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Nurs 2000 Exam-questions Solved 100% Correct
Critical Social Theory Expose social inequalities Challenging structural constraints and social policies and the status quo Use this theory to understand root causes and expose them Goals of Critical Theory 1.Analyze the social, economic, political, cultural, and environmental ways individuals and groups are harmed by social institutions and political processes 2.Act on these health damaging effects at a community level to facilitate structural change History of Health Promotion 1974 Lalonde Report- social determinants of health 1986 Ottawa Charter for Health Promotion- Emphasis on achieving equity in health Components of the Ottawa Charter for Health Promotions Emphasis on achieving equity in health social determinants of health Strongest predictor of health with Income being the most influential determinant
3 approaches to health promotion
- Medical- Biomedical (taking meds for example)
- Behavioral (quitting smoking for example)
- Social-environmental (cooking class for example) Social Ecological Model Strategies for health promotion are most successful when they target all the levels of influence Social Ecological Model Shows the different levels of influence For example gun violence. Individual- Identities biological and personal history factors Relationship- examines the relationships, close peers etc Community- explores the settings, schools, workplaces neighborhoods Societal- social factors that help create the arena for the violence to happen Population Health Promotion Model A cube shape image, which explains the relationship between population health and health promotion. This model identifies how population health approach can be implemented through action on the full range of health determinants by means of health promotion strategies Asks 3 questions: On WHAT should we take action?" (What determines health) "HOW should we take action?" (Ottawa Charter) , and "WITH WHOM should we act?" (What level, society, community, individual) Critical Social Theory
- Focus on entire populations & sub-populations
- Guided by assessment of population health status
- Considers broad determinants of health
- Considers all levels of prevention, with focus on primary
- Includes community, systems, and individual/family focus Community Health Nursing- Essential Functions
- Public health
- Health promotion
- Disease and injury prevention
- Health protection
- Health surveillance
- Population health assessment
- Emergency preparedness and response Canadian Community Health Nursing Standards of Practice 8 of them
- Health Promotion
- Prevention and Health Protection
- Health Maintenance, Restoration and Palliation
- Professional Relationships
- Capacity Building
- Health Equity
- Evidence Informed Practice
- Professional Responsibility and Accountability
Essential elements to achieve health for all
- education
- food supply
- safe water and sanitation
- maternal and child health
- immunization
- prevent and control infections disease
- promoting appropriate treating of common disease and injury
- providing essential drugs 5 types of health care. CNA/primary health care
- Promotive
- Prevention
- Curative
- Rehab
- Supportive/rehab 5 principles of primary health care/CNA
- Assessibility
- Public participation
- Health promotion
- Appropriate technology
- Intersectoral cooperation Primary Health Care- From the Alma Ata Declaration
Def: Liberalization in global trade, increased deregulation, business-friendly labor markets Open Market Big Corporations- don't want to pay taxes Privatization People are free to live without government intervention Reduced social and health spending Decisive political and professional leadership is required to address SDOH and reduce health inequalities Welfare State a system whereby the government undertakes to protect the health and well-being of its citizens, especially those in financial or social need, by means of grants, pensions, and other benefits Welfare state retrenchment Retrenchment of the welfare state pertains to various cost containment efforts governments have tried to introduce. Retrenchment has taken different forms in different countries and different policy areas. It can include cuts in generosity and increasing qualification conditions to make benefits less universal and restrict the number of recipient. Social Justice Fair distribution of society's benefits and responsibilities Upstream approach - advocate for change in structures and relationships that lead to poor health Shift from individuals to communities
Social class groups have different access to capital Requires political competence and citizenship Social Justice- HCP mandates CNA professional practice competencies: nursing practice requires- advocacy, political awareness and social responsibility CHN- advocate for change in policies, systems and resource allocation Sociopolitical action is a moral imperative Future of community health nursing depends on 2 things
- Our ability to recognize social, economic and political aspects of the environment as they affect health
- Our willingness to intervene at the community level for structural change Empowerment Move toward increased individual and community control, political efficacy, improved quality of community life and social justice Empowerment and addressing inequalities Individual- acknowledge constraints, increase individual capacity, advocate for access to resources
