midterm Flashcards
community health nurse (CHN)
- works with the community, not for
- protect and enhance human dignity
- practice with an emphasis on collaboration
CHN roles and functions
- advocate
- direct care provider
- collaborator
- consultant
- counsellor
- educator
- facilitator
- health promoter
- leader
- liaison
- manager
- researcher
earliest forms of health care in Canada
originated within practices of first peoples using traditional medicines and healing
earliest introduction of CHN
17th century New France provided by the Duchesse d’Aiguillon sisters
the grey nuns
first community nursing to understand health inequity and make contributions to
- access to health services
- food
- shelter
- education for the vulnerable
20th century nursing sectors
- hospital
- private duty
- public health and home visiting nurses
5 principles of the Canada health act
- public administration (transparent)
- comprehensive
- universal (available to all)
- portable (available max 3 months after residency)
- accessible (no user fees)
health promotion
protect, promote, and restore the physical and mental well-being of residents of Canada
upstream care
- big picture
- macroscopic
- focuses on improving fundamental, social, and economic structures and decrease barriers
downstream care
- focuses on individual
- microscopic
- focuses on providing equitable access to care and mitigate the negative impacts of disadvantages on health
CHN nursing process
- assess
- plan
- implement/act
- evaluate
public health
organized efforts of society to keep people healthy and prevent injury., illness, and premature death
public health agency of Canada
- established 2004
- mission to promote and protect the health of Canadians
chief public health officer of Canada
Dr. Theresa Tam (2017)
functions of a public health nurse
- health promotion
- health surveillance
- population health assessment
- disease and injury prevention
- emergency preparation and response
primordial prevention
- initiatives to prevent conditions that would enable a risk factor for disease
- (ex. iodized salt for micronutrient deficiencies, adequate minimum wage)
primary prevention
- impacts of specific risks are decreased with leads to a reduction in the occurrence of a disease
- interrupts chain of causality before a physiological of psychological abnormality is identifiable
- (ex. decreasing environmental risks, immunizing against communicable diseases)
secondary prevention
- interventions aimed at identifying a disease as early as possible which reduces the prevalence of the disease by curbing duration
- (ex. planning, implementing and evaluation early clinical detection and screening programs)
tertiary prevention
- aims at reducing long term impacts of a disease by eliminating or reducing impairment
- occurs after symptoms are present and reduces progression
- (ex. studies show marginalized women show improved HIV care when exposed to weekly texting intervention)
quaternary prevention
- identifies individuals at risk of over medicalization
- protecting populations from new medical procedures or interventions that are untested and proposing ethically appropriate alternatives
- (ex. those with VUS strains received mastectomy’s even though they were reclassified as benign)
theory
provides a basis that anchors practice and research
key aspects of nursing knowledge
- person
- health
- environment
- nursing
- health
- social justice
feminist theory
- encompasses perspectives committed to political and social changes that improve the lives of women
- focuses on equity, oppression and justice
critical social theory (habermas)
- used to develop practices with population groups who have been disadvantaged by social circumstances
- challenges the status quo
health equity
refers to all people being able to reach their full health potential and not disadvantaged because of circumstance like
- age
- race
- ethnicity
- gender
- social class
CHN standards
- health promotion
- prevention and health protection
- health maintenance, restoration, and palliation
- professional relationships
- capacity building
- health equity
- evidence informed practice
- professional responsibility and accountability
standard 1: health promotion
integrate using Ottawa charter strategies
- build health public policy
- create supportive environments
- strengthen community actions
- develop personal skills
- reorient health services
standard 2: prevention and health protection
- use socio-ecological model to integrate into practice
- actions are implemented to minimize occurrence of disease and their consequences
standard 3: health maintenance, restoration and palliation
- used to maintain maximum function, improve health, and support life transitions
standard 4: professional relationships
- work with others to establish therapeutic relationships
- optimizes participation and self determination of the client
standard 5: capacity building
- partner with client to promote capacity
