Community Health Nursing in Canada: Blueprint

• The class should be put in the subject line when emailing.
• Group contracts are due Sunday at midnight.
• A template should be used when creating a group contract.
• Group contract submissions should include unique things about the group's collaborative approach and be submitted as a .docx file through group sections.
• The exploration of neighborhood content begins next week.
• COCO and the course outlines are updated on the course shell.
• A copy of any course should always be downloaded.
• A community health nurse (CHN) works with people to promote health where they live, work, learn and worship.
• The patient includes individuals, families, groups, communities, populations, and systems.
• CHNs work in homes, schools, workplaces, streets, shelters, churches, field hospitals, community health centers, and outpost nursing stations.

Community Health Nurses of Canada

• The Community Health Nurses of Canada (CHNC) was established in 1987.
• It is a voluntary association of community health nurses and provincial/territorial community health nursing interest groups.
• CHNC provides a unified national voice to represent, promote and champion community health nursing and the health of communities.
• CHNC is an associate member of the Canadian Nurses Association (CNA).
• The Blueprint for Action for Community Health Nursing in Canada (2011) offers a national framework for dialogue on developing community health nursing practice in Canada.
• The Blueprint is the product of collaboration and is meant to provide diverse stakeholders a framework to inform decisions and activities that promote/protect the health of Canadians.
• The Blueprint identifies six areas of action.
• The intent of the Blueprint for Action is to inform decisions about CHN practice and promote and protect Canadians' health.

Six Areas for Action

• Scope of Practice; entails working across provinces and territories at full scope with more clarity in practice domains, such as common practice scope, practice roles, and nomenclature.
• Leadership; supports nursing leadership development and positions to advance community health nursing practice and provide a voice for the profession.
• Interprofessional and intersectoral partnerships; leverage successful collaboration inside nursing and reinforce partnerships with other professionals and sectors.
• Health Systems transform the health care system into a system for community health.
• Nursing Education supports strong educational preparation in community health nursing.
• Workplace Development improves access to professional development resources to advance community health nursing capacity.
• There are eight Canadian Community Health Nurses Standards of Practice.
• The next version of the standards and the professional practice module will integrate Indigenous nursing and health.
• Current practice reflects a greater emphasis on social justice and the social and environmental determinants of health.
• Employers use the standards to implement professional development programs, inform educational curricula, and guide research.

Canadian Community Health Nurses Standards of Practice.

• Health promotion, prevention and health protection.
• Health maintenance, restoration, and palliation.
• Professional relationships, capacity building, health equity.
• Evidence-informed practice, professional responsibility, and accountability.
• CHNs care for populations experiencing health inequities and health disparities.
• Populations experiencing health inequities in Canada include; First Nations, Métis, Inuit, LGBTQ2S or sexual orientation, and gender identity minorities.
• Newcomers or anyone in a marginalized category are also considered populations experiencing health inequities.
• CHNs can address Indigenous health inequities by identifying prejudice among health workers and integrating trauma-informed care into their practice standards.
• Providing services for all Indigenous peoples and advocating for better supports for health workers in Indigenous communities helps CHNs address inequities.

Recognition & Certification

• In 2005, the Community Health Nurses Association of Canada (CHNAC), which is now the CHNC, received formal designation of community health nursing as a nursing specialty by the CNA national certification program.
• The first CNA community health nursing certification examination was offered in 2006.

