Parish nursing and Jesus’ call to servanthood and practical care
“The church has a long history in health care…. nursing has always been the heart and centre of church-based health care. The characteristics of nurture, care, servanthood, and a holistic understanding of humans are central to nursing care.”—J.A. Shelley
Nancy, age 45, was feeling fine one morning, yet on a visit to the bathroom saw bright red blood in the toilet bowl. What could that mean? “I must go to the doctor this week,” she said to herself.
A week later at coffee, Nancy and her friend Mary were discussing Mary’s new job as a parish nurse in their church. They were talking about how Mary could work with the congregation, especially people with private or embarrassing health issues like “change of life” or cancer. Nancy mentioned that she had bleeding about a week ago, but after the doctor’s office quoted a three-week wait for an appointment, she decided not to bother.
Mary was startled as she questioned Nancy further about this bleeding, insisting Nancy see a doctor. Aware of how difficult it can be to get an appointment, Mary used her knowledge of the system and of Nancy’s health issue to get an appointment the next day.
Tests revealed Nancy had a fast growing kidney tumour. Within the week, the tumour was removed. Without the “third ear” of her parish nurse, Nancy would have dismissed the one warning sign she had. Mary’s advocacy, health teaching, and emotional and prayer support helped Nancy and her family through this difficult time.
Nurture, care, and servanthood are central not only to nursing care, but also to Jesus’ teaching in Matthew 20:26–28: “Whoever wants to become great among you must be your servant” for “the Son of Man did not come to be served, but to serve.” In addition, Jesus addressed the whole person when he said, “For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink…I was sick and you looked after me” (Matthew 25:35–36).
What form might holistic servant care take today?
Although each member of the body of Christ is called to respond to the needs around them, not all are equipped in the same way. Parish nursing – also called congregational health ministry – is one way congregations can use particular skills in responding to health-related needs and to fill the gaps in care offered by social and health service agencies and institutions in today’s complex world.
Parish nursing was conceived by Lutheran pastor Granger Westberg when he saw the following Christ-like qualities in the nurses he worked with in his hospital chaplaincy. “Nurses have a very special gift that no one else has.”¹
1) The ability to see beyond the patients’ problems and verbal statements into the deeper roots of the heart. He found nurses to be the best listeners.
2) Nurses seemed to have one foot in the sciences and one in the humanities, one foot planted in the spiritual world and one in the physical. Nurses have a holistic view of humans.
3) Nurses have a spiritual desire to help people and do not view the hospital as a warehouse for sick bodies. Nurses also seemed to be frustrated by the financial and structural problems that prevented them from giving the kind of care they would like to give and that they felt their patients needed.
Out of these observations grew Westberg’s vision for nurses to work in the congregational community along with the pastoral team and deacons or caregiver team.
What kind of preparation does this nurse need and how does he or she work in the congregation?
Generally, he or she is a registered nurse with special knowledge of how to bring together the elements of spiritual, physical, and emotional health when people are sick and in crisis or wanting more information about how to stay healthy. This special knowledge involves a view of the whole person – not just a body part such as the eyes, or a body system such as the digestive tract.
In addition, the parish nurse cares for people from an understanding that they are made in the image of God and that the spiritual element interacts with the physical and emotional, influencing both health and illness. For this reason, the nurse uses spiritual interventions such as prayer, meditation, spiritual or biblical readings, and songs along with communication skills, emotional supports, and physical or drug treatments. The environment or church community is also part of the nurse’s assessment and treatment plan along with the family and support groups within the church and community.
A love for the congregation, demonstrated in listening skills, and sound nursing knowledge are essential in beginning to work with and gain the trust of the congregation. Good problem-solving skills will allow the nurse to access community resources and organize training sessions for volunteers who can visit new parents who may have questions but need support and comfort, lonely and isolated elderly who also have physical problems, or those who are grieving with family far away.
A deep and growing spiritual understanding and connection with God that flows over into ministry is essential to the ministry of parish nursing. The nurse also needs to be able to develop, organize, and deliver educational sessions on topics such as understanding diseases, staying healthy, parenting, and defining spiritual health. For example, he or she is able to listen and provide guidance to adolescents about the use of recreational drugs or the place of healthy sexual behaviour in God’s plan for creation.
Where does a parish nurse fit?
A parish nurse works with spiritual professionals – chaplains and the pastoral team. Chaplains, who work mainly in hospitals, are educated to provide spiritual care and comfort without in-depth knowledge of the physical and emotional health and illness needs of people. Parish nurses can refer or consult with chaplains on specific concerns of congregational members entering care facilities or being discharged back into the community.
