Professional Communication: Weeks 1-7 Notes

• The provided text consists of study notes for the course "Professional Communication" at Toronto Metropolitan University, covering Weeks 1-7.

Conceptualizations of Health

• Disease refers to physiological/pathological bodily responses, representing an objective state of ill health with signs and symptoms.
• Illness is the human experience of disease, a subjective experience of loss of health that varies individually.
• Health is a multidimensional concept encompassing physical, mental, social, and spiritual dimensions.
• The World Health Organization (1974) defines health as a state of physical, mental, and social well-being, not merely the absence of disease.
• Wellness is a subjective experience akin to illness.

Approaches to Health in Canada

• Three key approaches to health in Canada examined: biomedical, behavioral, and socio-environmental.

Biomedical Approach

• Predominantly used in acute care, long-term care, public health, and rehabilitation.
• Health problems are primarily defined by physiological risk factors, such as lab values and pain scores.
• Illnesses and symptoms are attributed to underlying abnormalities within the body (disease).
• Mental health is considered separate and unrelated to bodily function.
• The focus is on pathology, with less emphasis on health promotion and disease prevention.
• Physical tests corroborate the client's illness condition.
• Client cooperation is required, but the client is generally a passive recipient of care.

Behavioral Approach

• Gained prominence with the Lalonde report in 1974, emphasizing a shift toward health determinants as well as individual responsibility.
• It assumes individuals will adopt healthy behaviors if they understand risk factors.
• It incorporates a client's lifestyle, exercise, and diet.

Socio-Environmental Approach

• Health is closely tied to social structures.
• Emphasizes the social context of health and personal health behaviors' relationship with social and physical environments.
• Identifies prerequisites for health, including peace, shelter, education, food, and income.
• Responsibility for health lies with society, rather than solely the individual.
• Social justice, equity, and client empowerment are focal points; nurses should adopt an "upstream approach" to empower clients.
• Bill 124 limits wage increases to a maximum of one per cent for total compensation for each of three years.

Social Determinants of Health (SDH)

• Income & distribution
• Social support networks
• Education & health literacy
• Employment & working conditions
• Physical environment includes:
  • Biological & genetic endowment,
  • Individual health practices & coping skills,
  • Healthy child development,
  • Healthcare services,
  • Gender & culture.
• Person-centeredness is crucial, supporting clients within their social environments and prioritizing cognitive, emotional, social, and psychological needs.

New Model of Care

• The client's belief in their illness isn't necessary, as it's the impact on their lifestyle or the disease's effect that matters.
• Illness is seen as a dysfunction within the person's physical and social environment, involving:
  • An individual having two major systems, and
  • Their whole self (social, environmental, cognitive, etc.) where problems are termed impairment.
• Pathology involves something being amiss with the person, the organs, or in the body.
• Influencing factors on each person include their personal context, beliefs, values, and attitudes regarding the condition.

Implications for Healthcare Providers

• A need to investigate holistically, taking into account mental and social well-being, beyond just pathophysiological perspectives when a patient seeks care.

Review of Healthcare Delivery System Settings

• The setting types include institutional, community/volunteer, and private sectors.

Institutional Sector

• Hospitals, long-term care (LTC) facilities, rehabilitation centers, and psychiatric facilities.

Community/Volunteer Sector

• Primary and secondary care settings where CHNs promote, protect, and preserve health through ongoing or episodic processes.

Levels of Care

• There are five levels of Health care.

Level 1 - Health Promotion

• Focuses on enabling and educating healthy individuals.

Level 2 - Disease and Injury Prevention

• Involves reducing risk factors for specific diseases and injuries, often targeting specific populations.

Level 3 - Diagnosis & Treatment

• Includes primary, secondary, and specialized (tertiary) care settings.

Level 4 - Rehabilitation

• Involves planning from the start to restore the patient to their prior functional level.

Level 5 - Supportive Care

• Addresses conditions that aren't getting better using palliative and respite care.

Introduction to Critical Social Theory (CST)

• CST aims to expose social relationships often concealed by objective appearances focusing on issues of social, economic and power relations.
• Nursing within social relationships focuses on human responses to illness and includes therapeutic relationships.
• Emphasis includes:
  • Reflections on asymmetry in power relative to the nurse-client relationship.
  • Views of power as a means of control and surveillance.
  • Examinations of power structures within the healthcare delivery system that identifies marginalized voices,
  • All knowledge is constructed through a society's history and traditions.
• Nurses should reflect on traditional nursing norms, expected behavior, and to reflect on the influence technology has for caring.

