Parish Nursing: Promoting Whole Person Health within Faith Communities

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Edited by: Phyllis Ann Solari-Twadell & Mary Ann McDermott

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  • Front Matter
  • Back Matter
  • Subject Index
  • Part I: Parish Nursing: An Overview of the Practice

    Part II: Parish Nursing: A Collaborative Practice

    Part III: Parish Nursing: Context for the Practice

    Part IV: Parish Nursing: Challenges to the Practice

  • Copyright

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    Foreword

    In the late 1960s and early 1970s I had the opportunity, as a faculty member of the University of Illinois College of Nursing, to participate in one of the Wholistic Health Centers developed by Granger Westberg in a church setting. Over the past 30 years, I have had the opportunity to see the ideas of whole person health develop from the early church-based family practice models to the current growing movement of parish nursing. As a program director and vice president of the Kellogg Foundation in more recent years, I have followed the development of parish nursing through a number of projects we have had the privilege to support. This compendium of chapters related to parish nursing provides a comprehensive overview of both the underlying philosophical and pragmatic issues of establishing parish nursing in a wide array of contexts. As we at the Kellogg Foundation focused our programming upon community-based models for health services delivery, we became increasingly convinced of the power of community as a positive influence on the health and well-being of people, and often, at the center of the community, was the church: the institutional hub around which the community was organized. Through the years, the development of parish nursing has resulted in the church becoming an increasingly important force influencing the health and well-being of people.

    Granger Westberg, the driving force behind the whole person health movement, describes in his chapter on the historical development of parish nursing how “the role of parish nursing is basically a reaching out for more whole-person ways of ministering to people who are hurting.” In many ways, that captures the essence of nursing, whether it be in hospital or community settings. Nurses through the ages have been the bridges between people and medical care systems. In parish nursing, nurses are bridges between people in the congregation, the church with its healing mission, and the medical care providers—physicians, dentists, hospitals, managed care systems, and a wide array of allied health providers. Time after time, nurses have emerged as the “glue” that holds things together, but we keep forgetting that lesson, and somehow we can't find a way of “fitting things” together so that support for the glue becomes as important as any of the individual pieces. In many ways, our current medical care system is one gigantic jigsaw puzzle, with each of the pieces magnificent in its detail and its sophisticated technological underpinnings. What good does it do to have magnificent pieces if they don't come together in a discernible pattern around the real health needs of people?

    Westberg notes that in the early evaluation of the Wholistic Health Centers, the evaluators determined that one of the most important factors in their success was that the nurses employed in the clinics spoke two languages: “the language of science and the language of religion. The nurses were acting as translators.” The role of nurse as translator is key to the success of parish nursing and, indeed, of nursing as a whole. Helping the person understand his or her physical condition, whether ill or well, and assisting that individual to take control of the management of his or her health is of primary importance. However, with our concentration upon the wonders of technology and our ability to “fix” things, too often attention is focused upon the wrong things. It is commonly assumed that building more health centers, bringing better technological equipment into communities, and bringing medical doctors into these practice settings will improve the health of people. Time after time, the evidence shows that this does little. We as a society have become fixated upon the medicalization of a whole array of problems: Attention-deficit children, depression, fatigue, obesity, wrinkled skin—all are viewed as medical problems to be solved with a pill or a potion. People needing only an understanding ear come to the doctor's office, to be given 8 minutes of time and most likely a prescription that will do little to address their underlying problems. No one in our society has time to listen, and certainly listening is not a reimbursable service in the world of medical care management.

    While the strength of parish nursing comes from the ability to bridge the worlds of medicine and religion and link to people, that also constitutes one of its greatest potential weaknesses. Where is the base of support for maintenance and further development of parish nursing? One of the most difficult challenges facing nursing in general and parish nursing in particular is the question of reimbursement for listening to people and being the glue to hold the whole system together around the needs of patients. One of the central problems described in this book is that of getting church finance committees to allocate money to parish nursing. Should the churches be the source of payment? Much of the parish nurse movement has been dependent upon nurses volunteering time and providing services. While volunteers are certainly important, parish nurses are just able to scratch the surface of the needs of people. Without a stable source of support for the administration of a parish nurse program, the effective use of volunteers is limited in addressing the comprehensive needs of the parish. Should the source of support for parish nurses be from the health care system? While the nurse is working to bring the pieces together around the needs of the patient, and thus facilitating the work of the system as a whole, it is highly unlikely that in our current frenzy to control costs (through the most ineffective ways), the effectiveness of parish nurses would be recognized in the form of financial support. What are people willing to pay out of their own pockets? If they do pay for parish nurses and demand them as part of the church budget, are they then not in competition with the churches themselves over revenue streams?

    In a capitalistic society, with societal institutions vying with one another for financial survival, there is little room for support of the bridges, or the societal glue, which holds things together. Parish nurses are at the center of this societal dilemma. While this book demonstrates the valuable societal role that parish nurses can play in a wide array of contexts, will there be sufficient societal support to maintain and expand this movement over time? While there is overwhelming evidence that getting members of a community together to focus upon solving common problems is a powerful way of effectively managing these problems, few of our resources are directed toward this end. Yet we continue, as a society, to pour more and more money into the “sophisticated” approaches while ignoring ways of mobilizing communities to take charge.

    Parish nurses, with their links to people, churches, and health providers, need to make highly visible the value of the work they are doing and openly address the issues related to long-term sustenance of this important movement. By mobilizing the church to fulfill its mission of being a healing force, parish nurses can assist in bringing wholeness to fragmented people and society. To do so, however, churches must embrace this as a legitimate part of their function rather than as an “add-on.”

    Parish nurses in a wide array of settings are reaching out to people who are hurting; they are joining with the church in its mission of healing. We hope that the church will embrace this movement and form a nurturing environment, that this book will become a widely used resource to expand this movement, and that churches, whatever their denomination, may join together in making this a more humane and caring society.

    Helen K.Grace, R.N., Ph.D., F.A.A.N., W. K. Kellogg Foundation, Battle Creek, Michigan

    Introduction

    Unfortunately, most readers of this book will be nurses and pastors.

