211 Community Nursing (SPRING) Study Cards - QUIZ 1

Question 1

What event in 2004 sparked the creation of the Public Health Agency of Canada?

Answer 1

SARS

Question 2

In what year and what organization recognized “the enjoyment of the highest attainable standard of health” as a fundamental right of every human being?

Answer 2

The World Health Organization in 1946

Question 3

Define advocacy.

Answer 3

• Most common ethical orientation in public health nursing practice that embraces the character of the WHO’s perspective on empowerment.
• It takes a stand for the practices, aims, and reforms that are in line with the moral goals of public health, which have a strong social justice orientation.
• Emphasis on advocacy activities that involve interventions to promote and protect the health of populations and that are sensitive to health inequities and marginalized and vulnerable populations.

Question 4

Define civic engagement.

Answer 4

• Civic engagement involves “working to make a difference in the civic life of one’s community and developing the combination of knowledge, skills, values and motivation to make that difference. It means promoting the quality of life in a community, through both political and non-political processes.”
• Civic engagement includes both paid and unpaid forms of political activism, environmentalism, and community and national service. National service, volunteering, and service-learning are all forms of civic engagement.

Question 5

List the 10 types of Practice Settings in the Community.

Answer 5

• public health nurse
• home health nurse
• rural nursing
• occupational health nurse
• community mental health nurse
• primary care nurse
• forensic nurse
• military nurse
• parish nurse
• telehealth nurse
• outreach/street nurse

Question 6

List 5 Common Roles that nurses working in community health nursing may perform in these various
Practice areas.

Answer 6

Teacher/ educator, facilitator, advocate, presenter, community mobilizer, evaluator, planner, policy developer, primary health provider

Question 7

Describe the difference between community-oriented versus community-based nursing approaches.

Answer 7

• Community-oriented nursing approaches are services that are aimed at the overall health needs of specific groups or populations within a community. Examples are: Nurses involved with public health, corrections, or schools who provide population-based health promotion approaches.
• Community-based nursing approaches are nursing services that are situated within a community. Examples of community health nurses are outpost nurses, home health nurses or clinic nurses.
• Some nurses could provide both.

Question 8

Define health disparities.

Answer 8

“… a particular type of health difference that is closely linked with economic, social, or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic -status, gender, age, or mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

Question 9

What are some examples of health differences?

Answer 9

These things could carry a direct correlation to each other regardless of health disparities:
Elderly vs Young
Male vs Female
Millionaires’ vs Non- Millionaires
Higher rates of arm injuries in tennis players vs the general population
Disease outbreak in affluent community

Question 10

What are some examples of health disparities?

Answer 10

Social, economic or environmental disadvantage
Happen to people who experience greater obstacles to health based on racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, physical disability, sexual orientation, gender identity, geographic location, or other characteristics linked to discrimination
- Literacy levels
- Unfair legislative policies
- Racism
- Discrimination
- Unequal availability of culturally or linguistically knowledgeable and sensitive health personnel
- Heavily influenced by Social Determinants of Health
- Another example: Canadians who live in remote regions of the country are not able to access nutritious foods such as fruit and vegetables as other Canadians.

Question 11

What are the 7 attributes for health disparities?

Answer 11

• Natural, biological variation
• Health-damaging behavior is freely chosen
• The transient health advantage of one group over another when one group is first to adopt a health-promotion behavior
• Health-damaging behavior in which the degree of choice of lifestyles is severely restricted
• Exposure to unhealthy, stressful living and working conditions
• Inadequate access to essential health services and other basic services
• Natural selection, or health related social mobility, involving the tendency for sick people to move down the social scale

Question 12

Before determining if something is a health disparity, we must first examine if it is a difference in inequity or inequality. To do so, explain the difference between inequity and inequality.

Answer 12

Inequity refers to unnecessary, unfair, avoidable and unjust differences arising from poor governance, corruption or cultural exclusion.

Inequality simply refers to the uneven distribution of health or health resources as a result of genetic or other factors or the lack of resources.

