NSG 1600 MIDTERM

Question 1

Define self-concept

Answer 1

The sum of one’s beliefs about oneself, which develops over time

Question 2

Define self-awareness

Answer 2

• Being cognizant of one’s own beliefs, thoughts, motivations, biases, and physical and emotional limitations and the impact these components may have on others
• Influence’s one’s self-concept
• One way to develop self-awareness is through regular and/or on-going self-reflection

Question 3

Define self-esteem

Answer 3

• Attitude about oneself; emotional appraisal of one’s worth
• Discouragement vs. encouragement

Question 4

What is the word?
Ways we describe ourselves and values we attach to these.

Answer 4

self-concept

Question 5

How do you know if you are self-aware enough?

Answer 5

• The more we can expose the hidden things in our lives, the more we can become more self-aware
• Be able to self-reflect

Question 6

What are the 5 components of self-concept

Answer 6

• fluctuates over time
• challenged by new situations/experiences
• can influence the therapeutic relationship
• can influence the healing process
• need to understand our own self-concept, and those of our clients and their families

Question 7

What 5 factors have an influence on self-concept? (think of the coloured wheel)

Answer 7

• body image (health impact)
• cognitive beliefs (value, what we believe is possible)
• emotional development (the impacts of social media)
• early attachment (adoption, foster care)
• self-awareness

Question 8

What are the 9 factors that influence self-concept and/or self-esteem?

Answer 8

• discouragement and failure
• encouragement and success
• sense of control (loss of control = less effort; feel like you have more control = more effort)
• confidence (successful interactions)
• sense of belonging
• poverty (social deterrents of health)
• religion
• culture
• media

Question 9

Who has an internal focus and concept/philosophy of self-concept?

Answer 9

Erikson

Question 10

In Erikson’s Growth and Development approach, identify the 9 stages of personality development and the corresponding ego strength.

Answer 10

Stages of Personality Development; Ego Strength

• 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 (nature adult); caring
• ego integrity vs ego despair (late adult); wisdom

Question 11

Describe Bronfenbrenner’s Ecological Systems approach. (may have to look back at notes for the visual - week 1).

Answer 11

microsystem, mesosystem, exosystem, macrosystem

choronosystem, lifespan

Question 12

Define self-identity

Answer 12

• the integrity of social and occupational roles and affiliations and self-attributed personality traits, attitudes, and beliefs and political ideology, religion, gender, and sexuality
• influences goal-directed behaviour and interpersonal relationships
• develops and changes over the lifespan

Question 13

Define worldview

Answer 13

• the way a group of people see their world, their physical and symbolic space, and their place in the world
• worldviews are influenced by culture, self-concept, and context
• can differ widely between individuals, or societal groups

Question 14

Describe the North American (Western) Worldview

Answer 14

• prizes individualism
• individuals are expected to leave home at adulthood and establish their own nuclear family
• individuals are expected to advance themselves financially, academically, and socially

Question 15

Describe Collective Societies

Answer 15

• Prize familial, community, and/or land-based connections
• Expect to live together in multi-generational households
• Seek to promote the advancement of the whole family or community, even at the expense of the self
• Can be culturally or racially driven or it can be influenced by family values

Question 16

In applying self-identity (fostering a positive self-concept) describe diverse clientele.

Answer 16

• differences in self-concepts, worldviews, and health-related perspectives or actions
• lead to different health care choices/actions

Question 17

In applying self-identity (fostering a positive self-concept) describe response to illness

Answer 17

• changes or challenges previous self-concept and self-identity
• alterations to body or appearance
• loss of function or ability
• dependence on others

Question 18

What are the 3 factors of therapeutic relationships? Define and describe the 3 factors

Answer 18

Therapeutic use of self
- how you use your unique personality and way of being in relationships with your client and their family

Need to know your “self”
- be yourself (self-awareness)
- be authentic/genuine

Need to understand how you relate to “others”
- seek to understand
- cultural humility

Question 19

What is reflective practice?

Answer 19

• thinking about and learning from past experiences
• have been doing this your whole life, whether consciously or not (avoid things that did not work; repeat things that did)
• need to formalize this process, AND record it

Question 20

People don’t learn from experience. They learn from reflecting on their experience. (T/F)

Answer 20

True

Question 21

What should you reflect about?

Answer 21

Things that went wrong
- mistakes
- missed actions/omissions
- negative interaction
- negative feedback

Things that went well
- successes
- education or new learning/information
- positive feedback
- personal progress
- what did I do today that I can build into my practice?

Question 22

What are the 3 stages of reflection? Describe.

Answer 22

What happened?
- be exact, include all details
- what emotions did you experience during the event?

Why does it matter?
- why did it happen?
- could you have done things differently?
- Why did you make the choices you did in the situation?

What next? (most important stage of the process)
- how will you change (your practice) as a result?
- test your reflections/plans - try out the new way. did it produce the expected results?

Question 23

What is the value of reflecting?

Answer 23

• you are consciously aware of your experience
• you can direct/decide your growth from your experiences
• you create new patterns of thought
• you practice will continually improve
• you can reflect on other people’s experiences as well - learn from others

Question 24

Define culture

Answer 24

A group of people who identify with each other on the basis of some common purpose, need, or background, or set of learned socially transmitted behaviours and beliefs arising from interactions within the group.

Question 25

Define personhood

Answer 25

The uniqueness of each human being, combined with a sense of personal continuity and personal anatomy.

Question 26

Define self-identity

Answer 26

The integration of social and occupational roles and affiliations and self-attributed personality traits, attitudes, and beliefs about political ideology, religion, gender, and sexuality; it influences goal-directed behaviour and interpersonal relationships.

Question 27

Define worldview

Answer 27

The way a group of people see their world, their physical and symbolic space, and their place in the world.

Question 28

how is self-concept impacted by growth and developmental perspective?

Answer 28

• Self-concept is affected by early attachment to a principle caregiver and how the caregiver meets the foundational emotional and physical needs of the infant and child.
• The ability to recognize emotions simultaneously develops with self-concept
• Different feeling of emotion (e.g., contentment, joy, dear, disgust) begin in infancy

Question 29

Describe ages 6-12 in relation to the growth and developmental perspective.

Answer 29

• considerable emotional development
• Potential in creating close relationships with parents and developing friendships
• Positive emotions also act as a buffer for negative life events
• Successful acquisition of abilities contributes to the formation of a positive self-concept and self-identity

Question 30

Describe early adolescence in relation to the growth and developmental perspective.

Answer 30

• Young adolescent: unable to integrate self-portrait, others hold varying opinion of adolescent
• Middle adolescent: cognitive-developmental changes account for shifting evaluations, unpredictable behaviours, and mood swings
• Later adolescent: self-concept and abstract thinking are further developed with experiences now being subject to higher levels of thought and analysis.

Question 31

Define ego integrity

Answer 31

the individual can look on his/her life achievements with satisfaction

Question 32

What is Bronfenbrenner’s Ecological systems approach described as?

Answer 32

external/environmental focus of self-concept

Question 33

Describe the environmental perspective.

Answer 33

• There is a complex bidirectional interaction between child development and the ecological systems within which the child interacts.
• Identifies the complexity of the interactions between systems and their influence on child development and self-concept
• Children are able to fulfill their growth and developmental tasks and develop their abilities is also influenced by the context of children’s lives within their families, communities, and the larger society

Question 34

what factors impact self-esteem

Answer 34

• Parental attitudes
• Child-rearing style
• Life experiences

Question 35

define the theory of incongruence

Answer 35

the ideal self and the real self must be congruent for a healthy self-concept. Illness might lead to poor self-concept. (Rogers, 1961).

Question 36

define the therapeutic use of self

Answer 36

how you use your unique personality and your way of being in a therapeutic relationship with clients and families.

Question 37

What are Carper’s 4 ways of knowing and what do they collectively provide?

Answer 37

Empirical
Personal
Ethical
Esthetic

the goal of providing appropriate, effective patient-centred nursing care.

Question 38

define the empirical way of knowing.

Answer 38

facts, scientific knowledge (i.e. pathophysiology, the rational behind the skills, evidences, etc.)

clinical research piece
evidence based work

Question 39

define the personal way of knowing.

Answer 39

knowledge of own self in a situation (i.e., self-reflection: what did you do well, what you could do better)

self-awareness/reflection
how am I in interaction with the person
interaction can influence patient outcomes

Question 40

define the ethical way of knowing.

Answer 40

morally correct in a situation (i.e., CNA codes of ethics, what is right/just and ought to be done, etc.)

what is best, right, should be done vs. what is done because of what the patient wants
connection to history (moral component/religion to nursing)

Question 41

define the esthetic way of knowing.

Answer 41

art of nursing, awareness of nursing in the moment of care (i.e., empathy, caring, genuineness, respect, relational, being with the other, self-disclosure)

nursing intuition - gets a feel for something in the room/something that is not easily measured

Question 42

are there other ways of knowing? list a few.

Answer 42

• providing education to patient as a way of knowing
• advocating for patient
• collaborative form of knowing
• spiritual
• cultural
• social-norms, what patient was brought up with
• impacts of a changing environment on health care (mosquitos)
• resources are not equally distributed

Question 43

what is emancipatory knowing?

Answer 43

emphasizes actions that arises from an awareness of social injustices embedded in a a social and political system.

is the human ability to recognize social and political problems of injustice or inequity, to realize that things could be different, and to work toward change that creates social justice for all.

requires critical examination that aims to uncover why injustices seem to remain invisible.

Question 44

what is hegemony?

Answer 44

the dominance of certain ideologies, beliefs, values, or worldviews over other possible viewpoints.

often hidden, taken as granted, taken as truth, and as the only possibility.

privileges certain groups over others.

tends to recreate itself or perpetuate itself. can be very hard to change.

emancipatory knowing works to “free” us of hegemonic thinking/being

Question 45

What is the power of emancipatory knowing?

Answer 45

helps the nurse look beyond individual experiences or situations. helps the nurse to consider the bigger picture. (how did they get into that position in the first place and how can we prevent them from getting there in the 1st place)

pushes nurses to discover the root causes for inequities.

motivates action toward change.

Question 46

what are the 4 ideologies/philosophies that are the foundation for emancipatory knowing?

Answer 46

critical theory
liberation theory
poststructuralism
feminist perspective

Question 47

define the critical theory.

Answer 47

describes a process of examining and challenging social inequities and injustices.

examines the root causes as well as the social consequences of such inequalities/injustices.

power balances.

Question 48

define the liberation theory.

Answer 48

sees education as a means for challenging existing knowledge, norms, and values.

provide/use education to create social change.

