Week 1 Community & Population Health NURS 3036 PDF 2025

NURS 3036: Community & Chapters 1, 2, 3, 6 Additional Material Population Health Nursing posted on D2L Week 1 J. DiCasmirro_2025 Topics for Today ▪Introduce Community & Population Health Nursing ▪Discu...

NURS 3036: Community & Chapters 1, 2, 3, 6 Additional Material Population Health Nursing posted on D2L Week 1 J. DiCasmirro_2025 Topics for Today ▪Introduce Community & Population Health Nursing ▪Discuss some of the historical milestones in the development of community health nursing in Canada ▪Review fundamental concepts & models ▪Introduce the Canadian Community Health Nursing Standards of Practice ▪Identify roles, settings, and functions of Community Health Nurses J. DiCasmirro_2025 Getting Started with Community & Population Health Nursing What do you already know about: ✓ Community Health Nursing? ✓ Social Determinants of Health? ✓ Population health? What do you want to know more about? J. DiCasmirro_2025 https://www.menti.com/al1k1h3jk9vh J. DiCasmirro_2025  What is Community Health Nursing? ▪ CHN practice describes the work of nurses who work in the community ▪ CHNs partner with people where they live, work, learn, meet and play to promote health Image retrieved from: https://comp-innovation.westernu.edu/tracks/olt-tracks/community-health/ J. DiCasmirro_2025  Population Health Approach Traditional health care: Population health approach: Provides treatment to Emphasis is on those with an Vs interrelated conditions illness/health concern and factors that influence The individual is the focus the health of populations over the life course What are the strengths associated with viewing health concerns as being “population based” compared to being “individual based”? J. DiCasmirro_2025  Upstream vs. Downstream Thinking Upstream thinking: ▪ A macroscopic, “big picture,” population health approach ▪ Includes a primary prevention perspective ▪ Considers determinants of health and other economic, political, and environmental factors Downstream thinking: ▪ Taking a microscopic individual curative focus ▪ Considers individual health concerns and treatments but does not consider the sociopolitical, economic, and environmental variables Image retrieved from: https://nccdh.ca/images/uploads/Moving_Upstream_Final_En.pdf J. DiCasmirro_2025  ▪ Health of the population is measured by health status indicators (life expectancy, preterm birth, cannabis use, Health & cancer incidence) ▪ According to PHAC (2018), a population health approach Population establishes indicators related to mental & social well- being, quality of life, life satisfaction, income, Health employment & working conditions, education & other factors known to influence health J. DiCasmirro_2025 Population & Aggregate Population: ▪ Large group ▪ Collection of people who share one or more personal or environmental characteristics ▪ Example: citizens of Thunder Bay Aggregate: ▪ Group within a population ▪ Populations with some common characteristic who frequently have common concerns ▪ Example: school aged children in Thunder Bay J. DiCasmirro_2025 Determinants of Health ▪ Income & social status ▪ Employment and working conditions ▪ Education and literacy ▪ Childhood experiences ▪ Physical environments ▪ Social supports and coping skills ▪ Healthy behaviours ▪ Access to health services ▪ Biology and genetic endowment ▪ Gender ▪ Culture ▪ Race / Racism J. DiCasmirro_2025 Social Determinants of Health https://www.youtube.com/watch?v=RMkBUXJLW9g J. DiCasmirro_2025  Equity & Social Justice Equity: ▪ Differences in social status within & between populations have a significant impact on the health status of the larger community where those differences occur. ▪ If the gap in social status is large, the health of the overall population decreases, health care costs increase & disharmony associated with exclusion is caused Social Justice: ▪ Ensuring fairness & equality in health services so all members have equal access to health care J. DiCasmirro_2025 Population Health Promotion Model J. DiCasmirro_2025 Think of a Health Concern impacting a Population … Use the model to break down how you would address it. Include a: ▪ With whom should we act? ▪ What should we take action? ▪ How should we take action? J. DiCasmirro_2025 The Population Health Promotion Model can contribute to the discussion of risk in 3 ways: 1) Moves the discussion away from victim blaming and calls for action on the full range of factors and conditions that determine health 2) Provides an analytical tool to help develop a clearer picture of those likely to be most at risk. Who are they? 3) It provides a planning tool and may