Week 9: Advocacy, Violence, Ethics, Global Health

Question 1

The process by which people are becoming more connected through increased economic integration, communication, and cultural diffusion.

Answer 1

Global Health

Question 2

In 2009, the Region’s crude birth rate of 13.5 per 1,000 population was higher than the Canadian average of 11.3 per 1,000 population in 2008.

True
False

Answer 2

True

Question 3

The absolute numbers of annual births in the Region have increased by almost 24 per cent (from 3,282 to 4,059) between 2005 and 2009.

True
False

Answer 3

True

Question 4

The Registered Indian Status (RIS) population has roughly a four times higher birth rate than the non-RIS population and significantly higher preterm birth rates than the non- RIS population.

True
False

Answer 4

False. RIS population has three times higher birth rate than the non-RIS

Question 5

Residents of lower socioeconomic status neighbourhoods have higher birth rates and higher preterm births than those of higher socioeconomic status neighbourhoods in the Region.

True
False

Answer 5

True

Question 6

The IMR in the Saskatoon Health Region has steadily declined over the years, and most recently ranged from 3.5 to 7.2 infant deaths per 1,000 live births (2007 to 2009) compared to the Canadian average of 5.1 per 1,000 live births (2007).

True
False

Answer 6

True

Question 7

what are the two leading risk factors of infant mortality?

Answer 7

teenage pregnancy and low socioeconomic status

Question 8

name three recommendation to decrease infant mortality

Answer 8

• Conduct a comprehensive review of every fetal and infant death in the Region (Enhance data collection and surveillance around maternal and infant health).
• Ongoing support for a congenital anomalies surveillance system;
• Establish a region-wide Maternal and Child Health Consortium;
• Implement an educational campaign and cultural competence curriculum for providers in services that span maternal and child health care;
• Scale-up, sustain and evaluate evidence-based interventions that address preterm births, low birth weight and teenage pregnancies for all communities.
• Population-based Services - Increase awareness of the importance of infant mortality and poor birth outcomes on the health status of Saskatoon Health Region residents, and promote a culture of wellbeing;
• Improve prevention and management of chronic diseases among pregnant women.
• Enabling Services: linking high risk individuals to needed services (Ensure that current programs and services targeted to high risk populations are meeting the needs of those clients).
• Direct Health Region Services: community-based health services providing a suite of essential health care

Question 9

global health diplomacy is one way of challenging?

Answer 9

oppressive power

Question 10

Identify and define the seven central ethical values of Canadian nurses.

Answer 10

1) providing safe, compassionate, competent, and ethical care
- nurses provide safe, compassionate, competent, and ethical care
2) Promoting health and well-being
- nurses work with persons who have health-care needs or are receiving care to enable them to attain their highest possible level of health and well-being
3) Promoting and respecting informed decision making
- nurses recognize, respect, and promote a person’s right to be informed and make decisions
4) Honouring Dignity
- nurses recognize and respect the intrinsic worth of each person
5) maintaining privacy and confidentiality
- nurses recognizes the importance of privacy and confidentiality and safeguard personal, family, and community information obtained in the context of a professional relationship
6) Promoting justice
- Nurses uphold principles of justice by safeguarding human rights, equity, and fairness and by promoting the public good.
7) being accountable
- nurses are accountable for their actions and answerable for their practice

Question 11

What are the 10 defining attributes of social justice?

Answer 11

1. equity (including health equity)- equity is based on the just treatment of all individuals, which includes equitable access and opportunity to meet health needs
2. Human rights (including the right to health): these rights are defined by the united nations universal declaration of human rights and the canadian charter of rights and freedom
3. Democracy and civil rights- these are outlined in the Canadian Bill of RIghts, democracy and civil rights exist when all have equal rights and power resides in the people and is not based on hereditary or arbitrary difference in privilege or rank
4. Capacity building- capacity building refers to giving strength to individual and institutional skills, capabilities, knowledge, and experience through coaching, training, resource networking, and technical support
5. Just institutions- just institution engage in just practices and the fai treatment of all individuals in institutions
6. Enabling environments- enabling environment support positive change, community empowerment, and policy development.
7. poverty reduction- the reduction of poverty through project, programs, and structural reforms of an economic, social, or political nature increases the standard of living and the social and political participation of the poor
8. Ethical practice- The CNA code of ethics for registered nurses and ethic review boards defines ethical practice for nurses.
9. Advocacy- advocacy involves the active support of individual rights and positive policy or system change
10. Partnership- partnerships that fosters social justice are based on the equitable sharing of roles and responsibilities among institutions and individual access sectors

Question 12

List and define the five justifications for a public health intervention.

