A SUPPLEMENT TO THE WINNIPEG FREE PRESS | THURSDAY, MAY 5, 2016 | VIEW ONLINE AT winnipegfreepress.com/publications
FORENSIC NURSING
NURSING IN PRACTICE AND POLICY
NURSE PRACTITIONER
NURSING IN YOUTH CORRECTIONS
NURSING EDUCATION
#NNW 2016 MAY 9-15 NATIONAL NURSING WEEK 2016 * CANADIAN NURSES ASSOCIATION and the CNA logo are registered trademarks of the Canadian Nurses Association/Association des infirmières et infirmiers du Canada. NATIONAL NURSING WEEK 2016 MAY 9-15, 2016 #NNW2016 cna-aiic.ca
* CANADIAN NURSES ASSOCIATION and the CNA logo are registered trademarks of the Canadian Nurses Association/Association des infi rmières et infi rmiers du Canada. Photos: Teckles Photograpy Inc. (L-R: 1-3, 5); John Gardiner, Vancouver Island Health Authority (4)
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NURSING MOMENTS
CELEBRATE THE CAREGIVERS NURSES ARE WITH YOU AT EVERY STAGE OF LIFE
A CHAMPION AT NORWEST CO-OP Caring. Compassionate. Inspiring. These are just a few of the many attributes that Renata Cook embodies. Renata has worked at NorWest Co-op Community Health Centre for 27 years. She started working as a primary care nurse at NorWest in 1989 and is now the Primary Care Coordinator. She has made an incredible difference in many people’s lives and has expanded the supports available at NorWest. Renata has an incredible ability to see where the needs are in the community and has advocated for funding, development and expansion of the team and programs. Her eyes light up when you talk about quality and patient safety and she is a champion in these areas. Her dedication, commitment, reputation, years of experience, and knowledge are why Renata is so well known and respected in the nursing profession and in the community. Renata instills motivation in our primary care team to consistently ensure client-centered care. She is both dedicated National Nursing Week is a wonderful opportunity to celebrate all the moments that make nursing extraordinary. Of course, most nursing moments aren’t celebrated.They happen quietly, when a patient comes out of surgery. They happen when a long-term care resident sits on a bed for the first time in a new, unfamiliar place.They happen when someone gets news that changes everything.They happen all the time. Here are just a few:
By Holli Moncrieff for the Free Press
previously weren’t open to us,” says Cheryl Giesel, president of the College of Licensed Practical Nurses of Manitoba, adding that operative recovery rooms and dialysis stations are two examples. “We care for our clients from birth to the end of life.” Giesel works in the surgical ward of a hospital. “It’s satisfying to see patients throughout their care. I really enjoy interacting with them. Some of the patients that you have really move you,” she says. Registered nurses are also encouraged to expand the scope of their practice. “The RN practice has evolved over the years to meet the needs of the health-care system,” says Pat Benjaminson, president of the Board for the College of Registered Nurses of Manitoba. “It’s really important to continue to encourage and support RNs in achieving the full scope of their practice. This helps increase access to health care, which increases the capacity to provide care, which is in the best interests of the public.” According to Benjaminson, there are 13,502 RNs and 172 nurse practitioners currently working in Manitoba. “Manitobans receive excellent health care due in part to RNs and the work they do,” she says. “They have a positive impact on the lives of Canadians every day. RNs are in roles that impact the health outcomes of patients.” Compassion and a willingness to work as part of a team are among the vital assets all nurses bring to their roles in every discipline. “RPNs have a genuine concern for others. It’s really about building a therapeutic relationship,” Jarrin says. “They do their work through interaction with their patients. You can’t take someone’s blood pressure to learn if he has depression.” The teamwork aspect is an important piece, as nurses usually work in conjunction with other health-care professionals. “We work as part of a health-care team, with patient safety being our utmost concern,” says Giesel. Too often we forget to show our appreciation to the nurses who are always there when we need them. If a nurse has helped you, a family member or a friend, it’s never too late
National Nursing Week is the perfect opportunity to celebrate the often- unsung heroes of health care. H eld each year during the week of Florence Nightingale’s birthday on May 12, National Nursing Week gives us a chance to celebrate all the nurses who contribute so much to our health and wellbeing. “It’s very important to celebrate all nurses for their contributions to our health,” says Jennifer Breton, executive director of the College of Licensed Practical Nurses of Manitoba. “All nurses in Manitoba study from the same foundation of nursing knowledge.” Nursing professionals in Manitoba include licensed practical nurses (LPNs), registered nurses (RNs), nurse practitioners, and registered psychiatric nurses (RPNs). Nurses of each discipline can fill a number of different roles and work in a variety of settings in addition to hospitals. “RPNs provide care to those who have mental health issues,” says Isabelle Jarrin, president of the College of Registered Psychiatric Nurses of Manitoba. “It builds on nursing — we have the knowledge and physical health experience with the mental health piece, so we’re able to assess individuals in a holistic way.” RPNs may work in long-term care, helping those suffering from dementia and delirium, either in personal-care homes or in the community. “Community mental health workers can work with individuals living in their homes who require assistance,” she adds. “RPNs can be found in crisis response centres, performing assessments of individuals who may have been sexually assaulted. They also find work as psychiatric emergency nurses.” RPNs often fill positions in non-mental health areas as well, such as hospital rehabilitation and geriatric units. The significant role nurses play in our health-care system has evolved at a rapid pace over the past few decades. “There’s been a dramatic change over the years as we practice to our full skills. We’re working in areas that
and innovative in her approach to all she does. She has been instrumental in supporting some
of our harder-to-reach populations. She was instrumental in bringing a much-needed primary care clinic to Gilbert Park, and it continues to grow under Renata’s leadership. She is a true champion for all community members, speaking up for those who are vulnerable and isolated.
Laura Horodecki Project Manager NorWest Co-op Community Health
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to send a card or to simply say thank you. National Nursing Week is the perfect time. ✚
Making a difference: Renata Cook.
