Public Health Nursing Vol. 20 No. 2, pp.
85–94
0737-1209/03/$15.00
Ó Blackwell Publishing, Inc.
Parish Nursing: Nurturing Body,
Mind, Spirit, and Community
Ingrid Brudenell, R.N., Ph.D.
Abstract Parish nursing is a model of nursing care that focuses
on health promotion and disease prevention within a faith
community. A descriptive study was conducted in the intermoun-
tain West to determine how faith communities form parish
nursing programs and what their effect is. Thirteen congregations
representing eight denominations with parish nurse/health min-
istries participated. Parish nurses, parish nurse coordinators from
two medical centers, pastors, and hospital chaplains (n ¼ 24)
were interviewed and provided documents from their programs.
Over time, congregations formed parish nursing/health ministries
using strategies in a developmental process. The process involved
significant support from the pastor, congregation members, and
the parish nurses. Collaboration between faith communities and
health organizations were successful using a limited domain
approach to attain specific health goals. Parish nursing is making
a contribution to integrating faith and health practices, promo-
ting health, and increasing accessibility to health care and
congregational activities. Conclusions and recommendations
are included for future research, practice, and education.
Key words: parish nursing, health promotion, disease preven-
tion, collaboration, faith community, religious leaders.
We need a new vision of health and well-being.
Give us new dreams and new vision.
Help us hear your stories. (Benner, 1992).
Parish nursing is a health-promotion, disease-preven-
tion model based on the care of the whole person within a
religious community (Berquist & King, 1994). The
purpose of this investigation was to describe parish
nursing and it’s effect on the health of faith communities
Ingrid Brudenell is a Professor with the Department of Nursing, Boise
State University.
Address correspondence to Ingrid Brudenell, R.N., Ph.D. Department of
Nursing, Boise State University, 1910 University Drive, Boise, Idaho
83275. E-mail: ibruden@boisestate.edu
located in southwest Idaho. This qualitative study used
interviews, participant observations, documents and
reports, photographs, and personal experiences during
spring 2000. Nurses, religious leaders, and hospital
chaplains described 13 parish nurse programs. Results
of the study will be discussed and recommendations made
for practice, research, and education.
REVIEW OF THE LITERATURE
Parish nursing—holistic care of body, mind, and spirit
focused on parishioners in congregations—was first
described and initiated by Reverend Granger Westberg
during the early 1980s in the Chicago area with six
churches and parish nurses (Westberg & McNamara,
1987). The initial program was interdenominational, with
Catholic and Protestant churches. Ecumenical cooper-
ation has been a characteristic of parish nursing from its
beginning. The concept and model has been adopted
throughout the United States, Canada, and other coun-
tries. The International Parish Nurse Resource Center
estimates that there are more than 3,000 parish nurses
(Biddix & Brown, 1999). In 1998, the American Nurses
Association (ANA) recognized parish nursing as a
specialty area of practice and published scope and
standards of practice (ANA, 1998). There are several
regional associations for parish nurses, such as the North-
west Parish Nurse Ministries, which facilitates education
and communication for parish nurses. In the intermoun-
tain region of the study, the first parish nurse preparation
course was offered in 1996 through a local university and
two medical centers. Since then, there has been a steady
growth in the number of congregations with parish nurses
and health ministries. It is estimated that there are
currently 26 parish nurse programs operating in the
region, but there are no exact numbers because there is no
central registry for state programs.
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86 Public Health Nursing Volume 20 Number 2 March/April 2003
PRACTICE OF PARISH NURSING
Parish nursing focuses on the faith community and
recognizes the relationship between spirituality and health
(Berquist & King, 1994; Biddix & Brown, 1999; McDerm-
ott & Burke, 1993) (Mycek, 1998; Salewski, 1993). The
ANA identifies seven role functions for the parish nurse:
integrator of faith and health, health educator, personal
health counselor, referral agent, trainer of volunteers,
developer of support groups, and health advocate. The
parish nursing practice is a professional model of health
ministry using a registered nurse (Solari-Twadell &
McDermott, 1999). Parish nursing has evolved since the
early 1980s into a specialized practice with an established
curriculum for preparation, ongoing education, and
professional organizations and relationships (McDermott
& Burke, 1993). It has been identified as an advanced
practice model that promotes healthier communities and
partnerships within a larger context than the faith
community that it serves (Brown, Congdon, & Magilvy,
1996; Magilvy & Brown, 1997).
