Running head: FACILITATING IMPROVED ACCESSIBILITY 1
Facilitating Improved Accessibility to Home Care Clients and Nurses
Rosa Tiberia
ParaMed Home Health Care
Clinical Nursing Experience
Professor Hali Sitarz
St. Clair College in Collaboration with the University of Windsor
March 29, 2015
FACILITATING IMPROVED ACCESSIBILITY 2
Acknowledgments
I would like to thank my preceptor Kateri McGuire, the acceptance and understanding of
my clients, those at ParaMed, and Professor Hali Sitarz at St. Clair College who had an impact
on my continued learning of community health nursing.
FACILITATING IMPROVED ACCESSIBILITY 3
Facilitating Improved Accessibility to Home Care Clients and Nurses
Introduction
In the final semester of my nursing program, I was assigned a community placement at
ParaMed Home Health Care. At this placement, I was paired with a community health nurse
who worked primarily in rural areas of Windsor/Essex County. Together, we performed a
variety of different nursing skills such as health teaching, wound care, and IV rehydration. My
nurse and I worked with different kinds of clients including palliative, diabetics, and those with
cancer. During my time, I noticed a lack of accessibility with both the client side and the nursing
side of this agency.
For clients, I saw a lack of accessible information for those who required more services
for their health care needs. Although an accessibility act is in place for Ontarians with
disabilities, a clear and definite resource is not available ParaMed’s clients which meet the same
standards. Continuing care in the home is a priority for ParaMed clients to prevent unnecessary
trips to the emergency room. Using a multitude of services, such as personal support workers or
hospice, may be required based on the client’s needs. I noticed how there was not a more
practical and identifiable document which assisted in this.
Having access to continuing education is essential for ParaMed’s nurses. While ParaMed
offers in-services to its nurses for practicing skills, these do not happen very often. In the
meantime, there may be nurses who feel uncomfortable performing skills in the community
without sufficient practice. Creating access to a more effective resource or program can greatly
influence the way nurses perform their duties.
This paper is meant to analyze the community through the eyes of the home health care
system and determine ways in which both clients and nurses can improve their access to reliable
FACILITATING IMPROVED ACCESSIBILITY 4
information. A combination of an environmental scan, a needs assessment, and a resource
evaluation was completed to assess the ways in which ParaMed can improve its accessibility to
both clients and nurses.
With these observations, I have formulated the following PICO (population, intervention,
setting, and outcome):
PICO
P: Patients receiving home care services and nurses that provide home health care.
I: Developing informative resources for patients; creating a way to continue education for nurses.
C: Accessibility to information.
O: Improved accessibility and communication to clients and nurses; evaluation of implemented
resources.
Community Assessment
For the purpose of this paper, I will evaluate current information on the level of
accessibility in the region of Essex County. A community assessment was completed using
Stamler and Yiu’s Community Health Promotion Model (2012). The community assessment
incorporates the following topics: physical and socioeconomic environments, health and social
services, culture and religion, government and politics, law and safety, education and health
child development, transportation, and communication. These topics help to identify gaps in the
health care system which may impact the way clients and nurses access information.
Physical Environments
The term ‘Essex County’ implies the town of Essex as well as the surrounding
municipalities which include: LaSalle, Kingsville, Harrow, Leamington, Lakeshore,
Amherstburg, and Tecumseh. Essex County does not include the City of Windsor, Chatham-
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Kent, or Pelee Island. Essex County consists of a total population of 177,720 as of 2011 and is
the southernmost county and census division of Canada (Census Canada, 2011).
Essex County is considered to be a rural area of Ontario. This status of rurality may lead to
poor health services because of geographic isolation. According to the Ontario Ministry of
Health and Long Term Care (2011), “Access to quality health care in rural, remote and northern
communities is a long standing issue in Ontario. The challenges of providing appropriate access
to health care in these communities stem from multiple factors: geographic remoteness, long
distances, low population densities, less availability of other providers and inclement weather
conditions”. This lack of access can subsequently lead to inequitable health statuses among its
residents.
ParaMed is responsible for the delivery of care to populations either in the home,
workplace, or school (ParaMed Home Health Care, 2013). It may be difficult for rural nurses to
be able to provide care for clients who live in these areas. In the past, ParaMed has had staffing
issues related to its availability of county-specific nurses. Many nurses live in the city of
Windsor and would like to work within those boundaries; however, this leaves a nursing deficit
in the county areas. It has been my experience working with these populations that many feel as
though their needs are not being met, mainly due to distance and lack of resources.
It is important to consider the amount of elderly populations because they make up most
of the clients who access home care services. There are more than 83,000 people over the age of
60 living in Essex County (Census Canada, 2011). With the added stress of distance, lack of
mobility, and increasing health needs, it is essential that these populations receive the care that is
needed. A report in the Canadian Medical Association identifies 78% of people entering their
retirement years are concerned about access to high quality home care (Ontario Association of
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Community Care Access Centres, 2014). Many of those (especially aging baby boomers) who
are accessing home care services feel as though they are not receiving enough care for their
growing needs.
Socioeconomic Environments
It is important for a health care agency like ParaMed to consider the economic factors
associated with this area that may affect health inequalities. In terms of economic
considerations, the following table illustrates a variety of characteristics of Essex County that
may impact the accessibility of health care as per the National Household Survey (2011):
Table 1:
Characteristic Total Male Female
Canadian Citizens 363,520 179,520 184,005
Not Canadian Citizens 17,825 7,790 10,035
Immigrants 81,730 38,755 42,975
Non-Immigrants 295,980 146,585 149,400
Visible Minority 57,795 28,690 29,110
Aboriginal Identity 7,495 3,525 3,975
Education: Total population aged 15 years and over by location of study compared with province or territory of
residence: No postsecondary certificate, diploma or degree
159,565 76,765 82,800
Education: Total population aged 15 years and over by location of study compared with province or territory of
residence: With postsecondary certificate, diploma or degree
153,145 75,000 78,145
Employed 168,375 87,100 81,280
Unemployed 18,180 10,080 8,100
Employment Rate 53.8 57.4 50.5
Unemployment Rate 9.7 10.4 9.1
Mode of Transportation:
Car, truck or van - as a driver
133,045 69,605 63,445
Mode of Transportation: 8,855 3,700 5,160
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Car, truck or van - as a passenger
Mode of Transportation:
Public transit
3,885 1,530 2,355
Mode of Transportation:
Walked
5,920 2,815 3,105
Mode of Transportation:
Bicycle
1,505 1,180 325
Mode of Transportation:
Other methods
1,350 575 780
Household Characteristics: Suitable 144,455
Household Characteristics:
Non-Suitable
7,835
Shelter Costs: Spending 30% to less than 100% of household total income on shelter costs
28,715
Without Income 18,685 7,705 10,985
With Income 294,020 144,060 149, 960
Average Income ($) 37,652 44,942 30, 649
Canada/Quebec Pension Plan benefits (%) 4.2 3.7 5.0
Old Age Security pensions and Guaranteed Income Supplement (%)
3.5 2.5 4.9
Income: In low income in 2010 based on after-tax low-income measure (LIM-AT)
66, 645 30, 905 35, 735
Income: Prevalence of low income in 2010 based on after-tax low-income measure (%)
17.5 16.5 18.4
Health inequities continue to be an issue with those who live in rural areas. Socioeconomic
determinants strongly have an implication on how people access health care (Public Health
Agency of Canada, 2008). The characteristics that were pulled from the NHS resemble the
Social Determinants of Health. Some characteristics that are worth mentioning are: the high
unemployment rate, those without income, and those who spend between 30% - 100% of their
income on shelter costs. The amount of people with low education is very high as well. Average
income is on the lower side with a high rate of immigrants and visible minorities. Diversity and
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multiple inequities have negative implications on the delivery and accessibility of health care
services. It is essential that health care organizations realize the gaps that are present in their
local populations and have services to help bridge these gaps.
