Community Development Nursing - Essay Example

Assessment 2: Presentation Report Written Assignment Adolescent Substance Abuse in Hong Kong: The Relevance to Community Nursing Background Young and adolescent substance abuse problem in Hong Kong is on the rise, and current governmental observations and data indicate that if a holistic prevention policy through interagency drive through multiple stakeholders may help controlling this problem. Community nurses may play important roles in these programmes. Objective To find out through theoretical research the possible roles of community nurses as agents of care delivery in controlling adolescent substance abuse problem in the elderly. Methodology Through analysis of the government healthcare publication, the actual magnitude of adolescent substance abuse problems was delineated. Following that, the relevant policy was analysed to demonstrate that a holistic care delivery programme is necessary. To determine the role of the community nurses, the ecological factors that foster the substance abuse problems in this age group were determined, again through the review of literature. The current approach can be based on preventive approach designed through knowledge about these factors, many of which individual, familial, and social may be effectively controlled through social modifications. Awareness about this problem would thus be most important. Conclusion From the community nursing point of view, due to the scope of exposure and interaction with the individuals within the community may help deliver care to those who are affected and prevent the risk factors that may prove to serve the purpose of achieving control on this problem. Table of Contents Contents Introduction Worldwide, the recent reports from mental health care and primary care facilities indicate the significant importance of community health and public health policies in care for substance abuse and mental health disorders. Despite government initiatives, it is unfortunate that research in this area is limited since there is a paucity of literature on substance abuse services or related mental health intervention approaches provided in the community care settings (Druss, et al. 2006). More pertinent may be the fact that with the changing scenarios of this problem, how the services can be adjusted or evolved over time. Therefore the question arises how the community practitioner delivers the care necessary for people with substance abuse with the dynamic care needs of these clients, or it is impossible to deliver care in the community, specially by the community nurses for this problem The Problem and its Magnitude In Hong Kong a survey conducted during the 2008-09 school year revealed increasing prevalence and problem of youth substance abuse. In comparison to the survey conducted 4 years earlier, this survey revealed an 1% point increase in prevalence of substance abuse among school students, which currently is 4.3% of the school students. It is more prevalent in the adolescent age groups, and the magnitude of the problem can be conceived from the epidemiologic data that among 12 year old school students, 4.6% declared that they had abused substances or drugs. When compared to the same data 4 years ago, which was 2.4%, there is a clear trend of lowering of the age of substance abuse. These data should be interpreted with caution since in many such cases, these surveys fail to reveal the actual prevalence due to fear of admitting abuse. Although these surveys can offer scientific data, it is important to understand the trend that may facilitate services that can combat youth drug problems, which has become very serious in Hong Kong. The "2008-09 Survey of Drug Use among Students" documents also reveals some very important information that are useful from the community nursing perspectives. This clearly states that the drivers of the decision to abuse substances among the youth reside in the community. The first is availability and the second is the hidden nature of the youth substance abuse. There is a noticeable increase in the trend towards use of psychotropic medicinal substances. Even in the primary school students, 37.5% were reported to use cough medications and 30.7% reported use of inhalants. Among the secondary school students, the most prevalent and preferred drug of abuse was ketamine, used by 49.4% of the abusers, which is followed by the use of cannabis by 35.6%. Some entertainment venues are used for substance abuse; however, about 36.2% of the youth in the secondary schools reported the use in a friend's home and 25% admitted using these substances at homes. This is in contrast to the public health policies of the government who proclaims that its goal is to foster a drug-free environment in order to facilitate healthy development of the youth (Press Release at news.gov.hk 2010). The Framework of Community Care Global community health care services have been reported to be inadequate in offering behavioural health services on site, the cost having been cited to be the major barrier. If this issue is examined from the perspective of rising problems in the adolescents and the youth, it may be imperative to have dedicated substance abuse services or relevant mental health services in the community. These data indicate there may be a need for such care, and there may really be potential needs to address the gaps between available services and the service needs. As a governmental response, the strategic recommendations were community mobilisation, community support, drug testing, treatment of cases, and law enforcement. The community care seems relevant due to hidden nature of the youth drug abuse, which is expected to increase further due to the law enforcement directions of the strategy (Yeung 1997). Thus there is a need for parallel strengthening of both combative and supportive community services against youth drug abuse. To this end, it would also be prudent to consider the fact that youth in itself is a risk factor for beginning drug abuse, and much of the community endeavours must be concentrated towards preventive community interventions against risk minimisation in partnership with the at risk population. In order to do that, it is important to understand the different predisposing variables in this problem, more importantly those which may strongly be present in the community itself. Thus these strategic directives should be promulgated through anti-drug publicity, measures for risk minimisation, ability to proactively identify the risk factors and relevant interventions, preventive education to the families and risk groups, treatment and rehabilitation of the established cases and so on (Sim 2007). It is evident that a fruitful culmination of the above agenda and objectives is only possible is the community care professionals and nurses work in close collaboration with the other stake holders such as education bureau, department of health and social welfare, and mental health department. The Community Nursing Approach Fortunately, the government recognises the role of community health services to ward off this problem, and they admit that the youth