Cardiovascular disease has been identified as a major health problem in the city of Baltimore, claiming more than two thousand lives in the year 2005 and has been identified as a leading cause of death for both males and females alike by the year 2007 (2). Thousands of individuals suffer significant disability or chronic illness due to this disease. Equally important is the fact that the death rate for heart disease in Baltimore is 30% higher compared to other states along with diseases such as stroke and diabetes. About 25 to 35 percent of Baltimore resident also report having high blood pressure, which is a major precursor of both stroke and heart disease. Actual rates are estimated to be higher as many individuals often do not know that they have the disease.
The increasing trend of cardiovascular disease within communities can be attributed to the interplay between various social and economic factors. Today, health disparities still exist between the rich and poor as well as those belonging in minority populations. Various research studies have demonstrated that concentrated poverty, as experienced in racially diverse communities, exacts multiple costs on both individuals and society. They combine to limit the opportunities and quality of life available to residents of high-poverty communities, especially for people of color, who face the greater likelihood of being segregated in urban communities where the rates of poverty are very high. At the same time, costs associated with healthcare were steadfastly rising and it was even estimated that the costs of healthcare for a family of four will double in 10 years and will continue to rise (WHO, 2011). Furthermore, 50% of personal bankruptcies resulted from medical expenses. In fact, a large proportion of individuals cite barriers such as financial incapacity as a major reason for not seeking medical assistance or treatment. In one study, it was found out that 20% of citizens who typically delay healthcare consultations are African-Americans, have no insurance coverage and are below the socio-economic pole. Immigrants are also another population group that would delay treatment as they experience communication difficulties. Particularly, they may even believe healers or folk medicine rather than consult a doctor or health care professionals. Furthermore, delayed treatment is another barrier towards achieving health and wellness. In terms of social factors, it is typically the family and one’s culture that serves as a major influence in developing a healthy lifestyle. However, peers can often serve as a major influence in development of healthy habits, particularly when the fast food culture is gaining popularity among school-aged children.
To address the increasing prevalence of cardiovascular disease, there is expectedly greater need for establishing strong and positive community relations. Programs that are directed towards proper management of cardiovascular disease have been proven to be very effective in controlling the number of patients suffering from it. Nurses, especially, also play an important role as they deliver health education and discharge planning as proven in various clinical studies, research and practice. Communication forms that vital link in establishing and maintaining connection to the community and building a favorable relationship necessary to project a good image for the agency or the organization. This is also crucial in establishing trust and in identifying and addressing the concerns of the community. In the community setting, the nurse is responsible for building relationships with the community and by being responsive to the changes it continually undergoes. The nurse must become an active part of the community by knowing the members, their needs and the available resources and then working to establish effective health promotion and disease prevention programs. The context of community based nursing is family-centered care within the community, thus the nurse should have a strong knowledge regarding family theory, principles of communication, group dynamics and cultural diversity as vulnerable clients frequently come from varied cultures, have different beliefs and values, few sources of social support and may face language barriers (Chalmers et al 1998). The client/family unit is in equal partnership with health care professionals.
As nurses, teaching is one of the focal points in the role of a nurse as nurses are expected to conduct health education to patients as well as teach colleagues and junior staff. The nurse aims to educate the family about the necessary care techniques, how to integrate care within family activities, and allows the family to assume a greater percentage of care in graduated increments. This is critical in order to attain a leadership role in health care regardless of the practice setting (Stanhope and Lancaster 2000). Health care providers must also learn to provide basic information regarding health promotion and disease prevention at a language that is easily understandable by the client. Family members must be encouraged to work towards a certain goal in achieving optimal health and should be allowed to make their own informed decisions regarding the management of their condition. Another strategy to ensure that the needs of the population are met is through continuous evaluation of current practices or interventions. In fact, process evaluation provides insight on which interventions work thus equating to positive implications both in the field of research and in practice as well. With all these steps taken into consideration, the disparities that exist today in healthcare may be decreased.
Chalmers K.L et al (1998). The changing environment of community health practice and education:perception of staff nurses, administrators and educators. Journal of Nursing Education 37:109
Levine D.M. et al. (2003). The effectiveness of a community/academic health center partnership in decreasing the level of blood pressure in an urban African-America population. Ethn Dis. 13:354-361
Meads, G. et al (2005). The case for interprofessional collaboration in health and social care. Wiley-Blackwell.
Smedley, B.D. et al. (2003). For the Committee on Understanding and Eliminating
Rational and Ethnic Disparities in Health Care, ed. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy of Science
Stanhope, M. & Lancaster, J. (2000). Community and public health nursing. 5th edition Mosby, St. Louis
World Health Organization (2011). World health statistics 2011. Geneva: World Health Organization.