Community Health Nursing
Community health nurses are a special group of nurses who work in the community with aim of helping the community improve their health through using locally available resources. They form part of the larger community and family health care professionals. Some of the functions of community health nurses are: community health and family health initiatives, health promotion, health education, detection and prevention of diseases, supportive health care services, and early identification of at risk groups and prompt intervention.
In order to explain and understand the role of community health nurse in a practical way, this paper will describe the process and plan of community assessment and diagnosis in relation to diabetes type II (NIDDM). The community assessment will be based on the state of Kuwait community which in the recent past has experienced increasing number of new diabetes type II cases. There health status will be assessed in relation to health issues with special interest in Diabetes type II (NIDDM). This is a state that has in the recent past reported increasing cases of diabetes type II.
The state of Kuwait is located on the western side of the Persian Gulf and it borders Iraq to the north and west and Saudi Arabia to the south. It has a coastline totaling 499 Km with its territory largely made up of desert. It experiences hot summers and short cool winters with average temperatures of 38c in august and 13C in January. Rainfall is hardly experienced with 26 rainy days annually. The state of Kuwait covers an area of 17,820 square kilometers and a population density of approximately 126 per square meter. The state is located in a desert region and therefore experiences tropical weather. According to a censure carried out in 2001, total population was found to be 2.25 million with life expectancy of 73.8 years (State of Kuwait, 2009).
Community Assessment Plan and Process
The process of community assessment is one of the fundamental role of nurses who work in the community for purposes of helping the communities to realize there weaknesses and how to overcome these weaknesses. As mentioned earlier, diabetes type II is a problem in Kuwait and therefore needs to be handled at all levels. Community assessment is a systematic process in which the nurse together with the members of the community determine the health problems & needs of the community & develop plans of action and implement those plans. The process is outlined below (Zerwekh, 2003; Holloway, & Wheeler, 2002; Grol 2000). Exploration: During the initial stages of planning the community assessment, the nurse carries out a community inventory; this is described as a step of mapping out the community with the purpose of obtaining baseline information that help plan for the rest of the assessment process. The nurse meets government officials and local leaders to brief them on the planned assessment; this will allow the nurse to have clearance from the relevant people. This also enables the nurse to have general knowledge on the terrain, roads/paths and the kind of people he/she will encounter (Mwangi, 2008). Planning for Assessment exercise: the following will be the objective of the assessment: to determine the disease (diabetes type II) burden on the community; to determine the most affected by diabetes type II in terms of age, sex, socioeconomic status; to determine the etiology and associated factors of diabetes type II; to determine the predisposing factors; to determine knowledge and attitudes of the community on diabetes type II and to determine what is currently being done by health care system; and community to curb diabetes type II. An assessment tool is normally used to collect the required information from the community members and any other relevant person (ICN, 1987 & 1997).
Recruitment and training of assistants: the nurse in charge of the assessment trains a few locals who will assist in data collection using the assessment tool. The trainees will also be involved interpretation of questions in the tool to the community members and therefore they need thorough training. Pretesting and reworking of the tool: the nurse takes the initiative of pre-testing the tool using people with similar characteristics as those of the community where the assessment will be done. This helps to detect faults and shortcomings after which corrections are made.
Execution of the Assessment: This stage involves actual going to the community and engaging the community into discussions and giving then the assessment tools so that they can feel it with relevant information. The nurse and her/his assistants help the community members fill the assessment tool through interpreting questions that one does not understand. The collected information is coded, grouped and analyzed. During the process of assessment, some of the people who will be consulted are community leaders and government representatives are community health workers working with the community. This is group of people who are knowledgeable and understands better the disease burden and process within the community. The health centers within the community will be a major stakeholder in the assessment process. The target group for the assessment will be adults aged 40 years and above and obese young adults as they are at risk group. Type II diabetes is known to affect these two groups and therefore the need to focus on them.