Equality is about sameness, fairness and justice by giving everyone the same thing. It can only work if everyone starts from the same place.

Equity is about fairness and making sure people have access to the same opportunities. Because there are often barriers that prevent some groups from receiving equal treatment we have to focus on equity before equality.

Question 13

List the determinants of health.

Answer 13

Income and social status
Employment and working conditions
Education and Literacy
Childhood experiences
Physical Environments
Social supports and coping skills
Healthy Behaviours
Access to Health Services
Biology and Genetic Endowment
Gender
Culture
Race/Racism

Question 14

True or false: Health disparities have overlap with the determinant of health?

Answer 14

True

Question 15

What are the four categories of health disparities?

Answer 15

1. Avoidable and acceptable
2. Avoidable and unacceptable
3. Unavoidable and acceptable
4. Unavoidable and unacceptable

Question 16

Define and give an example of an avoidable and acceptable health disparity.

Answer 16

Mostly not viewed as acceptable except in unique circumstances. Ex: natural disaster. Those involved in the natural disaster could have health effects and those who are not involved may not. The health outcomes are acceptable even if the disaster could have been avoidable.

Question 17

Define and give an example of an avoidable and unacceptable health disparity.

Answer 17

This is a big target of interventions. Ex. Unequal pain management in cancer patients with differences races. Can be related to cultural values and personal preferences but we need to be creative with our interventions then. It is avoidable because we can educate the patients and provide alternate therapies if wanted. Unacceptable because it puts a higher burden on the patient.

Question 18

Define and give an example of an unavoidable and acceptable health disparity.

Answer 18

Not a concern for the nurse. Ex: natural causes of aging on the body. Elderly people have higher incidence of hip fracture due to natural aging factors such as low bone density, arthritis, unstable gait.

Question 19

Define and give an example of an unavoidable and unacceptable health disparity.

Answer 19

Should be a concern for the nurse. Higher rates of disease in certain ethnic populations, could be due to genetic factors which makes it unavoidable. Unacceptable because it can get worse and can be linked to lack of accessibility, lack of affordability of healthcare and access to nutritious foods. Ex: Indigenous has higher risk of diabetes and due to healthcare settings they may not seek services or treatment.

Question 20

What type of health disparities are most often seen in the clinical and community health setting and need to be targeted?

Answer 20

Unacceptable and avoidable health disparities

Question 21

List examples of unacceptable and avoidable health disparities.

Answer 21

Lack of health insurance and high healthcare costs
- Less likely to get adequate care without health insurance or benefits, more likely to visit the ER and be admitted to the hospital, minorities are often enrolled in lower cost health plans with greater limits on spending, financial burden of benefits or health care coverage is expensive, high premiums

Lack of transportation to health care providers
People could be forced to isolate if they do not have transportation, or they end up spending a large amount of their budget on vehicle including other expenses, limited public transportation, disabilities may not be able to drive, often affordable housing is located far from main transport lines and commutes could be longer which reduces time for things like exercise, shopping or additional earning opportunities

Ineffective Provider-Patient Communication
Differences in reporting symptoms, threshold for seeking care, expectations of care, and adherence to preventative measures, patient may not feel comfortable asking questions, providers have less time to spend with patients when they are assessing them which can lead to miscommunication, fast paced environment, use of medical jargon

Language Barriers
Increased risk of nonadherence to medications, may have inaccurate diagnosis, use of informal interpreters can result in misunderstandings

Biased Clinical Decision Making
Disparities can often result from personal bias and personal beliefs, stereotyping leads to biased decision making this often occurs subconsciously

Patient’s Mistrust
- People may stop seeking treatment if they are facing discrimination, segregation and medical experimentation or general mistreatment

Question 22

Who is affected most by health disparities that are unacceptable and avoidable?

Answer 22

Minority populations
Low education levels
Low income levels
Rural communities
Immigrants
People with disabilities
Women
Can refer to DofH

Question 23

What is “stigma” and what are some characteristics?

