2019 – ‘Endowment Fund Awards – An Innovative Wellness Strategy for New Nurses at SickKids’ and ‘Apparent Cause Analysis’

An Innovative Wellness Strategy for New Nurses at SickKids

Team: Ann chang, Kelly McNaughton, Karen Breen-Ried, Bonnie Fleming-Carroll, Grace Garvey

Proposal: From hectic all night shifts to high-stakes surgeries, nursing is stressful. To mitigate some of this stress, this winning group is developing education sessions to ‘facilitate mental health awareness and well-being in new nurse hires’ at three 2019 Paediatric Nursing Orientations.

A summary report of their findings will be published here in the fall of 2020.


Apparent Cause Analysis

Team: Mollie Lavigne, Shagan Aujla, Andrea Boysen

Proposal: Accidents happen. But most can be avoided. That’s why SickKids launched Caring Safely in 2015 and it’s why these nurses are studying ‘Precursor and Near Miss events’. By analyzing their root causes, this team will empower clinicians and administrators to reduce harm. That way our nurses will be safer- – and so will our patients.

A summary report of their findings will be published here in the fall of 2020

2018 – Endowment Fund Awards – ‘All About Us Story Boards’ and ‘Masters of Flow: Training Emergency Department Nurse Navigators’

(Note: The following information is taken from “Remembering the Past. Redefining the Future: The Alumnae Association of the School of Nursing 2019 Impact Report”)

All About Us Storyboards

Team: Kim Hunter Szymanski Joanna Dockrill, Kate McCormick and Jane Hoang.

In 2016, cardiac nurses Lauren Scavuzzo and Kim Hunter-Szymanski noticed a problem on 4D.  Nurses were so busy moving from patient to patient that they had little or no time to get to know the families.  Their solution was simple….“All About Us Story Boards”, a family biography made of photographs, magic markers, stickers and paper hearts.  For parents the story boards would be a celebration of their child; for nurses, and the wider medical team, a way to understand what mattered to their patients and their families. Their pilot project was an unequivocal success but funding was limited and therefore, so was the scope.

According to Jane Hoang, a cardiac nurse, they were running sessions on 4D and in CCU and the families in the PICU would see what they were doing.  They were welcome to join in on the activity but no effort was put into recruiting PICU families to participate because funding was supposed to be for the Heart Centre only. 

To expand the program to the PICU, the team obtained funding from the Alumnae Association of the School of Nursing Endowment Fund.  Once they received the grant they were able to expand the program with inspiring results. Jane added that the board-making sessions are as important as the boards themselves, a chance for nurses to listen and families to connect. 

Thanks to the Alumnae Association more parents are sharing their stories, more nurses know which kids love lullabies and which kids love cuddles, which families have other children and which have one.  More nurses know their patients better and this translates into better, more personalized care.

Masters of the Flow – Training Emergency Department Nurse Navigators

Team: Julia Rice, Amanda Pontieri, and Lindsay Stewart

Ensuring every child gets the right care, from the right provider, at the right time is the role of the nurse navigator.  It’s not an easy job – especially when everything hits at once.  Think of the Emergency Department as an ever shifting jigsaw puzzle in which you need to place patients into the right spaces with the right staff.  To do this correctly you need a full assessment. Given that SickKids is a World class hospital, the range of patients is diverse and complex. This complicates an already difficult job.

The ED Flow Committee found a “massive inconsistency in the way the navigator works” which was leading to multiple downstream effects, including how quickly patients were being seen.

To achieve their goals nurses Lindsay, Amanda, and Lindsay obtained a grant from the Alumnae Association Endowment Fund to create a training package.  Now nurse navigators do one-on-one in-class training followed by an 8 hour clinical shift with a veteran navigator.  Emphasis is placed on thinking critically and creating capacity since real life emergency situations are impossible to anticipate. 

