Video: The 2008 Bazaar

Here is the "summary" of the 2008 Annual Holiday Bazaar for Gravel Hill.

Primary Ethical Princilpes for Healthcare Workers

When we talk about something like parish nursing, ethical principles shouldn't be far behind. Here is a list of ethical principles as described by Ruth Stoll, RN, director of the Parish Nursing and Health Ministry Course at the Samaritan Counseling Center in Lancaster, PA.

1. Beneficence. Do good and prevent harm to any and all aspects of a person. The principle is to act to promote the well-being of individuals wholistically. This includes an assessment of burden in respect to benefit, where a treatment should be considered morally obligatory when the benefits hoped for or obtained are proportionate to the burdens. A treatment would not be morally obligatory, though it still may be employed, if it is of little or no benefit or if the burdens outweigh the benefits. Again, the burdens and benefits must consider the whole person. However, we must remember that we do not determine this, nor does a family; it is the individual that must determine this for himself or herself.

2. Non-Maleficence. Do no harm. This is (or certainly should be) a core directive in every caregiver's practice, and is based on our belief in the dignity and sacredness of human life. Our intent must be never to intend to directly harm or kill another human being.

3. Autonomy. Otherwise known as self-determination. Autonomy is the ethical principle we seem to hear most about. It concerns each person's right to choose their own course of action in accordance with their individual values, life goals, beliefs, etc. Whether we agree with that choice or not, a person's choices should be honored whenever possible. The exercising of autonomy is based on informed consent. Therefore, individuals have a right to information concerning their own health and wellness, including diagnosis and prognosis. It requires that the person comprehends and understands the significance of the benefits and risks proposed for their health care based on their values and beliefs, has the capacity to make a decision, and makes any decisions without coercion, manipulation or undue influence. Informed consent is not a once-and-done discussion, but must be an on-going process.

4. Veracity (honesty). Do not deceive others. Those with whom we work should be given adequate and accurate information about their condition along with possible courses of action. Decisions made to withhold information or mislead individuals are rarely justifiable. This can sometimes be very difficult for parish nurses. In a hospital setting painful honesty is expected. In a parish setting we are expected to be more "caring," plus we usually know the people we are dealing with. We do not want to hurt them or cause them distress, so we can usually find ways to waltz around a problem before confronting it. It is your responsibility and duty to work with people and guide them if need be, so small problems in the present do not become overwhelming problems in the future.

5. Fidelity. Do not betray the trust of others. Honor your promises. Keep confidences.

6. Justice. We don't talk about justice much, but both the Hebrew Scriptures and the New Testament are very heavily weighted in their concern for justice. The importance of justice cannot be overstated and involves three issues:
Equality of Persons - Treat similar cases similarly, without prejudice or discrimination.
Reciprocity - Give to each person what belongs to or is strictly owed that person.
Social Justice - Distribute benefits and burdens equitably in your congregation, your community, and in society as a whole.

7. Professional Integrity. Act within the scope and standards of practice. Do not act contrary to your morals, ethics or conscience. Know scripture and live it out. Be above reproach and do nothing questionable. We are representatives of the Church of Jesus Christ and should act like it. Yes, this can be difficult, but whether we believe we have been called by God to work in this vocation or not, in essence, we have all chosen this path and should live according to its requirements.

Take Time

I managed to wrangle a few days this week to meet my sister and her family up in the Finger Lakes region of New York. Venturing to a place called Chimney Bluffs on Lake Ontario, I experienced a rainy, cool and very breezy day (if you can call a wind tunnel "breezy"). Since I like photography, my trusty Canon was along for the ride.

It was a good day. Despite the weather, which provided a rather non-colorized gray sky, I got some good pictures. But after tripping through the stones on the shore, jumping out of the waves to keep my feet dry, struggling up the side of the bluff, fighting the wind, constantly readjusting my hood to keep my ears from freezing off, and having achieved mucho-megabites of photos I can use to try to keep my parish nursing ministry alive, I realized I was missing something.

You see, when I was younger - before I had too much to do and not enough time to do it in - I always had time for God amidst the wonders of his creation. Nature always provided profound moments for me to experience "the Other." Those were the moments that helped me place what I was and who I was in and against the world. Amidst life's pain, confusion and disappointment, it was those moments that helped me experience the profundity of God, to lose myself in him, to worship and to pray. As I made my way off the bluff today, I realized that those moments had become fewer and farther between. Realizing I had missed out on the most important part of my walk, I hesitated and considered stopping to meditate, but the hour was getting late. I wanted to spend more deliberate time with God, but chose not to.

As pastors and parish nurses, we become virtually useless to ourselves and to others without taking time alone with God, because we lose the core of our ministry. It is our relationship with God that we tend to neglect as we get busier, but it is that relationship that led us to our vocation in the first place. Without nurturing our spirits, our attempts to nurture others become a witness of hollow words. We encourage others to do things we no longer do. Of course, we intend to spend time with God, and although that pull to be alone with the Lord increases, our time gets waylaid by the less important things of our lives.

Take time. Take time to experience God's creation. Take time to meditate and to pray. Take time to LISTEN to God. Get rid of your camera, or whatever it is that keeps you from seeking him, so you can experience once again the God who led you into service for him.

Do I love the fact that I got some good pictures today? You bet. But I wish I had more fully experienced God's creation by setting my camera down for a bit and taken the time to abide with him in a more focused manner through his magnificent creation. God still loves me, I know. So thank you, Lord, for your understanding and grace. Goodness! You've made a magnificent world!

