Conceptualizations of Health

Conceptualizations of Health

• Disease is an objective state of ill health that involves pathological processes.
• Illness is a subjective experience related to the loss of health..
• Health is a multidimensional concept with physical, mental, social, and spiritual aspects.

Ottawa Charter for Health Promotion

• Health is a resource for everyday living and a positive concept that emphasizes social, personal, and physical resources.
• Health promotion extends beyond the health sector and also beyond healthy lifestyles to focus on well-being.
• Wellness is a subjective experience.

Approaches to Health in Canada

• A biomedical approach, behavioral approach (Lalonde report, 1974), and socioenvironmental approach are the three main models for understanding health.

Biomedical Approach to Care

• Health problems are primarily defined by physiological risk factors.
• Illnesses and symptoms stem from underlying abnormalities in the body (disease).
• Mental and emotional health are considered separate from bodily function.
• Medical focus is on pathology with less emphasis on health promotion and disease prevention.
• Physical tests are used to confirm a client's illness condition, based on physical factors rather than mental.

Behavioral Approach to Care

• In 1974, the Lalonde report moved healthcare away from medicine and towards behavior.
• The focus shifted to health determinants, placing responsibility on the individual to understand risk factors and engage in healthy behaviors.
• Social determinants of health are the deficits in the behavioral approach, with a need for knowledge/education.

Socioenvironmental Approach to Care

• Health is closely tied to social structures.
• Emphasizes the social context of health and the relationship between personal health behaviors and social and physical environments.
• Prerequisites for health are identified to be peace, shelter, education, food, and income.
• “Upstream approach” should be taken by nurses (and for nurses!) Re: Bill 124

Social Determinants of Health (SDH)

• Income and its distribution
• Social support networks
• Education and health literacy
• Employment and working conditions
• Physical environment
• Biological and genetic endowment
• Individual health practices and coping skills
• Healthy child development
• Health care services
• Gender and culture

New Model of Care

• Illness can be the result of issues in the physical and social environment.
• Individuals are complex, two-system beings with influencing factors.
• Persons interact with physical, social and cultural contexts.

Implications for a New Model

• Non-medical reasons are considered to facilitate health.
• Resources are needed to alter contextual illness factors.
• Personal choice can play a role in wellness.
• Pathology-focused systems do not work because they focus on ignore all patient context and work in short time scales.

Healthcare Delivery System Settings

• Approaches available include Institutional, Community/Volunteer Sector, and Private Sectors

Institutional Sector Settings

• Hospitals
• Long-term care(LTC)
• Rehabilitation centers
• Psychiatric facilities

Community and Voluntary Sector (third sector) Settings

• Community services focus on primary and secondary levels of care.
• Primary role of community health nurses (CHNs) is to promote, protect, and preserve health in various settings.

Private Sector Care

• Healthcare that is provided on a fee-for service bases to the consumer such as Cleveland Clinic, Amica, and Stewart Homes

Levels of Care in Canada

• Level 1: Health Promotion
• Level 2: Disease and Injury prevention
• Level 3: Diagnosis and Treatment
• Level 4: Rehabilitation
• Level 5: Supportive care

Critical Social Theory

• A tool to explore and question discourse and its social world, seeking to reveal hidden agendas that influence our actions..
• A tool that allows us to examine the social construction of healthcare delivery that reinforces the unidirectionality of the discourse.
• Critical Social Theory helps to question the 'unthinking' (unconsciousness) ways of doing.
• Inequality exists, allowing review on how society if constructed.
• Allows focus on human illness, reflects on nurse-client asymmetry, examines nurse-client power, and views power as surveillance.

Role of the Nurse in Health Care Using a CST Perspective

• All knowledge is constructed and interpreted through society's traditional ways, that contain and control individuals.
• Awareness of domination and control challenges traditional assumptions.
• CST challenges the 'status quo' because facts are malleable, tied to values and beliefs.
• Voices are identified and addresses within healthcare structures that have been silenced.

CST and Relevance to Nursing

• CST enables nurses to identify the constraining powers in the system and power structures to which nurses are subjected.

CST: The Client-Nurse Relationship

• Power in the nurse-client relationship is asymmetrical because the client is seeking help.
• There is power asymmetry in human vulnerabilities which relates to caring behaviours.
• Traditional caring behaviours of nurses have implications for abuse.

Acute Care

• Acute care is dependent on time-sensitive, individual-oriented, frequent, rapid interventions.
• It encompasses all promotive, preventive, curative, rehabilitative, and palliative actions with the primary purpose to improve health with curative and diagnostic actions..
• Types of care include trauma, emergency, urgent, critical, and prehospital

Entry Points to Acute Care

• Emergency care via ambulance, urgent care referral, surgery, labor and delivery, routine procedures, follow-up care, and diagnostics

Examples of Acute Care

• Emergency rooms serve patients with acute, rapidly changing needs.
• Intensive care units are provided to patients experiencing a sudden decline in health
• Urgent care centers address urgent, non-emergency needs.

