1. Grace J. Tazelaar MS, RN Missions Director Nurses Christian Fellowship
Things They Didn’t Teach in Nursing School: Preparing for Missionary Nursing
Grace J. Tazelaar MS, RN
Missions Director
Nurses Christian Fellowship
Describe the differences between a scientific/medical understanding of Health and Illness and those of other cultures.
Appreciate that the gospel message is interpreted through a cultural worldview.
Identify tensions that often occur between cultures.
Present the basic spiritual needs that all people have and ways to provide spiritual care to meet identified spiritual needs.
Differentiate between professional education, competency based education for given tasks, and health education necessary for changing behaviors.

2. Topics for Missionary Nursing
Cultures/Worldview
Spiritual Care
How to teach

3. Culture/Worldview
Worldview – “culturally agreed upon perception of reality, in other words worldview bridges the gap between objective reality and a person’s perception of it”
Lane, Patty. A Beginners Guide to Crossing Cultures. Downers Grove, IL.: InterVarsity Press
Read story from Patty Lane
Living in Uganda – never could totally understand Uganda
Florence Muindi in Louisville – perception of missionaries.

4. Culture/Worldview
Values and Beliefs
Worldview
What we do or Practice

5. Culture/Worldview HEALTH AND ILLNESS
Nursing grew out of a Christian worldview
Historically nursing practice is based in the scientific/medical understanding of health and illness
Germ theory
Systems theory
Evidence based practice

6. HEALTH AND ILLNESS
Host cultures may have a different understanding of health and illness
Illness may be:
Considered normal – everyone suffers from this problem
Caused by a broken relationship
Related to a curse
Anne Fadiman When the Spirit catches You and You Fall Down

7. HEALTH AND ILLNESS John 9:1- 7
1 As he went along, he saw a man blind from birth.
2 His disciples asked him, "Rabbi, who sinned, this man or his parents, that he was born blind?"
3 "Neither this man nor his parents sinned," said Jesus, "but this happened so that the work of God might be displayed in his life.
4 As long as it is day, we must do the work of him who sent me. Night is coming, when no one can work.
5 While I am in the world, I am the light of the world."
6 Having said this, he spit on the ground, made some mud with the saliva, and put it on the man's eyes.
7 "Go," he told him, "wash in the Pool of Siloam" (this word means Sent). So the man went and washed, and came home seeing.
How do the disciples see this man born blind?
Disciples’ Worldview
Illness is caused by sin
Someone caused this illness
Similar to animistic cultures today – ancestors, curses, broken relationships cause illness
How does Jesus see him?
Biblical worldview
The “Why” of illness and suffering leads to a decision to
Draw closer to God
Blame someone – self, others, God
May or may not be the result of sin

8. Culture/Worldview Understanding of the Gospel message
Jackie and Bill are developing a relationship with Luc and Li. The have been drawn together because their third grad children have become best friends. Luc and his family are first generation immigrants from Vietnam. They have been in the United States for six years and during that time have developed good English communication skills. Jackie and Bill consciously work at bringing up spiritual matters with Luc and Li. They all seem to be in agreement about the importance of knowing Jesus, and Luc and Li have prayed to receive Jesus.
You can imagine their surprise when their daughter came home telling about the altar set up to Luc’s ancestors with real food on it! They did not understand this custom nor did they know what to say to their daughter. After prayer and talking with their minister, Jackie and Bill went to visit Luc and Li. They saw for themselves the altar and began asking questions about its meaning.
Luc explained the Vietnamese tradition of ancestor veneration. He believed it was important for him to pray to and honor his ancestors in order to secure their protection and blessing for himself and his family. In addition, Luc had a responsibility to honor his dead relatives so that they could be happy in their new lives. He explained that this tradition had been carried on in his family for hundreds of years.
Bill wanted to laugh. How could anyone believe such nonsense? But he refrained from commenting and began instead to ask Questions about Luc’s faith in Jesus. It soon became obvious that Luc saw no problem with believing in Jesus and venerating his ancestors.
Jackie began to talk to him and to Li, trying to explain how their ancestors had no power to effect their lives. She alos emphasized that Luc had no ability to secure a happier life for people who were already dead. She went on to share how their faith in Jesus was all they needed. They could pray to him and he would help them. The ancestors were dead and there was nothing they could do for them now. This prompted Luc’s questions, “Does this mean that my ancestors are in hell?” Sadly Jackie told him that if they had not believed in Jesus they would not be with him in heaven he died. Luc immediately said he would not believe in Jesus then because he could not be responsible for his parent and grandparents being in hell. All efforts to persuade him that what he believed would have no bearing on the final destination of anyone but himself were futile. The visit cam to an end and the two couples said a sad goodbye.
Opini – polygamy – “What else did the missionaries tell us that was wrong?”
The Missionary and the Diviner: Contending Theologies of Christian and African Religions (Paperback) by Michael C. Kirwen (Author)

