Faith and Health: Parish Nursing
By Melodie Olson, RN, PhD
One third of jesus’ miracles was concerned with health or the relief of illness. The Buddha’s first major teachings after the enlightenment were the Four Noble Truths, statements dealing with the existence of suffering and a blueprint for its relief.1 Islamic groups began hospitals during the crusades. A Jewish Rabbi and a Baptist minister sat side-by-side on a panel during a public health conference. When asked what the word "health" meant to them, both responded that health was anything that helped their members worship their God better. All faith traditions have a mission to support the health of their congregations.
Recognizing that health is a particular ministry of faith communities has given rise to a faith and health movement in the United States.2,3 The uniting view is that health is a "whole person" concept, integrating the body, mind, and spirit. The movement acknowledges the philosophy/theology of the faith group and the history and traditions of the individual assembly. The role of the faith community in promoting whole person health varies according to each tradition, but one major effort that has achieved prominence and respect across traditions is parish nursing.
Parish nursing builds on the mandate of the congregation to address health issues. It is a health promotion/ disease prevention role, focused on the faith community. This role does not embrace the medical model or carry out invasive procedures, medical treatments, or the maintenance of intravenous products.4 It is not home health. The parish nurse functions as integrator of faith and health, health educator, personal health counselor, referral agent, trainer of volunteers, developer of support groups, and health advocate. The parish nurse is an integral part of the congregation and works with the clergy and health ministry committee as appropriate.
History
Parish nursing began in the 1980s with support from the Kellogg Foundation, when Reverend Granger Westberg convinced several churches in Chicago to hire a registered nurse. During the previous decade, Kellogg funded a series of Wholistic Centers in churches (clinics staffed with physicians), and found they provided more "whole person" health care than did other settings. Unfortunately, the cost was too great to be continued independently by the congregations. In response, the model shifted to one of collaboration between a health system (e.g., hospital system, collaboration of hospital systems, faith-related foundation, community agency) and a congregation. The congregation would hire a parish nurse and would provide office space, required equipment, authority, a mission of health, volunteers, meeting space, and an organization. The health system, or community agency, would provide some funds for salary and an infrastructure for the parish nurse, including quality control measures, support groups, and continuing education. The health system also might be responsible for legal concerns, professional licensures, OSHA training, and other technical aspects usually provided by a human resources department. Several variations on this model have emerged to provide parish nursing care. Currently, parish nursing is an accepted method of health promotion in Canada, Australia, and Korea, as well as the United States.5,6
Education
The parish nurse’s education is based on both theology and professional nursing, especially community health nursing, and standards have been accepted by the American Nurses Association (ANA) Credentialing Center.7 The most widely accepted preparation for parish nursing is a nationally endorsed continuing education course, developed by a group of curriculum experts and based on a job analysis conducted by the International Parish Nurse Resource Center. The five- to eight-day curriculum is offered at several universities and recently has been revised to reflect current practice. Competencies are being developed and a movement toward ANA certification is being studied. There are also several academic courses and graduate programs in parish nursing, some of which are joint programs between Colleges of Nursing and Schools of Divinity.
Research
Rydholm documented the outcomes of 1,800 parish nurse program cases.8 Documentation was standardized using the nursing taxonomy of the North American Nursing Diagnosis Association and the Iowa Nursing Interventions Classification. Theoretical cost savings were realized primarily by sustaining chronically ill and aged people at home (empowering caregivers), thus preventing premature nursing home admissions, and by helping people recognize symptoms requiring immediate attention, thus avoiding more costly treatment later. Cost savings were estimated to be $400,000 for the first 600 visits. Referral, advocacy, assistance, active listening, and supportive education efforts were major nursing activities. More than half of the concerns addressed by the parish nurses were related to spiritual-psychosocial concerns such as unresolved feelings, transitions, interpersonal tensions, caregiver stress, and isolation.
In a review of the Carondelet Parish Nurse Program in Tucson, AZ, a sample of 15 hypertensive, diabetic, and overweight clients had lower blood pressure readings with a per client average reduction of 10-20 mm/Hg systolic and at least 10 mm/Hg diastolic.9 In addition, blood sugar readings decreased by 50 dL on fasting samples and there was an average weight loss of 10 pounds per client.
Not all parish nurses work in the same way to achieve their health and healing goals. Chase-Ziolek and Striepe evaluated parish nurse programs in rural and urban areas.10 The nurses in both programs volunteered their services and appreciated the opportunity to integrate their faith and nursing practices. However, nurses in rural areas most often provided services through home visits and telephone calls, whereas parish nurses in urban settings often provided services in the church building. Rural nurses were more involved with activities like case management and practical assistance, while urban nurses held more educational programs.
In another study of parish nursing practice, 11 nurses ranked the interventions they used most frequently in a single year: listening (6,050), teaching (3,770), touch (2,983), and spiritual care (2,799).11
Conclusion
Congregations are meant to be places of caring and healing by tradition and theology. Where congregations accept that mission, parish nursing has been shown to be an effective tool. When parish nursing programs partner with health care systems and public health agencies, they offer a systematic focus on the whole person, contributing a sense of health and wholeness to communities, and a sense of mission and meaning to parish nurses who feel called to this special ministry.
References
1. Epstein M. Thoughts Without a Thinker: Psychotherapy From a Buddhist Perspective. New York: Basic Books; 1995.
2. Droege T. Congregations as communities of health and healing. Interpretation 1995;49:117-129.
3. Foege W. The vision of the possible: What churches can do. Second Opinion: Health, Faith, Ethics 1990;13:36-42.
4. Solari-Twadell PA. The Emerging Practice of Parish Nursing. In: Solari-Twadell PA, McDermott MA., eds., Parish Nursing: Promoting Whole Person Health Within Faith Communities. Thousand Oaks, CA: Sage Publications, Inc.; 1999.
5. Olson J, et al. Educating parish nurses. The Canadian Nurse 1998;94:40-44.
6. van Loon A. The development of faith community nursing programs as a response to changing Australian health policy. Health Education Behavior 1998;25:790-799.
7. Health Ministries Association and American Nurses Association. Scope and Standards of Parish Nursing Practice Washington, D.C.: American Nurses Association; 1998.
8. Rydholm L. Patient-focused care in parish nursing. Holist Nurs Pract 1997;11:47-60.
9. Huggins D. Parish nursing: A community-based outreach program of care. Orthopaedic Nurs (Suppl) 1998;Mar-Apr:26-30.
10. Chase-Ziolek M, Striepe J. A comparison of urban versus rural experiences of nurses volunteering to promote health in churches. Public Health Nurs 1999;16:270-279.
11. Weis D, et al. Health care delivery in faith communities: The parish nurse model. Public Health Nurs 1997;14:368-372.
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