    Now that I have your attention, given that crabby opening line, let me say what I mean by that opening word “unfortunately.” Certainly, it does not imply lack of respect for members of the nursing and clergy professions. They are key to the development of the parish nurse concept and to realizing it. And—now let me use the second person—you nurses and nursing educators, you ministers and priests who have this book before your eyes, may not represent a congregation of the “converted.” This means that the authors of this book do not assume they are only “preaching to the converted.”

    You may be only half converted. That is, if you are a nurse, you are almost certain to be tantalized by the vision of parish nursing offered here, but you may immediately lose heart when you picture how hard it is to realize the role. Again, you may be only half converted as a pastor because, although you will see at once where this concept fits into the theology and mission of a congregation, you may have a hard time summoning energies to add “one more thing” to the complex institution to which you minister. Your table and agenda are full.

    Yet, I am convinced in both cases that you will be convinced by the arguments, inspired by the vision, and informed by the practical details of this book. The worry is that neither you nurses nor you pastors, without whose support the parish nurse project will get nowhere, will be lonely, apparently self-interested promoters. “Unfortunately,” you cannot carry it by yourself. Now let me drop the second-person language and start talking also to other readers who, one hopes, might be looking over your shoulder or might respect your recommendation.

    Fortunately, this is a book for, say, finance committees and stewardship committees of congregations. Pastor Granger Westberg, in his lucid and memorable account of how the parish nurse program was invented, tells how he worked his way around congregations, making the case. All went well until he reached the finance committee. There the trouble started. How can an item costing $17,000 or more be fit into a congregational budget? In his story, they are not villains but realists. Some of his best friends, and mine and yours, are no doubt on finance and stewardship committees, or should be. They simply know how hard it is to get busy congregations and their members to give priority to something new.

    One could say that the parish nurse program is a great money saver, but that does not work well because most members will never know it. A young politician doing some apprentice or intern work for a United States senator once told me of his work on a piece of legislation. As I recall it, the law would simply seek to enforce the demand that freight trains come equipped with a certain kind of flashing strobe light which would serve as a warning to cars approaching crossings. From studies made in the states which enforced and did not enforce such laws, it was estimated that about 20 lives would be saved every year. “Unfortunately, those 20 people will not ever know that this law, and the action by this senator, saved their lives, but, still, their lives will be saved.”

    There is no doubt, no doubt at all, that a parish nurse will similarly save people money. They help teach preventive medicine, which is the least expensive form of care there is. Through their counseling, their referrals, their “brokering” and “fixing,” there is no doubt that they will help individuals, insuring agencies, and governments save money in a time of health care financing crisis. One could verge on the point of overselling by reminding readers that healthy congregates have more woman- and man-hours to give through their congregations to the service of others and that the parish nurse program will help keep more of them healthy. But I use the fiscal theme here at the beginning only to symbolize the fact that there are large potential audiences for this book and to express the hope that it reaches them.

    Why make such a fuss about the locale for this recently developed form of service? Why focus on the congregation, when, historically, people have connected through the nursing profession with hospitals, visiting nurse programs, or home care—but not with places that have steeples and domes, altars and high steps, which made things hard for people in wheelchairs? Why?

    Some years ago, while writing about health and medicine in our part of the Christian tradition, I interviewed the presiding bishop of a denomination in that tradition. What advice could he give to someone who has just been given medical bad news? His answer: “My advice is that the person should have been an active member of a vital congregation for quite a few years.” Meaning? Meaning that when misfortune comes, it is important to be part of a community of care. A congregation enfolds one in intercessory prayer—loving one's neighbor on one's knees. A good congregation provides care and casseroles, rides to clinics, and cards for the beside table. It represents a gathering of people who have heard and keep on hearing the word of the Healer, who are busy interpreting the message of wholeness in a world of brokenness. By their own stumbling words, halting actions, and only sometimes distracted thoughts, they help the person who is ill come to terms with some of his or her problems, to cope, and, in a way, to transcend them on the pilgrimage to triumph.

    So the congregation is important. It will become more so as people realize its vital role in a time when health care in traditional institutions is simply beyond the range of more and more people, in a time when expenses grow. Not too long ago, a veteran physician who cares for aged people told me that he visited his 90-year-old father daily in a Jewish senior citizens' home. This physician can afford the best of care, and he provides it, for a man whose dignity is threatened along with his memory, which fails him thanks to a disease. “I have to say,” said this Jewish physician, “that for all the professionals in his range, the person who treats my father as a dignified and worthy human being, and who seems to get some response, is a young black aide who probably will tell you she does that for him because she loves Jesus.” The doctor went on to use that as an illustration of a resource in the believing community. “You folks spend too much time working on the religious angle in hair-raising, urgent, sudden health care crises—like ‘Shall we pull the plug?’ Religion has most to offer in terms of long-term care, of sustained relations, where year in and year out people have to be motivated to take care.” Congregations exist for that, and the parish nurse program helps them realize such care intelligently.

    In a way, the invention of the parish nurse concept is part of several revolutions going on before our eyes but hard to define and grasp.

    First, it is part of a revolution in the understanding of health and medicine. For two centuries we had been moving, usually unwittingly but sometimes wittingly, into accepting the model—as jargon has it, “paradigm”—that believed only conventional science could cure. Invest enough in research, make enough discoveries, develop enough professionals, build enough institutions, spend enough money, show enough awe, and such science would take care of our problems.

    Today, that model or paradigm is very much in question, not least among many scientists, researchers, discoverers, professionals, institution builders, and appropriators. They are coming to recognize that humans have or are “healing systems,” which come into positive effect only when they are seen in the context of the larger systems around them. Westberg reminds us that the parish nurse program was nurtured initially by a hospital that believes in human ecology. Believing thus, it promotes the idea that we humans have to be seen in the delicate web and fibers of our context, which includes God, nature, others, and the self.

    Of course, the search for a new paradigm can lead to many devices or prescriptions that can delude and misuse people. Some uses of the term “holistic,” for instance, are connected to ideas that connect the individual to the universe, its forces and energies, in such a way that the individual is “part of God” or “becomes God” or is offered complete transcendence of suffering and care. Often, this goes by the code word “New Age” holistic care. Without needing to contend that nothing good comes from disciplines connected with such an approach, we can observe its limits. People do keep suffering, falling ill, and dying in spite of their beliefs of that sort—or, for that matter, their belief in the God beyond the gods who is the Creator, the Healer, the One who cares and weeps with us on the path to fulfillment.

