Dear Colleagues:  Welcome to my Monday, May 4, COVID-19 report – now in the fourth month of COVID-19 in Ontario. For the many resources RNAO offers on COVID-19, visit the COVID-19 Portal. In particular, VIANurse is your go-to page if you need to augment your nursing and personal support worker human resources. You can refer to earlier update reports here, including thematic pieces in my blog. Feel free to share this report or these links with anyone interested – they are public.

Nursing Now – Webinar in English – now available for your view

Nursing Now is a three-year global campaign (2018-2020) that aims to improve health by raising the profile and status of nursing worldwide. Run in collaboration with the World Health Organization and the International Council of Nurses, Nursing Now calls on governments worldwide to place nurses at the heart of tackling 21st century health challenges and maximize their contribution to achieving universal health coverage. Nursing Now 2020 has honoured RNAO before by asking us to deliver webinars related to RNAO’s Best Practice Guidelines Program (BPG) and Best Practice Spotlight Organizations (BPSO). Last week we delivered a COVID-19 webinar – now available for your view.

Being person-and-family-centred during COVID-19

What does it mean to be person-and-family-centred during a pandemic? That is the question we asked some of the Ontario Health Teams that participate in RNAO’s Best Practice Spotlight program (BPSO OHTs).

During Knowledge Exchange calls and other meetings, BPSO OHT teams from across the full continuum of care shared ideas, resources and lessons learned. Some said that person-and-family centred care (PFCC) was the cornerstone of their pandemic response. Others said that PFCC has become even more important now – not only for the people and for families they care for, but also for staff.

Below is a summary of challenges and solutions discussed in our meetings.

Challenges during the pandemic

Social distancing means being isolated from loved ones, separated from social networks, and having to make tough decisions, like which sibling would visit a dying parent. It also means huge adjustments in the way that care is being offered. In the community, most in-person visits have been cancelled and replaced by virtual care.

Meanwhile information about COVID-19 is constantly evolving. This creates uncertainty and fear. It also means that organizations need to rapidly create policies and protocols and communicate these to staff, patients and families.

Care has become more complex. Chronic diseases are compounded by isolation, loneliness and poverty. Some people require logistical help, like accessing basic supplies and food. More people are experiencing emotional distress or mental health crisis.

Isolating at home has additional challenges for people living in close quarters. The risk of domestic violence has increased, and having confidential conversations or a private virtual visit is near impossible.

The increased reliance on technology has exposed inequities. Many people lack phones, phone plans or inadequate internet access. Those unfamiliar with technology need to gain new skills so they can connect with family or health providers.

Person-and family-centred solutions

Helping people stay connected:

• Sourcing phones and tablets, arranging internet access or helping people find ways to access free wifi or data plans
• Teaching people how to navigate social media accounts
• Facilitating contact with families through video calling (FaceTime, WhatsApp)
• Arranging “window visits”, especially for those in nursing homes
• Establishing new group virtual exercise classes and book clubs to promote health and address social isolation

Supporting mental health:

• Calling more frequently to assess evolving needs
• Applying the principles of person-and-family-centred communication (e.g., listening, therapeutic communication)
• Redeploying psychotherapy staff to provide telephone based counseling services

Communicating clearly and often:

• Sharing information regularly about what is known/unknown
• Being transparent about limitations (e.g., visiting)
• Establishing one consistent point person to work with families and provide updates about their loved ones

Assessing evolving needs:

• Calling daily or every 48 hours to assess coping, or to review goals and needs
• Developing “call scripts” to support the different types with questions that need to be asked as the pandemic evolves
• Adapting care plans based on changing needs

Meeting tangible needs in new ways:

• Partnering with community organizations and pooling resources to provide logistical support (e.g., helping people move from shelters to apartments, arranging delivery of groceries, medications or packages of essential needs)
• Ensuring continuity of care; having regular nurses to visit virtually or in person to address complex chronic diseases and social complexities

Being person-centred with staff

The BPSO OHTs also emphasized the need to take a PFCC approach to support staff. Here is what they said:

Meeting the emotional needs of staff:

• Acknowledging fears and concerns
• Meeting more frequently to offer support and help staff transition to new roles/approaches to care, dealing with decreased staffing
• Providing a “Wellness Cart” (e.g., with snacks, water, hand sanitizer)
• Offering virtual/phone counseling
• Responding to “Lavender alerts” to help staff cope and reduce the risk of PTSD (this is an immediate system of support for staff in crisis delivered by pastoral services or trained staff)

Keeping staff informed:

• Addressing uncertainties with increased communication
• Hosting Town Halls with senior leadership that address staff questions

Reflecting and celebrating:

• Taking the time to reflect with teams during the pandemic and documenting lessons learned
• Celebrate small wins and big successes

The RNAO BPSO coaching team thanks the BPSO OHTs for sharing the outstanding work they are doing to care for people and their families during this pandemic. We are impressed by the creative, flexible and swift solutions as well as the effective collaborations within your organizations, BPSO OHTs, and the greater community. We look forward to learning more from you and supporting your ongoing clinical excellence.

