Public Health Nurse Role & Community Health PDF

Public Health Nurse Role & The Community Health Nurses Standards of Practice NURS 3003 1  By the end of class, you will be able to: Examine community health nurses of Learning Canada (CHNC) standards of practice objectives...

Public Health Nurse Role & The Community Health Nurses Standards of Practice NURS 3003 1  By the end of class, you will be able to: Examine community health nurses of Learning Canada (CHNC) standards of practice objectives Explain the various settings within community health nursing Describe a nurse's role in community and population health 2  Update on Quiz 1 and Assignment Critical Community Health Nursing Outline Nursing roles functions and practice settings Public Health Nursing CHNC Standards of Practice Closing activity/mini assignment Quiz #1 – Week 4 Covers content weeks 1- 3 20 questions  Assignment 1 1. Identify a need for a social determinant of health to be addressed in a community that is meaningful to you. This could be any region in Canada. Refer to the chart on SDOH in Table. 8.1 for a list of social determinants of health (Lind and Baptiste, 2020). 2. Once you identify the relevant SDOH, you will propose an intervention and advocate for its uptake through a briefing note. Identify one strategy you could implement as a community health nurse to improve circumstances in the community using a population health approach 3. Provide evidence as to why you picked that determinant of health for your community and link the SDOH to the Community Health Nurses of Canada standards of practice. 4. Acknowledge the strengths and weaknesses of the proposed intervention(s). Sections on template Summary Background Current status Key consideration Recommendatio ns References 8.1 Chapter 34: Critical Community Health Nursing: An Imperative 8 Community Health Nurses work with: Clients can mean People where they individuals, live, work, learn, families, groups, worship and play communities, to promote health. populations and systems. 9 People Racialized persons with the Indigenous persons poorest Gender variant persons health and quality of Individuals left with precarious life access to the social determinants of health 10  Need to understand socioeconomic, political and Role of environmental trends Canada's "CHNs can (and should) point out CHNs that trying to change behaviour without changing its social context is unlikely to be successful" 11 Critical CHN Practice means: CHNs focus on broader and societal-level factors that impact health of populations. Ongoing involvement in higher-level initiatives help address root causes of inequities in health status. Use a critical social theory lens to advance social justice and advocacy through upstream and intersectional analyses. CHN education is required to be responsive, critical and proactive. 12  Why are nurses are positioned to take on issues of advancing Discussion health equity? question 13 Transformational Leadership CHNs are ideally positioned to act as leaders in promoting health and advancing health care in Canadian communities. They have knowledge of healthcare and community needs at the point of care and population health level to provide a unique opportunity to advocate for and lead positive systematic change. Transformational CHN leadership necessary to address health equity especially as it affects historically disadvantaged communities such as Indigenous and immigrant peoples. 14  Chapter 3: Nursing roles, functions and practice settings 15 Blueprint for Action The Blueprint for Action for Community Health Nursing in Canada (2011) provides a framework for ongoing dialogue on the development of community health nursing practice in Canada The Blueprint identifies six areas of action The purpose of the Blueprint for Action is to inform decisions about CHN practice and promote and protect the health of Canadians  1. Scope of practice (role clarity) – work across Canada at full scope & with clarity for the role in all domains of practice 2. Leadership – support nursing leadership development and Six areas positions to advance CHN practice & for action to provide a voice for the profession. 3. Interprofessional and intersectoral partnerships – Strengthen partnerships with other professionals and sectors. 17  4. Health systems – Transform the health care system into a system for community health. 5. Nursing education – Support Six areas strong educational preparation in for action CHN 6. Workforce development – Improve access to a range of professional development resources to advance CHN capacity. 18  There are eight Canadian Community Health Nurses Standards of Practice (Table 3.1) Standards Represent a vision for excellence of Practice Purpose is to define the scope and depth of nursing practice in the (updated community & establish 2019) expectations for acceptable, safe and ethic al nursing care Foundation for CHN competencies in specialty CNA certification exam  Current practice reflects a greater emphasis on social justice and the social and environmental determinants of health The standards are used by Standards employers, to measure of Practice performance of CHN practice, to implement professional development programs, inform educational curricula and guide development of new knowledge through research Profession al Practice Model and Standards of Practice Canadian Community Health Nursing Professional Practice Model Outlines a professional practice model that includes a structure, process and values supporting nurses'’ control over nursing care delivery and the environment in which care is delivered. Take a few minutes to familiarize yourself with this model. 