Voices from the CommunityCanadians and their Nurses’ take on Health, and Healthcare

Institute for Health and Social PolicyFebruary 26, 2013

Cheryl Armistead RN, MScNIngram School of Nursing

Community Health Nurses of Canada

Sean Clarke RN, PhD, FAANProfessor, Ingram School of Nursing

Director, McGill Nursing Collaborative for Educational Innovation in Patient and Family-Centred Care

with Kasha Mohr RN, BNI (c)

Outline

• Community Health Nurses (CHN): an introduction• Voices from the Community: Health and Healthcare• CHN as partners to advance the cause• The Collaborative bridge to the future

Voices from the Community

• ‘Place’ (community) matters. • Act now – with focus on solutions to improve conditions of

daily living• People/communities must be key actors at the table• CHN are your partners for equity in health and healthcare

Who we are• Nurses in Canada• Community Health Nurses• Front line - social, environmental and medical determinants of health

• Community Health Nurses of Canada

What we do

• Promote, protect, preserve health of people, families, groups, communities, systems, populations - where they live, work, learn, play and pray– Health as fundamental to living a meaningful life

• Full scope of practice• Resiliency/capacity• Social justice lens

– See: CHNC, 2011

The Notion of Equity• Health

– Is a function of how society choses to organize itself– Income, housing, food insecurity and social exclusion are major factors that

generate and reproduce health inequity over lifespan • See: Mutaner et al, 2012

– Elimination of systematic differences in health status between socio-economic groups

– Create opportunities and remove barriers to achievement of health potential

• Healthcare

– Equal use for equal need– Fair arrangements that allow equal geographic, economic and cultural access to available

services for all in equal need of care.

(Whitehead & Dahlgren, p. 11)

Wellesley Urban Health Model• Simulates impact over 30 years re 5 areas of intervention:

Healthcare access, healthy behaviour, income, housing, social cohesion.

• Outcomes: death, health conditions, disparity ratios. – Death rate reductions – strongest influence is healthcare access– Disability reductions – strongest influences are low income and social

cohesion; then healthcare access– Chronic illness reduction – strongest influences are low income and social

cohesion; then housing (not close)

• The path to health is through income and social cohesion

See: http://www.wellesleyinstitute.com

Voices from the Community• CNA National Expert Commission

– Year-long pan-Canadian consultation – Nurses, health-care providers, educators, policy/decision-makers– Public engagement and voice via YMCA partnership and

consultations with Canadians of all ages in 19 cities across Canada– New evidence and perspectives to the debate about how to

effectively transform and sustain our publicly funded national health-care system

– Multiple policy recommendations (See CHSRF: Muntaner et al. 2012)

See: Barbara Mildon, RN, PhD, CHE, CCHN (C), President CNA

“© Canadian Nurses Association. Reproduced with permission. Further reproduction prohibited.”

A Nursing Call to Action

4 Unifying Themes reveal Canadian Values

• Lead system transformation– Accelerate transition from acute to community; improve integration

• Focus on social, economic, environmental and Indigenous determinants– Root causes of poor health and use of healthcare system– Social and recreational resources to help Canadians be happy

• Promote Healthy Lifestyles– Better/clearer guidance and support

• Strengthen the voice of advocacy for and by nurses

“© Canadian Nurses Association. Reproduced with permission. Further reproduction prohibited.”

CHNC’s Brief to the National Expert Commission

• Creating a System for (community) Health– Redefine ‘expertise’; Citizen engagement and Voice – Health Accord 2014: expand to home, pharma and palliative care– Healthy Public Policy: equitable access to ‘health’– Economic models: risk-benefit approaches and beyond GDP – Canadian Index of Wellbeing: help change the conversation from

‘healthcare’ to ‘health’– Human Health Resources: All Canadians should know their

community health nurse• See: CHNC, 2011

Canadian Index of Wellbeing• “Measuring what matters”

• “Highest possible quality of life” – 64 indicators within 8 domains– Good living standards, robust health, vital communities, sustainable

environment, educated population, balanced time use, high levels of democratic engagement, access to & participation in leisure and culture

• “When the economy improves, Canadians reap relatively little benefit, when the economy stumbles, Canadians take the fall” (p.10).

