Environmental Health Post-Midterm Notes PDF

# Environmental Health ## Agenda: - Climate Human Health Impacts - Climate Change Health System Impacts - Environmentally Sustainable Health Systems - What can I do? ## Learning Objectives: - Identify the health impacts of a changing climate - Differentiate how climate change is affecting the he...

# Environmental Health ## Agenda: - Climate Human Health Impacts - Climate Change Health System Impacts - Environmentally Sustainable Health Systems - What can I do? ## Learning Objectives: - Identify the health impacts of a changing climate - Differentiate how climate change is affecting the health of individuals living in rural and urban communities - Recognize the environmental impacts of health systems - Recognize how environmentally sustainable health system actions can be promoted at the international and local levels ## Climate Human Health Impacts: - Your postal code has just as much of an impact on your health as your genetic code. - More CO2 reduces the nutritional quality of food. - Getting away from the term global warming, because it's so much more. - Two types of permafrost: Forever vs one that melts and freezes, the forever is disappearing. ### Description of the image: The image depicts a polar bear standing on a piece of ice in the Arctic. It is intended to be a visual representation of the negative impacts of climate change, such as melting ice and loss of habitat for polar bears. ## Climate Change and Health The image contains a diagram that shows the relationship between climate drivers, exposure pathways, health outcomes and the environmental and social contexts that influence these factors. ## Climate Human Health Impacts: - Climate change can affect human health in two main ways: - By changing the severity or frequency of health problems that are already affected by climate or weather factors. - By creating unprecedented or unanticipated health problems or health threats in places where they have not previously occurred. ### Direct Impacts: - **Natural Hazards:** Heatwaves, floods, wildfires, coastal erosion and droughts - **Air Quality:** Exposure to key air pollutants, including fine particulate matter and ozone, increases the risk of a range of adverse health outcomes and premature death. - **Infectious Diseases:** Diseases could emerge or spread due to continued warming, such as diseases transmitted by insects (e.g., West Nile virus) or animals (e.g., rabies) or spread from human to human (e.g., seasonal influenza), and those acquired by inhaling bacteria found in the environment (e.g., Legionnaires' disease). - **Increase in invasive pests** (easier opportunities) - **Food Safety and Security:** Disrupting food systems, including food processing, transportation and distribution, food preparation activities, animal migration, and pollinators and invasive pests. - If natural grazing animals food sources areas are smaller, cause they're migration patterns to change, impacts everything, food sources, money. - **Water Safety and Security:** Disrupting watersheds through contamination, drought, and a range of water-borne diseases. - **Cascading Impacts:** - **Mental Health:** Worsening of existing mental illness, new-onset mental illness, and mental health stressors (e.g., grief and vicarious trauma). ## Climate Human Health Impacts: Rural - Isolates, more likely to suffer environmental impacts, fewer human resources and financial capacity. - Generally involved and educated on their communities. ### Existing Concerns and Vulnerabilities: - **Receive less attention in media and research**. - **Geography:** Experience greater impacts from climate change, particularly in the Arctic and Subarctic regions. Communities are isolated between large distances. - **Functions of smallness:** Tend to have fewer financial, human, and formal institutional resources to respond to changes. - **Demographics:** Aging populations, out migrations to urban centers, growing Indigenous populations, resource-based livelihoods "boom and bust cycles", poverty, gender, ideology. -**Basic needs:** Existing water and food insecurity, telecommunication challenges, supply chains and transportation, fewer health care resources and critical infrastructure ### Key Health Concerns: - Challenges with access to and quality of food and water. - Exacerbation of chronic illness and infectious disease. - Potential unintentional injury and death. - Intensified challenges with mental health and wellbeing. ## Climate Human Health Impacts: Urban - Existing Concerns and Vulnerabilities: - **Urban Heat Island Effect:** Dramatic increases in the number of hot days and nights. Concrete, asphalt and other construction materials absorb and trap heat. - **Dependence on Infrastructure:** Highly dependent on services such as electrical power, drinking water, and transportation. Aging infrastructure and lack of climate resilient infrastructure. - **Pollution and Contaminants:** Noise, lights, traffic emissions, proximity to industrial facilities. - **Disaster Readiness:** Mobilizing