CARE – Spring 2010 | College of Licensed Practical Nurses of Alberta by College of Licensed Practical Nurses of Alberta

VOLU M E 24 ISSU E 1 • S PR I NG 2010

ISSN 1920-6348 CARE

“Lifeblood” Dialysis Nursing An Ordinary Man in Haiti Survey Says… Our Values Align

Practice and Addiction What Nurses Need to Know?

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inside spring 2010 VOLUME 24 ISSUE 1

cover story

8 Lifeblood Hemodialysis nursing is one of the most technical areas of practice. Alberta LPN roles are showcased through the Northern and Southern Alberta Renal Programs.

From the College

Know Your Healthcare Team

Nursing Practice and Addiction

The Operations Room

Profile: Dental Technologists/Technicians

Perspectives on Prevention and Risk

Stay Informed with Member Information

Cover photo: Sally Kotchorek, LPN - by Chris Fields

feature Ordinary Man 16 An in Haiti With past features from Afghanistan, Larry Leduc is a familiar face. Read how his final military commitment on a humanitarian journey to Haiti impacted this big-hearted soldier.

CARE is published quarterly and is the official publication of the College of Licensed Practical Nurses of Alberta. Reprint/copy of any article requires prior consent of the Editor of Care magazine. Editor - T. Bateman Signed articles represent the views of the author and not necessarily those of the CLPNA. The editor has final discretion regarding the acceptance of notices, courses or articles and the right to edit any material. Publication does not constitute CLPNA endorsement of, or assumption of liability for, any claims made in advertisements. Subscription: Complimentary for CLPNA members. $21.00 for non-members.

8 care | SPRING 2010

from the college

2010 and BEYOND… We have had a very busy introduction to 2010 at the College. New research has been released, more research is underway, and strategic work is being done; all relating to the Licensed Practical Nurse profession. The Knowledge and Education Project (KEP) report released in early 2010 is the culmination of three years of research looking at the academic knowledge held by students in all three categories of nurse, just prior to graduation. Not surprising it was discovered that RNs students have greater knowledge than either the LPN or the RPN, except in the area of psychiatric nursing where the RPN trumped the others. A phenomenon named “nurse-think” was discovered and refers to the type of thinking and critical evaluation nurses do because they are nurses. Again, not surprising, the RN student with their more extensive education demonstrated a greater beginning capacity for “nursethink.” All categories of nurse demonstrated sufficient “nurse-think” to begin their career. The LPN with a more focused education in fundamentals of nursing performed somewhat stronger than the RPN in medical-surgical care and equally as well as the RN students in standard care and procedures. No surprises here either, considering the education of each group. The researchers affirmed all three groups are sufficiently educated to function to their scope and heartily endorsed full utilization of all nurses: a concept strongly supported by CLPNA. The research is limited to novice nurses and the researchers acknowledge that experience and continuous learning impact the knowledge and skill of the nurse. They are clear that when assigning care, credential is not the qualifier but rather patient condition, knowledge and skill of the nurse, and overall supports in the setting are key considerations. In late 2009, the CLPNA contracted Cambridge Strategies Inc to assess what the public really values about professional nursing. A values-based survey was conducted with interesting results (see article page 36), that we believe are highly gratifying for LPNs in Alberta. In a nutshell, the public wants skilled, knowledgeable, caring and compassionate caregivers. LPNs completed the same survey, and what you value is virtually identical to what the public These results combined with the KEP research, confirming that LPNs are appropriAs the nurse at the bedside values. ately prepared for your scope of practice puts the profession in a great place. As the nurse at bedside you are well positioned to provide exactly what the public expects - competent you are well positioned to the committed care. And not only can you do this, from our survey of LPNs we discovered you are overwhelmingly (89%) committed to your full role. provide exactly what the

public expects - competent committed care…

May 9-15, 2010 is National Nursing Week in honour of Florence Nightingale, a nursing hero. Along with other nursing colleagues across Canada, we celebrate her and all that she did to advance nursing as a profession. More importantly the CLPNA celebrates you, the LPN who provides excellence in nursing every day. Your commitment to making a difference for your patients is contributing to the opinion of Albertans, that we have a world-class health care system in this province. In celebration, each LPN received two gifts from us in this CARE magazine. One is our annual Poster, which we encourage you to hang in your workplace. The other is a P.I.N., your Professional Information Networking system. Wear it with pride and let it work for you, and for the profession. Folks will notice, and conversations will begin. Through this you can increase positive public awareness of the LPN profession and by example show how we contribute to the desired patient experience. In addition, our social media campaign is underway; read more in this edition of CARE and on you P.I.N. card. Connect with us, spread the word and have fun with it!

The Annual General Meeting was held in Edmonton on April 7, 2010. For those not able to attend highlights for 2009 are in the Annual Report posted on the CLPNA website. The College is already well into the 2010 year and progressing towards the goals we set. Key Initiatives for the CLPNA in 2010 include increasing public understanding of the LPN role, establishing a Research Network within the profession, increasing direct communication with members, implementing online registration, working with our national counterparts on updating national exam competencies, development of a competency statement for the profession, and continuing to build on regulatory excellence. It promises to be challenging and as always we look forward to the opportunities. Have a great Nurses Week! With respect and admiration, Hugh Pedersen, President and Linda Stanger, Executive Director

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research ne of the hallmarks of a profession is that members contribute through the creation of new knowledge about the profession. This is done through research. Increasingly we are moving into a world of evidence based practice, and now more than ever there is a need to conduct research related to the Licensed Practical Nurse profession. The results of other nursing research are sometimes assumed to apply to the LPN, simply because the LPN is a category of professional nurse. This may not be a relevant or accurate assumption.

Research Network Development Day

The CLPNA is creating a Research Network, which will focus on: increasing the level of understanding within the profession regarding research; identifying relevant research questions about the profession; attracting funding to support research initiatives; and involving interested social science researchers who will work along with LPNs on research initiatives. Dr. Rena Shimoni, Dean of Applied Research at Bow Valley College spoke to an enthusiastic group of LPNs at the initial Research Network Development Day hosted by the CLPNA on March 19, 2010. A select group in Northern Alberta was invited to participate on a voluntary basis, with enthusiastic turnout and participation in the day. We were excited to see the seeds sown for the development of a research agenda for Licensed Practical Nurses. Many topics related to the Licensed Practical Nurse profession were discussed, with several that reflect areas of practice where our profession has accumulated considerable expertise through a unique and deep understanding of patients’ lived experiences. An additional session will be hosted by the CLPNA in Calgary for LPNs in southern Alberta. If you are interested in participating please contact Sherri@clpna.com.

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research

Survey Says… Licensed Practical Nurse and Public Values Align he chronic and constant uncertainty surrounding the Alberta heath care system lately is making a complex situation even more uncertain for the public and professionals. In the face of growing doubts about the direction and destination of the Alberta health care system there is a need for clarity and focus. In an effort to seek clarity and focus, the CLPNA decided to find out what Albertans valued most about professional nursing care.

The CLPNA recently hired my firm, Cambridge Strategies Inc., to conduct a “most/least” conjoint on-line survey of over 900 randomly sampled Albertans that tracked and ranked 15 key values around professional nursing care. We also ran a parallel program of the on-line conjoint survey for members of the CLPNA and were delighted to have 1461 participants as well. The findings are enlightening and should be instructive, reassuring, and empowering to Licensed Practical Nurses working in Alberta today, even with all the turmoil in health care these days. I say the results should be reassuring to LPNs because the value alignment and priorities of the public’s and those LPNs who took the survey are virtually identical. In other words LPNs believe in the same values and in the same way as the public as to what is important and expected in providing professional nursing care. So what are those important shared values? In order of priority the most important attributes for professional nursing care are Skilled, Knowledgeable, Caring/Compassion, Thorough, and Ethical care. These values dominate. Of all the values surveyed, 88% of the survey participants had one of these top values as their #1 choice. That means if you want to satisfy 88% of the

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Alberta public’s expectations in how you provide professional nursing care, you have to deliver on all of these five values. The good news for LPNs is that these values are the core professional and personal values that you overwhelming subscribe to each and every day on the job. The next big question and challenge is how well are LPNs delivering and communicating their delivery of these values to patients, the public, and the power-that-be in making health care policy? There are some challenges for LPNs coming out of the survey findings. We asked the public and CLPNA members how satisfied they were with the care they were getting or giving in terms of the 15 values. There is a difference in the satisfaction level perceptions between the public and the LPN professionals. One difference is at the professional level. Matters like collaborative care, resourcefulness, and responsiveness are larger concerns for nurses, but patients and the public are relatively indifferent to them. The other differences are in the rankings of values when “Importance” versus “Satisfaction” is considered. The top two values of Skilled and Knowledgeable are very important to LPNs and the public. But generally speaking Licensed Practical Nurses believe they are doing a more satisfactory job in all areas than the public perception. What does this mean for LPNs? Lots! First the findings show that LPNs and the public are on the same page as to what is important, and what expectations have to be met to satisfy the public that they are getting nursing care that reflects what is most important. The next insight is that LPNs have some self-checking to do about why they believe they are doing a more satisfactory job in providing the kind of values based

nursing care that is satisfactory to the public. Is this difference a perceptual or judgment misalignment or a communications problem, or both? Realistically it is only safe to assume that it is both and then deal with it as such. That means the CLPNA should look at undertaking an internal and external targeted and authentic communication effort that explains the roles, responsibilities, skills, and knowledge of LPNs to patients, public, and policy makers. This must not be glossy and slick public relations, or an expensive advertising campaign. Nobody trusts that kind of “communications” any more. CLPNA needs to share vital and mutually beneficial information about the Licensed Practical Nurse profession. This communications effort has to come from the care and compassion value side LPNs experience both professionally and personally. It must be directed at patients and their families, as well as to the general public and the policy making audiences. It has to be more word-of-mouth and based on authentic and genuine professional relationships with the key audiences that depend on the LPNs to deliver the skilled and knowledgeable care needed at the bedside. LPNs have to explain to people how they fit into the overall medical model. Clarifying the health care roles of the Doctors to diagnose and design; Nursing administrators and managers to manage and plan; and LPNs to directly deliver care at the bed-side, is a key to any successful communication for the LPN profession. Everyone has their role and responsibilities, but the LPN has the opportunity at the bed-side to be most effective and efficient in minute-by-minute skilled, knowledgeable, and compassionate care giving. The LPN can and should be a

reassuring source for human concern for people in care who are extremely vulnerable, scared, and often uninformed or misinformed about what is happening to them and what is being done for them.

WHAT DO YOU NEED TO DO NOW? Based on the survey results skilled, knowledgeable, caring, compassionate nursing is what people want and that is what you are and what you do because it is in your nature. Now you have to make sure to Talk-the-Walk if you are going to get the respect and rewards you deserve. This is how you show commitment to your profession and yourself as a professional. You also need to have conversations with your friends, families, and personal networks so they can understand and value the role, responsibility, and relationship of Licensed Practical Nurses in the health care system, and the people you serve. There will be training available for you on how to do this most effectively and professionally. Your message will be clear: Licensed Practical Nurses provide Competent, Committed Care and play an important role in the effectiveness of Alberta’s health care system.

WHAT WILL YOUR COLLEGE DO? Communicate, communicate, and commu nicate!! We have worked closely with Linda Stanger, Executive Director of CLPNA and her executive team, in formulating a plan which involves sharing LPN messaging with key audiences including other health care professionals, stakeholders, policy decision makers, media, and Albertans.

In addition to connecting with the mainstream media, we will be using social media as a way to get our message out. The use of social media is cost effective, immediate, and relationship-based and encourages word-of-mouth communications. Social media efforts will be interactive with you using e-mail, Facebook, Twitter, YouTube, and our CLPNA Blog and website for content and distribution. Social Media Training and Coaching will be Available: We will need help from any LPN who wants to be part of the solution to help make this happen. We will be in touch and provide you with training and workshops as well as coaching and mentorship on how to use social media to get our messages out to Albertans. Learning about social media is fun. It is also a very important tool for you professionally and personally. Word of mouth is known to be the most effective method of communications we know of, and LPNs are in the best position to use it.

IN CONCLUSION The bottom line is Licensed Practical Nurses have lots to be proud of in relation to how you contribute to the wellbeing of Albertans. The problem is you are too inhibited and reticent to blow your own horns. This has to change. It is not about being brash or boastful. It is about being caring and compassionate. It is about taking the time to explain to patients and others what LPNs do and to assure the public of your skills, knowledge, experience, and capacity to serve the greater good as you do your jobs - day in and day out. That’s exactly what the public wants! By Ken Chapman, Principle, Cambridge Strategies Inc.

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lifeblood The Hemodialysis Unit: Technical Nursing at its Finest Take blood out of the body, clean, refresh, and return. Thatâ&#x20AC;&#x2122;s how the heartbeat of life in a hemodialysis unit has been described. The scope of LPN practice in renal units in Alberta has expanded, creating arguably the most technically challenging healthcare skill set environment for an LPN, and placing them at the forefront of LPN practice in Canada. But life as an LPN in a hemodialysis By Chris Fields & Sue Robins

unit is also a much deeper human experience: itâ&#x20AC;&#x2122;s at the soul of humanity.

