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Dear Colleagues: Welcome to our Friday, October 16 report – now in the eighth month of COVID-19 in Ontario. Visit the COVID-19 Portal for the many resources RNAO offers on COVID-19. Find earlier update reports here, including thematic pieces in Doris’ COVID-19 Blog. RNAO media hits and releases on the pandemic can be found here. Daily Situational Reports from Ontario's MOH EOC can be found here. As always, feel free to share this report and links with anyone interested. RNAO continues to advocate for national long-term care standards in Canada As reported in the media, Prime Minister Justin Trudeau said he planned to push provincial premiers in a meeting earlier this week to work towards harmonized “norms” for long-term care (LTC) homes as the coronavirus pandemic continues. Speaking with reporters on Tuesday, PM Trudeau was asked about topics on the agenda for the meeting with the premiers, which will be the twentieth such meeting since the coronavirus pandemic began. PM Trudeau said in addition to discussing premiers’ demands for increased health transfers, he will also be raising the need for standardized rules for the level of care in long-term care homes. “I think that all Canadians want to know that their parents, grandparents, our seniors are well supported across the country,” he said, speaking in French. RNAO is fully on-side and so are the majority of Canadians! As our readers are aware, RNAO has been at the forefront of the demand to establish national standards in LTC, given the failure of provincial governments to act – for two decades – and the tragedy brought by the pandemic as a result. This week, RNAO wrote again to the prime minister and to Premier Doug Ford in anticipation of their meeting reiterating the urgency to establish standards. See the October 14 letter below. In the meantime, we plea to you to please sign urgently this Action Alert calling on the prime minister and our premier to act now! Dear Prime Minister Trudeau and Premier Ford, On the eve of your First Ministers’ meeting, RNAO is urging you to move forward with haste on the commitment made in September’s Speech from the Throne to set national standards for long-term care (LTC) across Canada. To date, two-thirds of Ontario’s 3,000 COVID-19-related deaths have been residents of Ontario’s LTC homes. COVID-19 has overwhelmed Ontario’s LTC sector once and threatens to do so again. For the protection of LTC residents, their loved ones and staff, the federal government has been asked to assist again – the first time with personnel from the Canadian Armed Forces and now, just this week, with the Red Cross. Our experience over the last seven months has demonstrated that this is not only a problem in Ontario. COVID-19 swept through LTC homes across the country early, taking the lives of more than 5,000 residents. That number represents more than 80 per cent of all COVID-19-related deaths in Canada. To our shame, the average percentage of COVID-19-related deaths among nursing home residents across other Organization for Economic Co-operation and Development (OECD) countries was less than half of Canada’s. This is a national failing that cries out for a national response. Over the past two decades, in report after report, experts across Canada have identified fundamental issues with Canada’s LTC sector and offered solutions. The standards set out in RNAO’s Nursing Home Basic Care Guarantee reflect an emerging consensus among experts across the country of what needs to be done to protect LTC residents now and in the future. The guarantee calls for:
For the protection and dignity of LTC residents across the country, these ought to be national standards. Prime Minister Trudeau and Premier Ford, as we confront a resurgence of COVID-19 across Canada, RNAO calls on you to lead the First Ministers to urgently establish national LTC standards. Every day that passes without such standards in place comes at the cost of lives and inconsolable grief. RNAO is always here to help make changes to our health system in Ontario and across Canada that save lives, lead to healthier outcomes and preserve the dignity of those in need. Please call on us to be of assistance. Reta’s Story (a contribution of Judy Smith, Reta’s daughter-in-law) In our report last week we confronted the fact that patient-centred care can be a reality or a dream. As you know, RNAO has been advocating for person-centred care for years. Our Person-and-Family-Centre Care Best Practice Guideline (BPG) is core to our work with the Ontario Health Teams (OHTs) that are Best Practice Spotlight Organizations (BPSO). RNAO’s work with Ontario Health Teams on person-and-family centred-care was at the centre of a BPSO OHT four hour meeting a few weeks ago, and here we have another glimpse, arising from that meeting, on what person-and-family-centred care looks like from the field. The following is a contribution from Judy Smith, who shares a story about her mother-in-law Reta. Reta is a 96-year-old, cognitively sound resident of an independent living retirement home. She has lived in the home for almost nine years. A widow for the past five years, Reta has suffered from arthritis and gout in multiple joints, a torn