Parish nurses have been described as nurses in the
congregation with specialized training who serve as
‘‘connectors’’ and use ‘‘health language as a lens to bring
the needs and opportunities of the community into focus
so that the appropriate connections can be recognized’’
(Gunderson, 1997; 62). Parish nurses systematically and
intentionally ‘‘weave a web of relationships, associations,
structures and individuals to build a community’’ (Gun-
derson, 1997; 62). Collaborations have been described
between parish nurses and public health agencies (King,
Lakin, & Streipe, 1993), parish nurses and oncology
nurses (Bay, 1997), home health care nurses (Abbott,
1998), and nursing educational programs (Magilvy &
Brown, 1997). These professional nurse networks are
being used to improve self-care of clients; provide more
continuity of care after and during illness; assess, plan,
and implement health education programs; and educate
nurses in community-based settings and practices (Chase-
Ziolek, 1999). Partnerships to address the needs of the
medically underserved through parish nurse programs
have been implemented (Rydholm, 1997; Huggins, 1998;
Chase-Ziolek & Streipe, 1999). For example in Tucson,
Arizona, the Carondelet Parish Nurse Network serves
elderly Hispanic and other community residents through
primary care, case management, and education (Huggins,
1998). The Immanual-Saint Joseph’s Mayo Health Sys-
tem facilitated a regional parish nurse network with 20
interdenominational churches in south-central Minne-
sota. A grant from the Robert Wood Johnson Founda-
tion supported the network to encourage registered
nurses, as members of congregations, to be more inten-
tional in helping elderly parishioners with their health
concerns. Results of the study suggested that facilitating
earlier access to care and supporting caregivers who
provide ongoing care for elders at home contributed to
substantial Medicare cost savings and improved the
elders’ quality of life by reducing feelings of isolation
and being overwhelmed. The use of parish nurse networks
has been an effective way of addressing health needs of
members of faith communities.
PURPOSE AND RESEARCH QUESTIONS
The purpose of this study was to describe the develop-
ment and effectiveness of parish nursing programs in a
specific geographical area of the intermountain West.
Two questions were asked.
How do faith communities form parish nurse pro-
grams?
What is the effect of parish nursing programs on health
outcomes?
Study Design and Methodology
The Institutional Review Board of Boise State University
approved the study. Participants signed informed consent
forms before interviews and received a copy of the form.
Every effort was made to ensure anonymity and confi-
dentiality and to protect participants through adhering to
protocol requirements.
A qualitative design, using the grounded theory
method, was used to answer the research questions.
A naturalistic approach was used to describe the parish
nurse programs as they exist and to derive the research
outcomes inductively (Streubert & Carpenter, 1995). The
researcher did not manipulate or control variables, and
concepts emerged through data collection and analyses.
Participants helped shape the study itself through their
observations and insights. During an earlier phase of the
study, it was determined from participants that it would
be useful to include pastors as well as nurses in the
sample. Therefore, nurses, pastors, and chaplains were
included in this study. The interdisciplinary perspectives
added richness to the data.
Data were collected from a purposive sample that
represented congregations with parish nurse programs in
the region. Participants in the sample were selected
based on their work in a congregational setting as an
identified parish nurse, religious leader, or hospital
coordinator of programs. Data collection was conducted
in a natural context, with most interviews performed in
a congregational or community setting or over the
phone, at the participant’s request. The participants
provided artifacts, reports, photographs, and other
documents to illustrate the programs. The researcher

used participant observation as a member of a parish
nurse team at a local congregation and site visits with 10
churches, attending parish nurse networking meetings at
both medical centers and the International Parish Nurse
Resource Center in Park Ridge, Illinois, and the North-
west Parish Nurse Ministries in Portland, Oregon.
Artifacts included photographs of bulletin boards in
churches, documents such as annual reports, assessments
of community health status, and newsletter articles from
church publications. Interviews were recorded with
permission, transcribed, and then analyzed using spe-
cialized software, Ethnograph. If an interview was not
recorded, because it was on the telephone or at a
restaurant, notes were kept and entered into the data
analysis. Memos were used, and the researcher recorded
ideas and notions into a journal concurrent with the
investigation.
DATA ANALYSIS
Constant comparative analysis of all data was concurrent
with collection. Ethnograph software was used for coding
of transcripts. Each piece of data was compared with an
emerging description of the process of parish nursing.
Artifacts, reports, and documents were analyzed for
themes, frequency of themes, and types of activities.
Emerging concepts and strategies were discussed with
some participants and verified with them through subse-
quent interviews, nurse meetings, and written feedback.
Efforts were made to increase the trustworthiness of the
data through establishing rapport, confirmation of inter-
views with participants, and obtaining feedback to the
results from experts in parish nursing. Consistency of
data analysis was facilitated with Ethnograph software
for analyzing text-based data and use of an iterative
process of using notes, transcripts, a journal of impres-
sions, and thoughts. Readings in the literature and visits
at the North-west Parish Nurse Ministries, Portland,
Oregon, and the International Parish Nurse Resource
Center in Park Ridge, Illinois, were used to compare/
contrast with data from the region.
