Lecture Notes 1st Semester 2024 Community Health Nursing PDF

**LECTURE NOTES 1 in CHN1** **UNIT: HISTORICAL DEVELOPMENT OF COMMUNITY HEALTH NURSING** **Learning Objectives** On completion of this of this unit, students will be able to: - Describe the four stages of community health nursing development - Describe factors that influenced the growth of...

**LECTURE NOTES 1 in CHN1** **UNIT: HISTORICAL DEVELOPMENT OF COMMUNITY HEALTH NURSING** **Learning Objectives** On completion of this of this unit, students will be able to: - Describe the four stages of community health nursing development - Describe factors that influenced the growth of community health nursing - Explain some of the roles of community health nursing - Summarize the settings of community health nursing **Introduction** Before one can fully grasp the nature of community health or define its practice, it is helpful to understand the roots and influencing factors that shaped its growth over time. Community health nursing is the product of centuries of responsiveness and growth. Its practice was adapted to accommodate the needs of a changing society, yet it has always maintained its initial goal of improved community health. Community health nursing development has been influenced by changes in nursing, public health and society that is traced through several stages. In tracing the development of public health nursing, now it is clear that leadership role has been evident throughout its history. Nurses in this specialty have provided leadership in: planning and developing programs; shaping policy; administration; and the application of research to the community health. Four general stages mark the development of public health or community health nursing. B. The district nursing stage A. **Early Home Care Stage (Before Mid 1800s)** - For many centuries female family members and friends attended the sick at home. The focus of this care was to reduce suffering and promote healing (Kalish and Kalish, 1986). The early roots of home care nursing *began with religious and charitable groups.* - In England the Elizabethan poor law written in 1600, provided medical and nursing care to the poor and disabled. - In Paris, St. Vincent de Paul started the sisters of charity in 1617, an organization composed of laywomen dedicated to serving the poor and the needy**.** In its emphasis on preparing nurses and supervising care as well as determine causes and solutions for clients\' problems their work laid a foundation for modern community health nursing (Bullough and Bullough, 1978). - The set back of these services were: - Social approval following the reformation caused a decline in the number of religious orders with subsequent curtailing of nursing care for the sick and poor. - High maternal mortality rates prompted efforts to better prepare midwives and medical students. - Industrial revolution created additional problems; among them were: - epidemics, - high infant mortality, - occupational diseases, - injuries and increasing mental illness both in Europe and America. - This stage was in the midst of these deplorable conditions and response to them that **Florence Nightingale (1820 - 1910)** began her work. - Much of the foundation for modern community health nursing practice was laid through Florence Nightingale\'s remarkable accomplishments. - Nightingale's concern for population at risk as well as her vision and successful efforts at health reform provided a model for community health nursing today. B. **District Nursing (Mid 1800s to 1900)** - The next stage in the development of community health nursing was the formal organization of visiting nursing (Phoebe, 58AD) or district nursing. - Although district nurses primarily care for the sick, they also thought cleanliness and wholesome living to their patients, even in that early period. - Nightingale referred to them as "health nurse". This early emphasis on prevention and health nursing became one of the distinguishing features of district nursing and later of public health nursing as a specialty. - The work of district nurses focused almost exclusively on the *care of individuals*. - District nurses recorded temperatures and pulse rates and gave simple treatments to the sick poor under the immediate direction of a physician. - They also instructed family members in *personal hygiene, diet and healthful living habits and the care of the sick.* - Problems of district nursing: - Increased number of immigrants - Increased crowded city slums - Inadequate sanitation practices - Unsafe and unhealthy working conditions - Nevertheless, nursing educational programs at that time did not truly prepare district nurses to cope with their patients, multiple health, and social problems. C. **Public Health Nursing Training (1900-1970)** - *By the turn of the century, district nursing had broadened its focus to include the health and welfare of the general public, [not just the poor]*. - This new emphasis was part of a broader consciousness about public health. Specialized programs such as infant welfare that brought health care and health teaching to the public and gave nurses an opportunity for more independent work, and helped *to improve nursing education* *(Bullough and Bullough 1978, p. 143).