T h e M e d i c a l P r o f e s s i o n a l ' s G a t e w a y t o H e a l t h & We l l n e s s
SPECIAL EDITION:
ALL ABOUT TRAUMA A NEW APPROACH TO PTSD EMPLOYEE ASSISTANCE PROGRAMS
DOCTOR HOMER TIEN FROM YUGOSLAVIA TO ORNGE
TRAUMA IN HEALTHCARE WORKERS WORKPLACE VIOLENCE IN HEALTHCARE
DRIVE ONLY... NEVER TEXT
Proud sponsor of:
ONTARIO BRAIN INJURY ASSOCIATION
education
• awareness •
support
Take the pledge at www.idont.ca Proudly sponsored by:
Dye & Russell, Personal Injury Lawyers www.dyeandrussell.com | 905.427.2000
SPECIAL EDITION:
ALL ABOUT TRAUMA
PAGE 6
The Medical Professional's Gateway to Health & Wellness
I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
PUBLISHER Audra Leslie
PAGE 7 E d i t o r i a l & Des i gn EDITOR-IN-CHIEF Karen Sheviak ART DIRECTOR Kat O’Donnell
FEATURE PAGE 8
PAGE 10
PUBLISHING COORDINATOR Katie Carroll WRITERS Marcus Fisher Stephanie Hinds PHOTOGRAPHY Dawn Riddoch Kat O’Donnell Shutterstock PROOFREADER Stephanie Hinds PRINTING North Alliance Press
Graymatter MARKETING SOLUTIONS
Navigate is published by
INSIDE NAVIGATE NEWS................................................3
HOSPITAL INNOVATIONS................................... 11
STRESS AND HEALTHY EATING............................4
MY PATH THROUGH NURSING........................... 12
EMPLOYEE ASSISTANCE PROGRAMS.......................................................6
DECODING ANNIE PARKER................................ 13
PTSD: A NEW APPROACH....................................7
WORKPLACE BULLYING IN NURSING: PART 2........................................ 14
DR. HOMER TIEN: FROM YUGOSLAVIA TO ORNGE...........................8
WORKPLACE VIOLENCE IN HEALTHCARE............ 16
TRAUMA IN HEALTHCARE WORKERS.................. 10
MEDICAL PROFESSIONALS AND PERSONAL INJURY LAW................................... 17
Co n t a ct Breeze Publishing 1550 Bayly Street, Unit 16A, Pickering, Ontario, L1W 3W1 phone:
Editor’s Letter
905-420-1810
To subscribe, visit www.navigatemag.com
In this issue of Navigate, we join the growing number of media organizations that are tackling the issue of trauma in healthcare workers and first responders. And who better to talk to than Dr. Homer Tien, medical director of Ornge and trauma surgeon at Sunnybrook. His experience in with trauma is unique, since he was also a surgeon in the Canadian Armed Forces, where he treated soldiers with injuries from the battlefield.
A d v e r t i s i n g Pol i cy Breeze Publishing accepts advertising based upon space availability and consistency with its mission to promote health, wellness and lifestyle for medical professionals. Navigate is not responsible for the content of advertisements, the products offered or the viewpoints expressed therein.
E d i t o r i a l N ote The information provided in this magazine is for educational and informational purposes only. It should not be used as a substitute for the advice of a qualified and licensed practitioner or health-care provider. The opinions expressed here are not necessarily those of Breeze Publishing, its affiliates or parent company. Different views may appear in future articles or publications. Articles in Navigate are copyrighted and must not be reprinted, duplicated or transmitted in any way without permission.
This experience has made Dr. Tien one of the foremost experts on both treating trauma and on its effects on healthcare workers. Our cover story (page 8) is the feature of our special section on trauma and gives you an inside look at his experience, and his recommendations on dealing with trauma. We also continue our series on bullying in the workplace (page 16). It is important for workplaces to recognize how serious this issue is, just as schools are starting to do. Other unique perspectives in this issue are the account of how one nurse chose her path during her career (page 12) and the story of Annie Parker, one of the first women in North America to be tested for the BRCA gene (page 13). We hope you enjoy reading this issue of Navigate. Let us know how we’re doing, and what issues you’d like us to cover in future issues. Until next time,
Karen
Karen Sheviak editor@breezemags.com
Imp
ENVIRONMENTAL REMEDIATION AND DISASTER RECOVERY EXPERTS SPECIALIZING IN:
Is your hospital
healthy?
2 | www.navigatemag.com
Mould Removal Lead Treatment Fire Recovery Containment Demolition Asbestos Removal Dry Ice Blasting Flood Recovery Disaster Relief
905-795-7700 deconenvrio.com
By Stephanie Hinds
NEWS CHRONIC
PAIN
THE TRUE COST
WATCH WITH CAUTION With winter here, television watchers can bask in the joy that comes with this season. We’ve been watching the commercials for months – amazing shows, new series and old favourites are all on their way back to a living room near you. But according to the American Heart Association, we need to watch with caution. The American Heart Association Rapid Access Journal Report says the more TV we watch, the more likely we are to face major health risks, such as pulmonary embolism, a blood clot that typically starts when blood becomes more stagnant in places in your lower body and travels to the rest of your body. “Without the specialized testing needed to diagnose it, it can be easily missed,” says Dr. Marla Shapiro, a medical expert. The study shows that 70 percent of pulmonary embolism deaths stemmed from people who watched between 2.5 to 4.9 hours of TV daily. For each additional two hours of TV, the risk of death increased by 40 percent and for those who watched five or more hours of TV on a daily basis saw their risk of death more than double. There are several risk factors that can increase the likelihood of pulmonary embolism. If you are obese, diabetic, a smoker, use hormones or have suffered from hypertension in the past, you need to be sure that you are as active as possible while in front of the screen. Some risk factors can be inherited, so setting up an appointment with your doctor to see what ‘invisible conditions’ you have is always a great idea.
