NRSG 4101 Class 1 (4) PDF

Professional Formation III: Foundations of Population- Focused Nursing NRSG 4101 Class 1 Winter 2025 Mindy MacNeil Gushue, MScN, BScN, RN, CMSN(C)  Agenda Brief Biography Review Course Syllabus Today’s Concept: Professional Identity Today’s Exemplars:  Health Inequalities...

Professional Formation III: Foundations of Population- Focused Nursing NRSG 4101 Class 1 Winter 2025 Mindy MacNeil Gushue, MScN, BScN, RN, CMSN(C)  Agenda Brief Biography Review Course Syllabus Today’s Concept: Professional Identity Today’s Exemplars:  Health Inequalities and Health Inequities in Context  Population – Focus Nursing  Public Health Nursing  Political Identity – Service Learning Acknowledgement: “NRSG 4101 2025 Course Materials adopted from Sam Hodder’s NRSG 4101 2024, with permission”.  Biography Hobbies & Interests Highlights Soccer Mom Mother of 3 Traveling Wife Music Dog Mom Research Interests: Assistant Professor CBU Supporting Nurses’ Mental Casual RN NS Health Health, Improving Post- Researcher Operative Outcomes Education & Certifications Work Experience BSc in Biology/Psychology SMU Nova Scotia Health – Acute Care BScN STFX (Surgical Unit, ICU, Perioperative MScN MUN Services) Certification in Medical/Surgical Casual in Long Term Care Nursing CNA Clinical Preceptor NSCC  Contact Information Required Textbooks Course Goals & Objectives Class Schedule/Outline Assignments Midterm Course Requirements and Evaluation Syllabus Class Participation Communication CBU Policies Absence Nova Scotia Health Immunization E- learning: https://elearning.nshe alth.ca/Studio/Catalog ue Professio nal Identity Health Inequalities and Health Inequities in Context Learning Exercise Question 1: What is your position on the following statement? “Good health is a matter of personal responsibility and choice.” Question 2: What is your perspective as a nursing student on the following statement? “What determines health status or influences population health?” Population Health What is Population Health? Population health is an approach to health that aims to improve the health of the entire population. Population health aims to reduce health inequities among population groups. The Determinants of Health are the broad range of personal, social, economic, and environmental factors that determine individual and population health.  The Determinants of Health The main determinants of health include: 1. Income and social status 2. Employment and working conditions 3. Education and literacy 4. Childhood experiences 5. Physical environments 6. Social supports and coping skills 7. Healthy behaviours 8. Access to health services 9. Biology and genetics 10. Gender 11. Culture 12. Race / Racism The Determina nts of Health The Determinants of Health The most influential determinants of health are income and social status. Factors of income and social status:  Gender  Income  Social Position  Education  Employment  Working conditions The Determinants of Health Recent literature points to the importance of social determinants of health for determining health status and health outcomes. As income brackets improve, Canadians have less sickness, longer life expectancies, and improved health. People with low socioeconomic status face a range of conditions that put them at risk for poor health, for example:  Drug and alcohol addiction  Homelessness  Food insecurity  National Collaborating Centre for Understanding the Health Gradient and the Determinants of Health. Health Gap (2013). Let’s Talk: Universal and targeted approaches to health equity.  What is Health Inequity? Health inequities are health differences between population groups – defined in social, economic, demographic, or Health geographic terms – that are unfair, unjust, and avoidable. Inequity & What is Health Equity? Health Health equity means all people Equity can reach their full health potential and should not be disadvantaged from attaining it, Strives to improve health outcomes for ‘all’ population groups, Seeks to reduce the excess burden of ill health among socially and economically disadvantaged populations.  1. Systematic: health differences are not random, but are patterned across the population – e.g., those with higher social status tend to have better health than Three those with lower social status Features 2. Avoidable: not the result of natural of Health biological differences; they are the result of how societies distribute resources and Inequities opportunities – therefore avoidable. 3. Unfair/Unjust: underlying the concept of health equity is a commitment to social justice and basic human rights such as access to clean water, food, education, and health care. National Collaborating Centre for Determinants of Health. (2013). Let’s Talk:  Health Inequities Systematic differences limiting the opportunity for communities to achieve their optimal health. 