* - **Lillian D. Wald's (1867-1940**) contributions to public health nursing were enormous. Her driving commitment was to *serve needy populations*. - **Wald's** *emphasis on illness prevention and health promotion through health teaching and nursing intervention* as well as her use of epidemiological methodology established these actions as hallmarks of public health nursing practice. - The public health nursing stage was characterized by service to the public with the family targeted as a primary unit of care. **D. Community Health Nursing (1970 to present)** - The *emergence of the term **community health nursing*** *heralded a new era while public health nurses continued their work in public health by the late 1960s and early 1970s*. - Many other nurses, not necessarily practicing public health, were based in the community. Their practice settings included community based clinics, doctor's office, work sites, schools, etc, to provide a label that encompassed all nurses in the community. - *The confusion* was laid in distinguishing between public health nursing and community health nursing. The terms were being used interchangeably and yet, had different meanings for many in the field. - In 1984 the division of nursing convened a consensus conference on the essentials of Public Health Nursing practice and education in Washington DC (1985). *This group concluded that community health nursing was the broader term referring to all nurses practicing in the community regardless of their educational preparation.* - **Public health nursing**, viewed as a part of community health nursing, was described as generalist practice for nurses prepared with basic public health content at the baccalaureate level and a specialized practice for nurses prepared in the public health at the masters level or beyond. - The debate over these areas of confusion continued through the 1980's with some issues unresolved even today. - **Public health nursing** continues to mean the synthesis of nursing and public health sciences applied to promoting and protecting the health of populations. - **Community health nursing** is used synonymously with public health nursing and refers to specialized population focused nursing practice which applies public health sciences as well as nursing services. **Explanation:** In the field of nursing, there has been ongoing discussion about the differences between **public health nursing** and **community health nursing**. These discussions were especially active during the 1980s, and some of the issues are still not fully resolved today. **Public Health Nursing:** - **Definition**: Public health nursing involves combining nursing skills with public health sciences to promote and protect the health of entire populations. It focuses on the health of large groups, such as cities, regions, or even entire countries. - **Role**: Public health nurses work on broader health issues, like preventing disease outbreaks, promoting vaccination, and developing health policies. **Community Health Nursing:** - **Definition**: Community health nursing is often used interchangeably with public health nursing. It also focuses on population health but is more specialized in certain communities or groups within a population. It still applies public health sciences, but it might be more targeted to smaller groups within a larger population. - **Role**: Community health nurses might focus on specific neighborhoods or groups, providing direct care, health education, and support services tailored to that community\'s needs. **Levels of Specialization:** - **Community Health Nursing as Entry-Level**: Some see community health nursing as a starting point for specialization in public health nursing. It involves learning and applying public health principles on a smaller scale or within specific communities. - **Public Health Nursing as Advanced**: Public health nursing is seen as a more advanced level, where nurses apply their skills on a larger scale, dealing with more complex public health issues that affect entire populations. **The Summary of Development of Community Health Nursing** +-------------+-------------+-------------+-------------+-------------+ | (Before mid | | | Curative | | | 1800s) | | | | | +-------------+-------------+-------------+-------------+-------------+ | District | | | Curative | | | nursing | | | and | | | | | | beginning | | | | | | of | | | | | | preventive | | | | | | care | | +-------------+-------------+-------------+-------------+-------------+ | | Needy | | | | +-------------+-------------+-------------+-------------+-------------+ | | | | | | +-------------+-------------+-------------+-------------+-------------+ **Factors Influenced the Growth of Community Health Nursing** The growth of community health nursing has been influenced by a variety of factors over time. These factors have shaped the practice and expanded its role in promoting public health. Here are some key influences: 1\. Epidemiological Shifts - Description: Changes in disease patterns, such as the rise of chronic diseases (e.g., diabetes, heart disease) and the decline of infectious diseases, have necessitated a shift in focus from hospital-based care to community-based care. - Impact: Community health nursing has grown as it addresses these evolving health challenges within communities. 2\. Public Health Policies and Legislation - Description: Government policies and laws, such as the establishment of public health departments and national health programs, have promoted the development of community health services. - Impact: These policies have created opportunities and funding for community health nursing roles. 