What Do You Know About Yourself?

Pick up any woman's magazine these days and there is some sort of self-quiz inside. Though of questionable validity, by simply answering the questions may discover things about yourself you didn't know, like how your favorite color provides insight into your personality, or why your choice of pet characterizes you, to how you and your spouse could have a better sex life. When I see these I wonder why anyone would take them. Certainly I have better things to do...

But once in a while, I take them anyway. Why? Sometimes it's fun. So if you also enjoy an occasional moment to respond to these little questionnaires, why not answer one that tells you something meaningful about yourself?

So here is one that barely borders on meaningful, if that. I certainly won't vouch for its accuracy. Its usefulness may simply be, for the theological neophyte, to open doors of inquisitiveness concerning the history of your own denomination or the Christian church in general. Your results could be:

Evangelical Holiness/Wesleyan
Emergent/Postmodern
Neo-Orthodox
Roman Catholic
Charismatic/Pentecostal
Classical Liberal
Reformed Evangelical
Modern Liberal
Fundamentalist

If you've never come across these terms but end up being labeled as something you're not familiar with, investigate it, especially if you didn't "score" where you thought you would.

Why? Because although parish nurses advocate medical care, we deal with human beings from a wholeness perspective. If I dropped the medical advocacy issues I deal with on one side of a scale and the emotional/mental health issues on the other side, the emotional/mental side would slam to the ground, launching the medical advocacy side into low earth orbit. Everything that is medically related has emotion and psychological issues interwoven. You cannot address the former without confronting the later.

I absolutely believe that the only way to gain insight into the psychology of any individual is by having first learned about yourself. I'm convinced that without the earnest, detailed and often painful work of self-exploration and analysis, we will forever be blind to the inner workings of another. Though we can never be totally self-aware nor achieve total understanding of another, we are not to throw our hands in the air in defeat without trying. It does mean that for us to even approach a level where we can be useful to others, we must first look at ourselves. Anything that may help us do that could be a useful tool.

Does that mean this little quiz linked to above is useful. Well...maybe not this one, unless you take it a bit further. However, in the future I will post a few tools that may help you to discover how fascinating it is to help people deal with their inner beings after first examining your own. If it takes simple, little questionnaires to start that process, so be it. I know we are all worth it - both you and the people you care for. God created - and he said that it was good!

Legal Issues in Health Ministries - Part 3

Here is Part 3 of the legal information provided by Barbara G. Graybill, Esq., of Schutjer Bogar LLC, located in Harrisburg, PA. I've reprinted the information directly below so I don't get in trouble.

The information herein reflects the views of the author. The information should be construed as general guidelines and not interpreted as legal advice. The materials should serve as a general reference to facilitate more thorough research and analysis with the assistance of a competent professional who would have an opportunity to consider the facts of any particular situation. ALL RIGHTS RESERVED. All materials herein, other than the statutory and regulatory provisions, are copyrighted but may be reproduced as long as authorship is properly acknowledged.

My own notes are in italics. They may or may not be as accurate as the information provided by Barbara.

FOR THE RECORD: LEGAL ISSUES OF HEALTH MINISTRY – Part 3

GUIDELINES FOR BEING LEGALLY DEFENSIBLE AS A HEALTH MINISTRY PARTICIPANT
1. Understand the scope of your responsibilities. Negotiate and educate your parish supervisor and boards regarding what you can and can't do. If you are a parish nurse, it does not mean that you function as a "free" home nurse to every member of the community but this misconception widely persists. Education of your congregation is extremely important.

2. Put it in writing. You should have a written job description which identifies your major goals and objectives; who is your "supervisor" and what reporting and accountability standards are being implemented; how you will report time; how you will keep case notes; who owns case notes; a description of your required reporting requirements; the number of hours expected; and the opportunities you will have to educate the parish on your role. Make sure you have notes when there could be obvious legalities involved, such as gun shot wounds, child abuse, elder abuse, etc.

3. Know the chain of command in your parish; have a good grasp of the guiding rules, practices, and cultural backgrounds. Use your denominational guidance. If you aren't sure if your denomination or church has them, investigate (example - The United Methodist Church has a Book of Discipline, which contains Social Principles. These can serve as guidance in certain situations.)

4. Avoid the appearance of impropriety. Many times, two are better than one, expecially in certain instances. For example, it is best to have another person around when you are placing an individual's narcotics in a med box for him to take, to avoid possible accusations of stealing medications.)

5. Do not take gifts or money directly from parishioners. Notify your supervisor of any attempts to give you money or other items. A gift given with the full knowledge of your supervisor may be okay, but don't accept "gifts in the dark." A good policy among all church employees is to not accept gifts or to report all gifts through your church channels.

6. Network and educate yourself. Realize that you may often run into conflicts; i.e., the wife who may be responding angrily to her sick husband because she is exhausted—and because she is exhausted, she is abusive or neglectful of her husband's needs; a wife being abused by her husband, an elder in the church; a teenager being sexually active with an older member of the church; an unwanted pregnancy; admission of pedophilia, alternate lifestyles against which your church may take a moral stand, etc. Plan for conflicts and think through them before you encounter them so you are prepared.

