Week 11 Social Justice: Equity vs Equality

      In week 11 we learned about social justice and how to differentiate between equity and equality. Before looking further into this topic I was aware of these terms but did not know how to distinguish the difference between them. From the articles in class, Braveman and Gruskin (2003) state “ equity means social justice or fairness; it is an ethical concept, grounded in principles of distributive justice” (p.254). When differentiating equality Braveman and Gruskin describe it to be “assessed with respect to specified measurable outcomes” (p.255).

      This weeks group facilitation did an excellent job using photos and words to teach the class the difference and meaning behind both these terms. Here is the picture they used in their presentation.

This picture depicts how equity involves fairness amongst everyone and how equality means that although we are equal (everyone has the same resources), this is not always fair. The group also used an example for those who are hands on learners. They divided the class into three sections based on lower, middle and higher class economic status and distributed chocolate coins to each. By taking away the higher economics group coins and giving it the lower, the students were able to even out the coins equally to each economic status group creating equity. However, this raises an issue for the higher economic status people. This population may feel that they worked harder than the other groups to gain these coins and it is not fair when they are taken away and distributed amongst the lower groups. From this activity I am able to understand why the higher economic status would favour equality and the lower group would prefer equity, as it would benefit them more and put them at an equal status with the higher people. When I think about which a health care provider would advocate for, it is now easy for me to see how equity exceeds equality. Nurses focus on individual needs and what may be beneficial for someone may not be the same for another person. If we strived for equality this would mean we see everyone as the same, and this is not true in nursing.

      The concepts of equity and equality shape our understanding of social justice as they come hand in hand. The Canadian Nurses Association (2009) states “social justice means the fair distribution of resources and responsibilities among the members of a population” (p.2). Social justice strives for equal opportunities to be healthy among individuals from different populations. Equity may result in equality as it brings everyone back to a same level, but you cannot have equality and it result in equity. Understanding this notion will aid nurses in our practice and how we advocate and provide care to clients.

      This week our professor did something different and played a voice clip for the class. The dialogue between the two women discussed how students who had background knowledge on technology were more likely than those who did not to browse different sources online and compare information. Upon reflection I consider myself to be information rich. I think this because my generation of young adults are surrounded by technology and throughout my education I have been required to use this and learn how to adapt to new advances. When debating if HITs fill in the gap of social justice or cause bigger gaps I took education in technology as a considerable factor. If HITs are introduced into healthcare there are some populations that will automatically have an advance over others. Those who would be challenged are the elderly or older adults. As they did not grow up with this form of technology they may find it difficult to understand and work such devices. Once this health technology is introduced, it would only be until years later until social justice can be achieved for everyone, as they are growing alongside the advances in health care and technology.

      Here is another comic picture for you to better understand the difference between equity and equality. Here the rich man thinks that by giving the poor population the same amount of pie as him that this is fair and will make them equal. However, although the same amount of resources are split among the two parties, one of them (the poor) are not being benefitted or having their needs met. 

References

Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiology and

      Community Health, 57(4), 254–258. doi: 10.1136/jech.57.4.254

Canadian Nurses Association. (2009). Social justice in practice. Ethics in Practice for Registered

      Nurses. Retrieved from http://www.cna-  

 aiic.ca/~/media/cna/page%20content/pdf%20en/2013/07/26/10/38/ethics_in_practice_april_2009_e.pdf

Dochasnetwork’s Blog. (2013). The world we want: Equality and equity? Retrieved from

      http://dochasnetwork.wordpress.com/2013/01/02/the-world-we-want-equality-and-equity/

McMurphy, A., Monteiro, J., Nguyen, C., & McBride, C. (2013). Social justice. [PowerPoint    

      slides]. Retrieved from

      https://www.fanshaweonline.ca/d2l/le/content/574917/viewContent/3008203/View  

Week 10 Health Policy

      This week in Health Informatics it was my groups week to present our class facilitation on the topic of policies. When creating our presentation there was only one article from the learning activity that we were able to educate ourselves from. Before beginning our presentation I expected to read information based on nursing standards of practice. I was surprised to read about how health policies are enabling patient engagement in care by creating the appropriate tools which will allow them to incorporate information they find relevant to their health. I also learned new terminology such as ODL (observations of daily living) and HIT (health information technology). An interesting idea this article proposed was the integration of using mobile devices which had an app geared towards self monitoring by patients. Allowing clients the opportunity to report their own health data promotes patient centered care. Gunn (2012), states that this will “empower patients to take ownership of their own health and play an active role in their treatment” (p.238). The benefit of including this into the future of health care is that nurses will be able to monitor early warning signs and prevent adverse events from happening.

