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CHNC-STANDARDS-HHN-Focus-May-2021-.pptx
1. Community Health Nursing
Standards of Practice:
Where do CHNs practice?
What standards of professional practice guide their work?
How is excellence achieved?
CHNC Standards and Competencies Committee
May 2021
Spotlight
on HOME
HEALTH
NURSING
2. CHNC:
the national voice of community health
nurses. Our goal is to advance community
health nursing across Canada and improve the
health of Canadians.
https://www.chnc.ca/en/standards-of-practice
3. At the end of this this session, participants will
be able to competently and independently:
Recognize the unique practice settings of home health
nursing
Discriminate the CHNC standards of practice
Consider how the CHNC standards contribute to
excellence in community health nursing practice settings
Explore examples of HHN competencies in practice
HOME
HEALTH
NURSING
6. COMMUNITY HEALTH NURSING
Specialties of CHN practice
Home Health (HHN)
• focus on prevention, health restoration, maintenance & palliation
• focus on individuals, designated caregivers, and their families
Public Health (PHN)
• focus on promoting, protecting and preserving the health of
populations
• links the health & illness experiences of individuals, families, and
communities to population health promotion practice
RN in Primary Care/Family Practice Nurses
• focus on preventative health screening, health education,
comprehensive assessment, treatment of minor acute illness,
chronic disease management, case management, system
navigation, therapeutic intervention (wound care, immunization)
and medication review with individuals and families
All Include:
Nurses
promoting health
of individuals,
families, groups,
populations,
communities and
systems
7. CHNC Standards of Practice:
Where do they fit?
Provincial standards
CHNC standards
HH, PH and FP competencies
8. What are the CHNC standards
of practice?
1. Health Promotion
2. Prevention and Health Protection
3. Health Maintenance, Restoration and
Palliation
4. Professional Relationships
5. Capacity Building
6. Health Equity
7. Evidenced Informed Practice
8. Professional Responsibility and
accountability
A vision
for
excellence
in
community
health
nursing
practice
9. Standards
promoting health
#4 Professional #1 Health Promotion #7 Evidence
Relationships Informed
Practices
#2 Prevention and
#5 Capacity Health Protection #8 Professional
Building Responsibility
#6 Health Equity #3 Health Maintenance,
Restoration and Palliation
Canadian Community Health Nursing
Standards of Practice, 2019
Standards #4,5,6,7 8 help achieve #1,2 & 3
10.
11. Community Health Nurses and Nursing Practice
Code of Ethics
Community Health Nurse
Community Health Nursing Standards
Discipline Specific Competencies
Professional Regulatory Standards
Theoretical Foundational concepts
Values and Principles
Community Health Nurses and System
Determinants of Health
Government Support
Community Organizations
Delivery Structure and Process
Management Practice
Professional Relationships & Partnerships
12.
13. CHN Standards of Practice:
Why do they matter?
Inspire
excellence
Foundation for
certification
Set criteria and
expectations
for safe
and ethical care
Define the scope
and
depth practice
Support human
resource
management
Strengthen
education
and professional
development
14. Unique Characteristics of
Community Health Nursing
View health as a
resource & focus on
capacities
CHNs promote, protect &
preserve the health of
individuals, families,
groups, communities &
populations…
…wherever people live,
work, learn, worship &
play….
…in a continuous versus
episodic process
Have a unique
understanding of the
influence of the
environmental context
of health
Work at a high
level of
autonomy
Build partnerships
based on primary
health care
principles, caring &
empowerment
Combine
specialized
nursing, social
and public
health science
with
experiential
knowledge
Marshal resources to
support health by
coordinating care &
plan nursing services,
programs & policies
15. What are the CHNC standards
of practice?
1. Health Promotion
2. Prevention and Health Protection
3. Health Maintenance, Restoration and
Palliation
4. Professional Relationships
5. Capacity Building
6. Health Equity
7. Evidenced Informed Practice
8. Professional Responsibility and
accountability
A vision
for
excellence
in
community
health
nursing
practice
16. Home Health Nursing (HHN)
Home health nurses are committed to the provision of accessible
and timely care which allows people to stay in their homes with
safety and dignity.
