In thIs Issue: 32 Examining the use of geriatric assessment - NENA.ca
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ISSN 2293-3921 Volume 40, Number 2, Fall 2017 In this issue: 32 Examining the use of geriatric assessment teams and comprehensive geriatric assessment in emergency departments 37 RADAR: A rapid detection tool for signs of delirium (6th vital sign) in emergency departments 44 Transport determinants for continuing care residents assessed by an EMS urgent response team: A retrospective observational study
Guidelines for submission
Editorial Policy Preparation of manuscripts 5. Direct quotations, tables and illustra-
1. Canadian Journal of Emergency 1. The original copy of manuscripts and tions that have appeared in copyrighted
Nursing welcomes the submission of supporting material should be submitted material must be accompanied by writ-
clinical and research articles, case stud- to the Canadian Journal of Emergency ten permission for their use from the
ies, and book reviews relating to the field Nursing editor. The author should retain copyright owner, and original author
of emergency nursing. one complete copy. and complete source information cited.
Plagiarized material will be rejected
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without explanation.
the articles and communications are ble-spaced (including references), layout
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Deadline dates:
January 31 and September 8
2 Vol. 40, No. 2, Fall 2017 · Canadian Journal of Emergency Nursing
ISSN 2293-3921 Volume 40, Number 2, Fall 2017
Canadian Journal of Emergency Nursing
NENA elected officers CTAS National Working Group
President Thora Skeldon & Erin Musgrave, ctas@
is the official publication of the National
Stephanie Carlson, president@nena.ca
Emergency Nurses Association, published nena.ca
twice annually by Pappin Communications, Past President
84 Isabella Street, Pembroke, ON K8A 5S5. Sherry Uribe, pastpresident@nena.ca
ISSN 2293-3921. Indexed in CINAHL. National Course
Copyright NENA, Inc., 2017 Treasurer
Kitty Murray, treasurer@nena.ca Administration Committee
Monique McLaughlin, Chair; Dawn
Editorial staff Website Coordinator Paterson , Western; Sharon Ramagnano,
Editor: Matthew Douma Norm Carter-Sim, webmaster@nena.ca Central; Denis Bouchard, Quebec; Maureen
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Director of Education and Training nena.ca
Trauma Section Editor: Domhnall Margaret Dymond, educationdirector@
O’Dochartaigh nena.ca
Domhnall.Odochartaigh@
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Committee chairs
Nominations
Pat Mercer-Deadman,
Geriatrics Section Editor: Mathieu Figeys Debra Pitts, Chair, nominations@nena.ca
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figeys@ualberta.ca
Awards/Bursaries
No part of this journal may be reproduced Pat Mercer-Deadman, Chair,
Provincial directors awards@nena.ca
in any manner without written permission British Columbia
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The editors, association and the publisher Sherry Uribe, Chair,
Alberta
do not guarantee, warrant or endorse conference2018@nena.ca
Jean Harsch, abdirector@nena.ca
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Research
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Send manuscript inquiries or submissions Steve Gagne (Independent Member),
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CJEN is the official publication of the New Brunswick
Marketing, Promotions and Social Media
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Pat Mercer-Deadman, Chair,
Articles, news items and illustrations Nova Scotia membership@nena.ca
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CJEN is published twice per year. Opinions
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addressed to the editor.
Cover photo credit: Daniel Sundahl
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PUBLICATIONS MAIL AGREEMENT NO. 41147033. RETURN UNDELIVERABLE CANADIAN ADDRESSES TO:
National Emergency Nurses’ Association, P.O. Box 365, Chilliwack, B.C. V2P 6J4
President’s Report
I t has been said, “plus ça change, plus
c’est la même chose”—“the more
it changes, the more it’s the same
thing”, usually translated as “the more
things change, the more they stay the
recognized at the NENA conference in
Charlottetown in June. Cathy Sendecki
and Donna Gallant were awarded
Honorary Lifetime Membership Awards
in recognition of their lengthy and faith-
NENA is excited to be partnering with
prnEducation in the development and
delivery of EPICC (Emergency Practice,
Interventions and Care – Canada) courses.
Beginning with EPICC Foundations in
same,” ( Jean-Baptiste Alphonse Karr). ful service to emergency nurses. 2014, the development team has added
This is true of emergency nursing and it EPICC Trauma and is beginning work on
The following emergency nurses were
is true of NENA. We follow predictable a pediatrics course. These truly Canadian
awarded NENA bursaries: Christina
cycles, but they are punctuated by the courses are offered in English and French.
Graham, Kyla Neary Griffiths (Margaret
unexpected—new medications, revised
Smith Award); Loree Vint (Debbie NENA has been a presence on CNA’s
procedures, staff churn, administration
Cotton Award); Monique McLaughlin; Certification Advisory Committee,
attitudes, and political climate.
Leah Chesney; Janet Calnan; Sharron supporting and encouraging certifica-
One of NENA’s most challenging changes Lyons; Tanya Penney; and Christina tion in emergency nursing ENC(C) for
in recent years has been the transformation Follador. Congratulations to each of you. our members and others. A link to its
of NENA from a collective of affiliated pro- Canadian Emergency Nursing Certification
Bursaries are available to NENA mem-
vincial emergency nursing special interest Exam Prep Course is posted in the Courses
bers. Information about NENA Awards
groups to an association of members who section of the NENA website. We encour-
of Excellence and other bursaries
are also members of their associated pro- age all our members to seek Emergency
and applications are available in the
vincial emergency nursing organizations. Nursing Certification. The deadline for
Documents section on the NENA web-
NENA’s Vision, OUR STRENGTH: renewals is November 30.
site. A call for applications will be distrib-
OUR MEMBERS; NOTRE FORCE:
uted to members in the new year. The NENA exists for the purpose of promot-
NOS MEMBRES, has dictated our direc-
annual deadline is March 15. ing excellence in its nurses and advancing
tion, but the change has not been easy. As
our specialty, intrinsically joined to the
I write this, a committee of NENA mem- NENA continues to administer Trauma
provincial organizations and its members.
bers from across Canada is working to Nursing Core Course (TNCC) and
define emergency nurse. We expect that this Emergency Nursing Pediatric Course Respectfully submitted,
will be the final key revision to our bylaws. (ENPC), as well as maintaining a strong Stephanie Carlson,
presence on the Canadian Triage and President
Of the things that remain the same,
Acuity Scale (CTAS) national working
a number of NENA members were
group.