      Based on this knowledge my group presented our class activity to our professor. Initially we were going to divide the class into groups of three based on different age groups: teens, adults and elderly and provide each with a specific case study. We were then going to have the class create examples of what types of information they would include into their ODL’s. Our professor geared us away from this idea and tried to have us think more around creating policies. Upon making these changes and presenting to the class, the students were successfully able to distinguish the main issue revolved around their age group and create health policies, which could be put in place to address these concerns. The teens were faced with the issue of health literacy, the adults were given a problem concerning security of health records and the elderly experienced confusion on working and accessing mobile devices. What is your stance on this? Do you think you could come up with a few health policies regarding these age related issues?

      During our class lecture, our professor asked each group to define policy/ health policy/ public health policy. According to the World Health Organization (2013), “health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society” (p.1). We were then asked to create our own definition of this term. Upon thinking and using my resources I formally came up with the definition as, the strategies and guidelines that are to be implemented into the health care system that result in an improvement in patient outcomes. If you had to come up with a definition of health policy what would it be? Nurses should be concerned about health policy issues because patients are our priority, we are their primary caregivers. 

      Although there seems to be many benefits to electronic health records in the future, the setbacks have me wondering what can be done to address these issues. One must consider how these electronic records will be accessed and by who, the privacy concerns and the education and training that would be required when new patients are learning to use these devices. Is making this possible really beneficial? Here is a video clip from YouTube where a woman named Regina Holliday explains her views on patient access to health records and how she believes it could save lives.

http://www.youtube.com/watch?v=msBYOYYeHPw

References

Gunn, H. (2012). InspireHealth: Engaging cancer patients in health. British Columbia Medical  

      Journal, 54(5), 238-242.

HHSONC. (Producer) (2011). Electronic health records (ehrs) can save lives: Regina hollida'ys story  

      [Web]. Retrieved from http://www.youtube.com/watch?v=msBYOYYeHPw  

World Health Organization. (2013). Health policy. Retrieved from

      http://www.who.int/topics/health_policy/en/

Week 9 eShift

      This week in class we were introduced to the eShift model of care. Before this class I was unaware what eShift was and what part it plays in health care. South-West LHIN describes eShift as “a technology-based initiative that connects an enhanced-skill Personal Support Worker (PSW) in the home with a registered nurse via a web-enabled iPhone” (p.1). The eShift allows for care to take place in the home of the client. If a certain issue or question arises, the PSW is able to contact a nurse and proceed using their feedback.

      This weeks class facilitation provided a case study regarding a PSW working in-home with the patient. From the perspective of the patient, her spouse, the PSW and the RN we were asked to reflect on the pros and cons that the eShift model would have on each member. There are many strengths that the eShift can potentially have on these people. The client will feel less as though they are a burden to others and there will be a decrease in stress put on spouses or family members who were originally caring for the patient. There will also be an increase in job opportunities for PSWs as well as nurses. Some further positives to using eShift are that the client is able to receive care in their home environment where they most likely feel comfortable. The client will also have a personalized relationship with the PSW, where their needs will be looked after at constant times. This model also aids in creating a learning experience where nurses are able to practice communication through technology with other health professionals. This concept relates to the CHNC’s fifth standards of practice: Capacity building, where nurses “actively share knowledge with other professionals and community partners and appreciates the importance of collaborative team work” (Community Health Nurses of Canada, 2011, p.19).

      With every advantage there are some disadvantages. When caring for patients, it is in the health care providers scope of practice to be knowledgeable of how to provide care. When a PSW is unsure of something and requires assistance from the nurse, they, as well as the client are in a vulnerable position as they wait for a response. Some  may also argue that this type of care takes away from a therapeutic relationship, as the PSW is focusing on their mobile device as well as the registered nurse never seeing their client that they are working with. Further potential issues may be the cost of this technology, privacy and security concerns as technology at times can be unreliable, as well the need to implement teaching programs. With health literacy, some people may not own mobile devices or know how to use them. This will make it difficult for those people to adjust to the use of technology. What are your thoughts on eShift? Do the benefits outweigh the costs?

      When our professor posed the question of whether a nurse needs to be physically present to undertake a nursing role, my initial response would be no. However, after further reflection I believe that this would impact the nurse’s care. In order to provide positive, efficient care, it would be beneficial to have that face-to-face interaction with patients. I believe that the eShift model is an advanced new form of health care that could have the potential to be integrated and built upon in the future. However, due to the many positives and negatives of this technology, I am still unsure whether it would truly benefit health care. This model has expanded my understanding and view of nursing. I have always viewed the nurses as providing first hand care to patients and not being the ones who were on the other end of the line communicating to clients via text.

