CAMEXUS Online Course
Canadian Content
Course Introduction
Welcome to the Canadian CAMEXUS theory course. This interactive online course
will provide an introduction to the health care delivery system and nursing roles in
Canada. The course content is structured within 6 learning objectives:
1. Compare and contrast the nursing organization structure and health care delivery
system in Canada, Mexico and the United States.
2. Analyze and discuss the role and scope of professional nursing practice in the
three countries.
3. Compare and contrast the cultural, ethical, political and economic issues involved
in providing nursing care in Canada, Mexico and the United States.
4. Recognize and discuss specific health care beliefs and values held by people in
the three countries.
5. Discuss the current and future roles of nursing in the three countries.
6. Identify and analyze cultural factors impacting the nurse’s role in client advocacy
in the three countries.
Each learning objective/section will be comprised of written information, Internet links
that provide pertinent information on the topic, additional readings and/or related
activities. At the beginning of each learning objective, you will be asked to post a
response to a discussion question related to the content in that section.
Overview of Canada – Geography and Population
Canadian Geography and General Facts
Canada occupies 41% of the northern part of North America and is the second largest
country in the world in total land mass (9,984,670 km2) (Natural Resources Canada
[NRC], 2006). It is bordered by the Arctic Ocean to the north, the Atlantic Ocean to the
east, the United States to the south and the Pacific Ocean to the west. Canada is
comprised of 13 provinces and territories and has two official languages: English and
French. Follow this link to find an interactive map of Canada that outlines the
provinces/territories and boundaries. Click on each province/territory to reveal the main
cities in each area.
http://atlas.nrcan.gc.ca/site/english/maps/reference/national/politicaldivisonsinteractive
The current population of Canada is approximately 36.2 million people. It is estimated
that 72% of the population lives within 150 kilometres of Canada’s southern border and
about 80% of the population lives within an urban setting. This leaves the majority of
Canada’s territory as sparsely populated wilderness (Statistics Canada [SC], 2007).
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Canadian Demographic Trends
There are a number of demographic trends that affect the Canadian population statistics
and also influence the health care delivery system. The first is the rapidly growing aging
population as a result of the ‘Baby Boomer’ generation reaching the age of 65 and of
increasing life expectancy in general. This trend presents challenges in terms of a decline
in the number of working age individuals, as well as an increased weight on support
systems, such as health care (SC, 2005). Follow this link to discover more about the
ageing population trend in Canada:
http://www.statcan.ca/Daily/English/051215/d051215b.htm
A second trend that impacts the Canadian population is the growth rate of Canada’s
Aboriginal peoples. The Aboriginal peoples of Canada include the Indian (First Nations),
Inuit and Métis peoples. These distinct groups have unique heritages, languages, cultures
and health issues. In the 2006 Canadian census, Aboriginal peoples accounted for 3.8%
of the Canadian population (1.17 million), up from 3.3% in 2001 and 2.8% in 1996. This
represents a growth rate of 45% compared to a growth rate of 8% for non-Aboriginal
groups. Reasons for increased growth of this segment of the population include a high
birth rate and more individuals identifying themselves as an Aboriginal person (Statistics
Canada, 2008). The following link further describes the growing aboriginal population
and the quality of life challenges that they face:
http://www41.statcan.ca/2007/10000/ceb10000_000_e.htm
The final population trend worthy of mention is the growing number of immigrant people
to Canada. Data from the 2006 Census show that the proportion of Canada's population
who were born outside the country reached its highest level in 75 years. The census
enumerated 6,186,950 foreign-born in Canada in 2006. They represented virtually one in
five (19.8%) of the total population, the highest proportion since 1931. Overall, Canada's
total population increased by 1.6 million between 2001 and 2006, a growth rate of 5.4%.
Newcomers who arrived in Canada between January 1, 2001 and May 16, 2006 were
responsible for 69.3% of this population growth (Statistics Canada, 2007). The following
Statistics Canada link provides further information on Canada’s immigrant population:
http://www41.statcan.ca/2007/30000/ceb30000_000_e.htm
Now click on this link to test your knowledge of the location of the Canadian provinces
and territories: http://www.lizardpoint.com/fun/geoquiz/canquiz.html
Now complete this short on-line quiz about Canadian demographics:
http://www.canadiangeographic.ca/atlas/Quizzes.aspx?ID=WHERE_QUIZ&lang=En
References:
Natural Resources Canada. (2006, July 27). Significant Canadian Facts. Retrieved July 9,
2008 from http://atlas.nrcan.gc.ca/site/english/learningresources/facts/supergeneral.html
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Natural Resources Canada. (2004, April 18). Political Divisions. Retrieved July 9, 2008
from
http://atlas.nrcan.gc.ca/site/english/maps/reference/national/politicaldivisonsinteractive
Statistics Canada. (2007, September 7). Population. Retrieved June 20, 2008 from
http://www41.statcan.gc.ca/2007/3867/ceb3867_000_e.htm
Statistics Canada. (2005, December 15). Population Projections. Retrieved June 20, 2008
from http://www.statcan.ca/Daily/English/051215/d051215b.htm
Statistics Canada. (2008, January 15). Aboriginal Peoples in Canada in 2006: Inuit, Métis
and First Nations, 2006 Census. Retrieved June 20/08 from
http://www.statcan.ca/Daily/English/080115/d080115a.htm
Statistics Canada. (2007, September 7). Ethnic Diversity and Immigrants. Retrieved June
20/08 from http://www41.statcan.ca/2007/30000/ceb30000_000_e.htm
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Learning Objective #1
Compare and contrast the nursing organizational structure and health care delivery
systems in Canada, Mexico and the United States.
Discussion question: What are your beliefs about the health care system in
Canada?
Text Reading: Storch, J. (2003). The Canadian health care system and Canadian nurses.
In McIntyre, M & Thomlinson, E. (Eds.), Realities of Canadian nursing: Professional,
practice and power issues. (pp. 34-59). Philadelphia Lippincott:Williams & Wilkins.
Canada’s Health Care System
Canada’s current health care system, known to Canadians as ‘Medicare’, has been a work
in progress since its inception in 1961. Reforms have been made over the past four
decades and will continue in response to changes within medicine and society in general.
The underlying premise, however, remains the same - universal coverage for medically
necessary health care services provided on the basis of need, rather than the ability to
pay. The Canada Health Act, the federal health insurance legislation, was introduced in
1984 to outline the Principles of Medicare, which are symbols of the underlying
Canadian values of equity and solidarity: public administration, comprehensiveness,
accessibility, universality and portability (Health Canada [HC], 2008). Refer to this
section’s reading for further information on these 5 underlying principles of Canada’s
health care system.
