NURS 317 - Community Health Midterm

What were some of the earliest forms of Healthcare in Canada

turtle island (Canada)

- Indigenous peoples would provide holistic healthcare, curative midwifery, and education regarding health and healing

- settlers would receive this care and learn fromf them

What did the 17th century of nursing look like?

;religious orders would provide healthcare and support the sick

- Grey nuns

a lot to do with social justice

- no divide between community and hospital healthcare and both in rural and urban places

What did nursing look like in the 18th and 19th century?

Nation Building and Nightingale Era

- Canada developed = immigration = new diseases indigenous people were not ready for = federal laws

- provincial health not federal responsibility with the social unrest and epidemics

- hospitals became centre of healthcare

- Nightingale is founder of nursing (great at epidemiology)

What factors have influence the history of nursing

racism

patriarchy

healthcare resource competition

gender bias

Socio-ecological context

challenges due to epidemics, immigration, inability to provide basic health to settlers and Indigenous peoples

nightingale and seacole used the epidemiology, statistics, awareness of environmental factors and SDoH for health promotion

military nursing: competencies of CHN, population health, prevention, emergency preparedness and disaster nursing

What did the 20th century nursing look like?

1. hospital: the shift to less emphasis on SDoH as the funding went there as you can SEE the outcome

2. private-duty

3. public health and home visit (self-employed CHNs, specialized and elite)

What were the first two sub specialities

1. public health nursing: started with school-aged children and evolved to maternal and in fact care

2. district nursing: home health nursing, early form of primary health care

Canada Health Act Principles

1. Public Administration

2. Comprehensiveness

3. Universality

4. Portability

5. Accessibility

- health promotion, prevention of disease and injury, health protection, and home health was not emphasized in the act

What are some big documents that have caused a shift in community health nursing?

Lalonde Report: environment, lifestyle, human biology, and the healthcare system are the 4 DOH

Alma Ata: primary health care

The Epp Framework and the Ottawa Charter: health promotion

Ottawa Charter: enabling people to increase control over and improve their health

Attributes of CHN

RELATIONAL!

- primary health care and advocacy

- political in nature to drive public and health policy change

six basic principles of collaboration

1. focus on the client

2. a population health approach

3. quality care and services

4. access

5. trust and respect

6. communication

Population health promotion

taking action on the interrelated SDoH that affects the population to create healthy change

reduce inequities, maintenance or improvement of health

*best change to facilitate social justice

primary prevention

impact specific risk factors so that incidence of disease is reduce (immunizations)

- UPSTREAM THINKING

Secondary prevention

identify disease processes as early as possible - at preclinical stage to reduce prevalence/duration of disease (PPD screening)

upstream thinking

a "big picture" population health approach that takes in the SDoH and more a primary prevention perspective

Power

is the ability to act so as to achieve a goal, ethically neutral

impacts health equity/inequity and social justice/injustice

health equity

every person has an opportunity to achieve optimal health regardless of the colour of their skin, level of education, gender identity, sexual orientation, the job they have, the neighbourhood, or if they are disabled

public health nursing

0focus on disease and injury prevention, health promotion, community development, program/policy planning

home health nursing

deals with disease care and treatment that requires surgical or medical interventions

- helps people live independently in their communities

tertiary prevention

reduce impact of long-term disease and disability by eliminating or reducing impairment or disability

- want to reduce persistence and progression

quaternary prevention

population at risk for over-diagnosis and overmedialization

- ADHD children

Why do CHN Standards of practice matter?

- Inspire excellence

- Foundation for certification

- Set criteria and expectations for safe and ethical care

- Define the scope and depth of practice

- Support human resource management

- Strengthen education and professional development

CHN Professional Practice Model

client is at the centre and the categories of

1. community health nurses and nursing practice

2. community organizations

3. system

all surround it

PARTNERSHIP MODEL

CHNC 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

How do the standards work in practice

Health promotion, prevention and health protection, and health maintenance, restoration and palliation are WHAT WE DO IN PRACTICE

Professional Relationships capacity building, health equity, evidence informed practices, professional responsibility DESCRIBE HOW WE PRACTICE AND WHAT WE EXPECT TO ACHIEVE

The five Ottawa Charter health promotion strategies:

1. build healthy public policy

2. create supportive environments

3. strengthen community actions

4. develop personal skills

5. reorient health services

health promotion

is the process of enabling people to increase control over and to improve their health

LOOK AT EXAMPLES OF THE STANDARDS

Capacity building

focus is to recognize barriers to health and to mobilize and build on existing strengths

- PARTNERSHIP IS KEY!

