Nurs 430 Community Health Course Outline PDF

Welcome and Introduction Introduction Outline: About Me Course Introduction Syllabus Review Questions Nursing Background: Public Health Nurse Community-Based Participatory Research (CBPR) Mixed Methods About the Community Health Course: 36 hours of course time: ○ N01 - September 4-December 4, 2024 ○ N03 – September 5-December 5, 2024 Lectures In-Person Lecture and Student Engagement Contacting Me - via USask email Canvas: Modules – reading list and resources Required Readings, Lecture Content, Guest Speakers is all testable Course Objectives: 1. Integrate the concept of community with the community health nursing role, congruent with national standards of practice. 2. Describe community-based concepts such as Epidemiology, Primary Health Care, Ethical Issues, Population Health, Capacity-building and be able to apply this knowledge to community nursing practice. 3. Utilize relevant theories and tools to assess, plan, evaluate, and implement nursing practice in a community. 4. Identify resources within the community setting, their relevance to client need and create strategies to utilize them for the enhancement of health. 5. Apply evidence-informed strategies in community nursing practice. 6. Explain the community health nurse role within collaborative, interdisciplinary and interprofessional partnerships that incorporate the uniqueness and diversity of community. 7. Recognize the community health nursing role within a collaborative and interprofessional team approach to emergency and disaster preparedness. Course Schedule: Found in Syllabus (starts on p.3) Weekly course topic and corresponding readings Weekly topics may shift In-Person Self-Study – ○ N01: November 5 & 6, 2024 ○ N03: November 1 & 7, 2024 Weekly Topics: Some of our course topics may be challenging. Please engage in self-care. If you feel the presentation may be traumatizing, you may choose to leave the classroom during the presentation or not attend the presentation. Please access USask supports if needed: Evaluative Components: Component Title Due Date Grade Weight 4 Seasons of Reconciliation November 17, 2024 @23:59 Pass/Fail Module* HESI: Community Health December 5, 2024 @ 23:59 Must receive 50% or greater Practice Tests* HESI: Comprehensive Exam December 5, 2024@ 23:59 Must receive 50% or greater #1* Midterm Exam N01: October 16, 2024 @ 30% 0800-0900 N03: October 17, 2024 @ 0800-0900 Community Health Issue Paper November 3, 2023 @23:59h 25% Final Exam TBD 45% Total 100% Midterm Exam: N01: October 16, 2024 @ 0800am N03: October 17, 2024 @ 0800am Located in Health Sciences GB06 – In-Person Multiple Choice – application questions Closed book, 1 hour Cover Sessions and Modules 1-5 Community Health Issue Paper (p.13): Theory application of class concepts. Groups of 2 people Choose own group on Canvas – under “People” in the Left Hand Navigation and the “Project Groups” Sign Up by September 13, 2024 @ 12:00h 8 pages max (body of paper) APA 7th Edition Due: November 3, 2024 @ 23:59h Community Health Issue Paper: Section 1- Introduction ○ Introduce the purpose of the assignment ○ Outline what will be discussed in the paper ○ Highlight why this topic is important to community health and community nursing Section 2 - Examination of the issue ○ Describe the community health issue within a Saskatchewan context. Provide a brief general description of the news article. Do not repeat every detail of the news article as I will review the news story myself. ○ Show evidence of having researched the issue, including relevant epidemiology, and discuss the impact on both individual and community level health. ○ Make connections to the social determinants of health Section 3 - Recommended Solutions Propose up to 3 possible solutions to improve community health related to this issue. Thoroughly apply The Population Health Promotion Model/Ottawa Charter and identify with “whom” the solution is targeted and the health promotion action area (or areas) each solution is consistent with. Describe the community health nursing role in facilitating each solution. Section 4- Interprofessional Collaboration ○ Explain why interprofessional collaboration is important in community nursing. ○ Describe what the benefits of interprofessional collaboration are in relation to community health. ○ Identify opportunities for interprofessional collaboration to carry out (some or all the) recommended solutions. ○ Identify what the role of each profession would be in carrying out the recommended solutions. ○ Utilize the CIHC interprofessional competency framework to guide your writing. Apply at least 2 competencies. Section 5- Conclusion ○ Summarize the key points of the paper Final Exam: Date to be determined by USask Registrar’s Office Multiple Choice Questions Comprehensive Exam – Content from Entire Term Closed Book, 3 Hour Exam Completion of Work Policy (p.16): As per undergraduate program policy (outlined in the Student Handbook available on the College of Nursing Getting Started webpage.) Students are required to complete all course components to receive credit for a course. Unless prior arrangements have been made with the course instructor, 5% from the earned grade for that assignment will be deducted for each calendar day that course work is late. A grade of zero will be applied to all assignments not submitted 5 working days after the due date, without prior written permission of the course instructor. Unless other arrangements have been made with the course facilitator, the last day for acceptance of assignment will be the final day of class in that course. It should be noted that even if assignments receive a grade of 0% because of late penalties (see above), they must still be completed in order to fulfill course requirements. Please see College of Nursing Literal Descriptors that will be used to indicate the level of competency a student has obtained pertaining to the learning objectives of this course. A rubric, specific to each assignment, may be provided to indicate how this mark was calculated. Making the Most of Your Learning: Create a Scheduled Plan Attend Class Required Readings Learning Objectives Actively Engage with Materials Create Partners Early and Make a Plan Introduction to Community Health Learning Objectives: 1. Define health promotion, population health, levels of prevention, primary health care (PHC), social determinants of health, and related concepts. 2. Describe the PHC principles (5). 3. Apply the population health promotion model in community health nursing practice. 4. Identify some of the challenges of health promotion in an Indigenous context. Critical Community Health Theory: Social Determinants of Health Ottawa Charter For Health Promotion Population Health Promotion Model Levels of Prevention Primary Health Care Principles Primary Health Care: Strategy for health care delivery – applies to whole system Whole of society across the continuum from health promotion to treatment, rehabilitation, and palliative care across the lifespan Acknowledged that improved health requires more than money spent on treatment Identified social & environmental conditions as determinants of health Underlying values are social justice and equity ○ New approach to health care ○ Moving away from biomedical model Primary Health Care VS Primary Care: Primary Health Care (Umbrella) ○ Whole-of-society approach ○ Principle-based, comprehensive approach ○ Improve the health of populations across the continuum of care (i.e., acute, community, long-term, corrections,etc.) ○ Across the lifespan (i.e., from birth to death) in all settings ○ Focuses on population, community, and individual level health strategies ○ Acknowledges the broader conditions that influence health ○ Values and principles are included into policy and implemented into programs and practice Primary Care (Under the umbrella) ○ Focus on personal health services ○ Refers to the delivery of community-based clinical health services Settings ○ Providers coordinate care ○ Enable equitable and timely access to other services and providers ○ Focuses on preventing, diagnosing, treating, and managing conditions ○ Also promotes health People focused 1 on 1 -> Individual based Treatment in community Don’t work in isolation, we work with others Doesn’t look beyond the individual PHC Essential Components: Education about health problems and prevention techniques. ○ Best practice, not just interactions between nurse and patient Promotion of food supply and proper nutrition. ○ Quality of food or food insecurity Adequate supply of safe water and basic sanitation. ○ Potable water at all times, proper infrastructure for water sanitation ○ Access to drinkable water Maternal and child healthcare, including family planning. ○ Suggests the health of the population ○ Access to reproductive care, birth control and abortions Immunization against major infectious diseases. ○ Actual access to vaccines Prevention and control of locally endemic diseases ○ Group/ geographic location ○ Ex: STD’s (syphilis, chlamydia). Appropriate treatment of common diseases and injuries using the PHC principle of appropriate technology. ○ Utilizing resources in appropriate locations ○ Principles of proper decision making Provision of essential drugs. ○ Access to drugs is a huge component ○ This is something primary health care is working towards PHC Principles: 1. Accessibility ○ Health services universally accessible to all in timely manner, ○ Barriers – geography, provider attitudes, stigma … It’s an intangible, its how an individual feels and experiences It’s not just the physicality of care 2. Public Participation ○ Clients (individual/family/community) participate in decisions about own health & health needs of their community Don’t mistake this for showing up for things It’s not the number of individuals but rather how the individual is involved 3. Health promotion ○ At individual/family/community