Economics
Canada's health care system is publicly funded and designed to ensure that all Canadian
residents have reasonable access to medically necessary hospital, physician and health
care services, on a prepaid basis via Canada’s tax base. Instead of having a single
national plan, Canada has a national program that is composed of 13 interlocking
provincial and territorial health insurance plans, all of which share certain common
features and basic standards of coverage (HC, 2008).
Roles and responsibilities
Roles and responsibilities for Canada's health care system are shared between the federal
and provincial-territorial governments. Health Canada, the federal government
department responsible for health, has a mandate to help Canadians maintain and
improve their health. Among other activities, Health Canada's responsibilities for health
care include setting and administering national principles for the health care system
through the Canada Health Act and delivering health care services to specific groups
(e.g., Aboriginal peoples). Working in partnership with provinces and territories, Health
Canada also supports the health care system through initiatives in areas such as health
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human resources planning, adoption of new technologies and primary health care
delivery. Visit Health Canada’s website for additional information on this agency’s role
in the health care of Canadians: http://hc-sc.gc.ca
The 13 provincial and territorial governments also have individual health departments
and are responsible for the management, organization and delivery of health services for
their residents. Under the Canada Health Act, criteria and conditions are specified that
must be satisfied by the provincial and territorial health care insurance plans in order for
them to qualify for their full share of the federal cash contribution, available under the
Canada Health Transfer (CHT) (HC, 2008). Browse the Manitoba Health website or the
Saskatchewan Health website for further information on the provincial health
departments:
http://www.gov.mb.ca/health
http://www.health.gov.sk.ca
The third level of health care administration in Canada is the establishment of regional
health authorities (RHA) within certain provinces. As an example, Manitoba is divided
into 11 regional health authorities all managed by independent boards, which are
responsible for operationalizing the delivery of quality health care services in their
regions. The RHAs receive their funding from the provincial government who is
ultimately responsible for ensuring the standards and quality of health services in each of
the provinces’ regions. Click on the following links for information on the Manitoba and
Saskatchewan Regional Health Authorities:
http://www.gov.mb.ca/health/rha/rhamap.html
http://www.health.gov.sk.ca/health-region-list
Health Care Delivery Settings, Issues and Challenges
Health Care Continuum: A variety of health care services are available to Canadians
and are provided by health care providers in a number of different settings. Primary
health care refers to the first level of care and the initial point of contact that a person has
with the health system. When Canadians need health care, they most often turn to
primary health care services. Examples include visits to family physicians, nurses and
nurse practitioners, telephone calls to health information lines, seeing mental health
workers and advice received from pharmacists (Health Canada [HC], 2006). Primary
care services are available to individuals to assist in prevention of illness, promotion of
health, address day-to-day health concern and provide chronic disease management.
For individuals who live in their homes and require assistance for nursing care, activities
of daily living and chronic disease monitoring and management, a number of communitybased health care services are available. These services, often known as ‘Continuing
Care Programs’ include;
 Home health care services provided by visiting nurses or health care assistants
e.g. Home Care,
 Out-patient clinics that facilitate access to physician specialists, physiotherapists,
occupational therapists, dieticians and other health care providers,
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

Public health programs including pre- and post-natal care, child health through
school programs and other wellness initiatives, and
Other support programs including home meal delivery and seniors’ support
programs.
For individuals who are no longer able to live independently in their own homes, there
are a number of supportive housing and long term care options available depending on a
person’s care needs and level of supervision and support they require. Personal care
(nursing home) services are available to qualified individuals and costs for these are
dependent on provincial funding guidelines and personal income. Refer to the following
websites for additional information on Manitoba and Saskatchewan personal care
services.
http://www.gov.mb.ca/health/personalcareservices/index.html
http://www.health.gov.sk.ca/personal-care-homes
For emergent or acute illnesses, available acute care services include ambulance/EMS
(emergency medical services), emergency departments/urgent care (housed within
hospitals) and tertiary care and community hospitals.
Urban, Rural and Remote Settings: As most Canadians (about 80%) live in or close to
an urban area, health care services and specialities tend to be focussed in these urban
settings. Health care providers working within these settings tend to be specialized in
certain areas of care.
For the remaining 20% of the population who live in rural and remote northern settings,
access to some health care services may be limited or unavailable due to the lack of
resources in their home area. This may require travel to larger centres to obtain access to
certain health care services, which can be limiting or difficult for more isolated or infirm
individuals. Health care providers who work in rural and remote northern settings may
not be as specialized in certain areas as their urban counterparts and act as a health care
‘jack of all trades’, as there are fewer people to provide health care services.
Patient-Centred Care: Over the past number of years, the culture of ‘patient-centred
care/practice’ has become one of the cornerstones of health care provision in Canada.
Collaborative patient-centered care enhances patient-, family-, and community-centred
goals and values, provides mechanisms for continuous communication among caregivers,
optimizes staff participation in clinical decision-making (within and across disciplines),
and induces respect for the contributions of all disciplines, including patients’
contributions to their own care (Health Canada, 2005). From a care-level perspective,
this means involving the patient/client/resident and family in all levels of careplanning,
from developing realistic health goals to implementation and evaluation of the outcomes.
Waiting for Services and Waitlist Management: Although the principles of Medicare
support that all Canadian residents have equal access to needed medical services, timely
access to certain services, specifically cancer, heart, diagnostic imaging, joint
replacement and sight restoration services, has become a significant issue in Canada
(Health Canada, 2007). Refer to this Health Canada link to learn more about Canada’s
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waitlist issue and what national and provincial initiatives are in place to help address the
concerns.
http://www.hc-sc.gc.ca/hcs-sss/qual/acces/wait-attente/index-eng.php
Canadian Nursing Organizational Structure
In Canada, there are three separate types of nursing organizations that are in place to
support nursing practice and address nursing practice issues. At the national level, the
Canadian Nurses Association (CNA) is a professional nursing organization that was
established in 1908 with the mandate to speak/advocate on behalf of the profession and to
protect the public. The CNA is affiliated with the International Council of Nurses (ICN)
and is a federation of provincial and territorial nursing associations. The CNA’s
activities include; influencing health and public policies, articulating nurses’ viewpoints
on nursing and health-related issues, supporting nursing research and addressing nursing
workplace and human resource issues (Rodger, 2003). Click on this link to read the CNA
Mission and Value Statement:
http://www.cna-aiic.ca/CNA/about/mission/default_e.aspx
At the provincial and territorial level, nursing professional associations and colleges
exist. In Canada, the provincial and territorial governments have delegated the right of
self-regulation to the nursing profession. Similar to other health care professions, nurses
are entitled to collective professional autonomy. This means that, with appropriate public
input through the association/college boards, the profession governs itself. The role of
the provincial/territorial nursing associations/colleges is protection of the public, which
makes regulation of nursing practice in their province/territory their main function
(Brunke, 2003; Rodger, 2003). The topic of provincial/territorial nursing regulation and
scope of practice will be discussed further under learning objective #2.
