Hospital News 2015 May Edition

INSIDEEvidence Matters ................................. 6

Nursing Pulse .....................................11

From the CEO's desk ..........................16

Health Care Technology .....................18

Careers ...............................................19

PALLIATIVE CARE IN THE COMMUNITY

FASTER RECOVERY WITH LAPAROSCOPIC HYSTERECTOMIES

8 9

FOCUS IN THIS ISSUESURGICAL PROCEDURES/PAIN MANAGEMENT/PALLIATIVE CARE:Non-invasive surgery, plastic surgery, orthopedic surgery and new surgical techniques including organ donation and transplantation procedures. New approaches to pain management and palliative care delivery.

MAY 2015 | VOLUME 28 ISSUE 5 | www.hospitalnews.com

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Theassisteddying debateUnderstanding the Supreme Court rulingBy Sarah Quadri Magnotta

HOSPITAL NEWS MAY 2015 www.hospitalnews.com

2 Focus SURGICAL PROCEDURES/PAIN MANAGEMENT/PALLIATIVE CARE

magine the frustration of not being able to put your car key in the ignition. Or not being able to hold your dog’s leash to

go for a walk. Most of us take these abilities for granted. For people with severe nerve injuries, this is often their reality.

At Southlake Regional Health Centre, plastic surgeon Dr. Casey Knight and her team are seeing encouraging improve-ments with a promising new surgical tech-nique aimed at helping patients regain hand function better and faster.

It’s called a nerve transfer. It is a surgi-cal technique that helps patients who have severe nerve injuries. Dr. Knight, who completed special training in hand and pe-ripheral nerve surgery, joined Southlake in 2010. Frustrated by the poor options avail-able to certain patients with compressed nerves, she was eager to begin performing this innovative procedure, which was new to Southlake.

Here’s how it works. Using a micro-scope, Dr. Knight goes into a “sick” nerve and identifi es which part of the nerve controls motor (muscles) and which part controls sensation. She then cuts a nearby healthy, expendable motor nerve and deli-cately plugs it into the motor component of the sick nerve. The idea is that the healthy nerve will help the sick nerve.

Dr. Knight has been trialing this new technique here at Southlake on patients who have nerve compression at the elbow level – the affected nerve is called the ul-nar nerve. The ulnar nerve is very impor-tant for hand function because it controls the small muscles of the hand, and it also provides sensation to the small fi nger and part of the ring fi nger.

Essentially, when the nerve gets com-pressed at the elbow, the brain is talking to the nerve but the message is stopped at the elbow and never reaches the hand. The nerve is there, like a pathway, it’s just not conducting properly.

The bigger problem is that when the muscles stop hearing the nerve signal they start to atrophy, or waste away. That leads to hand weakness and dysfunction in addi-tion to numbness.

In the past, the procedure involved re-leasing (decompressing) the ulnar nerve at the elbow and positioning it so that it was less vulnerable to further compression. With this standard procedure the ulnar nerve regenerates at approximately one millimetre per day. By the time the nerve regenerates from the elbow to the hand there’s a risk that the muscles could be permanently damaged.

The exciting thing about a nerve trans-fer is that it creates a shortcut. The idea

is that you take a healthy expendable do-nor nerve, plug that healthy nerve into the sick nerve at the forearm level, creating a much shorter distance to send signals to the muscle.

This allows the muscle in the hand to hear the signal. The donor nerve is of-ten described as a babysitter. “While the sick nerve recovers, there’s a babysitting nerve nearby helping out – making sure that signal still gets to the muscle,” Dr. Knight says.

Dr. Knight says there is promising evi-dence that in many cases, hand muscles will begin to recover after this procedure. In her case series of eight patients to date, “they recover faster, with better muscle function than we have seen in the past. It is still early, and we are talking small num-bers, but it is an encouraging trend.”

For Dr. Knight it’s all about working together. “This is multidisciplinary care in action: the neurologist identifi es the problem, I perform the operation, and the hand therapists guide the post operative rehabilitation. It is truly a team approach,” says Knight.

She feels very fortunate Southlake’s Hand Clinic has actively-engaged hand therapists. This allows patients to be seen by surgeons and hand therapists at the same time. Dr. Knight and Kathy Wilton, an Occupational Therapist and certifi ed Hand Therapist, work together at the Clinic. They have also worked together on all of the nerve transfer patients at Southlake streamlining both surgical and post operative care.

Thomas Sagar is one of Dr. Knight’s patients who chose to try the new proce-dure after being diagnosed with severe ul-nar nerve compression leading to muscle

atrophy in his hand. He says he had no idea that his condition was so serious un-til he saw his family doctor who sent him to Dr. Knight days later. He was grateful to Dr. Knight for helping him so quickly, “I think the world of Dr. Knight. It was a serious operation – it took a while to get over it. Kathy was wonderful doing the physio[therapy]. I was fearful after the dressing came off, and she really helped me get through it.”

Sagar’s wife Jane agrees. The two have been married for almost 44 years. They go to all their appointments together. She is pleased and grateful for the excellent care her husband received at Southlake, “Dr. Knight gave my husband a choice (be-tween the two operations) and now his hand is as good as new. After the surgery, Dr. Knight came to me and answered all my questions. She is wonderful.”

Dr. Knight is quick to credit the hand therapists like Wilton with helping to get patients better faster.

“Without the dedicated work of our hand therapy department, we simply wouldn’t see the kind of positive outcomes that we do, not just in nerve injuries but in many other hand-related injuries and conditions. Our hand therapists are doing a fantastic job.”

Dr. Knight and her team are work-ing together to track patient results, tak-ing quantitative measurements of hand strength to show improvements. Patients also undergo nerve conduction studies be-fore the surgery, and then one year later, to further quantify the effect of surgery.

“Subjectively, patients are telling us that their hands are beginning to work again, allowing them to perform their daily ac-tivities independently. Objectively, we are seeing their strength and sensation mea-surements improving. We are excited to hear patients tell us that they are able to do activities that they couldn’t do before,” says Dr. Knight.

Wilton says the beauty of this operation is that it will help muscles recover. She sees patients start to be able to do the little things they couldn’t do before, in a very short time. “Hearing about how happy one

patient was to be able to hold his dog’s leash and take the dog for a walk again is very rewarding. If this surgery were not available, people would still have pain and wouldn’t be able to use their hand. Now patients talk about how grateful they are. In a matter of weeks I start to see muscles coming back, hand function returns, even the appearance of the hand is so much better.”

Dr. Knight is also grateful, “we are able to perform this surgery in Newmarket be-cause I have support to do it – from my col-leagues, the OR and the hospital, the pa-tients, and the hand therapists. I’m proud of the fact that we are offering this proce-dure at Southlake. Community hospitals are bringing services to patients that have traditionally been available only at larger academic centres.”

This technique was championed by Dr. Susan Mackinnon. Canadian-born and ed-ucated, Mackinnon is a professor of plastic and reconstructive surgery at Washing-ton University in St. Louis, Missouri. Her life’s work and research has been around peripheral nerve surgery, and she has pio-neered a number of techniques. Dr. Knight says Mackinnon’s results are impressive. In fact, they suggest that this may become the new standard of care for certain patients who have injuries that fi t the criteria.

Dr. Knight has been at Southlake for the last four and a half years. She became passionate about peripheral nerve surgery during her residency training at McMaster University and credits great mentors with peaking her interest in the fi eld.

She describes her current surgical prac-tice as varied, and she loves being able to work with patients with a variety of ill-nesses and concerns. Her focus is on re-constructive plastic surgery. In addition to nerve surgery she performs hand surgery, breast surgery, and skin cancer surgery.

“I try to maintain variety in my practice so that I can serve my community well. Pa-tients like to be cared for near their home, and I believe we should strive to provide them with this option whenever possible.”

She describes the patients at Southlake as remarkable. “There is a critical trust relationship with patients, especially with new procedures,” says Knight. When she offered patients the option to try this new procedure, they all accepted it. “It’s hum-bling, and it will contribute to our knowl-edge in ways that helps others. This is key to evolving, innovating, and improving our care.” ■H

Kathryn Perrier is a Media and Government Relations Specialist at Southlake Regional Health Centre.

Trialing a nerve transfer procedure with

By Kathryn Perrier

I

Community hospitals are bringing services to patients that have traditionally been available only at larger academic centres

Kathryn Perrier

promising results

MAY 2015 HOSPITAL NEWSwww.hospitalnews.com

3 In Brief

Ontario hospitals are facing increasingly difficult decisions in 2015/16 and 2016/17 as they continue to absorb financial and service pressures after three years without a base funding increase, the Ontario Hos-pital Association (OHA)said in response to the provincial Budget.

Ontario’s hospitals routinely operate at 90 per cent capacity or higher and already have the fewest beds per thousand among all of Canada’s provinces. The efficiency dividend created from these efforts al-lows, in part, needed investments in other equally important parts of the health care system. Within this environment and, working with partners across the health system, wait times are down and more people are getting faster access to the care they need in critical areas, including can-cer surgery, cardiac procedures, cataract surgery, and hip and knee replacements.

“Hospitals will continue to innovate and transform and make every effort to ensure that the people of Ontario have access to high quality hospital-based care, ” said An-thony Dale, OHA President and CEO. “At the same time, as pressures increase, key system indicators such as emergency room wait times, ALC levels and others metrics need to be monitored carefully as they are potential warning signs for broader systemic challenges.

For several years, the OHA, working on behalf of the province’s 149 public hospitals, has advocated for the creation of a compre-hensive health system capacity plan. Ontar-io’s hospitals work closely with system part-ners, including the home and community care sector as well as the long-term care sec-tor, and a concrete, long term plan is needed to effectively address the changing needs of patients and clients in the province.

The health care system is at a pivot-al juncture. As the province continues to work towards its goal of eliminating the provincial deficit, hospitals will continue to work closely with the Government of Ontario, LHINs and their partners in order to assess risk and main-tain access to services. ■H

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Canadian Medical Association demands a plan for seniors

A group of health care organizations have begun work to study the effective-ness of both naturopathic and conven-tional medicine in treating Type 2 diabe-tes. Through a $418, 000 grant, researchers will have the opportunity to gain valuable insight into alternative treatment options, which will be shared to help diabetes pa-tients around the world.

The Brampton-based study will be a collaborative project among the Cana-

dian College of Naturopathic Medicine (CCNM), William Osler Health System (Osler), and the Wise Elephant Family Team (WE-FHT) – a local primary health care organization. Diabetes is more preva-lent in Brampton than in any other area in the province. Its incidence is 2.5 times higher than the provincial average of 9.64 diabetes cases for every 100 adults.

Patients who already receive care at WE-FHT will be offered the opportunity

to participate in the clinical trial, which Osler’s research team, in partnership with CCNM, will oversee.

Those participants who are ran-domly selected for the active treatment group will receive naturopathic care at CCNM’s Brampton Naturopathic Teaching Clinic (BNTC), which is located at Osler’s Brampton Civic Hospital, in addition to their ongoing treatment. ■H

Examining the effectiveness of naturopathic care on

Health Canada is working with the Ca-nadian manufacturers of prescription oral ibuprofen products to update the safety in-formation regarding the risk of serious car-diovascular side effects (e.g., heart attack and stroke) when these products are used at high doses (at 2400 mg/day). This risk increases with dose and duration of use.

Ibuprofen is a non-steroidal anti-in-fl ammatory drug (NSAID) used for pain and fever relief, and to reduce infl amma-tion. The majority of ibuprofen products in Canada are available over-the-counter. These products have a maximum recom-mended dose of 1200 mg per day and are to be used for a short duration of time

(seven days or less). No evidence of an in-creased cardiovascular risk has been found with over-the-counter ibuprofen when used as directed.

Serious heart- and stroke-related events are a known risk with all NSAIDs and the prescribing information contains extensive warnings on this risk. The new informa-tion is in light of a Health Canada safety review that found that oral ibuprofen tak-en at high doses (at or above 2400 mg per day) increases the risk of heart attack and stroke. The increased risk with high doses of ibuprofen is similar to the risk seen with some other NSAIDs, including COX-2 inhibitors (e.g. celecoxib) and diclofenac.

Health Canada recently communicated new prescribing recommendations regard-ing the cardiovascular safety of diclofenac.

Health Canada’s review concluded that the benefits of prescription oral ibu-profen products continue to outweigh the risks as an effective pain and inflam-mation treatment, but that additional measures are needed for these products to further reduce the cardiovascular risk. Prescription oral ibuprofen prod-ucts have a maximum recommended daily dose of 2400 mg, and are autho-rized to relieve the pain and inflamma-tion of rheumatoid arthritis and osteo-arthritis. ■H

Safety information for ibuprofen

Type 2 Diabetes Dr. Gregory Taylor, Canada’s Chief Pub-lic Health Officer, recently returned to Canada after spending a week in West Afri-ca. The visit was an opportunity to observe the evolving situation and needs on the ground as global efforts continue to reach zero Ebola cases.

The Canadian visit focused on treat-ment and prevention efforts in Sierra Le-one and Guinea, where Dr. Taylor was able to see first-hand the work being done and hear from those on the front-lines about their experiences in providing essential care and prevention support. Some high-lights included: • Red Cross and Médecins Sans Frontières Ebola treatment centres, where patient tri-age and screening processes, as well as vigi-lant sanitation procedures are in place to prevent transmission of the virus; • A Public Health Agency of Canada mo-bile laboratory in Magburaka, Sierra Leone, that provides rapid, on-site Ebola diagnos-tic support allowing for faster diagnosis and isolation of Ebola cases and patient care, and meeting with two recently deployed Agency staff onsite in Guinea to set up a new mobile lab; • The Kerry Town Treatment Unit in Si-erra Leone, where Canadian Armed Forces doctors, nurses, medics and support staff are working alongside their UK counter-parts to treat health care workers who have been exposed to the Ebola virus;

To date, Canada has committed more than $110 million to support health, hu-manitarian and security interventions to respond to the outbreak and for further re-search and development of Ebola medical countermeasures.

Canada’s comprehensive approach in-cludes financial, technical and in-kind con-tributions. These efforts seek to: help stop the outbreak, treat the infected, meet the increasing humanitarian needs arising from the crisis, and reduce associated threats to health and security. ■H

Canada is making a difference in the Ebola fi ght

Canada’s seniors are not getting the healthcare they deserve – not even close. Our system was created over half a century ago to meet the needs of a much younger population and we have not adapted to meet the growing number of aging Canadians.

The Canadian Medical Association and an alliance of partner organizations have decided to do something about it. Demand a Plan is a public campaign to encourage development of a national strategy on seniors care. So far thou-sands of Canadians have added their

voice to the call for a National Seniors Strategy. Tweets • 8 in 10 Canadians are concerned about having access to high quality home care and long-term care in their future. #se-niorsplan • There are 3.1 million informal caregiv-ers in Canada. They provide over 1.5 bil-lion hours of home and community care each year. #seniorsplan • More than 60 per cent of caregivers experience a high level of stress from be-ing a caregiver. #seniorsplan ■H

Ontario hospitals facing diffi cult decisions


4

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federal election could be called any time in the next few months, judging by the media coverage and the

ramping up of political activity. Many is-sues have been crowding into the media headlines in anticipation of the election – but with a notable absence of any con-sideration of healthcare by our political parties.

Apparently the subject is still on the minds of the electorate though, at least amongst my own circle of friends, col-leagues and neighbours, many of whom note the leading edge of our baby-boom-ers have now turned 65.

A good starting point could be an overlooked recommendation in the Romanow Report (#5) tabled in 2002, which suggested that our Canada Health Act needs to be both modernized and strengthened in order to reify the princi-ples of public administration, universal-ity and accessibility. The recommenda-tion also suggests we need to update the comprehensiveness of our health system and create a new principle of account-ability.

The recommendation is breath-taking in its scope – all the more since it is still relevant in 2015. Sadly, little, if any, progress has been made in the interven-ing 12 plus years since Romanow – and certainly not in the area of accountabil-ity, a sticking point for many Canadians.

Some of the key issues in healthcare that need renewed public focus include making the health care transfer payment details to the provinces and territories more clear; clear goals and objectives for provinces and territories to “buy change” in delivery models that measure health outcomes of interventions and ensure that these interventions refl ect best practices.

Clearly, the enforcement of the Can-ada Health Act by the federal Minister of Health is not occurring nor is it clear with whom the responsibility lies, so this needs to be revisited. It is also not clear

what the impact of trade agreements may be on the future of medicare – so it is imperative to have this discussion.

Finally, the creation of a national pharmacare program – the feasibility and implementation – has been largely neglected by the current federal govern-ment, but not by the general public.

Providing answers to these questions is the task of those who seek to repre-sent us in Parliament; seeking answers to these and other questions is the respon-sibility of concerned citizens.

From my direct experience as a physi-cian and as a patient, medicare generally delivers on its promise of providing care for all in a timely and effective fashion. Unfortunately wait times for total joint replacements are now increasing in some jurisdictions. While the principles of uni-versality, comprehensiveness, accessibil-ity, portability and public administration continue to resonate with Canadians, we must maintain a constant vigilance of medicare’s performance.

Where do we go from here?

While many progressive options are possible, one choice that has the poten-tial for high impact with the prospect of an enormous return on savings merits our attention: the adoption of best prac-tices across provinces and territories.

In 2010, the Organization of Eco-nomic and Cooperative Development (OECD) estimates that on average,

member states could save two per cent of their GDP by 2017 with the adop-tion of best practices in their health care systems, and that Canada could save 2.3 per cent. Given that Canada’s GDP is approximately $1.825 billion, this suggests the possibility of a savings of over $40 billion ($41.975) annually.

What does it mean to adopt best practices?

Simply put, an evaluation of success stories in healthcare delivery across Can-ada reveals “nuggets” in almost every jurisdiction. An example is the Alberta Bone and Joint Healthcare Institute that has revolutionized musculoskeletal care including hip and knee replacement, re-ducing wait times, shortening hospital stays and increasing satisfaction of pa-tients all in a cost-effective manner.

Another example is the practice of Patient Centred Care in the primary healthcare setting based on care, com-munication and common ground and treatment based on the best available evidence that patient and provider agree upon. This approach has been shown to reduce unnecessary tests, decrease the number of physician visits needed and provide higher satisfaction and better outcomes in the management of chronic conditions such as hypertension.

For a health care system to continue to serve Canadians into the future, con-tinued vigilance and progressive change with cost constraint must be attractive to policy and decision makers. Now it’s time we heard what our political parties plan to do for medicare. ■H

Robert Y. McMurtry is an expert advisor with EvidenceNetwork.ca, an active orthopedist and formerly Dean of Medicine at Western University and Assistant Deputy Minister of Health Canada. He was a special medical advisor to the Royal Commission of the Future of Health Care in Canada (Romanow Commission).

ABy Robert McMurtry

on the federal election agenda

Many issues have been crowding into the media headlines in anticipation of the election – but with a notable absence of any consideration of healthcare by our political parties.

Putting healthcare


5 SURGICAL PROCEDURES/PAIN MANAGEMENT/PALLIATIVE CARE Focus

y reimagining care for the 21st century, St. Joseph’s Health-care Hamilton is committed to renewing the promise of

providing healthcare for all. By integrating cutting-edge research with compassionate care, our researchers and clinicians work together to provide the best treatments and care to all members of our community.

Unfortunately, certain diseases make it diffi cult for health professionals to deliver care in optimal ways.

Those diagnosed with dementia have trouble thinking clearly and putting their thoughts together. They tend to have trouble remembering past events clearly and may fi nd themselves disoriented and confused.

The experience of dementia can often be painful not only for those living with dementia, but also for their family and friends. Because dementia disrupts the cognitive abilities of these individuals, it can make it diffi cult for clinicians and caregivers to deliver care that meets the needs of these patients.

Mental health researchers at St. Joseph’s Healthcare Hamilton are working towards the best ways to deliver care to geriatric pa-tients with dementia. Dr. Carrie McAiney and her research team are currently work-ing to improve palliative care and treat-ment at St. Joseph’s Healthcare Hamilton for this group of patients.

“Providing palliative care to patients living with dementia, especially those at more advanced stages, can be especially challenging because it’s diffi cult for staff to understand patients’ needs,” states Dr. Carrie McAiney, Director of Evaluation and Research, Seniors Mental Health at St. Joseph’s Healthcare Hamilton, and As-sociate Professor at McMaster University.

Dr. Carrie McAiney and McMaster Bachelor of Health Sciences student Co-lin Ngan recently conducted a qualitative study that strives to explore the internal experiences of nurses that deliver pallia-tive care to patients with dementia.

“The way that palliative and end-of-life care is delivered by clinicians is shaped by the perceptions that they have towards life and death,” explains Dr. McAiney. “Understanding how nurses think and feel about delivering palliative care to geriatric

patients with dementia will help us know how best to support staff, thereby provid-ing better care to our patients.”

The researchers found that major chal-lenges in delivering palliative and end-of-life care to patients with dementia were based around communicating with them and their families. This presented a sig-nifi cant challenge in recognizing pain and having conversations about death and dying.

Researchers also addressed the emotion-al struggles of staff in their study – noting how nurses also often undergo a grieving process when they provide end-of-life care.

“Staff form strong connections with the patients they care for, and with their fami-lies”, explains Dr. McAiney. “Because of this, staff need support when patients die and this relationship ends.”

The study involved interviews conduct-ed with nurses working in the Harbour North unit of our West 5th campus.

Since the new facility at the West 5th Campus opened its doors to patients in 2014, the Margaret and Charles Juravin-ski Centre for Integrated Health trans-forms the way in which we deliver care for patients diagnosed with mental health and addictions.

However, the new Centre also trans-forms the way in which mental health-related research will take place within St. Joe’s. Our researchers and clinicians work

side-by-side – increasing both collabora-tion and research translation.

As the study was conducted from within St. Joseph’s Healthcare Hamilton, Dr. McAiney and Colin Ngan were able to share the results of the study with our nursing teams. They were able to pass on what they found to be the greatest chal-lenges, and work with our clinicians to discover ways that these challenges could be overcome.

As a result of this research, one of the improvements being considered is the implementation of Comfort Care Rounds, a process of debriefi ng with staff about patients who are currently receiving pal-liative care and those who have recently passed away. Having a structured debrief process enables staff to identify the posi-tive aspects of the care they provided and how to make care even better in the future.

Working directly with clinicians allows our researchers to make direct improve-ments to the quality of life that our pa-tients experience.

By reinventing the ways in which pallia-tive care is delivered to geriatric patients, our researchers help to renew the promise of providing optimal care to all members of our community. ■H

Sebastian Dobosz is Research Communications Coordinator at St. Joseph’s Healthcare Hamilton.

patients with dementiaBy Sebastian Dobosz

B

The researchers found that major challenges in delivering palliative and end-of-life care to patients with dementia were based around communicating with them and their families.

Dr. Carrie McAiney (left) and nurses from the Seniors Mental Health Behavioural Unit at the West 5th Campus, St. Joseph’s Healthcare Hamilton.

Reinventing palliative care for

heryl Forchuk gets angry when she hears that people who are homeless and struggling with mental illness have been

treated like “garbage.” As a renowned nursing researcher, she often hears the comment when she asks these individu-als to tell her about their lives. Society “...would really like to pretend these groups don’t exist, or blame the victim,” she says. “There’s a general discomfort in really ac-knowledging what’s actually happening.”

Forchuk is the assistant director at Lawson Health Research Institute in Lon-don, Ontario, and a distinguished profes-sor at Western University. She works with mental illness survivors, health provid-ers and community agencies to fi nd out exactly what they need – and how to get it to them. Her research examining therapeutic relationships, transitional dis-charge, mental health, homelessness, and social inclusion has won many accolades, including two Registered Nurses’ Associa-

tion of Ontario (RNAO) awards: the Life-time Achievement Award in 2012 and a Leadership in Nursing Research Award in 2014. Forchuk has been active in RNAO for three decades, helping to create the Establishing Therapeutic Relation-ships Best Practice Guideline (BPG) and holding many executive positions in the Brant-Haldimand-Norfolk chapter. “One of the fundamentals of my research is not just to look at what is, but what could be,” she says.

