Inside: From the CEO’s Desk | Evidence Matters | Safe Medication | Long-term Care | Careers
July 2020 Edition
Hero Deb Davies Page 19
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Political distancing. At the very moment when Ontario’s nurses are putting their lives on the line during the COVID-19 pandemic, a provincial arbitrator denied them a fair wage increase. Why? Because the government’s Bill 124 tied his hands, imposing a 1% cap on wages. When a journalist asked Christine Elliott about the arbitration, she dodged responsibility saying, “That’s outside of our jurisdiction.” But the facts are: they drafted Bill 124; they passed it; they can change it. “Nurses are heroes in our health-care system,” Elliott said. But the government’s refusal to exempt nurses from Bill 124 proves those words are empty praise. Adding insult to injury, some municipal police officers and firefighters are exempt from Bill 124 and others received generous multi-year wage increases above the 1% cap. This inequality shows a blatant lack of respect and fairness. Nurses will continue to do what we always do – take care of the people who need us. But the Ford government has sent us a clear message… one we won’t forget.
Vicki McKenna, RN, ONA Provincial President
Contents JULY 2020 Edition
IN THIS ISSUE:
A Salute e to oes Nursing Heroes
▲ How does COVID-19 impact the brain?
▲ Advanced therapy gives a lifeline to the sickest of COVID patients
▲ A homegrown solution to PPE shortage
COLUMNS Guest editorial ..................4
In brief .............................6 From the CEO’s desk .....14
▲ Southlake’s first dedicated COVID-19 units
Safe medication ............50 Evidence matters ...........51 Long-term care ..............54 Ethics .............................62
▲ Virtual patient care
Researchers to test up to 10,000 Canadians for immunity to COVID-19
Why does it take a crisis to understand that
health workers are our health system? By Ivy Bourgeault, Sarah Simkin and Caroline Chamberland-Rowe n country after country, members of the public are clapping from their doorways and balconies to show their appreciation of health workers. It is becoming clearer than ever that our health system is largely our health workers. Ventilators do not work without health workers; testing does not happen without health workers. All forms of care required to respond to this crisis will require health workers. Health system capacity – of which health workers are a key component – is often represented as a flat line on epidemic curves. The main aim of flattening the curve is to keep demand below the upper limit of health system capacity. This flat line gives the impression that health system capacity is static. It is not. Social distancing is a way for us to help moderate the demand side of the equation, but how are we to bolster the capacity side of the equation to keep ahead of that curve? Ongoing analyses of health system capacity are modelling increased capacity of physical resources. What is unclear is whether these analyses are modelling health workforce capacity, and if so, how. Health workforce capacity is not simply the number of doctors, nurses, respiratory therapists or other essential health workers that are actively registered. What health workers are allowed to do (their scopes of practice) and how they do it (their practice patterns) can vary substantially, depending on the populations they
care for, the settings in which they work and the regulations by which they are governed. But health workforce modelling should not only model how work is typically done. In times of crisis, when systems are called upon to demonstrate resilience, responsiveness, and surge capacity, models need to take into consideration how work could be done and demonstrate what capacity could be mobilized through more optimal use of available resources. That is, how could we better utilize the whole of the health workforce to turn the capacity line upwards? Responding to this crisis will require shifting tasks and leveraging the full scope of skills available within the health workforce. These innovations are often employed in low resource settings, out of necessity, but even high-income countries are quickly shifting tasks and redeploying available human resources. In the UK, for example, anyone with skills in sedation, including dental nurses who are part of the National Health Service are being recalled to help respond to the COVID crisis. In Australia, physiotherapists are similarly being redeployed to work in acute respiratory teams. Additional pools of health workers, such as trainees and retirees, are being mobilized. To best accomplish this, we need to know who is in the health workforce, where they are, and what skills they have. Sounds straightforward – and yet, in Canada, these basic data are often fragmented, out of date or hard to access. Continued on page 13
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How does COVID-19 impact the brain? Researchers will study MRIs from survivors to find out By Samantha Sexton s healthcare professionals discover more about how COVID-19 affects the respiratory system, scientists suggest the virus could have potential neurological consequences in some patients. A team of researchers led by Dr. Simon Graham, Interim Director of Physical Sciences at Sunnybrook Research Institute, is launching a study to investigate how COVID-19 impacts the brain. “We know from early case reports in China that about 30 to 40 per cent of hospitalized patients had neurological symptoms,” says Dr. Graham, the study’s principal investigator. “Symptoms included headaches, confusion, and stroke. Most common was a loss of smell, which in the absence of any nasal congestion suggests that the virus may affect brain regions that control our sense of smell. Chronic neurological problems have also been associated with other types of coronaviruses, such as SARS and MERS (Middle East Respiratory Syndrome). Given the numbers of people infected by COVID-19, more detailed brain research is definitely needed.” “COVID-19 can have a big impact on the lungs, but at what point are symptoms a reflection of bottom up versus top down processes in the body? Breathing occurs when signals are sent from the brain down to the body. If some of the COVID symptoms are due to disrupted brain-to-lung signals, then this could be a blind spot in understanding the virus. This needs to be explored,” says Dr. Brad MacIntosh, study co-investigator and senior scientist at Sunnybrook Research Institute. “Our goal is to investigate this further to assess to what extent COVID-19 may impact the brain.” Dr. Graham, alongside his research team at Sunnybrook and collaborators at Baycrest, will study the neurological impact of COVID-19 through the use of clinical assessments and magnetic resonance imaging (MRI) of the brain in recovered COVID-19 patients. Patients who have tested negative are also invited to participate in the study,
Dr. Simon Graham and Dr. Brad MacIntosh.
acting as a control group. Study participants will be assessed at baseline and several months after their initial visit, to detect whether brain symptoms are present, and whether the symptoms resolve or linger. The research team aims to enlist several more imaging sites across the country to increase the number and diversity of the participants who are studied. “This collaborative effort is paramount in the discovery of how COVID-19 could potentially impact different regions of the brain and what effect the virus may have on thinking, learning and memory,” says Dr. Jean Chen, senior scientist at Baycrest’s Rotman Research Institute and co-principal investigator. Other Baycrest co-PIs include Dr. Asaf Gilboa and Dr. Allison Sekuler. “It is critical that we understand the possible effects of COVID-19 on brain health, both to address immediate needs and to prepare for longer term impacts,” adds Dr. Sekuler, Vice President of Research at Baycrest. “We are thrilled to be co-leading this study, and to be working with scientists from across the country
to get answers as quickly as possible.” “In addition to raising awareness of this issue among doctors and in the public,” says Dr. Graham, “the study will also allow us to direct patients in
need towards neurointerventions and treatments as early as possible.” The study is currently recruiting patients. Learn more about the study and H how to participate. ■
Samantha Sexton is a Communications Advisor at Sunnybrook Health Sciences Centre.
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JULY 2020 HOSPITAL NEWS 5
Poll shows Canadians are overwhelmingly
satisfied with virtual healthcare he Canadian Medical Association (CMA) released a national poll showing that Canadians are embracing virtual care options and would like to see them not only continued after the COVID-19 crisis subsides but improved and expanded in the future. The national poll conducted by Abacus Data between the 14th and 17th of May 2020 found that almost half of all Canadians have now accessed a physician using virtual care options and they are highly satisfied with the results. Those who connected with their doctor virtually during COVID-19 report a 91 per cent satisfaction rate – 17 points higher than in-person emergency room visits. Moving forward, almost half (46%)
ALMOST HALF OF ALL CANADIANS HAVE NOW ACCESSED A PHYSICIAN USING VIRTUAL CARE OPTIONS AND THEY ARE HIGHLY SATISFIED WITH THE RESULTS. of Canadians who had the opportunity to use virtual care since the pandemic outbreak would prefer a virtual method as a first point of contact with their doctor. “Physical distancing measures designed to keep Canadians safe during
our fight against COVID-19 have led to the adoption of virtual care out of necessity,” says Dr. Sandy Buchman, CMA President. “The train has left the station now that Canadians have had the opportunity to access virtual care, and they’ve had an overwhelmingly positive experience when they did so. We need to build on this momentum. Canadians should be able to access healthcare in a timely and convenient fashion.” The poll also highlighted that half of Canadians believe virtual care could impact the cost of our health care system, improve access to specialists (45%) and timeliness of test results (41%). Earlier this year, a CMA-led task force issued a report outlining recommendations on how the federal
government and stakeholders can improve and expand virtual care throughout Canada. “What’s needed now is for the Federal government to facilitate a pan-Canadian framework for virtual care, with provinces and territories playing a key role in how virtual care is improved and expanded,” says Virtual Care Task Force Co-Chair and CMA Past President, Dr. Gigi Osler. “All Canadians – from urban to rural, remote and Indigenous communities – can benefit from more choice and convenience when it comes to how health care is accessed and delivered.” More information related to the Virtual Care Task Force and public opinion research can be found online H at: https://www.cma.ca/virtual-care. ■
Building capacity in emergency shelters to prevent spread of COVID-19 he Dr. Peter Centre is creating a Community of Practice Hub for frontline service providers, health care professionals, and policymakers with the goal of building capacity within emergency shelters where people may need to use drugs and/or Urgent Public Health Need Sites (also known as Overdose Prevention Sites). Funded by Health Canada’s Substance Use and Addictions Program (SUAP), the need for the program comes on the heels of nation-wide communities moving people experiencing homelessness into temporary housing, in an effort to prevent the spread of COVID-19 amongst an already-vulnerable population. Starting this June, individuals and organizations operating emergency shelters or Urgent Public Health Needs Sites will be able to turn to the new community and healthcare
6 HOSPITAL NEWS JULY 2020
partnership, which includes videoconferencing, website access, and direct training sessions, for evidence-informed practices in responding to the needs of people who use substances in these environments. The Honourable Patty Hadju, Minister of Health, said: “Community-based expertise and collaboration are key to supporting people who use drugs and their communities, and this is even more critical in the context of the pandemic. The Government of Canada’s support for this project is another example of its commitment to helping ensure that service providers in communities across Canada have the tools they need to respond to the COVID-19 pandemic and help vulnerable populations.” The capacity building initiative will be national in reach in both English and French. It will give frontline workers the ability to ask procedural
and best-practice questions and access training from experienced professionals. “Increased overdose deaths in Vancouver prompted the Dr. Peter Centre to use funds from Health Canada’s Substance Use and Addictions Program (SUAP) to create the Community of Practice Hub. This will allow for the sharing of knowledge within the health and housing communities, which can then be used by frontline service providers and organizations to ensure effective protection for and harm reduction to persons who use drugs and/or are experiencing homelessness.” explained Dr. Hedy Fry, Member of Parliament for Vancouver Centre. Health Canada is supporting the Dr. Peter Centre for the Centre’s first-in-North America supervised injection site experience, and its subsequent learning and teaching. The Dr.
Peter Centre is positioned as a strong facilitator of knowledge exchange thanks to ongoing work with federal projects focused on harm reduction and increasing services for people who use drugs. Says Scott Elliott, Executive Director of the Dr. Peter AIDS Foundation: “We’re excited to take on this new role and share knowledge and skills with frontline service providers across Canada. We hope that our experience in this field will be an asset to everyone involved and will ultimately have an important role to play in helping to meet the care needs of people who use substances.” Both the videoconference calls and website will be active by late-June and subsequent training for frontline providers will occur at regular intervals over the next year. For more information about the program, please visit: H https://uphns-hub.ca/ ■ www.hospitalnews.com
Caring for patients on COVID-19 units:
Mental health remains low
despite signs of re-opening
orneau Shepell recently released the second of its monthly Mental Health Index™ report, showing a consistent negative mental health score in the country. The findings show that COVID-19 continues to have a negative impact on mental wellbeing, despite a slowing of infections, and most provinces proceeding with a phased reopening. The Mental Health Index™ for May showed a 12-point decline from the pre-pandemic benchmark of 75. This month’s overall score is identical to the score last month, however the sub-scores show a modest improvement in anxiety countered by a larger increase in isolation. The main factors contributing to poorer mental health in the month were anxiety
(-14.0 points), depression (-13.9), work productivity (-13.5), optimism (-12.3) and isolation (-11.9). Additionally, this is the second consecutive month where Canadians report an increase in mental stress compared to the prior month. The continuing low Mental Health Index™ score, plus the continued monthover-month increase in mental stress, raises concerns regarding the potential longer-term impact of the COVID-19 pandemic on Canadians’ mental health. Across the country, we see some modest improvement in the Mental Health Index™ in Alberta, Manitoba, Newfoundland and Labrador, the Maritimes and Saskatchewan, and declines in British Columbia, Quebec and Ontario. British Columbia had
the most significant increase in stress compared to the prior month, and Manitoba and Saskatchewan had the lowest increases. “As we enter the third month since COVID-19 was declared a global pandemic, there are still many questions regarding the reopening of the economy and what lifted restrictions mean for Canadians,” says Stephen Liptrap, president and chief executive officer. “The continued compromise to Canadians’ mental health and wellbeing demonstrates that there is still much work to be done to help mitigate this critical dimension of the public health crisis. As we start to see the end of the strict lockdowns, we need to remain vigilant about support for mental health and H not take our eyes off that issue.” ■
Capital funding of health care in Canada is critical, yet investment has declined in last 20 years apital funding of health care, used to build new hospitals, redesign or upgrade existing facilities and invest in new technologies, has declined in Canada over the last 20 years, according to an analysis in CMAJ (Canadian Medical Association Journal). “Despite increases in total health care spending in Canada, capital investment in Canadian health care has seen a substantial decline in recent years, contributing to Canada’s high hospital occupancy rates, hallway health care problem and operating inefficiencies,” writes Dr. David Klein, Dalla Lana School of Public Health and St. Michael’s Hospital, Unity Health, Toronto, Ontario, with coauthors. Without adequate capital funding, health care systems are unable to adopt new technologies for diagnosis and patient care or upgrade aging buildings and equipment, which
EXPERT LEADERSHIP TO OVERSEE INVESTMENT AND PROJECT EXECUTION IS CRITICAL.
can affect patient care and efficient health care delivery. “Capital funding to support infrastructure is largely neglected in discussions about annual funding, yet inadequate or uncertain capital investment may threaten the sustainability and equity of the Canadian health care system even more than the variable disbursement of operational funding,” says Dr. Klein. The authors argue that Canada and its provinces and territories should prioritize capital funding by • encouraging innovative funding models, such as public–private
partnerships with strong regulatory oversight • pursuing partnerships with strategic investors • improving tax breaks to encourage charitable giving • supporting better tools for decision-making • engaging community stakeholders in capital projects Expert leadership to oversee investment and project execution is critical. “More capital alone will not solve the problem,” they write. “Capital investment must also be overseen and managed by expert leadership, fairly, transparently and ethically, to protect the public’s interest and trust. The challenges underpinning the current level and effectiveness of our health care system will not be solved with one method alone.” “Ensuring adequate capital investment in Canadian health care” was H published June 22, 2020. ■
an approach for hospitals oronto and Spanish physicians describe in CMAJ (Canadian Medical Association Journal) an approach to create dedicated COVID-19 patient units, infection control protocols and care teams to help other hospitals safely care for patients. “The care of patients admitted to hospital with COVID-19 cannot be construed as falling within usual hospital operating procedures,” writes Dr. David Frost, a general internist at University Health Network and the University of Toronto, Toronto, Ontario, with coauthors. “Meticulous planning is required. There are unique challenges regarding necessarily strict infection control procedures, provision of care to potentially large numbers of patients and clinical considerations specific to COVID-19.” The approach is based on real-world experience in Madrid, Spain, and from Toronto’s University Health Network, one of Canada’s largest hospitals, as well as relevant medical literature. Some highlights include • Creating a dedicated COVID-19 unit with delineated risk zones and protocols • Establishing a buddy system for health care professionals to safely doff and don personal protective equipment (PPE) • Considering how rapidly care teams can be scaled up, how to integrate other physicians and how to maintain continuity of care • Standardizing procedures with checklists to maximize efficiency and safety for ward rounds • Adopting patient-centred practices to help lessen isolation and ensure links with families and caregivers • Fostering a culture of safety and clear communications to all stakeholders To provide rapid access to the approach, the authors have created an open-access website www.torontocovidcollective.com. “The ability to rapidly disseminate information, iterate protocols and collaborate with physicians around the world will continue to be important through subsequent waves of the pandemic,” the authors write. “Principles for clinical care of patients with COVID-19 on medical H units” was published June 3, 2020. ■
JULY 2020 HOSPITAL NEWS 7
Patient with COVID-19 is ‘thankful to be alive’ Carmine Posteraro, who spent nearly two weeks on a ventilator, says he wants to share his story to show how devastating the virus can be By Steven Gallagher armine Posteraro considers himself a miracle. On March 25, the day he learned he had tested positive for COVID-19, the Niagara Falls resident was taken by ambulance to the Emergency Department at Niagara Health’s Greater Niagara General Site. He had severe damage to his lungs, he was struggling to breathe and his oxygen levels were low. Shortly after his arrival, the 39-yearold was intubated: A breathing tube was inserted through his mouth and into his airway so he could be connected to a ventilator that would keep him breathing. Twelve days later, Carmine woke up in the Intensive Care Unit, which cares for the most critically ill patients, at Niagara Health’s St. Catharines Site. He was disorientated. He was alive. “I remember the nurse Marina saying to me, ‘Do you know where you are?’ and I said, ‘No.’ ” Three days later, after his condition had improved, Carmine was moved to the unit dedicated to caring for COVID patients at the St. Catharines Site. He spent 10 days on Unit 4A before returning home. “When they brought me out of the ICU to the fourth floor, the healthcare team was clapping for me. It was just amazing,” Carmine recalls. “I’m thankful for the Niagara Health team. From the person who cleaned my room, to the personal support workers, to the nurses and doctors, the care was amazing. Everybody treated me with dignity. I thank God every day that I’m here and that I was able to survive this. I feel like I was a miracle.”
my husband in the hospital at the same time. The healthcare team was so caring and amazing. They were the heroes who kept me going.”
After battle with COVID-19 Carmine Posteraro is thankful to be alive.
A MOM’S AGONY
Those initial 12 days while her son fought for his life were agonizing for Carmine’s mother, Rena. A no-visitor policy at the hospital during the pandemic meant she could not see him. “I just wanted him to live. I prayed a lot,” she says. “I had a lot of great support. The team in the ICU was fantastic.” Every day Rena spoke with the ICU team over the phone. She said everyone was incredible, but she especially wanted to acknowledge three Registered Nurses that she had regular contact with, Jim and Jane Hyman and Marina Savic, and Respiratory Therapist Peter Morrone.
“They said, ‘You call anytime,’ and that happened every single day. It was so comforting. I knew he was in good hands. I knew they were by his side when I couldn’t be.” Making the situation even more difficult for Rena was that her husband, Dominic, who had also tested positive for COVID-19, was admitted to the COVID unit on March 30 with a high fever and pneumonia. Dominic was in much better condition than Carmine, and he stayed in hospital just over a week before returning home. “I have the ultimate respect for front-line healthcare workers,” Rena says. “I don’t know what I would have done without them. I had my son and
During his time in hospital, Carmine also suffered kidney failure and required dialysis. His recovery is slow but progressing. He is often tired, has blurred vision and numbness in his legs. “It’s getting better every day,” he says. “I’m truly blessed to be here.” Carmine says he wants to share his story to show how devastating the virus can be and to encourage others to heed the advice of health experts to stay home as much as possible, practice physical distancing and clean your hands often. He also wants to stress how rapidly the virus can spread. Carmine had been receiving care at an addictions recovery program in London in March when the pandemic was declared. His dad drove to the western Ontario city to bring him back to Niagara Falls. A few days later, Carmine learned that a staff member at the addictions recovery centre had tested positive for COVID-19. Carmine, who was already feeling unwell, and his parents were tested for COVID. “Please follow the guidelines set out by the government and health experts,” says Carmine. “This virus really kicked the heck out of me. It really took a toll on me.” Carmine never imagined he could get so severely ill from the virus. “I never thought that I was sickly or prone to sickness,” he says. “I’m just thankful I’m alive.” Continued on page 10
Steven Gallagher works in communications at Niagara Health. 8 HOSPITAL NEWS JULY 2020
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From despair to hope: Advanced therapy gives a lifeline to the sickest of COVID patients By Ana Fernandes ver two months have passed and that piece of paper still lies on her coffee table, with four letters on it: “ECMO.” Irena Veronese had never heard that acronym before, but when it was first mentioned to her, it meant moving from complete despair to a shred of hope of saving her husband’s life. The treatment called Extracorporeal Membrane Oxygenation (ECMO) consists of a machine that oxygenates the blood outside the body. It is normally used for transplant patients or patients with severe heart or lung disease. During this pandemic, it has also been used as a last resort to save some of the sickest COVID-19 patients at Toronto General Hospital, part of the University Health Network (UHN). Mladen Veronese turned 54 years old on April 1, the same day that he was taken to hospital. He had no pre-existing conditions, but was one of the cases where COVID symptoms got very bad, very fast. Mladen has barely any recollection of that day, but when he arrived at St. Michaels Hospital on his birthday, his breathing had deteriorated to a point that he couldn’t finish a sentence. He needed support from mechanical ventilation. Irena and their 18-year-old son were back at home as they couldn’t accompany Mladen, because of isolation measures in place at the hospitals. Irena says it was all very sudden, and somewhat unreal. “We were getting calls from family and loved ones who wanted to congratulate him for his birthday, and we had
Dr. Marcelo Cypel (L) and Dr. Eddy Fan, directors of UHN’s ECMO program say the program’s success is the result of a “tremendous team effort.”
Photo credit: UHN
to tell them that Mladen was taken to hospital,” Irena explains. “We were anxious but also hopeful that he was getting help. I don’t think we realized back then how serious it would get.”
PREPARING FOR THE WORST
Three days later, Irena recalls getting one of the worst phone calls of her life. Her husband’s care team contacted her to say Mladen’s condition was deteriorating very quickly. His ventilator was on the maximum setting, he was in an induced coma and in the prone position (laying on his stomach) for best possible oxygenation, and yet he was not responding.
“It was a very difficult call. It felt like they were preparing me for the worst,” she says. About 10 minutes later, Irena got another call with a message of hope. Her husband had been accepted for the ECMO program, which is led by members of the Critical Care Medicine, Sprott Department of Surgery and the Ajmera Transplant Centre at UHN. “It was an emotional roller coaster. We went from the lowest point to believing a miracle was possible.” Irena quickly jotted down on a piece of paper that four-letter acronym so she could google it after. But as the doctors explained this was the only option to try to save Mladen, she
consented and held on to that shred of hope.
