Viral Hepatitis Competencies

Section 2: Nursing Assessment Competencies

2.1 Describe the importance of income and social status in viral hepatitis prevention, care and treatment

• The role of income security (e.g., employed, social assistance, retired)
• Types of income assistance available
• The impact of barriers such as unsafe housing, lack of food security and lack of affordable transportation on client health
• Strategies clients can use to access services such as alcohol treatment programs, travel support, and nutritional supplementation
• Access to medication coverage (e.g., private, provincial, NIHB) and eligibility

2.2 Explain the impact of stigma and discrimination

• Describe the different ways stigma and discrimination are experienced by those affected by viral hepatitis
• Describe how stigma and discrimination can affect health behavior
• Explain how discrimination can violate human rights
• Describe the importance of confidentiality and privacy as it pertains to viral hepatitis diagnosis and access to care
• Recognize and evaluate how personal values affect respectful relationships
• Understand how stigma by healthcare providers and community workers impacts access to testing, care and services

2.3 Explain the impact of the client’s level of literacy

• Assess the client’s understanding of information (e.g., reading, writing, expression and comprehension)
• Use of principles of adult learning (e.g., language that is appropriate to the client’s education, literacy level and ethno-cultural context)
• Facilitate client access to evidence-based information (e.g., peer support groups, internet)

2.4 Explain the impact of employment/working conditions

• Explain the rights of the individual around disclosure (e.g., non-disclosure at work) and to have their confidentiality respected
• Knowledge of the impact of disclosure of a viral hepatitis diagnosis on employment/career choices
• Understand profession regulatory and legal requirements regarding disclosure of viral hepatitis diagnosis
• Promote safe work environments, free from stigma and discrimination, that respect human rights and confidentiality
• Explain transmission prevention and post exposure management

2.5 Understand the influence of social environments

• Importance and impact of social network e.g., community groups
• Access to community resources
• Describe how social media may positively or negatively impact personal health decisions

2.6 Understand the importance of physical environments

• Recognize how living situation can contribute to increased prevalence and transmission (e.g., crime, substance availability, endemic country)
• Describe how safe and affordable housing is fundamental to health
• Explain the contribution of the physical environment (i.e., air/ground/water quality, chemical/biological exposure, food)

2.7 Understand the importance of personal health practices and coping skills

• Education on transmission prevention and vaccination
• Promote optimal liver health (e.g., limited alcohol use, harm reduction, healthy eating, physical activity)
• Choices can be affected by socio-economic environments (e.g., self-care, advocacy and coping mechanisms)
• Self-esteem, self-worth and resilience can affect health practice
• Impact of historic trauma

2.8 Explain the importance of healthy child development

• Experiences in early life that can affect lifestyle choices and behaviors in adulthood (e.g., childhood obesity, trauma and family history of substance use)
• Recognize potential pediatric exposure via vertical/horizontal transmission
• Recognize the barriers that can exist in the transition from adolescent to adult care
• Recognize risk factors that can influence the progression of liver disease (e.g., childhood obesity, substance use, lack of access to testing and care)

2.9 Describe the role of biology and genetics

• Describe factors that affect viral clearance (e.g., co-infection, host immune response)
• Describe factors that affect disease progression (i.e., modifiable and non-modifiable)
• Identify significant co-morbidities (i.e., metabolic syndrome, coinfections and mental health/addictions)

2.10 Understand comprehensive viral hepatitis assessment

• Describe the data required in a nursing history (e.g., risk factors, symptoms)
• Understand clinical presentation and physical examination (e.g., tattoos, spider nevi)
• Describe serological testing, investigations, imaging
• Describe extrahepatic manifestations
• Interpret viral load, genotype, resistance testing, seroconversion

2.11 Describe the impact of health services on viral hepatitis

• Describe current health systems in the care cascade (e.g., testing, linkage, treatment)
• Importance of client self-advocacy
• Role of significant others in client advocacy
• Nurse’s role in client advocacy
  Nurses’ role in advocating for health system change (e.g., improved access for care and medications, participation in advocacy organizations)
• Effect of stigma and discrimination on service access and utilization

2.12 Understand the role of gender

• Describe gender considerations that may affect acquisition
• Describe differences in gender on viral hepatitis disease progression and management
• The effect of hormones and pregnancy status (e.g., menopause, birth control, trans clients)

2.13 Understand the impact of culture

• Cultural implications related to viral hepatitis
• Culturally sensitive awareness (e.g., avoid actions that diminish, demean or disempower the cultural identity and well-being of an individual)
• Spiritual and religious beliefs impact decisions (e.g., natural healing beliefs)
• Recognize the impact of provider’s values on relationships and client decision-making