3\. Advances in Medical and Nursing Science - Description: Technological and scientific advancements in healthcare have made it possible to deliver care outside of traditional hospital settings. - Impact: Community health nurses can now provide more complex care in community settings, including preventive care, health education, and management of chronic conditions. 4\. Social and Economic Changes - Description: Changes in societal structure, such as urbanization, an aging population, and economic disparities, have increased the need for accessible healthcare in communities. - Impact: Community health nursing has grown to meet the demand for services that address social determinants of health and provide care to underserved populations. 5\. Educational Advancements - Description: The development of specialized nursing education programs in community and public health nursing has prepared nurses with the skills needed for this field. - Impact: More nurses are entering the workforce with the knowledge and training to provide community-based care. 6\. Health Promotion and Disease Prevention Focus - Description: A growing emphasis on health promotion and disease prevention, rather than just treatment, has driven the expansion of community health nursing. - Impact: Nurses are increasingly involved in educating communities, promoting healthy lifestyles, and preventing illness before it occurs. 7\. Community Engagement and Empowerment - Description: A shift toward involving communities in their own health care decisions and actions has encouraged the growth of community health nursing. - Impact: Community health nurses play a key role in empowering individuals and communities to take control of their health. 8\. Global Health Initiatives - Description: International efforts to improve global health, such as the World Health Organization\'s campaigns, have influenced the growth of community health nursing worldwide. - Impact: Nurses are increasingly involved in global health initiatives, bringing community health nursing to the forefront of international public health efforts. 9\. Technological Innovations - Description: The rise of telehealth, mobile health applications, and electronic health records has expanded the ability of community health nurses to reach and serve populations. - Impact: Technology has enhanced the scope and efficiency of community health nursing. 10\. Cultural Shifts Toward Holistic Care - Description: There has been a growing recognition of the importance of holistic and culturally competent care, which considers the physical, emotional, and social aspects of health. - Impact: Community health nursing has expanded to include a more holistic approach, addressing a wide range of factors that affect health. These factors collectively contributed to the evolution and growth of community health nursing, making it an integral part of the healthcare system focused on improving the health and well-being of populations. **Roles of Community Health Nursing** **Seven Major Roles:** **A. Clinician** **B. Educator** **C. Advocate** **D. Managerial** **E. Collaborator** **F. Leader** **G. Researcher** **A.Clinician role /direct care provider** - The clinician role in the community health means that the nurse ensures that health services are provided, not just to individuals and families but also to groups and population. - For community health nurses the clinician role involves certain emphasis different from basic nursing, i.e. -- [Holism, health promotion, and skill expansion.] **Holism in Health Care** - **Holism -** in health care is an approach that considers the whole person rather than just focusing on a specific illness or body part. It involves understanding and addressing the physical, emotional, mental, social, and spiritual aspects of a person\'s health. The goal is to promote overall well-being and to treat the person as a whole, rather than simply managing symptoms or diseases in isolation. **Key Concepts of Holistic Health Care:** 1. **Physical Health**: - **Definition**: The physical well-being of the body, including proper functioning of all bodily systems. - **Application**: Holistic care looks beyond the immediate physical symptoms to understand how factors like diet, exercise, and sleep impact overall physical health. 2. **Emotional Health**: - **Definition**: The ability to manage emotions and cope with stress, leading to a sense of emotional balance. - **Application**: Holistic care includes emotional support, counseling, and stress management techniques, recognizing that emotional well-being is critical to overall health. 3. **Mental Health**: - **Definition**: Cognitive functioning and mental wellness, including the ability to think clearly, make decisions, and cope with life's challenges. - **Application**: Holistic care may involve mental health services, such as therapy or mindfulness practices, to support a person's mental resilience. 4. **Social Health**: - **Definition**: The quality of relationships and social interactions, and the ability to maintain supportive social networks. - **Application**: Holistic care recognizes the importance of social connections, providing support for building healthy relationships and addressing social determinants of health like isolation or community support. 