- Email: [email protected]
Teaching community based nursing in a parish nurse faculty practice
Nurse Education in Practice (2006) 6, 232–236
Nurse Education in Practice www.elsevierhealth.com/journals/nepr
Teaching community based nursing in a parish nurse faculty practice R.N. Mary Lashley
*
Community Health Nursing, Towson University, 8000 York Road, Towson, MD 21252, United States Accepted 29 January 2006
KEYWORDS
Summary Managed care, shortened hospital stays, and a renewed focus on health promotion have opened up the field of community based nursing practice. To adequately prepare students for community based practice, schools of nursing are challenged to develop both undergraduate and graduate level community based clinical experiences. The parish nurse practice is an ideal setting to educate both novice and experienced nurses in the concepts of community based care. This article explores how a parish nurse faculty practice can be used to educate nurses on health promotion and community based care at all levels of the curriculum. c 2006 Elsevier Ltd. All rights reserved.
Parish nursing; Community based practice; Nursing education; Faculty practice
Introduction
As patients are discharged home from the hospital earlier in their course of recovery, the need for nurses educated in the philosophy and practice of community based care has escalated. Community based nursing is a philosophy of care that is characterized by collaboration, continuity of care, client and family responsibility for self care, and preventive health care (Hunt, 2005). Managed care, shortened hospital stays, changing demographics, and a renewed focus on health promotion open up new opportunities for providing community based care in non-traditional settings. Nurse educators both
* Tel.: +1 410 704 4206; fax: +1 410 704 6333. E-mail address: [email protected].
within the United States and abroad are developing curricula to address this new direction in health care (Carter et al., 2005; Nehls and Vandermause, 2004; Thies and Ayers, 2004; Hyttinen, 2001; Van Ort and Townsend, 2000). Schools of nursing are faced with the challenge of providing innovative community based experiences for their students at all levels of the curriculum. The parish nurse role has received greater attention by the nursing profession as demands for cost effective community based care have risen (Bay, 2004; Magilvy and Brown, 1997). Health care in the context of the faith community represents an alternative mode of health care delivery. Emphasis is placed on promoting health and access to care by addressing health care needs where persons live and worship. This model targets service delivery at the ‘point of living’ (Lough, 1999), since needs
1471-5953/$ - see front matter c 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2006.01.006
Teaching community based nursing in a parish nurse faculty practice are addressed directly where people work, play, or, in this case, worship. Parish nurses integrate health care delivery with a fundamental concern for the spirituality of persons (Anderson, 2004; Brudenell, 2003; Wallace et al., 2002). As such, they assume the multifaceted roles of health counselor, referral agent, educator, and advocate. Parish nurses practice within a faith community to deliver holistic health care to their members (Weis et al., 2002; Biddix and Brown, 1999; Schank et al., 1996). The faith community is a valuable setting for educating both novices and experienced nurses in the concepts of community based care (Kotecki, 2002; Moll et al., 2001; Brendtro and Leuning, 2000). In addition, such an experience brings the knowledge and skills of students and faculty directly to the community. The focus shifts from learning in the community to learning with the community. In essence, this community needs driven approach becomes the hub of the educational experience (Nehls and Vandermause, 2004). This article explores how a parish nurse faculty practice can be used to educate nurses on health promotion and community based care across undergraduate and graduate level nursing curricula.