people and resources, urban flooding is expected to be more frequent and intense. - **Smog warnings** - **Population Increase:** Ecosystem degradation and land loss, growing demand and pressure of services and needs. ### Key Health Concerns: - **Extreme heat**. - **Pollution**. - **Extreme weather events and disasters**. - **Our ability to adapt to these**. ## Climate Human Health Impacts: Equity - Impact different people in worst ways. ### Unequal Vulnerability: - **Health impacts vulnerability** is determined by the exposure to climate change hazards, the **sensitivity** to possible impacts, and the **capacity** to respond to, or cope with them. - **Compounding Existing Inequity:** Structural systems of oppression, such as racism and colonialism, also influence an individual's vulnerability to climate-related health risks. ## Power - Households in the **top 10%** are responsible for **36%** of carbon emissions. - And the **bottom 50%** are responsible for **15%** emissions. - You get **power** with a high social status and greater inequality. - **Wealthier countries** outsource pollution, manufacturing and resource extraction. - **Land grabs by wealthier nations**. ## Climate Change Health System Impacts - **Impact on community and individual health and well-being**. - **IV fluids in the states disruption by hurricane helene**. - **Jasper fire impact supply changes**. - **Because we live in a connected global society, we suffer from the trickle down**. ### Description of the image: The image contains a diagram that shows the relationship between social, cultural, and economic factors, determinants of health, health inequities, climate change vulnerability, health sector adaptation actions, climate drivers, exposure pathways and health impacts. ## Climate Change Health System Impacts - **The health care sector was responsible for 5.2% of national greenhouse gas emissions (Karliner et al., 2019) and has some of the highest greenhouse gas emissions per person against the healthy life expectancy at birth (Romanello et al., 2022).** - **Canada has been ranked within the top ten contributors to health care's climate footprint (Eckelman et al., 2018; Karliner et al., 2019).** - **On a per capita emissions basis, Canada's health care sector is within the top four, along with the United States, Australia, and Switzerland (Karliner et al., 2019).** ## Environmentally Sustainable Health Systems: Local & International ### Sustainable Health Care: **Basic principles that you can do** - **Prevention:** Promoting health and preventing disease by tackling the causes of illnesses and inequalities. - **Patient Self-Care:** Empowering patients to take a greater role in managing their own health and healthcare. - **Lean Service Delivery:** Streamlining care systems to minimize wasteful activities. - **Low Carbon Alternatives:** Prioritising treatments and technologies with a lower environmental impact. ## Environmentally Sustainable Health Systems: Examples: -**Policy support**: - Support climate-friendly agriculture and healthy urban planning. - Northern Health British Columbia Provincial Health Services Authority and Alberta Health Services both have household or community food security guidelines that include nurses in their practice recommendations (AHS, 2020, 2022; Northern Health, 2019; PHSA, 2006). - **Food-as-medicine**: - In Arctic acute care settings, the Northwest Territories Health and Social Services Authority (NTHSSA) has maintained an Aboriginal Wellness Programme where they provide country food. Since it began in 2012, there has been a 63.4% increase in the use of their services (ICHR, 2017). - In Alaska, hospitals bring donated food, such as moose, herring roe, and seal, to the hospital for patients (ANMC, n.d.; Petersen, 2021). - **Example: Planetary Health Nursing Internship Program, BC Cancer**: - **Blue Pads:** Decrease the use of disposable plastic absorbent pads for moist heat warming prior to peripheral intravenous cannulation at BC Cancer Prince George by 80% by August 2024. - Reduced overall use by 85% in the chemo room; Monthly overall average of 86 kg CO2 in blue pads down to 13 kg C02. - **Waste Segregation:** To increase recycling bins in the clinical setting. - **Chemo Sharps:** To change all single use cytotoxic sharps bins to the ChemoSmart to achieve is to reduce amount of plastic being incinerated. - Before project, the region was disposing of 1 single use cytotoxic bin in a 1.5 day, but now they are using one bin for 2.5 days. ## Environmentally Sustainable Health Systems: - **Who is at the decision-making table? Whose voices are being heard... or not?