What values must the CHN uphold

ones in both the CNA code of ethics and Canadian Community Health Nursings Standards of practice

morals vs values

morals: shared and generational societal norms about what constitutes right or wrong conduct

values: beliefs about the shared worth or importance of what is desired or esteemed within a society

purpose of the code of ethics

aspirational and regulatory: self-regulating professional and we strive to meet them

attributes of social justice

equity, human rights, democracy and civil rights, capacity building, just institutions, enabling environments, poverty reduction, ethical practice, advocacy, and partnerships

-assumes that all societies experience systematic oppression and inequities which affect some people more than others

- everyone contributes unintentionally or intentionally

social justice in community nurses framework

1. approaches tend to he concerned with the ethical use of power in health care

2. approach tends to view persons relationally as unique, connected to others, and vulnerable and unequal in power

3. tends to elicit concern for issues of everyday life and not primarily with crisis issues

ethical issues in CHN

pertain to capacity building, access and equity, negligence, and professional responsibly and accountability

Advocacy

act in the persons best interest and in their wishes, keep them informed, carry out instructions with diligence and competence, act impartially, maintain confidentiality

inequalities

must identify root causes of inequities

privilege vs oppression

P: societally granted, unearned advantages accorded to some people and not others. These are systemic or structural advantages based on identity factors

O: societally constructed disadvantages and disenfranchisement due to holding a marginalized identity.

race/racialization

social construction with biological consequences

importance of theory

roots that anchor both practice and research in the nursing discipline

guide practice and support understanding of why things are the way they are

cycle of oppression

Characteristics of Culture

Culture: language, gestures, tools, customs and traditions defining a group's values and organize social interactions

- culture is a social construction

- culture is shared

- culture shapes us at an unconscious level

- culture is fluid and dynamic

cultural competence

an ongoing process, not an outcome

process of respect, accept, and apply knowledge and skills appropriate to client interactions and not letting personal beliefs to influence the clients differing views

cultural safety, cultural awareness, and cultural sensitivity

cultural safety: knowing our own culture and its influence on interacting with someone, knowing the power imbalance favouring the HP and address it, learning and applying new foundational skills

Cultural awareness (an initial understanding that variations exist) and cultural sensitivity (showing respect and valuing cultural diversity) are steps towards cultural safety

cultural humility

a commitment to actively taking responsibility for seeking to understand the culture and experiences of others, being comfortable not being the expert, we cannot fully understand all aspects of a person

tips for working with interpreters

1. share information: gives information to the client, using plain language

2. confirm understand: ask to repeat back using their own words

3. rephrase or clarify: if further explanation is needed

4. continue on

- sit in circle, clear and simple sentences, ask open-ended questions, pause frequently

primordial prevention

measure that alter societal structures and there changing underlying determinants of health (changing public policies)

social control

a group's formal and informal means of enforcing its norms

"Mickey Mouse concept as it is used in a broad array of means

formal social control pertains to a legalized right to enforce order

facemasks, vaccinations, and social distracting are all tools made use of in controlling behaviour in the name of collective advantages

evidence informed decision making

research is used with clinical expertise, client preference, and available resources

PICO (population, intervention, comparison, outcomes)

critical appraisal of research

see who else had problem, use surveillance to see what you know about the problem in your community, context, document what happened

epidemiology

the study of the occurrence and distribution of health-related states or events in specific populations, including the study of the determinants influencing such states and the application of the knowledge to control the health problem

- look at who what when and where

- go on to the how and why

- started with John snow

association vs causality

A: occurs when there is reasonable evidence that a connection exists between a stressor or environmental factor and a disease or health challenge

C: an association that has been confirmed and there is a definite, statistical, cause-and-effect relationship between a particular stimulus and occurrence of a disease

- web of causation, two important concepts are necessary and a particular stressor must be present and sufficient amount of exposure is required

measurements in epidemiology

mortality: deaths

survival: describe the effect of a given disease and can be used to compare the efficacy of various treatments

morbidity: picture of a population and disease over time, questions population susceptibility and effectiveness of health promotion or treatment

prevalence vs incidence

P: the number of all cases of a specific disease in a population at any one given point in time / relative to the population at risk

I: identification of NEW cases of disease in a population over time (usually one year) / relative to the population at risk

screening and surveillance

screening: secondary prevention

case finding: contact tracing determine individuals whose health status is at risk

surveillance: constant monitoring of disease to assess patterns and identify events that do not fit the pattern

- screening tests need high sensitivity, need high specificity

epidemiologic triangle

host: human being in which disease occurs

agent: contagious/ non-contagious force that begins or prolongs a health problem

environment: context that promotes the epos sure of the host to the agent

epidemiological research methods

descriptive: the person-place-time model

analytical: how and why (examine associations and test hypothesis)

observational studies: cross-sectional/correlational studies, retrospective, prospective

experimental studies: clinical trials

attributable risk

burden of disease in a population based on risk factors, how much of the disease is caused by this risk factor

outbreak

sudden occurrence of a disease in a community which has never experienced the disease before OR causes occur in > numbers than expected

- two incubation periods have passed without any then it is over!

epidemic vs endemic

Epidemic is a a widespread occurrence of an infectious disease in a community at a particular time.

An endemic is a diease regularly found amongst people in a certain area

how to find the rates