Midterm Flashcards
What is reflective practice?
- thinking about and learning from past experiences
- formalizing the process and recording it
Is reflective practice conscious or unconscious? Lifelong or periodical?
It is something you engage in over life, whether consciously or not
- we avoid things that did not work
- repeat things that did
What is the reflective process? Discuss each step
- I interpret
- reflection in action - I respond
- I notice
- reflection on action
What is Gibbs’ reflective cycle?
- Description (what happened?)
- Feelings (what were you thinking and feeling?)
- Evaluation (what was good and bad about the experience?)
- Analysis (what else can you make of the situation?)
- Conclusion (what else could you have done?)
- Action plan (if it rose again, what would you do?)
What are the three stages/questions of reflection?
- What happened?
- Why does it matter?
- why did it happen
- could it have gone differently
- why did you make those choices - What next? (most important)
- how will you change your practice as a result
Who is Florence Nightingale? What were her values?
She is the founder of modern, professional nursing. She characterized nursing as suitable for those with a high moral calling - sobriety, chastity, loyalty, altruism, self-sacrifice. Nursing was a woman’s role and founded upon Christian values.
What are Carper’s four ways of knowing?
empirical, personal, ethical, and esthetic
What is empirical knowing?
facts, scientific knowledge, clinical research (i.e., pathophysiology, rationale behind the skills, evidences)
What is personal knowing?
knowledge of own self in a situation, self-awareness and recognizing how your interactions are part of your care and have an effect on the patient’s healing process. rejects approaching the client as an object and strives to actualize an authentic personal relationship (i.e., self-reflection, what did you do well, what you could do better)
What is ethical knowing?
morally correct in a situation, the moral code which guides the ethical conduct of nurses is based on the primary principle of obligation embodied in the concepts of service to people and respect of life (i.e., CNA code of ethics, what is right/just and ought to be done)
What is esthetic knowing?
art of nursing, awareness of nursing in the moment of care, knowledge gained by subjective acquaintance, the direct feeling of experience, creativity and style in design of providing nursing care that is effective and satisfying (i.e., empathy, caring, genuineness, respect, self-disclosure)
What is emancipatory knowing?
- it emphasizes action that arises from an awareness of social injustices embedded in a social and political system - realizing that things could be different and working toward change that creates social justice for all
- focuses on embedded discrimination or racism to better healthcare and create influential changes in healthcare
What two systems are at the core of injustice in emancipatory knowing?
Social and political systems
What is hegemony?
- the dominance of certain ideologies, beliefs, values, or worldviews over other possible viewpoints
- it is often hidden and taken for granted and as the only truth
What way of knowing aims to free individuals of hegemonic thinking?
emancipatory knowing
What are three things that emancipatory knowing can do for a nurse?
- help the nurse look beyond individual experiences or situations - consider the bigger picture
- pushes nurses to discover the root causes of inequities
- motivates action toward change
What are the four foundations of emancipatory knowing?
critical theory, liberation theory, poststructuralism, and feminist perspectives
What is critical theory?
describes a process of examining and challenging social inequities and injustices
examines the root causes as well as the social consequences of such inequities/injustices
What is liberation theory?
sees education as a means for challenging existing knowledge, norms, and values
provide/use education to create social change
What is poststructuralism?
examines how power balances are created and maintained by verbal and symbolic representations in society, and how these representations create or produce meaning
What is feminist perspectives?
criticized current power imbalances, challenged the status quo, challenged systems of oppression, nursing (and women) seen as oppressed group
What are the three dimensions of emancipatory knowing?
- ask critical questions - questions that focus on social injustices into awareness
- creative processes: critiquing and imaging - tend to occur in circular/iterative fashion & is activist in nature and leads toward “emancipation”
- formal expressions - action plans, critical analyses, manifestoes, vision statements & creates clarity/focus, brings awareness, and communicates injustices to those in power
What is the definition of worldview?
the way a group of people see their world, their physical and symbolic space, and their place in the world OR
a collection of beliefs about life and the universe held by an individual or group; the overall perspective from which the world is interpreted
What core experiences shape our worldview?
childhood/upbringing, culture/community, reinforcement/punishment, media/portrayals/stories
What SDOH has the greatest impact on health?
