Saturday, September 13, 2008

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...)

Friday, September 12, 2008

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