IN CELEBRATION OF NATIONAL NURSING WEEK, the CLPNM would like to recognize the dedication and contribution
LPNs make to the health and wellness of all Manitobans.
The CLPNM is the regulatory body that governs the practice of student practical nurses, graduate practical nurses, and licensed practical nurses in Manitoba.
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Alison Campbell (left) and Jenn Morgan.
NURSING MOMENTS << Continued from previous
INSPIRING ROLE MODELS I have been a Public Health Nurse (PHN) since 2001. My story of a nurse who made difference for me begins when I was 19 and had my first child. At the time, I had planned to go into social work when I found out I was unexpectedly pregnant and my schooling was postponed for a year. After my child’s birth, I became connected with the PHNs in the St. James community — in particular, Alison Campbell, who still practices in St. James. We connected really well and she provided me with a lot of great information. I attended a mom’s group at a church nearby where PHNs held visits every few weeks and provided developmental assessments, gave information and basically offered me reassurance that I was doing a great job! Amid all of this, I began to think that this was what I wanted to do with my life! I changed my career path and went into the field of nursing instead of social work. It was a long, hard journey to be a parent, attend university and complete all of my practical experiences and work, but it was worth it. In 2001, I got the chance to complete my final practicum in St. James alongside some of the same nurses who were there to offer me guidance in my time of need. I have worked as a PHN for the last 14-plus years and believe I have been able to make a difference for my clients in the community in the same way a difference was made for me. Jenn Morgan, RN BN Public Health Nurse, Point Douglas, WRHA
Charting success: From left, Brenda Weiss, Roberta Fransishyn and Barbara Ginter-Boyce, managers of Ophthalmology Programs at Misericordia Health Centre. PHOTO BY DARCY FINLEY
EYE ON TECHNOLOGY NURSING INFORMATICS LEAD TO ENHANCED PATIENT EXPERIENCE
By Jennifer McFee for the Free Press
they get scanned into the computer and filed into the computerized chart.” The web-based surgical slating system links Misericordia directly to ophthalmology surgeons’ offices. This streamlined process is particularly useful since Misericordia is the eye centre for the entire province and its clinics assess and treat more than 33,000 patients annually, including minor procedures and retinal injections. Misericordia also performs more than 11,500 ophthalmology surgeries annually, 80% of which are cataract surgeries. “The web-based system allows us to see the patient’s information here at Misericordia. We can preview the chart, transfer the information into our electronic medical record and schedule a patient for surgery,” Fransishyn says. “From the office, they’re able to see in real time exactly when that patient was scheduled and how the surgery slate looks. It’s worked really well with communication between ophthalmology offices and Misericordia.” A similar system is also bringing positive results in the ophthalmology clinics. “When patients come in for procedures, the information is all electronically sent. Instead of staff having to go through multiple pages of faxes and reports, trying to figure out what day this patient is having a procedure on, it electronically arrives in a concise one-page format with good notification,” Weiss says. “It’s clearly written exactly what the procedure is and all the demographics of the patient. It’s definitely more efficient that way.” Fransishyn and Weiss highlight the contributions of Barbara Ginter-Boyce, manager for the pre-assessment clinic and MHC’s partnership with eHealth Manitoba, and others who have been essential in rolling out the computer programs in different units. As well, the hospital’s talented team of nurses has stepped up to the challenge of working with new technology. “Our staff here at Misericordia have really embraced this change. You can imagine that some of our nurses have been nursing for 40 years and they’ve always used paper and pen. It was challenging and overwhelming for them, and they have done so well,” Weiss says. “I hear on a daily basis that they can’t believe all that they’ve learned and accomplished — and there’s still lots more to do. That’s a really proud moment for nurses that have evolved. Our young nurses who are computer savvy had a much easier time. I was really impressed with some of our nurses who didn’t have strong computer skills and really embraced it.” Like Weiss, Fransishyn knows the benefits are clear to see. “It’s been a lot of technology change in the last four years,” Fransishyn says. “It’s definitely changed the way we do our work here as we strive to be more efficient and enhance the patient experience.” ✚
When traditional nursing practices intersect with cutting-edge technology, it can be an eye-opening experience. N urses are experts at gathering, maintaining and updating health-care information about their patients, as well as continuously communicating with other medical professionals. This task is often onerous, with stacks of paperwork and lengthy charts. However, the job becomes much more manageable thanks to Nursing Informatics, which relies on technology for easily accessible and well-organized patient records. Roberta Fransishyn and Brenda Weiss have been instrumental in introducing new software at Misericordia Health Centre, both in the ophthalmology surgery program and in the clinics at the Buhler Eye Care Centre. Fransishyn, manager for the operating room and medical device reprocessing, quickly became a subject matter expert when MHC introduced new electronic medical records (EMR). “Nursing Informatics is integrating the use of computers and technology into everyday nursing care. It’s now allowed nurses to have more information at their fingertips so that we can use the real-time information to make knowledgeable health-care recommendations for our patients,” she says. “Here at Misericordia, we use an electronic medical record and we do all of our documentation on the computer in the patient’s chart.” In the pre-assessment clinic, computerized charts are now used to record all patient information that comes from surgeons’ offices, including consent forms, questionnaires and eye-health history. Eventually, a similar system will be implemented for day surgery and in the operating room. The EMR system provides a clear vision of a patient’s progress — and reduces miscommunications due to illegible handwriting or unfamiliar abbreviations. As manager of the ophthalmology clinics and eye bank, Weiss sees first-hand how the computerized system has dramatically changed nurses’ working lives. “We have four different clinics and they are all using electronic records. We no longer have paper charts. If a patient comes to a clinic and they have come many times before, their chart could be very thick. It could be a lot to go through to find the history and the past visits,” Weiss says. “Now you go onto the computer and, at a quick glance, you can see history and previous visits and next scheduled appointments, as well as past and present plans for this patient. We still have some paper components, but
Saluting her teammates: Joelle Blanchette.