Rapport de la présidente
I l est dit que : « Plus ça change, plus
c’est la même chose » ( Jean-Baptiste
Alphonse Karr). Ceci est vrai pour
les soins infirmiers d’urgence et pour
l’ANIIU/NENA. Nous suivons des
n’ont pas été faciles. Au moment d’écrire
ce rapport, un comité de membres de
l’ANIIU/NENA, de partout du Canada,
travaille pour définir les soins infirm-
iers. Nous nous attendons à ce que cela
Award); Loree Vint (Debbie Cotton
Award); Monique McLaughlin; Leah
Chesney; Janet Calnan; Sharron Lyons;
Tanya Penney; et Christina Follador.
Félicitations à chacune d’entre vous.
cycles prévisibles mais ponctués par des devienne la dernière révision clé de nos
Les bourses sont disponibles aux
moments inattendus; nouveaux médica- règlements.
membres de l’ANIIU/NENA. Les ren-
ments, procédures révisées, roulement
Sur les choses qui ne changent pas, plu- seignements sur les prix d’excellence de
du personnel, attitudes de l’administra-
sieurs membres de l’ANIIU/NENA ont l’ANIIU/NENA, d’autres bourses et les
tion et climat politique.
été reconnus en juin lors de la conférence demandes sont disponibles dans la sec-
Au cours des dernières années, l’un des de l’ANIIU/NENA à Charlottetown. tion Documents du site web de l’ANIIU/
changements les plus difficiles pour Cathy Sendecki et Donna Gallant NENA. Un appel de demandes sera lancé
l’ANIIU/NENA fut de passer d’un col- ont reçu les prix Honorary Lifetime aux membres au cours de l’année pro-
lectif de groupes d’intérêt provinciaux Membership en reconnaissance de leurs chaine. La date d’échéance annuelle est
spéciaux et affiliés en soins infirmiers longs et loyaux services envers les infirm- le 15 mars.
d’urgence à une association de membres iers et infirmières d’urgence.
L’ANIIU/NENA continue d’ad-
étant également membres de leurs organ-
Les infirmières d’urgence suivantes ministrer le Trauma Nursing Core
ismes provinciaux en soins infirmiers.
ont été récompensées avec les bourses Course (TNCC) et le Emergency
La vision de l’ANIIU/NENA - NOTRE
ANIIU/NENA : Christina Graham, Nursing Pediatric Course (ENPC), ainsi
FORCE : NOS MEMBRES – a dicté
Kyla Neary Griffiths (Margaret Smith que de maintenir une forte présence
notre direction, mais les changements
4 Vol. 40, No. 2, Fall 2017 · Canadian Journal of Emergency Nursing
dans le groupe de travail national de pédiatrique. Ces cours canadiens sont L’ANIIU/NENA existe afin de promou-
l’Échelle canadienne de triage et de gra- disponibles en français et en anglais. voir l’excellence pour ses infirmiers et
vité (ÉCTG) infirmières et faire avancer notre spé-
L’ANIIU/NENA est présente au Comité
cialité, qui est étroitement liée aux orga-
L’ANNIU/NENA est fière d’être en par- consultatif sur la certification de l’AIC,
nismes provinciaux et à ses membres.
tenariat avec prnEducation dans le déve- en soutenant et en encourageant la cer-
loppement et la livraison de cours EPICC tification dans les services de soins infir- Respectueusement
(Emergency Practice, Interventions miers ENC(C) pour nos membres et soumis,
and Care – Canada). Depuis le EPICC autres personnes. Un lien au Canadian Stephanie Carlson,
Foundations en 2014, l’équipe de déve- Emergency Nursing Certification Exam Présidente
loppement a ajouté EPICC Trauma et Prep Course est affiché dans la section
a commencé à travailler sur un cours Cours du site web de l’ANIIU/NENA.
Director of Education Report
N ENA has seen growth and cre-
ativity in developing educational
programs for emergency nurses.
Your National Course Administration
Committee (NCAC) is hard at work
NENA’s certification committee would
like to hear from emergency nurses about
your successes with promoting certifica-
tion in your workplaces and those strat-
egies that you have implemented that
Emergency Nurses Pediatric
Course – 5th Edition update
The project is full steam ahead with the
ENPC 5th revisions. The working group
anticipates the rollout in 2018.
with dissemination of the TNCC and assist emergency nurses in preparing to
ENPC across Canada. NCAC is very write the exam.
TNCC Instructors make
involved with the rollout of two new core
emergency nursing education courses: Contact information: their 20th anniversary as
Emergency Practice Interventions Care- educationdirector@nena.ca instructors!
Canada (EPICC) in both English and Margaret Balzer (ON) and Carolyn Hill
French. Canadian Concussion (ON) were recognized at NENA’s AGM
Collaborative (CCC) in Charlottetown, in May 2017.
Two courses are now available—EPICC-
Seventeen organizations across Canada
Foundations and EPICC-Trauma.
participate in the CCC and NENA is one ENPC Instructors make
Congratulations to EPICC working
of those sponsoring organizations. Two their 20th anniversary as
team members for such fabulous work.
new documents have been published on instructors!
The CTAS National Working Group
the website: Audrey Bell-Peter (ON), Jane Stuart-
NENA reps have been working hard in
two domains: CTAS rollout in Ontario 1) Four characteristics of good concus- Minaret (ON), and Marie Grandmont
and CTAS course revisions. Your NENA sion clinics ( July 2017) (MB) were recognized at NENA’s AGM
education team is hard at work and in Charlottetown, in May 2017.
2) The Top Five Key Messages from the
spends many hours working on devel-
5th International Consensus Statement
oping, teaching, and mentoring NENA- Education opportunities for
sponsored educational programs. on Concussion in Sport ( July 2017).
all NENA members—FREE!
All documents are available in English (The Rounds)
Emergency Nursing and French. An organization that sponsors a virtual
Certification Parachute Canada has published a new conference web-based program on emer-
There is a lot of BUZZ around certi- document on their website. This website gency medicine and critical care has
fication! Many emergency nurses are also has numerous resources for educa- offered a free one-year membership for
exploring this opportunity for career tion on concussion. NENA members. All NENA members
development. NENA is committed to were sent an email on how to sign up for
providing study resources for emergency Canadian Guideline on Concussion in this opportunity. If you are new to
nurses applying for emergency nursing Sport / Lignes directrices canadiennes NENA or missed the email, contact
certification in Canada. sur les commotions cérébrales dans le educationdirector@nena.ca for more
sport information.
