PPN Study Doc Week 9-12 PDF

PPN STUDY DOC WEEK 9-12 WEEK 9 Galileo: Emphasizes guiding learners to self-discovery. Franklin: Advocates for involvement in learning for better retention. CNA Code of Ethics (2017) ​ Ethical Foundations: ○​ Patients have the right to make informed decisions. ○​ Informat...

PPN STUDY DOC WEEK 9-12 WEEK 9 Galileo: Emphasizes guiding learners to self-discovery. Franklin: Advocates for involvement in learning for better retention. CNA Code of Ethics (2017) ​ Ethical Foundations: ○​ Patients have the right to make informed decisions. ○​ Information provided must be: ​ Accurate. ​ Complete. ​ Relevant to client needs. ​ Anticipate information needs based on: ○​ Physical, mental, emotional, and spiritual health. ○​ Risks and interprofessional treatment plans. Health Teaching ​ Definition: ○​ Instructional dialogue focusing on client-centered relationships. ○​ Purpose: ​ Provide knowledge and skills for informed decision-making. ​ Promote quality of life. ​ Prevent disease progression. ○​ Reference: Mallette & Yonge (2022, p. 307). What Do Nurses Teach? ​ Nurse's Teaching Areas: ○​ Medication use, lifestyle modifications, disease management. ○​ Health promotion, self-care strategies, post-treatment care. Role of the Nurse in Teaching ​ Nurses adapt teaching strategies by: ○​ Creating conducive environments for learning.  ○​ Using client-centered approaches. ○​ Selecting effective strategies based on client needs. ○​ Reference: Potter & Perry (2024, p. 331). Nurse Roles in Teaching 1.​ Guide: ○​ Encourage healthy behaviors. 2.​ Information Provider: ○​ Teach how to manage health effectively. 3.​ Resource Support: ○​ Connect clients to community programs. 4.​ Emotional Support: ○​ Help clients cope with challenges. ○​ Reference: Mallette & Yonge (2022, p. 314). Goals of Client-Centered Education ​ Engaging clients as active participants in the learning process-individual approach ​ Ensuring that health teaching interventions are supportive of the client’s preferences and values in order to achieve positive clinical outcomes. ​ Introduce participatory strategies, which build on client’s personal strengths ​ Collaborative learning environments allows nurses to offer sufficient information, specific instruction and emotional support to clients ​ The teacher must start where the learner is, while supporting the learners natural desire to learn RNAO: Facilitating client centered learning is based on the foundation of four pillars which includes: ​ Client Centred Care ​ Promoting Health Literacy ​ Building Knowledge and Skills ​ Supporting Self-Management Strategies RNAO L.E.A.R.N.S Model  1.​ Foundation: ○​ Client-centered care. ○​ Promoting health literacy. ○​ Building knowledge. ○​ Supporting self-management. 2.​ Acronym: ○​ Listen. ○​ Establish relationships. ○​ Adopt approaches. ○​ Reinforce health literacy. ○​ Name knowledge gaps. ○​ Strengthen management. Goals/Outcomes of Client Education 1.​ Maintain Health: ○​ Focus on prevention and wellness. 2.​ Restore Health: ○​ Improve outcomes post-illness. 3.​ Optimize Quality of Life: ○​ Support despite impairments. ○​ Reference: Potter & Perry (2024, p. 330). Three Learning Domains 1.​ Cognitive: ○​ Understanding and content mastery. 2.​ Affective: ○​ Attitude change and acceptance. 3.​ Psychomotor: ○​ Skills gained through hands-on practice. ○​ Reference: Mallette & Yonge (2022, p. 310). Transtheoretical Model of Change: Model is used to explore a person’s motivational readiness to intentionally change health habits. ​ Stages: ○​ Pre-contemplation: No recognition of a problem.  ○​ Contemplation: Awareness emerges. ○​ Preparation: Plans for action. ○​ Action: Change is implemented. ○​ Maintenance: Sustaining new behaviors. ○​ Reference: Mallette & Yonge (2022, p. 291). Learning Styles 1.​ Visual: ○​ Prefers demonstrations, visuals. ○​ Needs detail ○​ Organizes thoughts by writing them down 2.​ Auditory: ○​ Learn best through discussions. ○​ Talks about pros and cons ○​ Detail is not as important 3.​ Kinetic: ○​ Thrives with hands-on activities. ○​ Loses interest with detailed instructions ○​ Reference: Mallette & Yonge (2022, p. 316). Factors Affecting Learning Readiness ​ Influences include: ○​ Emotional readiness: Anxiety, motivation. ○​ Intellectual ability: Literacy, cognitive state. ○​ Physical state: Pain, illness. ✔ Crisis and life transitions can IMPROVE learning ✔Level of Social Support ✔Health Literacy ✔Developmental Stage ✔Culture ✔Self-Awareness ✔Social Determinants of Health Cultural and Developmental Considerations ​ Culture affects: ○​ What clients learn. ○​ How they learn. ​ Developmental stage impacts: ○​ Cognitive, physical, and emotional readiness. Processes Comparison Tanner’s Clinical Judgement Model NURSING PROCESS TEACHING PROCESS (2006) (P&P, 333) (P&P, p.333-40) (Alfaro-LeFevre, p.82, P&P p.296) ASSESSMENT Detecting/Noticing Gather data about Collects Data Clues Preferred learning style Learning Readiness Ability to learn Health literacy NURSING DIAGNOSIS Analyzing, Identify client’s needs based Identifies appropriate nursing diagnosis synthesizing and on 3 domains of learning based on assessment Interpreting data PLANNING Responding, Family involvement Develop individualized care plans considering actions Consider Learning needs through collaboration and setting priorities Create a plan (SMART) Collaborate IMPLEMENTATION Responding, Building logical information Perform Nursing care Involve client reflecting and making flow adjustments Involve client and family EVALUATION Reflecting and Determine outcomes: Identify success in meeting repeating ADPIE as Were they achieved? outcomes/goals indicated Health Literacy Definition ​ Definition of Health Literacy: ○​ The ability of individuals to access, understand, evaluate, and communicate health-related information effectively. ○​ Impacts on individuals: ​ Decision-making regarding their health. ​ Managing medication, treatments, and lifestyle changes.  ○​ Emphasis on critical thinking and problem-solving for health information application. ○​ Challenges: ​ Complex medical terminologies. ​ Misinterpretation of health materials. ​ Increasing health literacy is essential to empowering people to manage their health and advocate for their family’s and their own wellbeing, as well as reducing the burden on Canada’s health care system. Definitions of literacy and health literacy from other people: -​ WHOs definition: “ the cognitive and social skills which determine the motivation and ability of individuals to gain access to understand and use information in ways that promote and maintain good health”. -​ If the client cannot understand what is being taught, learning does not take place. Health literacy is defined by The Centers for Disease Control and Prevention as: -​ “The degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions”. -​ It includes knowing how to describe symptoms, where to find help for health issues, how to understand medical information and how to safely manage the use of medication. Another defenitiopn: -​ The ability to use printed and written information in society – to achieve one’s goals, and to develop one’s knowledge and potential. Key points: -​ The term low literacy skills is now used to represent almost 9 million adult Canadians who have serious problems with reading, writing and math. 4 out of 10 Canadians have less than adequate literacy skills. Living in an “information culture” requires higher levels of literacy than at any previous time in human history. Canadian Statistics on Health Literacy ​ Key Data: ○​ 6 in 10 Canadian adults lack adequate health literacy skills for effective health management. ○​ Groups most affected: ​ Older adults. ​ Those with limited education or language barriers. ​ Marginalized communities. ​ Implications for Nurses:  ○​ Simplify health education materials. ○​ Focus on culturally sensitive approaches. ○​ Ensure accessibility of health resources. The Impact of Poor Health Literacy ​ Consequences of Poor Health Literacy: ○​ Increased rates of hospitalizations. ○​ Poor medication adherence and health outcomes. ○​ Misunderstanding of treatment regimens. ○​ Higher healthcare costs due to preventable complications. ​ Nurses must actively identify and address low health literacy among patients. Assessing Health Literacy ​ Scenario-Based Skill Evaluation: ○​ Example task: Calculating medication dosages based on weight charts. ○​ Tools for Assessment: ​ Teach-back method: Ensuring patients can repeat or demonstrate understanding. ​ Use of questionnaires like REALM (Rapid Estimate of Adult Literacy in Medicine). ○​ Areas Assessed: ​ Numeracy. ​ Reading comprehension. ​ Practical application in healthcare settings. Skills Needed for Health Literacy (these are literacy in general tho) ​ Three Core Literacy Types: ○​ Prose Literacy: Understanding written text and health information pamphlets. ○​ Document Literacy: Navigating charts, graphs, and medical forms. ○​ Quantitative (numeracy) Literacy: Calculating dosages, blood sugar levels, or caloric intake. ○​ Problem solving ​ Importance: ○​ Helps patients engage in shared decision-making. ○​ Enables better comprehension of health risks. Strategies for Promoting Health Literacy ​ Key Strategies: 1.​ Use plain language: Avoid medical jargon. 2.​ Incorporate visual aids: Charts, diagrams, infographics. 3.​ Ensure cultural relevance: ​ Translate materials where needed. ​ Respect diverse communication styles. 4.​ Build interpersonal relationships: ​ Listen to patient concerns. ​ Encourage questions without judgment. 5.