RESULTS
Included in the purposive sample were 13 nurses, and
eight pastors representing 13 congregations with parish
nurse programs, two hospital chaplains, and two parish
nurse program coordinators from regional medical cen-
ters (n ¼ 24). (One parish nurse coordinator also served
as a hospital chaplain.) The parish nurse programs had
existed for 1 to 5 years. There were eight denomina-
tions represented among the congregations: Methodist,
Catholic, Presbyterian, Nazarene, Lutheran, Episcopal,
Russian Orthodox, and Baptist. Church membership
Brudenell: Parish Nursing 87
ranged from 80 to 2,500 members and included rural,
suburban, and urban areas in southwest Idaho. All the
parish nurses served in congregations of their own
denominational beliefs.
In the region, parish nursing primarily uses an unpaid
professional nurse volunteer model, but two nurses were
part-time employees of their congregations and were paid
through grants. All congregations had advisory com-
mittees or cabinets of professional or nonmedical volun-
teers from the congregation. Agreements existed between
churches and one of two medical centers for networking
opportunities, continuing education, cardiopulmonary
certification, health screening, and liability insurance for the
parish nurses. The nurses were included as professional
volunteers for the medical centers. In some instances the
medical centers had also helped obtain and were given
grants and provided consultation and supplies. This
assistance facilitated development of programs and is a
partnership that congregation staff and nurses recognize.
Faith communities form parish nursing/health minis-
tries in a developmental process. Strategies are used to
move forward, dealing with transitions and limitations
over time. The process involves knowing the congregation
and the community. There are four general phases of the
process: (1) a preliminary phase of ‘‘finding out or
thinking about parish nursing,’’ (2) ‘‘knowing the faith
community,’’ (3) ‘‘being accepted as part of the con-
gregation’s ministry,’’ (4) and ‘‘becoming an ongoing
ministry that distinguishes a congregation.’’ Each of the
13 programs was active in promoting health, reducing
risk factors and diseases, and improving quality of life
within a faith community. The effects of the programs on
health and quality of life were examined through stories
and self-reported documents.
Preliminary Phase: Thinking About Parish Nursing
In the first stage of finding out and thinking about parish
nursing/health ministry, pastors and nurses recounted
when they first heard about a health and spirituality
program. Several pastors heard about it at national
conferences and were aware that their denominations had
well-established health information and ministry pro-
grams. These include the Presbyterian, Methodist, Epis-
copal, and Catholic denominations. One said he heard
about it in 1984 in a conference of church staffing
positions, but it was 1997 before he was able to implement
the idea of a nurse on staff at his church. Another three
pastors described experiences with parish nurses and
recounted benefits to their congregations. Some pastors
viewed health ministry as another way to connect with
members and the larger community. Pastors and nurses
felt that the disarray and confusion in the health care
88 Public Health Nursing Volume 20 Number 2 March/April 2003
system created a need for the congregation to take more
action on behalf of members (Wineburg, 1996). Com-
ments were made such as: ‘‘Health care is so fragmented
and...thought this would help the members,’’ ‘‘It’s a way
to extend caring,’’ and ‘‘God is at work, and we needed to
find someone to help with reaching out to the parishion-
ers.’’ The concepts of holistic caring were evident in
comments such as ‘‘We try to be holistic as we can,’’ and
the ‘‘whole church and health connection can provide a
matrix to explore holistic caring.’’ Nurses were members
of congregations where they served as parish nurses.
Pastors stated, ‘‘Nurses have the professional training
and know their boundaries.’’ They can do ‘‘congrega-
tional health assessments.’’ Having professionals avail-
able and willing was a deciding factor in developing
health ministry. Nurses stated, ‘‘This is truly nursing at its
finest,’’ ‘‘It’s a mission’’ and ‘‘fulfills the ideal of integ-
rating body, mind and spirit in care.’’ Nurses tended to
find out about the parish nurse model from their pastors,
classes at the university, peers, and reading articles in
professional journals. The majority of nurses (n ¼ 12) in
this study had attended a basic course in parish nursing,
but other members of the health ministry team had
received no specific preparation for their role in faith and
health programs. Many congregation members were
unaware of parish nursing and health ministries for their
denomination.
Second Phase: Knowing the Faith Community
Most of the parish nursing programs have started within
the last 3 years. ‘‘Starting out’’ was the term used to
describe the beginning of the parish nursing/health
ministry within the congregation. This phase was des-
cribed by comments such as the program ‘‘just started,’’
‘‘finding a place’’ within the building, ‘‘just found an
office in the church,’’ or finding resources, ‘‘just received a
grant for 3 years,’’ ‘‘beginning to develop our vision and
mission,’’ and ‘‘We want to decide what our focus will be
(health ministry and parish nursing).’’ Many of the
aspects of starting a new parish nurse program were
similar to ones described by Biddix and Brown (1999).
An essential component of beginning a parish nurse
program is educating the congregation, the nurses, and the
pastor. Forming connections within the congregation with
members begins an important pattern of collaboration.