Question 49

define poststructuralism.

Answer 49

examines how power balances are created and maintained by verbal and symbolic representations in society, and how these representations create or produce meaning.

Question 50

define the feminist perspectives.

Answer 50

criticized current power imbalances.

challenged the status quo.

challenged systems of oppression.

nursing (and women) seen as oppressed group.

Question 51

identify and describe the 3 dimensions of emancipatory knowing.

Answer 51

ask critical questions.
- questions that focus on bringing social injustices into awareness

creative processes: critiquing and imagining
- tend to occur in circular/iterative fashion
- is activist in nature and leads toward “emancipation”

formal expressions
- how these new ideas are shared
- action plans, critical analyses, manifestoes, vision statements
- creates clarity/focus, brings awareness, and communicates injustices to those in power

Question 52

what is evidence?

Answer 52

generally refers to information derived from clinical research (look for relevance and reproducibility)

various kinds of research
- descriptive (stats around quality control measures)
- qualitative
- quantitative
- mixed methods
- synthesis/systematic review

Question 53

what are the 5 other forms of “evidence”?

Answer 53

Expert opinion
Experience
Patient preferences
Available resources
Contextual information

Question 54

what is evidence-informed practice?

Answer 54

nursing decisions and practice based on the best current evidence.

can take 17 or more years to get new evidence fully into clinical practice and policy.

even with best evidence, many patients do not receive the best or recommended care.

EIP = nurses apply research that has been conducted by others.
- need to know how to find, review, and critically analyze that research.

improves patient outcomes and practice according to evidence.

Question 55

describe the EIP process?

Answer 55

reflection
- critically review patient care and interactions

framing the question
- is this the best way.. ?

searching the research literature

critical appraisal of research literature
- which literature is best/strongest?

synthesis of findings from divergent literature

adaptation of findings to practice
- can it be applied/used in this situation?

implementation of practice change
- change management

evaluation
- did it work? impact on outcomes?

Question 56

how do you frame the question in the EIP process?

Answer 56

standard way of framing a clinical (or research) question (PICOT):

P = population/participants (Who?)

I = intervention (What?)
- measure/quantify

C = comparison (Control? if applicable)

O = outcomes

T = time (if applicable)

Question 57

describe the 6S pyramid for searching for research literature.

Answer 57

level of detail and specificity increases as you move downward.

? applicability increases as you move upward.

systems
summaries
synopses of synthesis
synthesis
synopses of studies
studies

Question 59

describe early nursing in “Canada”.

Answer 59

early nursing care provided by religious orders (mostly men at first, but it was difficult for them to provide care to women; later asked sisters from female religious orders to come and minister to the sick).

new colony of Canada devastated by epidemic of infectious diseases, largely spread via new settlers to Canada.

devastating effect on Indigenous populations (little resistance).

good nursing care was the only effective defence against smallpox, diphtheria, cholera, typhus, and scarlet fever. colonists brought these European diseases.

Question 60

describe the 4 points of colonization described in class.

Answer 60

goals were for European settlers to spread Christian values and convert Indigenous peoples to Christianity.

resulted in loss of culture, knowledge, tradition, way of life, family roles, community, and spirituality.

involved controlling people and exploiting land resources.

created many negative, lasting effect for Indigenous peoples of Canada. these effects linger today.

Question 61

describe the opening of the west in relation to Grey Nuns.

Answer 61

Grey Nuns (visiting nurses to Canada) spread out from Montreal toward the West.

they provided quality nursing care to all without consideration of race or social class to justify provision of care.

cared for patients in homes and in the convent.

later, established hospitals in many places, some of which still operate today (though often under new names now).

Question 62

who was Florence Nightingale?

Answer 62

middle class lady

founder of modern, professional nursing

rallied against customs that did not allow upper and middle class women to work (against her family wishes); characterizing nursing as suitable for those with a high moral calling (sobriety, chastity, loyalty, altruism, self-sacrifice).

cared for wounded soldiers in Crimean War.

dramatically decreased mortality and morbidity rates with simple nursing care.

elevated status of nursing.

first nurse statistician.
- kept stats to prove that what she was doing was working
- evidence based practice, research

applied principles of cleanliness and comfort.

her schools took a military-like approach.

Question 63

describe nursing in relation to World War.

Answer 63

women’s rights movement started right around the early 1900s (same time as WWs).

nurses gained respect and credibility.

nurses working on front lines during war time further advanced the image of self-sacrifice and heroism.

shortage of nurses as many women went to work at factories.

began to be seen as a profession of specialization, skill, and bravery rather than simply a religious vocation.

after WWI, nurses moved back toward the role of compliant handmaiden (deprofessionalization), largely due to poor working conditions in hospitals (low pay, high workload, few opportunities for learning).

after WWII, nurses were seen as maternal and nurturing, like the maternal role in the family.

before 1967, only females were permitted to join the nursing division of the Canadian military.

Question 64

as discussed in class, describe gender and diversity in relation to nursing.

Answer 64

historical, nursing was considered suitable for young, unmarried, white, Christian women.

Women’s Rights Movement: changed role of women in society (in and out of the home).

however, on-going challenges remain:
1. nursing still seen as women’s work.
2. women seen as sexual objects.
3. traditional societal values negate nurturing roles for men - seen as effeminate or homosexual.

multicultural dimension of Canada is changing the face of nursing.

Question 65

Describe hospital schools.

Answer 65

apprenticeship model

followed the Nightingale model.

students provided nursing care in exchange for education and costs of living.
- financial benefit to the hospital (enabled hospitals to provide nursing services at low cost).
- poor living conditions for students.
- education of questionable quality.
- long hours of strenuous work.
- men were not permitted to apply to all nursing schools.

Question 65

physicians as teachers -> apprenticeship model -> institutional training

(T/F)

Answer 65

True

Question 66

Mary Agnes Snively was the “Mother of Nurses in Canada”. how did she advance the nursing education?

Answer 66

superintendent at Toronto General Hospital School of Nursing.

established proper living conditions for students, a curriculum, established criteria for clinical and educational time.

formed Canadian National Association of Trained Nurses, which eventually became CNA (1924), recognizing that the nursing profession is unique.

introduced a 3-year course with 84 hours of practical nursing and 119 hours of instruction by medics staff.

Question 67

how did nursing expand in the 1950s and 1960s?

Answer 67

intense expansion of number of programs occurred across the country.

movement to separate nursing education programs from the authority of hospitals.

first Masters of Nursing program was established at University of Western Ontario in 1959.

Question 68

describe university programs for nursing.

Answer 68

community health practices promoted.

first undergraduate program established at University of British Columbia in 1919.

one year of study at the university followed by practice and hands-on training.

non-integrated: university assumed no responsibility for the 2/3 years of nursing prep in a hospital school of nursing.

University of Toronto developed the first curriculum with theory and practice integrated.

Question 69

describe the Royal Commission on Health Services of 1964.

Answer 69

called for better prepared faculty in schools.

quality and standards must be met in nursing education programs.

basic integrated model (theory and practice) became the program of choice.

target date of 2000 for all nurses to be prepared at baccalaureate level.
- PEI first to implement.
- QU continues to offer diploma program (as decided by the QU government).

Question 70

describe 1970 to the present in nursing.

Answer 70

Alberta Task Force on Nursing Education called for baccalaureate as entry to practice in 1975.

currently, most provincial and regulatory bodies have established the baccalaureate as entry to practice.

first nursing doctoral program was established at University of Alberta in 1991.

Question 71

describe nursing education today.

Answer 71

new and continually developing curricula.

increased access through online and distance modalities.

accelerated programs available.

educational standards monitored by the provinces
- responsive to changes in healthcare.

ensures greater quality and response to change.

lifelong learning.

Question 72

describe the 3 expanding roles for nurses.

Answer 72

nursing research
- Master and Doctoral levels
- knowledge translation/uptake (delayed)

nursing administration
- historically had “head nurses” - hierarchical military model
- now have unit managers, unions, and other nurse leader roles.

nursing policy
- regulatory bodies, professional associations, educational programs.
- working with different groups to improve the way we provide health care.

Question 73

list new challenges that nurses face.

Answer 73

chronic disease

physical inactivity and obesity

where we live and how we work

aging population

slowed growth of RN workforce

stress and mental health disorders are increasing

widening economic gap: poverty

meeting the basic health needs of Indigenous peoples

access to healthcare for immigrants and greater need for cultural safety

changing family structure

climate change

technological changes

nursing’s impact on politics and health policy; activism

preparedness for pandemics and epidemics

Question 74

who was responsible for the formation of the Canadian National Association of Trained Nurses in 1908?

Answer 74

Mary Agnes Snively. became the CNA in 1924.

Question 75

what are the 3 steps of nursing research?

Answer 75

posing the question, collecting data, and a presentation of the results (or the answer).

Question 76

where and why have nursing policies been developed? what are the different categories they fall into?

Answer 76

Nurses have developed policy in all areas of the profession (practice, education, research, and the policy sector itself). Development and implementation of policies that are in the best interest of the nursing profession fall into:

Regulatory bodies
Professional associations
Nursing unions
The academy
Practice policy

Question 77

what is the future of nursing shaped by?

Answer 77

The future of nursing is shaped by change and influenced by factors in demographics, economics, science and technology, family structures, and social and cultural issues.

Question 78

what are social determinants of health?

Answer 78

Income and income distribution; education; unemployment and job security; employment and working conditions; early childhood development; food insecurity; housing; social exclusion; social safety network; health services; Indigenous status; gender; race; disability

Question 79

what are areas of concern within nursing?

Answer 79

Stress and mental health; poverty and homelessness; family patterns; where we live and how we work; new Canadians and the changing nation; First Nations, Inuit, and Métis people; disease patterns; health care systems; nursing workforce: a changing landscape; the environment

Question 80

The nurse-patient relationship is always professional and therapeutic. It is characterized by:

Answer 80

trust
empathy
respect
professional intimacy

Question 81

empirics, the science of nursing (textbook)

Answer 81

There is a critical need for knowledge about the empirical world. It is systematically organized into general laws and theories.

The representation of health as more than the absence of disease is a crucial change; it permits health to be thought of as a dynamic state or process which changes over a given period of time and varies according to circumstances.

The discovery that one can usefully conceptualizer health as something that normally ranges along a continuum has led to attempts to observe, describe and classify variations in health, and levels of wellness, as expressions of a human being’s relationship to the internal and external environments.

“Natural history stage of inquiry”
The description and classification of phenomena which are ascertainable by direct observation and inspection.
Largely observational vocabulary

“Stage of deductively formulated theory”
Theoretical analysis which is directed toward seeking, or inventing, explanations to account for observed and classified empirical facts.
Terms have a distinct meaning and definition only in the context of the corresponding explanatory theory.

