Culture in Community Health Nursing

Housekeeping

• TT#1 marks from this semester were comparable to previous semesters
• Report any problematic group members to the course professor immediately
• Part 2 of group assignment is due to handed back by Monday

Characteristics of Culture

• Culture includes language, gestures, tools, customs, and traditions
• Theses charactertics define a group's values
• These charactertics organize social interactions
• CHNs should focus on how culture is defined and redefined
• Be aware of the power and privilege associated with defining other people's cultures
• A major barrier to understanding culture is the biomedical Eurocentric foundation of nursing practice
• Community health nursing practice emphasizes cultural contexts within broader societal structures

Characteristics of Cultures

• Culture is a social construction
• Culture is an integrated system in everyday life
• Culture is shared
• Culture is largely implicit and tacit
• Culture is fluid and dynamic
• Culture intersects with race, gender, ethnicity, class, language, and disability

Diversity in Canada

• Statistics Canada (2016) estimates that FNMI populations will likely exceed 2.5 million in the next two decades
• The 2016 Canadian Census recorded 7,540,830 foreign-born individuals who immigrated to Canada; 21.9% of the total population
• An immigrant is defined as someone eligible for permanent residency
• New immigrants' health status declines after arriving in Canada
• Foreign-born visible minority women are the most vulnerable to health decline
• Job opportunities are impacted by language barriers and racism
• These impact the social determinants of immigrant health
• Social isolation, refugee camp experiences, multiple war-related translocations, and awareness of family hardships are risk factors for post-traumatic stress
• New Canadians often have difficulty finding a nurse practitioner or a physician
• Health services are typically limited episodic care instead of comprehensive care
• New Canadians may wait three months for provincial health coverage eligibility

Culture, Race & Racism

• Culture is a broad term encompassing language, communication, relationships with land/food, rituals, art, customs, beliefs, and attitudes
• Race has no scientific basis; it's a social construct justifying racist notions of white supremacy
• Racism is the systematic denial of rights, representation, or resources based on racial differences
• Racism arises when "race" exclusively describes people of colour, which is referred to as racialization
• Racialization in healthcare results in racial profiling and inaccurate client assessments
• Racialization can negatively, derogatorily, demean, and endanger well-being
• Despite being a systematic issue, Canadians including nurses can take action to dismantle racism

Cycle of Oppression

• The cycle of oppression helps understand how stereotypes and prejudice lead to systemic oppressions
• The cycle starts with creating and maintaining stereotypes about individuals, families, and communities
• Prejudice is a preconceived opinion and way of thinking based on stereotypes that often runs without direct knowledge but is embedded in our thinking
• Discrimination is action or inaction based on prejudice
• Oppression is discrimination backed by systemic power, specifically health systems

Cultural Competence, Safety & Humility

• Cultural competence a process through which nurses plan effective and appropriate interventions for cultural health needs
• Cultural competence is a lifelong process that involves approaching relationships with openness and humility
• It is not about "knowing" specific cultures
• Cultural safety: Effective nursing practice should occur with clients from another culture and makes issues of power explicit
• Cultural safety models take cultural awareness and competence as a start, while cultural safety aligns with advocacy
• Cultural humility enhances/extends culturally safe care
• The First Nations Health Authority's #itstartswithme movement states that system-wide change starts with every individual in health
• Cultural humility and competence align with CHNC (2011) standards and competencies

Racism in Nursing

• Racism in nursing includes acting as a barrier to health equity and social justice
• Culture and values and application of racism to nursing
• Teaching about race, racism, and health in nursing
• Examples of racism in nursing include systemic racism toward nurses of colour, racialist discourses, and white privilege in the nursing profession
• More includes white lens perspective on nurse education, especially in mentor-student relationships.
• White Euro-Canadian privilege links to settler privilege
• Settler privilege includes unearned, current, and historical advantages that settler Canadians rely on due to the relationship to original settlers
• White privilege and settler privilege offer advantages across the lifespan and operate in health

Anti-Racist and Anti-Oppressive Lens

• A component of anti-oppression work includes understanding privilege, understanding how the cycle of oppression operates, and acting for social change
• An anti-racist and anti-oppressive lens involves CHNs actively seeing stereotyping, prejudice, and discrimination
• Spotting how the cycle of oppression plays out in education, research, policymaking, and social action
• Recognize operation of oppression and privilege daily to engage in understanding and mapping

Ecological Determinants of Health

• Necessary to sustain all life forms on Earth
• Ecosystems of Earth's atmosphere, oceans, lands, or essential "natural goods and services"
• Essential for life on Earth
• Essential resources for oxygen, clean water, shelter materials
• Indigenous Traditional Knowledge about ecosystems links to land and community site diversity amongst Indigenous population
• Indigenous people: Ancestral land relations offering unique insights called Traditional Ecological Knowledge and Wisdom

Environmental Health Inequities

• Children, older adults, and First Nation, Métis, and Inuit communities in Canada are known to be vulnerable to environmental health inequities
• Children more inclined to pesticide exposure after residential use
• Older adults more likely to be impacted by weather

Environmental Inequalities

• Indigenous communities vulnerable due to inadequate housing
• Inadequate housing exposes to overcrowding, mould, unsafe water
• The environment affects people differently
• Differences depend partially on geographic and geo-political
• Social location along axes of gender
• Social location along axes of race and ethnicity
• Socioeconomic status, occupation, and developmental stage are other elements

Global Change

• Climate change impacts Indigenous cultures, identities, food security, and health globally
• Increased air pollution via CO2 is a major climate change driver
• Climate change causes respiratory and cardiovascular diseases
• Pollution interconnects with Ecotoxicity and loss of biodiversity
• Increasing urbanization/displacement and related food/housing insecurity are sociopolitical trends which drive global change

Planetary Health and Environmental Health Equity

• Indigenous people's relationships to the land, deep respect, humility, and responsibility express Indigenous health and environment views
• Two-Eyed Seeing overcomes Western dualistic thought; it opens relationship toward the environment
• Intersectional ecological-feminist approaches, renouncing the practice of value dualism and hierarchical thinking
• Planetary health addresses significant, unprecedented impact by human activities on Earth's ecological systems, and its impacts on human health

Levels of Prevention:

• International, national, provincial, and municipal policies protect the environment, the focus of nursing practice at the primordial level.
• Primary prevention includes immunization, counselling, and supporting policies to reduce exposure; relate to environmental/occupational health
• Secondary prevention: early detection/screening to environmentally related disease limits disability
• Tertiary prevention: environmentally related disease recovery/rehabilitation from developed disease/condition
• Population health co-benefit approach include advocating with clients/community on pesticide-free lawns/gardens
• Recognize links between over-medicalization of patient and ecosystem health relative to pharmaceutical compounds in marine species
• Quaternary level: nursing practice advocating for appropriate patient selection of only the most drugs necessary