Advancing Foot Care Nursing in B.C. One Step at a Time, by Sandra Tetrault, RN
When Judy R.N. moved from Ontario to B.C. in the late 1990’s, she had taken a foot care course from a Podiatrist there. Judy had been practicing as a foot care nurse for 10 years in Ontario before moving to B.C. On her arrival to register with the then RNABC, they told her they had never heard of a foot care nurse working for herself. Judy set out to prove them wrong! She shortly met Ruth R.N who was a mobile foot care nurse locally, and together they started an interest group of about eight Foot Care Nurses.
Even within the nursing profession today, many nurses are unaware of what Foot Care Nurses do (although the title may sound obvious). Foot care nursing is not a new practice, and has been delivered for decades by the Victorian Order of Nurses. However, only within the last 15-20 years have nurses begun owning and operating their own foot care business. Currently, any nurse regardless of designation (LPN, RN, RPN, and NP) who has completed a foot care course is considered a Foot Care Nurse. Most of these nurses own their own foot care business, providing clinical care, education and referrals in variety of settings including home care, senior centre clinics, assisted living and complex care facilities.
Clinical care typically involves nail care, and care for corns, calluses, dry or cracked skin, as well as short term padding for off-loading as needed until new shoes or a Pedorthist may be seen for orthotics. We’re trained to assess diabetic patients for peripheral neuropathy using the monofilament test or tuning fork, provide education to patients, families and healthcare providers, assist in the prevention of foot issues, and make referrals to other healthcare professionals such as Wound Care Nurses, General Practitioners, Podiatrists, Pedorthists or diabetic clinics.
However, with the lack of established competencies, the quality of care being delivered has been an on-going issue within the foot care nursing community. While nursing has a long history of delivering foot care, ensuring nurses are providing the safest and highest quality of care while utilizing best practices has been difficult to do. Recognizing this issue, a group of nurses met in 2007 at a conference in Ontario and started Foot Care Canada with the goal of developing national guidelines for foot care nursing. In 2010, Foot Care Canada became the Canadian Association of Foot Care Nurses (CAFCN), with provincial and territorial advisors from each province.
Fast forward to spring 2015, CAFCN voted to hire two student nurses to gather information on the various foot care courses being taught across Canada. In the summer/fall of 2015, Dr. John Collins who had been contracted to facilitate the process of competency development asked members of CAFCN for volunteers to go through all of the competencies found in the foot care courses being taught across the country. Subsequently, the group identified a list of standard competencies for foot care nursing.
The group involved in this process consisted of nurses from all across Canada with varied nursing experience from varied foot care nurse career paths-many of us were educators in foot care programs. We met approximately weekly on “Google Hangouts” between October 2015 until April 2016 with Dr. John Collins as our facilitator. While it was a challenge for the nine of us to meet, considering our busy work schedules and time differences, we finished the competencies, and sent them out to 40 volunteers for peer review. Feedback back was subsequently reviewed, and a draft was developed.
Just a few months ago in May, the draft competencies were presented to the delegates at the CAFCN conference in Montreal, Quebec. With feedback from the conference delegates, the competency document is now currently being put together to be shared with external stakeholders before being finalized.
Some may ask: why bother with developing competencies in foot care? Well, first, they promote standardized foot care education across Canada. Currently courses range from anywhere from 8 to 180 hours, which has implications on the safety of patients. It also ensures that foot care nurses are following best practice guidelines, eliminates out-dated practices, and protects the public. Last, it helps with looking to the future to regulation and certification of Foot Care Nurses.
Pioneers such as Judy and Ruth have truly advanced foot care nursing over the past 20 years. From owning their own foot care businesses to mentoring many new Foot Care Nurses, these retired nurses are still involved in the meetings of the Lower Mainland Foot Care Nurse Interest Group and continue to have a part in assisting new Foot Care Nurses . There have been so many positive changes within foot care nursing over the past two decades, and the nurses that have been involved in advancing this specialty have been true leaders and innovators. As we continue to see the development of foot care nursing competencies, I am sure we will enhance our ability to provide the highest quality and safest care possible.
ABOUT SANDRA
Sandra has been practicing as Foot Care Nurse for 8 years. She is a Certified Foot Care Nurse (CFCN) with the Wound, Ostomy and Continence Nursing Certification Board (WOCNCB- U.S. Certification), and currently works as Foot Care Nurse Educator. She is the B.C. Advisor to CAFCN, ARNBC Network Lead for Foot Care Nursing, Co- Instructor for Foot Care Nursing programs at Vancouver Community College and Co- writer of online foot care nursing program for Camosun College, Victoria. She is also the owner of Healthy Feet Foot Care, and Co-Owner of Pededucation: B.C. Centre for Nursing Foot Care Education and Clinical.
Suicide Awareness Month & World Suicide Prevention Day
Shaely Ritchey, RN
September is Suicide Awareness Month with the 10th being World Suicide Prevention Day. During this month people typically share numbers for crisis lines, reminders to check on one's friends, and similar sentiments. While these are important messages, they barely touch the surface of real and meaningful suicide prevention strategies.
The Basics
Like many things, suicidal ideation exists upon a spectrum from passive to active. Wherever someone finds I along this spectrum, the pain they are experiencing is real and deserving of support - although what this support looks like for each person will be entirely individual (even for the same person at different times in their life.) Whether someone is experiencing passive or active suicidal ideation; whether these are experiences they live with or are encountering for the first time, people deserve the space to talk about their experiences without fear of judgment, stigmatization, and incarceration. The latter of which, a good deal of emerging research supports, can be more harmful than helpful.