Nurses and members of the health ministry ‘‘met with
church circles to explain what parish nursing is.’’ Bulletin
boards, newsletter articles, and inserts were used to provide
health information and explain the presence of the health
ministry. Parish nurses sought preparation and continuing
education through the International Parish Nurse prepar-
ation course offered through a local university in collabor-
ation with the two medical centers and the North-west
Parish Nurse Association. None of the nurses in this study
reported preparation in pastoral counseling or theology.
The basic preparation course facilitates working within
a congregational setting. All the nurses had extensive
experience in many areas of nursing practice, including
public health, medical surgical, and rehabilitation nursing.
Beginning a parish nurse program requires ‘‘getting to
know’’ the health concerns within the congregation.
Knowing was seen as ‘‘becoming aware of or familiar
with the congregation through observation, study and
experience. To understand and be fully aware not only of
the meaning or nature of something but also of its
implications’’ (O’Connor, 1996; 342–343). Pastors and
nurses both ‘‘know’’ their congregations and what they
want or need for their health ministry. This is an
important piece of forming collaborative relationships.
Awareness and knowledge of the congregation exists in
urban, rural, and suburban churches. Strategies to
increase knowledge of the health needs of parishioners
include health assessment surveys at religious services,
insider knowledge from being part of the congregation,
listening to fellow parishioners and groups to determine
needs, learning about faith-based resources, and asking
about interests for the church with the pastors. In
conclusion, using a community-health-nursing process
to assess needs and to integrate knowledge about national
public health standards and objectives may improve the
efficacy of achieving congregational and national health
objectives (Miskelly, 1995). In this study, nurses were
viewed as resources for health-promotion programs
within congregations. In contrast, Miskelly (1995) repor-
ted that nurses are invisible in the public health literature
as health promoters. Pastors viewed parish nurses as
‘‘insider experts,’’ which is consistent with being ‘‘a
trusted listener who speaks the language of physicians,
clergy, family, and other care providers’’ (Rydholm,
1997). Identification as an ‘‘insider expert’’ reinforces the
leadership role that nurses have within a congregation
and their potential effect on health.
Knowing a congregation and its members strengthens
understanding and the capacity to serve as an advocate
(Tanner, Benner, Chesla & Gordon, 1993). Nurses,
pastors, and chaplains described reaching out to con-
gregation members. Many church leaders identified the
elderly as needing more attention. One pastor described
the following situation.
The changes in the church worship, the times, style of
worship, have left many of the elderly behind. All
those things make them feel like the church abandoned
them.... He or she have been members of the church
for 60 years but haven’t been in the church but a time

or two in the past two years. But they helped to build
the church and have been part of the church and now
see it rarely. There is sadness about that. Again, that is
something that the parish nursing can help.
Parish nurses have improved the care of the elderly in
congregations and helped caregivers of the elderly cope
more effectively with the demands of caregiving. Assist-
ance to caregivers has allowed elderly residents to
remain in their homes and reduced costs for nursing
home placements (Rydholm, 1997; Biddix & Brown,
1999). Nurses in this study described helping parishi-
oners with finding home care and nursing home
resources.
An aspect of knowing the congregation comes
through fine-tuning the program to meet the exact needs
of the congregation (Smith, 1992). For example, a nurse
said, ‘‘We don’t follow the ‘heart month’ (events
scheduled for each month) schedule for our congrega-
tion, but we know what we need and what is important
and going on for us. We gear it for our church.’’
Another nurse described the volunteer ministry team as,
‘‘All members of the health ministry contribute to
creating a broad interdisciplinary program which capit-
alizes on their strengths.’’
Health ministry advocates through program planning
and using a variety of ways to communicate. Commu-
nication within the church using a variety of means
including bulletin boards, Web pages, newsletter articles,
inserts, speaking with groups, developing a logo, posters,
and announcements is used. This phase of ‘‘knowing the
congregation’’ eases into the next as successes and
transitions are mastered and the ministry begins to take
on a life of its own, independent of individual nurses or
team members. Being able to communicate what is
known through documentation of care and program
effectiveness is part of the language of health care. Each
of the programs in this study had a method of
documentation, tracking attendance at programs, and
evaluating effectiveness. Using data from multiple con-
gregations in a consistent and reliable manner was
reported as important for parish nurse programs.
Without adequate documentation of effectiveness, it
may be difficult to confirm whether programs are
meeting their mission (Coenen, Weiss, Schank &
Matheus, 1999; Weiss, Matheus, & Schank, 1997). This
is an area in which more-accurate documentation from
the congregations may be useful for program improve-
ment.
Another aspect of knowing a congregation was
identifying problems that could be addressed with
education or referrals. For instance, one parish nurse
organized an educational day to help ‘‘people cope with
Brudenell: Parish Nursing 89
the winter blahs.’’ Content on depression and financial
planning were also included. Members with concerns
related to depression and financial planning were referred
as indicated to community resources.
