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Inside: From the CEO’s Desk | Evidence Matters | Safe Medication | Ethics | Data Pulse

May 2018 Edition


Nursing heroes 2018 Page 30




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Contents May 2018 Edition


Surgical safety checklikst


▲ Nursing Heroes 2018


▲ Shorter wait times for breast reconstruction


▲ Living with cancer


COLUMNS Editorial ............................4 In brief .............................5 Data pulse ........................8 From the CEO’s desk .....18 Evidence matters ...........23 Safe medication ............60 Ethics .............................62

▲ Lung cancer research


Using technology to ease patients’ surgical journey


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Women’s work

Kristie Jones Advertising Representatives

Denise Hodgson

across every aspect of healthcare is largely invisible

By Ivy Lynn Bourgeault

ometimes an issue can be so pervasive that it is rendered nearly invisible. Take for instance the gender of the health workforce. Women comprise 82 per cent of health workers in Canada, in contrast to 47 per cent in the total labour force. This surpasses the global rate of 70 per cent. From 1997 to 2016, the health sector employment increased approximately 69 per cent, almost twice that of the Canadian labour force. The proportion of women working in that sector grew at a faster pace than that of men (72 per cent versus 55 per cent). Clearly the health sector is an important employment sector for women. Despite their numbers, women’s participation in the health sector is highly stratified. Women are less visible in leadership positions in healthcare. They lead fewer than 30 per cent of hospitals and other healthcare organizations. This is even lower in the more prestigious research intensive



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teaching hospitals.There are only five female CEOs of the 23 academic hospitals in Ontario. In professions where women are quickly becoming the majority, such as medicine, dentistry and pharmacy, only rarely do they occupy leadership positions. There are presently two female Deans of the 17 Canadian Faculties of Medicine (there have been three previously). Even in professions where women predominate, men disproportionately occupy leadership positions. Why? The lack of gender parity in health leadership positions can be attributed to both cultural assumptions about women’s leadership capability and to systemic gender barriers. A “glass ceiling” exists in healthcare just as it does in other sectors. The invisibility of the gendered nature of health work, where the skills and tasks of traditional female occupations are valued less than those of traditionally male occupations, also has implications for pay equity. Continued on page 5


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Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON

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Ontario Hospital Association ASSOCIATE PARTNERS:



EDITORIAL: May 7 ADVERTISING: Display – May 25 | Careers – May 29

EDITORIAL: June X ADVERTISING: Display – June 22 | Careers – June 26

Monthly Focus: Personalized Medicine/Volunteers and Fundraising/Health Promotion: Developments in the field of personalized medicine. Innovative approaches to fundraising and the role of volunteers in healthcare. Programs designed to promote wellness and prevent disease including public health initiatives, screening and hospital initiatives. + Special Focus: Hospital Pharmacy

Monthly Focus: Cardiovascular Care/Respirology/Diabetes/ Complementary Health: Developments in the prevention and treatment of vascular disease, including cardiac surgery, diagnostic and interventional procedures. Advances in treatment for various respiratory disorders, including asthma and allergies. Prevention, treatment and long-term management of diabetes and other endocrine disorders. Examination of complementary treatment approaches to various illnesses.

THANKS TO OUR ADVERTISERS Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News. 4 HOSPITAL NEWS MAY 2018

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ Canadian Publications mail sales product agreement number 42578518.


women’s work Continued from page 4

Opioid use IT’S CRITICAL WE USE GENDER TRANSFORMATIVE APPROACHES FOR THE HEALTH WORKFORCE IN CANADA The pay gap women experience in general is particularly notable in healthcare – 26 per cent. Because of women’s predominance in the health sector, eliminating the gender wage gap would have a profound impact on women’s economic empowerment more broadly. The highly gendered nature of health work also has implications for the invisibility of the endemic bullying, sexual harassment and violence experienced in the health workplace. Violence and harassment not only limits health workers’ abilities to undertake their work, it can silence their voices at leadership tables. A recent report by the Canadian Federation of Nurses Unions, Enough is Enough warns how violence in the health sector is increasing, caused by understaffing, inadequate security and increased patient numbers. Cutbacks in healthcare affect women workers disproportionately, but so too do investments. We are encouraged by the leadership of the federal government in taking a gender-based lens in its recent federal budget. We are asking for this to permeate to provincial and territorial investments into healthcare recognizing these are akin to infrastructure investments – that is, into the care infrastructure largely provided by women across the whole of the health workforce. Making the gendered nature of the health workforce visible is integral to

promoting gender equity, what is referred to globally as the gender-transformative change agenda. This aligns with the gender equity focus of Canada’s G7 Presidency. Many tools and guides that provide examples on how gender transformative policies and programming may be implemented are becoming available through the gender equity hub of the Global Health Workforce Network. These address discriminatory behaviors and patterns at various levels from pre-service education, to in-service training and mentoring, to policies at both the national, regional and/or district, institutional and community levels. The International Labor Organization, for example, has developed policies to address issues of sexual harassment, the gender pay gap, maternity leave and flexible working hours at both national and international levels. Comprehensive maternity and paternity leave structures across all health worker cadres, reserving a representative proportion of leadership roles for women and working exclusively with partners who show commitment to gender equity may prove to be effective starting points. There is a need for a fundamental shift in the way the health workforce is perceived, and in particular, women’s place within that health workforce. An explicit gender transformative apH proach in Canada is critical. ■

Ivy Lynn Bourgeault is CIHR Chair in Gender, Work and Health at the University of Ottawa and the lead of the Empowering Women Leaders in Health project. She is also an expert advisor with

linked to increased risk of falls, death in older adults ecent opioid use is associated with an increased risk of falls in older adults and an increased risk of death, found new research in CMAJ (Canadian Medical Association Journal). Falls are a leading cause of injury and death in older adults. However, evidence for a link between opioid use and falls is inconsistent. The study included data on 67 929 patients aged 65 and older who were admitted for injury to one of 57 trauma centres in the province of Quebec. The mean age of patients was 81 years, and the majority – 69% – were women. Falls were the most common cause of injury (92% of patients), and more than half (59%) had surgery for their injuries, with lengthy hospital stays (median stay of 12 days). Researchers looked at opioid prescriptions in the preceding two weeks before injury and found that the


patients who had filled an opioid prescription during this period were 2.4 times more likely to have had a fall causing injury. Patients whose falls were linked to opioid use were also more likely to die during their hospital stay. “This study confirms an association between recent opioid use and fall-related injury in a large trauma population of older adults,” writes Dr. Raoul Daoust, Hôpital du SacréCœur de Montréal and the Université de Montréal, Montreal, Quebec, with coauthors. “Physicians should be aware that prescribing opioids to older patients is not only associated with an increased risk of falls, but also, if these patients do fall, a higher in-hospital mortality rate,” conclude the authors. “Recent opioid use and fall-related injury among older patients with trauH ma” was published April 23, 2018. ■

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Six healthcare pioneers inducted into the Canadian Medical Hall of Fame DR. CHERYL ROCKMANGREENBERG O DR. VLADIMIR (WINNIPEG, MB): n Thursday, April 12th, six renowned medical pioneers were recognized as the 2018 Canadian Medical Hall of Fame Inductees at a special ceremony, hosted in partnership with the Schulich School of Medicine & Dentistry, Western University, including London’s own Dr. Vladimir Hachinski, one of the world’s leading neurologists who has changed survival odds for stroke sufferers everywhere.

notable achievements. As trailblazers in their respective fields, these experts underpin Canada’s role as a worldclass leader in medicine and health sciences. The 2018 CMHF Inductees are:


At the forefront of many battles for humane health care, Dr. Berger is a 40-year veteran of medicine and a tireless advocate for all people. Notably, in 2012 Dr. Berger co-founded Canadian Doctors for Refugee Care, coordinating nationwide protests on cuts to refugee health, eventually leading to the restoration of health coverage to 100,000 refugees.

presents scientific evidence about the dangers of excessive cleanliness.


He has transformed our understanding, diagnosis, treatment and prevention of the two greatest threats to the brain: stroke and dementia. Prior to the 1970s, stroke was untreatable. His eponymic Hachinski Ischemic Score (HIS) is now a standard for identifying the treatable components of dementia.

Dr. Rockman-Greenberg has devoted her career to bringing advanced medical knowledge and care to isolated and often vulnerable Indigenous populations. Working closely with the communities themselves, she developed diagnostic tests, screening programs, and treatments for disorders once poorly understood, improving the lives of generations of children and their families.

nity for dying patients. Dr. Mount is known for achieving the integration of palliative care as integral to humane health care. Future patients and their families will experience dignity and compassion facing some of their greatest challenges because of his vision.

the College of Physicians and Surgeons of Ontario in the 1880s, after being denied entry into medical school in Canada. In 1883, she spearheaded the creation of the Woman’s Medical College and later helped found the Toronto Women’s Literary Guild, Canada’s first H suffragette group. ■

INDUCTEES ARE INDIVIDUALS WHOSE DR. BALFOUR CONTRIBUTIONS THE LATE M. MOUNT HAVE LED TO DR. EMILY STOWE (MONTREAL, QC): (TORONTO, ON): EXTRAORDINARY Credited with coining the term DR. B. BRETT FINLAY As the first female physician to prac“palliative care,” Dr. Mount recogIMPROVEMENTS IN (VANCOUVER, BC): tice medicine in Canada, Dr. Stowe nized the need for special care to HUMAN HEALTH A Peter Wall Distinguished Profeswas eventually granted her license by alleviate suffering and enhance digCanadian Medical Hall of Fame (CMHF) Inductees are individuals whose contributions have led to extraordinary improvements in human health. Their work may be a single outstanding contribution or a career of

sor at the University of British Columbia, Dr. Finlay’s research in cellular microbiology has led to vaccines and treatments for drug-resistant infections. He is also known as the co-author of the provocative bestseller, Let Them Eat Dirt: Saving Your Child from An Oversanitized World, which

Joule boosts 3rd annual innovation grant program or the third consecutive year, Joule, a subsidiary of the Canadian Medical Association (CMA), is providing grant funding to drive physician-led innovation. In this round, Joule has upped the number of grants from five to nine and increased the purse from $150,000 to $200,000. The 2018 Innovation grant program seeks to provide funding to physicians, residents and medical students who are looking to develop or expand a project that provides a direct and positive impact on the lives of patients. Joule Innovation grant categories: Early-stage innovations (2 grants of $25,000): Open to early-stage ideas that have a credible business model


and proven feasibility; that have secured less than $500,000 in seed funding; that have less than $100,000 in annual revenue generated; and have less than three full-time employees. Seed-funding and revenue-generated does not include research and development funding or grant funding of any kind. These submissions may include product, service, technology or other innovations. Later stage and social innovation initiatives are not eligible. Later-stage innovations (1 grant of $25,000 and 1 of $80,000): This category is reserved for established initiatives – ones well on their way to building a successful business. These submissions have received seed funding greater than $500,000; are gener-

ating more than $100,000 in annual revenue; and have more than three full-time employees. Seed-funding and revenue-generated does not include research and development funding or grant funding of any kind. Initiatives may include a product, service, technology or other innovations. Early stage and social initiatives are not eligible. Social innovations (1 grant of $25,000): Open to early or later stage initiatives that address a societal problem in a manner that improves the status quo, and for which the primary value created is to health care as a whole. Applicants must be part of a not-for-profit initiative. Initiatives may include a product, service, process, model of care and/or policy.

Student and Resident grants (4 grants of $5,000): At Joule, we know that medical students and residents have no shortage of ideas – just time and money. All medical students and residents who do not receive an early-stage, late-stage or social innovation grant will be automatically assessed and the top applicants will be awarded one of four $5,000 grants – two to be awarded to students and two to residents. Interested candidates are invited to apply by submitting a 90-second video via the Joule app or at Sample videos are available on the app and website/innovation platform. The 2018 round of innovation grants opens April 20, 2018 and closes at midnight H on June 1, 2018. ■ MAY 2018 HOSPITAL NEWS 7


Wait gain: Canadians are waiting longer for some procedures

By Riley Denver

et’s face it – no one likes to wait. This is especially true when you or a loved one can’t receive immediate care, whether it’s making an appointment with your family doctor or receiving more urgent life-saving surgery. As part of an ongoing focus on wait times in Canada, the Canadian Institute for Health Information (CIHI) recently released updated wait time information for selected procedures in its Wait Times web tool. Most Canadians continue to receive hip fracture repair and radiation therapy within recommended wait times First, some encouraging news: approximately nine out of 10 Canadians received their hip fracture repair or radiation therapy within the recommended wait times in 2017. The benchmark wait time for hip fracture repair in Canada is 48 hours. Eighty-seven per cent of Canadians had their procedure within the benchmark time frame in 2017 – the same as in 2015. In the treatment of cancer, 97 per cent of radiation therapy was administered within 28 days – the Canadian benchmark. That percentage was also consistent with 2015 results. Wait times grow for joint replacement and cataract surgery, despite more procedures being performed Patients are waiting longer for joint replacements in Canada than they did even a few years ago. Last year, about three out of four patients (76%) received a hip replacement within the recommended wait time of six months. The percentage was 81 per cent in 2015.



Patients can wait to visit their family physician, have a diagnostic test and consult with a specialist, for example.

When does the wait time begin? Patients can wait to visit their family physician, have a diagnostic test and consult with a specialist, for example. For this analysis, the hip fracture repair wait time begins at admission to hospital. The wait time for the other procedures begins when the patient is ready to treat — that’s when the patient and physician agree to a procedure and the patient is ready to receive it.

For this analysis, the hip fracture repair wait time begins at admission to hospital. The wait time for the other procedures begins when the patient is ready to treat – that’s when the patient and physician agree to a procedure and the patient is ready to receive it. The story is similar for cataract surgery patients: 71 per cent had the procedure within the recommended wait time of 16 weeks in 2017, compared with 76 per cent in 2015. These longer waits were observed even though the number of procedures increased. There were seven per cent more hip replacements and six per cent more knee replacements done last year than in 2015. The number of cataract surgeries also increased by three per cent in that time.


Many factors contribute to longer wait times. These procedures are frequently associated with older patients. The last census showed that, for the first time, there are more seniors than there are children younger than 14 in Canada. The aging population could play a part

Riley Denver is a Communications Specialist at CIHI 8 HOSPITAL NEWS MAY 2018

in the increased demand for joint replacements and cataract surgeries. In addition, improvements in surgical practices, procedures and devices also expand the number of people who are eligible for surgery.


These procedures are only a small part of the wait time story in Canada. Measuring and monitoring wait times is an important step toward improving access to care. CIHI has several resources Canadians can use to understand the larger picture. CIHI’s Wait Times web tool also includes data on cancer surgery and diagnostic imaging wait times for you to explore. You can also look at wait times in Canada’s emergency departments in the Quick Stats section of See how Canada compares internationally with data from the Organisation for Economic Co-operation and Development. Timely access to medical treatment is important to all Canadians, and CIHI will continue to report on access H to care in Canada. ■

Wait times at a glance Hip replacement • 76% of Canadians received hip replacement surgery within the recommended wait time in 2017. Knee replacement • 69% of Canadians who underwent knee replacement surgery received the procedure within the recommended wait time in 2017. Cataract surgery • 71% of Canadians who had cataract surgery in 2017 received the procedure within the recommended wait time. Hip fracture repair • 87% of Canadians who needed hip fracture repair surgery had the procedure within the recommended wait time in 2017. Radiation therapy • 97% of people who had radiation therapy for cancer in 2017 received it within the recommended wait time.

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Breast cancer patients can receive shorter wait times for reconstruction with faster recovery By Danae Theakston he decision to have reconstructive surgery after a mastectomy is a very personal choice and it’s often a time when breast cancer patients are unsure which option is the best for them. Recognizing this is a scary and uncertain time in patients’ lives, Southlake Regional Health Centre’s Dr. Bimpe Ayeni, a registered plastic surgeon, is offering a less invasive option for people who are weighing their choices when it comes to breast cancer reconstruction. To bring this less invasive option to patients, closer to home, Dr. Ayeni studied and trained at McMaster University, Columbia University and Harvard University to learn the deep inferior epigastric perforator (DIEP) flap reconstruction surgery, a procedure that requires specialized surgical training. The DIEP flap reconstruction is a procedure in which surgeons take abdominal skin, tissue and vessels from the lower abdomen and bring that to the chest to shape and create a breast that is natural looking and heals faster. Since surgeons are using the skin, tissue and vessels of the patient, the DIEP flap provides a more natural look and removes the potential for complications related to implant reconstruction. “In many instances, the option for the DIEP flap reconstruction comes with a potential wait time of up to five months at downtown hospitals,” says Dr. Ayeni, “I wanted to be able to learn this procedure and bring it to patients closer to home and with shorter wait times.” The wait times that occur within Toronto hospitals can take up to five months, if not longer, just for a consult to determine if patients are eligible for this particular surgery. By learning this

Dr. Bimpe Ayeni is a registered plastic surgeon at Southlake Regional Health Centre.



Working with the oncologists, general surgeons and family physicians, Dr. Ayeni takes an interprofessional approach to cancer care. “Working to-

gether with the patient, physicians and surgeons involved in the cancer journey gives us an opportunity to discuss the patient’s options for breast reconstruction and determine the best route for the patient.” Bringing this exciting and innovative procedure to Southlake created a strong sense of morale and comradery within the team. “For our first procedure, the team was so dedicated and committed to keeping our patient safe,” notes Dr. Ayeni, adding “From our scrub nurse to our anesthesiologists, every single member of the team was focused on ensuring this procedure went smoothly for the patient.” Dr. Ayeni’s first DIEP flap patient at Southlake, Linda Savage, came to Dr. Ayeni six years after she had her mastectomy. After researching her options, Linda decided the most suitable option for her would be a procedure that used her own tissue for reconstruction, rather than implants. After speaking with the surgeon who performed her mastectomy, she was referred to Dr. Ayeni for the DIEP flap procedure. “I live in Newmarket, so it was really comforting to know that I had this advanced option so close to home,” Linda explains. “Dr. Ayeni and her team answered every question I had and put me at ease that this decision was the right one for me. The procedure and my recovery went smoothly and I am beyond happy with the end result.” Since Linda’s DIEP flap surgery performed at Southlake in October 2016, Dr. Ayeni and her team successfully completed one more DIEP procedure, and have five patients who are in the consultation process to have the procedure, providing patients with more options, faster recovery times and access to this life-impacting surgery closH er to home. ■

Danae Theakston is a Corporate Communications Associate at Southlake Regional Health Centre. 12 HOSPITAL NEWS MAY 2018

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CASE STUDY: Hospital Furniture The Salvation Army Toronto Grace Health Centre MEMBER PROFILE The Salvation Army Toronto Grace Health Centre (TGHC) is the only operating Salvation Army Hospital in Canada. The facility encompasses:

Complex continuing and palliative care; post-acute care rehabilitation





FLOORS, 74,600 SQ. FT.

