CNUR240 Community Health Test 1 Notes PDF

Week 1 Module Introduction Welcome to the dynamic field of community health nursing. In this module, we will explore health promotion (HP) within public health nursing (PHN) and community health nursing (CNH), practices essential to achieving Canada's goal of “health for all.” We will examine how i...

Week 1 Module Introduction Welcome to the dynamic field of community health nursing. In this module, we will explore health promotion (HP) within public health nursing (PHN) and community health nursing (CNH), practices essential to achieving Canada's goal of “health for all.” We will examine how individuals' social and economic positions shape their understanding of health and their access to care through a lens of social justice and health equity. Our journey will include reflecting on the concept of community and its defining characteristics. We will delve into the various interpretations of health, its status as a human right, and the principles of health equity. Additionally, we will discuss the notions of community, community health, and what constitutes a healthy community. This module will cover the assumptions, guiding principles, and ethical foundations that underpin the roles and practices of Community Health Nursing (CHN). Finally, we will review the roles, responsibilities, and scope of practice for community health nurses as defined by the Canadian Community Health Nursing Standards of Practice. Topics Community health Healthy community Social determinants of health Health equity and social justice Social analysis Community development Empowerment vs. advocacy Health literacy Community health nursing standards of practice Learning Objectives By successfully completing this module, you should be able to: Comprehend basic concepts in community health nursing. Explain the relevance of the ecological perspectives, social determinants of health, and community development in relation to promoting health in communities. Analyze critically the importance of social analysis, health equity, and social justice for promoting community health and culturally safe community health nursing practice. Explain the history of community nursing and its different roles in Canada. Appraise the role and responsibilities of community health nursing (CHN) as outlined in the Canadian Community Health Nursing Standards of Practice. Required readings Etowa,J., Ashley, L., & Moghadam, E. (2020). Policy, Politics and Power in Health Care. Chapter 2 in L.L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall (pp. 19–34). Craig, Phillips J., & Schofield, R. (2020). Nursing roles, functions and practice settings. Chapter 3 in L.L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall (pp 35–50). Dosani, A., Etowa, J., & van Daalen-Smith, C. (2020). Critical community health nursing: An imperative. Chapter 34 in L. L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall (pp. 604–609). Key terms Advocacy Community/Community health/Healthy community Community development Community health nursing Empowerment Health literacy Health/Wellness Social analysis and social justice Social determinants of health Critical Questions What are some of the personal and environmental factors that interact and impact on our health? Why, in the Western industrialized world, are we being encouraged to focus on the individual – the individual’s health and/or illness? How does this get organized as it does? Who might be gaining from this focus? Who might be losing? Canadian Nurses Association (CNA) The CNA challenges us as professionals: To practice “reflexivity” To take into account our own values and biases To consider the political dimensions of our use of language and discourse, as part of our professional practice Youtube video: https://www.youtube.com/watch?v=QboVEEJPNX0 What Is Health – A Critical Analysis If health is defined only in individual terms, the issues of power and control, and the unequal access to life chances are invisible and easily ignored. People live and work in groups, communities, and societies, which have lives of their own and impact on each other quite profoundly. Health Redefined “Health is a product of reciprocal interactions between individuals & their environments.” (WHO [1992, p. 409]) In this definition, it is noted that health depends on our ability to understand and manage the interaction between human activities and the physical and biological environment. Any examination of health must consider the health of individuals, families, groups, communities, societies, and the global context. The interrelationships between each of these components of health are very strong and cannot be considered in isolation from each other. Consider the Aboriginal health movement, the environmental movement, the women’s movement, colonialism, urbanization, etc. Social Determinants Of Health (SDOH) Non-medical conditions in the social environment in which people are born, live, learn, work, play, worship, and age. Influence a wide range of health and well-being, functioning, and quality-of-life outcomes and risks. Created by distributions of money, power, and resources at global, national, and community levels. Mostly responsible for health inequities; e.g. poverty, income, employment, education, housing, food in/security, race, sexual orientation. https://www.youtube.com/watch?v=XQkYIpCmTDw What Is Community Community in this context refers to a group of individuals