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Copy of Desktop

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Kimberly Carrera

on 12 November 2013

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Transcript of Copy of Desktop

Group 1: Constructing Disability and Illness
Kimberly Carrera
Anne Baah
Hacer Eroglu
Firdaws Abbas
Omoye Abu

Employment and working conditions significantly affect physical, mental, and social health. Paid work provides a sense of identity and purpose, social contacts, and opportunities for personal growth. Working conditions themselves can support health or pose health hazards. Healthy work places includes job and employment security, safe physical conditions, reasonable work pace, low stress, opportunities for self -expression and individual development, participation and work-life balance.
Employment and Working Conditions
Physical Disability and Accessibility
Enjoy the show!
Omoye - Brian Dyck
Kimberly- Nurse
Hacer - Government
Anne - Family member
Firdaws - Narrator
Tools for Analyzing Health Care Issue in Media Scan
Canada Health Act Principles
Primary Health Care Levels
Determinants of Health
Nurses' Scope of Practice Statement
from Nursing Act
Relevant Nursing Documents from Nursing Organizations
Canada Health Act
Levels of
Health Care
Disease & Injury Prevention
Political Economy, Human Rights, Feminist Political Economy Approaches
RNAO Client Centred Care Best Practice Guideline
Diagnosis & Treatment
Prior to this announcement, the principle of accessibility was not affirmed because access to medical resources was not on the basis of need.

According to the principle of accessibility, veterans with ALS should have access to health services regardless of their health status (barrier)

"Military veterans who have ALS will now be eligible for disability benefits,
treatment, home care support, qualify for adapted wheelchairs, medical resources, and housekeeping services among other things"

This affirms the principle of accessibility as the veterans will now have reasonable access to insured home care services

Sources: (Canadian Nurses’ Association, 2000, p. 1; Petrucka, 2009, p. 17)

Note : Accessibility refers to reasonable access to insured services & prompts advocacy for uninsured services

“The plan must provide for all Canadians (insured residents) to have reasonable access to insured hospital and physician services without barriers, regardless of income, age, health status, gender or geographical area. Additional charges to insured patients for insured services are not allowed (i.e., no extra billing/user fees). Health care services must be available based on the basis of need”

Addresses chronic health needs of clients of all ages, that is Persons living with long-term chronic conditions, OR/ Progressive illnesses or disabilities that worsen over time
Supportive care includes health, personal and social services provided to clients living with disability, who do not function independently, or who have a terminal disease.

There are two aspects of supportive care:
1. Palliative care: For people living with progressive life threatening conditions in homes, hospitals or hospice.
2. Respite care: Short term relief for family caregivers. Adult day care is one form of respite care. This can also be provided within the home by health care professionals and trained volunteers

In relation to the media scan, ALS is a progressive disease that causes the nerve cells to die and leaves the skeletal muscles paralyzed and worsens over time.

This places veterans with ALS in need of supportive care. Supportive care does not address a specific age but address all ages of which veterans are a part.

The media scan says that clients "will now qualify for adapted wheelchairs (personal), medical resources (health) and housekeeping services (social services)"

The media scan also states that "those who suffer ALS have little time to waste" which indicates that it is a progressive life threatening condition which requires palliative care.
Nurses Scope of Practice
The practice of nursing is the promotion
of health and the assessment of, the provision of, care for and the treatment of health condition by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function.
What is the RNAO definition of “timeliness’?

“The needs of clients and communities deserve a prompt response”

The media scan does not affirm to RNAO Values they did not have prompt response for benefits
Some of the veterans on the list of cases have passed away after suffering for years.

"Brian Dyck, an Ottawa police officer and former soldier," died early October 2010, after battling ALS for more than a year

For example, Brian Dyck, did not have the access to medical resources that would meet all his health care needs due to ALS not being covered by disability until after his death.

Client Centred Care
Human Dignity
Continuity & Consistency of Care & Caregiver
Responsiveness & Universal Access to Care
For example, “ Cal Schuler a student attending Western Canada, a High School broke his neck and became a quadriplegic, and due to the inaccessibility for disabled people, he had to finish his schooling online”

February 4th 2013: There continues to be newspaper articles about physical disability and accessibility and the barriers in the environment hindering people from accessing services

Dozens of school in Calgary have no accessible washroom stalls, are without wheelchair lifts between levels, and lack other features to help the disabled which hinders students from attending school

News Flash!!!

School boards struggle to meet needs of disabled; Older facilities rate poorly on accessibility
(The Gazette, 2010)

Studies have shown it is 60 % more prevalent in the military community, especially among those who served in the first Gulf War, possibly due to the exposure to different environmental conditions

Brian Dyck is an Ottawa police officer and former soldier who fought for the government to cover ALS in its benefits

Dyck died battling the illness with out benefits
36 cases under review, eight veterans have since died and money will go to their families.

