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December 3, 2019
As I approach the final days of my first course, critical foundations in health disciplines towards my Master’s of Health Studies through Athabasca University, I am prompted to reflect on my progress thus far. In the beginning I was feeling a combination of pride as well as nervousness. I had recently accepted a new role at work that came with a significant learning curve and I was unsure of how I would manage a new job and taking the leap to begin this journey in education. Although I was feeling very proud of myself for taking this step, it was also clear to me that I would need to create new structure in my life to allow for time to be dedicated to my learning. I was reminded that I value ongoing learning and enjoy the learning process. Throughout this course I have learned valuable theories related to health issues but I also learned a lot about myself and my learning style.
To begin this course, I started by introducing myself and spoke about my current role as a registered nurse working for a rural hospital in the community mental health department. I explored my profession’s role in the healthcare system as well as examined my role as a registered nurse specifically in the community I work in. Although I am now in an administrative role, the majority of my career has been spent working in a front-line capacity to deliver care to clients with a diagnosis of bipolar disorder, schizoaffective disorder and schizophrenia. My current role focuses on leadership, program development, quality improvement initiatives, and fiscal responsibilities.
Demonstrating professional behaviour both at work and while offsite is an expectation of a registered nurse. Therefore, when I was tasked with completing a professionalism audit via social media, I was not concerned. This is also in compliance with the College of Nurses of Ontario (CNO). Nurses in Ontario must meet practice standards which includes demonstrating professional behaviour. This is explained by the CNO (2002) through the accountability standard which dictates that the nurse’s behavior is accountable to the public and responsible for ensuring that their practice and conduct is congruent with the standards of the profession. This can be translated to online behavior as well as direct contact with patients.
Nurses work with an understanding of what “health” means, but upon a literature review I realized that there are many varying concepts of health. These concepts included the definitive idea that health is a state of complete physical, mental and social well-being and not merely the absence of disease (World Health Organization, 1948) as well as included concepts of health promotion strategies. The Government of Canada (2019) explained that there are societal and environmental factors that determine health of a population. This includes: income and social status; employment and working conditions; education and literacy; childhood experiences; physical environments; social supports and coping skills; healthy behaviours; access to health services; biology; gender; culture; and race (Government of Canada, 2019). This was a natural transition into my blog post which began to direct my focus on Social Determinants of Health. This was relevant to my practice as a mental health nurse since the social determinants of health impact every part of my clients’ lives. I understand the challenges that come with limited income, unstable housing, poor social supports and the impact this has on one’s overall health outcomes.
This led me to explore more multilevel systems of health related to mental illness. In my research I came across Dahlgren and Whitehead (1991)’s Wider Determinants of Health Model (Canadian Council on Social Determinants of Health, 2015).
This model stood out to me because it promotes a holistic approach to caring for patients. The model indicates that all lifestyle factors influence health outcomes and even accessibility to healthcare. In the mental health system there are numerous barriers in accessing healthcare, this is a gap that I strive to mitigate every day in my practice. One thing this course has taught me is that I have an underlying passion for helping those struggling with homelessness and mental illness which is presented as an important factor in this model. This concept was supported by a classmate, Lee Stuardo who indicated in a forum that homelessness and mental illness is a growing concern in other provinces such as British Columbia and blogged about the impact community has on an individual's mental health.
Inadequate housing does not merely mean that someone does not have access to a safe home, but it presents as a multitude of concerns related to accessing healthcare. I was surprised when I researched the prevalence of diabetes mellitus and hypertension in relation to mental illness for my blog post titled “How are Diabetes and Hypertension Related to Mental Illness”. As a nurse, I am aware of the adverse effects that some antipsychotic medications can have. However, when viewing this more holistically and considering that homeless clients are less likely to follow recommended treatment regimes, it is not surprising that the two chronic illnesses can have such a detrimental impact on the lives of my clients.
