Week 10- Nov 17th-Class slides.pdf

- NUSC 1P12: WEEK 10 PART 1: CHAPTER 29 SPIRITUALITY & NURSING (Potter et al., 2024) SPIRITUALITY not Religion ◦ A way of being in the world in which a person feels a sense of connectedness to self, others, a higher power or nature, or a combination of these: ◦ A sense of meaning in life ◦ Tr...

- NUSC 1P12: WEEK 10 PART 1: CHAPTER 29 SPIRITUALITY & NURSING (Potter et al., 2024) SPIRITUALITY not Religion ◦ A way of being in the world in which a person feels a sense of connectedness to self, others, a higher power or nature, or a combination of these: ◦ A sense of meaning in life ◦ Transcendence beyond self, everyday living, and suffering Spiritual Health: - sprirtuality is a part of the person as a whole ◦ Caring for the whole person ◦ Accepting beliefs and experiences ◦ Helping with issues surrounding meaning and hope SPIRITUALITY & HEALTH ◦ Spirituality is a dimension of overall health ◦ Spiritual needs may increase as health declines ◦ Patients with healthy inner spirituality are less likely to experience depression and conflicts ◦ Spirituality can provide psychological support, an improved sense of well-being, and support a healthy lifestyle Healing: the process of moving toward wholeness in all dimensions of health, encompassing the mental, emotional, physical, relational, cultural, and spiritual; as such, it may or may not be associated with curing a disease or disorder. - beyond the medial model What does this definition of healing suggest? Why is it important for nurses to understand spirituality, religion, healing, suffering, and how to appreciate all dimensions of health as we aim to move our clients toward wholeness? SPIRITUALITY & ILLNESS - in the context of spirituality ◦ Illness and injury resulting in suffering and loss ◦ Can produce spiritual challenges and transformation ◦ May cause patients to reconsider beliefs and feel anger toward self/other/higher power ◦ May help patients maintain spiritual practices and connect with self/other/higher power; may promote courage and growth ◦ Patients facing terminal illness; nurses providing palliative and hospice care ◦ Meaning of life; what comes after life - most patient when facing dealth reflect back on their life with regards to what their life ment Suffering: distress, pain, or anguish, whether physical, mental, emotional, and/or spiritual Can you think of a time you or someone you know has “suffered”? DEVELOPING & MAINTAINING SPIRITUALITY ◦A lifelong process - up and downs, more important and less important but contiunour throughout life ◦Spiritual care facilitated by being fully present in the moment, or “presence” ◦Reflective journaling - bible, karon ◦Meditation ◦Mindfulness How do you (or how might your patients) develop and maintain spirituality and faith? SPIRITUALITY & HEALTH Spiritual well-being has been associated with decreased anxiety, depression, loneliness, and addictive behaviour. It has also been associated with enhanced coping, resilience, compassion, longevity, and an overall sense of trust in one’s ability to navigate life’s challenges, including those associated with end of life. This overall sense may derive from trust in the deepest part of oneself, in life, in creation, or in a divine compasion presence. -- increased reduced stress due to increased coping and resileence within life So, how can we facilitate our own spiritual well-being? How can we care for the spirit of our clients and their families? How can we move them toward healing and away from suffering (even when we can’t cure or treat their disease or disorder)? CARE PLANNING & SPIRITUALITY - Support for spirality has always been associated with a negative event Sample Nursing Diagnosis I Why wait so long?- not common and under emphasized during life o “spiritual distress” related to “unmet spiritual needs arising from current health care crisis” as evidenced by “voiced feelings of hopelessness” OR - respects the diversity of the patients and how a patient identifies - you will not know how to respect and best care for someone if you don’t COMMUNICATE Sample Nursing Diagnosis II: Some people may go to there spiritual environment multiple times a week but what happens when hospitalized - always associated with death, food, and visitors ONLY o “readiness for enhanced spiritual well-being” related to “health care currently incongruent with personal spiritual needs, strengths, beliefs, and practices” as evidenced by “desire expressed by patient to receive care in keeping with personal spiritual needs, strengths, beliefs, and practices” REFLECTING ON SPIRITUALITY Think about how you, or others, may answer the question “what is spirituality?”