Introduction to Specialty Practice: Community Health Nursing

The health of a person is complete wellbeing and not just the absence of disease or infirmity and as per the holistic concept of health it includes all the aspects of health, that is, physical, mental, and spiritual (Witt et al., 2017). This is required so that a person can lead a socially and economically productive life. To make sure that everyone enjoys the same level of good health it is required that the existing problems in the public are identified so that their prevalence is reduced (Friis & Sellers, 2020). In order to do this, it is required that the disease is prevented before the impact increases more profoundly. Till very recent the school of thought was that disease after it has occurred is to be treated and cured. Now it is believed that disease can be prevented before it is caused so that the health outcome can be positive and impact of the disease on an individual and the society can be reduced (Evans & Stoddart, 2017). One of the ways to do so is the promotion of health. Health promotion is the way in which people can be enabled so that control over their health can be increased (Simonsen et al., 2020). The aim of the present essay is to identify healthcare issue which is present in the community, formulate focus, goals and objectives, an overview of the health promotion project, resources required and evaluation of the same.

Healthcare Issue

From the community placement, it was observed that one of the healthcare problems that were identified was diabetes. Diabetes is a chronic disease which affects the level of blood sugar in which the patients have a higher level (Moges et al., 2018). It can affect the quality of life of the people who are affected by it. Depending on the pathology it is of two types either it can be due to less production of insulin or have an autoimmune pathology in which the insulin receptors are destructed. In recent times it is seen that the non-communicable chronic diseases are more prevalent and there have been international policies to reduce the impact of these diseases. When the global perspective is seen for the year 2019 there were 9.3% and it is expected to increase to 10.9% by the year 2045 (Saeedi et al., 2019).

The main impact of the disease is almost 50% of the people were unaware of the fact that they were suffering from the disease. The control of diabetes is usually estimated by the glucose tolerance and in 2019, 374 million people had impaired glucose tolerance and it is estimated to increase to 548 million globally by the year 2045 (Saeedi et al., 2019). In Australia, it was seen that for the year 2017-18 almost 1.2 million people suffering from diabetes and the prevalence is seen more in males compared to females (Australian Bureau of Statistics, 2018). The impact of chronic disease can be seen on the economy of the nation as well as on individuals as there are more resources that are required for the management. In the year 2010, the total annual cost for the management of diabetes in Australia was estimated to be $ 14.6 billion (Davis et al., 2018).

The Focus of The Project

The main aspect of focus for the project is to target the people who are in the category of prediabetic and it is so the risk factors of the disease are kept away from each other such that the disease has less chance of occurrence. In recent times it is seen that there is an epidemic of obesity. The main impact of obesity is attributed to the fact there is a drastic lifestyle change and the eating habits have changed. This epidemic has caused a surge in the incidence of type 2 diabetes mellitus (Yazel-Smith et al., 2019). The incidence of youth in the category of prediabetes is more but at the same time, the proportion of people in the category has increased in the last decade. People in this category continue to be a public health concern as it increases the disease burden, as well as the economic impact of the same, is more. Targeting or focusing on this aspect can help in the prevention of disease occurrence. Diabetes is a multifactorial disease and it is important that the way of tackling the risk factors should also be such that different aspects are taken into consideration and health promotion is one of them (Arnold, 2020; Edelman et al., 2017).

Program Goals

The goal of a program is the one which is the ultimate outcome that is required or is wanted at the end of the program. In this case, the targeted disease is diabetes and the target population of the program is the people who are in the prediabetic category. The ultimate goal of the program is that the percentages of people who have developed diabetes are reduced compared to the baseline in the community. For the purpose of the present project, it is required that the goal that is formulated is SMART that is specific, measurable, achievable, realistic and timely (Bjerke & Renger, 2017). The goal that is set for the project is such that it is SMART. It reduces the percentage of people developing diabetes by targeting the people in a prediabetic category using means of health promotion by the end of one year.

There is a national policy that is present in Australia since 2010 which is called 'Diabetes Australia' (McLean, 2015). This is a federation which is in place in states and territories with over 16,000 members. It provides service to more than one million Australian registrants of the National Diabetes Services Scheme which is a scheme that is operative under diabetes Australia. One of the main roles that are undertaken by them is to raise awareness of the people regarding the seriousness of the disease, promotion of prevention, early detection and advocating ways for improvement of care, support and management of the disease (McLean, 2015). Key issues regarding the prevalence of type 2 diabetes mellitus are identified and policy has been formulated targeting those issues. The policy is made to ensure the prevention of obesity and other strategies in the at-risk population. Implementation of national preventative health taskforce and the social determinants of health which are the risk factors for the disease are identified and addressed (McLean, 2015).

