On June 14, 2017, CBC’s World News reported that “5 people, including Michigan health chief, charged in Flint water probe”. The investigation follows the poor quality of water in Flint where more than 100, 000 people were exposed to high levels of lead.
This topic may not be related to respiratory health but does speak to our accountability and actions as individuals with power and influence over other’s health.
Take the time to review:
-CSRT’s Standards of Practice at http://www.csrt.com/standards-of-practice/ and
-CRTO’s Stands of Practice at http://www.crto.on.ca/pdf/Standards_of_Practice.pdf
– CBC World Newshttp://www.cbc.ca/news/world/flint-water-health-chief-charged-1.4159883
-CNN-Flint Water Crisis Facts http://www.cnn.com/2016/03/04/us/flint-water-crisis-fast-facts/index.html
Farzad ‘Raffi’ Refahi
June 14, 2017
I was given the chance to share my thoughts and views in the Leadership Forum of Canadian Society of Respiratory Therapist in the 2017 annual conference. I spent few months studying and preparing a list of recommendations to remind managers of ways to improve their workforce (relating to different generations). In this post however, I will share some advice for employees, staff and students.
As you know, there are several factors that influence the characteristics of individuals such as gender, cultures, politics, race and ethnicity, educational background, age and many other factors. While individuals are grouped in various categories so they are better understood, each individual is unique.
Check out this quick chart with the list of the recent Generations:
|Baby Boomer||Generation X||Generation Y
|*Age in 2017|
Veterans grew up during wartime and scarcity. In order to survive and be successful, they had to be make calculated decisions, and had to work hard at their job. Change was associated with risks, which they may have not recovered from. Thus calculated decision making and royalty was the key to success. There are few existing biases and negative stereotypes out there which include Veterans being out of touch, Baby Boomers being workaholics, Generation Xers being slackers and Generation Y being demanding and disloyal. I hope that by explaining the experience and mentality of the individuals from different generations, it would lead to better understanding, empathy, and communication between people. I like to promote a culture of respects for everyone (regardless of their generation).
Baby Boomers are stereotyped as being workaholics. Just like Veterans, working hard lead to success! While Baby Boomers also had to work in a hierarchical structured workplace, they may not fully agree with this Top-Down structure. They enjoy having more options and more influence in the decision making.
Generation Xers are stereotyped as being Slackers. This generation cohort grew up taking care of themselves as both their parents were working. Keep in mind that there was an increase in divorce rates. It is not surprising that Generation Xers grew up being resourceful and independent. In addition, this generation was introduced to computers and access to information. They watched as corporations failed and had to laid-off staff. With a lack of full trust in institution and organizations, Generation Xers are careful in their relationships with organizations or employers. Generation Xers are resourceful, calculated, and may not be dedicated to a single employer/organization. This generation values work-life balance.
Millennials (Gen Y) are stereotyped as demanding and disloyal. Just like Generation Xers, Millennials are cautious about their relationship with organizations and employers. Grown up with instant access to computers, technology and information, this generations has higher expectations. Unlike the experience of Generation Xers, the parents of Millennials provided a lot of options to them, and included their children in more decision making. Thus, for Millennials and Generation Z, sharing their thoughts has been a normal part of their life.
Generation Z receives similar negative stereotype as Millennials. Just like Millennials, individuals from Gen Z are educated, enjoy instant access to information and opportunities.
To improve communication and to reduce the chance of perceived disrespect between generations, keep the communication style more formal and proper for older generations. Younger generation is comfortable with less formal communication and in less formal settings. Older generations value being heard as they like to pass on their knowledge and wisdom. Younger generation also enjoy sharing their thoughts and ideas despite having less experience than older generations.
Staff, students and employees need to realize that one size does not fit all, and they need to look at things through different lenses. Everyone is unique. Each person deserves a chance to work where they feel respected.
This post is meant to be short, simple, and to serve as a reminder. If you require additional information or have additional questions, feel free to get in touch with me.