Question 82

esthetics, the art of nursing (textbook)

Answer 82

The creative process of discovery in the empirical pattern of knowing

Art is expressive

“Expressed by the individual nurse through her creativity and style in designing and providing nursing that is effective and satisfying”

Empathy is important in this pattern of knowing

Question 83

the component of a personal knowledge in nursing (textbook)

Answer 83

Nursing considered as an interpersonal process involves interactions, relationships, and transactions between the nurse and the patient-client.

Personal knowledge is concerned with the knowing, encountering, and cactus living of the concrete individual self. One does not know about the self; one strives simply to know the self. This knowing is a standing in relation to another human being and confronting that human being as a person.

Question 84

ethics, the component of moral knowledge in nursing (textbook)

Answer 84

Choices raise fundamental questions about morally right and wrong action in connection with the care and treatment of illness and the promotion of health.

The ethical pattern of knowing in nursing requires an understanding of different philosophical positions regarding what it good, what ought to be desired, what is right; of different ethical frameworks devised for dealing with the complexities of moral judgements; and of various orientations to the notion of obligation.

Question 85

describe emancipatory knowing and problem solving.

Answer 85

Requires a deep awareness of often hidden injustices and the problematic and social practices that create them.

Question 86

describe emancipatory knowing and critical thinking.

Answer 86

The emphasis is on seeing what lies beneath issues and problems and redefining those issues and problems to reveal linkages among complex social and political contexts that create injustices.

Question 87

describe emancipatory knowing and reflective practice.

Answer 87

Involves a constant interaction between action and reflection.

Reflective practice is a significant personal process that leads to insight about one’s actions and the rationales for actions that have the potential to improve one’s practice.

Question 88

describe the the rebirth of emancipatory knowing in nursing (critical theory, liberation theory, and postconstructuralism).

Answer 88

CRITICAL THEORY
Used to describe both the process and the product of work that takes a historically situated and sociopolitical perspective and that challenges social inequities and injustices.
3 fundamental human interests:
1. Technical interest: the human capacity to create things and processes to understand the physical world; this requires empiric methods.
2. Practical interest: the human capacity to communicate and to get along within a social community; this requires interpretive and philosophic methods.
3. Emancipatory interest: the human capacity to see that something needs to change and to take action to change it; this requires critical and reflective methods.

LIBERATION THEORY
Considered education as a means of challenging the existing knowledge and values of the culture.

POSTSTRUCTURALISM
Analyses how discourse functions to create imbalances that disadvantage whole classes of persons, in an effort to illuminate possibilities for change.

Question 89

describe the dimensions of emancipatory knowing.

Answer 89

Critical questions
Who benefits?
What is wrong with this picture?
What are the barriers to freedom?
What changes are needed?

Creative processes
Critiquing
Imagining

Formal expressions
Action plans
Manifestations
Critical analyses
Visions for the future

Authentication processes
Social equity
Sustainability
Empowerment
Demystification

Integrated expression in practice
praxis

Question 90

describe in greater detail the formal expressions aspect of emancipatory knowing.

Answer 90

1. Manifestos: are action-oriented and impassioned portrayals of that which is problematic, the actions required to effect change, and descriptions of the ideals that are envisioned.
2. Critical analyses: examine what is, how it came to be, and who is disadvantaged.
3. Vision statements: describe in detail and envisioned future.
4. Action plans: describe an envisioned future, as well as what is required to reach that future.

Question 91

what are the steps in evidence-informed practice?

Question 92

what are the steps in conducting research?

Answer 92

1. Define question
2. Conduct literature review
3. Develop methods, information, and consent letters
4. Get ethics approval
5. Collect data
6. Analyze data
7. Write report
8. Disseminate report

Question 93

what is a microaggression?

Answer 93

subtle verbal and non-verbal insults toward marginalized people by well-intentioned individuals.

happens at a micro level - perpetrators are usually unaware.

Question 94

what are the impacts of micro aggressions?

Answer 94

micro aggressions are cumulative and a constant reminder of a persons’s second-class status in society.

for those who continuously experience slights and indignities, even a small and unintentional incident can be felt like an ‘aggression’.

perceptions of discrimination can negatively impact the well-being of young individuals, particularly self-esteem, academic performance, mental and physical health.

Question 95

what is internalized oppression?

Answer 95

“the belief among historically oppressed people that negative stereotypes about themselves and positive stereotypes about a dominant group are, in fact, true.”

Question 96

what if I am the victim of a micro aggression?

Answer 96

consider your safety first.

if you feel safe, the most important thing we can do is verbally acknowledge the micro aggression that has been committed and empower the aggressor to think about his/her words in a different way.

Question 97

how do you address a micro aggression?

Answer 97

CLARIFY
ask clarifying questions to assist with understanding intentions.

BE CURIOUS
come from curiosity not judgement

IMPACT
focus on the impact rather than the intent

PREFERENCE
state what you would prefer had happened instead

Question 98

what if I am the perpetrator of a microaggression and being confronted by the victim?

Answer 98

be open to criticism

receive with gratitude

don’t focus on your intent, listen to the impact the micro aggression had on the person

you can ask what part you got wrong and why

Question 99

what is the definition of a worldview?

Answer 99

the way a group of people see their world, their physical and symbolic space, and their place in the world.

a collection of beliefs about life and the universe held by an individual or group; the lens through which the world is viewed by an individual or group; the overall perspective from which the world is interpreted.

Question 100

What are the developing steps in a worldview?

Answer 100

EXPERIENCES
childhood/upbringing
culture/community
reinforcement/punishment
media/portrayals/stories

ANALYSIS/THOUGHT/REFLECTION
questions
discussion/debate
maturity/independence

Question 101

what are some Canadian culture issues?

Answer 101

INTENTION TO UPHOLD PRINCIPLES OF EQUITY AND SOCIAL JUSTICE

undermined by many prevailing laws, policies, practices, and attitudes

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.

Question 102

what is the definition of culture? what are the limitations of this definition?

Answer 102

culture has been defined as the values, beliefs, and practices common or inherent to a group of people.

LIMITATIONS

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. (intersectionality - affiliating with more than 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.

Question 103

how can we redefine culture and what does this new definition mean?

Answer 103

culture is a process.
we continuously participate in and create culture.
culture is constantly in flux.

THIS MEANS

we help to create culture in our community, in our workplace, and so on.

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.

Question 104

what are the 3 approaches to culture?

Answer 104

cultural sensitivity

cultural competence

cultural safety

Question 105

define cultural sensitivity.

Answer 105

emphasize that individual health care providers should become sensitive toward individual differences form dominant norms.

based on a static view of culture; sees culture as a characteristic of a person or group of people.

LIMITATIONS:

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 difference 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 others must be tolerated.

Question 106

what is cultural competence?

Answer 106

can be used to support either cultural sensitivity or cultural safety.

USED IN DIFFERENT WAYS:

can refer to nurses developing understanding of different cultures and 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.

LIMITATIONS:

seen as a checkbox

does not necessarily lead to action.

Question 107

what is cultural safety?

Answer 107

based on idea of culture as a process, something that is dynamic and ever changing; something that we create. (historical, economic, political, and local trends).

focuses on how a particular group is perceived and treated, rather than on what they think or do. (more actively addresses inequitable relations, racism, stigma, and discrimination within healthcare and society).

health and health care depend on the social, economic, and political position a group holds within society.

individual and institutional discrimination in health care creates risks for patients.

Question 108

describe the 2 steps of cultural safety in practice.

Answer 108

1. reflect on how our own biases, assumption, norms, and ways of being influence our viewpoints, interactions, and practices.

what advantages and disadvantages do you experience based on your social position in society.

2. critically analyze the culture of health and healthcare.

nursing in Canada is dominated by “Western” views on health and health care.

nurses are predominantly white and female.

influenced by: biomedicine = focus on natural sciences of physics and chemistry and biology; corporatism = health care follows a business model in terms of marketplace, management, and organizational behaviour; liberal individualization = value individuals over the collective, also hold individuals responsible for their own well-being and health in all domains.

Question 109

describe cultural safety in practice with patients/clients.

Answer 109

seek to understand - practice from a stance of inquiry and active listening.

practice non-judgemental acceptance of people (include unconditional positive regard).

anticipate where you will be most judgemental (personal assumptions/biases) and how you will practice in those circumstances.

pay attention when people say they are experiencing discrimination.

practice honesty - admit when you have done wrong, or don’t know what to say or do.

ensure people have the opportunity to communicate in the language that they are able to speak and understand.

Question 110

describe cultural safety in practice with colleagues.

Answer 110

develop skills and encourage to challenge stereotypes, assumptions, and generalizations.

counter unwarranted assumptions of others, even when comments are seemingly innocuous.

challenge the use of racial and ethnic categories whenever they are being used.

draw attention to the larger context that shapes health and health care inequities.

develop strategies to create a culturally safe environment for ALL patients (not just particular ones).

engage colleagues beyond your immediate clinical situation.

Question 111

what is cultural humility?
First Nation Health Authority (FNHA).

Answer 111

Cultural safety: is an outcome based on respectful engagement that recognizes and strives to address peer imbalances inherent in the health care system. it results in an environment free of racism and discrimination, where people feel safe when receiving health care.

cultural humility: is a process of self-reflection to understand personal and systematic biases and to develop and maintain respectful processes and relationships based on mutual trust. cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience.

requires: requires a commitment to lifelong learning, continuous self-reflection on one’s 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 inform.

Question 112

what is cultural assessment?

Answer 112

important part of comprehensive nursing assessment.

helps the nurse understand the meaning of decision and behaviours that may otherwise be confusing or judged negatively.

includes exploration of all relevant factors and experiences that may have an impact on the person’s health, their reaction to or feeling about their health, and behaviours around illness or disease.

Question 113

biomedicine

Answer 113

refers to the application of the principles of natural sciences such as biology and chemistry to understanding, treating, and promoting human health. Biomedical models are important but insufficient to understanding and responding to the health-related issues because they are tied to conceptions of health as located in individuals, people’s physical bodies, and micro level interactions but often leave unexamined the underlying social and structural dynamics that actually produce health and health inequality.

Question 114

colonization and colonialism

Answer 114

the takeover of a minority population (often Indigenous) by another nation and the resulting unequal relationships between them.

Question 115

corporatism

Answer 115

the use of a business model in shaping health care so that economics and profitability are the primary determinants rather than the promotion of human health.

