Midterm 1 Flashcards
Community Health Nurse (CHN)
- Professional bodies of Registered Nurses (RNs) working various roles in the community.
- Has knowledge on Public Health Science, Primary Health Care, Nursing Science and Social Sciences.
- Focuses on Promoting, Protecting & Preserving health.
- Public health promotions for individuals in the community.
- Community health reflects health of members.
- Health communities support health for individuals, families, groups, and populations.
- Health practices in divers health centers, schools, street clinics, youth centers, nursing outposts, etc.. meet health needs of its population.
Seven Functions of Community Health Nurses
- Public Health
- Health Protection
- Emergency Preparedness & Response
- Health Promotion
- Disease & Injury Prevention
- Population Health Assessment
- Health Surveillance
Public Health
Organization of society to keep individuals healthy, prevent injury, illness, and death. Combination of Programs, Services & Policies that Protect and Promote the Health of all Canadians.
- Protect neighborhoods, cities, and countries.
- Goal to enhance health status and promote health equity of communities.
Three Ps of CHN
Protection, Prevention & Promotion
Community Health Nurses of Canada (CHNC)
- Voice to Represent & Promote Community Health Nursing & Health Communities.
- Provides Community Health Nurses to share concerns & Issues.
- Are leaders in developing discipline Standards of Practice, Core competencies & Community Health Nursing Certification Process.
CHNC Standards of Practice
- Health Promotions
- Capacity Building
- Prevention and health protection
- Health Equity
- Health Maintenance, restoration, and Palliation
- Evidence Informed practice
- Professional relationship
- Professional responsibility and accountability
Health Portfolio
- Health agencies responsible for maintaining & Improving Health of Canadians.
- Maintained by Jean-Yves Duclos (Ministry of Health)
Five Agencies
1. Health Canada
2. Public Health Agency of Canada (PHAC)
3. Canadian institutes of health research
4. Patented Medicine Prices Review board
5. Canadian Food inspection agency
HISTORY: Community Health Nurse (CHN)
- Started with the practice of First Peoples using Traditional medicines & Healing practices.
o Indigenous women provided essential Health care to European Settlers.
o Epidemics of Infectious diseases introduced by European Settler.
-> War, Denigration of Indigenous cultures, and colonization of Canada lead to Social Health, & Economic Disparities of Indigenous Peoples.
History: 17th Century CHN
Introduction of Community health Nursing (CHN) by the Duchesse d’Aiguillon sisters.
o Health care in Homes, Hospitals, and Communities.
o Grey Nuns were the first community nursing order to understand Health Inequity and made contributions to;
-> Access to Health Services – Street Outreach
-> Food, Shelters & Education – for the Vulnerable
History: 19th-20th Century CHN
Hospitals, Private duty, Public Health & Home Care.
o Women volunteer and Leadership in communities was essential in the development for Community Health Nursing;
-> Lobby local officials
-> Serve tea at child welfare clinics
-> Provided transportation
-> Made referrals & Raised funds
History: 20th Century CHN
Infant Mortality rates climbing until 22nd Century.
o Health Education developed.
o Public Health Nurse (PHN) roles expanded from TB & School Nursing to Child Hygiene Programs & School Inspection Programs.
Canada Health Act & Health Promotion
- Health Promotion:
o Access to Health Services.
o Protect, Promote and Restore Physical and mental well-being of Canadians. - Only Medically necessary Physician Services & Hospital Services are publicly funded.
- Faces ideologies favouring efficiency & Short-term outcomes.
- Chronic disease prevention and management require more broad policy options.
Q: What are categories of early community health Nursing
- Substance use
- Mental health
- Health promotions
- Addiction
- School health
- Harm reduction
Q: Which organizations belong to the federal portfolio?
a. The Canadian Public Health Association
b. The public health Agency of Canada
c. Community Health Nurses of Canada
d. Health Canada
B & D
Q: The community Health Nurses of Canada “standards of Practice” includes how many standards?
8
Q: Which of the following organizations provides information regarding food labels and safety
a. Public Health Agency of Canada
b. Public health
c. Health Canada
d. Canadian Public Health Association
C
Q: Which organization provides reliable information regarding PH concepts like vaccines and outbreak notices?
a. Health Canada
b. The public Health Agency of Canada
c. The Canadian Public Health Association
d. Community Health Nurses of Canada
B
Q: Who Provided the earlier forms of Healthcare in Canada?
First peoples
Q: The Grey Nuns were thought to have been the first to provide what kind of nursing?