Those living with chronic pain understand too well the daily struggles of trying to maintain a normal life. They are familiar with the constant hospital visits, doctor’s offices and the desperation for relief. But the cost of chronic pain is a lot more than just taxing on one’s body. According to a study in Pain Management, the cost of patients who have chronic pain related to a past surgery can range from $2.5 million to $4.1 million per year in just one hospital. People with post-surgical chronic pain have special needs. Often, these needs are met with specific and persistent use of opioids and transitional pain service. But it’s not just about the cost—it’s also about the resources. The study showed that 90 percent of those who use medical resources like pain-related visits to physicians, extended hospital stays and even hospital readmission are postsurgical patients with chronic pain. The cost of caring for those with chronic pain can be anywhere from $47 billion and $60 billion per year—more than HIV, cancer and heart disease combined. In the study, Dr. Hance Clarke, a clinical researcher and Director of The Transitional Pain Service, says realizing and treating the pain before too much time passes is crucial. “We need to break the cycle of pain before it becomes chronic. It is much harder to treat someone when the pain is entrenched, and the window of opportunity is lost," he said. Part of this is recognizing when you are in pain, particularly after a surgery. Anywhere from 50 to 70 percent of patients leave with an opioid prescription and it only takes six months for post-surgical pain to develop into chronic pain. If you have chronic pain, visit your doctor to see what options are available to you. Living with chronic pain might be difficult, but managing it can be possible.
Keep in mind, this isn’t just about television. It’s about screen time in general. If you spend eight hours a day at work in front of a computer, make sure you’re getting up and walking around in frequent intervals. Or if you spend hours playing video games on your smartphone, incorporate more activity into your daily life. “It can be life-threatening,” says Shapiro. So be sure to keep your blood flowing, even while you’re binge-watching. The Medical Professional's Gateway to Health & Wellness | 3
Improving the Life of the E
I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
Stress and They can Stress is the body’s response to an event that is threatening, overwhelming or harmful. Sources of stress include fatigue, poor nutrition, sleep deprivation, lack of physical activity, illness and pain. Research indicates that approximately 40 per cent of individuals increase their food intake when stressed; 40 per cent decrease their intake when stressed, and approximately 20 per cent of people do not change eating habits during stressful events. Stressful events appear to cause a shift toward choosing foods that are high in fat and/or sugar. For people in situations of repeated bouts of minor, but daily stress, the body stays in a chronically activated state which may lead to weight gain, over time. Since stress is often unplanned and unavoidable, keeping nutrition in check during these tough times may be a positive way to manage complex circumstances. Here are some strategies for managing nutrition during stressful events. 4 | www.navigatemag.com
Balanced meals at regular times, including planned snacks. Eat three meals daily, spaced at equal intervals over the day. Eat breakfast within 30 minutes of waking up; include a source of lean protein and a whole grain in each meal. Keep fruit and veggies (fresh or frozen) around to help ensure you consume these antioxidant-rich foods, which are essential during times of stress. Plan for snacks, such as nuts, fruit, yogurt and whole grain crackers and cheese. Snacks can provide important nutrients, take the edge off hunger and help decrease cravings when you’re stressed.
Keep it simple. A bowl of vegetable soup and a grilled cheese sandwich; a veggie omelette with whole grain toast; whole wheat pancakes topped with yogurt and frozen fruit - all easy to prepare, delicious and healthy meals! These meals may also be the perfect end to a stressful day. Keeping foods around for quick, simple meals can make the difference between a healthy dinner and a run through the fast-food drive through. Make a list of your favourite healthy comfort meals and keep a few staples in your pantry for busy days.
Improving the Life of the E
HEALTHY EATING: go together
By Andrea Miller MHSC, RD
Avoid the fast food run/vending machine.
Go easy on your gut
Whether you experience stress daily, try to keep healthy snacks on hand. A bag of nuts, some dried fruit and bottled water in the car can provide a much needed healthy snack and help you avoid fast food and vending machine options.
Coping with stress can lead to changes in digestion. For some, things may speed up; for others, digestion might grind to a halt. Avoid high fat, highly seasoned foods during times of stress. Include fruit and veggies daily, and consider the use of a natural probiotic, such as yogurt or kefir, to keep the gut healthy.
Limit caffeine Caffeine may disrupt sleep, making stress even more difficult to manage. Choose caffeine-free foods and beverages after mid-day. Sleep deprivation is, on its own, a common chronic stressor that may contribute to increased risk for obesity and other chronic illnesses. It is estimated that roughly 30% of us sleep less than 6 hours per night, potentially leading to stress caused by sleep deprivation.
Don't use food to manage stress
Stress is a normal part of life, but left unmanaged, it can have a lasting negative impact on health and nutrition. Expecting the unexpected is one of the best ways to manage stress. Plan a few simple meals, keep a few healthy snacks handy and look for ways to de-stress without food.
For more information, visit http://www.amillerrd.ca or email andream@live.ca.