be used to address the health concerns of identified groups at risk J. DiCasmirro_2025  In the early 1970s, the most common model used in health In 1978, at the Alma-Alta care was the medical model, conference, primary health care which focused on treatment and became the preferred cure in institutions. international strategy. Primary 1974 Health early 1970s 1978 Care In 1974, the Lalonde Report initiated a shift toward population health promotion. Differs from primary care, which is the first contact between individuals and the health care system for the purpose of treating a disease. J. DiCasmirro_2025  How does Community Health relate to Primary Health Care? The 5 principles of primary health care adopted at Alma-Alta in 1978: 1. Equitable distribution of essential health services to all population. 2. Increased emphasis on services that are preventive and promotive rather than curative only. 3. Maximum individual and community involvement in the planning and operation of healthcare services 4. The integration of health development with social and economic development. 5. The use of appropriate technology. J. DiCasmirro_2025  Health Promotion Professional Prevention & Responsibility & Health Accountability Protection Health Evidence Standards of Maintenance Informed Practice Practice (2019) , Restoration & Palliation Professional Health Equity Relationships Capacity Building J. DiCasmirro_2025 https://www.chnc.ca/en/standards-of-practice Standard 1: Health Promotion CHNs integrate health promotion into practice using the 5 Ottawa Charter health promotion strategies EXAMPLES from practice: ▪ PHNs work with a community to advocate for a smoke-free town or municipality ▪ An RN in primary care promote physical activity and healthy eating when involved with the management of chronic diseases ▪ HHNs encourage families dealing with a chronic illness to participate in regular physical and social activities J. DiCasmirro_2025  Standard 2: Prevention & Health Protection CHNs use the socio-ecological model to integrate prevention and health protection activities into practice EXAMPLES from practice: ▪ PHN work with a parent’s organization and the police to promote proper installation of car seats through the media and conduct several clinics to provide one-on-one assessment and teaching ▪ An RN in primary care provides immunization across the life span with individuals in a clinic setting ▪ HHNs provide health teaching of people with diabetes in their management of the disease to prevent diabetic reactions J. DiCasmirro_2025  Standard 3: Health Maintenance, Restoration & Palliation CHNs integrate health maintenance, restoration & palliation into their practice to maintain maximum function, improve health & support life transitions EXAMPLES from practice: ▪ PHNs provide directly observed therapy (DOT) for people with TB in their living arrangement ▪ RNs in primary care support individuals requiring a referral to stroke rehabilitation ▪ HHNs care for disabled students in the classroom: Communication is required with the child’s guardian, teacher and/classroom assistant J. DiCasmirro_2025 Standard 4: Professional Relationships CHNs work with others to establish, build and nurture professional and therapeutic relationships EXAMPLES from practice: ▪ PHNs establish a therapeutic working relationship with families who have young children to have healthy child and parent outcomes ▪ RNs in primary care provide care for health and illness experiences to individuals and families over their lifetime. ▪ HHNs provide palliative care with a team of health care providers to individuals to enable them to remain in their home in their end of life J. DiCasmirro_2025  Standard 6: Health Equity CHNs recognize the impacts of the determinants of health & incorporate actions into their practice such as advocating for healthy public policy EXAMPLES from practice: ▪ PHNs identify that their smoking cessation messaging is not cultural safe nor considerate of the Indigenous realities and culture. Acknowledging the recommendations from the Truth and Reconciliation Committee, the PHN with other colleagues include Indigenous people begin a community consultation process ▪ An RN in primary care refers, coordinates and often facilitates individuals receiving financial assistance for drugs when completing the required government forms ▪ HHNs advocate with families caring for medically fragile children by seeking respite care for an exhausted families or by contacting their local MPP J. DiCasmirro_2025  Standard 5: Capacity Building CHNs partner with the client to promote capacity EXAMPLES from practice: ▪ PHN works as a partner with a