​ Use digital tools: ​ Apps and online resources tailored to patient literacy levels. Health Literacy and Consent Forms ​ Challenges in Traditional Consent Forms: ○​ Overly complex language. ○​ Lengthy documents with excessive details. ​ Revised Consent Forms: ○​ Simplified wording for clarity. ○​ Inclusion of bullet points for key messages. ○​ Use of visuals to demonstrate procedures or steps. ○​ Tested with patient groups for usability. Addressing Gaps in Health Literacy ​ Steps Nurses Can Take: ○​ Identify specific barriers faced by patients (e.g., language, reading level). ○​ Provide one-on-one counseling for key instructions. ○​ Create an inclusive environment that encourages learning. ○​ Leverage technology to improve access to educational materials. Health Literacy Tools and Resources ​ Tools for Nurses: ○​ Teach-back technique: Confirm understanding by asking patients to explain the information. ○​ Interactive teaching tools: Mobile apps, videos, and online simulations. ○​ Visual aids like infographics or printed guides with step-by-step instructions. Ethical Considerations in Health Literacy ​ Ethical Obligations: ○​ Ensuring equitable access to health education. ○​ Tailoring information delivery to diverse audiences. ○​ Avoiding assumptions about literacy levels. ​ Importance: ○​ Fulfills the principle of autonomy by empowering informed decision-making. ○​ Supports patients' rights to participate in their care. Health Literacy Initiatives ​ Key Takeaways: ○​ Nurses play a pivotal role in improving health literacy. ○​ Focus on: ​ Simplifying education. ​ Using patient-friendly tools. ​ Assessing individual needs continuously. ​ Importance: ○​ Better health literacy leads to improved patient outcomes and system efficiency. Readings to do: RNAO: ​ What is RNAO? ○​ RNAO stands for the Registered Nurses’ Association of Ontario, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. ○​ Mission: Advance nursing excellence, influence health policy, and advocate for healthy public policy. ○​ Importance: Provides evidence-based resources to support nursing practices. RNAO and Best Practice Guidelines (BPGs) ​ Best Practice Guidelines (BPGs): ○​ RNAO develops evidence-based guidelines to improve patient care.  ○​ These guidelines cover topics such as health promotion, chronic disease management, and mental health. ○​ Example: ​ Patient-Centered Care BPG: Encourages partnership between nurses and patients to ensure individualized care. ○​ BPGs help enhance the quality, consistency, and outcomes of nursing practices. Benefits of RNAO for Nurses ​ Professional Development: ○​ Access to workshops, webinars, and conferences. ○​ Opportunities to participate in nursing research initiatives. ​ Advocacy: ○​ RNAO influences healthcare policies by providing a nursing perspective to governments. ○​ Nurses are supported to advocate for patients and their communities. ​ Access to Tools: ○​ Resources such as the Nursing Best Practice Guidelines (NBPG) App for easy access to guidelines. ○​ Collaboration networks and mentorship opportunities. RNAO’s Role in Health Literacy ​ Promoting Health Literacy through BPGs: ○​ Guidelines emphasize teaching methods tailored to patient needs and literacy levels. ○​ Recommendations on how nurses can simplify medical language, incorporate visual aids, and foster better communication. ​ Support for Diverse Communities: ○​ RNAO resources address language barriers and cultural considerations. ○​ Guidelines promote inclusivity in healthcare delivery. RNAO and Patient Education ​ Patient-Centered Education: ○​ Focus on empowering patients through evidence-based information. ○​ Nurses are encouraged to assess and address individual learning needs. ○​ Example: ​ Teaching tools for chronic diseases like diabetes. ○​ Incorporates teach-back methods to confirm understanding. ​ Technology Integration: ○​ Use of online learning platforms to share accessible educational resources. ○​ Promotes digital tools for ongoing patient education. Health Literacy Integration and RNAO’s Role Health Literacy Definition (RNAO Perspective) ​ RNAO aligns health literacy with patient-centered care principles. ​ Nurses are key to simplifying complex health information for diverse populations. ​ Importance: ○​ Health literacy enhances patient autonomy. ○​ Linked to better treatment adherence and health outcomes. Addressing Health Literacy Challenges (RNAO Guidance) ​ Recommendations from RNAO BPGs: ○​ Plain Language: Avoiding medical jargon. ○​ Teach-back method: Ensuring patients accurately understand instructions. ○​ Cultural competence: Recognizing and addressing unique challenges in diverse populations. Nursing Strategies from RNAO ​ RNAO BPG Strategies for Nurses: ○​ Use interactive teaching methods. ○​ Incorporate storytelling or real-life examples for better comprehension. ○​ Leverage community-based programs to extend health education beyond clinical settings. Technology and Health Literacy (RNAO Influence) ​ RNAO promotes the use of digital tools to support health education. ○​ Examples: Apps, patient portals, and online interactive learning modules. ​ Digital solutions improve accessibility for rural or underserved populations. Importance of Health Literacy for Patient Outcomes ​ Outcomes associated with RNAO-supported literacy programs: ○​ Improved medication adherence. ○​ Enhanced chronic disease management. ○​ Better engagement in preventive health measures. Karen Laforet reading- Health Literacy and access to care: Key Trends and Definitions ​ Growth in Virtual Care:  ○​ The use of virtual health care increased from 19% in 2019 to 56% in early 2020 due to the COVID-19 pandemic. ○​ This shift is part of "Health 4.0," where digital tools like telehealth and mobile apps are used to deliver health care (Kickbusch, 2020). ○​ Digital Health Literacy (DHL): The ability to find, understand, and use health information from digital tools to solve health problems. ○​ Benefits of DHL: Better quality care, easier access, and lower costs. ​ Challenges in Virtual Care: ○​ Virtual care can make health care less fair, as not everyone has the skills or access to use digital tools. ○​ Health literacy (HL) is essential for using digital tools effectively but is often overlooked. Canada’s Health Literacy ​ Literacy Levels: ○​ Literacy in Canada is rated on a 5-level scale, with Level 3 being the minimum needed for most jobs and daily life. ○​ In 2012: 1.​ 48.5% of Canadians were at Level 2 or lower in general literacy. 2.​ 54.7% of Canadians scored Level 2 or lower in numeracy. ○​ Key Skills Affecting Health Literacy: 1.​ Prose Literacy: Understanding written texts. 2.​ Document Literacy: Using information in formats like schedules and charts. 3.​ Numeracy: Performing math and understanding numbers. ​ Health Literacy (HL): ○​ The ability to access, understand, and use information to stay healthy. ○​ Three important parts of HL: 1.​ Knowing where to find health information. 2.​ Understanding the information. 3.​ Using the information to make health decisions. ○​ About 55% of Canadians aged 16–65 score below Level 3 in health literacy. Digital Health Literacy (DHL) ​ What It Is and Why It Matters: ○​ DHL is the ability to use digital tools (like apps and websites) to understand and manage health care. ○​ Examples of digital tools: ​ Telemedicine.  ​ Health apps. ​ Fitness trackers. ​ Patient portals. ​ Barriers to Digital Health: ○​ People with lower income or education, especially older adults, often have low DHL. ○​ Some health-care professionals (HCPs) lack digital skills, which can prevent them from helping patients use these tools. ​ Impact on Inequality (negative): ○​ Virtual care can widen health inequalities because not everyone has the skills or technology to use digital health services. ○​ Social factors like language barriers, income, and education make it harder for some groups to access digital health care. Policy Strategies for Health-Care Providers 1.​ Train HCPs in digital skills during school and on the job. 2.​ Assess patients’ literacy levels before introducing digital tools (e.g., using tools like eHEALS). 3.​ Teach cultural awareness to help HCPs address diverse patient needs. 4.​ Create databases of reliable online resources for patients. 5.​ Build teams that focus on digital health to support both professionals and patients. 6.​ Provide guides for patients to prepare for virtual visits and ask the right questions. 7.​ Work with developers to create easy-to-use digital health tools. Strategies for Patients 1.​ Ensure access to affordable technology, like Internet and devices. 2.​ Offer community programs to teach digital skills, especially for groups with specific needs (e.g., new immigrants). 3.​ Reduce financial barriers by providing free or low-cost devices and Internet access. 4.​ Support people with disabilities by providing the tools they need to use digital health care (e.g., assistive devices). Challenges and Recommendations ​ Reluctance Among HCPs: ○​ Many health-care providers still prefer in-person visits, which slows the adoption of virtual care.  ○​ Education and policies are needed to address this and make virtual care more widely accepted. ​ Future Goals: ○​ Make sure health literacy is part of all public health plans and communication. ○​ Focus on helping underserved populations to ensure digital health care is fair and accessible. Summary and explanation: ​ Virtual care and digital health tools can improve health care but must be implemented in a way that includes everyone. ​ Policymakers and health-care providers must work together to close the digital divide and make digital health care accessible for all. ​ Health advancements should aim for fairness and equality, ensuring no one is left behind. Impact of Virtual Care in Canada: Positive Impacts: ​ Increased access for rural/underserved areas. ​ Greater convenience (remote consultations). ​ Enhanced self-management with digital tools. ​ Reduced operational and individual costs. ​ Raised awareness of digital health literacy. Negative Impacts: ​ Exacerbates inequities (low-income, seniors, limited skills). ​ Over 55% of Canadians have low health literacy. ​ Many providers are reluctant to adopt virtual care. ​ Digital divide (socioeconomic barriers, disabilities). ​ Misuse of unreliable online health information. WEEK 10 Early Healthcare (Pre-1867) ​ Local, Essential Service Model: ​ Health services centered on community-level care. ​ Responsive to Crises: Healthcare addressed immediate community needs with a focus on basic, accessible services.  ​ Role of Churches and Families: Centralized care structures provided by religious and familial organizations. ​ Primary Issues: ​ Sanitation Problems: Poor hygiene practices and infrastructure led to widespread illness. ​ Infectious Diseases: Lack of sanitation and modern medical practices made communities vulnerable to epidemics. British North America Act (1867) ​ Formation of Canada: Introduced provincial and federal jurisdictions. ​ The act gave certain powers to the federal and provincial governments (only 4 provinces at time) ​ Responsibility for health, education and social services were given to the provinces. ​ Federal government Health Responsibilities: ​ Included care for Indigenous persons, Canadian Forces members, veterans, and pharmaceutical safety. ​ Infographic: Depicts division of power, highlighting the roles each government level plays in healthcare administration. Industrialization (Late 19th - Early 20th Century) -​ Development of industries in a country or region on a wide scale. ​ Urbanization and Sanitation: ​ Industrialization drove urban population growth, worsening living conditions and hygiene. ​ Charitable and Voluntary Health Agencies: ​ Those unable to afford healthcare relied on charity, marking the growth of non-profit health organizations. ​ Key Legislative Developments: ​ 1916 Municipality Act: Allowed municipalities to use tax funds for healthcare providers. ​ 1919: Creation of the Department of Health to handle national health responsibilities. -​ 1930s: great depression happened -​ 1940s: provinces inspired to create a prepaid medical and hospitalization insurance plan. Important Events of the 1940s and 50s ​ Post-War Social Programs: ​ Introduction of universal social programs addressing the determinants of health. ​ Healthcare Institutional Shift: ​ Transition from home to institutional care; establishment of immunization programs. Tommy Douglas and Medicare (1947): ​ Premier of Saskatchewan and leader of the new democratic party ​ Helped weave the first strands of the social safety net that defines Canadian society today ​ He led North America's first socialist government serving as premier of Saskatchewan between 1944 and 1961. ​ He introduced over 100 important laws, including one that gave Canada its first government health insurance. ​ As the first leader of the federal New Democratic Party (NDP) from 1961 to 1971, he was perceived to be the conscience of Canada ​ Douglas’s advocacy led to Saskatchewan’s prepaid healthcare model, influencing national healthcare reform. ​ Medicare Evolution ​ Key Milestones: ​ 1961: Inpatient hospital care coverage across all provinces/territories. ​ 1972: Expanded to cover medical services outside hospitals. ​ Funding Adjustments: ​ Initially cost-shared between federal and provincial governments. ​ 1977: Block transfers reduced federal contributions, leading to extra billing and user fees. What is the safety net? ​ A term used to describe the presence of social programs aiming to prevent those most vulnerable from falling below a certain level of poverty and vulnerability. What kinds of programs would be in this category? ​ Canada Pension Plan (CPP): A funded pension that provides monthly payments to Canadians and their families after retirement, disability, or death ​ Employment Insurance (EI): Temporary benefits for workers, including sickness, fishing, and family-related benefits Expansion of the Social Safety Net -​ From 1950 onwards, significant progress made towards supporting the poor, elderly and disabled through “social safety nets” ​ Social Programs Introduction: ​ Programs like the Canada Pension Plan, Guaranteed Income Supplement, and Canada Assistance Plan aimed to support vulnerable populations.  ​ Medicare (example is OHIP): Central pillar of the social safety net, ensuring access to necessary health services. ​ ^set of 10 provincial and 3 territorial insurance schemes that provide access to hospital and physician services. Canada Health Act (1984) ​ Purpose: ​ To protect universal access by eliminating extra billing and prohibitive user fees. ​ 5 Core Principles: ​ Public Administration: Non-profit administration by a public authority. ​ Comprehensiveness: Covers essential physician and hospital services. ​ Universality: Every resident must be insured. ​ Portability: Coverage across provinces/territories and international travel. ​ Accessibility: Equitable access without financial barriers. ​ Provinces may ignore principles but may have federal dollars withheld. Federal and Provincial/Territorial Roles: -​ Healthcare is administered by provinces/territories with federal oversight -​ 13 separate provincial and territorial programs cost shared with the federal government under minimal conditions. ​ Federal Responsibilities: ​ Establishes national standards for health care system through the Canada health act, provides funds through money transfer, and delivers health services to certain groups like veterans, native canadians, persons living on reserves, military personnel, inmates of federal penitentiaries and RCMP. ​ Focus on health promotion and promotion as well as disease prevention. ​ Provincial/Territorial Responsibilities: ​ Developing and administration of healthcare insurance plans, ​ plan and fund care in hospitals and other healthcare facilities. ​ Reimburse health care providers and hospitals. ​ Deal with long term care and rehabilitation services ​ Manage some aspects of prescription care and public health. ​ Determine which services are covered. Public and Private Funding ​ Public Funding (think of OHIP and things necessary) : Accounts for 70% of healthcare financing, funded primarily by taxes (personal, corporate, sales tax, lottery). ​ Additional funds from other financial sources like sales tax and lottery proceeds are also used by some provinces Private Funding (think of ambulance mobile charge or insurance companies like manulife) ): Covers 30% through out-of-pocket expenses and private insurance,  ​ mainly for non-essential services like dental care, eye care, personal health supplies, residential care facilities, hospital costs not related to medical care (eg: semi-private room) and medications. Federal Transfers: History of federal transfers: 1957-1976: ​ Post secondary education hospital insurance medical care ​ CAP- canada assistance plan 1977-1995: ​ Comes from post secondary insurance----EPF: established program financing ​ Comes from CAP-------CAP (again) 1996-2003: ​ All comes from EPF and CAP------Canada health and social transfer CHST 2004 onward: (all comes from CHST) ​ Canada Health transfer CHT ​ CST canada social tranmsfer ​ Canada Health Transfer (CHT): ​ Major financial support mechanism for provinces, totaling $52.1 billion for 2024-25 (23% of federal spending). ​ Ontario will receive 20.2 billion in Health transfers from federal government based on 1707 per capita ​ Canada Social Transfer (CST): ​ Supports education, child care, social services; total for 2024-25 is $16.9 billion. ​ Increases by 3% each year to the year 2027 Equalization Payments: ​ The purpose of equalization is to ensure that provincial governments have sufficient revenues to provide comparable levels of public services at reasonably comparable levels of taxation.  ​ Total equalization funding grows in line with a 3 year moving average of nominal gross domestic product and is allocated amongst provinces based on formula set out in legislation ​ Provides additional funds to lower-revenue provinces to ensure equitable service levels. ​ In 2024-2025 equalization will support Manitoba New brunswick, newfoundland and labrador Novanscoatio ontario, PEI and quebec Dental Care for Canadians: -​ 2018: more than ⅕ canadians reported avoiding dental care cuz of cost ​ Dental Care Program (2022): ​ $5.3 billion over five years for low-income families (income < $90,000). ​ Expanded in 2023: ​ $13 billion over 5 years and 4.4 bi ongoing to health Canada to implement Canadian Dental care plan. Restricted to certain families: ​ Income less than $90,000 annually and no co pays for those under 70,000 annually with income. ​ Importance of Oral Health: Critical for overall health and well-being. Regular dental visits help prevent many issues. ​ Economic and System Impact: ​ Lack of dental insurance leads to expensive, ineffective emergency room visits, costing $1.8 billion (2017). ​ Oral health issues cause significant absenteeism: ​ 2.26 million school days missed annually. ​ 4.15 million working days are missed annually. ​ Health Risks: ​ Gum diseases increase the risk of heart attack or stroke by 2-3 times. ​ Pediatric Concerns: ​ Dental surgeries in children (ages 1-5) represent one-third of all day surgeries in pediatric hospitals. ​ Many of these could have been prevented with early oral health care. Pharmacare ​ Legislation (2024): ​ GOVERNMENT