Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.
I found an article on March 9th, 2020. I spent a few days with it, and now I share it with you.
Variability In Expiratory Flow Requirements Among Oscillatory Positive Expiratory Pressure Devices
by Sherwin E. Morgan, RRT, Steven Mosakowski, RRT, MBA, Brenda L. Giles, MD, Edward Naureckas, MD, Avery Tung, MD, FCCM Published online March 4, 2020. Available on The Canadian Journal of Respiratory Therapy (CJRT) : https://www.cjrt.ca/wp-content/uploads/cjrt-2019-025.pdf
Top 3 Reasons Why I enjoyed this Article
Firstly, this article is quick and easy to read.
Secondly, I had forgotten about the various Oscillatory Positive Expiratory Pressure (OPEP) devices on the market. This article was a nice introduction to various flows and pressures required to operate the units. The authors provide a recommendation for which units to be used by which population (small vs. larger patients) on page 10.
Thirdly, in the introduction the authors discuss the proper technique for using these devices (referencing Olsen et. al). You can find this description on pages 7 and 8.
Once again, you can view this article by visiting CJRT (which is owned by Canadian Society of Respiratory Therapists): https://www.cjrt.ca/wp-content/uploads/cjrt-2019-025.pdf
I always enjoy attending Canadian Society of Respiratory Therapists (CSRT) conferences, as there are variety of speakers, topics and streams. In May 2107 at the CSRT Conference in Halifax, I attended a talk, titled ‘Creating a Regionalized Lung Health Program’, by Christina Dolgowicz and Michelle Maynard. While I enjoyed the talk, I was more blown away by the dedication and hard work of the speakers.
As I slowly become more involved with the RT community, read articles and speak to healthcare providers, I hear more about Christina’s work. Some of her current and past roles include Chair of Champlain LHIN Lung Health Network, Lung Health Coordinator, Certified Respiratory Educator, RRT at The Ottawa Hospital, member at Quality Ontario and many other RT roles. Her contributions in the respiratory field vary from direct patient care and education, advisory to policy making, to establishing and promoting community-based pulmonary rehabilitation program.
Christina is highly respected among her colleagues and in the RT community, so I was delighted when she agreed to answer few questions about her journey, thoughts and views.
When did you first hear about the respiratory therapy field? What made you decide to become an RT?
I was completing my 3rd year of University and didn’t know what I wanted to do but knew I had to find a job when it was all done! I wanted also to come back to Eastern Ontario and thought I could go to school in Ottawa and started looking into college courses. My criteria for a program:
1. I wanted to go into healthcare
2. I didn’t want to be a nurse
So I looked into the courses that Algonquin College offered and it was between Respiratory Therapy and Diagnostic imaging… I met with the Anita Gallant (course coordinator at the time) to find out what being an RT was all about. To be honest, the only thing that stuck with me was: I got to wear scrubs and hold a pager – that sounded like being a doctor and looking like they do on the TV show ER – so I applied – and got in! It was during that first week that I found out what RTs do –like an ABG! (up until that point I did NOT do well with blood) so I almost dropped out… but thankfully I met some awesome classmates and stuck it out.
With various roles and years of experience, what are some of your memorable roles so far?
To be honest, I have been lucky to enjoy all of the roles I have worked thus far. I started originally at the Ottawa Hospital (2004) and despite working full time in the community now, I still work casual at the hospital. The hospital allows you to react quickly to critical situations and work as part of an interdisciplinary team – RNs, PTs, MDs and other RRTs. It’s professionally and personally rewarding – you get some great experience and make lifelong friends along the way.
Currently – my role as coordinator of the Lanark Renfrew Lung Health Program – is my most exciting role so far. I work with an awesome group of RRTs who are passionate about lung health in primary care (education, early screening, management, rehab) and their passion and wanting to make a change (and willing to say yes to opportunities that come our way) is what makes my job so much fun.
What is your passion that drives you each day working as an RT?
My passion is seeing the difference our program makes in peoples lives. In my current role, unfortunately I have less contact with clients, but I hear the stories through the rest of the team I work with. Occasionally I get to work out in the rehab program and it’s a humbling experience to see the daily struggles that people with chronic lung conditions live with. I also hear about frustrations from clients in regards to the lack of services that are available – and this also drives me to work harder in creating partnerships with other organizations to increase access to lung health services in primary care.
