State of research for Faith Community Nursing 2009

Using Nursing Interventions Classifications to Document Faith Community Nursing Transitional Care

ABSTRACT

One out of five Medicare beneficiaries is readmitted within 30 days after hospital discharge, and as many as three in four readmissions are preventable. This study describes transitional care interventions (TCIs) delivered by one faith community nurse (FCN) to at-risk seniors living in a certain ZIP code. Two years of nursing documentation (2,280 interventions) were translated into Nursing Interventions Classification standardized nursing language. Results indicate the FCN provided priority TCIs including spiritual care. In fully describing TCIs using a nursing language, results support that the FCN transitional care model is a method worth exploring to provide wholistic transitional care.

What Are the Characteristics of the Parish Nursing Research Literature and How Can it Inform Parish Nurse Practice and Research in Canada? A Scoping Review

BACKGROUND

Parish nursing is a specialized branch of professional nursing that promotes health and healing by integrating body, mind and spirit as a practice model. Parish nurses contribute to the Canadian nursing workforce by promoting individual and community health and acting as system navigators. Research related to parish nursing practice has not been systematically collated and evaluated.

PURPOSE

This review seeks to explore, critically appraise and synthesize the parish nurse (PN) research literature for its breadth and gaps, and to provide recommendations for PN practice and research.

METHODS

A scoping review was conducted using Levac and colleagues' procedures and Arksey and O'Malley's enhanced framework. The CINAHL, ProQuest and PubMed databases were comprehensively searched for original research published between 2008 and 2020. The final sample includes 43 articles. The Mixed Methods Appraisal Tool was used to critically assess literature quality.

RESULTS

There is a significant gap in PN research from Canada and non-U.S. countries. Methodological quality is varied with weak overall reporting. The literature is categorized under three thematic areas: (1) practice roles of the PN, (2) role implementation, and (3) program evaluation research. Research that evaluates health promotion program interventions is prominent.

CONCLUSIONS

More rigorous research methods and the use of reporting checklists are needed to support evidence-informed parish nursing practice. Building relationships among parish nurses, nursing researchers and universities could advance parish nursing research and improve evidence-based parish nursing practice. Research into the cost effectiveness, healthcare outcomes, and the economic value of PN practice is needed.

The State of Research on Faith Community Nursing in Public Health Interventions: Results from a Systematic Review

Though faith community nurses (FCNs) serve many roles in churches and communities, little is known about their roles or effectiveness in public health interventions. This systematic review summarizes the literature on recent faith community nursing interventions, examining trends, evaluating rigor, and proposing future research directions. Articles were downloaded from PubMed and CINAHL, and 24 studies were included. Interventions addressed various health outcomes. The FCNs participated in research by recruiting participants, developing study measures, and implementing programs. Results reported mainly process evaluation and provided few outcomes. Better evaluation is needed to understand the effectiveness of FCNs in public health research.

Faith Community Nursing: Using Spiritual Interventions in Diabetes Prevention

As the incidence of diabetes rises in the United States, education on diabetes prevention and management is paramount. Diabetes programs offered in churches or community settings have reported positive outcomes such as weight loss and improved glucose control. Delphi Survey technique was used to identify spiritual interventions used by faith-based and community-based coaches in leading Diabetes Prevention Program (DPP) courses. Results showed that faith-based coaches reported using prayer, active listening, and emotional support in their DPP course; giving hope, incorporating humor, and using spiritual/sacramental activities were rated as important or very important by most coaches and can be used by faith community nurses in their practice.

HIV Prevention Programming for Older African American Women: The Impact of a Faith-Based and Behavioral Science Partnership on Depressive Symptoms

Objective

The current study sought to test the effect of an HIV prevention intervention on depressive symptoms in a sample of older African American women.

Design Setting and Participants

A pretest-posttest randomized control group design was conducted in a mega-church in Los Angeles with a sample of 62 older African American women, aged ≥50 years, 29 of whom were randomly assigned to the experimental condition and 33 to the comparison/control condition.

Measures

A measure of psychological wellbeing (CES-D) was utilized to test the effect of the four-session group intervention vs the one-session informational group intervention on change in depressive symptoms from pretest to posttest. Demographic characteristics included: measures of age in years; relationship and employment statuses (coded 1 for yes, 0 for no); and educational attainment.

Results

Participation in the study was associated with a significant improvement in the women's psychological wellbeing from baseline to time 2; ie, decreased depressive symptoms. This change was greater for women in the four-session experimental group than for those in the one-session comparison group, due in part to a marginally significant interaction between time and experimental conditions.