“It was the early days of the pandemic, and we were all learning at the time to treat people with severe lung injury secondary to COVID-19,” she says. “Putting him on his stomach gave him time to recover from the severe inflammation on his lungs. It changes how the air enters the lung. It helps to improve
oxygenation and protects the lungs, allowing them to heal.” Dr. Tsang says she and the healthcare team are delighted Carmine is on the road to recovery. “To learn that he is now home and recovering, it’s very rewarding as a phyH sician. I am so happy for him.” ■
LEARNING WITH THE PANDEMIC
When reports about the severity of COVID-19 in Asia started to rise, in the beginning of the year, the ECMO teams at UHN mobilized quickly. The program was able to get not only more ECMO machines, but more drugs and personal protective equipment (PPE) in a time of international shortage. “Our team was very creative in finding quick solutions to keep everyone safe while also delivering the best possible care to our patients,” says Maria Kobylecky, Advanced Practice
Thankful to be alive Continued from page 8 CARING FOR CARMINE
Carmine’s recovery gave a boost to the team in the Intensive Care Unit, says Intensivist Dr. Jennifer Tsang. “I was so happy the day he was removed from the ventilator and the day he was able to leave the ICU,” she says. When he was first admitted, Carmine 10 HOSPITAL NEWS JULY 2020
had pneumonia and severe damage to his lungs – acute respiratory distress syndrome. He was placed into an induced coma in an effort to save his life. Important to Carmine’s recovery was lying him on his stomach for four days, 16 hours at a time, to improve his oxygenation, says Dr. Tsang.
NEWS Nurse Educator at the Medical Surgical Intensive Care Unit (MSICU). Nursing teams looked for examples of placing infusion pumps outside of the room and adapting models of care to minimize exposure for staff. They redesigned the unit to add more beds and also trained staff from other programs so they could support the ECMO teams. “It was still overwhelming to see how many COVID patients came in severely ill and requiring long hospital stays, but we felt more prepared because all this work was done ahead of time,” says Lourdes Calanza, a Registered Nurse at the MSICU.
A TREMENDOUS TEAM EFFORT
Mladen Veronese was one of many patients with COVID-19 treated with ECMO at UHN. Even as the pandemic slows down, severely ill patients are still being admitted to the program, and as young as 20 years old. “The patients referred to us during this pandemic are the sickest of the
sick, and who probably wouldn’t have a chance if it wasn’t for this treatment,” says Dr. Eddy Fan, Medical Director of UHN’s Extracorporeal Life Support Program. So far, 32 COVID-19 patients have been treated with ECMO at UHN, with an average survival rate of 65 per cent. This means giving a real fighting chance for patients who are on the brink of death. “We have the largest and most comprehensive ECMO centre in Canada and we provide the highest quality of care to our patients. This success is the result of a tremendous team effort,” says Dr. Marcelo Cypel, Surgical Director of UHN’s Extracorporeal Life Support Program. Every patient is looked after by a team of physicians, surgeons, nurses, perfusionists, respiratory therapists, physiotherapists, speech therapists, dietitians, pharmacists, patient care assistants, social workers, spiritual care professionals, and more. “We’re very proud to be able to provide this level of care,” says Dr. Cypel.
symptoms rapidly, who are under 65
Mladen Veronese (left) is one of many patients who survived COVID-19 after being treated with a heart-lung bypass machine at UHN.
Using this machine that works as artificial lungs also comes with risks. That is why there are some criteria to recommend this therapy. For COVID-19, for example, it is recommended for patients who aren’t responding to ventilation, who develop
years old and who don’t have certain pre-existing conditions. Mladen says he’s not sure if he’s unlucky for getting so sick with COVID or lucky for getting access to ECMO and having this second chance on life. His wife Irena quickly responds: “You are extremely lucky.” “We didn’t think Mladen would make it. And I think that’s the main reason I can’t throw that tiny piece of paper away. Those four letters ‘ECMO’ represent everybody involved in his care and the incredible journey to save him.” Although Mladen can’t remember much, as he was sedated during three weeks while being treated with mechanical ventilation and ECMO, he is extremely grateful to all his care teams across St. Michael’s, UHN and Bridgepoint hospitals – this last one where he had his rehabilitation care. After a very turbulent birthday in April, he now is planning a special celebration with his wife for their 25th H wedding anniversary, on July 2nd. ■
Ana Fernandes works in communications at University Health Network.
YOU TOOK THE OATH TO CARE FOR OTHERS. BUT WHAT ABOUT YOURSELF? If you need help, call the Wellness Support Line. cma.ca/supportline www.hospitalnews.com
JULY 2020 HOSPITAL NEWS 11
Southlake’s first dedicated COVID-19 units are feeling prepared and confident By Michelle Lee Hoy perations at Southlake Regional Health Centre have seen significant changes in the past few months. With the onset of COVID-19, our frontline nurses, physicians, support staff and leadership have had their days and nights turned upside down. Staff are being redeployed to new roles throughout the hospital to ensure work can continue during a time where many clinics and surgeries have been ramped down. Redeployed staff from all areas of the hospital – clinical and non-clinical – are standing on the frontlines as screeners for all those who enter the hospital to ensure we keep our patients and staff safe. The leadership team, the community, and fellow staff have offered each other support during this time. From free coffee and meal donations to extra attention on staff wellness, everyone has stepped up. During these unprecedented times, the sense of community – of family – is stronger than ever, especially for those on the frontlines who are caring for patients with COVID-19. Now, more than ever, they are coming together as one team, looking out for one another and spreading positivity across the organization. Two units at Southlake have become the first dedicated units for patients with COVID-19. Medicine 6 (referred to as Med 6), ordinarily an acute medicine unit, was the first to begin receiving COVID-19 patients after they had been swabbed in the ED or the Assessment Centre, so long as they did not require ventilation – those who did were more critical and were cared for in the ICU. As Southlake began to test more people for COVID-19, Med 6 saw a spike in activity on their floor. At first, there was some anxiety and fear of the unknown. Staff also felt challenged by the learning curve involved with shifting their nursing skills and knowledge over to completely focusing on caring for COVID-19 patients. But now, the staff on Med 6 have quickly settled into their new normal – they have recently transitioned to become a dedi-
12 HOSPITAL NEWS JULY 2020
The team on the Med 6 unit, comprised of physicians, RNs and RPNs. cated unit only for patients confirmed positive for the virus. “There was anxiety coming in and not knowing what the floor would look like when we typically always knew what to expect. It was stressful being the primary care providers for these patients in a time where our usual processes didn’t always apply,” says Danika Dalley, an RPN on Med 6. “It’s nothing that any of us have worked with before, so it has been a big learning curve, but we have worked together to find answers and we have each others’ backs.” Since becoming a dedicated COVID-19 unit in early March, Med 6 has seen a decrease in activity on their floor, offering them a quieter period they had not experienced in the past. All COVID-19 positive patients require individual rooms and all the semi-private rooms have been made private for now. Some staff from Med 6 have been redeployed to support other clinical areas of the hospital on days when their patient load is lighter. For example, when a patient in the Mental Health Department tested positive for COVID-19, staff from Med 6 went to
provide guidance to ensure their colleagues were properly equipped to safely provide care. Staff are finding other ways to support each other too. “Nurses have opened up their homes to other nurses so they wouldn’t have to expose their families and so we can all be safe together,” says Veronica Wiker, another RPN on Med 6. She added that nurses have been supporting each other and checking in on their team members now more than ever: “We’ve become more of a family unit than we ever have before.” The opening of the MSK (musculoskeletal), ordinarily an orthopaedic unit, to COVID-19 suspected patients allowed Med 6 to dedicate their efforts to caring for COVID-19 positive patients. Patients who require an inpatient admission and are awaiting their test results are now first admitted to MSK. The turnover rate for patient flow on MSK is high – patients are swabbed, admitted, test results are received, and then the patients are transferred to another unit in the hospital depending on their test result –
all within the span of 24 hours. There is also a learning curve for the MSK staff: learning how to care for patients with symptoms of COVID-19, becoming familiar with the proper donning and doffing techniques for PPE to ensure they can safely do their jobs, and keeping informed on the rapidly changing situation. “Infection Prevention and Control is doing an amazing job communicating to us, as are the managers and educators, who have done a great job at keeping us up-to-date,” says Heather Ward, charge nurse on MSK. “We are also loving that the Town Halls are seven days a week, and feature timely updates from senior leaders in the Emergency Operations Centre.” As prepared as the team on MSK feels, they also find it hard to describe how they are being affected by COVID-19: “I listen to the news and try to keep updated, but it is important to take a step back and put things into perspective so you don’t become overwhelmed,” says Helen Poff, RN and discharge planner on MSK. “There is some fear in everyone because of the uncertainty. But we try to be there for each other, and we talk things out a lot on the floor, either during our larger daily huddle or in smaller groups. The world is in a strange place right now.” One thing that the team has found brings them some joy and puts them in a positive mood is when Helen selects a song from their unit’s request list. All available staff gather at safe distances around the nursing station to hear if she has picked their request. For the next two minutes, they all have a bit of fun singing and dancing along as music streams out of Helen’s phone. When the song is done the team returns to their tasks feeling re-energized. Poff also notes that the support from the community has been felt and is greatly appreciated: “The community has been amazing, the support from them is heartwarming. We’re all going through this together, but to know we have their support is a nice feeling.” www.hospitalnews.com
REDEPLOYED STAFF FROM ALL AREAS OF THE HOSPITAL – CLINICAL AND NON-CLINICAL – ARE STANDING ON THE FRONTLINES AS SCREENERS FOR ALL THOSE WHO ENTER THE HOSPITAL TO ENSURE WE KEEP OUR PATIENTS AND STAFF SAFE. “Our staff are amazing,” says Dionne Sinclair, director of Southlake’s Medicine program. “They took COVID-19 head on, learned new processes, asked lots of questions, and adapted to the changes in information we have been receiving as the situation evolves, and they are now champions for the organization.” Clinical teams often work in collaboration to ensure patients receive the best care possible while in the hospital, and the COVID-19 pandemic has been no different. The ICU team worked closely with Med 6 staff as they transferred patients who no longer required
critical care. When MSK opened up to receive patients suspected of having COVID-19, they closely shadowed their Med 6 colleagues to ensure the process remained seamless. Med 6 staff continue to offer support to other units throughout the hospital as needed. And when Med 6 was able to discharge their first patient who had come from the ICU, the whole hospital came together to celebrate both the patient and the teams that provided care. Throughout all the changes the organization has faced, there has been one constant everyone at Southlake has been able to H rely on – Power of Many. ■
Michelle Lee Hoy is a communications strategist at Southlake Regional Health Centre.
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Healthcare workers With better data infrastructure and coordinated health workforce planning, we could proactively address inadequacies in the system and develop the flexibility necessary for the workforce to respond effectively to pandemic situations. We need to be building this infrastructure now. It is time for custodians of health workforce data – regulatory authorities, insurers, employers, health professional associations, educational institutions and all levels of government – to cooperate in the collection and sharing of information about the health workforce. Processes and pathways that emerge out of necessity should be maintained and developed after the crisis has passed in order to leverage this crisis as an opportunity for system strengthening. The performance of our health system – during this pandemic and
Continued from page 4
beyond – depends upon high quality and timely data to support decisionmaking. By prioritizing health workforce data and infrastructure, we will be able to better maintain the well-being and productivity of our health workers. We will be able to protect their physical safety by predicting who is going to need personal protective equipment and ensuring that this critically important equipment gets to workers when and where they need it. We will also be able to promote their psychological health and safety by planning for sustainable workloads and appropriate supports. Now more than ever we need to show our valuable health workers our support by explicitly including them in the capacity planning equation, and implementing protective policies and practices. Otherwise, we’re left with H one hand clapping. ■
Ivy Bourgeault, PhD, Sarah Simkin MD and Caroline Chamberland-Rowe MSc are investigators with the Canadian Health Workforce Network and the University of Ottawa.
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FROM THE CEO’S DESK
Power Change By Dr. Catherine Zahn he COVID-19 pandemic has set societal disparities in stark relief. There is evidence of this everywhere. We see it in who loses jobs, who is required to do dangerous jobs, who has the luxury of ‘self isolation,’ who’s digitally connected and capable, and the list goes on. Those who live with complex mental illness are amongst the most vulnerable and disadvantaged. The current narrative of mental health and COVID-19 goes like this: at some ill-defined point in the future, we will experience a new pandemic – a pandemic of mental illness. This isn’t a description of the future, it’s today. The idea that this is a problem to address later – after COVID-19, the public health measures imposed in response, and the economic downturn have taken their toll – is deeply worrisome. It suggests that the burden of mental illness is in the future and that it is directly related to the pandemic. Here’s the fact: the pandemic of mental illness predated COVID-19 by decades. Mental illness, including substance use disorders, is a burning hot issue right now. Those who live with mental disorders interact with an underfunded, disconnected system. They are vulnerable in all aspects of life and in all spheres of health. Their care and supports have been interrupted. Many are poor and they have tough living conditions that put them at risk for COVID-19. But there’s good news. The pandemic has, perhaps paradoxically, accelerated the exploration of solutions to longstanding mental health system challenges. Here are three examples.
Dr. Catherine Zahn First, we’ve embraced virtual care in a big way, and with lightening speed. Tele-psychiatry and tele-mental health have evolved over the past two decades, enabling service to remote and rural regions of the province with increasing sophistication. The COVID-19 crisis swept away obstacles to full-on implementation. Since March, virtual care visits at CAMH increased by over 750 per cent, creating access to mental health care and supports for thousands of patients. There’s no turning back. Adoption of virtual health platforms is a permanent and growing fixture of the health care
system, and when executed properly, provides an accessible, flexible and secure option for patient care. The caveats? It’s not just a matter of popping onto Zoom. There are legal, ethical and privacy issues that require attention. The provision of virtual care is a clinical competency that must be developed and demonstrated. And, virtual care is not appropriate or accessible for everyone. These are not reasons to step back, but rather reasons to formalize the practice, collect and share data to define and refine best practice. Secondly, consequences of the intense shortage of affordable and sup-
portive housing became a flash point during the pandemic, illustrating in living color the importance of housing to personal and public health. Safe housing is a health care right for those with mental illness. The scarcity of supportive housing is one aspect of inequitable funding for the mental health care system. It’s heartening to see that there’s been action. Emergency lodging for COVID-19 positive people living in shelters and on the streets – many of whom live with mental illness – has been procured in hotels. Toronto’s city council recently approved the development of 250 units of modular housing by September 2020. Is it too little? Yes. Is it too late? Maybe, but it’s a start. It’s time to amplify advocacy and maintain the momentum toward justice for society’s most vulnerable. If homelessness is a choice, it’s our choice. And third, the mental health sector has shown a willingness to come together, to collaborate and problem-solve in a way that we haven’t seen in the past. Hospitals and community agencies have spontaneously organized or willingly responded to directives, aiming to help each other protect our caregivers and provide care. In mental health, this work has also created the potential for a unified advocacy voice that calls for nothing more than equitable access to effective care and supports for the people we serve. We have more work to do. There are obstacles to overcome, speedbumps to navigate, structures to supersede. COVID-19 has presented an opportunity to position mental health at the centre of our healthcare system – to establish the fact that mental H health is health. ■
Dr. Catherine Zahn is President & CEO at the Centre for Addiction and Mental Health. 14 HOSPITAL NEWS JULY 2020
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P R O G R A M
T H E
Virtual patient care – the COVID-19 silver lining
Without leaving home, more than 1,000 patients a day are receiving care, education and therapy through virtual technology across St. Joseph’s Health Care London By Dahlia Reich n today’s digital society, it should be common place to talk to your doctor or attend a clinic appointment from the safety and comfort of home. Yet in health care, virtual technology
has been virtually lacking. Until now. Across St. Joseph’s Heath Care London, teams are rapidly and creatively taking advantage of what they see as the COVID-19 silver lining – the impetus to fast forward and more optimally
capture the benefits of virtual or remote patient care. In April, 50-60 per cent of all registered visits at St. Joseph’s were virtual, a jump from about five per cent pre-pandemic. The daily average is currently
about 1,000 virtual visits compared to about 200 a day pre-pandemic. “Our response to COVID-19 has helped us refocus our priorities to ensure our patients, many of whom have special health needs, keep connected
Embracing the opportunities While not all patients are having their needs met remotely, there are many highlights of virtual patient care at St. Joseph’s Health Care London: • Rehabilitation: Patient therapy programs in the Rehabilitation Program at Parkwood Institute Main Building are being delivered through videoconference. •Stroke: The Community Stroke Rehabilitation Team and Comprehensive Outpatient Rehabilitation Program are visiting patients and their caregivers through videoconferencing. Patients are progressing with their rehab using face-to-face virtual appointments, participating in group sessions and receiving stroke prevention education from the comfort of their homes. •Endocrinology: The Diabetes Education Centre, diabetes and osteoporosis clinics, with few exceptions, have moved to a full virtual care model. • Cardiac rehab: The Cardiac Rehabilitation and Secondary Prevention Program team, including rehab trainers, dietitians, nurses, psychologist, social worker and cardiologists, are engaging with patients through interactive telephone coaching sessions, telemedicine, video technology and a variety of online education resources. • Adolescent psychiatry: Teen outpatients in the Adolescent Psychiatry Program at Parkwood Institute Mental Health Care Building who are experiencing serious mental 16 HOSPITAL NEWS JULY 2020
health challenges are receiving dialectical behaviour therapy (DBT) from their mental health care team through a secure Webex platform. DBT is an evidence-based model of therapy that helps people learn and use new skills and strategies to better cope with stress, regulate emotions, and improve relationships with others. • Pain management: In the Pain Management Program, each physician has moved their practice to phone or videoconferencing visits, as have the allied health team, including nurses, psychologists, occupational therapists, physical therapists, a social worker, and clinical pharmacist. Virtual group sessions, e-newsletters and email support are among other new ways pain management patients are accessing care. • Inpatient programs - veterans, geriatrics and complex care and rehabilitation: At Parkwood Institute Main Building, patients, residents and their family members are finding comfort in virtual visits via video calls. Members of interdisciplinary teams provide support by partnering with individual families to facilitate – arranging schedules, booking a laptop or iPad and sitting with the patient/resident to make the calls. Seeing the delight, relief, laughter
and tender moments exchanged between patients, residents and families has been uplifting for staff to witness. • Allergy: The Allergy and Immunology Program for allergy and asthma patients have moved almost entirely to a virtual model of care. Patients are seen via telephone and videoconferencing to ensure continuity of care while also leveraging the relationship with primary care physicians to maintain treatments. One physician is participating with colleagues across Canada in virtual food challenges to help ensure the window of opportunity of food introduction isn’t missed in young children. Missing the window can increase the risk of food allergy in a susceptible child. • Chronic obstructive lung disease: The COPD and Pulmonary Rehabilitation Program team, including respiratory therapists, rehab trainers, dietitian, social worker, nurse practitioner, and respirologists, are providing continued care and programming using interactive telephone coaching sessions, telemedicine, and weekly email communications to patients that include video technology. The nurse educator has begun group education by telephone, which allows for continued group interaction and support. A group virtual exercise
program has also launched via Webex. • Long-term care: At Mount Hope Centre for Long Term Care, residents are experiencing virtual entertainment to stay engaged and entertained. Live music is happening via Skype, which is also connecting residents with loved ones thanks to staff who enable these important interactions. • Pet therapy: Therapeutic recreation staff at Parkwood Institute Main Building are ensuring patients can still enjoy their weekly pet therapy through virtual visits with their favourite St. John Ambulance therapy dogs. The dogs provide a sense of normalcy, comfort and excitement to their week. • Hand and upper limb: Physicians and therapists in the Roth McFarlane Hand and Upper Limb Centre are assessing and consulting with patients virtually using video and phone. Through video, therapists are able to see patient movements, limitations and restrictions and recommend care they can do at home to continue mobility and healing. •Ear, nose and throat: To move care forward, Otolaryngology - Head and Neck Surgery runs a clinic virtually three times a week, where patients are triaged and seen through videoconferencing. www.hospitalnews.com
NEWS with their health care team,” says Dr. Sarah Jarmain, Co-Chair of St. Joseph’s Quality Council and a member of the team implementing virtual care across St. Joseph’s. The organization is just at the beginning of this journey, says Glen Kearns, Integrated Vice President, Diagnostic Services and Chief Information Officer. “We will continue to engage patients and clinicians in planning and how we evolve and adapt to this new way of providing service to some patient populations.“ Without leaving home, many St. Joseph’s patients are receiving care, education and therapy through various virtual technologies. They include phone-based counselling and assessments, Ontario Telemedicine Network
Therapeutic recreation staff at St. Joseph’s Parkwood Institute Main Building are ensuring patients can still enjoy their weekly pet therapy through virtual visits with their favourite St. John Ambulance therapy dogs. The dogs provide a sense of normalcy, comfort and excitement to their week.
and a customized version of Cisco Webex appointments, online resources, e-newsletters, and more. All are being tapped with excellent results and appreciative feedback, “which tells us this is a model of care we must pursue post COVID-19,” adds Dr. Jarmain. This doesn’t minimize the struggle of those patients we haven’t been able to be see during the pandemic, says Dr. Jarmain, “but what teams have been able to do very quickly has been remarkable.”
VIRTUAL MENTAL HEALTH CARE FOR VETERANS
One unique population is veterans. Psychiatrist Dr. Don Richardson, Medical Director of St. Joseph’s Operational Stress Injury Clinic (OSI Clinic), a program that provides mental health supports for veterans, Canadian Forces members and the RCMP. He has seen benefits of the OCS Clinic’s team of psychiatrists, psychologists, social workers and nurses in their London, Toronto and Hamilton sites incorporating virtual care into daily practice during the pandemic. “Most of my patients have responded well to the use of both high-tech, secure, videoconferencing and the low-tech, but reliable, telephone for appointments,” says Dr. Richardson. “It’s been an important tool in ensuring we can continue to provide our patients care at a time when they are under added stress from the pandemic created by job loss, financial worries, family strain and increased isolation.” Involving family caregivers in therapy is also enhanced when care is delivered virtually as caregivers can participate in
Speechpathologist Debra Medzon doing a virtual care session. sessions or be close at hand to answer questions and provide insight into the patient and family’s needs. While research shows psychotherapy and mental health symptom management are effective through virtual care, Dr. Richardson admits there are challenges. “Establishing trust with patients is key to providing effective treatment, something that’s harder to do virtually,” says Dr. Richardson. “As clinicians, most of our training and experience is in face-to-face assessment and treatment. When using videoconferencing, the quality might not always be clear, or if delivering care by phone, we have to rely on more subtle clues to what’s going on with the patient such as changes to their voice. That’s difficult to do, especially with a new patient.” For mental health patients, it may also be difficult to transition back to face-to-face therapy once social isolation restrictions have lifted. Accessing care virtually may reinforce avoidance behaviours typical to someone with mental illness such as post-traumatic stress disorder and anxiety. Sometimes, coming for therapy is the only time that patient leaves their house in a week.
