NRSG73 – Test 2 Study Notes PDF

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NRSG73 – Test 2 Study NotesWeek 8: Mental Health NursingMental health: The capacity to think, feel, and act in ways that enhance the enjoyment of life and the ability to face life’s challenges.  Poor mental health can lead to mental illness.Mental illness: A group of medically diagnosable conditi...

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NRSG73 – Test 2 Study Notes Week 8: Mental Health Nursing Mental health:  

The capacity to think, feel, and act in ways that enhance the enjoyment of life and the ability to face life’s challenges. Poor mental health can lead to mental illness.

Mental illness:   

A group of medically diagnosable conditions that results in the significant impairment of an individual’s cognitive, affective or relational abilities. Result form biological, developmental and/or psychological factors. Can be managed using approaches comparable to those applied to physical disease (ie. Diagnosing, treating, rehabilitating).

Historical Context of Mental Health:      

Historically, mental health care in Canada has taken place within a context of culture, gender, and sociopolitical attitudes. Formal management of mental illness began in poorhouses and jails that provided little but containment. Mid-1900s: large institutional hospitals or asylums were built to provide more humane care Kingston Asylum 1919 -> Female Infirmary at the Hospital for the Insane, Toronto circa 1910. 1960s: a philosophical shift proposed that humane treatment would be best achieved in the community.

Today mental health service influential trends include:   

The consumer and family movements The recovery model: actively collaborating with client and family/support to develop interventions. The national mental health strategies

Risk factors:    

Certain populations are at higher risk because of greater exposure and vulnerability to adverse sociopolitical, economic, environmental, and biological circumstances. Experiences across the lifespan, such as trauma, violence, poverty, and discrimination have a fundamental impact on mental health. People who live with chronic oppression embedded within a social system will develop both physical and mental health issues. Women, Indigenous persons, visible minorities, individuals who identify as LGTBQ2S, homeless persons, refuges and persons with disabilities are particularly vulnerable populations.

Impact of mental illness:  

The global burden of disease attributable to mental illness and substance misuse has increased by 37% since 1900. The largest proportion of the population affected is between the ages of 10 and 29.

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Stigma, discrimination, and mental health are closely linked. Efforts have been made to reduce stigma towards mental illness locally and nationally- ie Bell Let’s Talk, Team 55. Bullying and harassment have been confirmed as significant contributors to poor mental health outcomes in youth and adults. Reporting criminal victimization is highly difficult for persons who experience mental illness because they often fear they will not be treated as credible victims.

Suicide in Canada:        

Suicide is a critical public health concern affecting all ages, races, abilities, gender identities and socioeconomic classes. Suicide is one of the leading causes of death in Canadian youth and is highest in the age group 40 to 59 years with an increased trend in late life for men. Indigenous youth are also at increased risk for suicide. Seniors face multiple losses of friends, family, health problems, diminished capacity and facing own mortality. Suicidal behaviours include suicidal ideation, suicide attempt and completed suicide. Stigma surrounding suicide prevents populations at risk and their families from seeking help. Survivors of suicide often feel isolated and experience complex emotions. CMHNs must be comfortable asking directly about suicidal ideation, the suicide plan, the means and if the person has access to the means.

Mental Health Nursing Care for the Most Vulnerable: Indigenous Populations:  

Mental and emotional pain continues to affect the lives of many Indigenous people who experienced trauma in residential schools. A trauma-informed approach should be exercised: views trauma as injury, prioritizes survivors’ safety, choice, and sense of ownership and control.

Homeless Persons:   

Homelessness is a public health emergency and risk associated with homelessness place homeless individuals among the most vulnerable. The vulnerability of homeless persons is often compounded by panhandling, sex work and illegal activities in order to meet basic needs. Often individuals in this population has a distrust for healthcare and social services; fear that of being judged, mistreated and reported to law enforcement.

Persons Who Misuse Substances:  

Substance misuse may develop following stressful or traumatic events, accidents that have caused painful injuries or chronically stressful situations. Loss of employment, sexual violence, car or work-related accidents, poverty, homophobia, domestic violence.

Refugees, Immigrants and Visible Minorities 

1 in 5 people living in Canada is a visible minority, with 20.6% of the Canadian population being born outside of Canada.

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Access to mental health services is often problematic due to langue barriers and because newcomers often find services are not culturally comfortable. High-priority conditions for newly arriving immigrant and refugees include domestic violence, abuse, anxiety, adjustment struggles, depression, torture and post-traumatic stress.

Organization of Mental Health Services:          

Emergency services, consisting of admissions to hospital and crisis stabilization units are initiated through general hospital emergency wards. Case management is a best-practice model providing assistance to people with mental illness and families. Assertive community treatment is a comprehensive, long-term, intensive case management approach. Primary health care services include general practitioners. Early intervention programs attempt to intervene prior to a full-blown episode of mental illness to mitigate the illness’s effects. Co-occurring disorders refer to the existence of a psychiatric diagnosis and an additional diagnosis of substance misuse. Self-help and peer support are integral parts of services for PMHIs and their families. Allow them to share their lived experiences with one another. Mental health promotion emphasizes positive mental health and recognizes the personal, social, economic and environmental factor. The collaborative mental health care model consists of PMHIs, family, caregivers and multidisciplinary HCPs.