Conclusions

This study demonstrates the utility of faith-based/behavioral-scientist partnerships in HIV programming. Findings contribute to the evidence on interventions that might reduce depressive symptoms and HIV risk among older African American women.

The Progression and Ongoing Development of a Research Agenda for Faith Community Nursing

Research is critical to the growth of professional nursing in every practice area. Faith community nursing research evolved slowly in the years following publication of the first research in 1989. A faith community nursing research agenda was developed in 2008 and research priorities have been reviewed every 2 years since 2012 at a forum held in conjunction with the annual Westberg Symposium. This article reviews the progression and ongoing development of a research agenda for the specialty practice of faith community nursing. Recommendations for the development of future research for faith community nursing are discussed.

Exploring the Experiences, Challenges, and Approaches of Parish Nurses in Their Community Practice

PURPOSE

To explore the personal experiences, challenges, and practices of parish nurses in their communities.

METHOD/DESIGN

The overall study used a mixed methods concurrent embedded design to describe parish nurses' experiences with diabetes education and preconception counseling in their practice. Also included were descriptions of generalized practices. Therefore, this current report will focus on these broader experiences. Focus group data were collected using face-to-face, teleconference, and video conferencing formats with 48 nurses who consider themselves to be parish nurses and analyzed with content analysis.

FINDINGS

Four qualitative themes were identified in the data: (1) Gaining Entry Through Trust, (2) Enhanced Focus on Spiritual Caring, (3) Accomplishing Much Despite Challenges, and (4) Practice Making a Difference. Parish nurses are uniquely situated to provide holistic care for the mind, body, and spirit of their patients. Despite the many positive aspects, parish nurses experience unique challenges, such as funding their practice and working independently.

CONCLUSIONS

The parish nurses can play a vital role in providing holistic care to patients in a faith-based community. Future work is needed to address the challenges of parish nurses such as access to continuing education programs related to health topics of concern to their community members.

Qualitative Analysis of Faith Community Nurse-Led Cognitive-Behavioral and Spiritual Counseling for Dementia Caregivers

This article presents themes emerging from semistructured interviews with dementia family caregivers in rural communities who participated in an integrative, cognitive-behavioral and spiritual counseling intervention, and with faith community nurses (FCNs) who delivered the intervention. The primary objectives of the counseling intervention were to ameliorate dementia caregivers' depressive affect and the severity of their self-identified caregiving and self-care problems. The qualitative portion of the study was intended to elicit caregivers' and FCNs' perceptions of the benefits and drawbacks of the intervention. We conducted interviews with seven FCN/caregiver pairs 4 times during the 6-month counseling process, totaling 56 interviews. Themes emerging from the interviews included caregivers' perception of burden and care partners' problem behavior; formation of therapeutic alliance between FCNs and caregivers; problem-solving skills, tools, and resources; caregivers' use of problem-solving strategies; spirituality in caregiving and counseling processes; FCNs' prior professional experience; and caregiver and FCN time constraints.

Increasing Physical Activity in Black Women: Results from a Randomized Trial Conducted in Faith-Based Settings

Objective

The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-integrated (FI) and a secular (SEC) intervention for increasing physical activity with a self-guided (SG) control group among African American women.

Design/Setting/Participants

L.A.D.I.E.S. was a cluster randomized, controlled trial. Churches (n=31) were randomized and women within each church (n=12 - 15) received the same intervention.

Interventions

FI and SEC participants received 24 group-based sessions, delivered over 10 months. SG participants received printed materials to review independently for 10 months. Participants were followed for 12-months post-intervention to assess long-term intervention impact.

Main Outcome Measures

Data on participant characteristics, physical activity, and intervention-related constructs were collected at baseline, 10 months, and 22 months.

Results

Intervention session attendance was greater for FI compared with SEC participants (15.7 + 5.7 vs 12.4 + 7.3 sessions, respectively, P<.01). After 10 months, FI and SEC participants significantly increased daily walking (+1,451 and +1,107 steps/day, respectively) compared with SG participants (-128 steps/day). Increases were maintained after 22 months in the FI group compared with the SG group (+1092 vs. +336 daily steps, P<.01). Between-group changes in accelerometer-assessed physical activity were not statistically significant at any time point.

Conclusions

The FI intervention is a feasible strategy for short- and long-term increases in physical activity among African American women. Additional dissemination and evaluation of the strategy could be useful for reducing chronic disease in this high-risk population.

