Volunteer Chaplain Training

1. Volunteer Chaplain Training Ministering to the Confused and Non-responsive Patient Module Six © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

2. 6.1 The Confused Patient • People may be confused for many reasons • Senility/Alzheimer’s Disease • Chemical Imbalance • permanent • temporary • Stroke • permanent • temporary • Head injury • permanent • temporary © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

3. 6.1 The Confused Patient • There are different types of confusion • Aphasia • Inability to talk at all • Able only to make sounds • Able to speak, but slurs speech • Able to speak, but mixes up words • E.g. Saying “sink” but meaning “washing machine” • Hallucination • Auditory - hearing something • Visual - seeing something • Tactile - feeling something • Disorientation • To time • To space/place • To circumstances • To people © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

4. 6.1 The Confused Patient • Confused patients have the same basic needs as others • Someone to “be with” them • Someone to hear their story • Their Story is important, even if “strange.” • They do not need to be corrected about their reality. • They need support and understanding. • Aphasic patients need empathy. • E.g - “It must be frustrating not to be able to communicate.” • They all need to know you care. © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

5. 6.1 The Confused Patient • Case study - Mr. BrownMr. Brown is 70 year old patient in the Intensive Care Unit (ICU). He is confused and disoriented to the point where he has to be restrained. He tends to ramble with his stories.B1: I need to get out of here and go to the races. I called my golfing partner and told him they are holding me against my will.P1: You sound as if you’re very frustrated about all this.B2: Yes, and it is my brother-in-laws birthday! We normally go over to Hot Springs and have a good time on the lake. I couldn’t get in touch with him, so I told my wife that I’d just go on over and they could come later.P2: Those sound like big plans.B3: But they have me tied down! I know what this is all about. They think I won’t turn in the golf cart where my sister works! But that’s no reason to hold me!P3: That must be angering for you.B4: I know you . . . You were that fellow that came to see me when I had my appendix out. (He seemed to be referring to years ago. This is the first time I had visited him.)P4: Well, I just wanted you to know that I think about you. (I touch his arm.)B5: (He smiles) I sure do appreciate you coming. (Tears come to his eyes.) © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

6. 6.1 The Confused Patient • Case Study - Mr. Brown • Notice: • How the pastoral care giver used good Feeling Responses • How the pastoral care giver didn’t try to correct the person’s perceptions or to explain the situation. • How the pastoral care giver let Mr. Brown know he cared. • Discussion Question: • In what ways was this visit significant to Mr. Brown? © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

7. 6.1 The Confused Patient • Case study - Mrs. GreenMrs. Green is an 82 year old patient on the recuperative care unit. She has come to the prayer service held on the unit each Friday. As a part of the service, I go around and ask each patient if they would like for me to pray for them and anoint them with oil. I have not met Mrs. Green before. She is recovering from a stroke and is aphasic. When I get to Mrs. Green, the following interaction takes place.P1: Mrs. Green, would you like for me to pray for you?G1: (Stammering) Ya … ya … tha … thu … (shakes her head “yes”).P2: O.K I will. (I hold up the bottle of oil.) Would you like to be anointed with oil?G2: (Stammering) Wa … ya … sa … thu … (shakes her head “yes”). P3: All right, I will. (I make a sign of the cross on her forehead with the oil.) I anoint you in the name of the Father, the Son, and the Holy Spirit. Amen. (I begin to pray.) Dear God, I pray that you be with Mrs. Green in a special way today. You know how frustrating it is to want to speak to someone - to want to tell them something - and they cannot hear or understand you. Mrs. Green knows that feeling too. Let her feel your presence near. Let her know you understand. And we ask that you touch her lips and make her to speak once again. Touch her and make her sound and well in body, mind, and spirit, through the power of our Lord and Savior Jesus Christ, in whose name we pray. Amen. G3: (Tears are streaming down her face and she is nodding her head up and down.) Thaaa … thaaaaaa … tha … P4: You are welcome. (I squeeze her hand.) © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

