Blog
Assignment 1
Professional identity and values are very important as I am currently in the early onset of my career in the healthcare field and I want to establish myself appropriately as a professional. Professional identity is defined as a form of social identity where one differentiates themselves from other professions which is macro with status, but also micro with the behavioural norms (Wackerhausen 2009). Additionally, professional identity stems from values and a sense of oneself (Enns 2014). Professional values provide the foundation for behaviour and form a blueprint for a healthcare provider (Melrose, 2021, p.118-119). Shwartz (1994) defines this as a guiding principle to motivate one’s actions and set a standard for judging and justifying actions. Together, professional identity and values form professional socialization which allow the individual to identify as a member of their professional group (Melrose, 2021, p.120).
For myself specifically, working as a part of the management team in a longterm care home, I want to possess a professional identity and values that have compassion for others, a commitment to the community and is resident focussed regardless of task difficulty. This means putting the needs of a resident or a fellow staff member before my own personal needs if it will improve their overall quality of life or job satisfaction. One way that I have managed to do this is by staying late when I have a heavy workload to ensure we have appropriate staffing to ensure the individuals working are able to fulfill all tasks, which in turn, ensures the residents are appropriately assisted with the activities of daily living. Being an employee for OMNI Health Care, our motto is “our passion is people '' which is meant to reflect on all professions within our home, and in doing so, sets a standard for professional identity and values by working for the needs of those around us.
I also strive to become aware of the sensitivity of topics that arise on a daily basis and think about upstream outcomes for my actions in a leadership role that preserves the quality of care we provide. This includes being aware of resident confidentiality and ensuring job duties are conducted in a way that respects all who are impacted by my decisions. For example, dealing with finances on a daily basis and having this insight on one’s personal affairs has to be performed with the utmost respect or else it could have severe implications when looking downstream for the reputation our home possesses.
In addition, I need to be aware of the footprint I leave, as it is easier to tarnish one’s identity than it is to build it up (Hoejmose et al., 2014). In doing so, I need to conduct myself as a professional in all forms of communication, whether that is speaking about my job in public, or the manner in which I represent myself on social platforms. When I performed an audit on my facebook account, I noticed that it was very easy to locate the posts from when I was much younger and less mature as I have not posted on my account in several years.
Being a part of the management team at only 23-years of age, I entered my position with a narrative based on assumptions by numerous staff members that I was too immature for the leadership role I occupied. Having been able to establish myself since, I have to sensor the information that people have access to and the identity that I want to portray. With this realization, I have had to delete the easy to access posts on my facebook page in order to ensure that I maintain the professional identity and values of a leader in longterm care. This has also led me to untag myself from posts such as one posted at a bar, as this could have been viewed as non-professional. This coincides with a report published by Roger Collier (2012) as most of the health care professionals who use social media are from a different generation than those who want to preserve the reputation of the profession. Collier also included evidence that even minor mishaps on social media can lead to job dismissal (2014). One way that I could learn from these findings by Collier is to look to other members of my management team with more experience for strategies to ensure I uphold the appropriate values of a professional in longterm care in order to portray my desired professional identity.
What is Health?
Week 5
In 1948, the WHO provided the world with a modest definition of health, which focused predominantly on one’s physical well-being. Specifically, the WHO definition of health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 2022). In 2022, the WHO definition of health still only covers one domain, and should look to focus on more than one’s physical health. The Government of Canada (2008) has adopted the Ottawa Charter for Health Promotion, which defines health with the recognition of upstream factors that may influence one’s health such as the environment, economic and social aspects. These can be categorized as the social determinants of health, which also include race, culture, gender, genetics, and access to health care services (Government of Canada, 2008). All of these examples from the 2022 perspective of health can be viewed as “prerequisites” that make an individual more susceptible to adverse health outcomes. A recent study conducted by Dalsania et al. (2022) explored the social determinants of health among African Americans in relation to COVID-19 mortality rates. Although race specifcally was not observed to have a direct effect on COVID-19 mortality rates, it was found that mortality rates were higher amongst those without a high school diploma as well as in homes without internet within counties observed (Dalsania et al., 2022). Using the Government of Canada’s adopted 2022 definition of health, it is apparent that social determinants of health such as one’s education and access to self-education or social networks via the internet had an impact on mortality rates.
