HAPPY NATIONAL NURSING WEEK! #YESTHISISNURSING - MAY - 3, 8 - RECIPE FOR PIE: IMPROVING THE CHILDHOOD IMMUNIZATION EXPERIENCE - CARNA
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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
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
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
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
4 ALBERTA RN SPRING 2018 VOLUME 74 NO 1 | nurses.ab.ca
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
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
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:
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
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
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.caARNET
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 11F 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.caThe 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 13R 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 19PUBLICATIONS 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.caF 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 21In 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.caPROFESSIONAL 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 23You can also read
