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Health ministry through local faith communities: a European perspective.

Introduction

The place of faith in contemporary health care has been a controversial issue, although throughout history faith groups have had a major role in the founding of hospitals and engagement with public health.

Over the last 30 years, led by the late Dr Granger Westberg of Chicago, faith communities have begun to reconnect with health through appointing registered nurses with community experience to lead various health and wellbeing initiatives. The practice has spread to 25 countries, including Canada, Australia, and New Zealand.

In the UK, parish nursing has been developing slowly over the last 10 years in a variety of churches. Most appointments are voluntary, for one or two days a week, but some are paid part-time posts. This article describes that practice and then reports on similar initiatives encountered in four different European countries.

The following definition of parish nursing was proposed and accepted by 600 parish nurses at an international symposium in Chicago in October 2000:

'Parish nursing is the intentional integration of the practice of faith with the practice of nursing so that people can achieve wholeness in, with, and through the community of faith in which parish nurses serve. (Patterson, 2008: 34)

Solari-Twadell and McDermott (1999) describe parish nursing as having seven functions:

* Personal health counsellor

* Health educator

* Trainer of volunteers

* Developer of support groups

* Integrator of faith and health

* Referral agent

* Health advocate.

As the practice has evolved it has become clear that the role is more complex, and following her latest research this new definition has recently been offered:

The practice of parish nursing includes care that supports: physical and psychological functioning, protection against harm, the family as a unit, effective use of the health care system, the health of the congregation and community as well as facilitating lifestyle change with particular emphasis on coping assistance and spiritual care. All this is dependent on the parish nurse being able to effectively mobilise volunteers in the congregation to support this model of health ministry.' (Solari-Twadell, 2013)

Parish nursing is so termed because the care is offered to anyone, living in the community around the church, of whatever faith or belief. It is founded on Judaeo-Christian principles. In some countries it is called 'faith community nursing' (Patterson and Slutz, 2011).

UK parish nurses do not carry out invasive treatments or prescribe medications, but through the activities outlined above they seek to improve health in their local communities. Hard-to-reach groups, such as asylum seekers or the homeless, have been encountered and signposted to appropriate NHS or third-sector care, often accompanied by effective monitoring as the parish nurse maintains an ongoing relationship with the client group.

People attending toddler groups and lunch clubs in faith buildings have benefited from health education activities, often involving visiting speakers such as health visitors and nutritionists. People at risk of falls, or who have just been sent home from hospital, have been followed up either as part of their regular faith-related activities, or as clients of a home-from-hospital or visiting scheme, potentially resulting in considerable savings to the NHS. Volunteers have been recruited, co-ordinated and trained to offer neighbourly care under the supervision of the parish nurse. Service users have become service deliverers and found a sense of identity and new purpose. Businessmen and women have been invited to breakfast events with talks by GPs on various health issues, raising awareness of the need to check for early signs of cancer, or have regular blood pressure checks. The most common intervention has been active listening beyond that which could be given at a surgery or hospital appointment.

All clients are made aware that the nurse is working for the faith community and that, if they wish, they may receive spiritual support or prayer as part of their care. Approximately half take up this offer, whether or not they are church attenders (Wordsworth, 2011). There is no requirement to change faith or join a particular group to access a parish nurse; the care is offered to people of all faiths or none, within the time available, and clients can be referred to someone from their own faith community if they so request. A five-day introductory course, study days and professional support are offered to registered nurses with community experience who are appointed and line-managed by the church.

Historical development in the UK

In June 2001 a parish nursing conference was held in Birmingham, England, at which the concept of parish nursing was introduced. Following that, and a study trip to the USA, I completed a masters-level dissertation examining the extent to which this specialty might be relevant to an English context. I then re-activated the planning group and organised three regional seminars, attended by representatives from nursing and the churches. A visit to the Department of Health (DH) in London in 2003 resulted in encouragement towards pilot projects and seven volunteers emerged from Baptist, Anglican and Salvation Army congregations.

The introductory curriculum offered by the International Parish Nurse Resource Centre was adapted for a UK context. The practice has slowly but steadily developed under the auspices of a registered charity, Parish Nursing Ministries UK. There are now 90 practising parish nurses in Scotland, Wales and England in most denominations. Many work volunteer hours for the church in addition to paid employment in the NHS, but at least 20% also have paid employment with the church. They are encouraged to build good relationships with local health services so that the work they do does not compete with, but rather adds value to what may be offered through the NHS.