Military veterans who suffer from the degenerative nerve disease amyotrophic lateral sclerosis are now eligible for disability benefits, treatment and home care support

Jean-Pierre Blackburn announced the new decision will benefit 36 cases currently being processed

Benefits to ALS patients will qualify for adapted wheelchairs, medical resources, and housekeeping services

Prime Minister Stephen Harper said his government would look into issue of veterans with ALS

The government has been resistant to funding benefits for veterans with ALS because of a lack of consensus on whether the disease is related to military service

Media Scan Newspaper: Highlights
Case Study: Mr. Brian Dyck
“concerned with the rights of the population and their equal right to well-being, housing, income, and health care services”
(e.g., for the population of veterans diagnosed with ALS).

Human Rights Approach

As Stone states in his article;
“The government has been reluctant to fund benefits for veterans suffering from ALS… because there is no medical consensus on whether the fatal disease is related to military service”
Government who opposed to fund the veterans for benefits, caused this particular population to have limited and unequal access to health care services, and treated veterans unfairly by avoiding their needs due to ALS

“it involves a fair distribution of benefits and burden among members of society”
“social justice flows from the idea that all person deserve basic necessities in addition to freedom/rights simple because they are human”

Therefore, veterans did not have equal right to treatment and equal right to well-being.
There wasn’t a fair distribution of benefits until after years of outcry and fought by the activist such as Brian Dyck who suffered and passed away before even receiving benefits for ALS.

Social Justice Philosophical Domain

(University of New Brunswick, 2012, p. 2)
Example of an Additional Current Newspaper Article:

Stone, L. (2009, Nov. 02). Paralyzed minister won’t vote on right-to-die bill; Quadriplegic backs euthanasia Resources must be provided ‘to make living the first choice’ he argues.

(Stone, 2009)

(Canadian for Care, 2009)
Learning Objectives
1. Discuss the issue of physical disability and accessibility

2. Discuss the issue in today’s media scan article in relation to course tools:

Canada Health Act Principles: Accessibility
Primary Health Care Levels: Supportive care

Determinants of Health: Working and Employment conditions
RNAO Best Practice Guidelines Values and Beliefs: Timeliness
Nurses’ Scope of Practice Statement
Social Justice Approaches: Human Rights Approach
Nursing Position Statement: ICN- Prevention of Disability and the care of people with disabilities
4. Highlight Clients Choice and Limits to Clients Choice:
College of Nurses of Ontario (CNO) Practice Standard: Ethics
5. Address nurses role in End of Life Care
CNO: Guiding decisions about end-of-life care
6. Explore disability as illness/ illness as disability
7. Reflect on two frameworks for viewing people living with disabilities
3. Introduce an additional media scan about Euthanasia and the nurse’s role
CNO Client Choice
(CNO, 2009, p. 3)

Client choice means self-determination and includes the right to the information necessary to make choices and to consent to or refuse care.

Clients know the context in which they live and their own beliefs and values. As a result, when they have the necessary information, they can decide what is best for themselves.

There are limits to client choice.

clients do not have the right to choose to endanger the safety of others.
Client choice may be restricted by policies that promote health; for example, restrictions on smoking.
Client choice is also influenced by the resources available in a particular situation.

What happens if the clients ask the nurse to perform an illegal act such as euthanasia?
“nurses need to inform clients, in a nonjudgmental manner, about the potential risks and harm associated with the practice, or that the practice is illegal in Canada or Ontario"

"By exploring the implications of the request and providing education and support to clients, nurses have a better chance of preventing a practice that has a risk of harm"

(RNAO, 2006, p.20)
College of Nurses of Ontario. (2009). Guiding decisions about end-of-life care.
Steven Fletcher 37 years old, quadriplegic
Had accident at the age of 23,his car collided a moose on a Manitoba highway
As a conservative MP, Fletcher believes terminally ill or physically disabled people should be allowed to choose death in some instances, however he will NOT vote YES to Bill C-384
Bill C-384- proposed law that will amend the current law which prohibits euthanasia and physician assisted suicide.

Fletcher opposes Bill C-384, stating that “at the end of the day, I think people should have the ability to choose. However, I also want to challenge Canadians to provide the resources so people choose life over death”
CNO End of life care
End-of-life care is grounded in the ethical values of nursing, which include:
respecting a client’s choice, well-being and life,
maintaining commitments
valuing privacy, confidentiality, truthfulness and fairness

How does this relate to a nurse’s responsibility?

