VOL XXIX NO 3 OCTOBER 2008 ACCESS

in THIS ISSUE: Clinical Corner • Code of ethics • Booster seat legislation Peer to Peer Network • New Graduates • and more! ARNNL STAFF Council Executive Director Pegi Earle 753-6173 [email protected]

Director of Regulatory Michelle Osmond 753-6181 Services [email protected]

Director of Communications Janice Lockyer 753-6198 [email protected]

Nursing Consultant - Colleen Kelly 753-0124 Education [email protected]

Nursing Consultant - Advanced Betty Lundrigan 753-6174 Practice & Administration [email protected]

Nursing Consultant - Lynn Power 753-6193 Practice [email protected] Front Row L-R - Bev White (President - Elect), Kathy Watkins, Peggy O’Brien- Connors, Jim Feltham (President), Janice Brennan, Cathy Burke. Second Row L-R - Project Consultant JoAnna Bennett (part-time) 753-6019 Pegi Earle (ED), Kathy Fitzgerald, Sandra Gear, Bea Courtney, Sandra Evans. Missing QPPE [email protected] from photo: - Ray Frew, Lynn Miller, Beverly Pittman, Margo Cashin, Joan Downey Accountant & Office Manager Elizabeth Dewling 753-6197 Jim Feltham, President 2008 - 2010 [email protected] Bev White, President-Elect 2008 – 2010 Ray Frew 2007–2010 Administrative Assistant to Christine Fitzgerald 753-6183 Executive Director and Council [email protected] Bea Courtney 2008-2011 (February) Kathy Watkins, St. John’s Region 2006 - 2009 Administrative Assistant to Jeanette Gosse 753-6060 Lynn Miller, Region 2008 - 2011 Consultants & Workplace [email protected] Janice Brennan, Western Region 2007 - 2010 Representative Program Sandra Evans, Central Region 2008 - 2011 Sandra Gear, Eastern Region 2007 – 2010 Administrative Assistant to Jennifer Rideout 753-6075 Beverly Pittman, Northern (Grenfell) Region 2007 – 2010 Consultants, ACCESS & QPPE [email protected] Peggy O’Brien-Connors, Advanced Practice 2006 - 2009 Administrative Assistant to Colleen Jones 753-6041 Kathy Fitzgerald, Practice 2006 – 2009 Consultants [email protected] Margo Cashin, Practice 2007 – 2010 Joan Downey, Nursing Education/Research 2008 – 2011 Administrative Assistant & Kirsty Wiik 753-6040 Cathy Burke, Administration 2007 - 2010 Data Processor, Registration [email protected]

Research Assistant & Julie Wells 753-6182 ARNNL Trust [email protected] contents ACCESS is the official publication of the Association of Registered Nurses of 1 | Message from the President and Labrador.

2 | Nurses Governing Nurses ACCESS is published three times a year in January, May and September. Subscriptions are available for $25.00 per year. 3 | Disclosure: Professional Responsibilities ON THE COVER: ARNNL President Jim Feltham and provincial Chief Nursing 4 | CNA Code of Ethics for Registered Nurses 2008 Officer Anita Ludlow pose with ARNNL staff, ARNNL Board members and frontline nurses after a meeting with Premier Danny Williams in June 2008. 5 | IT Responds to Community Needs

6 | The Peer-to-Peer Network: Supporting Nursing Editor | Janice Lockyer, Director of Communications Involvement in Information Technology Creative Design | Vanessa Stockley, Granite Studios 8 | The First Provincial Wound & Skin Care Manual Administration | Jennifer Rideout, ARNNL 9 | Nurse Practitioners: An Innovative Solution 10 | Nurses of Note Advertise in the next issue of ACCESS Contact Janice Lockyer, Director of Communications, ARNNL 13 | Clinical Corner [email protected] 753-6198 14 | BN Graduates 55 Military Road St. John’s, NL A1C 2C5 15 | Do You See What Eye See? A Transcultural Ph: (709) 753-6040 Fax: (709) 753-4940 Toll Free: 1-800-563-3200 Nursing Experience to Impoverished Mexico email: [email protected] www.arnnl.nf.ca 16 | Booster Seat Legislation ©Association of Registered Nurses of Newfoundland and Labrador (ARNNL). All rights reserved. 18 | Goings On For editorial matters, please contact the editor. The views and opinions expressed in the articles and advertisements are those of the authors or advertisers and do not necessarily represent the policies of ARNNL.

Access VOL xxIX NO 3 OctoBER 2008 Messagefrom the President s with summer days, the time since I assumed the role of President of the Association of Registered Nurses of Newfoundland and A Labrador (ARNNL) has quickly passed. It has been a busy time for your ARNNL executive and staff with the passing of the new Registered Nurses Act, CNA celebrating 100 years at the Biennial meeting in Ottawa and parading with nurses for the memorial of Beaumont Hamel. In June, the Legislative body of the Government of Newfoundland and Labrador passed the Registered Nurses Act. This piece of legislation updates our responsibilities and makes us more accountable to the population of our province. The new Act continues to give the nurses of our province the privilege of self-regulation and allows us to set the standards for entry to practice including those for Nurse Practitioners. The new Act also improves public transparency by increasing the number of public representatives on our Board from two to four. I am the first direct care nurse to serve in the role of President of ARNNL. I hope to bring a unique perspective on the role of nurses in our hospitals, communities and workforce to the Office of President. As I mentioned at our meeting in June, I wear many different hats, all of which inform my perspective on nursing. Continuing competency, work life issues and shortages are all things we have to deal with. The future of nursing will depend upon a workforce that is in tune with the needs of the people we serve and how we provide the care with resources at hand. We must continue to voice our concerns and sometimes take a different look at ways of providing services. In June, I had the honour of representing the Association at the CNA Biennial Conference which celebrated 100 years of nursing in . The CNA meeting included a discussion on the challenges of self-regulation and looked at why self-regulation is required to maintain public protection and quality health care delivery in these times of shortages. What became clear from the discussion, was that self-regulation allows us to be aware of and safe guard our standards for care while promoting continuing education so that we can maintain our competency. It was also an honour, during the meeting, to listen to the keynote speaker, General Rick Hillier, who took the opportunity to recognize nurses who have served in Afghanistan. This fall promises to be even busier as we begin work on fleshing out the new Act; continuing to work with our stakeholder groups on health human resource issues, quality of work life issues, and other important issues facing the profession; and work to raise our profile with members and the public. In all of this, one thing is certain, with the challenges we are now experiencing, we will have to develop new ways at looking at the problems facing the profession and the system in order to identify solutions that can help make health care viable over the long-term. This fall, I will continue to focus on linking with members and the public as I find it an excellent way to hear both what is happening at our work sites and how the public perceives our profession. It is also a way to ground our ARNNL Ends in reality and measure what they mean for nurses and the public. This will help the Council determine if we are on the right track or if we should change direction. I would like to conclude by, once again, thanking Pat Pilgrim for her guidance over the last two years. I look forward to working with the new Council and the staff at ARNNL as we face the challenges of our profession and keep nursing in the forefront of health care delivery in our province.