Third Phase: Being Accepted As a Faith Community
Ministry
Acceptance of the parish nursing and health ministry
program evolved naturally over time. Accepting is a
phase in which members of a congregation learn about
and accept the health ministry/parish nursing as an
ongoing, caring activity. The program has become part of
the ‘‘regular part of the church life.’’ Comments that
describe this stage include, ‘‘The congregation accepts the
idea of health care at church,’’ ‘‘People come every week
for blood pressure readings and to talk,’’ ‘‘They ask
questions about health care’’ and ‘‘ask me [the parish
nurse] to visit.’’ Connecting within the church and with
fellow members is seen through the change in functioning
of the health ministry board or team. The team functions
well and becomes more independent from the pastor in
making decisions and taking actions. A pastor, from a
church with a program in its third year, said, ‘‘I was
tickled that the team felt they could make decisions and
plan events without me at their meetings.’’
All pastors and nurses described ‘‘being present’’ or
visible—talking, praying, being with or involved in the
community—as key to becoming accepted as a caring
ministry. Articles in the church newsletters, bulletin board
displays, and Web pages were other ways used to become
visible. Being visible requires that parish nurses act as
health care leaders and ‘‘appear front and center’’ for
health ministry. Another aspect of being present is
participating in sharing the activities of parish nursing
through networking meetings sponsored by an affiliated
medical center. Best practices—activities and programs
that worked well—were presented for others to consider.
For example, a ‘‘self-esteem and sexual education
program that was well received’’ will be implemented
with another denomination. An important function of the
monthly meetings was to provide information about
community resources. For example, several churches
sponsored ‘‘brown bags’’ at the church for pharmacists
to meet with parishioners to discuss medications. Colla-
boration between congregational nurses and health and
social service agencies focused on meeting specific needs
held in common.
Mutual valuing—responding with reciprocal caring—
was described as another dimension of accepting a new
program such as parish nursing. Members of the health
ministry and those they served through visits described
mutual valuing: ‘‘I don’t know who gets the most benefit
90 Public Health Nursing Volume 20 Number 2 March/April 2003
from visiting. It’s tremendously rewarding for all parties.’’
Mutuality has been identified in the literature as an
essential part of caring (Benner, 1992). Mutuality
becomes more pronounced; as one nurse said, ‘‘The more
you do, the more you want to do.’’ A pastor described
mutuality as, ‘‘I simply mean that the sense that they
bring as much to us as we have to give them.... We get
past the suspicion, prejudice, that prevents us from being
who we are. That is what that is. Mutuality. The sense of
mutual support.’’ Through a health ministry, a sense of
mutual support may be enhanced.
Specific strengths in acceptance included advocacy.
Nurses and pastors provided examples of the successes of
parish nursing in seeking care for clients that would
recognize and improve their quality of life, as well as their
medical care. A pastor described how the parish nurse had
‘‘really gone to bat for her [a member of the congregation].
The doctors wanted the patient to go to a nursing home.
The patient was only 50 years old and wanted to stay in her
own home. The nurse really worked with her and the
medical staff so she could safely be at home.’’ Addressing
quality of life for people within the congregation can also be
seen in providing funds from the parish nursing accounts to
facilitate accessibility for the disabled to attend church
functions in wheel chairs. Four different churches used
funds to expand accessibility to those with disabilities. In
one church, it made it possible for a youngster with a
neurological condition to attend activities by using his
wheelchair and not having to be carried by others.
‘‘Opening the heart’’ as a way to extend the love and
care of a congregation into the community as well as the
congregation was an additional quality described by
participants. One pastor invited members of a minority
group in the community to share church space and
wanted members to begin ‘‘changing attitudes’’ about
those who are different. Frequently there were offerings of
services such as immunization clinics, health fairs, and
educational programs for the community. This was
especially valuable in rural areas with limited access to
health programs. In another instance, to highlight
awareness of breast cancer, during a worship service,
each member of the congregation who had a friend or
family member with breast cancer lit a candle. The entire
altar area was covered in burning candles. The pastor and
nurse felt that this was a ‘‘moving experience for all
members,’’ and it dramatically illustrated how many were
affected by this disease. A nurse who uncovered the
hidden pool of caregivers who often are unable to attend
worship services described responding to patterns of need
in the faith community and initiated a program called
‘‘lighten the load’’ to address the needs of caregivers.
Effects of parish nursing were assessed through stories
that have been described, through analysis of annual
reports, in self-reported articles, and through congrega-
tional health assessments. There were seven annual
reports provided by parish nurses, reports from 12 health
assessments, and examples from each nurse about health
educational materials provided at the church. Parish
nurses apply scientific and faith-based knowledge in their
health-promotion and disease-prevention interventions.