Image credit: http://maxpixel.freegreatpicture.com/Models-Old-Communication-Generations-Phone-1662191
Farzad Raffi Refahi May 18, 2017
This is the third part to a series of posts, titled ‘Improved’, aimed to assist with development and improvement of Respiratory Therapists and other Healthcare Providers as individuals and as clinicians.
I share recommendations and advice from Mr. Piyush Jadav, a healthcare professional with educational and work experience as a chropodist. In my conversation with Mr. Jadav, I asked for any recommendations for clinicians who either work 12 hours long day/night shifts/ acute care, and/or to those who work sedentary 9 hours shifts/diagnostic/patient education.
In time for foot health month, this post is released in May.
Footwear Advice for Clinicians/Hospital Workers
First off, when speaking about footwear; the most important thing is comfort. I have told many patients about what footwear is the best or most appropriate for them. The biggest issue with compliance has to deal with the level of comfort.
When speaking about footwear, at the most basic level there are 3 shapes of “lasts”. A last is the structure on which a shoe is built around.
With respect to hospitals, these same examples can be applied. Mesh/net material in shoes is usually not allowed in some departments due to risk of infection and lack of protection. Shoes that are used for long periods of walking in the hospital or clinic setting should not be used to recreational activity. Footwear that is meant for running/exercising are designed to absorb more force due its high demands.
Look for footwear with either Velcro or laces which provide stability to the midfoot as well as the ankles. Slip on shoes provide little to no support and have a shorter lifespan.
The best time to try on shoes is closer to the evening because one’s feet do swell slightly during the day. This will ensure a proper fit.
Also, try to change socks at least once a day. Try to designate a pair of shoes for work only, allowing them to breathe overnight. This will prevent excessive odour and moisture from building into the shoe. Never wear your shoes without socks, this can harbour excessive moisture and may contribute to athlete’s foot.
A typical clinician/hospital worker can be on their feet for 8-12 hours per day. Standing for long periods of time has been linked increased pressure on peripheral blood vessels. In addition, this can lead to varicose veins or “bulging veins”. Some of the first symptoms may include cramping, muscle aches and mild swelling. An inexpensive option to help with this would be to use mild compression (10-15 mmHg) stockings which may help with relieving symptoms, which can be picked up without a prescription from the pharmacy.
Piyush Jadav, B.Sc., D.Ch
Primary site of practice:
Uptown Health Centre
9325 Yonge St Richmond Hill, ON L4C 1V4
(905) 508 -8876
This is the second part to a series of posts, titled ‘Improved’, aimed to improve the life and work of Respiratory Therapist and other healthcare providers.
I share recommendations and advice from a friend who is a health professional with educational and work experience as a nutritionist. In my short conversation with her, I asked for any recommendations for clinicians who either work long 12 hours long day/night shifts/ acute care, and/or to those who work sedentary 9 hours shifts/diagnostic/patient education. I have added relevant resources to some of the suggestions so I recommend that you check out the reference section for additional information.
Regardless of the work-setting, clinicians get heavily involved with their responsibilities and may loose track of time and their food intake. Nutrition can directly impact cognition, concentration and decision making (1). My source, the nutritionist, suggests: stay hydrated, eat healthier, plan your meals, have healthier snacks, and give yourself time to adjust to healthy eating habits.
Stay Hydrated. Don’t ignore thirst. Drink water. Carry a container of water with you (at your desk/RT department). If you choose to drink other fluids, check out the 2014 guideline by Dietitian of Canada (2). This guideline suggests a daily water intake of 2.2 L for women and 3 L for men (19 years and older).
Eat Healthier. Eat more vegetables and fruits. It also adds more fiber to your diet (just remember to increase your water intake with it). Limit foods that are high in calories, fat and salt. Consider lean meat or alternatives. Check out Canada’s Food Guide for more details.