SHINING STARS I have the pleasure of working with an amazing and talented team of nurses: Todd, Sheri, Val, Ian and Arlene. We are a dedicated group of RPNs and an RN who work in mental health in an early intervention program for clients who have experienced their first episode of psychosis. Every day, nurses have the unique ability to see into the lives of others. We are a hand to hold and provide reassuring words to help others in times of crisis. Being a nurse means that you will never be bored; you will be surrounded by challenges; you will carry immense responsibility; and you will step into people’s lives and make a difference. We see people at their best and at their worst. We know what it means to be human; how to show compassion, care and patience. Todd, Val, Sheri, Ian and Arlene are true examples of nurses who go beyond the bedside and reach far into themselves to provide the utmost care and compassion to our clients. There are many moments in our nursing practice where we know we have made a difference. For example, Todd’s humour and lovely demeanor shines every day so that our clients and families can feel at ease in our program. Sheri is a star, who puts so many of our clients before herself, and we are all reminded of how much she cares when someone needs something. Whatever needs to be done, it is done without judgment and with respect and integrity for the client and family. Ian has a special way of connecting clients to things that they need that most of us didn’t know existed. He has an uncanny ability to problem- solve outside of the box. Without his support and knowledge, many of our clients would not be as far along in their recovery. Val is a burst of energy and a lovely clinician. She is quick to get involved and models her passion for mental health in her nursing practice. Arlene is a wonderful and skilled advocate for clients and families. Our program is very fortunate to have so many wonderful nurses. Thank you Todd, Val, Sheri, Ian and Arlene for doing what you do. Joelle Blanchette BScP.N., RPN
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TR UBLE SLEEPING CAN’ LIFT KIDS
Find more information on prevention tips for musculoskeletal injuries and sign up for the SAFE Work Matters e-newsletter at safemanitoba.com Sprains , Strains & Tears
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HEARTS OF GOLD REQUIRED: MISERICORDIA INTERIM CARE NURSES SHARE SPECIAL BOND WITH RESIDENTS Transitional caregivers: Registered nurses Bernie Ali (left) andTara McNaughton. PHOTO BY DARCY FINLEY
By Kristin Marand for the Free Press
a bath time, allowing for a phone call or a snack or having fun nicknames inspired by the residents. McNaughton smiles as she recounts the story of one former resident, a big fan of the TV music show The Voice. She liked to be called Shakira and she would call her health-care aide Christina. Cornish 2 is a unique environment in the Manitoba health system. The team is tight-knit and in it for the long haul. Previous nurses have stayed on for more than 40 years. Speaking to the qualities it takes to maintain that kind of longevity, McNaughton cites character, flexibility and a willingness to learn. To work in Cornish 2 is to be fully invested in the team, which McNaughton calls her “family.” And it’s not just in individual units that the family mentality is part of the culture, but rather throughout the entire facility. “I think Misericordia is a very special place to work. People really believe in the vision, mission and values. I
longevity. Another factor is McNaughton’s guidance and sunny disposition. A caregiver with more than 20 years’ experience, McNaughton has worked in many roles within nursing, from health-care aide to licensed practical nurse (LPN) to RN and manager, and she isn’t afraid to get her hands dirty. “I know everybody’s job role very well and I can help all my staff figure out easy ways to do things. I understand what they’re going through, what their experience is. And they’re aware I have no problem helping assist one of the residents with one of my colleagues,” she says. It can be bittersweet to work in a transitional unit, McNaughton admits. On the one hand, staff form wonderful relationships with the residents and their families and then have to say goodbye when they leave. On the other hand, constant change requires the team to be ever-evolving: learning, adjusting and thinking outside the box. Rising to the occasion to meet the needs of each new resident keeps the unit moving forward.
There is a vacancy for a Registered Nurse (RN) in Cornish 2, the Interim Care Unit at Misericordia Health Centre, but the position can’t be filled by just anyone. T he ideal candidate must possess the right blend of skills and experience, along with one special attribute — a heart of gold, says Tara McNaughton, Resident Care manager. “One thing that I’ve learned over the time I’ve been in management: everybody comes with qualifications but it’s the heart that I can’t fix. You have to have a heart for what we do,” McNaughton says. Interim Care’s three units (Cornish 2, 5 and 6) provide a comfortable home-like environment to 112 people who are waiting to get into the personal care home of their choice. The seniors admitted to Interim Care primarily have been transferred from a Winnipeg hospital and deemed unable to return to their own homes. “These are people that are very vulnerable; they’re going through a lot. We have to be very understanding, we have to be compassionate and kind. I’ve realized we can affect how people feel; it gives me the warm and fuzzies inside, because it means something,” McNaughton says. The clients of Cornish 2 are called residents, a term that’s indicative of the respect staff have for the people with whom they work. Supporting people and their families in the midst of a transformational life event can be incredibly stressful, which demands the team around the residents and their families be strong and work well together. “We work as one great big team and that, I think, is what the strength of our unit really is. It’s that everybody knows everybody’s name, we’re not just numbers and we really try and work together to support the residents and give them the best quality of care we possibly can,” McNaughton affirms. The staff in Cornish 2 take care to make sure each resident feels welcomed and at home, whether that means adjusting
“THESE ARE PEOPLE THAT ARE VERY VULNERABLE; THEY’RE GOING THROUGH A LOT. WE HAVETO BEVERY UNDERSTANDING,WE HAVETO BE COMPASSIONATE AND KIND.”
