Communities as a whole can have many different risks to the health of the people. The spread of disease and infection is must faster in urban settings due to the close proximity of people. Tuberculosis can become widespread in this way. The health and well-being of children can be threatened by preventable disease, violence, accidents, environmental toxins, and even injuries. There is unequal access to health care and insurance. Without either insurance or healthcare, the morbidity and mortality of infants, pregnant women, and other vulnerable populations increase greatly. Community health nurses work with these vulnerable populations in their communities to increase the level of health care and educate about specific hazard topics to help these communities help themselves.
Meadows notes “community health nurses are valued for their adaptability and willingness to provide care in many settings, including community health clinics, churches, homeless shelters, and schools” These nurses can be found working with pregnant women to ensure they have the resources necessary to care for the child they are bringing into the world. They can be found working with the homeless to educate about HIV/ AIDS. They can even be found working with emergency response plans to develop appropriate prevention and post-event treatment.

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A community health nurse can play many roles when it comes to home care especially in the patient’s home. Caring for elders often falls into the hands of family members. In this case, the community health nurse can assist the family by teaching them techniques and skills they will need in order to give the best possible care. The nurse also can become a care coordinator, working to gather all of the services that the patient needs and connecting these services to the patient .

There are sometimes barriers to services for home care patients within the communities. A workgroup put together by the state of Pennsylvania identified 22 different obstacles to obtaining home health care for those patients who require it. These barriers fall into three different categories; procedural, system, and informational barriers. Procedural barriers are those regarding the process of determining eligibility and arranging services. These include the length of the process, the difficulty of the process, overwhelming Medicaid applications, and unclear eligibility requirements. Informational barriers are those resulting from a lack of information. These include a lack of information about what home and community-based services are and how to access them, people do not have adequate knowledge about them, and this lack of information has created a stigma. Systemic barriers appear to be the most challenging. In fact, 14 different barriers were identified. In Pennsylvania, they found that there was no one comprehensive service across the entire state. More services for those who were not yet nursing home eligible, but in need of help at home was needed. The estate recovery program was disliked and misunderstood. People could be entitled to nursing home care but not to home care. There was a lack of funding. There were limited funds for people who need round the clock care at home. The amount of people working for these services was inadequate. There was no way to assure quality and improve issues that these services may have. The distribution of funds and waivers was not proportional within populations and communities. The eligibility requirements for obtaining home care services were too narrow. The services which assign waivers were not comparable. The quality of care given at personal care homes and assisted living residents needs to be improved before they can be allowed to home waiver, recipients. There was an inability to gain public funding to help those living in assisted living homes. There were too few Medicaid resources. Finally, there was no state or federal criteria to establish negotiated and shared risk .

People living in urban areas have better access to home health care and the community health nurse. Urban areas have better public transportation. It is easier for the nurse to get to the patient. Also, because there are more people in cities, there are more nurses and caregivers. This is also true of nurses who speak multiple languages so they will be better equipped to educate and train family members. More people also mean that there are more services available. Specialised services are more likely to be found in areas of the higher population because they will be able to reach a bigger market than if they were based in small towns. Having services available is essential to having access to them. Organizations are much more likely to provide services in a city of a million people rather than a tiny town of 200. It simply does not make sense offer home health care services with a back of millions of dollars to a few people who cannot fully take advantage. People in urban areas also tend to have a greater choice. Cities often have multiple hospitals, not just one. There is a bevy of doctors, nurses, and specialists available. This is true for the home health care nurse and the community health nurse as well .

    References
  • Harkness, G., & DeMarco, R. (2016). Community and Public Health Nursing(2nd ed.). Philadelphia: Wolters Kluver.
  • Meadows, P. (2009, January). Community Health Nursing. American Journal of Nursing, p. 19.
  • Pennsylvania Intra-Governmental Council on Long-Term Care. (2002). Home and Community-Based Services Barriers Elimination Work Group. Harrisburg, PA: Pennsylvania.