Who is helping who?

 Last Monday I was driving through my usual path to work.  At the Pulmonary Function Test (PFT) laboratory of Markham Stouffville Hospital, my colleagues and I perform PFT, 6 Minute Walk Test, Home O2 assessment, Arterial Blood Gas and occasional Exercise Induced Asthma test.  In the gaps between tests we provide patient education including Asthma, COPD and Smoking Cessation. On my drive to work last Monday around 7am, I was waiting to make a left turn when a car ran a red light and collided with the vehicle travelling in the perpendicular direction.  Because of the impact, the cars changed path and hit my vehicle. Everyone was okay. The cars had to be towed to collision reporting centre before being heading to repair shops. While I sat in the tow truck, the driver walked me through all the steps, gave me advice on what to expect that day and for the following days.  He even helped me organized all the required documents as I called my insurance company. As we were waiting for my rental vehicle to arrive, he said, “You said that you are a respiratory therapist… I have a bad habit”. He paused for few seconds and then continued… “I have been trying to quit smoking”.

Over the next 15 minutes we covered some smoking cessation information. I asked him questions and we went through some options.  He was motivated and willing.

 A few days later I was reflecting on this interaction and the conversation with him.  Sometimes you get to help someone when least expected. In my case you may get to help someone while they are helping you!  

 Yet another thought, or possibility, came to my mind.  Perhaps he asked me a question so I would talk about something I am passionate about.  Because over those 15 minutes, I was not thinking about the accident, being late for work, nor the hassles of fixing my car. In that time I was in the zone of helping someone else.  It was such a simple way to get someone’s mind off the stress of the situation.

 Are there any patient scenarios where this “technique” can be utilized? I am hesitant to call it a technique as by interacting with patients we, the health care providers, can establish a genuine rapport which can further improve patient care.   Maybe this method or technique can be used while getting things ready for an ABG? Perhaps before or while having a patient in the PFT body box or CT/MRI machine?

 

 Find out what the patient is passionate about during your ongoing conversation with them.  Ask them a relevant question or advice, and watch them focus on something positive.

 

Let me know if you have used this approach before and how it went!

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Shawna

Shawna (Urquhart) MacDonald is an active Respiratory Therapist at Hamilton Health Sciences (HHS).  I got to know Shawna as she also volunteers on the Board of Directors at the Respiratory Therapy Society of Ontario (RTSO).   Unbeknownst to me, I had actually been exposed to Shawna’s work over the past four years, as she has been one of the creative minds behind RTSO Airwaves, RTSO’s publication.  I am a fan of Airwaves because this publication celebrates respiratory therapists (RTs), and creates a sense of community in our field. I am fascinated by her level of dedication and contributions in the field.

When I heard that she has been helping with Respiratory Therapy Educational Retreats, I used the opportunity to gain more insight about her experiences and the Retreat.

Here is my conversation with Shawna:

 

Shawna, I know how busy you are with your family, work, RTSO Airwaves, Inspire 2019 planning, and the upcoming HHS RT Educational Retreat.  Thank you for taking the time to answer these questions!

Let’s take a moment and share little bit about you with our audience.
What made you decide to study respiratory therapy?

I have asthma…diagnosed when I was very young.  My childhood was filled with visits to hospital, different medication trials, and even a spontaneous pneumothorax! One summer I participated in a memorable pool exercise and educational program for asthmatic kids that was hosted by the Lung Association, so lung health strategies and Respiratory Therapy have been an influence in my life for a very long time.

I knew I wanted to be in a helping profession, specifically in healthcare in some capacity.  I wasn’t sure whether I wanted to be a pharmacist, a physiotherapist, an occupational therapist or a respiratory therapist!  However, the decision was an easy one after time spent shadowing each profession towards the end of high school.  My asthma experiences fuelled my passion for the profession!  I am a proud graduate of Fanshawe College, class of ’92.

 

Glad that you decided to study respiratory therapy!

What have been some of your memorable RT positions/roles so far?

