Parish Nursing in Kentuckiana: A Community Case Study
Written by Bea Keller, SCN
Monday, 05 June 2000 00:00
The concept of parish nursing was defined and developed in 1985 by Lutheran minister, Granger Westberg. This concept was brought to Louisville from the Chicago area by St. Anthony Hospital in 1991. Over the past nine years and many changes, parish nursing has proven itself to be of great value and service to the Kentuckiana area. So much so that presently there are 26 parish nurse programs in all stages of development in the area. While two of these programs provide a salary for their nurses, most rely on volunteer nurses to serve their congregations.
In 1997, I began facilitating a monthly support group for area parish nurses. Each month during an afternoon and an evening session, the parish nurses spend two hours sharing their many joys and frustrations. Although the numbers have remained consistently low (between one and 12 nurses at each session), those attending have been grateful for the opportunity to gather and talk with each other face to face. These support groups have also served those who are new to parish nursing and seek a direction for their programs. One area where the support groups have been particularly effective is for the nurse whose new project is not receiving the positive response from her congregation that she had anticipated. The other nurses and I are then able to ask questions and offer suggestions from our various experiences. Sometimes it is clear that this project was not meant to be and something else needs to be tried. It is at this time that differences from one congregation to another are very evident; what works in one may not work in another. It is important, although very difficult, for the nurse to look at these times as learning experiences and not failures.
The quarterly Kentuckian Parish Nurse Newsletter, with a mailing list of over 250, is in its third year of publication. A favorite section of this newsletter has been the list of upcoming events. Listing the health fairs gives the nurse who is hoping to host one the opportunity to visit and see a finished product. Parish nurses visiting these health fairs are encouraged to seek out the hosting parish nurse to give her support and encouragement. This newsletter also contains various articles of interest to parish nurses, current happenings in other area programs, and local and national educational opportunities.
One of those educational opportunities is here in Louisville. The Parish Nurse Certificate Program at Spalding University was established in June 1996, when the deans of the School of Education and the School of Nursing and Health Sciences met together with the director of the Ministry Studies Program and myself to discuss the possibility of developing a certificate program in parish nursing. All of us felt there was enough interest to begin a course at Spalding. Since then, six classes and 92 graduates have demonstrated that Louisville was very ready for this educational opportunity.
In designing a program for the Kentuckiana area, I had to look realistically at the time and expense involved. A program like the eight-day certificate program I had attended at Marquette University was not an option. The nurses I know lead very busy lives, caring for their families and going to full time jobs. This meant that most could not afford the time or the money for such an extensive program. Another factor was that many of the nurses were unaware of a very important aspect of parish nursing --pastoral care. They were comfortable with their nursing skills, but did not realize that the pastoral care element was just as important to this position. I felt that by providing the nurses with a short 15-hour course divided into five sessions they would be both more willing and financially able to attend. Because this was seen as only a beginning, the course was entitled "Introductory Certificate in Parish Nursing."
My theory was proven correct as the nurses attending the course realized ministering to their church members with their nursing skills was not a problem. They had the understanding of the medical system and the required nursing skills to perform the five roles of a parish nurse. These roles, identified by the first parish nurses in the Chicago area, are: 1) Health Educator, 2) Personal Health Counselor, 3) Referral Agent, 4) Facilitator, and 5) Integrator of Health and Healing. Those nurses who attended the introductory course realized, not only what they were lacking and needed, but also what they had a great desire for: more education in Scripture, pastoral care, and a basic understanding of the everyday operations of a church institution.
Out of this need the Intermediate Certificate Program in Parish Nursing was developed. Because Spalding University has been responding over the past ten years to the educational needs of lay people who desired to serve in church ministries, this seemed to be the ideal partnership. The Ministries Study Program's Mission Statement states that it is to "educate women and men who, out of dedication to God and in response to a call to ministry, seek interdisciplinary training for ministry and leadership within diverse and developing ecclesial and civic communities." To better serve working adults, the eight classes are taught at weekend college using a four semester, two year time frame. In order to address the various needs of these adults, classes can be taken for either a certificate or for college credit toward an undergraduate or graduate degree.
In January 2000, six nurses began their studies in the Intermediate Program. The nurses attended the first three classes with other students, who were pastoral associates, directors of religious education, youth ministers, men preparing for the deaconate and their wives, and others pursuing a degree in religious studies. Sixteen of these men and women were in the class with the nurses. The next three classes for the nurses were designed around the five roles of the parish nurse. After completing these classes the nurses rejoined the other students for their final two classes.
Over the years, designing, implementing, and maintaining these programs has taken much time and energy, but the enthusiastic response of the area nurses has made it all worthwhile. These nurses now know that parish nursing is more than just a job, position, or opportunity to volunteer. It is more than using their nursing skills. It also needs the knowledge of pastoral care and is a spiritual call in every sense of the word. A requirement of this Intermediate Program is participation each semester in a four-hour theological reflection class. This is where I see the nurses blossom. It is so exciting for them to finally be able to take their everyday happenings and look at them from a theological perspective using Scripture, reflection, sharing, and prayer.
When I first began my career in parish nursing back in 1993, it was as a coordinator of programs within two Catholic Churches here in Louisville. It was always exciting to see the interest of the volunteer nurses, but at the same time discouraging to learn of their time constraints. There were so many things they wanted to do, but these nurses knew how busy they already were and that their priorities had to be with their families and jobs. The challenge was to go with something these nurses felt was manageable for them. Both of these churches had over twenty nurses in their congregations, and they were willing to help with blood pressures once a month.
