NSG 1600 FINAL Flashcards
Canadian Healthcare System - British North America Act (1867)
Where health care started.
Divided responsibilities between federal and provincial governments.
Canadian Healthcare System - The Great Depression (1930s)
Many could not afford hospital stay or medical care.
Canadian Healthcare System - Tommy Douglas ( 1947)
SK: Hospital Insurance Plan
Copied across Canada — Hospital Insurance and Diagnostic Services Act (1957)
* Federal government covered —50% of hospital costs
* All provinces had adopted by 1961
Still issues with medical care costs outside Of hospitals (especially in rural areas)
didn’t think that is was fair that people had to pay out of pocket, created a plan.
Canadian Healthcare System - Medical Care Insurance Act (1962) in SK
Could afford this as federal government covering half of hospital costs
Doctors went on strike — negotiated fee-for-service system for physicians
Canadian Healthcare System - Medical Care Act (1966) — Federal
Provinces/Territories to share equally health care costs with federal government
Adopted in all provinces/territories by 1972
Canadian Healthcare System - Changes to federal contributions in 1977
Negotiations of agreement.
Federal government covering less
Some provinces began charging additional fees (service fees)
Canadian Healthcare System - Canada Health Act (1984)
Banned extra billing or user fees
Replaced previous Acts
All provinces adopted/following by 1987
Canadian Healthcare System - Provincial/Territorial Insurance Plans
Each province/territory has its own
Funding is primarily the responsibility of the province
Must follow the principles of the Canada Health Act
Canadian Healthcare System - Groups covered by Federal Government
Indigenous Peoples,Armed Forces and Veterans, RCMP, Inmates (federal)
what are the 2 Canadian health care systems today?
federal jurisdiction and provincial/territorial jurisdiction
what are the factors of the Canadian health care system federal jurisdiction?
set/administer Canada health act principles
assist in funding/financing
deliver health services for specific groups
promote national policy and programming to support/promote health and prevent disease
what are the factors of the Canadian health care system provincial/territorial jurisdiction?
develop/administer health care insurance plan
manage/finance/plan health care services
determine organization and location of health care facilities and services
reimburse physicians and hospital expenses.
what are the 6 principles of the Canada health act. what is the definition/mandate of each principle?
Public Administration
- Provincial/Territorial plans operate on a nonprofit basis through a public authority
Comprehensiveness
- Covers medically necessary services (hospital and physician services). Determine which services are considered medically necessary (differs across Canada).
Universality
- Services provided free of discrimination
Portability
- Insured residents can receive services in another province/territory without cost or penalty. Provide continuous coverage if resident relocates within Canada for up to 3
months
Accessibility
Provide access to health care facilities and providers based on medical need regardless
of ability to pay.
Sustainability
Proposed as a 6th principle. Not yet adopted.
what are on-going changes happening to the Canadian health act?
efforts to improve health care
efforts to ensure/improve sustainability
decentralization vs. recentralization
new technologies
budgeting changes
define the MEDICAL APPROACH to health care
dominant throughout 20th century
focused on maintenance of physiological, functional, and social norms
focused on treatment for disease and sees medical intervention as the way to restore health
little emphasis given to health promotion or disease prevention
challenged in 1974 by the Lalonde Report
explain the Lalonde Report (1974)
Minister of Health and Welfare
promoted individual responsibility for health
shifted focus away from seeing health problems solely as physiological risk factors that conveyed disease (as in medical model)
introduced idea of casual influences (or “determinants of health”) that also played a role in health
promoting health, preventing disease, rather than just treating disease
define the BEHAVIOURAL APPROACH to health care
de-emphasized medical intervention for the restoration of health
proposed new ideas of health promotion and disease prevention
placed responsibility for health on the individual
assumed that people would change their behaviour if they knew and understood the risk factors
saw education as a key to improving people’s behaviour or lifestyle and thereby their health
led to several initiatives, such as the creation of the Canada Food Guide
identify and explain 2 reports that fall under the behaviour approach to health care
Epp Report (1986)
- presented by Canadian Prime Minister for Health And Welfare (Jake Epp) at the First International Conference on Health Promotion (hosted by Canada in Ottawa in 1986)
- outlined several health promotion initiatives
Ottawa Charter (1986)
- came out of the same conference. signed by delegates from many countries.
- expanded the list of determinants of health and included social and political factors. this lost renamed the “Social Determinants of Health”
define the SOCIOENVIRONMENTAL APPROACH to health care
based on ideas coming out of Ottawa Charter and Epp Report
Acknowledges many social factors that influence the health and health choices of individuals
goal to promote health equity for all people
what is primary health care (PHC)?
An approach to health and a spectrum of services beyond the traditional health care
system.
* Includes all services that play a part in health, such as income, environment
* Emphasizes the social determinants of health (including non-medical determinants) and strategies to advance individual and population health.
* Primary care is the element within primary health care that focusses on health care
including health promotion, illness and injury prevention, and the diagnosis and treatment of illness
and injury.
- Foundational to the Canadian healthcare system.
what are the functions of primary health care (PHC)?
- Serves a dual function:
- Direct provision of first-contact services
- A coordinating function to ensure continuity and ease of movement across the system (includes referrals to specialized services)
- Currently delivered chiefly by family physicians and general medical practitioners —
mainly focus on diagnosis and treatment of disease and injury - Movement to shift this model to more of a health care team approach (including
nurses, physicians, therapists, etc.) to provide more comprehensive services to their
clients
what are the 4 pillars of primary health care (PHC)?
- Teams
Teams or networks deliver patient-centered care, which improves access through collaboration, coordination, continuity, and quality - Access
Attempts to address issues with accessing family physicians, especially in urgent or after-hours situations.
Brings health care services to the people - Information
Uses technology to improve effciency and quality of care
provision, and increase access to individual and general health information - Healthy Living
Embraces strategies of prevention, chronic illness management, and self-care
what are some barriers to primary health care (PHC)?
Individual-level Barriers:
* Lack of role clarity
* Lack of trust (attributed to lack of knowledge, scope of
practice, or competency of other team members)
Practice-level Barriers:
* Hierarchical issues in governance and leadership
* Team attributes and skills
System-level Barriers:
* Lack of interprofessional education and collaboration
* Lack of funding
* Lack of monitoring and evaluation
* Focus on illness care, instead of wellness care, by Canadian
populace
identify and describe the 2 health care delivery settings.
