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Reflections on Social Media and My Nursing Practice.

             According to the Canadian Nurses Association (CNA), the nursing profession in Canada is indeed one of the largest workforces in the country. Two pieces of legislation regulate the nursing profession in Ontario: the Nursing Act of 1991 and the Regulated Health Professions Act of 1991 (RHPA). While the RHPA provides provisions for all regulated health professions, the Nursing Act of 1991 is specific to providing the scope of practice of the nursing profession. The Nursing Act is the basis for the College of Nurses of Ontario (CNO) mandate. As a member of the nursing profession and a frontline worker, my role in the Canadian healthcare system is unique because I witness and experience the effects of policies and decisions made at the federal and provincial levels daily. Canada has a universal and publicly funded healthcare system. The system's goal is ideal, but it sure is not perfect. As population healthcare needs change, so should the provisions and policies that govern the services. It is, therefore, ethically necessary for nurses to advocate for the good of the population.

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          In the age of information technology, social media is a great tool to communicate, inform, educate, and gather information. It can be tricky for public servants to navigate social media. The nursing profession, in particular, is based on public trust. The Registered Nurses Association of Ontario (RNAO) and the College of Nurses of Ontario (CNO) invoke nurses to conduct themselves in a manner that maintains and builds on public confidence. According to the RNAO, an appropriate social media presence for nurses consists of a constructive, respectful, and authentic online persona. As professionals, nurses are accountable to a professional code of conduct.

 

          Nurses sharing confidential patient information on social media could have serious consequences. Misinterpretations of posts could damage their professional reputation. Healthcare professionals must prioritize patient privacy and confidentiality on social media. Moreover, one of the roles of nurses is to advocate for the public. Hence, while nurses may not be legally obligated, they are ethically bound to speak up for any issues that affect people's health. However, nurses must follow specific guidelines while adhering to the highest form of credibility. The bottom line is not to post anything on social media that would not be said in person as a professional.

 

          As an active social media user, even before I was practicing nursing, it is crucial to maintain integrity in how I portray my image on social media without compromising authenticity. I limit my personal social media platforms to Facebook and Instagram, while I use LinkedIn as my professional social media platform. Compartmentalizing my life has always been something that I have practiced since I started using social media. I believe strongly in creating boundaries between personal and professional life. However, I may not be legally bound to speak up; it is ethically crucial to do so when issues arise that affect public health. For example, during the height of COVID, I was very vocal on social media in advocating for wearing masks in public. My social media profile on Facebook is private, and I may influence public safety behavior among my family and friends. I used that leverage to advocate for public safety. It is essential to speak up as nurses when needed but to do so constructively and respectfully. By following the principles outlined by the International Nurse Regulator Collaborative, I can reduce my risk of violating the code of conduct of my profession. Over the years, and perhaps with maturity, I have tremendously reduced my social media utilization. I have grown to understand the risk of using social media unethically. It is vital to maintain professional boundaries and confidentiality in using social media. Although it is an excellent tool for educational purposes, it is undeniable that there is also much misinformation online. As a nursing professional, I think before I post. While there are risks in using social media, these should not prevent nurses from using social media platforms to communicate and connect. The benefits outweigh the risks.

 

          The digital world is continuously evolving. It is beneficial for nurses to acquire digital literacy skills to manage and keep up with global health challenges. However, responsible social media use must consider evidence-based practices and place the patient as the focus of care delivery.

What is the definition of health?

                  The definition of health has "implications for health policy, practice, health services, and health promotion" (Leonardi, 2018, p. 736). The World Health Organization's (WHO) definition of health since 1948 has not changed. The WHO defines health as a "state of complete physical, mental, and social well-being" (Constitution of the World Health Organization, 2023, p. n.d.). This definition seems simplistic and idealistic. It does not consider the prevalence of chronic illness in the aging population (Huber, 2011). Leonardi (2018) even suggested abandoning this utopian definition because it does not reflect the evolving needs of modern society. Although this definition of health may have been used successfully in public health promotion since its inception, he further states that it is problematic in its other functions, like its measurability and operational ability.

 

Below are the summarized criticisms of the WHO definition (Leonardi, 2018):

  1. The phrase "complete well-being" is considered problematic because it is an unattainable health standard for most adult populations, including the older population or patients suffering from chronic illnesses (Huber, 2011; Leonardi, 2018). 

  2. The definition could be more practical in real situations, like its utility in operations and scientific measures (Leonardi, 2018).

  3. The definition needs to be narrower. It is a political statement or "a concept much more closely related to happiness than health" (Leonardi, 2018, p. 737).

  4. The definition promotes the medicalization of society. Although unintentional, the practical implications lead to focusing on medical solutions and rejecting any other type of solution (Huber, 2011).