Examples of health-promotion activities and services that
were linked with scriptural passages included stress
reduction tips in the newsletter and bulletin boards;
healthy low-fat high-fiber eating through heart-healthy
brunches at the church; and baby baskets for new parents
filled with baby supplies, religious objects, and health
information such as the ‘‘back to sleep’’ campaign for
infants. In disease prevention or risk reduction, there were
six immunization clinics for adults and children, blood
pressure and diabetic screenings on a regular basis, and
classes with pharmacists for the elderly to better under-
stand their medications.
Facilitating connections between faith communities to
address common health concerns and issues will be
increasingly important as parish nurse/health ministries
become established in congregations. Emphasis on coali-
tion building, forming relationships, and community
building are areas that can be part of the parish nurse
programs. For example, collaborating with public health
and home health nurses may be beneficial in addressing
common health goals (King et al., 1993). Reaching out to
specific groups through faith-based interventions for
public health problems have been successful in other
parts of the country (Kiser, Boario, & Hilton, 1995).
Parish nurses increased connections between their con-
gregations and health agencies and professionals in the
community. These connections occurred with increased
frequency, depth, breadth, and intention as the programs
became more established.
Initially, the researcher was surprised when nurses and
pastors could not identify any ‘‘partnerships,’’ except with
one of the two medical centers. Rather than partnerships,
pastors and nurses recognized extensive collaborations.
Two aspects of collaboration were present in the rela-
tionships between congregations and health agencies and
other congregations. Gunderson (1997) described these as
respect for survival of partners and ‘‘limited domain’’
collaboration. For example, baccalaureate nursing stu-
dents completed community assessments at congrega-
tions. Students received educational opportunities, and
congregations received community assessments for their
use in planning health activities and programs (Murray,
1999). Limited-domain collaboration is a useful way for
organizations to come together for a specific project and
then to separate. It is useful for volunteer-driven organ-
izations such as congregations because it takes less time

and commitment than full partnerships. Other advan-
tages for this form of collaboration are stewardship of
resources, limited discussions about theology, and no
changes in organizational structures. Operating rules are
jointly determined to accomplish a goal in the commu-
nity. Limited domain collaboration has been termed ‘‘a
temporary conduit for common goals’’ (Gunderson, 1997;
57). Excellent examples of respect and limited domain
collaboration exist from all the congregations. One
example was a health fair for a congregation and the
community offered through a partnership of organiza-
tions. Perhaps this approach could be used in this
intermountain rural area to reach people who have
limited access to health care. Connecting in this manner
is efficient and effective in providing services and pro-
grams to benefit the congregation and the community
(Gomare, 1998). Additional research needs to evaluate
the effectiveness of the partnerships in strengthening
congregations and communities.
Limitations for development of the health ministry
were varied. One limitation during this stage is the idea
voiced by a pastor that, ‘‘It’s a good program (parish
nursing) but not essential like worship to a church.’’
Another pastor said, ‘‘It’s off the radar screen of
awareness.’’ Parishioners are unaware of many health
programs that churches provide. Limitations included
available time, because almost all the nurses and members
of the ministries were volunteers employed in professional
practices; lack of funds for supplies and programs; varied
attitudes and beliefs about health; and the newness of the
idea of having health care available through a congrega-
tion. Other limitations centered on collaboration. Pastors
and nurses identified factors that limited forming and
maintaining networks. Comments such as, ‘‘The minister
doesn’t want outside influences. We haven’t formed
community partnerships,’’ were expressed. Concern over
dependence on other institutions such as hospitals or
public agencies were identified as limiting collaboration
within the community. One minister said, ‘‘There are
denominational issues and things like that... . You don’t
always exchange information because we run in different
circles.’’ Limiting connections serves to disable one of the
important strengths of faith communities and health
ministries: connecting people. ‘‘Connecting is marked by
links across which resources, assets, power, and know-
ledge flow throughout the community’’ (Gunderson,
1997; 53).
Establishing a presence in the congregation is essential.
One participant said, ‘‘There wasn’t a sense of presence
generated among the members, and, because of that, the
parish nurse program did not get adequate cooperation
from leadership... . Nobody got the potential of the
program.’’ Another limitation may be conflicts between
Brudenell: Parish Nursing 91
the nurse, health team, and pastor. In one congregation, a
team member reported, ‘‘In the beginning, the parish
nurse and the minister butted heads a few times, but after
a while things got better. The minister feels strongly that
he must keep his thumb on things.’’ Another limitation
may be the inability of the team, nurse, and pastor to
convene around a common vision and mission. One nurse
described that they were working hard to define a vision
and what their scope would be for the congregation.
These difficulties were challenges met with varying success
by parish nurse programs.