Hospital Types

• Teaching hospitals provide high quality, significant research, and postgraduate training.
• Community Hospitals has no defined, strict classification.
• Small hospitals are defined by the Joint Policy and Planning Committee (JPPC) as single community providers with under 2,700 inpatient acute cases

Acute Care Organization

• acute care is organized into:
  • Respiratory units
  • L&D
  • Ambulatory care
  • Medicine units
  • Step-down units
  • Surgical units
  • Recovery rooms
  • Operating rooms
  • ICU/CCU
  • Transplant units
  • Dialysis units
  • Pediatric Units -Psychiatric units

Patient Experience of Acute Care

• The patient experience can be seen in scenarios like acute deterioration and chronic renal failure

Hospital at Home - New Era

• With many Canadian hospitals experiencing over capacity, this is a new alternative for acute care solutions.
• It offers hospital-level therapies, monitoring, and testing within patients' homes and is suitable for patients that need acute care but are stable.
• Those receiving this type of treatment are registered and treated like inpatients

Hospital at Home - Background

• Hospital-at-home care includes registering and treating patients as inpatients but in their homes.
• Patients get treatments and monitoring delivered from the hospital system to their homes with seamless transition and comprehensive care.
• Island Health launched this as a program in 2020 during the COVID-19 surge, and it helps manage hospital needs through strategic planning.

Hospital at Home - Global Influence

• Countries like Australia, Spain, and France have used this approach for over two decades.
• Research shows benefits such as lower readmission rates, shorter durations, and reduced need of residential care.

Island Health's Program (BC Model)

• Provides home visits, remote monitoring, and 24/7 professional access for conditions like congestive heart failure or COPD
• It's estimated that 5%-10% of inpatients are eligible, which reduces hospital burden while efficient care is provided.

Case Study: Alberta Example

• Alberta Health Services has a similar 'Complex Care Hub' program that launched pre-pandemic.
• Hospital congestion is lessened while high care standards with efficiently managed patient needs.

Benefits to Patients

• Patients recover better and have better overall health outcomes.
• Patients avoid stress and hospital-associated infections while staying in a familiar, comfortable environment

Challenges and Solutions pertaining to Hospital at Home

• Implementing hospital-at-home requires significant coordination and resources with key challenges being logistics, patient eligibility, and technology.
• For program success, continuous training for providers and robust support systems are essential

Hospital at Home Outlook

• There is a transformative potential with hospital-at-home, and it can be scaled to reduce hospital burdens and improve patient care quality
• Advances in telemedicine and remote monitoring technologies will support the delivery of care.

Conclusion pertaining to Hospital at Home

• This is a solution to the overburdened healthcare system while providing equivalent, if not superior, care.

Trust and Patient Safety

• Receiving acute care in a patient's home is more comfortable as innovation and supported care continues.
• Patients trust the healthcare system to be safeguarded when receiving hospital care.
• Trauma/negative experiences can put this trust at risk

What is Chronic Kidney Disease(CKD)?

• Severity is classified into stages and affects 10%-15% of adults
• ESRD: ~20k people are receiving dialysis, a process that removes waste and regulates minerals

What and why is Dialysis needed?

• It removes waste and regulate minerals in the body which also leads to regulated blood pressure.
• Hemodialysis (arm) and Peritoneal (stomach) are the types available.

What is Patient Safety?

• It includes equitable treatment with dignity while not cause preventable harm during a patient's health care encounter.
• Emotional harm can be considered from lack of respect, poor comms, or an environment that deters and individual from asking or speaking up.

Chronic Kidney Disease Studies

• Individuals with frequent hospitalizations and dependency on technology and health workers can be at risk.
• Although patients can be self-managing in CKD with appropriate literacy there can be still a challenge

Themes

• Expecting and receiving safe care comes with a sense of reporting concerns

Discussion with Patients

• Reluctance can occur if a patients concern has been overlooked to report and their own opinion to be superseded

Safety Strategy

• Safety strategies have favored physical harms but they need to equally combat issues of the emotional state
• Responding to worries may reinforce values and safety in providing support

High Acute Care Use in Canada

• Focused on demographics, socioeconomic standings and clinical standing to help with overpopulation and lower funding in these areas.

Canada Study Overview

• Study examines high acute care usage in Canada, focusing on demographic, socioeconomic, and clinical factors.
• HSUs are commonly defined using metrics, such as ED visits.
• Disparities can help guide targeted healthcare interventions and for a nuanced understanding

Canada Overview

• Study identifies several key demographic factors associated with high acute care usage.
• Male patients show a ratio 1.60 and older at 1.18.