Question 116

culture

Answer 116

is a process that happens between and among people; we continuously participate in and create culture, and culture is constantly in flux. No two persons share any given cultural affiliation in identical ways. In this context, culture is not a fixated characteristic that is inherent to any particular population or group.

Question 117

democratic racism

Answer 117

rather than using overt racial categories and idea of racial or biological inferiority/superiority, democratic racism uses cultural differences as a euphemism for racial differences to explain health, social, and economic inequities.

Question 118

diaspora

Answer 118

refers to the migration and dispersion of people from their countries of origin and it the intricate ties that migrate communities to maintain with their homeland.

Question 119

ethnicity

Answer 119

refers to a group that shares their heritage, language, culture, or religion but is a very ambiguous and dynamic concept that can encompass many different aspects such as race, origin or ancestry, identity, language, nationality, and religion. In Canada, ethnicity is often used as a polite term for race.

Question 120

indigenous

Answer 120

the term Indigenous peoples refers to the original inhabitants of countries throughout the world. In Canada, over 1.4 million people of the total population ~32.9 million (4.3%) identify as Indigenous, including First Nations, Métis, and Inuit people. The term Aboriginal is also commonly used, and the colonial term “Indian” is still used in federal government policy documents (e.g., The Indian Act).

Question 121

individualism

Answer 121

the valuing of individuals over the collective that is common to liberal democracies. Individualism is based on the idea that society is essentially an equal playing field, that people have fairly similar choices, and that individual rights are of great importance.

Question 122

neocolonialism

Answer 122

comprises, new, evolving, and ongoing colonial policies and practices that continue to govern, suppress, and subordinate certain groups. Whereas European colonial rule involved occupation of countries and lands, often through military means, neocolonialism involves more indirect forms of control through economic and cultural dependence, without the development of infrastructure in the subordinated lands as was characteristic of European colonialism.

Question 123

race

Answer 123

a way of categorizing people by primarily physical characteristics such as skin colour or hair texture. As was declared in 1951 by the United Nations Educational, Scientific and Cultural Organization (UNESCO), the concept of race has no basis in biologic reality and is therefore meaningless, independent of its social definitions and impacts.

Question 124

radicalization

Answer 124

categorizing people by racial characteristics and the resulting negative social, economic, and political effects.

Question 125

reflectivity

Answer 125

means continuously scrutinizing your own knowledge and the basis of your practice and always checking your assumptions and “blind spots”.

Question 126

structural conditions

Answer 126

refers to the social, political, and economic structures, systems, and institutions in our society that influence power relations, patterns of radicalization, class and gender relations, among others. For example, minimum wage policies are part of our economic structure and strongly influence peoples’ capacities to earn a living wage.

Question 127

visible minority

Answer 127

people who are identified according to the federal Employment Equity Act (1995) as nonwhite in colour (Caucasian) and as people other than Indigenous peoples.

Question 128

what does the Canadian Multiculturalism Act (Government of Canada, 1988) recognize?

Answer 128

This Act recognizes the freedom of all Canadians to preserve, enhance, and share their cultural heritage and promotes “the full and equitable participation of individuals and communities of all origins in the continuing evolution and shaping of all aspects of Canadian society and assist[s] then in the elimination of any barrier to such participation.

Question 129

define and explain cultural sensitivity (textbook)

Answer 129

The obligation of nurses is to find out what a person’s culture is and to be sensitive to, and tolerant of, differences from the presumed norm, with tolerance often implying a tolerating majority and a tolerated minority.

Limitations:
□ The diversity within any group often exceeds the diversity between groups
□ People often disagree with the classification to which other people assign them
□ Many people claim membership in a group but do not subscribe to all the practices associated with the group
□ Inventories of cultural values, beliefs, and practices can be stereotypical and can lead nurses to make erroneous assumptions about individuals
□ People from radicalized groups, in particular, may find the process of being categorized by ethnicity offensive
□ Cultural sensitivity can focus attention on and tightens emphasis on individuals, often in isolation of, and over-looking, the broader context of people’s lives
Sensitivity often implies (1) that there is a preferred norm outside of which sensitivity and tolerance are required, (2) that minorities are tolerated by a dominant majority (implying superiority of the majority), and (3) that nurses have only a passive responsibility to be sensitive but not necessarily engage in change

Question 130

define and explain cultural competence (textbooks).

Answer 130

A term that is used in different ways, sometimes meaning developing competence in understanding cultures, so that nurses become familiar with the beliefs, values, and practices of various groups of people. At other times, cultural competence is used in a way that is more comparable with a more critical understanding if culture, meaning that nurses should develop competence not only in learning about others but also in learning about themselves and about the contexts that shape experiences of culture and health care.

Question 131

define and explain cultural safety (textbook).

Answer 131

Culture is dynamic and ever-changing

Central ideas of cultural safety:
□ Cultural safety moves practice beyond the notion of cultural sensitivity to more actively address inequitable power relations, racism, stigma, and discrimination in health care and health policies. It actively aims to counteract the ongoing impacts of historical injustices on health and health care and puts the onus for safety in care on the provider
□ Cultural safety does not refer to the cataloging of culture-specific beliefs but rather it is how a group “is perceived and treated that is relevant than the different things its members think or do”
□ The social, economic, and political positions of groups within society influence health and health care.
□ Individual and institutional discrimination in health care creates risks for clients, particularly when people from a specific group perceive they are “demeaned, diminished, disempowered by actions and delivery systems” including by those who typically hold the power in health care contexts (namely, health care providers)
Critical reflexivity is essential to good nursing practice. Health care providers must “reflect not their own personal and cultural history and the values and beliefs they bring in their interaction with clients, rather than an uncritical imposition of their own understanding and beliefs on clients and their families

Question 132

what are 2 skills in practicing in a culturally safe manner?

Answer 132

Cultural safety always begins with self-reflection on how our biases, assumptions, norms, and ways of being influence our viewpoints, interactions, and practices.

Cultural safety requires being able to critically analyze the culture of health.

Question 133

describe historical societal expectations in regard to nursing.

Answer 133

Women have been historically socialized to achieve of be less than they are capable of becoming.

Claimed by nursing scholars and sociologists that nurses have been forced to work within a framework that focuses on societal expectations of women and what is considered women’s work.

Question 134

describe gender discrimination in regard to nursing.

Answer 134

Historical reality that women have - and continue to - work for lower pay than their male counterparts.

There are laws in place to ensure equal pay for equal work. There is pay equity that keeps pace with changes in society and a dynamic workplace.

Despite these law and increased awareness about employment and pay equity and activism, women still earn less than men, on average, for the same work.
Salaries in nursing remain low compared to other professions that require comparably high levels of skill, education, and responsibility.

Question 135

describe how there has been an expanding number of men in the nursing profession.

Answer 135

There is value in gender diversity in nursing

Male nursing students and nurses still cite many challenges, including societal stereotyping, social isolation, a lack of male role models, and a culture dominated by females.

Challenges males nurses face:
Experience resistance from patients and colleagues, expectations to carry out more physically demanding tasks, and being a visible minority in the profession.

Question 136

describe the value of diversity in nursing.

Answer 136

Recognition that the profession is evolving and that the advanced roles of the nurse are exciting opportunities for anyone.

Many patients today are aware of the value of a diverse group of professional nurses and the inherent value of having both men and women in the role.

Question 137

describe sexual harassment in nursing.

Answer 137

The Supreme Court of Canada defines sexual harassment as “unwelcome conduct of a sexual nature that detrimentally affects the work environment or leads to adverse job-related consequences for the victims.

Often referred to under the umbrella of workplace harassment, sexual harassment may include touching in a way that is inappropriate or uninvited; staring or making comments in a sexual way; being verbally abusive because of gender; making sexual requests, jokes, or remarks about a person or about a specific gender; or displaying sexually offensive images of any kind to others.

Question 138

what are key indicators of sexual harassment?

Answer 138

A feeling of having your space invaded or being cornered

A feeling of being disrespected

Noting behaviour that feels forced or too friendly

Question 139

what are indicators of an environment or workplace in which sexual harassment might happen?

Answer 139

Other persons confirming that they have been harassed

Power or administrative structures that support or protect the harasser while providing limited options for the harassed

A workplace where sexual innuendo, images, or humor is common or tolerated

Question 140

what is a physician-nurse collaboration?

Answer 140

Favorable patient outcomes have been positively associated with successful nurse-physician communication, as have decreased reporting of nurse burnout and greater level of job satisfaction.

Question 141

define sexism.

Answer 141

the assumption that members of one sex are superior to those of the other.

Question 142

identify and describe transcultural issues.

Answer 142

Culture is a complex phenomenon that can be defined as the worldview, lifestyle, shared knowledge, symbols, and rules for guiding behaviour and creating some degree of shared meaning within a group of persons.

Diversity is encountered whenever there are differences, whether these be gender, age, socioeconomic position, sexual orientation, health status, ethnicity, race, culture, or life experience.

Cultural competence includes cultural awareness - knowledge about values, beliefs, behaviours, and the like of cultures other than one’s own - and cultural sensitivity - the ability to incorporate the patient’s cultural perspective into nursing assessments and to modify nursing care in order to be as congruent as possible with the patient’s cultural perspective.

Question 143

what is cultural assessment?

Answer 143

Cultural assessment challenges nurses to examine their own attitudes and values about health, illness, and health care. When nurses understand the differences between their own values and beliefs and those of their clients, they can appreciate the strength of both. The plan of care can then become mutually respectful and effective.

Question 144

what is cultural knowledge?

Answer 144

Cultural knowledge includes learning about the health benefits and values of clients. It includes how these influence their response to health care and beliefs about self-care in health and illness, the role if health care providers and hospitalization, birth practices, death and dying, family involvement, spirituality, customs, rituals, food, and alterative or traditional therapies.

Question 145

when do transcultural issues arise?

Answer 145

Transcultural issues arise when nurses, patients, and families hold differing views of what is important or necessary regarding health, recovery, illness, or the dying process

Question 146

when you observe or experience a micro aggression, what are the 3 steps?

Answer 146

Step 1: Recognize that a Microaggression has Occurred
Educate yourself
Read the relevant literature
Have conversations

Step 2: Determine Whether to Respond
Assess the situation
Identify what you are trying to accomplish
Consider where and when you could address the microaggression

Step 3: Apply Helpful Tactics
Ask for clarification
Focus on the impact rather than the intent
Share your own process
Focus on the comment/behaviour, rather than the person

Question 147

when you receive feedback that YOU performed a micro aggression, what should you do?

