Canadian Association of Continuing Care Educators Conference

Posted on May 16, 2012 by kath

Annual Conference in Edmonton!

I was thrilled to meet up with educators I met two years ago at the conference in Saskatoon, as well as to meet new educators and nurses providing education in the clinical setting in Alberta.

The theme of this conference was “Promoting a Culture of Safety”.   Meg Soper RN & comedienne  gave the keynote address.  She suggested that to excel at education and leadership we need to: Be good at what we do, be good at communicating, live in balance, and remember humour/perspective.  Her stunning but simple sleeveless black dress, cut high over the shoulders, revealed beautiful big developed biceps… Though I enjoyed her humour… I drooled over the biceps and determined that I should think about thinking about the idea of joining a gym….. then I reached for a chocolate. (http://megsoper.com/)

Laura Milligan from NorQuest College provided a half hour presentation about Care of the Ortho Client.  I love to see people like Laura present.  Her knowledge and passion of bones and fractures radiated.  I learned and was inspired.

Stephen Symon from WorkSafe BC motivated me to go to their website and learn more about the latest of resources to promote safety in the workplace.

Marleen McClellan, Chair of the CACCE spoke at the AGM.  Marleen is a beautiful, gentle woman.  Well loved across the country for her leadership and her leadership style.  Marleen presented about the CACCE, focus project, and new website.  Summary:

  • CACCE is an affinity group of Canadian Association of Community Colleges (CACC).  One of their purposes is to promote common core skills and competence nationally of the “unregulated workers”.  Titles for “health care workers” across Canada vary and include: Personal Support Workers, Health Care Aide, Health Care Assistant.
  • CACC received funding from Health Canada, and in collaboration with CACCE,  has completed the development of “The National Educational Standards for personal care providers” This is a major accomplishment! The standards will be launched in Nova Scotia at the end of May.
  • Today at the AGM the new website was launched. See www.cacce.ca .  This site links with the ACCC website, will link to upcoming conferences, contact information, and documents pertaining to the educational standards.

Exciting research presented by Donalda Farwell Area Director from Bayshore Home Health, Jake Evans and Erin Bampton from NorQuest College spoke about “Enhancing recruitment and retention of diverse HCA’s in a continuing care organization using an intercultural lens”.   Jake talked about sensitivity and intercultural communication as including the mind, heart, and skill. He suggested that intercultural competence, in the context of health care be defined as the ability to deliver effective, understandable and respectful care that is provided in a manner compatible with the patients’ cultural health beliefs and practices and preferred language. (R Anan, I. Lhahiri, Intercultural Comptence in Health Care, 2009)

Jake presented a development model of intercultural sensitivity… suggesting that the level of understanding moves through the following levels of awareness:  Denial, Polarization, Minimization, Acceptance, Adaptation.

I recognized myself in his description of the person who “minimizes” the differences, focusing on the similarities rather than the differences.  He suggests that this works fine until one comes upon the differences and does not know how to navigate through the differences.  Hm..

I could have listened to Jake present theory on cultural awareness and practical strategies for the workplace and health care for hours!  In fact, I wonder if we can get him to come to Victoria for a conference! (Way to go Bayshore and NorQuest!!!)

Ron Schlegehmilch spoke about keeping heart as managers working in health care and education.

And thanks to Judy Van Seggelen from High River Hospital in Okotoks, I was able to stay and hear the final speaker, Shona Hommy-Bugarin from Northern Lakes College.

Shona spoke with heart about the human side of safety. She pulled together the theme of the conference addressing how this applies to the students who are being educated. SHona finished with “Feels like home to me” music and photos!

The highlight was meeting educators from Nova Scotia to British Columbia and north to Whitehorse and Yellowknife!  Thanks so much for the warm welcome!  Until next year!

Kath

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iPANEL research is worth following!

Posted on May 4, 2012 by kath

The iPANEL (Initiative for a Palliative Approach in Nursing: Evidence and Leadership) research team led a symposium on integrating a Palliative Approach in nursing education this week in Kelowna.  I was honoured to be invited and thrilled to share airspace with some of my heroes in nursing practice, research and education.