Recently, CNA had a certification discov-
ery week (Aug 20-27, 2017) to promote h t t p : / / w w w. p a r a c h u t e c a n a d a . Submitted by
the 20 nursing specialty certifications in org/injury-topics/item/canadian- Margaret Dymond, RN,
Canada. Fifty Canadian nurses who have guideline-on-concussion-in-sport BSN, ENC(C)
certification in one or more of the nurs-
ing specialties in Canada were mentors
for discovery week.
Canadian Journal of Emergency Nursing · Vol. 40, No. 2, Fall 2017 5
Rapport de la directrice de l’éducation
L ’ANIIU/NENA a vu sa croissance
et sa créativité croître dans l’élab-
oration de programmes d’édu-
cation pour les infirmiers et infirmières
d’urgence. Votre Comité national
certification dans une ou plusieurs spé-
cialités en soins infirmiers au Canada,
ont agi en tant que mentors durant la
semaine de découverte.
Cours pédiatrique en soins
infirmiers d’urgence – Mise à
jour 5e édition
Le projet est en pleine expansion avec la
Le comité de certification de l’ANIIU/ 5e révision ENPC. Le groupe de travail
d’administration de cours (CNAC/
NENA aimerait en savoir plus de la part anticipe un lancement pour 2018.
NCAC) travaille très dur dans la dif-
des infirmiers et infirmières d’urgence au
fusion du TNCC et ENPC partout au
sujet de leurs réussites dans la promotion Les instructeurs TNCC
Canada. Le CNAC participe beaucoup
de certification dans leurs lieux de travail, célèbrent leur 20e
dans le lancement de deux importants
ainsi que des stratégies mises en place
cours d’éducation pour les infirmiers et anniversaire en tant
pour aider les infirmiers et infirmières
infirmières d’urgence. Le Emergency qu’instructeur !
d’urgence dans la préparation de leur
Practice Interventions Care-Canada Margaret Balzer (ONT) et Carolyn Hill
examen.
(EPICC) est disponible en français et (ONT) ont été reconnues lors de l’AGM
en anglais. Coordonnées : educationdirector@ de l’ANIIU/NENA à Charlottetown
nena.ca (mai 2017).
Deux cours sont disponibles - EPICC-
Foundations et EPICC-Trauma.
Félicitations aux membres de l’équipe de Collaboration canadienne sur Les instructeurs ENPC
travail EPICC pour un incroyable travail. les commotions cérébrales célèbrent leur 20e
Les représentants ANIIU/NENA du (CCCC) anniversaire en tant
groupe de travail national de l’ÉCTG ont Dix-sept organismes partout au Canada qu’instructeur !
travaillé très dur dans les deux domaines : participent à la CCCC et l’ANIIU/ Audrey Bell-Peter (ONT), Jane Stuart-
Le lancement ÉCTG en Ontario et les NENE fait partie des organismes com- Minaret (ONT) et Marie Grandmont
révisions de cours ÉCTG. Votre équipe manditaires. Deux nouveaux documents (MB) ont été reconnues lors de l’AGM
d’éducation ANIIU/NENA travaille ont été publiés sur le site web : de l’ANIIU/NENA à Charlottetown (mai
beaucoup et passe de nombreuses heu- 2017).
1) 4 caractéristiques de bonnes cliniques
res dans l’élaboration, l’enseignement et
de commotion cérébrale (juillet 2017)
le mentorat de programmes d’éducation
Possibilités d’éducation pour
commandités par l’ANIIU/NENA. 2) Les 5 meilleurs messages de la part
du 5e énoncé du consensus international tous les membres de l’ANIIU/
Certification en soins sur la commotion cérébrale dans le sport NENA – GRATUITEMENT ! (Les
infirmiers d’urgence (juillet 2017) ronds)
Il y a beaucoup de discussions autour de Un organisme commanditant une con-
Tous les documents sont disponibles en
la certification ! De nombreux infirmiers férence web virtuelle basée sur la méde-
français et en anglais.
et infirmières d’urgence explorent la pos- cine d’urgence et les soins intensifs ont
sibilité d’un développement de carrière. Parachute Canada a publié un doc- offert une année d’adhésion gratuite pour
L’ANIIU/NENA est engagée à fournir ument sur leur site web. Ce site web les membres de l’ANIIU/NENA. Tous
des ressources d’études pour les infirm- contient également de nombreuses res- les membres de l’ANIIU/NENA ont reçu
iers et infirmières d’urgence qui font une sources pour en savoir plus au sujet de la un courriel sur la manière de s’inscrire. Si
demande de certification en soins infirm- commotion. vous êtes un nouveau membre de l’ANIIU/
iers d’urgence au Canada. NENA ou si vous n’avez pas reçu le courriel,
Lignes directrices canadiennes sur les
contactez-nous à educationdirector@
Récemment, l’AIC a mis en place une commotions cérébrales dans le sport /
nena.ca pour en savoir plus.
semaine de découverte de la certifica- Canadian Guideline on Concussion in
tion (20-27 août 2017) dans le but de Sport http://www.parachutecanada. Soumis par
promouvoir les 20 certifications de spé- org/injury-topics/item/canadian- Margaret Dymond, RN,
cialités en soins infirmiers. 50 infirmiers guideline-on-concussion-in-sport BSN, ENC(C)
et infirmières canadiens, détenant une
6 Vol. 40, No. 2, Fall 2017 · Canadian Journal of Emergency NursingEditor’s introduction & commentary
I could not be more excited or proud
to be the new editor of the Canadian
Journal of Emergency Nursing. Though
I am rather intimidated to take over from
the very capable Ashleigh Malarczuk.
There are some changes and opportu-
nities on the horizon. I will be working
with the NENA board to work out new
submission guidelines and article han-
dling processes. If you wish to be a peer
Cole. Original research has been submit-
ted by Kevin Lobay et al. on community
care emergency medical services and
Phillipe Voyer et al. on delirium screening.
