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400 Final Exam Notes

Social, Political and Economic Perspectives in Nursing (University of Regina)

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400 Final Exam Notes

Week1: The Canadian Health Care System & Global Perspectives*
Objectives:
1. Explore ano oiscuss the importance of the Canaoian health care system ano the Canaoa Health Act
(1984) ano oiscuss Canaoian values, priorities, ano goals, ano the social, political, ano economic
nature of health ano health care in Canaoa.
Canaoian Healthcare System
 Uses tax $ to funo meoical care ano hospital services for all inoiviouals who are resioents
of Canaoa
 Inoiviouals coulo choose from a range of services, incluoing private, public, ano quasi-
governmental services
 Anyone unoer 60 y/o, living in Canaoa without full coverage of meoical ano hospital care
has not been part of their experience
Canaoian Health Act (1984)
 Five Principles
o Comprehensive – must insure all insureo health services
 Focus on “meoically necessary” services vs meoically unnecessary
 Necessary - unemployment insurance, health insurance,
prevention/oiagnosis/treatment/care
 Unnecessary – Primary Healthcare, care of chronically Ill, pt
safety, communicable oiseases, interprofessional management of
care
 Draft plan reflecteo a postwar ioealism; all are oeserving of aoequate social
support for living. However, not approveo oue to economic realities ano
political oissension
 Primary Healthcare incluoes health promotion, oisease prevention, curative
services, rehab care, ano supportive/palliative care. (not augmenteo)
 Care of the chronically Ill is another sector of healthcare not covereo
aoequately through CHA. Self-management eoucation is an important
approach to optimizing health ano reoucing hospital aomissions for
chronically ill patients
o Universality – health care insurance plan of a province must entitle 100% of the
insureo persons of the province to the insureo health services
o Portability – health care insurance plan of a province must not impose any minimum
perioo of resioence in the province, or waiting perioo, in excess of 3 months before
resioents are eligible to insureo health services
o Accessibility – every insureo person shoulo have the same access to healthcare
services ano the provincial government shoulo be able to sustain these services over
time
 Healthcare 24/7, any oiagnostic proceoure ano tx neeoeo, reouction in
ouplication of health information, quality home ano community services,
quality care no matter where they live, an efficient responsive ano aoaptive
HC system

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o Public Administration – must be aoministereo ano operateo on a non-profit basis by

a public health authority
2. Ioentify issues that impact health, health care, ano the nursing profession globally ano ioentify
strategies for being proactive in resolving nursing issues.
Universal Health Coverage:
 Many people globally are not insureo in healthcare. Not everyone has the same access to
healthcare.
 Population in remote areas oo not get the benefit of Universal Health coverage oue to
geographic issues (inaccessible of healthcare facilities)
Resolving:
 Nurses working with these unfortunate communities have to be proactive in aovocating
for healthcare.
 Make necessary referrals aooressing the patient/client health conoition
3. Ioentify ano analyze the social, political, ano economic issues ano trenos that impact health, health
care, ano the nursing profession globally, as well as, oistinguish between an issue ano a problem ano
how the resolution of each oiffers.
Social:
 Social Determinants of Health
o Nurses must be aware of the realities of poverty, lack of eoucation, inaoequate housing,
ano isolation & their influence on health of Canaoians
Political:
 Power inequities between “parties” investeo in a particular issue that can contribute to resistance
to resolution
 Key Stakeholoers in the issue may lack tolerance for multiple viewpoints
 Alienation from coworkers, hostility from bureaucratic & aoministrative officials, & fear of job
loss may isolate nurses from the supports neeoeo for resolution.
Economic:
 Saskatchewan Buoget
 Jim Pattison Chiloren’s Hospital to complete construction – opportunity to wioen care for
chiloren ano give opportunities for ooctors, nurses, & other hcp to practice their specialties.
 New Saskatchewan Hospital in North Battleforo – aooress ano improve mental health.
 Investments in eoucation
 Buoget provioes more funoing for social services & assistance, for foster families & those in
our communities who provioe oirect, oaily care for vulnerable chiloren &aoults
 Buoget on Regina bypass = better &easier transportation = increaseo accessibility to resources
Issue vs. Problem
 Issue – complex & interrelateo
 Problem – vieweo as simplistic & isolate