9. Cultural tensions Lingenfelter, Sherwood G. & Mayers, Marvin K
Cultural tensions Lingenfelter, Sherwood G. & Mayers, Marvin K. Ministering Cross-Culturally: An Incarnational Model for Personal Relationships. Grand Rapids, MI.: Baker Books. 1997
Tensions about Time
Tensions in Judgment
Tensions in Handling Crisis
Tensions over Goals
Tensions about Self-Worth
Tensions regarding Vulnerability
Balancing act between the tensions outlined. One not better than the other (not a moral judgment); but we need to appreciate the other viewpoint.

10. II. Spiritual Care Assessing Spiritual Needs
Personal Relationship with God
View of God
View of Man
View of Jesus
Meaning and Purpose
Love and Belonging
Forgiveness

11. The Person Providing Spiritual Assistance
Should have their own spiritual needs met
Not get ahead of God and do in our own strength
Not get behind and miss opportunities
In tune with God
We need to carefully examine our motives for providing spiritual assistance.
Because we are not perfect, we sometimes get ahead of God and try to provide spiritual assistance on our own. Sometimes we use helping others to meet our own spiritual needs. We may find our identity and meaning in life as a spiritual person. Or we may seek to find favor with God by “doing” His work. Other times, we may drag our feet and miss opportunities that God has given us to provide spiritual assistance.
To prevent these failings that ultimately hinder God’s work from occurring, we need to carefully examine our motives for providing spiritual assistance. Is it because this is something God is prompting us to do? Or is it something we feel that we should or ought to do because of expectations that have been placed on us by ourselves or others? There is a tendency to think that without us, “the world would go to hell in a hand basket.” We get so caught up in the “doing” that we forget that the reason that God created us was to have a personal relationship with Him. We forget that He desires us to become all that He has created us to be. We fail to take the time to just “Be” and fellowship with God. This is not saying that we should all live hermitlike lifestyles. God created us for work in His Kingdom. However, doing only those things that God has called us to and gifted us for is freeing. We are not responsible to meet all the needs of everyone in the world. That’s God’s job. We are not fixers but facilitators.
We are only required to be obedient in the things He has given us to do. He has promised us that He will provide the resources that we need to do those things. “Therefore you do not lack any spiritual gift as you eagerly wait for our Lord Jesus Christ to be revealed. He will keep you strong to the end, so that you will be blameless on the day of our Lord Jesus Christ. God, who has called you into fellowship with his Son Jesus Christ our Lord, is faithful.” (I Corinthians 1:7-9) It is also comforting to know that our God is a redeeming God. He can and does use us in spite of our weaknesses and failures.

12. The Person Providing Spiritual Assistance
Motivation
Meet the spiritual need of the person for whom you are caring?
Meet your need to share the gospel?

13. The Person Providing Spiritual Assistance
Be obedient
Do only the work God has given us to do
Don’t try to do the work of the Holy Spirit
God often uses our weak areas
Glory goes to God

14. The Ministry of Presence
Being Christ in a person’s life.
Comfortable in silence
Therapeutic communication skills
Excerpt from The Last Thing We Talk About
originally published as A View From the Hearse
“I was sitting, torn by grief. Someone came and talked to me of God’s dealings, of why it happened, of hope beyond the grave. He talked constantly, he said things I knew were true.
I was unmoved, except to wish he’d go away. He finally did.
Another came and sat beside me. He didn’t talk. He didn’t ask leading questions. He just sat beside me for an hour and more, listened when I said something, answered briefly, prayed simply, left.
I was moved. I was comforted. I hated to see him go.”
[1] Bayly, Joseph. The Last Thing We Talk About. Elgin, IL, David C. Cook, 1970

15. Meeting Spiritual Needs Through Scripture
Personal study of the Bible prerequisite
Using scripture
Meet the identified spiritual need
Person is agreeable to the idea
Not using scripture
Inappropriate application
Persons with acute mental illness
Inappropriate application -- exhorting an anxious person with “Do not be anxious about anything,” (Philippians 4:6) is probably not going to relieve the anxiety.
Persons with acute mental illness can view scripture in a magical or confused way.