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“Today we are a full-fledged member of the hemodialysis team. I’m inspired by the ability to make a difference in someone’s life.” Sheila Green, LPN Blairmore Hemodialysis Unit

“Imagine the renal program as a chuckwagon race,” says Carol Easton, Director, Southern Alberta Renal Program (SARP). “The horses, drivers, outriders, outrider horses, the barn crew, and supporting staff all have different and essential roles but they are all working toward the same goal (excellence in patient care) with energy and expertise, and are all needed to succeed. LPNs are an essential and key part of SARP being able to do its business, and our ability to provide the right person doing the right thing at the right time for the patient.” To extend the chuckwagon analogy, it’s not surprising that a SARP program task force that shaped a 2007 quality of patient care-driven expansion of the ability of the LPN to work within full scope of practice was multi-disciplinary. Intended benefits include best utilization of nursing resources, enhancement of a collaborative, inter-professional approach to patient care, operational efficiency, and recruitment and retention of LPNs. Marilyn Bartoshyk, SARP Manager and lead on full scope of practice for LPNs, says there were two drivers behind the initiative to bring LPNs to full scope of practice in hemodialysis units: continuity of care for patients; and optimal utilization of all health care providers. “Enabling continuity of care creates efficiencies, makes for a better patient experience, and enhances patient safety. But this wasn’t just about LPNs. We also wanted to maximize the scope of practice for RNs by freeing them to address more acute unpredictable, unstable situations.”

For today’s LPN in the SARP program, it means there is little technical task difference between a RN and a LPN. Initiation of blood transfusions, and administration of some IV direct medications are the only technical skills a RN rather than a LPN performs. LPNs otherwise have control over all modes of access to blood, can administer immunizations and most medications, participate in transcription and processing of physician orders, preceptor new LPNs, complete patient assessments, and case manage patients, among many other tasks. The expanded LPN role has garnered national attention: in 2009 Beverley Preston, LPN and a colleague from Foothills Medical Centre, presented the expanded role of a dialysis LPN at a National Nephrology Convention in Saint John, NB. Michael Concannon, LPN at the Olds Hospital Hemodialysis Unit, has a wealth of dialysis knowledge. He has worked in a dialysis environment for over 30 years, has been at the Olds Hemodialysis Unit since it opened in 2002, and has trained beyond his LPN role as a technichian with advanced knowledge of the intricacies of the machine. He’s seen a few changes in the LPN role over the years. “Only RNs and LPNs can be certified to do dialysis, but the roles are changing and evolving. Today, we’re both equally responsible. Since 2007, there’s more of a feeling of being an equal among peers. The work is ultimately more gratifying because there’s greater respect for the LPN role.” >

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“The resilience of our patients is inspiring. Even in moments of despair, they have faith in themselves and in our staff as caregivers. It’s a privilege to come to work!” Denise Fillier Manager, Southern Alberta Renal Program

Hemodialysis services in Alberta are delivered through SARP in southern Alberta, and the Northern Alberta Renal Program (NARP) from Red Deer north. It should be noted that in NARP, LPNs perform virtually the same tasks as LPNs in the SARP program, with the exception IV push medications. As for any difference in LPN scope of practice between NARP and SARP, Carol indicates that the SARP and NARP program directors are in frequent contact, share the same philosophy, and continue to work to align the two renal programs. The high performance environment for today’s LPN in a hemodialysis unit does not come without hard work. Once hired into a unit, there’s a required sixweek class training program (RNs and LPNs take the same training), followed by a preceptorship and unit mentoring until the nurse feels comfortable.” The hard work pays off. The LPN practice permit in a hemodialysis unit indicates “Specialties: Dialysis, Immunization.” Renal dialysis and immunization are two of four recognized areas of specialized LPN practice under the Health Professions Act (the others are Orthopedic Specialty, and Operating Room Specialty). When asked if the LPN function in a hemodialysis unit is the most advanced technical environment there is for an

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LPN, Michael has a philosophical answer. “Well, yes and no,” he says. “Getting ten people up before ‘breaky’ in long term care is quite a skill and one I don’t have. I look up to people with ward skills. That being said, it’s fair to say that there’s a level of required clinical competence and the treatment of a level of acuity that would be impressive to LPNs in other health environments.”

There’s No “I” in “Team” What does a more advanced role for the LPN mean in a collaborative healthcare environment? According to Michael, while individual skills will always matter most to healthcare peers, LPN experience and knowledge is taken for granted today – which is a good thing. “The preassessment we do before connecting a patient is the same as a RN. We actively collaborate with the Charge Nurse – a two way street of communication. The RN is always in charge, but the LPN is expected to respond to and treat situations within their scope of practice on their own accord. If a heart stops, the RN is in charge, but all nurses have active team roles in a situation like that.” Michael adds, “Continuity of care is team work in this business. There’s healthy collaboration. We communicate to the point that it’s almost overwhelming, but as a result we all know our place in the team.”

Hemodialysis Is Not Routine Work The hemodialysis unit is not for every nurse. “You have to have great assessment and monitoring skills, Carol says. “The renal patient comes with a very complex medical condition. It’s a total body disease. People are on a number of drugs, there are drug interaction challenges, and the patient’s condition can change very quickly. The ravages of diabetes cause circulatory impairment that requires constant assessment and vigilance for things like foot problems.“ Then there’s the dialysis machine… “It’s is a very different machine…there’s nothing like it,” says Sally Kotchorek, LPN at the South Calgary Hemodialysis Unit. “Something happens, bells go off, and there’s an acute patient situation. Or there’s troubleshooting with the machine itself.” Describing the pre-assessment of the patient before connecting them to the dialysis machine, Sally says initial weight measurement and ongoing monitoring is critical. “You really have to watch patients. People can lose consciousness as a result of fluid being pulled out of their body.” She also indicates total body assessment is never-ending, citing dressings, foot assessments, post-op assessment, and Coumadin monitoring (not too much or too little) as a drumbeat of a typical day.

Training is also ongoing, including an exam and two days of training every year, and regular visits from an educator. “There’s always something new,” Sally says. When asked about her best day at work, Sally says for her it’s when she’s able to positively intervene. “One day I discovered a patient’s needle had fallen out - a situation that can become life threatening. The patient’s daughter was present and she was so grateful. It feels good to manage something that is a ‘non-normal’ situation…to make a difference for the patient.” Carol indicates that a source of pride in the program is its creativity, which she attributes to a team-based passion, commitment and tight focus. Carol recalls an image of a 99 year old on a stationary bike while on dialysis after an exercise program was introduced, and mentions initiation of a bereavement/palliative care program for patients, families, and caregivers.

Taking “Care” on the Road Creativity in providing program accessibility to patients puts on a show on the NARP program’s Dialysis Bus – the only mobile dialysis unit in western Canada. Custom built two years ago and bigger than a Greyhound, the bus is decked out with an interior designed by

a custom-designer of rock stars’ buses, and is wrapped in a covering that proclaims, “Bringing care to your community.” Six days a week, the bus thunders down Highway 16 and up Highway 43, to bring renal dialysis to patients in Hinton and Whitecourt – hospitals that don’t have dialysis units. A complete hemodialysis unit on wheels, Edmontonbased staff arrive at the hospital, hook the bus up to water, electricity, sewer and Internet services, and have the capacity to perform on-bus dialysis for up to four patients at a time. The bus is staffed by a tight knit team of two nurses and a bus driver/service worker. The nurses are nurses first, titles second. One team (there are two healthcare teams that rotate schedules) consists of Parkash Chand, LPN, Joanne White, RN, and Dawn Morgan, Driver. Parkash was an RN in India, but became an LPN when she immigrated to Canada in 1987. She’s worked in long term care, and nephrology, and has been a dialysis nurse for twelve years. She started work on the Dialysis Bus two months after it hit the road in 2008. “I always like adventures, and I knew the bus was different and I wanted to be part of it,” she explains. “There’s lots of assessment skills needed in dialysis, and a need to make quick decisions, especially on the bus.”

“The expanded role of the LPN in dialysis (2007) has been very profound for me. I had the opportunity to sit on the task force committee, along with many others, that help set up this role. As an advocate for the LPN, another colleague and I have subsequently shared our expanded role in several settings.” Beverley Preston, LPN Foothills Medical Centre

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I came into the renal unit from long term care where our scope of practice was slowly starting to change. In the renal unit I have been able to work more in my scope of practice, with a greater challenge and more opportunity. It has been exciting. Joanne Dewar, LPN Lethbridge Renal Unit

bus,” Parkash says, “is that I feel good about being able to come and help someone. We really do make a difference. The patients and communities appreciate us. I feel special to be a part of a team of travelling nurses.”

The Face of Dialysis: The Patient “Thank you for the patience you have in the work you do. We appreciate each and every one of you. Thanks for his happy face… and another birthday for him.” (Patient/family thank you card, Olds Hemodialysis Unit)

The nurses take on all the roles that would be staffed separately in a hospital environment. While the nurses can access consultations by telephone, they quickly learn how to take initiative, creatively think through problems, and back each other up as a team. Being in close quarters on the bus can bring its own challenges, but the teams clearly enjoy each other’s company. “I call this ‘camping dialysis,’” Joanne says. “You need to be independent, have confidence and be self-motivated to be in this job.” Life on the bus is privy to some beautiful sights – from wolves to mountains. It’s also a life that has some adventure, like the bear rummaging in garbage cans right outside the bus, a flat tire in -38 degree temperatures, a dead battery, being peppered by a flock of birds on a windy day, and shovelling of heavy snow off the roof of the bus. “What I like best about working on the

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Three times per week. Four hours each time. Tethered to an artificial ‘master chemist’ machine that is an almost full time job… tubular red rivers running silently, removing waste products from blood with dialysis fluid. A handful of teenagers. Some in their 30s. A majority over age 60. A 30% 5-year survival rate. A kidney transplant only a chimera on the horizon for most. The hard truth of end stage renal disease is that it’s a life sentence. “We sadly see the ravages of the disease process,” Michael says. “How you get to our room is varied… but ‘here’ is the great equalizer.” Noting the complexity of the disease, and the associated advanced skill set required to provide effective patient care, Michael says in philosophical tone, “generally, the road is down hill. People become undializable. Many suffer heart attacks. Limbs have to be removed. Many lose sight.” Toughest days are always ones where someone dies suddenly. For Sally, it was a patient who died while on dialysis after suffering a heart attack. “It was

dramatic and confusing. It had never happened before. But the pastor came in. We talked about it, and learned from it.” Michael is more comfortable talking in an optimistic tone. “Dialysis is not all about dying… it’s just one facet.” Michael notes they often see patients early on after diagnosis, when they are foggy and sick with uremia. “We will lift the fog from their blood and give them back a feeling of hope. We can make a huge difference.” The nurse-patient relationship in a hemodialysis unit is about more than the body. It’s also about the soul. Given the nature of the treatment, patients often see nurses as much as, or more than, their own family, over many years. Patient-nurse bonds become tight, like extended family. All conversations are on a first name basis. “You feel more connection,” Sally says. “They know you. They don’t want to be here, but they’re happy to see you. The bond is nice.”

Southern Alberta Renal Program (SARP) - everything south of Red Deer - 13 hemodialysis units - 76 LPNs

Northern Alberta Renal Program (NARP) - Red Deer north - 21 hemodialysis units - 77 LPNs Both programs also manage home hemodialysis, peritoneal dialysis, transplantations, and chronic kidney disease outpatient clinics.

me back and forth. Everything is here on the bus, and I love that I see the same nurses every time. They know me really well, and can tell if I’m unwell.”

Heather Petterson, LPN at the Olds Hemodialysis Unit, says the husband of a patient she treated in St. Paul still calls to wish her Merry Christmas every year. She left St. Paul six years ago.

Brandy adds, “This is very different than going to an inpatient unit. I have a different relationship with the nurses because we know each other so well. Last week, we were talking about Parkash’s new puppy. Parkash is very quick and does a great job starting the dialysis.”

“We hear their stories,” Michael says. “We celebrate birthdays together. At Christmas, we’re knee deep in appreciation sent by patients and families. That’s why I love this job. At its very heart it’s about people.”

For Michael, the patient relationship is a two-way street. “There’s lots of life skills in these people. There’s so much to learn from them. I wish I had known them prior to them getting sick.” For Sally, there’s deep respect for a few of her patients who manage to hold fulltime jobs outside the grueling dialysis schedule.

Life as a hemodialysis nurse is all about people like Brandy MacPhee, a young woman from Whitecourt who has been on dialysis for five years, and now receives services from NARP’s Dialysis Bus to replace the two hour, three days a week drive to Edmonton she used to make with her dad. “Having the bus come to Whitecourt is really great for my dad,” Brandy says. “I was too tired to drive myself after my dialysis, so my dad had to take time off work to drive

In a hemodialysis unit some issues weigh heavily, including end of life.

“Dialysis is a patient decision, and end of life issues can bubble to the surface,” Michael says. “Nurses feel closer to it because we know the patient so well, and it can become challenging because the main reason people stop dialysis is a quality of life issue.” Michael notes the nurse never stops treatment, but is also an advocate for the patient. “Many here have made that decision to stop… those who feel treatment has become torturous. We see the dilemma of choice.” In all these settings, relatives often come back for a visit long after a patient has passed away, to either connect with the spirit of their loved one, or to visit family friends… the nurses. They’ve had people in late stages of renal disease say the Hemodialysis Unit was the one place they didn’t mind coming to. It’s a fine testament to the power of the human spirit, and extension of caring and highly skilled nursing hands. n

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care | SPRING 2010

at issue

Practical Nursing Education in Rural Settings: Promising Practices Prepared on behalf of the Advisory Committee by: Jean Miller RN, PhD & Sylvia Teare BScN, MEd

“I like that it is accessible. I didn’t have to move, which would have been impossible financially for my family. If I had not been able to do this near home, I would not have been able to go into nursing. I have had a lot of support from the school and my instructors and I have been very happy that they are so flexible to help this work for me. I hope to work in my own community, and doing my education here will help me with that.” (PN learner in a rural Alberta community)

oday’s learners are looking for accessible and flexible programs that meet their individual needs, and for many living in rural and more remote settings this means not having to leave their communities. However, Practical Nurse (PN) programs are primarily offered in larger urban settings. Four Alberta colleges sought to address this gap by developing a web-based resource of promising practices to assist institutions adapt their existing programs for distributed learning. Distributed learning uses a variety of delivery approaches for example, print materials, online courses, and face-to-face (Alberta Education).

