Impact of Location on Nursing

NU11010 – The Nature Of Nursing (1) Matriculation no.: – 110015420

A neighbourhood is often considered as a living relationship between people and place: A geographical area, often within a town or city, determined by the values and aspirations of its residents as well as the impact of the socioeconomic conditions within it (Label et al., 2007).

The Templehall neighbourhood is one of several community council areas within the town of Kirkcaldy, county of Fife, situated within the electoral ward of Kirkcaldy North (Fife Council, 2012). Kirkcaldy is Fifes largest and most populated town with an approximated population of 49,709 (National Records of Scotland, 2014 b). Kirkcaldy is also amongst the 10% of most deprived areas within Scotland (SIMD, 2012), some neighbourhoods are 0% -5%, most deprived, whilst Templehall borders within lower scale: 10% -15% of most deprived areas in Scotland.

Templehall, comprises of 65 Census Output areas and over 49 postal codes and has an approximate population of 6847. The median age range for this area is: 45 -59 years, an average shared with the population of Scotland. This area, however, exceeds the Scottish average for the number of residents over the age of 75 by 100% and the number of residents aged below 16 years by 38% (National Records of Scotland, 2014 a.).

Within the area there are a number of local amenities, including: supermarket, pharmacy, Library, Local Council office, Primary Schools, dental practice, Linton Lane voluntary community education centre and Templehall community centre. This area does not have a G.P.’s surgery within its boundaries, although Victoria and Whytemans Brae NHS hospitals are approximately 1 mile, where a G.P. practice and pharmacy can be accessed.

Templehall is located approximately 2 miles, a 20 minute walk, from Kirkcaldy’s town centre. There is a regular bus service into the town centre, with both rail and bus links to neighbouring towns, villages and Cities, easing a commute for education or employment. A short distance from the A92, a road from Dundee to Dunfermline, connecting to numerous routes for further destinations, also allows the 44.5% of commuters traveling by car (KnowFife, no date, a.) a greater opportunity for employment out with the area. 59% of the population of Templehall are that of working age, with an approximated 31.96% in employment and 27.8% claiming key benefits (Scottish Neighbourhood Statistics, no date b.).

Templehall is a residential area comprising typically of semi-detached and terraced housing and flats: 18.5% of dwellings are detached, 24.5% of dwellings are Flats, 17% of dwellings are semi-detached and 40% of dwellings are terraced, (KnowFife, no date b.). Almost 60% of properties are social rented, double the averaged percentage for Scotland (Scottish Neighbourhood Statistics, no date b.), with a number of residents claiming key benefits to cover the cost of housing.

When defining a neighbourhood, especially for use of study or comparison of statistical data, Drummond (see Label, et al., 2007) states there are two main categories of elements that need to be considered to identify the neighbourhood unit: the inner characteristics and the geographic scale. Dahlgren and Whitehead (see Orme, et al., 2007) agree that a neighbourhood is a collaboration of key elements, “a mediator in relation to social and community networks and living and working conditions; the setting where individual behaviour and lifestyle is worked out”. Using data and information, considering all elements collectively and examining the relationships between them will allow health determinants to be identified and action plans to be generated for the prevention of ill-health, to support the promotion of health and to encourage a change within the community, in relation to health behaviours (Watkins and Cousins, 2010).

Data for the above graph have been sourced from: National Records of Scotland (2014 a.)

Evidence shows that people are leading healthier lives and living longer, contributing to an increasingly ageing population (Scottish Government, 2013). Audit Scotland (2013) predicts a rise of 38% in the number of people who will be over the age of 85 years in the population by 2016 and, assuming current circumstances remain constant, predict that the number of people aged 75 and over will increase by almost 60% by 2031. As will, without a doubt, the increased demand on public services and health and social care (Fordyce, 2013). This is why it is important for us to assess and evaluate current practice and reshape the delivery of care for older people, ensuring that the services provided are of high standards (Scottish Government, 2013).

The graph above shows the percentage of people aged between 60 – 74 years as similar to the Scottish average, although Templehall exceeds the Scottish average for the number of residents over the age of 75, by 100%, (National Records of Scotland, 2014 a.). HelpAge International (no date), O’Hagan (no date) and World Health Organisation (no date) detail that ageing is a global achievement as a result of the developing modern society: improved public health, sanitation and development of health and social care. A triumph that will produce numerous challenges when promoting health, preventing disease and managing illness, both in an acute hospital setting and within the homecare environment, (World Health Organisation, no date).

Unexpected hospital admissions are said to create more problems than solutions, in the older population: anticipatory care delivery, extensive assistance and unnecessary intervention as well as a prolonged hospital stay can affect the well-being and independence of patients (Scottish Government, 2013). Nutrition, fall risk and prevention, Skin care and wound management, mobility and Equipment to aid are just a few of the issues highlighted for our elderly patients (Scottish Government, 2006).

Dementia, discussed by AlzheimerScotland (2014) is described as the relationship between neurological damage and psychosocial factors, consisting of cognitive impairments, behavioural manifestations and functional limitations. There are estimated to be around 84,000 people living with dementia in Scotland, this disease has more prevalence within our elderly population, although is not part of the normative ageing process, (Alzheimer Scotland 2014). The prevalence of dementia is expected to increase as a result of demographic changes and psychosocial factors; doubling within the next 25 years.