Go to the iPANEL website, bookmark it, and check back to follow their learnings and highlights at http://www.ipanel.ca/

From their website: rationale for the research:

Three quarters of British Columbians who die, do so without being identified as people who could benefit from the services associated with palliative care.

2 Through research, we create new knowledge about how nurses can further integrate palliative philosophies and services into non-specialized settings that provide end-of-life care.

3 Our research is informed by and informs clinical practice.
4 Our ultimate goal is to advance the further integration of the palliative approach into nursing practice in every care setting.

Specialized palliative units and hospices are essential for end of life care but not appropriate for all persons facing life-limiting chronic conditions. By offering a palliative approach in multiple settings, we can better care for people and their families through the many transitions of chronic conditions like dementia, lung, kidney and heart diseases, and cancer. (Retrieved from www.iPANEL.ca  May 4th 2012)

The iPANEL team is full of talent and love their work.  Wonderful to witness them in motion!

Topics addressed during the day included:

  • The Case for iPANEL
  • Survey of Nurse and health care workers… their self perceived palliative care nursing competency scale (Della Roberts and Dr Rick Sawatzky presented preliminary results)
  • Curricular competencies and scopes of practice
  • Scoping review of best evidence for preparing nurses in a palliative approach
  • Innovative curricular and clinical education models (Susan Ross from TRU presented the course on Death and Dying that she is teaching this month at TRU)
  • Providing a Palliative Approach in Rural Areas (Dr Barb Pesut presented the preliminary research, followed by questions and feedback with our reflections)
  • Discussion of barriers to care, with wonderful story from a family caregivers, Teresa Nutini, then discussion by Donna Mednel (Interior Health), Gail Potter and TAMMY McLead from Selkirk College)
  • And I MISSED a presentation by the one and only Dr Gweneth Doane in the evening session on Preparing reflective and relational nurses for a palliative approach”
  • Stay tuned to their website!

Esteem and gratitude to these researchers who are ALL about integrating research in practice, and all about collaborating with people working in practice to participate in research… and all about working with educators to make it all happen.

Kath

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CLPNA conference – inspiring

Posted on May 4, 2012 by kath

The CLPNA (College of Licensed Practical Nurses of Alberta) conference has just finished in Edmonton.

Speakers, sessions included:

  • Healing Nurse-to-Nurse Hostility by Kathleen Bartholomew
  • Power of Storytelling  by Sue Robin – Bird Communication
  • “Do it Well and Make it Fun” by Ron Culberson, a former hospice social worker
  • “Embrace the Leader Within” by Michelle Cederberg author of “Energy Now”

Exhibit booths included a book store from “Self Connections” (Calgary), Colleges – Northern Lakes, Norquest, Lakeland and Bow Valley Colleges, but… the real hit must have been the Princess Florence booth with fabulous purses and scarves!

Participants who made me smile included: Hugh Pederson, the President of CLPNA with his warmth, kindness and caring… (how did you ever survive as a Millright for your first career?), Marcia Kleckner from Chinook Village in Medicine Hat (thanks for the warmth and welcome!).  Teresa Bateman, fellow twitterer and connector of great people.

FAVORITE QUOTE by Madeline McVey (VPA of Northern Lake College) described NL College as serving rural and remote northern Alberta.  She defined both RURAL and REMOTE.  She said “REMOTE means no Starbucks and REMOTE means no Tim Hortons!”  LOVE IT!

PASSION visible in Linda Stanger as she closed the conference, expressed her pride in speaking about the LPNs provincially, nationally, and internationally.

REFLECTION on LPNs : Thanks so much to UTA RACH and the other incredible LPNS whose practice and teaching have made me a better RN

REFLECTION on CLPNA: CLPNA is a leader in Canada. What a great team of people working together for LPNs in Alberta!  I am so glad to write for your CARE magazine.  Thank you for that opportunity.

Kath

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Nepal – patients required to bring caregiver with them to hospital

Posted on April 21, 2012 by kath

In academia students are often asked to reflect “in practice” and reflect “on practice”.  Sometimes, when I am in the midst of an experience it is difficult to comment on it… it is too close, and words fail me.  While in Nepal, not only was it an incredible experience, and so stimulating to meet such warm and kind people, but I had a difficult time understanding and sorting through the finer details of things.  There were pieces that I could not post because I was not sure I was correct in my assessments, or in my understanding.

