1
Q
critical thinking in nursing
A
Complex phenomenon
Can be defined as a process and as a set of skills
Uses knowledge and reasoning to make accurate clinical judgements
Foundation of clinical reasoning (process) and clinical judgement (outcome)
2
Q
cognitive skills in critical thinking
A
Interpretation
Analysis
Inference
Evaluation
Self-regulation
3
Q
dispositions for critical thinking
A
Truth-seeking
Open-mindedness
Analyticity
Systematicity
Self-confidence
Inquisitiveness
Maturity
4
Q
levels of critical thinking
A
Basic → rule-based, right/wrong
Complex → analytical + creative
Commitment → responsible clinical autonomy
5
Q
clinical reasoning vs judgement
A
Clinical reasoning → cognitive process
Clinical judgement → outcome / result
6
Q
5 rights of clinical reasoning
A
Right cues
Right action
Right client
Right time
Right reason
7
Q
phases of clinical reasoning
A
Client problem presentation – recognize and identify one or more problems
Client problem assessment – collect data and recognize patterns
Client problem analysis – analyze and interpret data to see relationships
Client problem hypothesis – categorize data; determine priority problems and actions
Client problem evaluation – test/evaluate hypothesis and determine client response
8
Q
benner’s levels of critical thinking
A
Novice – beginning practitioner, lack experience
Advanced beginner – marginally acceptable performance based on limited experience
Competent – ~2–3 years of experience
Proficient – broad experience, sees the “big picture”
Expert – extensive experience; intuitive grasp of situations
9
Q
reasoning types
A
Inductive
Deductive
Abductive
10
Q
ADPIE
A
Assessment – collect information
Diagnosis – analyze data, determine diagnoses
Planning – identify expected outcomes
Implementation – perform evidence-based interventions
Evaluation – determine progress toward expected outcome
11
Q
missed nursing care
A
anything omitted or delayed
12
Q
basic of communication
A
Exchange of information
Receiver interprets meaning
Listening > hearing
Influenced by perception + biases
13
Q
barriers to active listening
A
Preoccupation
Anxiety
Personal insecurity
Discomfort
Too much information
14
Q
evidence-informed knowledge
A
Knowledge based on research or clinical expertise
Helps make you a critical thinker
Improves patient outcomes
15
Q
interpretation
A
Looking for patterns
Ordering and categorizing data
Clarifying data
16
Q
analyses
A
Avoiding careless assumptions
Asking whether data really shows what you think is true
Considering other possible scenarios
17
Q
inference
A
Examining meanings and relationships in data
Forming hypotheses based on data
Drawing conclusions from data
18
Q
evaluation
A
Assessing situations objectively
Using criteria to measure effectiveness
Identifying required changes
Reflecting on own behaviour
19
Q
self-regulation
A
Reflecting on experiences
Adhering to standards
Applying ethical principles
Seeking ways to improve practice
20
Q
truth seeking
A
learn what actually happened, consider scientific principles + evidence, even if they do not support preconceptions/beliefs
21
Q
open-mindedness
A
be receptive to new ideas/others views. Respect right to hold diff opinions, be aware of own prejudice
22
Q
analyticity
A
determine significant of situation, interpret meaning, use evidence-informed knowledge, anticipate results/consequences
23
Q
systematicity
A
organized, focus on data collection
24
Q
self-confidence
A
trust own reasoning, seek confirmation when unsure
25
inquisitiveness
be curious, eager to acquire new knowledge
26
maturity
accept multiple solutions are possible, reflect on own judgements, consider other explanations
27
inductive reasoning
Making generalizations from observations
Identifying and organizing signs/symptoms into patterns
Drawing a conclusion based on those patterns
28
deductive reasoning
Starting with general possibilities
Determining specific hypotheses or client problems from them
29
abductive reasoning
Using reflection on explanations
To reach a conclusion or observation about a client
30
clinical judgement
Observed outcome of critical thinking and decision-making
Involves observing and assessing, prioritizing client concerns
Generating the best evidence-based solution
31
clinical reasoning
Cognitive process of identifying actual/potential needs
Collecting and analyzing data
Hypothesizing and performing nursing actions
Evaluating the results
32
tanner's thinking like a nurse
Thinking ahead – anticipate what might happen, be proactive
Thinking-in-action – rapid, dynamic thinking in the moment
Thinking back – analyze/deconstruct your reasoning afterwards to gain deeper understanding and make corrections
33
general critical thinking competencies
Scientific method – systematic, ordered data gathering and problem-solving
Problem solving – use information to reach a solution, then evaluate if it remains effective
