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Abstract

Community development process facilitate organized change efforts around a common concern with the purpose of enhancing wellbeing of the community people. Community people come together to make collective decision and generate solutions for common problems. Community development ranges from small initiatives to larger according to the size of the community and intensity of the recognized problem. In this assessment, the community of interest will be the group of people experienced nosocomial infection during their hospital stay. The collective change effort will be made to enhance knowledge of the common people about hospital acquired infections, implement strategies to demonstrate the importance of maintaining hand hygiene and make community people aware of the implications of self-medication with various antibiotics. A ‘community readiness checklist’ (CRC) is circulated to check the community readiness. It shows how community development supports the enhancement of community capacity to identify issues, finds opportunities, takes advantages of those opportunities and balances between competing interests. The write-up also provides rationale to support the selection COI and approach that is used to define the COI. It also explores how community development is more appropriate approach to take in order to create change.

Keywords: community development, community of interest, hospital acquired infections, community readiness, community leadership.

As stated by Brown and Hannis (2012), community development is an engagement process to assist organized change efforts regarding a common concern with the purpose of improving collective wellbeing. This indicates that community people come together to make collective decision and generate solutions for common problems. A community of interest (COI) includes group of people, who share common interest or passion (Brown & Hannis, 2008). They exchange ideas on a given interest, nevertheless, may know very less about each other beyond this area. This write-up would talk about the community development activities and provide with justification for the discussions and actions taken in accordance with the community development initiative.

As a surgical nurse my COI that I am focusing on is the patients, who experienced nosocomial infection during their hospital stay. The main focus is making the patients aware of self-medication with various antibiotics. A ‘community readiness checklist’ would be circulated among the COI. Majority of the answers as ‘yes’ would indicate that the COI is ready to accept community development initiative. According to the Public Health Agency of Canada almost more than 200,000 patients get infected annually and almost 8,000 patients die while receiving care in Canada (Infectious Disease—The Never-ending Threat – Public Health Agency of Canada”, 2013). This rate is attributable to the Clostridium difficile infection that has been tripled since past few decades. The statistics also revealed that almost 80% infections are spread because of the visitors, patients and healthcare workers (Infectious Disease—The Never-ending Threat – Public Health Agency of Canada”, 2013). Contracting with infection while receiving care in healthcare setup challenges the fundamental idea of healthcare, which is ‘making people well’. This justifies the reason behind selecting the COI. Nosocomial infection or healthcare associated infection (HAI) is a type of infection, which patient contract in a healthcare set up, home-care set-up and long-term care facility. Such infection neither developed nor present at the time of the patients’ admission (Bygott, Enoch, Carson, & Karas, 2008). Microbial resistance is a severe concern in health care, especially in emergency surgical wards. Building awareness levels of the patients admitting in the care setup should be a part of community development initiative. Healthcare authorities take initiative to train the nursing professionals so that they can carry out a safe patient care practice that further reduce the risk of HAI. However, there is very less effort has been put to make the patient population aware of HAI transmission. Doernberg et al. (2015) reviewed evidence-based knowledge on HAI consisting urinary tract infection, hospital-acquired pneumonia, sepsis, catheter-related infection and antibiotic-resistance, which highlight the significance for the nursing professionals caring for hospitalized patients (Doernberg, Dudas, & Trivedi, 2015). The review also demonstrated that nurses play key role in identification, management and prevention of infections in patients through the application of evidence-based measures in order to ensure safe healthcare setup for the patients. However, less focus has been given on an increase in patient awareness. This further support the idea of considering increase in patient awareness on HAI as one of the major community development initiatives in Canada. Methicillin Resistant Staphylococcus Aureus (MRSA) is a bacterial strain, resistant to methicillin antibiotic. It is difficult to manage, especially where the patients with open wounds, invasive devices, and poor immune systems are at highest risk of infection transmission. MRSA recently is community acquired (Dhawan & Kale, 2016). Thereby, selecting this issue as community development initiative is highly significant. The World Health Organization (WHO) considers hand hygiene as vital practice to reduce the risk of HAI. However, awareness on the concern and thereby, compliance with the medical practice is low. A survey by Rahmqvist et al., (2016) revealed that almost 1.6million people are suffering from HAI, considering both the developed and developing countries across the globe. Roghmann et al., (2016) in this regard have mentioned that effective implementation of preventive strategies related to the lessening of MRSA transmission by the care professionals could reduce the health mortality rates and expenditure. According to Rahim and Barnett (2009) HAI is preventable, however, the effort should be supported by various practices related to infection control, which would address patient population as well as the staff members. Poor hand hygiene practice is one of the major routes of transmitting hospital pathogens. These pathogens colonize within by resident flora that do not happen with transient flora. For instance, Staphylococcus aureus can stay alive for more than 2hours in hands, which necessitates good hand hygiene practice among the patients and the staff members.

The collaborative change effort that is the focus of the COI would be improving knowledge on hand hygiene practice. Rogerson et al., (2014) stated certain strategies that enable to overcome hindrances to change, which are awareness, accountability, reinforcement, engagement, teamwork, resources and support. Awareness is the collaborative change effort selected for this present work. Awareness on MRSA reduction practices, severity, rate and impact of the patients could be raised in different ways as part of implementation activities. Some of the collaborative change effort selected for the present community development initiatives would be campaigns on hand hygiene, individual stories, active surveillance and kick-off meetings. In order to make collaborative change effort effective, the COI need to develop short achievable objectives like: improving level of understating regarding hand hygiene among the common people. Hollander, (2009) stated that large-scale community change stems from better coordination comparative to isolated intervention o individual organization. Greater progress could be made in improving most of the serious problems if common people along with the health care system are brought together around a shared agenda in order to create collective impact. Dereski, (2015) in this regard have mentioned that such efforts do not happen often, not because it is difficult but because it is hardly attempted. This indicates a need to focus on collective change effort as a part of community development initiative.