The results have been fantastic.  Kids are being seen sooner, families are less frustrated, and staff are happier. Plus it’s giving nurses real leadership opportunities and the chance to advance their skills.  This leads to a different type of relationship with the charge nurse and physicians as well. This is all thanks to our HSC nursing alumnae endowment fund!

2017 – Endowment Fund Awards – ‘The Virtual Operating Room’ and ‘The Fear-Fighting Toolkit’

The Virtual Operating Room: Developing a Virtual Reality Simulation for Perioperative Nursing Education in Neurosurgery Craniotomy

Team: Linda Nguyen and Dr. Clyde Matava

The operating room isn’t always the best classroom. That’s especially true for craniotomies in which nurses are elbow-to-elbow with surgeons and anesthesiologists, anticipating every surgical need. It’s demanding high-stakes work. Plus, most craniotomies are unplanned emergencies. Nurses on neurosurgery rotations often rush into the operating room, off-guard and unprepared.

Linda Nguyen, the Interprofessional Education Specialist for the Operating Room, knew there had to be a better way. So she started digging until she found her inspiration right here at SickKids – Dr Clyde Matava. In 2014 Dr Matava co-founded the Collaborative Human Immersive Interaction laboratory (CHISIL), a joint project between SickKids, Sunnybrook, and the University of Toronto that uses virtual reality (VR) for everything from patient education to medical simulations. It was a perfect fit.

Two years and one endowment grant later, Linda has a fully functional VR simulation. Now nurses on neurosurgery rotation don’t have to wait months to assist in a craniotomy. They just turn on a computer program, attach a headset, and they’re there – inside a virtual operating room, practicing. “It just creates a safe, consistent environment for learners”, Linda says. And that’s all thanks to the alumni who fund research like Linda’s and who make leaps in nursing education like this possible.

The Fear-Fighting Toolkit: A Toolkit for Caring for Patients with Anti-NMDAR Encephalitis and Their Families

Team: Eugenia Law, Michelle Peralta, Dr Arlette Lefebvre, Joley Johnstone, Dr Ann Yeh, Katanya Fuerst, Daniela Bruce, Kathryn Miller and Sarah Alisch

Eugenia Law’s fellow 5C nurses weren’t just stressed – they were afraid. The problem was anti-NMDAR encephalitis, a disease in which the immune system creates antibodies that attack healthy cells, including the brain’s NMDA receptors, which control electrical impulses. The result? Seizures and psychosis. Radical personality changes and violet mood swings. for families, it’s a tragedy: for nurses, it’s unpredictability and stress and fear.

Eugenia saw first hand how patients went from calm and complacent to delirious and violent with little to no warning. And when patients lashed out or lost control of their limbs, nurses like her had to restrain them – a difficult often dangerous process. “Things happen,” Law explains. “Someone gets kicked or slapped.” The situation was untenable, both for nurses and for patients. So Eugenia decided to do something about it. With the help of a generous grant from the Alumnae Association of the School of Nursing Endowment Fund she began working on a toolkit to better prepare nurses to treat patients with anti-MNDAR encephalitis. And it’s making a difference.

It started with education, including an in-service session on restraints and a class on managing agitation. For more anti-NMDAR encephalitis-specific content Eugenia created a shareable digital folder with everything from trigger recognition to de-escalation strategies like mindful breathing. Next up is a step-by-step treatment plan. “It’s a kind of a check list that we can have above the patient’s bed that family can se and everyone can then work together to individualize treatment”, Eugenia says. Once finished it will mean better care for patients and happier, safer nurses.

(The information above is taken from: “Remembering the Past. Redefining the Future. The Alumnae Association of the school of Nursing, 2018 Impact Report)

2016 -Endowment Fund Awards – Increasing Resiliency to Nursing in Paediatric Oncology and Palliative care And Achy Penguin:Tool to Improve Pain Assessment in 4-7 Year Olds

Increasing Resiliency to Nursing in Paediatric Oncology and Palliative Care on 8A

After observing what appeared to be the burnout and exhaustion from staff on 8A, the team, made up of Tenecia Hiller, Amanda Li, Cristina Emanuale, Briar O’Neil, Bryanne Cassidy, Ann Chang, and led by Carolyn Wilson, suggested undertaking a Quality Improvement project to offer support for their peers and increase resiliency and work life. The project will use structured methods to shape a program aimed at improving nurse resiliency, including access to professional support to build resiliency and learn healthy coping mechanisms. 

