Pastoral Care and Dealing with the Angry Patient

Pastoral Care Giving Is Love and Understanding

Understanding the emotions of the terminally ill is key to pastorally treating them
Understanding the emotions of the terminally ill is key to pastorally treating them
Elizabeth Kubler Ross in her writings spoke of the five stages of grief.  In particular, her studies dealt with the reactions of terminally ill patients and the phases they went through.  Pastoral Care Giving involves an intimate connection of communication between care giver and patient.  In many cases, the care provider supplies the horrible news that someone will soon die.  Within this there will be a multiude of reactions.  One such reaction is anger.
So how does a nurse or pastoral care giver deal with the angry patient.  Ultimately with love and understanding!  The care of a terminally ill patient is more than just caring for his or her physical needs but is a caring for the totality of the human person.  In this regard, emotional symptoms must be treated as if physical symptoms.
Kubler Ross asked the question, why is the patient angry?  The only way to know is through communication and care.  Avoidance and frustration with a patient’s anger will not endear him or her to you nor will it make matters better.
Many patients may be upset over a variety of reasons.  Is their death premature or expected?  Is the death blamed on God or another doctor or treatment?  Is the anger a source of regret of how a person lived his or her life?  Is the anger due to the fact you never notice any family members coming to say “goodbye”.  Is the anger over a loss of control?  Is the anger over how the patient was treated the previous night by a different nurse?  Is the anger over the fact the person cannot die at home?
The realm of possiblities is endless and this is again why Kubler Ross insisted one cannot ignore the patient who is angry.  Instead, one must discover why the person is angry.
In one case study, Kubler Ross noted that an elderly man simply wished to have his side gate of his bed down so as to move his legs.  He feared the casket like formation he had to endure and it reminded him of death.  His nurse instead refused for fear of him falling.  She was more interested in reading her book by the bedside chair.  Maybe it was due to her own fear of facing death that she distanced himself from this poor man.  Regardless, the man would be frequently angry.
Another case study was of a man who always controlled his life, whether in his successful business or his command of his family.  His anger was a result of the loss of control to the nurses and other health related decisions.  Simply by identifying this and giving him options, he became less angry.  In fact, he always had a say or input in the course of action directed, but under the guise he had a “control” in the matter.
So as one can see, pastoral care is more than just taking one’s blood pressure or taking checking various readings, but it is also understanding the emotional dynamics that take place within the human mind.  Anger is merely a manifestation of something that is deeply wrong;  it shoud not affect health care professionals to the extent they ignore the angry patient, but instead push them to finding out why and alleviating it.
If you are interested in Pastoral Thanatology Certifications, please review the program.
Mark Moran, MA

The Pastoral Care Giving Provider as an Exquisite Witness

What is an Exquisite Witness in Pastoral Care?

Mother Theresa is an excellent example of an Exquisite Witness(Photo by Túrelio)
Mother Theresa is an excellent example of an Exquisite Witness(Photo by Túrelio)
In Pastoral Care, one crosses the line of just merely a provider but also a spiritual friend.  A friend who is there to comfort and reassure the spiritual and emotional element of a patient.  An Exquisite Witness is one who personifies this element of care of the dying.
From a defintion, an Exquisite Witness is a “health care, pastoral, or volunteer care provider  who enters the sacred space between two human souls-having the deepest respect for the yearning, seeking, and wishful hopes of the other to diminish the pain and survive in a new world after a loss.”
Beyond this, an Exquisite Witness is not judged by training but one’s willingness to care for other people and treat them with respect as they face the unknown of death.  St. Theresa of Calcutta comes to mind when one thinks of someone with such deep sancity and care for the sick.
Ultimately when it comes to witnessing, it is jouney where one does not pretend to have all the answers or cures but instead takes the time to sojourn with someone-to listen, observe and follow.
In Pastoral Care Giving, a witness also enters into three dimensions of care.  The first is the heart dimension.  Within the heart dimension, one finds the process of how old personal losses rise to mind when dealing with someone else’s current losses.  Sometimes these memories can affect the caregivers ability to properly witness.  The old memory haunts them so they avoid the current patient, or the old memory prevents the caregiver from focusing on the current pain of an indiviudal.  Caregivers must address the heart dimension of caregiving if they wish to properly care for the sick and dying
The second dimension is the head dimension.  This dimension is one’s knowledge of what grief is and how it applies to certain cases.  One’s experience and education are key elements to the head dimension.
Finally, the third dimension is the hands dimension.  This represents how the care provider acts and performs his or her duties for the patient.  It represents how the witness engages the grieving during their process of mourning.
These three dimensions are key to what we call an Exquisite Witness.  Hopefully as care givers we can all utilize our talents, as Mother Theresa, and help the dying find peace and solitude.
If you are interested in Pastoral Thanatology, please review the program.
(Information for this article was found in “Helping Grieving People-When Tears Are Not Enough” by J. Shep Jeffreys.)
Mark Moran, MA, GC-C, SCC-C