OF CANADA INTRODUCES LEGIS;LATION FOR FIRST PHASE OF NATIONAL UNIVERSAL PHARMACARE ​ June 5th 2024: Bill C-64 passed to implement a single-payer (government will be the sole payer) Pharmacare system  ​ Coverage includes essential medications, such as birth control and diabetes drugs. For anyone with a health card Primary Health Care (PHC) ​ Definition and Focus: ​ PHC is the foundational healthcare model in Canada, emphasizing prevention and health promotion. ​ Serves as the first point of contact in the system for nonurgent/emergent care as well as the vehicle for continuity of care. ​ Principles rooted in social justice and equitable access. ​ Four Pillars: ​ Teams: Collaborative, multidisciplinary care teams. ​ Access: Ensuring healthcare accessibility for all. ​ Information: Data-driven, patient-centered care. ​ Healthy Living: Promotion of lifestyle and preventive care. Healthcare Delivery in Canada Where: ​ Institutional: Hospitals, long-term care facilities, rehabilitation centers and psychiatric centers, ​ Community: public health centers, physician offices, community clinics, private clinics, and nursing agencies. ​ 5 Levels of Healthcare: ​ Health Promotion: Disease prevention and promotion of healthy lifestyles. ​ Disease/Injury Prevention: Vaccination, early screenings, etc. ​ Diagnosis/Treatment: Primary, secondary, and tertiary care. ​ Rehabilitation: Support for returning to daily life post-illness. ​ Supportive Care: Long-term, palliative, and hospice care. ​ Infographic: Map showing various healthcare delivery points across Canada. Primary Care ​ First point of contact in the healthcare system. ​ Provided by general practitioners (GPs), family doctors, or nurse practitioners. ​ Focuses on prevention, diagnosis, and treatment of common illnesses. ​ Settings include clinics, community health centers, and family doctor offices. ​ Examples of services: ○​ Routine check-ups. ○​ Management of chronic illnesses like diabetes or hypertension. ○​ Immunizations and screenings.  ○​ Health education and counseling. Secondary Care ​ Specialist care provided after referral from primary care providers. ​ Delivered in hospitals, specialized clinics, or, in some cases, at home or in the community. ​ Addresses more specific health issues. ​ Examples of services: ○​ Diagnostic services like MRI or CT scans. ○​ Care from specialists such as cardiologists or orthopedists. ○​ Outpatient care or short-term hospitalization. Tertiary Care ​ Advanced, highly specialized care for complex conditions. ​ Provided in large hospitals with cutting-edge technology or specialized healthcare centers. ​ Examples of services: ○​ Organ transplants. ○​ Cardiac surgeries. ○​ Advanced cancer treatments. Challenges in Health Care: ​ Economy of Health: Rising costs for health services and balancing healthcare budgets. ​ Climate Change: Impact of environmental changes on health (e.g., respiratory diseases, heatwaves) and the need for climate-resilient healthcare infrastructure. ​ Primary Health Care vs. Primary Care Spending: Disproportionate spending on curative services compared to preventive and community-based care. ​ Human Health Care Resources: Shortages of healthcare workers, leading to overburdened staff and burnout. ​ Aging Population: Increased demand for long-term care and chronic disease management, placing strain on resources. ​ Truth and Reconciliation Calls to Action: Addressing health disparities for Indigenous peoples through culturally safe care and reconciliation efforts. ​ Geography: Challenges in providing equitable healthcare to rural and remote areas, with limited access to specialists and tertiary care. ​ Social Determinants of Health: Factors such as income, education, housing, and employment influencing health outcomes and requiring systemic solutions. ​ Ethnocultural and Linguistic Diversity and Migration: Providing culturally and linguistically appropriate care to a diverse population. ​ Decentralization of Delivery: Provinces and territories manage healthcare delivery, resulting in regional variations in quality and access. Two tiered health care: -​ Patients who can pay for private health services receive better or faster service than the person using public service. -​ So basically it consists of public and private -​ Tier 1 or tier 2 Effects of privatization: -​ Denying citizens the right to purchase medical is an infringement to the right to life, guaranteed under the canadian charter of right and freedoms -​ Even if true, minor infringements of the rights of a few is a justifiable means of protecting the interests of many. -​ Compelling the affluent to participate with the poor in a national health-care system guarantees for those without money a standard of care. Implications of a Two-Tiered System for Social Justice 1.​ Unequal Access: Wealthier individuals can access faster, higher-quality care, leaving marginalized groups reliant on overburdened public services. 2.​ Resource Drain: Private care may attract healthcare professionals, weakening the public system. 3.​ Erosion of Universal Access: Ties healthcare quality to income, undermining equity and fairness. 4.​ Increased Health Inequalities: Creates disparities in health outcomes between income groups. 5.​ Ethical Concerns: Challenges the fairness and solidarity of a universal healthcare system. Compatibility with Canada Health Act (CHA) Principles 1.​ Public Administration: The public system must remain non-profit and adequately funded. 2.​ Comprehensiveness: Public healthcare should fully cover all medically necessary services, with private care limited to non-essential procedures. 3.​ Universality: Equal access to public healthcare must be ensured for all Canadians. 4.​ Portability: Public coverage should remain consistent across provinces and unaffected by private options. 5.​ Accessibility: Private care must not create barriers or reduce quality or access in the public system. Balancing Two-Tiered Systems with Social Justice  ​ Strengthen public funding to ensure high-quality, universally accessible care. ​ Limit private care to supplementary services, avoiding competition for resources. ​ Regulate private healthcare to protect equity and prevent negative impacts on the public system. While a two-tiered system may create inequities, careful regulation and investment in public care can help mitigate risks while maintaining CHA principles. Other factors influencing health care reform: -​ Changes in the way health services are delivered -​ Health care traditionally focused on hospitals and physician services -​ Increasing care delivery with primary health care centers, home care, new medical equipment -​ Currently our system is still very focused on hospitals, and emergency rooms are misused for primary care services Current issues: ​ Sustainability/cost ​ Hallway medicine: being treated in the hallway ​ Wait times ​ Indigenous health ​ LTC /acute beds ​ mental health ​ Equity/Accessibility ​ Pharma care ​ Staffing shortage ​ Aging population ​ Bureaucracy Policy changes: 3 crucial problems that require urgent action: ​ Wait times for elective care are too long ​ Services outside the Medicare basket are often inaccessible ​ Indigenous health disparities are unacceptable Current Issues in Canadian Healthcare  ​ Key Challenges: ​ Economic constraints, aging population, staffing shortages, long wait times, hallway medicine. ​ Indigenous health disparities, long-term care accessibility, and expanding service needs. ​ Debate over privatization and its implications for equity and social justice. ​ Infographic: Visual summary of top healthcare challenges and their impacts on the system and nursing. Martin article: Canada’s Universal Health-Care System: Key Features 1.​ Foundational Principles: ​ Access to healthcare based on need, not ability to pay. ​ Established with Medicare in 1947 (Saskatchewan). ​ Expanded across Canada by federal cost-sharing, unified under the Canada Health Act (1984). 2.​ Key Attributes: ​ Publicly funded through provincial/territorial insurance plans. ​ Core services (hospital, physician, diagnostic) free at the point of care. ​ Decentralized system with coverage portable across provinces. 3.​ Principles of Canada Health Act: ​ Portability: Coverage while traveling or moving within Canada. ​ Universality: Equal access to insured services. ​ Accessibility: No direct user charges for publicly funded services. ​ Comprehensiveness: Includes necessary hospital, diagnostic, and physician services. ​ Public Administration: Plans managed on a non-profit basis. Challenges and Recommendations 1.​ Challenges: ​ Long Wait Times: Elective procedures and specialist care delays. ​ Inequity: Gaps in access to services outside the core public basket (e.g., dental, vision). ​ Indigenous Health: Poor health outcomes and disparities for Indigenous populations. 2.​ Recommendations: ​ Renew the tripartite social contract (government, providers, public). ​ Expand the publicly funded basket of services. ​ Prioritize addressing social determinants of health and Indigenous reconciliation. Historical Milestones in Medicare  1.​ 1947: Saskatchewan Hospital Services Plan – first universal hospital insurance in North America. 2.​ 1962: Medicare expanded to include physician services. 3.​ 1984: Adoption of the Canada Health Act – banned extra billing and established funding eligibility criteria. Healthcare Financing 1.​ Three Layers of Services: ​ Layer 1 (Public): Core services (hospital, diagnostic, physician) funded by taxes. ​ Layer 2 (Mixed): Prescription drugs, home care, long-term care (public/private mix). ​ Layer 3 (Private): Dental, vision, complementary medicine, outpatient therapy. 