FAITH COMMUNITY NURSING SCOPE AND STANDARDS ...hmassoc.org/wp-content/uploads/Draft-of-FCN-Scope-and...196 community nursing practice from a national perspective, the professional

FAITH COMMUNITY NURSING: SCOPE AND STANDARDS OF PRACTICE, THIRD EDITION

2016

Draft Document

Health Ministries Association

July 15, 2016

DRAFT Document – Do NOT Forward 1

CONTENTS: 1

Contributors – TO BE ADDED LATER 2

Preface: Line 83, p. 4 3

INTRODUCTION: L. 106, P. 5 4

Function of the Scope of Practice Statement of Faith Community Nursing: L 131, p.5 5

Function of the Standards of Faith Community Nursing Practice: L 143, p.6 6

Application of the Scope and Standards: L 161, p. 6 7

Development of Faith Community Nursing: Scope and Standards of Practice, Third 8

Edition: Line 178, p 7 – TO BE ADDED LATER 9

Summary: L 181, p. 7 10

SCOPE OF FAITH COMMUNITY NURSING PRACTICE: L 201, P. 8 11

Description of the Scope of Faith Community Nursing Practice: L 203, p. 8 12

Definition of Faith Community Nursing: L 220, p. 8 13

The Specialty of Faith Community Nursing: L 244, p. 9 14

Distinguishing Tenets of Faith Community Nursing: L 264, p. 10 15

Foundations of practice: L 281, p. 10 16

Settings: L 303, p. 10 17

FCN Roles: L 335, p. 12 18

Clinical expert: L 350, p. 13 19

Consultant: L 361, p. 13 20

Coordinator: L 366, p. 13 21

Researcher: L 378, p. 14 22

Educator: L 384, p. 14 23

Administrator: L 392, p. 14 24

Evolution of Faith Community Nursing: L 397, p. 14 25

Focus on Spiritual Care in Nursing: L 472, p. 17 26

Ethics in Faith Community Nursing: L 547, p. 19 27

Culturally Congruent Care: L 588, p. 21 28


Educational preparation for faith community nursing: L 609, p. 21 29

Faith Community Nurse: L 611, p. 21 30

Graduate‐level prepared registered nurse: L 636, p. 22 31

Advanced Practice Registered Nurse: L 642, p. 22 32

Additional Faith‐related Designations: L 664, p. 23 33

Educational Approaches: L 680, p. 24 34

Mentoring: L 719, p. 25 35

Certification Process by Portfolio: L 751, p. 26 36

HMA Recognition of Excellence: L 782, p. 27 37

Ongoing Education and Competency: L 805, p. 28 38

39

Continued Commitment to the Profession: L 837, p. 29 40

Research and Faith Community Nursing: L 852, p. 29 41

42

Professional Trends and Issues in Faith Community Nursing: L 905, p. 31 43

44

Care Delivery and Transitional Care Coordination: L 916, p. 31 45

Behavioral Health/Mental Health Care: L 965, p. 33 46

Technology: L 982, p. 34 47

Compensation: L 1018, p. 35 48

Workplace Safety: L 1040, p. 36 49

Health Promotion and Self‐care: L 1066, p. 36 50

Influence of Spiritual and Secular Values: L 1101, p. 38 51

Nursing Response: L 1130, p. 39 52

53

Standards of Faith Community Nursing Practice: L 1154, p. 39 54

Standards of Practice 55

Standard 1. Assessment: L 1160, p. 40 56

Standard 2. Diagnosis: L 1212, p. 42 57


Standard 3. Outcomes Identification: L 1247, p. 43 58

Standard 4. Planning: L 1287, p. 45 59

Standard 5. Implementation: L 1345, p. 47 60

Standard 5A. Coordination of Care: L 1413, p. 49 61

Standard 5B. Health Teaching and Health Promotion: L 1457, p. 51 62

Standard 6. Evaluation: L 1504, p. 53 63

Standards of Professional Performance: L 1544, p. 55 64

Standard 7. Ethics: L 1546, p. 55 65

Standard 8. Culturally Congruent Practice: L 1599, p. 57 66

Standard 9. Communication: L 1654, p. 59 67

Standard 10. Collaboration: L 1687, p. 60 68

Standard 11. Leadership: L 1732, p. 62 69

Standard 12. Education: L 1775, p. 64 70

Standard 13. Evidence‐based Practice and Research: L 1806, p. 65 71

Standard 14. Quality of Practice: L 1862, p. 67 72

Standard 15. Professional Practice Evaluation: L 1918, p. 69 73

Standard 16. Resource Utilization: L 1943, p. 70 74

Standard 17. Environmental Health: L 1985, p. 72 75

76

Glossary – TO BE ADDED LATER 77

References and Bibliography – TO BE ADDED LATER 78

Appendix A. Faith Community Nursing: Scope and Standards of Practice (2012) – TO BE ADDED 79

LATER 80

Index – TO BE ADDED LATER 81

82


PREFACE 83

Faith community nursing acknowledges spiritual care as an essential component of a 84

specialized body of nursing knowledge and competencies. Faith community nurses (hereafter, 85

referred to as FCN) provide care to individuals, families, groups, and communities with 86

emphasis on promoting whole person health. 87

88

Faith community nurses hold themselves accountable to the scope and standards of practice; 89

state, commonwealth, or territory laws, statutes, and regulations related to nursing practice; and 90

federal regulations. 91

92

Changes in healthcare and nursing practice may result in new context for this nursing specialty. 93

The competencies related to the standards reflect current practice and provide details for 94

application of the standards. The listing is not meant to be exhaustive. 95

96

Recognition of the Specialty 97

The American Nurses Association recognizes faith community nursing as a nursing specialty. 98

99

Approval of the Scope of Practice 100

Content to follow 101

102

Acknowledgement of the Standards of Practice 103

Content to follow 104

105


INTRODUCTION 106

The American Nurses Association (ANA) published the first Scope and Standards of Parish 107

Nursing Practice in 1998. As the practice of parish nursing evolved and included multiple faiths, 108

the title of the specialty practice was changed to faith community nursing with the publication 109

of Faith Community Nursing: Scope and Standards of Practice in 2005. Since the second revision 110

in 2012, there have been dramatic changes in healthcare as well as the nursing profession. 111

Faith Community Nursing: Scope and Standards of Practice, Third Edition, describes the 112

specialty practice of faith community nursing for the nursing profession, faith community 113

nurses, other healthcare providers, spiritual leaders, employers, insurers, healthcare 114

consumers, families, and members of faith communities. The scope of practice statement 115

presents the framework and context of faith community nursing practice and accompanies the 116

standards of practice and professional performance and their associated competencies. The 117

scope and standards included in this document define the responsibilities of the FCN and guide 118

professional practice and performance. 119

The standards of Practice encompass significant actions taken by registered nurses and forms the 120

foundation of the nurse’s decision‐making. The Standards of Professional Performance describe 121

a competent level of behavior in the professional role, including activities related to ethics, 122

culturally congruent practice, communication, collaboration, leadership, education, evidence‐123

based practice and research, quality of practice, professional practice evaluation, resource 124

utilization, and environmental health. Registered nurses are accountable for their professional 125

actions to themselves, their healthcare consumers, their peers, and ultimately to society (ANA 126

