How can we ‘love our neighbour’ in fresh and innovative ways?
6 MINUTE READ
From Luke’s Journal Jan 2023 | Vol.28 No.1 | Evolving Professionals
Nel never missed an opportunity to be at church, but in recent weeks she had been absent, and Nel was missed. Our pastor visited her and Nel said she was fine and taking a break.
As a registered nurse and friend, I wondered about that statement and gave Nel a quick visit. I found Nel sad and depressed. After a short conversation, she said she was experiencing faecal incontinence and stayed at home because she did not dare to venture out, adding “I couldn’t tell the pastor that!”
I recognised she may be experiencing medication side effects and advised her to discuss this with her GP who could change her prescription to something without those side effects. Nel did this and was able to re-join church and community activities and her mental, physical and spiritual health improved. It is a simple example of how a health professional can positively impact the pastoral care of people within a church, and may extend such care to the geographic and/or cultural community a church serves.
Australians enjoy one of the highest life expectancies in the world, living around 25 years longer than a century ago.1 However, those years are increasingly being lived with debilitating chronic conditions that lead to disability and death.2 The Australian health system recognises that addressing the impacts of chronic disease on individuals, families and the community is its biggest challenge and must be addressed to control the escalating cost burden on taxpayers.3(p.7) Chronic conditions are occurring earlier in life, so most Australians will live longer but are likely to require complex care within their communities. The past four decades have seen the burden of disease in Australia move away from the acute illnesses, injuries and infectious diseases that suited an episodic-care model, toward chronic condition care that requires prevention and coordinated management models of care.4
“This situation presents an opportunity for churches to mobilise their gifts and resources to provide meaningful messaging and positive activities that promote health, prevent disease and facilitate self-management within their community.”
This situation presents an opportunity for churches to mobilise their gifts and resources to provide meaningful messaging and positive activities that promote health, prevent disease and facilitate self-management within their community. Helping people to effectively manage chronic health conditions is likely to mitigate the adverse impacts of disease and assist our over-burdened health system to manage escalating healthcare costs, whilst also improving personal health and wellbeing so people experience “life in all its fullness” (John 10:10, NCV) within a thriving community.
Optimal health and wellbeing occurs within the context of family and community support, where people share resources, nurture and care functions, and access preventative interventions.5 Twenty years ago, the World Health Organization launched the ‘Innovative Care for Chronic Conditions’ (ICCC )6 framework noting the ‘healthcare team’ should work alongside the ‘family’ and ‘community partners’ to create a triad of support for people living with chronic conditions, stating such partnerships could mobilise and coordinate care that supplements and complements hospital services. They noted the most effective personal engagement in self-management models occurred within supportive community networks. Most faith communities are supportive communities where quality education and support programs/ministries can address issues that promote whole-person health, wellbeing and lifestyle, and prevent disease, injury and abuse. They are able to provide compassionate care to their faith community and even reach out to the broader community.
The Christian Mandate to ‘Love Your Neighbour’
Christian churches have a biblical mandate to address issues such as poverty, oppression, marginalisation and illness as matters of justice, right living, compassionate service, and good stewardship. When this occurs it can positively impact personal, family and community health and bring healing and transformation. The first and greatest commandment for all Christians is to “Love the Lord your God with all your heart, and with all your soul and with all your mind.” (Matthew 22:37, NIV). We are called to be a “living sacrifice” (Romans 12:1, NIV), using body, mind and spirit, shaped to reflect the love of Jesus Christ to the people we serve. Jesus follows on with a second command to “Love your neighbour as yourself'” (Matthew 22:39, NIV). Our faith must not be just head knowledge that ignores the needs of others in our world, because it is not the “true and proper worship” (Romans 12:1, NIV) that God requires of us. It is not enough to say ‘I’m sorry about your situation and I care’. We are instructed to demonstrate God’s love through our words and actions. Jesus Christ instructs us in the parable of the Good Samaritan to act mercifully, adding we are to “Go and do likewise” (Luke10:37b, NIV) as individual Christians and as collectives via our churches.
