SHE'S LICENSED as a registered nurse, but Judy Rush would rather see patients at the kitchen table instead of a hospital room.
That's where she says she does her best work-listening, empathizing, and praying. And it's there, she says, that's often the best place to offer health care.
The first parish nurse at New Hanover Regional Medical Center said doctors used to make home visits, listen to family stories, and find out how families live. But those days are gone. Now parish nurses, shared employees of the hospital, and local churches, fill the gap.
"As a parish nurse, I sit around the kitchen table and share a cup of tea," said Ms. Rush, who has a nursing degree and psychology degrees. "Rarely am I in a hurry. I have the luxury of fewer rules and regulations and can be present in the moment with whomever I am with, available to listen, answer questions, and teach."
Ms. Rush serves three churches in Wallace, North Carolina, about 40 miles from Wilmington, North Carolina, home of the public hospital that began parish nursing in 1997. Parish nursing is a program that works with faith communities to deliver a holistic health care message-dealing with people's emotional and spiritual needs as well as physical needs, and teaching them to take care of themselves and each other to prevent disease.
One day, she may help a patient suffering from cancer understand the drugs. The next, she's leading an exercise class at church or praying with congregation members in their homes. On Sundays, she takes blood pressure readings between Sunday School and church.
"She's making a difference in the community," said Phil Gladden, pastor at Wallace Presbyterian Church. "People know who she is and are making use of her. She adds a dimension to the ministry here."
New Hanover Regional's parish nurse program is the second of its kind in the state. The hospital offered a $325,000 grant to participating churches to help pay for the program. Five Wilmington area churches have followed the Wallace churches into the program. The hospital has hired another parish nurse and several more faith communities have joined in Fall 1998, said Leigh Boaz, the hospital's parish nurse coordinator. "It encourages people to be healthier and not rely on the health care industry to patch them up," Ms. Boaz said.
Ms. Rush has an office at Wallace Presbyterian. In rural communities, the church is one place everyone meets, she said, making it an excellent base for an outreach program to improve health.
The federal government considers Duplin County, which includes Wallace, to be medically underserved. In 1995, the county had 4.7 physicians per 10,000 people. Nearby Brunswick County (4.6), Pender County (3.7), and even parts of heavily populated New Hanover County (9), also made the federal list.
Ms. Rush said people in rural counties typically are less likely to use the doctors they have. Urban residents do a better job of seeking preventive health services, she said. "A lot of rural-type people don't want to make waves," she said. "They just want to be nice. That doesn't serve them too well when they enter the technical world." One of Ms. Rush's roles has been to advocate for those people. One man suffering from cancer didn't understand the pain-killing medication prescribed by a specialist in Winston-Salem, North Carolina, about three hours away. Ms. Rush knew what questions to ask and how to get the doctor on the phone. She then taught the man how to take the drugs and what they were for.
Her office at the church is open for visitors between Sunday School and church, and she often uses that time to check blood pressures or counsel church members with medical or emotional problems they don't feel comfortable discussing with a doctor.
She also has started several programs reaching the community beyond her church members. Her monthly lunch sessions with area doctors are growing, drawing 50 people in April. She teaches two exercise classes a week and created a walking competition between three teams at the church. The losing team will treat the winners to dinner.
She updates a wellness bulletin board at four area doctors' offices and arranged for a trauma nurse to discuss drinking and driving to high school students just before their prom. She has set up blood pressure screenings at four county nutritional sites, where the elderly go to get a hot meal, and has already found some readings high enough to refer them immediately to a doctor.
Ms. Rush provides relaxation through guided imagery to help people deal with pain or breathing problems, and she is getting diabetes screening and weight loss programs started.
She's also getting training in pastoral care so she can more effectively deal with people's spiritual needs. The medical profession started within the church, with monasteries training the first doctors. Now the church is eager to reclaim its role as a center for health and healing. Studies have shown that good physical health is related to emotional and spiritual well-being. Ms. Rush said she'll pray with residents or read the Bible with them, but doesn't force that issue. "I try to meet them where they are," she said.
Wallace Presbyterian has grown since she arrived, although she attributes most of that to Dr. Gladden's arrival on April 1, 1998. But Dr. Gladden says it was more than that. Through the common bond Ms. Rush provides through her outreach efforts, the congregation is more connected and more in touch with each other, he said.
The fact that Wallace Presbyterian was willing to become the first in its denomination in this area to take on parish nursing, even when the church was between pastors, helped draw Dr. Gladden to the job. "I think most ministers would probably like to have something like this," he said. "They have said 'that sounds great' or 'can you get me some information on how we could do that.'"
Ms. Rush and Dr. Gladden are looking at ways to expand the program in the community. For example, Ms. Rush is learning Spanish so she can help a minister who moved from Mexico start a Presbyterian church to serve Duplin County's large migrant Latin American population.
Ms. Rush said this type of health care is the wave of the future. Parish nurses have already grown from a few hundred in the 1980s to more than 4,000 today as hospitals are becoming more interested in how the spiritual side affects patients' health. "Even though nurses were always taught to consider the spiritual care of patients, it never has been acceptable to cross that line," says Ms. Rush. "Now we've got doctors praying with patients before operations. It works-why not do it?"