NURS205 Module ONE 2019 20 PDF

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NURS 205: Community Health Nursing Module 1: Roles and Context Community Health Nursing Module 1 Module 1 consists of the following three lessons. Lesson 1.1: Community Health Nursing Objectives Upon completion of this lesson, you will be able to: 

Describe the roles and functions specific to community health nursing

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Develop an awareness of community health nursing subspecialties and various settings where community health nurses work.

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Explain the impact of the determinants of health on population health.

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Define Primary Health Care (PHC) and the five underlying principles that guide the framework.

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Understand the 4 levels of prevention and be able to apply them to practice.

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Describe what is meant by population health practice.

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Identify challenges to acceptance of population health practice.

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Become familiar with the Canadian Standards of Practice for Community Health Nursing and Entry to practice public health nursing competencies for undergraduate nursing education.

Required Readings Canadian Association of Schools of Nursing (CASN). (2014). Entry-to-practice public health nursing competencies for undergraduate nursing education, pp.12-16. Retrieved from CASN/ACESI website: https://www.canada.ca/en/public-health/services/public-health-practice/skillsonline/core-competencies-public-health-canada.html.

Canadian Nurses Association (CNA). (2015). Position Statement: Primary Health Care. Retrieved from: https://cna-aiic.ca/~/media/cna/page-content/pdf-en/primary-healthcare-position-statement.pdf?la=en

Lesson 1.1: Community Health Nursing © Continuing & Distance Education, St. Francis Xavier University (2019)

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NURS 205: Community Health Nursing Module 1: Roles and Context Community Health Nursing Stanhope, M., Lancaster, J., Jakubec, S., & Pike-Mac Donald, S. (2017). Community Health Nursing in Canada (3nd Canadian ed.). Chapter 1 & 3 & Appendix 1. Toronto: Mosby Elsevier. The Association of Faculties of Medicine of Canada (AFMC). (n.d.). AFMC Primer on Population Health. Retrieved from https://phprimer.afmc.ca/en/ Discussion In your textbook, Community Health Nursing (CHN) is defined as an overall term that includes community health nurses working in a variety of nursing practice areas such as public health, home health, occupational health and others. This definition includes nurses who not only practice in the community setting but whose focus of care embraces the individual, family, group or community. Read through tables 1-3 and table 1-4 of your textbook (p. 19-23) for a more indepth description of the roles, functions and practice areas for CHN. Regardless of where CHN’s work, it is defined as a specialty practice area. Roles for CHN have evolved and changed in response to a number of influencing factors such as the changes in health care with more patients being treated in their homes and the development of standards of practice for CHN’s. In 2003, the Community Health Nurses Association of Canada (CHNAC) developed standards of practice for this specialty area. Nursing standards demonstrate that a profession is concerned with making sure that the public is protected through identification of criteria of its professional practice (Canadian Nurses Association, 2007). In your textbook on page 24 you will find the conceptual model for the Canadian community health nursing practice standards. Appendix 1, pages 569-573 of your textbook gives a full description of the 7 standards of practice. It is expected that nurses within 2 years of beginning practice in community health nursing will be expected to meet the requirement of those practice standards. See Table 1.6 in your textbook for examples of how the standards are operationalized in practice. Community health nurses can also obtain a specialization certificate from The Canadian Nurses Association (CNA). This has been in place since 2006 and although not a requirement for practice, it does provide additional resources for nurses in this practice area.

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NURS 205: Community Health Nursing Module 1: Roles and Context Community Health Nursing The Canadian Public Health Association released the 4th edition of roles and activities for public health/community health nursing practice in Canada (2010). Essential functions of public health nurses are described in the document in terms of: health promotion, disease and injury prevention, health protection, health surveillance, population health assessment and emergency preparedness and response. Please review this required reading. The required reading from CASN (2014) identifies why those competencies are required for new nurses entering the profession. The rise in chronic diseases, the move away from expensive acute care to care in the community and globalization all point to a need for nurses to be prepared in public health. As you progress through this course, be sure to refer back to this document regarding the importance of the competencies. As mentioned above, CHN practice includes a focus on disease prevention. You will need to develop a working knowledge of the 4 (primordial, primary, secondary & tertiary) levels of prevention and be able to apply them to CHN practice. Although CHN’s may work with individual clients, their approach is from a perspective of the “bigger picture” or that of upstream thinking. Upstream thinking looks beyond the individual with a focus on the determinants of health. Their practice frequently involves collaborating with various groups, such as communities, families, individuals, other professionals, voluntary organizations, self-help groups, informal health care providers, governments and the private sector. The required reading “AFMC Primer on Population Health” gives further clarification regarding the levels of prevention. The theoretical foundation of community health nursing practice is based on a model of primary health care, which emphasizes health promotion and maintenance, illness and injury prevention, community participation, and community development. Primary health care is a conceptual framework that is used in providing essential care services (i.e., promote, preventative, curative, rehabilitative, and supportive) to prevent illness and promote health in populations (World Health Organization, 1978). Primary Health Care, as a concept, should not to be confused with primary care. Read through the required reading from CNA, page 2 and 3 for a clarification between the two terms. There are five underlying principles of Primary Health Care. These include accessibility, public participation, health promotion, intersectoral collaboration, and appropriate technology (WHO, 1978). Accessibility dictates that all Canadians should have reasonable access to health care services without financial barriers. Public participation encourages people to become involved in health planning and decision-making on matters concerning their health. Health promotion focuses on assisting individuals to remain healthy as opposed to treating them when they are ill. Lesson 1.1: Community Health Nursing © Continuing & Distance Education, St. Francis Xavier University (2019)

