Social Determinants of Health

The Canadian Public Health Association (CPHS), has a set of social and economic factors that impact our population’s health. There are fourteen determinants of health identified including;

• Income and Income Distribution
• Education
• Unemployment and Job Security
• Employment and Working Conditions
• Early Childhood Development
• Food Insecurity
• Housing
• Social Exclusion
• Social Safety Network
• Health Services
• Aboriginal Status
• Gender
• Race
• Disability

These are important considerations when caring for people.  For example, patients that are unemployed may struggle to afford medications from the pharmacy.  Understanding how these determinants of health can have an impact on their quality of life and their ability to access health care including medication, allows the nurse to provide adequate supports and resources to improve the person’s social determinants of health and ultimately their health and wellness overall. Along with determinants of health, Canadian nurses must also understand the implications of cultural influences in nursing care.

Canada has become increasingly diverse in the last century. According to Statistics Canada 2016, approximately 7,674,580 people in Canada fit into the visible minority population in Canada. Though health indicators such as life expectancy and infant mortality have improved for many, some minorities experience a disproportionate burden of preventable disease, death, and disability compared with non-minorities.^[1]

The British Columbia College of Nurses and Midwives (BCCNM) and the College of Physicians and Surgeons of BC (CPSBC) have been tirelessly working towards a practice standard on cultural safety and humility. BCCNM values cultural diversity and supports universal health care that transcends differences with respect to the culture, values and preferences of the individual, family, group, community, and population. Diversity characterizes today’s healthcare environment, and nursing is responsive to the changing needs of our society. To effectively promote meaningful client outcomes that maximize the quality of life across the lifespan, nurses must embrace diversity and engage in culturally safe practice.

When providing culturally safe care, nurses must recognize the critical component of cultural humility. Cultural humility is self-reflection of our own personal bias as well as recognition of other systematic biases. When we change our lens from one of using our nursing role as a power position, we need to consider fostering a relationship between ourselves and our clients that is built on trust and openness. ^[3]

Medication Administration and Cultural Safety

When administering medication, nurses build trust with their clients. Nurses must follow their scope of practice for medications but also recognize that it is vital to have their clients become key drivers in their own care. To create this relationship, nurses must consider cultural barriers that could impact the full engagement of the client, including language barriers, previous negative experience with medical staff, and distrust of health care. Utilizing open communication through the skills of relational practice allows nurses to develop a partnership in decision-making. Listening to the needs of the client initiates an open discussion that improves health outcomes through medication adherence and an understanding of key factors. ^[5]

Health Literacy and Medication Administration

Health literacy is “the ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in a variety of settings across the life course”^[6] 60% of adults in Canada find it challenging to obtain, understand, and act on health information or services in Canada. ^[7]

When providing education around medications, nurses must ensure that the content is at an appropriate level for the client to understand the key concepts; it is also useful to appeal to multiple learning styles, such as writing it out, diagrams and other visuals, or recall. For more information about cultural safety, health literacy, and medication administration, you can review the following resources.

1. Health Literacy: You talk to your patients but do they understand? The importance of health literacy in your practice. The Centre for Literacy offers a Health Literacy e-module.
2. San’Yas Anti-Racism Indigenous Cultural Safety Training Program.
3. Cultural Safety: Multiple Webinars to choose from. These webinars are free and sponsored through the BC Association for child development and intervention.