A Parish Nursing Ministry
By Jan Bear
How It Works at St. Nicholas Church, Portland OR
Parish nursing is a specialty practice and model of health ministry rooted in the historic ministry of the Church, and whose focus of practice is the faith community. It strives to bring health, healing, and wholeness to the whole person, addressing the physical, emotional, spiritual and social aspects of health and illness in a context of prayer and spiritual growth.
The St. Elizabeth Parish Nursing Ministry at St. Nicholas Parish in Portland, Oregon is presently made up of ten members. Although it is not necessary to have a medical background, most of the members do—doctors, nurses, a physical therapist, a speech therapist and others. They do not do hands on medical care as part of the parish nurse ministry except for periodic blood pressure checks, but they offer themselves as a resource for any one who needs help in any medical context.
They might coordinate rides for those who need them or call for packaged dinners that a family can simply pull from the freezer and heat for a quick, easy home-cooked meal. Of course, the specific needs are as unique as the sufferers, but the St. Elizabeth team seeks to learn those needs and finds the right people, frequently parishioners, who can address them.
The team also sponsors workshops on health topics, drawing on experts in the parish and the wider community. Since ours is a widely dispersed parish of primarily working families, it works best to hold workshops in conjunction with Vespers services, when people are likely to be at church anyway. Thus, workshops usually happen on Tuesday or Thursday after Vespers. Since many of the participants will be stretching out a long day, organizers provide snacks and make sure that the program does not go on too long because participants will have work or school the next day.
The team has worked with other parishes in our city to offer three half-day workshops on lay visitation. These longer workshops are usually scheduled on a Saturday.
Lay visitors are parishioners who informally visit people who are shut in or ill. The workshop training helps people who want to be a part of this ministry but are unsure of their skills or are uncomfortable visiting an ill or elderly person. Partly because of the emphasis on professionalism in our culture, people do not feel “qualified” to do what neighbors and community have always done. Because of our emphasis on individualism, people are afraid of “offending” or “intruding.” They need not only permission, but encouragement and training.
Lay visitors do not need to be healthcare professionals. They need to be caring people who are good listeners. They help the parish member who is isolated feel connected to the community. They let the shut-in know he or she is missed. The person they visit may simply be isolated and lonely or going through a difficult time. Lay visitors reach out and are present, looking for ways to care for that person in his or her struggles.
Recently, Dr. Dan Hinshaw, a palliative care expert from Michigan, spoke at one of these workshops. His was the third of four lay visitation workshops. He spoke about how Orthodox Christians look at death as opposed to the way the culture at large does. He and his wife, Dr. Jane Hinshaw, are both involved in promoting a home for the dying poor, called St. Elizabeth House, near Ann Arbor, Michigan. At the fourth workshop, staff of a local hospice addressed the issue of how to talk about death and how to minister to those who are dying and their families. Later, our parish put together a resource manual on the end of life and has been presenting workshops on how to prepare for death.
Lay visitors may work singly or in teams, as they and the parishioners feel comfortable. Going in teams is a good way to train new visitors, and it may also give the person being visited a sense of community. At other times, it may be difficult to coordinate visitors’ schedules, or the person being visited may feel overwhelmed by too many people. Team members work out what is best on a case-by-case basis.
One lay visitor, a member of the parish nursing team, Helen, who is a nurse, was passing through a hospital on a work assignment when she saw one of our parishioners, a young woman in labor. It was a difficult childbirth, and Helen stopped to pray with the young mother. Through her ministry and the Lord’s work, the young mother was able to be calmer, and the child was born safely.
The Beginning of the Parish Nursing Ministry in Our Parish
Nicholas began its parish nursing program in the Fall of 2002, as the pastor, Fr. George Gray, looked for help in dealing with the pastoral needs of his rapidly growing parish. He asked Karen Hadley, a registered nurse who had been involved in parish nursing for fifteen years, to spearhead the effort. Karen began with an invitation to a group of parishioners she thought might be interested in the project. Some were health care professionals, others were people whom Fr. George identified as being interested in pastoral ministry of various sorts. She found the members to be enthusiastic about the project, as were the members of the parish council when she discussed it with them, and then the parish at large. Fr. George talked about the ministry during homilies, and the parish nursing team started up blood pressure screening clinics once a month after Liturgy.
Even though some of the parish nurses found major health problems in this way, Karen says that the most important result of the blood pressure screenings was to establish relationships between the parish nurses and the parishioners, and to get people comfortable with the compatibility between faith and health and the whole concept of a parish nursing ministry. ” I am always amazed at how people will open up and discuss many things, when given the undivided attention of one interested person, especially a nurse,” Karen said.
Karen went back to school and took the basic parish nursing class. Although she had been doing the ministry for 15 years, parish nursing became a recognized specialty (recognized by the American Nurses’ Association) with an approved curriculum only in the early 1990’s. The curriculum is 37.5 contact hours and is taught by a certified faculty person. Karen recently received her certification as a faculty person and may be teaching the basic parish nursing class at one of our Orthodox seminaries in the near future.
How the Ministry Has Developed
Based on what Karen learned in class, the parish nursing team did a parish community assessment. Fr. George and the Health Cabinet (the name for the initial core group) worked hard to build a good response. The assessment helps the team learn what needs in the parish they should address and also helps promote the concept of parish nursing.