Meal Preparation. A main obstacle in healthy eating at work is preparation. Prepare food in advance: Purchase, prepare and cut your veggies before it is time to cook. Use slow cookers or pressure cookers to better fit your schedule. Cook higher quantity of food than needed and freeze it for later consumption (reference 5). If you don’t have time to prepare a meal and have to purchase a one at work, cut up some veggies and fruits to take with you.
Snacks. No matter how busy you may get, take the time to eat something, e.g. instead of having cookies and chips, cut up some bell peppers and celery sticks. Pair it with protein such as almonds and walnuts. It is better than working on an empty stomach (impacting concentration and overall performance at work). (3 and 5 ). Also when it comes to shakes, it is better to eat food than to drink it (chewing food improves the transmission of satiety signals).
Habits. Keep in mind that any behavioural change, including improving dietary intake, requires time and practice. Set SMART goals (Specific, Measurable, Attainable, Rewarding, and Timely) . Take small steps, keep motivated and enjoy!
Thank you to my nutritionist source (anonymous, so her opinions would not reflective of her employer(s) ) . Also, a thank you to my followers for allowing me to be part of your personal or professional development and growth.
Resources and references:
[End] [Farzad ‘Raffi’ Refahi HBSc/RRT/CRE. FarzadRefahi.com April 02, 2017]
Over the past few years, I have worked in various settings such as acute care, pulmonary function testing and patient education. My experience varied from working in an active 12-hours long day or night shift in the ICU/ER setting to a more sedentary 8 to 9-hours “office job”/shift in pulmonary function testing and patient education. I faced different challenges in each setting. For example, around the 4th month working in ICU/ER, I noticed that wearing quality footwear will have a significant impact by reducing discomfort, and indirectly improving my energy and concentration levels. On the other hand, during the less physically demanding shifts at PFT, I felt a total body fatigue and discomfort that stems from sitting for prolong periods of sitting down (i.e. reduced mobility and sedentary aspect of PFT/Patient Education setting). In an attempt to improve the quality of life of my fellow clinicians, I reached to various healthcare professionals to get their advice (which I will share in a series of posts titled ‘Improved’).
In this post, I share the advice, tips and wisdom from a Personal Trainer. Keerthanan Kugathasan is a personal trainer equipped with latest knowledge from his studies at York University’s Kinesiology and Health Science program. The following is a summary of his recommendations:
Working long sedentary hours a day can be detrimental to your body and health. Sitting more than 8 hours a day has been proven to increase the risk of muscular skeletal diseases, obesity, diabetes, cancer, heart disease and kidney disease (CDC. 2015). The spinal cord of the human body also puts up a huge strain, constantly in a curved position while you sit at your desk. This can evidently lead to poor posture when standing and sitting. Large muscles and joints, especially the ones located in the hip/lower region of the body, also tend to tighten up, as there is not much stretch or strengthening occurring as you remain sedentary in a sitting position for a significant period of time (AAOS. 2013).
In relation to the respiratory therapy job, there are days when clinicians endure a full 8-9 hour shift with not much physical activity. Although both the Acute and Diagnosis/Education job settings have differences in terms of hours and the amount of time you’re sedentary, it’s important to try and increase movement for the body so muscles and joints do not adapt into a sedentary setting.
My recommendations if you work long hours in a sedentary position:
Remember, you spend a great chunk of your adult life at work! Therefore, it is important to take care of your well-being and body while doing so.
-Keerthanan Kugathasan (Personal Trainer)
For further questions or advice, please email: firstname.lastname@example.org
>AAOS. Lower Back Pain. December 2013 http://orthoinfo.aaos.org/topic.cfm?topic=A00311
>CDC. Physical Activity and Health . June 04, 2015 https://www.cdc.gov/physicalactivity/basics/pa-health/
[End] [Farzad Refahi RRT. FarzadRefahi.com . March 19, 2017]
Farzad Refahi Feb 17, 2017
“The first experience of intubation on a manikin was so fun!”