Community

• Economic is important to note where a times of a 1.42 greater chance of high acute care.
• High acute and income can lead to delayed, inadequate healthcare.

Complex Dynamics

• Age and comorbidity scores interact in complex ways to influence acute care costs.
• Older patients are particularly at risk of high acute care usage

Acute Care Part 2

Assess the feeling of homeness in relation to space, place, privacy, and the sense of control, plus influence abilities A highly specialized setting to consider in the family dynamic.

Technology - Dense Environs

• Countries can enhance experience through visiting hours.
• Impact of place can shift with relationships and power.
• Lack of research can impact payment parking

Space Territories (ICU Setting)

• Patients want to know they can be in control and have privacy
• Patients want to be Social however this can alter recovery

Critical Illness

• People want to consider themselves existential as territorial possessions.

Organization of a Bed

• Spaces and patterns connect people but medical procedures happen here.

Study on Patient Centred Care.

• Room can be set for recovery to enhance or limit the recovery process within the space.

Patient Rooms

• There are multiple areas where these are less sustainable for both work and personal lives.

Isolated patient settings

• Can impact several items across the board when compared at hospitals
• The best choice of a patient is when they are most comfortable with their health

Person Family Centered Care

• Going beyond treating a disease and family and attending to the relationship aspect

Role of RNS

• Using nonverbal communication to have patience and discuss strategies

Practice and Inter Professional health

Advantages are better health outcomes, cost and efficient enhanced provider work.

Scope

• Including the team and care and client with the decisions and care.
• Involving the team so the patient knows the decision and process

Care and Week 4 Information

• Major factors include the environment and genetics
• Managing lifestyle is essential to prevent symptoms

Health promotion.

• Enabling to improve different social aspects.
• Promoting good child and substance health

Health promotion patterns

• Activity should involve high range that is relevant to healthy living

Success through screening

• There are options and access to multiple screening options
• Access to many languages is essential

Immunizations.

• Eradicating is essential to continue in a long history of the program

Developmental Screening.

• Monitoring can not establish diagnosis but is a step to continue to assess for assessment.

Acute Care vs Primary.

• Short term episode that has day to day help of health provide.
• Providing is over a lifespan.

Views on health and support

• It is more diverse and should be an integrated approach not just basic thoughts

Secondary

• More care by the assistance

###Tertiary

• Life threatening illness, which is often a intensive care unit etc.
• How we have used Healthcare as we now are with data and new changes.

###Public Health.

• Managing and providing health resources plus giving the best treatment to ensure we are health.
• Ensure personal and health efforts so we have clear objectives, and can treat.
• Registered health professionals are essential.
• Need to clarify and promote nurses in public primary care
• Design on role on care
• Promote nurses.

###4 Care Roles Relationship builder, care coordinator, support professional programme.

###Ageism Is discrimination.

• Healthcare exist across all levels and may be diverse.

###Article 1

• Look at location and homes in Canada.
• Look at the set of areas required in a setting

###Retirement homes in Canada.

• Over 65 that are not related as directed, which is paid for facilities.

###Long term Homes

• Residents are to stay in a more medical environment and have mental health issues.
• Government controls a home for what can be allowed in each situation

Government in Care - Differences

LTC 24.7 supervision They have intervention issues There are locked units

###RH care - Differences

Should have functional capacity They may have less cognitive impairments They can leave social networking to go out.

COVID issues

• Residents often account for the increase of deaths
• New infection and processes has to change and be updated.

###Discrimination

• Ineffective is concerned. Call for action on age discrimination
• There is need for improvement and methods as practice

3 Aim in practice

System review must show how they do in processes

Barries and Results

• Difficult navigating the healthcare setting
• Not know how to contact numbers and awareness with communication Limited to fund that they can and should be supported

Article on safety

• The death and accident can occur
• Had not confessed. offences continue

No red flags

Noone suspect The alarms did not sound

Systemic- Issues

Medication and management must improve.

What is rehabilitation.

• assist those with trauma
• Support the physical and social

###Challenges Rehabilitation is more then social and to resocialize with support

Ontario Background for rehab

• Ontario system is devided into 14 and has specific people that require knee or hip and heart procedures

2 themes and

The nursing is invisible They provided support and has a role and goal to help.

###Part B: Complementary

• Complimentary and alternative process
• Mainstream practices used alongside
• integrative will bring approaches that are coordinated

""Alternative" They are not supported"

Alternative Therapies

Chiro, massage, tai chi, yoga

Nursing.

Nurses now know drug interactions and can support and educate patients.

• Care is focused to reduce disability, with some people wanting to understand new medical help

###Common CAM

• Helps provide a solution with the healthcare

Clinical Use?

• There is the need for knowledge to access health and wellness or education to communicate the care that the patient is looking for

Application

Recommendations to the case study... The SCOPED is important when helping with cancer.