Achy Penguin: Usability Testing of a Smartphone-based Tool to Improve Nursing Pain Assessment and Management in Children Aged 4-7 Years,

Pain is common in hospitalized children yet it is frequently under assessed and under treated. Valid and reliable pain assessment is the first step in effective management. However, assessing pain in young children four to seven years old is a particular clinical challenge. There are validated tools to assess pain intensity in this group, but these tools do not capture information on pain location or provide patients with pain self management strategies. The project team team made up of Carley Ouellette, Jennifer Stinson, Chitra Lalloo, Fiona Campbell and Ted Gerstle, is focused on ‘Achy Penguin’, a smartphone-based tool designed to improve pain assessment and management among children four to seven years old. This innovative tool uses animal-based body maps to help children self-report pain location (by placing dots on a simple body map) and pain intensity (by choosing from a series of four faces illustrating different pain amounts). The app provides interactive self-management strategies, including deep breathing, relaxation, and distraction. The Endowment Fund will support usability testing of this innovative app with patients.

2015 – Endowment Fund Awards – 1. Good 2 Go Transition Program and 2. Prevention and Management of Paediatric PIV-related Harm

In November 2015 two awards were announced to the following teams. We look forward to hearing their reports in November 2016 at the Nursing Alumnae Endowment Fund event.
1. Good 2 Go Transition Program with team members Khush Amaria, Megan Henze, Margaret Schwan, and led by Geraldine Cullen-Dean. Teens with chronic health conditions can experience negative health outcomes when they leave SickKids and start their health care as adults. The Good 2 Go Transition Program provides support and education to health care providers about preparing their patients for this transition. Over the year this team will be testing a newly developed toolkit designed to help nurses teach teens with chronic health conditions about transition when they provide care during their hospitalization. The toolkit has tools and resources to help nurses discuss transitions with the teens in an entertaining way, including talking about differences in the adult health care system and learning about their illness–all key learning objectives for youth in transition. The project will include a step-by-step approach to integrating the use of the toolkit and evaluating its effect on nurses’ confidence and knowledge in supporting teens in their transition.
2. Prevention and Management of Paediatric PIV-related Harm with team members Darlene Murray, Rita Damignani, Hana Saab, and Judy Hawes. Paediatric peripheral intravenous (PIV) catheters are the most commonly used IV device in hospital patients. While they are low-risk, they can be associated with complications and the impact of these catheter related injuries can range from skin irritation to serious and permanent limb injury. In recognition of these potential complications, the project team will set out to improve outcomes for patients….reduce the rate and severity of PIV related injuries. In an effort to accomplish this goal, a team of clinical, quality improvement and evaluation experts are developing a toolkit for staff, patients and caregivers regarding PIV care. The toolkit includes prevention strategies as well as clinical practice changes focused on the standardized assessment of PIV related injuries and an evidence-based algorithm to standardize the management of PIV extravasations.
THE ARCHIVES – 2015
Through the support of the Alumnae Endowment Fund, the Hospital Archives was able to further improve the display cases, which were purchased from the ROM with funds from the Endowment Fund in 2012. The Archives, working with the hospital’s Creative Services Department, designed, produced, and installed new wrapping around the bases of the three display cases. As well, interpretive panels for the cases were installed. These panels provide key information about nursing at SickKIds and the School of Nursing specifically, providing context for any staff or visitors viewing the displays. The Archives had several other key highlights during the year.

