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2019 NPAA Conference Poster Presentations

Palliative End of Life Client’s Experiences with Receiving Nurse Practitioner Care in a Community (Supportive Living) Setting

Arsenault, Julia  RN, MAHSR, NP; Pasiorowski, Ashley RN, MN, NP; Appah, Yvonne RN, MN, NP, GNC (c); O’Rourke, Tammy  BS/MS, NP, PhD; Pooler, Charlotte MN, PhD, RN; Throne, Trina RN, MN, NP; Khalil, Iman RN, MN, NP

A qualitative study using participant interviews to examine family experiences with palliative/end-of-life (PEOL) care in Supportive Living (SL) settings when an NP is involved in that care.

Home Sweet Home: The Nurse Practitioner’s Office.

Blythe, Catriona RN MN NP CDE and Naraine, Ruby RN MN NP GNC(C)

The Red Deer Intensive Home Care team is an innovation developed to support efficient discharges from the hospital and to provide care for community clients at high risk for hospitalization.

In many situations, our healthcare system expects clients to present in-person for their healthcare. Whether they require follow-up after a lengthy and complex hospital visit, ongoing care for chronic diseases, or a medication review from their pharmacist, all require an in-person visit at the clinician’s office. For the majority of our homecare clients this is unachievable.

These clients are underserved by our healthcare system because they cannot present to a regular healthcare setting. Through physical, mental or cognitive limitations, they struggle to attend appointments. The expectation that these clients must attend appointments outside of their home is disruptive to their routine and can cause incredible physical and emotional stress, while, ultimately, preventing them from achieving their optimum health. At best this is an ordeal for their caregivers to facilitate and at worst an insurmountable feat adding to the already incredible burden of care.

Nurse Practitioners (NP’s) with the Intensive Home Care program bridge this gap for many home care clients. NPs provide follow-up care, do ongoing chronic disease management and conduct simple medication reviews. In conjunction with other health care professionals, NPs provide high quality primary health care services directly to the client in their home. This removes the need for repeated, disruptive and exhausting visits outside of their home and truly achieves client-centered care.

Neuroadvancements and the Role of Nurses as stated in Academic Literature and Canadian Newspapers

Deloria, Rochelle (Presenting Author)

Bachelor of Health Sciences, Department of Undergraduate Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

Dr. G. Wolbring

Associate Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

Introduction: Nurses are a particular health profession that encounter various neuroadvancements within their occupation.  Neuroethics was coined as a term and developed as a field to investigate various ethical, social and legal issues raised by the neuro-advancement. Of focus within neuroethics as well as neurotechnology governance, is the issue of public engagement, neuroscience literacy and stakeholder involvement. The integration of lifelong learning and professional development initiatives could be of use to properly teach nurses about the potential ethical, social and legal issues linked to neuroadvancements, which in turn would allow nurses to provide meaningful input into the neuroadvancement governance discussions. With their skillset, nurses execute the role of: employee/worker, advocate, medical professional, educator, and leader/expert.  Given the various roles of the nurse and the focus on literacy and participation increase in the neuroethics and neuro-governance discourses, we investigated the understanding of the role of nurses in the neuro-related academic and newspaper literature and whether the literature engaged with nurses and neuro in relation to governance, ethics and knowledge production and consumption.

Objective: To investigate the role narrative of nurses evident in the neuroadvancement discourse within academic literature and newspapers.

Methods: In Academic Literature, we performed two search strategies for the scoping review. We searched 70 neurotechnologies and the terms “neurote*” OR “neurosc*” or “neuroen*” in conjunction with a) the term Nurs* in the abstract, and b) the term Nurs* in the journal/source title. In newspapers, we searched within full text for the term Nurs* in combination with the terms: “neurote*” OR “neurosc*” or “neuroen*” and with the list of 70 Neurotechnologies. A manifest and latent coding process was performed on n=597 academic abstracts and n=1395 newspaper articles.

Results: We found that there was minimal engagement with the role of nurses and neuroadvancements within both academic literature and newspapers. No article raised the issue of nurses having to be knowledgeable on ethical and social issues, and how lifelong learning can be a tool utilized to gain competency in the social and ethical issues linked to neuroadvancements.

Conclusions: Their current positions within their occupation as educators, patients support and medical professionals, to name a few, engulf nurses in a variety of interactions and environments, allowing them to understand and see the impact of neurotechnology from multiple standpoints. It would be fruitful to acknowledge nurses as contributors to the governance and ethics discussions surrounding neuroadvancements. Lifelong learning initiatives should be thematized as one tool that can be used to build capacity within nurses to meaningfully contribute in the neuroadvancement governance and ethics discussions. Such changes would enrich the neuroadvancement governance and ethics discourse and further benefit professionals, academia, patients and the greater public.

Guided Occupational Therapist Cognitive Interventions in Critically Ill Patients (GOTCI): Protocol for a randomized control trial.