Pedagogical considerations in a parish nurse faculty practice Public concerns regarding quality, cost, access, and fragmentation of health care have contributed to the shift in care from the more traditional acute care setting to the community. As a community health nursing faculty, I have taught in an undergraduate baccalaureate nursing program for 20 years. Ten years ago, I began a parish nurse practice in a small 100 member Baptist congregation. In response to identified health needs within the congregation, I became involved in initiating health promotion programs within the church. Such programs included blood pressure screening clinics, senior wellness groups, home visiting services to the chronically ill and homebound, and consultation on health related issues. As my practice grew, I began to consider the benefits of having student nurses work with me in a collaborative faculty practice model. Faculty who assume the roles of both teacher and practitioner can serve as effective role models for students (Lough, 1999). Moveover, the integration of students into my practice has enabled me to develop educational experiences that can be uniquely tailored to the individual learning needs of the students. Since I know the client population well and
233
am familiar with my students’ unique learning strengths and needs, I am better able to match clients to students. For example, a student who lacks experiences with a certain type of client can be matched to that client. Also, clients who respond positively to nurses with certain traits (i.e. outgoing, sensitive, good listener) can be matched with a student who exhibits these traits. Because I am knowledgeable of the client’s health care needs and unique family situation, I am able to guide the student in planning appropriate nursing care to meet the client’s needs. I am also knowledgeable of resources in the community where the client resides and am equipped to direct students to specific resources to meet these needs. Since I have laid the ground work in building trust relationships with clients, the student experiences less rejection, is able to establish meaningful relationships sooner, and generally reports a more positive experience in the community health rotation. I am often asked whether students feel proselytized by working in a setting where spirituality is emphasized and a specific faith perspective espoused. To address this issue, I encourage students to explore the meaning of spirituality for themselves and their clients through critical dialogue and reflection. This type of narrative, interpretive pedagogy involves analyzing the meaning of experiences from a personal and professional context and examining the sociohistorical context in which this meaning making unfolds (Howard, 1982). Such critical reflection opens up new interpretations of the experience which, in turn, informs and reforms pedagogical practices (Meath-Lang, 1987). As students reflect on the meaning of their spirituality and the role of personal faith in sustaining persons through crisis, they begin to develop a level of comfort in discussing this once taboo subject. If fact, students have reported feeling more authentic and free to be themselves in this setting than in other clinical settings. Some students report that, while they grew up in a place of worship, they moved away from organized religion as they entered their young adult years. Being in a setting where their own spirituality is affirmed helped them to regain the spiritual side of themselves which they thought they had lost (Lashley, 1999). The parish nurse setting is also an excellent site for teaching holistic care. Increasingly, clients are calling for a more holistic approach to health care and openings to connect faith and healing. Parish nurse practices provide such openings (Anderson, 2004; Hurley, 1999). Parish nurses support clients to explore the meaning of suffering, prayer, and
234 belief in God to draw on personal faith to sustain them through crisis experiences (Davis, 1994). Such care is provided in a context that promotes trust and personal empowerment. The parish nurse practice setting is also unique in that students learn how to work with an interdisciplinary team composed, not of traditional health providers, but of clergy and lay leaders. Such persons often do not share a common language, and the student is challenged to work collaboratively with those who have insight into the social, emotional, and spiritual needs of the client. Church leaders are often called to be present with those experiencing pain and suffering and are important team members in providing holistic care. Nursing students working in parish nursing roles come to appreciate the unique contribution a spiritual leader can bring to restore client health and learn to identify ways to include clergy in the plan of care (Easton and Andrews, 1999). By working in a new context, conventional views of nursing practice are challenged. Students develop relationships with clients that are more holistic and egalitarian. Students provide valuable services which are mutually negotiated with the community, empowering both student and client. These professional service learning experiences are driven by community need (Cooper, n.d.; Nehls and Vandermause, 2004). One challenge of having students in a parish nurse practice is that the demands of the setting necessitate that students be available on days other than traditional clinical days (especially on Sundays when the church congregation is accessible). In my experience, students have been flexible and responsive in coordinating their personal schedules so that they are available at these critical times. Often, I will negotiate with students to schedule client visits and congregational programs at mutually convenient times for both the student and the church body. This requires that I also be accessible at off hours (evening and weekends) to provide adequate supervision.