Street outreach
Q: What types of epidemics were experienced after first contract with European settlers?
a. Tb and influenza
b. Diphtheria
c. Smallpox & Measles
d. Cholera
e. Typhus
f. All the Above
F
Q: The PHN’s role historically included which of the following at first?
a. TB Nursing
b. School Nursing
c. Child Hygiene Programs
d. Sanitation Programs
e. School inspection Programs
A & B
Q: How many criteria must provinces and territories meet under the Canada Health Act?
5
Q: Under the Canada Health Act, portability means there can’t be a waiting period more than how long?
3 months
Q: The term “Community Health Nurse” is a
a. Exciting
b. Broad
c. Umbrella
d. Confusing
C
Q: Who is known as Canadas first Nurse?
Jeanne Mence
Q: In late 19th century the term “Public Health Nurse” (PHN) is coined by American nurse _____________
Lillian Wald
Public Health
- Organized efforts of society to keep people Healthy & Prevent injury, illness, and premature death.
- Combination of Programs, Services, & Policies that Protect the health of all Canadians.
Public Health Agency of Canada (PHAC):
-> Established in 2004 and is Federal.
-> Mission – promote & Protect the health of Canadians through Leadership, Partnership, Innovation and Action in Public Health.
Six Essential Functions of Public Health
- Health Promotion
- Health Surveillance
- Population Health Assessment
- Disease and Injury Prevention
- Health Protection
- Emergency Preparation & Response
6 Functions of Public Health: Health Promotion
- Alcohol
- Child and Youth Health
- Healthy Eating
- Injuries
- Maternal and Infant Health
- Mental Health
- Oral Health
- Physical Activity
- Substance Use
- Tobacco and E-Cigarettes
6 Functions of Public Health: Health Surveillance
- Collection and analysis “Data & Analysis” of health data to detect early signs of illness & diseases trends.
- Information provided is needed to mitigate disease impact.
6 Functions of Public Health: Population Health Assessment
- Evidence informed process involving defining and assessing health status and needs of the community.
- Supports community engagement and planning.
6 Functions of Public Health: Disease and Injury Prevention
- Contributed to quality of life of Canadians
- Diseases & Conditions:
o Chronic Diseases + Conditions
o Health Care Associated Infections
o Infectious Diseases
o Injuries
o Mental Illness and Substance Use
6 Functions of Public Health: Health Protection
- Uses latest evidence to advance knowledge and Guidelines for practice.
- Surveillance data for monitoring and response.
- Monitor vaccine safety.
6 Functions of Public Health: Emergency Preparation & Response
- WHO: “strategic Framework for Emergency Preparedness”
- Safeguards water supplied or food sources
Public Health Achievements
Safe & Healthier foods: Contaminated food & water was a major concern (Typhoid, Tuberculosis, Botulism).
Control of Infectious Diseases: Controls spread of diseases, surveillance, and Chain of Infections.
Health Environment: Environmental Policies, reduced toxic emissions, improved air and water.
Vaccinations: Vapor Pressure Deficit (VPD) related deaths are significantly lower.
Tobaccos as a Hazard: Consumption in Canada has declined dramatically due to control efforts.
Motor Vehicle Safety: Preventable injuries, laws against drinking & driving, seat belts and car seats.
Universal Policies: Universal Access to Health care.
Safer Workplace: 1988-1006 number of injured per 1000 workers dropped from 60 to 40.
Family Planning: All forms of contraception became legal in Canada in 1969. 2 years later federal government began funding birth control.
VACCINES: Preventable Disease Deaths in Canada
- Pertussis: Ranked 45th, no documented deaths in 2020.
- Meningococcal Infections: Ranked 42nd, 8 deaths in 2020.
- Acute Poliomyelitis: Ranked 45th, no documented deaths in 2020.
- Measles: Ranked 45th, no documented deaths in 2020.
Public Health in Canada
Average lifespan of Canadians increased by more than 30 years since 1900s.
o 25 years of advances in Public Health.
Public Health Ontario (PHO)
- Partner with Government, Public Health & Health Care.
- Goal to Prevent illnesses and Improve Health.
- Scientific evidence and Guidance shapes Policies and Practices.
Disease & Injury Prevention
- Ways that Public Health Nurses can intervene
- Strategies aim to prevent onset of disease by risk reduction & downstream complications disease.
5 levels of prevention
- Primordial Prevention
- Primary Prevention
- Secondary Prevention
- Tertiary Prevention
- Quaternary Prevention
- Primordial Prevention
Prevent conditions, inhibit emergence and factors that increase risk of disease (environmental, economic, social, behavioral, cultural).
- Primary Prevention
- Prioritizes lessening the impact, of risk factors, reducing occurrence of incidence of a disease.
- Initiates before physiological or psychological abnormality identified.