Creating meaningful change for those experiencing a mental health crisis, living with mental illness and related struggles is complex and requires comprehensive prevention strategies and significant social and political change. If we want to truly see and participate in effective suicide prevention efforts, it requires us to be bold and reflective across multiple sectors of government and policy.
Real and meaningful suicide prevention looks like addressing the rising cost of living, safe supply, and access to harm reduction services, as well as accessible and affordable housing. It is better research and treatment advances in rare diseases and chronic health concerns, including disability and other forms of social justice. It is actions beyond words that align with truth and reconciliation as advocated for by Indigenous communities. It is searching the Brady Road landfill, the preservation of Indigenous languages, land back, and supporting traditional ways of being and knowing. It is essential infrastructure in rural and remote communities. It is climate justice. It is the deconstruction of white supremacy. It is anti-patriarchal. It is an equitable society and the redistribution of wealth. It is fair compensation for labour as all labour is skilled. It is access to affordable childcare. It is a living wage. It is people before profit. It is connection to community and purpose. It is gender affirming care and safe spaces to be as you are. It is non-carceral in nature whether we are talking about prison systems or mental healthcare. It is access to timely public health services. It is addressing mass burnout in our healthcare system whose staff have been calling for change for years. It is a world that is safe enough to reach out for help as we are so often instructed. It is changing the Mental Health Act and other outdated laws that impact people's fundamental human rights.
It is all these things and so much more.
For Nurses
To narrow in on one focus of change on this important topic that is relevant to nurses and other healthcare professionals, I want to bring our professional attention to the Health Professions Act (HPA) and the newer Health Professions and Occupations Act (HPOA). Both pieces of legislation outline regulations on practice for nurses experiencing a mental health crisis, living with mental illness, and struggling with substance use that are important to know.
The relevant portion of these acts to the topic of suicide prevention is section 32.3 and the related sections in the newer HPOA. Section 32.3 was first outlined in the HPA; It was enacted in 2003 and made effective in 2005 under then Minister of Health, George Abbott.
For reference, section 32.3 (1) of the HPA is as follows:
"If an other person is a registrant in a college prescribed by the minister for the purposes of this section and because of admission to a hospital or a private hospital as defined in the Hospital Act, for psychiatric care or treatment, or for treatment for addiction to alcohol or drugs the other person is unable to practise, the chief administrative officer of the hospital, or someone acting in that capacity, and the medical practitioner who has the care of the other person must promptly report the admission in writing to the registrar of the other person's college."
In simpler terms, if a nurse or other healthcare professional governed by the HPA is admitted to hospital (voluntarily or involuntarily) with a primary diagnosis of mental illness, a mental health crisis, and/or substance use, that individual is to be reported by the chief administrative officer to their regulatory body, whereby the body must review and approve the individual's ability to return to work alongside documentation from a medical professional indicating fitness to practice. In its determination of fitness to practice and/or any practice limitations to be made for a registrant who has been reported under section 32.3, the regulatory body may require information regarding the patient's diagnosis, prognosis, treatments, and/or details of their mental health status.
We know that nurses are subject to traumatic situations, high levels of stress, fatigue, and moral distress on a daily basis. Even for nurses who do not live with mental illness, the strains of the profession in the current state of BC's healthcare system make nurses highly vulnerable to poor mental health and/or mental health crises. It is important to note that those clinicians who are required to report another healthcare professional under section 32.3 of the current HPA are only following the law when such a report is made, and privacy is protected by the regulatory body.
The concerning aspect of section 32.3 is that its basis in research as to the risks potentially posed to a healthcare clinician who receives acute care treatment for a mental illness, or a mental health crisis are difficult to ascertain. The key questions should be whether a healthcare professional who receives acute care treatment for a mental health condition versus those with a mental health condition who do not receive acute care treatment, pose any higher risk to patients.
In the newer Health Professions and Occupations Act (HPOA), there are important updates to section 84 (what was previously section 32.3 in the Health Professions Act) which are as follows:
"Sec 84) (1) A licensee who is an employee of a health care facility must make a regulatory report with respect to another licensee if (a) the other licensee receives health services through the facility, and (b) the first licensee has reasonable grounds to believe that the other licensee is not fit to practise due to a health condition, whether or not the health condition is the cause of the other licensee's receipt of health services.
(2) A regulatory report must be made as follows: (a) subject to paragraph (b), as soon as reasonably practicable after the other licensee begins to receive health services through the health care facility; (b) if the health care facility is a hospital, on or before the date that the other licensee is discharged from the hospital.
(3) A regulatory report must include all of the following: (a) a description of the health condition referred to in subsection (1) (b); (b) the opinion of the first licensee as to whether the other licensee is fit to practise.
Sec 85) Duty to report if suspected significant risk to public : A licensee must make a regulatory report with respect to another licensee if the first licensee has reasonable grounds to believe that (a) the other licensee is not fit to practise, and (b) the continued practice of a designated health profession by the other licensee presents a significant risk of harm to the public."
These changes remove the specific stipulation of reporting a healthcare professional receiving acute care treatment for a mental illness, a mental health crisis, or substance use. While this is a positive step, we must consider that given stigma remains in our society for those experiencing mental health concerns, we can potentially expect that these acute care instances may still be reported.
There is a great deal of evidence that supports that individuals who have presented to emergency psychiatric services are at a much higher risk of completion of suicide after discharge. When you add in the stigma that is felt from being reported for simply having an illness (even if the intent is not meant to stigmatize – of course patient safety comes first) and the financial instability of not being able to work until approved to return to work after obtaining documentation, it is reasonable to be concerned for nurses going through this experience.
These are not conversations we typically have with our colleagues, but these are not uncommon situations, especially for nurses who may live with a mental health diagnosis. If this has happened to you, please know you are not alone nor are you less of a nurse for experiencing these challenges.
