The Role of the Health Care Aide

Evolution of Canada's Health Care System

Originally, individuals were fully responsible for paying their own hospital or doctor bills.
Those unable to afford care relied on charity organizations, such as the Victorian Order of Nurses (VON) and the Red Cross.
During the Great Depression in the 1930s, many sick or disabled individuals depended on family members for care due to financial constraints.
In $1947$ , Saskatchewan pioneered the first public insurance plan, which covered hospital services.
By $1961$ , all ten provinces and two territories had agreed to provide inpatient hospital care, with costs shared between the federal and provincial governments.
In $1972$ , insurance coverage was expanded to include medical services provided outside of hospitals.

Current Health Care System Structure

Responsibility for Indigenous Health: Health care for First Nations, Métis, and Inuit peoples is a shared responsibility among federal, provincial, and territorial governments, and Aboriginal organizations.
Public Health Services: These are generally delivered at the provincial, territorial, and municipal levels.
Federal Public Health Agency of Canada: This agency serves as a central point for efforts in disease prevention and control, and for responding to outbreaks of infectious diseases.

Canada Health Act (1984): Principles of Medicare

Comprehensiveness: The health insurance plan must cover all insured health services provided by hospitals, medical practitioners, and dentists (where applicable).
Universality: All insured residents of a province or territory are entitled to the same level of health care services.
Portability: Residents moving within Canada or temporarily absent from their home province/territory must still be covered for insured health services.
Accessibility: Reasonable access to health care facilities and services must be unimpeded by financial or other barriers.
Public administration: The provincial or territorial health insurance plan must be administered and operated on a non-profit basis by a public authority.

The Federal Role in Health Care

Administering the Canada Health Act.
Delivering health care directly to specific groups including: people living on reserves, Inuit peoples, members of the Canadian Forces and the RCMP, veterans, and inmates of federal jails.
Developing and implementing government policies and programs aimed at promoting health and preventing disease.
Transferring tax money to provinces and territories to help share the costs of medical care.
Specifically prohibiting service providers from charging clients extra or applying user fees for insured services.

Primary, Secondary, and Tertiary Health Care Delivery

Primary Care: The initial point of contact for acute medical problems (e.g., broken bone, bad cough). Care typically occurs in the community and is provided by doctors or nurse practitioners.
Secondary Care: Involves referral by a primary care provider to a specialist with specific expertise in a particular area. Care may take place in the community or hospital (e.g., referral to a cardiologist for heart problems).
Tertiary Care: A highly specialized and technical level of health care requiring specialized units (e.g., intensive care units) and advanced treatments. This care usually occurs in large research and teaching hospitals.
Quaternary Care: An extension of tertiary care, even more specialized, often dealing with experimental treatments.

Provincial or Territorial Role

Each province or territory is responsible for developing and administering its own health care insurance plan.
They finance and plan health care services in accordance with the Canada Health Act.
Refer to Table $2-1$ , page $29$ for specific provincial and territorial health insurance programs.

Health Care Challenges

Worker shortages across various health care professions.
An aging population, specifically the Baby Boomer generation (born between $1945-1964$ ).
The aging of existing health care workers.
Long waiting lists for surgeries, diagnostic tests, and other medical procedures.
Extended waiting times for admission to long-term care facilities.
Increasing costs associated with providing health care services.

Health Care Trends

Preventing illness and injury:
- Health promotion: Strategies designed to improve or maintain health and independence.
- Disease prevention: Strategies focused on preventing the occurrence of specific diseases or injuries.
Home care: An increasing reliance on health care services provided in a client's residence.
Alternative health practices: Growing interest and use of non-conventional health approaches.

Health and Wellness

Definition of Health: According to the World Health Organization (WHO), health is "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."
Expanded Definition: In recent years, this definition also includes the ability to lead a "socially and economically productive life."
Holism: A concept that considers the whole person, recognizing that all parts are interconnected.
Components of the Whole Person: The whole person comprises physical, emotional, social, cognitive, and spiritual parts.
These five parts are intricately woven together and cannot be separated.
Disability and illness impact the whole person, not just isolated parts.

Dimensions of Health

Physical Health: Influenced by genetics and lifestyle, achieved when the body is strong, fit, and free of disease.
Emotional Health: Feeling good about oneself, possessing strong self-esteem, self-control, and self-awareness. Involves accepting and offering help. Emotional health naturally fluctuates throughout life.
Social Health: Achieved through stable and satisfying relationships. Involves approaching others with respect, warmth, openness, and trust. Most individuals require a social support system, and support workers can be key members of this system.
Spiritual Health: Believing in a purpose greater than oneself. May involve membership in a formal religion. Requires respecting the expression of other people’s spirituality.
Cognitive Health: Keeping the mind active and creative. Support workers can promote clients' cognitive health by encouraging participation in stimulating activities.