MAKING IT WORK
It sounds easy – connect, focus, link or dial. In reality, virtual care comes with a host of both technical and process challenges. “Adopting virtual patient care into our physician practices isn’t as easy as opening a video chat or picking up the phone,” cautions Dr. Jarmain. “There are a lot of new processes and nuances our teams need to be mindful of such as patient privacy, technology requirements and what type of care they should or should not be providing remotely.” St. Joseph’s recently launched a guide for physicians to help them understand the virtual care technologies available to them. While there are still bumps to iron out, staff and physicians at St. Joseph’s are not only embracing the opportunities to incorporate virtual technology in care, they are excelling. “There has been outstanding dedication and ingenuity by staff and physicians in finding new ways to serve patients at this unprecedented time,” says Tom Janzen, Integrated Chief Medical Information Officer for St. Joseph’s. “And we will be stronger H for it.” ■
Dahlia Reich works in Communication and Public Affairs at St. Joseph’s Health Care London.
JULY 2020 HOSPITAL NEWS 17
Public health and health care: Partners in tackling COVID-19 By Melanie Sanderson ith the advent of COVID-19, public health terms such as flattening the curve and social distancing have become more wellknown household concepts. So too has the notion of how critical it is to stop the spread of the virus in order to keep people out of hospitals, preserving resources that enable nurses, doctors, and other healthcare professionals to save the lives that need saving. To provide a glimpse at what this behind the scenes work looks like, the Ontario Public Health Association (OPHA) launched #PublicHealthHeroes, a campaign to highlight examples of how public health individuals and teams throughout the province are helping communities to stay healthy and safe. A gallery of #PublicHealthHeroes from across the province are featured at OPHA’s campaign website https://opha.on. ca/What-We-Do/Projects/what-ishealth-equity-(1).aspx and through Facebook, LinkedIn and Twitter. By spreading the word about public health champions and those working in partnership with the many health care heroes of COVID-19, we are showcasing the various ways in which lives are saved during a public health crisis and celebrating the symbiotic nature of health care and public health work. Our colleagues in public health, be they public health nurses, doctors, inspectors, dental staff, health promoters, epidemiologists or registered dietitians and others, have all taken on a wide range of roles from conducting case management and contact tracing, completing daily surveillance reports, collecting evidence on the impact of physical distancing
WHETHER IT’S COVID-19 OR A FUTURE VIRUS, PUBLIC HEALTH PARTNERS CAN BE IMPORTANT ALLIES IN ASSURING THE PRESERVATION OF HOSPITAL CAPACITY FOR SUCH TIMES. on vulnerable populations, handling media calls, supporting high-risk families via telephone visits, liaising with municipalities and other stakeholders, continuing needle exchange and other vital programs, to answering public’s inquiries about COVID-19 and more. Examples of these daily behind the scenes tasks that public health workers and teams are performing to tackle COVID-19 include: • Raya, a Public Health Nurse at Peel Public Health is answering calls from the public and making referrals related to COVID-19 at Peel’s Public Health Contact Centre; • Amanda, a Research Analyst at the Simcoe Muskoka District Health Unit, leads the creation and maintenance of a local case and contact management database to provide disease surveillance and workload reports; • Ray, a Public Health Inspector in the Timiskaming Health Unit is providing expert advice to private sector employers, municipalities, school boards and others on infection control; and • Laura, a Registered Dietitian from the Haliburton, Kawartha, Pine Ridge District Health Unit is pivoting to complete medical surveillance calls and support case & contact management.
Each of the featured heroes in our campaign has also shared their inspiring messages to the public. Among their words of comfort, encouragement and inspiration, “When it comes to the health of our community, there is no ‘them’ only ‘us’, we are all in this together” is a common theme, and one that equally applies as we consider the breadth of sectors that must collaborate in response to such unprecedented times. The public health professionals featured in our campaign are just some of the champions working across the province to keep people healthy and safe. There are many more unsung heroes amongst the various sectors of primary, public and community health throughout Ontario. The collaboration among existing and new partners will continue to be an important part of rebuilding and the way we think about health in Ontario. This disruption has afforded an opportunity to better examine how the various parts of the health, social and economic systems are connected, where we are stronger together, and where gaps exist for the most vulnerable among us. In a world of finite resources, the importance of prevention is often susceptible to the urgent and unexpected. Lessons from COVID-19 are
showing just how interconnected prevention and health promotion efforts must be across the continuum of health systems in order to save lives and keep people out of hospitals. For example, through the implementation of public health guidelines and coordinated measures to quickly detect, track and isolate COVID-19 cases, an estimated 220,000 cases and 4,400 deaths had already been prevented in Ontario as of April 3,2020. Independent researchers also used modeling to determine the challenges that hospitals could have faced in intensive care units had public health not introduced “substantial physical distancing or a combination of moderate physical distancing with enhanced case detection and isolation”. Whether it’s COVID-19 or a future virus, public health partners can be important allies in assuring the preservation of hospital capacity for such times. Together let’s all be the heroes of tomorrow and create a system that is #BetterThanNormal and reflects a continuum of prevention, promotion, protection, treatment and care. In thinking about the future, one of OPHA’s public health champions suggested “increased collaboration and communication within the health care community… enables us to share our knowledge and help each other adopt best practices… to keep everyone in the community healthy and safe”. You can join our campaign and share your ideas for our future system by tagging us on Twitter or Facebook @OPHA_ Ontario. To learn more or become a member of the Ontario Public Health H Association visit www.opha.on.ca ■
Melanie Sanderson, MPH is Project Coordinator, Ontario Public Health Association. 18 HOSPITAL NEWS JULY 2020
A Salute to
Nursing Heroes CELEBRATING CANADAâ€™S NURSES
Brought to you by:
JULY 2020 HOSPITAL NEWS 19
NURSING HERO CONTEST 2020
List of Nominees
2020 Nursing Hero Awards Kaley Abernethy Thunder Bay Regional Health Sciences Centre
Andrea Blake-Gooding Humber River Hospital
Marie Dandal Sunnybrook Health Sciences Centre
Alana Ferguson Holland Bloorview Kids Rehabilitation Hospital
Ibrahim Akbar The Centre for Addiction and Mental Health
Glyn Boatswain Scarborough Health Network
Natalie Allison Markham Stouffville Hospital
Shannon Bruce Trillium Health Partners
Debra Davies Toronto General Hospital, University Health Network
Stephanie Fernandes Sunnybrook Health Sciences Centre Tina Frampton Eastern Health
Irene Aloa Sunnybrook Health Sciences Centre
Robhen Burry Eastern Health
Josephine Dela-Cruz Sunnybrook Health Sciences Centre
Johannah Alvarez Sunnybrook Health Sciences Centre Anderson Au The Centre for Addiction and Mental Health Nazrin Baksh The Centre for Addiction and Mental Health Uthaya Balakumar Markham Stouffville Hospital Nesan Bandali Sunnybrook Health Sciences Centre Heather Baril Trillium Health Partners Eldine Barnwell Sunnybrook Health Sciences Centre Aziza Barra Humber River Hospital Candice Benninghaus Thunder Bay Regional Health Sciences Centre
James Callahan Michael Garron Hospital Mary Ann Carreon The Centre for Addiction and Mental Health Anita Chan Trillium Health Partners Laletta Chang-Solomon The Centre for Addiction and Mental Healtht Natasha Conklin Sunnybrook Health Sciences Centre Deann Conway Eastern Health Dionne Cooper Sunnybrook Health Sciences Centre Tianilla Corredorra-Weigert Trillium Health Partners Biljana Crevar Niagara Health System Lisa Cummings University Health Network
Rochelle Bettencourt Southlake Regional Health Centre
Lisa Curammeng University Health Network
Jean-Paul Biancolin Humber River Hospital
Chuchita Dalman The Centre for Addiction and Mental Health
20 HOSPITAL NEWS JULY 2020
Mahadai Deosaran University Heath Network Rachel Duclos Thunder Bay Regional Health Sciences Centre Jessica Dwyer-Miller Eastern Health
Valdalee Frances-Furguson The Centre for Addiction and Mental Health Jane Gaanan Sunnybrook Health Sciences Centre Christine Gagnon-Desjardins The Royal Ottawa Hospital
Trisha Gajraj Humber River Hospital Cheryl Gayder-Ruzgys Niagara Health System Colin Generao Centre for Addiction and Mental Health Megan Gerbasi Southlake Regional Health Centre Loretta Gonzales Sunnybrook Health Sciences Centre Angelique Guggino Southlake Regional Health Centre Elissa Hagey Markham Stouffville Hospital Muhammad Hanifi Sunnybrook Health Sciences Centre
Sharah Haque Scarborough Health Network Zeynab Hassan The Centre for Addiction and Mental Health Rachelle Hicks Vancouver Coastal Health Corinne Huedepohl Alberta Health Services Jillian Hummel Sunnybrook Health Sciences Centre Lillian Hung Vancouver Coastal Health Nermin Ibrahim University Health Network
George Eappen Scarborough Hospital Network Melissa Edwards Eastern Health Gudlaug Einarsdottir Southlake Regional Health Centre Cody Elsegood Niagara Health System Kate Marice Escober Vancouver Coastal Health Cerian Esguerra Sunnybrook Health Sciences Centre Veronica Eshun The Centre for Addiction and Mental Health Tsegay Eyasu Centre for Addiction and Mental Health Joanne Farnden Saskatchewan Health Authority ww w w ww. wh w. ho ossp pit pit ital alne alne n ws ws.c s.ccom m www.hospitalnews.com
NURSING HERO CONTEST 2020 Amelia Inder The Centre for Addiction and Mental Health Raslen Jagoring Sunnybrook Health Sciences Centre Kesikan Sabapathy Jarayaj Sunnybrook Health Sciences Centre Janice Jones Sunnybrook Health Sciences Centre Jenny Jones Sunnybrook Health Sciences Centre Dusanka Kalabic VHA Home Health Care Balvinder Kaur The Centre for Addiction and Mental Health Salamma Kavalammakal Scarborough Health Network Andrew Kennedy Sunnybrook Health Sciences Centre
Edsel Mutia Scarborough Hospital Network
Alan Largo Sunnybrook Health Sciences Centre
Jada Myers Markham Stouffville Hospital
Yasmila Rasamanickam Rene Goupil Jesuits Nursing Home
Pursha Lawrence Trillium Health Partners
Shahrukh Nasir The Centre for Addiction and Mental Health
Lormie Realeza Trillium Health Partners
Rosemarie Lazaro The Centre for Addiction and Mental Health
Thu Anh Nguyen The Centre for Addiction and Mental Health
Charmaine Remani Sunnybrook Health Sciences Centre
Tracey Leathers Humber River Hospital
Cynthia Nippard The Royal Ottawa Health Care Group
Hope Liddie The Centre for Addiction and Mental Health
Rose Nolan Southlake Regional Health Centre
Kimberley Lienhart Sunnybrook Health Sciences Centre
Sherwin Nunag Sunnybrook Health Sciences Centre
Linda Liu University Health Network Jessica Malek Trillium Health Partners
Isaiah Khan Humber River Hospital
Anita Martin Centre for Addiction and Mental Health
Roya Khudayar Sunnybrook Health Sciences Centre
Catherine McCarnan Humber River Hospital
Sophia Konstantakis The Centre for Addiction and Mental Health
Pamela Meyer Centre for Addiction and Mental Health
Tanja Kotolenko The Centre for Addiction and Mental Health Donna Kuipers UBC Centre for Brain Health Multiple Sclerosis Clinic Kathy Kullercup Niagara Health System
Carol Rainford Humber River Hospital
Tessa Lamont The Centre for Addiction and Mental Health
Brett Morris Centre for Addiction and Mental Health Denise Morris Toronto General Hospital, University Health Network Debbilynn Murray The Centre for Addiction and Mental Health
Rebecca Oliveira Centre for Addiction and Mental Health Kim Oselil Centre for Addiction and Mental Health Hayley Painter Southlake Regional Health Centre Bonnie Palmateer Sunnybrook Health Sciences Centre Zuzana Panek Best Care Agency Limited Vanessa Phillips Mackenzie Health Dawn Pipher Southlake Regional Health Centre Tena Prado Humber River Hospital Jouko Puranen The Centre for Addiction and Mental Health
Michelle Richardson Niagara Health System Hillary Rosen Trillium Health Partners Suzanne Rush Southlake Regional Health Centre Marsha Samuels Westpark Healthcare Centre Samantha Schepers St. Joseph’s Health Care London Marcel Seereeram Sunnybrook Health Sciences Centre Elizabeth Seymour Southlake Regional Health Centre Ian Simpson Southlake Regional Health Centre Sandie Simpson Scarborough Hospital Network Chandra Sinkovic Southlake Regional Health Centre Linda Slodan Centre for Addiction and Mental Health
Tammy Small Espanola Regional Hospital and Health Centre Olivia Soave Southlake Regional Health Centre
Colleen Weaver Scarborough Hospital Network Jennifer Welton Humber River Hospital
Cynthia Stacey Unity Health
Anuson “Andy” Wijayaratnam Centre for Addiction and Mental Health
Gina Stokes Sunnybrook Health Sciences Centre
Starr Wilks Sunnybrook Health Sciences Centre
Sonya Sutton Humber River Hospital
Holly Williams Centre for Addiction and Mental Health
Jannet Sveridov Sunnybrook Health Sciences Centre Niall Tamayo Centre for Addiction and Mental Health Isabelle Tazbir Sunnybrook Health Sciences Centre Carmelita Tee-Vaz Humber River Hospital Ampigai Thirugnana sampanthan Southlake Regional Health Centre Kaitlyn Troup Niagara Health System Althea Van Massop Sunnybrook Health Sciences Centre Noralyn Velasco Sunnybrook Health Sciences Centre Michaela Villamayor Scarborough Hospital Network
Jacqueline Williams-Connolly Janeway Children’s Health and Rehabilitation Centre Rosalee Williams Centre for Addiction and Mental Health Julia Wilson The Royal Hospital Ottawa Kimberlee Wilson Collingwood General and Marine Hospital Bradley Woods Scarborough Health Network Christina Wray St. Joseph’s Health Care London Warun Yogananthan The Centre for Addiction and Mental Health
Rodolf Villanueva Humber River Hospital
Helen Yoxon Children’s Hospital of Eastern Ontario
Edson Villareal Centre for Addiction and Mental Health
Fariba Zaboli The Centre for Addiction and Mental Health
congratulates the 2020 Nursing Hero Contest nominees ww w ww. w.ho hosp ho spittal alnew news ne ws.c .co om m www.hospitalnews.com
JULY 2020 HOSPITAL NEWS 21
NURSING HERO CONTEST 2020
C O N G R AT U L AT I O N S TO T H E W I N N E R S O F O U R
NURSING HERO AWARDS st prize
University Health Network (Toronto General Hospital)
Children’s Hospital of Eastern Ontario
Corinne Huedepohl Alberta Health Services (Glenrose Rehabilitation Hospital)
Donna Kuipers prize
Vancouver Coastal Health (UBC Centre for Brain Health Multiple Sclerosis Clinic)
No shortage of
heroes or the first time in the 15 years since the inception of our Nursing Heroes Contest we made the difficult decision to postpone it. We originally started the contest in an effort to highlight some extra special nurses who went above and beyond for patients and as a way to say thank you. The first year prizes were televisions, then a stay at a hotel in Toronto. As the contest gained popularity and began to include nominations from across the country we moved to monetary prizes in hopes that the “winners” would be able to treat themselves to something they otherwise would not get for themselves. That first year we received just over 20 nominations. Here we are 15 years later at over 200 nominations from across Canada. Although we were unable to celebrate these nurses during Nursing Week as per tradition, 2020 is turning out to be a year in which we need to let go of tradition. The COVID-19 pandemic has brought health care to the top of everyone’s agenda. A public health event of this magnitude has not been seen in most of our lifetimes and hopefully it will be the first and last for all of us . It has exposed the vulnerabilities in an under-funded health system and demonstrated the need for improved efficiency in the adoption of health technology and innovation. It has also brought forward countless stories of strength, ingenuity and heroism. Not just from the nurses we recognize through-out the following pages, but from every single person involved in ensuring hospitals remain open and
safe. To all of the cleaners, security personnel, doctors, nurses, personal support workers, lab technicians, allied health professionals and every other staff member who has walked through the doors of a hospital to fight the good fight against COVID-19, we salute you. We thank you and we celebrate you alongside the nurses you will read about through-out this special section. You will also notice that this year we have two second place winners thanks to a generous advertiser who wanted to donate money for an extra cash prize. Behind every single nurse hero there is a team – and we received several team/departmental nominations this year. Unfortunately we are not able to publish every nomination but have included a special nomination for a team of professionals responsible for caring the most vulnerable demographic during this pandemic. If you have a team nomination you would like to submit, please send it along. As space permits we will publish them. It should include at least 500 words highlighting what is so special about this team. If you find your name on the list of nominees and want to see your nomination, email me at email@example.com and I will gladly send it. To this year’s winners and nominees, first we want to say thank you. Thank you for not only putting yourself at risk to go to work but for continuing to go above and beyond during a very trying time. On top of our gratitude and appreciation we congratulate you. All of us here at Hospital News H salute you. ■
Thank you to our Gold Sponsor HCP for sponsoring an additional prize this year!
22 HOSPITAL NEWS JULY 2020
Kristie Jones Editor, Hospital News www.hospitalnews.com
NURSING HERO CONTEST 2020
Debra Davies Toronto General Hospital University Health Network n behalf of the nursing and interprofessional team of the TGH Emergency Department, we would like to nominate Debra Davies, Nurse Manager, for the Nurse Hero Award. Debra Davies embodies a beautiful example of humanity in leadership. Since long before COVID-19, Deb has demonstrated unwavering leadership by advocating not only for nurses, but all of the staff in the ED including ward clerks, hospital assistants, housekeepers and physicians, just to name a few. As the manager and matriarch of our ED family, Deb supports her staff in every way, both as an exceptional leader and as a person with a huge heart. Whether she is hosting surprise grilled cheese or ice cream parties, Deb cultivates fun and an overarching sense of family within our walls and beyond. In times of personal tragedy or loss amongst members of our ED family, Debâ€™s ability to enable and inspire a compassionate response amongst the team is extraordinary,
where she is instrumental in our ability to grieve, heal, learn, adapt, and excel through difficult times together. While she leads from behind the scenes, she ensures she is visible and available on the forefront, with an eagerness to keep us informed, providing affirmation and encouragement to do our best work. She is thoughtful, kind and compassionate with staff and prize patients alike with gentle self-deprecating humour and shows us that strong leadership can shine through by being a team player and advocate for one another. Deb is not afraid to call upon us for our opinions or help and wholeheartedly those who demonstrate leadership to greater career opportunities. She inspires us to join her initiatives by motivating and empowering us to use our collective voices and is always the first to celebrate even the smallest of victories. Her actions inspire others to dream more, learn more, and become more both as individuals and as a team.
