BY: JEANE A. NIST, RN, BSN
Ms. Nist developed and managed the Parish Nurse Program at Holy Cross Health,
Silver Spring, MD, from its inception in September 1993 until her recent retirement.
She continues to be a resource for the program.
Through Them, Faith Communities Are Reclaiming a Role in Healing
Our religious traditions speak of ministries of presence and healing. The
prophets and patriarchs of old modeled this role for us. Many sacred passages
are commentaries of God's people, speaking from within their faith communities,
reaching out to the ill, the broken, the scorned, and offering them healing—through
touch, through the kind of listening that empowers, and through prayer. Throughout
the ages, these communities of faith provided the care and compassion that came
to be known as "health care." Along the way, that care lost much of its essence
because caregivers, who had in the beginning understood spirituality as integral,
began to see science as all-powerful. And the caregivers themselves, who had
been caring individuals with shared values and beliefs, became distanced specialists.
The contemporary "medical model" of health care tends to focus on the disease
and a technology of cure, thereby encouraging passivity and powerlessness in
the patient. The medical model tends to isolate people from their usual supports;
ignores the therapeutic value of their significant connections in life; and
often neglects their wholeness of body, mind, and spirit. Access to health care
is often difficult and confusing; delivery of care is frequently fragmented,
sometimes wasteful, and increasingly discriminatory and costly. Professional
caregivers, mirroring contemporary society's values, attempt to defy death and
to defeat all suffering and illness, rather than see them as intrinsic to life
and opportunities for growth and transformation.
It is true, of course, that the enormous technological advances we have achieved
in medicine save lives and alleviate symptoms. We need not abandon such achievements.
But we should consider using them with ethical discernment. It is increasingly
clear that changing unhealthy behaviors is as important as the most expensive
clinical tests or the most sophisticated clinical screening procedures. The
suffering that results from poor choices accounts for an unnecessary loss of
innumerable lives and for disabilities that are often accompanied by (and sometimes
rooted in) feelings of depression, low self-esteem, and worthlessness. Negative
health habits translate into billions of dollars in additional medical costs,
lost productivity, unemployment, and disability payments. Ultimately, we all
pay in increased costs, higher insurance premiums, and reduced access to care.
Today, however, a relatively new movement in faith communities is providing
us with an opportunity to embrace some of the wisdom of our ancients and to
focus again on the impact that spirituality, caring relationships, and a responsibly
balanced life can have on health and wellness.
Working to reclaim the church's role in the ministry of healing, these new
programs have emerged from a variety of religious denominations, emphasizing
the connection between spirituality and health; the importance of personal and
community responsibility in promoting and maintaining health; and the need for
improved access to the wealth of information, resources, supports, and care
that are available. The faith community has historically labored as God's change
agent in the arena of social justice. Why should we not enlist its power
in the name of health and well being?
Congregational health ministries are pursuing a concept of health that, moving
beyond merely combating disease, encompasses a broader vision: a commitment
to whole health—body, mind, and spirit. These ministries envision healing as
the achievement of harmony in the physical, emotional, social, intellectual,
and spiritual dimensions of life, a healing possible even without cure. The
new healing ministries acknowledge health and well-being as the fullness of
life that God intends for us.
Program Model, Process, and Timeline
Holy Cross Health, Silver Spring, MD, is privileged to be a part of that movement.
Our Parish Nurse Program is working with many committed faith communities in
support of congregational health ministries focused on wellness education, health
promotion, and preventive care. These ministries, each of which has its own
individual identity, are integrated into the life and ritual of the faith communities
they serve. We have found that ministries flourish when congregations become
aware of the necessity to expand to address unmet needs, when there is pastoral
support, when there are concerned members willing to commit their time and talents,
and when the concept of body-mind-spirit health is understood. Most successful
congregational programs have a strong volunteer health committee that supports
the work of a staff parish nurse. Our experience is that as congregations become
aware of the value of a staff position parish nurse, they begin to plan ways
to fund such a position.
What is often identified as a "volunteer congregational health ministry model,"
the model offered at Holy Cross, has become the dominant model in our geographical
area. As we have refined it, this model takes into consideration the relevant
characteristics of each participating faith community: its shared faith and
values, its sense of (or lack of) community, its ability to lead, its unique
culture or identity, as well as its assets and needs. Both the church as a community
and the church's members are the client population, the latter being envisioned
as individuals or as members of a family unit, depending on existing congregational
system dynamics.* A sense of community is significant in either affirming or
negating the potential benefit of reinforcement and modeling. (Without such
a sense, reinforcement and modeling, which have great potential in encouraging
behavior change, diminish in value.) Our conceptual framework incorporates not
only a systems theory perspective but also a redefined language for nursing
process. It blends the broader health ministry model with the basic theory and
roles of parish nursing.
