Changes in health care policy have reignited an interest in community health. Nurses can serve the community in a variety of ways. Community-oriented nursing focuses on the connection between the population's health status and the physical, social-cultural, and biological environment. A position as a community health nurse provides an opportunity to serve the underserved. Working with vulnerable medical populations helps to broaden your experiences, providing you with a better understanding of the unique practices and beliefs of other ethnicities and cultures. It can also give you a deeper understanding of the barriers to care faced by various populations. Completing the online RN-BSN program at Carson-Newman can prepare you for a fulfilling career in community health nursing. The program teaches you to employ evidence-based practices, critical thinking, patient advocacy, professional ethics and the principles of servant leadership to improve patient outcomes, community health, and your nursing practice.
Public Health vs. Community Health Nursing
There are differences between public health nursing and community health nursing. Public health nurses evaluate the health status of the whole community and the population’s health needs, whereas the community health nurse delivers health services on the individual, group, and family level. Public health nurses develop policy related to community health needs and plan for the community as a whole to prevent disease and disability and preserve the community’s health. In contrast, community health nurses (CHNs) partner with their local communities to promote health and prevent illness across the lifespan by identifying barriers to healthy lifestyles and general wellness. Community health nurses work with people from many different backgrounds, many of whom are disadvantaged and marginalized. They work with individuals, families, and groups to empower individuals accessing care to change unhealthy lifestyles.
Health disparities are the unequal burdens in disease morbidity and mortality rates experienced by ethnic/racial groups as compared to the dominant group. They can negatively impact subsets of the population who have systematically experienced greater socioeconomic obstacles to health. Sadly, health disparities remain problematic across the United States. It is well documented that ethnic/racial minorities are disproportionately affected by many conditions that impact their health in comparison to their white counterparts. Reasons cited for these disparities include socioeconomic status, geographic location (not enough providers in an area), health behaviors of the minority groups, access to health care, and direct and indirect manifestations of discrimination and exclusion.
Denise Rodgers, M.D., an expert on health care disparities, gave a speech entitled "Family Physicians and Health Care for the Underserved” at the American Academy of Family Physicians’ 2010 National Conference. In it, she stated: “To be poor in America means to be at significant risk of poor health in America.” Existing solutions have been ineffective in eliminating health disparities. Dr. Rogers addressed the lack of progress made towards the Healthy People 2010 initiatives to increase quality and years of healthy life and eliminate health disparities. It is vital health care professionals work collaboratively toward the goal of systematically closing the U.S.’s health disparities gap.
Solutions to Address the Needs of the Underserved
A shortage of primary care physicians in Tennessee and surrounding states has led to a large number of medically underserved. Nearly one in five Tennesseans lack adequate access to primary health care, according to an article on johnsoncitypress.com. The article cites a study by Avalere Health indicating that 18 percent of people in 111 different areas around Tennessee do not have access to enough doctors, due to an inadequate number of providers. Nurse Practitioners could be well positioned to fill the primary health care gap, however the state of Tennessee has not granted NPs with full scope of practice, necessitating a doctor’s approval of prescriptions.
Some needs of the underserved could be addressed by ensuring that all Americans have access to primary health care at an affordable cost, promoting wellness and healthy lifestyles. Many underserved in Tennessee live in rural communities rather than in urban centers where access to primary care is more readily available. When CHNs meet patients in their own environment, they reach marginalized members of society in a cost-effective way. They partner with patients to address existing and potential health problems by considering environmental and socioeconomic factors, and incorporate patients' belief systems, personal issues, and lifestyles into the nursing process. In the home setting, patients have more control over their behaviors; they choose whether or not to follow the plan of care. Nurses can help patients internalize the importance of healthy behaviors by teaching and adapting the care plan to the individual patient.
Since 1978, the World Health Organization (WHO) has endorsed collaboration between disciplines that could lead to accessible and affordable health care. Nowhere is this more imperative than in underserved communities with high needs and vulnerable populations. Providers from different disciplines could collaborate with the goal of improving health outcomes for their patients while working to deliver the highest quality of care. The aim is to achieve all three aims of the National Quality Strategy— better care and experience, improved population health, and lower costs. Interprofessional collaboration may reduce health disparities by bringing a comprehensive team (physicians, nurses, social workers, and pharmacists) to treat the patient and bringing extensive expertise to the local community that would otherwise not be present. This team provides additional resources, health care services, and the potential for unexpected positive outcomes for the community.
Effective communication among and between team members plays a significant role in the success of team collaboration. A community-based team entails a unified focus on wellness, prevention, recovery from illness, health maintenance, and advanced illness care. Collaboration requires the ability to work together with a high degree of trust, low reliance on hierarchy, and an innovative spirit to solve complex problems. The nurse serves a vital role by coordinating care across a continuum of health care services and managing multidirectional communication with the patient, family, team members, and other service providers. A lesser known member of the team is the community health worker (CHW) who serves as a cultural liaison, often bridging cultural and language barriers. The interaction between the nurse and the CHW can produce a robust set of interventions that optimize patient outcomes.
Dr. Rodgers notes "there are many partners in the community to work with us to improve the health status of everyone. It is important that we not feel that we have to do this alone." She reports, "Health care disparities are about us. They originate in the way that health care providers fail to provide quality health care to some patients." More attention must be paid to ensuring all Americans have access to primary health care at affordable cost, promoting wellness and healthy lifestyles, and addressing the determinants of health. Nurses have a critical leadership role in the delivery and coordination of care. Those who are BSN-prepared have the education, training, and competence to hold new roles on health care teams serving the underserved.
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For more information, please see BSN in 10: Why RN-BSN Credentials Are Linked to Better Patient Outcomes and Resolving Conflict in Nursing Careers.
Baldwin, D. M. (2003). Disparities in health and health care: Focusing efforts to eliminate unequal burdens. The Online Journal of Issues in Nursing, 8(1).
Gerber, L. (2012). Community health nursing: A partnership of care. American Journal of Nursing, 112(1), 19-20.
Porter, S. (2010, August 13). Underserved populations struggle with poverty, disparities in health care: National conference speaker challenges audiences. Retrieved from the American Academy of Family Physicians website.
Role of the public health nurse. (n.d.). Retrieved on September 15, 2018, from the Public Health Nursing weebly website.
Tri-Council for Nursing (2017, January). The essential role of the registered nurse and integration of community health workers into community team-based care [Tricouncil Statement].
Vanderbilt, A. A., Dail, M. D., & Jaberi, P. (2015). Reducing health disparities in underserved communities via interprofessional collaboration across health care professions. Journal of Multidisciplinary Healthcare, 8, 205–208.