ALL NOTES COMBINED

WEEK 1- Approaches to Health & Health Promotion

Class Objectives

• Describe course expectations and evaluative measures.
• Understand various definitions of health.
• Explain characteristics of different health approaches.
• Identify health determinants and their interrelationships.
• Distinguish health promotion from disease prevention.
• Analyze how nursing practice is influenced by health concepts and determinants.

Course Design Considerations

• Adheres to CNO competencies and CNA ethical code.
• Relevant to nursing practice and inclusive educational environment.
• Focus on pedagogical innovations emphasizing critical application and collaborative learning.

Course Content Highlights

• Approaches and Social Determinants of Health (SDOH)
• Health care systems, health of marginalized populations, ethics, leadership, and advocacy.

Evaluative Measures

• Storywork Assignment: Group work with individual reflection (20%)
• Contemporary Issues of Older Adults Presentation: (20%)
• Mid-term Exam: (25%)
• Final Exam: (35%)

Conceptualizations of Health

• Health Definitions:
  • Ability to realize aspirations, satisfy needs, cope with environment.
  • A resource for daily living, stability, potential actualization.
• WHO Definition (1984): "A state of complete physical, mental and social well-being."
• Health Status Continuum:
  • Ranges from illness to wellness; subjective experiences impact perceptions.

Historical Approaches to Health

1. Medical Approach:
   • Focus on physiological risk factors and medical interventions.
   • Emphasizes treatment over prevention.
2. Behavioral Approach (Lalonde Report, 1974):
   • Shift from medical to individual lifestyle focus.
   • Health behaviors recognized; determinants include lifestyle and environment.
   • Criticized for overlooking social determinants and promoting individual responsibility.
3. Socioenvironmental Approach:
   • Health linked to social structures.
   • Emphasizes upstream thinking; promotes policies benefiting entire populations.

Key Health Challenges and Frameworks

• Ottawa Charter: Focus on social determinants of health, social justice, empowerment.
• Epp Report: Identified health inequities, prevention strategies.
• Jakarta Declaration and Bangkok Charter: Emphasized health as a human right, socio-economic factors influencing health.

Determinants of Health

• Key Factors include:
  • Income and distribution
  • Education, employment, social exclusion
  • Gender, race, disability
  • Structural vulnerabilities impacting health care access.

Population Health Promotion Model

• Integration of health promotion and population health to improve health outcomes:
  • ACTION QUESTIONS: What can we take action on? How? With whom? Why?
  • Collaboration among stakeholders is vital to addressing health determinants.

Health Promotion & Disease Prevention Levels

1. Primary Prevention:
   • Immunization and risk reduction.
2. Secondary Prevention:
   • Early detection through screenings.
3. Tertiary Prevention:
   • Rehabilitation programs to prevent illness progression.

Principles of Health Promotion

• Contextual approach considering social, economic, and political influences.
• Long-term perspective emphasizing community empowerment and participation.

WEEK 2- Indigenous Health and Cultural Competence

Discussion Points

• Considerations for the role of nurses in promoting health equity vs. equality.
• Understanding complexities surrounding health disparities and need for systemic change.

Indigenous Health and Historical Context

• Education and Colonial Mindset:
  • Quotes from Egerton Ryerson and Sir John A. MacDonald reflect historical views on Indigenous education and assimilation.
• Indian Residential Schools Settlement:
  • Over 6 years of testimony from 6,500 witnesses documented the impact of residential schools on Indigenous communities.

Truth and Reconciliation Commission (TRC)

• Call to Action #18:
  • Recognizes the negative impact of past policies on Indigenous health.
• Call to Action #24:
  • Mandates medical and nursing schools to include Indigenous health issues, history, and cultural practices in curricula.

Social Determinants of Health

• Complex Factors:
  • Indigenous health influenced by education, employment, housing, income, and social support networks.
  • Colonialism and racism create unique challenges: self-determination, cultural continuity, environmental stewardship.

Determinants

• Proximal Determinants (Crown):
  • Early childhood development, income, social status, education, working conditions.
• Distal Determinants (Roots):
  • Historical, political, and social foundations.
• Intermediate Determinants (Trunk):
  • Health promotion, healthcare access, education, and social supports.

