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University of TorontoVº.2/Nº.2Back tothe futureNow more than ever,community health nursesare needed to builda healthy future for allCanadiansLawrence S. Bloomberg Faculty of Nursing155 College Street, Suite 130 Toronto, Ontario, Canada m5t 1p8Publication Mailing Agreement Number 40739532

6 Lawrence S. Bloomberg Faculty of NursingIllusration: Gracia Lam

CountdownThe world has been talking about communityhealth for years. It’s time to act—and forgovernments to listenBy Dean Sioban Nelson, RN, PhDFlorence Nightingale once described hospitals as only an ‘intermediatestage of civilization’, believing health was something that arose froma healthy environment. While the world’s most famous nurse is bestknown for her work at the Crimean War and the establishment of thetraining school for nurses at St. Thomas’s Hospital, London, her greatestpassion was for public health. As a statistician and pioneer healthscience researcher, Nightingale’s monumental report that followed thewar not only showed that more soldiers died of disease than as a resultof enemy action, but that in peacetime a soldier’s mortality rate washigh compared to that of civilians due to the poor sanitation of militarybarracks. This report led to major reforms in military housing as wellas hospital design.Less well known was Nightingale’s longstanding interest in India andher campaign to have the colonial government make the provision ofclean water its major priority. Cholera originated in the Ganges Deltaof India and is spread by contaminated water and food, and poorenvironmental management. Over the course of the 19th century,cholera killed millions of people in successive waves of epidemics acrossEurope, North America, Africa, Asia and, of course, India. According tothe World Health Organization, cholera is once again on the rise andhas re-emerged as ‘a global threat to public health and one of the keyindicators of social development’ Nightingale’s plan for clean water forIndia lost out to commercial interests and the development of the Indianrailroad. If she had succeeded, perhaps cholera would be a disease ofthe past and at least one of the WHO’s millennium goals would havebeen achieved.In 19th century North America, crowded cities, poverty and infectiousdisease created enormous public health challenges which were takenup by remarkable women, such as nurse Lillian Wald, of the famedHenry Street Settlement in New York, which was founded in 1893 towork among the immigrant poor of the Lower East Side of Manhattan.Long before the concept of social determinants of health was coined,these nurses were driven by political idealism and commitment tojustice to address the appalling health of immigrants, providing directcare to families, education on hygiene and nutrition, and eventuallyexpanding to a whole range of other services.Thus, by the time the catastrophic influenza of 1918-19 cut itsswathe across the globe, in the UK and North America, there had beensomething of a 50-year tradition of what was to become known aspublic health nursing and community care. In the days before it waspossible to manage common medical conditions, or to treat infections,it was recognized that what the system needed was an army of highlytrained nurses to ensure the health of mothers and babies, to educatefamilies, to work within schools to ensure healthy fit citizens for thefuture and to prevent the spread of infectious disease. This was the newpublic health nursing and in 1920 the nursing school at the Universityof Toronto, under the name Department of Public Health Nursing, wasestablished to serve that end.The sense of vulnerability to infectious disease that had been a simplefact of the human condition since the rise of agriculture actually beganto wane in affluent countries during the 20th century, as immunizationsbecame widespread and the management of acute conditionsbecame increasingly effective. But of course that was merely an illusion.Tuberculosis, once the blight of the world and so effectively remediedwith the development of streptomycin in 1943 and prevented throughimmunization programs, is back today and rising around the world,with multiple resistant strains causing near hysteria among quarantineagencies and the media. New diseases have emerged, such as AIDS, whileother known diseases, such as influenza, have continued to mutateand cause widespread concern (H5N1 and H1N1). The category ofinfluenza-like illness (ILI) is now the new risk. Interestingly this currentissue that is occupying so much policy and media time illustrates wellhow far the circle has come. We are approaching H1N1 the way weapproached many illnesses in the 19th century, when there was uncertainaetiology and/or few effective interventions. Then and now thebest approach is supportive measures based on principles of infectiousdisease management. In other words: wash your hands, stay home ifill, keep well hydrated.It is hard not to be struck by the ‘back to the future’ element to contemporarydiscussions about public and community health. The returnof the sceptre of infectious disease is only one such ghost of the past thatwe now realize our health-care systems ignored at our collective peril.Twentieth century hubris about the progress of medical science solvingsociety’s health problems has also led to the almost absurd situationthat today, with our relative wealth, high levels of education and accessto virtually limitless information, we are sick and getting sicker from‘life-style’ diseases. Fast food and processed food of low nutritional value,inactivity and smoking are taking a disastrous toll on our collectivehealth, and, most concerning, that of our children. Tragically, around theworld, these health problems come hand in hand with economic growthand social development, burdening so many countries with diseases ofboth poverty and wealth.It is sobering to think that the problems of western diseases that wenow face were predicted decades ago – and solutions proposed. In 1978,the WHO proposed in the Alma Ata meeting that health for all could onlybe achieved through the establishment of a vigorous primary health-carenetwork to serve and work with communities, identifying their needsand working with inter-professional teams to collaboratively createcustom-made, effective strategies to prevent disease and promote health.Later, in 1986, the Ottawa Charter of Health Promotion pointed towardsinter-sectoral collaboration, healthy public policy and communitydevelopment, among other strategies, to produce health for all. CanadianLawrence S. Bloomberg Faculty of Nursing 7

nurse academics have been teaching and researching about such ideassince their inception and those in practice have been working to achievethe ideal of health for all.More recently, innovative approaches to primary health care and publichealth services are being acknowledged by governments in Canada andelsewhere as the way forward (even if those words are at times not beingsupported by resources).But despite its great virtues, the contemporaryprimary health-care team model is still about individuals gettingthemselves to a clinic to see a physician or a nurse practitioner, at least inthe first instance. Homecare services are stretched with high volumes ofvulnerable clients with complex care needs. Program specific publichealth services continue to stretch thinner and thinner across our communitiesserving target audiences. How many ordinary citizens dopublic health nurses reach today? How do any of these services even beginto address the social determinants of health, the root cause of so muchill health?pressures on the acute system. Around the world—and Canada iscertainly no exception—first and foremost the solution relies uponredirecting resources from individual clinicians (be they physicians,nurse practitioners or other fee-for-service providers) and placing ourdollars in programs and salaries. One would think that in a publiclyfunded health-care system this would not be such a tough call, but itis. However challenging the politics of health care is on this matter,the fact remains primary health-care in its broadest sense is not simplya case of having more individual providers, or even teams of them. It isabout meeting people where they are, and working with communitiesand schools and grassroots organizations to promote health whereit is produced: in people’s everyday lives, outside of a decreed clinicalconsult time. Only by fully grasping this issue, and its implicationsfor the way our systems are organized, can we ever hope to dissipate thetsunami of acute-on-chronic disease that is heading our way as babyboomers age.Only by fully grasping this issue, and its implicationsfor the way our systems are organized, can we everhope to dissipate the tsunami of acute-on-chronicdisease that is heading our way as baby boomers ageThere is no question we need to continue to work to cure disease and tomore effectively manage those who are suffering from the consequences ofdisease or injury in the acute-care sector, long-term care or in the home.Nurses, along with colleagues across the health sciences, play a vital rolein this ongoing story. But as the health-care professionals who spend themost time with patients and families and who work in communitiesand in people’s homes, the real asset that nurses bring to the health-caresystem (and society) is the opportunity to prevent illness, to supportindividuals, groups and communities to engage in healthier practices,to advocate on their behalf when needed, and to establish partnershipswith the population to share knowledge and encouragement to improvehealth and people’s quality of life. And despite a great many efforts onbehalf of dedicated health professionals and service providers, in ourhearts we all know that it is farfetched to think that effective educationand support for behaviour change can take place while an individualis stressed, unwell and disconnected from her/his family or communityduring an acute episode, or during the pressured encounter of a clinicappointment or home visit.If we all agree on the vision then, in the end, change is about commitmentand resources. Transferring health-care dollars to the areaswhere they are needed to improve health, prevent the developmentof chronic disease, to guard against infectious disease and create communitieswith fewer accidents and injuries is easy to declare buthard to operationalize. We are caught in a trap of responding to urgentcurrent needs, instead of creating a system that leads to decreasing theCommunity health-care costs are minor compared to those of theacute care sector. Nonetheless the acute sector has the gravitationalpull of Jupiter on our health-care solar system dollar, and whenever thesqueeze is on it is the non-urgent sector that, to our peril, keeps getting cut.Cuts to prevention services tend not to end up on the front page of theGlobe and Mail for creating a disaster overnight. But disasters are certainlycreated in the long term. Our current ‘obesity epidemic’ was decades inthe making.Canada has much to be proud of: Alma Ata and the Ottawa Charterled the world in defining the true goals for health, and in recognizingthat the critical ‘system’ in question is not the health-care system butsociety as a whole. There is no debate that poverty, inequitable access toeducation, unemployment and lack of services (such as health services)create the conditions for disease. Florence Nightingale would certainlyhave agreed with that observation. Today, as our leaders debate the‘sustainability’ of our health-care system, Canadians need to be remindedof what community health nurses have long known: the promotionof health is the only way to build a sustainable future.One wit described the current health-care funding model as buyingmore mops to fix an overflowing sink. Well, we are up to our waists inwater these days, with an acute care sector stretched to capacity and floodwaters gathering upstream. We are beyond mops now.We know the answer is to keep people well. This century we just haveto mean it when we say it.8 Lawrence S. Bloomberg Faculty of Nursing

