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Unit 2 Blog #1: Where Do I Fit In Within The Canadian Health System?
I currently work as a registered nurse in Ontario. Nurses make up approximately over one third of the regulated healthcare workers in Canada, with approximately 300,000 nurses (Canadian Nursing Advisory Committee, 2002). To achieve this status I had to complete a Bachelors of Science in Nursing (BScN) at a university. After graduating I had to provide proof of graduation and successfully pass the NCLEX examination, plus pay a fee, in order to obtain my nursing license in Ontario as an RN; this license must be renewed yearly by paying a fee. Nurses in Ontario are regulated by a governing body called the College of Nurses of Ontario (CNO). The Code of Conduct (CNO, 2019) outlines a professional practice standard and expectations that all nurses must adhere too. The Code of Conduct is also a guideline for the public to present the expectations of behavior from a nurse while providing care. Nursing practice falls under the Regulated Health Professional Act, 1991 and the Nursing Act, 1991.
There are many different roles a nurse can participate within the health care system, being a staff nurse at a hospital being the most common one. I am a bedside nurse, meaning I work on a unit within a hospital providing patient care at the “bedside” level, this is also known as a “staff nurse”. I am in pursuit of my masters in order to become a nurse manager or clinical instructor. My role within the health care system is an important one. Bedside nurses spend a lot of time with patients in perspective of how much time other members of the healthcare team spend with them. In general we are an invaluable resource and advocate for our patients.
My professional values closely align with my personal. I believe that everyone should have fair and equitable access to health care. No one should have to sacrifice their health due to economic or situational status that would otherwise prevent them from seeking help. The Canadian health care system is universal, called Medicare, funded by tax revenue. Medicare covers approximately 70% of Canadian health care requirements the remaining 30% must be paid out of pocket or private insurance.
Our health care system is based on the Canadian Health Act, 1986, which primary objective is to protect, promote and restore physical and mental well being of all Canadians, achievable by removing barriers preventing access to healthcare. Although the theory behind this act is truly what Canada is about, there are many small and remote communities within this country that are underserved and under represented. Many factors contribute to this, mostly involve some aspects of the social determinates of health. But even a large subculture within a large community such as Toronto, can experience less then desirable health care. For example, the community of Scarborough within Toronto is made of largely of new immigrants and first generation Canadians. The three hospitals that serve this area are in need of upgrading. Unfortunately due to the lack of donations, a source of income commonly received by larger hospitals, educational centres etc, the states of the hosptials are not equivalent to the remainder of the GTA’s facilities. Although the staff have the training that is required by Ontario health regulations, if the facilities were larger, more modern and had a higher capability to provide health services locally, would this change any health comes for its residents?
I have a strong personal drive to serve under accessed and under represented communities. Growing up in a lower socioeconomic neighbourhood and family, I had to work very hard to break the cycle of poverty. I relate to working class neighbourhoods and recognize the social divide between the “have” and the “have not’s” and strive to provide care deserving to all Canadians, regardless of where their postal code is. This is why I feel my professional and personal values strongly align with one another.
Unit 3 Blog 2: What is Health?
In 1948, the World Health Organization (WHO), defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (Badash, 2017). Over the years, there have been many conferences and discussions regarding health, its meaning and the current state of health world wide. In 2022 is this statement an accurate depiction of what health could or should be defined as? This post will discuss my opinion on what’s is health and whether or not WHO’s definition remains relevant.
Hippocratic medicine in Ancient Greek time was the first medical approach to balancing behavioural and medicinal in order to achieve a state of health (Badash et al, 2017). And although the logic regarding how to maintain that balance has changes over the centuries, this theory still resonates. In my opinion, the current definition of health should reflect not a total or complete state of well being as defined by the WHO, but an ability to successfully manage any current health conditions and potentially mitigate any new health conditions via healthy lifestyle and education, in order to balance mental and physical health with a goal to achieve the best possible health outcomes.
