de Souza Nurses: Making a Difference in Cancer Care by desouzainstitute

I N S T I T U T E

de Souza Institute was established in 2008 by the Government of Ontario, in partnership with Cancer Care Ontario and the University Health Network. The Institute provides standardized, high quality and innovative online continuing education courses to healthcare professionals working with patients receiving oncology and palliative care. Through de Souza Institute, more than 6,300 healthcare professionals have obtained the latest knowledge and skills in hospice palliative and oncology care. Patients of de Souza trained healthcare professionals receive care and services catered to their psychosocial needs as they move along the cancer continuum. The Institute was named in honour of Anna Maria de Souza, a distinguished philanthropist and volunteer who lost her life to cancer in 2007. Phone: 416-581-7887 Email: support@desouzainstitute.com Web: www.desouzainstitute.com

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d e S o u z a N u r ses : M a k in g a Di f f e r en c e in C a n c e r C a r e

de Souza

de Souza I N S T I T U T E

de Souza Nurses: Making a Difference in Cancer Care

de Souza I N S T I T U T E

de Souza Nurses: Making a Difference in Cancer Care

In partnership with:

Contents About this book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Anna Maria de Souzaâ&#x20AC;&#x2122;s Lasting Impact . . . . . . . . . . . . . . . . . . . . . . . 8

A Message from our Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

de Souza Designations: A Symbol of Nursing Excellence . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

A Message from our Co-Chair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

OUR DESIGNATES Carol Gunsch Grand River Regional Cancer Centre . . . . . . . . . . . . . . . . . . . . . . 12

Audrey Cianfarani Etobicoke General Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Nicole Foy Northeast Cancer Centre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Tammy Powell Niagara Health System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Fiona Barham London Regional Cancer Program . . . . . . . . . . . . . . . . . . . . . . . . 16

Valrie Hursefield Etobicoke General Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Wanalda Parsons R.S. McLaughlin Durham Regional Cancer Centre . . . . . . . . . 18

Christine Hipgrave Simcoe Muskoka Regional Cancer Centre . . . . . . . . . . . . . . . . . 36

Wen Juan Huang Toronto General Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Jana Lee Breton Juravinski General Hospital and Cancer Centre. . . . . . . . . . . . 38

Komal Patel Brampton Civic Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Lorminia Realeza Mississauga Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Lollita Rahaman Brampton Civic Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Pat Cotman Princess Margaret Cancer Centre . . . . . . . . . . . . . . . . . . . . . . . . . 42

Maureen Watt-Smit Grand River Regional Cancer Centre . . . . . . . . . . . . . . . . . . . . . . 26

Pat Stalker London Regional Cancer Program . . . . . . . . . . . . . . . . . . . . . . . . 44

Cheryl Latondress Georgian Bay General Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

About this book Two in five Canadians will develop cancer in their lifetime. Over 63% of them will survive, but the journey to conquer cancer is a difficult one for patients and their families. It is critical that healthcare professionals have the most up-to-date knowledge to guide patients and their families, and offer them the best possible care tailored to their physical and emotional needs. In 2008, the government of Ontario created de Souza Institute to support training and ongoing competency development of health professionals that care for cancer patients and their families. Since then, de Souza Institute has delivered state of art online education and career counseling to more than 6,300 professionals across Ontario. A de Souza Designation is awarded to a healthcare professional who has completed the de Souza Institute comprehensive learning pathway to handle every situation, from: delivering a new treatment, managing a reaction to chemotherapy medication, alleviating anxiety and fears, or reducing suffering from pain and other symptoms. The de Souza Designates featured in this book represent a new gold standard in cancer care, and come from clinical programs and hospitals throughout Ontario. They all share the same passion and commitment to engage in lifelong learning and have demonstrated outstanding clinical competencies in caring for patients and families living with cancer.

A Message from our Director Welcome to de Souza Nurses: Making a Difference in Cancer Care. I am pleased to recognize each of these hardworking nurses, that have attained de Souza Designations and highlight their commitment to excellence in oncology and hospice palliative care. These recent de Souza Designates are healthcare professionals who despite years of experience, recognize that ongoing professional development and training is instrumental to delivering quality care. They are held in high regard and are team leaders. Cancer is a life threatening illness that has a profound impact, both physically and emotionally, on the lives of patients and their families. They want the best treatment and care and to be ensured that their entire healthcare team is knowledgeable of the latest best practices. de Souza Nurses are a new gold standard and shining examples of nursing excellence. They epitomize the spirit of a person-centred healthcare system. Thanks to these nurses, patients receive the best care possible.

A Message from our Co-Chair As the Chair of the Provincial Advisory Council, convened by Cancer Care Ontario and University Health Network, to guide the operation of de Souza Institute, I am proud to present to you this book about de Souza Nurses, their inspiration and their commitment to care. Supported by de Souza Institute, these outstanding clinicians practice the best medicine in our healthcare system, that is, delivering a person-centred, and evidence based cancer care service. Their impact can be seen across the entire continuum of care from prevention, screening, and diagnosis, through to treatment, survivorship or palliation. I look forward to more de Souza Nurses in the near future and the continued growth of de Souza Institute in leading professional training and promoting high quality healthcare across Ontario, Canada and internationally.

Joy Richards RN, PhD Chair, Provincial Advisory Council, de Souza Institute Vice-President of Professional Affairs and Chief Nurse Executive, University Health Network

Mary Jane Esplen, RN, PhD Director of de Souza Institute Professor and Scientist, Faculty of Medicine University of Toronto/ University Health Network 6

Joy Richards RN, PhD Chair, Provincial Advisory Council, de Souza Institute Vice-President of Professional Affairs and Chief Nurse Executive, University Health Network

Mary Jane Esplen, RN, PhD Director of de Souza Institute Professor and Scientist, Faculty of Medicine University of Toronto/ University Health Network 6

Anna Maria de Souzaâ&#x20AC;&#x2122;s Lasting Impact

de Souza Designations: A Symbol of Nursing Excellence

Anna Maria de Souza was a distinguished philanthropist and volunteer in Toronto. Born in San Sebastiao do Paraiso, Brazil, she passed away at Princess Margaret Hospital in September 2007, after a courageous battle with cancer. For over 42 years she worked selflessly in various fundraising activities to benefit a number of charitable institutions across Canada.

de Souza Institute offers five designations: de Souza Intern, de Souza Nurse Associate, de Souza Nurse, de Souza APN and de Souza Scholar. Similar to the Macmillan Nurse model in the U.K., these nurses are recognized by their colleagues, employers, patients and families, policy makers and the public. The designations showcase nursing excellence in cancer care and hospice palliative care.

Mrs. de Souza's efforts raised over $65 million for various deserving institutions, mostly located in the City of Toronto, and primarily in the area of healthcare. Her principal commitment was the Brazilian Carnival Ball, which she founded in the basement of a church in 1966. Each year, the Ball attracted over 1,800 guests and raised over $2 million net, making it the largest charitable fundraising gala in Canada. Every year, a different charity was selected as the beneficiary of the Ball's proceeds. In 2008, the proceeds were dedicated to oncology nursing at Princess Margaret Cancer Centre. These funds became the catalyst for the creation of de Souza Institute.

Earning a designation requires the completion of courses over a set of competencies: Treatment & Delivery of Evidence Based Care, Therapeutic & Supportive Relationships, Developing Professional Practice & Leadership, and Patient Teaching & Coaching. Additionally, for de Souza Nurses, APNs and Scholars, completing a clinical fellowship is required to develop oncology nursing leaders through specialized learning in direct practice. Funding opportunities are available for clinical fellows. Nurses with a de Souza designation are regarded as healthcare professionals possessing strong clinical, psychosocial and leadership skills and are known as lifelong learners providing excellence in nursing care. The designations are open to all nurses across Canada that care for patients with or at risk of developing cancer. Once a designation is achieved, nurses are expected to maintain their designation through ongoing professional education and practice. To learn more about de Souza Designations, visit:

www.desouzainstitute.com/designation 9

Anna Maria de Souzaâ&#x20AC;&#x2122;s Lasting Impact

de Souza Designations: A Symbol of Nursing Excellence

www.desouzainstitute.com/designation 9

Our Designates

Carol Gunsch, a Registered Nurse from Grand River Regional Cancer Centre is the very first de Souza Designate. Carol began working towards her de Souza Nurse Designation in 2008. After completing four credits from each of the four domains and a two week clinical fellowship, she was honoured with a plaque showcasing her specialization in 2012. Carol has worked as a dedicated Nurse Navigator in the GI Diagnostic Assessment Program at Grand River Hospital in Kitchener, Ontario.

