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Spring 1992 · Vol. 21 No. 1 · pp. 52–63 

Compassion: Infiltrating the Profession of Nursing

Evangeline Truex

Christ has inaugurated the Kingdom, God’s reign, which infiltrates every aspect of this world. But how does God’s Kingdom enter my world of caring for the sick, injured, and helpless—the world of health care? And in what way is God present to me as I care for them? What does it mean to pray, “Thy kingdom come; Thy will be done on earth as it is in heaven”?

The commitment to compassion reshapes professionalism.

My world is the world of nursing. This world has two major concerns: (1) care and compassion for the weak, sick, and injured and (2) the pursuit of professionalism, articulated as the delivery of a valuable service, based on unique knowledge, performed ethically, and practiced autonomously. What does it mean to follow God, the King into this world and infiltrate it with his characteristics? My specific interest is how compassion, an oft-neglected characteristic of our God, relates to this world of professionalism. An inquiry into the biblical understanding of God’s compassion may clarify our imitation of him in a world searching for professionalism.

I limit my inquiry into the nature of compassion to the Old Testament (O.T.). The word most often translated as “compassion,” {53} rahamayim, will be analyzed in its O.T. contexts. The O.T. concept of compassion will be explored through the perspectives of the compassion of God and the compassion of people, and through the metaphor of God’s compassion, namely, the mother.

THE COMPASSION OF GOD: GOD FOR US

In the O.T., compassion is an emotion or quality that is primarily attributed to God. God is overwhelmingly the One who is compassionate. 1 King David, when given an option, chose punishment by God rather than by people because he believed God was compassionate (2 Sam. 24:14). Or again, people plead for God’s compassion when they are in distress (e.g., Ps. 69:16-17). God may show his compassion through other people, for example, through the king (Jer. 42:12) or the captors (1 Kings 8:50).

God is also known to withdraw his compassion. Such withdrawal is understood as God’s anger. People experience widespread death and destruction when God withdraws his compassion (Jer. 13:14). Nehemiah speaks of it as annihilation and abandonment (9:19-31). Zechariah points to the continuing captivity (1:12). Isaiah notes the poignancy of Israel’s Creator and Maker withdrawing his compassion and leaving her city desolate (27:10-11). When God’s compassion is absent, God’s anger is experienced in concrete terms of judgment as well as in emotional terms of abandonment and rejection.

What causes God to withdraw his compassion? Jeremiah’s answer: God’s response to human wickedness, disobedience, and infidelity (Jer. 13:10-14). That is, God withdraws his compassion when people break relationship with him and do evil.

Amazingly, God manifests his compassion to these very people from whom he had withdrawn his compassion. They are the very people whom he had rejected and “not compassioned” (e.g., Hos. 2:25). He had been angry with them (e.g., Hab. 3:2), had given them the “burning of his wrath” (Deut. 13:18), and had chastened them in wrath (Isa. 60:12). They were the wicked ones (Isa. 55:7) and the ones who had disappointed God (Jer. 31:20). God’s compassion on these people brought an entirely unexpected turn of events.

What occasioned this change from God’s wrath to his {54} compassion? There seem to be two sides to this change. On the one hand, God forgives. He delights in mercy, pardoning sin, and returning to show compassion (Mic. 7:18-19). On the other hand, the people confess their sin, repent, and return to God. For example, Daniel prays to God, repents before him on behalf of the people, and then states his expectation of God’s compassion (Dan. 9:15-19). In the story line of Hosea, it is God who takes the initiative to restore the relationship (Hos. 2:16-21), while later the people are expected to repent (Hos. 14:2-3).

A Four-Way Demonstration of God’s Compassion

God’s compassion is manifested in at least four ways: restoration, presence of God, deliverance, and forgiveness. A predominant theme is restoration of a broken relationship. There are numerous examples: a favorite son, Benjamin, is returned to his aging father, Israel (Gen. 43:14); God gathers his people again and restores them to fellowship with him (Isa. 54:7); and God’s people are returned to their inheritance and land (Jer. 12:15). God also restores their fortunes, their numbers, and their honor (e.g., Deut. 13:18). Because of God’s compassion, broken relationships with his people are restored and a community is rebuilt.