Mostly I was inspired by the beautiful people, the genuine caring, and the intelligent and well educated nurses.  I was thrilled to be there, at the invitation of Dr Robin Love, to adapt the ‘Essentials in Hospice Palliative Care’ resources for the developing countries.  It was so much easier to make some of the changes when I was in this setting.  Not only was I more focused, but I was also able to hear the concerns and witness the realities of their caregiving.

Perhaps the most startling revelation was the requirement that all patients must have a family member to care for them while in hospital. As I consider this request, I can not help but consider how this would impact all those involved, I wonder how many people are not able to come to hospital because they do not have a caregiver, and consider those who leave their homes, jobs and children in order to provide care.   Then I picture the caregivers who sleep on the floor beside the bed, wash their clothes and hang them outside to dry, and are required to purchase and bring to the hospital all medications that are not stocked and supplied by the hospital.

In Canada we are challenged to provide good care for patients. Staff shortages are stressful for both patients and nurses.  I wonder if the time will ever come when patients will be told to bring their own caregivers with them to the hospital…

Thoughts?

Kath

Posted in Hospice Palliative Care | 5 Comments

Interesting facts about Nepal…

Posted on April 16, 2012 by kath

Nepal

Thanks to the presenters at the INCTR “Expanding Palliative Care in Nepal”  April 7,8, 2012 in Kathmandu for teaching me about Nepal! If any information is incorrect, please comment or email me.

Nepal:

  • Population 29.3 million
  • Percent of people with running water 2.8%
  • Unemployment rate 46%
  • Young population – 20 years Median age
  • Gross national income per capita USD 1,120.
  • Half of the population live on less than US$1 per day.
  • 38% of the population live below the poverty line.
  • Illiteracy is very high: 40% of men and 75% of women not able to read or write.
  • Approximately 40% of people can access health care in less than ½ hour travel.
  • 80% of population lives rural.  After they access the hospital once or twice, they often do not bother to return. The distance is too far, and they have expended all family finances.
  • Patients with cancer who are terminal at time of diagnosis – 69%
  • There are approximately 2 beds per 10,000 people
  • Most common cancers, men, lung, larynx, stomach…
  • Most common cancer, women, lung, cervix, breast, stomach…

Dr Bishnu Padel on Opioid availability for palliative care

  • 2003, 6 countries consumed  about 80% of opioid.
  • Developing countries, 80% of the world population used only a small percent of opioids.
  • 200 years after discovery of MS, oral MS was finally approved for Nepal… Dec 29, 2004
  • Oral Morphine available in 2005, but the supply was irregular
  • Why: supply, policies, regulations, paperwork,
  • Together, it made it very difficult to access Morphine.
  • Nepalese started making Morphine October 2009
  • And MS tabs in 2011. Now Nepal has access to Immediate release, slow release, injectable, and oral syrup…
  • Now, there is an increased consumption… but still only  0.1898 mg per capita…
  • Most hospices and hospitals have a supply of MS, but many rural areas do not!

Global issue!

  • 80% of the world lacks access to essential pain medications.
  • 15% of the world consumers 94% of global Morphine.
  • Morphine is the cheapest of all opioids.

Statistics indicate a need to increase global awareness and continue to advocate for global access to Morphine.

It is an exciting time to be in Nepal.  For those who have been here over the past ten years, there is remarkable growth and development in the field of palliative care.

Presentations by the Nepalese nationals were inspiring.  Fabulous presentations about including palliative care in core medical and nursing curriculum .

Hospice beds are increasing in number. curently five hospices, Some hospices have visiting teams.  Others have day care. ALl have inpatient beds.

Posted in Death and Dying in the 21st Century, Hospice Palliative Care | 4 Comments

A walk in the hills, Bhaktapur, Nepal’s New Years Day

Posted on April 13, 2012 by kath

A wonderful day,… left the guest house at  0600.

Wonderful team mates to journey with… Leslie, Corinne and Scott.  thanks much!

