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VOLUME 34 ISSUE 3 • FALL 2020 ISSN 1920-6348 CARE
Real
Knowledge,
Simulated
World Bill 30 &
CLPNA's Council
Shifting Perspective
on Documentation
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2 care | VOLUME 34 ISSUE 3
contents FALL 2020
8 4 | REGULATORY SPOTLIGHT
Bill 30: More Public Reps on
CLPNA's Council
5 | REGULATORY SPOTLIGHT
Understanding the Difference:
Regulator & Union
6 | REGULATORY SPOTLIGHT
AGM Watchable on Video
8 | COVER STORY
Real Knowledge, Simulated World
Virtual reality is offering practical nurse students
a sustainable and low-stress way to practice
real-life competencies to protect the public.
18 17 | Practical Nurse Educator Recognized
18 | RESEARCH
Shifting Perspective on Documentation
20 | Assessment & Control of Psychological
Copyright © 2020 College of Licensed Practical Hazards in the Workplace
Nurses of Alberta
CARE is published quarterly and is the official
publication of the College of Licensed Practical 22 | RESEARCH
Nurses of Alberta. Reprint/copy of any article
requires consent of the Editor of CARE magazine.
Eight Ways to Support Brain Health
Chief Editor - T. Bateman for Rural Older Adults
Editor, Communications Consultant - C. Black
Editorial services provided by
Bird Communications.
25 | Alberta LPN News
Graphic design by Tim Abel. Protecting the Public Interest
Signed articles represent the views of the author
and not necessarily those of the CLPNA. 22
The editor has final discretion regarding the
acceptance of notices, courses or articles and
the right to edit any material. Publication does not
constitute CLPNA endorsement of, or assumption
of liability for, any claims made in advertisements.
Annual Subscription: Complimentary for CLPNA
members, $21.00 for non-members.
care | FALL 2020 3
Regulatory Spotlight
Bill 30:
More
Public Reps
on CLPNA’s
Council
iStock.com/HAKINMHAN
I
n July, the Government of Alberta announced upcoming changes to
the Health Professions Act through the Bill 30 Health Statutes Amendment
Act. Bill 30 requires all health professional regulatory colleges in Alberta
to increase public member representation on their councils, hearing tribunals
and complaint review committees from the current 25 percent to 50 percent
of the total members. The Bill passed into law on July 29 and will take effect
on April 1, 2021.
The impact on Council and committee composition at the College of
Licensed Practical Nurses of Alberta (CLPNA) is currently being reviewed
and plans are being developed to meet the legislative requirements. Therefore,
the Council suspended the Council elections originally scheduled for August
while they determine next steps.
Currently, a minimum of 25 percent of the CLPNA’s Council members are
required to be government-appointed public members, while the remaining
75 percent are licensed practical nurses (LPNs). The present structure is three
public members, seven LPNs, and an LPN president. The new composition
will result in an equal number of public members and LPNs. All Council
members are obligated to uphold the CLPNA’s mandate to regulate and lead
the LPN profession in a manner that protects and serves the public. n
4 care | VOLUME 34 ISSUE 3
Regulatory Spotlight
Understanding the Difference:
Regulator and Union
The Health Professions Act (HPA) requires a clear separation between the responsibility of the
profession’s regulatory functions that protect the public and those related to salary negotiations,
economic and social standing of members of the profession.
CLPNA UNION
As the regulatory college of Licensed A union is an organized body that
Practical Nurses (LPNs) in Alberta, establishes a bargaining relationship
with authority under the Health with the intent to promote collaborative
Professions Act, the CLPNA exists labour relations between employees and
to protect the public through the employers. A union:
following regulatory functions:
• Negotiates conditions of
• Sets education, registration and employment such as wages,
annual renewal requirements benefits, conditions of work and
job security
• Sets and enforces practice,
conduct, and ethical standards for • Processes contractual grievances
delivery of professional services
• Assists employees with labour issues
• Ensures compliance with healthcare
legislation and regulations • Ensures fair representation of
employees
• Sets continuing competence
requirements • Promotes and protects health and
safety of employees
• Investigates concerns regarding
questionable conduct of an LPN • Provides access to opportunities for
professional development
• Maintains a public database
identifying the Registration For more information, LPNs can access
status (Active, Provisional, the collective bargaining agreement that
Suspended or Canceled) of LPNs governs their workplace setting. In non-
in the province of Alberta union organizations, these factors are
managed directly between the employer
• Provides information about the and employee.
practice of the LPN profession,
expected professional standards,
and guidelines that support
public safety
care | FALL 2020 5
Regulatory Spotlight
iStock.com/BongkarnThanyakij
ANNUAL GENERAL MEETING
watchable ON VIDEO
There’s a first time for everything! More than 220 LPNs
and stakeholders participated in a surprisingly intimate, AGM PROGRAM
streaming Annual General Meeting of the College of
Licensed Practical Nurses of Alberta on June 17, 2020. Welcome with Host Tamara Richter, CLPNA’s
Executive Officer
For many attendees, the CLPNA’s first online AGM was Presidential Address with Valerie Paice,
CLPNA's President (1:22)
also the first they attended. The AGM was held for decades
as part of the Annual Conference held every spring. This Thank You to Linda Stanger, Retired CEO (6:12)
year’s event was originally scheduled to coincide with a new Introduction of the CLPNA’s new CEO,
Education Forum however; due to COVID-19 public health Jeanne Weis (21:04)
restrictions, the AGM was transitioned to an online format. 2019 Annual Report Presentation (21:36)
Moving Forward with Jeanne Weis, CLPNA’s
It also included the public introduction of CLPNA's new Chief Executive Officer (28:03)
Chief Executive Officer, Jeanne Weis. Answering Your Questions with President
& CEO (38:40)
The hour-long recording highlights a farewell from retiring
CEO Linda Stanger, an overview of 2019 regulatory Available on the CLPNA’s YouTube Channel,
activities, and a look to the future of healthcare regulation www.youtube.com/clpna, with quick links to
select program times.
