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A word from Joy RichardsCourageous Practice Lives Here!!
“Courage is the capacity to confirm what can be imagined”. Leo Rosten
There are few more universally admired human characteristics than courage. Every identified culture and civiliza-tion attaches significance to exemplary
acts of courage and those individuals who are seen as courageous. Courage can be attributed not only to occasional and isolated acts of rescue or self-sacrifice, but also to typical daily living; everyday courage which compels us as individuals and health care providers to embrace life, and make choices in spite of fears, complexities and life’s day-to-day difficulties.
Courageous practice is not always easy! Championing our
iCAPUHN Physical Therapy (PT) point of care researchers Moissei Zinguer, Chaya Gottesman, Sherry Harburn, Vincent Lo, and Anna Michalski, along with George Djaiani (Anaesthesiologist, Cardiovascular), Sue Gowans and Carol Heck, Scientists, Health Professions received a UHN Allied Health Research Grant to evaluate the ability of acupuncture to decrease incisional pain following open heart cardiac surgery.
Patients who have had cardiac surgery receive medication for post-operative pain management. While postoperative medication provides sufficient pain relief for most patients, some require additional interventions for adequate pain control at rest and to be able to get in and out of bed and move around immediately following surgery – all important aspects of good postoperative care that promotes recovery and minimizes complications. While pain control can be improved by increasing medications, this is
eCAPCourageously Venturing into the Unknown
In September 2012, a second cohort of students began their learning journey in the Nipissing University Scholar Practitioner Nursing Program (NU-SPP). UHN is one of five academic health agencies in downtown Toronto that hosts this highly innovative BScN program. Students enter the NU-SPP with an undergraduate degree; this year’s cohort includes individuals with degrees in kinesiology, linguistics, music, and psychology. The goal of the program is to prepare “practice
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COLLABORATIVE ACADEMIC PRACTICEconnecting
knowledge to care
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Upcoming Event• January 25th, 2013
Health Professions Recognition Event http://intranet.uhn.ca/departments/allied_health/
AnnouncementsScholarships & Awards
The 2013 Nursing Scholarship & Award application process is open from now until noon on January 18, 2013.
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Season Greetings and Happy Holiday from all members of the Collaborative Academic Practice Portfolio, from our team to yours! We wish you, your colleagues and your families all the best of the holidays and health and happiness in 2013!!
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The Cornerstone Campaign
From left: Elise Arbic, Barbara Manera, Deb Appleton, John Manera, John Iannuzzi, Debra Johnston, Alison Cocking, Velta Vikmanis, Sean Kelly, Anna Pamaong, Ruth Macneur, Beth Curiale
Thank you Toronto! We’re still tallying the final amount raised for our community — stay tuned; we’ll announce the final number in January! We’re also excited to share that we had more than 11,000 climbers take part in this year’s Enbridge CN Tower Climb for United Way. By taking part in the 2012 Enbridge CN Tower Climb for United Way, you have helped make a lasting difference in our communities.
Because you gave, we are able to help people move from poverty to possibility. Because you volunteered your time, fundraised and gathered pledges, we are able to build healthy people and strong communities. And because you took action, we are helping kids be all they can be. We can’t continue to do this vital work without you — by coming together at the Enbridge CN Tower Climb for United Way; we’re able to build a better city for everyone.
One step at a time, you’ve done so much to help make this a better city for all.
We also want to extend a special thank you to all the volunteers, sponsors, partners, donors, community members, and other par-ticipants who made the Enbridge CN Tower Climb for United Way happen.
GET READY FOR THE NEXT CLIMB IN 2013
If you are interested in joining the 2013 UHN Climbs CN Tower team please email [email protected].
Applicants must complete the online form including as much detail as possible. In addition, the opportunity to attach an up-to-date CV is provided. The applicant is also required to provide the name and email address of one referee. The referee will be asked to complete an online reference form.
All completed applications and reference forms received by the deadline date will be reviewed by a selection committee. Appli-cants will be considered for all awards and scholarships for which they qualify. Selection committee decisions will be made before the end of March and the winners will be contacted with more details.
We look forward to honouring our staff as well as the many donors who have given so generously to nursing.
