PPN 101 Lecture Notes (2) PDF

Week 1 History of Nursing - provides a critical understanding of our society today - understanding the meaning of nursing and its implications through experiences - a reflection on our current system - encourages researching nursing disciplinary and profession - teaches us who we are and where we a...

Week 1 History of Nursing - provides a critical understanding of our society today - understanding the meaning of nursing and its implications through experiences - a reflection on our current system - encourages researching nursing disciplinary and profession - teaches us who we are and where we are going Why should we know our nursing roots? - we can develop a professional identity - promote cohesiveness and pride - offers knowledge and practice relationships - serve to challenge wisdom - provides understanding of political, social and economic influences that affect the profession today - contributes the advancement of nursing “The Angel of Mercy” - Mid 1800s through World War I - nurses were seen as noble, moral, religious, virginal and self-sacrificing - strongly tied to religion and religious images - Florence nightingale as the epitome of the angel of mercy Indigenous Caregivers - women healers played a vital role as nurses and midwives - policy of assimilation of indigenous peoples and eradication of their culture, including the suppression of healing knowledge and practice - indigenous women were barred from entering nurse training schools until the 1930s Charlotte Edith Anderson Monterey (1890-1996) - first indigenous nurse - accepted in new york not in Ontario - in WW1 worked as a nurse and midwife Bernice Redman - not able to attend nursing in Canada in 1940s - went to Virginia instead - practiced nursing in Nova Scotia - first black nurse to be awarded the Victoria Order of Nurses in Canada First Black Nurses to Graduate from a Nursing Program in Canada 1948 - Colleen L. Campbell, Marion V. Overton, Ruth Bailey, & Gwen Barton CNA - Canadian Nurses’ Association and Nursing History - knowledge of nursing history and how to assist nurses socially into the profession - challenges critical thinking among nurses - all nurses are responsible to integrate nursing history and education and professional awareness - supports historical research What shapes our image of nursing? Media: news reports (strikes, shortages, spotlights), TV/movie portrayal, advertisements about nursing Public perception: personal/lived experiences History: nurse pioneers, scholars and trail blazers Nursing perceptions: nursing associations/educational institutions What are the Implications for Nursing Recruitment? - need contemporary images for nursing recruitment - historical images can provide both inspiration and dissonance - heroes, harlots, handmaidens, - times of war - ‘life or death’ ‘virtuous hero as victim’ - virtue script in imaging of nurses (as kind, compassionate) - label of ‘angel’ caring, compassionate and comfort - self-sacrificing for the good of others - moral depictions - nurses as sexual objects, permeates images today - ‘Good’ nurse of personal virtues rather than academic aptitude or intelligence What are the Future implications to Shift the Image of Nursing? 1. Emphasize nursing’s unique body of knowledge defined through research 2. Critically analyze the media and the portrayal of nurses- get involved! 3. Make it your responsibility to uphold positive images of nursing Perceptions of Nurses of Hospitalized Children - 55.6% positive: Health, compassion and support and doing no harm Week 2 Program Philosophy - Phenomenology (lived experience) - Critical Social Theory (oppression-socio-political-economical) Phenomenology - recognize individuality and everyone has a different lived experience - understand each person has their own story - phenomena: things that are perceived by our consciousness - have the best optimal care to patients, deep human understanding - exploring the meaning of experiences of health/healing/illness - nurse-patient relationship Price · · · Historical Imaging wwl : Virtuous imaging nurses Moral depictions : sexual : as angels objects Descriptive Phenomenology: focuses on first-hand experiences of people so that others are able to ‘see’ and ‘feel’ these experiences without knowing the underlying social, cultural or political contexts Interpretive Phenomenology: examines contextual features of peoples’ lived experiences to arrive at deeper understandings of these experiences ** nurses can generate and use interpretive knowledge to address clients’ needs and tailor their care Nurse should ask: - the lived experience of a person who has a chronic illness? - the lived experience of a victim of domestic violence? - the lived experience of a first-year nursing student? - General knowledge - specific knowledge - “can this information be shared” - maintain TRUST - make sure you do not impose your own beliefs - we are here to educate, NOT make their decisions - active listening - empathy, being present and genuine Critical Social Theory - Ultimately the patient’s are in control of their lives - we need to make sure they do not feel oppressed - they are informed - challenge power imbalances and inequities that marginalized vulnerable people/cultures - disrupt the status quo and taken-for-granted assumptions - ex. Patients are oppressed, nurse is the oppressor Important Concepts Social Norms/Expectations - provide structure within society, promote forms of social control Social Norms (as social control) - perpetuated overtly, covertly and inadvertently Social discourses - shop what we come to know (or believe), right or wrong, through written/spoken language, media and literature Social construction - idea that has created and accepted by the people in a society - concept is an image or an idea - social phenomena are constructed - an idea that has been created and accepted by the people in a society Ex. - “marriage”, “adolescence”, “religion”, “disability” and “ability” Oppression - control people who have status or power - system of forces that can reduce, immobilize and mold people who belong to a certain group to effect their subordination to another group - enslaved by circumstances Critical Social Theory: what is the problem? What is the implication? How can we fix the root cause? Marginalization - living at the margin or fringes of society - being outside of the “main circle” of the dominant groups of society - may result in meaningful exclusion from processes and functioning of society - limited or little access to resources and opportunities Challenge the Status Quo - use a critical social approach to reveal oppression, marginalization and inequities - use phenomenological approach to understand the lived experiences of others - use social justice approach to advocate for the redistribution of opportunities and resources for vulnerable people Dawn Wooten - true advocate - whistleblower - courageously spoke about the medical care in Detention camps Social Justice - looking at fairness and equity not equality - one person may need more than others - Give what they need for fair outcome - nurses must champion social justice and promote public policies that improve the health of marginalized populations by addressing