in Alberta. n
6 care | VOLUME 34 ISSUE 3
Your
4 Moments for
Hand Hygiene
SEPTIC
FO RE A URE
BE ROCED
P
2
1
BEFORE INITIAL
PATIENT / PATIENT
ENVIRONMENT
4
CONTACT AFTER
PATIENT / PATIENT
ENVIRONMENT
CONTACT
3 AF
BODTE R
EXP Y FLUID
OSURE
RISK
1
WHEN? Clean your hands when entering:
BEFORE initial • before touching patient or
patient / patient • before touching any object or furniture in the patient’s environment
environment contact WHY? To protect the patient/patient environment from harmful germs carried on your hands
2 BEFORE aseptic
procedure
WHEN? Clean your hands immediately before any aseptic procedure
WHY? To protect the patient against harmful germs, including the patient’s own germs, entering his or her body
3 AFTER body fluid
exposure risk
WHEN? Clean your hands immediately after an exposure risk to body fluids (and after glove removal)
WHY? To protect yourself and the health care environment from harmful patient germs
4
WHEN? Clean your hands when leaving:
AFTER patient / • after touching patient or
patient environment • after touching any object or furniture in the patient’s environment
contact WHY? To protect yourself and the health care environment from harmful patient germs
Adapted from WHO poster “Your 5 moments for Hand Hygiene,” 2006. © Government of Ontario. Reproduced by permission
care | FALL 2020 7
Cover Story
Real
Knowledge,
Simulated
World By Andrea Anderson
Virtual reality is making its way into practical
nurse education, making it possible to practice skills and attain more
standardized student evaluations.
At a glance, Chantelle McLean might be mistaken for a young
practical nurse coming off the ward — if not, that is, for the sleek
black rectangle affixed in front of her eyes by a halo of straps.
In plum scrubs, McLean moves purposefully around a small square
of carpet with no clear boundaries, using her hands to manipulate a
set of controllers as she focuses intently on the task she’s completing.
Animated versions of her hands are displayed on a large television
mounted on a wall to her right, where observers share her
perspective as she moves through a hospital room. She washes her
hands, greets a female patient tucked in under a pale blue blanket,
and carefully tends to the woman’s intravenous (IV) line.
The world is virtual, but the scenario is real.
iStock.com/Dean Mitchell
Photography by Leroy Schulz
Interviews and photography for this story were
completed pre-pandemic, in January 2020.
8 care | VOLUME 34 ISSUE 3
Chantelle McLean, practical nursing student
care | FALL 2020 9
McLean is completing a task that licensed practical “The modality of education is changing, so we’re
nurses need to know on the job: maintaining an IV trying to adapt to that,” says registered nurse Sima
line for a patient with nausea. But she is practicing it Mehrabi, an instructor in NorQuest’s practical nursing
in a place where the stakes are lower and the supplies program.
seemingly endless — a
virtual reality (VR) For the past year or
scenario, set up in an so, practical nursing
experimental classroom students there have been
at NorQuest College getting opportunities
in Edmonton, where to complement their
McLean starts the final lab courses and clinical
year of her practical training with VR
nursing program this fall. software designed to
test their knowledge and
“It’s kind of like a hone their skills in IV
game,” she says. “I feel maintenance and insulin
it’s more calming than administration.
the lab work. I’m able to
do much better here than The medication
in the lab, where I’m a administration focus
little bit nervous.” was very carefully
selected based on
An entertainment tool student performance in
in rec rooms across existing clinical courses,
the country, VR is instructor feedback, and
increasingly finding its way into workplaces and scope of practice considerations for licensed practical
educational settings, including Alberta post-secondary nurses, explains Dustin Chan, senior manager in
institutions that offer the practical nurse diploma projects and innovation for NorQuest’s Faculty of
program, such as NorQuest College and Bow Valley Health and Community Studies.
College.
10 care | VOLUME 34 ISSUE 3missed. The goal of that gamification is to get students
to attempt the scenarios over and over until they get
“In the past few years, we’ve been tracking every single everything right.
clinical course, and all the concerns that have come up
and the pieces where students had needed some level of “Really that’s our evaluation of its effectiveness: does
remediation, and these two are really up there,” says someone want to come back and play it again?”
Chan, who holds a Bachelor of Science in Nursing. Chan says.
The faculty decided to focus on step-intensive A few hundred kilometers to the south, a newly-
medication administration processes where mistakes established VR laboratory for practical nurse students
can have serious consequences. To avoid mistakes, at Bow Valley College in Calgary is turning to VR for
practical nurses learn to systematically follow a a different, less game-focused application: evaluating
medication administration checklist and doublecheck student performance on adult health assessment —
that they are providing the right medication, at the another key competency in real-life nursing.
correct dose, to
the proper patient There, the goal
at an appropriate is not just to
time—steps that take provide students
time and practice to with another
perfect. way of practicing
their skills, but to
“From experience, establish a more
and other feedback, standardized,
we’ve noticed that objective, and
there are some efficient way for
students who do instructors to
want more practice,” evaluate student
says NorQuest performance on
practical nursing health assessment
instructor and scenarios.
primary lecturer
Patrick Kelly, a “We’ve always
registered nurse. tried to identify
where we could
In the real world — remove some of
be it the lab or clinic the subjectivity
— that practice that comes with
comes at the cost having a variety of
of materials such as people assessing
IV tubes that can our learners,” says
quickly add up, he At NorQuest College, L-R: Senior manager Dustin Chan; Nora MacLachlan,
explains. With VR, Chantelle McLean and Teodoro Melchionno, practical nursing students; Dean of Health
on the other hand, instructors Patrick Kelly and Sima Mehrabi and Community
the NorQuest team Studies at Bow
hopes to offer students a sustainable, low stress, and Valley College. “That was one of the problems that we
fun way to learn, making the experience as realistic wanted to solve.”
as possible, with gaming elements that allow students
repeated practice opportunities until they have The Bow Valley VR lab officially opened in February
perfected their skills and knowledge. 2020, and features 11 VR stations set around the
room’s perimeter, along with a central control station
At the end of each virtual scenario, the student sees for instructors to monitor student progress. >
an on-screen summary of how they did, Chan notes,
seeing exactly which steps they hit and any that they
care | FALL 2020 11Kristen Cameron, practical nursing student
Working with Calgary’s ICOM Productions, Kim
Hogarth, Associate Dean of Nursing at Bow Valley
College at the time of writing, helped develop the
adult health assessment software currently used
in the lab, which features nine diverse, expressive
patient avatars from different backgrounds with
different conditions.
