Intro to Health
Critical Social Theory:
- Refers to both a school of thought and a process of critique
- One of the fundamental beliefs underlying critical theory is that standards of truth or
evidence such as rules, habits, etc, are always created in a social context
- It is believed that no aspect of social phenomena may be comprehended unless it is
related to the historical whole and to the contextual structures that surrounds it
Phenomenology:
- Phenomenology and the significance of the lived experience is paramount to the nurse’s
understanding of the client
- Focuses on the relationship of the person in the world, not separate from it
- Phenomenology is the study of “being in the world”
- “world goes beyong the environment to include the meaningful sets of relationships,
practices, and language that we have by virtue of being born into a culture
Humanism:
- Based on the understanding that caring involves engaging in relationships that promote
self-discovery and self-actualization
- These relationships are based on an unconditional positive regard, empathic
understanding, and genuineness
- Humanism affirms the dignity, worth, uniqueness and potential of all people and the
tenets of this philosophy inform and guide nursing praxis
Feminism:
- Can be defined as a worldview that empowers and confronts systematic injustices
- Inherent injustices within societal, political, and economic structures limit and block
access to resources
- Historically, feminism explicated a societal reality of oppression against women but has
evolved to include issues related to both genders as well as marginalized groups
Post-colonialism:
- Colonial rule has shaped cultural forms and norms
- Indigenous cultures have been profoundly affected and influenced by the imposition of
social and spiritual norms of their colonizers
- Post-colonial perspectives attend to the social conditions related to colonization and
racism
- Informed nursing practice recognizes the consequent inequality perpetuated through
occupation and assimilation
Determinants of Health
Highlights from Chapter 1:
-
Perception of health influenced nursing and healthcare practices
Nature of health: Is multi-dimensional, contextual, and revolves around its interrelationship with disease, illness, and wellness
Disease: An objective sate of ill health
Illness: A subjective experience of loss of health
Health: An objective experience
Wellness: A subjective experience
Health:
- A central concept in nursing practice
- Perception of health influence nursing and healthcare practices
- Health is:
o A complete state of physical, mental, and social well-being, and not merely the
absence or disease or infirmity
Ottawa Charter for Health Promotion – WHO
- Health is a resource for everyday living, not the object of living
Community Health Nurses of Canada:
- View health as a dynamic process of physical, mental, spiritual, and social well-being
- Health includes self-determination and a sense of connection to the community
Approaches to Health in Canada:
Medical Approach: Emphasizes that medical intervention restores health
- Focus is on the treatment of disease:
- Health concerns linked to physiological risk factors
Behavioral Approach: Shift in the 1970’s with the Lalonde Report in Canada
- Medical approach alone was thought to be inadequate
- Report included determinants such as lifestyle, environment, human biology, and the
organization of health care
- Lifestyle factors become a prominent focus
- The responsibility for health is placed on the individual
- Health promotion – increase activity or quit smoking
Health:
Socio-Economic Approach: 1980’s shift
- Limitations of lifestyle focus emerges
o Studies showed that lifestyle improvements were made primarily by welleducated, well employed, and higher income Canadians
- Health is closely tied to social structures
o Poverty and unhealthy physical and social environments
1980’s Ottawa Charter:
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Identified prerequisites for health as peace, shelter, education, food, income, a stable
ecosystem, sustainable resources, social justice, and equity
Included “social, environmental and political contexts”
Focused on social justice and equity – incorporated the concept of empowerment
Health Promotion and Disease Prevention:
- Health Promotion: Directed toward increasing the level of well-being and actualization
o Focus on empowering people and changing current conditions to improve health
- Disease Prevention:
o Action to avoid illness or disease
- Both health promotion and disease prevention take a more proactive approach to
health
Social Determinants of Health:
- The conditions in which people are born, grow, live, work, and age, including the health
system
- These circumstances are shaped by the distribution of money, power, and resources at
global, national, and local levels, which are influenced by policy choices
- Are mostly responsible for health inequities – the unfair and avoidable differences in
health status seen within and between countries
Determinants of Health:
1. Income and Social Status:
2. Social support networks:
3. Employment/working conditions/job security:
4. Social environments:
5. Healthy child development
6. Biological and genetic endowment
7. Gender
8. Culture
9. Physical environments
10. Individualized health practices and coping skils
11. Health services
Social Determinants of Health:
1. Disability:
2. Early childhood development:
3. Education:
4. Employment and working conditions:
5. Food insecurity:
6. Gender:
7. Geography:
8. Globalization:
9. Health services:
10. Housing:
11. Income and income distribution:
12. Indigenous ancestry:
13. Race:
14. Social exclusion:
15. Social safety net:
16. Unemployment and job security:
Population Health:
- An approach to health that aims to improve health of an entire population and to
reduce health inequities among population groups
- In order to reach these objectives, it reviews and acts upon the broad range of factors
and conditions that have a strong influence on our health
Week 3: Family and Family Nursing
Family:
- A set of relationships that each client identifies as family or as a network of individuals
who influence each other’s lives regardless of whether actual biological or legal ties exist
- Each person has an individual definition of whom or what constitutes a family
- Respect for autonomy and diversity
- Meaningful relationships promote health
-
-
Historically defined as traditional or nuclear
No universally accepted definition
Highly individualized
Set of relationships:
o Biological entity:
o Legal entity:
o Social network:
o Degree of influence on individual’s health
Members can be humans or non-humans
Family is a central institution in society
Functions to reproduce, protect, support, nourish, and socialize
Family: Theories:
- Many theories make up the specialized body of knowledge of family health nursing. No
one theory is sufficient
- Theories provide:
o A frame of reference
o Inform and guide practice within the context of health promotion
o Examples:
 Systems theory:
 Structural-functional (Calgary Family Assessment Model) – CFAM
 Developmental Life Cycle Theory
Healthy Families:
- A healthy is able to integrate the need for stability with the need for growth and change
- Resilience and hardiness
o Resilience:
 Ability to cope with expected and unexpected life events
 View is to survive but grow from the life event
 Thrive in change
o Hardiness:
 Has effective strengths to maintain its stability, roles, and perspectives of
a healthy well-being
 View change as positive
 Active involvement in coping
- Flexibility
- Adaptation
- Communication
- Foundational beliefs and values
Characteristics of a Healthy Family:
- Communicates well and listens to all others
- Respect for other
- Have a sense of trust
-
Plays together
Interacts with each other with balance
Shares a sense of responsibility
Has traditions
Opens its boundaries to admit and seek help
Flexible structure
Relies on intrinsic and extrinsic resources
Control over its context
Family Nursing:
- Based on the assumption that every person, regardless of age, is a member of some
type of family form and carries family experiences that have profound influences on
their lives and approaches to healthcare
- Individuals are best understood within the context of the family
- A change in one member, affects other family members
- Goals of family nursing: To promote and support health and well-being
Approaches to Family:
- As a system:
o Family as client with an interactional component
o Focus is on the interactions
o Individual and family cared for simultaneously
- As a component of society:
o Viewed as one of many institutions in society
- Family as Context:
o Explore the health of an individual client within the environment of a family
o Traditional fopcus of nursing
o Family can either be a resource or a stressor the client (or both)
- Family as client:
o Focus is the entire family unit and its structure, function, and development
o Family is the foreground and the individual is the background
o Family is the sum of individual family members
o Explore relationships within the whole
o What issues are family issues
o How does the family support the health of everyone
o Support for healthy communication
o Support capacity
o Referrals for family therapy (boundaries)
Family Health Assessment:
- Definition: Exploration between the nurse and the family to gain insight into the family’s
perspective of health and well-being
- Purpose:
o Identify the level of engagement
o Establish the boundaries of therapeutic relationship
o Help identify gaps in family health
o Help identify strengths to re-establish family health
o Help identify intrinsic and extrinsic resources
Decision Making Framework:
- “Coming to know” the family (the lived experience)
- Determine what is “salient” to the family: Needs/priorities
Gordon’s Functional Health Patterns:
- Individual, family, community
Family Assessment Models:
Calgary Family Assessment Model (CFAM)
- Is relational
- Focused on strengths
- Guides nurses in a comprehensive family assessment
- International recognition and adopted by Schools of Nurses around the world
- 3 Major Categories of Family Life:
o Structural
o Developmental
o Functional dimensions
1. Friedman Family Assessment Model
2. McGill Model
Family: Conducting a Family Health Assessment Interview:
- Being present (engagement and termination)
o Acknowledge all members
o Use appropriate verbal and non-verbal cues
o Attend to members verbal and non-verbal cues
o Obtain informed consent
o Being flexible, individualize the interview
- Use a conceptual framework: Decision-Making Framework
o Use open-ended questions in a conversational style manner
o Document
- Genogram:
o Develop your own genogram, based on your structure
o Integrate 3 generations of family
o Include name or initials, age or year of birth, year of death if relevant, year of
marriage and divorce if relevant, health challenges
o Use lines to show connections
o Follow guidelines in Canadian Fundamentals Textbooks
- Value of Genogram:
o With a better understanding of own family, can better understand and assess
other families. Broadens awareness of different types of families, and their
structure
Week 4