nominate your nursing hero: 7th Annual Nursing Hero Contest in honour of National Nursing Week See page 27 for details focus in this issue
Gerontology/ Palliative Care/ Home Care
Natural Path������������������������������������������������� 17 From the CEO’s desk����������������������������������� 20 Legal Update������������������������������������������������ 23 Nursing Pulse................................................25 Ethics.............................................................29
C a n a d a’ s H e a lt h C a r e N e w s pa p e r
Volume 25 Issue 4
A day in the life at Donald Berman Maimonides Geriatric Centre By Lisa Blobstein
t’s early Friday morning and about a dozen 7th floor residents are participating in the Breakfast Club program. They are sitting in their wheelchairs or on chairs with their walkers nearby while eating and chatting. Today the residents have planned their own menu and are having scrambled eggs, toast and cheese served with orange juice and coffee/ tea. The Breakfast Club is one of about 20 daily activities led by Therapeutic Recreation Specialists at Donald Berman Maimonides Geriatric Centre in Montreal (DBM). “Leisure is an inherent part of life. Therapeutic Recreation brings out enjoyment in residents’ lives, taking into account what impairments and what abilities they have,” says Catherine Drew, a Therapeutic Recreation Specialist at DBM for the last 12 years. “When a resident is admitted to a longterm care facility they should be able to continue to engage in activities they enjoy.” At the Breakfast Club, a 100 year old resident tells her friends that she would like to go to Vancouver. “They have beautiful spas,” she says. Her friend chimes in “Look at the weather, I’d rather go to Florida.” The Breakfast Club provides a dining experience and the opportunity to socialize over the morning meal. Allison Friedman, the Therapeutic
Rose and Morty Booth participate in the Art Therapy program’s first open studio event called Fun Family Portraits at Donald Berman Maimonides Geriatric Centre in Montreal. Recreation Specialist leading today’s program says, “We create an ambience of home with flowers on the tables and the aroma of freshly cooked food.” When a resident is admitted to DBM, they and their family meet with the interdisciplinary team responsible for their care. This includes the Therapeutic Recreation Specialist (TRS). The team looks at the person’s interests, hobbies, likes/dislikes and finds activities that bring
them joy. “Therapeutic Recreation normalizes or deinstitutionalizes the experience of living in long-term care. Without appropriate specialized activities the residents’ quality of life would be diminished. We tailor programs to meet the individual needs of each resident so they can engage in a meaningful leisure experience- the more physically oriented enjoy sports, for the more social we
have conversation-based programs. If they can’t engage verbally, maybe they’ll enjoy playing cards. If they used to bowl, we’ll set up an adapted bowling game for them. The virtual Wii game brings the whole bowling experience to the residents while promoting physical upper body strength, range of motion and hand-eye coordination. For end-stage dementia residents, a hand massage or aromatherapy can
be very therapeutic,” explains TRS Kim Weippert. Activities at this 387-bed long-term care facility happen seven days a week, evenings, and weekends and give families the opportunity to enjoy these activities together such as during the family concerts on Sunday afternoons. More than 80 per cent of residents have some cognitive loss. “Sometimes you think you Continues on page 19
Do you know a nurse who has gone above and beyond the call of duty? Now is your chance to acknowledge and recognize the nursing heroes in your facility or community.
Hospital News will once again salute nursing heroes through our annual National Nursing Week contest. Nominate a nurse and share your story so that we can highlight the exceptional work that our nurses are doing and how they touch our lives. Stories/letters can be submitted by patients or patients’ family members, colleagues or managers. Please submit by April 18th and make sure that your entry contains the following information:
| Full name of the nurse | Facility where he/she worked at the time | Your contact information | Your nursing hero story
Please email submissions to firstname.lastname@example.org
Cash Prizes sponsored by:
NATIONAL NURSING WEEK – MAY 7 - 13
Hospital News, April 2012
Credit Valley celebrates first midwife-assisted birth By Liz Leake
he first midwife-assisted birth at the Credit Valley site of The Credit Valley Hospital and Trillium Health Centre took place in March with the arrival of little Violetta Strashko, weighing an even 8 lbs. As of January 1st, expectant mothers in Mississauga and the surrounding communities who choose to deliver their babies with the help of a midwife are able to do so at Credit Valley. The addition of midwifery care means that expectant moms and families now have greater choice about their obstetrical care at Credit Valley. “We are very pleased to be able to offer this choice to the women in this community,” says Angela Rea Mahoney, Director, MaternalChild Program. “The midwives that have joined Credit Valley will work closely with our obstetricians and family physicians to deliver to the highest level of care possible to our families.” A midwife is a registered health care professional who provides primary care to women with low-risk pregnancies. Midwives provide care to women throughout
pregnancy, labour and birth and continue to provide care to the mother and baby during the first six weeks following the birth. “Many women choose midwives because of the oncall continuity of care before, during and after the birth of the child,” says Stephanie Crouch, Lead Midwife, Midwifery Care of Peel and Halton Hills, the midwifery group now providing care at Credit Valley. “They also offer more time to the patient and rely on a more natural way of childbirth. Many expectant moms want the deeper personal relationship that often develops between the mother and the midwife.” For parents Nadiya Lopatina and Vlad Strashko, using a midwife was the opportunity to have a different kind of birth experience. “When our first child was born there were a lot of doctors and nurses involved and we didn’t really know them,” explains Nadiya. “This time, it was more personal; we knew the midwives. It was so good to have someone familiar to us at a time when there’s a lot of stress!” The new midwifery program at Credit Valley was
officially in place on January 1 and registered midwives began seeing clients immediately. Midwives must be registered with the Ontario College of Midwives in order to qualify for privileges. Midwifery services are fully funded by the provincial government. The Midwifery Care of Peel & Halton Hills provide support to 500 expectant mothers each year, and Crouch expects that midwives will attend between 80 and 100 births at Credit Valley in their first year. About 75 per cent of Midwifery Care of Peel & Halton Hills midwives’ patients opt for a hospital birth, while the remainder choose a home birth. In total, more than 5,100 babies are born at Credit Valley each year. Midwives have had privileges at the Trillium Mississauga site of The Credit Valley Hospital and Trillium Health Centre since 1994.
About midwifery in Ontario There are more than 550 registered midwives in Ontario, serving communities in 90 clinics across the province. Midwives have privileges at most Ontario hospitals.
Mom Nadiya Lopatina and her new daughter Violetta Strashko – the first midwife assisted birth at the Credit Valley site of The Credit Valley Hospital and Trillium Health Centre.
Since midwifery became a regulated health profession in 1994, almost 130,000 babies have been born under midwifery care, including almost 30,000 births at home. Midwives must complete a four-year university degree program. Laurentian, Ryerson and McMaster Universities all offer the Midwifery Program in Ontario. The Association of Ontario Midwives is the professional organization representing midwives and
the profession of midwifery in Ontario. For more information about midwifery contact the Midwifery Care of Peel & Halton Hills at 905-890-4914, or visit the Association of Ontario Midwives website at www.aom.on.ca. Liz Leake is the Manager of Communications & Public Affairs, Credit Valley Hospital site of The Credit Valley Hospital and Trillium Health Centre.
ONTraC Provincial Blood Conservation Program
Patient blood management begins 4 – 6 weeks prior to elective surgery By Donna Cole and Debbie Murfitt
ime spent waiting for elective surgery gives a patient and health care providers an opportunity to consider blood conservation strategies that might be appropriate to avoid the need for a blood transfusion during or
after the surgery. Some surgeries are identified as having an increased risk of blood loss, for example knee and hip joint replacement surgery, cardiac artery bypass surgery and radical prostatectomies. Transfusions are an important tool for surgeons but they do come with risks. While better blood screen-
ing techniques have reduced a patient’s chance of contracting HIV (1 in 10,000,000) or Hepatitis C (1 in 3,000,000), patients are still at risk of complication from transfusions, including infection, fever, fluid overload and a transfusion-related acute lung injury. All these can endanger a patient’s health and result
in extended hospital stay and decreased patient satisfaction. Transfusion itself has been found to be an independent predictor of increased length of stay and mortality. Established in 2002, and funded by the Ontario Ministry of Health and LongTerm Care (MOHLTC), the ONTraC program pro-
vides funding for a Blood Conservation Coordinator at 25 participating hospitals in Ontario. The Blood Conservation Coordinator works in conjunction with the physicians and patient to promote alternatives to blood transfusions in surgical patients by optimizing hemoContinues on page 6
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HospitaL News, April 2012
ontario hospital Association introduces framework for hospital executive compensation On March 23rd, the Ontario Hospital Association (OHA) introduced a proposed Hospital Executive Compensation Framework (Framework) and associated recommendations intended to strengthen hospitals’ executive compensation programs and improve their transparency� In December 2011, an Independent Expert Panel on Executive Compensation in the Hospital Sector (the Panel) chaired by former Deputy Prime Minister of Canada John Manley made a number of recommendations aimed at helping hospital board of directors ensure their decisions regarding executive compensation were replicable across the sector, and based on evidence and leading human resources practices� “The Framework and associated recommendations were based on the Panel’s work,” said Mark Rochon, Interim CEO of the Ontario Hospital Association (OHA)� “They were also shaped by Ontario’s current economic climate and Premier McGuinty’s call for leadership by Ontario’s broader public sector leaders�” The OHA’s shared the Framework and associated recommendations with hospitals earlier that week, and has made them publicly available at www�oha� com
Little change in wait times for canadians A new analysis from the Canadian institute for health information (CIHI) reveals that about 8 out of 10 Canadians receive priorityarea procedures—including hip and knee replacements, cataract surgery, hip fracture repair and radiation therapy—within the medically recommended time frames� Featuring provincial comparisons and trends in wait times, the analysis further reveals the following: • Almost all (97%) patients receive radiation therapy within the recommended time frame of four weeks;
• Similar proportions of patients receive hip replacement (82%), hip fracture repair (79%) and cataract surgery (82%) within these procedures’ respective time frames; and • Knee replacements have the longest wait times, with 75% of patients receiving care within the benchmark time frame� These results are largely similar to last year’s findings� From a national perspective, radiation therapy is the only procedure for which 90 per cent of patients receive care within the benchmark time frame� From a provincial/territorial perspective, hip replacement in Ontario is the only procedure to reach the 90 per cent threshold� Examination of wait time trends over the last three years reveals limited improvement toward benchmarks� This year, a few provinces showed longer wait times for areas such as knee and hip replacements and cataract surgery� British Columbia, New Brunswick and Prince Edward Island now have longer waits for knee replacement� P�E�I� also has longer waits for hip replacement and cataract surgery� However, two provinces showed wait time improvements for more than one priority area: Saskatchewan for hip and knee replacements and Nova Scotia for hip replacement and radiation therapy�
ontario health study becomes largest single health study in canadian history More than 175,000 Ontarians have joined the Ontario Health Study (OHS), the ambitious research effort designed to help scientists understand the complex factors behind heart disease, cancer, diabetes, asthma, Alzheimer’s and other common diseases� The milestone makes the OHS the largest single health study in Canadian history, and one of the most important health research efforts in the world� “The Ontario Health Study is being watched around the globe because of the novelty
of its online approach, the significance of its large scale and the diversity of participants,” says Professor Lyle Palmer, Executive Scientific Director of the Ontario Health Study� “We will be following individuals over their entire lifespan, giving us the ability to look at the development and progression of common conditions in the general population�” Every Ontario adult aged 18 and over can enroll in the OHS and complete an online health questionnaire at ontariohealthstudy�ca� The questionnaire, which takes 30 to 40 minutes to complete, asks participants to provide information about health-related subjects such as personal and family medical history, where they live, and their lifestyle and diet� Approximately 9�5 million Ontarians are eligible to volunteer for the Study�
Alberta registered nurses welcome launch of family care clinics The College and Association of Registered Nurses of Alberta (CARNA) welcomes the announcement regarding the opening of three pilot family care clinics in Edmonton, Calgary and Slave Lake� “The family care clinic model is an important new initiative which will expand Albertans’ access to primary health care services in their communities,” says Dianne Dyer, CARNA president� “These new clinics will allow people to access the services they need under one roof, benefiting from the knowledge and expertise of their collaborative health team and being connected to resources in their community�” According to Dyer, the benefits of inter-professional care and the development of a team-based approach to care are well-known and documented� Preventing illness and promoting health are the best ways to reduce demand on the over-stretched public health-care system over the long term� “Many of the issues facing our acute-care system are a result of lack of access to health services in communities,” says Dyer� “The demographics in the health professions mirror those of the gen-
eral population which means that we need to optimize the human resources that we have in the system� Registered nurses and nurse practitioner expertise could be better utilized to provide individual and community primary healthcare services including effective management of chronic illness, health promotion, injury prevention and lifestyle changes� The family care clinic model can also allow people to access badly needed health services without always going through a physician first and leverage the knowledge and expertise of the collaborative care team�”
statins may prevent pneumonia Statins may prevent pneumonia, according to a new study in CMAJ (Canadian Medical Association Journal)� Researchers from Israel and the United States analyzed data from the JUPITER trial, a randomized, double-blind trial with placebo control groups conducted at 1315 sites in 26 countries to look at the use of the statin rosuvastatin in disease prevention� The trial involved 17 802 men aged 50 years or older and women aged 60 years or older without a history of heart disease or diabetes� Patients were randomized to receive either a placebo or rosuvastatin, a statin used to treat high cholesterol levels and prevent heart disease� During a median follow-up period of almost two years, the researchers found that 214 people in the statin group compared with 257 people in the placebo group contracted pneumonia� The authors conclude that the “absolute risk reduction observed in this primary prevention setting was small, and the effects on infection may be greater in other settings�” For more information: http://www�cmaj�ca/lookup/ doi/10�1503/cmaj�111017
ontario hospital Association supports Patient-based Payment The Ontario Hospital Association (OHA) welcomes the Government of Ontario’s
move to implement patientbased payment for hospitals, which was announced by Ontario Minister of Health and Long-Term Care, Deb Matthews� The OHA has long supported the principle of patient-based payment plans and the use of standardized funding formulas, such as the Health-Based Allocation Method (HBAM), to incent and reward efficiency and quality and to recognize population needs� Like any significant changes in the health system, effective implementation is essential, and Ontario’s hospitals appreciate the government’s plan to consult and engage hospitals along the way in order to ensure that health system improvements effectively meet patients’ needs� “With thoughtful implementation, evidence demonstrates that there is great potential for patient-based funding to improve consistent use of best practices, equitable allocation of resources, and efficiency throughout the health system, which ultimately translates to better patient care outcomes,” says Mark Rochon, OHA Interim President and CEO�
my ehealth subscribers exceed 200,000 More than 200,000 patients in British Columbia have now registered for my ehealth to obtain their laboratory results directly via a secure patient portal: myehealth�ca� This is a major milestone since direct patient access to their personal health care information is a major shift in health care system management and a key component of the electronic health record vision for Canada� Consumer benefits include: • Rapid and secure onetime registration after visiting a participating laboratory; • Secure portal access; • Laboratory results from participating laboratories as soon as they are available; • Ability to graph historical trends; and • Opportunity to research and understand personal laboratory results�
What inspired our healthcare innovations? Understanding the people who will need them. To learn more, please visit www.philips.com/innovations.
