Community Nursing Notes PDF

Week 2 - chapter 3 and 4 A community health nurse (CHN) works with people where they live, work, learn and plate to promote health - They work in various settings such as homes, schools, streets, and shelters, churches, and community health centers - These nurses view health as a dynami...

Week 2 - chapter 3 and 4 A community health nurse (CHN) works with people where they live, work, learn and plate to promote health - They work in various settings such as homes, schools, streets, and shelters, churches, and community health centers - These nurses view health as a dynamic process of physical, mental, spiritual and social well-being and as a resource for everyday life that is influenced by circumstances, beliefs and determinants of health The Blueprint for action for community health nursing in Canada was released by the community health nurses of Canada in 2011 - It provides a framework and a point of reference for ongoing dialogue on the development of community health nursing practice in Canada - The intent of the framework is to inform the direction of CHNs in their practices and ultimately to promote and protect the health of Canadians Minority populations - Indigenous scholars advocate for the use of wise practices which incorporate traditional knowledge, cosmology and life ways to guide health practices with indigenous communities - LGBTQ+ community is another group that faces barriers: Healthcare providers who lack understanding of the needs of LGBTQ+ persons or have stigma and discrimination against them - Newcomers to Canada are another group who encountered worse health outcomes as a result of not being able to find culturally appropriate services, language barriers, and fear of deportation and lack of access to familiar foods Community Health Nursing (CHN) roles and practice settings Indigenous nursing Involves first nation, Inuit, and Metis nurses’ care, beliefs, values, practice, traditional knowledge and education, research, administration and policies Public health nursing Utilizes knowledge from public health, nursing, social and environmental sciences, and research Home health nursing The specialized area in which the nurse, employed by a home health agency, provides clinical care in the clients home, school or workplace - Chronic disease management, health promotion, health education, palliative care, rehabilitation, support and maintenance Primary care nurses Provide the first contact with the healthcare system - Encourages healthy lifestyle choices, health promotion,Collects information about the population to  initiate or evaluate services, supports healthy public policy Telehealth nurses Triage of health issues; consult; provide advice, counsel, support, and educate; as well as coordinate care for chronic disease management - A goal of telehealth nursing is self care management and support for individuals and families living in the community and being monitored at home Outreach/street nursing See their clients where they are and focused on building relationships while maintaining a safety, dignity of and respect for the clients - Mostly secondary and tertiary healthcare services with people who are homeless, like harm reduction through needle exchange, and facilitating access to services Rural and Northern Work in the community, homes, schools, clinics, outpost nursing Canada nurses settings/stations, and First Nation, Inuit, and Métiscommunities. - Focus on the roles of a PHN and primary care but in rural settings Military nurses Are commissioned nursing officers of the Canadian Forces Medical Service. Occupational health Base their practice on four interrelated components: individual, nurses health, occupational health nursing, and the environment - Health promotion, maintenance and restoration, and injury and disease prevention in the workplace Parish nurses Has specialized knowledge to promote health, healing, and wholeness; hired or recognized by a faith community and integrates faith and health into nursing practice Forensic nurses Provide for health care needs and to collect evidence for police and the legal system in a way that respects clients’ dignity, right to choice, and self-determination. Community mental Involves a blending of community nursing and mental health nursing health/psychiatric nursing. Population health vs public health Population Health: - Is the overarching approach to health that targets the improvement of specific groups toward reducing health inequities - Shapes public health practice Public Health: - Is the organized efforts of society to prevent injury, illness, and premature death  - Focuses on protecting and promoting the health of all Canadians through a combination of programs, services, and policies. - The essential functions of public health or health promotion, disease and injury prevention, health protection, health surveillance, population health assessment and emergency preparedness and response 6 essential functions of public health nurse: - PHNs roles and responsibilities are outlined in the six essential public health functions: - Health protection, - Health surveillance, - Population health assessment, - Disease and injury prevention, - Health promotion, and - Emergency preparation and response. It is important to note that PHNs intervene at five levels of prevention: Primordial prevention: Initiatives are those that prevent conditions that would enable the risk factors for disease from developing. Primordial prevention is often accomplished through healthy public policy. Example: iodized salt prevents micronutrient deficiencies - should PHN advocate for this to be a public policy? Primary prevention: The impact of specific risk factors is lessened, which leads to the reduction in the occurrence or incidence of disease. These initiatives interrupt the chain of causality at a point before a physiological or psychological abnormality is identifiable. For example, enhancing nutritional status, immunizing against communicable diseases, or improving water supplies. Secondary prevention: Initiatives that aim to identify disease processes as early as possible, which may reduce the prevalence of disease by curbing its duration. Physiological or psychological abnormalities are present but secondary prevention stops them before there is a manifestation as a symptom or sign notice by the individual. Example: screening early Tertiary prevention: Measures aim at reducing the impact of long-term disease and disability by eliminating or reducing impairment or disability. These interventions occur after signs or symptoms are present and reduce the likelihood of persistence or progression. The focus is on rehabilitation that minimizes suffering and maximizes potential years of functional life. Example: Marginalized populations living with HIV can have better outcomes when using text messaging with HCP (they have disease but outcomes are improved with intervention, texting = tertiary prevention in this example) Quaternary prevention: Initiatives are those actions that identify individuals or populations at risk of over medicalization. Example is protecting populations from new medical procedures or interventions that are untested and proposing alternatives that are ethically appropriate for both populations and healthcare professionals (more masectomy’s than necessary) 8 Community health nursing standards of practice: **check appendix of textbook - Important that CHN’s have their own standards because their scope of practice is different - These standards help set CHN as its own profession 1. Health Promotion: process of enabling people to increase control over, and to improve, their health - Ottawa Charter health promotion strategies: build healthy public policy, create supportive environments, strengthen community actions, develop personal skills, reorient health services 2. Prevention and Health Protection: Community health nurses use the socio-ecological model to integrate prevention and health protection activities into practice. These actions help minimize the occurrence of disease and injuries and their consequences - Examples: immunization, teaching people with diabetes about management… 3. Health Maintenance, Restoration and Palliation: Community health nurses integrate health maintenance, restoration and palliation into their practice - Examples: rehab, helping people live with their chronic illness - Focus is on maintaining maximum function, improving health, and supporting life transitions including acute, chronic, or terminal illness, and end of life 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. 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. Example: working with elders to support their care - Partnership is key - work with the client to build capacity and efficacy 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. 7. Evidenced Informed Practice: Community health nurses use best evidence to guide nursing practice and support clients in making informed decisions.  8. Professional Responsibility and accountability: Community health nurses demonstrate professional responsibility and accountability as a fundamental component of their autonomous practice. Week 3 - Nursing process and evaluation (chapter 10 pp. 226-234, 13, 14 329-332, 15) Page 260 might be useful for paper** Evidenced informed decision practice: - Reflects variety of factors that shape decisions in relation to the use of evidence in policy making - Evidence informed practice is broader than research utilization - It is an iterative process (doing something again and again, usually to improve it) - Evidence informed decision making involves considering valuable evidence from a variety of sources, including client or community health issues and local context, and the best available research evidence - Evidence informed practice is broader than research utilization - Process is circular in nature, beginning with defining the question and moving through various phases - When the evaluation phase is complete, you may have new questions to define and move through the cycle again Process of evidence informed practice: (starts at page 186 in textbook) 1. 2. 3. 4. 5. 6. 7. Define Research Appraise Synthesize Adapt Implement Evaluate PISO/PICO CHNs need to Once the articles are This stage Once you decide Once you have the After implementing questions be able to find found, you must decide requires that you which research best available a practice or policy high quality if their quality is consider the evidence to use, evidence and change, evaluation Define who the relevant sufficient. Valid? evidence found, you must consider adapted it to your period is needed to population/ information determine how to the population and population, you see if it is working intervention/ Guidelines are the deal with political factors need to decide outcome is Use highest level of conflicting results involved in making about whether to This means a synonyms for evidence found on the in different studies, a program or change practice period of data Eg: for new each 6S pyramid and identify which policy decision collection from mothers (pop.), component evidence you will Create a plan to baseline to ensure can e-health when Questions about use for decision Think about how address how that rates of the technology searching effectiveness or harms making the intervention everyone within the desired outcomes (intervention) of certain needs to be organization will be are like those in be used to Research interventions/preventio To decide which adapted to the informed of the the original study achieve healthy doesn’t starts ns are best answered evidence to use, local population proposed change weight in with the by randomized consider which Should also note if postpartum journals, it controlled trials source is the the Consider factors Implementation plan any potential period starts with most highly like magnitude of should include: negative outcomes (outcome) clinical If trials cannot be done, synthesized the issue in your diagnostic analysis are like those listed questions cohort design (one evidence (6S population, social (environmental in the study group gets intervention, pyramid - and political scan) to identify other(s) doesn't) is next guidelines #1) acceptability of the barriers and Let others in best program/policy supports to the similar populations If there are you wish to change being know about what Questions about conflicting results implement and introduced, the you did and how it  perceptions and from articles of ability to get client (individual, worked (eg: feelings are best equal quality, resources families, conference answered by qualitative consider relevance populations…), the presentations and research (such as to your population Can use the organization and the peppers, phenomenology and the resources Applicability and environment so that educational grounded theory) need to implement Transferability Tool barriers can be meetings) or the intervention by Buffett reduced and through informal Participatory action support online forums research (PAR) is used strengthened for questions and interventions that A champion may be evolve through needed to with the partnerships between enthusiasm and researchers and energy to push for participants (ex working practice change with indigenous pop.) Mixed methods are increasingly popular since health care topics are complex The most common community health research is program evaluation - The agency may conduct periodic chart reviews or database summaries Next most likely research in community health is client outcome measurement - Example, client mortality, morbidity, immunization status or communicable disease outbreaks - Client outcome measurement is the most likely information collected CHNs work and collaborate with the community as a partner - A community may be defined by: A group of people who live, learn, work, worship, and play in an environment at a given time. They share common characteristics and interests, and function within a larger social system such as an organization, region, province, or nation - Community is also defined by its place or geopolitical boundaries, which often are used to determine the location of service delivery - The core of any community is people who are characterized by their age, gender, socioeconomic status, education level, occupation, ethnicity and religion - Unlike having clients in hospitals or acute care setting to actively seek episodic care for their presenting problems, community health nurses must determine who and where their clients are, and why what when and how best to promote their health in the community All communities provide the following community functions: - Space and infrastructure for housing, recreation, government and housing and social services - Employment and income - Security protection and law-enforcement to protect the public from crime  - Participation, socialization and networking for all community members - Linkages with other community systems for opportunities for growth and capacity building Models and frameworks: A. Community as partner model - Community and nursing processes are the two main attributes of the community as partner model. - Community attribute is the community assessment wheel, which depicts the components of the community assessment: physical environment, education, safety and transportation, politics and government, health and social services, communication, economy and recreation. At the core is the residents - The nursing process attribute reflects the stress adaptation model. CHNs assess and analyze the degree of reaction to stressors experienced byy the community and implement purposeful primary, secondary and tertiary interventions to promote optimal client health B. Community capacity - the capacity building process strengthens the ability of a community, or health organization to develop and implement health promotion initiatives - Work with community members and their priorities for health promotion, health protection and restoration - Cassity building is a process to strengthen the ability of an individual or community to develop and implement health promotion initiatives and sustain positive health outcomes over time - It involves human resource and skill development, leadership, partnership, resource allocation and policy formulation - Community capacity building is a continuous process that allows the community members to take responsibilities of their own development C. Healthy cities, healthy community model - Bring community health workers and community members together to collaborate, work towards socially just, equitable, and healthy communities. “The community toolbox” D. Epidemiological framework - CHNs use the epidemiologic triangle (host- environment- agent) to examine the frequency and distribution of a disease or health condition - Examining the who what where why when and how, Examples: Covid and the opioid crisis - CHNs determines what the community is, who is affected (HOST), where and when the condition occurred (ENVIRONMENT) and how (AGENT) it occurred E. Community health promotion model (CHPM) - the CHPM emphasizes that the health of the population is influenced by the interplay of various determinants of health and the environments people live in  - Uses this understanding to guide community planning, intervention and evaluation - The goal is to apply community health promotion strategies to achieve collaborative community actions and to improve sustainable health outcomes of the community - This is a holistic approach to promoting the health of the population to attain a higher quality of community life and health equity Four community assessments Problem investigation Needs assessment - Population: black residents of Toronto - Population: newcomers in Northern - Strategy: community participatory BC approach - Strategy: focus group discussions - Outcome: increase vaccination rates - Outcome: challenges and barriers to among the population assessing breast health services - Focus evidence question: What - Focus evidence question: What are community participatory strategies are the challenges and barriers to effective to