In May 2003, the Congressional Budget Office released a report stating that nearly 60 million nonelderly American children and adults did not have health insurance coverage during at least part of the year (Congressional Budget Office, 2003). This is nearly one-fourth of all children and working age adults in the United States! Of course, many of these are parishioners in various congregations, or members of other faith groups in the United States. What can an individual congregation do to address this discrepancy in access to care that exists among its membership and neighbors? What can a congregation do to address other health issues that cry out for advocacy?
Jesus said, “As you did it to one of the least of these who are members of my family, you did it to me” (Matthew 25:40). Caring for those who are falling through the cracks is an important part of the Church's mandate to preach, teach, and heal. Working in partnership with a parish nurse, who serves as a member of the staff, and who has a primary role as health advocate, congregations can help to address access to care and other issues related to health and social justice.
PARISH NURSE ADVOCACY
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. (This mission statement for parish nursing was developed in 2002 by more than 600 parish nurses at the 14th Annual Westberg Symposium, an international professional meeting for parish nurses.)
Parish nurses promote health and well-being through professional nursing practice on behalf of a congregation, providing services to both the congregation and the community. These services consist of health education, assessment, advocacy, resource referral, coordination of volunteers, and development of support groups—all through the lens of integrating faith and health.
Currently, estimates show more than 10,000 parish nurses serving congregations in the United States, with several hundred in other countries such as Canada, the UK, Korea, Australia, New Zealand, Swaziland, Zimbabwe, and South Africa.
A parish nurse's specific assignments within the ministry of a congregation usually are decided in consultation with other church leaders, a “health cabinet” in the parish, or both. Together, they may design an outreach ministry to the surrounding neighborhood, or a very specialized ministry, such as within a school. Most parishes, however, prefer that the parish nurse serve broadly in response to the varied needs of the congregation and neighborhood. Advocacy is a very important piece of that response.
THE ROLE OF ADVOCATE
When considering advocacy in parish nursing, one must define what is meant by health. Health in the context of parish nursing is broadly interpreted to mean healthy and healing relationships with God, family, faith communities, society, and creation forged by the fostering of physical, emotional, spiritual, and social harmony. In other words, you aren't healthy if you don't have enough food to eat, adequate housing, and safe streets to walk. Health is more than the absence of disease or living fully within the limitations of a chronic or terminal disease. Health is a holistic approach to life and relationships.
The following sections show several ways whereby the parish nurse can make an important contribution as an advocate.
Help to obtain access to care
As mentioned earlier, nearly 60 million American children and working age adults do not have health insurance at some point during the year. Parish nurses can help to identify health insurance programs for which families might be eligible. For example, in Missouri, currently children living in families that earn up to 300% of the federal poverty level are eligible for health insurance coverage. Parish nurses can help to educate parishioners of their options, and if coverage is not available or affordable, they often can help parishioners obtain services for a reduced fee, or at no cost, through appropriate providers. Rev. Susan Naylor, a parish nurse and deacon at Emmanuel Episcopal Church in Webster Groves, spent several years as a parish nurse advocate for Bosnian refugees in downtown St. Louis, helping them access providers who would accept Medicaid managed care.
Serve as a health navigator
Even for parishioners with good health insurance, finding their way through the morass of physicians, clinics, hospitals, and paperwork (including the new Medicare D provisions) can be daunting, especially for the elderly. In addition, patients may not necessarily be aware of all their options. A parish nurse helps parishioners understand what questions to ask to be fully informed about their options for services and treatment.
Serve as a patient advocate in the healthcare system
The Rev. Dr. Richard Ellerbrake, President Emeritus of Deaconess Health System in St. Louis, tells us that our nation's “healthcare system” is neither health care nor a system. Why? Because it focuses on illness care, and the “system” is either unfinished or broken. To illustrate this point at the Westberg Symposium in 2002, Rev. Dr. Ellerbrake quoted Dr. William Jarvis of the Centers for Disease Control and Prevention (CDC), who announced that nearly 2 million patients annually get an infection while being treated in the hospital for another illness or injury. The CDC says that in the year 2000, ninety thousand of those patients died. These nosocomial infections are this nation's fourth most common cause of death, accounting for more fatalities than car accidents and homicides combined.
