Community Weeks 1&2 ( Textbook Notes - Community Health Nursing, A Canadian Perspective) PDF

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chapter 1 & 2 summaries from community textbook for week 1 content...

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WEEKS 1 & 2 NOTES FOR QUIZ WEEK 1 CHAPTER 1 ● CHN advocate for provision of primary health care & socio political leadership for development of health system and global health in practice ORIGINS OF COMMUNITY HEALTH NURSING ● Practices of first nation peoples using traditional medicines and healing ○ Yet to be acknowledged within history and modern practices of nursing & healthcare despite growing awareness of their value ● Epidemics of infectious diseases introduced by european settlers → colonization of Canada ○ Led to social, health & economic disparities among Indigenous peoples that persist today ● CHN practices integral part of relationship ○ Earliest form of nursing practice in Canada ○ Intersect with current trends in nursing, health care, health equity ● Canada’s first nurse: Jeanne Mance (1606-1673) ○ Established range of community health services (founding of Hotel-Dieu Hospital, MTL) ● The Grey Nuns → understood health inequity and made significant contributions to providing access to health services (food, shelter, education) for vulnerable (street outreach nursing) ○ Religious nursing orders were significant contributors to nursing education ● Establishments of sick bays and hospitals were considered part of a continuum of health services ○ Included education, home visiting, clinics, advocacy for social justice & essentials for life and health INCLUDING IMMUNIZATIONS NATION BUILDING & NIGHTINGALE ● Marked by political context of Canada’s development as a nation ○ Indigenous people still experiencing waves of epidemics introduced by immigrants ● BNA act → first nation legislative authority fell to federal government ● Later , Indian Act → indicated health services be provided under guise of medicine chest & pestilence clauses ● Responsibilities for organization of health care, including public health, devolved to provinces ● Organized health care provided at local (municipal) level thru public welfare or charitable organizations → legislation in 19th century to allow for establishment of of local/provincial health dpt ● Challenging conditions → social unrest due to capitalism, immigration, urbanization, weather led to vast health disparities. ● Florence Nightingale & women’s groups → hospitals being the centre of health care delivery ○ Understanding the importance of health data ● First school of nursing → St. Catherines, ON (1874)

● This time period → dominance of medicine and hospitals & issues of class and gender (remain today) ● Nightingale 5 essential points (pure air, pure water, efficient drainage, cleanliness, light) ● Mary Seacole (1801-1881): advanced nursing care of soldiers during Crimean war ● Women played vital role in development of community health services for rural and poor communities in late 19th early 20th centuries ● VON (Victorian Order of Nurses) → created by Lady Aberdeen in opposition to the National Council of Women ○ Encouraged local branches to extend their work and demonstrate capacity to deliver a wide range of community nursing services ○ Offered bedside nursing care to families who could not afford to hire private-duty nurses ○ Fulfilled dual mandate: charitable work among the poor and provision of affordable nursing care to the working and middle class EARLY 20TH CENTURY EVOLUTION ● Three distinct sectors: hospital nurses, private duty nurses, public health & home visiting nurses ● Public & home nurses different than nurses employed in other sectors ○ Remain in community practices longer than those in hospitals & private-duty ○ < financial stability & ^ salaries ● Early CHN practice → considerable overlap b/w public health nursing roles & homevisiting nursing roles ● Role of women’s volunteerism and leadership in communities continued to be an integral part in development of community nursing ● Public Health Nurse (PHN) first coined by Lillian Wald ○ Conception of practice was broad as they recognized impact of social determinants of health and attended to issues of poverty, culture, living conditions of the poor ○ Nurses perceived as ideal professionals to deliver these programs bc of medical knowledge ● Early 20th century → nursing specialities (of tuberculosis) ● First PHNs responsible for TB control, child hygiene programs, school inspection programs ● Early accounts of school nursing had broad focus on the social determinants of health and their impact on health of children and families ● Earliest maternal programs were the well baby clinics established by red cross peace program ● Women volunteers played essential roles in developing social, cultural and health care services in smaller communities ● Many communities wanted VN’s to provide bedside nursing care, rather than PHNs who focused on health education and prevention of illness ● District or Visiting Nurses → provided a comprehensive array of services fr. bedside nursing to preventive health teaching. ● Rural CHNs experienced challenges due to distance and climate ● Although VON continued to grow during postwar years, forced to respond to the changing face of healthcare in Canada ○ Hospital admission became the norm for Canadians requiring obstetrical, medical, surgical