- Secondary Prevention
- Identify disease processes as early as possible (preclinical stage) reducing prevalence.
- Disrupt before manifestations / symptoms are observed.
- Targets those already accessing healthcare services.
- Tertiary Prevention
- Aim to reduce the impact of long-term diseases and disability by eliminating or reducing impairment or disability.
- Occurs after sign or symptoms are present.
- Quaternary Prevention
- Identifies population at risk of over-medicalization.
- Guidelines and Policies to help protect individuals.
- Protects populations from new medical procedures or interventions that are untested.
Health Promotion
- Process of enabling people to increase control and improve their health to reach state of complete physical, mental, and social well-being.
- Individual must be able to identify and realize aspirations, satisfy needs, and chance or cope with environment.
- Canada is Health Promotions birthplace.
- Looks at improving overall well-being.
Ottawa Charter for Health Promotion
- Created in Ottawa in 1986, for worldwide use.
- Presents strategies and approaches for Health promotions
- Five key actions for health promotions
Upstream
- Acute care services + tertiary prevention
- Focused on individual treatment and cure
- Microscopic lens
- Focus on providing equitable access to care and mitigating the negative impacts of disadvantages on health.
Downstream
- Often prevention and promotion strategies focused on policy interventions that benefit the whole population or primary health care interventions that focus on well-being by addressing the root cause.
- Big picture/macroscopic.
- Improve fundamental social + economic structures and decrease barriers
Primary Health Care (PHC)
- Essential Health care made universally accessible to individual by participation.
- Focus on Health Equity
- Achieving Health should be priority in all sectors, not just healthcare.
Principles of Primary Health Care
1. Accessibility
2. Public Participation
3. Health promotion
4. Appropriate Technology
5. Intersectional Collaboration or cooperation
Eight Elements of Primary health Care
- Education about health problems and prevention techniques
- Promotion of food supply and proper nutrition
- Adequate supply of safe water and basic sanitation
- Maternal and child health care, including family planning
- Immunization against major infectious disease
- Prevention and control of locally endemic diseases
- Appropriate treatment of common diseases and injuries using the PHC principle of appropriate technology
- Provision of essential drugs
Health Equity
- Individuals have fair opportunity to reach fullest potential.
- Causes related to social environment:
o Income, Social Status, Race, gender, Education, Physical environment.
Social Determinants of health
Initially created to help understand why people of different social-economic groups experience different health outcomes.
Initiatives for Nurses targeting determinants
- Reduce child and adulthood poverty levels.
- Increases minimum wage to living wages.
- Advocate for progressive taxation.
- Advocating for intersectional action on health.
- Supporting political parties at provincial, territorial and federal levels.
* Encouraging greater workplace democracy to increase number of unionized workplaces.
Population Health Promotions
- Requires comprehensive, multi-step approach.
- Taking action on interrelated conditions that affect a populations health to create change.
- Maintains and improves health of a population.
- Reduces disparities in health status between people.
- Relationships between Population Health & Health Promotions.
Q: Water Purification and monitoring is an example of which public health function?
A. Health Surveillance
B. Health Protection
C. Health promotion
D. Disease and Injury Prevention
B
Q: Iodine Supplementation in salt is an example of what level of prevention?
A. Quaternary
B. Tertiary
C. Primary
D. Primordial
D
Q: Immunization programs are an example of what kind of prevention?
Primary
Q: The CHN wants to design a secondary prevention program. Which of the following would be correct?
A. Data base support group
B. Screening diabetic patients for retinopathy
C. Cervical cancer screening programs
D. Medication administration reminder program
C
Q: T or F, Primary Health Care and Primary Care are the same thing?
False
Q: How many social determinants of health does the Toronto Charter recognize?
12
Q: Restaurant inspections are examples of which public health essential function?
A. Health protection
B. Health Promotion
C. Health Surveillance
D. Disease and injury Prevention
A
Q: Communicable disease reporting is an example of which of the following?
A. Health protection
B. Health Promotion
C. Health Surveillance
D. Population Health Assessment
C
Q: A health Status report identifying the needs of a community is an example of?
A. Health Surveillance
B. Population Health Assessment
C. Disease and Injury Prevention
D. Health Promotion
B
Q: Immunization programs are examples of which of the following?
A. Health promotion
B. Health Surveillance
C. Disease and Injury Prevention
D. Emergency preparedness
C
Q: Screening for occupational cancers like lung cancer in firefighters is an example of?
A. Health protection
B. Health Promotion
C. Disease and Injury Prevention
D. Health Surveillance
C
Q: The active living community action project works to create programs to increase Ontarian’s physical activity levels is an example of?