Decision making – product of critical thinking that focuses on problem resolution
34
diagnostic reasoning
Determine patient’s health status
Uses physical/behavioural observations
Assigns meaning to behaviours, signs, and symptoms
35
clinical inference
Part of diagnostic reasoning
Draws conclusions from related pieces of evidence
Forms patterns of information from data
May require multiple meetings to gather more data
36
clinical decision making
defining patient problems/situations and selecting appropriate actions
37
standards for critical thinking
Intellectual standards – guidelines for rational thought
Professional standards:
Ethical criteria from the CNA Code of Ethics (safe, compassionate, competent, ethical care)
Criteria for evaluation – use of clinical guidelines (e.g., pain scales)
Professional responsibility – institutional guidelines and legislation
38
five pillars of critical thinking
Knowledge base
Experience
Competency
Attitudes
Standards
39
developing critical thinking skills
Case-based learning – explore complex problems and decisions without patient risk
Reflective writing – reflect to discover a situation’s purpose/meaning
Concept mapping – visually map health problems and interventions and their relationships
40
information literacy
Knowing when information is needed
Knowing how to find, retrieve, evaluate, and apply information effectively
41
patient education
imparting knowledge to patients + caregivers about their health
42
patient-centred approach to education
nurses help patients actively participate in their education + better self-manage their needs and care
43
patient-centred care
standard of care that positions patient as focus of care delivery + as partner in delivery of care using L.E.A.R.N.S. model developed my RNAO
44
L.E.A.R.N.S model
o Listen to patient needs
o Establish therapeutic partnership relationships
o Adopt an intentional approach in every learning encounter
o Reinforce health literacy
o Name new knowledge via teach-back
o Strengthen self-management via links to community resources
45
basic learning principles
- environment
- diff ages
- stye + preference
- motivation
46
ideal learning environment
Well-lit and well-ventilated
Appropriate furniture
Comfortable temperature
Quiet with few distractions
47
what affects ability to learn
Emotional capability – anxiety, emotional readiness
Intellectual capability – knowledge level, cognition
Physical capability – size, strength, coordination, sensory acuity
Developmental stage (diff stages for diff ages)
Social determinants of health
48
motivators for learning
Perceived severity of threat to health
Feeling vulnerable to the threat
Belief that response is effective
Belief in their ability to change behaviour
Social motives – connection, approval, self-esteem
Task mastery motives – desire for achievement
Physical motives – desire to maintain/improve health
49
social learning theory
When people believe they can execute behaviour, they are more likely to perform the behaviour consistently and correctly
50
self-efficacy
Self-efficacy = perceived ability to successfully complete a task
Self-efficacy arises from:
Verbal persuasion
Vicarious experiences
Enactive mastery experiences
Physiological and affective states
51
transtheoretical model of change
Precontemplation – not aware/no intention to change
Contemplation – aware, intends to change in future
Preparation – minor behaviour changes, intends major change soon
Action – modifying behaviour to create sustained change
Maintenance – prevent relapse and solidify new behaviours
52
goals of patient education
- Maintain and promote health + preventing illness
- Restoring health
- Optimizing quality of life with impaired functioning
53
teaching and learning as nurse
- Teaching is an interactive process that promotes learning
- Role of nurse
o Determine what patient needs to know and learning style, relay info
- Teaching as communication
o Listen empathetically, observe astutely + speak clearly
54
domains of learning
Cognitive (intellectual): remembering, understanding, applying, analyzing, evaluating, creating
Affective (attitudes/values): receiving, responding, valuing, organizing, characterizing
Psychomotor (motor skills): perception, set, guided response, mechanism, complex overt response, adaptation, origination
55
teaching approaches
Telling – direct, no feedback, limited information
Selling – two-way, persuasive
Participating – nurse and patient set objectives together
Entrusting – patient manages self-care
Reinforcing – use stimuli (social, material, activity) to increase desired responses
56
what should nurses evaluate after teaching patients
Were goals mutually set and realistic?
Can patient demonstrate the skill multiple times?
Can patient answer questions about topic?
Does the patient still have difficulty?
