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.
This month I found a great editorial post on May 15th, 2020. I spent a few days with it, and now I share it with you.
Will children reveal their secret? The coronavirus dilemma Luca Cristiani, Enrica Mancino, Luigi Matera, Raffaella Nenna, Alessandra Pierangeli, Carolina Scagnolari, Fabio Midulla European Respiratory Journal 2020 55: 2000749; DOI: 10.1183/13993003.00749-2020 https://erj.ersjournals.com/content/55/4/2000749
You will be presented by suggestions, ideas and theories such as high angiotensin-converting enzyme 2 (ACE2) receptor concentration, innate immune response as both protective and a destructive mechanism, and constitutional elevated lymphocytes.
Just like many of you, I have and will continue to go through changes during these challenging times.
My Journey So Far
Since our outpatient testing lab has closed, I have been deployed to assist the acute care respiratory therapy (RT) team. I have been working in Pulmonary Function Test (PFT) labs exclusively for the past 5 years. This has made me re-assess my awareness of acute care practices. I pulled out old notes and textbooks, and have been studying daily to refresh my knowledge. I had to reintroduce myself and get comfortable with specific ventilators and equipment (and get trained on some new ones). Being back in acute care, even in a supporting role, has made me feel vulnerable. I want to help the team in patient-care without being a burden to the team, without expressing false confidence, and without making mistakes that can impact patient care (and my licence to practice).
Continuous Support and Learning
Going forward, I will continue to help the acute care RTs in my hospital with steps that can make their lives easier which includes keeping an eye on the inventory, making ‘grab and go’ packages, circuiting vents, being the runner, and looking after simple respiratory assessments. On my own time, I will continue to review my RT knowledge using available resources such as my textbooks, notes, online videos and courses, networks and colleagues. I’ll be honest with myself and colleagues about my weaknesses and strengths, asking questions when needed, while trying to be mindful and aware of stress levels.
My Supportive Network
This transition has not been simple, but I am lucky to have a lot of support. The RT team at Markham-Stouffville Hospital has been very supportive. My fellow deployed RTs are amazing in team-work and supporting each other. Thanks to all the acute care RTs, and other healthcare providers, for all your hard work. I want to give a shoutout to the team at RTSO who have been understanding and supportive of my deployment. Also, to RT’s like Thomas Piraino, who are contributing to knowledge sharing and best practices for Mechanical Ventilation in this crisis. Tom, I don’t know how you manage all this! Research, clinical work, publications, family and still have time to do daily Mechanical Ventilation Q & A sessions (6 pm on his Facebook page https://www.facebook.com/respresource/ ). Your contribution to the RT profession is much appreciated!
Also, a big shoutout to my amazing wife, who supports me through all these challenging times. I am lucky to have strong family support in my life!
Take Care of Yourself
Be honest with yourself about your strengths and weaknesses. Navigating a new environment, at work and in life, can be scary and it tests us. Even though we may be trained, competent and capable, we all have doubts once in a while. I know its hard to take a moment for yourself in a time of crisis, but we also need to be mindful of our own physical and mental health so we can help our patients as well.
These are unique and challenging times. We are in this together! I am going to finish this post with a quote from Brené Brown (Daring Greatly. 2012).
“Sometimes the bravest and most important thing you can do is just show up.”
Farzad Refahi April 11, 2020 https://www.respiratory.blog/inthistogether/
During stressful times we tend to focus on the challenges and the struggles. It is important to not lose sight of the positive in our lives and to give gratitude.
Over the past few weeks, I have witnessed many amazing people stepping up to help everyone. Thank you, Sue Jones and Kelly Hassall, for your ongoing dedication and leadership to help RTs through Respiratory Therapy Society of Ontario (RTSO). Thank you, Gino Luigi De Pinto and Sue A., for keeping the RTSO website up to date with the latest resources.
Thank you, Thomas Piraino, for putting together the great resource on your website, and answering questions live on social media.
Also, a big thank you to Carolyn McCoy, Andrew West, Carole Hamp and Kevin Taylor for your ongoing hard work in the background.
Thank you to RT programs for lending your ventilator to hospitals, and taking your third-year students out of clinical rotations to keep them safe.
Farzad Refahi March 23, 2020 www.Respiratory.Blog/gratitude/ [End]
I have heard this question many times and in various forms.
Who is a respiratory therapist? What do respiratory therapists do? Where do respiratory therapists work?
With the current COVID-19 situation, respiratory therapists have been mentioned frequently. This blog post is meant to be a very quick overview. If you have any questions feel free to contact me and get in touch with your respiratory therapy organizations. I usually write for clinicians, but this post is meant for everyone as everybody is impacted by COVID-19.
Who are respiratory therapists?
“Respiratory Therapists are health care professionals who monitor, assess and treat individuals who have difficulty breathing”
How and why was the profession of respiratory therapy initiated?
The origin of this profession is from the second world war. It began as a technician role to reduce the workload of physicians and nurses. With a focus on the cardio-respiratory system, the role has evolved into a therapist and now includes various responsibilities.
What are the roles and responsibilities of respiratory therapists?
To keep things simple, I am going to give you a few different scenarios. They are not referring to any specific patient or organization. The teams are made of many amazing and dedicated clinicians who will be omitted in these scenarios so we can focus on the RT role!