The team hosted a special fund raising luncheon. They had a great response and raised a significant amount of money for the ministry. Working from the assessment, they planned health seminars for the year that included presentations on osteoporosis and bone density testing, depression, back health, allergies, end of life issues and stroke prevention. They decreased the blood pressure screenings to quarterly events and offer an annual hearing screening. They continue to sponsor one fund raising luncheon per year.
The ministry team took the name “St. Elizabeth” from Elizabeth the New Martyr of Russia, a convert to Orthodoxy and member of the Russian nobility, who used her resources to minister to the poor and sick in Moscow. When St. Nicholas Church was consecrated in 1998, it received a relic of hers to be placed in the altar.
Typically, the St. Elizabeth team hears about a need through word of mouth. Perhaps Fr. George or Matushka Daria will hear of someone who is ill or has had surgery or whatever, and will tell Karen. Karen calls and asks to arrange a visit. If that’s possible, she will assess needs and offer additional support. ” Most folks are hesitant to ask for or even to accept help,” Karen says, “but most always appreciate meals, cards and calls.” Many referrals happen because of casual conversation over lunch on Sunday. Someone will mention someone who has not been around and ask Karen to check on that person. Or Karen may notice that someone is ill or missing and follow up on her own.
Rides and dinners are coordinated through the St. Elizabeth team, but the ones who actually prepare the dinners or give the rides may not be part of the team, but other parishioners. If someone becomes aware that a dinner or a ride is needed, he or she contacts the parish nursing team, who get the word out to parishioners that have asked to be contacted in such a case. If it is an ongoing need, such as a long-term illness, there is a sign-up sheet.
Nursing Ministry as an Adjunct to the Priest’s Ministry
As pastor of an active parish, Fr. George sees the parish nursing team not as competition, but as an adjunct. Like many priests, he is pulled in many directions all the time. His visits to the sick and homebound continue, but the greater help that parishioners receive simply would not be there if only one person had to be responsible for all of it—especially if that one person were also responsible for everything else for which the priest is responsible.
Too, a nurse’s training enables the parish nurse to observe needs that a priest may not notice, as well as to know how to address those needs. The parish nurse can be an important resource for the priest in caring for the community. Furthermore, it is important for lay people to participate in caring ministries. Their efforts build the Body of Christ in giving as well as in receiving.
“The key to making this relationship work,” Karen says, “is for the priest and the parish nurse to have a good relationship, to understand how their roles complement one another, and what the boundaries are.” She is quite careful not to overstep her boundaries, she adds, and to seek Fr. George’s approval or advice before doing something new.
In that regard, Karen attended the Summer Institute at St. Vladimir’s Seminary in 2001. That year it focused on healing. She was particularly inspired by Dr. Paul Meyendorff’s teaching on unction and later discussed it with Father George. As a result, Fr. George commissioned a few members of the St. Elizabeth ministry team to anoint sick parishioners with oil taken from the shrine lamp that hangs near the relics of various saints in a reliquary in the church. This oil is not for sacramental anointing, but is the oil that is given to the faithful when visiting the tombs of the saints or from shrine lamps that they can take home and use. “We haven’t done this very often,” Karen says. “We’re still new at this—but when it has happened, it has been a powerful blessing.”
As an interesting result, one person was brought to Orthodoxy when a member of the St. Elizabeth team prayed for and anointed that person’s neighbor who was sick at home.
Supported by a Ministry of Prayer
Most important to the Parish Nursing Ministry is that all of the services rendered are supported by a multifaceted ministry of prayer. Fr. George leads an unction service for healing on the second Saturday of the month after Vespers. Anyone who wants unction for healing is welcome. The commissioned members of the Nursing Ministry team may pray for and anoint those they visit in their homes or in the hospital. A third aspect of our prayer ministry is a prayer box where prayer requests are placed. A volunteer “prayer coordinator” collects these requests and sends them out to the prayer team, a group of parishioners who have agreed to pray for these needs in their individual prayers. These prayer requests are also put into a monthly prayer booklet, along with the names of parishioners (the parish directory is prayed through on a cycle) and made available to everyone in the parish so that they can pray for each other.
Besides the Parish Nursing Ministry at St. Nicholas Church, the team has been promoting a pan-Orthodox parish nursing and lay visitation ministry in the Portland area. They have observed that small, individual ministries are difficult to maintain because resources are scarce. It would help everyone’s ministry efforts to share resources for training and education. They also hope that a collaborative ministry will promote community among the Orthodox parishes in the city and will be a good witness to Orthodoxy. So far, one other parish nurse from another Orthodox parish has been trained, but others have expressed interest in taking the class that will be given in January. The pan-Orthodox ministry is named after St. Nectarios.
A Final Example of the Ministry’s Work - Alla
Alla was one of the first parishioners that the Parish Ministry team was able to help - an older woman who had spent her life in caring for her invalid daughter, her aged father-in-law and anyone else who came her way. She once told me, “When I can get up in the morning and help someone, it’s a good day.”
As she neared the end of her life, it was time for her to receive help, and because her daughter was so sick, her family did not have the resources to help her in ways that she needed. When her car became unsafe to drive, a parishioner found her an inexpensive working car that would get her to church on Sundays, as well as to appointments and to visit her daughter throughout the week.
After her health deteriorated and she could no longer drive, the St. Elizabeth team worked with her physician to get her a walker, nutritional products, and a small portable oxygen system when she needed them. They worked with the family in many ways behind the scenes to make the end of Alla’s life as fulfilling as it could be.
Parish nursing is becoming more prominent as both medical and religious communities realize the confluence of their interests in healing the whole person—body, soul and spirit - within the context of a faith community.