rotator cuff in her left shoulder, and uses a four-wheel walker for mobility. For the past few years, her greatest fear has been falling. On March 24, 2019, Reta fell and was transported to Southlake Regional Health Centre by ambulance. She was diagnosed with a fractured right ankle and required an air cast. Her left ankle was also possibly fractured. Reta was admitted to acute care, and then transferred to the Reactivation Care Centre (RCC) for ongoing assessment and rehab. All Reta wanted was to go home. I was aware of a pilot program called Southlake at Home and asked that Reta be considered for admission. The longer she was in hospital, the higher her chances of becoming delirious, falling, becoming incontinent or catching a hospital-acquired infection. Thankfully, she was accepted and was discharged within two weeks of admission. The hospital’s rehab team worked with Reta on her goals, and what she would require for a safe return home. When her discharge day came, the team provided a package of materials describing the services she would receive. Although I am not Reta’s substitute decision-maker, I am the person she wants the care team to contact with information and questions. I received a call from SE Health, which administers the pilot program. The call was an introduction to their services, including details on the equipment that would be delivered to the retirement home. I was informed that a nurse case manager would visit Reta on the day of discharge to get her set up. I received another call when the promised equipment had not been delivered, accompanied by reassurances it would be there before Reta was home. This is an example of the good communication I came to expect from the team. It was essential to begin building trust, as was the 24/7 phone number we were given to call if there were any concerns. Helen was Reta’s nurse case manager. She visited that first day, determined Reta’s goals, and asked the family about ours. Reta already met her goal of being at home. In the longer term, she wanted to walk to the dining room, using her walker independently. She also wanted to attend her 95th birthday party, which was an outdoor event. Reta received morning and evening PSW support. Physio also visited to start work on her mobility, adjusting the height of her walker to ease pain in her shoulder. OT did a home safety assessment among other checks. And the team worked with the family and the retirement home to ensure Reta was able to eat in the dining room. Three weeks into the program, Reta felt comfortable cancelling her evening PSW as she was able to get into bed and remove the air cast on her own. Helen continued to visit daily to monitor progress, review the team notes and update the family when necessary. We were encouraged to call the team or leave notes if concerns arose. Mid-way through her journey, Reta received a phone survey about her impressions of the program. The family was also surveyed. One question that I appreciated: “How are you doing as a caregiver, what do you need?” Reta continued to meet her goal of walking with supervision to the elevator and dining room. Eventually, she started doing it on her own. Southlake at Home provided a different and more person-centred care model that focused on Reta’s goals, with consistent communication, smooth transitions, warm hand-offs, evidence of team communications, and family support. There was one shared assessment and chart, accessible to all team members, including primary care. Trust was established early, and Reta was afforded the dignity of setting, altering and meeting her own goals. Reta and the family feel she was able to have a short hospital admission and return to her home faster because of the Southlake at Home program. In our eyes this was a successful pilot that needs to be continued and expanded. Reta is still in her home and continues to direct her own care and finances. Update on RNAO webinars and events ~~~~~~ Nursing and Compassionate Care in the Age of Artificial Intelligence Virtual Symposium The symposium will happen on Wednesday, 21 October, 1:00-4:30 pm. A new era in health care and in nursing has begun. COVID-19 has accelerated the adoption of virtual care delivery models in Canada. According to a recent Ipsos poll, in the next 10 years, Canadians envision a health-care system with health technologies powered by artificial intelligence (AI) — such as predictive analytics and robotics. RNAO and AMS Healthcare are hosting a virtual pan-Canadian symposium to bring together nurses and other stakeholders to critically reflect and discuss this important topic. Join us at our virtual symposium to learn more about the emerging future and its potential impact on the nursing profession and the delivery of compassionate care. Target audience: nurses in all roles and sectors, other health professionals, educators, health service administrators, researchers, policy makers, media and technology experts. Program-at-a-glance: click here Digital flyer: click here Background documents are available here. The event is free, but registration is required. REGISTER NOW ~~~~~ Webinar on: Ask the Expert - Cannabis Edibles, Extracts and Topicals This webinar, on October 22, 12:00-1:30 pm, is in partnership with RNAO and the Cannabis Knowledge Exchange Hub at CAMH. Funding for this educational opportunity is provided by the Government of Ontario. This webinar series is co-hosted by the Evidence Exchange Network (PSSP, CAMH) and the RNAO. Target audience: registered nurses, nurse practitioners, registered practical nurses and nursing students across care settings, primary care providers, public health and health promotion professionals, allied health-care providers and policy makers. During this presentation, participants will:
Presenter: Dr. Robert Gabrys, PhD, Canadian Centre on Substance Use and Addiction Register here. ~~~~~~ Let’s Talk about Anti-Black Racism and Discrimination in Nursing Our monthly webinar series is designed for RNs, NPs and RPNs interested in receiving updates on RNAO’s Black Nurses Task Force and to engage in meaningful conversations that will inform the work of the Task Force. The Black Nurses Task Force has a mandate to tackle anti-Black racism and discrimination within the nursing profession. Media is welcome. Please RT a powerful piece by bxavier@thestar.ca tweeter handle @breanna_xcarter in today’s Toronto Star The upcoming webinar will be on Monday, October 26, 6:45-8:15 pm:Topic: Systemic Racial Discrimination and Microaggressions in the Workplace: From Recognition to Action. Everyone is welcome, please RT Objectives:
Presenters:
Stay tuned for details here and register here.Information about past webinars, including presentation slides, can also be found here.~~~~~~ Landscape and Emerging Issues with E- Cigarettes: Webinar Series Webinar 2 of a 3 part series - Tuesday, October 27, 12:00 - 13:00 pm Preventing E-Cigarette Use Amongst Youth This webinar is in partnership with the RNAO, Community Health Nurses’ Initiatives group (CHNIG) and Community Health Nurses of Canada (CHNC). Objectives:
Guest speakers:
Register here. ~~~~~~ Health System Transformation & COVID-19 Webinars - On Monday, November 9, 6:45-8:00 pm we will be holding the next monthly webinar for health providers. Details will be posted and registration will be available by going here. Information on past webinars, including videos and presentation slides, can also be found here. ~~~~~~ NP Knowledge Exchange Virtual Symposium NPs who are members of RNAO are invited at no cost to our NP Knowledge Exchange Virtual Symposium on Monday, November 23, 9 am to 4 pm. Explore the theme “Moving from Strength to Greater Strength: NPs in Ontario, Canada, and around the Globe” this November at our seventh-annual NP Knowledge Exchange Virtual Symposium. On Nov. 23, you will have a chance to network, collaborate and learn more about the NP Task Force and its compelling history, progress and promise to drive successful health transformation. In addition, understand how the clinical, policy and governance roles of NPs during COVID-19 impacted the system and can be leveraged in the vision for tomorrow. Speakers include Dr. Barbara Stilwell, executive director of Nursing Now; Helen Angus, Ontario’s deputy minister of health and many more. Co-chairs for the day are NPIG Chair Sally Baerg and RNAO CEO Dr. Doris Grinspun. This event is open to all NPs in Ontario who are RNAO members. See the agenda online. Register online today to secure your spot. #Togetherwecandoit Today is day #212 of RNAO’s #TogetherWeCanDoIt campaign. RNAO began this campaign on March 19 to cheer up health care workers and others in essential services. A central pillar of our campaign is #Maskathon to help spread the message and the actions of masks-for-all! In the thick of the second wave and with new areas moving into modified Stage 2 in Ontario, in other parts of Canada, and the world (the latter with some in full lockdowns), it is clear that we MUST avoid travelling from one community to others. If we don’t, things will get much worse and for longer. We call on everyone – again and again – to 1) work from home, if you can; 2) Use a mask anytime you are out and cover well your mouth, nose and chin; 3) Use sanitizer or wash your hands every time before you put your mask on and upon taking it off, and don’t touch your face while outside your home; 4) Keep your bubble to those in your household; 5) Remind your friends, family members, colleagues, neighbors and just about anyone you know to protect themselves and others. And, please do exercise to keep healthy and connect virtually – LOTS -- so no one feels lonely. Keep joining our webinars, facebook groups, and tell us how else we can support you! We are always here for you! Keep sending tips to pgbatten@rnao and we will feature those in our Blog. Our #Maskathon is still very active and needed. We love your pics! Keep sending these and encourage others to visit the RNAO’s Maskathon Portal where they can borrow graphics for their own social media play! We need your help in educating everyone on how to wear a mask correctly. On this later point, see what RNAO’s Nursing Students did, it’s educational, FUN and great for you to RT! BTW, follow NSO on tweeter and if you are a nursing student – BScN or bridging program: Join for FREE! And, for those who are already RNs or NPs: check this out there is RNAO fever and it is a good fever to have! Post your pics using #Maskathon because #TogetherWeCanDoIt.