7. Educate the parish about your responsibilities and the information and referral services you provide.

8. Know your liability carrier and the situations you are required to report to them. BE SURE THERE IS LIABILITY COVERAGE. There are situations where, even if nothing "happens," it is best to report an insident. One example is: You take a blood pressure Sunday morning during your routine blood pressure screening and later you find they were admitted to the hospital. Though you followed protocol, it might be best to report the incident to your insurance company. Check with them to find out what incidents they want reported.

9. Plan your office space to avoid compromising situations.

10. Plan your filing process to protect confidentiality.

11. Individuals who assume this role are often nurturers who want to "fix things." Realize what your role is—your obligation to the welfare of your parishioners equally — and realize that you can't be the one to fix things.  Realize that you can refer out. 

Legal Issues in Health Ministries - Part 2

Here is Part 2 of the legal information provided by Barbara G. Graybill, Esq., of Schutjer Bogar LLC, located in Harrisburg, PA.

The information herein reflects the views of the author. The information should be construed as general guidelines and not interpreted as legal advice. The materials should serve as a general reference to facilitate more thorough research and analysis with the assistance of a competent professional who would have an opportunity to consider the facts of any particular situation. ALL RIGHTS RESERVED. All materials herein, other than the statutory and regulatory provisions, are copyrighted but may be reproduced as long as authorship is properly acknowledged.

My own notes are in italics. They may or may not be as accurate as the information provided by Barbara.

FOR THE RECORD: LEGAL ISSUES OF HEALTH MINISTRY – Part 2

THE ROLE OF THE PARISH HEALTH MINISTRY PERSONNEL
Generally, health ministry personnel who are employees of a church may not practice nursing duties (if licensed as such), such as administering medications, starting IV's, dressing open wounds, etc. Since few parish nurse programs have a physician as a supervisor, the practice of nursing functions per se does not occur in an employment setting. Rather, the function of the nurse is one of information, education and referral in the parish. However, the church itself, if it encourages such actions, may face great liability unless a doctor becomes an "agent" of the church and assumes supervisory functions.

In parishes where a nurse performs nursing functions, not only is the church liable for her actions, but problems arise with the confidentiality of records issues, e.g., what may you tell a supervisor (minister, priest, etc.) about the individual receinging services. Generally, in a nursing situation, that information would be confidential. But the minister or priest has an obligation to oversee the functions of all actions taken officially on behalf of the church. His or her failure to do so can render the church liable with little or no defense.

In some situations, particularly poorer communities, parish nurses often provide nursing services. In this case the nurse, parish and insurance carrier must be very clear about the chain of command, supervisory responsibilities, and adherence to the nurse practice act with its attendant regulations, case law and statements of policy. In such a case, the nurse may feel compelled, because of a generous nature, to go beyond what is logically called for. If she does, it is at the risk of her license and subjects the church to greater liability. This is true whether or not the nurse functions as an employee or volunteer.

It should be understood that the role of the parish nurse is not the same as that of a home health nurse. The parish and the nurse must educate the community as to her appropriate role.

CONFIDENTIALITY ISSUES
The concept of confidentiality of information gleaned during the practice of parish health ministry raises some uncomfortable questions. For instance, if the parish nurse learns that a husband is abusing his wife, must that information be shared with the minister? What if the wife dislikes the minister and feel the minister theologically feels that a husband is obligated to control his wife? What if the wife doesn't care if the minister knows, but the minister, upon learning of it, accidentally releases that information in the course of a conversation in which another parish member is nominating the husband for office in the church?

It is very important that both the parish and the nurse understand the need for confidentiality and work out an acceptable plan for handling such situations. The health ministry provider will need to keep records of her work for purposes of liability, but what happens to those records upon her leaving the church? Are they the records of the church or the individual? And should the minister have access to those records? What if the church has a committee handling personnel matters—are the entitled to know anything more than the number of hours the individual is working? What standards can be in place to assure that the program and its personnel can be adequately evaluated?

The best rule of thumb for records is that the health ministry personnel log visits and time spent on such visits as the official record for personnel matters and reporting issues. Separate notes should be kept in the individual's file and should be the property of the health ministry personnel unless the church member specifically permits access to the file by any other individual. However, for the safely of everyone involved, it is important to set forth the understanding that the employing/supervising entity has with the health ministry personnel and PUT IT IN WRITING to avoid potential problems in the future.

SUPERIVSION OF VOLUNTEERS
The supervision of volunteers (for driving, delivering meals, etc.) often falls to the parish health ministry coordinator or falls under his or her purview. Where the parish health coordinator has such responsibility, authority and accountability follows. It is the supervisor's responsibility to take responsible steps to educate and inform the volunteers of any rules, policies or procedures of the church with regard to parish health ministry. Volunteers must understand the rules of confidentiality, the scope of the activities permitted, and the issue of liability. For example, does the parish's insurance cover volunteers who drive parishioners to appointments or deliver meals? That information needs to be clarified; in many cases, the volunteer is expected to have his or her own insurance. By supplying volunteers, has the church made sure that such volunteers are licensed and capable of driving? While volunteers are generally covered by the Good Samaritan statute, case law has not developed sufficiently to clearly define the role of the church.

Legal Issues in Health Ministries - Part 1

Finding information regarding legal issues in health ministry is like looking for half a needle in a silo of hay. Every state may have variations to any theme, but I obtained permission from Barbara G. Graybill, Esq., a lawyer with Schutjer Bogar LLC of Harrisburg, Pennsylvania, to publish the following information regarding Pennsylvania law that she put together for a parish nursing seminar I attended recently. She did request that I include the following:

The information herein reflects the views of the author. The information should be construed as general guidelines and not interpreted as legal advice. The materials should serve as a general reference to facilitate more thorough research and analysis with the assistance of a competent professional who would have an opportunity to consider the facts of any particular situation. ALL RIGHTS RESERVED. All materials herein, other than the statutory and regulatory provisions, are copyrighted but may be reproduced as long as authorship is properly acknowledged.

