Assignment 3- MHST601
Introduction
In September, I began a new chapter in my life with my return to school. After having been in the workforce for 14 years, I concluded that if I wanted to advance in my career in Public Health, I required a master’s level of education. This is something that I had contemplated on and off for many years, but something always prevented me from taking the leap. Now, my children were a little bit more independent, my husband’s career was advancing, and I felt it was time for me to put myself on the priority list as well. Over the past 13 weeks I have learned so much about myself as a professional and where and how I want to be viewed by others. I began to view social media as more than just a source of entertainment among friends. Weekly course activities gave me more knowledge around health equity and the challenges our vulnerable populations face within the Canadian healthcare system. Participating in forum discussions with peers from multidisciplinary backgrounds has really helped increase my understanding of multi-level influences on health within the Canadian health system.
Professionalism
In the first couple weeks of MHST601, I was tasked with reflecting on my professional identity and begin to examine what type of professional social media presence I wanted for myself. Booth and O’Connor (2017) examined the importance of using social media as an interactive tool to engage people to enhance learning. This has most definitely been true for me. I have seen first hand the benefits from engaging with my classmates on twitter in a variety on a variety of topics this term.
As a registered nurse, my professional practice is guided by my regulatory body- the College of Nurses of Ontario (CNO), my workplace policies and procedures and at my core they are influenced by my personal values and beliefs. Exploring these topics within this course has given me a better understanding of the role I play within the Canadian healthcare system. In 1991 we had the implementation of the Regulated Health Professions Act and the Nursing Act, which are pieces of legislation that look at how nursing is regulated in Ontario (Ministry of Health and Long-term Care, 2016). All these pieces together helped to create a strong foundation for the nursing profession, which I am proud to be a part of. As the term progressed and we explored many topics, it was my desire to learn how my role as a public health nurse could be better utilized to help increase health equity and better serve vulnerable populations in my area.
Determinants of Health & Chronic Disease
In 1948, the World Health Organization (WHO) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Constitution of the World Health Organization, 2006). In 2011, Huber argued that the WHO’s definition failed to address the changes facing the healthcare system. It was at this time that health professionals began to look at determinants of health and the role they play in an individual’s ability to achieve healthy outcomes.
During Assignment 2, I looked at asthma in school aged children and applied the social-ecological model (SEM) to get a multi-level perspective on this issue. Asthma is a chronic condition that significantly impacts the quality of life for individuals if not properly controlled. After completing my research for this assignment, I learned that change at many different levels can positively impact and change health outcomes for vulnerable populations. It was the advocacy and social media awareness after Ryan Gibbons death in 2012, that brought about new legislation in Ontario in 2015. This would create mandatory change in every school in the Province (Ontario law passes to let asthmatic kids carry inhalers in school, 2015). To learn more about this topic you can view my previous blog post found here.
Vulnerable Populations
Weekly coursework also challenged my classmates and myself to compare Provincial healthcare, programming/services, funding and data while examining a health issue. Sonia Kandola and I looked at Gestational Diabetes Mellitus (GDM Ontario vs. Alberta. The provinces were very similar in their delivery of care and supports during pregnancy and the postpartum period but when I looked deeper at this topic and examined its impact on Indigenous women, I found that regardless of the geographical location within Canada, this group was at a greater risk of complications. In general, GDM occurs in 2-4% of all pregnancies in Canada, however rates for First Nations women have been reported to range from 8-18% (First Nations Centre, National Aboriginal Health Organization, 2009).
Table 1: Summary of Effects of GDM on both Indigenous mother and baby. (First Nations Centre, National Aboriginal Health Organization, 2009).
The above table shows the risks that can occur when an Indigenous woman has GDM and the impact it can also have on her baby. Looking at this health issue through a SEM lens, I can see how a multi-level approach could positively impact this vulnerable population. Creating culturally safe and sensitive care for indigenous women in the area. Many First Nations individuals must travel a fair distance to connect with healthcare, resources and supports and this is also true during pregnancy. We need to create policy and increase funding to allow for appropriate resources to be established in First Nations communities.