22  Client – which includes individuals, families, groups, communities, systems and Who is the populations. core of practice? 23 What Code of ethics informs the Theoretical foundations work of Values and principles CHNs and Professional regulatory nursing stands practice CHN standards of practice with and discipline-specific competencies. clients? 24  Provides CHNs with a What is common framework for practice the Enables them to speak and benefit of advocate for clients in a unified manner. using this model? 25  CHNs provide care to populations Profession that experience health inequities and health disparities al Practice Populations experiencing health Model and inequities in Canada include: Standards First Nations, Métis, Inuit; LGBTQ2S or sexual orientation; of Practice gender identity minorities; and newcomers  Community Health Nursing Standards of Practice: Where do CHNs practice? What standards of professional practice guide their work? How is excellence achieved? Teaching students about COMMUNITY HEALTH CHNC Standards and Competencies Committee NURSING May 2021  CHNC: the national voice of community health nurses. Our goal is to advance community health nursing across Canada and improve the health of Canadians. https://www.chnc.ca/en/standards-of-pract ice At the end of this lecture, the learner will be able to competently and independently:  Recognize the unique practice settings and specialties wherein CHNs practice  Discriminate the CHNC standards of practice  Consider how the CHNC standards contribute to COMMUNI excellence in community health nursing practice TY HEALTH settings NURSING Canadian Community Health Nursing Professional Practice Model and Standards of Practice Group Learning Activity  Form a group of 8 students.  Usingthe following slides, review 1 of 8 standards as assigned to your group.  Plan to share 2 highlights of importance back with the rest of the groups about your standard.  Canadian Community Health Nursing Professional Practice Model Client as center  COMMUNITY HEALTH NURSING Specialties of CHN practice Public Health (PHN) focus on promoting, protecting and preserving the health of populations links the health & illness experiences of individuals, families, and communities to population health promotion practice All Include: Nurses promoting Home Health (HHN) health of individuals, focus on prevention, health restoration, maintenance & families, groups, palliation populations, communities focus on individuals, designated caregivers, and their and systems families RN in Primary Care/Family Practice Nurses focus on preventative health screening, health education, comprehensive assessment, treatment of minor acute illness, chronic disease management, case management, system navigation, therapeutic intervention (wound care, immunization) and medication review with individuals and families CHNC Standards of Practice: Where do they fit? Provincial standards CHNC standards HH, PH and FP competencies What are the CHNC standards of practice? 1. Health Promotion 2. Prevention and Health Protection 3. Health Maintenance, Restoration and Palliation A vision for 4. Professional Relationships excellen ce in 5. Capacity Building commun ity 6. Health Equity health nursing 7. Evidenced Informed Practice practice 8. Professional Responsibility and accountability Canadian Community Health Nursing Standards of Practice, 2019 #4 Professional #1 Health Promotion #7 Evidence Relationships Informed Practices #2 Prevention and Standards #5 Capacity Health Protection promoting health #8 Professional Building Responsibility #6 Health Equity #3 Health Maintenance, Restoration and Palliation Standards #4,5,6,7 8 help achieve #1,2 & 3 Community Health Nurses and System Determinants of Health Government Support Community Organizations Delivery Structure and Process Management Practice Professional Relationships & Partnerships Community Health Nurses and Nursing Practice Code of Ethics Community Health Nurse Community Health Nursing Standards Discipline Specific Competencies Professional Regulatory Standards Theoretical Foundational concepts Values and Principles CHN Standards of Practice: Why do they matter? Inspire excellence Strengthen education Foundation and for professional certification developmen t Set criteria Support and human expectations resource for safe managemen and ethical t Define the care scope and depth practice  Unique Characteristics of Community Health Nursing CHNs promote, protect …wherever people live, & preserve the health of work, learn, worship & individuals, families, play…. groups, communities & populations… Combine specialized nursing, View health as a Work at a high social and resource & focus on …in a continuous level of public health capacities versus episodic autonomy science with process experiential knowledge Marshal resources to Have a unique Build partnerships support health by understanding of the based on primary coordinating care & influence of the health care plan nursing environmental principles, caring services, programs & context of health & empowerment policies What are the CHNC standards of practice? 