I will probably publish this legal information in several blog entries so if you are interested, follow the blog titles to get all the information. I will place my own notes in italics to provide more information and as a "warning" that the information may not be as "accurate."

So here you go.

FOR THE RECORD: LEGAL ISSUES OF HEALTH MINISTRY (September 2008)

REALITY. There is no single answer for the same questions posed in different churches.

The question, "Can I be sued if…:" will always be answered "Yes." The real issue is, "Are we defensible?"

CHURCH STRUCTURE AND BELIEFS. Churches range from independent to connectional, conservative to liberal. Both structure and theology, as well as the personality of the minister, can affect how the parish health ministry is maintained and run. Additionally, parishioner expectations can impact the ministry. Before attempting to answer questions about how the parish health ministry is affected by legal issues, it is important to define the structure of the church and identify the key decision makers. A review of the insurance coverage is also critical.
Issues include:
1. Who has the ultimate decision-making power in your church?
2. What power does the governing board have, if any?
3. Are there religious/theological constraints on health care issues in your church regarding end of life decisions, birth control, family structure, etc.?
4. Who oversees the parish health ministry?
5. What is the relationship between health ministry personnel and the church?

EXPLORING ISSUES

VOLUNTEER. A volunteer is an individual who provides services without pay. Depending upon the type of work done and the amount of supervision, as well as any licensure the volunteer holds, liability issues may vary. A licensed individual providing services for which he or she is licensed is still held to the same standard of care as thought they were working for pay. However, under legislation passed to protect volunteers, the actions of the volunteer have to be extremely outrageous before they give rise to liability.

EMPLOYEE. An employee is defined as a person who works at the direction of, and for the benefit of, the employer. The employer has the right to supervise or set parameters for your work. Because of the concept of Respondeat Superior (the master is liable for the actions of his or her employee), an employee surrenders part of his or her autonomy in exchange for employment. However, a licensed professional still remains responsible to maintain the professional standards required by licensure; failure to do so may result in the revocation of your license.

INDEPENDENT CONTRACTOR. An independent contractor is a person who contracts with the provider to do certain services by virtue of the independent contractor's skills or licensure. The IC performs certain duties, but is ultimately responsible for the outcome of their own work. The employer generally does not have control of the work times and work process involved in the tasks, but only in the outcome. An IC must maintain his or her own liability insurance and worker's compensation and must submit proof of the same upon demand. Generally, the concept of IC can be resolved by looking at the degree of control the provider has with the independent contractor. Generally, parish health ministry workers do not fit into this category.

AGENT. An agent is someone who is authorized to act on behalf of the church or institution. The agent can be a volunteer, an independent contractor or employee. The scope of the agent's activities should be clearly delineated in writing; however, the appearance of authority often leads other entities to rely upon the agent's actions. This is a situation congregations need to have defined clearly in writing.

SCOPE OF EMPLOYMENT vs. SCOPE OF PRACTICE. An employer may limit the scope of practice of a licensed professional but may never enlarge it. An employer may not require you to do acts outside your scope of practice. And while the employer may limit the scope of your practice, it cannot limit the duty imposed upon you by virtue of your licensing. Therefore, it is critical to know both the scope of your practice and the actual duties of your employment. A job description is key to fully understanding the expectations of your responsibilities and liabilities.

Connecting Faith and Daily Life

"Connecting my faith with my daily life simply means that no matter where I am or what I do, I'm on assignment for God. I'm there for God. I'm God's hands. I'm God's feet. I'm God's ears. I listen with the ear of my heart to all that goes on. When God puts me in charge, God asks me to be there all ways and always."

Pat Miles, nurse

Twelve Beatitudes for a Parish Nurse

Parish Nurses are blessed with a variety of gifts that make them uniquely supportive of congregations.

1. Blessed be the parish nurse for she is caring.

2. Blessed be the parish nurse for she is available and accessible to congregations.

3. Blessed by the parish nurse for she is knowledgeable about community resources and process of referral.

4. Blessed be the parish nurse for she is cost effective.

5. Blessed be the parish nurse for she has a high tolerance for ambiguity.

6. Blessed be the parish nurse for she has had a generalist education and previous employment that have resulted in a broad variety of skills.

7. Blessed be the parish nurse for she is process oriented.

8. Blessed be the parish nurse for she is possessed with a generosity of spirit, both of time and talent.

9. Blessed be the parish nurse for she focuses on priorities.

10. Blessed be the parish nurse for she is committed, dependable and persevering.

11. Blessed be the parish nurse for she has a heritage and tradition of pioneering.

12. Blessed be the parish nurse for she is a believer...in God, clients, nursing, and in a better world--here and in the hereafter.


Adapted from Parish Nursing: The Developing Practice. Solari-Twadeli, A. and M.A. McDermott, ed. Park Ridge, IL: National Parish Nurse Resource Center, 1991.

Philosophy of Parish Nursing

Parish nursing is a specialty practice and professional model of health ministry distinguished by the following beliefs:

1. The parish nurse role reclaims the historic roots of health and healing found in many religious traditions. Parish nurses live out the early work of monks, nuns, deacons and deaconesses, church nurses, traditional healers and the nursing profession itself.

