Miller -- What Parish Nursing Can Do For Your Faith Community

What Parish Nursing Can Do
For Your Faith Community

by Margaret Miller, Ph.D., R.N.

In many ways, the U.S. is healthier than it has ever been, largely because of the successes of public health in the last century-life expectancy increased by over 50% because of improved sanitation (safe milk and water), improved nutrition, immunizations for mumps, measles, tetanus, diphtheria, polio, and improved medicines for infectious diseases. Unfortunately 2/3 of modern plagues that lead to early death (before 65) are caused by unhealthy life styles and are preventable-cardiovascular & cancer diseases, substance abuse, type II diabetes, sexually transmitted diseases, violence/suicide, and accidents (Mason, 1990).

In the years following World War II, funding for health care gradually increased to meet the majority of American citizens' needs by employer-based health insurance in the private sector, and government-based health insurance for the elderly, the poor, and the disabled. A relative few were uninsured, such as those working for small businesses and their families. Hospital construction growth and training of physicians and nurses were supported by federal funds. In the 1980's governmental policies and private sector initiatives were implemented to constrain out of control costs. Unfortunately over 40 million Americans are now uninsured and many more are underinsured (Sochalski & Patrician, 1998). The emergence of managed care has slowed costs, but one result is less available medical and hospital care at an affordable price. Communities are exploring other avenues to help individuals find answers to their health care needs. Because of their history in healing, churches and other faith communities have been sought out to be partners and a safety net for those in need as a natural part of ministry.

Health ministry reclaims ancient traditions of healing ministry in a faith community. Although the majority of these faith communities are Christian, many nurses in other faith communities are also working to bridge the artificial gap between spiritual health and the health of mind and body. Hebrews and the early Christian church did not separate these holistic perceptions of a person. Ancient Greeks, with the beginning of scientific inquiry through Aristotle's work, separated mind, body, and spirit. Religious leaders then concentrated on healing the spirit, while medical caregivers concentrated on the mind and body.

Nursing as we know it, began as a religious vocation for Christian nuns/deaconesses, and spread as a lay (female) profession with the advent of Florence Nightingale's teaching. In her extraordinary work in Turkey, caring for British soldiers (1/3 of whom were Irish), some of the nurses were an independent group of Roman Catholic Irish nurses. They reportedly spent much time trying to proselytize the Protestant soldiers (Harthill, 1996), giving medical and military leaders more justification for their resentment of the women nurses' presence at the military. After the war, Nightingale began the first secular nursing school for mature young educated laywomen, with an emphasis on moral behavior and using scientific skills of observation in their practice. Nursing was generally considered to be a personal calling from God, but spiritual care was the job of the clergy.

Nursing schools in religious hospitals taught that spiritual assessment and prayer were appropriate roles for nurses, and since patients were frequently of the same faith, there was not a question of proselytizing. When the emphasis in U.S. education shifted to science when the Russians were successful in sending up Sputnik in the late 1950's, that same shift occurred in nursing education too. At the same time, hospital schools of nursing were closing in favor of shifting nursing education to colleges and universities. The change was necessary for two reasons: (a) to provide needed scientific and liberal arts classes for a discipline that required more knowledge and critical thinking to provide care for patients who were receiving more complex treatments with the advent of many technological improvements in medical care; and (b) nursing education became too expensive for hospitals to pay for, once nursing students were no longer being exploited as night staff for patient care, either for free or for a small stipend, in the guise of "education."

Parish nursing in its present form began nearly 20 years ago in the Lutheran church. A Parish Nurse is a registered nurse who works as health minister in a faith community. There are five generally accepted roles: health counselor, health educator, referral source, facilitator of volunteers within the congregation/faith community, and integrator of the relationship between faith and health; some add an additional two roles, developer of support groups, and health advocate (Westberg, 1999). They coordinate educational programs, pastoral care, community resources, and support groups. Parish nurses, as a rule, do not do hands-on nursing care; the focus is on preventive care and ministry. The needs of a faith community drive the practice of the parish nurse, although there is one hands-on practice common to all parish nurses, doing blood pressure checks. This procedure is important for several reasons: it is a needed service since there is a high incidence of hypertension in this country; it is a non-invasive procedure; and it is a non-threatening way to initiate a discussion of other health concerns with their patients. Parish nurses also do not compete with community medical/social resources; they put their patients in touch with those resources that are accessible and work to advocate for access to resources that are not readily available.

