Come All Ye Faithful: Diversity in Faith Community Nursing

Come All Ye Faithful: Diversity in Faith Community Nursing

by | Jun 26, 2014 | Asian-American and Pacific-Island Nurses, Black and African-American Nurses, Hispanic and Latino Nurses, Magazine

By providing health education and wellness promotion in religious communities of color, minority nurses of all faiths can make a powerful difference in eliminating health disparities.

Not that long ago, nurses who answered a calling to promote physical and spiritual health in their places of worship were known as parish nurses or congregational health nurses. But in today’s unprecedentedly multicultural America, where many of the faithful are just as likely to attend a Muslim mosque or Hindu temple as a church or synagogue, this specialty area of nursing has acquired a new, more all-embracing name: faith community nursing.

“When what we do was first recognized by the American Nurses Association [ANA] as a specialty practice in the late 1990s, it was under the title ‘parish nursing,’” says Nancy Rago Durbin, RN, MS, FCN, interim director for faith community nursing for the Health Ministries Association (HMA), a professional association for faith community nurses (FCNs). But by 2005, when Durbin was part of a team working with ANA to update the specialty’s Scope and Standards of Practice, the limitations of that name had become glaringly obvious.

“One of the ANA leaders said: ‘Do you have to be Christian to claim this specialty?’” recalls Durbin, who is also director of Advocate Parish Nurse Ministry and the Parish Nurse Support Network for Advocate Health Care in the Chicago area. “When I said, ‘No, this is by no means an exclusive specialty, any nurse from any faith is welcome to practice,’ she said: ‘Well, your name doesn’t seem to include that.’ And she was right!”

Of course, the term “parish nurse” is still alive and well. It’s widely used to denote FCNs who work to improve health in specifically Christian settings. But professional organizations like HMA and the International Parish Nurse Resource Center (IPNRC), a ministry of the Church Health Center, now recognize that church-based nursing is one thread in a much bigger tapestry that encompasses many different faith traditions. In fact, the Church Health Center, despite its name, teaches FCN training courses to nurses of all faiths all over the world.

When and how did traditional parish nursing evolve into this broader, more culturally inclusive specialty? “I’ve always known it to be all-inclusive,” says Maureen Daniels, RN, MN, FCN, an IPNRC faith community nurse specialist. “I think it’s just the organic nature of it that’s helped it grow into more of these other faith settings. One of the things that’s so beneficial about this model is that it’s meant to be adapted to the community and to where the needs are.”

Different Faiths, Same Roles

No matter whether the faith they practice is Baptist, Buddhist, or Baha’i, minority nurses need to be involved in addressing the health and wellness concerns of their own faith communities. Even though most FCNs do this work on a volunteer basis while also holding regular nursing jobs, they can make a tremendous difference in improving health outcomes and reducing health disparities in communities of color—especially those that are economically disadvantaged and/or medically underserved.

“[Places of worship] can be a very important resource for promoting health, because they reach so many people on a regular basis,” explains Ann Littleton, a congregational health advocate at Sacred Heart Catholic Church in Greenville, Mississippi, which serves a predominantly African American congregation plus a smaller Hispanic congregation. “At our church, we probably have more people from the community gathered together in one place every weekend than anywhere else. We can pass out information about cancer, heart disease, stroke, and diabetes just like we pass out the Sunday bulletin.”

The roles FCNs perform are remarkably similar from faith to faith. The Canadian Association for Parish Nursing Ministry organizes those functions into this easy-to-remember acronym:

H – Health advisor

E – Educator on health issues

A – Advocate and resource person

L – Liaison to faith and community resources

T – Teacher of volunteers and developer of support groups

H – Healer of body, mind, spirit, and community

For example, Ameena Hassan, RN, a Muslim nurse who works in the ICU at Las Colinas Medical Center in Irving, Texas, has been providing faith community nursing services at her mosque, the Islamic Center of Irving, since 2009. It’s a large mosque, serving approximately 500 families in the Dallas area.