… oWhether or not an individual’s spirit is nurtured by religion, or expressed in spiritual terms, depends on the individual’s worldview (which is ever-evolving!). A worldview is a commitment, a fundamental orientation of the heart, that can be expressed as a story or a set of assumptions that we hold (consciously/subconsciously/consistently/inconsistently) about the basic constitution of reality (what is real to us, our truth). Thinking about and nurturing your own spirituality is crucial to being able to help patients explore theirs. ◦ What does spirituality mean to you? Write it down. ◦ Then take a moment to reflect on implications for your nursing practice- how might your personal definition (informed by your worldview) inform or challenge your role as a nurse? HOW DO NEW GRADUATES FEEL ABOUT THIS? “She just sort of said, “I’m absolutely terrified of dying.” And I said like, “Yeah, I can’t imagine. I haven’t died before.” She said, “You know what? I remember you mentioned to me that you were a Christian or something. Would you just pray with me?” I was like, “Yes.” I prayed with her, and afterwards she was just so thankful. She ended up passing pretty soon after that. I remember her husband calling me, and they were so thankful for me.” (Participant “Jay”) - Faith is vase and you can’t assume anything regarding patients faith You will encounter several diverse patients with varying spiritual needs in your clinical placements and eventually your own practice areas Consider the following: o Psychosocial bereavement counsellors for caregivers of palliative patients through the palliative care outreach team in the community - we worry so much about the patient but forget about their community o Certain long term care homes have religious/cultural affiliations and will prioritize patients accordingly - LTC homes have affiliation o Eg. Shalom Manor, RH Lawson Eventide, Tabor Manor - Deteriorating patient and allowing them to have their spiritual needs to be met during this time o Patients in the hospital requesting a chaplain or religious rites - very trained and working with people about there own faith, religen or spiritality o Dietary and treatment restrictions based on religious beliefs NUSC 1P12: WEEK 10 PART 2: CHAPTER 11 GLOBAL & PLANETARY HEALTH DIVERSITY & HEALTH & CONTEXT & CULTURE (Potter et al., 2024) WHAT DO WE KNOW… What do you know about yourselves (self), the others in your family (other), and your culture (context)? Have you always lived in Canada? If so, do you know anyone who has moved to Canada from another country? What do you know about their experience? Consider the international nursing shortage and what you know about other health care systems. Imagine you decided to move to another country one day. What would that look like for you? What information would you need? What may be some of the challenges and opportunities related to that transition? LET’S THINK ABOUT GLOBAL HEALTH & CULTURAL CONTEXT… o As future nurses, do you feel prepared to care for patients and families from around the world? thinking about the world and not a narrow context- need to thing in a wide context o What have you been learning about that will help you to be aware of your biases, and establish therapeutic relationships regardless of culture, differences in beliefs, language barriers, etc.? o Do you feel prepared to expand your view of “caring” to a global context? What would that look like, why is it important? Medical tourism- people getting right of the plane to give birth to a child here in Canada o “Nurses have a role to promote and support actions to optimize the health of the environment because of the link to human health” (CNA, 2017 as cited in Potter et al., 2024, p. 139) o “The health of people is connected to the health of animals and the environment” (CDC, 2022 as cited in Potter et al., 2024, p. 139) - we have a global responsibility as a nurse not just for patients o How do things that are happening around the world (globally) impact our health and the health of Canadians (immigration for humanitarian reasons)? o Imagine you are caring for a family that has just fled Ukraine/Afghanistan and arrived in Canada o Canadian Immigration Measures and Support for Ukrainians o Since 2021 Canada has focussed on resettling Afghan refugees, with a target of 40,000 GLOBAL HEALTH NURSING Global Burden of Disease (GDB) ◦ Metric to quantify population health (morbidity and mortality for ex.) Millennium Development Goals and Sustainable Development Goals ◦ Universal goals and targets planned to address health and well-being