In our ongoing effort to meet both mandates of “Connections”, informing readers about RGP services and promoting wellness by providing information on matters relevant to aging and health, following is an article by Joanne Fitzgibbon, Clinical Nurse Specialist and Kyle Whitfield, Community Development Facilitator, responding to the question,”How do we, as health professionals, work together with communities to create an environment where older adults with complex health issues have access to services that enhance their quality of life?”

Community Development and the Regional Geriatric Program

Community development within the Regional Geriatric Program came to be identified as an approach in 1994 when a Needs Study was completed in Hastings and Prince Edward Counties. This model or perspective of service delivery was identified by the Hastings-Prince Edward community as an approach that they were interested in implementing. Since it is a perspective from which we work, our work in other counties has also been influenced by this viewpoint. Community development has come to be defined, by the Regional Geriatric Program, as an approach which encompasses values and principles relating to:

· partnerships and collaboration with other groups and individuals who support older adults;

· working with communities to enhance already existing competencies;

· shared accountability and responsibility with community partners to enhance services for older adults;

· consultation with communities in order to understand the issues and strengths of the community as this relates to the quality of life of older adults.

In our roles as Community Development Facilitator and Clinical Nurse Specialist (CNS), we enact community development values and principles through working in collaboration to develop partnerships with other groups, many of whom provide care to older adults with complex health problems. To ensure close collaboration and communication in Hastings and Prince Edward Counties, for example, a group of individuals representing organizations who provide services to older adults is working together to enhance and implement specialized geriatric services through the most effective and efficient use of community resources. This team has been together since 1994 and involves: the Access Centre for Hastings and Prince Edward Counties, Victorian Order of Nurses, Tweed and District Community Health Centre and Seniors Services, Westgate Lodge Nursing Home, Belleville General Hospital and the Regional Geriatric Program.

Role of the Clinical Nurse Specialist (CNS)

There are two Clinical Nurse Specialists in the Regional Geriatric Program, but this article refers only to the CNS position held by Joanne Fitzgibbon. For this Clinical Nurse Specialist role within the RGP, community development is a context or a perspective which underlies the practice. The community development perspective blends well with the traditional model of CNS as nursing leader and change agent. This particular CNS role within the RGP is a relatively new role, rather unique, and perhaps pioneering. The CNS practice has taken on a focus of working primarily with health care providers in small community hospitals and long term care facilities to enhance competency and support “best practice”. The “working together” as partners often begins with exploration of a nursing practice issue and results in identifying a learning need related to caring for older adult patients with complex health problems. CNS practice includes working to develop collaborative education programs, doing patient consultations in which there is also an educational component, and being involved in research. The scope of the CNS practising from a community development perspective is broad. It involves being prepared to work with other practitioners, in the communities we serve, on the issues and capacities that they identify for themselves as being important to enhancing competency.

Role of the Community Development Facilitator

The aim of the role of the Community Development Facilitator within the Regional Geriatric Program is to develop and/or strengthen partnerships with communities in Southeastern Ontario to work together to discover ways to enhance services for older adults. This role began in 1995 and involves: identifying potential community links; facilitating the definition of issues affecting the quality of life and services for older adults in a community; facilitating decision making around those issues; facilitating the implementation of those decisions and evaluation of those actions in a collaborative way. Another role of the Community Development Facilitator, as well as that of other Regional Geriatric Program staff, is that of ensuring that communities throughout Southeastern Ontario are familiar with the services of the Regional Geriatric Program. This relates to facilitating the process of sharing information with communities about Regional Geriatric Program services and identifying ways for communities to best access those services.

How do we work together to produce outcomes?

To ensure close collaboration and communication, a community development team within the Regional Geriatric Program has been created consisting of: the Clinical Nurse Specialist, the Administrative Co-ordinator, and the Community Development Facilitator. The Community Development Secretary is also often involved. In our work together, there is:

· continual communication;

· collaboration in the development of plans which are based on and in consultation with community partners;

· continual and ongoing sharing of our learnings and other resources.

What comes out of the work we do together?

In the past three years several outcomes have been the result of collaboration between the Clinical Nurse Specialist and the Community Development Facilitator, as well as collaboration with community partners:

· strengthened relationships with many older adults in rural communities;

· enhanced relationships with organizations and groups who provide services to older adults or whose membership is made up of older adults;

· development of a Geriatric Medicine Clinic at Prince Edward County Memorial Hospital;

· enhanced opportunities to share educational information about aging issues in community newspapers and some agency newsletters;

· new links and educational opportunities with community hospitals and long term care facilities

At the core of community development is the concept of a learning environment and we continue to learn with communities to continually find new ways to “engage in empowering practice together”-- always with the aim of enhancing the quality of life of older adults in Southeastern Ontario. We look forward to your comments and suggestions for ways to do this better and for ways to enhance our partnerships with you. We can be reached at 613-548-7222 (Joanne Fitzgibbon, Ext. 2387 and Kyle Whitfield, Ext. 2326).

References

Wallerstein, Nina and Edward Bernstein (1994) “Introduction to Community Empowerment, Participatory Education, and Health” Health Education Quarterly, Vol. 21(2) 141-148.

Photo Cutline: Seniors gather at City Hall, June 8th, for Successful Aging, an evening of presentations, discussion and entertainment in recognition of Senior Citizens Month.