MEMBER NEEDS AND CHALLENGES • Fully furnish the facility to create comfortable and welcoming spaces • Ensure hospital-grade durable furniture, meeting infection control standards with long-term warranty • Secure competitive pricing and comprehensive service • Find resources to manage entire furniture contracting process • Ensure compliance with procurement regulations

It would have taken me at least 200+ hours to put out a furniture RFP and I never have the time, let alone while I was managing our three-year, multimillion dollar redevelopment at 650 Church St. cer,

HealthPRO PROCUREMENT SERVICES SOLUTION Create a furniture contract to meet the needs of TGHC which would also be scalable to meet the needs of Canadian hospitals across the country.

KEY BENEFITS/RESULTS • Savings of 10% on furniture contract • 200+ hours in resource efficiencies from outsourcing entire contracting process to HealthPRO • Flexibility to make additional capital equipment purchases on the hospital’s schedule • Procurement practices that meet public sector procurement regulations • Hospital-grade, durable furniture that adheres to stringent infection control guidelines and is designed for 24/7 use, with best-in-the-industry warranty

In the heart of downtown Toronto, a massive, three-year, multi-milliondollar redevelopment at the 60-year-old TGHC presented an opportunity for HealthPRO to develop a contract solution for furniture. To improve safety, security, functionality, efficiency, ergonomics and user comfort (staff, patients, visitors) at the aging TGHC facility at 650 Church St., the building was completely renovated. “First and foremost, we had to meet current safety standards, for example, fire codes, security, and patient safety,” says Ralph Anstey, CFO, TGHC. “But the dated, worn and uncomfortable furniture, most of which had been at TGHC for many decades, was also dilapidated and rundown.”

• HealthPRO contracting expertise and Haworth Healthcare furniture and supply chain experience

Every single piece of furniture had to be replaced – that was the only viable, acceptable option because the physical environment had to reflect TGHC’s deep commitment to providing the very best patient care.

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“My financial analyst, Mary Bui, and myself are the purchasing department – that’s why we rely on HealthPRO,” says Anstey. “It would have taken

me at least 200+ hours to put out a furniture RFP and I never have the time, let alone while I was managing our three-year, multimillion dollar redevelopment at 650 Church Street.” Over the course of its 20-year HealthPRO membership, TGHC has benefitted from the organization’s contracting expertise. TGHC has outsourced the contracting of everything from surgical supplies and equipment to pharmaceuticals to HealthPRO.

We knew that HealthPRO had the expertise, experience and resources required to create a furniture contract that met healthcare industry requirements. Together, HealthPRO and Haworth gave us a brand new look, improved usability and enhanced user satisfaction. – Mary Bui, Financial Analyst, The Salvation Army Toronto Grace Health Centre

HealthPRO’s furniture contract provided TGHC with product for public waiting areas, the outdoor garden lounge, staff offices, meeting rooms and lounges, as well as nurses’ stations and patients’ rooms. HealthPRO’s national purchasing volumes helped save TGHC approximately 10 per cent on their furniture purchases. “Savings generated by HealthPRO’s contract enabled us to buy better quality furniture that is more ergonomic and durable,” says Anstey. Well-designed public areas play a role in user satisfaction as the more comfortable and more occupied (screens, charging outlets) patients and families are, the more satisfied they will be. “We haven’t run formal surveys, but the anecdotal feedback and comments certainly indicate a high level of internal and external user satisfaction,” says Anstey. “We know that families are bringing their loved ones into the main waiting area for visits because it’s so welcoming and comfortable.” Through their contracting expertise, HealthPRO allows healthcare facilities just like TGHC to do what they do best while HealthPRO takes care of the rest.

“Internally, we simply didn’t have the resources, expertise or experience required to tackle a project of this size,” adds Mary Bui, Financial Analyst, TGHC. “We needed a resource we could rely on that had the dedicated staff, knowledge and contacts.” At the time, HealthPRO didn’t have a furniture contract, so they built one from scratch. HealthPRO did everything from defining the RFP specifications that met stringent healthcare usage and infection control standards to securing the best possible price.

HealthPRO Capital Equipment contracts offer: FLEXIBLE SUPPLIER SELECTION



In the end, Haworth, an industry leader providing healthcare furnishings covering clinical and transitional spaces, was awarded the contract.

From furniture and exam tables to carts and ultrasounds, HealthPRO provides members with contracts for all their new and replacement capital needs. 905-568-3478

All Capital Equipment contracts are currently open for commitment. Member input to develop new opportunities is strongly encouraged.


New outpatient joint replacement surgery program is reducing costs By Atifa Hamir and Sarah Warr here were more than 27,000 knee replacement surgeries done in Ontario in 2016, giving many patients relief from debilitating pain and improving their overall quality of life. However, these surgeries can be both time consuming and expensive, requiring patients to stay in the hospital for days after a procedure with significant costs to the healthcare system. A new outpatient joint replacement surgery program at Women’s College Hospital (WCH) is alleviating this burden on both patients and the healthcare system through a same-day service which allows patients to recover at home after a joint replacement surgery, while staying connected to their healthcare team using virtual technology. “The average length of stay for patients in a hospital after they’ve had a knee replacement surgery is up to three days,” says Dr. David Urbach, chief of surgery at WCH and co-lead of the program. “By changing these joint replacement surgeries from inpatient procedures to same-day procedures, we have the potential to transform the healthcare system by decreasing our dependence on inpatient hospital beds, improving wait times, reducing costs and making the system more sustainable.” The program, which was in development for more than a year, uses a combination of state-of-the-art surgical techniques and virtual care apps. Patients are in contact with their healthcare team including nurses, physiotherapists and physicians, both before and after their surgery. Prior to their procedure, they attend a preadmission appointment where they are advised of what to expect during the post-operative period and are


informed of devices that can make their at-home recovery easier such as a tablet-based app that is used by the patient at home during the recovery process. Shortly after a patient is out of surgery, they are assisted by a nurse and physiotherapist to first move into a seated position with their knee bent, stand, walk with a walker and finally navigate a small set of stairs with crutches. They are then discharged home, where their healthcare team can monitor their progress through the app. The app allows the patient to video call with their care provider and log important information that the provider can see, such as the levels of pain and/or nausea they may be experiencing. “The ability to provide this care at home in real time enhances the patient experience and allows them to recover in their own familiar environment,” says Victoria Noguera, director, perioperative services and gyne-

cology, WCH. “Through the post-op care app, patients have easy access to their physician and nurse practitioner, especially in the first three days at home when they may have more questions or concerns.” On April 9, Greg Nemez, a 56-yearold real estate agent, became the fifth patient to undergo a knee joint replacement procedure through the program. Prior to his surgery, Nemez, a lifelong athlete, experienced severe pain and arthritis due to an old football injury. His arthritis continued to get progressively worse leaving him unable to fully straighten his leg and with pain that radiated through his leg with each step. Nemez’s active lifestyle was one of the factors that made him an ideal candidate for the pilot project. Other than his arthritis pain, he is a very healthy individual who was motivated to get out of the hospital and recover as quickly as possible. Nemez had

previous operations on his knee before where he was kept in a full cast to recover, so he was eager to participate in this unique procedure. “Going from being a very active person to having to reduce my activity because of the pain has been very frustrating,” explains Nemez. “I’m excited to start working on the next steps of my recovery at home.” Nemez was discharged less than four hours after his procedure and kept in touch with his care team at home through an app which allowed him to log his pain and nausea levels. His experience, and the experiences of patients who preceded him, have demonstrated the many merits of the program to other care providers and patients alike. “This program is truly living up to WCH’s commitment to providing innovative care and keeping patients out of the hospital,” says Dr. Urbach. “We hope this program will be a model H for other hospitals across Canada.” ■

Atifa Hamir and Sarah Warr work in communications at Women’s College Hospital/Women’s College Research Institute. 16 HOSPITAL NEWS MAY 2018


What does it mean to be a Registered Nurse? Knowledge. Skills. Experience. !MKN?QQGMLôRF?RôK?ICQô?ôBGǪCPCLAC


Increasing access to care with a collaborative Community Health Hub By Carol Lambie n 2012, Waypoint moved its Outpatient Programs from a central location in downtown Midland to a building located on the property of the local general hospital. This move gave our clients an accessible building close to medical partners, but took away the proximity these services had to Waypoint’s HERO Centre located in downtown Midland that provides housing, education, employment, social and recreational services. In 2015 circumstances led us to start exploring options to bring both outpatient and community programming together in Midland’s downtown area with a vision to improve access to mental health services with other social services, employment opportunities and day to day living supports for clients such as the library, shopping and cultural centre close by. Recognizing this as an opportunity to develop a “hub” in support of Ontario Community Hubs Action Plan, collaboration with CHIGAMIK Community Health Centre, also looking for a new downtown location, began. Co-locating mental health and primary care services meets the Action Plan’s criteria for responding to local needs with a concrete way families can access a range of services, improving access to a broader range of wraparound services for better outcomes for people and reducing duplication with more-efficient and sustainable services. With the support of the Town of Midland, a beautiful park like setting across from a proposed new waterfront development was offered, bringing the therapeutic benefits of green space, natural light and walking trails. Like many communities across the province, the Midland and Penetanguishene area has a growing need for meeting “healthy community” planning guidelines, supporting an aging population as well as individuals and families experiencing complex physical and mental health challenges.


Carol Lambie

SUPPORTING TODAY’S FOCUS ON INTEGRATED HEALTH SYSTEM PLANNING THE “HEALTH HUB” BRINGS PRIMARY CARE, MENTAL HEALTH SERVICES AND TRANSITIONAL AGE YOUTH SUPPORTS TOGETHER IN A SINGLE LOCATION, A MODEL THAT PUTS PATIENTS FIRST Supporting today’s focus on integrated health system planning the “health hub” brings primary care, mental health services and transitional age youth supports together in a single location, a model that puts patients first. After numerous public meetings to share this vision, the collaborative journey began for a nurturing and safe place supporting CHIGAMIK’s promise statement of every one matters and Waypoint’s strategic priorities to improve access to mental health and addiction services for the people we serve as well as building new partnerships. Meeting healthy community planning guidelines by the Ontario Professional Planners Institute and the Ministry of Municipal Affairs and Housing, it connects a health centre to downtown retail, commercial and social services

via public transit, a trail system and residential neighbourhoods, ensuring equitable access for people, including those without an automobile. The new health hub also supports Waypoint and CHIGAMIK’s focus on cultural diversity and providing the necessary preventative healthcare for all ages through all types of healing. CHIGAMIK is designed to serve all populations who face barriers to accessing primary healthcare, with a focus on Indigenous peoples and our Francophone population. Waypoint’s Outpatient Services and the HERO rehabilitation staff support people with diverse values, beliefs and feelings who have mental health challenges through innovative and inclusive programming. The co-located health hub services address social issues that negatively affect health: seniors and oth-

ers with mobility challenges, chronic diseases and living alone; anyone who is without a primary care physician or nurse practitioner; individuals and families who self-identify as Francophone, First Nations, Inuit, Métis and people experiencing housing, low income, nutrition and employment challenges. The hub’s proximity to downtown is also an asset to the community’s economy. Clients, their family members, staff and visitors are close to shopping, restaurants and other services. A modern, new health care centre also attracts health care professionals including physicians. This major construction project is bringing many economic benefits for firms, contractors and tradespeople. Shovels went in the ground in October 2017 with the support from both organizations’ clients, staff and volunteers, healthcare partners, area municipalities, the County of Simcoe and the community. We are looking forward to the opening of this collaborative modern health centre supporting client wellness, easier access to services for residents and families, and recruitment of physicians and professionals to provide their care. Many of the building’s spaces will be shared such as physiotherapy, conference, community kitchen and gathering rooms, and youth programming space. Washrooms are gender neutral and common spaces will accommodate the particular needs of children, patients and people with physical challenges. Several rooms are designated for smudging for Indigenous ceremonies and the entire facility is intended to create a welcoming place for clients, staff and the community. This process has truly been a collaborative one, with both health care organizations being an equal partner from the beginning. We have embarked on this journey together and are moving this project forward in a very caring, respectful and innovative way. We look forward to this vision H becoming reality in our community.■

Carol Lambie is President and CEO, Waypoint Centre for Mental Health Care. 18 HOSPITAL NEWS MAY 2018


Largest-ever study of its kind

uses a tumour’s past to accurately predict its future By Hal Costie indings from Canadian Prostate Cancer Genome Network (CPC-GENE) researchers and their collaborators, published in Cell, show that the aggressiveness of an individual prostate cancer can be accurately assessed by looking at how that tumour has evolved. This information can be used to determine what type and how much treatment should be given to each patient, or if any is needed at all.


WE SHOW THAT THE PAST EVOLUTIONARY HISTORY OF A TUMOUR HELPS PREDICT WHETHER THAT TUMOUR WILL PROGRESS INTO AN AGGRESSIVE FORM The researchers analyzed the whole genome sequences of 293 localized prostate cancer tumours, linked to clinical outcome data. These were then further analyzed using machine learning, a type of statistical technique, to infer the evolutionary past of a tumour and to estimate its trajectory. They found that those tumours that had evolved to have multiple types of cancer cells, or subclones, were the most aggressive. Fifty-nine per cent of tumours in the study had this genetic diversity, with 61 per cent of those leading to relapse following standard therapy. “By incorporating time into the context of the existing knowledge we have about where a tumour is at diagnosis we were able to very accurately identify those patients whose prostate tumours needed no treatment, those men who could be cured by existing treatments, and those men who had

Dr. Paul Boutros Principal Investigator, Ontario Institute for Cancer Research and leader of CPC-GENE. Landmark study links tumour evolution to prostate cancer severity very aggressive tumours and may have benefitted from novel therapeutic options,” says Dr. Paul Boutros, Principal Investigator, Ontario Institute for Cancer Research and leader of CPCGENE. “Clinical decision making in treating prostate cancer can be very difficult. These findings pave the way for a new tool to improve our ability to determine the best approach for each individual patient, including sparing patients from unnecessary treatment or over-treatment and the associated side effects,” says Professor Robert Bristow, Director of the Manchester Cancer Research Centre at the University

of Manchester U.K., formerly of the Princess Margaret Cancer Centre in Toronto. “Tumours are a community of related cancer cells, and by examining their DNA using machine learning, we can gain insight into how they evolved from normal cells. In this paper, we show that the past evolutionary history of a tumour helps predict whether that tumour will progress into an aggressive form,” says Dr. Quaid Morris, Associate Professor, The Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, who collaborated with the CPC-GENE team on the study.

“Prostate cancer is the most common cancer among men,” says Reza Moridi, Ontario’s Minister of Research, Innovation and Science. “Ontario congratulates this research team, whose work is pointing the way toward improved testing and treatment.” The study’s findings are not its only contributions to prostate cancer research. The sequencing data generated during the course of the study are now freely available online to researchers worldwide to carry out further analyses, becoming the largest prostate cancer genomics resource available to-date. CPC-GENE is a team of multidisciplinary researchers from across Canada working to crack the genetic code of prostate cancer. Through funding of approximately $20 million, research of this magnitude has been made possible through a partnership between the Movember Foundation, Prostate Cancer Canada, and the Ontario Institute for Cancer Research. Dr. Stuart Edmonds, Vice-President of Research, Health Promotion and Survivorship at Prostate Cancer Canada, has released the following statement: “From the tireless work of researchers to the selfless giving of donors, we applaud the efforts of everyone who has played a role in helping make CPC-GENE possible. Since its beginnings as an ambitious undertaking that was massive in scope, the goal of this project has been to greatly improve personalized care for men with prostate cancer. The findings published in Cell – widely considered one of the most prestigious and highest impact medical journals – represent a monumental stride towards that goal. Together, we will continue to advance this important work on behalf of the one in seven Canadian men who will be diagnosed with prostate cancer and H their families.” ■

Hal Costie is a Senior Communications Officer at the Ontario Institute for Cancer Research. 20 HOSPITAL NEWS MAY 2018

KEEPING HOSPITALS SAFE. FIGHTING CANCER. Cobalt-60 from Bruce Power’s reactors helps sterilize 40% of the world’s single-use medical devices, and powers the Gamma Knife, which helps cure brain cancer.







Advocacy and support for Surgical Safety Checklists

Smart for patients and smart for providers urgical procedures are increasingly complex and carry a significant risk of potentially avoidable harm. For almost a decade, the Surgical Safety Checklist has been used by surgical teams across the country to support patient care through good communication and teamwork. A Surgical Safety Checklist plays an important role in reducing the likelihood of complications following surgery and is known to improve surgical outcomes. The three phases of the checklist include: Briefing (before the induction of anesthesia); Time-Out (before skin incision); and Debriefing (before the patient leaves the operating room). A Surgical Safety Checklist is smart for patients and smart for providers. The advocacy and use of a Surgical Safety Checklist in Canadian healthcare facilities has been endorsed by a Joint Position Statement adopted by the Canadian Patient Safety Institute, Alberta Health Services, Canadian Anesthesiologists’ Society and the Operating Room Nurses’ Association of Canada, and supported by many surgical interest groups. The purpose of the Position Statement is to convey the commitment of these organizations to prioritize perioperative patient safety by creating an environment conducive to the effective adoption and use of a Surgical Safety Checklist. It is a call to action that supports a cultural shift from the front lines – to leadership – to patients and advocates for the widespread use of the Surgical Safety Checklist. Surgical groups that have endorsed the Joint Position Statement, include: the Canadian Orthopaedic Association; Canadian Neurosurgical Society; Canadian Society of Cardiac Sur


NEVER EVENTS ARE SERIOUS PATIENT SAFETY INCIDENTS THAT SHOULD NOT OCCUR IF HEALTHCARE SYSTEMS SUPPORT AND EMPOWER PROVIDERS IN THEIR USE OF AVAILABLE PREVENTATIVE MEASURES geons; Canadian Society for Vascular Surgery; Canadian Society of Otolaryngology Head and Neck Surgery; Canadian Association of General Surgeons; Canadian Association of Paediatric Surgeons; Canadian Association of Thoracic Surgeons, the Society of Obstetricians and Gynaecologists of Canada, and the Canadian Urological Association. Supporters promoting the statement include the Canadian Ophthalmological Society and Canadian Thoracic Society.