Continued on page 24
JULY 2020 HOSPITAL NEWS 23
NURSING HERO CONTEST 2020
Continued from page 23
Throughout this COVID-19 pandemic, Deb has led by calm example. She has acknowledged fears and turned them into actions, continuously solicited input from all members of the team and personally ensured that these ideas were brought into timely fruition (for example, installation of plexiglass around the nursing stations, outside curtains for isolation patient privacy, portable sinks for handwashing and tv tray tables to promote physical distancing in the staff lounge). She is humble, ascribing recognition and improvements to others. Despite hardships faced along the way, she has been a warrior relentlessly dedicated to the safety and well-being of our team and the patients we serve. Through her exemplary role modelling, the TGH emergency department team has felt unified and remains positive throughout these unprecedented times. For all of this and much more for which there are no words, we are eternally grateful to our strong yet humble leader, Deb Davies. Sincerely, The TGH Emergency Department Team (Family)
SOME SNIPPETS OF THE NOMINATIONS FOR DEBRA DAVIES From Emmar, RN: For your unwavering leadership and guidenace during the COVID-19 pandemic. Your thoughtfullness filters down to us like a mother bird to her young fledgelings. The assurance you give to us at safety huddles is like food for the soul- we are all indebted to you for your wisdom, passion and protection. We salute and nominate you for this Nursing Hero Award. From Ela, RN: My name is Ela, I have been a nurse in the ER at TGH for approximately 20 years. I have been working with Deb Davies for all of these wonderful years. Deb has always supported her staff in every way, not only as the best leader, 24 HOSPITAL NEWS JULY 2020
DESPITE HARDSHIPS FACED ALONG THE WAY, SHE HAS BEEN A WARRIOR RELENTLESSLY DEDICATED TO THE SAFETY AND WELL-BEING OF OUR TEAM AND THE PATIENTS WE SERVE. but as a person with a huge heart. My life story is very sad. I lost my only son Phillip two years ago then a year later lost my neice Wiktoria. My life lost any sense of purpose, there were days I wondered how I even got up and went on living. For about a year I was not able to function, lost any interest in life and did not even consider returning to work. Through it all, there was Deb. Every step of the way, offering care and support that was crucial to me. Almost a year later I was welcomed back to work with open arms, an open heart, protection and guidance as I found my way back. Deb has made a tremendous impact and difference in my life for which I am forever grateful. She deserves recognition and appreciation for who she is not only as a person who is there for everyone in need, but also as a leader. I am proud to work under her leadership. From Sarah McDermid-Flabbi (RN, APNE): When Ela’s neice Wiktoria, who was a previous hospital assistant colleague in our ER, was hospitalized in the TGH ICU after a long battle with cancer, Deb ensured that on the day they removed Wiktoria from life support, that nurses and other hospital assistant staff working in the ED who wanted to give their condolences, hug our colleague tightly (both Wiktoria and Ela) and say our final goodbyes, were given that opportunity in small groups to do so in person and that their patient assignment was covered for that period of time. We greived together as a team, where Deb ensured to touchbase with each of us throughout the week, where she fostered a safe and compassionate environment for
grieving, healing, adapting and moving forward as a closely connected team. From Kim Mclease, RN: A word about Deb, Deb is my hero. She is like a mother to us all. She is dedicated and works tirelessly to ensure our safety. She always has our back and is our biggest advocate and loudest voice to the “higher ups”. She never stops fighting for us and helping us get things we need to improve our worklife and care of patients in the emergency department. Over the 13 yetars I have worked with Deb I have countless specific examples of how she has fought for us. In my own personal times of need she has always been there for me whether it was mentoring, a kind word, a warm hug, empathy, flexibility with scheduling etc. She also tries to make work as fun as possible despite the busy and stressful environment we face, from hosting grilled cheese days, ice cream days, potlucks, she has always tried to do everything possible to support all of us in dynamic and unique ways. She is a warrior and my true hero. From Joyce Osei, RN: Deb has been nothing short of amazing throughout this whole covid-19 pandemic. She is inspiring and exemplifies the meaning of true leadership. As a manager, Deb consistently treats us as team players. She is very approachable and makes herself available and visible throughout the day. She is always eager to give us updates, affirmation and encouragement to do our best work. From Michael Ngyuen, RN: When I was first introduced to quality improvement projects early on
prize in my career, Deb coached me along the way. When people said that “you won’t be able to implement a pressure ulcer project here because no one cares for it,” Deb cared and she made it work with me, every step of the way! To this day, she still coaches me regularly in my leadership career even though I don’t work full time in the ER. From Emma Gaylord, RN: Deb does not just carry the nursing leader title in the ED, but she demonstrates what it is to be a leader. When she has a vision, she is determined to accomplish that end goal regardless of the hardship along the way. She is not afraid to call upon us for help and in fact she inspires me to join her projects by motivating and empowering me with her strong but humble voice. Lastly, if you demonstrate leadership within the department she will support and guide you to greater career opportunities and will always be there to celebrate the smallest victory!!! From Dr. JoJo Leung, ED MD: “Deb embodies a beautiful example of humanity in leadership. Since long before COVID has affected us, Deb has demonstrated leadership by advocating not just for nurses, but all the staff in the ED including ward clerks, hospital assistants, housekeepers, physicians and others. During COVID, she has led by calm example, acknowledging fears and turning them to action, soliciting input from all members of the team and seeing that these ideas are brought into being in a timely manner (eg. the curtains for patient privacy and installation of portable sinks for handwashing). She is humble, ascribing improvements to others. Through her excellent role modelling, the TGH emergency department team has felt unified and remained positive throughout these difficult times. She is thoughtful, kind and compassionate with staff and patients alike with gentle self-deprecating humour and shows us that strong leadership can shine through by being H a team player.” ■ www.hospitalnews.com
NURSING HERO CONTEST 2020
Helen (Florence) Yoxon
Children’s Hospital of Eastern Ontario (CHEO) ursing heroes: are they born or are they made? Perhaps nursing heroes show up just when you need them most. It was late April 2020 when reports began surfacing of the dire situation in the city within long term care facilities hardest hit by the pandemic. The homes were struggling. Residents were suffering and dying. Staff were off sick or exhausted from the demands. Our facility was asked to support a local long term care facility meet the needs of the residents. Yikes, we are a pediatric hospital! What do we know about caring for the elderly? Where do we start? “How Can I Help?” came a cry from Helen Yoxon, our wellloved and seasoned Nurse Manager of our Palliative Care program and also Manager at our sister facility, Roger Neilson House, a pediatric palliative care home. Before we knew it, Helen’s charismatic enthusiasm and gentle but firm power of persuasion had a plan taking shape. Using a list of interested volunteer staff, Helen called each staff individually explaining the situation, the roles she was trying to fill and worked with the staff to find a suitable schedule. Managers who were reluctant to release staff to volunteer for long term care were won over by Helen’s relentless determination, positive attitude and her passion to help our elderly. Within days, Helen had built a schedule. She called staff before their shift and after their shift. She asked “How did it go? How can I help you? Do you have what you need?” A site visit soon followed. “I want to make sure the staff are ok and that they feel safe. This is all so new for them. I want them to know someone is there for them.” Soon after, Helen was a regular presence in the home spending afternoons supporting the leadership and the staff. As new leaders from the long term care corporate office arrived on site to support the home, Helen introduced them to staff and updated
them on work to date and work still outstanding. She rounded on the units checking on staff. When she saw staffing gaps she worked with our adult hospital partner and called staff to help fill the need. She helped identify opportunities for improvement for instance identifying low inventory of critical supplies and making calls to secure what was needed. She delivered PPE to the units and even helped housekeeping staff hang newly washed curtains. Helen continued her on-site support even through the weekends. For five weeks she was at the home almost seven-days-a-week, tireless in her dedication to make a difference for the residents. “I want to see this through. This is so important!” she said. As the outbreak wore on, Helen began to see the toll the experience in the home was taking on the residents, staff and families. She rallied a Social Worker colleague to provide
nd prize support to grieving families. Helen also attended family council meetings. She arranged debrief sessions for staff to give them the opportunity to talk about the challenges of caring for residents – the living and the dying. Many of the hospital staff volunteering for the long-term care assignment were early in their career. Helen encouraged them, helped give perspective and ensured they knew the work they were doing was valuable and extremely important. Helen recognized the staff had to collectively grieve the passing of colleagues during the pandemic. She worked with spiritual support to arrange a memorial.
In preparation, she bagged debris left over from the winter and called in a gardener to help prepare the grounds. The ceremony was simple, touching and extremely important to the staff. It would not have happened without Helen’s compassion, leadership and hard work. While it took a team from our facility, our adult partner hospital as well as staff and leaders from the long-term care facility to help the home declare the outbreak over, Helen was the glue pulling the pieces together. She inspired all of us with her hard work, commitment, resolve and resiliency. She was respectful and professional in all her dealings. She exemplified compassion and kindness in her attitude towards resident care and staff support. She showed grace under pressure. Helen left the home in a stronger place and truly went above and beyond the call of duty in her support during a very challenging time. Helen, as a seasoned RN will retire one day. She will look back on her years as a front line RPN, RN, unit Care Facilitator, Trauma Coordinator and Manager. She will remember the young nurses she supported and the patients and families she consoled. She will remember the time she spent in a long-term care facility during the 2020 pandemic. These will be chapters in the story of her nursing career. But Helen will also be a chapter in the lives of those she touched during COVID-19. Longterm care team members, leaders, residents and families will remember Helen. Her pediatric and adult hospital colleagues who were asked to help the long-term care facility will remember Helen. We will all remember and we will be grateful that Helen came by with her hero cape just when we needH ed her most. ■ Nominated by: Mary MacNeil Director Nursing Practice, Education & Clinical Technology, Simulation Program, Vascular Access Team and Scheduling Office CHEO JULY 2020 HOSPITAL NEWS 25
NURSING HERO CONTEST 2020
Glenrose Rehabilitation Hospital Alberta Health Services n 2017, Corinne Huedepohl, nurse practitioner (NP), Tone Management Service for Children at Alberta Health Services’ (AHS) Glenrose Rehabilitation Hospital in Edmonton became the first NP in Canada to receive privileges to independently inject botulinum toxin (BoNT-A) for children under anesthesia in an operating room (OR). Her journey to becoming the first started when her team at the Glenrose identified a goal of improving service delivery by increasing access to care for children experiencing pain related to spasticity and dystonia. The patient population included children with diagnoses of cerebral palsy, spastic paraplegia, spastic quadriplegia, spastic hemiplegia/monoplegia, acquired brain injury or other neurodevelopmental disorders. At the time, the team faced physician resource limitations which created a barrier to timely care for children in Northern Alberta who benefited from treatment with BoNT-A. After identifying barriers to care for children requiring this intervention, the next step was listening to stakeholders from the Glenrose and Stollery Children’s Hospital sites, reviewing existing needs, practices and resources as well as existing supporting policies and procedures. By collaborating with team physicians, goals were identified to achieve improved access to care for children requiring BoNT-A, with particular emphasis on more timely access for children experiencing pain. An education plan to build Corinne’s knowledge and skills was designed and completed over 18 months. After completing this education plan with the team’s physicians, a job addendum and improvement charter was drafted and signed by AHS, Stollery and Glenrose senior management and communicated to relevant stakeholders.
26 HOSPITAL NEWS JULY 2020
THANKS TO THE CHANGES TO CORINNE’S ROLE, CHILDREN EXPERIENCING PAIN ARE NO LONGER LIMITED BY INDIVIDUAL PHYSICIAN OR TIME AND CAN ACCESS TREATMENT IN A PRIORITIZED MANNER. The initiative improved clarity on the role of the nurse practitioner and allowed staff to have a better understanding of how to support the nurse practitioner in the operative services environment. The job addendum specific to Corrine’s role as most responsible provider (MRP) to admit patients referred to her, manage their care in the OR, perform the procedure, handle consent and orders, became
an attachment to the provincial NP role description across Alberta. The addendum was presented to executive leadership at both hospitals and escalated to provincial executive leadership where it was approved and signed off by Dr. Verna Yiu, President and CEO, AHS. The work was supported by the Zone Advance Practice Nurse leads as an opportunity to test a document to support NPs role. This case was prec-
edent setting for AHS, and will help pave the way for other NP roles. From the initial discussions in early 2015 until the final document was signed in July 2017, it took a team effort to expand Corinne’s NP role to become an independent provider of ultrasound and/or e-stim guided botulinum toxin injections in the Stollery OR with the support of a pediatric anesthetist and assisted by Stollery and Glenrose nursing staff. Through this process the essential roles of nursing have been established in bridging gaps to improve children’s pain care as part of spasticity management and the NP role in quality improvement essential. “Corinne stepped forwards to meet the need for more timely care for our patients, committing to a nearly two year education plan despite the www.hospitalnews.com
NURSING HERO CONTEST 2020
potential risk that, being the first, independent practice providing injections might not be approved,” says Dr. John Anderson, Facility Chief, Child Health, Glenrose Rehabilitation Hospital. Thanks to the changes to Corinne’s role, children experiencing pain are no longer limited by individual physician OR time and can access treatment in a prioritized manner. Today, Corinne performs and supports 50-60 per cent of monthly spasticity treatments in the operating room on patients between the ages of 3-17 years. On average, 95 per cent of procedures are completed within window and wait times have
been reduced for focal spasticity treatment for pediatric patients. “She has brought to our team a valued approach and perspective as a nurse practitioner which has improved system efficacy and access to services, but more importantly improved how we make patients and parents partners in their care, how we deliver care compassionately around stressful procedures and ultimately how we are better in treating a child’s pain,” explains Dr. H Anderson. ■ Nominated by: Georgia Davis RN BScN MN Manager, Nursing Practice & Acute Respiratory Services, Glenrose Rehabilitation Hospital
UBC Centre for Brain Health Multiple Sclerosis Clinic, Vancouver Coastal Health onna Kuipers is my nursing hero. I have had the privilege to work with her since I was a resident in the neurology Program at the University of British Columbia (UBC). When I was a resident, she was one of the Emergency Nurses at Vancouver General Hospital (VGH). I remember coming down to the emergency room at all times of the day and night and already noticing that Donna was a leader in her field. She would always be helpful (yet stern, in a kind way) with all of the trainees. She had an extremely high standard towards patient care. I interacted with her multiple times during my five years of residency, and during that time she was always kind, compassionate, hardworking and dedicated towards her patient’s, staff and colleagues. Our paths diverged after I graduated from Residency, but then, unexpectedly Donna re-entered my professional life. About two years ago, she became the clinical nurse leader at the UBC Multiple Sclerosis (MS) Clinic at the centre for brain health. By this time I was already eight years into practice as a subspecialty trained neurologist.
Words cannot do justice to how much Donna’s contribution to our clinic was beyond helpful. When she came to the clinic, we had 11,000 patients with no nursing leadership and in general there was a feeling overwhelm and lack of organization of nursing care at the clinic. Donna, in her leadership role was able to restructure our clinic, in the best way possible for patient care. Not only has she groomed a team of excellent nurses who now look after our patients alongside with the six neurologists who work at the MS clinic, she has developed many clinic initiatives such as safety checks in place to ensure that our patients on disease modifying therapies are getting appropriate monitoring and timely access to necessary treatment. Donna plays a vital role in contributing to the health, safety and best practices management strategies for our patients with multi-
ple sclerosis and other neuro-inflammatory diseases. And our patients are some of the most complex patients in the practice of Neurology! Because of her dedication, efficiency, initiative and caring, I invited her to come with me to Whitehorse, Yukon in order to assist in translating some of the nursing practices we had established at the UBC MS Clinic to Yukon medical professionals as I am in the process of developing an MS program there. Her leadership has been paramount in training our nurses in the Yukon as well. And even after the fact, she has extended herself to providing ongoing support and assistance to any staff in need, even after her job has been done. She is truly exceptional. Donna is always available to help, bears the best interest of all whom she interacts with to heart, and devotes herself to the highest standard of
professionalism, nursing practice and patient care. In addition, some other highlights of her nursing/professional career include the following: She worked for the Vancouver Organizing Committee (VANCO) as the Assistant Manager for a Poly health clinic in Whistler. During this time, she set up the medical and nursing clinic for the athletes during the 2010 Vancouver Winter Olympics. She has also worked as a Regional Clinical Educator for Vancouver Coastal Health, and she lectured for one semester at Langara College, teaching her craft to future Nursing students. She is dedicated to passing on her knowledge to colleagues and trainees. Now as the coronavirus pandemic has hit our country, she will continue in her nursing leadership role at the UBC MS Clinic but at the same time has volunteered go back to the ER as a frontline worker amidst this health crisis we are facing. I have never met a nurse as dedicatH ed as Donna. ■ Nominated by Dr. Ana-Luiza Sayao, Neurologist, Providence Health JULY 2020 HOSPITAL NEWS 27
NURSING HERO CONTEST 2020
Marsha Samuels West Park Healthcare Centre would like to nominate Marsha SAMUELS, RPN for the 2020 Nursing Hero Award for her outstanding commitment to patient care and remarkable dedication to the Nursing Profession. I first met Marsha when my mother was admitted to West Park’s 2EB, TB Unit on January 22, 2020. Since Day One, I have been continually impressed by Marsha’s professionalism, and devotion to patient care, specifically to the vulnerable population. Over the past months, I have spoken with different patients and other patient family members who have also noticed how compassionate and
respectful Marsha is while providing exceptional care. I have witnessed her on numerous occasions reserving time to think of the needs of various patients while making a personable connection so that the patient feels seen and heard. Marsha does not shy away from patients with complex medical conditions from diverse cultures even though there is a significant language barrier: be it Chinese, Romanian, Vietnamese or Portuguese. I feel that Marsha is genuinely interested to help the patient as I sense that she is intrinsically motivated, due to her very positive and energetic attitude.
Thank You, Thank You, Thank You We can’t say thank you enough! On behalf of all of us at the Health Care Providers Group Insurance Plan, we’d like to take a moment to celebrate all of the hard-working nurses across Canada! Each and every day, we’re thankful for the immense impact that you have on our health care system. Most importantly, we cannot express in words how truly JUDWHIXOZHDUHIRU\RXUVHOȵHVVDFWLRQVDQGVDFULȴFHV as you work to keep Canadians healthy and safe, not only throughout the COVID-19 pandemic but always. Your continuous compassion, care and dedication don’t go unnoticed! As a small token of our gratitude, we’re ecstatic to have the opportunity to contribute to the prizing for this year’s Nursing Heroes contest. You all give so much to our country and we’re so happy to be able to give back to you!
28 HOSPITAL NEWS JULY 2020
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I HAVE WITNESSED HER ON NUMEROUS OCCASIONS RESERVING TIME TO THINK OF THE NEEDS OF VARIOUS PATIENTS WHILE MAKING A PERSONABLE CONNECTION SO THAT THE PATIENT FEELS SEEN AND HEARD. It seems as though Marsha is always at work, but she takes it on with such courage and strength during these uncertain times. Marsha always wears her heart on her sleeve, working tirelessly and selflessly to provide consistent, professional yet compassionate patient care and to me, this demonstrates Marsha’s extraordinary dedication for the job and her strong work ethic. It is uplifting to see Marsha’s pride for West Park and her passion to take care of others. Marsha is truly an inspiration for going above and beyond the call of duty, not only for the Healthcare Profession, but certainly empowering to many other ‘boots on the ground’ from various essential professions, to which I can personally attest already made a lasting impression. Marsha has consistently shown an empathetic and calm demeanour no
matter how elevated the emotions or actions of some daunting patients yet, she deftly balances stoicism and respect. I was encouraged when Marsha provided reassurance to me about my mother’s condition, and offered a glimmer of hope, no matter how dire the situation. A true Team Player, I have observed Marsha always eager to assist, be it the patient, family members or checking in with her colleagues. All of these qualities I have described above are reasons why I believe that Marsha exemplifies nursing excellence. Thank you Marsha for making such a profound difference in our community. On behalf of your patients, we saH lute you! ■ Submitted by Bettina FONG www.hospitalnews.com
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NURSING HERO CONTEST 2020
Kate Marice Escober
Vancouver Coastal Health K elly’s journey began on May 20th, 2019 when she suffered a stroke that left her paralyzed from the neck down. She was 25 years old when she arrived at VGH spinal before being transferred to GF Strong on October 15th, 2019. Although Kelly was a resident of Vancouver, she grew up in Dartmouth NS where her family resides today. During Kelly’s time in hospital and at GF Strong our family took up a second residence in Vancouver. While Kristal and Todd commuted on a regular basis to be with Kelly I stayed behind and cared for Kelly on a daily basis. You can imagine how traumatic, scared and vulnerable Kelly and our family felt as we navigated this injury and everything it encompassed. When we met the nurses at the second floor,
Spinal Cord Injury GF Strong they took us in and cared for us and Kelly and our family grew closer to them as the days went by. All the nurses were wonderful towards the patients and their families. For us however the ones that made an impact to Kelly were Kate and Serena. Kelly became closer to these two wonderful nurses, Kate and Serena. They made her laugh at moments that Kelly needed it the most. They made her forget that she was just another patient and made her feel like life was normal on the days that they cared for Kelly. Talking to her about music, food and wine and silly stories seemed to help pass the time from her daily difficult routine. They really made Kelly feel very special. When Kelly decided on her date for Medical Assistance in Dying, Febru-
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Respecting people. Removing barriers. Maximizing potential. 30 HOSPITAL NEWS JULY 2020
ary 18th, they told her she needed to choose a nurse to be with her on that day. She gave three names. One nurse declined, Serena was not working on that day and Kate said yes. Kate’s dedication to her patients is outstanding. She is always caring and thoughtful. She is a wonderful person and above all a wonderful nurse. Kate was a blessing to us at the moments that we needed support the most. Kate (with the help of Serena) made the day so much easier for Kelly and also for us her family. She made sure that Kelly was feeling comfortable and that she had everything she needed. The respect, the professionalism, the love and caring that Kate showed to us would never be forgotten. Kelly’s mom Elena, Sister Kristal and Dad Todd choose Kate as our Nursing Hero. She deserved the reward for her wonderful work, for her loyalty and professionalism and for giving so much of herself to support Kelly, our family and the patients at GF Strong. Kate and Serena have now become part of our family. We can’t wait for them to visit us here in Halifax, Nova Scotia and one day when we go back to BC, rest assured that we will be visiting them and the wonderful staff at GF Strong. Nominated by: The family of Kelly Watson-Schutz. Elena Schutz-Henriquez (Mom), Kristal Watson (Sister), Todd Ellis (Dad)
e honouraobnl treated the both of us not only as their treamenti sured nurses, but also
We both work at GF Strong Rehab together and had gotten a chance to become close to one particular patient and their family members. It has never been easy to work on the spinal cord injury unit as patients are dependent with their every need. This particular patient and their family
loved us like a part of their family. It was extremely hard on us, the family, and those at GF Strong who worked with the patient, when the patient decided to go through with Medical Assistance in Dying (MAiD). When the date was decided for February 18th, 2020, the patient requested for 3 particular nurses to be the nurse for the day. Unfortunately, I could not be the nurse as I was off duty, the other nurse declined, but Kate thankfully said yes. Kate said that she would be more than willing to; even though the thought of MAiD saddened all of us. Kate and I worked together until the day of the patient’s MAiD date, and although I was off duty on the actual date, as per the request of the patient and the family, I came in to GF Strong to spend the day with them. Together with Kate, we were by the patient’s side until the time the MAiD team came and we had to say our goodbyes. Initially, the patient had requested that no one; not even family were to be by bedside as they were going through with the process. As the MAiD team was setwww.hospitalnews.com
NURSING HERO CONTEST 2020
KATE’S DEDICATION TO HER PATIENTS IS OUTSTANDING. SHE IS ALWAYS CARING AND THOUGHTFUL. SHE IS A WONDERFUL PERSON AND ABOVE ALL A WONDERFUL NURSE.
ting up, Kate and I asked if we could stay by their side and the patient said that they would be glad if we did. We held their hand and chatted as the process started. The patient said two really important things before they went to an eternal pain and suffering free sleep. They thanked us for being such wonderful nurses and for taking care of them and most importantly, asked and made us promise to watch over their family when they were gone. Kate and I have never been a part of the MAiD process before, but it was extremely heartbreaking and difficult to watch the patient leave us. Although a lot of tears were shed, Kate’s love, care, empathy, bravery, courageousness, tenacity, selflessness, along with her superb nursing skills shone through not only to the patient
but towards the family as well. Kate was the best choice to be the nurse for the day and every day she works as a nurse. Everyone at GF Strong loves her including the other patients, as her compassion and work ethic are outstanding. I know that Kate is still recovering mentally and emotionally from that day, as it hasn’t been easy. But she is doing wonderfully and continuing to put forth her best in everything she does. I hope that my testament, nomination and story, would not only allow her to win but especially highlight how amazing she is as a person and as a nurse. Kate is our hero, not only for the patient but to the family and those at GF Strong H as well. ■ Nominated by Serena Soo, BSN, MSN, RN, CRN(C)
From left: Serena Soo, Kelly and Kate Escober.
Safe Management Group Inc. thanks all our nurses for their commitment and dedication, you truly have put the care in Healthcare. The last four months, have certainly been challenging for all. The value of face-to-face interaction and the human touch cannot be understated, nor can the safety of our Healthcare workers.
