Barriers of Advanced Public Health Nursing in Women and Children in a Muslim Population in Saudi Arabia

Introduction

The objective of this paper is to present a highlight of a project that is meant to identify and curb barriers of advanced public health nursing in children and women in a Muslim population in Saudi Arabia. The project is expected to be implemented in the summer semester and end fall semester, meaning the implementation will take place in September and October.

Detail the Plan

Activities

To identify the barriers to advanced public health nursing in the Muslim women and children in Saudi Arabia, there are various objectives that will guide project implementation and evaluation. It is expected that this project will be used to identify the barriers to public health nursing and the strategies aimed at overcoming them. It is anticipated that a rapport will be created between the caregivers and the Muslim women and children. There could have been misunderstandings before, which might have led to poor access or rejection of the public health services. However, once the barriers are identified, various initiatives will be put in place to alleviate them. The assessment sessions will be a good opportunity to better understand what might have been contributing to the barriers witnessed before.

The proposed topic had to be submitted for approval by the course instructor. This approval was critical because it showed that the problem identified was worth studying or needed immediate attention. Submitting the project topic for approval was also necessary to determine if there was a need for institutional review board (IRB) evaluation.

The next step has been to seek the approval of administrators of various community health centers for the assessments of their clients and questionnaires to be distributed within their hospitals. An official letter to be authenticated by the university will be presented to the study centers to seek the permission to use their premises and resources during the project period. It is necessary to seek such a permission because successful evaluations would not occur without the support of the top management of the health facilities chosen for the study.

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It is also necessary to recruit the nurses who will help during the assessments and questionnaire distribution. However, the nurses recruited for the project must be those that have been trained in different public health matters. Besides, the nurses need to be those that can communicate in both English and Arabic. These nurses would have to be trained in how to conduct the assessments. Nonetheless, participation will be voluntary, meaning that the nurses and the women and children who will be taking part in the project will not receive financial benefits.

Once the nurses in the community centers have been identified, the next thing will be to assess and evaluate the training halls to determine their appropriateness for the assessments. The assessment halls will have to be spacious enough and have training resources. A special day will be set in order to draft the questions to be included in the questionnaire.

When everything is put in place, the process of assessment and evaluation is expected to last for two months. The process will begin in September 2016 and end in October 2016. Assessment will be used to gather vital information for the study.

Resources

The project begins with conducting a literary search to determine if the problem identified had been witnessed in the similar circumstances and warranted a further investigation in the population that had been selected. Indeed, the problem was found to have been impacting the government’s ability to provide the services to its citizens. Therefore, a clinical research project needed to be conducted to identify the specific problems and how to solve them. The initial search for necessary information required the use of the internet search engines. The search was conducted at the university’s library. The library was a useful resource because it was applied to gain the initial information that was to set the stage for subsequent analysis.

The best option for this project, which is to conduct an assessment of what the Muslim women and children consider as the causes of barriers, will require the training of nurses in how to gather information. Different training and assessment materials, such as books, pens, and pamphlets, will require finances. This strategy will also involve data recording and subsequent transcription. Therefore, recording and transcription tools will be needed. Given that the first option appears to be the most viable option focus will have to be shifted a lot towards it.

Evaluate the Plan

Overall, three strategies have been proposed for this project.

  • The first strategy, which involves an assessment, seems more viable followed by the third strategy where the questionnaires will be filled in.
  • The second strategy where the data that is pertinent to this study will be sought from the government website seems the least viable one, but may still provide the required data and information. The successful implementation of this project will heavily depend on the ability to communicate effectively with the people who will be taking part in the project. Through effective communication, the Muslim women and children will appreciate the importance of taking part in the assessment and volunteer valuable information.
  • Even though the strategy of searching the government website to extract information necessary for the project may seem to be not very viable, it is noteworthy that the government provides important health information on its website. As a consequence, this option needs to be implemented to determine its level of success. The questionnaires are very important tools for collecting data, but may be misleading if the wrong information is given. The findings and recommendations of the project will be disseminated to advanced public health nurses, particularly those that have to deal with the Muslim families, especially women and children.

