Faith Community Nursing

1. Faith Community Nursing Unit 4: Community Module 4: Care Coordination

2. Objectives:

3. Faith Community Conceptual Model

4. Defining Collaboration • Collaboration is a recursive process where two or more people or organizations work together toward an intersection of common goals • Collaboration does not require leadership and can sometimes bring better results through decentralization and egalitarianism. • Structured methods of collaboration encourage introspection of behavior and communication. • Linguistically, "collaboration implies more or less equal partners who work together” (Wikipedia 2009).

5. Benefits • Collaboration is a way to partner with more than one or two other organizations that the faith community has not been involved with before • Collaboration has many benefits. • collaborating with key professionals and various agencies in the community can legitimize an issue. • with the backing of multiple organizations and stakeholders, the ability to collectively capture the interests of key policymakers in the community can be multiplied. • based on collaborative efforts problems are solved that may have never been solved if each group had decided work independently on the issue.

6. Another benefit of collaboration is the synergy that occurs through participating in a group • When brainstorming an issue, ideas and energy create new avenues to address the issue. • During collaboration people become energized because each person at the table has a vested interest in finding a solution to the problem. • This synergy also may bring about the new ideas for additional resources that may be needed • Collaboration also might help obtain grant money. • Collaborative efforts may convince granting sources that the parish nurse ministry or congregation is committed to their members and the important issues in their congregation. • The parish nurse may be in the position to provide information to the grant writing process about the multitude of community resources that parishioners could use to improve or maintain their health. • It is important to note that some church-related projects have been awarded grants based on the number and strength of the collaborations formed. • Certain funding guidelines sometimes encourage grantees to expand those collaborations to include all stakeholders involved.

7. Barriers to collaboration • Some of the perceived barriers to collaboration are: • "Stranger danger" - a reluctance to share information with others. • "Needle in a haystack" - the belief that others may have already solved the problem. The question becomes how do you find them? • "Hoarding" - the basic premise that people do not want to share their knowledge because they see hoarding their information as a source of real power. • "Not invented here" means that the solution is not a product of the group; rather it comes from outside the group instead.

8. Differentiating between coordination, cooperation, and collaboration: • Coordinationis exchanging information and altering activities for mutual benefit that achieves a common purpose. • Coordination requires more than organizational involvement and networking. • It can be an important strategy to implement change. Coordination is most effective when all parties affected by proposed changes share in the decisions about the possible consequences of the changes.

9. Differentiating between coordination, cooperation, and collaboration: • Cooperation means exchanging information, altering activities, and sharing resources for mutual benefit to achieve a common purpose. • Shared resources may include sharing staff, work space, training, information, funding, and, in some cases, legal arrangements. • Collaborationis exchanging information, altering activities, sharing resources, and enhancing the capacity of another organization, for mutual benefit, and to achieve a common purpose. • Members of a collaborative effort view each other as partners that are willing to share risks, resources, responsibilities, and rewards. • A multi-sector collaborationis an alliance of public, private, and nonprofit organizations.

10. Differences The differences between these terms can be illustrated by considering these criteria: • Preconditions for success (“must-haves”) • Enablers • Desired Outcomes • Ideal Applications

12. Reflection As a parish nurse, which aspect of collaboration has more potential to improve health care? Which is better method of problem solving: coordination, cooperation, or collaboration?

13. Interdisciplinary Collaboration • The Enhancing Interdisciplinary Collaboration in Primary Health Care (EICP) Initiative, • “an interprofessional process of communication and decision-making that enables the separate and shared knowledge and skills of health care providers to synergistically influence the client/patient care provided”

14. Interdisciplinary Collaboration • Mitchell and Crittenden (2000) state that interdisciplinary collaboration in health care is needed in order for individuals and communities to survive. • The complexity of health care is too great for one practitioner or one discipline to handle alone. • The vast amount of information generated in health care is too voluminous for the solo practitioner to attempt to master; • Because the determinants of health are beyond the capacity of any one practitioner or discipline to manage. • In order to achieve our national goals of improved public health the number of interdisciplinary collaborations in healthcare must grow. • Health care professionals attempting to help our communities and preserve our disciplines must collaborate to survive. • Parish nurses should join these collaborative whenever possible so the connection between faith and healing is represented.

15. Objective 2 • Health care teams are routine in many organizations. • It is an expected and accepted practice in most organizations. • Collaboration is not quite the same as team work and requires a separate and distinct set of skills/competencies, not taught in health care curricula. • Some circles health care professionals are asked to include the patient in the collaboration, creating a new kind of practice. • Medical Home

16. IDCP • A new interdisciplinary collaborative practice • “requires fundamental alterations in existing health professionals’ values, socialization patterns, and workplace organizational structures. In order to facilitate such a change there is a need to create a new culture in health systems that supports trust, a willingness to share in patient care decision making, and meaningful inclusion of patients and/or to their families.”

