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Parish Nursing: Standards for Practice (2015)
Canadian Association of Parish Nursing Ministry (CAPNM)
Introduction / Preface

These Parish Nursing Standards for Practice are intended for use along with all other standards that apply to registered nurses engaged in Parish Nursing. To practice safely and competently, nurses comply with professional standards, base their practice on relevant evidence, adhere to the Canadian Nurses Association Code of Ethics for Registered Nurses, and continually acquire new competencies in their area of practice (CNA and CASN, 2004b)  

Standards for Practice set out the level of desired and achievable performance for Parish Nursing.  The Parish Nurse’s actual practice can then be measured against these written standards.

The indicators, which further describe each standard, “provide markers for best practice. They identify elements of practice performance for which there is evidence or consensus that can be used to assess and produce a change in the quality of care provided. Indicators describe what you would expect to see in place”. (CNA 2005)
Please note that words and phrases defined in the glossary are presented in italics throughout the document. 

These Standards for the Practice of Parish Nursing were approved by the CAPNM membership at the CAPNM AGM 2015.
(June 2015)

 Pending  - Copyright 2015 The Canadian Association for Parish Nursing Ministry
The Canadian Association for Parish Nursing Ministry (CAPNM) Standards
for Practice and Core Competencies may be copied for personal and
professional purposes. They may not be altered in any way. 

The following statement must appear on the copies: "CAPNM Standards for Practice  2015 have been copied with permission of the Canadian Association for Parish Nursing Ministry and have not been altered in any way."

PARISH NURSING STANDARDS FOR PRACTICE – 2015

Standard # 1: Professional Practice & Accountability

The Parish Nurse upholds the attributes of the profession through an ongoing commitment to responsible and accountable parish nursing practice. Each parish nurse is accountable to the individuals, families, and the faith community she/he serves. She/he is responsible for the quality and impact of the care provided, and for maintaining professional competence and continuing education.

Indicators:
The Parish Nurse:

  • Maintains current registration that meets national and provincial regulatory requirements 
  • Adheres to the nursing standards of practice in the jurisdiction of registration and CAPNM Standards for Practice (2015)
  • Upholds ethical standards and values as stated in the Canadian Nurses Association Code of Ethics, 2008 
  • Assumes primary responsibility for maintaining his / her own fitness to practice 
  • Maintains appropriate therapeutic boundaries in nurse / client relationships
  • Maintains the security and confidentiality of personal and health information and “safeguards personal, family and community information obtained in the context of a professional relationship." (CNA Code of Ethics, 2008)
  • Actively identifies learning needs and seeks opportunities to enhance parish nursing knowledge
  • Demonstrates ongoing competence through life-long learning, reflective practice and integrating new knowledge into parish nursing practice  (CNA 2004) 
  • Supports the advancement of Parish Nursing by maintaining active participation in nursing organizations and parish nursing networks
  • Documents nursing assessments, interventions and the plan of care
  • Systematically evaluates the quality and effectiveness of his/her parish nursing practice using reflection, peer evaluation, mentorship, and /or feedback to implement changes.

Standard # 2: Wholistic Nursing Care & Health Promotion

Each parish nurse views the individual as a unified whole of body, mind and spirit and considers spiritual care as central to the practice of parish nursing.  

In pursuing optimal health, the parish nurse recognizes that faith and health are clearly linked and that psychosocial and spiritual care are integral to promoting wholistic wellness. The parish nurse utilizes specific nursing strategies for promoting health with individuals, groups, families, the faith community, and the larger community. 

Indicators:
The Parish Nurse:

  • Provides nursing care, health education, and health promotion which emphasize a focus on wholistic health and well-being
  • Facilitates an interdisciplinary process with spiritual / pastoral care leaders and other professionals to achieve wholistic assessment and care 
  • Considers the determinants of health and their implications on health and well-being; provides culturally sensitive care that integrates these individual factors
  • Plans and implements programs and interventions that address identified needs within the faith community  (moved examples to glossary)
  • Identifies and seeks to address the primary causes, symptoms and complications of illness and disease, suffering and spiritual distress (re-worded)
  • Collaborates with individuals, groups, families and the faith community to engage  them in taking responsibility for maintaining and improving their health
  • Assists individuals, groups, families and the faith community to identify  strengths and develop coping responses across the life span and along the continuum of health and well-being 

Standard # 3: Facilitation of Spiritual Care 

Each parish nurse associates spiritual beliefs and practices with all aspects of an individual’s life and health. The parish nurse uses specific nursing interventions to provide spiritual care.    