The research Practical Nursing Education in Rural Settings: Promising Practices Project, was a joint endeavor of Bow Valley College, Norquest College, Northern Lakes College, and Red Deer College. It was funded by Alberta Advanced Education and Technology, Access to the Future Fund. This applied research project included a review of the literature and interviews with a purposeful sample of leaders from PN programs using innovative approaches to reach learners in diverse locations and

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situations. Resource development and promising practice highlights are highlighted described. This information will be of interest to those already using distributed learning as well as those redesigning traditional programs. The Web-based resource takes a skipand-scan approach. Using a self-assessment process, users respond to ‘yes’ and ‘no’ guiding questions that lead to advice from interviewees, information from the literature, links to useful resources, and applied scenarios. It also includes references and a glossary. Highlights of the practices include the following areas: • Leadership and Infrastructure

• Program Delivery • Faculty Development and Teaching • Learner Support These promising practice highlights illustrate the broad scope of issues institutions should consider in order to attract and retain learners from rural and underserved communities. The project team is developing strategies to keep the findings of this project updated and sustainable. n Readers are encouraged to visit the project website for more information on these promising practices as well as links to relevant resources.

www.ruralpn.ca

research

Can Scotland learn lessons from the Alberta Licensed Practical Nurse model? by Katrina Whittingham, Professional Development Facilitator, NHS Grampian, Scotland and MSc Nursing Student University of Aberdeen, Scotland

The Research Seed

What did I find?

When I discussed new roles in Scottish healthcare with a Canadian cousin, (Registered Nurse), I had no idea this was the seed of a research project that would grow into a Masters in nursing thesis and take me on a seven thousand mile round trip. My cousin said “That Assistant Practitioner role sounds like what a Licensed Practical Nurse (LPN) used to do in Alberta, now though they do so much more”. Could we in Scotland learn from the LPNs journey in Alberta as we embark on a role development journey ourselves?

With the assistance of my thesis supervisor six themes were identified, these were: • Educational preparation and fitness to practice • Role in practice: - There is under utilisation of LPNs in practice - Rural versus urban nursing - Role titles, “Assistant Practitioner” is not favourable • Professional Regulation versus licensing • Economic Drivers to create different types of nurse • Public Perception • New roles need to be supported throughout the healthcare hierarchy

Scottish Background In Scotland we are facing a demographic “time bomb” an ageing population with multiple chronic diseases and fewer younger people choosing to enter healthcare pre-registration education. (Royal College of Nursing, 2008, Scottish Government, 2001, 2002, 2005, 2009) There are plans to create new roles such as “Assistant Practitioners”, to provide career pathways for healthcare support staff and deliver healthcare previously considered to only be within the scope of practice of Registered Practitioners (Scottish Government, 2009, Skills for Health, 2008, 2009).

Why Alberta? Why Alberta? In Canada it appeared that nationally (CCPNR, 2004) the desire was for one family of nursing with collaboration between Registered Nurses, Registered Psychiatric Nurses and Licensed Practical Nurses. From the consideration of the further policy (CNA, 2005), Alberta appeared to have moved this agenda forward (CLPNA, 2007).

This qualitative research sought to construct a full picture of LPN practice in Alberta that Scotland could learn from, it did not seek to reach a consensus but to find how it was to be educated, practice, and be regulated as an LPN in Alberta. For more information, view the complete report on www.clpna.com under “News & Events”

Health Quality Council of Alberta releases findings of follow-up urban and regional emergency department patient experience report In January 2010, the Health Quality Council of Alberta (HQCA) released its second report examining the experience of patients who visited the 12 highestvolume urban and regional emergency departments (EDs) in the province. The report follows up on one released in 2007, which looked at all urban, regional hospital and community EDs in Alberta. The purpose of the report is to monitor changes in the performance of EDs with the greatest crowding pressures, longest wait times and poorest patient experience. For more information view the report at www.hqca.ca

care | SPRING 2010

Haiti

An Ordinary Man in

by Sue Robins

Larry Leduc is tanned, fit, and looks like he just returned from a mid-winter tropical holiday. In fact, he was somewhere tropical for six weeks, but it was far from a vacation. Larry was deployed to Haiti on January 21 to set up and work in a field hospital close to the epicentre of the earthquake. In 40 degree humid weather he got his tan, and dropped ten pounds. e was deployed on this humanitarian mission with the Canadian Forces, adding to a resume that already includes stints in Bosnia and Afghanistan as a Warrant Officer and Senior Operating Room Technician. You may recall reading his Letters Home from Afghanistan in the Fall 2007- Summer 2008 issues of CARE magazine.

Larry is 44 years old, and lives in St. Albert with his wife Mary and his two kids – Nicole (19) and Andre (16). He’s friendly and approachable in an unassuming way, and has been an LPN for eleven years. Larry just took a new position at the Mazankowski Alberta Heart Institute in Edmonton as the Unit

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Manager of the Cardiac Outpatient Unit. He’s President of the Alberta Society of Registered Cardiac Technologists and teaches instructors at NAIT to teach CPR classes. He also volunteers as a referee for the Edmonton Football Officials Association, and you can see him at Edmonton Eskimo games as part of the “chain gang”, running out on the field to double check football measurements in between plays. How does a seemingly ordinary man do extraordinary things? Three days after the earthquake in Haiti in January, Larry got a call to see if he was interested in being deployed on a hu-

manitarian mission, with the Canadian Military, to set up and staff a field hospital. His leadership and operating room skills were required on the team. Larry had just accepted a new position as Unit Manager at the Mazankowski the month before. He approached his manager, Jennifer Foy and Senior Operating Officer, Carol Manson McLeod at Alberta Health Services. Both were very supportive of the idea and told Larry to go, even though he had barely gotten his feet wet at his new job. Larry is careful to emphasize that without the support of the people back home – his wife, kids, and employer – he would not have been able to help in Haiti. Indirectly, all these folks had a part in the work done in Haiti, too. Sharing his Haiti story with CLPNA staff through a picture-filled presentation, Larry explains why he’s compelled to share his experience in Haiti. “I find it an easier way to cope is to talk about it, instead of keeping things inside. I think I can do teaching with telling. One part of being in a team is sharing experiences and information.” The images from Haiti are stunning: miles of garbage strewn along the road. Buildings built on thin rebar with weak concrete tumbled to the ground. In the midst of destruction, the pictures of the Haiti people stand out – most are well dressed, in clean, brightly coloured clothes.

icas. The destruction caused by the earthquake only compounded the troubles in an already-poverty stricken country. Many of the patients at Canada’s field hospital weren’t there for earthquake related reasons. This was their first opportunity to access medical care in their country, and 200 people a day lined up for triage. They arrived by foot or motorbike with a patchwork of ailments: a six year old boy with a two week old fracture in his arm. A woman with a massive tumour, the size of a turkey, in her abdomen. A young girl with scabies all over her face. Six day old twins who were abandoned by their mother. Michy, a five year old who was hit by a motorcycle. A toddler who had been born without a rectum and was awaiting a referral from a specialized surgeon. All evidence of a third world country, where only the elite had money and access to health services. There are emaciated cows, pigs, and people rummaging through garbage for food. People survive on what they have, says Larry. Haiti has no health care to speak of, even before the earthquake. It is the poorest country in all of the Amer-

The teamwork needed to set up a field hospital is amazing. Normally, it takes 180 days to prep, travel and erect the tents for a field hospital. The field hospital in Haiti was set up in 11 days, with the sweat and hard work of a team of

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a taste of money. The military life is a life of service. This naturally leads into a career in health care, for being a nurse involves similar characteristics: service, teamwork, clear chains of command. Larry is proud of what Canada has done for peacekeeping throughout the world. The military gave him a strong sense of being a team member and a part of something bigger than him. Haiti will be the last of Larry’s deployments with the military. “I’ve had a really good career with lots of service, from war zones to humanitarian aid. Haiti was a good closing experience, and now I’m ready to move on,” Larry concludes.

116 dedicated Canadians. Most of these folks are on active military duty, and were recalled late at night to fly across Canada to Petawawa, Ontario the next morning to prepare to be deployed. They had to receive briefings, prioritize equipment, then weigh and load the contents of an entire hospital onto a C17 aircraft. The team slept on the grass outside the busy airport runway on their first night in Port au Prince, Haiti. (Later to discover that Haiti has a huge population of tarantulas-and that tarantulas live in the grass...) They drove to the field hospital site the next day, passing by miles and miles of shanty towns – tough living arrangements before the earthquake, but made worse by the disaster. Some families live right on the 8 foot wide median between the lanes of the highway – complete with sheets for walls. Larry says the Haitian people are very religious people who smile easily. Despite their hardships, they do their best to live a good life. Children don’t whine or complain, they are used to living in pain because there’s no treatment for their ailments. The earthquake made a bad situation even worse. The field hospital had 88 ward beds, four ICU beds, four Resuscitation bays, two operating rooms and medical support units (such as lab, dentistry, pharmacy). This hospital allowed the team to serve about 200 people a day, treating hernias, vaginal infections, dental abscesses and

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tumours. There were fractures and amputations related to earthquake injuries – one gentleman had to undergo two amputations after his leg was pinned under a boulder for many days. Larry spent from 7 am to 10 pm at the field hospital on most days. The global sense of duty was evident in Haiti, with field hospitals from places that included Germany, USA, Sri Lanka, Mexico, Japan, France, Belgium, Norway, Korea, and Cuba. Life was hard for the Canadians at the field hospital, but they didn’t complain. They went to the bathroom in makeshift toilets as the camp was getting set up, and ate packaged food that was boiled in a bag. But they did what they had to do to serve Canada and the people of Haiti. “Man, I have had many hot long showers since I’ve gotten back home,” admits Larry. And who can blame him? The regular ration of water for a twice weekly shower was a bottle of water – in a country known for its heat, humidity, and dust. Why does one person... a seemingly ordinary man, feel compelled to help in such extraordinary ways? Larry says it’s about “service”, that he learned from the military. He grew up in small town Quebec, and has been working since he was 15 years old. Joining the military gave Larry opportunities for travel, job security, and

Larry’s service to people is far from over. He’ll bring his leadership to his staff at the Mazankowski, and continue to volunteer his time for the things he loves. The patients that Larry treated in Haiti took the time to say, ‘thank you’ – and that in itself was enough reward for him. n Interested in having Larry present to your team, contact him directly at larry_leduc@shaw.ca View more images at the Canadian Forces Image Gallery at http://www.combatcamera.forces.gc.ca

About Haiti POPULATION: 8.7 million INCOME: 80% of Haitians lived below the poverty line, before the earthquake DEATHS FROM EARTHQUAKE: from 150,000 to 230,000 people

know your healthcare team

Profile: Dental Technologists/Dental Technicians The following article has been submitted by the College of Dental Technologists of Alberta

he College of Dental Technologists of Alberta (CDTA) regulates and governs Dental Technologists and Dental Technicians under the Health Professions Act (HPA) to ensure public health and safety. The CDTA ensures that Dental Technologists and Technicians register with the College in order to regulate members and provide assurance to both the public and the patients. Dental Technologists and Technicians must follow the CDTA’s Standards of Practice and Codes of Ethics and like other health professionals, must continue to enhance their competency through continuing competency programs.

The CDTA: • Promotes professionalism in the field of Dental Technology • Sets the entry to practice education and training requirements • Administers licensing/registration examinations • Sets standards of practice and guidelines on conduct and practice • Develops programs to ensure members continue to provide competent services and improve their skills and knowledge • Ensures members are licensed and registered • Addresses complaints and/or concerns about the conduct of practicing members. In addition to regulating individual Dental Technologists and Technicians, the CDTA offers certification to Dental Laboratory Facilities through regular Inspections. This is to ensure that the Laboratory Facility is in compliance with the CDTA guidelines governing Standards of Public Health and Safety to those they serve and employ. Dental Laboratories must operate in compliance with laws respecting Canada’s Food and Drug Act, Health Canada Medical Device Legislation re-

specting class II, III and class IV Dental Prosthetic Devices, Health Professions Act of Alberta, Standards of Practice for Employees, Codes of Conduct for Employees, Regulations for the Profession of Dental Technologists and abide by the governing By-laws of the College of Dental Technologists of Alberta.

What is a Dental Technologist/ Dental Technician? Dental Technologists and Technicians are essential members of the dental health-care team. The Dental Technologist/Technician is responsible for the manufacturing of dental appliances and devices used to improve the well-being of the patient. This includes fabricating and/or repairing dental appliances in order to replace or enhance damaged, lost or irregular teeth.

The areas of knowledge are broken down into 5 competencies: • Crown and Bridge • Full Dentures • Partial Dentures • Orthodontics • Implants The Dental Technologist and Technician work in a laboratory setting. The Dentist will send the patient’s impression, together with the prescription to the laboratory, where the design, fabrication and/or repair of the prescribed prosthesis will take place. Dentists rely on the Dental Technologist’s/Technician’s professional judgment to assess and interpret the prescriptions. Any changes that might be beneficial to the patient are jointly considered. >

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know your healthcare team Dental Technologists and Dental Technicians also supervise the technical aspects of dental laboratory facility operations licensed by the Food and Drug Act of Canada. The mandatory supervision by a licensed Dental Technologist or Dental Technician ensures the safety of materials and components placed in the oral cavity by a dentist or other regulated health care professional. It is illegal for anyone other than a member of the College of Dental Technologists of Alberta to use the title “Dental Technologist”/”Dental Technician” or any variation of that.

What is the difference between a Dental Technologist and Dental Technician? In order to be classified as a Dental Technologist, one must have successfully passed all four competency requirements (Crown and Bridge, Partial Dentures, Full Dentures, and Orthodontics). A Dental Technician, on the other hand, must have successfully passed from one to three of the above competencies.

