National Nursing Week

10 WINNIPEg FREE PRESS - SATURDAY, MAY 9, 2015 Focus on Intervention Research helps nurses take care of family caregivers By Holli Moncrieff - For the Free Press Family caregivers often forget to take care of the most important people — themselves. U niversity of Manitoba associate professor Dr. Michelle Lobchuk is the Manitoba Research Chair in the area of Caregiver Communication. Her research focuses on ways nurses can be trained to intervene when they see a family caregiver struggling. By sacrificing a lot of their own time and personal concerns to look after a loved one, family caregivers often neglect their own health. This puts them at risk, and it can limit the time they're able to care for their family members. "Caregivers sacrifice a lot. They often don't pay attention to their own health-care needs, and health-care providers don't get much training on how to engage with family caregivers," Lobchuk says. "Our industry is still very much patient oriented." A communications lab was created at the grace Hospital to help Lobchuk further her research. "I really wanted to build something that looked like a home. It doesn't look clinical," Lobchuk says. "It's been six years of hard work to arrive at this point." For the time being, she is focusing on student nurses, but she hopes to include nursing graduates in the future. The student nurses are recorded as they interact with family caregivers. Both the caregivers and the nurses get to view the recordings in the communications lab, and the family caregivers explain how they felt during the interaction. Although many student nurses were reluctant to see how they appear on video, Lobchuk explains that the videos are a tool to help them understand how they're presenting themselves to caregivers. Being able to play the videos back also makes it easier to show nurses which areas of their approach need improvement. "The videotapes will help people see how they look when they put their training into practice. We want to boost the confidence of student nurses," she says. "I'd like to explore how empathetic dialogue can change behaviour." Lobchuk's plan is to develop standardized videos for nurses and caregivers to teach them how to engage. She hopes to offer a teleconferencing program as well. "We're trying to shift how we think and talk about health-adverse behaviour," she says. "We're focusing on getting student nurses to dialogue better with family caregivers, in order to change health-adverse behaviour. We'll see how our interventions help the students better understand the feelings and thoughts of the family caregivers." She recently completed the first pilot study, so there is no solid evidence yet. But she feels that nurses have the best chance of convincing family caregivers to take charge of their own health. "Sometimes caregivers just need permission to take better care of themselves," she says. "We're giving them a sense of empowerment by asking them to tell their stories. Every person's life is different." Family caregivers are an important part of our health-care system. Without their support, many patients would have to be hospitalized or moved to personal care homes. Strong family support can keep ailing relatives in their homes, which is the desired goal. "We're trying to keep people in their homes for as long as possible," Lobchuk says. "We'll develop goals to achieve health and wellness so the family caregivers can stay on the job longer." However, caring for a family member can be stressful and exhausting, and it becomes an all-consuming job for many caregivers who put their own needs on the back burner. The health of caregivers has long been a serious concern for Lobchuk. "Family caregivers are at a high risk for illness. They often don't take care of themselves. A lot of their health-adverse behaviours put them at risk of cardiovascular disease," she says. "Family caregivers engage in smoking, misuse of alcohol, poor diets and cravings for chocolate. A lack of exercise seems to be a big concern." ● Manitoba leads the way in models of care that give access to quality primary care through registered nurses and nurse practitioners. QuickCare clinics and Mobile Clinics are two unique models now operating in the province. W hat do you do when your two year old wakes up Sunday morning with an earache? Or your family member visiting from out of town forgot to bring her prescription medications on Christmas Day? Or your usual clinic is not able to see you until next week? You could see a registered nurse or nurse practitioner! "From time to time we all have minor health problems that crop up on weekends, holidays and evenings. Most of us would rather not have to go to the emergency department," said Health Minister Sharon Blady. "In planning an approach to this issue, we knew that registered nurses and nurse practitioners would be a good fit to address this challenge. We are now well on our way to having eight QuickCare clinics to provide timely care for minor health needs." QuickCare clinics are small nurse-led clinics that provide quality primary care for minor health concerns such as infections, cuts, scrapes, and prescription renewals. People can either drop in or call ahead to get a slot on the day's agenda. They will be seen by a registered nurse for minor health concerns — like a viral infection, insect bite, or a sprain — or by a nurse practitioner, who is able to care for more complex health issues, prescribe medications and order diagnostic tests. "Patients who have received care from the registered nurses and nurse practitioners at our QuickCare Clinics tell us they are very pleased with the services we offer," said Frankie Scribe, manager of QuickCare Clinics for the Winnipeg Regional Health Authority. "We value our patients' time, which is why our teams employ scheduling and customer service strategies that allow patients to choose between drop-in services or a later time-slot to avoid having to sit in a waiting room. Our efforts are meant to offer the right care in the right place at the right time." "Our registered nurses and nurse practitioners tell me they really like the work in the clinic," said Mike Fehr, manager of the QuickCare clinic in Steinbach. "They really enjoy being able to meet patients' needs and working to their full scope of practice." In the words of one nurse practitioner, "clients continue to voice how grateful they are for our sensitive, prompt, accessible, and respectful care. This happens on a daily basis." In addition to QuickCare clinics, Manitoba now also has two Mobile Clinics that visit small communities on a weekly basis. Registered nurses and nurse practitioners provide the full range of primary care services such as: Health promotion and education, health screenings and physical assessments, minor acute illness and wound care, care during epidemic or pandemic communicable disease outbreaks, well women's care, childhood and adult immunizations, chronic disease monitoring and management, and referral and linkage to health and social services supports. The travel required to access quality primary care can be a challenge for Manitobans living in small, rural communities. "We know that continuity of care is important to preventing and managing health issues," said Minister Blady, "and that travel for basic primary care was a challenge in some rural communities. So we thought what if we took the care to the communities instead?" The mobile primary care clinics are complete with two exam rooms and are equipped with the required medical equipment, laboratory and diagnostic equipment, and information technologies. Mobile Clinics also have the technology to provide a limited range of lab tests right on board. "Patients comment positively on the thoroughness of their visit and the way the nurses help them to manage their own health care and treatments," said Pam Walker, Director of Primary Health Care and lead for the Mobile Clinic in Prairie Mountain Health. QuickCare and Mobile Clinics are just the two newest types of primary care clinics in Manitoba that have registered nurses and nurse practitioners working in them. Nurses have a long history of working in community and primary health centres, Health Links – Info Santé, Access Centres, and various ambulatory care settings. Some of the roles include: Offering individual and group health education and counselling services, supporting the overall health of mothers, children, and seniors, and supporting sexual health. The province has also recently begun to look at implementing registered nurses and nurse practitioners in fee-for-service clinics, so that more Manitobans have access to a team of health care providers. Registered nurses and nurse practitioners are and will continue to be a key part of helping Manitoba's primary care system evolve over the next few years and offer a lot of value and benefit to Manitobans needing health care services. ● Manitoba's New Nurse-Led Primary Care Clinics Registered nurses and nurse practitioners provide timely care in QuickCare and Mobile Clinics. Photo by Darcy Finley Dr. Michelle Lobchuk says nurses are well-placed to help family caregivers take care of their own health. MAY 11 - 17, 2015 NURSING WEEK NATIONAL

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