We are to ‘love ourselves’ in ways that respect and nurture our body, mind and spirit and steward our health so we can flourish. This is because our body is a “temple of the Holy Spirit” (1 Corinthians 6:19-20, NIV) provided in trust, not to do with as we please, but to honour and serve God on this earth with the life and gifts we have been given. Therefore the church has a responsibility to teach people how to look after their body, mind and spirit, so they can grow toward wholeness.
“Therefore the church has a responsibility to teach people how to look after their body, mind and spirit, so they can grow toward wholeness.”
Jesus concludes his passage pointing out that “All the Law and the Prophets hang on these two commandments.” (Matthew 22:40, NIV). In short, Christians and churches lose credibility in the eyes of the world when we do not live as people who love and care for ourselves, one another, our community and the most vulnerable in our world. We forfeit integrity when our actions do not demonstrate good stewardship or enable just and right living. Loving our neighbour is not a charitable choice, nor a benevolent option, rather it is a commandment from our LORD, whom we seek to wholeheartedly serve.
So how can we, as health professionals, use our gifts, knowledge and skills in service, as we progress our career paths? We can grow, develop and use our God-given gifts and professional healthcare knowledge and skills to drive whole-person healthcare. We can support churches to be more whole-person focused in their ministries, and prepare church members to be active in their community with educated, appropriate, compassionate and empowering support to those in need, and especially our most vulnerable community members. This requires intentional preparation in the provision of effective strength-based support that encourages people and develops their personal capacity so they become all God intended them to be. It means adding a proactive health focus to traditional reactive pastoral care ministry within today’s Christian churches.
Adding a Health Focus to Pastoral Care Ministry
Health is more than the absence of disease. I describe it as a dynamic state of wellbeing which results from harmony between my body, mind and spirit, and my ability to adapt to, and live in harmony with, other people, the creation, and with God. Illness occurs when there is a disruption in any of those relationships. This understanding of health equates to the biblical concept of ‘Shalom’7 which Scripture describes as physical, psycho-social and spiritual wellbeing. This includes just and right relationships between people and nations that are the product of integrity, moral and ethical living that accords with Scripture and results in people experiencing peace, wholeness, health, and a sense of wellbeing.
Adding a ‘health’ focus to pastoral care includes the provision of proactive activities within the Christian faith community that promote personal and corporate health and wellbeing. Such activities incorporate biblical values, beliefs and practices that motivate and promote wholeness and inform compassionate care across the continuum of life. That continuum includes conception, birth, development and maturation, and takes in delay, decline, illness and death. A health focus facilitates ‘Shalom’, promotes wholeness, prevents disease, injury and abuse, enables coping, nurtures faith, ignites hope, demonstrates love, expedites healing, and cultivates relationships within the person (body, mind and spirit), between the person and others, between the person and the creation, and between the person and God.
The ‘care’ focus of pastoral care includes the reactive activities the Christian faith community uses to restore health and wellbeing. They are intentional responses to identified needs within our community that foster interdependence, mutuality, compassion and healing.
When both health and care foci are combined the ministry becomes balanced and holistic. It does not wait for a problem to occur in order to respond with Christ’s love. Rather it takes an approach that seeks to empower the person/s to discover God’s gifts within themselves to prevent and alleviate suffering. It is a Christian response to living a just and upright life (Micah 6:8). The relationship can be illustrated as a continuum:
Figure 1. The Health Continuum and its Focus on Health and Care Activities.8
Case example: Faith Community Nurses bring a health focus to pastoral care
Nurses Christian Fellowship Australia (NCFA)9 is preparing nurses by offering a 6-hour ‘SCAN’ (Spiritual Care for Australian Nurses) course that focuses on assessment and evidence-based strategies for self-care and practical application of whole-person focused spiritual care for nurses. Christian Medical and Dental Fellowship Australia (CMDFA) offers the ‘Saline’ course to provide practical tools that enable participants to share Jesus’ love with people for whom they care.10Australian Faith Community Nurses Association (AFCNA)11 offers an internationally recognised 40-hour course preparing nurses and healthcare professionals to provide effective health and pastoral care ministry within Christian faith communities and the populations they serve, enabling them to use their knowledge of health, disease, illness/care management, and combine it with their faith and personal gifts to create and sustain tangible networks of care within faith communities and beyond.