When experiencing stress, try to take time out for a walk, some deep breathing or yoga. Use music, reading or comedy to help you destress. Journaling, colouring, painting or other creative outlets have also been shown to decrease the body's stress response. The Medical Professional's Gateway to Health & Wellness | 5
I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
Promoting the Responsible Disposal of Medications and Sharps Did you know that in Ontario, the public can responsibly dispose of their unused or expired medications and used sharps free of charge at over 90 per cent of community pharmacies? The Ontario Medications Return Program and the Ontario Sharps Collection Program are 100 per cent industry funded and designed to give the public an accessible means to dispose of these materials. Free sharps containers are available at pharmacy counters. Sharps not placed into approved sharps containers are not considered safe for transport. Bleach bottles are not approved containers. Ontarians have access to the free 4.5 L sharps containers at over 3,500 locations province wide. Encourage patients to visit www.healthsteward.ca to find their nearest participating pharmacy for free sharps containers and disposal. And remember: medications should not be flushed or poured down the drain. Remind patients that they should bring their unused and expired medications back to the pharmacy. Pills should be placed into clear plastic bags with their outer plastic and cardboard packaging recycled. Liquids and prescription creams should be returned in their original bottles
6 | www.navigatemag.com
Employee
Assistance Programs: How to Get the Help You Need By Marcus Fisher
Many healthcare professionals need to talk to someone after a stressful or traumatic workplace experience. A fundamental part of being employed in the Ontario healthcare system is having access to an employee assistance program (EAP). But some healthcare workers may not even know about it. Access to the program is granted along with the rest of your medical benefits, and can be a valuable resource for everything from general employee wellness to relieving the stress of a traumatic experience. What is an EAP? An EAP is a confidential, short term counselling service for employees with personal problems that may affect their work performance. Often these programs are administered by outside organizations contracted by your employer. Who would I be talking to? The quality of the counselling will vary based on the organization contracted by your employer. Generally it will be a person with formal education in social work, psychology or counselling, often holding a bachelors or master’s degree. I’m worried this will damage my professional prospects. Just how confidential is it? Not all EAPs are created equally, and there can be a lot of variation in quality between different hospitals. Check to see if your EAP provider is part of the Canadian Employee Assistance Program Association. The CEAPA requires all members to administer their EAPs on the basis of “neutrality, confidentiality, and not being part of the disciplinary process” of your employer. Sounds amazing…. so what’s the catch? EAPs are a short-term, generalized service, meant to be a stopgap at best to help you deal with a wide array of mental health issues, and your benefits will only cover a limited number of EAP sessions. EAP counsellors often don’t have the specialized training needed to identify and properly treat the extraordinary traumatic experiences nurses or paramedics may sustain in the workplace. If you find that your EAP did not effectively help you, seek out trauma specialists through the Ontario Psychological Association.
Up until very recently, the mental health of our veterans and first responders was rarely talked about. But now it is in the news frequently, and for good reason. Paying attention to and treating the mental health of first responders will help keep them on the job, and having well-trained people stay in these demanding jobs should be a top priority.
timely access to treatment. PTSD cannot be formally diagnosed by a psychologist or psychiatrist until the symptoms have been present for four weeks or longer. But, she says, “the longer you leave people without treatment after a critical incident, the higher the chance that PTSD becomes entrenched and difficult to turn around.”
An organization in Ontario called Project Trauma Support (PTS) is aiming to help do just that. They were inspired by a program to help first responders with PTSD in California, and they are working to bring similar treatment to Canada. PTS offers support groups to regular cohorts of 12 people. Each cohort is either all men or all women, all from the same profession, whether it’s military or police, doctors or nurses.
“The longer you leave people without treatment after a critical incident, the higher the chance that PTSD becomes entrenched and difficult to turn around.”
A New Approach A soldier coming home from a war zone. A paramedic who responds to a serious car accident. A physician who watches a child die, unable to save him.
And even if a case is approved for treatment early on, there is still red tape to get through, plus delays in the medical system. Those three scenarios may seem different, but they all “There can be a wait of have one thing in common: the person may suffer from up to six months to see a “Our goal is to establish post-traumatic stress disorder (PTSD) because of what psychiatrist, possibly less a network of peers who for a psychologist, and not can offer support group in they have seen and experienced. all of these specialists have different communities, says Dr. Manuela Joannou, an emergency room physician in Perth, Ont., expertise inthe treatment of PTSD,” says Joannou. “If a person wants who is one of the founders of PTS. “There is not a whole lot of support to have psychological help early on, they may need to pay for it right now for first responders. They need a place to go where they themselves." can surround themselves with people who get it.”
“There is not a whole lot of support right now for first responders. They need a place to go where they can surround themselves with people who get it.”
There are also financial and cultural challenges at the organizational level. Whether it’s in the military, healthcare or policing, these organizations may feel that their WSIB or other insurance premiums will increase if they introduce programs to help people with PTSD. But, says Joannou, “They will save costs in the long run by keeping staff healthy and off long-term disability.”
PTS uses a variety of therapies to help people, including equine therapy, labyrinths and adventure outreach programs. These programs help first responders get reacquainted with fear in a safe environment. “One of symptoms of PTSD is hypervigilance, trying to numb down the fear, says Joannou. “The problem is that if you numb fear, you also numb the ability to care for your family, experience joy and so on.”
There also must be a culture in which it’s OK to admit that you are struggling to deal with a traumatic event. “A lot of people are afraid to say they need help because they saw what happened to the last guy,” she says. Making those changes takes time, but, says Joannou, it’s worth it to prevent “the untold human cost of people who are suffering.”
But getting that treatment out to those who need it is an uphill battle. Joannou believes that one of the biggest gaps right now is
For more information, visit www.projecttraumasupport.com. The Medical Professional's Gateway to Health & Wellness | 7
Improving the Life of the E
I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
Dr. Homer Tien: From Yugoslavia to Ornge W
By Marcus Fisher
hen you first walk in to Dr. Homer Tien’s office at Ornge, the provider of high-quality air ambulance service and medical transport to people who are critically ill or injured for the province of Ontario, it’s hard not to be impressed by the breadth of his accomplishments. As a young student, Tien joined the Canadian Armed Forces to pay for medical school, a decision which would propel him to a long and distinguished career in both military and civilian life. With service in both the Yugoslavia peacekeeping and Kandahar combat missions as a staff general surgeon, Tien would reach the rank of Colonel and be awarded the Order of Military Merit, presented to Canadian Forces members who demonstrate dedication and devotion beyond the call of duty. Civilian time at Sunnybrook Hospital in Toronto as the Medical Director for the Tory Regional Trauma Centre, Canada’s largest trauma unit, along with various other research chairs and honours, round out the credentials of someone who has been on the frontlines of Canadian trauma healthcare, sometimes literally, for over 20 years.