Determinants of Health in Canada

Factors that influence an individual's health status:

Income and social status
Employment and working conditions
Education and literacy
Childhood experiences
Physical environments
Social supports and coping skills
Healthy behaviours
Access to health services
Biology and genetic endowment
Gender
Culture
Race/Racism

Health Inequalities

Defined as differences in the health status of individuals and groups.
Are significantly influenced by the social determinants of health.

Optimal Health

The achievement of optimal health, or wellness, is possible across all five dimensions: physical, emotional, social, cognitive, and spiritual.
This concept embraces a holistic approach to health care.
Health is viewed as a continuum, not merely the presence or absence of illness.

How Health Beliefs Are Formed

Family influence
Social network influence
Community influence
Religion
Government

Person-Centred Care Approach - HCA Role (CARE Principles)

Support workers (HCAs) perform actions to support the client as a whole person, guided by the CARE principles:

C - Compassionate Caring through Competence:
- Caring: Having compassion for the client's dignity, independence, preferences (choices), privacy, safety, and holistic needs (physical, psychological, social, emotional, cognitive, cultural, spiritual).
- Competence: Applying the necessary knowledge, skills, behaviours, and attitudes to deliver person-centred care.
A - Accurate Observation:
- Observing the client's body systems and cognitive status, including:
  - Pain or discomfort
  - Behaviours
  - Cognitive status
  - Respirations
  - Skin integrity
  - Bowels and bladder
  - Eyes, ears, nose, and mouth
  - Appetite
  - Activities of daily living (ADLs)
  - Mobility
R - Respond:
- Responding to situations and safety hazards that may impact the HCA and/or the client.
- Recognizing the priority of the situation.
- Acting by performing the required skills.
- Reporting changes in the client to the appropriate regulated health care team member in a timely manner.
- Recording actions taken by the HCA in a timely manner.
- Reflecting to improve on future responses if needed.
E - Enhance Quality of Life:
- Comfort: Ensuring the client's feeling of contentment.
- Independence: Promoting the client's ability to guide and participate in their own care to the greatest degree possible.
- Support: Providing support with appropriate communication, implementing the care plan, activities of daily living (ADLs), family support, social support, collaborative care, and housekeeping duties.
- Safety: Maintaining safety by preventing harm to the client, the HCA, and the collaborative care team.

Role of the Support Worker

To assist clients by providing care and assistance to accomplish the tasks of everyday living.
The level of assistance required will vary greatly from client to client.
This role includes providing personal care and support services.

Settings for Support Work

Support workers operate in a variety of agency-based and community-based settings.
In all settings, a primary responsibility is ensuring the safety of clients, including those with cognitive or mental health challenges.
They may also assist clients with social support or social reintegration.
Support workers provide comfort and end-of-life care to dying clients.

Support Worker Responsibilities

Personal Care: Assisting with Activities of Daily Living (ADLs).
Instrumental Activities of Daily Living (IADLs): Assisting with these in community settings.
Observation and Reporting: Support workers are not responsible for deciding what should or should not be done but must observe and report changes in a client’s behaviour or condition.

ADLs vs. IADLs

Activities of Daily Living (ADLs):
- Eating
- Bathing
- Grooming
- Dressing
- Toileting
- Mobility
Instrumental Activities of Daily Living (IADLs):
- Assisting with finances
- Assisting with medications
- Arranging transportation
- Shopping for food
- Meal preparation
- Assisting with using communication devices
- Housework or basic home maintenance

Support Worker Responsibilities (Cont.)

Assisting nurses and other health care providers by strictly following the established care plan for each client.
Consulting with other health care providers to ensure coordinated care.
Providing family support.
Offering social support.
Performing housekeeping or home management duties.

People You Support

Patient: A person receiving care in a hospital setting.
Resident: A person living in a residential facility.
Client: A general term for a person receiving care or support services in the community, or for all people receiving health care or support services.
Important: Every person is unique and should be treated as such.

Caring for Individuals

Support workers provide care to a diverse range of individuals, including:

Older adults
People with disabilities
People with medical issues
People recovering from surgery
People with mental health problems
People needing rehabilitation
Children
Mothers and newborns
People requiring special care

Home Care

Establishment Rationale: Developed partly to reduce hospital costs and partly due to technological advances enabling earlier patient discharge.
Definition: Health care and support services provided to people in their own places of residence.
Commonality: These are among the most common community-based services.