    The parish nurse concept is born in an entirely different context of “whole person” care. It knows that in congregations people hear messages and try to realize them, messages directed to a world in which hate and misery, limits and pain, doubt and despair threaten almost as much as love and joy, boundary-breaking and pleasure, faith and hope are promised and realized.

    Not many seasons ago, I presented an essay by a Christian neurosurgeon to a secular group of physicians, humanists, and social scientists. He told what the service of “Christ crucified” meant to him when he interpreted his vocation, his life in respect to patients. Of course, the author reminded readers, he stayed within the bounds of his profession and kept the physician's convenant that one keeps in a pluralist society. That is, while he may use “invasive” techniques in brain surgery, he is not “invasive” in respect to patients' belief systems, not disruptive of their patterns, not ready to be distracted from what they have sought by coming to him. It was a nice, important distinction, without which he could not function and help in healing.

    One of the participants in the group spoke up in response. I suppose one who wanted to stereotype him would call him a latter-day Marxist social scientist. That is, he uses Marxist techniques of social analysis to call into question the professions and structures of our society. (He does have a good mind, and does not offer Marxian therapy, simply “socialized” care at this late date.) But he spoke up for others in the group when he said he hoped that the surgeon was not engaging in a new version of the body-mind distinction. That is, when this Christian deals with the body, he is nothing but a scientist, and when he deals with the mind, his mind, he is a believer. Without spelling out how, this professor said he hoped that the physician was more whole person oriented. He should use his faith to engage in critical analysis of how his profession works and through what institutions he works and toward what end they are all directed.

    This is not the place to follow up on what all that means and can mean. It is the place to remind ourselves that, in even the most apparently remote corners of “scientific” and “academic” life, thoughtful people are giving second thoughts to the place of faith in the provision of health care. It may take a few minutes to work such people around to understanding the vital role of congregations in the ecology of the lives of half of America. It may take a few hours to help them come to see the promise of the parish nurse program in respect to that role. This book will certainly help in such tasks.

    Most readers, however, are not going to be Marxist sociologists, scientific skeptics, secularists whose spiritual imaginations have atrophied (if they were ever given a spiritual vision at all). Most readers will be nurses and pastors, church committees and, one hopes, theologians, people whose vision has not yet been caught. They are people for whom constraints of time and money will be in the front of the mind but in whose hearts the Holy Spirit, who “calls, gathers, and enlightens” the congregation, is also active.

    One of the great advantages of parish nurse work, in contrast to that of the neurosurgeon in a high-tech hospital or the employee in a tax-supported institution, is that nurses work in a context where certain meanings are allowed to be developed explicitly. Theologian James Fouler has written on the two languages of pluralist society. On one level, out of respect for each other, in a spirit of tolerance and deference, to keep civil peace, we do not always “unload” the whole focused theme of our beliefs. Often we may feel that those beliefs could be of direct aid to someone else. Still, the rules of the game call for some holding back. For example, one doesn't enter into an interfaith dialogue and then suddenly change the rules of the game midway and try to pounce on partners with pitches for conversion.

    At the same time, says Fouler (I am rephrasing a bit), sometimes this situation makes us feel as if we are biting our tongues, choking to hold back what we might utter, holding our breaths, or stepping cautiously because we know there is a particular story, a special language of faith, a distinctive grasp of God's grace, which would be of greater aid than the language we would elsewhere use.

    The parish nurse program works chiefly in congregations or communities where a certain language of faith is ready at hand. This does not mean that the nurse becomes a preacher or has to be an explicit teacher or a theological expert. It means that she or he knows that one's individual faith story is privileged and not only can be brought up but is expected to have its place. It means that the nurse works in an ecology of meanings and care that asks her to draw on that message of grace and the practices and habits it encourages.

    One of the rules of etiquette for writers of introductions is that they should not give the plot away. There were many times, as I read this manuscript, that I wanted to steal more than the single Westberg story of his encounters with finance committees, to lure readers on, but these authors can and do speak for themselves. One of my marginal notes on the manuscript of a practical essay in this book—and there are several—is “these authors think of everything.” This is “how to” literature of a high order. Maybe what makes it all hold together is that it is also “why to” literature. We have needed that and will need it if we accept the “risk” about which Westberg speaks and dreams. We might risk helping discover and invent something new in human care at a time of great need, when hearts grow faint but the message of God in Christ does not.

    Rev. Martin E.Marty, Ph.D., University of Chicago

    Preface

    This book represents the work of many. Several of the authors are pioneers. Others offer their perspective, passion, and expertise in forwarding the ongoing development of parish nursing. The editors, through their relationships with the chapter authors, intend to address those who are interested in learning more about the concept of parish nursing. This book could be used as a text for parish nursing coursework, as well as introductory reading for health professionals, clergy, and lay leaders of congregations. The content should be of interest to any nurse interested in innovative, community-based practice.

    The concept of parish nursing is not new. Deaconesses and other religious men and women worked as part of the early church, nurturing health and healing. However, it was only in 1984 that Rev. Granger Westberg, who first had the idea of parish nursing, approached Lutheran General Hospital in Park Ridge, Illinois about initiating a pilot parish nurse program. Six nurses in six churches representing different denominations began to implement Westberg's vision. Thus a portion of the writing reflects the influence of this Illinois experience. In spite of this Midwest Christian beginning and the brief time period, parish nurses can be found internationally, serving both Christian and non-Christian faith communities.

    Terminology and language present a challenge. The gathering place for faith communities has many titles. Congregation, church, parish, temple, synagogue, and mosque are but a few of the names that identify these gathering spaces. The roots of parish nursing grow from a Christian perspective, and the text reflects this dynamic. There is no intent to ignore, exclude, diminish, or deny any faith, beliefs, traditions, or orientation. The term “parish nursing” was the name given by Rev. Granger Westberg to describe this concept. From a historical and societal perspective, other names, such as “congregational nurse” or “pastoral nurse,” are used today. These titles represent the intent of parish nursing. The pronoun she is used when referring to the parish nurse, as the overwhelming majority of individuals serving in this role are female.