care, shifting VON visiting nursing caseloads to care of convalescent and chronically ill individuals ● Military Nurses (often called during influenza virus) → demonstrated emergency preparedness ● CHNs → integral part of health services to the Indigenous peoples ● Outpost Nursing: nurses providing services in most remote, geographic locations (settlers & indigenous) NURSING EDUCATION ● First program in St. Catharines @ Gen and Marine hospital ● First baccalaureate program in UBC (5 year program) ● Later part of 20th century, diploma programs were phased out & baccalaureate degree became established requirement of entry-level public health nursing ● Entry level competencies: ○ Public health sciences in nursing practices ○ Population and community health assessment and analysis ○ Population health planning, implementation, evaluation ○ Partnerships, collaboration, advocacy, ○ communication in public health nursing ■ These competencies emphasize importance of developing and applying knowledge to address determinants of health, building relationships with communities, and understanding the critical relationships among individual, family, population health MID-20TH CENTURY EVOLUTION ● Community mental health nurses pioneered their new roles in complex interface b/w psychiatry and nursing and b/w community and institutional care ● Pressures on health care systems arising from the economic recession of the 1980’s caused widespread loss of nursing positions in all sectors of healthcare, most evident in hospital. ● Deinstitutionalization of patients from acute care and psychiatric institutions has resulted in need for innovative and comprehensive community-based healthcare programs and systems CHAPTER 2 ● CHNs accountable to a variety of authorities and stakeholders (public, regulatory body, employer) ● Media reports assert that Canada is in crisis; spending out of control, wait times unreasonable HISTORICAL MILESTONES ● 1832 → first quarantine station known as Grosse Isle, located in St. Law River, established to assess all newcomers and isolate those arriving w/ communicable disease ● Realization that individuals and communities could do something to stop the spread of disease and benefit fr. early detection was known as the “sanitary” idea ● Medicare → publicly funded healthcare ● Canada Health Act (CHA) → federal funding for essential medical services when provinces health insurance plans meet 5 criteria ○ Publicly administered → accountable to the public

○ Comprehensive → must cover necessary in-hospital, medical, surgical-dental services ○ Universal → available to all ○ Portable → available after a max of 3 mo. of residency and no extra charge for care out of province ○ Accessible → no user fees, health care providers must be reimbursed adequately ● Canadians have access to health care regardless of their ability to pay or where they live ● Articulates social contract that defines health as a basic right reflects the values of social justice, equity, community health services are areas that need to be strengthened within the CHA PARADIGM SHIFT ● Clinical definition of health was “absence of disease”, term “health promotion” used interchangeably with “disease prevention” ● The forward thinking framework identified four determinants of health ○ Environment ○ Lifestyle ○ Human biology ○ Health care system ● Goal of primary health care is attainment of better health services for all ORGANIZATION OF COMMUNITY HEALTH CARE ● Public Health Agency of Canada (PHAC) was created in 2004 to deliver on the federal gov. Commitment to help protect the health and safety of all Canadaians thru activities that focus on preventing chronic diseases and injuries, responding to public health emergencies and infectious disease outbreaks, strengthening practice of public health in Canada ● Limited # of indigenous-specific policies and frameworks ● ON was first province to develop an Indigenous Health and Wellness Strategy in 1990 to develop overarching Aboriginal Health Policy in 1994 ● Operation Health Protection in 2003 → a three year plan to rebuild public health ○ Address gaps in infectious disease control broader concerns related to disease prevention and health promotion ● Primary Care: core component of primary health care but is focused on services accessed at first point of contact w/ health system ○ Primary care teams produce better health outcomes, improve access to services, ensure the most efficient use of resources, and lead to greater satisfaction for patients and providers ○ Canada gone under many reforms, many remain incomplete & potential improvement for patients, communities, and health system has yet to occur ■ e.g. lack of role clarity fr. many professions joining tg w little preparation ○ Nurses working in primary care are almost exclusively salary-based ○ Investment still needed to support high-performing primary care modules for geographically and socioeconomically diverse population ● Public health: established under provinces and territories

