A SUPPLEMENT TO THE WINNIPEG FREE PRESS | SATURDAY, MAy 9, 2015 | view online at winnipegfreepress.com/publications
NURSES NATIONAL NURSING WEEK MAY 11 - 17, 2015 With you every step of the way
The Heart of Health Care Celebrating the work nurses do every day
By Holli Moncrieff – For the Free Press
Nursing isn’t just a career. It’s a calling. P at Benjaminson, president of the College of Registered Nurses of Manitoba, has been a registered nurse for 32 years. She knew at a young age that she wanted to spend her life in nursing. “My mother was a nurse, and she was very proud of it. I grew up knowing there were vulnerable people who needed care,” Benjaminson says. “I became a nurse’s aide at 15 and I just loved the work.” National Nursing Week is celebrated during the week of May 12 each year. Florence Nightingale’s birthday was May 12, and the week is an opportunity to reflect on the value of the work nurses do every single day, in hospitals, clinics, workplaces and social agencies. “It’s important to celebrate the work nurses do. Nurses play a critical role in our health-care system — they’re making contributions to our health-care system all the time,” Benjaminson says. “It means a lot to nurses to be able to celebrate each other.” This year’s theme is Nurses: With You Every Step of the Way. “Nurses truly are with patients every step of the way, from birth to death. They’re the backbone of the health-care system,” Benjaminson says. “It’s important to educate the public and let them know everything we can do.” There are many different kinds of nurses, including licensed practical nurses, psychiatric nurses, registered nurses and nurse practitioners. “It’s hard to define what makes one nursing group different from another. A lot of nursing overlaps among the scopes of practice,” says Christy Froese, president of the College of Licensed Practical Nurses. “Nursing is a great profession. You have a lot of opportunity to work in various practice settings.” Registered psychiatric nurses work in many different health-care areas, including hospital emergency departments and urgent-care clinics. “We get to see a side of people that isn’t always as evident in other forms of nursing. It isn’t always as evident as a broken leg or belly pain,” says Debbie Frechette, president of the College of Registered Psychiatric Nurses of Manitoba. “We’re able to really develop relationships with people that get to the heart of why a person is struggling. We need to develop a rapport with our patients.” Nurses are on the front lines of the health-care system and they often initiate and develop programs that improve patient care and outcomes. They are researchers, educators, administrators and innovators. Nurses are some of the busiest people on the planet. So busy, in fact, that finding the time to plan and organize National Nursing Week activities can pose a challenge. “You’re already working at a certain hum, and it really ramps up for Nursing Week. Quite often we’re so busy with other tasks that we don’t take the time to pause and celebrate,” Frechette says. “Nursing Week gives us time to stop and reflect on the great work we do and provides an opportunity for nurses to collaborate with each other. When the week is over, we realize it was rejuvenating.” As Canada’s population ages, the demands on the health-care system continue to increase. Benjamin says the responsibilities and duties of all nurses are constantly evolving to meet the new demands. “The College encourages registered nurses to practice to their full scope. It increases the capabilities of the health-care system and patients get the care they need when they need it,” she says. “Nurses want to be there for their patients. We’re very proud of nurses and the work they do.” Most nurses say that the best part of their job is being able to help the people who need care. “One of the most challenging parts of being a nurse is finding enough time to spend with each patient. We see so many people everyday,” Benjaminson says. “We get people and their families the information they need to make a decision about their health care.” ●
Carta and other members of the burn program team help patients deal with physical and emotional scars.
Helping burn patients takes dedication and team work By Jim Timlick - For the Free Press Commitment to Care
Tricia Carta will often say she has two families — one at home, and one at work. C arta is a clinical nurse specialist for the burn program at Winnipeg’s Health Sciences Centre. A big part of her job is coordinating the efforts of a multidisciplinary team of nurses, surgeons, social workers and therapists in helping burn patients through their journey of recovery, a recovery that can take as long as 10 years. Because she is involved in nearly every step of their journey, Carta spends countless hours with patients throughout their recovery. And while parting can be sweet sorrow, nothing brings a bigger smile to her face than when a patient is ready to go home and resume everyday life. “When you see patients every day for six to eight months or longer, you become part of their hospital family and become an important part of their recovery,” she says. “It’s very rewarding when you finally get to see them go home and lead a happy, productive life again.” Carta is a graduate of the nursing program at the University of Manitoba and has been working in the field for 20 years. She has been in her current role as a CNS for 10 years and has been working with burn patients for the past 15 years. She was inspired to become a burn nurse
by one of her professors at the U of M who had worked in the same role. After beginning her nursing career in the surgical intensive care unit, she soon determined she had more to offer and switched to the burn program. “I just knew it was the area I was interested in and wanted to pursue it,” she recalls. “It’s a very holistic approach to care. You are not just dealing with the physical scars but the emotional ones as well. It really requires a collaborative care team to meet the needs of the patient.” In addition to coordinating the burn program team, Carta lends her clinical expertise to research projects, provides solutions to issues such as wound care, helps facilitate an overall plan for patients, and assists with patients’ transitions from critical care to acute or rehabilitative care. “I’m often the constant for them throughout their healing process,” says Carta, who provides her expertise to all areas of the HSC. Still, Carta stresses she is but one small part of the burn program team at the hospital. The team includes everyone from nurses, critical care nurses, plastic surgeons and burn surgeons to occupational and physical therapists and social workers. Carta says one of the most rewarding parts of her job is being part of such a tightly- knit group. Coninued on page 2 >>
Thank you
to the many nurses who care for cancer patients across Manitoba. Your care, compassion and commitment are greatly appreciated.