Health and Social Services
In Essex County, there is currently one major hospital. Leamington District Memorial
Hospital is a rural, community hospital servicing people in the south east portion of Essex
County (County of Essex, 2014). This hospital’s vision statement is, “A leading rural community
hospital delivering compassionate care”, and its mission statement is, “Dedicated to improving
the health of the communities we serve” (Leamington Hospital, 2011). Essex County will be the
home of a new acute care hospital in the near future. This hospital will be updated, offer patient
and family-centered care, and will include modern hospital features that are built to the highest
standards (County of Essex, 2014). A date and location have not been confirmed. A site
selection process has been implemented to carefully consider the location of this new facility.
In terms of home care, Essex County is in partnership with CCAC (Community Care
Access Centre) who is crucial to the delivery of home health care services. In general, CCAC
helps to connect people with local health information and referrals to services in their community
(County of Essex, 2014). ParaMed Home Health Care works under the umbrella of CCAC as
well as a variety of service providers including: Bayshore Healthcare Ltd, ParaMed Home Health
Care, Revera Health Services Inc, Saint Elizabeth Health Care, and Victorian Order of Nurses
(Community Care Access Centre, 2014).
As of recently, ParaMed has partnered with Revera Health Services Inc to create an
integrated approach to delivering health care services. The merging of these two organizations
aims to increase the quality of care that is given to those in Windsor and Essex County.
FACILITATING IMPROVED ACCESSIBILITY 9
ParaMed remains in the final stages of this merging as of date. No further information is
currently available to the public and to the staff on its specific implications.
ParaMed has had its share of home care service interruptions this year. On January 30th
2015, CCAC announced a labour strike on the basis of home care staff feeling under-valued by
the Ontario Nurses Association. This strike lasted 17 days and staff went back to work on
February 17th, 2015. About 260 nurses work for Erie St. Clair CCAC which serves both Windsor
and Essex County. The strike was not expected to have a significant impact on the delivery of
home care services (Windsor Star, 2015). ParaMed is in close contact with CCAC for the
delivery and accessibility of home care services. During this strike, it was difficult to get in
contact with care coordinators for specific patient information with limited staff working. This
strike impacted the care coordinators of Erie St. Clair and newly discharged patients from local
hospitals. These patients were to be assessed in order of priority which slowed the referral
process during the strike. Many clients asked my preceptor and I if we were on strike during this
time. Some assumed that we would not be making home visits during the strike. My nurse
informed our clients of exactly who was on strike and that the individual care of clients in the
home would not be affected. At the beginning of March 2015, a letter was sent to those who
receive CCAC services by Lori Marshall, Chief Executive Officer, who apologized for any
inconveniences and gave a phone number if the public wished to voice any questions or
concerns.
This strike had the most impact on seniors who were made to wait longer in the hospital for
home care services. Seniors’ health is an important aspect in the health care of Essex County.
The elderly make up 58% of CCAC’s clientele in Ontario alone (Home Care Ontario, 2014). In
addition to the home care services CCAC provides, other services available in Essex County are:
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assisted living, housing with supports (retirement home subsidy), and long term care (County of
Essex, 2014). Accessibility to health services for seniors is crucial to maintain a healthy and
dignified life. Those living in rural counties have greater disparities and therefore require the
most assistance.
The Ontario Association of Community Care Access Centres reported a more growing,
aging, and diverse population in the near future. It indicates the themes that are seen in people in
hospice palliative care, and seniors and children with complex needs. Some themes include:
(1) A demand for services has been growing and will continue to grow;
(2) More demand for home and community care will also evolve what people need and their
expectations;
(3) Technology will continue to enable more effective home and community care; and
(4) There is a need for greater clarity about what we should expect from our health care system
and how we will pay for health services (OACCAC, 2014).
OACCAC’s approach to responding to health care changes is reported in their paper
Health Comes Home: Part 4: Launching the Conversation. “People with chronic conditions and
children with complex needs are living longer and choosing to live in their own homes for as
long as possible. That means we need more care and services in the community” (OACCAC,
2014). Addressing individual needs and providing custom care plans is needed to maintain the
health status of this growing population. Finding ways to facilitate these needs are what health
care organizations need to be part of in order to fully respond to the delivery of care.
Culture and Religion
Many residents of Essex County take pride in living amongst areas of rich history and
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influence. More notably, Essex County is the home of many First Nation tribes. These cultures
strive to preserve their heritages by having their own methods of treatment for illnesses as well
as practices for everyday life. Many of these minority groups have disadvantages when it comes
to accessing health care because of treaties and jurisdiction ambiguities. With all of the
complexities surrounding the access to health care services, First Nation populations still remain
strong in sustaining their beloved culture.
Together, culture and religion can have an impact on how clients require their health care
services to be delivered. During ParaMed’s initial visit when opening a new case, it is a
formality to ask clients if they have any religious affiliation that would impact the delivery of
health care. Asking these questions during the first clinical visit allows the nurse to demonstrate
culture sensitivity and awareness to one’s ethnic background in relation to their religious
affiliation. The following table shows the most reported religions in Essex County according to
the National Household Survey (2011):
Table 2:
Religion Total Male Female
Christian 284, 520 135, 800 148, 720
Muslim 15, 995 8, 105 7, 890
No Religious Affiliation
70, 665 38, 150 32, 520
Respondents who reported as being ‘Christian’ encompasses a variety of sub-religions
including: Anglican, Baptist, Catholic, Christian Orthodox, Lutheran, Pentecostal, Presbyterian,
United Church, and Other. ‘Catholic’ was reported as being the highest amount out of this
group.
