CNUR 401 Midterm PDF

CNUR 401: Population Health and Community Partnerships Notes Module 1 Part 1: Introduction to Community Health Nursing Learning Objectives: Describe community health nursing roles/activities Describe activities in each of the six areas unique to public health practice Identify ho...

CNUR 401: Population Health and Community Partnerships Notes Module 1 Part 1: Introduction to Community Health Nursing Learning Objectives: Describe community health nursing roles/activities Describe activities in each of the six areas unique to public health practice Identify how social justice applies to community health practice Explain how to promote health using the Ottawa Charter Strategies Differentiate primary, secondary, tertiary, and primordial levels of prevention Apply the concepts of downstream, midstream, and upstream to population health promotion strategies. Apply the Community Health Standards of Practice to nursing practice Definitions of Community Health Nursing 1. An umbrella term—includes community health nursing in a variety of practice areas, for example: Public health nursing Home health nursing Occupational health nursing Primary healthcare nursing practice Outpost nursing Commonly encountered practice areas/specialties for CHNs in Canada include: ○ Public health nurses (PHNs) ○ Home health nurses (HHNs) ○ Nurses working in health promotion in the community (NHPs) 2. A specialty nursing practice that involves working with the client to preserve, protect, promote, and maintain health. 3. Working with the people, not just for the people, in assessment, planning, intervention, and evaluation. The community health nurse (CHN) works In the community (providing health care to individuals and families) With the community (because the CHN views the community itself as the client) CHN Umbrella: Specialties and Roles CHNs focus on several specific populations and activities as determined by their areas of practice, roles, and functions. ○ Advocate Provides a voice to client concerns when necessary ○ Clinician or direct care provider: Provides hands-on care to the client ○ Collaborator Involves client and interdisciplinary team members or interagency groups working together toward improving client health ○ Consultant Provides advice and information to clients, health care providers, and agencies to assist in meeting clients’ health care concerns ○ Counsellor Provides support to clients to facilitate their decision-making in reference to emotional challenges ○ Educator Facilitates client learning through teaching that is appropriate to client’s situation ○ Facilitator Works with clients and others to set and fulfill health goals ○ Health promoter or change agent Assists clients in acknowledging the need for lifestyle changes and taking responsibility for working toward identified change ○ Leader Guides and encourages clients to take the initiative to explore options and make decisions to enable goal achievement ○ Liaison Acts as an intermediary between clients and agencies and other health care providers ○ Manager Plans and directs client care ○ Referral agent Directs clients to additional appropriate resources in the community  ○ Researcher Investigates phenomena related to health and identify opportunities for research CHN Practice Components CHNs focus on several specific populations and activities as determined by their areas of practice, roles, and functions. Most community nurses work in primary healthcare Not all CHNs work intensely in the area of community development and planning Not all use a population-based focus ○ Some individuals and families as clients Practice settings vary, but some consistency in roles and functions Canadian Community Health Nursing Standards of Practice guide all communities regardless of setting Canadian Community Health Nursing Standards of Practice Define the depth and scope of community nursing practice Criteria/expectations for acceptable nursing practice and safe, ethical care Support ongoing development of CHN Promote CHN as a specialty practice Foundation for certification of CHN as a specialty by the CAN Inspire excellence in and commitment to CHN Benchmark for new CHNs Canadian Community Health Nursing Standards of Practice (2019) Health Promotion Prevention and Health Protection Health maintenance, Restoration & Palliation Professional Relationships Capacity building Health Equity Evidence-Informed Practice Professional Responsibility and Accountability Central to Community Health Nursing Practice  Grounded in a broad understanding of health, equity & social justice Applying a broad knowledge base Systematic processes Building relationships Working in partnerships Organize resources Public Health An organized activity of society to promote, protect, improve, and (when necessary) restore the health of individuals, specified groups, or the entire population. A combination of sciences, skills, and values that function through collective societal activities and involve programs, services, and institutions aimed at protecting and improving the health of all people. ○ Six major public health functions are as follows: 1. Health protection 2. Health promotion 3. Population health assessment 4. Public health surveillance 5. Injury and disease prevention 6. Emergency preparedness and response What Is Public Health Nursing? Is community health nursing with a distinct focus and scope of practice. In the last 100 years, the emphasis in public health has shifted from management of communicable diseases to the prevention and management of chronic diseases. Public health nursing: ○ Population focused. ○ Community as context. ○ Health and prevention-focused. ○ Interventions occur at the community or population level ○ Concerned with health of all members of the population or community, particularly vulnerable subpopulations. ○ Considers the influence of the determinants on the health of clients. Concepts Guiding Community Work: Health Promotion and Empowerment Health Promotion Process of empowering people to increase control over and improve their health. Empowerment Actively engaging the client to gain greater control. Involves political efficacy, improved quality of community life, and social justice. Not something that can be done “to” or “for” people; it involves people discovering and using their own strengths Collaboration The commitment of two or more parties (e.g., agency, client, or professional) who set goals to address identified client health concerns. ex. Canadian Collaborative Mental Health Initiative (CCMHI), whose mission is to enhance collaboration between mental health care providers and primary care providers Upstream Thinking vs. Midstream Thinking vs. Downstream Thinking Upstream Thinking Midstream Thinking Downstream Thinking A macroscopic, Regional, local, Takes a “big picture,” community, or microscopic, population health organizational level. individual, curative approach “How can we focus to population Includes a primary change the causes health prevention of the illness or Considers individual perspective injury?” health concerns Considers and treatments, but determinants of does not consider health and other the sociopolitical, economic, political, economic, and and environmental environmental factors variables. “How can we “How can an illness change the causes and its of the causes or the consequences be conditions that set treated?” up the conditions  for illness or injury?” Prevention Community health nursing practice: one area of focus = disease prevention Disease prevention is divided into three levels: ○ Primary prevention Seeks to prevent disease from the beginning ○ Secondary prevention Seeks to detect disease early in its progression in order to make early diagnosis and begin treatment ○ Tertiary prevention Begins once a disease has become obvious; aims to interrupt the course of the disease The Social Determinants of Health The economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole Recent literature points to the importance of social determinants of health for determining client health. 