A SUPPLEMENT TO THE WINNIPEG FREE PRESS | SATURDAY, MAy 10, 2014
N URSING:
A LEADING FORCE for CHANGE
NATIONAL NURSING WEEK MAY 12 - 18, 2014
Celebrating the Profession Nurses play a vital role in every area of health care
By Holli Moncrieff – For the Free Press
National Nursing Week is an opportunity to cele- brate the unsung heroes in our health-care system. Nurses may not get all the glory, but they do a lot of the heavy lifting in every area of care. “Nurses are well-educated individuals who have an impact on planning, the execution of clinical practice, and the health care of the population of Manitoba,” says Cathy Rippin-Sisler, president of the College of Registered Nurses of Manitoba. “I’m not sure the public understands how broad- based a skill set nurses have. There’s still a very narrow stereotype of what nursing is.” National Nursing Week runs from May 12-18. The theme for the week is Nursing: A Leading Force for Change, and many members of the profession hope that some of the week’s events and activities will help educate the public about the vital role of nurs- es in the health-care system. “Nurses impact patients’ lives at various points in an individual’s lifecycle, from birth to death,” Rip- pin-Sisler says. “Nurses are involved in research, detailed planning, the administration of the health- care system and education. Nurses ensure that decisions made in clinical practice are evidence- based, and nurse practitioners play an important role in innovation. Four out of five executive offi- cers of our health regions have a nursing back- ground.” Each year, the college salutes nurses in sev- eral areas of excellence at an awards banquet. This year’s banquet is set for May 15. “Nurses are the professionals that are most prevalent across the health-care system, but they’re just going about quietly doing their work,” Rippin- Sisler says. “The awards banquet gives us the op-
portunity to recognize excellence in a variety of set- tings.” Christy Froese, president of the College of Li- censed Practical Nurses of Manitoba (CLPNM), says the role of nurses has expanded and grown more complex over the years. The college is holding an open house on May 15 to give the general public an opportunity to learn more about the work of LPNs. “Nursing Week is still a public education program that definitely needs to be in place. There’s not a great understanding of the role of the LPN. There’s still a lot of education that needs to happen,” Fro- ese says. “Nursing week is an opportunity to cele- brate and recognize nurses and all that they do for the public.” CLPNM executive director Jennifer Breton says the college is also organizing a blood drive with Can- adian Blood Services to coincide with National Nurs- ing Week. The drive is also set for May 15. “We thought about the altruism of nursing and decided we wanted to try to give back in some way. The blood drive is our way of engaging in an activity that demonstrates the giving nature of nurses,” Bre- ton says. “We hope to get as many people involved as possible.” Debbie Frechette, president of the College of Registered Psychiatric Nurses of Manitoba, says one of the biggest challenges for nurses is balan- “Nursing week is an opportunity to celebrate and recognize nurses and all that they do for the public.”
cing time with their patients with all the other work their jobs require. But nurses are getting more respect for the work they accomplish. “If you’ve been a patient in a hospital, you abso- lutely understand the importance of nurses. When people are in crisis, nurses are often their first point of contact,” Frechette says. “Nurses are impacting change on the system that affects direct-care providers and patients. People are realizing the potential impact we can have in someone’s life and how we can help them through a difficult time.” Since they’re on the front lines, nurses are often the ones who come up with ideas for improving the health-care system. For example, Health Sciences Centre is currently looking at reducing the use of seclusion and restraints on psychiatric patients, Frechette says. “I sometimes wonder if people really know that we’re there 24/7. We support patients when they’re the most vulnerable. In psychiatric nursing, we help our patients have hope that there is something on the other side.” Breton adds that the more the health-care system can embrace the full scope of what nurses are trained to do, the better the system will be. “LPNs are educated to provide quality care. To utilize LPNs to the fullest scope of their practice will only benefit the health-care system. There are so many places LPNs can work — emergency de- partments, maternity wards, management positions. A lot of facilities are already embracing the full scope of training for LPNs.”