who share certain qualities or live in a geographic area. The shared qualities include: A unit of practice; e.g., for Community Health Nurses (CHN) Physical or Geographic space Interdependent group of people interacting with each other Common interests: e.g., culture, language, sexual orientation Community of interests: e.g., shared beliefs, values or interests on a particular issue, or bound by ties of culture, occupation, religion, etc. Community of interest: around a shared perspective on a particular issue though not necessarily on other issues. Community of membership: population groups; e.g. gender, race, class, age, sexual orientation, culture, religion, nationality etc. Vulnerability to a health concern; e.g., HIV/AIDS, STDs, Diabetes, Cancer Dynamic – interactive web of ties – social, a sense of belonging Community Health Vs. Healthy Community Community Health Community health focuses on the health status of a specific group of people who live in a particular geographic area. It encompasses a variety of activities aimed at improving the health of the community members, including: Health Promotion: Education and outreach programs to encourage healthy behaviouyrs and lifestyles. Disease Prevention: Vaccination programs, screenings, and initiatives to prevent the spread of diseases. Access to Healthcare: Efforts to ensure that community members have access to medical services and care. Environmental Health: Initiatives to address environmental factors that can affect health, such as pollution and sanitation. Policy and Advocacy: Working on policies that promote health equity and improve public health infrastructure. Healthy Community A healthy community refers to a broader concept where the physical, social, and economic environments are conducive to health and well-being. Key features of a healthy community include: Physical Environment: Safe and clean surroundings, including access to parks, recreational facilities, and safe housing. Social Environment: Strong social networks, community engagement, and social support systems. Economic Environment: Economic opportunities, access to education, and job security. Access to Services: Availability of healthcare, education, transportation, and other essential services. Cultural and Recreational Activities: Opportunities for cultural expression and recreational activities that promote mental and physical health. What Is Community Development? Goal Helping communities to change – fostering community competence Values Absolute worth of individuals People are able to learn and change People can work together to change the conditions of their lives that may seem to be beyond their control One individual can change one aspect of their life and this can improve the overall health Community participation and group process are enhancing in and of themselves People are genuinely interested in participating in their own health Principles in Community Development Ensuring services are empowering; i.e., applied with dignity and cultural sensitivity. Using connective processes to ensure the basic goal is a caring, purposeful group. Organizational actions should be focused on altering structural conditions to prevent isolation and/or self-blame among community members. Collaborative strategies are employed to help clarify the task and empower the community in terms of their purpose and vision. Advocacy means challenging the status quo to help people become empowered even if there are conflicts or ambiguous issues. Capacity Building Developing the abilities and resources within the community to solve problems and sustain improvements. Providing training, education, and resources to enhance community skills. Community Development: Challenges To ensure health professionals do not impose their agenda on the community, members of the community should decide: what they wish to change, what services they need to assist change, and what support mechanisms are required to maintain change. The Role of Health Professional: “Advocacy” Provide information and opportunities for dialogue with others Community taking a leadership role in developmental planning. Help communities construct pathways to change in different levels Monitor the extent to which both government and non-government health organizations actually support community development What Is Health Literacy? The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Research People with lower levels of literacy experience poorer health and more hospitalizations than those with higher rates of literacy. People with lower levels of literacy may not reveal this to health professionals. Reading and Comprehension Understanding written health information, such as prescription labels, appointment slips, and health education materials. Being able to read and interpret instructions on medication and health forms. Numeracy Understanding and using numerical information, such as dosage calculations, blood sugar readings, and risk probabilities. Health Promotion Health promotion is a process that combines a personal, organizational and political development towards health. What Is Health Promotion “The process of enabling people to increase control over, and to improve their health.” (The Ottawa Charter of Health Promotion, 1986) The Community Health Nurses of Canada (CHNC) Standards of Practice state that Community Health Nurses (CHN) focus on health promotion and the health of populations. CHNC (2011) Integrate the Population