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Parish Nurses Who We Are...

Parish Nurses Who We Are, What We Do, And How We Do it
Replicated with Lutheran Parish Nurses International

By Marcia Schnorr, EdD, RN-BC
Introduction
The original descriptive study (2012) was completed by Carol A. Lueders Bolwerk, RN, PhD, Director of Parish Nurse Ministries at Concordia University Wisconsin.  The study is available at www.lcms.org/health/parishnurse/resources or www.lpni.org
Lutheran Parish Nurses International, NFP (LPNI) is a network of parish nurses serving Lutheran congregations and their communities throughout the world.  The largest number of Lutheran parish nurses are found in the United States of America (USA).  One or more Lutheran parish nurse has been identified in Australia, Canada, Finland, Germany, India, Madagascar, Norfolk Island, Palestine, and Papua New Guinea. Expressions of interest have been received by one or more individuals in several other countries but no Lutheran parish nurse has been identified.
Monthly Listserve discussions, annual study tours and intentional on-site visits for various purposes have suggested that there are both commonalities and differences among the Lutheran parish nurses in the global community.
The same survey used by Dr. Carol Lueders Bolwerk in her study was distributed to a convenience sample of Lutheran parish nurses who are part of the Listserve and/or participated in the LPNI Study Tour in 2015.  24 (27.5%) were returned from a possible 87.  (It is known that there are many more Lutheran parish nurses in the global community but not all known to LPNI.) Surveys were returned from Australia (4), Canada (2), Norfolk Island (1), Palestine (1), Papua New Guinea (5), and the USA (11).  A diaconal nurse from Finland explained that the survey was difficult for her to complete because she is in academia rather than practice.  It is speculated that language difficulties and intermittent internet capabilities made it difficult for some to respond.
All of the responding parish nurses were female. All except two served within their own faith community and were members of the church they serve.  Other descriptors noted are
  • The ages ranged from 39-79 with bimodal distribution of 3 each for ages 66 and 67.  The mean age is 60.9 years.
  • Nineteen respondents identified themselves as Caucasian; five were from Papua New Guinea; one identified herself as Asian.
  • Nursing education included licensed practical nurse (3), diploma (7), bachelor’s degree (7), masters as terminal degree (1), doctorate (2), other- CHW (2).
  • Parish nurse education courses varied from on-site 2-8 days or electronic or distance learning (with times varying from months to years).  On-site courses were taken by 14 parish nurses; 8 participated in either electronic or distance learning courses; 1 did not take a course; 1 did not answer.
  • Length of service ranged from 4 months to 27 years.  The mean was 8.6 years.
  • Twelve identified themselves as serving as a parish nurse coordinator either in their congregation or a network.  One took a parish nurse coordinator’s course; the others did not.
  • Twelve said they serve with other parish nurses.  Most cited 1-8 other parish nurses; two cited 60-70.
  • Twelve consider themselves as “volunteer” parish nurses with hours per week described as 2-3 (2), 5 (1), 30 (1), varies (8)
  • Eleven were paid a salary; 1 receives a stipend plus mileage and expenses; 10 receive no payment; 2 did not respond.
  • Those who receive payment listed the hourly rate as under $5 (2), $7 (1) $10 (2), $12 (1), $19 (1), $20 (1), $22 (1), $25 (1)
  • Some parish nurses identified other benefits such as insurance (3) and mileage (5)
  • Fifteen of the parish nurses consider themselves employees or volunteer employees of a church. Others identified hospital, nursing home, Lutheran Outreach Ministries, Consortium, Inner city Lutheran Schools, government, nursing school, clinic, or “other” as a place for employment. Two stated that they had no appointment.
  • Seven said they served more than one congregation.
