Week 10_ Canadian Healthcare System PDF

Criteria of a profession -​ specialized knowledge, skills, scientific methods and value based on research -​ Taught in a institution of higher education -​ High ethical standards of its members -​ Engages in expanding its body of knowledge through research Professional behaviors...

Criteria of a profession -​ specialized knowledge, skills, scientific methods and value based on research -​ Taught in a institution of higher education -​ High ethical standards of its members -​ Engages in expanding its body of knowledge through research Professional behaviors -​ Members function autonomously -​ Committed to advanced study -​ Motivated by service to society Professional nursing represents a practice discipline Attributes of a nursing professional -​ Knowledgeable -​ Accountability -​ Autonomy -​ Self regulation -​ Inquiry -​ Collegiality -​ Collaboration -​ Innovation -​ Ethics -​ Values College of nurses of ontario (CNO) -​ Responsible for regulating nurses in ontario -​ Mission to regulate nursing in the public interest -​ Every member is responsible for practicing in accordance with the code of conduct and standard of the profession and for keeping current and competent throughout their nursing career Philosophies -​ Phenomenology -​ Way of looking at the world -​ Philosophical study of the structures of experience and consciousness -​ Theoretical framework/approach focused on deep human understanding -​ A method for describing phenomena as they appear or are perceived by a person -​ Qualitative research approach that seeks to understand human experiences rather than determine cause and effect relationship -​ Understanding the meaning of clients lived experience of health and healing -​ Actualized through the nurse-client relationship -​ Critical society theory (CST) -​ Exposing underlying social relationships that are often concealed -​ Uncover constraints on human freedom  -​ Challenge power imbalances and inequalities that marginalize vulnerable people/cultures -​ (How can we change it and make people's lives better) -​ Expose the underlying social economic and political circumstances that perpetuate inequalities and cause oppression -​ Disrupt the status quo and taken for granted assumptions -​ Effect positive change in the conditions that affect people's lives -​ Addressing unequal social,economic and power relations within healthcare -​ How to come to know what we (think) we know -​ Social norms/ expectations - can provide structure within society, but may also promote forms of social control -​ Social norms (as social control) - can be perpetuated overtly,covertly and inadvertently -​ Social discourses - shape what we come to know or believe to be normal, right or wrong, through written/spoken language, media and literature -​ Oppression -​ Controls exhibited by people who have status or power -​ Systems or force that can reduce,immobilize and mold people who belong to a certain group to effect their subordination to another group -​ Marginalization -​ Being outside of the “main circle” of the dominant groups of society -​ Limited or little access to resources and opportunities -​ Loss of voice -​ Thrives on stereotypes and assumptions -​ Social justices -​ Concerned with fairness in society and advocate for equity in terms of distribution of societies benefits and burdens -​ Nurses must champion social justices and promote public policies that improve the health of marginalized populations by addressing social inequalities -​ Equality ensures that there is equal sharing amongst people -​ Equity requires a redistribution of access, opportunities and resources for vulnerable people -​ Challenging the status quo -​ Ask questions -​ Use critical social approach to reveal oppression, marginalizing and inequalities -​ Use phenomenological approach to understand the lived experiences of others -​ Use a social justice approach to advocate for the redistribution of opportunities and resources for vulnerable people -​ Make changes, even small changes -​ Social justices and values -​ Personal values -​ Develop at very young childhood and these become part of our self concept -​ Influenced by family,community,religious groups, teachers,media -​ Professional values -​ Develops as we socialize into the nursing profession -​ Some values in your personal life might be challenged when there is a conflict in your professional life -​ Ethical reasoning and decision making are needed to help the nurse work through these times of challenge -​ The 7 Core nursing professional values and ethical responsibilities -​ Providing safe, compassionate, competent, and -​ ethical care -​ Promoting health and well-being -​ Promoting and respecting informed decision making -​ Honoring dignity -​ Maintaining privacy and confidentiality -​ Promoting justice -​ Being accountable -​ Empirical knowing -​ Assumes what is known can be accessed through five senses -​ Reality is known primarily by observation and can be verified by other s -​ Empirical knowing is expressed in practice through scientific competence -​ Ethical knowing -​ Encompasses knowledge of what is right and wrong -​ Attends to standards and codes in making moral choices -​ Demands responsibility for one's actions -​ Protects