I have held many positions over the past 26 years, and all have them have grown me into who I am today, with many wonderful memories along the way. From bedside Clinician to Student Clinical Coordinator to Education & Development Clinician (RT Educator), and now back full circle to bedside Clinician again.  I have also volunteered in many different capacities over the years, sitting on various committees and working groups; planning RT Week displays, activities and events; and volunteering with professional bodies.  I was a CRTO PORTfolio reviewer for 10 years, and I thoroughly enjoyed that opportunity and learned so very much!  My favourite part of this was learning about what amazing things RT’s were doing across the province…this always provided such inspiration and sparked a renewed passion for the profession.  In 2014, I began volunteering with the Respiratory Therapy Society of Ontario (RTSO) as Editor of RTSO Airwaves (a quarterly publication of the RTSO) and as a Board member…my way of giving back to a profession that has given me so much.  These experiences and roles have shaped me into a well-rounded and seasoned therapist, but there is always more to learn and more ways to grow, both on a personal and professional level.

You definitely have a rich portfolio.  As someone who has volunteered with you, your level of dedication is clearly evident and appreciated!   I would like to ask you more questions for a possible second interview piece, but for now let’s talk about the upcoming Educational Retreat in Hamilton.

 

What is the goal of this conference and what can RTs who are attending this conference expect?  

What I love about the HHS RT Retreat is that it is a conference designed by Hamilton Health Sciences’ (HHS) RT’s specifically to meet the educational needs of Respiratory Therapists.  I am proud to share that a number of people involved with this event have been on the Planning Committee for several years…it is so rewarding! I have had the pleasure of wearing many hats with this event, from planning committee member to speaker to chairing the event one year…all wonderful experiences!

 

The HHS RT Educational Retreat offers professional networking, lectures, hands-on facilitated workshops, tremendous vendor support, and lots of prizes!  What is great about our event is that over the years, it has grown to support regional LHIN RT’s and affiliated RT Programs for Student Respiratory Therapists and RT Educators.  We have also built in ample time to liaise with our many corporate (vendor) supporters…we couldn’t run the event without them, and we have a unique approach get people mingling with our vendors through our ‘vendor passport’ system and prize draw.  It is truly a marquis event! 

 

Thank you Shawna for your insight!

This year’s HHS RT Retreat is happening September 18th, 2018 at Carmen’s Banquet Centre in Hamilton. The cost for this full day event is only $60 ($35 for students).

For those who are interested to learn more about this conference and to register, please click on the following link:  www.hamiltonhealth.ca/rtretreat2018

 

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RTSOleadership

#RTSO Leadership Summit 2018

Thank you Respiratory Therapy Society of Ontario (RTSO) for the 2018 Leadership Summit. What a great collection of motivated attendees, working together to create positive change.

#RTSO gives voice to RTs in Ontario. To support this organization I have volunteered on the board of directors for the past few months. It is an honour working along side this driven and passionate group of volunteers. Do you know an RT in Ontario who has not joined RTSO yet? See this link for more details: https://www.rtso.ca/rtso-membership-benefits/

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Tony Kajnar

Mr. Tony Kajnar is a senior therapist at the Sault Area Hospital.  His work experience extends from diagnostic testing to the anesthesia assistant (AA) role.  Beyond his main responsibilities at work, he has assisted with the expansion of the AA role at his hospital, co-chairs the Canadian Pulmonary Function Testing Symposium, leads the Pulmonary Diagnostic Committee with Respiratory Therapy Society of Ontario (RTSO), and assists RTs and PFT labs with adhering to the latest and best guidelines.  Tony and I crossed paths as we both actively look for clarity in the pulmonary diagnostic field.  His extensive knowledge, drive to improve the filed, and willingness to help others has positioned him to be a mentor to many including RTs.   He was kind enough to take time out of his busy schedule to answer my questions.

 

To begin, let me ask two of my favourite questions to ask RTs: When did you first hear about the respiratory therapy field? What made you decide to become an RT?

After my first years of college I realized I did not enjoy my choices and attempted to reevaluate my career options, I ultimately completed aptitude and interest testing to get career ideas.  I took a Myers-Briggs test and completed a book entitled “What Color is your Parachute”, these lead to several healthcare career suggestions.

At the top of the list was Respiratory Therapy, which I had never heard of.  I came up with a list of questions and contacted my local hospital RT department who were kind enough to provide a tour and answered my questions.  I was impressed with the freedom and variety that their daily role provided and then began working toward enrolment.

 

 

Since  graduating from the RT program you have had various roles, what are some of your memorable roles so far?

Like so many, I began as a staff therapist in a hospital.  The market was quite competitive so I worked part time for nine years.  I had obtained my CPR, ACLS and PALS instructor’s certificates and enjoyed providing continuing education as my schedule allowed.  During my instructor work I got involved with simulation education and simulation teaching, which I am pleased to see in concurrent education these days.

