Community Health Nursing in Canada - 5th Edition

Chapter 1: The History of Community Health Nursing in Canada

  • Early 1900s: Visiting nurses primarily worked with poor and destitute families.
  • Early 20th century: Public health nursing emerged to combat communicable diseases, infant mortality, and childhood morbidity.
  • Early 20th century social attitude: The state was not responsible for healthcare.
  • Primary reason for establishing school health programs: to promote the health of all children.
  • Earliest forms of healthcare in Canada: the practices of Aboriginal people.
  • The Grey Nuns: Canada's first community nursing order, providing health services, food, shelter, and education to the vulnerable.
  • The Victorian Order of Nurses: held the dual mandate of doing charitable work and providing affordable nursing care; Lady Aberdeen led the development
  • Public health nurses and home visiting nurses: Required post-diploma training at a university, unlike nurses in other sectors.
  • First two public health nursing specialties: TB nursing and school nursing.
  • Role of the first public health nurses in Canada: To promote the health of school children.
  • The Red Cross: Credited for establishing well-baby clinics.
  • Public health programs in rural, isolated areas: Limited success due to a greater need for home care and midwifery.
  • District and visiting nurses: Provided bed-side nursing and health education.
  • Publicly funded healthcare programs: Led to hospital admission becoming the norm for those requiring obstetrical care.
  • Military nursing: Requires the nurse to adapt practice in diverse settings.
  • Outpost nursing: Refers to nurses providing services in the most remote geographic locations.
  • Women volunteers: Played an important role in developing social and healthcare services in smaller communities.
  • First group of public health officials in the early 20th century focused on: Infant and child welfare.
  • School health programs: Taken over by the health department as part of the process of consolidating all public health programs.
  • The Victorian Order of Nurses: Viewed as Canada's oldest and most experienced visiting nursing organization.
  • Early school-based initiatives: Involved medical inspections of children followed by home visits.
  • Reduction in government spending in the 1980s and 1990s: Resulted in reduced nursing positions for community health nurses.
  • Community Health Nurses Association of Canada: Established in 1987.
  • The Romanow Commission's report: Recognized as a visionary document with recommendations for shifting resources and policy toward primary health care, home healthcare, and health promotion, with nurses as key players.
  • General public health nursing practice: Emerged from school nursing.
  • Three sectors of nursing in Canada in the 20th century: Hospital nurses, private-duty nurses, and public health nurses (including visiting nurses), with differences in practice settings, pay, education, and clientele.
  • Women's volunteerism and leadership: Contributed to community development, prioritized healthcare services, lobbied officials, and supported CHNs.
  • Physician support of local public health programs: Sometimes lacking due to fears of competition for patients and income.
  • Increased government responsibility for healthcare: Expanded programs, shifted focus to chronic diseases and injuries, and increased demands for postpartum home visits.
  • Specialized community health nursing: Resulted from social, economic, and political forces along with expanding knowledge.