“We do health education classes here every month,” says Hassan, coordinator of the mosque’s Health Advisory Committee. “We do blood pressure screenings and cholesterol screenings. We do mammograms every year, usually in April. During flu season, we do flu shots.”

The mosque also holds an annual health fair. At last year’s event—attended by almost 200 community members—local physicians, nurses, and dentists provided 100 cholesterol and diabetes screenings, 33 bone density screenings, 67 dental exams, and 42 vision exams. In addition, they gave 90 attendees nutrition advice and distributed 100 bicycle safety helmets to children.

At New Horizon Church International in Jackson, Mississippi, “cardiovascular disease is the number one health problem among my congregation, so we do lots of CVD screenings, education, and referrals,” says Ella Garner Jackson, RN, CHN, leader of the church’s Health and Wellness Ministry. Jackson and her team also provide a full calendar of other disease prevention programs, including exercise classes, kidney disease screenings, and HIV/AIDS education. On the advocacy front, the ministry helps increase access to health care for low-income church members by connecting them with community resources that provide affordable prescriptions.

Because Mississippi has some of the highest levels of poverty and African American health disparities in the nation—including disproportionately high morbidity and mortality rates from cancer, diabetes, and other chronic diseases—Jackson is especially focused on the FCN’s volunteer training role. In 2005, Jackson, who is also a cardiac case manager at Mississippi Baptist Medical Center, founded the Abundant Living Community Organization (ALCO), a nonprofit organization that has taught nearly 160 nurses and non-nurse volunteers to lead health ministries in African American churches throughout the state.

Same Roles, Different Needs

How faith community nurses carry out these roles is driven by the unique needs of the communities in which they serve. In some faith settings, for instance, FCNs must tailor their health promotion activities to accommodate specific religious requirements.

“In Islam, we don’t mix men and women together in the mosque,” says Hassan. “If we’re doing something like screenings or flu shots, we have to have it in two separate places for men and women. And the women’s space has to be covered, because they don’t want to [expose their bodies] in front of others.”

But in many minority faith communities, the biggest challenges for FCNs are more likely to revolve around cultural and socioeconomic needs than belief-based ones.

“Here in the Chicago metro area, Advocate’s parish nursing program includes two Latino congregations and two African American congregations,” says Durbin. “Our nurses who work with those communities are very focused on the needs of people who are disenfranchised, undocumented, and struggling with access to care. Some of our nurses are dealing with the problem of food deserts, and they’re trying to work with the communities to create sustainable vegetable gardens and increase access to quality foods.”

Littleton, a retired English teacher who became a church health advocate after taking the ALCO training in 2010, emphasizes that “in our Hispanic health ministry, we don’t ask about immigration status. If anybody comes to us in need of our services or a referral, we try to make them feel as comfortable with us as possible. It’s important for them to feel that we’re not going to pry into their status; we’re just providing health services that they need.”

One of the most empowering ways minority FCNs can lead their faith communities down the path to healthier living is by breaking down cultural barriers that exacerbate health inequities and impede access to care.

“In some African American communities, there is still enormous distrust of the health care system,” Durbin notes. “A black faith community nurse can become the entry point for many people to develop that trusting relationship. Someone may say, ‘I went to the public health clinic down the street and they were mean to me. So I’m not going back.’ And the nurse will say, ‘Well, how about if I go with you? Because that’s where you need to be to get your meds refilled.’ Then the nurse can physically take that person back to the clinic and help them [build a better relationship with those providers].”

Durbin also notes, “In our Latino communities, men’s health is a big issue. Many of the guys have traditional machismo cultural values, so they don’t take care of their health. And traditionally, it’s the women and the older men who are the churchgoers, but not the younger guys. Latino faith community nurses who know the culture can figure out creative ways to engage that core group of men, such as providing them with health information through the people who love these men and who do go to church.”

Enlisting the aid of lay community health promoters can also help FCNs connect with hard-to-reach populations. Daniels cites the example of a group of parish nurses in Portland, Oregon, who are partnering with local promotores to extend their health ministry outreach deeper into the Hispanic community. “Because the promotores had such good relationships with the people, and people trusted them so much, they were able to get many more community members to come to health events the nurses had organized than the nurses would have gotten by themselves,” she says.