    At the inception of parish nursing, the concept of the congregation as a health place was not well understood; however, there was a willingness to experiment and resources available to dedicate to pioneering this program. Today, with an emphasis on healthier communities, there is better understanding of and openness to the role of the congregation in health and the contribution of parish nursing. Unfortunately, increased demands on dwindling resources strain dedication to the growth and support of this program. Lack of documentation systems and research inhibit understanding of the outcomes and true value of parish nursing to the transformation of health care delivery.

    This book is divided into four sections. Part I addresses the unique modern-day history of parish nursing. Included are chapters that represent several perspectives: that of Rev. Granger Westberg, who had the original idea; that of those who have had the privilege of working very closely with him throughout the ongoing development of the movement; and that of those who have pioneered this role in various geographic and cultural settings. In Part II, parish nursing is discussed as being most effective when health ministry is intricately woven into the corporate life of the faith community. For this to occur, the parish nurse must understand that the congregation is a workplace where the mission of health and wellness gradually unfolds through the collective gifts and work of all parties. This second section is dedicated to these basic understandings. Part III highlights the parish nurse's work with multiple dimensions of life, nursing practice, and knowledge bases. This section of the book explores some of these important considerations. For the continuous learner, the chapters in Part III provide only highlights of each subject area, identifying a framework for more in-depth study. Part IV speaks to the challenges that are present in these early stages of the development of parish nursing: the expansion of the parish nurse concept internationally, areas for future study, and questions yet unanswered. The ongoing integrity of this practice will depend on client consideration, continuous dialogue, creative thinking, and the grace of God.

    There are a number of acknowledgments to be made. The editors first of all want to thank Rev. Granger Westberg for his creativity, tenacity, and inspiring leadership. The initial administrative leadership for the pilot of this program from Lutheran General Hospital needs to be recognized for their spirit of openness to the Westberg vision: George B. Caldwell, former President and Chief Executive Officer; Rev. L. James Wylie, Vice President of Church Relations; and Rev. Larry Holst, Director of Pastoral Care. Special acknowledgment is given to Anne Marie Djupe, R.N.,C., M.A., who was the first Director of Parish Nursing Services for Lutheran General HealthSystem. Anne Marie was a treasured colleague and friend; she died in 1995. Appreciation is given for the current support provided to the International Parish Nurse Resource Center of Advocate Health Care, the successor organization to Lutheran General HealthSystem. Through this vehicle many of the relationships undergirding the development of this text were worked out. Particular thanks are given to Richard Risk, President and Chief Executive Officer, and Rev. L. James Wylie, Senior Vice President for Religion and Health, of Advocate Health Care for their endorsement of the vision and their commitment to parish nursing. The editors express their gratitude to each of the contributors who were so generous in sharing their knowledge and experience. Special thanks go to Annette Mariani, Rusty McDermott, Denise Dowling, and Audrey Munger for their patience and persistence in typing and meeting deadlines as well as their dedication to parish nursing. Thanks also go to Sage Publications for believing in this project.

    There are also some individual acknowledgments to be made. Phyllis Ann Solari-Twadell expresses her gratitude to her daughter and son-in-law, Kim and David Kuhlman, and her stepson and his wife, Eric and Anne Twadell, for their love, encouragement, and support. Ann expresses her ongoing appreciation to her mother, Phyllis Solari, and her deceased father, Archie J. Solari, for the opportunities they provided for her. In addition, Ann acknowledges the contributions her brothers Joseph and Robert Solari have made to her life. She thanks John S. Klein and Rev. John Keller for the gracious direction they provided to her. Individually, she is grateful for the teaching and guidance provided by Rev. L. James Wylie. Her contribution to this work is dedicated in thanksgiving for the life, love, and support of her late husband, Stephen Lacombe Twadell.

    Mary Ann McDermott thanks her husband Dennis and her children, Dennis, Michael, Sarah, and William, for facilitating her interest in the parish nurse role. She thanks her former dean, Dr. Julia Lane; her present dean, Dr. Shirley Dooling; and her colleagues at Loyola University School of Nursing, particularly Ida Androwich and Mary Lynch, who were essential in the initial development of the program at St. Ignatius Parish, and to the faculty, students, pastors, and parishioners who have continued to make the program flourish. She is delighted to have been affiliated with the former Lutheran General Health Care System as a member of the system and hospital governance and current involvement in the governance of Advocate Health Care. She was a member of the previous Advisory Committee of the National Parish Nurse Resource Center.

    Finally, we want to thank all parish nurses past and present who have worked hard preserving this role in their faith communities. May God bless you all!

    Phyllis AnnSolari-Twadell, R.N., M.S.N., M.P.A., International Parish Nurse Resource Center Park Ridge, Illinois
    Mary AnnMcDermott, R.N., Ed.D., Marcella Niehoff School of Nursing Loyola University of Chicago
  • Postscript

    Phyllis AnnSolari-Twadell

    As the work of this text concludes, there are a few issues that need mention and comments. As parish nursing continues to be considered from the perspective of the health care institution, the church, and the client, differences can arise. These differences will continue to offer an opportunity to be in dialogue with each other. Dialogue will hopefully lead to new ways for those in our faith communities to experience health and wholeness.

    As parish nursing is considered part of an integrated delivery system, the rhetoric, regulations, and time frames of the health care institution may impinge on the manner in which the congregation manages its affairs. For example, the documentation of services provided by a parish nurse results in the creation of a medical record. If the parish nurse is employed by the health care institution and contracted for by the church, that medical record is the property of the health care institution. All of a sudden the institution's regulations are framing the delivery of health promotion services in the faith community. This ongoing development of parish nursing cannot be lost in the differentiated perspective of health, institution, and congregation. Time, resources, and creative thinking will continue to be needed to address blocks and avert obstacles. There will be no quick fixes or easy solutions, for parish nursing will continue to push traditional thinking.

    The financing of health promotion services in the community will also continue to nag at current policies for the payment of health services. Traditionally, health promotion services have been resourced. This continues to be the case for parish nursing. Nurses interested in serving in this role are most often underpaid or not paid at all, yet the services are provided by licensed health professionals. An answer to the continual question of what levels or kinds of services constitute unpaid services to a faith community versus what levels of services a professional nurse should expect to receive compensation for is yet unclear. Ministry does not mean receiving no compensation. Being in service to another does not mean there will be no compensation. These issues will require ongoing attention when the economics of parish nursing are addressed.

