Articles


Articles by GNABC members

Contributor: Erin Bampton RN, MN

Erin is a member of the Simon Fraser GNABC Chapter. Erin recently published her thesis work in two journals: Canadian Journal of Public Health and the Elsevier Preventive Medicine Reports

Congratulations Erin!

Canadian Journal of Public Health 2016 ErinBampton

Preventive Medicine Reports article ErinBampton2015

All current GNABC members are welcome to contribute literature to be posted on this website.

Examples of literature would include articles, viewpoints, letters, book reviews, anecdotes, or images.

Please send contributions to Cathy Farrow, GNABC Media Chair via email.


Veterans Affairs Canada

Submitted by Lorrie Brown, R.N., BSN, MA, District Nursing Officer, British Columbia Interior District, Veterans Affairs Canada

Members of the Royal Canadian Legion salute the cenotaph after laying their wreaths on Remembrance Day 2009 at Canadian Forces Base Esquimalt. Photo courtesy of Department of National Defence.

Veterans Affairs Canada (VAC) is a department of the Government of Canada which exists to repay the nation’s debt of gratitude to those whose courageous efforts have given us a legacy of peace and freedom, and have contributed to our growth as a nation.

VAC provides services to a highly diverse clientele which reflects the remarkable breadth of Canada’s contributions to world peace. Our clients include Veterans of both World Wars and the Korean War, along with modern Veterans and our allies. We also serve certain civilians who are entitled to benefits because of their wartime services, released RCMP members with service-related injuries, and survivors and dependants of these groups.

In addition to serving these clients, VAC receives many inquiries from members of the public and supports remembrance activities like parades, wreath ceremonies, and the construction and maintenance of monuments.

Information on eligibility, programs, services and activities is available by calling our toll-free National Contact Centre Network (NCCN) 1-866-522-2122.

District Nursing Officers
The role of the District Nursing Officer (DNO) is multifaceted, providing nursing consultation services to client service teams and outside agencies. The DNO provides nursing and advisory services on health benefits to clients, conducts and reviews nursing assessments, and adjudicates designated health care benefits and services. The DNO works closely with an interdisciplinary team of case managers, client service agents, physicians, and mental health and rehabilitation consultants.

In British Columbia, Veterans Affairs has three District Offices with centres in Penticton, Kelowna, Vancouver and Victoria. The local DNO for the British Columbia Interior District provides coverage to the interior of British Columbia between the U.S. & Alberta borders.

VAC Services and Benefits available to eligible Veterans:

Case management services are available for Veterans and their families who are coping with a serious injury, career transition or the loss of a loved one and may need assistance in this period of transition.

Disability Award is tax-free compensation for the noneconomic impacts, such as pain and suffering, of a servicerelated illness or injury. It is independent of rank and duration of service and is not linked to other New Veterans Charter payments. Disability Pensions are another form of financial compensation. Veterans (or family members) may be eligible if they served in the First World War, Second World War, Korean War, or the RCMP. Modern Veterans who applied prior to the introduction of the New Veterans Charter in 2006 were also eligible under the pension system.

The Financial Benefits program can help compensate for the economic impact of a service-related injury on Veterans or their families, like the loss of the Veteran’s salary due to a service-related injury or illness.

Funeral, burial and grave-marking assistance provides and maintains grave markers and offers financial assistance to Veterans’ estates where the Veteran died as a result of a service-related disability or where there are insufficient funds to provide the Veteran a dignified funeral and burial.

The Health Care Benefits Program offers a wide range of health care benefits and services to eligible Veterans. These include, but are not limited to, ambulance services; hearing, dental, medical, and hospital services; medical supplies; and vision care.

Services are also available for eligible Veterans, Canadian Forces members, and RCMP members living with a mental health condition.

Our rehabilitation program assists Veterans who have medically released or have a rehabilitation need that is primarily related to military service. VAC can provide the support needed to transition from the military to civilian life.