Bridging Cultural Differences

Even if a nurse doesn’t share the same religious, ethnic, or cultural background as the faith community he or she works with, collaborating with leaders within the community can be an effective way to bridge those gaps. For example, the Faith Community Health Ministry (FCHM) program at Carolinas HealthCare System in Charlotte, North Carolina, uses a model that makes it possible for the hospital system to meet the needs of virtually any belief community.

“We form partnerships with faith communities through either a faith community nurse or a faith community health promoter,” explains Sheila Robinson, BSN, RN, the program’s health ministry coordinator for Mecklenburg County. “My role is to help each one of those individual communities promote health and wellness within their own particular faith. I provide the clinical guidance and oversight to the nurses and the health promoters.”

This approach enables Robinson, an African American Christian nurse, to work with such diverse faith communities as the Hindu Center of Charlotte, a temple that serves about 2,000 families. Her health promoter partner is Chidaabha Vyas, vice president of the Hindu Center’s executive committee. When they first teamed up in 2012, one of their key projects was to survey the temple’s members about their most important health concerns and then develop programs targeted to those needs.

“Heart disease, allergies, and weight loss were some of the top concerns the community identified for us,” Vyas says. “Diabetes is a very big concern. And it’s not specifically the Hindu community that’s so affected by this disease,” she points out. “It’s [Asian] Indian people in general. Diabetes is more of a concern for us as a race, I would say.”

Being able to work side by side with a community liaison like Vyas makes it easier for both Robinson and Carolinas HealthCare System to serve the local Hindu community in culturally sensitive ways. “When we formed the partnership, I told Chidaabha, ‘I’m of Christian faith, so you will have to help me to be able to meet the needs at the Hindu Center,’” Robinson says. One cultural lesson she learned early on is that some members of this community may be uncomfortable with the idea of placing a terminally ill family member in hospice care.

“Again, this is more of an Indian cultural issue than a religious one,” Vyas stresses. “Some of us do not believe in speeding up the process of death. We believe death will come when it will come. Having a connection between our temple and the hospital system through the FCHM program is very helpful, because we can let them know that when an Indian family is resisting hospice it’s because there is a real cultural dynamic going on.”

A Higher Power

Praying isn’t enough to make America’s health disparities crisis go away. But by educating, advocating, and integrating spirituality with health in all the diverse settings where people gather together to pray, faith community nurses have the power to bring about real change.

“Because of our partnership with Sheila and the FCHM, something is happening at the Hindu Center now that was never happening before,” Vyas reports. “It has helped us develop a culture that prioritizes health. Before, health was thought of as more of an individual responsibility. But now, we’re beginning to develop a connection with our members based on the idea that ‘you are responsible for your own health, but the temple is here to help you be responsible for your health.’”

Jackson adds: “My pastor has told me, ‘I know that you’ve saved some lives in this congregation. I know that I am a healthier person myself because of all the education you’ve provided in the church.’ I can look out into the pews and show you people who were not going to the doctor, who weren’t taking their medicine, and who are now routinely seeing a physician. That’s at the heart of what a faith community nurse can do.”

 

Honoring Religious Practices

Honoring Religious Practices

by | Jan 12, 2014 | Magazine

When Maria Krol, DNP(c), MSN, RNC-NIC, a professor in Southern Connecticut State University’s nursing program, talks to her students about religious traditions, she gives them this concise advice: “I tell them check ‘I wouldn’t do that!’ at the door.” 

Krol’s point echoes what many experts say when thinking of the delicate and critically important intersection of religious beliefs and medical practices. No matter your own beliefs or your own understanding of what will make a patient’s health better, each patient has to be able to live with their choices, says Krol.

And while nurses need to have an understanding of the impact religion can have on a patient’s approach to medical instructions, they do not necessarily have to become experts in world religions to be effective.