Implementation of the Program Plan

The implementation of this project required a financial outlay. Specifically, the preferred strategy of assessing and educating the Muslim women and children within the premises of the community health centers had to be implemented within the short timeframe as stipulated in the project guide. The project had to be implemented between September and October 2016; this was a two-month implementation period that needed everything to be put in place very precisely. The director of nursing at the community center had to work closely together with the university’s school of nursing to ensure that the approval of the project was given and the process went on as it had been planned. The number of people who were to take part in the assessment and education plan as well as those meant to fill in the questionnaires had been decided before the actual study and adequate funds set aside to ensure that all the project needs were met. The finances that were set for the implementation of this project seemed to have been adequate because there was no need for additional funds.

The assessment and education strategy worked well for a number of reasons

Firstly, the public health nurses were able to receive successful training before the commencement of the implementation. The nurses managed to learn the principles or strategies that would quickly guide their interaction with the women and children. For instance, the nurses were made aware of the questions that they could ask or not ask the participants.

Secondly, the nurses were provided with the resources that they needed to conduct their activities, such as books, pens, brochures, and encoding instruments. The questions were posed to the participating Muslim women and children and were then expected to give their answers by speaking out. In the process of speaking, the speeches of the participants were recorded and later transcribed.

However, the women and children who were not willing to speak were given pens and booklets which they used to note down their responses. The responses could be written in Arabic or English, depending on the language that the participants could write well.

Importantly, the outcomes of the project were to be disseminated to the advanced public nurses to guide their health care service provision.

Program Progress Evaluation

Monitor Activities

After the approval and identification of the project, the nurses who were to take part in the assessment and education initiatives were identified. The identification of the nurses was an important stage because it was acknowledged that the nurses were going to play important roles in recruiting the project participants, taking part in the training of the people identified, and implementing the outcomes of the project. Undoubtedly, the recruitment of the advanced public health nursing professionals was conducted professionally. Indeed, many nurses expressed a willingness to take part in the project; however, the scope of the project meant that only a few could be recruited. The nurses’ recruitment was considered a success because more the number that was expected to take part in the study expressed their willingness.

The nurses were then trained in how to recruit those who were going to take part in the program. Similarly, this training went on successfully, and the nurses were able to learn how they needed to approach. Some of the nurses may have not been aware of culturally sensitive behaviors, especially the expatriates, but in the process of training, they became acquainted with the Muslim culture. Therefore, the trainings they were to receive were tailor-made to suit the Muslim women and children. The program started with the recruitment of the Muslim women and children who were coming to the health center for care services. The nurses approached the patients and asked them if they were willing to participate in the assessment and education sessions.

The assessments and education were conducted on Mondays and Fridays. Importantly, Mondays and Fridays were chosen because the data obtained from the health center showed that on average, there were more patients seeking health care services during those days. With many people seeking health care services during those days, the nurses were able to involve many Muslim women and children in the program. Indeed, the choice of the two days proved to be very effective because the nurses did not fail to get the number of participants that were targeted each day.

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It is also important to note that the nurses who were leading the assessment and education sessions had received adequate training before and were able to pass on this information to the women and children. The care professionals also showed a willingness to learn from the participants. Consequently, the sessions were interactive as both parties learnt from one another. The brochures that were provided during the training had important information that created awareness among the women and children. Therefore, as the participants carried the brochures home where they were expected to read more to understand the important roles that the advanced public health nurses played in their lives. Similarly, from the recordings of the participants’ speeches, the nurses got to know what they needed to uphold when dealing with the Muslim women and children. The nurses also learnt what the women and children do not expect them to do whenever they conduct public health campaigns. However, there should have been a way of making a follow-up, maybe, after three or six months to determine if the women and children still stick to and practice what they had learnt. For the nurses, regular evaluation to gauge there competence in serving special groups, such as the Muslim women and children, was considered as an important aspect of the program.

Budget

During the project, the student spent $ 200. One hundred dollars were used to print the brochures. These brochures contained the information which was to be disseminated to the Muslim women and children. The colored brochures were preferred because they were both appealing and attractive. Originally, the nurses were given a few copies printed; however, as more participants showed willingness to participate in the assessment and education program, the nurses printed more copies. One hundred dollars were also paid to the community health center for the recording equipment. Even though it could have cost more to hire the equipment, the hospital administration accepted the amount of one hundred dollars because they believed that the outcomes of the project were beneficial even to their own nurses who often engaged the community in public health service provision. The administrators of the community health center considered the project a worthy endeavor to partner in whatever way.

