HAPPY NATIONAL NURSING WEEK! #YESTHISISNURSING - MAY - 3, 8 - RECIPE FOR PIE: IMPROVING THE CHILDHOOD IMMUNIZATION EXPERIENCE - CARNA

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HAPPY NATIONAL NURSING WEEK! #YESTHISISNURSING - MAY - 3, 8 - RECIPE FOR PIE: IMPROVING THE CHILDHOOD IMMUNIZATION EXPERIENCE - CARNA
Recipe for PIE: Improving the
                                        childhood immunization experience
                                        PAGE 12

                                        Demystifying advance care planning
V O L U M E 74 N O 1

                                        PAGE 21
S P R I N G 2018

                                        Helping patients control their pain
                                        PAGE 28

                       Happy
                       National
                       Nursing
                       Week!
                       #YesThisIsNursing
                       May �-�3, ���8
                       PAGE 24                              nurses.ab.ca
HAPPY NATIONAL NURSING WEEK! #YESTHISISNURSING - MAY - 3, 8 - RECIPE FOR PIE: IMPROVING THE CHILDHOOD IMMUNIZATION EXPERIENCE - CARNA
CONTACT US
CARNA Provincial Council 2017–2018                                          CARNA Staff Directory
PRESIDENT                               CALGARY/WEST REGION                 General inquiries or to contact any member of CARNA staff:
Jerry Macdonald, MN, RN, CCN(C)         Tyler Burley, MN, BScN, RN             carna@nurses.ab.ca
Grande Prairie                          Calgary                                780.451.0043
president@nurses.ab.ca                  tburley@nurses.ab.ca                   Toll-free in Canada: 1.800.252.9392

PRESIDENT-ELECT                         Pritma Dhillon-Chattha,             Registration services       registration@nurses.ab.ca
                                        DNP(c), MHA, RN                     Practice consultations      practice@nurses.ab.ca
Dennie Hycha, MN, BScN, RN              Calgary
Ponoka                                                                      Conduct and complaints      procond@nurses.ab.ca
                                        pchattha@nurses.ab.ca
dhycha@nurses.ab.ca                                                         Communications              communications@nurses.ab.ca
                                        Nicole Letourneau, PhD, RN, FCAHS   Privacy Officer             privacy@nurses.ab.ca
NORTHWEST REGION                        Calgary
Tracy King, MN, RN                      nletourneau@nurses.ab.ca            STAFF
Grande Prairie                          SOUTH REGION                        Chief Executive Officer
tking@nurses.ab.ca                                                          Joy Peacock, BSN, MSc, RN
                                        Lisa Zubach, MSN
                                                                            jpeacock@nurses.ab.ca
NORTHEAST REGION                        Lethbridge
                                                                            780.455.5438
Jeannie Hare, RN                        lzubach@nurses.ab.ca
Redwater                                                                    Chief Operating Officer
                                        PUBLIC REPRESENTATIVES
jhare@nurses.ab.ca                                                          Jeanette Machtemes, MBA, CPA, CMA
                                        Steven Armstrong, OStJ, CD, MSc     jmachtemes@nurses.ab.ca
EDMONTON/WEST REGION                    Calgary                             780.453.0514
Derrick Cleaver, BScN, RN, MPH(c)       sarmstrong@nurses.ab.ca
                                                                            Chief Information Officer
Edmonton                                Janet Blayone, BA
                                                                            Damon Mayes, MSc, PStat, CStat
dcleaver@nurses.ab.ca                   Peace River
                                                                            dmayes@nurses.ab.ca
Sherri Di Lallo, MN, BScN, RN           jblayone@nurses.ab.ca
                                                                            780.710.3316
Millet                                  Phyllis Bohachyk
sdilallo@nurses.ab.ca                   Edmonton                            Chief Professional Practice Officer
                                        pbohachyk@nurses.ab.ca              Sandra Young, MN, PhD, RN
Janelle Ostby, BScN, RN
                                                                            syoung@nurses.ab.ca
Spruce Grove                            Michael Howden, B.Comm, CMA, CPA
                                                                            780.453.0540
jostby@nurses.ab.ca                     Priddis
                                        mhowden@nurses.ab.ca                Chief Public Affairs Officer
CENTRAL REGION                                                              Margaret Ward-Jack, BA, BEd
                                        Frank Work, QC
Dwayne Nagy, BScN, RN                   Spruce Gove                         mwardjack@nurses.ab.ca
Drumheller                              fwork@nurses.ab.ca                  780.453.0515
dnagy@nurses.ab.ca
                                                                            Complaints Director
                                                                            Rachelle Roberts, LLB, BScN, CTAJ
                                                                            rroberts@nurses.ab.ca
                                                                            780.453.0548
                                                                            Deputy Registrar
                                                                            Loreta Suyat, BScN, RN
                                                                            lsuyat@nurses.ab.ca
                                                                            780.453.0506

    nurses.ab.ca
2 ALBERTA RN SPRING 2018 VOLUME  74 NO  1   | nurses.ab.ca
HAPPY NATIONAL NURSING WEEK! #YESTHISISNURSING - MAY - 3, 8 - RECIPE FOR PIE: IMPROVING THE CHILDHOOD IMMUNIZATION EXPERIENCE - CARNA
CONTENTS
P R E S I D E N T ’ S U P D AT E

 4 Leadership challenge
                                                F E AT U R E S
R E G U L AT I O N

 5 Run for Provincial Council
 6 AGM and PC meeting highlights
 6 2019 renewal fees
 7 A snapshot of nursing in Alberta
 8 Calls for members

                                                                       12
18 Publications ordered by Hearing Tribunals
PROFESSIONAL PRACTICE

22 Spread knowledge, not infections
26 Why I’m a CNA orthopaedic-certified
   nurse
27 You Asked Us: NP prescribing
41 NoticeBoard, In Memoriam
C E L E B R AT I N G N U R S I N G

24 Happy National Nursing Week!
                                                RECIPE for PIE
30 CARNA Awards of Nursing Excellence
   recipients
                                                Improving the childhood
NURSING RESEARCH
                                                immunization experience
39 RNs in AHS not distributed proportionally
ARNET

11 Help us balance the scales
42 Upcoming ARNET events                                         Demystifying
                                                                 advance care

                                                                                                               21
CLOSING PERSPECTIVES

46 Yes, this is nursing!                                           planning

                                                HELPING PATIENTS

                                                                                            28
                                                 CONTROL THEIR

COVER PHOTO: ANDRESR/ISTOCKPHOTO.COM
THIS PAGE:
JACEK CHABRASZEWSKI/SHUTTERSTOCK.COM (PG. 12)
PHOTOGRAPHEE.EU/SHUTTERSTOCK.COM (LEFT),
DMYTRO ZINKEVYCH/SHUTTERSTOCK.COM (PG. 21)
BILLION PHOTOS/SHUTTERSTOCK.COM (PG. 28)

                                                                    nurses.ab.ca   | SPRING 2018   VOLUME  74 NO  1 ALBERTA RN 3
HAPPY NATIONAL NURSING WEEK! #YESTHISISNURSING - MAY - 3, 8 - RECIPE FOR PIE: IMPROVING THE CHILDHOOD IMMUNIZATION EXPERIENCE - CARNA
P R E S I D E N T ’ S U P D AT E