16. Meeting Spiritual Needs Through Prayer
Not magic
Personal prayer
For others
With their permission
Apart from the person on their behalf
Not magic – research into effectiveness of prayer determined by desired outcomes puts God in our box.
Personal prayer
“Prayer is intimate conversation between us and God. It is our response to God’s initiative. Prayer is recognition of our human limitations and our need for God…True prayer is a dialog.”[1]
Lord’s prayer as a model – ACTS
Spiritual warfare
For others
With their permission
A known comforting prayer – the Lord’s prayer
Pray short, simple prayers that present the hopes, fears, and needs to the Lord. Acknowledge God’s ability to meet these needs. If the need is not well articulated or understood, we can tell God that in prayer.
Apart from the person on their behalf – intercession
[1] Shelley, Judith A., and Fish, Sharon. Spiritual Care: The Nurse’s Role 3rd edition. Downers Grove, IL: InterVarsity Press p. 107.

17. Meeting Spiritual Needs Through the Church
The Body of Christ
Each has unique gifts to bring to the table
Each person is a work in progress – in need of grace
Everyone is needed
The Body of Christ
Each has unique gifts to bring to the table
Each person is a work in progress – in need of grace
Everyone is needed
Unity – the message of the gospel
Can’t be jealous of others gifts
By the love we have for one another, others will see Christ.
Don’t neglect the Church in our priorities.

18. Meeting Spiritual Needs Through the Church
Unity – the message of the gospel
Can’t be jealous of others gifts
By the love we have for one another, others will see Christ.
Don’t neglect the Church in our priorities.

19. How to Teach Most educators Aim at the cognitive domain
Focus on providing information
Tend to teach the way we have been taught.

20. How to teach Health education should Aim at the practice domain
Focus on changed behavior
Use methodology appropriate for adult learners

21. Adult Education Theory Implications
1. Adults are capable of learning throughout their lives
1. Everyone should be given opportunity
2. Adults are the agents of their own education
2. Emphasis is on learning; not teaching
3. Adults have a wide experience and have learned much from life
3. Begin with what they know
4. As adults grow older their memories may get weaker but their powers of observation and reasoning often grow stronger
4. Don’t emphasize facts as much as present concepts
5. Adults have a sense of personal dignity
5. Treat them with respect

22. Adult Education People Remember: 20% of what they hear
40% of what they hear and see
80% of what they discover for themselves

23. Adult Education Problem Posing method
Presents a problem (without offering a solution)

24. Adult Education Presenting the Problem Starters/Codes Songs Pictures
Dramas
Stories
Games/Riddles

25. Adult Education Qualities of Good Starters/Codes (5 Ss) Short Simple
Specific
Sensitive
Solvable

26. Adult Education SHOWeD See Happening Our Why Do
What did you see or hear?
Happening
What is happening?
Our
Does this happen in our community?
Give examples
Why
Why does it happen? e Do
What can we do about it?
How? Who? When? Where?

27. Curriculum Development
Professional
Body of knowledge
Regulated practice – License
Built on foundation of arts and sciences
Lack of nurse educators is worldwide – both in the US and in other countries
Lots of missions opportunities for nurse educators.

28. Curriculum Development
Competency/Mastery
Prepares person for a task/job
Focus is on skill/job performance
Information is limited to what is necessary to learn the skill
Community health workers
Certified nursing assistants
Physicians assistants

29. Develop a list of skills
What knowledge does the health worker need to do this task?
What would be nice to know
What would be good to know
What is essential to know
Malaria education
Professional education would teach the life cycle of the mosquito, pathophysiology, signs and symptoms of disease, laboratory tests, diagnosis, treatment, evaluation. Might include means of prevention.
Competency/mastery would teach how malaria is spread, how to diagnose and treat malaria, and how to prevent it.

30. Develop a list of skills
What attitude does the health worker need to do this task well?
Attitude is key to practicing the skill well.

31. Develop a list of skills
What practical skills does the health worker need to do this task?
Communication
Problem solving
Manual

32. Knowledge, Attitude, Practice
Learning has not taken place until it is put into practice
Head knowledge passes through values/beliefs before being acted upon
Smokers continue to smoke even though they know it is detrimental to their health
Distance between heaven and hell is distance between head and heart

33. Adult Education
What we do or Practice
Values and Beliefs
Worldview