faith community nursing scope and standards...
TRANSCRIPT
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FAITH COMMUNITY NURSING: SCOPE AND STANDARDS OF PRACTICE, THIRD EDITION
2016
Draft Document
Health Ministries Association
July 15, 2016
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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