2. The spiritual dimension is central to parish nursing practice. Personal spiritual formation is essential for the parish nurse. The practice holds that all persons are sacred and must be treated with respect and dignity. Compelled by these beliefs, the parish nurse serves and advocates with compassion, mercy and justice. The parish nurse assists and supports individuals, families and communities in becoming more active partners in the stewardship of personal and communal health resources.

3. The parish nurse understands health to be a dynamic process that embodies the spiritual, psychological, physical and social dimensions of each individual. Spiritual health is central to well being and influences a person's entire being. A sense of well being can exist in the presence of disease, and healing can exist in the absence of cure.

4. The focus of practice is the faith community and its ministry. The parish nurse, in collaboration with the pastoral staff and congregants, participates in the ongoing transformation of the faith community into a source of health and healing. Through partnership with other community health resources, parish nursing fosters new and creative responses to health and wellness concerns.

Root Assumptions
Parish Nursing is rooted in the Judeo-Christian tradition and is consistent with the basic assumptions of all faiths -that care for self and others is an expression of God's love.

Mission
The mission of parish nursing is the intentional integration of the practice of faith with the practice of nursing so that people can achieve wholeness in, with, and through the community of faith in which parish nurses serve.

Purpose
a. To challenge the faith community to restore its healing mission
b. To challenge the nursing profession to reclaim the spiritual dimension of nursing care
c. To challenge the healthcare system to provide whole person care

Strategic Vision
Access to a parish nurse ministry for every faith community


Reference:
Samaritan Couseling Center Congregational Ministries of Health Certification Course. Lancaster, PA: 2008.

Responding to God's Call

God calls every Christian to full-time ministry.All Christians are called to minister. God's call to ministry is not limited to a few saintly Christians who are deeply committed to pray, sacrifice and serve while others live "normal" lives in a secular society. Whatever vocation God calls you to-carpenter, doctor, farmer, teacher, homemaker, missionary, nurse-becomes the arena for your ministry.

While not everyone will earn their living through full-time ministry, every Christian must choose a vocation and carry out ministry as God directs. Everything you do must be for God's glory. God expects full-time Christian service from you.

God's call comes to people in different ways.

Biblical accounts of God's call vary greatly. It would be easier if God would speak his will in a clear, audible voice, burn a bush or two, or send an engraved invitation. It would require less faith if he called us all in the same, predictable way. Instead, he expects us to be sensitive and obedient to his direction as he leads us step by step.

God equips us and helps us fulfill his call.

God is the source of the gifts and graces that equip us to fulfill his call. Your call will take advantage of your strengths-an important indication of God's will for you. You may not be aware of those qualities and abilities before he calls you. The advice and help of other Christians will guide and affirm you as you seek to develop and to use your God-given potential for him.

God call some Christians to specific kinds of ministry.

Some Christians will be called to specific ministries, such as pastor, missionary, Christian education, or other ministries, in response and in obedience to the call of God. These callings carry with them such responsibility that the church requires special educational preparation in order to serve. Approval to serve in these areas includes careful examination and nurture before endorsement is given, credentials are granted, and appointments are made.

God calls us through other Christians

Fellow Christians have an important role in confirming or correcting your perception of God's call. Because everyone will not understand your response to God's call, you should prayerfully listen to fellow believers who encourage or question your pursuit of a particular ministry. God may be speaking through them. Then again, God may not be. You must discern the voice of God.


References:
Samaritan Counseling Center Congregational Ministries of Health. Parish Nursing Certification Course. Lancaster, PA: 2008.

Discerning God's Call for Parish Nursing (and everyone else!)

Here are some questions to ask yourself:*How do you define a "call?"
*What does a call mean to or for you?
*Why did you initially become a nurse? Did you have what you define as a call at that time?
*Why did you choose your specific area (or if your like me, your various areas) of nursing?
*Why have you decided you want to pursue parish nursing now?
*How is your call different now than it was when you first became a nurse?

Let's first consider what a call is...

"Very truly, I tell you, anyone who does not enter the sheepfold by the gate but climbs in by another way is a thief and a bandit. The one who enters by the gate is the shepherd of the sheep. The gatekeeper opens the gate for him, and the sheep hear his voice. He calls his own sheep by name and leads them out. When he has brought out all his own, he goes ahead of them, and the sheep follow him because they know his voice." (John 10:1-4)

Simon Peter...fell down at Jesus' knees, saying, "Go away from me, Lord, for I am a sinful man!"...Then Jesus said to Simon, "Do not be afraid; from now on you will be catching people." (Luke 5:8,10)

When the Pharisees saw this, they said to his disciples, "Why does your teacher eat with tax collectors and sinners?" But when he heard this, he said, "Those who are well have no need of a physician, but those who are sick. Go and learn what this means, 'I desire mercy, not sacrifice.' For I have come to call not the righteous but sinners." (Matthew 9:11-13)

Other scriptural references concerning call are:

Calling to a life of holiness/being set apart - 1 Timothy 1:9
Calling to be His people - 1 Peter 2:9
Calling to be His disciples and followers of Jesus - Matthew 28:18-20
Calling to love God, others and self - Matthew 22:37-39, Mark 12:29-31
Calling to serve one another - John 13:15, 34-35; Galatians 5:13
Calling to preach, teach and heal - Luke 9:1-3
Calling to minister - Isaiah 61:1-3
Calling to bear fruit - John 15:16, Galatians 5:16, 22-23
The Call of Moses - Exodus 3-4:17
Also see II Corinthians 10:18

In the book The Nurse's Calling by Mary Elizabeth O'Brien, she says, "Nursing is a call to a working partnership with God, with Christ, and a working partnership with your patients..." She relates biblical teachings, especially those of Jesus, to her "calling" as a nurse. She specifically examines the healing activities of Jesus, the concept of Christ as a role model in caring for the sick, and the Old Testament's theme of covenant (God's commitment to care for his people).

