Parish nursing--a conceptual framework

What Are the Perceptions and Experiences of Care Delivery Among Faith Community Nurses? A Systematic Review

OBJECTIVE

This systematic review set out to identify the unique perceptions and experiences of care delivery among faith community nurses (FCNs).

DATA SOURCES

This review was conducted and has been reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted using the following databases, Medline (OVID), EmCare for Nurses (OVID), PsycINFO (OVID), CINAHL (EBSCO), Cochrane, and PubMed. The search strategies included the use of truncations, adjacency search parameters, and Boolean operators using a range of key search terms. Predetermined eligibility criteria were applied to all studies. The review process was managed using Covidence systematic review software. Data extraction and quality assessment was conducted across all included studies. Data were analyzed using a narrative synthesis approach.

CONCLUSION

This review has made an important contribution by identifying the role that FCNs play in care delivery as trusted members of their communities who act as a conduit at the intersect of faith and health care. Irrespective of the location or faith denomination, what was common to FCNs was that they delivered care to address the physical, psychological, spiritual, congregational, communication, health system, and family-related needs of those in their care.

IMPLICATIONS FOR NURSING PRACTICE

The nurses represented in the included studies expressed concerns that patients experienced unmet supportive care needs because of a fragmented and highly complex existing health care system. Often, FCNs provided a valuable contribution in supporting patients in their care pathways and facilitated continuity of care among people who lived with preexisting comorbidities and who had complex health care needs. Further research is needed to understand the role that faith community nursing models might have in cancer care from the perspective of patients and other members of the multidisciplinary team across different international contexts.

The State of Research on Faith Community Nursing in Public Health Interventions: Results from a Systematic Review

Though faith community nurses (FCNs) serve many roles in churches and communities, little is known about their roles or effectiveness in public health interventions. This systematic review summarizes the literature on recent faith community nursing interventions, examining trends, evaluating rigor, and proposing future research directions. Articles were downloaded from PubMed and CINAHL, and 24 studies were included. Interventions addressed various health outcomes. The FCNs participated in research by recruiting participants, developing study measures, and implementing programs. Results reported mainly process evaluation and provided few outcomes. Better evaluation is needed to understand the effectiveness of FCNs in public health research.

Building Capacity Among Laity: A Faith-Based Health Ministry Initiative

A systematic review of topic-specific faith-based health programs determined that health outcomes can be improved though faith-based health interventions. A university research team, in partnership with the Kansas United Methodist Church and a United Methodist philanthropy, facilitated planning and development of a statewide initiative to increase the capacity of laity-led health ministry teams. The purpose of this paper is to describe the processes utilized to design and implement an initiative to increase capacity for laity-led comprehensive health ministry among Kansas United Methodist Church congregations and to share the key elements of the initiative.

Evolutionary conceptual analysis: faith community nursing

The aim of the study was to report an evolutionary concept analysis of faith community nursing (FCN). FCN is a source of healthcare delivery in the USA which has grown in comprehensiveness and complexity. With increasing healthcare cost and a focus on access and prevention, FCN has extended beyond the physical walls of the faith community building. Faith communities and healthcare organizations invest in FCN and standardized training programs exist. Using Rodgers' evolutionary analysis, the literature was examined for antecedents, attributes, and consequences of the concept. This design allows for understanding the historical and social nature of the concept and how it changes over time. A search of databases using the keywords FCN, faith community nurse, parish nursing, and parish nurse was done. The concept of FCN was explored using research and theoretical literature. A theoretical definition and model were developed with relevant implications. The search results netted a sample of 124 reports of research and theoretical articles from multiple disciplines: medicine, education, religion and philosophy, international health, and nursing. Theoretical definition: FCN is a method of healthcare delivery that is centered in a relationship between the nurse and client (client as person, family, group, or community). The relationship occurs in an iterative motion over time when the client seeks or is targeted for wholistic health care with the goal of optimal wholistic health functioning. Faith integrating is a continuous occurring attribute. Health promoting, disease managing, coordinating, empowering and accessing health care are other essential attributes. All essential attributes occur with intentionality in a faith community, home, health institution and other community settings with fluidity as part of a community, national, or global health initiative. A new theoretical definition and corresponding conceptual model of FCN provides a basis for future nursing knowledge and model-based applications for evidence-based practice and research.