5. **Spiritual Health**: - **Definition**: A sense of purpose and meaning in life, which may or may not involve religious beliefs. - **Application**: Holistic care includes consideration of a person\'s spiritual needs, offering support for spiritual practices or helping patients find meaning in their health journey. **Holistic Health Care in Practice:** - **Integrated Treatment Plans**: Holistic care often involves creating comprehensive treatment plans that address multiple aspects of a patient's health **For example,** i **I**n treating a patient with chronic pain, a holistic approach might combine medication, physical therapy, counseling, and lifestyle changes. - **Patient-Centered Care**: Holistic health care is deeply patient-centered, involving the patient in decision-making and respecting their values, beliefs, and preferences. It aims to empower patients to take an active role in their own health. - **Preventive Focus**: Holistic care emphasizes prevention by addressing lifestyle factors and promoting healthy behaviors that contribute to long-term well-being. **Example:** If a patient comes to a holistic health care provider with chronic headaches, rather than just prescribing pain medication, the provider might also explore the patient\'s stress levels, diet, sleep patterns, and even emotional well-being. The treatment plan could include a combination of medication, stress management techniques like yoga or meditation, dietary adjustments, and counseling to address any underlying emotional issues. **Summary:** Holism in health care is about treating the person as a whole---body, mind, and spirit---rather than just addressing symptoms. This approach aims to achieve optimal health by considering all aspects of a person\'s life, creating a more comprehensive and personalized care experience. - **Health Promotion focus on wellness:** The community health nurse provides service along the entire range of the wellness -- illness continuum but especially emphasis on promotion of health and prevention of illness. - **Expanded skills:** the nurse uses many different skills in the community health clinician role skill. In addition to [physical care skill], recently skills in [observation], l[istenin]g, [communication] and [counseling] became integral to the clinician role with an increased emphasis on environmental and community wide considerations such as problems with pollution, violence and crime, drug abuse, unemployment and limited funding for health programs. **B.Educator role** - It is widely recognized that health teaching is a part of good nursing practice and one of the **major functions of a community health nurse (Brown, 1988).** The educator role is especially useful in promoting the public's health for at least two reasons. The educator role: - Has the potential for finding greater receptivity and providing higher yield results. - Is significant because wider audience can be reached. - The emphases throughout the health teaching process continue to be placed on **illness prevention** and **health promotion.** - The issue of clients' rights is important in health care today. - [ *Every patient or client has the right to receive just equal and humane treatment*]*.* However, our present health care system is often characterized by [*fragmented and depersonalized services.* ] Reference: **Fragmented and depersonalized services** refer to aspects of health care delivery that lack coordination and personal connection, often leading to less effective and less patient-centered care. - As a manager the nurse exercises administrative direction towards the accomplishment of specified goals by *assessing clients' needs, planning and organizing to meet those needs, directing and controlling and evaluating the progress to assure that goals are met*. - Nurses serve as managers when they *oversee client care, supervise ancillary staff, do case management, manage caseloads, run clinics or conduct community health needs assessment projects.* - Case management refers to a *systematic process* by which the nurse assesses clients' needs, plans for and co-ordinates services, refers to other appropriate providers, and monitors and evaluates progress to ensure that clients multiple service needs are met. **Caseload** - **Caseload** refers to the number of clients or patients that a nurse is responsible for providing care to within a specific period. This can include individuals, families, or groups within a community. - Community health nurses seldom practice in isolation. They must work with many people including clients, other nurses, physicians, social workers and community leaders, therapists, nutritionists, occupational therapists, psychologists, epidemiologists, biostaticians, legislators, etc. as a member of the health team (Fairly 1993, Williams, 1986). The community health nurse assumes the *role of collaborator*, which means to work jointly in a common endeavor, to co-operate as partners. - *As a leader, the nurse directs, influences, or persuades others to effect change that will positively affect people's health*. The leadership role's primary function is to effect change; thus, the community health nurse becomes an *agent of change.* They also seek to influence people to think and behave differently about their health and the factors contributing to it. - In the researcher role community health nurses *engage in systematic investigation, collection and analysis of data for the purpose of solving problems and enhancing community health practice*. - Research literally means to search and/or to investigate, discover, and interpret facts.. **LECTURE NOTES 2 in CHN1** **UNIT 2: BASIC CONCEPTS OF HEALTH IN COMMUNITY HEALTH NURSING** **Definitions of COMMUNITY** **Broad definition:** **Community \--is a collection of people who interact with one another and whose common interest or characteristics gives them a [sense of unity and belonging].** **(By: Dryer's den).