Leadership challenge
                            The articles in this issue of Alberta RN     is usually elected by acclamation. This role allows you to have
                            have one thing in common: they               influence on nursing and health policy at a national and even
                            are about advancing our profession           international level, as a result of CNA’s membership in the
                            in the best interests of the public.         International Council of Nurses.
                                Are you interested in leading                The office of president involves a significant time commit-
                            that agenda? Are you passionate              ment. While the role is not full-time, CARNA provides funding
                            about nursing and its contribution           to replace time away from your employer on CARNA business
                            to the health of the people of Alberta       (to a maximum of the equivalent of 0.5 FTE) averaged over each
                            and Canada? Are you a team player            of the two years of your term. You should also be prepared to
who is ready to be team captain? Then maybe you should                   travel extensively, both within Alberta and around the country.
consider running for CARNA president-elect.                                  Serving as president is a once-in-a-career opportunity to
    The role of president-elect is a serious four-year commitment        influence nursing, health-service delivery and health policy
to your profession because, after serving two years, you auto-           in Alberta. Every president leaves her or his mark on the
matically become president of CARNA . The president is the               organization and the profession, and it is a tremendous
public face and voice of Alberta RNs and NPs. The president              professional opportunity for any nurse.
chairs provincial council, leading it in its deliberations, and              If you are considering running, ideally you have experience
chairs the AGM.                                                          serving on or chairing a governing board or council. You may
    As president, you will be able to meet with members of               have served on CARNA Provincial Council. You may have served
he provincial cabinet, such as the Minister of Health and                on the board of a nursing specialty group at the provincial or
Minister of Advanced Education, and other elected leaders                national level. Or, you may have served on the board of another
in government and opposition. You would meet with key                    group or organization. That said, CARNA provides ongoing
external stakeholders, including leaders in other health                 governance development education to all members of Council,
professions. You speak to the media when needed, and on                  including the president-elect and president.
behalf of CARNA at conferences, conventions and other                        So, if this sounds like you, CARNA needs you to run
large meetings throughout the province and the country.                  for president-elect. The nomination deadline is June 1st.
    As president-elect, along with serving on council, you will          Visit nurses.ab.ca to learn more about how to submit your
assist the president with chairing council meetings and taking           nomination. RN
the chair when the president is absent. The president-elect also
chairs the Finance, Audit and Pension Committee and serves               Je r ry M ac d on a l d,     MN, RN, CCN(C)
on the Leadership Review Committee.                                      780.978.1348
    During the second year of the term, the president-elect              president@nurses.ab.ca
attends two Canadian Nurses Association (CNA) meetings
in preparation for assuming the Alberta position on the CNA
board. This position isn’t automatic, but in past experience

ALBERTA RN                            Alberta RN is © Copyright 2018     EDITORIAL STAFF                       ADVERTISING SUBMISSION
SPRING 2018 VOLUME 74 NO 1            by the College and Association     Managing Editor: Lisa Pintaric        DEADLINES
                                      of Registered Nurses of Alberta,   Editor: Kyla Stocks                   Summer 2018 | June 12, 2018
Alberta RN ISSN 1481-9988
                                      and also reserves copyright        Designer: Julie Wons                  Fall 2018 | Sept. 11, 2018
Published four times per year         for all articles. Reproduction
by the College and Association                                           albertarn@nurses.ab.ca                Please note CARNA does not
                                      without written permission from
of Registered Nurses of Alberta       the publisher is not allowed.      ADVERTISING REPRESENTATIVE            endorse advertised services,
                                                                                                               products or opinions.
11620-168 Street NW                   Subscription is automatic          Jan Henry, McCrone Publications
Edmonton, AB T5M 4A6                  for CARNA members.                 PHONE: 1.800.727.0782                 Canadian Publications Mail
PHONE: 780.451.0043                   Rate for non-members is            FAX: 1.866.413.9328                   Agreement No. 40062713
TF IN CANADA: 1.800.252.9392          $ 42 CAD per year plus GST.        mccrone@interbaun.com                 Return undeliverable
FAX: 780.452.3276                                                        For advertising rates, please visit   Canadian addresses to:
carna@nurses.ab.ca                                                       nurses.ab.ca/advertising.             Alberta RN magazine
nurses.ab.ca                                                                                                   11620-168 Street NW
facebook.com/AlbertaRNs                                                                                        Edmonton, AB T5M 4A6
twitter.com/AlbertaRNs

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R E G U L AT I O N

RUN FOR PROVINCIAL COUNCIL
Being on council is a great opportunity
to represent the profession and
make a difference!
                                                                                                                     High Level

                                                                                                           Northwest

As a provincial councillor, you will...   We are seeking candidates in                                                                                            Fort
                                                                                                                                                                  McMurray

> Set CARNA’s strategic direction.        the following CARNA regions:                                          Peace River

> Make regulatory decisions in            > Calgary/West (three-year term)
                                                                                                  Grande Prairie

  the interest of the public.             > Central (two positions: two-year term                                                               Northeast

> Bring the voice of the profession         and three-year term)                                                          Whitecourt

  to health policy discussion.
                                                                                                        Edson
                                          > Edmonton/West (three-year term)                                                         Edmonton
                                                                                                        Edmonton/West
> Make regulatory decisions regarding     > Northeast (three-year term)                                                                              Camrose

  standards and guidelines for nursing
                                          We are also seeking a President-elect                                                           Red Deer

  practice, and standards for approval                                                                                                         Central
                                          to serve a four-year term (first two years
  for nursing education programs.
                                          as President-elect and the final two as
                                                                                                                              Calgary

                                                                                                                       Calgary/West

                                          President).                                                                                          Vulcan
                                                                                                                                                             Brooks

                                                                                                                                                          Medicine Hat

                                                                                                                                                     Lethbridge

For details about the role and nomination process, visit: nurses.ab.ca/elections                                                                 South

                               DEADLINE TO APPLY:               June 1, 2018
                                                                             nurses.ab.ca   | SPRING 2018          VOLUME  74 NO  1 ALBERTA RN 5
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R E G U L AT I O N

                                                              ���� renewal fees
                                                              For the 2019 renewal period, RN fees have increased
                                                              to $ 641.32 and NP fees have increased to $719.54.

                                                              Canadian Nurses Protective Society
                                                              (CNPS) fee increase
                                                              After four years of fee stability, the CNPS Board of Directors
                                                              has determined that a fee increase is necessary for the
                                                              2019 registration period. The 2019 fee for an RN will be

          AGM+PC
                                                              $ 48 ($14 increase over the 2018 fee). The 2019 fee for
                                                              an NP will be $122.50 ($ 37 increase over the 2018 fee).
                                                              A further increase of $ 37 is contemplated for NPs in 2020.

          Highlights                                          Learn more about the CNPS fee increase.
                                                              For more information please visit cnps.ca/2019feesCARNA

           MARCH ���8                                         Canadian Nurses Association (CNA) fee
                                                              We collect fees on behalf of CNA, which has increased
                                                              their fees by $ 2.90 per member.
Annual General Meeting and
Provincial Council highlights                                 Annual inflationary increase
                                                              Since 2012, renewal fees have increased annually to
AGM RESOLUTION: Make pharmacare                               account for inflation based on the annual Alberta Consumer
a policy and advocacy priority                                Price Index as published by Statistics Canada. This year,
                                                              there was a 1.6 per cent inflationary increase to fees.
During the AGM, members voted on and carried
the following resolution:                                     Capital contribution re-allocation
   Be it resolved that CARNA will make pharmacare
                                                              In March 2018, Council passed a motion to reallocate
   a policy and advocacy priority in 2018–19 by
                                                              $15 from the existing capital contribution to support
   supporting a call for a national pharmacare
   program.                                                   the operating budget effectively decreasing the capital
                                                              contribution portion to $15 per member per year.
At their June meeting, once they have time to review
pharmacare research, Council will determine what              2019 fee changes
action to take.
                                                                                                     CHANGE    CHANGE
Provide feedback on draft documents                                                                 FROM 2018 FROM 2018
Council agreed the following draft documents are               ITEM                                  RN FEE     NP FEE
ready to go to the next stage of document development,         CNPS fee increase                     + $14.00    + $ 37.00
obtaining member and stakeholder feedback.                                                            + $ 2.90    + $ 2.90
                                                               CNA fee increase
• Complementary and/or Alternative Therapy and
                                                               Annual inflationary increase            + $7.22     + $7.22
   Natural Health Products: Standards for Registered Nurses
• NEPAB Standards for AB Nursing Education Programs            Re-allocation from capital
   Leading to Entry to Practice as a RN                        contribution to operating budget      + $15.00    + $15.00
View documents and provide feedback by visiting                Reduction to capital contribution      - $15.00    - $15.00
nurses.ab.ca.                                                  ARNET contribution                     + $ 0.45    + $ 0.45
New pronouncement of death document                            GST                                    + $1.23     + $ 2.37
The document Pronouncement of Death was approved               Total registration fee change        + $25.80     + $ 49.94
by Council and is now available on our website at
nurses.ab.ca/documents.