1. Health Status Differences in morbidity and mortality 2. Distribution of Health Resources Accessibility, affordability, acceptability, availability, and quality 3. Social Conditions (SDoH) Where people born live, work, play, and age Health Inequities Climate Change Structural Housing Racism Rights of Pandemics Indigenous Health Inequiti es Technologi Education cal Advances Sexual, Mental Gender Health Reproducti ve Rights Social Safety Net Health Inequities – The Human Cost Excess morbidity, premature mortality Unfulfilled human potential Eroded social cohesion Excess bereavement Increased unpaid caregiver reliance  Health Inequities – Modifiable Contributors Medical care is estimated to account for only 10- 20% of the modifiable contributors to healthy outcomes for a population. The other 80 to 90% are health-related behaviors, socioeconomic factors, and Magnan, S. 2017. Social Determinants of Health 101 for Health Care: Five Plus Five. NAM Perspectives. Discussion Paper, National Academy of environmental Medicine, Washington, DC. https://doi.org/10.31478/201710c  Reducing Health Inequities Adopt a human rights approach to action on the social determinants of health and health equity. Intervene across the life course with evidence-informed policies and culturally safe health and social services. Intervene on both proximal (downstream) and distal (upstream) determinants of health and health equity. Deploy a combination of targeted interventions and universal policies/interventions. Address both material contexts (living, working, and environmental conditions) and sociocultural processes of power, privilege, and exclusion (how social inequalities are maintained across the life course and across generations). Implement a "Health in All Policies" approach. Carry out ongoing monitoring and evaluation. Public Health Agency of Canada. (2018). Key Health Inequalities in Canada: A National Portrait – Executive Summary  Lack of health insurance and high healthcare costs Common Language barriers Health Disparitie Lack of transportation s Provider-patient communication Biased clinical decision making Patient’s mistrust and refusal Equality, Equity, & Systemic Change Health Equity https://youtu.be/9R2burG K4HU https://youtu.be/F8UAanK 5WNA  Health Inequalities While the infant mortality rate in Canada has improved over the past few decades, this improvement is not equally distributed. Canadians living in the most materially deprived areas have rates of infant mortality 1.6 times higher than the rates of those living in the least deprived areas.  The CNA Code of Ethics for Registered Nurses (2017) is a statement of the ethical values of registered nurses. It demonstrates nurses’ commitment to Canadian persons with healthcare needs and Nurses’ persons receiving care. Contains 2 parts: Associatio  Part I. Nursing Values and Ethical n Code of Responsibilities Ethics  Part II. Ethical Endeavors Related to Broad Societal Issues CNA Code of Ethics Part I. Nursing Values and Ethical Responsibilities A. Providing Safe, Compassionate, Competent, and Ethical Care B. Promoting Health and Well-Being C. Promoting and Respecting Informed Decision-Making D. Honoring Dignity E. Maintaining Privacy and Confidentiality F. Promoting Justice G. Being Accountable  CNA Code of Ethics Part II. Ethical Endeavours Related to Broad Societal Issues Ethical nursing practice addresses broad aspects of social justice that are associated with health and well-being. These aspects are focused on improving systems and societal structures to create greater equity for all. Individually and collectively, nurses keep abreast of current issues and concerns and are strong advocates for fair policies and practices. There are 16 ways listed in the Code of Ethics to guide nurses to accomplish this.  What are the major differences Populatio between n-Focused population- focused practice Nursing and traditional direct-care practice?  Population-Focused Nursing Practice What is Population-focused Nursing? Population-focused nursing aims to improve the health of the entire population and to reduce health inequities among priority population groups. How does Population-focused Nursing differ from Traditional Healthcare? Traditional health care provides treatment to those with an illness and focuses on the individual.  Population-Focused Nursing Practice Individual-focused Nursing Practice Assessment, diagnoses, planning, interventions, and evaluation are carried out at the individual client level. Population-focused Nursing Practice Uses a defined population and/or aggregates as the organizing unit of care. Assessment, diagnoses, planning, interventions, and evaluation are carried out for a population or subpopulation. Levels of prevention (primary, secondary, tertiary). Population-level decision-making is different. Concerned with more than one subpopulation.  Race or ethnicity, Recent immigrants and culture, class, gender, refugees age, religion, gender Priority identity, sexual orientation, disease Single parents (mainly women) Populatio state, other social factors Persons with disability/ differently abled ns Low SES Low levels of People living with substance use disorder education/literacy Chronic physical and/or Unemployed, under- mental illness employed, or working conditions Persons experiencing Homeless or violence precariously housed Youth/elderly  Proportionate Targeted Universalism Universalism Recognizes universalism Recognizes that to level can still result in an Blended up the gradient, programs and policies unacceptable health gap, and that a targeted Approac must include a range of approach can have little effect on the slope of the responses for different hes to levels of disadvantage health gradient. Defines goals for all, Addressi experienced within the population. identifies the obstacles faced by specific groups, ng A Focus solely on most disadvantaged will not and modifies' strategies to address the