COMMUNITY ASSESSMENT AND DIAGNOSIS - Essay Example

?Running head: COMMUNITY ASSESSMENT AND DIAGNOSIS Community Assessment and Diagnosis Insert Insert Insert 12 October 2011 Community Assessment and Diagnosis Introduction Human life and experiences are influenced by multiple factors, and one of such factors is health. World Health Organization regards health as a state of completeness in terms of physical, mental, and social wellbeing, and not just absence of disease or infirmity (WHO 1978 cited in Funnell, Koutoukidis and Karen, 2008, p.67). This definition regards health to be a holistic concept that integrates physical, psychological, cultural, and social aspects. Primary health care (PHC) is the new paradigm upon which attainment of holistic health goals has become possible. Public health care rests on attainment of good health through community empowerment, coordination, prevention, and health education (Funnell, Koutoukidis, and Karen, 2008). Therefore, Ottawa Charter for Health Promotion-1986 and Alma-Ata Declaration-1978, have become frameworks upon which PHC builds and operates. Health assessment and diagnosis is part of primary health care, and this is vital specifically in designing, packaging, and implementing health care programs and policies. Therefore, a thorough understanding of health assessment and diagnosis is generally important as formidable foundation to attainment of good primary health care program or policy. Community Health Assessment In order to have a thorough understanding of the community, community assessment has become one way of understanding and conceptualizing community. Vollman, Anderson, and McFarlane (2007) describe community assessment as an organized, orderly, and logical process that involves coordinated attempts to understand a particular community. The role of community assessment cannot be ignored by any professional, since community assessment is associated with desire to identify desirable and undesirable factors that influence the health wellbeing of people in the community. At the same time, Hancock and Minkler (1997) ascertain that community health assessment plays role in generating information for change and subsequent empowerment (cited in Vollman, Anderson, and McFarlane, 2007). Community-as-Partner Model The model is based on Neuman’s model of total-person approach, which identifies (Anderson and McFarlane, 2010). Initially, the model was created as community-as-client model to illustrate the need for public health nursing but was later renamed community-as-partner model to reflect aspects of primary health care (Anderson and McFarlane, 2010). The model integrates and reflects aspects of systems models whereby, different parts interrelate and function in unity but the larger (whole) system is considered greater than the sub-sets systems. The model integrates the four aspects of nursing - person, environment, health, and nursing. Community-as-partner model builds on two major factors ingrained in the model: community as partner, and the utilization of nursing process to work among community people (Anderson and McFarlane, 2010). Community assessment wheel Source: Anderson and McFarlane, 2010 As the model can depict, key concepts of the model include community core, eight interacting community subsystems, community stressors, and boundaries, which have been named as normal level of defense, flexible line of defense, and lines of resistances (Lundy and Janes, 2009). Core constitutes community people with their values, beliefs, and history, and in turn, the core influences and it is influenced by the eight inter-related subsystems. The subsystems include physical environment, education, safety and transportation, politics and governance, health and social services, communication, economics, and recreation (Lundy and Janes, 2009). Apart from carrying out assessment on these two aspects, community nurse is further required to conduct assessment of current stressors that largely make the community experience tension, normal level of defense or current level of health within the community. Further, assessment should be done to evaluate the flexible line of defense that reflect or represent current temporary response to stressors or threats to community health (Lundy and Janes, 