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NURS 205: Community Health Nursing Module 1: Roles and Context Community Health Nursing Intersectoral collaboration involves the cooperation of multiple disciplines, agencies, and community and government sectors in improving economic and social development. This would involve, for example, development of healthy public policies to improve the health of the population. Appropriate technology requires that health care technology used within a community be appropriately adapted to the community’s social, economic, and cultural needs. It should reflect the health needs of that community, be cost-effective, and contribute in some way to the health outcome of the community. Read through your textbook for more in-depth application of these principles in community health nursing practice. Many CHN’s operate from a population health perspective. Essentially population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. This is accomplished by looking at and acting upon the broad range of factors and conditions that have a strong influence on our health (Public Health Agency of Canada, 2012). Review pages 4 and 5 in your textbook for a discussion on the determinants of health along with the social determinants of health. A distinguishing feature of the population health perspective is that it focuses on explaining differences in health at the population (e.g., community) level, rather than at the individual level (Stanhope & Lancaster, 2004). Chapter 3 in your textbook also provides more in-depth information on the settings, functions and roles of community health nurses in Canada. The Federal, Provincial, and Territorial Advisory Committee on Population Health, 1994, describe the concept of Population Health through a developed framework entitled: The Population Health Promotion Model. This model that is found on page 4 of your textbook is an integration of concepts of health promotion and population health developed by Hamilton and Bhatti. This model which is aimed at improving health explores four major questions: “On what can we take action?” How can we take action?; “With whom can we act?” and “Why take action?” (Saskatchewan Health, Population Health Branch, 2002). As shown in Figure 1-1 of your textbook, strategies for health promotion are listed on the right hand side with the determinants of health on the front side of the model, and the various levels of interventions on the top part of the model. The Population Health Promotion Model shows evidence-based decision making as the basis for action. This model can be used to plan actions or to address health concerns of groups at risk.

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NURS 205: Community Health Nursing Module 1: Roles and Context Community Health Nursing There are many challenges to maintaining a population health practice. As the majority of nurses’ work within the acute care setting, many feel that the primary role for nurses is at the bedside of the client. This perspective is also held by many in the general population who have traditionally viewed nurses as existing largely within the acute care environment. Another challenge is the socialization of nurses within the organizations for which they work, where practices may be incongruent with the principles of population health practice. The last challenge is the educational preparation available for nurses. As nurses, it is necessary to receive training not only to obtain clinical skills but also to be knowledgeable of population health practices in order to function effectively in the current health care environment. The concepts discussed in this part of the module serve as the building blocks for the rest of the course. Please do not advance to the next section of this module until you are confident you have a good grasp on this material.

References Canadian Public Health Association. (2010). Public health – Community Health Nursing practice in Canada: Roles and Activities. (4th ed.). Ottawa: Author. Community Health Nurses of Canada. (2011). Canadian Community Health Nursing: Professional Practice Model & Standards of Practice. Ottawa: Author. Public Health Agency of Canada (2012). What is the population health approach? Retrieved from http://www.phac-aspc.gc.ca/ph-sp/approach-approche/index-eng.php Saskatchewan Health, Population Health Branch. (2002). A population health promotion Framework for Saskatchewan Regional Health Authorities. Retrieved http://www.health.giv.sk.ca/health-promotion-framework

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Stanhope, M., & Lancaster, J. (2004). Community health nursing: Promoting the health of aggregates, families, and individuals. St. Louis: Mosby. World Health Organization (WHO) (1978). Report of the international conference on Primary Health Care in Alma Ata, USSR. Geneva, Switzerland: Author.

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NURS 205: Community Health Nursing Module 1: Roles and Context Community Health Nursing Lesson 1.2: Public Health Objectives On completion of this lesson, the student will be able to: 

Describe the organization and structure of public health in Canada.

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Describe the mandate of the Public Health Agency of Canada.

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Identify the core functions of public health.

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Define public health core competencies (7 broad categories).