In Carol’s words… My journey towards becoming a Registered Nurse was originally built on the basis of necessity – the personal care attendant/laundry aid position that I applied for at a local retirement home paid more than the minimum wage. It was here, at the age of 20, that I was introduced to a profession that I am now so proud to represent. A journey that started out 24 years ago and continues to percolate today has morphed into one incredible experience. Nursing is a career that demands rigorous mental and physical stamina, combined with a healthy dose of both personal and professional reflection.

My introduction to oncology was unfortunately through a personal tragedy. Through a very trying ordeal, and at the young age of only 52, my father succumbed to lung cancer in 1995. At high risk for developing lung cancer, symptomatic and then misdiagnosed, his diagnostic process was to say the least, not a pleasant experience. Once diagnosed and deemed palliative, he was assisted by some of the most compassionate and empathetic nurses I have ever had the opportunity to meet.

“

I was fueled by endless possibilities, and fostered by a profession that exemplifies commitment, compassion and the well-being of all.

”

When the opportunity arose to move into oncology nursing, I strongly believed that I too, could help ease some of my patients through

Carol Gunsch RN, BScN, CON(c) 12

their own cancer journey. Although I had been introduced to oncology in continuing care, the intensive care unit and again in the operating room, it was in 2007 that I had the opportunity to officially move into an outpatient oncologynursing role. In keeping with staying current, and up-todate with the very latest evidence-based care, continuing education has always been a priority throughout my nursing career. Shortly after entering oncology, I was fortunate to be introduced to the de Souza Institute. Specializing in oncology nursing education, the de Souza Institute was offering a course entitled “Patient Navigation in Oncology Nursing”. Ironically, at the same time, Grand River Hospital was contemplating a new position – A GI Nurse Navigator within a Diagnostic Assessment Program. I applied for both, and there started a role for me that remain as fulfilling today as it did back then. The de Souza Institute continued to grow, and as such so did I. The de Souza Institute was influential in my becoming a Canadian Nurses Association Certified Oncology Nurse, and in 2012 I fulfilled my goal of becoming a de Souza Nurse.

“

I was fueled by endless possibilities, and fostered by a profession that exemplifies commitment, compassion and the well-being of all.

”

When the opportunity arose to move into oncology nursing, I strongly believed that I too, could help ease some of my patients through

Carol Gunsch RN, BScN, CON(c) 12

In 2007, Nicole began working as a nurse in the medical oncology unit and strived to better understand her role in the area of oncology. After taking de Souza’s Chemotherapy and Biotherapy course, her interests grew. Nicole then attended a workshop led by Dr. Mary Jane Esplen, the Director of de Souza Institute, where she first heard about the de Souza Designation.

She confidently utilizes her skills in her daily practice with patients, their families and with colleagues. She encourages all nurses to take advantage of the knowledge de Souza Institute provides so they can apply specialized oncology education within their own practice.

According to Nicole, the de Souza Nurse Designation has been extremely valuable in developing specialized skills in chemotherapy and biotherapy, radiation, end-of-life care and psychosocial care. Nicole believes that she has been able to inspire other caregivers to continue advancing their knowledge.

Nursing is a career with endless personal and professional rewards. As a de Souza trained nurse I have the privilege of providing excellence in oncology care from prevention, diagnosis, cure and end-of-life care.

Nicole currently works as a primary nurse with medical oncologist Dr. Brindusa Moncanu at the Northeast Cancer Centre in Sudbury.

Nicole Foy

“

In Nicole’s words…

My background has been multi-faceted and includes mental health, long term care, community, and medical areas. Nonetheless, my transition to oncology is a continuing learning curve.

I am very proud to be a de Souza Nurse because it means that not only can I care for patients as an oncology nurse, but I have the most recent knowledge and support to share my expertise in cancer care.

RN, CON(c) 14

”

I was inspired to begin in hospice palliative care when I was working in the community as a nurse. Providing end-of-life care to those who wished to remain at home for their final time was a satisfying reward for the family and client. It was a wonderful experience knowing that I was able to offer the family the specialized care that they deserved. We joyously celebrate when new life enters the world, and palliative care allows us to assist the family in celebrating the final stage of life. As a society we are improving how we provide endof-life care but we still have room to improve by increasing resources to further deliver care and support in the final stages of a patient’s time. My job as a primary nurse at the Northeast Cancer Centre allows me to work in areas of patient navigation from first diagnosis, caring for and supporting the patient and family during treatment and throughout the transition to cure and prevention through to endof-life care. Nursing is a wonderfully diverse profession with boundless possibilities for education and satisfaction.

Nicole currently works as a primary nurse with medical oncologist Dr. Brindusa Moncanu at the Northeast Cancer Centre in Sudbury.

Nicole Foy

“

In Nicole’s words…

My background has been multi-faceted and includes mental health, long term care, community, and medical areas. Nonetheless, my transition to oncology is a continuing learning curve.

RN, CON(c) 14

”

In Fiona’s words… It would be misleading to suggest that I chose oncology as a nursing specialty when I completed my nursing training in 1988. Like most others, it was the beginning of a career that would be diverse in terms of areas of practice, knowledge and roles. Dr. Mary Jane Esplen has commented that nurses graduate as “generalists” in nursing and through continuing education and work experience we become specialized and competent in our areas of practice. I am no different; I believe that oncology nursing chose me in my years leading up to achieving my de Souza Designation.

Fiona Barham RN, CON(c)

Fiona is currently working at the London Regional Cancer Program as a Primary Nurse for various patient disease site populations. She also works with Dr. R. Kim in the Personalized Medicine Clinic which provides pharmacogenomic counselling for patients receiving chemotherapy and endocrine therapies.

Not only did Fiona gain a vast understanding of oncology but the de Souza Nurse Designation program included specialized training that helped her earn a role with the Personalized Medicine Team. She uses her designation experience to continue learning and initiating change within her area in oncology nursing and beyond.

During the ‘90’s when permanent full-time work was scarce, I decided to augment my hours of work in the Multi-Organ Transplant Unit with community nursing hours. Shortly after starting with the Victorian Order of Nurses palliative care nursing program, I realized that aside from the financial gain, an unexpected benefit of my work with the VON was the fulfilment and sense of satisfaction achieved while working with patients and their families to provide care that ensured comfort needs were met, and patients’ goals of care while dying at home were acknowledged. This change in mindset from what I had previously experienced in the acute care setting of the hospital ignited a side of nursing practice that I hadn’t previously experienced.

Later, as a Case Manager with CCAC, I sought out the complex care cases and palliative care cases finding the complexity of the needs of those patients both challenging and rewarding. Eventually, I made the decision after over 15 years in the acute care and community settings to make a change to ambulatory oncology care at LRCP where I continue to be a primary nurse for patients. I recall making the move thinking I had derived some worthwhile knowledge and experience from the patients I had cared for within the hospital and in the community however, not long after starting, I remember being very aware that I was definitely a novice in my understanding of oncology nursing. Being successful in this area takes an incredible amount of compassion, empathy and active listening. I came across a quote by “Flavia” which I still find appropriate when describing the oncology nurse who excels in the role… “And what is as important as knowledge?” asked the mind, “Caring and seeing with the heart” answered the soul. The recognition that no person is diagnosed alone; that a spouse, a partner, a friend or other family members are also affected was brought home to me with the diagnosis and eventual passing of my father from glioblastoma, and my mother who is a survivor of breast cancer.