UHN Educational Development Initiative
UHN Education is embarking on an environmental scan of staff to identify the strengths and opportunities for educational devel-opment at UHN in order to enable exemplary education for clini-cians and tomorrow’s healthcare leaders. Preliminary results will be shared in the New Year, culminating in a summit to determine our aspirations and future plans for educational development at UHN. It’s not too late to share your thoughts- follow this link!
https://www.surveymonkey.com/s/Edudevelopsurvey
Announcements ...from cover
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eCAP ...from cover
ready” nurses who are courageous, proficient, curious, insightful, and knowledgeable. The NU-SPP focuses on the creation of learning partnerships, both in the clinical and classroom settings. From the beginning of the program, students are partnered with experienced nurse preceptors for each clinical practicum and must design individual learning plans that will move them toward fulfillment of the College of Nurses of Ontario Entry to Practice Competencies by graduation.
Students learn by observing and participating in care with their preceptors, supplemented by extensive individual study and small group reflection seminars. During the first few days together this past September, the excitement, nervousness, and apprehension among the students was palpable. They were beginning a learning journey with many unknowns, and like stepping onto a tree-top canopy walk, the first few steps involved white knuckles and more than a bit of courage.
Margaret Duff, Nipissing University Faculty Advisor says, “After a few weeks in the program, students are already beginning to express confidence in their abilities to form therapeutic relationships with patients, and to understand the significance of the patient care they have observed. Students now report that their initial trepidation is gradually being replaced with a sense of pride in being able to contribute to patient care in a meaningful way, as well as a sense of empowerment and clarity with respect to their own learning goals and process”.
The NU-SPP completed the initial steps toward accreditation by the Canadian Association of Schools of Nursing in October of this year; further steps toward accreditation will be taken once students have graduated and moved into the nursing workforce.
UHN Advanced Cardiac Life Support Program takes flight
Until recently, UHN staff seeking Advanced Cardiac Life Support (ACLS) certification or recertification had no choice but to enroll in
external programs. Beginning this fall, staff have the opportunity to participate in a new on-site interprofessional ACLS program that offers the advantage of using the same equipment that is used in Code Blue response situations at UHN. Several staff, already certified ACLS instructors, have now become part of the teaching faculty for the UHN-based program. The program, fully endorsed by the Ontario Heart and Stroke Foundation, incorporates high fidelity simulation using the latest SIM Pad technology. The inaugural one-day recertification course ran on Oct 27th; the first full ACLS certification program ran on November 17th and 18th. This interprofessional simulation-based ACLS program is another first for UHN! For further information, please email [email protected] or visit http://intranet.uhn.ca/education/docs/ACLSFlyer.pdf
Course Director - Bert Laranjo, Course Instructor - Dr Boris Zevin, Medical Director - Dr Vukiet Tran, Course Coordinator - Brenda Ridley
Participants from the first full ACLS certification program – November 17th & 18th, 2012
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Courage lives in Education
Imagine an internationally educated healthcare learner coming to a new country, a new language, and a new healthcare system—it takes courage!! Participating in the innovative Interprofessional Education for Internationally Educated Nurses Clinical Placement Program (a Toronto Rehab - George Brown College partnership) fostered Valeriya’s “confidence in [her] nursing role, as an advocate for patients, and as a valued team member”. When an opportunity arose in the Complex Continuing Care program, Valeriya Shvedkina stepped right in communicating and collaborating with the interprofessional team to achieve the patient’s goals—that takes courage as a learner! Congratulations to Valeriya.
UHN Launches NICHE
We all know that seniors make up a significant proportion of the patient population at UHN. Last year, the Senior Friendly Steering Committee was struck to develop and implement strategies to better address the needs of our senior patients. The initial work of this committee has been focused on achieving accreditation as a NICHE hospital. NICHE (Nurses Improving Care for Healthsystem Elders) is a comprehensive program originating at the Hartford Institute for Geriatric Nursing at New York University College of Nursing.
The first step of the NICHE program involves an assessment of our current state of care for seniors. To this end, we are asking all clinical staff to complete the Geriatric Institutional Assessment Profile (GIAP), an online survey that takes approximately 15 minutes to complete. It is designed to
• identify gaps in nursing and interprofessional knowledge about geriatric care,
• measure staff attitudes and perceptions about working with older adult patients, and,
• identify current strengths and areas for improvement in relation to caring for our senior population.