The brochures contained the following information:

  • Brief information introducing the state of public heath awareness in Saudi Arabia.
  • Information regarding different public health problems that have been prevalent in the recent past in the country.
  • There was information on the Muslim women’s dressing code and what the women thought needed to be changed.
  • There was information regarding instances when it would be appropriate to allow men to provide care services to the women, as well as what the women thought needed to be changed.

However, there was a need for additional $ 270 to buy a laptop. The speeches that had been recorded during the assessment and education sessions needed to be transcribed. Therefore, the laptop was needed for the transcription. The additional costs did not change the objective of the program.

Program Efficiency

Costs

This project was very cost-effective. Undoubtedly, it could have cost more if the community health center had hired a consultant to conduct this project. From personal research, it was found that hiring a consultant to conduct the assessments and education could have cost up to $ 10,000 because the professionals charge exorbitantly. The money that has been saved from this project could become helpful in the provision of other important public health services that are needed in the community. Overall, this project was worth implementing in the way it was implemented because of its contribution to significant cost saving.

A project that similar to the current one can be repeated in the future. The implication is that when a similar project is to be conducted, the current guideline can be followed. Following a similar procedure would mean a significant costs reduction. A project that is cost efficient is worth implementing; therefore, this project should be considered seriously for implementation. It is evident that a project may not necessarily require large sums of money to implement effectively; rather, having a workable plan should be the major consideration.

Productivity

The selected advanced public health nurses from the community center were always around to take part in the training sessions. The nurses were enthusiastic about the project, thereby committing to it fully. The nurses gave their opinions concerning how they felt the discussion and education sessions needed to be conducted. Indeed, the opinions were very insightful and productive. For instance, it was the nurses who came up with the suggestion regarding the number of participants who needed to be in each discussion group. Each nurse had discussion sessions with a group of 10-15 women visiting the community center. The small groups were preferred because they were considered manageable and productive. They also promoted full interactive discussions. Productivity was measured through the level of satisfaction that was recorded from the outcomes of the sessions.

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Benefits

Numerous benefits were recorded from the program regarding the advanced public health nurses’ serving the Muslim women and children in Saudi Arabia. Firstly, the nurses were able to create good rapport with the target populations. The nurses realized that they could not achieve public health care goals if they did not work closely with the women and parents with children. Working closely with the women meant understanding their unique cultural and religious beliefs and practices and seeking for the ways of introducing them in care provision. Notably, the nurses learnt that Islam should be present in all areas of care giving. Besides, the nurses, especially the ones who were from other countries, learnt that public health care in Saudi is very gender specific. The Muslim women do not like being cared for by the male nurses or care takers. Initially, foreign nurses had reported the problem of the Muslim women refusing to be moved by the male nurses. Therefore, the nurses learnt that, unless it was very necessary, the Muslim women would be moved by the female nurses.
Moreover, the nurses had reported initially that they often felt powerless when caring for women who were always apathetic when faced with bad news. The women could insist that the bad news or change in health condition from bad to worse was as a result of God’s will. However, through the education sessions, the nurses were able to change the perception of the women’s view. The nurses taught the women that there were medical conditions that could be resolved through care giving.

The relationships between the nurses, the women, and the children were greatly enhanced. The nurses were able to create an environment where the women could discuss freely. In fact, the women were always eager to converse; however, the major challenge became the language barrier. The following challenge was solved when a translator was introduced during the education and assessment sessions. The translator was a Saudi nurse who could speak both English and Arabic. In cases where the nurses could have not formed bonds with the patients due to communication problems, the role of a translator nurse became very vital.

It was beneficial to learn that the Muslim women prefer to be informed of possible problems with their babies before birth. Nonetheless, there were those who felt that informing them about the potential problems was contradicting God’s idea of giving birth and taking care of children no matter their conditions. After having learnt this belief, the nurses had to come up with the ways of convincing the women of the need to be assessed to ensure that the unborn child is well-taken care of while those born with some problems receive health care immediately.

The nurses also benefitted from the sessions when they learnt that visitation is very important for the Muslim women. The Muslim women noted that they always felt happy whenever they were visited, particularly whenever they are in health problems or during sicknesses. The women rated visitation highly because they did not want to be left alone whenever there was public health care to be provided. The nurses realized that they could use such visits to implement their public health campaigns.