6 ALBERTA RN SPRING 2018 VOLUME  74 NO  1   | nurses.ab.ca
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R E G U L AT I O N

                                                         RN registrants by route of entry
                                                         TOTAL NEW RN REGISTRATIONS: 2,118

                                                                                              Alberta grads: 1,676
                                                                                              Other Canadian jurisdictions: 324
                                                                                              Internationally-educated
                                                                                              applicants: 118

           Highlights from the
        2016-2017 Annual Report                          Internationally-educated applicants
                                                         by continent
     Find the full report at nurses.ab.ca                TOTAL: 118

Practising members by registration category                                                   Asia: 72
TOTAL: 38,194                                                                                 North America: 24
                                                                                              Europe: 11
                                                                                              Africa: 6
                       Registered nurse: 37,186                                               Oceania: 5
                       Nurse practitioner: 545
                       Graduate nurse: 425
                       Certified graduate nurse: 20
                       Graduate nurse practitioner: 18
                                                         Total complaints received
                                                         Five year comparison

Practising members by age                                                                     2012/13: 200
                                                                                              2013/14: 269
                       70:
HAPPY NATIONAL NURSING WEEK! #YESTHISISNURSING - MAY - 3, 8 - RECIPE FOR PIE: IMPROVING THE CHILDHOOD IMMUNIZATION EXPERIENCE - CARNA
R E G U L AT I O N

 CALLS FOR MEMBERS
Important information                                                      Competence Committee
                                                                           One member needed
about committee                                                            The Competence Committee makes recommendations to Provincial Council
volunteering                                                               on Continuing Competence Program (CCP) requirements, monitoring
                                                                           member participation in the CCP and requirements for practice visits.
CARNA reimburses committee members for each hour spent in                  The Committee has the authority to approve, approve with conditions,
teleconferences or meetings, as well as meeting travel expenses.           suspend or refuse an application for a practice permit. Currently,
Salary replacement to the employer and/or per diems for unpaid time        the Committee is revising the CCP under the proposed changes to
away from work is paid. Preparation time for meetings, which may be        the regulation.
significant, is not compensated. Orientation and ongoing education
is provided to all committee members.                                      QUALIFICATIONS
Applicants are strongly encouraged to discuss their application with       • active CARNA registration as a regulated member in good standing
their current manager/supervisor to ensure release time from work          • minimum of five years of nursing experience
to attend meetings.                                                        • active listener and critical thinker
Individuals may only serve on one regulatory committee at a time.          • ability to interpret and apply policy, standards and legislation
This applies to the NEPAB, Registration, Registration Review,              • ability to consider evidence and information objectively and fairly,
Hearing Tribunal, Competence and Complaint Review committees.                putting aside personal beliefs when making decisions
                                                                           • ability to effectively articulate a position with supporting rationale
How to apply
• Visit nurses.ab.ca > Contact Us > Volunteer for CARNA.
                                                                           EXPECTATIONS OF MEMBERS
                                                                           • serve a four-year term
• Select the committee you wish to apply to under “Available Positions.”
                                                                           • attend up to four one-to-two day meetings per year, as required,
• Fill out the application form and click “submit.”
                                                                             at the CARNA office in Edmonton
What happens after I apply?                                                • participate in teleconferences as required
Selection for committees takes place in mid-August. The names              • attend a one-day orientation session in Edmonton on Oct. 23, 2018
selected will be forwarded for appointment to CARNA Provincial Council     • commit to preparatory time for meetings
in September. Candidates will be notified in late September if they have   QUESTIONS?
been selected.
                                                                           If you have questions about the work of the committee, or the
                                                                           expectations of members, please contact:
                                                                              Margareth Mauro, MN, RN
                                                                              Competence & Learning Consultant
                                                                              780.733.3359 / 1.800.252.9392, ext. 359
       APPLICATION                                                            mmauro@nurses.ab.ca
       DEADLINE
        JULY 27, 2018
                                        TERM for
                                        all coMmittees

                                       BEGINS
                                       OCT. 1, 2018

8 ALBERTA RN SPRING 2018 VOLUME  74 NO  1   | nurses.ab.ca
HAPPY NATIONAL NURSING WEEK! #YESTHISISNURSING - MAY - 3, 8 - RECIPE FOR PIE: IMPROVING THE CHILDHOOD IMMUNIZATION EXPERIENCE - CARNA
Hearing Tribunal                                                    Registration Committee
Six members needed                                                  Two nurse practitioners needed
Members of a Hearing Tribunal adjudicate hearings into              The Registration Committee reviews complex and challenging applications for
allegations of unprofessional conduct. Hearing Tribunal             registration and practice permits. Committee members are responsible for determining
members have to be objective in their consideration of              if an applicant/member has met legislated requirements and whether engaging in,
evidence presented at each hearing in determining whether           or continuing to engage in practice, may pose a risk to public safety.
the alleged behaviours constitute unprofessional conduct            The Committee may approve, defer or refuse eligibility for registration and/or
for each matter before them. If a member is found to be             practice permits, and impose conditions or restrictions on a permit that support
unskilled or has engaged in other unprofessional conduct,           public safety.
the tribunal will decide what measures are necessary to             The Registration Committee works with CARNA staff under the direction of Provincial
protect the public, how to remediate the nurse’s skill,             Council to draft/enact policies to guide registration-related decision making.
knowledge deficits or behaviours, and determine compliance
with its discipline orders. The work of the Hearing Tribunal        QUALIFICATIONS
Chair is compensated for decision writing.                          • active CARNA registration as a regulated member in good standing
                                                                    • minimum five years current nursing experience in direct care, administration,
QUALIFICATIONS
                                                                      research or education
• active CARNA registration as a regulated member in
                                                                    • active listener and critical thinker
  good standing
                                                                    • able to interpret and apply policy, standards and legislation
• minimum 10 years of current nursing experience
                                                                    • able to consider evidence and information objectively and fairly, putting aside
  • staff nurse in acute care or long-term care, and/or
                                                                      personal beliefs when making decisions
  • professional practice in long-term care or clinical education
                                                                    • able to make difficult decisions that may negatively impact an applicant or member
• active listener and critical thinker
                                                                    • able to effectively articulate a position with supporting rationale
• able to make difficult decisions that may negatively impact
                                                                    • able to work with and navigate various technology and software programs
  a member
                                                                      comfortably
• ability to consider all evidence and information objectively
  and fairly, putting aside personal bias in making a decision      EXPECTATIONS OF MEMBERS
• ability to effectively articulate a position with supporting      • serve a four-year term with an option for reappointment
  rationale                                                         • attend two-day meetings at the CARNA office in Edmonton every five to seven
                                                                      weeks (approximately 10 meetings per year)
EXPECTATIONS OF MEMBERS
                                                                    • commit to attend meetings on a regular basis
• serve a four-year term
                                                                    • attend a one-day orientation session in Edmonton on Oct. 23, 2018
• attend an average of 15-20 hearing days or compliance
                                                                    • participate in pre-meeting and urgent teleconferences as required
  meetings per year at the CARNA office in Edmonton
                                                                    • commit to preparatory time for meetings
• attend a one-day orientation session at the CARNA office
  in Edmonton on Oct. 23, 2018                                      SCHEDULED MEETINGS FOR 2018:
• attend an annual meeting                                          Oct. 23, 2018 Committee Orientation
• accept the responsibility of the Chair of the Hearing             Oct. 24-26, 2018
  Tribunal after approximately one year                             Nov. 29-30, 2018
QUESTIONS?                                                          QUESTIONS?
If you have questions about the work of the Hearing Tribunal        If you have questions about the work of the Registration Committee or the expectations
or the expectations of members, please contact:                     of members, please contact:
   Amy Payne                                                            Shelley MacGregor, BN, MBA, RN
   Acting Hearings Director                                             Registered Nurse Consultant
   780.732.4433 / 1.800.252.9392, ext. 433                              780.732.5297 / 1.800.252.9392, ext. 297
   apayne@nurses.ab.ca                                                  smacgregor@nurses.ab.ca