Home Health Nursing Competencies are the integrated knowledge
skills and judgement and attributes required of a nurse working in
home health to safely practice. Attributes include but are not
limited to attitudes, values, beliefs
Home Health nursing encompass disease prevention, restoration of
health, health promotion and protection with the goal of managing
existing problems and prevention potential problems.
(CHNC, 2011)
17. Standard 1: (8 indicators)
Health Promotion
Community health nurses integrate health
promotion into practice
“Health promotion is the process of enabling
people to increase control over, and to improve,
their health.”
Involves the individuals, families, groups,
communities, population and systems
1
P
R
an
A
The five Ottawa
Charter health
promotion
strategies:
1. build healthy
public policy,
2. create
supportive
environments,
3. strengthen
community
actions,
4. develop
personal
skills and
5. reorient
health
services
18. HHN - Health Promotion Examples
HHNs encourage families to use their
traditional practices of their
indigenous culture- use of sweat
houses, or poultices in wound care if
acceptable
HHNs encourage clients to quit
smoking for wound care healing using
motivational interviewing and goal
setting strategies.
19. Standard 2: (9 indicators)
Prevention and Health
Protection
Community health nurses use the socio-
ecological model to integrate prevention and
health protection activities into practice.
These actions are implemented in accordance
with government legislation and nursing
standards to minimize the occurrence of disease
or injuries and their consequences.
2
P
R
an
A
Socioecological
model focuses
on sustainable
solutions
20. HHN
Prevention & Health Protection
Examples
• HHNs provide health teaching of people with diabetes
in their management of the disease to prevent diabetic
reactions. Using self management support strategies to
build capacity and independence.
• HHNs encouraging mask wearing, and handwashing to
clients and family during COVID.
• HHNs When providing wound care, encouraging client
to include a multivitamin to help with wound healing
and to prevent further damage to the wound bed
• HHNs teach and engage the client is self care about
wellness strategies a they can do to help support wound
healing.
21. Standard 3: (6 indicators)
Health Maintenance,
Restoration and Palliation
Community health nurses integrate health
maintenance, restoration and palliation into their
practice
3
P
R
an
A
Focus is on
maintaining
maximum
function,
improving
health, and
supporting
life
transitions
including
acute,
chronic, or
terminal
illness, and
end of life
22. HHN- Health Maintenance, Restoration &
Palliation Examples
• HHNs care for disabled students in the classroom:
Communication is required with the child’s guardian,
teacher and/classroom assistant
• HHN is an important part of the end-of-life care team
with the client and family by providing end of life care
and providing care for clients to remain at home.
• HHN as part of an interprofessional team that support
Adult Day Programs in their community (e.g.,
Medication management, teaching and supporting non-
clinical staff).
23. Standard 4: (12 indicators)
Professional Relationships
Community health nurses work with others to
establish, build and nurture professional and
therapeutic relationships. These relationships
include optimizing participation, and self-
determination of the client.
4
P
R
an
A
Relational
Participative
24. HHN-Professional
Relationships Examples
HHNs provide palliative care with a
team of health care providers to
individuals to enable them to remain in
their home in their end of life
HHN consulting with the client’s
wound care team to discuss and ensure
best practice and holistic approach in
the wound care plan is followed to
support client outcomes.
HHN consulting with an
interprofessional team from a hospital
Geriatric Day Unit or Falls Clinic to
support client safety in the community.
25. Standard 5: (17 indicators)
Capacity Building
Community health nurses partner with the client
to promote capacity. The focus is to recognize
barriers to health and to mobilize and build on
existing strengths.
5
P
R
an
A
Partnership
is key!
Work with to
build
capacity and
efficacy
26. HHN- Capacity Building Examples
HHN encourages a mother and teens to work out a
schedule for ROM exercises for the grandmother. The
family is happy that they were able to work out the
problem together.
A HHN working with the family and client to figure out a
home care schedule that suits client needs and yet
maintains independence
A HHN encourage an end-of-life client has input into the
plan of care to ensure their goals are taken in to account.
HHNs support client and family independence with care
needs by providing client/ family teaching and support.