JULY 2020 HOSPITAL NEWS 31
NURSING HERO CONTEST 2020
By Roopdai Mohotoo and Nita Marcus
Florence Nightingale, the lady with the lamp, Mother Theresa in the refugee camp, Caring, compassionate, gentle and kind, A more noble profession, one could not find. The nurse is the doctor's eyes and ears, Records any changes, allays patient fears, Monitors rhythms, takes vital signs Administers drugs, sets up IV lines. The nurse is highly trained in her skills, To assist in the healing of wounds and ills, In the OR, wards or critical care, Her presence unnoticed because she is always there. With devotion and pride, she nobly serves, Though pressures, demands, may fray her nerves The nurse lowly paid, in gold is her worth, For she's truly god's angel sent down to earth
Thank You Thank you. Two words that have never meant so much right now, and yet, still donâ€™t feel like quite enough. On behalf of Ontarians everywhere, we the Registered Practical Nurses Association of Ontario (WeRPN) want to take the opportunity to express our GHHSHVWJUDWLWXGHIRUWKHVDFULÂżFH\RXÂśUHPDNLQJHYHU\GD\WR NHHSXVVDIH<RXÂśUHDWWKHIURQWOLQHVRIDÂżJKWDJDLQVWDJOREDO pandemic, and yet through it all, your hope, professionalism, and compassion inspires us. During this uncertain time, our healthcare system has been pushed to its limits and health professionals are working courageously GHVSLWHWUHPHQGRXVVDFULÂżFH:HXQGHUVWDQGQRZPRUHWKDQHYHU WKHLPSRUWDQFHRIFRQQHFWLRQDQGFRPPXQLW\7RJHWKHUZHDFWDV a strong voice for RPNs and champion innovative ideas so we can improve care for our patients, and better support our fellow health professionals. Today, more than 45,000 RPNs support patients in Ontario KRVSLWDOVSXEOLFKHDOWKXQLWVLQWKHFRPPXQLW\ORQJWHUPFDUH facilities, schools, and private health providers. When any of those RPNs encounter barriers to patient care, they can count on our support. We are stronger together. To learn more, please visit werpn.com
32 HOSPITAL NEWS JULY 2020
Elizabeth â€œLizâ€? Seymour Southlake Regional Health Centre ver since joining the cardiology team in 2015, Liz has been an active advocate not only for the patients, but also for her fellow teammates. As we all know, teamwork is important in a setting where things can change in a matter of seconds. While Lizâ€™s focus is on her patients, she also finds the time to boost the morale of our unit. For example, during the current pandemic, Liz created a very elaborate â€œboard of happinessâ€? where she encouraged everyone to post pictures of their children and pets (constant reminder to us all that there is life outside these walls that brings a smile to our faces).
and their families are happy with the physical (and psychosocial) care they receive. She ensures that not only is the patient well cared for, but that their support family have all their questions answered. As we all know, being hospitalized (especially during COVID) can be a very depressing, even traumatizing, time for many patients. Liz goes out of her way to get to know her patients better as people whose lives have temporarily derailed but who still enjoy things like music and conversation (just some things that are in very short supply during these trying times). She has even arranged for a â€œdance partyâ€? for one patient â€“ which
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LIZ CLEARLY HAS A VISION FOR A BETTER HEALTH CARE SYSTEM AND WILL ADVOCATE FOR CHANGES THAT WILL IMPROVE PATIENT CARE. Liz makes sure that everyone knows they are appreciated. She ensures she knows the names of the whole cohesive team, which includes not only the nurses, but all the people that make Cardiology such a wonderful team to be a part of â€“ the clerical staff, the housekeeping staff, the porters, allied health staff, among so many others. Liz takes the initiative to be a leader and gets the rest of the team involved by giving out thoughtful cards to a team member who has experienced a milestone in their life (whether it is a happy or a sad occasion). Patients are not excluded from Lizâ€™s â€œattitude boostâ€? as Liz makes sure they
improved the patientâ€™s state of mental health, if only for a short time. Liz clearly has a vision for a better health care system and will advocate for changes that will improve patient care. For example, she has encouraged many changes in regards to pharmacy timing and pharmacy stock of certain medications, which has led to a more timely provision of patient care. Liz takes the title of Unit Council President to heart and truly lives by the standards the council promotes. Not only are we, as her colleagues, blessed to have her on our team; this amazing nurse is just one reason that H makes Southlake extraordinary. â– www.hospitalnews.com
NURSING HERO CONTEST 2020
The Centre for Addiction and Mental Health t is my pleasure to nominate Zeynab Hassan for the Nursing Hero Award. I believe that she has made significant contributions to our organization and has consistently shown her dedication to going above and beyond the call of duty. Zeynab is a Clinical Informatics Nurse at the Centre for Addiction and Mental Health (CAMH). She began her journey as an inpatient nurse in 2014, where she became an expert in CAMH’s electronic health record, I-CARE, and became a champion for barcode medication administration to support patient safety. With this knowledge, she developed a desire to share her expertise with her colleagues and to be the clinical voice during the design and implementation of informatics initiatives. This
prompted Zeynab to pursue a role in Clinical Informatics. As a Clinical Informatics Nurse, Zeynab is the first point of I-CARE contact for many new nurses at CAMH and remains a point of contact by going above and beyond her role to diligently assist her former students as they become familiar with the system. In addition, Zeynab regularly identifies and flags technological barriers to nursing practice to CAMH’s Information Management Group and regularly represents the nursing voice on committees and working groups ensuring that patient care and experience are always at the center of decisions. One particular example that comes to mind is when Zeynab identified that there was a low number of patient photos in I-CARE and out of all current photos, many patients
ZEYNAB RECEIVED PRAISE FROM THE ORGANIZATION AND WAS COMMENDED FOR PROMOTING A NEW METHOD FOR PATIENT IDENTIFICATION, WHILE ALSO EMPOWERING PATIENTS TO CULTIVATE THEIR SELFCONFIDENCE AND SELF-WORTH. looked disheveled and unkempt. These photos were an inaccurate depiction of our patients, as a majority of these were taken at the start of the patient’s recovery at CAMH. She understood that a lack of accurate patient photos in the chart is a patient safety risk, as patient photos are commonly used for patient identification. To tackle these issues, Zeynab developed a two-step approach. The first was to improve the process for
capturing patient photos, as was convoluted and non-ideal for point of care staff. Zeynab spearheaded the in-house development of the “ClientPhoto” app, which made it easier to upload a patient’s photo in their chart, significantly reducing the time and effort it previously took to do so. Not only does this app enhance safety measures for clinicians, but it also allows patients to participate in
CARE Centre Salutes IENs for the Nursing Heroes Awards
Internationally Educated Nurses are CARE Centre’s Heroes in 2020 and Every Year! IENs and CARE Centre: Partners in Healthcare Diversity Contact CARE Centre to ﬁnd out more about IENs in Your Workplace Info@care4nurses.org www.care4nurses.org
CARE Centre for Internationally Educated Nurses (CARE Centre) has been supporting internationally educated nurses (IENs) back into practice for 20 years. Our member IENs come here from all over the world, determined to re-establish their nursing careers. They are heroes to us, being brave enough to immigrate to Canada for a better future, then facing many hurdles to become registered to practice. Our IENs have juggled survival jobs and young families while pursing education and sitting exams to achieve licensing. CARE Centre’s case managers and staff understand that for IENs, nursing isn’t a job, it’s a calling. Like SARS before it, the COVID-19 pandemic has taken frontline workers’ lives, but nurses continue to go to work in long-term care, in hospitals, in testing facilities and in the community. Our healthcare employer partners are champions in valuing and honouring IENs on the job. We salute our IENs for their challenging journey to registration, and everything they are doing for Canadian healthcare during the COVID-19 pandemic and beyond. Thank you IENs, all nurses and all healthcare teams for your professionalism and your courage. CARE Centre is funded by the Government of Ontario and Immigration, Refugees and Citizenship Canada. Visit www.care 4nurses.org for more information. 128A Sterling Road, Suite 202 Toronto, ON M6R 2B7 416-226-2800
34 HOSPITAL NEWS JULY 2020
NURSING HERO CONTEST 2020
the patient photo process actively. With her efforts, the rate of uploading the patient’s chart doubled within weeks of implementation. The second step was to improve the patient experience during the patient photo process. Zeynab piloted a patient event called “Take my Photo Day”, an event where patients have the opportunity to have photos taken of themselves by professional photographers. Hair and makeup services as well as lightly used clothing were also available for patients to use if they choose to do so. Once the photo is taken, patients are provided copies of it to keep, and they are uploaded to their chart with their consent. This event was able to reach 75 patients and Zeynab received praise from the organization and was commended for promoting a new method for patient identification, while also empowering patients to cultivate their self-confi-
dence and self-worth. This work is important for supporting patient safety particularly for processes completed by nurses like medication administration, but also ensuring that people with mental illness can be identified in dignified ways. She is currently working with CAMH’s Enterprise Management Office, Public Affairs, and CAMH Foundations’ Gifts of Light to ensure that this event becomes embedded in CAMH’s standard operational offerings. In closing, I truly believe that, should Zeynab be granted this award, it would make a tremendous contribution to ensure achievement of the goal of “Take my Photo Day” – to make a significant, positive impact on our paH tients’ journey to recovery. ■ Sincerely, Matthew Jabile Project Analyst, Enterprise Project Management Office, Centre for Addiction and Mental Health.
NURSING HERO CONTEST 2020
Galloway Health Centre Saskatchewan Health Authority oanne Farnden is a true nursing hero. When I first met her at the Galloway Health Centre in Oxbow of September 2017, I knew then and there that she was a special lady. I was a new grad, fresh out of school and eager to learn. The Health Centre in Oxbow was my first “real” nursing job and I felt I was ready to handle any patient or case load thrown at me. Joanne (Jo) greeted me with open arms and a big smile. I was lucky enough to be able to listen and learn from her experiences as a nurse. While I knew nursing would be challenging, I had no idea just how mentally and physically exhausting it could be.
After my orientation and starting on the floor on my own, I had emotions of excitement but also fear. Fear that I would be unsure of what to do or how to handle a specific case. Joanne continued to boost my confidence and reassure me that things would be okay. It wasn’t until one day that her and I were working together, that I had my first real “code blue” or pulseless arrest. I remember it well – an inpatient that had been admitted to us for quite some time with many co- morbidities. Being in a rural facility where there are only two RNs and one LPN staffed on days often made it challenging to juggle working with both inpatients and emergency patients at once. While
I was shaking with fear, Joanne was beside me, guiding and assisting me as we worked together to save this man’s life. I remember thinking “how can she be so calm right now?” But there she was, calm and collected as we pushed medications, started IVs and began our nursing care. In the end, we were able to save him together. This is not the only example of what makes Jo a true hero. Her commitment and compassion to her job and patients continues to shine through as she works day after day. She is always in good spirits and always the first one to crack a joke or make someone laugh. It is easy to see that Jo has a true passion for nursing and effortlessly enjoys caring for patients of all ages, shapes and sizes. Joanne has taught me how to care for a patient as if it was your family as well as how just a bit of compassion can go a long way for someone in need. She is a true role model and someone I aspire to be. Nominated by Linnea Harris RN
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The first Canadian graduate degree in home and community care. There is a large demand for graduate-prepared managers in private, public and not-for-profit organizations that plan, coordinate and deliver clinical and supportive health care in the community. Focusing on diversity, leadership and entrepreneurship, the MHA(CC) curriculum prepares graduates to effectively lead within this dynamic sector.
ryerson.ca/mhacc 36 HOSPITAL NEWS JULY 2020
brings out the best in people. She is a constant support to co-workers or patients. She shows respect to everyone she meets and thus in return she is well respected. I have seen that respect in patients, residents, support staff, and doctors. Two of Jo’s amazing attributes are her patience and humility. These contribute to her being such a great leader. New grad nurses are so comfortable asking questions and working with her. She has a natural way of putting people at ease. This also helps her in getting to the bottom of a situation and finding out the underlying problem with a patient. Nominated by Sylvia Mohrbutter, LPN
To come up with one nursing hero story about Joanne is very difficult, as there are so many. It is Joanne’s positive personality that shines through. One immediately knows it is going to be a good shift when you walk through that door at work and see Jo. It may become one of the busiest or most emotional days of your working career, but it will still be a good day. I have worked with Jo when STARS have had to pick up very critical patients and when patients have passed away, but with her support and her ability to instil confidence in others, I have gone home knowing we did our very best. To Joanne being a leader is not being in charge, but about taking care of people in her charge. She naturally
I once read an article that described characteristics of a hero. These characteristics were courage, selflessness, humility, caring and patience. Joanne Farnden meets all of these criteria, and more. She is a true leader. I remember first starting nursing. I was nervous, scared and excited. I am sure she could sense every one of those emotions. The first position I got was working alongside Joanne. We worked almost every shift together. She quickly greeted me with open arms and immediately made me feel like I had been a part of the team for years. I was excited because everyone held her with such a high regard; she has such a multitude of knowledge that she is always so eager to share. She demonstrates courage by adapting to every situation with such ease. She never gets worked up or nervous when an emergency or code comes in. I have seen her handle many different situations, and it’s like she has seen the cases a hundred times before. She www.hospitalnews.com
NURSING HERO CONTEST 2020 maintains composure all while giving meds, comforting family, and keeping open lines of communication with the team. Keeping in mind, working in a rural hospital, we don’t have a lot of the extra resources. We also have a unique setting being that Oxbow is a Health Centre; we have long-term care, acute and emergency services. So to maintain constant composure and always be one step ahead is certainly a trait to admire. She not only shows courage, but she inspires those she is caring for to be courageous. She is the most selfless person I know. Not once have I ever heard her complain about her workload or the daily demands of the residents or patients. She is always putting others fbefore herself, whether it is at work or in the community. She is always volunteering for numerous events in town, and trying to figure out ways to help others. I have been out in the community and her name comes up quite a bit. The common phrases are, “She was my nurse when I was in the hospital, she was amazing”, “She always gives so much to the hospital
JOANNE HAS TAUGHT ME HOW TO CARE FOR A PATIENT AS IF IT WAS YOUR FAMILY AS WELL AS HOW JUST A BIT OF COMPASSION CAN GO A LONG WAY FOR SOMEONE IN NEED. SHE IS A TRUE ROLE MODEL AND SOMEONE I ASPIRE TO BE. and to the community”, “She always know how to put a smile on our faces”, “She helped me through a very hard situation, and I am so grateful for the kindness she showed”. Joanne has so much love to give, whether it’s to the patients she is caring for, the co-workers she is with, or her family at home. She is an incredible individual. I constantly strive to be the kind and caring person she is. She inspires everyone around her to be more motivated and more dedicated workers, and more kind and caring individuals. She has a way of making the day brighter for each and every person she comes in contact with. She truly loves her job, and it shows. She will go above and beyond every day to
make someone’s day brighter, whether it is simply getting them a coffee, or showing them the motivation they need to get up and moving so that they can reach their goals. She is always striving to make patients and families more comfortable and keep the lines of communication open. She has been a support for families dealing with the death of a loved one, and will always make time to sit down with someone and just talk, give advice or comfort in their time of need, and a hug is always waiting if you need it. She is the easiest person to talk too, and it is because she genuinely cares about what you have to say. Her heart is so big. She has extreme amounts of patience; take it from me, a new nurse.
She has always taken the time to explain things to me, in a way that makes sense. She is always willing to answer my questions, even if there are a lot of them each day. She will answer me, crack a joke and keep going on with the day. She is patient with the people who come in through emergency; she always listens to what they have to say so that she can get to the root of the problem. I know that is an assessment technique of every nurse, but sometimes it is easy to assume things and place judgment. She is non-judgemental with her work, no matter how silly or non-emergent a problem is, she will always make a patient feel like their problem matters and that they will get the help they need. Joanne is truly one of a kind. She demonstrates all of the qualities of a great nurse and a hero every single day. All of the coworkers at Galloway Health Centre learn from her every shift. We look to her for advice, guidance, wisdom, motivation, knowledge and caring. She carries the weight of H all this with such ease. ■ Nominated by Jana Dunnigan RN
Fighting COVID-19 with community care From COVID-19 assessment centres, testing labs and homecare work, graduates of the Ted Rogers School of Management’s Master of Health Administration in (Community Care) program are taking the lead fighting COVID-19. The MHA(CC) program is the first Canadian graduate degree of its kind and addresses the demand for skilled leaders in private, public and not-for-profit organizations. Kittie Pang, a 2020 MHA(CC) graduate, is a project manager with the strategy and integration team at Sunnybrook Hospital. Kittie Pang Photo by Ian Patterson
Through her work with hospitals and Ontario Health Teams, she’s created programs to help senior residents in North Toronto and new mothers who are feeling isolated.
“I am hopeful the work we do will be successful and can be sustained even after the pandemic.” – Kittie Pang
NURSING HERO CONTEST 2020
Southlake Regional Health Centre n December 20th, 2019 while out shopping, Hayley Painter heard a cry for help. As a Registered Nurse, Hayley did not hesitate to jump in to assist. Hayley was in the midst of paying for her lunch in the large food court area at Square One Mall when she heard someone yell to call an ambulance. Without hesitation Hayley went to see if she could help. She was shocked when she came across a baby choking. A bystander was holding the baby upside down not knowing what to do. Hayley saw that the baby was blue, so she instinctively took the baby from the bystander and performed the Heimlich maneuver. When Hayley turned the baby over she saw that he remained a dangerous blue colour, his eyes wide open, and he made no sound. She could see something green coloured stuck in his throat and pulled it out. As she turned him over he was unresponsive.
gent need as although the baby was breathing on his own he continued to be lethargic with poor colour. Hayley carried the baby over to comfort the baby’s mother who was sobbing uncontrollably on the floor. Hayley continued to watch over both mom and baby while they waited for the ambulance to arrive. Like many parents, the mother had given the young infant something to eat while he was in his stroller. The infant was facing away from the mother so she didn’t notice that anything was wrong. It was a bystander that grabbed the mother’s attention when she noticed the little boy was blue. EMS arrived to take the infant to hospital. Hayley was thankful that the Mom had lots of family around to go with her to the hospital, otherwise she would not have hesitated to go with them.
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THE CHEERS OF THE BYSTANDERS BROUGHT HAYLEY OUT OF HER NURSING MODE AND BACK TO REALITY. HAYLEY COMMENTED, “IT WAS VERY EMOTIONAL AND OVERWHELMING. Hayley initiated CPR, all the while she was fearful she might hurt the baby. “I did a few chest compressions, my nurse mind came up in total focus. I knew instinctively what to do.” Hayley continued with chest compressions and the baby thankfully responded. He took a breath and started breathing on his own. A young security guard arrived and wondered whether 911 still was required to which Hayley confirmed the ur38 HOSPITAL NEWS JULY 2020
The cheers of the bystanders brought Hayley out of her nursing mode and back to reality. Hayley commented, “It was very emotional and overwhelming. I knew they just needed to get the baby to the hospital… I’m a mother and I’ve given my kids something to eat in their strollers 1000 times. I still don’t know what he choked on.” Later that night Hayley received a phone call from the mother; her baby boy was fine. The baby was discharged home from the hospital and was com-
pletely back to normal that night. The doctor told the mom that he was one lucky little boy, the nurse had saved his life. Hayley was overwhelmed to hear from the Mom. She was reassured that the little boy was alright. The Mom couldn’t thank Hayley enough for saving her baby’s life. The next day was his 1st birthday and Hayley was invited to his birthday party. Hayley explained to the Mom that she therself had to work the next day, but she wished him a very happy birthday. “Every December 20th I will never forget this little boy,” Hayley said. Hayley is very humble about her heroic actions, “I didn’t do anything that any other nurse would have done.” Hayley finds comfort and support in sharing the story with other nurses at Southlake. In telling her story Hayley heard from others who have stepped up to help while out and about in their
communities. “Talking to others who do this all the time helps to put things into perspective” she said. Hayley is advocating for everyone to make sure they are educated in first aid. “Public awareness is important, refresher courses are important. Everyone should have basic first aid, especially when you are a parent with young kids.” Hayley returned to work on the Post-Partum Unit at Southlake the next day continuing to reflect on what occurred. For Hayley the incident rekindled the important work that nurses do every day; a rebirth of what nursing means to her. Kudos to Hayley Painter – a hero to this little boy, his mother and family, H and to all of us, her Southlake family. ■ Nominated by Lorrie Reynolds, Director Patient Experience, Southlake Regional Health Centre www.hospitalnews.com
Proud to Celebrate the
Year of the Nurse This year, as nurses respond to the COVID-19 pandemic with compassion, expertise, resilience and commitment, it has become especially poignant that in honour of the 200th anniversary of the birth of Florence Nightingale, the World Health Organization has declared 2020 the International Year of the Nurse. Each year, more than 3,800 nurses at London Health Sciences Centre play a vital role in providing health services to patients. Thank you to all of our nurses for putting patients at the centre of everything you do.
