Thursday, June 28th 11:00am–12:00pm
11:00am – 12:00pm- 60 Minute Oral Presentations
500: Critical Community Health Nursing: A Canadian Call to Action
Josephine Etowa, PhD RN RM FWACN FAAN, University of Ottawa, Ottawa, ON, Dr. Aliyah Dosani, Mount Royal University, Calgary, AB, Dr. Cheryl van Daalen-Smith, York University, Toronto, ON
The paper will discuss how practice rooted in critical social theory (CST) (Stevens, 1992) helps community health nurses (CHNs) enact their advocacy role irrespective of their areas of practice (public health, policy, home health, primary health care, street nursing, etc). Serving as a magnifying glass that exposes otherwise unseen sources of health inequities (McGibbon & Etowa, 2009), CST provides the upstream and intersectional analysis necessary for CHNs whose practice is grounded in social justice. As such, CST affords the CHN with the capacity to understand and address the social circumstances, denials of power and agency, and the individualized victim blaming experienced by communities considered vulnerable or ‘at risk’.
· Discuss the role of critical social theory (CST) in community nursing practice.
· Describe how CST can advance social justice and advocacy work of community health nurses, through an upstream and intersectional analysis.
· Identify actions necessary to address the root causes of inequities in population and community health.
11:00am – 11:25am- 25 Minute Oral Presentations
501A: Breaking Bad... Barriers: Leading and Measuring Integrated Approaches for Change with Vulnerable, Complex Clients
Lorraine Telford, RN, BScN, MN, CCHN(C), Alberta Health Services, Edmonton, AB
Community, Home Health and Primary Care Nurses can use measurement to transform the way the needs of complex clients in the community are addressed to achieve the "quadruple aim.”
Vulnerable people with complex high needs, and the providers who care for them, experience challenges and encounter barriers. To address the unmet needs of vulnerable clients, interprofessional teams worked collaboratively to improve services and address barriers to care for 1800 identified clients in our community. Providers (40), clients (400) and community leaders from seven diverse service teams then participated in a large formal evaluation.
We modeled our measurement strategy after the Institute for Healthcare Improvement’s Triple Aim for Populations Framework. This framework centers on quality improvement and system redesign to improve population health, enhance patient experiences of care and reduce health care costs. A fourth aim, provider satisfaction, was added to create the "quadruple aim.” In addition, we measured the usefulness of these data to inform the programs.
· Learn how to use numerous data sources to examine collective community impact
· Identify what works with vulnerable clients in community health and primary care Understand ways integration and partnerships can lead to addressing common system barriers and system transformation
503A: Indigenous Communities Walking Through Systems Change
Kathleen Lounsbury, MSN (C) Trinity Western University, Surrey, BC
Community Health Nurses (CHNs) and indigenous stakeholders are adjusting to the current policy changes for healthcare delivery for First Nations(FN) communities in British Columbia (BC) via the First Nations Health Authority(FNHA). Alongside this group is another cluster of CHNs informally mandated within the North West Territories (NWT)) to provide a more holistic and innovative approach to care. BC is 10 years ahead of NWT in the process of implementing a more community-driven, nation-based approach to health care delivery. Findings will inform those with vested interests, to evaluate ongoing partnerships and collaborations at all levels of service delivery for compliance to the affirmed commitments.
In this comparative qualitative study, CHNs and FN stakeholders in both regions were interviewed in person and via teleconferencing with a series of open-ended questions about how they were adjusting to the each of the systems change. Each subset of participants from BC and NWT had questions tailored to their interests.
· Beginning knowledge of how CHNs are adapting to systems change within an indigenous context.
· Growth experienced by CHNs and stakeholders in areas of adapting to systems change.
· Observe ways in which organizational change can be improved upon on the 'front lines' of care in an Indigenous context.
504A: What is the Leadership role for Community Health Nurses in Digital Health?
Susan Sepa, RN, BScN, MSc, CHE, CPHIMS-CA, Canada Health Infoway, Toronto, ON
Recent survey data about Canadians use of technology to monitor and manage their health is shared in this presentation, including Canadians viewpoints on the privacy and security of their personal health information (PHI). Results will include how many Canadians desire access, and how many actually do have access to information in their medical record, the ability to email their provider, book appointments online and to renew prescriptions on line. A number of studies provide evidence that the engaged and empowered patient results in better health outcomes and care experiences, as well as better utilization of scarce healthcare resources. How does the use and access to electronic views of clinical information such as lab results, on-line consultations with health care providers from the home, and the online ability to request a prescription renewal affect the role of nurses in these settings? The highlights from a national study on nurses use of technology will add to the discussion on the role of community health nurse as a navigator on behalf of their patients using electronic tools and solutions.
