Nursing in Canada Flashcards
British North America Act
1867 - Confederation
Legislates Federal and Provincial responsibilities for healthcare
The Indian Act
1876 (Amended 1985)
- Outlined Indigenous access to Healthcare and other rights
- Lasting effects on access and care received by Indigenous peoples
Hospital Insurance and Diagnostic Services Act
1957
Saskatchewan, regulated in-patient services
First pre-paid hospital insurance plans for Canadians, stemmed from immigration, rural/urban divide, Great Depression, population growth, inadequate taxation base, etc.
Mecial Care Act
1966
- Evolved from the Hospital Insurance and Diagnostic Services Act
- Legislates Federal and Provincial cost sharing of hospital and physician services
Canada Health Act
1984
- Amalgamation of HIDSA and MCA
- banned extra billing and user fees
- The basis of our current system
““to protect, promote and restore the physical and mental well-being of residents of Canada… to facilitate reasonable access to health services without financial or other barriers”
Principles of the Canada Health Act (5)
- Public Administration
- Comprehensiveness
- Universality
- Portability
- Accessbility
Public Administration
- Not for profit, publicly administered
- Under the terms of the CHA, gov’t are allowed to contract for-profit corporations to provide health care (SNA)
LIMITATION: People can pay for their healthcare if they want to
Comprehensiveness
Covers: “Medically necessary hospital services “as the province/territory permits” (CHA, 1984, c.6, s.9)
LIMITATION:
Exclusions of health services that happen outside of the hospital: nursing services and home care for chronically ill patients, pharmacare, dental care…
Universality
- Covers “…100% of the insured persons of the province to the insured services provided for by the plan on uniform terms and conditions.” (CHA c.6, s. 10)
- Care should be respectful and “free of discrimination based on race, gender, income, ethnicity, or religion.” (Petrucka, p. 21)
LIMITATION: sometimes we don’t meet that mark: Systemic racism exists in our system , and there are some structures that prevent people from accessing their needed health services
E.g., On June 1st 2020, the Toronto Board of Health recognized anti-Black racism as a public health crisis
Portability
-No penalty/cost between provinces (you can access care across the country)
- NOTE: Services that are covered differ across provinces and territories
- Financing comes from Feds, but provinces can decide how they are going to distribute that money, what they are going to finance and what they aren’t, e.g., abortion care differs across Canada
Accessibility
-Insured persons will have ”reasonable access to health care facilities and providers, based on medical need regardless of the ability to pay.” (Petrucka, p. 21)
LIMITATIONS:
- Varying levels of access based on geography – availability of providers, facilities, transportation, child-care
- There are still discrepancies between access and affordability of additional care, time off work, etc.
Federal Government Responsibilities
- Sets and administers national principles
- Assist in financing services through transfer payments to the provinces
- Delivers services to specified groups who are not covered by the province: ○ Indigenous people ○ Veterans ○ Federal inmates ○ RCMP
Provincial/Territorial Government Responsibilities
- Develop and administer their own HC insurance plans
- Manage/finance and plan insurable services and delivery aligned with CHA
- Determine organization and location of hospitals, LTCs, employ HCPs, and determine amount of $ invested in HC services
- Reimburses doctors and hospital costs and some rehab/LTC services on basis of co-pay with end-users
Levels of Health Care (5)
- Health Promotion
- Disease and injury prevention
- Diagnosis and treatment
- Rehabilitation
- Supportive care
Health Promotion
Level 1
Focused on:
-Increase control and improve health
-Wellness services, advocacy for healthy public policy
E.g., Ottawa Charter for Health Promotion
Disease and injury prevention
Level 2
Focused on:
-Reducing risk factors
-Prevention strategies, e.g. immunization
-Behavioural aspects (support groups)
-Environmental actions (e.g., climate control activism)
Diagnosis and treatment
Level 3
Focused on:
-Managing existing health problems
-Primary (1st point of contact, e.g. family doc, NP)
-Secondary (specialized medical services)
-Tertiary (specialized technical care for complex problems)
Rehabilitation
Level 4
Focused on:
-Improved health and QOL for people with life-altering conditions
-Includes injury, mental/physical illness, addition
-Allied health: PT OT, RT, SW
Supportive care
Level 5 Focused on: -Chronic/progressive illness and disability -LTC, assisted living, home care -Respite/palliative care
The Nursing Act
1991
-Establishes and manages CNO and scope of practice
-Certifies:
○ Entry requirements
○ Title protection
○ Controlled acts
○ Quality assurance, safe care
○ Professional misconduct
○ Self-reporting obligations
Regulated Health Professional Act
1991
Consists of a Nursing Scope of Practice statement and regulation of Controlled Acts
Scope of Practice Statement (summary)
- promotion of health
- assessment, provision of care, and treatment of health conditions
- supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function
Controlled Act
- Performing a prescribed procedure below the dermis or a mucous membrane
- Administering a substance by injection or inhalation
- Dispensing a medication
- Putting an instrument, hand or finger into the body
Initiation of Controlled Acts (5)
- Assess client and problem
- Consider all options
- Weigh risks and benefits
- Decide on course of action
- Accept sole accountability for the procedure and ensuring consequences are properly managed
You have to assess if you have the knowledge, skill, and judgement to initiate and perform a procedure, and check with local scope and employer regulations