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Government & Politics
The overseeing government in Essex County is responsible for services and financial
obligations. Such services include: transportation on county roads, libraries, long term care, land
ambulance, emergency preparedness, and planning services. Essex County is also a funding
partner in services that include: child care, social services, public health, and social housing
(County of Essex, 2014).
Nationally, Canada’s health care operates as a publicly-funded system under the Canada
Health Act. This act is responsible for the universal delivery of health insurance plans for
federal cash transfers. Each province and territory must provide reasonable access to hospitals
and services without subjecting Canadians to extra-billing and user fees. Five principles of the
Canada Health Act are: universality, public administration, accessibility, comprehensiveness,
and portability (Health Canada, 2012).
Provincially, Ontario operates under the Ontario Health Insurance Plan (OHIP).
Provincial roles include: administration of health insurance plans, planning and funding of care
in hospitals and other health facilities, planning and implementation of health promotion and
public health initiatives, and negotiation of fee schedules with health professionals (Health
Canada, 2012). The Commitment to the Future of Medicare Act, 2004 is an act that works in part
with the CHA which solidifies Ontario’s commitment to insured access to health care services.
This act allows the Ministry of Health and Long-Term Care to ensure that all Ontarians with a
valid health card have ongoing equitable access to health care.
Every Ontarian has equal rights to access health care services, yet, inequalities are still a
factor. The Canadian government has stated that they are anticipating future problems with the
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way health care is delivered. Some trends that the government has noticed are: the progressive
aging of baby boomers, the high cost of new technology, and fiscal constraints. The ways in
which health care services are to be accessed in the future should be re-evaluated amongst
leading health care service providers, such as ParaMed.
Law and Safety
Residents in Essex County grow and prosper in very safe communities. Crime statistics
(2011) reported in The Windsor Star that the safest community in Canada is Amherstburg
followed by LaSalle. Other municipalities in Essex County that made the list are Tecumseh and
Lakeshore which ranked fourth and fifth, respectively. Kingsville was also mentioned and was
ranked at tenth (Wolfson, M, 2012).
What potentially make Essex County safe are the emergency services which include EMS,
fire, and police services. The Ontario Provincial Police (OPP) serves the towns of Leamington,
Tecumseh, Kingsville, Lakeshore, and Essex. (County of Essex, 2014).
While Essex County may be the safest place to live, other factors that influence safety are
the laws that are put in place. It is now the law to have accessible customer service as of January
1, 2008. This law requires businesses and organizations allow their operations to become
accessible to those with disabilities. The Accessibility for Ontarians with Disabilities Act 2005
creates provincial accessibility standards for those accessing goods and services (County of
Essex, 2014). This act is the first in a series of standards that will allow Ontarians to have
complete accessibility by 2025.
Education & Healthy Child Development
Healthy child development starts at the Windsor-Essex County Health Unit. Here, they
provide classes and programs for pregnancy and parenting. Such classes include: prenatal
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classes, feeding your baby, home visiting programs, immunizations, and nutrition (County of
Essex, 2014). It is important to educate expecting parents on healthy behaviours. Poor childhood
developmental characteristics (low birth weight or poor nutrition) can compromise brain
development that will extend through adulthood (Stamler & Yiu, 2012). It is also essential for
community health nurses to teach parents about other issues which may impact health and social
needs such as social assistance. Low-income or disadvantaged children are at a greater risk for
poor health and tend to not do well in school.
Learning to adopt healthy behaviours and societal norms are ideally set in schools. Both
elementary and secondary schools are operated by the following 4 school boards: Greater Essex
County District School Board, Windsor Essex Catholic District School Board, French Catholic
School Board, and French Public Board (County of Essex, 2014).
Transportation
A dependable transportation system is necessary to ensure that the community has access to
health care services. Currently, there is no public transit system for of Essex County. In lieu of
public transit, Essex County provides a program called the County Wide Active Transportation
System which encourages the use of human power to get around (County of Essex, 2014). ‘Self-
propelled’ transportation includes biking, walking, running, and in-line skating. (County Wide
Active Transportation System, 2014).
Many residents of Essex County do not participate in this kind of transportation system,
especially those who require home care services. Table 1 shows a variety of methods of
transportation as reported by the National Household Survey. While most people have access to
a vehicle, a good portion of the population uses other methods to get around. This can have a
negative impact on accessing health care if clients need to get to a doctor’s appointment or
FACILITATING IMPROVED ACCESSIBILITY 15
perhaps visit a local clinic.
Some clients rely on their own method of transportation or a family member/caregiver to
drive them to appointments, clinics, or drugstores. Other clients rely solely on health care staff
to visit them at home to provide care. Home health care organizations such as ParaMed are
dependent on their nursing staff to have their own vehicle in order to provide equitable health
care.
Communication
Communication is crucial for building relationships that can subsequently assist in the
delivery of quality health care services. CCAC is the main communication center between
communities and local health care service providers. “CCACs work together, and with
physicians, hospital teams and other health care providers to enhance access and co-ordination
for people who need care in their own homes in the community, in supportive housing, or in a
Long-Term Care Home” (Ontario Ministry of Health and Long Term Care, 2008). CCAC’s
Service Provider Relations Framework outlines the ways in which CCAC integrates its health
services to meet the needs of the public. The framework promotes interdependency to works as
an ongoing dialogue between CCAC and its service providers. It works to promote:
High quality, resource effective services to CCAC clients;
Successful and sustainable CCAC-Service Provider partnerships;
Consistent contract management practices within and across CCACs related to:
o Support of contract principles at all levels of the CCAC and Service Provider
organizations;
o Interpretation of contract language;
o Use of contract tools for performance measurement and monitoring; and
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Collaboration in the pursuit of innovations in practice and service delivery (Community
Care Access Centre, 2009).
Along with CCAC, ParaMed can communicate with their clients by providing a clear
directory of phone numbers and extensions that clients can call during regular office hours as
well as after hours. Effective and efficient communication sets the foundation for clear, concise
messages that can assist in the equitable access of health care services. Other services should
further be incorporated into the care of these clients to meet other health care needs. Some
clients may not be aware of services and organizations that could assist in their individual needs.
It is essential that a home care agency such as ParaMed facilitates in the holistic care of their
clients by calling upon other services within the community.
