With a shortage of doctors, it is the nurses and other allied health professionals who run the show in many of the primary healthcare settings in India. Nurses make up a major proportion of the health workforce. In this context we need more and more nurses who are capable of addressing the diverse healthcare needs of society. There is a shift from hospital based curative care to community based preventive and rehabilitative care, and a greater focus on giving people control over their health. Therefore, we need nurses who are equipped with specialized knowledge and skills in public health to work in community healthcare settings.
But the reality shows a different picture. Currently in India, diplomas, undergraduate, postgraduate, and doctorate level courses are offered in nursing. There are also various specialities and sub specialities in nursing at a Masters level. Many nursing educational institutions even the reputed ones in India are contemplating stopping their Masters programmes in community health nursing since there are no takers. If this trend continues, there is a possibility that community health nursing will become extinct in the near future. With my experience as a community health nurse educator, I think that the following factors have led to a staggering situation:
- A lack of good quality teachers who can teach and inspire the nursing students towards public health with innovative teaching and learning methods.
- Poor implementation of the community health nursing curriculum. There are very few institutions with an adequate infrastructure or budget to train students in community health. So as a cost controlling measure, they focus on fulfilling the mandatory requirements of the students so that their eligibility to appear for the university exams is not questionable.
- A poor attitude of some faculty staff who have done undergraduate nursing degrees and are in a position to guide the students in the community settings. Some of the staff do not have any passion towards community health and naturally their ill opinion gets transmitted to their students.
- The curriculum design of community health nursing should be revamped and restructured at both the undergraduate and the postgraduate level. There is a dire need to replace some of the outdated concepts and procedures that are currently taught, for example the utility of the community bag should be revisited and modified according to the current requirements of the patient community.
- There is a lot of collateral damage happening within nursing itself. I have encountered people in nursing who explicitly state that the activities done as part of community services are not as good as what is done in the intensive care unit of a hospital. This just shows people’s inability to understand the necessity of healthcare beyond the four walls of the hospital. Community health professionals have the capability to prevent the patient from going to ICU.
The future of community health nursing is primarily in the hands of educators. Fundamentally, we need to nurture the right attitude towards community health nursing in the minds of the trainee nurses during their undergraduate training. Without the community health nurses, the already weak public health system in India will suffocate and therefore community driven nursing is the need of the hour.
Meena P is currently working as a research officer at Institute of Public Health, Bangalore, India.
Competing interests: None declared.