clients autonomy and rights -​ Personal knowing -​ Characterized as subjective,concrete,existential and relational -​ A pattern of knowing about self and other, which occurs when nurses connect with the humanness of the clients experiences -​ Develops as nurses intuitively understand and connect with clients as unique human beings -​ Aesthetic knowing -​ Demands a deeper appreciation of the whole person or -​ situation -​ Moves beyond the superficial to see the experience as  -​ part of a larger whole -​ Enables nurses to experientially relate to their clients by intuitively and creatively responding to unforeseen parts of their stories. This allows everyone, including the patient, to learn new information. -​ Can be enhanced through storytelling, poetry, music or art -​ Emancipatory knowing -​ Enables nurses to recognize social and political problems of injustice or inequality -​ Facilitates the identification of social and structural changes that need to be made to ‘right the wrong’ -​ Allows nurses to be in a better position to ast as advocates in helping identify and reduce the inequities in health care -​ Reflective practice as a way of knowing -​ Many models to help nurses learn about reflective practices -​ Requirements for nurses to think about their part in -​ Reflective practice can be considered a way of knowing Lecture 3 Critical thinking -​ Purposeful and reflective reasoning while you examine ideas,assumptions and beliefs principles and conclusions -​ Skills -​ Interpretation -​ Analysis -​ Inference -​ Evaluation -​ Explanation -​ Self-regulation -​ Dispositions -​ Truth-seeking -​ Open-mindedness -​ Analyticity -​ Systematicity -​ Self-confidence -​ Inquisitiveness -​ Maturity -​ Components of critical thinginking -​ Specific knowledge -​ Experience in nursing -​ Critical thinking competencies  -​ General critical thinking competencies (scientific method, problem solving & decision making) -​ Specific critical thinking competencies in clinical situations (diagnostic reasoning, clinical inference, and clinical decision making) -​ Specific critical thinking competency in nursing (use of the nursing process Attitudes for critical thinking -​ Standards for critical thinking -​ Intellectual standards -​ Professional Standards -​ Ethical criteria for nursing judgment -​ Criteria for evaluation -​ Professional responsibility Specific critical thinking competencies in clinical situations -​ Diagnostic reasoning → enables an observer to assign meaning and classify phenomena in clinical situations by using observations and critical thinking -​ Clinical inference → process of drawing conclusions from related pieces of evidence -​ Clinical decision making → problem solving activity focusing on defining client problems and choosing appropriate treatments Week 7 Indigenous Populations and Health Equity Indigenous People and History -​ Indigenous people are recognized as people who: -​ Self-identify and are accepted as indigenous in the minority -​ Demonstrate historical continuity w/ early societies -​ Strongly linked to the land and have distinct systems in place w/ their own languages, cultures, and beliefs -​ Work to maintain and reproduce their ancestral people and communities -​ Reconciliation -​ Residential schools working to separate aboriginal children from their families and culture and indoctrinate them into new culture -​ This experience was hidden until survivors began speaking out about all the cases that ultimately led to Canada’s largest class-action lawsuit -​ For over a century, Canada’s Aboriginal policy aimed to eliminate Aboriginal governments, ignore their rights, terminate treaties, and ultimately make them cease to exist → cultural genocide  -​ The Truth and Reconciliation commision traveled around Canada for 6 years to hear stories and experiences first hand -​ Reconciliation required that the foundations of the residential schools be rejected and a new vision accepted based on commitment to mutual respect and understanding of indigenous peoples and their culture -​ The commission made calls to action: -​ Child welfare -​ Education -​ Language and culture -​ Justice -​ Health -​ Recognize and reimplement health-care rights of aboriginal people especially distinct health needs of specific groups -​ Establish measurable goals to close gaps -​ Provide sustainable funding for healing centers -​ Recognize value of healing practices -​ Add more Aboriginal professionals working in the health-care field -​ Call upon medical and nursing schools to include courses dealing with Aboriginal shit Structural Racism and Health Care -​ Funding and delivery of health care (Jordan’s principle) → prioritize care delivery over funding decisions -​ Child welfare systems → removing children from families -​ Poverty → low income and related issues (poor housing conditions, overcrowding, lack of clean water on reserves) -​ Racist assumptious about indigenous patients (Brian Sinclair and Joyce Echequan) → equitable access, respect for indigenous health knowledge, joyce’s principle Racism and its Impact -​ Brain Sinclair → went in for a bladder infection but was ignored until he died (racial profiling and stereotyping) -​ Racism increases rates of morbidity, mortality, and overall well-being -​ Eliminating