Transforming Care: A Christian Vision of Nursing Practice

By

Mary Molewyk Doornbos

Ruth E. Groenhout

Kendra G. Hotz

with

Cheryl Brandsen

Bart Cusveller

Mary Flikkema

Arlene Hoogewerf

Clarence Joldersma

Barbara Timmermans

Acknowledgments
vi

Introduction
i

Part One: Christian Faith and Nursing Theory

i. A Theological Interpretation of Nursing Practice
17

2. A Christian Vision of Nursing and Persons
40

3. A Christian Vision of Health and Environment
67

4. How Christian Faith Shapes Nursing Values: Care and justice
93

Part Two: Christian Faith and Nursing Practice

5. Psychiatric-Mental Health Nursing
117

6. Community Health Nursing
143

7. Acute Care Nursing
167

Works Cited
198

Index
207

This project has truly been a journey. It began in the fall of 2000 with a letter of inquiry from Bart Cusveller of the Lindeboom Instituut, Ede, The
Netherlands, to James Bratt, Director of the Calvin Center for Christian
Scholarship, regarding a project on Christian nursing. We gratefully acknowledge Bart's initiative and Jim's supportive response for providing the
impetus for this project. In the intervening years, the project has spanned
several grants, consultations, and a reading group. It has been a model of
collaborative endeavor in which the knowledge, expertise, and wisdom of
many have been essential to its development and completion.

First, we wish to acknowledge the Governing Board of the Calvin Center for Christian Scholarship for its financial support of this undertaking.
In addition, we are particularly indebted to James Bratt, Director, and
Donna Romanowski, Program Coordinator, for their encouragement and
wise council.

We are also grateful to Eerdmans Publishing Company for their faith
in this project. Specifically, we wish to thank Jon Pott for his formative
feedback, Linda Bieze for her assistance as managing editor, and Jennifer
Hoffman for her editorial work.

There were several consultants whose insights were essential to the development and revision of this manuscript. We especially wish to thank
Allen Verhey, formerly at Hope College, now at Duke Divinity School, for
reading a draft of the first half of the book and for offering thoughtful critique and advice. We are also grateful for the efforts of Rebecca Pruitt, then
Vice President for Mission and Ethics of Mercy Health Systems in
Oklahoma; Johanna Selles of Emmanuel College; and Marilyn Vander Esch of St. Clair County Community College. Dan Harlow and Helen
Sterk, colleagues from Calvin College, graciously offered their insights on
the nature of collaborative research. The input of the Calvin College
Nursing Class of 2004 was particularly helpful to us as we completed the
final revisions of the book.

Two expert nurse clinicians were invaluable in acquainting one of us
with the scope of professional nursing practice. Sarah Douma Boomstra,
of Spectrum Health, and Gail Koel, of Forest View Psychiatric Hospital,
generously gave of their time by consenting to a shadowing experience
over a period of several months.

Writing this book was truly a collaborative project, and all of the chapters have been written and rewritten numerous times by various members
of the team. Nevertheless, we would like to recognize the members of the
writing team and the portions of the book that they contributed as primary authors. Kendra G. Hotz served as primary author of the Introduction and Chapter One. Ruth E. Groenhout contributed the section of
Chapter Two on the concept of nursing and Chapter Four. Bart Cusveller
of the Lindeboom Instituut contributed to the development of the concept
of nursing. Several of our Calvin College colleagues developed sections on
the remaining three metaparadigm concepts of nursing: environment by
Cheryl Brandsen, Department of Sociology and Social Work; person by
Clarence Joldersma, Department of Education; and health by Arlene
Hoogewerf, Department of Biology. Our Calvin College nursing colleagues, Barbara Timmermans and Mary Flikkema, lent their expertise in
the areas of community health nursing and acute care nursing, respectively, and are responsible for those chapters. Mary Molewyk Doornbos
served as primary author of Chapter Five on psychiatric-mental health
nursing.

We are most grateful to the writing team for the hard work, good humor, and generosity of spirit that made the entire process a positive experience. A mere word of thanks to those who have contributed seems inadequate. Perhaps the vision that countless nurses and other health care
providers may be assisted in their efforts to articulate the relationship between their Christian faith and their vocation will suffice.

MARY MOLEWYK DOORNBOS

RUTH E. GROENHOUT

KENDRA G. HOTZ

Loretta is taking ice chips to the client in room 5723 when she realizes that
something has gone wrong. A loud, frightened voice is coming from room
5719, Mr. White's room. From her brief encounters with Mr. White -
whom she knows instinctively not to call by his first name - she knows
that he is a recently widowed 78-year-old client who was admitted with
chest pain and shortness of breath. His home is in one of the farming communities settled in the vast rural areas that surround this urban center, and
he is very much out of his element, not only in the hospital but in the city
itself. Everything seems too busy and too fast, and Mr. White always seems
suspicious - or, rather, worried - that things are being done to him in
the hospital that he does not understand and that may not be in his best
interest. His wife, Loretta supposes, had always taken charge of Mr. White's
health. He wishes his wife were with him now, and so does Loretta.

The cardiologist who visited with Mr. White yesterday, shortly after he
arrived on the unit, had explained to him that she suspected that the arteries leading into his heart had become blocked. She had ordered a test - a
heart catheterization - that would determine whether this was the case.
At the time Mr. White seemed to understand what the test would entail
and what his options would be if a blockage were found. But now Loretta
enters the room to find the 78-year-old in a state of panic and confusion.
He is holding the technicians from the cardiac studies lab at bay by shouting at them: "I'm not going anywhere with you! Where is my son? I need to
talk to my son! He'll know what to do. Go away!"

After twenty-five years as an acute care nurse, Loretta has seen this
scene before and has a good idea of how to intervene. Even though she spends most of her time in supervisory roles now, she still enjoys an occasional shift as a staff nurse. She gently asks the technicians if they might
give her a moment with Mr. White, and they oblige. Loretta asks a passing
aide to bring the ice to the client who requested it. She pulls the curtain between Mr. White's bed and that of his roommate, sits down, and asks Mr.
White calmly, "Tell me what's happening." After listening to his concerns,
she reminds him of the conversation he had with the cardiologist yesterday. Yes, he remembers, but he thought his son would be here by now and
doesn't want to go until they have a chance to talk. He is almost in tears.
"Your concerns make sense," Loretta assures him, even though she knows
that rearranging the cardiac studies lab schedule will be difficult.

Just as Mr. White is calming down, his son arrives. He's a big man who
wears khaki pants, an oxford shirt, and too much aftershave. He is in a rush
and looks like someone who always is. He assesses the situation quickly
and announces, "Dad, you have to go now. These good people are all waiting on you. You have to do what the doctor tells you to do. Tell him, nurse,
he has to go. Doesn't he?"

It would be so easy just to say, "Yes, you have to do what the doctor
says." But Loretta cannot do that if she is to maintain her integrity as a
nurse. Even after twenty-five years, there is no simple way for a nurse to
balance all of her responsibilities. Her role as a nurse calls for Loretta to be
a care-giver in multiple ways. She must be a teacher, an advocate for the
client, a steward of the resources of the hospital and of her colleagues, a coordinator of care, and a manager. She needs to respect Mr. White, to educate him, to help him make the best choices he can for his own health, and
to value his autonomy. In order to do all of those things, she needs to understand not only his physical condition but also his social location and
psychological state. She also needs to attend to her other clients, who have
similar, if not more urgent needs. But how do you do all of those things
when time and energy are short, and a client is scared, confused, and under
pressure from family members? And what do you do when one obligation
seems to conflict with another?