Nursing and The Community - PDF

Running head: NURSING AND THE COMMUNITY
Nursing and the community
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Community health services are essential in local regions to encourage and support
residents to remain healthy and prevent transmission of disease in the community. It plays a key
role in meeting health care needs of uninsured people and the community health workers play an
active role in meeting the unique needs of the communities. They are involved in creating
connections between health care system and people at risk of disease, managing care for
vulnerable group, determining health insurance plan and collaborating with health care providers
to understand community health needs (Payne et al., 2017). This essay provides a detailed
discussion on the function of Kyneton District Health service and the type of service provided by
the service along with typical patient population covered by the service. It also compares the role
and responsibilities of the nurse in the practice setting and the type of support available for
LGBTI person in the community health setting.
Kyneton District Health (KDH) Service is part of the Macedon Range community and it
provides local health service to around 42, 000 people living in Shire and surrounding area. The
core vision of KDH is to provide positive experience during care to all patients and keep track of
their performance on a regular basis (Kyneton District Health Service :: Home, 2017). KDH also
work in partnership with the Cobaw Community health service where staffs provide variety of
community health service to residents living across Macedon Shire (Cobaw Community Health
Service, 2017). A wide array of service is provided by KDH such as acute services, allied health
service, care in home, maternity care, surgical service and urgent care centre. In the area of acute
services, KDH supports local hospitals to provide variety of specialty services. The pharmacy
department, the North West Dialysis service, radiology and pathology service are also part of the
acute care service at KDH. The Macedon Range Community nursing team also delivers other
care programs such as district nursing, pose-acute care, transition care program, hospital in the

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home, palliative respite care and life limiting illness care. The community nursing team plays a
great role in chronic disease management, medication management, pain management, wound
care and developing care plans (Kyneton District Health Service :: Acute Services, 2017).
KDH is mainly serving the residents living at the Macedon Ranges Shire Council. The
council is located in central Victoria and has a population of about 47, 512 people according to
2016. The review of the population profile at Kyneton district has revealed that there are low
proportion of pre-schoolers in the district and high percentage of people at post retirement age.
Hence, considering the age structure of the community, the demand for age based service is high.
Therefore, My Aged Care is also a part of the care program of KDH that provides the best
service to meet the health needs of older people in the community. Another important service of
KDH is the Treehouse program, which is an innovative social program that helps to provide
health care service at home to people living with chronic or life limiting illness. This has helped
many people to become independent and return to meaningful activities in life (Community
profile | Kyneton District | profile.id., 2017).
Kyneton District Health Service has been able to achieve their vision because of the
contribution of nurses in the community setting. With the support of the KDH community
nursing team, KDH has been able to provide health care service at home and other services like
palliative and respite care. The district nurses have the responsibility to treat and manage health
of people of all ages and they provide quality support to patients by visiting their home. One of
the advantages of the district nurse is that they are qualified and well-trained in their work thus
bringing efficiency in the service. The nurses also have the duty to respect patients, engage them
in decision making, maintain privacy and confidentiality of patient’s information and advocate
for the care of patient (Kyneton District Health Service :: Care in Your Home, 2017). These role

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and responsibility are similar to the NMBA standards of registered nursing practice as it
mentions about engaging in therapeutic and professional relationship and providing safe and
responsive quality nursing practice. Hence, the responsibility of the district nurse to advocate for
patient is similar to NMBA standard 6 which states that registered nurse must delegate and
implement ethical goal directions actions (Nursing and Midwifery Board of Australia -
Registered nurse standards for practice, 2017).
The registered nurse at KDH has been found to cover a variety of roles such as pain
management, chronic disease management, medication management and many other roles.
Although other collaborative partners like health care professional and regional health care
partners also plays a key role in providing community care, however majority of service is
provided by district nurse. Their experience and expertise has helped in successfully integrating
wide variety of service and their main focus is to deliver the best care to patient (Kyneton
District Health Service :: Home, 2017). This responsibility has been fulfilled by building
effective therapeutic relationship patients. Research literature has also given lot of evidence
regarding building therapeutic relationship with patient. For instance, Sherwood & Zomorodi,
(2014) has defined that respect, genuineness, empathy, active communication, trust and
confidentiality are the underlying principles of therapeutic relationship and these values are also
a professional responsibility of nurses working at KDH. The core purpose of therapeutic
relationship is to support people in a way to promote healing and enhance functioning in patient.
The district nurse at KDH have gone a step ahead to fulfill this requirement by going to the home
of chronically ill patients to provide care (Kyneton District Health Service :: Care in Your Home,
2017). The success of the district nurse in building capacity is also dependent on level of support
provided by the Kyneton District Health Service. This is also explained by Bridges et al., (2013)