Building something better is what led Forchuk to nursing in the fi rst place. As a high school student in Brantford, she vol-unteered at the local hospital. As a nursing student at the University of Windsor, she enjoyed community health. Her psychol-ogy courses also fascinated her because so much is unknown about the mind.

In 1976, Forchuk graduated with her baccalaureate as well as a BA in psychology.

RN researcher helps marginalized populationsBy Jill Scarrow

C

Continued on page 11

Cheryl Forchuk knows there’s lots of work to do to end stigma associated with mental illness

Nursing Pulse


6 Evidence Matters

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he fast pace of surgical in-novation means new surgical technologies are constantly coming onto the market.

Many of these innovations are less-in-vasive alternatives to traditional surgery, which aim to result in fewer complica-tions and shorter recovery times. Will any of these new surgical techniques change the future of surgery? It’s hard to predict the future. But, CADTH can give us a peek into what the future could look like.

CADTH is continually scanning the horizon for emerging drugs, medical de-vices, and procedures likely to have a signifi cant impact on patient care and the health care system. CADTH horizon scanning involves systematically summa-rizing the available information on tech-nologies that are not yet licensed for use in Canada, not yet widely available, or not in routine clinical use. The resulting horizon scanning reports – called Issues in Emerging Health Technologies – are peer-reviewed, concise bulletins that describe the emerging technology, patient indica-tions, and regulatory status; summarize any available information on its adverse effects, costs, anticipated diffusion rates, and implementation issues; and discuss the available evidence and its reliability and quality.

One recent horizon scanning bulletin – Tympanostomy Tube Insertion System for Children With Otitis Media – reviewed the TULA System, which is a new tech-nology for placing tubes in the ear drums of children with recurrent ear infections.

While tympanostomy tube insertion in young children is usually performed under general anesthesia by surgeons in an op-erating room (OR), the TULA system al-lows it to be performed outside of the OR in an outpatient setting. This is more con-venient for children and their caregivers, and requires fewer health care resources. Also, because TULA uses local anesthe-sia, it avoids the potential risk of adverse drug reactions and complications associ-ated with general anesthesia. The studies of the TULA system identifi ed in the bul-letin suggest that it is effective and toler-able in terms of both the delivery of local anesthetic and the placement of tympa-nostomy tubes in children as young as 12

months, with few complications. At the time the CADTH bulletin was published, TULA had not yet been approved by Health Canada; and the review also noted that, because none of the studies followed patients beyond two weeks after the pro-cedure, the longer-term safety and effi cacy of this technology is not yet known. Still, this is a technology to watch – to see if it turns out to be a safer and more conve-nient option to traditional tympanostomy tube insertion for thousands of Canadian children.

Another CADTH horizon scanning bulletin – Femtosecond Laser-Assisted Cataract Surgery – looks at a novel use for the femtosecond laser. For more than

a decade, this technology has been used for vision correction (i.e, correcting near-sightedness or farsightedness), but it has recently been introduced as a new and less-invasive approach to cataract surgery. Femtosecond laser-assisted cataract sur-gery – or “FLACS” for short – is thought to result in more precise incisions and require less ultrasound energy to break up the lens prior to removal, potentially resulting in improved safety and clinical outcomes. However, it is unclear from the limited studies identifi ed in the CADTH review if FLACS results in improved clini-cal outcomes compared with conventional surgery. And FLACS is substantially more expensive. But, with conventional cata-ract surgery being the most commonly performed surgery in the world, keeping an eye on any potential advances in the fi eld is important.

CADTH – an independent, not-for-profi t agency that assesses health technol-ogies fi nds and summarizes the research on drugs, medical devices, and proce-dures. By regularly scanning the technol-ogy horizon to identify noteworthy emerg-ing trends and themes, CADTH provides a glimpse into the future of health tech-nology in Canada. To browse CADTH’s horizon scanning reports on a variety of medical technologies that are not yet available or widely used in Canada, visit www.cadth.ca/horizon-scanning. ■H

Barbara Greenwood Dufour is a Knowledge Mobilization Offi cer at CADTH.

Surgical techniques on the horizonBy Barbara Greenwood Dufour

T CADTH is continually scanning the horizon for emerging drugs, medical devices, and procedures likely to have a signifi cant impact on patient care and the health care system.



onversations about end-of-life care for a loved one are never easy to have, regardless of how long they are expected to live.

For William Osler Health System’s (Osler) palliative care team, these conversations hold the key to ensuring that the needs and wishes of each patient are understood. This is especially important because Osler serves one of the most diverse regions in Ontario, with close to 50 per cent of the population comprised of visible minorities and new immigrants.

Providing equitable care to such a di-verse population means health care practi-tioners have to be knowledgeable of cross-cultural models and approaches, as well as the beliefs, values, and practices of the di-verse populations being served. The needs of Osler’s rich religious, cultural, ethnic and socio-economically diverse popula-tion can vary dramatically from patient to patient and how the palliative care team addresses them can make all the difference to a patient and their family during their fi nal days.

“By understanding and respecting di-versity, we have allowed for individualized interpretations of the quality of life, death and dying, and we are able to integrate this into our patients’ care plans,” says Gur-winder Gill, Director of Diversity and Vol-unteer Services. “When a patient’s values and beliefs are not aligned with the care they receive, families can feel alienated, upset or misunderstood. This can nega-tively impact the patient’s palliative care experience as well as their family’s grieving process.”

Gill works with various units and de-partments across Osler, including the pal-liative care team, to ensure health care ser-vices are provided in an environment that respects, values and embraces diversity. For palliative care staff and physicians, this also means understanding that cultural competency skills are vital for ensuring our patients and their families have a sense of dignity during their loved-one’s end-of-life journey.

Each palliative care patient undergoes a psychosocial and cross cultural assessment, which provides the palliative care team with an understanding of the patient’s be-liefs, practices and values. Then a unique care plan is developed, with careful con-sideration being given to areas of potential confl ict or challenges.

Sometimes the challenges the team faces are more complex and require ad-ditional sensitivity. “In some cultures, families do not want their loved ones to know how long they are expected to live, however denying them this information goes against a physician’s obligations to disclose it,” says Gill. “In cases like this, we have to fi nd a middle ground to ensure both the family’s wishes and the physi-cian’s obligations are met. For example, this can be done by applying cross-cultur-al techniques and asking the patient what they would like disclosed and/or how they make decisions in their family unit.”

Osler’s palliative care program applies an inter-disciplinary approach to its prac-tice, providing patients with access to support from physicians, social workers, advanced practice nurses, and dieticians, to name a few, and a range of hospital and community resources.

Osler works closely with various com-munity health partners who assist in pro-viding the additional support some pa-tients may need. For some, this may mean accessing Community Health Centres which are pillars of support for low-income patients who require help navigating so-cial assistance while in care; or connecting with community organizations that pro-vide religious and culturally-appropriate support services.

“It is great to be able to chat with pa-tients and their families to identify what their unique palliative care journey looks like and incorporate those wishes into the patient’s care plan,” says Dr. Naheed Dos-ani, Palliative Care Site Lead and Physi-cian at Osler’s Brampton Civic Hospital. “For example, in some cultures, it is cus-tomary for patients to remain at home un-der the care of their loved ones for as long

as possible, and we are happy to help fami-lies develop the skills needed to provide certain types of care themselves to their loved ones so that we can honour their request.”

It is not uncommon for some patients to struggle with understanding palliative care because of their cultural or religious background. Often times it is diffi cult for them, to comprehend that their disease

is incurable and palliative care is needed. In cases like this, the team works to help educate patients and their families about end- of-life care and focuses on enhancing their quality of life.

“Palliative care isn’t just about dying, it’s about living well,” says Dr. Dosani. “Each patient has their own unique outlook based on their background and lifestyle and being able to identify this and work with the patient and their family can have a positive impact on their quality of life.”

Osler is a key member of the Central West Palliative Care Network (the Net-work), itself a partnership of Health Ser-vice Providers committed to providing leadership for a high quality, comprehen-sive, integrated and well-coordinated hos-pice palliative and end-of-life care system in the Central West Local Health Integra-tion Network (LHIN). Osler’s palliative care program is evolving to meet the high demand for specialized services required of a rapidly growing and aging popula-tion. In collaboration with the Network, the Central West Community Care Access Centre, Central West LHIN, Headwaters Health Care Centre and Osler have served as founding participants for a joint pallia-tive and end-of-life care “Pledge” which, when complete, will strive to improve the patient experience for those living with life-limiting illness in the Central West Region. A great need for coordinated, in-dividualized and respectful palliative and end-of-life care has been identifi ed and, through enhanced service delivery, work has already begun to close the gap. ■H

Donna Harris is a Strategic Communications Partner, William Osler Health System.

Providing equitable palliative care to diverse communitiesBy Donna Harris

C

It is not uncommon for some patients to struggle with understanding palliative care because of their cultural or religious background.

Dr. Naheed Dosani is part of William Osler Health System’s palliative care team, which provides individualized end-of-life care to a growing and diverse population.

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ost Canadians indicate that, if given the choice, they would choose to die at home with loved ones, yet almost 70 per

cent of deaths occur in hospital. As well, there is an ongoing need for acute care beds in hospitals – in-home palliative care would save these beds for those who need it most while giving end-of-life patients a choice in where to spend their fi nal days.

We know that addressing how people age is of great importance, but we also need to shine a light on delivering end-of-life care that is both effective and sup-portive for our patients, their families, and their circle of care.

In the past, here in Toronto, palliative care in the community was delivered by nu-merous health care professionals for each patient, and many felt a burden in having to repeat their stories to each health care

provider that they would encounter. From physicians to nurses, homecare workers and more, it wouldn’t be uncommon for a palliative patient and their family to inter-act with multiple care providers.

Though well intentioned, this model does not provide clarity or comfort for pa-tients and their loved ones during such a diffi cult time. Dealing with the end-of-life of a loved one is stressful enough, but hav-ing to interact with what may feel like a revolving door of care providers while not having any freedom of choice only com-pounds the situation. Patients and their families need to feel secure and confi -dent that their care team will deliver the best possible care that meets their unique needs, while focusing on what means most to them during this important time.

For many years, the Toronto Central Community Care Access Centre (CCAC) worked in tandem with health care team partners including the Temmy Letner Cen-tre for Palliative Care (Mount Sinai Hospi-tal) and Toronto Hospice to deliver patient care. Together as partners delivering pallia-tive care, we recognized the need for a new care model to ensure patients experienced one care team. We wanted to know how patients and their families felt about their care team, and how we could improve their experience. We asked for their feed-back, and listened very carefully. Working

closely with our partners, we knew that of-fering a “one team” experience for patients and their caregivers was paramount in raising their confi dence in their care team, feeling more secure in the services we pro-vided, and ultimately gave them the power of choice. With their comfort and well-being as the focus, the method of how they would be cared for was closely examined.

The integrated care team, comprised of hospice workers, CCAC Care Coordina-tors, Nurses, and Physicians, made some big changes to care delivery in the community. We instituted innovations that included a palliative huddle, written client records in home, streamlined communication tools (providing caregivers with one phone number to access the services they need,

rather than multiple numbers for multiple needs), and joint patient assessments. We are currently creating an electronic medi-cal record, accessible by the client’s cir-cle of care, as a standard for all patients. Changing partner communications and restructuring teams resulted in this “one team” approach. Though a patient could receive care from many members of the care team from numerous organizations, they now recognize them by name and as part of a single care team – unaware of the organization they work for. They are often delighted to know that when another care team member enters their home, they are already equipped with knowledge of the patient and their care history. In keeping with the mandate to provide outstanding care, the new CCAC palliative model has allowed family members and those in the end stages of life to have choices.

This new palliative model has allowed families and those at the end-of-life to have a choice not only about their quality of life, but how and where they would like to spend their fi nal days – within a medical environment or surrounded by loved ones at home.

Here’s an excerpt from a recent email we received from a palliative patient’s caregiver: “No words could ever express the deep gratitude I feel to these wonderful people and the caring meaningful way they helped me survive this very diffi cult time, and made it possible for our loved one to be at home until the end. They were more than caregivers, they became family, and that made all the difference. Thank God for this team, they will forever be in my prayers.”

And that’s what matters most. ■H

Dipti Purbhoo is the Senior Director of Client Services at the Toronto Central Community Care Access Centre and a leader of Toronto Central CCAC’s Integrated Palliative Care Program, which received the 2014 Minister’s Medal for Excellence in Health Quality and Safety.

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Most Canadians indicate that, if given the choice, they would choose to die at home with loved ones, yet almost 70 per cent of deaths occur in hospital.

A palliative patient at home.

palliative care in the community



elissa LeMarquand is thrilled to have her life back so soon after a laparoscopic hysterec-tomy at Rouge Valley Health

System (RVHS). She walked out of the Rouge Valley

Centenary hospital campus the day after her procedure feeling “pretty good” and was “back to normal” in about a month, which is less than half the recovery time of the more traditional hysterectomy. “I feel great now. I have energy and I’m back at the gym. I have my life back, ” says LeMar-quand.

Compared to a traditional hysterectomy, with large incisions through the abdominal wall, the laparoscopic hysterectomy offers: • Less pain; • No disfi guring scars; • Much less risk of wound infection; and •A 50 per cent faster recovery time of three to four weeks, compared to six to eight weeks for the more traditional surgery.

It’s a procedure RVHS’ physicians have much expertise in performing. In 2013, be-tween the two hospital campuses of Rouge Valley Centenary (RVC) in Scarborough, and Rouge Valley Ajax and Pickering (RVAP) in Ajax, Rouge Valley Health Sys-tem’s physicians performed the most hys-terectomies using a laparoscope than any hospital in the Central East Local Health Integration Network area.

Having the surgery, and the quicker recovery option, was a welcome relief for LeMarquand. Before the surgery, she had developed anemia due to very heavy bleeding during her periods. Iron supple-ments didn’t help her. Tired all of the time, she stopped exercising and put on weight. The bleeding was controlling her life.

Her family doctor referred her to Dr. Terry Logaridis, program chief of obstetrics and gynecology at RVC. An ultrasound re-vealed that she had six fairly large fi broids in her uterus.

“With the fi broids, my uterus was the same size as if I were three or four months pregnant, ” says LeMarquand.

Dr. Logaridis suggested a hysterectomy, but a minimally invasive option. By using a fi ber-optic instrument, or a laparoscope, a physician sees inside the abdomen and pel-vis without a large surgical incision. “Using a laparoscope, we make four small abdom-inal incisions, and the uterus is removed through the vagina. The patient can go home the same day or the next day, ” ex-plains Dr. Logaridis.

Several OB/GYNs at each RVHS cam-pus now offer the minimally invasive pro-cedure. Says Dr. Logaridis: “Rouge Valley pioneered this technique in west Durham and in Scarborough, through Dr. Suha

Eltayeb and Dr. Jean-Placide Rubabaza at RVAP and by Dr. Dayna Freedman and Dr. Caroline Huh at RVC. Our hos-pitals have invested in the equipment we need and in training our OB/GYNs in this procedure.”

Dr. Adebayo Odueke, program chief of

obstetrics and gynecology at RVAP, who also performs laparoscopic hysterectomy, credits RVHS for investing in the mini-mally invasive procedure. “We advocated for the advancement of the laparoscopic hysterectomy procedure since 2007 at our Ajax site. The majority of the obstetricians

and gynecologists at RVAP are now offer-ing this specialized procedure through the leadership of Dr. Eltayeb and Dr. Rubabaza, ” says Dr. Odueke.

Patricia Strickland came to Dr. Eltayeb, who is based at RVAP, when an ultrasound found that fi broids on her uterus had re-turned. Like LeMarquand, Strickland also had issues with her periods, including heavy bleeding and clotting. She had per-sistent knee and back pain and Dr. Eltayeb suggested that the fi broids were so large that they were contributing to that pain. Dr. Eltayeb performed a laparoscopic hys-terectomy and Strickland was thrilled with the results. “Dr. Eltayeb came and talked to me right after the surgery. Her bedside manner is amazing. I felt some twinges, but I didn’t even need to use the pain killer she prescribed, ” says Strickland.

She had no bleeding post-surgery, mini-mal scarring, and was able to walk regu-larly to aid in her healing.

Dr. Eltayeb, who has offered this surgery since 2007, cautions that there are some cases where this type of hysterectomy would not work, such as if a woman has a large uterus or a pelvic mass; if she has had multiple abdominal surgeries; or if she has a cancer history. Still, Dr. Eltayeb wants women to know about this technique of-fered by her and her colleagues at Rouge Valley. “While not every patient would be a candidate for this method, I would like women to know that this is an option. Ask your doctor if this is a good choice for you, ” she says.

Strickland certainly believes it was the best choice for her. “This has been nothing but a positive experience for me.” ■H

Jane Kitchen is the Communications Specialist at Rouge Valley Health System.

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Women return to active lives soon after laparoscopic hysterectomies

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Obstetrician-gynecologist Dr. Suha Eltayeb pauses from her rounds to display the scope used in the minimally-invasive laparoscopic hysterectomies that she and her colleagues perform at both Rouge Valley hospital campuses.”

In 2013, between the two hospital campuses of Rouge Valley Health System their physicians performed the most hysterectomies using a laparoscope than any hospital in the Central East Local Health Integration Network area.

Less invasive procedure means faster recoveries at Rouge Valley Health SystemBy Jane Kitchen



ew patient resources and clini-cal practice tools around end-of-life planning and care are helping empower heart failure

patients in BC. The fi rst of their kind in Canada in terms

of scope, the resources cover a broad spec-trum including six symptom management guidelines with topics on fatigue, pain, and nausea; appropriate prescribing; psychoso-cial considerations; practice resources for heart failure clinical professionals; and an implantable cardiac defi brillator (ICD) de-activation guideline. This ensures patients with ICDs have timely access to ICD deac-tivation and are comfortable during their fi nal weeks and days.

Developed as part of the BC Heart Fail-ure Strategy, the goals of the materials are to improve dialogue between heart failure patients and their care providers, facilitate a dignifi ed approach to heart failure end-of-life planning and engage heart failure patients as partners, while incorporating their unique values and beliefs.

“These tools help give patients the op-tion to begin to talk about their values with respect to end-of-life planning,” says Dr. Sean Virani, Provincial Heart Failure Physician Lead at Cardiac Services BC.

“They also provide health care provid-ers with the confi dence and guidance to be able to walk their patients and fami-lies through the process of end-of-life planning, including helping us recognize which patients should be offered this ser-vice, and how to begin to facilitate those discussions.”

For patients, the tools provide them with the opportunity to have their voices heard and ensure clear communication so

their wishes and questions are addressed.Sonny Kisch, one of the patient vol-

unteers who helped develop the material, knows this all too well. He has had a lot of experience in the health care system both as a cardiac patient and as a family mem-ber – his father, his paternal grandmother, and his maternal grandfather have dealt with cardiac problems.

“It’s extremely important for a patient and their family to feel like they’ve been heard and that their concerns have been addressed. Both the patients and their families need to understand and collabo-rate with the medical team about their treatment.” he says. “These resources em-power patients, giving them a measure of control and involvement in their care and provide them with the knowledge to make informed decisions about their care.”

In 2013, a provincial working group comprised of patients, family members and care providers from across all health authorities in BC was created. The group collaborated to create a heart failure end-of-life consensus framework, practice tools and resources that heart failure patients and health care providers can use to co-ordinate end-of-life care. The patient and practice resources were created based on current literature and recommendations from BC experts.

“Every single resource was developed in collaboration with the patient work-

ing group,” says Bonnie Catlin, Provincial Clinical Nurse Specialist, Cardiac Services BC – BC Heart Failure Strategy. “Their input was critical in helping us determine what needed to be included and what would be meaningful for patients and their families as well as their care providers, while helping to convey the information in a sensitive and clear way.”

Sonny added some elements speak more to health care professionals than patients but the documents can be used to help pa-tients better understand procedures that occur during their treatment.

“From a patient’s perspective, the fi nal result of this project is an extremely well-thought out, well planned and well put together set of resources that are succinct but not at the expense of information,” he says. “The shift to patient and family-cen-tred care is empowering patients and their families or caregivers to provide more ef-fective care after hospitalization.”

With a prevalence of more than 100,000 heart failure patients in BC alone, the need is great.

“The burden of heart disease is quite sig-nifi cant and many of these patients have one or more other diseases or conditions they’re also dealing with,” says Sean. “The tools are helping to provincially address the underserved heart failure patients with end-of-life planning and care.”

The tools have been positively received across the province since being completed in December 2014 and each health au-thority in BC is currently coordinating their regional roll out of the resources.

“The documents are innovative and really haven’t been thought about before. In fact, I’m not aware of any other provin-cially coordinated end-of-life ICD deacti-vation strategy that exists in Canada,” says Sean. “Because of their comprehensive scope, we’ve had great interest from other care providers in other hospitals, provinces as well as cardiac-related organizations across the country who want to use these resources. We post all of our care processes online so they are accessible to anyone who may want to use them.”

The Provincial Heart Failure Strategy is lead and funded by Cardiac Services BC (CSBC) a provincial agency responsible for planning, coordinating and funding adult cardiac care in BC.

CSBC was integral in the establishment of BC Heart Failure Strategy, bringing to-gether a team of dedicated interprofes-sional heart failure experts committed to providing best practice, quality heart fail-ure care, across BC. Their ultimate goal is to improve the health outcomes of British Columbians living with heart failure.

For more information on the BC Heart Failure Strategy and to access the resources, visit bcheartfailure.ca or contact Bonnie Catlin at [email protected] ■H

Alyshia Higgins is a Communications Offi cer, Provincial Health Services Authority.

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By Alyshia Higgins

N

For patients, the tools provide them with the opportunity to have their voices heard and ensure clear communication so their wishes and questions are addressed.

(L to R) Sonny Kisch, Bonnie Catlin and Dr. Sean Virani.

end-of-life care

commitment | dedication | excellence | compassionS P E C I A L P U L L O U T S E C T I O N

INSIDE MEET OUR NURSING HERO CONTEST WINNERSSee our special supplement on page N1

Nursing Heroes


N2 National Nursing Week 2015 — S A L U T E T O O U R H E R O E S

w e s t p a r k . o r g

Help turn I can't into I CAN!West Park Healthcare Centre helps turn I can't into I CAN! We provide specialized rehabilitation, complex continuing care and long-term care services. Our outstanding in-patient and out-patient rehabilitation services are designed to help people overcome serious health challenges following onset of major illness or injury such as stroke, lung disease, traumatic injury and amputation. Because imagination is in our DNA, West Park sees possibilities and hope that others might not see. From day one, we imagine a patient’s road to recovery and how we will help them achieve their highest potential. We are leaders in many areas of rehabilitative care because we never accept the status quo. Join us, and together, we can help patients on their road to recovery.

We are looking for clinical and non-clinical professionals to compliment our high-functioning teams.

We provide specialized services in:

• ABI Behavioural Services• Amputee Rehabilitation• Musculoskeletal Rehabilitation• Chronic Assisted Ventilatory Care• Home Ventilator Training• Neurological Rehabilitation• Prosthetics & Orthotics• Respiratory Rehabilitation & Day Hospital• Regional MS Services• Respiratory Continuing Care Services• Ambulatory and Outpatient Services

We have a two-way approach to patient care and the rehabilitative process. We work in partnership with our patients, set goals and work together to achieve these goals.

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To West Park’s Nurses For Living Our Values!

