top of page
Search

Final Reflections on "Critical Foundations in Health Disciplines"

  • abissett22
  • Aug 1, 2022
  • 6 min read

I have engaged in ongoing professional development throughout my career, including workshops, independent study, and mentorship. I've recently embarked on a course-based Master of Health Studies, to advance my skills in health leadership and education. In the first course, "Critical Foundations in Health Disciplines", I've learned alongside clinicians from many different clinical backgrounds, with varying levels of experience, yet we have all chosen to begin our studies by re-examining foundational concepts. The foundation of a physical structure not only supports the building, but also provides protection from natural elements and storms. Exploring our foundations can strengthen our professional skills enable us to maintain focus as we advance our practice in ever-changing environments.


Professionalism


We began our studies by considering our own professional identities, both in the workplace and online. We learned the importance of conducting regular self-audits (Etheredge & Fabian, 2022). We defined our own professional values. For example, my values include compassion, dignity, servant leadership, genuine human connection, and excellence. I appreciated the reminder this course offered to keep these values at the front of my mind through my education and career.


Health Systems


Our next focus was understanding our practice context. In Canada, there is federal legislation that sets out requirements for health funding and ensures Canadians have access to hospital, physician, and surgical-dental services (Canada Health Act, 1984). Each province is responsible to determine priorities and allocate resources. I work in Alberta, a province with a single health authority. Specifically, I work in Alberta’s Continuing Care practice area, in facility living (also known as long term care or LTC) and supportive living (also known as assisted living).


Defining Health, Health Determinants, and Vulnerable Populations


Several weeks of this course were spent on defining health, understanding health determinants, and highlighting the needs of vulnerable populations.


The World Health Organization defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO, 1946). Health is a resource for living, rather than the purpose of life (WHO, 1986). Proponents of an updated definition suggest including functional outcomes, and the ability to adapt to changing needs (Fallon & Karlawish, 2019). Health should also be defined on a continuum and include priorities that laypeople have identified: well-being, function, access to nature, humour, coping, and the feeling of having energy (Svalastog et al, 2017).


Factors that impact health extend far beyond biology. Determinants of health include education, employment, working conditions, housing, food, lifestyle, and social connection (Alberta Health Services, n.d.; Government of Canada, 2020; Holt-Lunstat, 2022; World Health Organization, n.d.). Determinants of health also impact admissions to facility-based care. These include advanced age, living alone, physical and cognitive limitations, assistance for instrumental activities of daily living, loss of a spouse, acute health events, chronic health conditions, education level, gender, social vulnerability, and preceding hospitalizations (Branch & Jette, 1984, Garner et al., 2018, Hedinger et al, 2015).


Vulnerable populations are groups of people who tend to be at high risk of adverse health outcomes, based on determinants of health. In Alberta, examples of vulnerable populations may include Indigenous peoples, individuals without homes, visible minorities, those who identify as LGBTQIA2S+, people with mental health concerns, and residents of facility-based care.


Multi-level Models of Health


Given the complexity of defining health, and the many determinants of health, the most effective models for understanding health tend to include multiple levels. One example is the “Main Determinants of Health” (Dahlgren & Whitehead, 1991), depicted in Figure 1. This model includes constitutional factors, individual lifestyle factors, social and community networks, living and working conditions, and general socio-economic, cultural, and environmental conditions.


Applications for Practice


The concepts of health determinants and multi-level understandings of health have applications in practice. In my studies, I focused on chronic illness and obesity in long term care. Figures 2 and 3 summarize my findings regarding obesity, through a multi-level lens. Figure 4 details the primary determinants of illness and long term care admission for each of the top three chronic illnesses in long term care: dementia, hypertension, and arthritis (Government of Alberta, 2018).




Future Directions


The final topic in MHST601 was future directions in health care. The COVID-19 pandemic has been devastating in care facilities. It has highlighted many pre-existing challenges and created new difficulties. The silver lining has been a renewed interest in re-imagining long term care. Recommendations in the literature have included a focus on resident-directed care, prioritization of quality of life, adequate and sustained funding, well compensated staff, clearly articulated modernized standards of care, and federal government support for provinces and territories to achieve high standards (Armstrong & Armstrong, 2021, Alkenbrack, 2021; Estabrooks et al., 2020; Grabowski, 2021; Zimmerman et al. 2022).

In Alberta, a thorough review of Alberta's continuing care system has been completed, with forty-two recommendations under 11 policy directions, as summarized below:


This review has informed new legislation that is coming in Alberta to promote person-centered and innovative service delivery, replace multiple existing acts, address gaps in existing legislation, improve transparency and accountability, and align requirements across the continuum of care (The Legislative Assembly of Alberta, 2022).