How did you get involved with promotion, initiations, implementations and operation of community lung health education and community-based pulmonary rehab programs?
I originally started working in primary care in 2006 at the North Lanark Community Health Centre and gained so much experience from my supervisor, Karen Jones. She worked very hard and advocated for RTs in primary care and she grew the program from 3 sites with 1 RRT to more than 10 sites and 4 RTs. With working at the hospital and in the community, I got a good sense of where I wanted to spend the majority of my career. I was frustrated at the hospitals with the amount of time it took to make a simple change – only because big tertiary centers are so large and changing policies/procedures takes a looonnnggg time. Making simples changes in primary care was much easier and there is such a need for RTs in primary care, so it was a perfect fit for me to remain working in primary care. Because of Karen’s guidance and mentorship and the success of the lung health program – I was able to continue her work and advocate for services that spread further than the sites we were currently working out of. I’m also someone who can’t sit still and need to continue to push forward for improving care for clients with lung disease. This may be a downfall, but I say yes to many opportunities that come our way because who knows what may come out of it!
What have been some of the challenges along the way?
Some of the challenges that are lack of funding and lack of communication amongst health care organizations. We are all working to improve the health care system experience, but sometimes it feels like we are all doing it alone. By working together, advocating for change, utilizing existing resources – it can really make a difference.
How can other leaders, communities, and health programs learn from your experience?
Just reach out! We are all working to continuously improve the client experience, ensure that we are meeting their needs and goals. By sharing our experiences together, we can share what we’ve learnt so far (and I will get some ideas from you as well!).
Can you share some thoughts about the role of community based pulmonary rehab programs?
A community pulmonary rehab program plays such an important role– it connects people and creates a peer support group, care can be provided close to home and out of hospitals/tertiary care centres. By keeping it in the community and out of hospital, it decreases participants risk of getting sick, participants can be connected to local programs to exercise with after the program is done, it saves the participant cost/time of travelling to a large organization and paying for parking and finally, because our staff work in the community – they may already be connected to many of the primary care providers who send us clients and it makes connecting and consulting that much easier. It is also less expensive to run a community program than a hospital program.
How can RTs be more involved with such initiatives (planning, decision making and operations)?
Look to your supervisors/managers and share your ideas with them! It always helps if those ideas i) align with the goals of where you work ii) improve the client experience iii) improves outcomes/quality of care and iv) saves the organization money! And don’t get discouraged – sometimes these things take time – but when the ideas come to life – it’s all worth it.
Any advice on how new RT’s can build up their leadership experience?
Get involved in your provincial and national associations – even if you’re fresh out of school! You can learn so much from RTs across Canada and you never know when those friendships produce an opportunity. I was on the CSRT Board of Directors in 2007 – 3 years after I graduated – and to this day I still meet up with the friends I made while I was on the board and that experience of serving on a national board really opened up my eyes as to how the profession worked.
Can you tell us a little bit about your experience working as Quality Standards Committee for COPD, part of Health Quality Ontario?
Health Quality Ontario – COPD Quality Standards Committee was a great opportunity for me. I was able to be a part of a provincial group, bringing together top players and lived-experience advisors to talk about COPD in primary care – something I am very passionate about! It was great to ‘dream big’ and produce quality standards of care that people should receive if they are diagnosed with COPD. They will be officially released in Spring/Summer of 2018 and it will be great to see how practices are changed based on these quality standards.
What is the next big growth area that you see for the RT profession?
I believe that the trend now is to have more RTs working in primary care. Traditionally we have been a tertiary care discipline – and the majority of our training is focused around working in critical care areas. We are seeing more and more RTs taking on a role of a case manager in primary care, managing chronic ventilated patients in the community, running rehab programs, delving into the management of cardiac conditions – it is so exciting! Primary care wants RTs to work with them. Not once have I heard a primary care team say: we don’t need an RT. They are calling asking: can you send us an RT? J I encourage RTs who are interested in working in the community to take the certified respiratory educator course and look for opportunities in primary care. It may start as spirometry screening and grow into a pulmonary rehab program – you never know!
