Health Conceptualizations and Approaches

Conceptualizations of Health

• Disease represents an objective state of ill health and reflects the pathological process
• Illness points to the subjective lived experience of the loss of health
• Health encompasses physical, mental, social, and spiritual dimensions, taking on a multidimensional concept

Ottawa Charter for Health Promotion

• Health is a resource for everyday life, not merely the objective
• Health emphasizes social, personal, and physical resources as a positive concept
• Health promotion transcends the health sector, extending to well-being and healthy lifestyles, representing significant scope

Approaches to Health in Canada

• There are three approaches to understanding health: the biomedical, the behavioural, and the socioenvironmental

Biomedical Approach

• Health problems primarily arise from physiological risk factors
• Illnesses and symptoms stem from underlying bodily abnormalities or disease
• Mental health remains separate and unrelated to bodily function, which is an important distinction
• The medical focus is on pathology more than disease prevention and health promotion
• Physical tests serve to either confirm or deny a client’s illness condition

Behavioural Approach

• The Lalonde report shifted the health approach to behavioural factors in 1974
• This approach placed importance on health determinants
• Responsibility for health lies with the individual, assuming they undertake healthy behaviours if they fully understand the risk factors
• This approach relies on altering risk factors for better health outcomes

Deficits of a Behavioural Approach

• Reliance on individual responsibility tends to overlook the social determinants of health and instead emphasize knowledge and education

Socioenvironmental Approach

• Health is closely tied to social structures for full insight
• Emphasis is on the social context of health and the relationship between individual health behaviours alongside social and physical environments
• The prerequisites for health include peace, shelter, education, food, and income
• Responsibility for health extends to society, not just the individual
• The focus is on social justice, equity, and client empowerment
• Nurses to take on the "Upstream approach" to emphasize a broad perspective at all times

Social Determinants of Health (SDH)

• SDH includes 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 constitutes a dysfunction in the individual's physical and social environment
• An individual has two major systems with influencing factors
• Each person interacts with two contexts: physical and social/cultural

Implications for This Model

• Non-medical reasons impact peoples' well-being overall
• Resources are needed to alter contextual factors
• Agency of the person indicates that personal choice is important in healthcare
• Systems focused solely on pathology disregard patient context and operate in short timeframes

Care Settings

• There are three main types of care settings: Institutional, Community/Volunteer, and Private Sector

Institutional Sector

• Includes hospitals, long-term care facilities (LTC), rehabilitation centers, and psychiatric facilities

Community and Voluntary Sector

• Community services focus on primary and secondary care
• Community health nurses (CHNs) promote, protect, and preserve health for individuals, families, communities, and populations

Private Sector

• Involves healthcare provided on a fee-for-service basis to the consumer
• Includes primary care, long-term care, rehabilitative care, and other services like dentistry and physiotherapy

Levels of Care in Canada

• There are five levels of care: Health promotion, disease and injury prevention, diagnosis and treatment, rehabilitation, and supportive care

Critical Social Theory

• This theory can explore and question discourse and its social world
• It assumes hidden agendas shape how we act, allowing examination of social construction of healthcare delivery
• It is important to be aware of inequality and how society is constructed, which has a direct and marked effect on people

CST Tools

• This theory aids the practice of mindful nursing, reflections on the asymmetry of the nurse-client relationship, power examinations, and power views

Nurse's Role in Health Care

• Analyzing power structures identifies marginalized voices in the healthcare delivery context
• CST theory assumes knowledge is constructed and interpreted through society's history and traditions
• Awareness of domination and control challenges traditional assumptions of truth, knowledge, and power
• CST challenges the status quo, as facts are malleable and intertwined with values

Acute Care

• High effectiveness depends on time-sensitive, individual-oriented, frequent, rapid interventions
• Diagnostic and curative actions aim to improve health with comprehensive promotive, curative, rehabilitative, or palliative actions

Acute vs Primary Care

Entry Points into Acute Care

• Include emergency care via ambulance, urgent care referrals, surgery requirements, labor and delivery, routine procedures such as dialysis or chemotherapy, follow-up care and diagnostics

Emergency Room Services Focus

• Emergency services are equipped for patients with intense medical needs, such as rapid change response and accident assistance

Intensive Care Units

• Changing patient needs require intensive care units with specialized tools, practitioners, expertise, and nurse-to-patient ratios

Urgent Care Focus

• Non-emergency needs include sudden sickness, minor injuries, or also for primary care purposes

Hospital Type Determination

• Teaching hospitals are affiliated with medical schools with significant research activity
• Community hospitals are undefined as either small or teaching
• Small hospitals fit guidelines put forward by the Joint Policy and Planning Committee (JPPC)

Acute Care Organization

• Includes respiratory, OBGYN, ambulatory care, and surgical units, medical, operating, and recovery and ICUs

Patient Experience of Acute Care

• Examples include chronic renal failure with acute deterioration

Duong (2023) - Required reading

• Explores the question of whether bringing the hospital home has the potential expand acute care capacity

Hospital at Home in a New Era

• Hospital at home provides hospital-level therapies, monitoring, and tests, while also providing the added benefit of patient comfort
• Hospital settings may suit patients needing acute care but stable enough to stay at home

Structure of home care

Expansion of home care

• Island Health launched its hospital-at-home program in 2020 given COVID-19 admissions
• Groundwork to anticipate growing inpatient needs took placed before the pandemic
• This approach may alleviate hospital congestion while maintaining high care standards

Hospital at Home Globally

• Countries like Australia, Spain, and France have used hospital-at-home for over two decades
• Further research indicates fewer readmissions and shorter durations for patients on the whole

Island Health Model

• Healthcare that centers on home visits, remote monitoring, and consistent access for patients
• Estimates by B.C. show many eligible candidates for this form of care, which also reduces hospital burden

Alberta Example

• Alberta Health Services launched a similar program in Calgary pre-pandemic
• The model works to alleviate hospital congestion while also maintaining high care standards

Benefits of Home Care

• Hospital-at-home allows patients to stay in a familiar, comfortable environment
• Stress and infections from hospital stays are avoided, and patients benefit from continuous monitoring
• This model results in quicker recoveries with better overall health outcomes

Hurdles

• Requires significant coordination and resources for implementation
• Necessitates innovative solutions and robust support
• Implementing eligibility requirements including logistical and technological integration

Conclusion & Future of healthcare

• Provides a solution better than normal healthcare on occasion
• Integrating a blended approach of hospital/at-home care may produce the best results

Patient Safety Background

• Medical dependency combined with frequent hospitalizations can result in safety blindspots

What is Chronic Kidney Disease (CKD)?

• CKD affects 10-15% of the adult population, and its severity is classified into stages

Dialysis

• Dialysis is a procedure to remove waste and extra fluids while keeping safe mineral levels to encourage blood levels

Hemodialysis and Peritoneal Dialysis

• Hemodialysis involves using an arm to extract and return filtered blood
• The type of dialysis involves fluid put inside the abdomen to take out waste

Actions against patient mistreatment and harm

• It is important to prioritize prevention as well as physical/mental health
• Patients can avoid feeling like they cannot question the doctors if actions are taken