James W. Feltham

1 Nurses Governing Nursing M argare t (P eg i) E arle , RN, MScN ince the last issue of ARNNL ACCESS W both This includes: ! the legal and ethical foundations for nursing h • increasingat the number of public representativesleg one Council to four, i practice in our province have shifted! On June a Priv 4, 2008, the House of Assembly established new legislation to • ensuring the register of members is accessible to the govern our profession, the Registered Nurses Act 2008, which public (in this regard we are moving to have a list of continues the privilege of self- regulation. Two days earlier, registered members available online), ARNNL Council approved the Canadian Nurses Association’s • strengthening the legislative authority for the professional new Code of Ethics for Registered Nurses which renews conduct review process and involvement of public our profession’s ethical values and responsibilities. These representatives, documents, along with the Standards for Nursing Practice • conducting disciplinary hearings in public, and (2007), provide the foundation for nursing in our province. • submitting an annual report to Government. TheyS demonstrate ARNNL’s responsibility for governing the Since 1996, government has been systematically reforming nursing profession while supporting nurses to provide safe the legislation of all regulated professions. The reforms to and quality nursing care in all roles, settings and domains of our Act are similar to those of other health professions. The nursing. This column highlights the nature of the changes to reforms support the public’s expectations for professional the RN Act and Code of Ethics. Members are encouraged accountability and transparency when professions are given to take some time to review the specific changes to both the right of self-regulation. documents which are posted on www.arnnl.nf.ca. Code of Ethics Registered Nurses Act The Code of Ethics is the foundation for nurses’ ethical The responsibility of self-governance continues to include the practice. The new code is now organized in two parts, right to set standards for education and practice, registration ethical responsibilities and ethical endeavours. All members and licensure, and professional conduct review and discipline. are accountable to uphold the seven core values and The changes to our Act focus on clarifying the responsibility accompanying responsibility statements: of self-governance, improving public accountability and • providing safe, compassionate, competent and ethical transparency and bringing more uniformity to the regulation care, of all health professions in the province. • promoting health and well being, When a profession is given the privilege of self-governance, • promoting and respecting informed decision-making, the public’s interest must always prevail. This responsibility • preserving dignity, is now explicitly stated in our new Act, “The objects of the • maintaining privacy and confidentiality, • promoting justice, and Association are, in the interest of the public of the province…” • being accountable. We must exercise this responsibility with care because there is the potential for a conflict of interest between the activities Ethical nursing practice also involves endeavouring to undertaken to protect the public interest as opposed to address broad aspects of social justice that are associated activities undertaken to advance the interest of members of with health and well being (i.e., the determinants of health). the profession. This responsibility is not new to ARNNL as So the code also describes endeavours that nurses are we have always strived to uphold the public interest in all encouraged to undertake to address these social inequities. our actions and, furthermore, it is our belief doing so is in the The primary focus of the Code continues to be the ethics of profession’s interest. nurses’ everyday practice and as such, it is a powerful tool to support ethical decision-making and advocacy in your We are pleased the new Act purports a broad view of self- practice setting. governance, thus maintaining and making explicit ARNNL’s authority to participate in activities promoting the health Conclusion and well-being of the public. Regulatory reforms in some Nursing practice has both ethical and legal dimensions. Our jurisdictions across the country have narrower approaches new Code of Ethics for Registered Nurses is clearly focused to professional regulation and do not provide for this broad on our responsibility to promote ethical practice in all our advocacy role. This will allow us to continue to advocate for endeavours. Our new Registered Nurses Act entrusts nurses, both the development of the profession and health policy through ARNNL, to govern the profession in the public’s when it is in the public’s interest to do so. interest. The public trusts us to uphold our responsibilities for The new Act requires ARNNL to be inclusive, ethical practice and self-regulation - what a privilege! open and transparent in our dealings with the public.

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Access VOL xxIX NO 3 OCTOBER 2008 Professional REsponsibilities Disclosure By Lynn Power, RN, MN, Nursing Consultant ARNNL In February the ARNNL, with the NL Association of Social Workers and the NL Health Boards Association, hosted a teleconference entitled Disclosure: Professional Responsibilities. Disclosure is a process that involves open communication, information sharing, and W ! fact finding for the purpose of improvement (CPSI, 2008). All professionals are responsible to provide leadership in the identification h at a Privilege and resolution of unsafe and unethical situations that could affect client care (ARNNL, 2007). Three guest panelists shared their perspective on disclosure: Tom Williams, Lawyer, O’Dea Earle; Stephen Dodge, VP People and Information Services, Eastern Health; and Heather Hawkins, past Director of Regulatory Services, ARNNL. Highlights of the discussion are summarized below.

Legal Considerations Professional Considerations For many health care workers, one of the biggest concerns Nurses have a professional obligation to be a client advocate, when it comes to disclosure is the potential legal ramifications/ whether the client is an individual, family, community, or implications of action(s) taken. And while there is reference population. RNs are expected to objectively evaluate, act to disclosure of information in legislation, there is no single upon and, as appropriate, report and document concerns on document that clearly outlines all aspects/implications. the clients’ behalf. However, there are often mixed emotions Within the legislation many statutes identify what you can inherent with this responsibility. Nurses may feel they don’t disclose and there are still others that outline what you have enough evidence, or it is someone else’s role, or are cannot disclose. There are even a few that leave absolutely worried about social implications, or fear of retribution. These no room for interpretation (e.g. reporting known child or feelings must be acknowledged and discussed, but ultimately elder abuse.) Even when the obligation is clearly outlined, for checked at the door. example giving evidence as per the Public Inquiries Act, the Our panel suggests the best advice, if you are feeling action and nature of information shared must be balanced unsure or conflicted, is to step back and focus on what’s best against other competing regulatory legislation, (e.g., RN in the public interest, seeking assistance, through resources Act, and your obligation to maintain client confidentiality). such as ARNNL, to ensure that you proceed in a professional These complexities make the decision to disclose a complex manner. one for RNs and all health care workers alike. As well, once During the teleconference, two specific areas of caution the decision to disclose has been made, the potential legal were highlighted. ramifications after you disclose are not black and white. Public Disclosure The best advice for all health care workers, according to our panelists, is to validate all information, present facts not If considering ‘going public’ on an issue our panelists offered opinion and consider what ‘the reasonable prudent nurse in a some good suggestions for questions you can ask yourself to similar situation’ would do. make sure your motivation and reasoning come from a place of logic and proper process: Organizational Considerations • Question your motives - are you disclosing to ‘save As employees, RNs have an obligation to their employer to yourself” or to save others? act in good faith and to hold information obtained through • Do you know the facts or is this an opinion? employment confidential, while maintaining professional and • Will your disclosure create more good or more harm? legal obligations. Likewise, the organization has a responsibility to support their staff by ensuring the availability of reliable • Have you gone through all the appropriate internal processes that enable reporting and support appropriate action channels first? once a report has been filed. For example, organizations should • Did you seek professional advice from ARNNL? have forums for discussion such as staff meetings, quality and • What are the potential personal implications, e.g., risk management departments, labor management linkages, employment, reputation? and professional practice councils; forms for reporting of • Can you be held liable for slander? occurrences, near misses, occupational health hazards, etc; • Are you breaching client confidentiality? and policies to identify expectations, including the appropriate During the discussion, a distinction was made between going channels to report concerns. There should also be clear policy public with a concern and participating in public advocacy for and procedure outlining what happens once an incident or healthy public policy, e.g., promoting breastfeeding. While concern has been reported. These should be easily accessible going public with a concern comes with a variety of procedural to employees and supervisors alike. considerations, it was clear that all panelists considered Our panel suggests that the best advice is to use these advocacy for healthy public policy as an appropriate, welcome, internal resources and hold the organization accountable to professional activity. work with you to address your concerns.

3 CNA Code of Ethics for Registered Nurses The revised Code of Ethics for Registered Nurses2008 is now available for download from the CNA website www.cna-aiic.ca. The code was revised to address changes in social values and conditions and to ensure that it meets the needs of practicing nurses. Used in conjunction with professional standards, laws and regulations that guide practice, the code provides guidance for ethical relationships, responsibilities, behaviors and decision-making. It serves as a means for self-reflection, provides a guide for feedback, and serves as a basis for advocacy. For greater emphasis and clarity, the code is now organized in two parts.

Part 1 Extras Identifies the specific values and ethical responsibilities that Ethical experiences such as, “ethical (or moral) courage” and nurses are expected to uphold in seven areas. “ethical (or moral) disengagement,” are described in the code • providing safe, compassionate, competent and ethical to help nurses recognize and reflect upon their experiences care, and discuss them with others. Ethical models are included to • promoting health and well being, help guide such a discussion. • promoting and respecting informed decision-making, New/revised sections have been added in the appendices to address ethical considerations in a pandemic or other • preserving dignity, emergency, and to explore the challenge of “conscientious • maintaining privacy and confidentiality, objection,” or how to respond when the expectations of • promoting justice, and others are in conflict with a nurse’s conscience. There is also • being accountable. information on ethical considerations in relationships with nursing students. Part 2 Although many characteristics of the code will be familiar Outlines endeavors that nurses undertake as part of to you, the additional information and guidance it contains ethical practice to address social inequities that affect client will help you address changes and new challenges you face health and well-being. For example, addressing the needs in nursing practice. of vulnerable populations and promoting awareness of To win a copy of the Code of Ethics, visit our website at global health concerns such as human rights and poverty. www.arnnl.nf.ca

Disclosure: Professional Responsibilities... continued from page 5 Electronic Leaks Professionals and organizations are committed to providing The panelists also raised awareness that professionals can safe quality care. However, things are not perfect! There inadvertently expose confidential information through the will be workplace concerns that will need to be addressed. inappropriate use of electronic information systems. Some Remember your legal, professional and employment safeguards were suggested: obligations to appropriately disclose those concerns. • Access only what you have the authority to access Please note: The entire Disclosure: Professional Responsibilities session is AND only the information that you need to deliver the available on our website. required health services. • Be cautious about using the internet, especially program sharing sites, e.g., music or chat sites. • Know your organizations policies about data management, (e.g., carrying information on temporary Discipline Notice devices such as memory sticks or laptop computers). Sybil Maynard ARNNL # 13136 • Obtain approval to use a camera, recorder or other As a result of a hearing on April 21, 2008, Sybil Maynard was found in breach of the Registered method of picture/information gathering within an Nurses Act, Section 21 2 (b) Incompetence and organization. 2 (d) Conduct that does not conform to the • Know the policies on the use of client information standards of the profession. for other purposes, (e.g., presentations or informal The Panel who oversaw the hearing ordered communications such as email or Facebook). that the registration of Sybil Maynard # 13136 be suspended pending conditions.