The invisiblesector: publichealth nursingA look at four Bloomberg Faculty ofNursing alumnae who are making theworld a safer placeStories by Lucianna CiccocioppoThe forgotten neighbourhoodsFamilies.” In 2007, Toronto Public Health embarked on a one-year pilotinitiative led by Toronto Social Services, which also included Parks,Forestry and Recreation and Children Services. It focused on a smallbut high-priority area of the city—the neighbourhoods of Jane andFinch— and specifically on sole support parents on social assistancewith children 6-17 years of age.Each department worked together to cut red tape and service thefamilies better. That meant a social services case worker accompanyinga public health nurse in a home visit, instead of a single mother tryingto head out to meet these people on separate appointments.The departments each learned what the other had to offer, or couldn’toffer, says Liddy, and were able to work together more effectively inreferring appropriate services.“Working with public health nurses, Toronto Social Services sawfirst-hand the number of families that were in distress, and that werestruggling with mental health and social issues,” says Liddy. “Manycaregivers were also living with pain on a daily basis, due to some otherhealth issue.”It gave the case worker a better understanding of what families weredealing with, she says, and why some couldn’t get back on their feet.It provided the holistic assessment that was needed to help familiesbecome more self-reliant.“As nurses, we worked intensely to link them to services, to find outwhat their needs were, and to connect them,” says Liddy. “We brokedown silos, and worked through the red tape. We really had to reachout to these families, but meeting the nurse, and seeing the supportfrom the other departments, made all the difference for them.”The award-winning program – it landed a 2008 Award of Merit at thePublic Sector Quality Fair—was extended, says Liddy with excitement,and is now expanding to different parts of Toronto.Want to change the world? Call a nurseAnn LiddyPhotograph: William CiccocioppoPublic health nursing is the care that goes on behind the scenes as theworld whizzes by. It’s the linking to other services and advocacy forchange that so many people, from so many walks of life, rely on. It’s thestaring down of the social determinants of health that has a hold onour communities.And yet, it’s the last stop of the health-care funding train, says AnnLiddy, BScN 9T9.“Everybody focuses on emergency responsiveness, not on pro-activecare,” says the acting manager for the healthy families program atToronto Public Health. “If all the funding is put into ‘fighting fires,’there’s very little left over for preventing them.”She’d like to see more support for initiatives such as “Investing inDr. Angela Cooper BrathwaiteLawrence S. Bloomberg Faculty of Nursing 9

adolescent group of moms had changed,” says Nelson.Training sessions at the clinic now include information from Nelson’sstudy, and health-care providers are encouraged to ask questionsabout the father’s role. More discussions lead to more connections, asreferrals to maternal and baby care and other public health nurses areincreasingly made for this group.There are similar stories on this side of the border as well, says RiffaatMamdami, BScN 9T9, a health promotions consultant at Toronto“Calling him up andsaying ‘Come onover, let’s chill’ wascode for sex.”Public Health, who has worked with teen moms in her nursing career.“There was this desire for some semblance of a normal family life,” saysMamdani, “at the risk of emotional or even sexual abuse.” Mamdamiis currently pursuing her master’s in community nursing at theBloomberg Faculty of Nursing and says these findings can be useful tohelp create practice guidelines for maternal health programs.Nelson wants to engage these fathers in the health care of thesechildren from the very beginning of pregnancy, in prenatal programs,not after the baby is born. “I don’t think we do a good job of involvingfathers. Many of these programs are very focused on baby and mother.But after the birth, when the teen mom shows up in the sexual healthclinic worried about an STI, we’ve missed nine months of havinghim engaged. And sex is now the leverage.”Glossary of Sexual Partner-Type TermsHubby: is a partner, usually a boyfriend, who holds marital-likestatus. The adolescent mother perceives that she and this partnerare in a life-long, committed, romantic relationship.Baby Daddy/Baby Father: is defined by the Oxford Englishdictionary as “the father of a woman’s child, who is not her husband,or (in most cases) her current or exclusive partner.” Adolescentgirls’ use of this term suggests biological paternity, while noting alack of parental involvement.Boyfriend: is a partner with whom the adolescent girl hasestablished a romantic, committed relationship, one that does not,however, carry the same sense of permanency as “hubby.”Friend with benefits: is a friendship in which occurrences of sexualactivity are allowable and accepted within the bounds of the relationship.This partner-type often does “favours” for the adolescentgirl, based on her needs, not as one-for-one transactions.Boo: is a sexual partner for whom an adolescent girl has a lingeringromantic attraction, and also possesses friendship-like qualities.Friend/Homeboy: is a friendship in which occurrences of sexualactivity are allowable and accepted within the bounds of therelationship. There is no lingering romantic affinity.Shorty/Booty Call: is a partner contacted for the sole purpose ofon-demand sexual encounters, which can occur any time of day, butare often arranged to take place in the late evening.One-Night Stand: is a partner in a short-term, sexual encounterwhere no previous relationship existed or is expected.Pop (pop-off): is a partner with an extraordinarily dense networkof sexual partners, simultaneously reviled for their indiscriminatecopulative patterns, and revered for their sexual prowess.Source: “Influence of sexual partner-type on condom use decision making by Blackadolescent mothers.” National Institute of Nursing Research, Study #F31NR008964Lawrence S. Bloomberg Faculty of Nursing 13