income/social status
Describe income/social status SDOH
- it affects all the others
- poverty is the greatest threat to health
Describe social support networks SDOH
- social connects are very important to overall health - affects health, healthy behaviours, and healthcare utilization
- social isolation may lead to stress, depression, vulnerability, and increased risk behaviours (smoking, substance abuse, overeating)
Describe education/literacy SDOH
- strongly connected to income and social status
- education increases job opportunity and security
- literacy has direct and indirect impacts on health (low literacy skills more likely to be unemployed, receive income support, higher stress)
What is health literacy?
ability to understand and apply new health information to changing circumstances
Describe employment/working conditions SDOH
Unemployment
- affects physical, mental, social, and emotional health
- employment provides sense of purpose, hope, and growth
- employment provides social connections
- benefits/pensions
Working conditions
- can support health or pose risks
- healthy work places
Describe physical environments SDOH
Housing
- affects health directly and indirectly (asbestos, over crowding, heating, mold)
- high rent/housing costs use up resources that could be used elsewhere
Food security
- food choices, nutrition, have great impact on health
Other environmental factors
- smoking/smoke-free
- air, water, soil, contamination
- climate and climate change
Describe biological/genetic endowment SDOH
- most cannot be changed (sex, genetics, age)
- can be influenced by social and physical environments, individual choices, and other determinants
Describe individual health practices and coping SDOH
- Many individuals cope through risky behaviours (smoking, drugs, alcohol)
- physical inactivity directly impacts health, stress, and coping
- tobacco use remains the leading preventable cause of death and disease in Canada
Describe healthy childhood development SDOH
- healthy child development influences lifelong health
- conception to adolescence is critical to biological and brain development that will shape learning and health behaviours
What is toxic stress and what SDOH does it fall under?
excessive and/or prolonged activation of body stress response systems in early childhood (pre-adolescence)
can be the result of exposure to stressors such as poverty, violence, conflict, neglect, and food insecurity
Describe health services SDOH
- accessibility (urban vs rural/remote & public vs private)
- types of services (primary care, hospital, home care, long-term care, public health)
- quality of services (expertise, wait times)
- other (vision/hearing, dental, medication)
Describe gender SDOH
- some diseases/conditions unique to, or much more prevalent in, one biological sex (i.e., pregnancy, prostate, cardiovascular)
- many health issues are functions of gender-based roles
Describe culture and ancestry SDOH
- many health practices and choices are influenced by culture
- influences personal definition/understanding of health and wellness
- immigrants and refugees may be more vulnerable to experience unmet/negative determinants & experiences in home country may impact health
- bias, discrimination, and prejudice
Describe social environments SDOH
- broadens lens to community/population level
- includes community norms/values, human rights, social security, and social relations
- social exclusion is the marginalization and exclusion that can occur based on many criteria; greatly impacts health
What is health promotion?
efforts directed toward increasing the level of well-being and self-actualization
What are the two strategies that influence the SDOH?
Health promotion & disease prevention
What is disease prevention? What are the levels of prevention?
actions to avoid or forestall illness/disease
- primary prevention
- secondary prevention
- tertiary prevention
What is primary prevention? Provide an example
protecting against illness/disease BEFORE signs and symptoms occur (i.e., immunizations, physical activity)
What is secondary prevention? provide an example
promote early detection of disease once pathogenesis has occurred, so that prompt treatment can be initiated to halt disease and limit disability (i.e., Pap test or prostate checks)
What is tertiary prevention? provide an example
activities initiated in the convalescence stage of disease and are directed toward minimizing residual disability and helping people to live productively with limitations (i.e., cardiac rehab after MI)
Define structural determinants of health
expands on SDOH to include historical, political, societal, and economic structures within society that place particular groups of people at a disadvantage - particularly indigenous peoples
all levels interact and influence each other
what are the three categories of structural determinants?
proximal, intermediate, and distal
what are proximal determinants? what part of the tree do they represent?
influence health in the most obvious and direct ways and encompass most SDOH
Considered as the crown or leaves of the tree structure
what are intermediate determinants? what part of the tree do they represent?
facilitate or hinder health through systems that connect proximal and distal determinants such as health promotion, health care, education, justice, government
- less direct impacts on individual health, but huge impacts on proximal determinants
considered as the trunk of the tree
what are distal determinants? what part of the tree do they represent?
deeply embedded influences that affect all other determinants, such as historical foundations, political contexts, social foundations, indigenous worldview and spirituality
considered as the roots of the tree
How do contemporary structures affect indigenous peoples?
