Heaven Sent -- Parish Nurses Are Making a Difference

Peggy Dryden, RN, MSN, MBA, MLS


May 06, 2004

Editor's Note:
Parish nursing is described in this interview with Maureen Daniels, RN, MN, the Director of the Deaconess Parish Nurse Ministry Network of St. Louis, Missouri. Parish nurses have a unique role in the community where much of their time is spent helping to improve quality of life and wellness in a faith-based setting. Maureen describes how she started the parish nursing role in her area (see Figure 1).

Figure 1. Maureen Daniels, RN, MN, Director, Deaconess Parish Nurse Ministry Network of St. Louis, Missouri.

Question: Many of the Medscape readers may not know what parish nursing is. Could you explain this role?

Response: Here is how parish nursing is described by the International Parish Nurse Resource Center:

"Parish nursing is a specialty practice of nursing that reclaims the historic roots of health and healing that began centuries ago in many religious groups and churches. Parish nurses carry on the work that was done by monks, nuns, deacons and deaconesses, church nurses and traditional healers and the nursing profession as well. The spiritual dimension is central to parish nursing, essential for the parish nurse personally, in her own formation and to the care she gives her clients. The focus of care is the faith congregation and its ministry. The parish nurse works in collaboration with the church pastoral staff and members to restore the faith community as a source of health and healing."[1]

As you see from this description, the parish nurse has an entire church congregation as her client. Individually and communally, the nurse and congregation work together to improve the health and wellness of members as well as the local community. Parish nurses focus on prevention and health-promoting programs and do not do "hands-on" care, such as dressings, invasive procedures, personal care, etc (we are not covered by insurance to do invasive-care procedures). The care we provide includes and embraces the core of nursing philosophy by caring for others, through teaching, counseling, referring, advocating, and involving others in providing care. Parish nurses serve in a variety of roles as health educators and counselors, referral sources, volunteer coordinators, and health advocates and by seeking to promote the connection between faith and health.[1]

Question: How is parish nursing different from other areas of nursing?

Response: Parish nursing is different from other types of nursing in that it springs from the faith base and the church. The entire congregation is the parish nurse's client. Parish nursing focuses on the total health/healing of the client -- body, mind, and spirit -- and works within the faith community. The spiritual care of this community is central to the parish nurse, and much of the work centers on the care of this larger group of clients. The nurse, due to the church base, forms long-term relationships with the congregation, at whatever phase of life they are in. Parish nurses also minister in some measure to the pastors and ministers they serve, as well as to the other staff at the church.

Many of our most vulnerable and needy clients are without healthcare. Parish nurses provide access to the healthcare system and advocate for the care of their client when there is no one else to do that for them. The parish nurse is the voice for many of the clients, especially the isolated elders at home or in nursing homes, many of whom have no one else to speak on their behalf.

Question: Could you describe your calling to parish nursing?

Response: My own calling came when I heard about the parish nursing role at a Christian Nurses conference. I had previously had about 5 years of chaplain training, including work in a hospital. When I heard about parish nursing and how it connected faith and health, I knew that parish nursing was what I needed to do. I realized I could use my gifts of caring, knowledge, and understanding, with my ability to teach, and combine them with prayer and spiritual care to bring healing. I talked with some people at my church about parish nursing -- they were very interested in my ideas. Our pastor recommended that I work with the ecumenical cluster of churches in our area and perhaps try to start a group program involving several churches.

After 2 years of meetings and with the support of the Director of Pastoral Care at the nearby hospital and the Deaconess Foundation, I started the position working full time as a paid parish nurse with faith that the increased funding needed would follow. No one could tell me how this might work with several churches, as it had not been done before. I was very sure that I wanted to do this ministry and that it was what God had wanted. After 2 1/2 years, this parish nursing program began with a cluster of 6 churches and 5 different denominations; 3 churches committed funding to the program.

Question: How does the funding for the parish nursing program work?

Response: The 6 churches have been associated as a Cluster for over 30 years. Any church in this community is able to join the parish nursing program by paying a small fee and coming to meetings. The 3 churches that committed funds to the parish nursing program did pledge about $5000 apiece per year and help support the Cluster fund-raising programs that we sponsored to bring in the extra funds. The other 3 churches joined but did not commit funds, and they receive the health-ministry newsletter, are invited to all classes and support groups, are offered flu shots, etc.

This is just how our 1 parish nursing program was set up. Other programs do not have this arrangement; most are individual churches who covenant with Deaconess Parish Nurse Ministries to have a parish nurse. After a 2-year declining grant, the church pays the full salary of the parish nurse and Deaconess pays the benefits. This has been the arrangement for each parish nurse in our Deaconess system. Also, a few of the nondenominational churches do contribute some donations and participate with our fund-raisers.

Question: Tell us about yourself. What background did you bring to your role as a parish nurse?

Response: In December 2003, I was promoted to the Director of Parish Nursing for Deaconess Parish Nurse Ministries. I currently supervise 27 paid parish nurses in our Deaconess group. I also spend time quilting, which has become my second passion.

During my nursing career, I have worked in a number of healthcare settings as a staff nurse, cancer nurse specialist, and nurse manager. I was a certified intravenous therapy nurse. I've had several years of pediatric nursing as well as a couple of years in a long-term-care facility. I also have over 10 years of experience in home healthcare.

