Public Health Nursing Vol. 9 No. 2, pp. 138-139 0737- 1209/92/$6.00 0 1992 Blackwell Scientific Publications, Inc.
NOTES FROM THE FIELD Shifting Gears-ChanGngParadigms: A Vision for Community Health Nursing Beverly Leipert, B.S.N., M.S.N.(c), R.N. I read with interest the editorial, “QI, CQI, QM, TQM, TQI, AYE, AYE, AYE,” in the September 1991 issue of Public Health Nursing. I found particularly interesting the discussion of the shift from a provider orientation to a client and outcome orientation in quality health care. Especially noteworthy was the discussion of the need for a vision of quality health care from within community health nursing. As a community health nurse working in an agency that is undergoing just such a paradigm shift, and as a master’s degree student who is researching the value of community health nursing from the nurses’ perspective, I could not resist the editor’s invitation to respond. In September 1991 my particular health unit reorganized in an effort to address current public health by using a social health model as outlined by Epp (1986). This reorganization was initiated to improve the health of the community by clearly defining goals that recognize environmental as well as physiologic effects on health. This was a shift for nurses from a one-to-one, reactive model to a proactive, community-based model. Two years of meetings and discussions by nurses at the health unit preceded this move. From the discussions, a decision was made to divide community health nursing into three focus groups according to age: the children’s group, which includes individuals age 2 to 12 years; the youth group, 13 to 18 years; and the adult group, 19 to 55 years. Each nurse chose the focus group of his or her interest. Within the focus groups, the nurses discuss how best they can provide quality care that meets the needs of each particular community. The professional challenges are to determine the needs of the community and how nurses can best facilitate quality care to satisfy these needs. First, as a result of the shift from geographic to age-specific practice, almost every nurse has had at least one new community
Address correspondence to Beverly Leipert, 302-44 East 13 Avenue, Vancouver, British Columbiu, Canada VST 4K7.
138
to get to know and vice versa. Second, it is difficult to leave familiar, satisfying roles and activities such as home visits and other one-to-one activities for the uncharted territory of community development. Third, there is the fear of failure and the difficulty in determining if indeed one is succeeding or failing to address the needs of the community. Finally, the whole process of assessing and identifying community needs, as we all know, is often slow, invisible, and time consuming. However, from my perspective as one involved in this process, I have a firm sense that we are making headway. All too often we and the communities we serve are looking for dramatic and revolutionary changes, changes that make good newspaper headlines. This, however, is not the only measure of progress. At the very least, nurses using a community-development approach are taking the time and making the effort to stand back and assess the quality of our practices. We are asking questions and looking for answers to the issue of quality health care for human communities. What has helped us to make these moves? First, community health leaders in one particular unit have a vision that the social health model and the communitydevelopment approach are effective ways to access and address health issues and needs. Nurse administrators sought input from community health nurses in the planning and implementation stages of this new self-reflective way of thinking. This consultation process helped the nurses to assess for themselves the value of this vision, Second, these nurse administrators encourage nurses to be innovative, to think of new ideas and new approaches. Failures and setbacks are accepted as part of the process by both nurses and administration. Third, communication between and among the focus groups helps to keep everyone informed, in touch, and involved. The support of all of our colleagues is invaluable as we leave behind the familiar and step into new territory. In short, now that nurses are better educated than ever before, this is a most empowering environment, and empowered nurses are better able to empower clients and communities.
Leipert: A Vision for Community Health Nursing
My experience in the evolvement and implementation of this social health model using community-development methods in Vancouver demonstrated to me the importance of a vision of, for, and by community health nurses. Equally important is the involvement of the consumers and participants in their vision of the kind of health care they want for themselves and their commu-
139
nities. Then quality health care can become a reality for us all. REFERENCE Epp, .I. (1986). Achieving health for all: A framework for health promotion. Ottawa: Health and Welfare Canada.
NOTES FROM THE FIELD Shifting Gears-ChanGngParadigms: A Vision for Community Health Nursing Beverly Leipert, B.S.N., M.S.N.(c), R.N. I read with interest the editorial, “QI, CQI, QM, TQM, TQI, AYE, AYE, AYE,” in the September 1991 issue of Public Health Nursing. I found particularly interesting the discussion of the shift from a provider orientation to a client and outcome orientation in quality health care. Especially noteworthy was the discussion of the need for a vision of quality health care from within community health nursing. As a community health nurse working in an agency that is undergoing just such a paradigm shift, and as a master’s degree student who is researching the value of community health nursing from the nurses’ perspective, I could not resist the editor’s invitation to respond. In September 1991 my particular health unit reorganized in an effort to address current public health by using a social health model as outlined by Epp (1986). This reorganization was initiated to improve the health of the community by clearly defining goals that recognize environmental as well as physiologic effects on health. This was a shift for nurses from a one-to-one, reactive model to a proactive, community-based model. Two years of meetings and discussions by nurses at the health unit preceded this move. From the discussions, a decision was made to divide community health nursing into three focus groups according to age: the children’s group, which includes individuals age 2 to 12 years; the youth group, 13 to 18 years; and the adult group, 19 to 55 years. Each nurse chose the focus group of his or her interest. Within the focus groups, the nurses discuss how best they can provide quality care that meets the needs of each particular community. The professional challenges are to determine the needs of the community and how nurses can best facilitate quality care to satisfy these needs. First, as a result of the shift from geographic to age-specific practice, almost every nurse has had at least one new community
Address correspondence to Beverly Leipert, 302-44 East 13 Avenue, Vancouver, British Columbiu, Canada VST 4K7.
138
to get to know and vice versa. Second, it is difficult to leave familiar, satisfying roles and activities such as home visits and other one-to-one activities for the uncharted territory of community development. Third, there is the fear of failure and the difficulty in determining if indeed one is succeeding or failing to address the needs of the community. Finally, the whole process of assessing and identifying community needs, as we all know, is often slow, invisible, and time consuming. However, from my perspective as one involved in this process, I have a firm sense that we are making headway. All too often we and the communities we serve are looking for dramatic and revolutionary changes, changes that make good newspaper headlines. This, however, is not the only measure of progress. At the very least, nurses using a community-development approach are taking the time and making the effort to stand back and assess the quality of our practices. We are asking questions and looking for answers to the issue of quality health care for human communities. What has helped us to make these moves? First, community health leaders in one particular unit have a vision that the social health model and the communitydevelopment approach are effective ways to access and address health issues and needs. Nurse administrators sought input from community health nurses in the planning and implementation stages of this new self-reflective way of thinking. This consultation process helped the nurses to assess for themselves the value of this vision, Second, these nurse administrators encourage nurses to be innovative, to think of new ideas and new approaches. Failures and setbacks are accepted as part of the process by both nurses and administration. Third, communication between and among the focus groups helps to keep everyone informed, in touch, and involved. The support of all of our colleagues is invaluable as we leave behind the familiar and step into new territory. In short, now that nurses are better educated than ever before, this is a most empowering environment, and empowered nurses are better able to empower clients and communities.
Leipert: A Vision for Community Health Nursing
My experience in the evolvement and implementation of this social health model using community-development methods in Vancouver demonstrated to me the importance of a vision of, for, and by community health nurses. Equally important is the involvement of the consumers and participants in their vision of the kind of health care they want for themselves and their commu-
139
nities. Then quality health care can become a reality for us all. REFERENCE Epp, .I. (1986). Achieving health for all: A framework for health promotion. Ottawa: Health and Welfare Canada.