Institutional Sector
* Hospitals
- Long-Term Care (LTC) Facilities
* Not part of insured services under Canada Health Act
- Psychiatric Facilities
* Rehabilitation Centers (including substance
rehabilitation centers)
Community Sector
- Public Health
- Physician Offices
- Community Health Centers/Clinics
- Assisted Living Facilities
- Home Care
- Adult Day Support Programs
- Community/Voluntary Agencies
- Occupational Health
- Hospice and Palliative Care
- Parish Nursing
what are the 4 levels of health care in Canada?
Level l: Health Promotion
Level 2: Disease & Injury
prevention
Level 3: Diagnosis and
Treatment
Level 4: Rehabilitation
Level 5: Supportive Care
describe level 1: health promotion
Examples:
- Enabling people to increase control over or improve their health
- Promotion of self-esteem in children and adolescents
- Wellness services
- Breakfast programs
- Anti-smoking education
- Anti-bullying campaign
- Heart healthy menu options
describe health promotion strategies (level 1).
From the Ottawa Charter for Health Promotion (1986)
1. Building Healthy Public Policy
2. Creating Supportive Environments
3. Strengthening Community Action
4. Developing Personal Skills
5. Reorienting Health Care Services
describe level 2: disease and injury prevention
Prevention services/strategies
Reduce risk factors for illness and injury
Examples:
- Cervical Cancer Screening
- Immunizations
- Support groups
- Environmental Action
describe level 2: sub levels of disease prevention
Primary Prevention: Prevent disease or injury before it
occurs (e.g. use of seatbelts and bike helmets)
Secondary Prevention: Promote early detection of
disease once pathogenesis has occurred or halt/slow the
progress of injury (e.g. mammograms to detect breast cancer)
Tertiary Prevention: Directed toward minimizing disability from disease or injury and helping people to live with limitations (e.g. cardiac or stroke rehabilitation
programs)
describe level 3: diagnosis and treatment
Recognizing and managing existing symptoms:
Three sub-levels
- Primary care: First contact with health care system such as family physician or NP
- Secondary care: Provision of specialized medical services in hospital or home settings.
Often referred to specialized practitioner for further diagnosis/care
- Tertiary care: Specialized and highly technical care usually provided in hospitals with advanced care equipment/practitioners
describe level 4: rehabilitation
Promote independence and self-care
Improve health and quality Of life for those facing life-altering conditions
Required after physical/mental illness, injury, or addiction
Services include:
- Physiotherapy
- Occupational and speech therapy
- Social services
describe level 5: supportive care
Clients with chronic illness, progressive illness, or disability
Long-term care and assisted-living facilities, adult day care centers, home care
Also includes respite care and palliative
what are the challenges to the health care system?
Cost Accelerators
* Technologies
* Demographics
* Consumer
involvement
Equality (Equity) and Quality
- Income Status
- Cultural Competence, Safety, and Humility
- Evidence-Informed Practice
- Quality and Client Safety
- Quality Workplaces
- Privatization of Services
- Health Care Human Resource
identify and describe nurses in Canadian health care
Types Of Nurses
* Licensed Practical Nurses
* Registered Nurses
* Registered Psychiatric Nurses
* Nurse Practitioners
Licensing
Scopes Of Practice
Staff Mix
* Unlicensed Health Care Providers and Delegation/Supervision
describe the health care reform
refers to discussions about, changes to, and creation of health policy that affects health care delivery
on-going issues to address:
- lack on continuity among providers and institutions
- health system access problems
- lack of care in rural and remote areas of Canada
- quality of work life for health care providers
Romanow Report (2001) - 47 recommendations
- tasked with evaluating health care system to see if it is sustainable.
define and describe values and beliefs
Values = our conception of what is good and most desirable
Dictate what we consider “right” and “wrong”
Instilled in us as we grow
Often subconscious
Reflected in the decisions we make, the actions we take, the opinions we express
define and describe ethics and morality
Ethics = the critical, structured examination of how we should behave in various situations
* Involves reflecting on and understanding norms, values, and beliefs
Morality = beliefs and traditions about how
should conduct ourselves toward others
* Usually more action-oriented
Moral Autonomy: we feel responsibility and
ownership for our chosen values and belief
what are ethical/moral dilemmas?
Situations in which the clear course of action may not
be obvious or there is disagreement
There may be strong ethical reasons to support
multiple courses of action
Or all alternatives have some kind of downside
describe ethical decision making
Several Models available to nurses to follow
Won’t point to a specific answer or solution
Instead, serve as a framework to guide discussion and
analysis or ethical problems
Commonly involves many stakeholders with their own values, perspectives, goals, and interests
describe ethical decision-making models
- Recognize the moral dimension
- Decide who the relevant parties are and determine their relationship
- Figure out what values are
involved - Weigh the benefits and burdens
- Look for analogous cases
- Discuss with relevant others
- Determine if proposed decision is in agreement with
legal/organizational rules - Reflect on own level of comfort with the decision
- Gather background
information - Identify whether the
problem is an ethical one - Identify key stakeholders
- Identify possible courses
of action - Reconcile the facts of the
case with relevant principles - Resolution
discuss moral integrity vs. moral distress
Moral Integrity = sense of consistency between our convictions and our actions
Moral Distress = results when values are pushed to a limit by
being consistently disrespected, trivialized, ignored, or compromised
* Find ourselves in situations where, for some reason, it is
difficult or impossible to stay true to our convictions
* Can be the result of moral dilemmas that are not
acknowledged or ignored and not resolved
* Can lead to feelings of anger, resentment, despair, or
powerlessness as well as anxiety, frustration,
dissatisfaction or guilt
define nursing ethics
The examination of the norms, values, and
principles in nursing practice
Separate from bioethics as nursing has a unique
focus on relationships
* Nursing practice consistently exists within a relational context
list ethical principles in nursing
Client Autonomy
Informed Consent
Trust
Fidelity (Truth-Telling, Deception, and
Withholding Information)
Beneficence
Non-maleficence
Justice
describe the 6 factors of the Code of Ethics
Contains standards and expectations of ethical practice for professionals
Founded on ethical theories, concepts, and principles (values)
May also contain tools for ethical decision making
Professional groups (like nurses) accept the duty serve the public interest and the common good
Defines acceptable and unacceptable behaviors, rules of conduct, and professional values and responsibilities
Clarifies principles that guide decisions and actions
discuss the ICN Code of Ethics for nurses (responsibilities and elements).