Traumas Impacting Indigenous Health

• Residential School System:
  • Enforced assimilation damaging cultural identity and family structure.
• Sixties Scoop:
  • Thousands of Indigenous children placed in non-Indigenous homes.
• Missing and Murdered Indigenous Women:
  • Ongoing crisis affecting communities.

Indigenous Health Outcomes

• Health Disparities:
  • Lower life expectancy, higher chronic disease rates.
  • Community resiliency derived from cultural practices important for health outcomes.
• Inclusive Perspectives on Health:
  • Medicine Wheel emphasizes holistic understanding integrating emotional, physical, spiritual, mental well-being.

Community Well-Being

• Indicators:
  • CWB scores significantly lower for First Nations compared to non-Indigenous populations.

Health Issues and Diseases

• Common Health Challenges:
  • Higher rates of diabetes, communicable diseases, mental health issues, substance abuse.
  • Notable higher cancer rates among First Nations.

Traditional Healing Practices

• Cultural Connection:
  • Emphasizes community, land, spirituality in healing processes.
  • Includes sweat lodges, medicine bundles, and traditional medicines.

Seven Grandfathers - Principles of Health and Wellness

• Core Values:
  • Truth, humility, respect, love, courage, honesty, wisdom.

Cultural Competence in Healthcare

• Reflection and Trust Building:
  • Healthcare professionals must reflect on biases to improve patient trust.
• Communication Skills:
  • Effective communication includes empathetic listening.
• Action Against Racism:
  • Staff training to recognize and address discriminatory behavior.

Case Studies and Real-Life Implications

• Joyce Echaquan’s Story:
  • Highlights systemic racism in healthcare.
• Brian Sinclair’s Story:
  • Example of medical neglect due to stereotypes.

Conclusion and Group Reflection

• Visualizing Health through Stories:
  • Engaging with Indigenous narratives informs care.
• Reflective Questions:
  • Guardianship of cultural practices, individual healthcare experiences, addressing power imbalances through education.
• Reconciliation Process:
  • Emphasizes community connection and collective memory.

WEEK 3- Canadian Health Care Delivery System and Community Health Nursing

Class Objectives

• Identify and define the principles of the Canada Health Act.
• Explain factors influencing ongoing healthcare reform.
• Discuss issues related to Indigenous health.
• Identify challenges and initiatives enhancing quality of the healthcare delivery system.
• Describe the five levels of healthcare and respective services.

Evolution of the Canadian Health Care System

• Historical Context:
  • The Great Depression impacted funding.
  • The Hospital Insurance and Diagnostic Services Act (HIDSA) established coverage for inpatient care.
• Social Safety Net:
  • A network protecting the vulnerable. Medicare: Funded by taxation, debated for sustainability.

Lalonde Report & Canada Health Act

• Lalonde Report: Upstream wellness approach introduced.
• The Canada Health Act combined HIDSA and the Medical Care Act, banning extra billing and user fees.
• Five Principles of the Canada Health Act (1984):
  • Public Administration, Comprehensiveness, Universality, Portability, Accessibility.

Organization and Governance of Health Care

• Federal Government's Role:
  • Sets/administers national principles; finances healthcare services.
• Provincial/Territorial Governments:
  • Develop/administer insurance plans. Manage service delivery.
• Professional Jurisdiction:
  • Most health professions self-regulated, various regulations exist.

Trends and Reforms in Canada’s Health Care System

• Influential Reports:
  • Kirby and Romanow Reports focused on regionalization.
• 10-Year Plan:
  • Focus on person-centered, accountable, efficient healthcare.

Role of Nurses in Health Care Policy

• Involvement in policy advocacy, development, implementation.
• Renewed calls for a Chief Nursing Officer post-pandemic.

Primary Health Care (PHC)

• Definition: First point of contact with non-urgent healthcare.
• Principles of PHC:
  • Accessibility, public participation, health promotion, appropriate technology, intersectoral cooperation.
• Services Provided: Health education, nutrition, immunizations, maternal health.