(e.g., Teaching client and family how to provide infusion
therapy and simple wound care)
27. Standard 6: (15 indicators)
Health Equity
Community health nurses recognize the impacts
of the determinants of health and incorporate
actions into their practice such as advocating for
healthy public policy. The focus is to advance
health equity at an individual and societal level.
6
P
R
an
A
28. HHN-Health Equity Examples
HHNs advocate with families caring for medically fragile children
by seeking respite care for an exhausted families or by contacting
their local MPP.
HHN offer the flu vaccine to house bound individuals to ensure
they are given an opportunity to have the injection if they want it
HHN advocate for “ wheelchair “ transportation in the community
for wheelchair clients to attend social activates.
HHN works with local community outreach clinic to support a
mobile van that services street youth an underhoused population.
(e.g., Simple wound care, counselling, palliative care support
referral support for services )
29. HHN-
Health Equity Examples
• HHNs working in an Indigenous Community Health center
who are not from the community, advocates for and seeks out
education or a mentor to support them in gaining knowledge
and awareness of the community cultural practices and
understanding of the role of Elders in the community. (e.g.,
Community protocols for welcoming Elders to working
groups, programs; how to offer tobacco in a respectful
manner).
• HHNs collaborates and seeks to understand how the client’s
culture and community barriers to access health services
impacts current health context. The HHN ensures a non-
judgmental approach and provides care. ( e.g. Providing
medication management to an Elder who refuses insulin for
managing their diabetes and wish to use only traditional
medicines.
30. Standard 7: (6 indicators)
Evidence Informed Practice
Community health nurses use best evidence to
guide nursing practice and support clients in
making informed decisions.
7
P
R
an
A
CHN
Practice is
Evidence
Based
31. HHN-
Evidence Informed Practice Examples
• HHNs are working on their wound care policy and consulted
the Best Practice Guideline to ensure best evidence is used.
• HHNs keep up in Palliation best practice for pain management
protocol
• HHNs works as a team lead to support Infusion Therapy
practices and build team capacity in best practices and
evaluation of any practice changes implemented.
• HHN is a member of the teams Professional Practice
Committee and contributes to ensure new evidence is
integrated into practice.
32. Standard 8: (14 indicators)
Professional Responsibility and
Accountability
Community health nurses demonstrate
professional responsibility and accountability as
a fundamental component of their autonomous
practice.
8
P
R
an
A
Accountability
Responsibility
Professionalism
Competencies
Transparency
33. HHN- Professional Responsibility and
Accountability Examples
A HHN is asked by an ALS client to be present when his
wife removes his Bi-PAP machine, which will result in his
death. The nurse explores the client’s reasons for this decision
and discusses the ethics around responding to this request
with the health care team as well as the nursing practice
advisor at their College of Nurses.
HHNs as part of a client’s Adult protection team to help
determine capacity
HHNS demonstrate their scope of practice and understand
the different scopes of practice in nursing and
interdisciplinary teams and works respectfully with
interdisciplinary team.
HHNs as part of the team with the client and family to
support MAID (medical assistance in dying)
34. Get your copy of the
Professional Practice Model &
Standards of Practice
Community Health Nurses of Canada website:
https://www.chnc.ca/
The standards are available on the CHNC website:
https://www.chnc.ca/en/store
35. Consider Membership to
CHNC
Join Community Health Nurses from across Canada
and enjoy the many benefits of membership.
https://www.chnc.ca/en/member-benefits
Support your professional association and this
important work!
37. References
Community Health Nurses of Canada (CHNC). (2019). The
Canadian Community Health Nursing Professional Practice
Model & Standards of Practice. Retrieved
from https://www.chnc.ca/en/standards-of-practice
Stamler, L.L., Yiu, L., Dosani, A., Etowa, J., & van Daalen
Smith, C. (Eds.). (2020). Community Health Nursing: A
Canadian Perspective, 5th Edition. Toronto Ontario: Pearson.
Editor's Notes
Notes:
A copy of this tool is available on the CHNC website
The visual representation of the Canadian Community Health Nursing Professional Practice Model depicts the client as central in the model surrounded by the 3 categories of the components: community health nurses and nursing practice, community organizations and system.
