KTI week 2 notes

Focus: Intersectionality
Social Determinants of Health (SDOH)
The impact of global health issues on Canadian nursing practice
Influence of neoliberalism on the health care system
Understanding and application of Story Theory by Liehr & Smith in nursing practice

Social Determinants of Health: Conditions in which people are born, grow, live, work, and age, impacting health outcomes.
Includes networks and conditions in:
- Socio-economic
- Cultural
- Environmental
- Health systems
Key behavioral factors: smoking, physical activity, alcohol consumption, dietary habits
Important resources: money, power, and material resources
Health inequities: Disparities in health outcomes influenced by social determinants.

Socioeconomic and Political Context
- Governance: policies affecting health.
- Macroeconomic Policies: broader economic factors influencing health.
- Social Policies: Initiatives targeting health accessibility and quality.
- Labour Market Issues: Employment conditions influencing health.
- Public Policies: Education, health care, and social protection.
Personal Socioeconomic Position
- Social Class: Stratification affecting access to resources.
- Gender and Ethnicity: Influences of gender and racism on health equity.
- Education: A significant determinant of health literacy.
Social Cohesion & Capital
- Includes cultural values and societal norms impacting health behaviors.
Physical and Biological Factors
- Biological and psychosocial factors influencing individual health outcomes.

Income and Social Status: Fundamental determinant influencing access to health resources.
Employment and Working Conditions: Quality of jobs can significantly impact health.
Education and Literacy: IQ impacts health literacy and understanding of health behaviors.
Childhood Experiences: Influence long-term health outcomes.
Physical Environment: Conditions where individuals live and operate.
Social Supports and Coping Skills: Community and family support systems.
Healthy Behaviors: Lifestyle choices affecting health.
Access to Health Services: Availability and affordability of health care.
Biology and Genetic Endowment: Innate biological factors affecting health.
Gender, Culture, Race/Racism: Additional dimensions affecting health inequity.

Low Socioeconomic Status: Major risk factor for poor health outcomes.
- 19% of Canadian children live in poverty—the highest rate in the developed world.
- Leads to increased risk of adverse health outcomes, lower educational attainment, and higher rates of poverty in adulthood.
Food Insecurity: Affects 12.7% of Canadian households in varying degrees (marginal, moderate, severe).
- Gender differences: Women face greater challenges related to SDOH compared to men.
Geographical Factors: Influence health including the impact of globalization and neoliberalism.
Disability: Discussed in both medical and societal terms affecting employment opportunities and earnings potential.
Education: Serves as a crucial factor related to other SDOH. Lack of education itself is not the direct cause of poor health.
Early Childhood Development: Discusses latency effects, pathway effects, and cumulative effects on health.
Employment Conditions: Employment security, physical work conditions, work pace, stress, and development opportunities as determinants of health outcomes.

Housing: Accessibility and affordability are crucial components of health.
Immigration: Impact of economic growth and sociocultural diversity on health outcomes.
- Observed ‘health immigrant effect.’
Income Distribution: Determines quality of other social determinants of health, specifically income impacts on health alone and distributions.

Colonization: Health outcomes related to the historical context of colonization affecting indigenous populations.
Race and Racism: Incorporating factors like institutional racism, personally-mediated racism, and internalized racism.
Social Exclusion: Marginalization within societal structures leading to poor health outcomes across social, cultural, and economic dimensions.
Social Safety Net: Risk factors for poverty and the impact of unemployment and job insecurity on health.

Correlation between income and health: lower income leads to material and social deprivation.
Social exclusion linked to poorer health outcomes, contrasted with higher income leading to longer and healthier lives.

Critical evaluation of whether the right questions are being asked in health research.
Importance of mobilizing research evidence to inform practice.

Multidisciplinary Team Collaboration: Nurses should engage with dietitians, social workers, and community partners.
Client Education: Nurses must understand community needs and the services available.
Implementing Strategies: Frameworks addressing both individual and community health issues.

Understanding Systems: Identify and understand health systems to deliver effective care.
Promoting Health: Encourage improved economic and social resources for communities.
Increasing Community Capacity: Build on existing resources to enhance care delivery.

Developed by Liehr and Smith, professors with extensive experience in nursing education and research.
Story Theory was established to connect nursing practice with research through the power of storytelling.

Core Concept: Stories are fundamental to human experiences and express personal identities across time.
Story Theory: Serves as a framework for the nurse-patient relationship, guiding health promotion.
Qualitative research is becoming increasingly important within this context.

Historical significance of patient storytelling emphasized in grand nursing theories. Example: Florence Nightingale’s emphasis on listening.

Individuals change through interactions with their environment in a continuous flow.
Present moments incorporate past and future experiences, impacting current health perceptions.
Meaning is derived through awareness and realization during patient narratives.

Process Overview:
1. Focus on present health challenges.
2. Reflect on past experiences to connect with present challenges.
3. Discuss hopes and dreams associated with current health issues.

Identifying high points and low points in a narrative.
Recognizing turning points that shift the current storyline or health perspective.

Gathering stories about challenging health experiences.
Reconstructing narratives for clarity and understanding.
Connecting existing literature with narrative-driven health challenges.
Naming specific health challenges based on stories told.
Identifying the narrative’s development, including pivotal moments affecting the outcome.
Highlighting efforts toward resolution and improvement.
Collecting further stories to fortify understanding and context.