- focus to recognize barriers to health and to mobilize and build existing strengths
standard 6: health equity
- recognize the impacts of the determinants of health and incorporate advocation into practice
- focus is to advance equity at an individual and societal level
standard 7: evidence informed practice
- use best evidence to guide nursing practice and support clients in making informed decisions
standard 8: professional responsibility and accountability
- fundamental component of autonomous practice
primary health care (PHC)
(1) accessibility
(2) public participation
(3) health promotion
(4) appropriate technology
(5) intersectional collaboration/cooperation
8 guiding principles to PHC
- evidence about health problems and preventative techniques
- promotion of food supply and proper nutrition
- safe water and basic sanitation
- maternal child and health care
- immunizations
- prevention and control of endemic diseases
- provision of essential drugs
Ottawa charter for health promotion
- 1986
- presented strategies and approaches for health promotion
- 5 key points
population health promotion (PHP)
process of taking action of social determinants of health that affect a populations health to create healthy change
reportable diseases
- AIDS
- chlamydia
- gonorrhea
- hepatitis A,B,C
- syphilis
- TB
community
group of people who live, learn, work, worship, in an environment at a given time
community functions
(1) space and infrastructure
(2) employment and income
(3) security, protection, and law enforcement
(4) participation, socialization, and networking
(5) links with others for capacity building
achieving community functions through
- communication
- leadership
- decision making
vertical communication
to link with larger communities or high decision making powers
horizontal communication
enables collaboration between members, environments, and other systems
diagonal communication
reinforces cohesiveness of both horizontal and vertical communication lines
formal leaders
are elected official politicians (members of parliament, mayor)
informal leaders
people with prominent positions in the community (religious leaders, elders of community, celebrities)
community as partner model
- assessment wheel with all components
- core of model is the community
- lines of resistance protect the community from threats
epidemiologic framework/triangle
- examines frequency and distribution of a disease or social condition
- host: who is affected
- environment: where and when condition occurred
- agent: why and how
community capacity approaches
- capacity building is a process to strengthen an individual or community to implement health promotion
- allows community to take responsibility of their own development
community asset mapping
- identifies strengths and potential resources for program planning and intervention
- evaluate assets and build community capacity
community health promotion model
- goal to apply health promotion strategies to achieve collaborative community actions and to improves sustainable health outcomes
- heavily influences by social determinants of health
communicable diseases
illnesses caused by specific infectious agent/toxic product that arises through transmission of that agent or its products from an infected person, animal or inanimate source to a susceptible host
bubonic plage (black death)
- 14th century
- first recorded worldwide threat from a communicable disease
- estimated 50 million deaths
alexander fleming
discovered penicillin in 1928
spanish influenza (1918)
- spread globally in 6 months
- killed 21-50 million people
- infected 500 million
smallpox
eradicated in 1980 due to vaccine by edward jenner (1796) and WHO education program
tuberculosis
public health crisis in some Indigenous communities since European settlers introduced through fur trade
vaccines
work by creating an immune response by stimulating the body’s immune system to make antibodies that provide infection protection
live/attenuated vaccines
- contain a weakened living version of virus or bacteria so it will not cause serious disease in healthy immune systems
- (ex. MMR, varicella)
- contraindicated while receiving chemo or raditaion
non live vaccines
- still viruses and bacteria
- made by inactivity/killing the germ in the process
- (ex. polio, TDAP)
- requires multiple doses
toxoid vaccines
- prevent diseases caused by bacteria that produces toxins in the body
- toxins are weakened during vaccine production process
- toxoids = weakened toxins
- (ex. TDAP)
subunit vaccines
- include only part of the virus/bacteria
- side effects are less common
- (ex. pertussis)
conjugate vaccines
- fight type of bacteria and has antigens
- connect polysaccharides to antigens and helps immune system respond
- (ex. COVID-19 mRNA)
community/herd immunity
resistance of a group to invasion and spread of infectious agent
STIs
30 different bacterial, viral, parasitic infections transmitted through sexual or skin-to-skin contact
