Susan Robinson, PHCNP, RN(EC)Project Coordinator, Shibogama Health Authority Mary Lou Winter, Assistant Health Director, Kingfisher Lake First Nation

Susan Robinson, PHCNP, RN(EC)Project Coordinator, Shibogama Health Authority Mary Lou Winter, Assistant Health Director, Kingfisher Lake First Nation

Shibogama Health Authority o Located in Northwestern Ontario, north of Sioux Lookout o Deliver health programs on behalf of Shibogama Health Council for the communities of Kingfisher Lake, Wapekeka and Wunnumin Lake o First in Ontario to transfer their community health services in 1994 Design their own health programs Allocate funds to community health priorities Evals kee

Innovation Funding Project o Target is remote, isolated nursing clinics o Focus to develop new service approaches Improve service access Improve responsiveness to community needs Improve health outcomes Improve client satisfaction Improve health provider satisfaction Increase cost effectiveness

Four Ontario communities were selected: o Shibogama o Eabametoong o Sandy Lake o Kashechewan Approval for 3 new positions o Nurse Practitioner (NP) o Registered Practical Nurse (RPN) o Laboratory Technician (Lab Tech)

How would they integrate into an isolated clinic? Nurse Practitioner Able to diagnose disease Utilize all resources for dx Write prescriptions for meds Order x-rays/labs and U/S Cast fractures Referral to specialist Supportive counselling skills Leadership/administration Community Health Nurse Consult MD Follow FNIHB guidelines Use directives/consult MD Consult MD/standing orders Referral to MD Consult MD Depends on background Nurse in charge

How would they integrate into an isolated clinic? Registered Practical Nurse Able to assess & provide tx with orders Stable client base; refer to community health nurse if unstable Uses directives/standing orders/consults MD Transcribe orders Extended scope Community Health Nurse Able to assess & provide tx with orders Follow FNIHB guidelines; unstable client base with MD intervention or transfer of care Uses directives/standing orders/consults MD Transcribe orders Community/population health

Lab Technician Who are they?: otrained health professionals with added skills in taking blood and other samples to diagnose disease What do they do? oclinical lab skills otake blood samples oprocess blood work oquality assurance

Model of care o Integrate emotional, physical, spiritual and mental needs of community o Integrate traditional land use and practices into health o Strengthen maternal/child bond o Empower women as traditional educators of the community from birth on; empower men as role models in childrearing o Focus on health education in the community

Philosophy o Community as a core o Self care o Continuity with living environment o Social harmony o Integrity of healing practices o Family connections

Two streams 1. Chronic Disease o o Diabetes Hypertension 2. Family Health o o o o o o Prenatal/postnatal Early life Healthy schools Food security Parenting Healthy relationships

How did Shibogama communities use these professionals? Population based model 1. NP, RPN and Lab Tech work with specific populations within the community 2. One community only for continuity Community survey.

Question Major health concerns Community responses 1. Diabetes 2. Addictions 3. Mental health 4. Nutrition 5. Child health & development 6. Elder care 7. Parenting 8. Obesity

Question Barriers to achieve health outcomes Community responses Housing Alcohol/drug use Food security Level of education Lack of cultural practices Isolation Lack of medical services

Question Role of NP Community responses Chronic disease Med reviews Order labs Diagnose x-rays Home care Yearly physicals Chart reviews Public health education Train community workers Decrease barrier to primary care Consultant for community health nurse Mental health screening Review specialist reports

Question Role of RPN Community responses Home visits Dressings Teen/new mother visits Elder visits Home care Foot care School health Chronic care Public health education MD clinics Post treatment care and f/u after MD visits Work with community workers and NP

Question Role of Lab Tech Community responses Would not improve care Chronic care & post MD clinic Process blood work

Question Team role Community responses 1-2 week rotations NP works before or after MD for 2 weeks RPN and Lab Tech after MD for 1 week 1 RPN in each community, NP rotates, Lab Tech helps nurses Learn Oji-Cree

Question Aspects inadequately covered by original model Community responses Education Chronic disease Preventive care Health promotion

Initial barriers: o Cultural sensitivity o Language o Accommodation o Collaboration with MD o Policies to practice o Lack of community understanding of roles

Additional resources: o Equipment o Additional exam room o Office space o Computer o Supervisory system o Vehicle o Ongoing training

Kingfisher Lake First Nation o Demographics o First community chosen Accommodation Office space In kind services Time commitment

NP role: o Primary care services o Prenatal care o Diabetes care o School health o Education o Consultant for community health nurses o Collaborative relationship with MD o Community networking

John is a 25 year old male who presents to the clinic with a skin infection for the third time John sees the NP: o Provide a comprehensive history o Perform a physical exam o Order blood work including diabetes screening o Treat local skin infection o Diagnose diabetes o Provide consistent follow up o Provide health education and teaching o Link John with the diabetes education program o Provide a specialist referral as needed

RPN role: o Home care visits o Diabetes care o Foot care o School health o Fitness classes o Blood pressure clinic o MD clinics o Community networking

Eleanor is a 65 year old diabetic requiring a foot assessment Eleanor sees the RPN: o Provide a comprehensive foot assessment o Offer foot care including nails and calluses o Assess the foot to find an infection o Consult with NP for diagnosis and treatment of infection o Provide health education about the infection o Provide teaching of proper foot care o Assist in changes required for footwear o Provide consistent follow up

Lab Tech role: o Monthly visits o Organizes clinic lab work o Community blood work o SHIPs blood work o Quality assurance

Project Coordinator role: o Unique to Shibogama o Integrate team into clinic o Liaise with FNIHB, hospital, Sioux Lookout community, Shibogama Health Authority o Monitor progress of project o Provide updates & reports o Mentor staff o Provide knowledge transfer

Evaluator role: o Provide data collection tools-project logic model o Collect initial data from field Integration of team Health outcomes o Midterm evaluation data

Evaluation data highlights: o What is working? NP consultation for community health nurses Increased primary health care visits Diabetic care has improved Foot care services Prenatal care is with one consistent provider (NP) Lab Tech role functioning well with quality assurance measures

Training community home care workers MD/NP collaboration Follow up visits/consistency in care Parenting workshops Increase in health education Community outreach

o Challenges? Role clarity of NP and RPN Integration of new roles with community health nurses Nursing staff/team coordination & communication Flow of information between providers/overlap of services Participation for educational events slow to start After hours translation

Future goals: o Parenting skills development o Mothering feast o Increased integration of land/traditions o Healthy relationships o Community networking o Community education o In-service education

Kingfisher Lake community perspective: o What have been the impacts on the community? o How have these new roles integrated into the clinic? o What lessons should be shared with other communities?

Questions?