Nurses Role
providing clients with support at the end of their lives or in making decisions about end-of-life care in any practice setting

supporting informed discussion about care goals and treatment options by facilitating communication with clients and members of the inter-professional team

contributing to client well-being and acting in the best interest of the client by facilitating the implementation of the client’s wishes about treatment and end-of-life care; and

knowing and understanding current legislation relevant to treatment and end-of-life care

Nurses must keep in mind that euthanasia and assisted suicide are illegal; there is no role for nurses in facilitating these activities

(Reutter & Kushner, 2010)

Ex: "some studies have shown ALS is 60% more prevalent in the military community, especially among those who served in the first Gulf war, possibly due to the exposure to different environmental conditions"
This shows veterans were exposed to unsafe physical work environment which could have led to the development of ALS.
The working conditions of the military poses health hazard as the job requires moving from one place to another, exposing them to different unsafe environmental conditions for instance land mine fields.

Using the frameworks for viewing with disabilities
Individual Pathology Framework
Social Pathology Framework
How can we view people with disabilities?
Biomedical Approach
Functional Approach
Environmental approach
Rights-outcome approach
Emphasizes diagnosis and treatment of dysfunctions, on individual abnormality and extent of functional limitations

Aim is to decrease the prevalence of the condition

Characterized as lacking in potential, life in institutions and other segregated housing were limited to providing for basic needs

Ex. Doctors are gatekeeper to disability benefits

Access to education and training, financial benefits, mobility aids and devices, and rehabilitation are all scientifically assess to determine person’s need
Biomedical Approach
Functional Approach
Views disability as an individual condition or pathology

Pathology is best treated with services that enable the individual to become as socially functional as possible

Services are more therapeutic in nature and include development of life skills, pre-vocational training, functional assessments, counseling and job training, and skills for independent living

It fails to consider the impact of larger social, economic and political factors that may prevent an individual from progression or meeting an ambition

Makes several assumptions about a person’s best interests that may be different from what a person actually wants

Environmental approach
Sees personal abilities and limitations resulting from an individual’s characteristics interacting with their environment

Disability arises from the failure of ordinary environment to accommodate people’s differences

The way environments are arranged and ordered constructs disability ex. A building lacking a wheelchair ramp creates an access to employment barrier for someone reliant on a wheelchair

When changes and supports are used, people with disabilities are able to participate

Grounded in disability discrimination

Rights-outcome approach
Grounded in fundamental human rights and freedom

Supports personal services, aids, and devices are required by some people to enable them to gain access to, participate in, and exercise self-determination as equal members of society.

Disability has social causes resulting from the way in which individual relate to how society is organized.

Goals are non-discrimination and equality for people with disabilities.

Principles aim to reduce civic inequalities to address social and economic disadvantage for people with disabilities

Nursing position statement

Prevention of disability and the care of people with disabilities.

International council of Nurses (ICN) supports programs designed to integrate people with disabilities in all aspects of daily life - in the family, school, workplace and community.
Nurses are key to early detection and intervention, and need to be involved in health promotion, prevention, teaching and counseling programs for people with disabilities and their families.
Nurses can play a significant role in policy and planning to improve the quality of life and care for people with disabilities..
Nursing education programs should address the role of nursing in the prevention of disability as a result of injury or illness.

ICN: Strategies to maximize nursing effectiveness
1. Ensuring that nursing education: addresses competencies necessary for the prevention of disability and the care and rehabilitation of people with disabilities; promotes fuller understanding of the particular problems faced by people with disabilities and their families; and, includes advocacy skills and a knowledge of programs and resources in the community.

2. Assisting, supporting and advocating for persons with disabilities and their families to access education, information and support services that allow them to lead fulfilling lives.

Stone, L. (2010, Oct. 16). Veterans with ALS get funds: Disease now included on disability benefit list. The Gazette. Retrieved from http://search.proquest.com.rap.ocls.ca/canadiannewsmajor/docprintview/758964608/fulltext/132E59B018B3511CB17/1?accountid=11530
Cuthbertson, R. (2013, Feb 04). School boards struggle to meet needs of disabled; older facilities rate poorly on accessibility. Calgary Herald. Retrieved from http://search.proquest.com/docview/1283948371?accountid=11530
Canadian Nurses Association (2000). Fact sheet: The Canada Health Act.
Coburn, D. (2010). Health and health care: A political economy perspective. In T. Bryant, D. Raphael, & M. Rioux ( Eds.), Staying Alive (pp.65-91).Toronto, Canada: Canadian Scholars’ Press Inc.
International Council of Nurses . (2000). Prevention of disability and the care of people with disabilities.
To what extent does the media scan affirm/go against Canada Health Act Principles?
Is the Canadian Health System undergoing challenges in accomplishing any of the RNAO Values & Beliefs of client centred care BPG?
Which level of PHC is addressed in today's media scan?
To what extent does the media scan affirm/ go against the determinants of health?
What is Nursing's position on physical disability and accessibility?
Reflective Questions
1. Income & Social Status
2. Social Support Networks
3. Education
4. Employment & Working Conditions
5. Physical Environments
6. Biology & Genetic Endowment
7. Personal Health Practices & Coping Skills
8. Healthy Child Development
9. Health Services
10. Gender
11, Culture
12. Social Environments
McMullin, J., & Davies, L. ( 2010). Social class and health inequities. In T. Bryant, D. Raphael, & M. Rioux ( Eds.) ,Staying Alive (pp.181-203).Toronto, Canada: Canadian Scholars’ Press Inc.
(Stone, 2010)
We hope you enjoyed our presentation!
Disability As Illness
The combination of disability with ill health is grounded in:
1. a narrow definition of health based on the presence of disease or infirmity,
2. the use of medical practitioners as gatekeepers to disability benefits
3. an inability to acknowledge the multiple ways in which disabilities are often created by societal norms that are inflexible in accommodating multiple needs.

