PPN 302- Class 1

Who makes up public health?

•  multidisciplinary actors with an ethical responsibility to take a health equity approach 

Role of multidisciplinary actors in public health

Guide how priorities are set, resources are allocated, and success is measured

Features of values (all values share six features)

1. Values are linked to feelings. 

2. Values motivate action because they are connected to larger goals. 

3. Values are more than any one action or situation.

4. Values “serve as standards or criteria.”(p4)

5. Values are assigned different levels of importance.

6. The “relative importance of multiple values guides [priorities and related] action.

Types of values

1. Instrumental: Behavioural

2. Terminal: State of existence

Instrumental: Behavioural (Types of values)

• I.e acting in solidarity and fairness

• Can support pursuit of terminal values 

• Instrumental values: Fairness, solidarity , courage, Accountability, Trust, Reciprocity. Compassion, Humility, Honesty, Respect 

Terminal: state of existence (Types of values)

• I.e health equity and self-determination 

• Terminal values: Health equity and a dignified life,

•  Social justice, self-determination, wisdom, love 

Theories of action that can explain gaps in intended values and health equity action: 

1. Espoused theory

2. Theory-in-use

Espoused theory (Theories of action that can explain gaps in intended values and health equity action)

The Beliefs and values thought to be motivated actions

Theory-in-use (Theories of action that can explain gaps in intended values and health equity action)

What is actually happening, based on observation

Value tensions that arise while taking health equity actions

while taking this can be considered within two larger societal tensions:

1.  A readiness for change versus a desire to keep things the way they are

2.  Wanting the well-being of others versus wanting success and power for oneself

Biomedical (individual level) examples Models on Perspectives of health

• Cancer

• HIV status

• Diabetes

• Hypertension

• Chronic Conditions

Behavioural (individual/group level)- blame on individual examples Models on Perspectives of health

• smoking/diet

• Drug use 

• Unsafe sex

• Unhealthy eating/ No exercise 

• stress

Harm Reduction (individual level) examples Models on Perspectives of health

• Using unclean needles, 

• Using too much drugs 

• Smoking too much 

• Not using condoms

Socio-environmental (community/society level) examples Models on Perspectives of health

• Stressful environments

• Poverty

• Lack of education/Self-esteem, trauma experiences

• Lack of safety, unemployment

• Social injustice/Racial injustice

• Social isolation

Behavioural treatment examples Models on Perspectives of health

• Education

• Educational resources,

• Social Marketing

• Public policies that support lifestyle changes

Biomedical treatment examples Models on Perspectives of health

• Medications

• Surgery

• Rehabilitation

• Therapies

• screening

Harm reduction treatment examples Models on Perspectives of health

• Providing Methadone 

• Providing clean needles, 

• Smoking reduction,

• Condom distribution

Socio-environmental treatment examples Models on Perspectives of health

• Political and economic policy development (equity policies)

• on social and welfare state development

• advocacy

• resource access

• skill building and empowerment

Health Equity*

fair distribution of resources and opportunities not equal distribution of resources and opportunities

Equality*

everyone benefits from the same support. This is equal treatment- this is equal treatment

Justice*

the cause of the iniquity was addressed- systemic barrier was removed

What is critical lens theory used for?

Question the taking for granted assumptions

Critical lens Theory lens Recognises that:

• Social, economic and political conditions have history 

• Scientific and practical ways of thinking and getting things done are open to systematic questioning and criticism 

Critical social theories help us:

• Unpack the taken for granted

• Look at power relationships and relations and the ways in which these are influenced by history, economics, politics, social structures 

• Question the status quo

Micro level perspective

Individual, family and/or neighbourhood contexts

Meso level perspective

Neighbourhood, group, institutional context

Macro level perspective

• Broader social, political, economic, historical context 

• Interaction of forces outside that may impact health

Community health nursing standards that guide CHN practices: 

• Promoting health

• Building Community capacity

• Building relationships

• Facilitating access and equity

• Demonstrating professional responsibility and accountability

Promoting health(Community health nursing standards)