Back at NorQuest, Kelly and Chan worked with
a software development team at the Edmonton-
based VR company, Dynacor Media. The
company was contracted to come up with the
practical nursing program’s VR software after
meeting with Jennifer Mah, Dean of the Faculty In its first year, the technology was primarily used as
of Health and Community Studies. a practical tool for students in an acute care course,
though there are plans to more fully integrate it into
“We acted as subject matter experts to work with the curriculum starting this spring.
Dynacor,” Chan recalls. “We gave them all the
pieces to ensure that the VR content adheres to the “We’re teaching them a skill in lab, and yes, they’re
curriculum and adheres to CLPNA standards of doing it over and over again,” Chan says. “But now
practice, and that it truly was evaluating the skill I’m going to put you in an open environment that’s
they’re trying to perform.” supposed to feel real. There are no step-by-step
instructions. You just have to play it until you figure it
The centre’s VR program launched in early 2019, out, and then you’ll get feedback at the end, which is
featuring software owned by NorQuest and a pair of kind of neat.”
VR systems set up in a central location in a classroom
to encourage interactions between students practicing So far, instructors like Mehrabi are getting positive
in the virtual world and their peers. feedback from students.
12 care | VOLUME 34 ISSUE 3“[Students today are] much more tech-savvy,” she
says. “This is what they can relate to.”
students are often young and relatively healthy,
Practical nursing student Teodoro Melchionno, a past abnormal sounds or findings on these assessments
student in Mehrabi’s class, agrees. Moreover, the VR are rare, meaning students may not encounter any
scenarios often serve to highlight “small errors you symptoms of concern until they reach the clinical
can make,” he says, “and make you better every single setting.
time.”
On an afternoon in late January, practical nursing
“I think [VR] could be implemented from the first student Kristen Cameron is interacting with one of
nursing course we take,” he adds. “Even health these avatars, an elderly man sitting up on a hospital
assessment. Why not?” bed with his legs dangling over the side. In a virtual
world that she sees
At Bow Valley, where through a headset and
adult health assessments that observers can
are already the focus, watch on a screen in
the VR program has front of her, she gently
so far been tailored to places her transparent,
looking at how students outlined hands on the
fare with some of the delicate, slightly grey
most common health skin on the patient’s
assessment scenarios back as he draws a
practical nurses might breath.
face in real life.
Along with what she
“In our course, Adult can see through the
Health Assessment, we headset, Cameron uses
teach the learners to do her virtual hands and
focused assessments,” virtual stethoscope
Hogarth explains, to feel and hear the
noting that “it helps sounds within. When
them to ask the right she places them in the
questions to determine correct places to check
what assessment they’re for disease symptoms,
going to complete.” known as landmarks
on the body, the
If a patient avatar program follows her
says she is unusually performance — as it
short of breath, for does for other students
example, a student At Bow Valley College, L-R: Associate Dean of Nursing Kim Hogarth; in other scenarios.
needs to recognize that Kristen Cameron, practical nursing student;
Dean of Health and Community Studies Nora MacLachlan
the patient requires Such computerized
a focused respiratory tracking takes the
assessment. Another patient avatar might describe guesswork away for instructors tasked with evaluating
symptoms that are characteristic of a cardiac or students’ health assessment savviness, Hogarth says,
allergic condition. since each student gets evaluated using the same
standards.
Before the advent of VR, practical nurse students
would typically assess each other when learning adult “When they’re listening or auscultating a chest with
health assessments, with one acting as the student and a stethoscope, it will track which landmarks they
the other the nurse, MacLachlan explains. But because listen to,” she says. “It will also tell us how long they
listened, because that’s also so important—you need to
listen for that full breath sound.” >
care | FALL 2020 13After completing the assessments, students complete
their charting, reporting whether they identified any
unusual features in the patient avatars at their virtual
hospital. While one-on-one evaluations with an Though the goal is to eventually replace subjective,
instructor might lead to some nerves or distraction for real life evaluations, the students will continue doing
students, “You kind of feel like you’re in your own assessments in the lab for the time being, until the VR
world” with VR, says Cameron, who donned a VR tool is more fully tested and validated.
headset to try out a trial version of the practical nurse
program’s software last year. Faculty at both Bow Valley and NorQuest have
ambitious plans for applying and expanding their VR
“It didn’t feel like anybody was around you programs. For example, MacLachlan notes that the
watching,” she remembers, “and I actually found it kinds of VR scenarios being used at Bow Valley might
Teodoro Melchionno, practical nursing student
was easy to pick up the abnormal sounds, because you prove useful for looking at how well individuals who
are used to hearing normal lung sounds, typically.” are returning to nursing or transitioning into the field
perform when it comes to adult health assessments.
Bow Valley’s Hogarth has already started working
on five additional scenarios that will represent atrial Back at NorQuest, Chan and his colleagues are
fibrillation and other conditions. pondering the possibility of providing remote learners
with VR educational tools as the technology continues
“All of our learners that are taking adult health to become more self-contained and streamlined.
assessment this term, we’ll start to roll through the
lab to be assessed [after learning and practicing the They are also wondering aloud about the prospect of
assessments],” she says. developing additional scenarios to tackle “soft skill”
development, to support students as they learn how to
talk to patients and navigate a healthcare setting more
comfortably.
14 care | VOLUME 34 ISSUE 3The VR software currently used at NorQuest
provides detailed feedback on student
performance, meaning it might find favour as an
Educators Getting
evaluative tool at some point. For the moment,
though, it is mainly being used as a fun, interactive
Real About VR
way to complement other teaching tools.