levels ○ Social determinants of health (SDofH) 4. Appropriate technology ○ Appropriate for community’s social, economic & cultural context ○ Latest tech not necessarily most appropriate Has to do with affordability, need The newest and most up to date isn’t always the best 5. Intersectoral collaboration/cooperation ○ Different health professions & sectors of society collaborate to establish local/national health goals, plan health services, & develop healthy public policies to address SDofH All of us working together Social Determinants of Health: Social and economic factors that influence individual and population health. Are interconnected and synergistic. ○ SDoH are just as important as what brought someone into the hospital Social Determinants of Health: Socioeconomic circumstances have as much or more influence on health status than medical care, genetics & personal health behavior Worldwide, poorer people have shorter life expectancies and morbidity rates Widening income gap seen as a public health concern ○ Income is intertwine, which means a lot of public issues are impacted ○ Addressing the social determinants of health is utilizing the upstream approach The River: Thinking upstreams means making smarter decisions Downstream thinking. Downstream approach reacts to problems after they've occurred, while Upstream approach aims to prevent problems from happening in the first place! Upstream approach looks at systemic factors that influence the mushrooming of problems into even bigger problems Upstream is thinking WHY WHY WHY Health Promotion: WHO (2009) in Stamler, et al. (2020, p. 138): ○ “the process of enabling people to increase control over, and to improve, health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment.” What does health promotion look like in practice A realistic holistic approach Giving them options Levels of Prevention: Primordial prevention ○ Initiatives that prevent conditions that would enable risk factors to develop Primary prevention ○ Impact of specific risk factors is lessened Secondary prevention ○ Early identification of disease and conditions and timely treatment Usually sit here Pap tests Screening tools Tertiary prevention ○ Once an individual becomes symptomatic, or disease or injury is evident. Rehab Reduce risk of MI Quaternary prevention ○ Actions that identify populations at risk of overmedicalization Unnecessary treatments or test Health Promotion Evolution: Lalonde Report (1974) ○ Focus on health, not illness ○ External forces influence health – biology, lifestyle Ottawa Charter, 1986: Charter Health Promotion Strategies: NEED TO APPLY TO PAPER Build ○ Build healthy public policy. Create ○ Create supportive environments for health. Environment aspect has grown Strengthen ○ Strengthen community action. Think bigger then the individual Develop ○ Develop personal skills. Traditional how do we give people tools and resources to foster health literacy Reorient ○ Reorient health services toward preventing diseases and promoting health. Moving beyond acute care Making them not just physically accessible but addressing the intangibles of accessibility An Indigenous Context and Health Promotion: Health promotion has a normative ideal regarding what is “good”. Behavior change is associated with potential paternalism. ○ A lot of health promotion is focused on that behavior change Assumption that a paternalistic state is a benevolent one. ○ The assumption we are the savior, and inserting into community because they “Know what's best” Colonial connection with paternalism, power, and control. Takes a deficit-based approach, pathologizing. ○ Can be diseased based, blaming Aims to empower, but treats Indigenous peoples as “don’t know what is good for [themselves]”. ○ It still has the colonial paternalism Further stigmatization of marginalized people as it amplifies their “failures”. ○ Highlights peoples errors Need to engage true empowerment, not just a pathway to a prescribed behavior. ○ Handing over the decisions to community to make those health and community decisions ○ Thinking upstream in regards to their wants and needs Ethical discussions are needed around health promotion. Indigenous control over health promotion initiatives. Respect the communities we are working with. Examine your own power as an individual practitioner to the institutional level. Power sharing may contradict the priorities of organizations and funding bodies. ○ How do you resolve these conflict in practice Population Health Promotion Model (PHPM): WHAT YOU NEED TO APPLY IN YOUR PAPER Population Health Promotion Model (PHPM): Population Health Promotion ○ Taking action on interrelated conditions to create healthy change ○ Maintaining or improving the health of populations and reducing disparities in health status between people (i.e. health equity) To bridge the gap between population health and health promotion Combines Ottawa Charter strategies, determinants of population health and potential interventions Understanding the Model: Who: With Whom Can We Act? (levels of society) What: On What Can We Take Action (determinants of health) How: How Can We Take Action (5 Ottawa Charter Strategies) Underpinned by Evidence Based Practice and Awareness of the Values and Assumptions in the Model Population Health Promotion Model: Group Work: ○ The health promotion team has been tasked with developing a comprehensive sexual health program. Identify three interventions to address sexual health using the population health promotion model answering: Who: level- schools (community) What: determinant- (education) How: Charter strategies- (creating a supportive environment and develop personal skills) ○ Focusing on a policy change within education with schools by investing in a shift with adding nurses ○ Developing personal skills, developing health development with children knowledge and genders ○ Introducing health fairs for parent teacher night, the caregivers need to be brought in as well ○ Focuses on the individual, family, community and society ○ Reorienting health services to fit the change within our society and need for sexual health education See examples of utilizing the model with diagrams at this link: https://www.canada.ca/en/public-health/services/health-promotion/population-health/pop ulation-health-promotion-integrated-model-population-health-health-promotion/developin g-population-health-promotion-model.html What Works?: Programs aimed at changing individual behavior have limited effectiveness ○ Include broader strategies Health strategies must be broadened to include: ○ political, Takes political will and financing form governments to invest in these strategies You will never get outside of politics because the political will determines what is funded ○ economic, Money talks ○ social, and Context, be a voice ○ cultural interventions Cultural adaptation is a big thing Empowerment of people to engage in public policy changes ○ Power in numbers, campaigns Solutions to problems involve changing social values and structures ○ Ex: people who don’t value or understand harm reduction are social values that conflict best practice such as safe needle sites Arise in environments with social justice and equity and where relationships are built on mutual respect and caring (rather than on power and status) ○ All about building a relationship, it all starts with building a trusting environment ○ There's a lot of barriers to get through to work in a good way Community Health Nursing Actions: Nursing Actions = Social Justice ○ Advocacy ○ Activism ○ Policy analysis Identifying gaps, and ways to strengthen ○ Political activities Lobbying ○ Community research Getting to know the needs and to be their worker bee Evidence-Informed Decision Making: Considers: ○ Best available research evidence from variety of sources ○ Local context ○ Client, community & political preferences ○ Resources ○ Evidence informed practice considers context in deciding whether to apply evidence What now?: Keep these things in mind when you are in your clinical placements: ○ What are the living and structural conditions of the people you are interacting with? Not just physical structures but can be invisible structures ○ What actions are you witnessing that might be related to poverty, food insecurity, or homelessness? Those SDH ○ What would it mean to screen for SDH? Maybe done in hospital, what can your assessments include ○ What types of nursing actions, i.e., advocacy, activism, research, do you observe/experience/participate in? CHN Roles; Community Assessment; & Capacity Building Learning Objectives: Describe the components of communities. Identify the different roles and focuses of CHNs. Describe how community-based and hospital-based practice differ. Illustrate the differences between CHNs and PHNs. Explain emerging trends in CHN practice. Explain the application of the community health nursing process. Summarize community capacity building and its challenges. What is a community? (Ch.13): Definition: “group of people who live, learn, work, worship, & 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 nations.” (Yiu in Stamler et al., 2020 p. 250) Community Functions: Space & infrastructure ○ Mental health in overcrowded environments Employment & income ○ Can they access employment Security & protection ○ Do people feel safe Participation, socialization & networking ○ Is there exclusion Links to other community systems Community Dynamics: Communication – vertical, horizontal, diagonal ○ Hierarchical communications, lateral communication, sometimes there is a barrier to communication Leadership – formal & informal ○ The bigger impact will depend on the community you are working with ○ Who are your connectors, who do you want to bring into your project Decision-making – formal leaders make decisions for the community, while informal leaders use their influence toward change ○ In a school parents/caregivers don’t have a lot of decision making in activities There’s over and covert dynamics What is a community health nurse?