She uses descriptors in regards to nurses that have spiritual underpinnings:
cup of cold water ministry
gift-givers
treasure in earthen vessels
anonymous ministers
ministry of presence
blessing
wound healer (Henri Nouwen)

THE CALL

What is a call? It is hearing God's voice, intently listening to what he is saying, and then following. It is about stilling yourself and obedience. Karaban states that at the heart of a call to ministry is the story of an encounter between an individual and God. Buber would probably say it is being obedient to the "I-Thou" encounter.

A call is individual and unique. It is not so much an invitation as a command. For me personally, it was not something I had planned. It did not make sense for a person of my age or income. Though there was a feeling of excitement (I like change), I did not embrace it with total joy because I knew there would be hardship. Yet I knew this call could not be ignored. I did not have a say in it--God chose the time, place, need, and plan. I didn't know all of those things ahead of time, and still do not know where this journey will lead. But it is about obedience; following without knowing the results; going even if you do not feel ready. The response to God's call may be sacrificial, be entirely dependent upon faith, be far out of your comfort zone, and may take you away from home.

How does God call?

• May put a particular vision or concern on one's heart and mind
• Directly through dreams, pain and discouragement, or other people
• May be clear, vague, over time, journey, and can be resisted
• May manifest as a desire to do what we feel educated/trained to do or want to do-such as a desire to minister to the whole person instead of just their disease or injury
• Desire to use one's gifts and talents 

God does not necessarily call the prepared, but rather, prepares the called. If you are called to something you do not feel prepared for, God will find a way, you will not have to.

One note of caution regarding hearing God's call through other people. Obviously, God can speak through those around us. However, everyone has an agenda, and there are personalities who, if they pray for something and "hear" an answer, have no problems telling you what you are called to or not called to because God told them through their own prayer. You must discern God's call. No one else can discern God's call for you. Do not be dissuaded by those who say you have no calling to a particular ministry. God will find a way around these people, but it will discourage and sidetrack you. Keep your eyes focused upon the One who calls, not the ones who claim to interpret your call for you!

Why is call important?

• It either sustains us or causes us to give up. It provides perseverance through the difficult times.
• It is assurance for a working partnership, that provides empowerment, strength and courage through God's own power and grace
• It allows us to be where God is at work, and we become part of God's plan (Jeremiah 29:11)
• It provides a sense of understanding that you are where you are "supposed" to be - you are a "round peg in a round hole"
• If you have heard God's call correctly you will experience change, growth and fulfillment in your ministry.
• The biggest reason - Ministry is too hard to forge ahead without a call. The rewards and affirmations are often too few and far between, and discouragements too great, because even though we minister among Christians, most ministers realize that Christians can be the most difficult people of all to serve. That's because most of us have an idealized understanding of what a Christian should be and how we should act. No one lives up to that ideal because we are all human. When the pettiness rears its ugly head, discouragement follows. Only a true call will be enough to keep you going through those times of trial and doubt. 

Some questions concerning God's call are:

1. Are you hearing God or are you hearing yourself?
2. Are you listening accurately?
3. Will you be "harmed" in some way? I do not believe God wants us to destroy ourselves because we cannot follow him if we injure our own physicality, emotional, mental or spiritual health.
4. What will it do to your family? I believe God cares about our families for our family is a gift from a loving God.  

Final thoughts about call 

 

Be certain it is God's call.
Be confident in God's power.
Be comfortable with God's plan.

 

References:
Carson, V.B. and H.G. Koenig. Parish Nursing: Stories of Service and Care. Philadelphia: Templeton Foundation Press, 2002.
O'Brien, M.E. The Nurse's Calling. New York: Paulist Press, 2001.
Samaritan Counseling Center. Notes from Parish Nursing Certification Class. Lancaster, PA: 2008.
Shelly, J.A. and A.B. Miller. Called to Care: A Christian Theology of Nursing. Downers Grove, IL: Intervarsity Press, 1999.

Faith Community Nursing: Scope and Standards of Practice

Parish Nursing Ministry is now called "Faith Community Nursing" by the American Nurses Association (ANA). The following information is taken from the ANA's Scope and Standards of Practice.

Foundation Documents for Nursing
The Foundation documents for Professional Nursing are the:
1. Code of Ethics for Nurses (ANA, 2001)
2. Nursing's Social Policy Statement (ANA, 2nd ed., 2004).
3. Nursing: Scope and Standards of Practice (ANA, 2004). Differs depending on specialty.