The institutions are also contemplating the
T he time, money, and expertise needed to come up
with immersive VR scenarios — complete with
headsets, controls, and highly tailored scenarios — are
possibility of commercializing the VR software still a hurdle for many institutions across the province.
they’ve developed, which could eventually bring But there is no shortage of interest.
complementary VR software from one practical
nurse program to another or into other fields of Some of the nine practical nursing programs in Alberta
healthcare that encompass the same skills. are considering, or actively pursuing, grant funding to
develop interactive VR programs related to specific
In the meantime, the institutions are considering healthcare applications — from practicing patient
ways to measure what success with VR looks interactions to managing aggressive behaviour often
like for their students. With that in mind, associated with dementia patients.
representatives from Bow Valley recently submitted
a grant to support research into VR outcomes Centres already working on VR applications are
at the centre, particularly in the areas of student buzzing about the possibilities for collaboration, and
anxiety and confidence. several programs are already taking advantage of
commercially available simulation and augmented
Hogarth, a graduate nurse practitioner who also reality systems.
completed Bachelor of Nursing and practical
nursing programs, knows that graduates At NorQuest, Bow Valley, and elsewhere, for example,
embarking on a new career may have some students are learning anatomy with the help of
trepidation about their new roles—anxiety augmented reality systems such as zSpace, which
that just might decrease for students who have uses specialized glasses to let students move and
demonstrated their skills successfully in the manipulate detailed three-dimensional body images
virtual world. on a screen, peeling away layers of skin, muscle, and
vascular systems with remarkable depth and detail.
“If there’s a way to give them a few more tools,
a little bit more knowledge, and a little bit more Other simulation software, such as vSim-Medical
confidence, it’s going to help them, it’s going Surgical, is being used by some rural practical nursing
to help the employer, and it’s going to help the students at sites such as Portage College in Lac la
patient,” she says. n Biche. Those simulations involve manipulating video
game-like avatars as they work with a virtual patient,
allowing students to hone clinical skills including
physical assessments, medication administration, calls
to physicians, and vital sign measurement.
With many post-secondary programs moving online in
2020 due to the ongoing COVID-19 pandemic, remote
learning has taken on increased importance, even
at sites where in-person education was previously
possible. With that in mind, practical nursing programs
at both Bow Valley and NorQuest are considering
strategies for reaching students online—for example,
with programs that allow broader simulations or
virtual interactions between students—though the
quick transition to online education, and budgetary
realities, remain challenging.
care | FALL 2020 15Pathway for Preventing
and Managing
Diabetic Foot Complications
Diabetic foot wounds are serious, debilitating and are considered one of the most feared complications of
diabetes. They are also the leading cause of amputations in Canada, with a five-year mortality rate as high
as 50%. Recognizing that 85% of amputations can be prevented, the Canadian Diabetic Foot Task Force
recommends:
All persons with diabetes receive
1. affordable and timely access to the medications, devices, education and care necessary for achieving
optimal diabetes control and preventing serious complications such as amputation
2. access to publicly funded services and devices to prevent and treat foot ulcers and avoid amputation,
including preventative foot care, foot care education, professionally fitted footwear and devices and
timely referrals to multidisciplinary teams
All health regions/agencies
1. prevent and manage foot complications by providing a well-defined referral pattern, and by co-ordinating
care and communication between health-care professionals who support people with diabetes as part of
a multi-disciplinary team
2. publish, on an annual basis, reliable data on diabetes-related foot care, using internationally recognized
metrics, to assist ongoing quality improvement efforts
mplications
and Ma naging Diabetic Foot Co
Pathway for Preventing
Person with diabetes, complications
Person with diabetes, or other complication with remission of foot
(every 1–3 months)
Person with diabetes, complications with current foot ulcer Intervention: Frequent
of ulcer or other complication
24 hours) and ongoing Goal: Prevent recurrence
with no history of foot Intervention: Urgent (within
ize complications
3–12 months) Goal: Eliminate or minim
Intervention: Regular (every ication CARE DELIVERY LOCATI
ON
t of ulcer or other compl STEP
Goal: Prevent developmen ON Risk Assessment
CARE DELIVERY LOCATI
STEP
ent
CARE DELIVERY LOCATI
ON Risk Assessment • Complete holistic assessm
STEP
ent • Foot screening based on ion/
Risk Assessment • Complete holistic assessm history of previous ulcerat
n,
ent • Foot screening: infectio amputation
• Complete holistic assessm active Charcot (structural Plan of Care
erative
• Foot screen for: pre-ulc collapse)
lesions , neuropathy, poor • Poor circulation and ulcerat
ion
• Address other health issues
and
tion, deformity and Plan of Care PREVENTATIVE ls
circula
al make appropriate referra
evidence of pressure/fung STEPS
infections, poor self-care, • Address other health issues ls
ill-fitting footwear • Education
and make appropriate referra
Plan of Care
footwear
• Education • Preventative foot care,
• Address other health issues ls and/or orthotic
and make appropriate referra
• Wound care, including l
offloading (pressure relief) • Support blood sugar contro
• Education WORSENING
CONDITION • Foot care and footwear: WORSENING Re‑screening
• Preventative foot care,
footwear needed by patients during CONDITION
on
and/or orthotics their acute episode • Every 1–3 months based
identified risk ntions
l • Support blood sugar contro
l t and Evaluation of Interve
• Support blood sugar contro Re‑screening, Reassessmen
ntions ed
t and Evaluation of Interve • May require medical and • As required based on identifi
Re‑screening, Reassessmen
surgical intervention risk factors
on ntions
• Every 3–12 months based t and Evaluation of Interve
level of risk Re‑screening, Reassessmen
d;
ed • Continues after crisis resolve
• As required based on identifi every 1–3 months
risk factors
• As required based on need
Relative financial
burden on
Relative financial health‑care system
burden on
Relative financial health‑care system
burden on
health‑care system
multidisciplinary
acute care centre
electronic wound clinic Powered by
patient’s home
diabetes care communication
primary care foot-care clinics
centre
clinic/office
Powered by
To download the Diabetic Foot Pathway for use in your workplace,
https://www.woundscanada.ca/docman/public/1686-diabetic-foot-complications-a-tab-1823e-final-hrnc/file
16 care | VOLUME 34 ISSUE 3Practical Nurse Educator Recognized
Dawn Witherspoon, associate chair of the Practical Nurse (PN) diploma
program at NorQuest College, is the recipient of this year’s Alberta Nursing
Education Administrators’ (ANEA) Leadership in Licensed Practical Nursing
Education Award.
