Community Health Resources Research Articles

A Qualitative Evaluation of a Citywide Community Health Partnership Program

While there have been numerous community-based programs in Baltimore, Maryland, aimed at helping patients access medical treatments and services, they historically were underutilized and did not operate synergistically. For that reason, sanofi-aventis, along with key stakeholders in Baltimore, developed the Community Health Partnership (CHP) to educate, empower, and connect patients to community health resources to enable patients to be more proactive about their health. The CHP utilizes a community health liaison (CHL) and a community health action team (CHAT) consisting of community health leaders who are hands-on activists and health care workers who coordinate activities and provide guidance for the CHP. The goal of the program is to foster community collaboration to raise awareness of the need to improve health in the community and to identify and connect patients to existing resources and services that can help. A qualitative evaluation of the Baltimore CHP was conducted through focus group and key informant interviews with members of the CHAT and CHP. Results suggest that the CHP program has enhanced patient-provider relationships, brought together a wealth of resources, and made people more aware of health information. The CHP facilitated providers' ability to help patients find resources and empowered patients in the community to better manage their health conditions. In parallel, physicians requested additional culturally sensitive resources on medical conditions that addressed the health literacy of their diverse patients. Through stakeholder engagement, many more communities beyond Baltimore can become better networked to help patients navigate the health care system and improve their health.

Fly-By medical care: Conceptualizing the global and local social responsibilities of medical tourists and physician voluntourists.

BackgroundMedical tourism is a global health practice where patients travel abroad to receive health care. Voluntourism is a practice where physicians travel abroad to deliver health care. Both of these practices often entail travel from high income to low and middle income countries and both have been associated with possible negative impacts. In this paper, we explore the social responsibilities of medical tourists and voluntourists to identify commonalities and distinctions that can be used to develop a wider understanding of social responsibility in global health care practices.DiscussionSocial responsibility is a responsibility to promote the welfare of the communities to which one belongs or with which one interacts. Physicians stress their social responsibility to care for the welfare of their patients and their domestic communities. When physicians choose to travel to another county to provide medical care, this social responsibility is expanded to this new community. Patients too have a social responsibility to use their community's health resources efficiently and to promote the health of their community. When these patients choose to go abroad to receive medical care, this social responsibility applies to the new community as well. While voluntourists and medical tourists both see the scope of their social responsibilities expand by engaging in these global practices, the social responsibilities of physician voluntourists are much better defined than those of medical tourists. Guidelines for engaging in ethical voluntourism and training for voluntourists still need better development, but medical tourism as a practice should follow the lead of voluntourism by developing clearer norms for ethical medical tourism.SummaryMuch can be learned by examining the social responsibilities of medical tourists and voluntourists when they engage in global health practices. While each group needs better guidance for engaging in responsible forms of these practices, patients are at a disadvantage in understanding the effects of medical tourism and organizing responses to these impacts. Members of the medical professions and the medical tourism industry must take responsibility for providing better guidance for medical tourists.

African American Church Health Programs

The church is a community resource that can help address areas of health disparity for African Americans by offering programs focused on primary prevention. Use of a logic model as a program evaluation tool highlights church priorities and program linkages (problems, goals, objectives, activities, outputs, and outcomes), providing clear evidence about meeting program expectations. Faith community nurses can lead program development, easily incorporating logic models within programming efforts. Church-based programs that document positive outcomes enhance program usefulness and value as a community health resource.

Essence of Palliative Care and Cooperation between Core Hospital and Community Health Resources

Essence of Palliative Care and Cooperation between Core Hospital and Community Health Resources

Access to and Satisfaction With School and Community Health Services for US Children With ASD

Our objective was to compare access to and satisfaction with school and community health resources among families with a child with an autism spectrum disorder (ASD) and families of other children with special health care needs (CSHCN). Parents of 40,256 children aged 0 to 17 were surveyed by the 2005-2006 National Survey of Children With Special Health Care Needs. Autism was defined by the question, "To the best of your knowledge, does (child) currently have autism or autism spectrum disorder, that is, ASD?" We used chi(2) and multivariate regression analyses to compare access to and satisfaction with services for parents of children with ASDs and parents of other CSHCN. Children with ASDs (n = 2123) comprise 5.4% of the CSHCN. More parents of children with ASDs reported difficulty using school and community services (27.6% vs 9.7%) and dissatisfaction (19.8% vs 7.9%) than parents of other CSHCN. Multivariate models determined that parents of children with ASDs were 3.39 times more likely to experience difficulty in obtaining services and 2.65 times more likely to be dissatisfied with services received than parents of other CSHCN, after controlling for household demographics and insurance status. Parents of children with ASDs reported a lack of available services and skilled providers. Parents of children with ASDs reported less access to and more dissatisfaction with school and community health services than parents of other CSHCN. An increased supply of appropriate services with qualified providers for children with ASDs is needed in the United States.