Health Promotion Model Identifying the level of intervention necessary to promote health Identifying which determinants of health require action or change to promote health Using a comprehensive range of strategies to address health related issues Differences Between Empowerment and Advocacy Empowerment involves increasing individuals’ or groups’ control over their own lives and decisions, enhancing their ability to act on their own behalf. Focus Approach Goals Methods Empowerment: Centers on Empowerment: Involves Empowerment: Aims Empowerment: Includes enabling individuals or building internal for self-reliance, self- education, training,  communities to gain capacities, skills, and determination, and resource provision, and control over their own confidence within personal or community support networks. lives and make individuals or groups. development. independent decisions. Advocacy: Focuses on Advocacy: Involves Advocacy: Aims to Advocacy: Includes influencing external external actions, such as achieve systemic awareness-raising, policy systems, policies, and lobbying, campaigning, change, policy reform, influence, representation, public opinion to create and public speaking, to and social justice. coalition building, and change on behalf of others. bring about change. campaigning. Community Health Nursing Many terms have been used to define nurses who practice in the community. The term varies across the world. In Canada the term “Community Health Nurse” (CHN) is used. The term used to describe nurses who practice in community settings can indeed vary globally. In Canada, the term “Community Health Nurse” (CHN) is commonly used to refer to nurses who provide care and support to individuals and groups within their communities, focusing on health promotion, disease prevention, and addressing community-specific health needs. Other countries might use different terms such as “Public Health Nurse,” “Community Nurse,” or “District Nurse” to describe similar roles. The role of community health nursing is defined below. A Practice Specialty That: Promotes, protects, and preserves the health of individuals, families, communities, and populations, in the settings where they love, work, learn, worship, and play in an ongoing or episodic process. Combines nursing, social, and public health science with primary healthcare. Builds on the capacities inherent in individuals, communities and more. Multi-faceted planning and co-coordinating of care, services, and programs with individuals, caregivers, other disciplines, organizations, communities, and governments. Community Health Nursing (2011) CHNs value caring, principles of primary healthcare, multiple ways of knowing, individual and community partnerships, and social justice. CHNs acknowledge its roots and traditions, embracing advances, and recognizes the importance of the need to continually evolve as a dynamic nursing specialty. CHNs view health as a dynamic process of physical, mental, spiritual, and social well-being. Health includes self-determination, realization of hopes, needs, and a sense of connection to the community. CHNS 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. Canadian Community Health Nursing Standards Of Practice (2011) Standards define the scope and depth of practice by establishing criteria for acceptable nursing practice: Desirable and achievable levels of performance. Criteria for measuring actual performance. Standards Of Practice Health promotion Prevention and health protection Health maintenance, restoration, and palliation Professional relationships Capacity building Access and equity Professional responsibility and accountability Community Health Nurses Work With Individuals and families Groups Communities Populations Systems and society Theoretical Foundations: Nursing Metaparadigm Includes Person (all of the above) Health Nursing Environment (culture) Social justice as central to the practice of community nursing Competencies: Public Health Nursing In Canada Core competencies are not designed to stand alone – rather they form a set of knowledge, skills, and attitudes practiced within the larger context of the values of public health – a commitment to equity and social justice. Public health sciences Assessment and analysis Policy and program planning, implementation, and evaluation Partnerships, collaboration, and advocacy Diversity and inclusiveness Communication Leadership All of the above are related to Community Nursing and CHNC Standards. Nursing Role Since a CPHN’s role is broader than just the client and community, as a nurse we need to be knowledgeable, resourceful, and empowering to institute change. So, at what level does this change happen? Moving to the Broader Context: Social Analysis and Social Justice Page What Is Social Analysis: Social analysis means raising questions about society and seeking answers. Purpose: To develop a critical awareness of the world and to lead toward social justice. Process: Critical questioning Gives rise to further questions about what is going on and who is getting hurt Leads to further research Brings out the links or connections between different social issues Helps to find out what is really going on beneath the surface of society, or beyond the appearances Social Analysis Helps People Become Critical What Does “Critical” Mean? To become: Conscious, aware, questioning, developing a discerning/sharp attitude, a habit of trying to get to the bottom of