Answer 147

Check in with yourself
Notice if feelings of defensiveness come up
Remind yourself that microaggressions are about actions, not intentions
Listen
Do your best to understand the impact you had on someone, rather than focusing on the intention behind your comment/behaviour

Acknowledge the microaggression
Acknowledge verbally that the person’s feeling are valid
Acknowledge verbally that your comment/behaviour had a negative impact, even though it wasn’t your intention

Apologize
Apologize
Remind yourself that the goal of your apology is to communicate that you acknowledge your mistake, not to receive forgiveness

Practice self-compassion
Remember that all humans make mistakes and acknowledging these mistakes is really difficult; if you were able to listen, acknowledge, and apologize for your comment/ behaviour, you handled this in the best way you could

Question 148

what are the social determinants of health?

Answer 148

• income and social status
• social support networks
• education and literacy
• employment security and working conditions
• physical environments (geography, housing, food)
• biological and genetic endowment
• individual health practices and coping
• healthy childhood development
• health services
• gender
• culture and ancestry
• social environments

Question 149

social determinants of health - define income and social status.

Answer 149

greatest impact
- affects all of the others
- poverty is the greatest threat to health (income is a major determinant)

affects multiple domains of health/wellness
- physical, social, mental, emotional

Income inequality - the increasing gap between the rich and the poor.

Question 150

social determinants of health - define social support networks.

Answer 150

SOCIAL CONNECTIONS
- strong relationships as important as other high-risk factors
- affects health, healthy behaviours, and healthcare utilization

SOCIAL ISOLATION
- stress
- depression
- vulnerability
- increased risk behaviours (drugs, substances, alcohol)

Social support affects health, health behaviours, and health care utilization through practical, emotional, informational, and affirmational support.

Links between social support with positive health outcomes.

Social isolation, exclusion, and lack of supportive relationships increase stress and vulnerability to disease directly, and indirectly through increased risk behaviours such as smoking, substance abuse, and overeating.

It is important to address social support in relation to not only individual behaviours but also the broader social, political, and economic context that shapes community norms, values and behaviours.

Question 151

social determinants of health - define education and literacy.

Answer 151

strongly connected to income and social status

education - increased job opportunity and security

literacy: direct and indirect impacts on health
- health literacy = ability to understand and apply new health information to changing circumstances
- important that they maintain their health after they leave our care

Important influences on health status because they affect many other health determinants. Literacy can influence health both directly (e.g., reading medication prescriptions, safety instructions in workplaces) and indirectly through use of services, personal health practices, income, work environments, and stress levels.

Question 152

social determinants of health - define employment security and working conditions

Answer 152

(UN)EMPLOYMENT
- affects physical, mental, social, and emotional health
- affects financial resources
- employment provides sense of purpose, hopes and growth
- employment provides social connections
- benefits/problems

WORKING CONDITIONS
- can support health, or pose risks
- health workplaces
- OH&S (occupational health and safety)
- interpersonal relationships
- NURSING: high stress, shift work, high rates of injury, and high rates of absenteeism

Question 153

social determinants of health - define physical environments (geography, housing, food).

Answer 153

HOUSING
- affects health directly (especially if inadequate) and indirectly (impact/connection to other determinants)
- high rent/housing cost use up resources that could be used elsewhere
- homelessness has significant impact on health

FOOD SECURITY
- food choices, nutrition, have great impact on health

OTHER ENVIRONMENTAL FACTORS
- smoking/smoke-free
- air, water, soil contamination
- climate and climate change

Question 154

social determinants of health - define biological and genetic endowment.

Answer 154

most cannot be changed
- biological sex/?gender
- genetics
- age

they can be influenced by social and physical environments, individual choices, and other determinants

Heredity is strongly influenced by social and physical environments, and considerable effort has been expended to prevent congenital defects through monitoring and improved preconception and prenatal care.

The social environment has a profound impact upon the function of one’s genes, providing the context and stimulus for the variable expression of an inherited code.

Question 155

social determinants of health - define individual health practices and coping.

Answer 155

many “risk” behaviours are also seen as coping strategies.

physical (in)activity: directly impacts health, stress, and coping. recommended 150 minutes of moderate-to-vigorous activity per week.

nutrition: obesity is at epidemic levels. connected with many health outcomes.

tobacco use still a major contributor to health issues in Canada.

Question 156

social determinants of health - define healthy childhood development.

Answer 156

conception and gestation.

healthy child development influences lifelong health
- conception to adolescence: critical to biological and brain development that will shape learning and health behaviour.

TOXIC STRESS = excessive and/or prolonged activation of body stress response systems in early childhood (pre-adolescence)
- can be the results of exposure to stressors such as poverty, violence, conflict, neglect, and food insecurity

early childhood education - can promote proper cognitive and social development and have strong impact on future health.

Question 157

social determinants of health - define health services.

Answer 157

ACCESSIBILITY
- urban vs. rural/remote
- public vs. private

TYPES OF SERVICES
- primary care
- hospital care
- home care
- long-term care
- public health

QUALITY OF SERVICES
- expertise
- wait times

OTHER
- vision/hearing
- dental
- medication

Question 158

social determinants of health - define gender.

Answer 158

some diseases/conditions unique to, or much more prevalent in, one biological sex.
- pregnancy
- prostate
- cardiovascular
- (taking hormones can increase different risk factors).

many health issues are functions of gender-based social roles.
- also continues to influence many health behaviours and choices

Question 159

social determinants of health - define culture and ancestry.

Answer 159

many health practices and choices influenced by culture.
- also influences their definition/understanding of health and wellness.

immigrants/refugees
- how to access services in a new country
- more vulnerable to experience unmet/negative determinants
- may also be impacted by experiences in country of origin

bias, discrimination, prejudice
- they may not receive the same level of care that others receive.
- remain prevalent, based on radicalization and ethnic identities
- may be systematic (structural), rather than on the individual level
- indigenous peoples and effects of colonization

Question 160

social determinants of health - define social environments.

Answer 160

broadens lens to community/population level.
- national/regional stability; freedom from violence

includes community norms/values, human rights, social security, and social relations

social exclusion - marginalization and exclusion can occur based on many criteria; greatly impacts health

Social environments are defined as the array of values and norms of a society [that] influence in varying ways the health and well-being of populations. In addition, social stability recognition of diversity, safety, good working relationships, and cohesive communities provide a supportive society that reduces or avoids many potential risks to good health.

Another important aspect of social environment is the absence of violence, both in the home (child abuse, intimate partner violence, older person abuse) and in the community (youth violence, bullying, assault by strangers, violence due to property crimes, violence in the workplace).

Question 161

what are the 3 levels of prevention? define and give examples.

Answer 161

primary prevention: protect against a disease BEFORE signs and symptoms occur.
- example: immunizations

secondary prevention: promote EARLY detection of disease.
- example: Pap test of prostate check

tertiary prevention: minimize RESIDUAL effects/disability of a disease.
- example: cardiac rehab after a MI

Question 162

describe the flowchart for “strategies to influence determinants”

Answer 162

health promotion: efforts directed toward increasing the level of well-being and self-actualization.

disease prevention: actions to avoid or forestall illness/disease
- 3 levels of prevention: primary prevention, secondary prevention, tertiary prevention

Question 163

what are the 3 structural determinants of health? explain what structural determinants of health is.

Answer 163

• proximal determinants
• intermediate determinants
• distal determinants

expands on SDOH to include historical, political, societal, and economic structures within a society that place particular groups of people at a disadvantage - particularly Indigenous Peoples.

all levels Interact and influence each other

create synergies of advantage and/or disadvantage

efforts to improve the health of Indigenous peoples needs to focus on the distal (roots) determinants, rather than the current primary focus on proximal determinants

Question 164

social determinants of health - define proximal determinants.

Answer 164

proximal (crown of tree or leaves) determinants - influence health in the most obvious and direct ways:

• early childhood development
• income and social status
• education and literacy
• social support networks
• employment
• working conditions
• physical environment
• culture
• gender

Question 165

social determinants of health - define intermediate determinants.

Answer 165

intermediate (trunk of tree) determinants - facilitate or hinder health through systems that connect proximal and distal determinants:

• health promotion
• health care
• education and justice
• social supports/kinship networks
• labour markets
• government
• private enterprise
• kinship, relationship to land, language, ceremonies, and knowledge sharing

less direct impact on individual health, but huge impact on proximal determinants.

Question 166

social determinants of health - define distal determinants.

Answer 166

distal (roots of tree) determinants - deeply embedded influences that affect all other determinants

• historical foundations
• political context
• ideological foundations
• economical foundations
• social foundations
• indigenous worldview, spirituality, and self-determination

Question 167

define and explain contemporary structures.

Answer 167

continue to perpetuate discrimination against Indigenous Peoples.
- many structures of colonialism endure
- indigenous ways and knowledge systems often seen as inferior
- continue to be marginalized geographically, socially, and intellectually
- insufficient resources and funding for many aspects of determinants - has led to substantial health disparities and inequalities that persist across generations

Question 168

what is vulnerability? what is structural vulnerability?

Answer 168

being in need, susceptible to injury, and at higher risk of harm than the rest of the population.

structural vulnerability: political, economic, and social arrangements that contribute to harms and the production of poor health in society. how we are positioned in society relative to class, age, gender, sexuality, and race make us more or less structurally vulnerable.

Question 169

what are factors that create vulnerability?

Answer 169

INDIVIDUAL
- personal choices
- individual characteristics
- circumstances

SOCIETAL
- SDOH
- structural factors
- health inequities

Question 170

define health.

Answer 170

is a product of people and their environment

determined by the complex interplay between social and economic factors, individual decisions and behaviours, and the environment we live in.

anything that alters the interplay can be a critical concern for nursing

must consider the SDOH when providing care in all situations

Question 171

explain health inequities.

Answer 171

those differences in health that are deemed unfair or unjust because they are a product of social processes that can potentially be changed.

can be distinguished from health inequalities because they are the result of structural arrangements in society and judged to be unfair because they are avoidable

health inequalities: differences in health among groups in the population that may be either positive or negative.

Question 172

what are general and specific conditions that contribute to vulnerability?

Answer 172

GENERAL
- stigmatization
- radicalization
- marginalization
- discrimination
- disadvantage
- SDOH - intersecting factors
- lack of access to resources
- victim blaming

SPECIFIC
- poverty and income inequality
- homelessness and precarious housing
- food insecurity
- social exclusion
- violence/trauma
- age

Question 173

how do we reduce vulnerability?

Answer 173

HEALTH EQUITY
- fair conditions in society that allow each person to reach his or her potential for health.