While the newer HPOA shifts away from specifically targeting mental illness and substance use in its language, education and anti-stigma work will be an important part of bringing this Act into practice. We must ensure that psychiatrists, physicians, and other health providers in the hospital are made aware of these changes, and address the internalized and systemic biases facing those experiencing mental illness, a mental health crisis, and/or substance use.
Improving the current state of the healthcare system also requires us to ensure that we improve the health of our nurses and other professionals who face incredibly challenging circumstances on a daily basis. Access to safe and supportive mental healthcare options that are non-punitive and individualized, allowing people to tend to their own wellbeing and fitness to practice, are critical in times like these.
Author Biography
Shaely Ritchey (she/they) is a registered nurse who works in acute and complex surgery. Originally raised upon unceded Lheidli T'enneh traditional territory; currently living upon unceded Lək̓ʷəŋən traditional territory Shaely is passionate mental health advocacy, is a co-founder of Vancouver Island Voices for Eating Disorders (VIVED), and volunteers with CMHA BC. In their free time, Shaely enjoys photography, hiking, and art.
Canadian Nurses Welcome the Global Nursing Community to the ICN Congress in July
By Nora Whyte RN, MSN
The Canadian Nurses Association (CNA) is hosting the 2023 ICN Congress in Montreal this summer from July 1 to 5. This will be the fourth time that Canada hosts a congress: the previous locations and dates were Vancouver in 1997 and Montreal in 1929 and 1969. The theme - Nurses Together: A Force for Global Health - provides inspiration during troubling times for the profession and the world. We'll hear perspectives on current global health challenges and examples from leaders in other countries on solutions to common issues facing the profession. We can expect to hear from authors of recent policy reports such as Recover to Rebuild and from representatives of the World Health Organization and the World Bank.
The International Council of Nurses (ICN) is a federation of more than 130 national nursing associations representing 28 million nurses worldwide. Nurses in Canada are connected to ICN through membership in CNA, our national professional association. Founded in 1899, the ICN's mission is "to represent nursing worldwide, advance the nursing profession, promote the wellbeing of nurses, and advocate for health in all policies." Canadian nurses have a strong history of contributing to ICN through the Board of Directors and in senior staff positions. The president of CNA represents Canada on ICN's governing body, the Council of National Nursing Association Representatives.
Past congresses I have attended have always had topics of relevance to our Canadian nursing and health care system, especially in recent years as we have faced changes in regulation, education and supports for practice. It helps to gain an appreciation for our interconnectedness in nursing globally by participating in sessions and meeting nurses from other countries. I have come away inspired by the speakers and stories I have heard. The social aspect is memorable also with receptions, meals and informal dialogue during poster and concurrent sessions.
At this congress, participants will hear about progress on the United Nations Sustainable Development Goals and developments on achieving universal health coverage. I'm looking forward to sessions profiling national nursing associations and their advocacy activities. For Canadian nurses, it's a great opportunity to see our CNA and CFNU leaders in action on the global stage and to meet some of the ICN Board Members. We will have an opportunity to learn about developments in Indigenous Health Nursing from the group of leaders holding Research Chairs in Nursing through the Canadian Institutes of Health Research.
Sessions in Montreal will be organized around eight sub-themes for presentations, posters, and policy discussions:
- Nursing leadership: shaping the future of healthcare;
- The critical role of nurses in emergency and disaster management;
- Driving the professional practice of nursing through regulation and education;
- Improving the quality and safety of healthcare delivery;
- Advancing nursing practice: pushing the boundaries;
- Growing and sustaining the nursing workforce;
- Promoting and enabling healthier communities; and
- Addressing global health priorities and strengthening health systems.
Throughout the Congress, delegates have opportunities to participate in informal Policy Cafés for discussion with selected experts. Planetary health, mental health nursing and gender equity are among the policy topics for these interactive sessions.
There is also a full day Student Assembly scheduled for June 30. It will provide students the opportunity to connect, explore and collaborate on priority issues selected by students themselves. The Student Assembly is open to undergraduate, graduate, and postgraduate nursing students.
Standard registration rates are available until June 15. Please note that there is a student rate (with proof of student status) and a discounted rate for nurses who are members of the Canadian Nurses Association. I value my CNA membership and our connection to ICN where Canadian nursing leaders have made a major contribution for many decades.
To members and friends of NNPBC, it will be great to have a strong contingent of BC nurses at this ICN Congress on Canadian soil as we embrace the opportunity of Nurses Together: A Force for Global Health.
Author Biography
Nora Whyte, RN, MSN, is a proud member of NNPBC and CNA, and is a BCCNM registrant. She has attended past ICN congresses in Vancouver, Durban, Barcelona and Singapore in addition to the virtual congress held in 2021. She acknowledges with respect that she lives and works on the Unceded traditional territory of the K'òmoks First Nation.
Eating Disorders Awareness Week 2023 – Transforming the Narrative: From Asks to Action
By Shaely Ritchey RN, BScN
Eating Disorders Awareness Week (EDAW) is a nationally-recognized week in Canada, from February 1st-7th. This week serves to bring awareness and understanding to the devastating impact of eating disorders on individuals and families across this country. Beyond awareness, we need action, that is why this year’s theme for EDAW 2023 is Transforming the Narrative: From Asks to Action.
This year's campaign aims to help people understand the connection between eating disorders and other co-occurring mental and physical health conditions or intersections of disadvantage, and to help various stakeholders understand the different types of action we must take to support people affected by eating disorders and co-morbid mental illness.
- Eating disorders are complex, serious illnesses.
- Multiple types of eating disorders exist. Despite the common stereotype, Binge Eating Disorder is the most common eating disorder and the majority of individuals with eating disorders do not present as underweight (less 6%).