Project Objectives

Objectives of the project are the short-term goals that will need to be achieved during the given time span in a consecutive manner so that the ultimate goal that is formulated for the project is achieved at the end of the project. These objective acts as a set of guidelines which the policymakers and everyone involved in the policy or the project right till the grass root level follow. First, the baseline is to be established for the existing prevalence of diabetics as well as the ones who are in the category of prediabetics. For this it is important that a method of screening is established as reliance on the hospital records is not possible as not everyone might have a recent record of their health which will help in establishing of the baseline. Next, health promotional activity is to be made which is custom-made for the community following the principles of health promotion as established by Ottawa charter (Thompson et al., 2018). Next, the effectiveness of the health promotional activity or activities is to be evaluated and if required changes need to be made. Next, the prevalence of the disease after the end of the project is to be estimated and then it has to be compared with the baseline established. Lastly, the impact evaluation of the project needs to be done.

Project Overview

Health is seen as an essential resource of everyday life and in order to live a fulfilling life, it is important that all the aspects of health are maintained. One of the ways in which a person or a community can achieve the optimum level of health is by the means of health promotion. By the means of health promotion, a person or the community can be enabled such that they can take care of their own health and reduce the impact disease can have on them. This project is developed such that it will be aimed to be completed over a period of one year. The health issue that is chosen is the one that is a chronic disease and the impact of the health promotional activity will require at least that much time.

First, a step that needs to be done is to establish a baseline data to obtain the percentage or number of people who are affected suffering from diabetes and the proportion of people who are in the category of prediabetic. This is an extensive procedure and will require time. For the purpose of this primary health centre in the community can be utilized and camp can be set for a free check of blood sugar of people in the community. This should include youth and adult population as per the rationale that is explained earlier. The time period that is allocated for this is one month.

Next, the formulation of health promotional activity which conforms to the principles of health promotion which was put forward in the Ottawa charter in 1986 (Thompson et al., 2018). The first principle is to build healthy public policy and for the current project, it is to reduce the incidence of diabetes. The second principle is to create a supportive environment which can be done by a reduction in the availability of carbohydrate-rich snacks in the schools and workplaces. The third principle is to strengthen community action. For this one day of the month is allocated for increasing the awareness in the community regarding diabetes and its impact. It has to be made sure that the way is innovative and reach the target population. The fourth principle is the development of personal skills. This can be achieved by means of health education. The prediabetic youths can be targeted in schools while the adults in the community where their knowledge about what they are eating is to be given. Along with this the importance of exercise is advocated them and the means of healthy eating and being more physical is made available to them. The last principle is the reorientation of health services. There is the existence of the national diabetic policy and it is required that the manpower allocation should be made accordingly so that it can cater to the needs of the population like availability of dietician or nutritionist. These health promotional activities are to be carried for a period of 8 months. At the middle that is in the fourth-month evaluation is to be done to understand the effectiveness and if required some changes can be incorporated. 

Next, the statistics are taken again at the end of the 10th month for estimating the percentage of people who are diabetic and it will be compared with the people who were prediabetic to know if there was any conversion. The time allocated for this will be one month as tracking the people from baseline is easier. Lastly, the evaluation of the program needs to be done and the time allocated for the same is one month.

Resource Identification

For the formulation of any project and further implementation of the same requires resources. The main resources that are required for the implementation of the health promotional activity are money, manpower, time, and infrastructure (Muellmann et al., 2017). There is a national policy for diabetes and it has fund allocation for the same which needs to be utilized for the current project. The use of the money will be for the remuneration for the professionals that will be present in the current project and the materials used to like making posters and pamphlets. It will also be used for the camps in first and the second last step and any kind of logistics that are associated with the project.

The project cannot work without manpower and the manpower that is required in the current project is nutritionist or dietician for the required people, laboratory and technician for the blood tests that are required. Community nurse for health education and involvement of school teachers for the same to be promoted in the school setting are other manpower that is required. Time as a resource has been considered and as mentioned before. Lastly, infrastructure is required for the implementation and first that is required is primary health centre of the community which can be used as the base for the project and also for the promotional activity in school it is used as another resource.