Four fundamental
responsibilities for nurses:
* To promote health
* To prevent illness
* To restore health
* To alleviate suffering
Four elements:
* Nurses and People— includes informed consent,
confiden tiality, advocacy,
social justice, and integrity
* Nurses and Practice—
incl udes competent practice,
clinical judgment, personal
health (fitness to practice),
safety, and dignity
* Nurses and the Profession—
includes self-regulation,
clinical practice standards,
management, research,
education, EIP, positive
practice environments, and
equitable working conditions
* Nurses and Co-Workers —
incl udes multidisciplinary
relationships, collaboration,
and reporting
describe the CNA Code of Ethics for registered nurses
First published in 1980
Several updates — most recent in 2017
Consists of 2 parts:
* Part I— Nursing Values and Ethical Responsibilities
* Outlines 7 primary values to guide practice
* Part 2— Ethical Endeavors
* Outlines approaches nurses can take to address social
inequalities
what are the 7 values identified in the CNA Code of Ethics for registered nurses
Value A: Providing Safe, Compassionate,
Competent, and Ethical Care
Value B: Promoting Health and Well-Being
Value C: Promoting and Respecting Informed
Decision Making
Value D: Preserving Dignity
Value E: Maintaining Privacy and Confidentiality
Value F: Promoting Justice
Value G: Being Accountable
Did you read over week 6 textbook notes?
yes
discuss nurses as leaders
Nurses are being required to assume positions of leadership and management in health care delivery much earlier in their careers today.
It is important to understand leadership and management roles early in your educational program and the relevant
competencies required of entry-level nurses.
You will need to “lead where you land”
describe leadership vs. management
Leadership = refers to a shared vision, values, organizational strategy, and
relationships
Management = refers to the competencies required to ensure day-to-day delivery of nursing care according to available resources and standards of professional practice
Nursing leadership is needed at every level
what are some leadership skills for nursing students?
Advocacy
Conflict resolution
Collaborative practice
Patient centeredness
Delegation
Evidence-informed decision making
what is the purpose of nursing organizations?
Bring nurses together for common goals or purposes
* Political action
* Advocacy
* Professional development
Also, to provide support, motivation, and
socialization
Promote leadership development
what is the value and purpose of nursing organizations?
Nursing leaders do more than delegate, dictate, and direct others in clinical settings. Leadership involves helping others to reach for their highest potential.
Nursing Organizations can:
- Address complex problems, issues, or concepts
- Capture the attention of the public
- Cast nurses as credible advocates and leaders
why have nursing organizations?
Benefits: provide structure and forums for professional development, publication of
research, lead national discussion on issues of
importance to nurses, and networking opportunities
Drawbacks: existence of so many organizations may blur the message of individual group or confuse who speaks for nurses
identify and describe the 3 types of organizations
Regional or Provincial
* College of Registered Nurses
of Alberta (CRNA)
* Alberta Association of
Nurses (AAN)
* United Nurses of Alberta
(UNA)
* Western and Northwestern
Region of Canadian
Association of Schools of
Nursing (WNRCASN)
National
* Canadian Nurses
Association (CNA)
* Canadian Nursing Students
Association (CNSA)
* Canadian Federation of
Nurses Unions (CFNU)
* Canadian Association of
Schools of Nursing (CASN)
* Specialty Practice Groups
(Ex: Canadian Council of
Cardiovascular Nurses —
CCCN)
International
* International Council of
Nurses (ICN)
* Specialized Focus Groups
(Ex: International Family
Nursing Association — IFNA)
what is the focus of nursing organizations?
administration
regulation
clinical practice
education
policy
research
protection
what 9 organizations in nursing were discussed?
ICN (International Council of Nurses)
CNA (Canadian Nurses Association):
CASN (CanadianAssociation of Schools of Nursing)
CNSA (Canadian Nursing Students’ Association)
CNPS (Canadian Nurses Protective Society)
CFNU (Canadian Federation of Nurses Unions):
CANA(College of Registered Nurses of Alberta)
UNA (United Nurses of Alberta)
AAN (Alberta Association of Nurses)
describe the ICN (International Council for Nurses)
- CNA members are automatically members
- Federation of national nurses’ associations representing nurses worldwide
- Ensures quality nursing care for all, sound health policies
globally, the advancement of nursing knowledge, and the
presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce - Advances nursing, nurses and health through its policies, partnerships, advocacy, leadership development, networks,
congresses, and special projects - Works with agencies within the World Health Organization
what is the vision and mission of the Canadian Nurses Association (CNA)?
Vision:
* Registered nurses: Leaders and partners working to advance nursing and health.
Mission:
* CNA is the national professional voice of registered nurses, advancing the practice of nursing and the profession to improve health outcomes in a publicly funded, not-for-profit health system by:
* unifying the voices of registered nurses;
* strengthening nursing leadership;
* promoting nursing excellence and a vibrant profession;
* advocating for healthy public policy and a quality health system; and
* serving the public interest
discuss CNA’s objectives
to advance nursing excellence and positive health outcomes in the public interest
to promote profession-led regulation in the public interest
to act in the public interest for Canadian nursing and nurses, providing national and
international leadership in nursing and health
to advocate in the public interest for a publicly funded, not-for-profit health system.
discuss CNA’s goals
In pursuit of the vision and mission, CNA has established the following goals:
* To promote and enhance the role of registered nurses to strengthen nursing and the
Canadian health system.
* To shape and advocate for healthy public policy provincially/territorially, nationally and internationally.
* To advance nursing leadership for nursing and for health.
* To broadly engage nurses in advancing nursing and health
describe the Canadian Nurses Protective Society (CNPS)
Not-for-profit society that offers legal advice and support, risk-management services, legal assistance and professional liability protection related to nursing practice in Canada.
Legal representation, whether it is in the context of a civil
proceeding, a criminal prosecution, or other forms of legal proceedings.
Provides a wide range of group workshops, webinars and online resources designed to reduce risk in your practice and help prevent patient harm.
CRNA members are beneficiaries for its legal assistance if you are the subject of an investigation due to a complaint filed against you with the College (or the provincial or territorial
association that regulates nursing practice.)
describe the United Nurses of Alberta (UNA)
Advocates for nurses, nursing profession, and Canada’s
health care system
Negotiates collective agreements (contract between
employer and employees) that regulate salaries, benefits, scheduling rules, overtime pay, sick leave, job security, and working conditions
Administers agreements to resolve disputes, improve
working conditions and protect nurses’ workplace rights
Represents members before Labour Relations Board
hearings, professional bodies’ disciplinary meetings
Affiliated with Canadian labour movement through
membership in the CFNU
If you work at a unionized worksite, you pay dues and
may become a member
describe the Canadian Federation of Nurses Unions (CFNU)
Represents nurses from provincial unions (UNA in Alberta) and student members of the CNSA
Nurse’s unions conduct
negotiations, job actions, resolution of grievances related to their members while also considering
impact on public
Addresses labor relations and
working conditions
Advocates for safe client care,
public healthcare system, social justice
describe the College of Registered Nurses of Alberta (CRNA)
Serve to protect the public by regulating the profession
The CRNA is our regulatory body - their authority is dictated by the Health
Professions Act (HPA).