    The economics of parish nursing are sometimes flavored by the feminist dimension of this role. Of all parish nurses, 98% are women. Historically, women in the context of church have often been the unspoken and least recognized contributors, particularly in traditions dominated largely by a male hierarchy. This thread runs deep within nursing, where, historically, male physicians have been the dominant figures. Do these perspectives continue to contribute to the giving of self in service with inadequate or no compensation? The most extreme example of this mind-set is the shifting of the cost of health care to the backs of the uncompensated. The shadows of economic injustice need to be examined when ongoing health services are expected to be made available by those who are already working another job in addition to attempting to serve their faith community.

    If parish nursing is going to continue to grow and mature, the acquisition of grants, research, and publication of that research will need to be a part of the process. As more and more nurses who have skills in research are attracted to parish nursing, it can be hoped that the body of knowledge regarding this practice area will grow. Today, parish nursing is seen primarily in a Christian context. The editors of this text invite comments, information, and documentation of parish nurse experiences in other religious traditions as well as about the transportability of parish nursing to other countries and specific ethnic groups. It is only through documentation of experiences and knowledge that the universal application of this practice will be understood.

    About the Editors

    Mary Ann McDermott, R.N., Ed.D., Professor of Maternal Child Health Nursing, Niehoff School of Nursing, Loyola University, Chicago, has her doctorate in curriculum and supervision. Her interest in nurses in churches began when she became a cofounder and served as the director of a Loyola University faculty nurse-managed center in a Roman Catholic congregation from 1981 through 1987. Accountability and, subsequently, documentation issues were a high priority and led to much debate and discussion among faculty peers and students regarding the necessity, format, and evaluation of record keeping in this nontraditional care site. She has been active with parish nursing and the Resource Center since being named to their Advisory Committee at Lutheran General Hospital in 1986. She serves as Chair of the system board of Advocate Health Care. Currently, she holds the title of Director for the Center of Faith and Mission for Loyola University of Chicago.

    Phyllis Ann Solari-Twadell, R.N., B.S.N., M.P.A., M.S.N., received her Bachelor of Science degree in nursing and her Master of Science in nursing from Loyola University. She received her master's in public administration from Roosevelt University and is now enrolled in the doctoral program in nursing at Loyola University as a part-time student. She has been employed for 22 years at Lutheran General Hospital/Advocate Health Care in Park Ridge, Illinois: For 10 of those years she worked in addiction treatment, and for the last 6 of those 10 she held the position of Director of Nursing Services at Parkside Lutheran Hospital, a specialty hospital for addicted patients. From 1984 to 1988, she was president of the National Nurses Society on Addictions. Currently, she is Director of the International Parish Nurse Resource Center and Interim Director of Parish Nursing Services, Advocate Health Care. In that capacity, she is the editor of Perspectives on Parish Nursing Practice, a regular publication of the International Parish Nurse Resource Center. She has coedited and is a contributing author of the text Parish Nursing: The Developing Practice. As director of the resource center, she coordinates the Annual Granger Westberg Symposium on Parish Nursing.

    About the Contributors

    Patricia Benner, R.N., Ph.D., F.A.A.N., is Professor in the Department of Physiological Nursing in the School of Nursing at the University of California, San Francisco. She received her Ph.D. from the University of California, Berkeley in stress and coping and health under the direction of Hubert Dreyfus and Richard Lazarus. She is the author of eight books, including From Novice to Expert: The Primacy of Caring, coauthored with Judith Wrubel; Interpretive Phenomenology: Embodiment, Caring and Ethics in Health and Illness and The Crisis of Care, with Susan Phillips; Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics, with Christine Tanner and Catherine Chesla; and Caregiving, with Suzanne Gordon and Nel Noddings. She is an internationally noted researcher and lecturer on health, stress and coping, skill acquisition, and ethics. Her work has had wide influence on nursing both in the United States and internationally—for example, in providing the basis for new legislation and design for nursing practice and education for three states in Australia. She was recently elected an honorary fellow of the Royal College of Nursing. Her work has influence beyond nursing in the areas of clinical practice and clinical ethics.

    JoAnn Gragnani Boss, R.N., M.S.N., M.S., is Parish Nurse Coordinator at Community Memorial Hospital, Menomonee Falls, Wisconsin, a suburb northwest of Milwaukee. She serves in a dual role that includes clinical practice and the management of a volunteer parish nurse network. Her clinical practice is partially funded by the cooperating churches of Sussex. Prior to this position, she practiced parish nursing in inner-city Chicago. She has had several articles on parish nursing printed in Health and Development, which is produced by the Christian Community Health Fellowship, and is a member of Sigma Theta Tau and the National Association of Catholic Chaplains. She is also on the CCHF Board of Directors.

    Sandra Schmidt Bunkers, R.N., Ph.D., is Associate Professor and Chair of the Department of Nursing at Augustana College in Sioux Falls, South Dakota. She obtained her bachelor's in nursing from Augustana College, her master's in nursing from South Dakota State University, and a Ph.D. in nursing from Loyola University, Chicago. She has practiced in a variety of settings, including psychiatric-mental health, community health, long-term care, and nursing education. Her focus of research is on lived experiences of health, using Parse's theory of human becoming and research methodology to guide such research as “Considering Tomorrow” for women who are homeless; “The Lived Experience of Hope” for those working with persons who are homeless; and “The Lived Experience of Feeling Cared For.” She serves as a consultant to a variety of health care entities interested in developing nursing theory-based practice models.

    Lisa Burkhart, R.N., M.P.H., is currently employed by Advocate Health Care Parish Nursing Services. Since May 1996, she has coordinated educational efforts (funded by a Kellogg grant) to automate parish nursing documentation, using nursing-standardized coding systems (NANDA and NIC) that are both practically and theoretically sound. She earned her bachelor's in nursing at the University of North Carolina-Chapel Hill in 1985 and a master's in public health at the University of Illinois-Chicago. She is currently a doctoral student at Loyola University, Chicago, Niehoff School of Nursing, studying nursing information systems as they relate to nursing-standardized languages. Her past positions include Director of Nursing Education, Regulation, and Legislation at the American Hospital Association, where she developed nursing policy, staffed national committees, and published articles related to nursing. Before that, she was Program Administrator for the American Medical Association, where she coordinated efforts in long-term care and managed care policy and was a member of the CPT editorial staff, which developed the coding system used for physician reimbursement.