How can RTs be more involved with decision making and planning in the hospitals, communities and ministry levels?
As mentioned above, start by getting involved with your professional associations (many of them are working at the ministry level), local lung association or find a task force/working group or committee at your hospital to get involved with. Maybe there isn’t one? If you have an idea and some support – create one!
Any advice on how RTs can expand their framework to support each other in a uniform and national way?
Join your professional and national association! Your regulatory college is there to protect the public – your professional associations are there to promote RTs and work for you! The worst thing I hear is people complaining about their lack of pay, their lack of respect amongst other health care providers, the lack of change in their job – want something to change? Get involved! There are some amazing, engaged RTs in Canada who are facing the same struggles that you may be facing – and by working together, we can make a difference.
Thank you Christina for allowing me to share your perspective and views with others. Also, thanks for your great contributions to the field of Respiratory Therapy!
Farzad ‘Raffi’ Refahi
In 2016, I gave a talk at the annual Canadian Society of Respiratory Therapists, CSRT, Conference. At that time I was working six days a week, running a blog, and was trying my best to prepare for the presentation. I was excited, nervous and driven. My presentation was far from perfect, however, I learned a lot in the process and from the self-reflection after it was completed.
Here are my top three pieces of advice for first time presenters at CSRT:
Know more about the topic than most people in the room. Do your research but don’t invest all your time on the research component. There will always be individuals who would know more about the topic than you would, however gather enough information so your talk would be beneficial to most people in the room. Presenting at CSRT requires quality and professionalism. Do your research, deliver the quality, but don’t spend the whole time sharing your research.
Keep It Simple.
Collect all the relevant information, process it and present it in few key points. A 45 minutes long talk is a short time to discuss all your findings. It is best to summarize or select only 3 to 5 key ideas/points, and then focus on the delivery of those points. Keep it simple. Present the key points without relying too much on technology. There seems to be always some technical issue during talks (happened during mine).
Practice… Practice… Practice. Get to know your material. I would encourage practicing enough to memorize. Practice in front of friends and individuals in the field. Use the feedback from the practice runs and modify your presentation until it is smooth and simple while delivering the main ideas. I videotaped my practice runs so I would identify areas that required more attention. Don’t be afraid to connect with your audience. Get to the room that your will be presenting early or during breaks. Stand where you will be presenting, look around and get to know the room. During your presentation don’t forget to breathe.
Here is the link to CSRT’s Call For Presenter’s page:
Ms. Christiane Menard is retiring from her position as the Executive Director of Canadian Society of Respiratory Therapists, after almost a decade of service (9 years). As a thank you for her contributions to the respiratory therapy field, this blog post is dedicated to her.
The first time I met Christiane was at the 2016 Ottawa Conference. Even as a relatively new respiratory therapist and a novice blogger, I was greeted with a big smile and a hug. She is full of energy, passionate and is very driven.
From a quick glance at her career accomplishments you can see that Christiane’s dedication to excellence is evident. Besides the position of Executive Director of CSRT, she held other positions such as the Communications Coordinator for Merck, Director with Society of Obstetricians and Gynecologists of Canada (overseeing Communications, Government Relations and Partnerships), and Director of Communications for the Canadian Association of Medical Radiation Technologists.
In 2017, she was the Honorary Lifetime Membership Recipient from CSRT.
I reached out to CSRT’s president, Mr. Jeff Dionne. This is what he had to share about her:
When I think of Christiane, I think of a true visionary. She took on the role as Executive Director for the Canadian Society of Respiratory Therapists during a time when things were quite unstable. Our profession was going through an identity transformation; our membership numbers were steadily dropping, our impact within the RT community was dwindling, and our image as a national organization was blurry at best. During her time as ED, we have witnessed numerous success stories emerge; from the Blueprint for Action for our profession in 2014, to our role in private practice, to the Anesthesia Assistant certification process, the CSRT is now a nationally recognized leader in the realm of professional association. Not only have we seen our student memberships double, but we are also proud to say that we have well over 4,000 members in our association. It has been through her tireless commitment and dedication for our profession that has placed us in such a positive situation for the years to come. Thank you, Christiane.
