Reflections on Community Health Nursing in Shomron (2002-2023), with academic sources

 

Reflections on Community Health Nursing in Shomron (2002-2023)

Introduction

My experience as a community health nurse in Shomron from 2002 to 2023 has provided me with deep insights into the role of trust-building, personal contact, and evidence-based practice in public health. Throughout my tenure, I observed the effects of different management styles, the importance of local engagement, and the challenges posed by bureaucratic inefficiencies in healthcare delivery. This essay will explore these themes while emphasizing the impact of community-centered nursing on vaccination compliance and overall health outcomes, incorporating research on culturally congruent care (Schim, Doorenbos, Benkert, & Miller, 2007) and the role of religious nurses in healthcare systems (Héliot et al., 2019).

The Role of Trust in Public Health

Imanuel is unique in that it has never experienced an outbreak of a vaccine-preventable contagious illness. This success was largely due to proactive community engagement, a crucial element in effective public health practice (Schim et al., 2007). I consistently reached out to parents who had not completed the vaccination schedule, organizing extra vaccination days in Imanuel and Kedumim. By forming relationships with community members, I was able to encourage partial vaccination compliance even among families initially opposed to vaccines. Research supports that building trust with patients leads to higher compliance and better health outcomes (Schim et al., 2007).

As a local resident since 1999, I had the opportunity to integrate health discussions into daily interactions—whether at the grocery store, synagogue, or community events. Many parents who were initially hesitant about vaccines eventually agreed to partial vaccination due to personal trust in me as a community member and healthcare professional. This aligns with evidence-based nursing practice, which emphasizes direct communication in improving health behaviors (American Nurses Association, 2024).

Challenges of Hierarchical Management

Unlike other communities where local Haredi nurses were employed, I was the only school nurse living in Imanuel. Despite encouraging local nurses to join, many declined due to the perceived challenges of the role. 

 

Religious identity can enhance workplace contributions when there is alignment between occupational and religious values (Héliot et al., 2019). I viewed my work as spiritually significant, indeed, one rabbi told me, "Every vaccine you give is an enormous mitzvah."

When I shared this insight with the head nurse, who had been there since about 2015,  she flicked her hand dismissively, made a scornful facial expression, and said, "think what you want." I was not "thinking what I want", I did not invent the notion that assisting in the delivery of health care is a good deed which reaps spiritual benefit. Thus, my commitment was not recognized by upper management. 

Indeed, you discover that stereotypes against subgroups can be used to decrease services to them, just make blanket statements like, "ultra-orthodox just don't was to vaccinate, that's the way they are," and this serves as a justification for rationalizing why an outbreak may happen in those communities. Build trust, and the outbreak is much less likely.

This head nurse exhibited open contempt toward my religious practices. When discussing kashrut with a colleague, she interfered with this discussion, which had not meant to include her, and expressed scorn.  As I noted, when I expressed that I viewed my work as a religious duty, she dismissed it with scorn.

Thus, my commitment was not recognized by upper management. The head nurse exhibited open contempt toward my religious practices, dismissing my beliefs and failing to acknowledge the role of spirituality in healthcare. Research shows that allowing religious identity expression in the workplace improves employee well-being and job satisfaction (Héliot et al., 2019).

Erosion of Community Nursing

Over the years, school nursing shifted from relationship-based care to a task-oriented approach. Initially, I worked weekly at two schools, allowing me to monitor post-vaccination effects. By December 2023, nurses were instructed to rely on teachers to report vaccine side effects, despite teachers being overwhelmed with other responsibilities. This shift represents a decline in the role of school nurses as trusted health professionals within the school system (Schim et al., 2007).

Furthermore, workload expectations increased drastically. Under various administrations—Aguda, Natali, and later that organization—nurses were initially expected to perform 30 vaccines per day, a reasonable goal. However, under that organization's management, this increased to 40-50 vaccines per day, placing immense psychological pressure on nurses. The 2022 lawsuit against that organization, where a child was mistakenly given a double dose of the Tetanus-Diphtheria-Pertussis vaccine within a week, highlights the dangers of prioritizing quantity over quality in healthcare (American Nurses Association, 2024).

The Accessibility Crisis in Vaccination Services

Another significant issue was the centralization of vaccine distribution. Until 2005, vaccines were available at both schools and public clinics. However, after this policy change, vaccines were only administered in schools, limiting access for parents who could not attend scheduled school vaccination days. Clinics offer flexible hours, including afternoon and Friday appointments, which are more convenient for working parents (Schim et al., 2007).

If the goal of public health policy is high vaccine coverage, why restrict vaccine availability? Schools only offer vaccinations sporadically, whereas clinics operate regularly. The lack of flexibility forces parents into inconvenient options, reducing compliance and defeating the goal of widespread immunization (Schim et al., 2007).

Culturally Congruent Care and Public Health Success

Outbreaks of measles, polio, whooping cough, and chickenpox have been recorded across Israel. However, Imanuel has remained outbreak-free. One key factor was understanding the cultural behaviors of the population. Knowing that families travel extensively during the High Holidays, I prioritized early vaccinations at the start of the academic year. This proactive approach ensured that children were immunized before traveling to high-risk areas, a practice supported by culturally congruent care models (Schim et al., 2007).

This is an example of culturally competent nursing, which aligns with research on the importance of cultural sensitivity in healthcare delivery (Schim et al., 2007). If vaccination timing is a crucial factor in community health, why isn’t it prioritized in national public health planning?

Conclusion and Recommendations

Healthcare is built on trust—between nurses and their communities, and between management and their staff. To improve public health outcomes, the following steps should be taken:

1. Reintroduce a community-centered approach to school nursing, ensuring that nurses have time for relationship-building and patient education (Schim et al., 2007).

2. Revise vaccine availability policies to allow both schools and clinics to administer vaccines, making immunization more accessible.

3. Implement feedback mechanisms that allow nurses to communicate field experiences to policymakers, ensuring that directives are aligned with real-world healthcare challenges (Héliot et al., 2019).

4. Shift from a hierarchical management style to a collaborative one, empowering nurses to use their professional judgment (Héliot et al., 2019).

5. Reassess the policy on parental consent for vaccinations, ensuring that parents fully understand the implications of their signed health declaration.

The true measure of successful community health nursing is not just in metrics and quotas, but in trust, accessibility, and ethical practice.

Many thanks for the opportunity to serve