Nursing Student Diaries – Community and Public Health – Entry 1
Nursing Assessment vs. Assumption + Health Care Cuts
My first three weeks of clinical placement at a community public health center have been enlightening as far as gaining a better understanding of the various roles and responsibilities that public nurses take on, as well as the different types of programming and clinical work that they do. I have already been able to see many examples of public health challenges at the individual, family, community, and system levels.
It has been interesting to broaden my own previous conceptualization of the entirety of the nursing process, which had been primarily limited to working with individuals and families in more of an acute care context. I had not really considered how a nursing diagnosis might be made regarding a whole population rather then a single client or family. Strangely, it was surprising to me how well the concepts of assessment, diagnosis, planning, intervention, and evaluating are expanded to working with larger populations.
I really enjoyed the experience of applying the “assessment” piece of the nursing process at a community level by performing a windshield survey. I had not anticipated how much information could be gathered by simply driving through, and walking around the neighborhood. Something that I found to be challenging while performing the survey was that, to a certain degree, some aspects of the assessment require one to make assumptions regarding what is being seen and what implications those observations may have. Much of relational nursing practice on an individual or family level relies on avoiding making assumptions regarding the lived experience of the client and how it shapes their thoughts/actions in any given context.
Because of this, I find it challenging to apply the same principles to the context of an assessment of a community or population as a whole. For example, when my group was doing a windshield assessment in a specific neighborhood, I saw a man who appeared disheveled and was wearing older, dirty looking clothes. One could assume many things about this man. Perhaps he is street-involved, or maybe just works in more of an industrial or agricultural setting that may cause his “shabby” looks. I think that it is important to acknowledge potential issues in making assumptions in performing any assessment, however I do appreciate that a windshield survey is only one piece of the community assessment puzzle.
While it bothered me a little to be making some assumptions in the process, the windshield survey combined with the previous day’s community facts, figures, and resources research, created a good base of assessment knowledge on which to build though utilizing other assessment methods that are more objective. By using different assessment strategies at the community level, one can potentially draw more accurate conclusions about the health and well being status of that community.
In the last week of my community health placement, I also had the opportunity to experience shadowing a Newborn/Maternal Public Health Nurse Liaison. During this experience I was able to have some really interesting discussions with the Public Health Nurse regarding some of the challenges faced in working in this setting. It was disappointing to hear that this liaison role had faced cutbacks to funding along the way, as the job had changed from a full-time, hospital funded position to a part-time, public health nurse role.
In several of the other hospitals in the region, the liaison role had been cut altogether and replaces with a series of transfer forms completed by the hospital RN and sent to the public health RN. While not particularly surprising, it is unfortunate to hear about these cutbacks because the liaison role provides new mothers with an early and visible connection to their community public health supports and resources.
While the forms may be straightforward enough for a maternity unit nurse to fill out prior to mom and babe’s discharge, that method may disrupt a mother's view and understanding of the continuity of care. As a new mother, possibly already feeling overwhelmed by all of the new information she has been told at the hospital, I can imagine it would be reassuring to see and meet someone who you will be connected to for support in the community.