NR 442 Week 8 Community Health Course Reflection Example

The Mobile Home Park Nobody Inspects: A Reflection on Where Responsibility Sits

Student Name

College of Nursing, Chamberlain University

NR 442: Community Health Nursing

Instructor Name

Month Day, Year

The Mobile Home Park Nobody Inspects: A Reflection on Where Responsibility Sits

What Changed

In the first week of NR 442 I took it for granted that every public problem in a town belonged to some office, and that the job of a community health nurse was to find that office and tell it about the problem. I now believe that some problems belong to nobody, and that finding them is one of the most important things a community assessment can do.

Evidence From My Own Work

The old belief is visible in my first discussion post. Writing about a restaurant closure, I said that the health department would handle anything that threatened health in a community, and that a nurse's role was to report concerns to the right department. I did not ask what the department was obliged or funded to do. In my windshield survey of Harlan Crossing in Week 2, I followed the assignment's instruction to attach an owner to every observation, and for most lines it was easy: the town owned the sidewalks, the fire district owned the fire station, the county health department inspected the grocery store. Then I came to the mobile home park just south of the town line, about 40 units, several with visible roof damage and one with a sewage smell near a cracked pipe. I wrote in the owner column that housing code enforcement belonged to the county, and then, when I checked, found that the county had no rental housing inspection program at all. My survey entry ended with the phrase no inspecting office. At the time I thought I had made a research error.

The Moment It Broke

The belief broke when I called the county to confirm. I asked the county health department's environmental health office whether they inspected mobile home parks. The sanitarian told me that the state licenses mobile home parks and inspects their water and sewer systems when they are licensed, but that this park had fewer units than the licensing threshold, so it was not licensed, and the county had no ordinance covering the condition of rental homes outside town limits. The sewage smell could be reported as a nuisance, she said, but only the property owner could be required to fix it, and only if the county attorney chose to pursue it. The town's building inspector had no authority outside the town line. No office was required, or funded, to look at the condition of those homes. That was not an error in my survey. It was the finding.

The Duty Nobody Held

The families in that park, several of them, according to the church pantry volunteer I spoke with, meatpacking workers who rent month to month, live in conditions that no public office is responsible for inspecting. If a child there develops asthma from mold, the clinic will treat the asthma, but no one will be obliged to look at the house. Rector and Stanley (2022) describe the community health nurse's role as including advocacy for populations whose needs fall outside existing services, and the American Nurses Association (2022) lists advocacy and collaboration among the standards of public health nursing practice. Before this course I read that as a general statement of values. Now I read it as a job description for situations like this one, where the nurse may be the only person who has noticed that the duty is missing.

How the Rest of the Term Looked After That

Once I had found one duty that nobody held, I started looking for others, and the later assignments gave me more. In the community assessment, I found that the county's nurse home visiting program served first-time mothers only, so a woman expecting her third child in a house with no heat had no program assigned to her at all, even though her risk was higher. In the population health analysis, I found that the largest single lever over the gap I was studying sat with the state Medicaid agency, not with any office in the county, which meant that the local health department could describe the problem but could not fix it alone. Each time, the useful question was the same one my windshield survey had forced on me: who is required to do this, and who is paying for it?

That question changed how I read service directories too. In my first draft of the community assessment, I listed eleven services for families, copied from the county resource guide. When I added eligibility rules to each line, four of the eleven turned out to be unavailable to most families in the area, because of income limits, age limits or a waiting list. A list of services is a list of offices; it is not a list of what people can use.

What I Will Do

Two commitments are small enough to check. First, I work as a school nurse in the district that serves Harlan Crossing, and I am required to report certain conditions and to complete a home visit form when a child misses more than ten days for a health reason. I will add to my home visit form a line recording whether the home is inside or outside the town limits and whether I observed a housing condition affecting health, so that the district has a count, however small, of children living in housing nobody inspects. Second, I will bring the mobile home park to the county board of health's public comment period in January, with my survey entry and the sanitarian's explanation, and ask whether the county would consider a rental housing ordinance or a lower licensing threshold. I do not expect the board to act quickly. Nies and McEwen (2019) describe policy change at the county level as slow and dependent on documented need, which is what the home visit line is meant to create.

What Is Still Unsettled

I do not know yet how to tell the difference between a gap that exists because nobody noticed and a gap that exists because someone decided it should. The county board may have chosen not to inspect rental housing outside town limits because it would cost money, or because property owners opposed it, or because no one ever asked. Each of those calls for a different kind of advocacy, and I have not yet learned how to find out which one I am facing. That is the question I will carry into the January meeting.

References

American Nurses Association. (2022). Public health nursing: Scope and standards of practice (3rd ed.).

Nies, M. A., & McEwen, M. (2019). Community/public health nursing: Promoting the health of populations (7th ed.). Elsevier.

Rector, C., & Stanley, M. J. (2022). Community and public health nursing: Promoting the public's health (10th ed.). Wolters Kluwer.