During National Nursing Week, the public is invited to an OPEN HOUSE at the College of Licensed Practical Nurses of Manitoba at 463 St. Anne’s Rd. Drop by on May 15 from 10 a.m.-4 p.m. The public is also welcome to attend a CLPNM-sponsored blood donor clinic on May 15. Call 204-663-1212 for more information. The College of Registered Nurses is hold- ing its 100th annual general meeting on May 16. And its Professional Nursing Awards banquet on May 15 will recognize excellence in five award categories:
• Lifetime Achievement: Sue Roberts RN BScN
• Interdisciplinary Health-Care Team: Geriatric Day Hospital, Seven Oaks General Hospital • Award of Excellence, clinical nursing practice: Karen Amos RN and Lisa Merrill RN • Award of Excellence, nursing education: Dr. Donna Martin RN and Carla Shapiro RN • Nursing Excellence, nursing administration: Dennis St. Laurent RN BN
2 Winnipeg Free Press - saturDAY, May 10, 2014
N URSING WEEK NATIONAL
Speaking my Language
Learning Cree helped northern nurse connect with patients
By Karen Christiuk – For the Free Press
Knowing more than one language is not a job requirement of northern nursing, but it’s clear that learning Cree has made registered nurse Mawussi Kassegne a better caregiver. Kassegne is the nurse in charge of the Health Canada nursing station in God’s River (Manto Sipi) Cree Nation. He has worked on remote Manitoba nursing sta- tions since 2006, and has been learning Cree since then. The path Kassegne took to learning Cree has been a long and winding one. Throughout his life, he has learned new languages for fun and to advance in his career. “I was born and raised in Togo, in West Africa, and the official language of Togo is French,” he explains. “At home, I mostly spoke Ewe with my family, which is a common language there. I went to university in Togo, studied to be a lab technician, and worked in that profession for many years. When I moved to Canada at the age of 32, I stud- ied nursing in French at the University of Montreal. Around that time, I had a lot of friends and co-workers who spoke Italian and Spanish, so I started to learn those languages a bit. I also learned some Haitian Creole because I had many friends from Haiti.” After his nursing studies were completed, Kassegne worked in different hospi- tals in Montreal, where he was exposed to both English and French. He first heard about opportunities to work for Health Canada through a physician who thought Kassegne would enjoy the independence and versatility of working in northern Manitoba. “My first posting was in Split Lake (Tataskweyak) Cree Nation. I worked in Eng- lish, and it was sometimes challenging, but I had good support from my col- leagues and some excellent mentors. But since everyone in the community also spoke Cree, I thought I should try to learn a bit of Cree.” When Kassegne discovered there wasn’t a local Cree language classroom course available, he took it upon himself to purchase three books on how to learn Cree, and was also given a book by a helpful community member. “People in the community noticed I had an interest in learning Cree, so they were willing to help me learn new words. Learning Cree helped me improve my communication with my clients and develop stronger relationships.” Kassegne has been working in God’s River for the past two years. He sees an average of 20 clients a day, and has found it’s mostly older adults who enjoy com- municating with him in Cree. “I’m certainly not fluent. However, I’m able to ask people basic things, like how old they are, or if they have pain. I usually start by asking them, ‘How are you?’ in Cree. I also know the Cree words for some medical terms. It’s helped me to improve the care I provide to them.” Although God’s River might seem very different from the African village where he was born, Kassegne says there are actually many similarities. “Walking or sitting on the beach by the lake is very peaceful, energizing and spiritual, just like my village in Togo. There are only dirt roads here, and the dust in the summertime also reminds me of home,” he says. “I also find that everyone here pulls together when there is an emergency. In Africa, your neighbour is your brother. It’s like that here too.”
For information about working as a nurse for Health Canada, call 1-866-RN- NORTH or email manitoba.nurse.recruiter@hc-sc.gc.ca.
Registered nurse Mawussi Kassegne has learned to speak Cree to better communicate with patients.
(Karen Christiuk is a Health Canada communications advisor.)
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.
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 10, 2014
N URSING WEEK NATIONAL
New Lease on Life Chronic-care patients aren’t just surviving, they’re thriving
By Jennifer McFee – For the Free Press
Chronic-care units are not typically associated with hope and healing. But the nursing team at Deer Lodge Centre has worked hard to change that perspective — and they’ve changed lives in the process. Clinical resource nurse John Prefontaine has seen remarkable improvements since he began working in the 44-bed chronic-care unit called Lodge 6 two years ago. “Chronic care used to be a destination for pa- tients with chronic needs, but there wasn’t a lot of expectations that they were going to improve in their conditions,” he says. “It was really more of a place to decline. That was anticipated.” Many Lodge 6 patients have end-stage diseases that may require dialysis, feeding tubes or breathing tubes. Some patients may need help with every- thing from washing and feeding to sitting up and turning over in bed. No matter what type of complex care a patient requires, the overall goal is the same for everyone. “Our mission has been to try to figure that pa- tient out and to bring them up to the optimum health level,” Prefontaine says. Both Prefontaine and his manager come from an intensive-care background, and they bring a new perspective to chronic care. “It’s just a different way of thinking. I like to call it continual care. In an acute-care setting, you evalu- ate a patient and you try to make changes to the patient’s care plan. That’s the kind of nursing model that we’re using. Coming from acute care, we looked at what we could do to make our patients’ health better,” he says. “One of our missions at Deer Lodge Centre is to make lives better. And my vision is patient-centered
care, so that’s the vision we use. We look at the patient and we try to make some changes that would better their health. We really have to involve the family to provide optimum care.” Prefontaine supervises a team of 52 health-care providers. They’ve seen steady improvements in quality of life for Lodge 6 patients, whose average age is between 55 and 65. “We had a total of four patients in 2013 that were able to remove their feeding tubes. They were actually eating. That is rare in chronic care. At one time, you would just take for granted that they would be with their feeding tube for the rest of their days,” he says. “We’ve also had people that we’ve assessed for swallowing. They still have their feeding tubes, but they’re able to take nourishment by mouth also. They don’t eat enough to maintain their health, but they’re able to get some from their feeding tube and some orally. There’s another five people in that cat- egory.” As well, staff were able to remove breathing tubes for another five patients last year. “Some of those tubes have been in a very long time. Some of those people now are actually eating and talking,” Prefontaine says. “It’s quite remarkable that somebody would take their first bite of food after years of not being able to do that.” Every nurse on the floor is sent to wound-care seminars, and they use a new system to evaluate skin. Since 2012, nurses and health-care aides have worked together to reduce the number of pa- tients with wounds from 36% to 6.8 % — a dra- matic improvement. “They’re not just surviving anymore, but they’re
actually thriving. We have to invest the time. My duty is to invest my efforts to make optimum care. I’m here to do that. We work on it on a daily basis in Lodge 6,” Prefontaine says. “The staff here is absolutely wonderful. We’ve made an investment in our patients. It takes the nurses. It takes the health-care aides working with us, but it also takes the entire health-care team.” Some patients have even made the transition out of chronic care and back into the community. “They might go home with home care. We have some gentlemen that are going to an assisted living arrangement. We’ve also had some patients that may go to a personal care home. That’s something that wasn’t happening in chronic care, so it’s quite exciting to us.” Along with two colleagues, Prefontaine is writing a feature article on their nursing model for a Can- adian Nurses Association (CNA) publication. They’ve been asked to present their work at a CNA annual meeting and biennial convention, which will be held in Winnipeg in June. As part of their research, they reviewed charts from 2013 and found that 24 of 73 patients experi- enced a reduction of their chronic-care indicators or had them removed entirely. “That’s the new beginning for some of these people. They thought they were coming to chronic care to stay here for the rest of their days. In fact, their quality of life has improved. They’re going to have different living arrangements, so that’s very exciting,” Prefontaine says. “It really comes back to making lives better. You always need to strive for that. These are people that we’re dealing with, and we have an obligation to provide the optimum health that we can.”
