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Bedford was classified as a town on July 1, 1980. On April 1, 1996, Bedford was amalgamated with Halifax, Dartmouth, and Halifax County Municipality to form the Halifax Regional Municipal (HRM) for the municipal level of government (Encyclopedia, 2019).
Adapted from Google map, 2019.
Bedford is a city and urban community. The history of Bedford began during the administration of Governor Edward Cornwallis who began the construction of a road leading to Minas Basin on the Bay of Fundy after establishing the garrison at Halifax. To protect it, he hired John Gorham and his Rangers to construct a fort on the shore of Bedford Basin. It was named Fort Sackville after Lionel Sackville, 1st Duke of Dorset The area around the fort became known as Sackville until the mid-1850s, when it became Bedford. Bedford has a population growth of 18,553 people. The main zone has Bedford South community under their umbrella and this area is the focus of my study. The language spoken is English, however, 4% of some residence speaks other language (City data, 2019).
The Community Framework
There is a hospital located in the heart of the community (Cobequid Hospital) which is accessible to all residents. There are several pharmacy stores and medical clinics.
The Halifax regional School board oversees elementary and high schools across the region and ensures that Schools are run to standards.
Bedford has several recreation centers and three libraries that are well equipped with books, computers videos and activities for all age groups. There are parks and lakes in the community.
Resident commute to work on a bus or ferry which is run by Halifax Municipality at a fare. There is also an access-A bus transit service for persons who are unable to use the conventional transit system due to physical or cognitive disabilities (Halifax-transit, 2019).
According to Canadian consensus data, (2011), there are 17.5% of children under the age of 20, 17.3% between 20-29, 14.2% between 30- 39, 15.1% between 40- 49, 22.4% between
50- 64, and 18. 2 % are 65 years and above.
Total percentage of visible minority is 10.8 with 5.3% black, 0.2% Arab/west Asian, 0.3% Chinese/Korean/Japanese, 0.5% South Asian/East Indian with 4.1% others. Bedford South community has 3.2% of Aboriginal origin (National Household Survey, 2016).
A three-phase plan was used for the assessment needs, which include: Exploration, Data gathering and Utilization. The collection of relevant information was from the local library, Bedford family centre, walk -in clinic, public health office, shopper’s drug pharmacy, Lawton pharmacy and Internet search.
Health Issue of the Community
The Canada Alzheimer’s Society, 2016, reported that there are 564,000 Canadians currently living with dementia and predicted a rise in this figure to about 937, 000 of Canadians who will live with it in the year 2031 (Canada Alzheimer Society, 2016). Also in 2012, the Canada Alzheimer’s Society determined that in the past year, people who had family members suffering from dementia spent over 444 million hours looking after them, these hours were unpaid, which represents $11 billion in lost income; Close to 227,760 people could have been working full time outside the home (Canada Alzheimer Society, 2012). As a whole, the 2016 report showed an estimate of $10.4billion spent by both health care system and out- of -pocket caregivers which was expected to increase to about sixty percent in the next fifteen years (Canada Alzheimer Society, 2016). This suggests that caregiving is a time and labour-intensive activity that can come at the cost of lost income for caregivers.
As cognitive functioning steadily declines, persons living with dementia experience increased difficulties maintaining activities of daily living such as shopping, personal hygiene and eating. This issue is due to a decline in memory. As a consequence, people living with dementia often need assistance with daily activities from a caregiver. Dementia and everything surrounding it is becoming a critically important issue, in terms of its impacts on people living with it, its care needs, personal, psychological social and highly demanding costs related to the disease, more so its wider impact on other parts of the health care system.
The Alzheimer Society of Canada determined that from the statistics taken in 2008, there will be an increase in the number of people living with dementia who stay and receive care at home from 55% to 62% in 2038, representing about 510,000 people in this type of care (Alzheimer’s Society of Canada, 2012). This is a significant portion of the Canadian dementia population who receives care at home thus highlighting the importance of examining the experiences and wellbeing of family caregivers, which can determine the quality of care rendered by family members providing in-home care. These experiences and wellbeing determines the quality of care rendered by family members who will care for them while at home
Determinant of Health
The following determinants of health that contributes to the health issues are discussed as follows.
Income and social status: According to Holland, (2004, p.1.) “Factors such as rising age, male sex, better socioeconomic status, and lack of previous involvement of the old person in the family decision were the social determinants of dementia”. Sociocultural factors which include cognitively stimulating activities, active socialization, and living in joint families were factors hindering dementia. The knowledge of these social determinants is highly important for developing targeted interventions in a community-based dementia care program. Most people in my community are low income earners which has a negative effect on their health behaviour due to lack of financial resources to provide a basic healthy diet for themselves and their families. Some of the individuals do not have enough money to purchase their medication. Unhealthy life style including tobacco smoking and alcohol consumption are the major cause of hypertension which is a major risk factor for dementia (Kulik, 2002) all these factors are evidence in my community.