Fourth Phase: Parish Nursing As an Ongoing Ministry
The ongoing ministry is recognized by the placement of
parish nursing/health ministry in the life of the congrega-
tion as established and essential. A pastor stated, ‘‘A
parish nurse position is in the church budget,’’ ‘‘People
can count on the parish nurse being there,’’ ‘‘This
ministry is wide open, with the imagination as the only
limit.’’ Few of the parish nurse/health ministries in this
area have become as essential to the congregation and
pastors as worship, music, and education programs. In
congregations that consider health ministry essential, staff
members feel like they ‘‘couldn’t manage without the
parish nurse.’’ The nurse and other members of the health
ministry have ‘‘really made a difference in lives of some of
the members.’’ A pastor said, ‘‘We want to continue the
program, its not just a nice program, but we are willing to
sacrifice to keep the program. It’s that important to us.
Continuity of parish nursing includes reaching out,
working with others outside of the congregation.’’ A
parish nurse and pastor from the same church described,
‘‘our church is in a high-risk area, and we would like to
reach out to more families in the neighborhood.’’ Plans
were being made for a pregnancy resource and wellness
center housed at the church. Another congregation with
the longest involvement with parish nursing/health min-
istry has developed a mentoring program for health
ministries and parish nurses from other denominations
and congregations. Developing close working relation-
ships between the pastor, parish nurse/health ministry
team, church staff, parishioners, and community agencies
facilitates reaching out beyond the congregation.
Challenges were identified primarily as time, energy,
and vision. One pastor said, ‘‘I see an unlimited future,
or, I should say, limited by the energy, time, and
leadership of the health ministry team to identify a core
purpose and vision for the faith community.’’ Another
pastor desired a focus on ‘‘more health promotion and
wellness orientation and less specific health-related activ-
ities.’’ This was echoed by a member of a health ministry
team, who said, ‘‘We need more than blood pressure
92 Public Health Nursing Volume 20 Number 2 March/April 2003
checks and talks about diet and exercise... . Our program
needs to be in more depth, needs more leverage from
within, and needs more support from the leaders of the
church to be successful in the future.’’ Realizing that the
vision and mission need to be revisited and discussed
within the strategic plan and vision for the congregation is
important for church leaders.
Transitions for all the programs have involved changes
in the membership of the health team, parish nurses,
pastors, and cycles of grant funding. Transitions are
planned and unplanned; the 2- to 3-year cycle of grant
funding terminates, or a parish nurse departs abruptly
with little notice. Transitions come with time and with
different circumstances. As the programs gain acceptance
and resources, more can be accomplished, but there is a
danger of overextension, lack of delegation, and ineffec-
tive use of resources, which may damage the success of
the ministry. One nurse who felt the program had
succeeded well described feeling ‘‘burned out’’ by the
needs of and lack of support from the broader congrega-
tion. What is essential to understand is that transitions
within a volunteer-based religious community are fluid
and continuous, requiring efforts to recruit and support
volunteers working in health ministry.
CONCLUSION
Parish nursing is relatively new to this region of the
intermountain West and appears to be part of a growing
faith and health movement. The 13 congregations in this
study followed a developmental process with four phases
to become established. A preliminary phase involves
thinking about parish nurse/health ministry programs,
deciding about the benefits, considering how they would
fit with a congregation and denomination, and deciding
to start a program. In the second phase, a commitment by
the pastor/religious leaders, nurses, and interested mem-
bers is made, with subsequent implications for a program
within the congregation. Assessing and knowing the
congregation and its needs are a beginning. The third
phase occurs as parish nursing/health ministry matures
and becomes accepted as a legitimate ministry within the
congregation. In this phase, parish nursing/health minis-
try becomes an effective conduit for community connec-
tions and advocacy for groups in the faith community. By
the fourth phase, the program is well accepted and
partially funded by a congregation as an essential
ministry. In fact, the health ministry is a distinguishing
characteristic of the congregation and their commitment
to health and well-being.
Parish nursing/health ministry is having a positive
effect on health and quality of life in congregations and
the larger community. Congregational health ministries
have the potential to significantly increase access to health
promotion and disease prevention information, providing
support for behavior change and healthier lifestyles
(Thomas, Quinn, Billingsley & Caldwell, 1994). The
health ministries connect physical and mental health with
the spiritual support of the congregation (Stolley &
Koenig, 1999). Parish nurses can serve as intentional and
systematic connectors within faith communities. Through
their work with congregations, community concerns such
as ‘‘building community assets for youth,’’ caring for the
elderly and their caregivers, and reducing threats of
violence can be addressed (Mercy, 1997; Mitka, 1998;
Parks, 1998; Smith, 1992). Parish nurse programs streng-
then congregational abilities to relate to, care for, and
connect within and with other denominations, health
agencies, and health professionals. Respect and limited
domain collaboration (Gunderson, 1997) were used in all
the parish nurse programs as an effective means of health
promotion, disease prevention, and addressing issues of
quality of life.
DISCUSSION
Strengths
Strengths of this study included the engagement of the
researcher and the participants, a naturalistic approach,
and the diversity of the participants. Many of the
participants, both pastors and nurses, provided inter-
views and reports and were available for additional
questions and clarifications. A naturalistic approach
captured the practice as it occurs in community settings.