The 2012 MacQueen Travel Scholarship, awarded by the Unite/CPHVA Education and Development Trust, enabled an exploration of the way in which faith communities are engaging with public health in four further European countries (see Table 1). The purpose was to see whether there were ways in which learning could be mutually shared and a European network for parish nursing established.

Faith communities and public health in Europe

Finland

The first visit was to Finland: the 'best place in the world to be a mother' (Save The Children, 2013). It also happens to be the one country where parish nursing has existed as 'diakonie' nursing since 1867. Many Finns belong to the Lutheran church and pay the optional church tax of 1.25% of earnings. Around 80% of all young people receive confirmation, but only 10% of the population are active members.

In Helsinki I met with a Lutheran representative who explained that within the 'diakonie' there are two orders: nursing and social work. Every local church has to have a pastor, a youth worker and a parish nurse or social worker.

In Helsinki around 40% of the diakonie are nurses; but in Oulu, a city to which I travelled, the ratio is greater and 65% are nurses. As Northern Finland is so sparsely populated some of these nurses can travel 60 miles in one day and the co-ordinators can travel up to 600 miles. Diaconia University of Applied Sciences (Diak) in Oulu trains nurses over three years with an optional extra year of theological preparation if they wish to join the diakonie. Educational exchanges with this university are available through the Erasmus scheme.

The state-run health centre in Oulu serves around 16,000 people. It has doctors, a laboratory, two diabetic nurses and public health nurses. Although it offers a more secular approach, relationships with the diakonie are usually good and annual meetings are arranged. If the client requests, the diakonie may accompany them to case conferences.

Hospitals in Finland are also state-owned and during one visit there the chaplain did a short service in the dining room of each ward to which patients were invited. The Finnish nurses were shocked to discover that this would not now be common practice in the UK.

The nine diakonie, based in the churches, take referrals from the state-funded public health nurses and hospital chaplains, and refer clients to them. Each diakonie nurse has a specialty: for older people, for sight-impaired or hearing impaired people, for mental health, for prisoners, for drug and alcohol addiction, for families for students and internationals, and there is one volunteer coordinator and one team leader. Sixty volunteers work with the nine diaconal nurses in the parish of Oulu. They are trained, supervised, and matched to the needs and ages of the clients.

Ukraine

Although there is health care available in Ukraine, it is by no means universally accessible and many of the sick people in this community are nursed at home, either by members of their family or by friends.

Kiev stood in stark contrast to Finland. The city had not encountered faith community nursing until 2012, when an American nurse introduced the concept with the Orthodox church in a poor suburb of concrete apartment blocks, surrounded by potholes and mud roads. She worked from a modest church building and conference venue, which bore no similarity to the very ornate buildings in the city centre.

In the teaching room 30 nurses, nuns and priests were listening to an Orthodox priest speaking in Russian on the spiritual journey that people may make. This was followed by a lecture from a doctor at the university hospital about how the church can seek to meet the health needs of the people who live around them. 'This kind of work will not be easy,' he said. 'It requires sacrifice of time and energy, but we have the example of Jesus. God calls us to follow Him and we will support one another.'

The next morning there were sessions on the history and philosophy of parish nursing. The ecumenically-mixed audience had travelled many miles. For some it was their first encounter with people from another denomination. There were Russian Orthodox, Catholics, Ukrainian Orthodox and Free Church nurses debating the practical application of the principles in a Ukrainian context, and linking with parish nurses in other countries through Skype. Later, the steering group directors discussed charity structure and function, training courses, finance, and quality standards. Almost all of the nurse attendees volunteered for further training. Several months later, 10 new parish nurses were given certificates and commissioned to work with their various churches.

Georgia

The old city of Tbilisi is punctuated by newly built parkways and elegant buildings among contrasting concrete apartment blocks, a reminder of the back streets of Kiev. It was a tense election time, among large but seemingly peaceful demonstrations. The work of the Baptist mission is based in a complex on the other side of town, a spacious but not elaborate building with views across the valley, home to around 40 senior citizens and displaced people, administrative offices and a teaching room.