Clinical resource nurse John Prefontaine and his team bring hope to patients at Deer Lodge Centre.
Winnipeg Free Press - saturDAY, May 10, 2014 5
MAY 12-18, 2014 NURSING: A LEADING FORCE FOR CHANGE
Talking about Tuberculosis Education is key to eliminating TB in First Nations communities
By Karen Christiuk – For the Free Press
Tuberculosis is treatable and curable, and Health Canada is working hard to eliminate it in First Nations communities, which are disproportionately affected by TB. “The disease can be cured within about six to nine months using several antibiot- ics together,” says Rose Anne Zacharias, manager of the TB Control Program for Health Canada’s First Nations and Inuit Health Branch in Manitoba. “Early diagnosis and treatment of TB is one of the most effective ways of reducing TB. Anyone who exhibits some of the signs of TB, such as a persistent cough, lasting at least two weeks, extreme fatigue, fever or chills, weight loss or chest pain, should be tested. TB is spread through the air when someone coughs or sneezes, so anyone who has had prolonged exposure to someone with TB, even if it was many years ago, should also be tested.” Educating First Nations peoples through public presentations, posters, and person- al discussions helps to end the fear and stop the spread of the disease. “We want to get the message out that
it’s really easy to get a TB test at a health facility in a First Nations community in Manitoba. And by getting tested, you can help to protect yourself, your family and your community.” Tuberculosis testing typically includes four main components. “A TB skin test is done on the client’s inner forearm, saliva samples are col- lected, and a chest X-ray taken. Then the nurse assesses the client for symptoms and asks about current or past TB expos- ure. All of this information, and test re- sults, is compiled into a treatment plan as needed.” If a client is diagnosed with TB, the treatment is usually fairly routine, even if they live in a remote community. “They travel to a hospital in Thompson or Winnipeg to see a specialist and begin treatment with four or five types of medica- tion for two weeks,” Zacharias says. “If the client progresses adequately and they are no longer infectious, they then re- turn to their home community to continue their TB treatment. The duration of treat- ment can be from six to 12 months de-
pending on the severity and location of the TB in their body. Tuberculosis is curable with complete treatment as prescribed. However, like other infectious diseases, people may become infected again later in life.” If left untreated, TB can cause extreme pain and a number of serious health prob- lems, such as permanent lung damage. “Although TB rates in First Nations com- munities in Manitoba have actually re- mained fairly stable for the past decade, rates are still higher than many other places in Canada,” Zacharias says. “Our goal is to eliminate TB completely from First Nations communities. This can only be achieved with public education, screening, treatment and infant vaccina- tions.” To learn more about how to protect yourself from TB, talk to your health care provider or visit www.healthycanadians. gc.ca/tuberculosis.
(Karen Christiuk is a Health Canada communications advisor.)
Rose Anne Zacharias wants to get the word out that early diagnosis and treatment can reduce instances of TB.
Misericordia Health Centre Pan Am Clinic Riverview Health Centre St. Amant Centre St. Boniface Hospital
Concordia Hospital Deer Lodge Centre Grace Hospital Health Sciences Centre Manitoba Adolescent Treatment Centre
Seven Oaks General Hospital Victoria General Hospital Winnipeg Health Region Winnipeg’s Personal Care Homes
6 Winnipeg Free Press - saturDAY, May 10, 2014
N URSING WEEK NATIONAL
Mothers’ Helpers Program reaches out to inner-city women who face barriers to prenatal care
By Jennifer McFee – For the Free Press
Most pregnant women struggle to juggle ultrasounds and prenatal appoint- ments with a hectic schedule. But imagine if the pressing issues in your life also included poverty, hunger, abuse, addictions or trauma. In these circumstances, a healthy pregnancy might seem almost unattainable as moms-to-be strive to survive. A project called Partners in Inner-City Integrated Prenatal Care (PIIPC) aims to help women in these situations to achieve a healthy pregnancy, resulting in healthier babies. Based out of the Women’s Hospital, the project focuses on women living in Point Douglas, down- town or the Inkster area who have been deemed at-risk of not having sufficient care during pregnancy. Clinical nurse specialist Lisa Merrill explains that many inner-city women face barriers with transportation, child care and long wait times that prevent them from getting the prenatal care they need. “Often they just have lots of other things that are going on in their lives that makes it maybe not the priority of their day; things like violence, substance use, homelessness. Also we have lots of moms who have housing and food se- curity as huge issues. A lot of them don’t have enough access to food,” Merrill says. “So when you have a list of things of the day that are of importance, food and housing may be more important than coming to the doctor’s office at nine in the morning.” Fear is another factor that may keep some women from seeking prenatal care.
