The aim of the report is to critically analyse the assessment of health needs for a chosen individual patient within the community. The rationale for this is to demonstrate an understanding of the theoretical and practical links in caring for individuals in the community. The definition of community will be discussed and the patient and community profile will be introduced. The relevant demographic and epidemiology factors will be examined and the social and kinship support networks will be identified and how they work together to provide individual holistic patient care. The role of the service providers in the community will be discussed and finally the impact of current legislation on the overall care provided will be analysed.
To protect the patient’s confidentiality in accordance with the Nursing and Midwifery Council (NMC) Code of Professional Conduct (2002) the pseudonym Betty Smith will be used to refer to the patient. Informed consent was sought from the community nursing team and verbal consent from the patient.
The meaning and significance of community varies enormously and how one defines this is important because it influences how community representatives may be identified and communicated with (Williams and Wright, 1998). Turton and Orr (1993) argue that problems of definition exist when looking at the word community. It is very difficult to identify a cross section of a community and there are some groups of people who are hard to reach. These include homeless people, unemployed people, asylum seekers, and minority ethnic groups (Naidoo and Wills, 2000).
Ewles and Simnett (1992) suggest that community can be defined as a network of people. The link between them may be a housing estate or an area in which they live. It might even be the work they do, their ethnic background or there may be some other common factor. Naidoo and Wills (2000) support this view and add that any geographical community will include people whose primary identity is based on different factors such as class, race, gender or sexual orientation and therefore people may belong to several different communities.
Community care may be seen to have a much wider meaning, not necessarily relating to sickness, but to other aspects of care delivery which could be applicable to the whole community (Watson and Wilkinson, 2001). Community health nursing is professional nursing directed towards communities or population groups as well as individuals living in the community. It includes assessment of the whole environmental, social and personal factors, which influence the health status of the targeted population (Royal College of Nursing (RCN), 1992).
- Patient Profile
Betty Smith is a 73 year old retired lady who lives by herself in a bungalow based in Evington. She has lived in Leicester all her life and was brought up by her mother and farther in Highfields and was their only child. She has a daughter who lives in Wigston and visits Betty regularly and has two sons, one living in Norfolk and the other in Berkshire both who are building contractors and visit Betty when they are free. She has 6 grandchildren, 3 of which live in Leicester. By profession Betty was a book keeper, however she was a licensed land lady for 8 years, care assistant and went on to become a Matron at the YMCA. Her hobbies include reading, which she has been doing from the age of 3, crosswords, watching all sports and watching the television. She has a network of friends and neighbours in the area and has recently started going out for meals, shopping and walks with them. See Appendix 1 for a detailed patient profile.
- Community Profile
The health both of Betty and her community may be affected by demographical and epidemiological factors (Watson and Wilkinson, 2001). This is particularly relevant to the District Nurse’s (DN’s) as they are concerned about the health status and health care of sick adults in the community (Blackie and Appleby, 1998). The demographic information was obtained from the 2001 Census (Appendix 1) and the epidemiology statistics were obtained from the 2004 practice profile (Appendix 2) and the Public Health Profile (2004) of Evington and its surrounding areas (Appendix 3).
Betty’s community of Evington lies East of Leicestershire (Appendix 4) and is described as a
Village. The total population of Evington is 9,788 (National Statistics, 2001), which is 3% of the total population of Leicester city. The age structure (Figure 1) resembles a similarity to the rest of Leicestershire although more than half of the percentage of people in Evington are over the age of 60. Wilkinson (1996) suggests that this age group makes up a significant proportion of the DN caseload and may have an obvious impact on the workload. Gastrell and Edwards (1996) reported that life expectancy has increased markedly during this century and as a consequence of longevity there are a rising proportion of elderly persons within the population and an increase demand in health provisions. The National Service Framework (NSF) for older people, (2001) supports this finding and suggests that elderly people have been recognised by the government as the main users of healthcare.