Canadian Community Health Nursing Standards of Practice PDF

Appendix A from Book p. 618 Introduction The Canadian Community Health Nursing Standards of Practice (the Standards) represent a vision for excellence in community health nursing. The Standards define the prac- tice of a registered nurse in the specialty area of community health nursing. They buil...

Appendix A from Book p. 618 Introduction The Canadian Community Health Nursing Standards of Practice (the Standards) represent a vision for excellence in community health nursing. The Standards define the prac- tice of a registered nurse in the specialty area of community health nursing. They build on the generic practice expecta- tions of registered nurses and identify the practice principles and variations specific to community health nursing in Canada. The Standards apply to community health nurses who work in the areas of practice, education, administration and research. Purpose of standards of Practice Define the scope and depth of community nursing practice Establish criteria and expectations for acceptable nursing practice and safe, ethical care Provide criteria for measuring actual performance Support ongoing development of community health nursing Promote community health nursing as a specialty and provide the foundation for certification of community health nursing by the Canadian Nurses Association Inspire excellence in and commitment to community nursing practice Set a benchmark for new community health nurses. using the standards of Practice Nurses in clinical practice use the standards to guide and evaluate their practice. Nursing educators include the standards in course curricula to prepare new graduates for practice in community settings. Nurse administrators use the standards to direct policy and guide performance expectations. Nurse researchers use the standards to guide the development of knowledge specific to community health nursing. community health nursing Practice Community health nurses value caring, principles of primary health care, multiple ways of knowing, individual and community partnerships, empowerment, and social justice. Community health nursing acknowledges its roots and traditions, embraces advances, and recognizes the importance of the need to continually evolve as a dynamic nursing specialty. (see Figure 2. History of Community Health Nursing) A new nurse entering community health practice will likely need at least two years to achieve the practice expectations of these specialty Standards. Strong mentorship, leadership and peer support, as well as self-directed and guided learning all contribute to the achievement of the expertise required. Community health nurses practice in a variety of specialty care services and work in a variety of settings (See Appendix F - Community Health Nursing by Area of Practice). Home health nursing and public health nursing are linked historically through common beliefs, values, traditions, skills and above all their unique focus on promoting and protecting community health. Evolving from centuries of community care by lay- women and members of religious orders, community health nursing started to gain recognition as a nursing specialty in the mid-1800s. Florence Nightingale and Lillian Wald as well as organizations such as the Victorian Order of Nurses, the Henry Street Settlement and the Canadian Red Cross Society have permanently shaped community health nursing. During the 20th century, public health and home health nursing emerged from common roots to represent the ideals of community health nursing. Community health nursing is situated on a foundation of ethical practice and caring. Home health nursing and public health nursing differ in their client and program emphasis. Both Public Health Nurses and Home Health Nurses have discipline specific competencies that define the integrated knowledge, skills, and attributes required to achieve the standards. (See Appendix G for a diagram depicting the Relationship Between Standards and Competencies. Community health nurses view health as a dynamic process of physical, mental, spiritual and social well-being. Health includes self-determination, realization of hopes and needs, and a sense of connection to the community. Community health nurses consider health as a resource for everyday life that is influenced by circumstances, beliefs and the determinants of health. The determinants of health are factors and conditions that affect health status and include social, cultural, political, economic, physical and environmental health determinants. Additional determinants of health specific to aboriginal populations have also been identified. (See also Appendix C – Determinants of Health) A Glossary of Terms, which further describes relevant concepts and terms related to community health nursing practice can be found at http://chnc.ca/nursing-publications.cfm standards of Practice for community health nurses standard 1: health Promotion standard 2: Prevention and health ProtectIon standard 3: health maintenance, restoration and PallIatIon standard 4: Professional relationships standard 5: capacity Building standard 6: access and equity standard 7: Professional responsibility and accountability Standard 1: Health promotion community health nurses integrate health promotion into their practice. “Health promotion is the process of enabling people to increase control over, and to improve, their health” The Community Health Nurse... a. Collaborates with individuals, families, groups, communities, populations or systems to do a comprehensive assessment of assets and needs, acknowledging that differences exist in assets and needs of different members of the population. b. Uses a variety of information sources including community wisdom to access high quality data and research findings related to health at the international, national, provincial, territorial, regional and local levels to plan programs and services. c. Seeks to identify the root causes of illness, disease and inequities in health. d. Considers socio-political issues that may underlie individual, family, group, community, population