Canadian Bates Guide to Health Assessment for Nurses

Canadian Bates Guide
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She Alberta. She received her PhD has been teaching nursing stu- from the University of Alberta, dents since , teaching health MS nursing from the University assessment for the past 17 years, of Hawaii, and BScN from the and currently teaches critical care University of Alberta. Since nursing and health assessment. She is committed to developing excellent learning ties in the Province of Alberta. Her lifetime approach to teach- resources for nursing students. Tracey appreciates her col- ing has been about supporting students to be successful.

Rene leagues and students for all their support. She sends a very spe- has been honoured with a Lifetime Achievement Award from cial thank you to FP for such unwavering support and the College and Association of Registered Nurses of Alberta, friendship.

Heartfelt thanks go She thanks them for their love, cheering, and patience dur- to her husband Wayne for his patient, unwavering, and loving ing this adventure and sends this message, I love you as blue support and to Jason, Mary, Stephen, and Julia for their un- as the sky, as bright as the sun, and all the way to the moon derstanding about fewer family dinners when book chapters and beyond.

She Nursing, University of Alberta she taught undergraduate and earned her bachelors degree from Smith College and her graduate health assessment, including advanced health assess- medical degree from the University of Rochester School of ment in Spanish to nurse educators in Mexico and Peru. A Medicine and Dentistry. This distinguished clinician and ed- nurse clinician earlier in her career, she used health assessment ucator has specialized in programs involving student and skills in remote and urban Alberta.

She values the opportunity physician training in geriatrics and patient-centered cultural to write with two dear, respected colleagues who share her pas- competence. At Texas Tech University, she oversaw a com- sion for excellence in health assessment in nursing. Lynn is prehensive curriculum redesign for the School of Medicine. As a Professor Emerita, her lifelong interest in languages teaching clinical skills.

Spanish, French, and Italian guides her travel choices for hik- ing, biking, and skiing. Special Populations. Their ex- Important topics for health promotion including risk fac- periences grow, expand, and trigger the required levels of tors and screening critical thinking from the first moments of their encounters Canadian guidelines and standards for assessing health with clients. Working through the steps of the health history and risks to health and physical examination reveals to them the multifaceted Canadian demographics profile of the client. Students learn to identify concerning Canadian statistics symptoms and signs, lifestyle practises, unexpected findings, Techniques for obtaining objective data and a nursing diagnosis that considers the client holistically.

Recording and analyzing client findings The skills that allow them to assess all clients also shape the Interprofessional collaboration image of the unique human allowing them to conduct an as- Critical thinking sessment and provide care. Collecting a comprehensive client Citations and additional references history begins to reveal the individual as that unique human Alignment with evidence from the health care literature being.

During the history interview, students and nurses in Relevant Canadian associations and Web sites practice become aware of areas for health promotion, iden- Canadian research related to health assessment. Health Assessment, the foundation for the application of The techniques of physical examination and history tak- health promotion in health assessment by nurses. This ing embody time-honoured skills of healing and client care. Chapter 2, Cultural Consi- direction for clinical thinking.

The quality of the history and derations in Health Assessment, introduces the concept of physical examination governs the next steps with the client cultural safety and describes how every clinical encounter is and guides the choices for subsequent tests. These important cross-cultural, involving differences between nurse and relational and clinical skills contribute to the development of client.

It provides learners with the current discussion on accomplished clinicians. Chapter 3, The Health talk with clients, collect subjective data, perform physical ex- History: Subjective Data, guides students through the tech- aminations, and apply clinical reasoning to understand and niques of skilled empathic interviewing, with a special focus assess client concerns.

Sections of this edition will also be on ethics, and encompasses the vital components of a health useful to nurses in practice, including nurse practitioners. Chapter 4, The book is divided into three units to facilitate learning: The Physical Examination: Objective Data, introduces the Foundations of Health Assessment, Regional and System Ex- essential elements for proceeding with the physical examina- aminations, and Special Populations. Five original chapters in tion. It includes the principles of the four basic examination this first Canadian edition encompass health promotion, cul- modes: inspection, palpation, percussion, and auscultation, ture, pain, nutrition, and documentation.

An original section and provides the beginner with an understanding of the on psychosocial assessment has been added. The chapter also contains information provide critical concepts that cross-cut all subsequent chap- about sequences for comprehensive and focused physical ex- ters. Key features of Chapters 3 through 25 are: aminations. Chapter 5, Documenting and Analyzing Find- Collection of subjective data ings, details the fundamentals of documentation, including Key symptoms and signs reported by clients the principles and methods for developing the written record.

It presents guidelines for and physiology related to pregnancy, and risks. The final documentation, types of documentation systems, and an ac- chapter, Assessing the Older Adult, outlines the approach to tual written record. Chapter 6, General Survey and Vital the heterogeneous older adult population in Canada, and Signs, provides guidance for the traditional vital signs and details techniques for promoting the special goals related to incorporates the new fifth and sixth vital signs.

Chapter 7, aging: maintaining health, social well-being and optimal lev- Pain Assessment, presents the current theory for addressing els of function, and delaying unnecessary depletion of phys- pain, available assessment, and the subjective and objective iologic and cognitive reserves. Chapter 8, Nutritional Assessment, considers Learners are expected to have had basic courses in human the digestive process, Canadian guidelines, measurements, anatomy and physiology.