1. Health Promotion 2. Prevention and Health Protection 3. Health Maintenance, Restoration and Palliation A vision for 4. Professional Relationships excellen ce in 5. Capacity Building commun ity 6. Health Equity health nursing 7. Evidenced Informed Practice practice 8. Professional Responsibility and accountability Standard 1: (8 indicators) Health Promotion The five Ottawa Charter health  Community health nurses integrate health promotion strategies: promotion into practice 1. build healthy public policy, “Health promotion is the process of 2. create supportive enabling people to increase control over, environments, and to improve, their health.” 3. strengthen community actions,  Involves the individuals, families, groups, 4. develop communities, population and systems personal skills and 5. reorient health services.  COMMUNITY HEALTH NURSING Practice examples from Specialties of CHN practice Public Health (PHN) e.g., Working community to advocate for a smoke-free town or municipality. Home Health (HHN) e.g., Encouraging families dealing with a chronic illness to participate in regular physical and social activities. Encouraging clients to quit smoking for wound care healing using motivational interviewing and goal setting strategies. RN in Primary Care/Family Practice Nurses e.g., Promoting physical activity across the lifespan and within communities Supporting healthy eating for health child development and chronic disease management Promoting living free from violence and injury; promoting healthy relationships within communities Standard 2: (9 indicators) Prevention and Health Protection Socioecological model focuses  Community health nurses use the socio- on sustainable ecological model to integrate prevention solutions and health protection activities into practice.21  These actions are implemented in accordance with government legislation and nursing standards to minimize the occurrence of disease or injuries and their consequences.  COMMUNITY HEALTH NURSING Practice examples from Specialties of CHN practice Public Health (PHN) e.g., Working 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. Home Health (HHN) e.g., Providing health teaching of people with diabetes in their management of the disease to prevent diabetic reactions. Encouraging mask wearing, and handwashing to clients and family during COVID. When providing wound care, encouraging client to include a multivitamin to help with wound healing and to prevent further damage to the wound bed RN in Primary Care/Family Practice Nurses e.g., Assessing height and weight of clients across the lifespan Implementing screening tools (Canadian Task Force on Preventative Health) Providing and participating in cervical screening clinics Standard 3: (6 indicators) Health Maintenance, Restoration and Palliation Focus is on maintaining maximum function,  Community health nurses integrate health improving health, and maintenance, restoration and palliation into supporting their practice life transitions including acute, chronic, or terminal illness, and end of life COMMUNITY HEALTH NURSING Practice examples from Specialties of CHN practice Public Health (PHN) e.g., Providing directly observed therapy (DOT) for people with TB in their living arrangement Home Health (HHN) e.g., Caring for disabled students in the classroom: Communication is required with the child’s guardian, teacher and/classroom assistant Providing and supporting end of life care and supporting clients to remain at home. RN in Primary Care/Family Practice Nurses e.g., Participating in health maintenance clinic visits for school age children annually Participating in patient education, medication review and direct observation therapy Nursing service in chronic disease management clinics Supporting clients in palliation by working through symptom assessment, management and access to resources  Standard 4: (12 indicators) Professional Relationships  Community health nurses work with others Relational to establish, build and nurture professional Participative and therapeutic relationships. These relationships include optimizing participation, and self-determination of the client. COMMUNITY HEALTH NURSING Practice examples from Specialties of CHN practice Public Health (PHN) e.g., Establishing a therapeutic working relationship with multigenerational families, and families that have young children to have healthy family outcomes. Establishing and maintaining interprofessional relationships (e.g., key informants, stakeholders, political, clergy, etc.) Home Health (HHN) e.g., Providing palliative care with a team of health care providers to individuals to enable them to remain in their home in their end of life Consulting with the client’s wound care team to discuss and ensure best practice and holistic approach in the wound care plan is followed to support client outcomes. RN in Primary Care/Family Practice Nurses e.g., Initiating and navigating client centered