Bringing It All Together


“Critical Foundations in Health Disciplines” has been a valuable opportunity to connect with health professionals across Canada from a variety of disciplines, expand my understanding of foundational principles, and create a foundation for the remainder of my master’s degree program. The initial emphasis on professionalism and interprofessional relationships prompted in depth reflection. The focus on health systems prompted in depth consideration of the multi-level context in which we practice. Definitions of health, health determinants, chronic illness, multi-level models of health, and vulnerable populations were inter-related topics; learning in one area supported deeper understanding of other areas. The course has concluded with a focus on future directions, which I have found motivating. I’m looking forward to continuing to learn in this Masters of Health Studies program and contributing to the future changes that will come in long term care.


References


Alberta Health Services (n.d.) What Determines Health?


Alberga, A.S., Edache, I.Y., Forhan, M., & Russell-Mayhew, S. (2019). Weight bias and health

care utilization: A scoping review. Primary Health Care Research and Development. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650789/

Alberga, A.S., Rusell-Mayhew, S., von Ranson, K.M., & McLaren, L. (2016). Weight bias: A

call to action. Journal of Eating Disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100338/


Alberta Health Services (n.d.) 7 standards for a bariatric friendly hospital.

Alberta Health Services (2018). Bariatric care needs assessment algorithm.


Aguirre, D.L., Perez, C., & Burkett E.K. (2022). Stability, security, and the social determinants

of health. Global Security: Health, Science, and Policy. 7(1). 13-23. https://www.tandfonline.com/doi/full/10.1080/23779497.2022.2047092


Branch, L.G., & Jette. A.M. (1984). A prospective study of long-term care institutionalization

among the aged American Journal of Public Health. https://ajph.aphapublications.org/doi/epdf/10.2105/AJPH.72.12.1373%20%20.

Bradway, C., DiResta, J., Fleshner, I., & Polomano, R.C. (2008). Obesity in nursing homes: A

critical review. Journal of American Geriatrics Society. https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.2008.01821.x

Bradway, C., DiResta, J., Miller, E., Edminston, M., Fleshner, I., Polomano, R.C. (2009).

Caring for obese individuals in the long-term care setting. Annals of Long Term Care. https://www.hmpgloballearningnetwork.com/site/altc/content/caring-obese-individ



Dahlgren, G. & Whitehead, M. (1991). Policies and strategies to promote social equity in


Etheredge, H. R., & Fabian, J. (2022). Communication in Healthcare: Global challenges in


Fallon, C.K. & Karlawish, J. (2019). It’s time to change the definition of ‘health’. Stat.

Holt-Lunstat, J. (2022). Social connection as a public health issue: The evidence and

systemic framework for prioritizing the "social" in social determinants of health. Annual Review of Public Health. https://www.annualreviews.org/doi/epdf/10.1146/annurev


Garner, R., Tanuseputro, P, Manuel, D.G., & Sanmartin, C. (2018). Transitions to long-term

and residential care among older Canadians. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/82-003-x/2018005/article/54966-eng.htm


Government of Canada (2020).Social determinants of health and health inequalities.


Government of Alberta (2018). Long-term care resident profile.


Harris, J.A., Engberg, J., & Castle, N.G. (2018). Obesity and intensive staffing needs of

nursing home residents. Geriatric Nursing. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281754/

Harris, J.A., & Castle, N.G. (2019). Obesity and nursing home care in the United States: A

systematic review. The Gerontologist. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524472


Hedinger, D., Hämmig, O., Bopp, M. (2015). Social determinants of duration of last nursing

home stay at the end of life in Switzerland: a retrospective cohort study. BMC Geriatr 15, 114. https://doi.org/10.1186/s12877-015-0111-3


Kopelman, P.G., Caterson, I.D., & Dietz, W.H. (2010). Clinical obesity in adults and children

(3rd ed). Wiley-Blackwell.


Loos, R.J.F, & Bouchard, C. (2003). Obesity - is it a genetic disorder? Journal of Internal


Pories, M.L. & Rose, M.R. (2017). Reframing our view of the bariatric patient. Bariatric


Puhl, R.M., & Heuer, C.A. (2010). Obesity stigma: Important considerations for public health.

American Journal of Public Health. 100(6): 1019-1028. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/


Svalastog, A. L., Donev, D., Jahren Kristoffersen, N., & Gajović, S. (2017). Concepts and

definitions of health and health-related values in the knowledge landscapes of the digital society. Croatian medical journal, 58(6), 431–435. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778676/


Wharton, S., Lau, D.C.W., Vallis. M., Sharma, A.M. Biertha, L., Campbell-Scherer,

D.,...Wicklum, S. (2020). Obesity in adults: A clinical practice guideline. Canadian Medical Association Journal. https://www.cmaj.ca/content/192/31/E875


World Health Organization. (1946). Constitution of the World Health Organization.

World Health Organization (1986). The Ottawa charter for health promotion. The 1st


World Health Organization (n.d.). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1


 
 
 

コメント

bottom of page