17. Collaboration Collaboration requires a definite set of skills and competencies in order to be successful. Core competencies for interdisciplinary collaboration include: • Be competent in a clinical practice discipline. • Understand and respect how other disciplines approach clinical and social problems. • Understand the context and complexity of population health and interdisciplinary strategies for cost savings and cost-effectiveness. • Demonstrate basic group process skills including communications, negotiation, time management, and assessment of group dynamics. • Understand the broader determinants of health including housing, social, and economic issues influencing the health problems of a population or group. • Understand community links essential to providing integrated services to a population group, and participate with community partners in creating and maintaining viable solutions to health issues influencing the target population.

18. Benefits

19. Collaboration Collaboration among professionals is a vital factor in safe effective health care. • Patient safety issues are often dependent on how well health care teams function under pressure at the bedside. • Lack of teamwork and collaboration leads to error and decreased quality in the care setting. • Lack of collaboration and coordination produces tension and disrespect among health professionals in the health care setting. • Skills for interdisciplinary collaboration are not taught in health professional education. • Impact of lack of collaboration for the client results in: • exclusion from decision making about care engenders feelings of powerlessness. • powerlessness leads to frustration and “non-compliance”

20. Reflection Why is interdisciplinary health care collaboration important today? Who should initiate an interdisciplinary healthcare collaborative?

21. Objective Three • Volunteers (unpaid workers) are a necessity inparish nursing. In some settings even the parish nurse is a volunteer. • Like many non-profit organizations, a faith community’s health ministry program might not be able to function without the help of volunteers. • Volunteers assist with a variety of tasks such as helping with health related programming completing necessary clerical work or serving as speakers for certain educational events. • Volunteers in faith based organizations may see themselves as God’s hand extended as they may feel that they are carrying out God’s plan for their lives by helping His people. • The PN must know how to recruit, train, manage, and supervise volunteers. Recognizing volunteers is also important. A planned program for sustaining volunteer involvement is also essential. 

22. American Red Cross Principles of Volunteerism from the American Red Cross: • Volunteers are not “free.” • Volunteers contribute more than meets the eye. • Volunteer” does not mean “amateur.” • Volunteers and the organizations they serve must meet each other’s expectations. • Volunteers must never be exploited. • Volunteers make excellent middle and senior managers.

23. The Recruitment Process • Where do volunteers come from? The parish nurse might consider this question before recruiting volunteers. • Understanding why certain people may want to work with the parish nurse may help the parish nurse recruit the right people. • The best place to recruit volunteers for the health ministry is within your faith community. • Church members are considered stakeholders and have alliances within that church and community. • Additionally, often a word from the pastor may encourage a volunteer to come forth to serve. • Why would someone want to volunteer to work in the health ministry? • They want to make a difference (contribute to a good cause) • They hope to develop new skills • They want to meet people and make new friends • Or some combination of these reasons.

24. There are times when the parish nurse may need more volunteers than the immediate faith community can provide. To find more volunteers the parish nurse can investigate places such as: • Corporate volunteer programsthat provide opportunities for employees to become involved in service to the community and allow their employees to work with nonprofit organizations during the workday. • Neighboring churches, synagogues, and other religious institutionswith volunteer programs may offer a wealth of volunteer prospects who are motivated by religious and altruistic beliefs to serve the broader community. • Internship programs at colleges and high schools often provide interns free of charge in exchange for a meaningful volunteer project. • Career counseling centers can help identify individuals who are changing careers and considering entering the nonprofit sector as volunteers. • Civic clubs, fraternal organizations, sororities, and fraternities can be a great resource for large numbers of volunteers. • Newspapers, radio, television are excellent vehicles to promote volunteer needs, and many will allow nonprofit organizations to list volunteer opportunities for free. • Governmental offices may also be a source of volunteers because some governmental organizations allow employees to leave work for up to one half day a week to serve as volunteers in the community. • High schools and colleges may have programs that require students to give hours of service to community projects. • Other nonprofit community organizations can be a tremendous resource in identifying and recruiting volunteers for our organization.

25. Training • In order that volunteers do the best job possible for the health ministry program, it is important to know the recruits and the recruits must know what to expect. • And at the same time, volunteers are more likely to stay onboard if they are picking up useful skills and if they know exactly what they are getting out of their volunteer experience. • Volunteer training is essential.