                                                                                                   nurses.ab.ca   | SPRING 2018   VOLUME  74 NO  1 ALBERTA RN 9
HAPPY NATIONAL NURSING WEEK! #YESTHISISNURSING - MAY - 3, 8 - RECIPE FOR PIE: IMPROVING THE CHILDHOOD IMMUNIZATION EXPERIENCE - CARNA
CALLS FOR MEMBERS
Registration Review Committee                                               Nursing Education Program
Three members needed                                                        Approval Board
The Registration Review Committee hears reviews of decisions made           One member needed
by the Registrar, Registration Committee or Competence Committee.           The Nursing Education Program Approval Board ( NEPAB) reviews and
The Committee hears and evaluates the reason(s) for requesting a            approves Alberta nursing education programs leading to initial entry
review, any sworn testimony and submitted documents. After hearing          to practise as a registered nurse or nurse practitioner and nursing
submissions from both parties and considering the applicable legislation,   education programs leading to re-entry to practise as an RN.
regulation, bylaws and policies, the committee may:                         NEPAB is a voluntary board with members representing approved
• confirm, reverse or vary the original decision                            nursing education programs, employers of RNs, the public, RNs and NPs.
• refer the matter back to the Registrar, Registration Committee or
   Competence Committee for further assessment and decision                 QUALIFICATIONS
• make any further order necessary to carry out the Committee’s decision    CARNA strives to achieve diverse representation amongst their
                                                                            membership by appointing individuals from a variety of practice settings
QUALIFICATIONS                                                              and geographic regions. RNs who are involved in direct nursing practice
• active CARNA registration as a regulated member in good standing          (e.g., front-line nurse, clinical specialist, advanced practice or preceptor
• minimum 10 years of current nursing experience                            for nursing students) and represent urban or rural (large and small)
• previous regulatory committee experience is an asset                      centres, are required.
• active listener and critical thinker
                                                                            EXPECTATIONS OF MEMBERS
• able to interpret and apply policy, legislation and standards
                                                                            • fulfill a five-year term with an option for a reappointment
• able to make difficult decisions that may negatively impact an
                                                                            • attend two-day meetings held quarterly in Edmonton
  applicant or member
                                                                            • attend a one-day orientation session in Edmonton on Oct. 23, 2018
• able to consider evidence and information objectively and fairly,
  putting aside personal beliefs when making decisions                      • adhere to the code of ethical conduct and maintain confidentiality
• able to effectively articulate a position with supporting rationale       • commit to preparatory time for meetings
                                                                            • participate in the reviews of and render decisions about nursing
EXPECTATIONS OF MEMBERS                                                       education programs
• fulfill a three-year term with an option to renew for a fourth year       • make decisions in the best interest of the public, nursing education
• review documents in advance of meetings                                     and RN profession
• attend an orientation session prior to review
                                                                            QUESTIONS?
• attend meetings on an as-needed basis (travel expenses covered by
                                                                            If you have questions about NEPAB, please contact:
  CARNA)
• attend a one-day orientation session in Edmonton on Oct. 23, 2018            Sandra Young
                                                                               Chief Professional Practice Officer
• volunteer on a rotating basis to act as Chair to draft and finalize
                                                                               780.732.7153 / 1.800.252.9392, ext. 573
  decisions of the committee (with assistance from the committee’s
                                                                               syoung@nurses.ab.ca RN
  legal counsel)
QUESTIONS?
If you have questions about the work of the committee or
the expectations of members, please contact:
   Lindsey Williamson
   Administrative Assistant, Boards & Committees
   780.453.0539 / 1.800.252.9392, ext. 543
   lwilliamson@nurses.ab.ca

10 ALBERTA RN SPRING 2018 VOLUME  74 NO  1   | nurses.ab.ca
ARNET

                              In 2017, CARNA members requested
                              over $1,728,000 in educational
                              funding assistance from our charity.
                              Conference registration fees: $126,817
                              Specialty nursing certification: $571,978
                              Degree level studies: $1,029,265
                                                                                                                                          Only one-third of
                                                                                                                                          educational funding
                                                                                                                                          requests were met
                                                                                                                                          in 2017.

                                                                                                                                      ARNET donors contributed
                                                                                                                                      $604,000 in educational
                                                                                                                                      funding supports to CARNA
                                                                                                                                      members in 2017.

                            Help us balance the scales in support of Alberta RNs
                            Become an ARNET supporter and see the difference                    Participate in an ARNET fundraising event: mark your
                            that advanced and continuing nursing education will have on         calendars for the upcoming 2018 ARNET events and follow our
                            the health and care of all Albertans and on the future of nursing   social media channels for ticket information. Your involvement
                            in our province.                                                    can make our events a success for nursing!
                            We know that ongoing and advanced nursing education                 • Friday, May 11: Lethbridge Nursing Gala
                            saves and improves the lives of Albertans each and every day.       • Friday, September 28: Lantern Walk
                            We know that ongoing and advanced nursing education is
                            critical for the advancement of Alberta RNs and the profession      Celebrate Nursing Week 2018 with ARNET:
                            of nursing in our province.                                         Honour a special RN through a donation to ARNET.
                                                                                                We’ll share your gratitude with them in a special Nursing Week
                            ARNET is committed to supporting Alberta’s RNs and NPs,
                                                                                                card.
                            but we cannot do this without your support. We cannot ensure
                            that current and future generations of Alberta RNs have the         Take part in our Nursing Week Sponsor Showcase.
                            advanced education they need to save lives. Will you consider       Show your support of the businesses that support nursing
                            becoming an ARNET donor and helping us save more lives?             education and receive cost-saving benefits for you and
                                                                                                your family.
                            How YOU can balance the scale for nursing
                            Become a monthly ARNET donor: just as one coin can                  Contact the ARNET office or visit our website
                            shift the balance on a scale, your small monthly donation           to learn how YOU can support nursing:
ERHNI1979/ISTOCKPHOTO.COM

                            has the potential to have a huge impact on the health and           1.800.252.9392, ext. 547 | arnet.ca
                            care of Albertans.