Health Action Team in a high school to mobilize students, parents, teachers, administration, and community partners to identify the school community’s strengths and needs, and prioritize, plan, implement, evaluate the growing vaping behaviour among youth. ▪ RNs in primary care provides health teaching about medication management to enable an individual to safely take their medication till the next clinic appointment ▪ A HHN encourages a mother and teens to work out a schedule for ROM exercises for the grandmother. The family is happy that they were able to work out the problem together J. DiCasmirro_2025  Standard 7: Evidence Informed Practice CHNs use best evidence to guide nursing practice and support clients in making informed decisions EXAMPLES from practice: ▪ PHNs are developing a new program for school age children related to physical literacy. They decide to complete a rapid review to find the best evidence to guide their planning ▪ An RN in primary care queries why many family givers in the primary care practice are experiencing chronic fatigue. A review of the literature reveals positive strategies to help caregivers reduce their stress. An on-line resource is developed and posted on waiting room TV ▪ HHNs are working on their wound care policy and consulted the Best Practice Guideline to ensure best evidence is used J. DiCasmirro_2025  Standard 8: Professional Responsibility & Accountability Community health nurses demonstrate professional responsibility and accountability as a fundamental component of their autonomous practice EXAMPLES from practice: ▪ A PHN is assigned to work in a needle exchange program. He has difficulty accepting the tenets of harm reduction and uses reflective practice personally and with his supervisor to understand and change his assumptions ▪ An RN in primary care discovers that the roles and responsibilities of the nurses on their health care team are overlapping. Meetings are set to problem solving together a clear definitions of each nursing role to share with the health care team ▪ A HHN is asked by an ALS client to be present when his wife removes his Bi- PAP machine, which will result in his death. The nurse explores the client’s reasons for this decision and discusses the ethics around responding to this request with the health care team as well as the nursing practice advisor at their College of Nurses J. DiCasmirro_2025 J. DiCasmirro_2025 CHN Standards of Practice: Why do they matter? J. DiCasmirro_2025 CHNs & Collaboration The community health nurse (CHN) works ▪ In the community (providing health care to individuals & families) ▪ With the community (views the community itself as the client) CHNs collaborate with the following: ▪ Physicians ▪ Social workers ▪ Nutritionists ▪ Physiotherapists ▪ Occupational therapists ▪ Other health care professionals ▪ The CLIENT J. DiCasmirro_2025 Canadian Nurses Association’s Position on Collaboration CNA has identified 8 principles for collaboration: 1. Focus on the client 2. Evidence-informed decision making 3. Access 4. A population health approach 5. Social justice & equity 6. Ethics 7. Communication 8. Cultural safety https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c- 5ebf0a138d5e/UploadedImages/documents/Interproffessional_Collaboration_position_statement.pdf J. DiCasmirro_2025 The Evolution of Community Health Nursing in Canada J. DiCasmirro_2025 Florence Nightingale ▪ 1850s: Sent by the British government to Asia Minor to care for soldiers wounded in the Crimean War ▪ Using simple epidemiological measures, documented a mortality rate that decreased ▪ Held strong prejudices against indigenous people & played a part in colonialism J. DiCasmirro_2025 William Rathbone ▪1859: The British philanthropist founded the first association for district nursing ▪ This led to the establishment of district nursing throughout the U.K ▪ It also led to the establishment of the Victorian Order of Nursing (VON) J. DiCasmirro_2025 Lillian Wald ▪ 1893: Began visiting the poor on New York’s Lower East Side ▪ Dynamic force for social reform, creating widely-adopted models of public health and social service programs ▪ Coined the term Public Health Nurse (PHN) ▪ Shaped public health nursing practice and influenced the Canadian Metropolitan Life Insurance Company that began a visiting home nursing service in the 1920s J. DiCasmirro_2025  Eunice Dyke ▪ Early 1900s: Ontario nurse with an interest in public health ▪ 1911: Became the first Director of Public Health Nursing in Toronto ▪ Public health nursing evolved in Canada in the late nineteenth and early twentieth centuries, largely because of her pioneering work J. DiCasmirro_2025  