Approach to the Psychiatric Patient: Case-Based Essays

Back to table of contents Previous article Next article Book ReviewFull AccessApproach to the Psychiatric Patient: Case-Based EssaysJohn Santopietro M.D.John Santopietro M.D.Search for more papers by this authorPublished Online:1 Oct 2009https://doi.org/10.1176/ps.2009.60.10.1404AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In a world of limited resources, imagine having access to case consultation with any of over 100 faculty at Columbia and Cornell at a moment's notice. As a clinician who has spent time in the trenches of community psychiatry, to me such access would be invaluable. Approach to the Psychiatric Patient, an extensive collection of case-based essays edited by John W. Barnhill, M.D., chief of consultation-liaison at New York Presbyterian Hospital and faculty at Weill Cornell Medical College and Columbia University Center for Psychoanalytic Training and Research, opens the door to a corridor rich with resource. Another important achievement of this collection is that it approximates a historical snapshot of the field. Each short essay is written from a well-defined angle. The authors write as if they had been asked an important clinical question by a colleague, creating tones of familiarity, urgency, and realism. The essays address one of ten composite cases that were well thought out and capture real-world problems. Each case is then addressed by about ten clinical points of view, including many familiar and respected names (Auchinloss, Mann, and Cooper, to name a few), and each section ends with a helpful list of the summary points.Approach to the Psychiatric Patient provides an educational resource that is valuable not only to trainees but also to seasoned clinicians in any of our disciplines. This book is filled with wisdom and insight. Some are classic, such as Kernberg on borderline organization and Schafer on therapeutic zeal. Some are cutting edge, with views from pharmacogenomics and neuroimaging. Others speak of social context, such as Kim Hopper's essay on a composite case of schizophrenia from a viewpoint titled Homelessness and Social History: "Psychiatry may make its own history, but it does not do so under circumstances of its own choosing. This hoary homespun truth becomes especially vivid in the lives of its protagonists—patients and providers alike—when they span periods of unusually disruptive change. Such is the case with Anthony Da Piazza: born in the era of secure confinement, suffering his first psychiatric crisis during the heyday of deinstitutionalization, and then settling into an extended period of residential and clinical instability (punctuated by bouts of outright homelessness) during a time when the mental health system itself was struggling to find its bearings, recoup public confidence, and establish a fresh set of ground rules."With such a distinguished and extensive group of essayists who gave generously to this project, one would hope that the editor rose to the moment. What a task: to coordinate over 100 points of view, to minimize redundancy and inconsistencies, and to maintain flow. In this Dr. Barnhill has succeeded masterfully through his vision for the work and the architecture he used. One might argue a few points—that the breadth of views comes at the expense of some depth, that there may be some institutional bias that could misrepresent the entirety of the field, that the sheer size of the work presents a challenge. These are minor. In the end this book is a gift—to trainees and the academic community, to multidisciplinary teams in the trenches who need practical wisdom, to historians of the future looking for a snapshot of our field at the beginning of this millennium, and (as the dedication indicates) "to the people who suffer from psychiatric illness, with the hope that the text helps improve their care."The reviewer reports no competing interests.Dr. Santopietro is medical director, Community Health Resources, Windsor, Connecticut. FiguresReferencesCited byDetailsCited byNone Volume 60Issue 10 October, 2009Pages 1404-1404PSYCHIATRIC SERVICES October 2009 Volume 60 Number 10 Metrics PDF download History Published online 1 October 2009 Published in print 1 October 2009

Approach to the Psychiatric Patient: Case-Based Essaysedited by John W. Barnhill, M.D.; Arlington, Virginia, American Psychiatric Publishing, 2009, 565 pages, $62