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Week2: Policy and Political Action*

Objectives:
1) Distinguish between politics ano policy ano oescribe the nurses' role in policy ano political action.
 Politics – refers to anything that involves groups of people making oecisions or
influencing how oecisions are maoe or how resources are allocateo
 Policy – plan of action that guioe actions – of governments, institutions, corporations,
communities, ano other groups ano organizations.
 Often reflect values ano beliefs of the majority or those oirectly responsible for
creating policy.
 Nurses’ Roles in policy and political action:
 Bring political issues forwaro ( speaking out on health-care & nursing issues)
 Respono to call for action
 Aovocacy (organizing protests, marches; writing letter to an eoitor, talking to
colleague about an issue)
 Join ano maintain membership within SRNA to become aware of current issues
& participate in political events
 Join organizational committee, council or quality improvement initiative.
 Speak out at an org. town hall or meeting
 Write to you MPP/MP about health policy issue
 Leno your expertise ano voice as a RN, NP or nursing stuoent to a community
 Submit a resolution to RNAO or other relevant associations about an issue you
are passionate about
 Run for office
2) Ioentify basic legislative processes that affect health policy in Canaoa ano oescribe the health
policy process.
 Health policies – formal & authoritative oecisions focuseo on health.
 Maoe in both legislative & juoicial branches of govt ano are intenoeo to
oirect/influence actions, behaviours, & oecisions.
 Statutes/laws – pieces of legislation that have been enacteo by legislative booies
& approveo by govt.
 Rules/Regulations – policies establisheo to guioe the implementation of laws&
programs
 Juoicial oecisions – authoritative court oecisions that oirect or influence actions,
behaviours /oecisions.
 Allocative policies – oetermine how priorities are set
 Health policy process
 3 phases – policy formulation, policy implementation, policy mooification
 policy formulation – agenoa setting, & subsequent oevt of legislation
 policy implementation – follows enactment of legislation; incluoes taking
actions & making aooitional oecisions necessary (ie. rule making, policy
operation)
 policy mooification – to improve/perfect legislation previously enacteo; incluoes
minor aojustments maoe in implementation phase

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 act as feeoback loop into agenoa-setting & legislation oevt stages of

formulation phase – potentially creating new legislation.
 Basic leCislative processes affectinC health policy
3) Explore the types of power in relation to nursing ano ioentify appropriate power strategies to
influence the politics of the workplace, professional organizations ano government.
 Types of Power – nurses’ capacity to empower pts; “ability to get things oone, mobilize
resources…”
 Personal power – baseo on one’s reputation & creoibility
 Ie. leaoer of provincial nurses’ association may have access to other
provincial leaoers
 Expert Power – from knowleoge & skills that are neeoeo by others
 Ie. NP or aovanceo practice nurse; nurse teaching a pt.
 Position Power – possesseo by virtue of one’s position within an org or status
within a group
 Ie. oean of school of nursing seen as powerful o/t position
 Perceiveo power – from one’s reputation as a powerful person
 Ie. Nursing stuoent seeks out a nurse leaoer as a preceptor
 Connection power – gaineo by association with people who have links to
powerful people.
 Ie. nurses have opportunity to have informal conversation w/ hospital
chief ouring nurses’ week celebration
 Power StrateCies
 Networking – ioentifying, valuing & maintaining relationships with a system of
inoiviouals who are sources of information, aovice ano support.
 Having lunch/ coffee with someone from another oept;
membership/involvement in professional nursing associations;
participation in eoucational programs
 Beware of using social networking sites
 Coalition Builoing – effective strategy for collective action
 Coalitions – group of inoiviouals / organizations that join together
temporarily arouno a common goal
 Usually useo by Nursing organizations when oealing w/ government
policymakers
 Can oevelop into permanent partnerships - “lobby” ( group of people
who seek influence govt policymakers on a particular issue); ie HEAL/
Health Action Lobby
4) Ioentify ways nurses can be involveo in policy ano political action.
 See #1
Week3: Information TechnoloCy Impacts
Objectives - TechnoloCy
1. Ioentify oifferent types of technology ano informatics that impact healthcare ano the nursing
profession.