Nurses working within the community must seek to address the identified key areas as the role demands an in-depth understanding of the physical, psychosocial, environmental and financial needs of each individual, with a family centred plan of care and realistic expectations, therefore each plan of care will differ. (D’Angelo, no date). Other local support service and organisations should be used to support patients and their families.

Templehall has 46.7% of single adult dwellings (ScotPHO, 2014), and although it has not been calculated, an assumption can be made that there may be some elderly people living alone. This could cause concern when assessing safety in the home and surrounding environment. A nurse should strive to ensure minimal risk of injury or harm, to provide appropriate support meeting the needs of each individual, whilst maintaining a balance of independence, (Farren, no date). Community groups, within the community centre, could provide a point of contact and help to maintain social health and well-being.

Data for the above graph has been sourced from: *1 – Scottish Neighbourhood Statistics (no date a.)

*2 – National Records of Scotland (2014 b.)

Ross and Mackenzie (1996) state that “those who experience material and social deprivation often experience the worst health and have the greatest need for health care”. This statement can be viewed as, somewhat, accurate when considering the neighbourhood of Templehall: higher levels of deprivation (SIMD 2012) are complimented with high levels of hospital admissions (ScotPHO 2010).

Templehall has been calculated to be within the 10% -15% bracket of the most deprived areas in Scotland (SIMD 2012). With both employment and income deprivation higher than the Scottish average, as detailed on the above graph.

It is approximated that 32% of the working age population are in employment and 27.8% are claiming key benefits. (Scottish Neighbourhood Statistics, no date b.). The average age of an unemployed person in Templehall is 24 years old, a decade earlier than the average of Scotland: 33 years old (National Records of Scotland 2014 b.). An average of 29.4% of the population, aged 16 – 74 years, are economically inactive: long-term sick or disabled, (Scottish Neighbourhood Statistics, no date b.), also impacting on the employment deprivation status.

Employment in Templehall is mainly elementary, often referred to as working class, occupations (20.6%), second to this is skilled trades (17.6%). There are no recorded management occupations and only 8.8% of professional occupations within the neighbourhood, (Scottish Neighbourhood Statistics, 2012). This type of employment that is normally associated within the lower pay scale, affecting the income status.

True that an influence on this status may also be due to cultural influence; the values and beliefs of the dominant community, the expectation to conform to the norm that has become apparent as acceptable and the perception of its worth, however diminished, within society, (Ledwith, 2007). Although with an appropriate level of support and education, delivered using a multi-disciplinary and an “inter-sectoral” approach, (DoH, 1989. See Ross and Mackenzie, 1999), the knowledge of the importance of health will improve, good health practices will be reinforced and unwanted health behaviours can be deterred within the neighbourhood. This will then assist practitioners in providing an effective, appropriate and responsive service to support and enhance the health and well-being of the community, (Ross and Mackenzie, 1999).

As detailed by the Scottish Public Health Observatory (ScotPHO, 2010) the majority of hospital admissions are from: alcohol conditions, drug related conditions, respiratory conditions, coronary heart disease, psychiatric admissions and assault, with many of the exceeding, and in some cases doubling, the level of the Scottish average. Again this may have been influenced by the norms of the neighbourhood, although health education and support services, previously mentioned, may assist to decrease unwanted behaviours, (Ross and Makenzie, 1999) and reduce the number of hospital admissions.

Data for the above graph has been sourced from: ScotPHO (2014).

More than 50% of the housing within Templehall is socially rented, almost double that of the Scottish average. Dominant factors that may influence this have previously been discovered; higher levels of employment and income deprivation, above average benefits claimants; including 29.4% of the neighbourhood that are economically inactive (Scottish Neighbourhood Statistics, no date b.), employment types and salary size, as well as other behavioural and societal influences: can collectively be headed under a description of social class.

“Links have been drawn between poor health and housing since the nineteenth century.” (Scottish Government, 2010) and although not conclusive, due to the clear identification of many other factors that can influence and affect health, it can be argued that the social influences and physical environment directly affect health and well-being of a person within an environment.

Detailed by Mind (2013), a safe and affordable home is an important factor when considering the general health of a person. Poor housing and homeless could increase the probability of developing mental health problems, (MIND 2013), it is important for a nurse practitioner to be mindful of this potential risk to health and well-being when assessing the needs of an individual and providing support (Goldie, 2010). Social class and the affects this might have on an individual or population must also be considered, (STEWART, 2013), the knowledge of local services and support and additional benefits available to assist those in need will allow the nurse in providing a bio psychosocial approach in the promotion of heath and well-being within the area. A nurse cannot directly change the environment within the community, but can, however, provide information, assessment with recommendation and support to enable possible changes to be implemented.

When working in a neighbourhood it is important for a nurse to have knowledge of the population profile and the norms within it, to be aware of local issues and support services available and have identified potential key areas to be addressed.

It is evident from research and readings that a nurse’s role within a community setting is part of a multidisciplinary team, focusing on health promotion and education, prevention and treatment of ill-health and providing support throughout, enabling residents in the community the opportunity to lead healthy fulfilling lives.

When considering actions of planning, delivering and assessing care needs a nurse must take a holistic view of the individual; considering numerous factors that can influence and affect health and health behaviours. Societal considerations must also be taken into account, with an approach that is compassionate, respectful and professional.

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