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Ministering in Special Situations aking a Hospital Visit

MHospital visits are a regular part of every minister's routine, even part time ministers. Hospital visits are always difficult, for with few exceptions (perhaps a new baby), visiting a hospital requires the minister to face pain directly. While effective ministers are caring, they are also people who sometimes have a strong need to "fix" the problems of others. When making a hospital visit, one must realize that providing Christ's presence is the ultimate goal. Physical sickness involves the total person. While the person's immediate needs may seem to be physical, the visit of the minister is primarily related to the patient's psychological, emotional, and spiritual needs. In addition, the patient's whole family is involved, family routines are disrupted, and all family members can be afraid. Preparing for the Visit. According to Kent D. Richmond and David L. Middleton, "The predominant emotion experienced by patients upon entering the hospital is fear."1 Fear may take the following forms: (1) The fear of separation. Entering the hospital requires that we leave home and be separated from family and friends. (2) The fear of dependence. We are totally dependent on various caretakers for our every need. (3) The fear of losing control. We surrender everything from privacy to the ability to start and stop our heart from beating. (4) The fear of pain and death. We are unaware of our ability to cope with pain, and the fear of death is always around us.2

Parking – Because of the frequency and importance of ministers' visits to hospitals, most hospitals provide services that make a minister's hospital visit more convenient. Among these privileges is reserved parking. Clergy that visit hospitals frequently should visit the hospital's appropriate administrative department to secure a clergy parking sticker.

1 Kent D. Richmond and David L. Middleton, The Pastor and the Patient: A Practical Guidebook for Hospital Visitation, (Nashville: Abingdon Press, 1992), 81.

2 Ibid., 80-81.

Entering the Hospital – As you enter the hospital, check with a receptionist to learn where the patient(s) that you will be visiting are located. By observing patient locations in hospitals, you can sometimes gain clues to a person's illness and status. When you arrive on the floor, check in at the nurse's station. Introduce yourself as the patient's minister. Ask if there is anything that you should know prior to your visit.

Entering the Room – As you approach the door, pay careful attention to your surroundings. Take note of special instructions on the door, family/friends standing in the hall, and the activity of the nurses or doctors if present. Knock softly on the door. If no one responds and you are aware that the person is able to speak, seek the assistance of a nurse. Many embarrassing moments occur when well-meaning ministers walk into hospital rooms at inappropriate times. If the patient is asleep, you should leave a card to make the patient and his/her family aware of your visit.

Making the Visit – If the person is alert, then begin your conversation with the patient with opening questions or comments such as "You're looking good today." or "How are you feeling today?" Pull a chair close to the person so that he/she doesn't have to talk loudly to be heard. Avoid speaking too loudly as if the person's hearing has been affected by his/her current illness. Avoid sitting on the bed. Whenever possible, allow the patient to take the lead in conversations. You are there to provide support for the patient, not to gain information. Whenever possible, let the patient determine the content of the conversation. The best gift you can offer the patient is simply your presence! According to Glendell Smith, "God's presence is experienced most vividly through persons who walk alongside others. God's caring presence mediated through you may be the gift they need in their confusion and struggles."3

Hospital visits should be brief. Usually, five to ten minutes is adequate depending on your relationship with the person and his/her needs. As you prepare to leave, voice a prayer. You may simply say, "Before I leave, I'd like to lead you in prayer. Is that alright?" Rarely will someone refuse. The prayer should be related to the unique situation of the person with whom you've visited. If the person has verbalized particular needs or issues, include these in the prayer. You may choose to hold the person's hand as you lead him/her in prayer. Some ministers also read a passage of scripture during a visit; however, this option should depend on the status of the patient and the comfort of the visitor. Before you leave, you should ask if there is anything that you or the church can do to assist the patient or his/her family.

3 Glendell Smith, "When Death Comes Slowly," Church Administration, vol. 40, no. 10, (July 1998), 9.

Leaving – As you leave, you may check in with the nurse's station again to alert them to anything that you've observed or that the patient may have mentioned to you. In some cases, you may need to be the advocate for the patient. If the patient has asked you to do anything, make a note so that you won't forget. If you're making many visits in one day, make notes so that you can provide accurate reports when you return to the church.