• Involves strategies that promote, protect and preserve health 

• Addressing health disparities and inequalities  

• Promoting health is a partnership 

  • Incorporate the lived experience of the community 

• Caring for the total human being 

Building community capacity (Community health nursing standards)

• A focus on strengths 

• Facilitates appropriate involvement of clients in identifying their health outcomes  and developing a plan of care 

• The result is empowerment 

• Doing with versus- doing for 

Building relationships (Community health nursing standards)

• Relationship building is knowing how to be with people

• Being respectful of diversity, health status, experiences, and beliefs 

Facilitating access and equity (Community health nursing standards)

• Enable access to resources based on community needs 

• Advocates for community members when they are unable to advocate for themselves

Demonstrating professional responsibility and accountability (Community health nursing standards)

• Various levels of accountability as CHNs 

• Being ethical to your practice 

  • Communicate appropriately 

  • Remain professional 

  • Maintain a high level of responsibility 

Who is your client? *

The community

Community defined

a group of people who live, work, and play in an environment at a given time

Factors of a community

• Physical or geographic space 

• Common interests, eg culture, language 

• Vulnerability to health concern eg, HIV/AIDS, STDS, diabetes 

• Dynamic- interactive web of tiers- social, a sense of belonging 

• Community of interests,

• Community of membership

Community of interest (Community factors)

e.g. shared beliefs, values or interests on a particular issue, or bound by ties of culture, occupation, sexual orientation etc

Community of membership (Community factors)

 population groups, eg gender, race class, age, sexual orientation, culture, religion, nationality etc

What are CHN treating? ( Community health issues)*

• Social injustice

• Racism

• Poverty

• Lack of education 

• Violence

• Victim blaming 

• Homelessness

• Unemployment

• Social isolation 

• Lack of housing 

• Lack of access

• inequality/inequity 

• Disempowerment 

• Low self esteem

Guiding principles of CHN*

• Community participation 

• Partnership 

• Doing with- versus doing for * 

• A focus on strengths 

What is a key guiding principle for CHN?

Doing with versus Doing for

Who can be a community health nurse?

RNs, LPN,RPNs, and NPs but only RNs are called community health nurses

Where do CHNs work?

works with people where they live, work, learn, worship, and play to promote health

Client defined

 individuals, families, groups, communities, populations, and systems. (not always one person)

Job of a CHN

work with their clients to identify and address their barriers to health with them. They view health as a dynamic process of physical, mental, spiritual, and social well being and as a resource for everyday life that is influenced  by circumstances, beliefs, and determinants of health

Blueprint for action for community health nursing in Canada:

released by  Community Health Nurses of Canada (CHNC) in 2011

Blueprint for action for community health nursing in canada: Function

a framework and a point of reference for ongoing dialogue on the development of community health nursing practice in Canada. Developed in consultation with CHNs and literature review. 

Blueprint for action for community health nursing in canada: Design

•  intent of the framework is to inform the direction of CHNs in their practices and, ultimately, to promote and protect the health of Canadians. 

• Further work needs to collaborate with the Canadian indigenous nurses association to guide their direction.

Identifies 6 areas for action: Blueprint for action for CHN in CAD

1. Work across provinces and territories at full scope and with greater clarity for the role in all domains of practice, such as common scope of practice, practice roles, and nomenclature;

2. Support nursing leadership development and positions to advance community health nursing practice and to provide a voice for the profession;

3. Build on successful collaboration within nursing and strengthen partnerships with other professionals and sectors;

4. Transform the health care system into a system for (community) health;

5. Support strong educational preparation in community health nursing; and

6. Improve access to a range of professional development resources to advance community health nursing capacity.

Downstream thinking is apart of….

Biomedical approach (individual level approach)

Midstream thinking is apart of…

• Behavioural approach (individual/group level)- blame on individual

• Harm Reduction (individual level)

Upstream thinking is apart of…

Socio-environmental (community/society level)