Editor’s note: This article is the first in a series of five articles about parish nursing, a relatively new profession of importance to Oak Ridge, which has dozens of churches and an aging population.

BY CAROLYN KRAUSE

When their 10-month baby girl woke up last Thanksgiving without energy or interest in pulling herself up to stand, Debra and Matt Stone were scared. Little did these new parents know that their first baby’s illness would make them especially thankful to modern medicine and their church’s parish nurse.

The Stones took their daughter Maddie to an Oak Ridge pediatrician the next day. He observed that the baby had a low-grade fever and favored one leg when standing. He asked that a sample of the baby’s blood be drawn and analyzed. Then he arranged for Maddie to be seen by a doctor at East Tennessee Children’s Hospital in Knoxville.

The Stones met with the hospital doctor, who examined Maddie. "This doctor told us our baby could have an infection or she could have leukemia or some other scary diagnosis," Debra said. "He asked us to bring Maddie to the hospital for a bone scan and other tests."

Upset and tearful, Debra called the Rev. Kerra Becker-English, the Stones’ pastor at First Presbyterian Church of Oak Ridge, and asked for her family to be added to the prayer list. The pastor agreed and obtained the Stones’ permission to call the church’s parish nurse.

Within an hour, Meg Tonne, a registered nurse who had worked for a cardiologist in San Diego and cared for dying cancer and AIDS patients in Dallas, called the Stones and offered to meet them at the Knoxville hospital.

"She was wonderful," Debra said. "While I walked around the hospital carrying Maddie, Meg would comfort Matt, and vice versa. She explained to us what the doctor was trying to do with different medical procedures and tests."

When it was time for Maddie to have a bone scan, Tonne explained to the parents that the baby would have to be put to sleep temporarily to ensure that she lay still. In this way, the scanner imaging her bones would produce a clear and accurate picture. Tonne told them they had the choice of holding or not holding the baby while she was injected with the anesthetic.

The Stones chose to hold and comfort Maddie. When the baby was knocked out, her body went limp. Plop! Both parents became very upset. "Meg was there to comfort us and assure us that the baby was fine, just asleep long enough to get a good picture of her hip," Debra said. "When Maddie was coming to, our pediatrician in Oak Ridge called me. I handed my cell phone to Meg so I could be with Maddie as she woke up.

"Meg actually talked to our doctor and got the diagnosis that she was able to explain to us. It was good news. Our baby just had an infection in her hip. She said Maddie’s hip was OK and would heal by itself. That was very helpful."

Tonne conveyed the doctor’s simple instructions to the Stones: give the baby a specific dosage of Motrin to reduce the inflammation and Tylenol to relieve her pain.

Since that incident Tonne has continued to be a godsend for the Stones. "Matt has been traveling a lot and when he is away, Maddie and I often get sick," said Debra. "Meg has gone to the store and brought food to us and helped with Maddie. When we gave blood at the church, Meg played with Maddie."

As parish nurse Tonne provides spiritual support for all generations. She visits shut-ins and church members who are injured, ill or recovering from surgery. She talks to them in their living room, in the hospital, in the care center or in the nursing home. She calls members on the telephone to discuss health and spiritual issues. She prays with and provides spiritual counseling to dying patients and their families.

At the church she is available to take church members’ blood pressure and pulse rate and do other health assessments. She conducts periodic screening tests such as bone density scans.

She arranges for physicians and other health professionals to give talks during monthly luncheons at the church. Recent topics covered at the church’s monthly "health luncheons," have been joint replacement, healthy eating, depression, heart health, end-of-life financial planning, personal safety and avoidance of identity theft. She makes available to church members literature on a variety of topics, such as home safety and teen depression.

Using funds from an anonymous donor, she purchased an automated external defibrillator (AED) for the church. She arranged for church members to learn CPR--cardiopulmonary resuscitation. She trained ushers and other interested church members in how to use the lifesaving AED on anyone in the church needing a heart restart.

Tonne organizes an annual blood drive, held at the church. If the quota of 30 percent of the church’s active members is met, the entire congregation receives coverage for the cost of blood.

So, what is a parish nurse? A parish nurse is a registered professional nurse who serves a church congregation as health counselor, educator and liaison between individual church members and the church staff as well as community resources, such as hospital personnel. The Stone family and many other members of First Presbyterian in Oak Ridge consider parish nursing an essential ministry.