“How they interpret practices is in some sense irrelevant to nursing,” says Marsha Fowler, co-author of Religion, Religious Ethics and Nursing, and professor of spirituality and ethics for the Haggard School of Theology at Azusa Pacific University in Azusa, California. Patients, even those within very specific traditions of one faith, can still have varying practices and beliefs. “What they share is how traditions define their health care and influence their choices,” says Fowler. “Interpretation of one’s own traditions is widely divergent.”

If you are unsure of a patient’s preferences and wishes, just ask, says Fowler. “At the heart of nursing is relationships,” she says. “At the heart of religion is relationships.”

“In this day and age, it is not politically correct to talk about religious beliefs,” says Barbara Head, president of the Hospice and Palliative Nurses Association, and assistant professor in the interdisciplinary program for palliative care and chronic illness at the University of Louisville School of Medicine. “But as a nurse, you have to ask about those beliefs.” And realize that even those who don’t align with a particular faith may still hold significant beliefs. “Think of spirituality before you drill down to religion,” she says. “Everyone is spiritual. There are very spiritual people who don’t go to church.”

A 2004 study published in the Annals of Family Medicine showed that 83% of respondents were open to discussing their religious beliefs and spirituality with medical staff at least in some circumstances. Patients reported wanting physicians to understand their beliefs and use that knowledge to help guide their approach and interactions. Some said they thought if caregivers understood their religious beliefs, they would gain a better understanding of the patient and how he or she makes decisions.

Most experts say nurses should have a general understanding of the major faiths of the population they treat, but should not be as concerned with understanding the practices as they are with understanding how the patient interprets those practices. “You need to know how religion functions and how religious traditions define health, care for the self, and care for the stranger,” says Fowler. “It is how their religious faith informs the ways they do or do not care for themselves during times of illness.”

And in many cases, nurses may find that most religions set aside many guidelines and regulations in instances of illness, says Fowler. In Judaism, she says, 610 of 613 religious laws can be set aside in case of illness—only idolatry, murder, and adultery cannot. But patients may want to adhere to certain traditions because those practices give them comfort. “If a patient has eaten a particular way all his or her life, the need to adhere to it may not be a matter of religious faith but a not wanting to change the diet when ill,” she says.

Nickie Burney, NP, a recent graduate of the Simmons School of Nursing and a nurse practitioner on the inpatient general medicine ward at Brigham and Women’s Faulkner Hospital in Boston, says sometimes patients are looking for reassurance before they open up to you. “Patients want to talk about themselves and how they treat a problem, and how their families react,” she says. “If you don’t give them space to understand their practices, you are shutting them down. Let them tell you that.”

One of the best ways to help patients who rely on faith and spiritual practices is to ensure a continuity of care throughout all the nursing staff and shifts. Nancy Beck, a nurse in a progressive care unit at a Columbia, Missouri, hospital, says reporting details from nurse to nurse keeps information from getting lost. If you can do this in front of the patients and the family, the result is that much better. “It relieves a lot of stress on the family when it is shared openly,” says Beck.

Of course, be mindful of any information that could cause discomfort. For instance, some faiths strongly believe in same-sex caregivers. Muslim patients who may need time to pray five times a day will appreciate it if procedures are not scheduled during those times. Some religious holidays require fasting, sometimes for hours at a time.

“Communication is the key,” says Krol. “You can’t assume they know something is important.” A diabetic cannot go a whole day without food, so Krol says finding a modification of the practice that will work and be acceptable to the patient is crucial. You can give all the instructions you want, she says, but if the plan is something that the patient is not willing to live with, follow-through will be poor.

Advice for New Nurses

Even if a nursing school offers a general overview course in world religions, the nuances of religious practice and belief are something you can only get by interacting with each patient. Hopefully, a nursing student learns a little amid the science-packed nursing curriculum, says Head. But it really takes time with patients and the guidance of a mentor for a nurse to gain comfortable footing on such an often-intangible subject.