The sections on these subjects in and approaches to assessing nutritional status, including the chapters of Unit II are intended to help students apply food intake and activity. Chapter 9, Psychosocial and Mental this knowledge to interpretation of symptoms, client exam- Status Assessment, is foundational to every encounter ination, and understanding of physical findings. Occasionally, a physical sign of a rare con- ronments. These chapters are arranged in the head-to- client.


When conducting a focused physical by practising on each other. The chapters then This first Canadian edition for nurses introduces new con- continue with the techniques of examination, including ex- tent and approaches that build on Bates Guide to Physical Ex- pected and unexpected findings, and examples of documen- amination and History Taking. This content springs from tation for the focus of the chapter. Each chapter closes with the learning needs of nursing students and our approach as tables to help students recognize selected unexpected find- nurse experts teaching health assessment.

Our goal is to cap- ings and their implications. Unit II contains: italize on Bates high quality content on physical examina- tion and history taking, and tailor the book for nursing and Chapter The Skin, Hair, and Nails the Canadian context. The foun- Chapter The Thorax and Lungs dational chapters on health promotion, culture, health Chapter The Cardiovascular System history, physical examination modes and anatomical vocab- Chapter The Breasts and Axillae ulary, documentation, current approaches to general survey Chapter The Abdomen and vital signs, pain assessment, nutritional assessment, and Chapter The Peripheral Vascular System psychosocial and mental status assessment provide additio- Chapter The Musculoskeletal System nal substantive content to the Bates Guide to Physical Chapter The Nervous System Examination and History Taking.

Each chapter reflects an evidence-based perspective, In Unit 3, Special Populations, learners will find chapters listing key Canadian citations and references where possible relating to two special stages of the life cycle: pregnancy and as well as relevant Canadian associations and Web sites. All aging. Chapter 24, Assessing the Woman Who Is Pregnant, tables are vertical so readers can page through the chapters contains Canadian guidelines for nutrition, supplements, and easily.

Physiology, Health Promotion, Screening, Prevention, His- It is essential that students learn to integrate the clients tory, Techniques of Examination, Examples of Documenta- story and the clients physical findings. Students will benefit tion, and a Case Study with Critical Thinking questions that by studying the relevant portions of the Health History as address knowledge, comprehension, application, analysis, they learn successive parts of the examination.

In a few areas, synthesis, and evaluation. For example, chest pain prompts evaluation of the particular symptoms. For example, headache is presented cardiovascular, musculoskeletal, and respiratory systems. The in Chapter 11, Head and Neck, while diarrhea is addressed symptoms of the urinary tract are relevant to the chapters on in Chapter 17, The Abdomen. The sections on Important the abdomen, the prostate, and the male and female genitalia. They also may refer frequently to the sec- Colour demarcates chapter sections and tables clearly, tions on Recording and Analyzing Findings that display leading students to insets of key material and special tips for selected examples related to the focus of each chapter.

This challenging aspects of examination and considering comfort, cross-checking will help students learn how to describe and dignity, and safety during the physical examination. Cana- organize information from the interview and physical exam- dian photographs and drawings have been added to better il- ination into an understandable written format. Further, lustrate key points. They can study the Cana- Skimming the Tables of Unexpected Findings makes stu- dian demographics and statistics, important topics for health dents more familiar with what they should be looking for and promotion, common concerning symptoms and signs re- the rationale for asking certain questions.

Students should ported by clients, cultural considerations, and Canadian not try to memorize all the detail that is presented. The best guidelines. They can review Techniques of Examination to time to learn about unexpected conditions and diseases is learn how to perform the relevant examination, then practise when a client, real or described, appears with a concern.

Stu- it under faculty guidance, and review it again afterward. Stu- dents could then use this tool to try to analyze the concern dents and faculty will also benefit from identifying common or finding, and make use of other clinical texts or journals to unexpected findings, which appear in two places. The right- pursue the clients situation in as much depth as is necessary. These are highlighted and Canadian Associations and Web Sites at the end of each in red and linked to the adjacent text.

Distinguishing these chapter for additional relevant sources. These tables display or describe various unexpected Faculty and teachers can turn to resources available on conditions in a convenient format that allows students Lippincotts ThePoint Web site. Students becoming proficient at interviewing are Glass of water advised to return to Chapter 3, The Health History: Sub- Tongue depressors jective Data, as they gain experience talking with clients of Ruler and flexible tape measure marked in centimetres different ages and emotional states.

Stethoscope with the following characteristics:. Ear tips that fit snugly and painlessly. To get this fit, Vaginal specula choose ear tips of the proper size, align the ear pieces Equipment for cytologic and perhaps bacteriologic study with the angle of your ear canals, and adjust the spring Reflex hammer of the connecting metal band to a comfortable tight- Tuning forks, one of Hz and one of Hz or ness.

Health promotion is a key concept in nursing and the other health sciences. Promoting health is at the heart of all nursing activities in every setting and is one of the four core metaparadigm concepts of nursing. Health promotion is conceived of in many different ways. It is not easily defined, and setting, time, academic discipline, and societal factors influence how it is put into practice. In Canada and Canadian nursing, the understanding of health promotion has evolved over time.

