Perspectives on Community and Health - Essay Example

?Nursing is a human practice discipline the core value of which is “care”. The nursing profession has a distinct perspective on individuals, community, environment and health. The understanding of human beings as individuals and as communities is the center of knowledge development in nursing. This knowledge is then used to promote, restore and maintain health of individuals as well as a community. From the days of Florence Nightingale the focus of nursing has been the health of the human beings but over the years the focus of nursing has changed and it no longer revolves around the treatment and cure of pathological problems only but also considers the relationships between people, environment and health (Walsh & Crumble, 2007). In nursing, the word community means a group of people sharing at least a single common characteristic. However, Hitchcock et al (2003) define community as “a little more than large number of individuals”. Generally health is considered to be the absence of disease (Gottlieb, 2012); however the concept of health defined by the World Health Organization (WHO) is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The community’s role in determining the state of health of a person and health behavior is quite important (Young & Van Niekerk, 2004). For instance, the facilities available in rural and urban settings differ and thus influence the state of well-being and the behavior of the people. Each community has its own culture and in nursing it is crucial to have an understanding of the culture and what makes one community different from the other (Srivastava, 2007). According to Wolgin (2005), a better knowledge and understanding of the cultural differences enables the nurses to provide better and more sensitive care and services. Nursing can be divided into two broad categories; clinical nursing and community health nursing. Community health nursing varies from clinical nursing in the sense that community health focuses on prevention of diseases while clinical nursing aims at restoring the health of the patient or making the expected death as comfortable as possible. The primary goal of community health is to overcome the threats to health before symptoms of pathology become detectable (Muecke, 1984). The community health nursing is concerned about the healthcare of the population as a whole. A clinical nurse focuses on developing a caring relationship that promotes health and healing of an individual in a clinical setting where as the main task of a community health nurse is the identification of health problems, prevention of disease and disability and promotion of health. The community health nurse works in different settings such as schools, homes, business establishments, clinics and offices. Both community health nurses and clinical nurses share common core values, beliefs and assumptions. The beliefs and assumptions help them determine what is right or wrong and thus provide care in a thoughtful and meaningful manner. These beliefs and assumptions guide them that all patients are equal and must have equal access to healthcare facilities. The Core Values of Nursing Although compassionate care is defined as the core of nursing, human dignity, autonomy, integrity, social justice and altruism (Callara, 2008) are the five actual core values of nursing. Human dignity is recognized as the core value of nursing practice with other values either arising from it or working to preserve it. This value signifies the fact that all human beings deserve respect irrespective of their age, gender, ethnic origin, status, religion, political ideology or criminal record. This value therefore recognizes that every individual or community has its inherent values and culture. For instance, some ethnic communities have their own way customs and folk healing practices and therefore the nurse needs to be very careful when introducing western medicine. Autonomy pertains to collaborative decision making and is restricted by the boundaries of competence which in turn are limited by the boundaries of knowledge (Sines et al, 2009). The term “autonomy” in nursing is used in the context of self determination and it means that those affected the most (individuals, families or communities) have the right to make decisions. It is the duty of the nurses to provide health-related information to the patients so that they can make the right decisions and once the decision regarding the treatment is made, the nurses should respect them (Callara, 2008). Nurses should aim at giving a good quality of life to people whether individuals or community in the way they choose to live and respect how they want to be treated. Integrity helps the nurses in maintaining the professional standards they are credited with. In healthcare, nurses create an environment of caring and respect; such an environment where values of caring and integrity are present for colleagues and for patients is very important for intensive caring profession. In this way nurses can create a community bonded by shared values (Barnum & Kerfoot, 1995). Social Justice in nursing means providing equal privileges of all aspects of healthcare such as health protection to all people. Nurses should support the legal, moral and humanistic principles associated with health. Social justice calls for fair and equal allocation of advantages and disadvantages in a society. When pertaining to health the societal advantages are access to medical care, prenatal care and efficient healthcare providers such as nurses while the cost of healthcare and disease and/or injury related mortality or morbidity are regarded as health related disadvantages. It has been observed that nurses ignore the disparities in healthcare and health status especially if they occur in minority communities. Embracing social justice as a core value, the nurses must make sure that social justice exists for all individuals, groups and communities they provide care for (Barnum & Kerfoot, 1995); one example of this type of justice is the allocation of the scarce resources among communities and individuals. Altruism is the self satisfaction one gets by helping others in a humanistic way; nurses seem to convey this characteristic. When directed at a community, altruism implies to the changing social conditions that meet the requirements of human welfare (Callara, 2008). The nurses therefore must work to bring about changes that will enhance the health of the individuals and the community. Community as seen by Shamansky and Pesznecker The health planners mostly use geographic definition of community (people living in a certain area) in assessment and planning work. Various “community models” are given by theorists which have proved to be quite useful to the nurses; however these models were different from the other in terms of geographic location, aggregate or target population (Barker, 2009). One such operational model of community was given by Shamansky and Pesznecker (1981) and was based on three important dimensions who, where and why. The theorists believed that the states of health and objectives of nursing care vary at different levels; the range and substance of health diagnosis are different too. According to Shamansky and Pesznecker (1981), the concept of community is confined by physical environment and revolves around three key elements namely locality, space and time and significance/ purpose. Locality involves people