|Parish Nursing - Yvonne Whitfield
Yvonne Whitfield is the Health Ministry Coordinator through the Community Benefits department of Southern Illinois Healthcare, a not-for-profit regional healthcare system in southern Illinois. She has also served as a parish nurse for the past three years at the First Presbyterian Church in Marion, Illinois.
Ms. Whitfield pioneered parish nursing in Southern Illinois. The First Presbyterian Church in Marion was the first congregational based health ministry with a prepared parish nurse in Southern Illinois. Working with the initial task force, Ms. Whitfield helped design and introduce the concept of health ministry/parish nursing to Southern Illinois Healthcare (SIH). Through its health ministry program, SIH has helped twelve churches in six counties establish health ministries with parish nurses. Other churches are at different stages of developing a health ministry. A parish nurse preparation course with curriculum endorsed by the International Parish Nurse Resource Center is now offered by SIH to nurses in Southern Illinois. In the past year twenty-five nurses have completed this course. The Southern Illinois Parish Nurse Network, a professional group for parish nurses, clergy, health ministers and others interested in health ministry, meets bi-monthly. The Health Ministry Update a quarterly publication has been established to share ideas and information about parish nursing/health ministry on a regional and national level.
Ms. Whitfield graduated from the Millard Fillmore School of Nursing at Buffalo New York, affiliating the first year at the University of Buffalo. She worked twenty years on med./surg., same day surgery, surgery, and recovery room at St. Joseph Memorial Hospital in Murphysboro, Illinois.
Yvonne values the importance of education to empower patients of all ages to participate in their healthcare decisions. She and another staff nurse developed an innovative approach to prepare children physically and emotionally for ear, nose and throat surgery. On the day of surgery it was not unusual to see children shooting baskets with a nerf ball or a mini game of soccer going on with the toddlers while others watched Disney videos as they waited for their surgery. The children went to surgery in a little red wagon or on a cart with minimal stress.
Ms. Whitfield attended A Parish Nurse Preparation Institute (Wisconsin Model) offered by Marquette University through St. Louis University under the direction of Rosemarie Matheus. Ms. Matheus is one of the foremost leaders in parish nursing today. She consults and mentors at the state, national and international level. Ms. Whitfield completed a Basic Preparation for Parish Nurse Coordinators conducted at the International Parish Nurse Research Center, the primary resource for parish nursing in the world today. She also completed the Spirituality and Healing in Medicine course offered by Harvard Medical School and the Mind/Body Medical Institute under the direction of Dr. Herbert Benson.
SIH/Community Benefits Department
PO BOX 3988
Carbondale, IL 62902-3988
(618) 457-5200 Ext 67830
Question 1 - Good Morning Yvonne, It sounds like parish nursing is truly a "wholistic" form of care. So often healthcare professionals neglect the spiritual aspect of health. And, in general, are not comfortable addressing spiritual issues with our patients.
From your brief description it appears parish nurses are largely supported by the churches. Are these paid positions or volunteer? What can small churches do to have parish nursing programs if they can't afford to pay someone full time or even part time? Also, who oversee's or supervises the parish nurse? Since there are no invasive procedures I assume physician direction is not required. Who are they accountable to? by yvette on June 5, 2000
Answer 1 - Parish nursing can be a paid or non-paid position. Whether paid or not, all parish nurses are held to the same high standards.
The terms congregation, faith community, church and parish are all used interchangeably. The organizational framework for the administration of a parish nurse program has four basic models although there are many variations from these basic models. They are:
- The Institutionally Based Paid Model - There are many distinguishing features to each model. For the sake of brevity, I will touch on the main differences. Advertising, interviewing, and selection of the parish nurse is done in partnership with the institution and the congregation. Compensation arrangements may vary. Typically the first year the institution will pay the insurance, benefits and 75% of the salary while the congregation pays 25%. Second year the institution pays insurance, benefits, and 50% of the salary, congregation pays 50%. Third year the institution pays insurance, benefits, and 25% salary. Fourth year and thereafter the institution pays insurance, benefits, and congregation pays 100% of salary. Basic preparation in parish nursing is facilitated for the parish nurse. Physician resources and consultation are available through the institution.
- The Institutionally Based Non-Paid Model - Assistance in selection of the parish nurse may be provided by the institution. A "Coordinator of Parish Nursing" or "Health Ministry Coordinator" usually is salaried by the institution to support the parish nurses providing services to the congregation. Basic preparation in parish nursing may be facilitated for the parish nurse. Physician resources and consultation may be available through the institution.