All registered nurses are governed by their provincial regulatory standards (e.g. the College of Nurses of Ontario Standards and guidelines.
The CHNC standards are over and above this expanding the depth and breath of provincial standards and defining specific expectations for nurses working in the community.
The Competency sets, which are the knowledge, skill and judgement you need to meet the standards are also available. The home health, public health and family practice competency sets are all derived from the standards and guide the practice of nurses in these areas of community health nursing. For example, a home health nurse uses the provincial regulatory standards, the CHNC standards and the home health nursing competency sets.
Other nurses in the community use subsets of these competencies. For example CHNs working in rural and remote parts of Canada might use all 3.
The final 2019 Canadian Community Health Nursing Standards of Practice consist of eight standard domains and 81 standard statements
As well Access and Equity from the 2011 standards has been changed to Health Equity. This standard domain experienced the addition of nine new statements and six reworded statements. The new statements more explicitly integrated concepts related to critical social theory, social justice, health equity, racism, and acknowledgement of marginalized populations including Indigenous people.
Standards 1, 2 and 3 describe what we do in practice; Standards 4, 5, 6, 7 & 8 describe how we practice and what we expect to achieve
Demonstrates the relationship between all the new standards
The visual representation of the Canadian Community Health Nursing Professional Practice Model depicts the client as central in the model surrounded by the 3 categories of the components: community health nurses and nursing practice, community organizations and system.
Canadian Community Health Nursing Professional Practice Model: Component Clusters (CHNC, 2011; CHNC,2013)
Definitions of each component could be shared:
The Client (Individuals, Families, Groups, Communities, Populations, and Systems)
Community Health Nurses and Nursing Practice
Community health nurse
Theoretical foundation
Code of Ethics
Values and principles
Professional regulatory standards
Community Health Nursing Standards of Practice and discipline specific competencies
Community Organizations
Professional Relationships and Partnerships
Management Practices
Delivery Structure and Process
System
Government Support
Determinants of Health
The visual representation of the Canadian Community Health Nursing Professional Practice Model depicts the client as central in the model surrounded by the 3 categories of the components: community health nurses and nursing practice, community organizations and system.
The following are outlined in CHNC standards booklet on page 8-10
Determinants of Health
Government Support
Delivery Structure and Process
Management Practice
Professional Relationships & Partnerships
Code of Ethics
Community Health Nurse
Community Health Nursing Standards
Discipline Specific Competencies
Professional Regulatory Standards
Theoretical Foundational concepts
Values and Principles
The visual representation of the Canadian Community Health Nursing Professional Practice Model depicts the client as central in the model surrounded by the 3 categories of the components: community health nurses and nursing practice, community organizations and system.
The community health nurse……(highlight some components of this)
The revised Standards incorporate new practice expectations involving cultural safety; cultural humility; Indigenous ways of knowing; levels of prevention; disease management; critical appraisal; knowledge translation; interprofessional competencies; and quality improvement.
Nurses in practice use the standards to Guide and evaluate their practice
The standards represent a vision for excellence
All nurses adhere to provincial and territorial Standards for Nursing Practice, and these are the foundation upon which other nursing standards are built. The CHN Standards define the practice of a registered nurse in the specialty area of community health nursing. They build on these generic practice expectations of registered nurses and identify the practice principles and
variations specific to community health nursing in Canada. The Standards apply to community health nurses who work in the areas of practice, education, administration, policy, and research. The standards (clockwise from the top):
Inspire excellence in & commitment to community health nursing practice. The standards are an expectation of practice after 2 years of experience in CHN
Promote CHN as a specialty and provide a foundation for certification as a clinical specialty with Canadian Nurses Association (CNA)
Establish criteria and expectations for acceptable practice and safe ethical care
Define scope & depth of community health nurse (CHN) practice
Support human resource management including provide criteria for measuring performance
Strengthen education and professional development through Providing a foundation for the development of PHN competencies and HHN competencies
Box 1: this is different from other types of nursing e.g. hospital nursing. Whereas in a facility setting like a hospital, the main focus is mostly on individuals and families, the CHN has a broad scope of practice that includes working with individuals & families, but also with groups and the broader community. Behind all endeavors is the overarching health of the entire population
Box 2: this again is unique to CHNsg – in a hospital setting, the clients come to the facility. In the community, the nurse brings the care to the individual, group community. CHNs provide service in diverse places such as people’s homes, schools, churches, community centres, on the street. This often poses challenges (Murray, 1998; Simoni & McKinney, 1998):
practice in the client’s personal environment (versus a facility environment).
distractions in other settings.
unpredictable situations (which are often the norm).