Next: An Oak Ridge High School science teacher did not think her church needed a parish nurse. A year after a parish nurse was hired, one of her children developed a serious medical problem, and the teacher changed her mind.

Meg Tonne, parish nurse at First Presbyterian Church, with Debra and Matt Stone and their daughter Maddie.

TWO PARISH NURSES MAKE AN IMPRESSION

Editor's note: This article is the second in a series of five articles about parish nursing, a relatively new profession that combines medical and spiritual training.

BY CAROLYN KRAUSE

Peggy Bertrand Terpstra, a physics teacher at Oak Ridge High School and former business software entrepreneur, once thought her church--First Presbyterian Church of Oak Ridge--did not really need a parish nurse. She was not a strong supporter in 2002 when church member Jim Wessel proposed the idea and brought it to fruition with the help of a grant.

"I thought we could all care for each other," she said. "I was not sensitive to people who had health problems because at that time, my family had no health problems. I didn’t understand that people with chronic or acute health problems have spiritual issues."

In the early days of 2003 a stomach-churning shock changed her mind. Ben, the Terpstras’ nine-year-old son, suddenly became seriously ill.

"Our perfectly healthy child was paralyzed and put on life support in five days," she said. "We took him to Children’s Hospital of East Tennessee, where he was diagnosed with Guillain-Barre syndrome."

This sometimes fatal illness is an auto-immune syndrome that affects the neurological and muscular system. The cause is not usually known.

"The Presbyterian church gave us incredible support," Terpstra said, citing visits and expressions of concern from parish elder Rebecca Bell, other church members and the church’s new pastor, the Rev. Kerra Becker-English. But the person the Terpstras saw the most was Barbara Parker, the church’s new parish nurse. Parker, wife of a Baptist preacher, was an employee of Methodist Medical Center of Oak Ridge but her office was at the church.

"Barbara made the trip to the hospital in Knoxville once or twice a week and provided wonderful support," Terpstra said. "Barbara understood both the medical aspects and spiritual nature of a severe illness and could talk to us—Dan, me, Ben and our daughters Katie and Sarah—from that perspective, as well. She prayed with us in Ben’s hospital room. She was there as a representative of our church, not the hospital, which has control over your life. She was more like an advocate for us."

The Terpstras thought the hospital gave Ben excellent treatment. However, the parish nurse helped ease their minds.

"Because we had a very sick child, we suffered anxiety and had questions about what does it all mean," Terpstra said. "I remember that Barbara provided incredible comfort. When she came into Ben’s hospital room, our anxiety was reduced.

"Barbara was comfortable with really sick people. She understood medical language in a way we didn’t. That was incredibly valuable. She brought Ben’s condition back to the church and interpreted it for our church family."

Parker made a presentation to Ben’s Sunday school class in which she explained to his classmates that he had a hole made in his neck, called a tracheostomy. This surgical procedure performed on Ben’s neck opened a direct airway through an incision in the trachea, or windpipe. Because the parish nurse had prepped Ben’s classmates in advance, they weren’t afraid to visit him nor were they horrified by the hole in his neck. As a result, he received lots of visitors, especially kids his own age. He also received many get-well cards from the congregation.

By year’s end Ben recovered completely. In 2004 Parker’s husband accepted a position in Nashville, so she left the Oak Ridge church. Wessel and a few church members organized a committee to search for a replacement. One of the applicants was Meg Tonne, a registered nurse in the church choir. She had experience working with heart, cancer and AIDS patients, including dying patients, in California and Texas. Tonne was hired.

In 2006 the importance of a parish nurse hit home again for the Terpstras when Peggy’s husband Dan underwent a heart test to figure out why he struggled with breathing. The doctors at Methodist Medical discovered he had blood clots in his lung that almost killed him. The cure for his pulmonary embolism was a daily dosage of blood thinner, which eventually eliminated the life-threatening clots.

Shortly after Terpstra told a friend during choir practice about her husband’s hospitalization, Meg Tonne visited the couple at Methodist Medical.

"Meg acts as a very strong figure," Terpstra says. "She is so Presbyterian. She has the theology down pat. She has her finger on the pulse of who has a physical problem or needs some moral support. She is extremely sensitive. She acts as an advocate.

"She talks to the doctors and interprets what they have to say. Meg is very direct and very comforting—I think she has a huge gift. She looks at what she does as a calling. I think the parish nurse ministry is very important especially when we have a congregation that is aging. It’s right up there with the pastor. She doesn’t preach but she cares. She’s very good with confidentiality. She is so smart. We got a rare find there. We just need to keep her."

