray for Gods 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 Lords Prayer lead us to believe in Gods 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 primary responsibility of the parish pastor. However, in the absence of 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 Gods people and prayer cannot be denied. By its very nature prayer becomes an open channel for Gods 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. !"Ask and it will be given to you; seek and you will find; knock and the door will be opened to you. 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. 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. 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. 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. 52-53The 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, one must consider the necessity of faith in the human experience - and the ability of both disciplines in order 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 Gods 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 foreboding. Payne later in her work speaks of the practice of invoking and inviting Gods presence as an essential task of prayer ministry as the work of the hospital chaplain and pastor, the task is ever of more importance in an emergent care situation. Prayer becomes the calm in the midst of a great storm, a reminder that God is speaking into the unknown, and that the faith that claims us as Gods 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

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faith is 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, Gods presence is evoked and the work of healing begins. We become ministers of Gods 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. Supportive clergy or religious leaders along with family members may participate in and encourage the process of prayer at the bedside. This furthers the idea of the patients clergy and the hospital working together to further advocate the use of supportive prayer in times of crisis. 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

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that is attentive to the spiritual care needs of patients and how to engage, protect, and 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 presenceThe 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 especially welcomed in the care experience 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 is 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

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Healing Carolyn Yoder articulates the practice of grounding people after 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, God desires and pursues a relationship with us, and 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 inherently 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

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relational identity furthers the idea that prayer and conversation with God during times of 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 through the deep troublesome waters of sudden illness, cardiac episodes, trauma, and in some cases emergent mental health situations. In recent years 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 work together in bringing 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 invoke possible change. Yet this change or eventual outcome is to be determined not by us but rather by faith as articulated in the book of Hebrews. (Hebrews 11) Communication makes possible the development of an identifiable Christian group. The Bible provides the language through which

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communication takes place in the church. (Gerkin 1997, 122) The bible demonstrates a pattern of how we are 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, creating and maintaining a climate of relationship within which all members of the community are understood and cared for. (Gerkin 1997, 126) It is even more important in emergent care situations that because as persons of faith, we struggle to find meaning, hope, and purpose in their suffering. Chaplains become a voice of calm and are 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 Nouwens classic work The Wounded Healer the vocation of the 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 Lords Prayer. (BCP) 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

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temporally separated from their church body. (Woodward 2011, 146) To encourage and comfort especially in times of spiritual and physical distress becomes the vocational calling of the chaplain. It is often that time does not permit the patients pastor to be present or other external variables prohibit this from happening. 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 patients 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 offeromg 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 due 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 as a means 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 their 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

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uphold me hour to hour. Give me peaceful days and restful nights. Bless me with a 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 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 Gods 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) Gods 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 to serve them fully, addressing spiritual care needs such as prayer, the presence of a chaplain or their personal pastor with the availability of the sacraments in assist them to find 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 that 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 casualty, and traumatic unexpected deaths. Staff should become a focus of care and prayer as chaplains move toward bringing sacred awareness 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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Calov, Abraham. In The Church and the Office of Ministry, by C. F. W. Walther, edited by Matthew C. Harrison, 133-136. St. Louis, MO: Concordia Publishing House, 2012.

Gerkin, Charles. An Introduction to Pastoral Care. Nashville, TN: Abingdon Press, 1997.

Jones, Chaplain Gerald L. "Prayer and Ritual ." In Professional Spiritual and Pastoral Care, edited by Rabbi Stephen B Roberts, 106-117. Woodstock, VE: Skylight Paths Publishing, 2013.

Koenig, Harold and Kevin Adams. "Religion and Health: Collaboration among healthcare disciples can shape future understanding of how persons cope through religion." Healing Spirit (Association of Professional Chaplains), Fall 2008.

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Lewis, Rev. Dr. Sharon. "God Heals: Outline." Basic Healing Course. Nokomis, FL: Amazing Love Healing Ministry, January 2014.

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Reichenbach, Bruce. "By His Stripes We Are Healed." Journal of the Evangelical Theological Society 41, no. 4 (December 1998): 551-560.

Rydholm, Laura. "Exploring Peaceful Passageways to End of Life Transition: A Work in Progress." The Oates Journal (Wayes Oates Institute), 2002.

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