- Eating disorders often occur when those who have multiple interacting vulnerabilities experience a period of malnutrition or stress. This stress triggers physiological and psychological changes that together culminate as an eating disorder. Vulnerabilities can include biological, psychological, cultural, and structural factors.
- Eating disorders affect people of all genders, sexual orientations, skin colours, sizes, (dis)abilities, ages, cultures, and socioeconomic classes. Those who face higher levels of marginalization and oppression are at disproportionate risk.
- Weight stigma presents an additional risk factor and potential harm for individuals seeking services.
- Eating disorders have the highest mortality rate of any mental illness outside of deaths due to the toxic drug supply. This loss of life is not only due to physical health consequences (which can occur at any weight), but also suicide.
Beyond mortality, there is significant morbidity associated with eating disorders.
Across the country, eating disorder services and research are chronically under-funded.
There is a lack of accessible, timely, and effective services on Vancouver Island and across BC (as well as Canada) particularly for adults with eating disorders.
Addressing eating disorders is an issue of social justice and human rights as marginalization and oppression increase vulnerability to eating disorders, create additional barriers to support, and increase the risk of experiencing harm in care settings.
Learning more about eating disorders, working alongside those with lived and living experience, dismantling stigma and bias associated with these conditions, and working to improve care for these individuals are all important steps in taking action.
To learn more about eating disorders and Eating Disorders Awareness Week as well as various actions you can take to help support those struggling, please visit the National Eating Disorder Information Centre (NEDIC) page: https://nedic.ca/edaw/.
Author Biographies
Shaely Ritchey (she/they) is a registered nurse who works in acute and complex surgery. Originally raised upon unceded Lheidli T’enneh traditional territory; currently living upon unceded Lək̓ʷəŋən traditional territory Shaely is passionate mental health advocacy, is a co-founder of Vancouver Island Voices for Eating Disorders (VIVED), and volunteers with CMHA BC. In their free time, Shaely enjoys photography, hiking, and art.
"Learning and Collaborating on Behalf of Patient Centred Care"
By Sherri Kensall, MSN, C Neph (c), CDE, C Gen (c)
Clinical Nurse Specialist
NNPBC Board Chair, RN Council President
It was 'go-live' On November 5th at Vancouver General Hospital (VGH) as the team worked to implement Cerner as part of our broader Clinical & Systems Transformation (CST) project. Cerner is a cloud-based electronic health record that will help us streamline administrative processes so that health care teams can focus more wholly on providing exceptional patient care. In a nutshell it makes our administrative load easier, provides access across sites, updates patient information in real-time, and integrates patient care records into a digital system. As one colleague put it, finally no more needing to decipher handwriting!
My colleagues and I on the hemodialysis unit at VGH jumped in ready to learn. The entire team had support from many of those already using Cerner. Supporting us we had the Cerner Team, the CST teams, the hemodialysis team from Providence Health Care who have been using Cerner for a few years, as well as physicians Drs. Copland and Harris, Florence Ng, Patient Services Manager at the VGH Renal Program, and our vascular access nurse. Patients were, dare I say it, very patient as we worked through our learning and initial usage.
What struck me as I learned this new to me system along with my colleagues was the way in which external teams supported internal VGH teams. They shared best practices, workflow information, real-life usage tips and tricks and provided us guidance on how to build our own routines. We listened to each other to get a sense for what we needed and how it could work on our particular unit. The teams were forthcoming, supportive, and highly collaborative. Many commented that the support from our colleagues from other sites reminded us how important it is to not only work together, but to connect as health professionals in work that benefits what we care about most, providing exceptional care to patients and clients. Learning something new is not always easy but we all recognize the need to make changes in how we approach patient care, particularly at a time when we know that the burden on health care, and specifically nurses, is intense and when we so often work short-staffed. The nursing team was engaged, asked good questions, and worked towards practical solutions.
With food and coffee in hand, all of us on the hemodialysis team began the work of ‘unpacking’ this new system. Like moving into a new house, there is always unpacking to do, and while you may not be able to find your favourite coffee mug right away, you are excited for the change and look forward to new possibilities. The team was energized by the collaboration, appreciative of having good colleagues and united in our joint effort to make the challenging work of health care better for patients.
I know that as nursing professionals we hold a complex body of scientific knowledge, are highly educated experts in relational practice, and that we are essential leaders in transforming our health care system. On November 5th, we had a chance to focus the usage of a new system through the lens of nurses who all stepped up and demonstrated that nursing leadership happens at every level, from the unit, the bedside, to the board room.
Gender-Affirming Care - Exploring Inclusive Terminology
Shaely Ritchey (RN, BScN) and Kalina Hunter (UVNS 3)
Language has the power to shape how we see the world as well as imagine ourselves and others within it. While words might seem insignificant at times, especially in busy practice settings, language can foster agency and hope amongst ourselves, the people we work with, and patients and clients. Language can also perpetuate harmful stigma and cause the erasure of marginalized groups. Indeed, language is one of the most powerful tools we carry with us as nurses in our everyday practice.
As our cultural awareness of the power of language and the importance of inclusivity expands, the application of awareness into real and tangible change in our practice settings becomes our collective and individual responsibility as nurses. Shifts in our understanding of the power of person-first language, trauma-informed care, cultural competency, colonial violence, and gender-affirming care require significant practice adaptations, one of which is careful reflection on the language and terminology we use when interacting with colleagues and those for whom we care.
For those of us who occupy intersections of privilege – whether we are white, cis-gendered, heterosexual, neurotypical, able-bodied, and so on – our awareness of needed change can be quite low, as we may never have encountered or questioned the dominant views and common language in our workplaces. Even simple terms, such as "female caregivers only" or "male/female catheterization" have consequences for marginalized individuals. What might seem like nothing to those of us who are privileged, can perpetuate further erasure of diversity, and perpetuate stigma.