Access to welfare states disability benefits is depending upon medical certification of disability by physician gatekeepers

Biomedical and functional approaches do not sufficiently acknowledge that the organization of society can often create disabilities

Non-discrimination based on human right provision acknowledges that people need to be treated differently in order to access services and have equal rights
Example from media scan: "medical consensus on whether the fatal disease is related to military services"
Medical practitioners were considered as gatekeepers to determine eligibility to disability benefits

( Rioux & Daly, 2010)

Illness As Disability
Illness is constructed as disability, particularly in terms of measurement of the health status of countries with instruments such the Disability Adjusted Year Life ( DALY). 

DALYs are used to "measure how many years a person or population loses as a result of ill health compared with an idealized and normalized perspective of health equated with freedom from disability"

The use of DALYS by the World Bank to measure a country's level of ill health turns illness into measures of disability

Basic assumption of DALY is that there is reduced value to a life lived with disability.

Another false assumption of the DALY is that the only way to enhance disability is through medical interventions.
An example from media scan:
Mr Dyck experiencing ALS doesn't mean that he did not experience health in other aspect of his life.
( Rioux & Daly, 2010)
(Petrucka, 2009, p.25)
(Stone, 2010)
(Stone, 2010)
(Petrucka, 2009, p.25)
It is the nurses' role to provide supportive care which includes the services of palliative and respite care.
(CNO, 2008, p.3)
(Stone, 2010)
(CNO, 2009, p. 3)
(CNO, 2009, p. 3)

(Stone, 2010)
1. Accessibility
2. Employment and Working Conditions
3. Timeliness
4. Supportive Care
5. Nursing Scope of Practice
6. Theoretical models of disability
7. Human Rights Approach
8. ICN Nursing Position Statement
9. Disability as Illness/ Illness as Disability
Pederson, A., Raphael, D., & Johnson, E. (2010). Gender, race, and health inequities. . In T. Bryant, D. Raphael, & M. Rioux ( Eds.), Staying Alive (pp.205-237).Toronto, Canada: Canadian Scholars’ Press Inc.
Petrucka, P. (2009). The Canadian Health Care System. In J.C. Ross-Kerr & M.J. Wood (Eds.), Canadian Fundamentals of Nursing. Toronto, Canada: Mosby Canada
Raphael, D. (2010). Social determinants of health: An overview of concepts and issues. In T. Bryant, D. Raphael, & M. Rioux ( Eds.), Staying Alive (pp. 145-155, 164-169, 177-179).Toronto, Canada: Canadian Scholars’ Press Inc.
Rioux, M. & Daly, T. (2010). Constructing disability and illness. In T. Bryant, D. Raphael, & M. Rioux ( Eds.), Staying Alive (pp.347-369).Toronto, Canada: Canadian Scholars’ Press Inc.
Registered Nurses Association of Ontario. (2006). Best practice guideline: Client centered care.
Rioux, M. (2010). The right to health: Human rights approaches to health. In T. Bryant, D. Raphael, & M. Rioux ( Eds.), Staying Alive (pp.93-119).Toronto, Canada: Canadian Scholars’ Press Inc
Stone, L. (2009, November 2). Paralyzed minister won’t vote on right-to-die bill; Quadriplegic backs euthanasia; Resources must be provided ‘to make living the first choice,’ he argues. Edmonton Journal. Retrieved from http://search.proquest.com.rap.ocls.ca/docview/434890827?accountid=11530
(ICN, 2010)
(ICN, 2010)
(Rioux & Daly, 2010)
(Rioux & Daly, 2010)
(Rioux & Daly, 2010)
(Rioux & Daly, 2010)
1. What are other health consequences that military veterans may face due to their work conditions?
2. Name one of the limits to client choice?
3. What other primary health care level would relate to Mr. Brian Dyck
4. _______________________ acts as gatekeepers to disability benefits.
(CNO, 2009, p. 3)
(Rioux & Daly, 2010)
(Calgary Herald, 2013)
Ex. Physiotherapy/Rehab for individuals to be included in society

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