14 Lawrence S. Bloomberg Faculty of NursingIllusration: Marco Cibola

Community careconundrumNow more than ever, community healthnurses are needed to build healthier lives for allCanadians. But it’s not as simple as it soundsBy Lucianna CiccocioppoA commercial office cleaner gets up every day and follows the sameroutine before heading to work: she apologizes to her body for theself-harm she is about to commit at her job. She maintains a physicallydemanding workload, holding down two jobs, without proper masks,gloves and equipment to handle toxic chemical cleaners, and withoutappropriate tools to reach and clean far-away places, such as ceilings.The pain in her shoulders is dulled by the fact her family back homeis living a better life, thanks to her. In fact, many people abroad, mostlyin developing countries, are living better lives thanks to the workfamily members are doing in Canada, work most Canadians refuse todo: in the construction, cleaning and hospitality venues.Governments at all levels in Canada turn a blind eye to theseworkers, the undocumented workers, says Dr. Denise Gastaldo, halfa million of them who are critical to Canadian society, but live inthe shadows of getting caught. “They usually over-stay their visas, sothey’re called illegal workers,” says Gastaldo, an associate professorat Bloomberg Nursing. “They’re a hidden population about which weknow so little. And yet we have international data that says this workhas a huge impact on their health.” It’s a serious problem in Canada,as undocumented workers are the fastest growing form of migrationworldwide, says Gastaldo.“We know there are mental health consequences of being sociallyisolated, but there are also physical health consequences because ofthe precarious nature of their work.” This population is living undersocial exclusion—self-imposed and imposed by society— fearing thatknock on the door that will ship them home. There are few initiativesor programs that include them, she explains.There are addiction issues among men, depression for women. Theseillnesses remain largely untreated, until their condition nosedivesinto severity “when it’s too late,” Gastaldo says. “There’s a lot of humansuffering caused by this economic situation.”Groups in Ontario, such as the Ontario Council of Agencies ServingImmigrants (OCASI) and No One is Illegal have been asking governmentsfor a moratorium, to give work permits to this population. “These groupsneed information to advocate, but it’s a catch 22—undocumented workerslive in hiding because they fear for their jobs, but we don’t have thedata, so we cannot advocate on their behalf,” says Gastaldo.Gastaldo studies this phenomenon, in cutting-edge research fundedby the Canadian Institutes of Health Research to help advocate for thispopulation. Community centres servicing this population are pressingfor this data as well. Her work with the Women’s College Network forthe Uninsured in Ontario revealed service providers in the communityfor undocumented workers have a huge burden because they lack theresources and money to help such groups.Studies show health-care service providers who work with veryvulnerable populations, such as undocumented workers, have amagnified workload that’s hidden in the health-care system. “Becauseundocumented workers have very little access to health care, theycome to a nurse at the very end of a problem. These cases are morecomplex and time-consuming for nurses.”Gastaldo speaks passionately about her work. The Brazilian hasimmigrated several times during her academic career, and knows thefeelings of displacement and starting over. What she doesn’t knowpersonally, but has seen up close, are the fears.“They’re so vulnerable and apprehensive when they have to negotiateor request anything. With no medical coverage, they only seek servicesfrom particular community centres that serve uninsured people, butthese are very few,” says Gastaldo. She explains that a wait of severalmonths just to get an appointment is the norm even when people arevery sick, and can’t get over- the- counter symptom treatments froma pharmacist. They may end up in a hospital emergency centre, andnegotiate the bill later, all the while worrying about being deported.“Health should be considered a human right for those who live inOntario,” says Gastaldo. “We need a strategy for continuity of care.We need primary health care to develop community health, promotehealth, prevent and treat disease at the community level. We need anetwork of community agencies working together towards this goal.”Last spring, Corey Liston, BScN 0T9 was the first Bloomberg Nursingstudent to conduct her placement at the Don Jail in Toronto. She caredfor clients afflicted with schizophrenia, schizoaffective disorder ordepression. Together with her preceptor, she would see who was transferredin, required assessments and administered medications. Shespoke to the clients before they saw their psychiatrist that day.“I thought this sounded like such a completely different environment,and I would learn about so many different things,” says Liston.“The mental health aspect intrigued me as well.”She was alwaysinterested in community nursing when she started her undergraduatedegree at Bloomberg Faculty of Nursing, and says she was surprisedat how hospital-based the program is. “It feels drilled into you that thehospital is the place to be,” says Liston.All Bloomberg Nursing students have 320 placement hours in thecommunity before they graduate, says senior lecturer, Dr. Geraldine(Jody) Macdonald, BScN 7T4. “It’s more hours than the Canadianaverage.” As former chair of a community health curriculum subcommittee,she’s working on introducing community nursing coursesearlier in the program. “We need to be thinking about a broader scopeLawrence S. Bloomberg Faculty of Nursing 15

“If you’re looking at the acuityof care in the community, there’svirtually nothing short oftransplant surgery that isn’thappening in the community.”of practice, so when students graduate, they have a vision of themselvespractising in either community or acute care settings,” says Macdonald.The situation today, however, sees most students opt for the hightech,fast-paced world of the hospital nurse, says Liston. “We feel wedon’t have the assessment skills or knowledge to be on our own, likeyou would be as a community or visiting nurse. So starting off in ahospital is a good way to get more nursing experience, and gain moreconfidence, before going out in a more independent position.”The problem, says Macdonald, is students don’t know what communitynursing is. “Many courses that include community contentcurrently are not labeled ‘community’, so students think it’s care ofthe elderly or young families. Today’s nursing students grow upwatching TV shows such as ‘ER’, so that’s what they think nursing is.And the community aspect doesn’t hold that awe for a technologicaland adrenalin rush you get from working in the emergency department,”she adds. “Many of our students would graduate without everhaving done a home visit.”Nursing schools have difficulties in accessing community placementsfor students. And the competition mode of Community CareAccess Centres, agencies funded by the Ontario health ministry toprovide a range of services for the public, has forced providers to bidon contracts, and push costs down by hiring part-time visiting nursingstaff and offering lower pay. The last thing a busy visiting nurse maywant to do is take on a student, to add to the workload, or take on theliability, if the student rides in the same car, explains Macdonald.It’s a problem Durham Health Department’s regional managerand public health nurse, Dr. Angela Cooper Brathwaite, PhD 0T4, hastackled by implementing a team preceptorship approach in partnershipwith the University of Ontario Institute of Technology in Oshawa.Preceptors supervise up to three students in the health department,over three terms per year.“It’s a huge change,” says Cooper Brathwaite, a part-time assistantprofessor at the Bloomberg Faculty of Nursing. “It takes a lot of ourresources. Every semester I have six to eight students, and it uses a lot ofmy preceptors’ time. But in order to increase knowledge, we chose thatmodel. In return, not only do we fulfill our professional responsibilityto educate the next generation of nurses, but we also hire some of thosestudents in the health department once they’ve finished school.”The approach to future health care needs to be seamless, saysMacdonald, something the World Health Organization has beenarguing for years. In 1978, the Alma-Ata Declaration, conceived at theInternational Conference on Primary Health Care in the former USSR,underlined the importance of primary health care, and called for urgentaction by member states to protect and promote the health of peopleeverywhere in the world, particularly in developing countries by theyear 2000. It declared health a socio-economic issue and a human right.More than 30 years later, the majority of countries are grappling withsky-rocketing health-care costs, and health human resource issues.And the world’s health systems are nowhere near the WHO’s vision ofa focused primary health-care model.But with an aging population, one that is living longer, many withchronic diseases, there are no doubts among health professionals thatpartnerships between acute care and the community will increase,and the solutions to the strained health-care system will come fromcare in the community. People enter hospitals the morning of theirsurgeries, and many are released the same day.“Recovery is happening much more frequently in the community,”says Macdonald. “If you’re looking at the acuity of care in the community,there’s virtually nothing short of transplant surgery that isn’thappening in the community.”Nurse practitioner and Bloomberg Nursing doctoral student, KristaKeilty, MN 9T5, has fond memories of working with a family ofa 14-year-old daughter with high needs and dependent on a ventilator.The patient was going home for the first time on her ventilator aftera life in and out of Sick Kids Hospital. Since her childhood, she hadprogressed from eating by mouth to gastric-tube feedings and nocturnalnon-invasive ventilation via face-mask, to 24-hour invasive ventilationvia tracheostomy (open airway in the neck), says Keilty.“Her mother was a single parent. And the girl had an 11-year-oldbrother who was identified as the second care provider in the home.He participated in all the care training, to the same standards as hismother, to ensure he could participate and provide safe care for hissister,” says Keilty.The family had to learn how to care for the tracheostomy, and tounderstand the signals if the tube gets blocked, or the ventilator doesn’twork and the child can’t breathe. Interventions include suctioning thethroat, and changing the tube out of the stoma. “He wanted to learnhow to do it with his eyes closed.” Adds Keilty: “He was the youngestfamily member that we worked with in that way. Transition [to thehome] means readiness for the entire family.”Keilty has been working in the area of transitioning ventilatedchildren from Sick Kids Hospital to their home for about 10 years. “Inorder to assist families in setting up the home and ensure they feelconfident and safe in their environment, we would help identify strategiesto assist families in managing all this technology in the care at home.These home visits [by nurse practitioners, respiratory therapists and communitynurses] can potentially avoid having a family travel to hospitalfor a clinic visit, and reduce admissions to hospital,” says Keilty. “We’vehad great success with that.”Keilty visits and writes care plans directly with the visiting nursesand other team members involved. “During a home visit, as an NPI can write a prescription and just take care of it, rather than sendinga prescription from the hospital to the community and finding outit’s not easily interpreted,” she says. Her doctoral work will researchthe impact of ventilation technologies in the home on the family careproviders’ health and quality of sleep.In the mean time, home visits carried out by Keilty and Sick Kids’team members, such as nurse practitioner Arlene Chaves , MN 0T7,ensure the hospital is regularly linked with all the care providers,16 Lawrence S. Bloomberg Faculty of Nursing