    Mary Chase-Ziolek, Ph.D., R.N., has been Coordinator of Geriatric Health Ministry at Northwestern Memorial Hospital in Chicago since 1991, working with churches and synagogues to develop health programs. She directs the Volunteer Congregational Health Program (VCHP), an interfaith, multiethnic network of 27 nurses volunteering in 21 churches that provides health promotion services. She is responsible for the training and ongoing support of the nurses who participate in the VCHP as well as for program development and evaluation. In addition to these responsibilities, she provides a weekly nurse drop-in center at a downtown parish. The VCHP began with a $231,000 grant from the Retirement Research Foundation in 1994 and is currently the recipient of a grant from the VNA Foundation.

    Margaret B. Clark, M.C.Sp., is Coordinator of Pastoral Care Services and Supervised Pastoral Education Programs at the University of Alberta Hospital, Edmonton, Alberta. She holds a baccalaureate degree in sociology, master's degrees in Christian spirituality and theology, and is currently enrolled in a doctor of ministry program. She is certified as a teaching supervisor in clinical pastoral education (CPE) with the Canadian Association for Pastoral Practice and Education (CAAPE). She ministered for 12 years in Roman Catholic parishes in Montana and California. For the past 14 years, she has been doing hospital ministry in Montana, Utah, and Alberta. She codeveloped and has cotaught both theoretical and clinical parish nursing courses offered at the University of Alberta and has been involved in professional presentations and publications related to that effort.

    Rev. Robert Cotton Fite, Ph.D., is an ordained pastor of the Episcopal Church, USA and a licensed psychologist. He is the director of the Pastoral Counseling Center at Lutheran General Hospital, Park Ridge, Illinois. He is also Adjunct Faculty at Garrett-Evangelical Theological Seminary in Evanston, Illinois, where he received his Ph.D. He serves on the parish nurse faculty at Lutheran General Hospital, part of Advocate Health Care. Together with Herbert Anderson, he published Becoming Married.

    Marsha Fowler, Ph.D., M.Div., M.S., R.N., F.A.A.N., is Professor, Haggard Graduate School of Theology and Graduate Program, School of Nursing, at Azusa Pacific University in Azusa, California, and the director of the university's Parish Nurse and Health Ministries Master's Degree Program. She is also Interim Pastor, Trinity Presbyterian Church, Pasadena, California. She lectures and consults nationally and internationally and writes in the fields of ethics, spirituality, and theology.

    Janet Griffin, R.N., M.S., is Director of the Parish Nurse Program at Trinity Regional Health System, Rock Island, Illinois. She is a graduate of St. Luke's Hospital School of Nursing, Davenport, Iowa; has a Master of Science degree in health education from Western Illinois University, Macomb; and has a certificate in health ministry from Iowa Lutheran Hospital, Des Moines. Her nursing practice includes clinical experience, teaching experience, and 4 years as a parish nurse for a large congregation in Davenport, Iowa. She was a coauthor of The Child in the Congregation: A Resource Guide for Parish Nurses (1995); the author of “Reminiscence: Enriching Life Through Memories,” an article in the January 1996 Home Health Focus newsletter; and has written a module on professional development for the endorsed curriculum the International Parish Nurse Resource Center developed for coordinators of parish nurse programs.

    Phyllis B. Heffron, R.N., M.S.N. is currently Research Associate at the University of Iowa College of Nursing, Iowa City. Her work is with the Family Involvement in Care research study, which involves the study of nursing home residents with a diagnosis of Alzheimer's disease and how family interventions and interaction with staff contribute to quality-of-life issues. She received a diploma in nursing from St. Luke's Hospital School of Nursing in Davenport, Iowa, her B.S.N. from the University of Maryland, Baltimore, and her M.S.N. from the Catholic University of America, Washington, DC. She has been a Faculty Facilitator with the R.N.-B.S.N. Program at the College of Nursing, University of Iowa, and is a member of the American Nurses' Association, the National League for Nursing, and the Gamma and Pi Chapters of Sigma Theta Tau International. She is a charter member of the Association of Nurses in AIDS Care.

    Rev. Lawrence E. Holst has been affiliated with Lutheran General Hospital (Park Ridge, Illinois) for its entire history. In June 1959 he began there as a chaplain-resident and was named Chairman of the Department of Pastoral Care in July 1960. He held this position for 31 years. In 1991, he began a new position with the Lutheran General Health System as Senior Staff Associate to the Office of Mission/Church Relations. In 1996, he retired. He received a B.A. from St. Olaf College, Northfield, Minnesota, followed by a B.Th. from Luther Theological Seminar, St. Paul, Minnesota and was later ordained into the Evangelical Lutheran Church. He has edited two books, Toward a Creative Chaplaincyand Hospital Ministry: The Role of the Chaplain Today and coauthored another, Ministry to Outpatients: A New Challenge in Pastoral Care. He has written numerous articles and is a lecturer in the fields of pastoral care and clinical ethics.

    Saralea Holstrom, R.N., has been a parish nurse at Our Saviour's Lutheran Church, Naperville, Illinois, of which she is a member, since May 1985. She graduated from Northwestern Memorial Hospital's School of Nursing and has had experience in medical-surgical and obstetric units in this hospital setting. Before she became a parish nurse, she was Medicare Charge Nurse and Assistant Director of Nursing at a convalescent-rehabilitation center in Naperville. As a parish nurse, she is a member of her church's pastoral care team, along with its four pastors and counselor, dedicated to providing whole person care of mind, body, and spirit to families of the congregation according to their needs. She and her husband Bruce have three grown children and have dealt with caregiving issues with their own aging parents.

    Reverend Leroy Joesten is Vice President, Religion and Health of Lutheran General Hospital, Park Ridge, Illinois, Advocate Health Care in the Chicago area. An ordained minister in the Lutheran Church (Missouri Synod) since 1967, he has served as an institutional chaplain for the last 25 years and as an educator in the Association for Clinical Pastoral Education since 1974. Prior to becoming a hospital chaplain, he served a Lutheran congregation in rural Iowa. He has administered a parish nurse program at Lutheran General and has also served as a faculty member to Lutheran General's program.