Developing parish nurse experiences across the curriculum Public concerns regarding quality, access, and cost of health care have led to changes in the context of nursing practice. Given the global emphasis on promoting primary health care for all (first espoused by the World Health Organization) and the United States Healthy People 2010 goals which emphasize health promotion and illness prevention, health
R.N. Mary Lashley promotion has indeed become an international priority. Therefore, the first community based course in our undergraduate, baccalaureate curriculum is a course that focuses on health promotion across the life span. Students in this course focus on developing communication skills, establishing a therapeutic relationship, teaching health promotion practices, and performing physical, developmental, and environmental assessments. To meet these objectives, I have assigned students to home visit clients who are members of the church body as well as clients who have been referred from outside sources to the parish nurse program. The student is responsible for performing an in depth needs assessment (including a focused physical examination), identifying the client’s major health promotion needs, and implementing a health promotion teaching plan to meet these needs. The student also has an opportunity to teach clients across the life span on a variety of health promotion topics during Sunday School, youth activities, or senior meetings. In the past, students have developed age appropriate health promotion programs on hygiene, nutrition, exercise, safety, visiting the doctor or dentist, and advance directives. Students may evaluate the effectiveness of their interventions through surveys of program satisfaction, knowledge assessments, or by data collection on number of persons attending sessions, accessing care, or receiving positive screenings. Students are also assigned to perform an environmental assessment of the church building. Groups of students are assigned to different parts of the church and systematically assess the property and grounds for health hazards. In the past, students have identified the following health concerns: (1) peeling paint in the church nurseries (The church building is over 50 years old and lead poisoning is a potential risk.); (2) cleaning fluids and toxic substances in unlocked rooms accessible to children; (3) broken lock at the front door entrance; and (4) lack of handicap accessibility in the church sanctuary. Evaluation of the effectiveness of this intervention is measured through environmental improvements made to the church building and corrective measures taken to address the identified risks. Finally, students have been assigned to perform well child home visits on families in the congregation. Included in this visit is an assessment of each child’s current immunization status, visits to the pediatrician, and major health or behavioral concerns. In addition, students are required to perform a Denver Developmental Screening Test on all children in the home under 6 years of age.
Teaching community based nursing in a parish nurse faculty practice The community health course taught at the senior level is aggregate focused and requires that I plan more challenging experiences in the community. In this course, students act as case managers, managing a caseload of multiple families, preferably exhibiting complex health or social needs. They also conduct health teaching and develop health promotion programs based on a needs assessment of targeted at risk groups both within and outside of the church congregation. Students are responsible for performing both family and community assessments. The assessment of the community in which the church is housed has been presented to the members of the church congregation in a professional forum. There are many leadership experiences available for students practicing parish nursing. An appropriate leadership experience for students in a community or leadership and management course would be to collect monthly statistics on parish nurse outcomes (i.e. number of visits made, telephone contacts, referrals, miles traveled, major programs/ activities conducted) and make professional presentations on these findings to the church congregation at monthly business meetings. Students can also be assigned to implement selected leadership initiatives in the church. These initiatives are aggregate focused and aimed at developing skills in research, program planning, resource coordination, and public speaking. One such initiative is the development of an orientation program on parish nursing for student nurses new to the parish nurse practice. This orientation includes information on the history of parish nursing, American Nurses’ Association Standards of Parish Nurse Practice, the role of the parish nurse in the local congregation, and an orientation to the church as a whole (i.e. demographics, key leaders, major