I believe in identifying that every patient has their own unique story and that there is a need to take the time to listen to that story. This becomes a powerful tool in guiding our patients to ensure that we make a difference as oncology nurse specialists in what is most likely the most difficult time in a person’s life. It can be challenging in our current work environments, where patient volumes and increased outpatient acuities are incongruous with human resources available, however it has become fundamental for me in my day to day practice to remain grounded by what initially drew me to oncology nursing and to advocate for what I believe are defining qualities of an oncology nurse expert. Having a de Souza Nurse Designation provides a professional assurance that as “guides” in oncology for our patients, we can provide excellence in care based on the latest information in best practice. The courses, workshops, and forums of discussion through de Souza, emphasized the importance of current information and discussion as a means of educating a team of individual professionals on the cancer care team. It is my hope that excellence in care for our oncology population of patients will be

sought as a standard to be achieved by all professions in oncology. This standard would ensure expert guidance to patients and their families during their cancer experience. My personal objective is to continue to impart my passion for oncology knowledge to the collective framework of our professional team as I myself continue to learn and grow within the diversity of roles available in oncology.

“

Remembering that these individuals have started on a journey that was not of their choosing, and that we as oncology experts are their “guides” providing education, treatment, symptom management, advocacy, access to resources and most importantly a listening ear are paramount to the skillset of an oncology nurse.

”

Fiona Barham RN, CON(c)

“

”

Wanalda began her designation in 2010 and after completing 150 hours and 4.0 credits of continuing education she was awarded with the de Souza Nurse Associate Designation in 2013. Continuing education is very important to Wanalda. She believes that it is essential to stay up-to-date with cancer care knowledge as it is always changing. After taking part in de Souza Institute courses she was able to utilize these new skills in her practice and share useful knowledge with her team members. Not only has Wanalda used her oncology knowledge in the work place, she says as a volunteer and an active member of her community, her knowledge has been used daily. With a nursing career spanning almost 40 years, Wanalda encourages nurses of all stages, novice or experienced, to take part in the designation as it provides the tools to prepare nurses when dealing with cancer patients across the continuum of care. Regardless of years of experience within the practice areas of hospice palliative or oncology care, courses with de Souza Institute can be seen as an introduction, a pathway into a new direction, or a way to stay current within cancer care.

In Wanalda’s words… My nursing journey followed my life. I remember in grade three being asked what I wanted to be when I grew up and I drew a stick figure of a nurse. That image remained engrained within me through my nursing career. My passion started with obstetrics, then gerontology, ending with oncology. Of all my nursing positions, oncology felt the most rewarding. The patients and their families uplifted me with their wisdom and courage. Over the past few years many advances have been made in the treatment of cancer. It is this evolution in new treatments that inspires hope within me for further advancements in cancer care. One of the challenges working in cancer care, was keeping up the fast pace of new information that affected the care. As well as finding avenues to help patients with the high cost of cancer treatments. The rewards came from working with a multidisciplinary team with the goal of providing the best patient outcomes.

Our unit is composed of a great team. Each individual plays an intrinsic role to help support one another. Being an oncology clinical trial nurse is a world of its own. It is exciting being exposed to the newest research on the international, national and provincial level. Our unit has over 70 clinical trials based on academic and pharmaceutical trials. I am proud when I tell someone that the money given to the Terry Fox Run each year helps fund clinical trials from the academic world.

“

I have worked with people living with cancer, not dying with cancer.

”

It has been said that clinical trials is the “nursery” of cancer care. New drugs, treatments and devices start here. This is scientific change.

Wanalda Parsons RN, BN, CON(c) 18

R.S. McLaughlin Regional Cancer Centre in Oshawa, Ontario is one of the top ranked cancer centres for quality by Cancer Care Ontario. I am very proud to have been a member of this cancer centre. I would be very much amiss if I did not mention our supportive manager, Kirsten Burgomaster. Her knowledge and dedication is the reason our clinical trial program excels. We work as a team. From the compassionate oncologists and nurses to the supportive and dedicated volunteers, the whole team works for the good of the patients and their families. As my nursing journey was nearing its cycle, this designation showed that even as a mature nurse I was current and able to leave nursing with my high standards having been met. The learning cycle continues through life. There will always be an opportunity to learn more than what we already know, to go above and beyond what is expected of us. This de Souza Designation has been one of my greatest nursing accomplishments.

“

I have worked with people living with cancer, not dying with cancer.

”

It has been said that clinical trials is the “nursery” of cancer care. New drugs, treatments and devices start here. This is scientific change.

Wanalda Parsons RN, BN, CON(c) 18

Wen began her de Souza Nurse Associate Designation when she felt there was a gap in the amount of emotional care she was able to readily provide to her patients. Seeking out new educational opportunities is how she discovered the de Souza Designation program.

oncology unit. Having seen many patients with cancer and other chronic issues, she believes that staff should continually maintain and enhance their knowledge, skills, attitude and judgment to improve the quality of patient care and patient services.

According to Wen, the designation program helped her learn and grow as a nurse in many aspects. She believes it has enriched both her professional and personal life. Wen viewed the designation as a great way to keep her knowledge current and would validate her competence in her area of clinical practice.

In Wen’s words…

“

We need to find a moment to teach and a moment to talk.

Wen Juan Huang

”

In 2010, Wen received her Canadian Nurses Association certification in Medical-Surgical Nursing. Now Wen works as a Care Leader at Toronto General Hospital in the surgical

I have always wanted to be a nurse because I like helping people. However, I did not plan my career in palliative cancer care from the beginning. I initially chose the adult surgical unit because I always knew my strengths were in using hands-on-skills rather than dealing with the emotional aspect of care. However, as my nursing years grow longer, I realized that most of my patients have cancer and some of them go through the palliative journey. The area of oncology seemed to be expanding with opportunities, and was becoming very necessary for patient populations in the community. I found that I needed to update my knowledge in order to better help my patients. I think of nursing as a profession instead of simply a job. It gives me a sense of pride and fulfillment. I have been a nurse for 25 years and can honestly say to myself that I still enjoy my work. My job as a Care Leader involves providing support to my colleagues in terms

RN, BScN, CMSN(C), CGN(C) 20

of patient flow and changes in their schedule to ensure a fair balance between family and work. My unit is very busy; we usually run above our budgeted beds and we work with other nurses coming from agencies and NRT staff and students. The feedback I hear from them is always positive and encouraging in regards to our team members. Being so familiar with the environment, I see that the main challenges in this line of work, is the willingness for nurses to be present with our patients during their cancer journey, especially in a surgical setting when our goal is to cure. Time is always a factor in our day to day work. There are also many rewards, like the moment your patient shows you that they are able to manage their pain and other symptoms for them to go home. The family members are less stressed because of the information that you provided allows them to feel informed and assured of what the process will be. Being a nurse in hospice palliative and oncology care requires a deep commitment to one’s profession; to lifelong goals of learning and self-improvement. We choose to be advocates for our patients and their family by providing quality care.

In Wen’s words…

“

We need to find a moment to teach and a moment to talk.

Wen Juan Huang

”

In 2010, Wen received her Canadian Nurses Association certification in Medical-Surgical Nursing. Now Wen works as a Care Leader at Toronto General Hospital in the surgical

RN, BScN, CMSN(C), CGN(C) 20

Komal began her nursing career at William Osler Health System in Brampton, Ontario in 2006 on an in-patient oncology unit where she had the opportunity to provide direct patient care, precept nursing students, mentor nurses, and educate healthcare professionals throughout the organization. Komal values lifelong learning and has demonstrated this in many professional activities she has engaged in including a position as chair of the Oncology Interprofessional Unit Base Council and the William Osler Oncology Journal Club. In 2011, Komal completed an RNAO clinical fellowship that focused on oncology and palliative pain and symptom management. Komal joined de Souza Institute as an Advanced Practice Nurse Educator in 2012. While working at de Souza Institute fulltime, she continues to work at Brampton Civic on a casual basis.

that I really considered oncology nursing. I had requested to have my fourth year placement on the same unit and this is when I knew for sure that oncology nursing is what I wanted to do. I was drawn to it being both rewarding and challenging at the same time.

Komal holds a BScN from the University of Windsor and has completed her Masters in Nursing with a teaching focus from Athabasca University. She obtained her Oncology CNA certification in 2010, Hospice Palliative Care CNA certification in 2012 and CVAA certification in 2014. Komal is also one of the first de Souza APNs in Ontario.