Resources and interest among faith based organizations for influenza vaccination programs

In the United States, annual influenza vaccination rates are suboptimal and are well below the national health objectives. Project VIVA mobilized community members and organizations to implement an influenza vaccination program in Harlem by administering vaccines in "non-traditional" venues, such as community-based organizations, pharmacies, and faith-based organizations (FBOs). FBOs have been recognized as important venues for health promotion initiatives within medically underserved communities. However, data regarding the extent of resources and interest in health promotion programs among FBOs are sparse. We conducted a telephone survey among 115 FBOs in three New York City neighborhoods with histories of low influenza immunization rates to identify the congregation's health concerns, interest in serving as a community-based venue for influenza vaccinations, and existing resources for health programming. Twenty-six percent of the FBOs had an established health ministry, while 45 % expressed interest in developing one. Seven percent included nurses among their health activities and 16.5 % had contact with the local health department. Most FBOs expressed interest in common health promotions programs; 60 % expressed interest in providing on-site influenza vaccination programs within their organization. Health programs within FBOs can be a point of access that may improve the health of their congregants as well as the larger community.

Spiritual interventions and the impact of a faith community nursing program

Faith community nursing had its formal beginnings in the Midwestern United States in 1984 when six nurses received financial support from a local hospital to work in churches. Over time, the churches assumed increasing responsibility for the nurses' salaries. The success of this initiative was associated with the understanding that faith communities are dedicated to keeping people well. The number of programs increased over the past 30 years and now there are thousands of faith community nurses serving populations around the world. Research for this specialty practice has not experienced comparable growth, and is needed to further develop faith community nursing science. This study, based on the Roy Adaptation Model, used a qualitative design to identify spiritual nursing interventions that faith community nurses use in their practice, and to examine the spiritual impact of a faith community nursing program. Data were collected from faith community members, clergy representatives, and faith community nurses with a researcher-developed demographic tool and a six-item open-ended questionnaire that were both mailed to participants (N = 112; n = 52; response rate = 46%) and analyzed through content analysis. A variety of spiritual nursing interventions were identified. Themes related to the spiritual impact included the physical, mental, and spiritual health connection, caring, hope, spiritual support and benefits, and religious concepts.

Parish nursing: nurturing body, mind, spirit, and community

Parish nursing is a model of nursing care that focuses on health promotion and disease prevention within a faith community. A descriptive study was conducted in the intermountain West to determine how faith communities form parish nursing programs and what their effect is. Thirteen congregations representing eight denominations with parish nurse/health ministries participated. Parish nurses, parish nurse coordinators from two medical centers, pastors, and hospital chaplains (n = 24) were interviewed and provided documents from their programs. Over time, congregations formed parish nursing/health ministries using strategies in a developmental process. The process involved significant support from the pastor, congregation members, and the parish nurses. Collaboration between faith communities and health organizations were successful using a limited domain approach to attain specific health goals. Parish nursing is making a contribution to integrating faith and health practices, promoting health, and increasing accessibility to health care and congregational activities. Conclusions and recommendations are included for future research, practice, and education.

Nursing the spirit: the Framework of Systemic Organization

AIMS

To elucidate the concept of spirituality as an essential and integrated dimension of the functioning of individuals and families through the Framework of Systemic Organization (Friedemann 1995) and to demonstrate with a case example, how a nurse can integrate spirituality in the care of a terminally ill patient.

BACKGROUND

Spirituality is the focus of discussion in nursing and other health professions in the United States of America, but whether or not it should be generally included in patient care is heavily debated. Also unanswered is the question about how spirituality should be addressed. The Framework of Systemic Organization (Friedemann 1995) is introduced here as an organizing structure to guide nurses in caring for the spiritual needs of patients. IMPLEMENTATION OF THE THEORETICAL FRAMEWORK: Spirituality is defined as connecting to systems such as God, nature or other people, and thus finding meaning through relationships. Key to spiritual care is the establishment of a balance between control and spirituality that is tailored to an individual patient's history, values and needs. A case example is used to show how a nurse intervenes with a patient who faces death.

FINDINGS

The example shows that control remains important in a patient's life process until death arrives. Nevertheless, a dying patient benefits from an increasing focus on spirituality to gain self-acceptance, reconciliation with the family and restoration of emotional health. Nurses are instrumental in finding the balance between control and spirituality that a patient desires.

CONCLUSION

Nurses who have explored and reconciled their own spiritual beliefs can learn to address their patients' unique needs within the broad context of family and environment. Nursing the spirit by using the Framework of Systemic Organization is a client-directed and intimate process that leads to growth of both patient and nurse.