Literature Review
The literature explains the benefits to increasing and improving nurse/client education for
the purpose of accessing effective health information. Client-centered interventions have been
shown to be more focused on facilitating proper use of Telemedicine and Telehealth whereas
nursing-centered interventions are focused on how nurses can access information to improve
their knowledge when working in the community. I am looking to create a resource for clients
that can facilitate optimal usage of local services which can be incorporated into ParaMed’s
orientation documents and given upon the first visit. For nurses, I want to create a resource that
can enhance their knowledge on procedures that are not commonly seen in their day to day. This
would benefit the clients by providing quality care nursing services and would decrease any risk
of harm. The literature review reflects both concepts.
Nurses
A study done by Fowler (2012) looked at how knowledgeable community nurses were on
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the topic of heart failure. Some of the nurse’s patients were having repeated visits and
readmissions to the hospital because of their illnesses related to heart failure. The study noted
how coaching interventions need to be tailored to the patient when promoting self-management.
“Nurses need to possess a strong understanding of the pathophysiology of heart failure because
this knowledge is key to understanding drug therapy and self-management principles” (Fowler,
2012). The results concluded that in order to improve nurses’ knowledge on heart failure, an
educational and communication-based intervention would be effective. This study is informative
for me because it explains how community nurses had a deficit in a specific topic and an
educational tool was implemented to improve their knowledge. The educational resource I
would create to improve nurses’ knowledge would be focused on a concept like this by utilizing
ParaMed’s existing protocols. This resource would be used by community nurses the way
hospital nurses can access pamphlets and flyers to improve their knowledge.
A suggestion made by RNAO to further improve accessing health care in communities is
to secure the continuity of care and continuity of caregiver. Current models of delivering nursing
care reflect best practice guidelines and continuing the use of the best evidence available
continues to optimize nursing care. Another suggestion is to expand the role of the RN by
maximizing knowledge, skills, and experience so that the nurse can practice within their full
scope. Lastly, addressing educational needs, recruiting and retention of health care professional,
and expanding the role of the RN is needed by developing a health-related human resource
intervention (RNAO, 2011). The goal for my nursing-based intervention is to maximize the
knowledge of community nurses so that they can continue to deliver high quality health care
services to their clients. I can do this by creating resources for them in the form of an
FACILITATING IMPROVED ACCESSIBILITY 18
educational tool that is standardized and meets specific criterion according to ParaMed’s current
policies.
Jefferies & Shah (2011) looked at how implementing different educational tools for
clinicians can be successful when providing information to patients. Their study suggested that
using pocket cards are preferred amongst clinicians because these tools are simple and easy to
access. The study also explains how multifaceted learning strategies are the most effective
intervention when implementing change. The study further explains how educational tools are
used more often because they are simple and easily accessible, and the simplest tools are the
most effective when leading practice change. My intervention for community nurses would be
to create an educational tool such as a pocket card or pamphlet that they can keep either in their
nursing bag or in the glove compartment of their car. It would meet quality standards by using
ParaMed’s existing procedural protocols.
A very informative piece done by Clark (2009) elaborates on patient educational
materials. She explains, “If used properly, a handout can be used to facilitate communication
between the provider and patient, and guide the patient education part of the visit, as well as give
a patient a document to use at home to refresh his/her memory and enhance understanding of
his/her condition and treatment plan” (Clark, 2009). Reasons to have educational handouts for
patients are: memory, anxiety, hearing, demand management, communication, and complexity.
The handouts should also be customized to include contact information for the clinic or hospital.
These handouts do not have to be patient-specific. Other things to consider for appropriateness
are: reading level, language, design, illustrations, content, demand-management value, ethnicity,
and source (Clark, 2009). The author provides helpful web links that meet health care standards
for patients to access such as Familydoctor.org and Healthfinder.gov. I can incorporate this
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valuable information when creating my educational resources for both nurses and clients. This
outlines specific topics to be aware of such as readability, content, and language which are
essential when trying to create a successful, useful resource.
Clients
According to the Registered Nurses Association of Ontario (2011), Ontario would need
to hire close to 15,000 more registered nurses to align the province’s nurse-to-patient ratio with
the rest of Canada. Accessing nursing care is an essential part of creating vibrant communities
and facilitating optimal health outcomes. “Full-time RNs, as compared with part-time and casual
employees, are closely associated with lower mortality rates, continuity of care and continuity of
caregiver for patients, and better morale” (RNAO, 2011). It is clear that there are not enough
nurses available to deliver face-to-face health care to those in Ontario. As of 2013, 15.6% of all
Ontario is having difficulty accessing health information or advice (Statistics Canada, 2015).
These statistics show that there is a deficit in the availability of nurses compared to the needs of
patients. Statistics also show that patients are trying to access appropriate health care but have
having difficulty doing so. ParaMed reaches a large portion of the population who access health
care services. Enhancing the way clients access health care by organizing phone numbers and
informing them about local services can bridge these gaps that are being seen, yet a resource
currently does not exist.
A study conducted by Moffat & Eley (2010) researched the use of Telehealth in rural
Australia. The report showed benefits to using Telehealth and Telemedicine for both patients
and professionals. The report claims to have improved access and quality of health care services
amongst those living in rural areas. The authors explain that patients have benefitted from:
“Lower costs and reduced inconvenience while accessing specialist health services; improved
FACILITATING IMPROVED ACCESSIBILITY 20
access to services and improved quality of clinical services” while health care professionals
benefitted from, “Access to continuing education and professional development; provision of
enhanced local services; experiential learning, networking and collaboration” (Moffat & Eley,
2010). The findings of this study suggest the increased use of Telehealth has the potential to
decrease inequitable access to health care. The findings also suggest using Telehealth to address
on-going problems of recruiting and keeping rural health care staff.
Telehealth Ontario is available to those living in Essex County. 211 is another service
which links the public with information and referrals for community, social health, and
government services. People who use ParaMed may not access these services and may not know
its value and benefits. Perhaps if clients were informed of this added service in times when
ParaMed cannot be reached, clients would have a better sense of health care accessibility.
Telehealth is a great way to bridge inequitable gaps; however, if clients want to access
health care information over the internet, they need to be more technologically savvy. There are
more than 700, 000 websites that offer health information and more than 50 million people who
seek this kind of information online as Cline & Haynes (2001) explains. Public health
professionals need to be concerned about this because clients can access the wrong kind of
information from a website that does not meet certain health care standards. Access can become
inequitable and could cause consequences for the health care system because of inaccuracy of
information. Clients can encounter navigational challenges because of numerous website design
flaws such as disorganization, technical language, and lack of permanence (Cline & Haynes,
2001). The authors suggest reinforcement is needed to evaluate quality standards and
information for websites offering health care information. Having a resource to present to clients
that is government officiated and meets quality standards can direct clients to the right kind of
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health care information and services. I can use this kind of information to formulate my own
resource to present to ParaMed that would allow for easier access to health care services.
