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Shephard R, Uy J, Otterman V, Betker C, Sandhu HS, Tjaden L, Apatu E, Di Ruggiero E, Musto R, Pawa J, Steinberg M, Payne E, Fang L. The Core Competencies for Public Health in Canada: Opportunities and Recommendations for Modernization. J Public Health Manag Pract 2024; 30:432-441. [PMID: 38603751 DOI: 10.1097/phh.0000000000001884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
CONTEXT The 2008 Public Health Agency of Canada's (PHAC's) "Core Competencies for Public Health in Canada" (the "Canadian core competencies") outline the skills, attitudes, and knowledge essential for the practice of public health. The core competencies represent an important part of public health practice, workforce development, and education in Canada and internationally. However, the core competencies are considered outdated and are facing calls for review, expansion, and revision. OBJECTIVE To examine the literature on public health competencies to identify opportunities and recommendations for consideration when reviewing and updating the Canadian core competencies. METHODS This narrative literature review included 4 components: 3 literature searches conducted between 2021 and 2022 using similar search strategies, as well as an analysis of competency frameworks from comparable jurisdictions. The 3 searches were conducted in collaboration with the Health Library to identify core competency-relevant scholarly and gray literature published in English since 2007. Reference lists of sources identified were also reviewed. During the data extraction process, one researcher screened each source, extracted competency-relevant information, and categorized these data into key findings. RESULTS After identifying 2392 scholarly and gray literature sources, 166 competency-relevant sources were included in the review. Findings from these sources were synthesized into 3 main areas: (1) competency framework methodology and structure; (2) competencies to add; and (3) competencies to modify. DISCUSSION These findings demonstrate that updates to Canada's core competencies are needed and overdue. Recommendations to support this process include establishing a formal governance structure for the competencies' regular review, revision, and implementation, as well as ensuring that priority topics applicable across all competency categories are integrated as overarching themes. Limitations of the evidence include the potential lack of applicability and generalizability to the Canadian context, as well as biases associated with the narrative literature review methodology.
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Affiliation(s)
- Rosemarie Shephard
- Author Affiliations: Public Health Agency of Canada, Ottawa, Ontario, Canada (Mss Shephard, Uy, Otterman, Payne, and Fang); National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, Nova Scotia, Canada (Dr Betker, Mr Sandhu, and Ms Tjaden); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Mr Sandhu and Drs Di Ruggiero and Pawa); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Dr Apatu); Canadian Public Health Association, Ottawa, Ontario, Canada (Dr Musto); Division of Clinical Sciences, NOSM University, Sudbury, Ontario, Canada (Dr Pawa); and Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (Dr Steinberg)
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Benoit B, Cassidy C, Campbell-Yeo M, Gillis D, Kirk S, Sim SM, LeDrew M, Loring S, Tomblin Murphy G, Elliott Rose A, Betker C, MacKeen L, Arseneau L, Shebib K, Reid T, Daman R. Development of Interventions to Support Provincial Implementation of the Baby-Friendly Initiative: A Study Protocol. Nurs Rep 2023; 13:1731-1741. [PMID: 38133119 PMCID: PMC10745531 DOI: 10.3390/nursrep13040143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Breastfeeding is internationally recognized as the optimal form of infant nutrition. The Baby-Friendly Initiative (BFI) is an evidence-informed program that leads to improved breastfeeding outcomes. Despite the benefits of breastfeeding, Nova Scotia has one of the lowest breastfeeding rates in Canada. Additionally, only two birthing hospitals in the province have BFI designation. We aim to address this gap using a sequential qualitative descriptive design across three phases. In Phase 1, we will identify barriers and facilitators to BFI implementation through individual, semi-structured interviews with 40 health care professionals and 20 parents. An analysis of relevant policy and practice documents will complement these data. In Phase 2, we will develop implementation interventions aimed at addressing the barriers and facilitators identified in Phase 1. An advisory committee of 10-12 administrative, clinical, and parent partners will review these interventions. In Phase 3, the interventions will be reviewed by a panel of 10 experts in BFI implementation through an online survey. Feedback on the revised implementation interventions will then be sought from 20 health system and parent partners through interviews. This work will use implementation science methods to support integrated and sustained implementation of the BFI across hospital/community and rural/urban settings in Nova Scotia. This study was not registered.
