Dave Ross

After a balmy fall, winter arrived in Toronto last week with a vengeance. Temperatures registered as low as -30C with wind chill. The city hunkered down and pedestrians bundled up against the extreme cold.

But there was also tragedy – and, after the death of two homeless people without shelter, Mayor John Tory ordered the medical officer of health to declare an extreme cold alert, activating warming centres for one of Toronto’s most vulnerable populations.

“It’s a shame that in 2015, in a country as wealthy as ours, we have such serious issues with poverty and homelessness,” says alumna Joyce Rankin. Rankin, who holds both a master of nursing degree and an MBA from �鶹ֱ��app, is clinical manager for Street Health in Toronto. (Listen to Rankin's powerful interview with CBC Radio's Matt Galloway on Metro Morning.)

“It is even more astounding that the city refused to consider wind chill in their determinations of cold alerts. It may be -5C, but in reality it is -20C with the wind chill – yet no extreme cold alerts are issued.”

Street Health is a non-profit community based agency serving the health and well-being of homeless and under-housed people in downtown Toronto. Writer Dave Ross spoke with Rankin about the shelter situation, the extreme cold, and what changes could be made to the system.

Why are homeless people dying on the street?
The shelters are over-capacity, and any suggestion they aren’t is false. The idea that we are providing enough shelter is also wrong. If we have enough shelter space, why are people dying on the streets?

Numerous non-profit and faith-based organizations operate Out of the Cold programs, which are well-attended across the city. If we have enough shelter space, why has the city relied on these organizations to provide services to this population for 28 years?

Programs like Out of the Cold run on the backs of donors and volunteers such as yourself. Does this indicate a gap in shelter services?
Absolutely. It’s ridiculous that the city relies on the presence of these volunteer-run spaces, and even more importantly highlights the need for safe and affordable housing for people, which doesn’t seem to be a priority for the city. Admittedly, there is no silver bullet solution, unfortunately.

Everyone needs protection from the cold – if you’re cold, take shelter and warm up. People who are homeless or living in poverty can’t always do that – shopping malls close, coffee shops don’t want you stay for long periods, and many can’t afford $3 to ride the TTC all night – the list goes on. �鶹ֱ��appless people also age fast due to trauma and stress, further jeopardizing their health and making them vulnerable to living in difficult conditions. This population is constantly fighting stigma as well. They are human beings that need support, not our judgments. Addiction happens in all walks of life.

We have a responsibility to shelter people, and we ignore the social determinants of health at every turn. Shelters, supportive housing and Public Health need to get together, and have a communications plan.

What about barriers to access? How does a person access a shelter?
Accessing a shelter bed is not a straightforward process in Toronto. One thing the city has done well is implement a single point of access on Peter Street, which functions as a referral centre to shelter space. The concept is good, but it is fraught with barriers. When a person shows up and requests a shelter space, it can take hours to find one, and it is expected that the individual has a means of staying in touch with the referral centre. This is a population that doesn’t have mobile phones or fixed addresses, so the notion that they are “contactable” is flawed. And if that person is offered a bed that doesn’t fit their needs and declines it, they are simply turned away, and spend the night on the street. The system has no flexibility in any way. Without flexibility there is absolutely no “wiggle room” which is the situation we are finding ourselves in now.

What could make a person refuse a shelter bed, especially during extreme weather?
Shelters are spread out across the city. Imagine you’re on Peter Street, and have been referred to a shelter in North York. How are you going to get there? What if you’re referred to a shelter where you’ve been assaulted? Or become ill? Or where they won’t take your pet, your sole companion in this world? Unable to accommodate your family? Shelters, while warm, are not necessarily a safe environment. There is no flexibility in the system, and that's what leads to situations where homeless people feel they must stay on the street.

If you could change things right now, in this current cold snap, what would you do?
I would open the armouries and more warming centres, offer this population immediate and simple access to shelter. Long-term, I want to see the two 24-hour shelters the city has promised, more safe, affordable housing for people, and ultimately, to see the development of a national housing strategy.