** - Factors such as income, age, gender, ethnicity and ability can affect resilience to climate change and the ability to transition to renewable energy. The equity approach can include: - Compiling and reporting on equity data. - Share "citizen data" to advance reporting and research on climate change. - Developing ongoing relationships with equity-seeking groups in the community to inform action. - **Evaluating program design** to avoid replicating or furthering historical inequities and to better address the diverse barriers, needs, and priorities of different parts of our community. ## What Can I Do? Why Nurses? - Environmental Health Advocacy is fundamental to our roots. - We are "fix it" people. - We recognize the wisdom of heeding early warnings and prevention. - We care passionately about our patients and our communities. - We are trusted conveyors of health information to our patients, community members, AND policy makers. - There a lot of us and the most trusted profession. ## What Can I Do? General Recommendations: - Start with what you are most passionate about, but have capacity for... - Accept and lean into the messiness; be flexible. - Be willing to accept failure and learn from it. - Intersectoral and interdisciplinary collaboration within and outside the health system. Find commonalities with other professions or sectors, and strategically align it with institutional or governmental priorities. - Tell your story and share climate change information. Work on your storytelling skills; Try using a narrative to engage the "head" and the "heart," which engages the "hands" along with them. See, Marshall Ganz. - Make a Plan – Action Alleviates Anxiety – And gets stuff done… - Advocate for climate change mitigation policies in your area. - Start small, such as the earlier examples, or maybe it is sampling increasing your eco-literacy or creating interest groups (it does not have to be fancy). - Support climate-friendly agriculture and healthy urban planning. - Alert people of the need to plan for managing decline and transition to a sustainable, post-industrial society. ## Emergency and Pandemic Planning - **Define disaster, the various types of disasters and their consequences.** - **Describe the national legislative frameworks and key activities involved in Canadian public safety and preparedness.** - **Explain the roles of community health nurses before, during, and following a public health disaster.** - **Provide examples of the impact of disasters on the nursing profession.** - **Discuss examples of health inequity during and following disasters and strategies to reduce inequity and ensure optimal safety and well-being.** - **Apply lessons learned from COVID-19 to future disaster and pandemic planning.** ## Disasters: - **Event** that causes great distress to many people. - **Caused** by nature, human error, biological hazards or infectious diseases. - **Serious threat** to public health - often perceived as random killers, loss of life. - **Occurs suddenly**. - **Depletes resources**. - **Long-term impact**. - Impacts more than just health - safety, infrastructure, economy. ## Types of Disasters: - **Natural:** - Biological - exposure to germs & toxins - e.g. pandemics/infestations - Meteorological – storms - e.g. hurricanes, cyclone - Hydrological – flooding, storm surge/coastal flooding - Ex: USA right now. - Geophysical – earthquake, tsunami, landslide, volcano - Climatological – extreme temperature - e.g. heat wave, cold wave, drought, wildfires - **Man-Made:** - Hazardous materials - Nuclear, radiation, chemical, biological - Chernobyl - Accidents - industrial, transportation, fires - Oil vat explosions. - Technological – computer viruses - Ransoms, hackers take over infrastructure. - Civil unrest - war, riots, bioterrorism, terrorism - Conflict zones - Structural collapse - Dam or bridge that breaks ## What are some disaster examples? - **Fires- respiratory issues, displacement, trauma** - **Code orange- mass casualties, broncos bus crash** - **International** - 9/11- loss of life was massive ## Definition of Pandemic: - The infection becomes widespread in different parts of the globe and affects a significantly higher proportion of the population than normal. - Pandemics are identified by their geographic scale rather than the severity of illness. - *H1N1*- worldwide pandemic because of geographic scale ## Public Safety and Emergency preparedness: - Not usually wide scale plans- not shared for safety concerns - What do you do for yourself and others. ## Emergency Measures Legislation: - **How we respond to disasters is from that bottom up.** - **Local -> provincial -> federal -> chain of command to deal with an emergency**. - Ex: Flooding in Manitoba -> military had to respond (federal for resources). - **The Emergencies Act (AUTHORITY):** - Special national powers if needed for following emergencies: public welfare, public order, international, war - Grounding air travel example. - **National Emergency - defined**:Urgent and critical situation that seriously endangers lives, health, and safety - Define it in a way to only utilize as much power that is needed -> so there isn't an abuse of power. - So large it exceeds the capacity or authority of province/territory. - No other choices. - Threatens the Government of Canada to preserve sovereignty, security, and territorial integrity of Canada. - Example: 9/11 piece and grounding air travel. - This act use to