While some surgical complications cannot be avoided, others are considered “never events” – serious patient safety incidents that should not occur if healthcare systems support and empower providers in their use of available preventative measures. Never events are a call-toaction, not a demand or an attempt to place blame or shame. The Joint Position Statement acknowledges these “never events” associated with surgical care:

• Surgery on the wrong body part, the wrong patient, or conducting the wrong procedure. • Wrong tissue, biological implant or blood product given to a patient. • Unintended foreign object left in a patient following a procedure. • Patient death or serious harm arising from the use of improperly sterilized instruments or equipment. • Patient death or serious harm due to a failure to enquire about known allergies to medications, or due to administration of a medication where a patient’s allergy had been identified. • Patient death or serious harm due to the administration of the wrong medication or substance during care delivery. “Although healthcare professionals make every reasonable effort to provide safe care to their patients, harmful surgical incidents, including wrong site surgeries and retained surgical items continue to occur in operating rooms across the country,” says Dr. Giuseppe Papia, Vascular and Endovascular Surgeon and Critical Care Medicine specialist at Sunnybrook Health Sciences Centre. “It is with standardized protocols like the Surgical Safety Checklist that can improve communication and collaboration across the surgical team and prevent patient safety incidents. Patient harm is reduced by fostering highly reliable surgical teams which work more effectively together to produce better patient outcomes. The Surgical Safety Checklist is an essential perioperative communications tool for surgical teams across Canada.” To learn more about the Surgical Safety Checklist and the Joint Position Statement advocating for and supporting the use of a Surgical Safety CheckH list, visit ■

Submitted by The Canadian Patient Safety Institute 22 HOSPITAL NEWS MAY 2018


New drugs for chronic pain: The search continues for something better than opioids By Barbara Greenwood Dufour hen seeking treatment for chronic pain, many Canadians will be prescribed an opioid medication. However, the current opioid crisis in Canada has called attention to the significant risks associated with these drugs. Furthermore, despite being such a common treatment for chronic pain, opioids don’t tend to be very effective over the long term. This has led to increased interest in alternatives to opioids for managing chronic pain that are not only safer but are also more effective. A number of non-opioid drugs have been suggested as alternatives for chronic pain, such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitor antidepressants, and anticonvulsants. But none of these drugs appears to have reduced the need for opioids in managing pain, and they also come with their own risk of adverse events. There are, however, some emerging non-opioid drugs in development. Might they offer safer and more effective treatment options for chronic pain? CADTH – an independent agency that finds, assesses, and summarizes the research on drugs and medical devices – recently conducted an Environmental Scan to identify and review the available evidence on non-opioid drugs for chronic non-cancer pain that will likely enter the Canadian market in the near future. CADTH identified several such drugs that have either been approved by a regulatory agency in another country or


A NUMBER OF NON-OPIOID DRUGS HAVE BEEN SUGGESTED AS ALTERNATIVES FOR CHRONIC PAIN, SUCH AS ACETAMINOPHEN, NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), TRICYCLIC ANTIDEPRESSANTS, SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITOR ANTIDEPRESSANTS, AND ANTICONVULSANTS are in clinical development, including three that could become available in Canada in the near future and potentially play a role in addressing the opioid crisis. They are ziconotide for severe, treatment-refractory chronic pain, tanezumab for chronic pain caused by osteoarthritis or chronic low back pain, and the capsaicin 8% patch for neuropathic pain associated with post-herpetic neuralgia. Ziconotide is an analgesic that was approved by the US FDA in 2004 for the management of severe chronic pain in patients who are intolerant of or not responding to other treatments. It’s injected into the spinal cord to block the transmission of pain signals. The evidence produced so far shows that ziconotide might be effective for these patients. It was, however, also found to be associated with some adverse events, including abnormal gait, dizziness, rapid involuntary eye movements, confusion, urinary retention, nausea, and vomiting. Tanezumab, a treatment for osteoarthritis-related pain or chronic low back pain, is said to target and stop the nerve growth factor activity

to reduce pain signals. The drug was previously studied as an intravenous infusion but is now being studied as a subcutaneous injection. Tanezumab has not yet been approved by the FDA – in 2010, the FDA put a hold on clinical trials of the drug when some participants developed rapidly progressive osteoarthritis and osteonecrosis that led to the need for joint replacements. However, the hold has since been lifted, and tanezumab has now been granted Fast Track designation for an expedited review. The evidence from studies conducted so far suggest that tanezumab may be effective for reducing pain related to both indications, with the main adverse effects reported to be abnormal peripheral sensations (e.g., numbness and tingling), especially at higher doses, and, in the one study in patients with chronic low back pain joint pain, pain in the extremities, and headache. It also appeared to result in a small number of patients requiring joint replacements in the osteoarthritis-related studies. A topical treatment – the capsaicin 8% patch – was approved by the FDA

in 2009 for the management of neuropathic pain associated with post-herpetic neuralgia, a complication of shingles. The patch contains a high concentration of synthetic capsaicin (the substance that naturally occurs in chilli peppers and gives them their heat) and is applied to the skin for an hour. The evidence produced so far on the capsaicin 8% patch shows that it could be effective for pain management in these patients. The most common adverse effects associated with this patch are redness and pain in the area where the patch is applied. There are several other non-opioid drugs that are in clinical development for the management of chronic non-cancer pain and may become available in the future. The majority of them are for neuropathic pain, pain related to osteoarthritis, and chronic migraine prevention. Until additional studies of any of the emerging treatments are conducted to further evaluate their safety and effectiveness, we can’t tell how likely they are to replace or reduce the use of opioids. However, staying familiar with what’s in the pipeline can give decision-makers advance knowledge to help them be better prepared, should these drugs eventually come on the Canadian market. If you’d like to learn more about CADTH or this environmental scan, visit You can find more evidence to help address the opioid crisis in Canada at www.cadth. ca/opioids and, follow us on Twitter @CADTH_ACMTS, or speak to the CADTH LiaiH son Officer in your region. ■

Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH.


NEWS Sandi Gowda never likes to be too far from her grapevines. With the Lillooet Hospital’s new virtual perioperative clinic, the Walhachin, B.C., patient didn’t have to be.

Virtual is the new reality Using technology to ease patients’ surgical journey By Interior Health andi Gowda is a farmer who lives near Walhachin, in the interior of British Columbia. Her three-acre crop is grapevines, which she hopes will eventually mature into viable fruit for one of the many emerging wineries in the province’s Thompson region. Even in the midst of winter, she prefers not to stray too far from her vines. That’s why Sandi didn’t hesitate when the call came to attend a virtual pre-surgical appointment at Ashcroft Hospital, about 30 minutes from home. It made for a much shorter day than a two-hour drive would have been to Lillooet Hospital and Health Centre, where she was scheduled for an upcoming colonoscopy. “It was convenient to go to Ashcroft and have the video conference there,” says Sandi, 55, who had her procedure on Jan. 25. “I may not have opted to have my colonoscopy at Lillooet if I



would have had to drive there for the pre-operative appointment as well. I would have probably asked to go to Kamloops (30 minutes away, where the wait time for the procedure was longer) instead.” Sandi is one of about 50 patients served by Interior Health, one of B.C.’s regional health authorities, who as of mid-April had taken advantage of the new virtual perioperative clinic at Lillooet Hospital. Lillooet performed approximately 230 elective daycare procedures in 2016/17, including esophagus and digestive system biopsies, hernia repair, vasectomies, gynecologic surgery, hand surgery, laparoscopy, and dental and periodontal interventions. Lillooet may not seem like the obvious choice for patients in the Ashcroft region to have a surgical procedure, given its more remote location and smaller size as compared to Royal

Inland Hospital in Kamloops, where patients from communities such as Ashcroft, Walhachin, Savona, Cache Creek, Bonaparte Reserve, Nicola Reserve, and Clinton may normally go. However, Dr. Nancy Humber, who is a general practitioner with enhanced surgical skills (GP-ESS) at Lillooet Hospital, saw an opportunity to make the surgical experience better for patients in the region. She envisioned a person-centred approach using technology that would reduce overall travel time and, at the same time, build an innovative surgical service delivery model for rural patients. It’s the latter that was especially important to Nancy, who is also Interior Health’s Executive Medical Director for IH West-Rural. Thus, the Lillooet virtual perioperative clinic was born. “We responded to a need,” says Nancy. “It was an opportunity for Lil-

looet Hospital to be a leader. It was an opportunity to mitigate barriers that geography creates by using technology, and to create a service delivery model from a regional lens instead of a community lens.” Here’s how it works: Using funding from B.C.’s Rural and Remote Divisions of Family Practice and Facility Engagement, Nicole Hochleitner-Wain, project coordinator in Lillooet, books patients to attend a video conference at Ashcroft Hospital. She travels there, sets up the telehealth equipment, meets the patients, and gets them settled – which is especially important for older patients who are apprehensive about technology, says Nicole. The patient then meets virtually with the surgical team, a consultation that includes a GP surgeon, GP anesthesiologist, and an operating room nurse. With this complete, the patient


only needs to travel for the procedure itself. Follow up is also done virtually or by telephone. That the appointment is done with a team approach was intentional, says RN Bobbie-Jo Allen. “It cuts down on time for patients, nurses, and physicians, because it’s all being covered in one appointment,” says Bobbie-Jo. “If we take a good, solid history and ask good questions, that covers everything, because most of the questions we would ask were the same.” There is some patient travel for the video conference, because it requires the use of a telehealth mobile unit. But operating room lead Maria Mascher says the use of video was an important component. Patients like the opportunity to meet the entire team. The team has the opportunity to hear the answers and ask questions together. It’s team building and high-quality com-

munication between the team and the patient for the best quality of care. “This way, patients can see the person behind the voice of their physicians and nurses. We thought it would be nice, getting to see a face,” Maria says, adding that helps make patients more comfortable before their procedures. And, adds Bobbie-Jo, the consultations normally are between 20 to 30 minutes, making a short commute to Ashcroft preferable to a longer drive to Lillooet. “If a patient has to travel two hours for a 20-minute appointment, and then two hours home, that’s a lot of time for a 20-minute appointment. That’s a whole day,” says Bobbie-Jo. The first virtual perioperative clinic was held July 24, 2017, with 14 clinics now complete. The Ashcroft hospital site is hoping to expand its network access to services with its own portable videoconferencing unit.

This article was submitted by Interior Health.

This virtual clinic model also exists in other communities in Interior Health, like Trail, and work is underway to incorporate more telehealth options for pre-surgical screening at several sites in the health authority. Feedback for Lillooet’s clinic has been positive, says Dr. Suman Sharma, a GP anesthesiologist. “Patients are very happy. One of the reasons it works is the one-to-one care given in a smaller centre. In a bigger centre they can feel lost.” Sandi echoed that sentiment. “I thought it was very efficient,” she says. “Even though it wasn’t in person, you’re still in contact. You’re still on real time. It’s very convenient. It’s private. You never have to feel uncomfortable if asking questions about personal issues. The doctor was thorough in explaining the process and what to expect. It was comfortable – the same as if I visited in an office.

“It’s a great model for the future for rural areas, for people who have a hard time getting to hospitals and clinics.” Nancy says that it’s a model that can be built on for the future, too, as it identifies a good and efficient way to use health-care funding. In this case, they had help from the Rural Division of Family Practice, and Interior Health’s Telehealth working group is also supportive. A blended model of face-to-face and virtual care is a way to address equity and access with fewer resources in rural and remote communities. “It shows that when a highly functioning team of people are resourced, they can address what is possible locally,” says Nancy. “It’s about seeing a need and having a team of people work well together to develop a service to meet need and respond and H adapt to what the needs are.” ■


Living with cancer, and left on their own By Esther Green iving with cancer is about dealing with the unknown. It‘s about trying to grasp the news of a diagnosis and starting to understand its life-changing effect. It’s about wondering if the treatment is working and whether the side effects will go away soon. It’s about questioning whether anything else can be done to overcome this illness. And it’s about figuring out what life will be like when treatment is over. The Canadian Partnership Against Cancer recently released Living with Cancer: A Report on the Patient Experience, a unique report that looks at the


disease exclusively from the perspective of the patient. The findings reflect the voices of over 30,000 Canadians and it is the country’s largest accumulation of data on the experiences of people living with, and beyond, a cancer diagnosis. The report shows that most Canadians with cancer believe our health system does a good job of treating the disease, however many report experiencing significant, and often debilitating, physical and emotional side effects, as well as practical concerns, during diagnosis, treatment and survivorship.

This may be expected, but what’s troubling is that patients are reporting that these concerns are often not being adequately addressed by their healthcare providers during the different stages of the disease. The survey data show that patients’ care providers didn’t always connect them with the services they needed, even when they had already made their concerns known. Over 50 per cent of patients, who reported having anxieties and fears following their diagnosis, were not referred to any support services for these concerns, and one in four patients in-

dicate that they were not satisfied with the emotional support they received during outpatient care. Furthermore, over 50 per cent reported being told by their care provider that their physical challenges, were “normal” following treatment and that nothing could be done about them, and over 30 per cent indicated a similar response regarding their emotional concerns post-treatment. One of the patients who was interviewed for, and featured in, the report said, “Following my cancer treatment, I felt like I was left floating in the breeze in a scary world of uncertainty.

Esther Green is the Director, Person-Centred Perspective at the Canadian Partnership Against Cancer. 26 HOSPITAL NEWS MAY 2018


CARE PROVIDERS NEED THE TIME AND SUPPORT TO BE ABLE TO PROMPT MEANINGFUL DISCUSSIONS WITH THEIR PATIENTS ASSESSING THEIR PHYSICAL, EMOTIONAL AND PRACTICAL CONCERNS BEFORE, DURING AND FOLLOWING TREATMENT I was no longer actively fighting against my tumour but I had this underlying fear that it might recur at some point. My doctors never told me I was in the transition phase of my cancer experience, they did not discuss next steps and things I could expect, and they did not direct me to any resources. I felt like I was on my own.” As the report highlights, care providers need the time and support to be able to prompt meaningful discussions with their patients assessing their physical, emotional and practical concerns before, during and following treatment. They need access to resources to help them provide referrals and direct patients to available services to support their needs. There are gaps in the health system in the way cancer patient symptoms are monitored and addressed. At cancer centres, hospitals and community care facilities in the 10 provinces, there is no systemic integration of monitoring of patient symptoms starting at diagnosis and continuing right through to survivorship. Care providers are not being provided with tools and/or other methods (i.e., patient navigators) to make this a routine and seamless practice for all patients. Efforts are already being made to address this problem. Over the past two years, the Partnership has been working with provincial cancer agencies and health organizations across Canada on a Patient Reported Outcomes (PRO) Initiative for those with cancer. This initiative involves having a standardized core set of patient-reported outcome measures and patient-reported experience measures in hospitals and cancer centres. The program is working to integrate these measures in a meaningful way

into clinical practice so that patients experiencing symptoms can have them recognized and addressed, leading to a better overall cancer care experience. These practices have been adopted in several provinces including the Prairie Provinces, Ontario, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, and three sites in Quebec. The Partnership will be moving to continue to scale up use of patient reported outcomes at cancer centres and hospitals in these jurisdictions and spread to other provinces and territories in the coming years. The PRO Initiative hopes to lead the shift in the delivery of cancer care in Canada from disease-centred to person-centred, with the needs of patients addressed during all stages of the disease. Providing person-centred care will ensure that those with cancer and their families are seen as unique individuals and receive coordinated support that is considerate of their time and preferences. It will also help in improving accessing to useful information that promotes self-care. Such initiatives are a start, but more needs to be done. To best support people with cancer and their families – from the moment they start wondering if they have cancer to post-treatment care – it is essential to treat them as individuals with a reality that extends beyond being a cancer patient. A health care system guided by a person-centred approach recognizes this and won’t leave patients to feel like they’re on their own. For people with cancer seeking support, you can connect with other patients and health-care providers at www. For support in your community, visit the Canadian Cancer SoH ciety’s Community Services Locator. ■

Dr. Hazem Elmansy is a urologist at Thunder Bay Regional Health Sciences Centre and one of few doctors in the world who can perform holmium laser enucleation of the prostate (HoLEP).

Urologist brings advanced and specialized surgical technique to Thunder Bay Regional Health Sciences Centre By Maryanne Matthews new prostate surgery method is improving care for patients and families in Northwestern Ontario. Dr. Hazem Elmansy, a urologist at Thunder Bay Regional Health Sciences Centre, is one of few urologists in the world able to perform the specialized surgery, and the only one in Ontario. The modern procedure is called holmium laser enucleation of the prostate (HoLEP) and is used to treat men with urinary outflow obstruction caused by an enlarged prostate. Compared to the traditional method, this procedure is less invasive and more precise, which means patients are discharged sooner, have a much shorter recovery time and the chance of requiring further surgery is very low. “Since beginning to offer the surgery in October, we’ve had really great success in treating otherwise difficult cases,” says Dr. Elmansy.