A brief history of the different approaches to health in Canada and a description of the characteristics of health promotion provide a foundation for the application of health promotion in health assessment by nurses. The Canadian nursing perspective on primary health care PHC is consistent with many global initiatives for health. Conceptualizations of health and its determinants influence the scope of Canadian nursing practice. Each approach takes a different view of health and its determinants; all three are important.

Medical Approach. A medical approach usually is associated with a biomedical definition of health as the absence of disease. The focus is on illness care, and the underlying assumption is that the major determinant of health is a good health care system. While a health care system is important, this approach does not emphasize a holistic view of health, nor does it focus on keeping Canadians well. Globally, it has become obvious that increasing the funding for curative care systems does not appreciably improve the health of populations as a whole. Nurses use the medical approach during the health history when they ask clients about their medications, how they take them, and what effect medications have.

During the physical examination, nurses use this approach when they observe for expected and unexpected findings. In Canada, the Lalonde Report introduced the concept of four influences on health: biology, environment, lifestyle, and health care organization. This report was heralded as a major breakthrough in the analysis of determinants of health and is recognized as the beginning of health promotion in Canada. By , the Canadian government had created a Health Promotion Directoratethe first of its kind in the world Pinder, Directorate activities tended to focus on lifestyle issues, particularly choices regarding tobacco, alcohol, drugs, nutrition, and exercise, to the exclusion of other determinants, especially environments.

The Lalonde Report ushered in the behavioural approach to health, with an emphasis on personal health practices as major health determinants. Nurses subsequently directed their primary strategies for enhancing health toward promoting healthy lifestyles and decreasing risk behaviours. They emphasized health-education approaches e. In health assessment, nurses assess many lifestyle practices while taking the comprehensive health history. For example, they inquire about exercise, breast or testicular self-examination, alcohol and drug use, skin protection, tobacco use, spirituality, dental care, use of protective devices in sports and recreation, and nutrient intake see Chapter 3.

When conducting physical examinations, nurses look for correlated subjective and objective data. These include taking height, weight, and vital sign measurements, and assessing for needle tracks, inspiratory wheezes, staining of fingers from nicotine, dental caries, skin lesions, and breast or testicular lumps see Chapters 6, 10, 13, 14, 16, and Critics of the behavioural approach fault its lack of attention to the direct and indirect influence of social and environmental factors on health through health practices. Risk behaviours actually may serve as coping strategies for people who must manage the stress of unhealthy living and working conditions over which they have little control.

For example, low-income women may use smoking as a coping strategy to manage the stresses associated with poverty Stewart et al. A socioenvironmental or ecological approach a social view of health and health promotion recognizes that the root causes of ill health reside in societal structures and environments. This approach emphasizes psychosocial factors e. The view of health is in positive, holistic terms rather than simply the absence of disease. The Ottawa Charter introduced an ecological view of health. This watershed document was the outcome of the first international conference on health.

The authors considered health to be the ability to satisfy needs, realize their aspirations, and deal with the environment. They labelled the determinants of health as prerequisites for health and defined health promotion as a process of enabling people to increase control over, and to improve, their health WHO, , p. Following the physical examination, they record and analyze findings in the context of the clients socioenvironmental conditions.

Not all definitions of health promotion reflect a socioenvironmental or ecological approach to health. The process of enabling people to increase control over, and improve, their health Most cited definition of health promotion WHO, , p. Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. Participation is essential to sustain health promotion action Nutbeam, , p. In Achieving Health for All: A Framework for Health Promotion Epp, , the Canadian government identified three major challenges to achieving health: reducing inequity, increasing prevention, and enhancing coping.

Nurses confronted these challenges and used the strategies proposed in the document in various settings. The government established Health Promotion Centres in six Canadian universities. Nevertheless, health promotion in Canada continued to concentrate on health education and lifestyle change Pinder, In a population health approach, planning to improve health considers all known factors, conditions, and. It emphasizes the use of epidemiological data to determine the causes of health and disease. In health assessments, nurses consider Canadian statistics on preventable disorders to identify risk factors relevant to their clients health.

By , Health Canada had profiled 12 determinants of population health, as shown in the accompanying table. These include individual factors personal health practices, individual capacity, and coping skills and population-level factors social, economic, and physical environments, and health services, which are viewed as foundational to individual factors ACPH, By , the Population Health Directorate had replaced Canadas Health Promotion Directorate and the population-health approach was guiding health policy in Canada Pinder, The Toronto Charter on the Social Determinants of Health contains a somewhat different view of what determines health Raphael et al.

This conceptuali- zation focuses on the influence of economic and social policies on the distribution of resources in society. The authors go beyond individual responsibility to societal responsibility for health and provide direction for policy advocacy by nurses. Support a holistic approach physical, mental, social, Use knowledge from various sources, including ecological, cultural, and spiritual aspects of health. Health promotion embraces core values such as empowerment, participation, and sense of control by ordinary people.