social inequities - equality ensures that there is equal sharing amongst people - equity requires a redistribution of access, opportunities and resources for vulnerable people Patterns of Knowing in Nursing - Empirical Knowing - is expressed in practice through nurse scientific competence Ethical Knowing: the Moral Aspects of Nursing - focuses on moral choices, what ought to be done - directs how nurses conduct their practice, select what is important, with respect to standards and codes - does not determine what should be done, but offers insights and advocacy - might not be a satisfactory answer but alternatives may be more or less satisfactory and responsible for one’s action - ethical knowledge assumes experience Personal Knowing: Relational - concerns self-understanding, empathy and compassion - authentic and genuine - recognizes humanness of one another - nurse-client relationship - interactions with through reflection on self Aesthetic Knowing - a deeper appreciation of the whole person or situation - can be enhanced through story telling, poetry, music or art - to experientially relate to their clients by intuitively and creatively responding to unforeseen parts of their stories - to learn new information Emancipatory Knowing - recognize social and political problems of injustice or inequity - to notice social injustices, investigate the causes of these injustices, and identify changes necessary to correct the structures of injustice and oppression - of social and structural changes that need to be made to ‘right the wrongs’ - nurses to be in a better position to act as advocates in helping identify and reduce the inequities in health care Ex. Nightingale and her writings about the inequities that affected women What is a Profession? It is a vocation or occupation that requires specialized knowledge, skill, scientific methods, and values based on research and is taught in an institution of higher eduction. - taught in an institution of higher education - high ethical standards of its members Professional behaviours - members function autonomously - members are committed to advanced study - members are motivated by service to society 7 Nursing Professional Values and Ethical Responsibilities 1. Providing safe, compassionate, competent, and ethical care 2. Promoting health and well-being 3. Promoting and respecting informed decision-making 4. Honouring dignity 5. Maintaining privacy and confidentiality 6. Promoting justice 7. Being accountable Ways of Knowing 1. Empirical 2. Ethical 3. Emancipatory centre 4. Aesthetic 5. Personal - Carper (1978) original 4 - Chinn & Kramer (2011) identifies socio-political and economic ways of knowing, known as emancipatory knowing <- includes emancipatory - progressing profession Empirical Knowing (Science of Nursing) - evidence-based - what can be verified - is expressed in practice through nurse scientific competence - ICU heavy - accessed through the five senses - observation Ethical Knowing (Moral of Nursing) - find your boundaries on ethical dilemmas - understand your own values and biases - what is right and wrong - attends to standards and codes in making moral choices - ICU heavy Personal Knowing (Compassionate side of Nursing) - relational - caring, empathy, connection - subjective, concrete - knowing about self and others, humanness of the client experience - understands and connects - PEDs and community nursing Aesthetic Knowing (Art of Knowing) - ex. Therapeutic touch, pets - not scientific in nature - deeper appreciation of the whole person or situation - intuitively and creatively responding to unforeseen parts of their stories - including patient to learn new information - story telling, poetry, music or art - ex. Spiritual leader in ICU or street nurse Emancipatory Knowing (Social Justice) - centre of the flower - to recognize social and political problems of injustice or inequity - social and structural changes that need to be made ‘right the wrong’ - better position to act as advocates in helping identify and reduce the inequities in health care - nurses are teachers and advocates Professional Nursing as a Practice Discipline? - late 80’s NDP Bob Ray fought for nurses pay equity - CNO looks at standard Nursing Attributes - knowledge - spirit of inquiry - accountability - autonomy - advocacy - innovative and visionary - collegiality and collaboration - ethics and values CNO - every member is responsible for practicing in accordance with the standards of the profession, for keeping current and competent throughout her or his nursing career - outline the expectations for nurses that contribute to public protection - they inform nurses of their accountabilities and the public of what to expect of nurses for nurses that contribute to public protection Standards - accountability - continuing competence - ethics - knowledge - knowledge application - leadership - relationships therapeutic nurse-client relationships professional relationships Week 3 Critical Thinking - purposeful and reflective reasoning during which you examine ideas, assumptions and beliefs, principles, conclusions, and actions within the context of the situation Barriers to Critical Thinking - attitudes and habits - cognitive dissonance (mental conflict) - personal vs. Professional values Five Step Clinical Decision-Making Approach Clinical Judgement Model ' ADPIE - Assess, Diagnose, Plan, Implement, and Evaluate Tanner’s Clinical Judgement Model (2006) - describes reasoning patterns - Noticing, Interpreting, Responding and Reflecting The glue and conscience of health care - what critical thinking skills and competencies are necessary to meet the needs of your clients and families? - do you need different skills/competencies to affect change in the institutions you work in? Basic Critical Thinking (Level 1) - concrete in your thinking - can’t think out of the box - trust the experts - dependent on rules and regulation Complex Critical Thinking (Level 2) - past the basic level - thinking less concrete - looking at the bigger picture - integrate more things - can multi-task - you’re looking at alternatives Commitment (Level 3) - no one reaches the pinnacle - question with confidence - you do more than consider alternative solutions available - basis of alternative solutions available, and action until a time as a result Components of Critical Thinking in Nursing 1. Specific knowledge base 2. Experience in nursing 3. Critical thinking competencies 4. Attitudes for critical thinking 5. Standards for critical thinking Competencies 1) Scientific Method: look, verify facts are true 2) Problem solving: gather, ongoing evaluation- adds to past information 3) Decision Making: making a decision, actions based on numerous options Specific Critical Thinking Competencies in Clinical Situation 1) Diagnostic Reasoning 2) Clinical inference 3) Clinical decision making Attitudes - open mindedness - acceptance that you don’t know everything - curiosity, integrity and humility Standards - intellectual standards - plausibility, depth, relevancy, broadness, fairness - CNO Novice to Expert: Complete beginner with no experience - practice with knowledge - we are novice Advanced Beginner - new graduate - 1-2 yrs of nursing - after passing the NCLEX Competent Nurse - 