Assumptions of CST and Relevance to Nursing

• CST enables the nurse to closely examine the constraining forces and power structures in nursing.

CST: The Client-Nurse Relationship

• The need to acknowledge and understand the power hierarchy within the nursing profession given power is asymmetrical in the nurse-client relationship because of their vulnerabilities.
• Nurses should be aware that traditional caring behaviors of the nurse could be used in a negative manner so that the patient behaves,

How Does CST Connect to Relational Inquiry

• Relational consciousness is a relation of intrapersonal, interpersonal and contextual factors.
• Inquiry involves a combination of two exposures on power dynamics and inequalities that guide nurses to take action and provide individual care.

Access to Healthcare and Indigenous People

• Barriers to healthcare for Indigenous people in Canada, includes a lack of availability, limited access, geographical separation/distances, social health determinants and power imbalances.

WEEK 2 - ACUTE CARE

• Effectiveness largely relies on interventions that are time-sensitive, individual-oriented, frequent, and rapid. Primary purpose? To improve health.
• Acute care encompasses health actions such as emergency, urgent, and prehospital care, short-term stabilization, critical care, plus trauma and acute care surgery.

How Hospitals Types Are Determined

• Includes: teaching, community, and small hospital types.

Teaching Hospitals

 - Affiliated with medical/health sciences schools plus postgraduate training; research activity.

Entry Point Into Acute Care

• Emergency, urgent care, surgery, routine procedures.

Top 5 Clinical Categories

• Circulatory system (most), mental health, digestive system, respiratory system, and musculoskeletal/connective tissues (least).

Average Costs

• The average cost for patients with ICU admission is $3,592, and for patients with general hospital admissions is $1,135.

How Acute Care Is Organized

• Via Respiratory, L&D, ambulatory, transplant, dialysis, pediatric, psychiatric units, plus medicine, step down units, surgery and recovery rooms.

Cutler et al. (2013)

• Critical illness a significant source of long-term physical/psychological suffering that involves single or multi organ failure.

Critical Illness Experiences of Patients

• Perceptions and Near Death: unreal experiences, proximity to death, transformations of perceptions, transformation of the body affected.
• Patients note distress given technology/dependence in critical care environments where healthcare relationships influenced recovery. Patient care depended on support.

Chung et al (2020)

• Acute deterioration involves physiological, psychological and cognitive changes, and defines adverse events as health complications (disability, death).
• They are exploring studies for patients experiencing acute experiences.

Patient Experiences of Acute Deterioration themes (Chung et al. 2020)

• Hallucinations, delusions, changes in perception with changes in body and emotional distress or well being

WEEK 3 - ACUTE CARE II

• There are many hospital patients that had acquired hospital stay and included those with ICU stays.
• Highly specialized and technological environment of an ICU has many functions, residence, work in ICU

Space of Territory

• ICU patients perspective on philosophy to privacy, control and caring

Source Isolation and Patient Well Being

• The study examined segregation issues from being in hospitals and limited opportunities for socialization
• The goal was to review well-being of the people and find a way for nurse to improve patient health
• Isolation has detrimental effects.

Person/Family Centered Care

• This needs collaboration with the patients'/families' care, developed a true partnership in their care

WEEK 4 - PRIMARY CARE, PUBLIC HEALTH & HEALTH PROMOTION

• A Health Promotion/Determinants of health; nurses integrate knowledge in population health and providing good health care.

Public Health Messages

• Attention focuses on every day and needs more engagement and routines. Needs many factors.

WEEK 5 - LONG TERM CARE AND HOMECARE

• Ageism in healthcare is across multiple levels
• Focus with combatting that; requires awareness, understanding, appreciating their individuality

Public Health Resources

• Look with those for help with daily activities, functional health, and long-term care

WEEK 7 - END OF LIFE CARE & PALLIATIVE CARE

• EOL is for those close death when there its little control. Comfort is the goal for healing and well-being
• Hospice is there with comfort for these. It will ease discomfort for those in pain and suffering.