- they continue to perpetuate systemic discrimination against Indigenous peoples
- structures of colonialism endure
- Indigenous ways of knowing seen as inferior
- continue to be marginalized geographically, socially, and intellectually
What part of structural determinants need to be focused on to improve indigenous health?
efforts to improve health of Indigenous peoples needs to focus on the distal determinants rather than the current primary focus on proximal determinants
Define vulnerability
Being in need, susceptible to injury, and at a higher risk of harm than the rest of the population
Define structural vulnerability
Political, economic, and social arrangements that contribute to harsh and the production of poor health in society
*Vulnerability is attached to the individual - they have or are vulnerable
How we are positioned in society relative to class, age, gender, sexuality, and race make us more or less structurally vulnerable
* Can be attached to the social structure that causes individuals to be vulnerable
What are individual factors that make someone vulnerable?
personal choices, individual characteristics, and circumstances
What are societal factors that create vulnerability?
SDOH, structural factors, and health inequities
Define health inequities
differences in health that are deemed unfair or unjust because they are a product of social processes that can be potentially be changed
How do health inequities differ from health inequalities?
they are the result of structural arrangements in society and judged to be unfair because they are unavoidable
Define health inequalities
differences in health among groups in the population that may be either positive or negative
What are general conditions that contribute to vulnerability? (8)
stigmatization, racialization, marginalization, discrimination, disadvantage, SDOH, lack of access to resources, victim blaming
What are specific conditions that contribute to vulnerability? (6)
poverty/income inequality, homelessness and precarious housing, food insecurity, social exclusion, violence/trauma, and age
Define health equity
fair conditions in society that allow each person to reach their potential for health
What is the role of the nurse in reducing vulnerability? (5)
- understand the root cause factors leading to vulnerability
- advocate for improved access to healthcare and strengthen community resources
- promote structural and systemic changes - social justice
- counter stigmatization and discrimination
- act as a voice for those that don’t have one
Define self-concept
the sum of beliefs about one’s self that develop over time - who am I and what can I become?
In a healthy person with a positive self-concept, core beliefs and feelings about self remain intact
A positive self-concept will assist you to more easily scale new learning experiences and difficult situations
An open and dynamic system - fluctuates over time
Define self-awareness
cognizance of one’s beliefs, thoughts, motivations, biases, and physical and emotional limitations and how these aspects affects others
How can a nurse develop an ongoing self-awareness?
through regular and/or ongoing self-reflection
Define self-esteem
attitudes about oneself; emotional appraisal of one’s worth
How can self-concept influence patients?
Self-concept can be nurtured through a therapeutic relationship and may have an impact on healing
A nurse should understand their own self-concept and those of the patient & their family
What five factors influence self-concept?
- body image
- cognitive beliefs
- emotional development
- early attachment (how caregivers meet emotional and physical needs of infant/child)
- self-awareness
What 9 factors may influence self-concept and/or self-esteem?
- discouragement/failure
- encouragement/success
- sense of control
- confidence
- sense of belonging
- poverty
- religion
- culture
- media
List Erikson’s 8 stages of growth and development
- Trust vs mistrust - infant (hope)
- autonomy vs self-doubt - toddler (will power)
- initiative vs guilt - early childhood (purpose)
- industry vs inferiority - school age (competence)
- identity vs identity diffusion - teen age (fidelity)
- intimacy vs isolation - young adult (love)
- generatively vs stagnation - mature adult (caring)
- ego integrity vs ego despair - late adult (wisdom)
What is ego integrity?
an individual can look on their life achievements with satisfaction which is the final testament to a positive self-concept
What are the five systems of Brofenbrenner’s model? Briefly describe the model.
- microsystem
- mesosystem
- exosystem
- macrosystem
- chronosystem
identifies the complexity of the interactions between systems and their influence on development and self-concept
Define the microsystem
activities and interactions within an individual’s immediate surroundings (i.e., family, neighbourhood, peers)
Define the mesosystem
connection between the immediate environment and other systems
Define the exosystem
consists of other larger social systems (i.e., religion, media, education, medicine, and community)
Define the macrosystem
considers laws, customs, and societal resources (i.e., culture, politics, economy, and social conditions)
Define the chronosystem
recognizes the historical influences and the passing of time (i.e., personal change, social change, historical time)
Define self-identity
the integration of social and occupational roles and affiliations and self-attributed personality traits, attitudes, and beliefs about political ideology, religion, gender, and sexuality
develops and changes over the lifespan - highly challenged throughout adolescence
What does self-identity influence?
influences goal-directed behaviour and interpersonal relationships
How can illness effect an individual’s self-concept according to Roger’s theory of incongruence?