Back to table of contents Previous article Next article Book ReviewFull AccessApproach to the Psychiatric Patient: Case-Based EssaysJohn Santopietro M.D.John Santopietro M.D.Search for more papers by this authorPublished Online:1 Oct 2009https://doi.org/10.1176/ps.2009.60.10.1404AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In a world of limited resources, imagine having access to case consultation with any of over 100 faculty at Columbia and Cornell at a moment's notice. As a clinician who has spent time in the trenches of community psychiatry, to me such access would be invaluable. Approach to the Psychiatric Patient, an extensive collection of case-based essays edited by John W. Barnhill, M.D., chief of consultation-liaison at New York Presbyterian Hospital and faculty at Weill Cornell Medical College and Columbia University Center for Psychoanalytic Training and Research, opens the door to a corridor rich with resource. Another important achievement of this collection is that it approximates a historical snapshot of the field. Each short essay is written from a well-defined angle. The authors write as if they had been asked an important clinical question by a colleague, creating tones of familiarity, urgency, and realism. The essays address one of ten composite cases that were well thought out and capture real-world problems. Each case is then addressed by about ten clinical points of view, including many familiar and respected names (Auchinloss, Mann, and Cooper, to name a few), and each section ends with a helpful list of the summary points.Approach to the Psychiatric Patient provides an educational resource that is valuable not only to trainees but also to seasoned clinicians in any of our disciplines. This book is filled with wisdom and insight. Some are classic, such as Kernberg on borderline organization and Schafer on therapeutic zeal. Some are cutting edge, with views from pharmacogenomics and neuroimaging. Others speak of social context, such as Kim Hopper's essay on a composite case of schizophrenia from a viewpoint titled Homelessness and Social History: "Psychiatry may make its own history, but it does not do so under circumstances of its own choosing. This hoary homespun truth becomes especially vivid in the lives of its protagonists—patients and providers alike—when they span periods of unusually disruptive change. Such is the case with Anthony Da Piazza: born in the era of secure confinement, suffering his first psychiatric crisis during the heyday of deinstitutionalization, and then settling into an extended period of residential and clinical instability (punctuated by bouts of outright homelessness) during a time when the mental health system itself was struggling to find its bearings, recoup public confidence, and establish a fresh set of ground rules."With such a distinguished and extensive group of essayists who gave generously to this project, one would hope that the editor rose to the moment. What a task: to coordinate over 100 points of view, to minimize redundancy and inconsistencies, and to maintain flow. In this Dr. Barnhill has succeeded masterfully through his vision for the work and the architecture he used. One might argue a few points—that the breadth of views comes at the expense of some depth, that there may be some institutional bias that could misrepresent the entirety of the field, that the sheer size of the work presents a challenge. These are minor. In the end this book is a gift—to trainees and the academic community, to multidisciplinary teams in the trenches who need practical wisdom, to historians of the future looking for a snapshot of our field at the beginning of this millennium, and (as the dedication indicates) "to the people who suffer from psychiatric illness, with the hope that the text helps improve their care."The reviewer reports no competing interests.Dr. Santopietro is medical director, Community Health Resources, Windsor, Connecticut. FiguresReferencesCited byDetailsCited ByNone Volume 60Issue 10 October, 2009Pages 1404-1404PSYCHIATRIC SERVICES October 2009 Volume 60 Number 10 Metrics PDF download History Published online 1 October 2009 Published in print 1 October 2009

Promoting Community Health Resources: Preferred Communication Strategies

Community health promotion efforts involve communicating resource information to priority populations. Which communication strategies are most effective is largely unknown for specific populations. A random dialed representative phone survey was conducted assessing current health resource community awareness, health resource utilization, and communication strategy preferences. The survey revealed that community members preferred to receive information on health resources from the Internet (28.3%), newspaper (26.4%), or mail (22.3%). Different priority populations had varying health communication strategy preferences (e.g., young adults prefer Internet, older adults prefer newspaper, and obese adults prefer mail). Ideally, if health resources are intended for adult audiences, a campaign that would include communication through newspaper (targeting older adults), mailing (targeting obese adults), and Web sites (targeting younger adults) would be the most effective approach. This research suggests that an assessment of communication strategy preferences of the priority population might be a crucial first step when developing health promotion programs.