Living without disease could be argued as being impossible. With medical advancements, life expectancy has increased, thus arguably leaving a nearly possible change of not developing some sort of physical or mental ailment over a course of a life time. With that being said, how can one achieve a complete state of social, physical and mental well being as defined by the WHO? And if you cannot, does that make you unhealthy? I also question if the state if being healthy also subjective. If someone is given a diagnosis of a chronic illness but is well managed can they deem themselves as healthy? In my opinion as a nurse I have seen many patients with co-morbidities that live a very healthy life style and live a very long life. I have also seen relatively younger patients with chronological age in their 50’s but biologically and medically are much more advanced for their age due to advancement of their disease. From my experience as an emergency nurse determination to lead a healthy lifestyle despite a diagnosis makes a big difference in outcome. Patients that embrace their diagnosis and adopt a healthy life style that encourages longevity despite chronic illness tend to have better health outcomes and longer life stands.
In conclusion, I do believe that the perception, as well as the definition, of health should be reevaluated and redefined to reflect current state of health of the population in the 21st century.
Unit 3 Blog 3: Social Determinants of Health
The World Health Organization (WHO) defined the social determinants of health as factors in which people are born, grow, work and age (Islam, 2019). The socio-political and socio-economic factors correlate frequently with resources available, thus also correlate to the general health and well being of certain populations. It is well documented that areas of lower socioeconomic population, as well as communities largely populated with minorities, have a lower life expectancy. Berwick (2020) explains in their article the ‘subway map’ metaphor for the social disparities and the correlation to life expectancies. As per Berwick (2020) if you were to examine the subway map from midtown Manhattan, an affluent neighbourhood, to South Bronx, a lower socioeconomic area, the life expectancy of its residence decline by 6 months for every minute on the subway train. The most recent example of illness and its direct relationship to the social determinants of health is the rampant spread and death from COVID-19 within certain populations and demographics.
Although COVID does not discriminate who it infects, the elderly, immigrant population and lower economic groups were hit the hardest. This has been attributed to a number of factors including crowded living conditions, multigenerational households, not able to work from home, working in the service industry and having to take public transport (Burstrom & Tao, 2020). This vulnerable population also had a higher number of people with underlying health conditions, as well as poor general health and nutrition (Berwick, 2020). So how can we relate this back to the WHO’s social determinants of health?
The concept of social determinants of health has dual meaning, referring to the social factors of promoting and understanding of health of individuals as well as the social process underlying unequal distribution of social factors that determine health (Islam, 2019). If health is directly correlated to social determinants of health how can we turn the page and make health a viable option for all? The current toxic circumstances outside of health care, such as institutional racism and discrimination of the lower income class does not allow for improvement in healthcare. As healthcare workers, physicians and nurses can speak out against discriminatory practices in healthcare accessibility, work with community organizations and advocate for fair healthcare treatment (Islam, 2019). During the COVID-19 pandemic, the community of Scarborough, in which I work in, was particularly hit very hard. Many community members fell ill including many deaths, while others lost their businesses and suffered large economic losses. The Scarborough Health Network organization noted the disproportionate amount of the population effected and worked with community leaders to host local vaccination clinics and information sessions in churches, community centres and mosques. Although we cannot change the circumstances in which we are born into, those who have a voice should lend it to speak up and support change within communities to improve social factors that improve health outcomes for others.
Unit 4 Blog 4: Multiple Spheres of Influence on Health
After reading the mandatory article regarding post colonial countries and inequality written by Thongs & Gahman, I found and additional three sources on explaining the multiple spheres of influence.
Gahman, L., & Thongs, G. (2017, September 20). In the Caribbean, colonialism and inequality mean hurricanes hit harder. The Conversation. https://theconversation.com/in-the-caribbean-colonialism-and-inequality-mean-hurricanes-hit-harder-84106?utm
Video: Sphere of Influence Explainer Video. https://youtu.be/CZt3QkRE_SA
· As a visual learner, this 6 minute video helped me understand what the spheres of influence are as applicable to everyday life. Great way to learn about the topic.
