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Introduction

Community health nursing has been defined as the fusion of public health and nursing practice applied in order to enhance and protect the health of a community (Schofield et al. 2011). Community health nursing is a specialized nursing field, the attention of which is centered on the health needs of susceptible populations, aggregates and communities. The practice is continuous and is comprehensively directed to different groups in a community. Community health nursing integrates the knowledge from professional nursing theories and public health science to enhance health within a community. 

Community health nursing blends nursing practice and primary health care with public health nursing. Community health nurses are required to conduct persistent and inclusive practice that is curative, preventive and rehabilitative (Schofield et al. 2011). The idea of care in this field is based on the supposition that care directed to an individual, the family, or a group contributes to the care of a community at large. The community health nurses are not limited to care for a certain diagnostic or age group. Community members are asked to take part in the development activities geared towards the education about, promotion and maintenance of community health. The activities necessitate comprehensive health programs that consider ecological and social influences, as well as the communities at risk. 

For a good understanding of community health nursing, it is significant to understand the influencing factors and roots that have contributed to its growth since it was introduced. Evidently, community health nursing is the result of steady responsiveness and growth for centuries. The nursing field is adapted to lodge the changing health needs of a community while maintaining its primary goal of promoting community health (Schofield et al. 2011).  The development of community health nursing has been influenced by changes in the society, public health and thus passed through various stages. In tracing the community health nursing development, it becomes apparent that the role of leadership is present throughout the history. The community health nurses offers leadership in shaping policy, planning and creating programs, administration and the implementation of research findings to community health. There are four stages that denote the community health nursing development (Schofield et al. 2011). They include the following:

  • Primary home care
  • District nursing
  • Public health nursing
  • Community health nursing

The paper discusses two health scenarios in the prenatal program of community health nursing. The actions taken to address the situations will demonstrate application of the McGill’s Model of nursing and CARNA competencies. 

Scenario 1: Domestic Violence

The first client the nurse visited was 36 years old and was expectant with a second child; the pregnancy was unexpected. The woman was also raising a 6 year old son from a past relationship. She had divorced the father of her first child about two and a half years ago. She started the new relationship in June 2014. The father of the unborn child was in jail for four months and was released at the beginning of June 2015. This man was charged with physical abuse towards the mother of his unborn child and her first born son. The assault and the incarceration of her new partner depressed the woman, and she decided to move to her father and stepmother’s house. The father of the client did not support her pregnancy and wanted her to commit an abortion. In addition, the father did not want to talk about the situation.

The client reported that she did not consider relying on support agencies as a good idea, and the only people she could talk to (family and friends) were rather judgmental. She is currently smoking about 2 or 6 times every day depending on the mood of the day. She reported that the whole situation has changed her life greatly. She is not feeding as required, especially in her condition. Additionally, she has cut her social circle and now spends her time in the house to avoid meeting the community members who will act judgmental. She is not sleeping well due to constant headaches. The client has sibling in Calgary but fears to talk to them since they do not approve of her new relationship. Her doctor has prescribed depression medications, but she refuses to take them saying that she hardly believes in pills. Limited Support and Child Welfare were also involved in the situation as they came to save the child.

The client was open about her previous relationship. She said the ex-husband was a difficult man. In the relationship, she experienced harassment and stalking behavior. After the end of the first relationship, she underwent depression that was never treated. Now, she cannot realize that she is in a new relationship with a boyfriend who has been to jail for domestic violence. After the father of the unborn child was released, the client wanted him to have access to their child. This man also has other children from past relationships. The client questioned about the logistics involved for the father to see his child. She was told that the hospital would know how to react based on the court order given on the situation. 

 

Background Knowledge

Domestic Violence Statistics

Statistics reveal that the percentage of domestic violence in Canada rose from 12% in 2010 to 16% in 2013 (Alberta Health Services, 2015). In the same year, the rate of family violence in Alberta was reported to be higher than the national average. Between 2004 and 2009, Alberta reported the highest cases of domestic violence (Statistics Canada, 2011). About 6% of men and 8% of women claimed they had experienced domestic violence during this period (Statistics Canada, 2011). Domestic violence is a common crime in Alberta’s justice system. As such, Alberta has eight courts specializing in domestic violence that help track cases by offering a central place for offenders and victims.