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Hospital News, April 2012
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Hospitals need to get back to basics
fter much thought and consideration I have Denise Hodgson Sr. Production Manager decided to do it - I Bala Gnanapandithan Sales Coordinator am going to use my column Daphne McPherson Publisher this month to address the Samuels Wall2wallmedia inc. elephant in the room – CBC’s Manager Marketplace Investigation on Michael Parker the cleanliness of hospitals. For those of you who haven’t seen it – Marketplace staff went undercover and applied a harmless gel (visible Advisory Board only with UV light) to variJonathan E. Prousky, Jane Petricic, ous places many would touch BPHE, B.Sc., N.D., FRSH President Chief Naturopathic Medical Officer Brainstorm communications & through-out 11 hospitals in The Canadian College of creations Ontario and British Columbia. Naturopathic Medicine toronto, on They went back 24 hours later North York, ON Olaf Koester, – and most of the time, in M.B.A., R.Ph. Cindy Woods, every single hospital – the gel Senior Consultant Communications officer Office of the Assistant Deputy was still there – meaning the The Scarborough hospital, Minister, Scarborough, ON surfaces had not received any Strategic Directions cleaning at all. & Provincial Drug Programs, Barb Mildon, Manitoba Health RN, PhD, CHE , CCHN(C) Sadly, I am not surprised. VP Professional Practice & I wouldn’t’ have thought we Dr. Cory Ross, Research & cne, B.A., MS.c., DC, CSM (Oxon), MBA, CHE needed an undercover report Ontario Shores Centre Associate Dean, Academic for Mental Health Sciences to tell us that our hospitals are Faculty of Community Whitby, on not as clean as they should be. Services and Health Sciences, George Brown College, One only has to look at the Helen Reilly, Toronto, ON Publicist number of hospital-acquired Health-care communications infections (HAI) in this counAKILAH DRESSEKIE, toronto, on senior communications specialist try to know there is a probrouge valley health system lem, and it’s wide-spread. Hospital acquired infections are nothing new. As an infant I was ill and brought Hospital News is published for hospital health-care professionals, patients, to the hospital – it was disvisitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for covered I had a milk allergy. hospitals outside Ontario. While in hospital for treatment I contracted something The statements, opinions and viewpoints made or expressed by the writers much worse – whooping do not necessarily represent the opinions and views of Hospital News, or the publishers. cough. So instead of spending a couple of days in hospital, I Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, ended up there for nearly two written or reported by its contributing writers, including product or months. Ironic that the place service information that is advertised. I went to get better ended up Change of address, notices, subscription orders, and undeliverable address making me a great deal sicker. notifications are to be sent to Hospital News, 405 The West Mall, Suite 500, We have come a long Advertising Representative
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way since then – clearly not far enough. Canada has the highest rate of HAIs in the developed world with nearly 250,000 of us contracting one every year. It is estimated that as many as 12,000 Canadians die every year as a result of them. That makes HAIs the fourth leading killer in this country. It’s high time we did something about it. Instead of pointing the fingers at hospital staff, management and cleaners we need to find a solution, and fast. This isn’t the result of lazy cleaning staff or clueless management. It’s a systemic problem, and one that requires the attention of provincial and federal governments alike. Our health care system performs miracles every day. The technological advances and treatments and cure for disease are astounding. So how is that we can’t get something as simple as cleanliness right? It seems like a no-brainer to me. Yes, there are huge financial pressures on the health care system, yes hospitals are being asked to do more with less – but that is no excuse. I often find myself defending our health care system, and do so with pride. I have no defense or excuses for this latest blow. The solution is simple – hospitals need to be cleaned thoroughly and frequently. There can be no short cuts or excuses. CBC’s Marketplace was
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told time and again by hospital insiders that hospitals just don’t have the resources – cleaning staff has been cut, and the cleaners just don’t have time. The old adage is that if we increase spending on cleaning, it will result in cuts to areas of patient care. I don’t buy it and I won’t accept that reasoning. Canadians deserve timely patient care in a clean and safe environment. We shouldn’t have to choose one or the other. There is a lot of talk about how to make our public system sustainable. I can say with 100% confidence the solution is not in cutting costs by scaling back maintenance and housekeeping. Hospital acquired infections cost the system from one to four billion dollars annually (estimates are wide-ranging). Re-investing in cleaning services seems the next logical step. The money spent would be retuned with a reduction in HAIs. I would go so far as to say that infection prevention may be the most sound investment hospitals though-out Canada can make. As we (at least in Ontario) move to a patient based payment system for hospitals – why can’t we also include cleanliness? Sure we have hand-washing audits and hospitals have to report their numbers publicly, but that is not enough. Provincial governments could develop a program where cleaning audits are performed regularly by independent third parties. A mandatory amount of each hospital’s budget should be designated to cleaning costs and follow-up should be conducted to ensure that is where the money was spent. Incentives need to be provided for maintaining a clean and safe environment just as they are for other areas of patient care. Hospital CEO bonuses should be based partly on how clean their hospital is – that would at least provide some impetus to find other efficiencies before cutting cleaning costs. It’s not a simple issue – but the solution is - hospitals need to be clean. It’s time to get back to basics and clean our hospitals to ensure they are places of healing, rather than places we go to get sicker. Kristie Jones Editor Hospital News
Hospital News, April 2012
Kemptville Hospital releases video celebrating launch of new joint replacement services By Jenny Read
n the same week that its 100th orthopaedic surgery patient received her new knee, Kemptville District Hospital released a video celebrating the launch of the program in late 2011, when it became one of a handful of small hospitals in North America performing this type of surgery. The entire organization had worked together to bring the program to launch in six short months. In the process, Kemptville Hospital had been transformed. The new Total Joint Replacement program is an innovative partnership between this small rural hospital and one of the largest teaching hospitals in Canada: The Ottawa Hospital. The program sees surgeons from The Ottawa Hospital performing joint replacement procedures in Kemptville Hospital’s state of the art operating facilities, reducing wait times for patients throughout the region and cutting down on overcrowding in The Ottawa Hospital. Knee recipients in Kemptville have appreciated the patient-focused care; the hospital consistently ranks among the top hospitals in Ontario for both patient and employee satisfaction. To make the video, titled “Kemptville Hospital: A Different Organization Now,” a group of 20 staff, administrators, physicians and volunteers sat down to talk about their experiences in preparing for the new inpatient surgical program. The video celebrates the sense of joy and accomplishment that permeated the hospital the day the first knee replacement surgeries were performed. It also speaks to the power available to an organization, and in fact to an entire system, when good people are happy to work together to build healthier communities. Kemptville Hospital staff recognized that as a small organization they had the potential to help solve a big problem, the problem of long wait times for this type of surgery. The video demonstrates how the people at Kemptville Hospital embraced the opportunity to be a different kind of small hospital, and how it felt to be engaged in meeting a systemwide challenge. More than 100 staff and friends of Kemptville Hospital gathered for the live release of the video at a celebration of the new surgical program, held at the
Kemptville District Hospital CEO Colin Goodfellow (left) and Dr. Geoff Dervin, Head of Orthopaedic Surgery at The Ottawa Hospital (right) at the celebration of the launch of the Total Joint Replacement program.
hospital on March 7, 2012. The 26-minute extended version was screened for staff; the hospital also created an
8-minute highlights version and a 2-minute preview. All three are available on the hospital’s Youtube channel,
http://www.youtube.com/user/ KemptvilleHospital The concept of a partnership between a large urban teaching hospital and a small rural hospital began to take shape in the spring of 2011 between senior administrative and medical staff of both hospitals, particularly Colin Goodfellow, CEO of Kemptville Hospital, and The Ottawa Hospital’s Head of Orthopedic Surgery, Dr. Geoff Dervin, who had been performing outpatient orthopedic surgery at Kemptville Hospital since 2006. Dr. Dervin performed the first knee replacement surgery at Kemptville Hospital on October 17, 2011. This innovative partnership is a creative use of wait-time funding: in order to decompress its operating rooms and get through its
waiting list more quickly, The Ottawa Hospital was prepared to bring surgeons, patients and wait-time funding to Kemptville Hospital, which would provide the operating rooms, nursing and allied health staff, and inpatient care. The collaboration between the two hospitals was welcomed by the local Local Health Integration Network (LHIN). “This successful partnership is an example of the out-of-the-box thinking our health system requires to continuously improve and meet the growing needs of our population,” says Sari Kline, Lead for Emergency Departments and Wait Times at the Champlain LHIN. Jenny Read works in Communications at Kemptville District Hospital.
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Hospital News, April 2012
New medication program wins national recognition By Stefanie Kreibe
he Medication Management Support Services (MMSS) pharmacy team in York Region was recognized with an “Overall Patient Care” Commitment to Care & Service Award, from The Pharmacy Practice and Drugstore Canada. These national awards recognize the many facets of pharmacy services including health promotion, disease management and inter-professional collaboration. The unique program brings pharmacists from York Central Hospital and Southlake Regional Health Centre into the homes of recently discharged seniors, and helps to smooth the transition from hospital to home. Seniors are at higher risk of readmission due to medication issues. This service focuses on medication reconciliation and ensuring seniors have the support they need to safely take the correct medication. “Patients, especially seniors over the age of 65, are often overwhelmed with the amount of information they receive upon discharge from hospital,” says Lisa Sever, Lead Pharmacist for
York Central Hospital Pharmacist Cynthia Cho-Kee visits with recent hospital patient Della in her home, to review her medication and make sure she knows how and when to take her prescriptions properly. the MMSS team and York Central Hospital Pharmacist. “Having a pharmacist review, reconcile, educate and solve drug-related problems with the patient in the comfort of their own home has proven to be extremely beneficial.” Funded through the Central Local Health Integration Network’s (LHIN’s) Healthy Seniors, Healthy Communities Emergency Department/Alternate Level of Care strategy, the MMSS program is lead by the Central Community Care Access Centre (CCAC). Referrals are sent to the pharmacy team by the Central CCAC
Case Managers. Referrals are assigned by the lead pharmacist for the program to the appropriate pharmacist are based on the patient’s needs and location. The team of 12 pharmacists, visit patients in their homes across the Central LHIN which includes South Simcoe, York Region, and parts of North Toronto. “Clients have told us how much they value the service. MMSS has helped them manage their pain symptoms, reduce falls, make fewer visits to the emergency department and feel better overall,” said Cathy Szabo, Chief Executive Officer, Central CCAC.
Home visits provide pharmacists with “the big picture” about how a patient is managing their medications. Visits give pharmacists the opportunity to simplify the medication regimen and help discard medication that is no longer appropriate for the patient. This minimizes confusion and makes the patient safer. The pharmacist can also identify if the patient would benefit from additional community services such as occupational therapy or a personal support worker. “This innovative model of collaboration helps to promote patient safety and enhance communication between care providers,” adds Jo-anne Marr, York Central Hospital’s Vice President Patient Services and Chief Nurse Executive. “Working together is the way of the future and we are happy to be recognized for our role in the development of this new program.” Some of the often overlooked challenges for seniors are the logistics of obtaining the medication from the pharmacy, adds Sever. “When a prescription is not filled, or a medication is too expensive or not in stock, there are possible solutions that pharmacists can offer.”
Beyond the visits themselves, pharmacists act as a liaison to connect the dots for patients, says Sever. “They reconcile medications by clarifying with the family doctor, identify and solve practical drug-related problems with the patient’s community pharmacist, such as if the patient is having problems taking any pills because of difficulty swallowing or opening bottles etc.” Documentation is shared to alert community pharmacists about changes to medication, which means they are better informed about challenges their patients are having. They are able to continue monitoring after the MMSS pharmacy team’s service is complete. The MMSS program is aligned with the Central LHIN Quality Action Plan to improve access, patient outcomes and overall quality of care across the local health system. This year, the dedicated group is on target to visit 1600 patients across the Central LHIN, meeting the needs of patients and helping to keep them safe. Stefanie Kreibe works in public affairs at York Central Hospital.
ONTraC Provincial Blood Conservation Program Continued from page 2 globin levels prior to surgery. For surgeries that have an identified risk of increased blood loss, normal hemoglobin levels are often not good enough! Target preoperative hemoglobin for these surgeries is greater than130 g/L. What happens if the hemoglobin levels are low? There are some safe and effective options that can be chosen prior to surgery to enhance the patient’s own blood supply. Be proactive about finding out what the hemoglobin is well before elective surgery. This wait time can be put to good use by taking advantage of blood conservation strategies to optimize the hemoglobin. A Blood Conservation Nurse, as part of a multidisciplinary team, can provide information regarding the strategies to raise hemoglobin levels.
What can be done before surgery to help reduce the risk of requiring a blood transfusion? Blood Conservation strategies can be discussed with the surgeon, blood conservation coordinator and physician. Oral iron may be started 4 – 6 weeks prior to surgery. Intravenous iron may be given to those patients with low ferritin levels and those who do not tolerate oral iron. Erythropoietin (Eprex) may be ordered as a supplement to the iron therapy to help the body produce more red blood cells and raise hemoglobin levels prior to surgery. In some cases, where high blood loss is expected, patients may consider storing their own blood (autologous donation) prior to surgery if deemed individually appropriate. Anemia is, however, a symptom, not a disease, and the cause of the anemia may need to be investigated to
ensure the most appropriate treatment Studies have shown that anemia is present in 30 - 50 per cent of patients before surgery. People who have anemia before surgery are more likely to need blood transfusions than those who do not have anemia. Appropriate management of anemia prior to elective surgery can reduce the likelihood of requiring a blood transfusion and its associated risks. Your doctor and the blood conservation coordinator can help to determine what blood conservation strategy is best for you based on what is causing the anemia. For further information on the Ontario Provincial Blood Conservation Program, please visit www.ontracprogram.com Donna Cole is the ONTraC Coordinator at Mt. Sinai Hospital and Debbie Murfitt is the ONTraC Coordinator at Trillium Health Centre.
Hospital News, April 2012
Focus: Gerontology/Palliative Care/Home Care
Helping caregivers cope with Alzheimer’s By Jerry Amernic
here may not yet be a cure for Alzheimer’s, but a new solution to help caregivers cope with family members who have the disease is now becoming available. Home Instead Senior Care is launching customized training for family caregivers who look after loved ones suffering from Alzheimer’s disease at home. The caregiver education program, two years in the making and free of charge, focuses on the care and dignity of the person and how to help him/her live a more fulfilling life. It is called Alzheimer’s Disease or Other Dementias CARE (Changing Aging Through Research and EducationSM) Training, and the intent is to help families remove some of the stress and dread associated with living with a loved one suffering from the disease. The foundation of the training program is a technique called ‘Capturing Life’s Journey’ which involves gathering stories and experiences about the senior prior to their having the disease – where they were born, edu-
cation, sports and hobbies, pets, family stories, how they met their spouse, information about their children, etc. This approach helps family caregivers, and Home Instead Senior Care’s professional CAREGivers, provide comfort while honouring the person’s past. It also keeps seniors with dementia engaged in daily life by using their stories and experiences to provide comfort and support, and reduce the effects of behaviour that lead to unhappiness. The idea is to provide personalized care to promote mental stimulation, help manage difficult behaviours, and better engage the person with Alzheimer’s or other dementias. Dementia is the umbrella term for different conditions that cause the brain to fail, and Alzheimer’s disease is the most common form. According to research conducted for the Home Instead Senior Care network, families caring for seniors with Alzheimer’s at home deal with such challenging behaviour as delusions, anger, aggression, wandering, and refusal to eat. “We know from our research and work in homes throughout the world that
families have two significant challenges when caring for their loved ones who have Alzheimer’s disease or other dementias,” says Jeff Huber, President and COO of Home Instead Senior Care. “The first is keeping the mind of their loved one engaged, and the second is being able to manage behaviour that may include belligerence and aggression. By using this person-centred approach, the program empowers the caregiver to connect with the senior on a personal level, which benefits the senior and their families tremendously.” Many seniors with Alzheimer’s and other forms of dementia end up in the hospital. The Alzheimer’s Society in the U.S. says that dementia patients take up one in four hospital beds in that country, and the number of admissions is soaring. In fact, figures from 144 primary care trusts showed a 60 per cent rise in hospital admissions for dementia patients between 2006-07 and 2010-11. During the same time frame, the number of emergency admissions climbed by 12 per cent. According to the experts, many of these hospital admissions and emergency visits
can be avoided. “The challenge is how to customize care for people with brain issues,” says Dr. Amy D’Aprix, a gerontologist and author, who was a member of the expert panel that developed content for Home Instead’s new Alzheimer’s Disease and Other Dementias CARE Training Program. “Here is a professional training program for professional caregivers and family caregivers that is not just a couple of hours of training. It teaches caregivers how to provide a higher level of care that is customized so they can connect with the person who has dementia.” The new Alzheimer’s Disease and Other Dementias CARE training will be available to family caregivers through in-class training or e-learning sessions. It features four modules that offer family caregivers instructive information about Alzheimer’s and other dementias, as well as insight for providing better care, and techniques to help improve the quality of life both for the caregiver and the family member who has memory loss. According to a 2010 Canadian study released
by the Alzheimer Society – Rising Tide - The Impact of Dementia on Canadian Society – the frequency and cost of Alzheimer’s will soon go through the roof. The study found that, within a generation, the number of people afflicted with Alzheimer’s in Canada will increase from 500,000 to 1.1 million. It also said the cost of handling the disease will rise from $15 billion to $153 billion, and the number of caregiving hours required will increase from 231 million to 756 million. Home Instead’s free Alzheimer’s training for families will be available online and in local training workshops, and through Home Instead Senior Care offices across Canada. For more information, contact any of its 30 offices or visit www. HelpforAlzheimersFamilies. com. Jerry Amernic is a writer with Freedman & Associates Inc., a firm that specializes in marketing and communications services for professionals, and for health care and senior care organizations. He can be reached at 416-8681500 or email@example.com
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Hospital News, April 2012
Focus: Gerontology/Palliative Care/Home Care
Long-term care outreach Nurse Practitioners provide end-of-life care at the bedside By Krista Luxton
oland Munro was dying. High-risk surgery that resulted from a sudden fall and post-operative complications left the active, 87-year-old musician in unbearable pain and his children with a heartbreaking task – preparations for end-oflife care. To provide comfort for their father in his final days, Roland’s children enlisted support from Sandra Del Signore, a Nurse Practitioner at The Scarborough Hospital and member of NPSTAT (Nurse Practitioners Supporting Teams Averting Transfers). This clinical outreach team is a collaborative effort by the Central East LHIN, TSH, the Central East Community Care Access Centre (CECCAC) and the Village of Taunton Mills to provide nursing home residents with the right care at the right time in the right place. In addition to managing his care, Sandra worked with the long-term care physician, nursing home, TSH staff, and the family to ensure that Roland received care in his own bed. As a result of this team effort, Roland’s wishes to die peacefully and painfree, surrounded by loved ones, were met. About 90 per cent of nursing home residents have a life-limiting condition and may experience a long period of chronic illness with exacerbation of symptoms. Palliative care is usually initiated to
Marjorie Munro (middle) and her daughter Lynda (right) remember husband and father, Roland Munro, who received end-of-life care from Sandra Del Signore (left), Nurse Practitioner at The Scarborough Hospital. With help from Sandra, Roland was able to die in the comfort of his nursing home, Trilogy LTC Centre, surrounded by his family.