Created by the Winnipeg Regional Health Authority, the program in- cludes representation from Healthy Child Manitoba, Manitoba Health, the Assembly of Manitoba Chiefs and University of Manitoba researchers. By the end of 2013, 105 women had enrolled in the program, and Mer- rill hopes to recruit more. To do so, public health nurses and outreach workers cruise downtown in a harm- reduction van, which allows them to offer on-the-spot pregnancy tests and initial prenatal blood work. Other women find out about the services through community agen- cies and groups, as well as through the Healthy Baby program. Other times, they just show up at the hospi- tal looking for help. “If anyone turns up at Women’s Hospital, they just page me and I come and meet with the moms. We do everything right on the spot, so there’s no waiting and no turning them away,” Merrill says. “I’m always fearful that they won’t come back. If they have enough cour- age to come here the first time, we want to make sure that we connect with them right away and bring them in for care.” If the women return for even one more appointment, Merrill deems it a success. “We have moms that come in with- out having seen a doctor at all in their whole pregnancy, and there are lots of complications that could go along with that,” she says. “We’re try- ing to prevent all of that so we have a healthier mom and a healthier baby.” While medical care is important, it’s equally essential to connect these moms with resources and sup-
Photo by Darcy Finley
Clinical nurse specialist Lisa Merrill tries to ensure that inner-city women have prenatal care.
“Lots of people are afraid to come. They might not have had a great experi- ence in the past in any institution. They’re a marginalized population, so it’s really hard for them to come. They’re afraid,” Merrill says. “Lots of our moms, through Child and Family Servi- ces, have had other children who may have been ap- prehended at birth, so they’re hesitant to come forward for fear that that might happen again.” But PIIPC aims to reduce these fears and challen- ges. To start, Merrill provides bus tickets or taxi vouch- ers to get women and their families to and from ap- pointments. She also provides food vouchers for pregnant moms and their children. “One of the most shocking things I found is that a lot of the moms who show up for appointments haven’t eaten at all. I had one mom who said it had been two days, and she’s pregnant,” Merrill says. “If you ask the questions, then we find that they just don’t have access to a food source. So we have meal vouchers to go to the cafeteria and have something to eat. If they’re not able to do that, then I have snacks and sandwiches from within the hospital. We give them a snack while they’re here waiting. Strangely, it brings them back. They know that when they come, they can have something to eat.” When it comes to waiting times, women in the pro- gram are fast-tracked so health-care providers see them quickly. “We need to get things moving forward. People have done a great job of taking on-the-spot patients who just show up. Maybe it’s not their day, not their time, but they’re here, so we will see them. There’s been great buy-in from our staff around that. They’ve been excel-
lent,” Merrill says. “Even for ultrasounds and fetal assessment, if we have a mom that we’ve identified as part of our pro- gram, they will fit them in. It’s been fantastic.” The evidence-based initiative is now in its second year, and funding is expected to continue for one more year through the Canadian Institutes of Health Re- search and the Manitoba Health Research Council.
port, both in the hospital and in the community. “It’s all of those things that are super important and will help them manage in their everyday life,” Merrill says. “This will help reduce the harm to them and their families.”
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Winnipeg Free Press - saturDAY, May 10, 2014 7
MAY 12-18, 2014 NURSING: A LEADING FORCE FOR CHANGE
In the Line of Duty
Traumatic stress has lasting impact on those who serve
By Jennifer McFee – For the Free Press
At many jobs, the stress ends when the shift is over. But for members of the RCMP and the Canadian Armed Forces, stress can linger and have a lasting impact on their lives. Nurse therapist Amber Gilberto works with these members, as well as with veterans, at the Oper- ational Stress Injury (OSI) Clinic based out of Deer Lodge Centre. “We can assess, diagnose and treat the OSI, which is exposure to any duty-related incident that has been traumatic in nature, not just deployment. It can be things that have been experienced in the workplace, any sort of harassment or anything that someone would consider to be traumatic,” Gilberto explains. “We see quite a few people who have been de- ployed to Afghanistan and Bosnia and other areas from the ’90s and earlier. With the RCMP, every day there seems to be something that could be trau- matic happening for them.” Under the OSI umbrella, conditions include anx- iety disorders, nightmares, depression and, most commonly, post-traumatic stress disorder. “So many people cannot stop thinking about cer- tain incidents. They seem to be more hyper-vigilant when they’re out. They have trouble with sleep. They have trouble being comfortable in social situations. It affects their life in all aspects,” Gilberto says. “We also see spouses and deal with some of the family issues that stem from OSI. It’s not just the individual. It definitely affects the entire family.” In her nursing role, Gilberto sees all new referrals for an intake assessment. These referrals can come from the medical officer on a Canadian Forces base, the RCMP divisional psychologist or representatives of Veterans Affairs. “We assess what’s going on with them, within their family, within their work environment. Symptom- wise, we get all the information from them. From there, we determine what needs to be the next step in the clinical process. Usually that is a psychologic- al assessment or a psychiatric assessment,” she says. “From that assessment, we are able to determine what the condition is and how we could best treat it.”