Effects of Domestic Violence in Children

The client was advised how witnessing (hearing, seeing or observing) a domestic violence can harm a child. Basically, children exposed to domestic violence are anxious and fearful. These children tend to be on guard waiting for the next move. Since they never know what triggers the violence, they always feel unsafe and worried for their siblings and mother. Children facing abuse are susceptible and deficient of affection and approval. The feelings of these children can be categorized into fear, shame, anger, sadness and depression.

Common Practice

The nursing approach as applied here entailed promotion of a safe environment, and educating the client on the impact of the situation on her and her children. The preceptor and the nurse demonstrated the profound knowledge in evaluating the situation . After gaining information about how the client felt and how her family handled the situation, the client was advised on the necessary steps to take to ensure hers and her children’s safety. The client was referred to a family matter program to enlighten her on post-partum depression. Post-partum depression is the overwhelming feelings of sadness and anxiety that make a new mother unable to resume to normalcy. In Calgary, post-partum depression occurs in about 12-16% of first time mothers and mothers who have had children before. PDD is triggered by numerous factors including societal pressures, stress and past episodes of anxiety and depression. The client was encouraged to join the program in order to learn how to protect herself.

Along with that, the client was referred to a dietician who gave her vitamin D and free prenatal vitamins. Counseling was arranged for the client through Sherrif King, and she was given mental health helpline for support. The client spoke with Homefont worker to arrange her safety plan and was connected with a domestic violence mentor program.    

Nursing Approach

Application of McGill’s Model

In Alberta, Calgary, the nursing practice has always been guided by the McGill Model of Nursing (Allen & Warner, 2002). The model aims at enhancing health interactions between nurses, patients and their families. The model requires nurses to create a positive environment for the patient. For example in scenario 1, the nurse was supposed to structure, uphold and strengthen the healthy potential of the patient by encouraging her family to be supportive of her. The McGill Model highlights that the family is the primary factor that influences a positive health outcome. As such, the efforts put by the family of the client towards addressing her depression matter much.

Further, the model concedes the ontology of humanity (Allen & Warner, 2002). This means that every person is entitled to the participation in their health experience and is required to take control over the situation and treatment decisions. Individuals are allowed to be reflective, mindful and flexible. By so doing, the client will be the architect of her experiences, and in turn, she will device coping strategies to guarantee her survival.

Though the model requires that a patient remains in his/her habitual surrounding, the nurse is required to improve that surrounding to ease the patient’s adaptation (Allen & Warner, 2002). In this case, the nurse was responsible for referring the client to a family and mentor program to ensure her safety and receive more advice and help.

Knowledge-based Practice

As evidenced by the scenario, the nurse demonstrates the competence when evaluating the situation and trying to find out whether the client is comfortable. On learning how the situation is affecting the client, the nurse suggests various options as discussed above to address the situation. This demonstrates application of knowledge-based practice. The importance of competence to the nursing practice as applied in the scenario is that it ensures positive health outcomes for the client.

Ethical Practice

The competence establishes professional judgement and decision-making steered by ethical values and responsibilities (College and Association of Registered Nurses of Alberta, 2013). In contrast to the community and client’s family, the nurse and the preceptor listened to the worries of the client and offered their advice, without judging her. The relevance of this competence as applied to the scenario is that it ensured a safe, honest and positive relationship between the client and the health team.

Barriers to Practice

Communication is an important skill in nursing practice especially in the case of domestic violence. The competence of a nurse is measured by his/her ability to make the patient understand that they are out to help him. In this scenario, the community nurse had to convince the client that she needed to understand her situation and worries for the right decisions to be made. The problem was that since the family and friends of the client were judgmental, the client was reluctant to communicate her troubles for fear of being judged.