Smoking Out the Smoking Behaviours
Assignment 2
Overview
The socioecological model (SEM) captures the overlapping relationship between each level of influence and how they work cohesively to impact each other (CDC, 2022). It is suggested that to prevent adverse health outcomes, one must focus on several of these factors at once as targeting the interconnectedness between several factors will allow for sustained changes (CDC, 2022). The first level focusses on everything at the individual level, such as behaviours and attitudes. This individual level subsequently correlates with the next domain of factors surrounding the individual such as the attitudes of their family that is categorized as relationships (CDC, 2022). The third level is the community, which could include one's workplace. Lastly, all of the levels are influenced by societal factors such as the policies and the cultural norms that may lead to unhealthy behaviours (CDC, 2022).
Application
The SEM is relevant to individuals I surround myself with on a daily basis. One area of concern for myself specifically, is that numerous individuals in my workplace smoke regularly, which in turn, puts them at risk of lung cancer. In order to use the framework of the SEM, each level of the model will be explored, which in turn, will allow the interconnectedness of each model to be explored. Once this correlation is identified, ways to mitigate these behaviours can be explored in order to suggest numerous mechanisms for a healthy behaviour change.
When observing smoking from an individual level in the SEM, targeting those based on SES can have an influence on smoking cessation efforts (Brusinelle et al, 2010). For PSWs in Ontario, wages range anywhere from $15 to $25 per hour (Statistics Canada, 2022). With most of the workforce in long-term care homes being composed of PSWs, it is apparent that a substantial amount of this workforce is likely to be of a low SES. This relates to my workplace in particular, a long-term care home in Prince Edward County, as 13.5% of the total population of Prince Edward County is living in low-income, with the living wage in this region significantly on the rise from $17.95 as of 2016 (Vital Signs, 2022). Since most of the workforce are PSWs that fall between the PSW wage scale in Ontario, this is an area of interest. Brusinelle et al. (2010) has shown that using SES to target smoking cessation through policy, community and social support mechanisms for low SES smokers is significantly influential.
In a study conducted by Xu et al. (2015), one can observe a “white collar” effect in that most individuals will follow the lead of healthcare professionals when it comes to their adopted health behaviours as a high proportion of the smoker population in China is composed of doctors. It was also demonstrated that lower socioeconomic status based on geography can impact smoking behaviours (Xu et al., 2015). This study demonstrates the influence that the community level of the SEM has on a population as the actions of professionals in the community of the individual can attribute to their unhealthy behaviours. It also demonstrates that one can target a geographic location with a predominantly low SES can have positive results on smoking cessation interventions (Xu et al., 2015). This, in turn, could be used for smoking cessation efforts as having doctors from the healthcare system in a geographic location with a low SES promoting efforts to quit smoking could be utilized.
The closest factor surrounding the individual in the SEM are their relationships with family and colleagues, which have been shown to influence individual attitudes towards smoking. A study conducted by Van den Brand et al (2019) found that the social environment, and in particular, their colleagues, had a strong influence on one’s efforts to quit smoking. It was therefore recommended that the workplace is the best area for smoking cessation interventions (Van den Brand et al., 2019), which is important for my workplace to minimize my colleagues' risk for lung cancer.
Interventions
Using the previously listed evidence, targeting the interconnectedness of the domains of the SEM is essential for smoking cessation efforts. On the individual level of the SEM, the attitudes and beliefs one has towards smoking allows them to come to terms with the behaviour, which is something that could be targeted. On the relationship level, other individuals in their family smoke which reinforces the behaviour as it could be viewed as a norm. To mitigate this influence on the individual level, we could surround the person who smokes with a more informative and supportive connection to foster a healthy behaviour change. On a community level, smoking could be focused on the workplace and how it has been fostered there. This could potentially be mitigated by providing a safe, non-smoking area and providing several educational opportunities about ways to stop smoking if they are interested, and how this could reduce their risk of lung cancer. On a societal level, policies could include no smoking anywhere on the work property, or offering non-smokers incentives to make up for their greater rate of productivity for the employer when compared to smokers. It is evident that all domains of the SEM are overshadowed by the policy domain, as this has an influence on all of the SEM domains beneath it. This is where the initial interventions should be focused.
