Transforming Care: A Christian Vision of Nursing Practice (2 page)

This is a book both for and about nurses, Christian nurses specifically.
It is about how faith structures nursing practice. Our goal is to offer a resource that will provide practicing nurses and nursing students with a way
to think about these tough questions and begin to formulate some answers. We do not want to provide a set of pat answers that nurses can
memorize and repeat by rote, nor do we wish to leave our audience of thoughtful practitioners and students with the sense that there are no answers. Instead, we hope to point to some resources from within the Christian tradition that can guide us as we seek to live out our vocations faithfully.

Loretta faces the sort of situation every nurse faces in the course of her or
his work. But because Loretta is a Christian, she also has a sense that her
faith in and relationship with a loving Lord should have some bearing on
how she acts and reacts in this sort of context. Thinking through how one's
Christian faith is lived out in the complex world of contemporary nursing
is not an easy task, but it is a rewarding one. It is also a task that can be
greatly assisted by turning to some of the resources that the Christian tradition has to offer.

In the mid-1970s, James Gustafson, a leading figure in Christian theological ethics, published a book that posed the question Can Ethics Be
Christian? To many people the question seems absurd and the answer obvious: Of course ethics can be Christian. Christians are ethical people, and
their faith calls them, among other things, to live moral lives. But
Gustafson points out that what Christians take to be the right thing to do,
or what they identify as a good way to live, looks pretty much like what is
generally accepted by non-Christians. And, in fact, Christians do not claim
that only Christians can be moral. Any Christian nurse has colleagues of
other faiths, as well as nonreligious colleagues, who carry out their responsibilities in ways that are clearly moral. Loretta is likely to respond to her
encounter with Mr. White in similar ways, whether or not she is Christian.
Both a Christian Loretta and a non-Christian Loretta would maintain professional standards, treat clients with respect, and show concern for the
good of the client.

If ethical actions are based on principles that are shared by Christian
and non-Christian alike, then what makes Christian ethics Christian?
Does a "Christian life" refer simply to whatever is left over when we subtract from the realm of morality anything that could be justified on nonChristian grounds? That leaves us with a very small realm of Christian life!
In the realm of nursing this would mean that only the portion of nursing
practice that is unique to the way Christians act would really be Christian nursing. This slim remainder, however, is not all that there is of Christian
ethics, nor is the broad agreement on ethical actions Christians can reach
with non-Christians something to ignore or find problematic. After all, we
Christians affirm that all things have been created through Christ who is
the Lord of all. Since the God of redemption is also the God of creation, we
should expect that what is broadly acknowledged as moral - what Hindus
and Muslims and even atheists would agree to - squares with much of
what Christians should endorse. We should expect that what is revealed
through creation and is, therefore, accessible to all will not be substantively
different from what is revealed through the redemption available in Christ.

When we turn to professional nursing practice, we find, then, as we
would expect, that in the vast majority of cases what the Christian nurse
does and refrains from doing is identical to what the non-Christian nurse
would do. One does not need to be a Christian to be a good nurse. A syringe is assembled in precisely the same way whether one is Christian or
not. The same is true for the administration of CPR, distribution of medications, charting, completing a health history, teaching a client about a
new diagnosis, conducting a community assessment, and so forth. And
this is true as well of the nursing practices that are more clearly moral in
nature. Nurses, Christian and non-Christian alike, care deeply about the
well-being of the clients they encounter in all of the contexts in which
nursing is carried out. The ethical principles found in any nursing textbook and foundational to nursing profession and practice are ones that
Christian nurses can generally endorse. Christians and non-Christians
alike wrestle with the difficulties of mediating between clients, their families and significant others, and other health care professionals. But when
we note these large areas of overlap, we might be led to ask, Can nursing be
Christian? Is there anything distinctive about the Christian nurse?

If there is something distinctive and if Christian ethics does refer to
something other than the slim remainder that is not shared with nonChristians, then what is that distinctive "something"? Gustafson proposes
that when we are speaking of Christian ethics, we are speaking of the ways in
which our faith qualifies our moral lives. By "qualify" he means the ways in
which the life of faith shapes, informs, and modifies our morality. There are
several ways in which faith qualifies morality, three of which are particularly
relevant to nursing practice. First, faith shapes and qualifies our character as
moral agents. Second, faith shapes our perspective as moral agents. Third,
faith shapes our values as moral agents. Let's examine each of these briefly.

When we say that faith shapes our character as moral agents, we mean that
Christian ethics is concerned not only with what we do but also with who
we are. "The experience of the reality of God," Gustafson argues, "evokes,
sustains, and renews certain `sensibilities' or `senses,' certain sorts of awareness, certain qualities of the human spirit. These in turn evoke, sustain,
and renew moral seriousness and thus provide reasons of the mind and
heart for moral life, indeed for a moral life of a qualitatively distinctive
sort" (Gustafson 1975, 92). Awareness of God as our loving Creator, in
other words, evokes in us senses of dependence and gratitude, and these
senses shape the "sorts of persons" we become and the "reasons of the
mind and heart" for being moral.

Christian nurses may engage in the same moral activities as nonChristians, but those actions emerge from a different center of
personhood for the Christian, a personhood that has been fundamentally
shaped by the experience of God's creating and redeeming grace. Having
been shaped as a certain "sort of person" makes the Christian nurse attentive to the structures of creation and to the distortions of sin in ways that
are distinctive. As persons formed by senses of remorse and obligation,
Christian nurses are especially aware of our tendency to be biased in favor
of our own interests. As persons formed by senses of possibility and direction, Christian nurses are attentive to God's continuing creative activity
and seek ways to become co-creators with God, conforming our actions
and intentions to what we are able to discern of God's direction for creation.