Caring Across the Continuum: A Call to Nurse Leaders to Manifest Values Through Action With Community Outreach

As health reform continues to advance, there is a need for nurse leaders to broaden their perspective related to possible nursing practice models and potential community partners in order to successfully address caring, accomplish the triple aim mandate, and achieve suitable metrics for maximum reimbursement. Intentional efforts must be made by nurse leaders to maximize caring and ensure that professional nurses are responding to the key drivers shifting health care delivery in the 21st century. Academic-practice collaboration (APC) and community-based participatory action research (CBPAR) align well. Together, they provide an ideal mechanism to pursue endeavors that extend evidence for caring services across the health care continuum. One APC/CBPAR model for community outreach that can maximize individual and population health outcomes is highlighted in this article. Furthermore, useful action steps are offered that could be taken by a nurse leader to develop and maintain any form of APC/CBPAR in order to manifest values through caring action across the health care continuum.

Do Faith Communities Have a Role in Addressing Childhood Obesity?

OBJECTIVES

Pediatric obesity is a multifaceted phenomenon. A partnership with faith-based communities to address the issue has been suggested. The purpose of this study was to describe the cultural beliefs of faith community leaders regarding childhood obesity and to examine attitudes about their role in addressing the issue.

DESIGN AND SAMPLE

A qualitative descriptive design informed by ethnographic methods and triangulation of multiple data sources was utilized to assess the cultural beliefs of faith community leaders. A purposive sample of 13 leaders (nine females, four males) from seven multicultural and multigenerational local faith communities participated in the study. No more than three participants from any one faith community were enrolled in the study.

RESULTS

Twenty-first century lifestyle challenges, accountability of behaviors (a dichotomy that fluctuated between individual responsibility to community and/or social responsibility), and the need for intentionality emerged as themes from the data.

CONCLUSIONS

Faith community leaders envisioned a role for faith communities in addressing childhood obesity. Findings support the ongoing development of population based health promotion programs through faith community engagement. The findings provide a foundation for nurses partnering with faith communities on health promotion programs targeting childhood obesity to address family health issues in a holistic way.

Why a faith community nurse program? A five-finger response

The value of a faith community nurse (FCN) program is difficult to communicate in a concise and effective manner to hospitals. It is important for FCNs and FCN Coordinators to have a well-rehearsed, value-added response to the question, "Why a Faith Community Nurse Program? "This article presents a concise, evidence-based response to this question and demonstrates the value of a hospital-supported FCN program in a five-finger response illustration. A concise "elevator speech" is an important strategy to provide a quick response in scheduled, intended, opportunistic, or spontaneous informal interactions in hospitals, and impact stakeholder perception of FCN program value.

Evolutionary conceptual analysis: faith community nursing

The aim of the study was to report an evolutionary concept analysis of faith community nursing (FCN). FCN is a source of healthcare delivery in the USA which has grown in comprehensiveness and complexity. With increasing healthcare cost and a focus on access and prevention, FCN has extended beyond the physical walls of the faith community building. Faith communities and healthcare organizations invest in FCN and standardized training programs exist. Using Rodgers' evolutionary analysis, the literature was examined for antecedents, attributes, and consequences of the concept. This design allows for understanding the historical and social nature of the concept and how it changes over time. A search of databases using the keywords FCN, faith community nurse, parish nursing, and parish nurse was done. The concept of FCN was explored using research and theoretical literature. A theoretical definition and model were developed with relevant implications. The search results netted a sample of 124 reports of research and theoretical articles from multiple disciplines: medicine, education, religion and philosophy, international health, and nursing. Theoretical definition: FCN is a method of healthcare delivery that is centered in a relationship between the nurse and client (client as person, family, group, or community). The relationship occurs in an iterative motion over time when the client seeks or is targeted for wholistic health care with the goal of optimal wholistic health functioning. Faith integrating is a continuous occurring attribute. Health promoting, disease managing, coordinating, empowering and accessing health care are other essential attributes. All essential attributes occur with intentionality in a faith community, home, health institution and other community settings with fluidity as part of a community, national, or global health initiative. A new theoretical definition and corresponding conceptual model of FCN provides a basis for future nursing knowledge and model-based applications for evidence-based practice and research.

Assessing the educational and support needs of nursing staff serving older adults: a case study of a community coalition/university partnership

Given the expected changes in demography and dependent care ratios, communities are preparing for the needs of older populations. Sometimes, communities form coalitions to address health-care needs. This case study evaluates a coalition/university partnership formed to assess the educational and support needs of nursing staff who are taking care of older adults across all service settings in one geographically defined community. A 17-member community-based coalition contracted with researchers from an external university to determine the perceptions of three key stakeholder groups: older adults and their families, all levels of nursing staff, and agency administrators. By applying principles of Participatory Action Research (PAR), this case study presents the challenges faced in the community-based coalition/university research team partnership. This coalition/research partnership is unique, differing from most academic examples of PAR because nursing professionals initiated the partnership.