Were patient’s needs and expectations met?
Documentation of: assessment, diagnosis, planning, interventions, response, and ability to manage after discharge
57
communication
exchange of information between individuals, groups or organizations
58
relational practice
guided by conscious participation with clients using skills like listening, questioning, empathy, reciprocity, sensitivity
Emphasizes initiative, authenticity, mutuality, and deep questioning
Requires awareness of self and how we connect to client and health system
59
relational communication
The will and active intention of nurses to join people where they are
60
relational inquiry
complex interplay of human life, world and nursing practice
61
elements of relational inquiry
- Intrapersonal – communicate w/ client in a way that allows you to asses within all people involved
- Interpersonal – communicating with client in way that allows you to assess what is occurring among + between people involved
- Contextual – communicating w/ client in way that allows you to assess what is occurring around people/situation
62
authenticity
being spontaneous and genuine, remaining ware of patient’s and one’s own in-the-moment experiences, cultivates trust
63
mutuality
being in mutual relation, “in sync”, being equal participants and respecting each other’s autonomy
64
questioning beyond the surface
approach to inquiry that nurses employ to facilitate relational practice within complex circumstances of health and illness, requires critical thinking
65
attention
taking notice of someone and regarding them as interesting and important
66
relational capacities
- Collaboration
- Commitment
- Compassion
- Competence
- Leadership
- Orienting
- Scrutinizing
- Curiosity
- Corresponding
67
perception
based on information acquired through the five senses, process of mentally organizing + interpreting sensory information into a meaningful conclusion, culture, education and background influence it
68
perceptual biases
human tendances that interfere with accurately perceiving + interpreting messages, attitudes + values from others
- People often assume others would think/feel/act the same as themselves in a scenario
69
seeking contextual knowledge
building block to providing context-based and relevant care, easy to learn but application is more difficult
70
reflexivity
being aware of your own patterns of communication + response to communication and responses you are evoking in others
71
levels of communication
intrapersonal
interpersonal
transpersonal communication (part of interpersonal)
small group communication
public communication
72
intrapersonal
o One’s thinking, known as self-talk or inner though
o Powerful form of communication occurring within an individual
o Highly consequential to interpersonal communication and collaboration
o Develop self-awareness + positive self-concept
73
interpersonal communication
o One-to-one interaction
o Between nurse and patient
o Most frequent in nursing practice
o Sometimes messages are received differently than messenger intended
74
transpersonal communication
o Occurs within a person’s spiritual domain
o Spiritual inquiry – approach to communication whereby nurses can join patients to create road map of what is meaningful, significant and important in their unique context
75
small group communication
o Occurs when a small number of people meet for a common purpose
o Usually goal directed and requires an understanding of group dynamics
o Members must feel accepted and comfortable
76
public communication
o Interaction with an audience
o Special adaptations in eye contact, gestures and voice inflection with use of media materials
o Purpose is to increase audience knowledge of health-related topics
77
communication process
Referent - motivates communication
Sender (encodes)
Receiver (decodes)
Message
Channels - means of conveying + receiving
Feedback - message return
Interpersonal variables - influence communication
Environment
78
verbal communication
o spoken or written
Vocabulary – don’t use medical jargon
o Denotative and connotative meanings – avoid terms that can be misinterpreted
o Pacing – messages better conveyed at appropriate speed/pace
o Intonation – tone of voice
o Clarity and brevity – simple, brief and direct
o Timing + relevance – poor timing can limit effectiveness
79
nonverbal communication
all 5 senses, transmission without words
(38% of communication vocal cues, 55% nonverbal body cues, 7% words)
- general appearance, facial expression, posture, sounds, eye contact, personal space etc
80
zones of personal space
Intimate: 0–45 cm (usually loved ones, nurses too)
Personal: 45 cm–1 m
Social: 1–4 m
Public: 4 m+
81
zones of touch
Social zone – hands, arms, shoulders, back: assess for permission
Consent zone – mouth, wrists, feet: need consent
Vulnerable zone – face, neck, front of body: consent & special care
Intimate zone – genitalia, rectum: consent & great sensitivity
82
symbolic communication
like art and music, creative expression can help healing
83
metacommunication
broad term referring to all factors influencing how message is perceived, communication about communication
84