to promote prosperity, end poverty, and provide protection for the planet Note: grey chart box 11.1 in textbook- what is the UN encourage the world to do to increase the worlds health and well-being ◦ “The optimal well-being of all humans from the individual and collective perspective” (CNA, 2009) ◦ Encompasses prevention, treatment, and care, while focusing on the improvement of health for all and health equity (Koplan et al., 2009) ◦ While we have talked about SDOH in the Imagine yourself working with many internationally Canadian context, if we step back educated nurses as your future colleagues. How further… what does this look like might this change and inform how you collaborate, globally? communicate, understand, and care for patients? EMERGING GLOBAL HEALTH ISSUES: A NURSE’S ROLE “Global health issues (GHIs) require global cooperation in response, planning, prevention, preparedness, and care that reflects health equity issues among nations. These issues require complex interprofessional and interagency cooperation and solutions that involve governments, non-profits, and many times include private companies and foundations. More than ever, the response to GHIs requires a broader understanding of how connected we are in today’s world. This article considers response to issues of emerging infectious diseases, human trafficking, maternal-newborn health; preparedness for health inequities within a framework of social justice, equity; and mal-distribution of health workers globally. We define and describe emerging global health issues from a nursing perspective and offer a call to action for nurses to increase awareness as global leaders.” Global drug shorteges, covid, supplies issues Edmonson, C., McCarthy, C., Trent-Adams, S., McCain, C., Marshall, J., (January 31, 2017) "Emerging Global Health Issues: A Nurse’s Role" OJIN: The Online Journal of Issues in Nursing Vol. 22, No. 1, Manuscript 2. INTERNATIONAL COUNCIL OF NURSES (ICN) https://www.icn.ch/ - great organization that has a lot of work to do ICN Mission: ◦ To represent nursing worldwide, advance the nursing profession, promote the wellbeing of nurses, and advocate for health in all policies. ICN Vision: ◦ The global community recognises, supports, and invests in nurses and nursing to lead and deliver health for all. CULTURE & CULTURAL DIVERSITY - can’t sillo people! ◦ Shared patterns of learned values and behaviours that are transmitted over time and that distinguish the members of one group from another ◦ Can include language, ethnicity, spiritual and religious beliefs, socioeconomic class, gender, sexual orientation, age, group history, geographic origin, education, and childhood/life experiences ◦ Multiculturalism - many culture co-existing ◦ Immigration ◦ Refugees ◦ Displaced persons - increase immigration not doing a great job to implement/ increased nurses in the work force ◦ Nurses must recognize the diverse values and understanding of health within social and economical contexts when providing care ◦ Nurses must plan, implement and evaluate care that is socially just ◦ Advocate for social justice ◦ Assess for social determinants of health (SDOH) in both socioeconomic and political context (especially employment/ working conditions; socioeconomic status/ poverty; and access to health care) ◦ Advocate for fair/just and safe employment environments ◦ Temporary workers: Charged exorbitant recruitment fees, forced to work unpaid overtime, subjected to dangerous working conditions, housed in sub-standard living conditions, income disparities ENVIRONMENTAL SUSTAINABILITY ◦An intact and healthy ecosystem ◦Disease is prevented by maintaining/ achieving healthy environments ◦“One Health”: the interdependence of humans, plants, and animals ◦Planetary health: the health of human civilization and the state of the natural systems on which it depends NUSC 1P12: WEEK 10 PART 3: CHAPTER 11 & 4 MARGINALIZED POPULATIONS & INTERSECTIONALITY Marginalized Populations: Chapter 4 (Community Health) Intersectionality: Chapter 11 (Global Health) MARGINALIZED ( POTTER ET AL., 2024, CHAPTER 4: COMMUNITY HEALTH NURSING ) Marginalized populations: those excluded from mainstream, social, economic, educational or cultural life (Potter et al., 2024, p. 52). Best understood in relation to SDOH. High priority populations: Populations exposed to the most risk through structural barriers of social exclusion, poor access, or dependency on others Who is “marginalized”? What can make someone “marginalized”? Why is this important for nurses to understand? Imagine you are a nurse, caring for a patient, what makes a patient “marginalized” and