Survey results will allow us to benchmark against other participating hospitals and to monitor our own progress from year to year as we implement education and quality improvement initiatives.
Thanks in advance for your support of this important initiative. We are relying on the results of this survey to provide us with good baseline information!
For questions about the GIAP Survey, please email [email protected] or by phone at 14-4292.
Preparing for Interview - Kathy Camelon, Registered Dietitian, shares her Breakfast Television experience
When I was invited to participate in a Breakfast Television (BT) program by the Toronto General and Toronto Western Foundation as part of a fundraising initiative for Diabetes at UHN, I initially felt hesitant. After some consideration, I took on the invitation cum challenge, and this is what I learned …
• Work with the Foundation to agree on key messages related to fundraising from the UHN perspective
• Consult with your UHN colleagues and be prepared to speak about the important messages for public education and awareness
• Have key messages in short sound bites.
• Get in your key messages at first opportunity – a planned five minute live interview can become a 3 minute spot depending on events of the day,
• Use props to help give the message – “A picture is worth 1000 words” … I was promoting the UHN recipe book generously sponsored by Sun Life and it was helpful to have it in front of me.
• Look around the set to see if anything detracts from your message. In my case I had the set crew remove large glasses of orange juice (something we do not recommend for people with diabetes) from the table in front of the host and me
• Get some media training - Public Affairs has good tips
• Get a good night’s sleep and relax – you have more expertise than you can imagine! Just give the basic messages you give patients every day.
Would I do things differently if I could do it over again? Of course - Like any other skill the more you practice, the better you become. An experience that was once considered courageous can become another routine part of our job and tremendous repertoire of talent! Congratulations to Kathy for her courage in being on BT!!
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Colina Yim, Advanced Practice Nurse
On behalf of His Excellency the Right Honourable David Johnston, Governor General of Canada, and the Canadian Liver Foundation (CLF), the Queen Elizabeth II Diamond Jubilee Medal to recognize Canadian volunteers, ma-jor donors and health care providers who have made significant contribu-tions, has been awarded to one of our own.
It is our honour to announce that Colina Yim, RN, MN, NP from Canada’s esteemed liver health care community will be awarded the Queen’s Diamond Jubilee Medal. Please reach out to Colina and extend your congratulations!!
Dr. Brian D. Hodges, UHN’s Vice-President of Education
Dr. Brian D. Hodges has won the 2012 Alpha Omega Alpha Robert J. Glaser Distinguished Teacher Award (American Association of Medical Colleges). Recognizing Dr. Hodges’ pas-sion and leadership, both nationally and internationally, he has advanced the science of medical education through seminal changes, including balancing the traditional four-year
model with an outcomes-based approach focused on demonstra-ble clinical skills and learning objectives. Congratulations Brian!
Dawn Tymianski, Nurse Practitioner
We are delighted to share that Dawn Tymianski, Nurse Practitioner at Toronto Western, has received the Baxter Award of Excellence in Leadership for Nursing Research. This annual award recognizes some-one who has demonstrated outstand-ing commitment to developing a research culture among practicing nurses at UHN, risked being available
for learning about research, and dedicated time and energy to learning with, coaching, and mentoring novice nurse researchers. The award was presented at Nursing Research Day on November 29th, 2012. Congratulations Dawn!!!
Let's welcome new hire - Stephanie Spielmann
Please welcome Stephanie Spielmann, newest member of the Nursing, New Knowledge and Innovation team in the role of biostat-istician/grant development and coor-dination. Stephanie is almost finished her PhD in social psychology from the University of Toronto and has seven years' experience conducting social science studies with specific expertise
in quantitative methods and statistics. As a complement to her statistical expertise, Stephanie has experience managing multiple projects and research assistants and has successfully communi-cated her research findings to a wide variety of audiences through published manuscripts, oral and poster presentations and inter-views with the media. Please seek Stephanie out and welcome her to UHN and to 1-EN!
