Public health is a science of promoting health, prolonging life, and preventing disease through informed choices and organized effort of individuals and communities, society, public and private organizations (Bresnick, 2017). It is primarily concerned with threats to health according to population health analysis. Also, it utilizes interdisciplinary approaches to occupational health, epidemiology, insurance medicine, biostatics, public policy, environmental health, health economics, community health, behavioral health, and other essential subfields. On the other hand, community health focuses on specific geographical areas, and it incorporates tertiary, primary, and secondary healthcare (Bresnick, 2017). It is primarily concerned with local policies and government in comparison to other health approaches. The objective of community health efforts is to encourage healthy living where populations play, learn, and work. Some of the projects in community health include underlying socioeconomic disparities and challenges in rural and urban areas.
Community-oriented nursing focuses on evaluating and understanding the broad needs of a community (Stanhope & Lancaster, 2017). They primarily focus on healthcare coordination, health promotion, disease prevention, and health education for the benefit of communities. Also, they identify high-risk groups within particular communities. According to the American Public Health Association, public health nursing is a specialty that incorporates skills and knowledge from public health nursing and sciences to improve community health (Stanhope & Lancaster, 2017). Nurses are required to reach out from vulnerable populations who may benefit from an intervention or service. Also, it is highly likely that people who are in urgent need of public health interventions are the least likely to request for such services such as people affected by the opioid epidemic. On the other hand, community-based nursing is oriented towards managing chronic or acute conditions while promoting self-care among families and individual clients (Stanhope & Lancaster, 2017). Through family-centered care, nurses counsel and teach clients so that they can develop healthy ways of taking care of themselves.
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Guiding Principles in Community Nursing
12 Principles of Community Health
They include:
Public health should critically address the basic requirements for health and causes of diseases while preventing negative health outcomes (Thomas, 2002).
Public health must address community health in a manner that respects individual rights in a community.
Public health priorities, policies, and programs must be evaluated and developed through techniques that incorporate community members’ input.
Public health should work and advocate for the disenfranchised populations by ensuring they access basic conditions and resources essential for healthy living.
Public health should evaluate and collect information necessary to implement effective programs and policies that promote and protect health.
Public health organizations should offer community members with information so that they can make key decisions regarding programs and policies while ensuring they obtain consent before implementing programs or policies (Thomas, 2002).
Also, public health should act responsibly and in a timely manner according to the resources, information, and mandate given by the public.
Public health should ensure that all their employees are professionally competent.
Furthermore, public health policies and programs should be implemented in a way that improves the social and physical environment.
Public health employees and institutions should foster affiliations and collaborations in a manner that enhances the institution’s efficiency and builds public trust.
Public health policies and programs should utilize a variety of techniques that respect and anticipate cultures, diverse values, and beliefs in the community (Thomas, 2002).
Public health institutions must respect the confidentiality of individuals and information that can cause harm to the community or individual if the information is made public. However, exceptions should be justified according to its impact on other people.
Ethical Tenets
The ethical tenets include:
Promoting support and advocacy for all disenfranchised people in the community.
Preventing harm
Trustworthiness
Do no harm
Ensuring professional competency
Promoting good
Respecting confidentiality, autonomy, and diversity.
Respecting both community and individual rights.
Transcultural Nursing
The diverse cultural and ethnic backgrounds of people requiring community health addiction and rehabilitation services needs cultural competency. The Campinha-Bacote's model is a framework that assists healthcare providers in developing culturally responsive services that address the needs of a multicultural population. The model views cultural competency as an ongoing process that a healthcare provider continuously seeks to provide healthcare services in the client’s cultural context (Campinha-Bacote, 2002). It incorporates the integration of cultural desire, cultural awareness, cultural encounters, cultural skill, and cultural knowledge. It has five primary assumptions:
Cultural competency is not an event but a process.
It consists of five constructs: cultural desire, cultural awareness, cultural encounters, cultural skill, and cultural knowledge.
There are more variations and diversity within ethnic groups in comparison to across ethnic groups.
There is a direct relationship between a healthcare provider’s ability to offer culturally responsive services and their professional competency (Campinha-Bacote, 2002).
Cultural competency is a significant component in providing culturally responsive and effective services to ethnically and culturally diverse clients.
Constructs of the Campinha-Bacote Model
Cultural awareness. It refers to an in-depth exploration and self-examination of an individual’s professional and cultural background (Campinha-Bacote, 2002). It allows an individual to recognize a person’s assumptions, biases, and prejudices about people who are different.