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as the study showed that nature of organizational setting can affect nurse’s capacity to build and
sustain therapeutic relationship with patient.
Complexity and moral dilemma is inherent in nursing practice and relational aspects of
nursing care are also critical to overcome such dilemma. KDH has emphasized on reducing the
ethical dilemma for nurses and this is evident by their claim that they ensure that patient’s right
to privacy and confidentiality of information will be ensures and all their staffs will properly
handle all personal and health information of patient. All staffs at the community health service
are committed to store patient’s information in a secure manner and comply with all standards of
the Health Records Act 2001 in Victoria. The privacy principles provided in the Act guides staff
to collect, use and store information in a secure manner (Kyneton District Health Service::
Privacy of Patient Health Information, 2017).
Research evidence has also given idea about the growing issues related to information
security and privacy in health care setting. Erickson & Millar, (2005) has explained that
advocating for patient’s right to privacy and confidentiality is the key role of nurse, however
there is a need to renew this commitment because privacy issues has increased within the health
care environment. Although all nurses are aware of their duty to respect patient’s confidentiality,
however challenges for nurses in maintaining confidentiality arises because of the development
of advanced technology and new demands in health care. Health Insurance Portability and
Accountability Act is one of the national legislation standards that protect patient’s right to
confidentiality of information. In case of KDH, the Health Record Act 2001 was a reference for
staff to maintain confidentiality standards. Feo et al., (2017) recommended that maintaining
integrity of nurse-patient relationship is the most crucial element to comply with patient’s
privacy and confidentiality requirement in health care or community setting.

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The review of roles and responsibilities in the KDH community health service also gives
the idea that it is the responsibility of carers to obtain all information to manage and attend to
client whenever required. Any concerns or issues experienced by the client are also
communicated to the Macedon Ranges Community Nursing staff. Ensuring professional
relationship with clients and being respectful to all people involved in care is also a key
responsibility (Kyneton District Health Service :: Care in Your Home, 2017). The review of
community nurse role also clarified regarding the difference in their role compared to hospital
nurse. For example, the hospital nurses have a single focus of attending to hospitalized patients
in health care setting, however community nurse have multiple role as they are designated to
provide to population of specific regions. Another important difference is that clinician is the
main medical authority who directs hospital nurse, however the community nurse get medical
autonomy to take decision, plan and implement nursing care measures for patients. The nursing
team at KDH also gets the liberty to take decision of shifting patients between home and hospital
based on their changes in symptoms. On the whole, it can be concluded that community nurse
like those recruited at KDH play a role not just in providing care inside hospital, but they also
engage in community awareness and preventive health role. They have the resilience skill and
ability to manage health care issues of diverse population (Fooladi, 2015). Hence, nurses play a
crucial role in the success of community health care program.
The KDH community health service is one of the community health services available in
Victoria to serve the people residing at Macedon Ranges community. By entering into
partnership with Cobaw Community Health service, KDH has also played an influential role in
serving the health care needs of LGBTI (lesbian, gay, bi, transgender, intersex) community.
They respect the diversity present in Victoria’s community and hence have implemented specific

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care program for LGBTI community. They are responsive to the health needs of LGBTI
community by working under the values of compassion, integrity, respect, commitment and
equity (Cobaw Community Health Service, 2017). Their flexibility is the main strength that has
enabled them to be innovative in service provision for LGBTI. Some of the relevant health and
human services available in Victoria for the health and well-being of LGBTI groups includes
general health care service, aged care service, mental health service, LGBTI inclusive service,
alcohol and drug service and sexual health service (Lesbian, gay, bisexual, transgender and
intersex health, 2017).
The presence of such health care service and support for LGBTI Victorians is also
necessary because this group faces discrimination which affects their physical and mental health
and eventually experience poorer health outcomes compared to other Victorians. Mental health,
general health, alcohol and other drug service are common health care service for this group
because there are many evidence regarding the impairment in health in these areas. LGBTI
people experiencing systemic discrimination and stigmatization are found to suffer from
emotional distress, anxiety and depression. Family rejection and being rendered homeless also
increases mental health issues and increase the risk of suicide attempts too (Friedman 2014). The
research literature by Russell & Fish, (2016) also highlights about mental health problem in
LGBTI youth. They are at high risk for compromised mental health because of negative
experience in society. Due to social acceptance issues in society, LGBTI youth are mainly
diagnosed with mood disorder, anxiety disorder and substance use disorder. In such situation,
several community based treatment and therapy are essential for them. The focus on developing
mental health service by KDH and Cobaw community health service is the right approach to
address health care disparities in LGBTI group.

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One of the influential LGBTI specific health care project that has been implemented in
Victoria is the Healthy Equal Youth project which had the main purpose of improving the mental
health of LGBTI youths. The Victorian government has arranged funding programs to promote
mental health and well-being in this group. This will act as an effective step to reduce the
suffering of LGBTI people and give them equal rights in society (Lesbian, gay, bisexual,
transgender and intersex health, 2017). Taking such kind of responsibility for the disadvantaged
section of the society is also a necessary component of community health service. Experience of
stigma and discrimination has been a reason for poor mental health as well as poor access to
mental health care for this group (Russell, & Fish, 2016). The identification of stigma as a barrier
for LGBTI in accessing health care service is also demonstrated by Whitehead, Shaver &
Stephenson, (2016) as the study showed that experience of stigma and fear of disclosing sexual
orientation drives many people away from health care service. This affects the health care
utilization rate in this group. In such situation, local agencies and community health agency hold
an important responsibility to prevent illness and address health issues in the group. KDH has
implemented specific health service for this group, however it is recommended that they focus
on implementing those interventions that decrease stigma and increase LGBTI group intention to
disclose their identity to health care providers. Such approach will be beneficial in increasing the
health care utilization rate and improving health outcomes in this group.
Social issues and family violence is a major problem for LGBTI people. Cobaw’s support
for LGBTI group is also evident from the commitment that they will protect all clients exposed
to violence and provide inclusive health care service specific to health needs of this group.
Cobaw staff collaborate with KDH staff to ensure that their clients get access to safe and
inclusive care. Their specific goal for promoting health and well being of LGBTI people is to