2-3yrs of experience - not too focused on task at hand - organizational skills The Expert Nurse - no top step - people can come to you - grasp “big picture” - experience-confident The Proficient Nurse - leads to expert, no time limit - take in more than one detail at a time - knows from experience what to expect Week 4 Metaparadigm of Nursing Why Theory - descriptive knowledge and explanatory knowledge Theoretical Framework? - structure - guides Theories have - inter-relate concepts - particular phenomenon Building a Theory - Idea - what are the variables - concept building blocks - what is our hypothesis? - Concrete (observable) to highly abstract (non-observable) - inductive process - deductive process What is a paradigm? - umbrella group “Health care” Meta-paradigm? - area of interest or concern “Nursing” - major component of nursing are person, environment, health & nursing - all theorists start here - keep concrete - this is our road map Conceptual: general meaning based on the theory Operational: specific direction of how concept is measured Nursing (Original) - the actions taken by the nurse on behalf of, or in conjunction with, the patient Social Justice - fairness and equity - advocacy - upstream nursing (root cause of things) - equity and equality Theory— Why? - knowing what is happening (descriptive knowledge) then finding out how something occurs - explanatory knowledge we are able to move toward knowing the kinds of changes we must make for some things to occur Theoretical Framework - provides structure for the study - a rationale for the predictions of the relationships between the variables - GUIDEs and directs the study What are the characteristics of Theories? - Theories are inter-relate concepts in such a way as to create a different way of looking at a particular phenomenon - theories are logical in nature; use orderly reasoning; are systematic Building a Theory - presents a systematic explanation of a phenomenon (Idea) - Theory designates specific relationships among concepts, providing a basis for us to propose (research- Evidence Based Practice) what are the variable - “Sets of ideas (concepts) used to describe, explain or predict the physical and social worlds Concept: building blocks Concept, Theory, Framework, Model - concept: concepts are mental images of reality tinted with the individual’s perception, experience and philosophical bent - concepts bring order to observations and perception - exist on a continuum from concrete (observable) to highly abstract (nonobservable) - BUILDING BLOCKS OF THEORY Building a Theory in a Conceptual Framework Propositions and Definitions - generated by inductive process (inductive reasoning) - evaluated (propositions are tested) and modified by deductive process Development of Nursing Knowledge - what is a paradigm? —> umbrella group “Health Care” - patterns or shared understandings - theories are often based on paradigms - paradigm shift - the basic parameters and framework for organizing the disciplines knowledge- they are abstract means of expressing knowledge What is a meta-paradigm? What do these question have to do with nursing? A paradigm: - patterns of shared understandings; a world view - theories are often based on paradigms - paradigm shift A meta-paradigm: - area of interest or concern to a discipline - most global appreciation Meta Paradigm (Meta= same or something about something) - metaparadigm-defined as the global concepts specific to a discipline Ex. Nursing - areas of interest or concern to a discipline - most global appreciation - major components of metaparadigm of nursing are PERSON, ENVIRONMENT, HEALTH & NURSING Theory of a theory= ABSTRACT ** all the theories start here, keep concrete, this is our road map Person - subject to dynamic changes in understanding- over time - includes individuals, groups of people, families and communities - each person, family and community has distinct physicals psychological, social, spiritual, cultural and developmental characteristics Client - the individual, family, group or community that is the recipient of nursing care Health - a subjective term that is determined by each person or community - more than the absence of disease or injury - an ideal state of well being in which all persons strive for - the patient’s state of wellness/illness Environment - the totality of all things (external and internal) that impact a person, families and communities - e.g., physical, cultural, social, political and economic circumstances - can impact a person’s health circumstances and their recovery - includes both social & physical environments Nursing - includes attributes, characteristics, and action of a nurse in relationship with a client and the nature of care provided - a partnership with clients and families where therapeutic and comfort caring can occur original—> the actions taken by the nurse on behalf of, or in conjunction with, the patient Meta-paradigm concepts and key nursing theorists Nightingale: promoted environment that were conducive to healing —> late Victorian concrete Roy: viewed the person as a biopsychosocial being in constant interaction with a changing environment —> research/logical Watson: viewed nursing as caring enacted between nurse and another, transcending the boundaries of time, space and physicality Parse: understood people to be in a continuous process of making choices and changing health priorities —> becoming human abstract Florence Nightingale - focused on the importance of the environment in health & illness - totality - concrete - first nurse to document - patient? Environment? Health? Nursing? - “notes on nursing” (1859) described the conditions necessary to promote health and healing - systematic thinker; pioneered data visualization of statistics - “putting the person in the best condition for nature to act” - phenomenological focus of the human-environment relationship to health Sister Callista Roy - Adaption Model of Nursing - Totality - progressive - “Roy Adaption Model (1976) - four modes of adaption: physiological needs, self concept, role function and interdependence - believed the goal of nursing was to facilitate adaption Madeleine Leininge - 60’s progressive - influencers from culture - totality Jean Watson - theory of human caring - Spirituality “caring” - the nurse can treat the body, mind and spirit of a person through establishment of a caring relationship - they must attend to their primary function and responsibility, which is caring - “Theory of Human Caring (1979), a model of caring that includes 7 assumptions and 10 carative factors Human Becoming Theory - meaning, languaging, transforming, originating, revealing/ concealing, transcendence= human becoming Social Justice - is a matter of life and death - it affects the way people live, their consequent change of illness Social justice is the 5th meta-paradigm concept Social Justice - aims to establish fairness and equity Downstream vs. Upstream approaches to Nursing - suggest that health disparities become health inequities when they are unnecessary, unfair, and preventable, resulting from social injustices that become engrained in the fabric of society - critical caring as an appropriate theoretical framework for understanding (and guiding) nurses’ fundamental responsibility to reduce health inequities—> what is critical caring? Week 5 Nursing theories are patterns that guide the thinking, being, and doing of nursing - they help organize our thoughts, reflections, observations and inferences - many describe theories as lenses because they colour and shape what is seen Nursing practice is based on these theories, foundational concepts, philosophies, principles, research findings, and practice wisdom All disciplines use theories and concepts to illuminate their distinct perspectives (i.e., the metapardigm of nursing; ways of knowing etc.) Grand Theory - provides a global perspective on nursing practice, education & research - can be applied in most nursing situations Middle-range Theory Practice Theory - very specific Theory to Practice - guides assessment, nursing diagnoses & nursing actions - renders practice more efficient & more effective - common language - labels & defines phenomena - articulates/ describes nursing practice - enhances professional autonomy & accountability - guides research - helps nurses to formulate research questions - research findings may validate or lead to modification of theory, which then impacts on nursing practice and can generate ideas for further research Evidence & Evidence- informed Practice (EIP) What is Evidence? - information derived from clinical research What is Evidence-Informed Practice? - the best available research evidence that is applied in conjunction with patient preferences, context, available resources and practitioner expertise Remember: Nursing practice is based on theory, professional values, evidence and clinical reasoning Creativity and Scholarliness in Nursing - nursing tasks can be mastered by anyone trained to perform them, nursing practice is a unique body of knowledge combined with a set of principles that guide the systematic application of that knowledge in an expanding array of contexts - aims to organize knowledge about nursing to enable nurses to use it in a professional and accountable manner Creative nursing practice is the direct result of ongoing theory- based thinking, decision-making, and action Week 6 Culture - culture can be understood as shared patterns of learned values and behaviours that are transmitted over time, and the distinguish the members of one group from another - culture can include language, spiritual and religious beliefs, socioeconomic class, gender , sexual orientation, age, geographic origin, and education - even within culture there are regional differences - incorporate client’s cultures build trust —> ask them about their culture —> how much they participate in - can’t make assumptions - hospital’s great resource from the other staff members Culture can also be understood as… A process that happens between people,. We continuously participate and create culture, culture is constantly in flux. No two person’s share any given cultural affiliation in identical ways… Madeleine Leininger Video - discipline of trans culture - “what’s their culture?” - “What does care mean?” Willing to provide culturally care, or care that fits What is the quality of care? Transculture Theory - to provide culturally congruent care—> enabling (guide/help) someone their culture - 1950’s theory created - nurses need the knowledge and practice congruent care - care is doing —> more to that - construct of trust—> reciprocal - do you understand what I’m sharing? Culture: The Canadian Context - colonialism: “the takeover of minority population (often indigenous) by another nation and the resulting unequal relationships between them” - Neocolonialism: “… new, evolving and ongoing colonial policies and practices that continue to govern, oppress and subordinate certain groups… involves more indirect forms of control through economic and cultural dependence…” Culture & Important Concepts for Nursing Practice cultural competence cultural safety cultural humility What is cultural competence? - defined as an ongoing process, whereby nurses stick to work within the client’s cultural context Key idea: nurses develop cultural competence rather than possess it Campinha-Bacote’s Process of Cultural Competence - know your own background and biases Cultural Awareness - insight into one’s own cultural background; recognize your biases, prejudices and assumptions - best practice to learn is from the individual A beginning step towards understanding difference that requires selfassessment and reflections about your own personal biases and feelings Cultural Knowledge - developing a sound foundational knowledge about diverse groups; knowing the norms, practices, believes, values; understanding the client’s worldview Cultural Skill - ability to collect assessment data through communication and physical assessment - you have to do it Cultural Encounters - interactions with individuals of different cultures; a learning experience - talk to the families, people you’re working with Cultural Desire - motivation and commitment to developing cultural awareness, knowledge, skills, encounters; and aspect of caring - you need to have that want Cultural sensitivity: the recognition that there are differences between culture and are reflected in ways that different groups communicate and relate to one another Cultural safety: enables safe care to be defined by those who receive that care, and challenges unequal power relations as the level of the individual, family, community and society How are these concepts related? - Key idea: cultural awareness and cultural sensitivity are separate concepts and are not interchangeable with cultural safety - achieving cultural safety is a step-wide progression - the outcome of cultural safety is that safe care, defined by clients wo receive that care, is provided Cultural Safety - is an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the health care system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care Cultural Humility - flexible and humble enough to let go of the false sense of security that stereotyping brings… to assess anew the cultural dimensions of each patient… to say that you do not know when you truly do not know - ongoing process - post LA riots—> post Rodney King - it’s ok not to know - life long learner Principles: - continuing - life-long learning and critical self-reflection - recognize and challenge power imbalances - institutional accountability VIDEO - love, compassion - what is our ultimate goal? Equity and equality - multidimensional concept, conceptualize 3 dimensions: - life long learning critical self reflection - mitigate the power imbalances dynamics - institutional accountability Cultural competence - implies all knowing/ all powerful - getting to understand the different cultures —> be happy for now knowing Culturally Sensitive Care to care for someone, i must know who i am. To care for someone, i must know who the other is. To care for someone, i must be able to bridge the gap between myself and the other Culture and Nursing Practice - as a nurse, what strategies would you use to develop cultural competence? Achieve cultural safety? Demonstrate cultural humility? What is Race? Race is defined as a socially constructed category used to classify humankind according to common ancestry and is