I will share with you the brief conversation I had with Chriastiane.
Looking back over the years as the Executive Director, what are some of the memorable moments that come to your mind that you can share with us?I have so many memorable moments and in each of these moments, it is the passion of the RT profession that was front and center. Whenever I went to provincial meetings, I always tried to find out about RTs and to learn more about what they did and the projects in their region. The most memorable moment was in 2014, I was in Vancouver for several meetings and on my way to the airport I accepted an invitation to visit the PROP program in Vancouver. A young and most passionate RT named Esther Khor gave me the grand tour of her organization and it was the most amazing set up I have ever seen. It was the first time, after working 40 years in the health care sector, that I saw an organization actually put in place a truly effective “patient centered approach” to care. I immediately invited her and her patients to speak at the 2015 conference and I feel this was one of the most memorable presentation at a CSRT conference.
How has the RT field changed from your point of view?I see a profession that has gained a lot of confidence in their knowledge and clinical skills. More and more RTs are working in less traditional roles like research, quality assurance, patient transport. I am very proud of all the RTs who continue their education and keep building on their RT skills and knowledge. Nine years ago, critical care was the most important area of practice. Now we see more and more RTs working in community and home care. Many RTs have entered a growing area of the health care that is most important – patient safety. The profession constantly shows its versatility and ability to adapt to the changes required in the health care sector. I have no doubt that RTs will continue to look for new applications of their skills and knowledge than any other profession.
What is next for you?I am retiring from being an Executive Director, but I love working. I just feel I am no longer able to work at the Executive Director level and knew it was time to take a step back. I plan to stay at CSRT in a lesser capacity for a number of months to support the transition of the new CEO. I will then find some part-time work where I can still use my knowledge and skills. As I will no longer travel for meetings, I look forward to attending more cultural events in Ottawa and going to the pool and gym more often.
What were some of the goals you set for yourself when you began as Executive Director and do you think you accomplished them?I had many objectives when I started – increase the CSRT membership, increase the number of participants at the CSRT conference, increase the income from sponsorship – and then I soon realized that none of these objectives could be achieved if we were not able to show the value of CSRT to our members and to our industry partners. So I think we have achieved those objectives by showing value. The most difficult objective to achieve had to do with the financial viability of the CSRT. When I started in August 2009 we had absolutely no money in the bank … no money for rent, no money for payroll. That was so overwhelming and I struggled with this for many years. It took nine years, and inch by inch, we increased our financial stability. This year is the first year that I feel we are on solid financial ground and that we do not have to borrow on the line of credit or on next year`s income to meet our financial commitments.
What are some words of advice for people in the industry who want to get more involved?Find something that is missing, something where you can make a difference, something that can be done better, and just do it! If I look back at who has done just that I think of Jason Nickerson, who got involved in international health, not because of the money, but because there was a need and he knew he could make a difference. Tom Piraino is another RT who saw a void in RT education with regards to the clinical applications of ventilation and he got involved in increasing knowledge and understanding in his institution, at the provincial level, at the national level and at the international level. It just takes effort, constant effort, and you can achieve everything by doing an inch at a time, one step at a time. The secret is to not get discouraged by hurdles … anyone can build a mountain one spoonful at a time!
What are some of the challenges you see in the future for RT’s and how can we as practicing RT’s prepare for those challenges? The biggest challenge for the RT profession is keeping up with the complexity of the health care sector. As the health care sector always seems to be in transition, the RT profession will also continue to be in a transition and there is no way to go but forward and learn more complex clinical applications. I do feel that the RT profession has been very quick to adapt to changes that have occurred in the past and I have no doubt that RTs will continue to increase their knowledge and clinical skills. RTs will surpass any challenge and will move forward where they are most needed and where they can make the most difference in the respiratory care of their patients.
Any final thoughts? My final thoughts ….I am so grateful that my last full time job was with the CSRT and that I had the privilege to have the trust and support of the RT profession who so generously shared their passion with me. I can brag that my last job, after working in the health care sector for over 45 years, was the best ever! Not many people brag about their job when they retire, but I do !
I want to thank Christiane for her dedication to our industry and for taking the time to speak with me.