COLUMN ONE : Nurses--Ministers of Health : Churches and synagogues are hiring professionals to combine medical skills with spiritual counseling. Parish nursing is fast becoming a national movement.

A cholesterol screening one Sunday morning in Independence, Mo., by a registered nurse uncovered a markedly high level in a man who had previously refused all medical attention.

Because the nurse was a staff health minister at First Christian Church, the man agreed to treatment. She helped him select a doctor, taught him stress management techniques, and assisted his family in understanding a new low-fat diet and exercise program.

“Now, because of his trust in his church and its ministers (this man) . . . is an advocate for preventive medicine,” said the pastor, the Rev. John B. Holcombe Jr.

The story at First Christian is being repeated frequently these days at innovative congregations across the country. Churches and synagogues, aware of the increasing complexity and spiraling costs of health care and the desire of members to integrate spiritual vitality and physical well-being, are hiring staff specialists to bridge the gap where traditional health care often is not working.

Although the role of health professionals in a church setting is only about 6 years old, about 1,000 congregations now have nurses. The number is expected to grow at the rate of 1,000 each year through the next decade, said Granger Westberg, a Lutheran hospital chaplain and medical school professor who is regarded as the founder of the parish nurse movement.

After he pioneered holistic health clinics in Chicago-area churches, Westberg’s concept of teaching nurses how to combine medical skill with spiritual counseling began to catch on. Spreading from churches and hospitals in the Midwest, parish nursing is fast becoming a national movement.

“There’s a new realization that scientific technology isn’t the answer to all illnesses,” said Westberg, now retired professor of religion and health at the University of Chicago. “It has neglected perhaps the most important ingredient, namely a person’s outlook on life.

“Let’s face it--some churches make people sick!” he said. “But a good church or synagogue can keep people well. A spiritually mature nurse on a church staff contributes greatly to clarifying the interrelationship of faith and health.”

In addition to reading blood pressures, they also typically visit shut-ins and new parents, arrange for hospice care and give CPR training to ushers. Other duties include teaching first aid and nutrition and helping aged parishioners cut through insurance and hospital red tape. They also advise families facing the perplexing ethical choices that accompany modern medicine.

In their role as ministers of health, these nurses also typically deal with loss and grief, dependencies and addictions, depression, eating disorders and dysfunctional relationships. They make referrals to appropriate agencies and resources, hold clinics to combat flu and tuberculosis, and teach classes on such topics as sex education, AIDS and bioethics.

Marsha Fowler, a bioethicist and professor at Azusa Pacific University’s Graduate Schools of Theology and Nursing, believes that contemporary medicine does not allow people to deal with the inevitability of suffering. Because of technological advances in recent years, she said, medical technology is primarily focused on prolonging life regardless of its quality.

“But the painless, non-suffering life is not possible,” she told colleagues at a conference in Newport Beach. Medicine “cannot tame the terror and eliminate the darkness.” Yet, she added, “parish nurses can help address this” by providing unique counsel traditionally not provided either through churches or in doctor-patient relationships.

Plus, parish nurses make house calls. “When you’re in a home you’re much more apt to pick up a person’s real story; it’s one of the most vital things we do,” said Barbara Connors, a health ministries consultant in Portland, Ore.

Connors related her experience of calling on an elderly woman who lived alone on minimal income. The woman had a very low energy level because she was not getting enough protein, Connors discovered. The reason she did not buy protein-rich foods, the woman told her, was because they cost too much.

After Connors put the woman on an inexpensive liquid breakfast supplement, she improved dramatically and was spry enough to get out to church again.

Access to health care and its cost will be “the No. 1 overwhelming bioethical concern” of the 21st Century, Fowler said. Health and ministry experts expect that as the average age of members in mainline U.S. churches continues to advance, such issues will be increasingly relevant to their members.

By 2000, U.S. health-care costs are projected to reach $1.5 trillion, but between 50 million to 60 million people will be uninsured or under-insured. Early detection and medical care could give those with high-risk health problems many more years to live.

“A remarkable number of nurses,” said Westberg, the health ministry pioneer, “have an almost uncanny ability to pick up cries for help from people--faster than doctors, I think. Doctors are seldom trained in preventive medicine.”

Church health ministries are trying to bridge other perceived gaps in health care.

As an illustration, the Task Force on Health and Wholeness for the Southern California West Synod of the Evangelical Lutheran Church in America includes experts in biomedical ethics and substance abuse. The group is chaired by two parish nurses, Dorothy Wagner and Marie Sorensen, both of Hollywood Lutheran Church. Sorensen, the church’s minister of health since 1987, takes blood pressure readings on the first Sunday of each month.

