Parish Nursing and Assessing the Health Care Needs
Of a Faith-based Community
Elizabeth P. Howard, PhD, RN, ACNP
Treatment programs at a substance abuse treatment facility may vary in methods but the end goal of helping drug addicts kick the habit is similar.
††††††††††† Nurses continue to seek care delivery models that take on a holistic approach. Parish nursing, an evolving mode of health care delivery, embodies the holistic approach with spirituality as its core.† A review the role of the parish nurse and an examination of the results of a health needs survey from one faith-based community shows consideration to the parish nursing role. Findings from the survey demonstrated the needs for respite care, grief and loss support groups, and health education regarding nutrition and exercise. With the initiation of a parish nurse position, knowledge about the health concerns of the congregation provides a reliable foundation from which to launch this role within a faith-based community.
††††††††††† Nurses continue to seek care delivery models that take on a holistic approach. In recent decades, conceptual frameworks and theories in nursing have considered the biological, psychological, and sociological aspects of the individual. More recently, the spiritual aspect of life and its contribution to the overall integrity and health of an individual has gained more attention. Parish nursing, an evolving mode of health care delivery, embodies the holistic approach with spirituality at its core. The purpose of this paper is to review the role of the parish nurse and examine the results of a health-needs survey in a faith-based community.
††††††††††† Although parish nursing has an ancient tradition within health care during the early history of churches, the origin of the current parish nursing movement is attributed to the Rev. Granger Westberg, a minister from the Lutheran General Health Care System in Park Ridge, Illinois (Westberg & McNamara, 1987).†
††††††††† In the 1980ís, the Rev. Westberg, a hospital chaplain, recognized the potential contribution of nurses to initiate and coordinate health care through an established religious organization. Integral to all models of holistic care is the spirituality component serving to enhance positive health outcomes. Thus, the parish nursing model continues to develop and expand, providing a means for the delivery of holistic care. Using religious groups for health care delivery improves accessibility to populations in urban, suburban, and rural settings (Schank, Weis, Matheus, 1996) and may impact the health disparities present in our country.
††††††††† With its initial conception, parish nurse roles were identified. These roles include that of health educator, personal health counselor, volunteer coordinator, community liaison, and role model (Solari-Twadell & Westberg, 1991). All nurses received preparation as educators. Often this education is directed towards patients and their families. Parish nurses have the opportunity to continue with patient-specific education but may also expand the practice to include group instruction on health topics most relevant to the congregation. In addition, parish nurses are accessible to the congregation on a regular basis affording opportunities to reinforce the educational material presented.
††††††††††† Parish nurses also assume the role of personal health counselor. In a health care system that has become increasingly complex and controlled by non-medical personnel, simply obtaining a response to a question about oneís health status may be cumbersome and discouraging for most people. Unlike other members of the medical community, they are not restricted by time or limited to a certain number of visits with their patients.
††††††††††† Grief support groups, playgroups for new mothers and children, and blood pressure screening are among the programs offered by many parishes. Because these types of programs require many service hours, parish nurses fulfill the role as program coordinator. They assume responsibility for soliciting and training volunteers, and scheduling programs that meet the needs of the congregation.
††††††††††† †Parish nurses also make a valuable contribution through the role of community liaison. In some communities, they may be the only link between the local hospital, health clinics, and local health care agencies. At times, people do not use community health care services because they are unaware of their availability. Parish nurses can be pivotal in identifying these additional resources and facilitating contact.
††††††††††† Finally, parish nurses are role models. By providing an example of a healthy lifestyle and modeling positive health behaviors, and practicing oneís spiritual values in the community parish nurses serve as role models for the parishioners.
Health Needs Survey
In one Catholic parish, located in a suburb of a major metropolitan area in the northeast region of the country, a group of interested nurses established a health ministry within the parish. As an initial intervention, the ministry began to offer blood pressure screening clinics on a monthly basis. The nurses, in accordance with guidelines available from the National Heart, Lung, and Blood Institute, developed a blood pressure screening protocol, maintaining records of the measurements; the nurses participated in health education related to blood pressure and heart disease with the parishioners.
††††††††††† The Health Ministry conducted a needs assessment survey to identify the needs and interests of the parish, particularly those that would be most helpful to the health care issues of the parishioners and to their families. Surveys were administered to adult parishioners as they entered the church to attend scheduled Masses. The parishioners were asked to complete the surveys and return them to designated baskets placed at the front exits of the church.