THANK YOU

INSIDE MEET OUR NURSING HERO CONTEST WINNERSSee our special supplement on page N1

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Thank you to our nurses for being amazing.At North York General Hospital, our teams are making a world of difference. Caring, skilled and dedicated, our nurses play an outstanding role in achieving a new standard of excellence in integrated patient- and family-centred care. On behalf of the people we serve across our diverse communities, we appreciate and recognize everything you do each day to offer the best and safest patient care.

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STAND OUTOUR NURSES


N3 S A L U T E T O O U R H E R O E S — National Nursing Week 2015

his year’s Nursing Hero Contest was a tremendous success. With over 100 nominations, one thing is certain – nurses can and do make a differ-ence in the lives of many.

The amount of nominations and the appreciation in the letters sent by those who want to honour their nursing hero never ceases to amaze us. It is very diffi cult to select winners, because truthfully, every single person who has been nominated is a hero. Every single nominee deserves to be acknowledged. And we know for every nominee there are 100 other nursing heroes making a difference.

Larisa Barbour works in the inpatient oncology unit at Sunnybrook Health Sci-ences Centre. An ‘angel of the night,’ Larisa provides more than physical care to her patients. Her clinical skills are certainly top notch. But what makes her a nursing hero is that her remarkable clinical skills are matched by her passion and ability to empathize with patients and families. These ‘soft skills’ as they are often referred to, are increasingly rare in a system that necessitates effi ciency and cost effectiveness.

Nursing is a demanding profession. Nurses are expected to wear many differ-ent hats – doctor, teacher, social worker, support worker, and cheerleader etc. It’s endless really – the demands put on nurses.

That’s why, when a nurse like Larisa who, day in and day out, provides an exemplary level of care to every single patient, she deserves to be recognized. We are honoured to name her this year’s Nursing Hero Contest winner. In addi-tion to her nursing skills, she inspires

those around her to be better nurses – a true nursing hero!Throughout these pages you will read about nurses who have made a tremendous

impact – like our 2nd place winner – Massey Nematollahi who empowers patients with knowledge. Massey’s dedication to her patients and her profession has impact-ed countless lives. She has developed tools and training programs to help patients with cancer through their diffi cult journey, often giving her personal time to ensure patient’s needs are met.

Chris Burden, our third place winner risked his own life to save a stranger who had been struck by lightning while golfi ng. Once hearing people had been hurt, Chris left the safety of the clubhouse to help, saving a man’s life in the process. His actions that day on the golf course and every day in the intensive care unit at Markham Stouffville hospital make him a nursing hero.

Contained in the following pages are snippets of letters from patient’s and col-leagues who have been so impacted by the actions of a nurse they were compelled to write us. That speaks volumes.

If you are a nurse that has been nominated and you would like to read your nomi-nation, please email me at [email protected] I am happy to send it to you

It is our hope that these stories inspire you to continue to go above and beyond for your patients and remind you that you are making a difference. If you are a patient, we hope you are inspired to speak up and thank a nurse who has made a difference in your care.

To every nurse we say thank you.Happy Nursing Week! ■H

Kristie Jones, EditorHospital News

Nursesmaking a difference

T

Nursing is a demanding profession. Nurses are expected to wear many different hats – doctor, teacher, social worker, support worker, and cheerleader etc.

2015 Nursing Hero Awards

1st

prize

Larisa Barbour, RNSunnybrook Health Sciences Centre

$1000 Cash Prize

Congratulations to the winners of our

Massey Nematollahi, RNSouthlake Regional Health Centre

$500 Cash Prize

2nd

prize

Chris Burden, RNMarkham Stouffville Hospital

$300 Cash Prize

3rd

prize



Because you cared…

The journey to recovery is a little easier.

Thank you to the many nurses who have made Ontario Shores Centre for Mental Health Sciences their choice for work.

Every day, we hear stories of how the care and support shown to patients in a mental

their recovery. To us, our nurses are everyday heroes using their expertise and knowledge to create an environment that is

Demonstrating this is not just a job but a passion, our nurses work

collaboratively with patients, their families

and other members of the interprofessional team to build on the care model through a patient-centred approach.

This shared journey promotes inclusion and empowerment and means the team approach is fully embraced as the individual

At Ontario Shores, we will continue to look for opportunities to celebrate our nurses for

building capacity and supporting others within the profession.

We are with our nurses every step ofthe way and are excited to celebrate National Nursing Week!

their recovery. To us, our nurses are everyday heroes using their expertise andknowledge to create an environment that is

lled with compassion, recovery and hope.

Demonstrating this is not just a job but a passion, our nurses work

collaboratively with patients, their families

At Ontario Shores, we will continue to look for opportunities to celebrate our nurses for t g patient care, building capacity and supporting others within the profession.

We are with our nurses every step ofthe way and are excited to celebrate National Nursing Week!

Thank You...

to the nurses of Ontario Shores

Centre for Mental Health Sciences.

RECOGNIZING A CARING, INNOVATIVE NURSING TEAM

Each year, a staggering 500,000

NIAGARAHEALTHSystème De Santé De Niagara

Niagara Health System



arisa Barbour is the defi ni-tion of a Nursing Hero. She consistently provides the highest level of compassion-

ate, person focused care and inspires others to be better oncology nurses and health care providers. Throughout this nomination letter, you will hear fi rst-hand the impact Larisa has had on the lives of those she provides care for and fellow colleagues at Sunnybrook Health Sciences Centre on the surgical oncol-ogy unit (D6). Larisa has been a nurse for over 25 years and an inpatient on-cology nurse since 1991. This is where I had the gift of fi rst meeting Larisa. As a new graduate nurse, I was privileged to shadow Larisa over a series of night shifts. My fi rst impression of Larisa was of her intense passion for patient care and her role as an oncology nurse. She always spends time making sure her pa-tients were comfortable before bed and taking care of little details like washing the patient’s face, helping them brush their teeth, and rubbing lotion on their backs. Larisa also spends time being pres-ent with patients’ unable to sleep to put them at ease and help them to fall asleep.

Larisa also plays an essential role in being present in the most diffi cult situ-ations and taking action to collaborate

with colleagues and ensure she does ev-erything in her power to promote excel-lent care across the continuum. With a smile on her face, you will fi nd Larisa supporting her fellow colleagues dur-ing a very busy shift, and assisting the oncoming teams with the tran-sition into a day shift. On one night, a code blue had occurred over the night shift. Larisa had played a key role in helping with the code, and supported the family when they were extremely anx-ious. Larisa was able to provide comfort during this highly tenuous time and was able to convince fam-ily to go home and rest once the patient was stable enough to be transferred to an ICU bed. Larisa assisted in the patient’s transfer so that the oncoming day shift nurse wouldn’t be trying to catch up for the rest of the day shift ensuring the pa-tient’s safety and continuity of person centered care as she was able to address the major concerns that lead up to the incident.

Larisa has a gift that encourages people to open their minds to the views

of others. She takes the time to get to know the patients and families she is caring for through the development of the therapeutic relationship. It is within this relationship that magic happens. She learns what is most important to pa-tients and families, brings that forward

to the team and challenges others to think differently by shar-

ing the perspectives of the unique individuals whom she cares for.

Every night Larisa com-pletes patient rounds, of-fering to freshen them up, rub lotion on their backs

and feet. In today’s fast paced inpatient unit, this is

a rare human touch that Larisa continues to provide. I have heard

time and time again, patients calling her their “angel”, and families of patients expressing their thanks and sincerity to Larisa for all that she does. A comment from a fellow colleague that speaks to Larisa’s special human touches; “I was coming to a day shift and I thought Larisa had left from her night shift and was amazed that at 0900, she was walk-ing a patient because she promised him she would walk him.

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Here are some of the things colleaguesare saying about Larisa: Larisa is more than just an excellent nurseI have never seen a nurse so committed to their vocation that whether she completed her shift or not, she would go above and beyond what is expected. For example, she asks all her patients if they want to freshen up, get their backs washed or at least wash their face and brush their teeth on top of offering and helping other colleagues with dressings etc. I would defi nitely want her as my nurse if I ever get sick because I know she will take very good care of me. She is defi nitely an excellent patient advocate, a great role model to new and experienced nurses, and someone who is caring and patient to those she takes care of. When patients get discharged from the unit, they always make sure a ‘thank you’ is passed on to Larisa and they always say how “unforgetful” the care she provided was.- Fatima San Pedro, RN

***Larisa demonstrates an excellent example of providing compassionate care, support and enriches the lives of the patients battling cancer. On many occasions she has stayed at work past her shift to sit silently beside the dying patient, play their favourite music or read to them. – Suman Iqbal, RN, former colleague

***While all of my oncology co-workers are inspiring, Larisa has that extra-special something: unwavering patience and boundless empathy. She’s the nurse we all strive to be and also hope to have if we ever found a loved one or ourselves in the hospital. – Melissa Keigher, RN

***I have had the wonderful pleasure to know Larisa as nurse colleague at the bedside, and now in my role as the Director of Interprofessional Practice. Larisa truly lives her values and brings her authenticity and compassion to the relationships where she impacts the lives of those she cares for, in the most meaningful way. Larisa is recognized as a leader in her clinical setting and her circle of infl uence extends far beyond the bedside. To know Larisa is to to feel her care, her personhood and know that thousands of lives have been changed by her human touch. Tracey DasGupta, RN, Director of Interprofessional Practice

***As the patient care manager for over 10 years on the unit that Larisa works, I am in a unique position to receive feedback from patients, families and her colleagues about the care she provides. I continue to be impressed about Larisa’s gentle unhurried approach to patients in giving care. She brings a sense of calmness appreciated by patients/families and staff. In seeing patients on Rounds when they speak of their positive experience during the night shift it is easy to know exactly who cared for them. Patients describe her as making them feel as being the most important person in her care. There is nothing too much for Larisa to do for patients and families. A back rub seems simple however for the patients this is highly valued and Larisa has consistently fi t this into her patients’ care. It is not unusual on Rounds for patients to mention that they had a back rub by Larisa. She carefully listens to patients to understand their care needs and advocates on their behalf to ensure their needs are met. I am pleased to support Larisa’s nomination for this prestigious Nursing Hero Award and have seen no one that I have encountered more deserving of this award. I would like to ask your committee to seriously consider Larisa for this award. Mary Glavassevich, RN, Patient Care Manager

***The 2015 Nursing Hero Award would be a fi tting tribute to one of our colleagues, Larisa Barbour. Larisa has been working in the oncology fi eld for most of her nursing career. She initially started on the medical and radiation oncology unit. When she felt the time was right to grow and develop as a professional, she took up the challenge of working on the surgical oncology unit. Larisa has been on the surgical oncology unit for the past 16 years.

Continued on page N6

Photo credit: Doug Nicholson, Sunnybrook

Larisa Barbour RN



Whenever I hear compliments from patients, her name is always mentioned. I would personally want her to be my nurse if I ever get admitted to a hospital. She gives patients a comfortable environment within the unfamiliar hospital environment.”

It’s the little things that Larisa does to make a nurse, team member, or a pa-tient feel special. Larisa remembers every nurse’s and staff’s birthday and buys cards and gifts from her own pocket, making sure the rest of the unit signs the card before surprising the birthday nurse. She also does the same when a patient has a birthday on the unit. Shirley Armstrong, a PSP working on the unit, adds “Larisa is the person that comes to mind when you say humanitarian. She is the most caring nurse you will fi nd and her only concern is the well-being of her patients. She is a joy to work with.”

For the above reasons, Larisa is a great mentor for novice nurses, and sets the example of how nurses should strive to care for our patients and their families. A new graduate nurse currently working on the unit says “Larisa is the nurse I strive to become. I admire her compassion and patience, and her mere presence itself is therapeutic. She positively connects with her patients, their loved ones, and her colleagues almost instantly. I cannot think of anyone else more deserving of this prestigious award.”

When I asked her colleagues if they would like to be part of this nomination, there was an outpouring of support and sense of unity that Larisa is very deserv-ing of the Nursing Hero Award. Her fel-

low colleague, Lori Haywood, RN, had this to write: “I have known Larisa Barbour for over 20 years. I can truthfully say, I have never met a more remarkable nurse/person. Nursing in the oncology program is both a physically and emotionally chal-lenging profession. In all the years I have known her, Larisa has never said unkind words or shown any frustration with any patient or family member that she has en-countered.

Nothing is too much for her. As she works exclusively night shift,

she is given the opportunity to comfort patients when they feel most alone and vulnerable. If they need kind words, a shoulder to cry on, a back rub or a show-er, Larisa provides it all with a smile. With my present specialty being a palliative care nurse, I have often met patients who have had the wonderful experience of be-ing under her care. So many of them refer to, “Larisa as an angel of the night”.

Families have expressed their apprecia-tion and all of them said they could go home feeling confi dent that their family members were in kind capable hands if Larisa was their loved one’s nurse.

I don’t know if I can cite a specifi c ex-ample of her kindness off the top of my head but suffi ce it to say that every per-son she has ever cared for has received a special gift. I believe Larisa should win this award, hands down, because of her expertise, compassion and consistency in providing 110 per cent every time she comes to work.”

Even a patient, Cat Ridout, who is currently in Australia wanted to express the care she received from Larisa: “Larisa

took care of me when I was in the hospi-tal for a bad case of salmonella poisoning. Her presence was like a warm hug during a time in which I was extremely nervous and feeling very unwell. She was beyond kind and very lovely. The time she took to care for me, meant the world to me.”

Another patient who is currently an inpatient states “Larisa was with me every step of the way. Being in hospital is one of the scariest experiences being vulnerable and not knowing what to expect. Larisa quieted my fears, her gentle and caring demeanour helped create a healing en-vironment I will forever be grateful for.” And yet another current inpatient con-fi rms the compassionate care Larisa pro-vided to them: “I immediately felt com-fortable with Larisa, her friendly smile and nonjudgmental approach. She was so patient with me, even though I was expe-riencing many problems that one night. I defi nitely support her nomination to this award, she is truly deserving. She is the defi nition of a nurse.”

Larisa not only has exemplary human touch for her patients, but also her col-leagues, both registered nurses and allied health. I hope through this nomination letter the awards committee was able to not only read the heartfelt messages in support of Larisa for the Nursing Hero Award, but also feel the overwhelming compassion and passion that Larisa em-bodies as an oncology nurse and a role model for new graduate nurses.

Thank you for considering Larisa Bar-bour for the 2015 Nursing Hero Award. ■H

Sincerely, Philiz Goh RN

When Larisa was a student in high school she volunteered to be a candy striper at one of the local nursing homes. Caring for others and engaging them in their care has been an integral part of Larisa’s professional growth.

Larisa has been a caring individual her whole professional life. She cares for the patients and their families. Taking the time to explain to them what is happening and what the next steps may be. Larisa predominately works the night shift for the reason that she can spend time with the patient and help them to be comfortable and to listen to them.

Many times Larisa would bring cream from home to use on the patients for a back rub. Spending the extra few minutes to ensure the patient is as comfortable as possible. If the patient has questions or wants to take a bit longer to go to the bathroom, Larisa is there supporting them to be independent and hearing their concerns about going home or being independent again.

Larisa has been a supporter of her colleagues as well. Taking the junior staff under her wing and helping them to adjust to the uniqueness of working nights and the challenges as well as rewards that this particular shift may bring. Larisa has had the consolidation nursing students with her as well from time to time. Helping the nursing students grow and develop has also been a particular skill that Larisa is able to demonstrate.

Larisa continues to seek out opportunities for her own professional growth and development through on going education. She encourages the novice staff on the unit to pursue excellence in oncology through their own growth and development. Anita Long, Advanced Practice Nurse

Continued from page N5Larisa Barbour RN

THANKYOU

Follow St. Joe’s online: /MyStJoes @MyStJoes /StJoesHealthCentre

stjoe.on.ca

TO OUR EXCEPTIONAL NURSESFOR ADVANCING THE HEALTHOF OUR COMMUNITY.By providing compassionate care, sharing their expertise with students and colleagues and taking on important leadership roles, our nurses live St. Joes’ mission and vision every day in our pursuit to become Canada’s best community teaching health centre.



hen I think of a nursing hero I think of someone who express-es their caring and commit-ment to their patients, their

health care organization, to the communi-ty and the larger world. It is an individual who has an urge to make a difference in someone’s life, their suffering, their heal-ing and ultimately their quality of life. It is with great admiration that I nominate Massey Nematollahi for the Annual Nurs-ing Hero Award 2015.

Massey is currently the clinical educa-tor at the Stronach Regional Cancer Cen-tre, Southlake Regional Health Centre in Newmarket, Ontario. Massey is an inspir-ing representative of the nursing profes-sion. She is highly skilled, a compassionate caregiver, a critical thinker, a collaborator who consistently evidences the highest ethical standards in her profession. Her achievements epitomize nursing at its best for patients and their caregivers. Her work and her vision impact the lives of patients and their families and give them hope as they face life threatening illnesses. Massey is not only active in nursing oncology here in Canada, but is a recognized inter-national presenter.

Massey has a passion for patient education encouraging and sup-porting her patients to be actively involved in their health and educa-tion. She provides an 8 week course for patients who are experiencing the symptoms of ‘brain fog’. This evidence based course teaches both patients and their families the techniques and strategies to manage brain fog in an informative, fun and interactive way. Patients and their families rave about this very successful program in helping them cope with daily activities. Countless numbers of cancer patients throughout her nursing career comment on her dedication in addressing their quality of life as well noting how she gives freely and endlessly of her time even personal time to ensure their needs are met. Patients write about her concern for not only their treatments but the quality of their life and how they progress through treatment. Others say they knew there was something special

about her because she helped them face their disease with courage and love. Many more comment on her ability to make you believe because of her compassion, integ-rity and unrelenting dedication to both her patients and her profession. She works tirelessly in all aspects of caring for her pa-tients.

Not only does she organize and provide chemotherapy teaching on a weekly basis, but she has created tools to increase pa-tient knowledge, for example a Pathfi nder tool. She has developed and implemented a patient education curriculum addressing after care, survivorship and management of low symptom scores. She supervises a team of volunteers and manages and con-tinues to develop the Patient Family Can-cer Library in the Regional Cancer Cen-tre. Massey recently initiated a travelling library cart to take information to patients in the chemotherapy suite who may not feel well enough to visit the library. This was presented as an Abstract at the joint meeting International Cancer Education Conference in Seattle WA, September 2013, co-organized by the American As-

sociation for Cancer Education, Can-cer Patient Education Network

and the European Association for Cancer Education. She is

an At-Large Member of the Board of Directors for the Canadian Patient Educa-tion Network.

As a clinical educator, Massey is Project Direc-

tor of the Nurse Led Small Molecule Chemotherapy Pa-

tient Education Program for the International Society of Nurses in

Cancer Care and is responsible for ensur-ing the program follows the ISNCC guide-lines. This program is focused on providing international nurses with resource materi-als and educating them in effective ways to use evidence based patient education materials that enhance both adherence and self-care capacity. As well, she has the responsibility as Chair of the Advisory Group and managing the activities associ-ated with the program.

Massey not only provides leadership in patient education at the Stronach Region-al Cancer Centre but has many leadership roles in building, fostering and maintain-

ing quality patient activities at Southlake and in the community. She sits on many committees for patient education. She has created a series of cancer education for patients, family and the community in York Region, Ontario. Her achievements are many, not only having published sev-eral articles in leading scientifi c and nurs-ing journals but she is a nationally and internationally recognized speaker and presenter at conferences in Canada and worldwide. She has received many awards

for her passion and enthusiasm to meet the unique needs of the cancer patient. And with all this she manages to continue to educate herself most recently completing the Certifi cation of Educators in Health Care Professions at Harvard University. Her urge to serve, her selfl essness how else do you describe an angel... a Nursing Hero.

Please consider this amazing and inspir-ing individual for your Annual Nursing Hero Award. ■H

Thank you, Kathy Dedrick

Clinical Educator, Southlake Regional Health Centre

Massey Nematollahi RN W

THEST. JOE’S

DIFFERENCE:

COMMUNITYOur nurses go above and beyond in delivering

exceptional experiences to our patients, their families and our community. They are an integral part of our team working to achieve our vision of advancing the

health of our community by being Canada’s best community teaching health centre.

If you want to be part of our interprofessional teamand make a difference in Toronto’s west end community,

take a look at our current career opportunities atstjoe.on.ca/careers.

Follow St. Joe’s online: /MyStJoes @MyStJoes /StJoesHealthCentre

stjoe.on.ca

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INFECTION PREVENTION AND CONTROL is integral to safe, effective and ethical nursing practice. In each province, the college of nurses has practice standards that describe the expectations for all nurses in infection prevention and control. These standards are based on the Public Health Agency of Canada’s guidelines entitled Routine Practices and Additional Precautions for Preventing the Transmission of Infections in Healthcare Setting. The recommendations in these guidelines are evidence-based, practical and effective in preventing healthcare-associated infections.

So why aren’t these practices routinely followed? There is ample evidence that most infections acquired by patients during their hospital stay are transmitted by the hands of healthcare providers. Nurses provide the most hands-on care to patients. It’s what we do. In recent years most hospitals in Canada have instituted auditing of healthcare providers to see if they are compliant with hand hygiene. Nurses usually score better than others on these audits – but compliance rates vary from 60 – 90%. Put yourself in the patient’s place. If that nurse was providing care for you or one of your family members would you feel that was acceptable practice? It’s time for nurses to take ownership of this issue. Not cleaning your hands before and after contact with a patient or between patients is unsafe practice. If we truly are going to provide safe, patient-centered care, then ensuring hand hygiene happens needs to become part of our nursing culture. If you see a colleague miss an opportunity to clean his/her hands – call them on it! If someone reminds you to clean your hands, thank them and do it. Remember – it’s not about egos – it’s about good practice.

Why does it take a scary bug like Ebola to get our attention? Each year thousands of patients in our hospitals acquire infections as a result of exposure to pathogens during their stay – and many die as a result. Yet, these infections and deaths don’t make headlines. They are often seen as a cost of doing business. Preventing these infections doesn’t require extraordinary measures. It requires routine practices.

I challenge all nurses to become infection prevention and control champions. Don’t wash your hands just because you think someone might be watching. Don’t put on gloves and a gown just because the sign on the patient’s door says so. Be a leader and keep yourself, your patients and your colleagues safe!

We wish all our Nursing colleagues the safest Nursing Week 2015.

Bruce Gamage RN BScN CIC, President, IPAC Canada

OUR NURSESKnowledge professionals providing inspired care

We believe that our nurses are a true expression of our mission and values

who place compassion, respect, social responsibility and excellence at the

forefront of patient care.

We recognize our nurses’ professional knowledge, experience and tireless

efforts in fulfilling our legacy of quality care and discovery.

We value the contribution our nurses make – working around the clock,

changing lives everyday.

We celebrate our nurses’ many accomplishments and their dedication to

nursing excellence in patient care, education and research.

Today, and every day, we thank our nurses for their unwavering commitment to our culture of caring and innovation.



urses perform extraordinary acts of kindness, compassion and heroism every day in the hospi-tal. Many times, those acts ex-

tend far beyond the halls of the organization.Chris Burden is a nurse. Whether he is

on duty in the Markham Stouffville Hos-pital Intensive Care Unit or is just going about his daily life outside of the hospital, he is always a nurse.

In June of 2014, Chris and his brother, a Halton police offi cer, were playing a round of golf under increasingly cloudy skies. When the sirens went off due to bad weather, Chris and his brother immediate-ly went inside in the club house. Moments later, a panicked golfer ran inside and yelled that some golfers were still on the course and had been struck by lightning.

Without thinking of their own safety, Chris and his brother ran through the pouring rain, thunder and lightning and found the golfers who had been struck. There were golf clubs strewn on the grass and a few men stumbling around. But there was one man who wasn’t moving. Chris immediately assessed the man and determined he needed CPR. The smell of burning fl esh and the site of clothes burned

to his body didn’t deter Chris who imme-diately started CPR. Eventually a pick-up truck was brought out to the course and the critically injured man was loaded on to the back and, accompanied by Chris, was driven through the storm back to the safety of the club house and an awaiting ambulance.