- The Congregationally Based Model - The congregation supports the development of this ministry on its own without the assistance of an institution. Advertising, interviewing,and selection is done by a task force or health and wellness committee of the church and pastor. The parish nurse is paid for services rendered to the congregation by the congregation. Basic preparation in parish nursing is financially compensated fully or in part by the congregation. Physician resources and consultation are sought through the congregation or the external community.
- The Congregationally Based Non-Paid Model - The congregation supports the development of this ministry on its own without the assistance of an institution. Advertising, selection and interviewing is done by a task force or health and wellness committee of the church and the pastor. The parish nurse is not paid for services rendered to the congregation. Physician resources and consultation are sought through the congregation or the external community.
Small churches that cannot afford to pay a parish nurse have several options. If a qualified RN in that church feels called to the ministry of parish nursing and wants to volunteer as an act of stewardship, a parish nurse ministry can be established using the congregationally based non-paid model or the institutionally based non-paid model. Another option is to join together with one or more small churches. Jointly they may be able to pay a parish nurse in the congregational or institutional based paid model or they may share a parish nurse in the non-paid models. Another option is to seek the services of a parish nurse as a mission outreach from a larger church. That would usually be a church with a paid model of parish nursing. Another option would be to apply for a grant. A caution would be to make sure there is a plan for continued funding if it is a paid model. Most grants will cover start up funds but the congregation must be able to sustain the program.
The parish nurse (according to all four models) is a part of the faith community under the direction of the pastor, priest, or rabbi. Parish nursing is an independent practice governed by the Standards of Clinical Nursing Practice (ANA, 1991), the Scope and Standards of Parish Nursing Practice (ANA, 1998) and the individual state's Nurse Practice Act.
Parish nurses are accountable, themselves, their employers as defined in their particular situation, which may or may not include the sponsoring institution, the director of pastoral care, and the director of nursing. They are always accountable to the congregation, the pastor, priest or rabbi and the health cabinet or committee. And, ultimately to God.
Thank you for your interest in parish nursing. I hope this has been helpful. Yvonne by Yvonne Whitfield on June 5, 2000
Question 2 - Very impressive accomplishments in this field. Does parish nursing work with any other segments of healthcare, such as nursing homes, hospitals, home health and/or hospice? If so what is the role? Seems this could be a nice fit to provide spiritual expertise especially with hospice. by tammy on June 5, 2000
Answer 2 - Tammy, Thank you for your question. There is a place for parish nursing in all areas of healthcare. Parish nurses visit their parishioners in the hospital. The parish nurse is a link for that patient with their faith community communicating the love and care of the people in the congregation. Parish nurses pray with their patients and reminding them that God is present with them. It is not unusual for the hospital staff to join in prayer. With permission of the patient, the parish nurse may talk with the doctor or nurse about any concerns or questions the patient had but was uncomfortable asking. When appropriate and again with the permission of the patient,the parish nurse may also be able to give the hospital nurse additional information about the patient that would aid in their care. Discharge planning is definitely an area for the parish nurse to be involved. In our hospital system, the case managers have a list of the churches with a health ministry, their parish nurse's names and phone numbers.
Just recently working as a parish nurse in my church, I was able to assist in facilitating arrangments for a homehealth nurse. I worked closely with the out of state discharge planner until connections were made with a local home health group. Parish nurses work especially closely with home health providers when the person's condition changes and home health is no longer appropriate. Sometimes that change is restored health and other times the parishioner comes under the care of hospice. Sometimes it is the parish nurse that initiates conversation about movement toward hospice.
At that sacred moment in a person's life when they are nearing death it certainly is appropriate for all disiplines to work together closely. The pastor, the hospice nurse and the parish nurse all bring their own gifts of caring to the parishioner and their family.