In Lynchburg, Va., the two hospitals there have agreed to support a new organization, the Lynchburg Area Church Nurses.

Betsy Jamerson, parish nurse at the city’s Westminster Presbyterian Church, made more than 200 home or hospital visits and completed 45 health assessments in her first seven months on the job. She also developed an information center in her office covering a variety of area health facilities and nursing-care options, and secured an all-electric hospital bed for church members’ use.

Congregations with younger members tend to concentrate on things such as prenatal care, child development and home safety, while churches with predominantly older members usually focus on issues such as when to withdraw a life-support system or whether to begin intravenous feeding for a terminally ill patient. Another consideration is modifying church facilities so that the handicapped and infirm can participate.

Doreen Dewey of Anaheim Seventh-day Adventist Church is among those who praise the nursing programs.

Last summer, Dewey learned she would need cancer surgery. Lou-Anne Keith, a parish nurse who divides her time between the Adventist and United Methodist churches in Anaheim, made daily calls on Dewey when she was in the hospital, then visited her several times a week while she recuperated at home.

Dewey said she appreciated hospital visits by her pastor as well, but the parish nurse “had more medical knowledge.” Because the nurse was also a woman, the visits were “more personalized.”

Even a pastor may get a little help from the parish nurse. When the Rev. Gary Barmore of Fairview Community Church in Costa Mesa consulted his about a recurring rash that he had, “she helped me realize it was related to times of high stress,” he said.

Barmore’s church is one of a dozen in Orange County linked with Hoag Hospital’s health ministries program; another 15 congregations plan to join next year. Meanwhile, the model at the Newport Beach Hospital has been copied in parish nursing programs developing across the nation.

Among other things, Hoag recruits, hires, trains and provides on-site support for nurses, and pays for their insurance and benefits package.

Participating churches contract for a registered nurse for at least 10 hours a week, and the pastor attends education classes at Hoag. Now, parish nurses are paid $10 an hour, with Hoag paying 50% of their salary the first year, 25% the second year and the congregation picking up the full fees plus built-in raises the third year.

The hospital’s share of the costs are paid for through donations from individuals who are enthusiastic about the work. The chaplain’s office at the Presbyterian-related hospital has promoted the concept, said Joni Goodnight, Hoag’s health ministries supervisor.

Some health ministry programs are not associated with a particular hospital, and some parish nurses are volunteers. The hospital-church model seems to offer the most advantages, parish nurses and pastors said recently while attending the first Western regional meeting of the Health Ministries Assn. The national organization, based in Des Moines, Iowa, was formed two years ago and already has grown to 750 members.

Another innovative pilot program was launched in the San Fernando Valley this year through Holy Cross Medical Center of Mission Hills. Receiving a start-up grant from the Sisters of Holy Cross, the interdenominational Parish Nurse Partnership involves five area churches, including a large, mainly Latino, Roman Catholic parish composed of many recent immigrants.

The Spanish-speaking nurse at Santa Rosa church found a great need for community health care, said Sister Colleen Settles of Holy Cross Medical Center. She added that the nurse is “teaching the concepts of Western medicine” to the parishioners, who are largely unfamiliar with the U.S. health system.

Health ministries and nursing are particularly strong in Southern California and the Midwest, and chapters of the Health Ministries Assn. are being formed in Virginia, Pennsylvania, Connecticut and Michigan.

Three universities have recently added specialty degrees in parish nursing: Azusa Pacific in Azusa; Georgetown in Washington, D.C., and Marquette in Milwaukee.

Nurses who graduate from these programs “are on the front line of patients’ ethical concerns,” said Fowler, the Azusa Pacific professor.

“At the bedside level, the single most important bioethical issue . . . is the way one goes about dying--withholding treatment and withholding treatment once it’s started; and how you evaluate this in terms of the person’s spiritual walk and beliefs.”

Fowler added that skilled health ministers will increasingly help people decide about such things as durable power of attorney--a legal instrument that designates a decision-maker to determine a person’s end-of-life treatment if the person is unable to do so. Fowler said she also sees increasing church involvement in decisions about accident victims and newborns with birth defects.

The health ministry concept seems virtually unopposed in either the medical or religious communities.

Once in a while, Westberg said, some lay people will ask why the church should get so involved in health matters. “But we say, ‘Jesus was in the healing business and the church always has been.’ ”