Health promotion emphasizes equity, social justice, and the common good CPHA, The prerequisites for health from the Ottawa Charter are very inclusive and convey a strong societal responsibility. The population health determinants from the Public Health Agency of Canada PHAC are fairly comprehensive and include both individual and societal factors. The PHAC Web site provides an excellent discussion of each and includes Canadian evidence for the effects on health see also Reutter, The social determinants of health from the Toronto Charter are consistent with other formulations and evidence, as well as with lay understandings of what determines health.

They align with existing Canadian government structures and policy frameworks, and are therefore relevant to Canadian decision makers and citizens. The social determinants make apparent those areas where there is either active governmental policy activity or inactivity Raphael, , informing nurses who are involved in political action. Understanding the relationships promotes more sensitive, nonjudgmental, and appropriate questioning and counselling during health assessment.

Nurses consider how income, culture, education, age, gender, social support, working and living conditions, and environments influence personal health practices and coping skills. They also appreciate that such factors may be beyond the control of clients and instead are determined by government policies. In health assessment, nurses use questioning to explore the influence of these broader social and physical environments on individual health. The health information or counselling they provide is relevant to the context of clients daily lives, and recognizes physical and psychological barriers to client engagement in health practices.

By understanding the root causes of health situations and the role of contextual factors on individual health, nurses strive to influence these determinants directly. The nursing scope of practice incorporates multiple strategies that go beyond individual client assessment to influence programs, services, and policies with effects on individual health. Nurses work collaboratively with other.

Nurses advocate for strategies that promote health locally in their organization, regionally in their political jurisdiction and health authority, provincially or territorially with their professional organizations, and nationally with nongovernmental organizations NGOs and federal bodies. All five strategies in the Ottawa Charter are within the scope of nursing practice.

Develop Personal Skills. Nurses know this strategy very well. The focus is on helping clients to develop personal health practices and to enhance coping skills as a result of health education that emphasizes client knowledge for directing choices and actions. Health education to individuals and groups is the traditional health promotion strategy that nurses use. For example, they provide information in diverse areas such as nutrition, physical activity, and parenting. They help clients to acquire adequate resources and supports for carrying out health recommendations. On a broader scale, nurses use social marketing to influence health behaviours widely and often incorporate media messages.

Create Supportive Environments. Nurses work with others to ensure healthy and safe physical environments as well as stimulating and satisfying living and working conditions WHO, Supportive environments can influence health and health practices directly, and nurses counsel clients to access and evaluate available programs. Reorient Health Services. Currently, health services in Canada and other high-income countries focus disproportionately on illness care.

Many health professionals, including nurses, focus more on health promotion, illness prevention, and assisting clients living with chronic illness than on curative care. One example of reorienting health services is a PHC system that ensures more equitable access to health care and health promotion. More attention to the provision of health care services in the home is another example. In addition, local and regional health services in many areas of Canada support the establishment of primary care networks as reoriented services Health Council of Canada, These interprofessional and multidisciplinary centres offer preventive, therapeutic, and emergent services at a single site.

Strengthen Community Action. Health is created and sustained in community relationships CPHA, Community development is a strategy for health promotion that emphasizes empowerment. Health professionals work with communities to increase their capacity to identify areas to enhance health. They work with other sectors to facilitate change. Involvement of communities in their own issues leads to more relevant and sustainable health programs, services, and policies.

Neighbourhood Watch is one widely established initiative that enhances neighbourhood safety and is active in many cities and towns across Canada. Build Healthy Public Policy. Policy advocacy is a legitimate nursing role increasingly incorporated in Canadian documents on nursing standards, competencies, and scopes of practice.

Advocating healthy public policy is the broadest and most effective way to address the determinants of health. It has been identified as a priority strategy for health promotion CPHA, and is at the foundation of all other strategies. Because policies in many nonhealth sectors e. For example, by establishing a policy that bans the use of trans fat in industrially produced foods, the healthier choice becomes the easiest choice for individuals and their families.

The Toronto Charter determinants specifically focus on areas that policy advocacy can address. Policies that affect health include adequate and affordable housing, child care, living wages, adequate welfare incomes, and progressive taxation. Develop Personal Skills With seniors Steady As You Go, a widely disseminated Canadian program, has reduced falls effectively in community-dwelling seniors.

Trained facilitators offer it to small groups of seniors with support from a health professional, usually a nurse. Seniors learn to identify their personal risk factors for falls and then to implement their own strategies to reduce their risks. With the general population The Act Now BC campaign promotes healthy living through partnerships with government and organizations in health, education, agriculture, and sports. Initiatives targeted to the general population range from social-marketing campaigns on lifestyle practices e. Interdisci-plinary collaboration from teachers, nutritionists, dental therapists, nurses, and community health representatives promoted the contest, which offered strong educational component.

Create Supportive Environments In the workplace The Innovative Workplace Health Initiatives project, consistent with a workplace health- determinants approach to workplace wellness, was launched in diverse corporate, industrial, and health care organizations in British Columbia, Saskatchewan, Manitoba, Ontario, Nova Scotia, and New Brunswick. The emphasis is on healthy physical work environments, physically healthy employees, and healthy social environments that support employees at work and in worklife balance. This is highly relevant to nursing practice from the perspective of nurses in occupational settings, as well as nurses in health institutions Sangster, The program helps communities, businesses, and organizations provide services in a way that meets the needs of seniors and ultimately will improve their quality of life.