                                                           Alberta Registered Nurses
                                                           Educational Trust
                                                                                        Ongoing education for RNs.
                                                                                        Improved health care for Albertans.          ARN E T.CA

                                                                                                                   nurses.ab.ca   | SPRING 2018   VOLUME  74 NO  1 ALBERTA RN 11
F E AT U R E

                  RECIPE for PIE
                   Improving the childhood immunization experience
BY SHAUNA GALLAUGHER, BS CN, RN AND JACLYN MATTHEWS, 4TH YEAR BS CN STUDENT

Immunizations are a necessary part of childhood, yet are often associated with negative
thoughts and feelings. Comforting children during these potentially stressful situations
can help alleviate negative perceptions and set children and families up for success
during future appointments.
   In 2016, the Positive Immunization Experience (PIE) project was created by an Alberta
Health Services (AHS) working group at the Westview Public Health Centre in Stony Plain
to improve the childhood immunization experience. The purpose of the PIE project was to
support knowledge translation by incorporating evidence into practice, empower patients
and families to improve their immunization experience through education, and create a
safe culture and environment for the patient, family and staff during potentially stressful
situations.
 CHART 1 / 5 Ps of PIE: Pain and Anxiety Comfort Strategies
 PHYSICAL                      PSYCHOLOGICAL                  PHARMACOLOGICAL   PREPARATION           PROCEDURAL
 > breastfeeding               > family coaching              > topical         > providing           > position to gain
                                                                                                                              JACEK CHABRASZEWSKI/SHUTTERSTOCK.COM

   during                      > age appropriate                anaesthetics      caretakers with       access to injection
   immunization                  distraction                                      educational           site without
 > administration of                                                              materials prior       interfering
                               > environmental
   a sucrose solution                                                             to immunization       with other pain
                                 controls
                                                                                  (pamphlets,           management
 > positioning                 > communication                                    videos, verbal)       strategies
 > injection technique           considerations
                                                                                > discuss caretaker   > order of injections
                               > neutral language                                 role in comfort     > nursing
                               > breathing                                        strategies            considerations
                                 techniques

12 ALBERTA RN SPRING 2018 VOLUME  74 NO  1   | nurses.ab.ca
The PIE group analyzed existing external
and internal resources and current
                                             ...the group created                          IMPLICATIONS FOR
                                                                                           NURSING PRACTICE
practices and determined that, while         child-friendly                                Childhood immunizations can be a
there are ample credible resources for
immunization comfort measures, the           visual stimuli and                            stressful experience for patients, family
                                                                                           and public health staff. Empowering
Edmonton zone could benefit from a more
cohesive approach. By incorporating
                                             PIE kits containing                           families through education and using
existing resources, the PIE group created
the 5-P approach to pain management
                                             age-appropriate                               appropriate evidence-informed interven-
                                                                                           tions to manage pain and anxiety helps
during immunizations with the intent         distraction tools for                         create a safe environment for everyone.
                                                                                           Analysis of the findings demonstrate that
of reducing or preventing pain and
anxiety related to vaccine administration.   the clinic rooms and                          PHNs better understand their role in
                                                                                           improving the childhood pain experience
Partly adapted from AHS’s Immunization
Program Standards Manual 3-P approach,
                                             school immunization                           associated with immunizations. And,
the five Ps of PIE suggest age-appropriate   program.                                      feedback from caregivers indicates that
                                                                                           the presentations provided caregivers
comfort strategies and additional prepa-
                                                                                           with sufficient knowledge to better
ration and procedural considerations.
                                             anxiety during immunizations. They            manage their child’s immunization
Compiled from existing resources, these
                                             also hoped that providing these resources     experience. Additional considerations
strategies were organized into a tabletop
                                             would empower families and decrease           for future program direction could
reference sheet for nursing staff.
                                             workplace stress for staff.                   include evaluating and improving
    With funding from the Tri-Community
                                                                                           knowledge translation to families for
Health & Wellness Foundation, the group      PIE PROJECT OUTCOMES                          pain and anxiety management strategies.
created child-friendly visual stimuli
                                             Prior to the presentation, participants           The PIE group would like to see
and PIE kits containing age-appropriate
                                             filled out a pre-test questionnaire           pain and anxiety comfort strategies
distraction tools for the clinic rooms
                                             about their immunization beliefs.             included in the formal PHN orientation
and school immunization program.
                                             This questionnaire also measured the          process in the Edmonton area and
Distributing information and resources
                                             participants’ beliefs about the role of       recommends the adoption of these
to patients and families before appoint-
                                             a public health nurse (PHN). Months           strategies for provincial nursing best
ments helped patients prepare for their
                                             later, participants filled out a post-test    practices. RN
appointments. Some of these resources
                                             questionnaire designed to evaluate
included pamphlets, websites and videos.                                                   REFERENCES
                                             knowledge translation to practice.
    The PIE group initially presented                                                      • Taddio, A., Appleton, M., Bortolussi, R.,
                                             Using a Likert scale to measure and rate
the findings to the Westview public                                                          Chambers, C., Dubey, V., & Halperin, S.
                                             the outcomes, the group was able to
health team, who began implementing                                                          et al. (2010). Reducing the pain of
                                             capture significant outcome indicators.         childhood vaccination: an evidence-
the PIE program. After incorporating
                                             A comparison of the average pre-test            based clinical practice guideline
feedback and receiving permission
                                             to post-test Likert scores revealed an          (summary). Canadian Medical Association
from the Edmonton zone public health
                                             increase in all 13 outcomes indicators.         Journal, 182(18), 1989-1995. doi: 10.1503/
leadership team, the PIE group then                                                          cmaj.092048
                                                 The largest group of indicator
delivered a train-the-trainer presentation
                                             increases came from “PHNs have a role         • Alberta Health Services. (2015). Standard
to clinical development nurses (CDN) for                                                     for the Administration of Immunizations.
                                             in improving the pain experience,”
the Healthy Young Families and School                                                        Section 6: Vaccine Administration
                                             averaging a 16 per cent increase from pre-
Program. The CDNs also received printed                                                      Standards
                                             to post-test. The second most significant
information on the PIE tabletop pain and
                                             increase was the PHN’s perception of the
anxiety comfort strategies, breathing
                                             caregiver’s responsibility to reduce pain,
techniques and a fact sheet with links
                                             which increased almost a full half-point
to credible sources for additional
                                             on the Likert scale. Many attendees
information. They were then asked
                                             reported new knowledge acquisition,
to share the information with staff
                                             specifically around comfort strategies,
at other public health centres in the
                                             and the presentation cleared up common
Edmonton area.
                                             misconceptions (e.g., breastfeeding during
    The main objectives of the presen-
                                             immunization was previously believed
tation were to support participant’s
                                             to be a choking hazard for the infant).
knowledge translation and provide
evidence-informed intervention strategies
to improve pain management and

                                                                                   nurses.ab.ca   | SPRING 2018   VOLUME  74 NO  1 ALBERTA RN 13
R E G U L AT I O N

   PUBLICATIONS ordered by Hearing Tribunals
Publications are submitted to Alberta RN by the Hearing Tribunal as a brief description to members and the public of members’
unprofessional behaviour and the sanctions ordered by the Hearing Tribunal. Publications are not intended to provide comprehensive
information about the complaint, findings of an investigation or information presented at the hearing.
To find out more, go to nurses.ab.ca/sanctions.