A third type of nursing organization in Canada is nursing unions. In most situations,
unions act on behalf of many Canadian nurses to negotiate working conditions and
remuneration. Through the process of collective bargaining, a collective agreement is
produced which provides a contract of employment between a group of nurses and an
employer. Nursing unions and collective bargaining usually occur at the
provincial/territory level. However, the Canadian Federation of Nurses Union (CFNU)
includes representatives from each of the provincial member unions. The CFNU
provides a national voice for the concerns of Canadian nurses and a support for provincial
nursing unions. Nursing unions are separate from nursing associations and colleges as
described above, as their mandate does not include regulation of the profession (McIntyre
& McDonald, 2003).
Website Search Activity
Using the following websites, find answers to the questions below;
www.hc-sc.gc.ca - Health Canada
www.cna-aiic.ca - Canadian Nurses Association
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1. Name 5 examples of health-related information for the public available on the
Canada Health website.
a.
b.
c.
d.
e.
2. An important health issue from CNA’s perspective is the promotion of healthy
aging. Name three activities that the CNA is undertaking to address this issue.
a.
b.
c.
References
Brunke, L. (2003). Canadian provincial and territorial professional associations and
colleges. In McIntyre, M & Thomlinson, E. (Eds), Realities of Canadian nursing:
Professional, practice and power issues. pp. 143-160. Philadelphia: Lippincott,
Williams & Wilkins.
Canadian Nurses Association. (2008). Vision and Mission. Retrieved July 12, 2008 from
http://www.cna-aiic.ca/CNA/about/mission/default_e.aspx
Government of Manitoba. (2002, July 1). Map of Manitoba's Regional Health
Authorities. Retrieved July 12, 2008 from http://www.gov.mb.ca/health/rha/rhamap.html
Government of Manitoba. (2008). Personal Care Services. Retrieved July 12, 2008 from
http://www.gov.mb.ca/health/pcs/index.html
Government of Saskatchewan. (2008). Retrieved on July 12, 2008 from
http://www.health.gov.sk.ca/health-region-list
Government of Saskatchewan. (2007). Personal Care Home. Retrieved July 12, 2008
from http://www.health.gov.sk.ca/personal-care-homes
Health Canada. (2008, June 18). Health Care System. Retrieved July 9, 2008 from
http://www.hc-sc.gc.ca/hcs-sss/index-eng.php
Health Canada. (2006, May 8). Primary Health Care. Retrieved July 12, 2008 from
http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2003accord/primaryprimaire-eng.php
Health Canada. (2005, January 5). Collaborative Care. Retrieved July 12, 2008 from
http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/collabor/index-eng.php
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Health Canada. (2007, May 25). Wait Times in Canada. Retrieved July 12, 2008 from
http://www.hc-sc.gc.ca/hcs-sss/qual/acces/wait-attente/index-eng.php
McIntyre, M. & McDonald, C. (2003). Unionization: Collective bargaining in nursing. In
McIntyre, M & Thomlinson, E. (Eds), Realities of Canadian nursing: Professional,
practice and power issues. pp. 322-337. Philadelphia: Lippincott, Williams & Wilkins.
Rodger, G. L. (2003). Canadian nurses association. In McIntyre, M & Thomlinson, E.
(Eds), Realities of Canadian nursing: Professional, practice and power issues. pp. 124142. Philadelphia: Lippincott, Williams & Wilkins.
Storch, J. (2003). The Canadian health care system and Canadian nurses. In McIntyre, M
& Thomlinson, E. (Eds.), Realities of Canadian nursing: Professional, practice and
power issues. (pp. 34-59). Philadelphia Lippincott:Williams & Wilkins.
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Learning Objective #2
Analyze and discuss the role and scope of professional nursing practice in the three
countries.
Discussion question: Reflect on the nursing role and scope of practice in your
state/country. How do you think this differs from the nursing role and scope of
practice in Canada?
Canadian Nurse Credentialing and Registration
To be eligible to practice as a Registered Nurse in Canada, nurses must;



Complete an approved nursing education program,
Write and pass the Canadian Registered Nurses Exam (CRNE), which is
developed and administrated by the CNA, and
Pay the registration fees and register through the nursing association/college
in the province or territory where they will be working as a nurse.
In Canada, the authority to regulate the nursing profession is through provincial/territorial
legislation. The provincial/territorial association/college has the authority to determine;







Standards of education or qualifications for members
Standards of practice
Use of the R.N. title
Scope of practice
Professional discipline
Approval of education programs for entry to the profession
Continuing competence requirements for members (Brunke, 2003).
The provincial/territorial associations/colleges also oversee the requirements for
registration of Nurse Practitioners. This expanded practice nursing role will be discussed
further under Learning Objective #6.
Below are the links to the professional nursing associations in Manitoba and
Saskatchewan. Browse through the website of your province of choice and learn more
about how these organizations manage these responsibilities.
Manitoba College of Registered Nurses – www.crnm.mb.ca
Saskatchewan Registered Nurses’ Association – www.srna.org
Scope of Nursing Practice
The scope of nursing practice is established within the provincial/territorial nursing
legislation. Refer to Part 2(1) – The Practice of Nursing, in The Registered Nurses Act of
Manitoba http://www.crnm.mb.ca/downloads/act.pdf or Section 2 - Interpretation 2(k), in
The Registered Nurses Act of Saskatchewan
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http://www.qp.gov.sk.ca/documents/English/Statutes/Statutes/R12-2.pdf for the defined
scope of nursing practice in these provinces. The Acts define the scope of practice in
general terms, therefore, associations/colleges have Nursing Practice Consultants who are
available to answer members’ questions about whether particular activities fall within the
nursing scope of practice.
Standards of Nursing Practice
Another important role of the provincial/territorial associations/colleges is the
development of standards of practice for their members. These standards of practice are
typically developed through a committee or working group of association/college
members and are then accepted by the board of directors. It is important that every
practicing nurse is aware of these Standards of Practice, as performance and behavior are
measured against them. Click on the following links to read the Standards of Practice set
out for Manitoba and Saskatchewan Registered Nurses:
http://www.crnm.mb.ca/downloads/standardsofpractice_web.pdf
http://www.srna.org/about/ends_standards_codes.pdf
Nursing Education and Entry-to-Practice Standard
In Canada, educational qualifications for entry-level RNs is an issue that has been
debated since the early days of organized nursing. At a policy level, the CNA supports
the position that a baccalaureate degree is the minimum education level required for entry
to practice (Canadian Nurses Association, 2004). This policy statement can be accessed
at the following link: http://www.cnaaiic.ca/CNA/documents/pdf/publications/PS76_educational_prep_e.pdf
Most nursing organizations in Canada have moved to this standard, with a few exceptions
where diploma programs have been maintained to assist with nursing workforce
shortages (Dick & Cragg, 2003).