A total of 186 completed surveys were returned and of these, 184 were usable. The survey consisted of four parts. Three sections identified the specific health areas/topics as: Home Care, Support Groups, and Health Education. For each of these three sections, parishioners were asked to rank order the three items that were most important to them using the numbers 1,2,3 with 1 indicating the highest level of importance. The fourth section was an open‑ended question that asked for additional comments and suggestions. The respondents had the opportunity to include their name and telephone number on the survey. In addition, they could indicate their interest in sharing time and talents with the Health Ministry.
†Data from the three quantitative sections of the needs assessment were analyzed using the SPSS software program. Responses were coded as 1,2,3. A check mark or a number greater than 3 was coded as 9. Given the limited number of responses to the qualitative question, the results were summarized in an outline format.
The Home Care section of the survey consisted of five defined items and included an open≠-ended question, allowing the respondent to specify other items/areas in home care. These five items were transportation, respite (rest for caregiver), telephone (visit) call, new mother/well baby visit, and assistance with community health resources.
†100 of the 186 parishioners responded to this section of the needs assessment. Figure 1 depicts the distribution of responses for each of the five items in the Home Care section. As shown in the bar graph of Figure 1, respondents picked respite care as the highest ranking perceived need with 44 of the 100 respondents ranking it first. Assistance with community health resources was second with 23 of 100 respondents ranking it first. Transportation was the most important need for 19 respondents. New mother/well baby visits was fourth with 14 respondents ranking it as their highest perceived need. Only 12 respondents ranked telephone call or visit as the most important perceived home care need. Respite care was the most frequently chosen need when analyzed regardless of rank assigned by respondent. Five respondents surveyed chose to specify an additional home care need. Their responses were frequent blood pressure checks, reading to the legally blind, meals when and if needed, shut-in visits, and someone to call to assess the need for an emergency such as rise in blood pressure.
The second section of the survey, categorized as Support Groups, was comprised of four specific items: grief and loss care givers, parenting, and alcohol/substance abuse. Respondents again had the opportunity to include additional items. Of the 184 respondents, 109 completed this section of the health needs assessment. Figure 2 shows the distribution of responses.† 41 chose grief and loss as their highest perceived need for a support group within the parish. Caregiver support was ranked first by 35 of the 109 respondents. Parenting was first on the list for 21 parishioners. Support groups for alcohol and substance abuse were ranked first among only 10 respondents. Support groups dealing with grief and loss was the most frequently chosen perceived need when analyzed regardless of rank assigned by respondent. Eighteen of the 109 respondents chose to specify an additional type of support group they felt was needed. Their responses were: interfaith families, grief and loss for children, parenting/new mother, children caring for parents, children and divorce, spirituality and health, weight loss, dementia, marriage, divorce, teen support heart conditions, medications, arthritis exercise groups, yoga groups, computer/internet addictions, mental illness, chronic illness, and pain management.
The suggestions for other support groups included all age groups. Areas identified are consistent with current health care issues prominent in society today including weight loss, divorce, caregiver burden, addictions and chronic pain. These suggestions also span across the bio-psychosocial realm reflecting a need for a holistic approach in the provision of health care services.
The third section of the survey, Health Education, contained seven items: heart disease, blood pressure control, nutrition and exercise, living, will/health care proxy, CPR certification, death and dying, and stress management. Respondents again had the opportunity to add any items of importance to them. Of the total number of respondents, 107 (67%) responded to this section of the health needs assessment survey.† Figure 3 illustrates the distribution of responses. Thirty-six chose nutrition and exercise as their highest perceived health education need. Blood pressure control, stress management and CPR certification were almost equally chosen among respondents as their highest perceived health education need selected as the most important by 28, 28, and 27 of the 107 respondents respectively. Living will/health care proxy was ranked first by 14 of the respondents. Thirteen respondents chose heart disease and 10 chose death and dying as their highest health education need. Nutrition and exercise was chosen most frequently as a health education need when analyzed regardless of rank among parishioners surveyed.† Six of the 107 respondents to the health education section chose to write in an additional need. Their responses were: prenatal yoga, obesity, and indications/ramifications of depression.