CARNA MEMBER                                                               loans and emotional support from them. The Tribunal issued a reprimand
REGISTRATION NUMBER: 52,504                                                and cancelled Nimira Lakhoo’s registration.
A Hearing Tribunal made a finding of unprofessional conduct against        CARNA MEMBER
member #52,504 who engaged in unprofessional and confrontational           REGISTRATION NUMBER: 69,026
communication with nursing colleagues on two occasions. The Tribunal       A Hearing Tribunal made a finding of unprofessional conduct against
issued a reprimand and ordered the member to complete the emodules         member #69,026 who failed to initiate CPR or call a code on a patient
on the Code of Ethics and prepare and follow a communication improve-      who had the goals of care designation R-1, who had been found
ment plan. Conditions shall appear on the member’s practice permit.        unresponsive, and without pulse or respirations. The Tribunal issued
Failure to comply with the Order may result in suspension of CARNA         a reprimand, and ordered the member to pass a course on responsible
practice permit.                                                           nursing and complete the emodules on the Code of Ethics. They also
CARNA MEMBER                                                               ordered the member to write a paper on codes and restricted the
REGISTRATION NUMBER: 54,006                                                member to working at her current employment sites pending satisfactory
The Hearing Tribunal made a finding of unprofessional conduct against      performance evaluations from each. Conditions shall appear on the
member #54,006 who, while working for CapitalCare, on two occasions        member’s practice permit. Failure to comply with the Order may result
failed to assess and complete vital signs, and on one occasion failed      in suspension of CARNA practice permit.
to follow medication administration protocols which resulted in Dilaudid   CARNA MEMBER
being administered instead of morphine; this error was also incorrectly    REGISTRATION NUMBER: 71,541
documented. For this finding of unprofessional conduct, the Tribunal       A Hearing Tribunal made a finding of unprofessional conduct against
issued a reprimand and ordered coursework. Conditions shall appear         member #71,541, who contravened her previous discipline Order of
on the member’s practice permit. Failure to comply with the Order may      the Hearing Tribunal during her supervised practice and whose practice
result in suspension of CARNA practice permit.                             failed to meet the standards expected of a RN when she pilfered
CARNA MEMBER:        NIMIRA LAKHOO                                         Hydromorphone from narcotic mini bags on a few occasions by
REGISTRATION NUMBER: 60,377                                                puncturing the mini bag and failed to document adequately or accurately
A Hearing Tribunal made a finding of unprofessional conduct against        regarding her patients on numerous occasions. The Tribunal issued a
Nimira Lakhoo #60,377, who had received through fraud and misrepre­        reprimand and directed the member to pass a course in documentation.
sentation total compensation in the sum of more than $85,000 from          The Tribunal accepted the member’s undertaking to not practise pending
her employer and insurance company between 2012 and 2014, when             medical reports confirming her fitness to return to practice. At that time
she submitted documents which she had falsified (medical reports,          she may get a setting approved with no access to medications, or may
laboratory results) ostensibly on behalf of her physician and other        go directly to a supervised practice where administration of medications
health-care providers, who were unaware she had sent them. Several         including narcotics is a duty. In either situation, the member shall have
dozen fraudulent documents, including photographs, were submitted          ongoing drug screening, counseling and medical care. The member
to support claims for sick time and insurance benefits for numerous        must continue drug screening and provide medical reports for two years
feigned illnesses and ailments including hypertension, diabetes, TIA,      following the successful completion of the supervised practice. Conditions
MI, pneumonia, fractured ribs, pneumothorax, facial herpes, retinal        shall appear on the member’s practice permit. Failure to comply with
detachment and ovarian cancer, all of which were completely false.         the Order may result in suspension of CARNA practice permit.
The member received a $50,000 early payout from her life insurance         CARNA MEMBER
policy because she fraudulently claimed she had terminal ovarian           REGISTRATION NUMBER: 76,473
cancer. For several years, she failed to show respect or demonstrate       A Hearing Tribunal made a finding of unprofessional conduct against
integrity to her nursing co-workers when she repeatedly lied to her        member #76,473 who engaged in an inappropriate conversation with
co-workers about her various fake illnesses, and accepted gifts,

18 ALBERTA RN SPRING 2018 VOLUME  74 NO  1   | nurses.ab.ca
the family of a patient regarding their intended donation of the patient’s   permit. Failure to comply with the Order may result in suspension of
organs. The member failed to remain at the bedside of a patient when         CARNA practice permit.
she was required to do so, and failed to demonstrate sensitivity when        CARNA MEMBER
she inappropriately (and in front of the family) requested an opportunity    REGISTRATION NUMBER: 95,139
to do chest compressions. The member inappropriately took a photo
of the family sleeping at a patient’s bedside with their cellphone and       The Hearing Tribunal made a finding of unprofessional conduct against
without their permission. The member made an inappropriate request           member #95,139. The member failed to demonstrate adequate pain
to her charge nurse and manager, asking that the member be allowed           management by inadequately completing/documenting pain assess-
to come into work the next day on her day off, unpaid, as a learning         ments, administering pain medication in a manner inconsistent
opportunity for herself, as the dying patient the member had been            with the documentation of pain assessments and failing to obtain
caring for was to be removed from life support on the member’s day off.      a co-signature for wastage. For this finding of unprofessional conduct,
The member engaged in an inappropriate conversation in front of              the Tribunal issued a reprimand and ordered the member to pass
a patient’s distressed family regarding problems experienced in              a course in documentation and basic medication administration.
the care of another patient. The Tribunal issued a reprimand and             The Hearing Tribunal also ordered that two performance evaluations
directed the member to undergo counseling/tutoring in therapeutic            be completed. Conditions shall appear on the member’s practice permit.
communications and provide a satisfactory report back to the Tribunal.       Failure to comply with the Order may result in suspension of CARNA
The Tribunal also ordered the member to prepare and implement a              practice permit.
communication improvement plan and write a paper on professional             CARNA MEMBER
boundaries. Conditions shall appear on the member’s practice permit.         REGISTRATION NUMBER: 95,457
Failure to comply with the Order may result in suspension of CARNA           A Hearing Tribunal made a finding of unprofessional conduct against
practice permit.                                                             member #95,457 arising from three complaints. The member failed
CARNA MEMBER                                                                 to document adequately or to follow up with the physician regarding
REGISTRATION NUMBER: 80,480                                                  orders for the client. In conversations with a co-worker, the member
A Hearing Tribunal made a finding of unprofessional conduct against          kept confusing two clients. The member administered Risperdal 75mg
member #80,480 who documented that she had administered a Fentanyl           in a single 3ml IM injection to a client contrary to the order. The member
patch when she had not done so; who failed to follow appropriate medi-       was unprofessional in communication with nursing colleagues when she
cation administration protocols when she placed the Fentanyl patch in        was yelling and swearing on two occasions. The member inappropriately
her pocket prior to administration; and who failed to communicate her        read and translated for a family of a resident the result of the CT scan,
failure to administer the medication in a timely manner when she found       which was beyond the member’s scope of authority and was inconsistent
the medication in her pocket when arriving home at the end of her shift.     with the physician’s interpretation of the test results. The member failed
On two shifts, the member documented that she had administered               to ensure an appropriate referral to the diabetic foot clinic occurred for
Tylenol and Sinemet when she had not done so. The member also                a patient. The member failed to adequately document care of clients.
inaccurately documented administration of medications Acetaminophen,         After being directed to do so, the member missed disposing of a few
ASA, Carvedilol, Furosemide, Risperidal and Amlodipine that had actually
                                                                             pages of her handwritten notes containing confidential client information,
been refused by a resident, and she failed to notify the physician           which were incorrectly stored in her office drawer. The member failed
of that refusal. The Tribunal issued a reprimand and accepted the            to document adequately on the client and acted outside her scope of
member’s undertaking to not practise as a registered nurse until she         authority when she put the client’s Zopiclone on hold for a week, without
had passed courses in basic medication administration, pharmacology          consulting the physician. The member inaccurately documented the
and documentation, and had completed modules on the Code of Ethics.          scheduling of Modecate administration for a client and inaccurately
Conditions shall appear on the member’s practice permit. Failure to          input medication orders for another client. The Tribunal issued a
comply with the Order may result in suspension of CARNA practice permit.     reprimand and ordered the member to pass courses in documentation,
                                                                             basic medication administration, interpersonal aspects of nursing and
CARNA MEMBER                                                                 emodules on the Code of Ethics. The member gave an undertaking to
REGISTRATION NUMBER: 85,316                                                  not practise pending a satisfactory report from her physician confirming
The Hearing Tribunal made a finding of unprofessional conduct against        fitness to practise. The next practice setting must be approved by the
member #85,316. The member was unable to ensure security of                  Tribunal, and the member is restricted to practising in that approved
medications that were removed from Pyxis between June 17, 2016 and           setting pending two satisfactory performance evaluations. The member
June 24, 2016 as a result of improper practices regarding the use of         must also submit further medical reports confirming her ongoing fitness
Pyxis. For this finding of unprofessional conduct, the Tribunal issued       to practise. Conditions shall appear on the member’s practice permit.
a reprimand and ordered the member to pass courses in responsible            Failure to comply with the Order may result in suspension of CARNA
nursing and ethics. Conditions shall appear on the member’s practice         practice permit.

