Determinants of Health

Determinants of Health

• The determinants of health are factors influencing the risk or distribution of health outcomes.
• Canada emphasizes these determinants via a population health approach.
• This approach considers all known individual and collective factors and conditions affecting population health status when planning health improvement actions.
• Epidemiological data is used in the Population Health Approach to determine the etiology of health and disease and identifies eight essentials.
• Social determinants of health are key in influencing the health of Canadians today.
• Social determinants are defined as the economic and social conditions shaping health at individual, community, and jurisdictional levels.
• These determinants affect a person's access to physical, social, and personal resources needed to meet aspirations, needs, and environmental coping.
• Health promotion focuses on improving well-being, while disease prevention targets avoidance, identification, or rehabilitation.
• Disease prevention can be primary, secondary, or tertiary.

Financial and Social Status (Socio-Economic Status)

• Financial and social status include food security issues, housing affordability/homelessness, interpersonal violence, substance use, chronic/communicable disease, and overall ill health.
• Poverty leads to lack of health resources, increased stress, and adoption of unhealthy behaviors to cope with limited resources.
• This includes education, job status, family/social supports, income, and community safety.

Social Support Networks

• These consist of avoiding isolation, exclusion, and lack of supportive relationships.

Education and Literacy

• Education and literacy are important components of health and wellness

Employment and Working Conditions

• Employment and working conditions have a direct impact on health

Social Environments

• Social environments include contaminants leading to disease, isolation in rural/northern areas, housing conditions, indoor air quality, urban development, lighting, and transportation services.

Physical Environments

• Housing is a key component from physical environments

Personal Health Practices and Coping Skills

• Health behaviors are key when considering factors that affect well being

Healthy Child Development

• A focus on the health of children leads to improved future health

Biology and Genetic Endowment

• Biology and genetic endowment also factor into the state of health

Health Services

• Health services play a definitive role in keeping people well

Gender

• Gender plays a part in the overall state of health

Culture

• Culture is a consideration when looking at well being

Health Promotion

• Health promotion is defined as enabling people to increase control over and improve their health by addressing a range of social and environmental factors, not just individual behavior.
• It focuses on informing, influencing, and assisting individuals and communities to take responsibility for their mental and physical health.
• Health promotion empowers people to improve their health by positively changing their physical, economic, social, and political environment.
• Changing behaviors requires internal motivation and external support.
• Health practitioners such as nurses should model healthy behaviors and support people during the change process.
• Health promotion requires a commitment to creating health-conducive environments.
• It is directed across the lifespan.
• Nurses must show understanding/leadership in health promotion through modeling healthy lifestyles.
• It strengthens community health services and working with communities, government, and other health providers.
• Nurses help clients to make their own choices about how to heal and the quality of their life.
• A client-centered, systematic approach to nursing care includes assessment, diagnosis, planning, and implementation

Ottawa Charter for Health Promotion (1984)

• Includes strategies such as building health public policy.
• Creating supportive environments.
• Strengthening community action.
• Developing personal skills.
• Reorienting health services.

Prevention in Health Promotion

• Primary prevention focuses on health promotion and protection before disease or dysfunction occurs, like vaccination, family planning, stress management
• Secondary prevention focuses on the early detection of health problems for treatment, such as TB skin tests, prostate cancer screening, and infant heel pricks.
• Tertiary prevention focuses on restoring function/rehabilitation such as cardiac rehab, pain management, and foot care for diabetes.

Health Promotion vs. Disease Prevention

• Health promotion informs and assists self care of mental and physical health, with people in control of positive change to their environment.
• Disease prevention avoids developing disease through primary, secondary and tertiary strategies.
• The goal for health promotion is to increase well-being and self-actualization.
• The goal for disease prevention is to avoid or delay disease & control risk factors, and are both complimentary.

Types of Health Promotion Programs

• Information Dissemination
• Health Risk Appraisal
• Lifestyle and Behaviour Change
• Environmental Control Programs

Nursing Role and Nursing Process

• Nursing is the promotion of health by assessment, care, and treatment of health conditions.
• It utilizes supportive, preventative, therapeutic, palliative, and rehabilitative approaches.
• Categories of health care include health promotion and illness prevention, diagnosis and treatment, rehab and health restoration, hospice and palliative care.
• Acute illness shows severe symptoms of short duration, such as quick abrupt symptoms.
• It requires help from healthcare professionals, and the patient can return to wellness.
• The nursing process is a method applying theory to nursing practice while helping people to meet their needs.
• The purpose is to maintain optimal wellness, requires client-nurse relationship.
• The process requires 5 phases: ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation).
• ADPIE provides organized approach to nursing care.
• ASSESSING is to collect, organize, validate & document data through interviews, history, tests, review.
• DIAGNOSING is analysing data by analyzing and interpreting the needs, problems, concerns of the client.
• Nursing diagnoses identify a central focus for care, but nurses do not provide medical diagnoses.
• Nurses use critical thinking skills to identify health problems, risks, and strengths.
• Nurses plan care based on prioritized problems and work with clients to formulate goals and desired health outcomes.
• Nursing selects appropriate evidence-informed nursing interventions and activities, and implement client specific care plans.
• Nursing diagnosis is a statement of health problem resulting from signs and symptoms.
• The diagnosis is a nursing judgement of physical, psychological, sociocultural, and spiritual conditions, with a known cause.
• PLANNING involves strategies to prevent or correct problems, establishing priorities, setting outcomes with the client, and consulting other health personnel.
• IMPLEMENTATION involves actions to achieve the outcome defined in the planning stage.
• EVALUATION determines if goals have been achieved, as ongoing, nurse collects data.