Establish and apply standards of practice
Once a nurse is registered, they are also members of CNA and ICN
describe the Alberta Association of Nurses (AAN)
An association dedicated to advancing nurses and the nursing profession by augmenting the strengths of Alberta nurses.
AAN is not a union
Works collaboratively with regulatory bodies (i.e., CRNA) and unions to support and advance all Alberta nurses and nursing professionals
Participation is voluntary
do students have a role/benefit from nursing organizations?
Courage and passion to address goals related to quality health care
Energy, knowledge, and skills to continue on the path despite challenges and adversity
Play a role in shaping the future of nursing education
Contribute to your professional growth
Network with other emerging health leaders
Education beyond the classroom, negation training, leadership skills, travel
Use your voice to turn your ideas into action
Recognize that organizations have shaped your education experiences (curriculum, practicum, testing, etc.)
describe the health profession act (AB)
This legislation requires (and gives authority) to health professional colleges to follow rules for investigating complaints, setting educational standards, ensuring ethical practice, and setting practice standards for
registered members.
In Alberta, CRNA is responsible for establishing and enforcing safe, ethical,
professional practice as set by HPA.
Under the HPA, there is a common framework
across all health professions for:
- registration
- continuing competence
- restricted activities
- professional conduct
- regulation, bylaws, code of ethics and standards of practice
- protected titles
define professional colleges
Govern and regulate the practice of their members in manner to protect and serve public interest
Protects public from incompetent and unethical practice
what does the HPA expect the CRNA to do?
govern members in a manner to protect the public interest
regulate the practice of the profession including the setting of qualifications for entering the profession
establish, maintain, and enforce standards for
registration and standards of practice
establish, maintain, and enforce code of ethics
approve programs of study and other courses for the purposes of registration requirements
develop and enforce continuing competence
program to ensure practicing registrants are maintaining competency in their practice
address complaints
describe the forming of the CRNA
The Alberta Association of Graduate Nurses was formed in 1916 and incorporated that same year under Alberta laws.
- Registered Nurses Act: By petition to the Alberta Legislature in 1920, the Act was amendedto Alberta
Association of Registered Nurses.
The regulation of registered nurses came under the Health Professions Act (1999) bringing the largest group of health-care professionals in the province under the Act and changing the name Of the
regulatory body for registered nurses to the College and Association of Registered Nurses of Alberta (CARNA).
In 2021, changed name to College of Registered Nurses of Alberta (CRNA) and took on a single regulatory mandate.
Association activities passed on to newly created Alberta Association of Nurses (AAN)
what does the CRNA ensure?
CRNA endeavors to ensure that all Alberta RNs and NPs provide safe, competent and ethical nursing care by:
- setting the qualifications for entering the profession
- approving nursing education programs in the province that prepare individuals to enter the profession
- issuing practice permits only to those who meet the legislated and regulatory requirements
- developing and enforcing professional and ethical standards for the desired and achievable level of performance against which nursing practice can be measured
- developing and enforcing a continuing competence program to ensure that practicing members are maintaining competence in their practice
- taking action when a member of the public, an employer or a CARNA member submits a complaint about the practice of a regulated member
- advocating for a high quality, cost-efficient health-care system that makes the best use Of the knowledge and skills Of RNS
- providing progressive, innovative leadership that encourages excellence and influences health policy
what are the college regulatory functions?
Registration = the individual is a member of the provincial or
territorial nursing college
Licensing = Once registered, and having also demonstrated that they meet all provincial or territorial requirements for RN
practice, a license is issued
* This means they are authorized to practice in that particular province or territory
identify the standards of practice
Practice standards:
* are established by all nursing regulatory bodies across Canada
* reflect the philosophy of nursing practice and codes of ethics
* are relevant to malpractice and negligence issues
provide directly relevant evidence of the standard of care
- provide criteria by which a nurse’s conduct will be judged in legal or disciplinary proceedings
what do most standards of practice provide?
provide a guide for safe practice
describe nurses’ responsibilities and accountabilities
provide performance criteria and ensure continuing competence
interpret scope of practice
provide direction for nursing education and research-based practice
facilitate peer review and quality improvement
CRNA Practice Standards
what are the entry level competencies?
Set by Provincial
Regulatory Body
Fairly consistent
across the country
Form part of the requirement for initial licensure
often used to guide the development of nursing education programs
identify the continuing competencies
after initial licensure, must demonstrate a commitment to continued competency
* Requires nurses to continually integrate and apply new nursing knowledge into their practice in order to remain current and safe
Links to Code of Ethics, Standards of Practice, and lifelong learning
* Reflect on own practice
* Develop learning plan for coming year
* Report on leaming plan — start cycle over
describe discipline in relation to the CRNA
The procedures are generally as follows:
* complaint in writing
investigation
* interim investigation
* disciplinary committee hearing
- penalties
- Appeals
CRNA Complaints
describe self-regulation
This privilege (nota right) is granted through legislation
Allows a profession to govern its own members
Comes with responsibility to protect public interest/trust
When nursing care is seemed unsafe, incompetent, or unethical, the regulatory body intervenes and places
the interest of the public ahead of the interests of the offending nurse
define scope of practice
Describes the activities/interventionsthata professional is authorized to perform (educated on and
competent).
Other factors to consider:
- Client need
* Practice environment
- Policies/standards of employer
- Nurse’s knowledge/competence/experience
identify and describe the difference categories of nurses in canada
Licensed Practical Nurses (called Registered Practical
Nurses in ON)
* 2-year Diploma
Registered Nurses
4-year Baccalaureate
* Same core knowledge for LPN and RN
* Clinical Nurse Specialists (for example: Wound Care Nurse)
Nurse Practitioner
* Advanced nursing role with expanded scope
* Requires additional training and education, as well as extensive clinical experience
Registered Psychiatric Nurses
* Focus on providing care to clients with complex psychosocial and mental health needs
what is the difference between registered nurses and registered/licensed practical nurses?