Chris worried and wondered about the man whose life he had saved for many weeks until one day he received a call from the family say-ing that the man was alive and still recovering from his very serious injuries. The daughter of the man told Chris that ‘...because of his actions, her father would be around to walk her down the aisle at her wedding.’ She thanked Chris and his brother for their selfl ess and courageous acts and said that ‘…they brought back to us what is most dear, the leader of our family, an important member of our com-munity and a friend to many.’

Chris was later honoured by St. John’s Ambulance for his heroics and was pre-

sented with an award from the family. The fam-ily thanked Chris for his heroic act and for saving

the life of their loved one.Chris remains humble and says the in-

cident isn’t about him being a hero. It was about him doing what he was always trained to do. Whether in the ICU or in the community, Chris believes it is his re-sponsibility to help others. He also used the opportunity to educate people about the importance of learning CPR.

Chris’ colleagues at the hospital were amazed by his actions but not surprised.

Chris is a respected member of the ICU team who believes in helping others and giving back.

He is on the hospital committee that supports organ and tissue donation and continues to use his skills beyond the hos-pital in his role as a clinical instructor with George Brown College.

Chris’ actions on that stormy day in June remind us that life can change in an instant and it’s how you react and respond that can truly make a difference. ■H

Nominated by Julie Sullivan. Patient Care Director, Markham Stouffville Hospital

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Are you new to Canada?Nouveau au Canada?

Do you want to improve your workplace communica on skills?

Pa pate in free Occupa n-Speci c Language Training courses Workplace Communication Skills for Health Care• dental hygienist• medical laboratory technologist• medical radiation technologist• nurse• personal support worker• sleep technologist

Workplace Communication Skills for Interprofessional Health Care Teams• dietitian• nurse• occupational therapist• physiotherapist• social worker

Visit http://www.co-oslt.org for more informationPour de plus amples renseignements sur les formations francophones consultez :

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To quality, you must have training or experience in the fields listed under each course above. Also, you must be a permanent resident of Canada or protected person and your English/French must be at an intermediate level (Canadian Language Benchmark 6 – 8 for courses delivered in English or Niveaux decompétence linguistique canadiens 6 – 8 for courses delivered in French).

Hospital News congratulates our nursing hero winners!

We thank all our hard working nurses and are honoured to

feature stories from the frontline!

Happy Nursing Week!

Thank You!



We thank our Rouge Valley nurses for providing quality care and serviceAs we celebrate 2015 National Nursing Week, we thank our dedicated team of nurses at Rouge Valley Health System. Each day, our nurses deliver quality care. We value their expertise, compassion and commitment.

Our Clinical Practice Leaders, Managers, Directors, and Vice Presidents provide leadership and direction to promote best practices; improve processes; and help transform our hospital and health care system.

Our Registered Nurses, Registered Practical Nurses and Nurse Practitioners demonstrate excellent care and service every step of the way by providing:

Support and care for families, infants and children in the Women and Children’s program;

Life-saving treatment and care as part of our Regional Cardiac Care program, in the Emergency department, and on our Critical Care units;

Efficient and quality experiences for patients coming for procedures and care in the Surgical program;

Acute and restorative care for patients in Medicine and Post-Acute Care;

Support to patients and families in coping with the challenges they may be facing in the Mental Health program.

We acknowledge and commend our nurses for the care and compassion they show to patients, families and colleagues. Thank you for being the best at what you do in making a wonderful and profound difference at Rouge Valley Health System.

www.rougevalley.ca

Medtronic Salutes all Nurses during Nursing week!



TO THE HEART & SOUL OF OUR HOSPITAL...THANK YOU ROUGE VALLEY NURSES

Our Board of Directors, staff, physicians, midwives and volunteers wish you all the best for National Nursing Week. Thank you for the quality care and service you provide every day. Your dedication to putting patients first helps us to be the best at what we do.



he world has changed very much since the days when Florence Nightingale was a leader but some nurses who

accepted the challenge to follow in her footsteps and help others in need have not. There are few like Florence Nightingale in our world today but within our world at Markham Stouffville hospital there is still one Patty Henderson.

Patty Henderson has worked at Markham Stouffville Hospital for over 20 years and the number of lives she has im-pacted during that time is immeasurable.

I have never heard anyone say any-thing less than amazing about Patty. From her colleagues to the families she works with, everyone she meets leaves feeling lucky to have had her in their life, even for a moment.

Patty works in the Neonatal Intensive Care Unit (NICU) taking care of our small-est patients and her colleagues say she was born to be a nurse. She is a natural caregiv-er and provides exceptional care to every patient and family she meets. She is a trust-ed advocate for her patients and once she has gone home, her concern doesn’t fade; she even calls the unit from home often to check and see how the babies are doing.

Patty works tirelessly with families of fragile newborns to help them develop the skills and confi dence to take their babies home as soon as possible.

Patty is the heart of our NICU at Markham Stouffville Hospital. She is a

caregiver, friend, teacher and the person everyone goes to for advice. She has the patience of a saint and has the ability to put anxious parents at ease. She has this gift to provide comfort to an anxious parent within seconds of meeting them while simultaneously dealing with complicated and at times, emergency health-care proce-dures. It’s truly remarkable.

“Patty helped care for my little boy when I delivered him at 35 weeks. When I walked through the hospital doors and found out that we were going to have our baby early, seeing Patty there helped me to be calm and know whatever was to happen, he was in the best possible hands and all would be okay,” says Julie Atkinson, parent and Child Life Special-ist at MSH. “I had the best and most ex-perienced NICU nurse anyone could ask for. Cooper is seven now and Patty still continues to ask about him. She carries a piece of each of the families she cares for with her and I believe they all carry a piece of her too.”

Patty continues to amaze me every day with her commitment to an excellent pa-tient experience, her compassion for fami-lies and coworkers, her passion for quality and teamwork and her dedication to en-suring that everyone who crosses her path experiences human empathy and under-standing. Her mannerisms and how she ap-proaches her work in a positive and ener-

getic way is inspiring to all of us who work with her and I cannot think of a better way to recognize Patty than to nominate her for the 2015 Nursing Hero Awards.

We have all met someone in the health-care world who has an amazing story, their glory moment that everyone knows them for. Patty has so many sto-ries, and is regarded by so many people as a hero, an angel and someone who truly changed their life that when people think of her, they don’t just think of her one great story they think of how she makes

everyone feel every day and how she is the true embodiment of what every nurse should aspire to be.

She is the type of nurse I think of when I hear “Nursing Hero” the one who is a hero every day, without recognition and without ever wanting anything more than for her patients to be well and their families to be comforted, positive and in good spirits. ■H

Nominated by Cheryl Osborne, Patient Care Director, Maternal Child Services, Markham Stouffville Hospital.

Neonatal Intensive Care Unit (NICU), Markham Stouffville Hospital (MSH)

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Hologic honours all our nursing heroes. Happy Nursing Week.

Hologic honours all our nursing heroes. Happy Nursing Week.



NURSING WEEK SPECIAL SUPPLEMENT

Join Us!Patient First | A Great Place to Work | Using Resources Wisely

The Brant Community Healthcare System is a fully accredited,

site of the McMaster University Michael G. DeGroote School of Medicine. Brantford General is a regional acute care health centre and the Willett, Paris provides urgent and ambulatory care.For a listing of our available positions, please visit our website at www.bchsys.org and click on “Join Us.” Please contact us at our information listed below if you have any questions.

200 Terrace Hill StreetBrantford, ON N3R 1G9

[email protected]

The Willet, ParisThe Brantford General

www.bchsys.org

The Brant Community Healthcare System is proud of its more than 575 Registered Nurses and Registered Practical Nurses who come together each day to provide exceptional care to the patients we are honoured to serve.

In a rapidly changing healthcare environment our nurses are constantly adapting - to increasingly complex patient care needs, new models of care, new technology, changing organizational structures, reallocation of beds, and shortages of staff. Yet each day, day in and day out, you are providing the best in care, with the best in compassion, exemplifying the best in nursing. Every day.

Thank you for all you do in putting patients first, making the BCHS a great place to work and using resources wisely.

Happy Nurses Week!



List of Nominees 2015 Nursing Hero AwardsCarol AirdPeterborough Regional Health Centre

Elaine Alfonso Jurado Alberta Health Services

Yasmin AllyRunnymede Healthcare Centre

Semira AminThe Hospital for Sick Children

Kirstin Anderson The Scarborough Hospital

Alvin AnicetonTrillium Health Partners

Katherine ArmentaRunnymede Healthcare Centre

Marivic AtipAlberta Health Services

Virginia AvancenaTrillium Health Partners

Stephanie BannisterSt. Joseph’s Health Care London

Larisa BarbourSunnybrook Health Sciences Centre

Bill BarnettHamilton Health Sciences

Ruby BlackburnAlmonte General Hospital

Laurel BoucherMcMaster Children’s Hospital

Chris BurdenMarkham Stouffville Hospital

Dolores Castro (Lolly)Runnymede Healthcare Centre

Soni ChackoRunnymede Healthcare Centre

Angie ColuccioTrillium Health Partners

Rebecca CosgroveAlberta Health Services

Megan CotroneMarkham Stouffville Hospital

Anne CrawfordSunnybrook Health Sciences Centre

Liza CruiseOrillia Soldiers Memorial Hospital

Gabriela CruzRunnymede Healthcare Centre

Liyan DengRunnymede Healthcare Centre

Meredith DePaulsenThe Scarborough Hospital

Rebecca DrobigWilliam Osler Health System

Katherine EdwardsMcMaster Children’s Hospital

Nicole EnglishPeterborough Regional Health Centre

Helen FisherAlmonte General Hospital

Sherri GayleHamilton Health Sciences

Whitney GowanlockOrillia Soldiers Memorial Hospital

Chantal GrenkeAlberta Health Services

Kimberley GrillsPeterborough Regional Health Centre

Mary HagueTrillium Health Partners

Laurie HeeremaGeraldton District Hospital

Patty HendersonMarkham Stouffville Hospital

Irene HilliardAlmonte General Hospital

Anita Ho-ChoiAlberta Health Services

Valrie Hursefi eldWilliam Osler Health Centre

Priya JelinRunnymede Healthcare Centre

Karen JohnsonTrillium Gift of Life Network

Janice JonesSunnybrook Health Sciences Centre

Nisha JoyRunnymede Healthcare Centre

Ali KardanKelowna General Hospital

Baljeet KaurTrillium Health Partners

Paul KoniecCentre for Addiction and Mental Health

Julie KozarOrillia Soldiers Memorial Hospital

Sherika LangleyRunnymede Healthcare Centre

Galyna LazarenkoRunnymede Healthcare Centre

Donna LozierParkwood Institute

Jackie Valencia– The Hospital for Sick Children

Jackie’s colleagues speak of her talent as a leader. She works as a Clinical Support Nurse and within her role she not only provides support to her fellow nurses, but to the families and patients as well. She is kind and intelligent. She works tirelessly to provide exceptional patient care. Jackie’s patients would tell you that she is kind, attentive and detail oriented. Jackie’s col-leagues would tell you that she is support-ive, encouraging and intelligent.

Jackie looks to advance nursing knowl-edge and nursing practice on 4D and throughout the hospital. For example, Jackie leads the Nursing Practice Coun-cil meetings throughout the hospital. She is very knowledgeable and her colleagues look to her for guidance. She continually looks for opportunities to improve patient care and patient safety at SickKids. She is passionate about her career and the pa-tients she cares for.

Cheryl Sarra – Sunnybrook Veterans Centre

As soon as we met my father’s primary nurse, Cheryl Sarra, we knew that he was in the best nursing hands that can be con-templated. He was so very fortunate that for the fi rst two years he was under her care. Angelic is the word that comes to mind to best describe Cheryl. She cares. She glows. She has an inner calm and composure that lies deep beyond the grasp of any outside stress, irritant, pressure or circumstance that might arise. She never appears to be hurried or anxious while ex-ecuting her responsibilities.

2nd nomination: Cheryl is one of those rare individuals who are born to care for others. Unselfi sh; compassionate; giving. These are the words that come to mind when I think of her.

Cheryl was nurse to my father, who was suffering from advanced Parkinson’s dis-ease when he came to Sunnybrook. Due to the illness, my dad could barely speak. It was very diffi cult for most people to com-prehend him and he would get extremely frustrated when he could not make himself understood.

Cheryl always listened patiently, and by asking the appropriate questions for my dad to respond to with a nod, was able to fi nd out what he needed.

3rd Nomination: The sunny disposi-tion, kindness, compassion, thoughtfulness and caring that she showed towards my fa-ther was remarkable. She defi nitely had a

gift working with older people and should be recognized for it. It isn’t easy dealing with a veteran with PTSD. I felt so lucky that Cheryl was in my father’s life during his declining years. He needed someone like her and so did I. I knew my father was in good hands and getting the best care he could possibly get. This sure eases a daugh-ter’s mind when she cannot be by her fa-ther’s side every day.

Cheryl was there the day my father took a turn for the worst and passed away. I will never forget the warmth and kindness she extended to me at this dif-fi cult time in my life.

4th Nomination: Cheryl is some kind of wonderful – dedicated, calm of nature, sweet of voice. She cares for the residents and their families. She couldn’t be more helpful, supportive, kind, and cheerful. She can explain medical terms clearly and succinctly, and look after the many small details that make the veteran’s lives valu-able and valued.

Cheryl was most welcoming when my father, Mr. Fred Newton, was admitted to Sunnybrook, and Cheryl is one of the primary reasons his transition from inde-pendent living has been so smooth. She is honest and realistic without being alarm-ing. Absolutely nothing is too much trou-ble, and she fi gures out what is required before we do.

I live in Vancouver, but I never worry for a minute when Cheryl is in charge.

Karen Prine – McMaster Children’s Hospital

Karen Prine is an example of the com-plete package. Elite in her fi eld with ac-creditations too many to mention. She is a true leader and mentor of women. Karen is responsible for a wide range of clinical programs where vital leadership is essen-tial. She is innovative in the way she ap-proaches any challenge facing women and the wider community as you can see by her endless efforts in the Hamilton area. She touches many without them ever knowing. That is a true leader.

Soni Chacko – Runnymede Healthcare Centre

Soni displays a very professional atti-tude towards her co-workers, patients and their family members. One of the qualities I admire in Soni is her non-judgemental attitude towards the staff. She is approach-able, respectful and very helpful on the unit. She goes about performing her duties very quietly and does not look for recogni-tion or attention when she helps others.

Mary Wadsworth – Trillium Health Partners

Mary Wadsworth has been an asset to the mental health department. More than twenty years of her impeccable service speaks volumes. It seems caring is in her blood. She is very empathetic, non-judg-mental and kind with all her patients. She has always got ample time for her patients to listen to their stories with genuine in-terest. She has never hesitated to advocate for her patients. Patients are at ease when Mary is on duty, for they believe that their solace in fi nding the right person. She is extremely supportive to the entire team – always keeping them in good spirits with her sense of humor. She is very dedicated.

Helen Fisher – Almonte General Hospital

Helen has contributed 31 years of ser-vice to the nursing profession. She retired from her full time position at Almonte General Hospital seven years ago and maintains a part time position where she strives to ensure that our new young nurses will be prepared to meet the needs of the patients in the 21st century. She is particu-larly vested in the junior nurses because she, as well as many of us want to be sure that there will be skilled nurses available to take care of us when we become patients!

Her diverse skills range from obstetrics, medical and emergency care but her spe-cial gift is that of a mentor. Helen naturally falls into this role. She is a natural teacher and leader for the front line staff. Her de-cades of experience overfl ow easily to the next generation.

Laurel Boucher – McMaster Children’s Hospital

She is the nurse you want to look after your family member. Her incredible sense of humour and her contagious laugh eases the situation and calms the patient. Her many, many years of nursing show as she does her job so easily. It comes naturally to her. Lau-rel is retiring this year and I will be sad to see her go. Her spirit and most of all her caring and nurturing way will be missed.

She has been involved in mentoring both new staff and nursing students. She always volunteers for diffi cult cases and is an amazing team player. She is the mother of 2 boys and she has balanced family life with professional life with ease.

You are amazing Laurel and I am blessed to have known and worked with you. May you enjoy many years of retirement because you have brought joy and comfort to many.

Hospital News salutes




Sherrie MaitlandProvidence Care Mental Health Services

Lorraine MartelliJuravinski Cancer Centre (HHS)

Jeffrey MaximoWilliam Osler Health Centre

Maureen McPheeJuravinski Cancer Centre HHS

Laura MicksTrillium Health Partners

Darlene MurphyHamilton Health Sciences

Edsel MutiaNorth York General Hospital

Massey NematollahiSouthlake Regional Health Centre

Emma PaceWilliam Osler Health Centre

Seetha PadmanabhanThe Hospital for Sick Children

Laura PageMcMaster Children’s Hospital

Susan PajorBrant Community Healthcare System

Lisa PapeAlberta Health Services

Laura PellaSouthlake Regional Health Centre

Dana PopleKingston General Hospital

Karen PrineMcMaster Children’s Hospital

Sinny RajasegaramMarkham Stouffville Hospital

Yvonne RamlallSunnybrook Health Sciences Centre

Madge ReeceHumber River Hospital

Tracy RentonTrillium Health Partners

Eleanor ReyesSunnybrook Health Sciences Centre

Lauralee RomboutsSt. Joseph’s Health Care London

Bonnie RyderPeterborough Regional Health Centre

Mary SallowsKelowna General Hospital

Cheryl SarraSunnybrook LTSE Veterans Wing

Anne SilkOrillia Soldiers Memorial Hospital

Lee Ann SimpsonThe Hospital for Sick Children

Huguette SiouAlberta Health Services

Robin SouleAlmonte General Hospital

Mary SrebotSouthlake Regional Health Centre

Gina StokesSunnybrook Health Sciences Centre

Erin StonehousePeterborough Regional Health Centre

Craig StrivensAlberta Health Services

Shinomon ThakadiyelRunnymede Healthcare Centre

Tess ThomasWilliam Osler Health System

Patricia ThompsonMcMaster Children’s Hospital

Linda TrozzoloWilliam Osler Health Centre

Paisley TwiggeAlmonte General Hospital

Jackie ValenciaThe Hospital for Sick Children

Grace VermeulenHamilton Health Sciences

Mary WadsworthTrillium Health Partners

Jen WebsterProvidence Care

Sherry WettlauferMississauga Community Care Access Centre

Leanne WhiteMarkham Stouffville Hospital

Bonnie WilkieKelowna General Hospital

Kathy ZajacPeterborough Regional Health Centre

Angie Coluccio– Trillium Health Partners

Angie supports ongoing education of our students by providing an orientation class for them (often on her own time), to ensure their clinical placement provides them an abundance of learning. Recently a car had crashed into the parking area below our unit and had caught on fi re. An-gie did not hesitate to assist the driver and passenger, and ensure they received the care they needed. It is truly and honour to work with Angie. She is truly fulfi lling her calling each day she is here. To quote a patient; “she is an angel who responds to those in need”.

Donna Lozier – St. Joseph’s Health Care London

Donna is the most calm, compassion-ate, reliable, quick thinking nurse I know. I have had the opportunity to observe Donna during her day to day work. She always presents herself in a positive man-ner and all her patients respect her and al-ways tell me how much they love Donna. I have said many times that if Donna retires I don’t know what we’ll do. No matter the day Donna always seems to have a han-dle on everything and many times I have seen her lend a helping hand to the other nurses on the unit. Whether it be to help a patient to the washroom, help physio with a hard transfer, etc. She never says she is too busy or doesn’t have time. She makes time to attend to everyone of her patients at all times.

Katherine Edwards – McMaster Children’s Hospital

She is an amazing nurse with skills sur-passing her years of experience. She is a calm, caring and fl exible care giver who always puts her patients fi rst. She stood out from the fi rst time I saw her. She is a strong player on the team. She knows her stuff and she takes on complicated cases willingly. She is an amazing charge nurse with fl exibility and knowledge of her team.

Megan Cotrone – Markham Stouffville Hospital

Mr. T. was a complex continuing care patient who was with us on the Uxbridge site’s unit for almost a year. There were several periods over the course of his stay where he became depressed, was refusing to eat and became noticeably weaker. Me-gan, being the kind-hearted professional

that she is, took it upon herself to improve Mr. T.’s mental and emotional state – and that’s when she started what she likes to call “Spa Day”. At least once a month, she would give Mr. T a manicure, pedicure, shave, hair-wash and hair-cut. She would also take the time to sit with him, help him eat and spend time conversing with him. She would take him out of his room and down to the main lobby – or outside when the weather was nice. We started seeing great improvements in his emotional state. Megan’s care for him went above and be-yond her duties as a nurse. If nothing else, she made him look forward to Spa Day!

Sherri Gayle – Hamilton Health Sciences

Nurse Sherri touched our lives with her professionalism, compassion and car-ing while my father was in hospital with end stage dementia. Her commitment and dedication was routinely demonstrated acting as patient/family educator and ad-vocate – listening to our concerns and tak-ing action. Sherri went above and beyond whether it was providing us with a much-needed compassionate hug or through a hand written bedside note updating us in the morning on how the night was. Sherri took time out of her busy schedule to en-sure that we kept everything in perspective to avoid caregiver burn out as well.

Linda Trozzolo – William Osler Health Centre

Linda is an extraordinary colleague, nurse and leader because she takes the time to listen, guide and mentor other staff in an encouraging way. Her positive approach and cheerful face gives light and encouragement to the staff in our unit. Working in the medical palliative care unit means that many of our patients are deal-ing with end-of-life sickness and cancer. Linda’s willingness to carefully listen to pa-tients and their families with extra tender-loving care makes a big difference in their experience.

Katherine Armenta – Runnymede Healthcare Centre

Katherine Armenta is a nursing hero whose maturity as a health care practi-tioner is simply beyond her years. Upon entering the profession three years ago, Katherine quickly earned the respect and admiration of patients, families and peers alike with her compassionate, kind man-ner. She intuitively grasped the dynamics

of a busy and often demanding hospital environment and rapidly rose to become a charge nurse. Leadership comes natu-rally to Katherine: she regularly develops innovative new approaches to everyday challenges that allow her unit (and often others) to function more effi ciently.

Mary Hague – Trillium Health Partners

Nursing is a caring, client-centered, ho-listic, and a helping profession. A nurse combines science and technology with people skills like communication, problem solving, teaching, and compassion. Nurses touch people’s lives as well at a time when they need help. It is apt to say that Mary Hague has been blessed, she is humble, honest, loyal, reliable, sincere, friendly, caring, kind, friendly, trustworthy, calm, permissive, respectful, smart and many other qualities.

Patricia Thompson – McMaster Children’s Hospital

Patricia Thompson has been a nurse for over 50 years. She has touched the lives of many. She has worked in many areas of the hospital and her last several years have been in the operating room. She has been involved in the biggest and most complex cases in our unit. She organizes, assembles and follows the process through. She amaz-es us everyday. Her commitment and love for the profession is seen everyday as she delivers her care to the patient and their family. She has the ability to make fami-lies feel safe and assured while delivering incredible care to them. You can see them ease as she speaks to them.

Laura Page – McMaster Children’s Hospital

There are so many words to describe Laura. She is dedicated, loving, caring, smart, fun, hard working, easy going but the word we think that describes her best is positive. There is not a single day Laura doesn’t have a smile on her face. Even during the most stressful situations she remains calm and upbeat. In December of 2014 Laura was diagnosed with Non Hodgkin’s Lymphoma, not that you could tell though because she hasn’t missed a sin-gle day of work, in fact she has been work-ing even more. During the last two months Laura has been working one on one every morning with a little guy getting radiation treatment at the JCC.

all 2015 nominees





Lorraine Martelli – Hamilton Health Sciences Centre

My father’s wish was to pass at home and during his last days he had me on the phone to Lorraine asking her questions what to expect and at one point he asked me to ask her if she would come to see him because he really wanted to thank her for everything she had done for him and our family.