1. Income and income distribution `Most important nationally. However, it is the distribution, rather than amount of wealth, that is associated with healthier people among the population. 2. Education Education provides skills useful for daily tasks, employment (income and job security), and community participation. Clients who have literacy challenges could be referred to community literacy programs. 3. Employment and working conditions Health status is improved with increased control of work circumstances and lower levels of stress. Unemployment is highly correlated with poorer health. 4. Early life 5. Food insecurity 6. Housing  7. Health services 8. Social support/exclusion The effects of social support may be as important as identified risk factors, such as smoking, physical activity, obesity, and high blood pressure. It is not the quantity of relations that matters but the quality. Low availability of emotional support and low social participation have a negative impact on health and well-being. 9. Personal health practices and coping skills Psychological characteristics, such as personal competence, locus of control, and mastery over one's life, contribute to mental and physical health; however, the focus on personal health practices has been characterized as blaming the victims instead of societal factors. 10. Environment Factors in the natural environment, such as air, water, and soil quality, are key influences on health. Human-built factors, such as housing. workplace, community, and road design, are also important. Many of the writings from a population health promotion perspective do not account for environmental implications. 11. Indigenous status 12. Gender 13. Race 14. Disability Milestones in Health Promotion Lalonde Report, 1974 ○ Marc Lalonde, Minister of National Health and Welfare ○ A New Perspective on the Health of Canadians ○ Introduced the term “health promotion” Epp Report, 1986 ○ Jake Epp, Minster for Health and Welfare ○ Achieving health for all: A framework for health promotion ○ Presented at the first Global Health Promotion Conference, World Health Organization and Canadian Public Health Association Ottawa Charter, 1986  ○ Drafted by the WHO, ratified at the 1986 conference ○ A framework for health promotion practice used today Population Health Approach, 1984 ○ Strategies for Population Health: Investing in the Health of Canadians ○ Population health approach officially endorsed by the provincial and federal Ministers of Health Primary Health Care In the early 1970s, the most common model used in health care was the medical model, which focused on treatment and cure in institutions. In 1974, the Lalonde Report initiated a shift toward population health promotion. In 1978, at the Alma-Ata conference, primary health care became the preferred international strategy. Primary health care is: ○ Model for essential health care ○ Based on practical, scientifically sound, and acceptable methods and technology ○ Universally accessible to individuals and families in the community at a cost that the community and country can afford to maintain ○ Comprehensive care that includes Disease prevention Community development A wide spectrum of services and programs Working in interdisciplinary teams Intersectoral collaboration ○ Differs from primary care, which is the first contact between individuals and the health care system for the purpose of treating a disease. Principles of Primary Health Care Five principles of primary health care were adopted at Alma-Alta in 1978: 1. Accessibility ○ Equitable distribution of essential health services to all populations. 2. Health Promotion ○ Increased emphasis on services that are preventive and promotive rather than curative only.  3. Public Participation ○ Maximum individual and community involvement in the planning and operation of health care services in decisions that affect their health 4. Intersectoral Collaboration ○ The integration of health development with social and economic development. Working for health in partnership with other disciplines and sectors 5. Appropriate Technology ○ The use of appropriate knowledge, skills, strategies, technology and resources Focus on promoting health and preventing illness by addressing the determinants of health Emphasizes coordinated action across society and assumes participation of citizens on issues that impact their health Primary health care is different from primary care ○ Primary care is the first point of contact in the HC system ○ PHC is a broader systems-based approach to health care that strives to organize the system in an efficient, fair, and cost-effective way ○ Recognizing that there are inherent differences in the needs of populations and care must be provided differently to those populations- not a “one size fits all” approach Module 1 Part 2: Community Health Nursing Standards of Practice Learning Objectives: Recognize the unique practice settings and specialties wherein CHNs practice Discriminate the CHNC standards of practice Consider how the CHNC standards contribute to excellence in community health nursing practice settings CHNC National voice of community health nurses. Our goal is to advance community health nursing across Canada and improve the health of Canadians. Community Health Nursing: Specialties of CHN Practice Public Health (PHN) focus on promoting, protecting and preserving the health of populations links the health & illness experiences of individuals, families, and communities to population health promotion practice Home Health (HHN) focus on prevention, health restoration, maintenance & palliation focus on individuals, designated caregivers, and their families RN in Primary Care/Family Practice Nurses focus on preventative health screening, health education, comprehensive assessment, treatment of minor acute illness, chronic disease management, case management, system navigation, therapeutic intervention (wound care, immunization) and medication review with individuals and families All Include: Nurses promoting health of individuals, families, groups, populations, communities and systems CHNs work in a wide variety of roles and spaces – from churches, to prisons, to Indigenous reserves, to outposts, to street nursing etc. The above 3 sub-sections tell a part of that story. CHNC Standards of Practice 1. Health Promotion Community health nurses integrate health promotion into practice Involves the individuals, families,  groups, communities, population and systems “Health promotion is the process of enabling people to increase control over, and to improve, their health.” ○ Ex. 1 - (PHN) Working community to advocate for a smoke-free town or municipality. ○ Ex. 2 - (HHN) Encouraging families dealing with a chronic illness to participate in regular physical and social activities. Encouraging clients to quit smoking for wound care healing using motivational interviewing and goal-setting strategies. ○ Ex. 3 (RN in PC) Promoting physical activity across the lifespan and within communities Supporting healthy eating for health child development and chronic disease management Promoting living free from violence and injury; promoting healthy relationships within communities 2. Prevention and Health Protection Community health nurses use the socio-ecological model to integrate prevention and health protection activities into practice.21 These actions are implemented in accordance with government legislation and nursing standards to minimize the occurrence of disease or injuries and their consequences. ○ Ex. 1 - (PHN) Working with a parent’s organization and the police to promote proper installation of car seats through the media and conduct several clinics to provide one-on-one assessment and teaching. ○ Ex. 2 - (HHN) Providing health teaching to people with diabetes in their management of the disease to prevent diabetic reactions. Encouraging mask wearing, and handwashing to clients and family during COVID. When providing wound care, encouraging client to include a multivitamin to help  with wound healing and prevent further damage to the wound bed ○ Ex. 3 - (RN in PC) Assessing height and weight of clients across the lifespan Implementing screening tools (Canadian Task Force on Preventative Health) Providing and participating in cervical screening clinics 3. Health Maintenance, Restoration Community health nurses integrate and Palliation health maintenance, restoration, and palliation into their practice ○ Ex. 1 - (PHN) Providing directly observed therapy (DOT) for people with TB in their living arrangement ○ Ex. 2 (HHN) Caring for disabled students in the classroom: Communication is required with the child’s guardian, teacher and/or classroom assistant Providing and supporting end-of-life care and supporting clients to remain at  home. ○ Ex. 3 - (RN in PC) Participating in health maintenance clinic visits for school-age children annually Participating in patient education, medication review, and direct observation therapy Nursing service in chronic disease management clinics Supporting clients in palliation by working through symptom assessment, management, and access to resources 4. Professional Relationships Community health nurses work with others to establish, build and nurture professional and therapeutic relationships. These relationships include optimizing participation, and self-determination of the client. ○ Ex. 1 - (PHN) Establishing a therapeutic working relationship with multigenerational families, and families that have young children to have healthy family outcomes. Establishing and  maintaining interprofessional relationships (e.g., key informants, stakeholders, political, clergy, etc.) ○ Ex. 2 - (HHN) Providing palliative care with a team of health care providers to individuals to enable them to remain in their homes in their end-of-life Consult with the client’s wound care team to discuss and ensure best practice and holistic approach in the wound care plan is followed to support client outcomes. ○ Ex. 3 (RN in PC) Initiating and navigating client centered interactions Participating in interprofessional team meetings to share knowledge amongst team that will enhance client care and outcomes. Advocating for inclusion and expansion of the nurse in primary care within communities 5. Capacity Building Community health nurses’ partner with the client to promote capacity. The focus is to recognize barriers to health and to mobilize and build on existing strengths. ○ Ex. 1 - (PHN) Working as a partner with a Health Action Team in a high school to mobilize students, parents, teachers, administration, and community partners to identify the school community’s strengths and needs, and prioritize, plan, implement, evaluate the growing vaping behaviour among youth. ○ Ex. 2 - (HHN) Encouraging a mother and teens to work out a schedule for ROM exercises for the grandmother. The family is happy that they were able to work out the problem together. Working with the family and client to figure out a home care schedule that suits client needs and yet maintains independence Encouraging an  end-of-life client has input into the plan of care to ensure their goals are taken in to account. ○ Ex. 3 (RN in PC) Empowering leadership and self advocacy within community members across the lifespan to address diverse needs Advocating for vulnerable populations such as youth, LGTBQ2, older adults, people of any age with chronic medical conditions 6. Health Equity Community health nurses recognize the impacts of the determinants of health and incorporate actions into their practice such as advocating for healthy public policy. The focus is to advance health equity at an individual and societal level. ○ Ex. 1 - (PHN) Identifying that their smoking cessation messaging is not culturally safe nor considerate of the Indigenous realities and culture. Acknowledging the recommendations from the Truth and  Reconciliation Committee, the PHN with other colleagues include Indigenous peoples to begin a community consultation process. ○ Ex. 2 - (HHN) Advocating with families caring for medically fragile children by seeking respite care for families or by contacting their local MPP. Offering the flu vaccine to house bound individuals Advocating for “ wheelchair “ transportation in the community for wheelchair clients to attend social activates. ○ Ex. 3 (RN in PC) Collaboration to enhance accessibility to resources Coordination of pharmacy and social worker to seek financial assistance that will provide drug coverage Collaboratively address barriers and challenges with and within the community 7. Evidenced Informed Practice Community health nurses use best evidence to guide nursing practice and support clients in making informed decisions. ○ Ex. 1 - (PHN) developing a new program for school age children related to physical literacy. They decide to complete a rapid review to find the best evidence to guide their planning. ○ Ex. 2 - (HHN) Working on their wound care policy and consulted the Best Practice Guideline to ensure best evidence is used. Maintaining competence in Palliation best