how does this impact how you care for them? What do we mean by “harm”? Other terms: underserved, disadvantaged people, structural vulnerability, equity-deserving groups Consider: Life circumstances, precarious conditions, marginalizing conditions, structural vulnerability vs. vulnerable populations. These terms shift us from a focus on the individual to their context including the system, attitudes, practices, policies, services, etc. What does that suggest? TERMS NOT the same on exam!!!! - the difference (POTTER ET AL., 2024, CHAPTER 11: P. 137) Health inequities ­ Differences in health that are unfair/unjust ­ Created by social conditions ­ Reflect unfair distribution of SDOH (access to education, good jobs, health care, etc.) Health disparities (sometimes used interchangeably with inequities) ­ Differences in health status linked with social, economic, and or environmental disadvantage ­ Adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, disability, sexual orientation or gender identity, geographic location, etc. Unfair social conditions or health inequities can cause disparities in health (shaping and exacerbating marginalization for some people more than others). these are just the start Any other things you can think of, or are there other ways we can explore or think about these potential conditions (alternate language, considerations, etc.)? Contextity and Depth INTERSECTIONALITY Not an easy term to know unless your educated “Intersectionality is a theoretical perspective regarding the influence of different social characteristics - race, ethnicity, gender, class, and socioeconomic status- on a particular phenomenon, such as the experience of health and its outcomes” (Potter et al., 2024, p. 137) What do you know about “intersectionality”? INTERSECTIONALITY Exploring the intersections of race, gender, and class and their impact on individual well-being has important implications for critically examining issues of justice and equity for marginalized populations TEDTalk – Kimberlé Crenshaw (1980s - Civil Rights Advocate – African American Feminist and Legal Scholar) TED talk - very racially driven- all face these intersentionalities she discuss - Not ‘group’ dependent!!!! very important for all problems, not just on what see is preaching!!!!!!!! - ‘if you can’t see a problem then you can’t fix a problem’ https://www.ted.com/talks/kimberle_crenshaw_the_urgency_of_intersect ionality?language=en#t-467942 LOOKING UPSTREAM they are the least likly people to ask for help Look at the root causes (look upstream) of vulnerability (SDOH and inequities) that produce poor health and affect health outcomes rather than trying to identify and target populations or individuals perceived to be vulnerable (look at why…) Take into account intersecting factors causing poor health ­ Look upstream at social, political, and economic factors influencing health •Crenshaw claims the law looks at issues of gender and race separately without sufficient attention to overlapping/compounding forms of discrimination (suggesting for example that BIPOC women experience structural injustice for this reason) •This argument acknowledges that disadvantages arise from the way society perceives particular individuals (social construction), rather than from characteristics inherent in those individuals. The concepts of health promotion, a socioenvironmental approach/SDOH, and intersectionality are important to understand in relation to one another versus in isolation. Source: https://cihr-irsc.gc.ca/e/52352.html REFLECTION… Think about community health, the health care system, the ethical principle of justice, SDOH, global health… Let’s also think about what we are exposed to, learning about, supporting, and advocating for with social movements in our world today… Let’s think about our own lives, our individual and ever-evolving “worldviews” (core beliefs and meanings that we use to explain the world around us and guide our way of being in the world). NUSC 1P12: WEEK 10 PART 4: CHAPTER 28 SEX, GENDER & SEXUALITY (Potter et al., 2024) SEXUALITY A central aspect of being human that is present throughout life beyond ­Encompasses sex, gender identity, sexual orientation + (WHO, 2021) Sexual health ­A state of physical, emotional, mental, and social well-being related to sexuality ­Characterized by a positive and respectful approach to sexuality and sexual relationships (WHO, 2021) How does sex, gender, and sexual orientation influence our worldview? How we see ourselves and others? unconcious biases, social constructed How is gender (and role identities) socially constructed? How has this