This later author and his team’s work is
reviewer for the journal, please contact me showcased in a special long-form research
My vision for the CJEN, as editor, is
describing your area of expertise. We are report. Allan Lai has provided an editorial
to partner with Canadian emergency
also seeking section editors in the areas of on clinical education and Mathieu Figeys
nurses to showcase the excellent work
trauma, geriatrics and pediatrics for 2018, et al. have written a literature review on
we do. My goal in this role is to bring
please contact me if you wish to volunteer geriatric assessment teams in emergency
scholarly process and scientific rigour
for these positions. I will also be seeking departments. I am proud and grateful for
while remaining accessible and collab-
expanded indexing in journal databases the hard work of the authors, peer review-
orative. The CJEN is the ideal venue
such as Medline, PubMed and Google ers, editorial and publishing teams, espe-
for showcasing Canadian Emergency
Scholar. CJEN is our journal and I want all cially during this, my first time at the helm
Nursing in the domains of clinical care,
emergency nurses to be proud of it. of the journal—thank you all.
education, leadership and research.
Specialty areas I hope to further show- In this edition of CJEN, we have some Matthew Douma, RN,
case are transport, forensic, northern world-class content. I am very proud to BSN, ACCN, ENC(C),
and indigenous nursing. If you have a be sharing the work of Daniel Sundahl CCNC(C), CCN(C)
project you wish to undertake and need on our cover and an explanation of his Clinical Nurse Educator
advice, or a paper you want to share with perspective and art. Furthermore, this Emergency Services
emergency nurses across the country, edition contains clinically focused litera- Royal Alexandra Hospital Emergency
then please reach out. I want to work ture review articles on trauma care topics Department, Edmonton, Alberta
with you to showcase your hard work. by authors Christopher Picard and Elaine
Treasurer’s report
M y name is Kitty Murray. I began
my term as treasurer in July
2016. As a board member, my
job is to work with our financial advisor,
Wendy Atkinson, who keeps our books up
Where do your yearly NENA membership
fees go? NENA keeps $30 of membership
fees (the balance going to the affiliated
province of the member). This portion
of fees provides monies for French trans-
and portions some of this to the affiliated
provinces and some to NENA to provide
these services.
I encourage all of you to be involved
in either your provincial or national
to date and above board. Together, we dis- lation of documents, course development
organization.
cuss how to invest profits for short-term (i.e., EPICC foundations, EPICC trauma
gains, we disperse funds for scholarships and soon EPICC pediatrics), bursaries, Kitty Murray
and bursaries, and we plan for our annual research grants, CJEN (our journal), as NENA Treasurer
NENA conference. We operate as a not for well as our annual NENA conference. As
profit organization. well as these membership fees, NENA
collects course fees from each participant
Canadian Journal of Emergency Nursing · Vol. 40, No. 2, Fall 2017 7National Emergency Nurses Association
NENA 2018
ANNUAL CONFERENCE
April 20-22, 2018
Delta Grand Okanagan
Kelowna, BC
Follow OGOPOGO To Kelowna!
8 Vol. 40, No. 2, Fall 2017 · Canadian Journal of Emergency NursingPre-Conference Workshops April 19:
EPICC
ABCD OF WOUND CARE
PEDIATRIC SIM DAY
April 20-22, 2018
An amazing line up of dynamic speakers on a
wide variety of topics including:
Sherry Stackhouse Triage Youth Mental
Jeff Solheim Trauma Health
Wayne Jeffries Pediatrics Stroke Updates
Winston Sayson Geriatrics Concussion
Grant Innes Forensics LGBTQS2
Bruce Campana Best.Job.Ever.
Barb Shellian…
SAVE THE DATE!
Canadian Journal of REGISTRATION STARTS IN DECEMBER
Emergency Nursing · Vol. 40, No. 2, Fall 2017 9Artistic and therapeutic expression
A few years ago, I heard a statistic
that shocked me; 12 Canadian
firefighters had killed them-
selves in 13 weeks. At the time, I knew
about Post Traumatic Stress Disorder
attended. Often these calls spill into the
emergency rooms of my community and
I’m forced to share these nightmarish
calls with the staff working there. There
have been so many life-altering emer-
for help and received the treatment I
needed. Anyway, last night I had my
first ‘save’ during a cardiac arrest, it
was my first code as the lead para-
medic. Thank you for getting me to
(PTSD) and its effects, but I had no idea gencies I’ve worked with the nurses in the point where I was able to make
just how fatal it really was. A week later, the ER; at the start of my career I hoped a difference in this man’s life. Keep
my platoon attended a lecture about for this excitement, but now these calls doing what you’re doing.”
the signs, the symptoms, and the causes haunt me. I wonder if these emergencies
There is help out there from people who
of PTSD. As I listened to the speaker, I have impacted my nursing friends the
specialize in mental health for emergency
recognized many of the signs and the same way.
workers. So many of us feel there’s no way
symptoms in myself and thought, do I
I create my images by first choosing one out and, for some, it’s the end of us. Seek
have PTSD? No way! Difficulty sleep-
of the invasive events in my mind. I stage the help you need.
ing, depression, being agitated and with-
the call and photograph it using cowork-
drawn were a few of the symptoms I I get criticized by people, telling me that
ers and actors. When I work on the
recognized. I’m only showing the negative side of
image I recreate how I felt during that call
emergency services and that my work
The speaker mentioned that many of instead of what I saw, I do this by digitally
is so sad and depressing. My answer to
his clients were surprised when he diag- drawing on top of the staged photograph.
them is that I’m trying to bring awareness
nosed them with this disorder; many felt It takes about a week to finish each piece
to mental health and PTSD through my
that they did not have a ‘trigger’ event. I and when I’m done the organic invader
artwork by showing the intense situa-
had to get checked. I made an appoint- from my mind is transferred into a life-
tions we face. I think being an emergency
ment with a psychologist and had a few less, one-dimensional image on my com-
worker is an amazing career and I recom-
sessions where he told me that I was hav- puter screen. It’s always scary to share my
mend it to anyone. What other job can
ing a normal reaction to abnormal expe- work and I still have several pieces I’ve
you make such a true difference in some-
riences. “Do I have PTSD?” I asked. “Yes, never shown anyone. I never anticipated
body’s life?
and anyone working in your field with others would attach their own experi-
the same amount of time and experience ences to my artwork and connect with Thank you everyone for your continued
will have signs of it too.” Luckily, my con- them so strongly. support. Stay safe and let’s watch out for
dition isn’t debilitating like it is for so each other.