Critical Analysis of the Findings and Recommendations
From the collected data, it is evident that poor nutrition and lack of exercise are major cause of type II diabetes in Kuwait as most of the individuals assessed are overweight. This is confirmed by a study carried out by Al-Hooti, (2008) titled “food consumption pattern for the population of the State of Kuwait based on food balance sheets” this study concluded that; “the food supply in Kuwait provided an excess of RDAs at a rate of 1.19 times of energy, 2.1 times of protein, 2.59 times of vitamin A, 1.37 times of thiamine, 1.39 times of riboflavin, 1.41 times of niacin, 2.52 times of vitamin C, 1.56 times of iron, and 1.10 times of calcium daily requirements”. This excess provision of nutrients is likely to lead to overweight putting the individual at risk of type II diabetes. The assessment also shows that the community members have knowledge deficit concerning diabetes as they could not differentiate between the different types of diabetes and predisposing factors, causes, treatment and management. The lack of knowledge is reflected on the poor eating habits and lack of exercises leading to over weight. Diabetes is a burden to this community in terms of productivity and financial constraints in that the affected individuals spent more time in health care facilities instead of going to work hence spending more money on treatment with the government using a lot of its revenues directly or indirectly in management of diabetes. The assessment has also revealed that a lot is being done in terms of prevention and treatment of diabetes although these interventions are not effective as they do not involve the community members hence no sense of belonging. The community is only viewed as consumers of the health care services instead of being viewed as major stakeholders in the management and prevention of type II diabetes and also as managers of their own health. From the above, it is clear that the following needs to be done: involving the community in issues concerning their health; health education and promotion programs on diabetes (etiology, risk factors, signs and symptoms, treatment and management, complications and prognosis); rehabilitation of affected individuals to avoid readmissions; establishment of Diabetic clubs where the affected individuals can be meeting occasionally to share their feelings, new ideas and personal experiences. Health Education and Promotion is one of the major interventions that will be carried out within the community. As already mentioned, knowledge deficit is a lethal weapon against prevention, management and control of type II diabetes. It is therefore the duty of the nurse to organize awareness campaigns amongst the community with purposes of educating them on all relevant issues on diabetes (type II). Health education/promotion empowers an individual with the much needed and relevant information that can be of great assistance in management of his/her health and other related issues (Thompson, 2004). The nurse can carry out this activity with the help of the local health professionals working within the community and even train some community members who will be educating their colleagues; this creates a sense of belonging and ownership among the community members in that they will participate in the health education/promotion activities as their own. This empowers the community and the information stays with them even years after the time of carrying out the assessment.
Just as in nursing process, evaluations helps in checking if the assessment was a success and whether there has been any positive impact and if interventions put in place had desired results. Evaluation also helps in knowing if the set goals and objectives were met, determining success or failure of the problem and to put corrective measure into place (Elaine, 2005; Jorsen, 1999). The assessment was successful in that the objectives were met and findings implemented and it could have been a flop if the objectives and goals were not met.
Summary of the role of the Nurse
From the above process and plan, the following have been brought out as some of the roles of the nurse during community assessment: management role-planning, organizing, controlling, staffing, and directing; Technical adviser -Sharing technical information with individuals, and communities; Assessor/ identifier – assessing the health status of the community. Identify existing & potential health problems; Health promoter – Sharing of prime health messages to promote the health of individuals, families and the communities; Evaluator – Determines performance and outcome of community healthy activities; Trainer – He/she has the responsibility to training the community members on issues related to diabetes (Field, & Lohr, 2000, ICN, 2007).
- Elaine, M. M., (2005). Health Bulletin – Promoting Healthy Behavior. Washington DC: Population Reference Bureau.
- Field, M. J., & Lohr, K. N., (2000). Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press.
- Al-Hooti, S. N., (2008). Food consumption pattern for the population of the State of Kuwait based on food balance sheets. Safat, Kuwait: Kuwait Institute for Scientific Research.
- Grol R. (2000). National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards. Br J Gen Pract ; 40:361–4.
- Holloway, I., & Wheeler, S., (2002). Qualitative Research in Nursing (2nd Ed.) Oxford: Blackwell Publishing
- International Council of Nurses (2007). Management of Nursing and Healthcare Services.
- International Council of Nurses, (1997). Nursing Research: Building International research Agenda. Report of the Expert Committee on Nursing Research. Geneva: ICN.
- International Council of Nurses., (1987). Blueprint for ICN Programme 1988-1993 toward more effective participation in Health Policy Making and Healthcare Delivery. Auckland, New Zealand.
- Jorsen, D. (1999). History and Trends of Professional Nursing. Washington DC: Mosby Company.
- State of Kuwait, (2009). General information about Kuwait.
- Mwangi, K. N., (2008). The Process of Community Diagnosis. Nairobi, Kenya: Upendo Publishers.