8 | www.navigatemag.com
Ornge, Ontario’s taxpayer-funded medical transport service, has been in the news in recent years due to allegations of lavish executive compensation and a subsequent 2012 criminal investigation. So it’s no surprise that someone with Tien’s stature was brought in to help right the ship as part of the new management team put in place in 2013. However, Ornge deals exclusively in medical transport, either via helicopter or fixed wing aircraft. The medical logistics of getting a patient quickly to the right facility is their core business, which isn’t something a crack trauma surgeon necessarily knows anything about. Tien’s military background was the main reason he was able to step into the Chief Medical Officer role. “How a patient arrived at the Sunnybrook trauma room was always a bit of a blur to me, but the planning of pre-hospital to hospital was always part of the military side of thinking about care,” says Tien. “So how we organized our pre-hospital system in terms of communications and prioritization came with the military experience.” To an outsider, Tien would seem to be a perfect fit for Ornge; someone with both experience in medical logistics and a background in trauma care. Anyone who’s watched “Grey’s Anatomy” knows that medical helicopters only handle the most serious of patients; critical, time-sensitive cases where every second counts. But Tien dispelled the idea that life at Ornge is all pulse-pounding action, “Trauma is probably a quarter to one-third of our work. Two-thirds of our work is actually in the North, where the distances are quite vast and hospitals are farther apart. For First Nations, some communities are air accessible only, meaning we will fly in for the whole gamut of acute medical care.”
"Two-thirds of our work is actually in the North...where for First Nations, some communities are air accessible only, meaning we will fly in for the whole gamut of acute medical care.” Tien’s focus since coming to Ornge has been broadening the company’s role in Ontario’s healthcare system, moving from the core transport focus to offering services like telemedicine. “We do transport, but transport is a means to accessibility of healthcare itself,” he says. “Through our “base hospital” program, we leverage the fact that we are the only ones that do critical-care paramedicine for the province to give advice to a rural physician who is requesting transport, allowing them to potentially treat the patient on scene.” By using its existing resources and expertise in transport of the sickest patients to help frontline partners, Ornge reduces the demand of its services and pushes out its medical expertise into the more isolated regions of the Ontario healthcare system. As a trauma surgeon in military and civilian settings, Tien has a special appreciation for both the physical and mental stresses that healthcare work can entail. He talks openly about the patients he treated that affected him the most, “Everything with kids are always the tough ones, especially when you have your own,” he says. As with most healthcare professionals, Tien believes that not personalizing his patients in these instances is his best line of defense to cope with the difficult things he sees. Yet he also believes that more can be done on an organizational level to help those working in healthcare cope with what they may see on the job. Although recent legislation calling for a strategy to deal with first responders’ PTSD excludes nurses, he sees it as a good first step, and believes that nurses will be included eventually.
The question is what the strategy should be once that inclusion is achieved, and Tien understandably draws on his military experience to answer that question. One surprising take is the ineffectiveness or even harm that can come from one of the most common processes currently in practice across Ontario: critical incident stress debriefings. “In the 90s when preparing to go to Yugoslavia as a GP, I took all the critical incident stress debriefing training to prepare for the conflict. I will say that psychiatrists who do know the field well have moved away from that since then because there is a belief people will revisit a trauma with peer counsellors who may not be as skilled in diagnosis and treatment.” So the emphasis shouldn’t be on the more traditional methods, but rather on wholesale change in how hospitals view their employees’ mental health. For Tien, the key to building resiliency in personnel is about organizations encouraging good mental health hygiene on a proactive basis. Whether it’s moderating your regular alcohol intake (i.e. not being dependent on that nightcap to get you to sleep each night), getting exercise, regular sleep (perhaps the hardest to do on shift work) and making sure your support network of friends and family is strong, building up your mental well-being for the inevitable hardships nurses and doctors see is something that medical organizations need to get better at emphasising to new healthcare professionals. That leads to another, bigger cultural change that Tien believes needs to take place within most civilian health organizations. When asked about younger Ontario nurses feeling stigmatized when mental health concerns were brought up in the workplace and fearing that they would appear to be “too weak to handle the job,” he acknowledged the tougher, macho culture that can exist in healthcare workplaces and advocated a more transparent and systemic environment for mental health concerns to come out. “In the military, for 30 years since Yugoslavia, it’s been about breaking down this barrier to talk about being scared during this or that rocket attack. So certainly, you can overcome it. If the military can now talk about it openly (which they do), there’s no reason healthcare can’t do so as well.” Tien pointed to proven methods like identifying natural peer counselors (natural leaders in a department) in an organization, empowering them with mental health training, and then allowing personnel to approach them with concerns on their own terms.
“In the military, for 30 years since Yugoslavia, it’s been about breaking down this barrier to talk about being scared. If the military can now talk about [mental health] openly (which they do), there’s no reason healthcare can’t do so as well.” So whether it’s being more proactive with your mental well-being to build up that resiliency, or encouraging different hospitals and health organizations in Ontario to begin the conversation on mental health transparency, Tien is optimistic about how mental health is beginning to be addressed in Ontario. ”It will come. I was talking to some colleagues the other day, and I can see it coming.” he says, in reference to nurses being recognized under the first responder legislation, and the mental health awareness developing within the healthcare profession. A welcome sentiment from someone who has seen first-hand why it is so urgently needed.
Ornge By the Numbers OVER
18,000
Ornge conducts over 18,000 patient related transports every year.
. APPROX
60%
Approximately 60% of Ornge patients are those transported in the North
OVER 13 MILLION
Ornge serves more than 13 million people
ABOUT
ON 1 MILLI
KM SQUARE
Ornge services an area of about 1 million square kilometres of land.
The Medical Professional's Gateway to Health & Wellness | 9
Improving the Life of the E
I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
Trauma
in Healthcare Workers Will your organization get you help if you need it?