At the nursing home the parish nurse is the link between the patient and their church family. It is a reminder that God is present with them and their faith community cares about them. When there is no other family for the parishioner, or when family is distant, the parish nurse becomes the parishioner's voice when they can no longer advocate for themselves. Many nursing homes hire parish nurses to work as part of the staff in the nursing home and in outreach to the community. by Yvonne Whitfield on June 6, 2000
Question 3 - Hi, Could you tell us the difference between "faith healing" as is typified in the ministries of Oral Roberts and other TV Evangelists and "health ministry"? by danno on June 6, 2000
Answer 3 - Health Ministry emphasizes health and wellness of mind, body and soul. It recognizes the power of the Divine in healing and seeks to combine it with scientific knowledge and medical understanding to achieve wholeness and balance in one's health. The congregation is the natural community in which the spiritual, medical and psychosocial resources can be integrated and applied to a person's healing and well-being. It is in the context of the faith community that a parish nurse can pray with a parishioner, check their blood pressure and arrange for a health minister to visit. Many of the parish nurses have advanced degrees and have been practicing from 10 to 30+ years. Bringing this knowledge and experience from the medical world together with their faith, love and caring, parish nurses work collaboratively with the doctor and minister effecting truly wholistic care for the best possible outcome. A parish nurse knows that prayer, scripture and the sacraments may be just as important as deep breathing.
Parish nurses understand that there may not always be able to be a cure but there can be healing. by Yvonne Whitfield on June 9, 2000
Question 4 - This sounds like a wonderful program. However, to be truly effective you need to work with physicians as an advocate for the patient and to help coordinate care in areas where the system lets them fall through the cracks. How have the physicians responded to the parish nursing program? Are they open to the services you offer? and do they view the parish nurse as a legitimate role in the care of patients? by Terin on June 6, 2000
Answer 4 - Hello Terin, Yours is a very timely question as I will leave the office in two hours to address the quarterly medical staff meeting about parish nursing. Education about the role of the parish nurse is very important and sometimes not truly understood by the physicians until an intervention has taken place. Our program is only years old but growing rapidly. The physicians that I have personally interacted with as a parish nurse have welcomed my interest in their patients. Two years ago at the Westberg Symposium for Parish Nursing I gathered with over 900 parish nurses, clergy and health ministers and I asked many that had worked as parish nurses for five years or more how the physicians viewed the role of the parish nurse. Without exception they all answered that the response was very positive. In fact one nurse told me of a call she recently received from a physician asking her to follow his patient.
In the book Parish Nursing by Phyllis Ann Solari-Twadell and Mary Ann McDermott, Dr. Greg Kirschner who served as Associate Director of the Family Practice Residency Program of Lutheran General hospital, Chicago stated that his involvement in the parish nurse program has, to date, been personally and professionally rewarding. He went on to say that he had witnessed the tangible benefits the program has had in his own community, with his own patients. He urges physicians to not only recognise the value of the parish nurse but to become active in some capacity in a health ministry program if there is one at their place of worship.
Through education and by supporting them, Parish nurses empower parishioners to be their own best healthcare advocate.
Thank you for your interest in parish nursing. Yvonne
by Yvonne Whitfield on June 6, 2000
Question 5 - Good morning Yvonne! It seems to me that Parish Nurses could help in situations where a sick or elderly person needs just a little bit of care to remain in the home, but does not require constant in home care. In addition to the spiritual guidance that you provide, I was wondering to what extent do Parish Nurses provide actual "medical" care within the home? by Artemis on June 6, 2000
Answer 5 - Hello Sidney, There are many services available to help the elderly person remain in their home. The parish nurse visits the home as needed. In the process of the visit. the nurse is assessing the parishioner and her home for changes that would indicate how they are managing at home. A mini physical assessment including listening to heart, lungs, blood pressure, and checking for swelling in the extremities can be done when indicated. The parish nurse counsels with the person to make sure they are taking their medications properly and that they have an adequate supply. The parish nurse also helps the person be aware of community services such as meals on wheels, senior transportation, senior citizen center, housekeeping assistance, and exercise programs for seniors and helps them connect with services they need. Many of the elderly manage well on their own but need some help when they are sick (colds or flu). Volunteers within the health ministry have received special training to go into the home and help on a temporary basis with meals, transportation to the physician's office, and bringing in groceries. This along with regular contact with the parish nurse is often enough to prevent a hospitalization. The health ministry also has volunteers to call the homebound each day to let them know they are cared about and to see if they have any needs.
Thank you for your question. Yvonne by Yvonne Whitfield on June 7, 2000
Question 6 - Hello Yvonne. I am also very impressed with your accomplishments. In addition to the many services listed above, what types of wellness programs are typically sponsored by the parrish nurse program? by Denise on June 7, 2000
Answer 6 - Each health ministry/parish nurse ministry is designed according to the needs and gifts of people in the congregation. That is what determines the programs that are offered. Here are examples of some wellness programs.
