Unit 5: Family Nursing Practice and Family Health Promotion: Policy Implications (3 weeks)

5.1 Overview

Family health promotion and family nursing practice are inextricably linked as seen in the previous units of discussion. There are factors that predispose some families to better health in comparison to others. For example, the determinants of health including access to health care services and socioeconomic factors or health related policy in support of family health on a micro, meso, or macro level.

5.2 Learning Outcomes

1. Describe how the health of families is impacted by health related policy.
2. Explain how the determinants of health contribute to the health of families.
3. Review and reflect how family nursing practice has evolved to place emphasis on family health promotion.

5.3 Readings & Resources

Clarence, D. (2018). Love and boundaries in relational practice. Canadian Nurse, 114(1), 26-27.

Clark, A. P., & Guzzetta, C. E. (2017). A paradigm shift for patient/family-centered care in intensive care units: Bring in the family. Critical Care Nurse, 37(2), 96-99.

Government of Canada. (2019). Truth and Reconciliation Commission (TRC) of Canada. https://www.aadnc-aandc.gc.ca/eng/1450124405592/1450124456123#chp2

Martin, P., Duffy, T., Johnston, B., Banks, P., Harkess-Murphy, E., & Martin, C. R. (2013). Family health nursing: A response to the global health challenges. Journal of Family Nursing, 19(1), 99-118. doi: 10.1177/1074840712471810

Moher, C. (2019). Putting families first: A strengths-based approach to serving families with young children. International Journal of Birth & Parent Education, 6(3), 24-2.6

Monsen, K. A., Swenson, S. M., Klotzbach, L., Mathiason, M. A., & Johnson, K. E. (2017). Empirical evaluation of the changes in public health nursing interventions after the implementation of an evidence-based family home visiting guideline. Kontakt, 19(2), e75-e85. https://dx.doi.org/10.1016/j.kontakt.2017.03.002.

Robinson, M., Coehlo, D. P., & Smith, P., S. (2022). Family health care nursing. Theory, practice and research (7th ed.). F. A. Davis.
(***Unit 3: Nursing Care of Families in Clinical Areas Chapters 14-19)

TRC Commission of Canada. (2015). Honouring the truth, reconciling for the future: A summary of the report from the TRC of Canada.http://www.trc.ca/assets/pdf/Honouring_the_Truth_Reconciling_for_the_Future_July_23_2015.pdf

5.4 Learning Activities

1. The Government of Canada has recently taken an important step toward building nation-to-nation relationship with Indigenous peoples that are based on the recognition of rights, respect, co-operation, and partnership (Government of Canada, 2019). The Truth and Reconciliation Commission (TRC) of Canada has produced recommendations and calls to action to be addressed by people, professionals, and organizations from varying levels and sectors (Government of Canada, 2019).

Norma Rabbitskin, is a Senior Health Nurse and 2017 alumna of the Athabasca University Post RN BN program. Rabbitskin is an active advocate for indigenous health, and promotes a coordinated response to the TRC of Canada’s recommendations related to family nursing practice and health of Indigenous families. Think about your response to the following questions, prior to reading Rabbitskin’s discussion.

Rabbitskin’s discussion related to the Calls to Action: The policy implication of the calls to action will slowly reverberate into every nursing and public health sector, as systemic change is incremental. When the TRC released its health recommendations, it signified a restorative phase, reaffirming a shared commitment to acknowledge traditional ways to health and wellbeing as outcomes. Working at the grass roots level, I see firsthand the necessity of having culturally appropriate health services. Recommendations 18 to 24 and 55 pertain specifically to health, as they are guiding principles for all health service providers, and are imperative within our Indigenous communities. Recommendation 22, addresses the need to continually advocate for parallel support of Indigenous traditional medicine approaches to healing and wellbeing. This affirms the requests made by Indigenous patients to have access to their ancestral healing practices. Our role as nurses is to understand the population we serve and advocate for parallel health support services where traditional medicine approaches is an option for ones’ health and wellbeing. We need to apply a holistic model, which includes mental health, emotional health, and spiritual health. The idea that our illnesses can be solved with prescriptions or a diagnosis comes from a single worldview. A pill doesn’t have spirit. Transformational changes will occur, when each of us answer the calls to action with culturally appropriate approaches at a personal and professional level.

