Community Health Nursing: Heroin Abuse in Baltimore, MD

Introduction to Community-Based Nursing

Providing care to individuals in a hospital setting is a controlled environment that can be challenging but ends at a prescribed time. By contrast, community-based nursing "focuses on individuals and families in their natural settings within communities" (Sanger, 2000). Both types of nursing center on the individual, but community-based care also requires that a nurse understand the issues patients face on a daily basis. A nurse whose primary role 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 population, mobilize resources, and assist community leaders with health policy development (Rallings, 2009). Although not every community-based professional will require all of these skills, this type of nursing demands a diverse skill set that aids the community and promotes health. This paper examines the community of Baltimore, MD as a focus for community-based nursing interventions.

Baltimore Community Profile

Baltimore is a working-class community on the upper reaches of the Chesapeake Bay, approximately one hour northeast of Washington, DC. The city was once a prosperous shipping port, but its economic base has shifted as the needs of the nation have changed. Like many other communities, Baltimore has embraced computer technology and now has a thriving base of large and medium-sized businesses supporting that sector (Health Department Baltimore Maryland, 2009). Unfortunately, this transition has not brought prosperity to all areas of the city. Many residents living in lower-middle-class and impoverished neighborhoods face significant problems, among them limited access to proper healthcare. Many formerly industrial areas have not recovered economically, and these communities within the city remain depressed and underserved.

Demographic and Epidemiological Data

The population of the city proper, estimated from the 2011 Census, was 619,493 people (Census Bureau, 2012). The ethnic breakdown was 63.6% Black, 31.5% White, and 2.5% Asian, with all other ethnic groups making up the remainder. People of Hispanic origin — some counted within either the White or Black categories — constituted 4.3% of the population. The survey reported that 52.9% of the city's population was female, and that a majority (82.4%) had lived in the same residence for more than a year. A large proportion, 77.4%, had a high school education or greater, while only 25.2% had earned a bachelor's degree. Although the median family income was $39,386 per year, 21.3% of residents lived below the poverty level.

The most notable finding is that the city's residents are disproportionately poor. As a result, they face greater difficulty as a group in obtaining quality healthcare. A survey conducted by the Baltimore City Health Department (2009) found that "research has consistently shown that health improves incrementally as levels of income and education increase." Given the high proportion of poor and under-educated residents, it is not surprising that many people report being in only fair or poor health. Many believe they have poor access to proper healthcare, and many among the chronically ill — those who are obese or have diabetes and/or hypertension — felt they could not access adequate care for their conditions. Notably, there was a large racial disparity: Black residents were nearly three times as likely as White residents to report poor access to healthcare, and income and education level showed equally large disparities (Health Department Baltimore Maryland, 2009).