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Inequality requires a shift in community nursing

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Community nurses can reduce inequalities Community nurses can reduce the impact of inequality

I was skating on the surface of one community for about nine months before the residents trusted me enough to tell me what was really going on. Richard Wilkinson, emeritus professor of epidemiology at Nottingham University, calls it 'social evaluative threat' and it stems from a widening social gradient.

The most vulnerable residents told me that they felt judged by services. Pride and fear makes them go to some lengths to hide their problems. Suddenly, I fell through the ice into a land of food banks, sofa-surfing and men contemplating ending their lives. They presented late and haltingly to services. Family breakdown stupefied them into substance misuse. They have not been near a nurse to make every contact count. They do not attend their smears, as it is the least of their worries.

Many of you have a good relationship with your patients and they tell you how they feel. My experience in the most disadvantaged communities is that they do not want to be found out and tell us what they want us to hear. Disadvantaged residents no longer recognised themselves in health professionals. The social divide is too great – and it is getting bigger.

It is time to revisit perhaps the most famous definition of nursing: 'The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.'

When your arm is broken, you need to be cared for, but when your life is broken, you need to be cared with. Assisting someone takes on a new meaning and today's skills are on a higher rung of Arnstein's ladder of citizen participation. The solution becomes residents and not nurses – Wanless' fully engaged scenario.

I'm working with disadvantaged fathers to enable them to improve their wellbeing and then see if it improves their children's wellbeing. I'm hunting for those that have solved their own problems and then I enable them to share the solutions, father to father. I've discovered that fathers who speak openly, overcoming their pride, encourage others to open up and healing begins. These fathers know exactly how to set the right conditions for this to happen.

So, here we are in a church hall on a Saturday where dads and children are in a non-feminised, non-stigmatising environment. I'm in the kitchen, or not there at all, as men will not open up when women are around. The children propose the activities. Dads and children bond and dads realise they are not alone with their problems. The only thing this nurse injects is the confidence to make it happen.

Heather Henry, deputy chair of the NHS Alliance

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