4. Position Statement: The Nurse's Role in Ethics and Human Rights (ANA, 14 Jun 2010).

(1.) Code of Ethics for Nurses
* Defines nurses' ethical obligations and duties and is the nonnegotiable standard
* Provides guidance in all settings
* Provides fundamental values and commitments
* Addresses boundaries of duty and loyalty

(2.) Nursing's Social Policy Statement
* Describes nursing's accountability to the public
* Identifies processes of self-regulation, professional regulation and legal regulation that maintain the public trust

(3.) Nursing: Scope and Standards
* Describes what nursing is, what nurses do, and their accountable responsibilities
* Describes who, what, where, when, why and how of nursing practice
* Serves as a guide to legislators in the passing of laws, rules and regulations that govern nursing practice
* The Board of Registration of Nursing oversees the implementation of the Scope and Standards
* The 2004 Nursing: Scope and Standards of Practice describes the details of each nursing specialty practice

Definition of Nursing
"Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations." [Nursing's Standard Policy Statement (2nd ed.), ANA, 2003.]

Definition of Faith Community Nursing
"Faith community nursing is the specialized practice of professional nursing that focuses on the intentional care of the spirit as part of the process of promoting wholistic health and preventing or minimizing illness in a faith community."

There are several assumptions that are made in regards to Faith Community Nursing:
1. Health and illness are human experiences
2. Health is the integration of the spiritual, physical, psychological, and social aspects of the patient promoting a sense of harmony with self, others, the environment, and a higher power
3. Health may be experienced in the presence of disease or injury
4. The presence of illness does not preclude health nor does optimal health preclude illness
5. Healing is the process of integrating the body, mind, and spirit to create wholeness, health, and a sense of well-being, even when the patient's illness is not cured

A Faith Community Nurse (FCN):
-is a registered professional nurse (defined as RN, not LPN) who serves as a member of the staff within the faith community
-must be knowledgeable in the nursing process, health care assets of the community, and spiritual beliefs and practices of the faith community to be served
-the FCN promotes health and prevents or minimizes illness by integrating the care of the spirit with care of the body and mind
***Intentional Care of the spirit is what differentiates this specialty practice from a community health nurse providing services within a faith community

FCN Interventions focus on spiritual health using:
* education
* counseling
* advocacy
* referral
* utilization of resources available to the faith community
* training and supervising volunteers
* collaborates with nursing colleagues to provide traditional services of nursing care
*** when another RN is not available and an urgent need is present, the FCN is responsible for both general and specialty nursing care

FCN practice will differ across faith faith communities based on:
* Legal and professional expectations
* Educational preparation of the RN
* Professional experience
* Position as defined by the faith community
* Needs of the congregation

The professional membership organization for Faith Community Nurses is the Health Ministries Association (HMA). HMA and ANA work together to promote understanding of faith community nursing as a specialized practice in the multidisciplinary practice arena of diverse faith communities. It does not promote one faith tradition but takes efforts to include all faith traditions.

Parish Nursing, or Faith Community Nursing, is a non-clinical discipline. This is important to know so you do not overstep your scope of practice and get yourself, or your church, into legal trouble. More on this later...

References:
As noted above, as well as Samaritan Counseling Center Congregational Ministries of Health. Parish Nursing Certification Course. Lancaster, PA: 2008.

What do you do as a Parish Nurse?

So what do you do as a Parish Nurse?

LISTEN! LISTEN! LISTEN!

PRAY FOR! PRAY WITH!

 

 

Educate and facilitate the process of care

• Living wills, advanced directives, durable power of attorney, financial assistance, transportation
• Find, evaluate and plan for alternative living arrangements such as in-home care, assisted living, day care, nursing homes, etc.
• Medication education, use of alternative treatments (herbals, meditation, relaxation)

Counsel with parishioners

• Utilize community agencies such as hospice, meals on wheels, area agencies on aging, senior citizen's resources, self-help resources
• Teach appropriate application of medical directives or orders, use of prescriptions, provide dietary guidance
• Coping with crises, support to care-givers, family members and friends
• Assess safety of the home environment
• Seek or suggest counseling for mental issues, such as depression
• Seek other appropriate care upon request, from physicians, specialists, nurse practitioners, dietitians, home care agencies, social workers, medical equipment companies, Ombudsmen

 Provide and promote health education for parishioners.   Seek outside resources and provide classes of interest or necessity.  Some sample classes could be:

• "Feeding Your Spirit"
• "Gaining a Healthy Lifestyle" - may be for women only, or teens, etc.
• "Using Your Faith to Enhance Your Lifestyle"
• "Depression-Prevention and Treatment"
• "Forgiveness and its Impact on Your Heart"
• *Coordinate and facilitate training activities, such as HeartSaver (CPR), Visitation, or Lay Health Team members
• *Coordinate and facilitate screening activities, such as Blood Pressure Screening (including follow-up monitoring), Health Heart Assessments for women, Bone Density Screening for men and women, or multi-screening fairs.
• *Obtaining information regarding prevention, diagnosis, treatment, continuing self-care for parishioners for various medical conditions (including pre-op and post-op care)
• *Home follow-up after surgery and/or hospital discharge

Ministry is accomplished by:

-home visitation

-office hours

-workshops

-telephone contact

-letter writing

-consultation and referral

-support groups

 

The professional nurse functions as a member of the pastoral team to promote health and foster healing among the members of the church community. The parish nurse does not provide invasive or hand-on treatment, such as administering medications, changing dressings, or providing personal care.

 

How do you do all this? Ah, there's the rub, especially since every parish nurse ministry is different. I would certainly welcome step-by-step instructions because just about everything you find is characterized by vague, non-directive language. I'll post what I can in upcoming blogs.

 

References:

Ruth I Stoll, DNSc, RN. November 2000. (With minor editing by me. Sorry Ruth...)

