Urban Areas and Nursing Research Problems
Whats are Urban Communities
Urban communities are home to heterogeneous ethnic, age, and
socioeconomic groups, populations that make up a large share of the underserved
in this county. These underserved populations face daunting hurdles that
challenge their ability to maintain healthy lifestyles.
Furthermore, urban
environments may provide limited or inaccessible support for individuals
seeking health promotion and disease prevention information and services.
Many
urban environments are marred by poverty, strained school systems, crowded
housing, unemployment, a pervasive drug culture, periodic street violence, and
high levels of stress.
Some health issues resulting from the urban environment
include high rates of HIV infections and AIDS, increased morbidity and
mortality due to violence, increased morbidity and mortality secondary to
substance abuse, the resurgence of infectious diseases (tuberculosis and
hepatitis B), chronic illness, and maternal/child health problems.
Health Issues in Urban Areas
Many of the health problems experienced by residents in urban neighborhoods
are preventable, at least in part, through lifestyle changes. Steps also can be
taken to reduce health disparities through early identification and treatment.
Unfortunately, statistics demonstrate that urban populations do not routinely
receive early screening and preventive health care.
Urban Areas and Nursing Care
When thinking about what urban means, nurses are confronted with a
number of images, ranging from shining tall buildings, greater opportunities
for employment, upscale housing, and community parks to dilapidated buildings,
vacant lots sewn with rubble, high rates of unemployment, congested
expressways. , youth gangs, drug dealers and drug addicts, and, most of all,
people.
Perhaps the images include the stark difference between African, Asian,
Caribbean, European, Hispanic, Middle Eastern cultures expressing the diversity
and cosmopolitan atmosphere of everyday life in big cities.
In some cases, the
images are those of opportunity; in others, of despair. Historically, urban
images in the United States have tended to oscillate between the positive
(cities as innovative, progressive, and modern) and the negative (cities as
alienated, pathological, and decadent).
Today, popularly depicted urban images
include culture, arts, and music; recreation and leisure; and the hustle and
bustle of commerce, as well as violent crime, rampant drug abuse, crumbling
infrastructure, transportation gridlock, and pollution.
These images not only
depict sharp contrasts between rich and poor but suggest that the worst states
of health are found among urban dwellers exposed to substandard housing,
poverty, unemployment, and drug abuse.
Process of Urbanization
The process of attaching meaning to these images is multifaceted.
However, there is no consensus on a common definition of urban.
Most
definitions include an interrelationship between people (demography) and space:
political and administrative boundaries, social and cultural arrangements,
economic and technological restructuring.
The process of urbanization in the
United States has resulted in political, social, economic, environmental, and
health changes; At the same time, political, social, economic, environmental,
and health changes have influenced the process of urbanization.
Urbanization is
a dynamic process, and its effects on health are seen and felt in different
ways within particular cities and across the nation.
Health Outcomes and Disparities in Urban Areas
Striking disparities in health outcomes among urban populations
provide compelling evidence of the significant health risk these groups
experience.
The health outcomes described below are observed in non urban
populations but are disproportionately seen in urban populations and leisure;
and the hustle and bustle of commerce, as well as violent crime, rampant drug
abuse, crumbling infrastructure, transportation gridlock, and pollution.
These
images not only depict sharp contrasts between rich and poor but suggest that
the worst states of health are found among urban dwellers exposed to
substandard housing, poverty, unemployment, and drug abuse.
The process of attaching meaning to these images is multifaceted.
However, there is no consensus on a common definition of urban. Most
definitions include an interrelationship between people (demography) and space:
political and administrative boundaries, social and cultural arrangements,
economic and technological restructuring.
The process of urbanization in the
United States has resulted in political, social, economic, environmental, and
health changes; At the same time, political, social, economic, environmental,
and health changes have influenced the process of urbanization.
Urbanization is
a dynamic process, and its effects on health are seen and felt in different
ways within particular cities and across the nation.
Striking disparities in health outcomes among urban populations
provide compelling evidence of the significant health risk these groups
experience. The health outcomes described below are observed in non-urban
populations but are disproportionately seen in urban populations.
Chronic Illnesses In Urban Population
Hypertension and heart disease: Thirty-eight percent of Blacks
suffer from hypertension; of those, only 25% are managing their disease.
Obesity: Forty-four
percent of Black and Latino women ages 20 and older are obese, compared to 27%
for all women and 37% for low-income women.
Diabetes: The
disease is 33% more common among Blacks than among the general population.
Latino and Native American populations report elevated morbidity rates from
diabetes, often exacerbated by poor nutrition and exercise habits.
Cancer: Major
disparity in cancer rates exist among Blacks, Latinos, Native Americans, the
elderly, and poor Americans. Failure to screen is often due to fatalism, lack
of knowledge, or limited access.
General health habits: Poor
nutrition, smoking, alcohol and drug abuse, minimal exercise and stress management,
along with other risk factors, appear to be more common among people with low
incomes, who tend to be urban residents.