Faith also qualifies our perspective as moral agents so that we interpret our
circumstances in terms of their religious significance. For Christians, this
interpretation is always framed by the story of God's creating and redeeming work in human history as it is revealed to us in Scripture. H. Richard
Niebuhr, an important twentieth-century theologian, explained that
Scripture helps us to see that our lives do not consist merely in individual
episodes disconnected from one another. Instead, all of the moments of
our lives are bound together in a narrative that is meaningful. For Chris tians the narrative coherence of our lives exists within and is shaped by
God's self-revelation in Christ. Niebuhr explains that

whatever else revelation means it does mean an event in our history
that brings rationality and wholeness into the confused joys and sorrows of personal existence and allows us to discern order in the brawl
of communal histories.... Through it a pattern of dramatic unity becomes apparent with the aid of which the heart can understand what
has happened, is happening, and will happen. (Niebuhr 1941, 109)

What this means concretely is that we find the meaning and importance of
our own life events interpreted through the meaning and importance of
the stories of the Bible. We interpret the significance of our circumstances
in light of the story of Scripture. Interpreted through the cross and resurrection, for instance, human suffering and death bear a different meaning
and significance than they would apart from them. Christians naturally
grieve over the loss of loved ones, "but not as those who have no hope"
(1 Thessalonians 4:13). For faith to qualify our perspective in this way
means not only that we must be attentive to the story of Scripture so that it
can illumine our experience, but also that we must be attentive to the context and details of our circumstances.

The facts of existence are like so
much loose type which can be
set up into many meanings. One
man leaves these facts in chaotic
disarrangement, or sets them
into cynical affirmations, and he
exists. But another man takes
the same facts and by spiritual
insight makes them mean glorious things and he lives indeed.

HARRY EMERSON FOSDICK

This notion of attentiveness is
sometimes captured by using the
word discernment. If we are going to
be faithful interpreters of the world
around us, and faithful hearers of
God's call both in Scripture and in the
suffering of those to whom we are
called to minister, then we need to
learn to see and hear the specific characteristics of the world around us.
There is a reason why Jesus describes
the kingdom of God as a search for
hidden details (a lost lamb, a lost
coin), and the reason is that God's
kingdom is a kingdom where the little things matter. Nurses know this, of
course. Care for a client can be good care only when the little things are
taken care of. a client who is bedridden is turned regularly to prevent bed sores; the parish nurse remembers details of the lives of people in the neighborhood; the mental health nurse
notices when a client is having a good
day rather than seeing only the crises.
This aspect of care reflects the way
God is shown in the Gospels: when Jesus tells us that God cares for sparrows
and wildflowers, when Jesus welcomes
children or notices Zacchaeus up a
tree. Christian nurses, then, need to be
careful, attentive observers of the details of their world, shaped by the stories of Scripture, and able to see life
from the perspective of beloved and
redeemed children of God.

The moment of grace comes to
us in the dynamics of any situation we walk into. It is an opportunity that God sews into
the fabric of a routine situation.
It is a chance to do something
creative, something helpful,
something healing, something
that makes one unmarked spot
in the world better off for our
having been there. We catch it
if we are people of discernment.

LEWIS SMEDES

Finally, faith qualifies our values and shapes the principles on which we
act. For example, Christian and non-Christian nurses alike will strive to respect client autonomy. But the Christian tradition will qualify the meaning
of that autonomy for the Christian nurse. As Christians, we know that we
are always dependent for our very existence, and for every good gift, on a
God of love. So for the Christian, autonomy occurs within the context of a
human life that is embedded within a broader context of interdependence.
From this perspective, the Christian nurse can see how important other
human relationships are to any expression of autonomy, and in cases such
as that faced by Loretta they can work to educate other family members in
what they can do to support a client's ability to understand and make good
decisions. Likewise, the Christian nurse will strive to enhance and sustain
client health but will also recognize that health on its own is not the ultimate goal of human life. We are given the gift of health so that we can live
in ways that bring glory to God. While this is a value that the Christian
nurse cannot impose on a client who holds different values, it does provide
a helpful perspective for seeing how health fits into, but is not the only
purpose for, a meaningful human life.

This book offers an interpretation of nursing practice that identifies
the ways in which faith shapes practice. Because of this focus, we do not
spend much time worrying about what the non-Christian would do that
would be different from what the Christian nurse is called to do, nor do we
try to find actions that are unique to Christian nurses and never performed by non-Christians. Since Christian nursing does not consist of the
"remainder" that is left after we subtract all that is common to the way
Christians and non-Christians practice nursing, the actions and practices
of Christian nurses need not always be different from those of nonChristian nurses. In fact, we are grateful for the conscientious work of the
non-Christian nurse and believe that it can glorify God, serve the good of
the client, and contribute to the building of the kingdom of God.

From the perspective of this book, the question is not, How do Christian
nursing practices differ from non-Christian practices? but rather, Who is the
Christian nurse? Why is nursing a noble calling that Christians should be encouraged to undertake? How does the Christian nurse understand her or his
relationship to God and how does that relationship shape her or his identity
as a nurse? Developing a Christian perspective on nursing practice is a matter of describing what "reasons of the mind and heart" there are for engaging
in this work. We are describing the "sort of person" the Christian nurse is
and the perspective and values that shape the practice of nursing for Christians. Nothing in this task requires us to reject or belittle the good actions of
non-Christians. The identity of the Christian nurse flows from membership
in the community of believers, from a relationship with a covenanting God,
not from proving that non-Christians are never ethical. Our task is to develop a normative vision of nursing practice for Christians, a vision that acknowledges it as a holy calling and that locates its activities within a broader
Christian duty to be responsive to human need and divine providence.