reportable STIs
- chlamydia
- gonorrhoea
- syphilis
- HIV
enteric infections
- enter the body through the mouth, intestinal tract and affect the digestive system
- seen through eating/drinking contaminated food or liquids
food borne infections
- toxins released by bacteria growth in food
- bacterial, viral or parasitic infections
- toxins produced by harmful algal species
water-borne pathogens
- enter water supplies through fecal contamination
- appropriate filtration and chlorination help decrease diseases
- (ex. cholera, typhoid fever)
zoonotic diseases
- transmitted between animals and humans
- humans are not needed to maintain life cycle
- transmission: bites, inhalation, ingestion, direct contact
- (ex. rabies, hantavirus)
vector-borne infections
- caused by viruses, bacteria, parasites that living creatures carry and pass on
- disease carriers are vectors
- (ex. lyme disease)
rabies
- fatality rate is essentially 100%
- post-exposure prophylaxis (PEP): available after exposure consultation with public health officials
program planning and evaluation
- conducting a situational analysis or community assessment
- identifying the problems or issues of concern
- considering possible solutions or actions to address the problem
- selecting the best alternative
- designing and implementing the program
- monitoring or evaluating the program
- analyzing and interpreting results of the monitoring and evaluation process
- using results to make modifications to the program to inform decisions about other programs
considerations for selecting a program framework
(1) community health agencies may have their own standards
(2) can be funding dependent
(3) selecting a framework based on specific considerations
(4) influenced by underlying values or principles of a program
program logic model
- inputs > activities > outputs > impacts > outcomes
- helps identify gaps
- 2 phases (CAT, SOLO)
CAT phase
- components
- activities
- target groups
SOLO phase
short and long term outcomes
intersectional theory (Kimberlé Crenshaw)
describes how our overlapping social identities relates to social structures of racism and oppression and is a way of understanding the complexity in the world, in people and human experience
intersectionality and health inequalities
measure inequalities by comparing groups of people based on a single factor
characteristics of maternal mortality in the united states
- no reduction in maternal mortality in the US except asian women
- cardiovascular disease, hemorrhage, and substance use disorder are leading contributors
opioid and stimulant related harm in Canada
- 91% increase in deaths during the pandemic
- males accounted for majority aged 20-59
integrating intersectional theory
- engage with communities that experience inequalities being studied
- explore inequalities across time
precede-proceed planning model
enables the community program develop to think logically about the desired end point and work backwards to achieve the goal
what does SWOT stand for
- strengths
- weaknesses
- opportunities
- threats
SWOT analysis
- identifies strengths and weaknesses
- ensures programs have adequate resources and staff
- determines if something is feasible
- used for long term planning
content analysis
grouping data into categories and identifying patterns
priority setting
- narrow down action possibilities
- guiding principles; buy-in, transparency, communication
gantt charts
tabular format used to present the sequence and timing of activities
multiple intervention program framework (MIP)
- 5 elements
- cycle where emerging lessons and new research can continuously inform the program
MIP element #1: identifying community health issue that is the program focus
- epidemiological and surveillance data
- describe current shifting patterns of illness in population
- identify disadvantaged population subgroups
MIP element #2: describe socio-structural features
- identify factors that directly contribute/cause the problem
- assess determinants of health
- strength analysis can help reveal potential solutions
MIP element #3: intervention options
- consider theoretically sound and effective strategies
- need community input
- be aware of reach, dose, and intensity of strategy
MIP element #4: intervention impact
- identifying optimal set of intervention strategies for maximum impact
- must be aware of changing policies
MIP element #5: implementation, impact, consequences
- outputs, outcomes, impacts
- expected and unexpected consequences
- program spin offs, sustainability
planning health promotion programs
- introductory workbook by public health ontario (2018)
- 6 step process
sex
chromosomal makeup determined by X or Y chromosomes
intersex
general term for a variety of conditions in which a person is born with reproductive or sexual anatomy that does not ft the typical definition of male of female
why sex differences matter