provide comfort measures and reduce unnecessary suffering until the resident reaches the end-of-life stage. “Our services allow residents to die in a place where they are comfortable, where the staff know them best, and where their wishes can be granted,” says Sandra. “If we recognize that they are dying and know they want comfort measures, we can facilitate this.” Sandra adds that many of her patients have dementia and can become confused and distressed when removed from their nursing home and
admitted to the hospital, particularly after a long wait in the emergency room. NPSTAT was created as part of the LHIN’s overall strategy to decrease avoidable emergency department transfers and hospital ALC days. In addition to providing care to residents for acute and episodic illnesses, NPs work collaboratively as part of the interprofessional team to facilitate palliative and endof-life care. Thousands of long-term care residents across the CE LHIN benefit from this innovative program. According
residents with care in their own beds.” Whenever a transfer to the ED and/or admission to hospital are necessary, NPSTAT helps to facilitate a smoother and more coordinated return to the nursing home. In addition to sharing best practices and healthcare initiatives, NPs also help to build capacity among nursing home staff by refreshing or introducing new skills and technologies such as initiating and managing IV antibiotics, rehydrating with hypodermoclysis, accessing and managing central access devices,
address end-of-life issues and questions, explore family concerns, fears and wishes, assess family dynamics and expectations, and provide appropriate counselling. “Families don’t want or expect heroics,” says Barbara. “They just want their loved one to be comfortable.” Roland’s children, Dave Munro and Lynda Vera, appreciated the end-of-life care provided by Sandra in their father’s final days. In addition to collaborating with the attending physician, Sandra utilized her clinical expertise and skills to ensure Roland’s advance directives were met. One such concern surfaced when Lynda and Dave remembered that their father had an internal defibrillator and they feared it would begin producing electric shocks as his heart shut down. “We didn’t need him to be in any more pain,” says Dave. “Sandra went above and beyond, after hours, to work with the hospital and borrow a magnet that would stop the shocks from the defibrillator. My sister and I were so grateful she was there.” Dave and Lynda remember their father as a jovial character who brought energy and joy to other residents in the nursing home. He lived there with his wife of 65-years, who suffers from dementia and who also received care from Sandra. “In the end, the NPSTAT team considers it a gift to help LTC residents make the transition to a ‘good death’ and to
"About 90 per cent of nursing home residents have a life-limiting condition and may experience a long period of chronic illness with exacerbation of symptoms."
to Linda Dacres, NP and Clinical Director of NPSTAT, the result has been a 97 per cent reduction in emergency department transfers of LTC residents who were assessed and treated by the NPSTAT team. It is estimated that this represents a saving of several million dollars and thousands of emergency department (ED) hours. “We believe the success of the program lies with our interprofessional approach to patient care,” says Susan Engels, Patient Care Director at TSH. “Our NPs work in collaboration with nursing home staff, physicians and hospital staff to provide LTC
maintenance of percutaneous drains and pain pumps, and changing G-Tubes. “At end-of-life, there can be a lot of feelings of guilt,” explains NP Barbara Bickle, a TSH staffer and member of NPSTAT, adding that nurses feel obligated to send residents to the hospital to treat symptoms when care can be offered in the nursing home, where families wish them to stay. “If you’re really listening to the family and know they are speaking on behalf of the patient, they’re advocating for what he or she would have wanted.” NPs also participate in family meetings to help
hear families and staff tell us, ‘she or he died well’,” says Linda. “However, such deaths are exceptions in long-term care where the dying process is often unrecognized.” She adds that a good death should be a healthcare priority – an indicator of our civility - as we plan our future state. Rather than interpreting the dying process as an end-point with no intrinsic value, it is imperative that we re-examine our commitment to do no harm – even at the threshold of death. Krista Luxton is a Communications Officer with The Scarborough Hospital.
Hospital News, April 2012
Focus: Gerontology/Palliative Care/Home Care
Baycrest opens lab to spark innovations in aging By Kelly Connelly
slim robot stole the spotlight when Baycrest officially opened its Innovation, Technology and Design Lab (ITD) in late February. The telepresence robot, spanning just over four feet in height with an iPad head that displays video images, moved niftily in all directions, quickly attracting a crowd of fascinated onlookers. The Open House showcased several cutting edge projects aimed at providing solutions to the challenges facing the health system and an aging population. Working with an industry partner, Baycrest is exploring assisted living, telepresence robotic applications for the home and long term care environments. The technology would enable a family caregiver to maintain visual and verbal communication and monitoring of their frail family member at a distance –from their work or home computer. The robot’s iPad head provides two-way visual communication, so both parties can see and talk to each other. A small mirror-like camera mounted on the robot’s pedestal body captures a 360-degree view of the room it is in. The 1,295-square-foot lab is outfitted with shiny white floor-to-ceiling walls that serve as one large scientific doodle pad – easily written on with dry erase markers during project team discussions and focus group brainstorming sessions. The lab is designed to bring together clinical staff, industry reps, artists, designers, engineers, students, family caregivers and seniors to explore creative ways of thinking and problem-solving. The discussions will act as a springboard for systematically developing and evaluating innovative products and services with potential commercial application. Baycrest’s ITD lab is unique in the world. It bridges the science world with the clinical and real-life client worlds of seniors. It aims to validate innovative solutions
in the real world, in real time, based on genuine human need and user-centred designs for the aging population. That’s why the ongoing involvement of key users such as seniors and caregivers is so critical to the process. And while there are other innovation labs using the same methodology, they are not embedded in a 21-acre campus with a seniors’ continuum of care that spans housing to acute care, a world-renowned cognitive neuroscience centre, and top minds focused on aging. “We also want to engage people not just in healthcare, but anyone who can contribute new perspectives and ways of exploring solutions,” says Bianca Stern, occupational therapist and director of Culture, Arts and Innovation at Baycrest. “The ITD lab is the place where people can take their ideas from inception to launch.” “The objective of the lab is to bring new solutions to people. We select projects that have an excellent potential for rapid transfer to market in one to three years,” adds Laurent
Moreno, manager of the ITD lab. Examining the use of avatars to enhance the well-being of frail, aging clients is another project underway in the lab. Baycrest is working with an industry partner to explore virtual reality applications that would provide recreational and social support for homebound, isolated seniors and caregivers, and be used for staff training and education. For example, senior clients with limited mobility could participate in activities they enjoy, such as going dancing or walking in the park, via an avatar that represents them in the virtual world. The lab is also testing mobile and tablet technology software that would facilitate smoother transitions of care for patients who move from hospital to long term care and help reduce the rate of readmissions to hospital. The project is funded by the Ministry of Economic Development and Innovation. Baycrest clinicians will be piloting these technology solutions to gauge their effectiveness in support-
Baycrest officially opened the new Innovation, Technology and Design Lab in late February.
ing real-time communication, care coordination and knowledge transfer among staff, families, and community care providers, from both the hospital and long term care sides. Other projects in development in the ITD lab: Re-thinking the nursing home model of the future – A diverse group of thinkers, from hospitality and retirement home industries, psychology, art and design, as well as seniors in the community and in long term care, are exploring the resident’s lived experience in the nursing home in order to identify ways that will allow seniors to age more comfortably in place. The model will also be a place for learning and teaching the next generation of caregivers, and will be linked to Baycrest’s new Centre for Learning, Research and Innovation in Long Term Care, funded by the Ontario Government. Social robot project – Baycrest is working with the University of Toronto’s Department of Mechanical and Industrial Engineering
to explore the use of social robots that would assist seniors with mild to moderate cognitive impairment residing in long term care environments. The robot, built with emotion-sensing computer software, is envisioned as a social coach on wheels, providing verbal cues and social encouragement, to motivate seniors to engage in recreational and self-care activities. The robot as social coach is a model already being tested elsewhere. In the U.S., a team of researchers at three universities (Memphis, Notre Dame and MIT) are developing a social robot as an assistive tutor for students. Delving into the exotic world of social robotics and avatars is a natural step for Baycrest. For several years it has been exploring emerging technologies, such as smartphones, as assistive aids or memory prosthetics for adults with a range of memory disorders, from mild cognitive impairment to severe amnesia. Kelly Connelly works in public affairs at Baycrest.
News, April 2012 10 Hospital Focus: Gerontology/Palliative Care/Home Care
Gentle Persuasive Approaches to better understand patients with dementia By Calyn Pettit
s a lead hand in the security department at the Juravinski Hospital and Cancer Centre in Hamilton Ontario, Jason regularly assists patients with dementia, an age-related disease that affects cognitive ability. Often, individuals with dementia become so confused or frightened that they appear unwilling to cooperate with those around them, posing a risk to the well-being of themselves or others. In these cases, Jason’s job is to decompress the situation, a task that often requires a great deal of patience and care. Jason recently completed training to become a certified coach in Gentle Persuasive Approaches (GPA), an educational curriculum that helps front line and ancillary hospital staff members better understand how to care for patients with dementia. Through GPA training, Jason learned that sometimes the best approach is to simply stop and listen. “Patients with dementia or delirium often see a security guard as a person with authority, and they feel safe speaking with us,” says Jason. “That’s why I make sure to give them the time to talk and fully listen to what they have to say. Just lending an open ear can be very reassuring to them.” Health care workers trained in GPA learn how to use a person-centred, compassionate, and gentle approach when responding to patients who are demonstrating challenging behaviours associated with dementia and/or delirium. The evidence-based curriculum was developed, implemented and evaluated in long term care settings in Central South Ontario in 2004 by a group of clinicians, educators and researchers with funding from the Regional Geriatric Program Central. Since then, it has spread to over 700 long term and complex continuing care facilities across Ontario and Canada. To date,
The Gentle Persuasive Approaches team at Hamilton Health Sciences. over 63,000 staff members have been trained in Gentle Persuasive Approaches, and 1000 of them have completed training to become certified GPA coaches. Until 2009, GPA had been accepted practice in long-term and complex care environments, but had not yet been evaluated for its effectiveness in acute care settings. In 2009, a pilot trial of GPA on the Juravinski Hospital’s hip fracture unit, supported by orthopedic manager Heather Pepper and clinical nurse specialist Karen Robinson, demonstrated a reduction in Code Whites (violent situations) and restraint use, as well as patient-related staff occurrences (patient-staff interaction where potential or actual negative outcome for the staff member occurs). In May 2010, with funding from Hamilton Health Sciences’ Centre for Healthcare Optimization Research and Delivery (CHORD), the program was widely implemented at the Juravinski Hospital (JH) and has since expanded to the Hamilton General Hospital (HGH). The CHORD funding has also supported a
research study that examines the effectiveness of GPA in acute care, using the JH as a test site. The study examines data pre- and post-GPA implementation, and has shown a reduction in the number of Code Whites, Code Yellows (missing patients), and the use of patient restraints at the JH. Study results also support that education in GPA provides staff members in the acute care context with the knowledge and confidence to respond effectively to older adults who exhibit challenging behavior. “GPA has been very effective in supporting staff to use other techniques and strategies versus restraints,” says Leslie Gillies, chief of nursing practice and project lead for GPA at Hamilton Health Sciences (HHS), which includes the Juravinski and Hamilton General hospitals. “It’s made a big impact as far as ensuring a least-restraint environment at HHS.” Staff members who participate in the one-day GPA education session learn a variety of techniques for responding to patients with dementia and/ or delirium who are displaying what is referred to as ‘responsive behaviour’. Anne Pizzacalla, a clinical nurse specialist and certified GPA coach at HHS, says the training encourages staff members to first change the way they think about this type of behaviour, which then influences the way they respond. “Using the word ‘aggression’ tends to be judgmental,” says Anne. “Aggression implies purpose or intent. Dementia and delirium are diseases of the brain. GPA
helps staff to understand that this behaviour isn’t being done on purpose.” Leslie says that when patients are behaving in an aggressive way, they are likely responding to an unmet need. Gentle Persuasive Approaches teaches staff members to perceive the world from the patient’s point of view. “They may be feeling fear or hunger or pain, and are not able to express themselves,” she says. “The behaviour is resulting from that, not because they are trying to be aggressive. With GPA, staff members are encouraged to stop and ask: ‘What’s causing this situation? How can we address this unmet need?’” “GPA training really made me understand the everyday world of a patient who has dementia or delirium,” says Jason. “I have a new sense of empathy when communicating with these individuals.” As in Jason’s case, GPA can be useful to any hospital employee who has some contact with patients with dementia or delirium. “We’ve had a great uptake with security, housekeeping, engineering, among other areas,” says Anne. “The education is relevant across many departments and disciplines. All departments are learning together.” “It is common for nonclinical staff to have contact with patients,” says Jason. “It’s beneficial for staff outside the direct line of patient care to receive GPA training. The training will not only help staff identify patients with dementia or delirium, it also provides confidence when responding to these encoun-
ters.” Maureen Montemuro, a clinical nurse specialist at St. Peter’s Hospital in Hamilton and one of the original developers of GPA, feels one key benefit of the program is that staff members can participate one day, return to work the next and immediately apply what they learned. Lori Schindel Martin, associate director – Scholarly, Research & Creative Activities at the Daphne Cockwell School of Nursing, Ryerson University, was also an original developer and evaluator of the GPA curriculum. She continues to play a key role as a member of the GPA CHORD Project team at HHS. “The team approach to the implementation and evaluation of GPA in an acute care setting has resulted in a highly successful research project,” says Lori. “The project was purposefully designed to enhance the transfer of knowledge to the point-of-care. It’s very exciting to be a part of this project.” For several years, GPA training has been provided to staff at St. Peter’s Hospital as part of their new employee orientation. Beginning in April 2012, as a result of its success in enhancing patient care at HHS, GPA training will be offered through the Clinical Practice and Education department as a continuing education opportunity for all hospital staff, and as a standard component of hospital orientation for new staff members across all sites. Calyn Pettit is a Public Relations Specialist at Hamilton Health Sciences.
patient safety 11
HospitaL News, April 2012
A special kind of lasting care By alicia Doris
n a hospital that often operates beyond its bed capacity, there’s one bed, in a big, bright, beautiful room that’s reserved for a very special patient and family experience� It’s the “Special Care Bed” at Peterborough Regional Health Centre’s palliative unit - a specially designed and appointed room where patients, and their families, who present to the emergency department can spend their final moments with a loved one� “Emergency departments are very busy, hectic environments - not ideal for patients and family members who need a quiet environment in which to say ‘goodbye’,”says Theresa Morris, PRHC’s palliative care nurse consultant coordinator� PRHC’s Special Care Bed practices are believed to be unique in Ontario, and have received much interest from other hospitals and palliative care practitioners� Morris explains the Special Care Bed is the right bed in the right place for the best end of life care possible� “The physical environ-
family members who have a bad bereavement experience are greatly affected,” explains Jagger Smith, PRHC’s palliative care manager� “Every team member in our area wants to make sure that this difficult time is as comfortable as it can be�” “Grief is a visceral experience that people need to heal from� And there’s less for family members to overcome if they can move forward from a positive place,” says Smith� “Death is a life event, and as a hospital – as health professionals – it’s part of what we do� We look after l to r: sherry Mossor, Charge nurse, Jagger smith, people at birth and we look Manager, Theresa Morris, nurse Consultant Coordinator, after people at death� There in PRhC’s Palliative Care unit. are few more noble responsibilities that I can think of�” ment is different than it is in and expertise of the multidisNinety-five-year-old Alan the ER� The emotional and ciplinary team – specifically Peterman was transferred spiritual environments are difthe nurses� Palliative care from PRHC’s ER to the palferent� Family members are nurses are skilled at bondliative care unit just three comforted in a big, private ing very quickly with family hours before his passing� His room, allowing them to attend members and in a matter of son, Michael, says that despite their loved one’s death in a minutes, establish a relationhis age, and having learned in dignified way,” says Morris, ship, putting everyone at ease� the ER that his father had sufadding patients can, and are Palliative care nurses also fered a heart attack and had oftentimes transferred from educate family members about pneumonia, he wasn’t expectthe ER to the Special Care the physical symptoms their ing him to die� Bed very quickly� loved one might experience� “My father had a great Once patients and their Their work is, in essence, ability to rally, and survive families arrive in palliative to normalize the end of life all sorts of things,” says care, they immediately begin experience� “Personal experiPeterman, adding he walked to benefit from the experience ence and research tells us that alongside his father, as his
nurse and his porter transferred him to the palliative care unit� Peterman describes not only the “pleasantness” of the unit, with its original artwork and windows, but the special skill of the staff members� “They left us alone to talk to him…but clearly they knew he was going to die shortly, and they would appear,” he says� “I had the sense of loving care with virtually everyone we dealt with�” Cara Peterman says the words “palliative care” were always terrifying to her, but as she accompanied her fatherin-law into the unit, she began to feel surprisingly better� “I couldn’t believe it – the palliative care unit didn’t feel as much like a hospital, and that made it much easier,” she says� “We really appreciated that the staff explained everything� They were focused on you and took the time to make everything so comfortable� We went away feeling that everything had been done that could have been done� It really was a blessing�” Alicia Doris is a Communications Advisor at Peterborough Regional Health Centre.