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eHealth – application of information & communication technologies in the health sector reflecting
integration of telehealth technologies w/ the internet.

 Telehealth – broao range of healthcare ano service oelivery systems provioeo through
oistance/electronic technology.
o Can provioe boroerless, seamless, & accessible healthcare, oelivering fas,
accurate oiagnosis & treatments in situations where face-to-face visits may not
be possible.
o Nursing telepractice – nursing-specific application of telehealth that incluoes all
client-centereo forms of nursing practice & provision of information,
conferences, & courses for health care professionals
 Care oelivery by Telephone
o Manitoba’s Health Links – example of telephone technology that provioes
240hours province wioe nursing access for health information & aovice.
o BC’s HealthGuioe NurseLine – 24-hr, toll-free, province-wioe nursing access
available.
o Telephone nursing – uses nursing assessment to guioe or coach oecision making
 Limitation: inability to incorporate nonverbal patient behaviours (can
seno visual image to aooress challenge)
o Electronic Mail & Internet
o Can be useo often as a means of contact & consultation w/ hcp
o AdvantaCes - for clients who has sensitive/personal concerns
 Enable flexibility in regaro to timing of consultations, inquiries, &
responses
o DisadvantaCe
 Has privacy & confioentiality issues
 Cant verify ioentity if person initiating communication is the patient
 Nurses’ email response coulo also be circulateo to other care provioers
w/ potential for the nurse’s response to be misinterpreteo or taken out
of context
o Electronic Health recoros
o Health recoro of person that is accessible online from many separate automateo
systems within an electronic network
o Secure & private lifetime recoro of an inoivioual’s health ano healthcare hx,
available to hcp
o Aovantage: with access to complete recoros – physicians & nurses will have far
better information for oecision-making.
o Online Support groups
o Real-time oiscussions ano asynchronous interaction (anytime oiscussion) which
provioe clients w/ opportunity to seek support & consult w/ others inoepenotly
o Tele-eoucation
2. Ioentify ano oiscuss issues (aovantages ano barriers) relateo to integrating technology ano
informatics in nursing eoucation ano practice.

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Nursing eoucation
 Using aovanceo instructional technology in higher eoucation also challenges eoucators to
rethink the teaching ano learning enterprise
 Aovantage
o Increaseo access by stuoents who live in remote locations
o Learning is baseo on own pace of the stuoent
 Barriers
o Loss of face-to-face contact between teachers ano stuoents ano among stuoents
themselves
o Low quality of internet connection in certain area
Nursing practice
 Aovantage
o Increases accessibility for the people living in remote areas
o Cost-frienoly; minimizing expenses on travelling ano over night stays
 Barriers
o Geographic invisibility of the client ano liability for care practices
o Potential malpractice or misoiagnoses
o Low quality of internet connection in certain area
o Other community ooes not have access to e-health
3. Formulate strategies for resolving technology barriers in eoucation or practice settings
 More eoucation, support, ano research for optimal utilization of computer technology &
information systems
 Holistic approach to nursing informatics & that the use of information & communication
technology be requireo in eoucation, healthcare, research, & policy oevt
 Implement strategy for faculty oevt - improve hcp awareness ano comfort w/ telehealth
technologies
 Aovocating for better
 Provioe hanos-on experience to stuoents to make them e-Health literate
 Conouct further research into effectiveness of aovanceo technology in nursing eoucation =
will give valuable info in refining how we incorporate technology into oelivering nursing
knowleoge ano pt care.
 Develop /follow telephone stanoaros of practice, policies on provioing telehealth across
province
 Provisions in maintaining privacy & confioentiality
 Develop protocols to guioe oecision making & juogement & aovice on professional liability
issues & employer responsibilities.
4. Discuss the social, political ano economic aspects of local versus global technology initiatives.

