Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Adding Value to Stretched Communities through Nursing Actions: The Wellington South Nursing Initiative

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Adding Value to Stretched Communities through Nursing Actions: The Wellington South Nursing Initiative

Article excerpt

Nurses have a key role in improving access to health and health services to address disparities (Hughes, 2006; Smith, 2007). Individuals, families and communities experiencing disparities often have significant unmet needs and are generally 'stretched'. The day-to-day pressures for many people require considerable juggling (Watson & Mears, 1996), meaning there is often little time or energy to prioritise or practice healthy lifestyles and engage with publicly available health programmes and services (Punzalan et al., 2006). For children this may mean inadequate diets, dental health problems and education interruption (Mackay, 2003; Oberg & Aga, 2010; Walton, Signal, & Thompson, 2009). Nurses' contribution to addressing disparities is increasing through the provision of innovative personal and population-based health services (Nelson, Wright, Connor, Buckley, & Cumming, 2009).

While many nurse researchers have examined the development of personal services, few have examined population-based work with stretched communities. Yet population-based approaches are important for addressing the determinants of health locally and globally (Anderko, 2010; Dankwa-Mullan et al., 2010) and understanding nursing work in this area is a priority for research (Association for Community Health Nursing Education [ACHNE] Research Committee, 2010). Nurses in the United Kingdom (Royal College of Nursing, 2007) and in the United States of America (Olson Keller, Strohscheim, Lia-Hoagberg, & Schaffer, 2004) have identified key nursing actions/interventions in populationbased nursing work. These straddle case finding and case management through to coalition building and advocacy.

This paper reports on a study of the Wellington South Nursing Initiative (WSNI), an innovative nursing service working predominately with stretched communities from Miramar South and Strathmore, neighbouring suburbs in Wellington, the capital of New Zealand (NZ). The service is provided by two primary health care (PHC) nurses. WSNI's uniqueness as a successful nursing service illustrates: (i) key processes that can assist nurses to enter and work with stretched communities in urban settings; (ii) the tensions and benefits of nurses using a population approach with a remit of 'adding value' to what is presently in place; and (iii) how nurses can support and assist communities and existing health services and programmes to link and work together to improve the health outcomes of children, their families and the community. Researching WSNI was part of a study between nurse academics and nurses working in innovative services designed to explore how urban-based PHC nurses address health inequalities.

The paper is in four sections. It commences with an overview of the literature of nursing and stretched communities, focusing in particular on nursing and population health. It then summarises the case study design utilised in this research. The third section presents an overview of WSNI including an introduction to the community and what has been achieved through this initiative. The final section details and discusses the model of nursing practice that underpinned and contributed to the achievements.

STRETCHED COMMUNITIES AND NURSING

There is no one way to describe stretched communities. Their characteristics arise from the origin of extenuating circumstances such as poverty, poor housing, forced migration, or acute crises with ongoing impacts such as an environmental disaster (e.g., earthquake) or an industrial event (e.g., mine collapse). Terms used in the nursing literature to describe such communities include vulnerable (Sanders, Schneiderman, Loken, Lankenau, & Jackson Bloom, 2010), underserved (Schulz, Ludwick, Cukr, & Kelly, 2002) and disadvantaged (Griffiths et al., 2009). The term stretched is chosen over these other terms because it captures the opposing forces of elasticity and tension experienced by people and communities, and with a positive view indicates the potential for resilience and movement. …

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