My recent activities outside of parish nursing include fund-raising and grant writing for the church's health ministry. I am also a choir member and musician with my husband at our Catholic church, and have been for the past 20 years.

Question: What are your day-to-day activities like? What is your schedule like? What sorts of patient problems or parish concerns do you deal with most often?

Response: When serving as a parish nurse (vs in the director role), my day started with various office activities -- picking up messages, making calls for follow-up, and contacting caregivers for clients. I spent some time setting up classes, support groups, or other programs for the churches as well as writing newsletters or articles for bulletins and making health posters covering topics, such as diabetes, breast cancer, and hypertension.

Some days I made home visits. Other days I had office hours at 1 of the 3 churches I served. I did blood-pressure screenings for groups that met at the churches and on Sunday mornings before and after the worship services. These screenings became opportunities for me to connect with individuals or family members who may, for example, voice concerns over a frail parent who is sick and needs services or a son who has chronic diarrhea and has gone undiagnosed despite visits to the physician. I was able to subsequently help the mother work with her son's lactose intolerance (see Figure 2).

Maureen Daniels participating in a church blood-pressure screening.

The parish nurse has contacts with social workers and physicians in the community, whose clients they might be involved with. Nurses meet with families to discuss the needs and care of parents, spouses, etc.

Parish nurses work with a "health cabinet" in their church, a committee that helps them with the health ministry. I also reported on my clients and programs to the ministry, as well as reported on the status of grants. In addition, reports are given to the Deaconess Parish Nurse Ministries and to the church councils or boards monthly and as required.

Question: What are the greatest challenges you face?

Response: I think our greatest challenge is working to keep parish nurses paid. The outcome studies that Deaconess Parish Nurse Ministries have done demonstrate that the best outcomes come from a paid parish nurse model vs a volunteer model. It's been our experience that those parish nurses, who stay at their jobs for many years, also give many unpaid hours and contribute enormously to the health of these churches.

Our funding has come from the payments the 3 churches committed to the salary as well as what we receive through grant organizations, local businesses, and many individual donations. Our experience indicates that once a parish nursing program is in place in a church, it becomes very well accepted and appreciated, and often the church members will advocate to maintain the program. There are no plans to expand our current program.

Another big challenge for us is the ability to accept people and the choices they make even though we believe they could make healthier choices that would give them a better or perhaps longer life. We can offer any number of classes and discussions to encourage changing health habits, but people must make their own choices.

Question: What do you view as your greatest contributions to parish nursing?

Response: Parish nursing has been the most satisfying (and challenging) nursing I have ever done in 30 years of working full time. It is satisfying because I can connect with the faith and spiritual needs of the clients in my care and relate to the client's faith and the strength they draw from that. This connection makes the healing more complete, whether or not the client is "cured" or not. For example, I find that helping clients who are working on lifestyle changes is more appealing to the client when done in the context of understanding the importance of our stewardship of the body, mind, and spirit to God and is more rewarding than other medical frames of reference.

I also enjoy the variety of work that parish nursing offers, the health teaching as well as home visits and advocacy, the health screenings, the health fairs, and the exercise classes. I appreciate knowing that my work is really part of God's plan for others.

I also enjoy the freedom to create programs to help meet the needs of the particular clients in the church at this time. When grief was an issue, because a number of folks have lost loved ones, I began a grief-sharing group to let those mourning know about the grief process and that there is help and others care, God cares. I refer those with more difficult issues to healthcare professionals.

My greatest contribution to parish nursing is faith -- faith in trying what did not seem possible. The 3 small churches were able to do together what could not be done separately. I have encouraged sharing our work and being accountable to church bodies as well as others who can support them. As Director, I am planning to use my leadership to help support other parish nurses.

Question: Would you recommend a position such as yours to other nurses? What qualifications/experience/education do you recommend for a position as a parish nurse?

Response: I would definitely recommend the position to other nurses who have had a number of years of nursing experience. This type of nursing takes a more experienced nurse who has a degree of spiritual maturity and the ability to integrate these skills.

Most parish nurses take a basic preparation course of about 30+ hours of classes, lectures providing information about topics, including the theology of health, working in a church, legal issues, and discussions on the parish nurses' different roles. Information about these basic courses taught by our 80 educational partners is available from the International Parish Nurse Resource Center.

Nurses who are interested can learn who is doing parish nursing in their area and contact those nurses for information. They can offer to assist the parish nurse with various tasks, such as blood pressure or other screenings, make home visits to assist a family with health needs, or work with volunteers. If a nurse is interested in getting some health-ministry activities started, she can begin by forming a committee to evaluate needs in the congregation, determine the resources available, and then decide what would help the most. Perhaps offering healthier foods at coffee hour or doing a program on a health condition, like diabetes, would be useful. Of course, the biggest impact would be to work to get a parish nursing program going in their church. The International Parish Nurse Resource Center Web site is a great place to start, and the Health Ministries Association Web site is very useful.

Thank you, Maureen, for telling your story. Readers interested in contacting Maureen Daniels, parish nurse, may email her at dpnm@eden.edu.