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Affiliation(s)
- Britney Benoit
- Rankin School of Nursing, Faculty of Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada; (L.A.); (R.D.)
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.C.); (M.C.-Y.)
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.C.); (M.C.-Y.)
| | - Doris Gillis
- Human Nutrition Department, Faculty of Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada;
| | - Sara Kirk
- School of Health & Human Performance, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - S. Meaghan Sim
- Research, Innovation, & Discovery, Nova Scotia Health, Halifax, NS B3S 0H6, Canada; (S.M.S.); (G.T.M.)
| | - Michelle LeDrew
- Breastfeeding Committee for Canada, Glen Margaret, NS B3Z 3H8, Canada; (M.L.); (S.L.)
| | - Sally Loring
- Breastfeeding Committee for Canada, Glen Margaret, NS B3Z 3H8, Canada; (M.L.); (S.L.)
| | - Gail Tomblin Murphy
- Research, Innovation, & Discovery, Nova Scotia Health, Halifax, NS B3S 0H6, Canada; (S.M.S.); (G.T.M.)
| | | | - Claire Betker
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada;
| | - Leanne MacKeen
- Reproductive Care Program of Nova Scotia, Halifax, NS B3H 1Y6, Canada;
| | - Lindsay Arseneau
- Rankin School of Nursing, Faculty of Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada; (L.A.); (R.D.)
| | - Kim Shebib
- Public Health, Nova Scotia Health, Halifax, NS B3S 1B8, Canada; (K.S.); (T.R.)
| | - Trudy Reid
- Public Health, Nova Scotia Health, Halifax, NS B3S 1B8, Canada; (K.S.); (T.R.)
| | - Ripu Daman
- Rankin School of Nursing, Faculty of Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada; (L.A.); (R.D.)
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Sandhu HS, Otterman V, Tjaden L, Shephard R, Apatu E, Di Ruggiero E, Musto R, Pawa J, Steinberg M, Betker C. The Governance of Core Competencies for Public Health: A Rapid Review of the Literature. Public Health Rev 2023; 44:1606110. [PMID: 37767458 PMCID: PMC10520247 DOI: 10.3389/phrs.2023.1606110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Core competencies for public health (CCPH) define the knowledge, skills, and attitudes required of a public health workforce. Although numerous sets of CCPH have been established, few studies have systematically examined the governance of competency development, review, and monitoring, which is critical to their implementation and impact. This rapid review included 42 articles. The findings identified examples of collaboration and community engagement in governing activities (e.g., using the Delphi method to develop CCPH) and different ways of approaching CCPH review and revision (e.g., every 3 years). Insights on monitoring and resource management were scarce. Preliminary lessons emerging from the findings point towards the need for systems, structures, and processes that support ongoing reviews, revisions, and monitoring of CCPH.
