Beyond the hospital: nursing in the community

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The FOCUS placement program is teaching nursing students how they can go beyond traditional nursing interventions

By Uhanthaen Ravilojan

When fourth-year nursing student Crystal first entered her program, she never thought she’d have to negotiate with landlords on behalf of her patients.

 She thought she would be administering injections or inserting urinary catheters. However, while completing her work placement as part of the FOCUS Community Mental Health Team at St. Michael’s Mental Health Service, she realized there was much more to nursing.

The FOCUS team uses Assertive Community Treatment (ACT) to help people with serious mental illnesses. ACT is a form of community nursing that usually takes place outside of a hospital setting. 

It is a comprehensive form of care, focusing not only on physical health, but also finances, hygiene and housing. It’s prescribed to individuals who are frequently hospitalized.

“I think learning community theory before entering the placement teaches you to withhold any kind of judgment that you would have, and a lot of people go into the profession because they want to practice compassion and help people,” said fourth-year nursing student Victoria Kurzinger.

This holistic approach to nursing is far from new. Its roots can be seen in the Grey Nuns, a charitable organization founded by St. Marguerite d’Youville in the 1700s that provided the sick and poor in Montreal with healthcare, shelter and education. There was no clear division between these different forms of care, rather, they were all seen as important forms of community treatment. 

Similarly, ACT addresses societal factors like income, education and working conditions that determine someone’s long term well-being. 

According to Statistics Canada data from 2008, earnings of university grads were 70 per cent higher than those coming out of high school or trades training. A higher income typically provides better access to safe housing and healthy food. 

But for people suffering from mental health issues this isn’t always an easy feat. According to the World Health Organization (WHO), discrimination towards people with schizophrenia and psychosis can “limit  access to general health care, education, housing and employment.”

A study in London, Ont. estimated that one third of homeless people in Canada have a serious mental illness. Nurses can give them a voice by advocating on their behalf to people like employers and landlords. 

“If they’re at risk of being evicted for any reason, you could help them talk to their landlord and work out a deal,” Kurzinger said. 

Some patients also need support from nurses to complete daily tasks like paying their bills, cleaning their apartment or getting to doctor’s appointments. 

Once, when a patient had to make an emergency visit, Kurinzger and Lam were tasked with taking care of their dogs.

“That was part of our nursing care,” said Kurzinger. “Not just giving an injection, but just [doing] something to support them.’’

Students are also taught to empower patients to make individual decisions regarding obstacles they face as a part of their conditions. 

If a patient has to visit the doctor’s office, but lacks clean clothes, they may not leave their house, Lam says. A nurse can guide a patient to finding the solution to this problem, asking if they know anyone who can support them by lending clean clothes.

The Ryerson nursing curriculum gives students the theoretical foundation for this approach to care, teaching students to take an empathetic look at health.

“Just showing your interest and motivation towards [them], that you are interested in [them] it can add so much,” said Kurzinger.

She said learning from experience allows for a more accurate reflection of her field.

“I think it’s mostly through experience that you learn how to navigate in the real world.”

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