By Marcus Fisher
In recent years you may have noticed the increased prevalence mental health issues have in our daily lives and in the news. Whether it’s ensuring our returning Afghanistan military veterans are getting the care they need, or understanding the difficulties of front line responders here at home, there seems to be more public awareness on the subject than ever before. This makes the results of our survey on healthcare providers’ traumatic experiences and PTSD in the Ontario healthcare system all the more surprising. Common themes in our interviews were workplaces’ lack of awareness and appreciation for the traumatic experiences healthcare professionals face. While lack of funding for employee mental health was a perennial concern, most frontline workers cited an apathetic organizational culture as the primary obstacle to improvement. In many cases nurses could cite existing internal resources, such as employee assistance programs and peer mentoring, being underutilized or misapplied due to a lack of organizational focus and communication. Nurses cited past traumatic experiences where they desired additional support, but did not use or could not describe the limited programs in their workplace due to a lack of awareness from supervisors. So the question stands: why does Ontario healthcare, especially those specializing in traumatic cases (burn victims, sexual assaults) not have an adequate organizational focus on the mental health of their employees? The answer may lie in the budget conscious and public service ethos of the organizations. While Ontario’s 14 Local Health Integration Networks (LHIN’s are regional organizations that formulate and implement the strategic direction of Ontario healthcare policy do have a focus on mental health, they are externally facing programs meant to deal with the general population, not internal stakeholders such as employees. We see this trend in other public services such as police, with recent innovations like the Hamilton Mobile Crisis Rapid Response Team (RRT) brought in to deal with high-risk situations involving mental health. First piloted in 2014, the RRT involved a mental health professional from St. Josephs Healthcare Hamilton accompanying a police officer as part of the primary response to an emergency call. Previously, mental health professionals had only gone on site as part of secondary, follow-up calls. The Canadian Mental Health Association estimated during this pilot project the RRT had “shown a 43 percent reduction in the number of apprehensions being made, due to individuals being referred to the appropriate services and care”, thus reducing repeat calls. Other favourable outcomes involved up to “580 hours of saved police officer time per year”. As a result, Hamilton Police Services and St. Joseph's Healthcare Hamilton made the arrangement permanent, and the Mobile Crisis Rapid Response Team has continued with expansion to Halton taking place in December 2015. But what does the external policy success of one police department have to do with the PTSD concerns of a health professional in Ontario? 10 | www.navigatemag.com
Ask anyone in the Ontario healthcare system, and it’s clear that budget considerations are a big impediment to any employee-focused initiative, mental health or otherwise. In Hamilton police saw huge benefits in integrating mental health concerns into its external policy, resulting in both improved service to the general public and reduced personnel costs. Mental health advocates need to show the same organizational benefits for internal policies. If new systemic policies on employee trauma are going to be pushed, it will have a better chance if the organization believes that it will not only help a valued employee when they hit rock bottom, but also its own bottom line. In order to do so, we need to answer some basic questions. How much is a healthcare professional’s effectiveness reduced by untreated psychological trauma? What is the percentage of people professionally treated for jobrelated trauma, which are then able to return to the same "high stress" line of work? What are the odds of those that receive professional treatment for trauma developing PTSD versus those that do not seek treatment? All these are important questions to answer when making the case that many mental health experts believe; that left untreated, widespread mental trauma inflicted on a workforce in high-stress occupations may actually increase personnel costs and exacerbate key metrics like experienced employee turnover. Dr. Jane Storrie was president of the Ontario Psychological Association from 2013 to 2015, and frequently consults with first responder organizations in areas like the treatment of occupational PTSD. “Unfortunately I don't have specific statistics because there have been very limited studies of mental health in policing, particularly in Canada,” she says. “When there are stats available, they tend to result from surveys carried out by individual police services.” Her focus is on police services, but the experiences and data speak to the same issue: a lack of data on occupational trauma and its effects on the organization. The truth is we don’t know how much untreated traumatic experiences are costing the Ontario healthcare system, both in human anguish and real dollars. How many nurses or paramedics have left their jobs after years of building up skills and experience? And how many could have been avoided with proper resiliency training or trauma treatment by a mental health professional? For those who believe this should be a priority, the solution is to demand proper statistics and data be collected throughout the entire Ontario healthcare system. Asking these questions may take longer, and we may not always get the answers we like, but it has a better chance of bringing wholesale change on a province wide level, as opposed to a fragmented and piecemeal approach. Reference: Canadian Mental Health Association: http://ontario.cmha.ca/news/ mobile-crisis-rapid-response-team-first-ontario/#.V5Zseo-cHSE
Improving the Life of the E
Hospital Innovations
By Navigate Staff
North York General Hospital
North York General Hospital’s breast cancer care program has become the first hospital in Canada to receive full accreditation from the National Accreditation Program for Breast Centers (NAPBC), which is administered by the American College of Surgeons. Accreditation by the NAPBC is given to centers that provide the highest quality of breast cancer care and undergo a rigorous evaluation process, which includes reviews of their performance. The standards include proficiency in leadership, management, research, community outreach, professional education and quality improvement. Patients at these centres must have access to comprehensive care with state-of-the-art services, a multidisciplinary approach to coordinating treatment, information about clinical trials and new treatment options, and quality care close to home.
For more information, visit www.nygh.on.ca.
London Health Sciences Centre
The team at London Health Sciences Centre became the first in Canada to perform a new surgical technique on cardiac patients. Called the transcaval approach to transcatheter aortic valve implementation (TAVI), the procedure is done through the femoral vein, near the groin, rather than through the femoral artery or through a chest incision. The procedure is available exclusively to complex patients whose arteries are inaccessible because they are calcified and narrow.
St. Michael’s Hospital
Concussions have been getting a lot of attention recently, and for good reason. Repeated concussions, even minor ones, can cause long-term effects. Researchers at St. Michael’s Hospital conducted a review of 10 studies that indicated that diffusion tensor imaging, an MRI-based neuroimaging method that allows for visualization of white matter tracts within the brain, may be an effective tool for distinguising patients who recover from those with persistent postconcussion syndrome (PCS) following a mild traumatic brain injury, such as a concussion. The research study, published in Frontiers in Neurology, concluded that: • Abnormal DTI readings were linked to an increase in number and severity of PCS symptoms. • Finding even minor damage to the corpus callosum, an area of the brain responsible for relaying messages to co-ordinate motor, sensory and cognitive information, may be associated with lasting behavioural, emotional and cognitive impairments in patients with mild brain injury. • DTI testing can detect damage not picked up by more common imaging methods like CT scans.