including the CCAC case manager, who can be updated on the child’smedical history and prognosis at family case conferences.CCAC case manager, Farzina Shivji, BScN 0T8, has seen the stress onfamily care providers once a member has been discharged from hospitalinto the home for recovery. “It’s hard for a family to absorb all themedical information, and there could be a language barrier,” saysShivji. She remembers one case where a patient required regularfollow-up blood work. But the family care provider had the medicalinstructions tucked away in a coat pocket, and forgot to refer to it.She uses her community nursing background to educate familieson their new role as care providers. She also manages how the nursingis progressing for the patient. “If someone is getting nursing visitsdaily for months, we need to ask ‘What’s going on here? Why isn’t thewound healing?’” says Shivji.“We need to focus on whatcauses these gaps in health andhealth care because much ofthis is modifiable.”In a world of shrinking resources, Shivji says her job gets morechallenging every day. “I find it difficult when services are continuallybeing cut back, because I feel like that’s my only tool to help people.When you take that away from me, what can I do when people can’tmanage anymore?”Dr. Arlene Bierman, associate professor and Ontario Women’s HealthCouncil Chair in women’s health at the Bloomberg Faculty of Nursing,has been busy these past few years leading a team of 60 investigators ina groundbreaking project called the POWER Study (Project for an OntarioWomen's Health Evidence-Based Report.) The landmark studyof inequities in women’s health, funded by ECHO, an agency of theOntario health ministry, has drawn international interest.The POWER Study (www.powerstudy.ca) is designed to serve as anevidence-based tool to help policy makers, providers and consumersimprove the health of and reduce inequities among the women ofOntario. The project is examining differences between women andmen, and among subgroups of women associated with socioeconomicstatus, ethnicity and geography in health-care access, quality andoutcomes across the continuum of care.The first two chapters were released this year. Bierman says she wassurprised with the findings, not about the health inequities in theprovince, but with how large they were. Women are more likely todevelop disability, and men are more likely to die prematurely.However, differences in health status among women were often largerthan those between women and men. The first chapter on the burdenof illness study found low-income men and women were three timesmore likely to be in poorer health than those in a higher income group,and 41 per cent of low-income men die before age 75.The cancer chapter found low-income women were less likely tobe screened than higher-income women for cancers such as cervical,breast and colorectal— cancers with a high cure rate if identifiedand treated early. It also found many women with low-grade abnormalPap tests were not receiving timely follow-up.“The study identifies many opportunities for intervention andimprovement,” says Bierman. “We need to focus on what causes thesegaps in health and health care because much of this is modifiable.”The findings found other issues. One in four low-income womenand men in the province reported “food insecurity,” that is, not havingenough to eat, worrying about not enough to eat, or not eating thequality or variety of foods desired due to lack of money. “This is a problembecause cheap, high fat, high carb foods increase the risk of chronicdiseases and lead to poor outcomes among those who have chronicdisease such as diabetes, hypertension or heart failure,” says Bierman. Ina rich province such as Ontario, “This is something we can tackle. We canensure everyone in the province has access to a healthy diet. It’s a basicthing we can do,” says Bierman, a geriatrician and senior scientist in the LiKa Shing Knowledge Institute at St. Michael’s Hospital.She argues for health promotion and disease-prevention strategiesthat address gender, income and educational differences. “Prioritizingchronic disease prevention and management is really the key tothe health systems’ sustainability, as the population ages,” explainsBierman. She’d also like to see more emphasis on disease prevention,primary care and community care in medical and nursing schools.“What’s unique about our project is our reports on population healthand clinical health areas. We’re really trying to bridge population,clinical and public health services because you really need to integrateacross those areas in order to improve overall health,” says Bierman.A number of LHINs (Local Health Integration Networks) are using thefindings to help develop their integrated health services plans. And aprofessor at Lakehead University in Thunder Bay, Ont. plans to use theburden of illness chapter as a resource in her sociology and women’shealth course.Bierman wants to add to the global discussion on health care andhelp stimulate change. “The WHO came out with an important reporton the social determinants of health in 2008, so there’s a lot of focusaround the world on tackling health inequities,” says Bierman. “Peopledon’t realize the magnitude of the problem, and how much we cando about it. By measuring and reporting evidence-based indicators,we provide objective evidence to inform priority setting and thedevelopment of interventions for improvement . We can then trackthese measures over time to ensure we’re making progress.”Still, Bierman remains hopeful and says the report found pockets of“great things happening in different practices and communities in theprovince. We just need to ensure it’s implemented everywhere."As anyone who has ever tried to kick a bad habit knows, behaviourchange isn’t easy. Dr. Jan Angus, BScN 7T8, PhD 0T1, associateprofessor at Bloomberg Nursing, is researching how to best supportpeople when they want to modify their risk for cardiovascular disease.Her CIHR-funded project (www.mdpi.com/1660-4601/6/9/2481)looked at two different regions: one in the Toronto area and another inSudbury and Districts, which represents a mix of northern urban orrural populations. The goal of studying the Sudbury area was toexplore differences between anglophone and francophone experiencesof risk modification.Many participants called their behaviour change a “constantbattle,” says nurse and co-investigator Isabelle Michel, a director at theSudbury and District Health Unit. “People had to make fundamentalLawrence S. Bloomberg Faculty of Nursing 17