The Health Ministries Association, along with the American Nurses Association, in 1998 recognized parish nursing as a specialty in nursing and the scope of practice was delineated. This is the first step in providing certification in a specialized field. Eventually, a parish nurse will be someone who has completed special training and supervised experience and has passed a certification exam. Parish nurses work in local congregations/faith communities, either paid or unpaid, part time or full time, depending on congregation resources. Some hospitals/university schools of nursing have parish nurses who either work directly in local congregations or help those congregations develop health ministries.

Parish nurses work in partnership with clergy and the congregation. For parish nursing to be effective, the congregation has to be a part of the process and to understand the relationship between faith and health. For example, spiritual distress also affects the health of body and mind. Research has shown that prayer and social support facilitate whole person healing. The entire congregation can carry out these two important healing modalities. Prayer and social support have been shown to be determinants in decreasing chronic stress, lowering blood pressure, and promoting general well being (e.g., Finney & Malony, 1985;Hunglemann, Kenkel-Rossi, Klassen, & Stollenwerk, 1985; Koenig & George, 1998; Poloma & Pendl, 1991). On-going research results show that praying contributes to physical healing, although there has been an ethical concern about praying for another person without his/her consent, especially if the prayer is not congruent with the desires of the ill person or if the prayer is for harm to the other person. Prayers in the best interest of the person(s) being prayed for is the best ethical view (DeLashmutt & Silva, 1998).

Health ministries also promote self-knowledge, personal responsibility, and interdependence among God's people. Since so many of the modern plagues are a result of high-risk behaviors, whether in such things as unhealthy eating, driving under the influence of drugs or alcohol, or unsafe sexual behavior, the congregation who clearly understands its role in whole person healing can make a difference in individuals' health outcomes. In today's climate of uncertain availability of total health care, parish nurses and the church can play a significant role.

References

Delashmutt, M., & Silva, M.C. (1998). The ethical dilemma of long distance intercessory prayer. Ethics Forum 8 (2), 1-3.

Finney, J.R. & Malony, H.N. (1985). An empirical study of contemplative prayer as an adjunct to psychotherapy. Journal of Psychology and Theology, 13 (4), 284-290.

Hartill, R. (1996). Introduction. Florence Nightingale: Letters and reflections. London: Arthur James.

Health Ministries Association & American Nurses Association (1998). Scope and standards of practice of parish nursing practice. American Nurses Association.

Hunglemann, J., Kenkel-Rossi, L., & Stollenwerk, R. M. (1989). Development of the JAREL Spiritual well being scale. Classification of the Nursing diagnosis Proceedings of the Eighth Conference North American Nursing Diagnosis Association, (Ed.) Philadelphia: J. B. Lippincott.

Koenig, H. & George, L. (1998). Want to lower blood pressure? Get out to church. International Journal of Psychiatry in Medicine, 28, 189-213.

Mason, J. (1990). Health care in the U.S.: Facts and choices. Second opinion: Health, faith, and ethics. (Ed.) Park Ridge Center.

Poloma, M.M. & Pendleton, B.F. (1991). The effects of prayer and prayer experiences on measures of general well being. Journal of Psychology and Theology, 19 (1), 71-83.

Sochalski, J. & Patrician, (1998). An overview of health care spending patterns in the United States: Using national data sources to explore trends in nursing services, Online Journal of Issues in Nursing, 1-11.

Westberg, G. (1999). A personal history perspective of whole person health and the congregation. In P.A. Solari-Twadell & M.A. McDermott (Eds.), Parish nursing: Promoting whole person health within faith communities. Thousand Oaks, CA: Sage.