  5. The definition leads to an assumption that well-being is always linked to health, which is incorrect (Leonardi, 2018).

  6. The definition assumes a consistent "positive correlation between physical, psychological, and social well-being" without considering some exceptions (Leonardi, 2018, p. 738).

 

              Social, cultural, and epidemiologic conditions have changed since 1948. The definition of health must evolve according to the needs of modern society. However, it does not have to be defined by a unique definition but rather through a pluralistic etymological view (Leonardi, 2018; Van Der Linden & Schermer, 2022). It is essential to analyze the definition of health through its pragmatic application in practice (Van Der Linden & Schermer, 2022).

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             Leonardi (2018) defines health as "the capability to cope with and to manage one's own malaise and well-being conditions. In more operative terms, health may be conceptualized as the capability to react to all kinds of environmental events, having the desired emotional, cognitive, and behavioral responses and avoiding those undesirable ones". This definition supports Huber's (2011) definition, which is that health "is the ability to adapt and self-manage in the face of social, physical, and emotional challenges." These two definitions encompass the idea that achieving health is not just through an individual approach but also through a complex dynamic process of considering interdependent factors such as social and environmental, which may affect overall well-being. Compared to the WHO's definition, this definition reflects more reality in the modern world and is more measurable in context.

 

           On the other hand, Schramme (2023) defends the WHO's definition of health as adequate and argues that much of the criticism is a matter of differences in interpretation. He says the WHO defines health as a holistic health rather than a perfect health. The WHO intends to define health as "a state of exhaustive well-being, including all relevant dimensions of its constitutive elements" rather than a "hypothetical, perfect state of well-being" (Schramme, 2023, p. 6).

 

           Regardless of the different interpretations of the definition of health by the WHO, it can be concluded that there is more than one process for achieving and maintaining health. Instead, it consists of complex dynamic approaches that consider the individual's physical, social, and mental capabilities and their adaptation to their relationship with the social and environmental elements. In other words, the social determinants of health must be considered when we define health. 

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References:

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Constitution of the World Health Organization. (n.d.). Retrieved October 9, 2023, from https://www.who.int/about/governance/constitution

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Huber, M. (2011). Health: How Should We Define It? BMJ: British Medical Journal, 343(7817), 235–237.

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Leonardi, F. (2018). The Definition of Health: Towards New Perspectives. International Journal of Health Services, 48(4), 735–748.

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Schramme, T. (2023). Health as Complete Well-Being: The WHO Definition and Beyond. Public Health Ethics,              phad017. https://doi.org/10.1093/phe/phad017

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Van Der Linden, R., & Schermer, M. (2022). Health and disease as practical concepts: Exploring function in context-specific definitions.    Medicine, Health Care and Philosophy, 25(1), 131–140. https://doi.org/10.1007/s11019-021-10058-9

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Determinants of Health & Nursing

        While achieving optimal health is an ongoing process, it is critical to consider the factors which may affect it. These factors are called the determinants of health. In addition to genetics and personal lifestyle choices, non-medical factors influence our capability to achieve optimal health (The Social Determinants of Health, n.d.). Determinants of health are “the broad range of personal, social, economic and environmental factors that determine individual and population health” (Public Health Agency of Canada, 2001, n.d.). 

 

The Public Health Agency of Canada (2001) has identified 12 determinants of health. They include:

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  1. Income and social status

  2. Employment and working conditions

  3. Education and literacy

  4. Childhood experiences

  5. Physical environments

  6. Social support and coping skills

  7. Healthy behaviors

  8. Access to health services

  9. Biology and genetic endowment

  10. Gender

  11. Culture

  12. Race / Racism

 

        The social determinants of health (SDH), specifically, “refer to a specific group of social and economic factors within the broader determinants of health” (Public Health Agency of Canada, 2001, n.d.). They are essential in influencing health inequities. Added to the list above, the World Health Organization (2023) identified food insecurity and early childhood development as SDH. These social and economic factors can have more impact on health than health care and lifestyle choices (The Social Determinants of Health, n.d.). 

 

     

 

 

 

 

 

 

 

 

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        It is fundamental to address the social determinants of health to eliminate or reduce the disparities in health among populations. As public health advocates, nurses are critical in improving health inequity by integrating social care into health care (Wise et al., 2023). Besides, nursing encompasses a more holistic approach model of care and has always concentrated on SDH since Florence Nightingale’s environmental theory (Olshansky, 2017). Nurses are in a prime position to lead this call to action. 

 

Nursing public health experts have recommended the following steps to include SHD in nursing practice:

 

  • Integrate SDH content in nursing education (Olshansky (2017; (Wise et al., 2023). According to Colburn (2022), to this day, education on SDH is limited in nursing programs. Schoon and Krumwiede (2022) presented a holistic health determinant model that allows nursing educators to incorporate SDH in nursing curriculums. Hopefully, this tool will serve as a framework for nursing schools to include SDH education thoroughly in nursing courses.

