Community Nursing



Question1: Collaboration

Collaborationamong the health care providers and the health care agencies is oneof the key factors that can reduce the rate of medical errors in thehealth care industry and enhance the treatment outcome. Collaborationin the health care is mostly hampered by poor communication, which inturn leads to inefficiency and adverse events. Collaboration can beenhanced in three major ways. First, the standardized handoff can beused to enhance transitions of care. This can be achieved through thedevelopment of handoff systems that are highly usable and haveinformation that is clinically relevant. This is consistent with therecommendation 8 that calls for a promulgation of standardizedminimum data sets in all professions and states (The Institute ofMedicine, 2010).

Secondly,the use of effective communication between the health care agenciesand health care providers and between providers and their clients canenhance collaboration significantly. An effective communication willfacilitate an appropriate flow of information among the stakeholders,which is the backbone of collaboration. For example, a required bythe recommendation 8 that the health care agencies (including theWorkforce Commission) should field survey each year, expand datacollection, and release its survey results quickly can onlycontribute towards an improvement in outcome if there is an effectivecommunication (The Institute of Medicine, 2010). This is because thecollection of valid and reliable data and the process of analyzingthat data require all participants to communicate and collaborateeffectively.

Third,collaboration across the health care sector can be achieved ifstandard processes and validated tools (such checklists and real-timebalanced scorecards) are used. The use of standard tools andprocesses can help the stakeholders in the health care sectorovercome the challenge of variations and be able to collaborateeffectively. This will in turn minimize errors, enhance efficiency,and outcome.

Question2: Ethics and diversity

Thefirst National CLAS Standard calls for the provision of equitable,respectful, quality and understandable health care in an effectiveway. Health care should also be responsive to the specific needs ofthe target communities. These needs include the cultural healthpractices, beliefs, language, communication needs, and healthliteracy among others (Office of Minority Health, Department ofHealth and Human Services, 2013). In essence, the first standardcalls for the respect of all people looking for health careirrespective of their cultural differences with the health careproviders.

Oneway to implement the principles of equality in the health care sectoris through adequate training of all health care providers. Thetraining program should focus on the key health practices and beliefsof the target community. For example, some Black Americans believethat the supernatural powers have a role in the occurrence ofdiseases (Oben, 2015). This means that the treatment process shouldembrace these beliefs and practices in order to attract thecollaboration of the black Americans. Administrators in the healthcare sector can design training programs that will increase thecultural competence of the health care providers. These trainingprograms should focus on helping the health care providers learn howto communicate with clients who come from different cultural grounds(including the black Americans) other than their own cultural group.This will ensure that the specific health care needs of the blackAmericans are adequately addressed. The treatment outcome will thenincrease since the black Americans will collaborate with the healthcare providers once they are convinced that the health care system issensitive to their specific needs.


Oben,N. (2015). How culture influences health beliefs. EuroMed Information.Retrieved august 18, 2015, from

Officeof Minority Health, Department of Health and Human Services (2013).National standards for culturally and linguistically appropriateservices in health and health care: a blueprint for advancing andsustaining CLAS policy and practice. Officeof Minority Health, Department of Health and Human Services.Retrieved from

TheInstitute of Medicine (2010). The future of nursing leading change,advancing health. TheInstitute of Medicine.Recommendation 8. Retrieved from

Community Nursing


Controlof communicable diseases- Prince George’s County, Fort Washington,Mary Land

Communicablediseases are the diseases spread from one person to another. Thespread occur via bacteria, airborne viruses, blood, or through bodilyfluids. Communicable diseases are also known as contagious orinfectious diseases. Examples of communicable diseases includeinfluenza, chicken pox, Ebola, hepatitis, HIV/AIDS, tuberculosis,among others (Browne,Hartrick, Reimer, MacLeod, and McLellan, 2010).In Prince George County, the most common communicable disease ispolio (poliomyelitis), virus that invades the nervous system of achild. Polio is a horrendous disease affects infants and youngchildren below the age of five years and can cause a lifetimecrippling condition. According to statistics, ten percent of poliocases get to paralysis stages and can cause death. Unfortunately,polio does not have cure. However, there two vaccines used to preventit.