Factors associated with health promotion in megachurches: implications for prevention

OBJECTIVE

Megachurches (churches with 2,000 + attendance) represent a community institution with extensive reach within the United States population, although little is known about their health and wellness programming (HWP). The purpose of this study was to examine factors associated with HWP in megachurches.

DESIGN AND SAMPLE

Staff at megachurches were recruited to take an online survey.

MEASURES

Questions addressed HWP, church demographics, health promotion-related beliefs, barriers, existing resources, and leader involvement (response rate 15.4%). Univariate and multiple regression analyses were used to examine influences on HWP.

RESULTS

Respondents (n = 110 churches) indicated that churches were primarily Baptist (23.6%) or Nondenominational (21.1%), had 2,500-4,999 congregation members (44.5%), primarily White congregation members (83.5%), and 31-60 employees (45.4%). More positive leader, advisory board, and church member perceptions of health and wellness, a supportive church doctrine for health, leader involvement in HWP, and the number of health-related and physical activity resources were positively associated with HWP (p < .05). Reporting fewer barriers was positively associated with HWP. The full regression model explained 56% of the variance in HWP, with number of health resources and church size as positive influences.

CONCLUSIONS

Targeting the social environment for health, implementing health-related policies and environmental changes could result in successful interventions for preventing chronic disease.

Integrating diabetes self-management interventions for mexican-americans into the catholic church setting

Churches provide an innovative and underutilized setting for diabetes self-management programs for Latinos. This study sought to formulate a conceptual framework for designing church-based programs that are tailored to the needs of the Latino community and that utilize church strengths and resources. To inform this model, we conducted six focus groups with mostly Mexican-American Catholic adults with diabetes and their family members (N = 37) and found that participants were interested in church-based diabetes programs that emphasized information sharing, skills building, and social networking. Our model demonstrates that many of these requested components can be integrated into the current structure and function of the church. However, additional mechanisms to facilitate access to medical care may be necessary to support community members' diabetes care.

Women's health promotion in the rural church: a Canadian perspective

The rural church may be an effective health resource for rural Canadian women who have compromised access to health resources. The purpose of this paper is to explore the relevance of the Christian church and faith community nurses in promoting the health of rural Canadian women in the evolving rural context. The findings from an extensive literature search reveal that religion and spirituality often influence the health beliefs, behaviors, and decisions of rural Canadian women. The church and faith community nurses may therefore be a significant health resource for rural Canadian women, although this phenomenon has been significantly understudied.

Leading their flocks to health? Clergy health and the role of clergy in faith-based health promotion interventions

Faith-based organizations are a frequent partner in health promotion due to their large and expansive reach across multiple demographics of the United States. These faith-based organizations are led by clergy members who have a strong influence over their institutions and who shape the physical and social environments of their institutions for health-related matters. The purpose of this review was to examine current issues associated with the health, behaviors, and well-being of clergy, highlight the literature on the role clergy play in delivering effective health promotion interventions, and present recommendations for improving clergy health and the involvement of clergy in faith-based initiatives.

A methodological review of faith-based health promotion literature: advancing the science to expand delivery of diabetes education to Black Americans

Non-traditional avenues, such as faith-based organizations (FBOs), must be explored to expand delivery of diabetes self-management education (DSME) to benefit Black Americans with type 2 diabetes (T2D). The purpose of this study was to methodologically review the faith-based health promotion literature relevant to Blacks with T2D. A total of 14 intervention studies were identified for inclusion in the review. These studies detailed features of methods employed to affect health outcomes that DSME similarly targets. Analysis of the faith-based studies' methodological features indicated most studies used (1) collaborative research approaches, (2) pre-experimental designs, (3) similar recruitment and retention strategies, and (4) culturally sensitive, behaviorally oriented interventions with incorporation of social support to achieve positive health outcomes in Black Americans. Findings indicate FBOs may be a promising avenue for delivering DSME to Black Americans. Informed by the findings, a focused discussion on advancing the science of faith-based interventions to expand delivery of DSME to Black Americans with diabetes is provided.

Faith community nursing: supporting mental health during life transitions

The Faith Community Nurse can be an important agent in supporting the mental health of individuals during important life transitions by providing social support, spiritual care, referral services, and health education. Faith communities often include individuals of many generations; the young and old, newly married and recently widowed, new parents, and families whose young adults have recently left home. Nurses who provide care in these settings will likely have unique and frequent opportunities to provide mental health services and referrals to individuals experiencing transitions related to crisis, hospitalization, death, and other important life changes. Faith Community Nurses are at the frontline, aiding faith communities in supporting holistic health of the mind, body, and spirit.