Here are three scenarios to put things in perspective:
Case One: Asthma Exacerbation
Mary, and her parents, had felt that her asthma was not fully controlled for a few days and the recent cold has made her breathing much more difficult. Today her mother took her to an emergency department (ER) due to the severity. In the ER, a respiratory therapist is called to initiate the nebulized Salbutamol and to re-assess the patient. Despite various interventions, Mary continues to deteriorate and the decision is made to assist Mary’s breathing with the use of a ventilator. An RT places a breathing tubing in the trachea and attaches it to a unit that breathes for the patient (i.e. a ventilator). The RT continues to monitor and adjust the ventilator to optimize Mary’s breathing. When Mary’s condition improves, assistance from the ventilator is discontinued and the breathing tube is removed. Mary is now able to breathe on her own. Part of the discharge process, an RT sits down with Mary and her parents to discuss self-assessment and monitoring, and proper inhaler techniques. A follow-up appointment, in a couple of weeks, is scheduled for Mary at the Asthma Clinic. In the Asthma clinics RTs perform a breathing test, called Spirometry, and provide patient education which includes understanding the disease, management, prevention and optimization in case things don’t feel like the norm.
Case Two: COPD Exacerbation
Michael ignores the worsening of his cough, chest tightness and difficulty breathing with even short distance walks. Today he finally decides to consult his family doctor. A decision is made for him to visit an ER. In the emergency department, various tests and treatments are done, and an RT is called to start supporting Micahel’s breathing (using a mask and a supportive unit called BiPAP). Michael’s breathing is optimized over the next day. He is transferred to the general ward for monitoring. Before discharge, an RT meets with Micahel for a smoking cessation conversation. The RT also provides education about the need for ongoing oxygen. A follow-up Pulmonary Function Testing and respirologist/pulmonolgist consult are scheduled. An RT with a Home Oxygen Company/team would visit Michael to set up the equipment, perform assessments, and provide further education. During Pulmonary Function Testing, an RT walks Michael through various breathing tests. At the respirology/pulmonology visit, an RT may sit down with Michael to review the proper inhaler technique. Same RT may also provide a smoking cessation consult. A follow-up PFT and respirology/pulmonology visit are scheduled.
Case Three: Mona and Baby Lisa – Labour and Delivery
Based on the assessments and monitoring of Mona, a difficult delivery is suspected. The team, including a respiratory therapist, is present in the delivery or operating room. Immediately after birth, RT and nurses perform the routine assessments and provide the required care. In this example, the RT puts a small “mask” on Baby Lisa’s nose to deliver a small amount of airflow or pressure. This will help to keep the lungs open slightly longer, and in turn, make breathing easier for Baby Lisa. The RT, part of the team, transfers Baby Lisa to the intensive care unit for further monitoring. Baby Lisa’s breathing is optimized by adjusting the CPAP unit as required. Use of CPAP will be weaned off as Baby Lisa starts feeling better. If Baby Lisa requires even more support, the RT can use a breathing tube to establish a better pathway, and a ventilator to deliver a more controlled breathing support.
There is more…
Respiratory therapists are involved with other roles such as managers, researchers, teachers, inventor, remote support using the phone/video-chat, transport team, consultant, policymaker, in-hospital code blue/pink resuscitation teams, operating rooms, sleep labs, CPAP educators, and others.
What can an RT do for someone with COVID-19?
Respiratory therapists can be part of the team who does the initial assessment. By applying nasal prongs or a mask, an RT can improve the body’s oxygen levels. When needed and indicated, inhalers can be given to optimize breathing. Assistance in breathing can be provided using non-invasive, such as CPAP and BiPAP, and invasive measures (Ventilators).
How to become a respiratory therapist?
Most clinicians in Canada complete their undergraduate studies and then apply for one of the many respiratory therapy programs in Canada. For the list of available programs in Canada, I will refer you to the website of the Canadian Society of Respiratory Therapists: https://www.csrt.com/rt-profession/#education. The training usually involves two years of academic and simulation learning, and a final year of clinical placements.
Where can I get more information about respiratory care and respiratory therapists?
On the national side, visit the Canadian Society of Respiratory Therapists: www.CSRT.com.
On the provincial side visit the College of Respiratory Therapists of Ontario: www.CRTO.on.ca, and Respiratory Therapy Society of Ontario: www.RTSO.com.
On a personal RT perspective, there is my website: www.Respiratory.Blog . In my interviews with different respiratory therapists, I try to share different perspectives and insights. Here is one example: Mieke Fraser’s post at http://respiratory.blog/mieke/ (published on October 25, 2017).
Thanks for your interest in respiratory care and respiratory therapists! Share this with others who may find it helpful!
Stay safe. Frequently wash your hands. Practice social isolation.
Here is a PDF version of this post for ease of sharing:
Today is March 20th, 2020. The first day of spring. Happy Nowruz to all those who celebrate the new year. Iranians, among few other nations, have the first day of spring as their new year.
While new year celebrations involve visiting others and sharing delicious food, this year will be quiet. I hope it is quiet. Let’s continue the social isolation. Let’s continue to practice proper hand hygiene. Let’s self-isolate if you are feeling unwell. Let’s think about the vulnerable population and the elder members of the family.
