Comprehensive Canadian Community Health Nursing (BNUR 3019)

Comprehensive practice flashcards covering Canadian Community Health Nursing, the Canada Health Act, CCHN Standards of Practice, public health ethics, community health assessments, group dynamics, and conflict resolution models.

What are the five core principles mandated under the Canada Health Act?

1. Publicly Administered

2. Comprehensive

3. Universal

4. Portable

5. Accessible

How is the Canadian healthcare system funded?

• Federal and provincial personal and corporate income taxes

• Additional provincial sales taxes and lottery proceeds

What responsibilities does the federal government hold in Canada's healthcare system?

• Oversees health service delivery

• Transfers funds to provinces and territories

• Develops guiding public health legislation

• Established Core Competencies for Public Health in Canada

Which pieces of provincial legislation govern public health practice in Ontario?

The Ontario Public Health Standards and the Health Protection and Promotion Act.

What epidemiological outcome did Florence Nightingale document during the Crimean War?

Using simple epidemiological measures, she documented that the mortality rate fell from $415\text{ per }1{,}000$ at the beginning of the war to $11.5\text{ per }1{,}000$ by the end.

What major educational conclusion was reached by the Weir Report of 1932 regarding public health nursing?

It concluded that public health nursing should become a specialized discipline within advanced higher education.

Which milestone Canadian report published in 1974 initiated the modern health promotion movement?

The Lalonde Report.

What health promotion framework is depicted in this emblem?

Ottawa Charter for Health Promotion (1986)

• Core Strategies:

  • Build Healthy Public Policy

  • Create Supportive Environments

  • Strengthen Community Action

  • Develop Personal Skills

  • Reorient Health Services

• Key Actions:

  • Enable

  • Mediate

  • Advocate

What key trend regarding home care was identified by the Romanow Report in 2002?

• Most rapidly expanding sector of community health care

• Proven more cost-effective than institutional care for older adults

What overall percentage decline in all-cause mortality occurred in the United States between 1900 and 2010?

Mortality from all causes declined by $54\%$ (falling from $1{,}719.1\text{ per }100{,}000$ in 1900 to $798.7\text{ per }100{,}000$ in 2010).

How does practicing 'in the community' differ from practicing 'with the community' in community health nursing?

Practicing 'in the community' focuses on delivering direct care to individuals and families residing within the geographic area, whereas practicing 'with the community' approaches the community collective itself as the primary client.

What are the five core principles of Primary Health Care (PHC)?

1. Accessibility

2. Health Promotion

3. Public Participation

4. Intersectoral Collaboration

5. Appropriate Technology

How does primary health care differ fundamentally from primary care?

• Primary Health Care: Broad, comprehensive approach focused on disease prevention, community development, and intersectoral collaboration

• Primary Care: First point of contact

What are the four levels of prevention utilized in community health nursing?

1. Primordial prevention (preventing the emergence of underlying risk factors)

2. Primary prevention (averting disease before it occurs in an individual)

3. Secondary prevention (early detection, screening, and prompt treatment)

4. Tertiary prevention (managing symptoms and reducing disability after a disease is established)

What are the 12 social determinants of health identified by the Public Health Agency of Canada (PHAC)?

1. Income and social status

2. Social support networks

3. Education and literacy

4. Employment and working conditions

5. Social environments

6. Physical environments

7. Personal health practices and coping skills

8. Healthy child development

9. Biology and genetic endowment

10. Health services

11. Gender

12. Culture

What professional framework is illustrated in this diagram?

The Canadian Community Health Nursing Professional Practice Model, showing the client at the core surrounded by community organizations, system influences, and community health nursing practice standards.

What are the eight Canadian Community Health Nursing (CCHN) Standards of Practice?

1. Health Promotion

2. Prevention and Health Protection

3. Health Maintenance, Restoration and Palliation

4. Professional Relationships

5. Capacity Building

6. Health Equity

7. Evidence Informed Practice

8. Professional Responsibility and Accountability

Which public health framework is illustrated by these nested spheres?

The Socio-Ecological Model, which examines health influences and prevention across four levels: Individual, Relationship, Community, and Societal.

Under the CCHN Standards of Practice, what is the focus of Standard 5: Capacity Building?

Empowering individuals and communities to define, assess, analyze, and act upon their own health concerns by collaborating with those affected and building upon existing community strengths.

What four bioethical obligations comprise Principlism in healthcare ethics?