Epidemiology,Spread, and Prevention

Casesof polio can occur both in epidemics and sporadically. According toresearch, 70-80% of polio victims are affected when they are belowthree years, while among them, 90% are unapparent (Rychetnik,Frommer, Hawe, and Shiell, 2002).The patient suffers from severe muscle pain, stiff neck, and to agreater extends, paralysis. The legs are the most affected comparedto other parts of the body. Normally, it spreads from one person toanother through faecal-oral route. Foodstuffs, such as milk and othercontaminated food with faeces are also known to act as a catalyst tothe spread of the disease. The public should be educated on theadvantages of immunization, as well as the safest disposal of humanfaeces. Additionally, at birth, a child should receive a trivalentlive attenuated vaccine.

CommunityHealth Nursing Intervention

Thiscommunity health nursing intervention in prevention of polio willinclude immunization, contact information, among other primarymeasures to deal with polio cases.

  1. Immunization- parents and the public will be educated on the causes and the prevention of the disease. In addition, they will be educated on the importance of immunization. Besides, we will engage the ministry of health and the government should to take the initiative and provide free immunization to children below five years. Similarly, we will campaign for the access to immunization services for all citizens.

  2. Contact information- this will involves educating providers about the legal requirements when reporting cases of communicable diseases, particularly polio. Additionally, we will advocate for effective contact notification services. Further, we will promote contact notification to the health providers and educate them about contact information.


Preventionsare the procedure taken to prevent occurrence of the disease, as wellas minimise its effects after it has occurred (Browneet. al, 2010).The intervention will address two levels of prevention: primary andsecondary prevention.


Primaryprevention promotes health, as well as protect against healththreats. In addition, it promotes protective factors and reduces riskfactors. Rychetnik(2002) states that primary prevention protects a disease fromoccurring in the first place hence, implemented before the problem.In this case, immunization against polio is the primary prevention.


Secondaryprevention detects and treats the disease in its early stages(Keller,Strohschein, and Briske (2008).It prevents the disease from causing serious effects or spreading toother people. Unlike the primary prevention, secondary preventiontakes place after the problem has begun. Therefore, it will targetpopulation at risk and the affected population.


Thisnursing intervention will target the whole population living in thePrince George County, particular parents with young children. Inaddition, research while be carried out in elementary school to comeup with detailed information on the spread of the disease. Theintervention will take place at schools, places of worship, publicmeeting, door-to-door campaigns, among other places. To ensure thetargeted population get the message, the intervention will take placeseveral times. The message will be spread out thrice a week for fourmonths. To achieve this, three levels of practises will be used:community level, system level, and individual/family level ofpractice. At each level, the intervention will contribute to thesuccess of ensuring healthy population. All the three levels areequally important, and in some cases, they are addressedsimultaneously. Every school nurse is likely to encounter theoccurrence of vaccine-preventable disease at one time or the otherdue to missing or delayed immunizations. According to the Centres forDiseases Control and Prevention (2005), this is expected inregardless of the population focus or work setting.

CommunityLevel of Practise

Theprimary goal of community level of practise is to educate the entirecommunity on the importance of polio immunization, as well thenegative consequences of immunization failure. This strategy willincrease the number of immunised children. At this level, the schoolnurses will work closely with the health educators on publicawareness campaigns. They will target the community at the schools,county fairs, community festivals, senior centres, and neighbourhoodLaundromats. The nurses will audit of immunization records at schoolsto identify the number of immunised children. In case of apolio-affected child, the nurses with work with the epidemiologiststo deal with the situation. Further, the nurses will assess childrenimmunization status and ensure appropriate treatment. In case of apolio outbreak in schools, it will be the nurse’s ethicalresponsibility to conduct immunization to the affected population.

SystemsLevel of Practise

Theprimary goal of system level of practise is to advocate for effectivelaws, practises, and policies of immunizations such as improvedclinic and services (Rippke,Briske, Keller, and Strohschein, 2001).At this level, the school nurses will work closely with clinics,schools, and parents to come up with population-based immunizationregistries, also known as immunization information systems. On theother hand, the registry will provide an official record forimmunization for schools within the county. The registry track willremind the parents on the next immunization.

Individual/FamilyLevel of Practice

Theprimary goal of individual level of practise is to identifyunimmunized children and ensure their immunizations are updated.Unlike the community level, individual level does not target aparticular population. The responsibility of the school nurse is toidentify children with delayed or missed immunization, assess thebarrier, and contact their parents and advice them how to obtainimmunization. Later, the nurse will follow up to ensure the childreceive the vaccine.

Proposedevaluation methods

Accessingthe health status of sample population, collection, and analysis ofqualitative and quantitative data is relevant. Qualitative data willbe collected interviews whereby parents will be interviewed on howthey occasionally take their children for immunization. Data analysiswill identify from expected rates of the disease and its riskfactors.