The use of technology and education can greatly affect a client’s access and quality to
health care services. A small town called Brazos Valley in Texas composed of 7 counties
developed a regional community solution to combat the issues rural populations were facing. A
2002 study revealed poorer health conditions and fragmented health care systems which were not
seen in urban parts of Texas. This localized strategy gave way to a “one-stop shop” where a
multidisciplinary team of health care professionals can deliver services to those in rural areas
(Garney, Drake, Wendel, McLeroy, Clark, & Ryder, B., 2013). Reduced overhead costs allowed
service providers to deliver services such as transportation, information and referral, and case
management to rural areas. Local oversight bodies evaluated the effectiveness of the solution by
collaborating with local entities which led to continuing the expansion of rural health care
services. Services like these and much more are already available in Essex County but there are
still people who do not make use of them or do not know how to contact them. A useful
resource should be the “one stop shop” by including local services that would be most frequently
used. Some services that I can add to my resource are: Poison Control, Canadian Mental Health
Association, Heart and Stroke Foundation, and Windsor/Essex County Health Unit.
Nursing Diagnoses
In order of priority:
1. Readiness for enhanced knowledge as evidenced by clients and nurses seeking new
resources.
FACILITATING IMPROVED ACCESSIBILITY 22
2. Deficient access to community health care services and educational tools related to rural
home care delivery as evidenced by clients and nurses requesting a standardized resource
to accommodate health care needs.
3. Ineffective continuation of nursing knowledge related to a lack of in-service education as
evidenced by nurses expressing a need to have more frequent continuing education
opportunities.
4. Risk for compromised health outcomes as evidenced by inequitable access to health care
services by living in rural communities.
Nursing Care Plan
Refer to Appendix A for a detailed nursing care plan for both clients and nurses.
Discussion
During my time at ParaMed Home Health Care, there were many barriers set in place that
created an overall challenging experience for me. Deciding what to focus my attention on was
difficult because there was a perceived lack of options. What eventually led to the idea of
improved accessibility came from emerging themes that I had noticed while visiting clients in the
rural areas of Essex County. Thus began the idea for my client-centered intervention on creating
a standardized resource that largely met the needs of clients. Creating a resource that only met
client-centered needs did not seem as though it would be a worthy project; which led to the
introduction of a nursing-centered intervention. The idea of creating a resource to improve
accessibility for both clients and nurses helped generate a holistic approach to my project.
While in the planning stages of my resources, I encountered several obstacles within the
organizational culture of ParaMed. First, the agency was experiencing a reduction in supervising
staff. This created barriers for obtaining permission to send out a survey to the nurses through
FACILITATING IMPROVED ACCESSIBILITY 23
their work phones. Eventually, the concept of my project was explained to a supervisor and the
survey was successfully sent. Another obstacle was the combination of the CCAC strike and the
merging with Revera Health Services. This, along with staffing shortages, demonstrated an
increased level of difficulty as I attempted to implement my resources.
Within a relatively small amount of time, the black cloud of obstacles had lifted and the
culture of ParaMed was sent back into motion. The strike ended rather quickly and new nurses
were recruited to fill the vacant supervising positions. I was able to speak to an appropriate
nursing supervisor about my project which resulted in their approval for my intended
interventions.
For clients, a standardized, laminated tool was created that included a directory of phone
numbers and government-officiated websites of local services on one side. On the other side,
space is allotted for clients to input their own phone numbers for family doctors, nurses, and
drugstores. This tool is meant to be placed in a convenient location, such as the refrigerator, so
that clients have easy access to health care information. A dry-erase marker is meant to
accompany this tool at the agency’s expense. A preview of this prototype is available in
Appendix E. This intervention is appropriate because it applies to seniors which make up the
majority of CCAC home care users. Furthermore, the font is large enough for clients to read, it
is attention-grabbing, and provides government-officiated websites for easy use as well as
emergency/referral phone numbers.
For nurses, compact, visually appealing educational pamphlets were created using input
from the survey presented in Appendix D. These pamphlets are meant to be replicated for each
nurse and kept with them in their car for easy access. They may also be used as educational tools
for clients when doing health teaching. The topics were chosen based on the skills that were
FACILITATING IMPROVED ACCESSIBILITY 24
most commonly requested. The responses generated from the survey reported 85.71% of nurses
requesting a need for improved education on ostomy and tracheostomy care. The finalized
prototypes are available for preview in Appendix F. To assist in those requesting other types of
resources, a suggestion is made for nurses to advocate to their head office for the supply of
newly implemented protocols as evidenced by the research provided in Appendix D.
Since the nursing-centered interventions were solely based on existing protocols, a
quality assurance check was performed to evaluate the consistency of information. The original
protocols that were used are available for preview in Appendix B. Each protocol identifies its
implementation date, a copy written date, and references.
The protocol entitled, “Application of Ostomy Appliance” (p. 33-35) was implemented in
March 1997 and its references include information from Potter & Perry (n.d). This document
was crossed-referenced with Kozier & Erb (2009, p. 1255-1277). The information provided in
Kozier & Erb resembles that in ParaMed’s protocol which establishes consistency between the
documents. The only difference between the two documents is that Kozier & Erb provides
rationale for most steps in order to assist the reader’s learning. Kozier & Erb also provide visuals
whereas ParaMed’s protocols do not.
For the tracheostomy care procedures, the protocols are divided into three different
documents: Cleaning Outer Cannula and Faceplate, Suctioning, and Tie Change. The documents
entitled, “Suctioning” and “Tie Change” were both implemented in March 1997. Their
references are from British Columbia Children’s Hospital, Children’s Hospital of Eastern
Ontario, and the Royal Ottawa Regional Rehabilitation Centre. While these were both
implemented in 1997, “Cleaning Outer Cannula and Faceplate” was carried out in March 2009.
References include that of Potter & Perry (2007), Robin Rice (1995), and St. Joseph’s Healthcare
FACILITATING IMPROVED ACCESSIBILITY 25
(2005). When comparing these documents to that of Kozier & Erb (2009), there is not much
difference in the information. Both provide a purpose for each intervention, a list of equipment,
and a detailed list on how to perform the procedures. Kozier & Erb may be the more superior
document of the two because it contains more detail, rationales, and pictures to facilitate visual
learning. One must note that while Kozier & Erb provides a more visually appealing skill
explanation, it is meant as a teaching aid for nursing students.