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News, April 2012 12 HospitaL Focus: GeRoNtoLoGy/paLLiative CaRe/HoMe CaRe
Creating a sustainable future for a small rural hospital
By Carol anderson and Laura Ricketts
develop the site as a “Centre of Excellence” in both ambulatory and inpatient care� This new specialized focus on seniors care established a platform for discussion about the possibilities of a broader role for Uxbridge in the future� The vision immediately generated discussion and excitement among the staff, physicians and key stakeholders, all of whom could now envision the campus becoming an important component within the Markham Stouffville Hospital framework�
mall rural hospitals across Ontario continue to struggle with the challenges of delivering efficient and effective high quality health services in an increasingly technological and complex health system� As a result of this changing reality, small rural hospitals, like Markham Stouffville Hospital’s Uxbridge site, must adapt in order to continue to serve as cornerstones of these rural communities� “The Uxbridge community feels strongly about the hospital and about the services it provides,” says Neil Walker, Chief Operating Officer, Markham Stouffville Hospital� “With that in mind, we wanted to look at ways of keeping our hospital vibrant and current� In order to do that, we worked with our community partners to create a new vision of a ‘renewed’ Uxbridge hospital�”
knowing the community and foreseeing future needs The Uxbridge site is a small facility currently offering select ambulatory clinics and minor procedures, diagnostic imaging and a 20 bed inpatient medical unit� Located in a primarily rural community about an hour northeast of Toronto, the Uxbridge site of Markham Stouffville Hospital serves a community with an aging
Making the vision a reality Patient Johnnie Trach works with rehabilitation assistant Lindsay drover as part of a program to support patients in returning to normal activities.
population� More than 13 per cent of the population is over the age of 65 and this is expected to increase over the next eight years� Specifically, the 65 to 74 and over 85 demographics are expected to grow by 53 per cent and 47 per cent respectively in this area of the province� “It’s well known that as a population gets older, there is a higher risk for frailty and as result we see more seniors who require services from our hospital,” says Julia Scott, Vice President and Chief Nursing Executive, Markham Stouffville Hospital� “There are numerous challenges to serving an aging popula-
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tion; however there are also many opportunities� In looking at the best way that our Uxbridge site can serve the community, we needed to find a balance of serving our seniors while continuing to provide care to everyone in the community�”
Considering the changing landscape of rural healthcare “There are a number of complex and inter-related issues when you look at providing care in a small hospital� Add to this a population that is aging and we must shift our approach to providing care,” says Walker� This is why the hospital considered the following issues in today’s health care environment when beginning the renewal process� • The impact of “chronicity” and an aging population on the health-care system is well documented� This impact, however, is even more dramatic in rural communities where health services that are often an alternative to hospital care have not been well established� Small volume facilities must constantly manage the need to provide a high standard of clinically competent care in the absence of critical mass� Small volume does not mean “less complex”� • The ability to access and share information quickly has supported the new age of informed health care consumers – individuals who understand and are accountable for their health and health issues and make informed choices accordingly� These individuals
access the services they want, regardless of distance and even cost� • New health service models for the delivery of best practice care have influenced referral and ambulance patterns resulting in many patients now “bypassing” their closest hospital to take a patient to a specialized centre, resulting in a significant decline in ambulance visits� • With escalating health care costs, many hospitals have merged or amalgamated to create larger multi-site hospital corporations� Often with these mergers comes the consolidation of services in order to ensure the delivery of high quality care delivered efficiently�
Forming a renewed vision for the uxbridge site Similar to many small rural communities, Uxbridge citizens are interested and involved in the activities of the local hospital� Recently, the local government established the Uxbridge Council Health Care Committee in order to participate in the planning and integration of local health services in their community� The hospital also has a very dedicated Foundation that continues to fundraise for the facility� This commitment made them a highly valued advisory group along with other community leaders to come up with a renewed vision for the campus� The vision involved supporting the site in establishing expertise in rehabilitative practices and geriatrics to
To make the vision a reality, a number of changes were implemented� The changes included altering the staffing mix at the hospital and enhancing allied health resources to include a dietician, rehabilitation assistant, occupational therapist, physiotherapist and others to assist with the rehabilitation of inpatients� One of the most significant changes was the consolidation of long-term specialty rehabilitation beds, referred to as Complex Continuing Care beds, at the Uxbridge site� In order to care for this patient population, additional capital equipment, such as ceiling lifts, was purchased through the Foundation’s fundraising efforts� The site is now equipped to care for patients from either the Markham or Uxbridge site who require this level of care, as well as patients from across Durham and York Region� By February 2012, the first long-term rehabilitation patient was transferred to the Uxbridge campus from Markham� The transfer of the first patient was the culmination of a great deal of effort, change and education� “The first transfer represented a huge milestone,” says Scott� “It really showed us what could be accomplished and how the site could fulfill a very necessary role for our community� This really is about providing the right care, to the right person in the right place�” The Uxbridge Campus continues to evolve as a centre for specializing in geriatrics and rehabilitation while supporting the health-care needs of the community� Carol Anderson is the director and Laura Ricketts is the manager of the Uxbridge site of Markham Stouffville Hospital.
Focus: Gerontology/Palliative Care/Home Care 13 Hospital News, April 2012
Returning home from hospital By Pam Stoikopoulos The idea of moving out of hospital and back home seems, on the surface, to be a transition worth celebrating. After all, for many patients it means returning to a familiar environment where they can enjoy creature comforts on the road to recovery. But it can also raise stress and anxiety levels for both the patient and their families, even when the prognosis is good. Gone is the “security blanket” of around-the-clock hospital care. “We were excited to bring my mom home,” recounts Christina Da Silva, of her post-operative experience with her mother last fall. “But there was also lots of stress. She was still in so much pain, it was scary. Her wounds needed to be changed regularly and we were worried about infection too,” she notes. Da Silva’s story isn’t uncommon. Whether it’s caring for an adult loved one who is coping with a chronic condition, recovering from surgery or is going home to live out their last days, the transition can raise concern. “Many people leave not really sure where to turn, especially if the move back home feels rushed,” says Nicole McEachern, an intake social worker for the Community Support Department at VHA Home HealthCare. “Depending on where you live, there may be a local program that helps with the transition,” she notes, including Central East’s Home At Last Program in Scarborough, of which VHA is a partner. The program assigns a Personal Support Worker (PSW) to discharged patients to escort them home, settle them in, buy groceries and, if needed, help with personal care. Similar programs are also offered throughout Ontario. In most cases patients rely on the support of friends and family for the move back home. Lenore Cabral, VHA’s Manager of Community Support Programs and a social worker, advises that loved ones help gather information for the patient to help with the transition and actively inquire about community supports that may be available, especially if worried about the transition. Cabral suggests that before discharge, families: • Request to speak with a, Community Care Access Centre (CCAC) Care Coordinator or a hospital social worker / discharge
A VHA physiotherapist assists a client recovering at home following knee surgery.
planner who can help families access and learn more about community resources and in-home supports if they feel they’re unable to cope with the patient’s return home on their own. Local adult day programs, for example, can give people caring for loved ones with cognitive impairments, dementia, etc. a break from their care giving duties. • Are clear about the diagnosis and prognosis and how the patient’s condition will impact their daily functioning. • Confirm any scheduled follow-up appointments and ensure they’re kept. According to Cabral this
is a critical component of acute care in the community and often prevents deterioration, relapse or failure to cope at home which can ultimately lead to a return visit to the emergency room. • Clarify what at-home care will be needed: be it a home safety assessment by an occupational therapist, wound care or strengthbuilding exercises. “It’s not surprising that people feel overwhelmed,” Cabral notes. “But knowing what to ask and the steps to take can ease the strain,” she adds. While Christina Da Silva’s
family was able to divvy up care giving responsibilities for her mom amongst family members, in hindsight she believes, “If we had to do it all over again, we probably could have used some extra help to take the pressure off. It would have given us peace of mind. We didn’t really have a concrete plan.” It’s one of the reasons, Cabral, collaborated with other health professionals, including members of Solutions—East Toronto’s Health Collaborate, to create a free telephone and online seminar on the topic. “Home is where most patients want to be, however, it can weigh heavily on care giving fam-
ily members—especially if they’re juggling other priorities,” says Cabral. The free Ring and Reach telephone and online seminar, Hospital to Home— Community Resources for Caregivers helps caregivers understand the challenges of going home and educates them about what resources are out there that they might be able to tap into. “Some of these can be provided by the community or health care system,” Cabral notes, but points out that because the system is stretched, those who have insurance coverage or can afford to pay for private home support may want to explore these options too. “The seminar really helps people know what questions to ask and what issues to consider in advance of a discharge. Planning ahead can help everyone feel more at ease and really enjoy their loved one’s move from the hospital to home,” she says. Hospital to Home— Community Resources for Caregivers, the first in a series of free Ring and Reach telephone and online seminars, takes place on Wednesday, April 11, 2012 from 7:00 p.m. until 8:30 p.m. Visit www.vha.ca/home/ ring-and-reach-seminars to register or contact Lenore Cabral at: 416-482-4603 or 1-888-314-6622 ext. 4603. Pam Stoikopoulos is Communications Manager at VHA Home HealthCare.
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News, April 2012 14 Hospital Focus: Gerontology/Palliative Care/Home Care
Caregiver support services help patients and clinicians access health care resources By Lisa Lombardo
aring for both your children and your elderly parents? You are not alone. More than one in five working Canadians belong to the “sandwich generation”, where the dual responsibilities of caring for both children and parents often leads to stress and burnout. Being a family caregiver can be a rewarding and fulfilling responsibility but also a challenging one if caregivers feel overwhelmed and do not know where to find help. “Family caregivers may have a difficult time organizing support services and assistance because services that can make caregiving more manageable are not centrally organized and are sometimes hard to locate,” says Nicole Beben, Executive Director of the Saint Elizabeth Care to Know Centre. “Family members often become caregivers suddenly. Caregivers tell us that getting support early on helps the transition from feel-
Saint Elizabeth connects patients and family caregivers to unique and innovative health care support resources. Photo Credit: Saint Elizabeth ing helpless to feeling empowered.” Saint Elizabeth’s Caregiver Compass is a free online information and support resource for caregivers which aims to simplify the overwhelming amount of information available and helps people find their way when they are not sure where to turn. The Compass provides readers with an overview of the types
of supports or resources they may need including: important information on government support programs, tips for managing finances, end-of-life care and more.
Ask Elizabeth Help Line Front line staff can find it difficult to help their clients and their families find appropriate services and support.
“Saint Elizabeth service staff encounter family caregivers every day in their work providing home care services,” says Natalie Strouth, an Information Specialist and RPN with Saint Elizabeth. “Responding to a need we saw with our own frontline staff, we created a specialized telephone hotline called Ask Elizabeth which connects patients, family caregivers and even health care workers with suggestions and nextstep information on where to access health care services and supports.” “Working as a nurse for Saint Elizabeth, I am often asked about everything from accessing social services to options for treatment,” says Strouth. One recent call to the Ask Elizabeth line came from a woman whose friend was receiving cancer treatment and she didn’t know how to arrange in-home overnight care. Ask Elizabeth staff assisted her with information about the services provided by Community Care Access
Centres, and connected her to a caregiver respite program. Staff also connected her with a local cancer support centre, information on government benefits, and medical transportation services. Ask Elizabeth staff answer questions around chronic disease management; access to services like transportation, meals on wheels, adult day programs as well as other support services and health care information. Patients and caregivers have found the Caregiver Compass and the Ask Elizabeth hotline invaluable when faced with the challenges that are part of a health care journey. The Caregiver Compass is available free online at www.caretoknow. org/flash/compass. The Ask Elizabeth hotline can be reached at 1.877.787.SEHC (7342) or via online chat at www.saintelizabeth.com. Lisa Lombardo is a Communications Coordinator at Saint Elizabeth.
Locum midwives provide relief to rural and remote colleagues By Juana Berinstein
idwives practice in rural, remote and northern communities across Ontario. Some of these midwives work in practices with midwifery colleagues, others are solo practitioners. Committed to their clients, they work hard to provide excellent primary care to women outside of urban centres. They willingly accept the challenges of working in smaller and sometimes isolated communities, and the workload and long hours that are part and parcel of the job. But the work can be tiring and, like all midwives, they
need support to have appropriate time off-call. In 2009, with support from the Ministry of Health and Long-Term Care, the Association of Ontario Midwives (AOM) introduced a program to respond to the needs of rural and remote midwives. The AOM Rural and Remote Locum Program relieves midwives for holidays, sickness, emergencies, continuing education or parental leave. It enables midwives to turn off their pagers with the confidence that their clients are in the experienced hands of another registered midwife. Last August, Collingwood
midwife Natalie Kirby returned to her northern Ontario hometown to do a month-long locum. While living with her parents in North Bay, Kirby gained new insight into the life of a solo midwife with a practice in Powassan (20 minutes south of North Bay). At her regular job at Midwives Nottawasaga, which is a shared-care practice, she works one week on and one week off. During her locum, she was on-call for 28 days in a row. She caught four babies during the second week, three in hospital and one at home. Kirby was granted locum privileges at North Bay Regional Health Centre for the duration of her stay, and worked with the healthcare team and the hospital. Even so, “being a remote solo midwife is an incredible responsibility,” says Kirby. “You don’t have midwifery colleagues to call for back-up. You are it.” Providing relief for the local midwife and continuing the philosophy and quality of care she had begun with her clients was a rewarding experience for Kirby. “Balance is essential in our career; being
pager-free so you can sleep, travel and do whatever you need to do.” She was also happy that the women in the community were able to stay in midwifery care. “If a locum didn’t come, the women would have been transferred to obstetrical care and wouldn’t have had home visits,” says Kirby. Without midwives and locums, maternity-care providers in rural locations, such as obstetricians, can be overstretched to meet the community’s needs. Kirby was thoroughly briefed on each of the clients before she arrived in the community, but says she made a point of revisiting some topics during her prenatal visits with clients. “It’s important to make sure that you’re on the same page with clients because every midwife practices a little bit differently. You want every woman to have the birth experience they want,” says Kirby. The job wasn’t without its challenges – such as orienting herself to a new midwifery practice and familiarizing herself with the protocols at North Bay Regional Health Centre – but Kirby says the
locum experience was an incredibly positive one. “I think it’s such a benefit for healthcare providers to have a chance to visit new communities, see how they do things and adopt good policies where they can,” she says. In addition to learning how another midwife practices, Kirby enjoyed collaborating with the members of the hospital’s health care team. She says she found everyone to be helpful, supportive and appreciative of the fact that she had come back home to do a locum. “I loved my experience!” says Kirby. Last year, AOM’s Rural and Remote Locum Program provided funding for 14 rural and remote midwives to have locums. In 2012, AOM hopes to be able to relieve even more midwives. If you are interested in finding out more about the program, please contact AOM at 416-425-9974 or 1-866418-3773 x2257. Juana Berinstein is the Director of Policy and Communications at the Association of Ontario Midwives.