West Virginia’s Response to the Rotten Truth about Oral Health

West Virginia University Extension Service has taken steps to increase the awareness and practices of good oral health. Significant barriers exist for optimal dental health and preventive care for youth in West Virginia. The 4-H Health Initiative strengthens community 4-H clubs through joint commitment to improve the Health “H,” club reliance on youth leadership, responsiveness to youth voices, and involvement of community health resources. These efforts bring oral health education and services to school-age youth. Evaluation data suggest that the model may impact oral health behaviors.

Contextualizing Immigrant Access to Health Resources

A vast majority of our understanding of immigrant health centers around traits of individuals and groups. While useful, current approaches to research on immigrant health decontextualize the experience of immigrants in the United States. This paper uses a historical case study of the Chinese community in San Francisco to develop a contextual framework to understand the levels of influence that impact the availability of health resources in immigrant communities. International, transnational, transcommunity, and enclave contexts have shaped health care access for Chinese immigrants in San Francisco. The conceptual framework provides a basis for future research, programmatic, and policy work that integrates individual and contextual factors in assessing and improving immigrant access to health resources.

Forming a Rural Health Partnership Network

Walker County, Alabama, population 70,713, typifies health challenges in rural America. The county is poor with per capita income $10,000 below the national average. It lacks an adequate health care infrastructure — 4 physicians per 10,000 population compared to 7 nationally. The county has severe chronic health problems. For example, there are 67 heart failure deaths per 10,000 population compared to 20 nationally (Alabama Community Health Resource Guide, 2008). There are many other similar statistics, but a new conjunction of health care providers and leaders offers promise for a united approach in Walker County.

The well-being of young people who care for a dependent relative: An interpretative phenomenological analysis

Developing health care systems have placed an emphasis on unpaid, informal care giving from family members as a community health resource. It is estimated that there are between 19,000 and 51,000 young carers in the UK who are at increased risk of physical and psychological ill health. Therefore, the aim of this study was to explore the personal experiences of young carers in relation to their well-being using interpretative phenomenological analysis (IPA). Semi-structured interviews were carried out with five young carers and the verbatim transcripts served as the data for an IPA. Three themes emerged: (1) what caring means; (2) isolation and distancing from others; and (3) integrating caring. The participants struggled to make sense of caring, found it relentless, overwhelming and frustrating. They experienced stigma, which led to secrecy and withdrawal, cutting them off from their social worlds and the benefit of social support. They actively sought to integrate caring into their emerging sense of self and identity, and derived a sense of pride from caring and used this to combat feelings of uncertainty and isolation.

Mental health issues and resources in rural and regional communities: An exploration of perceptions of service providers

To identify service providers' and community organisations' perceptions of the resources available to support people with mental illness and the unmet needs of this client group in rural Queensland. An exploratory study was undertaken involving focus group interviews across the study sites. Five regional towns in rural Queensland. Ten to 14 members were recruited for each of the five focus groups. The groups represented a diverse mix of participants including health and community service providers and representatives from community organisations. Participants identified gaps in services in relation to health, employment and education, housing and accommodation, transport and social inclusion and health promotion. Inter-service communication and inappropriate funding models were themes affecting service delivery. Specific service issues of housing and transport were identified to be particularly problematic for people with mental illness across all towns. Intersectoral communication and funding models require further research.

Service utilization in community health centers in China: a comparison analysis with local hospitals

BackgroundBeing an important part of China's Urban Health Care Reform System, Community Health Centers (CHCs) have been established throughout the entire country and are presently undergoing substantial reconstruction. However, the services being delivered by the CHCs are far from reaching their performance targets. In order to assess the role of the CHCs, we examined their performance in six cities located in regions of South-East China. The purpose of this investigation was to identify the utilization and the efficiency of community health resources that are able to provide basic medical and public health services.MethodsThe study was approved by Peking University Health Science Center Institutional Reviewing Board (NO: IRB00001052-T1). Data were collected from all the local health bureaux and processed using SPSS software. Methods of analysis mainly included: descriptive analysis, paired T-test and one-way ANOVA.ResultsThe six main functions of the CHCs were not fully exploited and the surveys that were collected on their efficiency and utilization of resources indicate that they have a low level of performance and lack the trust of local communities. Furthermore, the CHCs seriously lack funding support and operate under difficult circumstances, and residents have less positive attitudes towards them.ConclusionThe community health service must be adjusted according to the requirements of urban medical and health reform, taking into account communities' health needs. More research is required on the living standards and health needs of residents living within the CHC's range, taking into consideration the users' needs in expanding the newly implemented service, and at the same time revising the old service system so as to make the development of CHCs realistic and capable of providing a better service to patients. Several suggestions are put forward for an attainable scheme for developing a community health service.