be called the war act -> evolved. - **The Emergency Preparedness Act (PLANNING)** - Addresses need for cooperation at National/provincial/territorial levels. - Establish responsibilities, structure for training and education in emergency planning. - **The Emergency Management Act (RESPONSE):** - Defines roles and responsibilities for federal ministers. - Specifically for federal ministers. - Enhances information sharing between gov't and private industry. - Example: collaboration between PPE factory during a pandemic. - Provides infrastructure (IT, facilities, assets vital to health, safety). - Preserving what we are reliant and are vital for us. ## What are some emergency measures enacted in COVID-19?: - Sask-tel giving free wifi to all students. - PPE masks- N95 reusing. - Limiting toilet paper and hand sanitizer. - Benefits-> for groceries serves (economic level response). - Retired nurses and RNs were granted their license to increase the workforce. - Optimize the usage of the professionals at their disposal to plug the holes needed to be filled. ## Emergency Management: - All hazards approach. - When disasters strike their are elements to utilize. - Two factors: - **Probability:** likelihood of a hazard to occur. - **Statistical modeling (prediction)** - Impact: levels or degrees to which that hazard will effect - Human aspect - Health - Physical infrastructure - Economic/business impacts - Example: Field hospital -1,200 beds (capacity to take care of these individuals) - Ethical frameworks for decision making ## Stages of Emergency Management: - **Prevention:** to avoid disaster/emergency eg. Flu shot, dams. - Structural requirements, policies. - **Mitigation:** actions to reduce impact of emergency/human disaster eg. Infection control - In COVID-19 extra cleaning, stopping a fire from progressing. - **Preparedness:** plans before emergency occurs eg. Plans for who gets antivirals, ventilators. - All hazards approach, stockpile of supplies, funds for extra staff, planning through ethical models. - **Response:** coordinated actions such as: mobilize providers, coordinate healthcare services, acquire needed equipment & supplies eg. Mobile hospitals, retired RNs. - Accessing students, retired professionals, day-to-day operations. - **Recovery:** rebuilding to pre-emerge conditions & focus on reducing risk of recurrence. - Takes time, good time to reflect on the emergency, look at the evaluation piece and how that can inform our future response. ## CHN Roles in Emergency Preparedness: - **General** and will be tailored to the emergency-> might underestimate the variety and resources needed. - **Surveillance:** Looking at what's going on in the community, case following - Rely on you to have the best information. - **Educate** health professionals, volunteers and the public. - **Assess needs:** - Basic needs, how do you response, mobilize and utilize resources to respond. - Resource allocation (Ex: food bank) - **Health Services:** - Immunizations, contact tracing - **Advocacy:** - What can you do to help - Evaluate response measures - How did things go, front-line information. - **Decision-making with limited resources:** - Ex: school immunization was suspended during pandemic, how do you distribute them. - **Community connector:** - People look to you, lots of trust. - Advocacy for populations experiencing increased needs. - Leadership ## Disaster Impact on Nursing: - First responders also experience this as well. - ICN has now got competencies for disaster nursing. - Inclusion of nursing leadership in planning and implementing disaster responses - Bring knowledge and expertise. - Self-care -> continually do a self-assessment. - Evidence shows first-line workers in an emergency response can have secondary trauma and burnout. ### Stressors - Not enough PPE and reusing PPE (not using best practices, safety). - Watching patients deteriorate and die alone (takes a toll). - Experiencing moral distress (may not agree with decisions made). - Demands for nurses -> working 14 days in a row (how do you recover, coping mechanisms, PTSD symptoms). ## Disaster Impacts: - Nursing shortages even before the pandemic. - Disaster exacerbates this issue. - Increased burnout and challenges. - 40% of nurses want to leave the profession age 35. - Across provinces disaster. ## Solutions: - Feeling valued. - Safe and healthy work environment. - Mentorship. - Set leadership up for any type of failure. - Decrease lateral violence. - Support health and wellbeing **Burnout impacts not only the nurse but the patient because when errors occur they are impacted.