Health Inequities and Moral Distress Among Community Health Nurses During the COVID-19 Pandemic

Catherine Baxter; Ruth Schofield; Claire Betker; Genevieve Currie; Francoise Filion; Patti Gauley; May Tao; Mary-Ann Taylor

doi:10.25071/2291-5796.137

Authors

Catherine Baxter Brandon University https://orcid.org/0000-0001-7498-3239
Ruth Schofield McMaster University https://orcid.org/0000-0001-5292-9282
Claire Betker National Collaborating Centre for the Determinants of Health https://orcid.org/0000-0002-6340-1421
Genevieve Currie Mount Royal University https://orcid.org/0000-0001-9478-0850
Francoise Filion McGill University https://orcid.org/0000-0002-9368-9809
Patti Gauley Eastern Ontario Health Region https://orcid.org/0000-0002-8768-8199
May Tao Toronto Public Health
Mary-Ann Taylor Vancouver Coastal Health https://orcid.org/0000-0002-8102-4738

DOI:

https://doi.org/10.25071/2291-5796.137

Keywords:

Health Inequities, Social Justice, Moral Distress, Community Health Nurses, COVID-19

Abstract

The core values of community health nursing practice are rooted in the social determinants of health, health equity and social justice. Throughout the COVID-19 pandemic, community health nurses (CHNs) witnessed first-hand the impact on individuals in situations of marginalization. This research inquiry explored how health inequities among client populations contributed to experiences of MD among CHNs in Canada during the pandemic.

A total of 245 CHNs from across Canada participated in an online survey. Participants reported that during the pandemic individuals living in situations of marginalization were disproportionately impacted. CHNs were unable to provide the necessary health promotion interventions and experienced high levels of moral distress. The negative impact of the pandemic on individuals living in situations of marginalization illuminated the intersecting social and structural inequities that drive negative health outcomes and emphasized the need to adopt an equity focus for current and future pandemic planning, response, and recovery.

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Author Biographies

Catherine Baxter, Brandon University

Catherine Baxter RN PhD, is an Assistant Professor in the Faculty of Health Studies at Brandon University. Her current research focuses on moral distress, the integration of internationally educated nurses into the health workforce, and equity, diversity, and inclusion in nursing education. Catherine has extensive experience in curriculum design, accreditation, and program evaluation. She is currently a member of the Steering Committee of the Community Health Nurses of Manitoba and the Community Health Nurses of Canada Leadership Standing Committee.

Ruth Schofield, McMaster University

Ruth Schofield RN BScN MSc(T), is an experienced nursing professor in public/community health nursing and has taught at McMaster University and Western University. Her research focuses on community health nursing, nursing education, and mental health and housing with several publications. Ruth has over 23 years of public health nursing experience in various positions and programs. She is the founder of the new national PHN postgraduate program. Ruth has been a chair or general member of national and provincial Boards. She has led several national projects in the development of the CHN standards, competencies, educational guidelines, virtual simulation, and an accreditor.

Claire Betker, National Collaborating Centre for the Determinants of Health

Claire Betker, RN PhD Claire’s career began in southwestern Manitoba at a rural single-nurse public health office. She has worked in public health, home care, and primary health care in a variety of positions at local, regional, provincial, and national levels. Claire believes all nurses are leaders. It is through collective voice and action that we can work with and support communities where all people have a fair opportunity to be healthy. Claire is scientific director for the National Collaborating Centre for Determinants of Health (NCCDH), hosted by St Francis Xavier University. Her focus there is on public health leadership to advance health equity.

Genevieve Currie, Mount Royal University

Genevieve Currie RN MN PhD (candidate), is an associate professor in the School of Nursing and Midwifery at Mount Royal University in Calgary, Alberta. Her nursing experience is in pediatrics, family newborn, population health, and community health nursing. Her current research and teaching interests are focused on community health nursing practice and education, family centered care, and family engagement in health care and research. Genevieve is a member of the Community Health Nurses of Canada, Leadership Standing Committee.

Francoise Filion, McGill University

Francoise Filion RN MScN, is an assistant professor at the Ingram School of Nursing of McGill University since 2010. Her teaching and research interests are in community health nursing working with underrepresented populations. She has organized six nursing-led clinics in community organizations working with Indigenous populations and populations in situation of homelessness. She is leading a community health nursing clinical course for the past 10 years that creates health promotion and primary prevention projects in partnership with community organizations working with underserved populations.

Patti Gauley, Eastern Ontario Health Region

Patti Gauley RN BN MHS is the Chief Nursing Officer and Director of Health Promotion and Prevention at the Eastern Ontario Health Unit (EOHU) in Cornwall, Ontario. During her tenure at the EOHU, which began in 1993, Patti has been at the helm of several programs, including Healthy Growth and Development, Chronic Disease Prevention and Well-Being, Substance Use and Injury Prevention, School Health, and the Preschool Speech and Language program. She holds a diploma in nursing from the Salvation Army Grace General Hospital in St. John’s Newfoundland, a Bachelor of Nursing from Memorial University of Newfoundland, and a Master of Health Studies from Athabasca University. Patti is currently Chair of the Social Development Council for Cornwall and Area and the Board of Directors of the Glengarry Nurse Practitioner-Led Clinic. Patti has a passion for public health nursing, health equity and collective action.

May Tao, Toronto Public Health

May Tao RN MSN, is currently the Health Promotion Specialist at Toronto Public Health, currently coordinating for the RNAO Best Practice initiative to implement and evaluate best practice guidelines in her organization. May has a Bachelor degree in Nursing and a Master of Science in Nursing. She is also certified in Community Health Nursing with the Canadian Nurses Association. May has been participating in the RNAO Advanced Clinical Practice Fellowship building on leadership and youth engagement practice. May has also volunteered as an executive member of the Registered Nurses’ Foundation of Ontario and an active member of the CHNC Leadership Standing Committee.

Mary-Ann Taylor, Vancouver Coastal Health

MaryAnn Taylor RN, MSN is currently the Manager with Home Health and Home Support Services in Sea to Sky at Vancouver Coastal Health. Mary-Ann has a Bachelor of Science in Nursing from McMaster University and Master of Science in Nursing from the University of British Columbia. Her nursing experiences span from public health, primary care, women’s health, mental health and home health in rural and urban centres. She is currently the British Columbia Director with the Community Health Nurses of Canada and is a member of the Leadership Standing Committee.

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