2015b). In the application of standards to practice, the influence of context must be considered. 127

“Whether a particular standard or competency applies depends on the circumstances” (ANA, 128

2015b). 129

130

Function of the Scope of Practice Statement of Faith Community Nursing 131

The scope of practice statement describes the who, what, where, when, why, and how of the 132

practice of faith community nursing. The answers to these questions provide a comprehensive 133

picture of the practice, its boundaries, and its membership. Nursing: Scope and Standards of 134


Practice, Third Edition (ANA, 2015) applies to all professional registered nurses engaged in 135

practice, regardless of specialty, practice setting, or educational preparation. With the Code of 136

Ethics for Nurses with Interpretive Statements (ANA, 2015) and Nursing’s Social Policy 137

Statement: The Essence of the Profession (ANA, 2010), it forms the foundation of practice for all 138

registered nurses. The scope of faith community nursing practice is specific to this specialty but 139

builds on the scope of competent practice and professional performance expected of all 140

registered nurses. 141

142

Function of the Standards of Faith Community Nursing Practice 143

Standards are “authoritative statements of the duties that all registered nurses, regardless of 144

role, population, or specialty, are expected to perform competently” (ANA 2015). Standards 145

reflect the values and priorities of the profession and provide direction for professional nursing 146

practice and a framework for evaluation of this practice. The ANA (2015b) outlines six standards 147

of professional nursing practice and 11 standards of professional performance. Competencies 148

are included for each standard, which provide evidence (measurement criteria) of compliance 149

with that particular standard. 150

151

The scope and standards included in this document define the responsibilities of the FCN and 152

guide professional practice and performance. The Standards of Practice encompass significant 153

actions taken by registered nurses and forms the foundation of the nurse’s decision‐making. 154

The Standards of Professional Performance describe a competent level of behavior in the 155

professional role, including activities related to ethics, culturally congruent practice, 156

communication, collaboration, leadership, education, evidence‐based practice and research, 157

quality of practice, professional practice evaluation, resource utilization, and environmental 158

health. 159

160

Application of the Scope and Standards 161

This third edition of the Faith Community Nursing Scope and Standards of Practice provides a 162

valuable resource for FCN to use in decision making and when expanding, validating or 163


analyzing their professional practice. The document can be used to guide the development and 164

evaluation of many aspects of faith community nursing practice including the following (ANA, 165

2015b, p145): 166

• Initial preparation and ongoing educational programs 167

Role description and performance evaluations 168

Policies and procedures 169

• Quality improvement programs 170

• Processes for certification 171

172

Registered nurses are accountable for their professional actions to themselves, their healthcare 173

consumers, their peers, and ultimately to society (ANA 2015b). In the application of standards 174

to practice, the influence of context must be considered. “Whether a particular standard or 175

competency applies depends on the circumstances” (ANA, 2015b). 176

177

Development of Faith Community Nursing: Scope and Standards of Practice, Third Edition 178

(Content to Follow) 179

180

Summary 181

The scope and standards of practice for faith community nursing reflect the commitment of the 182

Health Ministries Association to partner with the American Nurses Association to promote an 183

understanding of faith community nursing as a specialized practice in the interprofessional 184

practice of diverse faith communities. HMA is the national professional organization 185

representing faith community nurses and others working in the expanding faith and health 186

movement. 187

188

As the diversity of participating faith communities expands in rural areas, towns, and cities, the 189

difficulty in finding all‐inclusive terminology to describe the beliefs and practices that have 190

evolved from the variety of traditions becomes more apparent. Terms used in this document 191


indicate an effort to include many faith traditions and not to promote any one particular faith 192

tradition. 193

194

Faith Community Nursing: Scope and Standards of Practice, Third Edition, reflects current faith 195

community nursing practice from a national perspective, the professional and ethical standards 196

of the nursing profession, and the legal scope and standards of professional nursing practice. 197

The standards are dynamic and subject to testing and change. 198

199

200


SCOPE OF FAITH COMMUNITY NURSING PRACTICE 201

202

Description of the Scope of Faith Community Nursing Practice 203

Faith Community nursing practice is guided by and congruent with the ANA’s Code of Ethics for 204

Nurses with Interpretive Statements (ANA, 2015a), Nursing’s Social Policy Statement: The 205

Essence of the Profession, 3rd Edition (ANA, 2010), and Nursing: Scope and 1Standards of 206

Practice, 3rd Edition (ANA, 2015b). The intentional care of the spirit as well as the promotion of 207

whole person health and prevention or minimization of illness within the context of a faith 208

community are areas of specialty practice within the framework of nursing, in which faith 209

community nurses strive to advance the health care and quality of life of all affected individuals 210

(HMA, 2012). Faith community nursing is dynamic and evolves with changes in knowledge, the 211

healthcare environment, and society. Faith community nurses include diploma, associate 212

degree, baccalaureate prepared registered nurses, graduate‐level prepared registered nurses, 213

and advanced practice registered nurses (APRN). The depth and breadth of an individual 214

specialty nurse’s scope of practice is determined by the nurse’s education, experience, practice 215

setting, role, and the specific population cared for by the nurse. Advanced practice nurses 216

function within the full scope of their licensure incorporating the specialty focus in their 217

practice. 218

219

Definition of Faith Community Nursing 220

Faith community nursing is a specialized practice of professional nursing that focuses on the 221

intentional care of the spirit as well as on the promotion of holistic health and prevention or 222

minimization of illness within the context of a faith community. The term faith community 223

nurse (FCN) is used to represent a registered nurse specializing in faith community nursing. 224

225

The FCN promotes whole person care across the lifespan using the skills as a professional nurse 226

and provider of spiritual care. The FCN provides spiritual care in the faith community as well as 227

in the broader community. The goals of a FCN are the protection, promotion, and optimization 228

of health and abilities; the prevention of illness and injury, facilitation of healing; and the 229


alleviation of suffering through the diagnosis and treatment of human response, and advocacy 230

in the context of the values, beliefs, and practices of a faith community, such as a church, 231

congregation, parish, synagogue, temple, mosque, or faith‐based community agency. 232

233

Healthcare consumer is the term used by the American Nurses Association to define a person, 234

client, family, group, community, or population that is the focus of attention and to which the 235

registered nurse is providing services as sanctioned by the state regulatory bodies. This more 236

global term is intended to reflect a proactive focus on health and wellness care, rather than a 237

reactive perspective to disease and illness. In narratives within the specialty of faith community 238

nursing, other terms such as parishioner, congregant, or faith community member may also be 239

included as descriptive terms. The term healthcare consumer may refer to the faith community 240

or broader community as a whole, or to groups, families, and individuals in the faith 241

community. 242

243

The Specialty of Faith Community Nursing 244

The FCN uses the nursing process to assess and address the spiritual, physical, mental, and 245

social health of the healthcare consumer. With an intentional focus on spiritual health, the FCN 246

primarily uses evidence‐based practice interventions such as health education, counseling, 247

prayer, presence, active listening, advocacy, referral, and a wide variety of resources available 248

to the faith community. The FCN may also train and supervise volunteers from the faith 249

community. As an actively licensed registered nurse, the FCN provides nursing care based on 250

standards and professional experience, legal expectations, and education. The FCN focuses on 251

the needs of the healthcare consumer population and the position as defined by the faith 252

community. The FCN collaborates with the interprofessional team including primary care, 253

community health, hospice, rehabilitation, home health, acute care, critical care, integrative 254

health, mental health, and long‐term care, as well as clergy and chaplains, to enhance nursing 255

care and promote quality outcomes. 256

257


FCNs advocate for public policy that addresses health disparities and promotes health and 258

wellness (ANA/HMA, 2012). In faith community settings, the FCN advocates for appropriate 259

levels of care, and access to care for vulnerable populations. FCNs advocate for healthcare 260

consumers by initiating referrals for community services, promoting health literacy, and 261

providing health education to empower individuals to manage their health concerns. 262