Indicators: 
The Parish Nurse:

  • Engages in personal spiritual growth and development 
  • Demonstrates respect for colleagues and individuals in his / her care 
  • Conducts spiritual assessments to identify spiritual needs and determine appropriate interventions, including referral to clergy when indicated
  • Assists individuals to clarify and express their spiritual values, beliefs, emotions, fears and hopes
  • Provides spiritual care that reflects the faith community’s theological beliefs, values and traditions
  • Is sensitive and respectful of the diversity of faith traditions, understandings of spirituality, and religious and cultural beliefs
  • Integrates spiritual and healing practices, as acceptable to the individual and the faith community; Encourages and nurtures those practices which support health, healing and wholeness, and from which strength and hope may be derived  
  • Consciously upholds hopefulness, vision, meaning and purpose in the lives of individuals, families, and the faith community
  • Facilitates the therapeutic relationship through presence, active listening skills, empathy and trust 
  • Supports the community of care through life transitions and challenges

Standard # 4: Communication & Collaboration

Parish Nurses communicate and collaborate within the structure and administration of the faith community to strengthen the capacity for health, healing and wholeness. Parish nurses create collaborative relationships and partnerships that connect individuals and foster healthy communication. 

Indicators:
The Parish Nurse:

  • Identifies the strengths and resources of the community of care
  • Establishes and maintains lines of communication 
  • Works within the polity, structure and values of the faith community to identify needs, perspectives, and expectations for accomplishing individual and community goals
  • Collaborates with clergy, pastoral care teams, committees, volunteers and other health care providers to determine effective ways to meet identified needs
  • Establishes community links which enhance access to health resources and agencies 
  • Collaborates with individuals and families to make referrals to health system, social services and community resources (internal and external)
  • Considers the readiness and values of the individual or family and receives consent to make referrals and share information
  • Incorporates group facilitation, effective communication and leadership skills in consultation, assessment, planning and evaluation
  • Recognizes and validates the contributions, gifts and roles of all staff and volunteers of the faith community

Standard # 5: Advocacy & Ethics (2015)       

Maintaining respect for ethnic, cultural and sexual diversity and individual choice, values and beliefs, the Parish Nurse supports and assists with access to relevant information, resources, health system and social services.

Treating all persons with respect and dignity, the Parish Nurse identifies vulnerable persons and / or populations and advocates for systemic and social change that increases community responsiveness.

Indicators: 
The Parish Nurse:

  • Facilitates the identification of health issues, assets, strengths, limitations, and resources for individuals, groups, populations, and the community. 
  • Seeks out knowledge of community agencies and services, and acts as a referral agent / liaison to system resources
  • Actively invites and supports others to identify their health needs and develop skills in self-advocacy; assists others in speaking for themselves and speaks appropriately for those who cannot speak for themselves  (see CNA Code of Ethics, definition of Advocacy)
  • Collaborates with the community / community agencies to address health and social justice issues and to advocate for appropriate resource allocation and access to health and social services
  • Supports workplace wellness within the ministry team / staff, and promotes a safe, healthy and healing environment  whenever the faith community gathers
  • Partners with others in the faith community to increase the capacity for ministries of care
  • Advocates for Parish Nursing and Parish Nursing Education
  • Becomes involved in issues that affect changes in health policy
  • Identifies ethical issues and personal values, communicating effectively to resolve ethical issues in a timely and professional manner                    

Standard # 6: Research & Evidence-Informed Practice: 

The Parish Nurse participates in and / or supports research activities that will strengthen and validate parish nursing practice. Within the context and preferences of the faith community, the Parish Nurse will integrate evidence-informed knowledge into his / her practice.

Indicators:
The Parish Nurse:

  • Identifies knowledge gaps in parish nursing practice and generates researchable questions
  • Participates in and / or conducts research within the scope of practice
  • Promotes the use of evidence-informed parish nursing knowledge
  • Evaluates and incorporates relevant research findings and best practice guidelines into parish nursing practice

Glossary of Terms

Advocacy: Assisting others in speaking for themselves and speaking appropriately for those who cannot speak for themselves (see CNA Code of Ethics). 

