NURS 3960 Week 8 Community Health Nursing PDF

Week 8: Nursing Care of Select Populations Community Health Nursing NURS 3960  1. Explore CH needs of men, women, and 2SLGBTQIA+ 2. Examine concepts of gender identity and sexual orientation in Canada 3. Discuss...

Week 8: Nursing Care of Select Populations Community Health Nursing NURS 3960  1. Explore CH needs of men, women, and 2SLGBTQIA+ 2. Examine concepts of gender identity and sexual orientation in Canada 3. Discuss societal causes of gender- based inequities and health outcomes Learning 4. Social determinants of health that influence health inequities of Objectives 2SLGBTQIA+ 5. Discuss CHN interventions that promote 2SLGBTQIA+ folks 6. Outline different types, prevalence, implication and challenges with STBBI, and associated health promotion and prevention strategies  Chapter 19: Gender and Community Health  How has gender influenced your life? What is gender? Concept cultivated, developed and understood within societal contexts Reinforced through relationships and institutionalized norms Gender ≠ Sex (Dosani & van Daalen-Smith, 2025) So, what about sex? Biological processes and external anatomy Differences in pharmacodynamics/kinetics Influences risk factors and disease processes (Dosani & van Daalen-Smith, 2025)  Women and men have a “true essence” Essentialist Sex organs Hormones Thinking Reproductive role Biology as destiny (Dosani & van Daalen-Smith, 2025)  TRANSGENDER AND NON-BINARY Gender Identity POPULATION IN CANADA (0.33%, 100,815) Parts of gender that match an internal sense of Transgender men Non-binary folks Transgender women self in relation to felt sense of gender and may not conform to assigned sex Cisgender: gender identity matches biological sex Transgender: gender identity different from biological sex, regardless of surgical/hormone reassignment processes Gender fluid: those that don’t identify with a single, static gender Two-spirit: Indigenous person born with masculine and feminine spirits in single body (Dosani & van Daalen-Smith, 2025) How does gender impact care? Risk exposure Health behaviours Health care access Impact perceptions of self and other Opportunities and access to resources Societal benefits What does this mean for CHN? Gender-based lens Developing healthy public policy Changing health care practices Gender mainstreaming (Dosani & van Daalen-Smith, 2025)  Race Don’t Forget: Ethnocultural background Age Intersectional Gender lens Indigenous Finances Differing ability (Dosani & van Daalen-Smith, 2025) Chapter 20: 2SLGBTQIA+ Clients What do you believe about sexual orientation? What’s led you to feel this way? Let’s get oriented Sexual orientation: romantic and sexual attractions toward people of one or more genders Homosexuality: romantic and sexual attractions toward individuals of same gender Heterosexuality: romantic and sexual attraction toward another gender Bisexuality: romantic and sexual attraction toward more than one gender Pansexual: romantic and sexual attraction toward all genders Asexual: no romantic or sexual attractions and no interest in such relations (Saewyc, et al., 2025) What’s all the stress about? Homophobia: a fear or hatred of gay men and lesbian women Biphobia: a fear or hatred of bisexual folks Transphobia: fear or hatred of transgender people Heteronormativity: heterosexuality is the norm and other orientations are not Cisnormativity: cisgender is the norm and other identities are not (Saewyc, et al., 2025) The cost of stigma and discrimination Minority stress Physical and sexual abuse Mental health issues Self-harm and suicidal thoughts and attempts Increased alcohol, tobacco and substance use Internalized homo-, bi-, trans-phobia Decreased self-care, self-esteem High risk sexual activities Pregnancy (Saewyc, et al., 2025) Disclosing 2SLGBTQIA+ identity: Coming out Difficulty related to type of relationship Nondisclosure can increase stress Increased depression and suicidal ideation in adolescents prior to disclosure with important relations Negative and neutral responses impact youth Discrimination decreases willingness to come out Stress of redisclosure with each new health care provider encounter (Saewyc, et al., 2025) How can CHN provide inclusive care? Address personal assumptions Use inclusive language Clarify level of confidentiality possible Consider educational material provided Challenge attitudes of fellow students, coworkers, and colleagues  Chapter 31: Sexually Transmitted & Blood-Borne Infections (STBBI) What are your views on sexuality and sexual health? What’s in a name? Venereal disease (VD): antiquated term, disease only contracted via sexual intercourse. Sexually transmitted disease (STD): disease transmitted via sexual intercourse, intimate sexual contact with gentiles, mouth or rectum Sexually transmitted infection (STI): more inclusive than STD as includes asymptomatic infections Blood borne infection (BBI): transmitted and caried via bloodstream STBBI: umbrella term This Photo by Unknown Author is licensed under CC BY-SA (Lokanc-Diluzio, et al., 2025) What’s out there in Canada? Bacterial STIs Chlamydia (most prevalent notifiable STI) and Gonorrhea (2nd most prevalent notifiable