- ensures interventions are relevant and effective
- how we understand morbidity, morality and life expectancy
essentialist thinking (problematic theory)
women and men have a true essence related to sex organs, hormones and their role in reproduction
biology as destiny
part of essentialist thinking that suggests that women are naturally caring and emotional whereas men are assertive and emotionally distant
gender
the characteristics of women, men, girls, and boys that are socially constructed
masculinity and femininity
social constructs that have been created and reinforced by societies over time
gender identity
- describes how we see ourselves as women, men, neither, or both
- individual sense of self
- may not confirm with assigned sex at birth
gender stereotype theory
suggests men are more masculine than women whereas women are more feminine
gender norms
ideas on how men and women should act that can restrict gender identity
gender roles
social and cultural expectations assigned to gender
binary
suggests people are either male or female and therefore are naturally masculine or feminne
cisgender
person whose internal gender matches their external gender identity
non binary
umbrella term used to include all gender identities that fall outside binary gender
agender
person who identifies as having no gender
bigender
person whose gender identity is a combination of 2 genders
gender fluid
person whose gender identity is not fixed. they may feel like a mix of 2 traditional genders but feel more like one at some point in time
two spirit
- describes a person who embodies both masculine and feminine spirit
- used in indigenous culture
gender non-conforming
person whose gender expression differs from societal norms for male and female
transfeminine
person who was assigned male sex at birth but who identifies with femininity
transmasculine
person who was assigned female sex at birth but who identifies with masculinity
pangender
person whose gender identity is comprised of many genders
genderqueer
person whose gender identity falls outside traditional binary gender structure
traditional gender roles in canada
- patriarchal authority was the norm
- strict roles in victorian era where men and women operated in operate spheres
- during world wars roles were more elastic
- gender role elasticity: returned to pre war norms
- 1960s women returned and stayed in the workforce
indigenous gender roles
- women responsible for household chores and gathering food
- men responsible for hunting large game, gathering wood and figthing
- led by Clan mothers who are responsible for ensure community welfare
- gender is fluid
gender inequity
occurs when individuals are not provided with the same opportunities in society because of their gender
leading health issues for transgender individuals
experience discrimination in
- employment
- health care
- overt and covert violence
- loss of social support networks
gender based lens
way to ensure policies, programs, services, and interventions are appropriate for everyone
misgendering
when non-binary people are addressed using gender specific language that does not match their gender identity
sexual orientation
the romantic and sexual attraction towards people of one or more genders
homosexuality
sexual attraction towards individuals of the same gender
heterosexuality
sexual attraction to another gender
bisexuality
sexual attraction to more than one gender
pansexual
sexual attraction to all genders
queer
another label for non-heterosexual individuals that some may prefer
social attitudes and stressors for 2SLGBTQIA+
- homophobia
- biphobia
- transphobia
- internalized homophobia
- heterosexism
socioecological examination
requires assessing the social determinants of health and reinforce the fact that some determinants are embedded in social structures that generate health inequality
role of CHN for promoting 2SLGBTQIA+ health
(1) primordial: shift social attitudes, decrease stigma, foster respect
(2) primary: creating groups for 2SLGBTQIA+ to learn stress coping techniques, focus on healthy living
(3) secondary: screen for HTN, STIs, PAPs and testicular exams using trans-sensitive language
(4) tertiary: HIV medication adherence, locating 2SLGBTQIA+ specific substance abuse tx programs
(5) quaternary: focuses on protecting clients from over-medicalization
role of CHN and communicable diseases
- surveillance
- contact tracing
- outbreak reporting and investigation
- prevention measures
- DTaP - IPV - Hib vaccine
- 2 months
- 4 months
- 6 months
- 18 months
Pneu-C-13 vaccine
- 2 months
- 4 months
- 1 year
Rot-1 vaccine
- 2 months
- 4 months
Men-C-C vaccine
- 1 year
MMR vaccine
- 1 year
Varicella vaccine
- 15 months
MMRV vaccine
- 4 years
Tdap - IPV vaccine
- 4 years
Hepatitis B vaccine
- grade 7
Men-C-ACYW vaccine
- grade 7
HPV-9 vaccine
- grade 7
Tdap vaccine
- 14 years
- 24 years
Td vaccine
- every 10 years
HZ vaccine (herpes zoster)
- 65 years
Pneu-P-23 vaccine
- 65 years