CHN Roles, Competencies and Practice Settings

• Indigenous nursing involves the care, beliefs, values, practice, traditional knowledge, education, research, administration, and policies of First Nation, Inuit, and Métis nurses.
• Public health nursing applies knowledge from public health, nursing, social and environmental sciences, and research.
• Home health nursing is a specialized area where the nurse, who is employed by a home health agency, offers clinical care in the client's home, school, or workplace.
• Primary care nurses provide the first contact with the health care system.
• Telehealth nurses triage health issues, consult, provide advice/counsel/support and educate, and coordinate care for chronic disease management.
• Outreach/street nurses see their clients where they are; they focus on building relationships while ensuring safety, dignity, and respect.
• Rural and Northern Canada nurses are active in the community; at homes, schools, clinics, outpost nursing stations, and in First Nation, Inuit, and Métis communities.
• Military nurses are commissioned nursing officers of the Canadian Forces Medical Service.
• Occupational health nurses base their practice on four interrelated components: individual, health, occupational health nursing, and the environment.
• Parish nurse is a nurse with specialized knowledge to promote health, healing, and wholeness; they are hired or recognized by a faith community; and integrates faith and health into nursing practice.
• There are approximately 60 certified parish nurses in Canada.
• Forensic nurses provide for health care needs and collect evidence for the police and the legal system in a way that respects clients' dignity, right to choice, and self-determination.
• Community mental health nursing involves a blending of community nursing and mental health/psychiatric nursing.

Expansion and Regulation of Practice

• There are four regulated nursing groups in Canada's profession: RNs, nurse practitioners, licensed/registered practical nurses, and registered psychiatric nurses.
• The College of Nurses of Ontario has guiding principles to distinguish RN and L/RPN practices.
• Nurse practitioners (NPs) are advanced practice nurses with titles used by NPs varying across practices, settings, provinces, and territories.
• Registered psychiatric nurses are educated and regulated only in western provinces (British Columbia, Alberta, Saskatchewan, Manitoba) and the Yukon territory.

Roles within Community Nursing include:

• Public Health Nurse, Home Health Nurse, Rural Nurse
• Occupational Health Nurse, Community Mental Health Nurse, Primary Care Nurse
• Forensic Nurse, Military Nurse, Parish Nurse, Telehealth Nurse, and Outreach/street Nurse

Public Health Nursing

• Integrates knowledge from public health, nursing, social and environmental sciences, and research.
• Integrates all of the above with concepts of primary health care, disease and injury prevention, community participation, community development, social health determinants, and health equity.
• The goal is to promote, protect, and maintain the health of the population.
• The essential functions of public health are health promotion, disease and injury prevention, health protection, health surveillance, population health assessment, and emergency preparedness and response.

Home Health Nursing

• Nurse who is employed by a home health agency.
• Offers clinical care in the client's home, school, or workplace.
• HHNs provide resources to promote clients' optimal well-being and functioning.
• HHNs empower clients and their caregivers or families to take charge of their own care.
• Indigenous nursing's nursing care and interventions are targeted towards Aboriginal communities and populations.
• This includes community empowerment.
• The Canadian Indigenous Nurses Association describes Indigenous nursing as nursing care and interventions informed by traditional knowledge, values, and beliefs.
• Indigenous nursing applies to clinical practice, education, research, administration, and policy that involve First Nation, Inuit, and Métis nurses.

Emerging Trends in Community Nursing

• Practice standards for CHNs include using political and social advocacy to change the conditions that lead to marginalization and inequities.
• The use of Information communication technology (ICT), such as workstations and telemonitoring applications, is expected of CHNs and continues to expand nursing practice.
• Evidence-based practices are becoming increasingly important for CHNs, like the guidelines of the Registered Nurses Association of Ontario (RNAO).
• With rising rates of chronic preventable diseases, preparation for CHN in undergraduate nursing programs is becoming more important.
• Lots of resources are available online and the sector itself is rapidly expanding.
• Community nursing is a great alternative, if working in the hospital setting is unappealing.
• Nurses beginning their careers in the community tend to remain in that setting for long periods of time.

Introduction to Ethics

• Community health nurses (CHNs) encounter ethical issues in all facets of their everyday work.
• Ethical nursing practice requires CHNs to be able to reflect critically upon their practice, make sound ethical decisions, and take appropriate action.

Ethical Values of Canadian Nursing

• These values, as stipulated by the CNA in "Values and Ethical Responsibilities", include:
• providing safe, compassionate, competent, and ethical care
• promoting health and well-being
• promoting and respecting informed decision-making
• honouring dignity, maintaining privacy and confidentiality
• promoting justice and being accountable.
• The term "ethics" encompasses the values, norms, moral principles, virtues, and traditions that guide human conduct.
• The study of ethics involves reflecting on what is good or right and determining what one ought to do.
• Both ethics and morals refer to right and wrong behaviors and conduct.
• Ethics are rules provided from an external source, whereas morals are an individual's own principles.