ministries of the church). Another leadership initiative is the development of a public relations program on parish nursing that can be used to make presentations to other church groups or professional organizations. The public relations initiative may include overheads, slides, powerpoint, video presentations or role play to communicate to outside groups or agencies the essence of parish nursing practice. A third leadership initiative is a client documentation system for the church. This assignment requires that the students develop relevant assessment tools, progress notes, and other records meaningful to the parish nurse practice and pilot these tools to determine their feasibility, effectiveness, and ease of use. As a result of this project, students have developed assessment tools
235
and progress notes that have been adopted for use within the parish nurse practice. Finally, the students may elect as their leadership project the development of a community resource directory which can be made public and accessible to the church congregation. The resource directory targets local community resources that members of the congregation could access if needed, with all relevant referral information (i.e. names and numbers of key persons to contact, eligibility requirements, types of services offered, fees and methods of payment, etc.). The parish nurse setting can also be used to further develop advanced leadership and population focused practice. At the graduate level, students can become involved in networking with other parish nurses outside the local church and with formal parish nurse networks in the area. For example, parish nurse coordinators are nurses employed by local hospitals who assist parish nurses in the community to plan and implement congregational health programs and services. The graduate student may collaborate with these coordinators to examine the needs of parish nurses across the county or state and to develop programs to meet these needs. In addition, there is a great need for outcome based research to document the effectiveness of parish nursing on congregational and community health. Graduate students can assist in data collection, analysis, and tool development or conduct their own research to examine an aspect of parish nursing practice. The parish nurse practice is also an ideal setting to conduct qualitative research and research on spiritual care issues. Through personal narrative, journaling, or interview, nurses can research the impact that parish nursing has on quality of life, faith support, patient satisfaction, health and well being, and other client variables. As with other types of service learning experiences, these activities respond to an identified need in the community. Moreover, these needs become the foundation for critical reflection and examination of oneself, one’s profession, and the society in which one lives.
Conclusion The parish nurse setting is rich in opportunities to develop creative and innovative educational experiences to teach nurses the principles and practices of community based nursing. Activities can be developed at all levels of the curriculum to teach basic concepts or advanced skills. Since parish
236 nursing is evolving and not rigidly prescriptive in its scope of practice, students have the freedom and flexibility to implement creative programming in the congregation where they practice. The faith community is an ideal setting for students to learn how to give spiritual care and to address the unmet health care needs of persons where they live and worship.
References Anderson, C., 2004. The delivery of health care in faith based organizations: parish nurses as promoters of health. Health Communication 16 (1), 117–128. Bay, M., 2004. Educational and experiential formation in parish nursing. University of Colorado Health Sciences Center. Unpublished doctoral dissertation. Biddix, V., Brown, H., 1999. Establishing a parish nursing program. Nursing and Health Care Perspectives 20 (2), 72–75. Brendtro, M., Leuning, C., 2000. Nurses in churches: a population-focused clinical option. Journal of Nursing Education 39 (6), 285–288. Brudenell, I., 2003. Parish nursing: nurturing body, mind, spirit, and community. Public Health Nursing 20 (2), 85–94. Carter, K., Fournier, M., Grover, S., Kiehl, E., Sims, K., 2005. Innovations in community based nursing education: transitioning faculty. Journal of Professional Nursing 21 (3), 167–174. Cooper, M., n.d. Four things faculty want to know about! The big dummy’s guide to service learning. Retrieved November 22, 2005 from. Davis, M., 1994. The rehabilitation nurse’s role in spiritual care. Rehabilitation Nursing 19 (5), 298–301. Easton, K., Andrews, J., 1999. Nursing the soul: a team approach. Journal of Christian Nursing 16 (3), 26–27. Howard, R., 1982. Three Faces of Hermeneutics: An Introduction to Current Theories of Understanding. University of California Press, Berkeley.