Most treatment protocols last 12 to 16 sessions and could include counselling services and medica- tions. But when it comes to recovery, treatment is only one part of the process. “There are other things that need to be con- sidered, such as transitioning out of the military or RCMP or reintegrating back into increasing social supports — anything that helps the person on their road to recovery,” Gilberto says. “We also have some groups that we offer. Often people will participate in the groups after they’ve completed their trauma-focused treatment. There are some residual symptoms that still need to be worked on, so that is a good way to expose people to interacting in a safe environment in group set- tings and to work on some of the issues that per- sist.” The journey to recovery is an ongoing process, she says, so clients can return for extra support whenever they need it. “People will have periods when maybe they might experience a resurfacing of some symptoms with stresses that might be going on currently in their lives. We try to prepare people for that, knowing that sometimes this can happen. It’s to be expected,” she says. “It doesn’t mean that you’ve relapsed. With life- altering events, they’re never forgotten, but certainly you can work through and process them and inte- grate them so that they don’t run your life.” Since the clinic launched a decade ago, Gilberto has noticed there is now less stigma associated with seeking help. “It’s getting better. I’m now hearing from some of the clients that their peer suggested they come here, so we have more of a presence. We’ve gained a good reputation. We have some really good rela- tionships with our referral sources,” she says. “I think there’s maybe more comfort with coming forward and maybe more knowledge with respect to what to do if you’re struggling with something. It’s not such a shot in the dark now. People know what the next step is and where they should be going and what to expect when they get here.” The impact of the clinic is evident in the ongoing work for the nurses and other staff. “In the last couple months, we’ve had over 20
referrals. The referral rate is steady and so is the clinic itself. There isn’t a day that’s not busy,” Gil- berto says. “We’ve evolved as a clinic over the last couple of years and we’ve made more room for the other things that need to happen prior to engaging in the treatment protocols and then following the comple- tion of treatment. So really, it’s more recovery ori- ented.” The clinic’s two nurses provide services to clients while they wait for treatment, and there’s followup after treatment. “The philosophy has shifted more to recovery-ori- ented and not just treatment-based. It’s more holis- tic and a broader approach,” says Gilberto, who is currently working on her master’s degree in psychi- atric therapy from Brandon University. She hopes to expand the services that nursing can offer at the clinic, since her thesis will focus on recovery from operational stress injuries. Her re- search centres on a meta-habilitation model that al- lows for an individualized approach while also in- cluding benchmarks of recovery. “This model speaks to the need to be more com- prehensive and to see the processes beyond the treatments as definitely more of a journey,” she says. “This is something that is going to help evolve the nursing role at the clinic and help expand the servi- ces that we provide to clients and families.”
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Nurse therapist Amber Gilberto works with members of the RCMP and military who are recovering from traumatic stress.
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8 Winnipeg Free Press - saturDAY, May 10, 2014
N URSING WEEK NATIONAL
Care on Call 24/7 Sexual assault victims find comfort in SANE setting
By Jennifer McFee – For the Free Press
Specially trained nurses offer a sense of compassion and comfort to patients during the difficult time after a sexual as- sault. Since the late 1990s, the Sexual Assault Nurse Examiner (SANE) program has provided medical and forensic care to people who have been sexually assaulted. As coordinators of the program, Candace Wylie and Ashley Smith lead a 14-person team that’s on call and ready to help 24-hours a day, seven days a week. In a specialized suite at Health Sciences Centre, the team sees men, women and transgender patients from across the Winnipeg Health Region, as well as children from across the province. Services are available to adults and adolescents with- in five days of the assault. For pre-pubescent children, visits should occur within 72 hours. Coming from an emergency background, Wylie is pleased to provide quick and comfortable care at a time when patients need it most. “One of the things I love about this is that we can give them one-on-one care at the time that they need it,” she says. “We have our own suite that we bring them back to. It’s com- pletely different. It doesn’t look like a hospital at all.” Apart from the exam room, the suite contains two separate
interview room so the patient feels as comfortable as possible without having to leave the suite. “When they come in, the whole exam process can take three to four hours from the time that we initially see them to when they go home. That time is basically spent in the suite,” Wylie says. “We try to help them with the whole discharge planning and try to make sure that they have a safe place to go and that everything is set up when they leave here.” Team members work closely with Klinic Community Health Centre, which sends a volunteer advocate for the patients. “They are there simply as a support to help walk them through the process, whether it’s to be there for the police interview or whatever the patient may need,” Wylie says. “They also provide them with a package regarding counsel- ling and followup resources for once they leave.” After patients leave the hospital, the SANE team also main- tains contact. “We do some followup with all of our patients who come through here,” Wylie says. “We try to give them a phone call to make sure that things are going OK and see if there’s any questions and concerns that they have.”
Candace Wylie (left) and Ashley Smith lead the Sexual Assault Nurse Examiner (SANE) team at Health Sciences Centre. Photo by Darcy Finley
sitting areas where the furniture and decor create a comforting, homey ambience. Police can take a videotaped statement in an
— Continued on page 9
There’s Nothing More Important Than Your Family’s Health.