CancerCare Nursing Staff
Flin Flon Community Cancer Network Nursing Staff
2 Winnipeg Free Press - saturDAY, May 9, 2015
MAY 11 - 17, 2015 NURSING WEEK NATIONAL
Compassionate Collaboration Project provides best care for moms and babies
By Pat St. Germain - For the Free Press
Skin-to-skin contact, breastfeeding and early attachment between mother and child give newborn babies the best start in life. A nurse-led collaborative pilot project at Health Sciences Centre (HSC) Women’s Hospital is finding that family-centred care is also the best medicine for newborn babies of opiate-addicted mothers who are on methadone maintenance treatment. Clinical nurse specialist Lisa Merrill, who works in the Women’s Health Program at HSC, spearheaded the team project after visiting B.C. Women’s Hospital, where she was surprised to find that babies and mothers who are on methadone stay together in the postpartum unit following birth. Typically, such babies are separated from their moms within hours after birth and transferred to an intermediate care nursery, where they receive medication to treat withdrawal symptoms. But B.C. Women’s Hospital found there’s often no need for medication when babies and mothers are cared for together. “So really for best practice we don’t want to medicate babies that don’t need to be medicated if the best solution is to be with their moms and be skin-to-skin and breastfeeding,” Merrill says. Since December, HSC has kept 15 moms and their babies together in the postpartum unit for seven days following birth, rather than send babies immediately to the intermediate care nursery. Seven of those babies were able to go directly home from the postpartum unit without requiring medication. Merrill says that represents a profound improvement. Between 2009 to 2012, moms on methadone gave birth to 44 babies at HSC, and only four of those babies were able to
go home without needing medication treatment. “We know that breastfeeding and skin-to-skin care with these babies helps significantly with their withdrawal symptoms. And that’s why we embarked on doing this, because we know that it’s best for both moms and babies to be cared for in this way,” she says. “And it provides opportunities for the moms to bond with their babies, which is extremely important.” Methadone is the gold standard for opiate addiction in pregnancy and it has many benefits, easing symptoms of withdrawal, reducing cravings for opiates and reducing the euphoric effects of opiates, which means patients are less likely to succumb to cravings. There’s an obvious stigma attached to addiction, particularly for pregnant women, but Merrill says addiction is more widespread than many people realize, and it affects all walks of life. “We have pharmacists, physicians, nurses— it’s a whole gamut of people who are on methadone and you would never know because they function totally normally every day.” The pilot project has reduced stress for moms, since they don’t have to travel back and forth to visit their babies in the hospital. And it’s had an enormous positive impact on patient flow through the intermediate care nursery, where babies often stayed for two or three weeks — and sometimes two months or more, depending on the severity of their withdrawal symptoms and the number of medications there were on. Merrill says the collaboration between the nursery and the Family-Centred Mother & Baby Unit (FCMBU) has been the best part of the project. “The babies were cared for in the nursery — and are cared for in the nursery if they have to go there for medication therapy — but it’s a different program, so we have the babies that are covered under the Child Health program and then we
have the babies who are normal, healthy, fine, and they’re covered under the Women’s Health program, so we really had to work collaboratively to sort this out,” she says. “Everyone in both programs, including physicians, nurses and allied health staff has really embraced the opportunity to make this happen. All staff have been fantastic to work with and have really raised the bar as far as care for these mothers and babies because they think it’s the right thing to do.” Brad Link, manager of patient care for the Intermediate Care Nursery, says that collaboration has had wide- scale benefits. “From an operations perspective, this essentially opened up patient flow in the sense that we could care for more babies,” he says. Nurses from the FCMBU assess each baby and if they determine that a higher level of care is needed, babies are immediately transferred to the intermediate care nursery for treatment. “It’s really quite an impressive process that we’ve put in place where the baby doesn’t wait,” Link says. “The baby comes down and is seen and assessed by a physician quickly.” Susan Harrison, manager of patient care for the FCMBU, Perinatal Relief Team and the Breastfeeding Service at Women’s Hospital, says her nurses have been delighted with the results of the project. “Their area of expertise is keeping babies skin-to-skin and supporting breastfeeding and they were actually really excited to be part of this pilot,” she says. “It’s a huge difference in how close the mothers are and in helping the breast milk come in and just how the babies withdraw less.” Harrison says the project is a great example of how nurses work collaboratively to provide the best care. “We are putting our patients first.” ●