reliant on differentiation by physical characteristics The concept of race has no basis in biological reality and therefore has no meaning independent of its social definitions The ideology of race has become embedded in our identities, institutions and culture and is used as a basis for discrimination and domination Racism and Racialization Racism is a concept widely though of as personal prejudice, but in fact, it is a complex system of racial hierarchies and inequities Racialization is the process of categorizing people into categories that are constructed as different and unequal in ways that lead to negative social, economic and political impacts Antiracism No one is born racist or anti racist. These result from the choices we make. Nurses can do: Anti racist - nurses must take a leadership role to prevent embedded racism from causing further harm to our patients and communities - nurses’ efforts to provost social justice and equity are not just about developing policies. Rather, their efforts are accomplished through dayto-day practices, conversations with on another, and interactions with clients, families, communities and leaders Nurses Speak out - watch video pg. 24 START CONVERSATIONS: Nursing Strategies and Implication - commit to equity (all people should have the same rights, and are deserving of health) - seek to understand yourself and other, and the context of people’s lives - analyze vulnerability, rather than locating it within individuals or groups (i.e. “at risk youth”) - promote practices and environments that are appropriate for the MOST marginalized (i.e. signs or brochures that can understood by people with low literacy) - treat problems as practice problems, not individual problems (i.e. the “difficult patient”) Importantly… - learn about yourself - learn about your context - learn about yourself within your context - learn about your clients within their contexts Commitment to equity, diversity and inclusion Week 7 Honouring the Truth, Reconciling for the Future - residential schools were created for the purpose of separating aboriginal children from their families, in order to minimize and weaken family ties and cultural linkages, and to in doctrine children into a new culture- the culture of the legally dominant Euro-Christian Canadian society - that experiences was hidden for most of Canada’s history, until survivors of the system were finally able to find the strength, courage, and support to bring their experiences to light in several thousand court cases that ultimately led to the largest class- action lawsuit in Canada’s history - more than 6,000 witnesses most of whom survived the experience of living in the schools as students - children were abused, physically and sexually, and they died in schools in numbers that would now have been tolerated in any school system anywhere in the country, or in the world Reconciliation - requires an understanding that the most harmful impacts of residential schools have been the loss of pride and self-respect of Aboriginal people, and the lack of respect that non-aboriginal people have raised to have their aboriginal neighbours - reconciliation is not an aboriginal problem; it is a Canadian one, it will take some time Truth and Reconciliation Commission - in order to redress the legacy of residential schools and advance the process of Canadian reconciliation, the Truth and Reconciliation Commission makes the following Calls to Action: child welfare education language and culture health justice Calls to Action for Health 1) to recognize and implement the health-care rights of aboriginal people as identified in international law, constitutional law, and under the treaties 2) to establish measurable goals to identify and close the gaps in health outcomes between aboriginal and non-aboriginal communities. Such efforts would focus on indicators such as: infancy mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infancy and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services 3) to recognize, respect, and address the distinct health needs of the Métis, Inuit, and off-reserve Aboriginal peoples 4) to provide sustainable funding for existing and new aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools 5) to recognize the value of aboriginals healing practices and use them in the treatment of aboriginal patients in collaboration with aboriginal healers and elders where requested by aboriginal patients 6) increase the number of aboriginal professionals working in the healthcare field, ensure the retention of aboriginal health-care providers in aboriginal communities, and provide cultural competency training for all healthcare professionals 7) to call upon medical and nursing schools in Canada to require all students to take a course dealing with aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skillsbased training in intercultural competency, conflict resolution, human rights, and anti-racism Structural Racism & Health Care - legitimized and normalized spectrum of attitude, practices and policies that consistently results in chronic and continuous substandard outcomes for indigenous people’s - funding & delivery of health care: Jordan’s Principles - Child welfare system: removing children from their families - Poverty: low in rom and related issues, such as poor housing conditions - racist assumptions about indigenous patients: the store of Brian Sinclair Ignored to death: Brian Sinclair’s death caused by racism, inquest inadequate, group says… Indigenous People WHO’s (2007) understanding of indigenous includes people who: - identify themselves and are recognized and accepted by their community as indigenous - demonstrate historical continuity with pre-colonial and/or pre settler societies - have strong links to territories and surrounding natural resources - have distinct social, economic or political systems - maintain distinct languages, cultures and beliefs - form non-dominant groups of society - resolve to maintain and reproduce their ancestors environments United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) - “establishes a universal framework of minimum standards for the survival, dignity and well-being of the indigenous peoples of the world.. - it elaborates on existing human rights standards and fundamental freedoms as they apply to the specific situation of indigenous peoples” - adopted by the UN general assembly of September 13th 2007 - Canada voted against it in 2007 (1 of 4 countries who did so) but officially endorsed it in 2016 Indigenous People and the Metapargim concept of Health - health is a concept that has multiple meaning. It is related to quality of life, is individually defined and is in dynamic interaction with the environment - families, individuals, groups, communities and society share responsibility for health - health promotion, accessibility, public participation, appropriate use of technology and multi-disciplinary collaboration, are seen as fundamental in achieving health for all Health… It is imperative that nurses understand the social determinants of health through an indigenous lens, explain the underlying economic and social conditions that shape health/ health concerns ex. Impaired access to appropriate and inadequate housing, income, education