Program Effectiveness

Satisfaction

The project was very satisfying. Program satisfaction can be measured from the perspectives of the Muslim women and children, the nurses, the student, the community health center director of nursing and hospital administrator, and Saudi Arabia’s Ministry of Health.
Firstly, the Muslim women and parents with children visiting the community health center reported that they were satisfied with the approaches that the nurses used to recruit them in the education and assessment sessions. For instance, the nurses were described as cautious and loving, which made most of the participants willingly take part in the study. Besides, the women reported that the nurses were very organized during the training and education sessions. For instance, all the areas of assessments were described distinctly; culture, religious beliefs, choice of caregiver, and caring for the sick are some of the areas that were each discussed separately. Through the separate discussions, the nurses were able to learn more about what the women believe in, as well as the practices that bar them from seeking or accepting public health practices. Importantly, the women were satisfied with the opportunity that they got to express some of the issues that for a long time they believe had affected their perception of the public health services offered by the government or private caregivers. Initially, some women had believed that suffering during illnesses was a result of Allah’s wish; however, from the program, the women learnt that it was possible to alleviate suffering during illnesses through public health strategies. The women were satisfied with the explanations that the nurses gave regarding the role of public health during illnesses, suffering, or dying.

Satisfaction with the project was also evident from the willingness of the Muslim women and parents with children to allow the advanced public health nurses to visit their home to perform or oversee the provision of health activities, such as mental health assessments and vaccination campaigns. Some Muslim women were reported to have opposed vaccination campaigns before the assessment and education campaign initiative, but they changed their minds after they were educated on the importance of allowing their children to be vaccinated. Besides, there was the issue of the seclusion of women for the period of forty days after giving birth. During the seclusion period, no health activity could be conducted on either the child or the mother. However, when the women were taken through the health complications that they were likely to suffer from during that period, they realized that they were not exposing themselves to health risks, but they were also exposing their children. This information was important and satisfying to the women who felt they needed to abandon or allow flexibility in some of the practices that were not necessary or hindering the improvement of health. Fasting during the holy month and prayers that would affect health programs were discussed. The women were satisfied with the proposal the nurses would provide a dietary guideline that adheres to the Islamic laws while not compromising the health of pregnant women.

Even though the women felt unease with male care providers or male nurses visiting their wards, the women were encouraged to accept the male nurses in extraordinary cases. For instance, the women were challenged about instances where only male nurses can offer a given care or where there is an emergency case that needs to be attended and only the male nurses are on duty. From the challenge, the nurses reported that they were satisfied with the examples that had been cited and would accept to be given care by the male nurses when it was necessary. However, the Muslim women noted that they still preferred to be served by the female nurses, in cases, such as birthing.
Most of the Muslim women acknowledged that their dressing code had been described before as a major issue affecting health provision. According to the women, dressing was part of the religious culture and tradition. Thus, they expected the nurses to be able to adjust their care provision to accommodate how they dressed. Besides, the women noted that they would be comfortable in their dresses or make adjustments when served by the female nurses. The most satisfying aspect on the issue of Islamic women dressing was their acceptance that wearing the veil or long dresses was part of their religious culture, but they would accept amendments to the dresses if such changes did not affect their religious teachings.

Overall, the women reported that they were very satisfied with the program and showed a willingness to take part in the future educational and assessment campaigns, particularly if such projects were going to be similar to the program that just ended. Satisfaction was as a result of the helpful information that these women had learnt.

Secondly, the parents with children noted that they were satisfied with the program. The information that the parents had learnt was going to reshape their approach to various health matters of their children. For instance, the women learnt that tying the red bracelet around the wrist of their children was not going to promote the healthy being (See Appendix D). The Muslim families had for a long time believed in warding off evil eyes using the red bracelet. However, the parents were encouraged to take their children to the care givers from birth to ensure that they get all the vaccinations as a way of promoting health being. The use of the bracelet was noted as a belief that lacks scientific support or proof; therefore, they needed not to rely on it. This presentation was very satisfying to most of the parents who reported that they would begin or continue to bring their children for health care assessments.