The only policy within my workplace regarding smoking pertains to areas in which employees can smoke, as there is a designated smoking area within 9 meters of the entrance. This policy attempts to coincide with the Smoking Cessation in the Workplace Guide that was published by the Government of Canada that proposes either a total ban of smoking on the work property or limiting smoking to designated areas within this distance from doors and windows (Government of Canada, 2009). Being on the joint health and safety team at my workplace, numerous concerns have been presented about the wording of the designated smoking area as being within 9 meters of an entrance, but it does not mention being this distance of all of the windows. This shows that the policy within my workplace needs amendments that clearly define such regulations. Being stricter on these policies with slightly more detail for employees, and potentially moving towards a total ban of smoking on the property, could aid in smoking cessation efforts.
Some additional policies that could be adopted in my workplace should pertain to break times. A lot of smokers within my workplace claim that they get more breaks being a smoker, which further reinforces their behaviours that puts them at a greater risk of diseases such as lung cancer. In 2013 alone, employers in Canada lost an average of $3,800 a year on unauthorized smoke breaks, and regular smokers took an average of 2.5 more sick days than non-smokers per year (Dobrescu et al, 2017). This is something that could be adopted in my facility as awarding more vacation time to those who do not smoke, or becoming stricter on break times could help with smoking cessation. Offering incentives such as more vacation time and payouts was found to be effective with lasting results for smoking cessation in a study conducted by Notley et al. (2019).
On the community, relationship and individual level, behavioural support interventions should be utilized. These interventions should focus on individual and group counselling as they use techniques targeting self-efficacy and motivation to quit smoking which has been found to be effective in smoking cessation (Rajani et al., 2021). Additionally, the Smoking Cessation in the Workplace Guide suggests that offering handouts with self-help resources such as phone numbers, brochures, surveys, or having professionals visit the workplace with take home resources and motivational talks could improve cessation efforts. These resources could allow not only the individual, but their immediate social network of colleagues to consider smoking cessation, which, as previously mentioned, has been found to be the most influential connection in the SEM for reducing smoking cessation. With these interventions, smoking cessation efforts could be implemented with the hopes of reducing smoking rates, and in turn, reducing the risk of lung cancer for my colleagues.
Comparing Ontario and Nunavut
I have decided to compare healthcare in Canada between my province, Ontario, and Nunavut. As we can see, Ontario scores higher in more categories than Nunavut. A’s being the highest score for the lowest rates in this geographical area, and D’s being the lowest meaning that this area ranks amongst the worst in Canada. One area in which Nunavut out scores Ontario with a lower mortality rate due to diabetes as they score an A+ compared to Ontario’s C ranking (Conference Board of Canada, 2015). Additionally, Nunavut is tied for the lowest life expectancy out of all of the provinces and territories with a D- and Ontario scored at the highest for life expectancy with an A (Conference Board of Canada, 2015). Overall, Ontario finished with an average B grade according to this Conference Board posting and finished at 7th overall among provinces and territories (Conference Board of Canada, 2015). Nunavut ranks at the bottom in almost every category and is amongst the worst in Canada for healthcare. Their life-expectancy averages at 71.6 years compared to the national average of 81.5 years (Conference Board of Canada, 2015). One reason for their low mortality rates from chronic diseases is because most of these diseases occur in the later stages of life, and this report explains that most individuals in this territory do not live long enough to develop these chronic diseases (Conference Board of Canada, 2015). The inaccessible healthcare in the territories can also be used to explain the low life expectancy, and more effort need to focus on more affordable nutritious foods and improve the socio-economic factors in this area such as housing, education, income, and recreation. In one of the courses I completed in my undergraduate career, I designed an action plan to improve the health of residents of Nunavut by designing a digital physical activity plan, as physical activity is associated with lowering the incidence of chronic disease. In 2020, the Federal Government has increased their investment in a medical travel fund by $17.6 million to the residences in Nunavut to compensate for this inaccessibility (Deuling, 2020).