My blog posts are usually meant for clinicians. This time, I am writing to every one, since dealing with COVID-19 is beyond the work of clinicians and healthcare system.
While you monitor your physical health, please don’t forget about your mental health. There are various electronic and video communication options that allow you to connect with others. Call the elderly to check-up on them. If you know someone in isolation, ask if they require groceries (being dropped behind their door).
Those who experienced SARS in 2003 may experience higher levels of anxiety around this time (especially clinicians). Make sure you connect with proper resources, support and intervention if required.
Give yourself mental breaks. Find a few trusted sources for news and COVID-19, and only review those. Constantly reading about it may induce increased anxiety. ( www.RTSO.ca is one of my trusted sources.)
Find appropriate stretches and exercises that can be safely done at home. Stay hydrated. Use this opportunity to stop smoking. Pick up that book that you always intended to read!
Don’t forget about the positive. Give gratitude for the good in your life. There are many great people who are doing their best to help out. A quick shout out to respiratory therapists and clinicians who continue to work to keep us healthy. Fatima Foster is creating a supportive online community for clinicians who are experiencing some anxiety around this time. John Meloche from Melotel Inc. is using the resources in his company to support communities and organizations who have non-for-profit COVID-19 support groups. There are many more examples if you look for them!
Our Pulmonary Function Lab has been closed for the past two days to reduce the risk of transmission to patients, especially the vulnerable populations. Things are changing daily, and there many unknowns. (To non-clinicians reading this, we do know proper hand hygiene and social distancing works!)
I have worked full time in a PFT setting over the past 5 years. With PFT lab closed, and a chance for deployment to other units, I need to do some reviewing!
The Essentials of Respiratory Care, Fourth Edition, by Robert M. Kacmarek, Steven Dimas and Craig W. Mach is one of my resources. This textbook was not actually a resource during my studying, however, it was a recommendation by one of the instructors (shout out to Paul Smith at The Michener Institute). Since I have not been trained in the acute care setting of my hospital, I don’t know about many of the protocols, selection of equipment and policies. I am still going to use this opportunity to review some respiratory care knowledge.
Do you have any up to date, open access and free resources to recommend?
I first heard of Mr. Gino De Pinto through other Respiratory Therapists (RTs) and indirectly through social media interactions. At the 2018 Vancouver Canadian Society of Respiratory Therapists (CSRT) conference, I had the opportunity to meet him in person. During the 2018 Respiratory Therapy Society of Ontario’s (RTSO) Leadership Summit, and through my discussions with him, I recognized his genuine care and passion for our field. When I spoke to one of his past students, he appreciated Gino’s evident care for students. His past and current students have commented on Gino’s direct and open communication, and his wiliness to stand by and for students in our field. I personally got to witness and appreciate his character as a fellow RTSO volunteer. He has brought enthusiasm to our board of directors and has re-energized our student engagement committee. I am happy to share my interview with Gino below.
Gino, thank you for taking the time to answer my questions. Let’s go to the beginning. How did you get involved with the field of respiratory therapy?
With the respiratory therapy profession having a low profile on television and in the media compared to the nursing, physician and paramedic fields, finding out about the profession was by accident. Going back to high school I enjoyed taking science courses and I was always fascinated with the cardio-respiratory system. My title for my final presentation for OAC Biology was “Exploring the World of the Blue Bloater and Pink Puffer”. A strong interest in science led me to the University of Waterloo where I received my Honours Degree in Science. During my final year at Waterloo, like many other RRTs I came to the realization that I needed to further my education if I wanted a career. Having both a brother and sister working in healthcare I started exploring opportunities. I applied to both the Medical Radiation Technology program and the Respiratory Therapy program at Fanshawe College. I was accepted into both programs. After going back and forth on a decision that would affect the rest of my life. I reached out to a family friend that was working as a RRT at the Timmins and District Hospital and I made arrangements to spend the day with a RRT to help with my decision. I spent the day with Susan Boisvert who showed me all the roles of the profession from PFTs to managing a patient on a ventilator. That was all I needed to make my decision and later that day I accepted my offer to Fanshawe College in the fall of 2000.
The graduating class of 2003 all faced the same challenge of entering a profession with much uncertainty. A few months from graduating, healthcare in Canada was dealing with the SARS crisis. As RRTs we were front line workers dealing with an infectious respiratory disease that people knew little about. Infection Control practices changed immensely since 2003. My students can testify how much emphasis I put on infection control practices during competency testing and I can trace that influence back to working in the aftermath of SARS. Since they were limiting visitors to hospitals during that time, I was offered a telephone interview for a temporary full-time job at Grand River Hospital. I was not able to set foot in the hospital but accepted the offer of employment as I thought it was a tremendous opportunity. During my time at Grand River Hospital I had some great mentors like Deb Bester and Jocelyn Hurst who helped mold my career. They set a high standard for patient care and for being accountable. Within a couple of years, I was able to take on a role as Resource Respiratory Therapist where I was able to learn how to create and maintain Policies and Procedures. I was a member of ICU council where I was able to use my voice as a RT to help with VAP protocols, help establish the RRTs role with the Critical Care Response Team and give my input into the design of the new ICU. This is where I could really see the importance of the interprofessional model that is so important with the patient-centered approach to medicine. After 16 years I continue to work at Grand River Hospital as a casual RRT. I have far less influence on the department as a casual but the position allows me to keep current with practice.