‘unique’ home situations encountered.
some family members may differ in their level of acceptance of the nurse in their territory
having to learn to use and trust what other professionals, the client and the community have already contributed and can contribute.
Box 3: this again is unique to CHNsg – much of the work that CHNs do is long-term and is usually not immediately apparent. The impact of the work is evident over the long-term.
Box 4 (Health is resource) – the focus on health and health promotion is critical to the work of CHNs. CHNs focus on individual/family/group/community strengths as a starting point. This is much different approach than focusing on illness or case finding.
Box 5 (autonomy) – CHNs work individually and as part of a team. They are very autonomous in the work that they do which can pose challenges e.g. lack of access to immediate professional support systems, few supplies, low technology, and difficulty in connecting with other professional caregivers. CHNs are skilled at relationship building and thus, some of these challenges can be mitigated.
Box 6 (environment) – CHNs have expertise in understanding the effects of the determinants of health – research is continually showing us that the determinants have much more impact on health than some of the ‘traditional’ aspects of health. Examples of the determinants include education level, poverty. The determinants will be discussed in more detail later.
Box 7 (partnerships) – much of the impact of CHNs’ work is due to the successful partnerships that are developed within communities. Partnerships, primary health care, caring & empowerment will be discussed in more detail later.
Box 8 (specialized) – CHNs draw from a broad base of specialties including nursing, social science & public health science.
Box 9 (marshal resources) – CHNs are masters at seeking out resources and facilitating what need to be done to support health.
The final 2019 Canadian Community Health Nursing Standards of Practice consist of eight standard domains and 81 standard statements
Home Health Nursing Competencies are the integrated knowledge skills and judgement and attributes required of a nurse working in home health to safely practice. Attributes include but are not limited to attitudes, values, beliefs
Home Health nursing encompass disease prevention, restoration of health, health promotion and protection with the goal of managing existing problems and prevention potential problems.
Give example (bold or other)
Applies health promotion theories and models in practice such as change theories, primary health care, population health promotion model, and social and ecological determinants of health including Aboriginal peoples.”
Collaborates with client to do a comprehensive, evidence informed, and strength-based holistic health assessment using multiple sources and methods to identify needs, assets, inequities and resources.
Seeks to identify and assess the root and historical causes of illness, disease and inequities in health, acknowledges diversity and the adverse effects of colonialism on Indigenous people, and when appropriate incorporates Indigenous ways of knowing including connectedness and reciprocity to the land and all life in health promotion.
Considers the determinants of health, the social and political context, and systemic structures in collaboration with the client to determine action.
Implements appropriate communication approaches such as social marketing and media advocacy to disseminate health information and raise awareness of health issues at individual and/or societal level.
Includes cultural safety and cultural humility approaches in all health promotion interventions.
Uses a collaborative relationship with the client and other partners to facilitate and advocate for structural system change and healthy public policy using multiple health promotion strategies.
Evaluates and modifies health promotion activities in partnership with the client.
.
Give example (bold or other)
Participates in surveillance, recognizes trends in epidemiology data, and utilizes this data through population level actions such as health education, screening, immunization, and communicable disease control and management.
Uses prevention and protection approaches with the client to identify risk factors and to address issues such as communicable disease, injury, chronic disease, and the physical environment (e.g. air, climate, housing, work, water, land).
Applies the appropriate level of prevention (primordial, primary, secondary, tertiary and quaternary) to improve client health.
Facilitates informed decision making with the client for protective and preventive health measures.
Collaborates with the client to provide emergency management including prevention/mitigation, preparedness, response and recovery.
Uses harm reduction principles grounded in social justice and health equity perspectives to identify and reduce risks, and increase protective factors.