1. Autonomy

2. Non-maleficence

3. Beneficence

4. Distributive justice

What are the seven structured steps of ethical decision making in community nursing?

1. Identify the ethical issues and dilemmas

2. Place them within a meaningful context

3. Obtain all relevant facts

4. Reformulate ethical issues and dilemmas, if needed

5. Consider appropriate approaches to actions or options

6. Make decisions and take action

7. Evaluate the decisions and the action

What are Upshur's (2002) three ethical principles governing public health interventions?

1. Principle of Least Restrictive or Coercive Means (education and discussion precede coercive measures; full power is reserved for exceptional circumstances)

2. Reciprocity Principle (society assists individuals and communities in fulfilling duties)

3. Transparency Principle (decision-making processes and contexts are open and clearly explained)

What six analytical questions make up Kass’s (2001) public health ethics framework?

1. What are the public health goals of the proposed program?

2. How effective is the program in achieving its stated goals?

3. What are the known or potential burdens of the program?

4. Can the burdens be minimized? Are there alternative approaches?

5. Is the program implemented fairly?

6. How are the benefits and burdens of a program to be fairly balanced?

What three core components define a community in community health nursing?

1. People

2. Place

3. Function

What essential conditions must be met for a CHN to establish an effective egalitarian 'Community as Partner' relationship?

• Perceive a need exists

• Trust the CHN can assist

• Feel contributions are valued

• Guaranteed confidentiality

• Involved from the beginning

What do the Status, Structural, and Process dimensions assess in a Community Health Assessment (CHA)?

• Status: Physical (vital statistics, risk profiles), emotional (satisfaction, mental health), and social components (crime rates, functional levels).

• Structural: Community health services, available resources, and social correlates of health.

• Process: Effective community functioning and collaborative problem solving.

What distinguishes direct data sources from reported data sources in a community health assessment?

• Direct sources: Firsthand primary data generation (e.g., windshield surveys, informant interviews, observation)

• Reported sources: Pre-existing secondary data compilation (e.g., Statistics Canada, CIHI)

What three demographic profiles are represented by these population pyramids?

• Expansive: High birth rate and rapid population growth

• Constrictive: Declining birth rate and aging population

• Stationary: Balanced age proportions and stable population

What assessment model and eight community subsystems are depicted in this diagram?

• Model: Community Subsystem Analysis (Anderson & McFarlane)

• 8 Subsystems:

  • Physical environment

  • Education

  • Safety and transportation

  • Politics and government

  • Health and social services

  • Communication

  • Economics

  • Recreation

What is a windshield survey and what purpose does it serve in community assessment?

• Method: Observational scan conducted by walking, driving, or biking through a community

• Purpose: Assesses the physical environment to identify local resources and stressors

What process and diagnostic synthesis is represented in this Community as Partner assessment flowchart?

• Model: Community as Partner assessment process (Vollman et al.)

• Analysis: Links environmental data to community stressors and lines of defense

• Outcome: Formulates a Community Health Nursing Diagnosis

What is asset mapping in community development?

• Identifies and catalogs local strengths, skills, and resources

• Fosters relationships and mutual aid

• Mobilizes assets for community-driven health initiatives

What planning framework and four operational quadrants are shown in this template?

The SOAR Analysis Template, an equity and strategic planning model evaluating Strengths, Opportunities, Aspirations, and Results.

What cyclical nursing framework is represented in this illustration?

• Model: Community Health Promotion Model (Camillia F Matuk)

• Cycle: Assessment, Analysis, Planning, Interventions, and Evaluation

• Focus: Centered on community people and determinants of health

How do groups, teams, and partnerships differ in their level of member interdependence?

• Group: Two or more individuals sharing a common purpose with low to moderate interdependence.

• Team: A specialized group focused on a specific collective goal with high interdependence.

• Partnership: An active, egalitarian relationship where parties co-lead all stages of planning, implementation, and evaluation.

What is the difference between an interdisciplinary team and an intradisciplinary team?

• Interdisciplinary: Multiple distinct professions collaborating (e.g., nurses, social workers, physicians)

• Intradisciplinary: Same profession with differing roles or scopes collaborating (e.g., RNs and RPNs)

What five dimensions comprise the group process?

1. Physical and emotional climate

2. Group involvement

3. Group interaction

4. Group cohesion

5. Group productivity

What are the five sequential stages of group development defined by Tuckman and Jensen (1977)?