 

  • Building an interprofessional workforce which may include representatives of social work, public health, city planning, occupational health, police, firefighters, and many others who can contribute to addressing SDH (Olshansky, 2017; Wise et al., 2023).
     

  • Prioritize nursing research on social and biomedical aspects of health to connect SDH to health outcomes and develop nursing interventions that alleviate problematic SDH (Olshansky (2017).
     

  • Collaborate with social and community agencies and institutions to recommend and advocate health policies that address SDH (Olshansky, 2017; Wise et al., 2023). Dickman & Chicas (2021) states that nursing is never neutral. Since nurses are also the most trusted public service, they can lobby for health policy changes that can challenge social structures or rectify inequalities in healthcare. Public policy advocacy is a crucial strategy for improving health outcomes for all (Dickman & Chicas, 2021).

 

 

        The vital role that nurses have to partake in addressing SDH cannot be further emphasized. As frontline workers, nurses have firsthand experience and expertise in identifying the underlying issues that affect health. A holistic approach to health is at the core of nursing. Therefore, the call to action to address health inequities by integrating SDH into nursing practice is a natural course of the evolution of the nursing profession. 

 

References:

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Colburn, D. A. (2022). Nursing Education and Social Determinants of Health: A Content Analysis. Journal of Nursing Education, 61(9), 516–524. https://doi.org/10.3928/01484834-20220705-06

 

Dickman, N. E., & Chicas, R. (2021). Nursing is never neutral: Political determinants of health and systemic marginalization. Nursing Inquiry, 28(4), e12408. https://doi.org/10.1111/nin.12408

 

Olshansky, E. F. (2017). Social Determinants of Health: The Role of Nursing. AJN The American Journal of Nursing, 117(12), 11. https://doi.org/10.1097/01.NAJ.0000527463.16094.39

 

Canada, P. H. A. of. (2001, November 25). Social determinants of health and health inequalities [Policies]. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

 

Schoon, P. M., & Krumwiede, K. (2022). A holistic health determinants model for public health nursing education and practice. Public Health Nursing, 39(5), 1070–1077. https://doi.org/10.1111/phn.13063

 

Social determinants of health. (n.d.). Retrieved October 11, 2023, from https://www.who.int/health-topics/social-determinants-of-health

 

Wise, J., Caiola, C., & Njie-Carr, V. (2023a). A fundamental shift in nursing is a requisite for achieving health equity: The nurses’ role in addressing social determinants of health. JANAC: Journal of the Association of Nurses in AIDS Care, 34(1), 125–131. https://doi.org/10.1097/JNC.0000000000000383

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Addressing Nursing Burnout: What health model is ideal?

         Burnout is the continuous negative, work-related syndrome developing gradually over time in initially "highly motivated, striving, achieving and non­ compromising individuals with good intentions and high ex­pectations who stretch themselves beyond the normal work boundaries for an extended period in their quest for meaning" (Cilliers, 2003, p.63). It then affects the individual's physical, psychological, and attitudinal workplace symptoms (Cilliers, 2003). Due to the demands inherent to nursing work, nurses are susceptible to burnout (Shao et al., 2018). Cilliers (2003) has summarized from previous studies that burnout is highest among nurses and physicians. Emotional exhaustion affects females more than males, while depersonalization affects males more than females. The consequences of burnout do not only affect the individual but also the patients, the institution, and the larger community (Cilliers, 2003). Nursing burnout can lead to poor quality of patient care, a higher rate of nurse turnover, and negative consequences for the nurse's health. This paper will explore the potential health model relevant to combat nursing burnout in Canada.

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         The prevalence of burnout among nurses and its consequences on the quality of care delivered to patients highlights the importance of self-care in nursing. Taking care of oneself involves prioritizing physical, mental, and emotional health through various activities (Colomer-Pérez et al., 2022). Recent research by Colomer-Pérez and colleagues has suggested that cultivating self-care agency and a sense of coherence could influence academic success, as demonstrated in a study of nursing assistant students. The salutogenic model of health can provide a framework to prevent burnout in nursing proactively. It is a concept developed by sociologist Aaron Antonovsky, focusing more on health preservation than disease causation or pathogenesis (Bhattacharya et al., 2020). It is concerned with the relationship between health stress and coping. The model aims to empower people with knowledge and resources to improve their lives and create healthy habits (Bhattacharya et al., 2020). Cilliers's (2003) study confirmed that nurses who experience high levels of salutogenic constructs can effectively counteract burnout. He further recommended addressing burnout symptoms at the individual, group, and organizational levels.