Prayer and reading the Qur’an are practices which the Muslim parents in Saudi Arabia reported as important aspects of the children’s lives. The children are supposed to read and master the holy book. Similarly, the children are supposed to fast during the month Ramadan, which may interfere with the public health initiatives. Nonetheless, the parents and the nurses agreed from their discussions and interactive sessions on the importance of not compromising the health status of the children during fasting. The parents were satisfied with the information on nutrition, as well as its quantities, frequency, and relevance of various food classes when fasting.
Thirdly, the nurses also expressed satisfaction with the program. The nurses expressed satisfaction with the manner in which the participants were chosen. The participation in the program was left open to all the advanced practice nurses who were willing to take part. Free participation created the perception that the nurses would own the processes in the program. In the end, more nurses than it had been expected registered to take part in the program; nevertheless, the number had to be reduced.

The nurses also expressed satisfaction with the way that the student had developed the project plan. The plan was developed in a way that the nurses were not expected to go to other health centers to conduct the training and education sessions. Instead, the nurses were expected to conduct their training and discussions at their workstations. This reduced the chances of inconveniencing travels and ensured a cost reduction. The nurses noted that they were very satisfied when they realized that they did not have to move out of their workstations.

Furthermore, the nurses expressed satisfaction with the student nurse who had developed the program because she was always willing to make clarifications on the phases or sections of the program that seemed unclear or confusing. Providing the clarifications ensured that the nurses implemented the program correctly. The nurses were satisfied with the equipment and materials that were chosen for the project implementation, particularly brochures, pamphlets, the training halls, voice recording and transcription equipment.
Importantly, the nurses were very satisfied with the response of the Muslim women and parents with children who willingly participated in the assessment. Initially, some of the nurses had expressed doubts that the women would take part; however, when the objective of the project was explained to the women, many of them readily accepted to take part. It appears that the nurses were able to make the women realize that there were some barriers to public health that needed to be identified clearly and the strategies aimed at minimizing them should be set. Apart registering to take part in the program, it was very satisfying how the nurses interacted freely and made contributions that would help reduce the current barriers. The women explained that some practices they wanted to be changed or modified in the ways that do not affect their beliefs during the public health campaigns. Likewise, the women expressed their desire to carry the brochures and pamphlets to their homes or communities where they would continue to educate the other women the things that they had learnt.

The student was a very important stakeholder in the endeavor. Firstly, the student was satisfied with the way that the project supervisor had helped her to modify the topic to suit study objective. The student noted that she continually remained in touch with the project supervisor to ensure that the topic was concise and implementable. The supervisor offered insights into what needed to be done during the implementation and what needed not to be done. Therefore, through the advice, this project is bound to meet its objective.

The student was satisfied with the nurses who took part in the project. The individuals exhibited the high levels of professionalism and passion. Professionalism was evident in the ways that the nurses used to recruit the women and conducted the studies. Specifically, the nurses reported that they did not coerce any of the Muslim women to take part in the program; rather, they used people’s skills to convince them to take part. Besides, the student noted that the nurses were very creative in their implementation strategies. Notably, the nurses always modified the training and education sessions without losing track of the study objective. The modifications were necessary because of the unique cultural and religious beliefs of the women. This resulted in the program being enjoyable and remaining within the timeline set.

The student noted that the most satisfying aspect of the program was to identify the barriers to advanced public health nursing and come up with the strategies aimed at minimizing them. This implies that the program objective had been achieved. Undoubtedly, any project that cannot achieve the objectives for which it is set represents a waste of resources both financial and non-financial. Therefore, the student had not wasted resources in designing and implementing the project.

The director of nursing and the hospital administrator at the community health center where this project was carried out expressed their satisfaction with the design and conduct of the activities. The training and education sessions did not affect the routine provision of health care services. The nursing director had feared that recruiting the heath center’s nurses in the program would affect the flow of activities. However, it turned out that only a few of the nurses would be required for the project at any particular time, meaning that the other nurses who were not in the program continued with their hospital duties.

Similarly, it was satisfying when some of the women who had taken part in the program thanked the hospital for allowing such a project to be conducted within their premises. This created a good image and closer ties between the community health center and the populations that it serves. The good image is necessary if the members of the community nearby are to continue collaborating or implementing the public health initiatives supported by the center. The center’s administrator was satisfied with how the equipment that had been taken from the center was used during the whole project. It was very pleasing to report that none of the voice recording and transcription equipment had been damaged. The equipment was returned in the condition that it had been taken, and the administrator reported in his equipment assessment report that he would not mind offering the equipment again if and when requested.