2.​ Current Trends: ​ Publicly sourced health expenditure: ~70.9%. ​ Private expenditure: ~30% (half from out-of-pocket payments). ​ Administrative efficiency: Low overhead costs (~2%). Health Inequities 1.​ Indigenous Populations: ​ Lower life expectancy: ~64 years for Inuit men (vs. 82 years national average). ​ Gaps in mental and physical health services. 2.​ Immigrants and Refugees: ​ Barriers to care: Language, legal literacy, limited access to regular doctors. Policy and Governance 1.​ Decentralized Delivery: ​ Physicians: Independent contractors under public insurance. ​ Hospitals: Separate governance structures. 2.​ National Coordination Challenges: ​ Variation in adoption of evidence-based practices. ​ Limited interoperability of electronic health records. 3.​ Health Technology Assessment: ​ CADTH (Canadian Agency for Drugs and Technologies in Health) provides guidance, but provincial adherence varies. Comparison with OECD Nations 1.​ Health Spending: ​ Canada: 10.4% of GDP (vs. 17.1% in the USA, 9.1% in the UK). ​ High costs for pharmaceuticals and private insurance coverage.  2.​ Health Outcomes: ​ Life expectancy: ~82 years (above OECD average). ​ Challenges: High wait times and unmet care needs. 3.​ Geographical Barriers: ​ Rural areas underserved (13.6% of physicians in rural regions). ​ Heavy reliance on telemedicine and patient transfers. Week 11 Values and beliefs: -​ First you need be aware of your own personal values and beliefs when they conflict with an institution or client ​ Make sure to not imply these values and beliefs on other people Accountability: -​ It is grounded in the moral principles: fidelity (faithfulness) and respect and dignity, worth, self determination of patients and others with whom nurses work. -​ CNA states: “Nurses are honest and practice with integrity in all of their professional interactions”. -​ Means able to to accept responsibility or to account for one's actions and refers to being answerable to someone for something one has done Professional accountability: Nurses who enact professional accountability……. -​ Keep up with professional standards -​ Documentation from communications is an example: because it holds accountable -​ Maintaining their fitness to practice: includes mental and physical state of body to give good practice -​ Stay within their scope of practice- making sure they have competense -​ Share knowledge with others: nurses, teachers or healthcare provider mentors -​ Advocate for comprehensive and equitable mental care services When might one's professional role come into conflict for accountability? Conflicts arise when nurses face ethical dilemmas, resource limitations, pressure to act beyond their scope, or fear of reporting issues. What role does accountability play in ethical and legal practice? Accountability ensures ethical care, legal compliance, accurate documentation, and advocacy for patient rights. CNO, definition of this organization: -​ Since 1963: 60 years have been protecting the public. -​ Largest healthcare regulator in CANADA -​ 1969 launched their communication  -​ They have expanded their reach using social media -​ 1976: first to show practice standards -​ 1985: moved into current practice -​ 1991: started acting like regulatory body -​ New century started using technology -​ 2020: initiated emergency assignment class in response to covid -​ Focuses on equity and human rights, by addressing barriers and promoting dignity and respect for all -​ Regulatory and process outcomes -​ Self regulated -​ MAIN IDEA FOR THEM: Protects the public best interest ahead of their own professional interests, protecting the public from us. Which is a privilege because they recognize putting the public before their own professional interests. -​ Recognizes that Ontario's nurses have the knowledge and expertise to regulate themselves as individual practitioners and to regulate their profession through the college. Regulates nursing and these are the ways they protect the public interests: Entry to practice requirements, enforcing standards, complaints and disciplinary processes (if someones makes a complaint, the disciplinary will take action), quality assurance programs -​ They are involved in legislation in the provincial government -​ They also share statistical information about Ontario nurses They fulfill their role by: -​ Establishing requirements for entry tio practice -​ Articulating and promoting practice standards -​ Administering its quality assurance program -​ Enforcing standards of practice and conduct Canadian nursing association (CNA): -​ We are all under their umbrella -​ Professional voice of RNs -​ Represent Canada -​ Oversees that there is equity and provinces -​ There is standard across the country and these standards are run by them: They made the old NCLEX -​ If you wanna work somewhere else like BC, you could do this because of them -​ They are on the federal level Main objectives for them: -​ Unify the voices of RN -​ Strengthening nursing leadership -​ Promotes nursing excellence and a vibrant profession  -​ Advocate for healthy public policy and quality health system -​ Serve the public interest International council of nurses (ICN): -​ Federation of more than 130 national nursing organizations -​ CNA is a member of the ICN Mission: -​ They oversee that there is a standard of practice across the board globally (includes promoting wellbeing of nurses) -​ Advance the nursing profession -​ Advocating for health in all policies Canadian association school of nursing (CASN)- don't confuse with CNA: -​ They set our curriculum: voice of nursing education and scholarship -​ Establishes and promotes national standards for nursing education -​ Promotes the advancement of nursing knowledge -​ Provides a national forum for issues in nursing education and research. -​ Represent all universities and colleges which offer part or all of an undergraduate or graduate degree in nursing , What you need to graduate to meet the entry level competencies, When we started this new program they changed up the curriculum, giving us what we needed -​ They oversee all the nursing programs in CANADA -​ Every school teaches the same thing, all main ideas to reach their competencies: represents all unis and colleges which offer part or all of an undergraduate or graduate degree in nursing Ontario Nurses association (ONA) -​ Trade union since 1973, ones that represent us, they are our union -​ They protect us, different to how all the other ones serve the public -​ Were in the same collective agreement, they negotiate everything we do with our finances -​ There tryna get the increase in levels: based on years of experiences -​ Tryna change the bill 29: that nurses are public, after covid they only got a 1 raise, then they went to court and got 10-11 raise. -​ ^basically tryna get us paid according to our worth. Their mission: -​ The Ontario Nurses’ Association (ONA) is a proactive union committed to improving the economic welfare and quality of work-life for our members, to enable them to provide high-quality health care. -​ “Respected, strong, united and committed to members who care for people”. -​ They negotiate our contract our negative agreement Vision:  -​ Membership driven, proactive union sensitive and responsive to ever changing needs in an evolving health care system. -​ Environment: Learning & personal growth, diversity & creativity -​ Foundations: mutual trust, respect, support & understanding -​ Goal: high quality efficient HCS, in partnership with communities, consumers and HC professional Advocate for: -​ Patient care environment -​ Equality -​ Safe environments and practices Registered nurses association of Ontario (RNAO) -​ Voice of nursing -​ Professional association representing registered nurses in Ontraio -​ Any registered nurse or nursing student can join for a fee -​ Not mandatory to join- Optional, it is your choice -​ If you join them you get liability insurance here -​ Foster knowledge based nursing practice -​ Promote quality work environments and professional development -​ Advance health public policy to improve health -​ Speaking out for nursing and speaking out for health -​ Best practice guidelines: videos on how to, or posters you see etc Sigma Theta Tau international (STTI): -​ Think of them as the recruiter for student nurses -​ International community of nurses dedicated to the advancement of knowledge, teaching, learning and service through the cultivation of communities of practice, education and research. -​ Founded in 1992 by 6 nursing students, -​ STTI has more than 100,000 active members -​ Members include nurses and administrators, academic nurse educators and researchers, policy makers, entrepenueurs and others working to fulfill the organization's vision -​ 600 chapters at institutions of higher education and healthcare partners from Armenia, Australia, Botswana to Thailand, the US and wales. -​ They recruit students who have good grades CNO: Code of conduct: The Code of Conduct is a practice standard developed by the College of Nurses of Ontario (CNO) to protect the public and promote safe nursing practice. It describes the responsibilities and accountabilities of all nurses registered in Ontario and outlines what clients, employers, colleagues, and the public can expect from nurses. Key Points About the Code of Conduct: 1.​ Purpose: ○​ Ensures nursing care is safe, compassionate, equitable, and discrimination-free. ○​ Centralizes clients in care, emphasizing diversity, equity, and inclusion. ○​ Guides nurses in delivering care through any method (in-person, virtual, telephone, etc.). 2.