Above: The collaborative team includes (from left) RN Tina Vieira, Family-Centred Mother & Baby Unit manager of patient care Susan Harrison, RN Karen Favaro, Intermediate Care Nursery manager of patient care Brad Link, clinical nurse specialist Lisa Merrill, RN Kelly Myshkowsky and RN Shelley Sawich. Photo by Darcy Finley
MENTAL HEALTH MATTERS
<< Continued from page 1
“We have very low staff turnover. I think a part of that is our team is very passionate about what we do and is very dedicated,” she says. “There is a passion for people to work with the patients and follow them through their journey.” In addition to her work on the front lines, Carta is highly involved in several educational initiatives. She has played a key role in developing clinical practice guidelines and helps educate emergency room and intensive care staff at hospitals around the province about regional standards for burn care. She has also presented a number of case studies at several national conferences. Carta is actively involved in research dedicated to finding new ways to improve wound care for burn patients, including more easily removable dressings. She is also part of a project to create a Canadian Burn Network that would standardize wound care policies and guidelines across the country. “It’s quite exciting,” she says of the initiative. “We’re hoping to provide a forum for knowledge sharing so we can have online discussions across Canada.” As if that isn’t enough, Carta has several other projects on the go. She hopes to become more active on the issue of burn prevention and says some of the most serious burn injuries, including those caused by camp fires, are preventable. She is also helping to spearhead a pilot project that will see tablet computers used to educate burn patients and their families to reduce anxiety prior to surgery and assist them through the recovery process. The project is slated to be rolled out sometime in the next year. ●
Thankyou, REGISTERED PSYCHIATRIC NURSES for making a difference!
Education Programs in Brandon & Winnipeg crpnm.mb.ca
TR UBLE SLEEPING CAN’ LIFT KIDS
For more information on prevention tips for musculoskeletal injuries visit safemanitoba.com Sprains , Strains & Tears
4 Winnipeg Free Press - saturDAY, May 9, 2015
MAY 11 - 17, 2015 NURSING WEEK NATIONAL
Transgender Studies Research measures understanding in health care
By Sherry Kaniuga - For the Free Press
When patients arrive at a hospital or medical office, it’s routine for health professionals to ask questions about their age and medical history. T hey should also feel comfortable asking patients if they identify as male or female, says Fiona Smith, an RPN and instructor in the psychiatric nursing program at the University of Brandon’s satellite campus in Winnipeg. “It may seem awkward to ask people what pronoun they prefer to use, or ask ‘What can you tell me about your gender?’ ” Smith says. “But we can’t assume that what we see is what we get with people.” To help determine how prepared new health-care professionals really are to work with transgender people, and to treat them equally, Smith is researching nursing familiarity with transgender individuals as part of her PhD studies through the Applied Health Sciences program at the University of Manitoba. She recently conducted an online survey of nearly 450 nursing students across Manitoba, Saskatchewan, Alberta and B.C., asking questions that measure their familiarity and comfort with people who identify as transgender, an umbrella term for people whose gender identity or expression doesn’t match their biological sex. “There really hasn’t been lot of knowledge about transgender persons. Some studies talk about how nurses can be hesitant to offend people by asking questions about gender, which perpetuates the invisibility of transgender people,” Smith says. When she began the informal part of her research around families with gender- variant children, Smith looked at how often families felt they had to educate the health professionals they encountered along their child’s journey. Her interest in the topic stemmed from previous
had a youth come out as transgender,” she says. These families’ experiences were similar to those of parents in her Master of Nursing study who had been seeking support for their depressed teens. Smith will spend this summer analyzing responses to survey questions that measure knowledge, familiarity, attitudes and how those attitudes influence behaviour. Questions ranged from ‘Have you seen a film with a character who was transgender?’ and ‘Have you casually observed someone who is transgender?’ to ‘Is someone in your family transgender?’ and ‘Are you transgender?’ She says part of her analysis will focus on “connecting these responses to whether higher levels of familiarity are perhaps linked to less negative attitudes towards transgender persons.” She also asked the nursing students to respond to nine statements such as ‘I would feel comfortable working with someone who is transgender,’ ‘I could have a friend who is transgender,’ and ‘I could marry someone who is transgender.’ “That’s kind of a negative measure, to look at people’s measure of discomfort,” Smith notes. “Then looking the other way, I asked some questions about how prepared they feel to work with people who are transgender, how well they know where to find resources, and whether their nursing education program has prepared them to work with transgender populations.” Smith believes that attitudes of health-care professionals towards transgender people are progressing, and that’s a step in the right direction. “I see a slow, steady progress. It’s certainly something clinicians are increasing their interest in and engagement with. At the same time, whenever you have any kind of change coming, and in context of not having a lot of information, people will get scared.” The important thing is for information to be gathered in a manner that’s respectful for everyone, she says. “Gaining more information will help practitioners who don’t want to ask someone about their gender for risk of offending them to feel more comfortable broaching the subject,” she says. “If we started incorporating just small things like asking everyone as a point of routine, ‘How would you identify your gender?’ and ‘What pronouns would you prefer to use on the checklist?’ these are small things that make a big difference, allow transgender people to become visible and allow us to develop an understanding and a measure of our understanding.” ●
research and work surrounding mental health issues in youth and the support needs of their parents. And it was something that touched her own life. “This was something I
had thought was very rare until 2008, when three families in my natural social circle
“ There really hasn’t been lot of knowledge
Smith says health practitioners have to be comfortable with questions of gender.
about transgender persons. Some studies talk about how nurses can be hesitant to offend people by asking questions about gender, which perpetuates the invisibility of transgender people.”
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.
Winnipeg Free Press - saturDAY, May 9, 2015 5
Nurses With you every step of the way
The Home Team These nurse practitioners make house calls
Hospital Home Team nurse practitioner Joanna Orlowski, with her client Doug Peterson.
By Holli Moncrieff - For the Free Press
Just call them health care’s most wanted — nurse practitioners are so sought after that many juggle several different jobs in clinics and hospitals. N urse practitioners are similar to general practitioners in terms of scope of practice. They can order tests, prescribe medication and refer their patients to specialists. “There is very little we cannot do. Our scope really did expand. Every day our role grows,” says Joanna Orlowski, who has been a nurse practitioner since 2010. “Some people feel that if they have a nurse practitioner they need a doctor as well, but they don’t.” Nurse practitioners cannot bill Manitoba Health. They can’t enrol their patients in certain programs or sign insurance forms, but most work with physicians who are more than willing to co-sign. “We can’t do surgery, but in so many ways we practice in similar roles to physicians. Our roles overlap,” Orlowski says. “Nurse practitioners are in many different settings, not just primary care clinics.” Orlowski works on a Hospital Home Team, helping people who have not done well in the traditional health-care system, either due to complex health concerns, complex social situations, or both. The team’s goal is to keep people in their homes and out of the hospital. “Some of our patients are homebound so they cannot see their provider. We bridge that gap,” she says. “We try to get referrals so they don’t have to go to the hospital.” Before becoming a nurse practitioner in 2008, Bev Dyer worked for Health Canada, providing medical care to First Nations communities. “First Nations communities often didn’t have physicians, so I wanted to continue with more of that autonomy,” Dyer says. She’s seen the public’s understanding of nurse practitioners improve a lot over the years. “In the beginning we had a bit of teaching to do so people would understand what a nurse practitioner is — what we do and what we can’t do. There is still a lot of education that needs to take place, but it’s come along quite a way,” she says. “When I first started, there was still a bit of confusion. There’s enough of us now that I haven’t run into that in a long, long time.” As part of the Hospital Home Team, Dyer and Orlowski make house calls in order to help those who are unable to see a health-care provider due to mobility issues, mental health concerns, or lack of social supports. They also assist patients who have been frequent visitors to hospital emergency rooms, working with them to address their health concerns in the community. “The reasons they go to emergency may not be strictly medical. They may be lonely; they may want a sandwich,” Dyer says. “We really strive to do health education and health promotion. We can spend more time with our patients and do more teaching.” An initial assessment looks at health, social and mobility issues — whether patients can get out on their own or shop for groceries, for example — and the team works together with patients and their families to set health-care goals. The nurse practitioners may connect them with other health-care services and providers. “If they’re going to the hospital a lot, we can probably have a role in helping them,” Orlowski says. “One Hospital Home patient is like 10 personal-care patients. Some patients need more time, and some need less, but seeing patients is still the part of my job that gives me the most satisfaction.” ●
Meet Manitoba’s Nurse Practitioners.