There also have been a number of stories about residents who have been neglected or harmed while in the care of a nursing home. A parish nurse can act as an advocate for patients in hospitals and nursing homes, to help monitor their care, and to encourage the patient and his or her family to speak up when they are concerned about some aspect of treatment.
Work to acquire needed services in a community
What if there are no providers of a needed service in a community? For example, in the St. Louis metropolitan area, there are very few dentists willing to provide care to children on Medicaid. Parish nurses have mobilized to address these concerns in a number of ways. One nurse arranged for the local health department to come to the after-school program in which she worked, where they provided sealants to children at no cost. Another parish nurse, Betty Leppard, who serves at St. Paul United Church of Christ in Belleville, arranged for children in her neighborhood to be bussed to a dentist's office in the next town. And a number of parish nurses are contacting a program, Smiles Across America, that connects children and dental providers. Is the problem eliminated? Not yet! But parish nurses are raising awareness about the issue, and improving the dental health of many children.
Mobilize for the health of neighbors
Parish nurses can work together with parishioners reaching into the community to improve the health of their neighbors. The Positive Family Program at St. Paul's United Church of Christ in St. Louis is led by Mary Ann Brischetto. Mary Ann facilitates classes on parenting and life management skills for families who are falling through the cracks. Many of the families in the program have been referred through the St. Louis City Family Court, with positive outcomes and rave reviews from both the participants and the Court. This program is helping families learn the skills they need to care for their children and to find stable housing, employment and healthcare. One of the program's graduates, “Bess,” is a mother of three kids 8 to 16 years of age. Through the Positive Family program, she has found safe housing and a long-term job as a paraprofessional, which in addition to work provides health benefits for her family. Her kids are in school and looking forward to healthy futures of their own.
Raise awareness of legislative issues related to health
Although parish nurses certainly cannot tell parishioners what to think or how to vote, they can educate parishioners about health-related issues being addressed by lawmakers and encourage action. Time and time again we have been told that even a few letters or calls to legislators make a difference. Parish nurses have helped to educate parishioners about proposed legislation related to changes in Medicaid coverage, the use and carrying of weapons, health insurance coverage for children, and the use of seatbelts, among other issues.
Advocate for environmental health concerns
Several of the parish nurses in St. Louis work in neighborhoods where nearly 40% of the children test positive for lead poisoning. Some of the other locations in which parish nurses work have environmental toxins in the ground, water, or air. Parish nurses help to educate parishioners and neighbors about environmental health concerns, and help them to know their choices for response. For example, parish nurses working in areas that have high levels of exposure to lead paint can help families have their children tested for lead poisoning, help them obtain treatment if necessary, help them identify sources for performing lead abatement and help them find alternate housing if necessary. A number of parish nurses also are in contact with their legislators about these issues, and encourage others to speak with their legislators as well.
Work for others in developing countries
Those drawn to parish nursing and healthcare ministry through the Church often find that it absorbs their entire lives. They often travel on mission trips to help with health-related concerns in developing countries, as well as in their own church. They often talk pastors and other parishioners into going with them to work on such projects as building schools and bridges, supplying water purifiers, and helping with projects that will develop the local economies to improve the health of the entire community. Parish nurses generally work through an organized group, such as CEPAD (a ministry of the protestant churches of Nicaragua working together in emergency relief, peacemaking, and development), or through a denominationally related mission organization to arrange such travel. Upon their return, they and the other participants on such trips become advocates for the people with whom they have worked.
Parish nursing, only 20-years-old, is growing rapidly. Currently, the ministry of a parish nurse includes far more than blood pressure screenings and telling people to exercise and eat more fruits and vegetables. For a congregation interested in expanding its ministries to the “least of these,” parish nursing is an effective model for change.
For more information about the International Parish Nurse Resource Center, visit its Web site atwww.parishnurses.org or call 314-918-2559.
Advocacy Roles for Parish Nurses
- Help obtain access to care
- Serve as a health navigator
- Serve as a patient advocate in the healthcare system
- Work to acquire needed services in a community
- Mobilize for the health of neighbors
- Raise awareness of legislative issues related to health
- Advocate for environmental health concerns
- Work for others in developing countries