Answer 12

1. Overall Benefit: the first justification for public health regulations. relies on statistics that indicate that regulations, in general, benefit society. For example, Health Canada controls what drugs and health products are made available to the public to project public safety.
2. Collective action and efficiency: the second justification. recognizes that health as a public good requires that government institutions make decisions about health and safety given all individuals cannot possess the expertise to make these decisions, nor would it be efficient for them to do so.
3. Fairness in the Distribution of Burdens: third justification, such as those associated with disease, disability, or public health interventions.
4. Harm Principle: fourth justification, developed by john stuart mill, established the initial justification for restricting the liberty of people in a democratic society
5. Paternalism: fifth justification, the interference of a person’s liberty of actions to promote his or her welfare, although normally this interference is only mild.

Question 13

what is informed consent?

Answer 13

consent is a basic principle underlying the provision of care, and without it a case for assault, negligence, or professional misconduct can be made against the nurse.

Question 14

process of informed consent include

Answer 14

The process of consent includes:
-CHNs disclosing, unasked, whatever a reasonable person would want and need to know in the client’s position.
-CHNs must provide information about the nature of the treatment and procedures they are offering, including benefits and risks, alternative treatments, and consequences if the treatment is not given.
-The presentation of this information must consider the client’s education, language, age, values, culture, disease, state, mental capacity, or mental competence to do so.

Question 15

what are the criteria for MAID in Canada?

Answer 15

is at least 18 years old and capable
has voluntarily made the request
has provided informed consent
has a grievous and irremediable medical condition, which means
- has serious and incurable illness, disease, or disability
- is in an advanced state of irreversible decline
- has a condition that causes enduring physical or psychological suffering and
- natural death is reasonably foreseeable

Question 16

what is Medical Assistance in dying (MAID)

Answer 16

as the administering by a medical practitioner or nurse practitioner of a substance, at a patient’s request, that causes his or her death or (b) the prescribing or providing by a medical practitioner or nurse practitioner of a substance, at a patient’s request so that he or she may self-administer the substance and in so doing the cause his or her own death.

Question 17

what is Bioethics

Answer 17

also known as health care ethics, refers to the study of ethical issues that are related to health and health care.

Question 18

what is environmental justice

Answer 18

refers to the inequitable exposure to environmental hazards or how environmental hazards disproportionately affect human of lower socioeconomic status”

Question 19

refers to “how nurses pay attention to ethics in carrying out their common daily interaction, including how they approach their practice and reflect in their ethical commitment to persons receiving care or with healthcare needs

Answer 19

Everyday Ethics

Question 20

“the process in which conditions and behaviour that were previously considered a normal part of life come to be understood as medical problems (e.g., the conceptualization of inattention and hyperactivity as attention deficit hyperactivity disorder)”.

Answer 20

medicalization

Question 21

Negligence: there are four key elements that must be proven to make a finding of negligence:

Answer 21

(a) that there was a relationship between the person bringing the claim and the person being sued, (b) that the defendant breached the standard of care, © that the plaintiff suffered a harm and, (d) that the harm suffered was caused by the defendants breach of the standard of care.

Question 22

social control is

Answer 22

refers “to the social processes by which the behaviour of an individual or group is regulated. since all societies have norms and rules governing conduct, all equally have some mechanism for ensuring conformity to those norms and for dealing with deviance”

Question 23

defined by american public health association (2017) as :the view that everyone deserves equal rights and opportunities that includes the right to good health”.
= also focuses on the relative position of social groups in relation to others in society as well as on the root causes of disparities and what can be done to eliminate them.

Answer 23

social justice

Question 24

list 3 similarities between cultural competence and cultural safety

Answer 24

• involves culture
• taking action to address inequities and enact appropriate interventions
• acknowledges and reflects on barriers of culture
• challenges inequalities
• happens along continuum

Question 25

list 3 differences between cultural competence and cultural safety

Answer 25

• key strength of cultural competence is action
• 5 constructs of cultural competence are cultural awareness, knowledge, skill, encounters, and desire
• 3 dimensions of cultural competence are awareness, attitudes, behaviours
• cultural competence is seen as a way to address culturally specific health needs, integrates the knowledge, attitudes, and skills that nurses would use in order to plan effective and appropriate interventions
• cultural safety involves understanding and naming power and privileges in the therapeutic relationship
• cultural safety grounded in critical social science perspective
• strengths of cultural safety include drawing attention more explicitly to addressing inequities

Question 26

what are the implications of these similarities and differences for CHN’s practice are:

Answer 26

-improving healthcare access for patients, aggregates, and populations
-acknowledging that we are all bearers of cultures
-exposing the social, political, and historical contexts of healthcare
-enabling practitioners to consider difficult concepts, such as racism, discrimination, and prejudice
-acknowledging that cultural safety is determined by those to whom nurses provide care
-understanding the limitations of ‘culture’ in terms of having people access and safely move through healthcare systems and encounter with care providers
-challenging unequal power relations

Question 27

Describe how cultural beliefs and values shape the interactions between nurses and clients.