263

Distinguishing Tenets of Faith Community Nursing 264

The specialty practice of faith community nursing includes the application of nursing science 265

and practice to individuals of all ages within a faith community setting and the surrounding 266

community. The differentiating factor from general nursing practice is the specific attention 267

that is given to the intentional care of the spirit. This specialty practice holds that all persons 268

are sacred and must be treated with dignity and respect. The foundations of the specialty 269

practice are in accordance with the ANA’s statements about nursing, social practice and the 270

essence of the practice. (ANA,2010, 2015b). 271

Essential to the practice of faith community nursing is a caring relationship that promotes trust 272

and the understanding of health as a dynamic process that embodies the spiritual, physical, 273

mental, and social dimensions of the person. Faith community nursing practice is influenced by 274

the theoretical principles of effective caring to promote health and individual or family growth 275

(Watson, 2008). Every human experience has mind‐body‐spirit components. Attention to 276

human responses of concern identified is accomplished by practicing a holistic approach to 277

health promotion recognizing the mind, body and spirit are intertwined. Particular emphasis is 278

placed on the spiritual component, particularly as it relates to whole person health. 279

280

Foundations of practice 281

The practice of faith community nursing is based on the assumptions that health and illness are 282

human experiences. Health is the integration of the spiritual, physical, psychological, and social 283

aspects of the person promoting a sense of harmony with self, others, the environment, and a 284

higher power; health may be experienced in the presence of disease or injury; the presence of 285

illness does not preclude health nor does optimal health preclude illness; healing is the process 286


of integrating the body, mind, and spirit to create wholeness, health, and a sense of well‐being, 287

even when the healthcare consumer’s illness is not cured (ANA & HMA, 2012). This specialized 288

practice is a continually evolving practice requiring integration of new knowledge and 289

awareness of ever changing resources to achieve desired outcomes. Data from research are 290

acquired from peer reviewed professional journals and other relevant professional publications. 291

The core values of faith community nursing embrace four major concepts: 292

Spiritual formation: an ongoing, essential component of practice that includes both self‐293

care and hospitality, through opening the heart to self and others as well as an 294

intentional process of fostering spiritual growth 295

Professionalism: practicing under the Scope and Standards for Faith Community Nursing 296

and the ANA Code of Ethics 297

Shalom: an understanding of health to be a dynamic process that embodies the 298

spiritual, physical, mental, and social dimensions of the person, 299

Community: fostering new and creative responses to health and wellness in partnership 300

with other community health resources. 301

302

Settings 303

Faith community nurse practice is nursing care that focuses on intentional care of the spirit, and 304

is practiced within the embrace of a faith community. A community of faith may be composed 305

of people of all ages. The FCN provides holistic nursing care to pediatric, adolescent, adult, and 306

geriatric members of the faith community who represent a diverse range of cognitive and 307

functional abilities. When an individual, family, group, or the faith community as a whole 308

experiences or desires a change in their level of spiritual, physical, mental, social, or 309

environmental well‐being, or when maintaining their current level of well‐being requires 310

nursing action, a FCN collaborates with them to develop a plan of care that incorporates 311

communal and individual spiritual beliefs and practices. 312

313

The needs and desires of individual members of the faith community provide direction for the 314

FCN interaction and often requires that the FCN visit members in a hospital or hospice, private 315


home, or residential facility, or accompany healthcare consumers as they navigate health 316

services within the community and beyond. During these encounters the FCN may also 317

intervene with spiritual care and provide a supportive, healing presence for both the healthcare 318

consumer and loved ones. 319

320

The setting for faith community nursing continues to expand as the needs of populations grow 321

and change. While the traditional setting is often a community of faith ‐ a church or 322

congregation, a synagogue, temple or mosque ‐ nontraditional settings may also include faith 323

based health clinics, day shelters, food pantries, senior centers and long term care facilities. 324

Faith‐based community sites for under‐served populations that provide food, housing, and 325

resources may also incorporate faith community nurses for chronic disease management, 326

screenings, health education and ongoing whole person care (Balint & George, 2015). 327

328

The size, concerns, assets, and expectations of the faith community will guide the development 329

of the expected role of a FCN. As a staff member, the paid or unpaid FCN is most often 330

supported and guided by a committee of faith community leaders and assisted by lay 331

volunteers. With education and supervision provided by the FCN, these volunteers may assume 332

tasks that family members would do for each other if they were available. 333

334

FCN Roles 335

Within the work of faith community nursing, multiple roles have been identified both within the 336

practice setting and within the structure of the specialty. The FCN serves the specialty in a 337

variety of roles including clinical expert, consultant, coordinator, researcher, educator, and 338

administrator. With faith community nursing practice there are identified roles of integrator of 339

faith and health, personal health counselor, health educator, health advocate, referral agent, 340

coordinator of volunteers, and developer of support groups (Hickman, 2006, p 29). 341

342

It is important to note that in the specialty of faith community nursing, faith community nurses 343

may work and function in an unpaid position. Many faith communities lack the financial means 344


to pay a nursing salary and may offer other compensations to provide support to the FCN 345

position. The lack of salary in no way diminishes the importance of their work, nor does it 346

negate the professional obligation to continue to follow all applicable laws and regulations for 347

registered nurses. 348

349

Clinical expert 350

As a clinical expert, the FCN may provide direct care to individuals, families, groups, the faith 351

community, and local communities served through the faith community. The multiple practice 352

settings of a FCN include the faith community, the home of the healthcare consumer, or 353

alternate settings where community members may seek care. To achieve optimal outcomes, 354

the FCN uses the nursing process to address the spiritual, physical, mental, and social health of 355

the healthcare consumer. Each plan of care is individualized to address the healthcare 356

consumers’ strengths and needs in order to achieve the best outcomes. As a clinical expert, 357

the FCN is a resource on issues of health for all groups of healthcare consumers and a champion 358

of health for the community as a whole. 359

360

Consultant 361

FCN’s provide consultation services to healthcare consumers within their practice setting. The 362