One of my classmates, Sonia Kandola posted a resource in our forums from the Association of Ontario Midwives (2018), that Ontario only has 30 Indigenous midwives out of the over 800 who have registered with the College of Midwives of Ontario. Indigenous midwives are more aware of the cultural and therapeutic interventions that may benefit this population during pregnancy. Meeting a client in their environment, with reduce stigma, more familial support and education around cultural ceremonies, can provide better pregnancy and health outcomes not only for mother and child but the family in general (Association of Ontario Midwives, 2018).
Future Direction of Healthcare
When dealing with a population that is often isolated or in rural areas/reserves, it is hard to fully comprehend the depth of health inequity. As a registered nurse, I have had limited training and education regarding Indigenous health and culture. I take pride in knowing that I provide top quality care to all my clients yet if I am being completely honest with myself, I do not feel adequately informed about supporting and providing care to Indigenous clients. This is an area that could be incorporated in to our educational Institutions and should be a program requirement for all Canadian. We need to ensure all healthcare professionals receive training in providing culturally sensitive care.
The Romanow Report (2012), examined the future direction the Canadian healthcare system and provided insights into changes to Indigenous healthcare. It looked at a multi-level collaboration (Richmond & Cook, 2016). The Government of Canada (2011) has created the Aboriginal Diabetes Initiative, which provides yearly funding to support over 600 different programs for Indigenous people living with diabetes, including pregnant women diagnosed with GDM.
In addition to policy reform, education and increased funding to change the direction of healthcare, we must also look at the importance of technological advancements. It is important that a person has access to the right therapy, but also adheres to a treatment plan that incorporates lifestyle changes to help manage this disease. There are many issues that cause Indigenous people to be unsuccessful in achieving the right therapy. A few include: resistance to lifestyle changes, lack of education and limited access to resources and support (Bailey et.al., 2018). New technology provides an opportunity to improve the quality of life for these individuals and will allow healthcare provides to closely monitor their client’s glucose levels. This data that is captured can easily be shared electronically with the entire healthcare team. This is valuable to the Indigenous peoples that live in rural areas as it will reduce the need for face to face clinic visits, be more convenient to the client and be cost effective at the same time (Bailey et.al., 2018).
Conclusion
There is so much potential for improving the way we deliver care to Canadians, especially to those affected by health inequity and vulnerable populations. This course has opened my eyes to the changes I can advocate for in my own organization as well as changes I can easily make in my day to day practice with regards to health equity and cultural sensitivity. I will continue to use social media to connect and collaborate with other health professionals so that I can fully meet the values and professional identity that I have created for myself as a registered nurse.
References
Association of Ontario Midwives. (2018). Indigenous Midwifery. Retrieved from https://www.ontariomidwives.ca/indigenous-midwifery
Bailey, Timothy, S., Walsh, John. & Stone, Jenine, Y. (2018, June). Emerging technologies for diabetes care. Diabetes Technoogy & Therapeutics; 20(S2) pp 78-84. Retrieved from: https://www.liebertpub.com/doi/pdfplus/10.1089/dia.2018.0115
Booth, R. & O'Connor, S. (2017). Meaningful use of Twitter in nursing education may improve student learning and should be considered as a viable educational tool to assist in the development of digital professionalism. Evidence-Based Nursing; 20:28. Retrieved from https://ebn.bmj.com/content/20/1/28
Constitution of the World Health Organization. (2006, October). Retrieved from World Health Organization: http://www.who.int/governance/eb/who_constitution_en.pdf
First Nations Centre, National Aboriginal Health Organization. (2009, Dec.). Gestational diabetes and first nations women: A literature review. Retrieved from: https://www.saintelizabeth.com/getmedia/2a590b00-994e-4e9f-9c81-c00f33748aad/Gestational_Diabetes_LitReview_2009.pdf.aspx
Huber, M. (2011). Health: How should we define it? British Medical Journal, 343,(7817), 235-237. Retrieved from: http://www.jstor.org/stable/23051314
Ministry of Health and Long-Term Care. (2016) Regulated Health Professions Act, 1991.
Ontario law passes to let asthmatic kids carry inhalers in school. (2015, April 15). Retrieved from CBC News: https://www.cbc.ca/news/canada/toronto/ontario-law-passes-to-let-asthmatic-kids-carry-inhalers-in-school-1.3055534
Richmond, C. & Cook, C. (2016). Creating conditions for Canadian Indigenous health equity: the promise of healthy public policy. Public Health Reviews. 37:2. Retrieved from
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