NUM3511 Assignment 2 - community health needs assessment project PDF

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community health needs assessment project...

Description

Assignment title:

Assessment 2

Unit code and Title:

NUM3511 – Community Health Care in Nursing and Midwifery Practice

Lecturer:

Carol Squire

Student Name:

Stefanie O’Connor

Student Number:

10181455

Date of Submission:

01/04/2021

Word Count:

1531

Table of Contents

Introduction...............................................................................................................................1 Demographics..........................................................................................................................1 Health Issues............................................................................................................................2 Social Determinants of Health...............................................................................................3 Discrimination.................................................................................................................3 Employment....................................................................................................................3 Health Care Access.......................................................................................................3 Identified Needs.......................................................................................................................4 Culturally Safe Care.......................................................................................................4 Mental Health..................................................................................................................5 Nutritional Education and Accessibility.......................................................................5 Conclusion................................................................................................................................5 References...............................................................................................................................7

1 Written Assignment Introduction The community health needs assessment (CHNA) is an important tool used to understand the health status and social requirements of a specific population (Guzys et al., 2021). The process of conducting assessments to inform practice is an important role of the registered nurse that is central to this exercise (Nursing and Midwifery Board of Australia [NMBA], 2016). This essay aims to outline the principles and processes of the assessment from the perspective of a community health nurse (CHN) working in an Aboriginal community in Derby. The CHN is imperative in the provision of primary health care using community partnership, interdisciplinary practice, health promotion and cultural safety (Yue et al., 2020). The collection and analysis of data provides an understanding of the region’s current health issues and needs (Guzys et al., 2021). Through collaboration with the community, these findings are used to form the basis for health promotion programs, resource distribution and planning to create and support a healthier community. Demographics The CHNA begins with research of community demographics using a range of datacollecting strategies. This can be done independently or through partnership with health professionals and community members and compared to the wider state of Western Australia (WA) (Guzys et al., 2021). Despite being one of the larger towns in the Kimberley, Derby is considered a remote region, with a population of over 2000 (Australian Bureau of Statistics [ABS], 2020). According to the ABS (2020), the Aboriginal community makes up 49% of the population compared to only 3% in WA. The community is significantly younger than the State with almost 50% of its residents under 20 years old (Western Australian Country Health Service [WACHS], 2018). As well as experiencing many health disparities, the region is also classed

2 as socio-economically disadvantaged, based on education, employment, income and housing (WACHS, 2018). Community health needs are serviced by the Derby Regional Hospital (DRH) and the Derby Aboriginal Health Service (DAHS) (Warwick et al., 2019). The DAHS provides valuable services encompassing the social model of health care which underpins community health nursing (Marley et al., 2014). This aligns with the Aboriginal definition of health which considers the physical, emotional, spiritual and social wellbeing of the community as a whole (Australian Institute of Health and Welfare [AIHW], 2016). Health Issues An analysis of secondary data can identify health issues amongst the population. Diabetes and kidney failure are noteworthy issues, with almost half of hospitalisations due to renal dialysis compared to only 3% amongst non-Aboriginal residents (WACHS, 2018). The rate of avoidable deaths caused by diabetes is 5.3 times higher than State, with Aboriginal people under 40 years old four times more likely to develop diabetes (WACHS, 2018). Infectious diseases are common and account for large numbers of hospitalisation and avoidable death (WACHS, 2018). Conditions including cellulitis, ear nose and throat infections and urinary tract infections are the leading causes of hospitalisation, whilst rheumatic heart disease is amongst the leading causes of avoidable mortality (WACHS, 2018). Mental illness and suicide are significant health issues amongst the community. Suicide is the leading cause of mortality, accounting for 20% of deaths (WACHS, 2018). This is noteworthy compared to rates of the State, with males 8.4 times more likely to commit suicide, and females 6.6 times more likely (WACHS, 2018).