We're delighted to have Shelizé Hirji, Corporate Planner, on our team
Shelizé Hirji, Corporate Planner, Corporate Planning, has accepted a secondment role two days per week with the CAP portfolio for the next six months. Since joining the team in October, she has made significant contributions!! We are delighted to have Shelizé bring her knowledge of UHN strategy, the balanced scorecard and business operations to our team. Shelizé reports to Susan Brown, Director Strategy and Transformation, and is actively involved in supporting advanced planning and the roll out of the portfolio’s op-erating plan. She will continue her work with the Wellness and York UHN Academy developments. This secondment provides Shelizé with a new learning opportunity while providing the CAP port-folio with increased alignment with Corporate Planning. Shelizé continues to report to Annabelle Bandurchin, Manager, Corporate Planning for her corporate accountabilities. A warm welcome to Shelizé!
Congratulations & Introductions
Academic AccomplishmentsResearch Challenge Publications
Collaborative Academic Practice is committed to providing sup-port for staff at the point of care to participate in knowledge creation about patient care and quality of work life phenomena. Since the inception of the novice nurse research program in 2006,
60 teams have participated in this highly successful program. We are proud to announce that these studies are being published in peer reviewed journals, as well as being presented locally, nation-ally and internationally. Congratulations to three of our Research
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Challenge Teams who have published their studies, and who con-tinue their efforts to translate research into practice.
Jeanne Evans, Jennifer L. Bell, Annemarie E. Sweeney, Jennifer I. Morgan, and Helen M. Kelly. (2010). Confidence in critical care nursing. Nursing Science Quarterly, 23(4), 334-340.
Prisco Salvador, Cristina Buco, Lisa Wang, and Doris Howell. (2012). A pilot randomized controlled trial of an oral care interven-tion to reduce mucositis severity in stem cell transplant patients. Journal of Pain and Symptom Management, 44(1), 64-73.
Karen Thomas, Ross Riggs, and Kimberly Stothart. (2012). The meaning of changing expectations: A qualitative descriptive study. Nursing Science Quarterly (in press).
With four novice research studies currently in the manuscript de-velopment stage, big thanks are owed to all those people at UHN who provide support and encouragement to the teams. This syn-ergy of effort towards academic practice creates an organizational culture where our novice researchers can reach the important pro-fessional milestone of publication in a peer reviewed journal.
Next quarter, we will highlight the academic achievements of our senior researchers in the CAP portfolio, which includes our Chairs in Research and PhD prepared colleagues in the Nursing and Allied Health Professions.
Publications
• Debra Johnston, Sherele McGhie, Rosalie Magtoto and Carol Skanes. (July/September 2012). The evaluation of a newly developed One Minute Pressure Ulcer Documentation Tool. World Council of Enterostomal Therapists Journal. 32 (3); 8-14.
• Hanna, E., Soren, B., Telner, D., MacNeil, H., Mandy Lowe, & Reeves, S. (2012). Flying blind: The experience of online interprofessional facilitation. Journal of Interprofessional Care: Early online, 1-7.
Presentations
• UHN Psychology Department. (November 9, 2012). GTA Psychology Practicum Day [Networking], York University, Toronto
• Langlois, S., Davidson, S. & Mandy Lowe. (Oct. 2012). De-veloping Team-Based Collaboration and Communication Competency in Geriatrics: A Comparison of Face-to-Face and On-line Learning. All Together Better Health IV, Kobe, Japan.
• Langlois, S., Davidson, S. & Mandy Lowe. (Oct. 2012). De-veloping Team-Based Collaboration and Communication Competency in Geriatrics. All Together Better Health IV, Kobe, Japan.
