Community health stands for preventing the development of possible diseases in a community (city, town, rural area, or others) and providing treatment for its population. According to Stanhope and Lancaster (2016), public health nursing can be called a mix of nursing theory and public health theory applied to ensure the population’s health. Community-oriented nursing emphasizes populations’ role, so it may be called a “population-centered practice” (Stanhope & Lancaster, 2016). So, community health nurses try to eliminate major health problems, taking a significant role in the whole health care system. Community-oriented nursing has four main concepts: person (client), nursing, health, and environment, the interconnection between which is rather complicated (Stanhope & Lancaster, 2016). However, the analysis of mentioned significant concepts that show understanding of community health nursing can be provided by discussing family assistance, barriers to home care initiation, and differences between rural and urban.
The Role of a Community Health Nurse
“Nursing” and “health” are two of the four most significant concepts of community-oriented nursing. To define the nursing concept, Stanhope and Lancaster (2016) should be recalled. Scholars claimed that community nurses try to achieve the goals of “preventing disease and disability and promoting, protecting, and maintaining health to create conditions in which people can be healthy” (Stanhope & Lancaster, 2016, p. 16). Moreover, the concept of “health” aims at achieving the best health state possible by implementing “nursing” practices. So, “nursing” stands for diagnosing health issues and keeping them from arising in society. Therefore, the close relationship between these two concepts is visible now; some examples should be provided.
Public health nurses prevent diseases and promote health programs in the communities, increasing awareness and stopping the illness level from rising. To begin with, health nurses may try to avoid the problem of maltreatment by launching relevant education programs for professionals working with youngsters in order for them to notice the signs of violence and protect them (Stanhope & Lancaster, 2016). Another way to improve quality of life is by preventing the illness level from growing. To demonstrate, by launching the distribution of condoms, community nurses may control the problem of sexually transmitted diseases. By this, public health nursing tries not to let the number of people having infections become bigger. However, the practice of community nurses goes beyond the introduction of awareness-raising programs and the distribution of health-related goods, as it involves home-based care.
Assisting the Families of Patients
Community nurses may connect a patient with his family by launching classes for relatives or advocating his desires. Public health nurses may have different levels of clients: individual, family, community, and population (Stanhope & Lancaster, 2016). Subsequently, a family may be discussed on different levels of analysis: when an individual is a patient (having a family as the client’s “environment,” which is another significant concept) or family itself as a client. According to Stanhope and Lancaster (2016), “environment” as a theoretical concept takes one form from the “the world, nation, state, locality, home, school, work, playground, religion, or individual self” list. The most common case for community nurses is having a relationship with families in the form of a patient’s environment.
Concerning nurses’ assistance to patients’ families, they may act as connectors. As it was claimed by Strandås and Bondas (2017), “nurses perceive the in-depth knowledge and understanding of the patient’s physical, cognitive and psychosocial condition as aids in choosing the right approach and tailoring nursing care” (p. 19). Therefore, having a deep perception of the client’s health conditions, community nurses may interact with his family, explaining his feelings to them, so mutual understanding between a patient and a family would not be traumatizing. As for the family as a client itself, public nursing is functional while introducing education programs, for example, for infants’ parents or those taking care of older adults. Although nurses may have complicated relationships with families, they usually act as connectors between patients and relatives.
Barriers to the Initiation of Home Care Services
To provide the community with home care services, public nurses may face such obstacles as strict bureaucratic requirements, financial issues, etc. As it is declared by Henning-Smith et al. (2020), some non-medical barriers to home care services are: “financial issues; transportation; nursing home availability and infrastructure; and timeliness” (p. 12). Firstly, nursing home care is usually expensive, so not every client can afford to pay for it, creating an obstacle to the development of home care services (Henning-Smith et al., 2018). Secondly, researchers emphasize transportation issues, as there is a lack of affordable programs helping patients go to nursing homes from hospitals (Henning-Smith et al., 2018). Thirdly, there is a lack of nursing home beds specialized for patients having complex medical disorders, such as psychiatric ones. Finally, patients often face bureaucratic issues while dealing with insurance companies and state agencies, claiming that it takes a long time for the former to approve home care nursing (Henning-Smith et al., 2018). Summing up the listed obstacles, it is rather complicated to initiate home care services in a community; however, some barriers may differ in their significance in rural and urban areas.
In order for home care services as a part of community-oriented nursing to be more open for the clients and society, loosening the bureaucratic requirement as a solution for the discussed barriers can be implemented. In other words, one of the obstacles to initiating home care service is timeliness, meaning that it is very time-consuming to pass all of the bureaucratic procedures. Patients may find it more convenient to use home care nursing if the bureaucratic issues while dealing with insurance companies will be less complicated (Henning-Smith et al., 2018). Therefore, the possible solution for breaking the barrier to home nursing initiation is to loosen bureaucratic requirements.
Home Care Services in Urban and Rural Areas
Rural home care services are slightly lower in pain and medication management, whereas urban is worse in introducing daily living activities. According to Chen et al. (2020), rural areas provide better conditions for the improvement in activities of daily living than urban areas. This may be connected with the environment and nature, giving people more opportunities to have a healthy everyday life. Concerning urban areas, people there are provided with better medication management, meaning that it is easier for them to find and consume necessary medication and treatment. Overall, rural home health services, provide patients with a limited range of professional therapies) are slightly lower in quality than urban ones (Chen et al., 2020, p.28). Therefore, there is a significant difference between access to home care services in urban and rural areas.
The community-oriented practice stands for eliminating health issues by stopping diseases from occurring and raising awareness by launching public education programs and home care services. Health nurses are helpful in connecting clients with their families (as an environment) because they have a deep understanding of patients’ conditions. Although home-based care is an essential part of public health nursing, it is rather complicated to initiate, as there are such barriers as lack of financial resources, transportation issues, absence of necessary home infrastructure, and timeliness. However, there are some solutions to decrease the complexity of home care initiation: loosening the bureaucratic requirement, for instance. Moreover, home care services differ significantly in urban and rural areas, providing a lower quality of treatment and limited scope of professionals in the latter. Summing up, the relationships between “health”, “environment”, “person,” and “nursing” key concepts discussed above support the understanding of public health nursing as a mix of nursing theory and public health theory used to secure community well-being.
Chen, H. F., Landes, R. D., Schuldt, R. F., & Tilford, J. M. (2020). Quality Performance of Rural and Urban Home Health Agencies: Implications for Rural Add‐On Payment Policies. The Journal of Rural Health, 36(3), 423-432.
Henning-Smith, C., Kozhimannil, K. B., Casey, M. M., & Prasad, S. (2018). Beyond clinical complexity: nonmedical barriers to nursing home care for rural residents. Journal of aging & social policy, 30(2), 109-126.
Stanhope M., & Lancaster J. (2016). Public Health Nursing: Population-Centered Health Care in the Community. Elsevier Mosby.
Strandås, M., & Bondas, T. (2017). The nurse-patient relationship as a story of health enhancement in community care: A meta-ethnography. Journal of Advanced Nursing, 74(1), 11–22.