“There is a high need for this type of surgery and being able to perform it here in Thunder Bay is of great benefit to patients across Northwestern Ontario. So far, patient satisfaction has been exceptional.” The HoLEP technique is very specialized and difficult to learn, but Dr. Elmansy is hoping to increase the number of capable urologists by starting a fellowship program. He’s hoping to work with the Northern Ontario School of Medicine to train more doctors, thus increasing the number of patients who can benefit from the procedure. For more information about HoLEP, patients and health care providers can contact Dr. Elmansy directly: For more information about services and surgeries offered at Thunder Bay Regional Health Sciences Centre, visit www. H ■

Maryanne Matthews is a Communications Officer at Thunder Bay Regional Health Sciences Centre. MAY 2018 HOSPITAL NEWS 27


A successful first in surgery: Collaboration at its best By Jolene Soares rom diagnosis to treatment, a full service community hospital requires professionals, including physicians from multiple specialties and departments, to collaborate. In Melanie Pascual’s case, this collaboration ended up being lifesaving. Melanie Pascual, a 26 year old registered nurse, came to Canada from the Philippines in 2015, to be a live-in caregiver. This was an opportunity to be reunited with her sister, Laila, who had also come to Canada for work in 2010. The thought of seeing snow for the first time was exciting and something she was looking forward to. Because of the nature of her work, Melanie was ignoring symptoms like headaches, heart palpitations, insomnia and swelling in the face as well as additional facial hair growth. After presenting in the Emergency Department at CCH, she had a follow appointment up with Dr. Paul Westergaard, a local internist. “When I saw Melanie in my office, her blood pressure was 240/110 which is very dangerous; if left untreated this can cause a rupture or tearing of blood vessels, particularly in the brain or chest. I called an ambulance for her directly from my office.” Melanie had agreed to be transported to Cornwall Hospital by ambulance, with some convincing from her sister. In the Emergency Department, Dr. Lemire was able to lower her dangerously high blood pressure with multiple medications. She then consulted Dr. Arab, the intensivist on call, for further investigation and admission to the Critical Care Unit (CCU). After an ultrasound, blood work, CT and MRI scan, it was determined that Melanie had Cushing’s syndrome. This is a rare condition that causes elevated levels of the hormone called cortisol due to a tumour on the adrenal gland. After six weeks of medi-


From left to right, Dr. Yen Dang, Melanie, Dr. Paul Westergaard and Dr. Raylene Sauve. cation to lower her blood pressure and cortisol levels, Melanie was ready for surgery to have the tumour removed. Using his advanced laparoscopic surgery training, Dr. Dang, a general surgeon at Cornwall Hospital, was brought in to review the case and perform the surgical removal of the tumour. Specialized infrared operating cameras were provided by Stryker Canada to utilize a cutting edge technique of intraoperative fluorescein. The Pharmacy department sourced the required dye and ensured it was on site, enabling visualization of the tumours blood vessels once injected. “While resection of adrenal tumours was part of my fellowship training in

Vancouver, the use of Indocyanine (Green dye) was a first for me. For a part of the operation, we switched the camera to “night vision mode” and this dye lit up the main blood vessels feeding the tumour, making its identification, and ultimately control, much safer. According to our Stryker representative, this was the first time this technique had been used in Canada for this type of surgery, and we are proud that it was possible here,” explains Dr. Dang. Dr. Raylene Sauve, anesthetist on the case also had to be well prepared, “Rapid blood pressure changes during the operation can make things complicated and dangerous,” she explained, but she was

prepared with a plan for every possible complication. The surgery was successful and Melanie is on the road to recovery with follow up appointments with Dr. Westergaard and Dr. Heidi Dutton, an endocrinologist in Ottawa. “Even though we are physically far away from home, we did not feel like it because we were so well taken care of, with everyone showing genuine concern and compassion towards our situation” expressed Melanie. “We are so glad Melanie’s doing better and proud to be part of a hospital that can provide this level of specialized care. It’s a sign of great things happening here in CornH wall,” says Dr. Dang. ■

Jolene Soares is a Communications Coordinator at Cornwall Community Hospital. 28 HOSPITAL NEWS MAY 2018

A client’s MVP.

Troy Lehman loves football. When he isn’t working on personal injury cases involving municipal liability and other complex issues, this busy lawyer plays quarterback on the flag football field. Playing quarterback is all about strategizing, getting the ball to your teammates and working to get to the goal line. As a litigator, Troy knows that careful planning, teamwork and focusing on his clients’ goals is the key to success. Troy is a litigation quarterback, planning the plays and involving the right experts to work in a tight formation. This approach keeps the case moving to the end zone. There is one other thing you should know about Troy. Whether it is on the football field or in the courtroom, he can’t stand to lose. In football, winning is about who scores the most points. In personal injury law, winning is about exceeding your clients’ expectations. As a personal injury lawyer, Troy wins the game when he obtains compensation for his clients that will help them rebuild their lives in a meaningful way.

To learn more about Troy visit Proud Member




A Salute to

Nursing H hirteen years ago when we started this contest we had no idea how our readers would respond. We just knew we wanted to honor the amazing work nurses do and give people (patients/families/colleagues) an opportunity to say thank-you. That first year we received around 40 nominations, and it has steadily grown since then. This year we are thrilled to have received a record 189 nominations. Heroism is alive and well in our health system – in spite of the many challenges that have come to light over the last year. Mainstream media in-


undates us with stories of health system failures and yes, there is definitely room for improvement and we have a long way to go in achieving health system efficiency. It is much less often we hear of a nurse who has made a difference in the lives of many, or even one. These stories don’t grab headlines. And that is why we started this contest – to share these stories of every-day heroes who have devoted their lives to helping others. I have had the pleasure of informing these winners/finalists over the last 13 years and almost every one of them has the same reaction – “I was just doing my job,” “ I am not a hero, I am just part of a really great team,” – I guess that’s part of what being a hero is – not even

re do ar he ou w hi w sio th cr he sit a T ca ne

commitment | dedication |



MAY 7-13, 2018




g Heroes m m ng efof he es hy se eng 13 as ng rt t’s en

realizing your impact on others and just doing what you do because it’s who you are. Every single nominee is a nursing hero. We have selected a few standout nominations to share – this year’s winner, Dan Chisholm has dedicated his entire career to helping patients with HIV/AIDS, providing compassionate care to a patient population that was often segregated and discriminated against. Mairlou Gagnon helped start and run a safe injection site in Ottawa in an effort to combat a startling increase in overdose deaths. These nurses are heroes working to care and advocate for extremely vulnerable patients.

Our third place winner, Angela Tsang is providing exceptional care to spinal cord injury patients while advancing research that could help these patients even more in the future. With 189 nominations, it is extremely difficult to select just a few for publication. I will be publishing more nominations online than we have space for in these pages, so please keep an eye out at If you are on the list of nominees, we would be thrilled to share your nomination with you. Please email me at As we celebrate Nursing Week across Canada, Hospital News would like to an extend a huge thank-you to H all nurses. We salute you! ■

Kristie Jones Editor, Hospital News



Dan Chisholm Casey House


Cash Prize

nd prize

Marilou Gagnon

Associate Professor, School of Nursing, University of Ottawa; Overdose Prevention Ottawa


Cash Prize


n | excellence | compassion


Angela Tsang

Vancouver Coastal Health


Cash Prize



List of Nominees

2018 Nursing Hero Awards

Alicia Bastalla, Mackenzie Health

Sylvie Bruyere, The Ottawa Hospital

Jody Battle, Bluewater Health

Susan Buchanan, University Health Network

Nilda Abila, Sunnybrook Health Sciences Centre

Alexandra Andric, Centre for Addiction and Mental Health

Daisy Aguilar, Vancouver Coastal Health

Ukamaka Aneke, Centre for Addiction and Mental Health

Grace Akhigbe, Bridgepoint Active Healthcare

Bonita Aphan, Trillium Health Partners

Liz Bjorog, Sunnybrook Veterans Centre

Ann Margaret Ali, Trillium Health Partners

Liza Augustine, Centre for Addiction and Mental Health

Angela Blasutti-Boisvert, The Ottawa Hospital

Verone Allen, Centre for Addiction and Mental Health

Jackie Avelino, University Health Network

Kwasi Boateng, Centre for Addiction and Mental Health

Teressa Allwood, 100 Mile Hospital

Selma Bajramoski, Sinai Health System

Wendy Alman, Kemptville District Hospital

Sarah Balet, Sunnybrook Veterans Centre

John Bottman, Waypoint Centre for Mental Health

Nan An Dinh, Humber River Hospital

Laura Bandstra, Markham Stouffville Hospital

Diana Beckford, Sunnybrook Health Sciences Centre Jean-Paul Biancoli, Humber River Hospital

Tabatha Bowers, Scarborough and Rouge Hospital Simon Bridgland, Trillium Health Partners Kim Brophy, Scarborough and Rouge Hospital Kathleen (Kate) Brown, Peterborough Regional Health Centre Lori Brown, Trillium Health Partners Viveen Brown, Centre for Addiction and Mental Health

Nirmala Budhram, Centre for Addiction and Mental Health Rose Buensuceso, Bridgepoint Health Lorna Cachola, Sunnybrook Health Sciences Centre Dian Cairns, Centre for Addiction and Mental Health Jennifer Cao, Humber River Hospital Andra Cardow, Casey House Anastasia Carron, Bluewater Health Soni Chacko, Runnymede Healthcare Centre Simone Charles, University Health Network Dan Chisholm, Casey House Tenzin Choekey, Runnymede Healthcare Centre Marcail Christian, The Hospital for Sick Children Audrey Cianfarani, William Osler Health System

Katherine Gagnon, North Bay Regional Health Centre

Charmaine Cupid, Centre for Addiction and Mental Health

Marilou Gagnon, Overdose Prevention Ottawa

Cindy Demakos, The Centre for Addiction and Mental Health Meredith Depaulsen, Scarborough and Rouge Hospital Erin Devereaux, Kemptville District Hospital Tsering Dolma, Centre for Addiction and Mental Health Gloria Dool, Alberta Health Services Rachel Downie, London Health Sciences Centre/ St. Joseph’s Health Care London Sharol Duncan, Centre for Addiction and Mental Health Jacquie Dunne, Markham Stouffville Hospital Susan Elliot, Centre for Addiction and Mental Health

Dolores Gauthier, Humber River Hospital Dannis Gaynair, Sinai Health System Lynn Gilkes, Sunnybrook Health Sciences Centre Karen Gimenez, Trillium Health Partners Connie Gomes, Providence Care (Ontario) Norena Gonzales, Providence Health Care (BC) Brandi Grozell, Sunnybrook Health Sciences Centre Sherry Guchardi, Southlake Regional Health Centre Lance Hermanstyn, Centre for Addiction and Mental Health Bev Hill, Peterborough Regional Health Centre Gina Huang, Sunnybrook Health Sciences Centre

Carla Erum, Runnymede Healthcare Centre

Janice Hurlbut, Centre for Addiction and Mental Health

Aimee Esmejarda, Runnymede Healthcare Centre

Patricia Hynes, Centre for Addiction and Mental Health

Shirley Eyles, Southlake Regional Health Centre

Angela Ianni, St. Joseph’s Health Care London

Elaine Con, Trillium Health Partners

Christine Finn Gillespie, Peterborough Regional Health Centre

Muna Ibrahim, Centre for Addiction and Mental Health

Cheryl Cook, Brockville General Hospital

Mandy Fracassi, William Osler Health System

Nermin Ibrahim, Trillium Health Partners

Corinne Cipra, Brockville General Hospital Samantha Cizikas, Trillium Health Partners Linda Clark, Peterborough Regional Health Centre


Mariella Cortes, North York General Hospital

NATIONAL NURSING WEEK 2018 Marylou Jarvis, Vancouver Coastal Health Mary Jemmett, North Bay Regional Health Centre Amanda Jober, Stollery Children’s Hospital Courtney Johnson, Alberta Health Services Guen Kernaleguen, Alberta Health Services

Amanda ‘Mandi’ McCue, Alberta Health Services

Lisa-Lynn Ould Gallagher, Trillium Health Partners

Suzanne Shaughnessy, Peterborough Regional Health Centre

Laurie McCutcheon, Huron Perth Healthcare Alliance

Sheila Paul, Trillium Health Partners

Vlada Shcherba, Centre for Addiction and Mental Health

Diana McQueen, Humber River Hospital

Anne Payne, Waypoint Centre for Mental Health

Lorraine Schubert, Centre for Addiction and Mental Health

Helen Milroy, Southlake Regional Health Centre

Catharine Petta, Holland Bloorview Kids Rehabilitation Hospital

Millicent Shewraj, Centre for Addiction and Mental Health

Laurie Morton, Humber River Hospital

Mary Ellen Plumite, Alberta Health Services

Alexis Siren, Centre for Addiction and Mental Health

Irene Khan, The Hospital for Sick Children

Jacob Mossop, Centre for Addiction and Mental Health

Magdalena (Megan) Koziel, Peterborough Regional Health Centre

Sherry Mossor, Peterborough Regional Health Centre

Liora Krinsky, Scarborough and Rouge Hospital Grace Lamarche, Cornwall Community Hospital Jennifer Lawrence, Centre for Addiction and Mental Health Rebecca Lewis, University Health Network Nan Li, Centre for Addiction and Mental Health Mu Ying Lin, Runnymede Healthcare Centre Wendy Macario, Hamilton Health Sciences Centre Claudine Maristella, Humber River Hospital Edgardo Marquez, Sunnybrook Health Sciences Centre Carly Martin, Providence Care (Ontario)

Annette Mukakigeri, Trillium Health Partners Anne Marie Murphy-Dagres, Providence Care (Ontario)

Ann Elizabeth Pottinger, Centre for Addiction and Mental Health Angela Poulton, Centre for Addiction and Mental Health Margie Powers, Providence Care Farzana Premji, Scarborough and Rouge Hospital

Estela Navarro, Misericordia Health Centre

Jonette Rama, Centre for Addiction and Mental Health

LieutenantCommander (LCdr) Laura Neal, Canadian Armed Forces

Sirju-Boodo Rautee, Trillium Health Partners

Heather Nesbeth, Trillium Health Partners Michael Nguyen, Runnymede Healthcare Centre Kim Nichiporick, Misericordia Health Centre Valerie Noel, Centre for Addiction and Mental Health Lina Oliver, Centre for Addiction and Mental Health Ibtisam (Ibi) Osman, Humber River Hospital

Anju Regmi, Centre for Addiction and Mental Health Ana Reyes, The Ottawa Hospital

Ryan Snowdon, St. Joseph’s Health Care, Hamilton Donna Spevakow, Centre for Addiction and Mental Health Rani Srivastava, Centre for Addiction and Mental Health Jennifer Steeves, Alberta Health Services Cynthia Stephenson, Peterborough Regional Health Centre Sangeeta Sukumaran, Humber River Hospital Janice Swaby, Humber River Hospital Jennifer Symon, Alberta Health Services

The Nurse

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

Angela Tsang, Vancouver Coastal Health, Vancouver General Hospital (F) Tamding Tsomo, Runnymede Healthcare Centre Ann Ukamaka Aneke, Centre for Addiction and Mental Health Abby VanCamp, Kemptville District Hospital Janelle Van Halteren, Humber River Hospital

Paula Reynolds, Humber River Hospital

Rahel Tewelde, Runnymede Healthcare Centre

Debbie Roopnarain, Centre for Addiction and Mental Health

Stephanie Thompson, Southlake Regional Health Centre

Sue Rouse, Humber River Hospital

Leah Thorp, Saskatchewan Health Authority

Carrie Webb, Southlake Regional Health Centre

Kelsang Topden, Centre for Addiction and Mental Health

Stephen James Webster, Alberta Health Services

Mike Rumble, ORNGE Air Ambulance Mary Jane Scott, Centre for Addiction and Mental Health

Marian Van Riel, The Ottawa Hospital Rosie Wang, Sunnybrook Health Sciences Centre

Monika Widjaja, Centre for Addiction and Mental Health Brenda Wilks, Southlake Regional Health Centre Alisha Williams, Humber River Hospital Kyra Wilson, Centre for Addiction and Mental Health Lyndsey Wintle, St. Joseph’s Health Care, London Tracy A. Woods, Southlake Regional Health Centre Barried Xavier, Runnymede Healthcare Centre Chime Yangzom, Runnymede Healthcare Centre Juyoung Yoon, Peterborough Regional Health Centre Roebuck Yumul, Scarborough and Rouge Hospital



Dan Chisholm Casey House

n 1988, as awareness of the AIDS epidemic grew in North America, people affected were dying quickly, in large numbers and alone. While in hospital, they were isolated from everyone, even caregivers. Meal trays were left outside the room where patients could not access them. Nurses, physicians and others were so afraid of “catching” the dreaded “gay” disease that they protected themselves and left patients alone, often leaving them to die without a single soul around. It was in this context that Dan Chisholm, a young RN working at St. Michael’s Hospital in Toronto, heard


DAN ALSO MODIFIED HIS KNOWLEDGE, SKILLS AND ABILITIES TO BECOME A NURSE WHO TRULY DEMONSTRATES THE DEFINITION OF THE WORDS ‘HOLISTIC CARE’ AS HE INTEGRATED BIO – PSYCHO-SOCIAL CONCEPTS INTO HIS PRACTICE of Casey House, the first freestanding hospice in Canada, for people with HIV/AIDS, and decided to join their team shortly after Casey House opened its doors in March 1988. Dan needed to go where clients would be treated like human beings and be cared for in

Stronger together When it was first proclaimed in 1985, the week designated to acknowledge nurses’ contribution to health care was called National Nurses Week. In 1993, the name changed to National Nursing Week to emphasize the profession’s accomplishments as a discipline. Canada’s nursing profession includes four regulated nursing designations. While differences exist in their scopes of practice, research suggests that strengthening collaboration between nurses and understanding the unique contributions of each nursing designation will positively impact the profession by increasing nurses’ satisfaction and improving patient outcomes. Our health system is facing significant challenges, so more than ever Canadians and health-care leaders are calling on nurses to work collaboratively and lead interprofessional health-care teams in different settings. Nurses are stronger together. The Canadian Nurses Association believes National Nursing Week offers a tremendous opportunity to recognize nurses from all domains, practice settings and designations to come together and celebrate the great work and value they bring to patients, clients and communities. Celebrate the nursing profession this week by using #YESThisIsNursing in your social media activities. Happy National Nursing Week from CNA!

Interested in getting more involved in the work of CNA or becoming a member? Visit


their final hours and days. He became one of the nurses who greeted clients with HIV/AIDS with a hug instead of a hazmat suit, which at the time was the preferred form of health care protection. Dan was an active member of the inter-professional staff team who strove to create an atmosphere where people with HIV/AIDS found acceptance, support and hands-on care; where clients and their chosen family could relax and feel welcome no matter the circumstances; where dying was a peaceful experience rather than a lonely one. Death was the only outcome in the early days of HIV/AIDs care. Clients were admitted to Casey House for one or two days, or for just a few hours prior to their death. Often clients were alone, shunned by families and society; a blur of stigma and fear. This intensive caring would also take its toll on the clinical staff; it was not uncommon in these early years for Casey House staff to support hundreds of young vibrant men who were dying.

