The Missing Position in Practice: A Neglected Issue in Community Health Nursing in Iran

Abstract

Global social and economic changes have not only led to substantial increases in elderly populations but also the manifestation of numerous degenerative and chronic diseases, and new patterns of disease caused by occupational hazards, environmental pollution and accidents.1,2 Today, public health concerns related to quality care, cost of medical services and low access to health care centers have led to a shift in the paradigm of healthcare from the traditional care settings to community centers.1 With regards to the same points, the health systems in a society must acquire the capabilities required for better meeting the ever-growing demands resulting from these changes.3 In order to meet these increasing needs and to raise the overall healthcare level of its communities, the Islamic Republic of Iran has envisioned short- and long-term plans within the framework of the 2025 Horizon Plan in various fields of research, education and provision of healthcare services.4 In line with this aim, the office of the High Commissioner for medical planning in the country has recently revised the educational curriculum for the Master’s course of community health nursing and has drawn outlines in order to focus the career position of their graduates on a community-oriented approach, in places such as healthcare centers, hospitals, rehabilitation centers, schools, addiction treatment centers, emergency services and natural disaster committees, and in all other organizations needing the services of community health nurses. Moreover, according to the vision drawn out in this plan, in the next ten years (by 2025) the graduates of community health nursing must be able not only to meet the changing needs of Iranian society, but also clearly attain regional and global standards in nursing education and offer effectual service to all members of the society.5 In addition, in most countries of the world, keeping such curriculum visions in mind, curriculum designers facilitate the career position of community health nurses so that they can give care to individuals, families and communities. Furthermore, the number of these nurses working outside the hospital in the community at large has increased substantially, and the community is called their clients.1 While in Iran, community health nurses after graduating with Master’s degree are in practice faced with an absence of specifically defined job positions even though the curriculum has designated the correct future occupational status. Therefore, Iranian community health nurses are mostly forced into employment in clinical settings or educational centers and do not have the ability like their counterparts in other countries to find a job and start serving at health centers which, as mentioned above, are predetermined before graduation.6 Now, in view of the above mentioned points, considering the absence of suitable tools for directing these community health nurses to their appropriate occupational and professional positions, this question arises that to what extent the devised long-term objectives (Horizon 2025) of the Islamic Republic can be achieved. It is recommended that the present process of employing community health nurses should be revised so that it facilitates their real occupational and professional positions resulting in providing better services to their clients