barriers in Health reduce health inequalities. those situations. Equity To reduce the steepness of the social gradient in health, actions must be National Collaborating Centre for universal, but with a Determinants of Health. (2013). Let’s Talk: Universal and targeted approaches to scale and intensity that is health equity. proportionate to the level s to Reduce Health Inequities National Collaborating Centre for Determinants of Health. (2013). Let’s Talk: Universal and targeted approaches to health equity. Practice Example – Breastfeeding Public/Community Health wants to promote breastfeeding in community. The nurse read the evidence showing a positive connection between breastfeeding and positive health and wellness outcomes as well as a connection between mothers who live on very low incomes and low rates of breastfeeding. Examples of some of the intervention approaches available to the nurse are: 1. Universal: Work with organizations, businesses, and community groups to advocate for baby-friendly environments. 2. Targeted: Offer breastfeeding education and support in lower-income neighborhoods 3. Targeted Universal: Advocate for baby-friendly environments, and work with community groups to strengthen policies and programs supporting breastfeeding engagement with low-income women. 4. Proportionate Universalism: What could this look like ? National Collaborating Centre for Determinants of Health. (2013). Let’s Talk: Universal and targeted approaches to health equity.  Population Health Conceptual Models Who Focus on population What All determinants of health How More emphasis on strategies other than individual skill development. Evidence What have we learned regarding what works in health promotion with populations from research, experiential learning, and evaluation. Population Health Promotion Model https://www.canada.ca/en/public-health/services/health-promotion/population-health/population-health- promotion-integrated-model-population-health-health-promotion.html  Population Health Conceptual Model Population Health Template Tool https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/population- health/population-health-approach/template_tool-en.pdf  Group Exercise Identify a public/community health initiative focused on health equity in your community. A. What concern was the initiative designed to address? B. Is the approach universal, targeted, targeted universal or proportionate universal? C. How has the initiative been effective? D. How have the initiative outcomes fallen short? E. How could the intervention be improved? Community Health/Public Health Nursing  Definitions of Community Health Nursing 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  Mental Health Community Nurse  Travel Nursing  Nurses working in health promotion in the community (NHPs) Community/Public Health Nursing Practice Nursing practice that focuses on working together to enhance the health of all people and communities - mainly those structurally disadvantaged - contributes to healthier and more equitable communities. Working collaboratively to promote and protect the health of people and the communities where they live, learn, work, and play.  Community Health Nursing Working with the people, not just for the people, in assessment, planning, intervention, and evaluation. 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) Community health nursing practice: one area of focus = disease prevention Disease prevention is divided into three levels:  Primary prevention  Secondary prevention  Tertiary prevention  Collaboration The commitment of two or more parties (e.g., agency, client, or professional) who set goals to address identified client health concerns. CHNs collaborate with the following:  Physicians  Social workers  Nutritionists  Physiotherapists  Occupational therapists  Other health care professionals  The client  CNA Position on Collaboration The Canadian Nurses Association (CNA) has identified eight principles for collaboration: (1) client-centered care (2) evidence-informed decision-making for quality care (3) access (4) epidemiology (5) ethics (6) communication (7) social justice and equity (8) cultural safety Community/Public Health Nursing Definition of Public Health Nurses (PHNs): Community Health Nurses who interact with clients* to promote, protect, and preserve health by using population health determinants based on sound knowledge that includes nursing science, public health science, and social sciences.  Community/Public Health Nursing What is Public Health? Community health nursing with a distinct focus and scope of practice:  In the last 100 years, the emphasis on public health has shifted from managing communicable diseases to preventing and managing chronic conditions.  