UPSTREAM AND DOWNSTREAM EFFORTS
- focus on the social and structural determinants

ROLE OF THE NURSE
- understand the root cause factors leading to vulnerability (include SDOH in the holistic assessment of the patient/client)
- advocator for improved access to healthcare and strengthen community resources
- promote structural and systematic changes - social justice
- counter stigmatization and discrimination
- act as a voice for those that don’t have one

Question 174

what does upstream mean?

Answer 174

what is causing all these people to fall into the river in the first place?

how can we prevent this?

Question 175

what does downstream mean?

Answer 175

saving people when they are in the vulnerable situation.

Question 176

what are some social influences on health?

Answer 176

health is a product of people and their environment.

social conditions that alter how people interact with their environment affect health.

social conditions of interest to health commonly called the Social Determinants of Health.

crucial for nurses to consider these determinants as part of the holistic treatment of patients and clients.

Question 177

what are the selected social issues?

Answer 177

• poverty
• homelessness
• intimate-partner violence
• aging demographic
• discrimination

Question 178

describe the social issue - poverty.

Answer 178

poverty and chronic hunger have significant impacts on physical health.

also have great impact on psychological health.
- helplessness and lack of control
- correlates strongly with poor health outcomes and social exclusion

children living in poverty greatly affected
- poor developmental outcomes
poorer educational outcomes
- increased disease

Question 179

describe the social issue - homelessness and precarious housing.

Answer 179

often experience inadequate nutrition, exposure, and violence.

often have limited access to appropriate health care resources

often experience exclusion, discrimination, and marginalization

difficulty accessing services

are more likely to experience mental illness and other concurrent conditions

are more likely to suffer from conditions affecting physical function, quality of life, and life expectancy

Question 180

describe the social issue - intimate-partner and/or family violence.

Answer 180

children and women most likely to be victims

can be physical, sexual, financial, verbal, psychological, and/or emotional.

those living in violent relationships can experience poor physical and psychological health; not only injuries directly from the violence, but also the effects of chronic stress and trauma

Question 181

describe the social issue - language of violence.

Answer 181

need to make sure our language is empowering and not threatening

be very careful of victim blaming

also be careful of micro aggressions

Question 182

describe the social issue - the Canadian elderly.

Answer 182

fastest growing demographic in Canada

fixed income + rising costs of living = many are now in poverty

many experience chronic illnesses which lead to increased isolation

assumption that adult children will provide for them. however, more and more unable to do so.

Question 183

describe the social issue - discrimination.

Answer 183

any judgment and actions that create and reinforce oppressive conditions that marginalize and/or restrain the lives of those being discriminated against.

still occurs every day in Canada. need more action and research to eliminate discrimination in its many forms.

sometimes “invisible”. need to make visible and advocate for systemic change.

Question 184

define social justice

Answer 184

right to equitable treatment, allocation of resources, and support for their human rights regardless of culture, gender, sexual identity, etc.

Question 185

describe the vulnerable clients and the nursing process (9).

Answer 185

assess strengths, identity limitations, and identify what will be required to identify concerns.

creating a trusting environment is key.

many vulnerable clients have experienced the harmful effects of stigma.

1. creating a trusting environments
2. show respect, compassion, and concern
3. do no make assumptions
4. coordinate services and providers
5. advocate for accessible health care services
6. focus on prevention
7. know when to “walk beside” the client and when to encourage the client to “walk ahead” (meet client as an equal)
8. know what resources are available
9. help clients develop their own support network

Question 186

what are the 3 aspects of power?

Answer 186

fluid and dynamic

relational

many social forms:
- social, cultural, economic, political, structural/systemic

Question 187

describe oppression.

Answer 187

relies on structural/systematic power on societal, national, and global levels to perpetuate over time.
- cycle of stereotyping and discrimination to preserve power structure.
- those in power create the system in ways that maintain their privileged status.

often “invisible”
- mechanisms of action or inaction are normalized and not clearly visible.
- have to work to make them visible in order to challenge them

Question 188

what is privilege?

Answer 188

right, benefits or advantage available only to a particular person or group

usually granted to those in positions of power

usually denied to those who are being oppressed; is a form of oppression itself

Question 189

how do we apply power, oppression, and privilege to nursing?

Answer 189

teacher to student

nurse to patient/client

types of patient/clients

interprofessional team

areas of nursing

Question 190

define power.

Answer 190

the authority or ability to carry out an action or influence others

Question 191

define empower

Answer 191

to facilitate that ability in another person

Question 192

define empowerment

Answer 192

harder to define; includes:

process of recognizing, promoting, and enhancing people’s abilities to meet their own needs, take action, solve their own problems, and mobilize resources in order to feel in control of their own lives

is a construct, rather than a concept, as it is not something one can observe; rather it is something one feels

implies a choice to accept responsibility and accountability for one’s own actions and choices

Question 193

what is personal empowerment?

Answer 193

value self; engage in self care

sense of empowerment in personal life can/will influence perception of empowerment in professional arena and vice versa

empowering others requires that we are first empowered; relies on self-awareness and reflection

Question 194

what is professional empowerment?

Answer 194

nurses must feel personally and professionally empowered in order to take action.
- requires nurses to be knowledgeable about and address systemic as well as interpersonal issues

empowerment of nurses in the healthcare environment can have personal, institutional, and patient care implications.
- empowered individual nurses are more likely to come together and form collaborative teams that work together to achieve shared goals for all unit activities.
- empowered nurses are more likely to accept divergent and conflicting solutions to problems, choose to support others, and work collaboratively rather than choosing divisiveness.

Question 195

describe empowerment of nursing students.

Answer 195

on a trajectory through education to graduation and then independent practice

many challenges towards feeling empowered

often a discrepancy between classroom experiences and clinical practice experiences

need to create safe, supportive, and empowering work environments

Question 196

what is empowerment of patients?

Answer 196

nurses can enable the process for patients to become empowered to manage their own health needs
- sets patient up with resources for their whole life, not just a single episode of care.

nurses need to act as advocates, facilitators, and resources; rather than as simply a care provider
- relinquish control; involve patient in own care planning and decision making
- empowerment is an interactive process - therefore it requires communication
- to make choice, patients must have adequate knowledge and understanding

Question 197

how is empowerment enabled?

Answer 197

empowerment comes from within; however, it can be enabled by others

nursing actions that enable the process of becoming more empowered:
- see the role of the nurse as an advocate, facilitator, or resource
- collaborate, rather than control
- avoid imposing personal values on others
- respect patient autonomy, and encourage maximum participation
- help patients through process of self-discovery - enhancing self-awareness, self-esteem, and self-efficacy
- be a role model

Question 198

what are some barriers to empowerment?

Answer 198

empowerment requires change:
- to self and self-perception - can lead to anxiety and fear

empowerment requires individual to move beyond what is known and take risks

empowerment requires individual to assume power and take responsibility
- some do NOT want this

empowerment requires knowledge of resources, choices, and options
- how does one get this?

social, cultural, economic, and political factors can also present barriers

Question 199

what are the definitions of intersectionality?

Answer 199

“a theoretical framework for understanding how multiple social identities such as race, gender, sexual orientation, SES, and disability intersect at the micro level of individual experience to reflect interlocking systems of privilege and oppression”

“a way of understanding and analyzing complexity in the world, in people, and in human experiences, including responding in ways that demonstrate cultural safety. The events and conditions of social and political life and the self can seldom be understood as shaped by any one factor (or identity). They are shaped by many factors in diverse and mutually influencing ways. When it comes to social inequality, people’s lives and the organization of power in a given society are better understood as being shaped not by a single axis of social division (be it race, or gender, or class), but by many axes that work together and influence each other. Intersectionality as an analytic tool gives people better access to the complexity of the world and of themselves

Question 200

explain the definitions of intersectionality.

Answer 200

intersectionality looks at how the different aspects of our personal identities determine what power, privilege, and/pr oppression we experience within our current social and political context or environment

it is a way to think about and act upon social inequality and discrimination

originally conceived to address the complex and multifaceted forms of discrimination faced by women of colour in the USA.

Question 201

how is intersectionality connected to health?

Answer 201

Connection to Health
Social Determinants of Health
* Strong connections between many SDOH and experiences of
privilege or discrimination by, and within, the healthcare system
* SDOH also influence access to the healthcare system
* Should oppression be added as a SDOH?

Impact on Health
* How you define yourself has influence on how you define your health, and vice versa
* Intersectionality provides a lens for looking at health promotion, by challenging existing inequities and definitions
* Intersectionality offers a way to expose how structural factors
interact to produce specific health outcomes for specific
individuals

Question 202

describe the social categorization in intersectionality.

Answer 202

visible vs. invisible
- choose may “labels” due tot heir connection to privilege, or distance from oppression

SDOH
- become a series of label that create a web of privilege or oppression

social hierarchy
- created by comparison of various “labels”
- provide status/rank in relation to others

Question 203

describe social location/social position.

Answer 203

The expression social location (or social position) is used to capture 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 live. That is, our social locations are relational, shifting and shaped by our positions in the social structures we inhabit. While largely determined by structures of inequality inherent in a social system, social location is also often lived as a deeply felt identity by individuals as they negotiate their position in a social setting.

Intersectionality has the potential to place the connections between structural determinants and their relationship to power in the foreground.

It is important to note that the same processes that create disadvantage also produce locations of privilege.

Question 204

describe the intersectional approach.

Answer 204

intersectionality is 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.

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.

allows for the combination of scholarships and activism in the pursuit of social justice.

particularly powerful for the design and implementation of interventions, not just at the personal and population levels, but also at the structural or “macro” levels of power.

Question 205

define health promotion.

Answer 205

□ Directed towards increasing the level of well-being and self-actualization.

The process of enabling people to increase control over, and improve, their health.

Question 206

describe proximal determinants.

Answer 206

Like the crown of the tree, proximal determinants influence health in the most obvious and direct ways. Proximal determinants include early child development, income and social status, education and literacy, social support networks, employment, working conditions and occupational health, the physical environment, culture, and gender.

Evidence that disadvantages and inequity within this stratum.

Give rise to all manner of physical, emotional, mental, spiritual, and social challenges.

Question 207

describe intermediate determinants.

Answer 207

Like the trunk or core of the tree, intermediate determinants facilitate or hinder health through systems that connect proximal and distal determinants. These determinants include health promotion and health care, education and justice, social supports, labour markets, as well as government and private enterprise. Within an Indigenous framework, intermediate determinants might also include kinship networks, relationship to the land, language, ceremonies, and knowledge sharing. At this stratum, determinants have a less direct impact on the health of individuals, yet profoundly influence proximal determinants.

Question 208

describe distal determinants.