(Ch.3): Community health nurses implement these public health standards and guidelines by focusing on smaller, more specific groups within their unique geographic locations. By tailoring interventions, educational campaigns and outreach to the needs of their local population, they create healthier, more dynamic communities Community Health Nurse: Work with people where they live, work, and play Work in various settings ○ Generally where people are in their own environment Used to describe all nurses who work in the community Eg. PHN, HHN, school nurse, occupational health nurse, etc. Two Approaches: 1. Community-Oriented – population, community focused, aimed at health promotion, prevention Eg. Public health nurse 2. Community-Based – provide care (acute & LT) to individuals & families in the community, outside of hospital Eg. Home health nurse, home care Introduction to CHN Roles CHN Roles: Public Health Nurses Nurse Practitioners Home Health Nursing Community Mental Health Nurse Forensic Nurse Parish Nurse Telehealth Nurse Outreach/Street Nurse Primary Care Nurses Nurse Entrepreneurs Rural Nursing Occupational Health Environment Community Health Researcher Military Hospital vs Community Nursing: Hospital ○ In the moment ○ 1-on-1 ○ Set schedule ○ Client- separated from family, identified by medical diagnosis, relatively depended ○ Environment- predictable, client freedome controlled ○ Locating client -captive audience illness ○ Safety-agency oversight ○ Nursing- activities focused on prescribed treatment of illness, medication & technology Short-term, predictable Community ○ Upstream ○ Further relationships ○ Larger clientele different roles ○ A lot more autonomy in decisions making ○ Client-context of family & community highly autonomous ○ Environment- client’s natural environment, highly variable ○ Locating client- uncertain, determined by client & family, requires planning ○ Safety- unpredictable ○ Nursing- more autonomous practice Interventions mutually decided on ^ based on client's values Emerging Trends in Community Health Nursing: Focus on community justice and social action Political and social advocacy increasingly important ○ Policy changing Information communication technology ○ More remote and cost-effective Increased acuity of clients in the community ○ Changes CHS- time, skills Using evidence in practice ○ Client’s are asking a lot more about research, information teaching role, correcting misinformation, providing proper resources Increase in rates of chronic preventable diseases ○ Will be ever-changing, lots of type 2 diabetes, what are the needs in the community, what are the programs Increase in natural disasters, pandemics ○ There will always be more Increasing emphasis on reducing health inequities ○ Public crisis with financing and funding Public Health Nursing (Ch. 4): Public Health: Public Health ○ “organized efforts of society to keep people healthy & prevent injury, illness and premature death. It is a combination of programs & services & policies that protect & promote the health of all Canadians” Public Health Nursing: Long history – Lillian Wald (US) ○ Founder of public health nursing ○ Differentiated between PHNs and RNs in acute care Canada – Social gospel movement and maternal feminism Early legislation focused on personal and environmental cleanliness Public Health Nursing: Under umbrella of CHN Public health science Principles of primary health care Nursing science and social science To promote, protect and preserve the health of populations Public Health Nursing Competencies Appendix B: Knowledge derived from public health and nursing science Skills related to assessment and analysis Conducting policy and programs planning, implementation, and evaluation Achieving partnerships, collaboration and advocacy Promoting diversity and inclusiveness Effective communication exchange Leadership capabilities Professional responsibility and accountability Foundations of Public Health Practice: Focus on entire populations or sub-populations with have similar health concerns or characteristics Guided by population health status as determined by a community health assessment Considers broad determinants of health – emphasis on vulnerable groups Considers all levels of prevention with focus on primary prevention Considers all levels of practice – community, systems, & individual/family Public Health Agency of Canada (PHAC): Public Health Notices ○ Disease outbreaks or possible health risks to Canadians, how to protect yourself Travel Health ○ Avoid disease, illness or other safety risks away from home Biosafety and Biosecurity ○ Biosafety training, pathogen hazards, exposure reporting, licenses, regulating laboratories or containment zones Health Science, Research and Data ○ Health data science, research, statistics, determinants of health, and monitoring and surveillance Diseases and Conditions ○ Symptoms, risks, and how to prevent treat and manage human disease and illnesses Food Recalls, Risks and Outbreaks ○ Food poisoning, Canada’s role in food safety, recent recalls and alerts Emergency Preparedness and Response ○ How we prepare to keep the public safe from epidemics, chemical, biological, radiological and nuclear events Public Health Practice ○ Careers in public health, workforce, development, networks, and training for public health specialists, students, hosting and collaboration Healthy Living ○ Behaviors that affect health, health and pregnancy, wellness, infant care, blood donation Vaccines and Immunization ○ Vaccination for children, adults, during pregnancy, travel vaccines, flu shot, information for health professionals Funding opportunities ○ Grants and contribution programs, how and why we give funding, who we have funded Who is the Chief Public Health Officer?: Dr. Theresa Tam Community Nursing Process (Ch. 13) Community Assessment What is a community assessment?: Ongoing systematic appraisal of the community. Comprehensive process because the health of the community clients is affected by the complexity of community functions and dynamics and the various SDOH CHNs utilize different frameworks and models to inform the assessment process When should you do a community assessment?: When you’re new to a community When you’ve been there for awhile & “want to take stock” When considering introducing a new program & want public participation to encourage success In response to a problem/crisis Different Types of Community Health Assessment Frameworks: 1. Epidemiological Framework ○ CHN examines the frequency and distribution of disease/health in the population using the epidemiology triangle Host-environment-agent CHNs determine what the community is, Who is affected (host), where and when the condition occurred or occurs (environment) and why and how (agent) it occurred. 2. Community Capacity (Assets) Approach ○ Capacity Building – CHN uses an approach that strengthens the ability of the community to develop & implement health promoting initiatives Two ways to view a community: Deficit Based – focus on needs & problems Assets Approach – focus on capacities & assets Clients vs Citizens Consumers vs producers Community Capacity (Assets) Approach An asset approach starts by asking questions and reflecting on what is already present: ○ What makes us strong? ○ What makes us healthy? ○ What factors make us more able to cope in times of stress? ○ What makes this a good place to be? ○ What does the community do to improve health? Community Asset Mapping: Identify communities' capacities & assets ○ 1) Primary Building Blocks are skills & experiences of local individuals & organizations, most easily accessible assets - located in community & controlled by members ○ 2) Secondary Building Blocks are assets within community, but controlled by outsiders ○ 3) Potential Building Blocks are resources outside neighbourhood, controlled by outsiders 3. Matuk’s Community Health Promotion Model: Goal – “apply community health promotion strategies to achieve collaborative community actions & to improve sustainable health outcomes of the community” Emphasis on social determinants of health Applies the nursing process at community level Types of Community Assessment: Environmental Scan – windshield survey Needs Assessment – investigate the nature of the needs, determine if it represents the opinions of the community, determine if they want/can make the change Problem investigation – e.g. outbreak Resource Evaluation – assessment and evaluation of resources Identifying Community Strengths & Concerns: Each community has own unique characteristics Some of these are strengths that CHN can build on Others contribute to health concerns Data Collection: Types and Sources ○ Quantitative (Statistics, survey), ○ Qualitative data (opinions, wind shield survey, focus groups, key informants, town hall meetings) ○ Participants observation ○ Demographic and epidemiological data ○ National statistics and community surveys ○ Local and provincial health departments, hospital data Methods ○ Community surveys (telephone, mail, internet, face-to-face interviews) ○ Community meetings ○ Focus groups: discussion with small groups of 8 to 12 people Data Analysis: Data is organized into categories, then summarized Data is analyzed and themes are noted Interpretation – what does this data mean? Community Nursing Diagnosis: Broad, aggregate group or community level All communities have strengths and challenges - community nursing diagnoses can reflect both Community Nursing Diagnosis Statement: Target population (Name the target group) ○ Broad, addressing community Problem or Wellness diagnosis (What is the issue/concern that needs attention?) Etiology (Why is there a concern? What are the causation factors?) Characteristics (How did you recognize this? (As evidenced by…) Types of Diagnosis: Problem ○ Newcomers in downtown