Thank you to Susan for introducing Gino to our field! Since graduation you have been involved with various roles, activities, and volunteering positions. Can you share with the readers some of your memorable roles so far?
I also had an opportunity to work at St. Mary’s General hospital on a
part-time basis for 4 years. Working at a cardiovascular hospital gave me a new
perspective on the profession. Working with great mentors like Danny Veniott
and Rob McGivern exposed me to how a great work ethic and positive attitude can
dramatically change a culture of a department. With their leadership the role
of the RT grew dramatically. Inserting of arterial lines became the norm, establishing
an Anesthesia Assistant program and a Weaning centre of excellence were just a
few highlights that I witnessed firsthand that influenced my career. Never
satisfied with the status quo of the profession are lessons that I learned from
my time at St. Mary’s. This is where I first met Lori Peppler-Beechey whose professionalism,
positive attitude and leadership skills were evident early. After working with
her for a years she resigned from St. Mary’s to start a new RT program at
Conestoga College. On one of her last shifts I told her if she ever needed
anyone to teach part-time to give me a ring. I thoroughly enjoyed being a
Preceptor for students at the bedside and thought this would be a great
opportunity. The phone rang a few months later and an opportunity to teach in
the lab presented itself.
Teaching part-time for the first 2 years of the program was stressful and
exhilarating. Going back to the textbook to refresh on content to ensure I was
teaching concepts appropriately was nerve racking but rewarding. Students came
with a tremendous passion to learn about respiratory therapy which made the
stress all worth while. After teaching part-time for 2 years there was an opportunity
to teach on a full-time basis with the focus of teaching and facilitating the
clinical year of the program. After finally having a regular full-time job at
St. Mary’s another difficult decision crossed my path. Do I leave a stable
full-time job for another full-time job at a College with a program that was
yet to be accredited? With the support of my wife, I made the decision to take
the job. The decision was made a bit easier knowing that I would be working
with great people like Lori Peppler-Beechey, Tim LePage, Kelly Hassal and Karl
Weiss. With this great team we were able to attain full program accreditation
During my first years of teaching at Conestoga College I am most proud of
the relationships formed with our clinical partners. Ensuring all stakeholders
had a voice in the education of RTs from Conestoga College positioned our
students for success and eventual employment. Helping establish and integrating
clinically immersive simulation into the program was another career highlight.
Working with a mentor like Karl Weiss on the design and implementation of
simulation into our curriculum was stressful and gratifying. Then being able to
present our findings at the 2013 CSRT conference in Niagara Falls allowed us to
showcase all our hard work. Another highlight was working with Karl Weiss on
developing our pediatric/neonatal hybrid rotation. With a bottleneck of
pediatric rotations shared with other college programs. We had to create a
clinical immersive simulation in combination with a traditional hospital
rotation to best prepare our students to meet those neonatal/pediatric competencies.
At that time, I was able to work with amazing subject matter experts like Gary
Tang, Ernie Matchett, Cathy Trocchi, Tami Tesseyman, Catherine Burke-Trembley and
Pam Hall. Collaboration was the key to success and their input and expertise
made for a great learning environment for the students and faculty.
Four years ago I transitioned from a full-time professor responsible for
the clinical year to a more traditional teaching position in the classroom.
During that time the program said good-bye to Lori Peppler-Beechey as she took
on new roles in leadership. Currently I have the pleasure of working with Pam
Hall who is now the program coordinator. Seeing the passion she has for
teaching her students is infectious. She is a tremendous leader, passionate for
the profession and a hard worker that has inspired me to be a better teacher in
In the context of a clinical setting, which area did you enjoy the most? Also, how can RTs be better clinicians?
I enjoy working in Critical Care the most. Learning about and applying new ventilator strategies is what makes our profession unique. Being at the bedside and looking back at the past 16 years of optimizing the patient while on the ventilator, I can look back and reflect on the trends. I have worked with mostly adults and seeing the adoption and implementation of ARDSnet, the use of APRV, HFO, prone ventilation, tracheal gas insufflation and the use of inhaled prostaglandin are just few examples of different strategies used to help patient’s breath. Being a patient advocate in my opinion is the best quality an RT can have. Being able to speak up and provide suggestions to help our patients is key. Recognizing that patients don’t all fit in the same box is the first step in ensuring your patient will receive the best possible care. Looking at waveforms, interpreting blood gases, looking at chest x-rays and providing evidence informed literature are all keys to making appropriate suggestions at the bedside. If you continue to advocate and look for solutions, you can sleep better at night knowing you tried all possible treatments to help your patient with their specific disease process.
Seems like the decision to become an instructor was not at random. Can you expand on that? Also, any advice for RTs who may want to get involved with this role?
As I mentioned earlier, I always enjoyed being a Preceptor to a student.
Being able to showcase your expertise and help students apply theory to patient
care was always rewarding. For those of you who are interested in teaching I
recommend that you respect the learner, this will ultimately create a positive
learning environment. Look for teaching opportunities within your organization
like becoming a BCLS or NRP instructor. Build your resume by going to
conferences and participate in webinars. When meeting educators express an
interest in teaching, gather their contact information and send them your
resume. When an opportunity presents itself be flexible and accountable. This
will help ensure you do not miss on future teaching opportunities.