A second theme associated with compassion is the presence of God. Zechariah has a beautiful picture of God returning to Jerusalem and stretching a measuring line over it; his house will again be built in the midst of his people (Zech. 1:16). Nehemiah remembers the pillar of cloud by day and the pillar of fire by night during the desert wanderings. In so doing, God, in his compassion, did not abandon them (Neh. 9:19). Thus, compassion motivates God to be present to his people, especially in difficult situations.

A third theme is that of deliverance. On several occasions, the writers plead for God to come in compassion and deliver them (e.g., Ps. 69:13-18). At times, this deliverance is from enemy nations (Ps. 79:8). At other times, this deliverance is from death. Daniel, for example, requests God’s compassion in order that he may understand the king’s dream and not die with the other prophets (2:18). Accordingly, compassion motivates God to deliver his people from destructive situations.

A fourth theme, forgiveness, understood as that which initiates God’s compassion, also becomes a strong theme {55} associated with compassion. Micah vividly pictures this hope of forgiveness when he says that God, in compassion, will bind our iniquities and throw them into the deep (Mic. 7:19). The Psalmist states that God restrained his anger, did not destroy Israel, but atoned for their iniquities (Ps. 78:38). This suggests that suffering is implicit in forgiveness. For God to come near to his people, to be present, requires his acceptance of the hurt that they had caused him with their infidelity. Hence, compassion motivates God to forgive sins—and we also glimpse a future time when God will take away the inclination to sin.

The four themes—restoration, presence, deliverance, and forgiveness—motivated by compassion are intertwined and mutually reinforcing concepts. For example, the story of Hosea clearly links them. Here, compassion motivates God to deliver Israel from his judgment (2:2, 24). Israel will then be restored to the land (2:25) as well as to God’s presence (6:3). And following God’s initiative of compassion, the people are expected to repent and ask God for forgiveness (14:2-3). The four themes thus form a matrix that speak of God’s desire to form a community in relationship with himself by means of restoration, presence, deliverance, and forgiveness.

Why did God show compassion?

Why did he restore unfaithful people to a relationship with him, becoming present to them, delivering them, and forgiving them? The writer of 2 Kings provides one rationale: it is because of his covenant with Abraham, Isaac, and Jacob, their forefathers (13:23). Even though the people have broken the covenant, God will remain faithful (Neh. 9:17-31). The writer of Exodus says it differently. When Moses asked God to show his glory as a sign of his presence, part of God’s reply was, “I will have compassion on whom I will have compassion” (Exod. 33:19). This passage indicates God’s freedom to show compassion to those he chooses. It suggests that God binds himself to those he chooses; his faithfulness and loyalty to those with whom he makes a covenant compel him to show compassion.

THE COMPASSION OF PEOPLE: GOD IN US

While God is the compassionate One in the O.T., people are also expected to show compassion to others. For example, the Psalmist blesses the person who is compassionate (Ps. 112:4). Or again, the Lord tells Zechariah that a true fast is expressed in part by showing compassion (Zech. 7:9), which in this context means not oppressing the widow or the fatherless, the alien or the poor (Zech. 7:10). Only two incidents are recorded in the O.T. in which persons are described as showing compassion!

In the first incident, Joseph, after being sold into slavery by his brothers, became a ruler in Egypt (Gen. 41-45). The brothers came several times for food when Palestine was in famine. On their second visit, Joseph saw his younger brother for whom he had earlier asked. When he saw him, Joseph was moved with compassion and quickly left the room to weep (Gen. 43:30). Compassion is here seen as a strong emotion. This compassion led him to reveal himself to his brothers, forgive them, and restore the relationship between them.

In the second incident, two women with one child came before King Solomon for justice (1 Kings 3:16-27). Each woman had given birth, but one child had died during the night. Now both claimed to be the mother of the living child and asked the king to decide between them. The king suggested the living child be cut in half and divided between them. The real mother was moved with compassion and pled with the king to keep the child alive and give it to the other woman (1 Kings 3:26). Here compassion was again a strong emotion that motivated the mother to deliver the child from death at her own expense.

Although God desired his people to be compassionate, the O.T. indicates that people generally were not compassionate. 2 Their lack of compassion was manifested as anger, often expressed in gruesome stories. Without compassion, power can be used against people, to harm and to destroy. Unfortunately, compassion is a characteristic of God that finds few expressions among people in the O.T.