Learning from our readers: Your examples

Do you have examples of how you or your organization has been person-and-family-centred during this pandemic? Please share with us! Email Oliwia Wilson with the subject line “PFCC during pandemic.”

More information:

• To learn more about BPSO OHT click here
• To learn more about Person-and Family-Centred care click here
• To learn more about RNAO’s work with OHTs, click here.

RNAO’s ViaNurse Program               

RNAO’s VIANurse program, launched on March 13, has already registered 7,358 RNs for virtual and clinical care, 1,023 critical care RNs (who have experience and continued competency in the provision of critical care), and 287 NPs. RNAO is continuously responding to requests from health organizations. So far, we have served 283 organizations, of which 215 are nursing homes and retirement residences. Please note that RNAO has also offered the government and employers to identify for them NPs and RNs who can help manage LTC organizations that are in crisis, and assist with urgent interventions where severe outbreaks are ongoing. For any nursing HHR needs go to RNAO’s VIANurse program

** Seeking RNs, NPs and nursing graduates ready to work in nursing homes in active outbreak

RNAO launched on Friday, April 24^th a fourth survey for RNs, NPs and nursing graduates urging them to register for work in nursing homes that are on an active outbreak. The availability of these colleagues is already fastening even more the matching of nursing staff to homes in dire need. For example, between April 20^th and May 2, we deployed RNs, NPs and/or PSWs to 109 organizations, including 102 nursing homes, with some of these organizations having been served multiple times. On Saturday, on a matter of hours from request we responded to the staffing needs of 11 additional organizations. Only one organization requested staffing support on Sunday. VIANurse has no backlog requests. Please retweet the following urgent tweet to have many more RN, NP and new graduates enrolled.  

For those of you ready to work in a nursing home with an outbreak – we need you –please CLICK HERE and complete our survey ASAP. We need your response as soon as possible given the rapidly evolving situation, and the urgent need in nursing homes across the province. The government has now improved the compensation, recognizing your critical role – see Ontario’s press release here.

So far we have got 350 responses: 261 RNs and 38 NPs and 41 nursing students – ready to go to nursing homes in an active outbreak - plus, 10 RNs who can do non-clinical work. These colleagues are being deployed as we speak, including over the weekend. 

Your messages: Voices and responses

Each day we welcome new readers to this daily report: thank you deeply for the work you do always and especially during this public health crisis, and also for keeping us well informed. You can see previous reports at RNAO updates and resources on COVID-19 for members and other health professionals. Feel free to share these updates with other health professionals and other organizations both at home and abroad. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. Many of the articles you see here are posted in my blog, where you can catch up with earlier issues. The COVID-19 Portal is here.

We received a communication from Claudia Gilchrist, RN, class 1973, President of The Mack Alumni Association that is celebrating 146 years in 2020, the Year of the Nurse!

In celebration of Nightingale’s 200th birthday, we remember that the very first nursing school in North America was formed in St Catharines, Niagara Region. Dr Theophilius Mack, who started the hospital in St Catharines, was very impressed when visiting the Nightingale nursing school in London, England. Nurses came from London to help start the first school in Canada, operating under the Nightingale system in 1874. Six graduated from the first class. It was known as The Mack Training School for Nurses up to 1969. The name changed to Mack School of Nursing, with the first graduating under this name in 1970, until its last class graduated in 1974. At that time the school closed and nursing programs were under the jurisdiction of the colleges.

As of today, the oldest active nursing alumni still is carrying on. The Mack Alumni members come together annually to celebrate the 1970 class, who would be celebrating their 50th anniversary. Unfortunately this year’s dinner is cancelled due to the virus, but we want the Class of 1970 to know that your nursing sisters congratulate you on your 50th!

Florence Nightingale had many famous quotes. In 1870 she said “It will take 150 years for the world to see the kind of Nursing I envision...” Is it a coincidence that if you take the year of the quote 1870 and add 150 years = the year 2020? Canadians should all be grateful at this time for her strength and her vision that made nursing a respected profession.

Stay safe for our nurses on the front lines.

Claudia Gilchrist ’73 – President, The Mack Alumni

To learn more about the Mack Alumni Association, go here.