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Discuss how core competencies would assist a public health organization

Required Readings Public Health Agency of Canada (2017). Core competencies for public health in Canada. Ottawa: Author. Retrieved from https://www.canada.ca/en/public-health/services/public-health-practice/skillsonline/core-competencies-public-health-canada.html. Public Health Agency of Canada (2009). Tracking Heart Disease and Stroke in Canada: Executive Summary. Ottawa: Author. Retrieved from http://www.phacaspc.gc.ca/publicat/2009/cvd-avc/summary-resume-eng.php Raphael, D. (2002). Social justice is good for our hearts: Why societal factors not lifestyles are major causes of heart disease in Canada and elsewhere. Retrieved from http://www.socialjustice.org/uploads/pubs/SocialJusticeisGoodforOurHearts.pdf. Although this article is from 2002 it is a germinal article that remains accurately relevant. Discussion Health care in Canada has undergone many changes with much attention on acute care facilities and much less attention on public health activities and programs. The public health system is made up of a collection of governmental, nongovernmental, and community organizations operating at the local, provincial and federal levels. At the federal level, the government oversees the delivery of public health services and develops legislation that guides public health practice Lesson 1.2: Public Health © Continuing & Distance Education, St. Francis Xavier University (2019)

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NURS 205: Community Health Nursing Module 1: Roles and Context Community Health Nursing throughout Canada. The Public Health Agency of Canada is a federal body that is accountable to the federal minister of health. They work closely with their provincial and territorial counterparts to help keep Canadians healthy. The legislative mandate for public health within each province and territory is present in one major piece of public health legislation, the Public Health Act. This act focuses primarily on the health protection and control of communicable disease portions of public health. Other acts and regulations are present in each province and territory and aim to restrict hazards to the health of individuals and of the public in general. Those secondary acts cover such areas as restricting second-hand smoke and legislation to enforce health standards in public areas. Because the legislation is provincial, the act varies between provinces. In Nova Scotia, the Public Health Act was revised and approved in the fall of 2005. The field of public health in Canada grew out of a need to have a central body responsible for policies and practices that had an impact on the overall health of individuals and communities. Historically, in order to address contagious diseases, governments had to assume responsibility for the health of communities. Governments set out mandates in terms of disease prevention and infrastructures were established to ensure the monitoring of population health and threats to it. Standards for things such as sanitation, food, medical services, and environmental health were mandated through legislation. Research has shown that the health of populations is influenced more by public health activities than improvements and efficiencies in the acute care system. Important achievements for public health during the last century involved immunizations, motor vehicle safety, safer food, healthier moms and babies, fluoridation of water and tobacco control measures. Important Canadian documents such as LaLonde Report (1974), the Alma Ata Declaration (1978), a Framework for Health Promotion (1986) and the Ottawa Charter (1986) have confirmed the importance of public health strategies and their relationship to improving the health of populations. In Canada, as in many developed countries, chronic diseases are fast replacing communicable diseases as leading causes of mortality. In the required reading by Dennis Raphael, nine key messages are given that emphasize the role that societal factors play with respect to major causes of heart disease in Canada. In the June, 2009 report released by the Public Health Agency of Canada (PHAC) entitled “Tracking heart disease and stroke in Canada” the report highlights progress that is being made in reducing mortality rates from cardiovascular diseases (CVD). The report indicated that in 2000 CVD was the 2nd most costly contributor of health care costs in Canada. Their concluding remarks suggest that although mortality rates are declining we must not be complacent as the number of

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NURS 205: Community Health Nursing Module 1: Roles and Context Community Health Nursing individuals who will be diagnosed with CVD may increase substantially in the years to come due to the aging baby boomer population. Most Canadians don’t think about how the public health system functions and takes for granted that crisis will be diverted quickly and appropriately should one arise. The incident in the summer of 2003 was a wake-up call not only for the general population but for those in charge of the health of the population. This incident was the outbreak of an unknown virus in Toronto called Severe Acute Respiratory Syndrome (SARS). The SARS outbreak prompted questions by both health care workers and experts in the field of public health. Why did SARS continue to rage as long as it did? SARS showed us the current system that was in place at that time was deeply flawed. The positive outcome of SARS was that it made us appreciate the importance of public health and the need for more resources being allocated to public health. SARS was also the trigger for the creation of the Public Health Agency of Canada (PHAC). The mission of PHAC is “to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health”, (Public Health Agency of Canada, 2008). PHAC has been involved in many initiatives to raise the visibility of public health in our country. Many professionals such as doctors, nurses, nutritionists, health educations, dentists and dental hygienists all work in public health. PHAC has been involved in the creation of core competencies for public health. Competencies are defined by PHAC as knowledge, skills and abilities that are critical to the effective and efficient function of an organization. Core competencies contribute to a more effective workforce and encourage service delivery that is evidence based & population focused, ethical, equitable, and standardized. Core competencies also assist in explaining to others, the nature of public health and help public health organizations identify the skills and abilities that are required to work in the organization. The final version 1.0 of the core competencies was released in September of 2007 at the annual Canadian Public Health Association conference in Ottawa, Ontario. In the final version, a total of 36 core competencies are divided under 7 broad categories. Read through the required reading from the P...