A. Health Protection
B. Health Promotion
C. Health Surveillance
D. Population Health Assessment
B
Q: A CHN advocating at town council for the creation of bike paths. This Is an example of?
A. Health promotion
B. Injury and Disease Prevention
C. Health Protection
D. Health Surveillance
A
Q: A public Health nurse is consulting with the local hospital to review and update the code black policy, this is an example of?
A. Health Promotion
B. Health Surveillance
C. Emergency preparedness and Disaster response
D. Health Protection
C
Nursing Metaparadigm
- Initially identified by Fawcett, describing key aspects of nursing knowledge.
- Updated by Schim & Benkert, added Social Justice increasing relevance for CHNs.
- Social Justice named as values of CHNs and incorporated in all CHNC Standards.
Social Ecological Theory
- Theory that influences health by interplay among individuals or communities (family, culture, and physical & social environments).
- Follows Social, Institutional and Cultural contexts of people.
- Looking to explain Social Inequalities in health and how they are distributed in the population.
Critical Social Theory
- Addresses power differentials and social inequities that affect health.
- Used to inform CHNs work with disadvantaged populations.
- Challenges the status quo and engages with problems of society through social transformation.
Feminist Theory
- Encompasses perspective that improves the lives of women and in turn, change the lives of all people.
- Movement to end sexism, sexist exploitation, and oppression, focusing on equity, oppression, and justice.
Post-Colonial Theory
- Challenges us to consider oppressive structures assuming a view reflecting dominant discourse and culture, giving voice to subjugated and Indigenous knowledge.
- Contributes to understanding how historical influences may exert an effect on current experiences of individuals.
- Challenges assumptions by encouraging self-reflection and exploration of oppression within nurse-client relationship.
Intersectional Theory
- Understand how multiple social identities and inequities intersect at the level of individuals and reflect social construction of oppression and privilege.
- Examines difference and influence of power.
- Way of understanding complexity in the world, in people, and human experience.
- Helps explain power dynamins and factors that influence how power is used in society.
- Emphasis on: Class, Religion, Culture, Race and Gender.
- Disease and Health conditions are not shared equally among all Canadians
o Social and economic conditions determine the likely hood of getting sick and dying – Health Inequities
What do Community Health Nurses do?
Care for people: Where they live, learn, play, worship, and work.
Improve Health: Promoting, preserving, and protecting the health of all.
Practice Orientated: Build individual or community capacity and facilitate equity.
Accountable: Demonstrate professional responsibilities and accountability.
Determine: Who and where their clients are and why, what, when and how to promote health.
Today: Provide care to range of patient populations and respond to diversity and changing population demographics.
To do so: Work autonomously to build community partnership to achieve health for all.
How?: Use community health nursing processes and tools to reduce health inequities.
What is a Community?
- Group of people who live, learn, work, worship and play in an environment.
- Share common interest and characteristics.
- Functions within large social systems (organization, religion, province, or nation)
- Characterized by age, gender, socioeconomic status, education level, occupation, ethnicity and religion.
Community Dynamics: Communication
Strong and cohesive patterns of communication
Vertical communication: Links community to larger communities or with higher decision-making power.
Horizontal communication: Connects community to work collaboratively with own members.
Diagonal communication: Reinforces cohesiveness of vertical and horizontal.
Community Dynamics: Leadership
Lead members by influencing decision making process using statis and position in the community.
Formal leader: Elected politicians, mayors, members of parliament, prime minister.
Informal leader: Individuals with prominent positions, religious leaders, executives, representatives of organizations, elders, philanthropists, celebrities, or local heroes.
Community Dynamics: Decision Making
Formal Leaders: Use government policies to make decisions for community.
Informal Leaders: Use status to influence community groups and effect change.
Effective leaders collaborate with community groups to advocate for optional change.
Epidemiological Framework - Triangle
- Used to examine the frequency and distribution of a disease of health and social condition in a population being studied.
- CHNs determine what the community is (environment), who is affected (host), why and how it occurred (agent).
Community Capacity Approaches: Capacity Building
- Process that strengthens ability of an individual, organization, community or health system.
- Aimed at developing and implementing health promotions.
- Involves human resources and skill development, leadership, partnership, resource allocation, and policy formulation.
- Enables community members to take responsibility of their own development.
Population Health: Builds on Health Promotion + Public Health
- Prevention and disease management.
- Approach to health, aims to improve health of population and reduce inequities among groups.
- Population health template has 8 key essentials
o Population health focus
o Address DOH and their interactions
o Base decision on evidence
o Increase upstream investments
o Apply multiple strategies
o Collaborate across sectors and levels
o Promote public involvement
o Accountable for health outcomes
Population Health: Focus on the health of Populations
- Determine indicators for measuring health status.