Goals

The overall goal of this project was to identify the barriers of advanced public health nursing in the Muslim women and children through an interactive education and assessment training known as PHEAC. The measurable objective was to identify the barriers and to improve acceptance of advanced public health nursing by 35% by June 2017.

In late September, the student identified two community centers where the PHEAC program was to be conducted. The two community health centers were chosen because they often received many Muslim women and children seeking public health services during the week. When the directors of nursing and administrators were approached, both groups initially appeared reluctant because of the fear that such programs would affect the flow of their daily activities. However, after getting an assurance from the student nurse who was to conduct the project that the project would instead lead to a better integration and understanding between the health centers and their clients, and reduce the barriers of public health nursing by approximately 35%, then the project was allowed to proceed. Therefore, apart from identifying the barriers, the project helped to create a new understanding among the nurses regarding the Muslim women and children. There had been many cases of misinformation before which led to the Muslim women not benefitting from public health initiatives. Denying the women and children in the Saudi health programs is basically denying them their right to life.

The program intended to show that it is possible to incorporate unique cultural and religious beliefs in care provision. The misconception about the Muslim women and children regarding public health service care needed to be done away with if the government of Saudi Arabia was to be successful in its campaigns. Apparently, the misconception seems to have been dispelled through the assessment and discussion sessions, and new information should be taught to both the nurses and clients seeking care services.

Program Impact

The project needs to be fully implemented by June of 2017. This project is expected to impact the government, advanced practice nurses, and Muslim women and children. From the insights gained during the discussion sessions, the advanced practice nurses offering public health services were expected to change their perception and care giving strategies. The nurses needed to align with or adapt to the practices that make the Muslim women and children feel honored and respected. Incorporating the strategies would lead to mutual working and access of many care services that the women do not approve currently.

The program is expected to impact the Muslim women and children. The discussions showed that there were very many misplaced notions about the public health services and the nurses who provide them. The target population got to know that it was their right to receive health assessments; however, this could only succeed if they allowed the nurses to conduct public health programs. By changing their perceptions about public health campaigns, there was going to be significant cost reductions and improved healthy being.
This program is bound to impact government public health campaigns, which might not have been very effective among the identified populations because of their uniqueness. Specifically, the government may use the recommendations from the program to develop the policies that will consider the unique requirements of the identified populations in care giving. In the end, the government will be able to offer focused care and alleviate the health problems that appears to be on the increase, such as obesity, diabetes, as well as belief in the traditional care giving, which is not scientifically proven.

Program Sustainability

This program remains very sustainable because it does not require external financial assistance. All the stakeholders involved in the study were locally based and were satisfied with how the program was conducted. The implication is that the nurses who took part were still willing to help in the program. The Muslim women also promised to share the new insights with their friends in the villages, meaning that more people are bound to read and learn what their colleagues, relatives or friends had learnt before. Therefore, the project remains implementable now and in the future, and it is expected to spread far and wide at no cost. Most importantly, the aspect of cost, which remains very low, appears to be the major point of sustainability of the project.

Conclusion

The discussions on public health service provision in Saudi Arabia continue to rage because of the outbreaks of diseases, such H1N1, H5N1, rift valley fever, the threat of Severe Acute Respiratory Syndrome, and coronavirus. Aside from the threat of infectious diseases, chronic ailments, such as hypertension, diabetes, cancer, heart diseases, genetic blood conditions, as well as childhood obesity, have been on the increase. The diseases are costly to treat even as the government sets a significant amount for the public health initiatives every year. The advanced public health nurses play an important role in helping to alleviate the disease problems. However, the professionals have often encountered problems, especially when they have to deal with special groups, such as Muslim women and children. Therefore, coming up with this project to highlight and seek the ways of alleviating some of the challenges encountered by the nurses in their endeavor to provide public health services should be lauded. The public health educational awareness campaign (PHEAC) is the project that was proposed. The project conducted in two community health centers had the volunteer nurses who took the target populations through training and discussions.

In the end, the barriers and the ways of dealing with the barriers were identified. The strategies of alleviating the barriers were a good thing because it was acceptable to both the nurses and the population of interest. The program was implemented successfully, and it is expected that more Muslim women and families with children will allow the nurses to conduct public health campaigns. The nurses also reported that they would become sensitive to the cultural and religious values of the two groups of populations.

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