• • For more information, visit www.stmichaelshospital.com.
The goal of TAVI is to restore normal blood flow through the heart and the body and reduce paravalvular leakage around the valve. Some patients with severe heart disease have very few treatment options, and this procedure allows these patients a chance at improvement and a better quality of life.
For more information, visit www.lhsc.on.ca. The Medical Professional's Gateway to Health & Wellness | 11
My Path in
Nursing By Amber McCarthy RN BScN CVAA (c) ACLS (c)
My career started in long-term care and ranged from acute care in the hospital to nursing at a methadone maintenance treatment clinic. Many times I worked multiple jobs and although I enjoyed many different aspects of each job, I was always searching for something else. In 2012, I obtained a position in home care nursing with Bayshore Health Care. I started to really enjoy my job and learned skills that I never knew would be necessary to perform my position in the field of home care. Bayshore offered courses on wound care, respiratory care (ventilators and tracheostomies), palliative care, IV certification and specialized medication injection training. I was able to care for any type of client in their own home. The variety on a daily basis was fulfilling. I could wake up in the morning and assist a client with wound care, visit a client for an assessment and injection, and end the day doing injection training for someone with chronic autoimmune disease. The next day could bring pediatric respite and an in-home infusion for a chronic genetic illness. I obtained my CVVA certification, which lead to an amazing opportunity as a primary nurse in a specialized infusion clinic. I then obtained my ACLS certification. At this clinic I would infuse clients with multiple diagnoses from different forms of autoimmune disease to certain types of cancer. I spent two years honing my infusion skills and increasing my knowledge base on specialized medications. At the same time, I taught specialized pump training in hospitals and clinics, obtained and taught CPR for nurses, and maintained clients out of the clinic - variety at its best! Being exposed to so many clients with chronic autoimmune disease and being able to support, follow up and educate the clients became my passion. I have the most incredible opportunity to be a constant support for clients on specialized medications for autoimmune disease. I follow their disease path and watch as a large portion of my clients increase their quality of life, decrease their active disease state and start to love their life again. For me, that is why I became a nurse: to make people feel better and help them “get better.” Bayshore has given me so many nursing opportunities I didn’t even know about. I am still learning about many more opportunities that I am a candidate for because I want to experience continual learning and growth as a nurse and a person. Amber McCarthy has a Bachelor of Science in Nursing Degree (BScN) in 2008 from the collaborative program with Trent University and Sir Sandford Fleming College, and is certified with the Canadian Vascular Access Association (CVAA) and the Advanced Cardiac Life Support (ACLS). 12 | www.navigatemag.com
D E C O D I N G
Improving the Life of the E
Annie Parker Living with Genetic Cancer By Karen Sheviak
Today, it seems like we’ve always known about a genetic component to cancer. But the reality is that it has only been 22 years since the BRCA gene mutation was discovered. Before then, even when many women in one family were getting and dying of the disease at a young age, doctors would often simply say that it was just “bad luck.” That’s exactly what happened to Annie Parker, who lived in Durham Region for 16 years but now resides in Brampton. She was only 14 years old when her mother died of breast cancer in the 1960s, then her sister passed away from the disease in 1978 before her 40th birthday, and a first cousin died of breast cancer the following year. “It was all around me. I found it very difficult to put it down to bad luck that our family had so much tragedy,” says Parker. Parker became a little bit paranoid, almost a hypochondriac, believing that she, too, would get cancer. “I went to the doctor for every hangnail,” she says. “They would say, ‘No, you don’t have cancer. It’s not something that can be passed down from generation to generation.’ Which at that time was thought to be true.” Before long she was diagnosed with breast cancer at just 29 years of age. Then she survived stage 3 ovarian cancer in 1988. Then in the early 1990s, she got a call from her oncologist at Sunnybrook. Parker was one of the first people to have such an extensive family history of cancer in her practice. “I had had conversations with her about my feelings [about her family’s cancer being genetic], and she said ‘Well, today I can tell you that you’re right. There is something called the BRCA 1 or 2 gene.’”
"It wasn’t bad luck. There really was a medical reason why a lot of my female family members were passing away."
Parker says she was “elated” when she learned of the gene’s discovery. “I didn’t want to say, ‘I told you so,’” says Parker. “But through all my sorrows, it really was true that it wasn’t bad luck. There really was a medical reason why a lot of my female family members were passing away.” Soon after, she was one of the first females in North America to be tested for the BRCA gene. Parker tested positive for the mutation, as did her brother. Her mother’s sister tested negative. She beat cancer (it was discovered behind her liver) a third time in 2005. Hoping to help others who have a genetic history of cancer like she did, she began working on a book about her life story. Then in 2010, she was introduced to director Steven Bernstein, who became interested in turning her story into a movie. That movie became Decoding Annie Parker, starring Helen Hunt, which was critically acclaimed and won awards at several film festivals. Parker says the process of creating the movie and dealing with the publicity was surreal. She is happy Decoding Annie Parker was successful because it gave her the opportunity to help other people. Her current passion is to start a foundation, but because there are so many out there, she wants one under her name to be a little different. “I want to educate and empower women,” she says. “I did not have that empowerment. Doctors were like God back then. You were told that this is what you have to do or you will die, and there was little access to research, no internet, no social media, nothing.” Parker is happy that things have changed so much for cancer patients nowadays. “There are so many go-to organizations now that nobody needs to feel the loneliness that I felt. When you are first given that diagnosis, you feel alone and there still is that feeling of ‘I am going to die.’ Cancer just seems to be the one disease where when you are told you have it, your whole life turns upside down. It’s not just about the patient; it’s about the caregiver, it’s about the family, it’s about the children, it’s about everyone.