Article 1. Spheres of Influence (n.d.). Retrieved February 27, 2022 from https://www.ifhhro.org/education/steps-for-change-section-1-how-can-human-rights-be-influenced-by-health-workers/
· This brief gives a visual diagram to explain how healthcare workers, who may be indirectly or directly involved in patient care, can influence human rights in regards to healthcare. This is a very simplistic breakdown to explain the basics on spheres of health and wear as a healthcare worker you lay within those spheres and what influence you may hold.
Article 2. Karches, K (2022). Spheres of influence and strategic advocacy for equity in medicine. J Gen Intern
Article 2. Karches, K (2022). Spheres of influence and strategic advocacy for equity in medicine. J Gen Intern
Med. 2021 November; 36(11): 3537-3540. Retrieved February 27, 2022 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133515/
Med. 2021 November; 36(11): 3537-3540. Retrieved February 27, 2022 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133515/
· This article discusses the COVID-19 health crisis and the strain on healthcare. It also discusses the health disparities that were brought to light during the COVID-19 pandemic and speaks from a physicians perspective of the situation and how as physicians to advocate for equitable healthcare and how to use their role to influence policies and practices.
Unit 4 Blog 5: Socio-Ecological Model of Health and Culturally Appropriate Health Teaching for Diabetes Prevention
As an emergency room nurse, I see a multitude of sick people, all ages and all lifestyles. One of the many common denominators of the sickest patients is that they tend to have the highest number of co-morbidities, with diabetes being the leader of the pack. According to www.diabetes.ca, diabetes accounts for 30% of stroke patients, 40% of heart attack, 50% of kidney failure requiring dialysis and 70% of non traumatic amputations each year. According to the same website, Canadians aged 20 years at present have a 50% chance of developing diabetes in their life time, and less then half of Canadians know how to recognise the signs and symptoms of diabetes. Those are some pretty alarming statistics, especially from a healthcare providers perspective. So how do we fix this trend? One of the ways to further analyse a specific health concern and how it relates to a specific population is by using the social ecological model of health.
The social ecological model of health (SEM) was first conceptualised and advanced during the 1947 Constitution of the World Health Organization. SEM recognises that health is effected by the influence between individuals, the community or group in which they associate with and their physical, political and social environments (ATSDR, 2011). Above is a diagram retrieved from the Agency for Toxic Substances and Disease Registry (2011) and provides a visual reference to how the SEM framework works. The approach of SEM is to focus on the community and social environments in order to promote disease prevention rather than focus on promoting individual health behaviours (ATSDR, 2011). The circles each represent an aspect that influences a persons health. The first circle represents the individual and includes their biology, age, income and health history. The second circle represents the persons closest individual social circle including family and friends. The third circle represents the settings in which people have social relationships such as school or work and the fourth circle reflects the societal factors that impact health including cultural, social norms, health, economic and social policies that creat or lessen socioeconomic inequalities between groups (ATSDR, 2011).
You cannot discuss SEM with out referencing the social determinants of health. The World Health Organisation (WHO) defined the social determinants of health as factors in which people are born, grow, work and age (Islam, 2019). The socio-political and socio-economic factors correlate frequently with resources available, thus also correlate to the general health and well being of certain populations. It is well documented that areas of lower socioeconomic population, as well as communities largely populated with minorities, have a lower life expectancy (Islam 2019). When examining a particular health concern of a individual you must reflect on their social determinants of health and correlate SEM in order to determine pre-existing or defining factors that may hamper the effectiveness of health teaching in order to prevent or improve quality of life in terms of chronic diseases and treatment. It is well documented that new generation and immigrant population tend to have lower paying jobs amongst other challenges, thus leading to social and economic disparities within the community (Burstrom and Tao, 2020).