living in an area, space and time refers to the history of the community and the environmental features while purpose/significance means the functional processes for instance educational services, government policies and the various forms of communication (Cody, 2008). These elements are both interdependent and dynamic. The model by Shamansky and Pesznecker describes a geographic community and the systems approach through which care can be provided. This model provides a systematic framework for data collection and analysis and community diagnosis. This kind of community model where people are related by a common characteristic (in this case geographical area) health diagnosis becomes easier as it is easier to familiarize with the environment and the lifestyles and thus identify the health issues that may threaten the community. For instance a community nurse can easily diagnose health issues in a community living in a slum area where sanitary conditions are poor. Contaminated water and unhygienic conditions are the main sources of diseases in such areas and the community health nurse can help the people by asking them to boil water before drinking, cover the cooked or uncooked food and use insect proofing such as nets etc. Shields and Lindsey (1998) In 1998 Shields and Lindsey added other variables to the definition of community; according to them when defining a community the variables context and resource, community as a client and relational and political factors (Hitchcock et al, 2003, p 343). Context and resource refers to two key elements; community and environment and both are considered inseparable. Shields and Lindsey see community as a dynamic and changing resource and it is the obligation of the nurses to seek strengths and capacities within the person, family or community. The nurses should be on a sharp lookout for elements not productive or healthful for the family. Shields and Lindsey imply that it is necessary to observe and concentrate on and make note of what the family or the community is doing right. This practice has proven to be useful as it forms the basis of future planning and interventions. In the Shields and Lindsey model, community is seen as a whole entity by the nurses. This perspective helps the nurses to see community as a practice unit and to identify the health issues that may threaten a community. The relational and political factors present the community to the nurses in a totally different perspective which moves away from traditional conceptualization. According to Shields and Lindsey community is more than mere involvement of people in relationship with others; it represents ontology; a state of being that infuses throughout the lives of the people (Parse, 2003, p 16). The relation factors include power relations in the community. Aspects such as age, class, gender and social status must also be considered when perceiving community. For example while treating obesity based diseases in a community the nurse can come across several reasons depending upon the social conditions of the patients, their ages, and the environment such as diet, heredity, inactive lifestyle etc. In this example when determining the cause of obesity the nurse will find that inactive lifestyle could be due to lack of exercises and time constraints, difficulty in moving (older people) and also because there were no parks nearby where people could walk or go for jogging. Similarly in young children obesity could be because of too much fast food or simply due to genetics. Thus a single health problem can occur due to a number of reasons and if explored through the Shields and Lindsey community model the nurses can address it from all aspects. Comparing the two models The Shamansky and Peszencker (1981) community model is restricted by the geographic boundaries. The nursing students were once asked to conduct a survey using the Shamansky and Peszencker community model on health issues related to Mein refugees residing in a building. The students found that a couple of non-Mein refugees also resided in the building as well. The nursing students excluded those refugees on the pretext that they did not share the language, activities and goals of the Mein refugees nor did they socialize with them. The definition of community by Shields and Lindsey (1998) extends to a wider population. It acknowledges the fact that an individual or a family can be a part of more than one community thus generating a greater response from the complex healthcare system. This model takes into account variables such as age, education and socioeconomic status when considering community and health aspects. However this model has few shortcomings for example it makes it difficult to practice nursing at the level of community. It also fails to localize the findings from one community to another and the comparison of health diagnosis across the different communities becomes difficult as well. Public health issues such as poverty, violence and drug abuse when dealt through this model can enhance a social change. The Community Health Nurse The nursing values not only express the values and ideas of nursing but also determine the correct directions. The values most important to a community nurse are holistic approach, equal health opportunities for all, providing services from health perceptions and the knowledge that an individual or a community is inseparable from the environment. The community health nurse adopts roles and activities as per needs of the individual or the community. The care provided by the nurse can be preventive, curative or rehabilitative depending upon the requirements. By making use of the different definitions of community, the community health nurse can not only identify the health issues but all address the nature of the health issues. The community health nurse acknowledges the fact that the individuals or communities they are working with should participate actively in decisions regarding their health and well-being with the knowledge and information provided by the nurse. This participation is viewed by the community health nurse as a basis of curative, professional and caring relationship that encourages empowerment. After identifying the risks in the lifestyle that threaten the health in a particular community, the CHN can educate the people about the harmful effects and can thus bring about changes in the lifestyle thereby decreasing the health problems to some extent. The roles and responsibilities put the CHN in a favorable position where she can advocate for the improvement of economic conditions and health status of the vulnerable communities. The CHN can make use of the different community models to provide more effective services. The Shamansky and Peszencker (1981) definition of community; where community is defined by the geographic area assists the nurses in solving the problem. The Shields and Lindsey (1998) model covers the problems from all angles as it considers different variables when defining a community. This broader view can help the community health nurse in controlling health issues on a larger scale. References Barker, A. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession: Essential Knowledge for the Profession. USA: Jones & Bartlett Learning. Barnum, B.S. & Kerfoot, K.M. (1995). The Nurse as Executive. USA: Jones & Bartlett Learning. Callara, L.E. (2008). Nursing Education Challenges in the 21st Century. 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