Social Support Networks: It is also important to inform family level caregivers the importance of the practice of involving old people in family level decision making process or other cognitively stimulating activities as they are likely to delay the development of dementia (Holland, 2004). Most elderly living in my community lives alone, most of their family members or children resides in another province and makes meal preparation difficult, they tend to eat anything available without considering their present health status as a result of absence of support system to assist with healthy meal preparation. According to Federal, Provincial and Territorial ACPH, (1999), cited from (RNPDC, Unit 1, 2019) “some experts believe that relationships may be as important to health as established risk factors such smoking and high blood pressure”. Most of the elderly do not belong to a social network of gathering, there is the absence of mutual obligations which makes people feel cared for, loved and valued.
Education and Literacy: Educational attainment influences health status (Braveman, et al, 2011). Some community individual has a low level of education which reduce the chances of living a healthy life, adhere to medication regime and participate in health promotion programs.
Employment and Working Conditions: A steady job in safe working conditions means more than simply a paycheck—employment can also provide the benefits and stability critical to maintaining proper health (Robert Woods’ foundation, 2012). Some of the older adult in my community are retired, the young adults are either unemployed or working in a stress related job. Studies reported that job stress is related to the incidence and prevalence of cardiovascular disease (Kivimaki,et al., 2002).The older adults do not have private pension they rely on government pension and may less likely access preventive care services that insurance covers.
Individual Health Practices and Coping Skills: Lifestyle-related factors such as obesity, drinking habits, diet, and physical inactivity are well established determinants of high blood pressure (Beilin, 1988). Some of the individual in the community I live use smoking as a coping strategy to relieve stress in other words this stress relieve strategy is detrimental to their health. Physical inactivity is also a risk factor for dementia, the older adult lack the resources to perform physical activity, some complain of arthritis and some lack social support to help with physical activity.
Health Service: If individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment. (Agency for Healthcare Research and Quality, 2008). Not all the people living in my community have equal access to health services. Some older adults that live in my community (which has low population density, poor transportation infrastructure, long waits, inadequate human resources and climate conditions) experience a significant barrier to health care access.
What is being done to address the issue of Dementia in my community?
Several initiatives have been adopted through health promotion to create awareness on how to control dementia. The public health nurse conducts several interactive and informative workshops in the community library on health and wellness, social support, early signs of dementia, health teaching on blood pressure monitoring, diet modification, physical activity and importance of adhering to medication.
Bedford Senior Service centre offers various social, physical and educational programs to seniors in the community. They provide medical transportation at a reasonable price to commute the senior to and from the hospital. They also provide services for meal preparation called “meals on wheels” for seniors who are unable to prepare their meals and individuals that needs a dietary modification (low sodium diet).
The public health nurse in Bedford family centre provides health teaching on high blood pressure, early recognition of dementia and management and care of people living with Dementia. There are several participating pharmacy and clinics all through Bedford community with the easy-to-use in-store blood pressure machine, and a Pharmacist available to review results with clients. The pharmacies include Lawton’s, Shoppers drug mart, Sobeys and so forth.
ROLE OF COMMUNITY HEALTH NURSE TO ADDRESS THE HEALTH ISSUE.
Community health nurses support the health and well-being of individuals, families, groups, communities, populations and systems. They are valued for their adaptability and readiness to provide care in different settings, including health centres, homes, schools, churches, shelters and other community-based settings (Canadian Association of Nurses, 2019).
Professional practice models include the structure, system and people that support nurses’ control over the delivery of nursing care and the environment in which care is delivered (Hoffart and Woods, 1996). Service delivery is focused on preventive, curative, social and environmental aspects of care; is responsive to community needs; and takes into account stewardship of resources for making services efficient and effective (Holland, 2004).
Community assessment is a process by which community members gain an understanding of the health, concerns, and health care systems of the community by identifying, collecting, analyzing, disseminating information on community assets, strengths, resources, and needs.
This is paper explains the Community Assessment study of Bedford south community, the community health issue (Dementia), determinants of health and how these problems are being addressed by the community health nurse of the community.
Caregiving roles, especially when they involve caring for people with dementia at home, are full of challenges. This is due to the nature of the need for people living with dementia to be closely supervised, the difficulties involved in managing behavioral and psychological symptoms of dementia as they manifest. Challenges also arise especially for caregivers because there is total dependency of people living with dementia on caregivers for the performance of activities of daily living. Sometimes the care needs of people with dementia are compounded by comorbidities and complications of dementia.
The public health nurse advocates for ways to enhance home care in order to facilitate direct care to patient who do not have resources to visit health care centres to participate in health teachings to promote healthy lifestyle. The public health nurse advocates for clients who do not have a private insurance to pay for medication by making referrals to social workers.
The VON advocate with the client by liaising with government, business and organization in other sectors to promote the health and self-reliance of the community. They also help in strengthening a community by providing advocacy for the prerequisites for health which include space, shelter, education, food, income, sustainable resources, social justice and equity.
The school nurse attends school board meetings and share concerns of not having enough nurses in schools to promote health education, they advocate for this concern to be addressed with school principals, parents and teachers and school boards for the purpose of improving the quality of care of the students. All these help to prevent juvenile onset of dementia.
Community health nurses consider health as a means for everyday life that is influenced by situations, beliefs and the determinants of health. They offer service delivery which is focused on preventive, curative, social and environmental aspects of care; is responsive to community needs; and takes into consideration stewardship of resources for making services efficient and effective.
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