Community Health Nursing Teaching and Assessment - Assignment Example

? Community Health Nursing: Teaching & Assessment of the of the Community Health Nursing: Teaching & Assessment I. Introduction Community nursing is clearly an initiative whose time has come. With the graying of Americans on the increase, the demand for geriatric and elderly care needs has skyrocketed across the nation. The present recessionary trend, coupled with uncertainty about the future also means that couples will tend to have few children and make lesser marriage commitments, which is worrisome for the people of coming generations. The current shortfall in medical care is expected to continue for some time, as it takes at least four to seven years for a medical graduate to become fully qualified and enter into professional life. In the meantime, community nursing using the available resources at hand can play a valuable part in lifting the health and spirit of local communities. Our war veterans are a source of esteem and joy not only to their own generation but to the present and coming ones as well. They are a symbol of America’s pride and have served the nation in its time of need. Many of them have been in the thick of combat, fighting wars in Vietnam, Cambodia, the Gulf, Afghanistan and Iraq as they defeated the armies and militants of opposing forces. Some have even been physically and mentally incapacitated as they bear the psychological scars that even time will not heal. We owe them a debt of gratitude. Facilities for war veterans where they are properly looked after cared for and understood is one way of repaying them for their efforts. At least they should be able to live out the rest of their lives in peace and quiet, comfortable in the knowledge that their work is done and now a new generation has risen to take charge. The Department of Veterans Affairs in the USA operates a number of veterans’ homes all across the nation. However there are other veterans who still want to live out the rest of their lives on their own or with their own friends and families. They do not want to be confined to a Veterans Home if they can help it. For such individuals, using the community nursing initiative is a welcome and viable way in which their day to day as well as long term care needs can be met. Community nurses work with individuals and their families to help prevent disease, maintain health and treat existing health problems. They try to promote, support and maintain the patient’s independence while providing advice for safe and healthy living and also assisting caregivers as needed. This paper will focus on providing community based nursing care to veterans of Long Island who are in need of support because of having chronic health problems or disabilities. They may need a caregiver to take them around and lack the transportation to do so themselves. Experience has shown that providing community health services through the caregivers, community helpers or even friends and neighbors can often be a viable and easily managed alternative. In such a case, the required procedures and medication are always kept at hand, the dosage is known and remedies or first aid for accompanying conditions is practiced till proficiency is achieved. All that remains is for the caregiver or the veterans themselves to phone the community nursing center or provider and get the required advice so that his condition is corrected or relief is made possible. In this paper we will make use of a community health model after assessing the patient needs, so that his or her condition is known and remedies can be ascertained. The use of tele-health devices like high definition audio and video conferencing equipment is increasing for making diagnoses, recommending treatments and reaching far off remote locations at the touch of a button. You can see, hear and communicate with doctor and patient online in real time. A caregiver can also be trained online to administer a particular treatment or to measure symptoms that can alert the doctor to current and potential health problems. It cuts the cost of commute as well as time and money spent on doctor’s visits. The doctor can also see more patients that way, from the privacy of his clinic or after hours at his home. It can save making house calls and save a patient’s life. Home blood glucose meters, blood pressure monitors, weight scales and health hubs form the bulk of devices ordered for home based health care all across America. It seems to be a viable option- better than nothing- for patients too ill to travel or who don’t have time to take and wait for a doctor’s appointment. Our country has one of the widest and best managed systems of veteran administration benefits and care in the world. New York has 79 Veteran Health Administration centers, 3 Veteran Benefits Administration centers and 6 National Cemetery Administration centers (www.va.gov). The Department of Veterans Affairs has been authorized to spend up to US$1.4 billion across the country by the Obama Administration to aid and support our war veterans. Out of the total of 950,400 veterans for New York City, comprising 885,900 males and 64,500 females as of 30 September 2010 (www.va.gov), there are a sizeable number of veterans having their homes at Long Island. They have either chosen to live here alone or with friends and family. The scenic beauty of the island, the relative peace and quiet and the friendships of old have encouraged and compelled many of these veterans to remain here. II. Community Overview Long Island NY has a rich and eventful history. It is the largest island in the USA and comprises four counties- Suffolk, Nassau, Queens and Brooklyn. The recently concluded 2010 census puts the total population at around 7.5 million people, giving it a density of 5,402 inhabitants per square mile. Queens and Brooklyn have traditionally not been regarded as part of Long Island however, being considered boroughs of New York City. The epithet of Long Island thus refers more correctly to the Suffolk and Nassau counties. Nassau was famous as the fastest growing county of the USA from the late 1950s to the 1970s due to the employment opportunities in the light manufacturing and high technology sectors. The proper and frequent access to trains and the proximity of La Guardia and JFK Airports are other reasons for the rapid influx of people here. The area has seen a lot of development going back to the Gilded Age of the wealthy robber baron industrialists, who constructed a number of residences here. It is also one of the more predominantly white populated areas. As per the 2010 census, New York County has a population of 19.37 million, of which the population of Long Island is 7.5 million. Population growth rate is 4 percent every 10 years. 