The award recognizes leadership in the advancement of nursing in education,
education program development and delivery, educational organization
involvement, scholarship in teaching and learning, and/or enhancing the
development of nursing students and creating effective practice-environments.
According to her nomination, Dawn is an enthusiastic leader who cares about her
team. She has a positive and collaborative relationship with faculty and staff in the
PN program and is dedicated to ensuring the goals of the college are reached. She
was instrumental in transforming the practical nurse curriculum, wrote questions
for the Canadian Practical Nurse Registration Examination, and has presented at
different conferences.
The CLPNA congratulates Witherspoon on her contribution to practical nurse
education. n
We can all help While social isolation is a complex
problem, some of the solutions don’t
promote the have to be. Everyone can reach out to
social inclusion seniors who might be feeling isolated.
It strengthens our community and
of seniors creates a shared benefit.
As a nurse, you are a critical connector for seniors in
your community. Connecting Edmonton Seniors has
compiled an online listing of Edmonton resources to
help you connect your senior patients.
For more information visit:
www.ConnectingEdmontonSeniors.ca
care | FALL 2020 17Research
Shifting Perspective
on Documentation
by Jennifer Jackson, RN, PhD, Assistant Professor, Faculty of Nursing, University of Calgary
”Paperwork”can be a bad word in nursing. Many
nurses have negative views of documentation, Allen1(pp2-3) recognized organizational labour as a legitimate
preferring to spend time directly with patients. part of nursing work and defined organizational labour as:
However, there is a new concept of organizational
“[Nurses’] work in bringing patients into the organisation
labour which is changing perspectives on what
and mobilising action; their work in maintaining an
constitutes important nursing work.
overview of the current status of individuals’ care and
communicating this to relevant actors; the work in
Documentation has long been recognized as an
ensuring all essential activities are carried out and do not
important part of self-regulation. It provides details on
interfere with each other; their work in assembling the
the work that was done, and any issues for a patient.
materials and resources that are required to support their
More than this, documentation keeps patients moving
conduct; their work in overseeing bed utilisation and
through the healthcare system, which is why it is a
their work in facilitating patient transfers.”
central part of nursing care.
18 care | VOLUME 34 ISSUE 3Organizational labour is performed central part of what nurses do – it just to sit down and write carefully to
mostly by nurses and is unrecognized hasn’t been recognized. help a patient make safe transitions
by everyone, including nurses in their care and communicate critical
themselves.1 Organizational labour The impact of documentation can information to other professionals.
is seen as “paperwork” or a also be seen in its role in managing Nurses can value the role of
bureaucratic exercise that removes cognitive load. Perhaps you have that documentation and give each other
nurses from doing their “real piece of paper in your pocket that you space to document well. All nurses
jobs”. However, Allen1 argues that can’t live without during your shift? can talk about documentation as
organizational labour is among This informal documentation is an real nursing work, and respect that
the most important work in the extension of nursing work, helping to it requires skill. Conversations with
hospital. Nurses manage the flow of keep track of activities and work to management can help to ensure that
information across a wide number be done. When managing on average there is support for documentation
of people and departments, creating 72.3 tasks per hour, it’s important to and that it is valued as a critical part
a patient’s trajectory through the keep everything organized. Formal of safe nursing.
system. For example, discharge and informal documentation plays a
paperwork helps manage a patient’s key role in helping nurses provide safe, It is also important to reinforce
journey from the hospital to home messages to students that
and may be the only information a coordinating patient care and
nurse in the community will receive keeping accurate records is a central
before meeting a patient. In this part of nursing. In my education,
case, documentation is not only
Nurses can I focused on learning wound care,
about recording nursing work. It value the role of medication administration, and
helps patients to transition between documentation other psychomotor skills. When I
different types of care without losing started working independently, I was
important information (like needed and give each other drowning in phone calls, coordinating,
blood tests or medication). space to document and documentation. I had dismissed
these skills and thought I knew how
As far back as 1977, Hockey2(p151) well. All nurses to do that stuff. But when the time
recognized that “The nurse’s can talk about came, documentation was just as
contribution to care may lie, at much a learned skill as any other
least in part, in the promotion of a
documentation as part of nursing. When you work with
functional synthesis of disjointed real nursing work, students, it is a great opportunity
endeavours”. Potter et al.3 found that to reinforce the importance of
nurses spend 26 percent of their time
and respect that it documentation and the role it plays
in consultation with others, and 23 requires skill. in patient safety. Documentation is a
percent of their time documenting competency that needs to be learned
care. The Royal College of Nursing4 and supported, as much as any other.
indicates that nurses spend 17.3 We can work together to ensure
percent of all their hours worked on comprehensive care. The same goes documentation is valued as a central
paperwork. Authors have consistently for whiteboards, status boards, and part of nursing work, as much as any
reported that nurses spent more time other sources of information that keep other kind of labour. n
arranging and documenting care everyone informed and on the same
than interacting with patients.5,6,7,8 page. *References available upon request.