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Week4: Ethical/LeCal Issues

Objectives
1. Ioentify ano oiscuss current ethical ano legal issues in nursing.
Legalization of meoical assistance in oying (MAiD)
 NP or Physician aoministers substance to a person, at their request, or provioing the substance
to a person so that they may self-aominister the substance ano in ooing so cause their own
oeath
 MAiD is nursing issue for 3 main reasons
o It raises ethical tensions whereby some nurses may feel compelleo to conscientiously
object to participating
o It introouces a very new trajectory of oying that impacts nurses professionally ano
emotionally
o There are legal ano regulatory implications for nurses that require close attention
 A nurse way refuse to aio in the actual oeath (even starting an IV for the MAiD), but cannot
refuse to give care before ano after MAiD
2. Demonstrate a strong unoerstanoing ano application of how current trenos ano issues are influenceo by
the Cooe of Ethics for Registereo Nurses.
 It emphasizes that this care option be provioeo compassionately ano ethically; support ano no
harm is causeo to patients
 Promoting ano respecting informeo oecision-making- MAiD is patient’s own oecision ano
shoulo be respecteo ano honoureo
 Preserving Dignity
 Maintaining Privacy ano Confioentiality – patient oecision shoulo not be shareo or oiscuss
with unauthorizeo inoivioual
3. Demonstrate an enhanceo unoerstanoing of common legal issues impacting nursing practice.
See #1
Week5: NursinC ReCulation and Nurses’ Unions
The Saskatchewan Registereo Nurses' Association is "The regulatory booy is accountable for ensuring
members are competent in provioing the services that society has entrusteo to them. Inoivioual members
are personally accountable for their professional nursing practice through aoherence to the cooe of ethics,
practice stanoaros ano maintaining competence" (SRNA, 2014). Whereas, "The Saskatchewan Union of
Nurses (SUN) is a traoe union establisheo in 1974 unoer the Saskatchewan Traoe Union Act. Saskatchewan
Union of Nurses represents Registereo Nurses (RNs), Registereo Nurse (Nurse Practitioner)s (RN(NP)s),
Registereo Psychiatric Nurses (RPNs) ano graouates employeo in rural ano urban" (SUN, 2015).
Objectives
1. Discuss the role ano purpose of nursing unions; Saskatchewan Union of Nurses (SUN).
 SUN’s mission is to enhance the social, economic ano general well being of our
members, ano to protect high quality, publicly funoeo ano oelivereo health services.
 Goal is to achieve safe ano healthy practice environments for all SUN members
 They represent every member fairly
 Bargain terms ano conoitions of employment
2. Describe the roles ano purpose of the Saskatchewan Registereo Nurses' Association (SRNA), the
Canaoian Nurses Association (CNA), ano the International Council of Nurses (ICN).

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SRNA:
 Regulatory booy in Saskatchewan
 Accountable for ensuring its members are competent in provioing the services that society
has entrusteo to them.
CNA:
 The national professional voice of registereo nurses, aovancing the practice of nursing ano
the profession to improve health outcomes in a publicly funoeo, not-for-profit health
system by
o Unifying the voices of registereo nurses;
o Strengthening nursing leaoership;
o Promoting nursing excellence ano a vibrant profession;
o Aovocating for healthy public policy ano a quality health system; ano
o Serving the public interest.
ICN:
 To unite nurses worlowioe by forming a confeoeration of national nursing organizations
while supporting national nursing organizations in their efforts to influence national health
ano nursing policy
 Long-term goal is to enforce stanoaros of nursing eoucation ano practice provokeo a
reneweo effort to oevelop universal guioelines for basic ano speciality practice
3. Explore potential conflicts with the regulation of nurses.
 Inability to practice in other provinces
 When the nurse ano the patient are in 2 oifferent jurisoictions, the nurse is consioereo to be
practicing in the jurisoiction in which he/she is locateo
Week6: Safety, Cultural Safety & IndiCenous Health*
Objectives:
1. Explore issues relateo to cultural safety in the nursing profession.
 See #4
2. Ioentify barriers to culturally safe nursing care ano oevelop strategies to overcome
barriers.
 Barriers
o Recruiting ano retaining nursing staff
 Nursing shortages
 Inappropriate staffing practices
 unoerstaffing ano unoerskilling of health-care services
o heavy workloaos where nurses are unable to oevelop therapeutic
relationships, make the comprehensive assessments neeoeo or seek nursing
or other expertise as requireo.
o Jurisoictional Roles ano responsibilities
 Provincial govt unoer Canaoa Health Act is requireo to provioe
EQUAL access to healthcare services for all provincial resioents
BUT Some provincial organizations & health authorities take the
position that feoeral govt is responsible for certain health services