It was very different to the massive new Orthodox cathedral, which was alive with people kissing icons, lighting candles, making confessions and having their weddings blessed. Around 93% of the population are Orthodox Christian, so Baptists, atheists, Moslems and Pentecostals are in the minority.

The order of St Nino was formed about 17 years ago by the Georgian Baptist church to reach out to the poor and needy. They have about 400 clients across the country, most of whom do not attend church but have been referred by people who knew of them. Medication and hospital treatment in Georgia is very expensive and so for the poor, basic nursing care is needed.

The first visit was to a basement room, where a deeply depressed young man of 21 was caring for his bedridden aunt and blind grandfather. He had started to train as an engineer but could not afford his fees so had to stop. Proper medical care could have prevented the aunt from being bedridden. The old man seemed quite fit and hearty apart from his sight limitation.

The role of the St Nino volunteer was to visit twice a week to befriend and help them. She did the same for a family in a nearby flat with an elderly dying mother whose son was recovering from a prostate operation, in one tiny room surrounded by all their belongings. The mother had been offered a place at the Baptist centre but the neighbours had said they would do the caring in return for the ownership of the flat. This is a common way of treating vulnerable people and the volunteer has to ensure that care really does happen; the neighbours appeared very quickly when they realised she was visiting.

The evening was spent discussing how pastoral education might be improved. It was proposed to commence a library which would include medical and health-related textbooks for the order of St Nino.

The Baptist 'cathedral' is very different from a Baptist church in the UK. The bishops wear robes and the service is liturgical. Bishop Rosyda is a mother of pre-teenage children with a theological degree and gifts in linguistics, youth work and pastoral care. About 150 people attend, of all ages. At the end of the service many come forward for a blessing with oil, and afterwards they file out with a truly Biblical kiss for each person.

A total of 25 staff and volunteers from the church attended a lecture and discussion about Parish nursing. Four were sisters--equivalent to parish nurses--and one was a medical doctor. They go to the government and ask to be referred to the poorest of the poor. Each sister has five volunteers whom she trains and supervises. These volunteers speak with deep commitment about their work. They have between three and seven patients each, most of whom need end-of-life care.

One problem they often encounter is mistrust; people want to know why they are doing this for free. But where their offer of care is accepted, they begin to visit. There are monthly training days for the sisters but most of the resource material they use is medical. It does not include spiritual, theological, professional or community health topics. They would like a link with parish nursing internationally, in order to access resources. Clearly, however, they would need to contextualise the material.

Germany

Germany is often quoted as the historical inspiration for Parish nursing. Florence Nightingale, a theologian and statistician as well as a public health nurse, was deeply influenced by the work of Pastor Fliedner in Kaiserswerth (Macdonald, 2001).

German citizens have to pay health insurance (15% of income plus 15% from their employer). They choose from 60 different insurance funds, which pay for Lutheran or Catholic hospitals with corresponding theological foundations. Patients can go to any one of these, or a state hospital, regardless of faith connection. Those without insurance or a European card have to pay. In addition there is new form of insurance for home care, costing 2-3% of income. Assessment is made by the insurance company and any professional help needed is provided by home care agencies. More than half of these have Christian foundations but have to compete. They can only provide care to the extent that it is paid for either by the insurance company, a charity, or private means. There is little extra time allowed for listening or attention to spiritual needs.

There is no equivalent to the UK health visiting service, and no continuing state registration, just a final examination. Some nurses have extra training as diaconal nurses, usually in a 'motherhouse' (like a convent) close to the hospital. They form a spiritual community but their practice is usually confined to their state-funded place of work.

The main churches are Lutheran and Catholic. Around 70% of population are members of one of these but only 5% attend church. There is a small church tax, only paid by those who are members of the church. That results in the expectation that everything offered by the church should be free of charge.

A German nurse had come to a Parish nursing introductory course in England and established a ministry in Southern Germany entitled 'Vis a vis' (face to face). She has developed a team of volunteers, a prayer ministry and, at the entrance to the church buildings, a shop called 'Treff Punkt Hoffnung' (meeting place of hope). It is a well stocked room where people can buy health related books, cards, gifts, and pick up leaflets on various health conditions. This showcases the work of a parish nurse to the congregation and community. There is space for conversations and prayer and GPs refer their patients for ongoing support.