2009). Lastly, assessment should be done to evaluate lines of resistance available in the community, together with community strengths that are reflected in the inter-related subsystems. Aboriginal community in Ontario Province Assessment of elderly population living with Parkinson disease Parkinson’s disease (PD) is classified both as chronic and progressive movement disorder condition that has no clear or established aetiology (Parkinson Society Canada, 2003). It comes second in prevalence after Alzheimer’s disease. The disease can be located in almost all ethnic groups and affects both men and women as they advance in age. Due to increasing prevalence of the disease, it is established that the impact it has on economic, social, and human population at large is enormous. Characteristics of PD are largely manifested in impairment effect it poses on those infected and subsequently reduce their quality of life. In Canada, it has been established that the prevalence of the disease is increasing as the ageing population increases (Parkinson Society Canada, 2003). Core (people) According to 2001 population census, Canada has about 200 different ethnic groups speaking around 100 different languages (Zimmerman, 2008). At the same time, Canada receives one of the highest numbers of immigrants and this has contributed to the country’s annual population growth rate of 1.5% (Zimmerman, 2008). Aboriginals are considered as some of the original inhabitants of Canada and are categorized as first nation’s people, Metis and Inuit. Today, all these groups constitute about 3% of Canada’s population (Zimmerman, 2008). Many Aboriginals in Canada reside in the province of Ontario (Spotton, 2002). Nevertheless, other population portions of Aboriginals have spread across different provinces of Canada. Average age among Aboriginals is estimated to be 24.7 years, and birth rate is twice compared to that of non-Aboriginals (Zimmerman, 2008). Aboriginals have preserved their culture for a long time and still maintain strong cultural and religious attachment to the land. For a long time, Aboriginals have been victims of economic, social, political, and legal mistreatment in Canada. As a result, poverty levels among Aboriginals are high as compared to non-Aboriginals, social inequality is prevalence in terms of health, unemployment, suicide, incarceration and general wellbeing, and many more (Zimmerman, 2008). Physical Environment In Ontario, Aboriginals represent a small population of the provinces total population but there are more Aboriginal people in Ontario than in any other province in Canada (Spotton, 2002). At the same time, Aboriginals in the province live largely in urban areas, in rural areas and on reserves, popularly known as First Nations communities. The province of Ontario has for a long time experienced good climatic conditions but with recent and increasing climate changes, this serenity is threatened (Union of Concerned Scientists, n.d). The province can be viewed within lenses of increased activities of agriculture, tourism, and excellent infrastructures. Ontario boost possession of vast natural resources and physical environment characterized by appalling landscapes, vast farmlands, forestry belts and numerous water bodies. Despite presence of vast natural resources, the province experiences high levels of environmental pollution as a result of increased urbanization and industrialization (Union of Concerned Scientists, n.d). Water sources in the province are polluted especially the lower Great Lakes while at same time air quality continue to be compromised. Degradation of the environment in the province can be evidenced in deteriorating ecosystems and increased temperatures being experienced in the province. Observation can be made of accelerated activities of mining, pulp and paper industries which are heavily located in the North. Increased livestock farming activities are also contributing to deterioration of overall quality of environment in Ontario. Environment wellness of the region is therefore rated low when compared to other regions (Natural Resource Canada, n.d). Spatial planning in the region has been described as one of the excellent in Canada but effects of climate change continue to disrupt people’s lives. Further, infrastructures