Saskatoon have inadequate income and resources and high family stress related to inadequate language and skilled trades programs to prepare newcomers to be employable as evidenced by high unemployment rates and inability to find work due to lack of language skills and Canadian work experience. Wellness ○ West-end community members have optimal waste disposal related to effective management of the community recycling systems as evidenced by 98% utilization of the recycling programs and 25% reduction of rodents in the city area. Community Capacity Building: “Process of involving a community in the identifying and strengthening those aspects of daily life, culture life, and political life which support health” CHNs engage with community members & work in partnership “as they define their own goals, mobilize resources, & develop action plans for collectively identified issues or problems.” Why Community Capacity Building?: Behaviour change does not work Ex: Focus Populations Problems or Wellness Diagnosis Etiology Characteristics Students in High School Potential for Healthy Lifestyles Related to their desires to learn As evidence by integrated school about nutrition and physical curriculum with and emphasis activities on healthy lifestyle practices Arnstein’s Ladder of Citizen Participation: Arnstein, S. R. (1969)A ladder of citizen participation, JAIP, 35(4), 216-224. bing.com/images Creative Commons http://competendo.net/en/Participation Time-tested Principles: Have patience Be flexible Be resilient Encourage others Be organized Embrace challenge Build networks Communicate, communicate and communicate! Challenges for CHNs: Managing power differentials Meeting unique community needs Reconsiders nurses’ professional role Lack of agency support (policies, resources) Much CHN practice still focused at individual or family level Key Ideas: Community members are the experts with respect to the needs, hopes & dreams of their community All community members have skills, knowledge & abilities to contribute. Inclusion must be intentional. Community development does not work well if members believe the answers come from outside the community (“experts”) School Nursing (Ch.17) Learning Objectives: Explain the importance of the school as a setting for health promotion. Describe comprehensive school health/health promoting schools. Apply the concepts of comprehensive school health to practice. Apply the Indigenous School Health Framework to practice. Examine the roles and functions of the public health nurse in school health promotion. School Nursing: Whom is the school community? ○ School-aged children & adolescents ○ Parents & guardians ○ School personnel ○ Neighborhood residents, businesses & service agencies Schools are a great community hub Child & Youth Health Promotion: Research has shown that school settings have a positive impact on most of the health behaviours and outcomes of this population School is an important social and physical environment where the child will experience nurturing and caring outside the family Children Rights: Article 12 of the 1989 United Nations Convention on the Rights of the Child states that young people have a right to participate in matters that concern them. There remains a reluctance to adopt policies that allow children to have a voice concerning matters that affect them, including health strategies implemented in schools. Canada’s school-based nurses must embrace an anti-oppressive lens to children, childhood, and PHN practice with young people. Health Challenges: Health concerns commonly addressed in school settings include: ○ Unintentional Injuries ○ Communicable Diseases ○ Unhealthy Weights/Weight Preoccupations ○ Risky Behaviors Child Health Equity: Child poverty rates are very high for new immigrants, visible minorities, and children with disabilities. A child- and youth-centred social justice and rights-based approach to school health nursing practice must be adopted. School-Based Health Promotion: Comprehensive School Health/Health Promoting Schools Integrates PHC Principles, Ottawa Charter, and equity approach Involves mobilizing an action group of students, parents, school staff, and community partners, including PHNs A planning process creates a shared vision of the school as a “healthy school,” assesses strengths, prioritizes needs, implements the plan, and evaluates the program Comprehensive school health encompasses the whole school environment that supports students in becoming healthy and productive members of society Four distinct but interrelated pillars: social and physical environment, teaching and learning, healthy school policy, and partnerships and services (p.339) Indigenous School Health Framework: Indigenous school health reflects wide consultation and a deep respect for Indigenous ways of knowing (p.341) Practice guidelines (p.339) Role of Public Health Nurse: Promoting Health with Individuals ○ Assessment, supportive counselling, and referral of students to needed services ○ Health education and skill development with students, families, school staff Promoting Health with Small Groups of Classrooms ○ Small group programming with students in areas of identified need ○ Staff education on health and development issues and on youth engagement ○ Parenting education School-Wide Health Promotion ○ Assessment, surveillance, and data analysis to identify strengths and priority needs in school populations ○ Ensuring a group to address school health or school improvement issues is established, and that it includes significant student participation and leadership Board- or District-Wide and Community-Level Health Promotion ○ Contributing to health policy development on school board working groups Erosion of Public Health Nurse from Schools: Removal of school-based nurses Loss of relationships and community connections Canadian Nurses’ Association (CNA) supports the PHNs in schools Impact on health outcomes??? Program Planning and Evaluation (Ch.14) Learning Objectives: 1. Describe the components of the assessment-planning-evaluation cycle. 2. Identify considerations in the planning and evaluation cycle - priority setting, engaging stakeholders. 3. Describe the program planning and evaluation frameworks – logic model, precede-proceed, SWOT analysis. 4. Apply the program planning and evaluation frameworks to practice - logic model, precede-proceed, SWOT analysis. 5. Differentiate between the different types of program evaluation – process, outcome, economic. Community Health Planning, Monitoring, and Evaluation: Plan programs, redesign existing services, monitor implementation and evaluate the impact Fundamental work of community health nurses Multiple stakeholders, sectors, interdisciplinary Program Planning and Evaluation Cycle: Not linear as it appears May need to be repeated It’s not finite is something that you get to keep working on What issue do you focus on?: What factors do you consider do you focus on What’s gonna help inform those decisions ○ SDH ○ Resources ○ With them not for them Prioritizing Health Issues: FACTORS Size of the problem- # affected Seriousness of problem- potential to result in severe disability or death Availability of resources- staff, time, money, equipment Equity- populations more affected ( higher risk, vulnerable) Community Awareness & Motivation- community preference Political Will to address It should be transparent How do you choose an intervention? Working affective Feasibility Do you have the accessibility, infrastructure, time Steps to Choosing a Promising Practice or Intervention: Find practices or interventions in the way you want to address the problem Use a program directly or change the conditions that make it possible Works in your community Implement the intervention, adjusting as you go ○ Having that flexibility Evaluate your work and results regularly as it can always be improved Some Questions to Ask: Reach, dose, and intensity for success? ○ Target population, expected amount of intervention and the quality (whether its tailored the community) How ready is the community for the intervention? ○ Working with them Is there a policy window opening? ○ Political will is a lot of interconnection What might enhance or reduce the impact? ○ Asset mapping, swot analysis Frameworks, Tools and Processes: These items will support planning and evaluation Why use a Model?: Provides procedural structure ○ Good communication tool- outlines the structures Provides framework for critical analysis ○ What are our resources, what are we doing Can be participatory (depending on which model) ○ You should be engaging your community in evaluating those aspects Provides means for evaluation, often at different levels ○ Should naturally flow Intervention Design/Planning Models: 1. Program Logic Model 2. Precede-Proceed Model 3. Swot Analysis 4. Multiple Intervention Program Framework 1. Program Logic Model Visual tool depicting what program plans to do & achieve over time Helps clarify the relationship between program activities and planned outcomes ○ An evaluation naturally comes out of it Builds consensus about program purpose and anticipated impacts ○ Something tangible that you can use to work with others Generates evaluation questions Program Logic Model Process: Stage 1: CAT ○ Components/Inputs – What is invested eg. staff, time, money materials, partners, equipment, space What your needs are -> you are constantly returning to this sections ○ Activities/Outputs – What is done for each component eg. Teach, deliver service (distribute clean needles), build partnerships Ex: education sessions ○ Target groups – intended recipients eg. Clients, agencies, policy makers You can’t necessary target everyone Stage 2: SOLO ○ Short-term outcomes (Learning) Fairly immediate like a pre-post test Immediate, direct results of program ○ Changes in awareness, knowledge, attitudes, skills, behavioral intent Long-term outcomes/Impacts (Actions & Conditions) Reduction in the prevalence in something, policy change, see an impact on the SDH, usually a time definer Overall goals of the program Changes in behavior, conditions, policies, health, economy, environment, social well-being Sample Logic Model: Simple logic model- Everyday Vacation Model Logic Model Logic Model for a Tuberculosis Control Effect Create your own 2. Precede-Proceed Planning Model: Community oriented participatory model for creating community health promotion interventions Assumes health risks are caused by multiple factors Multisectoral ○ Different partners not necessarily health related Tools to engage community partners include environmental scans, key informant interview, focus groups, SWOT analysis ○ Might be informal or formal Multiple assessments in the process Data is analyzed and priorities set Implementation of planned activities Evaluation – process, impact, outcome 3. SWOT Analysis: 4 components: ○ Strengths ○ Weaknesses ○ Opportunities ○ Threats Identifies both internal and external strengths, weaknesses, opportunities and threats Can be used to determine the feasibility of initiating or continuing a program. ○ Huge policy tool May help identify partners Evaluation Aspects: Formative, Summative & Economic When should you develop an evaluation plan?: As soon as possible! The best time is before you implement the initiative. After that, you can do it anytime, but the earlier, the better. 