STI): Transmitted via condomless vaginal or anal intercourse with infected individual and less often through oral intercourse without protection. Often symptomatic. Untreated leads to PID and inflammation of upper genital tract. Screening: urine tests, swabbing Tx: antibiotics Syphilis: least common notifiable STI. Transmitted via condomless vaginal or anal intercourse with infected individual. Multi-staged infection (primary, secondary, latent, tertiary). Often unnoticed initially: painless open sore at site of entry. Late-stage symptoms: damage to CNS, CVS – leading to paralysis, mental illness or death. Can be passed to infant during pregnancy or birth. Screening: blood tests, swab of lesion. Tx: long-acting benzathine penicillin G. Increase risk of contracting/spreading HIV. (Lokanc-Diluzio, et al., 2025) What’s out there in Canada? (con’t) Viral STIs: HSV (1+2) and HPV: spread easily, difficult to prevent, and non-reportable. Spread via skin-to-skin sexual contact and through childbirth. HSV symptoms: fluid-filled pruritic blisters, in or around genitals, buttocks or thighs. Burning with urination, fever, flu-like symptoms, swollen glands. Transmission decreased by 50% with condom use. Screening: swabbing or culture of lesion Tx: antiviral for management HPV (40+ strains affecting mucosa of anogenital tract, oral cavity and oropharynx). Can cause genital warts or abnormal cell changes. Screening: Pap test, clinical exams, special testing Tx: freezing, burning or laser for genital warts (Lokanc-Diluzio, et al., 2025) What’s out there in Canada? (con’t) Ectoparasites: Pubic lice and scabies: transmitted via sexual and non-sexual contact. Lice found on pubic hair, scabies burrow beneath the skin typically in warm moist areas. Screening: visual examination of areas Tx: OTC topical products with insecticides This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY (Lokanc-Diluzio, et al., 2025) What’s out there in Canada? (con’t) Vaginal Infections (vaginitis): May or may not be an STI. Symptoms: vaginal discharge, irritation, rash, pruritus, vaginal odour. Most common: Bacterial vaginosis (BV) and Candidiasis (yeast): not typically sexually transmitted, increases risk of HIV infection. Individuals with a penis usually asymptomatic or mild discharge/pain with urination. Trichomoniasis: sexually transmitted – protozoa Trichomonas vaginalis. Symptoms: foamy, yellow/green, musty/foul smelling discharge, itching/burning around the vagina, pain with urination/sexual intercourse. Tx BV + Trichomoniasis: metronidazole Tx yeast: OTC oral (fluconazole) or intravaginal (miconazole) (Lokanc-Diluzio, et al., 2025) What’s out there in Canada? (con’t) BBIs: can be transmitted by sexual activity, and reuse of contaminated equipment such as those from substance use or body modification and from pregnant individual to neonate or during birth. HIV/AIDS: symptoms generally mild and flu-like. Chronic symptomatic phase – immune system weakened symptoms: swollen lymph nodes, skin lesions, diarrhea, fever. AIDS dx when HIV + AIDS-defining illness = opportunistic infections, malignancies or neurological diseases. Screening: blood test, rapid HIV test (POCT) Tx: antiretroviral therapies Prevention: Prep + PEP (Lokanc-Diluzio, et al., 2025) What’s out there in Canada? (con’t) BBIs (con’t): Hep B: more infectious than HIV. Half asymptomatic, others develop fatigue, nausea, jaundice, vomiting, reduced appetite and arthralgia. Can become chronic carrier – lead to liver cancer, failure, or cirrhosis. Screening: blood testing Tx: combination antiviral Hep C: mostly asymptomatic, may develop fatigue, jaundice or arthralgia. Can develop chronic infection. Increased risk of infection with HCV if living with HIV, or HIV + other STIs. Screening: blood testing Tx: antivirals (Lokanc-Diluzio, et al., 2025) At risk populations: 2SLGBTQIA+ Indigenous Sex-trade workers Immigrants/refugees Correctional facilities Street youth Injection drug users Older adults (Lokanc-Diluzio, et al., 2025) What’s the level of prevention? Utilizing condoms during sexual intercourse Collecting urine and blood samples to analyze for presence of infection Getting vaccinated Taking prescribed antiretroviral medications for HIV diagnosis Informed consent and participant ability to withdraw from a trial for a new medication to treat an STBBI Program creation to keep youth from living on the streets (Lokanc-Diluzio, et al., 2025) Thank you! References Dosani, A. & van Daalen-Smith, C. (2025). Gender and community health. In A. Dosani, J. Etowa, & C. van Daalen-Smith (Eds.), Stamler and Yiu’s Community Health Nursing: A Canadian Perspective (6th ed., pp 429-448). Pearson Canada Inc. Saewyc, E., Abdulai, A., & Dhari, R.(2025). 2SLGBTQIA+ clients. In A. Dosani, J. Etowa, & C. van Daalen-Smith (Eds.), Stamler and Yiu’s Community Health Nursing: A Canadian Perspective (6th ed., pp 449-460). Pearson Canada Inc. Lokanc-Diluzio, W., Troute-Wood, T., & Shoyele-Stiksma, G. (2025). Sexually transmitted and blood- borne infections. In A. Dosani, J. Etowa, & C. van Daalen-Smith (Eds.), Stamler and Yiu’s Community Health Nursing: A Canadian Perspective (6th ed., pp 678-699). Pearson Canada Inc.