in big cities like Toronto tend to exhibit bias towards the needs of Aboriginals both in planning and socio-economic progress. Health and social services Ontario has the highest number of Aboriginals as compared to other provinces of Canada. The population of Aboriginals is growing at a faster rate than non-Aboriginal population in the province and in Canada as whole. The overall social condition of Aboriginals is not appealing, since many are illiterate, are unemployed, do manual and farm jobs, and overall social status is low. Research indicates that, today, there are health status and delivery of health service challenges Aboriginal people face as compared to other groups (Spotton, 2002). Majority of Aboriginals in the province have less education as compared to non-Aboriginals and the difference gets bigger as higher education attainment is evaluated and analyzed (Spotton, 2002). Education is perceived as key to other social and economic avenues and without proper education then poverty, unemployment and increased health insecurity is likely to remain high. Health status of the Aboriginals in the province again is not encouraging as majority are isolated from health and social services that other people enjoy due to their large presence in remote reserve areas. On overall, Aboriginal health in the province is worse than the rest of Canadians (Spotton, 2002). Many Aboriginals in the province have been found to be victims of chronic and infectious diseases. At the same time, elderly people in Ontario experience more health challenges than any other region and therefore require health services than younger people (Spotton, 2002). Aging population in the province is increasing, rated at 4.6% of those above 65 years and by 2020, there will be 11% older people in the province (Spotton, 2002). Majority of these older people live in reserve, some of which are very remote and far away from social and health services. Economics Ontario is one of the economically endowed provinces of Canada with Northern Ontario having one of heavy industries of Canada. Industries in the province are spread in key sectors such as: energy, engineering, mining, forestry, environment, medical health and product manufacturing. Majority of people in the region, specifically Aboriginals are employed in these industries in the lower ranks, hence their overall economic progress is limited. Employment rate for Aboriginals in the province as par 2001 census results stands at 55.1% as compared to 63.3% of non-Aboriginals (Spotton, 2002). The rate of unemployment for Aboriginals according same statics indicated that 14.7% for Aboriginals as compared to 6% of non-Aboriginals (). Further average income for Aboriginals is much lower when compared to incomes of non-Aboriginals. For instance, estimates shows that Aboriginals earns annual income that is $11,000 less than that of non-Aboriginal people, where annual income for Aboriginal is estimated to be $21,822 as compared to $33,027 of non-Aboriginals (Spotton, 2002). The Community Well-Being (CWB) index which measures overall wellness of a community using four major socio-economic indicators of education, labor force, income and housing indicate Aboriginals as compared to non-Aboriginals have low overall community well-being index (Spotton, 2002). Economic situation for majority of elderly Aboriginals is low and poor due to lack of stable employment history. Thus, dependency ratio of elderly in the region is high as compared to other provinces. With paramount economic instability, it becomes difficult to participate fully in social, economic, and health consumption, since purchasing power is generally low among many people. Diagnosis Lundy and Janes (2009) note that, upon successive completion of assessment of all elements found in the model, it becomes necessary for the community nurse to develop community diagnoses. The community diagnoses in this case should include community responses to stressors that involve problem identification, factors that cause the problem, and an outlined list of supporting data to ensure community diagnosis is valid (Lundy and Janes, 2009). Diagnosis one Prevalence of pollution in Ontario province as a result of heavy presence of industries, increased automobiles, and agriculture