Canadians and their Nurses’ take on Health, and
Healthcare
Institute for Health and Social Policy
February 26, 2013
Cheryl Armistead RN, MScN
Ingram School of Nursing
Community Health Nurses of Canada
Sean Clarke RN, PhD, FAAN
Professor, Ingram School of Nursing
Director, McGill Nursing Collaborative for Educational Innovation in
Patient and Family-Centred Care with Kasha Mohr RN, BNI (c)

• 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

• ‘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

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

• 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

• 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 socioeconomic 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)

• 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

• 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.”

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

• “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.

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

• 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

• ‘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)

RPNs/LPNs
23%
Psych Nurses
1%
RNs
76%

• 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

• 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

– 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)

• 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 minoritylanguage/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

• 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

• 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

• 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 minoritylanguage/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

• 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

• 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