Focus: Gerontology/Palliative Care/Home Care 15 Hospital News, April 2012
Finding peace in troubling times By Cayln Pettit
ise Johnson lies comfortably in her hospital bed, gazing toward the big, bright window in her room. “I feel such a feeling of peace,” she says. “I’m not afraid.” Lise is accompanied by her husband, Al, and their daughter, Nancy, on Ward C3 at the Juravinski Hospital. Last November, Lise was diagnosed with pancreatic cancer. Her symptoms arrived very suddenly - severe stomach pain that she assumed was the result of extreme indigestion. A diagnosis of cancer was the last thing the family expected. On Lise’s windowsill sits an oversized fishbowl, its clear glass reflecting the soft, white light of the crisp winter morning. It’s hard to miss, and not just because of its size. At first glance, the bowl appears to be full of candy, filled to the brim with a rainbow of tiny, coloured pieces. But, upon closer inspection, it becomes clear that the bowl is actually filled with hundreds upon hundreds of tiny origami cranes, each in a different colour and pattern. There are 1,000 of them in total, basking together in the streams of sunlight spilling in through Lise’s window. In Japanese lore, the crane is viewed as a sacred bird and is believed to live for 1,000 years. The act of folding 1,000 paper cranes grants the maker a wish, usually for good health or prolonged life. On Christmas Eve, Lise’s daughter, Nancy, received a phone call from one of her colleagues. A group of her co-workers had a gift for her mother, whom they had never met. Expecting a card or perhaps an arrangement of flowers, Nancy was overwhelmed when her colleagues presented her with the cranes, which they had been diligently folding for weeks. Lise was just as surprised when Nancy brought the cranes to her bedside. “They are just beautiful,” says Lise. “When I first saw them, peace fell over me right away.” Lise was given a few options to treat her cancer, although none were expected to significantly extend her life. She declined treatment, opting instead to spend her time enjoying the presence of family and friends at home. Since she received the cranes, Lise says she’s felt at peace with her reality. “Each day, I wake up in the morning and look at them,”
A gift of love and peace : After being diagnosed with pancreatic cancer, Lise Johnson received a gift of 1,000 paper cranes as a symbol of love, peace and well-being. she says. “I feel such a feeling of peace, hope and courage, knowing love was put into each special fold. I’m no longer afraid – my faith brings me that.” Ann Vander Berg, chaplain at Juravinski Hospital and Cancer Centre (JHCC), met Lise during her stay in hospital. Ann says that people often use physical objects as a means to connect with deeper spiritual and/or religious beliefs. But, she’s never before witnessed a gift of 1,000 cranes. “I’ve just never seen anything like it,” says Ann. “The ways in which people receive spiritual care are diverse, and this one is quite unique.” As a chaplain in Spiritual Care at Hamilton Health Sciences (HHS), Ann provides support to patients and their families during difficult times. At the Juravinski site, Ann is accompanied by fellow chaplain Dave Jones. “Basically, our job is to help patients utilize their own spiritual resources, whatever they may be,” says Ann. In the face of illness or when approaching end-of-life, individuals often turn to their spiritual belief system to make sense of their circumstances. They may be experiencing feelings of fear, uncertainty, regret, or even curiosity about what’s to come. In difficult times, there are many questions to be answered. “We’re all rational beings – we naturally want to make sense of what’s happening around us,” says Dave. “Our role as chaplains is to listen to the patient, help them interpret their experiences, and advocate for their wishes.”
At HHS, chaplains are available to support patients of all spiritual and religious traditions. Services include emotional support and grief counseling, and coordination of rituals and services. Referrals to a chaplain are usually made by a member of the health care team, such as the physician or nurse. Lillian Curtis is a chaplain at McMaster Children’s Hospital. Lillian says that, although a child’s understanding of spirituality may differ greatly from an adult’s, the chaplain’s approach to providing care and support is quite often the same. “Conversations with our younger patients are often focused on what they like to
do, and what gives and maintains meaning in their lives,” says Lillian. “Getting to the same level as the patient is very important.” As with adult care, the spiritual and religious needs of younger patients and their families are diverse. These might include rituals, such as baptismal services at a child’s bedside when a crisis arises, or blessings for an infant who is unable to make the transition from womb to the outer world. “These rituals are about giving expression to a reality and help to mark both birth and death,” says Lillian. Often, the chaplain is available simply to offer an open ear. “We want families to feel
that someone understands and cares for them, whatever the situation,” says Lillian. “To us, all persons are equal and all deserve a purposeful place in this world.” At HHS, chaplains are available on-call 24/7, and spiritual centres are located on the main level of each hospital site. The centres are open at all times for prayer, meditation or quiet reflection. For more information about spiritual and religious care and chaplain services at Hamilton Health Sciences, refer to the Spiritual Care page on the HHS Intranet. Calyn Pettit is a Public Relations Specialist at Hamilton Health Sciences.
News, April 2012 16 Hospital Focus: Gerontology/Palliative Care/Home Care
VP of Seniors Services ensures the right focus in Winchester
By Jane Petricic
he Winchester District Memorial Hospital (WDMH) is committed to supporting seniors – starting right at the top. Last year, the hospital hired Karl Samuelson, its first Vice President, Seniors’ Services, to lead a renewed commitment to this specialized care. And for Karl, the little things matter. Recently, he recorded a CD of old-time music for patients in Complex Continuing Care. The benefits were evident right away as an elderly cancer patient enjoyed the songs. “I can’t dance anymore but I can still move to the music,” she said with a big smile. Her husband later told the nursing staff that it was one of the best days she’s had. He was very thankful that the Winchester staff had done this for both of them. Karl says it’s his job to help WDMH serve the needs of the growing elderly population. “We want to earn our communities’ trust and provide for their needs. This role gives me the opportunity to work with an organization that truly wants to implement the
Last year The Winchester District Memorial Hospital hired it’s first VP of Senior Services, Karl Samuelson. very things that I have advocated for over the past two decades. This includes finding ways to keep seniors out of nursing homes for as long as possible.” WDMH is located about 40 minutes south of Ottawa, serving 90,000 residents in the surrounding communities. It is a full service hospital and serves as a hub site for cancer
care, dialysis and cataract surgery. Specialty clinics with visiting specialists from Ottawa hospitals are also offered. A $60 million capital expansion project has resulted in the most technologicallyadvanced facility in rural Ontario. The senior-focused philosophy can be found in every area of the organization. For
example, WDMH was the first rural teaching hospital in eastern Ontario and it wants to expand that learning to focus on seniors’ care. “For our medical students, there should be teaching in long-term care homes just as there are teaching hospitals. WDMH is committed to such an environment,” says Samuelson. Karl also serves as Administrator of Dundas Manor Nursing Home in Winchester, extending the senior-focused philosophy even further. Both organizations are part of the bigger Centre of Excellence for Rural Health and Education. It brings specific health care providers, educators and researchers together – and partners with other providers that impact the health of local communities. These partnerships support healthy rural communities putting patients and families first throughout their life. The Centre includes WDMH, a Community Care Building (under construction), Dundas Manor and other onsite and virtual education and teaching partners. Partners such as the local community care access
centre, public health unit, early years’ child centre and others come together for care on one site close to home. “We are committed to having the very best seniors’ services as part of our new Centre of Excellence,” adds Cholly Boland, CEO. “These include the hospital, nursing home and community services working closely together for the benefit of our seniors. Our teaching and research activities help us ensure that all of our services are of the highest quality.” Karl believes the Centre of Excellence in Rural Health and Education offers tremendous benefit for seniors in the region. “The day will come when the Centre of Excellence at WDMH will also be recognized across the country for its extremely progressive plan. We have the pieces in place and the infrastructure to get there. I’m excited to be part of that. And our seniors deserve nothing less.” Jane Petricic provides communications support to the Winchester District Memorial Hospital.
Strategies for seniors L
By Cyndy De Giusti
ike all hospitals in Ontario, St. Michael’s is looking at how best
to address the unique needs of seniors. Susan Blacker, director in charge of developing the elder care strategy at St. Michael’s, says, “There are a number of areas where a focused and systematic approach can provide clear benefits to the elderly. Two examples of initiatives now in implementation are: early mobilization and the prevention, diagnosis and treatment of delirium.”
Early mobilization key Dr. Sharon Straus, a geriatrician and director of the Knowledge Translation program at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, says, “Research shows that without mobilization, an elderly patient will lose one to five per cent of his or her muscle strength every day in hospital. About one-third of adults lose at least one activity of daily living when in hospital – many never recover fully.” St. Michael’s, along with 14 other teaching hospitals in Ontario, is studying the impact
of getting people moving very early in their hospital stays. The goal, according to Dr. Straus, is to assess all seniors within 24 hours of their arrival in hospital, develop care pathways that ensure mobility and then, make sure seniors are up and around at least three times a day. Early mobilization can be significant – reducing length of stay, improving a return to pre-hospital functional status, less depression, increasing discharge home rather than to alternate levels of care and lowering hospital costs.
Tackling delirium In another initiative, St. Michael’s has been looking at the impact of delirium on the elderly while in hospital. Delirium is a sudden onset of fluctuating awareness, impairment of memory and attention and disorganized thinking. People with delirium may also have hallucinations and sleep-wake disturbances. Terri Irwin, professional practice leader for nursing, says, “The research is frighten-
ing: 15 per cent of the elderly who come into hospital will have delirium, another 14 to 56 per cent will develop delirium during their hospital stays, and as many as 70 per cent of those cases will not be detected.” To combat delirium, St. Michael’s nurses are using a method to assess confusion in order to screen for delirium. A team led by project manager Orla Smith developed “HANDOVER” prevention strategies: hydration, activity and mobilization, nutrition, drugs, orientation, vision and hearing, elimination and rest/ sleep. When someone is diagnosed with delirium, there is now a pre-printed order set to ensure consistent and appropriate treatment. Families are invited to participate in developing care plans to help identify potential problems and to play a role in personalized solutions. Cyndy De Giusti is the Vice President, Communications and Public Affairs at St. Michael’s Hospital.
Natural Path 17
Hospital News, April 2012
Depression and the elderly:
How naturopathic medicine can help By Karamjit Singh
ccording to the Canadian Mental Health Association, depression is the most common mental health disorder affecting seniors. While the criteria for diagnosing depression in seniors is the same for adults, oftentimes the presentation of common symptoms (difficulty sleeping, physical problems, exhaustion) are thought to be related to aging. “Older people are not given the care they deserve,” says Jonathan Prousky, ND and chief naturopathic medicine officer at the Canadian College of Naturopathic Medicine (CCNM). “Their symptoms are easily dismissed because of their age. We need to take them seriously and give them time. As they get older, sometimes it is more difficult for them to express themselves.” What families and caregivers should bear in mind are the causes that can lead to depression in the elderly.
“Often when a loved one passes away, their partner is not equipped to go grocery shopping or to make meals since they never had to take on that responsibility. As a result, they suffer from severe nutritional deficiency/insufficiency, which can affect mood,” notes Prousky.
ability to communicate – all these factors can make the elderly more prone to depression.” When it comes to treatment, anti-depressants and therapy are often prescribed but there are also a number of naturopathic treatments that can help seniors cope.
"Depression is the most common mental health disorder affecting seniors."
Prousky stresses the importance of looking at the whole person instead of just the symptoms and says that’s where naturopathic doctors differ in their approach. “It’s crucial to look at what medications the patient is on, whether there is an underlying disease process, does the patient have physical limitations or suffering from chronic pain, is there a medical condition that is compromising their
For Prousky, diet and consuming nutrient-rich foods is key. “In cases where you have a widower who can’t make a proper meal due to physical limitations, there are programs like Meals on Wheels that can provide that service to them. I also encourage family members to go grocery shopping with their loved ones to show them what kinds of foods they should be buying,” he says.
In addition to consuming the right foods, Prousky also reminds caregivers to make sure the foods are being consumed properly. “There are diseases and medications that can lead to swallowing disorders in the elderly. For food and nutrients to be properly absorbed and digested in the body, take your loved one to a dentist to ensure there are no dental issues, or issues with chewing food. Sometimes a swallowing clinic is needed to evaluate a patient’s ability to get food from the mouth into the stomach.” There are a number of vitamins/minerals that have been shown to have anti-depressant and mood enhancing properties including: • Magnesium • B vitamins • Essential fatty acids Botanical herbs such as Rhodiola have been shown to have good efficacy for anxiety, depression and fatigue. However, Prousky does advise patients to seek out a natur-
opathic doctor and to be cautious when taking botanicals since they can potentially react adversely with prescription medications. From a lifestyle perspective, Prousky recommends taking melatonin to get a good night’s sleep and strongly encourages exercise where applicable. “Even if it’s a 20 minute walk every day or every other day, no pill can provide the benefits that exercise does,” he says. Naturopathic medicine is a distinct system of primary care that addresses the root cause of illness or disease and promotes health and healing using natural therapies. Naturopathic doctors (NDs) are highly educated primary care providers who integrate standard medical diagnostics with a broad range of natural therapies. Karamjit Singh is the Media and Community Relations Officer at the Canadian College of Naturopathic Medicine.
News, April 2012 18 HospitaL Focus: GeRoNtoLoGy/paLLiative CaRe/HoMe CaRe
unit designed for older patients is ACeing elder care
By Ciara Byrne
ore than a year ago, leaders at Mount Sinai Hospital stared reality straight in the face: the population was aging� Twothirds of the hospital’s medical patients were over the age of 65 and a new, holistic strategy was needed to care for older patients� What came next was a series of programs, ideas and innovations, including the opening of the hospital’s Ben and Hilda Katz Acute Care for Elders Unit (ACE) in April 2011� Since opening its doors, this dedicated, patient-care area for frail older adults has transformed the lives of patients and staff alike� Jocelyn Bennett, Senior Director for Urgent and Critical Care, says the unit is already delivering better outcomes for these patients� “With the ACE Strategy, we have developed something that is delivering patientcentred care in its truest sense� By seeing the whole person and going beyond their acute medical need, we are delivering the right care in the right
place at the right time,” says Bennett� While Mount Sinai was the first acute-care hospital in Canada to make geriatrics a core strategic priority in 2010, the tailor-made ACE Unit strengthened that promise� Aligning with an entire continuum of geriatric care, the hospital’s ACE Strategy ensures a patient’s journey through community, emergency, inpatient and outpatient settings is as integrated and seamless as possible� The goal of the ACE Unit is to enhance geriatric care in General Internal Medicine by recognizing that older patients often enter hospital with several social and health care needs� In developing the 28-bed unit, an existing ward was converted to create an elder-friendly environment� The space includes large clocks to promote orientation, high back chairs, raised toilet seats and hearing and visually impaired-assistive telephones, among other pieces of specialized equipment aimed at maintaining function and independence for these older patients�
An inter-professional leadership team of geriatric-trained medical, nursing and allied health professionals run the new unit� The ACE Unit also partnered with the Toronto Central Community Care Access Centre (CCAC) to create the role of an ACE Unit Care Coordinator, a specialized role that helps transition patients back home� In less than a year, the ACE Unit is already showing remarkable results� The team has been carefully monitoring its patient and system outcomes through independent surveys and measurements� The data is impressive� Compared to a year earlier, the use of urinary catheters, and the incidence of pressure ulcers have fallen� Patients’ lengths of stay have decreased and readmissions rates have been cut in half from 15�3 per cent to 7�6 per cent More importantly, ACE Unit patients have a 34 per cent increased likelihood of returning home after their stay in hospital and patient satisfaction rates have risen to as high as 100 per cent� Rebecca Ramsden, Nurse Practitioner
stephanie Pascual, Rn with a patient from the ACe unit. Photo credit: Kevin Kelly Photography. on the unit, says staff members have embraced the new approach� “This new strategy has ignited a passion in all of us for providing excellent care for older patients with a focus on maintaining their functional abilities� We have seen significant changes,” says Ramsden� But change in the approach to geriatric care goes beyond the numbers, says Dr� Samir Sinha, Director of Geriatrics� He notes there has been a cultural change too� “Staff members are now challenged to think about the older population with a focused approach and a geriatric lens, and they are seeing the enormous rewards that come with doing so” says Dr� Sinha� The cultural shift has happened through formal and informal education� Staff members have enhanced their skills in geriatric care� The
team-approach means there is a greater focus on early and comprehensive discharge planning and improved communication with patients and their families� The team also successfully developed and implemented evidenced-based, best practice care plans� These plans offer a standard of care for common geriatric syndromes� For Social Worker, Alana Weinstein, the real success of the ACE Unit has been watching older patients return home to their family and friends so they can continue to lead active, healthy lives� “By adapting our system to meet the needs of these patients, we are helping them preserve their independence, which is what ACE is all about,” says Weinstein� Ciara Byrne is an Internal Communications Specialist at Mount Sinai Hospital.
From dementia to diagnosis: a couple’s cautionary tale
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By Rosanne Meandro
wo years is a long time to wait between the first symptom of dementia and a diagnosis – precious time when 62-yearold Lou Grieve might have received medication and made plans for her future� But the time lapse wasn’t because she and her husband Wayne consciously put off seeing a doctor� It was because they did not understand that her mood and behaviour changes were classic symptoms of dementia� “The old Lou was chatty and engaged,” says Wayne� She loved her job as a child and youth worker with her local school board and liked to talk things over at length with him� “It was a way she processed things,” recalls Wayne, 64� “She was just a verbal person�”
points to treatment gap According to an Alzheimer Society survey of 958 family caregivers released in January, close to half of respondents live more than a year with symptoms of dementia before seeing a family doctor or other health care professional� Of these, 16 per cent waited more than two years� In hindsight, three quarters wished they had been diagnosed sooner so they could have received medications to minimize symptoms� While the Grieves sought help early, their story is a cautionary tale for the more than half a million Canadians living with dementia - and those who may be at risk� When Lou began coming home from work exhausted, Wayne chalked it up to the stress of her job� He, too, was a social worker and understood how trying it could be� But when Lou struggled to use her employer’s automated
phone system to call in sick, a red flag went up� “There was a practical kind of problemsolving that wasn’t happening� Lou was always really skilled on the computer� She was a whiz,” Wayne explains� Memory loss isn’t the only sign When the exhaustion wouldn’t go away, Lou visited her family doctor� She and Wayne saw him several times over the next two years as Lou’s symptoms progressed - from extreme fatigue to mood changes� The doctor’s assessment was depression, an illness whose symptoms include exhaustion, mood and behavioural changes that can sometimes mimic those of dementia� A tired Lou scaled down to part-time hours� By March 2008, she was still exhausted and less interested in things Continues on page 24
HospitaL News, April 2012
A day in the life at donald Berman Maimonides Geriatric Centre Continued from cover can’t get any reaction from a resident at all, but then you see them in a music program and they are tapping their feet, or sometimes you see them tearing up in a music program maybe because the music is reminding them of another time, or making them feel happy� You can often see it in their eyes,” says TRS Lucy Bridgeman� Music is one of the most popular activities at the Centre, in particular on the weekends when many families visit� Musician Edwin Orion Brownell plays the piano and sings for residents several days a week� Today, he’s performing a varied repertoire which includes 80’s rock’n roll, Jewish songs and familiar tunes from when the residents were young� “It takes them back to a time they remember and it’s amazing how they may not know what day it is but they can sing the lyrics,” says Brownell� “The attendees in long-term care are really the best audience I’ve ever had� I love coming here� The residents pay attention and really appreciate the music,” he adds as he heads to the elevator to entertain a crowd on another floor� Another activity at the
Therapeutic Recreation specialist Catherine drew assists donald Berman Maimonides resident shirley Levine with breaking an egg for the chocolate chip cookies they were preparing in the afternoon baking program.