Scenario 2: Culture and Mental Health

A 26-year old pregnant woman came to the community based prenatal program in Calgary, Alberta for a routine checkup. The client who was expecting her second child was from China. She spoke Mandarin, which made healthcare professionals use a language line for interpretation and in some cases, multicultural outreach staff from the prenatal program. The client has been in Canada for almost two years, and in China, she has a 3-year old child who lives with her parents. After giving birth to her first child, she did not breastfeed him as she is hepatitis B+, with the advice and apprehension that the disease could be passed on to the baby through breast milk. Accordingly, she used formula to feed the baby. The client does not work and stays with her husband who has a full time job. She also misses her son but cannot tell her husband or family. In addition, the client is also worried about her condition and is afraid to breastfeed her newborn due to hepatitis B+. In regard to this, nurses reassured her that the baby will not have any ill effect as he will be vaccinated at birth to prevent transmission. They also explained that the risk of transmission is minimal, which made her contented. The staff talked about stress management and advised her to be attending the weekly group meetings in order to connect with other pregnant women.

The client developed obsessive-compulsive disorder (OCD) with anxiety. This took place after her doctor prescribed “Viread”, a medication used to treat hepatitis B+, during pregnancy and to help protect the baby. Her major concern was that she could not help herself from searching on the Internet for some information about the medication as well as her condition though she trusted the doctor. From her research, she realized that the medicine is not recommended during pregnancy. The client stated that she has been stressed and that she could not stop herself from cleaning, doing laundry, and washing dishes, and redoing the same many times as she felt that her work was not good enough. She had not shared this feeling with her husband, family or friends. All through the conversation, she remained tearful.

The staff used the opportunity to explain to the client that she was dealing with great amount of stress. Nurses explained the importance of eating healthy in order to reduce the stress. In addition, she was asked for a permission to talk to her doctor at Mosaic clinic to find someone to assist her deal with the stress. The preceptor called the doctor’s office and scheduled an appointment for the client. The client was encouraged to attend the appointment at the clinic and even facilitated with a taxi voucher. The clinic conducted a mental health assessment and arranged for a consultation with a psychiatrist. The client stated that her father had mental illness, and she felt ashamed that she might also be mentally ill. However, he was affirmed that mental illnesses happen to many people, and it stems from the stress and anxiety that she is building.

Background Knowledge

Mental Health Statistics

Mental health issues are behavioral patterns or emotions linked to some degree of suffering, anguish, or impairment (AHS, 2015). Such problems encompass anxiety, schizophrenia, postpartum depression, and OCD, among others. In order to meet health care needs of people in Alberta, there have been modifications in care delivery. The incorporation of mental health and addiction services has generated an effectively positioned structure to meet health care requirements of all Albertans.

According to AHS (2015) one in five persons suffer from a certain kind of mental sickness during their lifetime while the rest have a family member, or a friend suffering from the same. The number of Canadians who fail to attend work on a daily basis as a result of mental illness are 500,000 (AHS, 2015). It is expected that from 2008 to 2038, the incidence rate of people suffering from dementia in Alberta will double (AHS, 2015). The implication is that by 2038, 2.2% of the entire population will experience some kind of dementia in contrast to 1.1% in 2008 (AHS, 2015).

Due to the high levels of mental health issues in the region, effective services and programs have been put in place to deal with the same. For instance, Alberta Health Services (AHS) is a wholly incorporated health system providing a range of programs including Access Mental Health, Acute Inpatient Psychiatry, Adult Psychiatry Program, and Women's Mental Health Clinic, among others. This is so particularly due to the fact that the number of seniors in Alberta is anticipated to amplify thus worsening the issue.

Cultural Diversity in Canada

Similar to any other developed nation, Canada is inhabited by people from various countries. These people have health care needs that range from lifestyle diseases to mental health issues. In most high income nations, enhancing care services associated with mental health issues for racialized groups is a major challenge. The reason is that culture and language play a vital responsibility in mental health service delivery. In order to deal with this, the Mental Health Commission instituted a project, the purpose of which was to deal with mental problems of racialized groups. Additionally, the project was intended to assist in the deliberations in achieving the objectives of Canada Mental Health Strategy (College and Association of Registered Nurses of Alberta, 2013).