Health Policy Usually acts, legislation or organizational Decisions, plans, and actions - societal health care goals Defines a vision - helps establish targets /points of reference Outlines priorities and expected roles Builds consensus, informs people (WHO, 2017). Health Programs Usually are formed from policies Plan of action aimed at accomplishing clear health care goals Details - work, by whom, when, what means/resources The Dahlgren-Whitehead Model Social factors impact communities or the person
- this model is often used in public health policies. Many ppl use this framework, health is determined my social factors Example of Dahlgren Whitehead Model
- there should be multiple layers to make change possible
- to look for change the right players must be involved
- the outer ring is the policies that came from the change
- change won't be sustainable unless you have policy to support it Root Causes of Health Inequalities Structural Influences on SDOH: (causes of the cause) •Economics •Social Policies •Politics Social Determinants of Health: •Food insecurity •Housing •Social Exclusion •Education •Income •Etc... Where you find policy •Federal/Provincial & Municipal Government Legislation •Statutory Bodies •International Treaties •Corporations
The integration of experience, judgement and expertise with the best available external evidence from systematic research An extension of evidence based medicine Political Economy Approach •the study of the role of public policy in influencing the economic and social welfare of a political unit •Politics (ideology, power) shape distribution of resources •Economics and politics closely tied and influence public policy Liberal state We are the least de commodified, market is considered more important then institutions. Canada, New Zealand, US, England What is the political state of Canada? Canada is a liberal welfare state Developing healthy public policy How to build Healthy Policy 8 steps
- Describe the Problem
- Assess Readiness for Policy Development
- Develop Goals, Objectives, and Policy Options
- Identify Decision-Makers and Influencers
- Build Support for the Policy
- Draft and/or Revise the Policy
- Implement the Policy
- Evaluate and Monitor the Policy Community Health Promotion Model Assessment----Analysis----Planning----Interventions----Evaluation Steps of planning a Health Promotion Program (6) 1.Pre-planning and project management 2.Conduct a community assessment 3.Identify goals, populations of interest and objectives 4.Identify strategies, activities, processes, objectives and resources 5.Develop indicators 6.Review the program plan (Evaluation) Community Health Needs Assessment (CHNA) Is a process that ... •describes the state of health of the people within a community •assists in identifying major risk factors and causes of ill health •identifies potential actions needed to address the major risk factors •also known as a Community Health Assessment (CHA) Why do CHNA's? (Community health needs assessment) •Determine health status of community residents •Make sure decisions are based evidence
Epidemiologic Triad host: genetics, family history, age, sex, race agent: biological, infectious, chemical, physical, nutritional or psychological environment: physical, biological or social Epidemiologic triangle as a Venn Diagram Epidemiology the study of the distribution and determinants of healthrelated states or events in specified populations, and the application of this study to the control of health problems. Epi = upon Demos = people Ology = science Is the bridge between biomedical, social and behavioral sciences Epidemiology con't Proof is impossible! However in epidemiology evidence is collected that suggests casual relationships are there Epidemiology and public health Emphasis on disease prevention
Epidemiology and clinical medicine Emphasis on disease classification and diagnosis (numerators) Epidemiology and pathophysiology Need to understand basic biological mechanisms in disease (natural history) Epidemiology and biostatistics Need to quantify disease frequency and it's relationship to antecedents (denominators, testing hypothesis) Epidemiology and social sciences Need to understand the social context in which disease occurs and presents (social determinants of health phenomena) Hill's criteria
- Strength
- Consistency
- Specificity
- Temporarily
- Biological gradient
- Plausibility
- Coherence
- Experimental evidence Analogy Ratio
Number of deaths from a specific cause in a given time period/ 100, Proportional mortality and death to case ratio Number of deaths assigned to a specific cause during a given time interval Infant Mortality Rate number of infant deaths during time period X 1,000 divided by the number of live births during time period Benchmark of the health of a country Case Fatality Rate (CFR) proportion of deaths within a designated population due to a given medical condition the number of deaths from a specified disease over a defined period of time/ the number of individuals diagnosed with the disease during that time; the resulting ratio is then multiplied by 100 to yield a percentage Mortality death Morbidity Illness a diseased state, disability or poor health due to any cause
Levels of Prevention Primary: Immunizations Secondary: Screenings Tertiary: Follow-up Care Incidence The number or rate of new cases of a particular condition during a specific time. Incidence = Number of new cases during a time period/ Population at risk during that time period Incidence is a rate- always show as a percentage Prevalence The number or proportion of cases of a particular disease or condition present in a population at a given time Prevalence = Number of existing cases/ Total number in the population at risk Prevalence is a proportion Relative Risk AKA Risk ratio, Attack rate