Answer 208

Distal or root (or structural) determinants of Aboriginal peoples’ health. Like the roots of a tree, these deeply embedded determinants represent the historical, political, ideological, economical, and social foundations (which includes Indigenous world views, spirituality, and self-determination) from which all other determinants evolve.

Question 209

define health inequities (textbook).

Answer 209

Those differences in health that are deemed unfair or unjust because they are a product of social processes that can potentially be changed. Health inequities can be distinguished from health inequalities in that health inequities are differences that are the result of structural arrangements in society and judged to be unfair because they are avoidable.

Question 210

define intersectionality (textbook).

Answer 210

Approach focusing on the multiple social circumstances that taken together shape the lives of individuals and thereby their chances to be healthy.

Question 211

define marginalization (textbook).

Answer 211

The process by which people are positioned to the periphery of society because of their identities, associations, experiences, or environments, and relative differences from dominant norms.

Question 212

define social determinants of health (textbook).

Answer 212

The conditions in society that impact the health of the population. This includes access to material factors, such as housing, income, social support, employment, and education, and access to health care as well as nonmaterial determinants, such as respect, power, and decision making.

Question 213

define social exclusion (textbook).

Answer 213

An expression of unequal relations or power among groups in society, which then determine unequal access to economic, political, social, and cultural resources.

Encompasses the structures and processes that shape inequity and access to resources that determine participation in society and shape health outcomes. Social exclusion may be based on many intersecting forms of discrimination along the lines of class, gender, sexual orientation ability, age, religion, and ethnicity.

Question 214

define social gradient (textbook).

Answer 214

Term for the hierarchy along which there are differences in health status. The lower a person is on the socioeconomic gradient, the poorer their health outcomes. This means that health varies on a continuum form better to worse, dependent on income and resources.

Question 215

define social justice (textbook).

Answer 215

A societal situation in which power and decision making are equally share and distributed so that all have equal chances in life.

Question 216

define structural violence (textbook).

Answer 216

Social structures, institutions, and/or policies that are responsible for harms to people and communities, often preventing them from meeting basic needs with social suffering as a consequence.

Question 217

define structural vulnerability (textbook).

Answer 217

Political, economic, and social arrangements that contribute to harms and the production of poor health in society. How we are positioned in society relative to class, age, gender, sexuality, and race make us more or less structurally vulnerable.

Question 218

why should Nurses focus on the upstream factors that contribute to vulnerability toward poor health.

Answer 218

(1) participate in health care and society in ways that will lessen inequities,

(2) understand how we can provide care within the context of their lives,

(3) provide care that takes inequities and vulnerabilities of individuals and groups into account.

Question 219

discuss upstream and downstream factors.

Answer 219

Many nurses work downstream, meaning that they are addressing existing health issues rather than working to prevent the illness, injury, or disease and/or promote health. Working downstream in the turbulent waters of health care delivery can limit our ability to look upstream to social influences or to see social action as part of our everyday work. However, we need to both respond to the consequences and realities of health inequities that manifest in poor health and disease, while taking action on the social factors that create vulnerability to poor health. It is not adequate to simply respond to health problems without looking upstream to identify and address the root causes that exacerbate vulnerabilities and inequities. Looking upstream is particularly relevant because it helps nurses resist a dominant tendency to “blame the victim” that is deeply embedded in societal structures and supported by a belief that poor health is solely a matter of personal responsibility. Looking upstream helps us recognize and address the broader determinants of poor health in individuals with health issues as well as valuing and contributing to public health activities of disease, illness, and injury prevention and health promotion. Even acknowledging these dynamics can be powerfully supportive to people who have experienced and thus anticipate blame and judgement.

Question 220

identify and explain the 4 categories of homelessness.

Answer 220

1. Unsheltered, which refers to street homelessness including living outside or uninhabitable building.
2. Emergency sheltered, living in homeless shelters, or shelters for women experiencing violence.
3. Provisionally accommodated, which includes those who are in transitional housing and do not have permanent housing.
4. At risk of homelessness, which includes those living in housing situations where their housing does not meet public health and safety standards or they are paying more than 30% of their income for housing.

Question 221

identify and describe the 3 Canadian approaches to health inequalities and intersectionality.

Answer 221

The Canadian Research Institute for the Advancement of Women (CRIAW)
Adopted what they call Intersectional Feminist Frameworks (IFFs)
Gender Based Analysis (GBA) - a common framework used in Canadian government and other organizations to examine how policy impacts men and women differently and tends to disadvantage women specifically, meant that those in the most disadvantaged social groups were left out of the analysis if other social locations were not part of the equation.
IFFs - described as fluid, specific, diverse, and interconnected both locally and globally.
For them, IFFs offer a way forward for dealing with the multitude of ways that people are disadvantaged with gender being one, but not the only, location where they intersect.

Institute for Intersectionality Research and Policy
The work here continues on the commitment to considering the multiple social locations that intersect to produce complex matrices of inequality.
When applied to health and health-related policies, the Intersectionality-Based Policy Analysis Framework (IBPA) is explicitly intended to expand and improve upon both Gender Based Analysis and Health Impact Assessment (HIA).
The IBPA framework revolves around a set of guiding principles (intersecting categories, multilevel analysis, power, reflexivity, time and space, diverse knowledges, social justice, and equity) and 12 key questions, both descriptive and normative/transformative to be used either in considering policy/program options, or in evaluating those already in place.
IBPA combines a theoretical and conceptual approach to intersectionality with a practice-based framework that makes it particularly useful for those working in the area of health inequalities and public policy.

Intersectionality and the Social Determinants of Health
Social determinants of health and specifically with the consideration of oppression as a social determinant of health.
Use intersectionality in combination with the social determinants of health and a specific attention to geography to describe what they call “synergies of oppression”.
This particular use of intersectionality attempts to tease out how intersections of the social determinants of health, those of identity categories, and those of geographies, create particular configurations of oppression where they intersect, which all impact on health and produce health inequalities.

Question 222

discuss the ruling power relations and the cycle of oppression.

Answer 222

The Cycle of Oppression:
A cyclical process created and sustained by ruling power relations.
Creates systems of advantage, privilege, and disadvantage.

1. Biased information leads to stereotyping
   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.
2. Prejudice
   A way of thinking based on stereotypes - is embedded in, and reinforced by, oppressive power relations.
3. Discrimination
   Action or inaction based on prejudice - made possible/condoned implicitly or explicitly by oppressive power relations.
4. Oppression
   Discrimination backed up by systemic power relations (e.g., government, education, legal, and health system policies; multi-national corporation).

Question 223

Who are the Indigenous Peoples? discuss this in terms of Canada and globally.

Answer 223

CANADA

Constitution Act of 1982

called “Aboriginal”, have been transitioning to Indigenous since 2015 (aligns with WHO and UN language)

Includes 3 groups:
- First Nations (Indian), Inuit, Metis (FNMI)

Aboriginal - actually means “not original”

GLOBAL

WHO and UN using term Indigenous Peoples more and more

Indigenous means “native to; sprung from the land”

Question 224

what are the legal categories of Indigenous peoples?

Answer 224

Indigenous or Aboriginal

• First Nation or Indian
  status (or treaty) Indian
  non-status Indian
• Metis
• Inuit

Question 225

describe Indigenous Peoples of Canada.

Answer 225

terms Indigenous or Aboriginal lump all groups together.
- however, they are they diverse from one another.
- lumping together causes a loss of their diversity and unique identity.

There are more than 50 Aboriginal languages, over 600 reserves, hundreds of Metis and Inuit communities, and thousands of Aboriginal people living in towns and cities across Canada.
- when referring to someone, be as specific as possible.

Question 226

what are the 7 different terminologies that we discussed in regard to Indigenous peoples?

Answer 226

Indian
Native
Aboriginal
FNMI (First Nations, Metis, and Inuit)
Indigenous
Settler
Newcomer

Question 227

Discuss Indigenous peoples history in regard to treaties.

Answer 227

indigenous peoples of North America had long history of making treaties before Europeans arrived in North America.

Treaties were made to establish peace, regulate trade, share land and resources, and arrange mutual defence.

treaty making among Europeans had a different meaning - recognize independence, claim sovereignty, and formally mark mutual respect.

yet, the first treaties made between Indigenous peoples and Europeans were generally peaceful and relationship-building.

Question 228

describe the history of Indigenous peoples in relation to colonization and assimilation.

Answer 228

in the 1800s, treaties between Indigenous Peoples and non-Indigenous governments were undermined by policies of colonization and assimilation.

Colonization - practices and polices designed to:
- remove indigenous peoples from their lands
- suppress indigenous nations and their governments
- undermine indigenous cultures
- stifle indigenous identity

assimilation - the social process of absorbing one cultural group into another. it is the aggressive cultural domination of one group over another.
- used tools like the Indian Act (1876, revised 1951, 1985), residential schools, relocation, and reserve policies.

Question 229

describe the historical and intergenerational trauma that Indigenous peoples face.

Answer 229

colonization and assimilation tactics used have resulted in historical trauma for many Indigenous people.

historical trauma = cumulative emotional and psychological wounding over the lifespan and across generations, due to loss of:
- culture, language, heritage, history, identity, land, livelihood, parenting skills, autonomy/self-determination.
- also has resulted in legacies of intergenerational family violence

Question 230

describe the on-going colonization.

Answer 230

unfortunately, the legacy of colonization and treaty disputes continues today.

federal government has been slowed to respond to Indigenous concerns, if at all.

examples include nova Scotia lobster fishing and the trans mountain pipeline.

cognitive imperialism
- a society that has accepted the European way of thinking - we see this as the right way. other people who have different views are assimilated and is not part of the right thought that is thought of as truth.

Question 231

describe indigenous health

Answer 231

greatly impacted by history of colonization, assimilation, and residential schools.

physical and environmental, conditions on reserves create health challenges (food security, clean water, adequate housing).

poverty and social exclusion, poor education, addiction causing serious issues.

inadequate health care services and lack of access; also lack of traditional or culturally competent care.

Question 232

identify and describe the 3 social determinants of Aboriginal peoples’ health.

Answer 232

PROXIMAL
- health behaviours
- physical environments
- employment and income
- education
- food insecurity

INTERMEDIATE
- health care systems
- educational systems
- community infrastructure, resources and capacities
- environmental stewardship
- cultural continuity

DISTAL
- colonialism
- racism and social exclusion
- self-determination

Question 233

what are determinants of health for Indigenous Peoples?

Answer 233

systemic racism, colonialism, and poverty are key factors influencing the health of indigenous peoples.

has resulted in lower life expectancy (7 years), higher infant mortality rates, lower education and income levels, and higher unemployment rates among other health inequities.

however beware of viewing indigenous peoples as disadvantaged or impoverished - can contribute to perpetuating the system of oppression.

need to use a strengths-based approach to partnering with Indigenous individuals, families, and communities.