At this point in my career, I work in two different roles: As a staff nurse at William Osler Health System; Brampton Civic Hospital, and as an Advanced Practice Nurse educator with de Souza Institute. At de Souza, I lead, develop and facilitate many oncology and hospice palliative care courses for healthcare professionals across Canada. Furthermore, I participate in research exploring the role of nurses in hospice palliative and oncology care settings within Ontario.

In Komal’s words… My journey as a nurse has been incredible. I knew I wanted to be a nurse after completing my grade 12 co-op placement in a community hospital. However, it wasn’t until my clinical placement on the oncology unit at Windsor Regional Hospital, during my third year of undergrad

Komal Patel

I’ve been working in oncology for the past 9 years and I love it; I learn something new every day. I am passionate about patient-centred care and about empowering patients and families through guidance, support and education throughout their journey with cancer.

Achieving my de Souza Designation was a significant milestone for me. It validates my competency to provide holistic care using best practices. It is also another step in my personal and professional growth towards becoming a well-rounded and independent practitioner.

“

Patient care and safety are the cornerstones of high-quality healthcare.

”

In my professional practice, as an advanced nurse educator in oncology and palliative care, I have witnessed the significant gap in service delivery, when a patch work of uncoordinated follow up services are offered to oncology patients who are discharged from cancer centers to community care. As indicated in the literature, NPs can play a significant role in caring for and supporting individuals dealing with cancer and end-of-life care issues and offer continuing care from hospital to community. Therefore, my three year goal is to complete the Post Master’s NP program. I will be officially starting the Post Master’s NP program in September 2015. As a nurse

RN, BScN, MN, CON(c), CHPCN(C), CVAA(C)

practitioner, I would like to continue to advance the nursing practice at all levels. I want to restore, maintain and advance the health of individuals, families and communities by using a holistic approach that is grounded in research. As nurses we are responsible and accountable for providing competent care, and keeping our skills up-to-date. Continuing education courses such as those offered through de Souza Institute have helped me enhance my knowledge to meet the needs of individuals and families dealing with cancer throughout the various stages of the cancer trajectory in this evolving healthcare system. To promote and provide the optimum level of care and safety, I actively enroll in continuing education courses, attend various conferences across the country and am constantly reading journal articles so that I am able to keep pace with relevant issues and developments. All in all, if I had to pass along a message to anyone thinking about a career in oncology or hospice palliative care, I would tell them: JUST DO IT!

Komal Patel

“

Patient care and safety are the cornerstones of high-quality healthcare.

”

RN, BScN, MN, CON(c), CHPCN(C), CVAA(C)

Passionate about nursing care excellence, Lollita pursued the de Souza APN Designation to enhance patient centered care. For Lollita, not only did earning her designation help her enhance the cancer experience for her patients, it also helped with the transition into her current position as an Advanced Practical Clinical Nurse Educator at Brampton Civic Hospital. Lollita is grateful for the positive impact it had in providing high quality care and the fluid communication with her interprofessional team. With her designation behind her, Lollita is continuing to work collaboratively with patients and their families to address and improve patient outcomes. She is also able to conduct research and reform hospital policies and procedures that reflect the best available evidence.

In Lollita’s words… My journey in nursing began when I worked as an RPN in the 80’s in palliative care with Baycrest Hospital. I spent time working at Sunnybrook, however I felt limited in my scope as an RPN. I went back to become a Registered Nurse with Humber College and found myself happier and much more content with my added educational background. I returned to palliative care with Sunnybrook and then Peel Memorial Hospital. It was with my expanding perspectives in endof-life care that led me to the decision to move into oncology care. I found myself working in inpatient oncology nursing; seeing a wider variety of patients from across the cancer continuum.

Lollita Rahaman RN, BScN, MN, CON(c), CHPCN(C), CVAA(C)

Continually taking courses to upgrade my skills and knowledge has always been important to me. I moved to the Brampton Civic Hospital and my passion for education persisted. I decided to become an educator, and in turn carried on with my own education. I completed my BScN at Ryerson University and a Masters with the University of Phoenix. Preparing to write my CNA specialty certification exams, led me to discover de Souza Institute’s study groups and courses. This excellent introduction, and successfully attaining certification in oncology and hospice palliative care nursing, encouraged me to further build my knowledge with de Souza. I enrolled in the pain management course as well at the standardized chemotherapy and biotherapy course and continued onto the APN Designation pathway. This designation was completed after my research project and 150-hour fellowship. This learning opportunity allowed me to create and implement a new standardized order set and decision tree for nurses admitting patients with febrile neutropenia. I developed this project to promote the management of patients being admitted, through clear clinical protocols. The educational experience I gained throughout the fellowship, courses, workshops and research project provided me with skills that are highly transferrable and valuable to my work.

In my current role as a Clinical Nurse Educator for William Osler Health, I am able to mobilize other nurses to become more involved in their professional development, by promoting continuing education and competency maintenance. Across our hospital; inpatient, outpatient, float pool and emergency units, most of our RNs are chemotherapy and biotherapy certified.

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To any new nurses,

beginning their career, I would tell them: Never give up. You never know it all. Each piece of knowledge you gain can change your thinking and enhance patient care and outcomes.

”

I truly value my de Souza Designation because it is a symbol of my dedication towards improving patient care. de Souza Institute represents a unique place in the cancer care landscape, and this designation is very special to me.

Another way that de Souza is unique is in their offerings, is that they are very inclusive of RPNs. Coming from a background where I began as an RPN, I can appreciate that many of the de Souza courses are interprofessional. RPNs that may not be CNA certified or have taken the chemotherapy courses are still able to enhance their clinical skills and educational experiences. Often times, in my area of work, we face challenges when we as nurses are unable to find time to discuss with patients and provide the psychosocial care that they deserve. However the most rewarding part is when you are genuinely thanked, or when your patient has reached acceptance and a meaningful understanding of what is happening to them. It opens your eyes to diverse patient perspectives. Since I was 5 years old, I would gather up all the old ladies in the neighbourhood and comb their hair. When they would ask me “What do you want to be when you grow up?” I’d always say a nurse. They agreed that my gentleness and consideration would take me there. Throughout my career, I would always gravitate back to cancer care. I hope to continue my passion for education in the field as my career goes on, by being involved in public speaking and attending conferences.

Lollita Rahaman RN, BScN, MN, CON(c), CHPCN(C), CVAA(C)

“

To any new nurses,

beginning their career, I would tell them: Never give up. You never know it all. Each piece of knowledge you gain can change your thinking and enhance patient care and outcomes.

”

As a registered nurse with a thirst for knowledge, Maureen was eager to take advantage of her learning opportunities. With the goal to enhance the patient experience across the cancer disease trajectory, she found that her designation helped fill the gaps in her practice and increased her overall knowledge of oncology and palliative care. Currently, Maureen works as an Education Practice Lead in the Oncology Program at Grand River Hospital and Regional Cancer Centre. She also works as a part-time educator at de Souza Institute.

In Maureen’s words… My journey as a nurse began almost 30 years ago. I was working as a healthcare aide in a nursing home when my first husband was diagnosed with leukemia. When I saw what the acute care nurses did, how knowledgeable they were, and how much they supported my husband and me, I knew then that was what I wanted to do.

Maureen Watt-Smit RN, BScN, MN, CON(c) 26

Later, a dear friend of mine was diagnosed with lung cancer. I was working in critical care at that time, and although I did my best to support her, I realized that I did not know what I did not know about cancer. I wasn’t fully knowledgeable of the treatments, protocols, side effects, and many of the supportive medications used. My friend’s cancer journey lasted almost four years: she had surgery, then had brain metastases, and then metastases to her upper chest.

As I shared that journey with her, I realized that cancer nursing was a specialized field of nursing that is very person-centered and unique to each individual as they follow the trajectory of the illness. My friend gave me the encouragement to pursue oncology nursing. My current role is an education practice lead for inpatient and ambulatory oncology nursing. Just by the title you can imagine that this position is all-encompassing, and very broad in responsibilities and accountabilities. Our oncology program has always strived to continually raise the bar in excellent oncology care, and that is reflected by the feedback we receive from our patients. I am proud to be a part of this caring community.