For eligible clients, residential care contributes to the cost of long-term care for injured, disabled, and aging Veterans residing in contract and provincially funded residential care beds.

Through surviving dependent benefits, when a disability pensioner dies, their survivor will continue to receive the same pension for a period of one year. After this period a survivor’s pension will be automatically paid.

The Veterans Independence Program is a national home care program to help eligible clients remain healthy and independent in their own homes or communities. The program offers a variety of services to eligible clients based on individual circumstances and health needs. All services under this program must be pre-authorized by VAC. The services may include grounds maintenance, housekeeping, personal care, home adaptations, access to nutrition, and transportation.

The War Veterans Allowance provides financial assistance for eligible low-income Veterans of the Second World War and/or the Korean War.

For further information please visit our website: www.veterans.gc.ca or call 1-866-522-2122. Reference: www.veterans.gc.ca


The Benefits of the Electronic Health Record for Older Adults across the Continuum of Care: Is the Computer Friend or Foe?

Submitted by Catrin Brodie, RN, MN, GNC(C)

This article is based from a previous article written for publication in the Journal of Gerontological Nursing.

The patient electronic health record (EHR) is a computerized document that includes all of a person’s health information. In the past, this information, was held by many different health care workers in paper files and may not have included all of the necessary information or health details. The EHR provides great benefits to the complex care needs of the older adult who are either in the hospital, in residential care or living in the community, because it contains all of the necessary information the doctors and nurses need to make the best decisions for their patient.

The greying of the population will have an incredible impact on the health care system and their caregivers, especially on Vancouver Island where about 9.0% of people are 75 years old or older, compared to 6.9% for the province of British Columbia. Did you know that roughly 2.7% of the population is aged 85 and over, compared to 2.0% for the Province? In addition to a growing population of seniors, baby boomers, currently between the ages of 43 and 62, make up approximately 31% of the population. Did you know that by 2010, the first wave of baby boomers will be nearing 65, and as they age, this will put more pressure on nearly every area of our health care system?

Background
Currently on Vancouver Island the patient records, documentation and information are either in a paper format stored in different locations, such as hospitals, home care offices, residential care facilities, physician’s offices, or via the electronic heath record or both. This paper system being held by many different health care providers and in many different locations is not a good system. It increases the chance of risks for seniors, such as repeating the same test, and medication errors due to more than one doctor ordering different medications and because of their complex health needs. Therefore, in 2008, the Vancouver Island Health Authority (VIHA) started to use the EHR to decrease the amount of paper and to make the patient information accessible to the responsible health care providers. The most important reason to make this change is due to the aging population, the increasing need to provide care to the frail elderly, a rising burden of illness from chronic diseases, and advances in technology and pharmaceuticals that are enabling new procedures and treatments. The EHR can therefore improve patient safety by having as much up to date clinical information “at the fingertips” or “point of care” as possible to assist in care delivery decision making.

History of the EHR
The first reports of computers being used in nursing care began to appear in literature in the 1970s. The use of the personal computer in the 1980s would allow for the “capture” of the nurse’s notes and patient care plans. The introduction of the Internet and web-based applications in the 1990s, enabled communication across distances and made it possible to transfer health information. In some areas computers became smaller and nurses could take them to the bedside or homes as laptops or personal data assistants (PDAs). The nurse could begin to access the patient information at the bedside, rather than returning to the nurse’s station. In 2000, an increased importance was placed on computerized information to help with decision making, quality improvement and research. The EHR is a tool which will increase efficiency, information gathering and research, and improve patient safety and patient health outcomes.

The Health Authority has begun to create an EHR for every person on Vancouver Island providing 24/7, online access to patient records and information in the hospital and remotely at home or from the doctor’s office. This allows for the best care for patients because now their doctors, nurses, hospitals and community services can share information across the information highway.

