NSG3123 Community Theory- Lec4 PDF

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Summary

Introduction to theory, principles and practice of community health nursing, including health promotion, maintenance, prevention and epidemiology. Encompasses community-based assessment, planning, intervention and evaluation with individuals, families and community-as-client. ...

Description

Week 4:

CHN Roles ; Functions & Practice Settings

Readings/Activities: - CH 3: Nursing Roles, Functions & Practice Settings - CH 5: Home Health NSG in Canada → OPTIONAL? - Appendix A: The Canadian CHN Practice Standard (pg 610-614 → ? ) - Appendix B: PHN Discipline specific Competencies - Appendix C: Home Health Nursing Competencies CHNs view ‘health ’ as a dynamic process of physical, mental, spiritual, and social well-being; and as a resource for everyday life that is influenced by circumstances, beliefs, and the determinants of health. CHN  = umbrella term used for all Community Health Nurses in Canada. - CHN (pronounced CHIN) usu refers to nurses working in Northern, rural, remote areas of Canada in a generalist role. - In Northern Canada and remote communities the CHN role is very unique and challenging; - most often involving primary care practice (at an advanced level) as well as the responsibilities of a PHN! 2years basic experience is recommended. Other nurses in Canada may have diff titles (depending upon the community and resources). - The PHN and the Home Health Nurse (HHN) are two of the most common titles. CHN Roles & Practice

→ CH 3 & Appendix ABC

How many types of nurses are there? ● Canada recognizes 20 nursing specialties (CNA 2015) ● Nursing practice has shifted from community based to hospital based back to the community again. ○ Prior to WW2 - 60% worked in community (home +community) ○ Medicare and technology changed things ■ By 1989 - 85 % nurses now in hospitals ○ PHC caused further change ■ In 2014 - 62% nurses work in hospitals ■ In 2016 – 15.8% in community sector ● (CH, PH, HH, primary care and telehealth) CNA calls for further alignment of the ratio of nurses in community to meet demographic changes and population health PRIMARY HC is a big factor that influenced the change in practice settings for nurses - A foundation Principle in Primary HC is access to care - Care is happening in many places of than hospital  

Summary: Why is PHC (primary HC) relevant to CHNs? ● It is community based ● It provides essential services in the community ● It considers the SDOH ● Focuses on health promo, & disease prevention/protection ● It includes therapeutic, curative, and rehabilitative care ● It promotes co-ordination, interdisciplinary and inter-sectoral care. ● It focuses the client as an equal partner ●

Good review clip: http://www.youtube.com/watch?v=Lk3qnb6gekU

Types of Hospital Nursing and Community Health Nursing : ● Hospital Nursing ○ Coronary care / ICU nurse ○ Dialysis nurse ○ ER nurse ○ Med/Surg nurse

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Obstetrical Nurse OR nurse Ped nurse Psych nurse 1

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○ Other Community Health Nursing ○ Public health nurse ○ Home health nurse ○ Mental health nurs ○ Military nurse ○ Occupational health nurse

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Parish nurse Community health nurse Primary care nurse / nurse practitioner Outpatient nurse Others

What is Unique About Community Health Nursing: - CHN promote, protect & preserve the health of individuals, families, groups, communities & populations → where ppl live/work/learn/play/worship → in a continuous vs episodic process - Work at a high level of autonomy - View health as a resource & focus on capacities - Combine specialized nsg, social and public health science w/experiential knowledge - Build partnerships based on primary HC principle, caring & empowerment - Have a unique understanding of the influence of the environmental context of health - Gather resources to support health by coordinating care & plan nsg services, programs, policies Activities of CHNs in Canada: (Bold = interventions explored in the course) ● Leadership ● Advocacy ● Outreach ● Building Capacity ● Building Coalitions & Networks ● Policy Development & Implementation ● Referral and Follow up ● Care & Counseling ● Case management ● Research and Evaluation ● Communication (including Social marketing) ● Resource management, planning and ● Community Development coordination ● Screening ● Consultation ● Surveillance ● Facilitation ● Team Building & Collaboration ● Health Education ● Health Threat Response

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Roles and settings of CHNs Federal govt distributes funding for HC to provinces/territories. - provinces and territories distribute money differently to their respective health care system. RESULT= system can look diff & differences in roles of CHNS’ from one province/ territory to another.