  • The parish nurses serve in locations considered rural (6), suburban (8), urban (5), inner city (2), island (1) town (2)
  • Parish nurses serve in congregations of various sizes from less than 100 (1), 101-200 (2), 201-300 (4), 301-400 (3), 401-500 (5), 501-600 (2), 701-800 (1), 801 and above (2)
  • Parish nurses cited usual Sunday attendance as less  than 100 (4), 101-200 (6), 201-300 (3), 301-400 (4), 401-500 (2), 501-600 (1), and 701-800 (1)
  • With the exception of the parish nurses from Papua New Guinea who whose congregations ranged from 98-100% Papua New Guinea ethnicity, the congregations were reported as 60-100% Caucasian, 0.01-35% African American, 0.1-25% Hispanic, 0.01-25% Asian.  The parish nurse from Norfolk Island reports multinational islanders and Caucasian.
  • The respondents were from the following Lutheran bodies:
    • Lutheran Church Missouri Synod- 10
  • Lutheran Church in Australia- 4
  • Evangelical Lutheran Church in America-1
  • Evangelical Lutheran Church in Canada-1
  • Evangelical Lutheran Church of Jordan and the Holy Land-1
  • Evangelical Lutheran Church Papua New Guinea-4
  • Lutheran Church Canada-1
  • Renewal Lutheran Church (Gutnius Lutheran Church PNG)-1
  • Other (Parish nurse is a member of the LCA but living on Norfolk Island where there is no Lutheran Church)- attends SDA- 1
  • The “typical” parish nurse in LPNI is female, Caucasian, 60.9 years of age with either a diploma of bachelor’s degree in nursing.  She probably completed an on-site parish nurse course.  She serves in the congregation where she is a member and has been in the position for 8.6 years serving as coordinator for a team of 1-8 other nurses.  She receives some remuneration but it may or may not be a salary.  Her congregation has a membership of 401-500 and could be located in either a rural, suburban, or urban setting.
    Comparison to Findings in Study by Dr. Carol Lueders Bolwerk
    There were similarities and differences between the findings in the original study by Lueders Bolwerk in the USA and the smaller replicated study with LPNI.
    • In both studies all the respondents were female.
  • In the original study, ages ranged from 35-86 (with a mean of 65 and 65% being 60 years or older).  In the LPNI study, ages ranged from 39-79 with 60.9 being the mean and a bimodal distribution of 66 and 67.
  • In the original study, 98% were identified as Caucasian.  In the LPNI study, 78% were Caucasian.
  • In the original study, 39% had been parish nurses less than one year.  In the LPNI study, the average length of service was 8.6 years with a range of 4 months to 27 years.
  • In the original study, 84% served within their faith denomination and church membership.  In the LPNI study 91% served in their own faith denomination and church membership.
  • The spread across various levels of nursing education were similar in both studies.
  •   
    What We Do
    The survey asked for the respondent to identify ages served, special groups served, and activities that they include in their parish nursing.
    Thirty-nine percent of the respondents identified the following populations served in the “infant through high school” division: infants/toddlers (6), preschoolers (5), primary grades (9), middle schoolers (8), and high school (9).
    Activities identified were
    • Infants/toddlers: speak at MOPS, newborn gift bags with Baptism encouraged, immunization information, help in nursery, nutrition, mix diet
  • Preschool: health topics at school, play group helper, hearing and vision checks, physicals, nutrition, mix diet
  • Primary: as requested by teacher, school health, vision and hearing, health teaching, personal hygiene education, blood pressure, height and weight
  • Middle school: sex education for parents, school health, vision and hearing, BMI, physicals, health education, peer pressure education
  • High school: sex education for students, topics upon request, hearing and vision, physicals, BMI, blood pressure, height and weight
  • Comparison to Findings in Study by Dr. Carol Lueders Bolwerk
    The original study identified health screenings, health education, vacation Bible school, hand-washing education and resources for parents as the main activities for infant to middle school groups.  The LPNI study did not identify vacation Bible school as an activity in which the parish nurse participated.
    The original study listed health education, health counseling, first-aid and CPR for the high school students.  The LPNI study did not include first-aid and CPR but was a continuation of physical exams and screenings.
    Seventy-eight percent of the respondents identified service to the “college to senior” division: college (6), middle aged (17), and seniors (20)
    College: resource person, teach healthy choices, BMI, BSL, blood pressure, weight and vision.