What advice do you have for RTs and
preceptors to better assist students in their growth? What advice do you
have for students to maximize their learning and growth?
Having students can present challenges. Listening and reframing your
question will better assist a student with their growth as a professional. Do
your best to be patient and try to remember what is was like when you were a
student. Students come to the hospital or home care setting wanting to do their
best. If a student is struggling with a certain topic try to remember what
stage of the clinical rotation they are at. Is it their first day or have they
been in the rotation for a couple of weeks? Knowing this will help you determine
how to best guide your student. Do they need to see a procedure for the first
time or an additional time? Do they need to review pharmacology or
pathophysiology so they can best understand treatment modalities? Once you have the answers to these questions
you can determine the appropriate feedback that will stimulate connections to
theory and help them grow as a learner.
Advice I give to students to maximize their learning is to be flexible.
Having multiple Preceptors can add stress to a student’s learning and growth as
a practitioner. At this point in your educational journey you would have had
multiple teachers with different teaching philosophies and styles. Not all the
teachers would have resonated with your learning. The same can be said about
Preceptors, but as a student if you respect what they want to teach you and
appreciate the time they are taking to demonstrate a practical skill will help foster
a relationship. By building relationships and trust, preceptors are more likely
to invest in your learning. If a preceptor invests in your learning you will
maximize all learning opportunities that present themselves.
Your contributions to the field include
holding few past and present volunteering roles. Can you expand on that? Also, this is a good time for me to ask about
your involvement with RTSO.
When I was a student at Fanshawe College I had great teachers who all volunteered their time outside the classroom. Paul Williams, Dennis Hunter and Sandy Annett led by example and all were volunteering with different aspects of the profession. For myself, helping establish a new respiratory therapy program for the first 8 years of my teaching career was very busy. Now that the program successfully navigated through two accreditations and has graduated over 10 classes, I am able to find time to give back. Our program had developed great relations with CRTO and CSRT. The next step was to build a strong relationship with RTSO. I had the pleasure of meeting Dilshad Moosa at the CSRT conference in Vancouver a couple of years ago. This meeting led to an opportunity to gain a position as a Co-chair of the student affairs committee. Once in that role I was able to see the importance and need of connecting the Ontario Respiratory Therapy programs with the RTSO. The RTSO plays an important role providing a voice to the profession. Being able to connect with great leaders like Sue Jones, Sue Martin and Nancy Garvey have given me a great perspective on the profession and where it is going. Once in this position I was approached to be on the Board and was happy to take on this new role. Since taking on this role I have had the pleasure to work with the Ontario colleges to increase student membership and provide contributions to the RTSO Airwaves. At this point I am more than happy to give a shout out to Shawna MacDonald editor of RTSO Airwaves who continues to provide excellent resources for the RT community and remember if you are an RRT in Ontario #MembershipMatters. Being able to model leadership traits in the profession to my students will hopefully encourage them to be great leaders when they graduate.
It is interesting how we are positively influenced by the
great work of others. I was a student
when RTSO held an educational day at The Michener Institute. I volunteered and was very impressed by the
leadership and professionalism of its president at the time, Mr. Jeff
Dionne. I also enjoyed and looked
forward to Airwaves (thank you Shawna!).
The decision to join RTSO and volunteer with the organization was an
easy one. As I mentioned in the
introduction, I am impressed and appreciative of all of your contributions to
I am going to take a step back to talk about the bigger image of our field. How do you see our field changing over the next few years? Also, what changes do you hope to see?
The role of the community RT has changed dramatically over the past
decade. More patients are at home needing support with their oxygen needs,
tracheostomy care and home ventilation. The government has funding to support
theses new initiatives so hopefully we will see continued support from leaders
in our profession to take advantage of these opportunities and promote our
profession. I am hoping we can learn from our Paramedic friends who are now
offering their services to patients in the community. Community Paramedicine
(CP) programs provide opportunities for Paramedics to apply their training and
skills in the community outside of their traditional 911 emergency response
role. CP programs promote Paramedics to
work in collaboration with other health care professionals and community
agencies to connect patients with needed health and community services. These
connections assist patients to participate in their care, maintain independence
and promote involvement in their communities. I see a real opportunity for RTs
to take on a similar role in the community and I hope to see initiatives like
this trickle down into our profession.
Outside of work and volunteering, what do you enjoy doing?
I love spending time with my family.
I have a wonderful and supportive wife named Judit and 3 beautiful children who
keep me busy. I love basketball and I am a die-hard Raptors fan. From watching
Alvin Robertson drain the first points in franchise history at Skydome to
watching this magical run of the Raptors hoisting the Larry OB has been a dream
come true. Now I patiently wait for the release of the next season of Stranger
Before we end this interview, do you have any final words to
share with the readers?
Farzad, it has been a pleasure knowing and working with you
over the past couple of years. I am hoping the passion and dedication that you
have for the profession spreads through our wonderful community. I appreciate
your inclusiveness while advocating for the profession. Keep doing what you are
Thanks Gino. The credit really goes to all the wonderful RTs out there, like yourself, who perform quality work and push to raise the bar despite all the obstacles along the way. I have simply been lucky enough to share my journey of learning and discovery with my followers.