** **Community is a group of people in defined geographical area with common goal and objective and the potential for interacting with one another** **(Maglaya defines a community as:)** **Community \--a group of people who share common interests, values, or characteristics and interact with one another within a defined geographic area or social setting.\"** **This definition emphasizes the shared aspects that bring people together and the interactions that define the community.** **The Three Features of a Community** **A community has three features, 1.Location** **2.Population** **3.Social system** 1. **Location-refers to the *specific geographical location* where a physical community exists and operates.** **-It encompasses both the *physical coordinates* (latitude and longitude) and the broader context of** **the *environment* in which the community is situated.** **-The health of the community is affected by its location.** ***Example:*** ***Imagine a small town nestled in the mountains of the Cordillera region. This place is approximately 16°N latitude and 121°E longitude. Its location in the Cordillera not only provides specific coordinates on a map but also influences its climate, economy, and culture. The mountainous geography affects health, outdoor recreational activities, and other aspects of life in the town.*** 2. **Population - refers to all the individuals living within the boundaries of that community.** **- These *[specialized aggregates]* refer to subgroups within the population that share specific traits** **or fulfill particular functions in the community.** ***Explanations:*** - ***Diverse groups of population- refer to the various subgroups within a community that have different*** ***characteristics and backgrounds. These differences can include race, ethnicity, gender, age,*** ***occupation, education, and [socioeconomic status].* *The diversity of these groups enriches the*** ***community, bringing a variety of perspectives, skills, and experiences.*** - **Specialized Aggregates: refer to subgroups within the larger population that have distinct characteristics or functions.** **Examples:** **\--*age groups*** **\--*occupational groups*** **\--*cultural or ethnic groups*** **.Age Groups:** ***Example:*** ***Consider a small city with a population of 50,000 people. This population includes:*** - ***Children and Teenagers: Attending local schools and engaging in recreational activities.*** - ***Seniors: Retired individuals who participate in community events and rely on local healthcare services.*** - ***Professionals: Specialized workers such as doctors, nurses, midwives, engineers, teachers, and artists who provide essential services and enrich the community\'s intellectual and cultural life.*** **.Occupational Groups** ***Examples:*** ***1. Healthcare Professionals*** - ***Examples: Doctors, nurses, pharmacists, dentists, and paramedics.*** - ***Roles: Providing medical care, conducting health education, and promoting public health.*** ***2. Educators*** - ***Examples: Teachers, professors, school administrators, and daycare workers.*** - ***Roles: Educating children and adults, developing curricula, and fostering lifelong learning.*** ***3. Public Safety Workers*** - ***Examples: Police officers, firefighters, emergency medical technicians (EMTs), and security guards.*** - ***Roles: Ensuring public safety, responding to emergencies, and maintaining order.*** ***4. Government and Public Administration*** - ***Examples: Civil servants, municipal employees, elected officials, and urban planners.*** - ***Roles: Implementing policies, managing public services, and planning community development.*** ***5. Environmental and Conservation Workers*** - ***Examples: Environmental scientists, park rangers, conservationists, and waste management workers.*** - ***Roles: Protecting natural resources, managing parks and wildlife, and ensuring environmental sustainability.*** ***6. Legal Professionals*** - ***Examples: Lawyers, judges, paralegals, and legal advisors.*** - ***Roles: Providing legal representation, interpreting laws, and ensuring justice.*** **Top of Form** **Bottom of Form** **3.Cultural or Ethnic Groups** ***Examples:*** ***In Luzon, the largest island in the Philippines, there are several cultural and ethnic groups, each with its own unique traditions and heritage.*** ***Here are some examples: (For student's reading)*** ***1. Igorot*** ***2. Tagalog*** ***3. Kapampangan*** - ***Location: Pampanga province in Central Luzon*** - ***Culture: Known for their culinary heritage, particularly their cuisine. Pampanga is famous for dishes like sisig and lechon. The Kapampangan also celebrate unique festivals such as the Giant Lantern Festival.*** ***4. Pangasinan*** - ***Location: Pangasinan province in the Ilocos Region*** - ***Culture: Known for the Hundred Islands, traditional folk dances, and the annual Pangasinan Bangus Festival celebrating the local milkfish.*** ***5. Ilocano*** - ***Location: Ilocos Norte and Ilocos Sur in the Ilocos Region*** - ***Culture: Renowned for their distinct dialect, traditional woven fabrics, and the Pamulinawen Festival. They are also known for their traditional cooking methods and dishes like bagnet.*** ***6. Bicolano*** - ***Location: Bicol Region in southeastern Luzon*** - ***Culture: Known for their spicy cuisine, including dishes like laing and bicol express. The Bicolanos also celebrate festivals like the Ibalong Festival.