Sunday 14 December 2008

Some Thoughts On Visiting.

It’s most likely that you’ll come into the hospital one of two ways, either by invitation from a particular patient or via the chaplaincy office when they discover a Pagan patient is asking for specific spiritual help. In either case it’s wise to make your first visit to the hospital via an appointment with the Chaplaincy office, for several reasons.

You will discover who the lead Chaplain is and she will discover who you are.
She can introduce you, the ward and other staff to each other which will facilitate your work no end.
You and she can discuss your work so that she finds out more about Paganism and you have someone to pass questions by.
If you don’t already have one she can advise you about getting a Criminal Records Bureau check (CRB)
which you will need if you’re going to do more than one
or two visits.

Here’re some pointers to consider.

1. Spend some time thinking about the purpose of your visit. Talk with a trusted friend or group of friends about it, people who’re up to more vigorous discussion than “Oh you’ll be great, you’re such a good person!” Get your intent really clear.

2. It’s important to hear, from the patient, what they think the purpose of your visit is.

3. Consider how you’re going to present yourself. Please don’t wear ritual clothing and kilos of Pagan jewellery. Personally, I’ve never felt the need to even wear a pentagram to draw attention to the fact that I Am A Pagan Chaplain. You’re there to quietly and unobtrusively be of service to a vulnerable person; drawing attention to them in a ward of strangers is not being of service to them. Also, don’t wear perfume, which can make ill people feel more ill.

4. Always phone the ward office first to let them know you’re coming and to negotiate a good time for you, the patient and the ward.

5. When you arrive on the ward, always go to the ward office first to let them know you’re there and to make sure that it’s still all right to visit. You don’t want to embarrass a patient who may be in the middle of something intimate. Never ever walk through closed doors or pulled curtains before checking and re-checking with the nurses.

6. You’re a guest of the patient. Be grounded, sensitive, polite and unpatronising to them and to other patients around them. Make gentle eye contact.

7. Think about where and how you place yourself. It’s almost never good to sit on the bed and you may just have to pull the chair around so you and the patient can see each other’s face.

8. Don’t touch any equipment, but do consider touching the patient at some point. People in hospital are seldom touched at any time other than to do something medical. Get over the ‘sexual assault’ paranoia, and just touch or hold a hand (that doesn’t have an IV in it) in a centred, reassuring manner without making a fuss.

9. Every visit will require a different amount of time. I’ve spent 2 or three hours with some patients and at times just going to the bedside, saying hello and asking if they need anything will be enough.

10. Listen, listen listen. Some of what you hear may be distressing. You’ve chosen to enter into a potentially distressing role, so contain it without withdrawing from the situation. Avoid frivolity.

11. If a patient complains about their care they may be right. But don’t undermine the staff. If you’re any doubt, talk with the lead Chaplain.

12. You may well be interrupted. Don’t assert your right to the patient but reassure them that you will visit again.

13. Wash your hands before visiting and after. If you find yourself with nothing to do, wash your hands.

Things to consider after a visit.

1. Timetable in a period of reflection after the visit. The multifaith room or chapel is an excellent place to do this. Talk with Deity. The purpose of this time is to be mindful of the importance of your meeting, to remember and even write down anything that you’ve been asked to do, and then to put the meeting to one side.

2. Maintain confidentiality. This is particularly important when talking with other Pagans and people outside of an official role beyond the hospital.

3. Where do you get your support? In this context support means a safe and supportive, professional meeting where you can express and experience your feelings in depth. It doesn’t mean being surrounded by people who think you’re great. Having a trusted person or group of people who will be loyal and honest is central to your continued good practice.

Reading Patients Notes

Simply: don’t.

You’re not entering into a clinical relationship with patients so you don’t need to know anything about what’s wrong with them. Nursing staff will let you know if a person can sit up or eat or drink or walk around and this should be fairly obvious in any case; if in doubt, ask.

The patient has a right to privacy, that is, he doesn’t need everyone knowing the fascinating soap opera of his life. Some people, in the depths of illness, may have done things that they’re now ashamed or confused about and frankly, you don’t need to know about that and they don’t need you to know about that.

Your way of being with a person cannot help but change if you know someone was violent in the past or that they suffered violence, often extreme violence. You’ll know from your own experience what it’s like when someone discovers a part of your past that you’re not comfortable with, there’s a shift, often unconscious, sometimes not, in the power balance. Mentally ill people can be particularly sensitive to the imbalance of power which is part of what makes many people mentally ill in the first place, so be with them as you are and as they are, here in this room at this time.

Are there individual reasons to be aware of a person’s history? Possibly. It’s too much of a generalisation to say never. But the potential for violence isn’t a reason. If the staff feel that you both will be safe with each other, and you feel personally safe then that’s good enough. All chaplains need to use our common sense, intuition and work on our personal development so that we don’t enter into the paradigm of even very severely mentally ill people becoming an automatic threat. Neither do we need to be able to be comfortable with every situation.

The role of a chaplain is to support the person in the here and now. This holds particular power in institutions, no matter how excellent, where routines and policies can often take precedence over the individual, nuanced needs of patients. Most staff will intend to treat everyone as an individual but when 20 people need washing before 10am and feeding between 12 and 1 a rather impersonal flow and routine is inevitable. One important role of the chaplain is to see the patient as something other than a patient: as an individual person with complex and unique ways of being in the world. Sometimes patients need to be reminded of this themselves and this can be achieved by aiming to be truly authentic, truly in relationship with each other, as two human beings rather than a Chaplain visiting a Patient, or an Expert giving something of value to someone in need.

Being a visiting chaplain is to enter a liminal space: you’re not a member of staff but you have a different kind of status to an ordinary visitor. Most hospital staff will be very cautious about telling any religious representative what they may and may not do because there’s uncertainty and fear about overstepping some kind of Equal Opportunity policy. This gives you particular access to vulnerable people. Consider the potential for the abuse of your power if you ever feel the need to read notes or ask about diagnosis or history. Who does it really serve?