McNaughton and the team at Cornish 2 believe it is a pleasure and a privilege to meet and work with the many different and unique people who spend time in their unit. The residents truly do become like family to the staff — like the Opa or Baba you never had, explains McNaughton. “They have come into my life and have shared with me their hearts and their life experiences and have impressed upon me how I can always do better — to be more inspired, to give back or try doing different things to make somebody smile, and my team shares that,” she says. “There are people that have really impressed upon our hearts — that have changed me. It’s just such a pleasure to become a part of somebody’s life and to walk some of their journey with them. It’s priceless.” ✚
think we all believe there is something better that we can do or create here,” McNaughton says. “It also helps that we can recognize each other as you walk down the hallways. When you see somebody on the elevator you talk to them, you just say, ‘Hi,’ whether or not you know them, but you know they’re wearing a uniform or a name tag, so they’re one of us, so we just acknowledge that. “We are one big family and we really are colleagues no matter what job we do. We’re all part of one bigger piece and we just acknowledge everybody as people.” Having exceptional senior leadership that supports the ongoing education of the staff in Cornish 2 is a contributing factor in the unit’s success and staff
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baby’s oxygen supply. Another nurse brought me gloves and retrieved a stretcher. I put the woman in a safe position and we arrived at the unit in record time. The baby was saved with an emergency/crash caesarean section. Reflecting on this moment, I realize that I never even asked the woman her name, yet I played a crucial role in her and her baby’s life. This was a rewarding end to my three-day shift. As a nurse, I had aided two women through one of the most difficult journeys of their lives. Life and death — that’s what we nurses deal with daily. I never knew I had it in me to carry out such an important and honouring role. I am like every other nurse; I sometimes resent working when many others are off enjoying weekends and holidays. But you know, I wouldn’t trade my career for a regular job. Why? Because I know I make a difference in people’s lives. And isn’t that why we’re here? Cindy Schulz High Risk Labour and Delivery Women’s Hospital, Health Sciences Centre MOTHER’S HELPER As a nurse, I know the experience of putting pieces of myself out into the universe, but I never really know the impact this has on those I care for. When I gave birth to my daughter, I had my first real experience of being on the receiving end of this care. I delivered by C-section, unexpectedly. The care I received at Women’s Hospital was first rate! My daughter was healthy, but I felt broken inside. Clinically, I understood what happened during my delivery, but emotionally I felt thrust into motherhood in a manner I wasn’t really expecting. In addition to this feeling, I struggled with a baby that wasn’t interested in breastfeeding. Again, clinically I knew this wasn’t the end of the world, but emotionally, I NEEDED to breastfeed. My care relationship with Susan Brasher, postpartum nurse and lactation consultant, helped me weather that storm. Her care, expertise and patience eased me into the experience of caring for my daughter and learning
patience myself as she learned to nurse. The quiet moments during which I sat in her office in those fragile first days of motherhood, her presence and support guided me in this new role. Beyond the clinical care, the way in which she positively changed me as a person was invaluable and something for which a simple “thank you” was never enough. Alicia Lapple, RN BN Communicable Disease Coordinator Population and Public Health - Healthy Sexuality and Harm Reduction, WRHA
NURSING MOMENTS
PROFOUNDLY HUMAN CONNECTIONS It was a typical shift for me — a 12-hour day and the start of three in a row. I was given the assignment to take care of a patient who had just been told that her baby was deceased. We cried a lot together as we discussed many things; the “why me?” questions and the “what happens now?” discussions. We also began the induction process. Having a baby is a painful process, but usually at the end of the painful journey, there is a wonderful reward — a baby; a beautiful human being who becomes the centre of your world. With the induction of an IUD (intrauterine death), there is pain in every form imaginable. The second day I came to work, I was scheduled to look after the same patient again, since we had already developed a connection. Her labour process had begun and we felt comfortable with one another. When my third 12-hour shift started, the other staff on the unit mentioned that they’d be willing to take on this patient due to the intensity of her situation. I felt like I would let her down if I didn’t look after her again and I wanted to be there with her during the most difficult part — the delivery. I needed to complete this journey with her, for her and for me, too. When I walked into her room, she was pushing, tired and exhausted. Her eyes met mine and she said, “You’re here! I knew you would come.” She delivered her baby and we cried as she held the infant. After the completion of paperwork and photos and too many questions to be answered at an emotional moment such as this, I had to transfer her to another ward and say goodbye. It was difficult for both of us. I went for a break to debrief alone and process all that had happened, and then I returned to the unit. No sooner had I returned when a code was called overhead, “Obstetrical 25!” I ran to the antepartum unit and came upon a pregnant woman whose umbilical cord had prolapsed, threatening her
Dealing with life & death: Cindy Shulz.
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HEALTHIER ALTERNATIVES SECLUSION REDUCTION REDUCES TRAUMA FOR STAFF AND PATIENTS
Supporting team: From left, Debbie Frechette, director of Patient Services, Annette McDougall, registered psychiatric nurse, and Lisa Knechtel, manager of Quality and Patient Care. PHOTO BY DARCY FINLEY
By Holli Moncrieff for the Free Press
in introducing the seclusion reduction program to the region. “Some of the units made their bathrooms a little more welcoming, more like a home environment.” Another proactive technique is creating personal safety plans for patients, which involves learning about what makes them feel distressed and what calms them down. “Having that calming strategy in place in advance before a crisis situation occurs is so important,” Knechtel says. “We’re more recovery- and patient-focused now.” A debrief and defusing process helps refine the program and gives both patients and staff the opportunity to discuss what is often a traumatic incident. “Once a patient is settled and able to engage in conversation again, we hold a debrief with the patient and ask what happened,” McDougall says.