Behavior Change

• Behaviours change through a cyclic process of taking action, and involves intentions, emotions, and behaviour.
• The process is Precontemplation -> Contemplation -> Preparation -> Action -> Maintenance -> Termination -> Relapse.
• The nurse assess readiness via asking "what is your action plan? What resources do you need? What support do you need from me?"
• The nurse can assess the level of risk, and provide the tools needed to maintain.
• Systemic Theory includes dynamic interplay of various influences in an individual's life.
• Harm Reduction helps reduce harm and improve quality of life

Integrative Health Care

• Healing is the subjective feeling of becoming whole.
• A nurse's role is to establish a transpersonal caring relationship and a healing environment.
• Integrative health care complements medicine with numerous approaches such as Indigenous healing, massage, and relaxation therapy.
• Nurses must understand diverse populations, the risks/benefits of complementary therapies to educate, and practice.
• Complimentary medicine is used with conventional or Western medicine.
• Nurses are obligated to explore a client's understanding of treatment.

Complementary Therapy Considerations

• Nurses are accountable for therapy appropriateness via client's status.
• The nurse must ask themselves about the client's health status, interventions, anticipated effects, benefits and risks, is the client informed, and do they have the authority.

Integrative Medicine

• Combines Western medicine and complementary medicine for safety/effectiveness.
• It focuses on underlying causes of illness and is safe, evidence-informed.
• Examples are Naturopathy and chiroprative therapy.

Alternative Medicine

• It is used in place of conventional medicine e.g. Acupuncture.
• Approaches are used instead of a conventional treatment.

Holism

• Combines mental, emotional, spiritual, relationship and environmental components.
• Individuals facilitate their own ow healing as the focus.
• Considers all components of health.
• Draws on biomedical and care-healing models and technology.

Holistic Nursing

• Values the awareness of whole people and whole-system interconnectedness.
• Sees the health experience as interralated on mind, body etc with optimal environments.
• The Canadian Holistic Nurses Association developed standards of practice.
• Appreciation for healing the spirit and body had hospital programs (music, art).

Humanism

• Mind and body are indivisible
• People are responsible for their lives.
• Well-being is a balance of satisfaction and contributions.

Balance

• Attained when each component reaches a state of equilibrium (Mental, Physical, Emotional, Spiritual, Environmental).

Energy

• The force that integrates and connects the body, mind and spirit.
• Involves grounding and centering.

Nurse's Role?

• Creating compassionate holistic care through hands, hearts and minds.
• Create healing environments for themselves to restore energy and replenish themselves to avoid burnout.

Integrative Health Care Categories

• Natural Products: supplements, botanicals, homeopathic meds.
• Manipulative Products: massage, acupressure, chiro.
• Mind-body-spirit: meditation, music therapy, psychotherapy.
• Energy Therapies: Therapeutic Touch, Reiki.
• Traditional Chinese medicine includes ayrveda, homeopathy, TCM (Traditional Chinese Medicine).
• Miscellaneous practices: Music Therapy, Humour and Laughter.
• Health Canada regulates natural health products.

Resposibilities for Nurses

• Nursing requires evidence-based knowledge
• Demonstrated care
• Teaching, respect of clients and clients autonomy
• Nurses also practice approaches such as meditation, imagery.

Integrative Medicine Education Requirements

• Biofeedback
• Therapeutic touch
• Chiropractic medicine
• Traditonal Chinese medicine

Indigenous Health

• Health and Wellbeing includes physical, emotional, spiritual and mental dimensions.
• Colonialism affects indigenous nations via domination.
• Colonization Purposeful settlemerns onto foreign lands by plundering, exploting.
• Institutions and policies were developed by settlers.
• Residential Schools were set up in the late 1800s-1996, and affected over 150,000 children.
• Sacred Teachings include Humility, Bravery, Honesty, Wisdom, Love

Medicine Wheel

• This includes a spiritual teaching tool.
• The wheel includes a sacred circle, and is made of materials on the land.
• The wheel includes most common is red, yellow, white and black
• Anishinabe & Ojibwe use North ->, East, South and West, being Winter, Spring, Summer and Autumn and mental, spiritual emotional and physical with sweetgrass, tobacco, cedar and sage.

Karen's Video (inc. 4 rascals, 5 rings / circles go from inside out)

• TOP = East, Red, Spiritual, Cultural, Feeling Inferior, Earth, Respect
• RIGHT = South, Black, Emotional, Social, Jealousy, Fire, Rights
• BOTTOM = West, Yellow, Mental, Political, Resentment, Water, Reciprocity
• LEFT = North, White, Physical, Economical, Not Caring except for one's self, Air, Responsibilities
• Structural Racism: Legitimized attitudes, practise, and substandard outcomes
• Intergenerational Trauma is the accumulated trauma of collective attacks on a group.
• Holistic Health is beliefs based on knowledge.
• The medicine ties spirituality and health, wellness is the balanced approach.
• Aspects of balance include community, relationships.
• Aspects of care include safety, elders, language, development and access to resources.

Culture

• Is defined through language, practices, and spirituality.
• Requires activity and continuity in the cultural expression.
• Expression helps promote healing.

Nutrition

• Fibre- the indigestible part of plant-based foods.
• The amout of calories depending on the the energy of the nutrients and food
• A Glycemic Index ranks carb rich foods by blood glucose level.
• Eating low GI leads to better control over blood glucose, cholesterol, appetite and heart disease.
• Low GI = grains, pumpernickel, Med GI = whole wheat, High GI = white breads
• The main source of energy for your body are carbs, protein and fats.
• They are all different nutrients which help regulate body processes and movements.
• Homeostasis maintains the body's balance.