Working with the pastoral team and congregation, the nurse assesses the health needs of the congregation. This may include providing care, advocacy, and hospital, house, or nursing home visits to congregation members and families with specific health problems of a social, spiritual, physical, and emotional nature. The support of the pastor and caregivers in the congregation is critical to the nurse’s work.
In today’s fragmented and over-stressed health care system, it is easy for the sick or elderly to “fall through the cracks” or not know where to turn first in an emergency or urgent situation. Often, the elderly need additional explanations of their medications or assistance in talking to the doctor in an office visit. The parish nurse does not replace the physician, but may help people navigate the health system, identify care priorities, and provide spiritual comfort in times of anxiety.
Making parish nursing a part of the pastoral team first involves the congregation acknowledging the role of healing (physical, emotional, and spiritual) in Jesus’ ministry and feeling a responsibility to do likewise. In addition, there must be recognition that nurses have that special knowledge of how to give holistic care, thus fulfilling Jesus’ mission on earth.
How does a church get a parish nurse?
As with any new concept, a written proposal from the church leadership could be a way to start a congregation on the process of finding a parish nurse.
The proposal should include: 1) a description of parish nursing that is an expression of the church mission and vision statement, 2) the rationale for having a parish nurse in that particular congregation, and 3) a specific, concrete proposal that identifies how the church will provide for the position on their team. The proposal should describe the parish nurse’s relationship with the pastoral team, caregiver team, and a parish nurse committee that includes representatives of all demographic groups in the congregation.
The focus of the parish nurse’s role should also be clearly identified. Does the congregation want to focus mainly on church members, or include an outreach element, for example, a nearby seniors’ residence? Will several churches – in the same area but of different denominations – employ one parish nurse who will divide time among the congregations? Or, will one denomination hire a parish nurse from their central office with the understanding that the nurse will work mainly in the denomination’s outreach in the inner city?
The parish nurse committee role is to bring the priorities of the congregation (or target group) to the attention of the parish nurse and help the nurse develop and evaluate these plans. Logistical questions such as space in the church for private conversations, locked space for private records, nurse registration fees, malpractice insurance, and an honorarium or salary need to be considered. In addition, monies need to be provided if the nurse needs to take a parish course or wants to attend annual conferences which will refresh the nurse and make the work more effective. The proposal should identify how the time and hours of work will be assigned as well as other benefits which provide structure to the ministry.
Parish nursing focuses on the integration of health (spiritual, physical, emotional, and social) in a holistic way for the individual, family, and the congregation (or target group).
The nurse is intimately connected to the congregation and its vision for ministry, possibly also extending as outreach into the surrounding community. A deep understanding of Jesus’ ministry of service in healing and health is required. The way the nurse goes about that work will change with the culture and the needs of the congregation. However the church’s mission has always been to bring shalom to those in need around it.
Married for 40 years, Elizabeth and Paul were in their early seventies. Both had been active in careers, church ministry, and raising a family. Recently, Elizabeth was distressed by Paul’s lack of energy and general absent-mindedness. Elizabeth’s friend encouraged her to speak to the parish nurse about her concerns. Maybe the nurse would know how to confront Paul.
On her visit with Paul, the nurse realized he was possibly suffering an early Alzheimer’s or similar memory condition. Depression – a commonly co-occurring condition – might also be a factor. She shared her findings with Elizabeth and Paul, and suggested they see their family physician. After helping them make an appointment with the doctor, the nurse asked the couple if she could read Scripture and pray with them. Elizabeth and Paul repeated Psalm 23 together – their psalm of comfort in difficult and uncertain situations in the past.
After the prayer, the couple said how much this had meant to them. Although the future was still uncertain, they had a plan and felt reassured they could work at the problem together. They also felt God cared about them and would be with them. God’s presence and peace was there too.
–Nurses Christian Fellowship
–Health Ministries Network
–Church Health Reader
–InterChurch Health Ministries Canada
Concordia University College of Alberta, Edmonton
University of Alberta Faculty of Nursing, Edmonton
Lutheran Theological Seminary, Saskatoon
University of Winnipeg Faculty of Theology, Winnipeg
Emmanuel College, Victoria University, University of Toronto
Waterloo Lutheran Seminary, Wilfred Laurier University,
St. Peter’s Institute for Catholic Formation, at St. Peter’s Seminary, London, Ont.