Program Evaluation

Before the start of the project, it is required that the involved stakeholders are involved in the decision-making process and their opinions are considered which can be done in the form of meeting or by conducting a survey. Program or project evaluation is the one which is a systematic method for the collection, analyzing, and the use of the information for developing the project further (Serra et al., 2019). There are two types of evaluation that need to be done in a project. One is process evaluation which is conducted during the time of the project. For the current project, the targeted population and the professionals that are involved in the project are asked to fill the survey form. This can be helpful in the collection of data regarding the effectiveness of the project and if there are any shortcomings which can be evaluated and required changes can be made. Another evaluation that is required and is done is impact evaluation which is to be conducted at the end of the project in which the above-mentioned process is repeated along with other things (Serra et al., 2019). Economic evaluation is conducted to understand the cost-effectiveness of the project (Serra et al., 2019). These can help in estimating the feasibility of the project and whether the required goal was achieved or not and if it requires to be extended.

Conclusion on Introduction to Specialty Practice: Community Health Nursing

Health is important and it is required to lead a fulfilling life and there are many aspects to good health. In recent times communicable diseases have reduced and non-communicable chronic diseases have increased. To reduce the impact and prevalence there are various measures taken nationally as well as internationally. In the present, the disease that is taken as an issue is diabetes which is seen as an increasing trend in Australia. Globally there is an increase of people in the prediabetic group and there are more youths in the category. For the current project, the goal set is to reduce the incidence of diabetes in the period of one year by the health promotion of people in the prediabetic category. There is a national policy which is 'Diabetes Australia' which works for the betterment of the same. The current project is proposed such that it will be completed over a period of one year. First, two months used for the collection of baseline data, next eight months for the health promotional activity, the eleventh month for collection of data and comparison to baseline and last month for evaluation. No project is complete without evaluation and in this project, three types of evaluations are required that is process, impact and economic evaluation.

References for Introduction to Specialty Practice: Community Health Nursing

Arnold, J. C. (2020). The importance of different knowledge types in health-related decisions—The example of type 2 diabetes. Sustainability12(8), 3396. https://doi.org/10.3390/su12083396.

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Bjerke, M. B., & Renger, R. (2017). Being smart about writing SMART objectives. Evaluation and Program Planning61, 125-127. https://doi.org/10.1016/j.evalprogplan.2016.12.009.

Davis, W. A., Peters, K. E., Makepeace, A., Griffiths, S., Bundell, C., Grant, S. F., ... & Davis, T. M. (2018). Prevalence of diabetes in Australia: Insights from the Fremantle Diabetes Study Phase II. Internal Medicine Journal48(7), 803-809. https://doi.org/10.1111/imj.13792.

Edelman, C. L., Mandle, C. L., & Kudzma, E. C. (2017). Health promotion throughout the life span-e-book. Elsevier Health Sciences.

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Friis, R. H., & Sellers, T. (2020). Epidemiology for public health practice. Jones & Bartlett Learning.

McLean, E. (2015). Chronic Disease Prevention and Management in Primary Health Care August 2015. https://daa.asn.au/wp-content/uploads/2017/01/Inquiry-into-Chronic-Disease-Prevention-and-Management-in-Primary-Health-Care.pdf

Moges, W. K., Muralidharan, A. R., & Tadesse, H. Z. (2018). Gaussian Longitudinal Analysis of Progression of Diabetes Mellitus Patients Using Fasting Blood Sugar Level: A Case of Debre Berhan Referral Hospital, Ethiopia. American Journal of Theoretical and Applied Statistics7(1), 21. https://doi.org/10.11648/j.ajtas.20180701.13.

Muellmann, S., Steenbock, B., De Cocker, K., De Craemer, M., Hayes, C., O’Shea, M. P., ... & Langøien, L. J. (2017). Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project. BMC Public Health17(1), 932. https://doi.org/10.1186/s12889-017-4929-9.

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Serra, C., Soler-Font, M., García, A. M., Peña, P., Vargas-Prada, S., & Ramada, J. M. (2019). Prevention and management of musculoskeletal pain in nursing staff by a multifaceted intervention in the workplace: Design of a cluster randomized controlled trial with effectiveness, process and economic evaluation (INTEVAL_Spain). BMC Public Health19(1), 348. https://doi.org/10.1186/s12889-019-6683-7.

Simonsen, N., Lahti, A., Suominen, S., Välimaa, R., Tynjälä, J., Roos, E., & Kannas, L. (2020). Empowerment-enabling home and school environments and self-rated health among Finnish adolescents. Health Promotion International35(1), 82-92. https://doi.org/10.1093/heapro/day104.

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Yazel-Smith, L. G., Pike, J., Lynch, D., Moore, C., Haberlin, K., Taylor, J., & Hannon, T. S. (2019). Blood sugar, your pancreas, and unicorns: the development of health education materials for youth with prediabetes. Health Promotion Practice20(4), 565-572. https://doi.org/10.1177/1524839918778555.

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