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NURS 430: Community Health Nursing
Building Partnerships Final Exam
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Primordial Prevention - Answer -Initiatives that prevent conditions that would enable risk factors to develop How do we set up our society, convenience stores away from schools? Conditions to improve diet and exercise E.g. more walkable city, harm reduction Primary Prevention - Answer -Impact of specific risk factors is lessened E.g. diabetes - soda tax, made water a drink of choice. It is upstream Secondary Prevention - Answer -Early identification of disease and conditions and timely treatment (Screening) E.g. diabetes Diagnosed with someone high risk, being sent to nutritionist, exercise program, screening for STIs Tertiary prevention - Answer -Once an individual becomes symptomatic, or disease or injury is evident. E.g. Diabetes - insulin and medication because they have been diagnosed Quaternary Prevention - Answer -Actions that identify populations at risk of overmedicalization
- Pt's with chronic pain can become addicted; aims to reduce likelihood of addiction but controlling pain
- Focuses on ethical practices
Components of the Ottawa Charter for Health Promotion - Answer -Food Peace Shelter Income Education Stable Ecosystem Sustainable resources Social Justice Equity 5 Key Actions of the Ottawa Charter for Health Promotion - Answer -1) Build Healthy Public Policy
- Create supportive environments for health
- Strengthen community action
- Develop personal skills
- Reorient health services toward preventing diseases and promoting health What is the Population Health Promotion Model? - Answer - Bridges the gap between population health and health promotion Combines Ottawa Charter Strategies, determinants of population health, and potential interventions What are the underlying values of Primary Health Care? - Answer -Social justice and equity 5 Principles of Primary Health Care - Answer -1) Accessibility
- Public participation
- Health promotion
- Appropriate technology
- Intersectoral collaboration or co-operation (HAPAI)
Conceptual Model - Answer -a way to organize and visualize abstract statements about the relationship between knowledge and practice Theories - Answer -more concrete statements that can be derived from conceptual frameworks and from practice Health Promotion - Answer -process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental, and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Population Health - Answer -approach used to understand and improve the health of an entire population or subpopulations, such as children, older adults, or newcomers to Canada. identifies and takes action to improve the root causes of health issues that impact the health of the overall population Primary Health Care - Answer -essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. What are the CHNC Standards of Practice? - Answer -1. Health Promotion
- Prevention and Health Protection
- Health Maintenance, Restoration and Palliation
- Professional Relationships
- Capacity Building
- Health Equity
- Evidenced Informed Practice
- Professional Responsibility and accountability *Standards 1, 2, and 3 describe what we do in practice; Standards 4, 5, 6, 7, & 8 describe how we practice and what we expect to achieve RN in primary care/ family practice nurses - Answer -focus on preventative health screening, health education, comprehensive assessment, treatment of minor acute illness, chronic disease management, case management, system navigation, therapeutic intervention (wound care, immunization) and medication review with individuals and families) Public Health Nursing - Answer -focus on promoting, protecting and preserving the health of populations links the health & illness experiences of individuals, families, and communities to population health promotion practice Home Health Nursing - Answer -focus on prevention, health restoration, maintenance & palliation focus on individuals, designated caregivers, and their families Examples of Health Promotion - Answer -encouraging families dealing with a chronic illness to participate in regular physical and social activities. Encouraging clients to quit smoking for wound care healing using motivational interviewing and goal setting strategies working community to advocate for a smoke-free town or municipality
Providing directly observed therapy (DOT) for people with TB in their living arrangement Participating in health maintenance clinic visits for school age children annually Participating in patient education, medication review and direct observation therapy Nursing service in chronic disease management clinics Supporting clients in palliation by working through symptom assessment, management and access to resources Professional Relationships Examples - Answer -Providing palliative care with a team of health care providers to individuals to enable them to remain in their home in their end of life Consulting with the client's wound care team to discuss and ensure best practice and holistic approach in the wound care plan is followed to support client outcomes. Establishing a therapeutic working relationship with multigenerational families, and families that have young children to have healthy family outcomes. Establishing and maintaining interprofessional relationships (e.g., key informants, stakeholders, political, clergy, etc.) Initiating and navigating client centered interactions Participating in interprofessional team meetings to share knowledge amongst team that will enhance client care and outcomes. Advocating for inclusion and
Capacity Building Examples - Answer -Encouraging a mother and teens to work out a schedule for ROM exercises for the grandmother. The family is happy that they were able to work out the problem together. Working with the family and client to figure out a home care schedule that suits client needs and yet maintains independence Encouraging an end-of-life client has input into the plan of care to ensure their goals are taken in to account. Working as a partner with a Health Action Team in a high school to mobilize students, parents, teachers, administration, and community partners to identify the school community's strengths and needs, and prioritize, plan, implement, evaluate the growing vaping behaviour among youth. Empowering leadership and self advocacy within community members across the lifespan to address diverse needs Advocating for vulnerable populations such as youth, LGTBQ2, older adults, people of any age with chronic medical conditions Health Equity - Answer -Advocating with families caring for medically fragile children by seeking respite care for families or by contacting their local MPP. Offering the flu vaccine to house bound individuals Advocating for " wheelchair " transportation in the community for wheelchair clients to attend social activates. Identifying that their smoking cessation messaging is not culturally safe nor considerate of the Indigenous realities and culture.