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Access VOL xxIX NO 3 OCTOBER 2008 IT responds to community needs

By Diane Alyward, RN, Scenario 1 - Interdisciplinary Support Scenario 3 - Self-Care Management Regional Director of Primary Health Care, You have just received a call that a You are the Diabetes Nurse Educator Manager of Community Health and Wellness, patient with multiple injuries from an for a large, sparsely populated, Labrador-Grenfell Health accident is enroute to your clinic. You geographical area. Until recently, you are a Nurse Practitioner and, except for spent most of your time traveling to One of the four a maintenance man with some first aid your clients. If the weather got bad, and pillars of Primary training, tonight you are the lone health it usually did, it might take several days Health Care is care provider in this remote community just to see one or two clients. You felt information technology accessible only by air this time of year. that if you could set up your office at the Outside, the wind is gusting and the airport, you might be able to get caught (IT). IT refers to using forecast is calling for a winter storm that up on some of your work because you technology to improve is expected to last for the next 24 hours spend more time there than in your the quality, access and will ground all flights in and out office. and coordination of of the community. You know that this This was the past however. Through information to enhance patient will be your responsibility for the a Primary Health Care initiative to next few hours. You are quite anxious, improve information technology, there access to health but have already called the secondary are videoconferencing units in every services and thereby, care centre and set up a videoconference health care facility in the region. You now improve patient care. with the internist and surgeon. They will are able to offer group videoconference In the Labrador- be able to see and talk to the patient sessions to provide information related Grenfell Region, a and assess the extent of the injuries. to diabetes self-management with As a team, you are able to collaborate people joining in from all over the significant amount on treatment options and decisions region. These people support each of funding from the to stabilize the patient until he can be other and offer suggestions on how they Primary Health Care transported out of the community. have dealt with problems and issues and Transition Fund was Scenario 2 - Remote Access what has worked for them. You have used to enhance While administering the last course of also been able to invite the pharmacist chemotherapy to your patient, you, his and the dietitian to sessions to provide information technology information on medication and dietary as we installed chemotherapy RN, discuss his upcoming appointment with the Oncologist based in control. videoconferencing St. John’s. The patient voices his concern You are much happier because you units in all of the that he does not know if he will be able are able to work more effectively, you health care facilities to keep the appointment because he get to spend more time with your family cannot afford the trip. His employment and you know that your clients are in the region. getting the education and support they Videoconferencing insurance has run out. He will be unable to qualify this year because for the last need to manage their disease. has the potential to six months he has had to spend one Conclusion help deal with many week a month receiving chemotherapy As these scenarios demonstrate, IT of the challenges and he is so sick after each treatment can increase accessibility to health care of providing health he is unable to work. He also says that services, support collaborative practice he was embarrassed to admit that he among health professionals and enable care in rural and cannot read, so the written material he remote geographical people to manage their own health. IT was given was of no use to him. You is indeed an essential pillar in achieving settings. The following reassure him that he will not have to primary health care and improving scenarios illustrate travel to St. John’s for this appointment. population how this technology You explain the Tele-Oncology Service health at and that he will be able to see and speak L a b r a d o r can be beneficial to with the Oncologist from the health patients, community G r e n f e l l facility in his home town. You offer to Health. members, nursing staff attend the session with him so you can and the entire health help clarify the information given to him care team by the doctor. Your patient leaves his appointment with you greatly relieved.

5 THE PEER-TO-PEER NETWORK

SUPPORTING NURSING INVOLVEMENT IN INFORMATION TECHNOLOGY By Judy Power, RN, MN

Nurses are already involved in using various types of information technology as part of their everyday work and are well aware that there are many new and exciting technology applications coming. How can nurses become more aware of what’s happening in the world of information technology, especially the electronic health record, and prepare themselves to embrace and support these changes?

ne of Canada Health Infoway’s clinician engagement The training program for nurse Peer Leaders was held in strategies is the creation of regional Peer-to-Peer August and supported with the attendance of Infoway’s ONetworks. Locally, the Newfoundland and Labrador Senior Nursing Advisor, Dr. Lynn Nagle. The two nursing Peer Centre for Health Information is handling the provincial Leaders in Newfoundland and Labrador are Heather Rumsey implementation of this initiative. Newfoundland and Labrador and Patricia Walsh. is part of the Atlantic Regional Network, which also includes Heather Rumsey is a nurse practitioner with a focus on New Brunswick, Nova Scotia, and Prince Edward Island, and long-term care with the Eastern Health Regional Authority. there are linkages to similar networks across Canada. These She also regularly works on the coast of Labrador. Prior to networks will support the implementation of electronic health becoming a nurse practitioner, Heather’s nursing career record (EHR) solutions that optimize the use of electronic health involved work in critical care and the community before record systems and ultimately improve clinical and financial serving in a nursing management role in long-term care. In outcomes within the health care system. More specifically, the 2005, Heather was seconded to Newfoundland and Labrador activities will support the acceleration, adoption and integration Primary Health Care Initiative as coordinator for the Chronic of information technology into regular work processes to Diseases Strategy, where she spent approximately two years. improve access, quality and productivity outcomes. Longer This role, combined with her clinical experience, provided an term, there is the possibility for linkages between the regional in-depth appreciation of the need for a seamless record of an networks, thus further extending the reach of lessons learned individual’s care regardless of where care was delivered. and best practices related to EHR implementations. Patricia Walsh is currently the Lead Clinical Information Nurse, pharmacist and physician Peer Leaders have been Specialist within the Central Regional Health Authority. She selected to work with their counterparts throughout the has been in a nursing informatics role for over 10 years, province. The goals of the Network are: supporting all clinical disciplines. Patricia has also worked • support peers in the use of technology within the as a staff nurse in many departments, with a major focus practice setting, in the emergency department and then in the professional • identify common and unique barriers and exchange development department as an educator. Patricia serves on advice on the application of health care technology several national committees that address the use of health solutions, information in an electronic venue and is quite excited to be • share best practices and build new knowledge, a part of the Peer-to-Peer Network supporting an Electronic • communicate stories that demonstrate accelerated Health Record. uptake within/between regional networks and Over the next few months, nurses can expect to hear more professional groups and across Canada, and from Heather and Patricia. In the Fall, launch workshops are • collaborate with Infoway to enable an environment that being planned for each region and there will be numerous accelerates the adoption and integration of information other opportunities to learn more about information technology toward improving clinical care outcomes. technology and the role of nursing.

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Access VOL xxIX NO 3 OCTOBER 2008 The Newfoundland and Labrador Electronic Health Record Since 2001, Newfoundland and Labrador, like many provinces across Canada, has been working to deliver safer and more efficient health care through the electronic health record (EHR). From Nain to St. Lawrence, the NL EHR will tie together a patient’s health information from numerous information systems to provide one patient record. Whether the information flows from a doctor’s office, a clinic, hospital or pharmacy, it will appear as one record – improving access to patient information by health professionals and supporting quality care. The Centre for Health Information has a mandate to implement all funded components of the NL EHR by March 31, 2011. The Centre is working with a number of stakeholders including health professionals, regulatory bodies, the Regional Health Authorities, provincial government, and Canada Health Nurses involved: Infoway to build the NL EHR. Funding for the development, Judy Power, Heather Rumsey implementation and operation of the NL EHR is provided by Regional Director, Primary Health Care, Nurse Practitioner the Government of Newfoundland and Labrador and Canada Eastern Health LTC Sector- Agnes Pratt Home Peer-to-Peer Network Subcommittee Eastern Health Health Infoway. Nurse Leader Nurse Peer Leader Bonnie Cochrane Patricia Walsh Change Management Consultant Lead Clinical Information Newfoundland and Labrador Centre Specialist, Central Health For more information on the Peer-to-Peer Network, please for Health Information Nurse Peer Leader contact Tom Alteen, Project Manager, (709) 752-6048, at the Peer-to-Peer Network Newfoundland and Labrador Centre for Health Information. Subcommittee Member

7 The First Provincial Wound & Skin Care Manual Introducing!By Debbie Farrell, RN, on behalf of the Provincial Working Group