- Measure and analyze population health status and health status inequities to identify health issues.
- Assess contextual conditions, characteristics, and trends.
Population Health: Address the Determinants of Health and their Interactions
- Determine indicators for measuring the determinants of health
- Address the Determinants of Health and their Interactions
- Measure and analyze the determinants of health and their interactions, to link health issues to their determinants
Population Health: Base Decisions on Evidence
- Use best evidence at all stages of policy and program development
- Explain criteria for including or excluding evidence
- Draw on a variety of data
- Generates data through mixed research methods
- Identify and assess affective interventions
- Disseminate research findings and facilitate policy uptake
Population Health: Increase Upstream Investments
- Apply criteria to select priorities for investment
- Balance short and long term investments
- Influence investments in other sectors
Population Health: Apply Multiple Strategies
- Identify scope of action for interventions
- Establish a coordinating mechanism to guide interventions
- Take action on the determinants of health and their interactions
- Implement strategies to reduce inequities in health status between populations
- Apply a comprehensive mix of interventions and strategies
- Apply interventions that address health issues in an integrated way
- Apply methods to improve health over the life span
- Act in multiple setting
Population Health: Collaborate Across Sectors and Levels
- Engage partners early on to establish shared values and alignment of purpose
- Establish concrete objectives and focus on visible results
- Identify and support a champion
- Invest in the alliance building process
- Generate political support and build on positive factors in the policy environment
- Share leadership, accountability and rewards among partners
Population Health: Employ Mechanisms for Public Involvement
- Capture the publics interest
- Contribute to health literacy
- Apply public involvement strategies that link overarching purpose
Population Health: Demonstrate Accountability for Health Outcomes
- Construct a results-based accountability framework
- Ascertain baseline measures and set targets for health improvements
- Institutionalize effective evaluation systems
- Promote the use of health impact assessment tools
- Publicly report results
Q: The nursing meta paradigm relating to CHN’s includes which of the following key aspects?
1. Client safety
2. Social justice
3. Health equity
4. Population focus
2
Q: An aggregate consists of?
1. 2 or more people
2. Group of people with common interests, demographics, and socioeconomics
3. Diverse group of people residing within the boundaries of a community
2
Epidemiology
The study of the occurrence of health-related states and events and determinants in specific populations and have the knowledge to control the problem.
Purpose of Epidemiology
- Describe health related events by answering the who, what, when, and where, by following trends in the population.
- Examine how and why by causality and modes of transmission.
- Results in implementing controls to prevent new illness, cure if possible, and rehabilitate or prevent complications.
Epidemiological model: Host
- Family history
- Sex
- Age
- Race
- Genetic profile
- Occupation
- Religion
- Previous diseases
Epidemiological model: Agent
- Biological / infectious - bacteria, virus, fungi
- Chemical – Smoke, poison, alcohol
- Physical – heat, cold trauma, radiation
- Nutritional – Excess, lack
- Psychological - Stress
Epidemiological model: environment
- Physical – Weather, geography, pollution
- Biological – Plants and animals, microorganisms
- Social – neighbourhood, housing, work
Susceptibility
- Combination of characteristics of each individual.
- Interacts with factors present or absent in other elements of the epidemiologic triangle.
- Factors may increase or decrease risk or susceptibility.
Modes of Transmission
Direct Transmission:
- Contact between the person with the disease and another through skin-skin or sexual contact
Indirect Transmission:
- Involves a common vehicle or vector
- Water, vector, vehicle, etc.
Disease preventions
Pre-pathogenesis or “etiologic” phase
- Primordial + Primary Prevention
Pathogenesis phase
- Secondary, Tertiary, Quaternary Prevention
Association and causation
How” and “Why” of a health challenge
Association
- Reasonable evidence that a connection exists
Causation
- Confirmed cause and effect relationship
Measurements in Epidemiology: Mortality Rates
“Death Rates” HCP must complete death certificates and file them with the government, making these available.
Example: Total number of deaths in Canada
Measurements in Epidemiology: Crude Mortality Rate
Compares the number of deaths from a specific cause within the entire population
Example: All deaths from MVC’s and compared them with the total population
Measurements in Epidemiology: Specific Mortality Rate
Compares the number of deaths from a specific cause in a particular subgroup with that whole subgroup
Example: Only teenage male deaths from MVC’s and compared with the number of male teens driving at the time.
Measurements in Epidemiology: Morbidity Rates
Illness rates that give a picture of a population and a disease/health challenge over time. Suggests susceptibility or effectiveness of health promotion/ treatment strategies
Measurements in Epidemiology: Prevalence Rate
- Picture of a specific disease process in a population at one given point in time.