R.N. Mary Lashley Hunt, R., 2005. Introduction to Community Based Nursing, third ed. Lippincott, Williams and Wilkens, Philadelphia. Hurley, J., 1999. Breaking the spiritual care barrier. Journal of Christian Nursing 16 (3), 8–13. Hyttinen, H., 2001. Target community-based nursing: more practising in community environments [Finnish]. Sairaanhoitaja 74 (3), 16–17. Kotecki, C., 2002. Community-based strategies: incorporating faith-based partnerships into the curriculum. Nurse Educator 27 (1), 13–15. Lashley, M., 1999. Congregational care: reaching out to the elderly. Journal of Christian Nursing 16 (3), 14–16. Lough, M., 1999. An academic-community partnership: a model of service and education. Journal of Community Health Nursing 16 (3), 137–150. Magilvy, J., Brown, N., 1997. Parish nursing: advanced practice nursing model for healthier communities. Advanced Practice Nursing Quarterly 2 (4), 67–72. Meath-Lang, B., 1987. The dialogue journal: Reconceiving curriculum and teaching. Dialogue IV, 2–3. Moll, R., Cook, L., Saul, J., 2001. Student corner. Church programs as a first clinical experience. Nurse Educator 26 (3), 122–124. Nehls, N., Vandermause, R., 2004. Community driven nursing: transforming nursing curricula and instruction. Nursing Education Perspectives 25 (2), 81–85. Schank, M., Weis, D., Matheus, R., 1996. Parish nursing: ministry of healing. Geriatric Nursing 17 (1), 11–13. Thies, K., Ayers, L., 2004. Community-based student practice: a transformational model of nursing education. Nursing Leadership Forum 9 (1), 3–12. Van Ort, S., Townsend, J., 2000. Community-based nursing education and nursing accreditation by the commission on collegiate nursing education. Journal of Professional Nursing 16 (6), 330–335. Wallace, D., Tuck, I., Boland, C., Witucki, J., 2002. Client perceptions of parish nursing. Public Health Nursing 19 (2), 128–135. Weis, D., Schank, M., Coenen, A., Matheus, R., 2002. Parish nurse practice with client aggregates. Journal of Community Health Nursing 19 (2), 105–113.
Nurse Education in Practice www.elsevierhealth.com/journals/nepr
Teaching community based nursing in a parish nurse faculty practice R.N. Mary Lashley
*
Community Health Nursing, Towson University, 8000 York Road, Towson, MD 21252, United States Accepted 29 January 2006
KEYWORDS
Summary Managed care, shortened hospital stays, and a renewed focus on health promotion have opened up the field of community based nursing practice. To adequately prepare students for community based practice, schools of nursing are challenged to develop both undergraduate and graduate level community based clinical experiences. The parish nurse practice is an ideal setting to educate both novice and experienced nurses in the concepts of community based care. This article explores how a parish nurse faculty practice can be used to educate nurses on health promotion and community based care at all levels of the curriculum. c 2006 Elsevier Ltd. All rights reserved.
Parish nursing; Community based practice; Nursing education; Faculty practice
Introduction
As patients are discharged home from the hospital earlier in their course of recovery, the need for nurses educated in the philosophy and practice of community based care has escalated. Community based nursing is a philosophy of care that is characterized by collaboration, continuity of care, client and family responsibility for self care, and preventive health care (Hunt, 2005). Managed care, shortened hospital stays, changing demographics, and a renewed focus on health promotion open up new opportunities for providing community based care in non-traditional settings. Nurse educators both
* Tel.: +1 410 704 4206; fax: +1 410 704 6333. E-mail address: [email protected].
within the United States and abroad are developing curricula to address this new direction in health care (Carter et al., 2005; Nehls and Vandermause, 2004; Thies and Ayers, 2004; Hyttinen, 2001; Van Ort and Townsend, 2000). Schools of nursing are faced with the challenge of providing innovative community based experiences for their students at all levels of the curriculum. The parish nurse role has received greater attention by the nursing profession as demands for cost effective community based care have risen (Bay, 2004; Magilvy and Brown, 1997). Health care in the context of the faith community represents an alternative mode of health care delivery. Emphasis is placed on promoting health and access to care by addressing health care needs where persons live and worship. This model targets service delivery at the ‘point of living’ (Lough, 1999), since needs
1471-5953/$ - see front matter c 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2006.01.006
Teaching community based nursing in a parish nurse faculty practice are addressed directly where people work, play, or, in this case, worship. Parish nurses integrate health care delivery with a fundamental concern for the spirituality of persons (Anderson, 2004; Brudenell, 2003; Wallace et al., 2002). As such, they assume the multifaceted roles of health counselor, referral agent, educator, and advocate. Parish nurses practice within a faith community to deliver holistic health care to their members (Weis et al., 2002; Biddix and Brown, 1999; Schank et al., 1996). The faith community is a valuable setting for educating both novices and experienced nurses in the concepts of community based care (Kotecki, 2002; Moll et al., 2001; Brendtro and Leuning, 2000). In addition, such an experience brings the knowledge and skills of students and faculty directly to the community. The focus shifts from learning in the community to learning with the community. In essence, this community needs driven approach becomes the hub of the educational experience (Nehls and Vandermause, 2004). This article explores how a parish nurse faculty practice can be used to educate nurses on health promotion and community based care across undergraduate and graduate level nursing curricula.