History Risk assessment tool; manage and prevent pressure ulcers, In 2004, senior nurse leaders from across the province leg ulcers, and diabetic foot ulcers. You can also learn about recognized a need to standardize wound care education and unique considerations for burn or oncology wounds and practice across the province to improve client services and obtain information on special procedures such as debridement reduce duplication of effort. Consequently, a provincial group and silver nitrate application. It is a jam packed wealth of of nurses with expertise in wound care was formed. These information, pictures, diagrams and advice. nurses represented all regional health authorities and came Conclusion – Continuing the Quest.... from all sectors of the continuum - acute care, long-term care There is much work left to be done to complete all and community. the group’s goals. Over the next year we will focus on The goals for the working group were: standardizing data collection through indicator development • to standardize and promote best practices in the and explore how to best educate the public and market the prevention and management of wound & skin care in all program, including how to appropriately work with industry provincial health authorities, to maximize the benefits for all. We are also exploring the • to create a framework for provincial policies and possibility of establishing a special interest group for health procedures, care professionals interested in wound care. For further • to propose standardized tools for assessment and information on any of these activities or on how to access the documentation, Manual, contact the member for your area on the Provincial • to educate and develop nursing knowledge and working group. roles through the identification of competency based You can see from the conceptual model depicted below, the education - students to practitioners, exciting future planned to enhance the quality of wound care • to identify indicators for the creation of a provincial data provided in this Province. base on wound care needs, practices, and outcomes, and • to create a common dictionary and product formulary. STRUCTURE PROCESS OUTCOMES To accomplish these purposes a plan was set in place (see conceptual model) and a wound care consultant, Carla Wells, Public Prevention Outcome Data was contracted to help with research. After considerable Health Care consultation, debate and discussion, the first provincial wound Provincial and skin care manual will be officially launched this fall. Organization & Assessment Program Manual Industry Support This comprehensive Manual will be an invaluable educational and resource tool for all health professionals who Standardization Care Outcomes have an interest and role in wound care. Effective skin and Evidence Interdisciplinary wound management must be based on knowledge, skill and Based/Research Approach collaboration. This Provincial Wound Care Manual Clinical Supports Client • Describes the wound healing process and how it affects the client’s overall health status. • Identifies risk factors affecting wound healing. The Provincial Wound & Skin Care members • Can help you apply the wound care principles using Eastern Health Central Labrador evidence based best practices. Norma Baker (Chair) Nancy Wright Terri-Lynn Ricketts • Identifies strategies/measures for preventing wounds and Louise Jones (past Chair) Patrina Blanchard ARNNL Margo Cashin Delilah Guy recurrences. Lynn Power Doris Lewis Western • Can increase your technical skills in wound assessment Pat Osmond Sherry McCarthy and documentation. Gillian Duff Mary Beresford Annette Morgan • Introduces new and innovative wound care technology. Research Consultant Debbie Farrell • Can help you select and apply the appropriate products Carla Wells pertinent to all types of wounds.

Further, the Manual can help you; understand how Are you passionate about wound care? nutrition affects wound management; utilize the Braden Do you want to promote evidence-based practices in your work setting? If so then you may want to help us set up a 8 new ARNNL Special Interest Group that will help nurses and others achieve these goals and more. For further Access VOL xxIX NO 3 OCTOBER 2008 information contact Mary at [email protected] Nurse Practitioners: An By Denise Cahill RN, NP Solution

urse Practitioners Primary Health Care (NP PHC) are percentage of seniors in the country. These statistics suggest registered nurses with advanced education and training an impending crisis situation in our province that will require N in assessment, health promotion and management of innovative solutions to effectively manage the aging geriatric chronic diseases. NPs PHC can work autonomously, initiating population. Early hospital discharge further compounds this care and monitoring patient outcomes or collaboratively with challenge as geriatric patients are discharged home without other health providers in community health centres, nursing having support services and safeguards readily available. This outposts, emergency departments, specialty clinics, family leads to readmissions due to ill-managed chronic diseases and practice clinics and long-term care facilities. NPs PHC can burnout of caregivers who strive to fill the inadequacies in provide essential health services using a holistic approach our health care system. In 2007, Eastern Health reported that to care. They can also prescribe medications (as defined by of 4414 medical discharges over 65, 334 were readmitted their provincial legislation) and order and interpret the results within 24 hours of discharge. Also there were 7309 days of screening and diagnostic tests. They are governed by four in hospital when patients were medically discharged and core competencies: health promotion; health assessment awaiting community placement. Therefore, a NP placement and diagnosis; prevention of illness and in community care could significantly complication; and professionalism and improve care post-discharge, reduce responsibility to care. The advanced NP This advanced role provides readmission rates to hospitals and decrease PHC role provides an innovative solution for an innovative solution for unnecessary emergency room visits. our ailing health care system especially in our ailing health care system Community Health Nurses (CHN) are also community care to the elderly population. a vital link in providing services to elderly especially in community care patients. They can visit elderly patients The ability to provide quality health care to the elderly population. post-discharge and report to the primary to our elderly population is an immense care physician if concerns are noted. challenge in our society. The increased However, physician offices are generally number of older adults requiring diverse health care services busy and not easily accessible. Few physicians perform house requires the development of cost-effective quality care services. calls and the patient can’t avail of clinical services, resulting Prudent management of chronic diseases, comprehensive in increase use of emergency room services. Overtaxed home assessments, medication reviews, monitoring and emergency rooms are not elder friendly and cannot easily maintenance of disease and home safety assessments are deal with the complex health requirements of the geriatric deemed essential services. They are required to maintain the population. These patients literally fall though the cracks elderly population safely within their homes and can equate of our health care system. A community based partnership to health care savings. between CHN and NPs can bridge the gaps in services and Recent statistics published in a provincial government provide an invaluable service to the geriatric population. discussion paper, Healthy Aging, showed that 13.4 percent of For more information about NPs in NL, check out the NL the population of NL are over the age of 65. This equates to NP special interest group website at www.nlnpsig.ca. 68,800 people. The paper also notes that in 2005, Statistics Canada estimated that by 2015 NL will have the highest References available upon request.

9 his month our Nurses of Note are the Newfoundland and Labrador recipients of the CNA Centennial Awards. The Awards are one-time awards created to celebrate 100 exceptional registered nurses whose personal and professional T contributions have made an outstanding and significant impact on the nursing profession, and also to celebrate the centennial of CNA in 2008. Nursing associations from across the country nominated registered nurses for the award, and the nominations were vetted by a committee. Lucille Auffrey, CEO of CNA, recognized that celebrating “only 100 registered nurses was no easy task” and added that “these recipients all share a determination to succeed, strength to lead change and a commitment to improving the health system for Canadians.” Recipients were highlighted at the CNA biennial convention from June 16 to 18 in Ottawa and will be highlighted again during an awards ceremony in November, which will mark the closing of CNA’s centennial celebrations.

We at ARNNL would like to congratulate all recipients and thank them for their dedication and inspiration!

Practice and Standards for the Care of the Aged; Protocol for NursesReporting Concerns About Patient Care; Joint Newfoundland/ PRESENT OCCUPATION/POSITION Danish Primary Health Care: A Nursing Model Project (designed RetiredViolet registered Ruelokke nurse, provincial advocacy officer to demonstrate improvement in the health status of the people in of the Federal Superannuates National Association, the project areas and a model for other provinces and countries); Newfoundland and Labrador and ARNNL Education and Research Trust a registered charitable foundation designed to promote, support and assist nursing education MAJOR ACCOMPLISHMENTS and research. Violet (Squires) Ruelokke is respected for her Violet has had a life time of meaningful volunteer work. She has vision, wisdom, and leadership in nursing provincially, nationally been a compassionate advocate for various vulnerable/marginalized and internationally. Throughout her 30-year nursing career she was populations (e.g., youth in the court system, and individuals with recognized for promoting excellence, introducing innovative health HIV/AIDS). As the provincial advocacy officer of the Federal care strategies, and client advocacy. Her leadership and commitment Superannuates National Association, she lobbies for health system to nursing established the profession as a credible and equal reform so our older population has access to a comprehensive range participant in health care reform in Newfoundland and Labrador. Her of affordable services and improved standards of care. She has had commitment to primary health care continues into her retirement. numerous accomplishments to her credit, among them: CNA Award Violet has been described as an inspiring leader and role model - “a for Student Showing the Most Promise for Leadership in Nursing nurse who exemplified all that a professional nurse should be.” (1957); Queen Elizabeth II Silver Jubilee Medal (1977); and ARNNL Violet was ARNNL president (1976-1978) and executive director Honorary Member (1999). (1981-1989). Select examples of major accomplishments initiated during her leadership include: First set of Standards for Nursing nominated by: Association of Registered Nurses of NL

bilateral projects between Canada, Nicaragua and Guatemala, promoting primary health-care nursing education. These projects use PRESENT OCCUPATION/POSITION innovative technology enabling nursing distance education into rural RetiredViola coordinator, Duff International Office, Centre for areas in Latin America, thereby strengthening access and promoting Nursing Studies (CNS), St. John’s, Newfoundland sustainable health-care systems. Viola further provided technical assistance to build Latin American nurses’ capacity in nursing policy. MAJOR ACCOMPLISHMENTS Retired in 2007, Viola continues as a nurse consultant on a Canadian Viola Duff’s nursing career as an educator, International Development Agency-funded project in Paraguay and mentor and administrator directly links into CNA’s on a Tula Foundation project in Guatemala. Viola believes Canadian 5 to advance international health policy and development nurses must contribute to the advancement of global health and in Canada and abroad to support global health and equity. Viola’s equity. contribution to advance Canadian nursing leadership in international Viola was recognized in 1997 as the first non-Nicaraguan recipient development is crucial in the educating and mentoring of up-and- of Ora Taylor de Deaz Award for Outstanding Nursing Practice in coming nursing students to pursue international work. Viola was Nicaragua based on her five-year tenure as visiting professor at the instrumental in establishing the international office at the Centre for Universidad Politécnica de Nicaragua. Nursing Studies (CNS) and was the first to initiate applications for international funding projects. From 2000-2007, Viola coordinated nominated by: Canadian Nurses’ Association (CNA)