An innovative program introduced in Manitoba’s mental health units has greatly reduced the level of trauma experienced by patients and staff. K nown as the Six Core Strategies for Seclusion Reduction, the initiative aims to meet the needs of acute-care mental health patients in the least restrictive way possible. “Confining someone in a locked room was used when a patient had lost control of their behaviour. Seclusion has limited therapeutic value and can be traumatizing,” explains Lisa Knechtel, manager of Quality and Patient Care at Health Sciences Centre. “There’s also the risk of trauma to staff when they have to confine someone in a restrictive space. It can lead to physical and emotional injuries for both patients and staff.” Only a small percentage of mental health patients are aggressive enough to require seclusion, Knechtel says, stressing that it’s not the norm. Often seclusion is more damaging than restorative to a patient’s mental health. “A lot of people with mental health diagnoses have a past history of trauma. When someone is secluded, it becomes a power struggle between staff and the patient,” she says. “Staff have to restrain the patient and escort them to a locked room, which can trigger past memories of abuse for the patient.” The seclusion reduction program builds a more supportive relationship between patients and staff, says Debbie Frechette, Health Sciences Centre director of Patient Services — Mental Health. “We work with staff to teach them tools to deal with people who have a risk of harming themselves or others,” she says. “We try to align those who are already doing this program with people who may need more support or skill-building.” While seclusion was already being used only as a last resort, there is a strong desire among mental health professionals to reduce it further, says Knechtel. “It’s about building a partnership with the patient. When you’re secluding them, it’s seen as us versus them,” she explains. “Seclusion seems more like punishment.” To reduce the need for seclusion, mental health units now provide designated safe places where patients can go and calm themselves when needed. “We’ve added comforting items and comforting rooms to our unit, which has been one of the biggest successes. We added massage chairs, stress balls, soothing music,” says Annette McDougall, a registered psychiatric nurse who has been instrumental
“IT’S ABOUT BUILDING A PARTNERSHIP WITH THE PATIENT. WHEN YOU’RE SECLUDING THEM, IT’S SEEN AS US VERSUS THEM - SECLUSION SEEMS MORE LIKE PUNISHMENT.”
Another debrief is held with staff to discuss the patient’s perspective. Following a successful pilot project at Health Sciences Centre, the seclusion reduction program was implemented in April 2014 at all in-patient mental health units in Winnipeg — at Seven Oaks General Hospital, Health Sciences Centre, Grace Hospital, Victoria Hospital and St. Boniface Hospital. In the first year, mental health units reported a 42% decrease in seclusion incidents, a 45% decrease in the total amount of time patients spent in seclusion, and a 67% decrease in days lost due to staff injuries. “We were really stretching our resources, so to have any success was really good,” says McDougall. “This was a huge team project on so many levels.” ✚
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NURSING MOMENTS
HOLIDAY CHEER In hemodialysis, patients are often seen as family. We see them a minimum of three times a week for four hours. The nurses get to know their patients and their families on a personal level. This is reflected in the unit on a day-to-day basis when you see the patients and staff laughing together and sharing information beyond patient care. Many patients have stated that it is the staff that makes being here bearable. Each Christmas, the nurses on our unit identify patients who are in need and make up hampers for them and for their families. The abundance of food and gifts that is freely brought in puts all of us (including the recipients) in the holiday spirit! Belinda Herner RN, BN, CNephC ProgramTeam Manager Hemodialysis St. Boniface Hospital AMAZING GRACE We were finishing a procedure one afternoon when a patient was explaining how his daughter was finding it difficult as a new nurse to bond with a patient, and then have things turn out badly for that person. I explained how funny it is that, over the years, I’ve come to be more accepting of death and the role I can play. I don’t see it as the ultimate “bad.” There is a time for death. It can even be good. Now, I’m not talking about hastening death – not at all – I’m talking about life completed. I explained that dying is so intimate; that at that time of life is when nurses can do so much good. We nurses are privileged and sometimes burdened with being in such an intimate place. We are holding hands, giving sedation, and turning patients to promote a comfortable position. We send all our compassion in warm hands and back rubs – not to promote life, but to allow for a peaceful completion of a life.
Belinda Herner and the HemodialysisTeam.
I was working in the Surgical Intensive Care Unit with an amazing, highly experienced nurse. I had been a nurse for about 12 years at that point, and had worked in the ICU for the past six. On this day, we had an elderly woman who was conscious and intubated, communicating with pen and paper. She understood that she was dying. There were comfort measures only; all heroics had been exhausted. The nurse I was working with gave her patient the most peace-filled surroundings by the window with a lot of natural daylight. The way that nurse cared for her patient had me in tears most of the night. There may have been some soft singing or humming from that nurse too. I can’t remember another time when I witnessed such compassion, and I don’t expect to. The
nurse just calmly did everything in her power to prevent air hunger, aches and pains and fear. Gentle caring and supreme grace are the words I could use. I felt like I had witnessed and been a small part of a miracle. This nurse’s care did not make the patient live longer, but permitted a peaceful closure to a life well lived. I see that nurse every now and then. I’ve been lucky enough to be able to tell her what an impact that night had on me. I believe she broke off a little bit of her grace and implanted it in me. I am honoured to be granted access to these most intimate times in my patients’ lives … all because I’m their nurse. Theresa, RN
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DELIVERING CARE AT HOME UCN NURSING STUDENTS HAVE TIES TO NORTHERN COMMUNITIES
BY HOLLI MONCRIEFF for the Free Press