​ Clients Defined: ○​ The term “client” refers broadly to individuals, families, substitute decision-makers, caregivers, groups, communities, and populations receiving care. 3.​ Legislative and Ethical Foundations: ○​ Informed by laws like the Ontario Human Rights Code. ○​ Incorporates recommendations from the Truth and Reconciliation Commission of Canada: Calls to Action (2015). 4.​ Relation to CNO Standards: ○​ Used alongside other CNO practice standards for guidance. ○​ Applied in regulatory processes, including Quality Assurance and Professional Conduct reviews, where nurses' practices are evaluated within their work context and circumstances. 5.​ Accountabilities of Nurses: ○​ Deliver care with professionalism and integrity. ○​ Uphold client-centered principles, respecting human rights and cultural safety. ○​ Provide care that avoids harm and ensures dignity for all. By adhering to the Code of Conduct, nurses meet their professional obligations while aligning with CNO's commitment to public protection and trust. Principles of the code: 1.​ Nurses respect clients’ dignity. 2.​ Nurses provide inclusive and culturally safe care by practicing cultural humility. 3.​ Nurses provide safe and competent care. 4.​ Nurses work respectfully with the health care team to best meet clients’ needs. 5.​ Nurses act with integrity in clients’ best interest. 6.​ Nurses maintain public confidence in the nursing profession. *Each principle has equal importance and works together to describe the conduct of nursing practice in Ontario. Professional conduct: -​ CNO professional conduct: professional misconduct (2019) Definitions of professional misconduct include: -​ Failure to maintain standards of practice working while impaired  -​ Abusive conduct theft -​ Failure to obtain informed consent and breach of confidentiality -​ Inadequate documentation and record keeping -​ Misrepresentation: doing beyond scope of practice -​ Failure to meet legal/professional obligations -​ Conflict of interest: you can work with your spouse tho -​ Inappropriate business practices -​ disgraceful, dishonorable and unprofessional conduct Other grounds for professional misconduct: -​ Guilty of an offense -​ Finding of professional misconduct in another jurisdiction -​ Sexual abuse: when nurse has sexual relations with patient. Example: touching genitals, when not necessary. ^this depends, read the room because soft touch for therapeutic relationships with an old person is ok. Reporting: -​ CNO states: that nurses take action in situations where a colleague's actions or behaviors put clients at risk or are perceived to be abuse toward a client in any way. -​ Therapeutic nurse- client relationship practice standard says: Nurses have a commitment to act in the best interest of their client but their actions must promote trust and respect of the profession. This includes reporting of any form of abuse to an appropriate authority as explained above. -​ Gunshot wounds: obligated to report to police -​ Child abuse: obligated to report and this is because of the child, youth and family services act,2017. -​ Sexual abuse: obligated to report to CNO ^any abuse or improper care of a client that results in harm or risk of a client is due to the Fixed long term care act, 2021. CNA code of ethics ​ History: 1954: ​ The CNA adopts the International Council of Nurses (ICN) Code as its first ethical code for nurses in Canada. 1980: ​ The CNA develops its own Code of Ethics, called CNA Code of Ethics: An Ethical Basis for Nursing in Canada. 1985: ​ The CNA introduces a new version titled the Code of Ethics for Nursing. 1991: ​ The 1985 Code is revised to address evolving ethical practices in nursing. 1997: ​ The Code is renamed and updated as the Code of Ethics for Registered Nurses. 2002: ​ The 1997 version undergoes a revision to reflect changes in healthcare and nursing practice. 2008: ​ Further revisions are made to ensure it remains relevant to contemporary nursing practices. 2017: ​ The most recent revision of the Code of Ethics for Registered Nurses is introduced, reflecting modern values and challenges in nursing. 2 parts to CNA: -​ Part 1: nursing values and ethical responsibilities -​ Part 2: ethical endeavors related to broad social issues Part 1: Nursing values and ethical responsibilities -​ Describes the ethical responsibilities central to ethical nursing practice articulated through 7 primary values and responsibility statements. -​ Statements are grounded in nurses' professional relationships with persons receiving care as well as with students, nursing colleagues and other health care providers. 7 primary values are: 1. Providing safe, compassionate, competent and ethical care 2. Promoting health and well-being 3. Promoting and respecting informed decision-making 4. Honoring dignity 5. Maintaining privacy and confidentiality 6. Promoting justice 7. Being accountable Part 2: ethical endeavors related to broad social issues -​ Think of this as social justice  -​ Ethical nursing practice involves endeavoring to address broad aspects of social justice that are associated with health and wellbeing. Ethics and professional practice (there is a lot of questions on moral agencies for exam): Responsibility: -​ reliability and dependability -​ Ability to distinguish right from wrong Accountability: -​ Grounded in moral principles of fidelity and respect for dignity, worth and self determination of patients and others with whom nurses work with. Advocacy: -​ Acting on behalf of others -​ Informed consent -​ Recognizing the need for change -​ Awareness of constrained moral agency Moral agency: -​ Someone who has the capacity to direct their actions to some ethical end. Example: good outcomes for patients. Entry-to-practice competencies for registered nurses: Defined as knowledge, skill and judgment necessary for safe and ethical practice for all RNS in Ontario- as described by the CNO -​ Same for every nursing program -​ If you graduate you can apply to everywhere because it's all been credited by chasm What the competencies are established for: ​ Protection of the public ​ Practice reference ​ Approval of nursing education programs ​ Registration and membership requirements ​ Legal reference ​ Public information ​ Continuing competence Overarching principles: Entry-Level Registered Nurses (RNs) Practice 1.​ Beginning Practitioners: ○​ Entry-level RNs are beginning practitioners in the nursing profession. ○​ It is unrealistic to expect entry-level RNs to perform at the level of experienced RNs.  2.​ Scope of Practice: ○​ Entry-level RNs work within the registered nursing scope of practice. ○​ They are expected to seek guidance when encountering situations beyond their current abilities. 3.​ Requisite Skills and Abilities: ○​ Entry-level RNs must possess the skills and abilities necessary to meet entry-level competencies. 4.​ Generalist Preparation: ○​ Entry-level RNs are prepared as generalists who practice: ​ Safely, competently, compassionately, and ethically in both health and illness situations. ​ With individuals, families, groups, communities, and populations across the lifespan. ​ In diverse practice settings (hospitals, clinics, community health, etc.). ​ Using evidence-informed practice to guide clinical decisions. 5.​ Educational Foundation: ○​ Entry-level RNs receive baccalaureate-level education that provides a strong foundation in: ​ Nursing theory and concepts ​ Health and sciences ​ Humanities ​ Research and ethics 6.​ Autonomous Practice: ○​ Entry-level RNs are expected to practice autonomously, but within the boundaries of: ​ Legislation ​ Practice standards ​ Ethical guidelines ​ Scope of practice specific to their jurisdiction. 7.​ Critical Thinking: ○​ Entry-level RNs are required to apply the critical thinking process throughout all aspects of their practice. Competencies: There are 101, under 9 categories/roles: 1.​ Clinician 2.​ Professional 3.​ Communicator 4.​ Collaborator 5.​ Coordinator 6.​ Leader 7.​ Advocate 8.​ Educator 9.​ Scholar Registration and Licensure: Some form of licensing or registration necessary for professions Control of profession is left to the profession: -​ Improve standards of practice and education -​ Register members and motor profession conduct -​ Judge the practice of professionals when disputes arise -​ Authority to remove from practice those who are found to be incompetent or unethical -​ The term nurse is a protected title by the CNO by professions Licensure vs. Registration in Nursing 1.​ Licensure: ○​ Definition: Licensure is granted by the provincial or territorial body, such as the College of Nurses of Ontario (CNO). ○​ Purpose: It gives an individual the exclusive legal right to practice the nursing profession (similar to how a driver's license gives legal permission to drive). ○​ Important Point: Not everyone can call themselves a nurse; only those who are licensed by the appropriate regulatory body are legally allowed to do so. 2.​ Registration: ○​ Definition: Registration refers to being listed as a member in good standing with an organization, like the CNO. ○​ Purpose: It ensures that the nurse has met the minimum level of safe practice required by the profession. ○​ Requirements for Registration: ​ Must meet practice requirements set by the regulatory body. ​ Must demonstrate no evidence of unsafe practice. ​ Must provide evidence of expanding knowledge and competence to meet evolving requirements as the profession changes. Key Points: ​ Licensure grants the legal right to practice. ​ Registration ensures competence and safety in practice, confirming that the nurse is maintaining current knowledge and skills. NCLEX: -​ Registration exams such as this contribute to patient safety -​ Tests whether the writer has knowledge, skill and judgment to provide safe care during their first year of practice. -​ As provincial regulator of nursing profession, we are accountable for ensuring that only those who demonstrate ability to apply nursing knowledge and provide safe care are able to practice in Ontario. -​ Does not test everything that is taught during a four year baccalaureate nursing program.  -​ Focuses on main things not everything because just what will keep the patent safe for entry level -​ Example of questions: pain management; medication administration; basic care and comfort; infection control; health promotion and maintenance; and concepts such as maintaining confidentiality of patient information”. -​ In addition, all drug names are generic and refer to medications that entry-level nurses are expected to know. Legal responsibilities of nurses: -​ CNO: confidentiality and privacy practice standard (2022) -​ To maintain confidentiality and privacy of client health information The CNOS Standard statements: ​ Personal health information practices ​ Knowledge consent and substitute decision-makers (SDMs) ​ The client’s right to access and amend his/her personal health information ​ Potential for harm ​ Disclosure without consent Regulatory law or statue law (there is questions on the exam about this): -​ Established to protect the public/ patients rights (advocating) -​ Sets legal boundaries of the job -​ Protects self from liability: by adhering to these laws protecting yourself from legal cases -​ Governs standards of care and nursing practice acts -​ Examples are the: nursing act and Regulated Professionals act (down below) Regulated health professions statute law amendments act (RHPSLAA): Key Highlights: 1.​ Expanding Services of Regulated Health Care Professionals: ○​ Allows nurse practitioners, pharmacists, physiotherapists, dietitians, midwives, and medical radiation technologists to deliver more services within their education and competency. ○​ Changes the rules for administering, prescribing, dispensing, compounding, selling, and using drugs in practice for various health professionals including chiropodists, podiatrists, dental hygienists, dentists, midwives, nurse practitioners, pharmacists, physiotherapists, and respiratory therapists. ○​ Nurse practitioners can now order X-rays, and physiotherapists can order them for specific purposes. 2.​ Improving Patient Safety and Strengthening the Health Care System: ○​ Health colleges are required to collaborate on developing common standards of knowledge, skill, and judgment for areas where professionals offer similar services.  ○​ Team-based care is a key component of quality assurance programs ensuring ongoing competence of health professionals. ○​ All regulated health professionals must have professional liability insurance. ○​ A process is established to ensure new drug prescribing powers are used safely. Understanding Canada's legal system (testable) -​ Two categories: public and private Public law: -​ Concerned with relations between individuals and the state -​ Includes constitutional, tax, administrative, human rights and criminal law. Private law: -​ Nurses are under this -​ Concerned with disputes between individuals -​ Examples include: ◊contracts, marriage and divorce, civil wrongs (including negligence Tortes (very important for exam) : -​ Under private law -​ Civil wrong against a person or property -​ Classified under intentional or unintentional -​ Intentional: Assault, Battery and Invasion of privacy -​ Unintentional tort low: negligence. Example: forget to put rail, patient hurts themself, it was unintentional but it doesn't matter because they were harmed 4 criterias are established: ​ The nurse owed a duty of care to the patient ​ The nurse did not carry out that duty ​ The patient was injured ​ The nurse’s failure to carry out the duty caused the injury Preventing negligence (important for exam): -​ Follow standards from from the CNO -​ Insist on appropriate orientation, education and staffing -​ Communicate with other health care providers -​ Develop carding rapport with patient family: -​ Document assessments, interventions and evaluations fully: if records are incomplete or missing, the care is presumed to have been negligent and therefore the cause of the patients injuries. -​ Example: nurses did not complete care properly leading to more complications. -​ Restraints too tight in the psych ward, causing blue hands= negligence. -​ Documenting accurately is what will help you -​ It must be accurate, complete, legible and objective -​ Documentation is a legal record  -​ Document assessments, interventions and evaluations fully Confidentiality and privacy: -​ Nurses have ethical and legal responsibilities to maintain confidentiality and privacy of client health information -​ Privacy belongs to the patient -​ Confidentiality is duty of the health care provider -​ How do nurses maintain privacy and confidentiality? Legislation for nurses: Personal health information protection act (PIPHA) [Testable]: -​ Governs all health information and privacy of client in Ontario -​ Defines information privacy as the client's right to control hope personal health information is collected used and disclosed, -​ PHIPA permits sharing of personal health information among healthcare team members, regardless of whether they are employed by the same organization: you can share it with anyone involved in the care, even if they are from a different organization. Personal information protection and electronic documents act (PIPEDA): -​ Federal legislation that protects personal information including health information in any electronic environment WEEK 12 Nursing regulation in Canada: -​ 1991- regulated health profession act (RHPA) in Ontario- started from the early 90s, set the standards for the CNA -​ Utilize unique nursing knowledge and expertise -​ Esure competency and monitoring of professionals -​ Development of nursing acts 1991 -​ Provincial development and definition of scope of practice. Nursing act 1991: -​ Nursing act establishes the mandate of the college of nurses of ontario and defines the scope of practice for the nursing profession Including: -​ Scope of practice -​ Classes of registration RHPA (regulated healthcare profession act): -​ Covers all healthcare providers  -​ List of different acts -​ Physicians have different scopes of practice that we do, they are all covered by this act and there's certain things we can do in this -​ If you go over your scope of practice you can go above the scope of practice which can violate tort law: negligence -​ Over scope of practice: changing drip chamber (pushing them below), it's for nurses or doctors in the emergency room. -​ ^depends on your environment- your environment is controlled, so if someone higher up says to do this and you are in the environment that you're supposed to be in, then you're okay. -​ The legislative framework establishes health regulatory collages, which regulate the professions in the public interest. -​ ^ these collages are responsible for ensuing that regulated health professionals privuide health services in a safe, professional and ethical manner -​ They set standards and investigate complaints about members of the profession and where appropriate disciplining them. Authorizing mechanism (overview from video): Controlled act (RHPA): -​ RHPA identifies controlled act that can be performed by all healthcare professions in Ontario -​ All nurses need authority to regulate a controlled act Example: -​ Applying bandage is not controlled act -​ Performing prescribed procedure below the dermis or mucous membrane -​ Administering -​ Putting instrument hand or finger: inserting catheter -​ Nurse practitioner are authorized to do more controlled acts: selling or dispensing medication -​ Only NP have access to selling and dispensing medication even though all nurses are in charge 3 authorizing mechanism: 1.​ Orders: 2.​ Delegation 3.​ initiation Other legislation -​ Authorized by other legislation -​ Ordering or authorizing healing machine Regulated health professions act (RHPA)- what is it? -​ Many people in healthcare are involved in this  -​ 27 groups to be exact -​ Aim: is to regulate professional procedures -​ Scope of practice and controlled acts -​ Focus/goal: consumer choice, quality care and apenesses/transparency -​ It does this by providing consumers, choice of safe, licensed and competent professionals. THe RHPA framework is intended to: -​ Better protect and serve public interest -​ Be a more open and accountable system of self governance -​ Provide a more modern framework for the hralh professionals -​ provide consumers with freedom of choice; and -​ Provide mechanisms to improve quality of care Goals: ​ To ensure that the health professions are regulated & coordinated in the public interest ​ That appropriate standards of practice are developed & maintained ​ That individuals have access to services provided by the health professions of their choice ​ That individuals are treated with sensitivity & respect in their dealing with health professionals, their Colleges & the Board Highlights of the legislation includes: Expanding the services of regulated health care professions: -​ Allows nurse practitioners, pharmacists, physiotherapists, dietitians, midwives, medical radiation technologists to deliver more services that they are now educated and competent to provide. -​ Changes the rules on drug administration for: podiatrists, dental hygenists, dentists, midwives, nurse practitioners, pharmacists, physiotherapists and respiratory therapists. -​ removing restrictions on X rays that can be ordered bby nurse practitioners and enabling phsyiotherapists to order X rays for specific purposes. Terms you must know: Controlled act -​ 14 of them -​ Nurses can only do a few: RNs, RPNS, NPs etc) All 14 of them: Examples: ​ 1.Communicating dx ​ 2. Performing a procedure on tissue below the dermis, mucus membrane, ​ cornea, teeth or scaling teeth  ​ 3. Setting or casting a fracture of a bone or dislocation of a joint ​ 4. Moving joints of the spine beyond normal ROM using fast, low amplitude ​ thrust ​ 5. Administering a substance by injection or inhalation ​ 6. Putting an instrument, hand or finger beyond: external ear canal, nasal ​ passage, larynx, opening of the urethra, labia majora, anal verge, artificial ​ opening of body ​ 7. Applying or ordering a form of energy ​ 8. Prescribing or dispensing, selling or compounding a drug ​ 9. Prescribing or dispensing vision devices ​ 10. Prescribing or dispensing hearing aids ​ 11. Fitting or dispensing dental prosthesis ​ 12. Managing labour ​ 13. Allergy challenge testing ​ 14. Psychotherapy *** (proclaimed with two year exemption) RNs and RPNs are authorized to perform the following controlled acts: 1. Performing a prescribed procedure below the dermis or a mucous membrane. 