Greg Selinger
Dave Chomiak MLA for Kildonan 204-334-5060 DaveChomiak.ca
Deanne Crothers MLA for St. James 204-415-0883 DeanneCrothers.ca
Greg Dewar
Dave Gaudreau MLA for St. Norbert 204-261-1794 DaveGaudreau.ca
Jennifer Howard MLA for Fort Rouge 204-946-0272 JenniferHoward.ca
Kerri Irvin-Ross MLA for Fort Richmond 204-475-9433 KerriIrvinRoss.ca
Bidhu Jha MLA for Radisson 204-222-0074 BidhuJha.ca
Ron Kostyshyn MLA for Swan River 204-734-4900 RonKostyshyn.ca
MLA for St. Boniface Premier of Manitoba
MLA for Selkirk 204-482-7066 1-855-695-1361 GregDewar.ca
204-237-9247 GregSelinger.ca
Nancy Allan MLA for St. Vital 204-237-8771 NancyAllan.ca
Gord Mackintosh MLA for St. Johns 204-582-1550 GordMackintosh.ca
Jim Maloway MLA for Elmwood 204-415-1122 JimMaloway. YourManitoba.ca
Flor Marcelino MLA for Logan 204-788-0800 FlorMarcelino.ca
Theresa Oswald MLA for Seine River 204-255-7840 TheresaOswald.ca
Clarence Pettersen MLA for Flin Flon 204-687-3367 ClarencePettersen.ca
Drew Caldwell MLA for Brandon East
Kevin Chief MLA for Point Douglas 204-421-9126 KevinChief.ca
Eric Robinson MLA for Kewatinook 204-943-2274 Eric-Robinson.ca
204-727-8734 DrewCaldwell.ca
Peter Bjornson MLA for Gimli 204-642-4977 1-866-253-0255 PeterBjornson.ca
Mohinder Saran MLA for The Maples 204-632-7933 MohinderSaran.ca
Erin Selby MLA for Southdale 204-253-3918 ErinSelby.ca
James Allum MLA for Fort Garry-Riverview 204-475-2270 JamesAllum.ca
Stan Struthers MLA for Dauphin 204-622-7630 StanStruthers.ca
Andrew Swan MLA for Minto 204-783-9860 AndrewSwan.ca
Matt Wiebe MLA for Concordia 204-654-1857 MattWiebe.ca
Melanie Wight MLA for Burrows 204-421-9414 MelanieWight.ca
Sharon Blady MLA for Kirkfield Park
204-832-2318 SharonBlady.ca
Thank you, nurses!
Winnipeg Free Press - saturDAY, May 10, 2014 9
MAY 12-18, 2014 NURSING: A LEADING FORCE FOR CHANGE
Drugs & Dementia
From the start, the SANE program has caught the attention of the medical community across the country. The initiative began when two emergency room nurses noticed the long wait time for patients who needed sexual assault exams, which require un- divided attention and specialized care. The ER nurses began to research existing nurse examiner and forensic nursing programs in the U.S., and they decided to start something similar them- selves. Smith says it’s thanks to the hard work of the program’s founders that the SANE team was formed. “The program in Winnipeg was the first of its kind in Canada, and now there’s one or more programs in every province. They saw the need for it, and we continue to see that because our patients now don’t have to wait in emergency for however many hours it may take,” Smith says. ‘We usually get to the hospital within an hour. That’s our goal, unless the patient has other injuries that need to be assessed or treated. All of our nurs- es have specialized training so we provide the med- ical care, but we also do a forensic examination as well.” Smith says it’s important to educate patients about their options. “Our biggest goal is to give patients the best in- formation we can so that they can make the best choice for their care. One thing we offer them is to have a medical examination in which we do a head- to-toe and look for injuries. We also test and offer prophylactics for sexually transmitted infection and pregnancy,” she says. “Then the second option we give them is if they would like to involve the police. We can assist them with contacting the police, and we will also do a forensic exam in which we collect evidence or swabs and specimens to give to the police.” The team works closely with police when it comes to sex crimes and child abuse, and they have month- ly meetings with an interagency sexual assault re- sponse team to discuss what’s working and what’s not. On average, the sexual assault nurse examiners see about 350 patients per year. However, that probably represents only a small portion of people who have been sexually assaulted, since many cases are not reported. Smith stresses that the service is available to anyone of any age and background. “We see all genders. We want to let people know that even men can come see us. We see any age from a few months up to patients in their 80s and 90s,” she says. “An important message we want to get out is that we are here. I think there are a lot of people who still don’t know that a program like this exists in Winnipeg and don’t know that there is this care that they can come and get.” CARE ON CALL 24/7 — Continued from page 8
Creative care and communication are better prescriptions
By Wendy King – For the Free Press
When it comes to managing distressing behaviours that dementia patients can present, good communication and creative problem-solving have proven to be a kinder, gentler prescription than antipsychotic drugs. Preetha Krishnan, the nurse practitioner responsible for the medical care of approxi- mately 150 residents at Lions Personal Care Centre and Misericordia Place, writes very few antipsychotic prescriptions. But she talks to a lot of people every day. Along with residents, families and facility staff, she is in regular communication with more than 300 people. Krishnan is working to eliminate the use of antipsychotic drugs as a form of chem- ical restraint for personal care home resi- dents. She knew little about dementia and anti- psychotic drug use when she started work- ing in long-term care in 2007. But her pas- sion is to integrate evidence-based care with clinical practice, so she studied every- thing she could. She soon discovered prob- lems. “What I was seeing in the clinical area was an inappropriate and excessive use of antipsychotics. I believe that medication use must be an effort to promote the high- est well-being and I didn’t see that in our residents at all,” she says. Too many people were wheelchair-bound and weren’t interacting with others. With the support of the director of care and the medical director, Krishnan began reviewing patient charts and asking questions. In many cases, she found that patients were being treated for behaviour that didn’t call for antipsychotics.