Accerlated baccalaureate nursing programs is a trend in nursing education that has
appeared over the past number of years. In 1993, the first accerlerated program opened
in Canada. By 2004, the number of accerlated nursing programs had grown to 31. These
programs are comprised of the standard four-year baccalaureate cirruculum that is
compressed over a shorter period of time, typically between 2 to 3 years. These
programs are geared to students who already have completed or partially completed a
non-nursing undergraduate degree and wish to complete their nursing education in a
shorter time frame in order to join the workforce faster (Ouellet & MacIntosh, 2007).
Website Search Activity
1.
Based on the CNA position statement on educational preparation for entry to
practice (link above), summarize their rationale for supporting a baccalaureate
degree as the minimum education standard:
__________________________________________________________________
__________________________________________________________________
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__________________________________________________________________
__________________________________________________________________
2.
Using either the Manitoba or Saskatchewan professional association/college
website as a reference (links above), briefly describe what a Continued
Competency Program is and how the provincial association/college ensures the
continuing competency of its members:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
References
Brunke, L. (2003). Canadian provincial and territorial professional associations and
colleges. In McIntyre, M & Thomlinson, E. (Eds.), Realities of Canadian nursing:
Professional, practice and power issues. pp. 143-160. Philadelphia: Lippincott,
Williams & Wilkins.
Canadian Nurses Association. (2004, June). Retrieved July 22, 2008 from
http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS76_educational_prep_e.pdf
College of Registered Nurses of Manitoba. (1999, July 14). The Registered Nurses Act.
Retrieved July 21, 2008 from http://www.crnm.mb.ca/downloads/act.pdf
College of Registered Nurses of Manitoba. (2004, September). Retrieved July 21, 2008
from http://www.crnm.mb.ca/downloads/standardsofpractice_web.pdf
Dick, D.D. & Cragg, B. (2003). Undergraduate education: Development and politics. In
McIntyre, M & Thomlinson, E. (Eds.), Realities of Canadian nursing: Professional,
practice and power issues. pp. 182-204. Philadelphia: Lippincott, Williams & Wilkins.
Government of Saskatchewan. (1988, September 15). Retrived July 21, 2008 from
http://www.qp.gov.sk.ca/documents/English/Statutes/Statutes/R12-2.pdf
Ouellet, L.L. & MacIntosh, J. (2007). The rise of accerlerated baccalaureate programs.
Canadian Nurse, 103(7), 28-31.
Saskatchewan Registered Nurses Association. (2007, October). Retrieved July 21, 2008
from http://www.srna.org/about/ends_standards_codes.pdf
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Learning Objective #3
Compare and contrast the cultural, ethical, political and economic issues involved in
providing nursing care in Canada, Mexico and the United States.
Discussion Question: Identify one important issue that you feel affects nursing
practice in Canada. Why do you think this is an issue and how do you feel it affects
nursing practice?
Text Readings:
McIntyre, M. & McDonald, C. (2003). Issues arising from the nature of nurses’ work. In
McIntyre, M & Thomlinson, E. (Eds.), Realities of Canadian nursing: Professional,
practice and power issues. pp. 288-303. Philadelphia: Lippincott, Williams & Wilkins.
McIntyre, M. (2003). The workplace environment. In McIntyre, M & Thomlinson, E.
(Eds.), Realities of Canadian nursing: Professional, practice and power issues. pp. 304321. Philadelphia: Lippincott, Williams & Wilkins.
Nursing Issues in Canada
Information regarding the cultural, ethical, political and economic issues impacting
nursing care in Canada will be discussed under the following:
 Ethical considerations
 Workplace issues
 Workforce issues
Ethical Considerations
In Canada, the CNA has developed a Code of Ethics for Registered Nurses, which has
been recently updated in 2008 (CNA1, 2008). The Code of Ethics can be viewed or
downloaded at the following link.
http://www.cna-aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf
The Code of Ethics for Registered Nurses serves as a foundation for Canadian nurses’
ethical practice. Along with provincial/territorial professional standards, laws and
regulations that guide practice, it provides guidance for ethical relationships,
responsibilities, behaviours and decision-making. The code serves as a means of selfreflection, provides a basis for feedback and peer review and also acts as an ethical
foundation from which nurses can advocate for quality work environments that support
the delivery of safe, compassionate, competent and ethical care.
The code is organized into two parts. The specific values and ethical responsibilities
expected of Registered Nurses in Canada are set out in Part I, through seven values and
associated responsibility statements. Endeavours that nurses may undertake to address
social inequities as part of ethical practice are outlined in Part II (CNA, 20082; CNA
20083).
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Ethics Case Study:
Review the following scenario, then using the CNA Code of Ethics document (link above),
answer each question below and identify which of the 7 ethical principles is/are relevent
to your answer.
A student nurse was assigned to a medical unit during her clinical rotation. She was
approached by her RN team leader and instructed to give an antibiotic to one of the
patients on the unit. The student nurse immediately obtained the antibiotic and
administered it. However, she gave the antibiotic to the wrong patient.
When the mistake was discovered, the RN team leader refused to write an incident report,
because she asserted that the patient who received the wrong medication was taking
antibiotics anyway, so there was no problem. The doctor was not notified and the
medication administration was not changed to reflect the error. Another dose of the
antibiotic was administered to the right patient.
Questions:
Should the incident have been reported?
Should the patient who received the extra dose have been informed of the mistake?
Should the student nurse have reported the error herself?
Workforce Issues
The workforce issues that will be discussed here include the nursing shortage, working
within interdisciplinary teams and a multi-cultural nursing workforce. Further
information on nursing workforce and workplace issues can be found in this section’s
readings.
Canada’s Nursing Shortage
Based on a 2002 study by the CNA, if we continue with past workforce utilization
patterns, Canada will experience a shortage of 78,000 RNs by 2011 and 113,000 RNs by
2016. These shortages are attributed to a combination of factors (CNA, 20084).
1.