Cultural knowledge. It is the process of searching and acquiring adequate educational foundation regarding diverse ethnic and cultural groups (Campinha-Bacote, 2002). It allows healthcare providers to utilize knowledge to address the diverse needs of a multicultural population.
Cultural skill. It describes the ability to gather accurate and relevant data about a client’s presenting problems while conducting a culturally based physical assessment (Campinha-Bacote, 2002). It allows culturally competent professionals to evaluate clients according to their practices, cultural values, and beliefs to identify their diverse needs.
Cultural encounter. It is a process that encourages healthcare providers to interact with clients from diverse cultural backgrounds (Campinha-Bacote, 2002). Directly interacting with diverse cultural groups modifies and refines a person’s existing beliefs regarding particular cultural groups while preventing possible biases or stereotypes.
Cultural desire. It describes a healthcare provider's motivation to engage in a process that makes them culturally familiar, aware, skillful, and knowledgeable (Campinha-Bacote, 2002). It is a genuine emotion and passion to be willing to learn, accept diversity, and build on differences.
The five constructs have an interdependent relationship. Moreover, healthcare providers can work from any construct to enhance their cultural balance. Also, they show the true nature of the cultural competency process. The model can be used in all areas of practice by healthcare providers including community health addiction and rehabilitation services.
Community Health Setting of Addiction and Rehab Services
Treatment
Drug treatment is essential when assisting addicted individuals to overcome compulsive drug use. There are three main evidence-based approaches to treating drug abuse: behavioral therapy, medication, and a combination of medication and behavioral therapy ( NIDA, 2018) . The type of treatment is based on the patient's individual requirements and the type of drugs used. Treatment medications, such as naltrexone, methadone, and buprenorphine, are available for people addicted to opioids while bupropion, varenicline, and nicotine preparations are available for people addicted to tobacco. Acamprosate, disulfiram, and dependence are available for alcohol addicts. Although buprenorphine is used to treat heroin addicts, it can also be used to treat people who are addicted to opioid pain medications. On the other hand, behavioral therapies assist addicts in participating in drug treatment while offering methods of avoiding drugs, preventing relapse, and coping with drug cravings. Moreover, they help people to enhance parenting skills, communications, and relationships.
Ethical Issues
There are ethical issues regarding the growing opioid epidemic in the US. The country is in the midst of a growing health crisis that is claiming lives and straining the limited healthcare budget. Although it is a prescription-only drug, opioids have caused many deaths. Practitioners are faced with a serious challenge of opioid prescription. When is it safe to prescribe opioids? There are increasing challenges for effective and safe pain management that have been made worse by the fragmented communication and care across practitioners and settings for different situations (Rieder, 2017). Also, how should practitioners respond without adversely affecting pain patients? Moreover, how can opioid prescription be modified to avoid opioid addiction? Also, is opioid therapy morally appropriate? Clinicians should only prescribe the drug when necessary. Furthermore, patients should only go into opioid therapy if they are fully aware of the benefits and risks associated with opioids.
The term paper has evaluated the significance of cultural competence when addressing community health addiction and rehabilitation services. In addition to cultural competence, nurses should incorporate the 12 principles of community health and ethical tenets to address the diverse needs of a multicultural population through the Campinha Bacote model. Drug addiction treatment involves three main strategies: behavioral therapy, medication, and a combination of medication and behavioral therapy. However, drug treatment, especially opioid therapy, is facing serious ethical concerns. There is a growing opioid epidemic in the US. Due to fragmented communication and care across practitioners and settings for different situations, the opioid epidemic has become worse. Other than addressing the cultural needs of patients, practitioners should evaluate the possible risks associated with opioid treatment.
References
Bresnick, J. (2017). How do population health, public health, and community health differ? Retrieved from https://healthitanalytics.com/news/how-do-population-health-public-health-community-health-differ
Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of transcultural nursing , 13 (3), 181-184.
NIDA. (2018). Treatment Approaches for Drug Addiction. Retrieved from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
Rieder, T. (2017) Am ethical dilemma for doctors: When is it okay to prescribe opioids? Retrieved from https://www.statnews.com/2017/09/26/ethical-dilemma-doctors-ok-prescribe-opioids/
Stanhope, M., & Lancaster, J. (2017). Foundations for Population Health in Community/Public Health Nursing-E-Book . Elsevier Health Sciences.
Thomas, J. C. (2002, July). A Code of Ethics for Public Health. Retrieved from NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/