3 Social Determinants of Health The CHN must consider the social determinants of health that effect the community so that implemented strategies can address these. These refer to a wide range of non-medical factors which effect health outcomes and equities amongst individuals and populations (World Health Organisation, 2017). Discrimination Discrimination is a fundamental cause of health inequality faced by the community. This can lead to a lack of participation in care and result in missed opportunities for necessary interventions (Chenhall & Senior, 2018). An alarming 97% of Aboriginal participants in a study by Kelaher et al. (2014) claimed to have experienced racism and discrimination in health care services at least once in their lives. This can be observed in the community where poor attendance in primary health care services has resulted in higher avoidable hospitalisation (WACHS, 2018). Employment The relationship between unemployment and poor health outcomes can be recognised in the CHNA. According to the AIHW (2016), lower employment and income groups are more likely to experience poor health throughout their lives. Unemployment and financial strain can be detrimental to a person’s physical, mental and emotional wellbeing (Pearson et al., 2020). The lower levels of employment and income in the community has impacted healthseeking behaviours, with the expense of many services discouraging participation in care (Warwick et al., 2019). Health Care Access Health care accessibility is a concern for the community as reduced access can lead to poor health outcomes (Pearson et al., 2020). Primary health care aims to identify modifiable conditions and risk factors and implement interventions to prevent avoidable hospitalisation

4 (Young et al., 2017). The CHNA shows that whilst Aboriginal residents account for 63% of emergency department attendances, the opposite can be seen for their utilisation of primary health care services (WACHS, 2018). This has resulted in avoidable mortality rates that are 2.5 times that of WA (WACHS, 2018). Primary data found that reasons for poor access include transport barriers, experiences of discrimination and a lack of education on the importance of early intervention (Warwick et al., 2019). Identified Needs Following a comprehensive collection and analysis of data, the CHN can identify a variety of felt, expressed and comparative needs of the community. Understanding the success of current services and programs as well as issues arising from a lack of adequate functioning is a fundamental process of the CHNA (Guzys et al., 2021). Disseminating results with the community is important in promoting engagement and a shared understanding of required action (Guzys et al., 2021). Collaboration is central to community health nursing and ensures a shared understanding of priorities between health care services and their consumers (Australian Commission on Safety and Quality in Health Care, 2017). Culturally Safe Care The need for modification and expansion of existing services to improve the delivery of culturally safe care is evident. Whilst the DAHS covers many primary services, their absence of after-hours care and emergency services highlights a need for further involvement in secondary and tertiary care to ensure cultural safety. Community surveys found that further partnership between the DAHS and DRH is required to eradicate discrimination and poor cultural competence, with expressed suggestions for community elder involvement (Warwick et al., 2019).

5 Mental Health The high rates of mental illness and suicide were a major concern. Despite suicide being the leading cause of death, statistics show that the community is only 1.5 times more likely to seek mental health care than the State (ABS, 2020). Although programs have been implemented in the region, their impact has proven to be inadequate. The DAHS’s Deadly Thinking program, for example, is a service aimed at emotional wellbeing and suicide prevention (DAHS, n.d.). However, at $198 per person, the expense of the workshop fails to reflect the financial capabilities of the community, highlighting the need for a more accessible service (Tighe et al., 2017). Nutritional Education and Accessibility Increased nutritional accessibility and education is a comparative need of the community. The high rates of diabetes and renal disease compared to the State highlight a gap in primary intervention to prevent avoidable health issues associated with poor diet. Webster et al. (2017) state that the remoteness of regional communities hinders access to fresh, quality produce and has resulted in poor adherence to a healthy diet. Participants in their study claimed that junk food marketing and affordability enabled poor food choices (Seear et al., 2020). The need for further promotion and availability of healthy foods was expressed by youth, who stated that whilst they had heard of diabetes, they were unaware of the risk factors (Seear et al., 2020). Conclusion Their findings indicated that those who experienced an episiotomy experienced more pain at 12–18 months postpartum, reported feeling “less strengthened” by childbirth and described their delivery as worse than expected compared with agematched controls who had not experienced an episiotomy. Their findings indicated that those who experienced an episiotomy experienced more pain at 12–18 months postpartum, reported feeling “less strengthened” by childbirth and described their delivery as worse than expected compared with agematched controls who had not experienced an episiotomy.

6 The CHNA is a fundamental process in understanding the needs of a chosen community and guiding resources to achieve maximising growth. The principles and processes of the CHNA can be explored by considering the perspective of a CHN working in an Aboriginal community in Derby. Primary and secondary data highlight health issues related to diabetes, mental health and infection amongst the community and their incidence compared to the wider population. Discrimination, unemployment and access to health care are social determinants of health which need to be acknowledged when managing a response. Following consideration of these factors, the need for improvements in culturally safe care, mental health services and nutritional education and accessibility can be recognised and guide future planning. Ultimately, successful health promotion and equity amongst any community requires respectful and meaningful collaboration between health professionals and the consumer to achieve optimal health outcomes.

