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Wellness
Subjective experience of being healthy
Illness
A subjective experience of loss of health
Disease
An objective state of illness detected by medical science
Durham college definition of health
- Defined by the person experiencing it
- Health existed living, including illness and dying, physical, socio-cultural, psycho-spiritual, political and economic aspects
- Influenced by intra personal, relational, and environmental
- Health is realized when there is harmony and balance
- Healing is the process of moving toward wellness, harmony, and balance
Dr. Jean Watson
- The harmony within the mind-body-spirit
- Theory of human caring: transpersonal self, more the deal with physical illness- care, Carative vs. curative
Vision of health for Ontario
- Live longer in good health
- Equitable access to affordable and appropriate HC
- Work together to achieve better health for all
World health organization
- Complete physical, mental, and social wellbeing
- Health is a resource of everyday life, quality of life, positive concept, social and personal resources, and physical capabilities
Medical Model
- Medical intervention restores health prevention
- Health problems defined by physiological risk factors
- Physical characteristics define health status and seen as precursors for disease
- Scientific medicine solves most problems
- It didn't work we weren't addressing underlying problems
Adequate health care
- Accessible and quality healthcare would improve Canadians health
Behavioural model
- 1970s extensive spending on health care but health was still declining
- Lalonde Report: shifted from medical model to behavioural approach
- placed responsibility of health on individual
- Medicine alone can't help
- Health determinants: Lifestyle etc
Health determinants
Lifestyle, environment, human biology, organization of health care
Socio- Environmental model
- 1980s: health was linked to social structures (poverty, pollution, poor water)
- Internationally more attention was given to social context of health
- 1986 WHOs 1st conference on health promotion creating watershed document: The Ottawa Charter For Health Promotion
Social determinants of health (12)
Income and social status
Social support networks
Education
Employment and working conditions
Physical environments
Personal health practices
Healthy child development
Health services
Social environments
Gender
Culture
Biology and genetics
Income and social status
- Poverty is #1 determinant of health
Living in poverty you are
- More likely to die early and suffer from disease
- Chronic health problems
- Experience decreased self esteem and depression
Social support networks
Good and bad
Good social support networks
- Positive health outcomes
- Someone to confide in
- Decreases stress, assist in coping skills
- Spouses, friends, fam
Poor social support networks
- Social isolation, exclusion, and lack of supportive relationships
-High risk behaviours
Education
- Increase employment opportunities
- Increase income security
- Increase knowledge and skills to problem solve
- Literacy
Employment and working conditions
- Support health if gym available
- Pose possible hazards like back pain
- Workplace stress
- Work: sense of identity/purpose
- Social contacts
- Personal growth
Physical environments
- Housing: adequate and affordable
- Homeless- increase mental illness, substance abuse, TB, chronic illness, exposure to extreme weather
- Contaminants in the air, water, food, soil can cause cancer/birth defects/respiratory illness, and gastric illness
- Food insecurity
Personal health practices and coping skills
- Effective coping skills prior to stressful event
- risk behaviours for detrimental health consequences includes
Physical inactivity, Poor nutrition, Smoking
Healthy child development
- Events between conception and 6 yrs determine childrens health for the rest of their lives
3 conditions for healthy child development
- Adequate and equitable income
- Effective parents and families (parent courses)
- Supportive community environments and early childhood development initive (prenatal care, attachment to care giver, early education)
Health services
- Approx 25% of a populations health status can be attributed to their health services
- Quality and accessibility to health care services
- Prenatal care, immunization clinics, LTC, public health
Social environments
- Values and norms of society that influence health and well being of population
- Includes: human rights, social security, and social relations
- Social exclusion is experienced by marginalized populations (poor, indigenous)
- No violence at home, work, or school
Gender
- Gender based social roles impact health
- Men die prematurely than women of accidents, heart disease, cancer, suicide
- Women suffer depression, stress, chronic illness, and death family violence
Culture SDOH
- Culture and language can influence interaction with HCS
- Language differences: low SSN, predjuice, denied opportunities for jobs and education
- Immigrants and refugee health: low income, unmet expectations, food and housing insecurity, job insecurity
Biology and genetics
Nature vs. Nurture: Heredity strongly influenced by social and physical environments