interactions Participating in interprofessional team meetings to share knowledge amongst team that will enhance client care and outcomes. Advocating for inclusion and expansion of the nurse in primary care within communities Standard 5: (17 indicators) Capacity Building  Community health nurses’ partner with the Partnership client to promote capacity. The focus is to is key! recognize barriers to health and to mobilize Work with to and build on existing strengths. build capacity and efficacy  COMMUNITY HEALTH NURSING Practice examples from Specialties of CHN practice Public Health (PHN) e.g., Working 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. Home Health (HHN) e.g., Encouraging 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. Working with the family and client to figure out a home care schedule that suits client needs and yet maintains independence Encouraging an end-of-life client has input into the plan of care to ensure their goals are taken in to account. RN in Primary Care/Family Practice Nurses e.g., Empowering leadership and self advocacy within community members across the lifespan to address diverse needs Advocating for vulnerable populations such as youth, LGTBQ2, older adults, people of any age with chronic medical conditions Standard 6: (15 indicators) Health Equity  Community health nurses recognize the impacts of the determinants of health and incorporate actions into their practice such as advocating for healthy public policy. The focus is to advance health equity at an individual and societal level.  COMMUNITY HEALTH NURSING Practice examples from Specialties of CHN practice Public Health (PHN) e.g., Identifying that their smoking cessation messaging is not culturally 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 peoples to begin a community consultation process. Home Health (HHN) e.g., Advocating with families caring for medically fragile children by seeking respite care for families or by contacting their local MPP. Offering the flu vaccine to house bound individuals Advocating for “ wheelchair “ transportation in the community for wheelchair clients to attend social activates. RN in Primary Care/Family Practice Nurses e.g., Collaboration to enhance accessibility to resources Coordination of pharmacy and social worker to seek financial assistance that will provide drug coverage Collaboratively address barriers and challenges with and within the community Standard 7: (6 indicators) Evidence Informed Practice  Community health nurses use best CHN evidence to guide nursing practice and Practice is support clients in making informed Evidence decisions. Based  COMMUNITY HEALTH NURSING Practice examples from Specialties of CHN practice Public Health (PHN) e.g., 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. Home Health (HHN) e.g., Working on their wound care policy and consulted the Best Practice Guideline to ensure best evidence is used. Maintaining competence in Palliation best practice for pain management protocol Working as a team lead to support Infusion Therapy practices and build team capacity in best practices and evaluation of any practice changes implemented. RN in Primary Care/Family Practice Nurses e.g., Participating in continuing education sessions that support current evidence informed practice Continually reviewing practice and research literature with various disciplines to enhance practice Standard 8: (14 indicators) Professional Responsibility and Accountability  Community health nurses demonstrate Accountability professional responsibility and Responsibility accountability as a fundamental component Professionalism Competencies of their autonomous practice. Transparency  COMMUNITY HEALTH NURSING Practice examples from Specialties of CHN practice Public Health (PHN) e.g., Working with a a needle exchange program based on harm reduction. Accepting the tenets of harm reduction and uses reflective practice personally Seeking the input and guidance of a supervisor/mentor to understand and change biased assumptions. Home Health (HHN) e.g., Assisting in the determination of capacity Understanding the different scopes of practice in nursing and interdisciplinary teams and working respectfully with interdisciplinary team. Assisting client’s and families to support MAID (medical assistance in dying) RN in Primary Care/Family Practice Nurses e.g., Utilizing interdisciplinary team approaches to client care Practicing in accordance with the Standards of Practice and Code of Ethics within the nursing profession Professionally liaising with colleagues to support and enhance practice including peer reviews  Thinking about practice expectations in all settings  Cultural safety (1f, 2g, 3d, 4e, 5h, 6i)  Cultural humility (1f, 2g, 3d)  Indigenous ways of knowing (5h)  Levels of prevention (2c)  Disease management (3f)  Critical appraisal (7c)  Knowledge translation (7d)  Interprofessional competencies (4k)  Quality improvement (8n)  These really enhance our CHN practice in Canada For Example:  Cultural safety : means the practitioner can communicate competently with a client in that client’s social, political, linguistic, economic, and spiritual realm.  