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Partnering with Community Role of Nurses 

Introduction to Code of Conduct for Nurses

Nurses being one of the most fundamental parts of the healthcare system have various job roles depending on which the roles and responsibilities of the nurses change (Salmond & Echevarria, 2017). Whatever the job roles of the nurses might be, they are often the first point of contact for the patient in the healthcare system while seeking medical care. The nurses work in an acute care setting, residential care setting, emergency, mental health and community setting. Depending on where they work and the population they are catering for the roles of the nurse change. In a community setting, there are various different roles that the nurse might need to undertake like that of the treatment provider, health educator, help in screening and keeping a record of the health and illness in a community (Stanhope et al., 2019).

There are various communities who can be called disadvantaged communities because of their complex characteristics like being of socio-economic and healthcare problems and these communities require special attention as they lack role models and opportunity compared to other communities (Javanparast et al., 2018). Depending on the impact of the disease, the government of Australia has categorized a few diseases as national health priority areas. The aim of the present essay is to discuss the working of the nurse in partnership using a strength-based approach in high needs community to address diabetes mellitus.

Role of Nurses in A Community Setting

Nurses in a community setting work with people who are from different cultural backgrounds and it is seen that they are disadvantaged or marginalized population (Stanhope et al., 2019). In a community setting, a nurse has more autonomy compared to while working in an institutional setting and it is because of the difference in doctor population ratio (Spetz et al., 2017). They not only work for the provision of care to the patient but also they assume the role of a leader such that and have active participation in case of emergencies or to tackle a long-existing problem.

Nurses in a community setting for the betterment of the health of the community and work as an interpretative bridge between the healthcare sector and community so that the social model of health is vocalized by them (Price-Robertson,2011). Healthcare system of Australia is a three-tier system and it often becomes difficult for the patient to navigate through that and ultimately get the treatment that is required and community nurses work in such a way that the system can be interpreted and people who require them can navigate through and get the required help.

Nurses along with other community workers act as grass root level workers and work in an interdisciplinary team so that they can cater to the needs of the community (World Health Organization, 2020). The other discipline that nurses work with is acute care system of general physicians, specialty care settings, psychologists, aboriginal health worker and other allied health (Price-Robertson, 2011). Nurses while working in the community should have sound knowledge of how in the community they are going to be working in, the working knowledge of the government schemes and policies, have good communication skills and leadership skills (Mallion & Brooke, 2016).

Impact of The Disease

Diabetes mellitus is a chronic condition in which there is a high level of the blood glucose present in the people suffering from it. This is a result of either impaired insulin action or reduced production of insulin (Bełtowski et al., 2018). Depending on the type of impairment, diabetes can be either type I or type II former is autoimmune which generally occurs in younger age group but type II is due to desensitization of insulin receptor and it occurs in older age group and it is more related to the lifestyle of the affected people. For the year 2017-18, it was estimated that 1.2 million people in Australia were living with diabetes (Australian Institute of health and welfare, 2019).

It is one of the most common causes of the morbidity and mortality globally and in the year 2017 it was attributed to the largest number of hospitalization in Australia and was the cause of 11% deaths in the same year (Australian Bureau of Statistics, 2018). These statistics are national average for the nation but when communities are considered on an individual level it is often seen that the data is either not available or reliable and that makes the blanket approach not successful in a community setting.

This can be seen as a hidden health gap and as a nurse, it becomes a duty that while working in a community setting. When considering a disease like diabetes the social, environmental and lifestyle factors present in a community which raises factors responsible for the high number of cases in a community which makes diabetes mellitus as one of the national health priority areas (Zheng et al., 2018).

There are various factors that are present in a community which affect the prevalence and impact of a disease on people. As a community nurse, it is required that the nurse focuses on all these factors that are responsible for the disease being a health priority issue (Stanhope et al., 2019). Nurses have various roles to play and it should be in such a way that it is in collaboration with the community through partnership using a strength-based approach. This is done in such a way that there is the development of mutual, respectful and supportive collaborative efforts. One of the most effective ways to do that is by making sure that community for whom the work is done is empowered and becomes self-reliant.

Partnership in Education and Literacy

The link between health literacy, education and its impact on health are profound (Bröder et al., 2017). The level of education determines the socio-economic status of a person and it can affect various health-related behaviours like health-seeking behaviour and by understanding how a disease can affect them people can take necessary preventative measures to reduce the impact of the disease (Chen et al., 2017). As a nurse, the action can be directed towards all the sections of a community for imparting health education at all the levels so that the increased burden of the disease is tackled.

The most important role of the nurse working in the community is to mobilize the stakeholders at all the levels to make sure that there is collaboration, alignment and integration between the sectors of health and education. There should be the establishment of the working relationship between the health sector and local education body like schools (Chiang et al., 2015). The community nurse takes the role of school health nurse and the students can be educated about the signs and symptoms of diabetes and what necessary precautionary measures should be taken to reduce the incidence of the disease.