Together we can do it

MOH EOC Situational Report #99 here for Sunday, May 3

Situation:  

• 434 new cases were reported today in Ontario, bringing the cumulative total to 17,553 (this includes 12,005 resolved cases and 1,216 deaths).
• In Ontario, a total of 327,775 tests have been completed, with tests performed at Public Health Ontario Laboratories and non-Public Health Laboratories. There are currently 9,785 tests under investigation.
• 1010 patients are currently hospitalized with COVID-19; 232 are in ICU; and 174 are in ICU on a ventilator.

EOC report #99 for May 3 informs of the following actions taken:

• The CMOH issued two memos (here and here) to public health units regarding the opening of seasonal/other essential businesses and guidance around secondary residences.

EOC report #98 for May 2 informs of the following actions taken:

• The Provincial Testing Guidance, Quick Reference Public Health Guidance on Testing and Clearance, Reference Document for Symptoms and Patient Screening Guidance have been updated and are attached (here and here and here and here). They will be available shortly on the ministry's website in French and English.
• A Guidance Document for essential, non-health care workplaces was developed and outlines what workplaces can do to prevent the spread of COVID-19. It is here and here and will be available shortly on the ministry’s website.

Staying in touch          

Please continue to keep in touch and share questions and/or challenges of any kind, and especially shortages of PPE. Send these to me at dgrinspun@rnao.ca. We are responding daily and are continuously solving your challenges. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU!

Thank you deeply colleagues in the front lines; in administrative roles; in all labour, professionals and sector associations, and in governments in Ontario, in Canada and around the world. We are here with you in solidarity. These are stressful and exhausting times; the only silver lining is coming together and working as one people – for the good of all!

Together, we must redouble our efforts to tackle COVID-19 with the best tools at hand: full, accurate and transparent information, calmness, determination and swift actions. 

Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
Chief Executive Officer, RNAO  

RECENT RNAO POLICY CORNER ITEMS:

1 May    - Migrant agricultural workers and the COVID-19 crisis – go here.

30 April - COVID-19 pandemic in provincial institutions and correctional centres – go here.

28 April - Supporting First Nation Communities during COVID-19 – go here.

27 April - Responses to COVID-19 for persons experiencing homelessness in Toronto: An update – go here.

25 April - Lessons learned through a COVID-19 nursing home outbreak – go here.

25 April - Letter from a retired RN to Premier Ford: The problems with LTC were evident long before COVID – go here.

23 April - Working with seniors in long-term care requires specialized knowledge – go here.

22 April - Shaking the stigma: We need a proactive COVID-19 response for mental health and addiction – go here.

21 April - We Require Expanded and Accessible COVID-19 Data in Ontario – go here.

20 April - Can Loss of Smell and Taste Help Screen for COVID-19? – go here.

18 April - COVID, Trump and the World Health Organization – go here.

16 April - A Home Based Model To Confront COVID-19 – The Case Of The Balearic Islands – go here.

15 April - COVID-19 and the Challenges in Homecare – go here.

14 April - Reprocessing Of N95 – An Update – go here.

14 April - A New COVID-19 Facility For Persons Experiencing Homelessness In Toronto – go here. 

13 April - Practical Tips for Safe Use of Masks – go here.

10 April - Ontario’s Tragedy in Long Term Care Homes and Retirement Homes – go here.

10 April - RNAO Action – Supporting Long-Term Care – go here.

10 April - Update For Nursing Students – NCLEX Exam – go here.

9 April - Celebrating Passover, Good Friday, Holy Saturday, Easter Sunday and the start of Ramadan during a pandemic – go here.

9 April - Guidance on use of N95 mask – go here.

7 April - Sentinel surveillance and on-site testing in the homeless service sector – go here.

7 April - Reprocessing of n95 – safe? – go here.

5 April - We must change the way we do testing and case definition – go here.

5 April - Ringing the alarm bells on critical care beds – go here.

4 April - COVID-19, stay at home and domestic violence – go here.

We have posted earlier ones in my blog here. Please go and take a look.

Information Resources

Public Health Ontario maintains an excellent resource site on materials on COVID-19. This is an essential resource for Ontario health providers. 

Ontario’s health provider website is updated regularly with useful resources here.

Ontario’s public website on the COVID-19 is there to inform the general public – encourage your family and friends to access this public website. The WHO has provided an excellent link for you to share with members of the public here.

Please promote the use of Ontario’s COVID-19 self-assessment tool: It also has a guide where to seek care, if necessary. Its use will provide the province with real-time data on the number and geography of users who are told to seek care, self-isolate or to monitor for symptoms. Data will inform Ontario's ongoing response to keep individuals and families safe.

Health Canada's website provides the best information capturing all of Canada. It contains an outbreak update, Canada's response to the virus, travel advice, symptoms and treatment, and resources for health professionals.

The World Health Organization plays a central role in addressing the COVID-19 pandemic. See here and here.

You can find up-to-date global numbers in Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE.

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