Includes cultural safety and cultural humility approaches in all aspects of prevention and health protection interventions.
Engages in collaborative, interdisciplinary and intersectoral partnerships in the delivery of preventive and protective services with particular attention to populations who are marginalized.
Evaluates and modifies prevention and health protection activities in partnership with the client.
Notes:
In home health care health promotion and health protection activities are emended in the visits for the clinical care/ context of the visit for the client /family. Not just “ doing wound care” but assessing for opportunities to support health teaching and prevent adverse events with a focus on client safety.
Give example (bold or other)
Holistically assesses the health status, and functional competence of the client within the context of their environment, social supports, and life transitions.
Supports informed decision making and co-creates mutually agreed upon plans and priorities for care with the client.
Uses a range of intervention strategies related to health maintenance, restoration and palliation to promote self-management of disease, maximize function, and enhance quality of life.
Includes cultural safety and cultural humility approaches in all aspects of health maintenance, restoration and palliation interventions.
Facilitates maintenance of health and the healing process with the client in response to adverse health events.
Evaluates and modifies health maintenance, disease management, restoration and palliation interventions in partnership with the client.
Notes:
Chronic Disease Management teaching and supporting new diagnosis is a large part of home care nurse role. Wound Care, Palliative Care and Medication Management ( infusion therapy and teaching clients to maintain lines at home ) are 3 focus areas of home health nursing referrals and service plans.
Give example (bold or other)
Recognizes own personal beliefs, attitudes, assumptions, feelings and values including racism and stereotypes and their potential impact on nursing practice.
Assesses the client’s beliefs, attitudes, feelings, and values about health and the impact of these on the professional relationship and potential interventions.
“Acknowledges that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies” in working with Indigenous people as stated in the Truth and Reconciliation Commission of Canada: Calls to Action.
Respects and supports the client in identifying their health priorities and making decisions to address them while being responsive to power dynamics.
Uses culturally safe communication strategies in professional relationships, recognizing communication may be verbal or non-verbal, written or graphic. Communication can occur via a variety of mediums.
Recognizes and promotes the development of the client’s social support networks as an important social determinant of health.
Promotes awareness of, and supports linkages to, appropriate community resources that are acceptable to the client.
Maintains professional boundaries in therapeutic client relationships.
Negotiates terminating therapeutic relationships in a professional manner.
Builds a network of relationships and partnerships with a wide variety of individuals, families, groups, communities, and systems to address health issues and promote healthy public policy to advance health equity.
Incorporates the domains from the National Interprofessional Competencies framework in working with other nurses and health care team members. Domains include 1) interprofessional communication, 2) patient/client/family/community-centered-care, 3) role clarification, 4) team functioning, 5) collaborative leadership, and 6) interprofessional conflict resolution.
Evaluates and reflects on the nurse/client and other community relationships to ensure responsive and effective nursing practice.
Notes:
Interprofessional collaboration and communication with provincial funders and services is a daily expectation of home care nurses
Give example (bold or other)
Uses an asset approach and facilitates action to support the priorities of the Jakarta Declaration
The Jakarta Declaration identified the following priorities:
Promote social responsibility for health
Increase investments for health development
Consolidate and expand partnerships for health
Increase community capacity and empower the individual
Secure an infrastructure for health promotion.
Enhances the client's ability to recognize their strengths, their challenges, causal factors, and resources available that impact their health.
Assists the client to make an informed decision in determining their health goals and priorities for action.
Uses capacity building strategies such as mutual goal setting, visioning and facilitation in planning for action.
Helps the client to identify and access available resources to address their health issues.
Supports the client to build their capacity to advocate for themselves.
Supports the development of an environment that enables the client to make healthy lifestyle choices, recognizing relevant cultural factors and Indigenous ways of knowing.
Recognizes the unique history of Indigenous people, and incorporates Indigenous ways of knowing and culturally safe engagement strategies in capacity building efforts.
Uses a comprehensive mix of strategies such as coalition building, inter-sectoral collaboration, community engagement and mobilization, partnerships and networking to build community capacity to take action on priority issues.
Supports community-based action to influence policy change in support of health.
Evaluates the impact of capacity building efforts including both process and outcomes in partnership with the client.