For more information, visit www.annieparkerbook.com.
The Medical Professional's Gateway to Health & Wellness | 13
g n i y l l u B WORKPLACE I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
2 T R A P lle nrietta Van hu ovalov and He ap Ch A a HN en OO Ol By the e PSHSA and Courtesy of th
IN NURSING
PREVENTION THROUGH AWARENESS As mentioned in Part 1 of this series, bullying creates a toxic work culture that can have negative consequences to everyone in a workplace. Recognizing the signs of bullying early and stopping the behaviours from penetrating into team dynamics is critical. There are two primary drivers in Ontario that lend support for implementing a comprehensive bullying prevention program. These are:
of harassment if they are a worker at the workplace. There are also provisions that a Ministry of Labour inspector has the power to order an impartial investigation. To prevent this type of order, workplaces must be diligent in how they complete an investigation. A new code of practice in Ontario provides guidance to workplaces on how to accomplish this.
1. LEGISLATION
2. STANDARDS
Workplace bullying, a type of workplace harassment, not only negatively affects the pschological wellbeing of workers but is also a contravention of the health and safety legislation in Ontario. Under the Ontario Occupational Health and Safety Act (OHSA), workplace harassment is defined as, “engaging in a course of vexatious comment or conduct against a worker in a workplace that is known or ought reasonably to be known to be unwelcome,” including workplace sexual harassment.
The National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard), was published in January 2013 by Canadian Standards Association and the Bureau de Normalisation du Quebec (BNQ). It defines a psychologically healthy and safe workplace as one that “actively works to prevent harm to workers’ psychological health, including in negligent, reckless, or intentional ways, and that promotes psychological well-being” (2013).
This is a very broad definition that is open to subjective interpretation. What one person finds “vexatious” another may not. The OHSA requires all workplaces to implement harassment policies, measures, procedures and programs, including how and whom to report to. Expanded requirements outline the need to do an effective investigation and provide a report to the affected individual and the person accused
The Standard is voluntary and includes a set of guidelines, tools and resources to assist workplaces. One of the attractive qualities of The Standard is that it can be implemented in whole, or in part and it can be done piece by piece, over time. Implementing the Standard can help workplaces move to a culture where harassment and bullying will not be accepted by anyone in the workplace.
14 | www.navigatemag.com
WHAT TO DO As a result of recognition of work-related mental stress claims arising from repeated workplace harassment/bullying, employers should seriously consider the need to implement best practices to avoid a toxic environment. The Conference Board of Canada Primer lists the following “Good Practices:”
• Define bullying and develop policies, procedures and programs to prevent and
Improving the Life of the E
Achieving a healthy work environment can be a challenge. Doing so requires us to think differently about almost everything that affects our workplace, including our culture habits and day-to-day practices. Change will not occur overnight. Implementation takes time and effort, and it takes a comprehensive approach spanning physical, cultural, social and job design conditions.
• Promote constructive interpersonal behaviours and self-awareness; and
Thanks to funding from the Ministry of Health and Long Term Care, PSHSA has been able to develop a website, www.healthyworkenvironments.ca. This site is a resource to engage the collective knowledge and experiences of healthcare providers across Ontario who are making a difference in their organizations. It brings together expert resources and leading practices with the individual experiences, success stories and practical ideas that are contributing to healthy work environments. Sharing and engaging knowldge through the site can help guide your workplace onto the path of achieving a workplace free of harassment and bullying.
• Educate employees and managers about why bullying should be addressed
• Bullying and harassment behaviours are part of a larger continuum of negative
manage bullying in the workplace;
• Proactively curb bullying through employee education including organizational and legislative expectations, what to do and what not to do and the consequences of bullying behaviour;
• Teach employees about how to self-manage interpersonal conflict;
including the business case against bullying (2015).
behaviour. And if left unaddressed, they could escalate to violence.
• Bullying and harassment behaviours can be subtle or blatant - be alert to HOW TO DO IT Developing a Program As with any other workplace hazard, organizations should be applying the RACE principle: Recognize, Assess and Control workplace bullying and harassment, and then Evaluating that the measures they have put in place are actually working. Recognize - Recognition can be achieved by the employer or supervisors actively identifying if bullying exists, or has the potential to exist. This includes training management on how to create a transparent and accountable culture where employees feel safe to report as well as gathering information through observations and monitoring feedback from exit interviews and one-on-one meetings. Assess - Assessing the risks can include culture surveys, Leadership 360 assessments that measure behaviour; reviewing the conditions and practices that can lead to bullying; and monitoring if they occur at worksites (excessive criticism, denying opportunities, work overload, gossip or false rumours, etc.). Control - Controlling the risk requires the development of policies, measures, procedures and programs to report, investigate and come to judgement regarding incidents of bullying and harassment in the workplace. A comprehensive training program along with appropriate mechanisms of accountability for all staff, regardless of their seniority in the organization, is crucial to success. Evaluate - Evaluation through follow up culture surveys and Leadership 360’s can measure if the strategies are effective and identify gaps for improvement. Usually these are monitored by Human Resources with consultation of the Health and Safety representative or Joint Health and Safety Committee.
subtleties.
• Monitor assumptions - one person's handshake is another person's violation of religious beliefs.
• Be mindful of suppressiona nd repression - people are usually afraid to report harassment, and harassers may be skilful at "managing up."
• Listen to both sides of a complaint fairly - take every complaint seriously and proceed with care.
• Meeting these new legal requirements is necessary but it's only the beginning to make your workplace program truly effective, you will need to lead by example.