practice for pain management protocol Working as a team lead to support Infusion Therapy practices and build team capacity in best practices and evaluation of any practice changes implemented. ○ Ex. 3 (RN in PC) Participating in continuing education  sessions that support current evidence informed practice Continually reviewing practice and research literature with various disciplines to enhance practice 8. Professional Responsibility and Community health nurses accountability demonstrate professional responsibility and accountability as a fundamental component of their autonomous practice. ○ Ex. 1 - (PHN) Working with a a needle exchange program based on harm reduction. Accepting the tenets of harm reduction and uses reflective practice personally Seeking the input and guidance of a supervisor/mentor to understand and change biased assumptions. ○ Ex. 2 - (HHN) Assisting in the determination of capacity Understanding the different scopes of practice in nursing and interdisciplinary teams and working respectfully with  interdisciplinary team. Assisting client’s and families to support MAID (medical assistance in dying) ○ Ex. 3 (RN in PC) Utilizing interdisciplinary team approaches to client care Practicing in accordance with the Standards of Practice and Code of Ethics within the nursing profession Professionally liaising with colleagues to support and enhance practice including peer reviews Standards 1, 2 and 3 describe what we do in practice Standards 4, 5, 6, 7 & 8 describe how we practice and what we expect to achieve Demonstrates the relationship between all the new standards What is it? A vision for excellence in community health nursing practice The 2019 Canadian Community Health Nursing Standards of Practice consist of eight standard domains and 81 standard statements The Health Equity standard domain experienced much revision from the last iteration of the CHNC standards, with the addition of nine new statements and six reworded statements. The new statements explicitly integrate concepts related to critical social theory, social justice, health equity, and racism, and  acknowledge the CHN role in mitigating the health inequities of marginalized populations including Indigenous people. The visual representation of the Canadian Community Health Nursing Professional Practice Model depicts the client i.e individual/family/group/community/population as central indicating a PARTNERSHIP MODEL. This model is influenced by not only our practice ethos but also the community organizations within which we work plus the systems that envelope our communities. Where do they fit? All registered nurses are governed by their provincial regulatory standards (e.g. in Ontario it is the College of Nurses of Ontario’s Standards and guidelines.) The CHNC standards are over and above the provincial/territorial regulatory body expectations …. expanding upon them by defining specific expectations for nurses working with diverse populations in a wide array of community settings and circumstances. The Competency sets, which are the knowledge, skill, and judgment you need to meet the standards are also available. The home health, public health, and family practice competency sets are all derived from the standards and guide the practice of nurses in these areas of community health nursing. For example, a home health nurse uses the provincial regulatory standards, the CHNC standards, and the home health nursing competency sets. Other nurses in the community use subsets of these competencies. For example, CHNs working in rural and remote parts of Canada might use all 3. Why do they matter? Foundation on which other nursing standards are built Define the practice of a registered nurse in the specialty area of community health nursing Build on these generic practice expectations 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, policy, and research. The standards (clockwise from the top): ○ Inspire excellence in & commitment to community health nursing practice. The standards are an expectation of practice after 2 years of experience in CHN ○ Promote CHN as a specialty and provide a foundation for certification as a clinical specialty with Canadian Nurses Association (CNA) ○ Establish criteria and expectations for acceptable practice and safe ethical care ○ Define scope & depth of community health nurse (CHN) practice ○ Support human resource management including provide criteria for measuring performance ○ Strengthen education and professional development through Providing a foundation for the development of PHN competencies Unique Characteristics of Community Health Nursing CHNs promote, protect & preserve the health of individuals, families, groups, communities & populations… ○ Whereas in a facility setting like a hospital, the main focus is mostly on individuals and families, the CHN has a broad scope of practice that includes working with individuals & families, but also with groups and the broader community. Behind all endeavors is the overarching health of the entire population  … wherever people live, work, learn, worship & play ○ In a hospital setting, the clients come to the facility. ○ In the community, the nurse brings the care to the individual, group community. ○ CHNs provide service in diverse places such as people’s homes, schools, churches, community centres, on the street. ○ This often poses challenges practice in the client’s personal environment (versus a facility environment). distractions in other settings. unpredictable situations (which are often the norm). ‘unique’ home situations encountered. some family members may differ in their level of acceptance of the nurse in their territory having to learn to use and trust what other professionals, the client and the community have already contributed and can contribute. …in a continuous versus episodic process ○ much of the work that CHNs do is long-term and is usually not immediately apparent. The impact of the work is evident over the long-term. View health as a resource & focus on capacities ○ the focus on health and health promotion is critical to the work of CHNs. CHNs focus on individual/family/group/community strengths as a starting point. This is much different approach than focusing on illness or case finding. Work at a high level of autonomy ○ CHNs work individually and as part of a team. They are very autonomous in the work that they do which can pose challenges e.g. lack of access to immediate professional support systems, few supplies, low technology, and difficulty in connecting with other professional caregivers. CHNs are skilled at relationship building and thus, some of these challenges can be mitigated. Marshal resources to support health by coordinating care & plan nursing services, programs & policies ○ CHNs are masters at seeking out resources and facilitating what need to be done to support health.  