1. Forming (orientation and acquaintance)

2. Storming (conflict and expression of individual feelings/real issues)

3. Norming (consensus, unity, and cohesion building)

4. Performing (collaborative, productive task execution)

5. Adjourning (task completion and disengagement)

What three broad classes of member roles exist in group work according to Benne and Sheats (1948)?

1. Task roles (focus on problem solving and goal completion)

2. Maintenance roles (focus on social climate, facilitation, and relationship preservation)

3. Non-functional roles (individualistic behaviors that impede group productivity and cohesion)

What are four classic leadership styles observed in group leadership?

1. Autocratic (centralized directive control)

2. Laissez-faire (hands-off, minimal direction)

3. Democratic/participative (collaborative decision-making with member involvement)

4. Shared/distributed (leadership responsibilities distributed flexibly among members)

What are the three structural types of group conflict based on who is involved?

1. Intrapersonal (conflict occurring within an individual)

2. Interpersonal (conflict occurring between two or more individuals)

3. Intergroup (conflict occurring between two or more groups)

What are the three common sources of conflict within collaborative teams?

1. Task conflict (disagreements regarding the work or content to be done)

2. Relational conflict (interpersonal friction and emotional incompatibility)

3. Values conflict (divergence in fundamental core beliefs and principles)

What conflict resolution continuum is represented in this diagram?

• Model: Barr and Dowding (2008)

• Continuum: 'Concern for self' (I-ness) to 'Concern for the group' (We-ness)

• Conflict styles:

  • Avoidance

  • Competing

  • Compromising

  • Accommodating

  • Collaborating

What conflict assessment tool is illustrated in this two-dimensional matrix?

• Tool: Thomas-Kilmann Conflict Mode Instrument (1974)

• Dimensions: Assertiveness (satisfying own concerns) and Cooperativeness (satisfying others' concerns)

• Conflict modes:

  • Competing

  • Collaborating

  • Compromising

  • Avoiding

  • Accommodating

What is the role of an Advocate in community health nursing?

An advocate amplifies and voices client concerns to challenge structural barriers and ensure access.

What is the function of a Clinician or Direct Care Provider?

A clinician delivers hands-on, direct clinical interventions across varied settings.

What does a Collaborator do in community health nursing?

A collaborator unites client inputs with multidisciplinary and intersectoral team members to optimize health outcomes.

What is the role of a Consultant in community health nursing?

A consultant shares specialized expertise and information with clients, agencies, and providers.

What is the responsibility of a Counsellor in community nursing?

A counsellor provides psychological and emotional support to assist clients through complex decisions.

What is the role of an Educator in community health practice?

An educator develops and delivers targeted teaching plans tailored to client health literacy and circumstances.

What does a Facilitator do in community health practice?

A facilitator coordinates resources and leads group dynamics to set and achieve health objectives.

What is the role of a Health Promoter or Change Agent?

A health promoter encourages recognition of behavioral and structural risk factors, supporting client self-determination for lifestyle changes.

What does a Leader do in community health nursing?

A leader directs and inspires individuals and collectives to explore options and navigate change.

What is the role of a Liaison in community health nursing?

A liaison serves as a bridge connecting clients with health agencies, social programs, and medical providers.

What are the core functions of a Manager in community nursing?

A manager directs, organizes, coordinates, and evaluates clinical plans and care delivery.

What is the function of a Referral Agent in community nursing?

A referral agent directs clients toward external community resources and specialized networks.

What is the role of a Researcher in community health nursing?

A researcher investigates clinical and community phenomena to build evidence-informed practices.

What is the role of a Coordinator in community health nursing?

A coordinator aligns diverse services, appointments, and care teams into a continuous care plan.

What is an upstream intervention?

Macro-level policies and structural changes that target root determinants of health (e.g., housing policy, income equality).

What is a midstream intervention?

Community- and organizational-level actions addressing physical environments, workplace hazards, or vulnerable groups.

What is a downstream intervention?

Individual-level clinical treatments for acute or chronic illnesses after diagnosis (e.g., medications, surgery).

What is primordial prevention?

Stopping the emergence of environmental and social risk factors across whole populations before they develop.

What is primary prevention?

Preventing the onset of disease by controlling specific causes and risk factors before illness begins (e.g., vaccines).

What is secondary prevention?