Westbrook et al.8 reported that nurses
**The CLPNA’s Policy on Documentation
working on wards completed an Nurses need to think and speak can be found on the CLPNA’s website
average of 72.3 tasks per hour, with differently about documentation. It at https://www.clpna.com/wp-content/
19-24 percent of these tasks relating can be hard when there are comments uploads/2018/04/doc_Policy_
to professional communication. about someone “sitting at the desk”, Documentation.pdf. This policy outlines
as though physical labour is the the CLPNA’s expectations of LPNs around
documentation and highlights some of the
However, these nurses felt that this only valid form of nursing. Instead,
legal implications and risks associated with
work was all considered a distraction, consider that a carefully written poor documentation practices.
rather than real nursing work. discharge summary or transfer note
Allen’s1 perspective shows how could prevent severe complications
documentation has always been a or errors. It is worth taking the time
care | FALL 2020 19THE HAZARD: What are The Canadian Standards Association (CSA) National
psychological hazards? Standard for Psychological Health and Safety in the
Workplace provides organizations with a framework
Psychological hazards are elements of the work and guidance to develop an effective psychological
environment, management practices or health and safety program. The standard identifies
organizational practices that pose a risk to mental 13 workplace factors that impact psychological
health and well-being. health. Employers should consider how each of the
following factors supports psychological health and
Common psychological hazards include exposure to safety: psychological support; organizational culture;
harassment, violence or traumatic events. However, clear leadership and expectations; civility and
long term exposure to less severe psychological respect; psychological job demands; growth and
hazards, such as increasing job demands or role development; recognition and reward; involvement
ambiguity, can also impact psychological health. and influence; workload management; engagement;
work/life balance; psychological protection; and
A worker’s psychological health can also be affected protection of physical safety.
by the following factors:
Work organizational factors THE EFFECTS: What are
•
•
shift work and hours of work
job security
the effects of psychological
• workload and pace hazards in my workplace?
• interpersonal relationships
• organizational change Exposure to psychological hazards can negatively
impact a worker’s physical and mental health. People
• technological change
sometimes develop negative coping behaviours to
deal with psychological hazards, such as alcohol or
Environmental factors drug abuse, which can create further psychological
• indoor air quality distress or possibly lead to addictions.
• lighting
• noise The conditions and behaviours that result from
poor psychological health can impact the employer,
Personal factors directly and indirectly, through:
• work-life conflict • absenteeism rates
• changing stages of family life • benefits costs
• pre-existing depression, anxiety, substance • turnover rates
abuse and other mental illness • accidents and injuries rates
• workers’ compensation claims
• disability rates
iStock.com/GDArts
20 care | VOLUME 34 ISSUE 3THE CONTROLS: How can 3. Encourage reporting and incident
employers and workers control investigation
psychological hazards? All incidents or near misses that result or could
result in psychological injury should be reported and
investigated. Due to the personal nature of these
1. Hazard Assessment
types of incidents, they may go unreported for fear of
The hazard assessment process involves identifying reprisal or blame. Unless incidents are investigated,
existing and potential hazards for every job and they are likely to be repeated. Reporting processes
every task at a work site. After hazards are identified, should be established in a way that respects the
each is assessed for the level of risk it presents and individual’s right to privacy and does not put the
appropriate control measures need to be put in place. person reporting the incident in jeopardy.
Below are some controls that will help you assess how
well you are controlling psychological hazards at your
4. Focus on prevention
work site. Develop a policy on psychological hazards.
Successful strategies to control work-related
Employers should indicate their commitment to psychological hazards involve three levels of
identifying and controlling workplace psychological prevention. Examples at each level are provided
hazards. This can be done by developing policies below for consideration when planning possible
and procedures to prevent or control psychological interventions.
hazards.
Level 1 prevention aims to prevent psychological
A good psychological hazard policy is clear, injuries or harm by:
supportive, and encourages reporting and • assigning reasonable work quantities
investigation of incidents. The policy should include: • creating psychologically safe work environments
• employer’s commitment to recognize and address and conditions
workplace psychological hazards • assigning work that aligns with the workers’ skills
• a statement that any acts of harassment are
unacceptable Level 2 prevention looks to reduce or modify impact
• a definition for workplace psychological hazards through:
• a requirement for a psychological hazard • education and skills development like developing
assessment communication strategies
• training for workers and managers on recognition • management of personal perceptions of stress
and reporting of psychological hazards • provision and promotion of wellness programs
• support for workers experiencing workplace • managing the personal work environment to
related psychological hazards remove stressors, such as ambient noise, air
• confidentiality for those experiencing or quality concerns, and ergonomic issues
reporting incidents
Level 3 prevention looks to lessen the impact of
2. Worker Training those experiencing psychological injuries or harm by
providing:
Worker training is a critical component of any safety
program. Training should include: • accessibility to employee assistance programs and
counselling
• hazard assessments for workplace related
psychological hazards • workplace accommodations, return to work
planning, modified duties
• general knowledge about the types of
psychological hazards and health effects • peer support networks
associated with exposure
• review of the employer’s policies and procedures
developed to address workplace psychological Contact Us
hazards OHS Contact Centre Website
• incident reporting expectations and procedures work.alberta.ca/ohs-contact us
© 2017 Government of Alberta This material is for information only. The information provided in this material is solely for the user’s information and convenience and, while thought to be
accurate and functional, it is provided without warranty of any kind. The Crown, its agents, employees or contractors will not be liable to you for any damages, direct or indirect, arising out
of your use of the information contained in this material.
care | FALL 2020 21Research
Eight Ways to Support Brain Health
for Rural Older Adults
By Juanita Bacsu, PhD, Post-Doctoral Fellow, Faculty of Kinesiology and Health Studies, University of Regina
and Shanthi Johnson, PhD, Dean and Professor, School of Public Health, University of Alberta.
Age is the greatest risk factor for
developing dementia, and the
number of rural older adults is rising
in Canada. As the rural population
ages, there is an increasing need
for knowledge on brain health and
cognitive health promotion within
a rural context.
This article takes a look at ways
to support brain health from the
perspective of rural older adults.
Introduction
Brain health is a growing concern
among older adults. Globally,
approximately 50 million people live
with dementia and this number is
projected to increase.1 Age is the most
important risk factor for developing
dementia,2 and the number of rural
older adults is rising in Canada.3 While
most studies focus on prescription
drugs and medical interventions, little
is known about the ways older adults
support their brain health, especially in
rural communities.