rCAPCollaborative Academic Practice is participating in two stud-ies with University of Toronto and Ryerson Nursing Faculty colleagues
1. The National Nursing Quality Report Initiative Pilot Demonstration Project (NNQR) is sponsored by the Canadian Nurses Association and funded by Canada Health Infoway and the Nursing Health Services Research Unit at the University of Toronto. The purpose of this mixed method study is to imple-ment a national nursing report card (NNQR-C). Along with pro-viding aggregate and anonymized financial and clinical docu-mentation from designated acute, long-term, mental health and complex continuing care inpatient units, nursing staff on these units will be asked to complete an online workplace en-vironment survey. Feasibility of data collection and reporting for health care organizations, and use of the NNQR-C indica-tors to support organizational quality improvement initiatives and outcomes will also be evaluated. Findings will inform the methodologies and strategy for sustainability of the NNQR. Four nursing units at UHN have committed to participate in the study: 15A at Princess Margaret Hospital (PMH), 4South at the Bickle Centre site of Toronto Rehabilitation Institute (TRI), 8A/B at Toronto Western Hospital (TWH) and 8ES at Toronto General Hospital (TGH). The UHN study team includes: Dr. Joy Richards (Principal Investigator); Susan Clarke, Teri Arany, Sarah Flogen and Veronique Bunton (Co-Investigators), who will be supported by Helen Kelly, Dr. Kathryn Nichol, Sue Bookey-Bassett and Robert Miller (Collaborative Academic Practice). The study is scheduled to begin in December 2012
once institutional authorization and study training has been completed.
2. The Development of a research program to enhance uti-lization of nurses and nurse practitioners in the Ontario healthcare system through discovery, integration and ap-plication - Study 3: Observation and Interview project is be-ing led by Dr. Souraya Sidani, Professor and Canada Research Chair of Health Interventions at the Ryerson University School of Nursing. The study aims to determine the extent to which nurse practitioners provide evidence-based, patient-centred and coordinated care, and is designed to explore general ap-proaches and specific strategies that NPs use to promote col-laboration between healthcare professionals and patients or their families. The study involves 1) observation of NPs practice and documentation of activities NPs engage in when interact-ing with healthcare professionals and patients, and 2) inter-views with healthcare professionals regarding their perception of the extent of collaboration among team members and tech-niques NPs use to foster collaboration and provide evidence-based and patient-centred care. Activities that NPs carry out to implement evidence-based, patient-centered and coordinated care will be linked to a later study to determine NPs' contribu-tion to patient and system outcomes. The study has recently received UHN Research Ethics Board approval and study start up activities are currently underway.
For more information on these studies please contact [email protected].
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pCAP
UHN Professional Practice and Bill 179
1. What is Bill 179?
Bill 179 is the Regulated Health Professions Statute Law Amend-ment Act, 2009. It amends 26 health-related statutes, and introduc-es a number of significant changes for professional practice at UHN. Bill 179 represents recently approved provincial legislative changes expanding the legal scope of practice for nurse practitioners (NP), pharmacists, dietitians, physiotherapists and chiropodists working at the UHN. These new changes apply to caring for patients both in the outpatient and inpatient hospital setting.
2. What are the benefits to the health care system?
• Enables health care practitioners to work to full scope of practice
• Facilitates efficient and effective patient access to care
• Improves navigation and transfer of accountability be-tween complex systems
• Strengthens interprofessional collaboration
4. What UHN processes are on-going to facilitate the legisla-tion into professional practice?
• Keymembers fromeachdisciplinehaveformedaBill179Interprofessional Task Force to address the impact and im-plementation of the legislation.
5. What is the mandate of the UHN Bill 179 Interprofessional Task Force?
• Toidentifyimplicationsforpractice
• Todevelopanimplementationframework
• Toanticipateandcommunicateon-goingandanticipatedfurther legislative changes
• Toreviewand/orreviseUHNPolicies,hospitalby-laws,EPRand medical directives impacted by the legislation
• TodevelopandimplementregularbimonthlyUHNcommu-niques
Thanks to Mary Jane McNally (Chair), Olavo Fernandes, Leanna Graham, Emily Musing and Dawn Tymianski for their courageous leadership on this!!
3. How is the practice of each profession affected by Bill 179?
Profession Amendments Allow the Following: Actions to Date
Nurse Practitioner Order all medications except narcotics, all laboratory tests, limited radiology and diagnostics, declare death, communicate diagnosis, admit and discharge a patient
Development of: Collabor-ative Practice Agreement, NP By-Law document, UHN NP Practice position statement, UHN NP Medi-cal Directive, NP insurance document
Pharmacist Adapt, extend or initiate prescriptions (with guidelines), perform POCT for dem-onstration, monitoring of disease or equipment, administer injection or inhalation (immunization)
Dietician Order POCT for blood glucose for patients under their care, complete LTC application
Physiotherapist Communicate a diagnosis (physical therapy), initiate a substance through inhalation, treat below the dermis, insertion beyond labia and anal verge (limited)
Chiropodist Order medication to meet patient needs (some restrictions)
Clinical Staff Bulletin - Important Change in Practice Regarding the Discontinuance of Lemon Glycerin Swabs
Background & Rationale
Please be advised that effective retroactively to November 1st 2012, the practice of the use of lemon glycerin swabs as mouth moistur-izers is discontinued.