Question 234

identify and describe the strengths of indigenous peoples.

Answer 234

RESISTANCE
- despite a concerted effort to assimilate the aboriginal peoples of Canada, 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, their language, and their identity.

Question 235

what are the pathways towards reconciliation that Crosschild identifies?

Answer 235

“DECOLONIZATION”
- question and alter power dynamics
- challenge cognitive imperialism and social/political ideologies
- unlearning and relearning (7 generations of people were affected).
- shifting culture.

Question 236

what are the roles for nurses in relation to indigenous peoples?

Answer 236

learn about the indigenous peoples of Canada
- understand the political and social climate and general Canadian attitudes towards indigenous peoples.
understand the historical and contemporary contexts and their impact on indigenous peoples and their health.

practice in culturally safe ways
- includes effective intercultural communication.
- problematic communication can become a patient safety issue.
- remember every individual is unique.

respect traditional indigenous ways
- fight the cognitive imperialism piece.
- advocate for your patient’s rights.
may have a variety of traditional practices.
- family and elders are also important.

build authentic and genuine relationships.

Question 237

how does one build authentic and genuine relationships?

Answer 237

connect with the people and the place.

be aware of the possible impact of past experiences.

learn about their history and traditions.

take time and let the community know who you are.

know the people and community before providing assessments.

be community-focused.

support traditional culture and language.

maintain a supportive attitude and develop genuine understanding.

Question 238

what are the 4 aspects of building responsible relationships?

Answer 238

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

Question 239

what does the word “kitimakisowin” mean? what are the 5 areas of kitimakisowin?

Answer 239

Kitimakisowin is a Cree concept that aptly describes the devastating effects of colonization on First Nations, Inuit, and Metis peoples. Kitimakisowin refers to all kinds of poverty, and if such poverty is not addressed adequately, there is risk for serious emotional, mental, physical, and spiritual problems and even death. Five areas of kitimakisowin include:
○ The poverty of participation as a result of marginalization.
○ The poverty of understanding as a result of poor education.
○ The poverty of affection resulting from the lack of support and recognition.
○ The poverty of subsistence as a result of inadequate resources.
The poverty if identity given the imposition of alien values, beliefs, and systems on local and regional cultures.

Question 240

what are 10 strategies that nurses can use to promote equity-oriented services in partnership with indigenous peoples?

Answer 240

Explicitly commit to fostering health equity.

Develop supportive organizational structures, policies, and processes.

Optimize use of place and space.

Re-vision the use of time.

Attend to power differentials.

Develop nursing care, programs and services to align with the local Indigenous contexts.

Actively counter racism and discrimination.

Ensure meaningful engagement of patients and community leaders.

Rely on relational nursing practice to address interrelated forms of violence.

Tailor care to address the social determinants of health.

Question 241

what is indigenous knowledge? identify the 5 different characteristics of indigenous knowledge.

Answer 241

Not homogenous there is diversity among Indigenous peoples.

Definition: Knowledge that comprises complex sets of technologies developed and sustained by Indigenous civilizations often oral and symbolic. It is transmitted through the structure of Indigenous languages and passed down to the next generation through modeling, witnessing, practice, and animation, rather than through written word.

Indigenous knowledge is embedded in community, practice, rituals, and relationships

As a living knowledge, it is holistic, contextual, and rational

There are different characteristics of Indigenous Knowledge (Castellano, 2000):
Personal
Orally transmitted
Experiential
Holistic
Narrative

Question 242

characteristic of indigenous knowledge: #1 Indigenous knowledge is personal

Answer 242

Indigenous knowledge relies on every person’s integrity and perceptiveness

There is no one person who ‘has’ the ‘truth’

The intersection of different voices and perceptions brings awareness to knowledge

Knowledge emerges out of relationships with the land, cosmos, and with non-human kin, an ideology which is regarded as “irrational” and “unreasonable” in contemporary research practices.

With multiple perceptions at the core, Indigenous knowledge actualizes itself in context and therefore, highly dynamic.

Question 243

characteristic of indigenous knowledge: #2 Indigenous knowledge is orally transmitted

Answer 243

Oral tradition is not a precursor to literate traditions. They are simply different ways of knowledge-keeping.

Through oral tradition, Indigenous knowledge is a collective enterprise. Telling stories multiple times, creates more comprehensive narratives that are reflective of the actual context where they are sold.

Question 244

characteristic of indigenous knowledge: #3 Indigenous knowledge is experiential

Answer 244

The land is alive.

To see this, you need to experience this and be on the land.

The senses can know more deeply and concretely than knowledge gained through reading or being told.

“Earth is our mother (and this is not a metaphor: it is real). The Earth cannot be separated from the actual being of Indians. The Earth is where the continuous and/or repetitive process of creation occurs” (Little Bear, 2000).

Question 244

characteristic of indigenous knowledge: #4 Indigenous knowledge holistic

Answer 244

Indigenous knowledge uses all the senses to get at that inner space that brings together “internal and external” worlds, the physical and spiritual are not separated.

Ceremonies carry knowledge in a holistic way. Fire, water, air, and land are all present in ceremonies.

Power comes from bringing complementary energies together.

Thus, all things are in constant motion or flux and this leads to a holistic and cyclic view of the world (Little Bear, 2000).

Question 245

characteristic of indigenous knowledge: #5 Indigenous knowledge is narrative

Answer 245

Stories contain the knowledge that is needed to live in a good way, transmitting vital teachings without preaching.

Knowledge happens and actualizes itself in the sharing.

Narratives uses metaphors guiding moral choices and self-examination.

Question 246

identify and describe the sources of indigenous knowledge.

Answer 246

Traditional Knowledges
Knowledges that we have gained through ceremonies, generations, and have accumulated these through time through different practices, elders, knowledge keepers.

Ecological Knowledge
The idea that we have learned from observation. About seeing things in nature and seeing patterns.

Revealed Knowledge
Things that come to you from dreams, visions, things that are not explainable using Western rationalization.

Question 247

what are the 5 Blackfoot ways of knowing?

Answer 247

Siksikaitsitapi
Knowledge that is experiential, participatory, and it is ultimately sacred.
A process that is community engaged and leads to transformational change through action and its intelligence through participation with the world and its knowledge gained from a cosmic union of human beings who are interconnected with the natural order.

Transformational change

Ihtsipaitapiiyo’pa (source of life)
Niinohkanistssksinipi (speaking personally)

Niitoyiistsi: respect, compassion, sharing and supporting, relationship

Question 248

what are Eurocentric values?

Answer 248

Individualism, Science, Capitalism, Christianity (Wolfe, 2006).

Linearity and singularity, and objective (Little Bear, 2000).
The concept of time, a progression, hierarchy (structure and power).

Duality - mind-body dualism of Descartes (Leder, 1992).

Question 249

what is epistemological dominance?

Answer 249

Western, colonial, Eurocentric - dominant forms of knowing

“culturalism”: an academic and pedagogical posture inherited from colonialism and based on the assumption that mainstream culture and knowledge’s are global and universal (Battiste, 2004).

“Cognitive Imperialism”: cognitive manipulation used to repudiate other knowledge and values (Battiste, 2004).

Abyssal thinking: Epistemic blindness to other epistemologies created as a result of domination (Santos, 2007).
Visible and invisible distinctions established through a logic that defines social reality as either on this side of the abyssal line or on the other side of the line. The division is such that the other side of the line vanishes and reality becomes non-existent and produced as non-existent.

Western knowledge as either or propositions (Little Bear, 2005).

Question 250

compare and contrast indigenous knowledge and western science.

Answer 250

WESTERN SCIENCE

Focuses exclusively on the physical/tangible world. The physical world is isolated from the spiritual, intangible sacred world.

Human beings are separate and distinct from the world around them.

Western science method lies on the principles of measurability, verifiability, predictability, and generalizability. Focusing on objects as discrete entities. Western knowledge proffers universal solutions to problems that are of human concern.

Western science proffers a fragmented, linear and hierarchical understanding of the world. It reduces experience to mechanical and mathematical relationships.

Western science serves exploitative systems of social interaction. It operates in an elitist and highly competitive system where only few achieve the status to carry knowledge forward.

INDIGENOUS KNOWLEDGE

The physical and the sacred realms are not separate.

Human beings are connected to all other living beings. Indigenous knowledge is non-anthropocentric.

For Indigenous knowledge there are no discrete objects of study. Knowledge is holistic, communal, and highly contextual. Following natural law, Indigenous knowledge does not aim at producing anthropocentric theories or solutions, but at observing relationships between elements within a system.

Indigenous knowledge reserves and respects all life enacting the principles of reciprocity and interdependence, balance and wholeness, inner and outer harmony.

Indigenous knowledge is inclusive, cooperative, and peaceful. It nourishes the learning spirit as a foundation for sustainable ways of being.

Question 251

what is sacred pain?

Answer 251

The Sundance (and other ceremonies) operate under a logic of non-anthropogenic circular reciprocity (Ahenakew, 2019).

The prominent features of Sun Dance are the fasting, dancing pledges, prayers, drumming, singing, sweat lodges, pipe ceremonies, and in some cases the piercing rituals.

Circular reciprocity: involves a form of gift giving that does not expect anything in return (Ahenakew, 2019). The idea is for the gift to be passed forward.

The goal of sacred pain is to transform the pain that causes suffering into a pain that leads to insight.

Pain is offered as a gift for healing for the community.

Question 252

what does it mean to support a disciplinary mandate?

Answer 252

Supports and values a pragmatic approach, epistemological pluralism, and a commitment to social justice and equity.

Pragmatism assumes that the meaning of phenomena can only be validated by its practical consequences (Doane & Varcoe, 2005; Peirce & Turrisi, 1997).

By assuming that knowing is inherently linked to practice, nursing knowledge is itself praxis (Doane & Varcoe, 2005; Garret, 2018).

Following a narrow approach to practice (i.e., evidence-based movements that privilege positivist and post-positivist paradigms) is an antithesis to the philosophical foundations of the discipline.

Epistemological pluralism (many ways of knowing).

Question 253

what is the relevance of indigenous knowledge to nursing?

Answer 253

Nursing acknowledges multiple epistemological sources as essential to inform nursing praxis (Carper, 2009; Chin & Kramer, 2008; Thorne & Sawatzky, 2014; White, 2009)
Skill
Aesthetic knowing
Ethical knowing
Empirical knowing
Intuition
Personal knowing
Sociopolitical knowing
Emancipatory knowing