Tomorrow: How does a church find a parish nurse who works well with the congregation.

Dan, Ben and Peggy Terpstra have greatly appreciated the support they have received from First Presbyterian’s two parish nurses.

ATTRACTING A PARISH NURSE

Editor’s note: This article is the third in a series of five articles about parish nursing, a relatively new profession of importance to our city.

BY CAROLYN KRAUSE

In 1999 Jim and Helen Wessel, elders of First Presbyterian Church of Oak Ridge, found themselves conversing frequently about how to care for their aging mothers. Noting the increasing number of church members with gray hair, they wanted their congregation to address such questions as these: How can we help our elderly members as they encounter health problems? What should a caring ministry look like?

So the Wessels organized and promoted brainstorming luncheons after the worship service on four consecutive Sundays at the church. At the time, Jim Wessel was a member of the church’s governing board, the Session, and also chair of the Session’s membership and human resources committee, now called the congregational care and outreach committee. Today Wessel is president-elect of the Methodist Medical Center Foundation board of directors.

Knowing about their caring ministry search, a Wessel family friend, Dorean Stuewe of Second Presbyterian Church in Knoxville, suggested that the Wessels talk to Carol Smucker, who had the same interest. Smucker suggested that the Oak Ridge church consider hiring a parish nurse. She had recently moved to Knoxville from Iowa, which Wessel calls a "hotbed for parish nursing." Smucker had been spreading the word about the value of parish nursing to churches in East Tennessee and had started a parish nursing program in Knoxville coordinated through Baptist Hospital.

From another friend, Carolyn Matthews, who served with the Wessels at their former church in Maryland and now was an elder at Bethel Presbyterian Church in nearby Kingston, Wessel learned that Bethel Presbyterian had a parish nurse. He invited her to talk about the activities of a parish nurse at the last brainstorming lunch.

After the luncheon series, Wessel called the Presbytery of East Tennessee in Knoxville to find out how many parish nurses served churches in the Presbytery. Besides Bethel, three churches in the Presbytery had parish nurses in 1999. They were Graystone, New Providence and Second Presbyterian churches. Today, three churches in East Tennessee have parish nurses employed by Covenant Health, which manages hospitals in the region. Seven parish nurses volunteer their services to inner-city churches in Knoxville. Seven churches in the Presbytery of East Tennessee have parish nurses.

Wessel applied for and received a grant from the Presbytery’s Specialized Ministries Division that covered half of the salary of the first parish nurse the Oak Ridge church hired. An anonymous donor paid for the other half of her salary.

Wessel then looked into financial arrangements between churches and employers of parish nurses. He learned that the parish nurse at the Kingston church was an employee of Methodist Medical Center of Oak Ridge.

A special financial arrangement was worked out between the church and the Oak Ridge hospital. In the first year MMCOR paid 75% of the parish nurse’s salary and the church paid 25%. The following year the hospital paid 50% of her salary and the church reimbursed MMCOR for 50%. The third year MMCOR paid 25% of her salary and the church 75%. The fourth year of this special arrangement the church reimbursed the hospital for 100% of her salary. From then on, the church pays the full amount of her salary by reimbursing the hospital. She remains a hospital employee for liability reasons.

Wessel convinced the church Session to hire a parish nurse. A committee was selected to interview candidates. The Session of the Presbyterian church followed the recommendation of the search committee and in 2002 hired Barbara Parker, a registered nurse and Baptist minister’s wife who had taken a one-week parish nursing course at Vanderbilt University.

In January 2003 Jim and Meg Tonne moved to Oak Ridge from Texas. The couple had been looking for a good city to retire in and a good church home. They chose Oak Ridge after doing considerable research. Jim took over the church web site and wrote computer programs for the American Museum of Science and Energy in his spare time. Meg, a registered nurse who had helped heart patients in San Diego and comforted dying cancer and AIDS patients in Dallas, sang in the church’s chancel choir but longed to return to nursing.

In late 2003 Parker’s husband obtained a new job in Nashville, so the Parkers decided to move there, leaving open the parish nurse position. Meg Tonne competed for and won the position in early 2004.

Now, Tonne is an employee of Covenant Health, which manages MMCOR. Her supervisor is Lynne Burchell, a former parish nurse. The church reimburses Covenant Health for her services. For Meg and the Oak Ridge church, it’s a win-win arrangement.