FCN works with denominations, foundations, and hospital systems to develop care plans and 363

programs based on the needs of the population to be served. 364

365

Coordinator 366

Faith community nurses participate in care coordination and serve as a “link” between 367

resources within the congregation, community, and healthcare systems. The FCN assists 368

healthcare consumers in navigating their healthcare access when care is shared among multiple 369

healthcare providers and sites. 370

371

Some healthcare systems have formal models of care continuity that include faith community 372

nurses. These institutions employ a coordinator to provide orientation, training, supervision, 373


and evaluation of faith community nurses. This administrative role includes oversight of 374

practice, documentation, professional development, and outcome measurements for FCNs in 375

their network. 376

377

Researcher 378

Faith community nurses integrate research findings into their practice and participate in 379

research at a level appropriate to their education and position. This may include sharing 380

research findings with colleagues, cultivating a climate of clinical inquiry, and disseminating 381

research findings through presentations, publications, and consultations. 382

383

Educator 384

The FCN provides education to healthcare consumers, family systems, other healthcare 385

providers, and the community at large. Health education is one of the main roles of the FCN. 386

Many healthcare consumers are more open to health education from a FCN in a trusted 387

relationship defined in the context of their faith. Faith community nurses promote an 388

atmosphere where individuals of all ages, through a variety of educational activities and one‐to‐389

one interactions, explore the relationship between values, attitudes, lifestyle, faith, and health. 390

391

Administrator 392

The FCN assumes the role of an administrator within the faith community. In this role, FCN 393

duties and responsibilities include program oversight, budgetary development/management, 394

evaluation of practice, and efforts to assure quality outcomes. 395

396


Evolution of Faith Community Nursing: 397

Nursing has its historical foundation deeply rooted in faith and health, as well as in the ancient 398

and recent traditions of many religions. Faith traditions established rules for public health, 399

including care of persons with infectious diseases. These communities also included visiting the 400

sick and caring for infants and the elderly as religious duty. This sense of duty to care for a 401

community’s members expanded to include “care for the stranger” and was the basis for early 402

diakonas—houses for strangers—which became the first charity hospitals. 403

404

The faith and health link evolved over time and has been influenced by cultural, political, social, 405

and economic events. Religious groups founded hospitals to provide care to vulnerable 406

populations, such as the poor, immigrant, and homeless. In the 12th, 13th, and 14th centuries, 407

religious orders provided care for persons with physical and mental illnesses. During the 16th 408

century, more than 100 female religious orders were founded specifically to provide care to the 409

sick, wounded and mentally ill. These were precursors to nursing practice. In the late 1800s 410

churches began to reclaim their role in healing. Diaconal ministries that developed in Europe 411

migrated to the United States, and immigrant churches imported the work of deaconesses and 412

other religious orders to provide health care to those in their communities. These religious 413

affiliations were instrumental in developing schools of nursing during the 20th century. 414

415

Florence Nightingale, trained through the Deaconess Institution in Kaiserswerth, Germany, felt 416

called to the service of the sick. In addition to her nursing education, she was a theological 417

scholar and writer. Her religious philosophy and belief in a higher power was the foundation for 418

her work to promote nursing as a trained profession, establish a public healthcare system that 419

included health promotion and preventive medicine, and advocate for health issues as a social 420

activist. The rich history of nursing’s evolution is exquisitely collected in Patricia Donahue’s 421

(1996) Nursing, The Finest Art: An Illustrated History. 422

423

In the late 1950s, Halbert Dunn, a physician, developed a public health concept that he called 424

high‐level wellness. His writings were a catalyst for wellness centers that began in the 1970s. A 425


growing public interest in complementary and alternative medicine influenced Western 426

conventional medical care to incorporate aspects of these models into integrated care. This 427

growing interest and focus on health promotion and wellness influenced the development of 428

faith community nursing. 429

430

In 1977, Rev. Dr. Granger Westberg in conjunction with W.K. Kellogg Foundation and the 431

Department of Preventive Medicine and Community Health of the University of Illinois College 432

of Medicine began a dozen medical clinics in neighborhood churches located in marginalized 433

communities. The intent was to bring about whole person health care in faith settings by 434

having spiritually oriented doctors, nurses, social workers and clergy working together. The 435

nurses in these “wholistic health centers” were referred to as “parish nurses.” 436

437

In 1986, the Parish Nurse Resource Center was created through the sponsorship of Lutheran 438

General Health System (now Advocate Health Care) in Chicago. The center provided a national 439

focal point for the development of parish nursing through its educational resources. With the 440

expansion of the practice to other countries, the name was changed to the International Parish 441

Nurse Resource Center (IPNRC). The IPNRC was relocated in 2002 to St. Louis under the 442

management of the Deaconess Foundation until 2011 when it was moved to the Church Health 443

Center in Memphis. In 2016 the name of the center was changed to the Westberg Institute for 444

Faith Community Nursing. 445

446

In 1989, a three year Kellogg Foundation Grant supported the development of the Health 447

Ministries Association (HMA). The HMA was incorporated as a non‐profit organization in Iowa 448

to provide communication and networking among faith community nurses. In 1997 the HMA ‘s 449

formal request to the American Nurses Association (ANA) was approved and ANA recognized 450

Parish Nursing as a professional nursing specialty and ANA recognized the HMA as the 451

professional membership organization for parish nurses. In 1998 ANA accepted and published 452

HMA’s Scope and Standards of Parish Nursing Practice. In 2005 revision of the text resulted in a 453

title change to Faith Community Nursing Scope and Standards of Practice to be inclusive of 454


nurses in all faith traditions. Today the HMA continues to provide education and practice 455

support for faith community nurses and others in healing ministries through their national 456

conference, publications, and membership services. 457

458

The standards of faith community nursing practice and professional practice were incorporated 459

into curricula, position descriptions, and performance evaluation processes. This intentional 460

focus on professional nursing practice provided the foundational work for advancement of the 461

specialty. In 2007, the HMA began work with the American Nurses Credentialing Center (ANCC) 462

to develop certification in faith community nursing. This work culminated in 2014 with ANCC 463

offering Certification by Portfolio in Faith Community Nursing. 464

465

Nurse‐led programs within faith communities continue to grow and evolve. Faith community 466

nurses impact the health and wellness of individuals, families, and communities. The 467

common expectation across faith traditions is that the professional registered nurse 468

functioning as a FCN possesses a depth of understanding of the faith community’s traditions, 469

as well as continuing competence as a registered nurse. 470

471

Focus on Spiritual Care 472

Nurses have long observed that when illness or brokenness occurs, health care consumers, 473

whether individually or with family or friends often turn to their source of spiritual strength for 474

reassurance, support and healing. Nursing Scope and Standards second edition (ANA, 2015a) 475

reaffirms that spiritual care is integral in all nursing practice. In the 2008 revision of the 476

Essentials of Baccalaureate Education for Professional Nursing Practice, the presence of 477

spiritual care and spiritual assessment in nursing curriculum were expanded to ensure the basic 478

education of nurses prepared them to conduct spiritual assessments and provide spiritual care. 479

The nursing specialty of faith community nursing emphasizes spiritual care or intentional care 480

of the spirit as an essential domain requiring education and skill beyond spiritual care provided 481

in the general practice of a registered nurse. 482

483


The faith community nurse uses the nursing process for assessment, diagnosis, planning and 484

evaluation of nursing care for individuals, families and communities. Diagnosis terminology is 485

applied across the general nursing profession through the use of standardized terminology as in 486

the North American Nursing Diagnosis Association’s (NANDA) comprehensive list of nursing 487

diagnoses including diagnoses on spiritual, physical and emotional health. Nursing diagnoses 488

related to spirituality include Spiritual Distress, Risk for Spiritual Distress, and Readiness for 489