Violence: Men,
young adults, and teenagers within minority populations, particularly Blacks
and Latinos, are mostlikely to be murder victims. Domestic violence accounts
for one of six homicides, particularly among young adults and Blacks.
Child abuse cases make up a significant portion of urban violence,
affecting mostly poor families. Maternal and Child Health Black, Native
American, and Latino infants have the highest morbidity and mortality rates in
the United States.
Low-birthweight Black babies account for most of these
deaths, but even normal weight Black babies have a greater risk of death.
Asthma risk is increased for poor, minority urban residents, both
initial attacks and exacerbations. Environmental factors such as air pollution
and cockroach allergens have been correlated with emergency room visits for
asthma.
ethnic minority groups, with significant social, economic, and health
consequences . HIV and AIDS The rates of AIDS among Blacks and Latinos are more
than triple that of the general population.
Women and their children are one of
the largest groups infected. Sexually active teens are a fast growing
population at risk for HIV infection.
Focus of Urban Health Research
Urban Health Research focuses on the
following processes, which form a circular link:
Identifying methodologies and models for developing culturally
sensitive research approaches, data collection instruments, and program
evaluation instruments.
Building partnerships with community members, nurses, and other
health professionals who have community-based practices and with
transdisciplinary researchers to identify and prioritize urban health issues
that need investigating.
Determining the most effective, culturally sensitive health
promotion and disease prevention intervention strategies and best practice
models for the targeted urban setting.
Implementing the most effective health promotion and disease
prevention intervention strategies and best-practice models within the targeted
urban community while simultaneously collecting evaluation data that will be
used to modify the implementation process as needed.
Nursing Responsibilities
As nurses we must be concerned about how the issues of urbanization
affect the health of urban communities. Residents of such communities are the
most reliable sources for this information.
However, they are not likely to
volunteer this information either because of distrust of researchers or the
perception that their opinions or facts are not valued by nurses or
researchers.
Hence, one of the early steps in the urban health research process
is to empower and recruit urban community members, especially minorities, to
become active research partners, not just participants, in research programs.
The overall goal of urban-related nursing research is to integrate scientific
knowledge, professional skill, community input and support, and political
advocacy of health promotion and disease prevention in an effort to create and
maintain healthy urban communities.
To achieve this goal, nurse researchers in
urban settings, with community input, must seek to develop, test, and
disseminate health care interventions, tailored to address the major urban
health care issues, that are found to be scientifically sound, culturally
relevant, and effective.
Once identified, the urban related nursing research
process continues with the implementation of effective interventions and best
practices within the community while maintaining overall health care costs.
When logistically feasible, it is advisable to take the programs or practices
to the target populations because this approach tends to foster participant.
Nursing Challenges
Nurses can meet the challenges of addressing the needs of urban
community residents by using a multidimensional approach that focuses on their
social, psychological, biological, and environmental needs.
Historically,
nurses have viewed the recipients of their care in a holistic manner, taking into
account all domains that have an impact on their lives. This approach is
particularly useful with urban minority populations, who tend to experience
many different stressors and who also tend to value the interpersonal process.
Innovative Research Projects
Through innovative research projects, innovative educational
programs, and new strategies for providing services, we can meet their needs.
For today, urban health is a priority.
With the recent economic trend that is
moving health care from hospitals to the community, current nursing students
are being prepared to shift their work setting to the community and to interact
with clients in their “home environment.”
This educational preparation should
result in better health care as well as stronger client advocacy, another
important aspect in the process. Nurses in the future will increasingly work in
community-based settings such as homeless shelters, community clinics, small
independent practices, schools, and church clinics.
Responsibilities of Nursing Researchers In Urban Areas
To summarize, for programs
of nursing research to be effective in urban communities the researcher must do
the following:
Design programs that are based on a comprehensive needs assessment,
including an identification of the target population. Make programs accessible
and affordable to the target population.
Ensure that the programs are
culturally competent and relevant to the target population (ie, consistent with
norms, attitudes, beliefs, and attitudes). Members of the target populations
should be included in program design, implications, and evaluation.
Ensure that the programs are consistent with the social and
community norms of the target population so that program participants will
receive consistent messages and reinforcement for the prescribed health
behavior plan.
Address the linguistic needs of the target population (ie., with
translators and health and education reading materials in the community’s
native language and at the appropriate reading levels).
When applicable, ensure that programs meet the needs of the deaf
and hearing impaired members of the target population, as well as those with
developmental disabilities.
Residents of urban communities have numerous health care
challenges. Fortunately, nurses with the proper education and training can
emerge to provide excellent compassionate and innovative care and to design
culturally competent and theory driven intervention that will produce positive
healthy outcomes.
One advantage of meeting this need is the fact that most
schools of nursing are located in urban communities, which enhances the interaction
between and among nurses, community members, and researchers.
Nurse researchers
are not the only ones who benefit from such interaction; students and the
people in the community also benefit. Nursing research projects designed and
implemented by building bridges with the community can provide the most
effective and cost-effective community-based health care.