Week 12: CHN Roles Part 2 & CHN Trends: Indigenous Health & Rural Health

Question 1

Blueprint for Action for Community Health Nursing in Canada:

Answer 1

released by the community health nurses of canada in 2011. provides a framework and a point of reference for ongoing action dialogue on the development of community through an extensives consultation with many CHNs across the country and a scoping review of the literature.

Question 2

community health nurse (CHN)

Answer 2

works with people where they live, work, learn, worship, and play to promote health. CHN works with their clients to identify and address their barriers to health with them. these nurses view health as dynamic process of physical, mental, spiritual, and social wellbeing and as a resources for everyday life that is influenced by circumstances, beliefs, and determinants of health

Question 3

Describe the difference between community oriented versus community-based nursing approaches.

Answer 3

Community-based approach: is the nursing care provided to individuals, families, and groups wherever they live, work, play, and learn, in other words, all nurses practice outside the hospital
Community-oriented approach: is population or community focused and aimed at health promotion and disease and injury prevention in an entire population or community

Question 4

C-Health Outcomes for Better Information and Care (C-HOBIC):

Answer 4

indications help assess the functional status of clients, their symptoms, therapeutic self-care, and risk of hospital readmissions or adverse events.

Question 5

How was the evolution of home care in Canada influenced in nursing practice today?

Answer 5

• homecare has evolve in response to providing health care services “closer to home”
• home care is increasingly shifting towards a focus on chronic and rehabilitative health care needs in order to support people as long as possible
• 1988, the federal government and all provinces and territories had launched home care programs and in 1999, home care was extended to FN and Inuit communities
• initiatives highlighted to focus and invest in homecare in Canada such as the Kirby and Romanow Report.

Question 6

What are the consequences to families of the expansion of home care within the health system?

Answer 6

• changing demographics: client are now being discharge earlier, including those which with mental health issues and those who wish to die at home
• Difficult working conditions
• lack of education regarding Home care: nurses often lack of home health in their education
• challenges for ongoing professional development

Question 7

who qualifies to be HHN

Answer 7

HHNs are RN, Licensed practical nurses (LPNS), & RPN.

Question 8

list three role of the HHN

Answer 8

• HHN conduct a comprehensive assessment of the client in order to develop a care plan, monitor the conditions, and make changes as needed
• Client education is provided regarding their conditions and treatment and includes such aspects as diet and mobilization to prevent compilations
• Identifying and mitigating client risk at home, such as potential for falls or medication errors

Question 9

Indian Act

Answer 9

passed, 1876, to ensure the management of reserve lands and communal monies, “civilize the Indian” through assimilation into colonial culture, eliminate clture and prohibit their rights, Indian residential schools and reserves were implemented, women were denied status, and First Nations people were prohibited from voting, forming political organizations, practising spiritual and cultural ceremones, and other life-limiting policies.

Question 10

Indian Agents

Answer 10

hired and paid by the federal government, where individuals assigned to carry out the terms of the Indian Act. Typically lived on the reserve or in very close proximity, First Nation people were required written permission from the Indian agent to leave the reserve , and every aspect of daily life, including growing their own food or raising livestock, was controlled by the agent

Question 11

Indian Hospitals

Answer 11

places for the intersection of race, medicine, and public policy. Operating exclusively for Indigenous patients further segregated while attempting to assimilate, and they existed in several forms for over a century, ending in the late 20th century, established through the work of missionaries, later formalized and continued by the Canadian government, peaking during the 1960s with 22 institutions nationwide with more than 2200 beds.

Question 12

Indian residential schools (IRS)

Answer 12

first established by missionaries in the late 1800s in various locations across Canada and, later, in partnership with the federal government. Children as young as four were forcibly taken from their homes and relocated to schools. The clear intent of assimilation, they were often separated from siblings and relatives, deliberately placed far from their communities; they were not permitted to speak their language, practise their culture, or form relationships critically important in formative years. Premise: absorb children into the general settler population through a process of education and religious indoctrination but caused cultural degradation. Children taught to be ashamed of their heritage, their people, and themselves. Parents legally required to send to IRSs, failure to do so meant punishment, like incarceration, which point children would become wards of the state and sent to IRSs in any case.

Question 13

Intergenerational Trauma

Answer 13

severe impacts on Indigenous communities due to the legacy of IRSs. Trauma experienced by many IRS survivors often resulted (and continues to result) in poor health, addictions, despair, and depression, impacting not only the survivors but also their parents, families, children, and communities.

Question 14

60s scoop

Answer 14

IRSs additionally served as state-run orphanages, aiding the child welfare system’s increased apprehension of children considered to be suffering “neglect” at home. In 1960, an estimated 50% of children attending the IRSs has been apprehended by child welfare agencies. The intent was to sever all ties to family and culture rather than support family reunification. Foster homes and mass transracial adoption followed from 1960-1990. These Indigenous children were placed with non-Indigenous families which caused a complete disconnect from their culture, customs, language, and spirituality. Adoption rate statistics of this era were highlighted in a 1980 study by the Canadian Council on Social Development exposing approximately 15000 Indigenous children in the child welfare system. 60s scoop was coined by Patrick Johnston in his 1983 book, Native Children and the Child Welfare System, commonly used in reference to the widespread apprehension of Indigenous children and the policies, or lack of, that prompted it.

Question 15

learning to see from one eye with the strengths of (or best in) Western knowledge and ways of knowing…and mostimportantly, using both eyes together for the benefit of all. Calls on health care providers to bring together these two ways of knowing not only to broaden nursing practice in a more holistic ways, but to ensure CHNs are always on a journey of looking for different perspectives in pursuit of finding better ways of providing care.