Enhanced Spiritual Well‐being. Other nursing diagnoses accepted by NANDA International that 490

are related specifically to spirituality include Powerlessness, Hopelessness, Ineffective Coping, 491

and Complicated Grieving (NANDA, 2014). 492

493

Faith Community Nurses may also use other nursing classification systems such as the OMAHA 494

System. The Nursing Interventions Classifications (NIC) and Nursing Outcomes Classifications 495

(NOC) represent the most common standardized systems for nursing interventions and 496

evaluating the effects of the interventions (i.e. outcomes) used across nursing, including faith 497

community nursing. Examples applicable to faith community nursing’s focus on spiritual care 498

giving include: Hope Instillation, Spiritual Support, Religious Ritual Enhancement, and Spiritual 499

Growth Facilitation. 500

501

Faith community nurses draw on professional skills that integrate spiritual care and nursing 502

care, as well as the resources of individuals and groups both within and beyond the faith 503

community, to provide whole person care. Faith community nurses may also incorporate 504

Wellness Diagnoses for Health Promotion that accentuate strengths and assets rather than 505

illness or deficits and incorporate a person’s positive aspects of life and health into their nursing 506

care (Stolte, 1996). Stolte cites several examples of wellness nursing diagnoses related to 507

spirituality: 508

Progressive religious faith 509

Maintaining strong spiritual foundation 510

Maintaining hope and trust 511

Progressive ability to forgive self and/or others 512


Continued belief in meaning and purpose of life 513

At peace with self and/or health status 514

515

Treatment may or may not cure an affliction. However, it is still possible through care of the 516

spirit for a person to be healed even if a cure—physical restoration—does not occur. A person 517

may be dying from cancer, but if a broken relationship between family members has been 518

reconciled or the person is at peace with the circumstances, this may be considered healing. 519

This broader viewpoint of healing is embraced by FCNs. 520

521

Assault, betrayal, accident, or death of a member of the community are examples of situations 522

that can affect an entire faith community. Members of all ages may manifest anger, grief, 523

depression, anxiety, fear, and spiritual or physical pain in varying degrees. A FCN’s response to 524

such an event is complex. Beyond identifying and meeting the needs of individuals and families, 525

the FCN treats the whole faith community as a healthcare consumer. Assessment focuses on 526

identifying the educational and supportive needs of the whole faith community. Interventions 527

occur at three different levels: community, family or group, and individual. 528

529

The FCN addresses a variety of issues that threaten the holistic health of persons in the faith 530

community, including: 531

• Individuals or families may lack food, shelter, transportation, income, or health care. 532

• Victims of violence, abuse, or exploitation in a variety of settings, including domestic 533

settings, may seek solace or sanctuary. 534

• Adult children of aging parents may seek guidance in talking with or determining the 535

appropriate living situation for a parent, and ongoing assistance from the faith 536

community. 537

• Victims of natural disasters and other life‐altering emergencies may require various 538

forms of assistance. 539

540


Some healthcare consumers will require support of basic needs so that they have the time and 541

space to reflect on spiritual issues; for others, spiritual care will be the direct response. The 542

form of spiritual care will depend on the beliefs and practices of the faith community; the 543

desire of the faith community, the group, or the individual; the skills of the FCN; and the 544

collaboration of other staff members and volunteers. 545

546

ETHICS IN FAITH COMMUNITY NURSING 547

The Code of Ethics with Interpretive Statements (the Code) (2015) is foundational to nursing 548

theory and serves as a guide to the art and science of nursing. The values in the Code apply to 549

nurses in all roles, forms of practice, and settings. “The nine provisions in the Code are an 550

expression of the values, virtues, and obligations that shape, guide, and inform nursing as a 551

profession.” (2015, p. vii). The provisions reflect three relationships: nurse‐to‐patient, nurse‐552

to‐profession, and nurse‐to‐society. The interpretive statements of each provision provide 553

guidance for ethical nursing practice and behavior. 554

555

Nurses practice with compassion and respect for the inherent dignity, worth, and unique 556

attributes of every person. Faith Community Nurses promote whole person health with 557

intentional inclusion of religious or spiritual well‐being and supportive care. Ethical healthcare 558

issues require nonjudgmental therapeutic nurse‐patient relationships. Faith community nurses 559

may: 560

guide conversations about care decisions arising at the intersection of faith beliefs and 561

medically prescribed care. 562

serve as a person’s healthcare advocate by accompanying them to medical 563

appointments, defining medical terms, and interpreting medical therapies that are not 564

understood. 565

guide discussions on advance care planning, minimizing unwarranted or unnecessary 566

medical treatment, and compassionate end‐of‐life care. 567

568


All nurses participate in the advancement of the profession through knowledge development, 569

evaluation, dissemination, and application to practice. Approaches to advancing the nursing 570

profession include research and scholarly inquiry; contributions to development, maintenance, 571

and implementation of professional practice standards; and participation in nursing and health 572

policy development. (the Code, 2015 p. 28). Faith community nurses contribute to 573

advancement of their nursing specialty by development of practice standards, application of 574

standards in specialty education and practice, and serving as representatives on institutional, 575

professional, and civic agency committees and boards. 576

577

Individual nurses have a collective voice through their professional organizations and 578

associations. Active participation in nursing’s organizations maintains the integrity of the 579

profession and provides mechanisms for nurses to address healthcare inequality, access to 580

care, and social justice. Faith community nurses advocate for appropriate levels of care for 581

vulnerable populations and those with limited access to healthcare resources. This advocacy 582

may include initiating referrals for treatment, obtaining home care resources, and promoting 583

community awareness of significant health problems. Faith community nurses may partner 584

with faith‐based and service organizations to promote supportive public policy for social justice 585

that promotes health, prevents illness, and reduces environmental detriments to health. 586

587

Culturally Congruent Care 588

In establishing a caring relationship with a person, when possible, all aspects of a person’s 589

nature must be acknowledged. Culture refers to the learned, shared, and transmitted values, 590

beliefs, norms, and life practices of a particular group that guides thinking, decisions, and 591

actions in patterned ways. (Leininger, 1978). Culture must be understood through cultural 592

knowledge, cultural awareness, cultural encounters, and cultural skill (Campinha‐Bacote, 2007). 593

Nurses integrate cultural knowledge into practice when assessing, communicating with, and 594

providing care for members of a racial, ethnic or social group. This cultural expertise requires 595

that the nurse has self‐awareness of personal cultural identity, heritage, and values as well as 596

engagement in life‐long learning to understand the culture of others. (ANA 3E, Standard 8). 597