Programs were located in suburban, rural, and urban
areas and congregations. Some of the congregations
were focused on a specific neighborhood or parish,
whereas others represented a wider geographic distribu-
tion of members.
Limitations
Limitations of the study were the homogeneity of the
programs to Christian faith-based congregations, which
appear to be the dominant group involved with parish
nursing. Other limitations included inconsistency in the
self-report data and the newness of the parish nurse
programs. Many programs were in an early or beginning
stage and had little record of accomplishment or docu-
mentation. The researcher’s assumptions and views of
partnerships were a limitation that presumed that part-
nerships existed and would be recognized by participants.
The researcher learned that collaborations more closely
approximated the working relationship of health agen-
cies, social services, and congregations. In the programs
included in this study, there were many effective ‘‘limited
domain’’ collaborations with organizations such as

The American Cancer Society, March of Dimes, and
local health district.
Many of the findings were similar to those described in
the literature. Differences were in the description of a
developmental process for becoming established that had
been elicited from participants’ experiences, the extent of
commitments by volunteer nurses, and the involvement of
health ministry teams and pastors with parish nurses.
Results of the study were shared with participants and
contributed to an improved understanding of collabor-
ation between health programs and congregations that
will benefit communities.
RECOMMENDATIONS
Research
Future research should compare the effectiveness of
health interventions through faith communities and
other community sites. Program evaluation of the
effectiveness of interventions needs to be done, factoring
in costs to the congregation and the community.
Effective programs would encourage ongoing funding
for the health-education and disease-prevention compo-
nents of the ministry. Evaluation and community
intervention studies within faith communities need to
become a high priority in public health and in health
ministry. Using valid instruments, Internet databases of
best practices and reports could strengthen the interven-
tions. Additional training, increased emphasis on docu-
mentation, and outcome identification and evaluation
will be necessary for congregational ministries to exam-
ine the effectiveness of their interventions. According to
Anne Solari-Twadell and Lisa Burkhardt at the Inter-
national Parish Nurse Resource Center, this will be an
increasing focus in the evolving practice (March 2000,
personal communication 2000). Interesting areas of
research could involve investigating questions about
quality of life and the faith community, spirituality in
health and healing, and health care practices within a
faith community.
Practice
Recommendations for advancing the practice include
more-systematic communication between parish nurses/
health ministry teams, pastors, and collaborators in the
community. One way this could be accomplished is
through Internet discussion groups and online meetings.
Many of the participants cannot afford the time to attend
meetings but could read and discuss issues in an open
forum. Perhaps a central Web site with information for
parish nursing would be helpful. Additional funding and
cooperation to maximize resources to continue and
Brudenell: Parish Nursing 93
expand programs is needed. The medical centers, colleges,
and universities in the area with health education,
nursing, or theology programs could assume a pivotal
role in supporting these developing programs. Developing
and using financial resources, updates on best practices in
health promotion and education, and evaluation strat-
egies and processes are ways that would support the
developing practice.
Education
Continuing education for religious leaders, parish nurses,
and members of health ministry teams should continue,
with an interdisciplinary, interdenominational approach
using a variety of media. Offering education in pastoral
counseling or lay ministry for parish nurses and members
of the health ministry teams could strengthen preparation
for roles in congregations. The official preparation course
for parish nurses is an essential beginning for this
developing practice area. Interdisciplinary learning
experiences for students and recruitment of students from
faith communities for health professions are ways that
students and educators could become involved in health
ministry. Specific examples in this region were faith
community assessments by baccalaureate nursing stu-
dents, health information and referral through student
projects, and holistic nursing studies focusing on spiritu-
ality and health.
In conclusion, parish nursing/health ministry has begun
in this intermountain western region as a grass roots
effort to improve health, integrate faith-based interven-
tions, and minister to members of congregations. The
programs are evolving and becoming more accepted as an
ongoing ministry. Parish nursing/health ministry pro-
grams are having a positive effect on individual and
community health. Respect and ‘‘limited domain’’ col-
laborations are ways that faith communities and health
agencies may partner to address common goals. Addi-
tional efforts to evaluate, collaborate, and communicate
could strengthen effectiveness of programs.
ACKNOWLEDGMENTS
I would like to thank the nurses, pastors, and chaplains
who shared their experiences and thoughts with me for
this study. I have been privileged to meet and hear their
visions for the future and stories of health care in a faith
community. I would also like to thank Audrey Omer,
R.N, M.S., for her assistance in data collection.
A grant from Mu Gamma, Chapter of Sigma Theta
Tau, Boise State University, and a Sabbatical award from
Boise State University funded this study. This support
was pivotal to the completion of the study.
94 Public Health Nursing Volume 20 Number 2 March/April 2003
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