The literature indicates that lemon glycerin swabs are detrimental to the enamel of teeth, drying to the oral mucosa (RNAO, 2008) and has an acidic pH level with no therapeutic benefit (Furness et al., 2007). Based on this evidence, lemon glycerin swabs should not be used and will be removed from all patient care areas.
Please Note
Soft bristled toothbrushes will be available through Stores/Sup-
plies Management as soon as possible. In the meantime, regular toothbrushes will be stocked.
Pink foam swabs will continue to be stocked for use with special patient populations, e.g., palliative care
UHN Oral Care Policy is currently under approval process
Best Practice Resources
Registered Nurses’ Association of Ontario – Oral Health: Nursing As-sessment and Intervention (2008) http://rnao.ca/bpg/guidelines/oral-health-nursing-assessment-and-intervention
Seniors Health Research Transfer Network – Oral Health Community of Practice (2012) http://www.shrtn.on.ca/community/oral-health-community-practice
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Did You Know?October was Occupational Therapy Month
This year, occupational therapists (OT's) at UHN came together on October 18th to promote and celebrate the profession. Charlie Chan, Vice-President, Medical Affairs, provided opening remarks and shared a moving story regarding how occupational therapy has impacted three generations of his family. Guest presenter, Ju-dith Friedland, Professor Emerita, Occupational Science and Occu-pational Therapy, University of Toronto engaged participants in the history of occupational therapy in Canada and the role of advocacy in the profession’s development based upon her new book “Restor-ing the Spirit: the beginnings of occupational therapy in Canada, 1890-1930”. There was an award ceremony, where therapists were recognized for many exciting accomplishments as clinicians and educators. The day ended with a reception that was open to the larger UHN/TRI community during which recent research under-taken by the UHN/TRI OT’s was presented. All who attended agreed that it was a very special celebration of the profession!
National Respiratory Therapy Week
Every year, respiratory therapists (RT's) nationwide celebrate the profession during our National Respiratory Therapy Week that runs during the last week of October. This year was no different. The CN tower lit up in colours of dark and light blue in recognition and celebration of Respiratory Therapy Week on Thursday October 25, 2012. The week was marked by many engaging lunch-and-learn opportunities to enhance our knowledge of cardiorespiratory health. A successful bake sale fundraising event also took place.
RT's from different hospitals also came together for a fun social night. Thank you everyone for supporting and celebrating Respira-tory Therapy Week with us. We can’t wait to do it again next year!
Spiritual and Religious Care Awareness Week
Did you know that how you hear, see, speak, touch and be with pa-tients impacts their spiritual well-being regardless if you are aware of your intentions and actions or not?
Dr. Shane Sinclair from the Spiritual Care Services at the Tom Baker Cancer Centre in Calgary, Alberta, was the invited guest speaker to celebrate Spiritual and Religious Care Awareness Week. He was an engaging speaker who shared courageous stories as well as the results of his research study Spiritual Care: And How To Do It. Results suggested all health workers are involved in delivering basic spiri-tual care on a daily basis…. some findings suggest
• Previous research has demonstrated that patients expect their spiritual needs be met by their health care providers,
• Research participants identified the five bedside skills as es-sential to spiritual care: hearing, sight, speech, touch and pres-ence,
• Consciously integrating these five bedside skills with qualities intrinsic in healthcare professionals, including their values and spiritual beliefs, is essential to delivering spiritual care, and,
• Participants identified spiritual care as both a specialized care domain and as a philosophy of care that informs and is em-bedded within physical and psychosocial care.
The results of the research resonated with staff from non-Spiritual Care disciplines. “I felt like what was shared echoes my philosophy of work - to look at the whole person, not just the illness," said Jenny Shaheed, Social Worker, PMH Psychosocial Oncology, "pro-viding basic spiritual care is about bringing humanity and empathy to our work."
