To participate in the Health Ministries Association survey of Faith Community Nurses please complete and return this survey. To return the survey you can:

1.Fill out the electronically using MS Word and EMAIL your survey to

2.Print the survey, fill it out, and POSTAL MAIL to:

Beverly Lunsford, Ph.D., R.N.

Associate Research Professor, School of Nursing; GWUMC

Director, The Washington D.C. Area Geriatric Education Center Consortium

900 23rd Street NW; Suite 6187

Washington, D.C. 20037

Faith Community Nurse Survey

Parish Nursing was designated a specialty by the American Nurses Association (ANA) in 1998 and the Parish Nurse Scope and Standards for Practice were published by Health Ministries Association[1] and ANA in 1998. These were revised in 2005 to reflect the ANA revision of the Nursing: Scope and Standard of Practice (ANA 2004) and the evolving practice of Parish Nursing (PN) to be inclusive of all faith communities with dissimilar faith traditions, practices, beliefs. The definition of Faith Community Nursing(FCN) is: “the specialized practice of professional nursing that focuses on the intentional care of the spirit as part of the process of promoting wholistic health and preventing or minimizing illness in a faith community.”[2]

Please answer the following questions to help us understand more about the current practice of Faith Community Nursing (FCN) and to determine the needs of FCN for education, networking, and support.

Section A. Characteristics of Faith Community Nurse

A.1.In your work as FCN, what do you call yourself

  1. Faith Community Nurse
  2. Parish Nurse
  3. Other ______

A.2.As FCN, do you practice according to the ANA Scope and Standards for Faith Community Nursing?

  1. Yes ______
  2. No ______
  3. Uncertain ______

A.3.Do you maintain Health Records on the clients you serve according to the Faith Community Nursing Scope and Standards for Practice,and the Nurse Practice Act of the state in which you practice?

  1. Yes ______
  2. No ______
  3. Uncertain ______

A.4.Have you attendedbasic preparation for FCN or PN?

______Yes ______No.

A.5.If you are a registered nurse, and do not practice according to the ANA Scope and Standards for Faith Community Nursing, please explain why ______

______

A.6.How many hours/week, paid or unpaid, are you scheduled/contracted to work as FCN? ______

A.7.In addition to your scheduled hoursas FCN, approximatelyhow many additional hours do you work in the same position? ______

A.8.As an FCN are you: a) paid hourly ____ b) salaried____ c) unpaid____ d) Other: ______

A.9.As an FCN, do you receive benefits? Yes ______No ______.

If yes, what benefits do you receive? Please check all that apply.

_____Health Insurance

_____Vacation

_____Mileage Reimbursement

_____Continuing Education

_____License Renewal

_____Liability InsuranceReimbursement

_____Retirement Plan

_____Other: ______

A.10.Please estimate the percentage of overall time you spend in the following functions as FCNby assigning a percentage to each category. The total number of % should =100%. You may leave a blank or write “0” in the functions that do not apply to your ministry. This question applies to the entire faith community – all ages.

______Health Assessments

______Health Educator (e.g., classes, articles, bulletin boards, pamphlets)

______Personal Health Counselor (e.g., individual health information, home

or hospital visits, screenings)

______Health Advocate (e.g., advocate for seniors with healthcare

professionals &/or institutions)

______Community Resource Liaison/Referral Agent (e.g., placement assistance for

Assisted Living, caseworker consultations, referrals to Arthritis Foundation)

______Collaborator with other healthcare professionals

______Volunteer Coordinator or Trainer of Volunteers

______Support Group Developer

______Integrator of Faith and Health (e.g., spiritual assessment, prayer, scripture

sharing, worship or healing services, referral to clergy)

______Other ______

A.11.Please indicate what skills you believe are most necessary to do your job well? Circle your response.

Least Necessary / Most Necessary
Clinical Expertise / 1 / 2 / 3 / 4 / 5 / 6 / 7
Interpersonal Skills / 1 / 2 / 3 / 4 / 5 / 6 / 7
Spiritual Maturity / 1 / 2 / 3 / 4 / 5 / 6 / 7
Knowledge of community resources / 1 / 2 / 3 / 4 / 5 / 6 / 7
Knowledge of PN role and functions / 1 / 2 / 3 / 4 / 5 / 6 / 7
Time Management Skills / 1 / 2 / 3 / 4 / 5 / 6 / 7
Knowledge of Denominational Doctrine / 1 / 2 / 3 / 4 / 5 / 6 / 7
Other: ______/ 1 / 2 / 3 / 4 / 5 / 6 / 7

A.12.What are the advantages of being anFCN? ______

______

A.13.What are the disadvantages of your role? ______

______

Section B. FCNModel Characteristics

B.1.What model of Faith Community Nursing do you follow?