increase vaccination rates accessing breast health services for black Torontoians? experienced by newcomers living in northern BC? Environmental scan Resource evaluation - Population: clients with disabilities in - Population: clients with lower incomes Halifax in Windsor - Strategy: community mapping and - Strategy: program evaluation surveys - Outcome: use of city recreation - Outcome: transportation services for facilities that are free of charge for individuals with disabilities lower-income clients from January to - Focus evidence question: How June available are the transportation - Focus evidence question: How often services for clients with disabilities did lower income clients living in living in Halifax Windsor use the cities free recreation services from January to June Population health: - Population health is an approach to health that aims to improve the health of an entire population - Goal is to reduce health inequities among population groups - Population health risk assessment identifies and targets clients who are most likely to contract a particular disease or develop unhealthy behaviors, and assess attributes that affect their health - The populations contribute to the overall productivity and quality of life in the community and to a sustainable and equitable healthcare system Community participatory tools for community planning:  - CHNs use community participatory tools to engage community stakeholders and population groups to address community health needs and to advocate for positive change Community needs matrix tool: - Used for participants to discuss, identify, rate, or explain which health problems are most important to communities and to chart this data - Degree of concern about each issue is tallied on a blank chart, then community health nurses facilitate the discussion to learn what the community has to say about their lived experience - Mutual planning, the CHNs assist the participants to make informed choices of the needed action, thus improved client outcomes Community engagement: - Is a process of developing relationships that enables stakeholders to work together to address health related issues - Present- future drawings allow community health nurses to see where community wants to go and formulate mutual intervention goals or objectives Data analyses in community health nursing practice (ch. 14) Validation: - Process of actively soliciting feedback from community members and key stakeholders - Is critical to ensuring data accurately reflects the communities lived experience - What may happen if data is not validated with the community? Framing data to align with the levels of prevention: - 5 levels of prevention, each can be informed by the data collected and eventually analyzed The importance of focusing on community strength - Strengths-based approaches assume that the individual, family, community or population has assets and strengths - Strengths are best built upon by the community health nurse - The focus is on building the capacity of partners - Strengths-based approach is more powerful in community nursing health than deficit-based approach Community health planning, monitoring and evaluation (ch. 15) - Planning-implementation-evaluation cycle: - Conduct a situational analysis or community assessment - Then identify problems/issues - Consider solutions or actions to address the problem - Design and implement the program - Monitor and evaluate the program - Analyze and interpret results of the monitoring and evaluation process - Use the result to make modifications to the program or to inform decisions about other programs Logic Model - Two planning stages in development of a logic model: - CAT (components, activities and target groups) - SOLO (short-term outcomes and long-term outcomes) - The logic model provides a means of documenting what the program is supposed to do, with whom and why - In CAT stage, activities are first clustered thematically into components for the program under review (example: suicide prevention program might include components of risk assessment, crisis intervention and peer support) - Activities are the specific intervention strategies for each component. The crisis intervention component may include training youth workers in crisis management and developing community supports for you think crisis - Target groups are the intended recipients of the program, in this example, these might be youth who are homeless or dislocated from their families or Indigenous youth - The purpose of the SOLO stage is to identify program outcomes - Short-term outcomes are the immediate and direct results of the program, and long-term outcomes reflect the ultimate goals of the program - Building the knowledge and skills of use workers to identify and support youth in crisis would be a short term outcome - Reducing youth suicide rates would be a longer-term outcome Tools and processes to support planning and evaluation: - PRECEDE-PROCEED planning model - This model enables the community program developer to think logically about the desired endpoint and work backwards to achieve that goal  - SWOT: strengths, weaknesses, opportunities and threats analysis - Identifies internal strengths and weaknesses of the organization or program, along with external opportunities and threats - It may involve document and policy reviews, community meetings, key - informant interviews and focus groups - A SWOT analysis may also assist in determining the feasibility of initiating or continuing a program Program planning and evaluation: - Priority setting: Transparency for selecting priorities is made apparent to individuals who are not directly involved. Communication strategy needs to accompany efforts to set priorities with partners to provided input - Priority setting inevitably means that you can either address all the identified needs nor operationalize all the proposed interventions - The first principle is buy-in which means needs to be addressed early in - Second principle is transparency, whereby the process for selecting priorities is made apparent