Essentials of Community-Based Nursing - Research Paper Example

Running Head: NURSING Nursing of the of the Nursing Introduction Florence Nightingale once said, "You ask me why I do not write something... I think ones feelings waste themselves in words, they ought to all be distilled into actions and into actions that bring results" (Woodham-Smith, 1951, 72). This quote is true because sometimes actions are more important than words (especially in the nursing profession). Since the early 1800s nursing has quickly evolved into what we know it as today. Nursing is a unique profession in that there are many different types of nurses, yet they can all experience the beginning of life as well as the end of life. Both nurses as well as community-based nurses can yield special bonds with patients and their families. To me nursing is a very worthwhile profession and to become any type of nurse is an award within itself. Nurses help people to maintain their best possible health, given their genetic and environmental constraints (Chitty, 2005, 57). According to the U.S. Department of Labour, nursing is one of the fastest growing occupations and there are many good employment opportunities available for nurses (U.S. Department of Labour, 2005, 24). That is a good enough reason why nursing is a great occupation for anyone to get involved in. To be a nurse one must be attentive, caring, and most importantly dedicated. To me a nurse is not only someone who takes care of you physically, but someone who can empathize and connect with you as the patient. Being a nurse is a full time job whether it is in the hospital or taking care of the family at home. A nurse should be able to establish trust with their patients and always be there for them in good and bad times. Community nursing is one aspect of nursing that allows for a nurse to be in more intimate surroundings with the patient. According to our textbook, community-based nursing is health care provided outside of acute care settings (Lundy and Janes, 2003, 50). Community nursing is great for people who want to get out of the traditional hospital surroundings and communicate with diverse populations in a certain community. Florence Nightingale is a great example of a community nurse. Florence Nightingale was known for her sensitivity and compassion towards her patients as well as to the nursing profession. Florence took it upon herself, despite her strict Victorian culture to go out into her community and take care of the sick and poor. Her experiences from the different communities she encountered allowed her to accomplish important tasks that forever changed the nursing profession. Today, the knowledge of community nursing benefits the practice of nursing by allowing nurses to learn about different communities and the diverse populations within them. Literature Review Community health nursing can play an important role in conducting community needs assessments that provide critical data upon which programming, planning, and evaluation should be based. The community health services developed for any given community should be planned with the specific needs of the community residents in mind (Hanchett, 1988, 60). A community needs survey is one method that should be periodically employed to ascertain the specific needs and concerns of community residents. Nursing conceptual models developed by CHNs are very appropriate to the assessment of all aspects of community life related to health and well-being (Lundy, 205, 49). Comprehensive community needs surveys should include assessment of environmental, psychosocial, and physiological aspects of health as well as indicators of health-related behaviours in the population (Martin, 1992, 76). The Omaha classification system adapted for this study provides a broad conceptual framework that facilitates the development of comprehensive programs of assessment. In many states the Public health services are in a state of crisis. The offers of traditional program may no longer be the key to present the types of services most desired by some communities (Lundeen, 1992, 17). Professional nurses can provide the leadership necessary to assess health needs and current public health practices in these communities and to recommend and implement programs appropriate to the needs of the present and the goals of the future. Community health nurses (CHNs) can play an important role in the implementation of studies related to the health needs of their communities of residence or service (Stanhope, 1988, 70). Assessment of the health-related problems of the residents of a community as perceived by those residents should be collected periodically by all communities-rural, urban, or suburban--regardless of the communitys demographic profile. The focus of these assessments of community needs should conform to a public health mandate which focuses on broad issues related to health promotion and disease prevention. A community health nursing theoretical framework is ideal for the development of community assessment methodologies. Aims and Objectives of the Study In this research study we want to analyze the community health nursing by conducting a comprehensive community health needs assessment survey that will be carrying out by the faculty and staff of an academic nursing centre under contract to a South London suburban community. Purpose of this study is to do research on: (a) development of a health-needs assessment tool based on a community nursing perspective; (b) health needs in the areas of environmental health, family health and well-being, and personal health and self-protective behaviours. Methodology The request for the community assessment is precipitate by a need for the community Board of Trustees to make some decisions as to the future of the community health department. Findings from the assessment will be needed to review the mission, organizational structure, and funding for community health services in the next 10 years. It will be resolute, after discussions with the city manager and elected officials in the community, that a broadly focused assessment approach would be utilized. A contract will negotiate with the academic nursing centre for faculty and staff to conduct the assessment using a community nursing framework. A number of community assessment frameworks are reviewing in the planning stages of this project ( Chamberlin, 1988; Hanchett, 1988; Higgs & Gustafson, 1985; Stanhope & Lancaster, 1988). A combination of the assessment techniques identified by these sources, including key informant interviews, epidemiological studies, analysis of existing community data/reports, and a survey of community residents, will be consider relevant to a comprehensive assessment of community needs. Most of these methods will be use and incorporated into the final report to the Village Board of this community. The need