Pedagogical considerations in a parish nurse faculty practice Public concerns regarding quality, cost, access, and fragmentation of health care have contributed to the shift in care from the more traditional acute care setting to the community. As a community health nursing faculty, I have taught in an undergraduate baccalaureate nursing program for 20 years. Ten years ago, I began a parish nurse practice in a small 100 member Baptist congregation. In response to identified health needs within the congregation, I became involved in initiating health promotion programs within the church. Such programs included blood pressure screening clinics, senior wellness groups, home visiting services to the chronically ill and homebound, and consultation on health related issues. As my practice grew, I began to consider the benefits of having student nurses work with me in a collaborative faculty practice model. Faculty who assume the roles of both teacher and practitioner can serve as effective role models for students (Lough, 1999). Moveover, the integration of students into my practice has enabled me to develop educational experiences that can be uniquely tailored to the individual learning needs of the students. Since I know the client population well and
233
am familiar with my students’ unique learning strengths and needs, I am better able to match clients to students. For example, a student who lacks experiences with a certain type of client can be matched to that client. Also, clients who respond positively to nurses with certain traits (i.e. outgoing, sensitive, good listener) can be matched with a student who exhibits these traits. Because I am knowledgeable of the client’s health care needs and unique family situation, I am able to guide the student in planning appropriate nursing care to meet the client’s needs. I am also knowledgeable of resources in the community where the client resides and am equipped to direct students to specific resources to meet these needs. Since I have laid the ground work in building trust relationships with clients, the student experiences less rejection, is able to establish meaningful relationships sooner, and generally reports a more positive experience in the community health rotation. I am often asked whether students feel proselytized by working in a setting where spirituality is emphasized and a specific faith perspective espoused. To address this issue, I encourage students to explore the meaning of spirituality for themselves and their clients through critical dialogue and reflection. This type of narrative, interpretive pedagogy involves analyzing the meaning of experiences from a personal and professional context and examining the sociohistorical context in which this meaning making unfolds (Howard, 1982). Such critical reflection opens up new interpretations of the experience which, in turn, informs and reforms pedagogical practices (Meath-Lang, 1987). As students reflect on the meaning of their spirituality and the role of personal faith in sustaining persons through crisis, they begin to develop a level of comfort in discussing this once taboo subject. If fact, students have reported feeling more authentic and free to be themselves in this setting than in other clinical settings. Some students report that, while they grew up in a place of worship, they moved away from organized religion as they entered their young adult years. Being in a setting where their own spirituality is affirmed helped them to regain the spiritual side of themselves which they thought they had lost (Lashley, 1999). The parish nurse setting is also an excellent site for teaching holistic care. Increasingly, clients are calling for a more holistic approach to health care and openings to connect faith and healing. Parish nurse practices provide such openings (Anderson, 2004; Hurley, 1999). Parish nurses support clients to explore the meaning of suffering, prayer, and
234 belief in God to draw on personal faith to sustain them through crisis experiences (Davis, 1994). Such care is provided in a context that promotes trust and personal empowerment. The parish nurse practice setting is also unique in that students learn how to work with an interdisciplinary team composed, not of traditional health providers, but of clergy and lay leaders. Such persons often do not share a common language, and the student is challenged to work collaboratively with those who have insight into the social, emotional, and spiritual needs of the client. Church leaders are often called to be present with those experiencing pain and suffering and are important team members in providing holistic care. Nursing students working in parish nursing roles come to appreciate the unique contribution a spiritual leader can bring to restore client health and learn to identify ways to include clergy in the plan of care (Easton and Andrews, 1999). By working in a new context, conventional views of nursing practice are challenged. Students develop relationships with clients that are more holistic and egalitarian. Students provide valuable services which are mutually negotiated with the community, empowering both student and client. These professional service learning experiences are driven by community need (Cooper, n.d.; Nehls and Vandermause, 2004). One challenge of having students in a parish nurse practice is that the demands of the setting necessitate that students be available on days other than traditional clinical days (especially on Sundays when the church congregation is accessible). In my experience, students have been flexible and responsive in coordinating their personal schedules so that they are available at these critical times. Often, I will negotiate with students to schedule client visits and congregational programs at mutually convenient times for both the student and the church body. This requires that I also be accessible at off hours (evening and weekends) to provide adequate supervision.