K

Posted in Hospice Palliative Care, Life Matters Too! | Tagged | 2 Comments

Three Things Every Nurse Needs to Know to Provide Excellent Care for the Dying

Posted on April 10, 2012 by Ann-Marie

Three things every nurse needs to know

Three things every nurse needs to know

Putting Death on the Table: By Kath Murray

On Feb 1st I gave myself an assignment when I sent the “Putting Death on the Table” one page ad to CLPNA for the CARE magazine.  My assignment, to write about the THREE THINGS THAT EVERY NURSE NEEDS TO KNOW TO PROVIDE EXCELLENT CARE FOR THE DYING!  This sounds like a great assignment, but imagine having to formulate the content!  Imagine inflicting this painful assignment on oneself!

Over the past month I have pondered this assignment daily.  During this time I identified at least a dozen things that one absolutely needs to know, value, or do, in order to provide excellent care for the dying!  I struggled to articulate the ideas, and struggled even more to prioritize the ideas.

Then tonight a woman expressed gratitude for the “Essentials in Hospice Palliative Care” text.  She described how the information helped her to understand what was happening as her friend died, and how she was better able to support and companion her friend through to death because she felt comfortable with the process.  She expressed a profound sense of gratitude for the experience, how companioning her friend through to death was life changing.  As she spoke I remembered the most important things for us to know in order to provide excellent care for the dying.   Years ago, as a brand new hospice nurse I identified three things that we need to provide excellent care….  Stop.  Look and listen.  When we are invited – cross the street.

We need to stop.  Put our agenda on hold.  Get our issues out of the way.  Quit worrying about the multitude of other things going on.  Take a deep breath.  Imagine clearing your brain of all the business and fussing.  Take a broom and sweep the path clear, allow the fresh air to blow in through open windows.  Breathe in the fresh salt air.

Look and Listen.  Look at the person, the family/loved ones/companions.  Assess what is happening.   What are the needs – needs that are spoken and those unspoken?  Listen to the concerns, fears, and questions. Assess not only the physical needs, but the psychosocial needs, the practical needs, the issues of loss and grief.  Assess how best to provide care, how to share information, and how to support informed decision making.

And then, sometimes, if we have stopped, looked and listened, we are invited to cross the street with the dying.  We journey with them for a ways.  We provide a safe place, a sacred place.  At some point, they continue on their journey, and when they are gone, we turn back.  Our lives, like the woman I spoke with tonight, are changed.

Sir Edmund Hilary said “We summited Mt Everest because of the people at base camp.  We could not have summited without their support.”  So it is with other journeys in life.  We cannot climb some peaks in life without the support of loved ones to share the load, help us navigate new land, and help us learn new skills.  Then, secure in their safety net, fortified by their strength, and inspired by those we love or trust, we rest, regroup, gather strength, and move onward.

A woman once said to me, “Dying ain’t for wimps”.  And another, “You only die once”.  And still another, “You don’t get to do it again”.

While we wait at base camp, we might hear requests for information about common issues and needs, comfort, and communication.  You might hear, “It’s not being dead, it is the dying I fear”.   You might receive questions about timelines,   “How long do I have?”  Or preferences, “I don’t want to die in pain.”  Or limits, “I have had enough.  I am tired.  No more tests. I want to die.”

The ground upon which we walk is sacred ground.  If we listen to the needs, the questions, and the concerns, we will have sacred opportunities to companion, be with, share information, education, and support informed decision making. As nurses our role includes being educators and being advocates.

When we listen, our role becomes that of advocate to communicate and ensures patients preferences and desires are met.  As nurses, we then, not only value the patient’s voice, but we value our own voice as well.

If we STOP LOOK and LISTEN, we will be privileged to hear needs, wishes, dreams and fears.  As nurses, it is our rather sacred privilege to provide a safe base camp, and to help patients prepare for the next step of their journey.

Posted in Education, Hospice Palliative Care, Three things | Tagged | 1 Comment

Teaching and Learning in Nepal

Posted on April 10, 2012 by kath

We all need to be heard and understood/

Once again I contemplate that we are more the same than we are different…. this time, when it comes to learning.

My reflective writing reads:  When it comes to learning:

  1. We all need to be understood and to be heard.
  2. We all need to understand the language and the content.
  3. We all need to be inspired.
  4. We all benefit when learning is enjoyable!

Though there are time when we learn when these needs are not met, or not important… my bias is that these help prepare and open the individual to learning.  And, no matter which culture we work in, we can facilitate learning if we remember these points.