Head’s advice for new nurses is also helpful for any nurse who wants to feel more comfortable dealing with religious topics. “Encourage people to talk, ask open-ended questions, and be a good listener,” she advises. Questions like “How does your spirituality impact your coping?,” “How important is spirituality and religion to you?,” and “What do you rely on in times of need?” can help you understand your patient’s needs.

Burney also advises listening carefully to other clues that may be faith-based. Discussions about foods or medicines they have used might give you more insight to their practices if you just ask about them. “I just tell them I have never heard of that and ask them what is that and what does that do,” she says. “You have to ask people what is going on.”

Finding Your Own Comfort Level

Nurses know their jobs bring them in contact with people in crisis who may be asking themselves and their caretakers tough questions. Patients might even ask you to pray with them or might inquire about your own religious beliefs. How comfortable are you with that?

“Nurses help people and tend to think they have to fix a problem and do something,” says Head. “There is no fix for spiritual questions.” And even when patients ask difficult questions like “What will happen after I die?,” Head says they are not looking for an answer. “They are asking to be heard. Even if you give an answer, it might not work for them.”

Nurses don’t have to solve everyone’s problems, and for issues they find uncomfortable or unable to answer appropriately, they should always remember to call on the leaders of the patient’s faith, whether that is a chaplain, rabbi, shaman, or whomever the patient prefers.

Sometimes, especially if a nurse is going through a personal crisis, spiritual discussions with patients can be uncomfortable. While many experiences in a nurse’s life can help others and be meaningful to them, assumptions about religion have to be set aside. That can be challenging for a nurse, but it is important for the patient.

“If a nurse is uncomfortable with that, he or she probably needs to do a little work in that area,” says Head. “There needs to be a self-awareness that there is that discomfort. They can read books or speak with a counselor or spiritual mentor.”

If you are comfortable with other religions and participating in some way, you can say to the patient, “You pray and I will pray with you,” advises Head. You can ask them for their words of prayer if you want. Some nurses prefer not to pray in another faith. That is fine, says Head, just let the patients know that while you respect and honor their beliefs, you are not comfortable participating but that you will call the chaplain for them.

“It is about taking a deep breath and being centered and confident in who I am,” says Beck. “My recommendation is to get clear on your beliefs and to know what is your truth.” Nurses certainly don’t come to this realization without some reflection and some thought, but if they can take the time to do so, they will end up in a much more comfortable place. Beck says she knows when most patients ask her about her beliefs, it comes from a place of caring.

Paths

A nurse’s responsibility is to make sure patients have enough information to make an informed choice about their own health care. “Once they are given that information, then we support their choice, even if it may not be our choice,” says Head. Especially in palliative care, choices about treatment are very personal. If the choices stir up feelings in the nurse, it risks shifting the focus of the conversation from the patient to the nurse. “Without even realizing it, I can walk into a room with an agenda,” says Burney, who is cautious about evaluating her own assumptions.

Carol M. Davis, DPT, EdD, MS, FAPTA, a professor emeritus in the University of Miami Miller School of Medicine’s department of physical therapy, recommends the FICA method of evaluating how to get a sense of what is happening with your patient.

The FICA evaluation method, developed by Christina Puchalski, MD, allows a nurse to assess how religion and spirituality play a role in a patient’s understanding and motivation to get better and what he or she relies on for support and comfort. The evaluation includes questions about the patient’s: Faith (Do you consider yourself religious?); Importance and influence of religion (How important is religion to you?); Community (Besides attending church, are you a member of other groups?); and Address in care (What can be done to help you get your religious and spiritual needs resolved here?).

Studies have shown that patients are comfortable with discussing religion with caregivers who are willing to walk the line of spirituality and science. “The bottom line,” says Davis, “is that active listening and compassion is enough, along with questions of ‘how can I help’ and ‘who can I get to come talk with you?’”

Despite the often-charged atmosphere around religion and diverse beliefs, nurses’ questions are often received with relief and welcome. “Human beings all want the same love and respect for the individuals we are and want to be listened to,” says Davis. “The ill have resources to cope, and for most people that will include some spiritual help. Our job is to help.”

Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.

 

Ad