                                                                                               nurses.ab.ca   | SPRING 2018   VOLUME  74 NO  1 ALBERTA RN 19
PUBLICATIONS ordered by Hearing Tribunals
CARNA MEMBER                                                             CARNA MEMBER
REGISTRATION NUMBER: 96,417                                              REGISTRATION NUMBER: 102,041
A Hearing Tribunal made a finding of unprofessional conduct against      A Hearing Tribunal made a finding of unprofessional conduct against
member #96,417 who charted “PIV became interstitial. Attempted X3        member #102,041. When in charge and caring for a patient, and after
but unfortunately unsuccessful,” which erroneously may lead one to       being advised by other nursing staff about concerns regarding the
understand that three insertions were made, when in fact, only one       patient’s respiratory status, the member failed to adequately document
insertion was made, although the member searched for a vein X3.          her assessments and interventions regarding the patient and failed to
The member failed to adequately document the care and/or assessment      appropriately intervene when the patient refused transfer to hospital
of a patient within the same shift after the care was provided, and      when the member failed to notify the patient’s physician of the
instead a late entry was made the following day. The member adminis-     patient’s refusal of the recommendation for transfer to hospital.
tered morphine 6mg in error rather than the ordered medication which     The Tribunal issued a reprimand and ordered the member to pass
was hydromorphone 6mg. The Tribunal issued a reprimand and directed      courses in documentation and in gerontological nursing. The member
the member to pass a course in documentation and restricted him          is prohibited from practising as an RN pending a letter from her next
to practising only in his current work setting pending a satisfactory    employer agreeing to do a performance evaluation. The member will be
performance evaluation. Conditions shall appear on the member’s          restricted to practising in that approved setting pending a satisfactory
practice permit. Failure to comply with the Order may result in          performance evaluation. Conditions shall appear on the member’s
suspension of CARNA practice permit.                                     practice permit. Failure to comply with the Order may result in
                                                                         suspension of CARNA practice permit. RN
MAID eighth pg ad:Layout 1            3/13/18         1:06 PM   Page 1

      MAID in Alberta Research Study
      Since June 2016, Medical Assistance in Dying has been
            legal in Canada, but each province has a
                 unique set of MAID procedures.
         We are asking Alberta nurses, physicians, and
          members of the general public to complete
          a brief (5 minute) survey on MAID in Alberta.
       The findings will be used for educational planning.
                          The survey link is:
   www.surveymonkey.com/r/MAIDinAlberta

                     NOT ICE
               Karen Spak has resigned
            from CARNA Provincial Council.
          There will be an additional opening
          for a council member from Central
            region in the upcoming election
                   (for a total of two).

20 ALBERTA RN SPRING 2018 VOLUME  74 NO  1   | nurses.ab.ca
F E AT U R E

                                                                                                                            Demystifying
                                                                                                                            advance care
                                                                                                                              planning

                                                                             BY LISA WEISGERBER, BS CN, RN, LORELEI SAWCHUK, MN, RN, CHPCN(C), AND JAMIE TYCHOLIZ, BS CN, RN

                                                                             D
                                                                                        uring night rounds, you discover an 81-year-old           the benefits of ACP are clear, many front-line providers are
                                                                                        patient apneic and pulseless. She does not have a         confused about the nature of ACP and the appropriate timing
                                                                                        Goals of Care Designation Order (GCD Order), so           for ACP discussions.
                                                                                        you call a code blue. Prior to the code team’s arrival,
                                                                             you provide chest compressions and can feel her ribs give            When should ACP discussions begin?
                                                                             way (and possibly fracture) due to your downward thrusts.            Many individuals with incurable life-limiting or life-threatening
                                                                             She is finally stabilized. However, her condition warrants           conditions are appropriately aligned to have ACP conversations.
                                                                             the search for her family, as she is transported to critical care.   However, ACP conversations should also be a routine part of
                                                                                You find yourself wondering if she will recover, and to           care for all adults, and should start early in a person’s disease
                                                                             what extent. You also wonder if anyone has discussed her             trajectory. ACP should also be revisited with any change in
                                                                             deterioration and prognosis with her. You wondered if you            a person’s health status and within all practice settings
                                                                             should have taken a role and how you could have also helped          including primary care, acute care and continuing care.
                                                                             prepare for this moment. As she worsened over the past
                                                                             few weeks, did anyone on the team think about the risks of           The registered nurse’s role
                                                                             her dying? And if so, why wasn’t a goal of care discussion           Advance care planning enables RNs to fulfill the fundamental
                                                                             brought forward?                                                     nursing responsibilities listed within the Canadian Nurses
                                                                                This concern gives rise to a vital question: what can             Associations Code of Ethics for Registered Nurses: promoting
                                                                             nurses do to ensure that the care and interventions a patient        health and well-being, and supporting personal choice and
                                                                             receives are in alignment with the patient’s values and wishes?      maintaining dignity. As such, nurses should encourage
                                                                             One answer to this question is to engage our patients in             their patients to engage in ACP by supporting them to think
PHOTOGRAPHEE.EU/SHUTTERSTOCK.COM (LEFT), DMYTRO ZINKEVYCH/SHUTTERSTOCK.COM

                                                                             a process called advance care planning (ACP).                        about, talk about and document their wishes for care.
                                                                                                                                                      Nurses are well-positioned to discuss preferences and
                                                                             What is ACP?                                                         concerns regarding future health-care planning with their
                                                                             Advance care planning is a way to help you think about, talk         patients. Moreover, nurses can help patients understand
                                                                             about and document wishes for health care in the event that          the nature and benefits of early planning.
                                                                             you become incapable of consenting to or refusing treatment              Engaging in ACP conversations should be a routine part of
                                                                             or other care.                                                       nursing care with those diagnosed with incurable life-limiting
                                                                                 Evidence suggests that although most people want to have         illness. Detering and Silveira say “asking a patient to consider
                                                                             greater control over decisions that occur during the final phases    his or her goals, values, and beliefs, and how these may
                                                                             of their life, only a small number have actually engaged in ACP.     influence their future medical decisions is helpful and may
                                                                                 The overall goal of ACP is to ensure that the care provided      be a good place to start the conversations.”
                                                                             to a person is consistent with their preferences and values,
                                                                             particularly in the event that they are no longer able to speak      Supporting patients to document
                                                                             for themselves.                                                      their wishes
                                                                                 The benefits of ACP are well-documented in literature.           In addition to engaging in ACP discussions, nurses should
                                                                             Early ACP conversations are associated with enhanced quality         encourage patients to document their wishes within a
                                                                             of care that complies with a person’s preferences, greater satis-    personal directive (PD). Within the directive, the patient
                                                                             faction with care, fewer non-beneficial medical interventions,       should be encouraged to appoint someone (called an agent)
                                                                             increased home-based care, lower medical costs, decreased            to make personal decisions on their behalf should they lose
                                                                             family distress and improved patient outcomes. Although              decision-making capacity.