impacted the nursing profession? SEXUAL ORIENTATION & GENDER IDENTITY Sexual Orientation o direction of one's sexual interest or attraction. It is a personal characteristic that forms part of who you are. It covers the range of human sexuality from lesbian and gay, to bisexual and straight (Rainbow Health Ontario, 2022) Gender Identity o person's internal and individual experience of gender. It is a person's sense of being a woman, a man, both, neither, or anywhere along the gender spectrum. A person's gender identity may be the same as or different from their birth-assigned sex (Rainbow Health Ontario, 2022) What year was same-sex marriage legalized in Canada? - legislation was past in 2005 https://www.rainbowhealthontario.ca/news-publications/glossary/ Sexual Orientation Gender * One is not equal to the other - what are brain say about are gender psychological sense of gender -sexual orientation- who you are attracted to - how you show yourself to the word - manerisiums - how they dress, act and behave - the physical part of the boy which is geneticly created inuterio - hormones, chromosomes, pitch LGBTQ2SI+ What do you think of this acronym? What are some individual and social implications and opportunities? - acronym has expanded o o o It is less important to know all the labels than it is to listen to what they mean to the person (be open to their individual interpretation and experience). Person who is.. Person who identifies as… is “identity-first” language. We want to use this just as we would do for a client with a chronic illness or any diagnosis. “I ask all of my clients/patients this…” “We ask everyone these questions…” “I always ask this…” CONSIDERATIONS - pronouns - what is social correct? Consider assumptions and stereotypes o Language and systems/processes (e.g. forms, documentation); gender-neutral words to refer to clients’ relationships o Preferred names and pronouns o Confidentiality of information shared o o o If you make a mistake, acknowledge it, apologize, be respectful and sincere, and seek to understand who they are. Don’t be afraid to ask/clarify Physical environment - signage, posters, washrooms, pamphlets/resources Terms - while can be helpful to understand them so you know what your client is trying to tell you if they use/ identify with a sexual orientation or gender identity, they should never be used to label others TRANSGENDER HEALTHCARE Transgender Clients (AMAB, AFAB) ◦ Physical body (sex assigned at birth) is incongruent with gender identity ◦ A transgender male/man is a person who was born female, identifies as male, and will typically use pronouns such as he and him ◦ A transgender female/woman is a person who was born male, identifies as female, and will typically use pronouns such as she and her ◦ Non-medical transition: legal, psychosocial ◦ Medical transition: hormone therapy, surgery ◦ Sex reassignment surgery, gender-affirming surgery ◦ Source: Gender confirming surgery | ontario.ca ◦ Remember he/she/they may be accessing health care for transition-related care, but don’t forget to see the whole person including their basic and general health and well-being. We don’t want to overlook other aspects of routine care (e.g. mental health assessment, risk of suicide, contraception, violence/ abuse, cancer screening). Source: SOGI Nursing Education http://www.can-sim.ca/games/courses/sogi-nursing-certification/ HEALTH PROMOTION & SEXUAL HEALTH o Safe sex and prevention of STIs (e.g. promoting use of condoms and making them accessible) o Preventing, screening for, and treating sexually transmitted infections o Contraception o Abortion referrals (funded procedure; no legal restrictions on abortion in Canada; personal values, consideration of own biases, beliefs, and values o Infertility o Violence, abuse, consent, assault o Sexual dysfunction (see Table 28.2, p. 484) o Screening o Vaccinations (e.g. for HPV (Gardasil®), a common STI that can cause cervical cancer) SEXUALITY & THE NURSING PROCESS Examples of nursing diagnoses ­Anxiety ­Interrupted family processes ­Deficient knowledge (contraception, STIs) ­Sexual dysfunction ­Ineffective sexuality patterns ­Social isolation ­Risk for other-directed violence ­Risk for self-directed violence NIAGARA: LOCAL RESOURCES QUEST Community Health Centre ­ www.questchc.ca Out Niagara ­ www.outniagara.ca ­Online bulletin board for the LGBTQ community in Niagara Rainbow Niagara ­ https://questchc.ca/participate-at-quest/rainbow-Niagara/ ­Offers support through QUEST community health centre ­Various support services for LGBTQ youth in the Niagara region including drop-in sessions and counselling