Best Practice Guidelines (BPG):  also called ‘clinical practice guidelines’ and are formally defined as: “user-friendly statements that bring together the best external evidence and other knowledge necessary for decision-making about a specific health problem” (Sackett et al., 1997). A BPG represents a review of a large body of research findings and recommends the most current and evidence-based information about an issue of concern to nursing. (RNAO)

Collaboration: building consensus and working together on common goals, processes and outcomes (RNAO, 2006).

Community of care – refers to whomever the nurse is working with whether individual, family, group, community, congregation/faith community, etc. This term is intended to reflect the diverse nature of the work and settings for parish nurses.

Client: The person or client who is the beneficiary of care from an RN may be an individual, but the client may also be a family, group, community or population (CNA 2007).

Determinants of Health: these include income and social status, social support, education and literacy, employment and working conditions, physical and social environments, biology, genetic endowment, personal health practices and coping skills, healthy child development, health services, gender and culture (Public Health Agency of Canada, 2003). 

Diversity: the variation between people in terms of a range of factors; the quality or state of having many different forms, such as national origin, color, religion, socioeconomic status, sexual orientation, etc.

Evidence-informed nursing / practice:  “the ongoing process that incorporates evidence from research, clinical expertise, client preferences and other available resources to make nursing decisions about clients.  Decision-making in nursing practice is influenced by evidence and also by individual values, client choice, theories, clinical judgment, ethics, legislation, regulation, health-care resources and practice environments.” At the community level, evidence-informed public health is defined as “the process of integrating science-based interventions with community preferences to improve the health of populations.  The concept of evidence-informed decision-making builds on evidence-based health care. It acknowledges the many factors beyond evidence – for example, available resources or cultural and religious norms – that influence decision-making." (CNA, 2010)

Fitness to Practice:  All the qualities and capabilities of an individual relevant to his or her capacity to practise as a registered nurse, including, but not limited to, freedom from any cognitive,  physical, psychological or emotional condition and dependence on alcohol or drugs that impairs his or her ability to practise nursing (CRNBC, 2006a; CRNNS, 2006b).

Health: a state of complete physical, mental, spiritual and social well- being, not merely the absence of disease or illness.

Health Promotion: a continuing process of enabling people to increase their control over and improve their health and well- being.

Life Transitions: includes the full spectrum and variety of human experiences that may result in change, coping and adjustment – some of these experiences include life stage adjustments, grief, loss, changes in mobility or health status, acute or chronic illness,  life-changing diagnosis, death, suffering, crisis, etc.

Lines of Communication: the role of the parish nurse encompasses establishing communication within the structure of the faith community, including with clergy, pastoral care teams, health cabinet / health committee, health professionals and volunteers to name a few; lines of communication are not limited to the faith community and may include establishing communication with the healthcare system and social services and with community agencies.

Nursing Interventions in Parish Nursing: Nursing care / specific strategies or programs designed to meet the identified needs of an individual, a family, a group, or the community; some examples include referral, advocacy, prevention, health education, support group facilitation, promotion and support of self-care activities, monitoring of health status, spiritual care, facilitation of spiritual practices, and spiritual or health counselling. 

Presence: Bringing one's whole self to the engagement with the client and being fully in the moment with another on a multitude of levels, physically, emotionally, cognitively, and spiritually. In Parish Nursing this may include active listening, silence, compassionate responses, empathy, walking alongside another, being witness to and / or participating in their life journey and transitions.

Spiritual Assessment: The process of gathering and organizing spiritually based data / information (such as beliefs, values, traditions, resources, spiritual practices and spiritual needs) to provide the basis for interventions and spiritual care.

Spiritual Practices: Actions & activities undertaken for the purpose of cultivating spiritual growth & development and / or supporting the person or community in worship and at times of crisis or transition; practices from which strength & hope may be derived.  Examples include prayer, rituals & symbols, sacred music, visitation, meditation, contemplative practices, reading scripture or spiritual books, compassiona

te touch, and sacraments.
Spiritual Distress (and Risk for Spiritual Distress): Recognized nursing diagnoses as per North American Nursing Diagnosis Association (NANDA); impaired ability to experience and integrate meaning and purpose through a person’s connectedness with self, others, art, music, literature, nature or a power greater than oneself; recognized nursing interventions are Spiritual Support, Facilitation of Spiritual Growth & Hope Instillation.