Brain Health and Rural Aging
Compared to urban seniors, rural
seniors often experience unique
barriers to dementia care and
services related to limited access to
medical specialists (e.g., geriatricians,
neurologists, psychiatrists), finances,
public transportation, education, and
health and support services.4 Since
the majority of dementia services
iStock.com/CherriesJD
exist in urban centres, this means
22 care | VOLUME 34 ISSUE 3Age is the most important risk factor for developing dementia,
and the number of rural older adults is rising in Canada.
that rural seniors must either travel to access services or 3 Keep active. Maintaining an active lifestyle supports
forego them.5 Consequently, access to dementia services our brain health and stimulates our minds. Go on a walk,
is a significant challenge for residents living in rural work in the garden, go swimming, make a scrapbook,
communities.6 join a bowling league, play pickleball, sing in a choir, visit
a seniors’ centre, or volunteer in the community.
Studies show that dementia and cognitive impairment
are more prevalent among rural seniors than urban 4 Challenge your brain. Challenging our minds helps
seniors.7 However, most of the work in this area remains to support our memory and boosts our mental sharpness.
urban-centric with little focus on brain health or cognitive Do a jigsaw puzzle, take music lessons, do needle work,
health promotion in rural communities.8 As the rural make a quilt, try a crossword or word search, play
population ages, there is an increasing need for knowledge different card games, or do a sudoku puzzle.
on cognitive health promotion within a rural context.
5 Eat healthy. Eating nutritious foods supports our
Methods: What we did brain’s ability to function and our overall health. Eat
green leafy vegetables, berries, fish and fruits.
Our team interviewed older adults in rural Saskatchewan
to learn about what activities they thought supported their 6 Chat with a friend. Mingling and spending time with
brain health.9 Using community-based research and an friends helps to improve our mood and reduces feelings
ethnographic methodology, two waves of semi-structured of loneliness. Send an email, chat on the telephone, visit
interviews were conducted with 42 adults (ages 60+ years) with a neighbour, play with a pet, grab a coffee, or use
in rural Saskatchewan. social media to stay connected with friends and family
members.
Participant observation was conducted by spending time
with five older adults to observe day-to-day activities 7 Relax. Relaxation can help us to reduce stress and
related to supporting their memory and brain health. improve our sense of well-being. Meditate, spend time
Guided by theories of culture, thematic analysis was used outdoors, write in a journal, paint a picture, drive in the
to identify key patterns and relationships within the data.9 countryside, listen to calming music, practice yoga or do
tai chi.
8 Ways to Support Brain Health 8 Sleep tight. Getting a good night’s sleep helps to
for Rural Older Adults support our mental capacity and our brain’s ability to
function. Limit caffeine, avoid naps close to bedtime,
Our findings revealed a more holistic and establish a nightly routine, and avoid rigorous physical
multidimensional view of brain health than previously activity or exercise before bed.
cited in the literature.10 Drawing on our study’s findings,
here are eight ways used by rural seniors to support their
brain health. Conclusion
1 Think positive. Having a positive attitude and feeling Brain health is an important and a vital part of healthy
happy is good for our brains and helps us to overcome aging. Our study identified a range of activities used by
stressful situations. Some ways to support positive rural seniors to support their brain health. Ask questions
thinking include listening to music, going to the hair and talk to your healthcare provider about other ways to
salon, smiling, reading funny jokes, doing exercises, and support your brain health. n
getting dressed-up.
References on request, or at https://www.centre4activeliving.ca/
2 Learn something new. It is good to get out of our news/2020/06/rural-older-adults/.
comfort zones and learn something different. Try a new
Reprinted with permission from WellSpring, Centre for Active
recipe, read about bird species, tell new jokes, learn about Living, June 2020, Volume 31, No. 06
star constellations, or play a new game.
care | FALL 2020 23Stay Independent.
Prevent Falls.
CONCUSSIONS SENIORS OLDER THAN 65 ARE
ARE THE MILDEST AND
MOST COMMON TYPE OF 10 TIMES MORE LIKELY
TRAUMATIC THAN THOSE YOUNGER THAN 65
BRAIN INJURY (TBI) TO BE ADMITTED TO HOSPITAL
FOR FALL-RELATED TBI INJURIES
SENIORS’ FALL-RELATED TBI HOSPITAL ADMISSIONS
88%
88% OF THESE More serious
than concussion
ARE MORE SERIOUS TRAUMATIC
BRAIN
THAN CONCUSSION
INJURIES
12%
Concussion
37% OF 16% OF
SENIORS
WITH FALL-RELATED
THESE HOSPITAL
ADMISSIONS
TRAUMATIC BRAIN INJURY WERE DISCHARGED
ARE ADMITTED TO EXTENDED
TO HOSPITAL CARE FACILITIES
AVERAGE ANNUAL COST
ANNUALLY, SENIORS’ FALL-RELATED PER VISIT1:
TRAUMATIC BRAIN INJURIES Hospital Admissions:
AGED 65+: $21,000
COST ALBERTANS AGEDAlberta
LPN News PROTECTING THE PUBLIC INTEREST
Practice Guideline on Virtual Healthcare
A
mong the many changes to healthcare due to the
COVID-19 pandemic is the accelerated adoption of
modern communication technologies. The Alberta
government announced that virtual doctor’s appointments
would become a permanent care option and Alberta
Health Services began using Zoom video conferencing as
an alternative to in-person appointments.
Through virtual healthcare, licensed practical nurses
(LPNs) can provide nursing services to patients through
technology, including videoconference, telephone, email,
or texting.
The College of Licensed Practical Nurses of Alberta
(CLPNA) produced a Practice Guideline on Virtual
Healthcare to support informed practice. LPNs can find
guidance on professional and legal expectations while
providing nursing services through technology. The
guideline may be especially valuable to those in self- iStock.com/AJ_Watt
employed practice.
The CLPNA’s Practice Guidelines are evidence-informed documents designed to assist membership with making
decisions about appropriate nursing practice, professional judgment, and flexibility.
UPDATED The newly updated Practice Guideline on Self-Employed Practice assists LPNs
who engage in or who are considering self-employed LPN practice.