Visit a QuickCare clinic.
What is a QuickCare clinic ? QuickCare clinics are there to meet your health care needs during times when most other clinics are closed. QuickCare clinics are staffed by nurse practitioners and registered nurses who can help prevent, diagnose and treat minor health issues. Because they are open evenings, weekends and holidays, they can save you a trip to an emergency room or having to wait for regular clinic hours. What health issues are treated at QuickCare clinics ? • Sore throat, earache, colds and flu, cough, hay fever or nosebleeds • Infections, rashes or sores
Find the QuickCare clinic nearest you WINNIPEG Unit 3, 620 Dakota Street 204-940-2211 WINNIPEG 363 McGregor Street 204-940-1963 WINNIPEG 17 St. Mary’s Road 204-940-4332 STEINBACH Clearspring Centre 204-326-7569 SELKIRK Unit 3, 1020 Manitoba Avenue 204-482-4399
• Stomach pain • Immunizations • Bumps, bruises or sprains • Stress or anxiety
manitoba.ca/betterhealth
Hospital Home Team nurse practitioner Beverly Dyer, with her client Norman Slutsky.
6 Winnipeg Free Press - saturDAY, May 9, 2015
MAY 11 - 17, 2015 NURSING WEEK NATIONAL
A Sympathetic Ear
A good listener is vital in times of crisis By Jim Timlick - For the Free Press
Registered psychiatric nurse Kris Lischynski’s job description could probably fill a page in a medical journal, but at its core, she says the job is all about being a good listener. L ischynski is a mental health consultation liaison nurse, one of two mental health nurses based out of Winnipeg’s Health Sciences Centre. As such, she is often one of the first people health professionals call in when a patient is having trouble coping with a sudden, life-altering situation such as a cancer diagnosis or the amputation of a limb. Patients may be dealing with a complex range of issues, including grief, schizophrenia, and post-traumatic stress disorder, and the key to helping them is often in providing a sympathetic ear. “Most times the people we are called in to see don’t actually have a mental health diagnosis. Often they just need someone to talk to,” says Lischynski, who has worked as a nurse for 20 years and has been at her current post for the past eight. “That’s what I really enjoy is listening to their stories and where they are coming from. It helps us to learn about them as a person. We can be more empathic and understanding. We tell them it’s OK to be sad or angry when you get a bad diagnosis. Having the whole picture allows us to treat them more holistically.” Lischynski and her fellow consultation liaison nurse are part of the mental health program at HSC, which means they can work with patients in any area of the hospital. One of their primary duties is to conduct a mental health assessment
Registered psychiatric nurse Kris Lischynski has many roles, including helping patients who are dealing with life-altering health issues.
“ I really want to normalize the whole issue of mental health. It’s something that affects all of us.”
based on the results of a one-on-one interview with the patient. As part of this process, they often offer coping strategies and may even recommend a patient for ongoing psychiatric support or treatment, although they don’t provide a diagnosis or prescribe medications. “We can’t fix a lifelong illness or a medical health issue,” Lischynski says. “We’re there primarily to offer support. But often we get feedback from patients who say that that’s where things really turned around for them. A lot of times people just want to know somebody is listening to them.” The same holds true for patients’ family members. Lischynski and other mental health nurses let loved ones know they are there for them too. “We listen to them and let them know it’s OK to be scared. Sometimes it’s providing them with basic help — ‘You need to go home and sleep’ or ‘Don’t just grab a cup of coffee, have something to eat.’ Sometimes it’s very basic stuff,” she says. Lischynski’s job often entails dealing with individuals who are not at their best physically or emotionally as a result of the health crisis they’re facing. The key is to diffuse the situation and emphasize to the person that what they are experiencing is perfectly normal. “A lot of it is (they feel) a lack of control. In a hospital there is not a lot of control for patients. You’re given a diagnosis and told what the treatment will be … but there’s not a lot of control,” she says. “We don’t want them to think, ‘People think I’m crazy’ and put up a wall. I really want to normalize the whole issue of mental health. It’s something that affects all of us.” In addition to assisting more than 1,000 patients each year, the nurses play a vital role in educating hospital staff about mental health concerns. This can include advising them on proper and effective critical incident stress management, leading discussions on any issues they may be struggling with or something as simple as having a brief conversation in the hallway. “We walk around the hospital all the time and we are sort of the unofficial face of mental health. People come up to us and say, ‘What can I do about this situation?’ It’s nice to be able to offer them support,” Lischynski says. “It’s a tremendous opportunity for us to provide that education and support. The formal part of it is big but the informal part of it is huge too.” ●