○ Funding generally involves combination of regional, provincial, territorial funds ○ Health starts where we live, learn, work, play ○ Overarching goal of public health is to enhance and optimize health status of communities and promote health equity; core functions: ■ Assess population status ■ Protect & promote health ■ Prevent disease and injury ● Cultural competence ○ Growing body of research → pervasive nature of racism against Indigenous peoples as well as institutional racism that lead to health disparities experienced by them ○ Many aboriginal people don’t trust & don’t use mainstream health care services bc they feel unsafe or they feel that the Western approach is alienating and intimidating ○ Cultural Safety training for health service providers ● Home care: wide range of health services delivered @ home and thru out community to recovering, disabled, chronically, terminally ill persons in need of medical, nursing, social, or therapeutic treatment/ assistance w essential activities of daily living ○ Not an insured health service under CHA ○ Lack of legislative framework results in wide variation in access to and availability of home care services across CA ○ Factors that impact need for new approach to provision of home health care ■ Canada is an aging nation w/ ^ rt. of chronic disease ■ Across country, reduction in #’s of family caregivers and support networks + decline in community support and volunteerism ■ Challenges exist in the recruitment and retention of health care workers ■ Increased use of technology for clients , providers, and the system allows for more home care ■ Gvts recognize the need for a greater role for the home and community care sector and its critical fxn in terms of efficiency and effectiveness of health systems given rising costs of health care, greater strains on public health expenditures, lower funding allocation for home & community based care ○ Significant provincial variations in degree to which services are publicly funded vs privately POLICY, POLITICS, POWER ● Policy: guides work of community health nursing and policy making is carried out within political context ● Politics: use of relationship and power to gain ascendancy among stakeholders to influence policy and allocation of scarce resources ● Power: ability to act so as to achieve a goal ○ Knowing who has power & who serves on key decision making tables ● ^ concepts are analyzed w/in context of health equity and social justice ● Health inequity: differences in health that are unnecessary, avoidable, unfair, unjust, or absence of

systematic disparities in health b/w social groups who have different levels of underlying social advantage or disadvantage ○ EVERY PERSON has an opportunity to achieve optimal health ○ Marginalized populations such as immigrants and refugees continue to experience barriers to accessing health system ○ CHN’s must acknowledge the sociopolitical processes that have implications for their practice at micro (individual) and macro (system) levels CHAPTER 3 ● CHN’s work in various settings such as homes, schools, workplaces, streets, shelters, churches, field hospitals, community health centres, outpost nursing stns ● Blueprint for Action for Community Health Nursing in Canada provides framework and point of reference for ongoing dialogue on development of community health nursing practice in Canada COMMUNITY HEALTH NURSING PRACTICE MODEL & STANDARDS OF PRACTICE ● Combining foundational nursing education w/ knowledge of community health nursing concepts ● Five key areas: ○ Build healthy public policy ○ Create supportive environments for health ○ strengthen community action for health ○ develop personal skills ○ reorient health services ● Community Health Nurses of Canada (CHNC): associate member of CNA ○ Advance practice and to improve health of Canadians; values: ■ Health defined as a human right for all Canadians ■ Healthcare system that requires balance of health promotion & illness care ■ Leadership as a req for system change & fundamental to supporting practices ■ Engagement of the voice of all populations - full partners ■ Social justice & health equity that are foundational and central to practices ● Core of practice is client, which includes individuals, families, groups, communities, systems, populations ● CHNC Standards of practice developed in 2003 revised in 2011, 2019 ○ Represent a vision for excellence in community health nursing ○ Measure performance of community health nursing practice by employers, support professional dvlpmnt programs, inform nursing education, guide dvlpmnt of new knowledge thru research ○ Seven standards: ■ 1. Health Promotion ■ 2. Prevention and health protection ■ 3. Health maintenance, restoration, palliation ■ 4. Professional relationships ■ 5. Capacity building ■ 6. Health equity