Special Situations

Emergency Room – Emergency room visits usually fall into one of two categories; (1) You are there to comfort a family whose loved one has been in an accident or some other traumatic situation, or (2) you are there to wait with someone during hours when the doctor is not in. When making a visit to an emergency room, be aware of the crisis nature/sense of chaos that is usually present. Your role will be to provide a sense of stability to the patient and/or family. Emergency room patients must first be assessed in a triage unit, which determines the patient's immediate needs. This assessment allows the patients in the ER to receive treatment according to the seriousness of their condition. When waiting with the family of someone who is critically ill or injured, you should be prepared to listen to needs, offer a prayer when appropriate, assist in calling other family members, and assist in important tasks such as caring for children. Since emergency room visits are urgent, the minister's role is to deal with crisis management or to intervene if needed. Richmond and Middleton offer the following suggestions for the minister who is seeking to provide a sense of structure and normalcy to a crisis: (1) Become actively involved with the family by helping them talk and vent their feelings. (2) Remain warm and calm and communicate a sense of control. (3) Attempt to control the environment to the degree that this is possible. The minister may suggest moving to a quieter waiting area, may adjust heating or cooling, or provide food or drink. (4) To paraphrase a common realtor's motto: The three most important aspects of crisis intervention are listening, listening, and listening. (5) Help the family to cope.

Gently remind them of effective coping from the past. In the event of death, the minister may assist in determining initial steps toward funeral preparation. (6) Be open to the opportunity to use spiritual resources.4

Intensive Care Unit – Visits to the intensive care unit (ICU) are usually limited to the immediate family and the patient's minister, and are further limited to certain times of the day for only a few minutes at a time. When visiting a person in ICU, you are obviously aware that the person is critically ill. As Richmond and Middleton state, "In ICU, dependence is total."5 There is every likelihood that the person will not be able to talk and may be unconscious; however, the sense of touch must not be underestimated. Patients in the ICU are very vulnerable because their bodily functions are all monitored, the lights are usually bright, they are not able to turn over or move, and they are often connected to respirators and feeding tubes that render them unable to speak.

Conversation should be limited to yes/no questions. Most often you should quietly tell the person who you are and offer some encouraging words or a brief prayer. No mention should be made of the person's condition.

Terminally Ill and Hospice – Visits to persons who have terminal illnesses are among the most difficult. You should not initiate conversation about the person's terminal nature; however, be open and willing to discuss it with them if they have a need to talk. Conversations about their illness may range from talk of their fear in facing the time ahead to discussions about their family and friends. They may want to talk about funeral arrangements, or they may be in complete denial. Always take your lead in conversation from the patient.

The primary role of Hospice is to provide at-home care for the terminally ill: "The primary concern of Hospice caregivers is quality of life and control of pain — not cure, but comfort. The focus is on life, on living with dignity until it's God's time to call them home."6

Hospice is always the last step in the dying process.

Surgery Waiting – Surgery waiting usually involves waiting with family members during the surgery of their loved one. Many of the above issues that relate to emergency rooms are applicable to surgery waiting; however, in the surgery waiting area the mood is usually tense and somber. There is a sense of urgency, though crisis intervention skills are not usually required. Often family members have anticipated the surgery; however, the results may be unknown. Richmond and Middleton list the following five types of surgical procedures. Each surgical procedure has its own set of associated fears: (1) Exploratory surgery carries the fear of what will be found. The discovery of cancer is often feared. (2) Cancer procedures carry the fear that the cancer will be widespread and uncontrollable. (3) Some surgeries threaten the patient with a change of life-style. (4) Various gynecological surgeries raise questions related to sexuality, appearance, and identity. (5) Transplant procedures carry the very real fear that the body will reject the transplanted organ.7

4 Kent D. Richmond and David L. Middleton, The Pastor and the Patient: A Practical Guidebook for Hospital Visitation, 83.

5 Ibid., 85.

6 Glendell Smith, "When Death Comes Slowly," 10.

It is important to acknowledge that the fears listed above can be fears of the patient and/or family.

Ministering to Families in Grief

Every minister is called upon to minister to families in grief; therefore, understanding basic issues involved with the grief process is important. When a family faces the death of a loved one, this crisis literally turns their world upside down. They are overcome with the feeling of wanting to replay old memories and live for a moment in the past. The initial shock of death is incomprehensible for persons who have not experienced it firsthand. The minister's role is multi-dimensional at this point, for he/she is called upon to "be" and to "do." In her book Caring Ministry, Sarah A. Butler offers the following suggestions:

What to Be

Be there – People may remember little of what we say in a moment of crisis; but they will remember our presence.

Be Flexible – Events and situations change by the moment. We must be flexible and go with the flow.

Be Familiar with Their Vulnerabilities – Realize the vulnerable state of the bereaved and respond accordingly.

Be a Listener – Let the person express whatever emotion he/she needs to express in this moment of crisis. Do not let your own discomfort stifle necessary responses of the person to whom you are ministering.