Community- and Facility-Based Settings

Each setting has distinct goals and offers different services.
Support workers provide vital services that enable clients to be as safe, comfortable, dignified, and independent as possible.
The current trend in the Canadian health care system is to decrease hospital costs by increasing resources in community-based services.
Regardless of the setting, support workers must be familiar with their specific scope of practice.

Types of Settings

Acute care
Subacute care
Long-term care
Respite care
Rehabilitation and restorative services
Palliative care
Hospice
Mental health care services

Policy & Procedure

Policy: A formal statement outlining how things should be done; it guides a support worker in performing their job.
Procedure: A set of detailed, step-by-step instructions designed to ensure that the goal of the policy is effectively reached.

Job Description Components

Key elements typically found in a job description include:

The title of the position.
The department in which the position is located.
To whom the position reports.
The overall responsibilities of the role.
Specific key responsibilities.

Being a Professional

Demonstrate respect for others, commitment, competence, and appropriate behaviour, including a professional appearance.
Maintain a cheerful and friendly demeanor, work when scheduled, perform tasks competently, and assist colleagues.
Exhibit enthusiasm, consideration, and honesty.

Professional Behaviours

A positive attitude
A strong sense of responsibility
A professional appearance
Discretion regarding client information
Commitment to lifelong learning
Advocating for the client
Discretion about personal matters (support worker's own)
Using acceptable speech and language

DIPPS (Principles of Person-Centred Care)

Dignity: The state of feeling worthy or valued, which involves respecting the client as an individual.
Independence: Allowing clients to do as much as they want or are able to do for themselves.
Preferences: Allowing clients to make choices about their care and daily life.
Privacy: Ensuring clients' bodies and personal affairs are secure from viewing or interference by others.
Safety: Ensuring clients are free from hazards and feel secure about the care provided.

Self-Confidence & Self-Awareness

These are crucial attributes for effective and professional support work.

Lifelong Learning

Continuous learning and professional development are essential for support workers.

Health Data & Electronic Health Records

The use and management of health data, often through electronic health records, are integral to modern health care.

Minimum Data Sets (MDS)

Key data points collected in MDS often include:

Mobility
Diet and nutrition
Socialization
Support systems for finances
Pain assessment
Medications
Elimination patterns and problems

Audits and Incident Reports

Audits: Systematic reviews of records to ensure compliance and quality.
Incident Reports: Documentation of unexpected events or occurrences, vital for safety and quality improvement.

Your Relationship with the Client

Relationship Definition: The connection between two or more people, shaped by their roles, feelings, and interactions.
Personal Relationships: Characterized by mutual intimacy and shared personal life.
Professional Relationships: Defined by specific roles, boundaries, and a focus on the client's needs.
Ethical Consideration: It is considered unethical and unprofessional to mix a professional relationship with a personal one.

Professional Boundaries

These are limitations on behaviour designed to protect vulnerable clients from caregivers who have access to private knowledge about them.
Power Imbalance: When one person is dependent on another, the balance of power may not be equal.
Awareness: Being aware of and making allowances for potential imbalances of power is crucial for maintaining professional boundaries.

Independence, Dependence, Interdependence

These are fundamental concepts in the professional helping relationship.
Client Goal: An important goal for most clients is to achieve or maintain as much independence as possible.
Respecting Choices: As a support worker, you must respect your client’s choices.
Non-Judgmental Approach: Clients should never feel that you are judging their decisions.

Independence and Balance of Power

When one person is dependent on another, a power imbalance exists.
Awareness of Power: Be aware of your "power" within the professional relationship.
Risk of Abuse: In some situations, this power dynamic can lead to the stronger person abusing the dependent person.
Client Involvement: If possible, involve the client in problem-solving and decision-making to promote their autonomy and mitigate power imbalances.

The Client’s Family

Support workers may assist the family in various ways.
Families can take many different forms (e.g., traditional, blended, chosen families).
The client determines who they regard as family members.
Definition: A family is a biological, legal, or social network of people who provide support for one another.

Families in Conflict

Stress of Illness/Disability: When illness or disability occurs, the stress on all family members can be significant, leading to conflict.
Forms of Conflict: Conflicts may manifest as expressions of irritation, anger, bickering, and arguments.
Hidden Conflicts: Sometimes, conflicts may be suppressed or hidden.
Team Intervention: Members of the health care team can sometimes assist families in resolving difficulties by encouraging open communication or defusing tense situations.
HCA Role: Support workers must observe and report on family interactions and be alert for any signs of abuse.