DBM is art therapy� Recently, family members, residents and companions took part in art therapy’s first open studio event called Fun Family Portraits� Art therapist Sondra Goldman and her team provided props such as silly hats, glasses and other accessories to create this everlasting family memory�
“It was so nice to see the residents get excited about this fun activity� You could see it in their eyes, feel it in their expressions� They truly
enjoyed themselves,” says Goldman, who had several volunteers help the participants choose which props they wanted to be photographed in�
Goldman recounts watching a playful sword fight between a grandfather and grandson as well as spontaneous singing by another intergenerational family� “By the time the picture was taken, the residents were so full of joy,” she says� Each resident received a photo of themselves to help decorate their room� Other similar events are planned for the future� “This is a wonderful opportunity for the family to bond with the resident even if they are unable to communicate verbally,” says Goldman� “Art allows us to stimulate our senses and share with others without the need for words,” she adds� Activities at DBM include birthday parties, doll therapy, bingo, bowling, mall outings and more� A calendar of activities is published once a month� Lisa Blobstein is a Communications Officer at the Donald Berman Maimonides Geriatric Centre in Montreal.
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News, April 2012 20 HospitaL From the Ceo’s Desk
embracing opportunities for better patient care
By Dr. Robert Halpenny
s a young man playing hockey, I came to the realization that I was more interested in practicing medicine than receiving healthcare for my hockey injuries� I gave up my hockey aspirations and entered medical school immediately realizing I had found my niche� Now, years later, I’m the President and CEO of the Interior Health Authority in British Columbia and I find us poised on the cusp of amazing new opportunities� Interior Health (IH) was created as one of five geographically-based health authorities in B�C� in 2001� We are responsible for ensuring publicly-funded health services are provided to over 742,000 residents of the Southern Interior� We serve a large geographic area covering almost 216,000 square kilometres including cities such as Kamloops, Kelowna, Cranbrook, Trail, Penticton and Vernon� The IH budget is $1�8 billion with over
dr. Robert halpenny is the President & Ceo of the Interior health Authority in British Columbia 18,000 employees and 1600 physicians� Also, within our health authority borders are a multitude of more rural and remote communities including 53 First Nations, 58 municipalities and 95 unincorporated sites�
The creation of one health authority for the Southern Interior has allowed us to improve health care services for our residents in many ways� Where 10 years ago patients often had to leave the region to receive the services
they needed, sometimes transferring between several different jurisdictions, our health professionals are now better equipped to meet residents’ needs locally and to provide standards of care that are consistent across the region� One of the new opportunities I’m excited about is our cardiac program and the new Interior Heart and Surgical Centre (IHSC) – just one piece of a nearly $1-billion capital plan that is improving healthcare in the Southern Interior of B�C� In September 2007, the provincial government announced a cardiac revascularization (angioplasties and cardiac surgery) program would be developed in Kelowna� This IH-wide cardiac program is designed to support the educational, diagnostic and treatment programs necessary to meet the challenge of delivering cardiac care to the Southern Interior region of B�C� Last November marked two years since the first percutaneous coronary intervention (PCI, commonly known as angioplasty) was performed at Kelowna General Hospital (KGH), one of two tertiary hospitals in IH� Previously, when a patient from the Interior required a PCI, they often waited in hospital for transfer to the Lower Mainland or Vancouver Island for the procedure� Since that first procedure, more than 2000 PCIs have been performed at KGH� Wait times are down 87 per cent and most importantly, lives are being saved� For every 100 patients coming into Kelowna General Hospital with a heart attack in 2010/11, nine more patients are alive today thanks to this service being available in the Southern Interior� Survival rates for Southern Interior PCI patients have increased from 88 per cent in 2005/06 to 97 per cent in 2010/11� We’re rolling out our cardiac plan in phases, and starting in December 2012, KGH will offer cardiac surgery� This will be the province’s fifth cardiac centre� Initially, cardiac surgery will be performed in two dedicated operating rooms on the existing site, while the Interior Heart and Surgical Centre is under construction� Construction starts in 2013, and the IHSC is projected to open in spring 2016 with capacity for 15 operating rooms� We’re currently planning for 155 open-heart
surgeries between December 2012 and March 2013, and then we’ll increase that number to approximately 590 surgeries annually� Another exciting area for the health authority is in technology� Technology has dramatically changed how and where Interior Health delivers care� Telehealth uses telecommunications technologies to connect patients and healthcare providers over large and small distances for the purpose of diagnosis, education, treatment, consultation and research� Interior Health has more than 41 telehealth programs, including the nationally recognized TeleThoracic program� TeleThoracic links patients in Cranbrook, Nelson, Trail, Kamloops, Williams Lake, and sites in the Northern Health Authority to thoracic surgeons at Kelowna General Hospital for initial surgical assessments and postoperative follow-ups� The recent TeleThoracic expansion in B�C� is modeled on this Interior Health program� Recently a physician shared this story with me on how technology is transforming the care we deliver: “On a recent occasion, while on-call and having dinner with friends, a call came in from Trail Hospital regarding a patient with an intracerebral haemorrhage that they wanted to transfer to Kelowna� I brought up the brain CT scans on my iPad� After review, I could reassure the doctor that transfer was not required and made recommendations for treatment� The patient responded well and did not have to be transferred out�” I find that story remarkable for a number of reasons� The first being that the patient received appropriate diagnosis and treatment quickly with the aid of technology� The patient did not require a 300 km fourhour transfer, avoided the stress of the transfer and being away from family and friends� The patient stayed in their home community, received the required care and responded well� The situation was a winwin for everyone involved� As Interior Health heads into it’s the next ten years, the question we’re asking ourselves is, “What more are we capable of achieving?” Stay tuned� Dr. Robert Halpenny is the President & CEO of the Interior Health Authority in British Columbia.
Hospital News, April 2012
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News, April 2012 22 HospitaL Focus: GeRoNtoLoGy/paLLiative CaRe/HoMe CaRe
Making moments matter: end of life care
By Helen Reilly
endy’s 42nd birthday fell on a bright, warm Monday� That September afternoon, Wendy Almeida breathed her last breath, succumbing to her long battle with cancer� She felt secure and loved� Friends and family gathered to celebrate with her the previous day� Later that week, friends and family gathered once again in Wendy’s honour – only this time, for a very different reason� There is little we can be grateful for when a loved one succumbs to disease� Still, when he or she finds relief from pain in a comfortable environment so that precious time can be spent with family and friends, there are blessings to be counted� That is, essentially, what hospice palliative care provides� Palliative care ensures patients with life-limiting illness, receive the care that considers a range of needs from spiritual to practical and is dedicated to valuing quality
Wendy Almeida (1969-2011).
of life while supporting families as well� Unfortunately, there aren’t enough palliative care beds available to support the number of families requiring the specialized level of care� In fact, only three in 10 patients in Ontario will gain access to a palliative care bed when they need one� The Healing Cycle Foundation, through an annual bike ride and yearround information campaign, strives to increase awareness and raise the much needed funds to support palliative care initiatives in Ontario� The foundation recently surpassed its goal to raise $1 million for palliative care at The Credit Valley Hospital in Mississauga and has now broadened its scope to also support hospices throughout Ontario� Through a grant process, hospices are invited to apply to the foundation for funding to support expenses related to practical needs as well as programs� Carpenter Hospice, affectionately referred to as ‘the most special home in Burlington’ receives government funding for nurses and personal care workers only� All other operational costs rely on the $1�3 million raised
family� Programs are designed to ease the burden on family during the illness and to provide the peace of mind for families who can know they provided the best care for their loved ones in their final days� In the months since Wendy passed away, her children and their father continue to seek support through grief counseling� Wendy’s parents, Betty and Wayne are very supportive, keeping their grandchildren overnight and helping with extracurricular activities� “It’s been difficult but we are taking it one day at a time,” says Roger� “We obviously miss Wendy, but we talk about her a lot, and I think that helps,” says Roger� He’s proud of Grant and Emily and is confident they are going to be okay� He acknowledges this first year is proving difficult but that they will get through it together� Grant recently made a pasta dinner for his family, all by himself� Roger can already see that Grant has his mother’s flare for cuisine can already see so much of Wendy in her daughter Emily who just celebrated her 13th birthday� Carpenter Hospice is one
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annually to support programs, food, and maintenance of the hospice itself� Wendy spent the final months of her life at Carpenter Hospice� The hospice offers patients comfort and support through specialized programs, including bereavement groups to support families� Adrienne Pringle, music therapist helps patients and families access the emotions and words they may not otherwise find� “We value music therapy as a part of the support system at Carpenter Hospice and we hope to expand the program if we can secure the funds to do so,” says Lesley� “Wendy really had a connection with Adrienne through the music – it was lovely,” her mother, Betty adds� The essence of palliative care is to embrace the entire
of the hospices that registered a team to raise funds for their own hospice in the annual ride on June 24, 2012� Every dollar raised by Carpenter’s team, the ‘Pedaling Philanthropists for Carpenter House’ goes directly back to the hospice� As well, hospices are invited to apply for financial grants through the foundation to support programs and services� For more information about palliative care, the bike ride or to learn how your hospice can secure funds, please contact Heather Campbell, executive director, The Healing Cycle Foundation at 905-820-6081 or visit www�thehealingcycle� ca� Live� Love� Ride� Helen Reilly is the Public Relations Coordinator at The Healing Cycle Foundation.
Legal Update 23
Hospital News, April 2012
Court affirms arbitrator’s award of mental distress damages By Melany Franklin and Rebecca Bush
ncreasingly, employees are seeking compensation for mental distress from their employers when they lose their jobs. In the labour context, where the relationship between employees and their employer is governed by a collective agreement, mental distress damages arising from a job loss are rarely awarded. In declining to award mental distress damages, arbitrators have relied on the Ontario Court of Appeal’s decision in Ontario Public Service Employees Union v. Seneca College of Applied Arts & Technology (2006), 80 O.R. (3d) 1, where the court stated that unless a collective agreement specifically states that an arbitration board can award aggravated, punitive and mental distress damages, the board is limited to awarding damages for lost pay and benefits. Recently, however, the issue of arbitrators’ jurisdiction to award mental distress damages arising from the manner of dismissal, and the type of employer conduct that will give rise to such damages, was revisited by the Ontario Divisional Court in Greater Toronto Airports Authority v. Public Service Alliance Canada Local 004, 2011 ONSC 487 (“the GTAA decision”). In the GTAA decision, the Divisional Court reviewed an arbitrator’s decision to award significant wrongful dismissal, punitive and mental distress damages to a 47-yearold employee who had been employed by the Greater Toronto Airports Authority (the “GTAA”) and its predecessors for approximately 23 years. She had been fired for alleged sick leave abuse and had grieved her dismissal. The employee had held a position as fleet coordinator, which required a considerable amount of walking. When she injured her knee at work, she was accommodated with modified duties until she had surgery on her knee. The employee’s orthopaedic surgeon provided her with a note stating she should be off work for four weeks after the surgery. At the time of the grievor’s surgery, the GTAA was experiencing a costly absenteeism and sick leave abuse problem, which it was addressing by
placing under surveillance employees who were suspected of abusing their sick leave. The GTAA decided to place the grievor under surveillance due to the fact that she was living with another GTAA employee who was under surveillance for suspected sick leave abuse. The surveillance produced observations of the grievor doing some driving and walking of limited duration. The employer confronted the grievor regarding these activities, and questioned her need to be off work for four weeks. Fearful of losing her job, and against the advice of her surgeon, the grievor returned to work early. She was not given modified duties, and her knee injury was aggravated. Nevertheless, the GTAA discharged the grievor for dishonesty. At the time of the discharge, the grievor had a clear disciplinary record and was regarded as a satisfactory employee. Throughout her years of employment, the grievor had taken a two month absence from work because of a mental breakdown, and had experienced significant problems because of her personal life, including mental, physical and sexual abuse, of which the GTAA was aware. The arbitrator found that the GTAA had failed to prove that the grievor has been dishonest in reporting her absences, and awarded her significant damages, which included lost back pay as well as future income loss, $50,000 in punitive damages, and $50,000 in damages for mental distress and pain and suffering in her knee. The arbitrator also found that the GTAA had acted in bad faith when it had decided to place the grievor under surveillance merely because of her association with another GTAA employee, when it had failed to consider modifying the grievor’s work responsibilities after her surgery, when it had fired the grievor without relying on any medical evidence, and when it had refused to consider lesser penalties. The arbitrator also held that the GTAA’s actions in the course of dismissing the grievor were the cause of the grievor’s development of PostTraumatic Stress Disorder, and that the GTAA should have foreseen the grievor’s extreme mental distress, considering the GTAA’s knowl-
edge of the grievor’s history of psychological problems. The employer applied for judicial review of the arbitrator’s award, challenging, in particular, the merits of the arbitrator’s mental distress and punitive damages awards. The Divisional Court upheld the arbitrator’s jurisdiction to award such damages, and reasoned that it stemmed from the provisions of the collective agreement and the Canada Labour Code (the “Code”). The Code allows an arbitrator to substitute a just and reasonable penalty for discharge or discipline, if the collective agreement does not contain a specific penalty. In this case, the collective agreement provided that an arbitrator could “substitute for discharge or discipline such other penalties that the arbitrator deems just and reasonable in the circumstances”. Although the collective agreement did not make a specific reference to mental distress awards, the court reasoned that the agreement gave the arbitrator wide remedial powers, and that he was within his jurisdiction to award mental distress damages. The Divisional Court also affirmed the arbitrator’s assessment that mental distress damages were foreseeable, given the expectation on employers to act in good faith when dismissing any employee, and given this particular employee’s psychological vulnerabilities. However, the
Divisional Court disagreed with the arbitrator’s award of the cumulative $50,000 award for both mental distress, and pain and suffering associated with the grievor’s knee injury. The court held that the arbitrator should have separated the mental distress damages from the damages for pain and suffering associated with the grievor’s knee injury, as the damages for the aggravation of the knee were not within the reasonable contemplation of the grievor and the employer, and were not supported by the evidence. The court therefore remitted the mental distress damages amount back to the arbitrator for determination. The Divisional Court’s reasoning in the GTAA decision has been followed in a number of recent decisions. For instance, in Windsor (City) and Windsor Municipal Employees’ (C.U.P.E., Local 543) (Leixner) (Re), 2011 CLB 9406, the arbitrator considered a grievance by an employee who had been dismissed for having allegedly stolen funds from her employer. The wrongfully dismissed grievor was reinstated. In considering the grievor’s claim for mental distress damages, the arbitrator acknowledged that, based on the principles discussed in the GTAA decision, mental distress damages may be awarded for bad faith conduct at dismissal, but found that on the specific facts before him, such dam-
ages had not been made out. Even more recently, in Coca-Cola Bottling and C.A.W., Local 385 (Chew) (Re), 2011 CLB 2409, the grievor was placed on sick leave and became eligible for workers compensation after he was told that his job was being eliminated. Despite an independent assessment which determined that the grievor was not physically or psychologically disabled, and despite the grievor’s requests to return to work, the employer refused to return the grievor to work. The arbitrator held that the employer had repeatedly failed to meet its duty to accommodate the grievor’s disability to the point of undue hardship, and to offer him suitable work. The arbitrator reinstated the grievor, and relying on the Divisional Court’s reasoning in the GTAA decision, awarded the grievor $18,000 in mental distress damages. The recent trend of successful mental distress claims in the labour context has heightened the importance of being aware of this issue in both unionized and nonunionized workplaces. Melany Franklin and Rebecca Bush are both Partners in Borden Ladner Gervais LLP’s Toronto office, Melany practices in the area of labour and employment law and Rebecca practices the area of torte and liability law.