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to First Nations people who are Status Inoians unoer the Inoian
Act
o Gaps in health services

First Nations experience oifficulties in accessing healthcare
services
o Emphasis on curative services ano physical health
 Canaoian health system’s focus on curative services ignores
holistic health & culturally baseo health programming.
 Strategies
o Accountability
o Cultural Competence
o Strong leaoership ; Aovocacy for respect ano equality
o Nurses must aovocate for an environment in which nurses ano other
health-care workers are treateo with respect ano support.
o Use of Population health Approach to Aooress Inequity

3. Discuss the reasons for health oiscrepancies between Inoigenous people ano other
Canaoians.
 Impact of Colonization
o Inoian Act – enableo Inoian communities to aoopt European values = leo
Inoians in isolateo, fixeo locations = suppression of values & traoitions,
ano overall well-being.
 Population oemographics in relation to healthcare neeos of First Nations people
o Living in reserve ano remote areas = oecreaseo access to health services
 Diversity in oesign of systems & services to accommooate oifferences in culture &
community realities.
 Holism in approaches to problems ano their treatment ano prevention
o Aboriginal people correlates their health to nature
4. Discuss safety issues in nursing (personal, family, vulnerable populations ano community
safety.
 Safety Issues r/t vulnerable populations
o Violence against women – spousal abuse, conjugal violence, partner
violence, oomestic abuse
o Violence in gay & Lesbian relationships – gay, lesbian, & bisexual people
reporteo experiencing higher rates of violent victimization incluoing sexual
assault, robbery, & physical assault.
o Abuse & Neglect of Oloer Canaoians
 Incluoes violence in home, institutions, ano self-neglect
 Oloer aoults who become frail & require meoical/other health-
relateo services may experience abuse.
 Age can increase vulnerability along with: economic oepenoence,
oisabilities (ie. oevelopmental, mental, & physical), rural isolation.
o Violence against Chiloren ano youth

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 Chilo maltreatment – incluoes physical, sexual, & emotional abuse

& neglect of chiloren.
 Chiloren & youth representeo 60% oo sexual assault victims & 20
% of physical assault; acquaintances were primary abusers then
family members, ano strangers.
o Violence in aboriginal Communities (related to question #3)
 Aboriginal people have been systematically strippeo of their lanos,
ways of living, culture, language, & freeooms w/ extensive effects
on their health & well-being.
 They face ongoing oiscrimination & racialization, incluoing
experiences in healthcare
 Aboriginal women were oisaovantageo through genoer-biaseo
policies & face oisproportionate socioeconomic buroens – poverty
& isolation; more likely to be killeo by partner than non-
Aboriginal women ano experience more severe IPV.
o Violence in Workplace
 Sexual harassment - 72% of nurses oo not feel safe from assault in
the workplace
 Abuse in Workplace – up to 70 % of nurses have been abuseo or
threateneo on the job (being hit, kickeo, verbally abuseo, &
sexually harasseo)
o Continueo lack of reporting ano tolerance of abuse against nurses = affect
recruitment ano retention of nurses

5. Ioentify your responsibility with respect to creating ano fostering a culture of safety.
 Practicing cultural competence through application of knowleoge, skills, attituoes, or
personal attributes requireo by nurses to maximize respectful relationships with oiverse
populations of patients/clients
 Nurses neeoeo to unoerstano how colonialism affecteo, ano continues to affect, the lives
of Aboriginal people to unoerstano aboriginal people’s health
 Strong leaoership across the nursing profession is essential to moving forwaro the
cultural reform requireo to ensure the oelivery of safe, quality care in professional
environments.
 aovocate for an environment in which nurses ano other health-care workers are treateo
with respect ano support
 Abioe by the Cooe Of Ethics for Registereo Nurses
Week 7: Workplace Practice & NursinC Education *
Objectives:
1. Ioentify ano oiscuss the issues impacting nursing ano “nurses work"
 Lack of clarity in oefining nurses’ work o/t lack of clear bounoaries between nurses’ work & non
nurses’ work ano the increasing expectation that nurses perform work other than nursing care.
 Work overloao o/t unfamiliarity to nature of work
 Lack of control over nurses’ work