Understanding the different scopes of practice in nursing and interdisciplinary teams and working respectfully with interdisciplinary team. Assisting client's and families to support MAID (medical assistance in dying) Working with a a needle exchange program based on harm reduction. Accepting the tenets of harm reduction and uses reflective practice personally Seeking the input and guidance of a supervisor/mentor to understand and change biased assumptions. Utilizing interdisciplinary team approaches to client care Practicing in accordance with the Standards of Practice and Code of Ethics within the nursing profession Professionally liaising with colleagues to support and enhance practice including peer reviews What do CHNs do? - Answer -they promote, protect, and preserve the health of individuals, families, groups, communities and populations... wherever people live, work, learn worship & play.... in a continuous versus episodic process. Standard 1: Health Promotion - Answer -Community health nurses integrate health promotion into practice "__________ is the process of enabling people to increase control over, and to improve, their health."
Involves the individuals, families, groups, communities, population and systems Involves the Ottawa Charter Collaborates with client to do a comprehensive, evidence informed, and strength-based holistic health assessment using multiple sources and methods to identify needs, assets, inequities and resources. Standard 2: Prevention and Health Protection - Answer - Community health nurses use the socio-ecological model to integrate prevention and health protection activities into practice These actions are implemented in accordance with government legislation and nursing standards to minimize the occurrence of disease or injuries and their consequences. Sociological model focuses on sustainable solutions applies the appropriate level of prevention (primordial, primary, secondary, tertiary, and quaternary) to improve client health Standard 3: Health Maintenance, Restoration, and Palliation - Answer -Focus is on maintaining maximum function, improving health, and supporting life transitions including acute, chronic, or terminal illness, and end of life includes cultural safety and cultural humility approaches in all aspects of health maintenance, restoration, and palliation interventions Standard 4: Professional Relationships - Answer -These relationships include optimizing participation, and self- determination of the client.
Standard 7: Evidence Informed Practice - Answer -community health nurses use best evidence to guide nursing practice and support clients in making informed decisions understands and uses knowledge translation strategies to integrate high quality research into clinical practice, education, and research. Standard 8: Professional Responsibility and Accountability - Answer -Community health nurses demonstrate professional responsibility and accountability as a fundamental component of their autonomous practice. Identifies and works proactively (individually or by participating in relevant professional organizations) to address health and nursing issues that affect the client and/or the profession. Provides constructive feedback to peers as needed to enhance community health nursing practice. Not task focused, process focused. Find that intrinsic motivation to self-regulate and to assess communities and complete necessary tasks Cultural safety - Answer -means the practitioner can communicate competently with a client in that client's social, political, linguistic, economic, and spiritual realm culturally appropriate health services to disadvantaged groups while stressing dignity and avoiding institutional racism, assimilation (forcing people to adopt a dominant culture), and repressive practices. Cultural humility - Answer -an approach to health care based on humble acknowledgement of oneself as a learner when it comes
to understanding a person's experience. It is a life-long process of learning and being self-reflective. Indigenous Way of Knowing - Answer -"Indigenous knowledge comprises the complex set of technologies developed and sustained by Indigenous civilizations. Often oral and symbolic, it is transmitted through the structure of Indigenous language and passed on to the next generation through modeling, practice and animation, rather than written word." _______________ is embedded in community practices, rituals, and relationships. _____________________ has 5 characteristics: personal, orally transmitted, experiential, holistic, and narrative. Knowledge translation - Answer -Refers to a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound use of knowledge to improve the health of Canadians Quality Improvement - Answer -involves CHNs working to improve health care delivery including effectiveness, access, capacity, safety, patient-centeredness and equity. PHN, HHN, and CHN - Answer -PHN - programs and services PH core function HHN - homes, residences, VNs, generalist practice, non-profit org and for-profit agencies that provides primary health care and health promotion programs