Answer 15

two-eyed seeing

Question 16

Describe five effects of the residential school legacy that continue to impact Indigenous communities today.

Answer 16

generational and intergenerational trauma
addictions
despair
depression
violence
abuse
incarceration rates
child welfare apprehension

Question 17

What are the health impacts of the 60s scoop, and how long have they spanned?

Answer 17

• health impacts: psychological and emotional problems, loss of cultural identity, disconnect from customs, language, spirituality.
• spanned from 1960s-1990s

Question 18

Describe how colonization is ongoing in today’s health care system.

Answer 18

-reports stories of racism, stigmatization, language difficulties, intimidation, harassment, and deep fear
-seeking help from ED like access to specialists, lab tests, and immediate treatments, they say that they have limited access to comprehensive and sepcialized care, long waiting times, communication barriers because of medical jargon, and interactive barriers with HCP
-see how Health care professionals are judgemental, has inadequate assessments, and reported their health care needs were not well addressed.

Question 19

What are the rights that the UNDRIP protects in relation to community health?

Answer 19

• have rights to self-determination in developing and determining health, housing, and other economic and social programs affecting them and, as far as possible, to administer such programs through their own institution
• right to traditional medicines and to maintain their health practices, including an equal right to the enjoyment of the highest attainable standards of physical and mental health

Question 20

provide examples of proximal determinants of health

Answer 20

Proximal (surface) Determinants: health behaviours, physicial environments, employment and income, education

Question 21

provide examples of intermediate determinants of health

Answer 21

Intermediate (core) Determinants: healthcare systems, educational systems, community infrastructure, resources, capacities, environmental stewardship, cultural continuity.

Question 22

provide examples of distal determinants of health

Answer 22

Distal (root) Determinants: colonialism, systemic racism and social exclusion, repression of self-determinism.

Question 23

Identify four concepts that would be discussed in a rural and remote nursing course.

Answer 23

• Reflect changes to rural and remote nursing roles, settings and models of practice as health systems transition toward a primary care model of service provision and delivery
• Specialized knowledge for performing activities related to public health, home care, emergency care, palliative care, and management of episodic and chronic conditions
• Collaboration with a NP, physician or itinerant specialist via telephone, telehealth, or other electronic means
• Nursing leadership and creating quality work environments

Question 24

identify four challenges experienced by nurses working in a northern community

Answer 24

• Inequity in health care access: fewer health care delivery options
• Inequity in technology: inadequate internet connectivity, health informatics and telehealth
• Inequity in water quality
• Food insecurity

Question 25

to the definition of rural include locators or geographic regions, like the location of hospitals, roads or specific political areas.

Answer 25

technical approaches

Question 26

Not static. Communities often seek alternate economic ventures, such as tourism, to sustain their economic and social viability

Answer 26

Socioeconomic status

Question 27

to defining rural refer to the nature of the rural community, including such features as specific services that are normally associated with larger population sizes.

Answer 27

Social Approaches

Question 28

resource base

Answer 28

will influence the health status of those who live in it. In rural, remote, and isolated communities where there is a heavy reliance on industries such as oil and gas, logging, mining, fishing and agriculture, interrelated injuries and illnesses impact the individuals as well as the community

Question 29

Culture is a social construction. They are learned through interaction and socialization over time.

true or false

Answer 29

true

Question 30

cultural competence

Answer 30

• Culturally competence: a process through which nurses plan effective and appropriate interventions that address culturally specific health needs
• Cultural competence is a lifelong process of approaching relationships with openness and humility rather than focusing on “knowing” specific cultures

Question 31

cultural humility

Answer 31

is a term that enhances and extends culturally safe care.

Question 32

involves unearned, current, and historical advantages that settler Canadians rely on by virtue of the historical relationship to the original settlers.

Answer 32

settler privilege

Question 33

which call to action # is:
We call upon the federal government to develop with Aboriginal groups a joint strategy to eliminate educational and employment gaps between Aboriginal and non-Aboriginal Canadians.

Answer 33

call to action #7

Question 34

which call to action # is:
We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.

Answer 34

call to action #22

Question 35

which call to action # is:
We call upon all levels of government to:
1.Increase the number of Aboriginal professionals working in the health-care field.
2.Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
3.Provide cultural competency training for all healthcare professionals.

Answer 35

call to action #23

Question 36

which call to action # is:
We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.

Answer 36

call to action # 24

Question 37

which theory: looks at oppression and social structures supporting oppression or discrimination as ways to understand violence by gender, sexuality, class, and race

Answer 37

Intersectionality

Question 38

which theory: Many forms of violence are linked to privilege and power differentials

Answer 38

People, Poverty, Power Model (3P)

Question 39

defined as actualized self-forgiveness by people experiencing poverty and oppression, and it is a key to building resilience

Answer 39

self-empathy

Question 40

Sexualized violence disproportionately impacts women, and is an example of violence that is rooted in gender inequity

True or False

Answer 40

True

Question 41

Universal screening for IPV is recommended as best practice for all girls and women above the age of 12

True or False

Answer 41

True

Question 42

integrates the importance and implication of trauma with the traumatic outcomes of violence.

Answer 42

Trauma and violence-informed care (practice, policy making, leadership)

Question 43

what are the four key practices of trauma and violence-informed care:

Answer 43

Build awareness among staff and clients
Emphasize safety and trust
Adapt your language
Consider trauma a risk factor