To be clear, a specific care requirement such as "female caregivers only" can be a very important part of someone's care, but it is important to reflect on what is being asked in this care consideration. Is the ask for female caregivers only, or is it a request for cis-gendered and female-appearing caregivers only? What are the implications of this on staff who identify as non-binary or transgender? If someone is transgender, are we asking them to then identify themselves as such? If someone is transgender and considered passing or not passing, does this change whether they are able to provide care for this patient? If that is the case, there are significant transphobic implications.
Similarly, "male or female catheterization" might seem like a simple anatomic statement, but gender identity and anatomy are not the same thing. Another important consideration is that many individuals who identify as transgender may decide against having gender-affirming surgeries or hormone therapy, but that does not make them any less of who they are.
Anatomy exists on a spectrum, the same as gender. We see examples of this in anatomical differences at birth. However, this comparison needs to be used cautiously as there is the tendency to frame these differences as birth "defects" or medical conditions which could be harmful to the individual in this circumstance, and highly stigmatizing to transgender persons as their experiences are not disorders, illnesses, or defects.
In a health care system that is already highly stressed, this conversation may seem superfluous, but it is lifesaving for gender-diverse individuals, both those accessing health care and working within it. There are serious mental and physical consequences related to stigmatization, erasure, and limited ability to access gender-affirming care.
Reflecting on the ways in which we use language to both help and harm, is a simple way of supporting inclusivity and co-creating safe spaces for those whose access to these kinds of environments is limited. While creating change at an organizational and systems-level is challenging, bottom-up approaches are just as important as trying to create change from the top-down.
Creating safety starts with us – as human beings interacting together and creating community between each other. Part of this work in creating change, includes challenging one another and having uncomfortable conversations between those with lived and living experience and those who work with them. In moving forward, it is important to honour the capacity of each of us, to participate in creating meaningful change with, and determined by, those who experience marginalization.
Questions for reflection:
- In your own nursing practice, how might you practice better gender-affirming care?
- As you reflect on this piece, are there are other language practices that could also be stigmatizing? If so, what are some examples and how might they be mitigated?
Further Reading and Resources:
- Gender-inclusive language guide
- Re-defining anatomical language in healthcare to create safer spaces for all genders
- Inclusive queer curricula in medical education
Author Biographies
Shaely Ritchey (she/they) is a registered nurse who works in complex surgery. Originally raised upon unceded Lheidli T'enneh traditional territory; currently living upon unceded Lək̓ʷəŋən traditional territory Shaely is passionate about the power of language in health care settings, particularly for marginalized and stigmatized communities. In their free time, Shaely enjoys wildlife and nature photography, reading and art, as well as mental health advocacy.
Kalina Hunter (she/her) lives on Lək̓ʷəŋən lands as an uninvited settler and is entering her fourth year of the BScN Nursing program at UVic. After graduation she hopes to work with the pediatric population. Kalina has a special interest in how childhood experiences impact brain development, functioning, and behaviour. She is a lover of many creative endeavours, from playing violin to painting to searching for sea glass on the beach.
Climate Emergency: The Time to Act is Now
Helen Boyd RN, MA & Raluca Radu RN, MSN
November 2021
In the summer of 2021, British Columbia experienced extreme heat between June 25th and July 1st (longer in some areas) where recorded temperatures reached about 40 degrees. Records were set on June 28th in Squamish which reached a temperature of 43 degrees, Port Alberni at 42.7 degrees, Victoria at 39.8 degrees and, on the 29th of June, 49.6 degrees in Lytton, which was the highest temperature ever recorded in Canada. Experts resoundingly agreed that these extreme temperatures would not have happened were it not for climate change. In BC, 719 people, or triple the usual number, died during this heat dome. Recently released details from a coroner's report attribute a staggering 595 deaths due to the temperature. Many were older adults, lived alone and were unable to cope with the extreme heat. The social isolation of these individuals prevents them from being able to access any supports or mitigation strategies that may be available. While we cannot predict when or how often these types of heat emergencies will happen, climate change is clearly accelerating the pace of such heat events and vulnerable populations are disproportionately affected.
BC also had a deadly 2021 fire season, having experienced many such seasons over the last several years. On June 30th, the day following the record-high temperature, the intensity and speed of a fire in Lytton eradicated much of the town, leaving an entire community without housing and infrastructure. Wildfires raged this year across the Interior of the province, leaving many people homeless and forced to breathe dangerously smoke-filled air. It should also be noted that 2019 was another particularly dangerous wildfire season, also impacting housing for affected areas and air quality for much of the province.
In the autumn of 2021, BC's western coast was then hit with what is known as a 'bomb cyclone', so named because of an extremely rapid drop in barometric pressure. As with the summer heat dome, this extreme drop in pressure and the sheer size and depth of the low pressure registered astounded meteorologists. Wind and rain slammed into the Pacific Northwest resulting in damage and, sadly, loss of life when two people in the Seattle area were killed when a falling tree crushed their vehicle.
In the last week, BC was ravaged by torrential rains, resulting in flooding, landslides and sadly again loss of life. Between November 14th and 17th BC saw a 300 percent above normal rainfall for November which resulted in landslides, flooding, infrastructure damage to highways and rail lines, loss of livelihood, and loss of life. People have been displaced from entire cities (Merritt and Lytton), in many communities already devasted by the summer wildfires. The 2021 wildfires were in fact a contributing factor in the landslides that occurred as the hills were made bare of trees and other forms of natural slope protection.