Kath

Posted in Death and Dying in the 21st Century, Education, Uncategorized | Tagged , , , , | Leave a comment

My experiences at the workshop on Advancing Hospice Palliative Care in Nepal

Posted on April 8, 2012 by kath

Welcome to the colours of Kathmandu!

Colourful dyes in Khatmandu

Colourful dyes in Khatmandu

In Katmandhu on April 7 & 8th, nurses, doctors, a dietician, educators, a few community members, and a government representative gathered for two days of presentations and brainstorming to discuss the future of HPC in Nepal. This workshop was sponsored by the Nepal Association of Palliative Care, and the International Network for Cancer Treatment and Research (INCTR).

The presentations were inspiring,  the people are inspiring.

At the conference, participants were talking about:

  • the need for a national hospice palliative care policy,
  • the man who opened the doors to getting Morphine manufactured in Nepal (vs having to purchase through India) who updated participants on opioid availability,
  • two remarkable presentations on PC education in medical and nursing education.

I find it difficult to share what I am hearing, as i am not sure if I have the details all correct, and there is soooo much to write, where do I even begin?

Twinning projects in hospice palliative care in Nepal?

There are six hospices in Nepal.  I visited Bharatpur at the National Cancer Hospital last week, about a 30 min flight from Kathmandu (the drive is anywhere from 4 to 14 hours!) Bharatpur has twinned with Victoria Hospice , and they just renewed their twinning agreement to work together in sharing knowledge of hospice palliative care.

Twinning Project for Nanaimo and Nepali Hospices

Victoria Hospice and Bharatpur Cancer hospital renew twinning agreement

Today we go to Bhaktapur Hospice, just half an hour from here.  Nanaimo Hospice has been twinning with Bhaktapur hospice for over five years now. In both cases, the twinning project has fostered relationships, sharing of learning, and strengthening of programs.

While we are here members of the Nanaimo Hospice team will work on the hospice unit with the Nepali staff  and lead an 8 day workshop.

At the request of the Nanaimo team, we are adapting the “Essentials in hospice palliative care” text and companion study guide.  I have come to participate in the piloting of these materials with the nurses.  This is a wonderful experience  for me, and I am thrilled.

 

Meeting LDM Online Students in person!

A few of the Life and Death Matters international students

I have also had the incredible opportunity to meet several of the students who have taken online courses with us at Life and Death Matters.  How profound to meet them in person!!!

 

 

 

 

 

 

Life Matters! – Visiting and Sightseeing

Meanwhile, as all this is happening, we have visited a few Hindu sites, witnessed cremations in holy places, and bathe in the beauty of the Nepali people.

Life and Death Matters visits Nepal

A man praying

Posted in Education, Hospice Palliative Care | Tagged , , , | 2 Comments

“Lighten up to Learn” – Lesson from Nepal

Posted on April 7, 2012 by kath

Each day is an adventure.

What a blessing to go to Bharatpur with Dr Fraser Black, and to witness the effects of the Bharatpur-Hospice Victoria Twinning project.  Greeted at the airport with flowers, warmth, and met Usha, one of our online students.

Next day joined the team for rounds.  Met Sabita and Mina (two of our online students)…. then visits to the community with Mina. She provided care with gentleness and such skill. Families and patient very appreciative of the home service. Wonderful to be welcomed into the homes and to see how people adapt to the needs with such limited resources, with creativity and grace.

Woke the next morning thinking, “In North America we  choke ourselves with policies, procedures, building codes, union agreements etc…”   Is is possible to respond to the needs that are ahead, the doubling in the number of annual deaths, when we are in a tightjacket of bureaucracy and so much time is consumed addressing the needs of a system rather than the needs of the patient and family?

As that progressed the same theme recurred in several different ways.

Policies and guidelines etc… are needed, but in order to address the massive needs of the aging and dying in the coming decades, we need to draw on all our creative juices!  If creativity is nixed early by the “can’t do’s” then movement will be impossible. We can not solve, or address these problems with the rigidity we have created.

Nepal, Mexico, other resource poor areas can teach us much about caring – but we may have to lighten up to learn!

Posted in Death and Dying in the 21st Century, Hospice Palliative Care, Uncategorized | Tagged | Leave a comment
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