Exception – Recent years with COVID- 19  Public Health Functions Six major 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  Characteristics: Community/ Public Health Nursing Population focused Community context Health and preventive focus – 1, 2, 3 (disease prevention) Interventions made at the community or population level Concern for the health of all members of the population/ community, particularly vulnerable subpopulations It is imperative to work with members of the community – Community engagement Practice Settings for Public Health Nursing PHNs are employed by an official public health agency, referred to as a health unit, health department, or regional health authority. Practice settings include the home, school, workplace, community health center, and clinical settings. PHNs have a baccalaureate degree in nursing with curriculum content in community health nursing, epidemiology, research, management, and leadership. Practice PHNs are very much involved in providing clinical services, such as Settings the following: Influenza prevention for Family planning Travel health Public Immunization Sexual health Health Breastfeeding Nursing Well babies 53  Functions and Roles of Public Health Nurses Advocate:  e.g., works with patients to obtain necessary resources Manager:  e.g., works with specific aggregate groups, such as conducting well-baby home visits; identifies the services needed most for the least cost Leader or consultant:  e.g., builds and maintains partnerships with community leaders and key stakeholders to identify community needs, such as the following: Playground safety Access to physical activity opportunities Hand hygiene Pedestrian safety Safer sex practices 54  Functions and Roles of Public Health Nurses Referral resource:  e.g., referring patients to health and social services available within the community Assessor of patient literacy:  illiteracy has medical, social, and legal implications Educator:  e.g., provides information to patients or staff Primary caregiver:  e.g., may provide prenatal services, or free immunization services for targeted populations Multiple roles in emergency preparedness and planning:  e.g., education, establishing mass dispensing clinics, communicable disease surveillance Multiple roles in communicable disease control:  e.g., finding infected individuals, notifying contacts, administering treatments  Upstream, Midstream, Downstream ‘Downstream’ addresses immediate health needs ‘Midstream’ address material circumstances such as housing and employment ‘Upstream’ advocate for greater fairness in power structures and income  Downstream Versus Upstream Thinking Upstream thinking: A macroscopic, “big picture,” population health approach Includes a primary prevention perspective Considers determinants of health and other economic, political, and environmental factors Downstream thinking: o Takes a microscopic, individual, curative focus on population health o Considers individual health concerns and treatments but does not consider the sociopolitical, economic, and environmental variables. Upstream, Midstream, Downstream  1. Public Health Sciences in Nursing Practice 2. Population and Community Health Assessment and Analysis 3. Population Health Planning, Implementation, and Evaluation 4. Partnerships, Collaboration and Advocacy 5. Communication in Public Health Nursing Competencies are complex know-acts based on combining and mobilizing internal resources (knowledge, skills, attitudes) and external resources and applying them appropriately to specific types of situations (Tardif, 2006).  Canadian Community A vision for Health excellence in community health Nursing nursing practice Standards Professionalism (2019) requires nurses in all roles to demonstrate professional standards. https://www.chnc.ca/membership/documents?c ategory=2  Canadian CHN Standards of Practice 1. Health Promotion 2. Prevention and Health Protection 3. Health Maintenance, Restoration, and Palliation 4. Professional Relationships 5. Capacity Building 6. Health Equity 7. Evidence-Informed Practice 8. Professional Responsibility and Accountability  Health Promotion and Empowerment Health promotion:  A process of empowering people to increase control over and improve their health. Empowerment:  Means 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 strengths.  Inspire excellence CHN Strengthen Foundation education Standard and for certification s of professional development Practice: Set criteria Why do Support human and expectations they resource management for safe and ethical matter? Define the care scope and depth practice  Nova Scotia’s In Nova Scotia, public health works with others to Public understand the health of our communities and acts together to improve health. Health Standards 1. Foundational Standard 2. Healthy Development Standard 3. Communicable Disease Standard 4. Healthy Communities Standard 5. Environmental Health Standard https://novascotia.ca/dhw/publichealth/documents/Public_Health_Standards_EN.pdf  Nurses have an essential role in Political Identity political advocacy and can Service Learning significantly influence policy- makers decisions.  Our Political Identity Professional Identity  Self-regulated  Autonomous  Collaboration  Direct service Political Identity  Civic engagement  Community partnerships  Political activism  Service Our Political Identity Knowing and showing oneself to be a political person in interactions with others cultivates nurses 'political identity. Effective policy is a relational process of civic engagement that requires commitment, seeing, listening, openness, dialogue, and responding to others with respect and compassion (Olsan et al., 2004)  How can nurses be politically active/ create opportunities to influence? Why do you think its important that Reflect nurses engage in political activism? on What skills do you need to have in the order to engage in advocacy on the following … social determinants of health? Are these skills similar or different based on your advocacy goals or focus areas? Final Thoughts?