Answer 23

Stigma is a strong feeling of disapproval that most people in a society have about something, especially when this is unfair.

Characteristics:

• Labelling of differences and negative stereotypes
• Separation between “us” and “them”
• Justifies the devaluing of people through stereotypes and exclusion
• Reinforced by unequal power dynamics in society
• Discrimination is ‘enacted’ stigma
• Effects health through stress
• Creates barriers
• Unjust treatment

Question 24

What impacts can stigma have?

Answer 24

• Effects health through stress: cortisol levels
• Creates Barriers: to housing, education, employment, and health services
• At higher risk of assault and injury
• Poorer mental and physical health

Question 25

How does stigma benefit those in power?

Answer 25

1. Keep people “In”: By enforcing preferred social norms and values
2. Keep people “Down”: Maintains one groups advantage in society
3. Keeps people “Away”: In order to avoid disease or a perceived threat

Question 26

What is the scope of social justice?

Answer 26

Working for social justice as a Community health nurse involves two guiding principles: recognizing inequities and taking action to eliminate them.
Recognizing inequities means identifying, understanding, and being able to describe inequities or injustices, the reasons for their presence, and how they affect population subgroups (including nurses). Responsible action to eliminate inequities means advocating for the reduction of the sources of oppression and working toward parity and fairness (CNA, 2009).

You might think of it as a continuum where nurses are aware or take action on one end, and being oblivious or choose not to act on the other.

Question 27

Does anyone benefit from the practice of stigma?

Answer 27

Yes. There are two groups impacted, those who are negatively impacted and another group…. The group that benefits from stigma, and benefits from the perpetuation of mainstream ideologies, that continue to maintain that settlers, people with European background are better.

Question 28

Does stigma causes significant costs to healthcare?

Answer 28

Healthcare costs associated with people not accessing services, waiting longer to go to hospital etc. Also included are costs related to poor productivity in the workplace.

Question 29

What are some examples of stigma practices as outlined in the Stigma model?

Answer 29

• discriminatory policies, norms, and behaviours
• Stereotyping and demeaning language and portrayals
• Social avoidance and exclusion of others
• Secondary stigma experienced by family, friends, or caregivers

Question 30

What are the ways that stigma can manifest?

Answer 30

1. Language – the words that people use in media, culture, health promotion initiatives, education, research, and policy shapes how people understand the world. We often use outdated language that can perpetuate stigma. Can use – people living with addiction.
2. Implicit or conscious bias – when someone reproduces negative stereotypes and myths about particular groups or individuals, resulting in discriminatory language differences ex: Canadian believe there are only two genders which shows in washroom signage, clothing labels, healthcare intake forms. Ex: previous patient with substance abuse issues, asks for something for pain
3. Lack of respect and understanding for people’s lives – this shows up a lot in Canadian because of colonialism and the unjust actions that were forced upon Indigenous people. The media is often not an accurate representation of real experiences. People often focus on individual factors and forget about the other social determinants of health that impact a person. Shows as lack of empathy and compassion
4. Fear of danger and of contagion – quarantine related policies, mandatory immigration screening, and notifiable disease frameworks can have unintended stigma attached to them. Immigrants can be seen as a specific public health threat and be blamed for carrying infectious disease. Fear can also drive stigma of mental illness.
5. Stigmatizing organizational culture – stigmatizing language, making assumptions, breaching confidentiality, using unnecessary precautions, and even in some cases, denying access to care. Burnout and compassion fatigue often contribute to this. There may be imposing rules and policies that do not fit everyone into a category, thus leaving some people uncategorized and unaccepted. Healthcare workers can often be reluctant to acknowledge or disclose their own stigmatized conditions because of lack of support.

Question 31

What are the characteristics of advocacy?

Answer 31

• advocacy is protecting
• It expresses and defends another’s cause
• Act as a client advocate (protects client, defends client from harm, represents client needs and wishes to others)
• Positive experience for nurse and clients