racism is essential to achieving health equity → requires new paradigms to influence healthcare Indigenous Health Practices -​ Values → respect, trust, and spirituality -​ Different indigenous groups have their own interpretations -​ Two-eyed seeing → perspective combining western and indigenous knowledge in healthcare in order to better meet the needs of indigenous people -​ Grounded in nurturing positive relationships → builds trust -​ FIRST approach → practices enhancing cultural safety -​ Family -​ Information -​ Relationship -​ Safe space -​ Treatment Social Determinants of Health -​ Refers to specific group of social and economic factors within the broader determinants of health -​ Relate to one’s place in society (income, education, employments, experiences of discrimination, racism, and historical trauma) -​ Through an indigenous lens: -​ Proximal determinants → direct influences on health (poor diet, exercise) -​ Intermediate determinants → indirect influence (lack of resources, poor living conditions, underfunded education) -​ Distal determinants → most influence (historical, political, social contexts) Week 9 Teaching and Learning Teaching and Learning -​ Health teaching → used in client centered relationships to provide clients and families w/ knowledge of life skills in regards to their illness -​ Nurses act as: -​ Guides → coach on actions -​ Information providers → how patients can better themselves -​ Resource support → connects clients to appropriate supports -​ Knowledgeable emotional support → minimizes impact of setbacks  -​ Teaching and learning → nurses help by: -​ Creating and adapting the environment to facilitate learning -​ Using patient centred approaches in assessing client needs -​ Using the most appropriate educational strategies -​ Client education → helps w/ maintaining and promoting health and preventing illness, restoring health, and coping w/ impaired function -​ Three learning domains: -​ Cognitive → understanding the content, used for changing attitudes and developing master of psychomotor skills -​ Affective → changing attitudes and promoting acceptance -​ Psychomotor → hands on skills development -​ Goals of client centered education: -​ Engages clients as participants in the learning process -​ Ensures interventions align w/ client preference and values Learning -​ Client centred learning has four pillars: 1.​ Client centred care 2.​ Promoting health literacy 3.​ Building knowledge and skills 4.​ Supporting self management strategies -​ RNAO L.E.A.R.N: -​ Listen -​ Establish relationships -​ Adopt intentional approaches -​ Reinforce health literacy -​ Name new knowledge -​ Strengthen self-management -​ Transtheoretical model of change: 1.​ Precontemplation → doesn’t think there’s a problem 2.​ Contemplation → thinks there’s a problem 3.​ Preparation → recognizes problem and willing to change 4.​ Action → engages in concrete action to change  5.​ Maintenance → perseveres w/ positive behavioural change -​ Learning styles: -​ Visual → seeing -​ Auditory → listening -​ Kinesthetic → hands-on Literacy Skills -​ Prose → knowledge and skills needed to understand and use info from written text -​ Document → “ “ needed to find and use into in various formats (maps, tables) -​ Numeracy → “ “ needed to do math and understand numbers -​ Problem solving → process of solving problems using goal-directed thinking/action -​ Health literacy → ability to obtain, communicate, process, and understand basic health info and services to make decisions -​ Three pillars: -​ Capacity to obtain health info (where to find help) -​ Ability to understand info gathered -​ Ability to apply health info Week 10 Canadian Healthcare System History of Canadian Healthcare System -​ Pre-1867: -​ Emphasis on local communities and essential services -​ Responsive to crisis -​ Centralized care to local churches and families -​ Problems → poor sanitation and more infectious diseases -​ British North America Act → 1867 -​ Birth of Canada -​ Gave more power to federal and provincial governments -​ Made provinces responsible for their own health, education, and social services (4 provinces at the time) -​ Federal government has some health responsibilities → healthcare for indigenous peoples, canadian forces, and veterans, pharmaceutical safety -​ Late 19th - early 20th century:  -​ Industrial revolution led to urbanization → more disease bcz of substandard living conditions and sanitation -​ Patients unable to pay for healthcare relied on charity -​ Growth of charitable and voluntary health agencies -​ 1916 → municipalities could use tax dollars to pay doctors and nurses -​ Before WWII, healthcare was mostly private -​ 1930s → great depression -​ 1940s → provinces got inspired to make prepaid medical insurance plans -​ 1940s - 1950s: -​ Establishment of the first universal social programs in Canada -​ Post-war economic growth and stability which helped healthcare -​ Healthcare shifted towards institutional care -​ Start of immunization programs -​ 1984 → extra billing became a threat to universality and access of medical insurance program, so the federal government enacting the Canada Health Act w/ 5 pillars 1.​ Public administration 2.​ Comprehensiveness 3.​ Universality 4.​ Portability 5.