65.7 percent of NY population is white, 15.9% black, 7.3% Asian and 8% others. Hispanics comprise 17.6% of the total population. The graduation rate for high schools and colleges in Long Island was low at 64 percent, but efforts are being made to improve this poor statistic to meet among other things the requirements of the No Child Left Behind Act. In fact the graduation rate has dropped from earlier levels of 85 percent in 2009 and 86 percent in 2008. The dropout rate which was on the increase seems to have steadied now. An expanded school day, remedial school during the vacations and adherence to stricter standards of discipline and learning has contributed to this. Economic disparity between districts has also been the cause to some extent. Hiring is expected to be up by 13 to 14 percent this year as opposed to an 8.8% unemployment rate for 20-24 year olds in 2009 and 9.2% in 2010. University grads are getting job offers from industries as diverse as rent-a-car agencies to banks, but jobs still abound for medical and computer science grads as with sales and marketing firms. Of course people who have jobs have to commute to work. As with other cities and towns, Long Island also has its own police, firefighting and other utility services. There are both private and public hospitals as well as a well known Veterans Care Center at Stony Brook University campus, operating six days a week. This facility has a 350 bed capacity. The Community Health Nurse needs to know this information because she can relate the available facilities at hand to the deserving populations or those who have been overlooked and marginalized either purposely or inadvertently. The need for community nursing is acutely felt in such communities where veterans, blacks and other minority groups have been marginalized because of language, cultural or other reasons. The community nurse role has been born out of this very need for the proper representation and care of all communities and groups within the society. III. Epidemiology of the Health Problem As concerns the epidemiology of the community health problem of veterans in Long Island New York, we will have to take a wider view of the problem and seek to integrate the various factors that could contribute to ill health, discomforts or pain in the veteran population of Long Island NY. There may be a number of different problems or situations that a community nurse would have to face in dealing with these veterans, but all of them can generally be placed under the headings of physical discomfort or disability, mental discomfort or disability and psychological factors. Studies in community medicine among similar populations have proved that there are a number of common factors that may be affecting each or all members of a particular community. Each generation also has its own set of beliefs and aspirations. In fact it is sometimes believed that the level of stress and disturbance caused by outside factors could very well contribute to illness or discomfort in the individuals themselves (Pedersen, 2007). All these war veterans have in fact passed through very trying times not only on the battlefield but the reality and stench of combat may be still on their minds or can be triggered by any event. That is why many a war veteran wakes up in a cold sweat or has bad dreams even years after an incident of combat (Townsend, 2008). We can only imagine that they are still shell shocked and may even become disoriented at times. There may be medication, psychotherapy or even hospitalization required where the veteran is kept under observation to see what triggers his or her undesirable behavior. The good and conscientious community nurse will seek to integrate the economic, social, cultural, political, ethical, media, psycho-social and environmental issues which could have contributed to the health problem (Stanhope, 2007). Let us say that the community nursing project wants to implement the principles and habits of good health in practice so that the goals of Healthy People 2020 are achieved within this community of veterans. If we look at the main risk factors for this age group we will come upon common factors of age related chronic conditions like the possibility of diabetes mellitus, dementia, arthritis or congestive heart failure. If these conditions are not acted upon in time or if low or improper medical care is given, it can result in further complications like partial or complete disability or even death. Helping manage these chronic conditions through proper advice on diet, exercise and promoting an active lifestyle in terms of both physical and mental health will go a long way towards the prevention or minimization of these ailments. Fear of falling and related injuries is another factor that affects as much as 1 in 3 older adults. Providing a chance for veterans to get out and exercise, take part in daily activities and events, improve and maintain their physical and mental health are all worthwhile goals. Community nurses can help population groups which are ignored or given minimal care such as racial minority groups or in this case, war veterans who do not have a full time caregiver to attend to their needs. So the first level assessment would entail establishing health threats, health deficits and stress points for the veterans group. The second step would involve recognizing common problems, deciding on community and individual actions and administering care through self or a member of the community. The final step involves problem prioritization, preventive potential and modifiability (Clark, 2008: 66-81). Once the collective problems have been diagnosed and categorized, we would need to see how to deal with the community health problems as a whole as well as the needs of each separate individual (Clark, 2008). While it is good to tackle major problems affecting the majority of the veteran population, it is also desirable to take each individual case if possible, assign a caregiver and establish communication with them or the veteran concerned to attend to their specific needs or requirements. This can be done by using tele-health devices in consultation with doctor’s advice over an audio-video channel. Where possible, bringing in weighing scales, light weights, manual treadmills and blood sugar monitoring equipment will also help in monitoring conditions of health and can be used to modify the individual and collective lifestyles of the veterans in a particular area, one by one. In this way community nurses can hope to improve the general health and well being of not only certain risk groups but the community of Long Island as a whole. IV. Population Aggregate and Developmental