Exercise Stress management Nutrition
Safety Smoking cessation CPR/First Aid
Stroke Aging Process Heart disease
Diabetes Lung Disease High Blood Pressure
Sickle Cell AIDS Cancer
Depression Drug/Alcohol problems Pain control
Divorce Anger/Violence Self-Esteem
Laughter End of Life Issues Pregnancy
Parenting Mid-Life Crisis Relationships
Single Parent Abusive relationships Living with Teenagers
Back Health Massage Therapy
Thank you for your question, Yvonne by Yvonne Whitfield on June 7, 2000
Question 7 - Hi Yvonne, As you've noted above, hospice teams recognize spirituality to be an important aspect of a person's care as they confront death. I've learned though that there can be very mixed motives for people wanting to play a role in the spiritual life of another person, hence have learned to rigorously screen volunteers and staff to prevent unsolicited evangelizing and/or taking advantage of emotionally vulnerable persons. HAve you had to deal with such issues in parish nursing? Who usually screens the hire of a professional called upon for balancing clinical and pastoral judgment?
Thanks for all you're doing....True Ryndes by TRyndes on June 7, 2000
Answer 7 - Hello True, Thank you for your very thought provoking question. In the parish nurse preparation course it is stressed that our role as parish nurses is not to evangelize but to try and meet people where they are on their spiritual journey. In this area all of the parish nurses except one are working in a non-paid model in their own church under the direction of their pastor or priest. The nurses are well known to the pastor and the parishioners and to date this hasn't been a problem although it certainly could be. I asked a colleague of mine that has worked for several years with the institutionally based paid model of parish nursing where the nurse is not known to the congregation and frequently is of a different faith. She said that she screens very carefully and she asks the churches to ask the same questions. If any red flags come up she makes the churches aware of her concerns. She has had only one instance of a problem with evangelism and it was remedied with counseling.
Thank you also, True, for the excellent discussion on End of Life issues that you recently co-hosted here on Healthbond. I really learned alot. I am happy to say that people receive outstanding care from the two Hospice groups in our area. Yvonne by Yvonne Whitfield on June 8, 2000
Question 8 - Have not heard of Parish Nursing. Intriguing concept. How do you see parish nursing playing a role in casemanagement? Seems like with consumers and employers constantly changing insurance companies, casemanagement within the insurance company is not able to properly serve the consumer - very fragmented. I would imagine very few consumers change churches, so was curious to your thoughts on this. Thanks by Luke on June 9, 2000
Answer 8 - Luke, Thank you for your very perceptive question.
Parish nurses do at times play the role of a case manager at church. They are the thread of continuity that will hold things together when parishioners are changing insurance companies or physicians or making other healthcare choices. With the permission of the parishioner, the parish nurse can interact on behalf of the parishioner with the hospital, nursing home, physician, insurance company and the minister. In our area, all the hospital, nursing home and community case managers have a list of the churches with parish nurses. With permission of the patient, the case managers will notify the parish nurse of the patient's discharge and plan of care.
Because parish nurses worship on a regular basis at the faith community they serve, they are well acquainted with many of the parishioners and their health problems. Sometimes they are able to see suttle changes in their health status before the parishioner is aware of it. Because of this they can encourage the parishioner to make an appointment with their physician and perhaps avoid a future trip to the emergency room.
The possibilities for parish nursing are endless. Thank you for your interest. Yvonne by Yvonne Whitfield on June 9, 2000
Question 9 - Yvonne, It's very exciting to hear about the good work that parish nurses do, and so needed in today's society. My questions are: do you have to have any special state licensure or certification such as a home health agency has, and are you obtaining physician orders to provide care for the people you see, specifically for medications and wound care? MAS by mstep on June 9, 2000
Answer 9 - Hello Marsha, Parish nurses are required to have a current license in the state they are practicing and practice under the nurse practice act for that state as well as the Standards of Practice for Parish nursing. Parish nursing was recognized as a speciality by the American Nurses Association in 1997 and Standards of Practice were approved in 1998. There is a preparation course for parish nurses with curriculum endorsed by the International Parish Nurse Resource Center, but at this time there is no certification for parish nursing.
Parish nursing is an independent practice and the nature of the practice is non-invasive, therefore physician's orders are not required. We do not dispense medications, do wound care, or any other invasive procedure. We do teach our parishioners how to care for themselves and also teach family members to assist when indicated. The role of the parish nurse is as an educator, health counselor, resource person, health advocate,and integrator of faith and health.
Thank you for you interest in parish nursing. yvonne by Yvonne Whitfield on June 9, 2000