THE METAPHOR OF GOD’S COMPASSION: GOD BESIDE US

Compassion is often thought of as a feminine metaphor for God because of its association with the word raham, or “womb.” Womb is the singular; compassion, the plural. The derivation of the word may, therefore, nuance our understanding of compassion. In O.T. thought, God is the one in control of the womb. 3 He brings life to conception. He provides the {57} womb that nourishes and sustains vulnerable and fragile life. He releases that life when viable and places it onto the breasts of one who continues to nourish and protect that life (Ps. 22:9-10). In so doing, God binds mother and child together. It is expected, then, that mothers will not forget their children, even when grown (Isa. 49:15). They will be motivated to forgive, seek reconciliation, offer protection, and be present to their children, despite their rebellion. Thus, mothers themselves may become living metaphors of God’s compassion. Mothers provide imperfect examples of how God deals with us and of how we, male and female, are to relate to our neighbors.

JESUS: PASSING ON THE BATON OF COMPASSION

The O.T. revelation of God’s compassion is enhanced by the New Testament (NT). Here, Jesus, “God with us,” broadens our understanding of compassion. Jesus bridges the gap between God and humanity, enabling and empowering his followers also to be compassionate through his Spirit. We, as his followers, are entrusted with the message of reconciliation (2 Cor. 5:19-20). Reconciliation describes the return to friendly relations, the same status that the compassion of God wrought in the O.T. 4 Those who have received God’s compassion, who have themselves been reconciled to God, forgiven, and delivered, respond with joy and obedience to God’s initiative and ongoing work of reconciliation.

COMPASSION WITHIN PROFESSIONALISM

God continues to call his people, including nurses, to be compassionate; that is, they are called to imitate God and Jesus in seeking restoration of broken relationships, becoming present to those in difficulty, delivering those in situations where God’s compassion seems distant, and forgiving others in order to restore them to community. Christian nurses, as members of the kingdom of light, are convinced of this challenge.

However, the nursing community is energetically persuading nurses to seek the status of a profession: “A search for exclusive knowledge, provision of a necessary service to the public, ethical practice, and autonomy both individually and as an association.” 5 The question becomes: How can Christian {58} nurses creatively and responsibly respond to these two challenges of compassion and professionalism? I suggest that the call to compassion takes precedence and transforms the concept of professionalism for Christian nurses. The commitment to compassion reshapes professionalism in each of its four dimensions. In this way, the kingdom of light infiltrates yet another world.

SERVICE: MOTIVATED BY COMPASSION

Both concepts of compassion and professionalism include the dimension of service to others. However, nursing does not, as yet, have a precise or specific articulation of its unique service to others. One well-known nurse theorist states that “care” is the essence of nursing. 6 Another nurse theorist states that nursing is action designed to bring about events and results that benefit others in specified ways. 7 I submit that compassion, as understood in the O.T., provides a distinctive articulation of nursing service for God’s people in this occupation.

In our day, in North America, sickness isolates people. The sick themselves withdraw for a variety of reasons: they lack the energy to interact socially, they deliberately avoid the awkwardness of “the well” not knowing what to say, or they feel embarrassed by their inability to conceal their symptoms. 8 The community also places barriers before the physically challenged; their difficulties with mobility limit their access to public places. 9 The sick are often sent to institutions to be cared for, away from their family and friends. And while in the institutions, they may feel dehumanized because of complex medical technology. 10 For a variety of reasons, then, sick people often feel alone and isolated; they are, in our North American way, expelled from community. Just as God in the O.T. showed compassion to his people when they were far from him, so the church, as Christ’s body, is called to serve these sick in love—to show compassion and initiate reconciliation—to bring them back into the community (John 13:34-35).

By their contact with the sick, Christian nurses are in a unique position to break the harrier of the isolation of the sick with compassion, to demonstrate God’s desire for restoration and reconciliation in visible and concrete service to the public. {59} Their work can manifest a sacrament of compassion. 11 Christian nurses are often required to care for the sick in quite intrusive ways, “caring for bowel, bladder, and skin.” In this intrusive care, both the sick and the nurse become aware of the frailty and limits of the body and are pointed to the religious dimension of life. The nurse, initiating intrusive care of “broken” bodies, sacramentally manifests the intrusive nature of God’s compassion which initiates reconciliation of broken relationships.