Wholistic: Refers to the whole, a whole item or whole body of a person or thing; considers the entire structure or makeup, which includes body, mind and spirit.

References: 

References: 

Standard # 1: Professional Practice & Accountability

Canadian Nurses Association (2002). Achieving excellence in professional practice: A guide to developing and revising standards. Ottawa, ON: Author.

Canadian Nurses Association (2002). Position Statement: Advanced nursing practice. Ottawa, ON: Author.

Canadian Nurses Association (2008). Code of Ethics for Registered Nurses, centennial edition 2008. Ottawa, ON: Author.

Canadian Nurses Association (2003). Position Paper: Scope of Practice. Ottawa, ON: Author.

Canadian Nurses Association (2004). Promoting Continuing Competence for Registered Nurses. Ottawa, ON: Author.

CAPNM Standards of Practice and Core Competencies (2007).  Ottawa, ON: Author.

Canadian Nurses Association (2015), Framework for the Practice of Registered Nurses in Canada. Revision #2 for consultation, November 4, 2014 (still in draft)

Standards 2, 3 & 4: Holistic Care & Health Promotion, Facilitation of Spiritual Care, Communication & Collaboration

Canadian Nurses Association (2010). SPIRITUALITY, HEALTH AND NURSING PRACTICE, Position Statement. Ottawa: Author.

College of Nurses of Ontario (2009), Practice Guideline, Culturally Sensitive Care 

Hickman, Janet S. (2006), Faith Community Nursing, Lippincott, Williams & Wilkins

O’Brien, Mary Elizabeth (2011), Spirituality in Nursing: Standing on Holy Ground, 4th edition, Jones & Bartlett Learning 

  • Chapter 5: The Nurse-Patient Relationship: A Sacred Covenant (pages 105-136)
  • Chapter 6: Spiritual Care: The Nurse’s Role (pages 137-167)
  • Chapter 13: Parish Nursing: Caregiving Within a Faith Community (pages 333-349)

Standard # 5 – Advocacy and Social Justice

Canadian Nurses Association, Code of for Registered Nurses, (2008), Ottawa, ON: Author.

Hickman, Janet S., Faith Community Nursing, (2006), Chapter 7, Community Connections, pages 143-157, Lippincott, Williams & Wilkins.

Standard # 6 – Research and Evidence-Informed Practice

Rycroft-Malone, Jo. (2008). Evidence-informed practice: from individual to context. Journal of Nursing Management.16, 404-408

Canadian Nurses Association. CNA Evidence-informed Decision-making and Nursing Practice (2010). Retrieved from www.cna-aiic.ca/media/can/page content/pdf en 2013 

RNAO, Retrieved from http://rnao.ca/sites/rnao-ca/files/ABCs_of_BPGs.pdf

General References:

Canadian Association for Parish Nursing Ministry (CAPNM), Standards of Practice and Core Competencies, (2007).

Canadian Community Health Nursing, Professional Practice Model & Standards of Practice, (2011), Community Health Nurses of Canada.

Canadian Nurses Association, Code of Ethics for Registered Nurses, (2008), Ottawa, ON: Author. 

Canadian Nurses Association. (2007). Framework for practice of registered nurses in Canada. Retrieved from http://www.cna-aiic.ca/CNA/documents/pdf/publications/RN_Framework_Practice_2007_e.p

Faith Community Nursing: Scope and Standards of Practice, 2nd Edition (2012), American Nurses Association. 

Hickman, Janet S. (2006), Faith Community Nursing, Lippincott, Williams & Wilkins

Johnson, M., Bulechek, G., Butcher, H., Dochterman, J., Maas, M., Moorhead, S., & Swanson, E. (2006), Nursing Diagnosis, Outcomes & Interventions, 2nd Edition, pages 423-426 & 599-600, Mosby / Elsevier

O’Brien, Mary Elizabeth (2011), Spirituality in Nursing: Standing on Holy Ground, 4th edition, Jones & Bartlett Learning

© CAPNM 2012