Through these stages of relationship building and interaction, the nurse must recognize and 598

eliminate barriers to care that have been created by cultural differences. 599

Faith community nurses advocate for appropriate levels of care for culturally diverse and 600

vulnerable populations with limited access to healthcare resources. This may include refugee 601

communities and other culturally‐linked communities. The faith community nurse advocates 602

for culturally congruent care that improves access to healthcare, promotes positive outcomes, 603

and reduces disparities. Faith community nurses, aware of the impact of discrimination within and 604

among vulnerable cultural groups, advocate for culturally‐sensitive care which may include the use 605

of medical interpreters and translators. Faith community nurses foster environments of civility, 606

kindness, and respect for these members of society. 607

608

EDUCATIONAL PREPARATION FOR FAITH COMMUNITY NURSING 609

610

Faith Community Nurse 611

The faith community nurse bridges two domains and therefore must be prepared in and 612

responsible for both professional nursing practice and spiritual care. Some faith traditions may 613

require additional educational stipulations and requirements. 614

615

The preferred minimum preparation for a registered nurse or advanced practice registered 616

nurse entering the specialty of faith community nursing includes: 617

A baccalaureate or higher degree in nursing with academic preparation in community‐ 618

or population‐focused nursing 619

Current experience as a registered nurse using the nursing process 620

Knowledge of the healthcare assets and resources of the community 621

Specialized knowledge of the spiritual beliefs and practices of the faith community 622

Specialized knowledge and skills to enable implementation of Faith Community Nursing: 623

Scope and Standards of Practice, Second Edition. 624

With many faith community nurses practicing in autonomous settings, it is essential for this 625

nursing specialty to support the 2010 Institute of Medicine’s Future of Nursing Report 626


recommendation that the proportion of nurses with baccalaureate degrees be increased to 80 627

percent by 2020. 628

Appropriate and effective practice as a FCN requires the ability to integrate current nursing, 629

behavioral, environmental, and spiritual knowledge with the unique spiritual beliefs and 630

religious practices of the faith community into a program of holistic nursing care. Such 631

integrative practice is required within all levels of the academic education of the nurse. With 632

education, mentoring, and a collaborative practice site, a faith community nurse may progress 633

in expertise from novice to expert in this specialty practice. 634

635

Graduate‐level prepared registered nurse 636

Graduate‐level prepared registered nurses are registered nurses prepared at the master’s or 637

doctoral educational level; have advanced knowledge, skills, abilities, and judgment; function in 638

an advanced level as designated by elements of the nurse’s position; and are not required to 639

have additional regulatory oversight. 640

641

Advanced Practice Registered Nurse 642

By definition, an advanced practice registered nurse (APRN) is a nurse who has completed an 643

accredited graduate‐level education program preparing her or him for the role of certified 644

nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), certified nurse‐midwife 645

(CNM), or clinical nurse specialist (CNS) who has passed a national certification examination 646

that measures the APRN role and population‐focused competencies; maintains continued 647

competence as evidenced by recertification; and is licensed to practice as an APRN. APRN is a 648

regulatory title and includes the four roles (CNP, CRNA, CNM, and CNS). The core competencies 649

for education and the scope of practice are defined by the professional associations. State law 650

and regulation further define criteria for licensure for the designated scopes of practice. 651

652

An emerging role in healthcare delivery models is that of an APRN and other graduate‐level 653

prepared nurses who have also acquired the additional specialized education for practice as a faith 654

community nurse. These nurses integrate theoretical and evidence‐based knowledge from 655


graduate nursing education with the specialized education of a FCN regarding the structure, 656

spiritual beliefs, and practices of the faith group. Examples that illustrate this role include a nurse 657

practitioner in a faith‐based healthcare site, an oncology CNS, a palliative care CNS; and a mental 658

health CNS practicing in a faith‐based community clinic. Besides providing nursing care, these 659

APRNs influence nursing care outcomes by serving as an advocate, consultant, or researcher in 660

the specialty area, by providing expert consultation for spiritual leaders and other healthcare 661

providers, and by identifying and facilitating improvements in holistic health care. 662

663

Additional Faith‐related Designations 664

National leaders of faith groups that recognize the importance of integrating this specialty 665

nursing practice into faith communities have developed mechanisms for mentoring and 666

providing informal and formal education in concepts of spiritual beliefs, practices, and rituals. 667

When such mechanisms are available within the faith group, the FCN may work with the 668

leadership of the faith community to meet the educational and practice requirements to earn 669

formal designation as a spiritual leader in the particular faith group. 670

671

Faith groups have different ways of designating or titling individuals who have attained an 672

advanced level of preparation and often undergone examination to determine fitness for 673

providing spiritual care. FCNs who achieve the requirements defined by the faith group in which 674

they are practicing may then be given a title by the faith community indicating their 675

achievement, such as deacon, minister of health, or pastoral associate. Titles such as these have 676

a specialized meaning within the faith community served and acknowledge the additional 677

education and training received by the FCN specific to the faith tradition. 678

679

Educational Approaches 680

Currently, the education of all nursing students preparing for the national examination for RN 681

licensure includes basic content on spiritual care. However, because of the intentional focus on 682

spiritual care by the faith community nurse, this educational exposure is not adequate 683

preparation for assuming the specialty role of a FCN. Faith community nursing requires an 684


extensive global knowledge base, which has led to the development of its own body of 685

knowledge beyond that established for general professional nursing practice. This body of 686

knowledge is continuously evolving; education beyond that required for licensure is therefore 687

necessary to ensure safe faith community nursing practice. 688

689

FCN nursing is unique in that there are various educational entries into the specialty practice. 690

Preparation may occur through accredited continuing education programs, baccalaureate 691

courses, or graduate nursing courses, or related content in counseling, public health, and 692

pastoral care. 693

694

A continuing education foundational curriculum was developed in 1996 as a pilot project of 695

Advocate Health Care and the International Parish Nurse Resource Center (IPNRC) with 696

collaboration among representatives from the existing leaders and educators of the emerging 697

parish nursing community. A continuing education curriculum was developed for both the entry 698

level faith community nurse and faith community nurse program coordinator. That curriculum 699

continues to be offered under the leadership of the Westberg Institute for Faith Community 700

Nursing (formerly IPNRC) and Church Health Center and through their relationship with 701

numerous educational partners as classroom and online models. 702

703

In addition to the IPNRC curriculum, university‐based continuing education and graduate 704

degree curricula and certificate programs were developed at universities across the nation 705

including Marquette University, Georgetown University, Duke University, and Concordia 706

College. Faith denominations have also developed educational content specific to their faith 707

practices and beliefs. These foundational courses provide a solid entry level educational 708

preparation into the specialty. The Health Ministries Association supports curricula 709

development through active participation of content experts. 710

711

Some faith community nurses have also completed graduate‐level and doctoral‐level 712

preparation in clinical nursing specialties, complementary care, palliative care, and holistic 713


health. Others have completed graduate level course work in seminaries and schools of 714

theology and religion, and formal Clinical Pastoral Education. These interdisciplinary 715

approaches to education and skill development expand faith community nurses’ expertise and 716

enhance their incorporation of spiritual care into their faith community nursing practice. 717

718

Mentoring 719

The American Association of Colleges of Nursing (AANC) position statement, The Baccalaureate 720

Degree in Nursing as Minimal Preparation for Professional Practice notes that 721

healthcare is shifting from hospital‐centered inpatient care to more primary and 722

preventive care in communities. This requires nurses to function with more 723

independence in clinical decision‐making, case management, guiding patients through 724

the maze of healthcare resources, and educating patients on treatment regimens and 725

adoption of healthy lifestyles. (American Association of Colleges of Nursing, 2000, p.1) 726