- Formula: # of people with given disease in a population during a specified time period. Divided by the total in given population at the same point in time
Measurements in Epidemiology: Incidence Rate
- Describes the identification of new cases of a disease in a population over time
- Formula: # of new cases of given disease in a population during specific period of time. Divided by average total population within the same specified time period
Communicable disease
- Improvements in sanitation, implementation of infection control, procedures and programs, vaccine programs, and antibiotics caused a decline in morbidity and mortality rates related to communicable diseases
- Advances in technology and medicine have helped shift the view away from response and treatment, to prevention, control and early detection
- Increasing population mobility and environmental changes have created new challenges
Historical Perspective
- TB, smallpox, leprosy, cholera, scarlet fever, typhoid fever, diphtheria, and poliomyelitis
- First recorded worldwide threat from a communicable disease
o Bubonic Plague “Black Death” - Spanish influenza pandemic of 1918
- Migration to Canada
Smallpox
- In 1967, 60% of the worlds population was at risk for smallpox
- Variola virus
- 3000 years
- Vaccine created by Edward Jenner in 1796
- Declared eradicated 1980
- Expanded education programs and immunizations
Tuberculosis
- Tuberculosis (TB) caused by Mycobacterium tuberculosis and is a reportable disease in Canada (has been since 1924)
o Latent TB is not reportable - Airborne transmission
- Known as “consumption”
Routes of Transmission: Contact Precautions
- Microorganisms are transferred through physical contact between source and host, or passive transfer
- Common: C.diffcile, MRSA, VRE
- PPE: Gloves, long-sleeved gown
Routes of Transmission: Droplet Precautions
- Droplets containing microbes are propelled short distances (2 meters)
- Sneezing, coughing, talking, AGMPs
- Common: rubella, mumps, bordetella pertussis
- PPE: Facial protection
Routes of Transmission: Droplet/Contact Precautions
- Droplets containing microbes are propelled short distances + microbes transferred on direct and indirect contact
- Common: cough, fever, URTI,
- PPE: Facial protection, mask, gloves, gown
Routes of Transmission: Droplet Precautions
- Small particles containing droplet nuclei are propelled and remain suspended in the air
- Sneezing, coughing, talking, AGMPs
- Common: TB, varicella zoster, rubeola virus (measles), monkeypox
- PPE: Negative pressure room, N95
Chain of Infection: Infectious Agent
- Includes bacteria, viruses, fungi, parasites
- Can be endogenous flora or exogenous flora
- Antimicrobials, disinfectants, and hand hygiene will kill microorganisms and break this link in the chain
Chain of Infection: Reservoirs in Health Care
- Humans, animals and the environment
- Hand hygiene following contact with individuals + environment, preoperative skin prep, cleaning the environment help break this chain
Chain of Infection: Portals of Exit
- Route by which the infectious agent leaves the reservoir
- Blood, body fluids, excretions, secretions and the integumentary system
- Reducing excretions and secretions, or covering portals of exits (dressings + masks) help break this chain
Chain of Infection: Portals of Entry
- How the agent enters the host
- Examples: mucous membranes of the respiratory tract, GI tract, urinary tract, broken skin
- Link can be broken by covering wounds, wearing PPE, using sterilized instruments, and hand hygiene
Chain of Infection: Susceptible Host
- Individuals must be susceptible for an infection to occur
- Factors specific to the infection ie: cell receptors
- Immunity levels
- Link can be broken by ensuring immunization, optimal nutrition, reduction of smoking and control of diabetes
Donning & Doffing PPE
Donning
1. Hand hygiene
2. Put on gown
3. Put on masks +/- N95
4. Put on eyewear
5. Put on gloves
Doffing
1. Remove gloves
2. Remove gown
3. Hand hygiene
4. Remove eye protection
5. Remove mask +/- N95
6. Hand hygiene
Vaccine preventables
- Vaccination is seen as of one of the greatest contributions to global health (apart from clean water and sanitation!)