I was very apprehensive about asking Lorraine this because I didn’t want to put her on the spot nor did I want to inconve-nience her.

I spoke with Lorraine and told her that dad was asking for her and wanted to thank her. To my surprise Lorraine didn’t even waiver she just asked for the address and what time she should come. Two days before dads passing Lorraine walked into a house fi lled with 35 people taking vigil over my father and saying their last goodbyes. Her demeanor was calm, com-passionate and professional. She came to my father’s bedside and although he was no longer awake she spoke with him for some time. After spending some time with dad, her words of support to the family was wonderful.

In my opinion Lorraine went above and beyond for myself and my family. I could not have coped without the support of nurses like Lorraine, she is and will always be the best nurse I have ever known.

Laurie Heerema – Geraldton District Hospital

Laurie originally started at the Hospital as a casual RN and within a year applied for the CNO position and was the suc-

cessful applicant. Laurie has made some amazing contributions and changes to the nursing department, as well as other departments in the Hospital. Even now as Chief Nursing Offi cer, Laurie has had to run home and change into her scrubs to work the fl oor (Acute Care or Emer-gency Department) to help cover when the need arises.

Shinomon Thakadiyel– Runnymede Healthcare Centre

Shinomon Thakadiyel is a charge nurse who’s well-known for going beyond the limits of his job description. No task is ever too big or too small – his only interest is to serve his patients or colleagues.

Soft-spoken and reassuring, Shinomon is a source of calm leadership whenever emergencies arise. His competence in such situations is exemplary and his actions in-spire colleagues to achieve the same level of excellence.

We call him “Superman” on our fl oor.

Laura Micks – Trillium Health Partners

Laura’s dedicated service was proved once again in accreditation in 2014. She was handed over the duty of education/preparing the staff of the whole process of accreditation.

She worked so tirelessly meeting individually with every staff member. This resulted in the very successful ac-creditation-2014. She is very patient centred.

She knows when to advocate for her pa-tients. She never hesitates to connect her patients with the appropriate resources.

Craig Strivens – Alberta Health Services

Craig has been working ICU for many years and is not only knowledgeable on al-most every aspect of practice, he is a true mentor. Through an insanely busy shift he still checks in on me and provides me with every learning opportunity he can think of. He is truly aspiring to make the newer staff on our unit valuable members of the ICU team. Craig is very supportive to all staff when a diffi cult admission comes in – he is always there to help out. And he is an amaz-ing resource to use when you need advice.

Nisha Joy – Runnymede Healthcare Centre

A strong patient focus is the hallmark of a true nursing hero, and at Runnymede Healthcare Centre, Nisha Joy’s standout work epitomizes this. Her caring manner is simply inspirational; the compassion she demonstrates in her interactions with patients encourages them to engage with their rehabilitation and remain positive throughout the recovery process.

Huguette Siou RN – Alberta Health Services

Huguette has been with the Family Medicine Team for 14 years and gradu-ated from nursing in 1986. She has shared her expertise with multiple staff and has been a strong advocate for her patients throughout her time on Family Medicine. We appreciate Huguette’s strength in her knowledge of the RN role and how it has changed over the years. Her clinical ex-perience goes unparalleled and we have

learned so much from her. Huguette will be retiring in May 2015 and we will miss her as part of our team.

Dana Pople – Kingston General Hospital

Dana Pople is an outstanding staff member working on Kidd 7 as a registered nurse. I had the pleasure of being Dana’s full-time line partner (up until January of this year), which basically means that we have the same schedule and set of shifts (two days, two nights, and fi ve days off).

I had been working with Dana for over a year (since her return from mater-nity leave), and within that timeframe, I learned a wealth of knowledge about my profession as a nurse, and also quite a bit about myself. Dana is a selfl ess person and always puts her work, patients, and fellow colleagues before herself.

Dana is always willing to lend a hand to any member of the health care team (nurs-es, PCAs, and other disciplines) no mat-ter what she is doing or what her patient assignment is like – she will drop what she is doing to help someone out (within reason). Despite the fact that Kidd 7 is a physically and mentally demanding unit to work on, Dana is always there to ease ten-sion and lighten the mood with her quick-witted sense of humour and infectious smile (I can actually picture her laughing at me right now as I write this).

Whitney Gowanlock – Orillia Soldiers’ Memorial Hospital

I am 15 years old and I have been a pa-tient of Whitney’s for the last nine years. She has been my Diabetic Nurse Educator

Because nurses are always there for us, we’re here for them.Nursing has always been about keeping patients safe by defining and measuring quality of care. With the OHA’s Health Care Risk Management and Patient Safety programs, we can help support nurses in their goal to improve quality and patient outcomes through continuing education.

Visit www.oha.com/courses to register today.

Health Care Risk Management - October 20 & 21Patient Safety - October 22 & 23

The Important Role of Nurses in Health Care Risk Management and Patient Safety Clinical risk management is concerned with improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and then acting to prevent or control those risks.

Nurses working in health care are an important part of the care team. They help keep patients safe by using risk management skills and techniques. They are continually assessing the environment for possible risks of harm and use their knowledge of potential risks and knowledge of the patient to ensure the patients’ safety. Nurses are required to have the clinical skills to understand medical issues that may arise, the assessment skills required to analyze the problem and recommend steps to improve procedures to reduce the likelihood of recurrence. They also have insight into the daily operations of their organizations which helps them to identify hazardous situations involving patients and act as advocates for their well-being.

Nursing has always been concerned with defining and measuring quality as far back as 1855 and Florence Nightingale. She is credited with analyzing mortality data and creating the world’s first performance measures in 1859.

Education has an important role to play in preparing nurses to be competent in providing safe patient care. Education and training assist nurses in developing the right knowledge, skills and attitudes with respect to patient safety and risk management with the result of improved quality and patient outcomes. The Ontario Hospital Association is pleased to support this need for education through their continuing education certificate programs, as well as workshops, broadcasts and conferences.

Learn more at www.oha.com/education

Happy Nursing Week and Thank You

to all Nurses for Your Hard Work and Dedication!




since the day I was diagnosed with diabe-tes and has been there for me every day since. Living every day with diabetes is not always easy. Whitney always encourages me towards my goals and is supportive of my efforts to do that. She has taught me a lot about my diabetes and the best ways to manage it.

Whitney is always available and makes appointments for me whenever I need them. She also has made herself available through social media and she also reminds me to do my bloodsugar when I have trou-ble remembering. I think that Whitney is the best nurse ever. She helps me and my Mom get through the everyday challenges of living with diabetes. It’s not fun to be diabetic but with Whitney’s support, it is manageable.

Ruby Blackburn – Almonte General Hospital

Ruby has dedicated her career to 45 years of nursing! She is driven to provide excellent patient care, always listening to patients and their concerns, both the spo-ken and unspoken. Her smile and gentle, healing hands we call them, soothe pa-tients, Ruby is the “patron of nights”. She walks the halls ensuring all the patients are feeling safe and comfortable. Ruby leads by example; her positive, respectful, caring, attitude just seeps into the souls of other workers on the fl oor and it fl ows from there. She never loses sight of the real person behind the pain and fear of illness.

Baljeet Kaur – Trillium Health Partners

One memorable example of when Baljeet did something beyond the call of

duty was when there was an emergency in the Intensive care unit (ICU) and they were in desparate need of a Punjabi in-terpreter. ICU had called the CCU unit and other units looking for an interpreter. When Baljeet heard this. She wanted to go and help right away, despite the fact she al-ready had a very busy assignment. She was asked to translate for the medical team, who was trying to contact a family member overseas. Baljeet managed to help and as-sisted the team in order to provide safe and informed care.

Bill Barnett – Hamilton Health Sciences

Bill has demonstrated throughout his career, a dedication to the care of pa-tients and his colleagues that is superior. He has reflected HHS vision, mission and values so completely throughout his entire career at many sites. But no one would ever know this at the corporate level because he is such a humble man who is quiet in his competence. But he deserves this recognition publicly from his patients, colleagues, community, management and hospital for which he has served for 25 years.

Bonnie Ryder – Peterborough Regional Health Centre

During challenging times, whether it be with co-workers, patients or patient fami-lies, when other staff are struggling, Bonnie will always step up to the plate to help in any way she can. She not only carries her own patient load but is constantly running to answer bells or to help someone on the other team if needed.

Bonnie is the defi nition of a team player, in more ways than one. Bonnie dislikes seeing her colleagues work short-staffed, so she will often pick up extra shifts and will work holidays so that staff with younger children can experience the joys of moth-erhood and/or fatherhood.

Valrie Hursefi eld – William Osler Health System

Val is a team player and more. Since she started her position at Etobicoke in Au-gust 2009, the units have been instilled with evidence based research and knowl-edge through Val’s teachings whether it be in-services, one-to-one or group huddles. Not only does the staff benefi t from her timely communication but the patients and their families defi nitely feel the comfort and compassion as the staff are able to provide patient-focused care bringing into focus the judgement and critical thinking skills that have been taught to them by Val.

Chantal Grenke – Alberta Health Services

Chantal graduated in 1993 and has been with the Family Medicine Team for over 10 years. She has trained and mentored many of the staff particularly on night shift. Her critical assessment and nursing skills have on more than one occasion saved a life.

A true pillar of strength on the unit, many staff have sought her out for advice and support in both personal life and ca-reer decisions. She is constantly helping others when needed to swap shifts, or help rearrange/understand their schedule when asked.

Karen Johnson – Trillium Gift of Life Network

Karen exemplifi es all the qualities one could ascribe to a nursing hero. She is very kind and compassionate, and consistently goes above and beyond the call of duty whether at her work place or out in the pub-lic arena. Her efforts not only saved her hus-band’s life when he had a heart attack, but more importantly, Karen saved her daugh-ter’s life following a tragic car crash as a re-sult of an impaired driver. Her daughter`s injuries were misdiagnosed and it was her mom’s skills and abilities that saved her life.

Karen worked diligently performing CPR for 15 minutes to save the life of a young man on the beach at Coburg, On-tario, after he collapsed during a summer volley ball tournament.

She also saved a man’s life in Windsor, Ontario, when he suffered a heart attack.

Rebecca Cosgrove – Alberta Health Services

Rebecca has been with the Family Medi-cine Team for 4 years. She began on Fam-ily Medicine as my wide-eyed, nervous but eager to learn student and eventually obtained a job as an undergraduate nurs-ing employee. Today, I am happy to say I have seen Rebecca grow into one of the strongest nurses I have had the pleasure to work with. Her quick critical thinking and assessment skills have on many occasions saved a life. She is a mentor to new staff and provides a form of structure to the oth-er members of the interdisciplinary team as a result of her knowledge, leadership skills and attention to detail.


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Nicole English – Peterborough Regional Health Centre

Nicky was caring for a frail elderly wom-an who had been admitted to the Medi-cal Short Stay Unit (MSSU). During her shift, the patient’s spouse was visiting and Nicky began to see that his medical condi-tion was deteriorating. She suggested that he get triaged and seen by an Emergency physician.

The spouse was triaged and identifi ed as being in acute respiratory failure, was seen immediately by a physician and was sent to a monitored area of the department. Throughout her shift Nicky continued to receive updates on the patient’s spouse and his condition, providing regular com-munication to her patient.

Early in the afternoon, it became appar-ent that the wife had become anxious and agitated that she could not see her hus-band or be assured that he was going to be okay. After getting confi rmation that the husband was to be intubated shortly, Nicky identifi ed that it was in the best interest of the patient to move her to be near her husband as soon as possible.

Nicky worked with the Occupational Therapist in the department to mobilize her patient and brought her to the bedside of her ill spouse, allowing her to hold his hand prior to and after he was intubated. This provided her with the reassurance that her husband was being cared for and reduced her anxiety.

Nicky went above and beyond in this example, recognizing what the patient’s wishes and needs were at the time and working creatively to ensure that these needs were met.

Liza Cruise – Orillia Soldiers’ Memorial Hospital

I have never met a nurse so dedicated to making the OR run smoothly and mak-ing sure that patients are taken care of well beyond what would be considered the standard of care. She is warm and welcom-ing to my patients and always makes sure to put them fi rst. When there have been requests for equipment I know for a fact that she has worked on procuring these items on her own time to ensure cases go perfectly – I have received many emails from her on evenings and weekends when I know she was not offi cially at work. I can confi dently say that she has made THE dif-ference in keeping the plastic surgery pro-gram running smoothly. Personally, with-out Liza there is no way my practice would have been able to get started as smoothly as it has,

Jeffrey Maximo – William Osler Health Centre

Although the physician treats the dis-ease, the nurse is the health care provider that treats the patient. First and foremost, nurses assess and care for the patients’ needs, emotional responses and defi ne the barriers to care. Jeffrey continually shows commitment to the service of the com-munity, and continuously demonstrates empathy, compassion, emotional stability, leadership, dedication, advocacy for our patients, and exudes intelligence.

He empathizes by identifying and shar-ing emotion and provides care for the patient in distress. The basic defi nition

of nursing is caring and empathy is at the core of nursing. He provides care for, and interacted with people of various ages, multicultural backgrounds and specifi c needs and requirements. He takes the time to listen, understand and protect the pa-tient’s cultural beliefs.

He uses experience, scientifi c knowl-edge, and instinct when assessing patients. Intuition in nursing is defi ned as the imme-diate understanding of a problem without the necessity of conscious thought. Jeffrey picks up on the smallest cues, nuances and seemingly unrelated patient statements that may render further investigation. Through his intuition, he saves lives and prevents further illness. He is the nurse that I aspire to become, and if I ever need-ed a nurse, he is the one I would want to take care of me, and my loved ones.

Susan Pajor – Brant Community Healthcare System

Over her 21 year career as a PACU RN, a Health and Safety Co-ordinator, and now as our District Stroke Best Practice Lead, Susan optimizes every opportunity to make a positive difference not only for pa-tients, but also for each of her co-workers. It turns out that caregivers, collaborators, colleagues, and students thrive with care and caring, too! I know that everyone who works with Susan can attest to this.” Her offi cial role is to help make the Ontario Stroke Network’s vision of “fewer strokes, better outcomes” a reality. Whether she is connecting with her peers over a major project, answering a simple question, or de-livering offi ce supplies, she is warm, kind, positive, enthusiastic, and encouraging.

Laura Pella– Southlake Regional Health Centre

Laura was special because she really went the extra mile to spend time talking with her patient’s and checking in regularly to see how they were doing. I had a few op-portunities to chat with Laura during my stay and I always felt uplifted with a sense of hope for the future each time I interacted with her. It was obvious to me that ward 3 must be a diffi cult place to work at times and the nurses in this area often do not re-ceive the thanks and appreciation that they absolutely deserve from their patient’s. Lau-ra was especially kind and it was obvious to me that she loved her work and helping the people under her care. I imagine nursing is a particularly diffi cult job at times but Laura always had a smile on her face, greeting the patient’s politely and making us feel like we were just regular people, equal to her. I cannot express enough the positive impact her friendly, knowledgeable, passionate and professional care had on my recovery.

Elaine Alfonso Jurado – Alberta Health Services

Elaine has been with the Family Medi-cine Team for 1 year; she graduated in the Philippines and has brought over years of experience working in diverse settings. During her short time on Family Medicine, I have trained Elaine in the Charge Nurse role, one in which she truly shines. I have received multiple (over 10 to be exact) written appreciation letters for patients and staff regarding the patient care she has provided, and from staff on how she has mentored or assisted them in a situation.

A standing ovation and sincere thanks to you, Ontario’s RNs, NPs and nursing students for the vital work you do. We are grateful for the potent combination of knowledge and compassion you use to stave off illness, keep people healthy, and care for them when they are ill. You help to ensure everyone – babies, the elderly, and all in between, those who wait for you in their homes, and who need you in their nursing homes or shelters, primary care clinics and hospitals – receives the care they need and deserve. Your expertise as clinicians, administrators, educators, researchers, and policy shapers has a profound impact on individual and collective health outcomes.As we celebrate your amazing work during National Nursing Week, we extend our deepest gratitude to you for keeping Ontarians healthy, and nursing those who are approaching the end of their lives. Th ese are not easy times, which makes your resilience and courage even more awe-inspiring. Th ank you for choosing to become a nurse.

Happy Nursing Week, and thank you to all nurses

Vanessa Burkoski RN, BScN, MScN, DHAPresident, RNAO

Doris Grinspun RN, MSN, PhD, LLD (hon), O.ONT.



Anne Silk – Orillia Soldiers’ Memorial Hospital

Over the course of my daughter`s che-motherapy Anne has gone out of her way to help my daughter feel comfortable and to make her trips to the hospital as pleas-ant as possible. She has brainstormed up ideas of what was triggering Nakeitta’s vomiting and how we could work together to control that. From pushing meds slowly to extracting saline out of an IV bag, she discovered that Nakeitta was having a re-action from the prefi lled saline syringes. Even Nakeitta’s oncology doctor didn’t believe Anne when she told him. Anne also goes out of her way to get Nakeitta a couple of warm blankets to keep her warm during her treatments, as Nakeitta wears a tank top, so it easier access to her power port. If Nakeitta is not feeling well on a particular day she will call me the next day to see how she is doing.

Lisa Pape – Alberta Health Services

Lisa has been with the Family Medicine Team for three years. Cheerful and bubbly, we can always count on her to brighten the day for patients or staff. Her positive attitude has inspired many patients to con-tinue on even when they “didn’t think they could take those three steps” or “get up out of bed for every meal”. A natural leader in teaching, she has mentored many students and shared her knowledge with other staff. She is always there to provide help to oth-ers on her team and go the extra step to ensure her patients feel “human” in the hospital – i.e. providing reading material, calling artists on the ward, fi nding recre-ational things for patients to do. We are lucky to have her.

Darlene Murphy – Hamilton Health Sciences

Darlene Murphy is the “night nurse”. She uses her expertise in assessment to champion the needs of the patient who cannot speak for themselves. I have been fortunate to work with her on many occa-sions and watch as she skillfully managed the care of many patients who have tak-en a turn for the worse. One situation in particular was very diffi cult. Darlene had managed to calm an elderly patient who became physically abusive towards nursing staff and her own family. This particular patient actually punched their daughter in the face and Darlene had gone out of her way to see that the daughter was okay. The patients’ family had seen me downstairs in the coffee shop and asked “how is that nurse doing? I did not expect that my mom would lash out like that? How do you guys do it?” I stated “It is hard but ... I think you should ask Darlene how she does it dur-ing the night shifts when no one is watch-ing”. I did not have the answers myself but I could only refl ect and think that this is an extraordinary person who still cares after being attacked by a patient and she still has the ability to come into work with a positive attitude every shift. Thank you Darlene for being the best you can be and inspiring me to be a better nurse.

Anita Ho-Choi – Alberta Health Services

Anita graduated from nursing in 1980 and has been with the Family Medicine Team for 11 years. Known for her “moth-er” like qualities (i.e. constantly feeding the staff and providing advice), her cheer-

ful busy bee disposition is well known on the unit. Anita is constantly learning and teaching/mentoring new staff and stu-dents. She has also been an advocate for patients (particularly when disposition is an issue) in ensuring that we as a service have provided all the support needed “to make sure the patient has a fair chance at getting back to their regular life”. She has been the voice of advocacy and reason in many instances where patients needed a little more time to improve and of which they were once again given a fair chance and grateful to her for being able to return to their own home. Anita retired in Febru-ary 2015, but continues on in our casual fl oat pool and for this we are grateful.

Paul Koniec – Centre for Addiction and Mental Health

Paul Koniec is a Registered Nurse (RN) here on LGUD. Paul is faced with the vi-carious trauma of clients in distress, acts as a therapeutic ear, and provides the care to our patients every day that helps them to fi nd a better quality of life every day. Paul goes above and beyond the duties of an RN every day that he is on the unit. He is involved in interprofessional programs that involve many other professions, he constantly advocates for the patients with a genuine desire to provide them with the best quality of life possible, and advocates for his profession.

Paul became involved in a program that myself and two other staff began on our unit to address the concerns of obe-sity that very often accompanies being confi ned as an inpatient on a psychiatric unit as well as the side effects of some of the medications that our clients take that cause weight gain. As part of an inter-professional approach, Paul educates our clients on the side effects of their medi-cations as well as lifestyle choices that they can make to help them lose weight. Our clients have expressed to me that they enjoy his sessions because they pro-vide a genuine experience. Paul speaks to the clients not as a clinician, but as a facilitator that helps to guide the partici-pants on a healthy way of life. Paul is a strong advocate for the rights of our cli-ents. He is not afraid to take acceptable risks with our clients to offer them the opportunity to experience more freedom in their day-to-day life and collaborates with the team in making those decisions. Very often there is a stigma attached to a client because of their past history (es-pecially if the index offence was one in-volving violence). This can cause some hesitation on the part of clinical staff to venture outside of the comfort zone with certain clients. While maintaining safety and risk management as the paramount considerations, Paul is able to offer cli-ents the ability to experience more free-dom and therefore help to more rapidly re-integrate them into the community.

Robin Soule – Almonte General Hospital

Robin has been nursing since 1984. She found her niche in Long Term Care. In this setting Robin fi nds she gets to know the pa-tients and understands their needs. Robin says, “it’s a privilege to take care of people at this stage in their lives”. Robin puts her heart and soul into the care she provides to the aging population with passion and cha-risma. Robin can be seen through the eyes of her coworkers as sweet, kind, adaptable, and compassionate – an all-around hero.

During Robin’s career she was bumped from her RPN position to a PSW position. She needed full-time work, so she took this move as an opportunity and in stride be-came a full time personal support worker. During her time as a PSW Robin worked hard, providing the best care she could to her residents and patients allowing her to feel rewarded. As a PSW Robin became more appreciative of the work they do and promoted the position as best she could. Eventually Robin was given the chance to work full time again as an RPN, but her time as a PSW is always remembered.

Robin has mentored six RPN students throughout her time at Almonte General Hospital and Fairview Manor and has in-stilled her desire to always learn upon them. Robin is able to guide her students to their best potential. She is able to adapt to chang-es, teaching her students not to be afraid of, but to embrace change. Robin often says to take every opportunity given because you’ll see it from a different perspective and may-be acquire something new. Robin is always looking at the big picture showing empathy towards the situation. She may walk in her own shoes, but most defi nitely takes a turn in other’s as well before deciding her per-spective on an idea or action.

Mary Sallows– Kelowna General Hospital

I have worked alongside Mary for over seventeen years. In that time, I have not once seen a bad day impact her positive spirit or “Can I help you” attitude. While not part of their regular duties, the Psy-chology Department frequently needs to request the already over-taxed Rehab Nursing staff to assist us, whether it be to

assist a patient to the restroom, replacing oxygen, IV bags, or assess the need for more imminent nursing care. Mary comes to the rescue, every time, without question, hesitation, or attitude. The current cli-mate in hospital is defi nitely overwhelming for patients and staff alike. There are days when there are more patients than beds, more people coming than going, and the stress level can be highly stretched among staff as they try their best to heal and com-fort. Mary truly is the sunshine on a rainy day. Patients and staff alike know that they can count on her humor and huge heart to make a difference in their outlook for the day. Mary cares. Period. She is not only great at the job she is paid to do, but she reaches far beyond the Job Description to do the “right thing”. When patients leave Mary’s care, they leave knowing they had the best that Interior Health has to offer.