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Access VOL xxIX NO 3 OCTOBER 2008 While completing her master’s degree in nursing, she developed an Infant Feeding Assessment Tool which is used internationally to PRESENT OCCUPATION/POSITION measure breastfeeding competence. Internationally Kay has made AdjunctKay Matthews honorary research professor, Memorial a difference. She was the project director for an Association of University of Newfoundland Universities and Colleges in Canada (AUCC)/Canadian International Development Agency (CIDA) five-year project in Indonesia focused MAJORof ACCOMPLISHMENTS on nursing, women’s health and community outreach that led to the Kay Matthews is a nurse who throughout her 50- development of a master’s program in nursing at the University of year career and into her retirement has brought Indonesia, and a demonstration project in women’s health in rural honour to the profession, contributed significantly to the development Indonesia. She was also a nurse-midwife consultant with MaterCare of the Association of Registered Nurses of Newfoundland and International, a nongovernmental organization that operates safe Labrador (ARNNL), and helped to improve best practices in maternal motherhood projects in Nigeria and Ghana, West Africa. child health care in provincial, national, and international spheres. One of her strongest attributes is her generosity in sharing her The following are a few highlights of her accomplishments.Note clinical and research expertise with colleagues. There are many Kay is currently an honorary research professor at Memorial maternal child nurses in Newfoundland and Labrador who hold Kay University of Newfoundland (2003). She was a professor in the out as their model nurse. In 2006, Kay was awarded an honorary School of Nursing for 20 years, where she presented and published doctorate at Memorial University for her service in maternity care on numerous occasions in her field of expertise – maternal child to the provincial, national and international community. She has health. Kay is officially retired from Newfoundland and Labrador but received many other awards from organizations including the Cross still practises and teaches nursing and midwifery in Nunavut. of Merit: Sovereign Military Order of the Knights of Malta (1997) and She is a trained midwife who has led many “firsts” in her career. the leadership award for Women’s Health in Atlantic Canada from For example, she established a community-based children’s centre, the Maritime Centre for Excellence in Women’s Health at Dalhousie and introduced antenatal classes and other labour support methods University. to the province, including the Lamaze method. She played a Kay served two terms on ARNNL Council and was a member of significant role in the creation of the province’s first birthing room and many committees over the years. In recognition of her contributions breastfeeding support group. She was a founding member and past to the profession she was a recipient of the first ARNNL award for president of the Alliance of Midwives, Maternal and Neonatal Nurses excellence in nursing practice in 1991 and was given honorary of Newfoundland and Labrador, and was a provincial representative membership in ARNNL in 2004. with the Canadian Confederation of Midwives. Kay has also contributed to her field through research and program development. nominated by: Association of Registered Nurses of NL

She has also conducted research to identify the needs of multicultural women and developed a cross cultural resource kit for PRESENT OCCUPATION/POSITION ethnic women experiencing abusive relationships in Canada. She has ProfessorLan Gien at Memorial University’s School of authored over 115 scientific communications including 20 books or Nursing. Founding member of CAIN and executive book chapters. committee member She is an advisor to the Canadian Nurses Association’s International MAJOR ACCOMPLISHMENTS Policy & Development divison for various projects including a consultant to the Strengthening Nurses, Nursing Networks and Lan has made a significant contribution in advancing Associations Program. She has been acknowledged locally, nationally excellence in international health and research. As a professor and and internationally for her achievements. The government of Vietnam researcher at Memorial University’s School of Nursing for over 30 in 2002 presented Lan with the National Medal for Improving the years she has been the director or co-director of teams that procured Health of the Vietnamese. In 2004, she was named distinguished over nine million dollars in research grants for projects in Canada alumni by Teacher’s College, Columbia University, New York. As and abroad. the president of the National Organization of Immigrant and Visible Her research is targeted towards community issues, for example Minority Women of Canada, she was awarded the Leadership Award reducing poverty, controlling HIV/AIDS, helping ethnic women for Women’s Health in Atlantic Canada in 2005 and in 2004 the access information on pre-post natal care and breastfeeding, training Association of Registered Nurses of Newfoundland and Labrador primary health-care workers and understanding how resource presented her with the Award of Excellence in Nursing Research. depletion affects communities in Newfoundland, Nova Scotia, Finland and Vietnam. nominated by: Canadian Association for International Nursing

11 of cont... Nurses Note the government for maintaining and improving public health nursing standards. PRESENT OCCUPATION/POSITION As Assistant Executive Director, Patient Resident Services (1985- RetiredAda Registered Simms Nurse 1993), she applied her expertise to better meet client needs MAJOR ACCOMPLISHMENTS by implementing changes to staffing patterns and the model of care delivery. She also initiated and directed the implementation Ada Simms is a retired nurse who throughout of a nursing information system to improve care planning and her 40-year career and into her retirement has measurement of outcomes. brought honour to the profession, contributed significantly to the development of the Association of Registered She was a strong proponent of continuing education, leading by Nurses of Newfoundland and Labrador (ARNNL), and helped example as one of the first nurses in the province to complete a to improve the provision of health services to the people of postgraduate diploma. In 1959 she completed her Bachelor of Newfoundland and Labrador. The following are a few highlights of Nursing degree from McGill University; in 1972, her Master of her accomplishments. Health Services Administration from the University of Alberta; and since her retirement, her Master of Theological Studies from Queen’s Ada started her career making a difference, for example, she Theological College in 2003. was the first in-service coordinator (1959-1960) hired within an NL tertiary care hospital, where she initiated the first policy and Throughout her career Ada contributed significantly to the procedure system. As a director of a school of nursing (1960-1965) ARNNL. She was President from 1980 to 1982, during which time Ada continued to lead innovation and was highly respected for her the association hosted the Canadian Nurses Association biennial, ability to stimulate initiatives that led to visionary approaches to purchased ARNNL House, and initiated the transition from basic nursing education in the province. nursing education to baccalaureate education. She served on numerous ARNNL committees (chairing many), and held various From 1965 to 1970 she moved into administrative roles and was other positions on Council, as well representing ARNNL on many appointed by the federal government as Nursing Consultant with the external committees. governments of Newfoundland and Labrador and Prince Edward Island. From 1972 to 1975 she became the Director of Health Ada has also contributed on several community boards and Research with the Newfoundland government, leading research organizations throughout her career. Her good service to the public related to the design of the health-care system, the delivery of nursing was recognized in 1999 by the Governor General of Canada when services and manpower planning. she was named Serving Sister of the Order of St. John of Jerusalem. Moving into the community as a Regional Supervisor of Public To honour and recognize Ada’s significant contributions to the Health Nursing (1978-1984) she again led change, implementing profession, the health system and the people of our province, home nursing services on weekends, starting the first prenatal classes, ARNNL bestowed upon her the award of Honorary Membership in and expanding the scope of Child Health Clinics. As Provincial the ARNNL in 2007. Director of Public Health Nursing she was a strong advocate within nominated by: Association of Registered Nurses of NL

resulted in her being recruited into the position of assistant executive director of nursing of a regional rural hospital, where she was PRESENT OCCUPATION/POSITION instrumental in improving the quality of RN’s work life. She brought RegionalGoldie nurse White in , Labrador in fair and equitable personnel policies offering nurses benefits such as maternity leave, access to continuing education and support to MAJOR ACCOMPLISHMENTS attend professional activities. Goldie exemplifies commitment, caring, and Goldie has obtained several certificates in hospital organization, innovation on the front line. For 50 years, she has management and administration, as well a baccalaureate in Health been providing health services to the people of Services Administration. She has current certification in advanced Newfoundland and Labrador (NL) in rural and remote communities, cardiac life support, trauma nursing care, diabetes educator, medical where she still practices today as a regional nurse. evacuation, advanced foot care and wilderness training (in case Goldie’s very first nursing position in a rural cottage hospital anything ever happened while transporting patients). In 2006, she illustrates the type of career she has embraced; within 8 months of completed the Nurse Practitioner program. graduation she performed 50 deliveries. Over the next five decades Goldie was one of the first ARNNL presidents to come from rural she has held a variety of community based positions where she Newfoundland, a position she held for 3 years. Over her tenure recalls having to develop and interpret x-rays in the clinic attic; learn ARNNL moved on primary health care, baccalaureate nursing how to inject local anaesthesia and perform dental care; and manage education, and distance education. For over 15 years she was wide spread communicable diseases such as TB and typhoid. Her president of the local ARNNL chapter. Chapters served as a link dedication to promoting community health services remains between ARNNL and local communities. Her chapter was well undaunted today. known for their dedication to professional activities illustrated in During a recent visit by the Premier of NL to Makkovik, Goldie the well known story of how she led her colleagues across an iced secured needed funds for a new ambulance by chauffeuring the in harbour by jumping on ice pans in order to attend an ARNNL Premier in the old truck that acted as their ambulance, so he could Annual meeting. experience what patients endured. Although most of her career has been in direct care, in the early 70’s her ‘let’s get it done approach’ nominated by: Association of Registered Nurses of NL

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Access VOL xxIX NO 3 OCTOBER 2008 Bottom Buddy The Bottom Buddy is an assistive device that facilitates independence with toileting. This toilet tissue aid has a long angled handle and a soft flexible head that grips and releases the tissue with a push of a button. This device supports patient’s independence with personal cleanliness when reaching/twisting is difficult for example after a shoulder or back injury or surgery. For Clinical more information see www.bottombuddy.com Trudy-Lynn Gill, Msc.OT.(c), Occupational Therapist, St. Clare’s Corner Hospital, Eastern Health.