Over these years I also worked part time in my hospital’s pulmonary function lab.  When I first started it was a requirement to obtain certification as a cardiopulmonary technologist and so obtained my CACPT(P).  I certainly enjoy diagnostics

The most challenging role to date was as an anesthesia assistant.

 

 

 

What made you decide to study and pursue AA?

Previous exposure to OR/anesthesia rotations in the RT program and our staff anesthesia department were quite positive for me.  Our hospital was part of the MOHLTC pilot into anesthesia care teams, our site was designated for an intra-op RRT/AA component and a post-op pain management with an RNEC.  This pilot was externally funded for two years but has since become part of our hospital program.

 

 

How has your experience working as an AA been? What are some areas of satisfaction and challenges working as an AA?

This role forever changed my perspective and bolstered my interest in health care.  The role was a great opportunity with so many difficult challenges to navigate.  A mantra from the Michener’s AA programs was “you don’t know what you don’t know” and that truly was reflected in the things that we were exposed to.  The more you learn the greater the engagement.

Our hospital did not have an RT role in the OR prior to the AA pilot, this created a very challenging environment in addition to the significant time investment in completing the basic and advanced AA programs.  Travelling to the Michener for our practicums and the late hours completing weekly assignments were both difficult and awesome. 

 

 

Any comments or advice for RTs who may want to consider becoming an AA?

This is an excellent opportunity for anyone truly interested in a role related to anesthesia.  There is a lot of competition and the path is extremely challenging.  Exposure to this role could help provide a better idea if the commitment is the right fit for you.  The role will vary from site to site which may influence your decision, so it is best to learn what you can from those practicing in your area.

 

 

How has the field changed over the years and has it been due to change in technology/equipment? Pharmacology? Protocols/practices? How do you see the role of an AA and the field of AA in the future?

My AA involvement was during phase one of the MOHLTC’s anesthesia care team model.   This initiative involved the CAS, their engagement and support is extremely important.  An RRT background may provide an edge for the clinical components of the AA profession but my greatest learning challenges were with the pharmacology and physiology involved with the anesthesia role. 

Anesthesia offers a departure from the acute care RRT role.  I was surprised to learn how the AA role was present for many years in Toronto, this was highlighted by the great faculty of the Michener Institute’s AA programs.  Some of my classmates were Quebec-trained RRT’s and I was impressed to learn how much the Quebec RRT program’s entry to practice competencies focus on anesthesia, not acute care.

The AA role is young and will no doubt change in ways that we cannot foresee.  It is important that we continue to have RT involvement in this exciting role.

 

 

How did you get involved with working and managing a PFT lab?

Have always had exposure to the PFT lab through the different hospital postings I have held.  It was a role I rotated through initially then had more permanent assignment in.  This eventually led to my current senior role in our hospital based PFT lab.

It is a great blend between technology, instrumentation and patient care for me.  There are plenty of opportunities for direct patient feedback, which is a great source of satisfaction.

 

 

Any comments or advice for those who may want to work in a PFT lab?

Our entry to practice competencies provides an introduction to pulmonary diagnostics but there is a lot consider with providing a formal diagnosis of lung disease and how our findings support treatment.  The ATS, ERS, CPSO and CTS practice and quality assurance guidelines are a good place to start in understanding the technical requirements related to this area of practice.  Understand the contraindications to testing you are involved with and actively screen for them prior to testing.  The quality based procedures and certified educator roles are also important to review and understand as they apply to the continuum of care.

Knowledge and understanding of the published practice guidelines is also important.  As standards change we need to be aware how this affects both diagnosis and treatment for lung disease.

 

 

How can the field of PFT improve to better serve the population?

There are many quality assurance standards to consider with lung function testing which are essential in categorization of lung disease and treatment.  We can all appreciate that objective lung testing is required to establish lung disease but only 50% of asthmatics and even less COPD patients have had such testing.  We must appreciate that there is a care gap; we need to support more accurate diagnosis and follow up to guide appropriate treatment in any lung condition.  Many patients being treated for lung disease have not had appropriate lung function tests to confirm or rule out their diagnosis. 

 

 

For some RTs and HCPs working in the acute care settings, the only exposure they have to COPD and Asthma patients is during the exacerbations.  As someone who helps COPD and asthma patients during all stages of their disorder or disease, what advice you have to share with RTs?