However, Dan felt he was making a difference, not only to the clients, but also to their partners and other members of the community. If you talk to Dan, he will tell you how well he remembers the first client who recovered enough to walk out of Casey House. The introduction of ARV’s (anti retro viral medications for treating the HIV virus) were making a difference. This was a new phenomenon for staff. Now they not only had to assist clients who were palliative to die with dignity but also had to help people live with the disease. This required a different type of nursing. There were now additional issues for both the client and his clinical team. Dan, already an excellent palliative nurse now had to learn how to support individuals living with HIV as a chronic illness, to manage the systemic and often debilitating components of having a severely depressed immune system. Dan had to pursue knowledge in what the disease process was doing to the body. He learned about the new medications and how they were affecting clients, how difficult it really was to live with HIV, the impacts of aging with HIV and what the long-term exposure to treatments meant to assist recovery whilst causing significant side effects. As more and more clients were living with HIV new populations of those infected with the virus were emerging. Mental health and substance use were



Nominated by: Kathryn van der Horden BScN RN, Clinical Manager, Casey House and Karen de Prinse, MN, RN, Chief Nursing Executive, Casey House

prominent issues for the majority of clients Dan was now seeing at Casey House. Once again, Dan had to enhance and build his skill set. Dan, an excellent palliative and then medical surgical nurse mastered the skills and became an excellent mental health and substance use nurse. As the team around these HIV clients changed, Dan also modified his knowledge, skills and abilities to become a nurse who truly demonstrates the definition of the words ‘holistic care’ as he integrated bio – psycho-social concepts into his practice. Continued on page 54


THIS IS YOUR WEEK! CNA joins you in celebrating the nursing profession.


Visit for celebratory messages and videos and to see how we helped make National Nursing Week a reality!



Photo credit: James Park

Marilou Gagnon

University of Ottawa; Overdose Prevention Ottawa

have known Marilou Gagnon for 12 years. She is an award-winning nursing educator and an outstanding researcher whose program of research focuses on social justice and the advancements of the rights of marginalized communities. In addition to this, she is known for her ability to engage in public debates and bring nurses together to advocate on issues related to HIV, harm reduction, drug policy, and health equity. In recognition of her advocacy work, she has received the 2015 Outstanding Advocate Award from the Canadian Association of Nurses in HIV/AIDS Care (CANAC) and the 2018 Leadership in Political Action Award from the Reg-



SHE IS AN AWARD-WINNING NURSING EDUCATOR AND AN OUTSTANDING RESEARCHER WHOSE PROGRAM OF RESEARCH FOCUSES ON SOCIAL JUSTICE AND THE ADVANCEMENTS OF THE RIGHTS OF MARGINALIZED COMMUNITIES istered Nurses Association of Ontario (RNAO). At the end of August 2017 she joined Overdose Prevention Ottawa (OPO), a group of passionate advocates who implemented a volunteer-run overdose prevention site in downtown Ottawa. This site was

opened as a direct response to the overdose crisis and the rising number of deaths in Ottawa. Between January and October 2017, there was a 76per cent increase in overdose deaths in Ottawa (the months of July and August showed the highest numbers of overdose deaths in that year). In

response to the lack of action at the municipal and provincial levels, OPO opened the first safer consumption site in the city on August 25 with the goal of preventing overdose and overdose deaths. At the site, volunteers were trained to prevent overdoses by actively monitoring and stimulating people who were heavily sedated. They were also trained to provide first aid to people who overdose. Guests who used the site could also access naloxone, harm reduction supplies, and fentanyl testing strips. The site remained open for 78 days. Every day, volunteers would set up the site, provide the service for three hours (between 18:00-21:00) and would take down the site (see picture). Rain


or shine, volunteers repeated this process through the months of September, October and November. The site was forced to shut down on November 9 due to the weather and lack of support from local and provincial authorities. A total of 3667 visits were recorded. Naloxone and rescue breathing was used five times to resuscitate people who had overdosed and stopped breathing. In addition to this, OPO estimated that between 78-234 overdoses were prevented by actively monitoring and stimulating guests who were heavily sedated. Being the only nurse on the core organizing team, Marilou was responsible for developing protocols, securing medical supplies, training all the volunteers (more than 120), sup-


porting the volunteers (including the nurse volunteers) during their shift, and acting as the clinical lead person for questions, issues, and media interviews. She was also a key member of the team, doing on average three to four shifts a week on top of her full time position at the University of Ottawa. As a nurse volunteer with Overdose Prevention Ottawa, I can attest to the fact that her contribution was simply outstanding. She had a direct impact on hundreds of volunteers by mentoring, training, and supporting them – in addition to designing a service that worked efficiently and safely. I was most impressed by her ability to mentor other nurses who were new to harm reduction. She would sign onto shifts to


train them one-on-one and encourage them to take initiatives, ask questions, and reflect on their role as nurses. She would follow-up with them after their shifts, send regular email updates, and debrief after difficult situations. She went above and beyond to support nurses who responded to overdoses and was available 24/7 to help them cope with that experience. She also

had a direct impact on hundreds of clients who use the service by being available to answer their question, help them connect with health care providers, assessing them when they were unwell and even saving their life, which she did one more than one occasion. Continued on page 54

Nominated by: Jean Daniel Jacob, RN, PhD, Associate Professor, School of Nursing, Faculty of Health Sciences, University of Ottawa



Angela Tsang Vancouver Coastal Health aving worked in research for many years, I’ve always believed that research is not only an extension but a huge part of our healthcare system. In my opinion, research and healthcare professionals should not only possess competencies expected of their roles but more importantly, they should be inherently caring. First and foremost, caring about patients/clients we serve and whose existence should be central in how we shape our values and goals. We should also care about the quality of the work we produce in all aspects of the job. While it is important to be able to carry out specific duties in the most effective and efficient way possible, it is imperative that


we conduct these duties demonstrating outstanding service, integrity, and compassion. The challenge at times in an increasingly demanding environment is finding this balance and being able to ensure that caring for patients is not overlooked. Our nursing hero nominee, Angela Tsang, has certainly demonstrated this balance and has exceeded all expectations. It’s my pleasure to be given this opportunity to highlight her outstanding qualities. Angela joined the Vancouver Spine Research Program a few years ago as she started her clinical research nurse position. She came with glowing remarks from our spine surgeons who have worked with her in the OR department at Vancouver General Hos-

#YESThisIsNursing We are excited to celebrate Nursing Week with our Nurse Practitioners, RPNs, and RNs! Working in a collaborative environment, our nurses demonstrate their ongoing leadership in the specialty of mental health practice by advancing their skills through specialized training such as CBT for Psychosis to ensure our patients receive the right care for their diagnoses. They demonstrate their commitment to advancing a Recovery environment through their participation in the hospital-wide implementation of the SafeWards model, providing staff and patients with concrete interventions to support Recovery utilizing a co-designed approach and the use of the Recovery Assessment Scale to

measure our patient’s perception of their Recovery. Ontario Shores’ nurses also helped us achieve key milestones over the past year which were aimed at improving access and reducing wait times for critical mental health care services, including the opening of the new Geriatric Transitional Unit which provides specialized services for individuals with dementia that present with challenging behaviours or severe psychiatric symptomology, the growth of our ECT program, and the expansion of CBT Services. We recognize the vital role that mental health nurses play in supporting individuals, families, and communities living with mental health challenges to improve their quality of life. #YesThisIsNursing! 38 HOSPITAL NEWS MAY 2018

pital. Angela expressed her strong interest in research and in particular, the work that our spine surgeons do as clinician-scientists. The research nurse role requires not only strong competencies as a nurse, but also the ability to swiftly learn different skills and requirements of specific research studies. After just a few months of working with Angela, it was very clear that she is exceptional. She communicates effectively at a high level, in a thoughtful and organized manner. Her ability to acquire new skills and to process information is evident as she learned the many facets of research, skills that involve patients both directly and indirectly. She considers new projects and the operational challenges as learning opportunities, which she faces head-on. While it’s not surprising to many that Angela is capable of taking on many responsibilities that are especially new to her, it’s still quite fascinating to see her achievements. As her manager, it has been very rewarding for me to witness her professional and personal growth – a demonstration of “taking a role and running with it.” Her willingness to learn and openness to the dynamic nature of research has made it possible for this growth to flourish. While the more tangible skills are commendable in and of themselves, qualities such as caring and awareness are also important in healthcare. These are some characteristics and values that I personally remind everyone in our research team to put at the forefront, as we deal with our day-today activities. In Angela’s case, her inherently caring nature is evident when she interacts with patients and their families. In many cases, this initial interaction involves individuals with a very recent traumatic spinal cord inju-


ry, where a clear understanding of her role as research nurse and her innate ability to be compassionate are both required. In this acute environment involving very vulnerable patients, her ability to communicate effectively and actively listen to both the patient and the patient’s family shines. As you can imagine, it would be impossible not to be affected and touched by the individual stories and the impact of traumatic spinal cord injury. In some of our conversations, Angela recognizes how deeply sad some of these situations are and realizes how impactful it has been on her, much more than she expected. She shows empathy towards others while conducting her duties as a research nurse in a very thoughtful and organized manner. It is by achieving this balance that makes her an excellent research nurse, particularly in an environment with patients requiring complex and specialized medical care. Self-evaluating and learning about herself is a reflection of her awareness and of her personal and professional growth. In her current role, she’s able to see some patients as they go through the continuum of care – from admission to VGH to their rehabilitation and community reintegration. Like many in our Spine Program who are very passionate in providing excellent clinical care, she finds fulfillment seeing patients and their families that she has come to know, witnessing their recovery and improvement. She always conducts herself in a calm, friendly, and professional manner. She is very patient and generous with the time spent with our research participants, addressing questions and providing assistance as necessary. Dr. Marcel Dvorak, Orthopaedic Spine Surgeon, UBC Professor,


ICORD Investigator and Associate Senior Medical Director, Vancouver Acute, VCH couldn’t agree more: “Angela Tsang is a truly exception-

al nurse in both the operating room where she functions as a subspecialty spine OR nurse and on the ward and in the clinic where she is a research

nurse responsible for examining and consenting patients to clinical trials that are often initiated within hours of devastating spinal cord injuries. You can imagine that it would take a particularly compassionate, informed, and delicate communicator to discuss the participation in a clinical trial that involves withdrawing spinal fluid from patients following acute spinal cord injury. Angela has the unique ability to speak to these patients from a place of competence, knowledge blended with equal measures of compassion. This is a particularly remarkable and unique skill that enables her to go beyond the call of duty every time she takes “research call” for our spine research studies. Dr. Brian Kwon, Orthopaedic Spine Surgeon, UBC Professor, ICORD Investigator and Canada Research Chair in Spinal Cord Injury had this to say: “Angela is the consummate professional in all aspects of her nursing role.

In the operating room, she is second to none in her knowledge of the surgical procedures and technology. When working on spine, she became more familiar with how to operate the surgical navigation system better than some of the spine surgeons! In her research role, she is instrumental in the conducting of clinical trials in acute spinal cord injury. She has mastered the role of talking to families in this time of crisis and providing them invaluable information about their spinal cord injury and related research. She has even taken a leading role in talking to patients with spinal cord injuries who are dying about donating their spinal cords for research after they pass. These are extremely sensitive discussions and Angela has been an outstanding resource for patients and their families. In so many ways (both clinically and in research) she has gone far and above her call of duty and is an inspiration H to many.” ■

Nominated by Allan Aludino, Research Program Manager, Vancouver Spine Research Program, UBC/VCH

Thank you to our nurses at Ontario Shores for supporting and empowering our patients through their recovery journey. #YESThisIsNursing!


Trillium Health Partners



#YesThisIsNursing May 7 - 11, 2018

National Nursing Week is a time to acknowledge the commitment, dedication and professionalism that our nurses bring to their practice each and every day as they provide exceptional patient care. Our more than 3,900 nurses at Trillium Health Partners wish to thank the allied health professionals, physicians, support staff, volunteers and learners who work together with them as partners in creating a new kind of health care, grounded in the values of compassion, excellence and courage. We are proud to work together as part of a team!

Better Together


Guen Kernaleguen Alberta Health Services uen is an enterostomal therapy nurse, often called a wound care nurse, at the Stollery Children’s Hospital in Edmonton, Alberta. When Guen explains to patients and families what she does, she says she deals with “bummies on the tummy” (intestines out of the stomach), g-tubes, sore bums, and wounds. What makes Guen unique is that she is the only enterostomal therapy nurse at the Stollery, providing care throughout the site, from intensive care to ambulatory clinics. While most nurses are specific to a unit, program, or area of a hospital, Guen provides care for all inpatients and outpatients who require wound care. While working in adult care, Guen became interested in wound care. She took an 18 month course and became registered with the Canadian Association for Enterostomal Therapy. After completing her training, she transitioned to paediatric care at the Stollery in 2014. Since then, she has also completed her clinical masters in wound healing. Every day for Guen is as different as the patients and families she cares for. Each time she meets with a family there is a lot of education to help patients and families learn methods and tricks that can make their lives easier. As a wound care nurse, she maximizes patient/family self-care through one-on-one education and consultation. She also does a lot of healthcare provider teaching with bedside nurses and physicians, and collaborates with inter-disciplinary team members on a daily basis. With complex wounds, there are many things that need to be considered for children. Pain tolerance


TOP is lower for patients, so understanding how to accommodate each child is different, and can take a lot of time and understanding. Physicians time some of their interventions so that Guen can be included – she believes timing things around what works best for the family will lead to better outcomes for the entire care team, including the family. While Guen can be found throughout the hospital, she spends a significant amount of time in the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU), working with some of the most complex pediatric cases at the Stollery.


When asking her colleagues if she is worthy of a nursing hero award, Dr. Vijay Anand, pediatric cardiac intensivist, was quick to vote for her. “Guen works around the clock, is the only person on call for what she does, and she takes care of the entire hospital. She is always available, willing to meet to discuss patients, and if she doesn’t already know the answer to your wound-care questions, she will find the answer. She is possibly the most dedicated healthcare provider I have ever seen. I don’t know how she does it. Before Guen started at the Stollery, we used to have pressure ulcers all the time in the PCICU. After she started, she worked with OT and PT, and she decreased the number of grade three or above pressure ulcers to zero (2015 and 2016). For a high-volume cardiac ICU, that is virtually unheard of.” – Dr. Vijay Anand

Guen is involved in a number of research projects at the Stollery, and initiates and participates in research that expands nursing knowledge. She is presently working with a team comprised of two intensivists and critical care Nurse Practitioner in intensive care to develop a wound assessment tool for Neonatal Intensive Care Unit patients. She is also involved in research with burn unit patients, aimed at improving the patient experience with dressing changes. At the Stollery, family-centered care is a priority. Guen embodies that in all she does, and by providing continuity of care to patients and families. Last year, Guen was featured on the Stollery Facebook’s page for their Faces of the Stollery album. The photo received over 500 likes and 30 shares. Comments from patients, families and staff included: “Guen is the most amazing gal I met in the NICU. She was so sweet and caring and patient. She gave me the confidence to change my son’s ostomy bag and made us so comfortable every time she was around”. – Kelby “She is absolutely amazing, and I could never sing her praises enough. We worked closely together with my son and his 4 stomas throughout his entire stay, and I am just so grateful for all of her knowledge and advocacy. So many medical professionals were dumb founded by his ostomy site, and she barely batted an eye before helping me to become hands on with my child’s wound care. By the end, the cardex had “address Guen or Mom on dressings”. – Cherish Guen’s smile, warmth, and calmness in a situation is infectious. She loves working with patients and families and really enjoys empowering parents to learn how to care for their kids and become comfortable with looking after certain aspects of their care. And it’s obvious that patients and families love H working with her too. ■

Nominated by: Kristy Cunningham, Executive Director of Critical Care and Respiratory Therapy, Stollery Children’s Hospital, Alberta Health Services



Leah Thorp Saskatchewan Health Authority Nursing Week Is Something To Celebrate! On behalf of all of us at the Health Care Providers Group Insurance Plan, we’d like to take a moment celebrate all of the hard-working nurses across Canada! The impact you have on our healthcare system is immense and invaluable, and we’re IRUHYHUJUDWHIXOIRUWKHSRVLWLYHGLÎ?HUHQFHV that you make each and everyday. Thank you for your continuous compassion, care and dedication!


hen I think of who I would consider a nursing hero, Leah comes to mind without pause. I had the unfortunate pleasure of meeting Leah when I became a loss mom. She was working as the Perinatal Outreach Coordinator at the Regina General Hospital where I had delivered my son sleeping six months prior. A friend and I arranged to meet with her and another staff member so that we could run past our ideas for a grief project – this would be a way to give back to the other families who would inevitably be facing loss in the future, just like we had. Leah and her coworker helped to coordinate the donation of handmade mementos for stillborn and miscarried babies without hesitation, encourag-


ing and guiding us along the way. She presented our project after having asked permission, when she travelled to a perinatal loss conference way across the country on the east coast. She helped to show us that what we are doing is worthwhile and appreciated. Because of her, we found purpose and a way to connect and support other loss moms. I will never forget our first delivery of mementos and first feedback from a family who had been impacted by our donation. Leah has helped us to build a supportive community. In Leah’s role, she facilitates a Perinatal Advisory Council, and I am lucky to have become one of the Patient Family advisors. She organizes meetings that have become a safe place for all of us to share our perinatal experiences, good and bad, which helps


I WANT TO THANK LEAH FROM THE BOTTOM OF MY HEART FOR ALL OF THE MEANINGFUL WORK SHE HAS DONE WITHIN THE PERINATAL LOSS COMMUNITY. SHE HAS TOUCHED MY LIFE IN MORE WAYS THAN ONE – WITH ENCOURAGEMENT, SUPPORT, GUIDANCE, RESOURCES, COMMUNITY, AND HANDS ON NURSING MYSELF, HUSBAND AND BABY to bring meaningful change to our healthcare teams. She has arranged for management and other professionals to sit and listen to our patient experiences – this in itself has been such a gift. She has helped patients find their voices and connected them with those who need to hear it most – their healthcare providers. At a recent perinatal loss conference where she was also involved, she had six loss parents share their stories with an entire auditorium full of people who wanted to learn from us.

And finally, when I experienced the loss of another baby, I was lucky to have Leah care for me through my labour. She was the best distraction on one of the worst days, and caught my precious baby for me, born sleeping. She treated him as she would have any other baby – our delicate little son, calling him by name and bathing him for us when we did not have the strength. We will forever cherish the memory box that we came home with from the hospital, the hand and footprints she so delicately pressed with ink for us.

I want to thank Leah from the bottom of my heart for all of the meaningful work she has done within the perinatal loss community. She has touched my life in more ways than one- with encouragement, support, guidance, resources, community, and hands on nursing myself, husband and baby. Thank you for giving a voice to those who have experienced most painful losses, and for helping everyone remember our babies. You are my nursing hero.