or system problems. (See Appendix C- Determinants of Health) e. Recognizes the impact of specific issues such as political climate, will, values and culture, historical context, client readiness, and social and systemic structures on health. f. Facilitates planned change with the individual, family, group, community, population or system (See Figure 3. Population Health Promotion Model) See Appendix H – Health Promotion) g. Demonstrates knowledge of determinants of health and effectively implements multiple health promotion strategies. (See Appendix H – Health Promotion) h. Identifies strategies for change that will make it easier for people to make healthier choices. i. Collaborates, along with other sectors, with the individual, family, group, community or population, to support them to overcome health inequities and take responsibility for maintaining or improving their health by increasing their knowledge, influence and control over the determinants of health. j. Understands and uses social marketing, media and advocacy strategies, in collaboration with others, to raise awareness of health issues and place issues of social justice and health equity on the public agenda. k. Applies relevant theories and concepts (e.g. Stages of Change Theory; Self-Efficacy Theory, Assets and Strengths xxi, Community Mobilizationxxii) to shift social norms and change behaviors in partnership with others while working on enabling factors to overcome barriers in the social and physical environment. l. Uses a client centered approach to help the individual, family, group, community and population to identify strengths and available resources to access health and take action to address their needs m. Evaluates and modifies population health promotion programs as needed in partnership with the individual, family, group, community, population or system in partnership with individuals, employers and policy makers. Standard 2: prevention and Health protection community health nurses integrate prevention and health protection activities into practice. These activities are often mandated by government programs to minimize the occurrence of diseases or injuries and their consequences. The Community Health Nurse... a. Participates in surveillance activities; analyzes and utilizes this data to identify and address health issues within a population or community. b. Recognizes patterns and trends in epidemiological data and service delivery and initiates strategies to improve health. c. Recognizes the differences between the levels of prevention (primary, secondary, tertiary) and selects the appropriate level of intervention. d. Facilitates informed decision making for protective and preventive health measures. e. Helps individuals, families, groups, communities, populations or systems identify potential risks to health including contributing to emergency and/or disaster planning, being knowledgeable about specific emergency / disaster plans and promoting awareness of the plan(s) amongst individuals, families, groups and communities. f. Uses harm reduction principles grounded in the concepts of health equity and social justice, to identify and reduce or remove risk factors in a variety of environments and settings including homes, neighborhoods, workplaces, schools and street. g. Provides prevention and protection services for the individual, family, group or community to address issues such as communicable disease, injury, chronic disease, physical environment (e.g. clean air, water, land) and community emergencies or disasters. h. Applies epidemiological principles for planning strategies such as screening, surveillance, immunization, communicable disease response and outbreak management, and education. i. Engages in collaborative, interdisciplinary and intersectoral partnerships to address health risks of the individual, family, group, community, population or system recognizing that some individuals and groups are disproportionately affected. j. Collaborates to develop and use follow-up systems to facilitate continuity of care. k.  Practices in accordance with legislation and regulation relevant to community health practice (e.g. public health legislation, child protection legislation and provincial/territorial/ federal regulatory frameworks). In addition, when relevant, practices in accordance with complementary sub specialty standards e.g. occupational health nursing; parish nursing. l. Evaluates practice (personal, team, intersectoral and interprofessional collaborative practice) in achieving out- comes such as reduced communicable disease, injury, chronic disease or impacts of a disease process. Standard 3: Health Maintenance, Restoration and palliation community health nurses integrate health maintenance, restoration and palliation into their practice. these are systematic and planned methods to maintain maximum function, improve health and support life transitions including acute, chronic or terminal illness and end of life care. The Community Health Nurse... a. Assesses the health status and functional competence of the individual, family, group, community, population or system within the context of their environmental and social supports. b. Develops mutually agreed upon plans and priorities for care with the individual, family, group, community, population or system. c. Identifies a range of strategies including health promotion, health teaching, disease prevention and direct clinical care strategies along with short and long-term goals and outcomes. d. Maximizes the ability of an individual, family, group, community, population or system to take responsibility for and manage their health needs according to resources and personal skills available. e. Supports informed decision making; acknowledges diversity, unique characteristics and abilities; and respects the individual, family, group, community or population’s specific requests. f. Adapts community health nursing techniques, approaches and procedures to health challenges and the challenges related to equity in health in a particular community situation or setting. g. Uses knowledge of the community to link with and refer to community resources or develop appropriate community resources as needed. h. Facilitates maintenance of health and the healing process for the individual, family, group, community, population or system in response to significant health emergencies or other community situations that negatively impact health. i. Evaluates outcomes systematically and continuously in collaboration with the individual, family, group, community, population or system including other health practitioners and inter-sectoral partners. Standard 4: professional Relationships community health nurses connect with others to establish, build and nurture professional relationships. These relationships promote maximum participation and self-determination of the individual, family, group, community or population. The Community Health Nurse...  