According to the World Health Organization (WHO), between 2030 and 2050, climate change is expected to cause roughly 250,000 additional deaths due to heat exposure, malaria, malnutrition and diarrhea. The WHO has also noted that, in the 21st century, there is no greater threat to human health than climate change. Carbon dioxide (CO2) and greenhouse gases (GHGs) have been released into the atmosphere in enormous quantities which in turn contributes to the Earth’s warming and/or extreme fluctuations in weather patterns. As a result, the quality of air, water and food is impacted, leading ultimately to a negative influence on human health.
These recent examples of the impacts of climate change are fresh in our collective consciousness and underscore the depth to which we are in a climate emergency. As nurses, we hold the public trust, ranking as the most trusted health profession year after year. Our work as nurses allows us to utilize our scientific, evidence-based knowledge to explain the potential impacts of climate change to patients' and clients' health and wellbeing.
The impacts of climate change will only continue to affect our everyday practice. Especially during the COVID-19 pandemic, as British Columbians are displaced from their homes due to wildfires, extreme temperatures, and flooding, left without food or belongings, our communities are vulnerable. Citizens are forced to find safe shelter where they are not exposed to COVID-19 and where they have access to water and adequate nutrition. Not only this, but extreme climate change events will continue to be felt more intensely over time and it is fundamental for nurses to understand the basic principles of health effects related to climate change.
Moreover, we have the opportunity to use our collective voice to advocate for policy change that will reduce the levels of greenhouse emissions and carbon dioxide and ensure that policy makers are aware of the very real impact on health and wellness when we neglect our climate and the planet we live on. We as nurses know that we must integrate a systems-wide approach rather than a reductionist one. We must focus on all the parts of health care and the environment collectively and determine ways to address the system as a whole moving forward.
Quite simply, our role as nurses is clear, we must raise awareness amidst the public of the climate emergency, take direct action in our healthcare systems and communities to mitigate the impacts of climate change and advocate for policies that protect the health of people and our planet. The time to act is now!
Questions for Nurses:
- How can you as a nurse and resident of BC enact change within your workplace(s) and your community?
- Do you currently engage in environmentally sustainable activities at your work and/or home? If so, in what ways?
- Which climate impacts in BC concern you most?
- How comfortable do you feel with the concept of Ecoliteracy and its relevance to your nursing practice?
- How do you think a nursing professional association such as NNPBC can be most effective in representing nursing’s climate change concerns in the wider policy context?
Bios
Helen Boyd
Helen Boyd is a registered nurse and mental health therapist who is passionately committed to conserving and enriching our planetary health for generations to come. She is the BC Representative of the Canadian Association of Nurses for the Environment (CANE) and Board member of the Canadian Association of Physicians for the Environment (CAPE). She is currently enrolled in graduate studies in Science and Policy of Climate Change at Royal Roads University with a particular focus on climate justice advocacy.
Contact: cvnhe@telus.net
Twitter: @HBoydrn.
Raluca Radu
Raluca Radu is a registered nurse and a full-time lecturer at the University of British Columbia, where she teaches in the BSN program and is proud of being the lead instructor of the Nursing 290: Health Impacts of Climate Change course. Raluca has served as an Executive Board Member for the Canadian Association of Nurses for the Environment (CANE) from 2019-2021. She is also part of a national ad-hoc group that is working towards integrating planetary healthcare in Canada. She is an advocate for initiatives that safeguard the environment and that empower individuals to take bold action to preserve the beauty that Mother Earth holds.
Contact: raluca.radu@alumni.ubc.ca
Twitter: @_Raluca_R
Resources:
Nursing During A Climate Emergency
Sherri Kensall, RN, CNS, NNPBC Board Chair
November 2021
Starting on November 14, 2021, British Columbia was hit by a rain event that broke many records. According to reports, total rain fall was estimated to be roughly 300 percent above normal for the month of November. This rain fall event, coupled with fire scorched hillsides from a terrible summer wildfire season, led to mudslides, flooding, evacuations, displacements and tragically, loss of life. Infrastructure damage means that the Lower Mainland has been effectively cut off from the rest of Canada, with roads and rail lines damaged by mudslides and flooding.
As nurses, we watch these events not only as individuals with families who live in the area, but as professionals who wonder about patients and clients and how people who may need life-saving care will be able to access services in the midst of this devastation.
As a Renal Clinical Nurse Specialist in the Fraser Health Authority, I care for vulnerable patients with complex needs who require specialized care. On November 17th, myself and a team of my nursing colleagues were called upon to travel from Abbotsford to Chilliwack to assist stranded dialysis patients. For four hours I triaged these patients. Along with my nursing colleagues and the other care providers on the team, we made complex decisions about who would require dialysis first, when, who might be able to wait and who required emergency care immediately. When we made decisions about the patients who required transport, we were assisted by an incredible crew of firefighters and other first responders who ensured patients were moved safely. As nurses we make complex decisions for patients and clients all the time, and we use our critical thinking skills to make judgement calls about who among the already compromised is the most vulnerable.
These calls to action are what I am reminded of when I think of nursing. It is our job to meet people where they are. Whether in a harm reduction scenario, in a community setting, or for those stranded without access to dialysis, we provide safe, competent, ethical, and evidence-based care. We do so without judgement and without question. There is little doubt that these extreme weather events are coming more closely together which means that as nurses, we must be prepared to provide nursing care in scenarios that we have yet to see or experience.
I know that our profession has the skills to continue to provide exceptional care in the face of extraordinary circumstances. I have had the pleasure of seeing just how fast and nimbly we take action.