26. Management • Volunteer retention requires careful management. • The management goal is to make volunteers feel successful and appreciated. • Managing volunteers is an ongoing task that involves constantly clarifying volunteers’ roles and responsibilities, providing feedback to on their work, keeping records of their performance, and keeping the volunteers inspired. • Matching the right person with the right job is critical for volunteers to be successful. • Volunteers feel appreciated and contribute in a meaningful way, the parish nurse should ask them to work on projects reflecting their strengths. • It is best to identify and create projects based on the volunteers’ skills and interests.

27. Show Appreciation: As is the case with paid employees, some volunteers may feel overburdened with work and have the potential to “burn-out.” The parish nurse can make sure that the volunteers are not shouldering more than their share and that they are comfortable with and have a mechanism for letting the parish nurse know if they are working too hard. Showing appreciating may help prevent volunteer burn-out. Use the following: • Invite the volunteers to health cabinet meetings • Hold volunteer social events • Invite volunteers to special training sessions • Give out a volunteer of the year award • Sponsor a volunteer appreciation luncheon 

28. Identifying roles, expectations, responsibilities and relationships • One of the greatest challenges for any organization to face is preventing friction among staff, be it paid or volunteer. If at the top level of the organization, board members, and executive directors disagree on where their responsibilities begin and end, similar problems may arise at other levels of the organization. • To help avoid problems arising from unclear or overlapping responsibilities, clear job descriptions must be written out for every position on your volunteer staff. Good job descriptions should itemize all of the duties of a position and should also specify what days and hours the volunteer will be working

29. Volunteers Assignments for volunteers: • Remember to match the task to the volunteers talents: Volunteers can: • Collect data • Provide professional consulting (in their field) • Design brochures, newsletters, logos, etc. • Edit documents • Maintain a database (remember to teach them about HIPPA rules) • Visit people in hospitals, homes or care facilities • Conduct on-line services such as “visits,” mentoring or instruction

30. Documenting Volunteer Service • It is important to keep records of their work. Adequate documentation helps the parish nurse make sure the volunteer force is used effectively. • It also protects the parish nurse in the case that a volunteer must, for some reason, be dismissed or the position responsibilities be revised. • Documentation on volunteers does not need to be complicated or voluminous. It can be done on paper or can be included in a computer database. • The basic information the parish nurse needs about new volunteers includes: • Name, address, telephone number • Education • Relevant experience • Interests and skills • Availability • Starting date • Emergency contact information • Pertinent medical information

31. DOCUMENTATION!! Proper documentation can help the parish nurse with: • Evaluating programs • Justifying program growth • Documenting volunteer achievements • Assuring accountability • Defining training needs • Pinpointing gaps in service • Providing letters of recommendation • Assuring accountability • Making long-term planning • Additionally, the parish nurse can create a work record log that documents the dates, times worked and the assignments carried out.

32. Dismissing a volunteer: • Occasionally the parish nurse may have to dismiss a volunteer. In doing so, the parish nurse should follow the same procedures as for a paid employee. • To avoid a difficult situation consider the following suggestions: • Make sure that all volunteers clearly understand the organization’s policies and procedures. • Utilize the work record log. • Provide volunteers with honest feedback on their performance. • Never discuss dismissing a volunteer with other staff people. Only the parish nurse, parish nurse’s supervisor (if applicable), and the volunteer should know about the termination. • If termination in imminent, be sure to make it very clear to the volunteer the reasons for the decision. • Manage personal emotions and be professional and polite. • Perhaps finding a different position for the volunteer will eliminate the need for dismissal.

33. Insurance • Once the faith community has decided to involve volunteers, the parish nurse must make sure that the faith community carries liability insurance and is covered adequately. • The parish nurse must also check with the faith community to see what their policy is about medical insurance for injuries incurred by volunteers. • Since there are few insurance companies specializing in nonprofit coverage, the parish nurse may have to negotiate special arrangements with the faith community’s insurance company to supply covering the volunteers.

34. Liability Those areas that the parish nurse must take into account about the issue of insuring volunteers are: • Liability: There are various ways that the faith community can be sued due to the actions of its volunteers. Be sure to check the faith community’s policies and ensure it is protected against the following possible scenarios: • If a volunteer injures someone (bodily injury) • If a volunteer slanders someone (personal injury) • If a volunteer damages someone’s property (property damage) • If a volunteer abuses/molests a client (sexual abuse & molestation) • If a volunteer renders an unqualified professional service - nursing, counseling, etc. (professional liability)

35. Injuries • Injuries: If a volunteer is hurt while working in the faith community they may be entitled to compensation beyond what their own insurance already covers. Speak to the faith community’s insurance company to discuss possible solutions to this problem. • Coverage under the faith community’s worker’s compensation policy. • Usually, this means adding a “voluntary” endorsement to the faith community existing worker’s compensation policy. The faith community is then charged based on hours worked by volunteers time the minimum wage. • Coverage under a medical accident policy. • These policies can cover anyone injured on the faith community’s premises, including volunteers. The policy can also be extended to cover off-site activities, sporting events or to and-from activities.