The idea behind doing this is that the education of children can help in imparting education to the family as well as to the community as a whole. Other roles of a nurse working in a community would be doing is that to increase the level of education of the adults in the community by increasing the health literacy about diabetes mellitus (Fooladi, 2015). It is a disease of lifestyle and health education of the adults is such that they can identify their behaviours and change for the betterment of their health. For the success of the educational intervention at the level of the school, it is important that the appropriate resources are leveraged like talking to the school authorities about integrating health with education (Nasca et al., 2019).

The next thing that the nurse needs to do is that appropriately utilize the available resources, for example, the community workers need to be motivated and mobilized so the resources are not concentrated in one area. For the adult population, the nurse can help in the conduction of community education which is specific to the age group which is more prone to the development of diabetes like the middle to old age-group. The health education that the nurse should impart is regarding the factors which cause diabetes, the lifestyle changes that affected people can take in terms of physical activity and change to a healthy diet (Marcus-Varwijk et al., 2020).

Partnership in Health Promotion

Community nurses are often at the forefront of providing healthcare to people living in a community and are an integral part of the healthcare system as the acute care that is being provided to the community is being more streamlined (Roden et al., 2015). Nurses in the community play an active role in the promotion of health as a part of healthcare practice. As a community nurse, the promotion of health would be made on the basis of principles of health promotion as the one given by the Ottawa charter (McBride et al., 2019). It is applicable to both individual and community as a whole. There are five basic principles and as a community nurse, it is necessary that all the principles are followed.

The first is building healthy public policy, in this case, the nurse would use the national policy for the reduction in the impact of diabetes mellitus should be understood and implemented at the level of community (Sykes et al., 2018). The next is to create a supportive environment both at home and at the workplace so that it does not promote the development and progression of diabetes mellitus. The lifestyle at the workplace should not be such that there is stagnation and should involve physical activity. As a nurse in a community, it is required that the required suggestion and implementation of the same are done for the workplaces. Another thing that can be done by the nurses is to have active participation to reduce the availability of confectionaries in the vicinity of the workplace and homes so that the consumption of high carbohydrate or sugar is reduced (Brabeck-Letmathe, 2016).

The next is to strengthen community action for health. The nurse can take part in the formulation of an action plan like doing a drive to encourage more people to join in the health drive for a healthy lifestyle (Rutledge et al., 2018). This can be done by the motivation of people as well as local community leaders to whom the nurse can pitch the idea. The idea of community action is to motivate the community to take diabetes seriously and another aspect of community action involves active screening and taking prompt action in case anyone is pre-diabetic. As a community nurse for the control of diabetes development of personal skills is required at the level of the individual as well as at the level of community. The main output is to give the responsibility of the health to an individual by empowering them.

The community is motivated to invest time, money and manpower for encouraging the people to get the help that is required to help in managing their diabetes and doing this it makes the community take in charge of its own health (Mendes, 2018). Lastly, a nurse should be able to help in the reorientation of health services like opening or promotion of diabetes care clinic and also a reduction in the health disparity that is present. A nurse plays a vital role by acting as a bridge between the community and healthcare system and is at the best vantage point to help the stakeholders to invest in the right sector as well as an allocation of healthcare professional should be done accordingly and nurses can help in making these decisions (Daivadanam, 2019).

In conclusion, nurses are interlinked with the framework of the healthcare system and they take on various job roles depending on their placement and their duties and responsibilities change. In the community, the nurses are such that they can help in the reduction of the impact of the disease and in the present essay diabetes mellitus is taken as one of the health priority areas. Disadvantaged communities are the ones which might not have access to proper healthcare and have health disparity due to the prevailing socio-economic condition. As a community nurse, one of the things that can be done is the provision of education to children as well as health literacy to adults which is done such that there community involvement. The other thing that the nurse should do is the promotion of health for community partnership as per the principles given by the Ottawa charter is to be used.

References for Code of Conduct for Nurses

Australian Bureau of Statistics. (2018). 4364.0. 55.001-National Health Survey: first results, 2017–18. https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2017-18~Main%20Features~Diabetes%20mellitus~50.

Australian Institute of health and welfare (2019). Diabetes. https://www.aihw.gov.au/reports/diabetes/diabetes-snapshot/contents/how-many-australians-have-diabetes/type-2-diabetes.

Bełtowski, J., Wójcicka, G., & Jamroz-Wiśniewska, A. (2018). Hydrogen sulfide in the regulation of insulin secretion and insulin sensitivity: Implications for the pathogenesis and treatment of diabetes mellitus. Biochemical Pharmacology149, 60-76. https://doi.org/10.1016/j.bcp.2018.01.004.