The neighbourhood in which I work is very multicultural with many new immigrants or first generation Canadians. Until working there I did not know that certain populations from specific ethnic backgrounds are more susceptible to developing certain chronic diseases such as diabetes. Although you cannot change a diagnosis of a chronic disease, you can teach someone how to live the healthiest life possible while managing the disease, but most importantly in my opinion, you can teach the next generation how to adapt their lifestyle in order to prevent the onset of the disease. A major risk factor which can also be identified as a precursor to adult diabetes, is childhood obesity.
According to Pereira, Padez and Nogueria (2019), childhood obesity tends to lead to adult obesity and generate a greater demand on the healthcare system for systemic illnesses. Diabetes is the leading non communicable disease on the rise globally, specifically in low income households, with unhealthy dietary behaviour being the largest contributing factor (Caperon et al, 2019). Caperon and her colleagues used the Socio-Economical model of Health (SEM) to gather information in order to provide socio-culturally appropriate dietary suggestion in order to maintain a healthy blood sugars in a population in Nepal. The authors noted the most influential determinants included cultural practices, social support, political and physical environment and individuals motivation and capabilities (Caperon et al, 2019). I found this interesting because although the study was performed in Nepal and in a more remote habitat, these determinants, as identified by the authors, are applicable to many different situations including the population in which I work among.
By examining the above mentioned influential determinants I began to think how it could be applied locally. If we want to inform the current generation of how to live and manage their chronic disease as well as teach the next generation preventative measures, how can we apply this approach using the SEM model? Cultural practices is probably the hardest one to break, these may include generational practices that are ingrained into everyday life. In terms of diabetes management and prevention, working with nutritionist who may be familiar with specific cultural cuisines and food preparation may assist in allowing the patients and families to relate with the teacher and their teaching so to speak. For example a nutritionist of Filipino decent may be able to understand the taste and preparation of culturally specific foods and be able to offer healthy preparation alternatives that still provide palatable satisfaction to the patient but improve the nutritional value of the food, which in turn may lead to higher compliance rates. This may also improve motivation as well.
Food security is a major issue for people in lower socioeconomic classes. Fresh fruit and produce are expensive and generally do not fit within grocery budgets, where as prepared and process foods are much more cost effective yet tend to be much more unhealthy. In order to help prevent childhood obesity, which includes teaching health food preparation and nutrition, better options must be available for this at risk group. Many communities have food gardens where the neighbourhood grows its own produce and shares amongst its members. Other community institutions, such as community centres, that serve at risk populations provide baskets of seasonal produce to help promote a better balanced nutritional options. But the problem lies on a larger scale and systemically. Healthcare providers and human rights activists need to address their local governments for better food security, lower the cost of healthy nutritious foods so they can become an option for the budget conscious population instead of readily available and affordable processed foods. For example, by providing breakfast and lunch programs in schools in lower socioeconomic areas help to target the highest at risk population by implementing preventative measures by educating what a healthy, well balanced meal entails. Another option would be to encourage free local cooking classes at a community centre where people will have access to a nutritionist to help teach about better balanced meals and the importance of overall health to prevent multi-generations from suffering from chronic diseases. By enacting an upstream approach to a public health crisis such as diabetes, targeting the next generation to prevent developing bad nutritional habits but also empowering and informing the current generation on how to alter their current cultural practices by using the SEM approach may help curb the an already growing health crisis such as diabetes.
Unit 7 Blog 6: Semester Summary and Future Directions of Healthcare
For the past 12 weeks I have had the opportunity to work and interact online with my fellow students of Athabasca University graduate program, who reside all over Canada and work in various aspects of health care. This was a unique experience for me as all my previous education has been nurse-directed therefore I only interacted with fellow nursing students. Reading the posts and blogs of my classmates allowed me to see the topics from their perspective as healthcare workers, not just from a nurses point of view. Although there were some minor differences across the country in terms of policies and professional regulatory bodies and practices, the main components remained the same regarding Canadians and their healthcare experience.
