Ethical Considerations Flashcards
Borders
Hx, roles, standard, health equity, race & culture, evidence informed practice, community assessment & development
Middle
epidemiology, CD, environmental health, family nursing, structurally vulnerable populations, health policy, disaster nursing
Parish/Faith Community Nursing
Reaching out for more whole person ways of ministering to people who are hurting
Nursing Ethics: Morals
Shared and generational societal norms about what constitutes right or wrong conduct
Nursing Ethics: Values
Beliefs about the shared worth or importance of what is desired or esteemed within a society
Population Health Definition
To improve the health of groups of people while reducing health inequalities and their underlying determinants
Requires coherent multi-level policies in health and other sectors
Uses a social equity lens
Community Health: Three Common Dimensions
Status
Structure
Process
Community Health: Status
Physical - measured by morbidity & mortality rates, life expectancy and risk factors
Emotional - measured by satisfaction & mental health
Social components - reflected in crime rates; indiv and family functional levels
Community Health: Structure
community services/resources and structure (social indicators of health)
Community Health: Process
effective functioning/problem solving
Characteristics of Healthy Community
clean, safe physical environment
peace, equity & social justice
access to food, clean water, shelter, income, safety, work & recreation
Participation in decision making
Strong cultural and spiritual heritage
Diverse and robust economy
Opportunities for learning and skill development
Access to health services, including public health and preventive programs
Socio-Structural Determinants
- Authentic engagement of the community in planning, monitoring, and evaluating programs is essential in addressing SDOH
- Determinants do not reside in isolation from each other; they are nested/inter-related; and as one determinant changes, another may also shift
- The DOH approach recognizes the need to implement population health intervention at multiple levels of the system
- Research to uncover the social determinants include etiological and laboratory studies, integrative reviews, qualitative and quantitative
Intersectionality: Advanced critical community nursing work
A “lens” for understanding: How multiple social identities such as race, gender, sexual orientation, socioeconomic status and disability intersect at the micro level of individual experience to reflect interlocking systems of privilege and oppression
How to Avoid a cookie cutter approach: use an intersectional Approach.
Social Equity Lens
- Health care planning and policy development: crucial to ensure the health and social needs of population groups are met
- Negative stereotypes permeate across all levels of society. Present in media - serving to discriminate against individuals based on their age
- Note: there is considerable variability in health & functioning in population groups (homeless, older adults, LGBTQ2S)
- Viewing pop. Groups as a homogenous group does not acknowledge the diversity
Roles and Functions of CHNs
Public Health Nurse
Forensic Nursing
Home Health Nurse
Primary Care Nurse
Parish/Faith community nurse
Telehealth Nurse
Outreach/Street Nursing
Military Nursing
Rural Nursing
Occupational Health Nurse
Ethics and Community Health Nursing
CHNs are required to uphold the values identified in the CNA code of ethics for registered nurses and follow the Canadian community health nursing stardards of practice in ethical, legal, and professional nursing practice situations/
Two important ethical obligations CHNs face
Confidentiality
Accountability
CNA Nursing Values and Ethical Responsibilities
a) provide safe, compassionate, competent and ethical care
b) promote health and well-being
c) promote and respect informed decision making
d) honour dignity (worth of each person)
e) maintain privacy and confidentiality
f) promote justice
g) being accountable
Ethical principles for effective advocacy
- Act in the client (group/community) best interest
- act in accordance with the client’s wishes and instructions
- Keep the client properly informed (communication)
- Carry out instructions with diligence and competence
- Act impartially and offer frank, independent advice
- Maintain client confidentiality
Advocacy: a nursing responsibility
CNA Code of Ethics & CHNC Standards of Practice: advocacy as an important nursing responsibility
- reduce the occurrence or severity of public health problems
- For Community health nursing: Apply information and resources to effect systemic change that shape the way people in a community live
- For public health nursing: Advocacy is intended to benefit aggregates
Harm Principle
justification to take action to restrict the liberty of an individual or a group in order to prevent harm to others
Principle of Least Restrictive
achieve public health needs, but the full authority and power should be used for exceptional circumstances
Education, facilitation, and discussion should precede any restriction or coercive measures
Reciprocity Principle
Society must be prepared to facilitate individual and community efforts to discharge their duties
Transparency Principle
Manner and context in which decisions are made
Approaches to Diversity in Community Health Practice: CNA position statement
nurses require “knowledge, skill, attitudes, and personal attributes to maximize respectful relationships with diverse populations”
ASKED: mnemonic represents key questions to encourage reflexive practice
Awareness
Skills
Knowledge
Encounters
Desire
Approaching clients equitably =
practising nursing with awareness and an underlying respect for diversity
Key Health Inequities in Canada Report
- Adopt a human rights approach to action on the SDOH and health equity
- Intervene across the life course with evidence-informed policies and culturally safe health and social services
- Intervene on both proximal (downstream) and distal (upstream) DOH and health equity
- “public health actions that focus on individual-level behavioural determinants may inadvertently increase health inequalities in the absence of accompanying efforts that target “upstream” socioeconomic, political, cultural and environmental factors”
Targeting the spheres: Inequities
Critical equity-focused multi-level interventions are necessary:
individual, organizational, community and systemic problems
- community health programs must identify root causes of inequities
- engage diverse leadership and stakeholders
- develop collaborative partnerships
- build capacity at various levels
Planning - Implementation - Evaluation Cycle
Identify problem -> consider possible alternatives -> select best alternative -> design program -> implement program -> evaluate program -> analyze findings -> utilize results -> analyze situation -> back to start