                                                                                                                                                                  nurses.ab.ca   | SPRING 2018   VOLUME  74 NO  1 ALBERTA RN 21
In addition to a personal directive, a person may have a
GCD order in place. Although the GCD order is a medical
order completed by a physician or nurse practitioner and
not completed by the patient, the GCD order should reflect
the patient’s values, beliefs and wishes for care. The PD and
GCD order documents will be explored in greater depth in
future editions of Alberta RN magazine.
    The take-away here is that nurses have an obligation to
ensure that the care provided to an individual is consistent
with their preferences, values and wishes. Promoting ACP is
a tangible and robust way of meeting this obligation.
    Help promote quality patient-centred care by encouraging
your patients to think about, talk about and document
their wishes for care now and in the future. Nurses and
other health-care team members can take part in these
conversations and prompt practitioners to begin these
important conversations. RN

REFERENCES:
• Brinkman-Stoppelenburg, A., Rietjens, J., & Heide, A. (2014).
  The effects of advance care planning end-of-life care:
  A systematic review. Palliative Medicine, 28(8), 1000-1025.
  doi: 10.1177/0269216314526272
• Canadian Hospice Palliative Care Association. (2014). Have you
  had the talk? 55% of Canadians have not. Retrieved from
  http://www.chpca.net/news-and-events/news-item-50.aspx
• Sudore, R.L., Lum, H.D., You, J.J., Hanson, L.C., Pantilat, S.Z.,
  Meier, D.E., Heyland, D.K. (2017). Defining advance care planning
  for adults: A consensus definition from a multidisciplinary
  Delphi panel. Journal of Pain and Symptom Management, 53(5),
  821-832. doi: 10.1016/j.jpainsymman.2016.12.331
• Baidoobonso, S. Patient care planning discussions for patients at
                                                                                    Spread
                                                                         KNOWLEDGE,
  the end of life: an evidence-based analysis. Ont Health Technol
  Assess Ser [Internet]. 2014 December;14(19):1-72.
• Alberta Health Services. (2016). Advance Care Planning and Goals

                                                                            not infections
  of Care Designation. Retrieved from https://extranet.ahsnet.ca/
  teams/policydocuments/1/clp-advance-care-planning-hcs-38-

                                                                                                                     TYLER OLSON/SHUTTERSTOCK.COM, MACROVECTOR/SHUTTERSTOCK.COM (SUPERBUGS)
  policy.pdf
• Detering, K., & Silveira. (2017). Advance care planning and
  advance directives. Retrieved from https://www.uptodate.com/
  contents/advance-care-planning-and-advance-directives                 BY CARRIE GRONAU, OHNC, RN
• Izumi, S. (2017). Advance care planning: The nurse’s role.            CARNA RN CONSULTANT, REGISTRATION SERVICES
  American Journal of Nursing, 117(6), 56-61. doi: 10.1097/01.
  NAJ.0000520255.65083.35.                                              A very smart nurse once told me
• Canadian Nurses Association. (1998). Advance Directives:              that “together we are a genius.”
  The nurse’s role. Retrieved from https://cna-aiic.ca/~/media/
  cna/page-content/pdf-en/ethics_pract_advance_directives_              Every nurse brings their own
  may_1998_e.pdf                                                        thoughts, experiences and wisdom
• Alberta Health. (2017). Personal directive: How it works. Retrieved
  from http://www.humanservices.alberta.ca/ guardianship-
                                                                        to their practice setting. Each one
  trusteeship/personal-directives-how-it-works.html                     of us has something to offer and
• Alberta Government. (2013). Understanding Personal Directives.        even a casual conversation can
  Retrieved from https://open.alberta.ca/dataset/efe6eaec-25a7-
  4f b1-ba60-4a37546a4c5a/resource/59c2ad84-87f3-40a3-bb37-             bring about major changes to our
  dde84d571315/download/opg-personal-directives-publication-            practice when we reflect on it.
  opg1646.pdf

22 ALBERTA RN SPRING 2018 VOLUME  74 NO  1   | nurses.ab.ca
PROFESSIONAL PRACTICE

   For example, the article “Breaking the chain of infection:    one nurse inside the room gowned and gloved, and the other
What RNs need to know” from the spring 2017 issue of             holding the glucometer outside the room – ensuring only
Alberta RN prompted a casual conversation with a friend          the strip touched the glucometer.
of mine.                                                            Donning, doffing, sweating – and my goodness, if you forgot
   My friend told me about an assessment at his workplace        something outside the room, you either waited for another
that revealed there were a number of surfaces in the hospital    staff member (who was also gowned and gloved in another
which neither environmental services nor unit staff were         room!) or removed your gown and gloves and got it yourself.
cleaning on a regular basis. This included chart carts, med         It was one of the most trying infection-control situations
carts and almost 200 other items.                                I had ever encountered.
   This was an ah-ha! moment for me. Of course, there were
areas that weren’t being cleaned! Why hadn’t I thought of that   Hindsight is 20/20
before? My mind was racing and thinking of all the surfaces    Reflecting back on the situation, I wondered what could have
I had overlooked while I was focused on more pressing issues.  been done differently.
   My friend’s workplace put a strategy in place to ensure     • Had I missed something?
there were no gaps going forward. And on a personal note,      • Were proper donning and doffing procedures followed by
his story taught me to never assume someone else has already       all staff?
taken care of the necessary infection prevention and control
                                                               • How was the “superbug” transmitted? Was it transferred
(IP&C) precautions.
                                                                   on scrubs – did someone brush up against a blanket that
My worst IP&C experience                                           fell on the floor? Had it travelled on our shoes?
Sharing knowledge with colleagues helps us learn from          •   Was there something in the room that was used outside
each other’s experiences and become better nurses, which           that  we hadn’t thought of?
is why I will share my story about my worst experience with    • Would more education have helped? What could I have
infection control.                                                 done to ensure visitors had proper education on isolation
    While I was working on a surgical unit,                                 precautions and understood the seriousness of
a patient at the very end of the unit had                                        IP&C?
a “superbug” infection. My colleagues                                               These questions and a million others raced
and I were very concerned so we were                                                through my mind. We never found out how
extremely cautious and proactive.            Everyone was united                      the infection spread. The possibilities
    The challenge was that it was                                                       were endless, but through diligent IP&C
a relatively new infection and               in their approach and                       practices, the outbreak was eventually
we didn’t know much about it.                doing their utmost                           contained.
Education was in order. There                to ensure that this                             The last and biggest question I had
were all-staff meetings about                                                             was: what can I do going forward to
the patient and management
                                             superbug wasn’t                              ensure that this never happens again?
of the bug. Educators came to                going anywhere else                             This was an opportunity to learn
the unit and provided us with                in the facility.                            and I made that a priority. I added a
the most up-to-date information                                                         learning objective related to IP&C in my
and best practices. Everyone was
united in their approach and doing
                                         But it did.                                   continuing competence plan. I was deter-
                                                                                     mined to make the best of a bad situation
their utmost to ensure that this                                                  and improve my practice while I was at it.
superbug wasn’t going anywhere else in                                             I hope that by sharing my story and what
the facility.                                                              I wish I had done differently, you’ll learn from my
    But it did.                                                      experience and be more prepared if you find yourself in
    A couple of days later, two doors down from the patient    a similar situation.
with the infection, another patient was diagnosed with             Did my story remind you of something that happened
the same infection. Then the patient in the room next to       to you? Share your best and worst IP&C situations with
that one. Crisis management went into effect. The unit went    your colleagues, unit staff and specialty practice groups.
on lockdown. Every patient was on isolation. The unit was      Every practice setting is different and holds unique IP&C
closed to admissions. Visitors were limited. It was a terrible challenges.
situation.                                                         By creating a dialogue when things go wrong, we can learn
    In case you missed it, let me just say this again: every   from each other and stop the same mistake from happening
patient was on isolation.                                      twice. RN
    It was a logistical nightmare. Providing care took twice
as long. Two nurses were needed to take one blood glucose –

                                                                                 nurses.ab.ca   | SPRING 2018   VOLUME  74 NO  1 ALBERTA RN 23
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