Resuscitation program. When a trial Perinatal Loss Team program was developed Leah eagerly joined to participate in providing appropriate care to families experiencing a loss at a variety of gestations. She strives to take every opportunity to learn more about Perinatal Loss and co-presented this response team approach at the Canadian Association of Perinatal and Women’s Health Nurses conference. Leah excels in her knowledge of the aboriginal population and participates in many committees working to improve the healthcare of this population. She currently co-chairs the Perinatal Loss Committee in Regina. Leah has achieved and maintains her Canadian Certification in H Perinatal nursing. ■



Through her position as the Perinatal Outreach co-ordinator Leah strives to teach evidence based nursing practice to healthcare providers around Southern Saskatchewan. She facilitates learning in many areas of high risk obstetrics including the Neonatal


Nominated by: Jennifer McKnight

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Catharine Petta Holland Bloorview Kids Rehabilitation Hospital atharine Petta graduated with a Registered General Nurse Certificate from King’s College from the University of London in 1981. Since that time, she has dedicated her time in various nursing care positions before coming to Holland Bloorview in 2005. Here, she worked on the specialized orthopedic and developmental rehabilitation inpatient unit. She is also a member of the Nursing Practice Council. In 2009, Catharine embraced a new position at the hospital in ambulatory care to focus her care on children with autism. In this role, Catharine has demonstrated enduring commitment to help children and youth with autism and their families live their most meaningful and healthy lives. Her role in the clinic is directly related to supporting clients and families at home. On any given day it is not uncommon for Catharine to receive numerous phone calls from parents who ask for her advice and expertise about situations they experience within their community. It was one of these situations that prompted Catharine and a research colleague at Holland Bloorview to collaborate and respond to a parent’s request. This request was to educate bus drivers about autism and provide them with the skills and strategies they need to ensure the drive and transition to and from school is a success for their children. A key component of the education is to develop communication strategies and approaches, all which affect a child’s ability to have a successful bus ride and day at school. With the goal of autism


awareness, these sessions provide bus drivers with effective strategies on how to best approach children with autism with understanding and empathy. The workshop has been delivered to over 200 bus drivers from two large school bus transportation companies in the greater Toronto area. These sessions were so successful that they have been conducted across Ontario and the team has been invited to numerous speaking engagements throughout North America. The education workshop uses a “train the trainer” model where leaders can now train drivers to reach an even broader audience. Catharine is also very involved in educating parents about healthy sleep for children with autism. The Autism Treatment Network completed research on sleep for this population with very positive results. With this valuable research Catharine participated in the development of an Autism Sleep Education Program, which she facilitates for clients and parents. When Catharine is not working in clinic, participating in research, working on her BScN at Ryerson University or educating families she is reaching out to other professionals in the healthcare community to build awareness for kids with autism. She has completed sessions with the Toronto Catholic District School Board, Ontario Camps Association, parent groups, Pediatric Nurses Interest Group of the Registered Nurses Association of Ontario

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and Pediatricians, much on volunteer time. Catharine is a strong, passionate and caring nurse who works collabora-

tively within an interprofessional team to ensure each client and their families are receiving the safest and most H meaningful care possible. ■

Thanking Ontario’s Registered Practical Nurses and all other health professionals during Nursing Week As we celebrate Nursing Week, the staff and board of directors at the Registered Practical Nurses Association of Ontario (RPNAO) would like to recognize and thank all of our colleagues and partners, not only in the nursing profession, but throughout the health care sector, for their commitment to patients and families. We would also like to take this opportunity to recognize the truly meaningful contributions that Registered Practical Nurses (RPN) make to Ontario’s health care system every day, and to celebrate the challenging and dynamic, yet deeply rewarding profession we have chosen. As our health care system continues to evolve, RPNs continue to showcase their knowledge and expertise, making positive differences in peoples’ live and leading innovation at the point of care. You are the experts at the bedside, empathetic communicators, ˎljɨƺljɥƃɽȈljȶɽƃǁʤɁƺƃɽljɰӗƃȶǁɰȟȈȢȢljǁɰʰɰɽljȴȶƃʤȈǼƃɽɁɨɰӝŚljȟȶɁʥ that patients and families are in good hands with Registered Practical Nurses.



Jacquie Dunne Markham Stouffville Hospital have worked with Jacquie Dunne for nine years. She predominately works as a co-facilitating nurse in the NICU at Markham Stouffville Hospital (MSH). Consistently she will volunteer to provide extra care to the most frail of our littlest patients who may have significant developmental vulnerabilities above their medically complex needs. Everyone that she works with recognizes how exceptional she is including Dr. Navneet Sharma, MSH Neonatologist, “Jacquie is a very passionate worker in our NICU, her skills are outstanding in what she does – she goes far beyond her nursing duties for the patient as well as the family. She has the ability to foresee and anticipate situations and implement an effective


care plan accordingly. In addition to her excellent clinical skills, she is also a great co-worker. Jacquie brings her maternal skills, empathy and compassion to work every day, which makes her stand out in her profession.” It’s the developmental care that these babies need – the cuddling, soothing, singing, nurturing and talking to them that she continually provides. And this is why Jacquie is a hero to me, her colleagues, the babies in the NICU, and to all the families she supports. This care helps babies develop a secure attachment with her which they need during the critical window of time in the first few weeks of their lives. These babies get to know Jacquie so well that they would eat for her and gain weight when she was on shift. She is so compassionate, professional,








empathic and non-judgemental and they would respond to her consistent caregiving. I can’t remember a time when Jacquie isn’t giving extra tender, loving, care over and above her daily nursing duties and the stories below stand out with babies who were medically fragile and admitted to the NICU for extended lengths of stay of weeks and sometimes months. 1) Jacquie was often scheduled to provide care for a baby girl diagnosed with Down Syndrome who had three young siblings at home that mom also had to care for, so this little girl was often alone in the NICU. Jacquie would go above and beyond for this little one. She would give lots of extra cuddles, talks and sing to baby when her mom wasn’t able to be at the hospital. Jacquie was also a wonderful

recruit for other staff to take cuddle turns when she was working with other babies. It was common for Jacquie to get staff on their lunch break or one of our volunteer cuddlers to support this little one. The mom is so grateful for the care Jacquie gave her baby. “She’s an amazing nurse, she thought beyond the medical needs of my baby. Without her, we would still be in the NICU trying to figure things out,” says Amy Ho. “She really got to know my baby and gave me tips to help with her development. She became like a member of our family.” 2) There was another baby who also had many exceptional diagnoses and week after week I would see Jacquie taking the care of this little girl.

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Mom was not able to be present all the time as she had other children as well. Jacquie was at the bedside comforting, soothing, and cuddling this girl when mom couldn’t be there. Jacquie went beyond the nursing duties to meet her attachment needs and provided developmental stimulation that was so critical during this time. According to mom, Tara Smith, “Jacquie took such good care of my infant daughter during her five-week stay in the NICU. Not only was Jacquie a skilled and attentive nurse to my daughter, but she was a source of support and light for me as well during those long and difficult weeks during my daughter’s recovery. I am so grateful for all Jacquie did to assist our family with her compassionate care. I will never forget her kindness!” 3) Jacquie also cared for a baby boy who was in Children’s Aid Society care and the foster family was not able to be in the hospital very often. She made sure that he was cared for,

cuddled, stimulated developmentally and nurtured. She organized the volunteers in the ‘cuddler program’ so that he would have hugs, songs, and cuddles on a regular basis. When she was done providing care for the other babies on the unit, she would be found at bedside with him making sure he had a calm soothing voice to hear. The common denominator is that Jacquie volunteers for the most medically and developmentally vulnerable babies in our NICU. She is so consistently positive, happy, smiling and sincerely engaged to meet the medical, physical, emotional and developmental needs of these little people and their parents. She is also a professional team player who engages the skills of the allied health team to its fullest potential to support each baby. Jacquie is delightful to work with and all parents that have had her caring for their baby would give H her a standing ovation. ■

Nominated by: Joey Crump, Social Worker



Stephen James Webster Alberta Health Services I

want to share this story as I found it very moving. I also feel that it is a good representation of the passion and dedication nurses have for the welfare of their patients both professionally and personally. I want to show the magnitude of the respect and thoughtfulness that was shown by an RN, Stephen, when a particular patient passed. I will use the name Mr. Smith for this patient for privacy purposes. Stephen had known Mr. Smith for several years when hospitalized for very long stretches on his unit. Mr. Smith was impoverished as a result of various social and physical issues over the years. He had very few friends and was estranged from family. Mr. Smith could be a challenge at times but the


staff became somewhat endeared to him because of his eclectic character, stories, dry humour and what he went through. He was a character and the unit staff became in a sense his family. At one point during his hospitalization Stephen had made a point of establishing a rapport with Mr. Smith when he realized that Mr. Smith was giving up. With the outstanding support and care provided by the nurses and physiotherapists on the unit Mr. Smith made strides towards improving his health. During his hospitalization, Mr. Smith re-connected with his faith as a source of strength. After a prolonged hospital stay, fraught with several complications and trials, Mr. Smith’s perseverance paid off. Eventually he made enough progress and was discharged.


Sometime later Mr. Smith returned to Stephen’s unit. After another long hospitalization it became evident that Mr. Smith was not going to be able to go home and was suffering. Mr. Smith’s health deteriorated; he experienced increasingly longer stretches of being unresponsive. It became evident that Mr. Smith’s condition was not going to improve and that his passing was likely being prolonged. The hospital came to the very difficult decision to remove aspects of care such that Mr. Smith would likely pass. One of Mr. Smith’s last conscious moments with Stephen was to smile in acknowledgement of wanting to listen to country music playing from a CD player that Stephen had brought for his room. On a shift where Mr. Smith was Stephen’s patient, it was determined that the level of health care was definitely going to be reduced significantly the following day. Stephen was not scheduled to work on that particular day. He had a good inkling that Mr. Smith would pass and would likely be alone. On his day off, Stephen went in to see Mr. Smith as a visitor at 7am to keep Mr. Smith company. Stephen found that Mr. Smith was unresponsive and confirmed the care would be reduced. Despite Mr. Smith’s state, Stephen spoke to Mr. Smith as if something would get through, telling him what was going to happen and that he wouldn’t be alone. Stephen held his hand and recounted some of the stories they had shared with each other. Knowing that Mr. Smith was religious, Stephen printed Psalm 23 and put it beside Mr. Smith’s pillow. Stephen read it to him throughout the morning.

Staff members came in to say their good byes during the course of the morning. Stephen continued to reassure Mr. Smith that he wouldn’t be alone and told him how his tenacity was admired for enduring the trials and suffering. The level of medical intervention was reduced. A few minutes later, Mr. Smith passed peacefully while Stephen held his hand. Mr. Smith was not alone. Shortly after Mr. Smith passed, Stephen found out that according to Mr. Smith’s religion it was a strict custom for the body to be guarded until buried. Stephen knew how much it would mean to Mr. Smith to follow the custom so he decided to stay until the funeral home arrived. More staff members came in to pay their respects and were quite moved by his death having known and cared for him for a long time. The transport to funeral home arrived just before 3pm. Mr. Smith had a leather back pack that was so aged and worn that it looked like a museum piece. It contained a few books and had been his one main possession in the hospital. Some of the staff had come up with an idea that it would be nice if it was buried with him. Several days later Stephen attended Mr. Smith’s modest funeral. Also present from the unit were physiotherapists and a nurse practitioner. The burial was done according to his religious customs and he was buried with his backpack. Many of Stephen’s fellow nurses told him they were glad Stephen was able to be with Mr. Smith at the time of his passing and also

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resent his “family” at the funeral. Mr Smith’s grave site was marked only with a simple plastic tag and ironically he is buried next to a doctor. When I mentioned that I wanted to submit this story, Stephen was initially reluctant as he considers himself to be part of a wonderful team of very caring professionals. However, he decided to let me proceed because if, by chance, this submission does receive any prize, he’d like to use it to get Mr. Smith an actual gravestone, albeit simple. Stephen’s story touched me deeply and I felt that it needed to be shared to show the extent of exceptional and compassionate patient care that many of our nurses exhibit above and beyond H on a daily basis. ■

Angela Cooper Brathwaite

Happy Nursing Week to Ontario’s RNs, NPs and nursing students Nursing Week celebrates the expertise and excellence nurses and nursing students bring to patients, families and communities across Ontario, and beyond. Your focus on evidence-based practice and attending to patients’ unique needs represents the very best of our health system’s strength. Your commitment to Ontarians and the profession extends far beyond the workplace. Your advocacy and voice in the political arena have led to important policy changes that have expanded the role of registered nurses and nurse practitioners, and improved access to care for the public.

RN, MN, PhD, President, RNAO

Doris Grinspun RN, MSN, PhD, LLD (hon), Dr (hc), O.ONT., CEO, RNAO

Thank you for the knowledge, compassion and courage to speak out for nursing and speak out for health.



Alexandra Andric

Centre for Addiction and Mental Health

lexandra Andric is a Registered Nurse who has worked at CAMH since 2006. Previous to the Nicotine Dependence Clinic (NDC), she worked in a variety of Psychiatric settings including the General Psychiatry Program and the Addiction Medicine Clinic. In her current role with the Nicotine Dependence Clinic, Alex provides counselling, support and education to clients. She also monitors clients’ responses to cessation medications, prescribes nicotine replacement therapy and co-facilitates several therapeutic groups. To our staff and clients, she is known as ‘Nurse Alex’. Nurse Alex is our nursing hero at the Nicotine Dependence Clinic. She is the sole nurse among our interdisciplinary team of social workers, physicians and therapists and a champion of evidence-based and high quality client-centred care and treatment for cli-


ents who are interested in quitting or reducing their smoking. She has embraced her role and treats over 1100 clients annually along with serving as a frequent and sought-after educator within CAMH and externally to the organization. Our nursing hero story is one of excellence in client care, inspiring change for clients and providing high quality health behavior change education for health professionals. Alex is extremely personable, approachable and ready to pitch in when her help is needed. Her attitude is consistently to go above and beyond what is required of her with the spirit of wanting the best for her clients and colleagues. I have worked alongside Alex for years in different capacities at the Nicotine Dependence Clinic and have had the opportunity to observe her as an educator and clinician. In our clinic, we often have a very crowded waiting room and there can



be some wait-time before clients get to see the physician or nurse. Many of our clients have been long-time smokers and attend our clinic with concurrent mental health or other health conditions. Alex welcomes each client with a bright smile and engages them right from the start so they feel comfortable, more relaxed and ready to approach their journey to address their tobacco use – something that is inherently difficult and can be uncomfortable. She is enthusiastic in her role and empowers clients to embrace this difficult change. As the sole nurse among our clinical team, Alex is in a unique position and is regularly faced with challenges that she must resolve. For instance, she approaches challenging scenarios with a lens of medical and clinical insight and assists her team in problem solving. When there are clients who present to the clinic in crisis (active suicidal ideation, intoxication, psychosis) Alex is adept at recognizing symptoms and leads the team in making a clinical decision of how to best treat the person. She makes them feel safe and grounded and often will be the one to accompany them to the ER when needed. Also, she routinely makes decisions around client medication interactions with smoking cessation prescriptions and Nicotine Replacement Therapy cessation aids to determine the best treatment options for each client. She uses sound clinical judgment during clinical case rounds and demonstrates, critical decision making skills when offering solutions and approaches to complex client situations discussed by the team. She establishes a healthy rapport with her many clients and is friendly and approachable. Her communication style is guided by her training in Motivational Interviewing. She guides clients along motivated self-change ensuring she is actively listening, is empathetic, rolls with resistance to change, elicits information from the client and then

provides feedback and recognizing the discrepancy between their treatment goals and current behaviours. Her excellence in therapeutic communication shines while she leads client groups and workshops. Alex speaks very clearly, uses language that is tailored for her audience (for example, does not use jargon while speaking with clients) and makes herself available for questions. She establishes a healthy rapport with her many clients and is friendly and approachable. Her communication style is guided by her training in Motivational Interviewing. She guides clients along motivated self-change ensuring she is actively listening, is empathetic, rolls with resistance to change, elicits information from the client and then provides feedback and recognizing the discrepancy between their treatment goals and current behaviours. She is very skillful in her use of MI and routinely seeks out further opportunities to enhance her training through workshops or meeting with her colleagues. When facilitating client groups, Alex makes everyone feel welcome and safe. She creates a safe space for clients to speak freely about their experiences and creates a non-judgmental climate. Some clients prefer not to share their experiences and Alex respects and acknowledges this as well. She affirms what her clients share and thanks them for their honesty and acknowledges that some things are difficult to share in a group. Nurse Alex has a very engaging presentation style and tries to lighten the mood of each session she facilitates which in turn helps with client retention and keeps clients engaged in treatment. She is the lead presenter of our “Getting Started” intake psychoeducation workshop and delivers this content on a weekly basis. She has been successfully able to turn otherwise dry material into accessible and inviting content intended to assist in behavior change and introduce clients to our services. She is an excellent

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NATIONAL NURSING WEEK 2018 communicator and speaks very clearly and illustrates concepts with examples which bring the material to life. She can synthesize complex scientific concepts and make them comprehensible to a wide audience. In an environment where there are often difficult and very challenging scenarios she has an infectious positive approach to her work that is admired by both of us as nominators and by her colleauges. Despite a full schedule with her clients, Alex demonstrates a passion for continuous self-improvement and goes above and beyond what is required for her role. An outstanding example of this is her commitment to enhancing her knowledge in Motivational interviewing (MI). In 2014, Alex applied to attend the Motivational Interviewing Network of Trainers (MINT) Training for New Trainers (TNT) workshop in Atlanta, Georgia. The MINT trainings are not certifications but are rigorous in nature and involve a competitive application process. The TNT workshop is the first step towards eligibility for membership with the MINT

network and only selects applicants who have demonstrated a breadth of proficient skills and application of MI. To prepare for this application, Alex engaged the expertise of an MI coach and completed many fidelity measures along with MI coding exercises and theory review. In addition to attending the TNT workshop, she participated in the MINT Forum offering a variety of workshops in advanced MI skill-building. Alex is an outstanding educator and routinely serves as faculty for various TEACH (Training Enhancement in Applied Cessation Counselling and Health) courses: in-class and online version of the Core Course, Tobacco Interventions for First Nations, Inuit and Metis Populations, Tobacco Interventions for Patients with Mental Illness and/or Substance Use Disorders and Motivating Change: How to talk so clients will listen and how to listen so clients will talk. She is often sought out by other organizations to deliver in-service trainings and workshops through TEACH and has trav-

elled across Canada to the Northwest Territories, Nova Scotia, Alberta, Manitoba and throughout Ontario. TEACH has trained over 6000 practitioners to date and Alex has been instrumental in the project’s ability to mobilize Faculty to travel across the country and deliver the trainings. She has also been a key faculty member in a series of online training modules used by a province-wide smoking cessation treatment program to train hundreds of practitioners from more than 200 organizations to deliver evidence-based content expertise in the fundaments of tobacco dependence pharmacotherapy. Because of this, more organizations and practitioners in the healthcare delivery system are able to integrate and deliver smoking cessation treatment to their clients and patients leading to improved health outcomes. Alex has had an equally strong focus on enriching the practices of her colleagues within CAMH. She has been involved in developing training videos intended to impart evidence-based practice guide-

lines for smoking cessation to CAMH practitioners. In addition, she has used in-service presentations to help colleagues from other departments at CAMH to increase their knowledge of tobacco dependence and guide them on integrating aspects of tobacco dependence intervention into their own practice. She has now become a sought-after faculty/trainer on tobacco cessation across the province, and increasingly within CAMH. In addition to training healthcare professionals and clients she also eagerly takes on nursing students in the capacity of a preceptor each year. In summary, Nurse Alex is a hero and champion of tobacco dependence treatment and education across CAMH and is one of the friendliest, most energetic and genuine colleagues I have known. It is a distinct privilege to work with her and to observe the impact she has on a daily basis among our team and with our clients. She is an inspiring and driven person who is well deserving of this Nursing Hero H award. ■