727

Nurses moving from acute, inpatient settings into community‐based faith community nursing 728

practice require reflective self‐assessment to identify individual learning needs and goals for 729

gaining this greater degree of independence in a broader clinical setting. Mentoring during 730

orientation can enhance faith community nursing practice. 731

HMA recognizes that many Faith Community Nurses begin their role as a lone practitioner 732

without benefit of a health system or network to provide a nurturing environment for growth 733

and development both spiritually and professionally. The novice FCN needs guidance and 734

support in order to establish and sustain a successful professional practice. The Health 735

Ministries Association has developed a mentoring program to assist faith community nurses in 736

competency development after completing foundational education. 737

738

The HMA FCN Mentor Program has been established to link the novice FCN with an 739

experienced HMA FCN leader in order to facilitate the sharing of knowledge, experiences, and 740

wisdom and to encourage growth and achievement by providing an open and supportive 741

learning environment. 742


743

Some educational institutions that specialize in religious education also offer relevant courses 744

or programs of study focusing on spiritual support and care. Innovative, interprofessional 745

collaboration provides other opportunities to increase knowledge and skills particularly related 746

to spiritual care and population health. Faith communities understand, support, and often fund 747

continuing education and spiritual development for FCNs to enhance their ability to provide 748

spiritual care. 749

750

Certification Process by Portfolio 751

Certification is a voluntary process for FCN nurses who meet the eligibility requirements and 752

provides an opportunity for FCN to document their achievement within their specialty practice. 753

The American Nurses Credentialing Center (ANCC) now offers Certification by Portfolio in Faith 754

Community Nursing. The Health Ministries Association has supported professional nursing 755

practice in faith community nursing through its development of standards of practice and an 756

ongoing goal of developing formal recognition of competency through certification. Faith 757

community nurses are encouraged to achieve certification. 758

759

In July 2013, HMA posted a call for those interested in participating in the ANCC Certification 760

process to apply to the ANCC invitation. A Content Expert Panel met in Silver Springs, MD that 761

autumn. These candidates were selected by ANCC from the pool of applicants who responded 762

to the ANCC invitation to serve in the certification process. In December 2013, an External 763

Validation Committee was selected from the pool of applicants to review FCN material compiled 764

by the Content Expert Panel. This committee completed an in‐depth survey. A Standard 765

Setting Panel and Appraisers were selected by ANCC. In August 2014, ANCC and HMA launched 766

the Portfolio Process for Certification for the Specialty Practice of Faith Community Nursing. 767

768

The designated credential for ANCC certification in faith community nursing is RN‐BC. FCN is an 769

abbreviation for faith community nurse and is not meant to indicate a credential. The 770

abbreviation FCN should not be written following a nurse’s name in a signature line. When 771


certified, the faith community nurse places RN‐BC behind his or her name and then spells out 772

faith community nursing to indicate the specialty. 773

774

Maintenance of certification beyond the initial certification examination is required every five 775

years. While specific details of the portfolio re‐certification process have not been finalized by 776

ANCC, re‐certification will likely be a combination of professional practice and activities such as: 777

continuing education (CE) credits/contact hours, program development, project 778

implementation, publication, research, teaching (e.g., clinical precepting, CE presentations), 779

academic education, and participation in professional organizations. 780

781

HMA Recognition of Excellence 782

The HMA established the Granger Westberg Leadership in Faith Community Nursing Award. 783

This award recognizes an outstanding Faith Community Nurse who exemplifies faith community 784

nursing and has achieved success in implementing a practice that is faith centered, spiritually 785

integrated, community driven, and holistic in its approach toward health promotion and 786

disease prevention. Criteria for selection include promoting a positive image of faith community 787

nursing, proactive response to health care needs of faith communities, resourcefulness and 788

creative leadership skills, effective use of practice, innovative teaching skills, professional 789

competency, and evidenced based practice. 790

791

The HMA has also established a Faith Community Nursing Society to recognize nurses who have 792

achieved certification. The FCN Society was formed to 793

Recognize superior achievement in the specialty practice of faith community nursing for 794

faith community nurse members of HMA. 795

Strengthen commitment to the ideals and purposes of the profession and the 796

organization that supports the work of faith community nursing. 797

Encourage ongoing leadership and involvement {present and future} in the evolving 798

practice of faith community nursing through efforts led by HMA. 799


Share best practices, attend educational seminars, discuss research, promote 800

professional publication, and engage in peer‐to‐peer networking. 801

Support and assist with improvement of the related specialty through identification and 802

development of new skills. 803

804

Ongoing Education and Competency 805

The American Nurses Association identifies that in the practice of nursing, “competence is 806

definable, measurable and can be evaluated. Competence is situational, dynamic, and is both 807

an outcome and an ongoing process. Competency is an expected level of performance that 808

integrates knowledge, skills, abilities, and judgment in formal, informal, and reflective learning 809

experiences. Knowledge encompasses thinking, understanding of science and humanities, 810

professional standards of practice, and insights gained from practical experiences, personal 811

capabilities, and leadership performance. Context determines what competencies are 812

necessary” (ANA, 2010a, p. 12). “Formal learning most often occurs in structured, academic, 813

and professional development environments, while informal learning can be described as 814

experiential insights gained in work, community, home, and other settings. Reflective learning 815

represents the recurrent thoughtful personal self‐assessment, analysis, and synthesis of 816

strengths and opportunities for improvement” (ANA, 2010a, p. 13). 817

818

A key requirement of faith community nurses is ongoing education and developing and 819

maintaining competencies. Faith community nurses practice in the role of independent and 820

collaborative direct care provider, educator, administrator, healthcare consultant, resource 821

person, supervisor of support personnel, public relations representative, leader and advocate. 822

Faith community nurses integrate cognitive, psychomotor, communication, interpersonal, and 823

diagnostic skills. Their ability to act effectively involves active listening, integrity, knowledge of 824

one’s strengths and weaknesses, positive self‐regard, emotional intelligence, spiritual 825

formation, and openness to feedback. 826

827


Faith community nurses must continually reassess their competencies and identify needs for 828

additional knowledge, skills, personal growth, and integrative learning experiences. 829

Competence in faith community nursing practice must be evaluated by the individual nurse, 830

peers, mentors, and faith community leaders. No single evaluation method or tool can 831

guarantee competence. The “registered nurse, regardless of specialty, role, or setting remains 832

accountable” for the nursing care provided in their practice and addressing their own learning 833

needs. (ANA, 2015, p.32). This is of particular importance for all FCNs who generally work 834

independently in the community setting. 835

836

CONTINUED COMMITMENT TO THE PROFESSION 837

Because the specialty practice of faith community nursing is relatively small in numbers, each 838

FCN is called upon to educate nurses, other healthcare providers, faith community leaders, and 839

the general public about this nursing specialty. 840

The FCN commits to lifelong learning in nursing, spiritual growth, and the beliefs and practices 841

of the faith community. There are numerous opportunities for personal and professional 842

growth both in and beyond the community. Major denominations support both programs and 843

professional development. The professional organization for faith community nurses, the 844