8. 6.1 The Confused Patient • Case Study - Mrs. Green • Notice: • How the pastoral care giver “stayed with” the patient. • How the pastoral care giver was sensitive to the patients feelings. • How the pastoral care giver demonstrated to Mrs. Green that he cared. • Discussion Question: • In what ways was this visit significant to Mrs. Green? © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

9. 6.2 The Non-responsive Patient • Again, these patients have the same basic need • Someone to be with them where they are • Someone to share their story, if not listen to it • These patients may be: • Comatose • On a ventilator • Conscious • Unconscious • Mentally incapacitated © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

10. 6.2 The Non-responsive Patient • These patients hear more than you think • Talk to them gently (no need to shout). • Beware of talking about them (they can hear). • Do not act like they are not there. • They respond emotionally to what is being said (if not cognitively). • Let them know you are there, and that you care. • Address them by name. • Tell them who you are and why you’ve come. • Touch them. • Tell them of others who are there or have asked about them. • Include them in the conversation with others. © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

11. 6.2 The Non-responsive Patient • Touch is important • Stroke the patient’s arm and squeeze it lightly • Hold the patient’s hand • Stoke the brow. • Place your hand on their head as in a blessing, especially when praying. • At times a cool wash cloth may be appropriate. • Do not forget that human touch is most therapeutic. © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

12. 6.2 The Non-responsive Patient • Silence is “golden” • Learn to be comfortable with long periods of silence. • You don’t have to always be saying something. • The patient can sense your presence. • Remember the “Ministry of Presence.” • Focus prayerful concentration on the patient. © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

13. 6.2 The Non-responsive Patient • “How I do it.” • Knock, walk in slowly • Go to bedside • I touch patient & say, “Mr. Jones, this is Chaplain; I have come by to be with you for a while.” • I say this even if family is present • I include patient in conversation • When leaving, touch patient & say, “Mr. Jones, I am leaving now. You will be in my thoughts.”

14. 6.2 The Non-responsive Patient • Case study - Mr. GrayI was called to the med-surg unit by the night charge nurse. She asked if I could come talk with Mr. Gray and “give him permission to die.” She explained that Mr. Gray was a 63 year old patient that had been near death for three days. She said he had been “hanging on by a thread,” and she felt he just needed to permission to go ahead and “let go.” When we entered the room, Mr. Gray was unconscious and had a blood pressure of 60/30. The heart monitor was “beeping” slowly. I went up to his bed and placed my hand on his arm. I spoke softly and gently, in my most “comforting” voice.P1: Mr. Gray, this is the hospital chaplain. I came to be with you for a little while and let you know that you are not alone. (I patted his arm and I was silent for a while, then continued). I am here with you . . . Your nurse is here with you too . . . And God is with you. (The heart monitor beeps are getting a little faster.) You do not have to be afraid. God promised that even though you walk through the valley of the shadow of death, you have no evil to fear, for He is with you. God is there waiting for you with open arms. (The beeps get even faster.) Don’t be afraid to “step over to the other side” because God is waiting there for you … to take you on to heaven. (The beeps are faster than ever now.)N1: (I look up at the nurse, and she is trying hard not to laugh.) Come here … (she whispers and motions for me to come with her outside.)P2: (Outside the room) What’s going on in there?N2: (Laughing out loud.) I think you made him mad! I should have told you a little more about him. For years he was a street bum and alcoholic. Lately his health got so bad, he really tried to get off the alcohol, and he lived in “half-way house.” However, he had so much wrong with him, that it finally got to him. I think if you had told him he was going to hell and meet all his old drinking buddies there, he would have liked it better! Now, his heart rate has returned to normal and his blood pressure is 120/80. He may last several more days now!(Mr. Gray died a week later.) © Copyright 2001 Al Henager. Use only with written permission and with proper credit.

15. 6.2 The Non-responsive Patient • Case Study - Mr. Gray • Notice: • How the pastoral care giver assumed too much. • How the patient could hear and respond to what the pastoral care giver said, even though the patient was unconscious. • Discussion Question: • What implications does Mr. Gray’s case have for your ministry? © Copyright 2001 Al Henager. Use only with written permission and with proper credit.