Nurses’ Role in Mental Health:    

Early identification and treatment of mental illness reduces its severity and promotes quicker recovery. CHNs play an important role in screening for physical health problems and adherence to medical treatment. Within family nursing, CHNs assess children whose parent lives with mental illness to ensure that their needs are met. CHNs play a significant role in advocating to reduce social inequities that impede mental health and recovery from mental illness.

Caregiver Burnout and Emotional Fatigue:    

Burnout can cause emotional exhaustion, depersonalization, and apathy after prolonged exposure to stress. This increased stress and fatigue may lead to mental illness, including anxiety and depression. This affects family members and professionals alike. Important to identify the early signs of emotional fatigue to implement strategies to reduce the strain.

Week 9: Indigenous Health Indigenous Health: 

Indigenous Peoples in Canada have Traditional Knowledge, medicines, and healing practices to support spiritual, physical, mental and emotional health and well-being

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Health is linked to their distinct culture and worldview that all beings are connected to each other and the land

Cultural Safety:     

CHNs need to build reflective, culturally safe practices grounded in a strength-based approach that honours Indigenous peoples’ cultures and health The health of many Indigenous communities is inextricably linked to their distinct culture and worldview that all beings are connected to each other and to the land Indigenous individuals also have the right to access, without any discrimination, all social and health services The CHN’s role is to support their rights and their health and well-being through nursing practice that respects the dignity of culture and community CHNs can play a key role in stopping colonial narrative and the inequities created by continued stigmatization

Indigenous History:      

Aboriginal: a colonial term created by the Canadian federal government Encompasses all First Nation, Métis and Inuit peoples Colonial: the power exerted by the dominant culture of settlers over Indigenous people to maintain authority Intent to replace the original population Indigenous: the original peoples of a land and their descendants Used by the UN in its aims to uphold the human rights of Indigenous peoples

Health Care Delivery Systems:    

The federal government and the First Nations and Inuit Health Branch (FNIHB) provide health services for First Nation and Inuit peoples living on reserves First Nations are increasingly assuming local control through the transfer of health services For acute-care services, First Nation healthcare systems interface with the Canadian healthcare system because hospitals are a provincial responsibility Various types of funding arrangements are available to First Nation groups seeking to administer their own community health programs

Social Determinants of Health:     

The Indigenous population shows disparities in virtually all areas of health determinants Low SES can be found in all Indigenous populations, regardless of rural, urban or remote location First Nation communities have been reclaiming their own education, including the development of culturally relevant curricula and the training of Indigenous teachers. On-reserve housing is often subpar by Canadian standards Rate of TB in Indigenous populations is 6X higher than in non-Indigenous populations, with the highest rate found among Inuit

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Trauma and injury, whether accidental or intentional, are related to physical environments and high on the list of health issues of Indigenous populations Healthy child development is an important health indicator for Indigenous populations, birth rate is almost twice that of the general Canadian population Indigenous people are represented in all occupations, including education, health, justice, business and the trades Changes have to made to the social determinants of health to overcome the poverty and thirdworld conditions present in too many First Nation communities

Culture, Self-Governance & Policies:     

Development of competent, culturally appropriate nursing care requires the CHN to keep in mind the historical, cultural and changing clinical healthcare delivery system Indigenous populations continue to remain a distinct cultural segment of Canadian society and some First Nation peoples hold traditional holistic health beliefs Nurse who move from one culture to another need to be informed of the values and norms of the society to which they are moving CHNs must also be aware of competing policies and jurisdictions Health education and promotion are part of the everyday contact with communities and groups; CHNs need to make the effort to make these activities culturally appropriate

Traditional Knowledge:   

Traditional world views of Indigenous peoples emphasize the interconnectedness of all things This concept is the basis of the medicine wheel framework Medicine wheels usually represent four quadrants of emotional, physical, mental and spiritual aspects of health and wellness

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This philosophy is being taught by elders to the youth in Indigenous populations Has been adapted to other issues including HIV/AIDS, diabetes, family violence and addictions

Applying Research Findings: 

Understanding inequalities in access to health care services for Aboriginal people: A call for nursing action (Cameron et al., 2014) -pdf on D2L

Study findings:   

Participants reported stories of racism, stigmatization, language difficulties, intimidation, harassment and deep fear Described limited access to comprehensive and specialized care, long waiting times, communication barriers (ie. jargon) and interactive barriers with health care professionals Described health care professionals as judgmental, received inadequate assessments and health needs not well addressed.