​ Accessibility Safety Net -​ Describes the presence of social programs working to help those vulnerable of reaching poverty -​ Beginning in the 1950s → more progress towards supporting the poor, elderly, and disabled w/ social safety nets (Canada Pension Plan, Canada Assistance Plan Act, Guaranteed Income Supplement) -​ Increased system costs a hella lot Government -​ Federal government -​ Setting and administering national policies through Canada Health Act -​ Finances healthcare -​ Health service to veterans, indigenous people, military personnel, RCMP, inmates, vulnerable people -​ Health protection and promotion, disease prevention -​ Provincial/ territorial government -​ Develops and administers healthcare insurance plans  -​ Plans and funds care in hospitals and healthcare facilities -​ Reimburse providers and hospitals -​ Long-term care and rehab -​ Manage prescriptions for public health -​ Determines coverage for insurance -​ Canada Health Transfer → largest money transfer from Federal government to provinces and territories funding healthcare (23% of overall spending) -​ Equalization → ensures sufficient revenue for levels of public services comparable to taxation -​ Canada Social Transfer → for post-secondary education, child development, early childhood education and childcare, social welfare and services -​ Public funding → through taxation from personal and corporate income taxes -​ Private funding → through out-of-pocket payments and private insurance (dental and eye care, some meds) Delivery of Healthcare -​ Five levels: 1.​ Health promotion 2.​ Disease and injury prevention 3.​ Diagnosis and treatment -​ Primary → first place of contact -​ Secondary → specialists following a referral -​ Tertiary → specialized care referred after secondary 4.​ Rehabilitation 5.​ Supportive care Week 11/12 Professionalism Professional Conduct -​ Licensure → granted by CNO, exclusive legal right to practice nursing -​ Registration → list of members in good standing of an organization -​ Ensures minimum level of safe practice -​ Those registered much meet practice requirements, show now evidence of unsafe practice, and show evidence of expanding knowledge and competence to meet evolving requirements -​ NCLEX → registration exam contributes to patient safety and accountability  -​ Competencies organized under 9 roles: 1.​ Clinician 2.​ Professional 3.​ Communicator 4.​ Collaborator 5.​ Coordinator 6.​ Leader 7.​ Advocate 8.​ Educator 9.​ Scholar -​ Code of Conduct → accountabilities of all RNs in ontario and what the public can expect from nurses 1.​ Respect dignity 2.​ Provide inclusive and culturally safe care by practicing cultural humility 3.​ Provide safe and competent care 4.​ Work respectfully within the care team 5.​ Act w/ integrity in the client’s best interest 6.​ Maintain public confidence -​ Privacy and confidentiality → ethical and legal responsibility to maintain -​ Provincial legislation: -​ Personal Health Information Protection Act (PHIPA) -​ Quality of Care INformation Protection Act (QOCIPA) -​ Federal legislation: -​ Personal Information Protect and Electronic Documents Act (PIPEDA) -​ Torts → civil wrong committed against a person or property -​ Intentional → assault, battery, invasion of privacy -​ Unintentional → negligence Organizations -​ College of Nurses (CNO) → since 1963, recognizes nurses have the ability to self-regulate their practice -​ Ontario Nurse Association (ONA) → trade union since 1973, advocates for safe environments and practice, patient care concerns, and equality -​ Registered Nurses Association of Ontario (RNAO) → ontario-focused, represents RNs, “voice” of the professions for RNs or nursing students -​ Canadian Nurses Association (CNA) → national association, advocates for federal nursing and policies, focuses on universal healthcare  -​ Canadian Association of Schools of Nursing (CASN) → voice for nursing education and scholarships, promotes national standards for nursing education, represents all schools and accrediting agencies -​ International Council of Nurses (ICN) → federation of more than 130 national nursing organization, represents nurses globally -​ Sigma Theta Tau International (STTI) → international community of nursing Ethics -​ Moral principles governing behaviour -​ Bioethics → principled reasoning across health care professions, guided by: -​ Autonomy → right to choose freely for oneself -​ Beneficence → doing or promoting good for others -​ Nonmaleficence → avoiding harm or hurt -​ Justice → fairness -​ Ethical dilemma → conflict of values -​ Moral distress → arises when unable to act according to their moral judgement -​ Moral resilience → capacity to sustain or restore integrity w/ moral complexity, confusion, distress, or setbacks -​ Health Care Consent Act (HCCA) → promotes authority and autonomy -​ Deals separately w/: -​ Consent to treatment -​ Consent to care facility -​ Consent to personal assistance service -​ Nursing act → establishes mandate of CNO and defines scope of practice -​ Regulated Health Professions Act (RHPA) → regulates professional procedures -​ Controlled act → something only qualified professionals can do, may be dangerous if performed by someone unqualified -​ Scope of practice → methods a professional can use and how they practice