Educational Requirements Dental Technology is currently a 2 year Diploma program at a CDTA approved educational facility. In Alberta this includes NAIT or The Calgary Dental Technology College. In order to qualify for acceptance, a high school diploma is mandatory with courses including Chemistry 30, Biology 30, Math 30 & English 30. (If one does not have English 30, TOEFL testing is required.) However, space is limited so a good academic standing is important. Many also find it necessary to have a high degree of technical ability, training and skills involving a diversity of techniques to be successful in the program. This includes possessing good hand-eye co-ordination and colour perception, dexterity in using small instruments, and patience in attending to minute details. Once in the program, students learn to reconstruct the look of natural teeth in

fixed restorations (ie. crowns, bridges and implant restorations), using porcelains, metal alloys and all-ceramic materials. For removable restorations (complete and partial dentures) and corrective devices (orthodontic appliances), students must learn and understand oral characteristics and fabrication techniques. Programs provide technical training in order to develop a thorough working knowledge of dental anatomy, communication skills and the knowledge of laboratory procedures. The practical laboratory work is emphasized to prepare the students for employment. In some provinces, an internship with a registered dental technologist or technician must be completed upon graduating from the Dental Technology program in order to be eligible to write the provincial registration examinations. The length of the internship may vary from province to province. Through an approved program, prospective Technologists and Technicians maintain compliance to Standards of Practice/Codes of Ethics.

Considerations to Becoming a Dental Technologist While Dental Technologists and Dental Technicians usually work independently from Dentists’ offices, typical employers can include Dental laboratories, private dental offices, Government institutions and hospitals, and Dental supply companies (ie. Technical representatives or sales representatives). Continued competency is extremely important as Dental Technology is changing rapidly with new materials and techniques quickly gaining clinical acceptance. One such technique is called CAD/CAM (Computer-Aided Design/ Computer-Aided Manufacturing). With the technological advances changing so quickly, staying current is essential. Dental Technologists and Technicians are considered an important part of the healthcare team which includes Dentists & Dental Hygienists, Orthodontists, Denturists, and Physicians. Each team works together in order to ensure the patient receives the best possible lifelong care. n

Learn more at www.cdta.ca

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at issue

Nursing Practice and Addiction: Exploring New Developmental Perspectives on Prevention and Risk ddiction is something we all think we know something about, and probably do to a certain extent, or we may have been personally impacted by someone we know who had an addiction. Often, we think of addiction as substance abuse but did you know that there are other types of addictions – “behavior addictions” and “process addictions”? What were you taught in your basic educational program about addiction? What do nurses (LPN, RN, RPN) need to know about risk factors in addiction? How do you find out the latest research related to the roots of addiction? These are the kind of questions that a small group of nursing leaders is currently exploring, assisted by the expertise of faculty including Drs. Kyle Pruett (M.D., Clinical Professor of Child Psychiatry and Nursing, Yale Child Study Center) and Marsha Kline Pruett, (Ph.D., M.S.L, Maconda Brown O’Connor Professor, Smith College School for Social Work).

Given the many content demands of any nursing education curriculum today, it is difficult to find the time and place to include all of the knowledge and skills that are deemed essential to ensure that the graduates from the program have met a minimum set of competencies. However, given the emotional, physical, and spiritual toll that addiction, a major public health issue, has on the individual with the addiction, on their family or significant others, and on society as a whole, a small steering group of representatives including academic LPN and RN leaders, under the expertise of the previously mentioned faculty, is exploring whether exposure to the latest knowledge and science related to addiction will make a difference in nursing practice. This article provides an overview of the work of that committee and identifies some of the key issues focusing on early adverse experiences, risk factors in addiction, plasticity of human brain development, and personal resilience that will be dealt with in a 4 day educational workshop opportunity for LPNs, RPNs, and RNs in Alberta

What are the risk factors related to the development of addiction? The curriculum will be more than the provision of a large amount of information or knowledge. A key part of this educational event will focus on interactive, clinically rooted discussions among the participants, facilitated by the faculty, Drs. Kyle and Marsha Kline Pruett. The primary focus of this educational opportunity is to examine key factors that increase an individual’s likelihood to first develop - then suffer from - an addiction. Addiction is defined as a disorder of brain functioning that involves the compelling urge to engage in repetitive behaviors, using drugs, sex, nicotine, diet, the Internet, etc. in spite of awareness that these repetitive behaviors carry, and perpetuate, negative consequences. Risk factors for addiction may be part of the individual, family, peer group, school, or

community experience. Deficits in emotion regulation skills and inability to get relief from untreated mental pain, untreated physical pain, family history of addiction (genetic factors), environmental factors, the theories related to the coexistence of mental illness and addiction (do drugs cause mental illness, self-medication using substances, the shared biology of mental illness and addiction) will be explored as contributing factors. Other particular areas that will be explored are the role of adverse childhood events, how one’s current stage of life and state of brain development may be impacted with substance abuse, and how brain plasticity may influence recovery. In addition, social alienation, parental disengagement (maternal and paternal), and stress, will be examined for the role they may play in the development and perpetuation of an addiction. >

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Why is brain development important? Brains are built over time, and the early influences in one’s life are critical. The architecture of the brain is constructed through an ongoing process that begins before birth and continues into adulthood. Brain architecture is built over a succession of “sensitive periods,” involving the formation of specific circuits that are reciprocally linked with the development of specific skills. A strong foundation in the early years of life increases the probability of positive outcomes in terms of learning, behavior, and health, just as a weak foundation increases the probability of poor outcomes. There is a growing body of evidence that some forms of stress and adverse experiences in early childhood can have enduring effects, resulting in biological reprogramming of the brain. However, we also know that brains continually change and brain development is lifelong. Core concepts of brain plasticity, the importance of sensitive periods, the inter-

generational relationships, the physiological response of the brain to stress, and the recent developments in the neuroplasticity of the brain will be reviewed as will the importance of attachment, early childhood stress and the brain, and the role of social support. So what difference does knowing make? One of the key reasons for this educational opportunity and this content review is to then identify what the implications are for clinical nursing practice. Current evidence amassed over the last decade suggests that prevention and early intervention is both wise and effective. Nurses have an important role in this regard. Is it possible to identify people and the degree of risk for developing an addiction? What might some of the early signs and symptoms look like? Is intervention necessary at these times or is it ok to wait? Who might I seek for consultation or refer to as a resource? When you are asking patients about possible challenges with addiction, do you ask about some of these early risk fac-

tors? How do you work with other members of the healthcare team to ensure these issues do not go unaddressed? What if you suspect that you or someone you know may be struggling with addiction? A continuing education curriculum focused on Nursing (LPN, RN, RPN) practice in Alberta This educational and experiential opportunity will be open to a minimum of fifty attendees in the fall of 2010. Three days of didactic and interactive curriculum delivery, followed by one day of application through experiential learning will be conducted. Lectures and discussions will be videotaped for subsequent use including distance delivery. n If you think this information is relevant to your practice and would like to participate in this unique educational opportunity, please contact Kate Pedlow, (General Counsel & Program Officer) at pedlowk@norlien.org.

Essential E ssential Leadership Leadership Skills Skills for for Health Health Care Care Professionals Professionals N NorQuest or Q u es t C College ollege a and nd N Northern or thern L Lakes akes C College ollege ha have ave c combined ombined ttheir h ei r rresources esources tto op present resent tthis h is c certificate er tificate p program. rogram. L Learn earn h how ow tto om motivate otivate a and nd iinspire nspire yyour our tteam! eam! D Delivered elivered iin n ttwo-day wo-day c course ourse m modules, odules, tthis his p program rogram c can an b be e ttailored ailored tto o vvirtually irtually e every very w workplace orkplace a and nd p provides rovides tthe he fl flexibility exibility ffor or p participants articipants tto o ffocus ocus o on n ttheir heir o own wn u unique nique n needs. eeds.

PUT PUT YOUR YOUR CAREER CAREER

IN IN THE THE

LEAD! LEAD! 22

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U Upcoming pcoming C Courses o u rs e s May and 5,, 2 2010 COMMUNICATION ▶M ay 4 a nd 5 010 – C OMMUNICATION June and 2010 WORKING TOGETHER ▶J une 114 4a nd 115, 5, 2 010 – W O R KI N G T OGETHER Call Now! C a ll N ow! For F or m more ore iinformation nformation a about bout tthis his p program, rogram, p please l ea s e c contact o nt ac t Northern N or thern Lakes Lakes College College toll-free toll-free at at 11-866-652-3456, - 866 - 65 52-3456, visit v isi t www w ww n northernlakescollege.ca, or thernlakescollege.ca, or or contact contac t Erin Erin Bampton Bampton att 780-644-6397 a 780 - 64 4- 6397 or or email email erin.bampton@norquest.ca erin .bampton@norquest .ca

www.norquest.ca w ww.norquest.ca

research

Understanding KEP: A non-researchers guide he recently released Knowledge and Education Project (KEP) report was the result of a collaborative project initiated by the Nursing Advisory Council of Alberta and included representation from the three regulatory colleges representing LPNs, RPNs, and RNs. The project was initiated in an effort to better understand the knowledge base of the three categories of professional nurse in Alberta. It was hoped this research might assist decision makers in making staffing decisions. The KEP study was restricted to a qualitative review of the acquired academic knowledge held by novice nurses in all three categories who were close to graduation but still students at the time of the study. The research was designed to explore the breadth and depth of knowledge held by all three types of nursing students at point of graduation using review of curriculum and regulatory documents, interviews and focus groups with students, and interviews with educators. The research is not an evaluation of the practical bed-side skill of novice nurses in delivering patient care. The KEP report provides some insight and reassurance about the entry to practice knowledge of new nursing graduates in Alberta. However, any generalization of the research beyond the evaluation of acquired academic knowledge of novice nurses would not be supported by the findings of the KEP study. Extrapolation of this research beyond its limited focus and findings would be inappropriate and possibly precarious. The KEP study in isolation is not a reasonable basis for making larger public policy decisions on professional nursing issues like roles, responsibilities, and scope of practice. The CLPNA Council and Executive team had a presentation on the KEP project by Dr. Margaret Hunsberger, princple investigator. She was very clear and forthright about the KEP research project findings, limitations, appropriate application, and insights. Dr. Hunsberger said the KEP research approach was not a quantitative statistically based random selection test of a hypothesis. Rather it was a qualita-

tive “naturalistic” research project that was context based using observation and interpretation of the participants to reach conclusions. She noted in naturalistic qualitative research approaches data interpretation depends on understanding the context, the language of participants, and the researcher’s ability to write with clarity and illumination. Dr. Hunsberger said considerable effort was made in the KEP project conclusions around understanding context, seeking patterns and finding trends in the observations of participant performance. Based on comments and clarifications from Dr. Hunsberger the good news is Alberta’s novice nurses, in all three categories, are appropriately educated for their current scope of practice and she encourages full utilization of all nurses. The data showed knowledge overlap and differences between the LPN, RPN, and RN novice nurses, but that would be expected based on differences in program length and focus. An important clarifying comment from Dr. Hunsberger was about the interpretation of the KEP report Executive Summary comment that LPNs were “… best suited to deal with stable patients.” She noted that “stable patient” is used with its common sense meaning (not one of the bizarre definitions sometimes created) and indicated that a more sophisticated context about stability should

include patient concerns, but go well beyond to consider the stability of the organizational and professional working situation of the LPN, the stability of employer and of government policy, all of which impact the ability of nurses to do their best work. Dr. Hunsberger suggested another section of the research report may be a more appropriate context to consider the roles, responsibilities and scope of practices for LPNs. The KEP report notes (p. 67) the three categories of nurses have “…three different types of credential backed by three different knowledge bases, which have amongst them both significantly overlapping and significantly different responsibilities.” Also, noted at the same page “RPN students were strong in the area of psychiatric illness and medication, but less so in medical surgical areas. LPN students were as strong as RN students in knowledge of standard care and standard procedures, but not so with more complex clinical issues. RNs showed the widest range of nursing knowledge, and except for psychiatric areas, also the deepest knowledge.” This KEP finding is a more useful context to help policy makers understand the different roles, responsibilities, and scope of practice of the various types of novice nursing provider in Alberta. The KEP study is a good, but limited start at improving and clarifying roles, responsibilities, and relationships in nursing care in Alberta. It answers some key questions but begs even more profound questions. The CLPNA thanks Dr. Hunsberger for her efforts throughout the KEP study. We hope her report heralds more health-system based research so Alberta can make systemic improvements that are evidence-based and not merely political or adversarial. n Thank you to Alberta Health and Wellness for funding this project. The full research report is available at www.clpna.com

care | SPRING 2010

mental health

Breaking the Silence Managing Mental Health in the 21st Century By Dr. Austin Mardon

FEAR OF HOMELESSNESS - a reality for far too many with schizophrenia. The biggest bogeyman for those who suffer from a serious mental illness, whatever stage of the illness they are in, is that they will become homeless. Homelessness can come from financial or mental health issues, many times from a combination of both. rom my living room, I watch a constant stream of homeless, or perhaps the nearly homeless, shuffling down our alley searching dumpsters for bottles and cans, the same dumpsters that have already been rifled through numerous times. With a shudder, I realize that if not for the love of my wife and the modern miracle of pharmacology, I myself could easily very easily - have been one of those faceless shuffling horde.