I hear from so many first responders
many others.
who don’t get the help they need, or Respectfully,
My disorder is a result of accumulated worse yet, who are not supported by Daniel Sundahl
events rather than one specific experi- their employers when it comes to men- DanSun Photo Art
ence. I process my thoughts by recreating tal health. I hear from a lot of people www.dansunphotoart.com
the images in my head and reproducing everyday about their experiences with
Editor’s note: If you are experiencing
them digitally. My artwork is the result mental health and emergency services.
stress because of trauma you have
of my healing process. When I started So many are so similar, we truly aren’t
experienced, please reach out. You are
posting my images online, I was over- alone in the way we feel. I’ve also heard
not alone. Resources may be available to
whelmed by the feedback I received. I from many who have received the help
you through your workplace employee
definitely struck a nerve in the emer- they need and are now in a better mental
assistance program and your primary
gency workers’ community—so many space. Here’s a recent message I received
care provider. You can call the Ontario
others could relate to my artwork and from a paramedic in the United States.
Mental Health Helpline anytime at
many said they broke down in tears when
“Hello Mr. DanSun. I wanted to 1-866-531-2600. PTSD information
they saw the images. I am truly humbled
thank you for your artwork and to let and resources are available through the
by the international attention my artwork
you know it’s made a difference in my PTSD Association of Canada, www.
has received, as well, but what’s more
life. About a year ago I was in a really ptsdassociation.com. If you have a
rewarding is the sense of community that
bad space, I was in paramedic school professional interest in PTSD care, Simon
it is fostering.
and carried a lot of demons with me Fraser University in British Columbia
I have a virtual Rolodex of events in my from my experiences on the road. I has a part-time online program called
head that invade my mind uninvited. saw your artwork and read some of First Responders Trauma Prevention and
I can control them during the day, but the comments and realized others Recovery Certificate, www.sfu.ca
at night they enter my dreams and run were feeling the same, it made me feel
amok. The motivation for my artwork like I wasn’t alone and that what I
is this Rolodex of events and calls I’ve was feeling was normal. I called out
10 Vol. 40, No. 2, Fall 2017 · Canadian Journal of Emergency NursingExpression artistique et thérapeutique
I l y a quelques années, j’ai entendu
parler d’une statistique qui m’a cho-
quée; En 13 semaines, 12 pomp-
iers canadiens s’étaient suicidés. À ce
moment, je savais ce qu’était le trouble
même certains m’ont dit qu’ils s’étaient
mis à pleurer après avoir vu les images.
J’ai été très touché par l’attention inter-
nationale de mes créations artistiques,
mais ce qui est encore plus gratifiant est la
jours, de nombreuses personnes me par-
lent de leurs expériences avec les services
de santé mentale et d’urgence. Il y a tell-
ement de personnes qui pensent comme
nous, et nous ne sommes pas les seuls à
du stress post-traumatique (TSPT) et ses communauté qui s’est créée grâce à cela. ressentir cela. D’autres ont réussi à recev-
effets, mais je ne savais pas à quel point il oir de l’aide dont ils avaient tellement
J’ai un nombre impressionnant d’évé-
pouvait être fatal. Une semaine plus tard, besoin et se sentent mentalement mieux
nements indésirables qui envahissent
mon peloton a participé à une lecture au maintenant. Voici un récent message que
ma tête. J’arrive à les contrôler durant
sujet des signes, des symptômes et des j’ai reçu de la part d’un ambulancier aux
la journée mais, la nuit, ils entrent dans
causes associées au TSPT. Pendant que États-Unis.
mes rêves et font ce qu’ils veulent. La
j’écoutais le conférencier, j’ai remarqué « Bonjour M. DanSun. Je voulais
motivation de mes créations artistiques
que je subissais une partie de ses signes et vous remercier pour vos créations
est en rapport avec ces nombreux évé-
symptômes. Est-ce que je souffrais aussi artistiques et vous faire savoir qu’elles
nements et ces appels auxquels j’ai
de TSPT ? C’est impossible ! Problèmes ont fortement influencé ma vie ». Il
participé. Souvent, ils entrent dans les
de sommeil, dépression, agitation exces- y a un an, je me suis retrouvé dans
salles d’urgence de ma communauté et
sive et en retrait, faisaient partie des un sombre monde intérieur. J’étais
je suis obligé de partager ces appels cau-
symptômes que je reconnaissais en moi. à l’école d’ambulancier et je portais
chemardesques avec le personnel qui
avec moi de nombreux démons qui
Le conférencier a mentionné que plu- travaille ici. Il y a eu tant d’urgences mar-
s’étaient accrochés à moi en raison de
sieurs de ses clients étaient surpris quantes auxquelles j’ai participé avec les
mes nombreuses expériences sur la
de savoir qu’ils avaient été diagnos- infirmiers/infirmières des SU. Au début
route. J’ai vu vos créations artistiques
tiqués comme souffrant d’un TSPT, de ma carrière professionnel, j’avais hâte
et lu certains des commentaires, et j’ai
et beaucoup d’entre eux pensaient de vivre ces événements, mais mainte-
vite réalisé que je n’étais pas le seul à
qu’ils n’avaient pas d’événements nant ils me hantent. Je me demande si
ressentir cela. J’ai vraiment eu l’im-
« déclencheurs ». Je devais savoir. ces moments ont également impacté mes
pression que je n’étais plus seul et que
J’ai pris un rendez-vous avez un amis infirmiers/infirmières de la même
ce que je ressentais était normal. J’ai
psychologue et j’ai fait quelques façon.
demandé de l’aide et j’ai reçu le traite-
séances. Il m’a dit que j’avais une
Je crée mes images en choisissant d’abord ment dont j’avais tant besoin. La nuit
réaction normale à des expériences
un de ces événements évasifs présents dernière, j’ai réussi à sauver une vie
anormales. Je lui ai demandé si je souf-
dans ma tête. Je mets en scène l’appel et pour la première fois au cours d’un
frais de TSPT. Il m’a répondu : « Oui,
je capture l’image en utilisant des collè- arrêt cardiaque. C’était mon premier
et toute personne travaillant dans votre
gues de travail et des acteurs. Quand je appel en tant qu’ambulancier en chef.
domaine, avec la même expérience et
travaille sur l’image, je fais ressortir les Merci de m’avoir aidé à arriver là où
le même temps passé à faire ce travail,
émotions que j’ai ressenties lors de l’ap- j’en suis en ayant réussi à changer la
aurait également des signes similaires
pel au lieu de décrire ce que je voyais, vie de cet homme. Continuez à faire
de TSPT ». Heureusement, ma condi-
puis je dessine numériquement au-des- ce que vous faites ».
tion n’est pas aussi débilitante que celle
sus de l’image que j’ai mise en scène. Il
d’autres personnes souffrant du même Les personnes spécialisées en santé
me faut environ une semaine pour termi-
trouble. mental pour les travailleurs et travaille-
ner chaque pièce et quand j’ai terminé,
uses d’urgence sont là pour vous aider.