Barriers to Primary Health Care

• Key Barriers:
  • Utilization, access issues, provider shortages, cultural safety concerns.

Levels of Health Care

1. Health Promotion: Involves wellness services and advocacy.
2. Disease and Injury Prevention: Focus on reducing risk factors.
3. Diagnosis and Treatment: Address existing health issues.
4. Rehabilitation: Services improving quality post-illness.
5. Supportive Care: For chronic, progressive conditions, including palliative care.

Community Health Nursing

• Focus Areas: Health promotion, protection, disease prevention, support for recovery.
• Community Health Status: Dependent on individual/community conditions, engagement in health-promoting environments.

Community Components & Assessment

• Essential Components: Include locale, social systems, individuals.
• Use community assessments to identify resources and health needs.

Strategies for Public Health Nursing

• Promote self-care, provide direct care, influence environmental factors.
• Build community partnerships to mobilize health action.

WEEK 4- Development & Theoretical Foundations Notes

Focus

• Focus on marginalized populations with specific risks and barriers.
• Approaches: Culturally competent care, trauma-informed practices, harm reduction.

Conclusion

• Nurses must foster strong relationships with clients, understanding unique circumstances.
• Continuous engagement and assessment enable tailored community health nursing practices.

Questions for Reflection

• In what ways can nursing shape current and emerging healthcare systems?

Class Objectives

• Understand nursing history, education, practice changes.
• Discuss nursing theories, challenges in theorizing, and conceptual frameworks.

Importance of Nursing History

• Provides a framework for understanding nursing meanings, links practices to historical foundations.

Indigenous Caregivers and Indian Hospitals

• Established health care practices pre-Nightingale.
• Indian Hospitals: Overcrowded, underfunded, separated care.

Nightingale’s Influence

• Founder of modern nursing; reformed hospital care.
• Advocated for rigorous training and created first nursing school.

Historical Context of Nursing Education in Canada

• Nightingale Model influenced Canadian nursing education; emphasis on respect.

Racism in Nursing Education and Practice

• Key figures challenged discriminatory practices.
• Barriers included biases based on race, marital status, and age.

The Canadian Nurses Association (CNA)

• Established scope, practice guidelines, and ethical code.

Weir Report on Health Care and Educational Reform

• Addressed exploitation of nursing students; recommended better educational quality.

Current Nursing Education Framework

• Continual development of national nursing curricula; emphasis on high standards across provinces.

WEEK 5- Nursing Ethics & Scope of Practice

Theoretical Foundations of Nursing Practice

• Definition: Theory serves as a set of assumptions linking concepts.
• Organized nursing theories foster accountability and improve practice.

Major Theoretical Models

• Practice-based Theories: evolved from practical settings.
• Needs Theories: Focus on human drives and competencies.
• Interactionist Theories: Focus on nurse-patient relationships.
• Systems Theories: Comprehensive view of entities' interactions.

Paradigm Debates in Nursing

• Conflict over defining nursing as an art vs. science; oscillation between traditional and modern frameworks.

Future of Theorizing in Nursing

• Encourage critical thinking and integration of new knowledge.

Understanding Values

• Definition of Values: Strong beliefs that influence behavior.

Value Formation & Clarification

• Formed through experiences, reflection, and communication.

What is Ethics?

• Study of good conduct, character, motives; involves philosophical ideals of right and wrong.

Nursing Ethics

• Code of Ethics: Guides nurses’ commitment to patient care, directs ethical challenges.

Values in Nursing Ethics

• Core Values: Safe, competent, ethical care; promoting health; respecting autonomy.

Key Responsibilities in Nursing

• Responsibility: Recognizing right vs. wrong, providing care.
• Accountability: Loyalty, promise-keeping, truth-telling.
• Advocacy: Acting for those who cannot speak for themselves.

Ethical Theory Branches

• Descriptive Moral Theory: Describes what people think and do regarding moral issues.
• Metaethics: Analyzes meanings of moral terminology.
• Normative Ethics: Establishes moral principles for evaluating actions.
• Applied Ethics: Addresses practical moral questions.