While the salutogenic model may be beneficial in the prevention and health promotion of burnout, it does not recognize the existing socioeconomic factors that affect burnout. It is necessary to rethink nurses' work, roles, and care observation and break down the profession's stereotypes (Montañés Muro et al., 2022). The role of gender stereotypes and the discrimination they cause, deeply rooted in the history of nursing, must be considered in addressing burnout (Montañés Muro et al., 2022). Although there has been an increase in the number of men entering the profession, nursing remains a female-dominated field. Emotional labor in nursing is undervalued, leading to burnout due to poor conditions and lack of recognition (Montañés Muro et al., 2022). Garcia (2022) states that burnout in nursing involves social pathology, where nurses are devalued, and nursing care remains unrecognized. He suggested that to address burnout, there must be a better recognition of the nursing profession and nurses, not only from an economic view but also from a socio-cultural perspective (Garcia, 2022).

            A recent study by Rubin and colleagues (2021) found that nurses in Canada have a higher prevalence of burnout, emotional problems, and high severe stress compared to the United States. Although the reasons may need to be clarified, the research suggested that it may be related to the differences in the healthcare systems of Canada and the United States (Rubin et al., 2021). In Canada's universal health care system, there is lower nursing income, inadequate staffing and fair treatment, and a higher rate of acute care bed occupancy. Personal financial pressures and a crowded working environment may have contributed to burnout (Rubin et al., 2021).
 

         Additionally, the COVID-19 pandemic has created a severe demand for nurses' workload. As reported by the media, nurses in Canada were pushed past their limits, causing burnout, and many have left the profession (Favaro, 2021; Jackson, 2022). A report by the Registered Nurses Association in Ontario (RNAO) in 2022 revealed that over 75 percent of Canadian nurses are experiencing burnout (RNAO, 2022). According to a study by Sullivan and colleagues (2022), nurses experience a severely higher rate of burnout during the pandemic compared to the burnout they experience under normal working circumstances. During the pandemic, the contributing factors of burnout are job stress, inadequate staffing, and inadequate pay for the work performed (Sullivan et al., 2022). Unfortunately, policies created by Canada's government indirectly contributed to burnout. For example, in 2019, the provincial government of Ontario introduced Bill 124. This bill caps the annual increase of nurses' compensation to one percent (Westoll, 2021). Although this bill has been repealed recently, the effects it caused during the pandemic have tremendously contributed to understaffing in the workplace and, consequently, burnout (Westoll, 2021). Recently, however, the government of Ontario filed an appeal to reverse the court order of repealing the bill (DeClerq, 2023). During global pandemics, nurses require extra support to decrease burnout, thereby also combatting the adverse consequences of burnout (Sullivan et al., 2022). Social support has an impact on improving the nurses' quality of life, thus enhancing the quality of care they provide (Velando-Soriano et al., 2020). 

         From Listopad and colleagues' (2021) systematic narrative review of the literature on burnout, they argued that the bio-psycho-social model is also not sufficient to assign all identified factors affecting burnout. The identified factors are divided into categories, namely, lifestyle, physical and mental health, self-reference, relaxion, work-to-life interrelation, support, working environment, big five personality traits, perceived meaningfulness, and sense of homeliness (Listopad et al., 2021). An extension of the model is needed to develop the understanding of burnout further. They argued that recognizing burnout as a disease rather than a phenomenon is necessary. They suggested extending the model to a bio-psycho-socio-spirito-cultural model. A more holistic view of the influencing factors affecting burnout is necessary to address it accordingly (Listopad et al., 2021).

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Figure 1

The Bio-Psycho-Socio-Spirito-Cultural Model of Health of Burnout

 

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            Consequently, Sullivan and colleagues (2022) have three recommendations to address burnout. Firstly, healthcare organizations must have a set of interventions established to protect the nurses' well-being. Secondly, they recommended checking the nurses for the risk of burnout as a prevention strategy. Lastly, they recommended establishing policies that protect nurses from inadequate staffing and prioritizing rest and breaks (Sullivan et al., 2022).

               To conclude, while the salutogenic health model emphasizes the factors that promote human well-being and may be beneficial in health promotion, it, unfortunately, is not sufficient in addressing burnout. Consideration of the factors beyond the individual agency and control is essential. A more comprehensive and holistic model of care, the bio-psycho-socio-spirito-cultural model, may be the answer to combatting burnout. Furthermore, health care policies affecting the nursing profession must also be considered as they indirectly affect the causes of burnout.

 

 

References

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HEART DISEASE: OH CANADA!

       Chronic cardiovascular conditions, such as heart failure, hypertension, ischemic heart disease, and stroke, are estimated by the Public Health Agency of Canada (PHAC) through the Canadian Chronic Disease Surveillance System (CCDS) (PHAC, 2018). This system collects uniform surveillance data while ensuring patients' privacy across all jurisdictions. The resulting pan-Canadian data can be accessed online (PHAC, 2018). According to the CCDS, heart disease "is the second leading cause of death and the leading cause of hospitalizations in Canada" (PHAC, 2017b, p. n.d.). Moreover, it affects more men than women (PHAC, 2017b).