Cultural humility : An approach to health care based on humble acknowledgement of oneself as a learner when it comes to understanding a person’s experience. It is a life-long process of learning and being self-reflective.  … for example  Indigenous ways of knowing, i.e. “Indigenous knowledge comprises the complex set of technologies developed and sustained by Indigenous civilizations. Often oral and symbolic, it is transmitted through the structure of Indigenous language and passed on to the next generation through modeling, practice and animation, rather than written word.” Indigenous knowledge is embedded in community practices, rituals, and relationships. Indigenous knowledge has 5 characteristics: personal, orally transmitted, experiential, holistic and narrative.  Levels of prevention – with additional layers of primordial and quaternary prevention  And… Critical appraisal of data and knowledge. assesses internal validity, the results and the relevance to practice. Knowledge translation: Refers to a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound use of knowledge to improve the health of Canadians Interprofessional competency: reflect what CHNs have always done – making this an expectation of everyone now. Quality improvement : involves CHNs working to improve health care delivery including effectiveness, access, capacity, safety, patient-centeredness and equity. Canadian Community Health Nursing Standards of Practice, 2019 #4 Professional #1 Health Promotion #7 Evidence Relationships Informed Practices Standards #2 Prevention promoting and health #5 Capacity Health Protection #8 Professional Building Responsibility #6 Health Equity #3 Health Maintenance, Restoration and Palliation Standards #4,5,6,7 8 help achieve #1,2 & 3  Get your copy of the Professional Practice Model & Standards of Practice  Community Health Nurses of Canada website: https://www.chnc.ca/  The standards are available on the CHNC website: https://www.chnc.ca/en/store  Student Membership to CHNC is warmly invited!  Join Community Health Nurses from across Canada and enjoy the many benefits of membership. https://www.chnc.ca/en/member-benefits  Support your professional association and this important work!  References  Community Health Nurses of Canada (CHNC). (2019). The Canadian Community Health Nursing Professional Practice Model & Standards of Practice. Retrieved from https://www.chnc.ca/en/standards-of-practice  Stamler, L.L., Yiu, L., Dosani, A., Etowa, J., & van Daalen Smith, C. (Eds.). (2020). Community Health Nursing: A Canadian Perspective, 5th Edition. Toronto Ontario: Pearson. What are some different types of Community Health Nursing roles? 67  Indigenous nursing Public health nursing Types of Home health nursing Communit Primary care nurses Telehealth nursing y Health Outreach/street nursing Nurses Rural and Northern Canada Nursing Military Nursing 68  Indigenous and Public Health Nursing Indigenous nursing involves First Nation, Inuit, and Métis nurses’ care, beliefs, values, practice, traditional knowledge and education, research, administration, and policies Public health nursing utilizes knowledge from public health, nursing, social and environmental sciences, and research.  Nursing in an Indigenou s Communi (Health Canada, 2015) ty 70  Home Health and Primary Care Nursing Home health nursing is a specialized area in which the nurse, employed by a home health agency, provides clinical care in the client’s home, school, or workplace. Primary care nurses provide the first contact with the health care system Home Care Nurses 72 Why is home care struggling in Canada? To menti 73 Telehealth Nurses & Outreach Nurses Telehealth nurses: triage of health issues; consult; provide advice, counsel, support, and educate; as well as coordinate care for chronic disease management Outreach/Street nursing: see their clients where they are and focused on building relationships while maintaining a safety, dignity of and respect for the clients Street Nurse (City News, 2020) 75  Occupational Health and Parish Nursing Occupational health nurses base their practice on four interrelated components: individual, health, occupational health nursing, and the environment Parish nurse has specialized knowledge to promote health, healing, and wholeness; hired or recognized by a faith community and integrates faith and health into nursing practice  Rural and Northern Canada and Military Nursing Rural and Northern Canada nurses work in the community, homes, schools, clinics, outpost nursing settings/stations, and First Nation, Inuit, and Métis communities. Military nurses are commissioned nursing officers of the Canadian Forces Medical Service.  Military Nursing (Canandian Forces, 2020) 78 Forensic and Community Mental Health Nursing Forensic nurses provide for health care needs and to collect evidence for police and the legal system in a way that respects clients’ dignity, right to choice, and self-determination. Community mental health nursing role involves a blending of community nursing and mental health/psychiatric nursing.  Check-in Of the types of community nursing, we just reviewed, what career path would you choose and why? 80  In Canada there are four regulated nursing groups Expansion within the profession: and RNs Nurse practitioners, Regulation Licensed/registered of Practice practical nurses Registered psychiatric nurses.  