Anesthesia Assistant Professional Development Day
On November 12th, 2012, University Health Network hosted the 6th Annual Anesthesia Assistant Professional Development Day. This event was created at UHN to promote continuing education,
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The CAP newsletter is an electronic bimonthly publication by the Collaborative Academic Practice portfolio. Newsletters will be posted on the internal and external sites of the UHN website. We encourage and welcome your feedback and questions. Please let us know how we're doing and what else you'd like to hear about. All comments are confidential. Please send them to [email protected]
A word from Joy Richards ...from cover
professional roles, leading change, being the voice of dissent, rais-ing the bar beyond status quo are challenging enough – but we are all called upon to do this in the most complex system in the world – health care!! We often do not see the acts of courage in our personal and professional lives, unless we are doing something extraordinary.
In reality, we bear witness to our patients, their families and our col-leagues expressing courage and daring in seemingly quiet, coura-geous acts every day. Four key truths are important to remember as you think about your own courageous practice:
Our courageous practice is unique to each one of us – so we don’t need to compare ourselves to others.
Our self-determination is connected to our personal power and courage…it is that ‘ah-ha’ moment of realizing deep in your bones that you have choice and you don’t need to be afraid.
Learning to practice courageously is a process and we don’t learn how to do it all at once, like learning to ride a bike. Rather, courageous practice has no final destination or end point; it is cycli-cal that is emergent.
The only way to discover your limits of what is possible is to go beyond them to the impossible!
What does courageous practice look like? It …
• is inclusive, inviting and inspiring …. lifting others up,
• lets go of long held assumptions and shares new knowledge, ideas and best practices,
• expands our current knowledge through professional and in-terprofessional collaboration rather than competition,
• seeks new solutions to old problems and considers new chal-lenges yet to be unfolded, and,
• uses both our head and our heart!
So be prepared. When you lead and practice courageously, you can expect obstacles. It might sometimes seem like the whole world is rising up against you. Those around you might be threatened as you exceed their limited expectations. Just remember, playing small does not serve our patients, UHN or the world!! Courageous practice lives here!! Courageous practice THRIVES here!
not always a desirable option since pain medications have some undesirable side effects (e.g. drowsiness, confusion, shallow respirations, nausea).
One intervention that can augment medications for pain control is acupuncture. Acupuncture is within the scope of practice for PT's and has been given, when indicated, for over a year, as part of clinical care in CVICU by one of the physiotherapy co-investigators on this study (Moissei Zinguer). This study will evaluate the effectiveness of adding acupuncture, when appropriate, to clinical
care for postoperative open heart surgery patients in CVICU. To date, 26 patients (17 male, 9 female) have been enrolled in the study. Preliminary analyses on the first 13 patients showed that there was a significant reduction in pain values immediately before acupuncture (7/10) and immediately after a 15-20 min treatment of acupuncture (4/10). Once the analysis for all participants is complete, the findings will be submitted for publication in a peer reviewed clinical journal. Study results will also be used to develop best practice recommendations for the use of acupuncture for pain management in this UHN clinical population.
iCAP ...from cover
and to provide a venue for Anesthesia Assistants (AA's) from across the province to network and exchange ideas. Over 80 AA's were in attendance representing 16 hospitals and two teaching institu-tions from across the province.
AA's work as part of an Anesthesia Care Team (ACT). The ACT is a physician-led innovative model of anesthesia delivery designed to maximize the use of available health resources, and improve surgi-cal efficiency approach to the delivery of anesthesia care. AA’s are specially trained health professionals that participate in preopera-tive evaluation, the monitoring of stable anesthetized patients and the follow up monitoring of post-operative patients.
The AA Professional Development Day included presentations from anesthetists that addressed relevant practices and trends. Mandy Lowe, Director of Education & Professional Development UHN Education and Collaborative Academic Practice and Associate Director of the Centre for Interprofessional Education at University of Toronto, and Patti McGillicuddy, Director of Professional Prac-tice in Allied Health/Health Professions gave a presentation about interprofessional collaboration and education. The event received a lot of positive feedback and concluded with ideas about creating a means of exchanging information and networking to utilize each other’s resources to standardize policies and medical directives across the various institutions. Courageous practice lives here!!