Canadian nurses are increasingly using electronic medical record solutions in their workflow, and are much more positive about the impact of this on improved quality of patient care and confidence in their skills. The greatest barrier continues to be that the majority of nurses work in hybrid paper and electronic environments requiring multiple log ins. These studies together are informative in advancing the nurses role in the community, and supporting their patients to use digital solutions to monitor and manage their health.
· Understand what digital health solutions Canadians expect to be able to access and use to monitor and manage their health.
· Understand the progress in Canada of Nurses use of technology in clinical workflow.
· Consider the impact of this new information about digital health on advancing the role of the community health nurse.
505A: Caring for a Healthy Canada: Can the Use of Champions and Coordinators Improve Outcomes in Home Visiting Programs?
Berni Candeloro, RN, BScN, Public Health Niagara Region, Niagara Falls, ON
Healthy Babies Healthy Children is a home visiting program which is designed to identify and support families with vulnerabilities that could compromise healthy child development. Evidence has demonstrated that outcomes for home visiting programs improve with use of a standard curriculum. Based on this evidence, Ministry of Children and Youth Services began a process to implement a suite of interventions that formed the backbone of a curriculum.
Methods: Through the use of multi-modal delivery of professional development resources including a key leadership position for a Master Trainer Coordinator, development of champions through extended roles, communities of practice, on-line and self-directed learning resources, PHNs have been supported in their learning and use of curriculum materials within home visiting services. Foundational to the delivery of professional development resources was the train the trainer model. The Master Trainer Coordinator role was developed as a component of the program to support Champions in their role to complete ongoing reliability processes.
Results/Conclusions: Results of reliability scores on standard tools continue to be consistently high within the province and remain high in comparison to a global sample. Participation in the monthly Community of Practice runs consistently at 80-90% which demonstrates a high level of knowledge and understanding of the materials as well as integration into practice. Early examination of program administrative data suggests a positive impact to family outcomes. This presentation will demonstrate actionable methods to address challenges to maintain a high level of reliable use of evidence in practice.
· Understand how the use of a multi-modal process has supported the implementation of evidenced based practice innovations in the home visiting context.
· Discuss the factors of leadership and relationship building to support professional development.
11:35am-12:00pm - 25 Minute Oral Presentations
501B: Mission Possible: Simulation in Community Health
Donalda Wotton, RN, MN, University of Manitoba, Winnipeg, MB, Christa Degagne, RN, BN, University of Manitoba, Winnipeg, MB, Rosemary Densmore, BPE, BEd, University of Manitoba, Winnipeg, MB
In 2017, faculty at the University of Manitoba were challenged to create three weeks of simulation experiences for the community health nursing clinical course offered in the final year of the bachelor of nursing program.
Little is written about simulation as a strategy to deliver clinical practice experience in community health nursing. Aspects of simulation seem foreign to the contextual aspects of community health nursing, however, other elements used in simulation are very applicable.
The creation and design of meaningful simulation learning experiences was based on the identification of learning that was needed to assist student who were entering nine weeks of community clinical practice. Following completion of the clinical practice component, two additional weeks of simulation was created with a focus on the key concepts of population health and leadership.
· Increase the knowledge of simulation as a learning strategy in community health nursing
· Disseminate information about specific examples of community health simulations
· Provide faculty and student perspectives about the use of simulation as part of a community health nursing practice course.
502B: Exploring the Complexity of Antimicrobial use by Poultry Producers through Situational Analysis: A One Health Approach to Facilitating Antimicrobial Stewardship
Megan Moore, RN, BSN, University of Saskatchewan, Saskatoon, SK
Threatening the advent of a post-antimicrobial era, antimicrobial resistance (AMR) is an adverse global health issue projected to account for 10 million deaths annually by 2050 if urgent action is not taken. While efforts have been made to address this issue in the human health sector, there is increasing evidence that antimicrobial (AM) use in food animals is another potential contributor to the spread and development of AMR across the human-animal interface. Within Canada nearly ¾ of AMs used in food animals are from the same classes as those used in human medicine. This signals cause for concern given that common resistant organisms causing infection in humans have been found in livestock, with some human infections sharing the same genes and plasmids as those found in food animals and retail meat. Community health nurses are in a unique position to demonstrate leadership in AMR efforts through a One Health approach that recognizes the complexity of factors contributing to the further spread and development of AMR.
To date there has been limited research exploring the current situation of Canadian food animal producer’s AM use, leading to an in-actionable Canadian AMR framework. A current situational understanding of the complexity, dynamic, and context of how Canadian poultry producers determine AM use is required to identify potential areas for action. Through situational analysis, I aim to examine the current situation of Canadian poultry producers, including attitudes and perceptions of information sources directing AM use and the multiple connections, relations, context, and historical elements influencing AM use. The findings will provide a point of reference in developing policy, guidelines, and interventions aimed at improving AM stewardship while also informing on the structural conditions impeding prudent AM use. By adopting a broader AMR view, nurses are well situated to demonstrate AMR leadership across the human-animal-environment interface.