Kristin Anderson – The Scarborough Hospital

At my recent hospital stay one nurse really stood out. Her name is Kirstin An-derson and not only is she an exceptional nurse, but she lifts the spirits of her pa-tients up just by being so alive and always in a great mood. It isn’t fun to have to stay in bed to re-cuperate. Going stir crazy, wishing you can get better, and go home as fast as possible. The best part of the day is when Kirstin comes in to check if I’m keeping ok, if I need anything, just coming in smiling and making little jokes ‘know-ing’ that we’re all bored and tired. She re-ally, really goes above and beyond and is so considerate and caring and from what I saw and heard, she works very, very hard.


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Leanne White – Markham Stouffville Hospital

For eight months, Leanne worked with Mr. Palmer, an elderly inpatient in the mental health department at Markham Stouffville Hospital (MSH), and his fam-ily. And as nurses working on inpatient units know, working with family members becomes a large part of your day and a vital part of providing a positive patient experi-ence. Hospitals can be a scary and unfa-miliar place for patients and their families – something that health-care workers can grow to forget – but not Leanne.

During Leanne’s time working with Mr. Palmer, she became close with his wife, Mrs. Palmer, helping her navigate her hus-band’s health-care journey and the tough decisions that came with it. “Leanne is an active listener who administers unlimited compassion,” says Mrs. Palmer. “She is al-ways willing to go the extra mile and has a quiet confi dence that is not only profes-sional, but reassuring and trustworthy.”

Mr. Palmer was on a wait list for long-term care, and when a spot became avail-able, it was eight months into his stay at MSH. Having become comfortable with his arrangements at MSH, Mrs. Palmer began to question her decision to accept a long-term care bed for her husband. Knowing the long-term care home was the right place for Mr. Palmer, the interprofes-sional team in mental health services tried to work with Mrs. Palmer to reassure her about her decision, but with no success – that is, until Leanne spoke to her.

Leanne spent some time speaking with Mrs. Palmer and encouraged her to

visit the long-term care home to see the environment and to make it feel more like home, she suggested that she deco-rate her husband’s new room to person-alize it for him. Knowing how difficult this move was, and how much anxiety it was causing Mrs. Palmer, Leanne did everything she could leading up to the transfer to ease the transition. And on that day, when the time came for Mr. Palmer to be transferred, Leanne couldn’t let Mrs. Palmer do it alone – so she went with them to the long-term care home to help with the transition into the new environment.

“Leanne’s support and dedication helped us greatly during the move to long-term care,” says Mrs. Palmer. “My husband has settled in very well and we have Le-anne to thank for that.”

Tess Thomas – William Osler Health Centre

I was privileged to be assigned “Tess” as my nurse in Emergency at Brampton Civic Hospital. What a blessing to me as I started what turned out to be 14 days in hospital. I The hospital physician recommended a Lasix drip IV that night... and it was to last 10 more days. He recommended a catheter but Tess offered me alternatives. With a good sense of humour she suggested I had 3 options... I could dribble down the hall to the bathroom, I could be hooked up to a catheter, or she could try to fi nd a pri-vate room, set up a commode beside my bed and we could handle it that way. She found the room, and the larger commode and made it work. ■H

More than ever before, Hospital Staff , Physicians, Key Life Support Systems and Patients all Need Reliable Wireless. And they’re demanding it now.With the exponential increase in the use of smart phones, tablets, health apps and other wireless systems, a robust, reliable, secure and fast wireless system is no longer an option. It’s required.

To get the most out of today’s sophisticated wireless systems, they have to be designed, commissioned and supported to meet their full potential. Genwave Technologies is a professional engineering firm that specializes in wireless. From Mission Critical Wi-Fi to Cellular Carrier enhancement systems or Public Safety Radio systems, Genwave will deliver reliable wireless. Wireless. Solved.

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Genwave Salutes All Nurses in Canada!

In today’s extremely fast paced healthcare environment, demands continue to increase. No one knows this better than our valued nursing staff. They get pressured from all sides - patients, patients family and clinicians.

Wireless systems are proving to be a lifesaver – literally and figuratively. With today’s modern Wi-Fi systems, Nurses are enabled to view systems, receive and provide updates in real-time, wherever they are. No more ‘information lag’ due to being away from the nursing station and a better environment due to reduced overhead paging.

A modern Wi-Fi system will often have ‘application layers’ which are dedicated networks for specific applications. With more systems, dispensing and imaging tools able to network wirelessly, a dedicated ‘life critical’ application layer is justified. This would be dedicated for life critical systems, have it’s own access and quality of service. Another layer would be dedicated for the healthcare staff. This mission critical layer would again be separate from other networks. A third layer would be dedicated for patients and their visitors, guest access.

In a properly designed, modern wireless network, each application layer would be engineered to meet the specific demands of its users requirements. But the design is key. To properly design and engineer a wireless network, it is critical to choose a partner with the software, tools and expertise. The design is the foundation of your investment.

If you don’t have a modern wireless system, don’t forget your critical nursing staff! We owe it to them to ensure their jobs can be done as effectively as possible.

Rob Graham is the CEO of Genwave Technologies Inc. a Canadian wireless engineering, design and system integration company.

Nurses Deserve Excellent Wireless!

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arol graduated from the Mc-Master School of Nursing in 1977. Her fi rst job was out-post nursing, providing pri-

mary health care to isolated communities in northern Manitoba and the Northwest Territories.

In 1980, she returned to Ontario and worked as a Staff Nurse with the Victorian Order of Nurses (VON) in Toronto. Carol became a Public Health Nurse with the Haliburton Kawartha Pine Ridge (HKPR) District Health Unit in 1983. From 1985 to1989 she was a Nursing Supervisor with the HKPR Health Unit and then with the Lindsay VON.

These early experiences provided Carol with the opportunity to become an advo-cate for the health and wellness of women and their children. Carol believed that with information and support, women could make the best choices in all aspects of their healthcare. This made her a prime candidate for her next role with the for-mer Peterborough Civic Hospital. In 1989, Carol was the fi rst Registered Nurse hired for the newly-developed Women’s Health Care Centre. This unique Centre was one of only four in Ontario, funded by the pro-vincial government.

In 1991, the Women’s Health Care Centre moved offsite, to a downtown loca-tion, to provide hospital-based and acces-sible services to women in the community.

Carol worked in that offsite location for 20 years, playing a pivotal role in devel-oping and expanding health care services for women in the City of Peterborough and surrounding regions. She established mutually respectful relationships with physicians, colleagues and our community partners, forming critical, collab-orative relationships which are still in place today.

In 1998, Carol obtained her Primary Health Care Nurse Practitioner Cer-tifi cate from Queen’s Uni-versity, thus fi lling the fi rst Nurse Practitioner role at Peterborough Regional Health Centre. She contin-ues her education through the Practice-Based Learning Programs of the Foundation for Medical Education, McMaster University. She gives back by mentoring and supervising new students to the program.

Women tell us they can talk to Carol about anything. Carol not only talks to her patients, she really listens. She never judges. She just helps. Her warmth, com-passion and professionalism equip her well to meet the needs of our culturally, socio-economically and demographically diverse population.

Carol’s schedule is fully booked with patients each day. You will hear her cheer-

ful banter. “Hi, I’m Carol. Carol Aird. Nurse Prac-titioner here.” She has

known many of her patients for years. She knows their

families and their life stories. She always fi nds the time to take

those last minute phone calls, to con-sult with a peer or to squeeze in one more patient. If not recognized by name, Carol is recognized by her long red hair, her big heart and her great shoes!

Within the Women’s Health Care Centre, Carol has a role in each of our programs. Through her experience and commitment to lifelong learning, she has worked to become expert in the areas of eating disorders, reproductive and sexual health, contraception, unplanned preg-nancy, menopause, breast cancer, osteo-porosis and sexual and domestic violence. Carol is the one designated medical exam-

iner for pediatric victims of sexual assault/abuse in our region. She is well-known and trusted by professionals across the hospital and the community.

Carol performs her duties with dignity. As a member of the multidisciplinary teams, Carol is valued for her tendency to share her skills and expertise, and for conveying her respect for the roles and expertise of others. Though she is viewed as an informal leader, she is consistent in her belief in the equal value of each team member.

From a professional perspective, Carol’s performance is exceptional. She will soon retire after 38 years in the profession. She will be missed, but Women’s Health Care is richer for what she has provided. ■H

Nominated by The staff of Women’s Health Care, Regional Centre (WHC) at the Peter-borough Regional Health Centre.

Peterborough Regional Health CentreCarol Aird NP

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HONOURABLEMENTION

The week of May 11 to 17 is Nursing Week across Canada – a week that includes the birthday of nursing pioneer Florence Nightengale.

The tens of thousands of Registered Nurses (RNs), Registered Practical Nurses (RPNs), and Nurse Practitioners (NPs) who work here in Ontario play a critical role in caring for the rest of us. Nursing is, after all, an invaluable component of the overall healthcare system that includes a wide range of equally valued professionals.

The vast majority of the nurses who care for us here in Ontario are members of the Healthcare of Ontario Pension Plan (HOOPP).

This security makes them confident contributors to the local economy. A study several years ago by the Boston Consulting Group found that defined benefit pension income represented between 7 and 15% of all income in the cities of Hamilton, Kingston, Thunder Bay and Elliot Lake.

The same study noted that in Ontario, defined benefit retirees spend $27 billion a year on local goods and services, including $3 billion in sales taxes, plus another $3 billion in taxation, supporting government programs. For a defined benefit pension plan like HOOPP, approximately 80 cents of every pension dollar comes from investment returns, the rest from member and employer contributions.

The defined benefit retiree group is far less reliant on taxpayer-funded retirement programs like the Guaranteed Income Supplement than those without a workplace defined benefit pension.So during this special week, let’s all pay tribute to these talented, energetic drivers of success in Ontario’s healthcare system. If you know a nurse, please take the time this week to thank her or him for the wonderful care they deliver.

What are HOOPP members saying about retirement?

“Being a member of HOOPP is an effortless aspect of my life that makes me feel very responsible. When people ask why I’m not worried about retirement and I tell them it’s taken care of, they think I must be a financial guru. Nope, I’m just a HOOPP member!”

“I blinked, and suddenly I was 51. Now I am so thrilled. In this current fiscal climate, I know I am truly blessed to have a defined benefit plan like HOOPP. Bring on the painting, the photography, the gardening, hiking and dinner parties!”

“HOOPP is allowing me and my family to focus on our lives without financial fear of the future. I am comfortable and content to let the good people at HOOPP do what they do best.”

This week, thank nurses for their many contributions.



The NurseFlorence Nightingale, the lady with the lamp,Mother Theresa in the refugee camp,Caring, compassionate, gentle and kind,A more noble profession, one could not fi nd.

The nurse is the doctor's eyes and ears,Records any changes, allays patient fears,Monitors rhythms, takes vital signsAdministers drugs, sets up IV lines.

The nurse is highly trained in her skills,To assist in the healing of wounds and ills,In the OR, wards or critical care,Her presence unnoticed because she is always there.

With devotion and pride, she nobly serves,Though pressures, demands, may fray her nervesThe nurse lowly paid, in gold is her worth,For she's truly god's angel sent down to earth by.

By Roopdai Mohotoo and Nita Marcus

OsgoodePD knows that today’s nurses work in an increasingly challenging health care system, with growing pressure to do more with less. A shortage of resources, the increasing complexity of day-to-day tasks, and the new opportunities and challenges presented by technology have all changed the landscape of nursing. Understanding and preventing legal risk and liability is critical. Our faculty of leading legal and health experts have developed practical, accessible programs which will equip you with the information and tools you need to manage risk. Learn from the experts so that you can protect yourself, your patients and your organization.OsgoodePD offers a variety of engaging learning opportunities specially designed by and for the nursing professional. Topics include: Documentation & Charting, Privacy Issues, Professional Misconduct, Abuse by Patients, Consent to Treatment.

This is what past delegates have said about our health law programs:

“Excellent presenters. Thanks for shedding your court gowns and being so approachable.”

“As a result of this program, I will bring valuable information back to my workplace to share with the RNs I supervise and other managers in the agency.”

“Very informative – I wish all of my staff could attend. Use of actual scenarios extremely helpful.”

“Excellent, informative, current, empowering and interesting – every nurse needs to know and hear again and again.”

Osgoode Professional Development | 1 Dundas Street West, Suite 2600 | Toronto

For a complete list of upcoming events or to register: Visit: www.osgoodepd.ca; Or Call: 416.597.9724 or 1.888.923.3394 Or E-mail: [email protected]

We understand your commitment to professionalism... and we thank you.

A WORLD LEADER IN LAW SCHOOL LIFELONG LEARNING

Directors RPNAO





hether in real life or not, a hero is someone people look up to for courage and inspira-tion. And yet, the fast-chang-

ing landscape of the Canadian healthcare dictates that our system needs real heroes who are bold enough to be catalysts of change and brave enough to explore un-chartered territories. From the health care standpoint, a real hero’s action, therefore, impacts not only patients at the elemen-tary level but ultimately, the effi ciency of the health care machinery.

My real nursing hero is a colleague work-ing as a Registered Practical Nurse (RPN) at the Sunnybrook Health Sciences Cen-tre in Toronto where she has been work-ing since 2000. Within that timeframe, Yvonne Ramlall has been receiving nu-merous accolades from both patients and colleagues. Her exceptional work ethic was recognized in 2009 when she received the Schulich Award for Nursing Excel-lence, the highest award given annually by Sunnybrook Hospital to outstanding and exceptional clinicians. In the nomina-tion package, colleagues commented that “while being a Registered Practical Nurse already demands much of her time, the nominee has extended her role far beyond the usual patient care routine at the hospi-tal. With her many research and mentor-ship activities, she has not only brought the role of RPNs to great heights but has also strengthened the impor-tant role of this discipline to the health care team.” With 42 members of the acute team signing a letter of sup-port for Yvonne’s nomina-tion, they added that “Pa-tients and families speak highly of the care that she provides… Yvonne contrib-utes to an inviting work place and she demonstrates the values of Sunnybrook through excellence, collabo-ration, accountability, respect, and em-powerment in her daily interactions with all team members.”

And yet, Yvonne never rests on her laurels. Recognizing the need to better understand and manage the pain experi-ence of patients, she embarked on another milestone in her career by engaging in practice-based research by completing a 2007 Registered Practical Nurses Asso-ciation of Ontario (RPNAO) Leadership Clinical Practice Fellowship Research Study program at Sunnybrook Hospital. A naturally gifted thinker, Yvonne started her research journey by asking challeng-ing and important questions and collabo-rating with experienced researchers who were both intrigued by her critical inquiry and showing support and admiration for an RPN who was going above and beyond her call of duty. When her fi rst research paper on pain management was accepted for publication in 2009 (to be followed by a second study in the same area published in 2010), Yvonne truly raised the profi le of the RPN profession. As a result of her

trailblazing career, she has been invited around the world to speak about her re-search: Ireland (2010); London, England (2011); Malta (2012); Melbourne, Aus-tralia (2013); and Capetown, South Africa (2014). And locally, she has been invited many times across the province to talk about her work. But while being invited as a speaker in various countries may already be a huge achievement, I always think that Yvonne’s greatest contribution is being an ambassador of change on how the role of the RPN in Ontario can also be replicated outside of Canada. Therefore, as an im-portant catalyst of change, her commit-ment to patient care and pain research has brought the Ontario RPN to the forefront of the Canadian health care revolution. In an article about her from the Sunnybrook magazine entitled “Feeling Her Patient’s Pain,” Yvonne remarked, “By asking ques-tions, we get answers. Sometimes those answers can tug at the heart. Not doing something about the negative outcomes will not improve the patient’s experience. Then, by not challenging yourself to ask the diffi cult questions, one will not be able to infl uence the change that is needed.” With these powerful words, it is no sur-prise she was awarded the 2014 Dr. Robert B. Salter Award from the Canadian Or-thopaedic Nurses Association (CONA).

Outside of her clinical role, Yvonne’s commitment to the nursing profession

was also felt at the RPNAO where she held a 2-year term as a

member of the Board of Di-rectors. Prior to this leader-ship role, she was appoint-ed to the College of Nurses of Ontario Council. She is also actively involved

as a member of the Execu-tive Board of the Toronto

Chapter of CONA where she helps in the planning of confer-

ences. Within the hospital, she has been actively involved in a number of commit-tees, including the Family Collaborative Committee; the Nursing Council; and was the Union Steward for RPNs at the Sun-nybrook Holland Centre.

Truly, the constantly evolving face of the Canadian health care landscape requires champions who are committed to make a difference in the lives of other people. But most importantly, our health care system requires innovative and bold leaders and practitioners who are brave enough to test the waters and explore the vast opportuni-ties that await them. At Sunnybrook Hos-pital, we have in our midst a hero whose strength lies not in weapons but in wisdom; whose strength lies not in physical power but in the commitment to make other people’s lives better; and whose dedication to work is a far cry from being fi ctitious. As a real life hero, Yvonne’s dedication to patients and the nursing profession is not only outstanding: it is exceptional. ■H

Nominated by: Jeffrey Andrion, Physio-therapist, Sunnybrook Health Sciences Centre.

Yvonne Ramlall RPNSunnybrook Health Sciences Centre

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e are writing this letter to nominate Kathy Zajac for the Nursing Hero Award. Kathy has worked in the Emergency

Department at Peterborough Regional Health Centre (previously Peterborough Civic Hospital) for more than 18 years. She is a wife, mother of two teenage boys and strong athlete, playing competitive hockey, baseball and golf.

In her numerous years in the Emergency Department Kathy has held many different roles including Charge Nurse, organizing the move into the new Emergency Depart-ment, participating in CBRN training ini-tiatives, liaising with community partners for emergency preparedness planning and most recently in a newly created role as a Resource Nurse in the department.

Kathy serves as a role model for many staff in the Emergency Department and is an excellent resource for new staff, physicians and corporately in helping to implement quality improvement proj-ects. She has a strong commitment to improving the patient experience in the department, holding herself and her col-leagues to the highest standard for de-livering excellent patient care – many times you will find Kathy speaking with a patient, their family or offering a warm

blanket and support to people in need in the department.

Regardless of the pace and volume of the work in the ED, Kathy maintains a calm demeanor, demonstrates lead-ership and is able to anticipate patients’ needs, ensuring that the entire team works to-wards exceeding patient and family expectations every day. Her sense of hu-mour, her approach to daily challenges and willingness to think outside the box and problem-solve proactively has allowed Kathy to excel and grow professionally.

The relationships that Kathy has been able to build with the staff, physicians and the leadership team at PRHC are a tes-tament to her character, dedication, and positive attitude that is present when she is working. Working closely with Kathy over the past few years, it is obvious that she is a highly engaged, motivated individual that enjoys her work and is a pleasure to work alongside – the department “feels” differ-ent when Kathy is present and her positive attitude helps to bring out the best in her colleagues, resulting in excellent patient care and a great working environment in

an often hectic, and busy department.

Most recently Kathy’s dedication to improving patient fl ow has resulted

in her trialing a new role at PRHC – the role of Re-

source Nurse; a position that is focused on ensuring patient

fl ow is maintained throughout the ED for both admitted and non-admitted pa-tients. Kathy held this position for almost one year, demonstrating the vast potential for this type of position – she was able to act as a support person for her colleagues in diffi cult situations, provide support and mentorship to the Charge Nurse, facilitate conversations with the physicians to deploy them to the areas of the department where the need was greatest and countless other daily tasks. Through Kathy’s hard work and commitment, it became apparent what the potential for the role of Resource Nurse in the department was.

The Resource Nurse position was piv-otal to making and sustaining flow im-provements in the department, creating excitement and capacity amongst the staff. Since Kathy trialed this position part-time in 2013, it has become a full-time position that is shared between two nurses and has been spread to multiple inpatient units across the organization. We are confident that Kathy played a key role in securing the success of this type of position and demonstrating the potential.

Regardless of all these things, which Kathy would say are commonplace and “just what she does”, she is modest, sarcas-tic and a well-respected member of the ED team. We appreciate everything that Kathy does for the leadership, staff and physician group at PRHC and could not imagine a more deserving nurse. ■H

Sincerely, Stella Johnson & Noel Bennett Managers, Emergency Department

716.829.8400 www.dyc.edu

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Peterborough Regional Health Centre

Kathy Zajac RN

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would like to nominate my nurse, and my colleague Shel-ley Wettlaufer whom I have known for the last few months

only. It is with great pleasure to nominate Shelley as an outstanding and dedicated person, who places the interests of our patients fi rst and foremost. A registered nurse by trade, with current registration with CNO since 1995, Shelley is the team lead for the West Community team with Mississauga Halton Community Care Ac-cess Centre (MHCCAC). She is also a care coordinator and the subject matter expert who provides a variety of support, advice, peer support and mentorship to her pa-tients, team, other health care profession-als involved in tertiary nursing care and also across MH CCAC. She continues to be instrumental in dealing with a variety of complex situations, resolving patient complaints and escalations and/or training on updates to our programs and software, or program service changes. As informal leader, Shelley acted as a liaison between teams and managers to provide direct front-line input and advocacy on work processes, programs or concerns. Her out-

standing work materialized in 2013 as she received the Exceptional People Award with MH CCAC. Shelley Wettlaufer was celebrated for her commitment to many Mississauga Halton CCAC initiatives through her continued volunteerism and leadership. She is recognized as the go-to resource person and consistently goes above and beyond to support her team. Shelley was part of the Alternate Work Ar-rangement (AWA) work-ing group and assisted in the development of the AWA program with MH CCAC, enabling our care coordinators to work from home and having a balanced work-life environ-ment. She was also presenting the AWA and the team lead models at the OACCAC conferences for the last two years. On a personal note, Shelley is a very approachable and open minded per-son and she is a role model not only for our new colleagues but to other health care professionals too. As a new member with her team, I found Shelley as a humble

but very engaged person who places the interests of our pa-

tients at the forefront of her deci-sions and I may say at her heart too.

Shelley was involved also in other pro-fessional developments and core projects, which include front line advisory com-mittee member, primary care integration project, Oakville Health Links pilot proj-ect, primary care liaison role with Oakmed health team, involvement on the selec-tion committee for formal CCAC awards

(2014), and member of the accreditation team that led to an exemplary standing ac-creditation (2014).

To me, Shelley is a perfect example of a nursing hero for her peers and her pa-tients. Shelley is truly an exceptional reg-istered nurse with a powerful vision and a tremendous infl uence to other MH CCAC colleagues and health care professionals within the circle of care. ■H

Nominated by: Hermes Clipa

Mississauga Halton Community Care Access Centre

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D’Youville offers choice for Canadianstudents seeking nursing degree

Buff alo, N.Y. - D’Youville College, a small private four-year institution near the Peace Bridge in Buff alo, has become the school of choice for thousands of Canadian students seeking an education in health care and education.D’Youville created western New York State’s fi rst four-year nursing program in the1940s and today off ers a complete array of nursing programs as well as other health care off erings. From Bachelor of Science in Nursing (BSN), Registered Nurse to a Bachelor of Science degree in nursing (RN to BSN), Master of Science in Nursing, Family Nurse Practitioner and a Doctor of Nursing Practice program, the college off ers it all. D’Youville, named aft er a well-known Canadian Saint, makes it easy for Canadians to attend. Students enrolled in the RN to BSN program receive 50 percent off tuition; all other Nursing programs receive a 10 percent discount for Canadian Students.In addition, there are Friday only classes to meet the needs of students who are working and clustered nursing courses on Th ursdays and Fridays for graduate nursing programs.Over the past fi ve years, D’Youville has invested approximately $70 million in newand upgraded campus facilities including new state of the art nursing simulation labsthat opened last year featuring the full body high tech patient simulator mannequinsthat bring amazing realism to the nursing students today. Th ese are the most advancedpatient simulators available today.Recently unveiled was another state of the art Simulation Lab to help teachstudents collaboration with a variety of health care disciplines. Th ese include pharmacy,physician assistant, physical and occupational therapy, dietetics, chiropractic andnursing, all taught at D’Youville.Th e students work together to treat a “patient” with specifi c symptoms.Th is lab features a simulated hospital room and another representing an outpatient clinic.D’Youville has been an excellent alternative for Canadian students for over 20 years.It’s within easy travel distance, aff ordable, with an accommodating atmosphere withclasses taught by professors with clinical experience.