Photo by Darcy Finley
STARS ® OPEN HOUSE MAY 23 Please join STARS air ambulance at our public open house on Saturday May 23, 2015 from 11 a.m. to 3 p.m. 155A West Hangar Road, Winnipeg, Manitoba, 204-786-4647 11 a.m. - Doors open to the public 11:30 a.m. - Opening speeches Noon - Demonstration helicopter landing and take off Half Moon Drive In food truck on-site with proceeds to STARS
ComeMeet ourNurses aswell as
our doctors, paramedics, and pilots
Winnipeg Free Press - saturDAY, May 9, 2015 7
Nurses With you every step of the way
Mental Health Matters Psychiatric Emergency Nurses provide timely support
By Holli Moncrieff - For the Free Press
Sometimes the deepest wounds are the ones you can’t see. Twenty-five years ago, patients with mental-health issues might wait for hours without being seen in hospital emergency rooms, and often left without getting the help they needed. T hat changed when psychiatric emergency nurses (PENs) began working in every emergency room and urgent-care clinic. “As soon as someone comes in presenting a mental-health issue, they get seen pretty quickly,” says Christina Dueck, a PEN at the Grace Hospital. “We look after individuals who come in with a mental-health issue, and people who are in crisis.” PENs have a number of different roles. In addition to seeing patients, they support staff members who may be struggling. They’re also there for the families of patients. “We’ve been asked to sit with a bereaving family and meet their needs during a really difficult time,” says Daryle Duke, who is also a PEN at the Grace Hospital. “I think more people should receive training in mental health. It’s a really broad field. Everyone has high and low points in their lives.” Duke was a student at the University of Manitoba when he saw a small advertisement about psychiatric nursing in the university newspaper. “I really didn’t have a clear sense of what I was doing at that point,” he says, adding something about the ad just spoke to
him. “I haven’t had any regrets in 25 years.” At the Grace, PENs work 12-hour shifts, and they’re available from 8:30 a.m. until 9 p.m. seven days a week. “Sometimes mentors or care workers will bring people in, encouraging them to take the first step toward mental health,” says PEN Jenna Smith. “We’re able to help and identify the concerns they have. It’s the first step in the process a lot of the time.” In order to see a PEN, patients can’t be under the influence of alcohol or drugs. If they have medical issues, those will be taken care of first. Some patients may be admitted to the hospital until they are able to receive help. “Mental-health clients are not stuck in a queue for five or six hours. They’ve got the doctor’s ear through us,” Duke says. “The most challenging part of our job is being inundated with all sorts of issues at once.” He adds that the stigma surrounding mental illness is easing, which encourages more people to seek help, and there’s better access to that help. However, Dueck feels there needs to be more education about mental health in general. The public has many fears about mental illness that are largely unfounded, she says. “The majority of people with mental-health problems are not what you see in the media. People that come to get help aren’t violent,” Dueck says. “We’re all subject to having some kind of mental or emotional break.” Smith wants her patients and future patients to know that it’s a sign of strength to ask for help. “The absolute best part of our job is seeing someone leave
Photo by Darcy Finley
From left: PENs Jenna Smith, Daryle Duke and Christina Dueck want people to know it’s always OK to ask for help.
very satisfied. We were able to talk them through the issue and give them resources for the future. They leave with a new lease on life,” she says. “We want everyone to know it’s OK to reach out for help.” Duke adds that no one is immune. Depression, anxiety and other challenges, such as stress-related breakdowns, can happen to anyone. “We’ve all had mental-health issues touch our family, friends, or ourselves in some way,” he says. “We love what we do. It’s a wonderful job, and most people really appreciate the care they receive. There is a lot of good work being done.” ●
Concordia Hospital
Misericordia Health Centre
Seven Oaks General Hospital
Deer Lodge Centre
Pan Am Clinic
Victoria General Hospital
Grace General Hospital
Riverview Health Centre
Winnipeg Health Region
Health Sciences Centre
St.Amant
Winnipeg’s Personal Care Homes
Manitoba Adolescent Treatment Centre
St. Boniface Hospital
8 Winnipeg Free Press - saturDAY, May 9, 2015
MAY 11 - 17, 2015 NURSING WEEK NATIONAL
Critical care nurse Margeaux Baunemann, (left) and STARS vice- president of operations Betty Lou Rock, who is also a nurse, are passionate about their work. Photo by Darcy Finley
Flying with STARS Critical care nurse thrives on challenge
Care to Make a Difference?