I know my medication has side effects that are serious but what choice do I really have? As I stand by my window feeling the heat rise from the register, I can see the choices others have made, to be in the cold. I haven’t always lived in such comfort. When I was a college student, I lived in substandard housing and even flop houses, as did many others. You expect to do that as a poor student, but know that deep down it is only temporary. For a portion of our society, that kind of housing is their permanent home. I have friends who pay over $750 a month to live with their doors bolted in slums. That amounts to 75% of

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their AISH income. I try not to think about how close we came to that reality. Some would say that we are really only one step up, because of the neighborhood we live in, but we own our small suite. Having my name on the title gives me such a sense of safety that I will be eternally grateful for those who went out of their way to help us, when we needed it the most. Every time I have changed medications, I’ve had an improvement, followed by a gradual deterioration. My wife now gives me something to cling to. Both of us had been scarred, but we look out for each other. I have seen friends with schizophrenia lured by the idea of normalcy take full time jobs only to break down shortly thereafter. They lose their income supports and disrupt their lives. Sometimes it leads to homelessness. I feel powerless, so I volunteer at charities such as the Champion’s Centre devoted to housing the mentally ill. I would rather be stable on my medications and poor, than normal for a moment to have it all taken away. Stable versus normal is the choice those

with mental illnesses have to make each day. It is believed that up to 75% of those who are homeless have a serious mental illness that they are not being treated for. Providing housing is only the first step. In 17 years, I have never consciously gone off my medication. For someone with my illness, that’s rare. I do sometimes wonder if I had become non-compliant at some point, if I would have ended up on the street like the ghostly figures I see in my alley. There go I, but for the grace of God… n

Austin Mardon received the Order of Canada for advocacy on behalf of those with schizophrenia in 2007. He is the local chair of the Champion’s Centre a charity devoted to alleviate homelessness in Canada. Email: aamardon@yahoo.ca

Alberta’s New Mental Health Act - Twenty Years in the Making By Sandra Harrison and Carol Robertson Baker

Same Act, Only Different: Recent amendments to the Mental Health Act enhance treatment options to support Albertans with mental health disorders in their journey of recovery. Many LPNs work in the community and in hospitals across Alberta to support patients in their recovery from mental illness. This article provides important information about amendments to the Alberta Mental Health Act that may impact your practice. What are the changes? This article discusses each of the changes under the Act including the: • Broadening the certification criteria; • Requirement for the provision of the notice of discharge, discharge summary and any treatment recommendations to the patient’s family physician; • Introduction of community treatment orders (CTOs); • Inclusion of patient rights; • Expansion of Review Panel responsibilities; and • Expansion of Mental Health Patient Advocate responsibilities. What events precipitated these amendments? Over the years, support and lobbying for community treatment orders, earlier intervention and the need for community mental health supports came from health care providers, individuals with experience of mental illness, their families and advocacy groups. In 2006, Judge Ayotte’s report arising out of the fatality inquiry into the deaths of an RCMP officer and a man who had a history of mental illness recommended the Mental Health Act (1990) be amended to permit community treatment orders. He concluded that had CTO’s “been in place in the years leading up to this incident, the tragedy it spawned might well have been avoided.” Judge Ayotte also recommended that the patient’s discharge summary and any treatment recommendations be given to an individual’s family physician at the time the

patient is released from hospital after receiving care and treatment for a mental disorder. Subsequently Bill 31, The Mental Health Amendment Act, was introduced by Government, passed second reading and was referred to an all party Standing Committee for review. Bill 31 subsequently passed third reading and received Royal Assent on December 7, 2007. When the Act was proclaimed it replaced the former statute and is known as the Mental Health Act (2007). It came into effect in two stages - September 2009 and January 2010. What is meant by recovery? In mental health, recovery is about hope, respect, empowerment, and quality of life. Recovery is a uniquely personal journey in which an individual learns to live with a mental illness and works with others to experience a better quality of life as a contributing member of society and often includes learning to live with their illness. The previous Minister of Alberta Health & Wellness, the Honourable Ron Liepert, was quoted as saying, “It is absolutely critical that individuals with serious and persistent mental disorders get both immediate and ongoing care. The amendments to the Mental Health Act allow for early intervention when individuals need mental health treatment and ongoing care after they return to their communities.” The Act not only facilitates earlier intervention, it enshrines patient rights and recognizes the need for community based services to be in place to support facility patients and those subject to a community treatment order. Broadening the criteria for involuntary admission Three criteria must be met for the involuntary admission of a person to a designated

mental health hospital. An admission certificate is issued by a physician if he or she is of the opinion that the person is: • Suffering from mental disorder; and • Likely to cause harm to the person or others or to suffer substantial mental or physical deterioration or serious physical impairment; and • Unsuitable for admission to a facility other than as a formal patient. The first and third certification criteria have not changed from the previous Act but the second criteria has changed substantially from 1990 when the focus was on the person “presenting or likely to present a danger to self or others”. Now, in order for a person to be certified, in addition to the first and third criteria, the person must be considered by two doctors to be “likely to cause harm to the person or others or to suffer substantial mental or physical deterioration or serious physical impairment.” This significant change is intended to enable earlier intervention and address a long standing concern of families, patients, and service providers that admission to hospital for treatment had been difficult. Providing the family physician with the discharge summary and treatment recommendations Under the amended Act, there is a new requirement that upon the release of a patient who had been receiving mental health care in hospital, the discharge summary and any recommendations for treatment must be sent to the individual’s family physician, if known, so that appropriate treatment can continue to be provided in the community. As well, under the Act a patient who was subject to a community treatment order, their substitute decision maker, any person providing treatment or care to the patient who was subject to the CTO, and the patient’s family doctor, if known, is given notice of the expiry or cancellation of the CTO along with any recommendations for treatment. >

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This enhanced communication between facility and community, and within the community, is intended to promote continuity of care. Introducing Community Treatment Orders in Alberta The amended Act introduces the community treatment order (CTO) in Alberta. Known by different names in various jurisdictions, the concept behind CTOs is that it is another tool for physicians to use to provide care and support for individuals in the community. The CTO is intended for use with a small number of individuals with a severe and persistent mental illness who are admitted to hospital as formal patients (patients who are subject to two admission certificates or two renewal certificates), are stabilized and then discharged only to lose contact with their treatment team or stop treatment in the community. When this happens their mental health deteriorates and they frequently need to be readmitted to hospital. It is thought that the use of a CTO may prevent or reduce this “revolving door syndrome.” Certain criteria must be met for a CTO to be issued. A CTO may be issued when the individual is residing in the community or immediately prior to discharge from hospital, if they meet the criteria. Criteria that reflect

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the recovery approach include the conditions that the individual is assessed as having the ability to comply with the CTO and that the services the patient requires to live successfully in the community under the CTO are available and will be provided to the individual. Community treatment orders are issued by two physicians, one of whom must be a psychiatrist. It is important to know that the CTO must include a treatment and care plan that is personalized to meet the individual’s needs. The treatment and care plan may outline medication, appointments, attendance in skill development programs, living arrangements, or other conditions that support the individual to stay healthy while residing in the community. If the individual subject to the CTO or their substitute decision maker believes that a change in the treatment and care plan is needed, they can request an amendment to the CTO. Community treatment orders are based on consent. Either the individual or their substitute decision-maker must provide consent except in limited circumstances. Consent is not necessary where the physicians issuing the CTO believe that the person has exhibited a history of not obtaining or continuing with community treatment or care that is

necessary to prevent the likelihood of harm to others and a CTO is reasonable and would be less restrictive than detaining the person as a formal patient. Patient rights are enshrined Just as in the Mental Health Act of 1990, under the amended Act patient rights are enshrined. That is, patients receiving care under the Act have certain rights under the law. It is noteworthy that Alberta is the only jurisdiction in Canada to protect patient rights under a community treatment order. Patients have the legislated right to be provided with information about their rights. This includes individuals subject to a CTO. They have the right to receive a copy of the CTO, request cancellation of the CTO by appealing the CTO to an independent body called the Review Panel, have legal counsel for the Review Panel hearing, appeal the Review Panel’s decision to the Court of Queen’s Bench, and to contact the Mental Health Patient Advocate. A CTO would be in effect for a six month period after it is issued unless it is cancelled sooner by a psychiatrist or the Review Panel. Unless it is renewed for another 6 months, it would automatically expire.

There is no limit to the number of times a CTO can be renewed. This means that the CTO could be in place for some time if the criteria continue to be met. If there is no appeal of the CTO by the patient, their substitute decision maker or another person on the patientâ&#x20AC;&#x2122;s behalf, the Review Panel is required to review the CTO at specified intervals. Mental Health Patient Advocate The amended Act not only affirmed the legislated mandate of the Patient Advocate to promote patient rights and investigate complaints but expanded the scope of responsibilities from only formal patients and those acting on their behalf to cover all patients, and those acting on their behalf, who are or have been detained under one or two admission certificates or renewal certificates, and/or who are or have been subject to a community treatment order. Albertaâ&#x20AC;&#x2122;s Mental Health Patient Advocate plays a unique role in the mental health system. Arms length from Government and independent from all service providers, the Advocate is appointed by the Lieutenant Governor in Council pursuant to Part 6 of the Mental Health Act to promote patient rights, support patients to exercise their

rights, and investigate complaints. Patients should be given information on how to contact the Patient Advocate. This should be provided by the treatment team at the time a certificate or CTO is issued and at any point in their care. The Mental Health Patient Advocate posters and brochures should be visible on hospital units, clinics and doctorâ&#x20AC;&#x2122;s offices, and in other places where patients access services. Under the Act, a person subject to the Act has the right to contact the Patient Advocate. The advocates in the Mental Health Patient Advocateâ&#x20AC;&#x2122;s office provide a province wide call centre service as well as make visits throughout the province with patients in hospital and those subject to CTOs, and are a resource for treatment team members. The focus of the advocateâ&#x20AC;&#x2122;s work is in four key areas: providing rights information; investigating and resolving complaints about a patientâ&#x20AC;&#x2122;s detention, care, treatment and rights; advocating on behalf of and supporting self advocacy by patients; and providing education about patient rights and the exercise of those rights to patients, families, the public, health care providers and many others.

and resolving complaints, the Mental Health Patient Advocate serves as a resource by: â&#x20AC;˘ Bringing a unique perspective in advising policy makers and legislators; â&#x20AC;˘ Supporting patient rights perspectives and recovery in the development and implementation of mental health policies and procedures; â&#x20AC;˘ Promoting public, professional and consumer awareness of rights and recovery related to issues in mental health through education, information sharing and knowledge exchange. It is our shared responsibility to ensure that individuals in recovery from mental illness know and exercise their right to be heard, respected and encouraged by hope for a better future. More information is available on the Mental Health Patient Advocate website at www.mhpa.ab.ca or by calling the office toll free at 310-0000 then dial 780422-1812. n About the Authors Sandra Harrison, MSW, is Albertaâ&#x20AC;&#x2122;s third Mental Health Patient Advocate. Carol Robertson Baker, BA, MEd, is the Assistant Mental Health Patient Advocate for Alberta.

In addition to providing rights information

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at issue

Changes to the Protection for Persons in Care Act

The Protection for Persons in Care Act (Act) has been re-written to better protect adults from abuse while they are receiving care or support services funded by the Government of Alberta. The re-written Act is expected to be proclaimed in the spring of 2010. Some of the changes to the Act include: • A timeline for reporting abuse. • A new definition of abuse that focuses on serious harm. • New duties for service providers and individuals who provide care or support services. • New compliance requirements. • New established roles of a complaints officer and director. • New offences and an appeal process. To view the Act online go to www.qp.alberta.ca and choose Laws Online. To purchase a copy of the new Act contact the Queen’s Printer Bookstore at 780-427-4952 (To call toll-free, first dial 310-0000) As further information becomes available, it will be posted at www.seniors.alberta.ca

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at issue

Improving Health Care for Dementia and Delirium Alberta Health Services is taking steps to integrate provincial projects in Seniors Health! A new department has been formed to lead these provincial projects. Specialized Geriatric Services, a stream of the new provincial Seniors Health portfolio, with funding from Alberta Health & Wellness, will promote a public awareness campaign on Dementia and Delirium in 2010-11. The Provincial Cognitive Impairment Strategy will start with a Delirium Prevention Program and increased public awareness of Dementia Care for health care workers and family caregivers. In 2000, it was estimated that 24,040 individuals in Alberta had a diagnosis of cognitive impairment (Alzheimer Disease and Other Dementias Provincial Strategic Direction Report). Of these, 40% were mild; 39% were moderate, and 21% had severe dementia; 4% lived in Long Term Care, and the remaining 96% lived in the community or supportive living. It is estimated that by 2010, there will be 99,120 seniors (age 65 and older) living in Alberta with dementia. As the fastest growing age group in Alberta is 65-84 (annual growth rather 3.8% McKinsey, 2008), it is anticipated that between the years 1991 and 2031, the numbers of Albertans with a diagnosis of dementia will more than triple. Annually, there will be approximately 1,400 new cases of dementia in the population of Alberta 85 years and older. In addition to the increasing prevalence of the disease, dementia’s impact on individuals, families and health care costs exceeds that of most other chronic conditions. It has a profound financial and emotional impact on family and friends. Health service providers are struggling to manage this growing population. Planning for service delivery needs to consider the services that will be required throughout the disease trajectory as well as interventions specific to the disease stage: early diagnosis, middle stage, late stage, and planning for end of life.

Knowledge about Delirium and Dementia has increased considerably over the past decade, creating opportunities to implement interventions which have been shown to be successful not only in improving the quality of care for clients and caregivers, but also in reducing health care expenditures and caregiver burden. In the province of Alberta, there are now better opportunities to link implementation to research activities. There is a growing body of information that identifies what constitutes good dementia care. This information needs to be disseminated to the wide variety of service providers involved in caring for individuals with cognitive impairments. A comprehensive Cognitive Impairment Strategy for Alberta will include: Standardized Clinical Pathways, Delirium Protocols, Dementia Protocols, Valid Assessment Tools, and will promote least chemical and mechanical restraint interventions. It will also include best practice guidelines for all older adults in the system – even those who are cognitively intact – “Senior Friendly Care.”

edge of appropriate dementia care techniques leads to inappropriate use of medications, crisis hospitalizations, early placement in long-term care facilities, and poor quality of life for individuals with dementia and their caregivers.