Once again, thank you Gino for sharing your insights with me and the followers. Also, thank you to the followers of this blog for taking the time to read this interview. Hope you enjoyed this interview as much as I did.
This post is put together by Farzad ‘Raffi’ Refahi and made available online by the support of John Meloche of the Melotel company.
Lynard Higoy is a Registered Respiratory Therapist (RRT) whose presentation I attended at the 2019 Canadian Society of Respiratory Therapists’ (CSRT) annual conference. He was energetic and passionate about the topics he presented. He works as a community RT, covering a vast area. His role greatly depends on interprofessional collaboration. I wanted to find out more about his work, and the work of independent or community RTs, so I connected with him over many emails. Thank you Lynard for sharing your perspective. Also, a big thank you to CSRT for exposing me to many amazing speakers at your conferences, such as Lynard.
Please join me as I interview Lynard:
I have a great interest in hearing about the spark or series of events that shape people’s decision to study respiratory therapy. How did you find out about the Respiratory Therapy field? Why did you choose to study RT?
It was pure accidental! I did not get in to the pharmacy program so I went to U of M’s school of Med Rehab open house. My original plan was to attend the open house for the physiotherapy program. Then I remember seeing different types of ventilators, Intubation kits, Jackson-reese and a pig lung. It was love at first sight and the rest was history.
You have been practicing for some time now. Can you share with us some of your memorable roles so far?
First one is when I was invited to be a speaker in the previous CSRT conference held in Niagara Falls. And also, when I was part of the Deer Lodge Centre Pulmonary Rehab Team In Winnipeg that won the 2014 Commitment to Care and Service Award, Collaborative Team Initiative.
I love the rural practice because you can spread your wings and maximize your scope of practice! Everyday is a different challenge! I may not be flying with STARS or part of the transport team, I may not be assisting with intubation in the trauma room but the acknowledgment and appreciation of my clients made me think that I’m a very valuable asset in the community. Since I’m the only respiratory therapist in Vegreville , Two Hills and Lamont employed by Alberta Health services, I have the feeling of accomplishment whenever doctors value my recommendation. The most memorable in my role as a community RT is when I was in doing some grocery shopping and my former pulmonary rehab client approached me with her daughter and told her “ This is the guy that helped me breathe better! Without him and his breathe easy program I won’t be here.” that is the most memorable moment for me so far as a community RT.
I think most of us go through the RT program thinking of the acute care aspect; Appreciating the immediate life and death decision making that can impact patients. With experience and exposure to patient care, we realize that there are multiple dimensions to patient care. Each role or setting is unique and vital to patient care. Seems like you have had the opportunity to experience and contribute to patient care in various settings. I have a quick question about the location. How did you end up covering Vegreville, Two Hills and Lamont ? Are you originally from that area or moved there for work? If you moved there for work, what contributed to that decision?
So I’m originally from Manitoba (U of M alumnus) and practiced there for 3 years. I followed my heart and moved to Alberta to be with back with my then girlfriend and now my Fiancée. It was a challenge to find a fulltime job in Edmonton especially as a community care RRT. I got a job offer in the private sector (Lakeland Respiratory) in Vegreville which is approximately 100 km east of Edmonton. The selling factor for this job was I’m going to run a pulmonary rehab in the town hospital so I said yes and took the offer. Then after 8 months my current position opened and I applied for it. I been in this position for 2 years now and liking it every single day. : )
Because of my current and previous work settings, I have had in person RT support within seconds to minutes away. Your experience has been different. Can you tell me about the planning, consideration, thinking framework, challenges and opportunities when working by yourself?
My piece of advice when you are in rural practice and working by yourself….. Don’t be scared to ask for help! I think this is when Inter professional collaboration comes in as a very important tool to be successful. I don’t work in my own silo anymore, I welcome ideas and expertise from other healthcare professionals such as OT, Physios, Exercise Specialist. Recreation, Social Work, Therapy assistants, Sleep Language Pathologists, Nurses and Admin assistants. At the end of the day, we all wanted one goal and that is to improve the well-being of our clients. My CSRT presentation “Screening for Dysphagia in COPD assessments” was a product of collaborating with our community SLP to reduce the rates of COPD exacerbations due to aspiration Pneumonia. The camaraderie of healthcare professionals working in rural areas are something that I admire, they are always there to help you all the time.
Also, working alone makes you realized how your research methodology course back when you were an undergrad is not to be discarded. Consider research journals as your friend if you have to work alone. If doctors asked me a respiratory question and I don’t know the answer, I’ll either contact my professional practice lead or search the Web for evidence-based practice research that can support my ideas.
Interprofessional efforts, communication, collaboration and trust are important part of patient care, as you have already mentioned. Was that the culture in place when you began working there, or was it something that had to be worked on?
The answer is both! The culture was in place before I started working here but just like every other worksite, you have to earn your keep. You have to prove that you are trustworthy, easygoing, that you value not only your job but the rest of the team and that you are not just there for the money but rather to always put your heart in what you do.
You mentioned articles and journals as one of your references. Do you have any favourite resources that you can share with us? Also, how do you support your growth? What’s your approach to continuing education? Beside teaching patients and their families, do you get the opportunity/train other healthcare providers?