Stage There are in fact many approaches to look at the cases of individual populations. One is the atomistic or holistic view. There is also the biological, anthropological, psychological or sociological view. Among the family based models we have the developmental model pointing to the different stages of family development. However, Erik Erikson had identified a number of psychosocial developmental stages for aggregate communities, which he outlined in his book ‘Identity and the Life Cycle’ (1994); he claimed that one level had to be complete before an individual or society could go on to the next level. The stages identified by Erikson were (1) trust vs. mistrust; (2) autonomy vs. shame and doubt; (3) initiative vs. guilt; (4) identity vs. role confusion; (5) intimacy vs. isolation; (6) generality vs. stagnation; and (7) ego integrity vs. despair. In fact I would say that a majority of these veterans in Long Island NY are stuck in the last stage, ego integrity vs. despair, asking themselves whether they had indeed lived a life that was worthwhile or not. They are liable to feel cheated as they are not being given the due respect and love of the community for the services they have rendered as veterans. Some of them are stuck in middle adulthood as they are still learning to be responsible for their own health in their senior years, living a life of retirement, having let go of their children treating them as responsible adults. The American public at large and the Department of Veterans Affairs in particular need to be cognizant and responsible for remembering, acknowledging and commending their services and efforts as veterans of war. It is only after they get this recognition from time to time can they appreciate that they have truly lived a worthwhile life in service of their nation. Otherwise at present they are torn between ego integrity and despair. It is quite obvious that this influences the veteran population’s health in a negative way. Community nurses can use this information by giving them genuine care and respect as individuals, treating them as star citizens of the Long Island community and creating events and activities that give them the respect and recognition they deserve. V. Political, Cultural and Economic Issues Political, legal and cultural factors also have an impact on the goals of community nursing and health. For instance, the present recession has dampened the spirits of many a community and the employment at Long Island is just picking up very slowly. There is still a long way before recovery is achieved. In such circumstances we are likely to forget the trials and tribulations of our veteran population, as we have problems of our own. Even our culture of individuality and aspiration does not make for good family relationships as a rule. It is quite likely that some families have walked out on these veterans as well, leaving them alone and disillusioned. VI. Community Diagnosis The diagnosis for the community is clear- we need to create in them more respect and recognition for veterans and the older population as a whole. It is highly possible that this community is wrapped up in itself and has no time or makes no effort to help its neighbor who might just be a war veteran. Veterans need to be respected both for their past services and as senior citizens of a community. This is what the community of Long Island needs to do. VIII. Community Health Nursing Role Using the Community Health Nursing Model, the community nurse first assesses the health status of the concerned group, diagnoses common problems, mobilizes the community, develops care plans and policies, informs, educates and empowers community representatives to act, providing needed guidelines and assurances to volunteers to assure a competent workforce. The success of the project can be judged by the efficacy of interventions in the prevention of disease or ailments for the selected target community group, in this case veterans. If their rate of disease and difficulties has reduced since the start of the project, it can be deemed successful or as making a positive difference to the lives of the selected community. Primary protection could be afforded by providing veterans with the means to enjoy and maintain a useful lifestyle free from disease while exercising, taking recreational activities and having a proper diet. Secondary protection would entail physiotherapy for someone who has had a fall to nurse him back to health. Tertiary prevention could be practiced by the community caregivers as a whole as they fit into their roles of getting help for veterans via tele-health devices and audio-video consultation from doctors. IX. Conclusion This assignment has dealt with the common health problems and concerns of the veteran population group of Long Island, New York. Due to the shortage of staff, proper and full time care facilities cannot be afforded to these individuals. Veterans of war and combat often experience a plethora of common difficulties and problems that only they can understand. Community nursing is one way in which we can target and find out the common maladies of such populations, create points of intervention and administer the treatment as and when needed. The existence and use of tele-health devices is an efficient and effective way in which the needed treatments can be pinpointed, administered and results obtained for often forgotten or marginalized groups (Stanhope, 2009). They can be administered by the veterans themselves or by a caregiver. In fact using community medicine in this way is one of the best and most cost effective means of ensuring the health of the entire community and especially populations at risk. References Clark, M. J. (2008). Community Health Nursing: Advocacy for Population Health, 5th ed. Prentice Hall. Clark, M. J. (2008). Community Assessment Reference Guide for Community Health Nursing: Advocacy for Population Health, 5th ed. Prentice Hall. Erikson, E. (1994). Identity and the Life Cycle. W.W Norton & Company. Pedersen (2007). PsychNotes: Clinical Point Guide, 2nd Ed. F.A. Davis Company. Stanhope, M. (2007). Public Health Nursing: Population Centered Healthcare in the Community, 7th ed. Mosby. Stanhope, M. (2009). Foundations of Nursing in the Community, 3rd Ed. Mosby. Sullivan, E.J. (2007). Effective Leadership and Management in Nursing, 7th ed. Prentice Hall. Townsend, C.J. (2008): Psychiatric Mental Health Nursing: Concepts of Care in Evidence Based Practice, 6th ed. F.A. Davis and Company. Townsend, C.J. (2007). Nursing Diagnoses in Psychiatric Nursing: Care Plans and Psychotropic Medications 7th ed. F.A. Davis Company. Website of the Department of Veterans Affairs. Accessed on 20 May 2011 at www.va.gov. Read More