Have a unique understanding of the influence of the environmental context of health ○ CHNs have expertise in understanding the effects of the determinants of health – research is continually showing us that the determinants have much more impact on health than some of the ‘traditional’ aspects of health. Examples of the determinants include education level, poverty. The determinants will be discussed in more detail later. Build partnerships based on primary health care principles, caring & empowerment ○ much of the impact of CHNs’ work is due to the successful partnerships that are developed within communities. Partnerships, primary health care, caring & empowerment will be discussed in more detail later. Combine specialized nursing, social and public health science with experiential knowledge ○ CHNs draw from a broad base of specialties including nursing, social science & public health science. Practice Expectations in All Settings The Standards incorporate practice expectations involving cultural safety; cultural humility; Indigenous ways of knowing; levels of prevention; disease management; critical appraisal; knowledge translation; interprofessional competencies; and quality improvement. These changes were made in the context of current literature and practice in Canada and our changing understanding of the complex forces that impact health. Our advancing knowledge enhanced by such important documents as the Truth and Reconciliation Commission Report has resulted in a current and leading document that will enhance Community Health Nursing practice in Canada. Cultural Safety Practitioner can communicate competently with a client in that client’s social, political, linguistic, economic, and spiritual realm. Cultural Humility Approach to health care based on humble acknowledgment of oneself as a  learner when it comes to understanding a person’s experience. It is a life-long process of learning and being self-reflective. Indigenous Ways of Knowing “Indigenous knowledge comprises the complex set of technologies developed and sustained by Indigenous civilizations. Often oral and symbolic, it is transmitted through the structure of Indigenous language and passed on to the next generation through modeling, practice, and animation, rather than written word.” Indigenous knowledge is embedded in community practices, rituals, and relationships. Indigenous knowledge has 5 characteristics: personal, orally transmitted, experiential, holistic, and narrative. Level of Prevention With additional layers of primordial and quaternary prevention Disease Management Critical Appraisal (Data and knowledge) Assesses internal validity, the results, and the relevance to practice. Knowledge Translation Refers to a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound use of knowledge to improve the health of Canadians Interprofessional Competencies Reflect what CHNs have always done – making this an expectation of everyone now. Quality Improvement Involves CHNs working to improve health care delivery including effectiveness,  access, capacity, safety, patient-centeredness and equity. Public Health Nursing Utilizes knowledge from public health, nursing, social and environmental sciences, and research, integrating these with the concepts of primary health care, disease and injury prevention, community participation, community development, the social determinants of health, and health equity in order to promote, protect, and maintain the health of the population The essential functions of public health are: Health Promotion PHNs work with a community to advocate for a smoke-free town or municipality. Prevention and Health Protection PHNs work with a parent’s organization and the police to promote proper installation of car seats through the media and conduct several clinics to provide one-on-one assessment and teaching. Health Maintenance, Restoration, and PHNs provide directly observed therapy Palliation (DOT) for people with TB in their living arrangements Professional Relationships PHNs establish a therapeutic working relationship with multigenerational families, and families that have young children to have healthy family outcomes. PHNs establish interprofessional relationships (e.g., key informants, stakeholders, political, clergy, etc.) Capacity Building A PHN works as a partner with a Health Action Team in a high school to mobilize students, parents, teachers,  administration, and community partners to identify the school community’s strengths and needs and prioritize, plan, implement, and evaluate the growing vaping behavior among youth. Health Equity PHNs identify that their smoking cessation messaging is not culturally safe nor considerate of the Indigenous realities and culture. Acknowledging the recommendations from the Truth and Reconciliation Committee, the PHN with other colleagues including Indigenous peoples to begin a community consultation process. Evidenced Informed PHNs are developing a new program for school-age children related to physical literacy. They decide to complete a rapid review to find the best evidence to guide their planning. Professional Responsibility and A PHN is assigned to work in a needle Accountability exchange program based on harm reduction. He has difficulty accepting the tenets of harm reduction and uses reflective practice personally and with his supervisor to understand and change his assumptions. Family Practice Nursing (FPN) Family practice nurses work in primary care settings for example community health centers, physician-owned clinics, and in partnership with interdisciplinary health teams. As the first point of contact with the healthcare system, primary care settings serve populations across the lifespan. Health Promotion Enable, educate, and empower clients to improve their health Promote physical activity across  the lifespan and within communities Healthy eating for health child development and chronic disease management Promote living free from violence and injury; promote healthy relationships within communities Prevention and Health Protection Assessing height and weight of clients across the lifespan Implement screening tools (Canadian Task Force on Preventative Health) Provide and participate in cervical screening clinics Facilitate Well baby, pre and post natal clinics Immunizations and vaccinations throughout the lifespan Healthy sexuality including STI testing and treating, reproductive health and teen clinics Health Maintenance, Restoration, and Participate in health maintenance Palliation clinic visits for school age children annually Participate in patient education, medication review and direct observation therapy Participate in chronic disease management clinics Support clients in palliation by working through symptom assessment, management and access to resources Professional Relationships Client centered interactions Participate in interprofessional team meetings to share knowledge amongst team that will  enhance client care and outcomes. Advocate for inclusion and expansion of the nurse in primary care within communities Capacity Building Empower leadership and self advocacy within community members across the lifespan to address diverse needs ○ For example, but not limited to advocacy