and health care, as result of historical colonialism and current day post- colonial racism- significantly contributes to these health concerns Social Determinants of Health through an indigenous lens 1) proximal determinants: direct influence, e.g., poor diet/limited access to nutritious food; lack of exercise, substance abuse; smoking 2) Intermediate determinants indirect influence on health, e.g., poor community Indigenous People’s Health and Nursing Practice - can be related to indigenous or people’s values, health and well being - important values include: 1) Respect 2) Trust 3) Spirituality - although there may be similarities, different indigenous groups have their own interpretations and may emphasize unique beliefs, world views and theories of indigenous health - in caring for indigenous people, nurses must work cooperatively in balance with indigenous ways of knowing Two-Eyed Seeing in Health Care - both western health care knowledge and indigenous knowledge, combing the strengths of each to better meet the health care needs of indigenous people - grounded in nurturing positive relationships; a relationship approach that focuses on building trust - The FIRST approach: practices to enhance cultural safety Family Information Relationship Safe Space Treatment Racism and Impact on health and Well Being - racism produces rates of morbidity, mortality, and overall well-being that vary depending on socially assigned races - eliminating racism is therefore central to achieving health equity, bu this requires new paradigms that are responsive to structural racism’s contemporary influence on health, health inequities, and research Objectives Week 1 —> Relate the personal and professional self to the nurse’s role —> Interpret the nursing process and nursing frameworks —> Examine the ethical and legal obligations of the nurse —> Critique the historical image of nursing —> Explore the gendered, political and economic nature of nursing —> Understand the historical, societal and environmental context of Indigenous Health in Canada Week 2 —> Compare and contrast the two program philosophies —> Demonstrate a beginning understanding of critical social theory (CST) and phenomenology and their relationship to nursing and Canadian healthcare —> Discuss CST in relation to social justice —> discuss ways of knowing in nursing —> examine personal and professional values and beliefs in relation to self-awareness and the nursing profession —> characterize nursing as a profession —> identify the criteria of a profession —> identify professional behaviours and link them to academic behaviours —> introduction to professional organizations and associations - CNO - CNA - CASN - ICN - RNAO - STTI —> Introduction to the CNO Standards of Practice Week 3 —> Describe the cognitive skills and critical thinking dispositions required for clinical decision making in nursing —> examine the 3 levels of critical thinking competencies as described by Kataoka-Yadira (1994) —> Examine the 5 stages of the Novice to Expert model as described by Benner (1982) —> Discuss the relationship between the Kataoka-Yahiro and Benner models —> explain the components of the nursing process —> describe the synthesis of critical thinking and the nursing process —> introduction to the Clinical Judgment Model —> introduction to critical thinking and ethical reasoning —> identify barriers to critical thinking and ethical reasoning Week 4 —> Describe and discuss paradigms, paradigm shifts and meta paradigms —> Discuss the meta-paradigm of nursing and its contribution to nursing knowledge Week 5 —> discuss the history, purpose and importance of theory development in nursing —> describe the perspectives of the following nurse theorists: Nightingale, Roy, Watson —> describe evidence informed practice and its relevant to nursing theories, models, and frameworks —> Define meta, grand, midrange and practice theories —> Describe scholarliness in nursing - focus on nursing knowledge (metapardigm concepts) - development of nursing knowledge - role of theory as essential to the nursing profession and nursing practice - relationship between theory, practice and research - linking theory to practice Week 6 —> Describe Campinha-Bacote’s model of cultural competence —> compare and distinguish the concepts of cultural safety and cultural humility - describe the concepts of colonialism and neocolonialism - articulate how these concepts relate to nursing practice —> define race and racism and explain why these concepts are important when providing nursing care —> compare and contrast the cultural contexts of health and illness —> review and examine the equity, diversity and inclusion (EDI) statement in the Student Handbook. Discuss the importance of EDI in nursing Week 7 —> Define the Calls to Action for health in the Truth and Reconciliation Commission of Canada report —> Define structural racism and how it can be manifested in the health care system —> Understand the history of residential schools and the impact on survivors today —> expand on the concept of cultural safety and its relevance for indigenous people in Canadian healthcare —> Describe fundamental aspects of nursing practice related to Indigenous people’s values, health and well-being —> Discuss the relevance of two-eyed seeing for nursing care in Canada VIDEO NOTES Week 1 Image of Nursing - nurse a person trained to care for the sick or invalid, especially in a hospital - noble and caring - community, direct patient care, administration, education, research Week 2 - CT: struggle for power - society is full of conflict and tension - stratification: poor and less powerful struggle to succeed - class, race, religion, gender, sexuality - inequality= power relations - social justice: inequality is wrong Oppression - Elizabeth Taylor - unsafe for marginalized people - “you are implying…” - explains oppression in five minutes or less - explain why is an aggression is wrong often dismiss the issues 1) ignore the comment- don’t owe an explanation 2) what they said was offensive “you are not okay with it” Week 3 Critical Thinking - evaluating information + evaluating our thought —> refine our though processes - examine flaws + biases - minimize biasing influence from culture + upbringing - change of position= appropriate response - explanation must be explained and testable - embraces scepticism= doubting suspending our judgment - reasoning, assumptions, biases - false dichotomies - black and white thinking underlying intolerance of ambiguity Critical thinker can: - handle uncertainty - prefers to be aware of their areas of ignorance - can wait for valid evidence - can wait for evidence-based answers - Intellectual independence - when we teach and encourage critical thinking we empower individual lives and invest in our collective future - involves stepping back to see all the angles - identifying the key points - weighing different options - being creative, reflective, adaptable = evaluating the evidence what is accurate? What is relevant? - taking a stand for yourself - encourages citizen involvement Week 4 - upstreaming: making smarter decisions, what better goals for all people to enjoy good health - downstream thinking Week 5 - racism: is a construct - dehumanizing - internalized oppression and racism - about the system Key Terms Tanner’s Clinical Reasoning Patterns Assessment: detecting/noticing cues Nursing Diagnosis: analyzing, synthesizing and interpreting data Planning: Responding, considering actions and setting priorities Implementing: Responding, reflecting and making adjustments Evaluating: Reflecting and repeating ADPIE as indicated Benner-Analysis of Theory Expert: Has intuitive grasp of the situation and zeros in on the accurate region of the problem Proficient: Perceives situations as wholes, rather than in terms of aspects Competent: Begins to understand actions in terms of long-range goals Beginner: Can note recurrent meaningful situational components, but not prioritize between them Novice: Has no professional experience Critical Thinking Skills and Dispositions Making Process Skill Interpretation: orderly in data collection, look for patterns to categorize data. Clarity what you are uncertain. Analysis: open-minded, look at information about a patient. Avoid making careless assumptions. What you believe is true or whether the scenarios are possible. Inference: examine meanings and relationships in the data. Form reasonable hypotheses and conclusions. Evaluation: identify required changes. Assess all situations objectively. Determine the effectiveness of nursing actions. Explanation: use knowledge and experience to select strategies you use in the care of patients. Support your findings and conclusions Self-regulation: adhere to standards of practice. Identify in what way you can improve your own performance. Continued Dispositions or Habits Truth-seeking: learn what is actually happening. Consider scientific principles and evidence, even if they do not support your personal beliefs Open-mindedness: be receptive to new ideas and tolerant of other points of views. Respect the right of other people to hold different opinions. Analyticity: determine the significance of a situation. Interpret meaning. Anticipate possible results or consequences. Use evidence-informed knowledge in your nursing practice. Systematicity: be organized and focused in data collection. Use an organized approach to problem solving and decision making. Self-confidence: trust your own reasoning processes. Seek confirmation from experts when uncertain Inquisitiveness: actively seek new knowledge Maturity: multiple solutions are possible. Reflect your own judgments; be willing to consider other explanations. Used prudence in making, suspending, or revising judgments. Biomedicine: natural sciences such as biology and chemistry to understanding, treating, and promoting human health. Colonization and colonialism: takeover of a minority population by another nation results unequal relationships between them Corporatism: the use of a business model in shaping health care so that economics and profitability are the primary determinants rather than human health Culture: process that happens between people. No two person share any given cultural affiliation in identical ways Democratic Racism: uses cultural differences as a euphemism for racial differences to explain health, social, and economic inequities Diaspora: migration and dispersion of people from their countries of origin and to intricate ties that migrant communities maintain with their homeland. Ethnicity: a group that shares a heritage, language, culture or religion. Such as race, origin or ancestry, identity, language, nationality, and religion. Individualism: based on the ideas that society is essentially an equal playing field, that people have fairly similar choices, and the individual rights are of greatest importance. Neocolonialism: evolving, and ongoing colonial policies and practices that continue to govern, oppress and subordinate certain groups. Involves more indirect forms of control through economic and cultural dependence Race: categorizing people by primarily physical characteristics such as skin colour or hair texture Racialization: categorizing people by racial characteristics and resulting negative social, economic, and political effects Reflexivity: always checking your assumptions and “blind spots” Visible Minority: people who are identified according to the federal employment equity act as non-white in colour (non-Caucasian) Concept: general abstract notion or ideas about thing we see, hear, feel, taste and touch. Things that are abstract (things we cannot sense) Critical Social Theories (CST): produces power imbalances that can be critically examined. To bring positive changes in he conditions that affect people’s lives. Grand Nursing Theories: offering a general orientation or philosophical stance about nursing Hypotheses: predict a relationship between or among variables. Used to accept or reject or confirm or disconfirm Metapardigm: concepts that are central or core to nursing: person, health, nursing, and environment. —> social justice is suggested Midrange (middle range) Nursing Theories: informed by practice and research and offer general directions for everyday nursing practice. Nursing Practice Theories: concerned with specific nursing situation and focused interventions. Nursing Theories: focused on nursing and the care of people. Can exist at different levels of understanding or abstraction Social Justice: fairness in society and states that all people, regardless of financial or social circumstances, ethnic origin, gender, religion, age, impairment, and sexuality, should have equal chances to succeed in life. Theory: sets of ideas (concepts, variables) to describe, explain, or predict the physical and social worlds. Variables: observable in characteristic, number, or quantity; CNA be quantified or measured. Assimilation: the social process of absorbing one cultural group into another. It is the cultural domination by another society Colonialism: the practice where countries such as England ruled nations as colonies and developed trade for the benefit of the ruling country Colonization: the outcome process of colonialism. Attempts to assimilate Aboriginal peoples into European lifestyles through force. The Indian Act, residential schools, and land alienation processes were all designed to assimilate First Nations people Cultural Competence: in nursing, the development of skills, knowledge, and attitudes among health-care providers in learning 1) themselves 2) contexts that shape experiences of their patients’ cultures, health, and accessing health-care services Cultural Safety: nursing’s responses to this history if the promotion of cultural awareness and sensitivity that seeks to be familiar with respect and nurture the unique and dynamic cultural identifies of all individuals and their families. The creating of a safe environment in which the needs, expectations, and rights of individuals and their families are met within unique contexts Indian Act: federal legislation, first passed in 1876, obligations and regulates the management of Indian reserve lands. Critical reasoning: a specific term- the process you use to think about issues at the point of care — deciding how to prevent and manage patient problems Critical thinking: a broad term— includes reasoning both outside and inside of the clinical setting Critical judgment: refers to to the result (outcome) of critical and clinical reasoning— the conclusion, or opinion you make after thinking about the issues Evidence-Informed Practice: available research evidence and applied in conjunction with patient preferences, context, available resources, and practitioner expertise. Nursing Research: using research to answer a nursing question as a support to nursing practice. CNO https://www.cno.org/ CNA https://www.cna-aiic.ca/en/home CASN https://www.casn.ca/ ICN https://www.icn.ch/ RNAO https://rnao.ca/ STTI https://www.sigmanursing.org/ Week 9 1. Explore the goals of client centered education 2. Discuss client centered learning and L.E.A.R.N.S (RNOA) 3. Describe the 3 learning domains 4. Examine the Transtheoretical Model of Change 5. Describe the role of the nurse in health teaching 6. Discuss factors affecting a client’s readiness and ability to leanr 7. Examine the characteristics of different learning styles according to developmental stage and in terms of cultural diversity 8. Relate the teaching process to the nursing process and clinical judgement model 9. Analyze health literacy and its impact on health Health Teaching - is a focused form of instructional dialogue used in client centered relationships - the purpose is to provide clients and families with knowledge and life skills needed to make good decisions, slow or present progression of mortality and promote highest possible quality of life Discuss the goals of Client Centered Education - engaging clients as active participants in the learning process - ensuring that health teaching interventions are supportive of the clients 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 desires to learn “No blame, no shame” it’s okay to not know - safe environment to ask RNOA L.E.A.R.N.S ** Four pillars 1. Client Centred Care 2. Promoting Health Literacy 3. Building Knowledge and Skills 4. Supporting Self Management L.E.A.R.N.S Listen, Establish, Adopt, Reinforce, Name, Strengthen L- Listen E- Establish Relationship A- Adopt intentional approach R- Reinforce health literacy N- Name new knowledge S- Strengthen self-management - on going, always ensure they are comprehending - you do this through out, non verbal cues, therapeutic relationship - read the person - “can you explain to me what i have said” “do you need clarification?” - on going check in Goals/Outcomes of Client Education - maintaining and promoting health and preventing illness - health restoration - coping with impaired functioning 3 Learning Domains ** Cognitive - understanding the content - is a prerequisite for changing attitudes and developing the mastery of psychomotor skills Affective - changing attitudes and promoting acceptance Psychomotor - hand on skill development - tactile - most are combination, but affective it seen in all. It is the WILL to do it. Nurse in Health Teaching Nurses act as: - guides coach on action to improve overall health - information providers-how patients can learn to better care for themselves - resource support- connect clients to appropriate community supports - knowledgeable emotional support- help clients minimize the impact of temporary setback Examine the Transtheoretical Model of Change Model is used to explore a person’s motivational readiness to intentionally change health habits Stages of Change 1) pre-contemplation: does not think there is a problem 2) contemplation: thinks there may be a problem 3) preparation: recognizes problem and willing to change 4) action: engages in concrete action to change 5) maintenance: preserves with positive behavioural change Ex. Weight gain —> diet - difficult for someone to learn in the pre-contemplation stage, some don’t pass this because they think it is their way. You need to adjust your way of teaching. Esp with discharge planning Discuss Factors Affecting a Client’s Readiness and Ability to Learn - level of anxiety - ability to learn - physical pain, nausea Comorbid health problems - crisis and life transitions can IMPROVE learning - level of social support - health literacy - developmental level - culture, language - self awareness Learning Styles Visual - learns best by seeing - likes to watch demonstrations, looks around; examines situations - organizes thoughts by writing them down, needs detail Auditory - learns best with verbal instructions, likes to talk thins through - details is not as importance - talks about situation and pros and cons Kinetic - learns best by doing, hands-on involvement, needs action and likes to touch, feel - loses interest with detailed instructions - tries things out Literacy: - 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 in now used to represent 9 million adult Canadians who have serious problems with reading, writing and mat. 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 Health Literacy: - defined by the Centres 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 decision” - it includes knowing how to describe symptoms, where to help for health issues, how to understand medical information and how to safely manage the use of medication Health literacy skills are “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” - estimated that 6 in 10 Canadian adults do not have the skills needed to adequately manage their health and health-care needs - the fact that there are more people with low levels of health literacy (60%) than there are with low levels of literacy (48%) noting there is a difference between the two the two types of literacy - in order to master health-literacy tasks, adults are usually required to use their prose literacy, document literacy and numeracy skills simultaneously - health literacy involves more than the ability to read or understand numbers. Context matters, as does the ability to find, understand, evaluate and communicate health-related information - often associated with medication non adherence, understanding of outcomes of medication Week 10 Objectives: 1. Discuss the history of the Canadian Health Care System, and how it evolved. What was the role of Tommy Douglas? 2. Describe key principles and implication of the Canada Health Act 3. Identify the role of the various levels of Canadian government in the delivery of health services 4. Examine the health carefully delivery models, Medicare, and privatization as health care funding model 5. Discuss single payer vs. Two tiered systems. Discuss in terms of social justice 6. Explore the roles of Health Canada (Federal) and The Ontario Ministry of Health and The Ministry of Long Term Care 7. Discuss current socio/economic/political issues facing Canada’s Healthcare system Safety Net: describe the presence of social programs aiming to prevent those most vulnerable from falling below a certain level of poverty and vulnerability. Week 10 The Canadian Health Care Delivery System - 65q - last 4 weeks - week 9: 8 questions - week 10: 10 questions - 38q from the last 4 weeks The Safety Net - to protect the vulnerable - to prevent those most vulnerable from falling below a certain level of poverty and vulnerability Social Safety Net - comes from the federal government - to protect the most vulnerable -ex. CERB Tommy Douglas- father of Medicare in Canada - British North America Act - federal government has some health responsibilities: health care