Be Christ's Presence – St. Teresa wrote that Christ has no body now but ours.

What to Do

Take Action – Crises often demand action, not words. You will be called upon to act: make telephone calls, give hugs, make coffee, answer the door, and anything else that is needed.

Stand By to Protect – Your judgment will be sounder in a moment of crisis, and you may be able to assist the bereaved in refraining from potentially self-destructive behaviors.

Assist with Decisions – You may have the opportunity to assist; however, resist the temptation to control. Most ministers are accustomed to "running things," and we are often called upon to assist in various crises. When dealing with a grief stricken family, all action must be careful, deliberate, and seasoned with much prayer and discernment.

Assist with Resources – People often cannot remember whom to call to gain assistance. You will be valuable in helping them to call the church and family members and to begin to make arrangements for the funeral and burial.1

Communicating Bad News

One of the most difficult acts of any minister is communicating bad news to a family, particularly the news of death. There is no easy way to communicate such bad news; however, the following suggestions may offer some help. (1) The person communicating the bad news must do so in a straightforward, honest manner, but not without great amounts of compassion. (2) Bad news is always better delivered in person and with the support of another person. (3) It is better to deliver bad news in a safe environment where the receiver is in the company of persons who can provide nurture. (4) Prayer should precede such an encounter and should be a part of the process as well. (5) Be prepared for extreme circumstances that may merit medical support or other crisis/medical intervention.

Assisting with Funeral Preparations

The music minister most often interacts with grief-stricken families when he/she is needed to assist with arranging for the funeral service. Many times the church's senior pastor has already met with the family, and many of the decisions regarding the funeral or memorial service have been made, including the music. Therefore, the music minister is usually only responsible for securing an organist and a soloist or vocal group.

However, the minister of music is often asked to meet with the family to assist them in planning the music for the service. The minister of music should be prepared to assist and offer suggestions. The following questions may help to get the conversation started: (1) Tell me about your (mother). (2) Do you remember any songs that were particularly meaningful to her or ones that have been meaningful to your family? (3) What would you like the service to communicate to those who are present? If your church does "Favorite Hymn Surveys," then keep them on file and take them with you when you visit with the family of a deceased church member. If you have particular recollections of conversations with the deceased about his/her favorite music, then recall these conversations as you visit with the family. Questions such as those above may help the family begin to focus on a service that has the potential to minister to all those who may attend. If family members have no musical suggestions, don't press the issue. Simply begin to make some suggestions of songs that you feel are appropriate for the service that they envision.

Sometimes families may suggest songs that seem inappropriate for a funeral or that may be difficult to locate. In such cases, if the material is sacred in nature, you are usually left to find the music and see that it is presented. If a family suggests music that you feel is inappropriate, then you should ask if there are other selections that they can recall. However, if they insist, you MUST seek the advice of your pastor or worship committee. Never tell a grieving family that their choices cannot be sung at a funeral. Refusing a family's funeral request is not an issue that you want to tackle on your own.

Music for funerals can often be very difficult to locate; therefore, ministers of music should keep old hymnals and songbooks as funeral resources. For a hard-to-find request, network with others in your area who can assist you. When you've ministered to a congregation for a long period of time, you may be asked to sing for funerals regularly, and often people will request songs that they've heard you sing. In addition, ministers of music should have a list of potential soloists and organists that they can call when needed. There is little preparation time for funerals, and it is sometimes difficult to enlist musicians.

Music ministers should have knowledge of and communication with funeral homes. Funeral homes have a protocol; when possible, follow their protocol. When you know the "usual" organist at different funeral homes and are familiar with their limitations and those of the facility, you will be better able to accommodate the desires of the family. For the sake of convenience and expense, many families opt for services at funeral chapels rather than the church. While this option is easier for the church, it provides challenges for the music minister since most funeral chapels are not designed for typical worship experiences. In most funeral chapels, the organist and the singer are separated from the congregation, and the music is often heard through a sound system. While this set-up allows for emotional distance (which is important for funerals), it does not allow for critical personal communication.