Yes, The CJRT, Pubmed, Science direct, and others. I’m a big fan of everything as long as it came from a reliable source. I totally support professional growth and continuing education. I’m currently pursuing my post baccalaureate diploma in Leadership and Management through Athabasca University, Faculty of Business which is one of my prerequisites for the MBA program. If time permits, I attend workshops, read journals, webinars and seminars that will help me with my everyday practice.
Yes, because of the nature of my work since I’m the only Community RT in my rural area, I serve as a respiratory clinical resource and I cross train other healthcare disciplines with RT work such as oxygen therapy, emergency trach changes, lung volume recruitment strategies and many more.
What’s your approach to teaching students and staff? What advice you have for RTs to be better preceptors? Also…what advice do you have for students to maximize their opportunity to grow and learn? In your opinion, what are some qualities that makes one a quality RT?
My advice, don’t be a smart aleck! I’m a big advocate of transformational leadership in healthcare. In order for them to succeed, you have to motivate them, inspire them and let them grow away from judgment and intimidation. Also, being a role model for students in order to raise interest and understanding with the stream that you work. Allow them to know their strengths and weaknesses so they would be able to self-reflect on their performance. You know you did a good job if one day they came back and say.. Hey you’re my RT hero and I’m following your footsteps. A quality to say this RT is the best?? I would say……. Being able to look beyond self-interest to the common good.
What has attracted you to the Leadership and Management? What made you decide to pursue MBA?
Management is where I have wanted to be since I was an RT student. I know as a community RT I am helping respiratory clients with my respiratory expertise such as smoking cessation, pulmonary rehab etc., but I think I want to work and be a catalyst for change in the management/senior leadership level. In this level, I would be able to work upstream and be involved in health policies that can substantially improve not only the respiratory health of Canadians but rather the whole Canadian healthcare system.
How do you see the future of our field?
I want to see more RRTs stepping into management and senior leadership roles. I mean not just respiratory therapy managers but management roles that have been dominated by other healthcare professionals. With our RRT skills such as juggling multiple tasks, time management, grace under pressure and resiliency, I believe we would be successful in these roles.
Outside of work, what do you enjoy doing? What are your hobbies?
If I’m not at work, either you’ll see me at the gym or at the lake. I like working out pretty much every day. I love both fishing and ice fishing. I also love to explore the world with my fiancée.
Any final words?
Keep the Respiratory Therapy Passion burning!
Thank you Lynard for opening my eyes to more unique perspectives. Also, thank you for your dedication to our field and the interprofessional team that looks after the patients. By sharing your views and experiences, you have helped to further represent our field and the work of respiratory therapists across all the healthcare settings. Congratulations on your engagement and good luck with your studies. I expect that the RT community will hear more about your achievements in near future.
A special thank you to the followers of this blog. Thank you for supporting a stronger RT presence!
November 15th is the World Chronic Obstructive Lung Disease (COPD) Day. Based on a study by World Health Organization (WHO) in 2015, COPD is responsible for “5% of all death globally that year” (WHO. Nov 2016). When it comes to care for COPD patients, many names come to mind; One of these dedicated individuals is Mrs. Sheery Tse.
Sheery is an active RRT who works and volunteers with COPD patients at Markham-Stouffville Hospital and Scarborough and Rough Hospital (Birchmount site).
The first time I met Sheery was in May of 2017 at a social event for COPD patients, where she was facilitating it on her own time. She is passionate about her work and is full of energy. She is praised and respected by her patients and colleagues as she truly cares and advocates for her patients. To get to know her better, I sent Sheery few questions:
When did you first hear about the respiratory therapy field? What made you decide to become an RT? I heard about being an RT when I did some volunteering at HSC. There I ran into a high school mate who was working as a RT. After spending some time with her and the team, I decided to apply to Michener for the respiratory technology course as it was called many, many years ago.
What are some of your memorable jobs/roles so far? In an acute setting I was always more interested in helping patients in the ER, providing care so they may breathe easier and giving a quick education of their puffer needs was very rewarding.
Now I love doing education whether it’s in the COPD clinic or at a healthcare office, seeing the patients understand their airway disease and why certain puffers work and how is rewarding.
What are your career goals? (and do you feel that you have accomplished them?) Given my age and how many years I’ve been in their field, I feel I have accomplished most of what I set out to do. Starting the COPD clinics in Markham and Scarborough from scratch has been very rewarding.
There are still a few goals I would like to see happen, a support group with just patients input and more exercise sessions available would be the biggies. Patients self-management at home is another area I would to see happen too.
How did you get involved with patient education (with COPD patients)?When Dr. M. Forse first came up with the idea of having a clinic for COPD patients, it sounded like something I would enjoy. I applied and was chosen as the educator. Now came the challenge, getting certified as an educator and quite trained.
How does a typical day look like for you?
Don’t think there is ever a truly typical day. It could be as simple as setting up for the clinic with patients charts and assessing the patients to triaging all new referrals, returning phone calls and emails from patients to meeting with pharma reps to hear what’s new, studies and of course being the nosy educator what’s on the pipeline for puffers. In between that I also need to triage patients into the exercise programs we have and call to see if they are willing to come in and for afternoons or evenings. Tuesday’s, Wednesday’s and Thursdays, I try to go to the exercise classes to provide some support and answer any question the participants may have. I’ve been called the “spy” as I do inform the respirologists if there are concerns about the participants, including possible flare up and low sats. Through these interactions we have been able to prevent patients from being seen in ER when the respirologists could fax a script for them, or as simple as asking if they started their on-hold meds. Low sats often, if they are with ProResp, I could get a RT to come assess on the track, other vendors, I ask the patients to contact their 02 providers and ask to be reassessed and the respirologist is informed.
