A trial scheme that has seen a church-based Christian nurse deliver transitional care to patients from in Cumbria and North Lancashire has been hailed a “phenomenal” success by a director of nursing.
The small-scale pilot saw University Hospitals of Morecambe Bay NHS Foundation Trust team up with Parish Nursing Ministries UK – a charity and umbrella body for nurses based at churches.
“They didn’t just get monitoring of their clinical conditions, they got holistic support”
Ten patients from an orthopaedic surgical unit at Barrow in Furness hospital – mainly elderly patients recovering from a fracture – were discharged into the care of a “parish nurse” working out of Emmanuel Community Church.
Working under a memorandum of agreement, parish nurse Ruth McDonald visited patients regularly to do basic checks and keep an eye on their progress and all-round welfare.
“The parish nurse isn’t a replacement for the district nurse – the role is step-down and non-interventionist,” said Ros Moore, chief executive of Parish Nursing Ministries UK.
“It offers monitoring such us routine blood pressure, observations, weight checks, nutritional advice, falls advice, medications advice. If the person had a wound, for example, the district nurse would do that,” she said.
“However, the district nurse only comes in now and again, but the parish nurse can go in every day,” she said. “If things are not okay they can intervene really quickly to get the patient back into hospital, if necessary, or get a GP before they deteriorate any further.”
Ms McDonald, a well-known bank nurse at the trust, worked closely with Lynn Dack, the matron for surgery at Barrow, who provided clinical supervision and support.
“They are coming from a faith-based perspective so patients are asked for consent”
Ms McDonald’s salary was paid by the church, which agreed she could dedicate her parish nursing hours to the project, but under the agreement the trust provided equipment and training, if needed.
Sue Smith, executive chief nurse at Morecambe Bay, said the pilot was an opportunity to test an innovative model of care based on successful parish nursing projects in the US.
“There is a dearth of support for patients in transitional care – the district nurses and social services are thinly spread to say the least as are the nurses in hospitals,” she said.
“So, we felt an opportunity to have available a nurse aligned to a local church community, who did not have the time limits somebody else would, could provide really holistic support and care for patients who could be monitored in the home but did not need too much intervention.”
She said the trial, which ran from August to December 2016, “went really well” with high levels of patient satisfaction and positive outcomes.
“They didn’t just get monitoring of their clinical conditions, they got holistic support because they got support with their emotional needs and had someone to just sit and talk to,” she said. “The thing about these chats is they enable you to stop patients from going into crisis.”
Those patients who returned questionnaires all scored the service 10 out of 10, said Ms Smith.
During the pilot, the parish nurse escalated two patients to higher levels of care including getting one sent back to hospital on her first home visit.
She referred others to further help and advice from their GP, district nurse, social care or pharmacy, and provided reassurance and continuity of care – all of which “would not have happened” otherwise, according to Ms Moore.
By the end of the trial period just the one patient had been upgraded to hospital care and one to GP care – the rest were self-caring, with either the same level of services or fewer services than before.
Ms Smith said another positive outcome was the fact that two patients – who already identified themselves as Christians – had started going to church again.
“Parish nursing isn’t about bringing people to church. That was, if you like, a by-product and not an outcome we set out to achieve,” said Ms Smith, who does not go to church herself but says she has “strong Christian values and believes in God”.
“But I think it was a really positive thing for those people, because all of a sudden they are surrounded by people who support and care for them when they might otherwise have been very isolated,” she said.
While the service was delivered by a Christian nurse, it was open to patients of any religious or non-religious persuasion and those who took part included two people with no religion and one Hindu.
“Nurses are doing it because it is about their Christian mission,” said Ms Moore. “They don’t go in to proselytise or evangelise or anything like that, but they are coming from a faith-based perspective so patients are asked for consent to be referred to a church-based services.
“While nurses don’t go in talking about religion, they do go in with a focus that is not just on physical care so will talk about people’s feelings and emotions and – if that person what to go to that place – talk about their spirituality,” she added.
Nurses have been disciplined and even struck off for expressing religious views at work. In a recent case – reported by Nursing Times – Dartford and Gravesham NHS Trust sacked nurse Sarah Kuteh for discussing her Christian beliefs and offering to pray with patients before they went in for surgery.
- Trust defends sacking nurse over religious behaviour
- PCT suspends Christian nurse for offering to pray for patient
- A Christian nurse suspended for offering to pray has sparked health care and religion debate
However, Ms Smith stressed the project was about providing “pastoral support” similar to the “listening and supportive” service offered by hospital chaplains.
She said it not only made economic sense – in that it can be delivered at no extra financial cost to the NHS – but it also fitted in with the goals of the NHS Five Year Forward View, which urged trusts to look at alternative models for transitional care in the community and work more closely with the voluntary sector.
“If one parish nurse managed to take 10 patients under her wing and provide really good care, then imagine if we had 10 parish nurses – that would mean 100 patients getting care at home that would enable district nurses, who have short task-orientated roles, to focus on the patients they need to focus on,” she said. “All of a sudden we have a community looking after our patients.
“I think it has been absolutely phenomenal and feel so proud to have been part of this small study that has made such a big difference,” added Ms Smith.
She said she was keen to explore whether the trust could work with more parish nurses and had raised the idea with the local clinical commissioning group and other partners, as well as recommending the concept to fellow directors of nursing.
Former Scottish CNO to gain honorary degree
In the meantime, Morecambe Bay will continue to offer the service to a small, selected group of patients.
Of the 100 or so parish nurses across the UK, about 25-30% are paid for their work, usually at band 5 staff nurse level, but the rest are volunteers.
They are responsible for maintaining their own fitness to practise but meet regularly with regional co-ordinators from Parish Nursing Ministries UK who offer professional supervision, support and education, training and development.
Ms Moore, who is a former chief nursing officer for Scotland, hoped the pilot would encourage more trusts to work with parish nurses.
“We hope this will encourage more churches to take this on and encourage the health service to look at how they can work with voluntary sector services like parish nurses and support them,” she said.