The technologicaltransformation of careHow the wireless world is integral tothe ‘new’ nursingBy Lucianna CiccocioppoFor some people, wireless handheld devices, such as personal digitalassistants (PDAs) and smart phones like BlackBerrys, are a vital necessity,a ‘how-did-we-ever-live-without-them’ part of their lives. For others,it’s a lifeline to better patient care. Katrina Owen, a visiting nurse withSaint Elizabeth Health Care in Barrie, Ont., uses her tablet personalcomputer, a wireless, hand-held PC, when visiting clients.“I had one patient who was depressed about her rare, chronic illness.I found links on the Internet for support groups on my tablet PC, andshowed her the interactive Web sites,” says Owen. “We sat together andwent through them, and she was immediately uplifted.”Owen has also used her Tablet PC to show educational videos onYouTube to clients. “There are great breathing and cardiac sounds onYouTube. I helped some parents understand what their baby’s cardiacdisorder sounded like.” Educational support includes referrals tocommunity networks for all the family members, not just patients, soshe can help children who are ill, or people who are grieving. “It helpswith the psychosocial aspect as well,” says Owen.It’s a tool for more than just e-mails and Internet use. Applicationsfor medical information, such as PEPID, can check drug interactions.Owen used the program for one client experiencing side effects. “WhenI listed all the drugs this patient was on and sent the information tothe physician, the medications were changed,” she says.Patient reaction is positive when they’re involved with the technology,Owen says. “It helps me be a better nurse; I’m definitely more informedon certain issues now. And I’m no longer afraid to say ‘I don’t know theanswer to that, but I know where I can find out.’”It’s a far cry from when Dr. Diane Doran first started her career inhomecare nursing. “I used to carry textbooks of medical and drugdictionaries in the trunk of my car to search for information, but Iwouldn’t bring them into the homes,” says the Lawrence S. Bloombergprofessor and U of T director of the Nursing Health Services Unit.Doran is the resident high-tech nursing expert and is leading tworesearch projects funded by the Canadian Institutes of Health Researchand the National Science and Engineering Research Council of Canada,with industry partners Nortel, RIM, Telus and HInext. The research involveswireless and monitoring technologies in and outside the hometo help manage chronic diseases more effectively.A ‘smart’ apartment is being developed by engineers at CarletonUniversity in Ottawa, where sensor technologies, such as a pressuresensitive mattress, can detect falls and instability and changes inweight, while sensors on refrigerator doors record eating habits, andthose on pill bottles monitor compliance with medication. Patientsfrom rehabilitation hospital Elisabeth Bruyère could be discharged tothe ‘smart’ apartment and be assessed to determine if they can managerehabilitation at home, says Doran.Another project is with Wilfrid Laurier University geographer Dr.Sean Doherty, who tracks diabetic patients on their exercise levels witha Global Positioning System (GPS) chip in their BlackBerry wirelessdevice. He’s developed an algorithm to monitor and translate data intomeaningful information for health-care providers about people’sactivity levels outside the home, applicable also to heart failure patientsand cardiac rehab patients, and other chronic diseases in Canada.Doran is researching how these technologies support clinicians inIllusration: Gracia Lam20 Lawrence S. Bloomberg Faculty of Nursing

ExpressionsOpinionsQ&AEventsNews22 Lawrence S. Bloomberg Faculty of Nursing

NewsSpring Reunion 2009More than 120 alumni reunited and reminisced on May 30 for SpringReunion 2009, at the Bloomberg Faculty of Nursing. Guests enjoyedbreakfast with classmates, toured the facilities and the innovativeclinical simulation learning lab.Class of 5T9 celebrated their 50th anniversary this year, and to markthis special occasion, classmates organized week-long activities.“This class really bonded,” says Denise Alcock. “We still support andcare for each other even though some live far away.”The 5T9 groupmeets every five years for their reunions, even though their differentpaths have spread them out to locations such as Bangkok, Comoxand Vancouver, BC, Roswell in Virginia, Solana Beach and San Diego,California, Sarasota, Florida, Ottawa, Calgary and more.“We faithfullycome together for each reunion, and once we enter the room, thetalking just starts as though there was never an absence,” says Alcock.The celebrations this year started Monday, May 25 when some alumnigathered for lunch. During the week, they made trips to local Torontolandmarks, such as the newly renovated Art Gallery of Ontario. A groupof eight 5T9 alumni who had roomed together during their time at theFaculty of Nursing went to the Briars Resort in Jackson’s Point midweekbefore the reunion weekend. They later met at one of their fellowclassmates’ home on Friday night for dinner, where scrapbooks andphotographs provided fodder for conversations and memories.Following the Faculty of Nursing Alumni Breakfast on Saturday, theyenjoyed dinner and an evening out at the Rosedale Golf Club, withspouses and children of some graduates.Distinguished Alumni AwardsThe Distinguished Alumni awardees are selected from alumni whowere nominated by their peers and fellow alumni. Congratulations toall of the winners on your achievements!Irene Elliott received the Award of Distinction for her work as anurse practitioner at the Hospital for Sick Children where she cares forchildren and their families living with epilepsy. In her 30-year nursingcareer, Elliott has made outstanding contributions to the development ofclinicians through her participation in interprofessional education andclinical preceptorship.Mary Glavassevich received the Award of Distinction and wasrecognized by many of her staff members as a leader, clinical educatorand mentor in her role as patient care manager, leader, clinicaleducator and mentor. She has made exceptional contributions tothe profession through direct patient care, research, and evidencebasedpractice.Donna Tweedell received the Award of Distinction and has used herclinical, teaching and research skills in various positions over theyears, including on faculty at Ryerson and McMaster universities.Tweedell was one of the first clinical nurse specialists in psychiatryand transplantation at Toronto General Hospital.Dr. Linda McGillis Hall received the Outstanding AchievementAward and is a recognized leader in nursing health services and systemsresearch. She’s currently a professor and associate dean (research andexternal relations) at the Lawrence S. Bloomberg Faculty of Nursing,University of Toronto.Bridgette Lord received the Rising Star Award – Clinical or communityNursing for her leadership role in the Rapid Diagnostic Breast Clinicat Princess Margaret Hospital, ensuring women are supported by anexpert advance oncology nurse during the diagnostic process. Thisclinic is an innovation in rapid diagnostic assessment for women with asuspicious breast abnormality and Lord has acted as a co-ordinator.For more information on the Distinguished Alumni Awardsand complete recipient profiles, please visit:bloomberg.nursing.utoronto.ca/alumni/awards.htmIMAGINE an interdisciplinary student-runclinic—volunteers wanted!IMAGINE is an interdisciplinary collaboration that includes studentsfrom dentistry, medicine, nursing, occupational therapy, pharmacy,physical therapy, social work, speech-language pathology and healthadministration. In conjunction with its community partners, IMAGINEwill provide hassle-free medical care and provide health educationworkshops for Toronto’s homeless and marginalized populations.IMAGINE is looking for nursing alumni volunteers to mentor, superviseand guide students providing basic medical care in the QueenWest Community Health Centre and/or delivering clinically focusedhealth-education workshops at St. Christopher House.Mentors are required to participate on Saturdays from 10:30am– 3:30pm at least once per school term (e.g. a total of three times percalendar year). Contact the Alumni Relations Office if you would like tobe involved: (416) 946 –7097 or development.nursing@utoronto.ca.iPod winnerCongratulations to Alma Veronica Marinelarena, BScN 0T5 onwinning the iPod Nano! We appreciate all the feedback we receivedfrom readers letting us know what they like most about Pulse. It isalways great to hear from you!Class of 3T3 alumna turns 100—and tells us all about itNot too many people reach the ripe old age of 100, but a Bloomberg Facultyof Nursing alumna celebrated just that and hand-wrote a letter to usto tell all about it. Vera Webb Major Crosby was born in Stratford, Ont.,in 1909 and turned 100 this past spring. Her nursing career began atBuffalo City Hospital Nursing School. Crosby returned to Toronto andgraduated with a Certificate in Public Health Nursing from theUniversity of Toronto in 1933. Listen to our conversation with Vera(and her tips for a long, healthy life) on our Web site:bloomberg.nursing.utoronto.ca/media/News_Stories/Class_of_3T3_alumna_turns_100_and_writes_all_about_it.htmLawrence S. Bloomberg Faculty of Nursing 23