"Hearing Our Voices - Nurse Advocacy In Action"
Michelle Danda PhD(c) RN CPMHN(C), Claire Pitcher MSN RN (C), Jessica Key BSN RN
September 2021
Recently, there has been an increased focus within North American media and society at large on racism in health care. As trusted and ethically-guided professional practitioners, nurses play an essential role in these conversations and thus it is imperative we understand the historical, social, economic and political roots of racism. It is equally important that we engage in anti-racism work, an example of which we will share below.
Background to the Issue of Racism in Canada
The concept of race is rooted in 18th and 19th century imperialism where colonizers constructed an understanding of the people who originally inhabited a geographical area as 'other' and 'less than' to justify exploitative colonizing practices such as resource extraction. This was despite the fact that, as stated by Claxton and colleagues, "[h]umans are intrinsically similar genetically and thus race is considered to be socially constructed, often by socially dominant groups, to reflect discriminatory or cultural attitudes of superiority". Over the past 4 centuries, this foundation of the process of 'othering' has led to countless iterations of race-based violence, discrimintation and oppression.
Canada itself is a settler-colonial state founded on the racist belief of Europeans being superior to Indigenous people and people of colour. Nurses' knowledge of this history is crucial for understanding the current Canadian context, where the Canadian Human Rights Act has offered its citizens legal protection against discrimination including racism since the mid-1980s. In many ways, this legislation laid the groundwork for Canada’s international reputation as a "multicultural and egalitarian country...free from racism and other forms of discrimination".
Understanding the Connection Between Whiteness and Power
This perception of a "Welcoming Canada", however, exists in stark contrast to the growing body of evidence stating racism both exists within the Canadian health care system and it negatively impacts the health and wellbeing of racialized people . Race is a social construction, meaning it is a subjective phenomena, interpreted and influenced by the values and beliefs of people. These beliefs, however, translate into very real and objective differences in the health and wellbeing of racialized people living in Canada. Within a culture of white supremacy, perceptions of who is 'white,' and in turn accepted into the dominant group, inherently impacts who has access to cornerstones of our survival such as housing, health care and social support networks. Meanwhile, understandings of whiteness have changed over time because this concept is not defined by any objective measure; rather, the concept of 'whiteness' has subjectively morphed to meet the needs of the dominant group over the past several decades to include and exclude various groups of people. Over the same period of time, authors, scholars and academics have begun to deconstruct ideas of whiteness and its ties to power, social status, and white supremacy. In Canada we pride ourselves on not having the race segregation of the United States, but this in itself is problematic because it silences the covert nature of othering by race.
In Canada, the pervasive yet false belief that "racism does not exist here" warrants close attention because this widely embraced narrative of a "welcoming Canada", obscures and silences the reality that racialized people experience poorer health outcomes than non-racialized people across our country. Too often, nurses who experience and witness intersecting forms of oppression, including but not limited to racism, sexism, homophobia, transphobia and classism, are expected to survive within, and whistleblow against, a broken system. It is time for us, as a nursing profession, to actively resist the insulting and dehumanizing questions of whether racism exists in health care, and rectify the ethics of placing the burden of changing the system on those negatively impacted by it.
According to Zancheta et al's 2021 article, "the large majority of racist practices result from social relations that go beyond the individual [...to] impregnate daily life until they become banal, invisible and inaudible [...thus] faciliat[ing] tolerance towards racist individuals [while] victims who protest against racism are labelled as paranoid and meddling killjoys" (3). This reality of racism as seemingly invisible to those in power underlies the narrative within health care of the 'always altruistic' nurse who is impervious to experiencing or enacting discrimination and bias. This narrative is front and centre each time a story appears in the media where blatant racism is at play, yet we are subjected to news headlines suggesting otherwise or giving the perpetrators of the racist actions the benefit of the doubt. Too often the only recourse in such stories comes via lengthy and arduous "official processes," such as public inquiries and/or pursuing criminal charges. One of the many harms of this reality lies in having racialized people be repeatedly forced to witness and experience racism within our political, social, economic and government systems while predominantly white leaders have the audacity to question whether racism exists.
Taking Action - Using Film In Advocacy
It was within this historical and current socio-political context that the co-authors of this article began to brainstorm how we could disrupt the above described trends. We also reflected on a short-film we had created together in 2019 which focused on the importance of compassion in mental health nursing. In retrospect, we realized that our shared commitment to practicing from a place of compassion as nurses could not be untangled from our commitment to acknowledging intersecting forms of oppression within the healthcare system. With our follow-up film, however, we wanted to situate conversations about compassionate nursing practice within a broader and more systemic context acknowledging that not all people are treated equally in health care.
To align with anti-racist practices, it was important for us to secure funding for the film so we could compensate our team and contributors for the time and emotional work of participating in the film. We secured a creative team, a small funding grant and began to work on bringing our idea from concept to reality. We wanted our creative process and film itself to push back against the culture and norms of white supremacy including forces such as urgency, perfectionism, valuing the written word over all else and valuing quantity over quality. Our goals were simple: to show up, work together and do our best to actively decenter whiteness.
What Can You Do?
We believe that disrupting the pervasive racism that exists within health care requires action at all levels from the grassroots frontline - through initiatives such as our creation of this film - up to and including formal action at the highest levels of government. As nurses, treading lightly to minimize the discomfort of acknowledging racism in healthcare is no longer an option for us and so, we created this short film. We share it alongside dialogue and a collection of follow-up resources to disrupt the racism we have witnessed and/or experienced. We invite you to watch this film, to engage in dialogue with us about this film via our website, to share it with your colleagues and to help us unite frontline grassroots action with sustained, systems-wide anti-racist action in health care and more specifically within nursing. We invite you to start and continue talking about and working to uproot racism as it shows up in your area of practice.
Click here to watch our film.
References
- Baldwin, J. (1984). On being white... and other lies. Essence, 14(12), 90-92.