Compassionate service challenges nurses to be present to the sick. Christian nurses, seeking to show compassion, imitate God by becoming present and vulnerable to the sick. In demonstrating God’s initiation in reconciliation, they do not distance themselves from the sick; 12 rather, they seek to walk with the sick in their suffering, to explore the religious questions of being and life, and to know God in the midst of suffering and death. Christian nurses can become fellow pilgrims with the sick, listening to their pains and pointing one another to the light that shines through their suffering. As they see the pains of the sick, so also they see that God “visits” the sick. Christian nurses must seek “connection”—reduce their distance—with the sick in order to show compassion. Through presence, they show that both they and the sick are intended to be part of the same community of followers of Christ.

Compassionate service also calls for forgiveness. For example, many people suffer sickness or disability because of an unhealthy lifestyle. They may have a spinal cord injury due to drug use and a related motor-vehicle accident. They may be heavy alcohol abusers and suffer liver cirrhosis, diabetes, or seizures. Their stroke or heart attack maybe directly related to overeating and lack of exercise. Christian nurses, by their presence and by seeking the restoration of these sufferers into the community of God, demonstrate God’s forgiveness in a concrete way. Or again, some sick people exhibit caustic attitudes and behaviors that tend to repulse visitors and care-givers. As mothers are expected to show compassion even to their rebellious children, so also nurses motivated by God’s compassion demonstrate forgiveness by their presence even to caustic clients.

Compassionate service seeks to deliver those who are sick. Those who are sick are often unable to care for themselves. {60} Nurses, through their specialized knowledge, are often able to care for the sick in such a way as to aid their recovery. They may be able to teach their clients self-care skills with the use of specialized equipment and in conjunction with other professionals so that clients may again function independently. Nurses can also use their political power to lobby for the removal of physical barriers to public places. Or they may use socialization tactics to remove emotional barriers to public events. Nurses can use their power to empower the sick, to use their power for the sick as compassion dictates, rather than against others as when compassion is absent. In this way, they demonstrate God’s desire to deliver the sick from their bad situations.

Christian nurses do not serve others in order to gain respect as professionals; rather, compassionate service flows out of obedience to God. As ones who have received compassion, they are empowered to extend compassion to others. They are aware of their ongoing need for the empowerment of God through his Holy Spirit. Therefore, they pray for their clients and their fellow-nurses. They also ask the believing community to stand with them in prayer, aware of the strength gained through this practice.

Compassionate service, for the Christian nurse, is also conveyed with joy. Humor, laughter, and cheer are part and parcel of the expression of presence. While this may seem out of place in the midst of tragedy or of a potentially embarrassing moment such as a bowel program, laughter symbolizes health and thus demonstrates God’s compassion in a tangible way.

SPECIALIZED KNOWLEDGE: TRANSFORMED BY COMPASSION

Nurses, in their search for professionalization, are seeking a specialized and unique body of knowledge. In emulation of the medical profession, they desire knowledge that is beyond the understanding of the non-professional. Compassion, I suggest, does not dispute the search for knowledge. However, since compassion seeks reconciliation and community first and foremost, it challenges the boundaries of that knowledge. Compassion motivates nurses to receive knowledge from clients as well as from other sources. It also motivates nurses to give knowledge away rather than to hoard or control it. Perhaps {61} the idea of a knowledge broker expresses the role of Christian nurses best. For example, they may seek to understand how a particular client manages his or her illness, or what problems this client has dealt with successfully, and then pass that information on to other clients in similar circumstances.

ETHICS: INFORMED BY COMPASSION

Nurses seek to practice by a code of ethics. Compassion does not challenge the desire to practice ethically. Yet professions generally agree that ethics can only be discerned internally due to their specialized knowledge base. Compassion, with its emphasis on the restoration of community, opposes this internal focus. The whole people of God become the community that calls one another to ethical behavior. Christian nurses will seek contact with other Christians, including clients, their families, and church members, to discuss and discern ethical issues.