- Age: increase in age and increase in chronic illnesses: consider if decrease in older persons health is result of age or impacts of poor SDOHs
Upstream
Health promotion and disease p-revention
Downstream
Appropriate for shot term, acute care conditions
Obesity up and downstream EX
DS: Focus on persons ill health after they are overweight (uphill battle problem already exists)
US: Address issues within food industry, advertising junk food thats easily accessible in school/work
Health promotion
- Increasing level of wellbeing and self actualization
- Process of enabling people to increase control over and improve their health
Disease prevention
- Actions aimed at avoiding/forestalling illness and disease
- 3 levels: primary, secondary, tertiary
Primary prevention
Activities aimed at protecting against disease before signs and symptoms occur (immunization, no smoking)
Secondary prevention
Activities aimed at early detection of disease once pathogenesis has occurred (screening far cancer)
Tertiary prevention
Activities in dictated in recovery stage of disease and directed toward minimizing residual disability and helping people live productively with limitations (cardiac rehabilitation program after heart attack)
Why is the Canadian health care delivery system important for nurses
Nurses are essential part of the CHCDS constituting the largest group of human health resources and recognized as invaluable to the health of canadians, nursing services are necessary for all patients seeking care nurses are fundamental in delivering this quality care, we require an understanding of the HCS
2006-2015
# of regulated nurses in Canada grew by 18.5%, 2015 283575 RN including 4090 RPN in Canada. 101319 RPN, 5000 physcriatric
Nurses role in HCS
- Nursing is integral to the health care delivery system (priorities always shifting, need to find out what priorities are to support it, control cost)
- Nurses have intricate knowledge of the HCS and its many complexities
Nurses must participate in
- Restructuring delivery systems
- Promoting excellence is health care
- Reinforcing the values of safe, quality, ethical patient and family centred care
Direct patient care in
LTC homes, hospitals, and institutions
MOHLTC Nursing Secretariat
Permanent administrative office within government, provide strategic advise on health and public policy issues from nursing perspective, RECOGNITION of the important tole nurses play in delivery
Nursing roles: MOH nursing secretariat led by provincial chief nursing officer
Michelle Acorn
Nursing roles: CEO of CNO
Anne Coghlin
Nursing roles: President of ONA
Viki Mckena
Nursing roles: Lakeridge chief nursing executive
Lesile Motz
CNO
Governing body of all nurses in Ontario, college sets requirements to enter the profession and establishes/enforces standards of nursing practice ensures quality of practice and confidence of nurses, all hospitals have nursing executives
Lalonde Report (1974)
- Shift from a medical to a behavioural approach to health
- New perspective on the health of Canadians
- Traditional medical approaches to healthcare were inadequate further improvements were necessary to improve health
- Responsibility of health was placed on individual
- ParticipACTION encouraged people to be active
Lalonde report identified what 4 determinants of health
- Lifestyle
- Environment
- Human biology
- Organization of health care
Ottawa Charter (1986)
- WHO's first conference on health promotion Ottawa
- Watershed moment for health promotion
- Puts the responsibility of health on Social, environmental, and political
Ottawa Charter prerequisites for health
- Peace
- Shelter
- Education
- Food
- Income
- Stable ecosystem
- Sustainable resources
- Social justice
- Equity
Ottawa Charter 5 major strategies of health promotion
1. Build healthy public policy
2. Create supportive environments
3. Strengthen community actions
4. Develop personal skills
5. Reorient health services
Health for all Jake Epp (1986)
- Reflects on socio-environment
- Canadas blueprint for achieving the WHO goal "Health for all 2000"
- Need for ways to prevent injuries, illnesses, chronic conditions, and disabilities
Health for all Jake Epp (1986) identified what 3 health challenges
1. Reducing inequities
2. Increasing Prevention
3. Enhancing coping mechanisms
Labonte (1993) 2 categories
- Categorized major determinants of health
- Psycho-social risk factors: Limited social networks, isolation, poor self esteem, and low perceived power
- Socio-environmental risk conditions: Poverty, low educational/occupational status, dangerous/stressful work, powerlessness, inequities of income or power
Jakarta Declaration (1977)
- Added 4 determinants
1. Human rights
2. Social security
3. Social relations
4. Empowerment of women
Jakarta Declaration declared that
Poverty is the greatest threat to health
History of medicare
- Canadas publicly funded HCS, all canadian residents have reasonable access to medically necessary hospital and physician services without paying out of pocket
When was medicare started and why
- 1947 by Tommy Douglas, premier of Saskatchewan
- Witnessed the effect of the depression and severe draught had on people of Saskatchewan and introduced 1st province wide insurance plan