Ethical Theories & Bioethics Principles

• Deontology: Actions defined as right/wrong based on rules.
• Utilitarianism: Value derived from usefulness.
• Feminist Relational Autonomy: Emphasizes informed choices.
• Beneficence & Nonmaleficence: Acting for the good of others, avoiding harm.
• Justice: Fairness in resource allocation.

Ethical Dilemmas in Nursing

• Common dilemmas include quality of life concerns, allocation of scarce resources.

Ethical Analysis Processes

• Analyze ethically by acquiring knowledge, clarifying values.

Confidentiality Case Scenario

• Balancing confidentiality and public safety regarding contagious diseases.

Legal Framework in Nursing

• Nurses operate under laws including constitutional and provincial statutes.

Professional Regulation in Nursing

• Regulatory bodies ensure safe, ethical nursing practices.

Scope of Nursing Practice

• Defined within the Nursing Act (1991): Promotion, assessment, care provision, treatment of health conditions.

Controlled Acts for Nursing

• Specific controlled acts permitted for RNs and RPNs.

WEEK 6- Informatics and Digital Health

Professional Competence

• Nurses recognize competencies and function within capabilities.

Delegation and Orders in Nursing

• Direct orders: Specific client-centered activities.
• Delegation: Authority temporarily granted.

Acts of Professional Misconduct

• Include inadequate documentation, failing to maintain standards.

Reflective Practice

• Critically evaluate practice to identify strengths and areas for improvement.

Goal Setting in Nursing Practice

• Use SMART criteria for effective goal setting.

CNO Practice Standards & Guidelines

• Resources for ethical and legal practices in nursing.

Nursing Informatics Overview

• Nursing Informatics (NI): Focused use of ICT to enhance practice and improve outcomes.
• Digital Health (DH): Development/use of digital technologies in healthcare.

Class Objectives

• Understand nursing informatics vs. routine technology.
• Identify Canadian issues related to nursing data management.

Applications of ICT in Nursing

• Patient scheduling, billing, diagnostic imaging, remote consultation.

Electronic Health Records (EHR)

• Definition: longitudinal health record including health status, treatments.

Nursing Data Standards and Interoperability

• Standards: Protocols for representing health information.
• Interoperability: Essential for communication across systems.

Canadian Privacy Legislation

• Privacy Act (1985): Governs personal information control.
• PIPEDA: Addresses electronic data handling risks.

Informatics Competencies for Nurses

• Address utilization of relevant information for evidence-informed care.

Social Media in Nursing

• Definition: Online tools for sharing information.
• Expectations for nurses: Maintain professionalism, manage confidentiality.

Six Ps of Social Media Use

1. Professional: Always act professionally.
2. Positive: Keep posts positive.
3. Patient Person-free: Avoid identifiable patient information.
4. Protect Yourself: Safeguard professionalism.
5. Privacy: Maintain boundaries.
6. Pause Before You Post: Reflect on online actions.

Helpful Resources

• RNAO: Social Media Guidelines, Canadian Nurses Protective Society.

Nursing Fundamentals II - Marginalized Populations, Mental Health & Well-Being

Land Acknowledgement

• Acknowledge traditional territory of the Haudenosaunee and Anishinaabe peoples.

Marginalized Populations

• Definitions of marginalization: Exclusion from social life, economic systems, cultural expression.

Diversity and Comfort

• Value in diversity for well-being. Nurses must be sensitive to cultural beliefs and engagement.

Trauma-Informed Care

• Recognizing past traumas; core elements include empowerment, safety, trustworthiness, collaboration.

Intersectionality

• Definition: Analyzes how social identities intersect affecting experiences.

Types of Intersectionality

1. Structural Intersectionality
2. Political Intersectionality
3. Representational Intersectionality

Importance of Understanding Intersectionality

• Enhances knowledge of determinants affecting health inequities.

Stereotypes of Older Persons

• Ageism: Negative attitudes towards older adults in healthcare.

Geriatric Syndromes

• Definition: Clinical conditions in older adults resulting from multiple system impairments.

Risk Factors for Geriatric Syndromes

• Older age, cognitive impairment, physical function, gender differences.