work and team projects for youth, LGTBQ2, older adults, people of any age with chronic medical conditions Initiate a memory clinic base on the need and request of client and family members impacted by dementia. Follow up includes linkage to resources. Participate in chronic disease management clinics Health Equity Collaboration to enhance accessibility to resources As a multi-professional team, the nurse coordinates the pharmacy and social worker to seek financial assistance that will provide drug coverage Food security and housing Collaboratively address barriers and challenges within and within the community ○ For example, but not limited to food security, housing Evidenced Informed Participate in continuing education sessions that support current evidence informed  practice Collaborate and review literature with various disciplines to enhance practice The clinic nurse queries why many family givers in the primary care practice are experiencing chronic fatigue. A review of the literature reveals positive strategies to help caregivers reduce their stress. An on-line resource is developed and posted on waiting room TV. Professional Responsibility and Interdisciplinary team approaches Accountability to client care Practice in accordance to the Standards of Practice and Code of Ethics within the nursing profession Professional liaise with colleagues to support and enhance practice including peer reviews Home Health Nursing (HHN) Home health nurses are committed to the provision of accessible and timely care which allows people to stay in their homes with safety and dignity. Home Health Nursing Competencies are the integrated knowledge skills and judgment and attributes required of a nurse working in home health to safely practice. Attributes include but are not limited to attitudes, values, beliefs Home Health nursing encompasses disease prevention, restoration of health, health promotion, and protection with the goal of managing existing problems and prevention potential problems. Health Promotion HHNs encourage families to use their traditional practices of their indigenous culture- use of sweat houses, or poultices in wound care if acceptable HHNs encourage clients to quit  smoking for wound care healing using motivational interviewing and goal setting strategies. Prevention and Health Protection In home health care health promotion and health protection activities are emended in the visits for the clinical care/ context of the visit for the client /family. Not just “ doing wound care” but assessing for opportunities to support health teaching and prevent adverse events with a focus on client safety. HHNs provide health teaching of people with diabetes in their management of the disease to prevent diabetic reactions. Using self management support strategies to build capacity and independence. HHNs encouraging mask wearing, and handwashing to clients and family during COVID. HHNs When providing wound care, encouraging client to include a multivitamin to help with wound healing and to prevent further damage to the wound bed HHNs teach and engage the client is self care about wellness strategies a they can do to help support wound healing. Health Maintenance, Restoration, and Chronic Disease Management teaching Palliation and supporting new diagnosis is a large part of home care nurse role. Wound Care, Palliative Care and Medication Management ( infusion therapy and teaching clients to maintain lines at home ) are 3 focus areas of home health nursing referrals and service plans. HHNs care for disabled students in  the classroom: Communication is required with the child’s guardian, teacher and/classroom assistant HHN is an important part of the end-of-life care team with the client and family by providing end of life care and providing care for clients to remain at home. HHN as part of an interprofessional team that support Adult Day Programs in their community (e.g., Medication management, teaching and supporting non-clinical staff). Professional Relationships HHNs provide palliative care with a team of health care providers to individuals to enable them to remain in their home in their end of life HHN consulting with the client’s wound care team to discuss and ensure best practice and holistic approach in the wound care plan is followed to support client outcomes. HHN consulting with an interprofessional team from a hospital Geriatric Day Unit or Falls Clinic to support client safety in the community. Capacity Building HHN encourages a mother and teens to work out a schedule for ROM exercises for the grandmother. The family is happy that they were able to work out the problem together. A HHN working with the family and  client to figure out a home care schedule that suits client needs and yet maintains independence A HHN encourage an end-of-life client has input into the plan of care to ensure their goals are taken in to account. HHNs support client and family independence with care needs by providing client/ family teaching and support. (e.g., Teaching client and family how to provide infusion therapy and simple wound care) Health Equity HHNs advocate with families caring for medically fragile children by seeking respite care for an exhausted families or by contacting their local MPP. HHN offer the flu vaccine to house bound individuals to ensure they are given an opportunity to have the injection if they want it HHN advocate for “ wheelchair “ transportation in the community for wheelchair clients to attend social activates. HHN works with local community outreach clinic to support a mobile van that services street youth an underhoused population. (e.g., Simple wound care, counselling, palliative care support referral support for services ) HHNs working in an Indigenous Community Health center who are not from the community, advocates for and seeks out education or a mentor to support them in gaining knowledge and  awareness of the community cultural practices and understanding of the role of Elders in the community. (e.g., Community protocols for welcoming Elders to working groups, programs; how to offer tobacco in a respectful manner). HHNs collaborates and seeks to understand how the client’s culture and community barriers to access health services impacts current health context. The HHN ensures a non- judgmental approach and provides care. ( e.g. Providing medication management to an Elder who refuses insulin for managing their diabetes and wish to use only traditional medicines. Evidenced Informed HHNs are working on their wound care policy and consulted the Best Practice Guideline to ensure best evidence is used. HHNs keep up in Palliation best practice for pain management protocol HHNs works as a team lead to support Infusion Therapy practices and build team capacity in best practices and evaluation of any practice changes implemented. HHN is a member of the teams Professional Practice Committee and contributes to ensure new evidence is integrated into practice. Professional Responsibility and A HHN is asked by an ALS client to Accountability be