NewsClass photographs: we need your helpIf you have recently visited the Lawrence S. Bloomberg Faculty ofNursing, you may have seen our Alumni Wall. This display showcasesclass photographs dating back to 1926. Unfortunately, we aremissing a few class years and we would like your help to complete thedisplay. If you or a fellow classmate have the class photograph forthe following years, please contact the Alumni Office at (416) 946-7097or development.nursing@utoronto.ca: 1950, 1960, 1968, 1974, 1978,2002, 2007In Memoriam:Dr. Jacqueline Sue Chapman, 1935 – 2009The Bloomberg Faculty of Nursing extends its sincerest sympathiesto the family and friends of Dr. Jacqueline Sue Chapman, professoremerita, who succumbed to illness on July 9, 2009 at Lakeview Manor,in Beaverton, Ontario.Lauded by many as an inspiration to nursing, Chapman was oneof Canada's most noted nurse researchers and devoted professors.Chapman was the first nurse in Canada to be awarded the prestigiousNational Health Research Scholar Award, when nursing research wasin its infancy, says Dr. Dorothy Pringle, professor emerita and a formerdean of nursing.“This was hugely significant,” says Pringle. “Most schools backthen weren’t doing any research. But Jacquie was a well-trainedresearcher. She gave nursing a ‘toe-hold’ in research enterprisein Canada.”Among her many honours, Chapman was named an AmericanNurses Foundation Scholar and was a founding fellow of theNightingale Society. She obtained her BSN from UBC in 1958. Shequickly advanced to head nurse roles and then to instructor positionsat UBC and at several American universities.She earned her MSN from Case Western University in Cleveland andher PhD in nursing from New York University. Her doctoral supervisorwas Dr. Martha Rogers, a prominent nursing theorist. Chapman’sdoctoral studies led to care improvements in neonatal nurseries.She became a full professor at the University of Toronto and was apart of the team that helped establish the PhD program here. She wasan ardent, but quiet, supporter of U of T, and was an active member ofmany faculty committees.“She was on all the management committees because her judgmentwas so good,” says Pringle, “and she knew how to train PhDs.”In retirement, she became an active member of her church andcommunity, sharing generously in the lives of those around her. Shemaintained a special passion for infants, children and education.She was an ardent traveler (she visited the Arctic and Antarctica) andenthusiast of the arts.She will be remembered fondly and missed by many, particularly byall the “grandchildren of her heart.”Elizabeth Anne (Betty) Burcher, 1949 – 2009The Bloomberg Faculty of Nursing is saddened with the sudden passing July 5, 2009 of BettyBurcher, public health nurse, senior lecturer, colleague, alumna and friend. Burcher began atBloomberg Nursing in fall 2002, after a stellar career spanning more than 30 years as a publichealth nurse, which included senior management positions in the teaching health unit, healthinformation and research, and also health planning at Toronto Public Health.“We knew we had scored a coup when this high-powered public health manager chose toteach with us,” says Maureen Barry, a close friend and senior lecturer at the Bloomberg Facultyof Nursing. But she never left her public health career entirely. Her indefatigable work duringSARS supported faculty and students through the unexpected crisis, and her contributionsto pandemic planning will not be forgotten.Burcher earned a sociology BA (Honours) in 1971 from the University of Waterloo and aBScN 1976 and MSc 1992 from the University of Toronto. She demonstrated tremendous collegiality and vision within the Faculty and withinterprofessional education colleagues. Burcher was an outstanding teacher, supporter and mentor of students, before and after they graduated,and a recipient of several teaching awards. She taught at the undergraduate and graduate levels.“She never explicitly stated it, but Betty was the kind of teacher you knew you could approach at any time," says recent nursing graduate,Hilary Hall. "She gave so freely of her time to student initiatives with very little fanfare.”“I think of her patience as a teacher, and her ability to explain concepts in multiple ways,” says former student, Jay Bass-Meldrum.“Betty encouraged me to be aware of the politics of nursing,” says Hall. “She talked often of 'hats' and in one conversation would share eachmoment her 'hat' was changing from faculty, public health to simply nursing colleague in the profession. Her sensitivity to the subtleties oflanguage and her ability to negotiate bureaucracies so effectively were immensely instructive.”Burcher was best known for her passion for public health, politics, social justice and women’s rights. She was respected and loved by a legion offriends, co-workers, students and family. Her outgoing nature, her passion for life, and her willingness to go above and beyond will be much missed.“The classrooms and corridors of the nursing building at 155 College St. will be strangely quiet without the sound of her infectious laugh,” says Barry.Burcher died due to complications arising from surgery to repair a brain aneurysm. Our thoughts and condolences go out to her partner,Doug Croker, and her son, Nick Croker, and her many friends in nursing across the University of Toronto campus and beyond.In her memory, the Betty Burcher Award in Community Health has been established for graduate students at the Bloomberg Faculty of Nursing.Call 416-496-7097 to donate or visit: bloomberg.nursing.utoronto.ca/Assets/Alumni/documents/InMemoriam/Burcher+new+donation+form.pdfPhotograph: Carolyn Cee24 Lawrence S. Bloomberg Faculty of Nursing

EventsCelebration in honour of ConvocationA reception will be held November 10 for the 2009 BScN studentsand their families. MN and PhD students will be invited to celebrateConvocation with their families at a reception in Spring 2010.Tuesday, November 10, 20092:30 pm to 4:00 pmMusic Room, Hart House7 Hart House CircleRSVP by October 26, 2009, maximum 2 guests(416) 946-7097 or development.nursing@utoronto.caDinner with 12 strangersIt’s a simple and fun idea: local alumni host dinners in their own homesfor students, faculty and fellow alumni in an effort to make U of T asmaller, friendlier place. An alumnus from the Faculty of Nursing willhost an evening of good food and good conversation. The program offersparticipants an opportunity to make new friends and valuable connections.Dinners will take place on a weeknight (Monday – Thursday) fromabout 6 – 9pm throughout the academic year. If this sounds like an eventyou may be interested in, please contact our Alumni Relations Office at(416) 946–7097 or development.nursing@utoronto.ca.Spring Reunion 2010—save the date!Join classmates, friends and colleagues at the Lawrence S. BloombergFaculty of Nursing for the Annual Alumni Breakfast on Saturday, May29, 2010.All years are welcome and honoured years include: 1930, ’35, ’40, ’45,’50, ’55, ’60, ’65, ’70, ’75, ’80, ’85, ’90, ’95, 2000 and 2005.More details to follow. Please feel free to contact the Alumni Officeat (416) 946-7097 or development.nursing@utoronto.ca if you havequestion, or if you would like to get in touch with you graduating yearto plan your reunion.Want to contact old friends?For assistance in contacting your fellow alumni, please do not hesitateto call us at (416) 946-7097 or at development.nursing@utoronto.ca.Find us on FacebookWant more nursing friends, or looking to stay in touch with old ones?Look for the officially sanctioned Lawrence S. Bloomberg Faculty ofNursing Alumni group on Facebook. Nursing students and alumni arewelcome to join, and stay in touch, learn about lectures, events andother Faculty or alumni news.Alumni lifelong learning seriesThis is a new program exclusively for our alumni and is hostedover lunch. Upcoming topics and speakers include:Oct. 23, 2009 Dr. Linda McGillis Hall:Gone south: Canadian nurse migration to the USHealth Sciences Building, 155 College St., Room 20812:00 – 2:00, including a luncheonOct. 30, 2009 Dr. Denise Gastaldo:Undocumented workers’ health issues in Ontario:Working conditions and access to health careHealth Sciences Building, 155 College St., Room 20812:00 – 2:00, including a luncheonNov. 6, 2009 Dr. Louise Rose:Hot topics in critical careHealth Sciences Building, 155 College St., Room 21512:00 – 2:00, including a luncheonTo RSVP, please contact:Alumni Relations Office(416) 946- 7097development.nursing@utoronto.caUofT-GnM-QrtrPage-FA:Layout 1 3/5/2009 10:45 AM Page 1“I was raised by asingle mom whocouldn’t afford to helpme through school.Without this scholarship,I wouldn’t be ableto pay my tuition.”KEVIN D. SHIELD Pursuing a Master ofHealth Science in Community Health and EpidemiologyLeave a gift to the University of Torontoand change a student’s life.Contact Michelle Osborne at 416-978-3811or michelle.osborne@utoronto.caLawrence S. Bloomberg Faculty of Nursing 25