Common Practice

Resilient and healthy communities (workplaces, schools) are essential building blocks for enhancing mental welfare, as well as reducing the negative impacts of mental health issues. It means that the significant number of promoting healthy communities cannot be overlooked. In Canada, there is a growing body of knowledge exploring mental health problems among the immigrants and racialized groups. The literature centers on various aspects including social determinants, the level of mental illness and the barriers to practice.

Various health systems have been established in Canada including Alberta Health Services. AHS provides a wide array of services and programs to persons suffering from health issues. The offer implies assessment, support, treatment, spiritual care and counseling to both youths and adults. Programs are provided in various facilities encompassing clinics, community health sites, and hospitals.

The enactment of the Mental Health Act of Alberta offers support for persons who are mentally unwell. The act was amended in 2010 to ensure that it continues to be responsive in meeting health requirements of involuntary patients while promoting a healthy community.

Nursing Approach

Knowledge-based Practice

Knowledge-based practice is one of the CARNA competencies that were employed in this case. The nursing approach applied in this case is eating healthy foods and stress management. After the patient attended the prenatal program, the nurse recognized that she was undergoing some level of stress, which was important in providing more intervention. The client explained what she was going through as well as her worries in relation to her hepatitis B+ condition and her fear to breastfeed her unborn child. However, she was explained that the degree of transmission was low as the baby could be given a vaccine to curb the same. With reference to OCD, the nurse explained to the client the importance of stress management. Additionally, the healthcare professionals also communicated and promoted the need for consuming healthy foods so as to cope with the stress and enhance health. The client was also linked to a mental health specialist after communicating with her doctor at Mosaic clinic. In the clinic, a mental health evaluation was performed, after which a consultation with a psychiatrist was arranged. Lastly, the staff explained to the client that mental illness affects many people and it develops from anxiety and stress. As a result, the need for controlling such factors was vital in managing and maintaining mental wellbeing.

Application of McGill’s Model

The purpose of this model is to guide nursing practice by promoting healthy interactions between healthcare practitioners and their clients. In this case, the application of the model was evident. For instance, the interaction between the nurse, preceptor and the client was effective as the client was allowed to talk and give her viewpoints in regard to various issues. She made a decision on searching information on the Internet relating to hepatitis B+, and the nurse was not opposed to it. The client was allowed to participate and make decisions on her health. In general, the aim was to promote positive health outcomes (Allen & Warner, 2002).

Ethical Practice

During the conversation with the client, some ethical principles were observed. This is important in nursing practice, and all health professionals are required to adhere to ethical principles and standards. Firstly, the staff was supportive of the client and encouraged her to deal with the condition effectively. The client pointed that she had no one to share her problems with, and thus, nurses acted as her solace, listened to her and advised her on how to cope with the problems. Basically, the nurses acted in the best interest of the patient by helping her deal with the anxiety while assuring her that the degree, to which the disease could be transmitted to the baby was minimal.

Barriers to Practice

Culture is a major barrier in the provision of health care. People from some cultural backgrounds do not like talking about their mental health issues making it difficult for healthcare professionals to meet their needs thus delaying treatment. Failure to reveal the status is linked with such factors as stigma. Language difficulty is another barrier. In this case, the client was from China and the nurse had to use the service of an interpreter. Language difficulties lead to communication infectiveness.

Conclusion

Addressing the issues of domestic violence and mental health problems is important in creating healthy communities. Certainly, such issues are prevalent among Canadians, and can only be solved by implementing appropriate strategies, programs, as well as services. Establishing efficient interventions also necessitates healthcare practitioners to demonstrate ethical and knowledge-based practice. Putting in place efficient assessment tools and better health promotion practices are also paramount in creating healthy communities.

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