Faith Community Nurses (FCN) usually work in church congregations, faith-based aged care, schools, and community services providing care to people of all ages and supporting caregivers. FCNs promote a whole-health perspective that supports people with pre-existing conditions to manage their health. They facilitate the integration of faith and health and can focus on specific cohorts of people such as families, children, youth, aged; or specific conditions such as disabilities, mental health, addictions, homelessness, chronic conditions, etc.. This ministry provides churches with opportunities to serve their community and focus their ministry on specific areas of interest.
The health focus of pastoral care is summed up as:
Health promotion: whole health (body, mind, spirit), family and community health that empowers self-care capacity
Education and health counselling: understanding health issues, education, coaching and support – in person, groups, print, seminars
Advocacy and referral: support to navigate health and care systems to locate resources, obtain referrals, support, advocating as needed
Listening and visiting: listen and discuss health, social and spiritual concerns; visits to connect with family, church and community
Training and coordination: prepare health and pastoral care volunteers to ensure quality ongoing whole person-centred support
Hope and spiritual care: support a person regarding mental/spiritual issues, prayer with a person’s permission, spiritual support and pastoral care
Effective self-care is critical to good chronic condition self-management (CCSM). The minimal contact Australians have with health clinicians provides only basic knowledge and engagement in ongoing self-management. Most positive health outcomes are mediated by a person’s health behaviours.12 Self-management differs from disease education because it focuses on motivating and developing the person’s self-confidence to manage their condition and make positive health choices.13 One of the most effective ways of doing this is an iterative person-centred approach to goal setting, decision making, problem solving and progress monitoring that is undertaken collaboratively with support, coaching, and systematic follow-up14 which is exactly the care health professionals can provide.
Faith Community Nurses are well placed to do CCSM as they have holistic, person-centred approaches to care.15 They are primary healthcare focused, educating the person about health options and self-management. They have good knowledge of community resources and expertise in helping people navigate health and community care systems.16 FCNs work with volunteers in the church’s health and pastoral care ministries to provide self-management planning, targeted encouragement and structured coaching to develop positive self-management behaviours. They may use a combination of home visits, telephone follow-up, education, information, motivational support and coaching to achieve sustained behaviour change.
The past three years of the COVID-19 pandemic has illustrated many urgent and unmet needs for community support to prevent social isolation and improve mental wellbeing. It has highlighted the risk of inadequate CCSM knowledge and skills within the community and the incapacity of the health system to provide the necessary support for that work. This presents an opportunity for today’s churches to reconsider how they can ‘love their neighbour’ in fresh and innovative ways that provide effective responses for today’s health needs. Churches can provide affordable or free community programs and relational activities that promote personal capacity, develop social cohesion, and enable self-care. We have an opportunity to serve in ways that let our community know we are followers of the God who loves them, and wants them to have an “abundant life” (John 10:10, ESV) now and in eternity.
If you are or your church, are interested in finding out more, you can locate more information at www.afcna.org.au.
Dr Antonia van Loon
Dr Antonia van Loon is the chairperson of the Australian Faith Community Nurses Association. Anne has worked in Emergency nursing; Tertiary education in nursing and health sciences; Community health research with vulnerable populations; and provision of church-based health education and consultancy. She is eager to encourage health and pastoral care ministry in today’s churches for the benefit our community and enable God’s kingdom on earth.