Detecting disease early through screening to halt its progression and prevent complications (e.g., mammograms).

What is tertiary prevention?

Managing symptoms, rehabilitating, and limiting disability once a disease is clinically established (e.g., cardiac rehab).

What is the primary focus of Standard 1: Health Promotion?

Enabling the population as a whole to increase control over and improve their health across all system levels.

How does Standard 1: Health Promotion address target populations?

It engages the entire population rather than focusing exclusively on at-risk individuals.

What framework is used in Standard 2: Prevention and Health Protection to structure activities?

The Socio-Ecological Model (spanning individual, relationship, community, and societal tiers).

What is the main goal of Standard 2: Prevention and Health Protection?

To minimize the occurrence and consequences of disease and injury through targeted public health actions and mandatory programs.

What care continuum is addressed by Standard 3: Health Maintenance, Restoration, and Palliation?

Holistic clinical care, functional rehabilitation, symptom management, and end-of-life care across the lifespan.

What core foundation guides Standard 4: Professional Relationships?

Connecting and caring built on mutual respect, non-judgmental acceptance, and awareness of professional power imbalances.

What is the key purpose of Standard 5: Capacity Building?

To boost the abilities of communities and individuals to self-direct, assess, and act on their own health concerns using existing assets.

What tool do community health nurses use in Standard 5 to uncover local strengths?

Asset-mapping.

What is the core focus of Standard 6: Health Equity?

Facilitating fair, universal access to health resources and providing culturally safe care to eliminate structural disparities.

What four elements are combined under Standard 7: Evidence-Informed Practice?

Best available research evidence, clinical nursing expertise, client preferences, and community context.

What ethical tension is highlighted under Standard 8: Professional Responsibility and Accountability?

The tension between individual civil liberties and collective community safety.

What professional obligations are emphasized in Standard 8: Professional Responsibility and Accountability?

High autonomous practice, maintaining competence, quality of care, and balancing multi-jurisdictional accountability.

Who established the three core public health ethical principles of least restrictive means, reciprocity, and transparency?

Ross Upshur (2002).

What is the Principle of Least Restrictive or Coercive Means?

The principle that coercive power is reserved for exceptional cases, prioritizing voluntary measures and education first.

What actions must precede liberty-limiting mandates under Upshur's framework?

Education, communication, voluntary facilitation, and open dialogue.

What is the Reciprocity Principle in public health ethics?

The obligation of society to support and assist individuals undergoing isolation, quarantine, or compulsory care.

What are common examples of support provided under the Reciprocity Principle?

Supplying groceries, safe accommodation, wage replacements, and necessary clinical care.

What is the Transparency Principle in public health ethics?

The requirement that all decisions, clinical criteria, and rationale are communicated openly, accessibly, and without hidden agendas.

Who proposed the five stages of group development in 1977?

Tuckman and Jensen.

What is the primary focus of the Forming stage?

Orientation, learning about members, and setting boundaries.

What characterizes the Storming stage?

Intragroup conflict, emotional expression, and competition for roles.

What occurs during the Norming stage?

Developing group cohesion, establishing norms, and agreeing on roles.

What is the central activity during the Performing stage?

Productive task completion and cooperative problem-solving.

What marks the Adjourning stage?

Completing objectives, wrapping up tasks, and disengaging.

What is the purpose of the Community Subsystems model?

To assess eight interconnected environmental and organizational subsystems surrounding the central community core.

What key features are evaluated in the Physical Environment subsystem?

Geography, air and water quality, zoning, green spaces, and environmental hazards.

What components are assessed under the Education subsystem?

Public and private schools, literacy programs, daycare access, and post-secondary institutions.

What services and infrastructure belong to the Safety and Transportation subsystem?

Police, fire, EMS, public transit routes, road safety, and cycling lanes.

What does the Politics and Government subsystem examine?

Municipal administrative wards, leadership presence, public participation, and political dynamics.

What facilities and resources are included in the Health and Social Services subsystem?

Hospitals, outpatient clinics, family health teams, social assistance offices, and food banks.

What channels are analyzed within the Communication subsystem?

Local newspapers, radio stations, community bulletin boards, internet access, and libraries.

What indicators are measured in the Economics subsystem?

Major employers, median household income, unemployment rates, retail diversity, and poverty levels.

What community spaces are captured under the Recreation subsystem?

Public parks, athletic fields, playgrounds, community centres, and cultural venues.