• Helps us question whether policy/ governments are responding to the needs and values of everyday Canadians (p.1)

See: Canadian Index of Wellbeing. 2012. How are Canadians really doing? The 2012 CIW Report. Waterloo, ON: Canadian Index of Wellbeing and Waterloo University.

Canadian People: Their Stories

• Systems for (community) health• Invisible people (NB student experience)• Disability & dignity (?)• Mental health and wellbeing• Impact of CHN

The CHN Perspective

• We bear witness:– Impact of healthcare and healthcare systems (+/-)– Impact conditions of daily living (+/-)

• We can challenge stereotypes and conventional thinking• We bring a resiliency/capacity lens• We are constrained – variance between what we can/should be

doing and what current roles allow• We must better prepare healthcare providers for scope of practice • We can/should be more prominent partners in policy

– See: Cohen and McKay 2010; CHNC, 2011; CNA, 2012

Key Messages

• ‘Place’ (community) matters. – The path to ‘health’ requires strong, cohesive communities (See: Wellesley)

• Act now – with focus on solutions– Healthy Public Policy to improve conditions of daily living– Guaranteed and adequate income will lead to better health

• People/communities must be key actors at the table– They know what they want/need

• CHN are partners for equity in health and healthcare at all levels– Every Canadian should know their Community Health Nurse (See: CHNC)

354 910 Regulated Nursing Workers in Canada in 2010

RNs76%

RPNs/LPNs23%

Psych Nurses1%

In 2010 in Canada …

• The ratio of RNs to population nationally was 1:127

• 63.0% of RNs worked in the hospital sector and 14.0% worked in the community health sector. 9.6% worked in nursing homes and long term care

• Mean age 45.4 yrs (20.9% under 35, 38.5% 50 and over)

• 6.4% male

What Nursing Has To Offer

• Broad theoretical base for undertaking patient assessment and interventions

• Keen awareness of logistical issues in delivering care and services

• Understandings of patient/family/community experience

• A history of bridging client and worker groups in health care (often) and of outreach

What is Nursing Research?– About the patient experience of health and illness, or

about nursing services and their impacts• “the continuous present”—sometimes hour to

hour/day to day unfolding of experiences and care – Methods approaches shared with other sciences• Quantitative and qualitative social sciences• Epidemiology and public health science• More rarely, basic and clinical sciences

– Nurses as project leads or as collaborators … – About 50 years old as a discipline (but most

development in past 20 or so in Canada)

Our Advantages/Challenges in Nursing at McGill

• School of Nursing in an international calibre research university– Imperative to have research and education in complementary

roles and at very high levels• Human service profession/discipline in a minority-

language/culture situation and at a time of much change in health services and higher ed

• Changing funding environment • Collaboration is especially critical to the survival and

flourishing of this community

Our Challenges in Nursing as Individuals and as a Profession

• Being informed about social, health care and economic trends ... Understanding the “stories within the stories” and truly incorporating the determinants of health into practice

• Considering bigger contexts of work and being organizationally/politically active:– Planning change– Bearing witness to external change– Leveraging nursing’s place in health care and in society

The Future of Nursing Research ...

• Clinical and policy relevance will be increasingly essential

• Different types of partnerships between clinical settings and researchers

• Different funding models • Different approaches for interdisciplinary

research

Our Advantages/Challenges in Nursing at McGill

• School of Nursing in an international calibre research university– Imperative to have research and education in complementary

roles and at very high levels• Human service profession/discipline in a minority-

language/culture situation and at a time of much change in health services and higher ed

• Changing funding environment • Collaboration is especially critical to the survival and

flourishing of this community

Collaborative Partners

• School of Nursing, Faculty of Medicine, McGill University

• Jewish General Hospital• McGill University Health Centre • [in planning phase—negotiations not yet

concluded/agreements not executed]: Douglas, St. Mary’s

But the aim is to build morebridges to …

• The health and health care community in Montreal– Including the community

• The rest of the McGill campus– Interdisciplinarity in research/scholarship, practice and

education • Other partners in Quebec, Canada and

internationally

• http://www.mcgill.ca/nursing/collaborative