Increasing demands of nursing services: The Canadian population’s health needs
create the demand for preventative and treatment-oriented services. As
mentioned in the course introduction, Canada’s population of older adults is
steadily increasing, and many older Canadians are living with multiple chronic
diseases. This has resulted in a steady increase in the acuity and complexity of
patient care, as when these individuals become ill, their nursing care is very
challenging. Also, there is much research to suggest that social determinants of
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health have an overwhelming influence on health status and utilization of health
and nursing services. Some of these determinants of health include poverty,
stress, social exclusion (particularly for non-European immigrant and Aboriginal
persons), employment and job security, social support and food security (CNA,
2005). The CNA information statement on social determinants of health and
nursing in Canada further discusses the challenges we face in Canada relating to
determinants of health:
http://www.cnaaiic.ca/CNA/documents/pdf/publications/BG8_Social_Determinants_e.pdf
2.
Recruitment and retention of qualified nurses: Similar to other countries, Canada
is experiencing a shortage of qualified nurses to work within the health care
system. This shortage can be attributed to a number of factors;
a. Governmental policy changes in the 1990’s, which eliminated RN positions
and converted many full-time positions to part-time. This resulted in an
increase in nursing workload, frustration and burn out, which in turn caused
many nurses to leave the country or the profession.
b. Decreased funding for nursing education programs resulting in a reduction of
nursing graduates by nearly one half between the early 1990’s and 2000 (from
9,000 to approximately 5,000). Recent data indicates that in the 2006-2007
educational year, the number of nursing graduates has now risen to 9,447.
However, it is estimated that 12,000 graduates (a 27% increase) annually are
needed to meet the increasing demands (CNA, 20085).
c. Similar to Canadian population trends, the nursing workforce continues to
age. In 2005, it was estimated that the average age of an employed RN was
44.7 years. It is anticipated that over the next 15 years, one half of current
working nurses will exit the workforce (CNA, 2002; CNA 2006).
3.
Health care system design: The design of the health care system must evolve to
meet the changing needs of the population’s health care requirements. Without
changing the past nursing utilization patterns, the recurrent shortage of nursing
services will continue. In response, governments and health care administrators
have been moving forward with alternative care delivery models that enhance
primary care services/access and include expanded nursing roles, such as the
primary care nurse practitioner. Also, is has been recommended that health care
disciplines work collaboratively to review overlapping areas of scope of practice
to ensure that all health care providers are utilized to their full potential (CNA,
20052).
Website Search Activity
Based on the CNA’s position statement on National Planning for Human Resources in
the Health Sector, name 3 aspects of their proposed framework that you feel will make
the most impact on addressing the nursing shortage in Canada. Why do you feel these
will have an impact?
http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS81_National_Planning_e.pdf
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1.
2.
3.
Interdisciplinary Teams
In most health care settings, be it acute, community or long-term care in either
urban or rural settings, nurses must work with other health care disciplines within an
interdisciplinary team environment. Depending on the setting and available resources,
these teams may be comprised of a nurse, health care aid/assistant, physician, dietician,
social worker, physiotherapist, occupational therapist, pharmacist, recreation
coordinator/therapist or spiritual care advisor. The patient/resident/client is the focus of
the team and an integral member, with the interdisciplinary members acting a resource to
find the best possible outcomes and options to restore or maintain the individual’s health.
As the nurse is the person in most consistent contact with patients/residents/clients, they
often function as the coordinator or ‘air traffic controller’ of the team process, ensuring
that team members are involved as needed and that communication and team meetings
occur to discuss and develop the care plan and evaluate outcomes.
A Multi-cultural Workforce
Not unlike the general Canadian population, many members of the nursing and
other health-related disciplines are non-native Canadians and represent a number of
cultures from across the world, specifically Asian and South Pacific areas. In 2005, it
was reported that 7.6% of the nursing workforce (19,230 nurses) received their nursing
education internationally and had moved to Canada to work within the nursing field
(CNA, 2006). For many of these individuals, English is a second language and it is a
challenge they must face and overcome to work effectively in the Canadian health care
system. Most universities and colleges offer English-as-a-second-language (ESL)
courses, with some providing courses specifically geared to immigrant individuals
working within the health fields. These programs help ease the transition to the Canadian
health care workforce by providing assistance with potential language barrier issues.
Workplace Issues
Two workplace issues will be discussed here; healthy nursing practice environments and
informatics in the nursing workplace. Further information on nursing workplace issues
can be found in this section’s readings.
Healthy Practice Environments
As nursing workload increases and patient acuity continues to rise, the complexity
of nursing workplaces can have a negative impact on the ability to provide quality care
and maintain healthy practice environments. If this is not addressed, it may lead to
nurses feeling a lack of control over their work, not having the resources or support to
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care for their patients/residents/clients and a decline in job satisfaction (McIntyre, 2003).
Specific examples of issues that may impact a healthy practice environment include.
1.
Working in isolation or isolated settings, i.e., providing nursing visits to
homes in rural settings or working alone in a northern nursing station.
2.
Workplace safety concerns and access to appropriate protective equipment,
such as eyewear, gowns, gloves, safety-engineered needles, etc.
3.
Workplace violence, including verbal, emotional, physical abuse and sexual
harassment from patients/residents/clients and their family members and coworkers (MacIntyre, 2003).
As this issue is crucial to the effectiveness of the health care system and continued
provision of quality nursing care, the CNA has taken an active stance and interest in
promoting healthy practice environments for Canadian nurses. Refer to the CNA’s
information sheet on improving practice environments for further details on how this
issue can affect practice and patient care, what is being done about it and what can
individual nurses do to improve their workplace environment (CNA, 2007).
http://www.cnaaiic.ca/CNA/documents/pdf/publications/NN_Improving_Practice_Environments_2007_
e.pdf
Nursing Informatics
The use of information and communications technology (ICT) in nursing practice
is an area that is steadily gaining momentum in Canada. In response to advances and
changes in society and the health care system, the CNA has developed an E-nursing
strategy for Canada (CNA, 20086). The following brochure briefly outlines the strategy
and directions:
http://cna-aiic.ca/CNA/documents/pdf/publications/Enursing-strategy-brochure-e.pdf
Some health care programs and facilities are further along the nursing informatics
highway than others. In Canada, many areas have transitioned to computerized health
record systems, which may include electronic entry of assessment data, progress notes
and physician orders. Other programs/sites may still be using a paper-based system.
Other examples of the use of ICT include telehealth patient consultations or
education sessions, where a remote community can access clinicians, specialists or
instructors who are sited long or short distances away via an audio/video link that enables
real-time interaction between both locations. A second example of remote access to
centrally-based clinicians is through various web-platform programs that allow nurses in
remote areas to enter on-line data (i.e., wound assessment information) that can be
viewed by a nurse specialist in a different location, who can then respond and provide
recommendations without the patient having to travel from their home.