    Bethany Johnson, B.A., previously was with Parish Nursing Services, Advocate Health Care as office coordinator. In this position she managed the day-to-day functions of the Office of Parish Nursing Services. Historically, she had management responsibilities for Lutheran General Hospital's first W. K. Kellogg grant, “Parish Nursing Services Project.” She also had management responsibilities for a second W. K. Kellogg grant, “Partners in Health and Healing,” which had a major focus on the development and refinement of a documentation system for parish nursing. She has a B.A. in English from Augustana College, Rockford, Illinois. Currently, she is pursuing a master's degree in education at Loyola University in Chicago.

    Patricia Kellen, R.N., B.S.N., serves as parish nurse at St. Isaac Jogues Church, Niles, Illinois, part of Advocate Health Care's parish nurse program. She has held this position since February 1994. After receiving her baccalaureate degree from Marycrest College, Davenport, Iowa, she served three years active duty in the Nurse Corps, U.S. Navy Reserves, at the National Naval Medical Center, Bethesda, Maryland. She has held staff and management positions in psychiatric nursing at Lutheran General Hospital in Park Ridge, Illinois and continued in that specialty at Sheridan Road Hospital, Chicago before changing to addictions nursing with a move to Alexian Brothers Medical Center, Elk Grove Village, Illinois. She is a member of the Documentation Committee, whose charge has been to develop nursing diagnoses and interventions specific to parish nurse practice.

    Jean King, R.N., M.S., is the Faculty Facilitator for the University of Iowa College of Nursing R.N.-B.S.N. Satellite Program in Emmetsburg, Iowa. She received her diploma from Mercy Hospital School of Nursing in Des Moines, Iowa, her B.S. from Buena Vista College, Storm Lake, Iowa and her M.S. in nursing from South Dakota State University in Brookings. She has worked in medical-surgical and public health nursing and has served as a curriculum and evaluation consultant in parish nurse grant projects and in hospice program development. She is a member of the American Nurses' Association and the Phi Chapter of Sigma Theta Tau. She serves as Chairperson of the Advisory Committee for Hospice of Northwest Iowa and Vice-Chairperson for the Clay County Board of Health, Spencer, Iowa.

    Greg Kirschner, M.D., M.P.H., is a family physician who attended medical school at Duke University and took his residency training at Lutheran General Hospital in Park Ridge, Illinois. He went on to become Associate Director of the Family Practice Residency Program there and develop an association with the Lutheran General Hospital parish nurse program as a physician advisor, faculty member, and steering committee member. Since 1995, he and his physician-wife, Carolyn, have served as medical missionaries in northern Nigeria.

    Robert Lloyd, Ph.D., in his current role as Director of System Quality for Advocate Health Care in Oak Brook, Illinois, is responsible for the development of systemwide quality indicators, measurement of the voice of the customer, and CQI education. He also serves as liaison to external organizations interested in quality data and its use. Before joining Advocate, he served as Director of Quality Measurement for Lutheran General Hospital and directed the American Hospital Association's national demonstration project on quality, the Quality Measurement and Management Project. He is a frequent speaker at national conferences and seminars and has published numerous articles, reports, and books on a wide range of topics.

    Patti Ludwig-Beymer, Ph.D., R.N., is currently employed as a clinical quality specialist at Advocate Health Care in Oakbrook, Illinois. As such, she serves as the project manager for systemwide clinical improvement projects on asthma, diabetes mellitus, and cardiac services. A nurse for over 20 years, she received her diploma in nursing from Mercy Hospital School of Nursing in Pittsburgh, her B.A.N. and M.S.Ed. from Duquesne University in Pittsburgh, and her doctorate in nursing from the University of Utah. She has practiced in a variety of settings, including acute care, community-based programs, and nursing education. She also conducts health services research and has published over 25 articles and book chapters on nursing and health care topics, including transcultural nursing, parish nursing, pathophysiology, cost accounting in nursing, advanced practice nursing, medication errors, patient satisfaction, and clinical quality improvement.

    Rosemarie Matheus, R.N., M.S.N., received her Master of Science degree in nursing from Marquette University in Milwaukee, Wisconsin as well as a certificate in theology from that university. She currently holds several positions: faculty on the staff of Marquette College of Nursing and coordinator of placement and supervision for parish nurses in Milwaukee Churches at Sinai Samaritan Medical Center and St. Luke's Medical Center. She has directed the Parish Nurse Preparation Institute, Phases I and II, and has consulted, published, and spoken extensively on a variety of aspects of parish nursing.

    Wendy Tuzik Micek, D.N.Sc., R.N., received her bachelor's, master's, and doctorate degrees in nursing science from Rush University College of Nursing, Illinois. She has practiced in a variety of settings, including acute care, the operating room, ambulatory surgery, and health services research. She is a member of the Midwest Nursing Research Society, Sigma Theta Tau International, Sigma Xi, the American Academy of Ambulatory Care Nursing, Ambulatory Management Network-Metropolitan Chicago Health Care Council, Association of Managed Care Nurses, and Association for Health Services Research. She has twice served as president of the Gamma Phi Chapter of Sigma Theta Tau International and has authored and coauthored publications for journals and book chapters; she also reviews abstracts for the annual Midwest Nursing Research Society conferences. She has presented at many professional seminars and conferences on such topics as patient satisfaction, quality of life, patient-centered care, patient care outcomes, professional nursing documentation languages, project management, and various clinical process improvement projects. Currently she is employed as a Clinical Quality Specialist by Advocate Health Care, where she develops, implements, evaluates, and manages systemwide clinical improvement projects on topics such as total joint replacements, anticoagulation, and mother and baby services. In addition, she provides continuous quality improvement education and supports quality management and care management within Advocate. Before joining Advocate, she was a nurse researcher for Rush Presbyterian St. Luke's Medical Center, where she served as a coordinator for the Picker Commonwealth study on patient-centered care and various other special projects.