Q&AA conversation withDean and ProfessorEmerita, Dr. DorothyPringle, RN, BScN,MS, PhD, OCPulse: You’ve been called a ‘transformational’ nursing leader, havingrejuvenated and revitalized the program at Laurentian University,and shifting the University of Toronto’s program from a professionallyfocused faculty to a research-oriented one. What impact have thesechanges had in nursing, and health care?DP: Nursing has become an accepted part of the health researchenterprise in Canada. We’re not still knocking on the door, trying to‘get in.’ We’re in all the nooks and crannies of that enterprise. NursesNancy Edwards and Joy Johnson are scientific directors of two CanadianInstitutes of Health Research institutes. We’ve had a nurse on CIHRcouncil since its inception; it’s simply unremarkable now. We’re just partof the scene. It’s important that we are part of this bigger picture abouthealth research and contribute to how the questions get asked. Theimplications for nursing care are answered in the course of doing that.Pulse: How do you feel about helping to make the Bloomberg Facultyof Nursing the premier provider of advanced practice nurses andPhD-educated nurses across Canada?DP: I’m ecstatic, in the sense of having had the opportunity to be apart of it. And quite frankly it was because my timing was rightso I got credit for a lot. I was dean at a point in time when it began tobe possible to recruit excellent, doctorate-prepared faculty members,which was very hard to do before the ’90s in Canada. We also hadpeople on faculty who were prepared to take risks. And they drovemany of the changes.We developed the PhD program because the PhD taskforce [Drs.Jacquie Chapman, Jane Graydon, Ellen Hodnett, and Hilary Llewellyn-Thomas] were effective, and they listened and incorporated input fromthe faculty as they developed the program proposal. Next—and wetook a deep breath on this, and we did it in two phases—we moved to apractice-oriented MN program and got out of the thesis program at themaster’s level because we had limited supervisory capacity. We madethe decision to give the PhD program priority when it came to supervisingtheses. This decision influenced other Canadian nursing facultiesthat also had big master’s programs with theses. We also believed thata non-thesis master’s created opportunities to incorporate practicerelevantcourses that we could not do if the students were doing a thesis.It also gave us a chance to emphasize research application rather thancreation at the master’s level.We launched the acute care nurse practitioner program; we were outin front in that. I’m very proud of our ACNP program and the leadershipthat was shown around it. We had the right people who developed theprogram and taught it. They had great credibility.Photograph: Lisa Sakulensky26 Lawrence S. Bloomberg Faculty of Nursing

Q&AFinally, the two year second-entry undergraduate program wasa very important leadership step for U of T. U of T introduced the firstfour-year university based nursing program in Canada in 1936 andso it seemed appropriate that U of T would introduce the next majorinnovation in BScN education 60 years later.Pulse: What was the thinking behind that decision?DP: I wish I could say it was based on some strongly held philosophicposition but it was budget cuts. We didn’t have enough money tokeep offering all our programs. The options were to get out of theundergraduate business entirely, since we had Ryerson Universityand York University doing a four-year program, or to create a smallsecond-entry program. It was cheaper and it was intended to bea boutique program, designed for 30 students. It didn’t catch on rightaway and the second year when we did not fill our class, [U of T]President Robert Prichard asked me if we got it right. By the thirdyear, we had no difficulty filling the class and the rest is history. Nowvirtually every university in the country has a second-entry programbut we are still the only one to focus exclusively on second-entrynursing education for undergraduates.Pulse: Given your expertise on aging and patient care, how do you seethe nursing sector addressing the issues and challenges stemming froman aging population, one that is living longer with chronic diseases—will the solutions come from community care?DP: I think the community will play a larger role than it doesnow, but I fear that it will be more by default, than by design. It’s notthat we don’t have lots of good models of community care withnurses as the core profession demonstrated over and over again, butwe haven’t had uptake at the political level. We know that as peoplemove into advanced old age they prefer to remain in their own homesand programs of support can make that possible at no more cost andwith less demand on the acute and long term care sectors than wehave in our current chaotic ad hoc way of doing things. It costs moneyto do well. There are pay-offs down the road but we need to continueto fund our very expensive current structure, and even in theboom days, there was never a sense from government that we hadenough money to take on these new models and fund them so thatthey are able to demonstrate their worth. We need to look five to 10years down the road to do that.We outsmarted ourselves. We’ve become very good at living to oldage. For many, the last eight years of life are fraught with healthchallenges. To manage health problems and to bring quality of life tothose last eight years requires considerable resources. We have themodel where nurses play a role but we have not been able to enactthem; we certainly don’t have them in place in Ontario. It’s appalling.Pulse: What does the future hold for nursing?DP: Nursing at its best is probably the most valuable component of thehealth care system because of our range and capabilities: intensivecare, emergency room care, the whole life-saving end of acute care, tocaring in the community. We know about health promotion, we knowthe prevention piece. We’ve been given long-term care as essentiallyour exclusive domain, but I seriously question if, as a profession, wehave embraced it. And we don’t treat it as opportunity to demonstratehow well it can be done...But, when nursing is at its best, it’s a beautiful thing.On a bad day, I worry about nursing, about how to make it possiblefor nurses to work at the bedside for their entire career and retain theirhealth and sustain their compassion and humanity, when they’reworking shifts, weekends and every other Christmas with a sore backand sore feet, and are trying to connect with and care about what a poor85-year-old woman is trying to tell them. That worries me a lot aboutnursing and nurses.On other hand, at this point in time, we have a better educated nursingworkforce than we’ve ever had before. We have nursing research andhealth research to call on, to assist us on a day-to-day basis, to findbetter ways of providing care. Importantly, nurses have never beforehad so many career choices within nursing and so many educationalopportunities to turn to. On a good day, I look at all these assets webring. We’ve never been better positioned to design the kind of patientcare that is required.Pulse: Which was more exciting to receive, the Order of Canada, or theU of T honorary degree?DP: They are so different. The Order of Canada was so unexpected,and there’s a bit of majesty with it all. I am enormously grateful tohave it. But I have to say, the honorary doctorate from U of T waswonderful. I felt loved at U of T; I didn’t feel loved when got the OC. Ifelt respected and that was terrific because a wide range of people arereceiving the OC so to be in that company, I think ‘Wow!’ They’re bothquite breathtaking in their own right, but ask me which one I enjoyedmore? The honorary doctorate at U of T. I was with people whom Ilove, respect, worked with— and who know my foibles. I got an honorarydegree from U of T despite the fact they know me [laughs] so that’squite special.Pulse: If you could invite anyone, dead or alive, to a dinner party, whowould it be and why?DP: I’d have a hard time choosing between Alice Munro and MargaretLaurence. These are Canadian women writers who capture the artof being Canadian, a woman, of being real and of aging. I would like totalk to them about how they know. And where that comes from.Pulse: What’s your idea of perfect happiness?DP: I never think of perfect happiness. It’s an underdeveloped conceptand not necessary. I guess I think of happiness as having an opportunityto do and be what’s important to you. That can be on a very small scaleor very large scale. You define what it is; and I don’t think it needsto be perfect. I think you can handle a lot of ‘not perfect’ if you haveenough of what happiness means to you.And a few million dollars helps [laughs].Dr. Dorothy Pringle is editor-in-chief of the Canadian Journal of NursingLeadership, and is a recipient of the Jeanne Mance Award from the CanadianNurses Association for lifetime contributions to nursing. She is also a fellow andboard member of the Canadian Academy of Health Sciences. She received herhonorary Doctor of Laws degree from U of T the 2009 spring convocation. Shewas dean of the Bloomberg Faculty of Nursing from 1988-1999.Lawrence S. Bloomberg Faculty of Nursing 27