Lastly, as part of the CNA’s E-nursing strategy, the NurseONE website was
launched recently. NurseONE is an interactive web-based resource that provides nurses
and nursing students with access to reliable, evidence-based information to assist with
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informed decision-making in nursing practice. Information is available on the website
for all nurses and Canadian nurses and nursing students are able to join as members and
access additional information and journal articles. A pilot program is taking place at the
University of Saskatchewan where the instructors are utilizing NurseONE in the
classroom as a replacement for traditional nursing textbooks (Bassendowski et al, 2008).
The NurseONE website address is www.nurseone.ca.
References
Bassendowski, S., Petrucka, P. Debs-Ival, S., Hall, A and Shand, S. (2008). Moving from
texts to portals: NurseONE in the classroom. Canadian Nurse 104, 5, 33.
Canadian Nurses Association. (2008, June). The CNA Code of Ethics for Registered
Nurses. Retrieved July 21, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf Canadian Nurses Association. (2008). Nursing Ethics. Retrieved July 23, 2008 rom
http://www.cna-aiic.ca/CNA/practice/ethics/code/default_e.aspx
Canadian Nurses Association. (2008). A revised code – The foundation for ethical
practice. Canadian Nurse, 104(6), 20.
Canadian Nurses Association. (2008). The Nursing Shortage – The Nursing Workplace.
Retrieved July 24, 2008 from http://www.cna-aiic.ca/CNA/issues/hhr/default_e.aspx
Canadian Nurses Association. (2008, June). Nursing Education in Canada Statistics.
Retrieved July 24, 2008 from http://www.cnanurses.ca/CNA/documents/pdf/publications/Education_Statistics_Report_2006_2007_e.p
df
Canadian Nurses Association. (2008). Better Health Care, Better Patient Outcomes: An
E-nursing Strategy. Retrieved July 24, 2008 from http://cnaaiic.ca/CNA/documents/pdf/publications/Enursing-strategy-brochure-e.pdf
Canadian Nurses Association. (2007, April). Improving Practice Environments: Keeping
up the Momentum. Retrieved July 24, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/NN_Improving_Practice_Environments_2007_
e.pdf
Canadian Nurses Association. (2006, October). 2005 Workforce Profile of Registered
Nurses in Canada. Retrieved July 24, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/workforce-profile-2005-e.pdf
Canadian Nurses Association. (2005, October). Social Determinants of Health and
Nursing. Retrieved July 24, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/BG8_Social_Determinants_e.pdf
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Canadian Nurses Association. (2005, November). National Planning for Human
Resources in the Health Sector. Retrieved July 24, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/PS81_National_Planning_e.pdf
Canadian Nurses Association. (2002, June). Planning for the Future: Nursing Human
Resource Projections. Retrieved July 24, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/Planning_for_the_future_June_2002_e.pdf
McIntyre, M. (2003). The workplace environment. In McIntyre, M & Thomlinson, E.
(Eds.), Realities of Canadian nursing: Professional, practice and power issues. pp. 304321. Philadelphia: Lippincott, Williams & Wilkins.
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Objective #4
Recognize and discuss specific health care beliefs and values held by people in the
three countries.
Discussion Question: Based on your current knowledge and readings to date about
Canadian citizens and the Canadian health care system, identify and discuss one
health care belief or value that you feel is important to Canadians.
Universal Access to Health Care
Although the health care system in Canada is not perfect, Canadians remain very
passionate about the importance of sustaining the Medicare system, which ensures
universal access to medically necessary health care services for all Canadians. This
belief forms a major underlying principle of our health care system. The Canadian public
also values publicly funded health care and the CNA, on behalf of all nurses in Canada,
provides support and lobbying activities around this important issue (CNA, 2008). Visit
the following link to learn more about CNA’s political advocacy role in maintaining
Canada’s universal access to health care:
http://www.cna-aiic.ca/CNA/issues/matters/default_e.aspx
In 2002, the Government of Canada released a commission report (known to Canadians
as the Romanow Report) that outlined a framework to sustain Canada’s health care
system for future generations. At the top of the list, echoing Canadians’ beliefs, the
report supported the continuation of a publicly funded health care system. The report
confirmed that there is no credible evidence linking for-profit health care delivery to
improved efficiency and outcomes. In fact, the Canadian experience had demonstrated
that a publicly funded system is more responsive to changes in health care needs (CNA,
2002).
Value Collective over Individual
Following from the theme in the above section, the publicly funded Canadian health care
system is based on the belief that what is good for the many is better than what is good
for one. Even if a person or their family do not require health care services at a given
time, it is there for others in need and will be there if needed in the future. In essence,
Canadians believe that by having a publicly funded system paid via the taxation base,
individuals do not need to be fearful about access to health care services or potentially
devastating costs due to an illness or surgery (Storch, 2003).
The Consumerism and Advocacy Movement
A consumer is generally thought to be a person who purchases or uses goods or services.
Consumers have the right to receive the full goods and services promised or purchased
and they also have a responsibility to be well informed about the goods and services they
are receiving. In Canada, the Consumers’ Association of Canada, along with the
Canadian Nurses Association and the Canadian Medical Association, successfully
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lobbied for the passage of Canada’s Health Act and universal Medicare. Consumer rights
in health care were defined as early as the 1970’s and formed the beginning of the health
care consumer movement in Canada. These included the right to:
 Be informed,
 Be respected as the individual with the major responsibility for his/her
own health care,
 Participate in decision-making affecting his/her health and
 Equal access to health care regardless of economic status, sex age, ethnic
origin or location (Boyle, 2003).
Today’s health care consumers are not merely recipients of goods and services, but want
and need to be partners in obtaining appropriate health care services. This is the reason
for the shift in care delivery to a patient-focused care model where an interdependent
relationship exists between patients/residents/clients and health care providers. Health
care consumers are now advised and consulted as opposed to the traditional relationship
where they depended on the decisions of the heath care providers (Boyle, 2003).
Today’s health care consumers are much more knowledgeable about available heath care
services and options and have access to an infinite amount of information on the Internet.
This can create some challenges for health care providers as some information available
on the Internet is not from reliable, evidence-based sources, yet have the ability to
influence consumers’ health care beliefs and decision-making.
A final issue worth mentioning under advocacy involves the protection of personal health
information. This issue has come to the forefront, both at the national and provincial
government levels. Health care consumers have advocated for, and should expect that
access to their health information is regulated through appropriate, reliable and consistent
standards. In Manitoba, the provincial government responded by passing the Provincial
Health Information Act (PHIA). In Saskatchewan, this legislation is called the Health
Information Protection Act (HIPA). These acts outline how individuals can access their
health information and how health care providers and facilities (‘trustees’) must protect
their patients’ health information. All health care providers working in provinces with
these privacy acts are required to be familiar with the legislation and are legally bound to
act accordingly. Follow these links to read more about the Manitoba and Saskatchewan
acts:
http://www.gov.mb.ca/health/phia
http://www.health.gov.sk.ca/health-information-protection-act
References
Boyle, I. (2003). The consumer movement. In McIntyre, M & Thomlinson, E. (Eds.),
Realities of Canadian nursing: Professional, practice and power issues. pp. 374-390.