Performing a quality assurance check was essential to identify gaps within ParaMed’s
protocols. The information contained in these documents is what nurses and supervisors rely on
to provide safe, competent care. Ensuring the consistency of the information as compared to
another recent, reliable resource was needed to further evaluate the accuracy of these documents.
The intention for these educational tools was to take ParaMed’s existing protocols and revitalize
them. The final products are pamphlets that are visually appealing, compact, and contain
accurate information to facilitate continuing education with ParaMed’s nursing staff.
A way in which one would measure the efficacy of these tools is by an evaluation survey
for each intervention which is provided in Appendix G. These evaluation surveys use a Likert
scale which measures the level of user’s satisfaction. The information gathered by these surveys
allows ParaMed to assess the level of the tool’s integrity. A decision can later be made whether
to continue using the proposed tools as is or to find ways to improve them.
Conclusion
To conclude my community health nursing process assignment, the proposed
interventions to improve accessibility appropriately meet the needs for both ParaMed clients and
nurses. Needs were identified by using surveys to create educational tools to facilitate the way in
which clients and nurses access information. This was an appropriate avenue to further explore
FACILITATING IMPROVED ACCESSIBILITY 26
because it applied to those accessing health care services in rural areas as well as nurses who
work for a health care agency.
The overall impact of my interventions has generated a well-received response amongst
clients, nurses, and nursing supervisors. I was able to meet with a supervisor at ParaMed who
provided me with feedback on where the future lies with my resources. Budget constraints
continue to be an issue as with any business. It may be possible to start implementing the
nursing-centered educational tools as paper copies to give to staff. For the client-centered
intervention, it may be more difficult to implement this because the resource needs to be
laminated. Cost for lamination may pose as an issue because the resource would also need a
supply of dry-erase markers. Overall, the supervisor showed great enthusiasm for the idea and
was able to foresee an active use in these educational tools. Their feedback provided strong
recognition to the idea of facilitating improved access to health care services and continuing
education amongst ParaMed’s clients and nurses.
The research I gathered elicited other needs that were unknown to ParaMed’s supervising
staff, as addressed in Appendix D. ParaMed can continue to utilize the information I gathered by
advocating to their head office for more, newly implemented strategies to meet these specific
needs.
Home health care agencies like ParaMed do their part by ensuring clients have reasonable
access to optimal health care services while also retaining knowledgeable and competent nurses.
Research has shown that despite these efforts, there are still populations who are receiving
inequitable health care services. Improving the ways in which accessibility is met to all clients
and nurses can bridge the long standing accessibility gaps that are seen within Canada’s health
care system.
FACILITATING IMPROVED ACCESSIBILITY 27
References
Census of Canada. (2011). Retrieved February 6, 2015, from http://www12.statcan.gc.ca/census-
recensement/index-eng.cfm.
Clark, N. (2009). Patient education materials. Florida State University College of Medicine.
Cline, R., & Haynes, K. (2001). Consumer health information seeking on the internet: The state
of the art. Health Education Research, 16(6), 671-692.
Community Care Access Centre. (2009). CCAC - Service Provider Relations Framework.
Retrieved February 27, 2015, from
http://healthcareathome.ca/serviceproviders/en/Documents/20131101Appendix
B.PDF#search=communication.
Community Care Access Centre. (2014). Retrieved February 18, 2015, from
http://www.healthcareathome.ca/serviceproviders/en/Service-Provider-Listing/Erie-St-
Clair.
Community Care Access Centre. (2014). How CCAC's care: An update on quality improvements
for patients.
County of Essex. (2014). Retrieved February 7, 2015, from http://www.countyofessex.on.ca.
County Wide Active Transportation System. (2014). Retrieved February 19, 2015, from
http://www.cwats.ca/en/places-to-go/explore-our-area.asp.
CTV Windsor. (2014). Concerns over homecare cuts in Windsor. The Windsor Star. Retrieved
February 27, 2015, from http://windsor.ctvnews.ca/concerns-over-homecare-cuts-in-
windsor-1.2122417.
Fowler, S. (2012). Improving community health nurse's knowledge of heart failure: Education
principles. Home Healthcare Nurses, 30(2), 91-99.
FACILITATING IMPROVED ACCESSIBILITY 28
Garney, W., Drake, K., Wendel, M., McLeroy, K., Clark, H., & Ryder, B. (2013). Increasing
access to care for Brazos Valley, Texas: A rural community of solution. The Journal of
the American Board of Family Medicine, 26(3), 246-253.
Health Canada. (2012, October 9). Canada's health care system. Retrieved March 9, 2015, from
http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcs-sss/index-eng.php.
Home Care Ontario. (2014). Facts & Figures - Publicly Funded Home Care. Retrieved
February 2, 2015, from http://www.homecareontario.ca/home-care-services/facts-
figures/publiclyfundedhomecare.
Jefferies, A., & Shah, V. (2011). Clinicians prefer simple educational tools for implementing
practice change. Simple Educational Tools and Practice Change, 33, 602-606.
Leamington Hospital. (2011). Retrieved February 18, 2015, from
http://www.leamingtonhospital.com/about.php?id=12.
Moffatt, J., & Eley, D. (2010). The reported benefits of telehealth for rural Australia. Australian
Health Review, 34(3), 276-281.
National Household Survey. (2011). NHS Profile, Essex CTY. Retrieved February 26, 2015,
from http://www12.statcan.gc.ca/nhs-enm/2011/dp- pd/prof/details/Page.cfm?
Lang=E&Geo1=CD&Code1=3537&Data=Count&SearchText=
Essex&SearchType=Begins&SearchPR=01&A1=All&B1=All&GeoLevel=PR&GeoCod
e=10#tabs1.
Ontario Association of Community Care Access Centres. (2014). Making way for change:
Transforming home and community care for Ontarians.
Ontario Ministry of Health and Long Term Care. (2008). Community Care Access Centres.
Retrieved February 28, 2015, from http://www.health.gov.on.ca/en/public/contact/ccac/.
FACILITATING IMPROVED ACCESSIBILITY 29
Ontario Ministry of Health and Long Term Care. (2011). Rural and northern health report.
Retrieved March 8, 2015, from
http://www.health.gov.on.ca/en/public/programs/ruralnorthern/docs/exec_summary_rural
_northern_EN.pdf.
ParaMed Home Health Care. (2013). Services. Retrieved February 25, 2015, from
http://www.paramed.com/homecare/about/.