- Work by creating an immune response by stimulating the body’s immune system to make antibodies
- Immunity can often last a lifetime, but does sometimes require a booster or annual dose
Vaccine preventables: Community/herd immunity
- The resistance of a group to invasion and spread of an infectious agent
- Based on a high proportion of individual members of the group being resistant to infection
Vaccine preventables: Sexually Transmitted Infections (STI’s)
- Passed from one person to another through sexual and non-sexual contact
- More than 30 different bacterial, viral, parasitic infections
- Transmitted through sexual contact (vaginal, anal, or oral sex)
- Can also be transmitted through skin-skin- contact (herpes and HPV), contact with blood, or during pregnancy/childbirth
- There are four reportable STI’s in Canada
- Chlamydia, gonorrhoea, syphilis, and human immunodeficiency virus (HIV)
- Since 2006 rates for chlamydia, gonorrhoea, and syphilis have even rising
- Incidence rates are highest amongst adolescents and young adults
Vaccine preventables: Water-Borne Pathogens
- Usually enter water supplies through fecal contamination from animals or humans
- Example: cholera, typhoid fever, dysentary, salmonella, shigellosis, vibrio, and variants of e.coli
- Municipal water systems with appropriate filtration and chlorination have decreased diseases
- Not all bacteria are managed with chlorine though!
Vaccine preventables: Zoonotic Diseases
- Transmitted between animals and humans
- Humans are not needed to maintain life cycle
- Transmission occurs through bites, inhalation, ingestion, and direct contact
- Examples: Rabies, hantavirus pulmonary syndrome, salmonellosis, listeriosis, brucellosis
Vaccine preventables: Rabies
- Highest case-fatality rate of any known human infection - essentially 100%
- Major carriers are bats, foxes, raccoons, and skunks
- The best prevention is the vaccination of animals against rabies, and pre-exposure vaccination of people working with animals
- Post-exposure prophylaxis (PEP): is available after exposure with consultation with public health officials
- Most infected animals succumb to rabies within a 5 day period
Q: Which of the following is NOT a function of epidemiology?
1. Describing
2. Explaining
3. Predicting
4. Controlling
5. Organizing
5
Q: The number of deaths related to overdose in Canada is an example of?
1. Mortality Rates
2. Crude mortality rate
3. Specific mortality rate
2
Q: The number of opioid related deaths in Ontario men ages 20-35 compared with all men in Ontario is an example of?
1. Mortality rates
2. Morbidity rates
3. Crude mortality rates
4. Specific mortality rates
4
Q: There are 38.25 million Canadians, 7.5 million of them are currently living with hypertension. The CHN can calculate which rate?
1. Prevalence rate
2. Incidence rate
3. Mortality rate
1
Q: “Susceptibility” is used to describe this other term?
Vulnerability
Q: What were the two forms of epidemiological data collected in the 1600’s?
Births and Deaths (birth and death rates)
Q: The first case-control study examined the relationship between?
Smoking and lung disease
Q: How many “building blocks” are there in epidemiology?
6
Q: Chlamydia is a sexually transmitted infection, and is transmitted?
1. Directly
2. Indirectly
1
Q: Which of the following is an example of an “agent” characteristic regarding the epidemiologic triangle?
1. Family history
2. Vodka
3. Geography
4. Housing
5. Age
2
Q: What are “host” characteristics?
Age, family history, race, genetic profile, occupation, religion/customs, marital status, previous disease/immune system
Q: Giardia is a water-borne illness, what mode of transmission would it take? (Direct/Indirect)
Indirect
Q: What was the first recorded worldwide threat in terms of communicable disease?
The bubonic plague/black death
Q: Which of the following communicable disease (CD) has been declared eradicated?
1. Shingles
2. Smallpox
3. Tuberculosis
4. Poliomyelitis
2
Q: What kind of transmission precautions do we use with TB?
1. Droplet
2. Droplet/contact
3. Contact
4. Airborne
4
Q: Name a portal of exit:
Blood, body fluids, excretions, secretions from wounds, integumentary system
Q: Droplet/contact precautions require all of the following PPE with the exception of?
1. Mask
2. Gloves
3. Gown
4. Eye protection
5. N95
5
Q: T or F, Tetanus is a reportable disease in Ontario
True
Q: All of the following are reportable STI’s in Canada with the exception of?
1. Chlamydia
2. Gonorrhoea
3. Syphilis
4. Herpes Simplex Virus (HSV)
5. Human Immunodeficiency Virus (HIV)
4
Sex
- Determined by X and Y chromosomal makeup.
- Assigned at birth
- Male, Female or Intersex
- Biological and physiological characteristics
Gender
• Gender is a concept that we as individuals cultivate, develop, and understand based on what society reinforces through social and institutional norms
• Gender is the expression of one’s sex in terms of masculinity and femininity and is rooted in culture and history
• Gender is recognized as a key social determinant of health
WHO defines gender as:
• “The characteristics of women, men, girls and boys that are socially constructed”
• Includes norms, behaviours, roles, and relationships with each other
• Varies between societies and can change over time
Issues based by intersex communities: Infants + Children
- Majority of infants born with “genital ambiguity” are otherwise healthy, and genital surgery isn’t recommended until the child is old enough to participate in the decision
- Medically unnecessary cosmetic surgery’s and procedures to revise the initial surgery
- Initial assignment may not fit with the individual as they mature
- Repeated genital exams
- Parental distress
- Lack of peer support
Issues based by intersex communities: Adults
- Gender transition if initial sex assignment is incorrect
- Providers uneducated in intersex issues
- Access to health insurance
- Dependence on hormone therapy
- PTSD and other mental health concern
- Scarring/loss of sensation due to prior genital surgery
- Fear of intimacy
- Lack of peer support
Caring for the Intersex Community
- Intersex Is used as it is the least stigmatizing.