to solicit specific data from a sample of community residents on perceived health problems, their current utilization patterns, and attitudes toward future community health services require the development of a new survey tool. Survey Instrument The complete Community Health Needs and Utilization Survey (CHNUS) instrument covers seven different areas including (a) respondent and respondent household demographics, (b) health and safety problem identification, (c) respondent health-related and self-protective behaviours, (d) awareness and utilization of current health department services, (e) respondents household interest in selected health-promotion programs and services, (f) respondents insurance coverage for health-promotion programs and services, and (g) respondents evaluation of how health-promotion programs and services should be funded ( Lundeen, Kreuser, & Mundt, 1992). The problem-identification section of the survey instrument is based on the Client Problem Classification Scheme developed by researchers ( Martin, Scheet, Crews, & Simmons, 1986). Developed and tested by CHNs, this comprehensive assessment scheme is being used and further refined in community health settings across the country ( Martin & Scheet, 1992). The problem-classification scheme is selected as a basis for this assessment because of its comprehensive conceptualization of community health issues which expands the scope of problem choices presented to respondents beyond many health assessment tools. Use of this existing taxonomy mitigated investigator bias based on any preconceptions about the nature of the health problems experienced by residents for any particular community. Problem areas are divided into three major categories including (a) environmental health, (b) psychosocial health, and (c) physiological health. These categories are renamed "Environmental Health and Safety," "Personal and Family Well-being," and "Physical Health" in the CHNUS. Questionnaire includes health-related behaviours, are also included in the CHNUS in two sections entitled "Health-Related Behaviours" and "Personal Prevention Measures." Although analysis of these latter sections provided direction for community health planning, results are outside the scope of this article. Sample The population of interest resides in a suburb of a South London city, 99% of the residents are English. There is a growing population of residents 65 and older (15%) which already exceed the national average (11%). Only 2% of the residents are below the poverty line as compared to a national figure of 12%. There are few demographic survey questions also, regarding gender, age, marital status and the income of the respondents. Procedure The survey tool will be mail to a systematic sample of community households that will be generate from a computerized listing of the addresses of all community households. The survey will accompany by a letter from the Community Board President encouraging participation in the study. The survey will be initially mail to a total of 25% of the households in the suburb. This will proceed by an article in the local newspaper discussing the survey and encouraging all residents to respond. A second follow-up mailing to the same households will be send after one month. This will again proceed by local newspaper coverage. Limitations of the Study During the survey there may be a major limitation for this study will be a sampling problem that can affect many studies conducted through mail survey. There should be planned community health services along with the needs of all section of the community keep in mind. It is to be recommended that the findings that are related to these subgroups be measured as prospective underestimates of the true prevalence of problems in the community until such time as additional, focused "oversampling" of these groups is conducted. Such additional data collection may be best accomplished through (a) solicitation of survey respondents through outreach to identified subgroups of the population, (b) focus group discussions, and (c) one-to-one interviews with community residents in the subgroups. Discussion Many of the personal health issues identified most frequently by the suburban community residents are those related to the psychosocial aspects of personal and family well-being. The families in this stable, upper middle class community are struggling to maintain a balance between provider and nurturing roles. Women and young families are particularly vulnerable. Although this is an issue which has received much concern in recent years in disadvantaged communities, it is important to note that it is not only low-income respondents who are affected. Financial problems are evident for a selected subset of the population in this affluent community with female-headed, single-parent families and older single women being most at risk (Lundeen, 1992, 20). Single-parent families are particularly vulnerable to problems with inadequate daycare and feelings of low self-esteem. Evidence of the effect of these stressors in many homes is indicated by the incidence of verbal abuse reported by nearly one quarter of all households with children under 20. For the suburban community residents, the problems of an old population are one of the main health issues. As it grows to be increasingly complex for older residents to deal with their own care independently, there is a need of additional assistance for this population to remain in their homes (Martin, 1992, 78). This is mostly true for aged, widowed women. If community health services are to make possible the early recognition of health problems and assist or put into service prevention and early interference strategies to assist community residents to get and continue the uppermost possible levels of health, a heavy importance on the psychosocial features of wellness is specify. References Bureau of Labour Statistics, U.S. Department of Labour, Occupational Outlook Handbook, 2004-05 Edition, Registered Nurses, 23-27 Chitty, Kay Kittrell. (2005). Professional Nursing Concepts & Challenges. St. Louis: Elsevier Saunders, 56-63 Lundy, Karen Saucier.,& Janes, Sharyn. (2003). Essentials of Community-Based Nursing. Boston: Jones and Bartlett, 49-52 Woodham-Smith, Cecil. (1951). Lonely Crusader: The Life of Florence Nightingale, 1820-1910. New York: McGraw-Hill, 72-74 Lundeen, S. P., Kreuser, N. J., & Mundt, M. M. (1992). The community health needs and utilization survey. Manuscript submitted for publication, 16-24 Martin, K. S., & Scheet, N. J. (1992). The Omaha system: Applications for community health nursing. Philadelphia: Saunders, 75-78 Stanhope, M., & Lancaster, J. (1988). Community health nursing (2nd ed.). St. Louis: Mosby, 66-70 Hanchett, E. S. (1988). Nursing frameworks and community as client: Bridging the gap. Norwalk, CT: Appleton & Lang, 56-61 Read More