7 References Australian Bureau of Statistics. (2020). 2016 census quickstats. https://www.abs.gov.au/websitedbs/D3310114.nsf/Home/2016%20QuickStats Australian Commission on Safety and Quality in Health Care. (2017). National safety and quality health service standards (2nd ed.). https://nationalstandards.safetyandquality.gov.au/ Australian Institute of Health and Welfare. (2016). Australia’s health 2016. https://www.aihw.gov.au/getmedia/9844cefb-7745-4dd8-9ee2-f4d1c3d6a727/19787AH16.pdf.aspx Derby Aboriginal Health Service. (n.d.). Derby aboriginal health service. https://www.derbyaboriginalhealthservice.org.au/ Chenhall, R. D., & Senior, K. (2018). Living the social determinants of health: assemblages in a remote aboriginal community. Medical Anthropology Quarterly, 32(2), 177–195. https://doi.org/10.1111/maq.12418 Guzys, D., Brown, R., Halcomb, E. & Whitehead, D. (2021). An introduction to community & primary heath care (3rd ed.). Cambridge University Press. Kelaher, M. A., Ferdinand, A. S., & Paradies, Y. (2014). Experiencing racism in health care: the mental health impacts for victorian aboriginal communities. Medical Journal of Australia, 201(1), 44–47. https://doi.org/10.5694/mja13.10503 Marley, J., Mc Loughlin, F., Atkinson, D., & Hadgraft, N. (2014). Aboriginal health research in the remote kimberley: an exploration of perceptions, attitudes and concerns of stakeholders. Bmc Health Services Research, 14(1), 1–11. https://doi.org/10.1186/s12913-014-0517-1

8 Nursing and Midwifery Board of Australia. (2016). Registered nurses standards for practice. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professionalstandards/registered-nurse-standards-for-practice.aspx Pearson, O., Schwartzkopff, K., Dawson, A., Hagger, C., Karagi, A., Davy, C., Brown, A., & Braunack-Mayer, A. (2020). Aboriginal community controlled health organisations address health equity through action on the social determinants of health of aboriginal and torres strait islander peoples in australia. Bmc Public Health, 20(1), 1859–1859. https://doi.org/10.1186/s12889-020-09943-4 Seear, K. H., Atkinson, D. N., Henderson-Yates, L. M., Lelievre, M. P., & Marley, J. V. (2020). Maboo wirriya, be healthy: community-directed development of an evidence-based diabetes prevention program for young aboriginal people in a remote australian town. Evaluation and Program Planning, 81. https://doi.org/10.1016/j.evalprogplan.2020.101818 Tighe, J., Shand, F., Ridani, R., Mackinnon, A., De La Mata, N., & Christensen, H. (2017). Ibobbly mobile health intervention for suicide prevention in australian indigenous youth: a pilot randomised controlled trial. Bmj Open, 7(1). https://doi.org/10.1136/bmjopen-2016-013518 WA Country Health Service. (2018). Kimberley health profile. http://www.wacountry.health.wa.gov.au/fileadmin/sections/publications/Publications_b y_topic_type/Reports_and_Profiles/eDoc_-_CO__Kimberley_Health_Profile_2018.pdf Warwick, S., Atkinson, D., Kitaura, T., LeLievre, M., & Marley, J. V. (2019). Young aboriginal people's perspective on access to health care in remote australia: hearing their voices. Progress in Community Health Partnerships, 13(2), 171–181. https://doi.org/10.1353/cpr.2019.0017

9 Webster, E., Johnson, C., Kemp, B., Smith, V., Johnson, M., & Townsend, B. (2017). Theory that explains an aboriginal perspective of learning to understand and manage diabetes. Australian and New Zealand Journal of Public Health, 41(1), 27–31. https://doi.org/10.1111/1753-6405.12605 World Health Organisation. (2017). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 Young, C., Tong, A., Gunasekera, H., Sherriff, S., Kalucy, D., Fernando, P., & Craig, J. C. (2017). Health professional and community perspectives on reducing barriers to accessing specialist health care in metropolitan aboriginal communities: a semistructured interview study. Journal of Paediatrics and Child Health, 53(3), 277–282. https://doi.org/10.1111/jpc.13374 Yue, P., Xu, T., Greene, B., Wang, Y., Wang, R., Dai, G., & Xu, L. (2020). Caring in community nursing practice: inductive content analysis reveals an inter-dynamic system between patients and nurses. Journal of Clinical Nursing, 29(15-16), 3025– 3041. https://doi.org/10.1111/jocn.15312...