With all of the health-care rhetoric, I am delighted to see a renewed interest in the parish nursing dialogue. Parish nursing programs are about health ministry and congregational care ministry. Parish nursing emerged in the 1980s out of the Lutheran hospitals in the Chicago area.

The term, parish nurse, is also known as faith community nurse in academic circles. A parish nurse or faith community nurse is knowledgeable in both professional nursing and spiritual care. The spiritual dimension of persons is central to parish nursing. The focus of parish nurse practice is the congregation and its ministry. Some traditions relate a parish nurse to a deaconess.

By the 1990s, and because parish nurse programs had an aesthetic appeal, non-faith based institutions begin to launch parish nurse programs. The non-faith based parish nurse programs were often led by marketplace thinkers, as opposed to mission/ministry thinkers.

The marketplace approaches provided a commodity to a congregation with the church being the site for delivery of health promotion and wellness programs. Besides the mission/ministry and marketplace approaches, a third approach also emerged.

I labeled the third approach to parish nursing as the access approach. Access models were driven by community development theories of advocacy, poverty, justice and empowerment. Access models were political in nature, based on equal access for all resources, aiming to realign existing resources.

Many endowments and funding agencies gave grant monies to start up parish nurse programs wanting to improve access issues for the underserved. The access programs were often part of community coalitions.

There are varying assumptions in the three approaches I have described. In the mission/ministry approach, the nurse is a volunteer or paid staff on the ministry team of the congregation. Persons are served by a nurse called to congregational care ministry.

In answering the call to be a steward of the faith, the nurse finds purpose and meaning in rendering health ministry on behalf of their faith. Faith formation is at the core of understanding health because it is within faith formation that one comes to understand the integration of faith and health. The integration of faith and health is about becoming equipped with a capacity to endure the onslaughts of life – the spiritual, emotional, behavioral and psychological ups and downs.

In the marketplace approach the nurse may or may not be a member of the congregation. Marketplace approaches can offer in-reach programs for church members or assist in outreach to the underserved, geographic neighbors of the sponsoring congregation.

In the 1990s, many of the parish nurses were paid by hospitals and expected to produce predetermined outcomes for the health system. The marketplace approaches of the 1990s just did not bring about the hoped-for results and many faded away.

The nurse in the access approach serves as an advocate for the oppressed and is a catalyst or change agent to promote empowerment outcomes. The nurse as a social change agent may or may not fit into the ministry plan of a congregation because some faith communities promote social justice more than others.

The call is action based for a common good that leads to changes in the relationship between our government and our economy. Access approaches emerged in response to the decline in accessible health-care services and as government organizations began to seek community partners to assist with responsibilities of meeting the health-care needs of our poor.

Faith can be expressed through access models as some will offer programs to instill hope and teach that having a future is found in delaying gratification. However, faith formation comes through the congregation, and learning to delay instant gratification is best learned on a spiritual journey.

Parish nursing as a sub-specialty of the secular discipline of nursing continues to emerge. Congregational care has been central to the Christian church since its inception. Many programs exist as blends of the above approaches, and all three approaches contribute to redefining health.

The average person is not aware of the varying differences in philosophies behind parish nurse programs and, needless to say, would not recognize more than wonderful and needed services are being rendered.

Given the current state of the health-care dialogue, the time may be at hand for congregations to give a closer look at parish nursing and health ministry. Shrinking health-care resources are a reality regardless of the current debate.

Are congregations ready to reclaim health and caring ministries? Can we let go of secular health-care expectations and help others find health and healing as they accept the boundaries God provides one day at a time?

Christians are called to caring ministries. Congregations are full of people who want to reach out to hurting people but are unsure of the best way. Parish nursing may be a way to re-establish caring congregations.

Sybil Smith, a registered nurse, lives in Lyman, S.C., and is an independent consultant for ministries of health. She is the author of “Parish Nursing: A Handbook for the New Millennium,” a guide to designing health ministry programs that will complement a congregation’s ministry priorities.

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