The Funeral Service

While some funerals have elaborate orders of worship and include congregational participation, most services are primarily directed by one minister who prays, reads scripture, and presents a message, eulogy, or homily. More elaborate services are usually held at the church and involve the music minister in the planning. For less elaborate services, orders of worship are usually not printed for the congregation, but should be provided for the persons directly involved (organist, vocalist, and minister). The singer and organist will usually know the titles of the songs prior to the service but may not know the order until they arrive and actually receive it from the minister or funeral director.2

Pay for Funerals

Since many people have prearranged funerals, singers and accompanists for funerals are paid by the funeral home; however, this is not always the case. Sometimes the family will pay the musicians from a personal account, and sometimes families do not pay musicians. This may result from either lack of knowledge or an oversight. If you are not paid for services provided for a funeral, you should not inquire or send a bill. I have always assumed I'd be paid nothing, and I've considered this ministry an important part of my music ministry. If I'm paid, I appreciate the gesture; if not, I am not disappointed.

2 For a thorough discussion of funerals and memorial service see Randall Bradley and Franklin Segler, Understanding, Preparing for, and Practicing Christian Worship, 2nd ed., (Nashville: Broadman and Holman Publishers, 1996), 209-13.

After the Funeral

There are many books written that offer suggestions for dealing with one's own grief and assisting others with their grief. The suggestions offered in this section are meant to be pastoral suggestions that may provide assistance to ministers who lack professional counseling skills.

It is important for every minister to realize that grief takes time. Some experts believe that it takes three years before the bereaved begin to experience more good days than bad days. This fact alone adds perspective to the grief situation and to the need for appropriate follow-up by the ministers and the congregation. The following suggestions may prove helpful:

1) Understand the accepted stages of grief.

2) Write a short note.

3) Call and visit often.

4) Don't rush the process.

5) Listen with your heart.

6) Encourage grievers to accept all of their feelings.

7) Resist any temptation to recite clichés.

8) Make specific invitations. Instead of making blanket invitations to an event, specifically invite until the bereaved is able to accept.

9) Urge caution concerning hasty decisions.3

10) Offer to talk about the deceased.

11) Never simply sign a sympathy card. Always write a note — preferably one that genuinely remembers the deceased person.

12) Assist the bereaved in re-connecting with life.

Ministering Through Counseling

Formally or informally, counseling is a part of every minister's work. As a minister, you will often listen to the problems of parishioners. This kind of informal sharing, which is sometimes presented in the form of prayer requests, may become part of the minister's daily routine. However, people (church members and others) often share issues that need greater attention. When people have serious issues, they usually make an appointment, or they will linger following a service or event. When the latter happens, the person is usually in considerable emotional pain, which might be compared to an emergency room visit. In these cases you should view yourself as an ER doctor who provides temporary relief until the patient can see their regular doctor! Actually, unless you have specific training as a counselor, all of your counseling should be seen as an ER visit, not a hospital stay!

The Need

Many people have tremendous emotional difficulty. While they will approach the senior pastor for counseling issues, most will talk with the minister with whom they work closely, respect, and have developed a relationship. The dilemma for the music minister (and other ministers as well) is discerning his/her commitment to minister to the total person coupled with the lack of knowledge and training to deal appropriately with the multiplicity of problems that are encountered!

Basic Tools of the Trade

1)Always have someone else in the building or in close proximity when counseling. This rule applies to both same sex or opposite sex counseling. While this suggestion is usually offered in response to issues related to sexual misconduct among ministers, other issues such as safety are also important.

2)Counsel in a room that is not totally private. A window in the door is preferred.

3)Create a referral list of counselors in your area who are qualified and respected.

4)Avoid physical contact in a counseling situation. Hugging or holding hands is inappropriate. While most ministers seem to be concerned with being seduced in the counseling situation, more ministers actually become the seducers!

5)Avoid counseling someone who is dealing with issues that are personal to you or which you have not resolved. Examples may include counseling someone about an extramarital affair when you have been involved in a similar situation yourself or counseling someone about depression when you are dealing with depression.

6)Be sure that your church has adequate liability insurance to protect it from lawsuits that may result from counseling. Most liability insurance does not cover sexual misconduct!

7)Avoid subjects that deal with sexual intimacy. Under no circumstance should sexually explicit language be used.

8)When child abuse is reported to you, you are usually required by law to report it.

9)Avoid developing co-dependent relationships in counseling. You must stop the relationship before a person begins to depend on his/her relationship with you.

10)Messiah complexes are common among counselors/ministers. You are not capable of helping all people. Your ability to minister is directly related to your ability to embody Christ.

11)Ministers who counsel frequently should be involved in ongoing supervision. You must have someone outside the church who can help you remain accountable.

12)Ministers should keep written records of sessions including dates, names, significant statements, and other appropriate information. Counseling notes must be kept in a secure location.

13)Recognize the importance of confidentiality. Confidentiality means sharing information with no one, including your spouse!

14)You must never use privately disclosed information in sermons, writings, or in any other form of public discourse.