Vulnerable Populations: Older Adults
Week 11
One specific vulnerable population includes older adults. In Canada, older adults aged 85 or older are one of the fastest growing demographics throughout the entire country with a 12% increase since 2016 and is expected to triple over the next three decades with the baby boomer population beginning to enter this demographic (Statistics Canada, 2022). With this increase in the older adult demographic, the need for essential services related to their health increases, as more than a quarter of this population are currently living in long-term care facilities which coincides with numerous chronic health issues (Statistics Canada, 2022). Often, older adults are among the most vulnerable in all of Canada as the numerous chronic health issues creates an economic hardship on this population, as the cost of care exceeds their income (Seniors First, 2022). Additionally, timely healthcare responses may continue to get worse for the older adult population as the increasing population will raise their demand, which will far exceed the available workforce we possess in Canada (Statistics Canada, 2022).
Having completed my undergraduate degree in Kinesiology, I believe that the best way to assist the aging demographic, who will eventually become older adults, is through prevention measures in a primary healthcare approach rather than focussing upstream in a “band aid approach” in a downstream, tertiary health care response. Creating a more strict framework such as doctors following up in a phone-call weekly to ensure the aging population are satisfying their 150-minutes a week of moderate intensity exercise could be one of the best ways to prevent our healthcare system from becoming exhausted so that it can provide timely care when required (Centers for Disease Control and Prevention, 2022). Exercise has been proven to delay the onset of chronic diseases, and will significantly improve balance amongst older adults which limits the rate of falls (Centers for Disease Control and Prevention, 2022), one of the highest risks for hospital stays and mortality among older adults in Canada (Government of Canada, 2021). A study conducted by Booth et al. (2012) shows that physical activity delays the onset of 35 chronic diseases, and further demonstrates that physical inactivity is the primary cause for chronic diseases. With this evidence, I believe that a such framework could be used to significantly improve the lives of prospective older adult populations by preventing chronic diseases.
Reflection
Week 13
Throughout MHST 601, I have primarily based my research and application of course concepts to long-term care (LTC) where my career path is based. Over the seven units in the course, I have frequently made connections to LTC by focusing on older adults as a vulnerable population, whose demographic makes up the majority of the LTC residents. I have also focussed on the staff in LTC. Through revisiting my blog posts, assignments and additional curation of course concepts, I will reflect on the main takeaways of this course.
In Unit 1, we focussed on professionalism. In Chapter 4: Creative Clinical Teaching in the Health Professions, the correlation between professional identity and professional values were explored and how they influence our career fulfillment. Professional identity is a form of social identity and how we see ourselves fitting in with a profession, and professional values are the foundations of our behaviour and how these existing values we possess may influence our career choice (Melrose, 2015). From my own reflection on my early career, I am a member of the management team in a LTC home, with the hopes of eventually taking on the role of administrator or as a member of the Ministry of Health. I can identify with this field with my caring mentality and the close connection to older adults in my upbringing which has led me to this career choice. Additionally, our social media audit allowed me to truly reflect on the professional identity I want to portray. I found that an article by Greysen et al. (2010) provides an exceptional analogy comparing social media to a mirror in that it reflects the best and worst content. After reviewing my own profiles, I ended up deleting my Instagram account and creating one that will only be recognizable to my close family and friends. I also created a new Twitter account focussing on building my professional career.
In Unit 2, we explored federal and provincial health systems in Canada. Specifically, we examined the Canada Health Act (CHA) and ways that it can be modernized. I connected this unit to Health 305: Health Policy that I took at Queen’s University, where we discussed how the CHA is built on the foundation of five principles: 1) public administration, 2) comprehensiveness, 3) universality, 4) portability, and 5) accessibility (Health Canada, 2015, p.4). Additionally, the CHA aims to provide equality in care by making it the same for all (Flood, 2016). From the readings, however, we can see gaps in the CHA as it does not cover essential health services necessary for optimal health (Flood, 2016). Some of these uncovered services include dental care, mental health and pharmaceuticals (Canada Health Coalition, 2021). Numerous studies have shown that a plethora of deaths could be prevented by services such as drug plans, and that the CHA has left the healthcare system with no accountability mechanisms as it operates between both provincial and federal legislation (Canada Health Coalition, 2021).
For myself, specifically, working in the private sector of LTC, there are numerous services that are required by our residents daily that fall beyond the scope of the CHA. LTC itself is not covered by the CHA, forcing out of pocket payments from families, making essential services such as customized wheelchairs/walkers, necessary pharmaceuticals for diseases such as diabetes, and glasses unattainable (Wohlgemut, 2022). Not having these devices and proper care due to a lack of coverage has increased the risks of health implications such as falls (Wohlgemut, 2022). From my personal connection to LTC after studying the CHA in MHST 601, it is apparent that the CHA needs to be modernized. This modernization needs to include accountability of who is designing the framework for publicly funded healthcare services, as well as focus on its principles of universality and accessibility in providing essential services such as dental care, mental health services, vision care, and assisting with the costs of LTC.