MOH EOC Situational Report We are posting each day the Daily Situational Reports from Ontario's MOH EOC at RNAO’s website. That way, you can access the Ministry’s guidance at any time. For a more detailed Ontario epidemiological summary from Public Health Ontario, you can always go here. Here is a segment from the latest Situation Report #265 for 16 October:
Update
Staying in touch Please continue to keep in touch and share questions, comments and challenges. Send these to me at dgrinspun@rnao.ca and copy my executive assistant, Peta-Gay (PG) Batten <pgbatten@rnao.ca>. RNAO’s Board of Directors and our entire staff want you to know: WE ARE HERE FOR YOU! Thank you deeply to each and all of you for being there for our communities – everywhere and in all roles! Together, in solidarity, we are stronger and more resilient. These continue to be tough times for many colleagues – especially those working in the front lines in countries around the world hit hard by evil COVID-19! Remember, during stressful and exhausting times, the only silver lining is -- coming together and working as one people – for the good of all! Doris Grinspun, RN,MSN, PhD, LLD(hon), Dr(hc), FAAN, O.ONT
RECENT BLOG ITEMS: 9 Oct - RNAO relieved that Premier Ford engages late, but essential, action – go here. 9 Oct - Patient-centred-care – the dream and the reality – go here. 2 Oct - RNAO urges stricter measures to combat rapidly rising number of COVID-19 infections – go here. 25 Sept - Nurses say throne speech advances A Just Recovery for All – go here. 18 Sept - Is Your Hospital Using Blood Wisely? – go here. 18 Sept - RNAO calls to Delay Action on CNO Council Decision to Expand RPN Scope – go here. 11 Sept - International Overdose Awareness Day: Statement from RNAO – go here. 11 Sept - RNAO joins global movement: A Just Recovery for All – go here. 28 August - RNAO letter to Prime Minister Justin Trudeau regarding Speech from the Throne – go here. 21 August - Black August and an update on RNAO’s Anti-Black Nursing Task Force – go here. 21 August - Winter Surge Planning: How one Ontario Health Team is Preparing – go here. 14 August - Insights from Cuba: Primary care as the focus of COVID-19 prevention – go here. 7 August - School reopening: Ontario government can still do the right thing on class sizes – go here. 31 July - Preparing for the second wave of COVID-19: Discussion – go here. 31 July - Important announcement regarding the VIANurse program – go here. 31 July - Government must immediately mandate hiring to avert second tragedy in LTC – go here. 24 July - Preparing for the second wave of COVID-19: What is the plan? – go here. 17 July - RNAO launches new social media campaign #Maskathon – go here. 17 July - RNAO calls on government to reunite families in LTC homes in Ontario – go here. 10 July - Nurses’ mental health, leave of absence and return to work experiences – go here. 10 July - RNAO continues to pursue family reunification in LTC – go here. 10 July - Support Zimbabwean nurses arrested and fired for protesting deteriorating pay and working conditions during pandemic – go here. 3 July - RNAO launches task force to tackle anti-Black racism within the nursing profession – go here. 3 July - Rather than praise, let’s protect our nurses – go here. 3 July - Nurses celebrated diversity during Pride month – go here. 26 June - Nursing Home Basic Care Guarantee – go here. 26 June - Masks for all – the policy imperative in Canada – go here. 18 June - Annual General Meeting – an exhilarating week! – go here. 12 June - Petition on masks for Canada – go here. 12 June - LTC: RNAO releases list of 35 reports and recommendations dating back 20 years – go here. 6 June - Statement – RNAO stands together with our Black sisters and brothers – go here. 3 June - Adapting harm reduction during a pandemic – 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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