Community Health Nursing in Iran: A Review of Challenges and Solutions (An Integrative Review)

Abstract

Background and ObjectiveIn recent decades, nursing has witnessed many changes in Iran. Despite the numerous advances in nursing, the health system faces many challenges in community health nursing. This study aims to review the challenges in community health nursing in Iran and provide an evidence-based solution as well.Materials and MethodsThis article is an integrated review of the literature regarding the challenges in community health nursing published between 2000 and 2021 in the databases Scopus, Medline, Cochrane Database of Systematic Reviews, Science Direct, Google Scholar, Scientific Information Database (SID). After performing searches, 20 articles were selected and studied. Data analysis was done using Russell approach (2005).FindingsThe results of this study were summarized in 6 themes consisting of challenges in community health nursing education, practical challenges in community health nursing, policy-making challenges in community health nursing, management challenges in community health nursing, and infrastructural and cultural challenges. Solutions were also proposed to address each of the above issue.ConclusionsThe results of the study showed that diverse challenges exist in community health nursing in Iran, considering that community health nurses play an important role in providing primary health care and community-based care. In order to solve these challenges, the authors have some recommendations: modifying the structure of the health system with the aim of moving toward a community-oriented approach from a treatment-oriented one, developing laws to support community health nurses, creating an organizational chart for nurses at the community level, modifying nursing students' training through a community-based approach, and covering community-based services and care under insurance.

Explaining of existing challenges of community-based undergraduate nursing education in Iran: a qualitative study

“…This issue has also caused a gap between theory and practice, paying attention to it reduces the gap between nursing theory and practice. Focusing on the lessons that suit the community’s needs and its localization is one of the suggestions presented in different studies [ 2 , 27 , 32 , 33 ].…”

“…In addition, “educational challenges” such as students' poor understanding of community health nursing courses, considering community health nursing internships as futile, and poor efficiency of community health internship programs, were obstructed. The last theme “policy challenges in nursing” such as failure to determine the position for providing nursing services in the community and health system, lack of clear job descriptions for community-based nurses, and so on were emphasized in their study [ 32 ]. Most of their findings are in line with many of the results of the present study.…”

“…At the same time, the community needs the education of nurses based on holistic views [ 26 , 33 , 43 ]. Hosseinnejad et al (2022) have stated that currently, the focus of the health system is on disease-oriented approaches instead of prevention-oriented ones, and this issue is an essential reason for high costs in the treatment sector and causes problems in allocating resources to nurses in the health field [ 32 ]. The study’s result by Karimi et al (2013) showed a weakness in nursing students’ community-oriented and holistic attitude.…”

“…In line with the present study’s finding "intangibility of lessons and defects in the implementation of the community-based program", some studies have shown the lack of application of some of the contents of theoretical lessons in internship environments and subsequently created a gap between theory and practice. This issue has been caused by what is read in theory is not tangible in practice, and the program’s implementation faces problems [ 2 , 32 , 33 ]. It seems that if the curriculum is modified based on the structure and health needs of the community, this problem will be mainly solved.…”

Community-based nursing: a concept analysis with Walker and Avant’s approach

“…2. Solving community-based nursing challenges such as hospital-oriented and treatment-oriented in the health system, defects in the position and role of communitybased nurses, flaws in community-based education infrastructure, deficiencies in trust, awareness, and acceptance of nurses in the community by the people [7,38,39], 3. Meeting the health needs of individuals, families, groups, communities and populations, developing community capacity for health, social justice, and eliminating health inequality [11,12,16,23,30,[40][41][42][43][44], 4.…”