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provide information to them about LGBTI service, value and respect the diversity of this group
and appropriately train the staff to provide necessary care to this group (Cobaw Community
Health Service, 2017). Hence, as a community health service, it can be said that KDH is taking
step in the right direction to ensure that all people irrespective of their sex, gender and race get
the equal right and access to health care in the community. The importance of their inclusive
service is that LGBTI people will never feel uncomfortable while revealing their sensitive
information to the staffs. They have the right environment and values to ensure that clients never
have a bad experience with them. Such approach is critical to provide the right support to this
group because research has showed that LGBTI people are discriminated by the health care staffs
too. Hence, when primary health care service cannot serve the health needs of LGBTI people,
community health service like KDH can act as the right means of support for this people.
The essay summarized the service and roles and responsibilities of staffs working at the
KDH community health service in collaboration with Cobaw community health service to
illustrate how promote health and well-being of Victorian community. The strength and
weakness of its service and staff action has been evaluated with support from relevant research
evidence. There focus on respecting the diversity in the communication is also evidence from the
implementation of inclusive service for LGBTI people. In the future, they can contribute in a
significant way to make LGBTI people feel safe and develop trusting relationship with health
care providers in Victoria.

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Reference
Bridges, J., Nicholson, C., Maben, J., Pope, C., Flatley, M., Wilkinson, C., ... & Tziggili, M.
(2013). Capacity for care: meta‐ethnography of acute care nurses' experiences of the
nurse‐patient relationship. Journal of Advanced Nursing, 69(4), 760-772.
Cobaw Community Health Service. (2017). Cobaw Community Health Service. Retrieved 18
November 2017, from https://www.cobaw.org.au/
Community profile | Kyneton District | profile.id. (2017). Profile.id.com.au. Retrieved 18
November 2017, from http://profile.id.com.au/macedon-ranges?WebID=110
Erickson, J., & Millar, S. (2005). Caring for patients while respecting their privacy: renewing our
commitment. Online journal of issues in nursing, 10(2).
Feo, R., Rasmussen, P., Wiechula, R., Conroy, T., & Kitson, A. (2017). Developing effective
and caring nurse-patient relationships. Nursing Standard, 31(28), 54-63.
Fooladi, M. M. (2015). The Role of Nurses in Community Awareness and Preventive
Health. International journal of community based nursing and midwifery, 3(4), 328.
Friedman, M. (2014). The psychological impact of LGBT discrimination: How the LGBT
community is being harmed each and every day. Brick by Brick.
Kyneton District Health Service :: Acute Services. (2017). Kynetonhealth.org.au. Retrieved 18
November 2017, from http://www.kynetonhealth.org.au/index.php/our-services/acute-
services/

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Kyneton District Health Service :: Care in Your Home. (2017). Kynetonhealth.org.au. Retrieved
19 November 2017, from
http://www.kynetonhealth.org.au/index.php/our-services/community/
Kyneton District Health Service :: Home. (2017). Kynetonhealth.org.au. Retrieved 18 November
2017, from http://www.kynetonhealth.org.au/
Kyneton District Health Service :: Privacy of Patient Health Information.
(2017). Kynetonhealth.org.au. Retrieved 19 November 2017, from
http://www.kynetonhealth.org.au/index.php/patients-visitors/privacy-patient-health-
inforamtion/
Lesbian, gay, bisexual, transgender and intersex health. (2017). Www2.health.vic.gov.au.
Retrieved 19 November 2017, from
https://www2.health.vic.gov.au/about/populations/lgbti-health/understanding-lgbti-health
Nursing and Midwifery Board of Australia - Registered nurse standards for practice.
(2017). Nursingmidwiferyboard.gov.au. Retrieved 19 November 2017, from
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards/registered-nurse-standards-for-practice.aspx
Payne, J., Razi, S., Emery, K., Quattrone, W., & Tardif-Douglin, M. (2017). Integrating
Community Health Workers (CHWs) into Health Care Organizations. Journal of
Community Health, 1-8.
Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender
(LGBT) youth. Annual review of clinical psychology, 12, 465-487.

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Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender
(LGBT) youth. Annual review of clinical psychology, 12, 465-487.
Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: the QSEN
competencies redefine nurses' roles in practice. Nephrology Nursing Journal, 41(1), 15.
Whitehead, J., Shaver, J., & Stephenson, R. (2016). Outness, stigma, and primary health care
utilization among rural LGBT populations. PloS one, 11(1), e0146139.