Stop Dribbling Research shows that approximately 70% of the elderly population who suffer from urinary incontinence can be cured, or have their symptoms alleviated. Further, there is evidence that nursing Breath of Pure Oxygen staff use strategies to contain incontinence, rather Contrary to popular belief, there is no set liter flow then promote continence. For information on how rate to use with non rebreather masks. However it is to reverse this disturbing trend go to www.rnao.org/ critical that the flow rate is high enough to prevent the bestpractices and read Promoting Continence Using bag from deflating with patient’s exhalation. Prompted Voiding (RNAO, 2005). The concentration of oxygen delivered to a client via the Venturi mask system can be altered if the openings in the coloured flow concentration adaptors are blocked, for example, by bedsheets. For this reason it is important to use the clear plastic protector/cover that comes with the system over the adapter to ensure SAFETY TIP: Ask, Look, and Listen that the flow delivered is the flow desired. Medication Reconciliation (med rec) is an effective strategy for preventing adverse drug events. Med Dan Johnson, RT, EasternHealth rec is much more then double checking, it requires increased vigilance to ensure that you have an accurate and full picture. To obtain a ‘true’ list of what your client is taking, it is recommended that you verify the profile using 2-3 sources of information. Patient Respect and Culturally Sensitive Care Interviewing the client and/or family is the most Many clients, because of religious or cultural important source. Other check points may include beliefs shun pork-derived products. However, verifying drug names, dosages etc from the up-to- many common drugs are pork derived. Drugs such date labels on the client’s medication package and/ as pancreatin, heparin, and low molecular weight or contacting the dispensing pharmacy or ordering heparins such as lovenox, as well as oral medications physician. Med rec also requires that you gain in gelatin capsules and even some vaccines contain an understanding on how the person uses pork-derived ingredients. As professionals, we have their medications, for example, when are a responsibility to our patients to inform and seek they taken and with what. Further, all consent before administering any such products. this information needs to be reviewed with every client move, for example, upon Jennifer Milmine, 3rd year BN Student, Memorial University admission, transfer, and discharge. Newfoundland School of Nursing Dannie Currie RN, MN, DHSA,Safer Healthcare Now! National Campaign, Safety Improvement Advisor

Editor’s Note: Clinical Corner is designed for nurses to share information that they have found in their experience to be practical, safe, and effective. ARNNL requires that the information provided reflect good nursing judgment. We do not confirm the validity of the submitter’s tip in the literature. ARNNL does not endorse any products identified in the submissions to this column. 13 BN (Collaborative) May 2008 Graduates

Susan Acreman Cindy Fitzgerald Coachman’s Cove Melanie Osmond Paradise Gonish Anderson Channel-Port aux Basques Paula Rose Foley tilting Pam Parrill St. Anthony Nicole Anstey Jessica Freake Joe Batt’s Arm Amanda Hollett Parrott Paradise Sarah Anthony Mount Pearl Jeanette Fudge Gander Maria Parsons Marie Antle Goulds Jenny Fudge Robert’s Arm Nicole Parsons Benoit’s Cove Tanya Antle Nova Scotia Anna Gale Codroy Valley Jenelle Peach Stephanie Atkinson Carolann Gale Doyles Lindsey Pearson Rushoon Pamela Bailey Mount Pearl Troy Giles Corner Brook Violet Pike Amy Barnes Mount Pearl Elva Green Victoria Deanne Pitcher Winterton Bobbie-Jo Bartlett Wanda Griffin Kippens Laurie Porter Chris Bath Tizzard’s Harbour Leah Guzzwell Gander Nicole Power Shearstown Megan Beck Swift Current Elaine Handcock Mount Pearl Janice Preston St. John’s Deann Bennett Flat Bay Sheranne Hann Burgeo Diana Pretty-Stead Dildo Shaina Bennett St. John’s Katherine Harris St. John’s Colin Pynn New Chelsea Colin Blanchard Corner Brook Erna Henke Nestleton, Ont. Crystal Randell Raleigh Holly Brady Fortune Chantel Herridge Grand Bank Ashley Reddy Nancy Bragg Greenspond Victoria Hickey O’Donnells Alicia Reid Deer Lake Janice Brennan Stephenville Crossing Julia Hicks Paradise Trista Reid St. John’s Brian Brenton Pasadena Jennifer Hillier Griquet Hank Rice Brighton Crystal Brett Clarke’s Beach Shauna Hollett Springdale Melissa Richards Corner Brook Joelle Bridger Badger Stephanie Holloway South Joanne Rideout Janice Brown Arnold’s Cove Jennifer Hooper Campbellton Krista Rideout Buchans Stephanie Browne Grand Falls-Windsor Jodene Hopkins Rigolet Crystal Rose Gander Jenny Bursey Carmanville Donna Horne Mill River, P.E.I. Amanda Rowe heart’s Content Sandra Bursey Paradise Brandi Howell Paradise Ainsley Ryan St. John’s Kristin Caines Bartlett’s Harbour Melissa Hunt Wareham Sara Seymour Butlerville Melissa Card Badger Natasha Hunt St. John’s Ashlee Sheppard Coley’s Terri Lynn Cassell Cottlesville Jenelle Hurley herring Neck Daniel Sheppard Pasadena Todd Chard St. John’s Stephanie Jones St. John’s Rebecca Sheppard Bay Roberts Jonathan Christopher St. John’s Kelly Kean Badger’s Quay Kelly Sims Franklin, Tenn. Lorie Churchill Portugal Cove Desiree Knee Grand Falls-Windsor Colin Slaney Courtney Coish Paula Lacey St. John’s Candice Smith Mount Pearl Kara Colbourne St. Anthony Sheila Lainey Fox Island River Megan Smith Jacques Fontaine Krista Colbourne St. Anthony Carolyn Lawrence Pasadena Megan Snook Sharon Collins hare Bay Shawna Lee St. George’s Maralee Snow Baytona Courtney Cooper Grand Bank Erin Ryan Lewis Colliers Angie Spurrell Brookfield Ashley Costello Jeremy Loder Corner Brook Beverly Squires St. Anthony Allison Courage Paradise Kelly Lush Pasadena Colleen Squires St. John’s Charlene Cron Oates harbour Grace Stephanie Lynch Bellevue Beach Liam Squires St. John’s Jane Crosbie St. John’s Carla Major Deer Lake Stephanie St. Croix St. John’s Bradley Cumby Paradise Stephanie Major Corner Brook Marie Strang St. John’s Deanne Curnew victoria Terrilyn Matheson Alicia Taylor Corner Brook Kara Emma Daniels Renee Maynard St. John’s Jennifer Temple Botwood Renee Davis Grand Falls-Windsor Timothy McAllister St. John’s Brian Terry Irishtown Heather Dawe Conception Bay South Brittany McCarthy Port Saunders Stephanie Tiller Mount Pearl Danielle Decker Gander Carla Ann McKenzie Corner Brook Nicole Tobin Mount Pearl Chelsea DeGruchy New Glasgow, N.S. Joanne McLean Spaniard’s Bay Katherine Tuck St. John’s Tina Del Rizzo St. John’s Sarah Moore Dildo Nichole Tuttle Shearstown Alana Devereaux Mount Pearl Kristie-Ann Morgan Gander Stephanie Walbourne Corner Brook Nancy Dinn Goulds Amy Mugford Makinsons Erica Walsh St. John’s Laura Dodd Corner Brook Jane Mulcahy Mount Pearl Janine Walsh St. John’s Jessica Drover harbour Round Zoe Myers Castor River North Terri Walsh-Lucas Stephenville Crossing Tara-Lee Drover heart’s Delight Rebecca Nash hermitage Amelia Walters Burnt Islands Amy Drummond Frederickton Danielle Noble Robert’s Arm Lori Warford Conception Bay South Tina Dunne Sabrina Noftall Shelle Wells Cormack Sarah Dwyer tilting Sabrina Novotny Ajax, Ont. Shauna Welsh Summerford Jessica Dwyer-Milley St. John’s Lisa O’Brien Corner Brook Jonathan White Newtown Rosemary Eddison Roddickton Kimberly Oake Deer Lake Maria White St. Brendan’s Natasha Edwards St. John’s Karla Oates Joyce Williams Freshwater, P.B. Candace Eveleigh Corner Brook Jenny Oldford happy Valley-Goose Bay Kimberley Young Marystown Marty Fewer Benoit’s Cove Melanie Oldford Mount Pearl