Philadelphia: Lippincott, Williams & Wilkins.
Canadian Nurses Association. (2008). Nursing and the Political Agenda. Retrieved July
24, 2008 from http://www.cna-aiic.ca/CNA/issues/matters/default_e.aspx
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Canadian Nurses Association. (2002, November 28). Romanow Report Hits the Mark.
Retrieved July 24, 2008 from http://www.cnaaiic.ca/CNA/news/releases/public_release_e.aspx?id=68
Manitoba Health. (2008). The Personal Health Information Act. Retrieved July 24, 2008
from http://www.gov.mb.ca/health/phia/
Saskatchewan Health Ministry. (2007). Health Information Protection Act. Retrieved July
24, 2008 from http://www.health.gov.sk.ca/health-information-protection-act
Storch, J. (2003). The Canadian health care system and Canadian nurses. In McIntyre, M
& Thomlinson, E. (Eds.), Realities of Canadian nursing: Professional, practice and
power issues. pp. 34-59. Philadelphia: Lippincott, Williams & Wilkins.
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Objective#5
Discuss the current and future roles of nursing in the three countries.
Discussion question: What do you see as a primary role for Canadian nurses in the
future and why?
Current Areas of Practice
Current practice opportunities for nurses in Canada are many. Practice settings include
acute/hospital care, community programs, outpatient clinics and long-term care. A
variety of roles within each of these settings are also available and include clinical,
management, education and research opportunities.
Specialty Certification
For nurses who work within a specific area or specialty, the CNA offers a national
certification program for 17 different areas of nursing practice. The certification
credential indicates to patients, employers, the public and professional licensing bodies
that the certified nurse is qualified, competent and current in a nursing specialty. To
certify, nurses must register and write a competency exam developed by peers in their
field. Upon passing the exam, they are considered certified in that specialty for a 5 year
period and are allowed to use the designation associated with that specialty (CNA, 2008).
To learn more about the CNA Certification Program, follow this link:
http://www.cna-aiic.ca/CNA/nursing/certification/default_e.aspx
Website Search Activity
List 5 different nursing specialties that are available for certification through the CNA
Program, and the associated designation:
1.
2.
3.
4.
5.
Shift from Illness Care to Prevention and Promotion
Health Canada believes that illness prevention and health promotion can hold health care
costs down and improve quality of life in the long term (Health Canada, 2008). In the
health care system, there has been a fundamental shift in focus away from illness care, to
more resources and programs directed at illness prevention and health promotion of
individuals, families and communities. However, the number of nurses employed in
hospitals/acute care settings has remained quite consistent over the past 10 years at just
under 60% of the total nursing workforce (CNA, 2006).
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Website Search Activity
Visit the Healthy Living section of the Health Canada website at http://www.hcsc.gc.ca/hl-vs/index-eng.php and name 4 different health promotion or disease prevention
programs/resources that are currently in place:
1.
2.
3.
4.
Expanded Practice Roles in Nursing
As we move further into the 21st century, nursing roles must evolve and develop to match
the needs of the population and health care system. In response to changes in the past
number of years, including the renewed focus on improving access to primary care
services, the nursing profession has responded by advocating for more advanced nursing
practice positions. The CNA position statement on Advanced Nursing Practice was
updated in 2007 to outline the characteristics, educational preparation and roles of
Advanced Practice Nurses in Canada (CNA, 2007). This statement can be accessed at:
http://www.cnaaiic.ca/CNA/documents/pdf/publications/PS60_Advanced_Nursing_Practice_2007_e.pdf
The Nurse Practitioner (NP) role has gained much support over the past number of years
and the number of NP positions and graduates has steadily been increasing. Although
many nurses in Canada (particularly nurses in remote northern nursing stations)
functioned in advanced practice roles for many years prior to this new interest, they did
so without the proper structure, recognition or legislative support.
Similar to the licensing and registration process for RNs, the NP role and scope is
determined by provincial/territorial legislation and registration is through the respective
nursing association/college. After completing the educational requirements set out by
their province/territory, NPs must pass either the Canadian Nurse Practitioner Exam or an
American Nurses Credentialing Center exam (CNA, 20082). Once this is complete, the
NP registers with the professional nursing association/college in their province/territory
and is able to function within the expanded scope of nursing practice. This is dependant
upon the respective legislation, but usually involves the ability to order and receive the
results of diagnostics tests, diagnose a disease or condition, prescribe certain medications
and perform minor surgical procedures. Refer to the following link for further details on
the history, legislation and statistics on Nurse Practitioners in Canada:
http://www.cnaaiic.ca/CNA/documents/pdf/publications/Nurse_Practitioner_Workforce_Update_2006_e
.pdf
Another expanded nursing practice role that exists in Canada is the Clinical Nurse
Specialist (CNS). The CNS is also an advanced practice nurse with additional graduate
education, and functions within 5 domains; practitioner, consultant, educator, research
and leader. CNSs also contribute to the primary health care framework by improving
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access to quality care. CNSs are often employed by hospitals or health care programs to
advance and further develop evidence-based nursing practice. They usually spend less
time in the practitioner realm compared to NPs and more time in the education and
research roles and they also do not tend to function in the expanded scope of nursing
practice (CNA, 2003).
In 2005, the CNA released a report on Exploring New Roles for Advanced Practice
Nurses. In this report, three additional advanced practice roles were identified for
potential development in Canada; the nurse anaesthetist, the nurse midwife and the
advanced practice nurse case manager. These roles are well established in a number of
countries outside of Canada, including the United States, and well documented in the
literature. In Canada, midwifery is legislated and regulated in several provinces, but it is
currently considered an independent speciality as opposed to an advanced nursing
practice role. For these roles to move forward as recognized advanced practice nursing
positions, a number of factors would need to be addressed including enacting legislation
and regulation, developing educational competencies and curriculum, funding and
staffing educational programs and creating employment opportunities. Opportunities for
developing new advanced practice nursing roles arise from physician shortages, gaps in
service and change in political climate. These new roles may service to decrease waittime for surgical procedure, improve pain management, support healthy pre- and perinatal care and facilitate access to health care services in a timely and cost-effective
manner (CNA, 2005).
International Nursing Opportunities in Canada
As Canada continues to experience a nursing shortage, there are active recruitment efforts
and processes to encourage international registered nurses or students to move to Canada
and work or study to become a nurse. Qualified nurses who have skills in speciality areas
or are willing to work in small or remote communities are the most in demand (CNA,
20083), but all interested nurses and/or students are welcomed to review the application
requirements and processes.