NURSING HERO CONTEST 2020
Trillium Health Partners/University Health Network hen I think of a nursing hero, I think of someone who carries their heart on their sleeve. I think of someone who expresses their caring and commitment to their patients, their community and the world. It is an individual who has an urge to make a difference in someone’s life, their suffering, their healing and ultimately their quality of life. It is with great admiration that I nominate Nermin Ibrahim. My faith in humanity has been quite shaky at best, from everything that has been happening. Upon being admitted to Toronto General hospital, I was withdrawn from any expectation. Beyond great care I was receiving from the staff, I encountered a full of life, love and compassion clinician named “Nermin”. She was the nurse practi-
tioner student with the general internal medicine team that was overlooking my care. I was admitted for three months and was followed by Nermin for two months. Nermin made my disdained reservations towards humanity disappear. It seems like I forgot what genuine concern for others looked like. Nermin managed to make me laugh and see humans in a different light. I believe for such a wonderful person; she is unaware of the enormous impact she has on her patients. Just by being her kind self, I found myself being distracted from my severe pain, even if only for a brief moment. She radiates warmth and generosity. She is very patient and genuinely listens. She is extremely professional, diligent and meticulous with her assessments while remaining completely humane. Her
Helping our heroes care for Scarborough At Scarborough Health Network (SHN), our response to the COVID-19 pandemic has been swift and effective – and we, along with hospitals and health care providers across the province, remain optimistic as case numbers continue to drop. For our community hospitals, this success rests largely on the hard work and commitment of our nurses and frontline staff as they deliver the best possible health care to the people and patients of Scarborough. To support our frontline heroes and our hospital’s most urgent needs in the wake of COVID-19, SHN Foundation established the COVID-19 Emergency Fund and the Help Our Heroes PPE Drive. Since fundraising began, more than $2.2 million has been raised, and more than 400,000 PPE supplies have been donated, including over 4,000 handmade fabric masks. Also, more than 14,000 meals have been delivered to our hospital teams by local businesses, restaurants and organizations. “Thank you to our donors for stepping up during this challenging time and helping those who are working to keep Scarborough safe and healthy,” said Alicia Vandermeer, President & CEO, SHN Foundation. “No matter the size, every gift and offer of support for our hospitals is important and appreciated.” Learn more at
SHNFoundation.ca 40 HOSPITAL NEWS JULY 2020
sympathy and care for me will not be forgotten. Nermin made sure I was heard, understood and validated. She took the time to address my concerns sincerely. Her selfless care to everyone was so appreciated, and I know she gave the same care to everyone because that is her. She was always accessible and never made me or my family feel like we were imposing or a burden to her. Nermin was very kind and compassionate to my family and me. My stay at the hospital was complicated with respiratory failure. I remember vaguely she sat at my bedside and calmly explained to me what’s going on and that she called my daughter who was on her way. Nermin came in to check on me and, on the family, almost every hour and ensured that all my family’s questions and concerns were addressed. She genuinely cares about her patients and goes above and beyond to keep them comfortable. In a couple of days, I got better, and nonetheless, she took the time to sit at my bedside and explain to me what happened for the past week. She was never rushed and made the demands of her job seem like second nature. I can’t even imagine what kind of toll her job must take on her life. Long working hours, watching people suffer, dealing with death, going above and beyond her call of duty. I don’t want to just say thank you, but I want to salute her for being a hero, every single day of her life. Nermin you are an amazing and astonishing clinician and human being. I know she would say she was just doing her job, but by being herself, working in harmonious sync with the team, she has my eternal gratitude. Nermin has a great heart that shows caring and professionalism in all she does. She is a great communicator and person that shows incredible compassion in all her actions. She made a stressful time bearable and helped me
and my family feel at ease whenever she was around. I encourage other patients to come here to see what it looks like when a clinician loses herself in service of others, without requiring thanks. A huge thank you to Nermin, my angel with a stethoscope, who made a difference in my quality of life. Please continue to be the amazing light you are, making a difference in the lives of everyone you come across. Nominated by Mr. K
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I would like to nominate Nermin Ibrahim, a Nurse Practitioner student at Toronto General Hospital – who I encountered in January of this year. I’ve probably written this nomination a hundred times in my head, but it never seems to convey the sincere gratitude that my family feels towards the staff at TGH. The knowledge and confidence of the staff helped me keep my shoulders straight and understand the process of dying. The love and compassion from everyone on the team made us feel like we were not alone. We received excellent care from all the staff, yet I have to single out a clinician who went the extra mile. Nermin was an extraordinary clinician who was most caring, and her only concern was the well being of her patients. My father’s exit was exactly what I had hoped for, and he was as comfortable and pain-free as is possible. It’s the little things that Nermin does to make a patient feel special. Words alone are not enough to explain all she has done. Nermin has a gift that encourages people to open their minds to the views of others. She takes the time to get to know the patients and families she is caring for through the development of the therapeutic relationship. It is within this relationship that magic happens. She learns what is most imwww.hospitalnews.com
NURSING HERO CONTEST 2020 portant to patients and families, brings that forward to the team and challenges others to think differently by sharing the perspectives of the unique individuals whom she cares for. Her knowledge and expertise impressed me, considering she introduced herself as a nurse practitioner student with the internal medicine team. Still, her outstanding knowledge assured me that we were in good hands. Words can’t express our appreciation for the care and compassion that Nermin brought to my dad during his last days. He had put up a long fight, and when he needed to let go, she helped us to let go and to feel at peace with our decision. It’s a fine line that you have to walk as your loved ones approach death. Thank you, Nermin, for your gentle hand and for allowing a certain level of personal choice to be retained. The time that she took to discuss my dad’s goals of care, and end of life choice was hard, but she did it with such a gentle and caring tone that it was not traumatic to my dad or me. I was struggling with deciding on the plan of care. Nermin was a huge support and a resource for us. Her hand-holding and support during this
time is something I will never forget. When I look back at that time, I remember how stressful and aggressive I was at times, but her smile, calming face and her loving guidance through such sorrow is an irreplaceable asset. The care Nermin provided was above and beyond. Her care was sincere and heartfelt. I am so grateful for having Nermin part of the team that took care of my dad in his last days. I want to say, thank you to unsung heroes such as Nermin for all that she does. Nermin exemplifies what a clinician should be; in fact, she raised the bar! Her concern, positive attitude and bedside manner were excellent. She is kind but professional, demonstrating kindness and empathy for us during these challenging times. She is truly a hero and recognizing her for her compassion, generosity and selflessness is the least I can do. Saying “Thank You” seems so insufficient, but I can find no words that truly express my feelings appropriately, so I will stick with those two simple words with the hope that she knows the depth of emoH tion and gratitude they contain. ■ Nominated by: Joanne, a grateful family member of a patient.
JULY 2020 HOSPITAL NEWS 41
NURSING HERO CONTEST 2020
Uthaya Balakumar and Natalie Allison Markham Stouffville Hospital oo often during this pandemic we have heard stories of how families – unable to be with their loved ones in person due to hospital visitor restrictions – have had to say tearful goodbyes via a screen or window. While these restrictions are so important to protect everyone in our hospitals, they have also fundamentally altered how we support patients and families. However, registered practical nurses Natalie Allison and Uthaya Balakumar are two nursing heroes in our Palliative and Complex Continuing Care unit who are demonstrating determination and innovation in order to bridge the gaps COVID-19 has made in end-oflife care. There is no better example of their commitment than the support they provided to Ann Melis and her son Shaun. Ann was brought to the Emergency Department at our Markham site by Shaun the evening of Saturday, May 2 suffering from end-stage chronic obstructive pulmonary disease. Ann’s COVID-19 test results were still pending when Uthaya began car-
42 HOSPITAL NEWS JULY 2020
ing for her on May 3. With her death imminent within the next 24 hours, Shaun desperately wanted to be with his mom, even if it meant he could only see her from the window outside of her hospital room. Although the Palliative and Complex Continuing Care unit is on the ground floor of the hospital, initially Ann’s room was in a courtyard area that is inaccessible at this time. Uthaya knew she had to do something to help Shaun and worked with Natalie – who assumed Ann’s care during the night shift – to arrange for Ann to be moved to a room on the unit that Shaun could most easily access from the hospital grounds. Once there, Natalie positioned Ann as close to the window as possible by lengthening the tubes for her medical equipment. For the rest of the night, as Shaun sat in a chair outside his mom’s room, Natalie regularly called him on his cell phone to explain all the care she was
providing to his mom – just like she would do if he was there in the room. In the early hours of May 4, Natalie learned that Ann’s COVID-19 swab was negative. Although families would normally not receive this information in the middle of the night, knowing that Shaun was right outside, Natalie immediately wanted to share the good news! After not reaching Shaun on his cell phone, Natalie raced out of the hospital to let him know he could join his mom at her bedside. Shaun – who had fallen asleep in the cold and the rain – could not believe that Natalie came all the way out to get him at 3 o’clock in the morning. He shared that, although being by his mom’s window was good enough, it was even more comforting for him to be there by her side when she passed. Going above and beyond like this is simply how Natalie and Uthaya feel
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they should serve the patients and families who entrust our hospital with their care. Natalie has often told me that she never found her true love for nursing until she began working in palliative care. She was Uthaya’s preceptor when Uthaya started at MSH as a nursing student. Now, as her mentor, Natalie is instilling this same passion for nursing in Uthaya. Natalie and Uthaya continue to improve the experience for patients and families. For instance, they have added posters on the windows with the room number so family members who cannot come into the hospital can find their loved one more easily from outside. It’s a privilege to serve alongside them as part of the exceptional palliative care team we have here at Markham Stouffville Hospital. They are true nursing heroes who exemplify our hospital’s ‘honoured to care’ H culture. ■ Nominated by Wendy Punchard, Patient Care Manager, Palliative and Complex Continuing Care, Markham Stouffville Hospitalxxx www.hospitalnews.com
Thank you nurses... for everything you do! I started my career very young, becoming a registered nurse at the age of 19. I immediately loved it. As a nurse you’re immediately thrust into a personal relationship with patients and their families; it’s a privilege to be part of people’s lives in this way. Along with fellow providers, nurses are there, putting patients and clients ﬁrst. Whether they work in hospitals, in long-term care, in patients’ homes or other settings – they are leaders in our healthcare system. And while our nurses, like many professionals, are being challenged, each of you are stepping forward and working together to control the effects of COVID-19. From all of us at HIROC, we would like to say how incredibly thankful we are for nurses across Canada. We are here to support you in responding to the current crisis and whenever you may need us. Take care and stay safe. Catherine Gaulton Chief Executive Officer, HIROC
PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
NURSING HERO CONTEST 2020
Technology Should Help Nurses, Not Hinder:
A New Approach to Bedside Video Chat
Even before the COVID-19 pandemic hit, nurses were stretched thin. Now, with isolation measures in place, a new task has landed on many nurses’ plates: helping patients virtually visit with their family and friends at home. Without good hospital-based solutions, nurses are being relied on to help patients charge tablets, set up video chat accounts, troubleshoot issues and generally act as bedside tech support. This can be particularly `vwVÕÌi`vviÃVi>ÀÃÜ iÀiÃ>Þ}}`LÞiÌÛi`iÃÃÃ important, yet technology is challenging to navigate. At HeathHub, we’ve heard these challenges and we’ve responded by developing a new bedside video chat solution called myHealthHub Connections. Our easy-to-use video chat requires no account creation and no downloads. It’s delivered at the bedside on accessible, hospitalgrade touchscreen devices that have no trip hazards. And it’s designed Ã«iVwV>Þ vÀ ÕÃi >>`> Ã«Ì>Ã° / >Ì i>Ã ÕÀÃiÃ V> vVÕÃ on nursing and patients can gain more freedom. While nurses are busy changing lives, we’re trying to make theirs a bit easier.
Learn more at www.healthhubsolutions.ca/covid-solutions 44 HOSPITAL NEWS JULY 2020
Geriatric Service Nurses Centre for Addiction and Mental Health e enthusiastically submit a nomination for the 15th Annual Hospital News Nursing Hero Awards, in recognition of both the inpatient and outpatient nurses in Geriatric Service at the Centre for Addiction and Mental Health (CAMH). There is a total of 52 part time and fulltime nurses that demonstrate a commitment to patient care day in and day out in the Geriatric service. This team of nurses provide care to some of CAMH’s most vulnerable and psychiatrically and medically complex patients. Our geriatric patients have the highest mortality risk associated with COVID-19. The nursing team went
above and beyond their duty by putting their expert clinical skills into high gear to ensure our patients were safe, connected to family and community, and were staying active during the crisis. One of our geriatric inpatient units was the first to present with COVID-19 cases in the hospital. While it was the collaborative effort of the entire clinical team to get through this wave of the pandemic, it was the 24/7 presence and intense work put forth by the nurses, that contributed to our unit becoming COVID-19 free after only a few weeks with a mortality rate much lower than in similar geriatric settings. The team not only carried out their regular nursing duties, but also www.hospitalnews.com
bration, and family and friends were so appreciative of the effort put forth by the nursing team to engage the patient and recognize his birthday during this trying time. This nursing team is a highly trained and skilled group of individuals. This was more evident than ever over the last several months. The nurses pulled on both their psychiatric and medical expertise to provide stellar care to all patients, but more specifically to one palliative patient. The geriatric nurses were able to provide this patient with holistic and compassionate care at the end of his life by making his death comfortable and dignified. In this patient’s final days, he was surrounded and cared for by staff who had known him for many years and were able to provide compassionate patient centered care in his last moments. Our outpatient nurses put in tremendous effort to adapt to vir-
HM took time to plan events and make a stressful time a little less stressful. The team worked together to celebrate and acknowledge milestones for our patients. As you can imagine celebrating a birthday while in hospital may be difficult, but in hospital during a pandemic makes it extra difficult. One of our patients celebrated a birthday in
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the midst of the pandemic, the clinical team collaborated to organize a socially distanced birthday party for the patient. The party was held outside on the enclosed patio with family and friends joining to celebrate with the patient and team through Skype. The patient thoroughly enjoyed the cele-
tual ways of providing care to our long-term care partners, who were especially devastated during the pandemic by ensuring their patients were safe and cared for in the community. The outpatient nursing team also stepped-up to provide support to their inpatient colleagues when staffing on the units was challenging during the pandemic. The compassion, optimism and kindness of the nurses working in the Geriatric Service does not go unnoticed. The nursing team provides outstanding care and approaches their work with amazing amounts of empathy and energy. With all of this in mind, we whole-heartedly support the Geriatric nursing team in the nominaH tion for the Nursing Hero Award. ■ Sincerely, Dr. Ariel Graff – Inpatient Medical Head, Kim Johnston – Clinical Director, Rong Ting – Senior Manager, Dr. Tarek Rajji – Chief, Yifan Zhang – Clinical Operations Coordination Leader
Thank You Nurses While you’re changing lives, we’re trying to make yours a bit easier. Bedside patient engagement solutions to keep patients connected, informed and entertained. So nurses can focus on what they do best.
NURSING HERO CONTEST 2020
Linda Liu t is with great pleasure and enthusiasm that we would like to collectively nominate Linda Liu RN for the Hospital News Nursing Hero Award. We have had the privilege of working with Linda since January 2019, when she came onboard as the Clinical Nurse Specialist (CNS) on the Consultation-Liaison (CL) Psychiatry Team at the University Health Network’s Toronto General Hospital (TGH). The Consultation-Liaison Psychiatry Team provides psychiatric care and mental health support in complex, medically ill populations. In her advanced practice nursing role, Linda provides mental health support to patients, supports teams across TGH on a consultation basis, and educates staff on mental health literacy. The role of the CNS within the team is an integral one and Linda has quickly become a highly valued member of our team. We believe that she is an exceptional candidate for this important award for the reasons highlighted below. Linda’s role on the CL Psychiatry Team involves working with patients who are experiencing complex medical and psychiatric needs. Linda is an exceptional team member and consistently demonstrates fair, thorough and balanced assessments. She communicates her impression to the team in a clear and succinct way during our multidisciplinary meetings. While she is highly collaborative, she does not shy away from advocating for patients when she believes that important factors are being overlooked. She has cultivated strong working relationships with other services, which has been essential when advocating for patients and communicating treatment plans. She is a strong advocate for patients with psychiatric illness and addiction, a population that is often stigmatized and disadvantaged within conventional medical settings. This dedication to vulnerable popula-
University Health Network
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46 HOSPITAL NEWS JULY 2020
tions leads to improved patient-centred outcomes and promotes equitable access to healthcare resources. Linda is passionate about supporting vulnerable patients and advocating for their mental health needs. This is reflected daily in her attendance at family meetings, nursing team huddles, and in the incredibly comprehensive and thorough care plans she develops for patients. These care plans are collaboratively developed with patients, families and caregivers, and reflect a patient’s preferences, communication needs, and coping styles. They are invaluable resources for medical teams, primary nurses and allied health team members, all of whom provide daily care. Additionally, Linda consistently models the need for patient autonomy and patient-centred care during code whites and when leading staff debriefs following challenging staff-patient interactions. Linda’s dedication to patient-centred care is also exemplified by how
effective she is at connecting patients with needed supports. While this has always been an important part of her role, this has been amplified during the COVID-19 pandemic and the necessary, albeit challenging, limitation on hospital visitors. She has consistently been able to identify creative methods for patients and families to remain connected during this most difficult time. Unsurprisingly, COVID-19 has also revealed the need for ongoing mental health support post-discharge, and Linda has helped patients navigate this process so that their discharge from hospital is seamless with a swift uptake of mental health resources. There have also been innumerable occasions during the COVID-19 pandemic, when she has been called on to provide brief, safe, non-stigmatizing mental health support to colleagues, subsequently connecting them with more formal mental health resources and supports as wanted or needed.
On a more personal note, Linda is funny, kind, compassionate and an absolute pleasure to work with. Despite the inherent challenges of working with such a complex patient population, she maintains a positive approach to the work and sets a new standard for excellence every day. It is such a privilege for us to work with her and learn from her. On behalf of the Consultation-Liaison Psychiatry team at the Toronto General Hospital, we unanimously believe her to be highly deserving of this award. We thank you for your consideration and look forH ward to hearing from you. ■ Nominated by, Dr. Susan Abbey – Psychiatrist-in-Chief, UHN, Dr. Adrienne Tan – Psychiatrist, Medical Director of the Medical Psychiatry Program, UHN, Dr. Rima Styra – Psychiatrist, Dr. Carla Garcia – Psychiatrist, Dr. Kathleen Sheehan – Psychiatrist, Dr. Noha Abdel Gawad – Psychiatrist, Shannon Wright – Nurse Practitioner www.hospitalnews.com
Thank You! From Trillium Health Partners
Thank you to the 4,100 Nurses at Trillium Health Partners for your unwavering commitment to providing exceptional care for the patients, their families and the community we serve. Trillium Health Partnersâ€™ Nurses would like to acknowledge and thank all members of the interprofessional team, all health care workers and the community for their ongoing support and partnership as we provide safe, compassionate and high-quality care at all times and during the current COVID-19 pandemic.
A pandemic of
grief By Shelly Cory and Danielle Saj ever in our lifetimes has Canada experienced the volume and complexity of grief as has resulted from the COVID-19 pandemic. Canadians have been robbed of goodbyes with dying relatives and forced to grieve in isolation without funeral rites. People working in healthcare report little acknowledgement of or support for their work-related grief and trauma as they manage the complexities of putting themselves and their families at risk, while supporting the health and emotional needs of seriously ill and dying patients and families separated by public health restrictions to contain the virus. The pandemic has contributed to a complex experience of grief as a result of deaths and other significant losses, including jobs, financial security, business failures and “life as we know it.” “The process of dying is being distorted, and what we can expect then, is the process of grieving is going to be distorted,” says Dr. Harvey Max Chochinov, Psychiatrist and distinguished professor at the University of Manitoba. As a result, an increasing number of Canadians will require support. However, existing grief services are fragmented, under-funded and insufficient to meet the volume of need. Organizations providing grief services are reporting significant increases in requests for grief supports while donations to fund these services are plummeting due to the economic pressures Canadians are facing. Those looking to access services must overcome barriers such as long waitlists, geographic limitations, and financial insecurity. The challenge of
accessing grief services is more pronounced for Indigenous Peoples, those living in rural and remote areas, immigrants and refugees, children and youth, Francophones, the precariously housed and those in the corrections system. Left unaddressed, prolonged, complicated grief heightens the risk of depression and the risk of suicide. “This is the hidden tragedy in the current crisis, but one that will also have long term implications for many individual Canadians as well as our health care systems and the economy,” says Paul Adams, spokesperson for the Alliance. “Many people are now facing the deaths of loved ones, isolated from networks of family and friends that normally help people get through such heart-wrenching moments in their lives. Unless we step up and help people now, we will be dealing with the human toll for many years to come.” For these reasons, the newly formed Canadian Grief Alliance – a coalition of national leaders in grief and bereavement convened by the Canadian Virtual Hospice – is urging the Government of Canada to bolster the country’s grief services to meet the growing demand. Existing and recently announced mental health initiatives do not include grief services. The Alliance is asking the Federal Government to invest $100 million in sustaining and expanding grief services over the next three years and $10 million in research to guide responses to pandemic-related grief. The Canadian Grief Alliance’s priorities include: • Developing a consultation-driven National Grief Strategy to focus investment to maximize access to grief services.
THE PANDEMIC HAS CONTRIBUTED TO A COMPLEX EXPERIENCE OF GRIEF AS A RESULT OF DEATHS AND OTHER SIGNIFICANT LOSSES, INCLUDING JOBS, FINANCIAL SECURITY, BUSINESS FAILURES AND “LIFE AS WE KNOW IT. • Sustaining and expanding existing grief services and resources with tailored resources for Indigenous Peoples, children and youth, seniors and other populations with specific needs. • Access to specialized grief supports for front-line healthcare workers and first responders suffering grief-related work trauma. • A public awareness campaign to increase understanding of grief, healthy coping strategies and existing resources like MyGrief.ca and KidsGrief.ca. • Rapidly scaling up research capacity to better equip health providers, communities and the country to better respond to the evolving, long-term grief and bereavement needs posed and amplified by the pandemic.
The proposal was submitted to federal Minister of Health Patty Hajdu and to the Prime Minister on May 12 and discussions with Health Canada have commenced. The Alliance has been encouraging Canadians to send a strong signal to the government that supporting grieving Canadians should be a priority. To date 750 organizations and individuals have signed on to support the proposal. The goal is to reach 1,000 sign ups. To read the proposal or sign up to support the initiative go to www.virtualhospice.ca and follow the prompts. “We are stronger together. It is critical that we have supports in place for Canadians who are hurting in these unprecedented times and that we are supporting people working in health care with the grief they may be expeH riencing. It’s the right thing to do. ■
Shelly Cory is Executive Director of the Canadians Virtual Hospice. 48 HOSPITAL NEWS JULY 2020
Local COVID-19 patients have
better ICU outcomes By Deana Lancaster he overall mortality rate for COVID-19 patients admitted to intensive care units (ICUs) across the Lower Mainland during the first peak of infection was significantly lower than in other regions around the world, finds a new study. The case series, published in the CMAJ (Canadian Medical Association Journal), tracked the outcomes of 117 patients with COVID-19 admitted to six intensive care units in Metro Vancouver between Feb. 21 and April 14. As of May 5, 85 per cent of the patients were recovered or still recovering, and 61 per cent had been discharged home. Researchers compared the overall mortality rate of 15 per cent for patients in ICUs at Vancouver General Hospital, Surrey Memorial Hospital, Lions Gate Hospital, St. Paul’s Hospital, Royal Columbian Hospital and Richmond Hospital with those from previous case series which had recorded mortality rates as high as 62 per cent for patients in intensive care in Wuhan, China; 50 per cent in Seattle, Washington; 26 per cent in Lombardy, Italy; and 23 per cent in New York. Patients in the local study had similar demographics and severity of illness as patients in the Lombardy, Seattle, New York, and Wuhan case series, noted the authors. Also similar were the critical care interventions used in each region, which included mechanical ventilation, prone ventilation, and high-flow oxygen therapy. One notable difference though, was the ready capacity in our intensive care units, says Dr. Donald Griesdale, senior author of the study, critical care physician at Vancouver General Hospital, and associate professor at UBC’s Faculty of Medicine. “We did not get overwhelmed by a surge of patients with COVID-19 as they did in other parts of the world,” he says. “We had
The COVID-19 unit at Vancouver General Hospital.