Deemer, Kirsten BScN, MN, ANP;  Oviatt, Stephanie BSc, MScPT; Parsons,  Michelle BA. BHScPT; Towson, Mallor BScHSS MScOT OT; Herold, Karolinay RN MN; Fiest, Kirsten  PhD & Posadas, Juan MD MSc

Background: The presence of ICU delirium is directly correlated with higher mortality rates and is an independent predictor of cognitive and physical impairment following critical illness. Cognitive interventions, as part of a non-pharmacological strategy, is an emerging adjunct to current delirium prevention protocols.

Trial Purpose: The aim for this study is to evaluate the effect of specific OT guided cognitive interventions on delirium in adult critically ill patients.

Methods: This is a prospective randomized control trial for critically ill adult patients. Patients will be randomized to receive usual delirium prevention practices or to the experimental group who will receive usual delirium prevention practices plus guided occupational therapist cognitive interventions. Patients in the experimental arm will receive OT guided cognitive interventions titrated according to RASS for 20 min per day, twice daily, 5 days per week. Delirium will be measured according to the Intensive Care Delirium Screening Checklist.

Outcomes: The primary endpoints for this study are the prevalence of delirium and delirium duration. The secondary endpoints will include, cognitive function, physical function, quality of life, ICU length of stay, hospital length of stay and days of mechanical ventilation.

Accessibility and Efficiency in Primary Health Care. Can Nurse Practitioners Play a Key Part in Bridging the Gap Through Telemedicine?

O’Reilly, Stefanie MN NP;  Slomp, Rachel MN NP; & Kirkham, Kayla MN NP

As healthcare costs surge in Alberta over that of neighbouring provinces and patients cite increased difficulty accessing health services, it is imperative that the present healthcare delivery models are reevaluated. A growing number of Albertans are without a primary care provider. Albertans with a formal existing family physician report inadequate access to their doctor and long wait times leading to abandoned health concerns until the situation becomes urgent or emergent. The current system is costing more overall for the province and the patient. These cited concerns scratch the surface of population health, without considering health maintenance, chronicity, or variations within the health of Albertans. Proposed strategies to target this healthcare burden in Alberta include increasing accessibility to care and allowing patients to become more active participants in their own health care management. Primary care by way of telemedicine offers a patient inclusive solution for all Albertans across the lifespan in achieving sustainable, accessible care. Utilizing telecommunication technology, clinicians can provide Albertans with primary care through virtual platforms such as email, telephone, and video encounters with often a minimal time delay. Telecommunication ease of access appeals to Albertans as an all-embracing group, comprising the needs of remote dwelling citizens and vulnerable Albertans alike. A look at inclusion of telemedicine within Canada demonstrates savings in patient time, increased economic productivity, increased care accessibility to rural communities, enhanced appropriate use of emergency departments, increased clinician efficiency, and reduced delays in time sensitive acute care admissions. Furthermore, a decrease in wait time for specialists is reported when able to start the process remotely. These are just a few examples of telemedicine practice advantages. A growing number of Canadians and employers are incorporating virtual care health services into their care management formula and are increasingly satisfied with accessibility to care and their health outcomes. To enhance the existing care model, Nurse Practitioners are able to provide a high quality of virtual primary care services to Albertans in a cost-effective and fiscally valuable approach. Nurse Practitioner care provision in telemedicine satisfies appropriate resource allocation to Albertans, addresses primary care health issues through a traditional assessment- diagnosis- management process, and ensures the inclusion of principles of health promotion and disease prevention, while maximizing efficiency. Preliminary research concludes that Nurse Practitioner telemedicine services are effectively reducing office visits all while providing a high quality of care indicated through high patient satisfaction scores. In making the health services approach and delivery simpler for Albertans, we may further observe better engagement, and improvement in both Albertans perceived and perceptible personal health and wellness overall. Nurse practitioner led telemedicine clinics serve to lessen the current strain and address limitations on our traditional health care systems in Alberta leading to improved overall care for Albertans.

Assessing Nutrition Content in an Integrated Nursing Program

Saini, Amrita BN Student, and Mannion, Cynthia RN PhD

University of Calgary

Objective: To audit, assess and suggest improvements to nutrition content in an integrated nursing program in the Spring/Summer semester.

Rationale: Nurses work in many healthcare settings and have access to patients where nutrition is important in chronic illness management, and health promotion for people at all stages of growth and development. Historically, nutrition was a key component in nursing curricula but currently there is less emphasis on nutrition content. Implementation of fundamental nutrition content will better enable nurses to provide care and promote health for all their patients.

Methods/Analysis: For this QI project, I audited mandatory nursing courses offered in the spring/summer term 2018. I gathered 17 course outlines, attended 4 classes and took notes from lecture, and class discussion. I categorized the information and compared it to evidence based nutrition information. Nutrition content in nursing was compared to nutrition content in a kinesiology course, and a medical course. Resources for comparison included current nutrition position papers, Health Canada’s website, and the Institute of Medicine’s Reports on Dietary Recommended Intakes for macronutrients and micronutrients. A report with suggestions and recommendations will be prepared and presented to the Undergraduate Curriculum Committee in September 2018.