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Treatment of heart disease involves medications, lifestyle changes, and surgical interventions. Surgical cardiovascular treatment has slowly evolved from open sternotomy to minimally invasive cardiac surgery, depending on patient needs (Treatments, n.d.; PHACa, 2017a). The government has initiated and funded health promotion programs focused on awareness and encouraging healthy living. Examples of these programs are the National Automated External Defibrillator (AED) Initiative, Healthy Canadians Community Fund, Canadian Diabetes Strategy, and Integrated Strategy on Healthy Living and Chronic Disease (PHAC, 2008). 

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         The economic burden of heart disease is costly (Smolderen et al., 2010). In 2009, the government of Canada introduced the Canadian Heart Health Strategy and Action Plan (CHHS-AP) (Smith, 2009). The main focus of the strategy is on prevention and health promotion. However, it has not secured any funding (Smith, 2009). In addition, the provincial government of Ontario still needs to update its funding policy (CorHealth Ontario, n.d.). So far, the government of Canada, through the Canadian Institutes of Health Research (CIHR), has invested in a national research network for heart failure (CIHR, 2022). 

 

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Self-reflection: Content creation and social media

          Having graduated from university over a decade ago, much regarding technology has changed. It is now easier to find, store, and share resources. It has evolved from bulky hardcopies to accessible access to the internet. Social media and content creation are excellent tools for collecting, storing, and sharing information. However, what comes with technology is a sense of responsibility and caution. Only some things shared online are credible, and how we share the information matters. Nurses are professionally responsible and accountable for their social media conduct. The nursing profession is based on public trust. Therefore, it is crucial to maintain professionalism online. This paper is about my self-reflection on content curation and social media utilization as introduced throughout the thirteen weeks in Critical Foundations in Health Disciplines (MHST 601) course.

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Content Curation

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             What is content curation? I have learned the concept from MHST 601 - Critical Foundations in Health Disciplines. Content curation is "the process of finding the best and most relevant information and sharing it with your target audience" (Nuss, 2019). Throughout this course, I have learned how to find, sort and store information gathered for a particular topic assigned each week. I was introduced to Zotero software and used it as a curation tool to help me organize my resources and create sub-folders for each weekly topic to make retrieving them easier. The software is user-friendly and very practical. It has also made developing a bibliography and citations easier, although I also have the American Psychological Association (APA) manual as another reference. After gathering them in Zotero, I posted them in my e-portfolio to share with my classmates and the public. This content curation method has been a new experience for me as a learner.

        Years ago, collecting and gathering information was achieved through hard copies of books, journals, etc. It used to be an arduous and time-consuming process. Technological advancements have helped tremendously make content creation easier and more accessible. 

        As a nursing professional, content creation has been a valuable strategy for publishing credible content as I position myself as an academic in my program. It allowed me to save resources and provide value to my audience. By finding and sharing helpful content with my audience, I can become a valuable resource for my followers online. Content curation has helped me save time, grow my portfolio, build connections, and stay informed of the most relevant information. I plan to improve my skills in content curation for future courses. 

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Social Media

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        Social media is an excellent tool for sharing information, although it also comes with risk. Healthcare workers need to be careful of what they share online, or they may risk their professional licenses and, worse, face legal action. 

        While I have been an active user of social media since its inception in the 2000s, I have never used it as a tool to share professional or academic information. I have only used social media for personal use. MHST 601 has introduced me to the value of social media for educational purposes. Although it is an excellent tool for sharing, gathering, and collecting information, I have always been cautious in using it professionally. My perspective on social media use has evolved since taking this course. It has taught me about social media's value, limitations, and professional guidelines.

            As a nurse, I am bound to my profession's ethics and code of conduct. Two pieces of legislation regulate the nursing profession in Ontario: The Nursing Act of 1991 and the Regulated Health Professions Act of 1991 (RHPA). While the RHPA provides provisions for all regulated health professions, the Nursing Act of 1991 is specific to providing the scope of practice of the nursing profession. The Nursing Act is the basis for the College of Nurses of Ontario (CNO) mandate. As a member of a regulated profession, I am responsible for maintaining in-person or online professionalism (CNO, 2023). 

         Throughout this course, I have learned the importance of maintaining integrity in my social media posts and how I portray my image online. I limit and continue to use my personal social media platforms to Facebook and Instagram, while I continue to use LinkedIn as my professional social media platform. However, I have utilized Wix website as an additional professional platform for this course. Compartmentalizing my life has always been something that I have practiced since I started using social media. I believe strongly in creating boundaries between personal and professional life. Since taking this course, I have reduced my use of social media and have been extra cautious about what I post, personal or professional. The Registered Nurses of Ontario has provided nurses with guidelines on social media use (RNAO). These guidelines have helped me improve and gain more confidence in using social media professionally (Social media guidelines for nurses, n.d.).