1. Formative (Process) Evaluation: Assessment of program implementation - are program activities occurring as planned? ○ a. Progress Monitor program activities Eg. # of clients seen; # of classes held; hours of service delivery; # staff used; # referrals made; $ spent - Should be ongoing ○ b. Relevance - Is program suitable to meet the needs of the target group? ○ c. Adequacy – Extent program addresses the entire health issues defined in the assessment Not quite as immediate as making those quick changes 2. Summative (Outcome) Evaluation: Assesses outcome of the program Extent short, mid, long-term objectives met ○ a. Effectiveness – client and staff satisfaction & whether program met objectives ○ Eg. Short term – knowledge increase; Mid term participants changed behaviour ○ b. Impact - longer term results of program eg. Changes in morbidity or mortality ○ c. Sustainability - Long-term viability of the program - Are there enough resources to sustain the program? Should be looking at this through our programming 3. Economic Evaluation (both process and outcome): Cost Effectiveness Analysis (CEA) ○ Compare programs with similar objectives to determine which is most cost-effective at achieving desire objectives ○ Outputs not measured in monetary terms eg. Lives saved; cases prevented Cost-Benefit Analysis (CBA) ○ Quantify all costs & benefits in monetary terms ○ Dollar benefits > dollar costs? Formulating Recommendations: Actions to consider as a result of the findings Base recommendations on solid evidence from evaluation Ensure recommendations are practical and realistic Work with stakeholders Epidemiology for Community Health Nursing (Ch. 11) Objectives: Describe the differences between epidemiological approaches. Identify and explain the components of the epidemiological model. Differentiate between association and causality and explain some of the criteria that suggest a causal relationship. Define measures in epidemiology and their application in practice. Differentiate between screening and surveillance. Apply epidemiology practices to community health nursing. Epidemiology: Hippocrates ○ Relationship between the environment and health or disease Cholera epidemic (mid-1850s) ○ John Snow noticed a relationship between cholera deaths and drinking water source Cholera dehydrates you super quickly and it found in fecal matter and water ○ The story of John Snow Yellow flag signaled cholera epidemic and it was very bad John Snow became determined to figure out what was causing the disease They originally thought it was in a bunches of air called miasma John decided it was from the water, and visited all the victims families and found that all the families had taken water from one pump The pump was dismantle and was discovered to have a cesspool of germs John Snow basically started the idea of epidemiology through detective work and became the known father of epidemiology It’s not always easy to implement the practices in regards to epidemiology Florence Nightingale: Retrieved from https://itelligencegroup.com/uk/local-blog/reworking-florence-nightingales-diagram-of-the -causes-of-mortality-in-the-army-in-the-east-with-sap-lumira/ Florence Nightingale was just as important as male figures in epidemiology This included the chimera war, and she generated evidence through statistics It was Nightingales record keeping, that allowed for change-> now known as modern epidemiology She also plotted and created visuals for the data, which was ahead of her time What is Epi?: The study of the distribution and determinants of health-related states or events (including disease) and the application of this study to the control of diseases (deterrents) and other health problems Distribution-the frequency and patterns in terms of person, place, and time (who, where, and when). Determinants - factors that cause or contribute to a disease or change in health Deterrents-factors that prevent or reduce the chance of developing a disease ○ Epidemiology is very biological- not a lot of attention towards the controls ○ Controlling an outbreak as just as important as epi, despite it not being highlighted as much What does Epi examine? Everything?: Environmental exposures Lead and heavy metals Air pollutants and other asthma triggers Infectious diseases Foodborne and waterborne illness Influenza, pneumonia, pandemics Injuries Increased homicides in a community National surge in domestic violence Non-infectious diseases Localized or widespread risk in a type of cancer Increase in major birth defect Natural disasters Hurricanes Earthquakes Terrosism World trade center Anthrax release Study of how disease affect populations Skills used- effective communication (verbal or written), How does the role of the clinician differ from the epidemiologist? Clinician Epidemiologist Broad roles Specialized research/ education Implementation Instructors role Information/ policy oriented Statistically motivated Individual demographic/ Focus= patient Group/population demographic/ Focus = community Diagnosis Identify/predict trend Therapy Control Cure Prevention More risk for infection (people presence) Less risk for infection (lab settings) What is Epi?: Descriptive Epidemiology describes the distribution of health events -> patterns of those events in populations: (descriptive statistics, count data) ○ What is the disease? Ex: Measles ○ Who is affected? Specific populations ○ Where are they? Postal codes, address, ○ When do events occur? Analytic Epidemiology searches for the determinants of health events -> factors, characteristics & behaviors that determine patterns (interpretive statistics, testing) ○ How does it occur? Contact, airborne ○ Why are some affected more than others? SDH, ex: lower economic status, lack of access, health literacy Epidemiological Model: Host: Person in which health event occurs Intrinsic characteristics which influence susceptibility: family history, sex, age, race, occupation, religion/customs, marital status, immune status, lifestyle, etc. Most important factor is exposure ○ Knowing how something is transmitted Agent: health challenge/force that begins or continues a health event Agent Types ○ Biological – infectious agents ○ Chemical – toxins, pesticides, smoke, alcohol, etc. ○ Physical – radiation, heat, cold, machinery, trauma, etc. ○ Others - Absence of substance, psychological stress Environment: Context that promotes the exposure of host to agent ○ Physical – climate, geography, pollution ○ Biological – plants/animals (reservoirs for agents) Animals are great reservoirs ○ Social – neighborhood, housing, work, socioeconomic factors (education, income) Epidemiological Assessment Framework (Ch.13): CHN examines the frequency and distribution of disease/health in the population using the epidemiology triangle ○ Host-environment-agent ○ CHNs determine what the community is, Who is affected (host), where and when the condition occurred or occurs (environment) and why and how (agent) it occurred. Covid-19 example Primordial Primary Secondary Tertiary Quaternary Prevention Prevention Prevention Prevention Prevention Measures that Measures that Measures that Measures that Measures that identify alter societal later exposures detect prevent people who are at risk structures and that lead to pathological relapses and for harms from thereby disease (ex: process at an further overmedicalization. changing immunizations) earlier stage deterioration (ex: overdiagnosis and underlying when treatment (ex: follow-up; unnecessary determinants of can be more care and polypharmacy) health (ex: effective (ex: rehabilitation) changing public population-based policies) screening) -Text Alerts -Immunization -Rapid test kits -Education - Booster shots -Quarantine -Masks -Drive through -811 - Hospitalizations posters -Screening testing -Follow-up post -Immuno-compromised -Social -Testing when testing -Elderly Distancing traveling - 2-weeks -BiPAP training and -Vaccines when symptom free trialing traveling -Sedate pts for vents Epidemiological Data Sources: World Health Organization Health Canada Public Health Agency of Canada Statistics Canada Canadian Institute for Health Information Provincial health departments Health Authority Modes of Transmission: Direct transmission ○ Direct contact between the person and disease, person and person (with disease), sneezing Indirect transmission ○ Vehicle (inanimate object) or vector (a mammal) or food poisoning Screening and Surveillance: Screening and surveillance are used by public