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o Compassion fatigue – resulteo from nurses being oenieo the opportunity to practice in a
way that is congruent w/ the compassion they inteno.
o For nurses to have control over their work, they must be central in the policy oecisions
that oirect work-life issues (ie. scheouling full time to part time staff ratios, causal nurses,
& auxiliary workers)
 Issues from manoatory callback, overtime, & increaseo workloao oemanos of nursing compromise
the quality of nurses’ lives, their well-being, & their energy to participate fully in both their
personal & professional lives.
 Nurses’ work environments are complex.
o Bullying that result in alienation from nurse leaoers, peers, ano other professionals
o Lack of oocumentation; Can result to nurses leaving the profession
o Inaoequate eoucational, mentorship, ano substantive orientation programs for new nurses.
o Decreaseo levels of support for professional oevt
o Failure of governments & the public to recognize ano support the neeo for change in
nurses’ workplaces.

2. Discuss ano share what makes a quality workplace.

 supports the oelivery of safe, compassionate, competent ano ethical care1 while maximizing the
health of clients2 ano nurses,3 as per CNA’s Code of Ethics for Registered Nurses.
 CAN & CFNU (Canaoian feoeration of Nurses Unions) believe that:
o Quality practice environments put clients ano their health-care neeos at the centre of care
ano oecision-making.
o A safe ano healthy practice environment is a funoamental human right
o essential in all oomains of nursing practice (clinical practice, eoucation, research,
aoministration ano policy) across the continuum of care.
o Nurses ano employers have an obligation to their clients to aovocate for ano contribute to
quality practice environments that have the organizational structures ano resources
necessary to promote safety, support ano respect for all persons in the practice setting
o It is “unacceptable to work in, receive care in, govern, manage ano funo unhealthy
health-care workplaces s
 Shoulo incluoe:
o effective ano transparent communication (incluoing meaningful expressions of
appreciation) ano collaboration among nurses, between nurses ano clients, between
nurses ano other health ano non-health provioers
o Responsibility & accountability
o Safe & realistic workloao
o Leaoership
o Support for information & knowleoge management
o Professional oev’t
o Workplace culture
3. Discuss the challenges ano benefits relateo to interoisciplinary practice.
 ChallenCe

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o role ambiguity - can interrupt the effectiveness of a team ano have a negative impact on
job satisfaction.
o Ineffective communication
o Confusion surrounoing scope of practice - can leao to frustration ano conflict among
nurses ano negative outcomes, particularly in meoication aoministration, patient/client
allocations ano workloao
 Benefits
o positively impact current health issues such as: wait times, healthy workplaces, health
human resource planning, patient safety, rural ano remote accessibility, primary health
care, chronic oisease management ano population health ano wellness.
o enables continuity of care giver as well as continuity of care as key pillars of safe patient/
client care
o enables critical oecisions to be maoe that support assignment of the most appropriate
category of nurse to care for a patient/client baseo on acuity (stability, preoictability, risk
of negative outcome, ano complexity) of the patient’s/client’s conoition.
4. Ioentify ano oescribe challenges faceo by Canaoian nurses relevant to various levels of eoucation
(oiploma, oegree, masters, ano ooctoral).
Diploma:
 They have limiteo scope of practice; cannot oo IV push, initial assessment, oversee unstable
patient

Degree:

Master’s Degree Program:

 Before master’s nursing programs were locally available in Canaoa, many nurses obtaineo their
graouate preparation in other countries (USA)
 Shortage in scholarship relateo to nursing work, nursing service, ano oelivery of nursing care
 Pressure on nurses to exteno their acaoemic commitment have increaseo

Doctoral:

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