These were my initial thoughts after trying intubation on a manikin for the first time on Feb 13, 2012 at The Michener Institute. My first intubation in a simulation setting. “So Fun”. Reaching for the laryngoscope with the left hand, sliding the tongue to the left. Recalling to lift up and NOT to bend the wrist. To pass the tube through the cords. To establish an airway. To intubate. A palpable excitement in the clinical laboratory as my classmates took turns to attempt this skill. Somehow it made us feel powerful, and closer to becoming a Respiratory Therapist, an RT.
This post is a self-reflection, a personal opinion, and does not represent the thoughts and the beliefs of my employers. I will make references to intubation as a unique RT skill, without suggesting that it is the ultimate required intervention. Also, I will draw on my experiences and insights as a lifeguard and a respiratory therapist, without any attempts to fully describing the responsibilities of each job.
When I read my Facebook post from 5 years ago, I started to think about my role as an RT. I realized that my views and thoughts have shifted, or expanded to be more accurate. I had gone through the same realization some years ago about a similar case. I started recalling my training and work as a lifeguard.
To be a lifeguard. To recognize the signs of struggle, to make that dive, and to save someone. Many swimming classes and training sessions prepares one to become a lifeguard. The idea of being able to save someone is a strong motivation to jump through all the hurdles and requirements. However, when you complete the training sessions and start working as a lifeguard, you realize that the ability to ‘dive in and save’ , is only a very small part of your actual shift. Does that take away from the skills and abilities of a lifeguard? Absolutely not. But one quickly learns that there are many more processes in place to make someone a quality lifeguard. The meaning of ‘saving’ someone shifts and expands. Once trained, lifeguards are equipped with many skills to approach and intervene with the situation at hand. However, most of the shift is spent on preparation and monitoring. Yes. Lifeguards spend most of their time preventing the opportunity to do the glamorous ‘dive and save’. Time is spent to scan the swimming pools before the beginning of the shift: scanning for any loose bricks, sharp corners, water quality and levels. During the shift, they monitor any risky behaviour by the patrons. They move around to have a clear view of those in the water. Lifeguards have learned to expect and predicts certain patterns. In case of emergency, they use the skills and routines that they have spent hours practicing. Once the incident is dealt with, they spend time documenting and communicating with appropriate staff. The incidents are monitored to recognize any patterns.
I had a very similar insight when it came to practicing respiratory therapy. After finishing my undergraduate studies and then few years of respiratory therapy program, I became an RRT. I learned that if intubation is the required intervention then RTs are willing and ready to perform the task. However, just like my lifeguarding experience, a lot of effort is spent on recognition, monitoring and prevention. After performing any required intervention, RTs educate and follow-up to prevent the repeat of this incident. With additional knowledge and experience, one stops thinking about one specific event and start thinking about the bigger spectrum of care.
Let’s imagine that you are an RT responding to a page for intubation of an Asthma exacerbation. The initial nebulizer and oxygen therapy treatment has failed, and deterioration has continued; Intubation has been selected as the next intervention. You intubate and ventilate, and the team uses the appropriate pharmaceutical therapy to help the patient. Your job as an RT may have been done for that instance, but you soon realize that there is a whole system in place that will continue to take care of this patient. Your colleague may be called in during discharge to review an Asthma Action Plan with the patient. This patient goes home and returns to his/her daily life. He/she books an appointment with an RT, a certified respiratory educator, to discuss the recent events. During the session, spirometry is done to compare the current values with his/her baseline. A review of the current puffers is done. Puffer techniques are assessed, corrected and/or reviewed. The action plan is reviewed and modified as needed. A list of triggers is updated, and plans to prevent these triggers are discussed. Our patient is monitored by a team of RTs/CRE/Respirologist/MDs/nurses/Pharmacists who look after him/her. If all of the above fails, then we know there is a team of healthcare providers waiting in the emergency departments and ICUs to assist and treat such exacerbations. Preparation, monitoring, interventions, and follow ups.