Perceived health needs of urban African American church congregants

Theory-based assessment of congregant expectations and needs should be conducted prior to beginning a parish nurse program. However, no such assessments are found in the literature. Using Andersen's Health Access Model as a framework, investigators conducted interviews with 117 randomly selected congregants in five urban African American churches to describe their perceived needs and expectations. Causing most concern were the following: (a) symptoms of illness--high blood pressure (50.4%), dental problems (43.6%), and back pain (41%); and (b) health habits/risks--weight (75%), exercise (63%), and diet (63%). Younger adults were significantly more concerned about all aspects of their health than their older counterparts. Women were significantly more likely to express concern about health habits and health risks than males. No significant relationship was found between perceived need and access to care. Although terming health care services "adequate", congregants expressed many unmet health needs. This seemingly contradictory finding may illuminate a concrete role for the parish nurse, i.e., addressing personal health care concerns not alleviated by the current "adequate" health care delivery system. This study's significance lies not only in providing programming guidance, but also in theoretical insights into the role of the parish nurse.

Spirituality and spiritual care provided by parish nurses

The high level of religious participation in the United States provides a venue for parish nursing, a holistic nursing specialty that emphasizes the relationship between spirituality and health. This descriptive study measured two aspects of spirituality (spiritual perspective and spiritual well-being) in a national sample of parish nurses and described variables related to their practice. Furthermore, it qualitatively examined the provision of spiritual care to clients in this parish nurse sample. Parish nurses scored high in spiritual perspective and spiritual well-being and reported an emphasis on health promotion and education in their activities. Three views of spiritual interventions (ideal, general, and specific) were reported. Types of spiritual interventions typically fell into one of four categories: religious, interactional, relational, and professional.

Parish nurses influencing determinants of health

How are the concepts health, health promotion, faith community, and health determinants connected? How can a nurse draw on the unique features of a faith community to promote health? In this article, we explore the relations among these concepts and consider the answers to these questions. Parish nurses provide a concrete example of the interactions among these concepts. They are often hired by faith communities to intentionally promote health within and beyond the faith community. Increasingly, faith communities are being used as settings for health promotion interventions. We describe examples of how a parish nurse can influence 2 determinants of health: social support and healthy child development.

Needs assessment of homebound elders in a parish church: implications for parish nursing

The goals in managing chronic illnesses in the elderly are to maintain the highest possible level of functioning, promote independence in self-care, and enhance quality of life. Parish nursing is one mechanism for providing care for homebound elders with one or more chronic illnesses. However, determining the holistic health needs of older parishioners before developing a parish nursing program is helpful. The holistic needs of elders in two parishes were determined through two multidimensional functional assessment questionnaires and a quality of life scale. Results indicate that this population of elders had relatively high levels of functioning. Quality of life was relatively high and was associated with overall functional abilities.

A comparison of urban versus rural experiences of nurses volunteering to promote health in churches

Recent years have seen a resurgence of the health and healing role of the church. Nurses have been involved in this movement through the development of health ministry and parish nursing with a growing number of nurses volunteering their services to congregations. This program evaluation research study compares two programs (one in an urban environment and the other in a rural environment) that use nurses who volunteer in congregations to promote health and well-being. The study found that the two programs differed significantly with regards to the location where nurses provided care. The urban nurses provided most service at the church, while the rural nurses provided service through home visits and phone calls as well as at the church. The groups were also significantly different in the ethnicity, education, work status, and age of the nurses. Further differences were also found in the type of services the nurses provided; for example, the rural nurses were more involved in case management and practical assistance than their urban peers. The two groups were similar in the program support they valued and in their appreciation of the opportunity to integrate their faith and their nursing practice.

Healing partners: the oncology nurse and the parish nurse

OBJECTIVES

To explore the role of the parish nurse and to examine elements of a parish nurse program and standards of care.

DATA SOURCES

Journal articles, book chapters, and personal experience related to parish nursing.

CONCLUSION

Parish nursing is a fairly new specialized area of nursing with standards of care and professional performance. The parish nurse concept has gained acceptance across the country and the number of parish nurse programs are increasing.

IMPLICATIONS FOR NURSING PRACTICE

The parish nurse focuses on health promotion within the context of the beliefs, values, and practices of a faith community. The role of the parish nurse centers on providing education and support to members of a congregation. Oncology nurses and parish nurses can work together as partners in providing care to patients with cancer and their families.