Mon trouble provient d’une accumu- cet envahisseur intérieur présent dans ma
Beaucoup d’entre nous pensent qu’il n’y
lation de plusieurs événements plutôt tête devient cette image sans vie et uni-
a pas de sortie à ce cauchemar, mais l’aide
que d’une seule expérience spécifique. Je dimensionnel sur l’écran de mon ordina-
est là.
traite mes pensées en recréant des images teur. C’est toujours un peu effrayant de
dans ma tête et en les reproduisant numé- partager mes œuvres, et j’en ai plusieurs Certaines personnes ont critiqué mes
riquement. Mes créations artistiques sont que je n’ai jamais présentées. Je n’ai jamais œuvres en me disant qu’elles ne montrent
les résultats de mon processus de guéri- imaginé que d’autres personnes allaient que le côté négatif des services d’urgence
son. Quand j’ai commencé à afficher mes intégrer leurs propres expériences à mes et que mon travail est triste et déprimant.
images en ligne, j’ai été très surpris par le créations artistiques et s’y connecter de Je leur réponds en leur disant que j’essaye
nombre incroyable de commentaires que manière aussi forte. de sensibiliser les personnes à la santé
j’ai reçus. On aurait dit que j’avais touché mentale et au PSPT par mes créations
Tellement de premiers intervenants
une corde sensible dans ma communauté artistiques en montrant les situations
me contactent et n’ont pas l’aide qu’ils
des travailleurs et travailleuses d’urgence. intenses auxquelles nous faisons face.
devraient recevoir, et certains ne sont
Tellement de personnes se sont retrou- Être un travailleur d’urgence est quelque
même pas soutenus par leurs employeurs
vées dans mes créations artistiques, et chose d’incroyable et je le recommande à
quand il s’agit de santé mentale. Tous les
Canadian Journal of Emergency Nursing · Vol. 40, No. 2, Fall 2017 11quiconque car il n’y a pas beaucoup d’au- Note de la rédaction : Si vous êtes victime Canada (www.ptsdassociation.com). Si
tres emplois qui vous permettent de faire de stress à cause d’un traumatisme que vous vous avez un intérêt professionnel dans
une réelle différence dans la vie d’une avez subi, n’hésitez pas à communiquer. les soins associés au TSPT, l’Université
personne. Vous n’êtes pas seuls. Des ressources sont Simon Fraser de Colombie-Britannique
disponibles dans votre lieu de travail par le a un programme en ligne à temps partiel
Merci à toutes et à tous pour votre sou-
biais de programme d’aide aux employés qui se nomme « First Responders Trauma
tien continu. Restez prudents et aidons-
et votre fournisseur de soins primaires. Prevention and Recovery Certificate »
nous les uns les autres.
Vous pouvez contacter en tout temps le (www.sfu.ca).
Respectueusement, Service Info Santé mentale Ontario au
Daniel Sundahl 1-866-531-2600. Les informations et les
DanSun Photo Art ressources sur le TSPT sont disponibles
www.dansunphotoart.com par le biais de la PTSD Association of
NCAC report
F all always reminds me of the begin-
ning of a new school year and even
though I am no longer in school,
somehow I have this renewed sense of
purpose; a time to start afresh, to make
“lists” of things to do (which we have put
off during those lazy days of summer).
L’automne me rappelle toujours le début
d’une nouvelle année scolaire. Je ne suis
pas à l’école mais je pense que je devrais
être plus organisé comme quand j’étais
étudiant.
So, it seems appropriate to be asked to
do a “report” of NCAC’s activities for
NCAC teaching EPICC in Charlottetown! From left to right: Maureen Doody,
the journal. On m’a demandé de faire un
Val Lamb, Denis Bouchard, Monique McLaughlin, Sharon Ramagnano and
résumé des activités de la NCAC. It also
Dawn Paterson.
seems appropriate that this should follow
Thanksgiving and Emergency Nursing
connecting with nurses nationally and to Our Facebook page TNCC ENPC
Week—where we reflect on how thank-
support access to quality nursing educa- EPICC (NCAC) is a wonderful opportu-
ful we are for family, friends and country
tion. We are concerned about the barriers nity for us to share articles, podcasts, etc.,
and where we celebrate our brothers and
(financial, language and geographical) to motivate nurses in lifelong learning. It is
sisters in this incredible profession of
that prevent nurses from accessing edu- also a great networking for nurses to meet
ours. Je voudrais tout d’abord vous dire
cation. Les infirmières de ce comité nationally. We encourage you to post pho-
Joyeux Thanksgiving et Bonne Semaine
représentent le meilleur des soins infirm- tos of your courses, share articles, podcasts
des soins infirmiers d’urgence à tous mes
iers à l’échelle nationale. We are voicing on the Facebook page. We love hearing
collègues infirmiers.
those concerns at the national table as from you. Connect with us on Facebook.