By this point in the course I realized that I would concentrate my research on homelessness within the mental health population in an attempt to identify strategies that were being successfully implemented. What I found was that the majority of individuals in Toronto, Ontario met the diagnostic criteria for two or more mental illness diagnoses (HomelessHub, 2016). This frightening statistic drove me to continue exploring the impact of homelessness on an individual and how that can lead to suicide amongst the homeless population. A video by Eye Witness News (2017) explains how homelessness can lead to feeling helpless as well as the unsafe living conditions and coping strategies this population implements in order to cope with life on the streets. This week’s coursework gave me a new perspective on working with my clients and supporting my team to better serve this population. After reading about the incidence of suicide amongst the homeless, I was able to collaborate with a local shelter to provide mental health supports to those who are temporarily seeking shelter.
My work as a clinical manager of a community mental health program includes creating new and innovative ways to deliver care and better services for our clients. My collaboration with the local shelter was a good start but I felt there was more to be done in terms of symptom reduction and management of serious mental illnesses. This was also prompted by the question posed in week 12’s forum: "what excites me when I think about the future of healthcare?" I immediately began thinking of eliminating barriers to treatment and came across new strategies for point of care testing for monitoring treatment with clozapine. This is a medication I am very familiar with and have seen substantially positive outcomes but unfortunately there are strict monitoring protocols that many mental health clients are not able to adhere to. Cision (2019) explains that a simple finger prick sample of blood can be used to provide a detailed value of white blood cell count and absolute neutrophil count which is compliant with the monitoring protocol to be on the medication. This testing can be done by a nurse outside of a lab, eliminating the barrier for clients to access this medication. In my opinion, this is a much more efficient approach to treatment with improved technology and a strategy that I will attempt to implement for my team.
Overall, I have developed a thorough understanding of the foundations of healthcare in Canada. This course has taught me the significance of viewing healthcare from a multilevel perspective, while developing the practice of information curation. My research has helped to identify needs in my community while being directed by the determinants of health and their influence on health outcomes. Furthermore, this course has provided an opportunity to develop my research skills and the ability to collaborate with my classmates across the country.
References:
Athabasca University. (2019). Retrieved December 2, 2019, from Athabasca University: https://www.athabascau.ca/
Athabasca University. (2019). Master of Health Studies (MHST 601). Retrieved December 2, 2019, from Athabasca University: https://www.athabascau.ca/syllabi/mhst/mhst601.php
Canadian Council on Social Determinants of Health. (2015). A review of frameworks on the determinants of health. Canadian Council on Social Determinants of Health, 17.
Cision. (2019, October 17). HLS Therapeutics announces Health Canada grants medical device license for White Blood Cell Point-of-Care Device to be marketed as CSAN® PRONTO™ . Retrieved November 25, 2019, from Cision: https://www.newswire.ca/news-releases/hls-therapeutics-announces-health-canada-grants-medical-device-license-for-white-blood-cell-point-of-care-device-to-be-marketed-as-csan-r-pronto-tm--899297239.html
College of Nurses of Ontario(2002). Professional Standards, Revised 2002. Retrieved September 27, 2019, from College of Nurses of Ontario: http://www.cno.org/globalassets/docs/prac/41006_profstds.pdf
Dahlgren G, Whitehead M. 1991. Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden: Institute for Futures Studies.
Eye Witness News. (2017, November 20). Zero Suicides campaign: Homeless people often don't get the help they need. Retrieved November 18, 2019, from YouTube: https://www.youtube.com/watch?v=3Gy3GrH0hRQ&t=45s
Government of Canada. (2019, June 28). Social determinants of health and health inequalities. Retrieved October 6, 2019, from Canada.ca: https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
HomelessHub. (2016, December 9). What are the stats on homelessness and mental health in Toronto? Retrieved November 1, 2019, from Canadian observatory on homelessness: https://www.homelesshub.ca/blog/what-are-statistics-homelessness-and-mental-health-toronto
World Health Organization. (1948). Constitution of the World Health Organization. Retrieved from http://www.searo.who.int/about/about_searo_const.pdf?ua=1
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