What year were all provinces providing in patient hospital coverage
1961
Pre medicare: Canada history of social programs- 1867
Constitution Act- self governing colony
Pre medicare: Canada history of social programs- 1891
Children's aid society
Pre medicare: Canada history of social programs - 1896
Red cross
Pre medicare: Canada history of social programs - 1897
Victorian order of nurses
Pre medicare: Canada history of social programs- 1918
Canadian mental health association
Pre medicare: Canada history of social programs- 1800s-1930s
Private medicine, pay for service
History of medicare- 1947
Saskatchewan introduces a public universal insurance plan
History of medicare- 1962
Saskatchewan introduced funding for medical care outside of hospital
History of medicare- 1966
Medical care act: Federal, provincial, and territorial government agreed to equally share health costs
History of medicare - 1972
All provinces and territories offering medical insurance, all Canadians having access to hospital and medical care regardless of financial status
History of medicare- 1977
- Cost of sharing with federal government didn't last
- Replaced with transferring tax points, decreased federal contribution
Hall commission (1979)
Warned that extra billing by doctors and user fees by hospitals threatened accessibility to care
History of medicare- 1984
Federal government enacted Canada health act: Universal, accessible, comprehensive, portable, publicly administered health insurance system
Canada health act (1984)
Primary objective of Canadas HCP is: "To protect and promote and restore the physical and mental well being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers"
5 principles of Canada Health Act
1. Public Administration
2. Comprehensiveness
3. Universality
4. Portability
5. Accessibility
Public administration
- Public authority administers and operates the health care insurance plan on non-profit basis
- Held responsible and accountable to the provincial/territorial government and subject to audits of their accounts and financial transactions
Local Health Integration Networks (LHINs)
- 2006 MOHLTC divided the province into 14 regions or Local Health Integration Networks
- Bring together health care partners from - hospitals, community care, community support services, community mental health and addictions, community health centres and long-term care
- Ensure services are integrated and coordinated
- Comprehensive access to health care system - better experience for Ontarians
Comprehesiveness
- The health insurance plans of the provinces and territories must insure all medically necessary health services (insured services — hospital, physician, surgical-dental) and, where permitted, services rendered by other health care practitioners
Universality
- All insured persons in the province or territory must be entitled to public health insurance coverage on uniform terms and conditions
Portability
- Residents moving from one province or territory to another must continue to be covered for insured health services by the "home" province during a minimum waiting period, not to exceed three months, imposed by the new province / territory of residence. Residents temporarily absent from their home provinces or territories, or from the country, must also continue to be covered for insured health care services
Accessibility
- Reasonable access by insured persons to medically necessary hospital and physician services must be unimpeded by financial or other barriers, such as discrimination on the basis of age, health status or financial circumstances. Reasonable access in terms of physical availability of medically necessary services has been interpreted under the Canada Health Act as access to insured health care services at the setting "where" the services are provided and "as" the services are available in that setting
The Romanow Commission (2002)
- Medicare is sustainable and needs to be preserved
- Modernize the Canada Health Act to include 5 recommendations
Ramanow Commission, modernize the Canada health act to include these recommendations
1. Integration of technologies such as national and personal EHRs
2. Improve access for Canadians in remote areas
3. Ensure and measure quality
4. Improve and expand Primary Health Care
5. Strengthen and expand home care - e.g. home mental health case management, palliative home care, post acute home care
Organization of health care in Canada: Federal
- Set and administer national standards for the health care system through the Canada Health Act
- Assist in the financing of provincial health care services through financial transfers - "tax points"
- Deliver health care for specific groups
- Provide policies and programs that promote health, prevent disease and protect health for Canadians
Organization of health care in Canada: Provincial
Develops & administers own health insurance plan following the 5 principles of the Canada Health Act - OHIP
In Ontario, MOHLTC are responsible for
- managing and delivering health care services;
- planning, financing, and evaluating the provision of hospital care;
- physician and allied health care services;
- managing some aspects of prescription care and public health.