Benefits
Using the EHR can improve population health in the following ways. It allows the caregivers access to xrays, laboratory results, and medication information right at the time they need it; therefore, assisting to speed up the time to make their decisions. Other benefits are the ability to write doctor’s orders, communication, care planning and clinical notes, faster referrals between doctors, fewer delays ordering tests and getting results, and fewer reporting errors. There are often many different people involved in their care and they need to have all the information and the ability to communicate this information between each other. Many older adults have long term care case managers, home care nursing, a general doctor or specialists that are all involved in their life and health care decisions. The increasing numbers of the aging population of Vancouver Island, their increased care needs and complexities, is a significant reason why the EHR should be used.

Consent and Confidentiality
A patient entering the health care system will be providing “presumed consent” for their information becoming part of the EHR. This means that they may not give their consent in writing but the health authority will presume that if they are in the hospital for treatment that they are aware all of the care team has access to their information. However, there are processes in place to protect the privacy and confidentiality of the patient. To protect data there are restricted login passwords, digital signatures and special coding. As well as policies, the staff are expected to follow that only the health care worker that is directly responsible for that patient can access their information. There is password protection and coded patient identifiers to help protect patient confidentiality, and the software automatically locks a device after a period of inactivity.

Conclusion
Simpson stated in 2001 that, “by 2011, computers will learn and reason better than humans. By 2012, they’ll memorize, recognize, and learn in a human fashion. By 2013, health care professionals will view them as colleagues rather than tools. Health care will finally grasp the gold ring of precision as computers eliminate the guesswork, eradicate the deadly errors, and usher in the age of accuracy” (Simpson, 2001, p.14). Do you agree that the prediction for 2011 has come true? Over time, every British Columbian will have a personal EHR, which will be a secure and private lifetime record of their key health history and care within the health system and this record will be available electronically to their health professionals to support high-quality care.


Age Related Anorexia: Do Current Dietary & Nursing Interventions Do More Harm Than Good?

Submitted by Susan Madlung, RN, BScN, GNC(C) and Dr. Munider “Bobby” Nijjar, RD

Anorexia related to normal aging processes is a result of various anatomical, chemosensory, and biochemical changes that occur as our bodies’ age (Morely, 1997). Age related anorexia is a widespread concern in care homes and residential care institutions. Residents experiencing anorexia often require significantly more clinical time from care team members than other residents.

Current dietary and nursing practices in geriatrics attempt to address anorexia, as well virtual reality headset as the resultant weight loss and malnutrition, of the institutionalized older adult. However, these practices have proven to be ineffective on the whole. The study engaged in, argues that traditional dietary and nursing practices typically implemented to address anorexia may actually antagonize the natural preexistent condition, often resulting in social isolation and food and meal time aversions which further contribute to anorexia with resultant malnutrition and weight loss.

The purpose of this project was to introduce new practices based on a review of scholarly literature sbiancamento denti in the area of anorexia of aging. These innovative approaches to the management of anorexia can maintain or improve the nutritional status of older adults presenting with the signs and symptoms of age related anorexia. Several recommendations emerged from the literature reviews that have proven to be effective in minimizing the immediate impact of anorexia of aging.

In the initial case study, we found that implementing these recommendations significantly increased the appetite and wellbeing of the resident. Tolerance, duration and frequency of strengthening exercises increased significantly. After the 3 month study, the case subject appeared happier, more active and more content. A chronic wound (> 1 year) rapidly healed.

The findings of this literature review and subsequent recommendations are the beginning of a dialogue about how to best review and revise dietary and nursing practices in residential care settings to improve the effectiveness of managing age related anorexia.

In November, 2010, Bobby and Susan were invited to present the results of their literature research and case study at the American Dietetics Association Conference & Expo in Boston, Mass. Their work was well received with an audience of more than 500. They continue their research with a larger study underway in a long term care facility in West Vancouver, B.C. In this study they will also examine time factors related to the administration of the recommended interventions over current practices.

They can be contacted for further information at bobbynijjar@hotmail.com or susan.madlung@vch.ca and are available for consultations.