Henrietta Van Hulle, BN, MHSM, COHN (C), CRSP, CDMP (hvanhulle@ pshsa.ca ) is Executive Director, Health and Community Services, at the Public Services Health & Safety Association. For more information, visit www.pshsa.ca. To download their Bullying in the Workplace booklet, visit https://www.pshsa.ca/wp-content/ uploads/2013/02/BullyWkplace.pdf
Public Services Health & Safety Association (PSHSA) works with Ontario's public and broader public sector workers and employers, providing occupational health and safety training, resources and consulting to reduce workplace risks and prevent workplace injuries and illnesses.
PROGRAMS, TRAINING AND SKILL DEVELOPMENT A healthy work environment is critical to the wellbeing of every healthcare provider. It is essential for the overall satisfaction of healthcare professionals, for successful recruitment and retention, and for quality patient care. The Medical Professional's Gateway to Health & Wellness | 15
I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
Workplace
VIOLENCE in Healthcare
When we consider the working conditions of healthcare workers, we think about underfunding, long shifts and too many patients in the care of too few staff members. But one thing that often escapes our attention is violence against healthcare workers. A study published earlier this year in the New England Journal of Medicine revealed that 46 percent of American nurses reported violence in one of their most recent five shifts, and one in three were physically assaulted. The statistics are similar in Canada, and, in fact, the number of reported events in Ontario have been increasing over the last five years. The Public Services Health & Safety Association (PSHSA) is working to change that with the Violence, Aggression and Responsive Behaviour (VARB) project. The goal of the project is to give workplaces practical tools and a consistent model to reduce the incidences of violence in healthcare. The project is being completed in several phases, and the first part to be completed is the Flagging Handbook. This handbook, which will be offered free to all healthcare workplaces in Ontario, gives guidelines for flagging patients who have had a history of violence or exhibit behaviours that indicate they have the potential to become violent. By alerting healthcare staff ahead of time, the hope is that they can take measures to help prevent the violent acts from happening. However, the approach requires careful consideration, according to Henrietta Van hulle of PSHSA. There are several questions that need
16 | www.navigatemag.com
By Navigate Staff
to be asked before a flagging policy is introduced. First, what would cause a patient to be flagged? Does a history of violence, under any circumstances qualify, and how violent must the patient be? Second, do you flag the person’s chart, or use a wristband, which then allows anyone to know the patient’s private status? Third, how do we ensure that the flagged patient does not get a lower level of care than one who is not flagged? Finally, is there evidence that flagging patients reduces the number of assaults on staff? The answer to the last question appears to be yes, according to Van hulle. She says that several large hospitals have reported that flagging appears to be helping. PSHSA will be reviewing the toolkit and making changes based on feedback during the next phase of the VARB project. The results will hopefully create a safer, violence-free workplace for all Ontario healthcare workers.
Public Services Health & Safety Association (PSHSA) works with Ontario's public and broader public sector workers and employers, providing occupational health and safety training, resources and consulting to reduce workplace risks and prevent workplace injuries and illnesses. For more information, visit www.pshsa.ca. To download the Flagging Toolkit, visit http://www.pshsa.ca/ products/flagging-resources/
Medical Professionals and Personal Injury Law By Marcus Fisher
Medical malpractice isn’t the only reason your patient may need legal counsel Patients, especially those with physical trauma where someone else is involved (i.e. car accidents), will often require legal help just to navigate the complex requirements of their insurance company to receive the full range of benefits to which they are entitled. Personal injury law can encompass working on a client’s behalf with insurance companies, workplaces, or other parties who had a duty of care for the patient but failed to fulfill that duty. The focus of most medically related legal work is returning a patient to their pre-accident status Just as medical professionals are working to treat and heal a patient of a traumatic injury, ideally returning a patient to their pre-hospital physical condition, the job of medical legal representation is to return their client to their pre-hospital material condition, whether that is in terms of resources, mobility or other functions required to return to their lives in an undisturbed form. In order for a patient to be made whole in their lives after a traumatic injury, they often will need to avail themselves of both the medical and the legal systems to address all of their life needs. Most medical legal work will never even go to trial In the vast majority of cases, whether legal counsel is dealing with the insurance companies, their workplace, or the party that caused an accident, most actions are settled out of court; negotiated by both sides’ lawyers to reach a settlement that both sides find acceptable. These settlements are often predicated upon the lost wages a patient will need to live on while recovering from injuries, or the home care necessary to recover from the injuries themselves. What happens during medical treatment can affect a patient’s legal prospects greatly
Involvement in the legal system is often the last thing any medical professional wants to think about when it comes to their job. The idea of getting sucked into a legal action on behalf of a patient is often the proverbial stick used on new nurses and doctors to make sure they’re following workplace regulations correctly. Yet personal injury law remains inextricably linked to the healthcare system in Ontario, often for reasons that have nothing to do with suing hospitals, doctors or nurses for medical malpractice. Chris Richard, of Graves and Richard Personal Injury Lawyers, with over 10 years’ experience, and Jim Vigmond, of Oatley Vigmond Personal Injury Law Firm, with over 30 years’ experience, sat down with us to provide perspective on what medical professionals need to know about the legal component of a patient’s experience going through the Ontario healthcare system.
Since the vast majority of patients need to be treated medically before exploring what resources they will require during their recovery period, what happens in the hospital will obviously impact how patients will return to their lives. But it’s not only how successful a surgery or treatment goes that determines a patient’s quality of life once discharged. A patient’s condition and progress via patient notes are often one of the main information sources that legal determinations are made upon. Medical professionals are held in high esteem by the general public - that means juries, too Both lawyers cited nurses, doctors and paramedics as being highly respected by almost all the juries they’ve encountered, making their testimony and written medical records of great weight in most cases, whether they go to trial or not. You can help your patients with simple note taking guidelines: contextualize your daily comments (just how bad is it?), give examples or meaning to the concepts you write down, and use outside sources to corroborate what a patient tells you if possible.
The Medical Professional's Gateway to Health & Wellness | 17
Improving the Life of the E
www.dyeandrussell.com (905) 427-2000
Hope & Recovery for the
Durham Region