    Rev. Gerald Nelson, M.Div., has been the Senior Pastor of Our Saviour's Lutheran Church in Naperville, Illinois, for the past 23 years. He is a Concordia College and Lutheran School of Theology graduate and has served congregations in Waterbury, Connecticut, and St. Claire Shore, Michigan. He leads seminars around the country on the theme “Making It Work in the Parish.” Under his leadership, the congregation of Our Saviour's has grown to over 4,000 members and has added a Parish Nurse staff position and a Parish Counselor to its pastoral care team. Other ministry developments include a new mission led by his son, Michael, which is growing rapidly and has started a successful preschool. In addition, under Rev. Nelson, Our Saviour's has purchased a second facility where an Early Childhood Center (called “Celebration”) is serving over 200 families and where additional worship services will be added.

    Joanne K. Olson, R.N., Ph.D., holds a Ph.D. in nursing with a focus on nurse-client interaction. She has a master's degree in public health and a baccalaureate degree in nursing and has held positions as a clinician, supervisor, and educator in Minnesota, Missouri, Ontario, and Alberta. She has been a faculty member at Maryville University, St. Louis, Missouri, the University of Western Ontario, London, Ontario, and is presently Associate Professor on the Faculty of Nursing at the Univiersity of Alberta. Her teaching, research, and writing interests are in the areas of community and family health, nursing education, nurse-client interaction, and parish nursing. She has numerous professional publications, frequently presents her work at professional conferences, and serves on the Board of Directors of Sigma Theta Tau International Nursing Honor Society. She has codeveloped and cotaught both theoretical and clinical parish nursing courses offered at the University of Alberta.

    H. Scott Sarran, M.D., M.M., at the time of this writing, was Vice President for Clinical Quality Improvement for Advocate Health Care, Oakbrook, Illinois, an integrated delivery system serving the entire Chicago area. In this capacity, he is responsible for clinical process improvement and care management initiatives, including practice guidelines, utilization management, and case management; medical leadership for Advocate Health Partners, the umbrella organization for Advocate's eight PHOs, with approximately 140,000 covered lives including Medicare and Medicaid full-risk capitation; system quality, including support of continuous quality improvement, patient satisfaction, clinical indicators, and infection control; and clinical information systems. He has been Medical Director for a 50,000-member PHO and Chairman and Residency Program Director for Family Practice at Lutheran General Hospital and continues to practice Family Medicine. He is Board-Certified in Family Practice with Certificates of added Qualifications in Geriatrics and Sports Medicine. He receive his master's in management from the J. L. Kellogg Graduate School of Management at Northwestern University and his M.D. from Northwestern University Medical School.

    Marcia Schnorr, R.N., Ed.D., has been active in the practice, promotion, and education of parish nursing for many years. She is the parish nurse at St. Paul Lutheran Church in Rochelle, Illinois; National Parish Nurse Coordinator for the Lutheran Church Missouri Synod; Adjunct Professor in Parish Nursing for Concordia University, Wisconsin; and on the nursing faculty at Kishwaukee College in Malta, Illinois. She has a diploma in nursing from the Swedish-American Hospital School of Nursing in Rockford, Illinois, a B.S. and M.S. (with majors in nursing), and an Ed.D. (adult education) from Northern Illinois University. She has presented at numerous regional, national, and international parish nurse conferences and has been a regular contributor to newsletters, journals, and other publications. She has completed the requirements to become certified by the Lutheran Church Missouri Synod as a lay church worker and has a Solemn Appointment to St. Paul Lutheran Church in Rochelle, Illinois.

    Jane A. Simington, R.N., Ph.D., holds a Ph.D. in health sciences with a focus in mental health and program planning. She has a master's degree in nursing with a clinical specialization in gerontology and a baccalaureate degree in both nursing and psychology. She has held positions as a clinician, supervisor, counselor, researcher, and educator. She has been a faculty member at the college and university level, including Hawaii Pacific University, and is presently a sessional lecturer on the Faculty of Nursing at the University of Alberta. Her teaching, research and writing interests are in the areas of gerontology, mental health, and complementary methods of healing and spiritual well-being. She has numerous professional publications and frequently presents her work at seminars, workshops, and conferences. She has an independent practice that focuses on life transition management and has codeveloped and cotaught both theoretical and clinical parish nursing courses at the University of Alberta.

    Antonia Margaretha Van Loon, R.N. DipAppsScCHN, B.N., M.N., Ph.D.(cand.), is a doctoral candidate at Flinders University of South Australia. Her research project involves designing and developing conceptual models of faith community nursing within the Australian context. She is the founder and chairperson of the Australian Faith Community Nurses Association, which provides nurses working in Australian faith communities with support, basic educational preparation, networks, continuing education, resources, and consultancy for this new role. She holds a degree in nursing, postgraduate qualifications in community health nursing, and a master's by research degree from Flinders University. Her research focus is on spiritual care and primary health care in nursing practice. She continues to practice as a registered nurse at Flinders Medical Centre, where her clinical focus is on emergency nursing. She was a Lecturer in Nursing at the University of South Australia from 1988 to 1997 when she began full-time doctoral studies to introduce faith community nursing to Australia.

    Rev. Granger Westberg, author of the best-seller Good Grief and many other articles and texts, is best known for his work with the Wholistic Health Centers and his work in conceptualizing, developing, and telling the story of parish nursing. He has been a parish pastor; hospital chaplain at Augustana Hospital in Chicago; Professor at the University of Chicago; the first Dean of the Institute of Religion at Texas Medical Center in Houston; Professor of Practical Theology at Wittenberg University in Springfield, Ohio; consultant; and well-known public speaker and writer, advocating the church's role in preventive medicine since the early 1940s. He is now retired and remains in a consultative capacity to the International Parish Nurse Resource Center, Advocate Health Care.

    Rev. L. James Wylie assumed his present responsibility as Senior Vice President, Religion and Health, Advocate Health Care in 1995. He has been associated with Lutheran General Hospital from its opening on Christmas Eve, 1959, to the present. From 1963 to 1967 he served at Lutheran Medical Center in Brooklyn, New York, which was then an affiliate of the HealthSystem. In the late 1960s, his involvement with the Corporate Board and management in the areas of health strategy and global health interests resulted in the development of the early strains of what is called today Congregational Health Partners. During the 1970s, he served as Vice President of Human Resources; in the early 1980s, he was involved in the formation of what is now the Park Ridge Center, a HealthSystem affiliate which has gained national renown as the Center for Health, Faith and Ethics. In addition, he has maintained corporate responsibility for parish nursing since its inception. This includes supporting the ongoing development of the International Parish Nurse Resource Center.


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