Furthermore, as a social media consumer, I have learned how to filter information online. While social media may be a great tool to share relevant information, it can also be a tool to spread misinformation. As a professional nurse, I am responsible for ensuring the credibility of my sources for social media use (Ross, 2019). 

 

Conclusion

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        In conclusion, content creation and the use of social media for educational purposes are new concepts to me. They can be used for e-portfolios and blogging to share information professionally with the target audience. Throughout this course, I have learned the value of both concepts and have applied and practiced them to the contents of my portfolio for this course. I have gained confidence in my content creation and social media use skills. Misinformation and online professional misconduct are identified risks of using social media. This course has taught me how to conduct myself online professionally and how to navigate the integrity of the information I want to share online. As a professional nurse, I must ensure that the information I share online is credible and unbiased. If I am mindful of the guidelines of professionalism, I can continue to improve and develop my online persona. My perspective on social media and content creation has changed since taking this course. 

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References

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Worker with Ladder

Future of Cardiac Surgery and Nursing Implications

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As coordinator and team lead of the Transcatheter Aortic Valve Implantation (TAVI) and Minimally Invasive Cardiac Surgery (MICS) programs in the institution where I work, I witness what technology can do to provide patients with better options and outcomes. Providing treatment options to patients who are otherwise rejected for surgery is the future of cardiac surgery.

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Multidisciplinary healthcare models like perioperative medicine, innovative operating theatres, robotic interventions, intraoperative management, patient safety, risk identification, and postoperative rehabilitation increasingly use artificial intelligence (AI) (Mumtaz et al., 2022). It is fast-evolving and promising for the future of cardiac surgery. Artificial intelligence is a branch of computer science that attempts to simulate intelligent human behavior (Merriam-Webster, n.d.). Being able to predict future outcomes and using AI in cardiac surgery will help further advance the treatment options for patients.

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However, a shift in the training of cardiac surgeons is also necessary for the future of cardiac surgery. In recommendations to improve the future of cardiac surgery, Al-Ebrahim and colleagues' research proves that cardiac residents need at least one year of training in Catheterization Laboratories (Cath Lab) to give birth to the interventional surgeon (Al-Ebrahim et al., 2022). In TAVI procedures, for example, the interventional cardiologist and cardiac surgeon collaborate with the other care team members to decide the appropriate intervention for a patient. This example shows the benefits of training in the cath lab for future cardiac surgeons.

With its diversity ethos, Canada is in a great position to establish AI in healthcare. However, considerations of AI's limitations must be included in its application in healthcare (A. Kassam & N. Kassam, 2020). There are barriers to implementing novel AI technologies (Mumtaz et al., 2022).

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Moreover, it has implications for how nurses provide care to their patients. For example, electronic documentation has decreased and shifted nurses' workload to focus more on patient care rather than the task of manual documentation. AI can be used to predict how to make nurses work more efficiently. It is essential to prepare nurses with a strong education foundation on AI principles as it is destined to transform healthcare (Buchanan et al., 2021). As advocates of patients, nurses have a unique understanding of the complexities of the healthcare environment. Hence, their participation in implementing AI in healthcare is essential, especially concerning its ethical and social implications (Risling & Low, 2019). 

 Advancements in technology regarding heart health can hopefully help in reducing the incidence of cardiovascular diseases in Canada. 

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My Evolving Integrated Understanding of Health

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          Throughout the Critical Foundations in Health Disciplines (MHST 601) course, I have gained new knowledge and perspectives on Canadian health and healthcare. I was also able to explore new ideas and topics from which I need to become knowledgeable from my classmates. This blog summarizes my journey through the thirteen weeks of this course.

       

Unit I: Inter-professional Connectedness

          In week one, I introduced myself online using a software called Sway. It was my first time using the software, and it allowed me to be creative in introducing myself online to my class. Furthermore, the main tasks for the first week were to do social media and professional audits. A professional nurse's credible online presence contributes to a solid online portfolio (Ross & Cross, 2019). Through my audit, I found that my social media presence is active and vast, although it is limited to Facebook and Instagram.

On the other hand, my professional online presence is limited only to LinkedIn. As a public servant, I have always been cognizant of my social media use. I know the professional guidelines I am accountable to as per the Registered Nurses of Ontario (RNAO) and the College of Nurses of Ontario (CNO). This exercise has validated my social media behavior and has helped me further understand my professional responsibility.