  • Middle-aged:  health teaching, teach Bible studies, blood pressure clinics, visitation, walking groups, grief, flu shot clinic, BMI, prayer, sharing food, weight, vision
  • Seniors: visitation, arthritis exercise, foot care, Bible study, blood pressure clinic, newsletter, Lutheran Womens Missionary League, senior groups, walking group, medical equipment closet, assist with doctor visits, assist with shopping, monthly German group, BMI, BSL, food, weight, vision, recreational activities, diabetes education, flu shot clinics, celebrate recovery group, medication education, prayer shawls
  • The following special groups were identified by the respondents: elderly (10), frail elderly (7), retired (3), developmentally disabled (4), widowed (8), veterans (6), chronically ill (7), coffee and friendship (2)
     
    Comparison to Findings in Study by Dr. Carol Lueders Bolwerk
    The original study identified health education, first-aid, and CPR for the college student.  Parish nurses identified blood pressure screenings, health education, visitation, exercise ministries, monthly newsletters, and flu shot clinics as their main service for the middle aged and older adult. The LPNI study found similar listings but also had walking groups and BMI as common activities.
    How We Do It
    Fourteen respondents report a budget (ranging from $800-$22,880).  Three obtain money from grants and donations.  One reports a “large fund from selling Sunday newspapers and donations”.  Nine respondents did not identify any source of funding.
    Thirteen have a health committee with 1-9 members that provide support in the ministry.  Committee members may include clergy, other nurses, teachers, elders, psychologists, lay people, members of the seniors group, and church board members.  Meetings vary from semi-annually to bi-monthly.
    Ten respondents have secretarial help. Twenty acknowledge clergy support.  Eight have funds provided for travel, continuing education, and workshops.
    Fourteen respondents said they were supported by their family.  Some said their husband or other family members love, support, and help with programs and other needs.  One said “my family does not feel this is ‘real nursing.’” One said her family seems proud.  One said that her spouse is a non-Christian.  Two said they live alone and do not have a family.
    Sixteen feel supported by their clergy. Comments included “he won’t let me cut my hours down,” “he encourages me,” “pretty free say in program,” and “he keeps me informed.”  One said they were in a vacancy, but has been supported in the past.
    Fourteen felt supported by their congregation.  Comments included “many do not think there is a need for a nursing position in the church…a few think it should be stopped.”  “Most do not get involved with activities, however, do ask medical questions.”  “Those who have not used my services are sometimes not sure what I do.”  Some report support through verbal acknowledgment, notes, and/or donations.
    Eleven feel supported by their community saying there are often more from the community attending their programs than members.  Others say that people in the community do not know what parish nursing is and so do not actively support it.
    Comparison to Findings in Study by Dr. Carol Lueders Bolwerk
    The international study and the original study were similar in many ways.  Both studies had between one-half to two-thirds feeling support from clergy, family, and family as well as in having a committee.
    Conclusion
    The international study showed that parish nurses reflected the ethnicity of their country with the exception of countries with multiple ethnicities.  In countries with mixed ethnicity, parish nurses in the study were Caucasian. The average age for parish nurses in Australia, Canada, and the USA was older (63.6) than the average age for parish nurses in Palestine and Papua New Guinea (51.3).  (The average for the ample population was 60.9 years.)
    In most demographics the international study and the original study were similar.  The roles for parish nursing were similar across the sample population but the specific programs varied with socio-cultural norms and needs.  All parish nurses provide a Christ-centered ministry with prayer, devotions, and ministry of presence and visitation being a regular part of their ministry.
    Recommendations
    1. Continue to develop opportunities for parish nurses in the global Lutheran community to promote, support, and equip parish nurses in their ministry.
    2. Identify a “national representative” for each country known to have Lutheran parish nurses to assist with identification of Lutheran parish nurses and to serve as a liaison in disseminating information.  [This representative will help to minimize obstacles due to language barriers, time differences, and unavailability of electronic media.]
    3. Increase sample size in future research.
    4. Continue to offer cost-effective study tours (including scholarship and suggestions for funding) throughout the global Lutheran community.
    5. Utilize Skype and similar methods for two individuals or small groups to network, pray, and learn from one another.
     
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