nurse-patient helping relationships
o Important to create a therapeutic environment
o Narrative interactions – nurses often encourage patients to share personal stories in a therapeutic relationship
Can help understand context of patient’s life
o Collaborative communication – promotes personal responsibility, enables self-expression, strengthens patient’s problem-solving ability
Mutual gain and respect, desire to satisfy both needs of parties
85
nurse-family relationships
o Same principles guiding on-to-one helping relationships also apply when patient is in a family unit
o Requires additional understanding of family dynamics, needs and relationships
86
interprofessional collaborative practice (ICP) relationships
o Many aspects of nurse-patient relationship also apply
o Team building, facilitating group process, collaboration, consultation, delegation, supervision, leadership, and management
87
nurse-community relationships
o With community groups by participating in local organizations, volunteering or politically active
o Includes public bulletin boards, newspaper, TV, websites, etc
88
people centred care
include patient in care planning, based on respect + sensitivity to values and beliefs, patient is expert in own life, goals and wishes
89
elements of professional communication
courtesy
use of names
trustworthiness
autonomy and responsibility
assertiveness
90
SOLER
o S – sit facing patient
o O – keep open posture
o L – lean toward patient
o E – maintain eye contact
o R – relax
refers to active listening
91
therapeutic communication
Active listening
Sharing observations
Sharing empathy
Sharing hope (without false reassurance)
Sharing humour (appropriately)
Sharing feelings
Using touch (with permission)
Using silence
Providing information
Clarifying
Focusing
Paraphrasing
Asking relevant questions
Summarizing
Self-disclosure (careful, intentional)
Confrontation (only with trust and permission)
92
non-therapeutic communication
Asking personal questions
Giving personal opinions
Changing the subject
Automatic responses / clichés
False reassurance
Sympathy instead of empathy
Asking for explanations (“why”)
Approval/disapproval
Defensive responses
Passive or aggressive responses
Arguing
93
hearing vs listening
Hearing: accidental, involuntary, effortless
Listening: focused, voluntary, intentional
94
values
strong personal belief and an ideal believe to have merit
95
values of nursing
o Providing safe, compassionate, competent and ethical care
o Promoting health + well-being
o Promoting + respecting informed decision making
o Preserving dignity
o Maintain privacy + confidentiality
o Promoting justice
o Being accountable
96
ethics
– study of philosophical ideals of right and wrong behaviour
- What one thinks one ought or not to do
- Values + standards in nursing individually or professionally
97
integrity
acting in an honest manner based on strong moral principles
- Professional integrity, practicing in a manner that maintains appropriate ethical behaviours + upholds professional code of conduct
98
responsibility
characteristics of reliability + dependability
- Distinguishing right + wrong
- Duty to perform actions adequately + thoughtfully
99
accountability
accepting responsibility for one’s action, grounded in fidelity, veracity and respect
100
advocacy
acting on behalf of another person, speaking for persons who cannot speak for themselves or intervening to ensure views are heard
101
answerability
able to offer reasons + explanation to other ppl for aspects of nursing practice
102
values formation
- Acquired in many ways thru upbringing and acculturation
- Moral development – distinguishing right from wrong and forming values which base actions throughout childhood and adolescence
- Cultural values – values adopted through immersion in a certain social setting
103
values clarification
- Clarifying values helps you articulate what matters most + priorities
- Values change over time
- Value clarification – process of appraising personal values
o A process of personal reflection, making conscious decisions about what’s most important
104
values conflict
personal values not congruent with those of a patient, colleague or institution
105
ethics vs morals
- Morality is concerned with norms, principles or what “ought to be”
- Ethics focuses on reflective analysis of those norms/principles and putting them into action
o Requires critical reflection
often used interchangeably tho
106
fidelity
faithfulness, respect for dignity, worth and self-determination of patients + others, loyalty, promise-keeping + truth-telling
107
CNA code of ethics
guides nurses, statement of ethical values and nurses’ commitment
108
CNA says nurses who are professionally accountable are:
Keeping up w/ professional standards, laws + regulations
Ensuring they have competence to provide these practices
Maintaining fitness to practise
Sharing knowledge with other nurses, students + health care providers and giving feedback
Advocating for comprehensible + equitable mental health care services
109
informed consent
nurses advocate on behalf of patients to make sure patient understands treatment + has capacity to give consent