Finding medical professionals willing to work in the North has always been a challenge. T he solution? Train the people who already have strong ties to Manitoba’s northern communities. University College of the North (UCN) has been overwhelmed with the success of its nursing program at both of its main campuses, which are located in Thompson and The Pas. The school also has 12 regional centres located across northern Manitoba. “Over 80% of our students are from the North. For the first five years after graduation, they’ll stay in a bigger centre to get acute-care experience, but most of our students will move back to their smaller North communities,” says Vicki Zeran, UCN’s Dean of the Faculty of Health. More than 50% of UCN’s students are Aboriginal, and Zeran says approximately 70% of people living in the North are Aboriginal as well. “It makes sense to have Aboriginal people in nursing to care for people in northern communities,” she says. “There is a pressing need for health care in the North and northern and Aboriginal people feel a need to provide that care.” UCN offers a joint Bachelor of Nursing degree program in cooperation with the University of Manitoba. The four-year
successfully completing the program. “Our attrition rates should decrease because it’s more competitive to enter the program now,” she says. “It used to be on a first-come, first-served basis, with no pre- professional year at the beginning.” One of the challenges facing the college’s nursing students is the hurdle they must overcome after graduation. “Before our students graduate, they have to do 12 weeks of a full-time nursing practicum, and after graduation, they must apply to the College of Registered Nurses for registration after passing the National Council Licensure Examination (NCLEX),” says Zeran. “We’re struggling with our NCLEX (pass) rates, as are most schools across Canada. In response, we’re trying to develop exam questions which are more reflective of NCLEX-type.” Students take a predictor exam before they graduate to build their confidence before they take the NCLEX. This trial run can also pinpoint potential problems before students sit for the official examination. UCN offers both day and evening programs to its students. The average age of its students is 32, and the majority are single parents. All students have access to a variety of services, including a computer lab that is open 24/7, academic and personal counselling, a library, student housing, scholarships and bursaries, day cares and various student activities. ✚ medications, she looked up at me and asked, “How is your mom?” My reply was that my mom had passed on a number of years earlier. Her reply to me was, “Oh, I am sorry to hear that. Were you close?” I told her some of the things about my mom, and she told me I was most fortunate to have had the time with her that I had, and I agreed. Now, to most people this would appear and sound like an everyday conversation, but when you work with someone with any form of dementia, you learn that these insights are few and far between. So when they do occur, they are most precious, because at that moment, this resident had a little window of what was real and in the moment for her. As a nurse, you learn to appreciate these very precious moments and you never forget about the individual that gave them to you, for at that moment she made me feel much loved and very special, and I thank her for that. Sue Lapointe, LPN Golden West Centennial Lodge JUST A NOTE … Nurses make a difference with their knowledge, their compassion, and the trusting relationships they establish with their patients/residents. Thank you for allowing me to have a say about the profession that I love. Paula Thomas
program includes a pre-professional year, which Zeran says has greatly increased the students’ chances of success. “Most courses you have to take in the first year are defined. Our curriculum is almost identical to the University of Manitoba’s,” she adds. “What sets us apart is that a lot of our systems are geared toward Aboriginal students.” The college provides programs for adults over 19 who have been out of school for at least six months. Along with an Aboriginal Centre and the presence of elders who work at both campuses, UCN is in the process of developing a mentorship program to help students with their studies and point them in the right direction. “We have one of our retired nursing instructors tutoring our third-year students,” says Zeran. “Students are encouraged to ask for one-on-one help if they need it.” The demand for the nursing program was so great that UCN tightened up the entrance requirements. While the college can accept 20 nursing students at each site, at least 60 people apply each year at both campuses. “We have no shortage of nursing students. Nursing is an excellent profession. There are many different types of careers in nursing and this type of caring profession enables nurses to give back to their communities,” Zeran says. “We usually have about 30 graduates per year.” The program currently has a 35% attrition rate, and Zeran would like to see a significantly higher number of students
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could make this process easier for themselves as well as the health benefits. A teacher came by and reported to the students that they should “listen to the nurse” and that “she knows what she is talking about.” Then, the teacher said, “She saved my life.” I turned to her and looked perplexed, since I didn’t immediately recognize her. The teacher continued and said to me, “Well, you came to my house and helped me with my newborn and breastfeeding and at that time, you saved my life.” That was MY MOMENT. You just never know when you are going about your daily work as a nurse what a difference you can make. I have been a public health nurse for 30 years and a nurse for 32 years and that day has always stuck in my mind as one of those MOMENTS. Shelly Coupland Public health nurse, WRHA Access Transcona APPRECIATING PRECIOUS TIMES Over the years, I have worked in many different nursing settings including acute medical, medical rehab, palliative care, private nursing care and now, long-term care. As time passes, you see many things that teach you the value and the meaning of caring and how your words or actions have impact, on others and yourself. One such time for me was while working in long-term care. I was working on the Alzheimer’s Unit of Golden West Centennial Lodge. We had a lady on the unit who had been a registered nurse in her career. This particular day, staff and resident alike were talking about family members, moms, dads, siblings, etc. As I had approached this lady to give her the scheduled
NURSING MOMENTS
A new mom’s lifesaver: Shelly Coupland.