“THIS STUDY DOESN’T DETERMINE THE CAUSE OF THE OUTCOMES, BUT WE DO KNOW THAT EVEN IN THE ABSENCE OF A PANDEMIC, GREATER CAPACITY STRAIN AT THE TIME OF ICU ADMISSION CAN LEAD TO INCREASED MORTALITY,” the capacity to ensure that all patients with COVID-19 had access to critical care if they needed it – we didn’t have to make choices about who should go into the ICU.” That capacity was made available in mid-March, before our local surge of patients, by cancelling non-urgent and elective surgeries and by increasing the number of available ICU beds in Metro Vancouver COVID-19 centers. Local health authorities were propelled to early action after Canada’s third case was reported in the
Vancouver Coastal Health region on Jan. 28, followed by the country’s first outbreak, and then first death, in early March. “It was all hands on deck,” says Dr. Anish Mitra, a critical care physician at Surrey Memorial Hospital, and cofirst author on the study along with VCH researcher Nicholas Fergusson. “There was no opportunity for complacency.” According to the study, about 40 per cent of local patients were admitted to an ICU on a daily basis, com-
pared to the New York case series, for example, in which 22 per cent of COVID-19 patients were admitted to the ICU at some point in their treatment. “This study doesn’t determine the cause of the outcomes, but we do know that even in the absence of a pandemic, greater capacity strain at the time of ICU admission can lead to increased mortality,” says Mitra. Perhaps even more important, Griesdale said, were the actions taken by the larger community to flatten the curve and prevent a surge of critically ill patients from overwhelming our hospitals and ICUs. “It reflects the strong leadership we have in Public Health, at the provincial level from Health Minister Adrian Dix and Dr. Bonnie Henry; and in our own health authorities, by Dr. Patricia Daly in VCH, and Dr. Martin Lavoie at Fraser Health. People listened and did their part by staying home and practicing social distancing as they were asked to. Those collective actions by everyone didn’t just flatten the curve, they saved lives.” VCH is responsible for the delivery of $3.6 billion in community, hospital and long-term care to more than one million people in communities including Richmond, Vancouver, the North Shore, Sunshine Coast, Sea to Sky corridor, Powell River, Bella Bella and Bella Coola. VCHw also provides specialized care and services for people throughout BC, and is the province’s hub of health care education and research. Fraser Health is responsible for the delivery of hospital and community-based health services to over 1.8 million people in 20 diverse communities from Burnaby to Fraser Canyon on the traditional territories of the Coast Salish peoples. Our team of nearly 40,000 staff, medical staff and volunteers is dedicated to serving our patients, families and communities to deliver on our vision: Better health, H best in health care. ■
Deana Lancaster is the Communications Leader at Vancouver Coastal Health. www.hospitalnews.com
JULY 2020 HOSPITAL NEWS 49
Natural Health Products: A potential or hidden culprit of drug interactions By Christy Mak, Angela Chen, and Certina Ho ore than 70 per cent of Canadians have used natural health products (NHPs) such as herbs, vitamins, minerals, and homeopathic medicines, which are commonly available in community pharmacies and are regulated by Health Canada. According to a survey conducted by researchers in British Columbia between July 2016 and June 2017, consumers typically use NHPs for minor ailments and chronic health conditions. While NHPs are available without a prescription, this does not mean that they are risk-free and absolutely safe for all. In fact, 12 per cent of Canadians report that they have experienced unwanted side effects from the use of NHPs. Many consumers do not ask their healthcare providers about adverse consequences that NHPs may cause. Therefore, clear communication between healthcare providers and consumers is important to identify potential drug therapy problems and prevent harmful drug-NHP interactions. As the go-to healthcare professionals for medication therapy management, pharmacists should educate patients, as well as other healthcare providers, the proper use and selection of NHPs, advise on potential sides effects and interactions pertaining to NHPs, and be vigilant in reporting suspected adverse events involving NHPs to Health Canada. NHPs may interact with prescription drugs or with another NHP. For example, they may change the way prescription medications are metabolized and affect how they are absorbed, which may then increase or decrease the drug concentrations in the body. Some NHPs are more commonly used than others. St. John’s Wort is a herbal supplement commonly used for treating depressive disorders. Side effects of St. John’s Wort are generally mild, including upset stomach, dry mouth, headache, fatigue and dizziness. How-
TO AVOID POTENTIAL DRUG-NHP INTERACTIONS, HEALTHCARE PROVIDERS SHOULD BE COMPREHENSIVE IN INFORMATION GATHERING AND ASK PATIENTS ABOUT THEIR NHP USE. ever, St. John’s Wort can affect prescription drug metabolism by inducing liver enzymes in the body, which may cause significant drug-NHP interactions with certain classes of antidepressants. Other common drug interactions with St. John’s Wort include oral contraceptives, certain oral chemotherapy and medications for HIV/ AIDS. St. John’s Wort may reduce the efficacy of these medications and lead to treatment failure. Vitamins and minerals are the most often purchased NHPs by Canadians. Vitamin D and calcium are commonly recommended for adults for osteopo-
rosis prevention; and folic acid is recommended for women of reproductive age to prevent neural tube defects in fetuses. Multivitamins and minerals can also be used to treat deficiencies, poor nutrition, and digestive disorders. Similar to St. John’s Wort, they may cause mild side effects, such as upset stomach and headache. However, some vitamins and minerals are associated with potentially serious interactions with prescription medications. Minerals such as iron, calcium, aluminum, and magnesium may reduce the absorption of some antibiotics, resulting in decreased efficacy and in-
adequate treatment of the infection; they may also decrease the effects of levothyroxine by interfering with its absorption in the body if taken in close proximity. To avoid potential drug-NHP interactions, healthcare providers should be comprehensive in information gathering and ask patients about their NHP use. Health professionals should also be aware of the risks and benefits of NHPs and be ready to discuss these considerations with patients. If in doubt, check with the pharmacist. Below are some key points regarding the proper use and selection of NHPs that healthcare providers and patients should be aware of: • Look for licensed NHPs (i.e. the eight-digit Natural Product Number (NPN) or Homeopathic Medicine Number (DIN-HM) on the product label) that have been reviewed by Health Canada and deemed to be safe and effective under their recommended conditions of use. • Consult a pharmacist before buying and consuming any NHPs. • Inform healthcare providers in the patient’s circle of care regarding the use of other medications, over-thecounter drugs, and NHPs. Although NHPs do not require a prescription, they could cause side effects and interact with patient’s other medications. • Manage/monitor medication therapy and the use of NHPs to avoid interactions. • Report adverse reactions associated with NHPs to Health Canada at https://www.canada.ca/ en/health-canada/services/drugshealth-products/medeffect-canada/ adverse-reaction-reporting.html. If Canadians are educated on the above considerations for the use of NHPs, they can safely experience their benefits while avoiding adverse reacH tions and interactions. ■
Christy Mak and Angela Chen are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto. 50 HOSPITAL NEWS JULY 2020
Evidence on COVID-19: Finding credible information in an evolving situation By Barbara Greenwood Dufour he internet is a popular resource for Canadians looking for health information. During the COVID-19 pandemic, this is no less so. However, the risks of encountering incorrect information about COVID-19 may be greater. Because it’s a new disease, we know less about it than we do about other illnesses. And in this information void, misinformation can thrive. Health misinformation spreads quickly on the internet, and so can its negative consequences. Stories about unproven COVID-19 treatments can lead people to misuse drugs and other therapies, inadvertently harming themselves or others. False narratives about the pandemic, such as conspiracy theories, can cause undue panic. And because misinformation is often presented in uniquely persuasive ways, it can erode people’s trust in the credible sources of information it contradicts.
WHERE TO FIND CREDIBLE INFORMATION ABOUT COVID-19 ON THE INTERNET
There are several reliable websites where you can find credible health information. One is the CADTH COVID-19 web portal – covid.cadth. ca. CADTH is an independent, evidence-based agency that finds, assesses, and summarizes the research on drugs, medical devices, and procedures. In response to the COVID-19 pandemic, CADTH launched this web portal to provide access to trustworthy information about COVID-19. Here you can find a growing number of freely accessible CADTH evidence reviews as well as web-based resources from other trusted organizations. CADTH recently posted the following reports on COVID-19, and these are just a few highlights from the web portal. Please note that any key findings presented here are
THIS HANDOUT PROVIDES TIPS AND RESOURCES TO HELP ANYONE CRITICALLY APPRAISE HEALTH INFORMATION THEY FIND ON THE INTERNET. accurate at the time of writing this article. The information on the site is being updated daily to reflect the rapidly changing and growing state of the international scientific evidence related to COVID-19: • a review of antibody-based serological tests for COVID-19 to assess how well they perform and what their clinical role might be (which is unclear) • a review of the antiviral drug remdesivir for patients with COVID-19 (which, is not approved in Canada and access to it is limited to clinical trials) • an update of its review of chloroquine and hydroxychloroquine for COVID-19 (there is uncertainty regarding the clinical benefit of using these drug regimens for COVID-19) • a briefing note on the use of contact tracing apps as a public health tool to contain the spread of COVID-19.
HOW TO ASSESS OTHER WEB-BASED INFORMATION THAT YOU FIND
Even if you get your COVID-19-related information only from trustworthy websites, it’s nearly impossible to avoid coming across content from questionable sources. There are many false or misleading claims online that, for example, certain herbal remedies, vitamins, household products, or medicines can cure or protect against COVID-19. Whether you are finding information yourself or it’s being shared with you by a family member, a colleague, or a patient, there are things you can look for to assess the credibility of the content. A few years ago, CADTH developed its Evaluating the Credibility of Health Websites: Can You Trust Dr. Google? handout. This handout provides tips and resources to help anyone critically appraise health information
they find on the internet. It includes a list of criteria to look for as well as red flags that could indicate a website is providing unreliable information. It was developed for a broad audience – all health care decision-makers – from members of the public to clinicians. So, it might be useful to health care providers who are having discussions with patients about COVID-19 information found on the internet. More recently, CADTH produced a new handout that incorporates elements of the earlier one. This handout – What You Should Know About Drug Treatments for COVID-19 – is intended for a lay audience, and it explains the risks of using unproven COVID-19 drug treatments. It was developed to help the public see through the hype about COVID-19, offer tips on how to assess the reliability of health information found on the internet, and provide a list of reliable websites that feature plain-language information on COVID-19. CADTH is committed to providing Canada’s health care decision-makers with reliable information during this challenging and uncertain time. Subscribe to the CADTH e-alert system – at cadth.ca/subscribe – to receive the CADTH Weekly COVID-19 Update, which lists the latest content that’s been posted on the CADTH COVID-19 web portal. All the documents posted on the portal, including those referred to in this article, are freely available. Publicly funded organizations responsible for health service delivery, clinical society stakeholders, and Canada’s ministries and departments of health can ask CADTH for a review of new COVID-19-related evidence by submitting a request at covid.cadth. ca/submit-a-request or by contacting their CADTH Liaison Officer. Visit cadth.ca to learn more about CADTH and follow us on Twitter @ H CADTH_ACMTS. ■
Barbara Greenwood Dufour is a knowledge mobilization officer at CADTH. www.hospitalnews.com
JULY 2020 HOSPITAL NEWS 51
St. Joseph’s Healthcare Hamilton has developed a homegrown solution to reduce the risk of COVID-19 transmission – protective hoods sewn by volunteers, which are used throughout the hospital during high-risk aerosol generating procedures.
A homegrown solution to PPE shortage By Elaine Mitropoulos n the face of a national PPE shortage, St. Joseph’s Healthcare Hamilton has developed a homegrown solution to reduce the risk of COVID-19 transmission – protective hoods sewn by volunteers, which are used throughout the hospital during high-risk aerosol generating procedures. As St. Joseph’s Healthcare Hamilton gradually resumes health-care services, including surgeries, registered nurse Linda Schouwstra designed and fabricated protective hoods for her colleagues to wear during emergency intubations and surgical procedures. A quilter in her spare time, Linda says she was prompted to make the protective hoods in early April, when
the projected shipment of PPE the hospital normally uses was delayed owing to the pandemic. “When we were running low on the product, someone asked, ‘do you think you can make something?’ I got up in the middle of the night – I couldn’t sleep – and made a template from some pumpkin fabric that I had in my sewing room,” Linda says. “It spiralled from there.” From respiratory therapy to anesthesia, the protective hoods are used widely at St. Joe’s, and Linda has shared the pattern with other hospitals in the community. Originally, Linda enlisted the sewing skills of her family and friends to make the first 300 hoods. She now has
an army of St. Joe’s volunteers who are sewing hundreds of hoods in their homes, before they are sterilized in hospital. Clyde Meldrum, a patient turned volunteer, is among the sewers. Normally, Clyde volunteers in the hospital’s outpatient pulmonary rehabilitation program. Over the course of the pandemic, however, Clyde – a former college professor – taught himself to sew with help from his wife. “I lay out the hoods from the rough material, my wife cuts them, and I sew them,” says Clyde, who drives to the hospital from his home in Oakland, Ontario, to pick up kits containing the material. “It’s something we can do to help the hospital, the staff, and pa-
tients – we’re thrilled to be involved.” The hoods are made from fabric used to wrap medical instrument sets. Once sewn, they are put through a sterilization process to mesh the fibres and make the hoods impervious. “With the use of surgical drape material, the hoods have been designed to provide excellent protection for head and neck and are, as an added bonus, very affordable. These hoods are impermeable to water, are easy to don and doff, and even come in two sizes,” says Dr. Janet Farrell, chief of anesthesia at St. Joe’s. “The hoods are now a standard part of our code blue protected anesthesiology equipment. With adversity comes H invention!” ■
Elaine Mitropoulos works in Public Affairs at St. Joseph’s Healthcare Hamilton. 52 HOSPITAL NEWS JULY 2020
Hydroxychloroquine not effective
in preventing the development of COVID-19 when used as post-exposure prophylaxis new study suggests that hydroxychloroquine is not effective in preventing the development of COVID-19 in individuals exposed to SARS-CoV-2, the virus responsible for the disease. This is the main conclusion of the first double-blind, randomized, placebo-controlled trial of hydroxychloroquine for disease prevention to be completed. Coordinated with a large study led by Dr. David Boulware at the University of Minnesota, this clinical trial was led in Canada by Drs. Todd Lee and Emily G. McDonald at the Research Institute of the McGill University Health Centre (RI-MUHC), in collaboration with partners at the Universities of Manitoba and Alberta. The results are published in the New England Journal of Medicine. “While we had hope this drug would work in this context, our study demonstrates that hydroxychloroquine is no better than placebo when used as post-exposure prophylaxis within 4 days of exposure to someone infected with the new coronavirus,” says Dr. Lee, Scientist at the RI-MUHC and Associate Professor of Medicine, Division of Infectious Diseases at McGill University and one of the lead authors of the study.
OVERALL, 107 OF 821 OF PARTICIPANTS DEVELOPED COVID-19. This trial included 821 asymptomatic adults with household or healthcare exposure to someone with confirmed COVID-19, who were enrolled nationwide in the United States and in the Canadian provinces of Quebec, Manitoba, and Alberta. Among them, 719 participants reported a high-risk exposure, of less than six feet (2 metres) for more than 10 minutes without one of the components of personal protective equipment (e.g. mask or face shield), to a confirmed COVID-19 contact. For the most part, they were healthy younger community dwelling adults (average age 40 years). Within four days of exposure, the participants received either placebo or hydroxychloroquine by commercial courier which were to be taken over five days, starting with a stronger dose on day 1. Investigators and participants were blinded to the treatment assignments, and an independent data and safety monitoring board (DSMB) externally reviewed the data.
“This is the gold standard method for this type of intervention,” says Dr. McDonald, Investigator at the RI-MUHC, Director of the MUHC Clinical Practice Assessment Unit and co-author of the study. “It is incredibly important that we complete randomized controlled trials so that we have the best available evidence for how to prevent the spread of COVID-19.” Overall, 107 of 821 of participants developed COVID-19 (either confirmed with a test or symptomatically compatible disease) over the 14 days of follow-up. Both confirmed cases and probable cases were included, due to some lack of availability of diagnostic testing in the United States. Amongst those who received hydroxychloroquine, 49 developed the disease (or compatible symptoms such as fever or cough), vs 58 in the group that received the placebo. Two patients were hospitalized, one in each group. No deaths occurred. Medication side effects like nausea and abdominal discomfort were more
common for patients taking hydroxychloroquine compared to placebo (40% vs. 17%), but no serious treatment-related adverse reactions were reported, including any heart arrhythmia. ‘’Our study’s results set politics aside and provide unbiased evidence to guide practice in the prevention of COVID-19 and reinforce the importance of randomized clinical trials as we work together nationally and internationally to combat the novel coronavirus,’’ says Dr. Ryan Zarychanski, Manitoba lead and Associate Professor of Internal medicine, Max Rady College of Medicine, University of Manitoba and Senior scientist, Research Institute in Oncology and Hematology. Canadian co-investigators include Matthew Cheng, Ilan Schwartz, Lauren MacKenzie, Glen Drobot, Nicole Marten, Lauren Kelly, and Sylvain Lother. More research is needed to determine whether hydroxychloroquine can be effective for the early treatment of COVID-19, and whether pre-exposure prophylaxis could be effective in highrisk populations. Various trials are ongoing worldwide, including in Canada (covid-19research.ca). At the MUHC, a trial looking at early treatment in the H community is underway. ■
Old drug, new tricks: How an existing medication could reduce the severity of COVID-19 esearchers around the world are looking to develop new drugs to battle the COVID-19 pandemic, but some existing medications are also getting attention for their role in potentially reducing the severity of disease. One such class of drugs includes those used to treat high blood pressure. The drugs – technically called angiotensin II type 1 receptor blockers or ARBs – have been shown in previous studies to mitigate the worst effects of respiratory infection and viral pneumonia. These preliminary results caught the eye of Dr. Jim Russell, a Professor in the Depart-
ment of Medicine at the University of British Columbia and Principal Investigator at the Centre for Heart Lung Innovation in St. Paul’s Hospital, who believes that these drugs may help prevent hospitalization, intensive care unit (ICU) admission, and death due to COVID-19. This does not mean, however, that anyone should start taking the drugs to prevent infection or to manage their symptoms if they get sick. Those previous studies were based on animal models, and Dr. Russell notes that there is almost no data on the effectiveness of this treatment in humans. His study is therefore an important one to build on
existing evidence and fill a crucial data gap. Unlike a new antiviral treatment that would stop the virus in its tracks, Dr. Russell and his team are working with the theory that ARBs could reduce the severity of COVID-19 by decreasing inflammation in vital organs, such as the heart, or by decreasing the injury caused by angiotensin II (the hormone the drugs are already designed to block). These are important components for recovery, as studies have already shown that COVID-19 increases the risk of acute cardiac injury (i.e., damage to heart tissue) and that angiotensin II is very elevated in
patients with COVID-19 – which is bad news because the hormone narrows blood vessels, potentially starving the heart, kidneys, and intestines of blood and oxygen. If ARBs can help reduce the likelihood of either of these outcomes, then the risk of death will decrease, as well. “There are many opinions about whether or not these cardiovascular drugs will help with COVID-19, but we won’t know for sure without any data,” says Dr. Russell, noting that his team is coordinating the study across 30 Canadian sites. “We hope that we can be the best study to answer the question about whether perH sonalized use of ARBs can work.” ■ JULY 2020 HOSPITAL NEWS 53
LONG-TERM CARE NEWS
Five digital healthcare innovators address COVID-19 and its impact on seniors By Arielle Townsend he global longevity sector has experienced major challenges due to COVID-19. Long-term care residents, hospital staff, and older adults with underlying health complications continue to be among those most impacted by the pandemic in Canada and around the world . Digital healthcare innovators across the country are responding to these challenges by leveraging their solutions to address the immediate needs of seniors and their caregivers, as well as the longterm effects of the virus on senior care. Below are some of these innovators and their solutions, which vary from virtual clinician-support systems, to products helping seniors communicate with family members, and remote patient monitoring platforms. By offering real-time solutions, these innovations demonstrate the importance of flexible, digitally-driven healthcare resources that can evolve to meet the needs of older adults and their circle of care, both during the present health crisis and beyond.
CareStory empowers caregivers and family members to provide person-centred care to older adults. By using a QR code, the app captures a resident’s personalized care needs, for example, their medication or the type of music that calms them when agitated. “This gives caregivers lots of support,” says Bill Dai, President of Emersewell, the company that developed CareStory with Baycrest. “It can reduce onboarding cost, time, caregiver turnover rate, number of responsive behaviours by residents, and use of sedatives.” This app will be especially helpful to new staff and volunteers coming in to provide extra support to long-term care facilities during COVID-19. By supplying real-time updates on the unique needs of residents, the app will allow staff to provide quality care and reduce the burden of their workload.
The app will also give family members peace of mind, knowing that they can contribute to the care of their loved ones while observing physical distancing protocols. To further support long-term care centres during this time, CareStory is being offered for free to the first 10 centres to sign-up for the app. Contact firstname.lastname@example.org to learn more.
Careteam brings together patients, their personal support teams and healthcare professionals through a collaboration platform that focuses on person-centred care. The platform, which was developed and tested with support from CABHI’s I2P2 program, is based around a shared care plan and secure communication. As part of its COVID-19 response, Careteam
can triage COVID-related cases and provide tailored information, remote check-ins, and follow-ups. For example, if a patient has been tested or told to self-isolate due to risk of exposure, Careteam will provide follow-up care instructions specific to their situation and set up virtual check-in appointments with their care providers. “Through Careteam we are able to make sure that a person’s COVID-19 status is being updated, while also making sure that their regular health needs are being addressed so they don’t end up with deteriorating health,” says Careteam Chief Commercial Officer, Jeremy Smith.
Curiato’s patient monitoring platform aims to reduce caregiver burden and improve safety measures for
front-line staff. Powered by a thin, flexible smart bed cover, the platform transforms any surface into a monitoring system, one with the capacity to collect actionable health information such as temperature, moisture and pressure. Curiato also plans to adapt their platform to detect for thermal stress (extreme changes in skin temperature), a known indicator for worsening conditions brought on by viruses like COVID-19. Dean Sas, Curiato’s Chief Business & Financial Officer, believes the system can build capacity in the healthcare system and prevent exposure to the virus by allowing staff to remotely monitor patients. “The technology we’re developing with support from CABHI can reduce the frequency of direct contact procedures with the patients,” says Sas. Continued on page 57
Arielle Townsend is a Marketing & Communications Content Specialist at the Centre for Aging + Brain Health Innovation (CABHI). 54 HOSPITAL NEWS JULY 2020
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LONG-TERM CARE NEWS
The human face of care aides in Canada By Carole A. Estabrooks and Janice Keefe here will be many heroes in the coming months, some already rising to the challenge of COVID-19, including nurses, doctors, paramedics and hospital cleaners, as well as delivery drivers, grocery store workers and warehouse staff. But there’s one critical occupation that is routinely forgotten when we champion the heroes: nursing home care aides who stayed when even their own lives and the lives of their families were put in danger. When they are remembered at all, they are mentioned in passing, as a homogenous block, without giving much thought to the real people they are, the work they do and the challenges and dangers they face – both before the crisis and now, during the pandemic. Care aides suffer along with families and residents when these older adults die, separated from family under difficult and sometimes unpleasant circumstances.
WHO ARE CARE AIDES AND WHAT DO THEY DO?
Care aides, also known as nurses’ aides, personal support workers or continuing care assistants, are the largest work force in long-term care homes in Canada, providing upwards of 90 per cent of direct care. Their role is central to the quality of care and quality of life of individuals living in long-term care homes. Now, their work is central to the survival of our most vulnerable population. Over 80 per cent of residents in Canadian nursing homes are now living with some kind of cognitive impairment (dementia). Many families often take on tasks like feeding, helping with mobility and engaging socially in the care homes, but because they can no longer visit, this puts even more onus on care aides to safeguard them. By nature, the work of care aides is intimate – it involves bathing, feeding
and toileting residents. They can’t practice the advised ‘social distancing.’ And yet, we also aren’t consistently giving them the personal protective equipment (PPE) they need to keep themselves safe. COVID-19 has hit nursing homes across the country hard with more than 600 nursing homes reporting COVID-19 cases and many reported COVID-19 related deaths – and these numbers rising daily. We’ve put care aides in a state of triple vulnerability: their work is more important than ever, yet they are working in understaffed conditions, and they are underpaid and underequipped to do it adequately – while also putting their own safety and that of their families at risk. The long-term care system is particularly susceptible to being overwhelmed right now because, as over
a decade of Translating Research in Elder Care research has shown us, it was running on zero margins before the COVID-19 crisis.