To identify this focus a ‘community readiness checklist’ (CRC) would be beneficial. A CRC would be circulated among the COI. Majority of the answers as ‘yes’ would indicate that the COI is ready to accept community development initiative. Hagemeier et al., (2016) opined that community readiness is a degree to which it is ready to take action on any issue. This approach is effective because community readiness is measurable, issue-specific, variable based on different section of the community and essential knowledge to address any issue. The checklist questions should be relevant enough, which would help me to understand whether community is ready to accept the community development initiative. To understand the knowledge about the issue, I may include a question that indicates knowledge and awareness on signs and symptoms of HAIs. I would check what type of information is available within the community on the selected issue, availability of local data on the selected issue, how common people obtain information within community. Using a rating scale will be effective too. For instance, using a scale from 1-10 (1 being ‘in no way’ and 10 being ‘strong concern’) it would be known how much HAI is a matter of concern within the selected community in Canada.

Bumbalová et al., (2016) stated that various factors effect health and well-being in a community and individuals within a community play a role in accordance with the community’s health needs. The COI sees a need for a strong framework in which a community could take comprehensive approach to improve and maintain health that includes evaluating health needs, determining its resources, resources for promoting health, implementing and developing strategy for action and incorporate strategies where accountability should lie for definite results. While developing health improvement programs, individual communities should consider particular situations including factors like capacities, resources, health concerns, political, social perspectives, and challenging needs. Any single committee may not prescribe what action a community needs to consider to address the identified health concerns or who is responsible for such conditions, however, a committee may believe that communities should address the identified issues and a systematic approach towards health improvement of individual people within the community. For instance, having grocery stores that offer various nutritious foods in deprived neighbourhoods may assist people to make better and healthier choices in their regular diet. People will be safe and healthier if they are aware of the consequences of toxic substances, infectious agents. Better housing, clean environment can provide healthier place to live and in turn reduce the rate of infectious conditions like flu, respiratory pneumonia, wound infection and so on (Winkler, Deller, & Marcouiller, 2015). This shows that community development is a more appropriate approach in bringing change to health.

Community readiness conserves valuable resources like money, people and time by controlling the strategy selection, which are most likely to be positive. It is an inexpensive, ready-to-use and efficient tool that promotes ownership of an issue and community recognition. As this tool can be used by the community people and as it identifies the requirements and assumptions of the communities, the tool makes it easier for the community members to view any issue and understand the effects of the issues. Due to strong community ownership, the tool ensures that the strategies are sustainable and culturally congruent (Holmes, 2016). Community readiness supports the application of local resources and experts and not relies on outside resources and experts. This is because local experts may not much aware in terms of professional sense but better understand the community people and current happenings. Community readiness creates clear vision for healthy change. The level of readiness reflects the level of community competency and illustrate how healthy a community is in handling issues. Thus, in the presence context it could be mentioned that community readiness checklist would explain the extent of community readiness while considering the eradication of HAIs.

Community leaders aim to improve different community aspects, especially to develop more resilient and stronger local communities (Archibald, Sharrock, Buckley, & Cook, 2016). They support individuals within the community that help them to promote their skills to effect change in the community. Such skills are created through formation of social groups work for common agendas. The leaders understand how to work with individuals and affect community’s positons in a larger social context.  Considering community development, community leadership along with skills, knowledge, partnerships, volunteers, networks have been recognized as major indicators for civil society and stronger communities (Holm & Severinsson, 2013). Effective community leadership is a major contributing factor to social development. Leadership approach is relied on a principle that individual’s development improves entire community capacity. For instance, awareness on HAIs to a limited number of people would not be effective in developing healthier community. This could be achieved through training that prepares individuals with the tools, understand decision-making process and allows their opinions and views to be incorporated and expressed into future planning as well as development. Acquisition of innovative skills further enhances addressing issues that affect their communities. This further strengthen the capacity of the communities to recognize opportunities and addresses crunches in new ways (Archibald, Sharrock, Buckley, & Cook, 2016).

As mentioned earlier, I have assessed community readiness by using a ‘community readiness checklist’ that is circulated among the COI. Majority of the answers as ‘yes’ would indicate that the COI is ready to accept community development initiative (Rauws, 2016). For instance, if a question like ‘are community members are aware of their power to act together to benefit the community?’ has an answer as ‘no’, indicates that the community members presently discuss their concerns through the support groups. The concern like the services people receive for HAIs through the community health services are not brought for to the care providers and as a consequence, the people are not aware of their power to act in collaborative way to support the community and also probably due to the fact that the community care providers have not enquired their feedback. In this change effort, I being a surgical-nurse would be act as a catalyst to help my COI group to develop solutions to the issues on HAIs.

The effects of the assessments for the community development initiative would be helpful if good hand hygiene practice is developed among the community people, if they avoid self-medication to sidestep antibiotic resistance, understand importance of follow-up with GPs and medication adherence.

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