The program has several components. Its steering committee reflects a wide range of sectors and disciplines, including a PHN specializing in health promotion of older adults www. Reorient Health Services To address accessibility Nurses are integrally involved in the expanding use of communication technology to ensure accessible health services, particularly for rural and remote communities.

For example, the National Telehealth Project implemented and evaluated initiatives in First Nations communities in British Columbia, Alberta, Saskatchewan, Manitoba, and Quebec that enhanced health service delivery and shared health information and expertise. In several provinces, nurses are involved in telephone health information services such as Health Link in Alberta and BC NurseLine in British Columbia, which provide topical health information, identify relevant symptoms, and assist clients to make decisions about seeing a health care professional.

They focus on health promotion in its widest sense, with an emphasis on meeting the prerequisites or determinants of health beyond illness care. Strengthen Community Action For food security Advocacy, networking, and coalition building are strategies used to address food-security issues, commonly leading to the development of collective kitchens and community gardens.

In Qubec, the collective kitchen strategy has flourished for more than 2 decades, and a provincial lobby coordinates activities. The Calgary Health Region provides training sessions for people to become collective kitchen coordinators. Community garden initiatives are supported in urban centres such as Toronto, Ontario, and Victoria, BC, contributing to food security for participants and opportunities for collective community action to address social concerns. Nurses can share information about these programs with their clients during health assessments.

In public health services and nongovernmental organizations NGOs , nurses work closely with communities to develop and sustain these programs. For physical activity The PEI Active Campaign began in to create friendly competition among 12 communities for physical activity. All types of physical activity e. In , the campaign broadened to pair Prince Edward Island communities with those across Canada.

Build Healthy Public Policy To promote safety The rural culture of Newfoundland and Labrador fosters widespread recreational use of all-terrain vehicles ATVs by children and adults, who often fail to wear helmets during use. Statistics on injuries and deaths related to ATVs are alarming. Nurses in this province actively participated in the lobby for legislation on safer use of ATVs, which the Depart- ment of Government Services passed in The legislation mandates use of helmets with ATVs, avoidance of public roads and highways, abstinence from alcohol while driving, and minimum age of 16 years for drivers of adult-size ATVs.

To reduce homelessness Cathy Crowe, a Toronto Street Nurse, advocates tirelessly to reduce homelessness. She co-founded the Toronto Disaster Relief Committee TDRC , which succeeded in declaring homelessness in Canada a national disaster, and advocates on numerous issues related to the health of homeless people. Presented below is the original model that was subsequently augmented to include three additional determinants of health: culture, gender, and social environments. Values Values and d Assumptions Assumptions. This model aligns with nurses understanding of what determines health and how they can influence health status.

Recognizing that citizens are likely to be healthy when they live in healthy communities, the provincial government developed an action plan using a population- health approach.

Practical Nursing - Semester 1

It defined 3-, 5-, and year outcomes for four priority areas for action: mental well-being, accessible nutritious food, decreased substance use and abuse, and active communities. Its writers affirmed the Ottawa Charter prerequisites for health see pp. They declared poverty to be the greatest threat to health. Perhaps what is new in this document is its emphasis on the role of the private sector in health promotion. The Declaration presents several priorities for action: promotion of social responsibility for health in public and private sectors, increased investments for health in all sectors, consolidated and expanded partnerships for health at all levels of government and in the private sector, increased community capacity, individual empowerment, and adequate infrastructure for health promotion.

Its authors recognize health as encompassing well-being, both mental and spiritual. The charter identifies several critical factors influencing health:. The charter highlights the vulnerability of children and the exclusion of margina- lized, ability-challenged, and indigenous peoples. The authors emphasize the need for strong political action, broad participation, and sustained advocacy.

The countries that subscribed to the charter committed to making health promotion central to global development and a core responsibility for all governments for the purpose of capacity building and empowering communities with adequate resources. The charter emphasizes securing corporate sector commitment to maintain health- promoting workplaces and ethical business practices.

Among them are NGOs, government agencies, and professional organizations. Its mission is to advocate for individual and community health according to the public health principles of health promotion and protection, disease prevention, and healthy public policy see www. With the support of Health Canada and stakeholders across Canada, the CPHA produced the seminal document Action Statement on Health Promotion , outlining important concepts and principles of health promotion and priority health promotion strategies from the Ottawa Charter. The federal governments Health Canada is involved in the delivery of health promotion programs, which inform nurses who counsel individual clients regarding preventable disorders www.

Two prime examples are the Federal Tobacco Control Strategy and the Canadian Diabetes Strategy, which incorporate intersectoral collaboration. The priorities are to identify people at risk, develop awareness and prevention programs, and provide training for caregivers. Programs with strong government support include the Canadian Health Network; a bilingual Web-based information service that covers an extensive list of health topics to help Canadians make healthy choices as of April , this service is now incorporated into the PHAC Web site ; and the Pan-Canadian Healthy Living Strategy, which addresses risk factors contributing to noncommunicable diseases.