Roles of CHNS can be identified and classified as either community oriented or community based approaches. Community Oriented Approach ● Population or community focused ● Aimed at health  promotion and disease and injury prevention In entire population or community Community Based Approach ● Nursing care  provided to individuals, families, and groups Where they live, work, play and learn ● In other words – ALL  nurses who practice outside hospital Look at various CHNS on a scale to help define if they are community oriented or community based approaches

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- orange bubbles = all the CHN practice settings Horizontal axis = identifies if nurse is more individual or population focused in their day to day work. - Ex: street nurse? → street nurse tends to be more individual focused in day to day care. Vertical axis = depicts if the nursing practice is community oriented (population oriented/focused) or community based. - Ex: street nurse is more community based Street nurses are influenced by population health & advocate for population health – the day to day work tends to be on the individual or small group .

Most CHNs work in one of these 3 settings: Public  Health Units, Home Care Agencies or Community Health Centers. - Note the similarities and differences in the three. Community Health Centers were introduced in Class 1 - They are not much talked about in the text as the CHC model is unique to Ontario. - CHCs are definitely an important part of the Ontario PHC system. MUST have a general sense of the role of CHCs in Ontario. - https://www.ontario.ca/page/community-health-centres 3

SO many CHN’s in so many Role → HOW TO REGULATE what we are doing: - Standards of Practice - Competencies of Practice CHNC - Community Health Nurses of Canada = an associate member of the CNA. = a voluntary association of CHNs consisting of CHNs & provincial/territorial CHN interest groups - CHNC provides a unified national voice to represent & promote CHNsg & health of communities. - CHNC provides a forum for CHNs across CAD to share issues of mutual concern & to communicate through meetings and national publications. - CHNC monitors trends + issues in CHNsg & identifies/responds to issues of interest & concern which affect all CHNs across Canada. - CHNC represents the view of CHNC to the Canadian Nurses Association. - CHNC = leader in development of discipline-specific standards of practice, core competencies, and a community health nursing certification process. - These activities have led to a greater understanding of CHNsg and will inc the knowledge and ability of CHNs and nursing students in Canada. The mission of the CHNC is to advance  practice and to improve the health of Canadians.  Values of the CHNC : 1. HEALTH is a human right 2. A HEALTH CARE SYSTEM that: ● balances health promotion and illness care ● Has leadership for system change, ● engages all voices &, ● Works towards social justice and healthy equity ● CHNC Homepage → For more info on membership go to: https://www.chnc.ca/en/member-benefits CHNC hold an annual national conference in CAD cities → connect w/other CHNs to discuss health issues and strategies.

Blueprint for Action for Canadian CHNsg: - released by Community Health Nurses of Canada in 2011 to provide a framework, and point of reference, for on-going dialogue for the CHNs in Canada. -

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CHNs work in so many different settings - complex interplay of our interventions - with individuals, groups, communities and populations - CHN’s work is in promoting, protecting or restoring health AND preventing illness, CHNsg is unique and challenging.

informed by CHNs across Canada, and a scoping review of the literature: - Purpose = inform the direction of CHNs in their daily practices & promote and protect the health of Canadians. OUTER RING - 6 components: areas for action that the professional specialty of CHNsg need to be engaged in. MIDDLE RING - incorporates CNA Code of ethics that guides all Canadian Nsg practice + our discipline specific competencies (PHN competencies for example – to follow) + the standards of practice INNER RING = where we are as individual CHNs Canadian CHNsg Professional Practice Model: (2011) → do not need to memorize it. 13 components organized into 4 main categories: 1. CHNsg & Nsg Practice (Yellow) → what informs the CHNs practice 4

2. Community Organizations (Orange) 3. The system (Blue) 4. Core of the model, in the center - the pt! The Standards of Practice and discipline specific competencies are areas we need to take a look at.

Community Health Standards & Competencies Generic Nursing Standards of Practice → specialties have specialty standards of practice & competencies for that specialty. - For CHNS it is the CHN standards of practice. - Depending upon where the CHN may work there will be core DISCIPLINE competencies: - Currently CHN practice has 2 core discipline competency documents: - One for Public Health Nurses & another for Home Health Nurses. EX: In Canada, a PHN would have to meet the: 1. Nursing standards of practice 2. Standards of practice for CHNsg 3. Core competencies for Public Health – Health Canada. Standards of Practice → LOOK AT: Appendix A ● refers to level of service (what), ● intervention (how) ● & outcome Core Competencies PH in Canada ● Essential knowledge, skills and attitudes necessary for the practice of PH Discipline Specific Competencies ● PHN – Appendix B ● HHN – Appendix C The PURPOSE of the standards: ● to define the scope and depth of practice in the community, and ● establish expectations for acceptable, safe, and ethical nursing care The standards will: 1. measure performance of CHNsg practice by employers, 2. support professional development programs,