Ideal self and real self must be congruent for a healthy self-concept. However, illness makes the ideal self and real self distant leading to a poor self-concept
How can encouragement improve self-concept in an ill patient?
patients faced with illness require consistent and realistic encouragement to rebuild their confidence
nurses use interventions that accept clients where they are, guide them to take appropriate risks, and provide opportunities for success which fosters and restores self-concept
Define worldview
the way a group of people see their world, their physical and symbolic space, and their place in the world
What factors influence worldview?
culture, self-concept, and context
How does the therapeutic relationship effect self-concept?
therapeutic use of self, how you use your unique personality, and your way of being in a therapeutic relationship with clients and families is crucial to aiding self-concept
Define democratic racism
“Cultural differences” used as a euphemism for racial differences to explain health, social, and economic inequalities
prevents the identification of social and structural barriers, discriminatory practices, and racism. instead, blames the victims for their own outcomes and the inequities they experience
Is subtle and unlikely to be challenged unless recognized and exposed
Define culture
culture has been defined as the values, beliefs, and practices common or inherent to a group of people
What are the limitations of the definition of culture?
- culture becomes synonymous with race or ethnicity
- suggests you can know another person’s culture simply by determining which group they affiliate with, or associating them with a particular group (people may affiliate with more than just one group)
- overlooks power structures and social conditions
- assumes values, beliefs, practices, etc. do not change over time
- overlooks the complexity of an individual’s life and experiences
What is the contemporary definition of culture?
defines culture as a process that happens between people
we continuously participate in and create culture
culture is constantly in flux
What 3 considerations arise from the contemporary definition of culture?
- we help to create culture in our community, in our workplace, etc.
- we must engage in self-reflection and self-analysis to identify our own culture(s) and social location, and how that shapes our values, beliefs, and behaviours
- we must consider differences between us and others in terms of social context, power structures, and social inequities
Define cultural sensitivity
emphasizes that individual healthcare providers should become sensitive toward individual patient differences from dominant norms
based one a static view of culture; sees culture as a characteristic of a person or a group of people
ex. providing information sheets about a specific ethnic group or culture
What are the six limitations of cultural sensitivity?
- people do not agree with the group they are assigned to, and may find categorization offensive
- individuals may not subscribe to all the practices associated with one particular group
- individuals within a group may have significantly different values, norms, and practices
- leads to stereotyping and erroneous assumptions
- does not consider the broader context and social/power structures of the person’s life
- implies there is a preferred norm, and other must be tolerated
What are the different definitions/ways of cultural competence?
- can refer to nurses developing understanding of different cultures and the beliefs, values, and practices of various groups
- can also refer to learning about the contexts that shape culture and individual experiences, whether in others or oneself
What supports either cultural sensitivity or cultural safety?
cultural competence
what are 2 limitations of cultural competence?
- seen as a checkbox
- does not necessarily lead to action
List the 4 dimensions of cultural safety
- based on the idea of culture as a process, something that is dynamic and ever changing, something that we create - culture shifts in relation to power dynamics within society, as well as historical, economic, political, or local trends
- focuses on how particular groups are perceived and treated, rather than what they think or do - actively addresses inequitable power relations, racism, stigma, and discrimination within healthcare & society
- health and health care depend on the social, economic, and political position a group holds within society
- individual and institutional discrimination in healthcare creates risks for patients
What are the two steps of cultural safety in practice?
- reflect on how our own biases, assumptions, norms, and ways of being influence our viewpoints, interactions, and practices (social position)
- critically analyze the culture of health and health care
- nursing in Canada is influenced by Western views (biomedicine, corporatism, and liberal individualism)
Define cultural humility
a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust.
involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience
What are two goals/characteristics of cultural humility?
- requires commitment to lifelong learning, continuous self-reflection on one’s own assumptions and practices, comfort with “not-knowing”, and recognition of the power/privilege imbalance that exists between clients and health professionals
- is interactive: we approach another person with openness to learn; we ask questions rather than make assumptions; and we strive to understand rather than to inform
Define racialization
the process of categorizing people into racial categories that are constructed as different and unequal in ways that lead to negative social, economic, and political impacts
Define assimilation
the social process of absorbing one cultural group into another - it is the aggressive cultural domination of one group over another
What did the practices and policies of colonization aim/design to do?
