National Nursing Week

C M Y K MAY 12-18, 2014 NURSING: A LEADING FORCE FOR CHANGE WINNIPEG FREE PRESS - SATuRDAY, MAY 10, 2014 11 You might say Dawn Zawadski's love of nursing is in her blood. "It's a great job. I'm never going to get bored be- cause there are so many things that I do every day," she says. As the nurse coordinator for Manitoba Bleeding Disorders, Zawadski strives to improve the lives of patients whose blood doesn't clot the way it should. "There are lots of different types of bleeding dis- orders, but they are all rare. For example, there are approximately 3,600 patients across Canada with hemophilia. That just gives you an appreciation of how rare it is," she says. "There are also very few people that know a lot about them, so it's very challenging. How do you teach the world about bleeding disorders when you never know when a patient's going to appear on their doorstep?" A big part of her job is making sure there's col- laboration among all the health-care providers and community agencies that come into contact with patients who have a bleeding disorder. "They need to know that that person has a bleeding disorder in case they get into trouble," she says. Zawadski also spends a lot of time pro- viding education to her patients and their families, other health-care professionals and the community at large. "We recently did a rollout for all the triage nurses that were recertifying in triage across Manitoba on bleeding disorders. Sometimes I talk to dentists. We go to schools and day cares to give presentations — anywhere that someone could bleed." In her presentations, she breaks down the pro- cess of how blood clots. "If you cut yourself, your body makes the blood vessels get small to slow down the bleeding. That's the first step. If that doesn't work, then the plate- lets detect that there has been an injury, so they go to the site and try to block it off and cover up the hole. If there's a lot of pressure coming down that vein, eventually that pressure builds up and it breaks free all those platelets. Then you start bleed- ing again," she says. "The final step in the clotting process is some- thing almost like fish-netting called fibrin, and it cov- ers all of those platelets and protects them and keeps them in that spot." A component called Factor VIII is needed for the fibrin to create a stable clot. But patients with hemophilia have a deficiency in this factor, so this final stage of clotting doesn't occur. "Our patients will not necessarily bleed more, but they'll bleed longer. They'll form a little bit of a clot and then it will get pushed away. Then they'll form another clot and it will get pushed away. So until they get that factor that they're missing, they never really will seal up that hole," Zawadski says. "In some cases, the patients will give themselves that factor at home. We want to teach our patients how to live with the disease, so self-management and independence are a huge part of that. In other cases, patients might not know how to do that, so they'll come to the clinic and we'll give them a dose. It's like an IV medication, so it's given by intra- venous." For patients who administer the treatment them- selves, the benefits are boundless. They have the freedom to travel, and the frequency of their bleed- ing episodes is reduced. As a result, they have healthier muscles and joints, since they haven't been damaged by frequent bleeding. "The other great thing now, with all the recombin- ant products, is that people are living longer. So now people that have hemophilia, their life expect- ancy is almost the same as those that don't have hemophilia, which is absolutely a great thing," Za- wadski says. "In the past, people got HIV and hepatitis. Now these products are safe. But now that people are living longer, we don't know a lot about what hap- pens when you age with hemophilia." In her nursing role, Zawadski deals with new situ- ations as they arise. Recently, a patient with hemo- philia had coronary artery bypass surgery at St. Boniface Hospital. Zawadski helped to ensure that there was an adequate supply of the much-needed factor replacement product. It was administered through a continuous infusion process, which deliv- ered a steady supply to the patient's vein through a mini-pump. Zawadski wrote an abstract about the ex- perience, which she will present at the up- coming World Congress of Hemophilia in Australia. "It's really an exciting time because now we're starting to learn more and more about hemophilia and how to manage that." Zawadski is pleased to see the progress that is being made to improve quality of life for patients. "An important thing for me, as a nurse, is not so much that I do things for my patient but that I give them the tools so that they can do it themselves," she says. "I want my patient who has a bleeding disorder to lead as normal a life as possible, and that's what's happening." Blood Work Making progress in care and treatment of bleeding disorders By Jennifer McFee – For the Free Press Dawn Zawadski says improvements in products and care help patients lead better and longer lives. Photo by Darcy Finley "There are lots of different types of bleeding disorders, but they are all rare. For example, there are approximately 3,600 patients across Canada with hemophilia. That just gives you an appreciation of how rare it is," she says.

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