Website Search Activity
Using the following websites, answer these questions relating to international nursing
opportunities in Canada:
www.cna-aiic.ca
www.nurseone.ca
www.crnm.mb.ca
www.srna.org
1.
Is a visa required for international applicants to work as a nurse or study
nursing in Canada? Yes/No
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2.
What language requirements exist to work as a nurse in Canada?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
3.
Where do international nurses apply for their license to practice? Briefly
describe the application and registration process.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
4.
Where can international nurses apply to work?
_______________________________________________________________
_______________________________________________________________
References
Canadian Nurses Association. (2008). Obtaining CNA Certification. Retrieved July 24,
2008 from http://www.cna-aiic.ca/CNA/nursing/certification/default_e.aspx
Canadian Nurses Association. (2008). Canadian Nurse Practitioner Exam Program.
Retrieved July 24, 2008 from http://www.cnaaiic.ca/CNA/nursing/npexam/default_e.aspx
Canadian Nurses Association. (2008). Becoming a Registered Nurse: International
Applicants. Retrieved July 26, 2008 from http://www.cnaaiic.ca/CNA/nursing/becoming/international/default_e.aspx
Canadian Nurses Association. (2007, November). Advanced Nursing Practice. Retrieved
July 24, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/PS60_Advanced_Nursing_Practice_2007_e.pdf
Canadian Nurses Association. (2006, October). 2005 Workforce Profile of Registered
Nurses in Canada. Retrieved July 24, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/workforce-profile-2005-e.pdf - Retrieved July
24, 2008
Canadian Nurses Association. (2006). The Regulation and Supply of Nurse Practitioners
in Canada: 2006 Update. Retrieved July 24, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/Nurse_Practitioner_Workforce_Update_2006_e
.pdf
Canadian Nurses Association. (2003, March). Clinical Nurse Specialist. Retrieved July
24, 2008 from http://cna-
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aiic.ca/CNA/documents/pdf/publications/PS65_Clinical_Nurse_Specialist_March_2003_
e.pdf
Canadian Nurses Association. (2005, June). Exploring New Roles for Advanced Practice
Nursing. Retrieved July 24, 2008 from http://cnaaiic.ca/CNA/documents/pdf/publications/Exploring_New_Roles_ANP-05_e.pdf
Health Canada. (2008, June 27). About Health Canada. Retrieved July 24, 2008 from
http://www.hc-sc.gc.ca/ahc-asc/index-eng.php
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Objective #6
Identify and analyze cultural factors impacting the nurse’s role in client advocacy in
the three countries.
Discussion Question: Identify and discuss a cultural issue that you feel impacts
Canadian nursing today.
Reading:
Wasekeeskaw, F. H. (2003). Challenges for the new millennium: Nursing in first nations
communities. In McIntyre, M & Thomlinson, E. (Eds.), Realities of Canadian nursing:
Professional, practice and power issues. pp. 447-469. Philadelphia: Lippincott,
Williams & Wilkins.
Multicultural Nursing Care
Canada is a country of many cultures and, as a nation, values the importance of
respecting cultural ties, beliefs and traditions. Canadian cultures include a blend of:
 Aboriginal peoples, whose ancestors inhabited the land prior to the European
settlers,
 Canadian-born descendents of the original European settlers and immigrants
from England, France, Scotland, Ireland, the Ukraine and other countries, who
often identify strongly with these familiar ties and traditions, and
 Non-native immigrants to Canada from many areas of the world, with many
arriving from Asian and South Pacific areas.
As most Canadians require nursing care at some point in their life, nurses must be able to
provide culturally competent and sensitive nursing care for the cultures of all Canadian
residents. This principle is embedded within the CNA Code of Ethics and culture is also
considered one of the 12 key determinants of health (CNA, 2004).
Canada is a bilingual country and has two official languages, French and English.
Although many Canadians are not fluent in both languages and the most common spoken
language in English, there are areas of the country with francophone communities where
French is the preferred and primary language. Quebec residents are primarily
francophone, and in addition, francophone communities are present in parts of Manitoba,
New Brunswick and Ontario. In these areas, health care providers must be able to speak
the French language to provide culturally sensitive and appropriate care.
Website Search Activity
Using the CNA Position Statement on Promoting Culturally Competent Care and the
CNA Code of Ethics, provide a response to the two questions below.
http://www.canaiic.ca/CNA/documents/pdf/publications/PS73_Promoting_Culturally_Competent_Care_
March_2004_e.pdf
http://www.cna-aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf
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1.
Briefly describe what the term ‘cultural competence’ means to you.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
2.
What specific things can an individual nurse do to promote culturally sensitive
nursing care?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
First Nations Nursing Care
Of special mention under multicultural care issues and advocacy is nursing care for the
First Nations peoples. As mentioned in the course introduction to Canada, First Nations
peoples are the descendents of the native Indian inhabitants of the country. This segment
of the population is expanding quickly, and with this growth, the health care system must
change and evolve to meet their unique health needs and challenges.
In regards to specific health conditions, this group tends to experience higher rates of
diabetes and diabetes-related complications and mental health illness, such as depression
and youth suicide. Often First Nation communities are located in rural, northern or
isolated areas where access to basic necessities and health care services are limited or
absent in many cases. However, many First Nations individuals have moved from
remote reserves to urban areas to seek a different lifestyle, but often they find themselves
living in poverty and poor housing conditions in core city areas. By examining the
determinants for health, concerns have been raised that many First Nations peoples and
communities face inequities within the health care system (Wasekeesikaw, 2003).
The overall responsibility for the health of all Aboriginal peoples, including First Nations
individuals and communities, lies with the federal government under Health Canada’s
First Nations and Inuit Health Branch (FNIHB). For further information on the history of
health-related concerns of this group and the role of nurses and nursing in the delivery of
health care services, refer to this section’s reading and visit the FNIHB website at
http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/index-eng.php .
References
Canadian Nurses Association. (2004, March). Promoting Culturally Conpetent Care.
Retrieved July 26, 2008 from http://www.cnaaiic.ca/CNA/documents/pdf/publications/PS73_Promoting_Culturally_Competent_Care_
March_2004_e.pdf
Health Canada. (2008, May 25). First Nations and Inuit Health Branch. Retrieved July
26, 2008 from http://www.hc-sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/index-eng.php
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Wasekeeskaw, F. H. (2003). Challenges for the new millennium: Nursing in first nations
communities. In McIntyre, M & Thomlinson, E. (Eds.), Realities of Canadian nursing:
Professional, practice and power issues. pp. 447-469. Philadelphia: Lippincott,
Williams & Wilkins.
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