Patient-focused care in parish nursing.

Abstract

Parish nurses are documenting their outcomes and, with them, instances of cases in which parish nurse interventions have potentially resulted in substantial cost savings to the federal government through averted Medicare expenses. Theoretical cost saving estimates implied in the first 600 visits exceeded $400,000. Half these estimates were related to scenarios where caregivers were sustained to facilitate ongoing home care. The other half were related to disregard of signs and symptoms warranting prompt attention. In either case, advocacy, referral, assistance finding, active listening, and supportive education efforts served to overcome major stumbling blocks to access for those elders and their caregivers who felt physically and emotionally isolated or overwhelmed by their situation. Facilitating access meant earlier, simpler, more cost-effective treatment of conditions that might otherwise have escalated to require complex care. In the 1800 stories of record, half the concerns addressed by parish nurses were related to spiritual-psychosocial concerns (e.g., unresolved feelings, transitions, interpersonal tensions, caregiver stresses, and isolation). The other half were related to physical concerns (e.g., symptom disregard, illness self-care deficits, and struggles pertaining to functional safety or independence). Most significant, the former often contributed to the latter.