We began taking blood pressures on the first weekend of the month after each church service. I soon realized that we were missing a large number of elderly members who probably had the most need for this service. These were the ones who came very early to get the parking place close to the exit and left early so they could safely walk slowly down the steps and exit the parking lot free of congestion. We began to do blood pressures before and after each church service. This change was very significant. Not only were more members participating in having their blood pressures taken, but they were experiencing more privacy for asking their medical questions since there was not a line. It was reassuring that after a few months the members began identifying the first weekend of the month as blood pressure time, dressing appropriately, arriving earlier, and coming prepared to ask their questions. Getting a very high blood pressure was always a concern for the nurse. Because this was an adult model of nursing, the nurses did not keep a record of the blood pressures. Instead, they recorded it on a card that was given to each member. This card also listed the range of blood pressures from normal to dangerously high. The church member was then responsible to follow through with the teachings of the parish nurse. Being the caregivers that nurses are, this method has been difficult for some. Nevertheless, maintaining an adult model of teaching in parish nursing is very important in order to prevent burn out of the parish nurse. The parish nurse needs to frequently remind herself or himself of the five roles of parish nursing.
Home visiting by the parish nurses was greatly appreciated by the pastor and the Eucharistic Ministers. They now had a place in which to refer their medical concerns. One difficulty that non-medical people have with referrals to the parish nurse is that they tend to wait until it is too late for a parish nurse to be effective. The parish nurse comes to the congregation with a set of wellness and health promotion eyes and ears. We do not operate from an illness model. It is when the member is first diagnosed with Alzheimer's that we need to begin our visits; unlike the time I received a referral from the pastor as the gentleman was running out of the house with no clothes. Nor the time the wife called because her husband was on the floor and she couldn't get him up. In both of these cases I was able to minister to the wives, but an early intervention would have been more appropriate. It usually takes about a year before the entire church grasps the parish nursing concept.
A special gift of parish nursing has been being able to pray with those I visit. As a former hospice nurse, I was all too familiar with the surprise revelation that required me to extend a home visit past the usual time. With parish nursing, after the first few minutes of friendly conversation, asking the parishioner what they would like to pray for today has been very helpful. It opens the door to the individual's real concern. One time it may be for one of their physical problems and the next time it could be for a family member in crisis. Whatever the concern, we are able to have prayer regarding it and then I am able to address the issue. It is such a gift to spend 45 minutes in therapeutic listening with a shut-in; who then often thanks me because he or she now feels so much better. It is truly a win-win situation.
My most memorable time as a parish nurse did not occur during a blood pressure screening or a home visit, but at a choir practice. During a pastoral staff meeting, the music minister told how Lori, one of their members, was dying of cancer, and how the other choir members were having such a difficult time watching her decline. I sat there as everyone who knew this woman was overcome with grief. No one said anything. As nurses we come in contact with this type of situation daily, but it is not common place at a pastoral team meeting. My suggestion that the choir have a ritual healing prayer service for this woman, was gratefully accepted. It was arranged that the choir practice would begin 15-minutes earlier than usual on the following Sunday morning. When I arrived, I was very surprised to find Lori present also. Her strength was such that she was forced to choose between the choir practice and the church service. On that day she chose the choir practice. After a moment of panic, I turned to the Holy Spirit for guidance and She did not fail me. The choir members were already in a circle so I asked that Lori be placed in the center of the circle. Using the gifts of the choir, I requested that they sing the hymn "Be Not Afraid." I asked that they imagine Christ also present in the circle, surrounded by a healing white light. The choir members were instructed to extend their hands toward the center of the circle. In each of their hands they were to imagine their own personal blue healing light. This blue light was then extended toward the center of the room, allowing it to merge with Christ's white light. We directed all this light toward Lori. This was done very slowly and prayerfully. We concluded by singing "Amazing Grace." Although after the ritual there were not many dry eyes (including mine), there was much joy and love shared. Lori died a few weeks later. I know much healing took place within myself and the choir members that morning, and I hope and pray that Lori died more peacefully because of our prayers for her.
Over the past seven years of my involvement with parish nurses, I have discovered it is the lack of money that prevents more nurses from becoming involved in this ministry. Most congregations expect their nurses to volunteer. These nurses, who are busy with families and jobs, are very limited as to how many hours they can volunteer. What most churches don't realize is that these nurses would be willing to take a large salary cut in order to minister in their churches. As I look back over the history of parish nursing here in the Kentuckiana area and see how far we have come, my faith in the workings of the Holy Spirit tells me that some day more churches will provide a salary for their parish nurse. And I see it as another one of those win-win situations in which the nurses, the churches, their members, and the surrounding community will all benefit.
There are new exciting things happening in the Kentuckiana area that will affect the future of parish nursing. In September, a chapter of the Health Ministries Association (HMA) will form and begin meetings here in Louisville. It is hoped that this national organization will become a network for all denominations interested in and involved in health and healing ministries in this city. As their brochure says, HMA is "people of faith gathering together for a healthier community." Spalding University is also looking at the possibility of developing an Advanced Certificate in Parish Nursing for nurses who are interested in further education in this area. And the Holy Spirit is continuing to call nurses forth to help the people of God care for their temples (I Cor 6:19) in churches throughout the area.
Bea Keller is a Sister of Charity of Nazareth. She received nursing degrees from Highland Park Community College, Highland Park, Michigan and Mercy College of Detroit, Michigan; a graduate degree in Holistic Health Education from John F. Kennedy University in California; and a certificate in parish nursing from Marquette University, Milwaukee, Wisconsin. Her career in parish nursing began in 1993. Presently she is a parish nurse educator and consultant and teaches the Parish Nurse Certificate Programs at Spalding University in Louisville, Kentucky.
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