Developing parish nurse experiences across the curriculum Public concerns regarding quality, access, and cost of health care have led to changes in the context of nursing practice. Given the global emphasis on promoting primary health care for all (first espoused by the World Health Organization) and the United States Healthy People 2010 goals which emphasize health promotion and illness prevention, health
R.N. Mary Lashley promotion has indeed become an international priority. Therefore, the first community based course in our undergraduate, baccalaureate curriculum is a course that focuses on health promotion across the life span. Students in this course focus on developing communication skills, establishing a therapeutic relationship, teaching health promotion practices, and performing physical, developmental, and environmental assessments. To meet these objectives, I have assigned students to home visit clients who are members of the church body as well as clients who have been referred from outside sources to the parish nurse program. The student is responsible for performing an in depth needs assessment (including a focused physical examination), identifying the client’s major health promotion needs, and implementing a health promotion teaching plan to meet these needs. The student also has an opportunity to teach clients across the life span on a variety of health promotion topics during Sunday School, youth activities, or senior meetings. In the past, students have developed age appropriate health promotion programs on hygiene, nutrition, exercise, safety, visiting the doctor or dentist, and advance directives. Students may evaluate the effectiveness of their interventions through surveys of program satisfaction, knowledge assessments, or by data collection on number of persons attending sessions, accessing care, or receiving positive screenings. Students are also assigned to perform an environmental assessment of the church building. Groups of students are assigned to different parts of the church and systematically assess the property and grounds for health hazards. In the past, students have identified the following health concerns: (1) peeling paint in the church nurseries (The church building is over 50 years old and lead poisoning is a potential risk.); (2) cleaning fluids and toxic substances in unlocked rooms accessible to children; (3) broken lock at the front door entrance; and (4) lack of handicap accessibility in the church sanctuary. Evaluation of the effectiveness of this intervention is measured through environmental improvements made to the church building and corrective measures taken to address the identified risks. Finally, students have been assigned to perform well child home visits on families in the congregation. Included in this visit is an assessment of each child’s current immunization status, visits to the pediatrician, and major health or behavioral concerns. In addition, students are required to perform a Denver Developmental Screening Test on all children in the home under 6 years of age.