Culture and Diversity

Diversity: The state of different individuals and cultures coexisting within a society.
Ethnicity: Refers to groups of people who share a common history, language, geography, national origin, religion, or identity.
Culture: Refers to the shared characteristics of a group of people, including their language, values, beliefs, habits, ways of life, implied rules for behaviour, music, and traditions. Everyone possesses a culture.

Prejudice

Prejudice: An attitude or opinion about a person formed solely based on that person’s membership in a group, rather than on individual merit.
Bias: Occurs when a person is unable to impartially judge issues due to a preformed point of view.
Stereotyping: An overly simplistic and generalized view of a group of people (e.g., racism, sexism, ageism).
Discrimination: Includes prejudice against the LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning) community, such as homophobia and transphobia.

Cultural Conflict

Occurs when one person attempts to dictate another person's culture or cultural practices.
An individual living within different cultures simultaneously can also experience feelings of internal cultural conflict.

Cultural Competence

The ability to interact effectively with people from diverse cultures or socioeconomic backgrounds.
In Health Care: Includes the ability to deliver care that is respectful and responsive to the health beliefs, practices, and linguistic needs of clients.
Key Understanding: It is crucial to understand that not everyone from a particular culture will demonstrate identical health beliefs or practices.

Ethics

Ethics: Refers to principles or values that guide decisions on what is morally right or wrong, and what is considered good or bad.
Morals: The fundamental principles of behaviour that each person believes to be inherently right or wrong for themselves.
Values: Qualities or principles that an individual considers worthwhile or important in a person or situation.
Belief: A conviction that something is true or exists.

Code of Ethics

Health care teams establish professional helping relationships with clients and have developed ethical standards to guide their interactions.
Regulated Professions: Have formal codes of ethics provided by their governing bodies.
Support Workers: While support workers typically do not have a formal code of ethics, many employers implement informal codes of ethics or codes of conduct for their staff.

Principles of Health Care Ethics

Health Care Ethics: The philosophical study of what is morally right and wrong when providing health care services.
Ethical Dilemma: A situation that often involves an apparent conflict between opposing moral choices, making a clear-cut decision difficult.
Four Basic Principles: The foundational principles of health care ethics are:
- Autonomy
- Justice
- Beneficence
- Nonmaleficence

Autonomy

Also known as self-determination or having free choice regarding decisions that affect one's life.
Complexity: Becomes complicated when a client’s decision could lead to risks or even death.
Respect: Respecting clients’ autonomy means refraining from judging their choices or lifestyle.

Justice

The principle that all people should be treated in a fair and equal manner.
Challenges: It can be challenging when some clients are easier to work with than others, making one potentially want to spend less time with demanding clients or those whose lifestyles are disapproved of.
Upholding Justice: Support workers uphold this principle by showing concern for all clients, regardless of their conditions or temperaments.

Beneficence

The principle of doing or promoting good.
Client Needs First: A client’s needs must take precedence over those of their family.
Supervisor Contact: If a family member’s request conflicts with the client’s best interests, the supervisor must be contacted.
Related Concepts: Beneficence and professionalism are closely related.

Nonmaleficence

The principle of seeking to do no harm.
Scope of Practice: Family and clients may innocently ask support workers to perform tasks outside their scope of practice, which could cause harm if the worker is not trained.
Confidentiality: Support workers must never discuss confidential information such as diagnoses or medical, surgical, or treatment plans with the client or family; instead, they must refer them to their supervisor.

Ethical Dilemmas

A code of ethics provides guidelines for ethical behaviour but does not offer direct answers or rigid rules for every situation.
Steps to Address: When faced with an ethical dilemma:
- Carefully consider the four principles of health care ethics (autonomy, justice, beneficence, nonmaleficence).
- Collect as much relevant information about the situation as possible.
- Consider all possible options for resolving the dilemma.

Questions to Ask Yourself When Dealing with Ethical Dilemmas

Does the option respect the client’s wishes and preferences?
Does the option treat the client justly and fairly?
Does the option provide the client with a short-term benefit or a long-term benefit?
Could the option cause harm or increase the client’s risk for harm?
What are all of the possible consequences to the client, family, or others involved with this option?

Maslow's Hierarchy of Needs

Physiological Needs: Basic necessities for survival (e.g., food, water, shelter).
Safety Needs: Security and protection from harm.
Love/Belonging Needs: Social connection, affection, and belonging.
Esteem Needs: Self-worth, achievement, and recognition.
Self-actualization Needs: Reaching one's full potential and personal growth.

Promoting Comfort

An overarching goal in health care, ensuring clients feel at ease physically, emotionally, and psychologically.