These resources help nurses to provide accurate and current information during individual health assessment. Raphael suggests that more support for policies that address the social determinants of health is needed to reduce health inequities in Canada today. In response to catastrophic public health events e. The PHAC focuses on the five essential public health functions: health promotion, health protection, health surveillance, disease and injury prevention, and population health assessment.

The PHAC also led the development of public health goals for Canada, reflecting a broad vision of health congruent with health promotion, and created the Pan- Canadian Public Health Network. This network facilitates collaboration and sharing of public health expertise among provincial and territorial jurisdictions. Six expert groups have been established to address public health issues, including health promotion see www. Provincial and national nursing organizations are ideally positioned to advocate for healthy public policy and to reorient health systems in the direction of PHC.

It is a national network nonprofit organizations, professional organizations, health charities, and academic researchers formed to influence public policy for sustaining the health of Canadians. The WHO Commission on the Social Determinants of Health, established in , has the mandate to recommend interventions and policies that narrow health inequities through action on the social determinants of health. Monique Begin and Mr. Stephen Lewis represent Canada, which funds three of the nine knowledge networks: early child development, globalization, and health systems. The commission held its eighth meeting in in Vancouver, BC.

A PHC approach includes first-level primary care basic medical. The principles most often associated with PHC are as follows:. Accessibility to essential, comprehensive health care services for all people, with no unreasonable geographic, financial, or cultural barriers. Public participation by individuals and communities in decision making about their health care and the health of their communities.

Health promotion involving activities related to health education, illness prevention, policy advocacy, and strong community participation. Appropriate technology so that methods of care and service delivery are socially acceptable and affordable.

Intersectoral and interdisciplinary cooperation to address health determinants CNA, Although primary care and primary health care are often used synonymously, traditionally, primary care has been provider-driven, institutionally oriented, and individually focused with an emphasis on clinical diagnosis and treatment service provision.

Under a PHC umbrella, primary care would incorporate health determinants, health promotion, preventive health care, clients as partners in care, and meaningful community agency relationships to facilitate accessibility and referrals CNA, Nurse scholars Hills et al. They suggest that health promotion and PHC could be integrated through interprofessional education and multidisciplinary teams in community health practice.

These organizational structures are beginning to take hold in several Canadian provinces, primarily as a result of the federal government Primary Health Care Transition Fund Health Council of Canada, The emerging role of nurse practitioners in reoriented health systems is promising, provided that they maintain a strong health promotion focus. The nurses value base aligns with that of health promotion: client participation, empowerment, and equity Hills et al.

Settings represent health-influencing environments, based on the belief that individuals are in dynamic transaction with their sociophysical milieu Kalnins, The resources available in the social settings where individuals act and live affect the potential for social systems, including health promotion programs, to promote health-enhancing behaviours in these same clients.

By integrating settings in the health history, nurses consider each client not only as an individual but also as a member of groups or populations in different social and physical environments. This dual perspective increases awareness of the environmental conditions and broader determinants of health that shape clients health experiences.

It is consistent with a socioenvironmental or socioecological perspective of health promotion and avoids limiting individual-focused practice to biomedical intervention and behaviour change. Five different settings that nurses need to consider in health assessments are schools, homes, workplaces, health care facilities, and communities. During the health history, nurses ask questions that capture the influence of the social and physical environments on client health in these settings see Chapter 3.

The social environment incorporates culture, income and social status, gender, social support and inclusion, empowerment, personal health practices, and coping skills. The physical environment includes the physical structure of the environment and health services. Children, adolescents, and young adults spend considerable time each day under the influence of schools or postsecondary institutions.

School environments are influential on the quality of education, which is a highly significant determinant of health and well-being. Worldwide, numerous programs and initiatives aim to provide supportive healthy educational settings. This multifactorial approach includes teaching health knowledge and skills, changing the social and physical environments of the school, and creating links to the wider community Health Evidence Network, It is particularly effective in promoting mental health, healthy eating, and physical activity Health Evidence Network, Supportive school environments that foster resilience and focus on asset development, protective factors, and social connectedness reduce the risk of health-related problems and support the healthy growth and development of children and youth Canadian Consensus Statement, , p.

It incorporates four main components:. Formal and informal teaching and learning about health, health risks, and health issues. Health and support services for early identification and treatment of problems that can influence learning e. Supportive social environments e. Healthy, clean, and safe physical environments, including opportunities for physical activity and healthy nutrition Canadian Consensus Statement, The health promoting university initiative emerged in The Edmonton Charter for Health-Promoting Universities and Institutions of Higher Education Health Promotion and Worklife Services, includes goals, principles, and priorities for educational institutions to be healthy learning and working environments.

The focus is to help people develop personal health practices and coping skills through education and environmental conditions that are appropriate and safe for everyone. During comprehensive health histories with youth or young adults, nurses consider social and physical factors in the learning environment that may influence health. In addition to the general setting questions, they also inquire about specific school setting topics. If clients have a chronic health condition or disability e. Does he or she How available are mental health services e.

What friends does the client have at school? How To what extent are there adequate and safe physical included does he or she feel in school and extra activity facilities and programs that provide opportu- curricular activities? This may be particularly important nities for physical activity including sports and extra- when considering the effects of income and culture. How healthy is peer support? To what extent are foods low in nutritive value How much support do teachers provide to the client? Do school discipline policies and effective manage- What written policies exist for the administration ment practices convey respect?