News, April 2012 24 Hospital Focus: Gerontology/Palliative Care/Home Care
Therapeutic model enhances standards of care in geriatric psychiatry
By Jennifer Bastarache
hen Robert was advised that his wife Marlene, 72, who is living with Alzheimer’s disease, should be transferred from a longterm care facility to a mental health hospital, he was devastated. “I expected that she would be placed in a cell with a bed and four walls,” he says. However, when he first arrived at Ontario Shores Centre for Mental Health Sciences (Ontario Shores) to tour the facility and speak with clinical staff in the Seniors Memory Disorders Unit, he was pleasantly surprised to see plenty of light and open space within the unit, throughout the hospital and its surrounding property. Marlene came to Ontario Shores to receive the kind of patient-focused care that other long-term health care facilities were unable to provide. “Because of her illness,
she had verbal and physical behavioural challenges, lashing out when anyone tried to assist her with simple day-today tasks,” Robert says. “You know it is the illness that is causing her to behave this way because by nature she is the kind of person who would not swat at a fly if it landed on this table – that’s just the kind of person she is.” Over the last 60 days, Robert has come to Ontario Shores almost daily for several hours at a time to spend time with his wife, holding her hand and showing his love and support. “She may not be aware of why she is here or what her health issues are, but she knows something is different,” he says. “She often tells me ‘I just want to be normal again’.” Today he is happy his wife is being cared for by a good team of health care professionals and pleased with the way Ontario Shores staff have been able to care for his wife
A senior patient at Ontario Shores enjoying the courtyard gardens. and manage her behavioural challenges. Robert is one more person whose perception about mental healthcare has changed. “There is a misperception about senior mental health care,” explains Steve Mathew, Clinical Manager, Outpatient Services, Geriatric Psychiatry
and Neuropsychiatry Program. “Many people believe seniors are here because they are getting old and no longer have the ability to function at home; but at Ontario Shores, we provide specialized care that is goal-directed, individualized and focused on helping each patient reach or maintain his or her potential and optimal wellbeing.” As the aging population across Canada increases over the next twenty years and the number of people with dementia is on the rise, Ontario Shores is enhancing the standards of senior psychogeriatric care and introducing the province’s first Psychogeriatric Services Therapeutic Model for Inpatient Care. “This therapeutic model was developed to strengthen customized psychogeriatric inpatient services at Ontario Shores,” says Sheryl Bernard, Administrative Director,
Geriatric Psychiatry and Neuropsychiatry Program. “The ultimate goal is to achieve excellence in patient care and the highest quality of living for the older adult living with both medical and psychiatric disorders.” The majority of senior patients at Ontario Shores are over 65 years of age who live with dementia or some form of memory loss that is persistent and interferes with daily functioning. “The therapeutic model allows us to give hope to people like Robert, who, like many loved ones, struggle with the impact of this disease,” Mathew explains. “Our staff often provide more than clinical care to our patients – they provide education, information and counsel to family members and loved ones as they try to cope with and understand the illness and associated symptoms.” The therapeutic model Continued on page 26
From dementia to diagnosis: a couple’s cautionary tale Continued from page 18 that once animated her. That’s when Lou decided to stop driving. Then she stopped working altogether. All the while, the Grieves sought counselling and nutritional advice from health professionals, hoping to bring Lou back to her old self. “I felt we were continuing to miss something,” recalls Wayne. But they never suspected
dementia. Like many people, the only symptom they associated with dementia was memory problems. CAT scan reveals brain atrophy The turning point came when the doctor referred the Grieves to a psychiatrist in the fall of 2008 to ask about visual hallucinations Lou was beginning to experience, her
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increased anxiety and the fact she was being “coy” about not taking her medication. The psychiatrist ordered a CAT scan which showed frontal cerebral atrophy. A referral to a cognitive neurologist followed soon after, along with MRIs and memory tests. In January 2009, they received a formal diagnosis. It was Pick’s disease, a type of dementia also known as Frontotemporal dementia. But by this time, the illness had progressed too far along for Lou to make decisions about her care. Wayne, now retired, has been caring for Lou at home and plans to keep her there as long as he can. Don’t minimize symptoms He receives 10 hours a week of help from a personal support worker through his local home care agency. He also attends monthly caregiver support sessions at his local Alzheimer Society. Earlier detection could have given him these supports sooner and helped him understand what Lou was going through. “You’ve got to take on the role of advocate yourself because your partner or parent can’t do it themselves. Don’t minimize their symptoms,” Wayne urges. For more information about Alzheimer’s disease
or to locate an Alzheimer Society near you, visit www. alzheimer.ca Ten signs to be aware of: • Struggling to remember recent events • Finding it hard to follow conversations or watching a program on TV • Forgetting names of friends or familiar objects • Difficulty recalling things that they have heard, seen, or read • Repeating themselves or losing the thread of what they’re saying • Having difficulty with thinking and reasoning and judgment • Suddenly becoming anxious, depressed or angry • Becoming confused in familiar places • Experiencing changes in personality and mood • Feeling confused in familiar surroundings Health professionals play a vital role in improving the lives of people with dementia, from post-diagnosis support to end-of-life care. The Alzheimer Society offers practical tools and resources on dementia care, managing challenging behaviour and supporting caregivers, as well as guidelines and strategies that promote person-centred care.
To learn more and download these resources, go to www.alzehimer.ca and click on the For health-care professionals icon. Rosanne Meandro is the Chief Communications & Media Relations Officer at the Alzheimer Society of Ontario.
Health care professionals: Be alert to early signs and symptoms of dementia Dementia describes a group of brain disorders whose symptoms include loss of memory, judgment and reasoning, and changes in mood and behaviour. Brain function is affected enough to interfere with a person’s ability to function at work, in relationships or in everyday activities. Alzheimer’s disease is the most common form of dementia and together with other dementias, will affect 1.1 million Canadians in the next 25 years. In absence of a cure, early diagnosis is essential to getting the right information, treatment and support early in the disease. It allows those diagnosed and their families to have greater control over their lives and start planning for the future.
Nursing Pulse 25
Hospital News, April 2012
Easing the cancer journey RNs who work as patient navigators ensure those diagnosed with cancer aren’t left feeling lost or forgotten in Ontario’s health-care system. By Melissa Di Costanzo
ver a year ago, Krista Vance’s life spun out of control. In the spring of 2010, she began bleeding when she used the bathroom. Vance, 39, thought hemorrhoids had developed because her gallbladder had recently been removed. By the fall, she was bleeding more heavily and experiencing uncomfortable cramping. She made an appointment with her family physician, who ruled out hemorrhoids and arranged for an appointment with a surgeon out of fear the symptoms may point to cancer. Vance left her doctor’s office, sat in her car, called her husband, and started to cry. Days later, she learned her physician’s fears were confirmed. She had stage three colorectal cancer. “I was in shock,” recalls the stay-at-home mother to three girls in Waterloo. “I didn’t know how to handle that because it was the last thing I was expecting.” Then, Carol Gunsch entered Vance’s life. Gunsch is a registered nurse and patient navigator specializing in colorectal cancer at the Waterloo Wellington Regional Cancer Program. She works in the gastrointestinal diagnostic assessment program. She connected with Vance prior to her cancer treatment and, as the Waterloo mom says, played an important role in making an overwhelming ordeal a little more manageable. “There was no question that somebody was taking care of me, which was nice because you don’t feel like you can take care of yourself,” says Vance. “For me, (Gunsch) was a godsend.” Following a cancer diagnosis, some patients become increasingly anxious about their future, or wary about the health-care system. In fact, many describe it as maze-like. This may cause them to postpone or skip appointments, delaying their treatment. RNs who work as patient navigators in Ontario help guide patients in three key areas: they screen for symptoms; get patients through the diagnostic process in the most expeditious way; and ensure patients are not lost when transferred from one health-care team to another. Patient navigators also provide education and support.
The results of a recent survey of more than 2,000 patients by Cancer Care Ontario (CCO) show Ontario navigators are having an impact. More than half of those surveyed were in the process of being diagnosed with lung cancer; the rest, colorectal cancer. Preliminary results from the November 2011 research show patients have less anxiety and are reporting improvements in shortness of breath because a navigator has zeroed in on these symptoms. Armed with three years of experience as a supportive care coordinator in outpatient oncology, Gunsch began her position as a navigator two years ago. She was one of the first to sign up for the CCO pilot project that has introduced 14 patient navigators in hospitals across the province. With funding from the Nursing Secretariat, Ministry of Health and LongTerm Care, patient navigators were hired in 2009-2010 in Barrie, Oshawa, Thunder Bay, Kitchener, Toronto, Hamilton (in collaboration with Niagara), and Kingston. The second phase of the pilot started in April 2011; navigators were added to another seven hospitals in London, Ottawa, Windsor, Newmarket, Sudbury, Toronto and Mississauga. Gunsch’s professional experience made her an ideal candidate for the role. From 2007-2010, she worked in partnership with a medical oncologist and heard patients’
first-hand accounts of gaps in the health-care system. Some described feeling lost or left hanging. She became interested in CCO’s pilot because she wanted to help close those gaps. Gunsch took on the job with an initial goal of assisting patients who felt disoriented. Now, she says her role has evolved into much more: she helps patients with symptom management, and is in constant contact with them to answer questions and concerns. Over the course of one day, Gunsch chats with eight to 10 patients, and also talks to family members who may have questions such as: Can I have more information about the diagnosis? What will my loved one go through next? How can we prepare for the next steps? Some patients – Vance included – are referred to Gunsch on the day of a colonoscopy. Other referrals come shortly after the procedure, and around the time of diagnosis. Gunsch connected with Vance the day after her colonoscopy to explain tests and timelines. She ended their first conversation by telling Vance to call her anytime. The two spoke almost daily about appointment times and various procedures. Gunsch spent a whole hour during one of their initial calls explaining each test, Vance remembers, adding that the RN also linked her to HopeSpring Cancer Support Centre in Waterloo, which offers a number of resources, including peer support, to those living with cancer. Their
relationship ended when Vance began seeing her medical oncologists, though Gunsch met with her numerous times to lend additional support. “The hardest part is the waiting,” she says. “(Gunsch) just moved me along as quickly as possible.” Vance says a lot of tears from her three children – who were 11, 9 and 6 at the time – accompanied news of her diagnosis. “It’s a nightmare to think (what) if I lose my mom (as a kid),” she says. But Gunsch, she adds, played a vital role in reducing the mom’s anxiety level by connecting her with a social worker. “As you’re talking to (patients) more and more every day (their stress) just drops. They’re no longer in panic mode when they call you,” Gunsch says of her ability to not only impact on patients’ satisfaction, but also their anxiety levels. “To me, that’s my greatest pleasure out of this role…to see that difference.” The patient navigator position started forming roots in Ontario in 2007, following consultations between CCO and key stakeholders, including nurses, primary care physicians and patients. During these meetings, patients talked about the confusion, anxiety and fear they felt in the time between suspicion of cancer and diagnosis. Patient navigators working in the province’s funded pilot program are RNs. CCO chose to include nurses in this role
because patients who are suspected to have cancer benefit from the clinical judgment capabilities of an RN, explains Esther Green, provincial head of nursing and psychosocial oncology with CCO. “We listened very carefully to what the patients said and placed the role in that greatest area of need.” In Canada, Nova Scotia was the first province to implement the position in 2001. Although referred to by different names – in Quebec, navigators are called infirmière pivots en oncologie – patient navigators exist in every Canadian province. For Vance, whose cancer treatment has now wrapped up, navigators are essential caregivers during what can be a worrisome, life-changing period in your life. “The sense of somebody on your side from the beginning – you can’t replace that with anything else,” she says. Carol Gunsch is a member of the Registered Nurses’ Association of Ontario (RNAO), the professional association representing registered nurses in Ontario. Melissa Di Costanzo is staff writer for RNAO. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve. Visit www.RNAO.org to become a member.
Canada-wide serious injury care with a local “touch” BAYSHORE HOME HEALTH delivers a wide range of nursing and attendant care to people with serious injuries, helping them regain their daily lives and reintegrate into their communities. Our nurses are specially trained to deal with clients who need advanced clinical care, while our personal support workers perform many delegated tasks for individuals with catastrophic and non-catastrophic injuries. They are supported by internal clinical experts and our National Care Team – a convenient, central contact point for workers’ compensation boards, insurers and government care programs, providing standardized client reporting and timely service. With 50-plus offices across Canada, we also offer a local “touch” when it comes to professional care for people with serious wounds, fractures, amputations and spinal cord/acquired brain injuries. To learn more, please call 1.866.265.1920.
News, April 2012 26 Hospital Focus: Gerontology/Palliative Care/Home Care
St. Joseph’s Health Centre supports palliative care patients with a team approach By Kris Scheuer
t. Joseph’s Health Centre, Toronto is not designated as a palliative care facility, but we provide quality treatment and compassionate support for palliative patients in medicine units throughout our hospital. In some cases, the Health Centre is the last place of care for our patients diagnosed with life-threatening illnesses. Our Palliative Care Team consists of doctors, a nurse practitioner, coordinator, chaplain and a social worker. Other Health Centre professionals are brought in as needed including a dietitian, physiotherapist, occupational therapist, speech-language pathologist, pharmacist, clinical ethicist, child life specialist, respiratory therapist and interpreter services. We treat palliative patients on units throughout the facility with an interprofessional approach to their care. For example, our hospital’s transitional care unit is where we treat our Alternative Level of Care patients who no longer need acute care treatment at our facility and are awaiting transfer elsewhere for example to a long care facility, palliative care facility or rehabilitation centre. On the Health Centre’s 43-bed transitional care unit, at any given time about nine patients will be palliative, explains Sandra Dickau, the Patient Care Manager for this unit. Daily, the team on this floor will talk about all the patients including anyone who
A doctor at St. Joseph’s Health Centre connects with a palliative patient. Photo by Roger Harris. is palliative to assess patients’ needs. “We prepare (palliative) patients for transfer to a more formal palliative care setting. However about 40 per cent of palliative care patients on this transitional care unit will get their end of life care at St. Joseph’s,” says Dickau. Palliative patients on this transitional care unit are very involved in directing the care they want and need. Families are active participants in the care plan with no restriction on visiting hours. As a Catholic hospital, the Health Centre offers religious and spiritual care 24/7 for all
our patients and their loved ones. Cindy Elkerton is one of our Chaplains for patients on the transitional care unit. “In some cases, patients ask for help reaching out to a relative or loved one they have lost touch with and want to see before they pass on,” says Elkerton. There’s also grief support for family and loved ones of a patient who is close to the end of life or who has passed on. “If they (patients’ loved ones) haven’t experienced a loss, they have all kinds of fears about what they are supposed to do. I normalize the grieving. There is no right or wrong way to grieve,” explains Elkerton. “Although journeying with a patient during those last days of life can be difficult, it is also a great honour. Palliative patients and their families often have many fears and concerns, by helping them through some of that we feel like we were able to really serve that family,” she adds. Another service is our Palliative Care Volunteer
Program, which we first launched in 2009. These volunteers help palliative patients on various units throughout the hospital. In order to prepare them for this role, the volunteers complete 30 hours of education and training and 70 volunteering hours. They also participate in off-site visits at the Toronto Rehabilitation Institute and Dorothy Ley Hospice where they attend information sessions and have individualized training with volunteers at those sites. The Health Centre’s palliative care volunteers also received infection control education and complete interprofessional mentor/ preceptor workshops. Marion McLaughlin has been a volunteer at the Health Centre for seven years and a palliative care volunteer since 2009. “We spend time talking with them (palliative care patients) and try to accommodate any special requests,” says McLaughlin. “I find it rewarding. You know you have helped someone and made them comfortable and helped them through a difficult time.”
For family members of a palliative patient, it can be a relief to know that a volunteer is with their loved one so the patient is not alone when the family takes a moment to get some rest or something to eat. “I find it rewarding because it is a wonderful program for patients and their families,” adds McLaughlin. Joanne Britto, who is a 22-year-old palliative care volunteer agrees. Britto grew up in New Zealand and Australia and moved to Canada in 2009. In 2010, she decided to give back to her new community in Toronto by volunteering at the Health Centre. She is considering going to medical school to become a doctor. She said the Health Centre’s Palliative Care Social Worker Jose San-Pedro mentors the palliative care volunteers. He has written extensively on how to support patients and their families with weighty issues including mortality, grieving, the physicality of dying and spirituality. This literature is an extra resource for volunteers on how to help families and palliative patients, mentions Britto. “I do very little talking and a lot of listening,” says Britto. “They like to talk about their past. It’s a time to celebrate their life. Volunteers play a role in lending an open ear and open mind especially those without family or friends to visit them.” Britto realizes people often assume that being a palliative care volunteer is sad or depressing, but for her it’s an uplifting experience. “Some of the palliative care patients and their families are some of the happiest people. They are very enlightened about life. We rarely talk about death. We talk about celebrating life,” says Britto. “It’s the best place to learn about how we (should) live life to the fullest every single day.” Kris Scheuer is a Communications Associate at St. Joseph’s Health Centre in Toronto.