Nominated by: Julia Lecce

CARE Centre Salutes IENs during Nursing Week 2018 CARE Centre for Internationally Educated Nurses (IENs) began in 2001 as one of the first government-sponsored bridge training programs in Ontario. CARE Centre receives funding through the Ontario Ministry of Citizenship and Immigration, and also receives funding from Immigration, Refugees and Citizenship Canada for a Pre-Arrival Supports and Services (PASS) program. CARE Centre provides IENs with one-on-one case management, language and communication skills, exam preparation, professional development, observational job shadowing, mentoring and networking to help them become registered to practice. Since its inception, in collaboration with community and settlement services, healthcare employers and academic institutions, CARE Centre has provided assistance to over 4,000 IENs from more than 100 countries. CARE Centre member IENs work in all nursing fields in Ontario including acute and long-term care, community and public health nursing, and in management and educator roles, among others. CARE Centre recognizes the value of nurses with diverse education and experience and is committed to advancing their full contribution to Canadian healthcare. Contact us to find out more about recruiting opportunities. CARE is a registered charity (Charitable Number 84420 5948 RR0001). To learn more about CARE Centre and its work, please visit

CARE Centre Celebrates Internationally Educated Nurses during National Nursing Week 2018 IENs and CARE Centre: Partners in Healthcare Diversity Contact CARE Centre to find out more about IENs in Your Workplace

128A Sterling Road, Suite 202 Toronto, ON M6R 2B7 416-226-2800



Amanda Jober

Stollery Children’s Hospital, Cystic Fibrosis (CF) Clinic would like to nominate Amanda Jober of the Stollery Children’s Hospital, Cystic Fibrosis (CF) Clinic for the 13th Annual Hospital News Nursing Hero Awards. Since joining the Ambulatory Cystic Fibrosis Clinic in 2014, we have come to know Amanda as a dedicated, loving, compassionate, knowledgeable nurse and friend. Amanda came to the clinic when my daughter was an energetic and imaginative 5-yearold. My daughter has grown up with Amanda and with any luck she will be my daughter’s nurse until my daughter takes the first terrifying steps into the adult world. No doubt Amanda will help to love and support us as we prepare for that transition.


Amanda is not just our nurse. She is like family. We see her regularly, we phone her even more! When things are going well we visit every three months, the past few years far more frequently. Amanda has helped us through some of the hardest times and celebrated with us when things are going well. We don’t just come to clinic, we are welcomed to clinic. Amanda is kind, patient and fun-loving with my very precocious daughter. Since my daughter has grown up in the clinic Amanda knows all of my daughter’s imaginary worlds and even the names and events of imaginary siblings. There have been Pokémon hunts, wheelie-stool horse rides and even a dance party in the clinic room as my daughter was pre-


paring for her first ever admission to hospital. These are just some of the ways she supports my daughter to be a kid in often very difficult situations.

outdoor family and through Amanda and the amazing CF Clinic team we are able to spend weekends in the back country, go cross country skiing and

AMANDA IS CERTAINLY OUR SUPERHERO, SHE DOES SO MUCH MORE THAN KEEP MY DAUGHTER ALIVE. SHE ALLOWS US TO LIVE Amanda and the entire CF Clinic team work very well together. They seem to have a very respectful relationship within the team, and this carries through to how they support their patients. The clinic team supports, trusts, respects and consults each other. This gives our family so much confidence in every member of our team. I have no hesitation putting my daughter’s future in their hands. With the support of this team we work together to develop health goals but also life goals. We are an active

travel. We work together to manage risk vs reward in ways that make life meaningful and enjoyable. Through the hardest times we have had Amanda’s support. In the difficult decision to get our daughter a G-tube, Amanda supported us the entire way. Listening to our concerns and as always helping us to weigh the risk vs reward. Once the decision was made, on our clinic follow up Amanda presented my daughter a doll with a G-tube which Amanda had hand sewn into the doll’s stomach and then carefully repack-


aged. This exceptional gift was one more way Amanda went above and beyond to help my daughter to normalize the G-tube through play. Amanda consistently shows how much she cares and how much she understands that thriving with this disease is more than just doing treatments, it is learning to accept new things, adapting to constant change and finding ways to embrace the new normal. Not only does Amanda and the CF Team show extraordinary support and dedication at clinic they can often be found supporting the entire CF Community at fundraisers and events that are hosted by Cystic Fibrosis Canada. The passion they show for the patients and families they care for extends well beyond the clinic walls and well be-

yond the clinic hours. For Amanda the personal commitment to caring and supporting her patients runs so deep that she has a tattoo with roses that in part symbolize cystic fibrosis. Amanda is an amazing nurs;, she is well trained and knowledgeable in cystic fibrosis. She is an exceptional caregiver who combines her training and knowledge with compassion, care and respect. As our clinic nurse Amanda and the entire CF Team provide us with the tools, resources, education and confidence to live a truly amazing life. We feel like we are heard, appreciated and a part of the team that will see my daughter thrive well into the future. Amanda is certainly our superhero, she does so much more than keep my daughter alive. She allows us to H live. ■

e honouraobnl menti

Nominated by: Michelle

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Marilou Gagnon 2nd Place Winner Continued from page 37

WHILE POLITICIANS WERE HIDING BEHIND BUREAUCRATIC PROCEDURES LETTING OUR PATIENTS, NEIGHBORS, FRIENDS AND FAMILY MEMBERS DIE BY THE DAY, MARILOU STEPPED-IN WITH HER OPO TEAM TO PROVIDE A SAFE SPACE WHERE PEOPLE WHO USE DRUGS COULD FEEL RESPECTED, DIGNIFIED AND EMPOWERED On September 19, she was training a nurse on shift when they had to respond to an overdose after a guest immediately stopped breathing and lost consciousness. After two doses of naloxone and rescue breathing, the guest regained consciousness and had stable vital signs. By the time the paramedics arrived, she was back on her feet. On multiple occasions, I have seen Marilou assess guests who were unwell and needed help: a young guest who was anxious and paranoid after smoking cannabis, a guest who was short of breath and coughing at the bus stop, a guest who was presenting symptoms of a stimulant overdose, one of our regular guests who was feverish and weak and another one with complex wounds, just to name a few examples. Every time, she would find a solution and work with other volunteers to connect guests with health care services while respecting their wishes and preferences. There is no doubt in my mind that what she accomplished with Overdose Prevention Ottawa makes her a nursing hero. I cannot think of another nurse who is more deserving of this Nurse Hero award. “Marilou Gagnon always goes above and beyond for the community, as well as for the team at Overdose Prevention Ottawa. She is an ideal example of a leader. She continually worked hard in order to improve the care and services that were offered at the OPO site. She is distinguished by her professionalism, remarkable leadership and communication skills. Also, her leadership entails her as a very approachable person. Marilou is a talented and caring nurse, it was a pleasure to work with her and see how she always puts the clients and our team’s best inter54 HOSPITAL NEWS MAY 2018

est above all.” Gabrielle Charron, RN (OPO nurse volunteer) “Being aware of the overdose crisis, not only across Canada but also in Ottawa, Marilou could have chosen to

remain in her university professor role. Instead she was instrumental in initiating Ottawa’s first safe consumption site run entirely by volunteers. From a grassy block of land no bigger than an urban lot, tents were erected and equipped, volunteers gathered, food and supplies arrived and Overdose Prevention Ottawa (OPO) was born. Despite public, emergency service, and political objections the project started, continued and grew under Marilou’s guidance and leadership. People who use drugs were drawn to the site, and lives were saved, rather than lost.” Cynthia Kitson, NP (OPO nurse volunteer) “While politicians were hiding behind bureaucratic procedures letting our

patients, neighbors, friends and family members die by the day, Marilou steppedin with her OPO team to provide a safe space where people who use drugs could feel respected, dignified and empowered. Marilou inspired me as a nurse to embrace my role as an advocate and to speak up against inhumane laws that contributed and perpetuated the deaths of thousands of Canadians. It is Marilou’s exemplification of patient-centered care and her contagious passion for advocacy that makes her a nurse hero! I will be forever grateful to Marilou for having contributed to making me a better nurse, a better advocate and a better person. Thank you!” Jean-Laurent Domingue, RN (OPO H nurse volunteer) ■

Dan Chisholm Continued from page 35 Today Casey House is no longer a hospice, but a stand-alone HIV/ AIDS hospital. We recently moved into a new state-of-the-art building, with a new day health program, a new electronic health record and an ever-changing inpatient environment in which Dan is nursing. On any given day, Dan can be found delivering a wide variety of care: providing palliative care in one room, dealing with chest tubes on a client transferred from an acute care hospital’s ICU in another, or supporting someone who is homeless, alone and trying to find other ways of coping with their trauma than by their current substance use. Dan has to adapt daily from client to client. Dan is a nurse who embraces change; learning and growing as clients needs have shifted. Dan mentors new staff, students and his peers so they too can move with the changes we all face in health care. In his role as permanent charge nurse, which he has occupied for over a decade, Dan is the constant, the knower, the facilitator, the mentor, the supporter and most importantly the example of nursing at its finest.

1st Place Winner IN HIS ROLE AS PERMANENT CHARGE NURSE, WHICH HE HAS OCCUPIED FOR OVER A DECADE, DAN IS THE CONSTANT, THE KNOWER, THE FACILITATOR, THE MENTOR, THE SUPPORTER AND MOST IMPORTANTLY THE EXAMPLE OF NURSING AT ITS FINEST Dan is celebrating his thirtieth year at Casey House and his commitment to the clients we serve is truly remarkable. Dan is retiring in June 2018. Looking back on his time at Casey House, his nursing career and his spirit in continuing to provide high quality, effective care it is easy to celebrate Dan and his contributions. Although Dan started out his career as one of many working in a large major hospital in Toronto, he has dedicated his career to a small organization, serving some of our most vulnerable citizens. He has made a difference in many lives at Casey House. In a climate of fear, Dan and his colleagues were not only brave, but also driven by compassion for those who were otherwise marginal-

ized. Dan has remained committed to this population despite phenomenal change over the past three decades. Change can be difficult for many people, but Dan has adapted by expanding his knowledge, abilities and skills to make a difference. Dan is a NURSE who leads by example; caring in the face of the unknown, committed to those he serves. He has assisted countless individuals to live with their HIV/AIDS diagnosis, through the peaks and valleys of their health care journey, and ultimately honouring their lives by caring for them as they died. Any nurse can only hope to have accomplished so much and affected so many throughout their career. Dan is a true H nursing hero. ■


The Consistency of Compassion hen Humber River Hospital opened its doors as North America’s first digital hospital, it was a massive transformation. As with any major undertaking, the move was a mix of excitement at how Humber River was advancing patient care and a nostalgic urge to preserve the past. Not only did patients and staff from three separate facilities come together, but longtime dedicated nurses were walking into a new facility that embraced state-of-theart tools and equipment, automated delivery robots,


bedside computer terminals and Canada’s first hospital-wide Command Centre. Looking back, it’s remarkable to see how much nursing has changed. Or has it? The proliferation of computers, mobile devices, and the growing ability to access the internet anywhere and anytime has irrevocably altered how the healthcare industry operates. Nurses serving on the frontlines today, are adapting how they deliver patient care. More so than ever, nurses are becoming knowledge workers. Embracing technologies to strategically

deliver patient care at the right time, in the right place, and for the right reasons. Not only are nurses becoming more techsavvy, but as more and more patients have access to online medical information, they are empowered to play a more active role in managing their health. As a result, nurses today spend more time educating and guiding their patients. They are also able to help them develop individualized healthcare plans, achieve specific patient goals and most importantly improve health outcomes.

Ida Aspro, a patient who remembers the Church street site fondly, remarked “The new space is bigger and brighter, it has a sense of peace, but the consistency of care and the dedication is still the same. You feel confident you are in the best hands.” Ida reminds us that amidst all the advancements, nurses at Humber River Hospital continue to provide a level of compassion, quality and care beyond compare at every interaction.

Nursing has come far and so have you

Thank You


Patient Care Reinvented MAY 2018 HOSPITAL NEWS 55


Terminal lung cancer patients

accessing medication faster thanks to Canadian first laboratory test By Robert DeLaet first of its kind laboratory test in Canada validated at London Health Sciences Centre (LHSC) and made possible by research at Lawson Health Research Institute provides patients with non-small cell lung cancer a non-invasive option to be tested for a gene mutation and receive life-extending second line therapy medication. Non-small cell lung cancers account for nearly 85 per cent of all lung cancers, with 10 cent of those tumors experiencing a mutation in the epidermal growth factor receptor (EGFR) gene. “EGFR is a gene we all have that maintains normal tissue in the lung,” explains Dr. Mark Vincent, oncologist, London Regional Cancer Program (LRCP). “In some lung cancer patients, the gene turns on inappropriately causing cells to multiply in the lung, grow into cancer cells and eventually spread throughout the body.” Usually the gene mutation appears in late stage lung cancers and patients that are terminal. “There are pharmaceuticals, or first line therapy options, that block the gene mutation with high rate of success; however, their efficacy only lasts a year,” adds Dr.


From left: Dr. Bekim Sadikovic, section head for the molecular genetics laboratories, and Dr. Mark Vincent, oncologist, in the lab where EGFR mutations are tested using the circulating tumour DNA in a patient’s blood. Vincent. After approximately a year, the effects of the mutation return and cancer cells continue to multiply. A novel second-line therapy drug is available to block EGFR mutation, but patients require a biopsy to prove that the mutation has occurred. For small cell lung cancer patients, an invasive biopsy is associated with risk, particularly if the tumour is in a difficult to each place, “some patients cannot or opt not to receive a biopsy due to risks associated,” says Dr. Vincent. Dr. Bekim Sadikovic, section head for the molecular genetics laboratories,

and his team at London Health Sciences Centre’s Pathology and Laboratory Medicine program have validated a blood test capable of detecting EGFR mutations from tumours, using the circulating tumour DNA in patient’s blood. For patients having progressed through first line therapy, this new test reduces the need for additional invasive testing while identifying if the second line therapy would be appropriate to treat this new mutation. “Our test requires a blood draw and we will know the results of the test within 24 to 48 hours,” says Dr. Sa-

dikovic. “If the test detects an EGFR mutation in blood sample, we can be certain that the patient has the mutation in tumour tissue, without having to perform a surgical procedure or biopsy. Alternatively, in case of negative result, there is still a possibility of mutation in tumour, but the tumours may not have shed enough DNA to appear in the blood test.” Should a test prove negative, patients still have the option of a biopsy. Within the past year, circulating tumour blood testing was only available in the United States of America and patients were required to pay for the testing. “We are now ahead of the curve in offering this option to our patients,” exclaims Dr. Vincent. A positive test result allows patient the option of a new second-line therapy that reverses the mutation. “We are able to give these terminal patients an added year of life. Importantly, toxicity is reduced in the second-line therapy drug and patients are able to live the remainder of their life with fewer complications and at a higher quality.” “This is our first clinical application of a blood test that can detect genetic mutations in cancer,” continues Dr. Sadikovic. “We are developing our inhouse capabilities to broaden testing to other cancers including melanoma H or colon cancer.” ■

Robert DeLaet is a Consultant, Communications & External Relations at Lawson Research.

Reshaping palliative care for patients By Dr. Martin Chasen nd-of-life care is a sensitive topic. Given that this stage in a patient’s journey can often be overwhelming and frightening – it is critical to go beyond treating the illness symptoms and provide care for the patient as a whole. This principle is at the core of William Osler Health System’s (Osler) Palliative Care program which pays special attention to the patient’s phys-



ical, social and psychosocial spheres for a more holistic view on care and healing. Narratives behind patients’ situations often show that while they may be in physical pain, their biggest issue is often other contributing factors, like how the family is suffering from the burden of having an ill father. Osler’s medical team is collaboratively working with patients and tailoring the approach to care to positively im-

pact their overall frame of mind and well-being, resulting in more effective treatment. The palliative care program has a multi-pronged model of care supporting patients at various stages of illness through a palliative medicine consult team in the hospital, comprehensive Supportive Palliative Care Outpatient Clinic, community-based Home Palliative Care Program and Cancer

Survivorship Clinic – the only one of its kind in the Greater Toronto Area. Central to this robust approach is delivering integrated care to better meet the individualized needs of patients. Managed by a group of physicians and nurses, including those specializing in palliative care, oncology, respirology and surgery, the team works together to develop a centralized care plan for each patient. As well, social


Southlake doctor helps palliative patients manage pain without narcotics By Kathryn Perrier t’s really tough for anyone who is supporting their loved one through their final days of life. Caregivers don’t always know what to expect and most don’t realize that the patient could need pain medication that could render them unable to communicate. But at Southlake Regional Health Centre (Southlake), Dr. Alim Punja is providing compassionate care to palliative patients that allows them to manage their pain without narcotics. When patients receive a terminal cancer diagnosis, the question of how much pain they will experience is always top of mind. Southlake’s Palliative Care team and Dr. Punja are taking chronic pain management to the next level to allow patients to live their remaining days with less pain and less sedation during those last meaningful moments. “Uncontrolled pain is something that all palliative patients and their families worry about in their final stages of life and knowing that there may be an alternative solution gives patients and their families hope,” says Dr. Punja, on ways he is always looking to do things better for his patients. Dr. Punja is an anesthesiologist at Southlake. He has extensive expertise


in treating cancer-related pain for our palliative patient population. Together with the Palliative care doctors, they have found a way to help our palliative cancer-care patients manage their pain while decreasing or avoiding the use of narcotics. Most recently, Dr. Punja treated a patient who was using very high doses of narcotics for pain that made her essentially uncommunicative with her family. Dr. Punja arranged for her to have a permanent IV line and taught her partner to administer small doses of local anesthetic at home, as needed. In the final days of her life, this patient was essentially off all narcotics and could fully communicate with her family. Families and patients say Dr. Punja’s work, to keep his patients comfortable and able to communicate in their last days of life, means the world to them and to their loved ones. They are also grateful to Dr. Punja for giving them time together. Without this alternative treatment, they would have never been able to say everything they needed to say during those last days and moments. This is the first time a Southlake patient has received this level of care, where the patient or family member is taught how to administer small doses

Dr. Alim Punja is an anesthesiologist at Southlake Regional Health Centre. of local anesthetic as needed instead of using narcotics. Arden Krystal, president and CEO of Southlake Regional Health Centre says, “I am thrilled to see this dedication to our patients, and to know that this patient and her family had added quality time together is incredible. Thank you to Dr. Punja and his team for this great work in serving this patient and her family with purpose.” Dr. Punja will continue to support his patients in the same manner in order to keep them comfortable, offering them the opportunity to live their last days with less pain and to be able to communicate with their loved ones.

