Community Health Nursing in Canada

Historical Milestones in Community Health Nursing in Canada

• The Canadian Constitution mandates that provinces offer comparable public service levels for similar taxation rates
• The federal government promotes equalization by providing funds and setting conditions for their receipt
• In 1947, the provincial government of Saskatchewan established publicly funded healthcare, and the federal government followed suit in 1957
• The Canada Health Act of 1984 reinforces five central principles in provincial healthcare systems
• Healthcare systems should be be publicly administered
• Healthcare should be comprehensive for all
• Healthcare should be universal
• Healthcare should be portable
• Healthcare should be accessible

Paradigm Shift in Community Health Nursing

• The Lalonde Report of 1974 presented a vision of health promotion services as vital to Canada's health care
• Lalonde's framework identified four health determinants: environment, lifestyle, human biology, and the health care system
• These determinants were the basis for the current conceptualization of health
• The primary goal of health care is better health services for all
• The Epp Framework contributed to the Ottawa Charter for Health Promotion
• Jake Epp's paper focused on reducing health inequities for low-income groups, suggesting strategies for public engagement, community service enhancement, and public health policy coordination
• The Ottawa Charter greatly changed health promotion

Organizations of Community Health Nursing

• Community health nursing organization and delivery in Canada is influenced by various factors like emerging diseases and health emergencies
• The Public Health Agency of Canada (PHAC) helps protect Canadians' health and safety, focuses on preventing chronic diseases and injuries, responds to public health emergencies and infectious disease outbreaks, and strengthens public health practices in Canada
• There are a limited number of Indigenous-specific policies and frameworks
• Some provinces lack a specific legislative framework for healthcare responsibilities in Indigenous communities
• In 1990, Ontario was the first province to develop an Indigenous Health and Wellness Strategy, followed by the Aboriginal Health Policy in 1994
• Most Canadian provinces and territories have shifted to regional health authority structures for all health service delivery, integrating most or all health services including CHN services
• Primary Health Care is a core component
• Primary Care is the first point of contact in clinical services enhances health status of communities and promotes health equity
• Cultural competence reduces health inequities and improves outcomes
• Home Care ensures safe care for individuals in their homes with dignity

Policy, Politics, and Power

• Community health nursing practice operates within in sociopolitical environment
• Work of community health nursing is guided by policy, and policy making is done within a political context
• Community Health Nurses must understand how policy and politics affect patient care quality, safety, accessibility, and working conditions
• Power involves knowing team members and their roles, recognizing decision-makers, and identifying future leaders
• Health equity is affected when social conditions prevent people from making health-promoting decisions or actions
• Fairness in treatment and decision-making is central to social justice
• Ensuring good health for all is identifying and enhancing ways to address systemic disadvantage
• Community Health Nurses must navigate the complex policy environment by understanding the effects of sociopolitical processes on their micro and macro practices

Challenges in Community Health Nursing

• Community Health Nurses influence the health of individuals, families, communities, and society, but face challenges, including health system issues, unclear roles, need for strong leadership, and interprofessional relationship issues
• Health system challenges necessitate advocacy and collective action for system change
• Lack of role clarity requires greater role for CHNs across Canada
• A lack of strong leadership leads to invisibility of CHNs
• Issues in interprofessional relationships require strong organizational support
• Leadership and community influence development is a key strategy for all Community Health Nurses
• The Registered Nurses Association of Ontario's "Best Practice Guideline: Developing and Sustaining Nursing Leadership" discusses the positive impact of leadership in the workplace and community
• Nurse leaders need to articulate a clear vision, and have broad prespective, considering communities, the political landscape, and the larger health and social systems
• Support for community and public health nursing includes: effective management, organizational culture, and appropriate government policy