drug abuse problem happens to have very complicated root causes. These causes are only prevalent and active in the community scenarios, and they are very difficult to elucidate and address in the conventional mental health clinical approach. While research in other countries have revealed many previously unknown variable and determinants, the community practice experience suggests that the substance abuse problems in the youth are often caused by underlying family, academic, personal, and other problems. Moreover, the very nature of the drug abuse problems is that once acquired, the habit is very difficult to be having a complete riddance due to chemical modification of the individual neuropsychiatric bearing. Anti-abuse community mental health work may this be enduring, tedious, long-term and would need very close monitoring, followup, and support. There is need of health promotion approach for brining about behavioural changes at the cognitive level of all the affected, likely to be affected, exposed to risk, and at risk individuals through different strategies. Interagency care and commitment may be the solution, and there is a need to strengthen the community avenues of care through interagency collaborative care (Valente, Chou and Pentz 2007). Therefore, there is need for better exploration of all these factors through research that may identify the knowledge gap and existing knowledge, which would foster such care delivery. Review of Literature A study by Shek (2007) indicated the policy of Hong Kong Administration that tells about interdepartmental collaboration to holistically tackle the problem. Illicit substance use is viewed by authorities as a derivative of popular culture and youth subculture. The adolescent substance abuse is a grave concern in Hong Kong mainly due to the easy and fast flow of information especially those related to psychotropic drugs, since it is an international city. Therefore, the scenario will mimic those of other places which pertain to this global problem. In the early 200s, the substance abuse became a part of the rave party culture, and the main substances of abuse were nonopiate psychotropic drugs. Concurrently, there was a prevalent belief among the young population that these psychotropic substances are non-addictive and can be a valid choice in their lives (D. Shek 2007). Leaving aside the law and enforcement angles, it is important to understand the issue of adolescent substance abuse from the community care point of view. It has been stated that a successful community approach must attempt to understand this issue from the ecological perspective focusing on the risk and protective factors, since these are commonly used to guide the strategies of interventions. Literature indicates various risk factors within the community and home environments which may be personal such as high sensation seeking and meaninglessness, familial such as growing up in broken families, at the level of school such as poor peer relationship and peer pressure and low academic achievement and low self esteem, and community oriented such as growing up in deprived communities. All these factors potentiate the chances of adolescent drug abuse. The positive thing is that the adolescents are good groups to work with since they are fast adjusters and are known to accommodate well against adversity. However, there is also a felt need to understand the individual vulnerabilities and hazards from the social life so these can be modified through appropriate evidence based interventions to develop better frustration tolerance and resilience in these individuals (D. Shek, Resilience in adolescence: western models and local findings 2001). In the present scenario, social problems show no tendency to decrease. However, the motives to begin substance abuse, specially with psychotropic drugs, although begins with psychosocial problems and curiosity coupled with peer influence, the main reason to pursue that is a lack of awareness. Many young people believe that taking psychotropic drugs is trendy and not at all serious and without consequences. What they do not know is that substance abuse will always have serious health consequences. As indicated earlier, this needs a holistic approach to control the problem through a collaborative approach through different stake holders. If resilience is the main protective factor, Hauser has identified various classes of protective factors that might protect the individual in such a way that, the young person may ultimately take a decision to change or even not to pursue the habit. These protective factors are important since promotion of them would control the tendency to start substance abuse in the at risk individuals. At the individual levels, these factors are hope, faith, healthy style of attribution, self-esteem, and self-efficacy. A supportive family environment and a promotive school environment may also strongly contribute to this end. Parental supportive factors such as guidance and an externally supportive social network have been suggested by some other authorities (D. Shek 2006). Therefore building awareness should be the priority in any preventive programme. It has been argued and suggested that there is absence of structured school-based awareness programmes in Hong Kong, and there must be systemic coverage of relevant topics as a part of the curriculum, since it would at least generate enough awareness about the problem of substance abuse leading to questions to an offer of substance abuse. This would address the curiosity factors that is known to be present in several cases. Studies indicate that an effective substance abuse prevention programme is very effective in reducing substance abuse behaviour (Tobler, et al. 2000). The next important area is family factor. In the young in most cases, family related frustration leads to the first episode. Alcohol related studies indicate that the first episode always potentiates the future episodes. Adolescent delinquency and substance abuse literature also indicates that fostering healthy family conditions may go a long way to prevent substance abuse. Systemic and didatic parent-child factors needs to be addressed in order to foster healthy family conditions (Lam and Shek 2006). Summary and Conclusion This study indicates that adolescent substance abuse is increasing in Hong Kong, and unless controlled, these will have dangerous implications for the health of the adolescents. Policy directives indicate a holistic interagency drive to control the problems. From the community nursing point of view, due to the scope of exposure and interaction with the individuals within the community may help deliver care to those who are affected and prevent the risk factors that may prove to serve the purpose of achieving control on this problem. Studies have revealed different protective factors which may be implemented in practice to accomplish these. Bibliography Druss, BG, T Bornemann, YW Fry-Johnson, HG McCombs, RM Politzer, and G Rust. "Trends in Mental Health and Substance Abuse Services at the Nation's Community Health Centers: 1998-2003." 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