o Nurses protect patients privacy + confidentiality by helping access health records
o Intervening if other members of healthcare team fail to respect privacy
o Follow policies that protect patients' privacy
110
constrained moral agency
feeling of powerless to act for what you think is right or if you believe your actions will not effect change\
o If you experience constrained moral agency, you will have difficulty being an effective advocate
111
layers of CNA code of conduct
7 values
guiding principles under each value
context + ethical responsibilites under each guiding principle
112
7 values of CNA code of conduct
o Honouring dignity + autonomy of all people
o Valuing relationships and humanizing care
o Maintain integrity and accountability in nursing practice
o Pursuing truth and reconciliation
o Promoting social justice
o Providing competent professional nursing practice
o Preserving privacy and confidentiality
113
6 Ps of social media use
- Professional
- Positive
- Patient or person-free
- Protect yourself
- Privacy
- Pause before you post
114
descriptive moral theory
explains what people do or think about moral issues
115
metaethics
field of ethics that analyzes meaning of key terms like right, obligation, good and virtue attempting to distinguish what is moral and what is not
116
normative ethics
normative ethical theory is prescriptive, tells us how we ought to think about moral questions, judge the quality of and evaluate decisions based on obligations to others
117
applied ethics
aka practical ethics, looks at how decisions should be made in particular situations and ask questions about what moral beliefs + values should apply in specific contexts
118
deontology
system of ethics that defines actions as right or wrong according to moral duties, principles, rules or imperatives (from Immanuel Kant)
o Role of nurse is to discern what their duties are and act consistently with, and in the spirit of those duties
o Do not look at consequences, but instead critically examine a situation for existence of essential rightness or wrongness
o Concerned with presence of principle regardless of outcome
119
utilitarianism
aka consequentialism, or sometimes teleology, emphasis on outcome or consequence of action, value of something determined by its usefulness
o Guiding principle is greatest good for greatest number of people
o Concerned with effect an act will have
120
bioethics
1970s theory, decided that then-current ethical theories not sufficient for health care, broad general term across health care professions
o Biomedical ethics – denote ethical reasoning for physicians
o Based on obligation, outcome and reason
o Central idea – health care ethics, moral decision making in health care guided by four principles, examine situation, determine which principle has priority, use it to guide actions
121
bioethics principles
Autonomy – self-determination/freedom of patient
Beneficence – promote patient’s good
Nonmaleficence – avoid harm
Justice – fairness and equity; includes social justice
122
feminist ethics
analyzes gender prejudice es and unjustifiable differential consideration + treatment applied to any marginalized group
123
relational ethics
ethical understandings are formed in, emerge from a person’s relationship with others, focuses on role of relational context or experience relationships in shaping moral values
124
environment - relational ethics
concerns critical elements/characteristics of health care system within which a nurse works, interconnectedness of health care system
125
embodiment - relational ethics
knowledge generated from mind, body and spirit, healing cannot occur unless scientific knowledge and human compassion are given equal weight
126
mutuality - relational ethics
relationship that benefits both nurse and patient and harms neither, both must be willing to participate in respect + nonjudgementalness of others ideas + values
127
engagement - relational ethics
connecting with another person in an open, trusting + responsive manner, commitment to keeping relationship caring + respectful
128
ethical dilemma
conflict between two sets of human values, both of which are judged to be “good” but neither of which can be fully served
129
steps to analyze ethical dilemma
Determine whether the issue is an ethical dilemma
Gather all relevant information
Examine your own values
Verbalize the problem
Consider possible courses of action
Reflect on the outcome
Evaluate the action and outcome
130
cultural safety
beyond awareness and acknowledgement, grounded in decolonization of health care and outcome of respectful engagement resulting in people feeling safe when receiving health care
131
stages of cultural competence, lowest to highest
- Cultural destructive ness (hating)
- Cultural incapacity (blaming)
- Cultural blindness (not seeing)
- Cultural sensitivity (tolerance)
- Cultural competence (understanding)
- Cultural proficiency (embracing + working together)
132
cultural humility
o A lifelong process of self-reflection and critique (role of learner) that includes the recognition of power imbalances when working in partnership with
patients.