Teaching community based nursing in a parish nurse faculty practice The community health course taught at the senior level is aggregate focused and requires that I plan more challenging experiences in the community. In this course, students act as case managers, managing a caseload of multiple families, preferably exhibiting complex health or social needs. They also conduct health teaching and develop health promotion programs based on a needs assessment of targeted at risk groups both within and outside of the church congregation. Students are responsible for performing both family and community assessments. The assessment of the community in which the church is housed has been presented to the members of the church congregation in a professional forum. There are many leadership experiences available for students practicing parish nursing. An appropriate leadership experience for students in a community or leadership and management course would be to collect monthly statistics on parish nurse outcomes (i.e. number of visits made, telephone contacts, referrals, miles traveled, major programs/ activities conducted) and make professional presentations on these findings to the church congregation at monthly business meetings. Students can also be assigned to implement selected leadership initiatives in the church. These initiatives are aggregate focused and aimed at developing skills in research, program planning, resource coordination, and public speaking. One such initiative is the development of an orientation program on parish nursing for student nurses new to the parish nurse practice. This orientation includes information on the history of parish nursing, American Nurses’ Association Standards of Parish Nurse Practice, the role of the parish nurse in the local congregation, and an orientation to the church as a whole (i.e. demographics, key leaders, major ministries of the church). Another leadership initiative is the development of a public relations program on parish nursing that can be used to make presentations to other church groups or professional organizations. The public relations initiative may include overheads, slides, powerpoint, video presentations or role play to communicate to outside groups or agencies the essence of parish nursing practice. A third leadership initiative is a client documentation system for the church. This assignment requires that the students develop relevant assessment tools, progress notes, and other records meaningful to the parish nurse practice and pilot these tools to determine their feasibility, effectiveness, and ease of use. As a result of this project, students have developed assessment tools
235
and progress notes that have been adopted for use within the parish nurse practice. Finally, the students may elect as their leadership project the development of a community resource directory which can be made public and accessible to the church congregation. The resource directory targets local community resources that members of the congregation could access if needed, with all relevant referral information (i.e. names and numbers of key persons to contact, eligibility requirements, types of services offered, fees and methods of payment, etc.). The parish nurse setting can also be used to further develop advanced leadership and population focused practice. At the graduate level, students can become involved in networking with other parish nurses outside the local church and with formal parish nurse networks in the area. For example, parish nurse coordinators are nurses employed by local hospitals who assist parish nurses in the community to plan and implement congregational health programs and services. The graduate student may collaborate with these coordinators to examine the needs of parish nurses across the county or state and to develop programs to meet these needs. In addition, there is a great need for outcome based research to document the effectiveness of parish nursing on congregational and community health. Graduate students can assist in data collection, analysis, and tool development or conduct their own research to examine an aspect of parish nursing practice. The parish nurse practice is also an ideal setting to conduct qualitative research and research on spiritual care issues. Through personal narrative, journaling, or interview, nurses can research the impact that parish nursing has on quality of life, faith support, patient satisfaction, health and well being, and other client variables. As with other types of service learning experiences, these activities respond to an identified need in the community. Moreover, these needs become the foundation for critical reflection and examination of oneself, one’s profession, and the society in which one lives.
Conclusion The parish nurse setting is rich in opportunities to develop creative and innovative educational experiences to teach nurses the principles and practices of community based nursing. Activities can be developed at all levels of the curriculum to teach basic concepts or advanced skills. Since parish
236 nursing is evolving and not rigidly prescriptive in its scope of practice, students have the freedom and flexibility to implement creative programming in the congregation where they practice. The faith community is an ideal setting for students to learn how to give spiritual care and to address the unmet health care needs of persons where they live and worship.
References Anderson, C., 2004. The delivery of health care in faith based organizations: parish nurses as promoters of health. Health Communication 16 (1), 117–128. Bay, M., 2004. Educational and experiential formation in parish nursing. University of Colorado Health Sciences Center. Unpublished doctoral dissertation. Biddix, V., Brown, H., 1999. Establishing a parish nursing program. Nursing and Health Care Perspectives 20 (2), 72–75. Brendtro, M., Leuning, C., 2000. Nurses in churches: a population-focused clinical option. Journal of Nursing Education 39 (6), 285–288. Brudenell, I., 2003. Parish nursing: nurturing body, mind, spirit, and community. Public Health Nursing 20 (2), 85–94. Carter, K., Fournier, M., Grover, S., Kiehl, E., Sims, K., 2005. Innovations in community based nursing education: transitioning faculty. Journal of Professional Nursing 21 (3), 167–174. Cooper, M., n.d. Four things faculty want to know about! The big dummy’s guide to service learning. Retrieved November 22, 2005 from
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