By Todd Lewys - For the Free Press
Bachelor of Science in Psychiatric Nursing (BScPN) Bachelor of Nursing (BN ) Master of Psychiatric Nursing (MPN)
Ask Margeaux Baunemann what it’s like to be a critical care nurse for STARS Air Ambulance service, and her response is succinct. “I t’s controlled, but at the same time, completely uncontrolled,” says Baunemann, who is also an ER nurse at St. Boniface General Hospital. “When we’re dispatched to answer a call, we have no idea what we’re going to land on. We could be told we’re going to a one-car accident, and then end up landing at the scene of a three-car accident where there are several patients to deal with, not just one or two. It’s a job that requires you to be adaptable.” A typical day sees Baunemann and her three team mates — a paramedic and two pilots — on call at STARS headquarters in Winnipeg. Once a call is received, they jump into action. “When we get dispatched during the day, we’re up in the air within eight minutes; if we’re dispatched at night, we’re up in the air within 10,” she says. “Some days we might get one call. The most I’ve ever answered in one day is three. That was a very busy shift.” The STARS team keeps critically ill patients stable while transporting them to hospital. Teamwork and communication are essential, Baunemann says. “We do a lot of talking right from the moment we leave the base, and it continues right through the call. We’re very focused on our tasks, but at the same time, we’re always watching out for each other,” she says. “We’re fortunate that we’ve received amazing training. It really helps us prepare for the types of patients we fly, and the different situations we’re involved in.” Treating a critically-ill patient in the cramped confines of a helicopter isn’t easy. “Basically, we can reach every piece of equipment without
moving. That’s great, because you can get whatever you need quickly. At the same time, there’s not a whole lot of room to work. When a patient is unstable, it’s a lot of work.” With all it’s challenges, Baunemann says she absolutely loves the job. “When I applied, due to my ER background, I had a pretty good idea of what I was getting into. I have a pretty adventurous spirit, so I was pretty sure I’d be up to the challenge. I was hooked the first day with all the excitement,” she says. “Every day is different — that’s one of the biggest draws for me. It’s also refreshing to be able to be in a job where I can really focus in and give the best care I can give, putting the patient first. I feel like we’re making a real difference.” Betty Lou Rock, vice-president of operations for STARS Manitoba, says everyone on the STARS team is passionate about their work. And although the organization has endured some intense public scrutiny in the recent past, they’ve learned from it, and have gotten better at what they do as a result. “We’re now working very well with the Winnipeg Regional Health Authority (WRHA) and are becoming increasingly integrated into the emergency response system,” she says. “We’re working very positively with everyone to make the system as efficient as possible. STARS is something that’s needed in the province to serve people in rural Manitoba. It’s a service that benefits all of us.” Rock, who was the program director of critical care for the WRHA until 2011, says STARS will expand its scope in the near future. “A helipad is being built at the Health Sciences Centre, and we hope to have it in use by the end of the year. Having that in place will, for example, allow us to bring a critically ill patient from an accident on the Perimeter,” she says. “We’re becoming increasingly more efficient, and are happy to be here. Things are moving forward in a positive manner, and our goal is to get even better at what we do in the coming years.” For more information, visit www.stars.ca ●
JoinUs in Health Studies
Faculty of Health Studies 270-18th Street, Brandon, Manitoba R7A 6A9 For information call: 204-727-7403 or 204-571-8567
www.brandonu.ca/Academic/HealthStudies/
NURSES WITH YOU EVERY STEP OF THE WAY The College of Nursing at the University of Manitoba would like to acknowledge and celebrate National Nursing Week with the nursing community. As leaders in nursing education, we are committed to working with you to promote excellence in nursing education, research, and practice. We are honoured to grow the profession by educating future nurses.