Celebrating National Nursing Week!

www.hrh.caHumber River Hospital

Humber River Hospital Nurses: valued partners in delivering high quality patient outcomes

At Humber River Hospital, our nurses play an important role in the delivery of health care as front line providers across the continuum of hospital care. We recognize the important contributions of nurses’ knowledge and expertise to delivering high quality patient outcomes.

Strong leadership, empowered professionals, and exemplary practice are the essential foundation of nursing at Humber River Hospital. Nurses are engaged in program decision-making and are involved in various committees throughout the programs and corporate nursing councils.

Program-based advanced practice nurses, clinical practice leaders and nurse practitioners work collaboratively in partnership with the integrated healthcare teams on enhancing practice, supporting education, and participating in research initiatives.

Humber River Hospital is creating a new model of care for its community, one that places the patient and family at the centre of the care process at all times. Integrated with our new facility, now under construction in northwest Toronto,

Humber River nursing team. Currently, many of our nurses are involved in the transition planning for our new hospital, looking ahead to opening day on October 18, 2015, ensuring the move to our new home is seamless and safe for patients.

Our nurses are important partners in our organization. As they celebrate National Nursing Week, everyone at Humber River Hospital salutes our nursing team for their caring and commitment.

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or many health care providers, codeine has been somewhat of a household name in the realm of pain management.

Codeine, an opioid medication available in various forms, was commonly used to treat mild to moderate pain, and could ei-ther be prescribed or purchased without a prescription in some combination products behind the pharmacy counter. In order for codeine to do its work in relieving pain, it fi rst needs to be converted by our bodies into morphine.

But not everyone processes codeine the same. For some, the conversion is more rapid and results in higher concentrations of morphine than intended, posing a risk of toxic levels of morphine in the blood. In children and adolescents, this risk is espe-cially concerning.

“Without genetic testing, we can’t know which patients will convert codeine into more or less morphine, making it unpre-dictable, and having potentially serious consequences such as decreased breathing or even death,” says Leanne Patel, clinical pharmacist in the emergency department at McMaster Children’s Hospital (MCH).

In 2011, MCH took action to minimize codeine use in pediatric care. Codeine was

removed as an option in pediatric order sets, as well as in post-partum care, since codeine may affect infants through breast milk. Instead, morphine was encouraged as a safer alternative.

This patient safety initiative was driv-en ardently by pediatric pharmacists and physicians, and pre-empted a 2013 rec-ommendation from Health Canada that codeine use be suspended in pediatric pa-tients aged 12 or younger.

Most recently, codeine has been offi cial-ly removed from the medication formulary across Hamilton Health Sciences for pedi-atrics and post-partum women, and a deci-sion was made to expand this philosophy

to all emergency departments and urgent care centres across the Hamilton Niagara Haldimand Brant Local Health Integration Network, to demonstrate an abundance of caution with the pediatric population.

Pharmacists at MCH have supported the process change from the beginning with education, resources and follow-up with physician prescribers and learners. The hospital has shared its policy and edu-cational materials with community part-ners, including smaller community hospi-tals and pharmacies, to encourage further

uptake of the “no-codeine” philosophy for children.

“One of our responsibilities as leaders in pediatric emergency medicine is to work with our community partners to ensure we are all providing the safest, most effec-tive care to children,” says Dr. Anthony Crocco, emergency physician at MCH and head of pediatric emergency medicine at McMaster University. ■H

Calyn Pettit is a public relations specialist at Hamilton Health Sciences.

Not everyone processes codeine the same. For some, the conversion is more rapid and results in higher concentrations of morphine than intended, posing a risk of toxic levels of morphine in the blood.

Kids and codeine:

By Calyn Pettit

F

Leanne Patel, clinical pharmacist and Dr. Anthony Crocco, pediatric emergency physician have led a patient safety initiative at McMaster Children’s Hospital that has eliminated the use of codeine, which can be harmful for some children, in pediatric care at the hospital.

Continued from page 5She completed her master’s degree

in 1980. The demands of a young family and the absence of any Canadian doctor-ate programs in nursing made a PhD dif-fi cult. Then, Forchuk met nursing theorist Hildegard Peplau, who pressured her to go to the U.S. for a doctorate. Forchuk completed her PhD in 1992 at Detroit’s Wayne State University.

Through her work at the psychiatric hospital in Hamil-ton, Forchuk learned some psy-chiatric clients feared leaving the hospital because the staff and fellow clients were their only family and friends. A col-laboration between staff and clients was launched with the goal of improving relationships between hospitals, community health providers, and peer sup-port networks.

“Some studies have found as many as 43 per cent of suicides happen in the month after discharge,” she says. “As well, most re-admissions happen (then). Yet this is the period when we have this huge gap between hospital and community.”

In January 2015, Forchuk released the results of a study that found supportive, therapeutic relationships decrease lengths of stay by nearly 10 days, saving the health system approximately $30 million. She says it’s frustrating that her research has not led to change across the health system, but she understands why. It takes time and resources to collaborate between

the hospital and community sectors.The situation is more precarious for psy-

chiatric clients without a home. Forchuk began working in London in 1994, around the same time she started to fi nd psychiat-ric survivors living in shelters. It was the

beginning of an era in On-tario that saw public hous-ing costs transferred to mu-nicipalities, welfare rates slashed, and deinstitution-alization that brought more clients to the community.

“People weren’t connect-ing the dots to see this was a disaster in the making,” she recalls.

Twenty years on, For-chuk says the real solutions need to come from a level of government that can prop-erly fund housing. In Janu-ary, she became a member of the Liberal government’s new Expert Advisory Panel on Homelessness and she is eager to take her advocacy

to the next level so no one is ever made to feel like “garbage.”

The Registered Nurses’ Association of Ontario (RNAO) is the professional as-sociation representing registered nurses, nurse practitioners and nursing students in Ontario. For more information about the association, or to become a member, visit www.RNAO.ca ■H

Jill Scarrow is a freelance writer in Burlington, Ontario.

Marginalized populations

Eliminating the risk, for safer pain management

Cheryl Forchuk is the assistant director at Lawson Health Research Institute and a distinguished professor at Western University



n the morning of January 14, 2015, Mount Sinai staff from across the organization crowd-ed into the auditorium to learn

and celebrate some thrilling news: Mount Sinai was the fi rst hospital in Canada to achieve Magnet® status, a prestigious, international credential that measures excellence in nursing and patient care. Awarded by the American Nurses Creden-tialing Center, only about seven per cent of American hospitals have this designation, placing Mount Sinai among the top tier hospitals in North America.

Joining the ranks of Magnet-recognized hospitals is a source of great pride for me and everyone at Mount Sinai. As a nurs-ing professional and senior hospital leader, it reinforced for me the importance of em-powering those who are directly involved in patient care and ensuring they have a voice in decision-making. Our Magnet status shows that our efforts in these areas and others have yielded real, measurable improvements in patient outcomes – al-ways the most important metric.

The Magnet Recognition Program® supports professionalism in nursing by promoting autonomy, infl uence, advocacy, professional development, leadership and shared decision making. Alignment with the program underscores the high standard of nursing at Mount Sinai and our commit-ment to constantly raising the bar of excel-

lence to benefi t our patients and staff. The designation refl ects a long-term, full-scale team effort to continually improve patient care at the hospital, supported by every group at the hospital.

The journey to MagnetThe Magnet Framework specifi es a set

of factors, supported by evidence, that are important for establishing positive work environments that support professional nursing practice resulting in quality pa-tient, organizational and system outcomes. The pillars of this framework are: Trans-formational leadership; structural empow-erment; exemplary professional practice; and new knowledge, innovations and im-provements. Not only are these Magnet principles, but they are the foundation for nursing professional practice and support Mount Sinai Hospital’s commitment to delivering ethical, safe, quality, evidence-based care.

I’d like to share some examples of these foundational changes. Led by the nursing team and supported by staff and leaders from every area of the hospital, these ef-forts helped Mount Sinai achieve Magnet status.

Transformational leadershipAt Mount Sinai, leadership is about

more than just the position you hold – it’s about demonstrated leadership through action and a commitment to excellence. Nurse leaders at all levels exemplify Mount Sinai’s values, mentor their colleagues, ad-vocate and infl uence change to benefi ts patients and their families.

So when a nurse in our Neonatal Inten-sive Care Unit (NICU) proposed special training and certifi cation for NICU nurses to reduce infections from Peripherally In-serted Central Catheter (PICC) insertions, her recommendation was accepted. A se-lected PICC team was established from volunteer nurses and put into action. They quickly saw a signifi cant drop in PICC-related infections. This early success led to an expanded role within the unit. The leadership of this team resulted in a change in the work environment and to neonatal outcomes.

Structural empowermentNurses at Mount Sinai Hospital are en-

couraged to play an active role in organi-zational and professional decision-making. Fostering empowerment and increasing di-rect care nurses’ voices in decision-making is a key strategy within the Department of Nursing, and participation in both external and internal decision-making bodies is en-couraged, promoted and expected.

The organizational structure of our clin-ical teams is designed to ensure that deci-sions are made with full interprofessional participation. Interprofessional teams make up committees and councils that ac-tively shape care at every level.

For example, the hospital’s Effective and Effi cient Utilization Committee took ac-tion when the nurses in the Pre-Admission Unit noted that many of the diagnostic tests routinely ordered were unnecessary. The fi ndings informed a revised process that reduced the number of tests, saving time and funds. These changes also im-proved experience of the 6,000 patients prepared for surgery each year in the unit.

Exemplary professional practice

As an internationally-recognized aca-demic health sciences centre affi liated with the University of Toronto, Mount Sinai is committed to teaching the next generation of health-care professionals, encouraging continuous life-long learning, and developing its professional staff. Our Nursing Department actively supports the development of nurses through profes-sional nursing organizations at the local, provincial and national levels. Our nurses’ commitment to professional development is apparent and ongoing. Recognizing that

professional certifi cation is closely tied to clinical excellence, the Department of Nursing is working to increase the number of certifi ed nurses by fi ve per cent year-over-year.

New knowledge, innovations and improvements

Using evidence to create knowledge, inspire innovation and improve patient safety and outcomes is an essential com-ponent of professional nursing practice, and top priority for our team that can make a real difference for our patients. We use Sinai-specifi c data, as well as national benchmarks, to monitor and evaluate performance to help inform our practices and provide learning opportu-nities. This is critical to giving our nurses more opportunity to ask important ques-tions and support evidence-based care, both essential for improving patient out-comes.

For example, hand hygiene compliance data informed the allocation of nurse hand hygiene champions on each unit. With their initiatives promoting hand hygiene practices, we’ve seen greater adherence to hand hygiene policies (in-creased to 86 per cent) and a correspond-ing decrease in hospital-acquired Meth-icillin-resistant Staphylococcus aureus infections (dropped to zero per cent).

The next stepsAll of these nursing practices and pro-

grams work together to create the kind of collaborative, evidence-based, sup-portive environment that contributed to Mount Sinai’s Magnet status. The leader-ship of our nurses and clinicians and the commitment of the entire team at Mount Sinai have created a culture dedicated to giving our patients the best care. Receiv-ing Magnet recognition was a wonderful and proud moment for everyone at Sinai. It is an important acknowledgment of the ongoing journey of development and im-provement that underpins our continu-ous quality improvements at all levels of the organization. ■H

Mary Agnes Beduz is Vice President Professional Practice and Associate Chief Nurse Executive, Mount Sinai Hospital.

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Mount Sinai’s journey to Magnet statusBy Mary Agnes Beduz

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Mary Agnes Beduz announces Magnet recognition

Mount Sinai cheers news of Magnet recognition



avid Gallagher had just fi n-ished a two week European cruise when he found himself inexplicably short of breath

and unable to make his way through the airport to visit family in London. Days after arriving in the UK, Gallagher was rushed to hospital, where he spent two weeks and received three blood transfusions. Doctors told him that he contracted a virus that had reopened an old ulcer and had further constricted his aortic valve. Once he was well enough, Gallagher’s daughter fl ew out to bring him home. Still, he was barely able to get out of a chair to walk from room to room.

Gallagher’s cardiologist at Trillium Health Partners suggested that he undergo Transcathether Aortic Valve Implantation (TAVI), a procedure used to treat patients with severe Aortic Stenosis. If left untreat-ed severe Aortic Stenosis poses a high risk of progressive symptoms or even death. The only effective treatment is to replace the diseased valve through open heart surgery or TAVI. Many patients suffering from aortic stenosis undergo open heart surgery to treat the condition. However, there is a portion of the patient population who are considered high risk and are not eligible for open heart surgery. For a num-ber of reasons Gallagher fell into the high-risk category. TAVI is a less invasive, safe and effective treatment option for high risk patients, which is only available in a hand-ful of hospitals in Ontario.

Thankfully, Gallagher was able to re-ceive the TAVI procedure at Trillium Health Partners. “Through commitment and innovation we have been able to pro-vide our patients with the best quality care closer to home,” says Elena Holt, Program Director, Cardiac Health, Trillium Health Partners. “We are so proud of what we have been able to accomplish with this program.”

Trillium Health Partners recently cel-ebrated a milestone when it completed its one hundredth TAVI procedure. The hospital performed its fi rst case in February 2012.

Gallagher underwent TAVI on Sep-tember 2, 2014. A day later he was up and walking around. “The nurses kept telling me to slow down but I didn’t want to stop. I felt great,” says Gallagher. Four days af-ter his procedure Gallagher was discharged from hospital. Almost eight months post-TAVI Gallagher has a new lease on life.

“I feel like my old self again. I am able to go for walks and spend quality time with my family. I am so grateful. Before TAVI my family really didn’t think I was going to make it, I was so weak and short of breath. By next year I will be ready to run in the Olympic Games!” says Gallagher. “It really is an amazing, life changing procedure”

Nancy Pearce, a TAVI nurse at Tril-lium Health Partners could not agree more. Pearce works with all of the TAVI patients and witnesses the transformation fi rsthand. “It is wonderful to see and hear patients and their families comment on the signifi cant improvement in their quality of life following the TAVI procedure,” says Pearce.

Pearce also commented on the pro-fessionalism and teamwork of the TAVI

group. TAVI procedures combine the clin-ical expertise of both the Interventional team and Cardiovascular Operating team to support the patients through this mini-mally invasive procedure.

“Over the last few years, we have gained clinical expertise and have developed an awesome, collaborative team that sur-rounds our patients with excellent care. We work incredibly well together. It is not often that you see a team working so seam-

lessly together. It is unique and we are very proud of that,” Pearce adds.

Trillium Health Partners’ Regional Car-diac Program now receives funding for its TAVI volumes and has established itself as a TAVI Centre. ■H

Catherine Pringle is a Senior Advisor, Communications, Public Affairs and Partnerships at Trillium Health Partners.

VS.

YOUR ADVANTAGE, in and out of the courtroom.

www.thomsonrogers.com

Innovative procedure gives high-risk patients a new lease on lifeBy Catherine Pringle

D

Trillium Health Partners recently celebrated a milestone when it completed its one hundredth TAVI procedure.


14 Focus SURGICAL PROCEDURES/PAIN MANAGEMENT/PALLIATIVE CARECover story

The assisted dying debateor the fi rst time in his life, Dr. Donald Low was wrong. The renowned Toronto Microbi-ologist who passed away from

a brain tumour in 2013, thought physician assisted dying would take years to become legal in Canada. He shared that opinion in a video that was recorded eight days before he died.

“It will be a long time before we mature to a level where we accept dying with dig-nity,” proclaimed Low on September 2013. “There’s a lot of opposition to it; a lot of clinician opposition to dying with dignity. I wish they could live in my body for 24 hours and I think they would change that opinion. I’m just frustrated, not being able to have control of my own life; not being able to make the decision for myself when enough is enough.”

For many Canadians, Low became the face of assisted suicide in Canada when his video plea went viral on YouTube. Low,

who had previously been hailed a hero for his leadership in easing public concern during the 2003 SARS crisis, was now ask-ing for the public’s help as he fought the battle of his life.

“Don was an advocate for death with dignity and I hope his courage to tell people that changed the conversation in this country,” says Maureen Taylor, Low’s widow, a former National Health Reporter with the Canadian Broadcasting Corpora-tion and now a Toronto-based Physician Assistant. ”He would be happy about the Supreme Court’s decision in February [to legalize assisted death in Canada] because he believed Canadians were ready for this. But I also think the ruling would’ve sur-prised him because it came a lot faster than he expected,” she adds. “Don was always right, but if he was here now, I would wave my fi nger at him and say Don, you were wrong.”

While there’s no specifi c evidence to suggest Low’s video infl uenced the deci-sions of Canadian law makers, his passion-ate address elevated the topic of assisted suicide in Canada – once again – to the forefront of discussions across the country.

Assisted suicide in Canada has a long and controversial history. In 1972, the fed-eral government permitted attempted sui-cide and the legal right to refuse medical treatment originated at the same time, as technology in medicine granted physicians the ability to keep patients alive longer. In the 1970s, a string of court cases won a mentally capable person the right to refuse medical intervention.

Today, the argument over patient free-dom centres around issues of active eutha-nasia and assisted suicide, as patients who live in constant, unbearable pain or with a deteriorating or terminal illness such as Alzheimer’s and Multiple Sclerosis battle for the right to choose to die.

These arguments are reinforced by the infl uence of other jurisdictions – U.S. states that have legalized assisted suicide, including Oregon (and the media atten-tion surrounding the Brittany Maynard case); and European countries including, The Netherlands, Luxembourg and Swit-zerland, where assisted dying is an accept-ed legal practice. Assisted dying advocates like Steven Fletcher, Winnipeg Conser-vative Member of Parliament, also play a role in bringing cases of assisted suicide in Canada to the forefront. In March 2014, Fletcher introduced two private member bills – one permitting physicians to assist people in ending their lives under specifi c conditions and the other proposing a com-mission to monitor the system.

Also – let’s not forget what happened last June, when The National Assem-bly in Quebec passed Bill 52 – the ‘death with dignity’ law – allowing terminally ill patients to receive medical aid in dying in that province. The bill replicates the Eu-ropean model of assisted dying by includ-ing those individuals experiencing unbear-able suffering, but who may not be within months of dying.

Interestingly, in a 2014 poll facilitated by Dying with Dignity – a Canadian char-ity – 84 per cent of Canadians surveyed agreed that “a doctor should be able to help someone end their life if the person is a competent adult who is terminally ill, suffering unbearably and repeatedly asks for assistance to die.” The assisted suicide poll surveyed more than 2,500 Canadians and was conducted online by Ipsos, a mar-ket research company, last August.

So what does public opinion about as-sisted suicide in Canada imply about Ca-nadians now, since the Supreme Court rul-ing; and, what is the impact on Canadian physicians?

“The profession as a whole acknowl-edges that society is in favour of [assisted dying]. It’s pretty clear in all the opinion polls and there is a social expectation that we develop some way to do this,” says Dr. Chris Simpson, President of the Canadian Medical Association (CMA); Professor of Medicine and Chief of Cardiology at Queen’s University; and Medical Director of the Cardiac Program at Kingston Gen-eral Hospital and Hotel Dieu Hospital.

While Simpson admits he expected what the ruling delivered, he noted that it being ‘unanimous’ came as a surprise to him and many other physicians in the CMA membership.

“[Also surprising was] the fact that they didn’t refer to terminal illness, it was very much how the patient defi ned intoler-able suffering. It was a defi nitive judgment when I was expecting a little bit more,” adds Simpson. “It [the ruling] leaves a lot of unanswered questions around the de-tails. If the federal government declines to replace the legislation, then it’s going to be up to a group like ours to determine clinical guidelines and how it’s going to be regulated. It’s part of our civic profession-alism. On issues like this we need to show leadership and we intend to do that.”

According to Simpson, assisted dying among Canadian physicians as a whole is a “really emotional” subject.

“While half to two thirds of physicians would not want to assist suicide, the ma-jority of the profession understands there is a role even if most of us personally feel we don’t want to be involved in that,” says Simpson. “[Above all], we think there should be a way to provide service to all Canadians who need it.”

Although polls and other tools that gauge public opinion appear to be in fa-vour of assisted death in Canada, there remains a strong opposition, comprised of many individuals and organizations that make up that opposition – all of whom are fi ghting to have their voices heard.

Dr. Will Johnston, Chair of the Eutha-nasia Prevention Coalition in British Co-lumbia is one of those voices. He says the Supreme Court’s ruling on assisted sui-cide was “reckless and had the hallmarks of a predetermined outcome.”

“The Supreme Court has left itself in a position where it is hard to understand who they would say no to, to a request for assisted suicide,” Johnston explains. “They pointed out that you don’t have to be terminally ill or physically suffering. You have to be an adult, but the Charter forbids age discrimination. You are sup-posed to be competent, but the door has been left open for the next court to en-dorse killing of those now incompetent based on wishes expressed in the past. Basically, there is nothing in the ruling to prevent the abuses we have seen in Europe.”

Johnston adds that the kind of irre-sponsibly wide open ruling that the Su-preme Court has created “is like tossing a hand grenade to parliament which has been told to make a rigorous and strin-gent law. With the lack of checks and balances, it remains to be seen how effec-tively the government can do this.”

Dr. Catherine Ferrier, President of the Physicians’ Alliance against Euthanasia and a Montreal physician who works in the division of Geriatric Medicine at the McGill University Health Centre, is also opposed to physician assisted death in Canada. Ferrier, who has focused her career on caring for patients with demen-tia, says Canada needs to pay attention to the “slippery slope” and protect those people who are vulnerable to abuse.

“Killing is not healthcare. To say peo-ple suffering from dementia are better off dead is an insult to my patients and other people who have dementia,” she says. “The goal of medicine is to preserve life, to support people who are facing death, not to cause the death of patients. In the Quebec law, they defi ne euthanasia as a medical act. But it’s not a medical act. It’s an act contrary to the goals of medicine.”

Ferrier says people are answering polls based on a misunderstanding of what words mean. In other words, the notion that to be “dignifi ed,” a person has to be fully autonomous, Ferrier says, is basi-cally taking words and “redefi ning them.”

Instead of focusing on assisted death, Ferrier strongly urges Canada to look at the problems and fi x these problems. She says that someone who expresses the need to die is someone who is “asking to receive better care.” That they don’t mean it when they say they want to die; “they mean help me; help me to feel bet-ter so that my life has value.”

By Sarah Quadri Magnotta

F

“Killing is not healthcare. The goal of medicine is to preserve life, to support people who are facing death, not to cause the death of patients”Dr. Catherine Ferrier, President of the Physicians’ Alliance against Euthanasia

What does the Supreme Court’s ruling on Assisted Dying mean for Palliative Care in Canada?

• 70 per cent of Canadians don’t have access to Palliative Care

• The Canadian Medical Association (CMA) estimates that between 16 and 30 per cent of Canadians who would benefi t from good palliative care receive it, out of the 250,000 people who die every year

• The CMA affi rms their commitment to increasing awareness and improving palliative care across Canada

• Statistics show that in jurisdictions where assisted death is legal, high quality palliative care is defi ned as “excellent”

• According to Statistics Canada, approximately 70 per cent of Canadians will die in a hospital and of those who do, 10 to 15 per cent will be admitted to an Intensive Care Unit

• In a Canadian study published in the Canadian Medical Association Journal (CMAJ) in November 2014, Dr. John You and his team discovered doctors weren’t having enough conversations about a patient’s end-of-life choices

• Visit http://www.advancecareplanning.ca/making-your-plan.aspx to learn more about end of life care options

t does the Supreme



“What we really need is to improve pal-liative care and ensure that people have access to expert end-of-life care,” she ex-plains. “There is a lack of access to pallia-tive care services and to doctors who are trained to administer palliative care. Be-cause of this lack of resources and training, people don’t always get good care at the end-of-life.” Also, palliative care, as it has developed, is focused mostly on patients dying from cancer. With other diseases we don’t know when people are going to die, and their needs may not be the same. They also need to receive high quality end-of-life care. Ferrier feels strongly that every-body who is looking after patients who are dying “should have the skills to care for patients in end-of-life. That means hav-ing a team, with a diversity of medical and psychosocial skills, which can address all the needs of the patient.”