As the prevalence of cognitive impairment increases, all individuals involved in the provision of health, social, and housing services for older adults will need to know more about these conditions. The literature suggests that insufficient knowl-

If you would like to be involved in reviewing pamphlets, posters, order sets, and education strategies for public awareness of normal aging and illness trajectory of dementia related diseases, please contact colleen.zimmel@albertahealthservices.ca.

It is time to become creative and work together to make caring for people with dementia, and their families, less of a challenge. If dementia is better understood, appropriate care planning can be provided. It is a time for communities to partner with health providers to enhance service delivery to seniors and those less than 65 years of age with dementia related diseases. It is time to optimize our interdisciplinary workforce to full scope of practice to share the information needed to provide better care for seniors and especially for those with cognitive impairment. It is time to ask those that experience dementia and their caregivers to discuss the issues of importance with the ultimate goal of assisting us to improve quality of life for care providers and care recipients. n

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Hypertension: Where We Stand in 2010

According to the Public Health Agency of Canada’s (PHAC) 2009 Survey on Living with Chronic Disease in Canada, one in five Canadians over the age of 20 are aware they have hypertension. (Public Health Agency of Canada, 2009) Hypertension is still a leading cause of morbidity and mortality in Canada.

What is the role of the clinician? Jody Wiebe, RN Dr. Charlotte Jones

CHEP (Canadian Hypertension Education Program) highlighted the following key messages in 2009: Know your numbers. Targets for blood pressure include <140/90 mmHg for most people, <130/80 mmHg for people with diabetes or chronic kidney disease, and <135/85 for clients on home blood pressure monitoring. (Canadian Hypertension Education Program, 2009 Recommendations) Over half of the people in the Public Health Agency of Canada Survey on Living with Chronic Disease in Canada said they had never discussed blood pressure targets with a health care professional. (Public Health Agency of Canada, 2009) Assess blood pressure at every appropriate visit. For information on diagnosing hypertension, refer to the 2009 Canadian Recommendations for the Management of Hypertension ‘What’s new, What’s old but still important’ booklet available at www.HTNupdate.ca. Treat to target. Most patients will require more than one drug. For more information on antihypertensives, refer to the 2009 Canadian Recommendations for the Management of Hypertension ‘What’s new, What’s old but still important’ booklet available at www.HTNupdate.ca. Assess overall cardiovascular risk. This includes assessing for dyslipidemia, dysglycemia, abdominal obesity, diet, and lack of physical activity. Healthy lifestyle changes remain the cornerstone for controlling hypertension. Counseling patients on lifestyle changes can help motivate behavior change and reduce their risk. The recent PHAC survey revealed that among Canadians with hypertension, 58% were physically inactive, 71% were overweight or obese, 58% were not eating the recommended fruit and vegetable servings per day, and 17% reported smoking daily or in social situations. (Public Health Agency of Canada, 2009) Lifestyle recommendations from CHEP and Blood Pressure Canada include: • Reducing dietary sodium www.lowersodium.ca • Eating a diet rich in fruits, vegetables, and low in saturated fat • Doing 30-60 minutes of moderate physical activity 4-7 days per week • Maintaining a healthy body weight • Limiting alcohol consumption • Quitting smoking

Stay Up to Date CHEP’s theme for 2010 is Innovative Knowledge Translation. To help health care professionals stay current on hypertension, all CHEP and Blood Pressure Canada materials are available at www.HTNupdate.ca. Health care professionals can register on the website to be notified immediately via e-mail when new materials are added.

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at issue

Urinary Tract Infections in Continuing Care Centres By Mary Carson, PhD, Sara Gallinger, RN, BScN and Sandra Leung, BScPharm

rinary Tract Infections (UTIs) are the most common infection in continuing care centres yet are one of the most difficult to diagnose. Assessment for UTIs can be particularly challenging if residents have non-specific symptoms or are unable to verbalize how they are feeling. Communication among nurses, physicians and pharmacists is crucial to ensure proper diagnosis and treatment for residents with suspected UTIs. Nurses play a key role in this dialog because they are the first to investigate the vast majority of UTIs in continuing care centres.

The Clinical Practice Guideline (CPG) for UTI in Continuing Care has recently been added to the library of CPGs published by the TOP (Towards Optimized Practice) program in Alberta. This CPG was developed with input from physicians, nurses and pharmacists working in continuing care centres. The CPG includes a Clinical Care Pathway designed to guide care and facilitate communication among the three professions. The clinical pathway is available from the continuing care desktop of Alberta Health Services and from the TOP website at: www.topalbertadoctors.org/informed_practice/clinical_practice_guidelines.html. It is a step-by-step guide to clinical decision making and is intended to remain as part of the resident chart. An introduction to the care pathway follows: Step One. Does the resident have symptoms that indicate a UTI? n Typical symptoms in non-catheterized residents. UTI should only be considered if the resident has typical, localizing symptoms. In non-catheterized residents this includes acute dysuria alone or an elevated temperature plus one of the following: new or increased urinary frequency, urgency or incontinence; new flank or suprapubic pain or tenderness; or hematuria. Elevated temperature is a key indicator of UTI in the elderly, but it is important

that temperature be compared to baseline values. n Typical symptoms in catheterized residents. Elevated temperature is a typical symptom of a UTI in catheterized residents. As for non-catheterized residents, a temperature >38°C or 1.1°C above baseline is significant. In addition, a UTI may be indicated by any of the following: new flank or suprapubic pain or tenderness; rigors; or new onset delirium. n Caution. Non-specific symptoms including worsening of functional status, worsening of mental status, increased confusion, delirium or agitation, or increased falls indicate a change in resident’s medical status but do not indicate a UTI unless typical symptoms are present. Unless medical status is declining rapidly, push fluids for 24 hours and then reassess. If typical symptoms develop, treat as for UTI. If non-specific symptoms continue without development of typical symptoms of a UTI, consider the possibility of an alternate diagnosis. If symptoms resolve, no further intervention is required. n Note. With good hydration, non-specific symptoms often resolve. Importantly, if the resident is medically stable, there is no evidence of increased morbidity or mortality associated with waiting 24 hours to see if typical symptoms develop. Note that residents on fluid restrictions will need to be assessed and monitored individually. Step Two. Discuss findings with physician or nurse practitioner n Resident status. If the resident shows typical UTI symptoms, contact the physician or nurse practitioner. Be ready to report resident temperature, temperature in relation to baseline, changes in urinary function (dysuria,

new or increased frequency, urgency, or incontinence), presence of localizing pain or tenderness, and hematuria. For catheterized residents, new onset delirium is also an indication of UTI. Because antibiotic therapy may be ordered, be prepared to discuss the resident’s renal status. A recent calculated creatinine clearance (CrCl) is a measure of renal function and is helpful in making decisions about antibiotic selection and dosing. n Orders. Orders may be obtained for a urine culture and sensitivity (C&S). Empiric antibiotic therapy may also be ordered depending on the resident’s medical status. n Push fluids. Continue to push fluids unless the resident is on fluid restriction. Step Three. Collect urine specimen for C&S Proper specimen collection and storage prior to transport to the laboratory will ensure optimal results. n Timing. To make sure that laboratory results are meaningful, collect urine samples before initiation of antibiotic therapy. n Specimen collection. For non-catheterized residents, midstream urine (MSU) samples should be collected to avoid specimen contamination. For female residents unable to provide a MSU sample, collection via an in/out catheter is recommended (an order from the physician or nurse practitioner is required for in/out catheterization). A freshly applied condom catheter can be used for males unable to provide a MSU sample. Urine should be collected in the C&S specimen container supplied by the laboratory. >

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n Specimen handling. Make sure specimens are stored in the refrigerator while awaiting transport to the laboratory because organisms multiply quickly at room temperature. Specimens should be picked up and transported to the laboratory within 24 hours of collection. n Information for the laboratory. Provide relevant resident history and clinical information for the laboratory such as symptom onset, catheterization, drug allergies, and the name of the antibiotic (if ordered before C&S results available) as this will assist laboratory staff with testing, interpreting and reporting C&S results. Step Four. Urine C&S results Review of a resident’s urine C&S results is a critical step in ensuring appropriate treatment of UTI. Check each of the following points and discuss with the physician, nurse practitioner and/or pharmacist if needed. n Bacterial count. A bacterial count ³108 cfu/L is significant and usually indicates a UTI in residents with typical symptoms. Bacterial counts <108 cfu/L do not confirm a UTI. Note: A significant bacterial count alone does not indicate a UTI and antibiotic treatment is not indicated if the resident is asymptomatic or has non-specific symptoms. If no infection is indicated by C&S testing, STOP antibiotics immediately. n Multiple organisms. About 20% of UTIs are associated with more than one organism. The presence of three or more organisms usually indicates contamination; if so, a new specimen is needed. n Susceptibility. The laboratory report will indicate which antibiotics will be effective against the organism(s) identified in the specimen. Check laboratory results against the medication orders to ensure that the organism causing the UTI is sensitive to the antibiotic which has been selected for therapy. In the case of multiple organisms, all organisms need to be sensitive to the prescribed antibiotic. n Retesting not needed. Repeat C&S after antibiotic therapy is completed is NOT recommended unless symptoms of a UTI persist.

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Step Five. Renal function and dose adjustment n Calculated creatinine clearance (CrCl). Renal function decreases with age and is monitored in continuing care centres to facilitate medication management. A calculated CrCl <60 ml/min indicates a significant loss of renal function and the need for adjustment of medication dosing. If an antibiotic has been prescribed, consult with the pharmacist to ensure that the dose is appropriate with respect to renal function.

Use of antibiotics to treat abnormal urine characteristics • Foul smell is not an indicator of UTI and can be caused by many factors including poor hygiene, diet or dehydration. • Abnormal color is not suggestive of a UTI. A UTI should be suspected only if the resident is symptomatic. • Gross hematuria is usually not caused by a UTI, but rather by other factors. Consider alternate diagnoses. Remember

COMMON MISCONCEPTIONS Diagnosis of UTI using dipstick or Chem-9 Although a negative dipstick rules out a UTI, a positive dipstick is not diagnostic for a UTI. Pyuria, the presence of white blood cells in the urine, is very common in the elderly. In asymptomatic residents, pyuria is not related to a UTI and does not indicate antibiotics are needed. Routine dipsticks do not improve resident outcomes and are not recommended. Best practice includes resident monitoring and assessment followed by laboratory C&S testing if typical symptoms of a UTI are present. Initiating antibiotics in the absence of UTI symptoms Asymptomatic bacteriuria is the presence of bacteria in the urine of an individual who does not have symptoms of a UTI. The prevalence of asymptomatic bacteriuria increases with age and is very common among residents in continuing care centres. Elderly persons who are asymptomatic do not have an infection and do not require antibiotic therapy even though they may have bacteria in the urine. The most common reason for inappropriate use of antibiotics in continuing care is treatment of asymptomatic bacteriuria. Antibiotics, whether taken for the right or wrong reasons, are not without risk. Receipt of antibiotics is associated with increased likelihood of carriage and/or infection with resistant organisms. As a consequence, subsequent infections might be difficult or impossible to treat. This risk is a serious side effect of antibiotic use and can persist for many months after antibiotic use has stopped.

UTIs are the most common infection among residents in continuing care centres. Proper diagnosis requires assessment of the resident for the presence of typical symptoms. Laboratory testing is indicated for residents with typical symptoms of a UTI. Urine C&S and creatinine clearance results should be used to guide antibiotic selection and dosing. For medically stable residents with non-specific changes in functional or mental status, push fluids for 24-hours and reassess; antibiotics can be safely delayed during this period of observation to see if symptoms resolve or if typical symptoms develop. Asymptomatic bacteriuria is common in the elderly. Antibiotic therapy is not indicated unless typical symptoms of a UTI are present. Diagnosis of UTIs in the elderly can be challenging. Careful assessment and good communication among nurses, pharmacists and physicians will ensure optimal care for residents with suspected UTIs.