A LIFE-SAVING MOMENT My Moment in Nursing happened when I was at a busy Grade 4 immunization clinic one morning. It had been a very hectic morning immunizing Grade 4 students. I was busy explaining to a group of students in the library why they should be getting the hepatitis B needle, and ways they
Resource Nurse St Amant Centre
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WINNIPEG FREE PRESS - THURSDAY, MAY 5, 2016 9
NURSES: WITH YOU EVERY STEP OF THE WAY
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NURSING MOMENTS
SHARING COMPASSION My nursing moment took place one evening when a patient was coming into the Operating Room at St. Boniface Hospital for an emergency procedure. The patient was a very young, handicapped and severely mentally challenged woman with minimal communication skills, who was absolutely terrified without her family at her side. It became my one and only goal for the next while to do everything in my power to console someone who did not understand what I was trying to tell her as we started a long process of induction. Due to the complexity of her health and poor vascular access, the anesthetist on my team had to persevere until we had appropriate IV access for a general anesthetic. It was incredibly unsettling for me to watch someone go through this experience, not understanding what was happening to her, why this operating room team of scary mask-wearing individuals was constantly trying to start IVs; it must have been the scariest day of her life. I couldn’t explain or justify our actions to her, all I could do was hold her hand, gently stroke her hair, wipe away her tears and remind her to breathe, and to tell her that she was going to be OK. It was an experience that
NEW BEGINNINGS YOUTH ADDICTIONS STABILIZATIONS UNIT IS FIRST STEP TO RECOVERY
revealed more empathy than I knew I had within, and that brought out the rawest form of humanity and compassion that I could give to someone in such a terrifying time. I provided her with
the care that I would want for myself or for someone in my family if in a similar position. The essence of our role as nurses is to give the quality care we expect for ourselves and for our loved ones. This “moment” will have a lasting impact on me and how I care for those around me, yet I hope this woman doesn’t remember a second of it. I went into nursing because I wanted to help others; I wanted to know that at the end of every shift, of every day,
BY HOLLI MONCRIEFF for the Free Press Marymound’s Youth Addictions Stabilization Unit (YASU) provides a soft place to land before young people hit rock bottom. T he unit provides short-term, seven-day stabilization and detoxification for youth who are struggling with addictions. “It’s a place where they can clean up and have somewhere safe to sleep for a while, a short-term stay until they’re sobered up,” says Kelly- Ann Stevenson, a registered psychiatric nurse who facilitates the program. “For seven days they’re somewhere safe and can access resources with a clear head.” YASU accepts young people between the ages of 12 and 17 who need help dealing with a chronic addiction to drugs and/or alcohol. The youths arrive at the unit in one of two ways. They can sign in voluntarily, or they may be brought in by a police officer, social worker or a parent. “It’s a last resort when parents don’t know where to go, when they’ve tried everything,” Stevenson says. “When a parent or a social worker is at their wit’s end and they’ve tried everything, this is a last bit of hope for the family.” A week may not seem like a long time, especially when someone is fighting an addiction, but Stevenson says a lot can happen in seven days. “Youth are willing to do the work to get out pretty fast. This is a real wake-up call for them. It’s an opportunity to have a health assessment,” she explains. “They receive education and medical attention, but the bulk of it is referrals to other resources in the community. For the first couple of days, they spend a lot of time resting.” In addition to receiving any medical treatment they might need, the youths undergo counselling. “There are often underlying or co-occurring issues when a young person has an addiction. We’re seeing depression and PTSD. They’re trying to self-medicate
and self-soothe,” says Stevenson. “They have an inability to handle stressors in their life. Many times they have to change their friends to change their patterns of use.” YASU practices a harm-reduction model. “If they’re using very strong drugs, we get them to use less or less-strong drugs — we get them to step down to something that’s not as harmful,” Stevenson says. “Usually the youngest are mostly using marijuana with a little bit of alcohol.” Unfortunately, there is no quick fix for addiction. Stevenson may see the same young people a number of times before they are able to stay clean. “This is the first step in their recovery process. Treatment takes a long time, and the important work is what they do when they leave us,” she says. “Parents need to understand that the cycle of addiction is a process. It will take a couple of times until the youth get it right. Every time they come back, I see it as a great opportunity to try again.” Stevenson has been working with youth for 32 years. Before coming to YASU, she worked as a psychiatric nurse at the Manitoba Adolescent Treatment Centre for 30 years. She cherishes her role as YASU’s resident “Baba.” “I just enjoy working with the youth so much. I’m Baba here — cooking for them, nurturing them at times. Sometimes those meals mean so much to them,” she says. “I’ve always worked with youth. It can be very challenging, but also very rewarding.” For Stevenson, helping youth is more than a career — it’s a calling. She knew it was what she wanted to do by the time she was the same age as her current patients. “I did a lot of peer support as a teenager. My friends would come to me for help and advice,” she says. “I took that natural ability and was able to get the training to make it a career.” The YASU program is now well established and it has been extremely successful. To date, more than 1,000 young people have accessed services at YASU, stabilizing and receiving counselling. Parents have been overwhelmingly pleased with the program and the new beginning it has offered their children. ✚
that I’d contributed in a positive way to another human being’s life. In a time where we may
feel we can’t do enough for someone, their health,
and their situation, I think it’s empowering and refreshing for nurses to stop and
understand the influence they can have, even in the smallest snapshots of
time. Thank you to the patients who teach us to become better nurses and more empathetic human beings. Jaime Prystenski RNBN, MN Continuing Education Instructor Operating Room St. Boniface Hospital
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MENTAL HEALTH MATTERS
In celebration of National Nursing Week
oui! Where succes s begins Train for your nursing career … And expand your employment opportunity Baccalauréat
Thankyou, REGISTERED PSYCHIATRIC NURSES
NURSES WITH YOU EVERY STEP OF THE WAY
The College of Nursing at the University of Manitoba celebrates National Nursing Week. We stand alongside the nursing community and recognize the exceptional work of nurses and the important role they play in primary care and patient safety. As leaders in nursing education, we are committed to working with you to promote excellence in training, research, and practice. It is our honour to grow the profession by educating future nurses.