I feel that the main challenges of hospice palliative or cancer care for nurses are helping patients meet those domains of need. Time constraints and multiple demands on nurses can lead to compassion fatigue when nurses feel that they haven’t been able to support the patients as much as they like. There is a delicate balance between caring and caring too much. The rewards far outweigh the challenges: hospice palliative and oncology nursing exemplifies what Florence Nightingale’s nursing vision of care was all about: being there for the patient.

As healthcare professionals, I believe that we do our best work when we are current and diverse in knowledge. de Souza Institute provides that opportunity.

Since my career began, I have always been an active participant in new learning opportunities. I am a lifelong learner, and strive to stay abreast of innovations that will improve the care and outcomes for patients. In the future, I am looking to obtain more expertise in psychosocial care and survivorship to help the interdisciplinary team expand patient support to include community resources and family practitioners. I believe in the vision of cancer care close to home, and feel that every patient should have equal access to resources and supports in their own community.

Cancer nursing is more than just the physical care of patients under a medical model. Nurses have the privilege to connect with patients and families to support their numerous needs across the cancer care trajectory. To me, the domains of need; physical, informational, psychological, social, spiritual and practical, should always be utilized as a template to guide cancer nursing practice and patient care.

There is ongoing exponential growth in cancer care information: from diagnostics, screening and genetics, to treatment and survivorship. I feel that it is my responsibility as a professional healthcare provider to stay apprised of as much current oncology knowledge as I can. We owe it to ourselves, our patients, and our colleagues to be well informed. Our expert guidance will help patients to become more autonomous in managing their own care.

“

”

Maureen Watt-Smit RN, BScN, MN, CON(c) 26

As healthcare professionals, I believe that we do our best work when we are current and diverse in knowledge. de Souza Institute provides that opportunity.

“

”

Cheryl works as a Registered Practical Nurse at Georgian Bay General Hospital in Midland. Her passion for palliative nursing began when she took courses with her local palliative care network. Later, Cheryl wanted to continue advancing her palliative care knowledge and found de Souza Institute. She felt that the psychosocial oncology course was very beneficial because it allowed her to learn about expansions in the palliative and oncology fields. The psychosocial aspect of knowledge proved to be most valuable to her as she was able to utilize those skills when dealing with her patients and their families. Cheryl believes that if one is truly passionate about palliative care they should keep pursuing education in that area. Recently Cheryl earned the Robert Hartog Award for Innovation in Health Care through the Georgian Bay General Hospital Foundation. This achievement awarded her with $5000 to use towards education.

In Cheryl’s words… Nursing has come a long way from graduation. To be honest, near the end of my nursing course, I was thinking of quitting and not finishing. I felt I had chosen the wrong career. And here I am 30 years later, loving my job and specializing in palliative care.

Cheryl Latondress RPN

A hospice palliative care nurse is a special person. They are kind, caring, and compassionate. They must love their job but most importantly, they have a deep passion for palliative care. We work beside individuals as they begin on an unknown road or they are continuing a journey that was previously started. Frequently the main challenges in an acute setting are giving palliative patients and families the time and setting that they so deserve. Often there is too little time to develop a rapport. Sometimes it is all about symptom management and other times it involves an interdisciplinary team approach to get everyone agreeing on a future plan of care.

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...to be there for patients and families To be an advocate. To help navigate the system. To give a hug, to sit quietly, but most importantly to be there to listen.

”

When my dad was diagnosed with small cell carcinoma of the lung, he already had metastasis to the bone and lymph system. A diagnosis no one was expecting. This form of aggressive cancer took him from us in less than five months. No one should have to go through that experience alone; whether you are at home, in hospice or in the hospital. My experience with my dad gives me first-hand knowledge of what a family is going through, and helps me to answer what the future could possibly look like, and that I am there for them. Achieving a de Souza designation was huge for me. I was astounded when I learned I was the first RPN in Canada to receive this designation. I feel I am seen in a new light with regards to palliative care by my peers, pharmacy and the doctors; as someone with extended knowledge and resources. Knowledge is a powerful tool. For me, continuing education is not a chore, especially when it involves something you are passionate about. Over the past three years, while completing my de Souza designation, the psychosocial

course was instrumental in my approaching the CEO with regards to a traditional healing room after noticing a patient go outside to complete a traditional ceremony in the winter. We have a large First Nations population and thanks to collaboration we now have a beautiful traditional healing room. During the past two years, I worked on a policy for no resuscitation, palliative order set for last days of life and currently working on implantable cardioverter defibrillator deactivation at end-of-life. Since obtaining my de Souza designation, I continue to advocate for RPNs who wish to specialize in palliative care. This past year, I endeavored to challenge the CNA Hospice Palliative Care Nursing exam. I strongly feel if you have the knowledge and skill, it should not matter whether you are an RN or RPN. Nursing scopes of both disciplines have expanded and changed over the years. With this failed endeavor, some good did come of it. I have been invited by the Canadian Hospice Palliative Care Association to be part of their national palliative conference in Ottawa in October 2015.

Cheryl Latondress RPN

“

...to be there for patients and families To be an advocate. To help navigate the system. To give a hug, to sit quietly, but most importantly to be there to listen.

”

Audrey Cianfarani, a Registered Practical Nurse at Etobicoke General Hospital – William Osler Health System, began her Nurse Associate Designation when she felt there was a gap of knowledge she wanted to fill in her practice with a better understanding of oncology. As a skilled and experienced RPN for over 40 years, she still craved a larger and more comprehensive perspective on the journey that her patients and families had gone through before she was acquainted with them. Audrey’s designation gave her the much needed confidence and tools she was looking for, to effectively communicate and engage in meaningful conversation with her patients and their families. Most recently, Audrey also completed the Capstone Project with Lambton College, making her the first de Souza Designate to achieve the double de Souza Nurse Associate and Lambton College Certificatge in Oncology.

In Audrey’s words…

Audrey Cianfarani

My nursing career has been absolutely and unbelievably amazing, a dream come true. The patients and their families are my true inspirations. They are the ones that are experiencing the challenges and difficulties of the cancer journey each and every day. They are the true teachers, mentors and heroes. All they ask in return is that we listen and learn so

RPN 30

that their journey is not in vain but a source of hope and comfort for others that follow in their footsteps. What has always drawn me to the nursing profession is a desire to help those that are ill, sick or dying and need a helping hand. There was never a doubt in my mind that nursing would ultimately be my choice of a professional career. Contributing to such an incredible field such as hospice palliative care is an honour and most of all a labour of love. The story of one patient grew exceptionally close to my heart: Maria was a 70 year old female admitted to the unit with shortness of breath. She was diagnosed with lung cancer but was also a diabetic. She was one of the gentlest people I have ever met and it was a privilege to know her. Her daughter was a great asset to us as she would visit frequently and stay with her mom at night. Gradually, her shortness of breath and diabetes were brought under control and she was able to return home for a short period of time. On her second admission, her condition had noticeably declined, and the palliative care unit would become her refuge. Her dyspnea was more pronounced, which expressed itself in a lot of anxiety and restlessness. Pain, nausea and vomiting were also issues that needed to be addressed.

Pain and symptom management provided comfort for this terminally ill patient. Both patient and family were always so grateful for all of the care that they received. About two weeks before the patient passed away, the mother and daughter composed a poem entitled, “Our Floor Angels”. The poem demonstrated simply, how we are perceived by the people we serve and how we make a difference in their lives. This story is just one of many that I could narrate because of its inspirational qualities and the positive effect it had on my career and helped to shape the person I am today. My own personal definition or concept of hospice palliative care is the holistic approach that keeps the mind, body and soul of a terminally ill patient as one complete, inseparable entity. The whole approach to care is formulated in such a manner that both the patient and his family have more control over what kind of life experiences they will participate in, as well as the kind of death and dying process they feel is right for them. The focus of palliative care for the patient with a life threatening illness is to reduce suffering and increase the quality of their life through patient and family centered care. Pain and symptom management as well as a support system that encompasses not only the patient’s physical requirements but his emotional and spiritual needs as well, aid

both the patient and his family as they try to understand the experience they are facing. The difficult task of living through the dying process becomes a little easier and more positive when our humanness is emphasized more than the illness itself. In this field of work, the main challenges in my experience and opinion has to do with communication, knowledge and understanding the process. For the healthcare provider navigating the healthcare system is familiar because of the job description. However, the knowledge and understanding of the patient is often fragmented and piecemealed and the gaps are filled in with myths and misconceptions. For the patient and family it can be very difficult because of the unfamiliar new territory. Combine the experience with the illness process it can be very confusing, unpredictable and wrought with a lot of fear and anxiety.