While the challenges are immense in this time of great healing, inherent in all of us, are the gifts of our ancestors’ roots of how to continuously maintain our cultural service. My nursing and Cree ancestral foundation guides my work, to conscientiously respond to individual and family requests for traditional healing with healers/Knowledge Keepers. Our role as nurses is to advocate for our clients and their families access traditional healing methods. The goal is not only to articulate this reality, but to identify harmonious cultural processes that ensures inclusion of traditional healing methodologies into primary care models and setting; ultimately worthy of being passed along for the intergeneration.

de Leeuw, S. (2017). Putting calls into action: Treating aboriginal patients in collaboration with indigenous healers and elders. Canadian Family Physician. 63(1);56-59. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5257223/

Rabbitskin’s discussion related to health policy: Health related policies, such as the TRC calls to action, do impact the well-being of our home-fires (home) in transformative ways, as we are in a great time of healing. I can only speak from my experience; at a micro level of our ancestral Cree ways of being continues to be our family’s foundation. Within our Indigenous communities, local leadership, community Elders and members are activating their own cultural health programming. Indigenous communities at a meso level are responding with cultural measures, to meet the health crises that impact the emotional, intellectual, and physical and spirit core of our people. Self-determining with building own local capacity and commitment to OCAP (Ownership, Control, Access and Possession) guides all of our community-of-practice research at a macro level (Saskamoose, Bellegarde, Sutherland, Pete, & McKay-McNabb, 2017). The will exists within our families and community to find middle ground between Traditional and western health practices. What works for us within our homes, will work for our communities, we must give ownership to our people to define their whole health needs. Education in all of its forms is critical and maintaining good communication with partners between communities and health organizations is essential. Health policies do chart, shared principles for change, as in the calls to action, they outlined core tenets for a holistic approach at all levels within the Canadian health care system.

Sasakamoose, J., Bellegarde, T., Sutherland, W., Pete, S., & McKay-McNabb, K. (2017). Miýo-pimātisiwin developing Indigenous Cultural Responsiveness Theory (ICRT): Improving Indigenous health and well-Being. The International Indigenous Policy Journal, 8(4). https://doi.org/10.18584/iipj.2017.8.4.1

Rabbitskin’s discussion related to the Canadian context and history: Understanding Canadian history and its treatment of Indigenous people is a critical step towards healing. As a part of our shared healing journey, as an Indigenous nurse, one needs to know from where they come from, in order to know where they are going. Our parents and grandparents and loved ones suffered from the imposed federal government assimilation policy that instituted all indigenous children attend the residential school system. Even today it continues to negative impact many generations. As nurses and those who are within the health sector, we have much work to do. However, we must be courageous and truthful as we learn to unpack, the historical intergenerational pain and unresolved trauma, which is the underlying cause of many sickness we see today.

2. Consider the determinants of health in your assessment of family health promotion. What types of factors would you explore with the family? How do the determinants of health relate to the health of the family?

3. Nurses are guided by various nursing theories and models for assessment, intervention, and evaluation within family nursing practice. Nurses enter into a relationship with patients and families during the assessment phase. This relationship should be nurtured from the beginning so that a healthy partnership can be formed, maintained, and terminated appropriately during the course of the interaction.

a) What are some barriers in establishing relationships with patients and families?

b) What are some barriers in carrying out nursing interventions targeted at patients and families?

c) How does policy at varying levels help support or hinder family nursing practice?

4. You are at the end of the course after reviewing all the units, participating in the discussions, completing the readings and learning activities, and submitting your assignments. How would you describe family health promotion and family nursing practice to a colleague? What elements would you include in your description?

Choose at least 2 learning activities and post your discussions to these questions over 3 weeks in the Unit 5 Forum and engage in dialogue with your fellow classmates, as you would in a face-to-face setting. Aim to build on the discussion rather than merely posting the answers to the questions. Integrate your readings and use additional evidenced based resources to inform and support your discussion. Take a look at the Scholarly Evidence Guide for reference on how to select appropriate resources!

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