Developmental Tasks for Older Adults

• Challenges include health declines, retirement adjustment, coping with grief.

Aging Well and Quality of Life

• Nursing collaboration with older adults to improve life quality.

Community-Based and Institutional Care

• Healthcare settings vary; respect individual decisions on service types.

Nursing Assessments for Older Adults

• Assess interplay between physical, psychosocial aging aspects.

General Survey in Older Persons

• Initial assessments reveal non-verbal cues and age-related changes.

Restorative and Palliative Care

• Restorative aids recovery; palliative emphasizes quality of life.

Vulnerability & Stigma Associated with Mental Illness

Overview of Mental Health: Key Concepts

• Professor Lynn McCleary's background; emphasizes importance of knowledge in accessing care.

Facts about Mental Illness and Stigma

• Stigma blocks access, and diagnostic overshadowing affects care quality.

Perceptions of Mental Illness

• Terms invoke varied feelings; public misconceptions contribute to stigma and discrimination.

Mental Health Definitions

• Mental Illness: Significant distress and impaired functioning.
• Mental Health: A state of well-being to cope with life stresses.

Barriers to Mental Health Care

• Unmet mental health needs, funding disparities, lengthy wait times for services.

Attitudes Within Healthcare Professions

• Evidence of negative attitudes among nursing professionals impacting care.

Final Thoughts on Stigma and Mental Illness

• Access is compromised by stigma; nurses' role in continuous education is essential.

WEEK 10 - Black Health/ Racism

Black Populations (BP) in Canada

• Approximately 1.5 million people; historic communities linked to contemporary immigrants.

Determinants of Health in BP

• Proximal & Structural Determinants impact health outcomes; health inequality definitions.

Defining Race & Racism

• Race is a social construct; racism leads to privilege disparity and health inequities.

Historical Context of Racism

• Colonization and slavery reinforce generational trauma and systemic issues.

Confronting Racism in Healthcare

• Racism manifests as systemic issues impacting quality and access to care.

Intersections in Healthcare

• Understanding multiple discrimination forms faced by clients is essential.

Anti-Black Racism

• Definition and focus on challenging systemic racism and promoting equity.

WEEK 11- Global & Planetary Health

Global Health Governance & Institutions

• Governance defined; global health shows unequal power distribution favoring high-income countries.

Transition from MDGs to SDGs

• Overview of transition targeting broader issues including economic growth and inequities.

Theoretical Perspectives of Global Health

• Focus on health equity, intersectionality, political economy impacts on health resource distribution.

WEEK 12- The Experience of Loss, Death, and Grief

Types of Loss

• Necessary, actual, perceived, maturational, situational losses defined.

Responses to Loss

• Emotional responses vary; factors influencing responses include type and perception of loss.

The Nurse's Role in Grief and Loss

• Support patients during end-of-life scenarios; facilitate discussions about death.

Medical Assistance in Dying (MAID)

• Criteria for MAID, informed consent process, legal status.

Understanding Grief

• Emotional response to loss; symptoms include sadness, confusion, withdrawal.

Theories of Grief

• Kübler-Ross’s and Bowlby’s stages described.

Nurses' Experience of Grief

• Nurses also experience grief; require support and coping strategies.

Spirituality in Health Care

• Connection between spirituality and health; importance of understanding spiritual dimensions.

Assessing Spirituality in Patients

• Use FICA Spiritual History Tool to assess spiritual needs.

Integrative Health Approaches

• Holistic nursing integrates conventional and complementary approaches for health well-being.

WEEK 13- Self Care & Resilience

Self-Care and Resilience in Nursing

• Definitions, importance, and historical context of self-care in nursing.

State of Nursing Workforce

• Global nursing shortage, burnout, significant nursing vacancies.

Building Resilience in Nursing

• Resilience as adaptation; key factors for resilience identified.

Strategies to Promote Self-Care

• Supportive work environments and professional development crucial for well-being.

Nursing Self-Care Activities

• Physical, emotional, mental self-care strategies discussed.

Personal Care Plan and Commitment

• Creating a personal care plan and developing SMART goals for self-care.