WHO’S HOLDING IT ALL TOGETHER?
TREC data collected across more than 90 long-term care homes in BC, Alberta, Saskatchewan and Manitoba, some of it collected for more than a decade reveal that he majority of care aides are women (90 per cent), over 40 years of age (67 per cent) and almost two-thirds (61 per cent) speak English as a second language. Thirty per cent of care aides work at more than one long-term care home simultaneously, in order to gain full time hours or earn a living wage. Most have worked 10 years on average as a care aide, about half of that time on the same unit.
Care aides consistently report higher levels of burnout and lower levels of mental health than the general population. They are regularly – before the pandemic – under work duress. Our study documented the frequency with which care aides in Canada, skipped or rushed essential care tasks on their last shift because they had insufficient time. Essential care tasks include things like taking residents for a walk, talking with residents, performing mouth care, toileting, bathing, feeding, dressing and preparing residents for sleep. More than 65 per cent of care aides reported rushing at least one essential care task and over 57 per cent of care aides reported missing at least one essential care task altogether on their last shift. COVID-19 is only revealing fault lines that already existed in long-term
Dr. Carole A. Estabrooks is Scientific Director of the pan-Canadian Translating Research in Elder Care (TREC) program and Professor & Canada Research Chair, Faculty of Nursing at the University of Alberta. Dr. Janice Keefe is Professor of Family Studies & Gerontology, the Lena Isabel Jodrey Chair in Gerontology and Director of the NS Centre on Aging at Mount Saint Vincent University. 56 HOSPITAL NEWS JULY 2020
LONG-TERM CARE NEWS
Digital healthcare innovators Continued from page 54
CARE AIDES, ALSO KNOWN AS NURSES’ AIDES, PERSONAL SUPPORT WORKERS OR CONTINUING CARE ASSISTANTS, ARE THE LARGEST WORK FORCE IN LONG-TERM CARE HOMES IN CANADA, PROVIDING UPWARDS OF 90 PER CENT OF DIRECT CARE. care. Now we must do everything we can to make sure we don’t put either our vulnerable seniors or our care aides at unnecessary risk. We need to protect our long-term care heroes now. We need to do everything in our power to immediately raise staffing levels in nursing homes to safe levels, no matter what it takes. We need to prioritize essential PPE to all care aides. Governments should also consider providing, as Quebec and BC have already done, ‘top up’ or ‘danger pay’ for care aides, recognizing the risks that they are incurring and ensuring they do not need to, as many do currently,
work in more than one care home or one job at once. We need to immediately begin planning for the mental health support that these essential workers will require in the aftermath of the pandemic’s first wave. We need to look at these short-term solutions carefully and ensure we do not have negative unintended longterm consequences for example, from the one workplace policy. If we do not intervene immediately to better support the front line in nursing homes, the outcomes will be far worse than they need to be – among both residents and this essential H workforce. ■
CABHI-supported GeriMedRisk is an interdisciplinary telemedicine consultation and education service for doctors, nurse practitioners and pharmacists in Ontario. Using telephone, fax and eConsult, clinicians receive a coordinated response to questions about optimizing medications, mental health and comorbidities in older adult patients from a team of geriatric specialists and pharmacists. Responding to the pandemic, GeriMedRisk has frequently updated their COVID-19 resources on the various experimental treatment methods available. Dr. Joanne Ho, creator of GeriMedRisk, says their geriatric drug information intends to help prevent adverse health outcomes caused by over-medication, drug interactions and harmful side effects. “Our hope is that we can make it easy and efficient for prescribers to refresh their knowledge about medications, and to become familiar with the drug interactions as it pertains to their older adult patients.”
CABHI-supported healthcare startup, MEMOTEXT, is leveraging its Ring of Support (RoS) system to act as an at-home healthcheck and COVID-19 screener for seniors. RoS is a personalized platform that uses automated phone calls and Amazon’s Alexa voice assistant to provide users with daily medication and event reminders. The voice assistant connects to virtual care provider, SE Health, so that a nurse can be dispatched in case of an emergency. Caregivers can also receive corresponding updates through their mobile device. MEMOTEXT Founder & President, Amos Adler, wanted to adapt the RoS system to help seniors access around-the-clock healthcare without risking exposure to the virus by visiting a hospital or doctor’s office. Since it was launched in early March, the RoS COVID-19 Rapid Response tool has been deployed in the homes of 18,000 H patients. ■
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LONG-TERM CARE NEWS
Dementia: Triaging lifesaving By Rosanne Meandro hen Burnaby resident Mario Gregorio was diagnosed with dementia 12 years ago, he was determined to continue to live a full life as long as he could. As a volunteer for the Alzheimer Society of Canada, Mario has educated thousands of people about dementia and helped write the Canadian Charter of Rights for People with Dementia in collaboration with the Societyâ€™s Advisory Group of people living with dementia. So, when the COVID-19 pandemic hit, and news started coming from Italy about doctors having to choose who got an ICU bed and who didnâ€™t, he got concerned. â€œPeople with dementia are lumped in together with seniors in long-term care,â€? he says, â€œso you are put on the bottom of the list.â€? Gregorio lives independently, like so many others who maintain a good
quality of life for years after a dementia diagnosis. But he knew that in a pandemic, when scarce resources had to be rationed, doctors might not take that into account, and not even consider people with dementia for critical care. â€œI thought, â€˜Oh, we better start thinking about it and talk about it because we donâ€™t want that to happen,â€™â€? he says. Unsurprisingly, the Alzheimer Society of Canada had the same idea. To help the medical community answer questions about how to treat people with dementia, the Society convened the COVID-19 and Dementia Task Force, a team of leading researchers, clinicians, and dementia specialists from across the country. Its goals: â€˘ to advocate for better care for Canadians living with dementia, â€˘ to reduce the stigma and discrimination against people living with dementia.
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The task force broke into teams that tackled a number of topics, including the question of how to allocate scarce resources in a pandemic. The objective was to help medical professionals make decisions in a crisis and make sure they would treat people with dementia with respect and fairness. With the rapid spread of COVID-19, doctors and hospital administrators needed help with contingency planning, says Dr. Eric Smith, Professor of Neurology at the University of Calgary and Hotchkiss Brain Institute, who chaired the team that looked at the question of allocation of resources. â€œWe thought through how you would evaluate someone with dementia, along with people with other health problems,â€? he says, â€œto determine who might be offered critical care, including mechanical ventilation, versus what patients may not be able to receive that kind of care.â€?
The committee came up with a set of guidelines for doctors that fit into three categories: 1. Treat each person who has dementia as an individual, without making assumptions about their degree of ability or their quality of life. This means recognizing that many people with dementia are living with good quality of life and should not be dismissed just because of their dementia diagnosis. People living with dementia have â€œa wide range of different abilities,â€? says Dr. Smith. â€œHealthcare professionals should not assume that just because someone has dementia, they are either very disabled or suffering from poor quality of life.â€? 2. Treat each person living with dementia with respect, be honest with them, and provide the best care you can. In other words, says Dr. Smith, â€œif someone with dementia needs care
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resources but is not able to receive it because the health system is overwhelmed, that person deserves an explanation – an honest explanation – and they deserve the best alternative care, which could be palliative care.” 3. Encourage people with dementia to let their doctors and caregivers know what kind of medical intervention they would like if they become seriously ill: whether or not they want to be resuscitated, put on a ventilator, etc. “It’s important to think through advance medical directives and wishes before someone becomes critically ill,” says Dr. Smith, “so that their wishes can be known.” Gregorio is also a member of the COVID-19 and Dementia Task Force. He says it’s critical for people living with dementia to speak up for themselves.
“We want to make sure that people with dementia are not left out,” he says. “Most of the articles I’ve read in the media assume that people with dementia are going to be excluded from medical care. This should not happen. Our rights are the same as those of any other citizens of Canada. We should not be put at the bottom of the list for treatment just because of our diagnosis.” Find out more about the COVID-19 and Dementia Task Force and its recommendations. Are you living with dementia or are caring for a family member with it? Alzheimer Societies across Canada are here for you. To find one near you, visit our website at alzheimer.ca. While there, check out our hub of COVID-19 resources to help you get through the H pandemic. ■
Rosanne Meandro is Director, Communications at the Alzheimer Society of Canada.
Care after hospitalization
about where to turn, how to cope and where to get help. can be an overwhelming process. Our goal is to ensure that feel most comfortable – home.
Support is just a phone call away.
JULY 2020 HOSPITAL NEWS 59
Researchers to test up to 10,000 Canadians for immunity to COVID-19 By Unity Health Toronto study led by Toronto researchers will be the first in Canada to use bloodbased antibody testing on a large, random sample of Canadians to better understand a critical question for policy makers: how long does immunity to COVID-19 last? The Action to Beat Coronavirus (Ab-C) study will track up to 10,000 Canadians over a six-month period in a collaboration between the Centre for Global Health Research at Unity Health Toronto, the University of Toronto and the Angus Reid Institute. The study will examine COVID-19 immunity levels over time. There is still only preliminary data on the antibody response that occurs after exposure to the novel Coronavirus. The implications are enormous, particularly as countries lift physical distancing measures and vaccine development continues. “This study will establish a national platform to assess interventions and progress, stand as a model for nationwide epidemiological studies, and inform public health decision-making and the general public,” says Dr. Prabhat Jha, director of the Centre for Global Health Research at St. Michael’s Hospital of Unity Health Toronto. The first phase of the study is underway: an online questionnaire will be sent to over 10,000 Canadians drawn from the Angus Reid Forum, a nationally representative panel of Canadians, to gather information about their COVID-19 experience and request permission for mailing a blood spot collection kit. Starting the first week in June, researchers will begin sending simple home kits to participants who agree to be tested. Participants are selected randomly, regardless if they have been exposed or not to COVID-19. They will self-administer a simple blood
The study will be the first in Canada to use blood-based antibody testing on a large, random sample of Canadians to better understand a critical question for policy makers: how long does immunity to COVID-19 last? collection and return to the laboratory at St. Michael’s Hospital of Unity Health Toronto. The study will use at least two Health Canada-approved antibody tests to monitor levels of antibody titres. Participants will be able to see their results if they choose. Phase one will the study will collect a national westimate of people infected, and in turn will inform the infection fatality rate. Four to six months later, a second round of questionnaires and antibody testing in the same individuals will provide information on ongoing transmission, changes in the immune status of the population and the durability of the immune response. “Retesting four to six months later will document the short and
medium-term immune profile of Canadian communities as well as ongoing transmission.” says Dr. Jha, who is also a professor of epidemiology at The Dalla Lana School of Public Health at the University of Toronto. “This collaboration furthers research on Covid 19 symptoms in Canada originally conducted by our Institute in early April,” says Dr. Angus Reid, chairman of the Angus Reid Institute. “This very large sample study will answer critical questions about how many Canadians have been infected including those who have been asymptomatic.” Canadians can find additional information on the study at AbCstudy.ca or by calling 1-833H TEST-ABC. ■
Dr. Prabhat Jha is involved in the Action to Beat Coronavirus (Ab-C) study that will track up to 10,000 Canadians over a sixmonth period.
This article was submitted by Unity Health Toronto. 60 HOSPITAL NEWS JULY 2020
Nutrition and type 2 diabetes prevention A
ccording to Diabetes Canada, in 2019 approximately 11 million Canadians were living with diabetes or prediabetes. This equates to approximately one in three Canadians. The Canadian Diabetes Cost Model predicts that by 2029 approximately 13 million Canadians will be living with diabetes or prediabetes. Expanding preventative approaches for diabetes is essential for maintaining and improving the quality and the sustainability of our health care system. An important component of diabetes prevention is nutrition.
PREVENTING TYPE 2 DIABETES THROUGH NUTRITION
Dietary change is an important part of preventing and managing diabetes, as even minor modifications can help reduce a person’s diabetes risk. One of the first steps in preventing the onset of this chronic disease is reflecting on how food choices may impact your diabetes risk. If you are a health care practitioner concerned that your patient may develop type 2 diabetes, have an open and non-judgmental discussion with your patient about their dietary intake. It is important to avoid demonizing foods and refrain from classifying foods as ‘good’ or ‘bad’ and instead look at the overall diet and the individual’s pattern of eating. A few different patterns of eating have been suggested for those looking to reduce their risk of developing chronic diseases, such as type 2 diabetes. Health Canada recommends Canadians follow the Canadian Food Guide, which emphasizes the consumption of vegetables and fruits, whole grains and lean protein sources. Two other patterns of eating highlighted by Diabetes Canada to help reduce risk is the DASH diet, and the Mediterranean diet. Nutrition Connections recently hosted a free webinar on the Mediterranean diet, where Registered Dietitians discussed the key aspects of the diet and its benefits on prevention and management of chronic diseases. One of the learnings from the webinar is the identification of “sometimes” foods. After discussing and focusing www.hospitalnews.com
on the pattern of eating, you may want to identify which foods are ‘sometimes’ foods. ‘Sometimes’ foods are highly processed foods, such as refined grains (i.e. white bread), sugary foods and sugary drinks. While these foods should be limited, if your patient wants
to have a treat occasionally there is nothing wrong with that! Being mindful and purposeful about occasionally enjoying “sometimes” food will help patients regulate their intake. It can also help them understand how these foods affect their blood sugar levels.
As part of the conversation, ask your patient if there are one or two dietary modifications they would like to set as a goal. One way to help your patient achieve their goals is to use a meal planning process. Continued on page 63
This article was submitted by Nutrition Connections.
‘Standing on the shoulders of giants’ For inspiration and encouragement during the pandemic, St. Joseph’s Health Care London staff and physicians are listening to “The Whisper of the Sisters.” By Dahlia Reich he COVID-19 pandemic has been an unprecedented time for health care providers around the globe, with historic challenges. But at St. Joseph’s Health Care London, trail blazers of long ago have helped guide the way. They are the pioneering Sisters of St. Joseph who laid an indomitable foundation of responding in times of great need – with respect, excellence and compassion. This legacy can be felt at all times within the walls of St. Joseph’s, but now it can also be heard. To offer inspiration and encouragement to staff and physicians during the pandemic, Dale Nikkel, Coordinator of Spiritual Care at St. Joseph’s, is connecting today’s care providers to the legacy of the Sisters through song. He wrote and recorded the The Whisper of the Sisters, which was recently shared across the organization. “The Sisters of St. Joseph faced contagious diseases at different times in their history,” says Nikkel. “Records show that back in 1899, there were times when one-third of the hospital beds were occupied by patients with typhoid fever – a significant epidemic at the turn of the century. They would also have provided care when the Spanish flu infected hundreds of thousands of Ontarians a century ago, spreading fear and panic. It’s a differ-
Painted rocks outside the hospital. ent time. And a different disease. But we follow the same spirit of togetherness and compassion today, ‘standing on the shoulders of giants’ to navigate these current challenges.” Nikkel has been writing songs for many years, performing in cafes, churches and folk clubs, using music as a form of expression and celebration. His musical outlet these days is playing guitar with his family bluegrass band with his wife and three children. In The Whisper of the Sisters, accompanied by historic as well as timely photos taken at St. Joseph’s, Nikkel reminds staff and physicians that strength and courage can be found in the spirit and “gentle whisper” of the Sisters.
If you let yourself be still, you can hear the gentle whisper of the voices of the Sisters, the Sisters of St. Joseph And they’re calling out our names Telling us to be the change And in trials that we face, They’re with us all the way “Now more than ever, all members of the St. Joseph’s family are living the values instilled by our founding Sisters of St. Joseph,” says Dr. Gillian Kernaghan, President and CEO of St. Joseph’s. “The Whisper of the Sisters is truly a moving and beautiful tribute to the Sisters and all who carry on their H work today.” ■
Dahlia Reich works in Communications and Public Affairs at St. Joseph’s Health Care London. JULY 2020 HOSPITAL NEWS 61
Trust and medical knowledge By Clair Baleshta he importance of medical knowledge is highly emphasized in our current healthcare system. Due to a focus on evidence-based medicine, we direct a considerable amount of attention to topics like research and empirical knowledge when it comes to treatment recommendations or other clinical practices. Unfortunately, the significance of this knowledge tends to overshadow the role that trust also plays in healthcare. Trusting relationships between care providers and patients can serve many important functions, but one aspect of trust that is not often discussed is the impact it has on our ability to produce and communicate the knowledge that we depend on in medical settings. Before discussing this specific function of trust, note once again that the
concept is often altogether overlooked in healthcare. Our focus on the importance of things like evidence, facts, and the provision of accurate information to patients can direct attention away from trust in clinical encounters. For example, if a patient refuses to consent to a highly recommended treatment, their clinician may assume that the patient is misinformed, does not comprehend the information being provided to them, or is simply acting irrationally (Hall et al. 2012, Goldenberg 2019). In many circumstances, however, a lack of trust may be just as relevant to the refusal as any other factor. To consider a more thorough example, suppose a patient was recommended insulin therapy for their diabetes. In response, the patient expressed a concern about becoming addicted to the medication. As this is a common myth
about insulin use (American Diabetes Association 2007), the clinician quickly dismissed the patient’s worry and instead asked them to sign a consent form for the treatment. The patient refused to consent, which the clinician viewed as entirely irrational. From the patient’s perspective, however, the clinician’s dismissal of their concern made them less trusting of the treatment recommendation. The patient’s fear of addiction, although seemingly ungrounded, was connected to genuine concerns about the disruption to their life that a dependency on insulin might cause. By disregarding their worry, it appeared to the patient that their clinician did not care about these underlying concerns related to their wellbeing. Ultimately, without being able to trust that the clinician had their best interest at heart, it was
difficult for the patient to accept any recommendations. To contrast this example, high levels of trust in healthcare settings have been associated with greater acceptance of recommended treatments as well as adherence to those treatments (Allinson 2016) . This notion of trust, generally speaking, refers to an assured reliance on the character, ability, strength or truth of someone or something (Merriam-Webster 2020). Trust also necessarily involves an element of risk; if we were already certain of someone’s truthfulness (for example), then it would not be needed in the first place. So, with trust comes a level of vulnerability (McLeod 2015). This requirement brings forth clear applications to healthcare, since the dependency of patients on care providers often necessitates trust (McLeod 2015).
Clair Baleshta is a Knowledge Integration graduate from the University of Waterloo and will be commencing her Masters in Philosophy at the University of Guelph in September 2020. 62 HOSPITAL NEWS JULY 2020
TRUST IS OFTEN REQUIRED FOR EVIDENCEBASED MEDICINE AND PRACTICES LIKE INFORMED CONSENT TO BE EFFECTIVE. Although understanding this need for trust might not be difficult in contexts where dependency is obvious, we all rely on trust far more in our daily lives than most of us recognize. Since no one person has the resources, time, or expertise to independently learn most facts about the world, much of our knowledge comes from trusting information provided to us by others (Hardwig 1991). If we did not trust in this way, we would not be able to know, for instance, that the earth is round or that certain countries exist (McLeod 2015). In fact, even much of our formal education system relies on trusting what our educators tell us. Similarly, trust is central to the production of knowledge in the medical sciences. This may seem counterintuitive, given that science is commonly viewed to be a highly skeptical and questioning field of study (Crease 2004). Yet, with dramatic increases to the specialization of experts in the discipline, along with the time-consuming nature of data collection and analysis, very rarely can one researcher carry out all aspects of a study on their own (Hardwig 1991). This is evident from the increasing commonality of large research teams and multi-author papers (Hardwig 1991). Trust in the knowledge and work of fellow experts is required for research collaboration to be effective, and it is also needed anytime new research builds on the previous work of others (Hardwig 1991). In this way, trust is necessary for the collection of empirical data and evidence that our healthcare system relies on. Recognizing that medical experts depend on trust may make it easier to see the relevance of the concept when applied to patient care as well. Trust is needed not just for the production of knowledge, but also for the communication and acceptance of it. Because of this, trust is often required for evidence-based medicine and practices like informed consent to be effective. When a patient does not adequately trust their care provider, recommendations carry far less weight. No amount of www.hospitalnews.com
data or evidence can improve this since the patient does not have faith in their source. A lack of trust may also pose challenges for the informed consent process, as it becomes far more difficult for patients to disclose information or ask questions if they do not trust their provider (Allinson 2016). Therefore, to ensure that scientific evidence is being effectively communicated, and that patients are genuinely informed about their options, attention must be paid to establishing trust. There are many ways that care providers, regardless of specialization, can increase their trustworthiness with patients. One way is for providers to take the time to recognize and address all patient concerns respectfully. The example of a patient refusing insulin therapy is meant to show that a loss of trust can occur when even seemingly ungrounded concerns are not recognized. Demonstrating reliability is another fundamental way to avoid diminishing trustworthiness as a care provider. Whether or not a provider follows through on commitments and behaves consistently in their relationships with patients greatly impacts their ability to retain trust. Also, taking extra steps to advocate for patients by facilitating processes or helping to connect them to resources is a very effective way to establish trustworthiness when possible. One thing that all of these points make clear is how building trusting relationships takes time (Fritz & Holton 2019). While this is a resource that care providers are often short on, doing the extra work upfront to establish trust with patients can actually save both time and resources in the long run (Goold 2002). But also note that, more than any of the specific trust-building strategies mentioned above, the most important part of establishing trust is simply paying attention to it. Just being cognizant of the role trust plays in healthcare will help providers notice opportunities for creating or maintaining it, as well as recognizing the times H when it must be improved. ■
Continued from page 61 Planning meals ahead of time will allow your patient to reflect on if they are eating in a way that will help them meet their goals and leave room to make changes as needed. As your patient experiments with making changes to their eating patterns, revisiting their goals will help you and your patient recognize achievements and identify challenges. These recommendations and guidance are not exhaustive and are an introduction on how you can help your patient prevent type 2 diabetes through nutrition intervention. For more detailed guidance on diabetes
prevention, treatment or maintenance refer your patient to a Registered Dietitian.
RESOURCES TO SUPPORT HEALTHCARE WORKERS
For 20 years, Nutrition Connections, key program of the Ontario Public Health Association (OPHA), has been providing nutrition and healthy eating services, including resources and tools to support diabetes prevention. Healthcare workers are invited to access free diabetes resources and more H by visiting nutritionconnections.ca. ■
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