Chapter 2: Financing, Policy, and Politics of Healthcare Delivery

  • Saskatchewan in 1947: Implemented Canada's first universal health insurance program.
  • Canada Health Act (1984): Purpose was to ban extra billing and user fees.
  • Canada Health Act: Cornerstones are publicly administered, comprehensive, universal, portable, and accessible.
  • Canada Health Act (1984): Primary objective is to protect, promote, and restore the physical and mental well-being of Canadian residents.
  • Canada Health Act (1984) success: Ensures access to healthcare by establishing criteria and conditions for insured healthcare services.
  • Biomedical model: Dominated public and political thinking when the Canadian Medicare System was created in 1957.
  • The Lalonde Report: Was revolutionary and led to a reconceptualization of health promotion.
  • Ray Romanow: Stated, "The practice of healthcare has evolved. And despite efforts to keep pace, medicare has not."
  • Canada's healthcare ranking: Life expectancy at birth ranks among the highest in the world.
  • The Lalonde Report (1974): Identified four determinants of health: environment, lifestyle, human biology, and healthcare system.
  • Epp Report: Provided the basis for the Ottawa Charter.
  • Primary care focus: People accessing healthcare services at the first point of contact.
  • Ontario: Province where Family Health Teams deliver primary healthcare.
  • Provinces and municipalities: Fund public health in Canada.
  • Disparity in human resources among provinces: A challenge of public health in Canada
  • Home care: Services have been steadily growing in Canada over the past 35 years.
  • Agency contracted by the Local Health Integration Network: Delivers home care nursing and support services in Ontario.
  • Role clarity component: Sharing a common language to describe the role for community health nurses.
  • Describe their role with confidence: Would help community health nurses to be valued more by other healthcare professionals.
  • Social awareness: Identified as attributes of nurse leaders that contribute to effectiveness:
  • A work environment that has access to resources: Within a context of community health nursing practice, organizational support positively influences practice.
  • Building relationships and trust: Transformational leadership practices include:
  • Greater sense of affiliation with organizational goals: Professionals working in health service organizations with strong leadership demonstrate.
  • Leadership expertise: Personal resources are necessary for developing and sustaining leadership:
  • Promoting community health solutions across sectors: One way to strengthen collaborative leadership at the national level:
  • Primary Care: a person's first point of contact with the health care system. Primary care services are dominated by medicine and have focused mainly on acute care and treatment of disease. The largest group of primary care providers in Canada is physicians. Other primary care providers are nurse practitioners, dentists, chiropractors, pharmacists, dieticians, midwives, optometrists and to some extent PHNs. Most Canadians access primary care though a family or general practitioner who is reimbursed on a fee-for-service basis. Only a few Canadians receive primary care services through a CHC, walk-in clinics, or emergency rooms.
    • Example related to CHN practice: A family who a PHN visits in the postpartum period may also see the primary care provider, most likely a GP, around the same time, increasing the need for interprofessional communication.
  • Primary Health Care: a philosophy or approach to care that involves the principles set forth at Alma Ata in 1978: health care that is accessible, affordable, and acceptable; uses appropriate technology; promotes health; and recognizes intersectoral and interdisciplinary approaches.
    • Examples related to CHN practice: a multidisciplinary community health council with several CHNS as members collaborates with a community to develop a network of safe bike and walking trails through residential and industrial neighbourhoods (page 22).
  • Two federal initiatives in the development of health promotion:
    • Lalonde Report (1974): acknowledged the limitations of the funded medical/treatment system. Presented a vision for health promotion. Identified four determinants of health, with an emphasis on lifestyle and the environment. Led to a global reconceptualization of health promotion.
    • Epp Report (1986): expanded the definition of health promotion, incorporated some of the tenets of primary health care, and emphasized social/environmental/political dimensions of health. Formed the basis for the Ottawa Charter of Health Promotion.
    • Ottawa Charter of Health Promotion (1986): International document identifying the prerequisites for health, strategies for promoting health, and outcomes of the strategies. Acknowledges that caring for one's self and others is conducive to health. Identifies caring, holism, and ecology as essential concepts in health promotion.
    • Population Health Template and Population Health Promotion Model (2001 and 1996): resources developed to put population health and health promotion into action. Used nationally and internationally in program planning, community development, and resource allocation (page 20)
  • Historical milestones in the development of the Canadian healthcare system:
    • 1867: Constitution Act assigned responsibility for hospitals to provinces but did not explicitly assign responsibility for health policy.
    • 1919: National health insurance on the Liberal Party platform.
    • 1947: Saskatchewan gets Medicare under Tommy Douglas.
    • 1957: National Hospital Insurance and Diagnostic Services Act (HIDS) provides financial incentives to the provinces to build hospitals through 50/50 grants if provinces meet five key principles.
    • 1962: Saskatchewan gets universal, publicly funded medical insurance.
    • 1966: federal Medicare including physicians' services; if provinces meet same principles as HIDS, feds pay 50% of costs
    • 1971: all provinces participate
    • 1977: Established Programs Financing Act changes federal share of health costs to a per capita block grant
    • 1996: Canada Health and Social Transfer (CHST) payments include federal transfer payments for health, postsecondary education, and welfare (page 18-19)
  • Canadian values reflected in the current Medicare system.
    • Social justice: All members of society, including the most vulnerable, are entitled to free health care in Canada.
    • Equity: All Canadians are viewed equally and without discrimination in terms of universal health care coverage.
    • Community: All members of society contribute through taxation to provide everyone in the community with access to health care regardless of ability to pay (page 18).
  • Principles of the Canada Health Act (1984):
    • Publicly administered: Health care funds are administered by a local elected regional health authority under the direction of the provincial health department.
    • Portable: A person from Saskatchewan can receive insured health care in Ontario.
    • Accessible: Families across Alberta have access to pediatric health care in their own communities or in communities within their health region without additional user fees.
    • Universal: All residents of British Columbia are covered by B.C. health care.
    • Comprehensive: In-hospital health care, such as medically necessary surgery, is covered in the province of Newfoundland (page 18).