RNs
* Have a lengthier and more in-depth education, usually at the university level
* Stronger focus on critical thinking, critical analysis, evaluation
* Care for more complex and unpredictable client populations
* Have more Opportunities to specialize
* Leadership in practice, education, administration, research, policy development with opportunities for advanced practice roles
RPNs/LPNs
* Have a shorter and more basic education, usually at a
community college
* Care for less complex clients and predictable client
populations
* Have fewer opportunities to specialize
discuss the appropriate use of titles
What Is Nursing?
* There are numerous definitions of nursing; however, each
province/territory will set out a broad definition of nursing in legislation.
When Can You Call Yourselfa Nurse?
* Only those who meet criteria defined in legislation can use the title
Calling yourself a “Student Nurse” is a privilege
that also comes with responsibilities
how does the HPA define the RN practice?
RN Practice
In their practice, registered nurses do One or more of the following (based On an ethic of caring and the goals and circumstances of those receiving nursing services):
apply nursing knowledge, skill and judgment to assist individuals, families, groups and communities to achieve their optimal physical, emotional, mental and spiritual health and well-being, assess, diagnose and provide treatment and interventions
make referrals,
prevent or treat injury and illness,
teach, counsel and advocate to enhance health and well-being,
co-ordinate, supervise, monitor and evaluate the provision of health services,
teach nursing theory and practice,
manage, administer and allocate resources related to health services
engage in research related to health and the practice of nursing
provide restricted activities authorized by the regulations.
what are restricted activities (controlled acts)
Legislation specifically defines which activities can be performed by which professional groups
High-risk activities performed as part of providing a health service that require specific
competencies and skills to be performed safely
Authorization under professional regulatory
college and the employer
Knowledge and competency of health care professional
Client needs (assessment and critical thinking)
Acuity/stability/complexity of the client
discuss delegation
access the knowledge and skills of the delegate
match tasks to the delegate’s skills
communicate clearly - give unambiguous directions
listen attentively
provide feedback
what are the 5 rights of delegation from NIH?
Right task
* Appropriate to delegate for that patient
Right circumstances
* Good decision making needed to determine
what to delegate and where
Right person
* Right nurse delegates to right staff member for
the right patient
Right direction/communication
Right supervision
what is a profession?
How does this differ from a vocation? A trade?
What makes nursing a profession? What are some other professions?
How is nursing similarto other
professions? How is it different?
describe nursing as a profession
thorough academic preparation
intensive clinical training
unique body of expertise
autonomous practice
strong ethical guidelines
sense of altruism
discuss professional status
Society gives us elevated status as professionals and expects us to meet specific needs
Have a duty to meet the needs determined by society
Take that duty seriously (Historically, took oaths or pledges)
Have an obligation to serve the public interest and common good (motivated by altruism)
Focus not only on the individuals they serve but on society as a whole
Placed in positions of respect and are given the power to engage in important decisions that influence and shape public policy, law, and societal norms
what is meant by public interest?
Refers to how a profession enacts its obligations to ensure the welfare of society
In nursing, this means the provision of safe, competent, and ethical patient care
Means we place the interests of the public above the interests of the profession or of individual nurses
what are the elements of the nursing profession?
expertise
autonomy
accountability
autority
unity
define expertise
Specialized Knowledge
* Bachelor degree
prepared
* Licensing exams
* Continuing
education
* Specialty
Certifications
* Advanced degrees
Technical Skills
- Intensive Clinical
practice preparation
- On-going
Certification
Body of Knowledge
- Evidence-based
Practice
- Reflective Practice
* Scholarship and
Research
define autonomy
Nursing is a self-regulated profession
* Governed by regulatory bodies — CARNA
* Have to meet specific criteria to obtain a license and practice as a member of the
profession
* Title of “nurse” is protected
Individual Practitioners also have autonomy
* Means we are free to make decisions and act based on our knowledge base —
requires competency and accountability
* Must remain within our scope of practice
define accountability
“Nurses are accountable for their actions and answerable for their practice.”
- CNA Code of Ethics (2017)
We must remain responsible and accountable
- To CNA code of Ethics
- To Nursing Practice Standards (CARNA, etc.)
- Other documents from Regulatory bodies and Government
- Scope of practice Statutes
- Other literature/evidence/scholarship
Doing so has made us the most trusted profession
define autority
Health Professions Act — Grants CARNA authority to regulate nursing in Alberta
CARNA — Grants individuals authority to practice as
Registered Nurses in Alberta
Individual RNs — held accountable by society and CARNA to practice according to standards
Can be disciplined by CARNA for malpractice or misconduct
define unity
As a group, have shared values and goals
Come together with a shared voice
Can act as powerful advocate or activist on many levels
Work together to meet the healthcare needs of society
Professional Associations and Unions
discuss professional association in relation to Alberta association of nurses (AAN)
standardize services provided by its members
perform political, advisory, and policy functions
assist with educational needs of members
provide a professional hub for its members
describe professional nursing (6 factors)
Being Accountable
* Taking responsibility for
and answering for the
professional, ethical, and
legal duties of one’s own
actions
Public Trust
- This is a privilege. Held to
a higher standard
- Ensure privacy and
confidentiality
- Accountable for all
actions
- Act in interest of public
good at all times
Professional Boundaries
- Maintain appropriate
boundaries within nurse-
patient relationship
- Onus is on the nurse
- Must remain therapeutic
boundaries
- Includes steps of
establishing, maintaining,
and terminating the
relationship
Therapeutic Relationship
* Introduce self using
name and designation
* Obtain consent for all
actions
* Keep all patient
information private and
confidential
* Proper use of social
media
Professional Presence
- Act with confidence,
integrity, passion,
optimism, and empathy
in accordance with
practice standards,
codes of ethics, and
other guidelines
- Remain non-judgmental
and objective
Leadership
- Not limited to high-level
or formal roles
- Includes taking
initiative, advocacy,
questioning
appropriately, and peer
support
define concept
an idea that we conceive to represent objects and experiences in the world around us. A concept can be about concrete things that we experience through our senses, such as pain, hunger, or shortness of breath. Concepts can also be about things that are abstract or not experienced through our senses, such as spirit, love, or grief. A concept is communicated using words to describe the concrete or abstract notion.
define grand nursing theories
theories offering a general orientation of philosophical stance about nursing.
define midrange nursing theories
theories that are informed by practice or research and offer general direction about particular areas of nursing practice.
define nursing metaparadigm
the set of core concepts that define the discipline of nursing. Includes the concepts of: person, health, nursing, environment.
define nursing practice theories
theories offer direction for specific situations and focused nursing interventions.
define nursing theories
theories focusing on nursing and the care of people, families, and communities. Typically, they address concepts in the nursing metaparadigm.
define theory
sets of concepts used to describe, explain, or predict the physical and social world. Theory suggests relationships within, between, or among concepts. In nursing, theory informs practice, and at the same time, practice informs, challenges, or confirms theory.
explain the meta paradigm framework
○ Person: receives care from the nurse
○ Health: beyond being well, one’s ability to use all human powers
○ Environment: external (e.g., fresh air) and internal (e.g., intake) factors
- Nursing: modifying and/or managing the environmental factors to implement laws of health
The Concept of Person
Nurses interact with persons for the intentions of providing holistic nursing care.