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Access VOL xxIX NO 3 OCTOBER 2008 A transcultural nursing experience to impoverished Mexico by Christopher Nolan, 4th yr BN student, MUN (Fast-track)

An interesting story and an equivocal challenge working with Mexican people was their hesitance to say ‘no’ while testing their vision. Vision testing is a methodical process and as examiners we were constantly asking “is this clearer?” Many of the patients would always say yes! During my first few examinations, the patients had me puzzled and I had no s a Bachelor of Nursing fast-track student at Memorial idea which prescription was needed as it seemed everything University of Newfoundland who is set to convocate in made their vision clearer. I soon found out that this indeed, A October 2008, I felt it imperative to make the most out was a cultural norm and that I was not going crazy! of my university experience and so, set out to do this for two Our multidisciplinary team was able to help hundreds of weeks of my nursing practice elective course. impoverished Mexicans regain improved vision. Mexicans In 2005, I had traveled with an organization called Samaritan’s who otherwise would have had to decide -- do I buy food Purse to Belize, Central America. During my trip, I volunteered or do I go see an eye doctor? Many of the people we helped in make-shift medical camps and helped distribute Christmas had vision loss so severe that none of the glasses we had could gifts to local children and adolescents. In mid-February of perfect their vision, but they were amazingly content and 2008, I began doing research into this same organization grateful with any improvement we could provide to them. and came across an opportunity that looked appealing. After I remember, in particular, one patient, an older woman, being accepted by the organization and granted permission who was technically blind in one eye, due to cataract removal, from the School of Nursing, on August 8th, 2008 I once and who had immature again embarked on a journey with Samaritan’s Purse to cataracts in her other eye. Querétaro, Mexico. There, I resided at a local orphanage with For her, simple activities eleven other individuals from across Canada and, together, such as walking, cooking we offered a variety of medical assistance to residents of the and being able to see the area. I was cross-culturally trained in eye anatomy, eye health faces of her grandchildren and disease, vision screening and testing. I was also taught was a constant struggle. to prescribe basic eyeglasses to individuals in need who did As my patient, I was able not have the financial ability to visit an optometrist and who to examine her eyes and would otherwise have lived without what most of us take for give her two prescriptions granted; the gift of sight. (prescription sunglasses and normal eyeglasses) that My experience in Querétaro taught me an important BN student Christopher Nolan performs vision lesson about transcultural nursing. For while transcultural although clinically barely testing on a resident of Querétaro Mexico. nursing is covered in the nursing curriculum at Memorial helped her vision, made a University and most other accredited Bachelor of Nursing drastic improvement to her quality of life. When trying her programs in Canada, it is difficult to realize exactly what glasses on, she began to sob and in Spanish spoke “now I can cross cultural training entails by reading it from a text book see my grandchildren”. She was in disbelief that the service or scholarly article. Closely related to transcultural nursing we were providing was free-of-charge and that a group of is cultural competence, a term that sounds self-explanatory individuals cared so much about people like her that we were and unceremonious, but in my opinion, is contrary. Leininger there to help. This is a memory I will forever cherish. (2002) describes cultural competence as nurses having the We live in a world where cultures mesh and intertwine ability to understand that cultural differences exist in their unceasingly and as nurses we work in a special profession provision and delivery of safe-competent nursing care to where we will inevitably cross paths with clients from various clients of differing cultural backgrounds. From experience backgrounds. I feel it is unrealistic and insurmountable to be as a nursing student, I have difficulty believing it is possible culturally aware of all cultures that exist, but what we can do and realistic to be culturally competent in a world where so is use our sense of curiosity and the desire to holistically get to many cultures exist. For me, being submersed in a different know each of our patients. Nursing is a degree that, for me, cultural meant being respectful and showing genuine respect has and will continue to open many doors. Doing international to people, being patient and sensitive, and above all, asking volunteer work is, and will continue to be, a desire of mine questions. In doing so, I quickly found out that Mexicans were which will hopefully lead to many more future opportunities more than willing to share their story and the reasons behind to help others. certain cultural norms and practices. References available upon request.

15 As a Nurse, why should I take notice of the Booster Seat Legislation? BY Shelley Bauer RN, MN, Continuing Nursing Studies - Facilitator LPN Health Assessment

n July 1st of this year, it became mandatory in NL to use a booster seat for children who have outgrown a car seat Oyet who do not fit the vehicle seat belts safely. Children between 40-80 lbs, under 57 inches tall and under 9 years of age must ride in a safe and appropriate booster seat. Nurses, just like some of the general population, don’t always know how or why this legislation was necessary and why they should take notice of it. As a nurse, a mom, an educator, a taxpayer and a child passenger safety instructor trainer, I give you 5 good reasons to take note of this legislation:

Take the time to boost your child and your patients up to safety. Kids Because it will save lives. in Safe Seats is a Newfoundland’s only child passenger safety action Motor vehicle collisions are the leading cause of death and injury among children group. Visit our website today: www.kidsinsafeseats.ca and youth (Canadian Hospitals Injury Here is a simple chart about the 4 stages of child passenger safety. Cut it out and post it on 5Reporting and Prevention Program). Between 100 your fridge, the coffee room or beside the weigh scale at work. and 150 Canadian children under the age of 12, die from motor vehicle collision injuries every year, most are in the 5-9 age range “the forgotten For the small child – keep him/her rear facing children”. Stage 1: until he/she is at least 22 lbs. Infants In a rear Because it will save the health care For the big/heavy child – get a larger rear facing up to one facing car seat that will keep him safely rear facing until he system money. year of seat. is at least one year of age AND pulling himself Children using seatbelts instead of booster age up to a stand independently. There are seats that seats are 3.5 times more likely to suffer a can be used rear facing up to 35 lbs. 4significant injury in a collision and 4 times more likely to suffer a severe head injury. The more severe the injury, the longer the hospitalization, the more procedures required, the longer rehabilitation Stage 2: All forward facing car seats should be tethered, time and the greater the health care cost. and have tight seatbelts and snug harnesses. Toddlers In a For the big/heavy child – there are new car seats over Because it will save our province forward available that allow you to keep your child in a 1 year money. facing car forward facing car seat using the internal harness of age, In 1999, there was a conservative estimate seat. until they are at least 60 lbs. This is good for heavy weight 22- that motor vehicle collisions cost this young children (under 4 or so) who might not be 3province over 9 million dollars in indirect costs. 40 lbs able to leave the regular seat belt connected. These are not the direct costs of providing health care to the injured person but the less tangible cost in days of work lost by the family of the injured There are lots of booster seat styles available. person, permanent disability and life long losses in There are booster seats that are converted from productivity. These losses continue to this day. In a a rear facing/forward facing car seat, there are Stage 3: booster ones that convert from a forward facing car seat, Because it is not an expensive or there are boosters-only large and boosters-only For seat, inconvenient measure. small. The trick is to find one that fits your child children with or If you have head rests in the back of your and helps him fit the seat belt properly. The lap 40-100 lbs. without a vehicle, a booster seat suitable for a child belt needs to be on the child’s hip bones, not 2from 40lbs to 100lbs, costs only $35. This is less back. soft tummy. The shoulder belt should cross the than a month of music lessons, or a date out to the middle of the clavicle, not rubbing the neck or in movies or hockey game. The booster seat will fit in a large grocery sack to go from car to car, daycare front of the face. to grandma’s house or taxi to home. Use the seatbelt in the vehicle ONLY WHEN: Because no parent, aunt, uncle or Stage 4: The child can sit all the way back on the seat. grandparent deserves to live through For children The child’s knees bend over the front of the the death or life threatening injury to seat. over 80 In the their child. The seatbelt lap portion fits on the hip or thigh 1 lbs, over seatbelt in It does not matter who the parent is (nurse, doctor, bones, not the soft abdomen. 57 inches the back teacher, police, fisherman, gas station attendant), The seatbelt shoulder portion fits the middle of tall and seat. the pain of losing a child or being responsible for the child’s shoulder, not rubbing the neck or in their severe injury is almost crushing. over 9 front of the face. years of The child can stay properly seated (as in #1-4) age. for the whole trip.