Results: Less than 1 hour of class time was devoted to nutrition in 12 hours of class audits in contrast to a 39 hour course in Kinesiology and 9 hours in Medicine.  Fundamentals were often not included, and there was little information on the Dietary Recommended Intakes or Canadian Guidelines. Nutrition information was restricted to specific diseases such as diabetes, or to acute care patients who are tube fed, or infant feeding. Nursing knowledge related to fundamental nutrition is hard to identify.

Discussion: In an integrated curriculum, foundations of nutrition could be introduced in year one and built in sophistication year after year. Patients and health care providers may hold beliefs about food that can be both myth and speculation, and seldom evidence informed and these should be addressed. with current nutritional information. The challenge remains how to include nutrition content in curriculum that is already content heavy.

Alberta Palliative Care Competencies and Education Project

Sawchuk, Lorelei MN NP CHPCN(C)

INTRODUCTION & AIMS: Under the direction of the Provincial Palliative and End of Life Innovations Steering Committee, the Covenant Health Palliative Institute is working toward developing multi-disciplinary provincial palliative care competencies (phase one) and identifying and describing palliative educational opportunities in relation to these competencies (phase two).

RELEVANCE: According to a 2016 IPSOS poll, Canadians feel that palliative health care providers should receive certification for additional training specialized in palliative care (86%) and that mandatory annual training for palliative health care providers should be implemented (82%). Nursing and medical associations have implemented national standards. Educational institutions and organizations have responded. Health Care Providers nonetheless express the need for additional guidance and education. Nova Scotia, British Columbia and Ontario employ diverse approaches to the development of palliative competency frameworks. In this project we employ an evidence-based approach to the competency development in Alberta.

DESCRIPTION: Phase I of this project will result in the development of 16 discipline-specific palliative competencies. Membership representation for each discipline includes frontline Health Care Providers (HCPs) from each Alberta Health Services Zone, Covenant Health, and contracted providers; each professional college and regulatory body, professional practice, academic representation from educational institutes, and in some instances Alberta Health representation. A rapid review of the literature identified competency sets for each discipline. Emphasis is provided to the Irish and Nova Scotia competencies. The Consensus Oriented Decision-Making Model is used to facilitate each discipline-specific working group discussion. The competencies are organized into 8 Core Competency Domains and 4 Optional Competency Domains and structure according to the All, Some, Few Model of Palliative Expertise. An average of 6 1.5 hour meetings are anticipated for consensus. In phase II of this project, a database/repository of palliative care educational opportunities for HCPs will be created along with a map linking currently available palliative care education to the core competencies identified in phase 1.

RESULTS AND IMPLICATIONS: Palliative care competencies are expected to lead to better attainment and retention of skills in undergraduate, post-graduate, and continuing education thereby complementing HCPs’ formal education and experience. Moreover, HCPs will be able to choose the most appropriate educational opportunities for their discipline and context. A map between competencies and education will assist HCPs to strategically plan their knowledge and skills development. Additionally, it is anticipated that this project will build a community of practice among each discipline, and increase palliative care awareness among the Alberta Health Care Providers.

Collaborative Community Care (C3) for Seniors

Anne Summach RN MN NP-FAA, Director of Health Services at Sage Seniors Association

Academic partnerships with seniors and community organizations to develop, deliver, and evaluate evidence-based, innovative, solutions to the system problems they face has never been so important. Solutions that are population focussed, driven by senior engagement and supported by relevant evidence are known for being the most successful in addressing system problem. Nurse Practitioners, can provide visionary leadership in the formation of academic/community partnerships to improve aging outcomes. In March of this year, the first Academic NP Faculty Practice clinic opened in Edmonton, Alberta.  This clinic was the result of a collaboration between a faculty of nursing and an established seniors social and recreation service agency in an urban center. An NP faculty member co-led the development of a proposal to the Government of Alberta to provide funding for the capital and operational costs of establishing and implementing primary care services on-site at the senior’s center.

Key Features of the Model: Collaborative Community Care (C3) for Seniors

1.       NP leadership (clinically and administratively

2.       Academic-Service Partnership

3.       Co-location of primary care and social/recreational services

4.       Senior focused

5.       Participatory development, delivery and evaluation

Since the inception of the vision for the addition of primary care services to the existing seniors social and recreational services, seniors have been engaged in several activities to influence the design and implementation of the model.  These activities include, needs and feasibility assessments, architectural design discussions, interviews with core interprofessional team members, and focus group sessions to inform the delivery of services. Preliminary evaluations demonstrate the importance of this NP-led model in providing wrap-around services to seniors in community.

The purpose of this poster is to describe emerging and encouraging outcomes from the first year of operations, and to present potential scalability for future NP-led Primary Health Care Models in Alberta.