*As used in this article, the word congregation indicates a church membership,
not a religious institute.
We have found that focusing on common congregational values, beliefs, and
language; and using community strengths (within a suggested model, process,
and timeline) provide insights into the incentives that motivate church members
to action and the barriers that impede action. Thus equipped with these insights,
the ministry team can create a safe environment in which church members are
more prepared to participate in discernment regarding their health and to challenge
the church's role in its stewardship. People can explore together a relational
understanding of health and self-care, the depth of their own commitment to
act wisely and to make informed decisions in health matters, the obstacles to
health, and ways they might consider how to deal with illness and care giving.
The outcomes we are seeking involve a cultural change that can realistically
be achieved only over time—in fact, over generations.
Early on, we discovered that, as we engaged communities of faith in the spirit
of attending to their uniqueness and surrendering to God's time and plan, a
definitive process and timeline with which we could guide developing ministries
began to evolve. With this process in mind, we approach the faith community.
We share each congregation's journey to health ministry, serving as resource,
mentor, and facilitator. This initially involves one or more enthusiastic members
exploring the concept and identifying existing ministries (e.g., eucharistic
ministers, homebound visitation, senior groups), congregational dynamics, and
potential member energies. The resultant health ministry team is made up of
church members, professional and nonprofessional, as well as interested liaison
staff and lay leadership, reflecting the community.
Everyone serves according to his or her reserves of energy and level of expertise.
We work closely with this team, suggesting strategy and providing start-up information,
literature, and materials. We use the process described above, adapted to the
faith community involved, to ensure a unique health ministry, appropriate to
the assets and needs of the individual congregation and able to access available
community resources. We worship with them; we are a regular presence at health
ministry team meetings and events; we receive their mailings. We encourage them
to listen to members' "stories" in individual and intergenerational settings
in order to elicit concerns, personal risk factors, and prevalent behaviors
that affect health and well-being. We provide ongoing one-on-one consultations,
a resource library, and health ministry tools. Accompanying activities might
include services and prayers for healing, health education programs, preventive
screening, wellness counseling, advocacy, referral, support group development,
and visitation programs, as well as receiving guidance from experienced professional
advisers (health ministry team members, for example).
Health promotion activity focuses on individual community assessed needs,
national health themes, and Healthy People 2010 goals. Partnering with the Parish
Nurse Program at Holy Cross includes educational and networking opportunities
throughout the year for parish nurses, health ministry team members, and clergy.
Our quarterly newsletter, Partners in Health, provides reflections, congregational
news, and information on seasonal health themes and relevant area events. We
host a fall retreat and self-care day, a spring education day, an annual clergy
gathering, and two annual regional networking and resource meetings. We ask
the faith communities with whom we partner to obtain the support of their pastor
and any internal congregational governing body and to commit themselves to the
development of an intentional, holistic health ministry. This commitment
includes regular communication with our program, attendance at its events, and
appropriate reporting. However they evolve, the ministries respect individual
values and beliefs; respond to specific assessed needs; and are brought into
existence through the expertise, enthusiasm, and energies of congregational
members and/or specialized parish nurses.
Parish nursing is an evolving practice of professional nursing. The practice
was recognized by the American Nurses Association with its publication in 1998
of the "Scope and Standards of Parish Nursing Practice," which was developed
by the Health Ministries Association. Based on "whole person health," a dynamic
and relational process, parish nursing offers care that embraces all aspects
of the human dimension (although it sees the spiritual dimension as fundamental)
and provides it in the context of the faith community. Parish nursing differs
from the "medical model of care" in that the delegated functions of professional
nursing—performing or providing invasive procedures or "hands on" care (requiring
medical orders)—are not part of the practice. Along with performing the tasks
already described, parish nurses serve as pastoral partners, oversee (and are
supported by) a congregational health ministry team, and are responsible for
ensuring confidentiality and accountability in their practice.
Nurses who wish to identify themselves as congregational parish nurses must
be aware that a professional practice requires specialized education and adherence
to licensing and practice standards. To be a parish nurse, one must be a registered
nurse compliant with his or her state's nurse practice act and with the "Scope
and Standards of Parish Nursing Practice." Excellent parish nurse education
programs (complete with a certificate for the graduate) are available. People
interested in information about such programs should contact the Health Ministries
Association or Deaconess Parish Nurse Ministries.* Most institutions involved
in parish nurse programs can also answer questions about parish nursing and
refer interested callers to appropriate parish nursing courses. Some curriculums
now provide graduate credits.