PROGRAM AND AUTHORS Do Bugs Need Drugs? is a community education program about the wise use of antibiotics. This article coincides with publication of a new Clinical Practice Guideline and Care Pathway for UTIs in long term care by the Towards Optimized Practice program in Alberta. Mary Carson is the Program Director for Do Bugs Need Drugs? Sara Gallinger is an Infection Control Practitioner and Sandra Leung is an Assistant Pharmacy Manager with Alberta Health Services, Integrated Facility Living. Do Bugs Need Drugs? is supported by Alberta Health and Wellness

www.dobugsneeddrugs.org 1-800-931-9111

Urinary Tract Infections in Long Term Care Clinical Pathway

Typical Symptoms (1)

(No Indwelling Catheter)

(1) PRACTICE POINT

(Indwelling Catheter)

Indications (check all that apply):

Â&#x2020; Acute Dysuria OR Â&#x2020; Temp >38o C or 1.1o above baseline on 2 consecutive occasions PLUS one or more of the following: Â&#x2020; New or increased urinary frequency, urgency, incontinence Â&#x2020; 1HZ Ă&#x20AC;DQN RU VXSUDSXELF SDLQ RU tenderness Â&#x2020; Hematuria

Â&#x2020; Temp >38o C or 1.1o above baseline on 2 consecutive occasions Â&#x2020; 1HZ Ă&#x20AC;DQN RU VXSUDSXELF SDLQ RU tenderness Â&#x2020; Rigors Â&#x2020; New onset delirium

Date/Time ___________ Initials ____

1RQ VSHFLÂżF V\PSWRPV 5HVLGHQWV ZKR DUH cognitively impaired may not be able to verbalize V\PSWRPV RI D 87, 1RQ VSHFLÂżF V\PSWRPV ZKLFK may indicate a UTI include: Â&#x2021; :RUVHQLQJ IXQFWLRQDO VWDWXV Â&#x2021; :RUVHQLQJ PHQWDO VWDWXV LQFUHDVHG confusion, delirium or agitation Â&#x2021; )DOOV QHZ RU PRUH RIWHQ Unless medical status is declining rapidly, PUSH )/8,'6 )25 +56 DQG WKHQ 5($66(66 Â&#x2021; ,I W\SLFDO V\PSWRPV GHYHORS WUHDW DV IRU 87, Â&#x2021; ,I QRQ VSHFLILF V\PSWRPV FRQWLQXH ZLWKRXW development of typical symptoms, consider an alternate diagnosis Â&#x2021; ,I V\PSWRPV UHVROYH QR IXUWKHU LQWHUYHQWLRQ LV required

PUSH FLUIDS (2) Discuss with physician or nurse practitioner Date/Time __________ Initials ____

(2) PRACTICE POINT

Orders obtained Â&#x2020; Urine C+S (3)

Alternate diagnosis Continue to monitor resident status

(3) PRACTICE POINT

Â&#x2020; Antibiotic therapy Date/Time ________ Initials ____

Date/Time ________ Initials ____

Urine C&S (3) Â&#x2020;

Â&#x2021; 8QOHVV RQ IOXLG UHVWULFWLRQ

Â&#x2021; Urine specimens should be collected %()25( DQWLELRWLF WKHUDS\ LV LQLWLDWHG Â&#x2021; Urine specimens should be refrigerated until pick-up by lab

Urine specimen collected

Date/Time ________ Initials ____

Urine C&S Results (4) Â&#x2020;

6LJQLÂżFDQW

Â&#x2020;

1RW VLJQLÂżFDQW

Date/Time ________ Initials ____

Final checklist: Â&#x2020; 6723 $17,%,27,&6 LI & 6 UHVXOWV DUH QRW VLJQLÂżFDQW 25 LI & 6 UHVXOWV DUH VLJQLÂżFDQW

Â&#x2020; $QWLELRWLF LV FRQVLVWHQW ZLWK UHFRPPHQGDWLRQV LQ JXLGHOLQH RU %XJV Drugs. Â&#x2020; 2UJDQLVP LV VXVFHSWLEOH WR WKH SUHVFULEHG DQWLELRWLF Â&#x2020; CrCl values reviewed. Therapy appropriate for renal function. Â&#x2020; Pharmacist consulted (If N/A check here _____). Â&#x2020; )LQGLQJV GLVFXVVHG ZLWK SK\VLFLDQ RU QXUVH SUDFWLWLRQHU Date/Time ___________ Initials ____

(4) PRACTICE POINT Â&#x2021; %DFWHULDO FRXQW Â&#x2022; 8 FIX / LV VLJQLILFDQW Â&#x2021; More than 3 organisms usually indicates contamination Â&#x2021; Clinical correlation is necessary for a diagnosis of UTI NOTE: Repeat C&S after antibiotic therapy is NOT necessary unless typical UTI signs and symptoms persist.

For complete guideline refer to the TOP Website: www.topalbertadoctors.org Adapted from Alberta Health Services (Edmonton) Seniors Health

care | SPRING 2010

at issue

Orchestrating the Health-Care Team Using Simulations to Rehearse By Dawn Ansell, Coordinator, Interdisciplinary Simulation Lab, Practical Nurse Diploma program, NorQuest College

Imagine that you have been asked to organize a group of professional musicians for a fundraising concert. Each musician is considered an expert at his or her mastery of their musical instrument. However, the musicians have limited experience playing with an orchestra. imilarly, most health-care team members have also learned their roles in isolation from other members of the team. Like the musicians, they are experts in their own field but have limited experience as interdisciplinary team members. An orchestra rehearses to learn to play together and to master their performance. During rehearsal, they play as though they are playing for an audience. They discuss how the rehearsal went and make changes to improve the performance. Ultimately, the orchestra’s performance benefits from rehearsal.

Similarly, health-care teams use simulation with actual client care situations and authentic equipment to rehearse their roles as interdisciplinary team members. (Harder, 2009) Like the musicians, the performance of the health-care team benefits from rehearsal with other team members. This is a classic example of experiential learning; engagement followed by self-reflection. (Green and Holloway, 1997) (Paige and Daley, 2009) Others have classified the layers of learning that take place in simulation as “constructivism”. (Harder, 2009). Since January 28, 2009, health career students at NorQuest College in Edmonton have taken part in simulations in NorQuest’s Interdisciplinary Simulation Centre (NISC) located in the Health Education Centre on 106th St. Simulation begins as collaboration between the simulation instructor/operator the program instructor. Student preparation for simulated clinical experiences

care | VOLUME 24 ISSUE 1

begins as they watch the orientation video and read the client’s orders and the medical and social history. The students are introduced to high fidelity mannequins as though they are health-care clients and they assume roles of either a care provider or a family member for the duration of the simulated clinical experience. Students are encouraged to recognize, respond and reflect on the events of the simulation. Students prepare for roles as family members, friends or advocates by reflecting on the effect of the client’s circumstances on their role. They might anticipate how a family member is likely to feel and how that might be expressed. They seek to understand how watching a loved one in pain can influence family members. They are encouraged to project how feelings might influence behaviours and communication of the health care provider. The NISC instructors/operators use computers to vary assessment data and transmitters to speak for the client. They cue students to recognize client distress and to respond with appropriate communi-

cation and professionalism. They then assist program instructors to facilitate student reflection on their actions in the simulation and suggest modifications to improve performance. Students integrate life experiences, classroom knowledge, skills and professionalism in the simulation centre as they rehearse for their performance in clinical practice. Evaluation in the NISC is limited to informal self-assessment and peer assessment. As such, it is deemed a safe environment for students and for staff. Students and instructors learn without the limitations of evaluation as they take chances and try new approaches in this safe environment. Students of Health Care Aide and Practical Nurse programs have been engaged in simulations as orientations to clinical practice. In these they are exposed to salient features of a set of common circumstances and encouraged to set priorities and react. In addition, practical nurse students have taken part in simulated clinical scenarios in which the client’s status is deteriorating, and therefore must initiate a rapid response or code blue for cardiopulmonary resuscitation.

Programs in Allied Health Careers at NorQuest College include Physical Therapy Assistant, Pharmacy Technician, Therapeutic Recreation and Mental Health Rehabilitation. Students from all four programs have taken part in the first interdisciplinary simulation scenarios based on communication with clients. These students meet the high fidelity mannequins as they interview them in community settings such as a homeless shelter and a day hospital to establish a social history. Other interdisciplinary activities are in development. The simulation centre has also hosted students for remediation, internationally educated nurses, Advanced Orthopedics for the LPN, Unit Clerks, and post-graduate continuing education students in simulated clinical scenarios. Sometimes putting yourself in someone else’s shoes is what it takes to realize what works and what needs to change. All simulations take place behind a one-way glass and are recorded to a DVD. Students watch each other during their rehearsal and then review the DVD to discuss and reflect on the events of the simulation. Student responses to their simulated clinical experiences have been overwhelmingly positive. Instructors are witnessing behaviour changes in students and the impact of simulation with repeated return to discussion. Opportunities for research within NorQuest College are in discussion and interagency opportunities for collaboration are in place. NorQuest College is an active member of an Interdisciplinary Health Education Partnership (IHEP) with NAIT, MacEwan, and the University of Alberta. This group is breaking ground in interdisciplinary education and simulation including research, collaboration in the development of scenarios, evaluation, faculty development and opportunities for all members to learn. These scenarios will be piloted by interdisciplinary instructor and student teams representing all member institutions in the spring of 2010.

HEALTH PROFESSIONALS TAKE HEED New Legislation proclamation April 1, 2010

Gunshot and Stab Wound Mandatory Disclosure Act (Bill 46) This new legislation requires healthcare facilities and emergency medical technicians to report all gunshot wounds and defined stab wounds to the police. It supports the Government of Alberta’s goal of promoting safe communities. The legislation is intended to reduce the risks posed to public safety in general and health care professionals in particular by enabling police to take immediate steps to initiate an investigation leading to the prevention of further violence, injury or death, when an individual enters a health facility with a gunshot or stab wound. Health care professions will not have to make the determination of a gunshot wound being criminal in nature as all gunshots will be reported. The legislation also gives health care practitioners clarity regarding disclosure by clearly laying out the responsibilities and expectations of health practitioners and police. Minimal disclosure of patient information is sought, limited to registration information and not treatment or diagnostic. For more information view the new Act at www.qp.alberta.ca/Laws_Online.cfm

In 2008, NorQuest’s Interdisciplinary Simulation Centre invited interest in a provincial interdisciplinary lab educators group. There was tremendous response indicating great interest in meeting to discuss approaches to skills and simulation labs. This Lab Educators of Alberta group meets regularly and is collaborating on a website and other means to share information. Ultimately, our goals in NorQuest’s Interdisciplinary Simulation Centre include offering intradisciplinary and interdisciplinary simulations for the NQC health careers programs, for students of programs external to NQC with NQC students, and for post-graduate health-care providers seeking competency or clinical updates. Interdisciplinary simulation provides the members of the health-care team the opportunity to ‘orchestrate’ teamwork in client circumstances. n Green, A. Holloway, D. (1997) Using a phenomenological research technique to examine student nurses’ understandings of experiential teaching and learning: a critical review of methodological issues. Journal of Advanced Nursing, 26(5), 1013-1019. Retrieved from ebscohost.com October 22, 2009. Harder, B. Nicole. (2009, September) Evolution of Simulation Use in Health Care Education. Clinical Simulation in Nursing. 5(5), pages e169-e172 Retrieved October 21, 2009. Paige, J. B. Daley, B.J. (2009, May). Situated Cognition: A learning framework to support and guide high-fidelity simulation. Clinical Simulation in Nursing, (5(3), pages e97-e103. Retrieved October 21, 2009.

Finding the right balance for you. )LHOG /DZ¶V 3URIHVVLRQDO 5HJXODWRU\ *URXS )LHOG /DZ¶V 3URIHVVLRQDO 5HJXODWRU\ *URXS

We are proud oud to act as legal counsel for the College of Licensed Practical Nurses of Alberta HGPRQWRQ FDOJDU\ \HOORZNQLIH ZZZ ÀHOGODZ FRP ZZZ ÀHOGODZ FRP

care | SPRING 2010

Do you have a desire to improve the health, wellness and quality of life of older adults? Network with other Nurses interested in gerontology!

www.agna.ca

care | VOLUME 24 ISSUE 1

the operations room Member Information - College Activity - Best Practices

NATIONAL NURSING WEEK May 9-15, 2010

competent - committed - care National Nursing Week is a time to celebrate nursing and all that you do as a Licensed Practical Nurse. Nursing Week provides a time for each nurse to reflect on nursing, your own career, and the team around you. To thank you for your contribution to our healthcare system, the College of Licensed Practical Nurses of Alberta (CLPNA) is providing each Licensed Practical Nurse in Alberta with a Professional Poster and a new P.I.N. This P.I.N. is your Professional Information Network, which connects you with Your College as we work together for this profession. We encourage each of you to hang the poster in your workplace and wear your pin with pride. This is an opportunity for Licensed Practical Nurses across Alberta to share who you are with your patients and your peers.

Council Appointments District 7 Alona Fortier

On December 11, 2009 Council accepted Roberta Beaulieuâ&#x20AC;&#x2122;s interest for the position of District 6 representative. Roberta graduated from Northern Lakes College in 2007 and currently works in a medicine unit (Five North) at the QEII Hospital in Grande Prairie.

On December 11, 2009 Council accepted Alona Fortierâ&#x20AC;&#x2122;s interest for the position of District 7 representative. Alona graduated from NorQuest College in 2008 and currently works in public health in Fort McMurray.

CLPNA Council and staff welcome these two new members to the council table.

clpna.com

District 6 Roberta Beaulieu

care | SPRING 2010

the operations room

Does CLPNA have an approved list of medications that Licensed Practical Nurses (LPNs) are educated to administer?

Under the Health Professions Act (HPA) LPN Regulation (2003), there are very few restrictions around what medications a LPN can and cannot administer. In fact, the language is “administer anything” in relation to injectable and IV medications, and oral medications are not limited through Regulation. HPA intends to leave flexibility for employers to work with the competence and scope of practice as defined by the profession.

The following are frequently asked questions to CLPNA’s Practice Consultants by our members, managers, educators, or the general public that could provide valuable information for you in your practice environment.

The LPN Competency Profile discusses the following medication routes: • enteral (oral, tube feed, nasogastric delivery) • parenteral (subcutaneous, intramuscular, intradermal, intravenous: including direct intravenous since 2009) • percutaneous (skin/topical application, mucous membranes, sublingual, buccal, optic, otic, nasal, inhaled, vaginal and rectal). It may not be appropriate for LPNs to administer all medications in all settings. Decisions’ regarding the most appropriate health care provider to administer medications is based on the knowledge and competence of the provider, the supports in place in the practice setting, and the complexity of client care required. Agencies need to have policies and guidelines in place to identify roles and responsibilities when employees are involved in medication administration.

I have been asked to perform a procedure that I have not done in a very long time. What do I need to do prior to practicing something that I am not familiar with?