In the last journal, you met our current we work to overcome those barriers. We Share your photos of your courses, inter-
NCAC members: Denis Bouchard, our are currently in negotiations with ENA esting articles (yes in French). Please also
French rep; Dawn Paterson, our Western around the contract to provide TNCC contact as at courses@nena.ca (this is
rep; Sharon Ramagnano, our Central and ENPC in Canada. We are still advo- our e-mail address and we will definitely
rep; Maureen Doody, our Eastern rep; cating for French translation in all of our respond to your questions). We need to
Val Lamb, our EPICC rep and yours educational materials. We are support- hear your concerns, questions and com-
truly, the Chairperson of NCAC. At the ing the rollout of EPICC nationally, as ments. We want to be a responsive com-
end of May, we all met for the first time we feel EPICC provides many solutions mittee to you. Nous voulons entendre vos
as the National Course Administrative to some of those barriers to education. pensées et vos questions. Notre comité est
Committee at the NENA Conference For anyone interested in knowing more là pour servir les infirmières.
in beautiful Charlottetown, PEI. I was about EPICC, feel free to check out the
“The best way to find yourself is to lose
humbled and inspired to be part of this website epicclearning.ca. Nous travail-
yourself in the service of others.”
dynamic group of nurses. The lead- lons sur le contrat avec ENA pour TNCC
—Mahatma Ghandi
ership and vision of these incredible et ENPC. Nous aidons à soutenir l’édu-
nurses is what drives our committee. We cation EPICC. Nous parlons pour la tra- Monique McLaughlin
have a shared commitment and value of duction française. Chairperson NCAC
12 Vol. 40, No. 2, Fall 2017 · Canadian Journal of Emergency NursingProvincial snapshots
T he year 2017 has been a pro-
ductive one for many of the
provincial emergency nursing
associations. Numerous challenges and
opportunities are facing emergency
Saskatchewan consists of more than
250,000 km of roads, the greatest amount
of road surface of all the provinces. Fiscal
concern is a strong driver. Operational
details remain either undecided or unan-
In Ontario, eCTAS has been rolled
out in many emergency departments.
The Emergency Nurses Association of
Ontario (ENAO) is a central contrib-
utor to its successful implementation.
nurses across the country. nounced at the time of this writing. As of October 2017, there are more
than 120 hospitals participating, triag-
Mental health and addictions pose some Manitoba is facing some the greatest
ing approximately 400,000 patients per
of the greatest challenges for emergency fiscal challenges that Canadian emer-
month. More money is being allocated
nursing in the west. British Columbia gency nurses have seen since the mid-
by the Ontario government, 140 million
continues to be the nation’s opioid cri- 1990s in Alberta and early 2000s in New
dollars, targeting alternative level of care
sis epicentre with Alberta following sec- Brunswick. The Winnipeg Regional
patients and improved access to home-
ond. The Canadian Institutes of Health Health Authority is committed to sav-
care—a “back-end” investment to reduce
Information are reporting a ten-fold ing 83 million dollars in the 2017/18
ED wait times. Ontario has one of the
increase in Albertan opioid-related hos- fiscal year. Hospital specialization is on
lowest rates of hospital bed availability in
pital admissions in October 2017. Under the horizon for Winnipeg. By compar-
North America and West Europe at 2.3
significant pressure, the Saskatoon ison, cities like Vancouver and Calgary
beds per 1,000 people.
Health Region is expected to open a have fewer emergency departments per
dedicated assessment unit for people capita, and wait times are roughly half In the summer of 2017, Maritime emer-
experiencing addictions or mental health of what they are in Winnipeg. Clinical gency departments struggled with
emergencies, followed by a permanent consolidation is underway with Victoria reduced hours and short staffing-related
mental health emergency department in Hospital emergency department con- closures. Fortunately, some very suc-
2019. verting into an Urgent Care Centre and cessful conferences were also had in the
Misericordia Urgent Care transitioning region. The NENA ‘Find the Edge’ con-
The Saskatchewan Ministry of
into an Outpatient IV Clinic. Eventually ference in Charlottetown was a shining
Health has announced that, effective
the Seven Oaks emergency department success, as well as the Atlantic Trauma
December 4, Saskatchewan will amal-
will convert into an Urgent Care Centre and Emergency Medicine Conference in
gamate the current 12 health regions
and the Concordia Hospital’s emergency Moncton. The 2019 NENA conference is
into one, operating under the name of
department will close altogether. At end in the planning stages, to be held in New
Saskatchewan Health Authority. Names
of the 24-month reform period, three Brunswick, and hosted by the 70 ener-
of new board members were announced
emergency departments and two Urgent getic and capable members of NBENA.
in October and Saskatoon will host the
Care Centres will remain in Winnipeg. In a further exciting development in
head offices.
Considering the immense strain emer- nursing education, Holland College in
The predictable stated objective is to gency nurses in Winnipeg are experienc- PEI is pioneering nursing education in
improve coordination of services to pro- ing, the Emergency Department Nurses’ dementia care using the principles of
vide quality and timely healthcare to all Association of Manitoba requested a Gentle Persuasive Approach.
Saskatchewan residents. Delivery of care change of venue for the Spring 2018
Thank you to Marie Grandmont, Janice
to rural and northern areas is difficult, as conference, which will now be hosted in
L. Spivey, Debra Pitts for their contribu-
it is in the other provinces and territories. Kelowna, BC.
tions to this segment.
Canadian Journal of Emergency Nursing · Vol. 40, No. 2, Fall 2017 13Clinical teaching strategies that inspire and
get the most out of your learners
By Allan Lai
Introduction pelvic bleed before. Cuing the learner to identify their learning
C linical teaching has become a fundamental skill in emer- needs and strategies based on their experience will empower
gency nursing. The demand for 24-hour emergency them to decide how and what to learn. Putting the learner in the
care has never been greater, and coupled with the global driver’s seat facilitates their accountability for their own learn-
nursing shortage, emergency departments (ED) are recruiting ing, which is in keeping with the principles of adult learning the-
and training more specialized emergency nurses to meet the ory (Kaufman, 2002).
demands. Technology is evolving at a rate that has never been Having set the stage earlier allows the emergency nurse to diag-
witnessed in history, which, in turn, has led to innovations in nose the learner; that is, to identify what type of competence
patient treatment that greatly influence how ED nurses practise. and transition stage they are experiencing. A learner identified
Some argue that it is a professional responsibility for current as being keenly and consciously aware of their incompetence
emergency nurses to train and support the success of the next and who may be in transition shock requires mentorship, posi-
generation of emergency nurses. tive feedback, and normalization. On the other hand, a learner
The pressures facing EDs have been well documented. A lack diagnosed as being unconsciously incompetent and in a honey-
of physical space to provide care, high acuity, and a seemingly moon phase would require realistic expectation setting (Kramer,
revolving door of patients are all problems that nurses face when 1974).
they teach. Complicating this are the ambiguous roles for the Expectation setting, Facilitation, Giving feedback with
emergency nurse working with a learner: Should they be teach- clean language
ing or facilitating? How should they teach? Moreover, the pres- The emergency nurse and the learner should set expectations at
sures of time can give the impression that a deep exploration of the beginning of clinical, and they should mutually evaluate their
clinical discussions should take a backseat to patient care. progress routinely throughout clinical training. Expectations
Whereas the literature surrounding clinical teaching in emer- should be set in relation to the learner’s competence. The major-
gency medicine is extensive, searches for literature on clinical ity of the time, emergency nursing students are novices in their
teaching specific to emergency nursing yield limited results. To approach to ED patients. It’s therefore necessary to set realistic
address this gap, this article will offer effective teaching strategies expectations to reflect their novice level. For example, an emer-
for emergency nurses hoping to inspire and get the most out of gency nursing student may have the goal of planning and deliv-
learners in the ED. ering care to a patient suffering from anaphylaxis, but their speed
and skill may not be fully developed. In this example, the emer-
A structured approach gency nurse should share their concern for acuity beyond the
Studies exploring the characteristics of effective clinical instruc- learner’s skill level, and they should come to a mutual agreement
tors (as defined by students) have suggested that effective with the learner regarding the best way to approach the patient.
instructors promote autonomy and have expertise in the rele- When applying the principles of adult learning theory to our
vant clinical setting, strong feedback, and clear communication learners, emergency nurses must recognize that trainees are
skills (Kelly, 2007; Mailloux, 2006; Tang, Chou, & Chiang, autonomous and problem-focused, that they learn from their
2005). To apply these characteristics to the ED, the following mistakes, and that true theory conceptualization must be rele-
strategies are presented in an ABCDEFGHI mnemonic familiar vant to the practice (Kaufman 2002). This method of delivering
to emergency nurses. education is less about “teaching” and more about facilitation.
Assess the learner, Build trust, Cue them, and Diagnose For example, allowing the learner to see a new patient arriving
their learning to a care space independently is much more beneficial for their
Assessing and acknowledging the learner’s experience is critical learning than “tag-teaming” a patient without the learner’s con-
in establishing a clear and respectful relationship. Given that sent. As the facilitator, the emergency nurse should ensure that
nearly all medical, surgical, and psychiatric conditions in vary- key patient treatment priorities are not delayed, such as timely
ing degrees of acuity present to the ED, an understanding of the electrocardiograms for acute chest pain.
learner’s prior experience will provide the means to identify the ED patients often have incomplete histories or no collateral infor-
learner’s stage of competence and transition (Kramer, 1974; mation. Allowing the learner to experience this independently,
Benner, 1984). For example, an emergency nurse trainee may sort through their line of questioning, and make minor mis-
have a wealth of experience in critical care and, thus, be comfort- takes will let the learner truly grasp the practice of emergency
able with rapid sequence intubation. However, the trainee may nursing. Once the learner has reached a conclusion or stalled in
not have been exposed to or have treated an undifferentiated their progress, the emergency nurse can facilitate the learner’s
14 Vol. 40, No. 2, Fall 2017 · Canadian Journal of Emergency Nursingexperience by asking clear, concise questions that may have mistakes. Self-concept and motivation to learn are driving factors
more than one acceptable answer. These questions are generally for learner success, and an emergency nurse can promote this by
open-ended and genuine, and they facilitate learner reflection. sharing positive feedback often. Both positive and constructive
One such example would be: “What made you choose to apply feedback should allow the learner to share their perspective.
continuous SpO2 monitoring?” Avoid asking leading questions
Hear and listen more/talk less & Independence
where a specific answer is wanted, such as: “What three condi-
It has been found that teachers wait on average less than one
tions require SpO2 monitoring?”
second for a response to a question from a learner (Peninciner,
Using clean language, such as debriefing with good judgment, 2002). The emergency nurse should be prepared for silence
is a skill that can further enhance learner reflection. Advocacy/ when waiting for an answer to a question. Be prepared to wait
inquiry is a method of clean questioning where the emergency ten seconds or longer. This allows the learner to hear, decon-
nurse reveals their frame of reference while genuinely inquiring struct, interpret, synthesize, and formulate a response. In the
about the reason for the learner’s action or inaction (Rudolph et event that patient care is a priority resulting in time limitations,
al, 2007). For example, the emergency nurse may choose to ask a inviting the learner to reach a conclusion and return when ready
question using advocacy/inquiry such as: “I noticed you did not to share can be highly effective. Promoting this independence
apply an SpO2 probe in your primary survey. I felt it would’ve will motivate the learner, tap into their experience, and orient
helped your decision-making. Help me understand your thought them to do more and memorize less.
process.” This approach allows the emergency nurse to reveal
their perspective and prevents the learner from guessing what Conclusion
their teacher wants them to say while simultaneously allowing Clinical teaching in busy emergency departments is both chal-
for a genuine answer. The learner may respond with an answer lenging and rewarding. Embracing the uniqueness of the ED and
that can generate rich clinical discussion, such as: “I did not incorporating these qualities into teaching strategies can lead
think the SpO2 reading would have changed my management to rich learning experiences for emergency nursing students.
because the fingers were cold and we would treat the dyspnea Although these strategies are provided in a linear format here,
regardless of the SpO2 reading.” One powerful question can gen- like emergency assessment frameworks, one can be flexible and
erate more learning points than multiple closed questions. creative in implementing them.
Effective constructive feedback in the emergency department
must be respectful, concise, timely, and given only with the About the author
learner’s permission. Mistakes will happen, and if used as learn- Allan Lai, BSN, RN, ENC(C), completed his BSN
ing opportunities, they serve as powerful teaching tools. While at Thompson Rivers University in Kamloops, BC. He
setting the stage of clinical, an emergency nurse who informs the currently practises as an emergency nurse at Vancouver
learner that feedback will be shared gains their permission. This General Hospital and teaches the emergency nursing
allows the relationship to be respectful, and trust is reinforced. specialty program at the British Columbia Institute of
Feedback should be objective, concise, timely, and devoid of jar- Technology. He also supports the EPICC National Design Team
gon. The speed of the ED can cause the learner to forget and, in various ways, most recently as a project team member for the
in some cases, the learner may genuinely be unaware of their upcoming EPICC-Pediatrics course.
Canadian Journal of Emergency Nursing · Vol. 40, No. 2, Fall 2017 15You can also read