things; i.e., discovering the roots causes; i.e., thinking upstream The Purpose? to seek the truth of a situation to make visible any injustice that characterizes the situation Social analysis is orientated: toward social justice toward taking action toward promoting change to contributing to the quest for greater social justice In summary, as nurses, it is crucial to be reflective and ask critical questions to uncover the underlying social determinants of health and health inequities. We have demonstrated that defining health solely in individual terms obscures issues of power, control, and unequal access to life opportunities. The social, economic, and political factors – such as poverty, housing, food security, unemployment, Indigenous rights, racism, sexism, heterosexism, environmental issues, homelessness, immigration, violence, and human rights – are responsible for most observed health inequities in the population. As Community Health Nurses (CHNs), we must advocate for social change and justice, helping communities overcome disempowerment. Promoting critical health literacy through education and community capacity building is fundamental to the effective implementation of any public health strategy. Health literacy is defined as the outcome of education and communication that increases people’s capacity to engage in a range of actions that enhance their health and participate in social actions that improve health outcomes and opportunities for health. Recognizing the structural determinants and policy context of health, and engaging in social and political actions that advance both individual and collective health, are important steps in promoting community empowerment and fostering community competence. Community Health: People working collaboratively to shape and develop the community in a way that will help them achieve positive health outcomes. Health community: Commitment to achieving the health and well-being of individuals, families, and various groups of people. Health equity: The absence of systematic disparities in health (or in the major social determinants of health) between social groups who have different levels of underlying social advantage/disadvantage. Social determinants of health: Integrated and overlapping social and economic factors that that determine health and well-being and are responsible for most of health inequities in the population. Community development: A process where community members come together to take collective action and generate solutions to common problems. Social analysis: Developing a critical awareness of the world by with the aim of bringing social justice. Week 2 Module Introduction The ecological perspective is a valuable framework for promoting health within communities, emphasizing the interaction between individuals and their physical and social environments. This approach is based on the understanding that public health and well-being are influenced not only by individual behaviours but also by broader social, economic, and environmental contexts. Empirical evidence demonstrates that impoverished individuals suffer more illnesses, disabilities, and shorter life expectancies, and have a poorer quality of life compared to affluent individuals. These disparities are strongly linked to structural factors such as age, gender, race, ethnicity, income, education, employment, housing, food security, social inclusion, and living and working conditions. These factors, known as the social determinants of health, are often beyond any individual's ability to change. This module employs the ecological perspective to discuss the concept of social determinants of health and to highlight health disparities among vulnerable, at- risk, and marginalized populations. It will illustrate that these conditions are preventable and explore approaches to reducing health disparities. Additionally, we will examine upstream and downstream thinking in the context of health promotion. Topics Ecological perspective Social determinants of health Health inequity Social justice Upstream thinking  Ottawa charter and health promotion Learning Objectives By successfully completing this module, you should be able to: Reflect critically on concepts of health, health inequality, health equity, and social justice. Consider critically current health inequities and disparities in relation to populations who are more vulnerable to being marginalized, and/or at-risk in Canada. Examine critically the concept of the social determinants of health from differing perspectives. Demonstrate familiarity with similarities and differences regarding community, public health, and health promotion perspectives in relation to reducing social inequities in health in the work towards social justice for all. Required 1. Lind, C., & Baptiste, L. (2020). Health promotion. Chapter 8 in L. L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.) Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall (pp. 137–167). * Note-1: Concepts of thinking upstream vs. downstream (p.140). Resources 1. What makes us get sick? Look upstream, (18:13) Dr. Manchanda. 2. Social determinants of health (9:20) – A discussion of social determinants of health.  3. What it is Health Equity? (3:34) Health Equity Institute. A discussion of social determinants of health, health equity, with a focus on social justice (being political). Key terms Health disparities Health Equities Social determinants of health Upstream thinking