We need to advocate for documenting accurate lung function, screening for post bronchodilator reversibility and ongoing follow-up testing in patients.  Many patients with COPD and Asthma are not optimized and follow-up testing or assessments may not be considered after symptoms have been controlled.  Testing can help support titration of their inhaled medications.   Careful review of treatment, effectiveness of treatment and accurate categorization is also important in an effort to prevent future exacerbations.  Many patients may not be aware of their diagnosis and some may not understand their treatment options and delivery devices.  There are many opportunities to help patients gain better control.

 

 

With a sudden burst of various puffers coming to the market over the last 3 years, what is important to keep in mind? How can RTs better assist their patients with their puffers?

The new treatment options require us to continually review and update our knowledge in order to maintain consistency for the patient.  The medications and their role in respiratory guidelines are part of our best practices.  Being familiar with these medications, their delivery devices, mechanisms of action, interactions and precautions is all part of our professional responsibility.

 

 

I am going to ask few questions about the leadership side of your career.   In Sault Area Hospital you have been involved in many projects which not only improved the quality of patient care, but also expanded the role of RTs and AAs.   How did you get involved with or initiate changes in your hospital?

Some experiences were the result of job postings; other initiatives came from interest or certifications I worked towards. 

Policy and procedure updates have always been a challenge for me.  Sometimes the need to change has been a result of ongoing best practice and clinical guideline updates.  Other times it was from staffing or operational changes that brought new duties or refined them.  Developing effective communication with administrators and clinical leaders to outline policy and training required to accomplish appropriate changes is an area where our profession could benefit from additional resources, groups and references. 

 

 

Any recommendations for those who want to initiate positive change in their work environment?

Get involved in areas you are passionate about, this makes the work you put into the role much more enjoyable.  There are many opportunities with your professional associations, get involved where you can as there is always need for our profession to support future growth with our ever-changing health care system.

 

 

You have been active in improving the quality and standards of diagnostic testing including PFT.  How did you get involved with the Canadian Pulmonary Function Symposium?   What have been your goals?   How could RTs benefit from this annual symposium?

Several clinical practice issues lead to a search for clinical resources in order to address them.  

I attended the Medgraphics Cardiorespiratory Diagnostics Seminar in 2014 and was shocked to learn that it has been offered every year since 1994.  

I got involved with the Canadian Pulmonary Function Symposium after it ran in 2015.  I attended and offered to get involved with my fellow co-chairs, Laura Seed and Murray Beaton.  The Canadian PFT symposium is intended to be a resource for any clinician interested in pulmonary diagnostics.  Speakers and topics reflect current topics in addition to reviewing best practices and quality assurance requirements for pulmonary diagnostics. 

This experience has provided opportunities to meet several individuals, researchers and manufacturers who have helped answer clinical questions and motivated my ongoing involvement in supporting pulmonary diagnostics advocacy.

 

 

On a path to clarify and improve guidelines and protocols, you have been active in asking questions, surveying practices across the country, and vocalizing important concerns that need attention.  In your opinion, what are some areas that need more attention?  What are some of the obstacles?  How can RTs get involved?

I believe communication and knowledge transfer is an obstacle for our profession given our relative numbers to other professional groups.  It is easy to get lost in our health care system. 

My hope is to have a supportive clinical practice network that includes respiratory therapists.  There are many clinical practice areas that would benefit from formal study and publication involving the RRT role across all practice settings.  Research is an area I hope to see more RRT’s getting involved in for benefit of patients, the profession and our health care system. 

 

 

Looking at the RT profession, what do you see as the next big growth area?

Don’t think I can accurately predict the next area of growth but I certainly hope that we will see the development of an advanced practice respiratory practitioner, similar to the nurse practitioner role.  Such a role could support patients with lung disease in ways that go beyond our current authorized acts.  This role could also support our profession through advocacy and research as well as providing a goal for other colleagues to work toward.

 

 

As we get close to the end of this interview, do you have any final words or comments for the readers?

Certainly hope to see more RT’s get involved in promoting health care, advocating health care reform and research.  Hope to see RT’s support others for the benefit of patient care and best practices.

 

 

Thank you, Tony, for taking the time to answer my questions.  Also, thank you for your ongoing contributions in the respiratory therapy field!

 

If you would like more information about the upcoming PFT Symposium check out http://www.cacpt.ca/PFT-Symposium-2018-Details.pdf  .  This year’s event is taking place in Calgary, AB, from September 21st to 22nd (2018).

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International Women’s Day

My blog would not be where it is today without the contributions of great RTs out there. Check out these blog posts profiling some of the amazing women in our industry!


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