An integrated health assessment includes individual behaviours, interpersonal family relations, and physical home conditions. Research has shown that characteristics of the family, socialization, and interactional processes are associated with health-related behaviours including nutrition, physical activity, risk taking, and coping responses. Assessment of the family context is relevant to enhancing individuals social, emotional, spiritual, and physical well-being Ford-Gilboe, In addition to consideration of the family as a social environment, the physical environment in which the family lives is important.

Home safety is a major issue for health promotion. Injury statistics indicate that the home is not a particularly safe. What are the effects on the individual? To what extent are family members a source of social What aspects of the broader context of family life support for the client? What are the health practices and beliefs, values, and Can the individual afford adequate housing?

What are the exercise, nutrition, and hygiene practices of the family? Employment and working conditions are recognized as a health determinant and as a setting in which other health determinants are influential. Healthy workplaces contribute to individual well-being by preventing occupational disease and injuries, promoting positive lifestyle behaviours, and enhancing workforce well- being and productivity. A healthy workplace promotes job satisfaction, retention, quality performance, and reduced costs related to injury, worker compensation claims, and health benefit claims Lowe, The workplace as a health promotion setting incorporates both the physical and the psychosocial environments Polanyi et al.

The physical environment includes the building or space in which work is conducted as well as the work processes and products. The psychosocial environment reflects the organizational, economic, legal, cultural, ethical, and political context of the workplace. Elements of a healthy workplace include environmental and occupational health and safety programs, health and lifestyle practices, workplace culture, and supportive environments National Quality Institute, Research suggests that health outcomes among workers are linked to the content, organization, and arrangements of paid work Polanyi, Healthy workplaces provide job and employment security, safe physical conditions, a reasonable work pace, low stress, opportunities for self-expression and individual development, participation, and worklife balance Jackson, In contrast, unhealthy work conditions include dirty and dangerous jobs e.

In recent years, Canada has given priority attention to working conditions in the health care sector. Nurses need to consider the workplace from four perspectives: 1 as providers of client care, 2 as employees, 3 as managers of personnel, and 4 as members of a professional organization. The leadership of the Office of Nursing Policy at Health Canada has examined several reports on the health care sector:. Three approaches to workplace health promotion have emerged in Canada. They provide a useful framework for nurses to determine areas for client assessment, because they exemplify how the social and physical environments of the workplace influence individual health: Occupational health and safety traditionally emphasizes health protection, safety, and reduction of biological, chemical, ergonomic, physical, and psychosocial hazards and risks in the workplace setting.

Workplace health promotion initiatives broaden the individual worker focus to include healthy lifestyles, education, and resources in the workplace e. Most recently, the promoting workplace determinants approach further extends initiatives to consider organizational factors i. The focus is to reduce stress and improve employee well- ness, including flexible work hours, worksite redesign, enhanced supervisor skills and practices, office communications, educational advancement opportunities, and familywork or worklife on-site provisions e.

This approach considers individual job factors such as control and decision latitude, the nature and structure of work includes psychological strain , physical demands, pace and volume of work, repetitiveness of tasks, and skill range used. Organizational factors at the unit or company level include remuneration and benefits, worker participation in decision making, management philosophy, and the structure of personnel relations Polanyi et al.

Are they equipment e. What physical demands are involved in the particular How well does the client relate to co-workers and work performed? Is the pace, volume, or repetitive- managers? How are concerns addressed? What job factors influence individual sense of well- Are Material Safety Data Sheets available for haz- being e. What policies are in place to reduce exposure to What engineering controls e.

This was in response to social conditions such as changing morbidity and mortality patterns, the consumer movement for informed decision making, and political support for reorienting health services to be consistent with a determinants- of-health perspective and focus on health promotion Johnson, Health care facilities often are assumed to be a positive influence on health, but a settings approach challenges this belief.

Consumers and health professionals have increased awareness of the potential for health-compromising conditions as well. Although health care institutions are typically defined by their focus on providing acute care, long-term care, psychiatric care, and rehabilitation Johnson, , settings include community-based facilities, such as retirement residences that also deliver health care. Of particular interest is health promotion for clients who receive health services and residents who receive broader health services.

The WHO advocated for a health-promoting hospital framework in Such a framework focuses on client well-being, organizational practices to support inter- professional collaboration, and contributions to community and public health Whitehead, It has implications for a more inclusive or holistic perspective of the health experience beyond acute episodes of care. This means that clients are provided with health education to assist them in coping with their health situation after discharge, enhancing self-care and health behaviours.

A health-promoting hospital environment also enables clients to be involved in decision making about their care. Long-term care or nursing home settings provide a unique opportunity for nurses to focus on health promotion. These settings are home for clients, in contrast to acute care institutions where discharge to the community is the goal. The professional-centred work focus of this setting may contribute to social isolation for the resident, role ambiguity among family members, and stress for everyone Logue, Promoting cooperative staff and family activities provides opportunities to integrate the family unit into resident care and enhance well-being.