to individuals who are not directly involved - The third principle is communication Planning, monitoring, evaluating programs - GANTT charts - Use to present the sequence and timing of activities that must take place in order to accomplish the specific objectives of the program or project Week 4 - nursing and the environment (CH 27 & 32) The age of Anthropocene refers to a period in earth's evolution that has seen the significant impact of human activity on the environment to such an extent that some of the ecological determinants are threatened - Pollution control will help alleviate poverty - Indigenous traditional knowledge about ecosystems is closely linked to land in place of community, and as such it is diverse and reflects that I adversity of indigenous people around the world - Ancestral relationship with the land has given indigenous peoples unique insights called traditional ecological knowledge and wisdom (TEKW) Ecological determinants of health and planetary health The age of Anthropocene - The age of human impact on earth - humans negatively impacted environment so bad that it gets its own title - Increased degradation of environment and climate change due to human behaviors - Causes of anthropocene:  - Model of energy production - energy produced by coal, oil and natural gas emits large amounts of greenhouse gasses (main cause of global warming) - Resource consumption model - These cause changes in water cycle, imbalances and destruction of ecosystems, extreme meteorological phenomenon, acidification of oceans and disappearance of forests - Solutions: - Relying on renewable and non polluting energy sources (sun, water, wind) - Equal use of natural sources = more sustainable to prevent anthropocene from becoming last stage of our planet Ecological determinants of health are: - Always viewed in conjunction with social determinants of health - Acknowledge, and are informed by, other integrative, holistic, and indigenous approaches to health and wellness - Human health around the world depends on the ecological determinants of health and the wise stewardship of these goods and systems Ecological determinants of health are defined as: - Basic elements derived from nature (oxygen, water and food) - Vital ecological processes, natural resources and systems that make life possible on our planet (ozone that protects UV radiation) - Essential for human existence on this planet, particularly for the development of human cultures and civilization (stable global climate with temperatures, abundant energy, materials to construct shelter and tools) The ecological determinants of health and global change - CLIMATE CHANGE - The last 100 years have been the warmest in history, largely attributed to arise in greenhouse gasses, particularly CO2 from burning fossil fuels such as oil, gas, and coal - Global warming contributes to the spread of vector borne diseases, such as the Zika virus - Changing weather patterns affect the indigenous peoples as it is increasingly difficult to predict animal movement and when it is safe to hunt in travel - POLLUTION - In addition to air pollution, we are also concerned about the contamination of freshwater ecosystems and soil contamination with metals and synthetic chemicals that affect food supplies and agricultural products - The the majority of deaths due to pollution occur in populations rendered vulnerable, including children and the poor - Ecotoxicity (accumulation of toxins on ecosystems) and loss of biodiversity are interconnected with pollution  - SOCIO POLITICAL TRENDS - In addition to climate change and pollution, significant socio political trends drive global change. Among them are increasing urbanization and displacement, with related food and housing insecurity - By 2030, 2/3 of the world's population will live in urban areas - health impacts = increased obesity and food shortages Planetary health - Planetary health alliance defines planetary health as a solutions oriented transdisciplinary field and social movement focused on analyzing and addressing the impacts of human distractions to earth's natural systems on human health and all life on earth - Planetary health is concerned with the unprecedented impact of human activity on earth's ecological systems and its consequences for human health - Planetary health perspective is increasingly involving from its more anthropocentric viewpoint - When the planet is unwell, so are we and vice versa - Humans are harming their own health by harming life sustaining ecosystem Planetary health for nurses - Is critical to understand and appreciate the profound therapeutic effects of nature on human health, or its salutogenic effect - Salutogenesis, as opposed to pathogenesis, is concerned with pathways to health and healing - Process of “planetary salutogenesis” refers to going beyond anthropocentric discourses of health and towards a learning process involving humans and environments that are values as equal, interdependent entities - Instead of looking at the environment as something dangerous and to be feared, planetary health recognizes that we can achieve and sustain the health of future generations by taking care of our planet's natural systems - Framework: The framework of planetary health illustrates how human activities in the form of consumerism, overpopulation and environmentally damaging technologies are the underlying drivers of ecological change - This change negatively impacts air quality, food production, infectious disease exposure, freshwater access and natural phenomena - Socially mediating factors contribute to negative health incomes, including malnutrition, infectious diseases and non-communicable diseases, displacement and mental health - The mediating factors of public policies, decision making governance, and advances in technology can also contribute to positive health outcomes - This framework depicts a mechanism of how humans are harming their own health by harming life-sustaining ecosystems Ecological health inequities: Geopolitical location refers to the effect of governments