SELF-EMPLOYED
It includes info on risk management, liability, conflicts of interest, professional
PRACTICE boundaries, information management, technology and social media, work
GUIDELINE environment, and infection prevention and control.
This document replaces the Practice Guideline on Independent Practice.
Questions? Contact the CLPNA’s Professional Practice Team at Ask CLPNA, practice@clpna.com,
780-484-8886 or 1-800-661-5877 (toll free in Alberta).
care | FALL 2020 25REGISTRATION
2021 RENEWAL
SUBMIT BY
DEC. 1
2020
Annual LPN Registration Renewal begins October 1 for 2021.
The CLPNA encourages all LPNs to renew before December 1 to
pay the lowest registration fee of $350. For those who delay, the
renewal fee is $550 when submitted between December 2 to 31.
Formal notices will be sent by email from the CLPNA’s Registrar.
Practice Hours Requirement for 2022
By 2022, all Licensed Practical Nurses will be required to have
Members must successfully provided nursing services for a minimum of 1000 hours within the
complete the annual previous four-year period (2018 – 2021) to be eligible for registration.
Registration Renewal This requirement will not apply to recent graduates who have been
registered for fewer than four years.
process in order to:
DO NOT LET YOUR PRACTICE PERMIT EXPIRE
• work in Alberta as a Licensed Practical Nurse
in 2021 (with Active registration type) Only those with a valid, unexpired CLPNA Practice Permit are
authorized to work as an LPN in Alberta or use the title ‘Licensed
• OR change their registration type from Active Practical Nurse’ as stated in Schedule 10 of the Health Professions Act.
to a non-practicing Associate
• OR cancel their practice permit and notify the The repercussions of working with an expired or invalid practice permit
CLPNA they are not renewing for 2021 are serious and impact both an LPN’s registration and disciplinary
status. All employers will be notified immediately as the nurse must
For complete info, see www.CLPNA.com, stop working until the practice permit has been reinstated. (Typically,
employers may also issue a suspension.) The process to become
“Members”, “Registration Renewal”.
reinstated may take weeks and involves the CLPNA’s Registration and
Complaints Departments. Fees totalling $1280 must be paid, including
$780 in Practice Permit Fees and a $500 Complaints Fee.
26 care | VOLUME 34 ISSUE 3REGISTRATION RENEWAL
MATERNITY, LEAVES AND CANCELLATION FEES, DEADLINES AND PROOFS
Maternity or Short-Term Leave?
The CLPNA recommends LPNs renew for an Active Practice 2021 REGISTRATION RENEWAL FOR ACTIVE PRACTICE PERMIT
Permit to return to work without delay for those taking short-
term or maternity leave. (The Associate membership type is Fees Paid Fees Paid After
October 1 - December 1 December 2 - 31 December 31
not recommended.)
Reinstatement Required
$350 $550 $300 Registration Levy may apply
Retiring or Not Renewing?
A non-practicing Associate membership for $50 provides a
CARE magazine subscription and frequent practice updates. Fees may be paid online by credit card (VISA or
It does not allow the individual to work as an LPN in Alberta. Mastercard), or through previous enrollment in our
Associates who apply for an Active Practice Permit must Pre-Authorized Payment Plan. For different payment
still meet all registration requirements including application methods, contact the CLPNA during business hours to
approval, fee payment, criminal record check, and evidence of make alternate arrangements. All fees will change at
being actively engaged in practice (1000 practice hours in the 12:00 am (midnight) on the dates listed. CLPNA
previous four years). LPNs choosing this option will be listed Payment Policy: Registration fees are in Canadian
on the Public Registry as “Associate” with a reason of “Permit dollars and are non-refundable.
Cancelled Non-Practicing”.
Reinstating Registration after Dec 31
Cancelling? On January 1, 2021, the Registration Renewal system
To cancel registration completely, LPNs should select will close and those who have not renewed will have
the “Cancel” option on their 2021 Registration Renewal their practice permit suspended. Those still wishing
application. This will capture final info about the LPN’s practice to register must complete the ‘Previously Licensed
hours and Continuing Competency Learning Plan. Until the in Alberta’ process. Total fees will be $780 ($100
Registration Renewal form is submitted, LPNs will continue Application, $350 Practice Permit, $300 Registration
to receive reminders, suspension and cancellation notices as Levy, $30 Criminal Record Check). If the applicant
required by the Health Professions Act. worked without a valid practice permit, a $500
Complaints Fee is added, for a total of $1280.
Practice Permits
PREPARING TO RENEW After Registration Renewal is approved, most members
will receive access to their Practice Permit and tax
To begin the 2021 Registration Renewal application, receipt. For those on the Pre-Authorized Payment Plan,
login to https://www.myCLPNA.com directly, or go access to their Practice Permit will become available
to www.clpna.com and in the upper right corner click after the final payment is processed in late November.
on the blue “myCLPNA Login” graphic.
Proof of Registration on Public Registry
BEFORE BEGINNING, GATHER: Proof of an LPN's current and future registration status,
practice conditions, and more can be found using the
1 Your www.clpna.com password. CLPNA’s Public Registry of LPNs at www.clpna.com.
2 Your nursing practice hours. Count hours from
Jan. 1, 2020 to the submission date of your Prepaying Registration Renewal Fees for 2022
Renewal application. Then, add your estimated The new Pre-Authorized Debit (PAD) plan allows
practice hours from that date to Dec. 31, 2020. members to pay their 2022 Registration Renewal Fee
For guidance, see the Policy: Practice Hours and using automatic bank withdrawals of $35/month for 10
the Nursing Practice Self-Assessment Tool. months. Go to www.clpna.com, “Members”, “Registration
Renewal”.
3 Your Continuing Competence Program (CCP)
Learning Plan for 2020 and 2021. Questions? Contact CLPNA at registration@clpna.com,
4 Your employer(s)/organization(s)’s contact info. 780-484-8886, or toll-free at 1-800-661-5877 (toll free
in Alberta only).
5 Your payment method, if not enrolled on the
Pre-Authorized Payment Plan.
>
care | FALL 2020 27You can also read