Public Health Agency of Canada. (2008). Social and economic factors that influence our health
and contribute to health inequalities. Retrieved February 26, 2015, from
http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2008/fr-rc/cphorsphc-respcacsp07a-
eng.php
Registered Nurses Association of Ontario. (2011). Creating vibrant communities: RNAO's
challenge to Ontario's political parties.
Stamler, L. L., & Yiu, L. (2012). Canadian health nursing: A Canadian perspective. (3 ed.).
Toronto, Ontario: Pearson Canada Inc.
Statistics Canada. (2015). Difficulties accessing health information or advice, among those who
required care at any time of day, household population aged 15 and over, Canada,
provinces and territories. Retrieved February 21, 2015, from
http://www5.statcan.gc.ca/cansim/a47.
The Windsor Star. (2015). Retrieved February 18, 2015, from
http://www.blogs.windsorstar.com/news/thousands-of-ccac-nurses-go-on-strike-in-
windsor-and-across-province.
Wolfson, M. (2012, September 18). Essex County safest place in country. The Windsor Star.
Retrieved March 8, 2015.
FACILITATING IMPROVED ACCESSIBILITY 30
Appendix A
Client-Centered:
Goals Nursing Interventions P, N, G Target Date EvaluationParaMed clients will report
improved access to
necessary services as
evidenced by 25% higher
satisfaction scores pre - and
post – intervention.
Poll clients and ask whether they find
difficulty in accessing health care services and
if they would like to have a new resource be
created to facilitate in this.
P January 31,
2015
Out of 10 clients polled, all said yes.
This indicates that there is a need for
a more standardized resource to meet
the needs of the clients.
Create resource according to quality
standards, readability, and appropriateness for
clients as outlined by Clark (2009)
P March 15,
2015
An evaluation tool was created using
a Likert Scale that measures the
tool’s efficacy. A preview is
available in Appendix G
Pilot the new resource to ParaMed
supervisors
P March 29,
2015
I met with a ParaMed supervisor on
March 19, 2015 where I presented a
completed prototype and an
evaluation tool. More detail is
FACILITATING IMPROVED ACCESSIBILITY 31
provided under the heading
“Conclusion”.
Nursing-Centered:
Goals Nursing Interventions P, N, G Target Date Evaluation
ParaMed nurses will report
improved access to
continuing education
services as evidenced by
25% higher satisfaction
scores pre - and post –
intervention.
Create a survey for nurses to access on their
work phones that will ask if they require a
new resource and what kinds of information
they would like to see on it.
P January 31,
2015
The survey went live on February
9, 2015 on
www.surveymonkey.com
Nurses were given three questions
to answer. As of date, 7 people
responded. A more in-depth look
on responses is available for
preview in Appendix D.
Assess the responses and formulate a
prototype according the most responded
topics.
P March 29, 2015 According to the survey responses,
85.71% reported an interest in
learning more about the
application of ostomy appliances
FACILITATING IMPROVED ACCESSIBILITY 32
and tracheostomy care and
suctioning.
Create resource according to quality
standards, readability, and appropriateness
for nurses as outlined by Clark (2009)
P March 15, 2015 An evaluation tool was created
using a Likert Scale that measures
the tool’s efficacy. A preview is
available in Appendix G
Pilot the resource to supervisors at ParaMed
for evaluation.
P March 29, 2015 I met with a ParaMed supervisor
on March 19, 2015 where I
presented completed prototypes
and an evaluation tool. More
detail is provided under the
heading “Conclusion”.
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Appendix B
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Appendix C
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Appendix D
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Appendix E
Phone Numbers and Useful WebsitesAlzheimer Society of Windsor and
Essex County519-974-2220 www.alzheimerwindsor.com
Arthritis Society 800-321-1433 www.arthritis.caCanadian Cancer Society 519-254-5116 www.cancer.ca
Canadian Diabetes Association 800-226-8464 www.diabetes.ca Canadian Mental Health
Association Windsor/Essex519-255-7440 www.cmha-wecb.on.ca/
home/home.aspCentre for Addiction and Mental
Health800-463-6273 http://www.camh.ca/en/
hospital/Pages/home.aspxCCAC 519-258-8211 www.ccac-ont.ca
Elder Abuse Ontario 866-299-1011 www.elderabuseontario.caFamily Services Windsor/Essex 519-966-5010 www.familyserviceswe.caHeart and Stroke Foundation of
Canada519-254-4945 www.heartandstroke.ca
Hospice of Windsor/Essex 519-974-7100 www.thehospice.caPoison Control of Ontario 800-268-9017 www.ontariopoisoncentre.com/
poisoncentre/Senior Safety Line 1-866-299-1011 www.onpea.caTelehealth Ontario 866-797-0000 www.health.gov.on.ca/en/public/
programs/TelehealthWindsor/Essex County Health Unit 800-265-5822 www.wechealthunit.org
FACILITATING IMPROVED ACCESSIBILITY 56
My Doctor’s Office:
Ext: My Nurse:
Ext: My Drugstore:
Ext:
Other Important Phone Numbers:
Appendix F
911Police, fire, or medical
emergencies
311For Windsor residents to
request information on non-emergency programs or
eventswww.citywindsor.ca
211For Windsor and Essex
residents to request information for community,
social, health, and governmental services
www.211windsoressex.ca
FACILITATING IMPROVED ACCESSIBILITY 57
Application of Ostomy Appliances
Changing a Two Piece Bag
Carefully pull the pouch away from the skin in a downwards direction
Put the soiled bag into a plastic garbage bag
Use a towel and wipe away any access stool from the stoma
Use a wash cloth with warm tap water and mild soap and gently wash the entire ostomy area in a circular
motion
Rinse area well and pat dry with a towel
Let the skin air dry. In the meantime, assess the stoma site the same as in a one piece
Check the size of the stoma with a measuring card and trace the size on the new pouch
Next, cut a hole in the new pouch according to the size of the measuring card
Apply a barrier wipe around the stoma to prevent skin irritation
Fit the flange over the stoma and hold it in place for 30-50 seconds as warmth increases the adhesion to
the skin
Attach the stoma bag to the flange starting from the bottom ensuring alignment
Press the bag to expel air, the reapply the clip or clamp
Wash hands and document
Necessity of Buying Colostomy Bag [Online Image]. (2013). Retrieved March 15, 2015 from https://ostomysupplies23.wordpress.com/2013/05/10/necessity-of-buying-colostomy-bag/ParaMed Home Health Care. (1996). Application of ostomy appliance. Care Procedures.Stoma Bag Guide [Online Image]. (2013). Retrieved March 15, 2015 from http://www.ostomylifestyle.org/content/stoma-bag-guide.