Therapeutic model enhances standards of care in geriatric psychiatry Continued from page 24 involves educational and best practices initiatives which provide staff with the necessary tools and training to help guide patients and families through Ontario Shores’ collaborative recovery model, bringing a sense of hope for patients and families. In addition to mental
healthcare, Ontario Shores interporfessional teams provide assessment and care for physical and medical issues that are common among seniors. The therapeutic model for pshychogeriatric care was developed by a best practices working group at Ontario Shores and is based on several guidelines including the
Canadian Coalition of Seniors Mental Health, the Canadian Consensus on Dementia, the Registered Nurses Association of Ontario Best Practices Guidelines and the American Psychiatric Association. Jennifer Bastarache is a Communications Officer at Ontario Shores Centre for Mental Health Sciences.
Hospital News, April 2012
Do you know a Nursing Hero?
COMMITMENT DEDICATION COMPASSION LEADERSHIP
Hospital News’ 7th Annual Nursing Hero Awards Along with having their story published, the winner will also take home: 1st Prize:
Cash Prizes sponsored by:
Look around you. Have you been inspired, encouraged or empowered by an employee or a colleague? Have you or your loved one been touched by the care and compassion of an outstanding nurse? Do you know a nurse who has gone above and beyond the call of duty? Now is your chance to acknowledge and recognize the nursing heroes in your facility or community. Hospital News will once again salute nursing heroes through our annual National Nursing Week contest. We hope you will share your stories with us so that we can highlight the exceptional work that our nurses are doing and how they touch our lives. Stories/letters can be submitted by patients or patients’ family members, colleagues or managers. Please submit by April 18th and make sure that your entry contains the following information: • • • •
Full name of the nurse Facility where he/she worked at the time Your contact information Your nursing hero story
Please email submissions to email@example.com or mail to: Hospital News, 405 The West Mall, Suite 110, Etobicoke, ON, M9C 5J1
News, April 2012 28 Hospital Focus: Gerontology/Palliative Care/Home Care
Anticipating an aging population How one Women’s College scientist is helping to prepare our health-care system
By Heather Gibson
oday’s health care costs make up 46 per cent of Ontario’s budget. And if our system doesn’t adapt, by 2054, after the proportion of seniors in our population has doubled what it is today, Ontario’s healthcare costs will account for more than 80 per cent of the provincial budget.1 Preventing that from happening is what gets Women’s College scientist Dr. Andrea Gruneir out of bed each morning. “Making healthcare more effective and more efficient is absolutely critical as the Ontario population ages,” says Gruneir. To move our system in the right direction, Gruneir led a recent study, published recently in the peer-reviewed journal JAMDA. Her insights are helping policy-makers understand how gaps in the health-care system can increase the burden on emergency departments. “By understanding how these gaps contribute to patterns of emergency department use, and possibly hospital readmission, we can begin to target new models of care that address these weak points in our system, and prevent health crises that lead to poor outcomes, both for frail older adults and the health system as a whole.” Gruneir’s population-based
Dr. Andrea Grunier, Scientist, Women’s College Research Institute. cohort study examines rates of emergency department use by long-term care (LTC) home residents. She found that health-care transitions, especially those from hospital to LTC, are associated with an increase in emergency department transfers. “The findings really highlight the need for a stronger focus on transitional care, especially for vulnerable older people who are being discharged from hospital to long-
Apostle Bala Success Abraham the President and Founder of Apostolic Triumphant Church International will be in Toronto, Canada at, Jesus Embassy Worship Center for a miracle Revival, Entitled “Establish My Faith”. Date: Time:
April 6, 7, and 8th 2012 7:00 p.m. nightly, Sunday April 8th at 10:00 a. m. Location: 131 Sunrise Ave, Unit 5 O’Connor Rd East York Toronto M4A 1B2. Be there with all your trouble to exchange with miracle Blessings of Christ, Also, Dr Bala Abraham the true commander of the Army of Christ is coming to Mount Zion Ministries, Canada for supernatural release of your Divine Harvest Date: April 27th, 28th and 29th Time: 7:00 P/M nightly and Sunday 10:00 a.m. Location: Mount Zion Ministries Canada, at 105- 107 Kenhar Drive, Toronto, On, M9L 1N5 Great things will happen for you.
term care, and who frequently need more support to ensure they continue to get better,” says Gruneir. In fact, in another report2 released in November 2011, Gruneir found that older women living in the community are more likely to rely on children for support, compared to older men who are more frequently cared for by their living spouse. “Most older people are women, and most are living
with multiple chronic conditions,” Gruneir explains. “Also, most of these women are living without the benefit of a spouse’s care and support.” With more supportive transitional systems, Gruneir hopes that vulnerable older people will be healthier and better supported. And so will their families, including spouses as well as adult children who are often busy juggling their own children
and jobs. “But to develop effective new models that address these gaps and shortfalls in our health-care system, we first need to understand exactly where the weaknesses lie,” says Gruneir. “That’s what my work is currently focused on.” Heather Gibson is the Research Communications Advisor at Women’s College Research Institute in Toronto.
Supporting caregivers at end-of-life By Vanessa Sherry
aring for a friend or family member at the end-of-life can have many different faces - a woman struggling to manage a career and family while caring for a husband with cancer; a senior citizen with health problems caring for a spouse with Alzheimer’s at home; a single mother trying to support a dying sibling who lives thousands of kilometers away. “As the aging population in Canada continues to increase, so will our need for informal or family caregivers,” says Sharon Baxter,
Executive Director of the Canadian Hospice Palliative Care Association (CHPCA), “we need to work together to better support those who care for those with a chronic or life limiting illness.” According to the CHPCA, more than 259,000 Canadians die each year, and most in old age. With the aging of our population, by 2026, the number of Canadians dying each year will increase by 40% to 330,000. Each of those deaths affects, on average, five other people – mainly family and loved ones who care for others. The question is, how do
caregivers get the support they need? What tools and resources are out there currently to assist caregivers with decision making at end-of-life? A 2007 Health Care in Canada study showed that, 23 per cent of Canadians said that they had cared for a family member or close friend with a serious health problem in the last 12 months. Adverse effects on this group of people included: using personal savings to survive (41%) and missing one or more months of work (22%). Canadians often do not Continues on page 30
Hospital News, April 2012
Ask the Ethicist:
What an ex-girlfriend taught me about surgery By Ken Kirkwood
once dated a woman who was discussing the untimely demise of a friend’s relationship due to infidelity. During that conversation, the kind in which people harshly judge the unfaithful party, she dropped a bomb. She confessed that she always told the truth, but that didn’t mean she had to tell someone everything, just never lie. I imagine you’re saying to yourself “how did you let that one get away?” You may also be protesting at the fine, and self-serving, distinctions she made between the truth and the “whole” truth. Fast forward ten years and in the midst of an education day with surgical residents, the issue of the supervision of residents during surgery came up. To my great unease, it became apparent that surgical residents have been left without any direct supervision by senior physicians while operating on patients. The unnerving part of it is that the
patients consented to being operated on by residents who were being supervised by an experienced surgeon. As the discussion carried on, some confessed to supervising numerous surgeries – as many as four – at the same time.
is true and if it is a factual statement, it can be verified. But one could, tell no lies and yet deceive another by leaving certain details out. When we use the term “honesty” in medical ethics, we speak of sharing the true impressions
form your surgery under his or her supervision, what do you imagine? You’re probably thinking of a hovering senior surgeon watching over a slightly nervous resident, correcting every move and coaching the resident through-
"The reality is that the supervising physician may be moving between multiple operating theatres at the same time." This is all allowable, in part, because patients “consent” to it. The patients consented to it, I proposed, because what they imagine as supervision was different than what actually happens. In common conversation, we use “truthfulness,” “honesty,” “not lying” and “truth” as synonyms. The assumption we make with each one implies the other. Our common sense of honesty suggests that by telling the truth, I’m being honest and not lying. But the definitions are a little finer than that. Truth is just that – the statement
we have about a patient’s case, but more than that, we speak of the complete impressions we have about that patient’s case. To omit some relevant fact or opinion which is owed to the patient is not technically lying – since everything said is true – but it is deception, which is trying to create a false impression in the patient’s mind, and that is dishonest and unethical. Maybe some of you reading this in waiting rooms around Canada are waiting for your own surgery. Ponder this: if the physician tells you that a resident will per-
national nursing week 7th Annual Supplement
The May 2012 issue of Hospital News will be celebrating National Nursing Week in Canada with a special pull-out feature showcasing our “Nursing Heroes” contest winners as well as highlighting outstanding leadership and stories from the nursing frontlines!
Don’t miss this opportunity to celebrate and acknowledge the outstanding contributions of our hard working nurses with your own thank you ad! Inquire about our reduced rate advertising package, contact Denise Hodgson at
416-626-4870 firstname.lastname@example.org 1 9 8 7- 2 01 2
out the procedure. The reality is that the supervising physician may be moving between multiple operating theatres at the same time, leaving your surgery for prolonged periods of time. Is that what you imagined? Probably not. I would suggest that you ask the physician what “supervising” means, and how much in-person guidance will actually be offered. Even surgeons are sometimes vague about describing what “supervision” meant, they can’t lie to you in answering your questions – so ask. Don’t assume that just because your
surgeon is a caring, skilled professional with a good reputation doesn’t mean that he or she isn’t going to take calculated risks with your health to manage his or her patient load. I’m sure someone will email me to say that things are not as bad as all this, but consider this: at one Ontario hospital which I was visiting in the past year, I was reassured that they had recently passed a rule that supervising physicians had to be on hospital grounds while their residents were operating. I can image that being supervised from another part of town, the country, or the world, is definitely not what patients have in mind when they are told “supervision.” Kenneth W. Kirkwood, Ph.D is Assistant Professor of Ethics in the Faculty of Health Sciences The University of Western Ontario. If you’d like to submit a question to “Ask the Ethicist” please email email@example.com.
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News, April 2012 www.hospitalnews.com 30 HospitaL Focus: paiN CoNtRoL/RHeUMatoLoGy/CoMpLeMeNtaRy HeaLtH/HeaLtH pRoMotioN
supporting caregivers at end-of-life
Continued from page 28 realize the financial impact caregiving has on families, and are often unaware of the assistance programs offered by certain employers� If you are currently caring for a friend or family caregiver with a terminal illness, ask your employer whether they offer any Compassionate Care Benefits� As a leading-edge global company, GlaxoSmithKline includes in their employee benefit package the option of up to 13 weeks paid leave to employees who require time away from work to care for a dying family member� If your company does not offer these kinds of benefits, the Federal Government offers up to six weeks of Compassionate Care Benefits for those caring for a critically ill friend or family member� For more information on the Compassionate Care Benefit please go to www�servicecanada�gc�ca� If you are a professional who would like to learn more about discussing the Compassionate Care Benefit with patients, please go to www�chpca�net� Another way to ease the burden of caregiving at the end-of-life is through Advance Care Planning� Advance Care Planning is a time for you to reflect on your values and wishes, and to let others know your future health and personal care preferences in the event
Caring for a friend or family member with a terminal illness can be taxing; fortunately, there are resources to support caregivers.
that you become incapable of communicating for yourself� A 2008 study found that the absence of Advance Care Planning or end of life care discussions was associated not only with worse patients’ ratings of quality of life at the end, but also increased anxiety and depression in caregivers� An Advance Care Plan leaves fewer decisions to family caregivers, significantly lessening
HospitaL News, April 2012
the stress already faced by caring for a person with a critical illness� To learn more about Advance Care Planning and the Speak Up: Start the conversation about end-of-life care campaign, please go to www�advancecareplanning�ca� For those currently caring for a loved with a chronic or life limiting illness, there are many resources out there to
The St. Thomas Elgin General Hospital (STEGH) is the only Community Hospital awarded the Platinum Award for the Quality Healthcare Workplace Award for the 2nd year in a row through the Ontario Hospital Association. Our Vision is to deliver an excellent patient care experience, in a safe and compassionate environment, in collaboration with our healthcare partners. We have recently been approved for a redevelopment and expansion project that includes; a 15-bed Acute Mental Health Inpatient Unit and an Outpatient Mental Health Day Hospital; a new Emergency, Ambulatory Care and Surgical Services and Central Supply Departments; and improvements to our main entrance and throughout the hospital. The Surgical Suite consists of 4 operating rooms with one endoscopy suite, performing a wide variety of General, Thoracic, Orthopaedic, Urology, ENT, Ophthalmology, OB/Gyn and Maxillofacial surgical procedures.
O.R. Technicians - 2 Full-Time, 2 Part-Time
A Registered Practical Nurse currently registered with the College of Nurses of Ontario, you hold an Operating Room Nurse Certificate from a recognized program or equivalent, a Current Basic Cardiac Life Support Certificate, and have one year operating room experience. You must demonstrate knowledge of perioperative patient care, commitment to ongoing/continuous professional development, punctuality, and basic computer skills. You must be available 7 days/ week for 7.5 hour tours, and other tours assigned by the hospital. Applicants who wish to be considered for the vacancy shall submit their resume directly to:
and click on All applicants will be considered.
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We Value: Compassion, Accountability, Respect, Excellence, Safety
Vanessa Sherry is a Communications Officer at the Canadian Hospice Palliative Care Association.
DeaDline for May 2012 issue: May 1, 2012
help during this difficult time: The Canadian Caregiver Coalition is a diverse group of national and provincial organizations from across Canada that works collaboratively to represent and promote the needs and interests of family caregivers with all levels of government, and the community - www�ccc-ccan�ca� The Canadian Home Care Association promotes excel-
lence in home care through leadership, awareness and knowledge to shape strategic directions� They believe in accessible, responsive home care and community supports which enable people to stay in their homes with safety, dignity and quality of life - www� cdnhomecare�ca Canadian Virtual Hospice provides support and personalized information about palliative and end-of-life care to patients, family members, health care providers, researchers and educators� – www�virtualhospice�ca The Canadian Hospice Palliative Care Association distributes several free resources for caregivers� These resources include: Living Lessons® A Guide for Caregivers, A Caregivers Guide: A handbook about end-of-life care, Advance Care Planning Workbook, and much more� To order resources from the Canadian Hospice Palliative Care Association please go to www� market-marche�chpca�net� The Canadian Hospice Palliative Care Association also has many events and online resources for caregivers at www�chpca�net�
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Hospital News, April 2012
View career ads at www.hospitalnews.com
Share your clinical expertise in mental health nursing as our very rst
Manager - School Mental Health Nursing Team
Nursing Opportunities in Northern Manitoba First North Health Group was recently awarded priority provider status for nursing relief services in Manitoba’s remote northern communities and is seeking to hire 60+ experienced community health nurses. If you are looking for a unique experience and opportunity to make a difference, join our team and take advantage of the following: • Competitive compensation packages • Daily northern living allowance • Flexibility in timing and length of assignments • Continuing education support • 24-hour administrative and clinical support • Paid orientation • Referral bonuses
The Toronto Central Community Care Access Centre (CCAC) is dedicated to supporting and enhancing the quality of life, independence, health and well-being of individuals in the community by offering a single point of access for community services and demonstrating leadership and excellence in community care. A new initiative, the Mental Health & Addiction Nurses in District School Boards Program is important to Ontario’s plan to improve services and support for children and youth with mental health and addictions needs. The program will help district school boards build the capacity to recognize and respond to student mental health and addiction issues.
Hear from our people:
We are looking for an experienced and achievement-oriented manager to lead the planning, development and implementation of this new and innovative program in district school boards served by the Toronto Central CCAC. A signicant proportion of mental health problems and illnesses have their onset during childhood or adolescence; early recognition and intervention can be critical. This will be your goal as you combine your interdisciplinary focus and passion for mental health nursing to build and manage a dedicated School Mental Health Nursing Team to support students with mental illness and substance abuse concerns. An RN in good standing with the CNO, you have direct clinical experience in providing mental health and addictions services for children and youth, including school-based programs, enhanced by 3 to 5 years of success managing in a multidisciplinary, culturally diverse health care environment. This role calls for a proven leader with a track record of building teams and advancing the clinical practice of multiple health disciplines, someone who has used theory and research/evidence-based outcomes in practice, and is familiar with relevant legislation and committed to the highest level of customer service and client care. A master’s degree in Nursing or Health Administration would be ideal. English/French bilingualism is an asset.
Applicants must have current registration with Manitoba’s College of Registered Nurses and CPR/BCLS certification. ACLS, TNCC/ ITLS, NRP, PALS/ENPC certification preferred.
If you are seeking a chance to truly make a difference in the lives of others as well as your own, please send your resume directly to: Wanda Goslin, Director of Human Resources, Toronto Central Community Care Access Centre, 250 Dundas Street West, Suite 305, Toronto, ON M5T 2Z5. Fax: 416-506-1629. E-mail: firstname.lastname@example.org.
To apply, please email your resume to email@example.com
Most Community Care Access Centres of Ontario are governed by the requirements of the French Language Services Act. We provide services in French and encourage applications from French-speaking candidates.
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HospitaL News, April 2012
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