What Parish Nurses Can Do For Congregations

Look in most any book or just about any Web site concerning parish nursing and you'll find the following about what a parish nurse does:

Generally, parish nursing is a health promotion, disease prevention role based on the care of the whole person, which encompasses seven functions:

1. Integrator of faith and health
2. Health educator
3. Personal health counselor
4. Referral agent
5. Trainer of volunteers
6. Developer of support groups
7. Health advocate 

Specifically, a parish nurse can:

• Assess congregational health needs (e.g. the elderly, children, issues based on geography or income, etc.)
• Visit the sick, shut-ins, new mothers and bereaved, as requested by pastoral staff
• Coordinate volunteers and services
• Provide specific programming for individuals or groups (Blood pressure screenings, seniors, teens, shut-ins, etc.)
• Develop resource lists for referrals and services within the church and the community
• Coordinate support groups
• Provide individual or group counseling

These can play out in innumerable ways. Your own imagination and the needs of your congregation can take you most anywhere. However, the needs of your congregation must be the determining factors that provide direction in your ministry, or else your ministry will be somewhat irelevant.  

 

If you are new to parish nursing, always remember that building a ministry takes time--lots of time. Start with easy tasks, such as blood pressure screenings on Sunday mornings. Make yourself visible. Define your purpose for yourself and to your congregation. Do surveys or talk to leaders of your church, to church committees, and to your congregation to find out where you are most needed. Work closely with your pastor. 

 

References:
Samaritan Counseling Center Congregational Ministries of Health. Parish Nursing Certification Course. Lancaster, PA: 2008.

What Is A Parish Nurse?

Parish nursing is not what its title sounds like. It is not "nursing" in the hands-on sense; it is not the church's version of a visiting nurse; it is not an on-call resource for individuals who don't want to bother their doctors; it is not the medical care solution for those who cannot afford insurance.

A parish nurse is a unique, specialized practice within the professional registered nurse community that focuses on the promotion of health and wellness within the context of the values, beliefs and practices of a specific faith community, such as a church. Parish nursing is a ministry, and its mission is to the congregation in which the parish nurse serves. Ideally, it is also involved in ministry to the greater community in which it is located. 

Parish nursing holds the spiritual dimension of health as central to its practice, but also concentrates on the psychological well-being as well as the physical. All three must work in conjunction with each other, for the spiritual, psychological and physical must all exist in harmony for there to be peace within. For a spiritual community in Christ, shalom is the ideal of being.

How is Parish Nursing relevant to the Church?

* Care for all of God's people is central in the teachings of the Old and New Testaments. It is also a concern evident in the letters of Paul.
"Then Jesus called the twelve together and gave them power and authority over all demons and to cure diseases, and he sent them out to proclaim the kingdom of God and to heal." (Luke 9:1-2)

* The understanding of health is not simply the absence of disease, but incorporates the physical, social, psychological, and spiritual well-being of the whole person. A sense of well-being is essential for existing in harmony with self, others and God.

* Throughout history, Christian churches have taken a lead in caring for others.

* Medical care has limitations and therefore needs help with preventative medicine, health education and in motivating people to care for themselves. Motivation is heightened by spiritual committment.

* Most congregations do well when performing "crisis care," but often fail in other types of care due to lack of communication, lack of coordination, lack of educated individuals to carry out care, or lack of people needed to provide care. Parish nurses can assist in all of these areas and can work to attempt to prevent crisis before it happens, or at the very least, be prepared for crisis should it occur.
Everyone has needs and burdens. How many things could be prevented if we tried to address needs and burdens before they became overwhelming? For example, most patients in hospitals have some type of preventable illness. A parish nurse can provide regular assessments and guidance to people. Most healthcare does not offer preventative monitoring.

* The church has many advantages as a healing institution:
It welcomes all age groups
It encourages and nourishes families, not just individuals.
It provides for an organized approach to teach health and wellness, because individuals attend weekly
When the spirit is rejuvenated, it provides strength to the psychological and physical aspects of being.

* The church is a powerful influence for those who attend.

* Ideally, the church accepts people in sickness and in health. Providing acceptance may be where our ministry is most relevant.

References:Samaritan Counseling Center Congregational Ministries of Health. Parish Nursing Certification Course. Lancaster, PA: 2008.

originally posted 12 September 2008

Cure versus Healing

Cure alters what is; Healing offers what might be.
Cure is an act; Healing is a process.
Cure acts upon another; Healing shares with another.
Cure manages; Healing touches.
Cure seeks ultimately to conquer pain; Healing seeks to transcend pain.
Cure ignores grief; Healing assumes grief.
Cure encounters mystery as a challenge for understanding;
Healing encounters mystery as a ready channel for meaning.
Cure rejects death and views it as defeat;
Healing includes death among the blessed outcomes of caring.
Cure may occur without healing; Healing may occur without cure.
Cure separates body from soul; Healing embraces the soul.
Cure tends to isolate; Healing tends to incorporate.
Cure combats illness; Healing fosters wellness.
Cure fosters function; Healing fosters purpose.


by Fred Recklau


As parish nurses, we want to fix things. Often we can facilitate communication, or connect or direct individuals or families to that place where they can find assistance. However, our role, more often than not, is to stand with someone in their process and to be the sustaining presence, not the problem solver. We cannot cure anyone, but we can help people heal themselves through God's love and grace.

originally posted 12 September 08 by Lynn Hackman