Social Justice

• Equity in society.
• It entails equitable distribution of society's benefits, responsibilities and their consequences.
• Focuses on the relative position of social advantage of one individual or social group in relationship to others in society; root causes of inequities and what can be done to eliminate them.
• Societal benefits and responsibilities are distributed so that disadvantaged populations have priority.
• Equity is fairness involving situations have to be judged in relation to the contexts in which they occur.
• If a difference between two groups or individuals is unnecessary/avoidable within a context it is an unfair difference/inequity.
• Equitable situations are the way inequities/social are measured.
• Equality means being equal.
• Equality is about equal shares and equity is about fair shares.
• Root causes of inequities are socio-cultural norms/aspects of systems, structures, institutions and routines that create or sustain unfair differences between individuals/groups, and/or contexts.

Attributes of Social Justice

• Includes equity
• Human rights
• Democracy and civil rights
• Capacity building
• Just institutions
• Enabling environments
• Poverty reduction
• Ethical practice
• Advocacy and partnerships
• Social justice assumes that all societies experience systematic oppression/inequities (e.g., racism, sexism, heterosexism, classism) which affect some people.
• Individuals contribute to oppression/inequity (even unintentionally) and are responsible for contributing to the achievement of social, political, and economic parity.
• Social justice is important when situating the ethical dimensions of health-care policy within a broad political understanding of the healthcare service role in society.
• Social justice approaches are concerned with how power is used ethically in health care.
• Social justice may consider ethical factors in community nursing such as; the use of power in health care, persons being viewed relationally as unique, and everyday life issues.

Social Control

• Social processes by which the behavior of individuals or groups is regulated.
• Includes mental health act.

Five Justifications for Public Health Programs and Policies

• Overall benefit, collective action and efficiency, and fairness in the distribution of burdens.
• The harm principle and paternalism.

Ethical Issues in Community Health Nursing

• Ethical and legal issues that can arise in community health nursing practice: health promotion/prevention and health protection.
• Health maintenance, restoration, and palliation.
• One way of addressing ethical concerns is to implement the five levels of prevention: primordial, primary, secondary, tertiary, and quaternary prevention.
• Specific areas of ethical and legal concern include:
• capacity building
• access and equity
• professional responsibility and accountability
• negligence

Levels of Prevention in Health Care

• Primordial prevention aims at preventing the emergence or development of risk factors with health education and promotion being modes of intervention.
• Primary prevention aims to prevent disease when risk factor is present while lifestyle modification is the mode of intervention.
• Secondary prevention aims at prevention of complication of disease that is already occurring while early diagnosis.
• Is the mode of intervention.
• Tertiary prevention aims prevention of disability or death with rehabilitation while disability prevention is the mode of intervention.
• Quaternary prevention aims prevention of over diagnosis and treatment with rehabilitation while disability prevention is the mode of intervention.

Legal Responsibilities

• Maintaining privacy and confidentiality is a legal responsibility of CHNs.
• CHNs must disclose health information on a need-to-know basis and follow privacy legislation, with exceptions for court orders.
• Legal issues may arise from negligence resulting from a breach in the standard of care.

Capacity Building

• CHNs work collaboratively to build individual and community capacity through empowerment and advocacy.
• Community health nursing advocacy stands for reforms aligned with public health goals.
• CHN advocacy often has a strong social justice orientation for populations sensitive to health inequities or marginalized.

Political ethics

• Ethical problems in the community can manifest as political issues.
• Power is ethically neutral; however, the use of power carries ethical significance.
• Efforts to prevent disease and injury limit individual liberty (e.seat belt laws).

Explore the goals and utilization of the Blueprint for Action for Community Health Nursing in Canada. Learn about its role in addressing practice inconsistencies, enhancing collaboration, and guiding nursing education to improve skills and knowledge.