Dr. Punja is as an anesthesiologist and interventional chronic pain physician with the department of anesthesiology at Southlake Regional Health Centre. After completing his medical training at the University of Calgary, Dr. Punja then completed postgraduate training in anesthesiology at the University of Ottawa and a clinical fellowship in interventional chronic pain management at the University of Toronto. For more information about the science behind this approach and how lidocaine infusion can work as an effective approach for management of H chronic pain please click here. ■

Kathryn Perrier works in communications at Southlake Regional Health Centre.

ers, dieticians, and physio and occupational therapists help support the treatment process to ensure patients receive the best possible care in a way most convenient to them. It is important to highlight continuity of care for patients regardless of where they are being seen. For instance, many oncology patients are referred back to the care of their family physicians and, if need be, can come back to the hospital to be seen by their specialist right away. This is less disruptive for them and improves their day-to-day care.

Moreover, patients treated with a palliative care approach requiring urgent attention can be directly admitted to the hospital from the clinic or home care, avoiding the Emergency Department. This makes it easier for them to receive the care they need, where they want to receive it, and helps reduce some of the stress that comes with end-of-life care. This patient-centered approach is also apparent in the program’s Cancer Survivorship Clinic. Staffed by a dynamic team of physicians, nurses and social workers, the clinic supports pa-

tients as they heal and build their lives after cancer. In addition to monitoring the long-term effects of treatment, the Survivorship Clinic evaluates psychosocial disturbances such as anxiety and depression, and refers patients to community programs, like Wellspring, to support important lifestyle changes. Patients and family members receive information and encouragement, empowering them to manage their own care and well-being – paying attention to details like exercise, stress management and proper nutrition.

The program aims to treat the patient, not the disease. It’s not a breast cancer patient. It’s a patient with breast cancer. By taking an integrated approach, the palliative care team provides patients with a care program designed to treat all aspects of disease in a more streamlined, effective manner. By listening to the needs of patients, Osler’s Palliative Care Program’s model of care strives to make things easier for patients and their families and improve their quality of life during this trying H time. ■

Dr. Martin Chasen, Medical Director of Palliative Care, William Osler Health System.



Entirely true

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1. When I am in pain, it keeps m night. e awake at 2. When I am in pa reminds me of in, everything I see or do pain 3. I try to avoid activities that ca use pain. 4. When I feel pain I’m scared th beginning of a terrible problemat it’s the . 5. Pain seems to bother me m ore than it does other peop le. 6. When I feel pain, I think ab out it even when I don’t mean to . 7. I can’t stand pain 8. When I’m in pain. I feel dist an even when I’m talking to themt from people . 9. As soon as th e medications to pain comes on, I take reduce it. 10. Pain sensat ions terrify me. 11. When I’m in pain, things do n’t feel real. 12. I feel sick to my stomach wh en I am in pain

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Instructions: Th beliefs, though e statements listed below have or do wh ts, feelings and actions th describe a part of theiren they are in physical pain at people carefully and plabody hurts). Read each (ie., when best reflects ho ce a check mark (✓) in thstatement e box that w true that sta tement is for yo u.

New way of measuring pain could lead to improved approaches in treatment

By Megan Mueller anada Research Chair embarks upon three pain studies in the process of creating and testing a new tool to measure pain. Highly effective, it points to future directions in treatment. How can we improve our understanding of pain to help thousands of Canadians who experience chronic pain? The answer to this vital question starts with the development of valid and reliable measurement tools. Canada Research Chair and Distinguished Research Professor of Psychology Joel Katz led a team of researchers from York, Toronto General Hospital and the Centre de recherche du Centre hospitalier de l’Université de Montréal in a study that developed and assessed a new tool for measuring how people respond to pain as well as the thoughts and feelings they have when they’re in pain: the Sensitivity to Pain Traumatization Scale (SPTS). The goal of this work, which was funded by the Canadian Institutes of Health Research (CIHR), the Social



Sciences and Humanities Research Council of Canada (SSHRC), York University, and the University of Toronto, was to evaluate the validity and reliability of the SPTS in people with and without ongoing pain. The SPTS passed with flying colours. Katz’s research team concluded that it is an excellent new resource for assessing people’s reactions to pain, and published their findings in the Journal of Pain Research (2017). “The SPTS measures the tendency for people to respond to pain in a way that’s similar to how they respond to other traumatic events. So, for some people, pain itself is a traumatic stressor, and living with pain on a daily basis can be traumatizing,” Katz explains. “The SPTS could lead to improved approaches in treatment for people who live with pain on a daily basis,” he concludes. Katz is one of Canada’s leading researchers in psychological, emotional and biomedical factors involved in acute and chronic pain. He is par-

ticularly interested in the processes involved in the transition of acute, time-limited pain to chronic, pathological pain; interventions to minimize acute post-operative pain; and the relationship between PTSD and chronic pain.


For the past two decades, pain research has become increasingly focused on the link between pain and anxiety. This line of inquiry was influenced by the findings of a large American survey of 5,692 individuals in 2005, which revealed that anxiety disorders showed as strong an association with chronic spinal pain as did mood disorders. This research found that chronic spinal pain was very often present with other pain conditions, chronic diseases and mental disorders, and that this played a significant part in role disability associated with chronic spinal pain.

Researchers then started to consider the role of post-traumatic stress disorder (PTSD) and pain. They found core mechanisms that are mutually reinforcing, such as reminders of the trauma, emotional triggers and anxiety related to pain perceptions. This research, collectively, started to paint a more cohesive picture of pain, anxiety and PTSD. This is what led Katz to develop the SPTS. In the 2017 research article, his team undertook three different studies, each adding a different piece to the puzzle.


The goal of Study 1 was to create the new questionnaire, the SPTS, to accurately measure the possibility that, for some people, pain represents a traumatic stressor. In this study, a group of 116 first-year York students completed a questionnaire about current pain and pain history.



Opposite: The Sensitivity to Pain Traumatization Scale.

The study protocol was reviewed and approved by the research ethics board at York University, the Human Participants Review Subcommittee. Students provided information about fear and the physical symptoms of anxiety. The severity and impact of a traumatic event were also measured, as were levels of anxiety related to pain. This study was successful in that the SPTS was shown to be consistent and highly reliable.


The objective of Study 2 was to evaluate the properties of the SPTS in two groups of York students: those who were pain-free (555 in number), and those who were facing ongoing pain

Joel Katz (268). Participants, totalling 823, were recruited between 2009 and 2013. Again, the study protocol was reviewed and approved by the research ethics board at York University. Participants were asked to complete an online survey that featured nine questionnaires to assess anxiety, traumatic responses, perception of painful experiences and depressive symptoms. The SPTS was, again, proven to be consistent and highly reliable.

Study 3 took place at Toronto General Hospital. The study protocol was approved by the University Health Network Research Ethics Board at Toronto General Hospital and by the York University Human Participants Review Subcommittee. In study 3, the participants, 345 in total with ages ranging from 25 to 90 years, had undergone coronary artery bypass graft surgery – the most common type of heart surgery – a minimum of six months prior to the study. Using the SPTS, the subjects completed questionnaires involving pain history, anxiety, traumatic responses, perception of painful experiences and depressive symptoms. Patients also rated their average post-surgical chest pain; movement-evoked pain, such as deep breathing; and pain upon gentle touch to the affected areas. Thirty-seven per cent of participants reported chronic pain, a result of the surgery, with over 80 per cent

of these patients reporting pain at the time of assessment. Twenty-seven per cent of participants reported ongoing pain unrelated to the surgery, with over 90 per cent of these patients reporting pain at the time of assessment. Again, the reliability and validity of the SPTS were deemed excellent.


Taken together, all three studies (united in one comprehensive research paper) provide key evidence in support of the validity and reliability of the SPTS, and point to the possibility of new improved approaches for treatment for patients in pain based on how they score on the SPTS. This research also opens the door for future work. Other avenues to explore could involve administering the SPTS at different points after surgery to better monitor pain and possibly predict spikes in pain; or the new tool could be applied in non-pain settings, nonsurgical chronic pain groups and H the general population. ■

Megan Mueller, Manager, Research Communications, Office of the Vice-President Research & Innovation, York University.

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Communication gaps and patient safety By Samantha Li and Certina Ho ommunication gaps between patients and different health care providers (HCPs) are negatively impacting patient safety. A total of 134 medication incidents associated with moderate to severe harm between 2009 to 2017 were extracted from the Institute for Safe Medication Practices Canada (ISMP Canada) Community Pharmacy Incident Reporting (CPhIR) program (http://www.cphir. ca), of which 58 per cent involved communication gaps. Communication gaps occurred between patients and HCPs (for example, physicians, pharmacists, nurses, etc.) or among HCPs. These gaps included incomplete verbal or written communication, or lack of communication. In some of these incidents, communication gaps had led to severe harm, such as hospitalization or even death. Figure 1 is an example of a medication incident that involves various degrees of communication gaps



Ineffective communication skills Advancement in technology has facilitated instantaneous communication globally (for example, text messages or instant messages via social media, etc.). However, as people communicate more frequently, the form of content becomes increasingly superficial and ineffective. This is apparent in the digital world but is also influencing in-person communication skills. Can poor communication skills, amongst patients and HCPs, compromise quality of care, and patient safety? TIME IS THE LARGEST BARRIER TO COMMUNICATION Communication is a critical competency for HCPs. An open dialogue 60 HOSPITAL NEWS MAY 2018

Figure 2 – Hierarchy of effectiveness

with patients will facilitate a stronger patient-HCP relationship and may also allow for better gathering of patient information. However, HCPs are often challenged with limited facetime or contact time with patients. Decreasing time with patients may negatively affect the ability for patients and HCPs to build a relationship and also patient safety. It is not uncommon that each patient sees their HCP for a mere 20 minutes; and in some health professions, even less than that. How

can patients and – HCPs optimize the limited time that they spend together?


PREPARING FOR THE APPOINTMENT Patients are the common denominator among interactions of all members of the circle of care. Patients need to be educated on inquiring for the necessary information from their HCPs, such as, whether there are any changes in their medication(s), the

nature of the changes in their therapy, and what actions are required on their part as patients. HealthLinkBC has printable patient reference sheets that will guide patients with communication and asking important questions during different appointments (for example, new ailment, follow-up appointment, etc.) HCPs should ensure that their patients fully understand what happens during the encounter. Techniques such as “show and tell” counselling and “teach back” patient

SAFE MEDICATION Figure 1 – A medication incident that involved communication

education can help HCPs gauge the patient’s understanding. In addition, ISMP Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists collaborated and developed a set of five questions to help patients start a conversation about their medications to improve communications with their HCPs. When both parties come prepared for the interaction, it facilitates more effective and efficient communication. TECHNOLOGY A patient’s healthcare team should communicate with each other and with the patient. The hierarchy of effectiveness (Figure 2) demonstrates that merely expecting individuals to communicate, provide/receive education and information is, superficially,

updates and alerts for dose discrepanMERELY EXPECTING INDIVIDUALS TO cy, dose too high, or dose too low, etc.). COMMUNICATE, PROVIDE/RECEIVE EDUCATION CONCLUSION AND INFORMATION IS, SUPERFICIALLY, THE The current state of the system is MOST FEASIBLE, YET THE LEAST EFFECTIVE that HCPs are not communicating efAND SUSTAINABLE SOLUTION fectively, with each other or with the

the most feasible, yet the least effective and sustainable solution. So why not use a high leverage solution, like technology, to approach the problem and facilitate lasting change? Current communication techniques (such as phone calls and faxes) are not effective, not timely, and may overload HCPs with paper. Our HCPs need better tools to facilitate direct communication with each other to help prioritize tasks with respect to their different levels of urgency. The gold standard would be a fully functional e-health system. HCPs will

then have ready access to the patient’s health and medication records. This would give clinicians the “full picture” of a patient’s history and would be especially useful if a patient is not aware of the health condition(s) and/ or medication(s). In the meantime, HCPs should demand their point-of-care or clinical decision support software vendors to arm them with better communication and clinical tools (for example, an app that will allow and support for urgent communication; or safety features, such as reminders for patient medication list

patient. The inherent nature of society’s current way of communication largely hinges upon technology and networking. It is therefore prudent to leverage technology and evolve our current tools in order to be able to even begin delivering the highest possible standard of the future for patient care and safety. The solutions are not by any means novel. Some are even obvious and simple. In the end, all parties involved in the circle of care are responsible for ensuring that communication is clear and complete, as gaps in communication can have a detrimental effect on a H patient’s health and safety. ■

Samantha Li is a PharmD Student at the Leslie Dan Faculty of Pharmacy, University of Toronto; Certina Ho is a Project Lead at the Institute for Safe Medication Practices Canada.



Sexuality in end-of-life care: Who should start the discussion? By Andria Bianchi

n December 2017, Canada’s federal government called on the Minister of Health to create a framework for palliative care. This call to action was motivated by an increasing need to provide good palliative care services for people living with serious and life-limiting illnesses. Palliative care is a patient-centred approach that has been shown to improve individuals’ quality of life by offering effective pain and symptom management and helping people have a good end of life experience that is in keeping with their goals, values, and beliefs. Palliative care can be offered in various settings, such as in hospitals, long-term



care facilities, hospices, and in one’s home. One topic that is seldom discussed as a part of what it means to provide end-of-life services in public settings, however, is that of sexuality. Although sexuality can be of considerable importance to individuals’ quality of life (which is an important part of providing patient-centred and end-of-life care), it is a taboo topic that is often overlooked. Sexuality can be defined in different ways. A broad definition of sexuality “encompasses identity, gender roles and orientation, eroticism, pleasure, and intimacy” (Moynihan and Bober, 2017). As stated in one of the few ar-



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ticles considering sexuality and endof-life care, Margaret J. Redelman says that sexuality is “vital to many people’s self-concept and a sense of personal integrity… [which] sustains adaptability and resilience enabling ability to cope with adverse circumstances.” Sexuality can also be an “intimate form of communication that helps relieve suffering… in the face of life limiting illness” (Hordern & Currow, 2003). A patient’s sexual interests will differ depending on their age, the nature of their relationships, the severity of their illness, alongside other personal preferences based on present life circumstances. Irrespective of the potential benefits of sexuality and its relation to individuals’ quality of life, discussions about sexuality/sexual preferences rarely occur when it comes to providing holistic end-of-life care. As stated by Sue Lennon, perceptions of sexuality and endof-life “often come with the tag line ‘but it’s probably the last thing on their minds’” (Lennon, 2016). The topic of sexuality and intimacy are often medicalized in healthcare, where discussions around fertility, contraception, erectile dysfunction, and menopausal statuses are discussed and a broader definition of sexuality is rarely employed (Hodern, 2007). The idea that sexuality may be pertinent to individuals’ quality of life in end-of-life contexts was explored in a 2008 study by Lemieux et al. The study examined what the term ‘sexuality’ meant to palliative patients with advanced cancer and considered whether they would be comfortable discussing sexuality with healthcare providers. The results of this study indicated that “[s]exuality continues to be important at the end of life, especially for those who experience it as a way of connecting with their partner” (Lemieux, et al., p. 632). Although

sexuality was determined to be an important part of many individuals’ endof-life circumstances, “several barriers to experiencing this were noted in the palliative care unit and hospice care,” thereby preventing patients from engaging in a fulfilling sexuality at the end of their lives. Some of the barriers to experiencing sexuality were: lack of privacy, shared rooms, uninviting physical spaces, intrusion by staff, and bed sizes. While the physical barriers may be challenging to alter in organizations that are operating under increasing fiscal constraints, some of the non-physical barriers (e.g. intrusion by staff) can potentially be overcome by having discussions with patients. All of the participants in Lemieux’s study “felt that [sexuality] should have been brought up as a part of their care” (Lemieux, 2008, p. 633). The participants suggested that clinicians should approach the topic with professionality, transparency, and in a forthright manner in order for their sexual preferences to be discussed and accommodated. This suggestion was reinforced by Lennon, who said that “the majority of patients are happy to talk about ‘it’ (or at least would not be offended if asked). They do however want the health professional to open the conversation” (Lennon, 2016). Based on these studies, it seems that patients are willing and wanting to discuss sexuality when receiving palliative care in hospitals, hospices, and long term care units… but they want clinicians to commence the discussion. Sexuality is a moralized topic that may be challenging to discuss, and while I do not anticipate this article to necessarily alter clinical practices, I do hope that it encourages those working with patients who have serious and life-limiting illnesses to consider what it would mean to discuss sexuality as a part of H providing patient-centred care. ■

Andria Bianchi is a Bioethicist at the University Health Network, a PhD Candidate at the University of Waterloo, and a board member of the Canadian Bioethics Society.


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Hospital News 2018 May Edition  

Focus: Surgical Procedures, Oncology, Pain Management, Palliative Care and Special Nursing Week and Heroes Supplement.

Hospital News 2018 May Edition  

Focus: Surgical Procedures, Oncology, Pain Management, Palliative Care and Special Nursing Week and Heroes Supplement.