Chapter 3: Nursing Roles, Functions, and Practice Settings

  • Blueprint for Action for Community Health Nursing in Canada (CHNC, 2011): It is a point of reference for ongoing dialogue about community health nursing practice
  • The Blueprint for Action for Community Health Nursing in Canada: outlines six areas of action, one of them being supporting nursing leadership development
  • The Canadian Nurses Association predicts that by 2020: 60% of nurses will be working outside of the acute care setting
  • Secondary Prevention: Screening school children for vision and hearing is an example of:
  • What activity is an example of a community health nurse working at the individual level? Providing immunization in a travel clinic
  • Tertiary prevention: A community health nurse has successfully lobbied the government to invest in a rehabilitation facility for people with traumatic brain injuries. What type of health promotion strategy does this represent?
  • Social justice: Which of the following is foundational to health equity and central to community health nursing practice?
  • The mission of the Community Health Nurses of Canada (CHNC) is to: Advance practice and to improve the health of Canadians
  • Domains of practice for community health nursing: Clinical practice, research, administration, and education are known as:
  • Standards of practice for community health nursing: The purpose of ___ is to define the scope and depth of nursing practice in the community and establish expectations for acceptable, safe, and ethical nursing care:
  • Public health nursing and home health nursing: Which two types of community health nurses are the largest groups?
  • To increase the health of the public by preventing disease: What is the goal of public health nursing?
  • Home health nursing: The aim is to provide accessible, responsive, and timely care which allows people to stay in their homes with safety and dignity. This statement is representative of which type of nursing?
  • Primary health care: What type of health care is described in the statement: "healthcare that is scientifically sound, socially acceptable, universally accessible to individuals and families and at a cost that the community and country can afford"
  • Occupational health nurse: What type of community health nurse focuses on health promotion, maintenance and restoration, and injury and disease prevention in the workplace?
  • Chronic disease management nurse: The 5 A's of behavior change (assess, advise, agree, assist, and arrange) are used by which type of community health nurse?
  • They use harm reduction strategies specific to vulnerable population groups: Which of the following statements best represents the work of outreach/street nurses?
  • Works with clients who have been the victims of crimes: What is the primary focus of a forensic nurse's work?
  • Take additional nursing education with a focus on advanced clinical nursing practice: What action is required if a community health nurse wants to become a primary health care nurse practitioner (PHCNP)
  • Providing meningitis prophylaxis to high school students in an outbreak situation: What is an example of a health promotion activity that a public health nurse would provide?
  • Parish nursing integrates faith and health into nursing practice: Which of the following statements pertains to Parish Nursing?
  • At the Northwest Rebellion in 1885 with the Metis uprising against the Canadian government: The first recorded instance of military nursing in Canada was:
  • Health equity: Which term best describes the following statement: Everyone, regardless of socially determined circumstances, has an equal opportunity to attain their full health potential without being disadvantaged
  • Engaging in capacity building of communities: Which of the following is part of the standards of practice for community health nurses?
  • Rural/outpost nurse: What type of community health nurse focuses on primary care, chronic disease prevention and management, substance abuse prevention and management, personal practices and coping skills, low income supports, and access to housing?
  • Three of the practice settings of community health nurses in terms of role focus and unique characteristics of nursing practice.
    • Public Health Nurse: Role focus-mandated by legislation to promote and protect the health of populations. Focus is on health enhancement, health protection, and disease prevention. Unique characteristics-primarily works with a healthy population, minimal contact with unwell people, may have entire community as client. Work setting-public health unit
    • Home Health Nurse: Role focus-client as individual or family; provides direct clinical care and case management. Unique characteristics-works alone, practises highly autonomously and independently, adaptable to client-controlled environment. Work setting-client home or school
    • Parish Nurse: Role focus-client as individual or group; focuses on education, counseling, and referrals. Unique characteristics-integrates faith-based approach to care. U.S.-based credential available. Work setting-a United Church
    • Occupational Health Nurse: Role focus-client as individual or group; provides direct care, including primary, secondary, and tertiary preventive services. Unique characteristics-addresses health, safety, and well-being for employees. May earn specialty credential from CNA COHN(C). Work setting-a meat-packing plant (pages 43-46)
  • Two professional nursing associations as they relate to community health nurses
    • Community Health Nursing Association of Canada (CHNAC) developed the Canadian Community Health Nursing Standards of Practice (2003).
    • Canadian Nurses Association (CNA) is a national voluntary association that exists to link nurses who work in the same practice area. Will work with CHNAC to create a national certification for CHNs. All provincial associations except Quebec belong to the CNA.
    • Provincial regulatory body and professional associations regulate the profession of nursing in each province. Protect the public through maintaining a nursing registry. Professionally advocate for nurses and the public to have a strong publicly funded universal health care system. Promote excellence in nursing practice (page 38).
  • The seven Canadian Community Health Nursing Standards of Practice:
    • Health promotion
    • Prevention and health protection
    • Health maintenance, restoration, and palliation
    • Professional relationships
    • Capacity building
    • Access and equity
    • Professional responsibility and accountability (page 40)
  • Several factors, both enablers and barriers, are influencing community health nursing education:
    • Enablers: strong community-academic partnerships, supportive curriculum structures and processes.
    • Barriers: devaluing community health nursing education, insufficient time in theory classes and clinical placements (page 55).