Below is a letter written by Edna Kinsella, a parish nurse at Christ the King Catholic Church in Missoula, Montana, to a fellow nurse interested in learning more about parish nursing.

First, a little about myself. During my forty-two years of nursing I have been a staff nurse in med/surg, obstetrics, surgery and emergency, an emergency room supervisor, adult nurse practitioner and a hospice nurse. Since retiring four years ago, I trained in parish nursing and have been practicing in my 700 family Catholic parish. I also teach the advanced directive, care of the dying and bereavement segment of our statewide parish nurse training program.

In this time of rising medical costs, reduced employee benefits, lower incomes, and a nationwide nursing shortage, parish nursing is an excellent utilization of nursing hours. Recognized as a nurse specialty practice by the ANA, its scope of practice is limited only by a nurse's training, professional and life experience, personal gifts, time, and ability to dream.

Parish Nurses do not provide "hands on" care, such as IV's, for several reasons:

1. Legal liability for the church and increased insurance expense.
2. Instead of duplicating services, we advocate for our people and refer to care already available in our area.
3. One or two nurses cannot possibly do the hands on care for hundreds of families.

Parish nursing provides a continuity of care unachievable through any other source for the following reasons:

1. Services are free, thus available to everyone, and illnesses are caught earlier when easier and less expensive to treat.
2. They already have an established relationship with parishioners before illness occurs and share a common faith.
3. Provide physical, mental, emotional, social and spiritual care to not only the patient but to the entire family.
4. Can follow families through every setting: home, doctor's office, hospital, rehabilitation, nursing home, hospice.
5. Care begins at conception and continues through a person's death and the family's bereavement.
6. Bride the gap between medical care and pastoral care.
7. Patients can be referred by the pastor, staff, doctor, friends, or self-referral.
8. Promote wellness through parishioner education and advocacy for needed services.
9. Parish nurses recruit, train and coordinate volunteers.

This model of nursing is very cost effective. Parish nurses, from any different faiths and expertise, work together and freely share materials and programs not only citywide but across our entire state. Thus one nurse doesn't have to do everything, and developmental costs aren't duplicated. Our Directory of Active Parish Nurse Programs in Montana (hard-copy only) lists our areas of expertise as well as other information. Consequently, even isolated nurses have help and support available at all times.

The effectiveness of this unique model of nursing cannot be measured by hospital or clinic criteria or by their time tables. Most of the first one to two years will be spent in self-education, parish nurse promotion, and developing relationships with other service groups such as public health agencies, social workers, food banks and battered women's shelters. Time is also needed to assess parish needs, to recruit a parish nurse support and advisory board, to locate outside resources (often free), and to develop a working relationship with the church staff.

Now I'll show you how it actually works. Our parish needs assessment identified the care of the dying and bereavement (especially peri-natal bereavement) as our top priority.

To begin, I visited every type of person or agency in our town which provides services for this need. Everyone willingly taught me about their work and provided free informational materials.

Hospice/Hospice Nurses
Hospitals/Hospital Chaplains
Nursing Homes
Social Workers
Oncology Clinics
Pharmacist
Neonatal Intensive Care
Physical Therapists/Respiratory Therapists
Cancer Society
Home Health Agencies
Bereavement Counselors/Compassionate Friends
Nursing Agencies
Surgical Supply Companies
Public Health Department
Beauticians/Wig Makers
Schools/Libraries
Mortuaries/Cemeteries
Homeless Shelters
Missoula Demonstration Project
Pastors
County Extension Agency (excellent grief articles free)

Working on the Missoula Demonstration Project's Faith Community Task Force and the Advanced Directive Task Force for the past three and one-half years has kept me up to date on developing care for the dying and enabled me to establish ongoing relationships with other caregivers in this field.

I created a basic bereavement information packet, a peri-natal packet, and a children's packet according to age and development. Additional materials are added for specific needs such as suicide, murder and the death of a child.

Families receive these packets on a Parish Nurse's first first. Nurses then visit weekly the first four weeks, twice a month for the next two months, and then monthly for as long as needed. We also recommend additional help, such as a counselor as required.

Practical needs necessitated the development of a MOMS support group, an Elizabeth Ministry (friendship network for expectant Moms and Dads), and a volunteer group to provide meals and other help as needed. Our Parish Service Group, which provides the entire funeral luncheon free of charge, was also expanded.

Because holidays are so painful, a newsletter discussing healthy self-care, family memorial ideas and how others can help those who are grieving was mailed to every family in the parish. A four week series of bulletin inserts about grief was also done at Christmas.

In the Fall, I taught a day-long free workshop on Advanced Directives, Care of the Dying and Bereavement. A local bookstore sole related books and gave us ten percent of their profit, which was used to start a lending library at church. Participants each received a packet of information and could select other handouts from the materials donated by 22 different agencies. This workshop was attended by people city wide and parish nurses throughout the state.

If a couple who have lost a baby become pregnant, the mother is visited frequently during the first trimester and help is provided as needed throughout the entire pregnancy.

Finally, a volunteer group consisting of two family physicians, four nurses, one social worker and a grief counselor developed an annual peri-natal bereavement service for the entire city:

1. The prayers and music were specific to this type of loss.
2. Upon arrival the parents sign a teddy bear quilt made for this service, and they are given a piece of the material.
3. The parents receive hand embossed name cards and handmade candles for the naming ceremony that they can keep.
4. The church choir and the city choir sing for this service.
5. Harpists from the Chalice of Repose play for the service.
6. At the close of the service, everyone keeps their liturgy sheet and receives a gift of wildflower seed packet to pot or plant in their garden to create a place to think about and pray for their child.
7. A reception is held for the families, materials are available at an information table, and families can sign-up for a follow-up workshop or bereavement support group.

Thank you for reading this long letter. There simply is no other way to describe how parish nursing works. May God bless you all on your work.