** ## Social Justice and Health Equity in Disasters: - How a disaster will impact a community is based on economical political, cultural and health. - Groups that experiences biggers impacts are women, children, those with disabilities, poverty, older adults (basically anyone with a SDH). - Disparities in terms of INDG and metis individuals -> blatant treatment - COVID-19 outbreak northern Sask INDG communities = blockades. - Long-term care homes= clients weren't receiving any care, immediate attention. - Inform the planning so these things don't happen again. ## COVID-19 Response: Lessons Learned: - **Prevention and Mitigation**: - Pre-existing barriers to SDOH - Systemic racism, sexism, ageism - Higher transmission and worse health outcomes - **Preparedness** - Better communication collaboration b/n federal and provincial/territories public health agencies - National Emergency Strategic Stockpile System - National Vaccine Strategy - **Response:** - Lack of coordination between federal and provincial/territory. - Pandemic response varied significantly across Canada. - **Recovery:** - Surge capacity interrupted routine care. - Exacerbated chronic shortage of RNs and healthcare providers. - Strategies must address the mental health effects across diverse populations. - Recovery underpinned by social justice and equitable. ## Guides and Resources: - Gov't of Canada: Get prepared website has a publications section with many brochures and guides related to safety during emergency situations. - Link: Publications (getprepared.gc.ca) - Canadian Emergency Measures - https://www.getprepared.gc.ca/cnt/rsrcs/mrgnc-mgmt-rgnztns-eng.aspx - Get Prepared http://www.getprepared.gc.ca/index-eng.aspx - Saskatchewan Emergency Management - https://www.saskatchewan.ca/residents/environment-public-health-and-safety/emergenc y%20management ## Gear Up Guest Presentation: - **Ag health and safety alliance team:** - International gear up for ag team - Serbia, denmark, sweden, canada, australia - Presentation done by Kendra Ulmer and Carolyn Sheridan - **Gear up for AG online resources:** - Use these resources long after our program is over. - Specific program for Nursing students in 4th online. - **Community health nursing and building partnership:** - Rural health care. - Understanding the culture of agriculture. - Partnerships. - Populations. ## Health promotion and injury prevention: - Nurses can impact the health and safety of the agricultural community. ## What do you want to learn? - I know very little so I am excited to learn. - I know little to nothing about agriculture so I don't know what I want to learn, I guess I am wondering how it relates to nursing specifically. - Literally anything. - How this can relate to rural nursing. - Questions to ask patients to know they are safe in their working conditions (especially when they are self-employed on farms). ## Personal Protective Equipment (PPE): - Right PPE for the job with the right fit: - Proper care. - Proper storage. - Have PPE in the right place. - For all occupations. ## Hierarchy of controls: - **Most effective- Elimination:** - Physically remove the hazard. - **Substitutions:** - Replace the hazard. - **Engineering Controls:** - Isolate people from the hazard. - **Administrative controls:** - Change the way people work. - **Least effective- PPE:** - Protect the worker with PPE. - **As a nurse, use the hierarchy of controls as a framework in place all the time** ## Agriculture is one of the most hazardous occupations: - **Farming is unique, a worksite and homesite.** - **Hazards:** - Chemicals. - Working long hours, isolation, working alone. - Livestock handling. - Respiratory hazards. - Grain bins/wagons. - Extreme weather and environment. - Machinery. - Technology. - Zoonotic diseases and other illnesses. ## Livestock safety: - Important if you work in a rural area. - Low-stress cattle handling - Needle safety - **Machinery and technology:** - Musculoskeletal - The vibrations can affect an individuals health and safety. ## Extreme weather: - **Flood** - **Fires** - **Hail** - **Cold weather** - **Hot weather/sun** ## Speed versus safety: - **15 deaths per year** - Agriculture are typically working hard and fast. - Time is critical to them. ## Prevention Strategies: 1. **Understand agriculture occupation hazards**. 2. **Understand how the hazards impact you and your clients**. 3. **Determine your strategy to be part of prevention strategies**. 4. **Understand PPE** ## ATV safety: - Most deaths are caused by rolling. - 50% of deaths are related to agriculture. - Several hazards- terrain. - Colorful protective equipment. - Inform families ### Prevention strategies - Most preventative is engineering strategies - Appropriate vehicles for operator side - Basic maintenance - Most programs, 50% have rolled an ATV ### Things we can do: - Wear helmet - Goggles/.safety glasses - Wear gloves - Wear sturdy boots - Crush protection device - Select ATVs with safer design ## Bodily impacts: - Lungs - Symptoms: - Cough - SOB - Sore throat - Headaches - Risk factors: - Asthma - Smoking - Occupational exposures - Cattle or grain - How much dust is a problem - Depends upon - Amount of dust - Size of the dust particles - Type of dust - Respiratory Hazards - Dusts - Molds & fungi - Gasses - Metal fumes - Chemicals - Zoonotic diseases ## Lung protection - **Right respirator for job, fit**. - **Do not use NIOSH- no protective factor for agriculture**. - **Respirators** - Air purifying - Disposable - Reusable - Power for purifying (PFPR) - Oxygen supplied - SCBA - **Immediately dangerous to life and health (IDLH)** - Hydrogen sulfide- H2S - Can kill people in 1-2 breaths - Pork industries - **Organic Dusts/Mold** - What is in organic dust - Feces - Animal dander - Bacteria - Endotoxins - Mod - **Gasses, fumes, vapors** - **Ammonia, pesticides, paint, disinfectant, also known as acid gas and organic vapors** - Hobbies: woodworking, auto-body, painting, shop work ## The ear - The degree of hearing loss depends on how many ear cells are affected. - Signs and symptoms - "Say what" - Turning up volume on TV, radio - Ringing in ears - Muffled speech- helling - Anxiety when trying to hear - Typically over 50% have had tinnitus, a major sign of hearing damage. ## Noise exposures: - Increases heart rate and blood pressure, GI issues. - How loud is to loud- in decibels, 85 decibels. ## Protect your hearing: - Exposed for 8 hours, safe exposure graph. - How do you know - 3 feet away hearing. - Known the noise reduction rating. ## Body: - Pesticides enter you body through - Eyes, nose, mouth and skin ## Eyes: - Understand the importance of safety glasses. - Right size and shape. - Welding goggles and face shields ## Zoonotic disease - Prevention - HH - PPE - Good animal health - Good practice - What are the hazards to the animal handler - Hendra virus, calving, scabby mouth ## Stress and mental health: - Utilize resources. - Keep in mind that everyone could be struggling. - Do more Ag foundation - Sask ag maters- farmers can have 6 counseling sessions. ## Agriculture prevention PPE strategies: - Hearing prevention - What type - Eye protection - Safety glasses - Goggles - Respiratory protection - What type - Body - Gloves - Coveralls - What else is needed - Pesticides - Cattle - Grain - Dairy - Poultry - Swine ## Airbus H145: - Same mission, new fleet. - 250 km/hr range of 550 km - 2 patient load ## Racism, Cultural Safety, and Critical Community Health Nursing ## Learning Objectives: - Explain the impacts of racism and the cycle of oppression on health access and status. - Describe cultural humility and cultural safety in nursing. - Apply CPR Racism to nursing practice situations. - Identify and discuss the components of anti-racist, critical community health lens in nursing practice, education, and research. ## Definitions: - **Race** - Category of identity that began through European colonization, socially constructed, used to promote hierarchy of supposed superiority (CNA, 2024; Reading, 2013 as cited in Allan & Smylie, 2015; Stamler and Yui, 2020) - **Racism** - "an ideology of inferiority that is used to justify unequal treatment (discrimination) of members of groups defined as inferior by both individuals and societal institutions" (Williams, 1999 as cited in Stamler & Yiu, 2020,p.172). **RACISM IS VIOLENCE** (Graham, 2024) ## Racialization: - Constructions and assumptions used in everyday social encounters to negatively categorize people in order to interpret what they say and do. - Implies power differentials (unequal power relationships). - Not a theoretical issue but a pragmatic one. - Is not a neutral process: Impact on people's lives and health status. - People of any race can be racialized. - Class, gender, accent, language involved in racialization. ## Cycle of oppression: - **Oppression:** discrimination backed up by systemic, structural power (e.g., political and public policy, economics; education, legal, health & media system decision making. Results in ageism, classism, colonialism, heterosexism, racism, sexism... - **Stereotype:** exaggerated, oversimplified, fixed image, often negative, held by persons, groups, systems (eg.. political, economic, education, legal, health governing systems, media...) - **Discrimination:** actions or inactions based on prejudice-made possible/condoned implicitly or explicitly by systemic, structural power. - **Prejudice:** preconceived opinions based on stereotypes. Results in consistent, interconnected ways of thinking, understanding ## Impacts of oppression: - Discrimination results in significant access barriers. - Culturally unsafe care and inaction. - Inadequate of under treatment. - Less quality of care. - Increased morbidity and mortality. ## Racism and White Settler Privilege in Nursing: - Education, practice, research, leadership and policy making create and sustain racism. - Nursing theory and intellectual development based on white, Euro-Canadian class and privilege. - White privilege and settler privilege (synergistic) offer invisible advantages across a lifespan. ## Who is affected?: - Client/Patient/Families/Communities. - There are power differentials between nurses and clients (individuals, groups, communities). - Healthcare Providers - There are power differentials within health care, within interprofessional teams, within the nursing workforce. ## Experiences in healthcare- patient/client: - "They treated me like crap and I know it was because I was Native". The health care experiences of Aboriginal peoples living in Vancouver's