Brabeck-Letmathe, P. (2016). Nutrition for a better life: A journey from the origins of industrial food production to nutrigenomics. Campus Verlag.

Bröder, J., Okan, O., Bauer, U., Bruland, D., Schlupp, S., Bollweg, T. M., ... & Jordan, S. (2017). Health literacy in childhood and youth: A systematic review of definitions and models. BMC Public Health17(1), 361. https://doi.org/10.1186/s12889-017-4267-y.

Chen, K. J., Gao, S. S., Duangthip, D., Li, S. K. Y., Lo, E. C. M., & Chu, C. H. (2017). Dental caries status and its associated factors among 5-year-old Hong Kong children: a cross-sectional study. BMC Oral Health17(1), 121. https://doi.org/10.1186/s12903-017-0413-2.

Chiang, R. J., Meagher, W., & Slade, S. (2015). How the whole school, whole community, whole child model works: Creating greater alignment, integration, and collaboration between health and education. Journal of School Health85(11), 775-784. https://doi.org/10.1111/josh.12308.

Daivadanam, M. (2019). Community and stakeholders' engagement in the prevention and management of Type 2 diabetes: A qualitative study in socioeconomically disadvantaged suburbs in region Stockholm. Global Health Action, 12(1), 1609313. https://doi.org/10.1080/16549716.2019.1609313.

Fooladi, M. M. (2015). The role of nurses in community awareness and preventive health. International Journal of Community Based Nursing and Midwifery3(4), 328. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591566/.

Javanparast, S., Windle, A., Freeman, T., & Baum, F. (2018). Community health worker programs to improvehealthcare access and equity: Are they only relevant to low-and middle-income countries?. International Journal of Health Policy and Management7(10), 943. https://doi.org/10.15171/ijhpm.2018.53.

Mallion, J., & Brooke, J. (2016). Community-and hospital-based nurses’ implementation of evidence-based practice: Are there any differences?. British Journal of Community Nursing21(3), 148-154. https://doi.org/10.12968/bjcn.2016.21.3.148.

Marcus-Varwijk, A. E., Peters, L. L., Visscher, T. L., Smits, C. H., Ranchor, A. V., & Slaets, J. P. (2020). Impact of a nurse-led health promotion intervention in an aging population: Results from a quasi-experimental study on the “community health consultation offices for seniors”. Journal of Aging and Health32(1), 83-94. https://doi.org/10.1177/0898264318804946.

McBride, K. A., MacMillan, F., George, E. S., & Steiner, G. Z. (2019). Health promotion and social determinants of health. Social Determinants of Health, 131-152. http://handle.westernsydney.edu.au:8081/1959.7/uws:51222.

Mendes, P. (2018). Community as a ‘spray-on solution’: A case study of community engagement within the income management programme in Australia. Community Development Journal53(2), 210-227. https://doi.org/10.1093/cdj/bsx008.

Nasca, T. F., Changfoot, N., & Hill, S. D. (2019). Participatory planning in a low-income neighbourhood in Ontario, Canada: Building capacity and collaborative interactions for influence. Community Development Journal54(4), 622-642.https://doi.org/10.1093/cdj/bsy031.

Price-Robertson, R. (2011). What is community disadvantage? Understanding the issues, overcoming the problem. Communities and Families Clearinghouse Australia Resource Sheet. https://aifs.gov.au/cfca/publications/what-community-disadvantage-understanding-issues-ov.

Roden, J., Jarvis, L., Campbell-Crofts, S., & Whitehead, D. (2015). Australian rural, remote and urban community nurses' health promotion role and function. Health Promotion International31(3), 704-714. https://doi.org/10.1093/heapro/dav018.

Rutledge, G. E., Lane, K., Merlo, C., & Elmi, J. (2018). Coordinated approaches to strengthen state and local public health actions to prevent obesity, diabetes, and heart disease and stroke. Preventing Chronic Disease15. https://doi.org/10.5888/pcd15.170493.

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing36(1), 12. https://doi.org/10.1097/NOR.0000000000000308.

Spetz, J., Skillman, S. M., & Andrilla, C. H. A. (2017). Nurse practitioner autonomy and satisfaction in rural settings. Medical Care Research and Review74(2), 227-235. https://doi.org/10.1177/1077558716629584.

Stanhope, M., Faan, R. D., Lancaster, J., & Faan, R. P. (2019). Public health nursing e-book: Population-centered health care in the community. Mosby.

Sykes, S., Wills, J., & Popple, K. (2018). The role of community development in building critical health literacy. Community Development Journal53(4), 751-767. https://doi.org/10.1093/cdj/bsx019.

World Health Organization. (2020). State of the world's nursing 2020: Investing in education, jobs and leadership. https://apps.who.int/iris/bitstream/handle/10665/331677/9789240003279-eng.pdf.

Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology14(2), 88. https://doi.org/10.1038/nrendo.2017.151.

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