Next: Meg Tonne explains in her own words some of the joys and challenges of serving a congregation as a parish nurse.

Jim Wessel was instrumental in starting the parish nurse program at First Presbyterian Church of Oak Ridge.

PARISH NURSING DO’S AND DON’TS

Editor’s note: This article is the fourth in a series of five articles about parish nursing, a relatively new profession of importance to our city.

BY CAROLYN KRAUSE

Through its pastor, music director and religious education director, a typical Christian church nourishes the spiritual health of its congregation. Some churches also support the congregation’s physical health and spiritual well-being through a parish nurse.

First Presbyterian Church of Oak Ridge has had a parish nurse since 2001. Jim Wessel, chair of what is now the church’s congregational care and outreach committee, led the effort to win funding for the position. Barbara Parker was the church’s first parish nurse. Meg Tonne now fills the 20-hours-a-week position. Keeping the position funded has been a challenge.

Tonne is an employee of Covenant Health, which provides her with a salary and health insurance benefits, even though her job is to serve the congregation of First Presbyterian Church. She is available at the church office at the corner of Lafayette Drive and Oak Ridge Turnpike every Tuesday, Wednesday and Thursday or by appointment.

Lynn Burchell of Covenant Health supervises Tonne and parish nurses at three other area churches. They are Covenant Presbyterian Church, Tellico Village Community Church and Sequoyah Hills Presbyterian Church. Seven churches in the Presbytery of East Tennessee have parish nurses.

Besides visiting shut-ins and church members recovering from illnesses and surgery in the hospital or at home, Tonne provides information on community resources and helps individuals and families obtain needed health and social services. She provides educational materials and information through health programs, brochures, monthly articles in the church newsletter, videos and books.

Tonne has developed a pamphlet for the congregation that makes it clear what a parish nurse does and does not do. For example, the pamphlet states that the parish nurse does not provide hands-on care, except for assessments of blood pressure, pulse rate and respiratory health. Also, the parish nurse does not provide medical care and diagnosis, home care services, psychological counseling, social services and physical, occupational or speech therapy.

"Health counseling and spiritual counseling are services I provide," she continued. "I try to help people foster a sense of spirituality and find meaning and purpose in life. Those are two secrets to a longer life."

She makes referrals to doctors, recommends home health care agencies and lends medical equipment such as canes, crutches, walkers and wheelchairs. She arranges for community outreach programs through monthly health luncheons that are open to the public.

She encourages church members to assist in providing transportation, food and cards to ill parishioners or to volunteer with the church’s congregational care and outreach committee. If no family is available, she accompanies the patient to the doctor or to get medical tests, serves as an advocate for the patient and family, explains medical language, makes sure questions are answered and provides emotional support.

"A lot of people in a typical congregation think a parish nurse just visits shut-ins," Tonne said. "They don’t know about the support that a parish nurse gives when a family is in crisis, when a loved one is dying. Once one person in a family has been sick, the rest of the family appreciates what a parish nurse can do. Many doctors don’t know what a parish nurse is either."

Partly because of her training and experiences and partly because of her nature, Tonne is comfortable discussing death with dying patients and their relatives. "Many doctors, nurses and even pastors are uncomfortable helping dying patients cope with their spiritual needs," she said. "It is very much a parish nurse’s job to find out what those spiritual needs are and help the patient meet them, especially when the patient is facing major surgery or is dying.

A parish nurse can facilitate discussion between a dying patient and family members and help them say things that need to be said to each other.

"When I make my monthly visits to shut-ins, we pray together," she said. " You learn what a person’s spiritual needs are, what they are worried about, what their questions are. You can’t give them answers but you can help them talk about their thoughts and concerns and share their feelings.

"When you talk about health needs, you can’t separate the physical from the spiritual. They are entwined. You can’t be healthy without a good spiritual outlook. God gave us each a miraculous body and it’s a matter of gratitude to take good care of it. I feel that God wants me to use my gifts to help other people feel His love when they are hurting. That’s my job. I feel called to do this with every ounce of time and strength."

Tonne takes church members to the doctor if they need transportation. "I think it’s important to have a second person with you when you go to the doctor," she said. "A patient is anxious and doesn’t always hear what the doctor says. I explain afterward what the doctor said."

