Parish Nursing - A New, Yet Old Model of Care
By Peggy S. Matteson, RNC, PhD
The history of sending churchwomen into homes of parishioners and community residents to provide health care dates back to the third century. By the nineteenth century religious denominations in the United States were implementing health ministry programs within congregations (Zersen, 1994). This trend toward health care for the whole person has led to the development of an independent nursing practice role - parish nursing, a specialized practice of nursing and health ministry.
Church leaders and nurses share a common perspective. Both are committed to empowering people to reach their full potential. Both believe in the self-care capacity of people. Both believe that healing can always occur, even when cure is not possible (Simington, Olson & Douglass, 1996).
What is parish nursing?
Parish nursing is a unique, specialized practice of professional nursing that holds the spiritual dimension to be central to practice. A parish nurse focuses on the promotion of health within the context of the values, beliefs, and practices of a faith community, such as a church, synagogue, or mosque. The nursing practice includes the faith community's mission and ministry to its members (families and individuals) and the community it serves (HMA/ANA, 1998, p. 1).
Implementation of this role requires a registered nurse that can fulfill the expectations of the independent practice of nursing as defined by the nurse practice act of the Commonwealth of Massachusetts, the Scope and Standards of Parish Nursing Practice, as well as, the interdisciplinary role of being a member of a ministry staff. In Massachusetts, there are more than 50 parish nurses. Most are working on a part time basis with the majority unpaid volunteers.
Comprehensive health requires the integration of the physical, psychological, social and spiritual aspects of the client system. Such integration allows harmony with self, others, the environment and God creating a sense of "wholeness, salvation or shalom" (HMA/ANA, 1998, p. 6). Incorporating the spiritual beliefs of the client into the nursing process enables their faith perspective and religious practices to become an intrinsic part of the health and healing process. With this as a basis of care the parish nurse assesses and develops interventions based on the integration of the spiritual beliefs of a client. Without this focus the pervasive nature of spiritual distress can reduce the benefit of nursing care to a client's biological and psychological conditions. Prayer with and for a client, as well as other expressions of faith and healing may be incorporated into the nursing care plan.
A parish nurse works within an interdisciplinary framework that includes clergy and the other staff members serving a faith community. Members of the ministerial team consult, plan and care for their congregations together. They work interdependently within the boundaries of their professional expertise while sharing mutual values and respect for each other's unique contributions.
For example, as part of their ministry pastors, parish nurses and lay workers all do hospital or home visits with parishioners or community members. However, each goes with a different perspective, assessment focus and purpose to their interaction. Communication among members of the team allows the recipients of care to reap the full benefit from these visits as the team member provides follow-up interventions or members best prepared to meet the specific needs of the client.
What does a parish nurse do?
The job description of the parish nurse is constantly evolving. The composition and concerns of each local congregation and the community it serves determine specific activities. A parish nurse assesses the needs of a specific congregation in order to respond to the holistic health needs of members of all ages and all degrees of health and illness.
Interventions are then planned based on the assessed needs of the members of the congregation. Clients are empowered to implement a plan of self-care in collaboration with family and congregational friends, the parish nurse and health ministry (HMA/ANA. 1998).
The most common interventions of a health ministry require the parish nurse to fulfill the roles of educator, counselor, referral agent, advocate and facilitator. The acronym HEALTH may be the easiest way to remember the multiple facets of this role (Striepe, King, & Scott, 1993).
Health Counseling. Parishioners seek out the parish nurse to discuss personal health problems and to explore health care choices. Common concerns are parenting issues, use of medications, choosing care providers, communicating with medical providers, and prioritizing conflicting responsibilities. Others in need of support include members in life-style changes; caregivers in their work with a family member or the elderly desiring to remain in their homes are also
Educator of Holistic Health. One of the most needed and valuable activities is to raise the health awareness of a congregation and foster an understanding of the interrelationship between lifestyle, personal habits, attitudes, faith and wellbeing. Parish nurses provide information through seminars, workshops, and printed materials in newsletters and bulletins, handouts, displays on bulletin boards and individual sessions. Popular topics include depression, nutrition, exercise, complimentary therapy, CPR, first aid, and preventing back injuries.