health officials to assist in the prevention or control of certain diseases Screening: the testing of individuals who do not have symptoms in order to detect a health problem ○ That could be swabbing, postpartum depression screening tool Surveillance: the constant watching or monitoring of diseases to assess patterns and quickly identify events that do not fit the pattern ○ One case vs multiple Association VS Causation: Association – reasonable evidence that a connection exists between two factors, i.e., stressor and health challenge ○ Usually some statistical testing, still not a definitive causation Causation – definite cause & effect relationship between two factors Criteria for Causation: Temporal Relationship ○ Time, need to have an exposure prior to the disease Strength of Association ○ When exposed to a stressor it's more likely to bring on the disease Dose-Response ○ The person who is most exposed will see the greater effect Specificity ○ The one antigen causes the issues ex: strep A doesn’t cause measles Consistency ○ The contamination is flooded through those who are exposed Biologic Plausibility ○ Consistency across science and studies, may not get the exact results but similar Experimental Replication ○ The studies steps should be easy and able to follow to recreate Measurements in Epidemiology: RATE: ○ A rate is a measure of the frequency with which an event occurs in a defined population Usually counts ○ Used instead of raw numbers so can make comparison To determine the prevalence ○ Numerator generally crude count of health event of interest ○ Denominator generally the size of the population of interest Most Common Rates: Mortality Rate – number of deaths in a population Morbidity Rate – number of cases of disease or health challenge in a population Morbidity - Prevalence Rate: Disease in a population at a point in time ○ Context specific ○ The point is to be able to compare Formula: # 𝑝𝑒𝑜𝑝𝑙𝑒 𝑤𝑖𝑡ℎ 𝑑𝑖𝑠𝑒𝑎𝑠𝑒 𝑖𝑛 𝑔𝑖𝑣𝑒𝑛 𝑝𝑜𝑝. 𝑎𝑡 𝑜𝑛𝑒 𝑝𝑜𝑖𝑛𝑡 𝑖𝑛 𝑡𝑖𝑚𝑒 𝑇𝑜𝑡𝑎𝑙 𝑖𝑛 𝑔𝑖𝑣𝑒𝑛 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑠𝑎𝑚𝑒 𝑝𝑜𝑖𝑛𝑡 𝑖𝑛 𝑡𝑖𝑚𝑒 𝑥 1000 = Prevalence Practice Question: 200 people in a town of 5000 have influenza on a given day when you are there studying influenza. Calculate the prevalence of influenza. ○ 200/5000= 0.04 x 1000= 40 40 out of every 1000 people have influenza on the day of the study Morbidity - Incidence Rate: New cases in a population over time ○ Count data is still the same, and it's different with the denominator of those who do not have the disease Formula: # 𝑛𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑑𝑖𝑠𝑒𝑎𝑠𝑒 𝑖𝑛 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑖𝑛 𝑔𝑖𝑣𝑒𝑛 𝑝𝑒𝑟𝑖𝑜𝑑 # 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑎𝑡 𝑟𝑖𝑠𝑘 𝑖𝑛 𝑠𝑎𝑚𝑒 𝑝𝑒𝑟𝑖𝑜𝑑 𝑥 1000 Incidence Practice question: 75 people in the town developed influenza the next week of the study. Calculate the incidence of influenza ○ 75/4800 x 1000= 15.6 16 of every 1000 residents developed influenza during the next week of the study. Social Epidemiology: The study of relationships between health and a broad range of social factors such as race, social class, gender, etc. (Harper & Strumpf, 2012). An alternative / a complement to epidemiology’s exclusive focus on disease A “science of change” but difficult to attribute causation Health & disease is rooted in the social organization of society. Notable Achievements: Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard Results: Decline in morbidity and mortality Measure of disease burden and changes in outcomes over time Led to average of 30-year increase in life expectancy How CHNs Use Epidemiology: As members of interprofessional teams that analyze health and disease causation in the community Surveillance and monitoring of disease trends – recognizing patterns Documentation is a source of data for epidemiological reviews Communicating risk factor numbers To develop and initiate appropriate prevention programs Discovering the Tapestry of the CHNC Standards and Competencies: Appreciative Interviewing and Developing Stories from the Field.” CHNC: the national voice of community health nurses. Our goal is to advance community health nursing across Canada and improve the health of Canadians. https://www.chnc.ca/en/standards-of-practice Student Membership to CHNC is warmly invited!: Join Community Health Nurses from across Canada and enjoy the many benefits of membership. https://www.chnc.ca/en/member-benefits At the end of this lecture, the learner will be able to competently and independently: Recognize the unique practice settings and specialties wherein CHNs practice Discriminate the CHNC standards of practice Consider how the CHNC Standards will contribute to excellence in your practice settings within Nursing 431.6 Recognize the power of story as the foundation for competent practice In the tapestry of life, we are all connected. Each one of us is a gift to those around us, helping each other be who we are, weaving a perfect picture together.: By the end of this interactive session, we will ○ weave stories from all participants in a rich and colorful representation of our CHNC Standards of Practice while, discovering our own personal opportunities for professional growth. The Influence of the CHNC Standards of Practice: All nurses adhere to provincial and territorial Standards for Nursing Practice, and these are the foundation upon which other nursing standards are built. The CHN Standards define the practice of a registered nurse in the specialty area of community health nursing. They build on these generic practice expectations of registered nurses and identify the practice principles and variations specific to community health nursing in Canada. The Standards apply to community health nurses who work in the areas of practice, education, administration, policy, and research. The standards (clockwise from the top): Inspire excellence in & commitment to community health nursing practice. The standards are an expectation of practice after 2 years of experience in CHN Promote CHN as a specialty and provide a foundation for certification as a clinical specialty with Canadian Nurses Association (CNA) Establish criteria and expectations for acceptable practice and safe ethical care Define scope & depth of community health nurse (CHN) practice Support human resource management including provide criteria for measuring performance Strengthen education and professional development through Providing a foundation for the development of PHN competencies ○ A vision for excellence in community health nursing practice Canadian Community Health Nursing Standards of Practice, 2019: Standards 1, 2 and 3 describe what we do in practice; Standards 4, 5, 6, 7 & 8 describe how we practice and what we expect to achieve Demonstrates the relationship between all the new standards What are the CHNC standards of practice?: Health Promotion Prevention and Health Protection Health Maintenance, Restoration and Palliation Professional Relationships Capacity Building Health Equity Evidenced Informed Practice Professional Responsibility and accountability ○ The 2019 Canadian Community Health Nursing Standards of Practice consist of eight standard domains and 81 standard statements Standard 1: (8 indicators) Health Promotion Community health nurses integrate health promotion into practice ○ “Health promotion is the process of enabling people to increase control over, and to improve, their health.” Involves the individuals, families, groups, communities, population and systems Give example ○ Applies health promotion theories and models in practice such as change theories, primary health care, population health promotion model, and social and ecological determinants of health including Aboriginal peoples. ○ Collaborates with client to do a comprehensive, evidence informed, and strength-based holistic health assessment using multiple sources and methods to identify needs, assets, inequities and resources. ○ Seeks to identify and assess the root and historical causes of illness, disease and inequities in health, acknowledges diversity and the adverse effects of colonialism on Indigenous people, and when appropriate incorporates Indigenous ways of knowing including connectedness and reciprocity to the land and all life in health promotion. ○ Considers the determinants of health, the social and political context, and systemic structures in collaboration with the client to determine action. ○ Implements appropriate communication approaches such as social marketing and media advocacy to disseminate health information and raise awareness of health issues at individual and/or societal level. ○ Includes cultural safety and cultural humility approaches in all health promotion interventions. ○ Uses a collaborative relationship with the client and other partners to facilitate and advocate for structural system change and healthy public policy using multiple health promotion strategies. ○ Evaluates and modifies health promotion activities in partnership with the client. Standard 2: (9 indicators) Prevention and Health Protection Community health nurses use the socio-ecological model to integrate prevention and health protection activities into practice.21 These actions are implemented in accordance with government legislation and nursing standards to minimize the occurrence of disease or injuries and their consequences. Give example ○ Participates in surveillance, recognizes trends in epidemiology data, and utilizes this data through population level actions such as health education, screening, immunization, and communicable disease control and management. ○ Uses prevention and protection approaches with the client to identify risk factors and to address issues such as communicable disease, injury, chronic disease, and the physical environment (e.g. air, climate, housing, work, water, land). ○ Applies the appropriate level of prevention (primordial, primary, secondary, tertiary and