- Browne. "Moving Beyond Description: Closing the Health Equity Gap by Redressing Racism Impacting Indigenous Populations." Social science & medicine 184 23–26.
- Canadian Human Rights Commission. (1985). Canadian Human Rights Act. Ottawa, Ontario: C. Theroux.
- Claxton, N. X., Fong, D., Morrison, F., O'Bonsawin, C., Omatsu, M., Price, J., & Sandhra, S. K. (2021). Challenging Racist" British Columbia": 150 Years and Counting. University of Victoria and the Canadian Centre for Policy Alternatives (BC Office).
- Okun, T. (2021). White supremacy culture - still here. Retrieved from https://www.whitesupremacyculture.info/
- Shiells, G. (2010). Immigration history and whiteness studies: American and Australian approaches compared. History Compass, 8(8), 790-804.
- Zanchetta, M. S., Cognet, M., Rahman, R., Byam, A., Carlier, P., Foubert, C., ... & Espindola, R. F. (2021). Blindness, deafness, silence and invisibility that shields racism in nursing education-practice in multicultural hubs of immigration. Journal of Professional Nursing, 37(2), 467-476.
Collaboration Matters: Nursing and Oral Health
Afifa Lahbabi Eidher, RDH
April 2021
April is oral health month in B.C. and dental hygienists are exploring ways to help the public understand the importance of maintaining good oral hygiene and how it could even save their life! One of our goals is to engage more effectively with the nursing profession because no one knows patients better than nurses. Dental hygienists believe that if we do our job well, we may have a hand at preventing some members of the public from ending up in your emergency room. And really, isn't that the goal of all of us who work in healthcare? I am certain that with the help of nurses, we can make significant strides towards improving the health of all British Columbians.
Registered dental hygienists have always known that a direct link exists between your oral health and your overall health. We have worked hard over our career spans to educate the public and to encourage other healthcare professionals in relaying this important message to everyone. Contrary to what we have seen in the past, I am happy to report that the way the public now views their oral health has finally changed. Gone are the days when my patients would question the need for regular, preventive cleanings or dental visits, when some people believed it was better to ‘leave a little plaque’ or that fluoride was dangerous to your overall health. In 2021, we now have indisputable evidence that what is going on in your mouth is all too often a reliable indicator of what is happening with your overall health.
When COVID first happened, dental hygienists were ordered to stop working, and that interruption lasted almost three months. Although there were certainly personal hardships during this time, the reality is that we were alarmed by how this would affect the health of our patients – I was especially concerned about my immunocompromised patients and my community health colleagues were very worried about their clients living in long-term care. Mobile dental hygienists were unable to enter the sites that they regularly attend and felt anxious knowing that some of their regular patients had gone without any sort of oral health care for months. The result of this disruption of care resulted in dentists being called in, often only able to prescribe pain medication over the phone or transferring the patient to the ER so extractions could be done – not an ideal outcome for frail or elderly patients.
Sadly, many patients over this time of COVID have cancelled or delayed their scheduled visits with me because they do not want to risk getting Covid-19 by making their way to ‘another’ appointment. Many overdue patients are falling through the cracks, their gum disease is progressing along with build-up of hard and soft deposits that carry harmful bacteria, increasing their risks of health implications.
Good dental hygiene can help prevent halitosis, tooth decay, gingivitis, and periodontal disease. But there are other, even more important reasons to keep your mouth healthy. Research shows that gum disease may put you at risk of serious health problems such as heart attack, stroke, endocarditis, pneumonia, poorly controlled diabetes, preterm labor, and low birth weight in babies.
Unfortunately, the list of potential health risks goes on, in recent years gum disease has also been linked to a higher risk of hypertension, kidney disease and Alzheimer’s disease. Furthermore, some diseases such as diabetes and HIV/AIDS can compromise the body’s ability to heal or to fight off oral infections, as a result making them more severe and more difficult to control. As nurses who work with frail elderly are undoubtedly aware good oral hygiene has been shown to reduce the mortality from aspiration pneumoniai, and good oral health is linked with better outcomes in cardiac patients.ii
Other factors can also influence a person’s oral health. As a dental hygienist I regularly see patients with complicated medical histories who take medications such as painkillers, antidepressants, antihistamines, or diuretics for example, all of which can reduce salivary flow. This can have devastating effects for some. Saliva works by neutralizing the acids created by the bacteria in the mouth, if this process is hindered, patients will be more at risk of periodontal disease and/or rampant decay.
Periodontal disease (periodontitis) is a serious gum infection caused by bacteria which has been allowed to accumulate around the teeth and gums. Once harmful bacteria colonize the oral cavity, they will make their way through small blood vessels and capillaries in your gums – this heavy bacterial load will not only put you at risk for permanent bone loss and/or tooth loss, but will travel your blood stream, spread throughout your system, and trigger an inflammatory response that can put your health at risk. Professional intervention with a dental hygienist is essential for putting a stop to this damaging reaction.
It is important for everyone to have an effective oral hygiene routine that includes an individually tailored maintenance program at home and regular needs-based visits with your dental hygienist. Professional removal of hard and soft deposits is crucial for disrupting the biofilm responsible for the progression of gum disease. In most cases, gum disease and periodontal disease are painless, and as such are very deceiving, leading some individuals to think that foregoing routine dental hygiene visits is no big deal.
During oral health month, and every month throughout the year, I am reaching out to my nursing colleagues and asking you to partner with us in reminding patients that good, preventive oral hygiene could save their life.
No one understands the needs of patients more than nurses and dental hygienists. We need your eagle eye, and the trust patients place in you – and in return, we will work diligently at keeping patients well maintained, healthy and out of your emergency room.
Helpful links:
Afifa Lahbabi Eidher, RDH