Advocate/ Resource Person. People often need assistance in speaking to health care providers about their concerns or explaining their health needs to family members. Accompanying a client to a doctor's office or emergency room, making phone calls to set up appointments for home care services, or explaining a client's needs to family members are ways that a parish nurse may advocate for a client and assist in obtaining the support they desire.
Other resources provided by the parish nurse might include conducting screenings for hypertension, vision, hearing, scoliosis and other conditions. Some churches have found it comforting to have the parish nurse establish and monitor a blood bank at a local hospital for use by members of the congregation.
Liaison to Community Services. Parish nurses act as a liaison between their clients and their community so that parishioners may draw on health related resources from not only within the congregation but also the larger community. This can be an invaluable help to people seeking specific information about a health condition affecting themselves or a family member, a support group based on a philosophy supportive of their own, a social service or government program to support individuals or families through difficult times, or accessibility to current treatment of a chronic disease.
Teacher of Volunteers. Parish nurses soon learn that they can not possibly respond to all the requests for their help. Some times it is a time factor, other times it is because there are others available with a specific expertise that is needed. The incorporation of lay and professional volunteers allows the parish nurse to develop a multifaceted health ministry program.
Parish nurses recruit and train congregational volunteers to extend the health and caring mission of the church. They provide support to other parishioners through home or nursing home visits, providing meals and other supportive assistance within a home, emergency babysitting, transportation to health care appointments, etc.
Healer of Body, Mind and Spirit. Parish nurses help to clarify the relationship between faith and health through poster displays, articles in the church newsletter, presentations to church groups or classes, participation and presentations within worship services. Individuals or families may request that a parish nurse pray will them, or explore the meaning of an illness or tragedy in their life, recommend meditations for spiritual growth and healing, etc. Preparation and education, careful listening, and reflection as well as a wide variety of resources and the partners on the health ministry team enable the nurse to respond thoughtfully and appropriately.
What is the Place of the Parish Nurse within the Health Care System?
Parish nursing integrates current medical and behavioral knowledge with the beliefs and practices of a faith community to promote health as wholeness and to minimize illness, the experience of brokenness. Parish nursing promotes health and healing by empowering the client system to include health and healing beliefs from a faith perspective in order to achieve health (HMA/ANA, 1998). This is a broader perspective of care than currently provided by our illness-focused system.
Public health nursing or home health nursing appear on the surface to have similar focuses to parish nursing and health ministry. Public health nurses provide a population focused practice. Community health nurses provide a liaison with community services, make home visits and incorporate family members into the care of a client. Both provide care based on the independent and dependent practice of nursing. However, they are limited in the practice of integrating the spiritual realm of care.
When health is defined as wholeness, salvation, shalom, it requires the integration of the physical, psychological, social and spiritual aspects of the client system and harmony with self, others, the environment, and God (HMA/ANA, 1998). Improvements in a person's health will come about only as they integrate this interplay between body, mind and spirit, assume greater responsibility for their own health and for the health of their community. Health becomes a spiritual problem calling for a change in outlook and behavior rather than a medical problem calling for a scientific breakthrough (Wilkerson, 1998).
In health ministry the focus is on health promotion, healing and hopefully a cure. Healing focuses on the process of integrating the body, mind, and spirit to achieve wholeness, health and a sense of well-being, even when the curing of disease may not occur (HMA/ANA, 1998). This is the work of parish nursing. The new Scope and Standards of Parish Nursing Practice (1998) will enhance the development of this independent nursing practice role.
Health Ministries Association/American Nurses Association. (1998). Scope and Standards of Parish Nursing Practice. Washington, DC:
ANA. Simington, J., Olson, J. & Douglass, L. (1996). "Promoting Well-Being Within A Parish." The Canadian Nurse 92(1) 20-14.
Striepe, J., King, J.M., & Scott, L. (1993). Nurses in the church: Profiles of caring. Journal of Christian Nursing(Winter):XX.
Wilkerson, J. (1998). Health Ministries and Parish Nursing. Dayton,OH: HMA.
Zerson, D. (1994). "Parish Nursing: 20th Century Fad?" Journal of Christian Nursing 11(2)19-21.
Article was first published in Massachusetts Nurse 69(3), 5. Do not reproduce without citing this fact.