quaternary) to improve client health. ○ Facilitates informed decision making with the client for protective and preventive health measures. ○ Collaborates with the client to provide emergency management including prevention/mitigation, preparedness, response and recovery. ○ Uses harm reduction principles grounded in social justice and health equity perspectives to identify and reduce risks, and increase protective factors. ○ Includes cultural safety and cultural humility approaches in all aspects of prevention and health protection interventions. ○ Engages in collaborative, interdisciplinary and intersectoral partnerships in the delivery of preventive and protective services with particular attention to populations who are marginalized. ○ Evaluates and modifies prevention and health protection activities in partnership with the client. Standard 3: (6 indicators) Health Maintenance, Restoration and Palliation Community health nurses integrate health maintenance, restoration and palliation into their practice Give example (bold or other) ○ Holistically assesses the health status, and functional competence of the client within the context of their environment, social supports, and life transitions. ○ Supports informed decision making and co-creates mutually agreed upon plans and priorities for care with the client. ○ Uses a range of intervention strategies related to health maintenance, restoration and palliation to promote self-management of disease, maximize function, and enhance quality of life. ○ Includes cultural safety and cultural humility approaches in all aspects of health maintenance, restoration and palliation interventions. ○ Facilitates maintenance of health and the healing process with the client in response to adverse health events. ○ Evaluates and modifies health maintenance, disease management, restoration and palliation interventions in partnership with the client. Standard 4: (12 indicators) 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. Give example (bold or other) ○ Recognizes own personal beliefs, attitudes, assumptions, feelings and values including racism and stereotypes and their potential impact on nursing practice. ○ Assesses the client’s beliefs, attitudes, feelings, and values about health and the impact of these on the professional relationship and potential interventions. ○ Acknowledges that the current state of Indigenous People’s health in Canada is a direct result of previous Canadian government policies in working with Indigenous people as stated in the Truth and Reconciliation Commission of Canada: Calls to Action. ○ Respects and supports the client in identifying their health priorities and making decisions to address them while being responsive to power dynamics. ○ Uses culturally safe communication strategies in professional relationships, recognizing communication may be verbal or non-verbal, written or graphic. Communication can occur via a variety of mediums. ○ Recognizes and promotes the development of the client’s social support networks as an important social determinant of health. ○ Promotes awareness of, and supports linkages to, appropriate community resources that are acceptable to the client. ○ Maintains professional boundaries in therapeutic client relationships. ○ Negotiates terminating therapeutic relationships in a professional manner. ○ Builds a network of relationships and partnerships with a wide variety of individuals, families, groups, communities, and systems to address health issues and promote healthy public policy to advance health equity. ○ Incorporates the domains from the National Interprofessional Competencies framework in working with other nurses and health care team members. Domains include 1) interprofessional communication, 2) patient/client/family/community-centered-care, 3) role clarification, 4) team functioning, 5) collaborative leadership, and 6) interprofessional conflict resolution. ○ Evaluates and reflects on the nurse/client and other community relationships to ensure responsive and effective nursing practice. Standard 5: (17 indicators) 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. Give example (bold or other) ○ Uses an asset approach and facilitates action to support the priorities of the Jakarta Declaration ○ The Jakarta Declaration identified the following priorities: ○ Promote social responsibility for health ○ Increase investments for health development ○ Consolidate and expand partnerships for health ○ Increase community capacity and empower the individual ○ Secure an infrastructure for health promotion. ○ Enhances the client's ability to recognize their strengths, their challenges, causal factors, and resources available that impact their health. ○ Assists the client to make an informed decision in determining their health goals and priorities for action. ○ Uses capacity building strategies such as mutual goal setting, visioning and facilitation in planning for action. ○ Helps the client to identify and access available resources to address their health issues. ○ Supports the client to build their capacity to advocate for themselves. ○ Supports the development of an environment that enables the client to make healthy lifestyle choices, recognizing relevant cultural factors and Indigenous ways of knowing. ○ Recognizes the unique history of Indigenous people, and incorporates Indigenous ways of knowing and culturally safe engagement strategies in capacity building efforts. ○ Uses a comprehensive mix of strategies such as coalition building, inter-sectoral collaboration, community engagement and mobilization, partnerships and networking to build community capacity to take action on priority issues. ○ Supports community-based action to influence policy change in support of health. ○ Evaluates the impact of capacity building efforts including both process and outcomes in partnership with the client. Standard 6: (15 indicators) 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. Give examples Engages with the client using critical social theory and an intersectional approach from a foundation of equity and social justice. Assesses how the social determinants of health influence the client’s health status with particular attention to clients who are marginalized. Understands how power structures, unique perspectives and expectations may contribute to the client’s engagement with health promoting services. Advocates for and with the client to act for themselves where possible. CHNS should speak truth to power! Participates with community members and advocates for health in intersectoral policy development and implementation to reduce health equity gaps between populations. Engages with clients who are marginalized in the coordinating and planning of care, services and programs that address their needs and perspectives on health and illness. Refers, coordinates and facilitates client access to universal and equitable health promoting services that are acceptable and responsive to their needs across the life span. Collaborates with community partners to coordinate and deliver comprehensive client services with the goal of reducing service gaps and fragmentation. Understands historical injustices, inequitable power relations, institutionalized and interpersonal racism and their impacts on health and health care, and provides culturally safe care. Supports the client’s right to choose alternate health care options, including “to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients” as stated in the Truth and Reconciliation Commission of Canada: Calls for Action. Advocates for resource allocation using a social justice lens. Uses strategies such as home visits, outreach, technology and case finding to facilitate equitable access to services and health-supporting conditions for populations who are marginalized. Advocates for healthy public policy and social justice by participating in legislative and policy-making activities that influence the determinants of health and access to services. Takes action with and for the client at the organizational, municipal, provincial, territorial and federal levels to address service gaps, inequities in health and accessibility issues. Evaluates and modifies efforts to increase accessibility to health and community services, and to advance health equity. Standard 7: (6 indicators) Evidence Informed Practice Community health nurses use best evidence to guide nursing practice and support clients in making informed decisions. Give example ○ Uses professional expertise in considering best available research evidence, and other factors such as client context and preferences and available resources, to determine nursing actions. ○ Seeks out reliable sources of available evidence from nursing and other relevant disciplines. ○ Understands and uses critical appraisal skills to determine quality of research evidence. ○ Understands and uses knowledge translation strategies to integrate high quality research into clinical practice, education, and research. ○ Uses quality evidence to inform policy advocacy, development and implementation. ○ Uses a variety of information sources including acknowledging diverse perspectives and Indigenous ways of knowing. Standard 8: (14 indicators) Professional Responsibility and Accountability Community health nurses demonstrate professional responsibility and accountability as a fundamental component of their autonomous practice. Give example (bold or other) ○ Assesses and identifies unsafe, unethical, illegal or socially unacceptable circumstances and takes preventive or corrective action to protect the client. ○ Recognizes ethical dilemmas and applies ethical principles and CNA Code of Ethics. ○ Works collaboratively in determining the best course of action when responding to ethical dilemmas. ○ Provides leadership in collaboration with the community to advocate for healthy public policy based on the foundations of health equity and social justice. ○ Identifies and acts on factors which enhance or hinder the delivery of quality care. ○ Participates in the advancement of community health nursing by mentoring students and new practitioners. ○ Participates in professional development activities and opportunities to be involved in research. ○ Identifies and works proactively (individually or by participating in relevant professional organizations) to address health and nursing issues that affect the client and/or the profession. ○ Provides constructive feedback to peers as needed to enhance community health nursing practice. ○ Documents community health nursing activities in a timely and thorough manner. ○ Advocates for effective and efficient use of community health nursing resources. ○ Uses reflective practice to continually assess, and improve personal community health nursing practice including cultural safety and cultural humility. ○ Acts upon legal obligations (applicable provincial / territorial / federal legislation) to report to relevant authorities any situations involving unsafe or unethical care. ○ Uses available resources to systematically evaluate the achievement of desired outcomes for quality improvement in community health nursing practice. Thinking about practice expectations in all settings: Cultural safety (1f, 2g, 3d, 4e, 5h, 6i) Cultural humility (1f, 2g, 3d) Indigenous ways of knowing (5h) Levels of prevention (2c) Disease management (3f) Critical appraisal (7c) Knowledge translation (7d) Interprofessional competencies (4k) Quality improvement (8n) ○ The Standards incorporate practice expectations involving cultural safety; cultural humility; Indigenous ways of knowing; levels of prevention; disease management; critical appraisal; knowledge translation; interprofessional competencies; and quality improvement. ○ These changes were made in the context of current literature and practice in Canada and our changing understanding of the complex forces that impact health. Our advancing knowledge enhanced by such important documents as the Truth and reconciliation commission report has resulted in a current and leading document that will enhance Community Health Nursing practice in Canada. ○ Mention that the numbers refer to references found in the Standards. How do you describe relational practice?: https://www.chnc.ca/en/standards-of-practice Exploring Relational Practice: Relational practice is the skilled action of respectful, compassionate, and authentic interested inquiry (Zou, 2016) ○ interpersonal but also intrapersonal Relational practice is collaborative ○ reflexive, responsive Relational practice relationships embrace and interpret context ○ context changes everything Relational practice explores the personal, interpersonal, intrapersonal and social structural factors that shape people’s experience. ○ social justice, health equity Discovering the gifts and gaps in your practice through your nursing stories: In each clinical interaction or story, ○ Am I consistently fully present with the folks I am serving? ○ Do I believe that my clients have unique perspectives and expertise that they bring to our clinical relationship? ○ Do I take steps to allow the client story to be told? ○ Do I listen respectfully to the opinions of patients and family members? ○ Do I facilitate active participation in the way the story is shaped moving forward? ○ Do I offer dignity, respect, and partnership as the foundation to information and collaboration? ○ Am I consistently purposeful and intentional? ○ Do I use evidence to guide my nursing interventions? ○ Am I transparent and open with my colleagues about my valuing of client perspectives? Sex, Drugs, & Harm Reduction Objectives: By the end of this lesson, students should be able to: ○ Explain the concept of harm reduction, and how it relates to nursing practice ○ Provide (at least) 3 examples of harm reduction practices nurses can engage in ○ Provide a broad definition of trauma informed care ○ Explain how trauma informed care relates to nursing practice ○ Identify structural causes of sexual health inequities ○ Begin to understand 'band-aid solutions' versus looking at the 'root causes' of health inequity The Basics: Evidence-Based: An approach to decision making and problem solving that uses the best evidence from research, studies, and data to inform solutions. ○ “This is the most recent research and recommendations by professionals” Sex Positivity: Sex positivity is an attitude that celebrates sexuality as a part of life that can enhance happiness, bringing energy and celebration. Sex-positivity recognizes that sexuality is more than just sex. Sex can be a positive force in people's lives. Sexuality should be celebrated, not shamed. - International Planned Parenthood Federation ○ “Talking about sex in a realistic and positive way” Harm Reduction: Harm reduction refers to policies, programs, and practices that aim to minimize negative health, social, and legal impacts associated with certain practices (e.g., sexual activity), policies (e.g., access to care), and laws (e.g., drug laws). Harm reduction is grounded in justice and human rights - it focuses on positive change and on working with people without judgement, coercion, or discrimination. - Harm Reduction International ○ “Whether we like it or not, people engage in potentially harmful activities. If people are going to do this, how can they do it safely and in a way that minimizes harms” Intersectionality: Intersectional thought is rooted in resistance movements by women of colour against violence and oppression in the late 19th and early 20th centuries. Intersectionality theory emphasizes that the root causes of marginalization cannot be traced to one specific social location (e.g., race, class, or gender), but rather include an overall analysis of how power functions to create a matrix of intersecting oppressive processes impacting people occupying multiple marginalized social locations. Multiple categories of difference (e.g., gender, race, and social class) are both created and sustained by structures of domination. These categories of difference create categories of “other” that inform societal norms and standards in our everyday social processes. Intersectionality emphasizes that this matrix of power differentials constrain opportunities for marginalized people, while privileging dominant groups, resulting in a status quo of oppression that is embedded in everyday institutions. Trauma-informed care: In trauma-informed services, safety and empowerment for the service user are central, and are embedded in policies, practices, and staff relational approaches. Service providers cultivate safety in every interaction and avoid confrontational approaches. Trauma-informed approaches are like harm-reduction-oriented approaches, in that they both focus on safety and engagement. - BC Provincial Mental Health and Substance Use Planning Council A key aspect of trauma-informed services is to create an environment where service users do not experience further traumatization or re-traumatization (events that reflect earlier experiences of powerlessness and loss of control) and where they can make decisions about their treatment needs at a pace that feels safe to them. What is trauma- and violence-informed care (TVIC)? ○ TVIC expands on the concept of TIC to acknowledge the broader social and structural conditions that impact people’s health, including institutional policies and practices. ○ Talking about sexuality and substance use within service settings can be difficult. ○ Using a TVIC approach helps ensure that the broader structural and social conditions are acknowledged and that organizational policies and practices as well as provider practices do not contribute to re-traumatization. Example TVIC strategies: ○ Acknowledging the effects of historical and structural conditions; ○ Seeking client input about safe and inclusive strategies; ○ Encouraging client empowerment in relation to treatment options and adoption of harm reduction strategies; and ○ Implementing policies and processes that allow for flexibility and encourage shared decision-making. Stigma: Internalized stigma: An individual’s acceptance of negative beliefs, views, and feelings towards the stigmatized group they belong to and oneself. Perceived stigma: An individual's awareness of negative societal attitudes, fear of discrimination, and feelings of shame. Enacted stigma: Encompasses overt acts of discrimination, such as exclusion or acts of physical or emotional abuse; acts may be within or beyond the purview of the law and may be attributable to an individual’s real or perceived identity or membership to a stigmatized group. Layered or compounded stigma: A person holding more than one stigmatized identity. Institutional or structural stigma: Stigmatization of a group of people through the implementation of policy and procedures. Can we think of examples? Internalized stigma ○ Not applying for a job because of gender identity Perceived stigma ○ Fear of disclosing sexual practices to family provider Enacted stigma ○ Not believing a sex worker who was assaulted ○ Derogatory terms Layered or compounded stigma ○ HIV positive serostatus, sexual orientation, ethnicity Institutional or structural stigma ○ Banning MSM from donating blood STIBBIs: Sex is a normal and healthy part of our lives, but many types of infections that can be spread through sexual activities Over the past decade, reported rates for chlamydia, gonorrhea, and infectious syphilis continued to increase substantially. Many cases are asymptomatic or have minor symptoms until the later stages of infection. Untreated, STIBBIs can cause infertility and other serious complications. People aged 15-24 have higher rates STIs continue to remain a significant public health challenge in Canada, disproportionately affecting certain populations. COVID amplified this. Transmiss

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