Answer 27

-learn to speak to clients and having language interpreters when engaging in
conversation with them
- having a better therapeutic relationship with them
- knowing your own values and beliefs will help you work with patients and nurses better
- eliminate cultural barriers and health inequities
- become more culturally competent, safe, and aware

Question 28

what are the three dimension of cultural competence?

Answer 28

(1) awareness (having some knowledge of
cultural similarities and differences combined with self-reflection);
(2) attitudes
(sensitivity, openness, being nonjudgemental, and respecting differences);
(3) behaviours
(require creativity while providing care through a “cultural lens”)

Question 29

what are the five constructs that inform the process of cultural competence?

Answer 29

i. cultural awareness:
self-examination;
ii. cultural knowledge,
iii. cultural skill: collecting and assessing data,
iv. cultural encounters: the process of relationships,
v. cultural desire: motivation of the
health care provider

Question 30

a relatively recent term that enhances and extends culturally safe care, a process of self-reflection where healthcare providers make a commitment to understand their personal and systemic biases through education and reflection, and to maintain respectful processes and relationships based on mutual trust

Answer 30

cultural humility

Question 31

involves actively seeking knowledge about postcolonial power imperatives, happens synergistically among the colonized and the colonizers, and hence, decolonization should integrate this shared history, can only occur when Indigenous peoples and Canadians face one another across historic divides, deconstruct their shared past, and critically engage with the realization that the present and future are similarly tied together

Answer 31

decolonization

Question 32

the dominance of white, European ways of thinking and knowing

Answer 32

Eurocentrism

Question 33

Oppression

Answer 33

is discrimination backed up by systemic power, ie) public policies and in education, legal, and health systems (eg., ageism, classism, racism, sexism, and colonialism)

Question 34

Prejudice

Answer 34

creates barriers across the life course, preconceived opinions and whole way of thinking based on stereotypes

Question 35

racialization

Answer 35

assumes that race is the primary, natural, and neutral means of categorization and that the groups are also distinct in behavioural characteristics, which result from their race.

Question 36

settler privilege

Answer 36

involves unearned, current, and historical advantages that settler Canadians rely on by virtue of the historical relationship to the original settlers of Canada, offer invisible advantages across the lifespan

Question 37

societal structure

Answer 37

underpin society. Political, economic, and social structures of society and the culture that informs them (eg., law, religion, health care, government).

Question 38

Describe the characteristics of culture

Answer 38

• Culture is a social construction, cultural norms, behaviours, and values are learned through socialization within the family and community
• Culture is an integrated system embedded in everyday life. Beliefs and health care practices are usually consistent with the overall paradigms that are used to make sense of the world
• Culture is shared. Beliefs that have meanings and are shared by a group are called cultural values. These values are transmitted within a group and impaired over time. Values shared by people form cultural stability and security.
• Culture is largely implicit(implied though not plainly expressed) and tacit(understood or implied without being stated). Shapes us at an unconscious level. Most times we do not stop to consider the assumptions and expectations that ground our behaviours and decisions.
• Culture is fluid and dynamic. Adapting and changing, especially with increased global migration and access to technology, ie) racialized cultures have been influenced by the dominant Canadian Eurocentric culture. Growing diversity and global interconnectedness have influenced the Canadian culture in return.
• Culture is expressed and intersects with other social constructs such as race, gender, ethnicity, class, language, and disability. ie) people with both visible and invisible disabilities may consider themselves to be sharing common cultural identities and experiences rather than having a “pathological” disorder.

Question 39

care that minimizes the psychological and physical stress that health promotion and illness can inflict. continuously setting a mindful stance to minimize the occurrence of additional trauma inflicted by clinicians and the healthcare system in the course of care. ie. meticulous attention to physical and emotional environments that are compassionate and welcoming- including practising in a culturally safe way.

Answer 39

what is Atraumatic Care?

Question 40

human trafficking

Answer 40

extremely lucrative transnational business, reaching as far as, and generating the same amount of money as drugs and firearms trafficking,. profit is created through sex trade trafficking; controlling and exploiting people to generate ongoing income. Average age is 13-15 years. Signs: repeat visits for ST, unexplained injuries, fearful behaviour and language barriers.

Question 41

People, poverty, power (3P) Model:

Answer 41

provide an overarching way for CHNs to understand and intervene and to act for social change to address violence and its economic, psychological, spiritual and physical health impacts
Trauma is directly and indirectly connected to structural oppression.