The needs assessment contained a section asking the parishioners for additional comments and suggestions. Several parishioners expressed gratitude to the ongoing work of the parish; eight parishioners had specific comments and suggestions. They suggested the Health Ministry offer baby‑child care for working parents and companion services for shut‑ins, sponsor speakers on various topics such as allergies, exercise, senior center programs, pain management and health proxy; and present talks on the dangers of medicine and mental health issues.
††††††††† Findings from the Health Care Ministry Needs Assessment survey demonstrate that among the 186 parishioners who responded, the majority report needs such as respite care, grief and loss support groups, and health education regarding nutrition and exercise. In addition, the survey results identified several other needs related to Home Care, Support Groups, and Health Education.† Respite care and nutrition and exercise have been identified in other faith groups (Brudenell, 2003). Facilitating collaboration between health and social service agencies and the congregation highlights the community liaison component of the parish nurse role. Many of the items identified in the 3 sections of this survey may be addresses through a formal collaborative approach between the congregation and various health and social service agencies.
††††††††† There were several topics identified in the health education section. These results support the role of the parish nurse as a health educator. A parish nurse may be capable of providing formal and informal education classes on various health topics. However, without expertise in all of the subject areas, the nurse could tap into the resources of the parish and utilize volunteers to deliver some of the health education programs.
†††††††† ††††† With the initiation of a parish nurse position, knowledge about the health concerns of the
congregation is required (Brudenell, 2003). The results of this survey provide useful information with which to establish future health ministry program goals and objectives, consistent with the needs of the parishioners. These results however, must be interpreted in light of the scope of this needs assessment and its limitation to those parishioners who chose to respond to the survey. The study also is limited to those parishioners attending scheduled Masses on the weekend data was collected.
†††††††† Since the inception of the profession, nurses have always approached health care delivery in a holistic manner. The use of the church as a place for health care delivery dates back to the early first centuries. Over time, the role of faith communities in health care delivery has changed greatly. In the most recent decades, there has been increased focus on the mind/body interaction as well as the use of spirituality to aid in maintaining or reestablishing oneís health status. At the same time, changes in the health care delivery system has resulted in fragmented, ineffective, health care leaving many individuals vulnerable to potential exacerbations or the development of additional co-morbidities.
†††††††† In some parishes, the parish nurse is a volunteer position. Other parishes have affiliated with schools of nursing and implemented the role utilizing nursing faculty and graduate nursing students interested in pursuing an advanced practice position as a parish nurse. Other parishes have initiated the role as a staff position with salary and benefits. Parishes need to create physical space such as meeting rooms and office areas with storage for files. They also need to develop and reproduce informational materials and purchase basic equipment such as blood pressure cuffs and stethoscopes to effectively provide basic services to parishioners.
††††††† The institution and expansion of the Parish Nurse role a timely, valuable supplement to the delivery of health care bringing patients to the most optimal level of health possible.
Elizabeth P. Howard, PhD, RN, ACNP is Associate Professor of Nursing at
Northeastern University Bouve College of Health Sciences School of Nursing
in Boston, MA.† In addition, she volunteers as a member of the Health Ministry at her parish and participates in monthly blood pressure screening clinics.† She can be reached at 617-373-4590 or e-mail at firstname.lastname@example.org .
Marion Growney, RN, MS, ACNP is an Acute Care Nurse Practitioner at Massachusetts General Hospital in Boston, MA. She was a student in the acute care nurse practitioner program and assisted Dr. Howard in the analysis of the survey data. She can be reached at 781-944-3109.
Brudenell, I. (2003). Parish Nursing:† Nurturing Body, Mind, Spirit, and Community.
††††††††††† Public Health Nursing, 20, (2), pp 85-94.
Schank, M.J., Weis, D., Matheus, R. (1996). Parish Nursing:† Ministry of Healing.
††††††††††† Geriatric Nursing, 17, (1), 11-13.
Solari-Twadell, A. & Westberg, G., (1991). Body, Mind, and Soul. The Parish Nurse
††††††††††† Offers Physical, Emotional, and Spiritual Care. Health Progress. September,
††††††††††† pp. 24-28.
Westberg, G. & McNamara, J. (1987). The Parish Nurse:† How to Start a Parish Nurse
††††††††††† Program in your Church. Park Ridge, Il.:† Parish Nurse Resource Center.