“The behaviour was layering more clothes, some inappropriate defecation and urina- tion. But it’s not bothering the person,” she says. “What I found was we were treating be- haviour that was disturbing, not disturbed.” She believed that by using an evidence- based model, most patients could —and should — come off these medications. The trick is to find the underlying meaning be- hind the behaviours, not just use drugs to make them disappear. One story that troubled her was a patient who had been prescribed antipsychotic medication because she was looking for her husband. “I felt so sad. It was the last thing she remembered from her life —why would we take that away from her?” she says. “Some days, I cried myself.” For Krishnan, the process quickly became more about humanitarian care, and not just about the scientific question of stopping the use of antipsychotics. She built a team with her staff and the families of the pa- tients. They were all understandably nerv- ous about what could happen. “I told them if they start the behaviours, I will give you the medications back. But right now, I can’t give you something that we don’t have an indication to prescribe.” She started with residents who were stable and gradually reduced the medica- tions while at the same time monitoring their responses and adapting to their differ- ent needs for care. She recalls one wheelchair-bound patient who was on large doses of two different medications. The patient’s decline, which included lack of interaction, lethargy and an
inability to eat, was attributed to the progress of dementia. But when the medi- cation was slowly reduced, the patient was soon able to walk, self-feed and even dance. The resident lived for another four years. These days, staff no longer ask for anti- psychotic medications. Instead, they look for other strategies, and Krishnan mostly prescribes analgesics for pain and laxatives for constipation. Once patients are comfort- able, they are settled. Her results have been so good that at Lions, she is down to one patient on medi- cation. The facilities Krishnan works in have the lowest antipsychotic use in the region, and even in the country. She is confident that with teamwork and education, it is possible to put an end to the unnecessary prescrib- ing and prolonged use of antipsychotics in people with dementia. The team’s success story has been pub- lished in journals, and Krishnan has pre- sented her work to many conferences, in- cluding the Ontario Long-Term Care Physicians’ conference in 2010. She says she has an important message for prescribers. “Medication use must be an effort to pro- mote the highest well-being. And don’t let the medication rob the quality of life of the long-term residents or the people with the dementia,” she says. “Quality at the heart of everything we do — especially quality of life — is a critical outcome measure for determining the value of pharmacological treatments for behav- ioural problems in people with dementia.”
Nurse practitioner Preetha Krishnan takes a more humanitarian approach to patient care.
CELEBRATING NURSING A LEADING FORCE FOR CHANGE The Faculty 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 support the profession by educating future nurses.
For more information, visit umanitoba.ca/nursing
10 Winnipeg Free Press - saturDAY, May 10, 2014
N URSING WEEK NATIONAL
The Nurse Practitioner Is In Raising awareness that NPs are primary care providers
By Holli Moncrieff – For the Free Press
Sylvie Beaudry runs a pediatric practice at St. Boniface Hospital. She diagnoses patients, orders tests and prescribes medication. If ne- cessary, she can refer her patients to special- ists, but Beaudry is not a physician. She’s a nurse practitioner. There’s still a lack of awareness that nurse practitioners are qualified to perform many of the same services as family doctors. Like gen- eral practitioners, NPs are also primary care providers. “Some specialists don’t understand that we function as primary care providers as well. Even our colleagues don’t always understand our role,” Beaudry says. “The main challenge of this job is having our role understood by our colleagues, other professionals and the public. We try to edu- cate the public and have put a lot of materi- als out there, but there’s still a lot of work to do.” She adds that QuickCare Clinics, which are staffed by NPs, have given the profes- sion more public exposure. The clinics were created to take some of the pressure off hospital emergency rooms and fill gaps in the health-care system. Patients with minor acute issues such as in- fected cuts, severe headaches, rashes, back pain and vomiting can expect to have a shorter wait time at QuickCare Clinics in Winnipeg, Sel- kirk and Steinbach than they would in an emer- gency room. And people who can’t get an ap- pointment with their family doctor, or who don’t have a family doctor, can visit a QuickCare Clin- ic for birth control, immunizations, prescription refills, sexually transmitted infections and min- or illnesses. NPs are helping to ease the burden on the health-care system, which is a great benefit to
the patients. “We definitely have a role in improving care and increasing access to primary health care. We’re able to get people seen and taken care of quicker, and we can provide temporary care when someone can’t find a family doctor,” Beaudry says. “We complement the system. We help to alleviate the burden to increase ac- cess to primary care.” NPs work in many roles, providing care in hospital clinics and ERs, community clinics, long-term care homes and other facilities. Edu- cators and researchers, they’re registered nurs- es who have had additional training and earned “Some specialists don’t understand that we function as primary care providers as well. Even our col- leagues don’t always understand our role,” Beaudry says. advanced degrees. Beaudry became an NP in 2006, after work- ing as a registered nurse for more than a dec- ade. “I always wanted to be in medicine, and this is the nearest thing that I could do. I like being able to be more independent, and I enjoy the broad scope of my practice,” she says. “The main difference between a registered nurse and a nurse practitioner is we have in- dependent practices. We’re able to diagnose illnesses and prescribe medication. We follow our own patient load, depending on what de- partment we work in. Obviously, if you’re in emergency you can’t do that.”