Through my short RT career so far, I have worked in acute care, pulmonary function testing and sleep apnea education/CPAP. I have had the opportunity to view our role from a wide spectrum. It is comforting to know that this system of prevention, treatment, and follow up is active in all the settings. While this system is not perfect, there are caring people who are trying to make improvements. By thinking about the bigger image, and staying humble, we can be a better member of this spectrum of care.
In hindsight, the thought of diving in and rescuing someone via intubation seems glamorous and ‘fun’, however, it is but one aspect of being an RT. Respiratory Therapy field is expanding and we are the driving force behind it.
We said farewell to 2016 and welcomed 2017. After few days of celebration we returned to our regular schedule. Having a new year’s resolution is common and well established for many individuals. Creating a new year resolution is not a new concept, and can be linked back to 4000 years ago, in the ancient Babylon (1). We can all recall the elements of an effective goal setting/plan. SMART. Specific, Measurable, Attainable, Realistic and Timely. We have been exposed to effective planning throughout our academic and clinical training. However, I would like to remind you of an important step that will benefit both us and our patients. Planning for possible and upcoming obstacles will be the focus of this post. During my undergraduate studies, Kinesiology with a minor in Psychology, students were encouraged to explore possible obstacles that may hinder the performance and recovery of their patients. Let’s look at one scenario.
The client works in an administrative setting where the stress of producing end of month reports elevates his or her stress level. This anxiety may lead to an increased urge or temptation to variety of thoughts, actions, feelings and behaviours. Our client may end up working longer hours in the final days of the month, and resort to take-out and unhealthy eating habits. Also, in order to meet his/her deadlines, he/she skips the dedicated exercise time. If our patient is trying to quit smoking or recently has stopped smoking, stress may trigger an automatic impulse to reach for a cigarette. Also, if others in the office react and behave in the same unhealthy manner when faced with stress, there will be an added external confirmation and enabling. Now, if we sit down with the client and identify this monthly obstacle or challenge, we can better plan for it.
Meals: Packing healthy snacks and lunch/dinner so it is readily available. Benefits include saving money, one less thing to possibly to worry about, and providing the body with a well balanced energy and nutrients.
Exercise: Exercise helps to lower stress and improve mood, which allows individuals to remain calm and better focus on task on hand (2). Consider taking 30-minutes walk breaks, without the distraction of listening to the news, reading/replying to emails, talking on the phone, or watching a TV show/Netflix.
Smoking Cessation: By preventing or managing stress triggers when overwhelmed, individuals can better handle their cravings. Avoid accompanying colleagues who are going outside to smoke. (For other list of available resources check out: http://www.smoke-free.ca/pdf_1/smoking_guide_en.pdf )
When people become stressed, the fight or flight conditioning kicks in, their focus becomes narrowed, and they are more inclined to repeat what they have trained themselves to do. We can adopt the lessons from this case study and apply it to our lives. Take the time to analyse and identify the obstacles in our plans. Write them down. It may feel weird or silly to do this exercise but you will thank yourself in the long run. Create a list. (If X happens, then I can do A, B or C). Keep it simple. Break down each step into smaller parts. Keep track of your progress. Celebrate every small achievement in your path. Keep at it!
Farzad ‘Raffi’ Refahi
1. Bennett, Howard. Why do we make new year’s resolutions? Washington Post (online). Posted: December 31, 2015
2. Exercise and stress: Get moving to manage stress. Mayo-Clinic (Online). Posted: April 16, 2015
As it is the case for us Repertory Therapist, as is the case for a large portion of professions, Continuing Education (CE) is required and mandatory. Regulatory bodies, such as our The Canadian Society of Respiratory Therapists (CSRT), use CE to have us certified and registered members, be equipped with the latest skills and know-hows of our field and update us with on new and / or reformed practice guidelines.
In my three years of being a RT, I have already taken part in various CE programs, and so I believe it is time for some humble reflection on this matter.