*For some faith communities (traditional white Christian churches, for example),
the word "member" tends to denote an individual person. For others
(African-American and other ethnic churches, for example) "member"
tends to denote a family unit.
Developing ministries encounter some barriers. Many people, for example, see
"health" as passive and concerned only with the physical; they see "care" as
a disease-focused activity requiring "hands-on" intervention. Some pastoral
staff members and established church leaders may feel threatened by new ideas
and approaches to congregational life. Others, potential health ministry team
members, both professionals and nonprofessionals, as well as the members to
be served, may resist an integrative, participatory, and empowering approach
to health and care. Traditionally, congregational accountability has not included
reporting and evaluating activities. Because of this, accurate data—which is
necessary to ensure program quality, sustainability, and funding—can be difficult
to obtain. If members of the faith community are unaware of the wealth of accessible
resources available and preoccupied with other agendas, they will have little
energy for the initiation of new programs. Then, too, as is the case with many
mission projects, funding is limited and administrative support scarce. However,
the barriers experienced are minimal in comparison to the blessings received.
A Sacred Calling
Over the past 10 years, our experience in Holy Cross Health's Parish Nurse
Program has shown us that congregational health ministries can have a positive
impact on the community. The parish nurses and health ministry teams in 35 affiliated
congregations have the potential to touch more than 70,000 lives. They provide
a continuum of care in health and wellness activities that are based on stated
congregational mission and on assets and needs assessment processes. Congregational
clergy are engaged in ecumenical dialogue regarding shared concerns and community
health initiatives. Involved clergy, staff and, members, as well as nonaffiliated
regional parish nurses and health ministers view the program as a valuable educational
and development resource; theyregularly attend program-sponsored conferences
and networking events. We distribute our newsletter to more than 400 congregational
and community members committed to the improvement of community health. As the
program's reputation has spread, interested individuals, church institutions,
clergy associations, university programs, government departments and community
agencies have consulted us. In many cases, "These consultations have led to
mutually beneficial collaborations producing creative approaches to the changing
health dynamic and focus of care.
For us, this is a sacred calling. We have learned that spirituality, although
rooted in diverse theologies, is the framework that shapes our role in the community,
affecting both our institutional presence and our personal lives. We have discovered
a great sense of freedom in having a common language that transcends life's
vulnerabilities and the barriers sometimes imposed by particular theologies,
dogmas, and rituals. Each of us has experienced loss and pain, gaining wisdom
from our own broken-ness. Indeed, it is as wounded healers that that
we are able to reach out to others.
By integrating spiritual reality into wellness and health promotion, we affirm
life as whole and interdependent, allowing us to touch others in a more meaningful
way. We are nurtured and inspired by the gifts freely given by the parish nurses
and congregational health team members and by the ministries we are privileged
to support. We feel blessed to be able to work in a religiously based and mission-driven
environment that provides us with an opportunity and resources to emphasize
the vital relationship of spirituality to whole health and the role of
each of God's children in creating communities of care. We feel privileged
to practice in an area of nursing that openly allows us—indeed, demands of us—that
we ask ourselves and others the questions that open the door to spiritual reflection
on all that life holds: the everyday sacred, with its everyday crosses and resurrections.
For more information, contact the Health Ministries Association (980 Canton
St., Bldg. 1, Suite B, Roswell, GA 30075; phone 1-800-280-9919); Deaconess Parish
Nurse Ministries (475 E. Lockwood Ave., St. Louis, MO 63119; phone 1-314-918-2559/2527);
or American Nurse Publishing (600 Maryland Ave., SW, Suite 100 West, Washington,
DC, 20024-2571).
WHAT DO PARISH NURSES DO?
- Parish nurses and health ministry teams work to reintegrate the healing
tradition into the life of faith communities by:
- Interpreting the relationship between faith and health
- Promoting personal responsibility for health and wellness
- Serving as health counselors and educators
- Keeping aware of available resources and making appropriate referrals
- Acting as advocates for people who have health needs but only limited resources
- Recruiting and training volunteers
- Providing visitation to church members
- Initiating caring relationships with the elderly, the chronically ill,
and the "worried well"
HOLY CROSS HEALTH'S PARISH NURSE PROGRAM
Our Parish Nurse Program, the first of its kind in the Baltimore-Washington,
DC, metropolitan area, was initiated at Holy Cross Hospital, Silver Spring,
MD, in September 1993. The program was originally funded by a grant from the
Holy Cross Health System, South Bend, IN. Today the program is supported by
Holy Cross Health, Silver Spring, MD, a member of Trinity Health, Novi, MI.