Palliative care and protecting the vulnerable population are at the fore-front of Simpson’s mission and message as CMA President.

Simpson points out that many people assume if there is a focus on medical aid and dying it will distract from a focus on palliative care. However, he adds that what he’s seen in other jurisdictions, in Europe and the U.S., the opposite actu-ally occurs, where there is more emphasis placed on palliative care and it “raises the bar for the entire end-of-life experience.”

“We’re still going to be very heavily based on palliative care,” Simpson says about the CMA’s position. “We have a white paper coming out shortly and we’re

going to be really promoting palliative care. There are pockets in Canada of real excel-lence in palliative care. Across the country it’s been estimated that between 16 and 30 per cent of Canadians who would benefi t from palliative care receive it. There’s not enough palliative care available and we need to work on that.”

“We also need to address the vulner-able population, with regards to assisted death,” Simpson adds. He says that hav-ing legislation will make the system better and will be a very clear “rulebook” for ev-eryone to follow, ensuring the appropriate safeguards are in place for people who may face abuse in the case of assisted death.

With two sides to a very controversial and complex issue, what does the future hold while the Canadian law makers are deciding how to proceed?

“It’s a two prong strategy,” says Simp-son. “We’re [the CMA is} working to generate a detailed guideline of what as-sisted dying will look like. As we develop this we will be reaching out to provincial regulatory bodies and the federal govern-ment directly, ensuring that we have some mechanism to stay in touch, to make sure the end results are harmonized.

At its foundation, assisted dying is like any other health care issue in this coun-try – it’s about patient care, so how does Simpson think patients benefi t from ac-cess to assisted dying?

“We’ve seen that the majority of people in other jurisdictions derive so much com-fort from having the drugs. It’s the notion that they have the control – knowing that it’s [assisted death] an option re-establish-es control even though few people will ac-tually use it.”

Almost two years after Low’s death, Taylor says having control is paramount.

“If we lived in Oregon and Don had the prescription [for the lethal medication], he would’ve been calmer,” Taylor says. “He would’ve put it in his bedside table and the anxiety may have dissipated a little if he just knew it was going to be available.”

As she plans the days ahead, with hopes of greater healing and remembering her husband’s “better” days – before a termi-nal diagnosis – Taylor is passionate about helping Low’s grandchildren to remember

him – “what a great man he was and what he did for infectious disease in Canada.” She will also remain an advocate for as-sisted dying, fi ghting for what she knows her husband wanted.

“There is no slippery slope,” she says. “Assisted dying will come to Canada and we are ready for it. Canada will do this in a compassionate way, allowing access to those who need it and putting the proper safeguards in place for those who shouldn’t be using the program.” ■H

Sarah Quadri Magnotta is a Hospital News Advisory Board Member and a Toronto-based freelance journalist. Sarah is currently completing a Master’s of Science Degree in Strategic Communications at Columbia University in the City of New York.

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The Supreme Court has left itself in a position where it is hard to understand who they would say no to, to a request for assisted suicide”Dr. Will Johnston, Chair of the Euthanasia Prevention Coalition in British Columbia

Understanding the Supreme Court of Canada’s ruling on Assisted Dying in Canada

• February 6, 2015 – Supreme Court votes unanimously in favour of doctor-assisted death in specifi c cases

• The ruling states that competent adults with grievous and irremediable medical conditions have the right to ask a doctor to help them die

• The court has given federal and provincial governments 12 months to craft legislation to respond to the ruling. Until such time, the ban on doctor-assisted suicide remains in place. If the government doesn’t write a new law, the court’s exemption for physicians will stand

• The case was brought forward by the B.C. Civil Liberties Association on behalf of two women, Kay Carter and Gloria Taylor, both of whom have since died. A lawyer on behalf of Carter and Taylor argued that the two women were being discriminated against because their physical disabilities didn’t allow them to kill themselves the way able-bodied people could

• The decision comes 22 years after the Supreme Court rejected a claim by Sue Rodriguez, a British Columbia woman with amyotrophic lateral sclerosis (ALS), to have a doctor help her to commit suicide

• With this ruling, the rest of Canada joins Quebec which passed Bill 52 – the ‘death with dignity’ law – allowing terminally ill patients to receive medical aid in dying in that province as of June 2014

di h S

“The profession as a whole acknowledges that society is in favour of [assisted dying]. It’s pretty clear in all the opinion polls and there is a social expectation that we develop some way to do this.” Dr. Chris Simpson, President of the Canadian Medical Association


16 From the CEO's Desk

ore often than not, when a patient stops to tell me about his or her experience receiving services from Providence Care,

the key component of the feedback is not a critical review of the actual, technical care interventions we provided. Rather, they fo-cus on how our staff made them feel, how comfortable they were in our hospitals or long-term care home, or how they were treated with respect and compassion.

I began my career in healthcare as a nurse. As we focus on Nursing Week this month, I am refl ecting on the huge oppor-tunity we have as nurses to infl uence the patient experience each and every day.

The role of the nurse is evolving beyond traditional bedside care, and it is exciting. Few other professions offer such a wide range of specialties, work environments, and opportunities. At Providence Care, nurses are leading quality improvement, championing new technologies and advo-cating for vulnerable populations.

For example, Providence Care’s nurses are improving the experience of patients with pressure ulcers. Over the past few years, our nursing staff have led initiatives to reduce the severity of these wounds amongst our inpatients and residents.

Their work to review best practices, ana-lyze our data, listen to and understand the needs of the people we serve has paid off. We’ve seen improvements in both the quality of care we’re able to deliver, and cost reductions because of more effi cient use of our resources.

This is just one example of nurse-led quality improvement – there are hundreds more. Recently, Providence Care celebrat-ed the groundbreaking of the Napanee Area Community Health Centre, where our community mental health teams will be co-located with other local health ser-vices. It’s the third service “hub” we’ve been a part of establishing in past years, thanks to the connections, commitment and hard work of many frontline care-givers, including nurses as well as Allied Health staff and physicians.

Long-term care is another exciting frontier for nursing, with new roles for Advanced Practice Nurses and Nurse Practitioners, as well as nurses with spe-cialty training in areas like mental health. We continue to strengthen our Seniors Mental Health outreach and mobile re-sponse teams at Providence Care. Nurses on these teams work alongside the staff at long-term care homes to observe and assess residents who require behavioural supports (due to dementia or other ill-ness), and help create care plans that are person-centred and meet their needs. The impact is, in many cases, fewer visits by long-term care residents to the emergency room, and an improved care experience for the resident and often their families as well.

People often speak about how complex our health care system is, and how nurses can be navigators for patients who are transitioning between providers or try-ing to understand where to go to receive the right level of care. I’ve referred to several examples of how nurses are now working “beyond the bedside” to make a difference.

And yet, when I think about the role of the nurse and how it has changed and

grown since I began my own career as a frontline staff at a Toronto hospital, there’s a key piece that’s still the same.

Like all of us who work in healthcare, at Providence Care and across the system, the biggest way we make a difference in the lives of patients is by providing great care, and that has not changed since I gradu-ated from nursing school. As nurses, there are opportunities every day to think about what we can do for individual patients, clients and residents, to enhance their lives and improve their wellbeing. While our profession is evolving, it is founded on compassion – and we continue to see that lived out today. ■H

Cathy Szabo is President & CEO, Providence Care (Kingston, Ontario).

The evolving role of nurses – and what has stayed the sameBy Cathy Szabo

M

As nurses, there are opportunities every day to think about what we can do for individual patients, clients and residents, to enhance their lives and improve their wellbeing.

Cathy Szabo



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May 5-6, 2015 Human Resource Strategies for Healthcare Toronto Website: www.healthhrcanada.com

May 6-9, 2015 13th Annual Primary Care Today The International Centre, Toronto Website: www.pri-med.ca

May 20, 2015 Multi-Incident Analysis Workshop – Analyzing medication incidents one group at a time ISMP Canada 4711 Yonge Street, Toronto Website: http://www.ismp-canada.org

May 27-29, 2015 Annual Achieving Excellence Together Conference Western Harbour Castle Hotel, Toronto Website: www.oaccac.com

May 28-30, 2015 Collaborative Care – Imaging and Treatment Palais des congress, Montreal Website: www.jointcongress.ca

May 28-30, 2015 CIRA Annual Meeting Le Centre Sheraton, Montreal Website: www.ciraweb.org

May 29-30, 2015 Global Telehealth 2015 Metro Toronto Convention Centre, Toronto Website: www.coachorg.com

May 31-June 3, 2015 eHealth Metro Toronto Convention Centre, Toronto Website: www.e-healthconference.com

June 11-12, 2015 National Conference On Dementia Care Toronto, ON Website: www.insightinfo.com/national-conference-dementia-care/

June 14-17, 2015 IPAC Canada 2015 National Education Conference Victoria Conference Centre, Victoria BC Website: www.ipac-canada.org

June 24-25, 2015 Health Canada Regulatory Reforms Toronto, Ontario Website: www.pharmaregulatory.ca

September 15-16, 2015 National Elder Friendly Hospital Conference Marriott Bloor Yorkville, Toronto Website: www.healthcareconferences.ca

September 30-October 1, 2015 3rd Annual National Forum on Patient Experience Toronto, Ontario Website: www.patientexperiencesummit.com

or many of us, describing physical pain can be as sim-ple as saying “ouch” when we stub our toe. But as a clini-

cian, what happens when your client can’t clearly communicate how much pain they are in?

This situation is common for many clini-cians at Holland Bloorview Kids Rehabili-tation Hospital who often meet children who have diffi culty communicating the kinds of physical pain they feel due to a disability or medical condition.

Children with cerebral palsy (CP) ex-perience multiple sites and sources of on-going pain due to changes in the body as a result of CP. In many cases, acute and procedural pain is recognizable to a clini-cian or parent, whereas chronic pain is more likely to be missed. In fact, a Holland Bloorview study showed that 25 per cent of children with CP experienced pain that af-fected participation in everyday activities.

“If clinicians are able to accurately as-sess pain, they can work with families to help develop appropriate interventions to manage pain” says Nick Joachimides, Man-ager of Patient Safety at Holland Bloor-view. However, pain in children with dis-abilities is an area with little research and consensus, leaving clinicians with a limited number of uniform pain assessment and in-tervention tools to turn to.

The Evidence to Care (EtC) team at Holland Bloorview was created in 2011 to tackle exactly this type of gap in knowl-edge. The team facilitates the identifi ca-tion of the best available research evi-dence, and then works with clinicians to inform new approaches to care. It is part of Holland Bloorview’s ongoing commit-ment to transform care through evidence, knowledge generation and translation.

After getting input from a multidisci-plinary clinical group, researchers and fam-ily leaders, the Chronic Pain Assessment Toolbox for Children with Disabilities was identifi ed as one of EtC’s fi rst priority projects.

Building the Toolbox required a work-ing group led by EtC team to complete a systematic review of pediatric chronic pain assessment tools and a structured review of clinical practice guidelines. An expert con-sensus activity was also completed to iden-tify the best tools and resources to include for clinicians.

The fi nal Pain Toolbox combines pain as-sessment recommendations from the 2013 Registered Nurses Association (RNAO) Best Practice Guideline, the CP-specifi c practice points developed by experts at Holland Bloorview and fi fteen assessment tools to identify chronic pain and look at the impact pain has on a child’s everyday activities.

To bring this new knowledge into prac-tice, the EtC team worked with Holland Bloorview’s Centre for Leadership in Childhood Development to lead a pilot project assessing chronic pain in children who have CP.

“Asking about pain and its impacts has always been a key part of our assessment,” explains physical therapist and EtC clini-cian champion Katie Symes, “The chronic pain toolbox allows us to do this in a more standardized way, using tools that are reli-able and sensitive to change.”

The Toolbox provides a range of meth-ods and techniques that can be customized for children with CP who may have dif-ferent ways of explaining the kind of pain they experience.

Understanding how pain affects the livelihoods of children with CP is not only important for clinicians, but also Holland Bloorview clients and their families.

“Pain management is crucial. It impacts all aspects of my son’s life,” explains Jan Magee whose teenage son Wesley has CP. “When he’s in pain it may mean he can’t use his walker, or he can’t focus because the pain is distracting him. It affects his mobility, his independence, his mood – all aspects that affect his overall quality of life.”

The Toolbox has now been successfully piloted in a numbers of outpatient clinics at Holland Bloorview.

Dr. Anne Kawamura has used the Tool-box at Holland Bloorview’s Pediatric Re-habilitation clinic. Kawamura worked with EtC to select the best tools for her clients. She agrees that the Toolbox facilitates a more consistent approach to pain assess-ment.

“We weren’t missing pain in large num-bers of children,” says Kawamura, “How-ever for those who were experiencing pain, it was a signifi cant issue for them.”

By providing a comprehensive list of methods to identify the degree and types of pain in children with disabilities, the Toolbox is having signifi cant and positive impact on pain management at Holland Bloorview.

With funding support from the Govern-ment of Ontario and the hospitals’ Foun-dation, Holland Bloorview is able to share its new knowledge and promote evidence-informed pain assessment broadly within the healthcare system. The Toolbox and manual to support its implementation is now available at www.hollandbloorview.ca/toolbox. ■H

Michelle Halsey is a Senior Communications Associate at Holland Bloorview Kids Rehabilitation Hospital.

Tools of the trade:

By Michelle Halsey

F

Pain in children with disabilities is an area with little research and consensus, leaving clinicians with a limited number of uniform pain assessment and intervention toolsto turn to.

Providing methods to help children with chronic pain


18 Health Care Technology

hile we all experience pain, it is estimated that about 340,000 Canadians suffer from chronic neuropathic

pain. The International Association for the Study of Pain describes neuropathic pain as “pain caused by a lesion or disease of the somatosensory nervous system”, which includes muscles, bones, joints, and other sensory systems. Patients of-ten describe neuropathic pain as burn-ing, stabbing, shooting, aching, or like an electric shock.

Currently there is no proven cure for neuropathic pain but one technology that is not well-known, and is, as a result, an underutilized treatment option, is spinal cord stimulation (SCS).

SCS neurostimulators are about the size of a pacemaker (approximately 4 cm in diameter), and are typically placed un-der the skin of the abdomen. Like a pace-maker, the device used for SCS consists of two parts: an implantable medical device called a neurostimulator and thin, fl exible wires called leads. Instead of delivering electrical impulses to the heart, how-ever, the neurostimulator delivers them through the leads to the epidural space

in the spinal cord. Normally, pain signals travel through the nervous system in the spinal cord, but the electrical pulses sent from the neurostimulator modify these pain signals before they reach the brain.

Neurostimulation, including SCS, was fi rst developed in the 1970s by Medtronic and now over 260,000 people worldwide have benefi tted from SCS. In Canada, SCS therapy is indicated for the manage-ment of chronic, intractable pain of the trunk and/or limbs.

Despite its long history, many people are unclear about the evidence support-ing the effectiveness of SCS compared to other forms of treatment for chronic neu-ropathic pain. A recent article by Toronto Western Hospital neurosurgeon Moham-med F. Shamji in The Journal of Current Clinical Care sheds some light on the ef-fectiveness and indications for SCS, in-cluding leg-dominant failed back surgery syndrome, chronic inoperable limb isch-emia, and painful diabetic neuropathy.

Leg-dominant failed back surgery syndrome represents persistent neuro-pathic leg pain following structurally cor-rective spinal surgery. Shamji notes that a large multi-centre randomized controlled

trial for patients with failed back surgery syndrome found that 58 per cent of study subjects receiving SCS exhibited substan-tial pain relief versus only 17 per cent relief for those receiving conventional medical management. Another large trial had similar fi ndings (47 per cent of pa-tients receiving SCS saw substantial pain relief versus only 11 per cent for study subjects receiving conventional medical management).

Chronic inoperable limb ischemia is limb pain that occurs at rest, caused by a severe compromise of blood fl ow to the affected extremity. Shamji highlights a meta-analysis of six studies and nearly 450 subjects found pain relief were more frequently observed in the SCS group than in the medically treated group.

Painful diabetic neuropathy (PDPN) is a common complication of diabetes. SCS use in patients with PDPN was ex-plored in a multi-centre randomized clinical trial in which both pain and qual-ity of life were substantially improved in the SCS group compared with medical management and at six months 23 per cent of SCS participants were free of all analgesic use.

What does this mean for physicians?

Shamji concludes that while the man-agement of neuropathic pain can be chal-lenging, “it is incumbent on physicians managing chronic pain to be familiar with the array of potential interventions.” Moreover, he notes that as technology ad-vances, the use of SCS will only grow.

in spinal cord prove effective for chronic painBy Pam Winsor

W

Continued on page 19

SCS neurostimulators are about the size of a pacemaker (approximately 4 cm in diameter), and are typically placed under the skin of the abdomen.

Electrical pulses



hronic disease accounts for nearly 75 per cent of all deaths in Canada each year. In ad-dition, medical care costs for

people with chronic diseases account for 42 per cent of total direct medical care ex-penditures, not to mention the estimated $54.4 billion loss in productivity due to ill-ness. Needless to say, chronic illness has major impacts on the Canadian health care system and the national economy. The Canadian Family Physician Cancer and Chronic Disease Prevention Survey reported in 2012 that family physicians were selective in screening patients for selected cancer and chronic diseases dur-ing periodic health examinations (PHEs). The barriers to conducting clinical screen-ings cited by physicians include the lack of time as well as lack of motivation, ab-sence of fi nancial incentives, lack of val-ue placed on the continuity of care, and contradictory recommendations issued by professional and scientifi c organizations and government health agencies. Even when clinical screenings are conducted through conventional practice, the meth-ods for collecting the information is rarely consistent, and the quality of the informa-tion collected is not always accurate.

However, technology offers an oppor-tunity to make clinical screenings a con-sistent part of patient registration. Patient self-service, delivered on tablets or onsite kiosks, is an effective tool for overcom-ing these challenges in emergency de-partments, clinics, and private practice settings. Allowing the patient to answer clinical screening questionnaires through an electronic device can improve the ac-curacy of the data, as well as patient satis-faction, cost savings, and outcomes.

Patient-centric technology can be used to screen for high-risk behavior, and re-ceives better results than bedside inter-views. In a 2012 study at Johns Hopkins, Dr. Yu-Hsiang Hsieh and his team used patient self-service kiosks to screen pa-tients for HIV in the emergency depart-ment. According to the study, 70 per cent of patients preferred interacting with a ki-osk over in-person bedside interviews with clinical staff. A compelling 60 per cent

also said they would be interested in using the kiosk to self-test in the future. By us-ing an electronic survey, patients felt less judgment than if they were interviewed by a clinician and therefore responded more willingly and more honestly to sensitive lifestyle questions. Thus, the kiosk-based screening resulted in testing signifi cantly greater portions of patients with high-risk sexual behavior and injection drug users, and yielded higher rates of newly identify HIV positive patients.

Similarly, Dr. Edwin Boudreaux at the University of Massachusetts Memo-rial Medical Center conducted a study to maximize patient acceptability and data completeness of collecting patient reported outcomes in the emergency de-partment. This study replaced the con-ventional method of collecting patient reported outcomes, including pain ratings, past medical history, and a battery of be-havioral health screeners recommended by the National Institutes of Health, with an electronic system delivered through tablet PCs at the bedside. The system al-lowed systematic and effi cient collection and documentation of patient reported outcomes with no clinician effort. The application was optimized to improve acceptability and data completion by pa-tients, leading to more than 95 per cent of ED (emergency department) patients who initiated the survey completing all of the items. Key features to maximize complete-ness included: presenting a single question per screen, using multiple-choice response options rather than responses that require alphanumeric keying, and allowing pa-tients to pause and return to the assess-ment if they were interrupted by medical testing or interventions. Satisfaction as-sessments revealed that 90 per cent of pa-

tients found the survey length, which took an average of 9 minutes, to be acceptable during their ED visit. This study shows that patients are satisfi ed with patient-centric technology, even in the busy, de-manding setting of an ED.

One clinic in California that is part of a large, national health system in the Unit-ed States also used patient-directed ques-tionnaires as a tool for preventative care and achieved tangible fi nancial results as an added benefi t. By using question-naires to screen for inappropriate use of antibiotics through kiosks and a decision support algorithm, the clinic reduced in-appropriate prescription of antibiotics for their patients and subsequently avoided the cost of acute care for patients who de-velop pneumonia as a result of resistance

to antibiotics. Acute respiratory infections (ARIs) make up 10 per cent of outpatient visits at this organization’s clinics and 20% of that patient population are over-prescribed antibiotics. Patients with pneu-monia are typically treated at the hospital for an average of two weeks and the cost of treating patients with antimicrobial re-sistant organisms versus those without can range from $6,000 to $30,000. Using the lower estimate of $6,000 in hospitalization costs, early intervention to reduce over prescription of antibiotics through the ki-osks has the potential to save a clinic of a 10,000 patients $1.2M a year.

The search is on for the holy grail of best practices in preventative care. However, addressing preventative care doesn’t have to be a formidable effort – there are simple ways to produce signifi cant return and better outcomes. Conducting simple pa-tient-directed self-guided clinical screen-ings through technology is a viable way to start achieving this objective. Very small implementations have proven success in collecting information for preventative care with a positive patient response and signifi cant return on investment. ■H

Daniel Theobald is Co-Founder and CTO, Vecna.

NCLEX RN ReviewRPN Exam Prep Class (CPNRE)Personal Support Worker (PSW) 26 Weeks-$1999Location: Toronto School Of Health 245 Fairview Mall Drive, Suite 723 Toronto, ON M2J 4T1 Tel: 416-800-8281

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or call 416-505-3922Continued from page 18

Technology improves preventative care through screeningsBy Daniel Theobald

C

Is spinal cord stimulation being effectively used to treat pain in Canada?

The Ontario Health Technology Advi-sory Committee (OHTAC) makes recom-mendations about health interventions to the health care system and the Ontario Ministry of Health and Long-Term Care. Its primary goal is to ensure that Ontario residents have access to health interven-tions that optimize patient outcomes and provide the best value for money.

In 2005, OHTAC estimated the need for SCS was 330-660 patient cases per year in Ontario. Last year, almost 10 years later, the most optimistic estimate is that only 15 percent of eligible patients in Ontario had access to SCS therapy. The national average is 23 percent, with access being the highest in Saskatchewan.

The good news is that several Ontario hospitals are working to improve access to

this technology, ensuring sustainable fund-ing and comprehensive care.

How will I know if spinal cord stimulation will work for my patient or me?

Whether you are interested in SCS for yourself or for a patient, it’s important to discuss and determine the kinds of pain treatments that may work. The choice of treatment depends on the type of pain, its severity, and your/your patient’s response to pain treatment. If a pain specialist thinks you or your patient is a good can-didate for spinal cord stimulation, you can discuss completing a screening test to see if it will provide adequate pain relief. ■H

Pamela Winsor is Director of Health Policy and Stakeholder Engagement at Medtronic Canada and was a critical care nurse for 15 years.

Careers DEADLINE FOR JUNE 2015 ISSUE: MAY 26, 2015

VIEW CAREER ADS AT: www.hospitalnews.com

Electrical pulses effective for spinal cord

The Canadian Family Physician Cancer and Chronic Disease Prevention Survey reported in 2012 that family physicians were selective in screening patients for selected cancer and chronic diseases during periodic health examinations.



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