Health Ministries Association, provides opportunities for networking and ongoing education in 845

the practice specialty as well as with other disciplines. 846

While the FCN may be the only healthcare provider in the faith community, the best practice 847

cannot be provided in isolation. Personal and professional support, education opportunities, 848

and resources are available. Accessing these will improve both the care provided to the faith 849

community and the continued progress of the specialty. 850

851

RESEARCH AND FAITH COMMUNITY NURSING 852

Faith community nurses incorporate research on the spiritual dimensions of diagnosis, 853

interventions, and outcomes to improve whole person health for individuals, families, and 854

communities. Research reports may be found in the nursing literature and publications of 855

other health professionals, as well as the professional literature focused on health ministry, 856


chaplaincy, theology, spirituality, and spiritual care. Findings from a variety of non‐nursing 857

disciplines provide understanding of the strong connection between spiritual well‐being, 858

participation in religious practices, and holistic health. Research conducted at the National 859

Institutes of Health and academic institutions has established a relationship between spiritual 860

practices and health, thereby expanding the knowledge base for the specialty of faith 861

community nursing. Involvement in a faith community provides health benefits through social 862

support, a social identity, and a sense of power beyond one’s self. Religious and spiritual 863

practices, such as meditation, prayer, and touch, are reported to lengthen life, improve the 864

quality of life, and improve health outcomes by enhancing psychological, physical, and spiritual 865

well‐being. 866

867

Faith community nurses may incorporate nursing theory as rationale for nursing practice and 868

interventions. Nursing theoretical frameworks for nursing evolved in the mid and late 869

twentieth century and care of the spirit has been an integral aspect of many nursing theories, 870

including: 871

Florence Nightingale identified the importance of spiritual care and that the needs of 872

the spirit were as critical to health as those individual organs which make up the body. 873

Callista Roy’s adaptation model (1976) discusses the adaptation of individuals and 874

families to health and illness that includes psychological and spiritual aspects. She 875

addresses the moral‐ethical‐spiritual self and religion or religious practice as dimensions 876

that influence a persons’ adaptation, particularly the person’s view of life, functional 877

capacity, and attitudes and behaviors related to health and illness. 878

Paterson and Zderad (1976) describe the person as “an incarnate being, always 879

becoming, in relation with men and things in a world of time and space” (p.19). 880

Parse (1981) describes the transcendent quality of human beings, “nursing is unfolding 881

in simultaneous mutual interchange with the world transcending with greater diversity 882

and complexity” (p.172). 883


Jean Watson (1985, p.45) explains the person by emphasizing the existence of the 884

“human soul” that is greater than the physical, mental and emotional existence of a 885

person at any given point in time”. 886

Betty Neuman (1995) views the person as a “whole” with physiological, psychological, 887

sociocultural, developmental, and spiritual variables in dynamic interaction. 888

Madeleine Leininger (2002) defines cultural care as the “subjectively and objectively 889

learned and transmitted values, beliefs, and patterned lifeways that assist, support, 890

facilitate, or enable another individual or group to maintain health and well‐being, 891

improve their human condition and lifeways, or deal with illnesses, handicaps, or 892

death.” (189). 893

894

Research by faith community nurses to describe the scope of practice and evaluate the benefits 895

of faith community nursing specialty practice is increasing. Studies include investigations of the 896

measurement of clinical outcomes, cost–benefits of faith community nursing interventions, and 897

descriptive studies of FCN models of practice. More recently, faith community nurses enrolled 898

in Doctor of Nursing Practice (DNP) degree programs are developing research on spiritual 899

aspects of nursing care. Faith community nurses may participate in discovery of research 900

questions and formulation of research related to the intersection of spirituality, theology, and 901

health. Faith community nurses share peer reviewed findings with colleagues and integrate 902

evidence‐based research in their practice. 903

904

PROFESSIONAL TRENDS AND ISSUES IN FAITH COMMUNITY NURSING 905

In the coming years, all nurses will experience the impact of emerging trends and challenges 906

related to nursing practice and healthcare delivery. Faith community nurses have a 907

professional responsibility to participate in examining potential and real impacts of change, 908

developing positive productive responses, and evaluating outcomes. The ANA 2013 909

Membership Assembly conducted an electronic environmental scan completed by the nurses in 910

attendance which envisioned future change impacting nursing and healthcare. (ANA, 2013). 911

The most frequently cited areas of future change included societal/external trends that will 912


impact nursing, ways in which nurses are working differently, and ways in which patients are 913

acting in new or different ways related to health. 914

915

Care Delivery and Transitional Care Coordination 916

New models for healthcare delivery and reimbursement are being developed. In the next two 917

to five years, reimbursement will shift from volume‐driven fee‐for‐service to value‐based 918

models using metrics such as quality and patient satisfaction. Medicare’s value‐based modifier 919

for large medical practices treating Medicare patients went into effect in 2015 with full 920

implementation scheduled for 2017. One component of growing importance to patient 921

satisfaction scores includes meeting emotional needs through spiritual assessment and care 922

(Williams et al, 2011; Balboni, 2014). Patients whose spiritual needs are not being met are 923

reporting lower ratings of quality and satisfaction with their care (Sharma et al, 2012). Nurses 924

who address and support patient’s spiritual needs can have a significant impact on patient 925

satisfaction scores. This provides opportunity for faith community nurses, as experts in 926

providing spiritual care, to collaborate with nursing education colleagues in providing spiritual 927

care education to nurses in other specialties. 928

929

The role of the faith community nurse in transitional care embodies the practice and ministry of 930

integrated whole person care. This nursing intervention begins with the promotion of well‐931

being and the goal of preventing disease and chronic conditions in order to sustain a balance 932

and quality of the life experience. The FCN provides guidance through the recognition of health 933

status, awareness of brokenness, and the potential for return to the optimum level of 934

contribution to overall quality of community health. It is identified in the hospitalized 935

population, but includes anyone experiencing health challenges: the woman preparing for the 936

birth of her child; the person newly diagnosed with a chronic or untreatable condition; 937

chronically‐ill older adults; the adolescent struggling for personal identity; or the person seeking 938

employment in order to keep his/her family together. All are in transition and each from time 939

to time may seek support or resources from the FCN. 940

941


Post‐hospital transitional care includes a range of time‐limited services and environments that 942

complement primary care and are designed to ensure health care continuity and avoid 943

preventable poor outcomes among at risk populations as they move from one level of care to 944

another, among multiple providers and across settings (Naylor, 2011). The faith community 945

nurse may decrease or prevent readmission by providing comprehensive nursing interventions: 946

Review of the written discharge plan 947

Assessment of patient and/or caregiver understanding 948

Medication reconciliation 949

Post‐discharge services: Follow‐up appointments, outstanding tests 950

Patient education: care procedures, safety, signals for contacting provider, what to do if 951

problems arise 952

Telephone reinforcement 953

Access to community resources and services 954

955

Examples of healthcare system‐based models partnering with faith community nurses are 956

emerging. Independent FCNs also provide transitional care to persons at increased risk of 957

complications and readmission which may include those with chronic illnesses, isolated elderly 958

persons, persons with limited

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FAITH COMMUNITY NURSING SCOPE AND STANDARDS ...hmassoc.org/wp-content/uploads/Draft-of-FCN-Scope-and...196 community nursing practice from a national perspective, the professional