           I synthesized and curated my professional audit the following week in a blog post. I explored a few blogging websites and curation tools. In the end, I chose Zotero as my curation tool software. It is user-friendly and practical. Then, I chose Wix as my e-portfolio domain. I have had experience using blog websites, namely Wix, Tumblr, and WordPress. I picked Wix as it allows for more creativity and is user-friendly. I intended to create a minimalistic motif for my e-portfolio. 

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Unit 2: Federal and Provincial Health Systems of Canada

           In the third and fourth weeks of the course, the class was tasked to understand the Canadian healthcare system better, including but not limited to my role as a registered nurse and the legislative and regulative body regionally and federally. As a registered nurse working and currently registered in Ontario, the Nursing Act of 1991 and the Regulated Health Professions Act of 1991 (RHPA) regulate the nursing profession. The Nursing Act is the basis for the mandate of the CNO (2023). 

           Canada has a universal, publicly funded healthcare system. As a frontline healthcare worker, I am a public servant and a witness to the effects of policies and provisions decided on the provincial or federal level. My primary responsibility as a nurse in public service is to advocate for the population and practice my profession within the rules and regulations drawn upon by the legislative and regulative body of the province, I am working in (CNO, 2023). In this part of the course, I better understand my position as a healthcare professional within the Canadian healthcare system.

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Unit 3: Health of Canadians – Understanding Health and Determinants of Health

           Although the World Health Organization (WHO) has kept its definition of health the same since 1948, scholars have long debated expanding its definition but have yet to agree. As I read about determining the definition of health, I leaned toward Leonardi's (2018) definition. According to Leonardi (2018, p. 736), health is "the capability to cope with and to manage one's own malaise and well-being conditions. In more operative terms, health may be conceptualized as the capability to react to all kinds of environmental events, having the desired emotional, cognitive, and behavioral responses and avoiding those undesirable ones". This definition supports Huber's (2011, p. 343) definition, which is that health "is the ability to adapt and self-manage in the face of social, physical, and emotional challenges." Compared to the WHO's definition of health, these two definitions reflect more of the current healthcare needs of the modern world. In other words, determining the social determinants of health is crucial in defining health.

           During this part of the course, I broadened my knowledge and awareness of the social determinants of health (SDH). SDH "refers to a specific group of social and economic factors within the broader determinants of health" (Public Health Agency of Canada, 2001, n.d.). They are essential in influencing health inequities. Added to the list above, the World Health Organization (2023) identified food insecurity and early childhood development as SDH (WHO, n.d.). As a nurse, I have a critical role in reducing health inequity by integrating social care into health care (Wise et al., 2023). Holistic care is already embedded in nursing. Thus, including SDH in nursing practice is a natural course in the profession's evolution.

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 Unit 4: Multilevel Approaches to Understanding Health – Beyond the Individual

           My knowledge of models of health is minimal. I learned about the different models of health through this course, particularly the biopsychosocial model. My topic of interest is nursing burnout and determining the most appropriate model of health to address it. Nursing burnout is a phenomenon that has been studied for a long time but was particularly highlighted during the COVID-19 pandemic. Through my readings, I decided to focus on the salutogenic model of health as a starting point because most of the responsibility to address burnout is laid on the nurses. However, with further inquiry into the topic, I learned the need to expand the model of health to address nursing burnout even further beyond the biopsychosocial model. Listopad and colleagues' (2021) literature review on nursing burnout revealed the need to expand the biopsychosocial model of health on nursing burnout. They recommended adding cultural and spiritual factors to create a more holistic perspective in addressing burnout.

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Unit 5: Chronic Disease Prevention and Management

           In Unit 5, the class was tasked to identify a chronic disease, surveillance, and management. Because I work in cardiac surgery, I focused on chronic cardiovascular diseases and management in Canada. These include heart failure, hypertension, ischemic heart disease, and stroke, according to the Canadian Chronic Disease Surveillance System (CCDS). It is the second leading cause of death and the leading cause of hospitalizations in Canada (PHAC, 2017).

My designation in my workplace allows me to learn the different treatment options for cardiovascular disease in the hospital, in addition to medications and lifestyle changes. However, this course broadened my knowledge and understanding of how cardiovascular disease is managed on a gross scale. Canada recognizes the economic burden of heart disease and introduced the Canadian Heart Health Strategy and Action Plan (CHHS-AP) (Smith, 2019). The focus of the strategy is on prevention and health promotion. Unfortunately, the strategy has not secured any funding.

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Unit 6: Vulnerable Population

           I recognize that the indigenous population of Canada is one of the most marginalized communities. Therefore, I focus on their heart health in this part of the course. I have learned that a more holistic approach to healing is recommended (Heart and Stroke Foundation of Canada, n.d.). The historical and continued impacts of colonialism on the heart health of indigenous communities cannot be denied (Schultz et al., 2021). In addition, there is also a need to recognize the link between mental health and heart health. Ultimately, the recommended approach includes a culturally sensitive strategy, centering on an indigenous perspective, to address heart health in indigenous communities (Fields et al., 2022). Addressing healthcare among indigenous communities is part of the Truth and Reconciliation process (Schultz et. al., 2021).  