2. Administering a substance by injection or inhalation. Putting an instrument, hand or finger i. beyond the external ear canal, ii. beyond the point in the nasal passages where they normally narrow, iii. beyond the larynx, iv. beyond the opening of the urethra, v. beyond the labia majora, vi. beyond the anal verge, or vii. into an artificial opening into the body. 4.​ Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception, or memory that may seriously impair the individual’s judgement, insight, behaviour, communication, or social functioning. 5.​ Dispensing a drug (administer) Initiation of controlled acts: -​ Authority to Initiate: ○​ Some RNs can independently decide to perform specific controlled acts without needing a doctor’s order if certain conditions are met. ○​ This is known as initiating a controlled act.  ​ What Does "Initiate" Mean?: ○​ The RN assesses the patient’s condition. ○​ The RN decides that the procedure is needed. ○​ The RN either: ​ Performs the procedure themselves, or ​ Writes an order for another nurse to perform it. ​ Conditions: ○​ The RN must ensure: Initiating the act is within their scope of practice. ​ Responsibility: ○​ The RN who initiates the act takes full accountability for the decision and the procedure’s outcome. This framework ensures patient safety while giving RNs the autonomy to act in critical situations. Delegation of controlled acts: Authority: ​ The Nursing Act (1991) gives nurses authority to initiate certain controlled acts if they meet specific conditions. ​ Not all nurses will be competent to initiate controlled acts, and not all nursing roles include this requirement. Controlled Acts RNs (Meeting Conditions) Can Initiate: 1.​ Wound Care: ○​ Includes care for wounds below the dermis or mucous membrane. ○​ Procedures: ​ Cleaning, soaking, irrigating, probing, debriding, packing, dressing. 2.​ Venipuncture (VP): ○​ Establish peripheral IV access and maintain patency with normal saline when: ​ The client requires medical attention, and delaying VP is likely to harm. ​ IV access is for imminently prescribed treatment. 3.​ Health Management Activities: ○​ Assisting clients by inserting: ​ Instruments beyond narrow nasal passages, larynx, or urethral openings. ​ Instruments, hand, or finger beyond: ​ Anal verge, artificial openings, or labia majora. 4.​ Psychotherapy: ○​ Treat clients using psychotherapy techniques delivered through a therapeutic relationship. RHPA- what can nurses not do? -​ Communicate a diagnosis  -​ apply/order energy -​ Prescribe or dispense drugs/eye-glasses/hearing aids Being a regulated health professional: What affects does this have on…… Patient Safety: ​ Ensures adherence to strict standards for safe, effective care. ​ Ongoing education maintains competence. ​ Systems exist for patients to report unsafe practices. Accountability: ​ Professionals are legally and ethically responsible for their actions. ​ Regulatory bodies monitor compliance and address misconduct. Advocacy: ​ Promotes patient rights and access to proper care. ​ Pushes for improvements in healthcare systems and policies. Scope of practice (Nursing act- 1991): -​ Describes, in a general way, what a profession does, the methods it may use and how the professional’s practice -​ The nursing act says: “The practice of nursing is the promotion of health and the assessment of, the provision of, care for, and the treatment of, health conditions by supportive, preventative, therapeutic, palliative, and rehabilitative means in order to attain or maintain optimal function Ethical decision making: Bioethics: general term for reasoning for healthcare principles, principles ideas that consitittue good 4 principles that guide moral decision making: Autonomy: right to freely choose for oneself, patients right to choose between options may conflict with what health care -​ Beneficence: promoting good and that the patient is more important than self interest Nonmaleficence: avoiding harm or hurt, it is not the same as considered “doing good”, balancing risks and benefits of treatment while trying to cause the least possible harm for the patient. Justice: fairness- competitions for a scarce resource, justice mandates that decisions to be fair and unbiased Ethics and professional practice: Responsibility, accountability, advocacy and moral agency- someone who has capacity to direct their actions to some ethical end. What is an ethical dilemma: -​ Everyone has their own ethical dilemmas -​ Equally compelling reasons for and against two or more possible courses of action and where choposing 1 course of action means that something else is relinquished or let go. Where can we find it? -​ Any practice setting What are contributing factors to the complexity of ethical issues in nursing: -​ Increase in nursing scope of practice and responsibility -​ Attention to issues of professional negligence -​ Life sustaining technology: technology is getting very advanced, and were not providing dignity -​ New policies, regulations (MAID) -​ Social media -​ Staffing shortages -​ Inadequate resources -​ Confidentiality Where can we find it? -​ Any practice setting Examples of ethical dilemma: -​ Patient was to die at home and pull the plug. The family wanted him to stay: compromise for the sake of the patient's autonomy, while also considering the family's support. You're also doing moral resilience Moral distress -​ Moral distress are issues of concern for different reasons. -​ Moral distress occurs in the day-to-day setting and involves situations in which one acts against one’s better judgment due to internal or external constraints. -​ Putting aside one's values And carrying out an action one believes is wrong threatens the authenticity of the moral self. -​ CNAs definition: -​ Journal 1988 Often Caused by: -​ Intuitional policy -​ Lack of resources -​ Inadequate staffing ratios -​ Increased patient acuity Potential Effects on Professional Practice: -​ Burnout -​ Increased occupational stress -​ Staff turnover -​ Leaving the profession -​ Decreased quality of care -​ Physical and emotional illness Moral resilience Defined as “The capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, distress, or setbacks.” -​ Moral distress and related phenomena can be the impetus for building moral resilience in the nursing workforce CNA Take Away Messages: -​ Nurses are more likely to thrive in workplace settings that support ethical practice. -​ The ability of nurses to exercise their moral agency is a professional priority. -​ Morally resilient nurses are sure of their purpose and mindful of threats to their integrity. HCCA (health care consent act) -​ Promotes individual authority and autonomy -​ Deals separate with: -​ Consent to treatment -​ Consent to care facility -​ Consent to personal assistance service -​ Health care practitioners have no authority to make treatment decisions on behalf of clients Informed consent: Consent for a treatment is informed if: -​ The person received information that a reasonable person in the same circumstances would need to make a decision -​ The person received responses to any requests for any additional information Information about the treatment must include: -​ Nature of the treatment -​ Expected benefits -​ Risks and side effects -​ Alternative courses  -​ Likely consequences of not having the treatment HCCA: SDM (substitute decision maker) -​ Substitute decision-makers may make a treatment decision for someone who is incapable of making own decision -​ Typically, the SDM is a spouse, partner or relative (HCCA provides a hierarchy to determine who is eligible to be the SDM) -​ SDM has the right to access the same information that a capable client would be able to access Nursing responsibilities: informed consent -​ Always explain to the client the treatment or procedure they are performing -​ Do not provide treatment if there is any doubt about whether the client understands & is capable of consenting (this does not apply if SDM has consented) -​ Advocate for clients’ and SDMs’ access to information about care and treatment -​ Informed consent does not always need to be written, it can be oral or implied Who would provide consent for: -​ An unconscious patient? -​ An unconscious patient in an emergency situation? -​ Patients with mental health issues? -​ Older adults? -​ Children? -​ Adolescents?