Like a hospital nurse, a parish nurse is bound by the HIPAA privacy laws that make up the Health Insurance Portability and Accountability Act, enacted by Congress in 1996. "If someone asks me how Melanie is doing, I will be tactful and say, ‘Why don’t you call Melanie and ask her how she is doing? She would appreciate a phone call or visit from you.’ I am always careful to get people’s permission to add their names to the prayer list or the announcements to the congregation about who is in the hospital. Confidentiality is a matter of respect as well as a matter of law."

"My job can’t be scheduled," Tonne says, noting that she is available 24/7 to help a church member in distress. "One of the things I love about this job is that I can be flexible."

One of the things that the First Presbyterian congregation loves about her job is that she’s doing it well.

NEXT: Meg Tonne’s supervisor at Methodist Medical Center of Oak Ridge talks about parish nursing.

Meg Tonne, parish nurse with First Presbyterian Church, discusses the results of a heart rhythm screening test.

WHY PARISH NURSES MERIT CHURCH SUPPORT

Editor’s note: This article is the last in a series of five articles about parish nursing, a relatively new profession of importance to our city.

BY CAROLYN KRAUSE

Lynne Burchell, clinical manager of Covenant Health’s Senior Services, would like to see many more parish nurses in East Tennessee.

"Only one parish nurse in Oak Ridge is employed by Covenant," she said. Covenant manages Methodist Medical Center of Oak Ridge, the only hospital in the city.

Burchell’s office employs three parish nurses. One parish nurse, Meg Tonne, works for First Presbyterian Church of Oak Ridge. The other two parish nurses are Laurette Beekman at Sequoyah Presbyterian Church in Knoxville and Mary McNeal at Tellico Village Community Church in Tellico.

"We also have seven parish nurses who volunteer their services to inner-city churches in Knoxville," Burchell said.

Parish nurses are registered nurses who have received special training. Tonne and other parish nurses in the area received parish nurse training at Vanderbilt University. However, the university in Nashville no longer has a parish nurse training program. According to Burchell, Alice Grady at the Fort Sanders School of Nursing in Knoxville offers parish nurse training.

Burchell never had formal parish nurse training, but she worked as the associate in caring ministries for First United Methodist Church in Oak Ridge. "I used my nursing background to help answer the medical questions of members of the church’s congregation," she said.

Now Burchell serves as supervisor of parish nurses, including Tonne of Oak Ridge. She described the services she offers as parish nurse supervisor.

"I facilitate a monthly peer group supervision meeting with all of the parish nurses employed locally by Covenant," she said. "I also am here to help provide resources for our parish nurses. For example, we have a speaker’s bureau and we help find resources for health fairs and support groups."

Burchell feels strongly that every congregation can benefit from having a parish nurse.

"Parish nursing is a much-needed part of the continuum of home care and community-based

services," she said. "Faith-based organizations are playing a larger role in the health of their congregations as part of their mission to provide value-added ministries."

Burchell would like to see a parish nurse in each church in and around Oak Ridge. A parish nurse can provide health and spiritual counseling during visits to shut-in members. A parish nurse can visit church members who are or have been in the hospital.

"As the baby boomers age, each congregation will have an increasing number of seniors who can benefit from the medical understanding and spiritual insights that the parish nurse can provide," she said.

The Rev. Kerra Becker English learned about parish nursing when she became pastor at First Presbyterian Church of Oak Ridge in early 2003.

"I’ve had the pleasure of working with two parish nurses, Barbara Parker and Meg Tonne," she said. "Because of their extensive experience, they taught me how to better visit people in the hospital and care for the ill and dying in the congregation. Churches would do well to consider nursing as a complement to their health ministries. Christians are called to imitate Jesus, who spent considerable time with people who came to him for healing."

Churches often are reluctant to hire a parish nurse because of the cost. The congregation pays the salary of the parish nurse, who can work half time or full time, depending on what each church can afford. However, churches can get grants to hire a parish nurse. Sometimes anonymous donors will support the nurse’s salary for a year or more.

"Covenant has been fortunate enough to get grants for the parish nurses we have," Burchell said. "There are various sources for grants, such as the Presbytery of East Tennessee."

The parish nurse is a necessary addition to any church, Burchell said. "A parish nurse not only supports the ministerial staff but also can educate church members about health and help them navigate through the medical and insurance complexities of the health care continuum."

In this way, a parish nurse can help ease a different type of headache.

Lynne Burchell (left), Meg Tonne’s supervisor at Covenant, with Laurette Beekman, parish nurse at Sequoyah Hills Presbyterian Church.