and decision-making bodies, which can impact public policies and how resources are distributed - Some governments may perpetuate the exploitation of natural resources and the oppression and domination of less powerful groups in society Social location refers to your place or position in society and it has an impact on your access to a clean natural environment and how much, if any, control you have over that environment - Indigenous peoples in Canada most affected by ecological injustices due to a long and enduring pattern of structural racism - Their land and waters which are crucial to maintaining their traditional ways of life and to the protection of natural ecosystems - Women take on different social roles and responsibilities that expose them to different environments, potentially leading to negative health outcomes - Example: responsibilities for child care and older adult care may confine woman into a domestic environment with higher exposure to various indoor air pollutants from cooking with wood stoves, particularly in resource poor countries, or chemical cleaning products - From a population house perspective, in Canada the majority of people living in poverty are women, specifically single parenting mothers and their children - Low income neighborhoods can expose residence to in adequate housing, leading to negative health outcomes such as depression and exposure to lead, pesticides, molds, noise and unintentional injuries Environmental health inequities: - The planets ecological systems are threatened by human action, including climate change, pollution, resource depletion, marine degradation and population growth - The environment affects people differently depending in part on geographic and geopolitical location - Canada it is recognized that children, older adults and first nation and Inuit communities are particularly vulnerable to environmental health inequities - Children are more susceptible to residential use of pesticide exposure than adults - Older adults are more vulnerable to weather events such as heat waves - Indigenous communities are more vulnerable due to an advocate house thing that can expose them to overcrowding, mold or unsafe drinking water Examples: - Developmental, or lifespan, perspective: the youngest and the oldest members of society are rendered most vulnerable to ecological health inequities and injustices result of their anatomy, physiology, and practices - Older adults are more vulnerable to weather events such as heat waves - Children are more susceptible to residential use of pesticide exposure than adults - Studies indicate a link between air pollution and detrimental effects on developing brain through a process of neuroinflammation  - Health inequities and injustices concerning geolocation are disproportionately experience by indigenous peoples - Indigenous communities are vulnerable due to inadequate housing that can expose them to overcrowding, mold or unsafe drinking water - Persistent organic pollutants (POPs) around the Great Lakes region of North America have been found in the breastmilk of Inuit woman - Prenatal exposures to polluting toxicants, such as POPs, have been associated with reproductive interference in both male and female sex organs, cognitive impairments, learning disabilities, attention deficit and hyperactivity disorders, dyslexia, and autism in children Global change - Ecotoxicity and loss of biodiversity are interconnected with pollution - Socio political trends drive global change; among them are increasing urbanization and displacement, with related food and housing insecurity - Climate change clearly has an effect on the physical environment and is impacting indigenous cultures, identities, food security, and health on a global scale - Air pollution, specifically the increase in CO2, is a major driver of climate change at the same time causing respiratory and cardiovascular diseases - Primordial prevention is concerned with identifying and preventing the risk factors of disease as early as possible and include: - Primary prevention related to environmental and occupational health might include immunization, counseling about reducing exposures, and supporting policies - Secondary prevention involves promoting early detection or screening of environmentally related disease and limiting disability - Tertiary prevention involves recovery or rehabilitation of an environmentally related disease or condition after the disease has developed - Tertiary prevention involves rehabilitation or recovery of an environmentally related disease or condition after the disease has developed - Quaternary prevention approaches, involve action taken to identify those at risk for over medicalization to prevent people from invasive medical interventions and provide them with procedures that are ethically acceptable - Nursing practice at the level of quaternary prevention would include advocating with patients for prudent selection of only the most necessary drugs to be prescribed Community health nursing practice Primordial Primary Secondary Tertiary Quaternary prevention prevention prevention prevention prevention Policies that aim Could include: Secondary Tertiary Action taken to at protecting the Initiation of prevention prevention aims identify a patient environment are discussions with involves to prevent or population at  the focus of new parents on screening, the further risk of over nursing practice how they can purpose is to deterioration of medicalization at the primordial facilitate healthy detect a harmful an already comment to level environments occurrence existing protect them before it can condition from invasive Instead of One-Health cause more medical allowing a outreach service harm Population interventions, potentially provides free health co-benefit and provide harmful activity veterinary care An example approach would them with the to proceed until alongside would be a include hair care evidence of its human health collaboration advocating with procedures impact on the services such as with an the client which are