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Affiliation(s)
- Harman Singh Sandhu
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NS, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Lynda Tjaden
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NS, Canada
| | | | - Emma Apatu
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Richard Musto
- Canadian Public Health Association, Ottawa, ON, Canada
| | - Jasmine Pawa
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Clinical Sciences, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
| | - Malcolm Steinberg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Claire Betker
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NS, Canada
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Haworth-Brockman M, Betker C, Keynan Y. Saying it out loud: explicit equity prompts for public health organization resilience. Front Public Health 2023; 11:1110300. [PMID: 37304086 PMCID: PMC10251661 DOI: 10.3389/fpubh.2023.1110300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction In the early days of the COVID-19 pandemic there were numerous stories of health equity work being put "on hold" as public health staff were deployed to the many urgent tasks of responding to the emergency. Losing track of health equity work is not new and relates in part to the need to transfer tacit knowledge to explicit articulation of an organization's commitment to health equity, by encoding the commitment and making it visible and sustainable in policy documents, protocols and processes. Methods We adopted a Theory of Change framework to develop training for public health personnel to articulate where and how health equity is or can be embedded in their emergency preparedness processes and documents. Results Over four sessions, participants reviewed how well their understanding of disadvantaged populations were represented in emergency preparedness, response and mitigation protocols. Using equity prompts, participants developed a heat map depicting where more work was needed to explicitly involve community partners in a sustained manner. Participants were challenged at times by questions of scope and authority, but it became clear that the explicit health equity prompts facilitated conversations that moved beyond the idea of health equity to something that could be codified and later measured. Over four sessions, participants reviewed how well their understanding of disadvantaged populations were represented in emergency preparedness, response and mitigation protocols. Using equity prompts, participants developed a heat map depicting where more work was needed to explicitly involve community partners in a sustained manner. Participants were challenged at times by questions of scope and authority, but it became clear that the explicit health equity prompts facilitated conversations that moved beyond the idea of health equity to something that could be codified and later measured. Discussion Using the indicators and prompts enabled the leadership and staff to articulate what they do and do not know about their community partners, including how to sustain their involvement, and where there was need for action. Saying out loud where there is - and is not - sustained commitment to achieving health equity can help public health organizations move from theory to true preparedness and resilience.
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Affiliation(s)
- Margaret Haworth-Brockman
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Claire Betker
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NS, Canada
| | - Yoav Keynan
- National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Clark EC, Cranston E, Polin T, Ndumbe-Eyoh S, MacDonald D, Betker C, Dobbins M. Structural interventions that affect racial inequities and their impact on population health outcomes: a systematic review. BMC Public Health 2022; 22:2162. [PMCID: PMC9685079 DOI: 10.1186/s12889-022-14603-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
AbstractStructural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 29 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that affect the structural determinants of health and health inequities and improve daily living conditions.
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Ndumbe-Eyoh S, Muzumdar P, Betker C, Oickle D. 'Back to better': amplifying health equity, and determinants of health perspectives during the COVID-19 pandemic. Glob Health Promot 2021; 28:7-16. [PMID: 33761795 PMCID: PMC7994919 DOI: 10.1177/17579759211000975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Equity and social justice have long been key tenets of health promotion practice, policy and research. Health promotion foregrounds the pertinence of social, economic, cultural, political and spiritual life in creating and maintaining health. This necessitates a critical structural determinants of health perspective that actively engages with the experiences of health and wellbeing among diverse peoples. The inequitable impacts of pandemics are well documented, as are calls for improved pandemic responses. Yet, current pandemic and emergency preparedness plans do not adequately account for the social and structural determinants of health and health equity. METHODS Through five one-hour online conversations held in April 2020, we engaged 13 practice, policy, research and community leaders on the intersections of COVID-19 and gender, racism, homelessness, Indigenous health and knowledge, household food insecurity, disability, ethics and equitable futures post-COVID-19. We conducted a thematic analysis of speaker and participant contributions to investigate the impacts and influence of COVID-19 related to the structural and social determinants of health. We analyzed which policies, practices and responses amplified or undermined equity and social justice and identified opportunities for improved action. FINDINGS Analysis of the COVID-19 pandemic revealed four broad themes:• oppressive, unjust systems and existing health and social inequities;• health and social systems under duress and non-responsive to equity;• disproportionate impacts of COVID-19 driven by underlying structural and socioeconomic inequity; and• enhanced momentum for collective mobilization, policy innovations and social transformation. DISCUSSION There was a strong desire for a more just and equitable society in a post-COVID-19 world, going 'back to better' rather than 'back to normal.' Our analysis demonstrates that equity has not been well integrated into pandemic planning and responses. Social movement and systems theories provide insight on ways to build on existing community mobilization and policy openings for sustained social transformation.