intersecting oppressive processes impacting people occupying multiple marginalized social locations. _______________Multiple categories of difference (e.g., gender, race, and social class) are both created and sustained by structures of domination. These categories of difference create categories of "other" that inform societal norms and standards in our everyday social processes. emphasizes that this matrix of power differentials constrain opportunities for marginalized people, while privileging dominant groups, resulting in a status quo of oppression that is embedded in everyday institutions. Trauma-informed care - Answer -In ________ services, safety and empowerment for the service user are central, and are embedded in policies, practices, and staff relational approaches. service providers cultivate safety in every interaction and avoid confrontational approaches. __________ are like harm-reduction- oriented approaches, in that they both focus on safety and engagement. a key aspect is to create an environment where service users do not experience further traumatization or re-traumatization (events that reflect earlier experiences of powerlessness and loss of control) and where they can make decisions about their treatment needs at a pace that feels safe to them. Trauma- and violence-informed care - Answer -___________ expands on the concept of TIC to acknowledge the broader social and structural conditions that impact people's health, including institutional policies and practices. talking about sexuality and substance use within service settings can be difficult. Using a ___________ approach helps ensure that
the broader structural and social conditions are acknowledged and that organizational policies and practices as well as provider practices do not contribute to re-traumatization. TVIC Strategies - Answer -Acknowledging the effects of historical and structural conditions; Seeking client input about safe and inclusive strategies; Encouraging client empowerment in relation to treatment options and adoption of harm reduction strategies; and Implementing policies and processes that allow for flexibility and encourage shared decision-making. Perceived stigma - Answer -An individual's awareness of negative societal attitudes, fear of discrimination, and feelings of shame.
- Fear of disclosing serostatus to family provider Internalized Stigma - Answer -An individual's acceptance of negative beliefs, views, and feelings towards the stigmatized group they belong to and oneself.
- Not applying for a job because of gender identity Enacted Stigma - Answer -encompasses overt acts of discrimination, such as exclusion or acts of physical or emotional abuse; acts may be within or beyond the purview of the law and may be attributable to an individual's real or perceived identity or membership to a stigmatized group.
- not believing a sex worker who was assaulted Layered or Compounded Stigma - Answer -a person holding more than one stigmatized identity.
- HIV positive serostatus, sexual orientation, ethnicity
Many infections passed to the neonate happen due to the parent not being aware of diagnosis. For example, if a mother has an HSV outbreak during delivery, the child has a 50% chance of the infection. In approximately 70% of cases, the mother has no history of genital herpes. Venereal diseases - Answer -This is a very old term used to describe STIs. The term _____ comes from the Greek "Venus", the Goddess of love, sex, beauty, and fertility! STDs - Answer -People used to use the term ______, but diseases usually have symptoms and most STIs don't. STIs: Sexually Transmitted Infections - Answer -Some people use the term ________, but it's important to remember that some infections can be transmitted through blood and sexual contact. STBBIs: Sexually Transmitted and Blood-borne Infections - Answer -can be transmitted through sexual contact and/or through contact with blood, and they do not always have symptoms Reportable infection - Answer -When lab tests for these STIs are positive, they are reported to a local medical health officer, who uses this information to help prevent the spread of the STI. This information is confidential: it is not shared with other people. These infection require contact tracing, where clients are asked about your past and present sexual partners and anyone who they have shared drug equipment with. Non-reportable infection - Answer -These STIs do not get reported to local medical health officers. We do not have statistics for these STIs because we don't keep track of who has them.
Testing methods and what they detect - Answer -Urine
- urine testing can be used to detect chlamydia and gonorrhea Blood
- blood testing can be used to detect syphilis, HIV, and hepatitis. Can also detect HSC, although not routinely Swab
- Swabs of the vagina, rectum, throat, or cervix can be used to detect chlamydia, gonorrha, herpes, syphilis (if a sore is present), HPV (cervical swabs), BV, and trichomoniasis Visual
- Visual inspections can be used to detect thrichomoniasis, HPV (with genital warts), public lice and scabies Gold standard of experimental design is? - Answer -randomized control trial Definition of epidemiology - Answer -- study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such astates and the application of this knowledge to control the health problem
- essentially the study of the distribution and determinants of health-related states or events (including disease) and the application of this study to the control of diseases (deterrents) and other health problems Harm Reduction is..... - Answer -a strategy that decreases risks associated with harms related to certain behaviours
- Goal-oriented
- Humanistic
- meeting people where they are
- Non-judgemental