Here is a video on YouTube I came across on eShift. It talks about what it is, who it involves and some of the benefits to this model.

http://www.youtube.com/watch?v=us6Dy41ljz8

References

 Community Health Nurses of Canada. (2011). Professional practice model & standards of practice.  
      Canadian Community Health Nursing. Retrieved from

     http://www.chnc.ca/documents/chnc-standards-eng-book.pdf 

SouthWestLHIN. (Producer) (2012 ). Quality award winner - eshift [Web]. Retrieved from

      http://www.youtube.com/watch?v=us6Dy41ljz8

South-West Local Health Integration Network. (nd). eShift helps patients and the South West

      CCAC. Retrieved from http://www.southwestlhin.on.ca/newsletter.aspx?id=60

Week 6 eHealth

      In week 6 of health informatics we discussed eHealth. Gulzar, Khoja and Sajwani (2013) state “eHealth is defined as the utilization of information and communication technologies (ICT) to support health and health related fields, such as health surveillance, healthcare services, health literature, health education, knowledge and research” (p.1).

      This weeks class facilitation began their activity by asking the class about their social media accounts and if they had ever used these to research health information. What I did not know that this group made clear to me was that Facebook could be used to search general information. After discovering this I will take into consideration using Facebook as a resource when searching topics online. Another question this group asked the class was if they had ever self diagnosed online. I was able to admit that I have done this before and continue to do so. Unfortunately I rarely tend to make visits with my doctor to follow up on these findings that I come across. Do you ever self diagnose online as well? A more professional term for self diagnosing is cyberchondriac. Anwar and Khan (2013) state “cyberchondriac is a term pertaining to a person who seeks health-related information on the Internet” (p.72). When self diagnosing online, people tend to search their symptoms and focus on the worst possibilities. This may lead people to feeling anxiety over their current health status.

      A hands on activity that this group assigned to the class was having us read a case study about a young boy with certain symptoms he was experiencing. Each group from the class was given a social media account to research these symptoms and see what results we came across. The variety of predictions that the class stumbled upon made me realize how many possibilities of findings there were to this specific case and how this is a non effective method of research. When looking up symptoms online, one should remember that not each answer is the accurate one and a check up to the doctor would be required to confirm these assumptions.

      During class lecture there was an activity where groups were able to choose a health topic and explore it on a social media site of our choice. I chose to look up chickenpox on YouTube. From the comments on various videos I came across, I was able to read on peoples personal experiences with this health issue and the advice they were giving to the public. This is evidence-informed advice as it incorporates peoples personal experiences and understandings.

      A new model was introduced to me during this weeks lecture, the Honeycomb model. Kietzmann, Hermkens, McCarthy and Silvestre (2011) describe the honeycomb as the “constructs that allow us to make sense of how different levels of social media functionality can be configured” (p.243). The honeycomb is separated into 7 sections: Presence, sharing, conversations, groups, reputation, relationships and identity. 

      During an activity in class, my group was assigned the social media site Flickr to examine based on these 7 sections. What I understood from this is that different social medias play specific roles for viewers. This may be support such as emotional, instrumental (financial or practical), informational or appraisal (Khalili, 2013). This has made me explore what my role as a nurse would be related to providing online health information and when working with clients who research online. I believe a nurse should be educated on what makes a source reliable, so that when patients come in, a nurse is able to direct them to credible and accurate websites. As social media is expanding, more sites are being created that provide health information. It would be beneficial for clients to know which online sites they can rely on.

References

Anwar, S., & Khan, S. (2013). Risks of online self-diagnosing: Cyberchondriacs. British   

      Columbia Medical Journal, 55(2), 72-73.

Gulzar, S., Khoja, S., & Sajwani, A. (2013). Experience of nurses with using eHealth in Gilgit-

      Baltistan, Pakistan: a qualitative study in primary and secondary healthcare. BMC Nursing,   

      12(1), 6-11. doi:10.1186/1472-6955-12-6

 Khalili, H. (2013). Health informatics within nursing; Week 6 consumer health informatics and

      eHealth – cont’d [PowerPoint slides]. Retrieved from    

      https://www.fanshaweonline.ca/d2l/le/content/574917/viewContent/2970570/View

Kietzmann, J. H., Hermkens, K., McCarthy, I. P., & Silvestre, B. S. (2011). Social media? Get

      serious! Understanding the functional building blocks of social media. Business Horizons,

      54(3), 241–251. doi:10.1016/j.bushor.2011.01.005