■ 7. Evidence informed practice ■ Professional responsibility and accountability ○ Key characteristics of CHNs are reflected in the standards, include high lvl of independence, autonomy, resourcefulness, collaboration w/ client and his/her family & community ○ Community-oriented approach: population/community focused and aimed at health promo and disease, injury prevention in an entire population and community ○ Community-based approach: nursing care provided to individuals and families and groups wherever they live, work, play, learn ( all nurses who practice outside the hospital ) ● CHNs called to provide care to populations that experience health inequities compared to the general population of Canada (e.g. First Nation, LGBTQ2S) ● Wise practices: incorporate traditional knowledge, cosmology, and lifeways to guide health practices with indigenous communities NURSING ROLES ● Indigenous health nursing refers to the ways in which nursing care is provided to Aboriginal clients and also the way in which nursing interventions are targeted towards Aboriginal communities and populations ○ Nursing care and interventions informed by traditional knowledge values and beliefs ● Public health nursing utilizes knowledge fr. public health, nursing, social & environmental sciences, and research, concepts of primary health care, disease/injury prevention, community participation, community dvlpmnt, social determinants of health, health equity ○ Promote, protect, maintain health of population ○ Essential fxns of public health are health promotion, disease and injury prevention, health protection, health surveillance, population health assessment, emergency preparedness and response ● Home health nursing: include chronic disease management, curative practices, health promotion and health education, palliative care, rehabilitation, support maintenance, social support, support for the family so that the client can continue to live in the community ● Primary Care Nursing: high degree of specialization req for care; e.g. family practice nurse, primary care nurse, primary health care nurse (textbook table 3.2), primary health care nurse practitioner ○ Provide first contact w healthcare system settings ● Telehealth: remote delivery of health care services using technology and digital communications for assessment, information exchange, clinical decision making, interdisciplinary collaboration, prvd care ○ Provide a range of services: triage of health issues, consultation, provision of advice, counselling support, health education, care coordination for chronic disease management ○ Goal → self-care management and support for individuals and families living in the community and being monitored at home ● Outreach/street nursing: provides primary care, home health care, mental health services, public health services, work in rural/urban areas ○ Provided often by PHN, primary care nurses, HHN ● Rural Nursing: provincial nursing programs across the country developed specific nursing programs for providing health services in remote areas of Northern Canada

○ Locations present challenges for provision of adequate healthcare services, midwifery, urgent care ● Occupational Health Nurses: formation of national association in Canada ○ CCOHN, NAOHN, COHNA ○ Occupational health nurses base their practice on a nursing conceptual framework with four interrelated components: individual, health, occupational health nursing, environment ○ Focuses on the worker or worker group by promoting health, preventing illness or injury ○ Environment described as a dynamic interaction b/w workers and workplace CHAPTER 4 ● Public Health: organized efforts of society to keep people healthy and prevent injury, illness and premature death ○ Promote health ○ Prevent and ctrl chronic diseases and injuries ○ Prevent and ctrl infectious diseases ○ Prepare for and respond to public health emergencies ○ Serve as a central point for sharing Canada’s expertise with the rest of the world ○ Apply international research and development to Canada’s public health programs ○ Strengthen intergovernmental collaboration on public health and facilitate national approaches to public health policy and planning HISTORICAL EVOLUTION ● 1830’s → during this period, there was little understanding of the nature, origin, transmission of the disease; infectious diseases accounted for deaths of countless Indigenous peoples and early settlers ● Confederation (1867) → first Public Health Act (1884) ● Public health nursing grew out of religious persuasion and public conscience of social gospel mvmt and maternal feminism. ○ Focused primarily on improving physical environmental conditions to reduce maternal and child morbidity and mortality ● First PHNs worked for charitable / religious organizations PRIMARY HEALTH CARE & PUBLIC HEALTH NURSING ● PHNs called on to make a converted effort to enact the principles of primary health care, to think abt the risk factors contributing to sickness and disease to prevent illness or injury by addressing barriers to health ● Public participation is a primary health care principle that is integral to PHNs achieving sustained change PUBLIC HEALTH NURSING DISCIPLINE-SPECIFIC COMPETENCIES ● PHNs largest group of public health employees; fxn under laws and regulations of various government bodies th...