Early Public Health Efforts in Canada ▪ Practices of First Peoples using traditional medicines & health practices ▪ Driven by epidemics ▪ Public health nursing became organized in 1900s – TB, home visiting, schools ▪ Post WWI – screening, social assistance for health care, immunization, sewage, clean water ▪ Post WWII – prevention & health education ▪ 1970’s to present – Lalonde, Epp J. DiCasmirro_2025 2000 To the Present ▪ Community Health Nursing is now the broader term that encompasses other subspecialties ▪ e.g., public health nursing, home care nursing, ▪ In 2003 the CHNC Standards of Practice were published. ▪ In 2008 the core competencies for CHNs were released. ▪ 2019: Revision and release of Canadian Community Health Nursing Professional Practice Model & Standards of Practice ▪ 2024: Home Health Nursing Competencies Version 2.0 J. DiCasmirro_2025 Break Time J. DiCasmirro_2025  Community Health Nursing in Canada: Settings, Functions & Roles Community Health Nursing Practice Settings J. DiCasmirro_2025  Care & Counselling ▪Risk assessment & response ▪Early identification of disease or health threat by gathering data ▪Employ risk communication techniques to prevent harm ▪Supportive counselling ▪Therapeutic interventions (e.g., wound care) ▪Outreach J. DiCasmirro_2025 Continuity of Care ▪Make linkages to improve client's health status J. DiCasmirro_2025 Discharge Planning ▪ Connecting clients & services to ensure an appropriate flow or continuity of care after hospital & in the community ▪Goal = prevent health problems from arising following discharge J. DiCasmirro_2025 Referral Process ▪ Referral process: ▪ Directing clients to another sources of assistance ▪ CHN must be familiar with resource barriers & client barriers to the referral process ▪ Hospital discharge planning often involves referral for community services, so the discharge planner should be familiar with the referral process ▪ The discharge planner often works with a community case manager to facilitate the transition of the patient into the community J. DiCasmirro_2025  ▪Involves strategic practices to inform people about health promotion, illness prevention, and treatment ▪Health literacy assessment often the starting place ▪Developmental stage is an important assessment ▪Health education is tailored to the unique individual or community group J. DiCasmirro_2025 Team Building, Community Development & Collaboration ▪Work with teams & collaborate to build the capacities of communities for health & well-being J. DiCasmirro_2025 Interprofessional Collaboration ▪CHNs collaborate with: ▪Physicians ▪Social workers ▪Nutritionists ▪Physiotherapists ▪Occupational therapists ▪Other health care professionals ▪Clients & their families J. DiCasmirro_2025 Consultation, Decision ▪ Consultation with a range of stakeholders Making, ▪ Client groups, professionals from other Leadership & sectors, other health professionals Followership J. DiCasmirro_2025 Research & Evaluation Includes screening, surveillance & evaluation tasks Broader evidence-informed community health nursing is a part of these functions and practices Evaluating patient & program outcomes, & the conditions & contexts of community nursing work J. DiCasmirro_2025 Health Advocacy Creating broader awareness of health issues & supporting action or change Interacting with clients, families, communities, broader decision-makers & wider health services systems CHNs collaborate & demonstrate commitment to equity, social justice, & policymaking activities How else is this done? J. DiCasmirro_2025 Case Management ▪A strategy to improve accessibility & continuity of client care ▪Includes incorporation of assessment, planning, coordination, delivery & monitoring of the health services J. DiCasmirro_2025 Community Health Nursing Specialties Commonly encountered practice areas for CHNs in Canada: ▪ Home health nurses (HHNs) ▪ RN in Primary Care/Family Practice nurses ▪ Public health nurses (PHNs) J. DiCasmirro_2025 The Home Health Nurse ▪ Traditionally, home health nurses (HHNs) have been registered nurses (RNs) who work in the community, usually in the client’s home, providing direct nursing care ▪ Victorian Order of Nurses [VON] ▪ Currently, most rapidly expanding health care field J. DiCasmirro_2025 Home Health Nurse Cont’d ▪ Function as generalists ▪ Involves direct & indirect care ▪ Combination of disease prevention, health promotion, and episodic, illness-related services provided to people in their place of residence ▪ Incorporate knowledge specialization & skills in areas such as : ▪ Home chemotherapy ▪ Mental health J. DiCasmirro_2025 Growth of Home Health Nursing ▪Home