- Some individuals hold intersex as an identity, while some do not
- Individuals should have autonomy to use whichever term(s) they prefer when speaking about their own body and preferences
- Recognize that historically some intersex individuals have been denied access to true and accurate information about their own bodies, medical histories, and have have medical procedures performed without consent
- Discuss in a warm and matter-of-fact manner that intersex is more common than people think
- Ask what pronouns and terminology someone prefers never assume
- Don’t assume gender identity or sexual orientation
- Don’t assume the patient has menstrual periods
- Understand right to refuse to be examined, observed, or treated by trainees
Understanding Health Outcomes - Intersex
Essentialist Thinking
- True essence
- Based on hormonal differences
Biology As Destiny
- Enforces gender stereotypes
- Lifespan approach to care
Gender Norms
- Are ideas on how men and women should act
- Social principles that govern behaviour and can restrict gender identity
- Includes traditional “masculine ideals”
- Self reliance, stoicism, emotional control
- Includes traditional “feminine ideals”
- Quiet, nice, selfless, passive, emotional, thing, defining one’s self through relationships
- Gender norms are flexible and change over time
- They can lead to inequality
- Women have been conditioned to seek treatment for themselves as well as be the primary health provider for the men and children in their lives
- Gender Stereotype Theory
- Suggests men are generally perceived as more masculine than women, and women are perceived as more feminine than men
Traditional Gender roles in Canada
- Gender roles are specific to the time and place
- Patriarchal authority was the norm in the colonies
- Less common among indigenous communities (but this was later influenced by missionaries)
- In the colonial ear, once a woman was married, she was no longer a legal person
- Gender roles become more strict during the Vectorial era where men and woman operated in ‘separate spheres” in middle and upper classes.
- Gender roles became more elastic during world wars, “watershed moment”
- Gender-role elasticity: returned to pre- war levels and returned to existing norms
- Roles were re-established in the 1950’s and were rigid due to turmoil
- 1960’s women returned and stayed in the workforce
Binary
- Binary notions of sex and gender are heavily entrenched in many societies and organizations
- Suggests people are either male or female and “therefore naturally masculine or feminine”
- CHN’s must be aware of the debate and dialogue that is happening around changing notions of the concept of gender
- Will help best serve the diverse members of the community in which you work
- This notion is being challenged!
- Harvard’s application process enables students to chose male, female or the words that best describes their gender, or nothing at all
- Many universities (ie, UofV, TMU) have renovated washrooms to be gender neutral
*Cisgender
Cisgender
Describes a person whose internal gender identity matches their external gender identity.
Non-Binary
Non-binary is used as an umbrella term to include all gender identities that fall outside of the gender binary.
*Agender
*Bigender
*Gender Fluid
*Two-Spirit
*Gender non-conforming
*Transfeminine
*Transmasculine
*Pangender
*Genderqueer
Agender
Describes a person who identifies as having no gender
Bigender
Describes a person whose gender identity is a combination of two genders
Gender Fluid
Describes a person whose gender identity is not fixed. They may always feel like a mix of the two traditional genders, but may feel more one gender some of the time, and another gender at others
Two-Spirit
Describes a person who embodies both a masculine and a feminine spirit. This is a culture-specific term used among Indigenous peoples
Gender non-conforming
Describes a person whose gender expression differs from a given society’s norms for male and females
Transfeminine
Describes a person who was assigned male sex at birth, but who identifies with femininity to a greater extent than masculinity.
Transmasculine
Describes a person who was assigned female sex at birth, but who identifies with masculinity to a greater extent than femininity.
Pangender
Describes a person whose gender identity is comprised of many genders.
Genderqueer
Describes a person whose gender identity falls outside of the traditional binary gender structure.
Gender based lens
- Way of ensuring that policies, programs, services and interventions are appropriate
- Sheds light on constraints and opportunities of individual
- Enables the CHN to also consider class, race, ability, sexual orientation, and indigenous status when considering strengths and barriers
Pronouns
He / Him
She / Her
They / Them
Ze / Hir/Zir