For more information, visit umanitoba.ca/nursing
Winnipeg Free Press - saturDAY, May 9, 2015 9
Nurses With you every step of the way
Never a Dull Moment Primary care nurses take on a variety of roles
By Holli Moncrieff - For the Free Press
Primary care nurses might hold the secret to easing the burden on Canada’s health-care system. These nurses support doctors and nurse practitioners by taking an active role in preventative health, chronic-disease management, wound care and reproductive health. H owever, their role isn’t always fully understood, and they continue to be under-utilized, says Jennie Marshall, a primary care nurse at the Corydon Primary Care Clinic. “There aren’t too many primary care nurses. We’re a type of nursing that’s really hidden. Our role can be expanded so primary care nurses are in more clinics,” she says. “Having primary care nurses on staff increases a doctor’s ability to have a lot more patients on their roster. One of the pillars we look at is preventative health. This is something we’re really excited about.”
medication and possible complications, and have a big talk about nutrition and exercise,” says Marshall, who has been a primary care nurse for 12 years. “You don’t have to have diabetes to attend. We’ve had families of our diabetic patients come.” Along with the other two primary care nurses at the clinic, Marshall holds Well Baby sessions and teaches pregnant moms about prenatal health. “The Well Baby classes can be about anything from breastfeeding to normal elimination, home safety, and poison control,” she says. “Our prenatal classes are about establishing healthy habits for babies during the pregnancy.” Teen clinics are held once a week. While the main focus is on reproductive health, Marshall says kids can come in for sprained ankles or minor ailments like colds, as well. “It gives (health-care) providers more time with their patients if we can take this on.”
“We’re the communications person between the provider and the patient. We advocate on behalf of our patients.” One of the most challenging aspects of the job is staying on top of new developments in the health-care field. “It’s both a blessing and a curse, how much information there is available. Evidence-based studies are really important. We try to base a lot of our nursing care on them,” Marshall says. “There are such a wide variety of situations we have to deal with. There’s never a day I’m not learning.” Marshall sees the clinic’s clients in person or holds phone consultations with them. She loves helping people take a proactive approach to their health. “The best part of this job is being able to interact with so many different people on a daily basis. Every day is different.
“ We’re the communications person between the provider and the patient. We advocate on behalf of our patients.”
The Corydon clinic takes a team approach to health care, with six doctors, two nurse practitioners, and three primary care nurses working closely together and collaborating whenever possible. “You need a lot of good communication. We receive a lot of trust from the primary providers,” Marshall says.
Diabetes management is one example of an area where primary care nurses can take an active role. At the Corydon clinic, nurses run a monthly diabetes class to educate people on managing their health. “We go through the basics, about the
It’s always challenging and it’s always exciting,” she says. “This type of nursing always felt comfortable. It felt like home to me. I absolutely love my job.” The biggest requirement for a primary care nurse? Being able to roll with the punches. “The role of a primary care nurse is very different and kind of challenging. You have to be someone who is OK with flexibility and change, and who likes to think outside the box.” National Nursing Week offers an opportunity to celebrate and recognize the many roles nurses play. And Marshall says this year’s theme — Nurses: With You Every Step of the Way — truly resonates with her. “We take care of people from cradle to grave.” ●
oui! Where success begins Train for your nursing career … And expand your employment opportunity Baccalauréat
en sciences infirmières (Bachelor of Nursing) Sciences infirmières auxiliaires (Practical Nursing) • •
Marshall uses teaching tools to educate patients about diabetes management.
ustboniface.ca
Photo by Darcy Finley
Thank you, Manitoba nurses!
There’s nothing more important than your family’s health.
Greg Selinger
Sharon Blady MLA for Kirkfield Park
Nancy Allan MLA for St. Vital 204-237-8771 NancyAllan.ca
Dave Chomiak MLA for Kildonan 204-334-5060 DaveChomiak.ca
Deanne Crothers MLA for St. James 204-415-0883 DeanneCrothers.ca
Jennifer Howard MLA for Fort Rouge 204-946-0272 JenniferHoward.ca
Ron Lemieux MLA for Dawson Trail 204-878-4644 Ron-Lemieux.ca
Kerri Irvin-Ross MLA for Fort Richmond 204-475-9433 KerriIrvinRoss.ca
Ron Kostyshyn MLA for Swan River 204-734-4900 RonKostyshyn.ca
Flor Marcelino MLA for Logan 204-788-0800 FlorMarcelino.ca
Erna Braun MLA for Rossmere 204-667-7244 ErnaBraun.ca
James Allum MLA for Fort Garry-Riverview 204-475-2270 JamesAllum.ca
MLA for St. Boniface Premier of Manitoba
204-832-2318 SharonBlady.ca
204-237-9247 GregSelinger.ca
10 Winnipeg Free Press - saturDAY, May 9, 2015
MAY 11 - 17, 2015 NURSING WEEK NATIONAL
Focus on Intervention Research helps nurses take care of family caregivers
Registered nurses and nurse practitioners provide timely care in
QuickCare and Mobile Clinics.
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’s New Nurse-Led Primary Care Clinics
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. ●
Dr. Michelle Lobchuk says nurses are well-placed to help family caregivers take care of their own health.
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