a. Builds a network of relationships and partnerships with a wide variety of individuals, families, groups, communities, organizations and systems (e.g. community and volunteer service organizations, businesses, faith communities and with health professionals and other sectors) to address health-related issues and support health equity. b. Uses a holistic and comprehensive mix of community and population-based strategies such as coalition building, inter-sectoral collaboration, partnerships and networking to overcome health inequities. c. Assesses individual, family, groups, community and system beliefs, attitudes, feelings and values about health and health inequities and their potential effect on the relationship and intervention. d. Recognizes her or his personal beliefs, attitudes, assumptions, feelings and values about health and their potential effect on interventions/strategies. e. Is aware of and uses culturally relevant communication strategies when building relationships. Communication may be verbal or non-verbal, written or graphic. It may involve face-to-face, telephone, group, print or electronic methods. f. Respects, trusts and supports or facilitates the ability of the individual, family, group, community, population or system to identify, solve and improve their own health issues. g. Involves the individual, family, group, community, population or system as an active partner, applying community development principles, to identify relevant needs, perspectives and expectations. h. Recognizes and promotes the development of health enhancing social support networks as an important determinant of health. i. Maintains awareness of community resources, values and characteristics. j. Promotes and supports linkages with appropriate com- munity resources when the individual, family, group, community, population or system is ready to receive them (e.g., hospice or palliative care, parenting groups). k. Maintains professional boundaries in long-term relationships in the home or other community settings where professional and social relationships may become blurred. l. Negotiates an end to the relationship, in a professional manner, when appropriate (i.e., when the client demonstrates readiness and assumes self-care, when the goals for the relationship have been achieved, or based on the direction of the organization/employer). m. Evaluates the nurse/client relationship as part of regular practice assessment.  Standard 5: Capacity Building community health nurses build individual and community capacity by actively involving and collaborating with individuals, families, groups, organizations, populations communities and systems. the focus is to build on strengths and increase skills, knowledge and willingness to take action in the present and in the future. The Community Health Nurse... a. Works collaboratively with the individual, family, group, community, population or system (including other health care providers) to identify needs, strength, available resources and strategies for action. b. Uses community development principles and facilitates action to support the priorities of the Jakarta Declaration (See Figure 4) c. Engages the individual, family, group, community, population or system in a consultative process from a founda- tion of equity and social justice. d. Recognizes and builds on the readiness of the individual, family, group, community or system to participate and act. e. Uses empowering strategies such as mutual goal setting, visioning and facilitation. f. Understands group dynamics and effectively uses facilitation skills to support group development. g. Helps the individual, family, group, community or system to participate in issue resolution to address their determinants of health. h. Helps groups and communities to gather available resources that support taking action to address their health issues. i. Actively shares knowledge with other professionals and community partners and appreciates the importance of collaborative team work. j. Supports the individual, family, group, community, and population to advocate for themselves. k. Encourages lifestyle choices that support health. l. Applies principles of social justice and advocates for those who are not yet able to take action for themselves. m. Uses a comprehensive mix of strategies to address unique needs and to build individual, family, group, community, population or system capacity. n. Supports community action to influence policy change in support of health. o. Actively works with community partners including health professionals to build capacity for health promotion. p. Evaluates the impact of change on the health outcomes of the individual, family, group, community, population or system. The Jakarta Declaration identified the following priorities; 1. Promote social responsibility for health 2. Increase investments for health development 3. Consolidate and expand partnerships for health 4. Increase community capacity and empower the individual 5. Secure an infrastructure for health promotion. Standard 6: access and equity community health nurses facilitate access and equity by working to make sure that resources and services are equitably distributed throughout the population and reach the people who most need them. The Community Health Nurse... a. Assesses and