In Units 3 and 4 we explored the determinants of health as well as multilevel approaches to understanding health beyond the individual. One thing that surprised me was how vague the World Health Organization's (WHO) definition of health is, which I expanded on in a blog post. This WHO definition states that health is “the complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO,1948). It is apparent that an updated definition of health needs to be adopted by the WHO to encompass the social determinants of health (SDOH) to reduce the global divide of health inequities which can influence one's health from as early as birth (Marmot et al., 2012). I was able to form connections to Health 101: The SDOH that I took at Queen’s University as there are 12 social determinants of health, and from this list, it is apparent that the development of chronic diseases forms from upstream risk factors. From my own experience in LTC, I have met numerous individuals who have frequently cited their inability to afford nutritious foods, adequate housing, and sufficient employment and education throughout their life leading up to their admission into LTC. This is captured by Bravemann and Gottlieb (2014) as the SDOH are “the conditions in which people are born, grow, live, work and age and the fundamental drivers of these [chronic] conditions.” This demonstrates that health is much more than the WHO definition and that chronic diseases are directly associated with upstream factors, which is a major takeaway from this course and is a future direction.
I was able to build on my knowledge of the SDOH in Unit 4 by analyzing health on a multilevel approach that focusses on upstream and downstream factors surrounding the individual (Galea, 2015). These perspectives allow us to connect between levels in healthcare. In this unit specifically, I focussed on the smoking population in my workplace in LTC and how this puts our staff and smoking residents at risk of lung cancer. In my blog post, I used the socio-ecological model of health to explain ways in which we could alter one’s smoking behaviours in the hopes of providing an upstream treatment for lung cancer and how relationships between these levels put those at risk (Galea, 2015). In this model I was able to observe how policies shape the actions of all levels, and under this level of influence are community/societal influence and the interpersonal level, all in which impact the behaviours on the individual level (CDC, 2022). When I used this for the smoking population in my workplace, I looked at policies to ban smoking on workplace properties and proposed incentives for non-smokers who, as the statistics show, do not take as much break time nor sick days as smokers (Dobrescu et al, 2017; Notley et al., 2019). These incentives would be used to entice smokers to quit in order to reap the rewards of non-smokers (Notley et al., 2019). Subsequently, these levels intertwine with the societal/community influence, and how physicians taking a stand against smoking and changing the views of coworkers could alter behaviours. Lastly, these all interact with the individual to shape their perspectives on smoking where helplines and brochures could provide direct insight into the outcome of their actions. Moving forward in my career in LTC, I will use the socio-ecological model as a means of promoting healthy behaviour changes.
In Units 5 and 6 we explored chronic disease management and vulnerable populations. In Unit 5, we researched Chronic Disease Prevention and Management which emphasized the uncoordinated approach between provincial and territorial governments (Government of Canada, 2007). In this report, primary care physicians are seen as the focal point in managing and preventing chronic diseases (Government of Canada, 2007). In Unit 6, we then explored vulnerable populations where I focussed predominantly on older adults, who make up most of the costs of our healthcare system and are of particular interest to me given my career in LTC. I wanted to emphasize the aging demographic, and how our healthcare system in its current state will not be sustainable to satisfy the demand of older adults needing healthcare services. With this recognition, it is apparent that the principles learned in Unit 5 in disease prevention and management are integral to prevent our healthcare system from becoming exhausted.
Having completed my undergraduate degree in kinesiology, I believe that upstream thinking is the best way to tackle chronic diseases, as it is a means of prevention rather than management. This is also a future direction that could be taken as discussed in Unit 7. Specifically, I believe that ensuring most of the population satisfies their weekly physical activity guidelines is the best way to prevent chronic diseases as a study by Booth et al. (2012) show that physical inactivity is the primary cause of chronic diseases. With these recommendations, I think this is a feasible solution to prevent the aging population from exhausting our healthcare system and will protect the prospective vulnerable older adults from being susceptible to chronic diseases.
References
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