I truly believe in the intention and goal of such CE structures. It is constructive. However, it does hold some specific limitations. My main concern about the CE system is that it takes a one size-fits-all approach. Take for instance, an RRT with a focus in neonatal ICU can register for an online courses which will help review the knowledge side but would lack the ‘hands on’ evaluations, as well the in-person teaching or feedback (i.e. proficiency) which I find to be essential for our stream of healthcare profession. During my time at The Michener Institute, as I am sure it has / was the case in your educational institution, one quickly realizes that while the theory becomes palpable when it is later combined with the practical, hands-on training, and the feedback from teachers to better adjust to strengths and weaknesses that each and every RT student confronts.
Another limitation of the current system is lack of universal standard. This passive approach has allowed some courses, e-module and conference materials to be out of date, and lack sufficient and quality material.
Furthermore the cost-benefit of online versus in-person training has to also be taken into consideration. The online courses and modules to be more cost and time efficient, not to mention conveniently accessible, but it lacks the interprofessional opportunity and technical aspects that is incorporated in the in-person workshops and conferences. However, despite this definitive bright side to the in-person training, one cannot ignore its time and financial burden. One needs to pay higher fees for conferences/workshops than online courses, coupled with the burden of having to request time off work which means wage loss. As I had to maintain a part-time job along with my full-time RT job, for most of my career in this profession, I really appreciated the flexibility of online courses, as it allowed me to maintain a better work-life balance. However I really value the direct and immediate feedback and interaction with the instructions during the workshops and conferences. Recent research stresses the importance of associations taking into account the preferences of its members for CE courses (i.e., online versus in-person). Researchers have studied medical CE courses and have suggested a transition to Professional Development portfolio that encourages clinicians to identify goals and to take relevant courses in selected pathways. An example of such portfolio approach can be found with the existing structure of The College of Respiratory Therapists of Ontario (CRTO).
There are numerous frameworks, theoretical approaches to Continuing Education and Professional Development Portfolios which are either implemented or being considered and which deserve comparison and further analysis. If you are interested to learn more about this topic I recommend looking at Continuing Education in the Health Professions, by Gail Warden and colleagues, published in 2010 through The National Academies Press. You can access this document online by clicking on the following link: https://www.nap.edu/catalog/12704/redesigning-continuing-education-in-the-health-professions .
As you may know, there has been some recent changes to CRTO’s Professional Development and QA process. I strongly recommend that you check out their website for additional information.
|In Ontario and for CRTO:
“The CRTO does not require any number of annual CE credits. As an RT in Ontario, the CRTO QA Program requires you to maintain your PORTfolio on an ongoing basis, and complete any other assessment when requested. More information on the CRTO QA Program can be found on the CRTO website under QA Practice. Changes are currently being made to the existing QA program, so please stay tuned. ”
|For Alberta and College and Association of Respiratory Therapists of Alberta:
” Please refer to the continuing competency package in the secure members section of www.carta.ca ”
|For Saskatchewan College of Respiratory Therapists:
“Visit www.SCRT.ca -> Resources -> SCRT Continuing Education Program
|For Manitoba Association of Registered Respiratory Therapists Inc. :
” http://marrt.org/site/cc?nav=04 –> click on the provided link on the page for the PDF file. ”
|For l’Ordre professionnel des inhalothérapeutes du Québec :
” You can find all the information with the following links :
|Visit the general website for the following organizing bodies: New Brunswick Association of Respiratory Therapists Inc. , Newfoundland and Labrador College of Respiratory Therapy , Nova Scotia College of Respiratory Therapists , and New Brunswick Association of Respiratory Therapists Inc. .
Special thanks to the following individuals for their help with this post:
Bryan Buell (CARTA),
Ardis K Monarchi (SCRT),
Carole Hamp (CRTO),
Lee Hurton (MARRT),
Catherine Larocque (OPIQ), and
Katherine Nollet (CSRT).
By Farzad Refahi HBsc RRT CRE
Edited by Farhad Refahi HBA, MA Public Policy
Dec 09, 2016
’Respiratory Therapy By Farzad’
Resources and suggested reading: