The Challenge of Shifting the Focus of
Care from Hospital to Homes:
Can Nurses Meet Community Needs?
Contribution of Leslie K. Hardy
Panel - May 31,1995
Child Health 2000
International Pediatric Nursing Conference
Vancouver, BC.
Introduction
When I heard the title of the panel (and the question therein), I thought - should there be a question? I think that comes from the work in which I've been engaged over the past two years - developing a curriculum for a nursing program in brand new university. My colleagues and I, at UNBC had the challenge of structuring a curriculum which would be
- relevant to the regional community
- moving into community care which would include primary health care, continuing care, health promotion and
- accountable to that community
What I would like to do is to discuss how we explored meeting these aspects and at the end, to answer the question posed to the panel.
The Region and the Challenges
The region we are expected to serve constitutes the top half of the province and a quick look at a map would indicate that the characteristics of this region include
- it is northern.
- there are many rural residents as there is only one city of 73,000 (Prince George), several towns under 15,000
population and a number of small towns or villages.
- there are a number of isolated places, mostly by air, others reached only by long distances by road.
- the geography creates challenges as there are mountains, dense forests.
- the climate can create treacherous conditions for travel in winter - blizzards, black ice on the roads.
- the population is scattered, with a cultural variety (35% of the province's aboriginal population reside in this area; there
are pockets of South Asian Canadians, Chinese Canadians) and, on average, the residents of the North are younger.
- there is also the economic vulnerability created by one industry towns (mining, oil industry, forestry).
These factors create a community of a certain profile and health challenges include
- for the younger age group (25-44 years) MVA rates are high.
- life expectance in the region where UNBC is located (Northern Interior) is the worst in the province.
- teen pregnancy rates are 2 to 3 times higher than the rest of the province.
- illiteracy rates (measured as being less than grade 9 education are the highest.
- aboriginally health concerns include an infant mortality rate twice the provincial rate, high suicide rates, and the fact
on average, First Nations people in B,C. live 7-10 fewer years than other B.C. residents.
These challenges are ripe for community nursing action.
Additional issues which are more general include;
- access issues. How do the residents access regional facilities as well as lower mainland services for territory care?
- recruitment and retention of health care professionals of all sorts.
- basic professional education in which non-urban health care (knowledge and skills) is included. This is very much linked to the recruitment and retention issue. If students are not exposed to the topic they will see rural and remote health are as less important, less prestigious.
These few features being to define this community, to outline the parameters which distinguish it from other communities. For community nursing there are issues which are different:
- There are fewer health professionals for larger geographic, sparsely populated areas. How do nurses ensure service?
- We face what I refer to as "ruralism" in our policy makers. Policies are constructed for urban practice without due attention to the impact on rural and remote practice.
- Traditional values with regard to women's roles, to the physician as the ultimate in health care presents in the north. Thus, it is expected. that the burden of community care will fall on women in families. As well, accepting primary health care by nurses will be more of a struggle.
All of this mean that there will be a greater demand on nurses in the community.
Conclusion
While all of this seems daunting, it is exciting for we have the opportunity to.
- rethink our role, to use all of our skills, to meet real need,
- influence the changes occurring in health care.
The question for me is not "can we meet community needs?" but "how can we do it?" We have been preaching PHC community nursing for years now is the time to show that we weren't bluffing, that we believe in our own rhetoric.