Activities to promote family stability and connectedness include encouraging continuity in family caregiving activities; providing opportunities to maintain emotional bonds; giving access to communi- cation media, including computers for residents; and providing private areas for celebration of family events or meals.

A family-centred nursing approach fosters family relationships in nursing homes; may prevent deterioration in family ties; and provides emotional, spiritual, and health benefits to both the family system and the older adult who is institutionalized Logue, Retirement communities are distinctive settings that integrate housing and programs to promote the health, well-being, and social functioning of residents. They provide independent and assisted-living programs for older adults, including a range of food, social, recreation, housekeeping, personal care, and wellness services Young et al.

Residents range from healthy older adults to frail older adults with complex health problems. The scope of services includes health care, as well as daily living issues related to meals, social engagement, and activity. Nurses health assessment of residents should consider the social and physical environmental determinants of health. In health-promoting health care facilities, outcomes should focus on assisting people to increase control over their health.

This may include situational control, self-efficacy, enhanced self-care, enhanced self-concept, improved pain control,. Comprehensive health assessment by nurses identifies institutionalized client and resident concerns and the potential for health promotion.

Health Assessment Resources

Canadian Bates' Guide to Health Assessment for Nurses: Medicine & Health Science Books @ Buy Canadian Bates' Guide to Health Assessment for Nurses: Read 1 Kindle Store Reviews -

Their assessment should consider selected, relevant aspects of the organization, the service providers, and the community of the clients or residents Johnson, Are these satisfactory to the difference in focus between acute care settings which the client? Is required assistance available when needed? How does the client relate with care providers in the Does the client have access to needed resources acute care, long-term care, or residential setting?

What social support does the client have from family What hygiene practices and policies are in place to and friends? How is the client involved in care decisions? Is oppor- What strategies are implemented to prevent, detect, tunity provided for involvement from family or sup- or treat health problems arising from the health facil- port a network? What opportunities for social interaction does the What supports would benefit the client on discharge client have? It is the setting in which we customarily act, associate with others, learn about life, and express our values.

It is here that we most strongly interact with our culture and with others cultures Raeburn, , p. Communities influence health. For example, an increased sense of community belonging has been linked to self-rated health Ross, The purpose of a focus on community in individual health assessment is to understand the community conditions social and physical environments that shape individuals health experience, especially the resources available and risks that may be evident in the community environment.

The Community Assessment Wheel is a useful framework for nurses to assess resources and risks Vollman et al. It addresses aspects of the physical environment e. Nurses also use this framework to explore the social environment of the community e. Nurses adapt their health assessment according to the individuals health situation, age, and other characteristics. What support networks does the client have in the What community conditions influence individual community? What community issues are identified and how do How suitable is the physical layout of the community they influence the individuals health experience?

Canadian Bates' Guide to Health Assessment for Nurses

What opportunities exist for participation in What services and resources are available to the community events, initiatives, and issues? The unhealthy Canadian workplace. In Population Health Promotion Model. Knowledge D. Raphael Ed. Toronto, ON: Canadian Scholars status of a single-parent mother? Comprehension Press. How would you incorporate a health-determinants Lowe, G.

Healthy workplace strategies: Creating perspective during a health assessment for an older adult change and achieving results. Ottawa, ON: The Graham living alone in her own home in the community? Application Stewart, M. Smoking among vironmental approaches to an individual health assess- disadvantaged women: Causes and cessation. Canadian ment. Analysis Journal of Nursing Research, 28 1 , Identify the advantages and the challenges to incorporat- ing a socioenvironmental or socioecological health promotion perspective in health assessment. Synthesis How will you evaluate the effectiveness of a health promo- tion perspective in your health assessment of a post- secondary student?

Test Questions community health nurse would begin by assessing the: a. To enhance personal health practices, the most b. A few nursing students revealed to a faculty advisor that c. Follow-up d. Further assessment showed that the students expressed their belief in the 2. During the initial stages of working with a group of single importance of maintaining good health practices, but that teenage mothers to improve their living circumstances, a most students had discontinued weekday efforts because. Faculty members supported the support for students.

To assess the need for health promotion among the d. Physical assessment and health history 5. From Question 3, the program planners work with the b. Individual student interview and questionnaire students and faculty to develop and implement a set of c. Review of literature and consultation with faculty strategies that provide students with alternatives such as d.

Walk-through of education facility and faculty peer support, life skills counselling, fitness activity groups, questionnaire and a social action student coalition. These strategies best reflect which of the Ottawa Charter strategies for health 4. Program strategies consistent with a socioenvironmental promotion? Building healthy public policy students in Question 3 would include: b. Creating supportive environments a. Developing personal skills and fitness.

Reorienting health services. Bibliography parent and two-parent families. Research in Nursing and Health, 20, Ezer Eds. Socioeconomic status and health: The challenge pp. American Psychologist, 49, Green, L. The settings Advisory Committee on Population Health. Strategies for approach to health promotion.

Poland, L. Ottawa, I. Rootman Eds. Thousand Oaks, CA: Sage. Beauvais, C. The well-being of children: Hamilton, H. Population health Promotion: Are there neighbourhood effects? Family Network. Calgary Urban Project Society. Taking action on population health: A Calgary, AB: Author.

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