environment and immunization for interdisciplinary community on ethically human health is the homeless team to issues such as acceptable collected, nurses pet owner ascertain if pesticide free can advocate for newly proposed lawns and There's a ethically policies will have gardens to concern about responsible a negative protect humans pharmaceutical choices impact on the and non-human compounds in environment and nature, such as freshwater and Making use of health equity bees, from saltwater marine the outcomes - For harmful species, Nursing precautionary instance, if a chemicals practice at this principle to new subdivision level would support is proposed, You include advocacy action could screen the advocating with subdivision patients for proposal for prudent potential harmful selection of only effects to the the most natural necessary drugs environment or to be prescribed to ensure green by physicians spaces are included Nursing and emergency preparedness and disaster response (ch 32) What is disaster? - As defined by public safety Canada, disasters or social phenomenon that results when a hazard intersects with a vulnerable community - Disasters affect Public Safety in these communities with long-term adverse socioeconomic, health, and environmental effects - Adverse effects of disasters do not affect individuals and groups equally Types of disaster: - Natural disasters: unpredictable; happen very quickly or slowly; floods, droughts, earthquakes, tsunamis, volcanoes, wildfires, plane crashes  - Natural disasters are unpredictable and can happen very quickly, or slowly - With advanced warning, such as weather reports, impacts can be mitigated - Human-made disasters: often result in mass numbers of civilian injuries and deaths; include bioterrorism, bombings, and technical disasters - 25 Canadians were among the many killed when terrorists attack the world trade center towers - Epidemics can occur when an infectious disease spreads rapidly, affecting a large number of individuals within a population (can be non-infectious i.e. opioid crisis) - Epidemics become pandemics when the infection becomes widespread in different parts of the globe Levels of management: The Emergencies Act has been used once, in response to the Canada convoy protest in 2022. The War Measures Act, which the Emergencies Act replaced, was used on three occasions: during both the First and Second World Wars, and during the 1970 October Crisis. - Local municipalities have the first responsibility in managing an emergency and if their capacity is exceeded, the province responds, and likewise, they call on federal government for assistance - Federal legislation found in three complementary acts: - The Emergencies Act, - The Emergency Preparedness Act* - The Emergency Management Act The emergencies act allows the federal government to grant the use of special powers to ensure the safety and security of Canadians during a national emergency - Federal government intervention is restricted to only the most serious emergency situations, while respecting the authority of the provinces and territories to govern within their own geographical jurisdictions The emergency preparedness act functions as companion legislation to the emergencies act - While the emergencies act provides the authority for government action, the emergency preparedness act provides a basis for the planning necessary to address disasters of all kinds - Specifically, the emergency preparedness act addresses the need for cooperation between the provinces and territories at the federal level to establish responsibilities and provide structure for training and education in emergency planning The emergency management act replaces parts of the emergency preparedness act to strengthen the government's readiness to respond to major emergencies by defining the roles and responsibilities for all federal ministers - It enhances information sharing between various levels of government and the private sector and provides critical infrastructure consisting of physical and information technology facilities, Networks and services that are vital to the health and safety of Canadians Furthermore, each Minister of the Crown is responsible under Section 6 of the Act: to identify the risks that are within or related to his or her area of responsibility — including 1.prepare emergency management plans in respect of those risks; 2.maintain, test and implement those plans; and 3.conduct exercises and training in relation to those plans. Public safety and emergency preparedness in Canada - Emergency management involves mitigation, prevention, preparation planning, responding and recovery; effective management can avoid the escalation of an event into a disaster - By completing a Hazard Identification Risk Assessment (HIRA), organizations can prioritize specific threats based on risk of probability and consequence or impact - Public health authorities use the Incident Management System as an operational framework for emergency preparedness and response planning - Public Health Ontario (2020) adopted a framework and developed a comprehensive set of 67 indicators corresponding with the elements to support all aspects of emergency management Nurses in disasters and emergency response: - Nurses from all settings play a critical role during all phases of emergency or disaster response - Integral role nursing profession plays in all aspects of emergencies, including prevention, mitigation, preparedness, response, and recovery - PREVENTION involves activities taken to prevent or an avoid an emergency or disaster, before the emergency - like promoting healthy lifestyles through public health education - MITIGATION involves actions that can reduce the impact of a disaster on the community. Influenza vaccination and infection control measures are - PREPAREDNESS programs are intended to maximize the insufficiency of the response through planning and preparation. Actions taken before the emergency, focus on plans to establish communication systems, conduct training and test response plans - RESPONSE activities are designed to address the immediate effects of an emergency. They focus on operations and include the mobilization of providers, the coordination of healthcare services and the acquisition of necessary supplies - RECOVERY programs are designed to return a situation to an acceptable and normal condition. Recovery is usually the longest phase and focuses on restoration. It may also include prevention or mitigation measures design to avert future emergencies - Nurses and health care workers in emergency or disaster response experience tremendous secondary traumatic stress and burnout Two unique contributions of the ICN document are: 1. the inclusion of nurses’ leadership role in planning and implementing disaster response  2. the emphasis for nurses to include assessments of their own physical and mental health, and those of their colleagues, during disaster response, as well as attending to their own health and well-being in the recovery phase Social justice and health equity in disaster response: - Canadian nurses must develop an agenda that strengthens education in disaster nursing - CHNs who are knowledgeable and competent in emergency preparedness are necessary to meet the challenges of unpredictable threats from disaster - Essential to be actively involved in the development of healthcare policies Week 5 - Gender and community health (ch. 19, 20) - Canada was the first country to include a wider definition of gender as part of its national census in 2021 - Gender is a concept that is often taken for granted with a one-size-fits-all approach Gender in Canadian context: - Men identify as transgender earlier while women come out later - 300 people in Canada aged 15 and older identify as transgender or non-binary - World Health Organization (WHO) established the Commission on Social Determinants of Health (CSDH) - Gender inequities damage the health of women and girls throughout the world - Girls and women have less power, privilege, and access to resources than do men. - Female life expectancy in Canada is higher than that of males - Indigenous populations in Canada have a lower life expectancy at birth than non-Indigenous populations - In rural or remote regions, high long-term unemployment rates, lower levels of education, small immigrant populations, and relatively large Indigenous populations Sex is not the same as gender - Sex is a socially constructed categorization - Sex is male/female (X and Y chromosomes) while gender is how someone chooses to present - Some biological processes will always be at play because of innate sex characteristics Sex and gender as determinants of health: - Gender roles are defined as the social and cultural expectation - Cisgender refers to a person whose gender identity matches their biological sex  - Transgender refers to “a person whose gender identity is different from their biologically-assigned sex, regardless of the status of surgical and hormonal gender reassignment processes” - Concepts of masculinity and femininity are social constructs - CHNs must be mindful of their own beliefs and assumptions regarding sex, gender and what constitutes “normal” gender expression Indigenous notions of gender: - Indigenous cultures have different definitions and expressions of gender than Western cultures - Two Spirit - Multiple genders and a wide variance of gender roles existed in many tribal societies and communities - Gendered violence inherent in settler colonialism which impacted Indigenous women, girls, and two-spirit peoples Societal causes of gender based inequalities: - Institutionalized gender: - Gender inequity occurs when individuals are not provided the same opportunities in society because of their gender or gender-identify - Example: women presents with abdo pain, first question asked is “are you pregnant”, man presents with abdo pain, questions are very different - It’s important for CHNs to understand past experiences of discrimination in healthcare settings - People who identify as transgender and non-binary avoid seeking medical attention due to discrimination Gender bias is the root of gender inequities and generally arises from three problems: - Overgeneralization - “what’s good for men is good for women” = FALSE - Gender and sex insensitivity - ignoring variables that contribute to differences (like sex characteristics) - Double standards - assessing same citation on basis of gender (waiting room example) Gender-based Lens and community health nursing practice - Using a gender lens to examine a context helps to purposefully illuminate the unique constraints and opportunities men and women face. - CHNs need to reflect on the degree to which programs are gender-blind, aware, exploitative, accommodating, or transformative - The Gender Responsive Assessment Scale is highly relevant to the work of CHNs who wish to be appropriate, responsive, and gender transformative in their practice. - In federal buildings, you must provide free feminine products Gender mainstreaming: ? Community health nursing practice and gender advocacy - CHNs seeking gender transformative primordial prevention would:  - Strive to reduce and eliminate flawed assumptions and non-critical approaches to community health nursing practice - Training staff on approaches = primordial prevention approach because talking about before you are even working - CHNs seeking gender transformative and primary prevention would: - Challenge essentialist lenses used to explain sex and gender differences in project and program planning 2SLGBTQIA+ clients (chapter 20) - Gender identity = internal development of your sense of self as a gendered person - Transgender (or trans), non-binary or gender diverse people may experience their gender identity as not fitting what others think it is or should be or as not fitting within a binary model of man and women - They may identity as non-binary, genderqueer, gender-fluid or another label - Cisgender refers to the majority of people whose internal gender identity matches their external body appearance and gender performance -