Members from each of these regulated nursing Expansion groups contribute to and improving health outcomes for the Regulation Canadian population and of Practice practice in a variety of community settings across Canada. Current health care transformation calls for  Nurse practitioners (NPs) are advanced practice Expansion nurses. Titles used by NPs vary across practice settings and and provinces and Regulation territories. Registered psychiatric of Practice nurses: educated and regulated only in the (2 of 2) western provinces of British Columbia, Alberta, Saskatchewan, Manitoba, and the Yukon territory  Using what you’ve learned in the lecture today, 1. Identify a CHN role that interests you the most. 2. Identify a social determinant of health the nurse would have to address in that role Activity 3. Develop two basic interventions to address the SDOH (2 of) one downstream, and one upstream. 84 Chapter 4: Public Health Nursing 85  Early PHNs worked with low- Historical income communities which differentiated them from hospital Evolution of nurses or private nurses in high- Public income homes PHNs focused primarily on Health improving physical environmental conditions to reduce maternal Nursing and child morbidity Many early PHNs worked for religious or charitable organizations  As public health programs Historical became more complex, Evolution of PHNs were hired to work Public in civic health departments across Health Canada Nursing In addition to maternal, infant and childhood mortality, PHNs were instrumental in delivering immunization and vaccination programs  PHNs function under laws and regulations of various government bodies that oversee public health and sometimes challenge current Fundament laws to support community health als of Public PHNs must have a working Health knowledge of Federal Nursing Provincial territorial governments, and Indigenous organizations  PHNs are population-oriented and Fundament must possess a comprehensive als of knowledge base in areas such as epidemiology to assess population- Public level health threats Health PHNs population oriented approach Nursing allows for effective intersectoral collaboration  Table 4.1 identifies discipline- specific competencies for Public Health Nurses: Competenc ies of 1. knowledge derived from Public public health and nursing science; Health 2. skills related to assessment Nursing (1 and analysis; 3. conducting policy and of 2) program planning, implementation, and evaluation;  Table 4.1 identifies discipline- specific competencies for Public Health Nurses: Competenc ies of 4. achieving partnerships, collaboration, and advocacy; Public 5. promoting diversity and Health inclusiveness; 6. effective communication Nursing (2 exchange; of 2) 7. leadership capabilities; and 8. professional responsibility and accountability.  Table 4.2 highlights the Core roles, responsibilities, and essential six public Function health functions: s of Health protection, Health surveillance, Public Population health assessment, Health Disease and injury prevention, Nursing Health promotion, and Emergency preparation and response. Public Health Nurse- Ottawa Public Health  PHNs focus on social justice as they Social work toward achieving equal rights Justice and opportunities for individual citizens, families, communities, and and Public populations Health PHNs are committed to reducing health inequities that are unjust and Nursing (1 avoidable by focusing on the basic of 2) prerequisites for health (i.e. shelter, education, food, and income), Social Justice and Public Health Nursing (2 of 2) PHNs examined and addressed issues by lobbying for community-wide programs or systems-level policy change and through direct contact with individual citizens PHNs advocate for healthy public policy and social justice by participating in legislative and policy-making activities that influence determinants of health and access to services Lillian Wald – coined the term “Public Health Nurse” – read about her in this week’s module content 96  Review this content in this week’s module content on Canvas. Curriculum-Public-Health_FOR-WEB.p df (live-hss-cms.pantheonsite.io) Read Chapter introduction. What are 2- 3 key takeaways from this introduction? 97  In pairs, complete Activity #2 – How do we put people at the center of health care? 98 99 Did we meet our learning objectives? 100 References 1. Canadian Forces. (2020). CAF story the two uniforms of a military nurse. https://www.youtube.com/watch?v=fWuBwtVgYno&ab_channel=CanadianAr medForces 2. City News (2020). The coronavirus pandemic through the eyes of a Toronto street nurse. https://www.youtube.com/watch?v=Vy_TM4RxuTM&ab_channel=CityNews 3. Community Health Nurses of Canada (CHNC). (2019). The Canadian Community Health Nursing Professional Practice Model & Standards of Practice. Retrieved from https://www.chnc.ca/en/standards-of-practice 4. Health Canada (2015). Nursing in a First Nations community. https://www.youtube.com/watch?v=Iayo-_vn6Jk&ab_channel=HealthCanada 5. Stamler, L.L., Yiu, L., Dosani, A., Etowa, J., & van Daalen Smith, C. (Eds.). (2020). Community Health Nursing: A Canadian Perspective, 5th Edition. Toronto Ontario: Pearson. 101