What drew you to nursing, and how did you find your way to Street Health?
I have never wanted to be anything but a nurse. Even after 25 years, I look forward to my work every day. I am also fortunate to have had incredible mentors through all of my education. My obstetrics instructor in my college program, Nancy Barber, was so passionate about nursing, and Francine Wynn at Bloomberg Nursing was a leader who forced me to think about nursing in a whole new way, a skill I value today. Doug Hyatt, from the Rotman School of Management, was (and still is) one of the most inspiring professors I have met. Most importantly, my nursing friends continue to influence me. The friends I made during my first job at Mount Sinai in 1988 are still my closest friends. They worked hard to support me in nursing, but also in my transition to a new city and new career.

I’ve volunteered with Street Health and organizations like it for many years. After establishing my career as a critical care nurse in hospital settings, I had the opportunity to volunteer with these organizations more, which has grown into a full-time job with Street Health. I love the fact that I can work intensely to support colleagues working with the very marginalized in our society, and work with them to advocate all levels of government to support people and help them get out of poverty. We are constantly challenged, but the work we do is rewarding, and most of all, important.

If you see someone in need during extreme weather, contact 311 or 911 immediately.

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Convocation 2014: Meet Bloomberg Nursing's Deidre Bainbridge

sgupta — Fri, 20 Jun 2014 12:05:10 +0000

Convocation 2014: Meet Bloomberg Nursing's Deidre Bainbridge sgupta Fri, 06/20/2014 - 08:05

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Assistant Professor Margaret Blastorah with Deidre Bainbridge (photo by Dave Ross)

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For the University of Toronto’s Deidre Bainbridge, it was a long, winding − but ultimately rewarding − road to her Master of Nursing degree.

“I didn’t actually choose nursing as a career until I had been a nurse for 10 years,” Bainbridge says.

Despite her early interest in forensic medicine, the abundant employment opportunities for RNs led Bainbridge to a two-year diploma in nursing. She put those skills and knowledge to work as a forensic nurse at the Sexual Assault & Domestic Violence Care Centre at Women’s College Hospital. But she didn’t stop there.

A volunteer at the Toronto Rape Crisis Centre’s 24-hour hotline, Bainbridge also took on a part-time role at the Bay Centre for Birth Control.

With her professional life focused in the increasingly important and sensitive field of female reproductive health, Bainbridge then began working toward her BScN. And, in 2001, she completed the Primary Health Care Nurse Practitioner Program post-degree certificate.

After becoming a nurse practitioner, Bainbridge finally “chose” nursing as her career. She quickly discovered she was in a unique position to examine, diagnose and treat patients.

More important, Bainbridge says, she had the chance to make an impact in forensic nursing at Women’s College Hospital − where she’s now spent more than two decades providing care and counsel to vulnerable women.

Forensic nursing is a specialty that involves the provision of care to victims of crime, including sexual and other assaults. It may also involve working with perpetrators of crime deemed not criminally responsible for their actions. Forensic nurses collect and preserve physical evidence, document and photograph injuries and provide witness testimony when needed.

“As a nurse practitioner, I have educated more than 1000 nurses across Ontario on how to examine, test and treat victims/patients of sexual assault” says Bainbridge.

She also provides follow-up care to victims/patients in the six months following the assault – testing and treatment for sexually transmitted infections, support and education, and help managing sleep disturbance and depression as a result of assault.

“We really address the bio-psycho-social needs of the patient/victim,” she says.

It’s challenging and important work. But it isn’t for everyone.

“Bearing witness to the capacity we as human beings have to be violent and cause pain and devastation to others can be profoundly upsetting,” Bainbridge says. “There are only a handful of forensic nursing experts in Canada, in part due to being a relatively small area of specialty, and in part due to the nature of work – this work is emotionally difficult, leading to compassion fatigue and burnout.”

Bainbridge intends to keep working to advance the field in which Bloomberg Nursing has helped her become a leader, by leading clinical research and writing articles for publication, among other initiatives.

“The Bloomberg Faculty of Nursing at �鶹ֱ��app has a solid reputation internationally largely because of the leadership and research scholarship generated by the faculty in women’s health, particularly women’s mental health.”

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Managing children's pain, improving decision-making

sgupta — Mon, 26 May 2014 15:09:53 +0000

Managing children's pain, improving decision-making sgupta Mon, 05/26/2014 - 11:09

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Jacqueline Hanley

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A first-year Master of Nursing student talks about pediatric nursing

After completing a degree in Biology and Psychology, Jacqueline Hanley was certain she wanted to be part of a professional program, and was leaning towards medicine and physiotherapy until she had an opportunity to take part in a research study where she had the opportunity to see nurses in action.

After enrolling in the BScN program at the University of Toronto's Lawrence S. Bloomberg Faculty of Nursing, she knew she had found a field that met her desire to learn and grow as a professional. Hanley took a job at Toronto’s Hospital for Sick Children after graduating in 2010 but returned to Bloomberg Nursing in 2013 for her Master of Nursing (Clinical) where she penned a particularly moving piece for The Toronto Star about a day in the life of a pediatric nurse at the hospital.

How does a pediatric nurse respond when someone asks how their day was? Writer David Ross sat down with Hanley to learn a bit more about the student behind the writing.

What drove you to write this prose?

I was with my friend and colleague as she drove me home one night after a very draining day at work. It wasn’t a busy day at all, but I was emotionally and physically exhausted. I remember talking to her about how I often had a hard time explaining to my husband, Shaun, what my days were like, and why I came home so worn out. We chatted about how there is just no way to capture what it is about a day that makes it good, or bad, or hard, or happy. When I wrote this, I was feeling a bit lost and lonely, because nursing is a job that really becomes such a big part of you, and yet I feel that so few people outside the profession understand the role.

Pediatric nursing isn’t defined by changing diapers and dishing out medications, and it’s also not about being a hero or an angel. We hold hands and wipe tears sometimes, and we certainly do enjoy the many moments of cuddling, playing, and chatting. But we also have years of rigorous education behind us. We know our pathophysiology and pharmacology. We react to constantly changing scenarios, and make hundreds of decisions daily – decisions that require a lot of knowledge and skill, decisions that require good judgment and the ability to think critically. We are accountable professionals, individually, and yet work as a team. We use evidence to inform our practice, and do our best to stay up-to-date with an ever-changing health care environment. We work hard to be efficient and knowledgeable while still being compassionate, responsive, and empathetic.

It’s hard to explain the balance of the emotional and psychosocial aspects of the job with the technical and physical aspects. That’s what was going through my head when I began to form this piece of prose. By the time I got home after that car ride with my friend, I had a few lines of the piece floating through my mind, and the next day, I sat down to write out my thoughts. The final piece that you’ve read is almost exactly what I initially wrote out.

You wrote “I know I probably won’t spend my career at the bedside, but I know how much I’ll miss the bedside when I finally walk away.” Where do you see your future in nursing?

My real passion and interest is in pediatric pain, particularly related to working with nurses to improve knowledge and practice. I’m also a huge fan of SickKids itself – the organization and its people offer so much support for nurses who want to pursue their interests and make improvements that benefit our patients. I love being a bedside nurse and directly contributing to patient care, so I don’t ever want to completely lose touch with the clinical aspects of nursing. Ideally, I could work in some type of role that combines pain education, quality improvement, and clinical care or decision-making. I might have to invent an entire job to make that happen, though!

You completed your BScN in 2010. Now you’re working on your MN Clinical. What has driven you to advance your nursing education?

Even when doing my BScN, I had a strong feeling I would want to continue my education and pursue my Masters degree. For the first two or so years of my career on my unit at SickKids, I was focused on developing my skills and expertise as a new nurse and becoming comfortable in the role. As I began to transition out of the role of a novice nurse, I found myself getting a bit restless and looking for more out of my career. I joined the Education Council on my unit and began to do some quality improvement work in the hospital, pursuing my interest in pediatric pain. I founded a Pain Resource Group on the unit, worked toward becoming a Pain Champion within the hospital, and began to precept students and new staff. I knew the MN degree would go a long way towards supporting my career goals of working as a pain expert within the hospital, and exploring more in the areas of nursing research and education.

Nursing is not an easy field to work in, but pediatric nursing can be particularly difficult. What drew you to this field?

I love working with families, and that is a large and necessary part of pediatrics. I love that children provide easy reminders of why we do what we do. We see them grow, reach milestones, and tackle life’s challenges with incredible strength and maturity. It’s a very rewarding area to work in. I also had great experiences with my student placements at SickKids that helped me realize what a fantastic place it is to work. We describe our nurses on the unit as our “unit family” because we really are a sort of family. There’s a phenomenal level of support, friendship, and trust between us. I honestly can’t imagine working anywhere else.

Have you always wanted to be a nurse?

I have always been interested in the sciences and in health, but when I was in high school, I had no experiences with nurses and had no idea what the role really involved. Towards the end of my first degree, I worked on a research study that gave me the opportunity to see nurses in action. I realized then that nursing was what I was looking for. I liked that I could combine my academic interests with my desire to work with people, and participate in education, clinical care, or research. Before that experience, I had seen nursing as a very practical, technical job, and hadn’t recognized the autonomy and professionalism that also defines the role.

Dave Ross is a writer at the University of Toronto's Lawrence S. Bloomberg Faculty of Nursing.

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New program aims to improve care for children with life-threatening illnesses

sgupta — Thu, 17 Apr 2014 17:04:48 +0000

New program aims to improve care for children with life-threatening illnesses sgupta Thu, 04/17/2014 - 13:04

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(photo by Piccadilly Pink via Flick)

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Enhancing palliative and end-of-life care

Researchers at the University of Toronto and The Hospital for Sick Children (SickKids) hope to improve palliative and end-of-life care for children all across Canada, with a new program backed by the Canadian Partnership Against Cancer (CPAC).

“Palliative care is not just about caring for children who are going to die from their disease, but also about providing excellent care and support to families right from the time a child is diagnosed with any type of life-threatening illness whether they go on the survive that illness or not,” said Kimberley Widger, co-lead of the initiative, assistant professor in the Lawrence S. Bloomberg Faculty of Nursing at University of Toronto, and nursing research associate with the paediatric advanced care team (PACT) at SickKids.

“The threat of death is always there and the various treatments we give to these children to try and cure them are often painful and intense.They should not have to wait until they are dying to benefit from all the good things that palliative care has to offer.”

The program, known as Education in Palliative and End-of-Life Care for Pediatrics (EPEC®-Pediatrics) is funded by a grant from CPAC, part of that organization’s larger $13 million nation-wide initiative. Specifically designed for paediatric oncology physicians and advanced practice nurses, the EPEC program will ensure regional teams from each of the 16 paediatric oncology programs across Canada receive comprehensive education about evidence-based palliative care while also acquiring the tools to teach others.

“When I talk to parents about their experiences with health care professionals during the time their child was dying, I hear both ‘good’ and ‘bad’ stories,” Widger said. “When I hear the great things that many health professionals do to support these families, I am so proud of our professions and I share these examples in my teaching.

“When I hear the examples of things that health professionals did or said (or did not do or say) that added to the burden carried by the family, I am motivated to keep working hard to make things better for the next family.”

Widger, who moved into research after years of clinical practice, said families need to receive care from health professionals who understand and apply the principles of palliative care to improve quality of life and address fears not only for the child, but for the whole family.

“It was often little things I did that could make a difference for families,” Widger said. “I could never take away the family’s pain of watching their child die, but I could make sure that I did not do anything to make that pain worse and I could ‘simply’ be there in the midst of that pain so they were not alone.”

Even with improvements in treatment, childhood cancer remains a leading cause of non-accidental death in children. Of the approximately 10,000 children living with cancer in Canada, more than 200 will die from the disease this year. Palliative care for children focuses on alleviating the physical, social, psychosocial and spiritual suffering experienced by children, while also promoting quality of life, fostering family connections and sustaining hope, Widger said.

“If we can regularly measure how well health professionals are meeting the needs of these families then we can identify what is being done well and what areas need more work,” Widger said. “Now I can use the instrument I developed during my PhD to continue assessing the quality of end-of-life care to see if any changes we make in the care provided actually makes a difference for families.”

Upon completion of the curriculum, regional teams will become EPEC®-Pediatrics Trainers, with the knowledge and tools to disseminate all aspects of the curriculum to other healthcare providers. Trainers will be supported by the project team to implement new knowledge and skills and lead quality improvement projects in their local communities with a goal of improving the quality of palliative and end-of-life care for children with cancer.

“Children with cancer see a variety of health care professionals in hospital, in the community and at home. By enhancing knowledge about paediatric palliative care across the board, we feel that this education initiative provides a real opportunity to make a difference in the lives of children and families who are dealing with cancer,” said Dr. Adam Rapoport, co-lead of the initiative and Medical Director of PACT at SickKids.

Dave Ross is a writer with the Lawrence S. Bloomberg Faculty of Nursing at University of Toronto.

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