Providing care to a few individuals in a hospital setting is a controlled environment that can be difficult but ends at a prescribed time. On the other hand community-based nursing "focuses on individuals and families in their natural settings within communities" (Sanger, 2000). Both types of nursing focus on the individual, but community-based care also requires that a nurse understands the issues that his or her patients are facing on a daily basis. A Nurse whose primary job is within a community setting must be able to survey the area for health dangers, conduct outreach with individuals and community organizations, manage cases, teach proper health techniques to a diverse group of people, mobilize resources, and assist community leaders with health policy development (Rallings, 2009). Although all of these skills may not be required by every community-based professional, this types of nursing requires a diverse set of skills that aid the community and promote health. This paper looks at the community of Baltimore, MD as a focus in community-based interventions.
Baltimore is a working class community on the upper reaches of the Chesapeake Bay just an hour Northeast of Washington, DC. The community was once a prosperous shipping port, but the industry has changed as the economic needs of the nation have also changed. Baltimore, like many other communities has embraced computer technology and has a thriving base of large and medium-sized business that support this occupation type (Health Department Baltimore Maryland, 2009). Unfortunately, this has not meant prosperity for all areas of the city, and there are many people living in lower middle class and poor areas that have a number of problems among which is access to proper healthcare. Many areas where industry previously thrived have not recovered, and these communities within the city remain depressed and hurting.
Demographic and Epidemiological Data
The population of the city proper, estimated from the 2011 census, was 619,493 people (Census Bureau, 2012). This population had an ethnic breakdown of 63.6% Black, 31.5% White, 2.5% Asian, with all other ethnic characteristics making up the remainder of the data. People of Hispanic origin (some counted in either the White or Black categories) constituted 4.3% of the population. The survey reported that 52.9% of the population in the city was female, and that a majority (82.4%) had lived in the same house for more than a year. A great majority, 77.4% had a high school education or greater, while only 25.2% had graduated college with a bachelor's degree. Although the median income per family rests at $39,386 per annum, 21.3% of people are below the poverty level.
The most remarkable finding is that the people within the city are disproportionately poor. Because of this fact, they have more difficulty as a group obtaining quality healthcare. A survey was conducted by the Health Department of Baltimore (2009) and it found that "research has consistently shown that health improves incrementally as levels of income and education increase." Due to the level of poor an under-educated persons in the city, it is not surprising that a large number of people report being in just fair or poor health. Many people believe that they have poor access to proper healthcare and many in the chronically ill group (those who were obese, had diabetes and/or hypertension) believed that they were not able to access adequate care for their condition. Interestingly, there was a large disparity between the racial groups. Blacks were almost three times as likely as Whites to report poor access to healthcare, and income and education level also showed equally large disparities (Health Department Baltimore Maryland, 2009).
Baltimore is a city that has a great deal of businesses that are boarded up, and communities that have very few healthcare facilities. On two random trips through the outskirts of the city where there are a greater number of residential neighborhoods, it is obvious that many people are living at or below the poverty level. Many houses have broken windows and general disrepair. While the city has tried to revitalize the waterfront and had been largely successful, there are many areas which have seemingly been neglected. It is interesting that the city boasts a world-renowned medical center in Johns Hopkins, but has others that are very poorly rated.
There are actually a great number of clinics and hospitals available to residents, but they are generally overworked and understaffed. But, unfortunately there is one issue that many believe is a consequence of the poverty and poor educational attainment of people in the region -- heroin abuse. Clinics and rehab centers are available for addicts but it does not seem to be helping curb the problem.
In 2009, Forbes Magazine printed an article entitled "The Drug Capitals of America" in which they named the areas of the country which most subject to a specific type of drug. Illicit substances such as cocaine, methamphetamine and marijuana were examined and other cities were labeled as the "capitals" of those particular drugs, but the substance of choice in Baltimore is heroin. According to Vardin (2009) "Public-policy pros remain baffled that the heroin problem never receded in Baltimore like it did in most other big American cities. There were 184 heroin-related overdoses in Baltimore in 2006…" This issue has been a health issue that has received a great deal of publicity and intervention since the 1970's, but there seems to be little that has actually been done to rein in the destructive practice. People in the city of Baltimore are more likely to die of a heroin overdose, long after the drug hit its peak in other areas, than any other city in America.
It could be said that the issue in the city is poverty because the demographics show that it is one of the poorest large cities in the United States, but poverty breeds other issues within a community. Drug issues have long been linked to depressed economies and areas where the educational attainment is below the national average and that seems to be the case in Baltimore. With all of the cosmetic fixes that the city has made over the last two decades, it has done very little to arrest the tide of heroin-related deaths that occur.
Baltimore was once a thriving maritime city located close to the seat of U.S. power and the seat of Naval significance. Although the location has not changed, the energy within the city has. Crime is not the problem that it once was (Baltimore was once considered the major crime capital of the United States), but there are still elements within the city that make it difficult to alleviate the major health problems that exist. Heroin came into Baltimore at the same time it did other large U.S. cities, but the drug remains popular amongst too great a number of residents. The trend, which has been substantially down in most areas of the country, has not changed a great deal in Baltimore. It seems that as the drug became less popular at some time during the last two decades people did turn to other substances for comfort, but the reason that heroin has remained popular in Baltimore is that it can still be had relatively cheap. But, the issue is not that a specific type of drug can be easily obtained in a certain area; the issue is that people still feel the need to shelter themselves with an illicit substance.
Due to the extremely poor conditions in the city and the lack of educational attainment, drugs remain a popular alternative with heroin leading the list. The fact that there are some great health facilities in the region does not seem to matter. The leadership of the city has not historically…