· Understand the importance of a One Health approach when addressing antimicrobial resistance.
· Describe the current antimicrobial resistance trends in both humans and animals.
· Community health nurses are in a prime position to engage in antimicrobial resistance action across the human-animal interface.
503B: Bringing Baby Friendly (BCC, 2016) Guidelines to Faith Communities: An Inspiring Journey
Kate McCulloch, MSN, RN, CCHN(C), University of the Fraser Valley, Chilliwack, BC, Faith and Society Committee member, BC Synod of the Evangelical Lutheran Church, BC in Canada
The Baby Friendly Hospital Initiative was established in 1991 by the World Health Organization (WHO) and the United Nations Children Fund to address maternal and child health (Breastfeeding Committee of Canada, 2017). Canada adopted this initiative and renamed it the Baby Friendly Initiative (BFI) to reflect inclusion of hospital and community health services (BCC, 2017). Babies and young children have the right to feed whenever and wherever as needed; therefore, community services outside of health care also have a responsibility to create a welcome space for breastfeeding.
Guidelines for protecting, promoting and supporting breastfeeding in faith communities were established and shared among 49 parishes around the province of British Columbia (BC). The BC Synod of the Evangelical Lutheran Church in Canada (ELCIC) supported Baby Friendly (Breastfeeding Committee of Canada, 2016) guidelines that were created to enable places of worship within the BC Synod to welcome mothers to feed their babies and young children whenever and wherever needed. In addition, many of these gathering places welcome community members for daycare, music groups, non‐profit groups (e.g. Alcoholics Anonymous) and food pantries, and the guidelines would be displayed for their benefit as well.
· Recognize the significance of bringing the principles of the Baby Friendly Initiative to faith communities
· Compare and contrast the challenges of bringing Baby Friendly Initiative guidelines to health services and faith groups in the community
· Explore the values and beliefs in faith communities that are congruent with the Baby Friendly Initiative.
504B: The Role of Technology in Women’s Empowerment: A Scoping Review
April Mackey, RN, University of Saskatchewan, Regina, SK, Sandra Bassendowski, EdD, RN, University of Saskatchewan, Regina, SK
This presentation focuses on the key themes that emerged from a scoping review methodology for a Masters of Nursing thesis. The research question was as follows: What is the impact of information and communication technologies (ICTs) on the level of women’s empowerment?
The extant evidence explores how ICT has played a role in the promotion and support of women’s empowerment as well as supporting the development of policies and relevant programs. Improved uptake of ICTs can assist in providing women with employment resources and opportunities that could narrow the gender wage gap, promote education and health literacy via e-learning initiatives, and reduce the incidence of violence against women.
· Recognize the ways in which the use of technology within society can have significant social implications, specifically related to gender as a determinant of health.
· Formulate strategies that utilize emerging technologies to support women's empowerment in the community setting.
505B: Reaching Out-Meeting People Were They Are At
Debbie Rodger, RN, ACRN Saskatchewan Health Authority, Regina, SK
Saskatchewan currently has the highest rates of HIV per capita in Canada and some of the highest rates of Hepatitis C in the world and unknown numbers of undiagnosed due to lack of access to medical care and testing. In Regina an underserved population was noted in the North Central Neighbourhood. The population of the area has many unmet social determinants of health which includes transportation. Lack of transportation poses a barrier to accessing medical care including testing and diagnosis of HIV and HCV, services which is very limited within the confines of the neighbourhood. The NICHE project was developed to establish an outreach nurse in the neighbourhood that could provide a variety of services to the residents of the community. A steering committed was formed and goals were established. Goal one: Improve testing rates for HIV and Hepatitis C in the community with this population and ensure that negative results received post test and harm reduction counselling. Goal two: Those with HIV positive results were linked to care both in the community and in the clinic setting and for those who tested positve for Hepatitis C work up and treatment would be initiated in the community. The NICHE Project development is ongoing and at this point involves 3 sites with nursing support, phlebotomy support and the ability to fibrsocan those with Hepatitis C. Goal 3: All clients are entered in MedAccees Electronic Medical Record with a NICHE profile which wil provide a means to collect data and outcomes which can be measured by movement along the continuum of care. Goal four: Updating clients' immunizations by reviewing a client's immunization history and providing all necessary immunizations.
· The importance of engaging the at risk population.
· The benefits of providing multiple services in one location.
· How to develop a trusting relationship with a population at risk to promote the continuum Hepatitis C and HIV care including diagnosis, linkage and retention in care.