The Concept of Health
Includes the physical, psychosocial, relational, and spiritual aspects of an individual, family, or community.
The Concept on Environment
The totality of all the things that affect a person and includes both the external and internal contexts.
The Concept of Nursing
Provide safe, compassionate, competent, and ethical care
Promote health and well-being
Promote and respect informed decision-making
Preserve dignity
Maintain privacy and confidentiality
Promote justice
Be accountable
what are the 3 nursing theories?
Grand nursing theories
Midrange or middle-range theories
Nursing practice theories
define assessment
a systematic and ongoing process of gathering, organizing, validating, and documenting data related to the client’s health status through inquiry, collaboration, and using various resources.
define clarification
seeking additional information to confirm understanding.
define clinical judgement
the process nurses use to critically evaluate and interpret client data and then make informed decisions about their client’s care.
define diagnosis
involves analyzing data, identifying health problems and risks, as well as strengths, and formulating diagnostic statements
define ecomap
a pictorial depiction of how a person values his or her attachments to people or activities.
define evaluation
to review and measure whether the care goals were met, to identify if there were any unintended outcomes, and to determine if any changes to the plan are required to accomplish any unmet goals.
define genogram
a pictorial representation of the client’s family and health patterns.
define implementation
an intentional effort to achieve the client’s health-related goals.
define interpreting
understanding the clinical significance of how data fit together to inform clinical decisions regarding client care.
define interventions
planned nursing actions taken to address client or family needs, working toward previously established collaborative goals for client or family outcomes.
define nursing diagnosis
a clinical judgement that identifies the client, family, group, or community’s response to actual and potential health conditions/life processes.
define nursing process
a systematic and rational method for planning and providing client care organized around a series of phases that facilitates holistic and client-centered nursing practice.
define outcome
a measurable response (such as an attitude, acquired skill, behaviour, or state) to nursing care provided to clients, families, or communities.
define planning
the steps taken by the nurse, interprofessional team, client, and family to develop goals, identify desired health outcomes, formulate care plans, prioritize nursing interventions, and coordinate necessary resources.
define synthesis
process of combining assessment data, nursing knowledge, and clinical experience to determine the provision of care.
define taxonomy
a codified way of categorizing and classifying information.
describe the nursing process
Assessment
Collect data
Organize data
Validate data
Document data
Purpose: establishing a database of information about the client’s response to health concerns or illness and his or her ability to manage his or her health care needs.
Diagnosis
Analyze data
Identify health problems, risks, and strengths
Formulate diagnostic statements
Purpose: identifying client strengths and any health problems that could be prevented or resolved by collaborative care and by independent nursing interventions.
Outcomes/Planning
Prioritize problems and diagnoses
Formulate goals and define desired health outcomes
Select nursing interventions
Write nursing care plan
Purpose: develop an individualized nursing care plan that specifies client goals and the desired health outcomes, along with related nursing interventions.
Implementation
Reassess client
Determine resources requirements
Implement nursing interventions
Supervise delegated care
Document nursing activities
Purpose: assist the client in meeting the desired goals and health outcomes. Promote wellness. Prevent illness and disease. Restore health. Facilitate coping with altered function.
Evaluation
Collect data related to outcomes
Relate nursing actions to client goals, outcomes
Draw conclusions about problem status
Continue, modify, or terminate the client’s care plan
Purpose: determining whether to continue, modify, or terminate the plan of care.
identify and describe the 4 types of assessment
Initial assessment
Meeting for the first time. Nurse explores presenting problems, contributing factors, and may also conduct a physical assessment.
Focused assessment
Specific details about the presenting concern.
Ongoing assessment
Re-evaluate client status.
Will help determine if condition has improved, worsened, or stayed the same.
Emergency assessment
Trauma or emergency situation
ABC - airway, breathing, circulation
identify and describe the 3 types of planning
Initial planning
Usually part of the admission assessment and identifies what actions are required to move forward in providing client care.
Ongoing planning
Continuous and involves adapting client care in response to new information obtained through assessment and evaluation.
Discharge planning
Anticipates and plans for the client’s needs as he or she transitions between health services as well as independent living.
define the acronym SMART
specific
measurable
attainable/achievable
relevant/realistic
time-limited
define context
the environment, situation, or occasion that affects a related thought or topic.
define critical inquiry
can be used interchangeably with critical thinking in some circumstances, depending on the definition of critical thinking. Infers an expanded type of thinking used to reflect on evidence for judgement.
define critical thinking
a combination of skills and dispositions to maximize one’s ability to purposely reflect, think deeply, and act purposely.
define deductive reasoning
using generalizations to create specific conclusions.
define dispositions
personal traits, attributes, or qualities.
define evidence-based practice
the use of various types of knowledge to guide one’s practice in the clinical setting toward the goal of quality client care outcomes.
define inductive reasoning
when specific events, or findings from those events, are used to form broader generalizations.
define perfections of thought
originally coined by Paul (1990), these are traits or goals that describe clear, concise, exemplary thinking.
define reflective skepticism
positive, respectful examination, analysis, and questioning of a specific topic or issue.
define reflective thinking
a consecutive, successive thought process, prompted by uncertainty or perplexity, where consequence and grounds for the belief are thoroughly examined.
define thinking outside the box
thinking that is considered unconventional or against commonly engrained traditions. Thinking outside the box is often used synonymously with creative thinking or creating a new perspective, in contrast to “thinking inside of the box,” which is thinking that follows traditional pathways or perspectives. Thinking inside the box is often representative of the “status quo” or usual ways of thinking about things.
what is relational practice?
Refers to interpersonal communication skills, as well as the means of building and
sustaining health promoting relationships with clients, families, colleagues, and
others. (CLPNA)
One of the NESA Cornerstones of Nursing Curriculum/Praxis:
* Engaging students in partnering with people in their care, and other members of the inter-professional team, to build on strengths and create conditions that support health, healing, and wholeness.