______Congregational (faith community)

______Institutional (Please estimate the size of your institution in the categoriesin B. 2, 3, or 4 below

______Other:

B.2.If you serve in a congregational model, what is the approximate size of the faith community you serve?

a)Under 250 b) 251-500 c)501-1000 d) 1001-5000 e) Greater than 5000

f) Other ______

B.3.If you serve in a school or outpatient facility, what is the approximate TOTAL number of clients served in a year ?

b)Under 250 b) 251-500 c) 501-1000 d) 1001-5000 e) Greater than 5000

B.4.If you serve in a hospital facility, how many beds are in your facility?

c)Under 250 b) 251-500 c)501-1000 d)1001-5000

e)Greater than 5000

B.5.Check the following geographic classifications best describes the area in which your services are located?

___Rural (open country or places/villages with population less than 2,500)

___Small town or small city (2,500-49,999 population)

___Urban area with a population 50,000 -250,000

___Urban area with a population greater than 250,000

B.6.Please estimate the socioeconomic distribution of the faith community or institutional setting you serve by assigning a percentage to each category. The total number of % should = 100%

______Poor

+______Low income

+______Middle income

+______Upper income

= 100%

B.7.What is the year of your birth? ______

B.8.What is your gender? a) female ______b)male ______

B.9.How many years have you been a registered nurse? ______

B.10.In what nursing specialties do you have experience? Please check all that apply.

a)Critical Care/ED _____ b) Medical/Surgical _____ i) Other ______

c) OB/GYN _____d) Pediatrics _____

e) Mental Health _____f) Hospice _____

g) Gerontology _____h) Community Health _____

B.11.What is your highest professional degree?

a)Diploma _____ b) ADN _____ c)BS _____ d) MS ____ e) PhD _____ f) Other ______

B.12.How long have you been an FCN? ______

B.13.Do you have a health cabinet or wellness committee? a) Yes _____ b) No _____If no, skip to Section C. 1

B.14.If yes, what is the occupational make-up of your health cabinet/wellness committee?______

______

B.15.If you have a health cabinet or wellness committee, what role do you serve?

a)Member _____ b) Chair _____ c) Other: ______

B.16. Do you find the health cabinet or wellness committee helpful to your ministry?

a)Yes _____

b)No, please explain: ______

______

Section C. Characteristics of Clients Served

Please tell us about the number of clients served and/or visit volume during 2009.

C.1. TOTAL number of unduplicated clients[3]?
C.2. Total number of client visits

Beginning on line C3, please indicate the number of unduplicated clients by each demographic group (the sum of each category should not exceed the total number of unduplicated clients reported in line C.1.

Number of unduplicated clients
Gender
C.3.Males
C.4.Females
Ethnicity
C.5.Hispanic
C.6.Non-Hispanic
C.7.White
C.8.Black/African American
C.9.American Indian/Native Alaskan
C.10.Asian
C.11.Native Hawaiian/Pacific Islander
C.12.Two or more races
C.13.Other (known) race
C.14.Unknown ethnicity
Age
C.15.Infant (<12 months)
C.16.1-4 years
C.17.5-9 years
C.18.10-14 years
C.19.15-19 years
C.20.20-24 years
C.21.25-39 years
C.22.40-54 years
C.23.55-69 years
C.24.70 and above
Primary healthcare coverage
C.25.Medicaid
C.26.Medicare
C.27.Other government
C.28.Commercial
C.29.Service contract
C.30.Uninsured
C.31.Other (Specify: ______)

C.32.How many clients with limited English proficiency did the Program serve during 2009? (Please enter either the number or percent.)

Number of unduplicated clients with limited English proficiency_____#

ORif number is not available:

Estimated percent of clients with limited English proficiency____%

C.33.Does the Program have a specific focus on any of the following population subgroups? (Mark all that apply.)