AUTONOMY: CHALLENGED BY COMPASSION

Nurses, in their search for professionalism, are seeking autonomy. Compassion, which seeks community, challenges the goal of autonomy. It motivates the search for interdependence rather than dependence or independence. It encourages Christian nurses to seek out a Christian community to discern ethics together. In the hospital, it advocates that Christian nurses work together with other health care personnel in an interdisciplinary or transdisciplinary fashion in which the client and/or family as well as other disciplines are included in decision making. Christians seek neither sole control over nursing functions nor total dependence. Rather, they seek to work in cooperation with others, whether “professionals,” clients, or otherwise.

CONCLUSION: COMPASSION INFILTRATES PROFESSIONALISM

Christian compassion reshapes professionalism for believing nurses. Compassion articulates certain necessary aspects of service: restoration to the community, presence, deliverance, forgiveness, obedience, and joy. It transforms the search {62} for unique knowledge, seeking to give knowledge away. It informs the code of ethics, drawing in the whole believing community in ethical decision-making. And it challenges autonomy with its emphasis on relationship.

As one nurse educator stated, Christian motivation in nursing “gets in the way” of economic and political rewards for nursing. 13 She may have understood correctly. The nursing Christian, in showing compassion, may be professionally subversive!

NOTES

  1. There are at least fifty-seven instances when God is characterized as compassionate. Approximately three/fifths of these references are found in the prophetic literature.
  2. S. Daniel Breslauer, in a study of Isaiah 40-55, states that divine power as well as divine example is necessary for humans to be compassionate. “Power, Compassion and the Servant of the Lord in Second Isaiah,” Encounter 48/2 (1987): 173.
  3. Phyllis Trible notes that control of the womb “belongs neither to women nor to their husbands, neither to the fetus nor to society.” God and the Rhetoric of Sexuality. Philadelphia: Fortress Press, 1978, 35.
  4. The componential features of the word domain involve “(1) disruption of friendly relations because of (2) presumed or real provocation, (3) overt behavior designed to remove hostility, and (4) restoration of original friendly relations.” Johannes P. Louw & Eugene A. Nida, eds., Greek-English Lexicon of the New Testament based on Semantic Domains, 2nd ed., Vol. 1. New York: United Bible Societies, 1988, 1989, 502.
  5. Susan Leddy and J. Mae Pepper, Conceptual Bases of Professional Nursing. Philadelphia: Lippincott, 1985, 40-43.
  6. Madeleine M. Leininger, ed., Care: The Essence of Nursing and Health. Detroit: Wayne State University Press, 1988, 3.
  7. Dorothea E. Orem, Nursing: Concepts of Practice, 3rd ed. New York: McGraw Hill Book Company, 1985, 10.
  8. Anselm L. Strauss et al., Chronic Illness and the Quality of Life, 2nd ed. St. Louis: The C.V. Mosby Company, 1984, 76, 77, 83.
  9. Strauss et al., 194-195.
  10. Strauss et al., 197.
  11. Sacrament is understood as a concrete or material expression of spiritual reality. Thomas N. Finger argues that humanity, in virtue of its bodily nature, requires material expression of spiritual reality. The incarnation can be understood as God relating to us sacramentally. Christian Theology: An Eschatological Approach, Vol. II. Scottdale, PA: Herald Press, 1989, 333.
  12. Myron Ebersole states that both distance and intimacy are necessary and must be held in tension. He states that distance is necessary for objectivity and for the client to feel safe enough to reveal secrets of the inner self. “Understanding Professional Distance,” Perils of Professionalism. Donald B. Kraybill & Phyllis Pellman Good, eds. Scottdale, PA: Herald Press, 1982, 125. When explained this way, distance sounds like the superior relating to the inferior. I suspect that {63} professionals are socialized to believe in the value of distance and therefore are able to rationalize it. In the Christian community, helping one another is given from a position of equality, from that of a fellow pilgrim rather than from one who knows and has arrived to one who has not yet made it.
  13. Winnifred Gustafson, “Motivational and Historical Aspects of Care and Nursing,” Care: The Essence of Nursing and Health, Madeleine M. Leininger, ed. Detroit: Wayne State University Press, 1988, 68, 71.
Evangeline Truex is adjunct instructor, Tabor College and part-time nurse, Salem Hospital, Hillsboro, KS.

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