inner city. - Aim: To explore the experiences of Aboriginal people who use illicit drugs and alcohol in Vancouver's inner city. - "So [the nurse] showed me how to inject, but she was so mean about it. She was not accommodating. She said I should how to do it myself. They treated me like crap and I know it was because I was Native. We all know because of the look-there's a look. When you need the medical care we put up with it. We shouldn't have to. We bleed the same way, we birth the same way. We have no choice. Could be like [participants name], hasn't been to a doctor in 25 years. Can't all do that." ## Experiences in healthcare- nurses: - Interpersonal, institutional and structural racism in Canadian nursing: A culture of silence. - Across Canada. - Aim: How interpersonal, institutional and structural racisms intersect in the professional experiences of racialized nurses and how they respond. - "There was a scuffle and I was calling for help. And nobody wanted to come in... This room was directly outside the nursing station and when I went in there, there were all kinds of people sitting around the nursing station. When I came out, there was nobody there. Everybody had just gone elsewhere so they didn't have to help." - When she reported the incident to her supervisor. The response was “ Well it looks like we are just going to have to do something about your colour." ## Experiences in healthcare- nursing students: - Let's call a spade a spade. My barrier is being a black student. - Aim: To explore experiences of black undergraduate nursing students, review barriers affecting retention and success and suggest evidence-based mitigation strategies. - "In podcast assignment feedback, the instructor said she appreciated everything I wrote, but she was deducting marks for my accent. She had no right. I questioned the unjustifiable accent marks deduction." - "Black people's concerns are usually ignored. This affects people's sense of self-esteem, their mental health, and performance in school. An instructor said something racially offensive, I brought it up, and it was minimized. I was told the instructor worked with a lot of Black people; she couldn't be racist." ## Anti-Racist Approach: - "Practice of identifying, challenging, preventing, eliminating, and changing the values, structures, policies, programs, practices, and behaviors that perpetuate racism" (Government of British Columbia, 2020, as cited in Graham, 2024). - Involves action that extends beyond not being racist (Graham, 2024). - Challenging root, structural, systemic causes; nursing practices that support and sustain (Stamler & Yiu, 2020) - Examining own values, assumptions, ways of thinking (Stamler & Yui, 2020) ## Cultural Humility: - An approach to health care based on humble acknowledgement of oneself as a learner when it comes to understanding a person's experience. - Life-long process of learning and being self-reflective. - Self-reflection to understand personal and systemic biases. - Life-long learner when it comes to understanding another's experience. - To develop and maintain respectful processes and relationships based on mutual trust. ## Cultural Safety: - Is about ethical and respectful relationships between people. - Must be practiced by individuals AND institutions. - Outcome based on respectful engagement. - Recognizes and strives to address power imbalances in healthcare. - Results in an environment free of racism and discrimination. - Focused on clients' experience. - People feel safe when receiving care. ## Cultural Competence Vs Cultural Safety: - **Cultural competency:** - Provider focused - Individualized-responsibility on the provider. - Acquiring cultural knowledge. - Perpetuates a process of "othering" (different from oneself or the dominant culture). - Oversimplified understanding of other cultures, cultural stereotypes. - Checklist to achieve - **Cultural safety:** - Client-centered. - Includes client, community, systems, processes, policies. - Contextual considerations. - Reflective of power, privilege, and biases. - More challenging for systems and providers. ## Indigenous Cultural Safety- Effectiveness: - Variety of terms used in the literature - cultural safety, cultural awareness, cultural respect, cultural competency, cultural humility. - Absence of research linking training interventions to improved non-Indigenous health care worker's knowledge and engagement skills. - Lack of tools to measure effects. - Very little evidence of patient-focused impacts. - No measures of systems-level effects. - No observable impacts to more culturally safe care. - **RCT** - **Novel Tools to Assess Pt Outcomes of Indigenous Cultural Safety Training.** - 3 arm RCT - Sanyas Training; Brief Anti-Bias Training; Control Continuing medical education (time matched to intensive training) - Evaluation Tools - Unannounced Indigenous Standardized Patient visits (pt would recommend clinician, pt experience), clinical practice guideline adherence - Findings: either training arm had higher odds of recommendation