Institutional sector
- Hospitals, LTC facilities, psychiatric facilities, rehabilitation centres
- Offer services to inpatients (may have outpatient services also)
Community Sector
- Public Health
- Physician offices
- Community Health Centres
- Assisted Living
- Home care
- Adult Day Support Programs
- Community and voluntary agencies
- Occupational Health
- Hospice and Palliative care
- Parish nursing
5 levels of care
Level 1: Health Promotion
Level 2: Disease & Injury Prevention
Level 3: Diagnosis and Treatment
Level 4: Rehabilitation
Level 5: Supportive Care
Level 1: Health promotion
"Health promotion includes strengthening the skills of individuals to encourage healthy behaviours and it also includes building the healthy social and physical environments to support these behaviours."
(Health Canada, 2005)
•Examples:
•Anti-smoking education
•Wellness services
•Promotion of self-esteem in adolescents
•Advocating for healthy public policy
Level 2: Disease and injury prevention
- Illness prevention services to help clients reduce risk factors for disease and injury
•Examples:
•Screening - e.g. blood pressure clinics, blood glucose monitoring
•Immunizations - Flu clinics, HPV vaccines in schools
Level 3: Diagnosis and treatment
- Recognizing and treating clients' existing health conditions
- 3 sub- levels:
•Primary care - entry into health care system
•Secondary care - specialized medical service on a referral from a primary care provider
•Tertiary care - specialized technical care in diagnosing and treating a complicated or unusual health problem
Level 4: Rehabilitation
- The restoration of optimal health (after a life-altering illness), enhancing quality of life, while promoting independence and self-care.
- Examples:
•Orthopedic rehabilitation centres
•Rehabilitation for substance abuse
•Spinal cord injury rehabilitation
Level 5: Supportive care
- Health, personal, and social services offered to people who are disabled, who cannot function independently, or who have a terminal condition
- Examples:
•Palliative care - hospital, hospice, or home
•Respite care - short-term relief for family caregivers by health care providers or volunteers e.g. Adult day support programs
5 levels of care
1. Health promotion
2. Disease and injury prevention
3. Diagnosis and treatment
4. Rehabilitation
5. Supportive care
Indigenous populations and statistics
- Indigenous people represent an important and growing group within Canada
- 2011 Statistics
´Indigenous people surpassed 1.4 million
´Indigenous people accounted for 4.3% of the total Canadian population
´56% of Indigenous people live in urban areas (growth of 49% since 1996)
´46% of Indigenous people consist of children and youth < 24 years
Indigenous groups in Canada (3)
´First Nations
´Metis
´Inuit
Indigenous peoples
- Indigenous peoples of Canada are exceptionally diverse: Groups have different cultures, languages, societal structures, economics and histories