The social determinants of health is not a uniquely Canadian experience, this is a global phenomenon first defined by the World Health Organization (WHO) as factors in which people are born, work, grow and age; socioeconomic factors correlate with resources available, thus also correlate with health outcomes (Islam, 2019). All countries across the world have different socioeconomic groups within their population. It has been well researched and well documented that the populations that fall under the lower socioeconomic group tend to have higher numbers of multiple health issues and chronic disease management. Minorities tend to be the largest number of this population, and experience unequal access to healthcare. In Canada, the First Nations population has been well documented as underserved and discriminated against in our country, with the atrocities of residential schools displayed in the media as of late. I was surprised to find out about Indian Hospitals during the course of my research about this at risk population. In September 2021, Alberta Health Services published a YouTube video regarding this subject matter, and if you are unfamiliar with these hospitals you should watch and learn about this important aspect of Canadian healthcare history. Here is a link to the video https://youtu.be/5o9ubDDmF98
In keeping in line regarding social determinants of health and chronic disease management, I had previously discussed in a blog post about diabetes and how the social determinants of health correlates to negative health outcomes. By utilizing the socioeconomic-ecological model (SEM) of health as a framework to establish how individuals and groups as well as political influences can affect an individual’s health. In my previous blog I mentioned cultural appropriate health teaching for effective diabetes management as well as food security for those of lower socioeconomic means. In order to better understand how SEM influences diabetes, I looked into the topic deeper.
SEM is a reciprocal framework model; the individual is influenced by their environment and their environment is influenced by them. SEM suggests that an individual's behaviour is integrated into a complex network involving intrapersonal characteristics, interpersonal processes, institutional factors, community features and public policy (Salihu et al, 2015). My previous post mentioned childhood obesity and food culture practice and how to reach certain cultural groups regarding health choices to prevent or manage diabetes. I recently found an article regarding one group of researchers trying to reach out to diabetic populations in Africa and how they used the SEM theory to address difficulties implementing a diabetes prevention and education program.
The authors, Bamuya et al (2021), studied groups of diabetic patients in Lilongwe, Malawi and Maputo, Mozambique to analyze poor patient outcomes in terms of their diabetes management and the five domains surrounding the patient as per the SEM theory. It was noted by the authors that decisions impacting the education and support programs for diabetics was greatly influenced by community infrastructures. Cultural values and beliefs greatly influenced this population in terms of medical treatment. There was a strong belief, especially amongst rural areas, that diabetes and its symptoms were associated with witchcraft and many sought out traditional treatment options prior to seeking medical advice. There are cultural taboos regarding treatment such as injecting oneself with insulin (Bamuya et al, 2021). In order to reach as many of the populations as possible, the local division of government that addresses health launched a multimedia campaign including radio, WhatsApp, social media as well as included as many friends and family as possible to the education sessions of diabetic patients (Bamuya et al, 2021).
The actions of these African cities in order to educate as many people as possible brings about the next question, what is the future direction of healthcare? Without a doubt COVID launched healthcare in Canada, and perhaps internationally, into a whole other realm! I personally noted that in the first wave of COVID, the vast decrease in walk-in patients to the emergency departments was significantly reduced. As the consequential waves continued I noted that the walk-in patients began to steadily increase as fear of the disease subsided. With COVID, many virtual platforms to speak to a physician were free, a service that was previously a pay-per-fee service in Ontario as it was not covered by OHIP. This allowed patients requiring minor medical attention to receive it. Currently many doctors' offices are still very restricted in the number of patients they are willing to see, thus driving a large number of ‘non’ emergencies back to the hospital waiting rooms. A lot of the time people are there due to lack of education or just fever and need of reassurance. Reflecting on this made me think how the underlying intentions of the African health governments use of multimedia could be effective. By increasing the amount of virtual visits to address minor medical issues, multimedia advertising websites for parents for information such as how to properly treat a fever at home and when it’s necessary to come to the hospital, having a virtual consultation with a pharmacist or a dietician would provide the patients with the education, attention and reassurance that everyone needs. There will always be a place for in person medicine, that is inevitable, but by increasing virtual visits and online educational presence creates an easy to access and convenient means of relaying information to a large group of population.
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