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Affiliation(s)
- Sume Ndumbe-Eyoh
- National Collaborating Centre for Determinants of Health, Antigonish, Nova Scotia, Canada
| | - Pemma Muzumdar
- National Collaborating Centre for Determinants of Health, Antigonish, Nova Scotia, Canada
| | - Claire Betker
- National Collaborating Centre for Determinants of Health, Antigonish, Nova Scotia, Canada
| | - Diane Oickle
- National Collaborating Centre for Determinants of Health, Antigonish, Nova Scotia, Canada
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Dobbins M, Dubois A, Atkinson D, Bellefleur O, Betker C, Haworth-Brockman M, Ma L. Nimble, efficient and evolving: the rapid response of the National Collaborating Centres to COVID-19 in Canada. Health Promot Chronic Dis Prev Can 2021; 41:165-170. [PMID: 33599448 DOI: 10.24095/hpcdp.41.5.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since December 2019, there has been a global explosion of research on COVID-19. In Canada, the six National Collaborating Centres (NCCs) for Public Health form one of the central pillars supporting evidence-informed decision making by gathering, synthesizing and translating emerging findings. Funded by the Public Health Agency of Canada and located across Canada, the six NCCs promote and support the use of scientific research and other knowledges to strengthen public health practice, programs and policies. This paper offers an overview of the NCCs as an example of public health knowledge mobilization in Canada and showcases the NCCs' contribution to the COVID-19 response while reflecting on the numerous challenges encountered.
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Affiliation(s)
- Maureen Dobbins
- National Collaborating Centre for Methods and Tools, Hamilton, Ontario, Canada
| | | | - Donna Atkinson
- National Collaborating Centre for Indigenous Health, Prince George, British Columbia, Canada
| | - Olivier Bellefleur
- National Collaborating Centre for Healthy Public Policy, Montréal, Quebec, Canada
| | - Claire Betker
- National Collaborating Centre for Determinants of Health, Antigonish, Nova Scotia, Canada
| | | | - Lydia Ma
- National Collaborating Centre for Environmental Health, Vancouver, British Columbia, Canada
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Villeneuve MJ, Betker C, Guest T. The Canadian Nurses Association: Reflections on the NCLEX-RN through the Lens of Nursing History and Evolution. Nurs Leadersh (Tor Ont) 2019; 32:17-21. [PMID: 32083527 DOI: 10.12927/cjnl.2020.26105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Decades of work by professional associations, regulators and educators have produced an ethical, reliable, robustly educated and regulated nursing workforce that enjoys high levels of respect in Canada and around the world. The officers of the Canadian Nurses Association comment here on the organization's history and changing role in regulatory policy over the past decade during the introduction of the American NCLEX-RN examination as the assessment tool for entry-to-practice for Canadian registered nurses. Facing forward, to maintain a strong, trusted nursing workforce the association remains committed to meaningful collaboration among nursing's professional, regulatory, education and union sectors.
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Affiliation(s)
| | | | - Tim Guest
- President-Elect, Canadian Nurses Association, Ottawa, ON
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Granger M, Schofield R, Fox J, Dilworth KE, Whyte N, Thompson K, Betker C, Clarotto A, Butler EC. Three Decades of Professional Nursing Leadership: The Impact of the Community Health Nurses of Canada. Nurs Leadersh (Tor Ont) 2018; 31:63-73. [PMID: 30860971 DOI: 10.12927/cjnl.2019.25754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In 1987, six Canadian community health nursing leaders recognized the need for a national body to represent and advocate for the diverse practice of community health nursing and the health of communities. Their vision and action three decades ago resulted in the formation of the Community Health Nurses of Canada (CHNC), a national professional nursing association. This paper will describe the development of CHNC from an early vision to a recognized centre of excellence for community health nursing in Canada. Significant milestones described include developing structures to advance excellence in practice, creating and acting on a vision, advancing leadership capacity, supporting professional development and promoting best practice, advancing community health nursing in undergraduate education and advocating for health policy.