You need to ask yourself the following questions: • Am I currently authorized by this employer to perform this procedure? • Do I need to seek additional education from the health care team, clinical nurse educator, or somewhere else to ensure my own competence? • What support do I need to ensure patient safety as I perform the procedure? Some competencies simply need a review of theory; others require a more formal update to ensure safety. It is your professional responsibility to ensure that you have the competencies necessary to perform the procedures you are practicing, at all times. Contact our Practice Consultants at practice@clpna.com or 780.484.8886

NOTICE OF REGISTRATION FEE INCREASE

After thoughtful deliberation, the Council of the College of Licensed Practical Nurses of Alberta has directed that the annual registration fee be increased to $300 effective for the 2011 registration year and $350 for the 2012 registration year. The last membership fee increase was for the 2004 registration year. The LPN profession has made significant advances over the past six years and we are confident this is not going to stop. Respecting that it takes time for members to plan for a fee increase, we are providing eight months notice of the new fee structure. Renewal

Fees Paid Before December 1

Fees Paid December 2 - 31

Fees Paid January 1

For 2011

$300 $350

$330 $380

$350 $400

For 2012

care | VOLUME 24 ISSUE 1

the operations room

CLPNA seeks Council Members How do YOU get Your DUCKS in a Row? CONTINUING COMPETENCY PROGRAM

2010 VALIDATION If you were selected to participate in the Continuing Competency Program (CCP) Validation for 2010, you have received your information package by now. This year, 850 Licensed Practical Nurses are participating in either the Full Validation process including verification of learning submissions, or a Basic Validation. Members selected for either process are required to submit the requested continuing competence information to CLPNA by June 1, 2010. Support for members requiring additional help with the CCP Validation is enhanced this year. Besides additional resources on our website, there are weekly web conferences during April/May with information and an opportunity to answer your questions. View www.clpna.com for more information.

he College of LPNs of Alberta seeks LPNs interested in becoming involved in College affairs. Members residing in three election Districts are invited to let their name stand for election to the CLPNA Council by submitting a Nomination Package before May 31. This opportunity allows direct participation in the College’s Mission: “To regulate and lead the profession in a manner that protects and serves the public through excellence in Practical Nursing.” In June, LPNs in the election Districts will select their representative by mail-in ballot.

The Council is responsible for the overall general direction of the College, operating on a broad policy and overall planning level. In particular, the Council is responsible for ensuring the College operates on a sound financial basis. The Council does not manage day to day operations or the “means” of achieving outcomes. Formally, the Council deals with College business through the Executive Director. Further information about Council duties is available from www.clpna.com under “About the CLPNA.” Council members attend one or two-day meetings every three months to review reports of College business and to plan upcoming goals. Districts up for election in 2010 are:

District 1 What do I do if I am selected to participate in the Full Validation? The Full Validation requires completion of all four parts of the form received by mail. The form has step-by-step instructions to guide you as you verify your learning and rank how it changed your thinking and your behavior. Please complete each step and return the form including verification of learning with your submission. What do I provide for verification of my learning? For the Full Validation, please include documents that verify the two learning objectives you completed in 2008 and 2009. This may include copies of certificates, in-service attendance record, or a completed Record of Professional Activities from your CCP binder. What is the CCP Basic Validation? The Basic Survey is an assessment of continuing competence knowledge, skills, and attitudes. The questions validate what the LPN reported at registration renewal regarding completion of CCP commitments. The Basic Validation is a version of the Full Validation, which does not involve submission of records.

South Zone Lethbridge & Medicine Hat

6 5

District 3

Central Zone Red Deer

3 CLPNA District Map

2 1

District 5 Part of the North Zone (old Aspen Health Region)

SUBMITTING A NOMINATION To place a name on the ballot for the Council election, interested members must submit a Nomination Package to the CLPNA before May 31. Nomination Packages and more information is available from www.clpna.com or by contacting the CLPNA. The College prepares and distributes ballots by mail to each member of the election District within 14 days following the close of nominations.

Your Profession - Your College care | SPRING 2010

the operations room POSITION STATEMENT: The LPN role in Triage - Specific Settings Approved by Council - December 11, 2009. Revised March 4, 2010

The College of Licensed Practical Nurses of Alberta (CLPNA) is mandated by government to regulate the profession of Practical Nurses in a manner that serves and protects the public. Accordingly, the College develops documents that guide and support the Licensed Practical Nurse profession, and inform employers and the public. A Position Statement is a detailed document describing perspectives of the College of Licensed Practical Nurses of Alberta related to the Licensed Practical Nurse profession, and includes documented references to support the position and statements of the College. Licensed Practical Nurses (LPNs) have been working in Alberta for over sixty years. Mandatory education, changes to basic programs, advancements in scope of practice, and acceptance of LPNs as professional nurses, have all impacted how the LPN profession is utilized and valued in the health system today. As the competencies within LPN scope of practice have changed, so has the LPN role in areas such as rural emergency departments, physician clinics, and primary care networks. With the move to focusing more care within communities, these roles come with many opportunities and challenges to ensure quality practice environments and excellence in nursing care for Albertans.

In the Implementation Guidelines for the Canadian ED Triage & Acuity Scale (2009), the Canadian Association of Emergency Physicians (CAEP) defines Triage as “the sorting or prioritizing of items (clients, patients, tasks...).” CAEP also discusses “Rapid access to assessment by a health care provider increases patient satisfaction and enhances public relations. An efficient triage system should reduce client anxiety and increase satisfaction by reducing length of stay and waiting times in the emergency department.” For more than ten years emergency departments across Canada have utilized the Canadian Triage and Acuity Scale (CTAS) as an instrument to define patient need for timely care. CTAS has also provided a measurement tool to assess and determine acuity levels to provide the essential resources for emergency care. The development of the Position Statement: The Licensed Practical Nurse role in Triage - Specific Settings involved a broad consultation with rural practice settings, practice experts, and LPNs throughout Alberta. This statement defines in detail the role of the LPN in assessing patients and determining the CTAS score within specific practice settings. View the full Position Statement at www.clpna.com

Fredrickson-McGregor Education Foundation for LPNs

TAKE A COURSE,

GET A GRANT!

Taking a course to enhance your LPN practice? CLPNA members holding an Active Practice Permit may qualify for an Education Grant, and receive funding for course tuition cost. APPLICATION DEADLINES

FOR COURSE COMPLETION DATES BETWEEN

April 30, 2010 July 31, 2010 October 31, 2010

November 1, 2009 to October 31, 2010 February 1, 2010 to January 31, 2011 May 1, 2010 and April 20, 2011

Grant FAQs (Frequently Asked Questions) and Grant Application Forms at

HTTP://FOUNDATION.CLPNA.COM EducationFoundation@CLPNA.com or (780) 484-8886

care | VOLUME 24 ISSUE 1

16.5% 1403 12.9% 1103

R8 11.4% 11.1% 11.2% 10.8% 10.2% 976 947 958 922 8.6% 867 7.3% 730 625

membership statistics 19-25

26-30

31-35

36-40

41-45 46-50 AGE GROUPS

51-55

56-60

61-65+

2009 CLPNA Registration Data

R3 R1 Registrations

LPN Registration Trends 2008 487

2009 661

Other Canadian Registrants

238

277

Non Canadian Registrants Renewals

363 6758

136 7452

TOTAL

7859

8531

Alberta Initial Graduates Re-Entry LPNs

2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 124 1988 81 1987 1986

LPN Gender Distribution

94%

6% 53

1998

1999

2000

2001

2002

2003

2004

601

413 247

205

2005

2006

2007

YEAR

12.9% 1103

Average Age: 2007 - 42.2

1998

2008 - 41.2

Percentage of Loss/Increase

8531

8.6%

7859 7264 6863 6533 6037 5575 5172 4848 4431 4342 4606 4723 4963 5562 6196 6378 6545 6651 6736 6956 7225 7894 8643

8.1% 5.8% 5.0% 8.2% 8.3% 7.8% 6.7% 9.4% 2.0% -5.7% -2.5% -4.8% -10.8% -10.0% -2.9% -2.6% -1.6% -1.3% -3.2% -3.7% -8.5% -8.7%

2009

601

413

16.5% 1403

Age of Active LPNs

2008

Number of LPNs

247

205

11.4% 11.1% 11.2% 124 10.8% 9010.2% 81 80 74 41 976 34 958 922 8.6% 947 867 7.3% 1999 2000 2001 2002 2003 2004 2005 20067302007 2008 YEAR 625

R9 2009

2009 - 40.7 16.5% 19-25 26-30140331-35 36-40 41-45 46-50 51-55 56-60 61-65+ 12.9% AGE GROUPS 11.4% 11.2% 11.1% 10.8% 1103 10.2% 976 947 958 922 8.6% 867 7.3% 730 625

Out of Province & International Registrations

R3 R6

601

413

26-30

31-35

36-40

41-45

46-50

51-55

56-60

61-65+

AGE GROUPS

Distribution of LPNs by Health Region

247

124

2009 41 34 20082008 2009 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2007 YEAR 2006 2005 In Migration Breakdown 16.5% 2004 1403 20032009 12.9% 11.4% 11.1% 11.2% 10.8% 1103 20022008 10.2% 976 947 958 922 8.6% 20012007 867 7.3% 730 20002006 6252005 1999 2004 BC SK MN ON QU NB NS PEI NL NT YK NU USA OTHER* | | | | | | | | | | | | | 1998 200393| 0 87 13 19 122 8 5 15 7 0 1 0 43 19972002 19-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65+ 19962001 TOTAL - 413 AGE GROUPS *Philippines 19952000 19941999 19931998 19921997 1996 1991 1995 1990 1994

R2 R1

19-25

205 53

Number of LPNs

Percentage of Loss/Increase

R1 Chinook Regional Health Authority R2 Palliser Health Region

425 7859 476 8.1% 294 7264 293 5.8%

R3 Calgary Health Region

180868631995 5.0%

R4 David Thompson Regional Health Authority R5 East Central Health R8 R6 Capital Health

R9 Northern Lights Health Region

TOTAL

R2 R1

6533 863 8.2% 838 Number Percentage of of LPNs Loss/Increase 380 6037 407 8.3%

85315575 8.6%7.8%

R7 Aspen Regional Health Authority R8 Peace Country Health

Other Canadian

200885312009 8.6%

R4 R3

2784 2987 78595172 8.1% 6.7% 419 5.8% 9.4% 72644848 455 374 383 5.0% 6863 2.0% 4431 8.2% 6533 131 133 -5.7% 4342 8.3% 6037 406 539 55754606 7.8% -2.5% 7859 6.7% -4.8% 517247238531 48484963 9.4%-10.8% 44315562 2.0%-10.0% 43426196 -5.7%-2.9% 46066378 -2.5%-2.6% 47236545 -4.8%-1.6% -10.8% 4963 -1.3% 6651 -10.0% 5562 -3.2% 6736 -2.9% 6196

care | SPRING 2010

the operations room CLPNA Council President Hugh Pedersen Executive Director/Registrar Linda Stanger

OUR MISSION

linda@clpna.com

To lead and regulate the profession in a manner that protects and serves the public through excellence in Practical Nursing.

District 1 (RHA Regions 1, 2) Marie Boczkowski District 2 (RHA Region 3) Donna Adams - Vice President

OUR VISION

District 3 (RHA Regions 4, 5) Jo-Anne Macdonald-Watson

Licensed Practical Nurses are a nurse of choice, trusted partner and a valued professional in the healthcare system.

District 4 (RHA Region 6) Sheana Mahlitz District 5 (RHA Region 7) Jenette Lappenbush

The CLPNA embraces change that serves the best interests of the public, the profession and a quality healthcare system.

District 6 (RHA Region 8) Roberta Beaulieu

By 2012 the CLPNA expects:

District 7 (RHA Region 9) Alona Fortier

• To be a full partner in all decisions that affect the profession • LPNs to embrace and fully exploit their professional scope of practice and positively impact the nursing culture • LPNs actively involved in planning and decision making within the profession and the healthcare system • LPNs to assume leadership and management roles provincial, nationally and internationally within the profession and the health care system • An increase in LPN registrations to 12,000 by 2012 • LPNs to actively promote and support the profession • Employers fully utilizing LPNs in every area of practice • The scope of practice to evolve in response to the unique and changing demands of the healthcare system

Public Members Peter Bidlock / Robert Mitchell Ted Langford To contact Council members please call the CLPNA office and your message will be forwarded to them.

CLPNA Staff Tamara Richter Director of Operations

tamara@clpna.com

Teresa Bateman Director of Professional Practice

teresa@clpna.com

Sharlene Standing Director of Regulatory Services

sharlene@clpna.com

COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA

Linda Findlay Practice Consultant/CCP

lindafindlay@clpna.com

CLPNA Office Hours

Log On to clpna.com

care | VOLUME 24 ISSUE 1

Regular Office Hours • • • • •

CLPNA Publications Learning Modules Competency Profile Job Listings Annual Report 2009

and more…

Monday to Friday 8:30am to 4:30pm Closed for Statutory Holidays

APRIL 8 & 9, 2010 I EDMONTON MARRIOTT AT RIVER CREE RESORT

The 2010 CLPNA Spring Conference wishes to thank all conference delegates, speakers, partners, and sponsors for your involvement and support. Your contributions and attendance helped to make this yearâ&#x20AC;&#x2122;s conference a memorable and successful event for all involved.

Special thanks to the following sponsors:

For post-conference details, please visit our website at www.clpnaconference.com

care | SPRING 2010

ISSN 1920-633X CARE Publications Mail Agreement Number 40050295

St. Albert Trail Place, 13163 - 146 Street Edmonton, Alberta T5L 4S8 Telephone (780) 484-8886 Toll Free 1-800-661-5877 Fax (780) 484-9069

Return Undeliverable Canadian Addresses To: St. Albert Trail Place, 13163 - 146 Street Edmonton, Alberta T5L 4S8 email: newsletter@clpna.com

www.clpna.com

Celebrate your chosen profession by committing to Talk-the-Walk! Social Media has a profound impact today, allowing a forum for dynamic and engaging messaging that you can be involved in. Join the CLPNA via our Social Media campaign. This is about YOU, be part of the discussion by: • joining the discussion on our Blog http://blog.clpna.com • following us on Twitter www.twitter.com/CLPNA

Licensed Practical Nurses Talk-the-Walk

• watching us on YouTube www.youtube.com/CLPNA • becoming a fan on Facebook www.facebook.com/CLPNA Wear your new P.I.N. – and join the Professional Information Network, which will be your connection with Your Profession and Your College.