A Quick Reference Guide for Nurses
FACILITATING IMPROVED ACCESSIBILITY 58
Procedure
Carefully pull the pouch away from the skin in a downwards direction
Put the soiled bag into a plastic garbage bag
Use a towel and wipe away any access stool from the stoma
Use a wash cloth with warm tap water and mild soap and gently wash the entire ostomy area in a
circular motion
Rinse area well and pat dry with a towel
Let the skin air dry. In the meantime, assess the stoma site for:
Redness and irritation Colour (should be pink) Size (should not be swollen)
Check the size of the stoma with a measuring card and trace the size on the new pouch
Next, cut a hole in the new pouch according to the size of the measuring card
Apply a barrier wipe around the stoma to prevent skin irritation
Remove the sticky side of the pouch and apply it over the stoma
Press the bag to expel air, the reapply the clip or clamp
Wash Hands and document
Changing a One Piece Bag
EquipmentNew collection bag
ScissorsTowels
Wash ClothPlastic garbage bagDisposable glovesMeasuring Card
Barrier Wipe
After gathering supplies, wash hands, don gloves, and explain the procedure to the client
It is best to change the bag in the bathroom so as you can remove the soiled collection in the toilet
before removing the pouch
Depending on the equipment, you may have to unclamp or unclip the bag to remove the soiled
collection
Some pouches can be 1 piece or 2 pieces:
FACILITATING IMPROVED ACCESSIBILITY 59
Tracheostomy Care and Suctioning
Changing the Tracheostomy Ties
ParaMed Home Health Care. (1996). Tracheostomy: Cleaning outer cannula and faceplate. Care Procedures. ParaMed Home Health Care. (1996). Tracheostomy: Suctioning. Care Procedures. ParaMed Home Health Care. (1996). Tracheostomy: Tie change. Care Procedures.Tracheostomy Neckband Collar [Online Image]. (2015). Retrieved March 18, 2015 from: http://www.baytownmedicalequipment.com/Catalog/Online-Catalog-Product/423/Disposable-Collection-Jar
A Quick Reference Guide for Nurses
Equipment:New TiesScissors
Clean Cloth and TowelHydrogen Peroxide and Water Solution (½ & ½)
Wash hands and explain procedure to the client
Cut a length of the new ties long enough to go twice around the client’s neck
Turn the client’s head to one side
Cut one end of the tie and clean the exposed skin using a cloth with ½ & ½ hydrogen peroxide
and water. Repeat on the other side
Pat dry. Do not use powders or lotions unless otherwise prescribed
Loop one end of the tie through the faceplate and secure it with a loose knot. Repeat on the
other side
Test for fit. You should be able to fit your index finger between the neck and the tie
Wash hands and document
Special Considerations:Change the ties after suctioning
Ties should be changed once a day or more often if they are wet or dirty as to prevent rashes or
other skin problems
FACILITATING IMPROVED ACCESSIBILITY 60
Cleaning the Outer Cannula Suctioning
Equipment4 x 4 Gauze Squares
Cotton Tip Swabs3% Hydrogen Peroxide
Normal SalineNon-Sterile Gloves
After gathering supplies, wash hands, don gloves, assemble equipment, and explain the
procedure to the client
Position the client either sitting or semi-reclining with the neck slightly hyper-extended
Remove the dressing around the tracheostomy tube and inspect the skin for:
Redness Swelling Ulcers Bleeding
Clean the exposed cannula with a cotton tip swab moistened with 3% hydrogen peroxide, then use a saline soaked cotton swab to rinse
Clean the stoma with a cotton tip swab moistened with hydrogen peroxide in a circular
motion going inward to outward, then use a saline soaked cotton swab to rinse
Pat the skin dry with a dry gauze square and replace the tracheostomy dressing
Wash hands and document
EquipmentSuction Machine
Clean GlovesSterile Gloves
Sterile CatheterNormal Saline
Sterile Cup
Check physician’s orders, wash hands, and explain the procedure to the client
Don a pair of clean gloves and pour normal saline into a sterile cup
Connect the sterile catheter to the suction machine and test it to make sure it is working. Normal suction
pressure is 80-120 mmHg
Don sterile gloves on your dominant hand only to manipulate the catheter
Lubricate the tip of the catheter with normal saline and then introduce it into the tracheostomy without
applying suction
STOP inserting if resistance is met
Apply intermittent suction when withdrawing the catheter and rotate it from side to side for a maximum of 10-15 seconds. Repeat until
secretions are cleared
Clean the catheter by suctioning normal saline
Make sure the client has a way to breathe in between suctioning
Dispose of gloves and catheter when finished
Wash hands and document
Suctioning
Appendix G
Client Satisfaction Survey
Dear ParaMed client,
We are asking that you assist us in providing feedback for our newly developed phone number and websites resource. This survey will be used to improve our health care delivery service practices. Your answers will be kept confidential. Please return a completed survey to your nurse. If you have questions, you can contact ParaMed at (519) 972-7760.
Thank you.
Rate our resource tool on a scale of 1-10:
9 – 10 Excellent7 – 8 Very Satisfied5 – 6 Satisfied3 – 4 Not Satisfied1 – 2 Poor
1. How long have you been using our phone number and websites directory tool? Less than a month 1 – 3 months 4 – 6 months Never used
2. How helpful do you find our phone number and website directory tool to be? Please circle your answer.
1 2 3 4 5 6 7 8 9 10
3. How satisfied are you with our directory?
1 2 3 4 5 6 7 8 9 10
4. How likely is it that you will use or continue to use this directory?
1 2 3 4 5 6 7 8 9 10
5. Please provide commentary on what ParaMed Home Health Care can do to improve this product in order to further assist your access to health care services:
Employee Satisfaction Survey
FACILITATING IMPROVED ACCESSIBILITY
62
Dear ParaMed employee,
We are asking that you assist us in providing feedback for our newly developed ostomy and tracheostomy care resources. This survey will be used to improve our commitment to continuing education. Your answers will be kept confidential. Please return a completed survey to your supervisor. If you have questions, you can contact your nursing supervisor.
Thank you.
Rate these resource tool characteristics on a scale of 1-10:
9 – 10 Excellent7 – 8 Very Satisfied5 – 6 Satisfied3 – 4 Not Satisfied1 – 2 Poor
Characteristic Poor Not Satisfied Satisfied Very Satisfied ExcellentHelpfulnessConvenience
Accuracy of InformationUsefulnessReadability
Please provide commentary on what ParaMed Home Health Care can do to improve these products in order to further facilitate your access to educational resources: