NURS 208 Final

structure of healthcare

structure of healthcare

federal and provincial jurisdictions

federal jurisdiction

• financing provinces and territories - transfer funding

• delivers services to first nations and inuit, veterans, inmates of federal penitentiaries

• government policy and programs (approved drugs, assess environmental risks, etc.)

provincial jurisdiction

• each province is responsible for administration of their own delivery of health services

• decide on how many physicians, nurses, and other care providers are required

points of care

primary care, secondary care, tertiary care, quaternary care

primary care

• is provider driven

• the first level of contact with; a health professional within the national healthcare system, about a healthcare problem - leading to a decision regarding a course of action to resolve any actual potential health problem

• brings healthcare as close as possible to where people live and work

• 1st level of diagnostic treatment care

secondary care

involves diagnosis and treatment...referred by a primary care provider to a specialized care at a hospital

tertiary care

specialized consultative care involving dedicated supports and resources usually based on a referral from a primary or secondary HCP, usually in a large research or teaching hospital

quaternary care

highly specialized (difference in type and availability)

primary health care

• foundation of Canada's healthcare system

• is a philosophy and model for improving health that focuses on promoting health/wellness, preventing illness, and promoting continuity of care. underlying values: social justice, equity

• is essential healthcare made universally accessible to individuals, families, and groups in the community by means acceptable to them through their full participation and at a cost that the community and country can afford

five guiding principles of primary health care

accessibility, public participation, healthcare promotion, appropriate technology, intersectoral cooperation

approaches to healthcare

medical, behavioural, socio environmental

medical approach

• focus on healthcare is on curing disease and health problems

• health is defined as the absence of disease

• medical interventions for health restoration were emphasized, heavy reliance on in-hospital care

• reactive approach (downstream)

behavioural approach

• health defined as the product of making healthy lifestyle choices

• promoted individual responsibility for health

• focus on health promotion, disease prevention, and education

• lalonde report identified 4 influences on health: human biology, lifestyle, the environment, health services

socio-environmental approach

• views health as the product of social and environmental determinants that provide incentives and barriers to the health of individuals and communities

• proactive approach (upstream)

accessibility (PHC)

a continued and organized supply of essential healthcare services that is available to all people with no unreasonable geographic or financial barriers

public participation (PHC)

individuals and communities have the right and responsibility to be active partners in making decisions about healthcare

healthcare promotion (PHC)

through health promotion, people build an understanding of the SDOH and develop skills to improve and maintain own health and wellbeing

appropriate technology (PHC)

appropriate modes of care are available based on a society's social, economic, and cultural development (equity focused)

intersectoral cooperation (PHC)

commitment from all sectors is essential for meaningful action to the health determinants

Canada Health Act

• federal legislation that puts in place conditions by which individual provinces and territories in Canada may receive funding (Canada Health Transfer) for health care services provided they conform with certain specified criteria

• promotes adherence to five national standards (the criteria that provincial/territorial health insurance must respect in order to receive federal cash contributions

public administration (CHA)

all administration of provincial health insurance must be carried out by public authority on a non-profit basis. they also must be accountable to the province or territory, and their records and accounts are subject to audits

comprehensiveness (CHA)

cover all insured services provided by hospitals, physicians, or dentists (medically necessary). may vary across provinces/territories

universality (CHA)

all insured residents are entitled to insured health services- must register with respective government

portability (CHA)

a resident that moves to a different province or territory is still entitled to coverage from their home province during a minimum waiting period (not to exceed 3 months). this is true for temporary visits to another province or out of country. these conditions are set out by each province/territory

accessibility (CHA)

all persons have reasonable access to healthcare facilities, regardless of location. reasonable meaning access when and where they are available, as they are available. protects from extra charges or discrimination (age, health status, and financial circumstances)

purpose of the pillars of the Canada Health Act

ensure that all Canadians (eligible residents) have reasonable access to insured health services on a prepaid basis without direct charges at the point of care. the act makes Canadian healthcare more reliable, ensures that no essential health service is left out.

types of community health nurses

public health (PHN), home health (HHN), RN in primary care/family practice nurses

public health nurse (PHN)

• focus on promoting, protecting, and preserving the health of populations

• links the health and illness experiences of individuals, families, and communities to population health promotion practice (social justice, attention to human rights and equity, evidence informed policy and practice, SDOH)

home health nurse (HHN)

• focus on prevention, health restoration, maintenance, and palliation

• focus on individuals, designated caregivers, and their families

RN in primary care/family practice nurses

focus on preventative health screening, health education, comprehensive assessment, treatment of minor acute illnesses, chronic disease management, case management, system navigation, therapeutic intervention (wound care, immunization) and medication review with individuals and families

CHNC standards of practice

• health promotion

• prevention and health protection

• health maintenance, restoration, and palliation

• professional relationships

• capacity building

• health equity

• evidence informed practice

• professional responsibility and accountability

what is theory?

• a set of ideas (relationship among concepts) that describe, predict, explain the physical and social world

• a theoretical perspective can be understood as a lens through which we look, serving to focus or distort what we see

• in health, they often help us explain, understand, and predict health behaviour

environmental theory (Florence Nightingale)

• the act of utilizing the patient's environment to assist in recovery

• the nurse/patient relationship is important

• the environment has a direct effect on the patient's well being

• environmental factors such as fresh air, clean water, cleanliness, and light contribute to good health and recovery

• the nurse can act to modify the environment and influence patient outcomes

metaparadigm

describes a global way a professional discipline looks at the world

nursing metaparadigm

concept of person, concept of health, concept of environment, concept of nursing, concept of social justice

Etuaptmumk (Two-Eyed Seeing)

learning to see from one eye with the strengths of indigenous knowledges and ways of knowing, and from the other eye with strengths of western knowledges and ways of knowing, and learning to use both sides for the best benefit

Critical Social Theory

• considers multiple social and economic forces resulting in power differentials in society

• examines the relationships of power and the underlying structures (not natural and fixed) in society that produce inequalities in a population

Post Colonial Theory

• considers the role of race and history in creating inequities. need to be aware of the expectation of a dominant culture and what impact that could have on the local community and their place in it

• encourages us to examine and consider how events from the past shape the present context of health and healthcare

Health Promotion

• the process of enabling people to increase control over the determinants of health and thereby improve their health

• health promotion has evolved to include individual health behaviours

• a social-political process, involving multiple interventions, over a prolonged period of time, action at several levels across sectors

Ottawa Charter

• defined and developed the concepts and components of health promotion

• increased awareness and expanded upon the determinants of health inits discussions of the prerequisites for health such as peace, shelter, education, food, income, sustainable resources, social justice, and equity

• moved away from expert in control to the roles of advocate, facilitator, supporter, and mediator

Ottawa Charter health promotion strategies

build a healthy public policy, create supportive environments, strengthen community action, develop personal skills, reorient health services

build a healthy public policy

aim is to make healthier choices by adopting healthy public policy (ie ban cell phones while driving)

create supportive environments

providing environments in all settings that are safe, satisfying, stimulating, and enjoyable (flexible workplace policies, quality childcare programs)

strengthen community action

empowerment (process of enabling people to increase control over decision making) and community development. focus on strengths (community health boards)

develop personal skills

education, support and resources to enable individuals to make healthy lifestyle choices (parenting classes, early childhood intervention)

reorient health services

shift to community-based care, family focused, health promotion

levels of prevention

primordial, primary, secondary, tertiary

primordial prevention

prevention of risk factors themselves, beginning with a change in social and environmental conditions in which these factors are thought to develop (food security)

primary prevention

"upstream" actions to prevent disease/injury before the signs and symptoms occur (immunizations, infant car seats, preconception folic acid)

secondary prevention

"midstream" actions that promote early detection of a disease/injury (screening for skin cancer, mammography clinics)

tertiary prevention

"downstream" actions that minimize residual disability from disease and help the clients to live productively without limitations (rehab after suffering a head injury)

health protection

• wide range of activities undertaken by public health departments and also by some government agencies, such as the public health agency of Canada

• spans primordial and primary prevention

harm reduction

• is a philosophy, a set of programs, and a practice

• focuses on preventing the harms of behaviours, not reducing or eliminating those behaviours per se

• views substance use as a public and personal health issue

• evidence based approach

• accepting people as they are; avoiding judgement - this includes rejecting the position that abstinence is the only option; emphasizing the dignity of each person; being compassionate, and; challenging the policies that cause unnecessary harm' like criminalization of drug use, refusing services to people using substances, and inadequate housing among many others

population health

helps us identify the full range of factors that determine health, and a health promotion perspective guides action on these factors to improve populations health

social justice

• the view that everyone deserves equal rights and opportunities and this includes the right to good health

• when we work for social justice, we address the social, economic, and political origins of health inequities - the root causes

• social justice is a moral and ethical responsibility for nurses (part of every nursing role, regardless of setting)

health inequity

• differences in health that are unnecessary, avoidable, unfair, and unjust

• could be avoided if reasonable action is taken

• these inequities are the result of policies and practices that create an unequal distribution of money, power, and resources among communities based on race, class, gender, place, and other factors

the cycle of oppression

stereotyping, prejudice, discrimination, oppression

stereotyping

exaggerated, oversimplified, fixed images held by persons, groups, political/economic decision makers...is embedded in, reinforced by societal power

prejudice

preconceived opinions based on stereotypes - is embedded in, and reinforced by societal power

discrimination

actions or inactions based on prejudice - made possible/condoned by (implicitly or explicitly) by societal power

oppression

discrimination backed up by systematic or structural power (governance policies and procedures in education, legal, health systems...)

health literacy

• the capacity to obtain, process, understand basic health information and services; make appropriate health care decisions (act on information); access/navigate healthcare system

• hidden barrier to communication with patients

social marketing

the use of strategic marketing practices to influence social behaviours and benefit the target audience

six benchmark activities of social marketing

• voluntary behaviour change

• consumer research

• segmentation and targeting

• 4 P's

• exchange

• competition

4 P's of social marketing

product, price, place, promotion

product

includes services, behaviours, and policy changes

price

the cost associated with it, what the person needs to give up

place

where it can be carried out, environmental/social context

promotion

appeal to consumer, want to engage in behaviour

community

• a group of people who live, learn, work, worship, and pray in an environment at a given time

• share common interests ad characteristics and function within a larger social system such as an organization, region, province, or nation

community assessment

• a systematic, ongoing process of data gathering

• identify strengths and assets as well as challenges (SDOH)

windshield survey

• use a variety of senses to capture the essence of the community, determine areas for further investigation and sense the tone of the community

• observe where populations of interest meet and interact

community health promotion model

assessment, analysis, planning, interventions, evaluation

assessment (CHPM)

• focus on purpose of assessment

• assess what determines the health of the community

analysis (CHPM)

• identify community strengths and needs

• formulate community diagnosis

planning (CHPM)

• address health promotion challenges

• reduce inequities

• increase prevention

• enhance coping

interventions (CHPM)

• implementing primary, secondary, and tertiary prevention

evaluation (CHPM)

• gather evidence

• monitor results for progress/change

• what will indicators of success be?

• what are desired outcomes?

• how will we measure outcomes?

epidemiology

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

John Snow

epidemiologist whos hypothesis was that the contaminated water was the source of cholera, a waterbourne illness

how did John Snow prove it?

• people who were not drinking from the pump/contaminated source were not dying

• the location of the outbreaks allowed the pump to be narrowed down

• the exceptions that helped prove his theory were the people who died that shouldn't have (outside the contamination area), and the people who should have died but didn't (within the contamination area)

how did John Snow collect his info?

spot map (tracking cases and location), observation, using maps to identify where people were ill and where they weren't, there were no methods of complicated statistical analysis

screening

• testing of individuals who do not have symptoms

• examine for validity (test what you want them to test) and reliability (consistent in results overtime)

• as new knowledge develops, diagnostic tests and policy may change

surveillance

monitoring of diseases to assess patterns and quickly identify events that do not fit the patterns

epidemiological triangle

agent, host, environment

agent

• factor that either needs to be present or lacking for disease to develop

• biological, physical, chemical, nutritional, psychological

• ex. nutritional can be excess or lack (like essential vitamins)

host

• human being in which the disease occurs

• demographics, biological (ex. genetics), social, economic, lifestyle factors, previous disease, immune system, race

environment

• context that promotes exposure of the host to the agent

• physical (weather, geo, pollution), biological (plants, animals, microorganisms) and social factors (neighbourhood, work, housing)

modes of transmission

direct: direct contact, droplet spread indirect: airborne transmission, vehicle, vectors

direct contact

• occurs through skin to skin contact, kissing, and sexual intercourse

• contact with soil or vegetation harbouring infectious organisms

droplet spread

• spray with large, short-range aerosols produced

• sneezing, coughing, talking

• classified as direct because direct spread over a few feat before droplets fall

airborne transmission

• infectious agents carried by dust or droplet nuclei suspended in air

• aerosols may remain suspended in the air for long periods of time and can be blow over great distances

vehicle transmission

food, water, biological products, and fomites

vector transmission

• living organisms that can transmit infectious pathogens between humans, or from animals to humans

• mosquitos, fleas, ticks

chain of infection

reservoir -> modes of transmission -> susceptible host

portal of exit

• path by which pathogen leaves the host

• usually corresponds to wherever pathogen is localized

portal of entry

• manner in which pathogen enters the susceptible host

• must provide access to tissues in which the pathogen can multiply or a toxin can act

• often, infectious agents use the same portal to enter a new host that they used to exit the host

• non intact skin, mucous membranes, respiratory system, GI system, genitourinary system

natural history of disease

progression of disease from onset to resolution without intervention

susceptibility stage

• pre pathogenesis

• before onset of disease

• disease is in population, but individual does not yet have it

• only risk factors are present

• primary prevention

subclinical stage

• causal (etiological) factors present in the body and causing pathological changes

• no signs or symptoms

• called "incubation period" when talking about infectious diseases

• begins with the invasion of an infectious agent and continues until agent multiplies enough to produce host reaction and clinical symptoms

• patients can still transmit disease

• secondary prevention