present when his wife removes his Bi-PAP machine, which will result in his death. The nurse explores the client’s reasons for this decision and discusses the ethics around responding to this request with the health care team as well as the nursing practice advisor at their College of Nurses. HHNs as part of a client’s Adult protection team to help determine capacity HHNS demonstrate their scope of practice and understand the different scopes of practice in nursing and interdisciplinary teams and works respectfully with interdisciplinary team. HHNs as part of the team with the client and family to support MAID (medical assistance in dying) Module 2 Part 1: The Community Assessment Process Learning Objectives: Define concepts of community health including dimensions, measures, and data sources. Explain the concepts and approaches used in community assessment Identify how concepts of community development are applied in the community assessment process. Differentiate primary and secondary data sources in community assessment. Discuss the ethical principles applied to the community assessment process. Explain the concepts and processes used to analyze community assessment data. Community Health Assessment Process of gathering information from a variety of sources  ○ to understand the present situation of a community group ○ to understand its preferred health situation This information is used as the foundation for health promotion program planning Defining Community Community refers to “people and emerging relationships as individuals develop and commonly share agencies, institutions, and a physical environment” ○ Society made up of different kinds of communities ○ Community members are defined by what they have in common: Interest/Concern Geography Focus Types of Communities Community of… Definition Example Interest Population or community Group of people who group expected to receive want to build walking trails benefits from the project in their community Concern Population has similar Group of older adults that concerns is concerned with the low levels of lighting on the sidewalks and designated walking areas Geography Population from a specific People living in the same geographical area neighborhood who meet to set up a neighborhood watch program Practice Diverse practice areas Mental health strategies in who meet to share schools, surgical practices knowledge/learn from one in Peds patients another Specific Concept of Community that We Assess: Dimension How we measure the dimension Where we find the information (Data Sources) People Population itself Stats Canada (number/density) Local newspaper Demographic structure of Civic reports the population Chamber of Commerce Formal Groups (schools, businesses, gov't bodies, health & welfare) Informal Groups (clubs, networks) Place Geopolitical boundaries Tourist bureau Transportation: roads, Local gov't offices rivers, railway Maps History Library archives Physical Environment: land Census data use, housing Function Production, distribution Provincial/Territorial offices consumption of goods & Police station services Social and local research Socialization of members reports Social control Churches/religious Adapting to change organizations These factors are: ○ interdependent, and they ○ function together to meet a variety of needs ○ CHNs must consider all 3 when planning interventions within partner agencies Determine who is your community? ○ Demographic profile (people) ○ Description of the patterns/variations in health status (place) ○ Information on the physical, sociocultural & political aspects of the community impacting health (function) Indicators of a Community’s Health Being Measured in Assessment Status: Morbidity/mortality, life expectancy Information about individual communities or groups (single parent families, ethnic groups, occupational groups) ○ Census data ○ Vital Stats ○ Health Authority ○ Canadian Institute for Health Indicators (estimates of health determinants, health status health system use) Structure: Services, resources characteristics of the community structure itself Patterns of service use Treatment data from service providers Provide insight into number of available hospital beds, clinics to attend, and family doctors in the area Community structure is a social indicator or correlates to health ○ Demographic data: SES, racial distribution age, gender education all have a relationship to health status ○ Social determinants of health ○ Some have more impact on health than others Process: Effective community functioning or problem-solving Important because this directly relates to the community’s ability to engage in taking action to address health concerns Community health is the process of involving the community in maintaining, improving, promoting, and protecting its own health and well-being Data Collection Process Step 1: Orienting to the Community Establish Relationships ○ Biggest issue is gaging entry or acceptance into the community. Relationship building from the onset is essential ○ Learn as much as possible about the partner agency/community ○ Clarify methods of communication and documentation with the partner ○ Familiarize yourself with organizational mandates, procedures, protocols  ○ Keep track of people you meet and their roles (and your responsibilities to them) ○ Schedule regular face-to face meetings with agency representatives throughout the project ○ Builds trust ○ Ensures participation/engagement of the partner Define the health promotion project, population group and health issue ○ Some background work will be completed by faculty to identify setting and possible topics/initiatives ○ History of the agency and the context of their practice is important ○ Determine if the agency already has a project(s) idea or a project(s) in development ○ Projects will be shaped to meet needs of both community partners and student learners Identify Community Contacts ○ May work with a community group or within a larger agency connected to external agencies or partners ○ Plan intentionally for engagement: Who should I connect with? How do I connect with them? ○ Staff meetings are a great place to begin making connections. ○ Connecting early facilitates orientation ○ Process takes time ○ Identify gatekeepers: people with formal or informal roles who control access to the community group Define the Project, Population & Issue ○ During orientation, reach agreement on mutual goals for the experience ○ Understand the historical perspective and key events that led to the initiation of the project or project idea (ie: emerging health issue or requests from community members) ○ Being able to fully verbalize or define the scope of your project will take time ○ Each team member should prepare one question when meeting with different groups  ○ Leads to discussion and increase understanding of how you can engage with the organization ○ Learn about other community partners connected to the agency/community you are working with ○ Mandates or past working relationships with partners may influence