___Uninsured

___Homeless

___Public housing residents

___Veterans

___Migrant workers

___Victims of domestic violence

___Other (Specify: ______)

___None of the above

C.34.Please select the type of primary care that best describes your Practice (mark the one most appropriate response with an “X”):

___education

___counseling

___advocacy

___referral

___utilizing resources available to the faith community

___training and supervising volunteers

___collaborate with other nursing and healthcare specialties

___Other (Specify:______)

Section D. Services Provided

Please indicate the number of visits during 2009 that involved the following interventions

Service category

/

Number of visits

/

Estimated percent of visits

D.1.Physiological: Basic
D.2.Physiological: Complex
D.3.Behavioral
D.4.Safety
D.5.Family
D.6.Health System
D.7.Community

List the most common primary care services provided by your Program in the following table

Service

/

Number of visits

/

Estimated % of visits

Primary care services

Access and outreach services

D.8.Transportation
D.9.Community education
D.10.Community screening events
D.11.Other (Specify: ______)

Nursing Diagnoses and Interventions

D.12.If your Program uses nursing language, select the language your Program uses for nursing diagnoses (mark the one most appropriate response with an “X”)?

___None (skip to question C12)

___Home Health Classification System (HHCC)

___International Classification for Nursing Practice (ICNP)

___North American Nursing Diagnosis Association (NANDA)

___Omaha System Problem Classification Scheme

___Other (Specify: ______)

If the Organization uses a standardized nursing language for nursing diagnoses, please list the 8-10 most frequent diagnoses using the language the Organization reports. List number of visits for each during FY08/09 (2009).

Nursing diagnosis

/

Number of visits

What type of group support services have you provided in the past 3 years. Indicate whether your Practice provides the following GROUP services by marking the appropriate column with an “X.” If services are provided, enter the number of individuals served. Report each group program using the one most appropriate category. Individuals may be counted for each group program they participated in – but not for each session within a single, multi-session program.

Type of group service

/
Provided?
/

Number served

/

Specify topic/targeted disease/condition

Yes / No
D.13.Chronic disease management
D.14.Disease education
D.15.Health promotion
D.16.Mental health
D.17.Parenting
D.18.Prenatal education
D.19.Adolescence
D.20.Seniors
D.21.Caregiving
D.22.Grief and loss
D.23.WIC
D.24.Other

Medical diagnoses and services

Please provide number of visits during 2009 for the following diagnoses. Draw on all diagnostic fields available (primary and secondary).

Diagnosis
/
Number of visits
D.25.Diabetes mellitus
D.26.Obesity
D.27.Depression
D.28.Non-tobacco substance abuse disorder – but excluding tobacco dependence
D.29.Tobacco use disorder
D.30.Hypertension
D.31.Asthma
D.32.Supervision of normal pregnancy
D.33.Cognitive Impairment, including Alzheimers
D.34.Other:
D.35.
D.36.

Section E. FCN Perception of Needs

E.1.Have you attendedbasic preparation for FCN or PN?

______Yes ______No. If no, please skip to question E.4.

E.2.Was the information you learned from the Program useful in your work as FCN?

_____Yes, very useful _____Yes, somewhat useful _____Undecided

_____No, not very useful _____Not useful at all

E.3. What educational programs have been most helpful to you in your work as FCN?

E.4.What additional education programs do you feel would help you?

E.5.What support services are most useful to you as FCN?

E.6.What additional support services do you feel could be provided for FCN?

E.7.What collaborations and/or networks are most useful to you as FCN?

E.8.What collaborations and/or networks would be most useful?

Section F. Revenue

Indicate the sources of income and/or support for your services as FCN.

F. 1.Patient Care Revenue

_____Medicare

_____Medicaid

_____Insurance

_____Self Pay

_____Negotiated Contract

F. 2.Other operating revenue

Enter grant and other operating revenue totals for 2009.

______Federal

______State

______Local

F. 3.Are any grant amounts reported above for activities other than patient care?

___Yes

___No

If yes, please describe the purpose/goals of the grant(s): ______

______

F. 4.. Non-operating revenue

______Health care system

______Congregation(s)

______School Revenue

______Other

F. 5.Negotiated contracts and managed care plans

Describe any contracts or managed care plans that will help us understand your source of funding for FCN services.

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[1]Health Ministries Association is the professional membership organization for nurses in this specialty.

[2]American Nurses Association (ANA), 2005. Faith Community Nursing Scope and Standards for Practice. American Nurses Association, Washington, D.C.

[3] Each client should be counted only once, regardless of the number of visits.