health care is expanding in response to: ▪Increased demands for cost-effectiveness of services ▪Shorter hospital stays ▪Consumer preferences ▪Technological advances (e.g., smart phones) ▪Proven quality of service of home health care nurses ▪Aging Canadian population J. DiCasmirro_2025 Challenges of Home Health Nursing ▪Meeting privacy needs of the client & family & adapting as needed, to the client’s lifestyle ▪Must practice autonomously, with little structure ▪The home environment lacks many resources typically found in health care institutions J. DiCasmirro_2025  Public Health ▪ Organized activity of society to promote, protect, improve &, when necessary restore the health of individuals, groups, or entire populations ▪ A combination of sciences, skills & values that function through collective societal activities ▪ Involve programs, services & institutions aimed at protecting & improving the health of all people J. DiCasmirro_2025  ▪ Population focused ▪ Community as context ▪ Health and prevention focused ▪ Interventions occur at the community or population level ▪ Concerns itself with health of all members of the population or community, particularly subpopulations made vulnerable ▪ Considers the influence of the determinants of the health of clients J. DiCasmirro_2025 Practice Settings for Public Health Nursing ▪ Public health agency (i.e., local public health unit) ▪ Practice settings include the home, school, workplace, community health centre & clinical settings Historically, the main practice settings for PHNs were homes & schools This began to change in the late 1990s, due to a greater focus on population health There is currently a renewed movement toward comprehensive school health J. DiCasmirro_2025  Influenza prevention Public Family planning Health Travel health Nursing Immunization Practice Settings Sexual health Cont’d Breastfeeding Well babies J. DiCasmirro_2025 Canadian Association of Schools of Nursing (CASN): Public Health Entry to Practice Competencies (2014) Domain 1—Public Health Domain 2—Population Domain 3—Population Sciences in Nursing and Community Health Health Planning, Practice Assessment and Analysis Implementation, and Evaluation Domain 4— Partnerships, Domain 5— https://casn.ca/wp- https://casn.ca/wp-content/uploads/2014 Collaboration and Communication in Public content/uploads/2014/12/ https://casn.ca/wp-content/uploads/2014/12/F Advocacy Health Nursing FINALpublichealthcompeE https://casn.ca/wp-content/uploads/2014/12/ Nforweb.pdf https://casn.ca/wp-content/uploads/ J. DiCasmirro_2025 Occupational Health Nursing ▪ RNs, usually with additional educational preparation & experience ▪ Work in industry & other workplace settings to promote the health & safety of workers ▪ Focus on workplace health safety J. DiCasmirro_2025 Practice Settings for Occupational Health Nursing The OHN’s scope of practice is broad & includes: ▪ Worker & workplace ▪ Administration & assessment & management surveillance ▪ Research ▪ Primary care ▪ Legal & ethical ▪ Case management monitoring ▪ Counselling ▪ Community orientation ▪ Health promotion & protection J. DiCasmirro_2025 Functions & Roles of Occupational Health Nurse 1. Part of the occupational health team 2. Health promotion 3. Primary, secondary & tertiary levels of prevention 4. Assess individuals & taking an occupational & environmental health history 5. Work-site walkthroughs or assessments of the workplace J. DiCasmirro_2025  Rural & Outpost Nursing ▪ Rural is generally defined in terms of either the geographic location and population density, or the distance from (e.g., 40 km) or time needed to commute to (e.g., 30 minutes) an urban centre ▪ Approximately 1/5 of the Canadian population resides in rural settings J. DiCasmirro_2025 Rural & Outpost Nurses Cont’d ▪ Reside in the community where care is provided ▪ Actively involve communities in the planning and development of community health programs & strategies ▪ Barriers to health care in rural settings: ▪ Accessibility ▪ Affordability ▪ Acceptability J. DiCasmirro_2025 Community Health Nursing in Rural Settings Cont’d ▪ CHNs need to have an accurate understanding of rural clients to design community health programs that are available, accessible, & appropriate J. DiCasmirro_2025  Street/Outreach Nurse ▪Street nurses: ▪RNs with community health nursing experience ▪Are often PHNs or nurse practitioners ▪Work in community health centres or for public health units, usually in urban centres ▪Work with people who have difficulty accessing traditional health care services, or who experience homelessness, substance use disorders & mental illness J. DiCasmirro_2025  Corrections Nurse ▪RNs who work in correctional facilities, providing community health nursing interventions that include direct care, health promotion, disease prevention, inmate advocacy & crisis intervention J. DiCasmirro_2025 The Telenurse ▪ Telehealth- broad term that refers to the use of a variety of technologies (including telephone, computer, and video or audio teleconferencing) to deliver health care services over distance ▪ Telenurse: ▪ RNs who provide nursing service to patients by using only information technology ▪ Require specific nursing knowledge and skills that include enhanced and strong clinical knowledge J. DiCasmirro_2025  Forensic Nurse ▪ Forensic nurses work within 4 subspecialties: ▪ Forensic psychiatric nursing ▪ Forensic nurse examiner ▪ Death investigator working with the medical examiner ▪ Forensic corrections nursing J. DiCasmirro_2025  Nurse Practitioner ▪ RNs with advanced practice education ▪ Work collaboratively in health care teams ▪ Perform an expanded role, such as prescribing certain medications, ordering particular diagnostic tests, & ordering X-rays & ultrasonography ▪ Scope of practice includes assessment, diagnosis, & management of patient care for common episodic conditions across the lifespan J. DiCasmirro_2025  Challenges in Current CHN Practices ▪ Health System challenges ▪ Emphasis on illness care ▪ Role clarity ▪ CHNs feel their experiences and roles are under valued ▪ Leadership ▪ Invisible ▪ Organizational supports: 1. Values unique and combined contribution of staff 2. Deliberately establishes leadership and mentoring plans 3. Has a clear vision engendering commitment 4. Stable funding and access to necessary resources to accomplish work J. DiCasmirro_2025 World Health Organization https://www.who.int/ J. DiCasmirro_2025 Public Health Agency Canada https://www.canada.ca/en/public-health.html J. DiCasmirro_2025 Public Health Ontario https://www.publichealthontario.ca/ J. DiCasmirro_2025  1. Health protection Major public 2. Health promotion health 3. Population health assessment functions in 4. Public health surveillance Ontario 5. Injury and disease prevention 6. Emergency preparedness and response J. DiCasmirro_2025 Thunder Bay District Health Unit www.tbdhu.com J. DiCasmirro_2025 Northwestern Health Unit www.nwhu.on.ca J. DiCasmirro_2025 Ontario Health atHome www. https://ontariohealthathome.ca/region/north-west/ J. DiCasmirro_2025 Nursing Code of Ethics & CHN Ethical Principles: ▪ Autonomy – ability to self-govern ▪ Nonmaleficence - seek to produce least amount of harm ▪ Beneficence – provision of high-quality nursing care ▪ Distributive justice - position of one social group in relation to others and seeks root causes of disparities Ethical Obligations As members of society: As CHNs: 1. To not harm others 1. Confidentiality 2. To respect others 2. Accountability 3. To tell the truth 4. To keep promises Ethical Decision Making Ethical decision Ethical issues: Ethical making: dilemmas: That component Moral challenges Puzzling moral of ethics which facing the nursing problems in focuses on the profession which morally process of how justified reasons ethical decisions for both taking are made and not taking a certain course of action are envisioned Ethical Decision Making at Levels of Prevention ▪ Primary prevention ▪ CHN struggles with providing COVID-19 vaccine to only those who can attend a daytime vaccine clinic ▪ Secondary prevention ▪ CHN recognizes a group of low-income lone parents do not have adequate income to provide healthy meals for their children ▪ Tertiary prevention ▪ Time restraints and lack of resources only allow a CHN to provide education for diabetic management to a small group of older-person patients Ethical Deliberation in Public Health There are 4 ethical aspects for consideration: 1) Harm – take action to restrict the liberty of an individual or a group in order to prevent harm to others 2) Least restrictive means - a variety of means exist to achieve public health needs, but full authority and power should be used for exceptional circumstances 3) Reciprocity - Society must be prepared to facilitate individuals and communities in their efforts to discharge their duties 4) Transparency - the manner and context in which decisions are made  Next Week ▪ Evidence Based Practice, Epidemiology, Working with the Community & in Groups ▪ Form your groups for the Virtual Community Assessment (VCA) & Roundtable Meeting ▪ Post the names of the students in your group, along with the name of community on the D2L Discussion board by the due date ▪ I will keep track & approve groups/community on D2L J. 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