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Unit 7: Future Directions

           In the last unit of the course, I have identified the future treatment options for cardiac disease. Although there is a need for health promotion and prevention strategies, my focus was on treatment because that is my field. As the coordinator of minimally invasive cardiac surgery in my workplace, I witnessed some of the most innovative treatment options for heart disease and the future of integrating artificial intelligence (AI) in predicting patient outcomes. The future of health care is digital. Hence, the training and education of healthcare professionals must also evolve. For example, in cardiac surgery, there is now a need for an interventional surgeon (Al-Ebrahim et. al., 2022). Nursing education must also evolve, integrating artificial intelligence into the curriculum. However, as patients' advocates, nurses must also take leadership in ensuring that safe, quality, and ethical care is considered in the use of innovative solutions like AI (Risling & Low, 2019).

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Conclusion

           My journey throughout this course has been an exciting learning process. This course expanded my knowledge and understanding of health issues I am passionate about beyond treatment. Each week has allowed me to explore topics affecting my healthcare work. Furthermore, curating the data I gathered for each topic was challenging but a good exercise. The curation tools introduced at the beginning of this course have helped me tremendously. I have gained new perspectives in understanding Canadian healthcare through this course. In addition, I have also gained new confidence in data curation.

 

References

Al-Ebrahim, E. K., Madani, T. A., & Al-Ebrahim, K. E. (2022). Future of cardiac surgery, introducing the interventional surgeon. J Card Surg, 37(1), 88-92. https://doi.org/10.1111/jocs.16061

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College of Nurses of Ontario. (2023, August). Code of Conduct. https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf

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Field, S. N., Miles, R. M., & Warburton, D. E. R. (2022). Linking Heart Health and Mental Wellbeing: Centering Indigenous Perspectives from across Canada. Journal of Clinical Medicine, 11(21), 64-85. https://doi.org/10.3390/jcm11216485

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Heart and Stroke Foundation of Canada. (2023, November). A holistic approach to Indigenous health. https://www.heartandstroke.ca/en/articles/a-holistic-approach-to-indigenous-health/

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Huber, M. (2011). Health: How Should We Define It? BMJ: British Medical Journal, 343(7817), 235–237. https://doi.org/10.1136/bmj.d4163

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Leonardi F. (2018). The Definition of Health: Towards New Perspectives. International journal of health services: Planning, administration, evaluation, 48(4), 735–748. https://doi.org/10.1177/0020731418782653

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Listopad, I. W., Michaelsen, M. M., Werdecker, L., & Esch, T. (2021). Bio-Psycho-Socio-Spirito-Cultural Factors of Burnout: A Systematic Narrative Review of the Literature. Frontiers in Psychology, 12, 722-862. https://doi.org/10.3389/fpsyg.2021.722862

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Public Health Agency of Canada (2001, November 25). Social determinants of health and health inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

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Public Health Agency of Canada. (2017). Heart disease in Canada: Highlights from the Canadian Chronic Disease Surveillance System. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-canada-fact-sheet.html

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Risling, T. L., & Low, C. (2019). Advocating for Safe, Quality and Just Care: What Nursing Leaders Need to Know about Artificial Intelligence in Healthcare Delivery. Nursing Leadership (Toronto, Ont.), 32(2), 31–45. https://doi.org/10.12927/cjnl.2019.25963

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Ross, P., & Cross, R. (2019). Rise of the e-Nurse: The power of social media in nursing. Contemporary Nurse, 55(2–3), 211–220. https://doi.org/10.1080/10376178.2019.1641419

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Schultz, A., Nguyen, T., Sinclaire, M., Fransoo, R., & McGibbon, E. (2021). Historical and Continued Colonial Impacts on Heart Health of Indigenous Peoples in Canada: What is Reconciliation Got to Do With It? CJC Open, 3(12 Suppl), S149–S164. https://doi.org/10.1016/j.cjco.2021.09.010

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Smith E. R. (2009). The Canadian heart health strategy and action plan. The Canadian journal of cardiology, 25(8), 451–452. https://doi.org/10.1016/s0828-282x(09)70116-3

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Wise, J., Caiola, C., & Njie-Carr, V. (2023). A fundamental shift in nursing is a requisite for achieving health equity: The nurses' role in addressing social determinants of health. JANAC: Journal of the Association of Nurses in AIDS Care, 34(1), 125–131. https://doi.org/10.1097/JNC.0000000000000383

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World Health Organization (n.d.). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health

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