“

The rewards in hospice palliative and cancer care are sometimes simple and other times more complicated to fathom. Firstly, it is the kind of specialized experience that this area of nursing has given to me. Secondly it is all about the journey that the patient and family have undertaken and are travelling. The mere fact that they are allowing me to be a small part of their lives and trusting me to care for their loved ones in such difficult circumstances is truly humbling and awe-inspiring. The hospice palliative and oncology continuing education over the last decade has increased my awareness, compassion, empathy, learning, confidence and communication skills. Continuing education has provided me with the tools that have enhanced my work experience and allowed me to practice the profession I love.

I have the opportunity to care for patients on both ends of the spectrum, the terminally ill as well as those patients requiring active treatments and interventions to improve and extend the quality of their lives when they return home. It is certainly an area where all of our nursing skills are being utilized to promote patientcentred care with the best possible outcomes. 31

”

In Audrey’s words…

Audrey Cianfarani

RPN 30

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With over 25 years of nursing experience, Tammy currently works with the Niagara Health System. In keeping on par with demands in cancer care that the community has faced, the Niagara Health System has expanded towards a fuller spectrum of cancer care services with the opening of the Walker Family Cancer Centre in March of 2013. With the skills gained through the completion of her de Souza Nurse Associate Designation, Tammy looks forward to new opportunities such as becoming a Nurse Navigator or continuing her professional development in order to obtain her de Souza Nurse Designation as well.

In Tammy’s words… From the age of two, I have always wanted to be a nurse. My journey into nursing started in Antigonish, Nova Scotia at a very small nursing school called St. Martha’s School of Nursing. Becoming a cancer nurse happened by chance for me. The floor that I worked on was a medical unit that was chosen to become a medical oncology/palliative care unit. At first it was very difficult, but as time went on oncology became my passion and the most rewarding job I have ever had. Yes, each day can be difficult but in this day and age people are living well with cancer. It is not the death sentence it used to be, each day I get to go to work and help people live.

Tammy Powell RN, CON(c)

A few weeks ago we had a family member of one of our patients come to see us just hours after his loved one passed. We cried together, laughed together and celebrated together and this gave us all a little bit of closure. It’s hard sometimes because we don’t always know what happens to our patients after they finish their treatments, but this wonderful man felt the need to share his sorrow and his joy with

us for the care that we provided to him and his wife. Moments like this touch your soul; this is why I am a cancer nurse. To know that I have helped in some small way gives me purpose and passion to get out of bed every day and do what I do. It is an honour to be called a cancer nurse. I have worked through the spectrum of care, from the moment of diagnosis until the last breath is taken and I would not trade it for anything. The unique quality about cancer care is that each patient responds differently to their diagnosis, their treatment, their outlook on life. Because each person’s cancer journey is different, I get to meet and learn from a vast variety of people. Having the privilege to work in a brand new state of the art hospital and cancer centre has been both challenging and rewarding. We have new patients starting treatment on a daily basis. They enter the chemo room full of fear and anxiety and when they leave they often tell me how good they feel and that they were so surprised how happy and upbeat the chemo room was. They come in expecting a sad, dreary room full of strangers but end up hearing laughter and often celebrations as another patient completes their treatment. Our unit is very warm and inviting with a lot of natural light coming in through a wall of windows. I have the pleasure of working with a wonderful

“

As a nurse, I see people at their worst, during the most intimate, challenging and frightening moments in life. If I can make a small impact in a person’s life with a kind word, a tender touch, lending a shoulder to cry on or just by listening, these are the most memorable moments of my journey as a nurse.

”

group of people who truly care about their patients and are committed to ongoing specialized oncology education. We work as a team, because without each other we would not be able to do what we do every day. Obtaining my de Souza Nurse Associate Designation has given me the needed tools, skills and knowledge to provide the best possible care to my patients going through a very

difficult time in their lives. I have been able to accomplish many goals by completing my specialized education and look forward to many more new challenges to come. Being a nurse for over half of my life I have learned that the most important thing you can do as a nurse is to take care of yourself. When I was a new nurse it was difficult to show your emotions, it was seen as a sign of weakness. As a piece of advice to other nurses; know that it is okay to cry with a family, take time to allow yourself to grieve over the loss of a patient. We are human, we are allowed to feel. Do not beat yourself up or feel weak because you care. The day that I stop feeling is the day I will no longer be a nurse. I am not saying that those who do not show emotion do not care but I am saying it is okay to show how you feel if it feels right to you. No one but you can make that judgement. There is always that one patient, or that one family that we will never forget. If we keep everything bottled up it will eventually take its toll. You may not be the type of person to show your emotions but find a way to express how you feel, keep a journal, find what works for you; if you don’t it will burn you out eventually. Allow yourself time to heal. I will close with a quote from Maya Angelou – “They may forget your name, but they will never forget how you made them feel.”

Tammy Powell RN, CON(c)

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Valrie began taking courses with de Souza Institute in 2010, and soon began working towards an APN Designation. This entailed a research project, one hundred and fifty hours in a clinical fellowship and completion of the required courses towards obtaining over 4.0 credits. Valrie currently works at the Etobicoke General Hospital site of the William Osler Health System as a Clinical Nurse Educator. In an educator role herself, she is immersed in the importance of continuing on with professional development in order to provide patients with optimal palliative care. Being witness to the gaps in knowledge about palliative care issues, Valrie chose to develop an educational brochure regarding advance care planning for patients and families. She also facilitated interdisciplinary staff training on how to incorporate advance care planning as part of discussions during the inpatient admission phase.

In Valrie’s words…

Valrie Hursefield RN, BA, MHA, CHPCN(C), CVAA(C) 34

As a clinical nurse educator here at William Osler Health System I provide and facilitate education to all healthcare professionals not limited to nursing. I have fifteen years of nursing experience, nine of those years within William Osler itself and I’ve been a Clinical Nurse Educator now for six years. I ensure that clinical competence; organizational standards and practices are maintained as well as actively promoting excellence in

clinical practice. I identify gaps in knowledge and skills of necessary staff and then I take the required steps to provide them education and the support needed to close those gaps.

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…We are only guests in our patients’ lives. We should be honoured that they are allowing us in at such a sensitive time…

”

My de Souza APN Designation, I hold dearly; as a prestigious designation that affirms my commitment to providing the best possible care to patients while supporting continued nursing education and mentorship. Initially, I pursued the de Souza Designation because I want to be able to help my colleagues meet the challenges that are associated with working with oncology and palliative care patients. I enjoy the flexibility of completing majority of the courses online; which is accommodating to anyone’s schedule. Also the courses that culminate with a workshop at the end offers the opportunity to consolidate your self-directed

learning and the shared knowledge and experiences of nurses who have also completed the course. I like the fact that the courses are specialized to oncology and palliative care, but they are not limited to just the clinical aspects, they also address the psychological needs of healthcare professionals; for example courses are offered on managing anxiety and grief. I also appreciate the career counselling and the support that is accessible, and I think that is unique to de Souza Institute. The courses highlight current issues and practice changes in oncology and palliative care, and so I use that information, in conjunction with the College of Nurses’ guidelines to facilitate practice changes and improvements within the organization I work for. Having undertaken the courses myself with de Souza Institute, I am now uniquely positioned to encourage other nurses to do the courses and see how that knowledge is transferred or translated into excellent patient care. I really do believe that nurses should keep going, keep learning. Not just for the sake of learning but to make it worthwhile. It proves your commitment to excellence in patient care. de Souza has helped me to be more equipped, to behave in a manner that reminds me that I am only a guest in their lives. I am not in control of everything that is happening with the patient, tI am there for a limited time and I just think it’s a great honour.

In Valrie’s words…

Valrie Hursefield RN, BA, MHA, CHPCN(C), CVAA(C) 34

clinical practice. I identify gaps in knowledge and skills of necessary staff and then I take the required steps to provide them education and the support needed to close those gaps.