OpinionsIllusration: Phil28 Lawrence S. Bloomberg Faculty of Nursing

OpinionsCultivating a newsolution to the acutecare crisisBy Shirlee Sharkey, president and CEO, Saint Elizabeth Health Care,adjunct professor, Lawrence S. Bloomberg Faculty of NursingAfter a steady stream of company all summer long, fall weekendsat the cottage often afford the time to start working in the yardagain. However, along with clearing things out and straighteningthings up, I often find myself getting preoccupied with dealing withthe weeds. Within hours of arrival, I am pulling out every tool inthe shed – the lawn mower, the weed whacker, the garden shears – allthe while pledging that next year, we will bring in the topsoil, getthe right plants and lay the groundwork for a yard that is less overrunby weeds.I share this analogy to illustrate that the seemingly never-endingchore of weeding, in the absence of architecture, is a decidedly downstreamand ineffective solution. It strikes me that this is not entirelydissimilar to our current approach to solving the growing crisis inacute care.Today, acute care hospitals are under tremendous pressure toimprove patient flow, increase efficiency and reduce wait times. At thesame time, more than 5,000 beds at Canadian hospitals on any givenday are occupied by patients who no longer need hospital care and arewaiting to be discharged. Studies show alternative level of care (ALC)patients in 2007-08 accounted for five per cent of hospitalizations and14 per cent of hospital days.Fast forward to 2015, when there will be more people in Canada overthe age of 65 than under the age of 15, and it is clear that, in the absenceof new and creative solutions, the picture is poised to get worse beforeit gets better.What we need is a two-pronged approach that includes interventionsto deal with the crises of today while simultaneously layingthe foundation for a larger solution that is optimized for tomorrow’sreality. Home and community health care can play a key role on bothof these fronts.In the more immediate term, Ontario’s Aging at Home initiative isproviding seniors with an expanded range of innovative home care andcommunity support services to help them live independently. Inaddition to supporting non-traditional partnerships and greater systemintegration, many of these projects are now targeted at decreasing thenumber of ALC patients in hospitals as well as reducing pressures onemergency rooms.As a result, homecare nurses are increasingly working in partnershipwith acute care colleagues and community partners to help facilitatetimely discharges and smooth transitions, whether it’s providingpatients with a safe and reliable alternative to hospitalization for shorttermcare and recovery, or offering the necessary supports to helpthem return and settle in at home.While these programs are both beneficial and encouraging, in lightof demographic trends, talent shortages and rising costs, it is doubtful thatsuch interventions alone will be enough to unleash the potential ofindividuals and families in their everyday lives, in order to ensure thefuture sustainability of our health-care system.To solve the acute care crisis in the long-term, we need to begin tolay the foundation for an integrated health-care system that is designed,organized and funded not only to embrace all levels of care, but alsoconsumer needs, choice and preferences. This requires us—as a profession,a system and a society – to collectively re-imagine the way we understand,access and experience care. In the future, with the opportunitieswith knowledge dissemination and technological advances, locationwill no longer be the determining factor.For many, many years, the homecare sector has been viewed in alimited way as a substitute for acute care or a delay tactic for institutionalization.This has resulted in a historical fixation with understandingthe cost-benefit of one part of the system versus the system as a whole.Today, research shows that 90 per cent of Canadians would prefer tospend their final years at home. What an incredible opportunity thiscould be to reframe the starting point of our health-care system in orderto realize the true potential of homecare programming, a communityapproach and the desires of people and their health-care providers.The type of cultural shift that is required to move the system forwardis not a simple or speedy undertaking. It involves alignment, collaborationand synchronicity across the health-care continuum. It requiresalternative delivery models, funding structures and incentives. Andit necessitates that we tailor the entire system to individuals and thecommunities they are a part of, not the other way around.This presents an exciting leadership role for nurses. As a profession,we have the opportunity to not only incorporate the patterns of illnessand treatment, but to use our knowledge and experience to lead andinitiate change in an environment we are passionate about.By virtue of their focus, Community Care Access Centres, publichealth agencies and homecare providers are building a cadre of nursesthat must incorporate the behaviours and preferences of individuals andfamilies in their homes and communities. I encourage all nurses andeveryone working in the health-care system to understand and respondwith sensitivity to people in the broader context of their lives. Thisis fundamental to laying the foundation for a transformed healthcaresystem.In the ‘busyness’ of everyday life, it is easy to lose sight of the long-termand focus only on what needs to be done today. Creative solutions andsustainable approaches require time and collective effort. To truly solvetoday’s acute care crisis, we must dig a little deeper and avoid gettingovercome by the weeds.Shirlee Sharkey, CHE, MHSc, BScN, BA is also cross-appointed to the Facultyof Medicine’s department of health policy, management and evaluation atUniversity of Toronto. She can be reached at ssharkey@saintelizabeth.com.Lawrence S. Bloomberg Faculty of Nursing 29

ExpressionsNursing students in a 1930s practical classat the University of Toronto’s Department ofPublic Health Nursing.90 years of shapingnursing education, researchand practiceDo you remember your first practical class? Can you help us trackdown the first male nursing graduate? Do you know of any alumniwho helped with the war effort in the 1940s? Share your memories,stories, ideas and photographs with us, as the Bloomberg Faculty ofNursing gears up to celebrate 90 years of innovative, forward-thinkingnursing education and research. From certificates and diplomasto BScNs and PhDs, from maternal and baby care, to SARS and H1N1,more than 11,000 nurses have graduated from this Faculty, as clinicians,practitioners, researchers and educators, providing the answersto the questions shaping the future of Canadian health care. We wantto hear these stories for a special anniversary edition of Pulse. We’llalso have numerous exciting events planned throughout 2010, suchas the 90th Anniversary Awards, recognizing 90 outstanding alumni.Visit http://bloomberg.nursing.utoronto.ca/alumni/newsevents.htmfor regular updates. Contact development.nursing@utoronto.caor call 416-946-7097 to be a part of our celebrations, as we look back…and forge forward.Photograph: University of Toronto Archives30 Lawrence S. Bloomberg Faculty of Nursing

IMAGINE an interdisciplinarystudent-run clinic helping the mostvulnerable people in Toronto.Now IMAGINE being a part ofthis innovative effort.IMAGINE is an interdisciplinary collaboration among students from dentistry, medicine,nursing, occupational therapy, pharmacy, physical therapy, social work, speech-language pathologyand health administration. In 2010, in conjunction with its community partners, IMAGINE willprovide hassle-free medical care and provide health education workshops for Toronto’s homelessand marginalized populations.Volunteers Wanted!(Left) Students and IMAGINE volunteers Naureen Siddiqui(health administration), Cindy Chow (speech languagepathology), Jen Galle (medicine), Ryan McGuire (pharmacy),Anatoli Chkaroubo (pharmacy), Daniella Moss (nursing),Candie Sabel (nursing), Carol Aiga, (occupational therapy),Alison Rowe (social work), Fahreen Ladak (physiotherapy) andNadine Lam (pharmacy).IMAGINE is looking for nursing alumni volunteers to mentor, supervise and guide studentsproviding basic medical care in the Queen West Community Health Centre and/or deliveringclinically focused health-education workshops at St. Christopher House.If you would like to be involved, contact the Bloomberg Faculty of Nursing AlumniRelations Office at (416) 946 –7097 or development.nursing@utoronto.ca.

First in NursingImpact patient care. Lead practicechange. Pioneer new roles.Our outstanding team of clinicians, educators and researchers arepart of the answers to the questions shaping the future of healthcare in Canada. In 2010, the Bloomberg Faculty of Nursing celebrates90 years of world-class research and education that has helped toshape the discipline of nursing.Learn to lead at the Bloomberg Faculty of Nursing.Find out more about the Lawrence S. Bloomberg Faculty of Nursing,and see how we can help you further your career in nursing.www.bloomberg.nursing.utoronto.ca