Nursing occurs within the context of a relationship. It is a “relational” practice.
define relational practice.
Relational nursing practice is an understanding of patients’ health care needs within complicated contexts, in which
patients experience health care and nurses deliver nursing care.
define authenticity
true to yourself, actively present and genuine in how you communicate and interact with patients.
define active listening
being present both physically and emotionally - actively listening and empowering the patient’s own voice, involves creating a safe space for the client and being with the client. listen to what is said, AND what is not said.
define self-awareness
meeting the needs of the client rather than your own needs. self-awareness developed through self-reflection.
define empathy
the ability to emotionally and cognitively understand and communicate the experience and feelings from another’s point of view - a critical ability for nurses to have.
define rapport
development of trust and understanding within the nurse-client relationship
define trust
evolutionary process and an attitude in which an individual relies with confidence on another.
define self-disclosure and confidentiality
disclosure for the purpose of enhancing the therapeutic outcome for the client; safeguarding information and not sharing without consent.
define mutuality and intentionality
finding common ground, a shared sense of understanding; actively choosing to care, ideally motivated by intrinsic desire to improve client’s experience and outcomes.
define honouring complexity and ambiguity
continually assess, adapt, and revise understanding of the client’s lived experience.
define reflective practice
process of mentally reviewing, analyzing, and comprehending events, situations, or actions and their meaning.
5 questions to ask yourself when active listening
- Why is it important for me to actively listen to the client?
- How am I demonstrating that I actively listen?
- What strategies can I use to facilitate active listening?
- What prevents me from actively listening?
- What are the consequences to the nurse-client relationship if I fail to actively
listen?
discuss the 10 characteristics of therapeutic relationships and personal relationships. explain characteristic for each relationship.
Behavior
- TR: Regulated (Code Of Ethics: Professional Standards)
- PR: Guided by personal values and beliefs
Remuneration
- TR: Nurse paid to provide care
- PR: No payment
Length
- TR: Only as long as needed for care
- PR: As long as desired
Location
- TR: Defined: Where nursing care is provided
- PR: Undefined; unlimited
Purpose
- TR: Goal-directed to provide needed care
- PR: Pleasure; interest-directed
Structure
- TR: Nurse provides care to client
- PR: Spontaneous: unstructured
Balance of Power
- TR: Unequal: Nurse in position of power
- PR: Relatively equal
Responsibility for relationship
- TR: Nurse responsible
- PR: Equal responsibility
Preparation for relationship
- TR: Nurse requires trashing/preparation
- PR: No formal training or preparation
Time spent in relationship
- TR: Contract outlines hours Of work/care
- PR: Personal choice
what are the phases of a therapeutic relationship?
Pre-Orientation (or
Pre-Interaction) phase
* prior to meeting cient:
May receive shift report,
review client chart or
other documents
Orientation (or
Interaction) Phase
* Self-Awareness. Fist
Impression. guiding Trust,
Consent. Expectations
Working Phase
* Collaboration with client
toward established goals
Termination Phase
different ways to ensure therapeutic communication
Open ended questions
Clarification
Probing
Paraphrasing
Sharing observations
Silence
Summarizing
different ways of non-therapeutic communication
Giving Advice
Closed-Ended Questions
* Leading Questions
Changing the Subject
Automatic Responses
- False Reassurance Cliché
- Sympathy
Expressing Approval or Disapproval
Belittling Feelings
Defensive Responses
what is health
an objective measure
what is wellness
a person’s subjective experience of being healthy
what is disease
the physiological deviation from normal - considered objective and measurable
what is illness
a person’s subjective experience of living with disease
describe and define health and well-being
Health is “…a state of complete physical, mental, and social well-being and
not merely the absence of disease or infirmity.” (WHO, 1948)
Health as a status vs. Health as a resource
Well-being is “the presence of the highest possible quality of life in its full breadth of expression, focused on but not necessarily exclusive to: good living standards, robust health, a sustainable environment, vital communities, an educated populace, balanced time use, high levels of civic participation, and access to and participation in dynamic arts, culture, and recreation.”
(Canadian Index of Wellbeing, 2016)
what are the 8 domains of wellness
emotional wellness
intellectual wellness
occupational wellness
physical wellness
sexual wellness
spiritual wellness
environmental wellness
social wellness
define emotional wellness
Understanding feelings
Managing and/or controlling those
feelings
Appropriately expressing feelings
define intellectual wellness
Attainment of
knowledge
Realization of creative potential
Seek stimulating activities to ensure growth of self
define occupational wellness
Also called vocational domain
How much value placed on work?
Paid vs. Volunteer
Satisfaction through providing
service to others
define physical wellness
Efforts at sustaining states
of health
Lifestyle choices
Diet/ exercise
Self-care
Developmental stages
define sexual wellness
Sexuality and sexual function
Intimacy and respectful relationships
Safety
Cultural context
define spiritual wellness
Holistic view of the individual — mind, body, and spirit
Sense of meaning for life
Relationships with self, others,
nature, or a higher being
define environmental wellness
Use of and need for natural resources
Clean air, water, land
Food security
Population, urbanization,
industrialization
Impacts of climate change
define social wellness
Relationships with others
Friends and Family
Roles, boundaries, identity
Respect, cooperation, support, and communication
Communities, civic relationships, economic relationships
give examples why self-care is important for nursing students
May experience wellness changes in many domains
Learn to care for others, but also need to care for
themselves
School is stressful, as is relocating and loss of social
supports
You are also forming a new identity and changing
existing relationships and expectations
Need to learn and maintain positive self-care habits
what is health promotion?
Process of enabling people to increase control over and to improve their health
Can be focused on various levels:
* Individual
* Family
* Groups/ Community
* Population/ Society/ Nation
- Global
Is a process that is relational — depends on relationship between HCP(s) and target individual(s) or group(s)
give examples of health promotion models
Some focused more at the individual, family, or small group level
* Pender’s Health Promotion Model
* Transtheoretical Model
Some focused more at population, nation, global level
* Population Health Promotion Model
what are the 5 health promotion strategies?
Come from the Ottawa Charter for Health Promotion (WHO, 1986)
1. Strengthen Community Action
2. Build Healthy Public Policy
3. Create Supportive Environments
4. Develop Personal Skills
5. Reorient Health Services
define fitness to practice
All the qualities and capabilities of an individual relevant to his or her capability to practice as a nurse, including freedom from
any cognitive, physical, psychological, or emotional condition or a dependence on
alcohol or drugs, that impair his or her ability to practice nursing. (Gregory text, p.