Poliointervention in the Prince George County should be given a priority,given that polio is a cruel disease that has no cure. As people say,prevention is better than cure, immunization against polio should begiven to all children below five years old. Failure to do so, in thesome years, there will be many paralysed adults because of polio.Nevertheless, it is recommendable for the school nurses to advocateand continue participating in polio prevention campaigns.


Browne,A. J., Hartrick Doane, G., Reimer, J., MacLeod, M. L., &ampMcLellan, E. (2010). Public health nursing practice with ‘highpriority’families: the significance of contextualizing‘risk’.&nbspNursingInquiry,&nbsp17(1),27-38.

Keller,L. O., Strohschein, S., &amp Briske, L. (2008). Population-basedpublic health nursing practice: The intervention wheel.&nbspPublichealth nursing: Population-centered health care in the community,186-214.

Rippke,M., Briske, L., Keller, L., &amp Strohschein, S. (2001). Publichealth interventions: Applications for public health nursingpractice.&nbspRetrievedNovember,&nbsp7,2009.

Rychetnik,L., Frommer, M., Hawe, P., &amp Shiell, A. (2002). Criteria forevaluating evidence on public health interventions.&nbspJournalof epidemiology and community health,&nbsp56(2),119-127.

Community Nursing



  1. Affordable Care Act (ACA)

Itis clear from the website that health insurance marketplaces areorganizations created to assist in the acquisition of affordablehealth insurance in agreement with Affordable Care Act. People fromFort Washington community can greatly benefit from health insurancesince it protects people from unanticipated high medical expenditure.It is highly advisable for people undergoing life changes such asgetting married, about to get a baby, moving out, losing anotherhealth cover, to enrol for a health coverage, since they stand togain a lot. It is important to point out that when an open enlistmentperiod for a particular year is over, one can still enrol for thatyear’s coverage on two conditions: i) due to life changes such asmarriage, preparing to get a baby or cancellation of other coverage,and ii) Through Medicaid which covers the poor. However, Medicare isnot part of the Health Insurance Market place, since they areconsidered. People from Fort Washington, Mary Land stand to getvarious benefits by enrolling in health insurance market place suchas: access to free preventive care like vaccines and check-ups.

Incase of an emergency, a person covered by health insurance marketplace can access care from the nearest hospital. The hospital shouldtreat a person regardless whether they have insurance since theinsurance company cannot charge more for accessing emergency servicesfrom a hospital which is considered out-of-network. There are someplans that existed long before health care law was signed, nowreferred to as “grandfathered plans”. Grandfathered plans areconsidered non-marketplace and when its plan year ends, it can eitherbe cancelled, changed to cover the new rights and protections or theinsurance company can allow one to renew the plan without the newrights and protections.

  1. Environmental Health

Ididn’t know that many of the rivers in Fort Washington, Mary Landare impaired and the causes for impairment have not been recorded.Rivers such as Paul Spring Branch, Little Hunting Creek andPiscataway Creek have all been damaged and this causes a seriousconcern to the residents’ health. I also didn’t know that FortWashington community has been adversely affected due to water and airpollution. All organisms depend on clean water to sustain life andwhen water bodies are destroyed or polluted, they become a healthhazard not only to people but all other organisms especially theaquatic organisms. Consumption of polluted water causes waterbornediseases such as cholera, typhoid and dysentery. On the other hand,burning of hydrocarbons such as fossil fuels has been established byEPA as the main source of air pollution in Fort Washington, MaryLand. Hydrocarbons have contributed greatly to the depletion of theozone layer exposing Fort Washington residents to harmful radiationswhich are highly harmful to their health

Asa community health nurse, I would first ensure that all no personfrom Fort Washington community consumes water from the impairedrivers. Secondly, I would ensure all the impaired water bodies havebeen assessed to determine the causes of impairment. Havingestablished the root cause of the damage, I would educate thecommunity on how best to prevent water pollution and raise theirawareness on the impact of polluted water sources on their health. Iwill also liaise with the l appropriate local organizations in chargeon assessing and ensuring water quality to ensure the right measuresare put in place to clean up the impaired water bodies. It is alsoimportant to work closely with the local organizations in charge ofcontrolling air pollution, to formulate and implement effectivepolicies to reduce air pollution especially through hydrocarbons.


EPA,United States, Environmental Protection Agency. Available at,38.73946,-77.00153&ampcLat=&ampcLon=&amppSearch=Fort%20Washington,%20MD Availableat