36. Reflection As the parish nurse which aspect of preparing a plan to with volunteers was most rewarding? What is most frustrating? When is the best time to recruit volunteers?

37. Support Groups • Support Groups: • Collaborating with congregants to explore getting additional help during difficult adjustment periods is an important role of the parish nurse. The parish nurse can assist with finding or starting a support group. • Definition of Support groups: • A support group is an environment or place for people to give and receive both emotional and practical support as well as to exchange information with people who are experiencing similar life experiences.  

38. Support Groups Reasons to Join A Support Group: Many support groups offer: Support groups are made up of people with common interests and experiences. People who have been through, or are going through, a similar circumstance may be able to offer more than sympathy. They may be able to relate to another person on a deeper level. The nurse can communicate that many people are unaware of the additional benefits of joining a support group such as gaining practical tips and learning about valuable resources. Information about medical treatments, research and strategies (through brochures, booklets, websites, telephone help lines, and person-to-person sharing in the group meetings). Information about public policy, legal resources, privacy laws, and protection from discrimination. How to find adequate medical or physiological information. Ways to find out about financial assistance, grants, stipends, or scholarships.

39. Kinds of Support Groups: • Support groups can vary in how often they meet, their area of focus, and who facilitates them. • professional facilitators or by specific • peer-support groups • Support groups exist for many topics. For example, support groups can be for people: • with a specific medical condition; • with a relationship to an affected person, such as a sibling, spouse, or child; • looking for services such as short-term stand-in help for caregivers, rehabilitation services, or financial and estate planning; or • dealing with grief and loss.

40. Comparing Support Groups: It is important for the individual to find a compatible group. • Professionals can contribute information and resources and help with organizational tasks such as planning meetings, setting up the meeting room, sending out messages, and obtaining speakers. • Others may prefer a peer environment. "I've been there too" perspective. • A faith – based support group has the added advantage of being able to draw on shared beliefs and values related to hope and life’s meaning. A faith based support group also helps the faith community regain its place as the place for physical and emotional healing.

41. Additional Facts about Support Groups • How often a group meets depends on its purpose and the needs of its members. • Large groups with many chapters may have local meetings once a month and annual meetings for the whole organization. • Small groups intended to address a specific issue, for • Some groups are designed to last for only a short time (four to eight weeks); other support groups may last for many years. • Support groups meet where the group members are best served. • Hospitals offer support groups, but groups can also meet in an individual’s home, churches or temples, libraries, or other community buildings. • Online support groups, which may be especially helpful for people who are homebound, have limited free time to attend meetings, or don't have a group nearby that meets their needs. • Size varies depending on the purpose of the group and the needs of the members. • Some groups have fewer than ten members; others may have thousands. • Groups that have as their goal raising money, influencing public health policy, or educating the public tend to be very large. • Emotional support groups, for example, around grief or loss typically are small, so that participants can feel safe expressing feelings.

42. Choosing A Support Group: A parishioner looking for a support group might consider the following: • Are you seeking specific information about medical treatment options? Companionship? Peer counseling? • How far can you travel? Do you need help with transportation? • Is the kind of group you want just for someone who is ill, or also for family members? Will a mixed group work for you? • What about the emotional dynamics of the group? Are you looking for a group where you can openly discuss feelings, or are you primarily interested in finding services to further education and research? • Are you seeking a group run by a professional facilitator, or a peer-support group? • Are you seeking to integrate your faith into your healing process? 

43. Starting a Support Group • Starting a new group is time-consuming and takes much work. • Established group probably has certain advantages, • such as already established informational materials, meeting times and places, and professional contacts. • However, in some cases the type of group needed may not exist in the faith community or broader community. • Ways to begin a new group include getting the help of a local hospital, doctor, church or temple.

44. Organizing considerations: • Knowledge of the stages of group development: formation, maturation, termination and time limits. • Group context: physical environment-place, arrangement of space, temperature control and room environment, and expected behavior of participants. • Group structure • Group size • Location of meetings • Length of sessions • Group Roles • Leadership: Lay or professional • After a group is started, the members may want to consider listing it through the local paper or an associated organization

45. Reflection What factors or principles can guide the parish nurse through this process? Describe how this process will be beneficial to the faith community.

46. Discussion & Questions

47. Next Up…Beginning Your Ministry