77; CNA Code of Ethics)
who decides fitness to practice?
Responsibility is on the nurse to determine their fitness to practice
- Designated in Code of Ethics (Value G; Statement 5) and by Regulatory Body (CRNA Practice Standards for Registrants; Standard 1.13)
Nursing Students vs. Employment
- Regulations/Policies
- Accommodations
what are threats to fitness to practice?
Short-term
- Acute illness
- Injury
- Accident
- Sleep deprivation
- Medication side effects
Long-term
- Chronic illness
- Cognitive condition or impairment
- Severe emotional stress
- Problematic substance use
define bisexual
an individual who holds an attraction for more than one gender on an emotional, physical, and/or sexual level; sometimes, one gender is preferred over others.
define cis gender
an individual with a gender identity that aligns to one’s assigned sex.
define determinants
factors that affect health, such as income and social status, social support networks, education, working conditions, social environments, physical environments, personal health practices and coping skills, biology, gender, and culture.
define diseases
the physiological deviation from “normal,” that is, therefore, objective or measurable.
define ecoliteracy
using the knowledge of ecosystems to advocate for sustainable communities.
define gay
in the context of individuals, this term refers to males who express and attraction to the same gender (male); the attraction is felt on a romantic, emotional, erotic, and sexual level. Men who participate in same-sex relationships may not self-identify as gay.
define health
a positive concept, beyond physical capabilities, that emphasizes social and personal resources. Holistic understanding of health is central to the definition of health promotion. The Ottawa Charter emphasizes certain prerequisites for health, which include peace, adequate economic resources, food and shelter, and astable ecosystem and sustainable resource use. These prerequisites highlight the inextricable links between social and economic conditions, the physical environment, individual lifestyles, and health. Although health is a positive, it is not the point to living; health is a resource for living well.
define health promotion
the promotion of healthy ideas and concepts to motivate individuals to adopt healthy behaviours. Health promotion is also the provision of information and/or education to families and communities encouraging family unity, community commitment, and spirituality, all of which can make positive contributions to health.
define illness
the subjective experience of living with a disease or condition and its accompanying symptoms.
define lesbian
a woman who expresses an attraction to individuals of the same sex/gender; this attraction is felt on an emotional, physical, and/or sexual level.
define nursing process
a multistep framework used to create a plan of care, including assessment, nursing diagnosis, planning, interventions, and evaluation.
define objective knowing
concrete, measurable knowledge; often easily defined as the “opposite of subjective”.
define pan sexual
an individual has a sexual attraction to a number of gender identities.
define population health
improving the determinants of health from the perspective of a nation.
define queer
all-encompassing term of diverse sexual orientations and gender identities; the term is inclusive of lesbian, gay, transgender, and other categories.
define self-change behaviour
an action the client is willing to employ to meet health outcomes.
define self-efficacy
the judgement a person makes of his or her personal ability to organize and carry out a particular course of action.
define subjective knowing
knowledge informed by perception, personal views, experience, or background.
define transgender
an individual who expresses himself or herself outwardly as a gender that is not based on anatomical sex.
define transsexual
an individual who self-identifies with a sex not assigned at birth. Transsexual persons may undergo hormonal and/or surgical transitioning to the sex they identify with most, i.e., female-to-male and male-to-female. Trans men and women can take social, legal, and medical, and/or surgical steps to find comfort in their own body.
define two-eyed seeing
from the Mi’kmaw Etuaptmumk, a way of viewing health that is both indigenous and western.
define two-spirited
some indigenous peoples identify with both the feminine and masculine spirit. The term reflects distinct and diverse gender variances and expressions.
define well-being
the presence of the highest possible quality of life, including aspects such as good living standards and education; robust health; a sustainable environment; vital communities with high levels of civic participation; and access to and participation in arts, culture, and recreation.
define wellness
there is no universally accepted definition of wellness. Wellness is an evolving process of becoming aware of and making choices toward a fulfilling sense of individual life accomplishments. Dimensions of wellness includes both physical and mental components. Wellness describes a multidimensional state of being involving the existence of positive health, exemplified by the individual’s experience of life quality and his or her sense of well-being.
what are the 3 fundamental ideas behind wellness?
The domains are interrelated
Wellness seems to ebb and flow within and among domains
The client is responsible for making choices toward reaching higher levels of wellness; the nurse cannot make choices for the client
define health inequities
Avoidable, unjust, and unfair systemic differences in health status within the population. Socially produced and modifiable.
define health inequalities
Identified differences in health status of individuals, groups, or populations. These differences are based on measurable data, such as biological, socioeconomic factors (e.g., employment, income, education, social supports), individual behaviours, physical and environmental (i.e., geography), early childhood development, and health care access.
define disparities
Measured outcomes caused by health inequities closely linked to determinants of health, and affecting diverse groups who have been discriminated against or excluded. The ability to track patterns enables assessment of health of populations to examine improvements over time, with a central aim to achieve health equity.
what are some actions to reduce health inequities?
To adopt better governance and development.
Goal: experiences in applying health impact assessment. Work across sectors to reduce poverty, improve social protection, advance key determinants, such as housing.
To promote participation in policy-making and implementation.
Goal: reforming government processes to increase openness of data, transparency and participation, and engaging citizens. Providing approaches to engage and empower indigenous peoples for self-governance.
To further reorient the health sector toward reducing health inequities.
Integrate equity, including gender-related considerations, into the design and delivery of programs and services. Provide capacity and tools to advance health equity.
To strengthen global governance and collaboration.
Provide financial contribution to countries and international organizations. Foster North-South support in information sharing and technical expertise.
To monitor progress and increase accountability.
Strengthen monitoring systems and methods to report on health inequalities. Share evidence to inform policy and action.
what are the 4 phases of a therapeutic relationship?
Preorientation phase
Shift report.
Employ critical communication and thinking skills when reviewing client data, recognizing that client conditions and behaviours change throughout the course of the client’s stay or treatment.
Orientation phase
Self-knowledge on the part of the nurse is one of the greatest influences when communicating within the orientation phase.
Working phase
Nurse acknowledges that collaboration is the key to client success.
Nurse uses effective communication such as silence, touch, open-ended questions, paraphrasing, shared observation, self-disclosure, and listening.
Termination
May occur at the end of each shift, upon client transfer to another unit or facility, upon discharge, or upon death.
define clarification
Perception checking