The blood centre as a community health resource

Blood centres in the USA encounter over 35,000 blood donors every day, a number that is far exceeded worldwide. This daily encounter of thousands of people with the healthcare system offers an unusual opportunity for blood centres to engage these donors in ways that contribute to individual and community health. In addition, a positive interaction at the blood centre may encourage donors to return more often, thus enhancing the blood supply. The wealth of medical information gathered by blood centres also presents an opportunity for epidemiological studies of health and illness that affect the community at large. Donors receive a 'mini-physical' as part of the donor qualification process. Required procedures include blood pressure measurement and haemoglobin determination. Targeted education, counselling and referral of donors with hypertension and/or low haemoglobin engages them in the care of critical personal health issues. Carbonyl iron supplied to female donors of child-bearing age replaces iron lost in the donation and can retain them as active blood donors. A range of optional screening tests and procedures offer enhanced interactions between the donor and the blood centre. Inexpensive tests, such as cholesterol and random blood glucose determination, can detect abnormalities that may initiate further medical interventions to address cardiovascular and diabetic risks. These enhanced medical interactions with donors must be undertaken with care and appropriate medical supervision. However, the opportunity, indeed the responsibility, to act on important medical information enhances the range of medical support for donors and is an opening for blood centres to expand their involvement in the health of the community.

Developing networks between workers and community for health promotion of workers in small businesses

The purpose of this study is to assess preventive factors to workers' health care in small businesses, and to develop the network between workers and the community health resources. The life expectancy of 65 years of the Fuji City citizen, and their SMR of cancer, stroke and cardiovascular disease were worst in the Shizuoka prefecture. The ratio of workers in small business with workers under 50 employees was 97.5% in this city. To assess the preventive factor for the worker's health promotion, we obtained information both of the health care system and the health consciousness of the employee of small business, through a questionnaire by mail. 22.7% in business did not execute the periodic health check. The awareness of illness was in 18.4% of them. 48.4% of them became aware of the anxiety of mental health, and 82.2% of them were conscious of the uncertainty of the future health. 41.5% of them did not receive the detailed medical examination and treatment. We hope employers in small businesses would set up the opportunity of periodic health checks of employees, for getting rid of the anxiety of mental health and the uncertainty for the future health, and develop the network between the workers and the community.

Propuesta para un registro clínico de demencias

We outline a proposal for the structural and functional features needed to develop a registry of dementias which can be used to collect standardised information that is both reliable and valid concerning cases of dementia in the specialised health care centres within a particular geographical area. Due to the shortage of information about aspects concerning the impact of dementias on the health care system (in terms of the usage of resources and patterns of detection, referral, diagnosis and treatment in usual clinical practice in primary and secondary care), a sequential implementation of the registry is proposed so that it can be adapted to each health district or region. The first step is to identify the cases and sources of information; second, a system for collecting data must be developed that allows information to be gathered in a standardised manner while at the same time making it possible to work in close collaboration with the specialists who diagnose dementia; and, third, it must be set up with the logistics and staff needed to centralise all the functions and activities of the registry. Epidemiological surveillance is an essential instrument for planning, managing and distributing community health resources, for following up the natural history of chronic diseases and for assessing the impact of programmes of prevention. In this respect, and from a functional point of view, the proposed registry of dementias meets all the basic requirements of epidemiological surveillance.

Training community-responsive physicians.