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Affiliation(s)
- Morag Granger
- Past President, Community Health Nurses of Canada, Manager, Public Health Nursing Clinical Services Team, Saskatchewan Health Authority, Regina, SK
| | - Ruth Schofield
- Past President, Community Health Nurses of Canada, Assistant Professor, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Joyce Fox
- Executive Director, Community Health Nurses of Canada, Midland, ON
| | - Katie E Dilworth
- President, Community Health Nurses of Canada, Chief Nursing Officer, Toronto Public Health, Toronto, ON
| | - Nora Whyte
- Founding Board Member, Community Health Nurses of Canada, Adjunct Professor, University of British Columbia School of Nursing, Vancouver, BC
| | - Kate Thompson
- Communications Officer and Past President, Community Health Nurses of Canada, Senior Nurse Consultant, Indigenous Services Canada, Ottawa, ON
| | - Claire Betker
- President, Canadian Nurses Association, Past President, Community Health Nurses of Canada, Acting Executive Director, Active Living, Population and Public Health Branch, Manitoba Health, Seniors and Active Living, Winnipeg, MB
| | - Anne Clarotto
- Retired, Past President and Board Member, Community Health Nurses of Canada, Former Director of Promotion and Prevention, Community Mental Health, and Long-Term Care Programs, Interior Health Authority, Sanca, BC
| | - Evelyn C Butler
- Retired, Former Executive Director, Community Health Nurses of Canada, Toronto, ON
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McPherson C, Ndumbe-Eyoh S, Betker C, Oickle D, Peroff-Johnston N. Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity. Int J Equity Health 2016; 15:129. [PMID: 27539080 PMCID: PMC4991018 DOI: 10.1186/s12939-016-0419-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/05/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. METHODS A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. RESULTS Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. CONCLUSIONS This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity.
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Affiliation(s)
- Charmaine McPherson
- School of Nursing, Faculty of Science, St. Francis Xavier University, Box 5000, Antigonish, NS B2G 2W5 Canada
| | - Sume Ndumbe-Eyoh
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Box 5000, Antigonish, NS B2G 2W5 Canada
| | - Claire Betker
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Box 5000, Antigonish, NS B2G 2W5 Canada
- Population Health and Health Equity, Public Health and Primary Health Care, Manitoba Health, Healthy Living and Seniors, 4th floor, 300 Carlton St, Winnipeg, MB R3B 3M9 Canada
| | - Dianne Oickle
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Box 5000, Antigonish, NS B2G 2W5 Canada
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Schofield R, Ganann R, Brooks S, McGugan J, Dalla Bona K, Betker C, Dilworth K, Parton L, Reid-Haughian C, Slepkov M, Watson C. Community health nursing vision for 2020: shaping the future. West J Nurs Res 2010; 33:1047-68. [PMID: 20660926 DOI: 10.1177/0193945910375819] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As health care is shifting from hospital to community, community health nurses (CHNs) are directly affected. This descriptive qualitative study sought to understand priority issues currently facing CHNs, explore development of a national vision for community health nursing, and develop recommendations to shape the future of the profession moving toward the year 2020. Focus groups and key informant interviews were conducted across Canada. Five key themes were identified: community health nursing in crisis now, a flawed health care system, responding to the public, vision for the future, and CHNs as solution makers. Key recommendations include developing a common definition and vision of community health nursing, collaborating on an aggressive plan to shift to a primary health care system, developing a comprehensive social marketing strategy, refocusing basic baccalaureate education, enhancing the capacity of community health researchers and knowledge in community health nursing, and establishing a community health nursing center of excellence.
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Affiliation(s)
- Ruth Schofield
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.
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