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…We are only guests in our patients’ lives. We should be honoured that they are allowing us in at such a sensitive time…

”

Christine began participating in de Souza courses as a way to supplement her experiences working as a radiation oncology nurse at the Simcoe Muskoka Regional Cancer Centre of Royal Victoria Health Centre in Barrie. After completing over 4 credits in the learning domains of practice as well as completing a 75-hour clinical fellowship with the Princess Margaret Cancer Centre and SMRCC; she has earned the title of 'de Souza Nurse Designate'. When completing her designation, her goal was to promote a holistic approach to cancer care and bring in a survivorship model to facilitate high quality care for patients and families. Christine approached her clinical fellowship with clear goals in mind; to expand her knowledge in the management of radiation related side effects, to broaden her understanding of the nurse navigator role and to take part in a survivorship model to enhance the care she provides to the families and patients she supports on a day-to-day basis.

In Christine’s words…

Christine Hipgrave

I have been a Registered Nurse for over 25 years, and have worked with Royal Victoria Regional Health Centre for over 13 of those

years. I have had experiences working in the surgical program, and most recently, for over three years I have worked in the Radiation Treatment Suite.

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What made the most impact on me was observing the positive patient response when their concerns were validated.

”

During my fellowship experience, I was able to work closely with a nurse practitioner to grow a deeper understanding of radiation related issues, such as skin related toxicities in the GI, head and neck patient population. I also spent a great deal of time observing the practices maintained in other clinics outside of my role. This broadened my understanding of

RN, BScN, CON(c) 36

the nurse navigator roles, nurse led clinics, as well as gaining skills towards advanced patient assessment. I was also especially interested in breast cancer and colon cancer patients, in the specifics of their cancer journeys. The fellowship allowed me to work in clinical settings outside my current area of practice in radiation oncology. The clinical placement enhanced my practice in oncology/palliative care by giving me a better understanding of the patient experience throughout the cancer care continuum from diagnosis, follow-up and through to discharge. In my current role, in the Radiation Therapy Unit, I am educating patients as well as their families, and introducing them to radiation treatments in a therapeutic and caring manner. On a daily basis, I am able to actively collaborate with other professionals across disciplines, to create cohesive plans for our patients; to best meet their specialized needs. Pursuing continuing education allows nurses to grow both professionally and personally. With my added knowledge, I am in a position where I am able to act as a mentor to my colleagues; fostering relationships with other nurses to benefit their practice, and in turn promote excellence in patient care.

In Christine’s words…

Christine Hipgrave

I have been a Registered Nurse for over 25 years, and have worked with Royal Victoria Regional Health Centre for over 13 of those

years. I have had experiences working in the surgical program, and most recently, for over three years I have worked in the Radiation Treatment Suite.

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What made the most impact on me was observing the positive patient response when their concerns were validated.

”

RN, BScN, CON(c) 36

Jana Lee Breton currently works with Hamilton Health Sciences in Hematology/ Stem Cell Transplant Unit, located at the Juravinski General Hospital and Cancer Centre. Jana Lee specializes in the treatment of lymphoma, leukemia, myeloma and those receiving stem cell transplants. She has amassed over 32 years of experience spanning across education, research, administration and patient care. She exemplifies a passion for her practice in every aspect and is a wonderful example to her colleagues who aim to follow similar paths in their professional development. Attaining a de Souza Nurse Associate Designation can successfully fill a gap in knowledge, or it can be used as a turning point into a new clinical focus to further accomplish professional goals. With a de Souza Designation, Jana Lee is even better equipped in achieving her aspirations of providing the best possible patient care.

Jana Lee Breton

In Jana Lee’s words… I have had many personal experiences dealing with cancer. I can empathize with my patients and their families. My goal is to make their journey meaningful and help them cope with complex physical, psychological and spiritual challenges along the way. In our unit, our patients range in age from 16 to over 90 years old. Dealing with the developmental phases of life can be a challenge for the patient, family and the nurse especially when told there are no further treatment options available and death is imminent. We perform allogeneic and autologous transplants, and so my role is to provide care to the recipient of the transplant as well as supporting the related donor who is a family member. Our patients are usually hospitalized for their chemotherapy, and thus we develop strong bonds with them and their family; enabling us to provide consistent quality care.

Hematology and Oncology is relatively new to me. I began taking courses to expand my knowledge. I have always been a lifelong learner and de Souza has been instrumental in this phase of my career. de Souza is a well-organized program that is constantly evolving to meet the growing need for education in oncology. I am proud to have accomplished a goal I set for myself when I began education with de Souza. It has motivated me to continue my studies with de Souza as new courses and initiatives are being offered. I am currently

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I have worked in many fields of nursing and hematology is by far the most rewarding nursing care I have ever had the privilege of being part of. To me, oncology nursing symbolizes caring, compassion, respect and empathy for our patients, their family and especially for each other in the healthcare team.

I have had the opportunity to experience many interesting initiatives that have made my career very diverse. What I love most about our profession is that we practice at the bedside, participate in research, educate others and manage the business of healthcare.”

RN, BScN, CON(c)

(Photo Credit: Cory Breton)

working on my completion of the de Souza Designation. I have my Canadian Nurses Association specialty certification in Oncology. My next endeavor will be to complete a clinical fellowship in oncology.

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Jana Lee Breton

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RN, BScN, CON(c)

(Photo Credit: Cory Breton)

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Lorminia currently works as a Clinical Quality Care Leader with Trillium Health Partners, and is the very first designate from the Mississauga Hospital site. Her initiative in seeking continuing education in the field of oncology has broadened her ability to create positive changes in her clinical practice. Her de Souza Nurse Designation included a clinical fellowship centred on the role that nurses play when supporting patients receiving oral systemic therapies, as well as the vital responsibilities nurses must be accountable for, including storage, safe handling, safe administration and management of side effects. She also aimed to create a quick reference tool for front line nurses to gain access to information easily.

In Lorminia’s words…

Lorminia Realeza RN, BScN, CON(C)

My journey as a nurse has been full of surprises. I started as an Emergency Nurse, worked in a Medical Surgical Unit, worked as an Occupational Health Nurse, and finally found my passion in oncology nursing. I have worked in the Philippines, in the USA and Canada.

I am the oldest in a family of seven and culturally, I was designated to take care of all my younger siblings. Nursing is a caring profession and my experiences as the main caregiver of the family inspired my inclination towards becoming a nurse. Considering the role I am in today, my fatherin-law motivated me to become a nurse in the area of oncology. I was at his death bed and I was very hesitant to administer him his Demerol. This was in 1988, however I will never forget how disturbing it was to see him grimace and hold on to the hands of his son when he was in pain. My father-in-law had an agonizing four hour struggle before he passed away. Reflecting on this experience, I decided to learn more about pain management and end-of-life care. In the past I suffered because of a lack of knowledge in the area, but now I am proactive with providing enhanced pain and symptom management and end-of-life care.

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Oncology nursing is nursing with your head and with your heart.

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As a clinical quality care leader, I take pride in the fact that I can be present at the bedside, mentor colleagues with advanced care planning and attend meetings with the interdisciplinary team to discuss goals of care. I am also involved with discharge planning, coordinating home care services to ensure palliative patients make a successful and comfortable transition into the home. Housekeeping, patient care assistants, nurses, occupational therapists, physical therapists, and occupational therapy assistants all have a role to play in providing the best patient experience. Trillium Health Partners is a Regional Cancer Centre that I believe puts forth only the greatest efforts to achieve patient-centered care. There is abundant teamwork in our unit. A cancer nurse is an active advocate for the patient and their family. They are at the bedside in the cancer trajectory of every patient. From breaking bad news, to choice of treatments, managing treatment related side effects, providing psychosocial support and finally in offering end-of-life care; a cancer care nurse is present in every stage along the way. A cancer nurse with her expertise is like a beacon of light to patients and families with their cancer journey.