The "community-responsive" primary care provider has a population health perspective and is prevention-oriented, culturally competent, collaborative, and an active community leader and patient advocate. To encourage residents to value this level of community involvement and possess the requisite knowledge and skills, St. Luke's family practice residency program has developed a longitudinal community medicine curriculum designed to teach the four domains of physician-community involvement: (1) insight into sociocultural aspects of patient care, (2) familiarity with community health resources, (3) community-oriented primary care skills, and (4) community involvement.(1) Training physicians with the desire and skills to practice in medically underserved communities is a program goal. The three-year community medicine curriculum begins during residency orientation with a windshield survey of the communities served by the campus-related clinics. During the first year, all residents participate in a four-week community medicine rotation. By providing health education and clinical services to diverse populations in community clinics, agencies, and schools, they begin to develop community health-improvement skills, while observing role models, developing advocacy skills, expanding cultural awareness, and experiencing interdisciplinary collaboration. At the end of the first year, residents select a community clinical site, where they will see patients and develop a community health-improvement project during the last two years of training. A required "capstone presentation" describes the scope and nature of each resident's project by focusing on process and outcome measures. Innovative qualitative evaluation tools include a written portfolio of reflections and sequential "video journaling." An attribute-based progression matrix developed by Alverno College was adapted to facilitate serial identification and tracking of resident growth in eight domains: communication, analysis, problem solving, aesthetic responsiveness, global perspectives, valuing in decision making, social interaction, and effective citizenship.(2) Support for this program is provided by HRSA, Wisconsin AHEC, Aurora Health Care, and the medical school. A recent program graduate, now a faculty member, demonstrated the potential for this educational strategy by developing a local "Reach Out and Read" program. Targeting literacy as a factor related to the cycle of poverty and poor health, she implemented an intervention in which residents read with their pediatric patients during each visit and give the child a book to take home. As each residency class implements health-promoting interventions, this longitudinal community medicine residency curriculum will improve community health through "service learning," as well as develop a cadre of young physicians who practice community-responsive clinical medicine and have the skills and confidence to choose to serve underserved populations.

Community medicine in action: an integrated, fourth-year urban continuity preceptorship.

To provide an opportunity for fourth-year students at the University of Wisconsin Medical School in Madison to immerse in urban community medicine during a 34-week program. This experience enhances the integrity of the fourth year as well as merges medicine and public health perspectives in medical education as called for by the Medicine and Public Health Initiative. A limited number of fourth-year Wisconsin medical students have the opportunity to select a one-year, continuity-based preceptorship at the Milwaukee clinical campus with a focus in one of three domains: family medicine, internal medicine, or women's health. Students participate in the following clinical activities: a one-year, integrated preceptorship (one to three half days per week in a primary preceptor's office), medicine subinternship, senior surgery clerkship, selectives (16-20 weeks of clerkships relevant to preceptorship focus area), and one month of out-of-city electives. Complementing this community-based clinical experience is the opportunity to develop an increased appreciation for urban community health issues and resources by participating in a required urban community medicine clerkship and a mentored student scholarly project focusing on an aspect of urban community medicine and population health. All students begin the year in July with a four-week urban community medicine clerkship, which is based on the St. Luke's family practice residency's community medicine rotation and arranged by residency faculty. They conduct a "windshield survey" of a Milwaukee neighborhood, observing health hazards and identifying assets, and then present these observations to others in the clerkship. During this first month, students are introduced to the work of a variety of social service agencies, the Milwaukee City Health Department, and the Aurora Health Care/UW community clinics, which serve the state's most diverse zip codes. They meet with providers and researchers who share their expertise in infectious disease, preventive medicine, perinatal epidemiology, domestic violence, sexual assault, and disease management. Students develop increased understanding of barriers to health and personal resilience by listening to focus groups conducted with homeless men and undocumented Latino women. They participate in a resident and faculty development retreat on enhancing community medicine knowledge and skills. By August, students select an advisor and outline a project designed to expand understanding in the areas of urban population health research, community health education, professional education, or health intervention planning and evaluation. Faculty members at the Center for Urban Population Health work closely with the students throughout the year, which includes two weeks in the spring that are dedicated to intensive work on the projects. This fourth-year, urban community-based preceptorship is designed to provide students with an alternative fourth year that integrates skill development in clinical and community medicine, offers a continuity primary care experience, and showcases innovative urban health resources and role models. It is hoped that these students will pursue graduate medical education in Milwaukee, incorporate a population perspective in their practice, and choose to work in neighborhoods that are currently underserved.

Ethical Issues in Rural Nursing Practice in Botswana

The concern for ethical principles and values is not limited to health professionals alone. However, ethical principles in nursing act as safety valves for social control to prevent professional misconduct and abuse of the rights of clients. As a result of colonial experience, developing countries like Botswana usually follow the European lead, especially examples from the UK. This article examines the ethical problems and dilemmas associated with rural nursing practice in Botswana, a developing country in sub-Saharan Africa. The major ethical problems identified are related to the distribution of and access to health resources in rural communities. It is proposed that nurses must assume responsibility in the field of access and allocation by working collaboratively with governments and other professional bodies, and that nurses as a global community must work together as a team to support each other.