3. inform nursing curricula, 4. guide the development of new knowledge through research. IMPORTANCE of CCHN Standards: ● √Define scope & expectations of CHN practice for safe, ethical care. ● √Support the ongoing development of CHN. ● √Demonstrate CHN as a Specialty. ● √Provide a foundation for certification as a clinical specialty with CNA. → CNA  Specialties ● √Inspire excellence in & commitment to CHN practice. 2 CHN Core Competencies *** 1. Public Health: PHN – Appendix B 36 competencies in 7 categories: 1. PH sciences 2. Assessment & Analysis 3. Policy & program planning, implementation and evaluation 4. Partnerships, collaboration and advocacy 5. Diversity 6. Communication 7. Leadership 2. Elements of HHN: HHN – Appendix C 7 Elements: 1. Assessment, monitoring & clinical decision Making 2. Care planning and Care coordination 3. Health maintenance, restoration and palliation 4. Teaching & education 5. Communication 6. Relationships 7. Access and equity 8. Building capacity 

Provincial/Territorial Standards for Nursing Practice & Specialty Standards Various sets of standards for your nursing practice → All nurses must abide by these standards. - provincial/territorial standards - specialty area = standards of that area that you must meet in order to practice. - This is where the CCHN Standards fit in.

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After that you must follow the organizational standards of your employer then the local unit specific standards!

Competencies for Entry to Practice: Generic competencies for a RN to practice → Not Testable ● NOTE: how many of the competencies in your ONO provincial Standards are actually linked to community practice! ○ Here’s the link:  https://www.cno.org/globalassets/docs/reg/41042_entrypracrpn-2020.pdf

Health System Challenges Nursing is the largest healthcare profession with great potential power BUT has struggled to inc its visibility & to collab with other stakeholders to influence health policy. The PHNs ability to shape this complex health care environment by playing an active role for positive impacts on the health of communities is often met with multiple challenges and barriers: - EX: numerous calls for strengthening primary health care & shifting toward community health & preventative care, an emphasis on illness care provided in institutions REMAINS the current way of thinking. Inadequate funding and resources for disease prevention & health promotion remain an issue → constant + real threat. - The lack of stable long-term funding = major barrier to effective practice and service delivery. - Stable funding for Public Health → https://www.ontariohealthcoalition.ca/index.php/mounting-health-care-cuts/  PHNs recognize that advocacy & action are a priority to shape the system change. Leadership → Leadership in public health is a challenge contributing to the invisibility of PHNs. - Leadership is about identifying a problem/new condition that requires change, then identifying the vision and skills to affect change and influencing and motivating others toward action. -

PHNs are educators, seasoned collaborators, skilled communicators, and critical thinkers; - their knowledge of health in communities = skills needed to close health equity gaps through more visible leadership roles at decision making tables.

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Leaders know it is impossible to achieve change in isolation. - critical for leaders to foster relationships with community partners, decision makers, and funders

Key characteristics of CHN reflected in the standards: ● High level of independence ● Autonomy ● Resourcefulness ● Collaboration ● Strong community & individual assessment skills

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Critical thinking & problem solving Understanding of the community and its resources Understanding of the healthcare system Strong foundation health promo 7

GUEST SPEAKER: Elizabeth Ryan (Public Health) & Diane Roscoe (Home Care) Ottawa Public Health -

1 of 35 health units in Ontario The Health Unit for Ottawa Governed by a Board of Health under the Health Protection and Promotion Act Mandated by the MOHLTC to provide public health programs and services

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Provides bilingual PH programs and services to approx 1 million residents in Ottawa Boundaries: Cumberland (East), Fitzroy Harbour (West), Ottawa River (North) and Osgoode (South) Works w/individuals, families, groups and the community in a variety of diverse settings Approx 600+ employees → inc now bc covid (~1200+)

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Teaching health unit → work w/all post secondary institutions

Core Public Health Functions: organized efforts of society to protect & promote health - Assessment and Surveillance - Disease prevention - Health promotion and policy development - Emergency management - Health protection