Beaudry works in the ambulatory clinic at St. Boniface Hospital weekdays from 8:30 a.m.- 4:30 p.m. “I spend most days seeing patients. The bulk of my practice is healthy kids, but I also deal with some acute-care (cases),” she says. “The best part of my job is the interaction with the kids and their families, and the ability to manage them independently.” Beaudry also works with teenage mothers and their babies. She runs clinics every mor- ning and two afternoons each week. She tries to reserve two afternoons each week for pro- fessional development and research. Due to turnover in her department, her research time has so far been dedicated to patient care, but she’s excited about tackling new projects. “There is a bunch of different research going on with nurse practitioners. Other nurse practitioners have done research into the cost effectiveness of care,” she says. “We’re trying to improve pain man- agement for kids. When they come in for immunizations, how do we help them deal with the fear and the pain?” Beaudry says it’s a wonderful career, particu- larly for those who enjoy independence and the ability to make their own decisions. “We have direction from nursing leadership, but we’re able to be independent practitioners and our practices are definitely not dictated by physicians. We’re responsible for our own deci- sions,” she says. “I’m able to consult appropriate specialists when needed and can order diagnostic tests. There are a lot of challenges, but it’s very ful- filling and I really enjoy it. I love my job.”
Sylvie Beaudry enjoys independence and a broad scope of practice as a nurse practitioner.
11
Winnipeg Free Press - saturDAY, May 10, 2014
MAY 12-18, 2014 NURSING: A LEADING FORCE FOR CHANGE
Blood Work Making progress in care and treatment of bleeding disorders
By Jennifer McFee – For the Free Press
You might say Dawn Zawadski’s love of nursing is in her blood. “It’s a great job. I’m never going to get bored be- cause there are so many things that I do every day,” she says. As the nurse coordinator for Manitoba Bleeding Disorders, Zawadski strives to improve the lives of patients whose blood doesn’t clot the way it should. “There are lots of different types of bleeding dis- orders, but they are all rare. For example, there are approximately 3,600 patients across Canada with hemophilia. That just gives you an appreciation of how rare it is,” she says. “There are also very few people that know a lot about them, so it’s very challenging. How do you teach the world about bleeding disorders when you never know when a patient’s going to appear on their doorstep?” A big part of her job is making sure there’s col- laboration among all the health-care providers and community agencies that come into contact with patients who have a bleeding disorder.
lets detect that there has been an injury, so they go to the site and try to block it off and cover up the hole. If there’s a lot of pressure coming down that vein, eventually that pressure builds up and it breaks free all those platelets. Then you start bleed- ing again,” she says. “The final step in the clotting process is some- thing almost like fish-netting called fibrin, and it cov- ers all of those platelets and protects them and keeps them in that spot.” A component called Factor VIII is needed for the fibrin to create a stable clot. But patients with hemophilia have a deficiency in this factor, so this final stage of clotting doesn’t occur. “Our patients will not necessarily bleed more, but they’ll bleed longer. They’ll form a little bit of a clot and then it will get pushed away. Then they’ll form another clot and it will get pushed away. So until they get that factor that they’re missing, they never really will seal up that hole,” Zawadski says. “In some cases, the patients will give themselves that factor at home. We want to teach our patients
ing episodes is reduced. As a result, they have healthier muscles and joints, since they haven’t been damaged by frequent bleeding. “The other great thing now, with all the recombin- ant products, is that people are living longer. So now people that have hemophilia, their life expect- ancy is almost the same as those that don’t have hemophilia, which is absolutely a great thing,” Za- wadski says. “In the past, people got HIV and hepatitis. Now these products are safe. But now that people are living longer, we don’t know a lot about what hap- pens when you age with hemophilia.” In her nursing role, Zawadski deals with new situ- ations as they arise. Recently, a patient with hemo- philia had coronary artery bypass surgery at St. Boniface Hospital. Zawadski helped to ensure that there was an adequate supply of the much-needed factor replacement product. It was administered through a continuous infusion process, which deliv- ered a steady supply to the patient’s vein through a mini-pump.
Zawadski wrote an abstract about the ex- perience, which she will present at the up- coming World Congress of Hemophilia in Australia. “It’s really an exciting time because now we’re starting to learn more and more about hemophilia and how to manage that.” Zawadski is pleased to see the progress that is being made to improve quality of life for patients.
“They need to know that that person has a bleeding disorder in case they get into trouble,” she says. Zawadski also spends a lot of time pro- viding education to her patients and their families, other health-care professionals and the community at large. “We recently did a rollout for all the triage nurses that were recertifying in triage across
“There are lots of different types of bleeding disorders, but they are all rare. For example, there are approximately 3,600 patients across Canada with hemophilia. That just gives you an appreciation of how rare it is,” she says.
Manitoba on bleeding disorders. Sometimes I talk to dentists. We go to schools and day cares to give presentations — anywhere that someone could bleed.” In her presentations, she breaks down the pro- cess of how blood clots. “If you cut yourself, your body makes the blood vessels get small to slow down the bleeding. That’s the first step. If that doesn’t work, then the plate-
how to live with the disease, so self-management and independence are a huge part of that. In other cases, patients might not know how to do that, so they’ll come to the clinic and we’ll give them a dose. It’s like an IV medication, so it’s given by intra- venous.” For patients who administer the treatment them- selves, the benefits are boundless. They have the freedom to travel, and the frequency of their bleed-
“An important thing for me, as a nurse, is not so much that I do things for my patient but that I give them the tools so that they can do it themselves,” she says. “I want my patient who has a bleeding disorder to lead as normal a life as possible, and that’s what’s happening.”
Dawn Zawadski says improvements in products and care help patients lead better and longer lives.
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