Cultural Diversity in Care Giving

Caregivers Need to be Culturally Sensative to Their Patient’s Needs

Cultural sensativity is important in primary care
Cultural sensativity is important in primary care
As the world has become smaller, interaction with other creeds, cultures and races has become more prevelant in all aspects of life.  Caregiving is no exception as doctors, nurses, pastoral counselors and other caregivers find themselves in direct contact with different cultures who demand and deserve certain care.
Within the area of grief, it is essential, according to John Bowlby, that we understand cross-cultural ideals, especially in grief to better provide the vital care patients need.  Rituals, mourning, and family interaction varies from culture to culture and  health care providers need to respect these particular cultures in their  treatment.  By becoming educated with the basics of religious and cultural ideals a care provider can be better equipped to treat his/her patient.  Yet, before generalizations enter into one’s mind, the caregiver must also realize that there are deviations from the norm and not to expect certain reactions from a particular group merely because of their background.
Unfortunately, they did not teach this in medicial school and sadly, it may not have even been considered important but only an after thought.  However, as trained caregivers who aspire to a certain level of professionalism, it is important to be educated in regards to the world and potential patients.

The “House” Syndrome

Photo property of Kristin dos Santos: Hugh Laurie who plays the notorious and brilliant Dr. House, always right but never culturally sensative
Photo property of Kristin dos Santos: Hugh Laurie who plays the notorious and brilliant Dr. House, always right but never culturally sensative
The lack of bedside manner by many caregivers has given rise to pastoral caregivers to become a crossroad between patient and provider, but the “cultural malpractice” by primary providers still remains a concern.  Doctors and many health care providers seem to care only about the healing of the body or the cure of the disease instead of the treating the entire person.  This “House” syndrome, from the celebrated television drama, is only too many times the norm.  The doctor is more concerned with the puzzle and relates very little to the humanity or cultural diversity of the individual they are treating.
Primary caregivers need to understand the spirituality and the culture of each patient.  This is why it is so important for primary providers to do spiritual assessments of patients.  This can be done by a simple conversation with the patient or with the family.  In this assessment, you can become familiar with how the person views life and what religious affiliations he/she has.  Also in doing this, a doctor can treat the whole of the person.  A patient who is beyond saving, sometimes wants someone to pray with them.  Although doctors need to keep a certain distance to maintain objectivity, there are certain times when praying with a patient may be acceptable, especially if requested or both share the same faith.   Spiritiual assessments not only help the doctor become more sensative to the cultural element of the patient but also enables the doctor to be more than a guy in a “white coat” but also a fellow human being who cares.
If you are interested in Pastoral Care Giving, please review the program.
(Information for this article was found in “Helping Grieving People-When Tears Are Not Enough” by J. Shep Jeffreys)
Mark Moran, MA, GC-C, SCC-C