activities has led to increased pollution of environment thereby resulting into low quality air. This in turn affects and contributes to increased cases of Parkinson diseases. The overall emission to the environment is enormous and substances produced in mineral fields circulate and infect air of the province. Further, prolonged periods of droughts, and use of chemicals like pesticides have also contributed to pollution of the environment. Research carried out by Harvard School of Public Health established that frequent and continuous exposure to pesticides increased the likelihood of developing Parkinson’s disease by 70% (Organic Gardening Magazine, 2008, p.63). Poisonous smog and poor city quality have also been found to be prevalent in industrial countries and has been linked to increased cases of senile dementia, Alzheimer’s and Parkinson’s disease (Abokor, 2008). Intervention and subsequent planning for this should include enactment of minimum environment gas emission laws by companies, instituting fines and penalties to largest emitters of gas in the environment and regulation of use of chemicals in the fields. Diagnosis two Health and social inequality and inaccessibility have isolated many Aboriginals in Ontario from enjoying better health and overall wellbeing. Health services, together with social services have direct link to occurrence, sustenance and prevalence of a particular form of disease (Feeny, Kaplan, Huguet, and McFarland, 2010). For example, poor health services, lack of health insurance, prevalence of unemployment, lack of physical exercise facilities, and overall low levels of illiteracy have been attached to high prevalence of chronic disease in any given population (Feeny, Kaplan, Huguet, and McFarland, 2010). In Ontario province, Aboriginals are victims of health and social injustices and this very fact tends to accelerate cases and infection of Parkinson’s disease. Intervention strategy should fulcrum on the need to improve both social and health facilities and services for Aboriginals in the province. Social and health policy need to address the prevalence of inequality in obtaining information, accessing, consuming, and subsequent referral to social and health services in the province by Aboriginals. Diagnosis three Economic disadvantages that Aboriginals are subjected to have limited their access to good health care, proper diets, proper physical exercises, and the general wellbeing of their lives. Economic plays an important role in society. People with good and constant income exhibit high and constant purchasing behaviors. Further, economy dictates the kind, amount, and quality of foods one eats. Economic wellbeing also dictates the kinds of health facilities, opportunities, and services one can access or obtain. Majority of Aboriginals especially older people in Ontario province are poor and largely dependent. They are likely to lack good care and suitable health environment. Obtaining medical is a problem and participating in physical exercises is almost impossible. Therefore, attached to this is prevalence of Parkinson disease. Intervention strategy need to address the issue of economically empowering Aboriginals in this province, creating income sources for older people, and increasing social security for older people. Conclusion In many countries of the world, the concept of primary health care (PHC) has become powerful and today, many resources are being channeled towards realization of primary health care goals. Achieving the goals requires entry into community where the emphasis of PHC rests. The best method of entering community and having adequate understanding of the health issues of population is through conducting community health assessment. Data obtained in assessment becomes vital and important for diagnosis and subsequent planning of intervention strategies. Therefore, it is always important to carry out assessment using a well-defined and understandable model like community-as-partner model. References Abokor, A. (2008). Study links Parkinson’s disease and pollution. The Toronto Observer. Retrieved October 12, 2011, from http://www.torontoobserver.ca/2008/04/07/study-links-parkinsons-disease-and-pollution/. Anderson, E. T & McFarlane, J. M. (2010). Community as partner: theory and