your project by providing context or additional direction Step 2: Assess Secondary Data Review sociodemographic data (census, neighborhood profiles, determinants of health) Review epidemiological data on health status Review previously conducted community surveys/program statistics Review national and local policy documents Review literature and best practice guidelines Summarize secondary data “so what?” Defining Community of Interest and Population ○ What are the boundaries of my community of interest? ○ What groups in the community are of interest to me (ie men and women aged 65 and over; new immigrants)? ○ What is the profile of this subgroup population (gender, language, education, income, housing, and living conditions)? How does this profile compare with the community as a whole? ○ Where does this subgroup live in the community? Are members spread evenly throughout the community, or do they tend to settle in some areas rather than others? Secondary Data ○ Collect information relevant to your community of interest ○ Information to inform health planning that is collected for other purposes ○ Easier to gather this information when the community of interest is defined geographically ○ Purpose of collecting is to learn what is already known about the determinants of health relevant to that population ○ Much of this info can be found in a range of existing data sources Births, deaths, census data, immunization records, data collected by health authorities  ○ May not answer the specific questions that are of interest to you Summarizing Secondary Data ○ Challenging step ○ Identify or combine the resources that have the same or similar information ○ Important to identify data that provides a compelling reason for working with the community group or issue. ○ Research-based evidence from best practice guidelines that recommends a specific approach is vital Step 3: Assess Physical & Social Environment Information collected directly from community residents and health service providers to provide specific information Builds on secondary data Perspective of the community will evolve during this process as you learn more about where people live, work, study, and play. This knowledge provides meaning and context to the secondary data Assists in the team selecting appropriate assessment methods. Primary Data Collection Informant Interviews Critical part of the community assessment. Select community members and directly talk to them. Can be formal leaders but does not have to be. This takes time and preparation but is very valuable. Having a prepared interview guide is important- know what questions you want to ask and a list of follow up questions/probing questions to keep your informants talking. ○ “Would you explain further?" ○ "Would you give an example?“  Be sure to start your interview with information on what the purpose of the information is and who will access the information such as the information will broadly be in a group presentation or perhaps you intend to quote- the speaker should be aware of the scope and intent. Focus groups This hasn’t been the most popular method in this course. Lots of planning goes into a focus group including the size of the group- usually small subset of specific people. CHN’s who conduct focus sets the agenda of the topic within the focus group and utilize skills as a facilitator/moderator to keep discussions going, probe for deeper understanding of what's being said. Its important to remember that as the facilitator- the CHN is not meant to participate in the discuss, but rather record what the group is saying. Windshield surveys CHN can drive/walk and potentially in take public transport around the community making observations about the community. The Windshield survey is a short and rapid community health assessment. Community Forums Can be in person, or online. An ○ Town hall where members discuss community issues or  perhaps where several communities come together to discuss issues or mutual interest Secondary analysis of existing data Surveys Surveys are used in clinical semi-frequently but the community health nurse doesn’t often use original surveys in the community assessment processes but rather draws on secondary analysis of existing well constructed population health surveys relevant to the specific target population ( Constructing a survey that is valid and reliable is time-consuming and costly. Mapping Direct Obecondaservation Along with informant interviews, this is a popular method of collecting information about the community. It is intentional sharing in the life of the community There is limitations to participant observation as its based usually on a single opinion of an individual Bringing the information back to the community to verify is important. Let's say you see two children you preserve picking on a third child during recess. You may conclude bullying behaviors are common in your community school. However, when ask in a survey to  the children if they experience frequent bullying its not noted as an issue. Upon going to teacher of the students to discuss the incident you learn it was an isolated issue and not something that is regularly occurring in the community. Primary Data: Physical and Social Environment Get a map Get out to see, hear, and talk to people Can’t complete this process from your computer!! Put yourself in the shoes of a community member Takes time & feels very different from working in an institutionalized setting Helps ensure your team will be working on relevant and feasible community issues Work as a team to organize and strategically create questions to ask community members Before going out be clear about how you will present yourself and explain the purpose as part of clinical practice Be comfortable introducing yourself, explaining who you are, where you are working, and what you are doing Gaining critical assessment skills essential to the progress of your health promotion project Step 4: Primary Data Investigate the Health Issue in More Depth Progressive Inquiry (short-term projects) ○ Expands the depth and breadth of your knowledge of the community ○ Methods suited to natural/informal settings ○ Best suited to determine an issue for action for short-term projects ○ Focus groups and questionnaires may be appropriate in some settings- require more work and more time in preparation ○ Collect information in a systematic way to provide information on the present health situation and the preferred health situation Cycles in Progressive Inquiry  Team decides on 2-3 initial questions Ask questions where people gather Compare responses, identify themes & trends Determine 2-3 more specific questions Ask questions informally where people gather ○ Fosters developing relationships with communtity members ○ Systematic and gradual approach to collecting in-depth assessment information ○ Aim is to engage community members in disucssion ○ Understand their health concerns ○ Identify what they would like to change/enhance Guided Observation (short term projects) ○ Collecting detailed