OPH Team: - Public health nurses - Nurse practitioners - Registered nurses - Registered practical nurses - Nutritionists PUBLIC HEALTH NURSE ROLE: - Health promo - Health protection - Disease and injury prevention

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Dieticians Epidemiologists Public Health inspectors Dental hygienists Physicians Dentists -

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Project officers Youth officers Evaluation officers (PPEO) Program assistants

Health surveillance Population health assessment Emergency preparedness and response

Temporary OPH Leadership Structure:

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OPH 8 NEW Service Areas Service Areas 1. COMMUNICABLE DISEASES

TEAMS/Work

Good for students

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Covid19 case & contact management Communicable disease and Enteric and Zoonotic Infections Covid19 school support team Rapid Response and Readiness Team

2. HEALTH PROTECTION Good for students

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Covid19 outbreak management Other IPAC Inspection, health hazards, safe food and water

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Immunization Dental Healthy growth and development Mental health Healthy communities Se health and Harm reduction

4. COMMUNICATIONS & COMMUNITY ENGAGEMENT Good for students

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OPHIC ERPL = Covid19 emergency response team → answers calls Work includes aligning stakeholder relations (some liaison work at the strategic vs operational level) and communications w/organizational priorities

COMMUNITY OPERATIONS

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Work includes understanding & responding to needs of neighborhoods at higher risk for covid19 transmission w/community partners & anti-racism initiatives Some function that are currently w/Liaison Section within IMS

KNOWLEDGE EXCHANGE, PLANNING & QUALITY

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Planning ahead for what is needed to address the pandemic Quality improvement and analysis for all operations

PERFORMANCE & CORPORATE SERVICES

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Oversight of resources needs, human and financial, and ensuring IT strategies support our work

PUBLIC HEALTH & MEDICINE UNIT

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Includes defining the AMOH’s leadership contributions across the organization and acting as the MOH as needed

3. HEALTH PROMOTION Good for students

Selecting OPH for Consolidation Select a Service Area Opportunities depend on program capacity and availability Work shifts may include days, evenings, weekends Some placements may have special requirements (ex: bilingual, car, interview) Employment at OPH → Apply online at ottawa.ca/jobs City of Ottawa → Summer Student Employment PHN Trainee for new grads PHN

Home Care Nursing Carefor Health and Community Services ● Not for profit ● Over 1500 employees across 3 geographical areas : Ottawa , Renfrew Counties , Eastern Counties ● Allied Health – Physio, Occupational therapy, Dietician, Social Work ● Community Support Services: Drivers, Homemakers, Meals on Wheels ● Personal Support Workers – 500 and growing ● Day Programs, Guest House and Retirement Home for cognitively impaired persons 9

Community Health Care Agencies –supporting Home Care ● ~ 5 “Home Care Agencies in Ottawa have contracts with the Champlain LHIN to deliver nursing in the home, ● Agencies “specialize” in some areas to ensure competencies are maintained ○ Pediatrics ○ peritoneal dialysis ○ Total Parenteral Nutrition ○ Palliative care ● Approximately 600 – 700 nurses (RN and RPN) are employed as visit nurses in the community in Champlain LHIN Trends in Community/Home Care ● Call it Community Care – use clinics for nursing - less costly, ○ Bc Home Care can mean care delivered in your home but we use CLINICS ● MOTTO = Teach, reduce, discharge – discuss d/c plans on the first visit – must be able to engage pt in own care, ● Chronic Disease Self Management (example: diabetes), ● Greater need to be accountable for the care we provide to our main contractors and ultimately the tax payer, Certification becoming more important: → Need more education & be certified  ound specialist” d  esignation from Wounds Canada ● wound expertise is a must –  RN/RPN and become “ w within their scope of practice, NSWOC/WCCC/SWAN (RPN)/ ● Palliative – C N A Hospice Palliative Certification ● CVAA – Canadian Vascular Access Association Certification Community Care/Home Care – The Evolution ● Inc acuity of client’s, ● PSW’s support client's with bathing and personal care ● nurses are more skill, teaching and task oriented, ● Movement from  home based care to clinic care – Carefor has 2 nursing clinic sites with the capacity to run 3 - 4 at each site for a total of 6/7, ● Other agencies also have nursing clinics ● A number of specialty programs at Carefor: ○ Palliative care and supportive oncology including CHIPP (chemo home infusion) (~35%) ○ Complex Wound care (~45%) ○...