Oncology nurses should be proactive with self-care because this leads to compassion fatigue. Compassion fatigue prevents a nurse from delivering excellent cancer care. Cancer nurses cannot give what they don’t have. In this position, there is a fair share of advantages and rewards, as well as the diverse challenges. The rewards can be a grateful family who sends an obituary with special thanks to the cancer nurses in the unit. It can be a bouquet of flowers, a thank you card, or a box of chocolates; however the most rewarding feeling is knowing that a patient was provided the best cancer care possible. A peaceful death is very comforting to witness. The main challenges in hospice palliative and cancer care are caregiver burnout and the lack of sufficient dialogue between physicians, patients and family. This leads to lack of congruence between the care provided and the expectations of the patients and families. Oncology nurses can make a significant impact one patient, one family at a time. It will not always be an ideal experience, challenges will always be present but this is where the nurses’ resiliency comes into play. At the end of the day, our nursing conscience will set us free.

In Lorminia’s words…

Lorminia Realeza RN, BScN, CON(C)

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Oncology nursing is nursing with your head and with your heart.

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With over 38 years of experience, Pat currently works in the Princess Margaret Cancer Centre in the Palliative Care Outpatient Clinic. In the past, she has worked as a Clinical Trials Nurse, in the Department of Medical Oncology, Drug Development, and is well experienced in ambulatory clinics, in gastroenterology, gynecology and hematology. Pursuing continuing education in oncology and palliative care provides an enhanced understanding of the cancer care continuum and a de Souza Nurse Designation validates her hard work. After gaining the opportunity to observe various settings outside of her clinic setting, she further appreciates the benefits of professional development as well as supporting colleagues in their own continuing education.

In Pat’s words…

Pat Cotman RN, CON(C) 42

We are all touched by cancer in some way, sometimes personally, at times through family, friends and colleagues. As an oncology nurse I am in the respectful position to be directly involved with patients dealing with the complex effects of cancer. I have the opportunity to connect with patients and their families. My goal is to provide knowledgeable, empathetic and supportive care during this distressing life event. Working in Palliative Care I was often asked if I found my role depressing. My response was just the opposite. I found my role very rewarding.

I was on the side where I could work toward making things better for patients and families. The focus is on establishing goals of care and delivering care with respect and empathy with the intention to decreasing distress and suffering. In my role, I am a specialized oncology nurse and work in several disease

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The role of the

oncology nurse is evolving, becoming more specialized and essential in

”

providing good patient experiences.

sites supporting patients undergoing various treatment modalities and in different stages of their illness. I always work in the ambulatory clinic setting and am assigned on a daily basis to where I am most needed which could be almost any disease site. I am a member of a dynamic team of nurses who support, educate and deliver care to our patients and their families. We, the nurses, have the continuing opportunity to develop our skills and share knowledge while practicing our profession. Through these efforts we have the ability to influence the care our patients receive by striving for improvement and the discovering 43

novel approaches. I am in the unique situation to work with many leaders and experts and benefit from the example they lead with and the knowledge they impart. As a contributing member of the Palliative Care team I played an important role in the delivery of this care through assessing and managing physical and emotional pain and symptoms and establishing psychological and social supports. People are afraid. In most cases when distress is recognized, acknowledged and managed there is a strong sense of decreasing anxiety and acceptance. For many years, I had been away from direct bedside nursing and later in my career I developed a yearning to return to direct patient care. Having a strong interest in oncology I began with self-directed distance learning with Loyalist College in Belleville, Ontario. Eventually I was successful at achieving my goal which was to practice nursing again at Princess Margaret Cancer Centre. It was here I was introduced to the de Souza Institute. I have continued my learning over the past number of years leading me to the completion of my Nurse Designation. I believe in and participate in lifelong learning as it contributes to my personal and professional development along with keeping me abreast of new approaches and advances. I will continue learning with de Souza as well as through the many other opportunities we have at UHN and with the Canadian Association of Nurses in Oncology.

In Pat’s words…

Pat Cotman RN, CON(C) 42

“

The role of the

oncology nurse is evolving, becoming more specialized and essential in

”

providing good patient experiences.

Pat Stalker, a devoted nurse from London Health Sciences Centre has proudly earned her de Souza Nurse Designation as a symbol of her perseverance and commitment to cancer care. Earning this designation involved the completion of courses as well as a clinical fellowship, which she focused on Radiation Oncology Therapy. She developed a deeper understanding of radiation therapy, including planning, treatment, quality assurance and the overall patient experience. Currently, Pat works as a Clinical Educator for the London Regional Cancer Program, covering both inpatient and outpatient areas. Pat is also a de Souza Institute Chemotherapy Facilitator. Her day-to-day practice is even further enriched with the latest knowledge, skills and best practices, so that she may continue to positively influence her nursing colleagues, patients and their families.

In Pat’s words...

Pat Stalker RN, BScN, CON(C)

I can’t remember a time when I didn’t want to be a nurse. I would say a desire to help and care for others really drew me into this profession. Early experiences as a candy-striper in our local hospital ensured me, this was the career for me. Academically, sciences were always my favourite subjects- especially learning how the body functions made nursing an obvious choice for me. My first job in nursing was on a medical surgical unit –this gave me lots of opportunities to see the different fields of nursing and because it was

also associated with a cancer centre, it is where I developed my love of Oncology. I remember one of my first patients who underwent ostomy surgery for cancer of the colon – as a new nurse I shared some of his fears and we developed a relationship where we learned about caring and coping with ostomies together. In the palliative care and oncology settings I find these nurses to be highly educated and skilled with a desire to provide care that optimizes the experience for the patient and family. Nurses can truly make a difference to the patient’s life not only through their knowledge and skill, but also in their care – and using their presence to support patients through a difficult time. Challenges are many, from time restraints, limited resources, conflict within teams, to not always achieving the outcome that patients and families desire, are just some that come to mind. In addition, dealing with death and dying and coping with grief and loss does have an impact on staff – so paying attention to this and developing strategies to manage this impact is important to enable you to continue to care for this group of patients. Rewards are also many – our patients are very unique in the way they cope with this devastating disease and their ability to share their experiences, hopes and fears with the healthcare team. Although situations can be difficult, the patient and families’ ability to cope with this stress is very uplifting and I believe builds strength in the nurse caring for them.

I always tell new nurses that they have chosen the best area of nursing to work in. There is so much variety and so many opportunities with

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...many oncology patients are eager to share their experiences and fears. This results in very special relationships within the healthcare environment, which are so rewarding to me as a nurse.

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in the field that one will never be bored and it is a truly amazing career choice. You need to love oncology to stay in this field, if you do not, you will soon recognize this and leave – but if you stay it will be because it is something you love. Having the opportunity to work in a field that you love and working with other dedicated healthcare professionals and our amazing oncology patients will be a very rewarding career.

After 20 years at the bedside I am currently in the role as clinical educator and support nurses in the inpatient and outpatient units within our large teaching hospital. Our hospital provides many opportunities for learning and for career development while caring for this specialized group of patients. Education has always been important to me and is a lifelong philosophy of mine. I have a quote on my desk – “It wasn’t a waste of time if you learned something” – when I stop learning it is time to leave nursing. De Souza makes learning easy with the variety of educational opportunities available to continue to advance my knowledge and skill in Oncology. It became a goal of mine to achieve my de Souza Designation since I first knew it existed. It is a personal achievement and accomplishment, and it validates the work that I do in providing education to oncology nurses. Secondly it is the recognition from others – family, staff, and leaders - that I have achieved this status and that de Souza is recognized across the province and very soon across Canada as leaders in Oncology education for nurses and others. In the future, I will continue to take courses in Oncology and support my learning and that of other nurses in oncology. Even in retirement I am quite sure I will stay in touch with oncology through volunteering or support in the community.

In Pat’s words...

Pat Stalker RN, BScN, CON(C)

I always tell new nurses that they have chosen the best area of nursing to work in. There is so much variety and so many opportunities with

“

...many oncology patients are eager to share their experiences and fears. This results in very special relationships within the healthcare environment, which are so rewarding to me as a nurse.

”

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I was diagnosed with cancer. There's one

Supporting quality cancer care through quality education

thing that I wish I had when I went through cancer — a nurse who had training that de Souza Institute offers in psychosocial support.

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Nicole Foy, RN

de Souza Nurse Cancer Survivor

For more information about de Souza Institute, please visit:

www.desouzainstitute.com

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