Week 10: Gender, LGBTQ+ and Community Health Sex and Gender:         

The terms sex and gender are related, but they are not synonymous Sex refers to the biological and physiological; it is commonly understood to mean chromosomal makeup and is determined by X or Y chromosomes Gender is the expression of one’s sex in terms of masculinity and femininity and is rooted in culture and history Gender identity describes how we see ourselves as women, men, neither, or both, and this affects our feelings and behaviours Gender roles are defined as the social and cultural expectation Cisgender refers to a person whose gender identity matches their biological sex Transgender refers to person whose gender identity is different from his or her biological sex and does not relate directly to sexuality Gender relations refers to how we interact with or are treated by people in the world around us based on our ascribed gender CHN must be mindful of their own beliefs and assumptions regarding sex, gender, and what constitutes “normal” gender expression

Community Health Needs:    

Governments and other agencies are increasingly using gender-based analyses to ensure that the programs and policies they develop are equitable Perceiving gender as a modifiable determinant of health, CHN will be empowered to identify, apply, and evaluated gender-sensitive strategies to promote an individual’s well-being Exploring how gender impacts health at various levels assist us in identifying how health outcomes are impacted by gender Gender bias is the root of gender inequities and generally arise from three problems:  Overgeneralization: what is good for men is good for women  Gender and sex insensitivity: ignoring gender and sex as important variables  Double standards: assessing the same situation differently on the basis of gender

Health Outcomes:

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Sex and gender are powerful determinants that influence the health of individuals, families, communities, systems and populations Men and women differ biologically in terms of the diseases they develop, the symptoms they experience, and the ways in which they respond to medicines and other treatments Gender ideals mediate their experiences and expression about health and illness The effects of sex and gender sometimes combine and lead to particular health outcomes Little is currently known about the health outcomes of individuals who identify as transgendered, two sex or intersex, but this requires consideration and further information is needed

Indigenous Perspective of Gender:     

Indigenous cultures across North America have different definitions and expressions of gender than are found in Western cultures Gender is much more fluid notion than just being a man or woman Two Spirit refers to Indigenous people born with masculine and feminine spirits in one body Multiple genders and a wide variance of gender roles existed in many tribal societies and communities Third or fourth gender category, neither male or female, and were seen to hold an important role of bridging the genders

Gender-based Inequities:    

Institutionalized gender reflects the distribution of power between genders in the political, educational, religious, media, medical and social institutions in any society Gender inequity occurs when individuals are not provided the same opportunities in society because of their gender or gender-identity Presently, Stats Canada does not collect specific health statistics pertaining to transgender individuals However, across government and other agencies, we are seeing in gender-based analysis to ensure programs and policies are equitable

Intersectional Gender-based Lens: 

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Using a gender lens to examine a context helps to purposefully illuminate the unique constraints and opportunities men and women face The Gender Responsive Assessment Scale is highly relevant to the work of CHNs who wish to be appropriate, responsive and gender transformative in their practice CHNs need to reflect on the degree to which programs are gender-blind, aware, exploitive, accommodating or transformative CHNs can ask wide-reaching questions, consult with diverse groups, and ensure that the programs are gender-appropriate and reflect an intersectional approach

Gender-specific Prevention and Advocacy CHNs seeking gender transformative primordial and primary prevention:       

Strive to reduce and eliminate flawed assumptions and non-critical approached to community health nursing practice Challenge essentialist lenses used to explain sex and gender differences Strive to reduce and eliminate gender-based inequities Advocate for all CHNs to participate in GBA+ training Think upstream and question powerful gender role prescriptions that oppress Eliminate invisibility, experience of harassment, transphobia, and social exclusion Strive to ensure a gender-based lens in health promotion planning while considering barriers to quality of life (ie. Sexism, racism, heterosexism, sizeism, classism, ableism and ageism)

Developmental Processes and Dimensions:    

Sexual orientation can be defined as romantic and sexual attractions toward people of one or more genders Dimensions of sexual orientation: sexual relations with one or more genders; self-labelling as heterosexual, gay, lesbian, bisexual and queer or “questioning” Gender identity is a complex development of one’s sense of self as a gendered person and is not the same as physiological sex Most scientific evidence leans toward a genetic basis for sexual attraction with identity and behaviour influenced more strongly by culture and societal attitudes

Sexual orientations:    

Homosexuality refers to romantic/sexual attractions to the same gender Heterosexuality refers to romantic/sexual attractions to another gender Bisexuality refers to romantic and/or sexual attractions to more than one gender Queer is an umbrella term indicating a non-heterosexual orientation. Some individuals may be unsure of their orientation and may prefer to identify as “questioning” their orientation.

Gender Identities: 

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Transgender or gender diverse  Individuals who may feel their core gender identity does not match what others think it is or should be  Individuals may feel that their gender does not fit within a binary model of man or woman Cisgender  Individuals whose internal gender identity matches their external body appearance and gender performance

Societal Attitudes and Current Stressors Reluctance to disclose sexual orientation or gender identity, or fear of the consequences of disclosure relates to several essential concepts:  

Homophobia -internalized homophobia can appear as low self-esteem and reduced self-care; may lead to adopting health-compromising activities to cope with distress Biphobia

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Transphobia Heterosexism: an assumption that heterosexuality is the norm and lack of awareness that other orientations or genders exist along the spectrum of “normal” Cissexism privileges cisgender identities and bodies over trans identities and tr...