Notes:
Client and Family Teaching & Client and Family Engagement are key skills that home care nurses use to support and encourage capacity of clients and families to stay safely at home.
Engages with the client using critical social theory and an intersectional approach from a foundation of equity and social justice.
Assesses how the social determinants of health influence the client’s health status with particular attention to clients who are marginalized.
Understands how power structures, unique perspectives and expectations may contribute to the client’s engagement with health promoting services.
Advocates for and with the client to act for themselves.
Participates with community members and advocates for health in intersectoral policy development and implementation to reduce health equity gaps between populations.
Engages with clients who are marginalized in the coordinating and planning of care, services and programs that address their needs and perspectives on health and illness.
Refers, coordinates and facilitates client access to universal and equitable health promoting services that are acceptable and responsive to their needs across the life span.
Collaborates with community partners to coordinate and deliver comprehensive client services with the goal of reducing service gaps and fragmentation.
Understands historical injustices, inequitable power relations, institutionalized and interpersonal racism and their impacts on health and health care, and provides culturally safe care.
Supports the client’s right to choose alternate health care options, including “to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients” as stated in the Truth and Reconciliation Commission of Canada: Calls for Action.
Advocates for resource allocation using a social justice lens.
Uses strategies such as home visits, outreach, technology and case finding to facilitate equitable access to services and health-supporting conditions for populations who are marginalized.
Advocates for healthy public policy and social justice by participating in legislative and policy-making activities that influence the determinants of health and access to services.
Takes action with and for the client at the organizational, municipal, provincial, territorial and federal levels to address service gaps, inequities in health and accessibility issues.
Evaluates and modifies efforts to increase accessibility to health and community services, and to advance health equity.
Notes: Home Health care nurses work with many different populations of clients in their community. They collaborate with the provincial funder to ensure referrals and access to services is available equitably for their clients.
Notes:
Home health care nurses “ see” the impacts of health inequity in their work and advocate for supports and services for their
Give example (bold or other)
Uses professional expertise in considering best available research evidence, and other factors such as client context and preferences and available resources, to determine nursing actions.
Seeks out reliable sources of available evidence from nursing and other relevant disciplines.
Understands and uses critical appraisal skills to determine quality of research evidence.
Understands and uses knowledge translation strategies to integrate high quality research into clinical practice, education, and research.
Uses quality evidence to inform policy advocacy, development and implementation.
Uses a variety of information sources including acknowledging diverse perspectives and Indigenous ways of knowing.
Notes:
Home care nurses are “ expert generalists” in many cases as they provide care for many different client needs from wound care, infusion therapy, complex pediatric clients, palliative care. Home care nurse must be up to date with current evidence in may different fields. Some teams have access to consultants that support the work but the nurse in the home needs to be open to integrating new new evidence into practice.
Give example (bold or other)
Assesses and identifies unsafe, unethical, illegal or socially unacceptable circumstances and takes preventive or corrective action to protect the client.
Recognizes ethical dilemmas and applies ethical principles and CNA Code of Ethics.
Works collaboratively in determining the best course of action when responding to ethical dilemmas.
Provides leadership in collaboration with the community to advocate for healthy public policy based on the foundations of health equity and social justice.
Identifies and acts on factors which enhance or hinder the delivery of quality care.
Participates in the advancement of community health nursing by mentoring students and new practitioners.
Participates in professional development activities and opportunities to be involved in research.
Identifies and works proactively (individually or by participating in relevant professional organizations) to address health and nursing issues that affect the client and/or the profession.
Provides constructive feedback to peers as needed to enhance community health nursing practice.
Documents community health nursing activities in a timely and thorough manner.
Advocates for effective and efficient use of community health nursing resources.
Uses reflective practice to continually assess, and improve personal community health nursing practice including cultural safety and cultural humility.
Acts upon legal obligations (applicable provincial / territorial / federal legislation) to report to relevant authorities any situations involving unsafe or unethical care.
Uses available resources to systematically evaluate the achievement of desired outcomes for quality improvement in community health nursing practice.
Notes:
Home Health care nurses work independently so they need to be very aware of their standards of practice and accountability for keeping their practice current.
