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Give a definition of what a community is – it is not solely geography, but includes factors of culture, ethnicity, age, etc. Consider principles of community care and critically discuss how a PHN in Ireland could ensure that care provided in her particular community is both inclusive and comprehensive.
A community may be defined in many different ways. Community care can also be defined differentially, maybe in relation to a fundamental philosophy, may in terms of imposed limitations and definitions of community delineation.
One definition of;community’ is “A social group of any size whose members reside in a specific locality, share government, and often have a common cultural and historical heritage” (http://www.sustainablemeasures.com/Training/Indicators/Cmmunty.html). This notion of community identifies the key elements of community in relation to healthcare that concern healthcare service providers and policy makers. Communities can be defined in terms of their location, but it is not enough to delineate communities in terms of specific areas, because communities are not simply collections of people who are in close proximity with each other by happenstance (Webb, 1986). Communities occur because of features which bring people together, often because of need, such as family support, or because of common interest, such as healthcare support groups. However, not all groups which share a common interest are communities (Trevilion, 1993). Location and purpose seem to be aspects of community, sharing not only common interest but common activities and common purposes, common concerns and common needs (Sines et al, 2005).
Culture, ethnicity, age, gender, sexuality, all of these can be characteristics which define a community, but they could also be different elements of identities and needs within a particular community. For example, it is possible to talk of traveller community health, traveller women’s health, gay men’s health, and the like, and thus we are referring to communities which may exist within geographical communities, or despite geographical boundaries (McMurray, 2003).
Within the United Kingdom, issues surrounding community health and wellbeing have concerned healthcare providers, particularly in defining distinct communities or sectors of communities, in order to identify health needs and develop and mobilise services in order to meet those needs (Lewis, 1999). However, these needs and the communities focused on have been traditionally limited to government-defined communities or definitions of who belongs to what community (Lewis, 1999). More recently, the re-orientation of UK healthcare services towards a more patient-centred model has led to the upsurge of service user involvement in design, development and evaluation of services (Pickar et al, 2002; Simpson et al, 2006; Tait and Lester, 2005; Telford and Faulkner, 2004; Humphreys, 2005).
This could be viewed as a means of breaking down the traditional hierarchical barriers between ‘the community’ or communities being served by healthcare providers, and the providers themselves (Telford and Faulkner, 2004). Addressing community needs can be informal, local, or national and formal, and seems to form part of governance strategies in the UK and Ireland (DoHC, 2001). Such strategies also now seem to focus not only on the service user information role, through gathering feedback and through service user involvement (Poulton, 1997), but also the need for greater collaboration, within and between healthcare and community/ social care/ voluntary sector agencies (Cumberledge, 1986; Fisher et al, 1999). These are all very good ideals, but in order to make user involvement and collaborative approaches work, information needs to be applied to practice, and practice needs to be changed for the better. This requires staff at some level to enforce these changes.
It might be that the Public Health Nursing role within the Irish community healthcare context could be viewed as one of the loci for the enforcement of community-oriented healthcare provision. However, more information is needed on how this ‘enforcement’ of change could be achieved through this role. For example, collaborative care planning, needs assessment and care provision has existed for decades (see for example, Webb, 1986), but this kind of joined up working is still not a reality of practice, with failings in communication and challenges of interprofessional working still dogging the footsteps of primary healthcare providers (Poulton and West, 1999). If healthcare providers cannot work well with each other, they set a poor example for joined up working with community-focused or community-derived groups, as well as individuals who identify themselves as belonging to certain communities.
Community services within the Irish context cover both health services –primary, secondary and tertiary – and social care services, all of which are supposed to meet the needs of the individual and the community. However, provision and suitability of services can vary by location. Because of the diverse nature of communities, it might be difficult to provide services which meet all community needs in any given location. This would suggest a need for flexibility of care provision, and again underlines the need for good inter-professional, inter-disciplinary, and inter-agency working. Public Health Nurses are accustomed to working with multiple professions and agencies, but there is a need to re-evaluate concepts of diversity in relation to the communities which occur within their sphere of practice.
Community is a term which encompasses many aspects of social life. Healthcare services which have a community focus would have to be very flexible, adaptable, and even creative, because of the increasingly diverse nature of communities. This diversity emerges not only from social changes, some of which are driven by economic, media and technological changes, but also by new understandings of communities and their inherent components, differences and similarities. Community focused models of service design and provision are those which would involve service users in design, planning, governance and evaluation of services, but such involvement must be representative of the increasing diversity of the communities concerned.
Public health nurses are in a good position to access and support all sectors of the community within the Irish context, and to support service users to provide input into all levels of health and social care provision, even into healthcare professional education. However, understanding communities is an ongoing issue and services must be designed to reflect the true needs of each community. As such, they must be responsive rather than prescriptive.
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