- removed indigenous people from their lands
- suppress indigenous nations and their governments
- undermine indigenous cultures
- stifle indigenous identity
Define historical trauma
cumulative emotional and psychological wounding over the lifespan and across generations, due to a loss of
- culture, language, heritage, history, identity, land, livelihood, parenting skills, autonomy
What are the 3 R’s that highlight the strengths of Indigenous peoples?
- Resistance - despite a concerted effort to assimilate the peoples, they have maintained their identities and their traditional culture
- resilience - concept used to explain or understand positive adaptation to life despite harsh conditions
- reclaiming - have experienced much loss, working to reclaim their culture, language, and identity
What are the 4 pathways for decolonization?
- question and alter power dynamics
- challenge cognitive imperialism and social/political ideologies
- unlearning and relearning
- shifting culture
What are four things nurses can do to improve interactions with indigenous peoples?
- learn about the Indigenous peoples of Canada - understand historical and contemporary contexts and their impact
- practice in culturally safe ways - includes effective intercultural communication and unique individuality
- respect traditional indigenous ways
- build authentic and genuine relationships
What are the 4 R’s to building responsible relationships with indigenous peoples?
- respect - there is not just one knowledge
- relevance - not all knowledge is literate
- reciprocal relationships - teaching and learning is a 2-way process
- responsibility - shift to work WITH indigenous peoples
What are the five characteristics of Indigenous knowledge?
- Knowledge is personal - there is no one person who has ‘truth’ & it actualizes itself in context and is highly dynamic
- knowledge is orally transmitted
- knowledge is experiential - the land is alive
- knowledge is holistic - all things are in constant motion/flux and this leads to holistic/cyclic view of the world
- knowledge is narrative - stories transmit vital teachings without preaching
What are the three sources of Indigenous knowledge?
- traditional knowledge - gained through ceremony, generations, and have accumulated them over time
- ecological - learned from observation, seeing things in nature and seeing patterns
- revealed - things that come to you through dreams and visions, and are not explained through Western thinking
Define culturalism
an academic and pedagogical posture inherited from colonialism and based on the assumption that mainstream culture and knowledges are global and universal
Define cognitive imperialism
cognitive manipulation used to repudiate other knowledge bases and values
Define abyssal thinking
epistemic blindness (blinded to other ways of knowing created by others way of knowing) to other epistemologies, created as a result of domination
Define sacred pain
transforms the pain that causes suffering into a pain that leads into insight
Define intersectionality
looks at how the different aspects of our personal identities determine what power, privilege, and/or oppression we experience within our current social and political context or environment
*note: not merely a multiplying of identity categories such as gender and race. rather, it is meant to provide a means of analysis for how particular identities and conditions are located within structures of power
How does intersectionality impact health?
- how you define yourself has influence on how you define your health
- provides a lens for looking at health promotion, by challenging existing inequities and definitions
- offers a way to expose how structural factors interact to produce specific health outcomes for specific individuals
What is social location/position?
captures the idea that while each of us occupies a specific and individual place in the world, it is produced by our relationship to the social settings in which we live.
social position is relational, shifting, and shaped by our positions in the social structures we inhabit
What is the intersectional approach?
moves beyond explaining the relationship between various discrete variables to address WHY those relationships occur and illuminate the social and context-dependent constructs or the power structures within those relationships
How do labels effect health?
labels influence how we see others and ourselves within society - whether we ‘fit’ or not
intersectionality aims to make these labels and systemic oppression visible
What are the three components of power?
- relational - requires more than one person
- fluid & dynamic - power changes across contexts, experiences, etc.
- many forms - age may have an influence one power, social, economic, etc.
What preserves power structures?
A cycle of stereotyping and discrimination - those in power create the system in ways that maintain their privileged status
How is oppression often invisible?
mechanisms of action or inaction are normalized and not clearly visible - we have to work to make them visible to challenge them
What are the four stages in the cycle of oppression?
- Biased information leads to stereotyping
- Prejudice
- Discrimination
- Oppression
Define stereotyping
An often negative, exaggerated belief, fixed image, or distorted idea held by persons, groups, political/economic decision makers - is embedded in and reinforced by oppressive power relations
Define prejudice
a way of thinking based on stereotypes - is embedded in and reinforced by oppressive power relations
Define discrimination
action or inaction based on prejudice - made possible/condoned implicitly or explicitly by oppressive power relations
Define oppression
discrimination backed up by systemic power relations (i.e., government, education, legal, health policies)