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Access VOL xxIX NO 3 OCTOBER 2008 Trust Award Recipients: Spring 2008 Continuing Education Competition

CNA Certification Barbara Albrechtsons (St. John’s) Cynthia Bartlett (Mt. Pearl) Wanda Coffee (Goulds) Andrea Doyle (St. John’s) Lorraine Evans (Deer Lake) Dorothy Evans-Hawkins (Flatrock) Beverley Fennelly (Paradise) Anita Forward (St. John’s) Penny Grant (St. John’s) Florence Kane (St. John’s) Cheryl Keating (Corner Brook) Karen Kelly (Pasadena) Christine Kelly (Paradise) Kayla Letto (Corner Brook) Deanne Madore (Jeffrey’s) Andrea Moores () Katherine Organ (Port Aux Basques) Joanne Peddle (Paradise) Ulrica Pye (Corner Brook) Debbie Ryan (St. John’s) Tanya Shalaby (St. John’s) Sandra Stone (St. John’s) Patricia Sutton (Corner Brook) Colleen Weeks (Kilbride)

Conference Linda Bonnell (St. John’s) Michelle Delouche (Paradise) Viola Finn (Mt. Pearl) Beverley Rockwell Lola Gushue (Gander) In Memoriam Gloria Head (St. John’s) It is with great sadness that the Association of Registered Nancy King (St. John’s) Nurses of Newfoundland and Labrador marks the passing Terri Lester (St. John’s) th of Beverley Rockwell, BN, RN, MSc., on August 16 , 2008. Debbie Lynch (Paradise) Beverley had a long and distinguished history with the ARNNL Georgina Macfie (St. John’s) having served as President Elect from 1984-86, President Jennifer Matthews (St. John’s) from 1986-88 and Past President from 1988-90. Beverley Barbara Moyst (St. John’s) was also one of the first Trustees of the ARNNL Education Sheila Parsons (Corner Brook) and Research Trust in 1986. During her time with ARNNL Arlene Scott (Torbay) Beverley was active on the Task Force on Entry to Practice Merlee Steele-Rodway (Mt. Pearl) as well as the Primary Health Care Project. Beverley was also involved in the work that led to Newfoundland and Labrador being one of the founding members of the Canadian Nurses Protective Fund. An active and well respected member of faculty at Memorial’s School of Nursing, Beverley was known for her dedication to her students and to her profession. Her legacy of activism and education will have a lasting impact on the nursing profession for many years to come.

17 Goings on...G oings on... coming soon! Another great book about nursing from the authors of From the Voices of Nurses… A Life of Caring: Sixteen Nurses Tell Their Stories Marilyn Beaton, Jeanette Walsh & Marilyn Walsh A collection of Oral histories from nurses practicing during the 20s and 30s in Newfoundland and Labrador. Want to win a copy of ISBN 978-1894377-251-0 Available October 2008 ‘A Life of Caring’? Visit our website www.arnnl.nf.ca before November 15th, 2008 to enter.

Important Notice Examining Options for Dialysis to Registered Nurses Who Work in NP-Type Roles Services in Rural and Remote And Employers Regarding Newfoundland and Labrador the ARNNL Nurse Practitioner The Newfoundland and Labrador Centre for Applied Health Competency Assessment Program Research (NLCAHR) has completed the first project of the The ARNNL Nurse Practitioner Competency Assessment Contextualized Health Research Synthesis Program (CHRSP), Program (NPCAP) will be discontinued. Effective July and the report is now publicly available on the NLCAHR 1, 2009 the ARNNL will no longer be issuing initial NP website. registration and licensure to registered nurses based on The first study looked at the issue of how we can meet the the successful completion of the NPCAP. As of July 1, province’s needs for dialysis services in rural and remote 2009 only RNs who have successfully completed a course populations, while considering efficacy/effectiveness, of study approved by Council will be considered for initial cost, acceptability, and feasibility of the available treatment registration as an NP. options. Note: This will not affect the ongoing licensure status of NPs The goal of CHRSP is to provide health decision makers with who were assessed as eligible for registration and licensure the best available evidence that is attuned to the capacities, using the NPCAP up to and including June 30, 2009. characteristics and needs of Newfoundland and Labrador. Anyone who requires more information about the NPCAP Reports available on NLCAHR website: www.nlcahr.mun. or this notice should contact [email protected] ca/research/chrsp

The Community Health Nurses Association of Canada has released a translated and revised edition of the CCHN Standards of Practice. The SOP were first published in 2003 and define community health nursing practice and set out the professional expectations for community health nurses. To view the CCNN Standards of practice visit: http://www.chnac.ca

Conferences and Workshops 21st Operating Room Nursing Association of CGNA 2009 - Making Moments Matter Canada (ORNAC) Conference The 15th National Conference on Gerontological Nursing June 7–12, 2009 St. John's, NL May 27–30, 2009 Banff Conference Centre, Alberta For further information contact registration co- Keynote speakers include: Dr. Beth Berry, Dr. Gloria chairs, Val Tilley [email protected] or Jo Moss - Gutman, Laurie Skreslet and Dr. Dorothy Pringle. [email protected]

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Access VOL xxIX NO 3 OCTOBER 2008 ings o LG Health Mentoring Program o n Call for G ... for Regional Nursing Goi . Abstracts n .. Community Clinics in Labrador have been gs on The Academy of Canadian Executive Nurses, the Canadian a strong supporter of preceptoring nursing Association of Schools of Nursing, the Canadian College of Health students. Through partnerships with Service Executives, the Canadian Healthcare Association, the Government, Health and Social Canadian Nurses Association and the Canadian Public Health Development, nursing students gain clinical Association are pleased to issue this call for abstracts for the 2009 Nursing Leadership Conference. experience in Public Health, Home care and Nursing leaders play a pivotal role in ensuring professional Community Clinics. practice environments that support positive outcomes for clients, In April 2007, a 4th year nursing student, Jane Rennison families and communities. started on her adventure of community health nursing in This call for abstracts is for both concurrent oral and poster Nain. Out of that came the renewed idea of developing the presentations. Submissions should focus on local, regional, provincial, territorial, national or international initiatives on nursing LGHealth mentorship program for Regional Nursing. Past leadership that are of interest to a broad range of nurses and are programs in 1998 and 1999 have been very successful in related to one of the five conference themes. retaining nurses in Labrador. Thus in June 2007, Jane began For more information visit: http://www.cna-aiic.ca/CNA/news/ a 10 month preparation program in Regional Nursing. The events/leadership/default_e.aspx program provided the knowledge and experience needed for a newly graduated nurse entering this advanced role. Throughout this entire program Jane’s constant mentor, Pat Crotty, Regional Nurse II, Nain maintained the support needed to gain confidence, experience, knowledge and skills. With the help of numerous preceptors at different rotations, Jane has also gained critical thinking, decision-making, collaborative planning and coordination of nursing care. Jane starts her new nursing career in Nain on May 5th, 2008. We wish you the best as you apply the knowledge and skills you have gained and use your enthusiasm as you continue to learn. Kathy Elson, RN Jane Rennison, BN Clinical Nurse Coordinator Regional Nurse I, Nain Community Clinic Community Clinics LG Health ARNNL President meets General Rick Hillier at CNA AGM General Rick Hiller (left) and ARNNL President Jim Feltham (right).

Jurisdictional Review of CRNE Exam comes to the Janeway: Questions: June 24th 2008 RNs meet Danny Cleary and touch Lord Stanley’s Cup Kathy Watkins, centre for Nursing Studies; Peggy Daly, MUN; April Daley, Left to right: Sarah Druken(PCA), Jane Mulcahy (RN), Gerri Williams (PCA), Eastern Health; Corinne Humby, Eastern Health; Gemma Langor, Centre for Sue Brocklehurst (RN), Daniel Cleary, Trish Lane (RT), Elizabeth Kelly(Clerk II) Nursing Studies; Gladys Schofield, Centre for Nursing Studies; Marilyn White, Western Regional School of Nursing; Doris Edwards, Western Regional School of Nursing; Paula Kelly, MUN; Anne Blackmore, Eastern Health; and Ruth Martin Eastern Health Go oings on... ings on...G 19 HOME and AUTO INSURANCE for members of the Canadian Nurses Association

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Access VOL xxIX NO 3 OCTOBER 2008

Projet : Annonce People Concept 2008 Publication : Bulletin Épreuve # : 2

No de dossier : MM7305-07-U_MM_GD_ME_EN•cnanurses Format : 7.5 X 10 Date de tombée : 5/03/08

Client : Meloche Monnex Couleur : N&B Graphiste : Francis Trottier

Hamelin Martineau • 505, boul. de Maisonneuve O. Bureau 300 • Montréal (Québec) H3A 3C2 • T : 514 842 4416 F : 514 844 9343 ATTENTION : Merci de vérifier attentivement cette épreuve afin d’éviter toute erreur. 21 2009 ARNNl Meeting Date Changed to June 22nd-24th ARNNL wishes to inform members of a change in the date of the Annual General Meeting from June 1st - 3rd to June 22nd - 24th. The AGM will continue to be held at the Arts and Culture Centre, Corner Brook. The AGM date was changed as it coincided with the June 1st - 2nd 2009 Canadian College of Health Service Executives and Canadian Healthcare Association national conference Accountability in Health System Leadership: A Balancing Act to be held in St. John’s. This event will be hosted by our province.

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