The CRPNM is the regulatory body for the psychiatric nursing profession in Manitoba crpnm.mb.ca
en sciences infirmières (Bachelor of Nursing) Sciences infirmières auxiliaires (Practical Nursing) • •
For more information, visit: umanitoba.ca/nursing
ustboniface.ca
10 WINNIPEG FREE PRESS - THURSDAY, MAY 5, 2016
#NNW2016 MAY 9-15, 2016 NATIONAL NURSING WEEK 2016
Construction crew: From left, registered nurses and managers of nursing and clinical projects Nicolette Holling-Kostiuk, Lisa Merrill, Doris Sawatzky- Dickson, Heather Elands, Karen Bodnaryk, Jacquie Habing and Laurel Flaming Demler are eager to welcome the new Women’s Hospital. PHOTO BY DARCY FINLEY
SPECIAL DELIVERY NURSES COLLABORATE ON WOMEN’S HOSPITAL BUILDING PROJECT
BY JENNIFER MCFEE for the Free Press A former labour nurse is now delivering in a completely different capacity, contributing to the birth of the new Women’s Hospital. N icolette Holling-Kostiuk, manager of nursing and clinical projects, spent many years as a bedside nurse in labour and delivery while also putting her experience to use in the triage unit. In 2009, working groups began to gather information for the new Women’s Hospital project, with a focus on clinical work. Based on her wealth of experience as a registered nurse, Holling-Kostiuk became the go-to nursing representative for the triage unit and eventually took on a permanent management position. “People say it’s a once-in-a-lifetime experience for a nurse to be involved in building a new hospital in your career. It’s quite rare and this is a particularly big project,” she says. “It’s very interesting, and I’ve learned a huge amount. At the same time, they don’t know what I know about taking care of patients, so it’s a relationship where everybody learns from the other person.” Since 2010, construction has been underway to build the new $235.9 million Women’s Hospital, which will span nearly 400,000 square feet at the northeast corner of the Health Sciences Centre campus. The current 65-year-old facility is cramped for space as it labours to accommodate more than
5,000 deliveries per year, as well as 7,000 annual gynecological surgeries and 29,000 ambulatory care visits to the outpatient clinic. The existing facility, located on the south end of the HSC campus, will be repurposed for another use. Construction is expected to be substantially complete this fall, with the HSC Women’s Hospital slated to open one year later, subject to change as the project progresses. This 12-month period will allow much-needed time to move, train and orient staff to the new building so they can adapt to the systems and provide safe, expert care to families. As part of the planning process, Holling-Kostiuk asked front-line staff about their wants and needs, and then she relayed the information to the design experts. One of the main improvements in the new facility will be its private patient rooms. “From an infection-control point of view, it’s really important. It’s also really important from a confidentiality, patient privacy and recovery point of view,” she says. “There are the occasional patients that benefit from having a roommate, but generally speaking, this is a very positive move.” The new building will also enhance collaboration between the Women’s Hospital and the Children’s Hospital. The intermediate care nursery, neonatal intensive-care unit (NICU) and a small neonatal unit will all be in close proximity in the new Women’s Hospital, where the postpartum moms will be on the fourth floor while the NICU and intermediate care nursery will be on the second floor of the same building. “If you have a critically ill newborn, you want to be where your baby is. In the new hospital, it’s just two floors down by
elevator. On top of that, when they go to see their baby, they’re in a private room,” Holling-Kostiuk says. “Today, the NICU and the intermediate care nursery have large rooms with four or six babies in them. So if you’re with your sick or dying baby or you want to breastfeed or cuddle with your baby, you can’t do that privately because all the other babies and visitors are in arm’s reach.” Holling-Kostiuk is also pleased that the new building will focus on a comfortable environment with the added goal of achieving LEED (Leadership in Energy and Environmental Design) silver standards. “Sunlight beams into the building in many places, so it’s being designed in a way that my generation has not been used to. The hospitals we work in now are square and boxy. They don’t have a ton of windows and are pretty basic,” she says. “The design of this new building has curved walls with windows wherever possible. It has the comfort of both staff and patients in mind. It will be beautiful in places.” Once construction is complete, the integration work will begin in earnest. “Our group has grown because we’re getting closer to being able to move in. It is a huge undertaking to move us in with all the people, the patients and the processes,” she says, adding that four more clinical managers have been hired in term positions. “They’re all actively involved in all of this as well. At the same time, they have to keep their units functioning on a day-to- day basis. It’s an enormous project. It’s extremely intricate and complex. There are so many systems that need to be working exactly correctly.” ✚
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I also have a wonderful partner who is a nurse and it feels so amazing to feel cared for, loved and safe. Back to work tomorrow, back to being a nurse — and I’m very proud of that. YvonneTalbot – Psychealth Health Sciences Centre I HAVE … I have delivered a newborn baby who couldn’t wait for the physician to arrive. I held the hand of a surgical patient, terrified he was dying. I advocated for a patient with mental health issues. I shaved a patient’s face prior to his family coming to see him for the last time. I have cried with families. I have massaged backs. I have painted toes. I have encouraged and supported patients who needed to know that they are valued and worthy. I have been a resource to colleagues and collaborated with team members to improve the delivery of care. I have cared for others through all aspects in the continuum of birth, life and death — and I know I have made a difference. LorenaThiessen BN RN Quality/Process Improvement Officer WRHA Surgery Program
Never underestimate what it means to a patient when you take time to brush her hair or include her in a conversation and see her smile. Those are the memories that they, and their families, will take from here. I can’t help but think of the impact the staff had on them. Stephanie smiled for the first time in months, her coccyx wound healed to the point she could sit again, she was nourished and she was cared for. They all were! Well done! Jodi Dusik Sharpe RN BN CNNC Patient Care Manager – 3E Palliative Care Riverview Health Centre A VIEW FROM THE OTHER SIDE One night recently I woke up at 3 a.m. in pain. I could not relieve it — in fact, it got worse. I have to admit, I was scared. I was worried that it could be a cardiac problem. Since women present with different symptoms than men, I decided to go to the emergency department. The ER team ordered a stat EKG, and an ultrasound, did blood work, and gave me some pain medication. Luckily, I found out that I was not having a heart attack! I will need to have some followup, but it’s nothing serious. I am so grateful to have received such great care from the nursing team. It’s very different to be on the other side … to be a patient. It gave me a very different perspective.
NURSING MOMENTS
CARING FOR OTHER CAREGIVERS We hear of many positive experiences from Grace Hospital patients and their families. Many times, patients are admitted as a result of trauma or critical illness, and families struggle with leaving their loved one alone. Such was the case for “Stephanie’s” parents. Caring for their loved one had taken a significant toll on them. On the day they arrived for admission at Grace Hospital, when I met Stephanie’s mother for the first time, she spoke of being exhausted and feeling unable to leave her daughter’s bedside during her admission. Appreciating the fact that these parents have been caregivers to Stephanie her entire life, their lives revolved around her needs and schedule and they trusted very few to care for her the way they did. I was immensely proud to hear them say the next day (24-hours after admission) how they trusted the staff and how engaged they felt they were in caring for Stephanie. The team earned their trust within hours of admission. That is something to be proud of! Stephanie’s parents felt they could visit for shorter periods each day, and they rested and began to take care of themselves in preparation for her return home.
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