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- United Nations. Department of Economic and Social Affairs Population Division [Internet]. Geneva: 2022. Revision of World Population Prospects; 2022. [cited 2022, Aug 16]. Available from: https://population.un.org/wpp/.
- Australian Institute of Health and Welfare. [Internet]. Canberra: AIHW; 2016. Australia’s health 2016: in brief. Cat. No. AUS 201. 2016; [cited 2022 Aug 16] Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129557059.
- Australian Health Ministers’ Advisory Council. [Internet]. Canberra: 2017. National Strategic Framework for Chronic Conditions. [cited 2022 Aug 16] Australian Government. Canberra. Available from: https://www.health.gov.au/resources/publications/national-strategic-framework-for-chronic-conditions.
- Glasgow RE, Davis CL, Funnell MM, Beck A. Implementing practical interventions to support chronic illness self-management. Jt Comm J Qual Saf. [Internet]. 2003 Nov [cited 2022 Aug 16];29(11):563-74. Available from: https://pubmed.ncbi.nlm.nih.gov/14619349/ doi: 10.1016/s1549-3741(03)29067-5. PMID: 14619349.
- World Health Organization [Internet]. Geneva: 2002: Noncommunicable Diseases and Mental Health Cluster. 2002; Innovative care for chronic conditions : building blocks for actions : global report. [cited 2022 Aug 16]. Available from: https://apps.who.int/iris/handle/10665/42500
- The NIV Bible [Internet]. The Meaning of Shalom in the Bible. [cited 2022 Aug 16] Available from: https://www.thenivbible.com/blog/meaning-shalom-bible/
- Van Loon AM. Health and Pastoral Care Ministry. Wayville, South Australia: Baptist Care SA; 2018.
- Nurses Christian Fellowship Australia (NCFA). [Internet]. Australia: NCFA; 2021. Spiritual Care for Australian Nurses. [cited 2022 Aug 16]. Available from: https://www.ncf-australia.org/.
- Christian Medical and Dental Fellowship Australia (CMDFA). [Internet]. Australia: CMDFA; 2022. Saline course. [cited 2022 Aug 16]. Available from: https://www.cmdfa.org.au/saline-process.
- Australian Faith Community Nurses Association (AFCNA) [Internet]. [Australia]. Foundations of Faith Community Nursing. [cited 2022 Aug 16]. Available from: https://afcna.org.au/how-do-i-become-a-fcn/.
- Pearson ML, Mattke S, Shaw R, Ridgely MS, Wiseman SH. Patient Self-Management Support Programs: An Evaluation. Final Contract Report (Prepared by RAND Health under Contract No. 282-00-0005). AHRQ Publication No. 08-0011. Rockville, MD: Agency for Healthcare Research and Quality; November 2007. [cited 2022 Aug 16]. Available from: https://www.ahrq.gov/research/findings/final-reports/ptmgmt/index.html
- Coleman MT, Newton KS. Supporting self-management in patients with chronic illness. Am Fam Physician. 2005 Oct 15;72(8):1503-10. PMID: 16273817.
- Patient Self-Management Support Programs: An Evaluation. Content last reviewed April 2020. Agency for Healthcare Research and Quality, Rockville, MD. [cited 2022 Aug 16]. Available from: https://www.ahrq.gov/research/findings/final-reports/ptmgmt/index.html
- Van Loon AM. Faith Community (Parish) Nursing. In Puchalski C, Cobbs M, Rumbold B. Spirituality and Health. Oxford, UK: Oxford University Press; 2012. p. 219-226. https://doi.org/10.1093/med/9780199571390.003.0031
- Cooper J, McCarter KA. The development of a community and home-based chronic care management program for older adults. Public Health Nurs. 2014 Jan-Feb [cited 2022 Aug 16];31(1):36-43. doi: 10.1111/phn.12049. Epub 2013 May 6. PMID: 24387773.