Fifteen Lutheran nurses practice around Speyer and one Baptist nurse works in Hagen. Researchers, medical consultants, and chaplains take part in the day-release training, the costs being currently borne by the Lutheran church. I contributed several sessions over two days.

Conclusion

In each of these countries faith communities have a role to play in supporting the public health services. In the Ukraine and Georgia this is more often hands-on care. But in all four countries there is space for church involvement, using the medical and disease process knowledge of the nurse to bring reassurance, to monitor, to refer, to pray, to educate, to coordinate volunteers, to identify appropriate resources, and to offer advice. All of the nurses are prepared to offer care to anyone, regardless of denomination or faith, and although spiritual care is integral to the practice, I did not witness any attempt to proselytise. The issues common to all are:

* Increasing public awareness of the role

* Recruitment and training of volunteers

* Building ecumenical relationships

* A need for increased funding.

I will take some of the ideas I encountered back to UK parish nurses. From Speyer the concept of a resource shop in the church building as a showcase for health ministry; from Tbilisi the addition of health-related books and journals to theological libraries and the effective deployment of volunteers; from Kiev the power of parish nursing to bring together women and men from different denominations that have never talked to each other; and from Finland the possibility that one day every church will have someone on their ministry team whose task it is to enable the church to reach out to its community in unconditional service and health ministry.

The benefit has been mutual and the development of continuing relationships will enable a strengthening of health and well-being programmes from faith communities in our five countries. It will hopefully also mark the start of a European network for Parish nursing, linked to the International Parish Nurse Resource Centre.

Key points

* Faith communities are reconnecting with health in the UK through parish nursing

* The practice aims towards more effective use of health services and health promotion, with a focus on spiritual care

* Similar initiatives exist in other European countries, with some variation depending on context

* The practice crosses denominational boundaries and assists the effective deployment of volunteers

* Common issues include the need for further promotion and funding mechanisms

No conflict of interest declared

References

Macdonald L. (2001) Florence Nightingale's Spiritual Journey: Biblical Annotations, Sermons and Journal Notes. The Collected Works of Florence Nightingale, volume 2. Waterloo, ON: Wilfrid Laurier University. Patterson DL. (2008) Health Ministries: A Primer for Clergy and Congregations. Cleveland: Pilgrim Press: 34. Patterson D, Slutz M. (2011) Faith community/parish nursing: what's in a name? Journal of Christian Nursing 28(1): 31-3.

Save The Children. (2013) Available from: www. savethechildren.net/news [Accessed May 2013]. Solari-Twadell PA, McDermott MA. (1999) Parish nursing: promoting whole person health within faith communities. Thousand Oaks, California: Sage Publications.

Solari-Twadell PA. (2013) Definition proposed at the UK Symposium. Theddingworth, Leicestershire, November 2013.

Wordsworth HA. (2011) How far does parish nursing make a difference to the mission of English Churches? Unpublished Doctoral thesis, University of Wales.

Helen Wordsworth RN RM RHV RNT MTh DMin Chief Executive Officer, Parish Nursing Ministries UK

Correspondence: helen.w@parishnursing.org.uk
Table 1. Parish nurses in Europe

Country   Number of      Denomination          Type of care most
          active                               commonly offered by
          parish                               nurses and
          nurses (as                           volunteers
          at Nov 2013)

Finland   700            Lutheran              Health advocacy and
                                               promotion, spiritual
                                               care

Ukraine   15             Orthodox, Catholic    Health promotion,
                         and Free Church       hands on care,
                                               spiritual care

Georgia   16             Baptist               Hands on care,
                                               spiritual care

Germany   15             Lutheran, Baptist     Health advocacy,
                                               home visiting,
                                               spiritual care

UK        90             Anglican, Baptist,    Health promotion,
                         Catholic, Church of   health advocacy,
                         Scotland, Church in   home visiting,
                         Wales, Independent,   spiritual care
                         Methodist, New
                         Churches,
                         Pentecostal,
                         Salvation Army
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Title Annotation:PROFESSIONAL AND RESEARCH: PEER REVIEWED
Author:Wordsworth, Helen
Publication:Community Practitioner
Article Type:Report
Geographic Code:4E
Date:Jan 1, 2014
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