Question 42

power and control wheel

Answer 42

applied to describe micro (individual and family), meso (public health systems, healthcare institutions) and macro (colonialism and patriarchy) violence and health interventions– from individual and family intervention to social change for addressing violence,

Question 43

systemic empathy

Answer 43

important foundations for preventing violence, an inherent understanding embedded in societal systems, such as judicial, healthcare and education systems of the importance of striving for structural changes and community liberation.

Question 44

systemic oppressions

Answer 44

broad term that describes racism and other systemic injustices that intersect and impede people’s aspirations, progression and quality of life. ie.heterosexism, racism, sexism

Question 45

result of social inequities, such as lack of resources r/t social support, social connection, family and community support and access to culturally safe health and social services. Social poverty feeds violence because it makes people feel less worthy and it can often stir bitterness.

Answer 45

social poverty

Question 46

“systemic violence”; structural perspective, thinking about the role of systemic processes in the creation and perpetuation of violence, such as the ways that violence is framed and organized by the health care system, legal system and other societal systems and institutions

Answer 46

structural violence

Question 47

trauma-related impacts can cause parental insecurity, overwork, fatigue, and irritability, limited availability of parents to children;

Answer 47

Trauma & Violence Informed Care (TVIC)

Question 48

vicarious trauma

Answer 48

phenomenon of changes in cognition and worldview that result from empathic response and repeated exposure to narratives of trauma; involves the transmission of emotionally laden trauma stories and witnessing the results of psychological , spiritual and physical traumans of people, families and communities in the course of practice ie; Practitioners: nightmares, fearful thoughts and intrusive images, cynical and distrustful. In nursing: emotional numbing, nightmares, irritability, distancing and withdrawal and spiritual and moral suffering as a result of their trauma work.

Question 49

Globalization

Answer 49

is a constellation of processes by which nations, businesses, and people are becoming more connected and interdependent via increased economic integration, communication exchange, and cultural diffusion

Question 50

disease burden

Answer 50

refers to the number of years lost due to disease as measured by financial cost, mortality, morbidity, or other indicators

Question 51

what is Geographic Scope: in Global Health, International Health, & Public health

Answer 51

• Deals with issues that directly affect health of all people in the world including those that transcend national boundaries.
• Deals with health issues of resources constrained countries rather than one’s own country of residence or citizenship
• Deals with issues that shape population health of a community or entire country and within the geographic boundary of that country

Question 52

what is level of collaboration and cooperation: in Global Health, International Health, & Public health

Answer 52

• Initiatives often require cooperation of countries around the world. In addition, collaboration occurs across various sectors within government, non-governmental organizations and the private that are involved in finding solutions to global health problems
• Various interventions that are planned and put into action usually require bi-national cooperation
• Various solutions that are planned and put into action typically do not necessitate global cooperation; interventions occur within individual countries only.

Question 53

what is focus on individuals on population in Global Health, International Health, & Public health

Answer 53

• Concerned with all strategies that improve the health of all people, including health promotion and illness prevention at the population level and clinical care of individuals. Builds on national public health initiatives and institutions.
• Encompasses both health promotion and illness prevention in populations and clinical care of individuals. However, the scope of solutions is limited to the countries working together
• Focuses on health promotion and illness prevention programs at the population-level within a country.

Question 54

what is access to health in Global Health, International Health, & Public health

Answer 54

• Primary objective is health equity among nations and for all people. Embraces transitional research and action that promotes the health of all people in the world. Considers underlying social, economic, political, and environmental determinants of health
• This often appears as resource-rich countries assisting resource poor countries to improve the health of their populations, respectively
• Focuses on promoting health equity within and between communities within the geographic boundary of a country

Question 55

what is areas of expertise in Global Health, International Health, & Public health

Answer 55

• Promotes approaches that are highly interdisciplinary and intersectoral
• Welcomes a collaboration between a few disciplines but no emphasis is placed on taking intersectoral approaches to solutions
• Promotes intersectoral collaboration, especially between those working within the health sciences and social sciences

Question 56

2.1 million people became infected with HIV in 2015 and at the end of that year, a total of 36.7 million people were living with HIV globally

True
False

Answer 56

True

Question 57

Upahur’s principles and frameworks

Answer 57

• Harm principle
  - PH Actions are justifiable to prevent harm to others, but not to prevent harm to oneself – allows for restriction of liberty
• Least restrictive or coercive means
  - Full force of state authority reserved for exceptional circumstances
• Reciprocity
  - assisted in discharging their duties and be compensated for burdens imposed on them
• Transparency
  - Everyone should be involved in decision making, having equal input, free of political interference or coercion