133
cultural competency
o Describes a compilation of knowledge, attitudes, and skills for working with individuals of the same and different cultures
134
cultural pluralism
o Diverse groups maintaining their unique cultural identities while living together harmoniously
135
multiculturalism
o Ideas and ideals related to respect for, and celebration of, our cultural diversity, operationalized at the federal, provincial, and municipal levels
136
value orientation
o Values learned and shared through socialization
o Reflect “personality type” of particular society
137
medication order components
1. Medication name
2. Administration route
3. Administration frequency
4. Medication dose
5. Qualifying phrases (for specific reason/condition)
138
types of medication orders
Scheduled – at specific times
PRN – as needed
One-time/short series – limited number of doses or one-time
STAT – immediately
Verbal – given verbally, written by nurse, later signed by prescriber
Standing/preprinted – standard sets for common conditions/procedures
139
contextual factors that influence communication (assessment)
physical + emotional - ability to communicate, psychological
developmental factors - consider age (children need simple)
sociocultural - follow patient/family lead, cultural competence
140
impaired verbal communication
nursing diagnostic label used to describe patient with limited/no ability to communicate verbally
o Different types of impaired verbal communication (like culture vs deafness)
141
primary goal of nursing interventions
facilitate trust
142
continuity of care
collab w/ other healthcare members in interprofessional team
143
elderspeak
DO NOT USE CONDESCENDING
144
health spending ontario
Health-sector spending is increasing steadily, projected to grow at about 3.4% annually.
Expected to reach roughly $86.7 billion by 2025–26.
145
aging population
Adults aged 85+ are one of the fastest-growing demographic groups.
Currently about 2.3% of the population.
Over 25% of those aged 85+ live in collective dwellings (e.g., long-term care), creating increased demand for nursing and elder care.
146
AI in nursing
AI is not replacing nurses, but is being used to augment nursing practice (e.g., decision support, monitoring tools, workflow assistance).
147
wearable devices
Increasing use of wearables that collect health-related data, including:
Glucose monitoring
Blood pressure
Heart rate
Fitness tracking
Sleep data
148
mental health trends
50% of Canadians experience a mental illness by age 40.
1 in 5 Canadians experience a mental illness each year.
Youth (15–24) are most affected by mental illness and/or substance use.
149
pharmaceutical spending
Major drivers of increased health spending include Ozempic and newer, high-cost medications such as those for cystic fibrosis.
150
opioid crisis
Contributing factors:
Over-prescribing
Toxic illegal drug supply
Policy responses include:
Closing consumption sites near schools/daycares
Investing $378 million in new treatment hubs
151
public health agency of canada
Core Responsibility #2:
Protect Canadians from infectious diseases by:
Predicting, detecting, assessing, and responding to outbreaks
Preventing, controlling, and reducing the spread of infectious diseases
PHAC also sets targets and tracks national data related to:
Immunization rates
HIV transmission
Antimicrobial resistance
Foodborne illnesses
Pathogens of international concern
152
largest body in health care
nurses
153
cultural competence
Exists on a spectrum, ranging from strong humility to strong openness.
A knowledge-based skill set used to work respectfully with diverse populations.
154
population trends
Canada’s population is growing, largely due to international migration.
Most people live in metropolitan areas.
The population is aging, influenced by longer life expectancy and lower birth rates.
155
gender diversity
A portion of adults identify as transgender or non-binary, reflecting evolving understandings of gender.
156
indigenous people
Indigenous Peoples make up a significant proportion of the population and experience:
Higher rates of illness
Lower overall health status
Shorter life expectancy
Many Indigenous languages and Nations exist across Canada.
Colonial policies (e.g., Indian Act, residential schools) have caused lasting inequities in:
Health care
Education
Housing
Employment
Income
157
immigration patterns
Historically, immigration was mainly from Europe, but has shifted to include more newcomers from Asia, India, and the Middle East.
New immigrants often arrive in good health, but health can decline over time due to social and economic factors.
Challenges for immigrants include:
Stress of relocating
Language barriers
Navigating the health system
Discrimination and mistrust
Delays in accessing health coverage
Limited access for non-status individuals
158
traditional and complementary medicine
Many cultural groups use traditional healing systems, based on their own beliefs and practices.
Traditional medicine may be used as a first-line approach.
Non-conventional treatments may be called complementary or alternative medicine.
Integrative medicine combines biomedical, traditional, and complementary approaches in an evidence-informed way.
159
general immigration impact on health
Health is shaped by:
Social and economic status
Language
Access to services
Cultural safety
Experiences of discrimination
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