What are some of the challenges and joys of working with COPD patients?
Joys is seeing the patients in a follow up visit tell us how well they are doing, having the patients return from a trip they did not think they would be able to go on because of their airway disease, seeing how well they’re exercising. Challenges is trying to convince the patients they need to use their maintenance puffers regularly, and the same with those on 02. Most often, they are so used to being deconditioned and breathless, they’ve adapted to do without. Smokers are the biggest challenge, getting them to even think about quitting is often a huge step. Cutting back with each follow up is rewarding to hear, telling us they’ve actually quit is even more so.
Based on your experience, what are some of the common struggles for COPD patients, and how can RTs better assist these individuals?
The most common struggle, is self-management and deconditioning. They’re breathless so often they feel they can’t do much. Try is one of my favourite word to use at the clinic and at exercise classes. Knowing if and when they need to be seen is a biggie too. They really are independent and don’t want to bother their healthcare team and often end up getting worse and needing to be admitted. Providing tools for them to figure out if it’s a simple cold, a flare up or more is something all healthcare providers need to give so they may manage their disease better and hopefully not get to the point they become very ill.
What are your thoughts on the latest 2017 COPD Guidelines and New Medications in the market? *
New guidelines are constantly changing, latest is to decrease use of ISC with COPD patients unless they have at least one exacerbation a year to decrease the chance of getting pneumonia. When we first started the COPD clinic we had short acting puffers (Ventolin, Atrovent) ICS(Flovent) combo (Advair, Symbicort) and a LAAC(Spiriva) that just came on the market. Now we have choices, we can provide patients with the puffers they need in a device that is easier for them to use so compliance increases. There may be more I the future, good for the patients, more challenging for healthcare providers as we will need to know them, how they work and how to use them to provide better support for patients.
Any advice or final thoughts to share with RTs?
Final words, healthcare is an amazing profession, there are many different streams available, even for RTs from in hospital, to clinics, to home care. Patients safety and wellbeing should be the most important thought in our work. Giving patients respect, support and information should be on going.
The best review in the COPD clinic is when the patient comes in, and asks for a hug, calls you by your name and remembers what you said and did for them. At the end of the day, my hours spent volunteering means they get the support they need. From a simple support I have been given so much more I return from them. It is very rewarding, even in sadness when they pass. We have family call to let us know how much they appreciate all the support we gave to their loved ones.
Thank you Sheery for your dedication and hard work!
*To the readers of this post, please continue to refer to the guidelines and medication pathways provided by the facilities/organization you work at. The answers provided my Mrs. Tse is to provide perspective and is not to replace the protocols provided by your employer or RT governing body.
To share the views of an experienced RT for Respiratory Therapy Week, I reached out to Ms. Mieke Fraser. I first met Mieke when she was one of the supervising instructors for Ventilation Lab during my studies at The Michener Institute. I also ran into her at various professional development events including the latest Better Breathing and Canadian Network for Respiratory Care (CNRC) conferences. She is passionate, caring and an authentic RT. Her wisdom is built from years of experience, which includes but not limited to Mount Sinai Hospital and Bridgepoint Active Healthcare. She is also in the process of getting ready for her upcoming talk at the CNRC National Respiratory Care and Education Conference in Calgary. I asked Mieke what it means to her to be a respiratory therapist. This is what she shared with us:
I was working with an enthusiastic and engaging RT student yesterday that brought to front of mind what it means to me, to be an RT:
First, it’s the moment of connection with a patient and then if I’m lucky, the building of a therapeutic relationship with the patient and their family. We are fortunate to be able to treat patients across the health care system. I value being part of the team that helps patients with the most fundamental actions of life – their breathing.
Secondly, because I can make a human connection with them, and then help them with something as important as their breathing, I believe I can ease their suffering (maybe just a little or in some cases immensely).
We are a highly skilled and widely experienced profession. As a brief example: in a given week, I could be optimizing ventilation for a patient in ICU, helping to protect lungs from injury and allow healing, recovery, and growth in NICU; providing treatment in the ED for patient with acute exacerbation of their chronic respiratory disease; providing education and facilitating greater self-management to that patient with chronic respiratory disease; counselling a patient towards smoking cessation; and, helping facilitate a peaceful death.
And finally, as a RT with a few years of experience, I value being able to share my experiences, my approach, my wisdom, my perspective, my skills and knowledge to the next generation of RTs. Showing them how to assess a patient, to look at the details but also see the big picture, to make the differential list, to respectfully touch during assessment and treatments, to listen and connect with our patients, and so much more …
I am proud of the valuable role we have within a multi-disciplinary team, at times overshadowed by the larger-in-numbers presence of nursing and physicians. I would have to say that those individuals – the patients and families – with whom we make that moment of connection know we are different, and maybe just a little bit special, for we intimately assist them with the most precious piece of their life – their breath. For when you can’t breathe, nothing else matters.
Mieke Mieke Fraser, BSc RRT CRE
Thank you Mieke for taking the time to share your thoughts with us!