2014 – Endowment Fund Award – The Autism Toolkit Project

In 2014, the Autism Toolkit project team was the recipient of the award in recognition of the project’s innovation and focus on family-centred care. Team members included Michele Durant – RN, BSc, MSc Co-Lead, Helen Forrest – ANPE Co-Lead, Michelle Peralta, Barbara Muskat, Arlette Lefebvre, Andrea Greenblatt and Bonnie Fleming-Carroll.
Before the 1980’s one in every 2000 children was diagnosed with Autism. Today it is one in 68. As the number of children diagnosed has been on the rise world-wide, in turn more children with Autism require care at paediatric hospitals. While the hospital environment is unfamiliar, unpredictable, noisy, complex and frustrating for any child, it is particularly challenging for a child with Autism. Staff see a spectrum of traits associated with this diagnosis that presents uniquely in each child. However, the features of the condition that often impact hospital care relate to challenges in verbal communication, complex behavioural responses to sensory issues, difficulties coping with change, and fixated interests that are highly focused and intense.
A gap in the care of children with Autism was identified, leading to a drive to develop a comprehensive process that maximized both the assessment and care planning processes by an interprofessional task force within the perioperative program. In response to the need to help nurses conduct ‘just in time’ care planning, Ms Durant and Ms Forrest along with their team undertook the development of an Autism Toolkit – an electronic toolkit consisting of three phases to help meet the needs of children with Autism in this setting.
In summary the tookit’s phases are:
• Assessment – prehospital interview to determine child’s needs and strategies family uses
• Care Delivery – tailored care supported by online evidence-based resources for various clinicians and implementation of a clinical coaching process
• Impact – captures care outcomes when accomodations are made based on the child’s identified needs
The project was developed to improve the experience of the child, and to enable staff to enhance skill development in the understanding and managing behaviours associated with Autism. The project will be evaluated by examining clinicians’ experiences in implementing the strategies and their perceptions of the impact of the implementation on patient care.
Looking forward – The Autism Toolkit project continues to progress, launching the ‘just in time’ training for staff within perioperative services. The evaluation of the first week of training is anticipated to be completed in January 2016.
The project’s innovative curriculum and processes have been presented locally at SickKids at an education showcase and the Strengths-Based Care Symposium for Nursed and Interprofessional Clinicians. Next steps include coaching and the development of champions; embedding new practices into day to day routines; and scaling up to other high risk clinical sites.
ARCHIVES – 2014 – The Alumnae Association of the School of Nursing Endowment Fund continues to support the work of the hospital’s archives which collects, preserves, and celebrated the history of nursing at SickKids. David Wencer, Library Technician, is responsible for maintaining the records and shared highlights of the year:
• 10,362 accessions are currently held in the archives
• 88 unique reference requests were answered
• Displays for several events were created, including Nursing Week, the reunion for the class of 1964 and a co-exhibit with Ryerson University celebrating their nursing program
• Outreach increased, including an interview with the Toronto Star and presentation at Ryerson University
(Website Manager: Notes for this report were made from the 2014 Impact Report prepared for the Alumnae Association of the School of Nursing Endowment Fund by SickKids Foundation)

2013 Endowment Fund Award – The Child and Family Presence at Nursing Shift Handover Project

Krista Keilty and Karen Sappleton were the inaugural recipients of the Hospital for Sick Children Alumnae Association of the School of Nursing Endowment Fund Award in 2013. They received their award for their work on the Child and Family Presence at Nursing Shift Handover Project. Ms Keilty is a Nurse Practitioner with the Centre for Innovation and Excellence in Child and Famil- Centred Care and a Project Investigator through the Research Institute. Ms Sappleton is a Social Worker and Manager of the Centre for Innovation. Ms Keilty has led the research and evaluation of the project and co-chairs the Steering Committee with Dr Mary McAllister Associate Chief-Nursing Practice.
The project’s aim was to explore enabling child and family involvement in nursing shift handover. From initial findings they were able to secure additional funding through the Mary Jo Haddad Innovation Fund to build teams and engage staff across the hospital.
In 2011 and 2012 the hospital had carried out an organizational assessment about child and family-centred care that showed that family presence at handover was one of the most important priorities. The Shift Handover Project set out to study the effects of family involvement during the handover, and implement this novel practice change.
To support the implementation of the initiative on three diverse units, a toolkit was developed to promote the use of a standardized nursing shift handover. The tool kit provides direction for the process through the use of educational aids, a process map, handover template, FAQs and scripting, information pamphlets for families, and an audit tool.
Early Findings – The patients and families that participated in the study were asked to provide feedback before and after implementation, and the effectiveness of the new model was determined based on three areas:
• Did the families and patients feel at ease with the current process
• Did they feel important information was discussed during the handover
• Did they feel that they had input into what was discussed
All scores improved after implementation of the new system. Most notably was the improvement on feelings of partnership, as families felt like they could give more input in the care of their child. Research also indicated that families were not concerned with confidentiality as they felt that their involvement in the handover was more important.
The project is essential to ensuring that SickKids is providing optimal child and family-centred care, and address the concerns that families have expressed in regards to patient care. To ensure that the process is meeting expectations and that the family voice was being heard, the project met with two advisory committees. Implementation is being extended into additional units and adjustments are being made based on patient and family needs.
The Nurses’ Perspective – As expected there was some reservation on the part of the nurses. Challenges that were identified included confidentiality for patients, maintaining timeliness, ability to leave shifts on time and patient interruptions. Nurses were involved in brainstorming and educational sessions to help alleviate concerns and help make the changes more efficient. Feedback from nurses after implementation has been that, while some challenges remain, the practice has become more personal and engaging for both the families and the nurses. Overall, the changes have been beneficial and nurses appreciate the ensuing benefits.
Sharing Results – The findings of the project have been shared at more than 10 different meetings and conferences, internally at SickKids, provincially and internationally. It has won various awards including best child and family centred care poster at the 10th Annual SickKids Patients’ Safety symposium. Presenting at these meetings is beneficial, not only to disseminate the important findings, but it helps the presenter develop their skills and experience and gain recognition for the work being done. The team plans to publish this initiative to share the valuable information. (Website manager: Report here is based on a shortened version of the 2014 Impact Report prepared for the Alumnae Association of the School of Nursing)
The study’s authors:
KRISTA KEILTY – Krista is a Nurse Practitioner with the Centre for Innovation and Excellence in Child and Family-Centred Care and a Project Investigator through the Research Institute. She will complete her PhD Nursing Science at the Bloomberg Faculty of Nursing, University of Toronto in early 2015 and continue her nurse scientist training as the Rotman Post-Doctoral Fellow for Innovation in Paediatric Home Care. Ms Keilty’s clinical practice has informed her research interest in the experience of family caregivers of children with acute and chronic illness.
KAREN SAPPLETON – Karen is a Social Worker and transition healthcare professional in “Good 2 Go”, in the Division of Adolescent Medicine as well as an Interprofessional Education Specialist with the New Immigrant Support Network (NISN). She was a social worker at SickKids for approximately six years. At NISN Karen is an education specialist looking at the dissemination and sustainability of culturally competent healthcare in SickKids as well as in organizations throughout the province, with a focus on health equity and social justice.

2012 – Alumnae Endowment Fund Launched

Many Alumnae members, SickKids Foundation and hospital staff gathered to celebrate the launch of the Endowment Fund and to hear Judith Young, RN, MScN speak on innovations in care over the first 100 years (1886-1975), all introduced at the hospital by nurses or relied on nurses for their success.  While we know we need to hear another talk on nursing innovations in the years since 1975, we were very proud to hear again how HSC nurses throughout the decades changed the way we care for children in our community and in the world.  Many of us studied and worked at SickKids in those years and led the way to change.  Thanks to Judith for her presentation and for the walk down memory lane in pictures.

Now, through the Endowment Fund, the Alumnae will continue to support nursing excellence and innovation through grants for projects that will continue to improve care.

We look forward to meeting again next year, hearing about more about the priceless contributions nurses make to care, and hearing from the first recipients of our Endowment Fund.