An outgrowth of Holy Cross Health's social accountability process, the Parish
Nursing Program functions under the system's Mission Services Department as
a "Community Benefit Ministry." The program is an expression of the system's
mission "to serve together in the spirit of the Gospel, to heal body, mind and
spirit, to improve the health of our communities, and to steward the resources
entrusted to us."
Our existence as a health-promotion program that is spiritually focused, community
based, culturally respectful, and needs-specific demonstrates Holy Cross's commitment
to excellence. The congregational partnerships formed steward both the resources
of the institution and the assets of the community. Such collaborative partnerships
affirm and embrace the talents and professional expertise of congregational
members and the mentoring support and sustaining resources of the institution
and the larger community. Many of our staff members, both active and retired,
are involved in health ministries in their own faith communities.
"As parish nurse coordinators, we are a gift to faith communities," says Carmella
Shaw, RN, BSN, MA, the current manager of Holy Cross Health's Parish Nurse Program.
"We work with such communities as consultants, coaches, and mentors. We help
them to envision and articulate a vision to their faith community and provide
support for implementation. It is an awesome blessing to be able to be part
of the congregational health ministry programs in the community."
We began the program by approaching faith communities in the hospital's immediate
neighborhood. These were congregations that had expressed an interest to members
of our program's Mission Action Committee, which had conducted a feasibility
study before the program was launched. The churches involved were largely traditional,
white, Christian congregations, though some had some ethnically diverse members.
As these congregations developed and stabilized their health ministries, the
positive impact became evident.
In another county, we saw an opportunity to replicate our achievements in
an outreach reflecting our institutions' broadened focus. In 1998 we received
funding from our system to develop a complementary model of health ministry
in local African-American faith communities. We were encouraged to do so by
the strengths we saw in that community: its shared biblical faith; its members'
loyalty to family, church, and community; and its pastoral leadership and existing
"nursing units."*
In the case of the African-American community, we hoped that people historically
mistrustful of the traditional health system would be open to an approach that
was respectful of them and relevant to their needs. And, indeed, we found this
to be so. To lead the project, we hired a community member, a skilled nurse
and a community health educator who was well aware of the community's cultural
characteristics, assets, and needs.
We have found that our original model and development process can be adapted
to other situations. The spiritually focused health ministries created thus
far are empowering church members (and their families) by providing them with
the knowledge and supports necessary to improve their health status and to reduce
health disparities. In the future, we would like to develop, on a collaborative
basis, a lay health adviser/promoter model of health ministry for other culturally
diverse communities of faith. Such programs have been successfully attempted
in other underserved ethnic communities, where limited knowledge and economic
resources, lack of health insurance, physical impairment (disability or diminished
mobility caused by a combination of age, fatigue, and disease), lack of transportation,
isolation, discrimination, and fear restrict access to health care.
—Jeanne Nist, RN, BSN
*'Nursing units,' which attend to parishioners during worship services,
are a strong traditional presence in some African-American congregations in
the South. While on duty, unit members wear a white uniform. Usually, any
church member 14 or older is welcome to join.
A PARISH NURSE'S STORY
Marilee, a parish nurse, shares her story about Sue, a member of the church's
congregation and a person with serious health problems. "As Sue got sicker,
I became more involved in her care as an advocate for her and as a referral
source."
Marilee's visits became more frequent as Sue was moved first to a hospital
and then to a nursing home. Marilee was at Sue's side when Sue died; afterward,
she helped Sue's family through the grieving process. Providing one-to-one compassionate
care is work Marilee loves.
Supported by the congregation's health and wellness committee, Marilee conducts
ongoing needs assessments and prepares programs to address identified needs.
The supportive services in place focus on nutrition and weight control, exercise
and fitness, stress management, care of chronic illness, caregiving and bereavement
support, visitation, health and wellness counseling, meal preparation, blood
pressure screening, pregnancy and family care; they include an annual screening
for depression. She also writes newsletter articles, posts bulletin board notices,
facilitates flu clinics, and coordinates other volunteer activities.
Marilee sees a great need for such programs. "People are living longer now,
and seniors have more health issues to deal with," she notes. "Parish nurses
work in an arena that allows them to prevent illness and hospitalization, in
a way that no other health care environment really does." This is possible because
parish nurses know congregation members and see them frequently, and, as a result,
are able to offer a holistic approach to health.
—Jeanne Nist, RN, BSN
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.