The doctor had just given her husband the diagnosis, and the return appointment was scheduled for a month later. She had so many questions, she didn't know where to start — she hadn't even formulated them in her mind until she was in the car driving him home. Would she be able to care for her husband alone? Would they have to give up their home? Would their social security and retirement cover their expenses? Concerns about the treatment, fears about the future, questions about "what will we do?" all churned inside as she passed by the church. Who could they talk to? Who would understand the confusion they both felt and help them find some answers? She pulled into the parking lot; they entered the church and knocked at the door of the parish nurse.

Faith Community Nursing, commonly known as parish nursing, is a unique and growing movement within communities of faith of all traditions. For centuries, churches have been involved in the delivery of healthcare; however, more recent history has identified a movement toward separation of faith as the work of the church and healing as the work of healthcare institutions. The concept of parish nursing is a way to reverse that trend and allow churches to rediscover their mission to "preach, teach, and heal."

Churches are the focus of communities and neighborhoods and touch the lives of large numbers of people. What better place to influence people to become more effective partners in the management of their personal health? What better place to offer support and counsel to the concerns of the aging congregation? Nursing has always understood the relationship between body, mind, and spirit in whole person health. Who better to work with congregations and communities to establish a health ministry than the parish nurse?

"Faith community nursing is the specialized practice of professional nursing that focuses on the intentional care of the spirit as part of the process of promoting wholistic health and preventing or minimizing illness in a faith community" (Faith Community Nursing: Scope and Standards of Practice, Health Ministries Association, American Nurses Association, June, 2005, page 1). Comprehensive health/wellness requires the integration of physical, psychological, social, and spiritual aspects of an individual — the weaving together of each thread into the tapestry of the whole being. A parish nurse is a registered professional nurse who, as a member of the ministerial team, provides preventive and restorative care with a focus on health promotion and spiritual care within the values and beliefs of a faith community.

Parish nurses function in a variety of roles with a focus on spiritual health and use the nursing interventions of counseling, education, resource utilization, and advocacy. As health counselors, they provide expertise and a listening ear, serving as "translator" between the faith and healthcare communities. With knowledge in both areas, the parish nurse can clarify issues and reinforce the strong tie between faith and health. In the role of health educator, parish nurses provide educational programs and health screening opportunities for the congregation. They function as advocate and referral agents, helping individuals navigate the healthcare system and finding community resources and support services to improve quality of life.

Working with volunteers to extend this caring ministry and developing support groups are also roles of the parish nurse. When a parish nurse visits an individual in the hospital, home, or nursing home, it is as a representative of the congregation that cares for that person. Equipped with assessment skills and nursing knowledge, the nurse works with other healthcare providers in collaborative relationships for the benefit of the individual and community well-being.

Although every parish nurse practice is different based on the needs of the individual congregation, the ministry is particularly suited to address the needs of the elder individual. There are so many issues that come to the forefront as we age — health concerns, losses, changes in life status. A parish nurse can help individuals deal with those issues, find resources, discover options, answer questions, or give the gift of simple "presence" to one who is alone. A health ministry directed by a parish nurse can go a long way in providing a caring, healing environment within the congregation.

When Susan, the parish nurse at the local church, went to visit Harold because she hadn't seen him around lately, she found him angry and upset. It was the tenth time Harold's son had insisted that he move to an assisted living facility in the past month. Harold missed his wife so and loved this house in which they had spent their life together; he didn't want to move. "Sure he was not as spry as he used to be. Yes, he did have some trouble with the stairs; and oh, he missed his medications once in a while, but he could get along. It just wasn't fair."

After talking with Harold about his concerns, Susan inspected the house with a "new" pair of eyes. With Harold's permission and the help of a few congregation members, they moved his bed from the second floor to the dining room, took up loose carpets, and did a "safety check" of the house. Susan arranged to have someone check in on Harold regularly and set up his medications in a daily dispenser. She set up rides to church on Sunday with a close neighbor and agreed to call Harold's son (who lived several states away) once a week to give him updates.

Harold was happy, his son was satisfied, and there was one less admission to an assisted living facility. This may not have happened if there had not been a parish nurse in the congregation. There may not have been anyone who had the same entry into Harold's home and life.

From strength training, tai chi, healthy cooking, exercise groups, and medication information to living wills, blood pressure screenings, and help with insurance forms, parish nurses can provide a wide range of programs for the older adult. But perhaps the most important thing that a parish nurse brings to the congregation is that "intentional care of the spirit" with which all care is provided. Parish nurses bring a caring "presence" to each encounter; and whatever the issue, they hold the soul of another gently in their hands.

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Sharon Adkins, MSN, RN, is the Director of the Center for Parish Nursing and Health Ministries at Vanderbilt University Medical Center and Adjunct Faculty at Vanderbilt University School of Nursing. She received her BSN in nursing from the University of Minnesota, her MSN in Nursing Administration from Vanderbilt University School of Nursing, and attended the Parish Nurse Institute, Marquette University.

She is a community facilitator to clergy and congregations regarding the establishment of parish nursing and health ministries; and she provides training, continuing education, resources, and support to parish nurses and the congregations they serve.

On a national level, Sharon is the Immediate Past President of the Health Ministries Association and locally is a member of the Boards of Alive Hospice, Hospital Hospitality House, the Tennessee Nurses Foundation, the Tennessee Center for Nursing, the Tennessee Respite Coalition, and the Nashville Clinical Pastoral Education Partnership. She is past president of the Tennessee Nurses Association. E-mail: sharon.adkins@Vanderbilt.Edu.

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