practice in nursing. PA: Lippincott Williams & Wilkins. Retrieved October 12, 2011, from http://books.google.com/books?id=ZJoDm8mg8YIC&pg=PA172&dq=Community-as-Partner+model&hl=en&ei=5pKVTrbqFoe4hAf-idmpBg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CC8Q6AEwAA#v=onepage&q=Community-as-Partner%20model&f=false. Feeny, D., Kaplan, M. S., Huguet, N & McFarland, H. (2010). Comparing population health in the United States and Canada. Population Health Metrics, vol. 8, no. 8. Retrieved October 12, 2011, from http://docs.google.com/viewer?a=v&q=cache:3axdL4fwESEJ:www.pophealthmetrics.com/content/pdf/1478-7954-8-8.pdf+health+and+social+inequality+a+prevalence+of+parkinson%27s+disease+in+Canada&hl=en&gl=ke&pid=bl&srcid=ADGEESjNR7cuJ8SXYja9WLJoh1suoMtAn07KjmeNzfn7XzYflTmxjzKIcX9uJSNUojI43kDcd8htVjn01bzfNasYIJU9p3WS1nuGRkYzS4yFZeg7hy-hBKiNQg6KY_qgjIsIQkVl5B3O&sig=AHIEtbSzrZCUPlqJ6yKP9GnXffMA21pSqw. Funnell, R., Koutoukidis, G & Karen, L. (2008). Tabbner's nursing care: theory and practice. Sydney: Elsevier Australia. Retrieved October 12, 2011, from http://books.google.com/books?id=iyGLjn0Md0sC&pg=PA69&dq=health,+primary+health+care+and+population+health+promotion&hl=en&ei=A0mVTtyzFMnAhAf-meTHBg&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEgQ6AEwBA#v=onepage&q=health%2C%20primary%20health%20care%20and%20population%20health%20promotion&f=false. Lundy, K. S & Janes, S. (2009). Community health nursing: caring for the public's health. MA: Jones & Bartlett Learning. Retrieved October 12, 2011, from http://books.google.com/books?id=fj5dInclgw0C&pg=PA38&dq=Community-as-Partner+model&hl=en&ei=5pKVTrbqFoe4hAf-idmpBg&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDUQ6AEwAQ#v=onepage&q=Community-as-Partner%20model&f=false. Natural Resources Canada. (N.d). “Quality of life: Physical environment index”. The Atlas of Canada. Retrieved October 12, 2011, from http://atlas.nrcan.gc.ca/site/english/maps/peopleandsociety/QOL/phy_qol_uc/1. Organic Gardening Magazine. (2008). Organic gardening. USA: Rodale Inc. Publishers. Retrieved October 12, 2011, from http://books.google.com/books?id=RcMDAAAAMBAJ&pg=PA64&dq=air+pollution+and+prevalence+of+parkinson+disease&hl=en&ei=RjCWTvrHPIbIhAe3qojVBg&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDgQ6AEwAQ#v=onepage&q&f=false. Parkinson Society Canada. (2003). Parkinson’s disease: social and economic impact. Retrieved October 12, 2011, from http://docs.google.com/viewer?a=v&q=cache:fqzjGjDinMMJ:www.parkinson.ca/atf/cf/%257B9ebd08a9-7886-4b2d-a1c4-a131e7096bf8%257D/PARKINSONSDISEASE_EN.PDF+prevalence+of+Parkinson+disease+in+Canada&hl=en&gl=ke&pid=bl&srcid=ADGEESh1wm1_G5wMOzO7G0A8r641t7nsbUy3V4-U5Xe1aUB1NcuL9eoqas8iRuiAbXSa8O4ILWZsE-3L3DBurkGGJnwCPB-zt_VALIYo3_WYJU6R1kO-TMAavyntsv5QsHXoAvMTLpfU&sig=AHIEtbQ3cZiZAjrZOFLFtUYjy2wBVytmaA. Spotton, N. (2002). “A Profile of Aboriginal peoples in Ontario”. Retrieved October 12, 2011, from http://docs.google.com/viewer?a=v&q=cache:4-urHBwYWqYJ:www.attorneygeneral.jus.gov.on.ca/inquiries/ipperwash/policy_part/research/pdf/Spotton_Profile-of-Aboriginal-Peoples-in-Ontario.pdf+Aboriginals+in+Ontario&hl=en&gl=ke&pid=bl&srcid=ADGEESivv4TVXU9UuCunLSaKtI1wSz2yxk_XCeWiLWmmRS6UXKzXQRlBov2LveXVUuI5R7LYtgtYpNna-IGB4makTzV3EL757mq4y8QCbGP8aSMiJo5n1TJRhlivFDw9oY6amCPVKV_s&sig=AHIEtbSM97193kqmxVdNSz0J_-VWGDHikw. Union of Concerned Scientists. (N.d). Global environment: Climate change in Ontario. Retrieved October 12, 2011, from http://go.ucsusa.org/greatlakes/glregionont_pro.html. Vollman, A. R., Anderson, E. T & McFarlane, J. M. (2007). Canadian community as partner: theory & multidisciplinary practice. PA: Lippincott Williams & Wilkins. Retrieved October 12, 2011, from http://books.google.com/books?id=udek5bjoKjIC&pg=PA220&dq=Vollman,+Anderson,+%26+McFarlane,+2008&hl=en&ei=tnOVTorqK9C1hAfmqvytBg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCwQ6AEwAA#v=onepage&q=Vollman%2C%20Anderson%2C%20%26%20McFarlane%2C%202008&f=false. Zimmerman, K. (2008). Canada. Lonely Planet. Retrieved October 12, 2011, from http://books.google.com/books?id=kv4nlSWLT8UC&pg=PA52&dq=Aboriginals+of+Northern+Prairie+of+Canada&hl=en&ei=cceVTqeTNMSFhQfXienXBg&sa=X&oi=book_result&ct=result&resnum=6&ved=0CEsQ6AEwBQ#v=onepage&q=Aboriginals%20of%20Northern%20Prairie%20of%20Canada&f=false. Read More