*** **Integration \--in a community context refers to the process of combining different elements, groups, or resources to create a cohesive and functioning whole. This can involve integrating various services, practices, or cultural elements to improve the well-being and functionality of the community.** ***Explanation*** 1. ***Integration of Services: This involves coordinating various services such as healthcare, education, and social support to provide comprehensive and efficient support to community members. It ensures that people can access the services they need without having to navigate multiple separate systems.*** 2. ***Integration of Cultural and Ethnic Groups: This refers to creating an inclusive environment where diverse cultural and ethnic groups can coexist harmoniously, share resources, and contribute to the community\'s development. It involves recognizing and valuing differences while promoting mutual respect and collaboration.*** 3. ***Integration of Community Resources: This involves bringing together various resources such as local businesses, non-profit organizations, and government agencies to address community needs and challenges. It helps in pooling resources, knowledge, and expertise to achieve common goals.*** ***Example*** ***Community Health Integration*** ***In a small town, various health-related services are integrated to improve overall community health. For example:*** - ***Healthcare Services: A community health center integrates medical, dental, and mental health services under one roof, making it easier for residents to receive comprehensive care.*** - ***Public Health Programs: The health center collaborates with local schools to provide vaccination clinics and health education workshops for students and their families.*** - ***Social Support: The center works with local social services to offer support for issues such as substance abuse, housing, and food insecurity, ensuring that individuals receive holistic care.*** ***This integrated approach ensures that community members receive coordinated care and support, addressing their health needs more effectively and enhancing their overall quality of life.*** **3.Social System -refers to the complex network of relationships and institutions that make up a community,** **allowing it to function and thrive.** **-Various parts of a community's social system interact and support each other, including the** **health system, family system, economic system, and educational system.** **Categories/ Classification of of Social System** **1. Health System** - **Explanation: This system includes all the organizations, institutions, and** - **Examples: Hospitals, clinics, public health departments, and health insurance** **2. Family System** - **Explanation: The family system encompasses the relationships and structures** - **Examples: Nuclear families, extended families, single-parent families, and child-** **3. Economic System** - **Explanation: This system includes all activities and institutions involved in the** - **Examples: Local businesses, banks, employment opportunities, and markets.** **4. Educational System** - **Explanation: The educational system comprises all the institutions and processes** - **Examples: Schools, colleges, universities, and vocational training centers.** **Interactions Among Systems:** **These systems do not operate in isolation; they interact and support each other in various ways:** - **Health and Family Systems: A robust health system supports families by** - **Economic and Educational Systems: A strong educational system prepares** - **Family and Educational Systems: Families play a critical role in supporting** - **Economic and Health Systems: Economic stability allows individuals and families** **\*\*\*By interacting and supporting one another, these parts of the social system create a balanced and dynamic community capable of addressing the needs and challenges of its members.** **FUNCTIONS OF COMMUNITY (For student's reading)** **Communities serve various essential functions that contribute to the well-being and development of individuals and the collective group.** **Here are some key functions of a community:** **1. Social Support and Connection** **\--Communities provide emotional support through shared experiences, empathy, and** **understanding.** **\--They offer a sense of belonging, reducing feelings of isolation by connecting people with** **similar values, interests, or goals.** **2. Cultural Preservation** **\--Communities preserve cultural traditions, languages, and customs, passing them down** **through generations.** **3. Resource Sharing and Cooperation** **4. Education and Learning** **5. Economic Support** **6. Political and Social Advocacy** **7. Health and Well-being** **8. Safety and Security** **9. Identity Formation and Personal Growth** **10. Recreational and Cultural Activities** **\--They offer recreational activities that promote physical health, relaxation, and enjoyment.** **11. Spiritual and Moral Development** **CHARACTERISTICS OF HEALTHY COMMUNITY** **A healthy community is characterized by several key attributes that contribute to the well-being of its residents.** **Here are some essential characteristics:** 1\. Access to Quality Healthcare 2\. Healthy Environment (Clean Air and Water) 3\. Safe and Supportive Infrastructure 4\. Strong Social Networks 5\. Education and Employment Opportunities 6\. Economic Stability 7\. Inclusivity and Equity 8\. Active Lifestyle and Healthy Choices 9\. Civic Participation 10\. Resilience and Adaptability **These characteristics contribute to a supportive, thriving community where residents can lead healthy, fulfilling lives.**