understands the capacity of the individual, family, group, community, population or system. b. Assesses, in collaboration with partners, the norms, values, beliefs, knowledge, resources and power structures of the client (individual, family, group, community, population or system). c. Identifies and facilitates universal and equitable access to available services. d. Collaborates with colleagues and with other members of the health care team and community partners to promote effec- tive working relationships that contribute to comprehensive client care and optimal client care outcomes. e. Collaborates with individuals, families, groups, communities, populations or systems to identify and provide pro- grams and methods of delivery that are acceptable to them and responsive to their needs across the life span. f. Provides culturally sensitive care in diverse communities and settings. g. Supports the individual, family, group, community and population’s right to choose alternate health care options. h. Advocates for equitable access to health and other services and equitable resource allocation. i. Mobilizes resources to support health by coordinating and planning care, services, programs and policies. j. Refers, coordinates or facilitates access to services in the health sector and other sectors. k. Adapts practice in response to the changing health needs of the individual, family, group, community, population or system. l. Uses strategies such as home visits, outreach and case finding to overcome inequities and facilitate access to ser- vices and health-supporting conditions for potentially vulnerable populations (e.g., persons who are ill, elderly, young, poor, immigrants, isolated or have communication barriers). m. Analyzes and addresses the impact of the determinants of health on the opportunities for health for individuals, families, groups, communities, populations and systems. n. Advocates for healthy public policy and social justice by participating in legislative and policy-making activities that influence determinants of health and access to services. o. Takes action with and for individuals, families, groups, com- munities, populations and systems at the organizational, municipal, provincial, territorial and federal levels to address service gaps, inequities in health and accessibility issues. p. Monitors and evaluates changes and progress in access to relevant community services that support the determinants of health. Standard 7: professional Responsibility and accountability community health nurses demonstrate responsibility and accountability as a fundamental component of their professional and autonomous practice. The Community Health Nurse... a. Assesses and identifies risk management issues and takes preventive or corrective action individually or in partner- ship to protect individuals, families, groups, communities, populations, and organizations from unsafe, unethical, illegal or socially unacceptable circumstances. b. Identifies ethical dilemmas about whether responsibility for issues lie with the individual, family, group, community, population, or system or with the nurse or the nurse’s employer. c. Makes decisions using ethical standards and principles, taking into consideration one individual’s rights over the rights of another, individual or societal good, allocation of scarce resources, and quantity versus quality of life. d. Seeks help with problem solving, as needed, to determine the best course of action when responding to ethical dilemmas, risks to human rights and freedoms, new situations and new knowledge. e. Provides leadership by creating change within communities and systems. f. Advocates for societal change to support health for all based on the concepts of health equity and social justice. g. Uses current evidence and informatics (including information and communication technology) to identify, generate, manage and process relevant data to support nursing practice. h. Identifies and acts on factors which affect practice autonomy and delivery of quality care. i. Participates in the advancement of community health nursing by mentoring students and new practitioners. j. Participates in research and professional activities. k. Identifies and works proactively (individually or by participating in relevant professional organizations) to address nursing issues that will affect the individual, fam- ily, group, community, population or system. l. Appreciates and develops teamwork skills that contribute proactively to the quality of the work environment by identifying needs, issues and solutions, using conflict resolution skills and collaborative decision making. m. Provides constructive feedback to peers as needed to enhance community health nursing practice. n. Documents community health nursing activities in a timely and thorough manner (includes telephone advice and work with individuals, families, groups, communities, populations and systems). o. Advocates for effective and efficient use of community health nursing resources. p. Uses reflective practice to continually assess and improve personal community health nursing practice. q. Seeks professional development experiences that are consistent with: current community health nursing practice; new and emerging issues; the changing needs of the population; the evolving knowledge of the impact of inequities or social injustices; determinants of health; and emerging research. r. Acts on legal obligations (applicable provincial / territorial / federal legislation) to report to relevant authorities any situations involving unsafe or unethical care. This care may be provided by family, friends or other individuals and involve or be directed toward children or vulnerable adults. s. Identifies desired outcomes and related indicators in collaboration with individuals, families, groups, communities, populations, systems or the workplace. t. Uses available resources to systematically evaluate the achievement of desired outcomes including the availabilty, acceptability, efficiency, and effectiveness for quality improvement in community health nursing practice and the work environment.